Financial Resource Management Knowledge, Skills, and Attitudes for Entry-level Physical Therapist Practice: A Survey of Physical Therapists in Ohio.

INTRODUCTION: The purpose of this study was to explore the perceptions of physical therapists (PTs) regarding the importance of financial resource management (FRM) knowledge, skills, and attitudes (KSAs) for entry-level practice and investigate the roles of PT education programs (PTEPs), clinical education experiences (CEEs), and employers in addressing these KSAs. REVIEW OF LITERATURE: FRM KSAs have been identified as components of professionalism and leadership and, as such, are a required element in student PTs (SPTs) educational preparation. SUBJECTS: A purposive sampling of convenience strategy was employed by requesting a free mailing list for Ohio-licensed PTs. METHODS: An online survey was developed based on PT Clinical Performance Instrument Criterion #17, "Patient Management: Financial Resources," as this tool is frequently used to endorse entry-level status of SPTs. Potential participants were solicited through email. Mixed methodology was used to analyze survey results. RESULTS: The survey was completed by 266 PTs. FRM KSAs in legal and regulatory compliance were perceived as most important, followed by coding and billing. Forty-eight percent of participants indicated that FRM KSAs were "less important" (n = 111) or "considerably less important" (n = 17) than clinical care skills, whereas 39.8% (n = 106) believed that these skills are of the same level of importance. Ten themes were derived from qualitative responses regarding the FRM content that should be provided by PTEPs. Participants indicated that the role of PTEPs was to provide an introduction and foundation to FRM, whereas CEEs should facilitate intentional exposure and opportunities to apply FRM KSAs with supervision. Employers were expected to provide education regarding clinic-specific operations and reimbursement considerations, as well as mentorship that included reviewing complex billing for accuracy, offering guidance for improving time management skills, and discussing fiscal responsibilities to both the employer and patient. DISCUSSION AND CONCLUSION: This information may guide PTEPs and clinical personnel in providing focused meaningful instruction regarding FRM aspects of PT practice to SPTs and entry-level clinicians.

Impact of Task-Fit Misalignment and the Director of Clinical Education: A Grounded Theory Study.

INTRODUCTION: The roles and responsibilities of the director of clinical education (DCE) are of interest in the academic physical therapist (PT) community. This study explored the impact of professional and positional task characteristics of the DCE position on task-fit misalignment within PT education programs. Task-fit explores how the tasks of a particular job align with the appropriately trained person who holds the position. REVIEW OF THE LITERATURE: A recently published DCE Matrix highlights 2 extremes of misalignment and nonoptimal task-fit between the position and the person. Misalignment was investigated rather than alignment because negative connotations often have greater impact on behavior, decision making, and relationships. The impact of misalignment is unknown. SUBJECTS: Program directors and DCEs among ACAPT member PT programs were surveyed. METHODS: A qualitative grounded theory design was used. Two rounds of surveys with focused questions about the impact of task-fit misalignment. Qualitative content data analysis through a constant comparative process was followed. Respondent descriptive statistics were collected. RESULTS: Three realms of impact were identified when misalignment of positional and professional characteristics exists. The realms include the 1) individual person holding the position; 2) academic program; or 3) physical therapy profession. There is a high level of agreement that task-fit misalignment affects each realm; variability exists about its prevalence. DISCUSSION: There seems to be an interconnectedness of impact among the person, the program, and the profession when misalignment exists between the fit of the DCE to the job or the work environment to the DCE. Findings indicate job crafting may be necessary to evolve the nature of the DCE work toward higher director-level tasks. This is the first study of its kind to explore the impact intersection of person-job fit and task-fit and the impact on a DCE's responsibilities. Nonrespondent or attrition bias may have limited sample size.

An Anterior Cruciate Ligament (ACL) Injury Risk Screening and Reduction Program for High School Female Athletes: A Pilot Study.

Background: Anterior cruciate ligament (ACL) injury causes physical, mental, and financial burdens. Therefore, it is imperative to screen, identify, and educate athletes who are at high-risk. The combination of screening and education could identify those at risk and potentially reduce future injuries. Purpose: The purpose was to conduct a feasible community pre-season screening program for high school female athletes for the presence of known modifiable risk factors that predispose them to sustaining a non-contact ACL injury. Study Design: Non-experimental prospective study. Methods: A convenience sample of 15 healthy female athletes were recruited from local high schools, consisting of 11 soccer players and four basketball players.  A pre-season screening program was designed encompassing four stations that addressed modifiable neuromuscular and biomechanical risk factors including range of motion (ROM), jump-landing technique, strength, and balance. Athletes were categorized into high-risk versus low-risk groups based on cutoff scores previously established in the literature. Results: Every athlete met the high-risk cutoff score for at least one extremity during the ROM screening, and some met high-risk cutoff scores for more than one ROM. Out of all four categories tested, lower extremity ROM demonstrated the greatest deficits. Conclusion: This study identified athletes as having multiple modifiable risk factors that can be addressed with training and exercises. This supports implementing a pre-season program aimed at screening for injury risk factors. Level of Evidence: Level 3.

The VetEd Conference: Evolution of an Educational Community of Practice.

The VetEd conference was developed with the aim of growing an educational community by providing an opportunity to share ideas, innovations, research, and best practices in veterinary education in a friendly, affordable, and inclusive environment. The annual conference has been hosted by the veterinary schools in the UK, Ireland, and the Netherlands, becoming the official conference of the Veterinary Schools Council in 2017. The current study investigates the extent to which the development of the conference has contributed to the evolution of a community of practice. The conference proceedings' abstracts were analyzed to identify trends in number, type, and author information. This was complemented by oral histories exploring the impact of VetEd on developing the veterinary education community. The number of abstracts has increased from 40 (2010) to 137 (2018), and these are predominantly posters, with the major themes being technology-enhanced learning, clinical skills, and assessment. The authors have been increasingly international, representing 8 countries in 2010 and 22 in 2018. Nine interviews were undertaken with those involved in organizing VetEd. The inclusivity of the conference and the engagement of a wide variety of delegate groups are key themes that emerged. Concerns emerged around the organizational challenges and the potential for the conference to outgrow the founding principles in the future. VetEd has become a key event in the annual calendar and represents an initiative that has contributed to the ongoing development of the veterinary education community.

The Use of Lecture Recordings as Study Aids in a Professional Degree Program.

Lecture recording is now common in many educational institutions, leading to discussion about how best to support student learning. In this mixed methods study, we used a survey (n = 46 participants), think-aloud methodologies in observed study sessions (n = 8 participants) and recording analytics (n = 637 recordings) to characterize how veterinary students utilize recordings during their studies. Only 48% of survey respondents considered they were more likely to use recordings as exams approached, but 78% considered they used recordings more when the topic was difficult. In the observed study sessions, students characterized their use of recordings as helping them to control their learning environment, allowing them to pause and rewind challenging topics, and as a jumping off point for future study, allowing them to structure the seeking out of additional information. In a linear model describing the recording analytics, students who had entered higher education directly from high school were more likely to watch more of a lecture than graduate entry students. In addition, the most visited lectures were also the ones with more view time (F(5, 631) = 129.5, R2 = 0.50, p < .001). Overall, this study suggests that veterinary students were selective about their use of recordings in their study strategies, often using them to make up for deficits in their knowledge and understanding, or to supplement their experience at veterinary school. We discuss the consequences and implications for student study skills support.

The development of the AWIN welfare assessment protocol for donkeys / O desenvolvimento do protocolo de avaliação de bem-estar AWIN (Animal Welfare Indicators) para jumentos

The donkey population has increased in the last 10 years, with an estimated 50 million donkeys currently worldwide. Donkey welfare, meanwhile, is an increasing global concern that receives close public scrutiny. However, multiple challenges are surrounding how donkey welfare is assessed and recorded. The Animal Welfare Indicators (AWIN) project is the first project, funded by the European Commission, intended to improve donkey welfare by developing a scientifically sound and practical on-farm welfare assessment protocol. The present study describes the procedure for the development of the AWIN welfare assessment protocol for donkeys: 1) selection of promising welfare indicators; 2) research to cover gaps in knowledge; 3) stakeholder consultation; 4) testing the prototype protocol on-farm. The proposed two-level strategy improved on-farm feasibility, while the AWIN donkey app enables the standardized collection of data with prompt results. Although limitations are linked with a relatively small reference population, the AWIN welfare assessment protocol represents the first scientific and standardized approach to evaluate donkey welfare on-farm.(AU)

Na última década, a população de jumentos vem aumentando; estima-se que existam aproximadamente 50 milhões de em todo o mundo. O bem-estar dos jumentos é uma preocupação global crescente, que recebe um escrutínio público próximo. No entanto, existem vários desafios em torno de como o bem-estar do jumento é avaliado e registrado. O projeto Indicadores de Bem-Estar Animal (AWIN) foi o primeiro projeto, financiado pela Comissão Europeia, destinado a melhorar o bem-estar dos jumentos, desenvolvendo um protocolo de avaliação do bem-estar cientificamente válido e prático na fazenda. O presente estudo descreve o procedimento para o desenvolvimento do protocolo de avaliação de bem-estar AWIN para jumentos: 1) seleção de indicadores promissores de bem-estar; 2) pesquisa para cobrir lacunas no conhecimento; 3) consulta às partes interessadas; 4) testando o protocolo do protótipo em fazendas. A estratégia proposta em dois níveis de avaliação melhorou a viabilidade na fazenda, além disso, o aplicativo AWIN donkey permite coletar dados de maneira padronizada e mostrar resultados rapidamente. Embora a limitação esteja ligada a uma população de referência relativamente pequena, o protocolo de avaliação de bem-estar do AWIN representa a primeira abordagem científica e padronizada para avaliar o bem-estar de jumentos em fazendas.(AU)

Effect of Temperature on Plant Resistance to Arthropod Pests.

Temperature has a strong influence on the development, survival, and fecundity of herbivorous arthropods, and it plays a key role in regulating the growth and development of their host plants. In addition, temperature affects the production of plant secondary chemicals as well as structural characteristics used for defense against herbivores. Thus, temperature has potentially important implications for host plant resistance. Because temperature directly impacts arthropod pests, both positively and negatively, distinguishing direct effects from indirect effects mediated through host plants poses a challenge for researchers and practitioners. A more comprehensive understanding of how temperature affects plant resistance specifically, and arthropod pests in general, would lead to better predictions of pest populations, and more effective use of plant resistance as a management tactic. Therefore, the goals of this paper are to 1) review and update knowledge about temperature effects on plant resistance, 2) evaluate alternative experimental approaches for separating direct from plant-mediated indirect effects of temperature on pests, including benefits and limitations of each approach, and 3) offer recommendations for future research.

SHORT-TERM OUTCOMES OF CONSERVATIVE TREATMENT FOR FEMOROACETABULAR IMPINGEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS.

BACKGROUND: Femoroacetabular Impingement (FAI) is becoming increasingly more common with noted impairments in physical function, increased pain, and decreased quality of life. Typically, a conservative approach is used through physical therapy or intra-articular injections before an invasive surgical approach is utilized. Identifying the proper course of conservative care by the clinician will aid in improving outcomes. PURPOSE: The purpose of this systematic review and meta-analysis was to investigate short-term effects of conservative physical therapy and intra-articular injections on pain and physical function measures in patients with FAI. STUDY DESIGN: Systematic Review & Meta-Analysis. METHODS: A systematic review and meta-analysis were completed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with the International Prospective Registry of Systematic Reviews. A literature review was performed in May 2018 using Pubmed, CINAHL, Proquest, and Scopus. Inclusion criteria included humans classified as having femoroacetabular impingement, conservative rehabilitation, and utilization of outcome measures in the domains of pain or function. Exclusion criteria included absence of skilled interaction and study protocols that were not completed. RESULTS: Seven studies were included that summarized physical therapy or intra-articular injection outcomes for femoroacetabular impingement management. Results showed that conservative interventions for short-term periods are effective in reducing pain and improving function for femoroacetabular impingement. Overall, physical therapy revealed moderate to large effect sizes and statistically significant differences in both pain (SMD, 0.91, CI: 0.07, 1.76, p=0.030) and function (SMD, 0.80, CI: 0.34, 1.28, p=0.001) for femoroacetabular impingement. Intra-articular injection demonstrated small effect sizes for pain outcomes (SMD, 0.29, CI: -1.25, 1.83, p = 0.710) and small to moderate effect size for improvement in function (SMD, 0.49, CI: 0.03, 0.96, p = 0.040). CONCLUSIONS: Physical therapy demonstrated positive results to self-reported pain and function and may hold more promise than intra-articular injection alone. Common treatments that were associated with improved outcomes were patient education, activity modification, manual therapy, and strengthening. There are a limited number of high-quality articles on this topic, which should be addressed in future research. LEVEL OF EVIDENCE: 1a.

Physical Therapist Student Readiness for Entrance Into the First Full-Time Clinical Experience: A Delphi Study.

Background: To consistently prepare physical therapist students for their first full-time clinical experience, the entry-level curriculum must provide and assess competency in the essential knowledge, skills, attitudes, and professional behaviors. Objective: The purpose of this Delphi study was to develop consensus on a core set of elements that should be demonstrated by physical therapist students prior to entry into their first full-time clinical experience. A second aim was to obtain the recommended competency levels and assessment methods. Design: The study was conducted using the Delphi method. Methods: Purposive selection and snowball sampling techniques were used to recruit clinical instructors, recent graduates, directors or academic coordinators of clinical education, and academic faculty. Four web-based survey rounds were used to achieve consensus, defined as agreement among ≥80% of respondents. The first round gathered demographic information on respondents and identified elements that were deemed essential; the second collected information about clarity and redundancy in the elements provided; the third asked participants to rank their agreement with elements and themes; and the fourth gathered the level of competency that physical therapist students should demonstrate prior to beginning a first full-time clinical experience. Results: Consensus revealed 95 elements, categorized under 14 themes, which were deemed essential for readiness for the first clinical experience. Levels of competency for each element were identified. Limitations: Participants might not have represented all academic programs, practice settings, and geographic locations. Conclusion: This study identified the specific knowledge, skills, attitudes, and professional behaviors in which all physical therapist students in the United States need to demonstrate competency before their first clinical experience, regardless of school or setting, which would allow learning experiences to be tailored appropriately.

IS MULTI-JOINT OR SINGLE JOINT STRENGTHENING MORE EFFECTIVE IN REDUCING PAIN AND IMPROVING FUNCTION IN WOMEN WITH PATELLOFEMORAL PAIN SYNDROME? A SYSTEMATIC REVIEW AND META-ANALYSIS.

BACKGROUND: Patellofemoral pain syndrome is one of the most common causes of knee pain, especially in the female population. Conflicting evidence exists on whether a multi-joint strengthening program produces a greater outcome when compared to a single joint approach. PURPOSE: The aim of this systematic review and meta-analysis was to investigate the effectiveness of a multi-joint strengthening program compared to a traditional single joint strengthening program in reducing pain and improving function in females diagnosed with patellofemoral pain syndrome. STUDY DESIGN: Systematic Review and Meta-Analysis. METHODS: A computer-based search (population: women with patellofemoral pain syndrome, intervention: multi-joint strengthening exercises, comparator: single joint strengthening exercises, outcome: pain and function) was performed. Databases including PubMed, CINAHL, SPORTDiscus, Cochrane, PEDro, and Scopus were searched up to May 23, 2017 for randomized clinical trials published since 2004. A hand search of relevant articles and exploration of Grey Literature (including clinical trials.gov, Grey Literature Report, and Open Grey) was also completed. Data was extracted for the following information: exercises prescribed, outcome measures, and overall results from the study. RESULTS: Five studies, each of high quality based on the PEDro scale, met the inclusion criteria for this systematic review and meta-analysis. Statistically different outcomes were found that favored the multi-joint intervention group for short-term and long-term self-reported pain and functional pain, short-term functional performance, and long-term self-reported function. CONCLUSION: The results of this review show that statistically significant data are available that favor implementing a multi-joint exercise program in comparison to a single joint program for the reduction of pain in females with patellofemoral pain syndrome. Limited statistical evidence, however, is available to support a multi-joint program over a single joint program in the improvement of short-term functional performance and long-term self-reported function in females with patellofemoral pain syndrome. LEVEL OF EVIDENCE: 1a.

EXERCISES THAT FACILITATE OPTIMAL HAMSTRING AND QUADRICEPS CO-ACTIVATION TO HELP DECREASE ACL INJURY RISK IN HEALTHY FEMALES: A SYSTEMATIC REVIEW OF THE LITERATURE.

BACKGROUND: Anterior cruciate ligament (ACL) injury is common among females due to many anatomic, hormonal, and neuromuscular risk factors. One modifiable risk factor that places females at increased risk of ACL injury is a poor hamstrings: quadriceps (H:Q) co-activation ratio, which should be 0.6 or greater in order to decrease the stress placed on the ACL. Exercises that produce more quadriceps dominant muscle activation can add to the tension placed upon the ACL, potentially increasing the risk of ACL injury. HYPOTHESIS/PURPOSE: The purpose of this systematic review was to compare quadriceps and hamstring muscle activation during common closed kinetic chain therapeutic exercises in healthy female knees to determine what exercises are able to produce adequate H:Q co-activation ratios. STUDY DESIGN: Systematic Review. METHODS: Multiple online databases were systematically searched and screened for inclusion. Eight articles were identified for inclusion. Data on mean electromyography (EMG) activation of both quadriceps and hamstring muscles, % maximal voluntary isometric contraction (MVIC), and H:Q co-activation ratios were extracted from the studies. Quality assessment was performed on all included studies. RESULTS: Exercises analyzed in the studies included variations of the double leg squat, variations of the single leg squat, lateral step-up, Fitter, Stairmaster® (Core Health and Fitness, Vancouver, WA), and slide board. All exercises, except the squat machine with posterior support at the level of the scapula and feet placed 50 cm in front of the hips, produced higher quadriceps muscle activation compared to hamstring muscle activation. CONCLUSION: Overall, two leg squats demonstrate poor H:Q co-activation ratios. Single leg exercises, when performed between 30 and 90 degrees of knee flexion, produce adequate H:Q ratios, thereby potentially reducing the risk of tensile stress on the ACL and ACL injury. LEVEL OF EVIDENCE: 2a- Systematic Review of Cohort Studies.

The Effect of Temperature and Host Plant Resistance on Population Growth of the Soybean Aphid Biotype 1 (Hemiptera: Aphididae).

A laboratory experiment was conducted to evaluate direct and indirect effects of temperature on demographic traits and population growth of biotype 1 of the soybean aphid, Aphis glycines Matsumura. Our objectives were to better understand how temperature influences the expression of host plant resistance, quantify the individual and interactive effects of plant resistance and temperature on soybean aphid population growth, and generate thermal constants for predicting temperature-dependent development on both susceptible and resistant soybeans. To assess indirect (plant-mediated) effects, soybean aphids were reared under a range of temperatures (15-30 °C) on soybean seedlings from a line expressing a Rag1 gene for resistance, and life history traits were quantified and compared to those obtained for soybean aphids on a susceptible soybean line. Direct effects of temperature were obtained by comparing relative differences in the magnitude of life-history traits among temperatures on susceptible soybeans. We predicted that temperature and host plant resistance would have a combined, but asymmetrical, effect on soybean aphid fitness and population growth. Results showed that temperature and plant resistance influenced preimaginal development and survival, progeny produced, and adult longevity. There also appeared to be a complex interaction between temperature and plant resistance for survival and developmental rate. Evidence suggested that the level of plant resistance increased at higher, but not lower, temperature. Soybean aphids required about the same number of degree-days to develop on resistant and susceptible plants. Our results will be useful for making predictions of soybean aphid population growth on resistant plants under different seasonal temperatures.

A SYSTEMATIC REVIEW OF THE EXERCISES THAT PRODUCE OPTIMAL MUSCLE RATIOS OF THE SCAPULAR STABILIZERS IN NORMAL SHOULDERS.

PURPOSE: The purpose of this systematic review was to determine the exercises that optimize muscle ratios of the periscapular musculature for scapular stability and isolated strengthening. METHODS: A systematic search was performed in PubMed, CINAHL, SPORTDiscus, Scopus, and Discovery Layer. Studies were included if they examined the muscle activation of the upper trapezius compared to the middle trapezius, lower trapezius, or serratus anterior using EMG during open chain exercises. The participants were required to have healthy, nonpathological shoulders. Information obtained included maximal voluntary isometric contraction (MVIC) values, ratios, standard deviations, exercises, and exercise descriptions. The outcome of interest was determining exercises that create optimal muscle activation ratios between the scapular stabilizers. RESULTS: Fifteen observational studies met the inclusion criteria for the systematic review. Exercises with optimal ratios were eccentric exercises in the frontal and sagittal planes, especially flexion between 180 ° and 60 °. External rotation exercises with the elbow flexed to 90 ° also had optimal ratios for activating the middle trapezius in prone and side-lying positions. Exercises with optimal ratios for the lower trapezius were prone flexion, high scapular retraction, and prone external rotation with the shoulder abducted to 90 ° and elbow flexed. Exercises with optimal ratios for the serratus anterior were the diagonal exercises and scapular protraction. CONCLUSION: This review has identified optimal positions and exercises for periscapular stability exercises. Standing exercises tend to activate the upper trapezius at a higher ratio, especially during the 60-120 ° range. The upper trapezius was the least active, while performing exercises in prone, side-lying, and supine positions. More studies need to be conducted to examine these exercises in greater detail and confirm their consistency in producing the optimal ratios determined in this review. LEVEL OF EVIDENCE: 1a.

Advance care planning in motor neuron disease: A qualitative study of caregiver perspectives.

BACKGROUND: Motor neuron disease is a fatal disease, characterised by progressive loss of motor function, often associated with cognitive deterioration and, in some, the development of frontotemporal dementia. Life-sustaining technologies are available (e.g. non-invasive ventilation and enteral nutrition) but may compromise quality of life for some patients. Timely commencement of 'Advance Care Planning' enables patients to participate in future care choices; however, this approach has rarely been explored in motor neuron disease. AIM: We aimed to investigate caregiver perspectives on the acceptability and impact of advance care planning, documented in a letter format, for patients with motor neuron disease and caregivers. DESIGN: This is a qualitative cross-sectional study. Data were analysed by a narrative synthesis approach. PARTICIPANTS AND SETTING: Structured interviews were held with 18 former caregivers of deceased patients with motor neuron disease. A total of 10 patients had created a disease-specific advanced directive, 'Letter of Future Care', and 8 had not. RESULTS: A total of four global themes emerged: Readiness for death, Empowerment, Connections and Clarifying decisions and choices. Many felt the letter of future care was or would be beneficial, engendering autonomy and respect for patients, easing difficult decision-making and enhancing communication within families. However, individuals' 'readiness' to accept encroaching death would influence uptake. Appropriate timing to commence advance care planning may depend on case-based clinical and personal characteristics. CONCLUSION: Advance care planning can assist patients to achieve a sense of control and 'peace of mind' and facilitates important family discussion. However, the timing and style of its introduction needs to be approached sensitively. Tools and strategies for increasing the efficacy of advance care planning for motor neuron disease should be evaluated and implemented.

Welfare Conditions of Donkeys in Europe: Initial Outcomes from On-Farm Assessment.

This paper is a baseline study to present the initial outcomes of data collected in a sample of EU donkey farms using the AWIN welfare assessment protocol for donkeys, comprehensive of 22 valid, reliable and feasible animal-based indicators. A total of 20 donkey facilities (N = 12 in Italy and N = 8 in United Kingdom) were visited and 278 donkeys of different breed, aged 2-45 years, were assessed. Three assessors underwent a common training period to learn how to perform and score all the indicators included in the protocol. Data was collected using digitalized systems and downloaded to a database. A descriptive statistic for each welfare indicator was calculated. The authors found recurrent issues: 25% of donkeys were moderately over weight; although most of the assessed animals had good quality hoof care, 15.16% of them presented some signs of neglect, such as overgrowth and/or incorrect trimming; 18.05% of donkeys showed an avoidance reaction to an approaching human in the avoidance distance test. The protocol has proven to be applicable in different management conditions and for donkeys of different attitude.

Advance care planning in motor neuron disease: A systematic review.

OBJECTIVE: Motor neuron disease (MND) is an incurable progressive illness, characterized by incessant deterioration of neuromuscular function. Timely commencement of advance care planning (ACP) may enable patients to participate in future care choices. The present systematic review aimed to summarize what is known about the prevalence, content, patient/caregiver benefits, healthcare professional (HCP) awareness/support, and healthcare outcomes associated with ACP in the MND setting. METHOD: Quantitative and qualitative studies were identified through database searches and eligibility assessed by one author and verified by her coauthor. Data extraction and quality assessments against standardized criteria were completed by the two authors. RESULTS: Of the 422 studies identified, 16 were included. The research methods generally lacked rigor. Advance directive (AD) prevalence varied considerably across studies. Disease progression was the strongest predictor of AD completion. ACP processes may clarify patients' wishes and promote communication. HCP attitudes or lack of awareness may limit ACP processes. Varying patient preferences may make flexible approaches and timing necessary. SIGNIFICANCE OF RESULTS: Important benefits may be associated with ACP in the context of a motor neuron disease (e.g., feelings of control/relief and refusal of unwanted treatments). However, further evidence is required to verify findings and identify optimal streamlined approaches (e.g., use of decision aids) consistent with patients' (and caregivers') needs over time.

Effect of mouse antisera targeting the Phlebotomus papatasi midgut chitinase PpChit1 on sandfly physiology and fitness

In sandflies, the absence of the peritrophic matrix (PM) affects the rate of blood digestion. Also, the kinetics of PM secretion varies according to species. We previously characterised PpChit1, a midgut-specific chitinase secreted in Phlebotomus papatasi (PPIS) that is involved in the maturation of the PM and showed that antibodies against PpChit1 reduce the chitinolytic activity in the midgut of several sandfly species. Here, sandflies were fed on red blood cells reconstituted with naïve or anti-PpChit1 sera and assessed for fitness parameters that included blood digestion, oviposition onset, number of eggs laid, egg bouts, average number of eggs per bout and survival. In PPIS, anti-PpChit1 led to a one-day delay in the onset of egg laying, with flies surviving three days longer compared to the control group. Anti-PpChit1 also had a negative effect on overall ability of flies to lay eggs, as several gravid females from all three species were unable to lay any eggs despite having lived longer than control flies. Whereas the longer survival might be associated with improved haeme scavenging ability by the PM, the inability of females to lay eggs is possibly linked to changes in PM permeability affecting nutrient absorption.

Effect of mouse antisera targeting the Phlebotomus papatasi midgut chitinase PpChit1 on sandfly physiology and fitness.

In sandflies, the absence of the peritrophic matrix (PM) affects the rate of blood digestion. Also, the kinetics of PM secretion varies according to species. We previously characterised PpChit1, a midgut-specific chitinase secreted in Phlebotomus papatasi (PPIS) that is involved in the maturation of the PM and showed that antibodies against PpChit1 reduce the chitinolytic activity in the midgut of several sandfly species. Here, sandflies were fed on red blood cells reconstituted with naïve or anti-PpChit1 sera and assessed for fitness parameters that included blood digestion, oviposition onset, number of eggs laid, egg bouts, average number of eggs per bout and survival. In PPIS, anti-PpChit1 led to a one-day delay in the onset of egg laying, with flies surviving three days longer compared to the control group. Anti-PpChit1 also had a negative effect on overall ability of flies to lay eggs, as several gravid females from all three species were unable to lay any eggs despite having lived longer than control flies. Whereas the longer survival might be associated with improved haeme scavenging ability by the PM, the inability of females to lay eggs is possibly linked to changes in PM permeability affecting nutrient absorption.

Sheep laterality.

Turning preferences among 309 white-faced ewes were individually evaluated in an enclosed, artificially lit T-maze, followed by each ewe choosing either a right or left return alley to return to peers. Data recorded included time in the start box, time in the T-maze, exit arm chosen to leave the T-maze, and return alley. Right and left arms of the T-maze were chosen 65.7% and 34.3% of the time, respectively, while right and left return alleys were chosen 32.4% and 67.6%, respectively. Exit arm and return alley were not independently chosen (p <.0001), with observed counts being higher than expected under independence when ewes made the same choice for exit and alley (RR or LL turn patterns) and being lower than expected for alternating choices (RL or LR). Out of the 309 ewes, 28.2% and 30.1% chose RR and LL turn patterns, respectively, while 37.5% chose the RL turn pattern, but only 13 (4.2%) chose the LR turning pattern. Overall, ewes that initially turned right when presented a second turning opportunity had a slight preference to alternate their turning direction, while ewes that initially turned left tended to continue turning left when given another chance to turn. Exit arm and return alley laterality was not related (α =.05) to time of day the test was administered, ewe's age or genetics, most recent liveweight, or most recent shorn fleece weight. The mean time spent in the start box (21 s) was not related to exit arm (p =.947) or return alley (p =.779). Mean time (15 s) spent in the T-maze was not related to exit arm (p =.086) or return alley (p =.952). More research will be required to understand sheep turning laterality and how it can impact working facilities and research equipment.

Investigating the potential benefits of on-site food safety training for Folklorama, a temporary food service event.

Folklorama in Winnipeg, Manitoba, Canada, is a 14-day temporary food service event that explores the many different cultural realms of food, food preparation, and entertainment. In 2010, the Russian pavilion at Folklorama was implicated in a foodborne outbreak of Escherichia coli O157 that caused 37 illnesses and 18 hospitalizations. The ethnic nature and diversity of foods prepared within each pavilion presents a unique problem for food inspectors, as each culture prepares food in their own very unique way. The Manitoba Department of Health and Folklorama Board of Directors realized a need to implement a food safety information delivery program that would be more effective than a 2-h food safety course delivered via PowerPoint slides. The food operators and event coordinators of five randomly chosen pavilions selling potentially hazardous food were trained on-site, in their work environment, focusing on critical control points specific to their menu. A control group (five pavilions) did not receive on-site food safety training and were assessed concurrently. Public health inspections for all 10 pavilions were performed by Certified Public Health Inspectors employed with Manitoba Health. Critical infractions were assessed by means of standardized food protection inspection reports. The results suggest no statistically significant difference in food inspection scores between the trained and control groups. However, it was found that inspection report results increased for both the control and trained groups from the first inspection to the second, implying that public health inspections are necessary in correcting unsafe food safety practices. The results further show that in this case, the 2-h food safety course delivered via slides was sufficient to pass public health inspections. Further evaluations of alternative food safety training approaches are warranted.