Elemental analysis of vertebrae discerns diadromous movements of threatened non-marine elasmobranchs.

River sharks (Glyphis spp.) and some sawfishes (Pristidae) inhabit riverine environments, although their long-term habitat use patterns are poorly known. We investigated the diadromous movements of the northern river shark (Glyphis garricki), speartooth shark (Glyphis glyphis), narrow sawfish (Anoxypristis cuspidata), and largetooth sawfish (Pristis pristis) using in situ laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) on vertebrae to recover elemental ratios over each individual's lifetime. We also measured elemental ratios for the bull shark (Carcharhinus leucas) and a range of inshore and offshore stenohaline marine species to assist in interpretation of results. Barium (Ba) was found to be an effective indicator of freshwater use, whereas lithium (Li) and strontium (Sr) were effective indicators of marine water use. The relationships between Ba and Li and Ba and Sr were negatively correlated, whereas the relationship between Li and Sr was positively correlated. Both river shark species had elemental signatures indicative of prolonged use of upper-estuarine environments, whereas adults appear to mainly use lower-estuarine environments rather than marine environments. Decreases in Li:Ba and Sr:Ba at the end of the prenatal growth zone of P. pristis samples indicated that parturition likely occurs in fresh water. There was limited evidence of prolonged riverine habitat use for A. cuspidata. The results of this study support elemental-environment relationships observed in teleost otoliths and indicate that in situ LA-ICP-MS elemental characterization is applicable to a wide range of elasmobranch species as a discriminator for use and movement across salinity gradients. A greater understanding of processes that lead to element incorporation in vertebrae, and relative concentrations in vertebrae with respect to the ambient environment, will improve the applicability of elemental analysis to understand movements across the life history of elasmobranchs into the future.

Randomised controlled trial of a transprofessional healthcare role intervention in an acute medical setting.

As demand for health services increases, attention has turned to the development of alternate models of service delivery that maximise efficiency. These include skill sharing models, in which cross-professional skills are delivered by appropriately trained professionals. The usage of skill sharing models is increasing in some professions, but little evidence on efficacy currently exists. This article reports on an intervention of the use of a transprofessional role, which involved delivery of services from a range of health providers, including physiotherapy, occupational therapy, dietetics, speech pathology, podiatry, social work, and psychology, by a trained professional, developed and trialled in the acute medical setting in Toowoomba Hospital, Queensland, Australia. A single-blind randomised controlled trial examined the clinical efficacy of this skill shared service. Participants were allocated at random to either standard care (n = 29) or the new model of care (n = 29) groups and compared on a range of patient and service provision outcome measures. Descriptive outcomes indicated that patients receiving the new model of care underwent more comprehensive and prompt assessments in the health domains included than those in standard care, and demonstrated more positive health and functional outcomes at 1-, 3-, and 6-month follow-up. Given the paucity of research on skill sharing, this study provides preliminary evidence of the effectiveness of skill shared roles in acute settings.

Systematic Review of Burnout in US Nurses.

Nurses experience high levels of burnout, and this has become a major factor in recruitment and retention of nurses. Several factors have been associated with burnout, but it is not clear which factors are the most significant predictors. Understanding the most prevalent factors that are associated with burnout will allow for the development and implementation of interventions to ameliorate and/or reduce burnout in the nursing workforce.

The New SNOMED CT International Medicinal Product Model.

Objectives: To present the new SNOMED CT international medicinal product model. Methods: We present the main elements of the model, with focus on types of entities and their interrelations, definitional attributes for clinical drugs, and categories of groupers. Results: We present the status of implementation as of July 2018 and illustrate differences between the original and new models through an example. Conclusions: Benefits of the new medicinal product model include comprehensive representation of clinical drugs, logical definitions with necessary and sufficient conditions for all medicinal product entities, better high-level organization through distinct categories of groupers, and compliance with international standards.

The prevention of depressive symptoms in low-income, minority children: two-year follow-up.

We present 2-year follow-up data on the efficacy of the Penn Resiliency Program (PRP), a school-based depression prevention program, with low-income, racial/ethnic minority children. This program taught cognitive and social problem-solving skills to 168 Latino and African American middle school children who were at-risk for developing depressive symptoms by virtue of their low-income status. We had previously reported beneficial effects of the PRP up to 6 months after the conclusion of the program for the Latino children, but no clear effect for the African American children. In this paper, we extend the analyses to 24 months after the conclusion of the PRP. We continue to find some beneficial effects for the Latino children and no differentially beneficial effect for the African American children. Implications of findings and future research directions are discussed.

Fat oxidation and its relation to serum parathyroid hormone in young women enrolled in a 1-y dairy calcium intervention.

BACKGROUND: Increased dietary calcium is associated with changes in body composition. One proposed mechanism is that dietary calcium increases fat oxidation, potentially via regulation of serum parathyroid hormone (PTH) concentrations. OBJECTIVES: The objectives of the study were to determine whether acute or chronic increased dairy calcium intakes alter postprandial whole-body fat oxidation and whether the increased intake is related to changes in PTH concentrations. DESIGN: Normal-weight women aged 18-30 y were randomly assigned to a low (<800 mg/d, control; n = 10) or high (1000-1400 mg/d; n = 9) dietary calcium intake group for 1 y. Whole-body fat oxidation was assessed by measuring respiratory gas exchange after each subject consumed 2 isocaloric liquid meals containing 100 or 500 mg Ca at baseline and 1 y. Fasting serum PTH was measured at baseline and 1 y. RESULTS: The mean 1-y change in fat oxidation was higher in the high-calcium group than in the low-calcium control group after a low-calcium meal (0.10 +/- 0.05 compared with 0.005 +/- 0.04 g/min; P < 0.001) and a high-calcium meal (0.06 +/- 0.05 compared with 0.03 +/- 0.04 g/min; P < 0.05). The 1-y change in serum log PTH was negatively associated with the 1-y change in postprandial fat oxidation after a high-calcium meal (partial r = -0.46, P < 0.04) when controlled for the1-y change in total body fat mass. CONCLUSIONS: The results suggest that a chronic diet high in dairy calcium increases whole-body fat oxidation from a meal, and increases in fasting serum PTH relate to decreases in postprandial whole-body fat oxidation.

Analysis of Requirements for the Medication Profile to Be Used in Clinical Research: Protocol Feasibility Studies and Patient Recruitment.

A "Medication Profile," the information about the medicines a person is using and has used, is a core part of many electronic health record systems and summaries. However, there is little objective research into the data elements that the profile should contain to support the uses it must serve. With the increasing emphasis on secondary uses of electronic health information, as well as supporting the requirements to support direct to patient care, the Medication Profile should also support the requirements from clinical research. However, there is little, if any, description of these available. This paper describes an analysis of a set of study eligibility criteria that was undertaken to investigate which medication-related data elements would be required to support two clinical research use cases: the parameters to query a patient's Medication Profile to assess their suitability for entry into a trial (patient recruitment) and the parameters to query a set of Medication Profiles in a data warehouse to assess whether the eligibility criteria as described would yield a reasonable cohort of patients as potential subjects (protocol feasibility). These medication-related data elements then become information requirements that a Medication Profile should ideally meet, in order to be able to support these two uses in the clinical research domain.

An approach for utilizing clinical statements in HL7 RIM to evaluate eligibility criteria.

The HL7 RIM (Reference Information Model) is a commonly used standard for the exchange of clinical data and can be employed for integrating the patient care and clinical research domains. Yet it is not sufficiently well specified to ensure a canonical representation of structured clinical data when used for the automated evaluation of eligibility criteria from a clinical trial protocol. We present an approach to further constrain the RIM to create a common information model to hold clinical data. In order to demonstrate our approach, we identified 132 distinct data elements from 10 rich clinical trails. We then defined a taxonomy to (i) identify the types of data elements that would need to be stored and (ii) define the types of predicate that would be used to evaluate them. This informed the definition of a pattern used to represent the data, which was shown to be sufficient for storing and evaluating the clinical statements required by the trials.