Alternative approaches to 'enhanced observations' in acute inpatient mental health care: a review of the literature.

Formal 'enhanced observations' involving allocating one or two nurses to place an patient under continuous observation when acutely ill and at risk of self-harm are ineffective, contribute to impersonal care, are stressful to practitioners and reinforce the perception of a custodial environment. The aim of this literature review was to systematically bring together published studies and research that identified alternative approaches to 'enhanced observations' from those proposed in the Standing Nursing and Midwifery Advisory Committee guidelines on individuals receiving care on open acute inpatient settings. The literature search strategy resulted in the retrieval of five empirical studies, with further analysis revealing six potential interventions relating to the development of an alternative approach to observations. These are: (1) assessment; (2) nurse autonomy; (3) ward management initiatives (4) engagement and collaboration; (5) a team approach; and (6) intermittent observations. The review emphasized how enhanced observations and the development of alternative approaches are a complex activity requiring planning and consideration to facilitate appropriate implementation. The review also highlights a dearth in empirical evidence for alternatives, and a need to revise current practices because of the dissatisfaction from clients and practitioners involved in this intervention.

Quantitative trait loci affecting clinical mastitis and somatic cell count in dairy cattle.

Norway has a field recording system for dairy cattle that includes recording of all veterinary treatments on an individual animal basis from 1978 onwards. Application of these data in a genome search for quantitative trait loci (QTL) verified genome-wise significant QTL affecting clinical mastitis on Chromosome (Chr) 6. Additional putative QTL for clinical mastitis were localized to Chrs. 3, 4, 14, and 27. The comprehensive field recording system includes information on somatic cell count as well. This trait is often used in selection against mastitis when direct information on clinical mastitis is not available. The absence of common QTL positions for the two traits in our study indicates that the use of somatic cell count data in QTL studies aimed for reducing the incidence of mastitis should be carefully evaluated.

Identifying and injecting myofascial trigger points.

Myofascial pain syndrome is characterized by the presence of discreet, hypersensitive nodules known as trigger points. A myofascial trigger point is a hyperirritable locus within a taut band of skeletal muscle, located in the muscle and/or fascia (1). They are palpable within muscles as cord-like bands within a sharply circumscribed area of extreme tenderness. Trigger points are found most commonly in muscles involved in postural support.

A primary screen of the bovine genome for quantitative trait loci affecting twinning rate.

An autosomal genome scan for quantitative trait loci (QTL) affecting twinning rate was carried out in the Norwegian Cattle population. Suggestive QTL were detected on Chromosomes (Chr) 5, 7, 12, and 23. Among these, the QTL positions on both Chr 5 and Chr 23 are strongly supported by literature in the field. Our results also confirm previous mapping of a QTL for twinning to Chr 7, but definitely suggest a different location of the QTL on this chromosome. The most convincing QTL peak was observed for a region in the middle part of Chr 5 close to the insulin-like growth factor 1 (IGF1) gene. Since IGF1 plays an important role in the regulation of folliculogenesis, a mutation search was performed by sequencing more than 3.5 kb of the gene in actual families. The sequencing revealed three polymorphisms in noncoding regions of the gene that will be important in fine structure mapping and characterization of the QTL.

Twinning rate in Norwegian cattle: frequency, (co)variance components, and genetic trends.

The overall twinning rate was shown to increase from .6% in the first parity to 4.0% in the sixth parity, and a positive phenotypic trend for twinning rate was observed during the time period considered (1978 to 1995). The distribution of bulls according to the average percentage of multiple births of daughters in first and second parity showed that some bulls had an extremely low twinning frequency and others exceeded the population mean by approximately six times. (Co)variance components were estimated for twinning in first and second parities using a linear sire model. The analysis included either first- and second-crop daughters (1.4 and .9 million records for first- and second-parity cows, respectively) or first-crop daughters only (.6 and .4 million records for first- and second-parity cows, respectively) from 2,043 sires. Heritability estimates were .7 to .8% in the first parity and 2.8% in the second parity. The genetic correlation between twinning in the first and second parities was approximately 1. Part of the phenotypic trend observed can be explained by a genetic trend for twinning rate.

Clinical mastitis in Norwegian cattle: frequency, variance components, and genetic correlation with protein yield.

Records of clinical mastitis in first lactation Norwegian Cattle from 1978 onward were analyzed. Variance components for clinical mastitis were estimated with a linear sire model using records of more than 1.2 million cows from 2043 sires, resulting in heritability estimates of 0.035. Different strategies for extracting data gave very similar results, and estimated heritability for mastitis was the same with univariate and bivariate (with protein yield) analyses, which indicates that selection bias caused by correlated responses from other traits in the breeding goal is not a problem with this data set. The estimated genetic correlation between clinical mastitis and protein yield is 0.25.

Short communication: validation of estimates of genetic trend in the Norwegian cattle population.

We examined alternative definitions of herd x year effects in models used to estimates genetic trends for clinical mastitis in Norwegian Cattle. The model with random herd x year effects showed significant bias and clearly overestimated genetic trend. To obtain unbiased estimates of genetic trend for clinical mastitis with this data, herd x year should be defined as fixed. Our results emphasized the importance of validating estimates of genetic trend.

Prospects and strategies for genetic improvement of the dairy potential of tropical cattle by selection.

The import of genetic material and the use of crossbreeding to improve the dairy merit of tropical cattle has been criticized for eroding the livestock genetic resources of the tropics. An alternative is genetic improvement of the indigenous cattle through selection. The objective of the present paper is to examine the feasibility of this alternative. Constraints to genetic improvement of tropical cattle through selection are discussed. Low reproductive rates and high calf mortality reduce the intensity of selection. The generation interval, which is long in cattle, is further prolonged by the late sexual maturity and the long calving intervals in most tropical breeds. The most serious constraint is, however, that the extensive milk recording schemes which support dairy cattle breeding programmes in many temperate countries are almost non-existent in the tropics. In this situation, the most realistic approach to improvement through selection is to start with a single nucleus herd (or a group of cooperating herds). Two alternative selection programmes (with and without progeny testing) for a closed herd of 500 cows are outlined. The alternative which assumed no progeny testing, i.e. selection of bulls on pedigree information only, gave the fastest genetic improvement (predicted at 36 kg/year). By distributing breeding bulls from the herd the genetic progress can be disseminated to the outside population with a time lag of about two generations. A nucleus herd can supply about 15 selected bulls per 100 cows in the herd per year, enough for a population of several thousand cows.

When groin pain is more than 'just a strain': navigating a broad differential.

Most groin pain results from musculotendinous injuries, but not all groin pain signifies simply a pulled muscle. The pain can stem from one or more musculoskeletal or nonmusculoskeletal origins, such as avulsion fracture, osteitis pubis, or hernia. While acute causes are often readily identified, chronic groin pain can present a diagnostic challenge. Paying close attention to the history can help identify acute causes such as strains and avulsion fractures; determining the location and nature of the pain can also help with diagnosis. Conservative treatment is often effective for treatment of acute injuries such as strains and avulsion fractures.

Marker-assisted selection for a sex-limited character in a nucleus breeding population.

The benefits of marker-assisted selection were examined by simulation of an adult multiple ovulation and embryo transfer nucleus breeding scheme. Animals were either typed for two polymorphic marker loci, 20 centimorgans apart, flanking a single biallelic quantitative trait locus and were evaluated using a model accounting for marker information, or animals were not typed but were evaluated by a conventional BLUP animal model. Selection was for a single trait measured on females, and each dam had 4 sons and 4 daughters. Nucleus foundation animals were chosen from a base population in linkage equilibrium. With the favorable allele at an initial frequency of 0.5, marker-assisted selection substantially increased responses at the quantitative trait locus but reduced the polygenic responses. Cumulative genetic gain increased by up to 3, 9, 12, and 6% after one, two, three, and six generations of selection, respectively. If the favorable allele was initially rare (frequency of 0.1), the merits of marker-assisted selection were even more pronounced (genetic gains increased by up to 9, 19, 24 and 15%, respectively). The superiority of marker-assisted selection over conventional BLUP increased when a restriction was placed on selection of full brothers and decreased when variance of the quantitative trait locus used in the evaluation model was overestimated.

Marker assisted selection for genetic improvement of animal populations when a single QTL is marked.

A Monte Carlo simulation study to evaluate the benefits of marker assisted selection (MAS) in small populations with one marked bi-allelic quantitative trait locus (QTL) is described. In the base generation, linkage phase equilibrium between the markers, QTL and polygenes was assumed and frequencies of 0.5 for the two QTL alleles were used. Six discrete generations of selection for a single character measured on both sexes followed. An additive genetic model was used with the QTL positioned midway between two highly polymorphic markers. Schemes were simulated with a distance of 10 cM between the QTL and either of the two markers and with the QTL explaining 1/8 of the total genetic variance in the base generation. Values of 0.5, 0.25 or 0.1 were assumed for the heritability. Eight males and 16, 32 or 64 females were selected each generation with each dam producing four sons and four daughters as candidates for the next generation. Animals were evaluated with a conventional BLUP animal model or with a model using marker information. MAS resulted in substantially higher QTL responses (4-54%), especially with low heritabilities, than conventional BLUP but lower polygenic responses (up to 4%) so that the overall effect on the total genetic response, although in the majority of cases favourable, was relatively small. With QTLs of larger size (explaining 25% of the genetic variance) comparable results were found. When the distance between the QTL and the markers was reduced to 2 cM, genetic responses were increased very slightly with a heritability of 0.5 whereas with a heritability of 0.1 responses were increased by up to 10%, compared with conventional BLUP. Results emphasize that MAS should be most useful for lowly heritable traits and that once QTLs for such traits have been identified the search for closely linked polymorphic markers should be intensified.