Assessment of effectiveness of deworming options in recently weaned beef cattle utilizing different anthelmintic programs in the southeast.

This study evaluated the effects of three different anthelmintic strategies on animal performance and anthelmintic effectiveness in weaned calves during a 42-d preconditioning period. The study was conducted at four locations over 2 yr and included a total of 797 recently weaned spring-born calves (initial BW 260 ± 37.7 kg). At the start of each year, at each location, calves were weaned and randomly assigned to one of four treatments: 1) oxfendazole (ORAL); 2) transdermal eprinomectin (POUR); 3) both anthelmintic treatments (BOTH); and 4) the control (CONT) group who did not receive treatment. Anthelmintic was applied per the manufacturer recommendation, the transdermal eprinomectin was administered at 1 mL per 10 kg and oxfendazole was administered orally at 1 mL per 50 kg. Weights were measured at the start of the study (day 0) and again at the end of the preconditioning phase (day 42). Fecal samples were collected at the start of the study prior to treatment application (day 0) and again on day 14. Rumen fluid was collected at the start of the study prior to treatment (day 0) and again on day 6. There were treatment effects for all performance metrics (P < 0.001). All treatments had greater weight gain and value of weight gained (P < 0.024), and all three strategies did not differ from each other (P > 0.420). On day 0, there were no (P = 0.795) treatment effects detected for fecal eggs per gram (EPG) counts. On day 14, there were (P < 0.001) treatment effects for EPG counts with feces from CONT calves containing greater (P < 0.014) EPG than feces from treated calves. EPG in feces from BOTH calves did not differ (P > 0.123) from the other two treated groups and feces from POUR calves tended (P = 0.052) to contain greater EPG counts than feces from ORAL calves. Volatile fatty acids were similar across treatments on days 0 and 6 (P > 0.115). Butyrate tended (P = 0.063) to be lower in ORAL on day 6. These results suggest that using eprinomectin and oxfendazole in combination was an effective strategy for reducing EPG and improving performance during a 42-d preconditioning phase.

An Innovative Approach to Health Promotion and Wellness for University Students with Intellectual and Physical Disabilities: A Case Series.

A university setting offers a unique opportunity to address physical activity for individuals with disabilities. The purpose of this case series was to highlight the development of a formal student-assisted exercise program and examine its impact on the perceived quality of life, exercise confidence, and functional mobility of college-aged individuals with intellectual and physical disabilities. Data from twelve participants was analyzed. Seven participants demonstrated an improvement in scores on the Self-Efficacy to Exercise scale and eight improved in functional measures associated with strength. Thus, a collaborative assisted exercise program in a university setting may positively impact health and physical activity, and exercise participation in young adults with physical and/or intellectual disabilities.

The impact of maturity stages on yield, quality, and nutritive value of ensiled Johnsongrass [Sorghum halepense (L.) Pers].

Johnsongrass [Sorghum halepense (L.) Pers.] is a non-native, invasive species that causes substantial losses in row crops and hay fields, which could be minimized by using Johnsongrass as a conserved forage. Two experiments were conducted to evaluate the yield and quality of Johnsongrass ensiled at four maturities: harvested every 3 weeks (3WK), boot stage (BOOT), flower stage (FLOWER), and dough (DOUGH) stages. In experiment 1, yield, botanical composition, nutritive value, and fermentation characteristics of Johnsongrass were measured. In experiment 2, Johnsongrass silage was incubated for 48 h for assessment of gas production, pH, in vitro dry matter digestibility (IVDMD), and volatile fatty acids. The experimental area consisted of 16 plots (2.74 m × 4.57 m) divided into four blocks, and treatment was randomly assigned to plot within block. Each year, silage was prepared for each plot from the two cutting closest to July 1. After 10 weeks, the silos were opened, and silage samples were frozen for further analysis. Data from both experiments were tested for the effects of maturity stage and harvest timing (first and second harvest). The results from experiment 1 showed an increase (P < 0.0001) in dry matter yield from 3WK stage to DOUGH. Johnsongrass, as a proportion of the total botanical composition, declined at the end of the growing season for 3WK but increased in FLOWER (P = 0.0010). In the first harvest, 3WK and BOOT stage silages had the greatest concentrations of crude protein and total digestible nutrients and lowest of fiber (neutral detergent fiber and acid detergent fiber; P < 0.0001). In the second harvest, differences in nutrient content were significant only for 3WK silages, which showed the best nutritive value (P < 0.0001). In experiment 2, IVDMD of silage followed the same trends described for nutritive value from experiment 1. Overall, these results demonstrate that Johnsongrass can be successfully ensiled, but to optimize forage nutritive value and quantity, Johnsongrass should be ensiled before it reaches the flower stage.

Clinical shadowing experience PIF rubric.

BACKGROUND: The purpose of this study was to develop and evaluate a tool for documenting professional identity formation (PIF) among preclinical medical students, via reflective writings (RWs) about their clinical shadowing experiences. APPROACH: To address our key questions, stakeholders conducted comprehensive literature analysis, and the authors developed an analytic rubric through an iterative immersion/crystallisation process. EVALUATION: Rubric iterations were empirically tested, assessed for interrater reliability, refined and then applied in successive development phases to medical student RW narratives. Twenty-nine first-year RWs on their shadowing experiences were included for this developmental evaluation. IMPLICATIONS: The clinical shadowing experience PIF rubric is a theory-informed analytic tool that demonstrates feasibility of measuring PIF in preclinical medical students' RWs. Reliable use of this tool currently requires a team approach that could be improved by machine learning.

The Relationship Between Interprofessional Collaborative Practice Experience and Interprofessional Attitudes in Students from Health Professions.

Interprofessional collaborative practice (IPCP) can be achieved through purposeful interprofessional education of healthcare students within a clinical environment. The purpose of this study was to examine the relationship between past participation of students in IPCP with interprofessional attitudes of students, as measured by the Interprofessional Attitudes Scale (IPAS). It further examined differences in IPAS based on profession. A Pearson correlation examined association of IPCP experience with IPAS scores. An analysis of covariance evaluated group differences, with post-hoc tests examining pairwise differences. Participants (n=170) consisted of students from medicine, physical therapy, social work, nursing, and pharmacy. A positive relationship existed for IPAS scores and IPCP experiences for medical students and pharmacy students, but no other profession. Medical students scored lower on interprofessional attitudes when compared with other professions. Further, when controlling for IPCP experience, IPAS scores differed between medical students and all other professions for total score as well as the teamwork, roles and responsibilities subdomain. Results indicate that the volume of IPCP experience may have a relationship with interprofessional attitudes among health professional students. Evidence supports the need for continued strategic curricular design to cultivate interprofessional behaviors in students through implementation of greater amounts of IPCP experiences for students.

ON Time Mobility: Advocating for Mobility Equity.

Mobility is a human right. The traditional definition of mobility in physical therapy practice is centered on translocation and, while accurate, is not comprehensive. In this article, we propose the ON Time Mobility framework: that all children have the right to be mobile throughout their development to explore, engage in relationships, and develop agency to cocreate their lives. This perspective highlights interconnected principles of timing, urgency, multimodal, frequency, and sociability to begin discussions on supporting the right to hours of active mobility each day for all children. We propose critical evaluation and discussion of these principles followed by a call to action to shift our conceptualization and enactment of mobility. This mobility rights perspective challenges current medical systems, industry, and government to collaborate with children with disabilities, their families and communities to support mobility as a source of physical and social interactions that define and develop individuals (see Supplemental Digital Content 1, the Video Abstract, available at: http://links.lww.com/PPT/A398 ).

From everyday life predictions to suicide prevention: Clinical and ethical considerations in suicide predictive analytic tools.

Advances in artificial intelligence and machine learning have fueled growing interest in the application of predictive analytics to identify high-risk suicidal patients. Such application will require the aggregation of large-scale, sensitive patient data to help inform complex and potentially stigmatizing health care decisions. This paper provides a description of how suicide prediction is uniquely difficult by comparing it to nonmedical (weather and traffic forecasting) and medical predictions (cancer and human immunodeficiency virus risk), followed by clinical and ethical challenges presented within a risk-benefit conceptual framework. Because the misidentification of suicide risk may be associated with unintended negative consequences, clinicians and policymakers need to carefully weigh the risks and benefits of using suicide predictive analytics across health care populations. Practical recommendations are provided to strengthen the protection of patient rights and enhance the clinical utility of suicide predictive analytics tools.

Efficacy of Various Facial Protective Equipment for Infection Control in a Healthcare Setting.

INTRODUCTION: The coronavirus 2019 (COVID-19) pandemic has reinforced the importance of facial protection against droplet transmission of diseases. Healthcare workers wear personal protection equipment (PPE), including face shields and masks. Plastic face shields may have advantages over regular medical masks. Although many designs of face shields exist, there is a paucity of evidence regarding the efficacy of shield designs against droplet transmissions. There is even less published evidence comparing various face shields. Due to the urgency of the pandemic and the health and safety of healthcare workers, we aimed to study the efficacy of various face shields against droplet transmission. METHODS: We simulated droplet transmission via coughing using a heavy-duty chemical spray bottle filled with fluorescein. A standard-adult sized mannequin head was used. The mannequin head wore various face shields and was positioned to face the spray bottle at either a 0°, 45°, or 90° angle. The spray bottle was positioned at and sprayed from 30 centimeters (cm), 60 cm, or 90 cm away from the head. These steps were repeated for all face shields used. Control was a mannequin that wore no PPE. A basic mask was also tested. We collected data for particle count, total area of particle distribution, average particle size, and percentage area covered by particles. We analyzed percent covered by particles using a repeated measures mixed-model regression with Tukey-Kramer pairwise comparison. RESULTS: We used least square means to estimate the percentage area covered by particles. Wearing PPE regardless of the design reduced particle transmission to the mannequin compared to the control. The LCG mask had the lowest square means of 0.06 of all face-shield designs analyzed. Tukey-Kramer pairwise comparison showed that all PPEs had a decrease in particle contamination compared to the control. LCG shield was found to have the least contamination compared to all other masks (P < 0.05). CONCLUSION: Results suggest the importance of wearing a protective covering against droplet transmission. The LCG shield was found to decrease facial contamination by droplets the most of any tested protective equipment.

Indirect standardization for rare events and a dynamic standard population rate: An analysis and simulation of U.S. military suicide mortality rates.

INTRODUCTION: Comparing suicide mortality rates between the U.S. military and U.S. general populations is common in lay and professional literature. Standardization is required for this comparison to account for differences in the population structure, but small event counts complicate the analysis. METHODS: We demonstrated the performance of direct, indirect, and reverse-direct standardization using U.S. military and U.S. general population suicide mortality data from 2011 to 2018. We also used simulations of direct and indirect standardization in annual comparisons, and over time for the standardized mortality ratio in Poisson regression. RESULTS: Indirect standardization outperformed direct standardization for annual rate standardization. Direct standardization with combined subgroups can produce a biased estimate. Reverse-direct standardization was unbiased, but it generally yields incorrect interval estimates. Over 2011-2018, the U.S. military suicide mortality data were very consistent with the U.S. general population. CONCLUSION: Indirect standardization provides more flexibility in rate standardization with rare outcomes. For comparisons between the U.S. military and the U.S. general populations, it can provide valid point and interval estimates of standardized rates and ratios both within a single year and between years without combining categories to account for sparseness.

Dystonic Golfer's cramp: Pilot study of propranolol and looking at the hole.

INTRODUCTION: There is limited data in the scientific literature using quantitative methods to assess response of golfer's cramp to intervention. The objective of this pilot study was to use quantitative measures to study the effect of propranolol and looking at the hole when putting. METHODS: 14 golfers completed 50 10' putts (10 each x 5 conditions): two-handed looking at the ball, right hand only looking at the ball, two-handed looking at the hole, then following a single 10 mg oral dose of propranolol two-handed and right hand only putts looking at the ball. Quantitative measurements of putter movement and surface EMG to assess wrist muscle co-contraction were measured. RESULTS: Based on video review of the putting, five golfers with dystonic golfer's cramp and nine with non-dystonic yips were compared. Those with dystonic golfer's cramp had more putts with the yips and yips with co-contraction when two-handed putting looking at the ball, no increase when putting right hand only, less smoothness of putter movement, and all of these improved following propranolol and when looking at the hole. The non-dystonic group had an increase in yipped putts and yipped putts with co-contraction putting right hand only and no improvement with either intervention. CONCLUSION: Yipped putts with co-contraction, right hand only putting, and smoothness of putter movement differed between dystonic golfer's cramp and non-dystonic yips. Propranolol and looking at the hole only improved dystonic golfer's cramp putting. This is the first pilot study of oral medication treatment for this task-specific dystonia.

The Relationship between Trauma Exposure and Psychiatric Hospitalization for Suicide Ideation or Suicide Attempt among Patients Admitted to a Military Treatment Setting.

Suicide attempts and psychiatric hospitalization represent the final outcomes of a complex dynamical system of interacting factors that influence a particular individual's likelihood of engaging in suicidal behavior, as well as their ability to seek help prior to acting upon suicidal impulses. This study examined the association between different types of lifetime trauma exposure and the likelihood of psychiatric hospitalization following a suicide attempt (SA) rather than suicidal ideation (SI) alone. Electronic medical records for 1100 U.S. military service members and their dependents admitted to a military psychiatric inpatient setting for SA or SI were reviewed for documented lifetime trauma exposure history. Findings indicated that exposure to at least one childhood trauma of any type, and childhood neglect in particular, increased the likelihood that an individual would be hospitalized for SA rather than SI. Exploratory gender-stratified analyses demonstrated that childhood neglect, childhood sexual abuse, and adulthood traumatic loss may be linked with the likelihood of being hospitalized for SA. These findings demonstrate the importance of developing more detailed and nuanced conception of factors known to be associated with suicide as their effects may depend on details of their timing and nature, as well as their interactions with other systems.

Informal Work and Sustainable Cities: From Formalization to Reparation.

Informal workers produce economic, social, and environmental value for cities. Too often, policy elites, including those promoting sustainable cities, overlook this value, proposing formalization and relying on deficit-based framings of informal work. In this perspective piece, we bring critical research and community-produced knowledge about informal work to sustainability scholarship. We challenge the dominant, deficit-based frame of informal work, which can dispossess workers, reduce their collective power, and undercut the social and environmental value their work generates. Instead, thinking historically, relationally, and spatially clarifies the essential role of informal work for urban economies and highlights their potential for promoting sustainable cities. It also reveals how growth-oriented economies reproduce environmental destruction, income inequality, and poverty, the very conditions impelling many to informal work. Rather than formalization, we propose reparation, an ethic and practice promoting ecological regeneration, while redressing historic wrongs and redistributing resources and social power to workers and grassroots social movements.

Prediction Models for Suicide Attempts and Deaths: A Systematic Review and Simulation.

Importance: Suicide prediction models have the potential to improve the identification of patients at heightened suicide risk by using predictive algorithms on large-scale data sources. Suicide prediction models are being developed for use across enterprise-level health care systems including the US Department of Defense, US Department of Veterans Affairs, and Kaiser Permanente. Objectives: To evaluate the diagnostic accuracy of suicide prediction models in predicting suicide and suicide attempts and to simulate the effects of implementing suicide prediction models using population-level estimates of suicide rates. Evidence Review: A systematic literature search was conducted in MEDLINE, PsycINFO, Embase, and the Cochrane Library to identify research evaluating the predictive accuracy of suicide prediction models in identifying patients at high risk for a suicide attempt or death by suicide. Each database was searched from inception to August 21, 2018. The search strategy included search terms for suicidal behavior, risk prediction, and predictive modeling. Reference lists of included studies were also screened. Two reviewers independently screened and evaluated eligible studies. Findings: From a total of 7306 abstracts reviewed, 17 cohort studies met the inclusion criteria, representing 64 unique prediction models across 5 countries with more than 14 million participants. The research quality of the included studies was generally high. Global classification accuracy was good (≥0.80 in most models), while the predictive validity associated with a positive result for suicide mortality was extremely low (≤0.01 in most models). Simulations of the results suggest very low positive predictive values across a variety of population assessment characteristics. Conclusions and Relevance: To date, suicide prediction models produce accurate overall classification models, but their accuracy of predicting a future event is near 0. Several critical concerns remain unaddressed, precluding their readiness for clinical applications across health systems.

Suicide in the Military: Understanding Rates and Risk Factors Across the United States' Armed Forces.

This paper presents data from the United States Department of Defense Suicide Event Report System for years 2012-2015 to detail descriptive, longitudinal rate data and risk factor profiles associated with military suicide. The annual findings were aggregated from all U.S. military suicide deaths and suicide attempts. Data elements included the most common method of suicide (firearms), most common behavioral health diagnoses (substance abuse/dependence), common life stressors (failed intimate-partner relationships), and an individual's history of operational deployment. Age- and sex-adjusted rates for the Services were compared with rates for the U.S. adult population. Results showed that the current reporting period (2015) is similar to patterns that have been observed over the preceding years and to patterns reported in the overall U.S. adult population. Suicide rates remain elevated but stable for both the Active and Reserve Components of the Military Services compared to historical levels observed prior to 2003. Finally, we discuss common errors and misinterpretations that can occur when analyzing surveillance data.

Suicide ideation and self-efficacy to avoid suicidal action among psychiatrically hospitalized military personnel.

Individuals with suicide ideation require self-efficacy to avoid engagement in suicidal behaviors. Low self-efficacy has been examined as a risk indicator for suicidal behaviors. The Self-Efficacy to Avoid Suicidal Action (SEASA) scale assesses self-efficacy to resist suicidal urges and was originally evaluated in a sample of adults receiving treatment for substance use disorders. The goal of this study was to explore the link between suicide ideation and self-efficacy to avoid suicidal action among a high-risk group of psychiatric inpatients. Military personnel psychiatrically hospitalized following a suicide-related event (N = 139) completed a modified version of the SEASA and provided a full history of suicidal behaviors. Data were analyzed using multiple linear regression. Severity of worst time point suicide ideation, endorsement of any current suicide ideation, and history of multiple lifetime suicide attempts were associated with lower self-efficacy to avoid suicidal action. Self-efficacy to avoid engagement in suicidal action is a belief that can be strengthened and practiced within evidence-based treatments such as cognitive behavior therapy for suicide prevention. Thus, providers are encouraged to target this type of self-efficacy in case conceptualization and treatment planning. Future research on how self-efficacy to avoid suicidal action can be effectively measured are needed.

The Yips: Methods to Identify Golfers with a Dystonic Etiology/Golfer's Cramp.

PURPOSE: To determine whether quantitative methods could separate golfers with a possible dystonic cause of the "yips" from those that appear to be nondystonic. METHODS: Twenty-seven golfers completed 10 two-handed and 10 right hand-only putts. Surface EMG assessed forearm muscle co-contraction and motion detectors monitored wrist and putter movements. Based on a videotape review, golfers were grouped into those with yips of dystonic etiology, those with the yips nondystonic, and those with no yips. RESULTS: On video review of two-handed putting, five golfers had yips that appeared to be dystonic, nine had yips that did not appear to be dystonic, and 13 had no yips. During two-handed putting co-occurrence of a yipped putt and wrist flexor/extensor and/or pronator/supinator co-contraction was significantly more frequent in those with dystonic yips. The dystonic group had no increase in the number of yipped putts or yips with co-contraction when putting right hand only, whereas the nondystonic group had significantly more yipped putts and more yipped putts with co-contraction with right hand only. CONCLUSIONS: Quantitative methods were identified that appear to identify golfers with a dystonic etiology for the yips. It is not just the frequency of yips nor just specific motion patterns alone, rather it is also a combination of yips with co-occurring co-contraction when putting with two hands, and then right hand only, that distinguished this possible etiology. Despite being a small study, identifying a dystonic pattern, even in a nonpressure indoor setting, may aid in assessment and possible monitoring of treatment.

Conserved forage-based systems for backgrounding weaned beef calves.

A 45-d backgrounding study was conducted to compare animal performance, forage nutritive value, digestion dynamics, and diet costs of conserved forage systems for weaned beef calves. One hundred and eight weaned Angus × Simmental beef calves (initial BW 279 ± 34 kg) were randomly assigned to one of three diets (n = 3 pens/treatment): 1) free-choice annual ryegrass (RB; cv. 'Marshall') baleage and 4 kg of a 50/50 mixture of pelleted soybean hulls and corn gluten feed, 2) free-choice Tifton 85 bermudagrass (BH) and 3 kg of a 50/50 mixture of pelleted soybean hulls and corn gluten feed, or 3) free-choice corn silage (CS; cv. Pioneer P1662YHR) and 2 kg of a 85% cracked corn and 15% cottonseed meal mixture. Diets were formulated to achieve a target gain of 0.9 kg/d based on the NRC (2000) requirement for a 270 kg growing calf. Animal performance (initial BW, final BW, and ADG) was measured on days 0 and 45 of the study. Forage nutritive value and an in vitro digestion trial were conducted to evaluate supplementation effects on forage diet digestion dynamics. Data were analyzed using PROC Mixed in SAS 9.4 as a completely randomized design. Pen was the experimental unit. Mean initial and final BW of the animals did not differ (P = 0.50 and P = 0.99, respectively) across treatments. Calf ADG for RB, BH, and CS diets were 0.61, 0.72, and 0.72 kg/d, respectively, and did not differ across treatments (P = 0.57). Based on these results, these forage options supported a similar level of gain when used for backgrounding beef calves. Forage in vitro DM digestibility differed 48 h after digestion, and BH + 50:50 had greater 48-h digestibility than when unsupplemented, which may be related to complementary forage-supplement interactions. In diets containing RB and CS, digestibility was greater with no supplementation at the 48-h time point. These data support the observation that supplementation type and level influence conserved forage diet digestibility compared with forage alone. The cost of feeding a baleage-based diet in this system was higher ($1.37/d) than CS or BH diets ($1.02 and $0.95/d, respectively). Results suggest that RB baleage-based diets may support a similar level of gain to BH or CS diets in growing beef calves, but supplement type, level, and ration costs should be evaluated when determining cost-effective backgrounding options in the Southeastern United States.

Utilization of an interprofessional integrated clinical education experience to improve medical and physical therapy student comfort in treating patients with disabilities.

Purpose: The purpose of this study is to examine the impact of an interprofessional education (IPE) clinical experience for medical and physical therapy students on students' comfort levels and attitudes toward patients with disabilities. Methods: Forty students were recruited for this study, 20 from the College of Medicine and 20 from the Doctor of Physical Therapy Program at University of Central Florida with 10 students from each program self-selected into a control group or an experimental group. The experimental group attended an IPE clinical experience that included an encounter with a patient with a disability. Students completed standardized inventories on their perceptions of difficult rehabilitation situations, comfort levels, and attitudes prior to, and immediately following, the clinical experience. The control group completed the same standardized assessments. Results: Using the rehabilitation situations inventory (RSI) statistically significant changes in scores from the pre- to the post-intervention (P < 0.001) were observed. In addition, a statistically significant (P < 0.05) improvement in comfort levels was found in five of the six RSI subscales which include staff-staff interactions, families, motivation/adherence, aggression, and sexual situations. Attitudes toward disabled persons (ATDP) and interactions with disabled persons (IDP) failed to find statistically significant changes in respondent scores due to the intervention (P > 0.05). Conclusion: Both medical and physical therapy students reported increased comfort in dealing with rehabilitation situations after attending the IPE clinical experience. This supports the use of clinical encounters with individuals with disabilities as component of education on treating patients with disabilities.