Feeding distillers grains to cattle may affect beef tenderness early postmortem.

The objective of this study was to evaluate the effects of dietary fat source with modified distillers grains plus solubles (MDGS) on beef tenderness through examination of sarcoplasmic reticulum (SR) membrane fatty acid composition, changes in sarcoplasmic calcium concentration, Warner-Bratzler shear force (WBSF), sarcomere length, and proteolysis early postmortem. Steers (n = 256) were fed for 134 d on either corn, or a diet containing 40% full-fat MDGS, 40% de-oiled MDGS, or 38% de-oiled MDGS plus 2% corn oil. Twenty-four USDA Choice carcasses (three carcasses per pen; eight pens per treatment) were selected within each dietary treatment, and strip loins were collected and aged for 2, 9, 16, or 23 d postmortem and subject to retail display (RD) for an additional 7 d. Feeding MDGS increased (P < 0.05) concentrations of linoleic acid (18:2) and tended to increase (P = 0.06) total polyunsaturated fatty acids (PUFA) in the SR membrane. Steaks from cattle fed MDGS had greater sarcoplasmic calcium concentration than steaks from cattle fed corn at day 2 postmortem (P = 0.05). Steaks from steers fed de-oiled MDGS and de-oiled MDGS plus corn oil tended to have lower WBSF values (P = 0.08) than steaks from cattle fed corn at 2 d of aging with 0 d of RD. There were no differences among dietary treatments for sarcomere length (P = 0.92) and troponin-T degradation at 2 d postmortem (P = 0.60). Results suggest that feeding MDGS may increase early postmortem release of calcium into the sarcoplasm due to increased 18:2 and PUFA concentration in the SR membrane, which could result in increased beef tenderness early postmortem.

Effects of dietary fat source on beef strip loin steak display life.

The effects of feeding different dietary fat sources with modified distillers grains plus solubles (MDGS) on beef display life were evaluated. Steers (n = 256) were fed for 134 d on either a corn, 40% full-fat MDGS, 40% de-oiled MDGS, or 38% de-oiled MDGS plus 2% corn oil diet. Twenty-four United States Department of Agriculture Choice carcasses (3 head/pen) were randomly selected within each dietary treatment and strip loins were collected and aged for 2, 9, 16, or 23 d. Steaks from each aging period were placed under retail display (RD) conditions for 0, 4, and 7 d. Stearic acid was predominant (C18:0; P = 0.03) in beef from the de-oiled MDGS plus oil treatment in comparison with all other dietary treatments. Feeding MDGS increased linoleic acid (C18:2; P < 0.01) and polyunsaturated fatty acids (PUFA; P = 0.01) in comparison to the corn diet. The de-oiled MDGS plus oil group had greater C18:3 content (P = 0.03) when compared to corn, but no differences were observed between all other diets. There were no differences among dietary treatments for L* (P = 0.74) and b* (P = 0.25) values. The de-oiled MDGS group had lower a* values than all other treatments (P < 0.01) at day 5 of RD. The corn treatment had greater a* values (P ≤ 0.05) than de-oiled MDGS and de-oiled MDGS plus oil at day 6 and 7 of RD. Strip loin steaks from cattle fed full-fat MDGS tended to have lower a* values (P = 0.10) than steaks from cattle fed corn at day 7 of RD. Feeding de-oiled MDGS resulted in greater discoloration (P ≤ 0.05) at days 5, 6, and 7 of RD when compared to corn. Steaks from the de-oiled MDGS plus oil and full-fat MDGS groups had greater discoloration scores at day 7 of RD in comparison to corn (P ≤ 0.05). Strip loin steaks from cattle fed corn tended to have lower thiobarbituric acid reactive substance (TBARS) values (P ≤ 0.10) in comparison to de-oiled MDGS and de-oiled MDGS plus oil at day 7 of RD. Results suggest that feeding MDGS to cattle reduces color and lipid stability in addition to increasing C18:2 and PUFA content of beef. Addition of corn oil to de-oiled MDGS decreased redness and increased discoloration and lipid oxidation in comparison to corn diets.

Behavioral health integration in primary care at Brigham and Women׳s Advanced Primary Care Associates, South Huntington.

Of the many problems facing the US healthcare system, the shortage of behavioral health providers in outpatient settings is particularly profound. To address this issue, Boston׳s Brigham and Women׳s Hospital identified ways to incorporate behavioral health into primary care when it opened the South Huntington Primary Care clinic in August 2011. When the needs of its patients were more complex than anticipated, the clinic created assessment tools and refined care processes to identify, triage, and monitor patients with mental illness. Key insights from the South Huntington experience include. • Hiring for roles instead of training can decrease costs of implementation. • A process for reflection, assessment, and adaptation is a critical component of innovation. • Innovations must adapt to the specific needs of the local community. • Innovations are most effective when they reflect the capabilities of local providers.

Review of rapid diagnostic tests used by antimicrobial stewardship programs.

Rapid microbiologic tests provide opportunities for antimicrobial stewardship programs to improve antimicrobial use and clinical and economic outcomes. Standard techniques for identification of organisms require at least 48-72 hours for final results, compared with rapid diagnostic tests that provide final organism identification within hours of growth. Importantly, rapid microbiologic tests are considered "game changers" and represent a significant advancement in the management of infectious diseases. This review focuses on currently available rapid diagnostic tests and, importantly, the impact of rapid testing in combination with antimicrobial stewardship on patient outcomes.

PBP2a mutations causing high-level Ceftaroline resistance in clinical methicillin-resistant Staphylococcus aureus isolates.

Ceftaroline is the first member of a novel class of cephalosporins approved for use in the United States. Although prior studies have identified eight ceftaroline-resistant methicillin-resistant Staphylococcus aureus (MRSA) isolates in Europe and Asia with MICs ranging from 4 to 8 mg/liter, high-level resistance to ceftaroline (>32 mg/liter) has not been described in MRSA strains isolated in the United States. We isolated a ceftaroline-resistant (MIC > 32 mg/liter) MRSA strain from the blood of a cystic fibrosis patient and five MRSA strains from the respiratory tract of this patient. Whole-genome sequencing identified two amino acid-altering mutations uniquely present in the ceftaroline-binding pocket of the transpeptidase region of penicillin-binding protein 2a (PBP2a) in ceftaroline-resistant isolates. Biochemical analyses and the study of isogenic mutant strains confirmed that these changes caused ceftaroline resistance. Thus, we identified the molecular mechanism of ceftaroline resistance in the first MRSA strain with high-level ceftaroline resistance isolated in the United States.

Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant Gram-negative bacteremia.

BACKGROUND: An intervention for Gram-negative bloodstream infections that integrated mass spectrometry technology for rapid diagnosis with antimicrobial stewardship oversight significantly improved patient outcomes and reduced hospital costs. As antibiotic resistance rates continue to grow at an alarming speed, the current study was undertaken to assess the impact of this intervention in a challenging patient population with bloodstream infections caused by antibiotic-resistant Gram-negative bacteria. METHODS: A total of 153 patients with antibiotic-resistant Gram-negative bacteremia hospitalized prior to the study intervention were compared to 112 patients treated post-implementation. Outcomes assessed included time to optimal antibiotic therapy, time to active treatment when inactive, hospital and intensive care unit length of stay, all-cause 30-day mortality, and total hospital expenditures. RESULTS: Integrating rapid diagnostics with antimicrobial stewardship improved time to optimal antibiotic therapy (80.9 h in the pre-intervention period versus 23.2 h in the intervention period, P < 0.001) and effective antibiotic therapy (89.7 h versus 32 h, P < 0.001). Patients in the pre-intervention period had increased duration of hospitalization compared to those in the intervention period (23.3 days versus 15.3 days, P = 0.0001) and longer intensive care unit length of stay (16 days versus 10.7 days, P = 0.008). Mortality among patients during the intervention period was lower (21% versus 8.9%, P = 0.01) and our study intervention remained a significant predictor of survival (OR, 0.3; 95% confidence interval [CI], 0.12-0.79) after multivariate logistic regression. Mean hospital costs for each inpatient survivor were reduced $26,298 in the intervention cohort resulting in an estimated annual cost savings of $2.4 million (P = 0.002). CONCLUSIONS: Integration of rapid identification and susceptibility techniques with antimicrobial stewardship resulted in significant improvements in clinical and financial outcomes for patients with bloodstream infections caused by antibiotic-resistant Gram-negatives. The intervention decreased hospital and intensive care unit length of stay, total hospital costs, and reduced all-cause 30-day mortality.

Integrating rapid pathogen identification and antimicrobial stewardship significantly decreases hospital costs.

CONTEXT: Early diagnosis of gram-negative bloodstream infections, prompt identification of the infecting organism, and appropriate antibiotic therapy improve patient care outcomes and decrease health care expenditures. In an era of increasing antimicrobial resistance, methods to acquire and rapidly translate critical results into timely therapies for gram-negative bloodstream infections are needed. OBJECTIVE: To determine whether mass spectrometry technology coupled with antimicrobial stewardship provides a substantially improved alternative to conventional laboratory methods. DESIGN: An evidence-based intervention that integrated matrix-assisted laser desorption and ionization time-of-flight mass spectrometry, rapid antimicrobial susceptibility testing, and near-real-time antimicrobial stewardship practices was implemented. Outcomes in patients hospitalized prior to initiation of the study intervention were compared to those in patients treated after implementation. Differences in length of hospitalization and hospital costs were assessed in survivors. RESULTS: The mean hospital length of stay in the preintervention group survivors (n = 100) was 11.9 versus 9.3 days in the intervention group (n = 101; P = .01). After multivariate analysis, factors independently associated with decreased length of hospitalization included the intervention (hazard ratio, 1.38; 95% confidence interval, 1.01-1.88) and active therapy at 48 hours (hazard ratio, 2.9; confidence interval, 1.15-7.33). Mean hospital costs per patient were $45 709 in the preintervention group and $26 162 in the intervention group (P = .009). CONCLUSIONS: Integration of rapid identification and susceptibility techniques with antimicrobial stewardship significantly improved time to optimal therapy, and it decreased hospital length of stay and total costs. This innovative strategy has ramifications for other areas of patient care.

Improving health through policies that promote active travel: a review of evidence to support integrated health impact assessment.

BACKGROUND: Substantial policy changes to control obesity, limit chronic disease, and reduce air pollution emissions, including greenhouse gasses, have been recommended. Transportation and planning policies that promote active travel by walking and cycling can contribute to these goals, potentially yielding further co-benefits. Little is known, however, about the interconnections among effects of policies considered, including potential unintended consequences. OBJECTIVES AND METHODS: We review available literature regarding health impacts from policies that encourage active travel in the context of developing health impact assessment (HIA) models to help decision-makers propose better solutions for healthy environments. We identify important components of HIA models of modal shifts in active travel in response to transport policies and interventions. RESULTS AND DISCUSSION: Policies that increase active travel are likely to generate large individual health benefits through increases in physical activity for active travelers. Smaller, but population-wide benefits could accrue through reductions in air and noise pollution. Depending on conditions of policy implementations, risk tradeoffs are possible for some individuals who shift to active travel and consequently increase inhalation of air pollutants and exposure to traffic injuries. Well-designed policies may enhance health benefits through indirect outcomes such as improved social capital and diet, but these synergies are not sufficiently well understood to allow quantification at this time. CONCLUSION: Evaluating impacts of active travel policies is highly complex; however, many associations can be quantified. Identifying health-maximizing policies and conditions requires integrated HIAs.