Maternal and direct genetic parameters for tail length, tail lesions, and growth traits in pigs.

Tail length and tail lesions are the major triggers for tail biting in pigs. Against this background, 2 datasets were analyzed to estimate genetic parameters for tail characteristics and growth traits. Dataset 1 considered measurements for trait tail length (T-LEN) and for the growth traits birth weight (BW), weaning weight (WW), postweaning weight (PWW), and average daily gain (ADG) from 9,348 piglets. Piglets were born in the period from 2015 to 2018 and kept on the university Gießen research station. Dataset 2 included 4,943 binary observations from 1,648 pigs from the birth years 2016 to 2019 for tail lesions (T-LES) as indicators for nail necrosis, tail abnormalities, or tail biting. T-LES were recorded at 30 ± 7 d after entry for rearing (T-Les-1), at 50 ± 7 d after entry for rearing (end of the rearing period, T-LES-2), and 130 ± 20 d after entry for rearing (end of fattening period, T-LES-3). Genetic statistical model evaluation for dataset 1 based on Akaike's information criterion and likelihood ration tests suggested multiple-trait animal models considering covariances between direct and maternal genetic effects. The direct heritability for T-LEN was 0.42 (±0.03), indicating the potential for genetic selection on short tails. The maternal genetic heritability for T-LEN was 0.05 (±0.04), indicating the influence of uterine characteristics on morphological traits. The negative correlation between direct and maternal effects for T-LEN of -0.35 (±0.13), as well as the antagonistic relationships (i.e., positive direct genetic correlations in the range from 0.03 to 0.40) between T-LEN with the growth traits BW, WW, PWW, and ADG, complicate selection strategies and breeding goal definitions. The correlations between direct effects for T-LEN and maternal effects for breeding goal traits, and vice versa, were positive but associated with a quite large SE. The heritability for T-LES when considering the 3 repeated measurements was 0.23 (±0.04) from the linear (repeatability of 0.30) and 0.21 (±0.06; repeatability of 0.29) from the threshold model. The breeding value correlations between T-LES-3 with breeding values from the repeatability models were quite large (0.74 to 0.90), suggesting trait lesion recording at the end of the rearing period. To understand all genetic mechanisms in detail, ongoing studies are focusing on association analyses between T-LEN and T-LES, and the identification of tail biting from an actor's perspective.

The Syrian Vulnerable Person Resettlement Programme: evaluation of Edinburgh's reception arrangements.

BACKGROUND: During 2015 and 2016 a group of Syrian refugees were resettled in Edinburgh, Scotland under the United Kingdom Government Syrian Vulnerable Person Resettlement Programme. We evaluate the strengths and weaknesses of the settling in arrangements for these refugees. METHODS: Semi-structured interviews were conducted with five Arabic interpreters who had worked extensively with these refugees. Interviews sought their impressions about what went well or was not successful. Interviews were transcribed and key themes extracted and analysed. RESULTS: Six themes emerged: 'first impressions', language skills, different healthcare systems, health of the refugees, relationships between the interpreters and refugees and support for the interpreters. CONCLUSIONS: The welcoming arrangements went well and exceeded refugees' and interpreters' expectations. There was perhaps too much information given immediately and reinforcing details about various public services and facilities after a first few months would be worthwhile. The Syrians were unfamiliar with NHS structures and found lack of direct specialist access surprising. Problems were amplified by low English levels. A need for Arabic literacy classes was also identified. Interpreters were often used informally out-of-hours and a better system with first contact in Arabic should be established. Interpreters find this work particularly stressful and the provision of psychological support for them should be prioritized.

Instructional Insights: Restructuring the Fieldwork Experience: One Clinic's Journey.

Although there are standards for occupational therapy education, there are no universal standards for the affiliated fieldwork settings, only guidelines from the educational institutions. As a result, a student learning experience often varies dramatically from facility to facility. Several factors that may affect the clinical experience include the preparedness of a student, the willingness of a clinic to work through potential student challenges, and the theoretical foundation a clinic has built for disseminating occupational therapy practice skills. This article highlights the journey of one clinic through a redesign of the occupational therapy fieldwork program and outlines the steps taken to transform student experiences and improve program success. Starting with a self-directed review of the fieldwork process, and through a combination of program redesign, application of a theoretical foundation, and refocus toward a competency-based program, the student success rate at this acute rehabilitation hospital drastically improved and achieved positive feedback from all involved.

An effective educational strategy for improving knowledge, risk perception, and risk communication among colorectal adenoma patients.

BACKGROUND: We have previously shown that most adenoma patients are unaware of the personal and familial implications of their diagnosis. Our goal was to determine whether a brief, computer-based educational program (CBEP) administered alone after polypectomy, or in combination with a personalized letter (PL), was more effective than standard care (SC) for heightening awareness and improving risk communication. METHODS: Using a quasi-randomized design, adenoma-bearing subjects were assigned to the CBEP +PL (n=99), CBEP (n=96), or SC (n=120) arms. The CBEP was administered before discharge from the endoscopy unit. All subjects completed a phone survey 3 months postpolypectomy assessing knowledge, risk perception, and notification of first-degree relatives. RESULTS: Composite knowledge scores were higher (P<0.05) for the CBEP+PL group than CBEP and SC groups. Subjects in the CBEP+PL group were more likely (P<0.05) than those in the SC group to know that adenomas but not hyperplastic polyps were precancerous, that patients with adenomas were at increased risk of future adenomas, and that the siblings and children of adenoma patients may be at increased colorectal cancer risk. Subjects in the CBEP+PL group were also more likely (P<0.05) to know their polyp's histology, perceive themselves and their siblings/children to be at increased risk of colorectal neoplasia, and notify a first-degree relative. These associations remained significant after adjusting for age, sex, race/ethnicity, education, and endoscopist. No differences were observed between the CBEP and SC groups. CONCLUSIONS: The CBEP+PL intervention is an effective strategy for improving knowledge, risk perception, and risk communication among adenoma patients.

Deficiencies in knowledge and familial risk communication among colorectal adenoma patients.

GOALS: Our primary objectives were to assess knowledge about familial risk and risk communication among colorectal adenoma patients. BACKGROUND: The first-degree relatives (FDRs) of colorectal adenoma patients diagnosed before the age of 60 years may be at increased risk of colorectal cancer and should begin screening by the age of 40 years. Adherence to this recommendation requires effective risk communication between physicians, affected patients, and their at-risk relatives. STUDY: We conducted a telephone survey of 129 consecutive English-speaking adenoma patients younger than 60 years treated by 11 endoscopists at two medical centers. Information regarding patient demographics, awareness of familial risk, and risk communication was elicited. RESULTS: A total of 71 eligible subjects responded to the survey. Few responders (n = 25, 33%) were aware that their FDRs were at increased risk of colorectal cancer, and only 56% of knowledgeable patients identified a physician as the source of information. Awareness was strongly associated (P < or = 0.001) with patient-initiated information-seeking behavior. Most knowledgeable patients (n = 20, 80%) reported that they had informed > or = 1 FDRs about their diagnosis, and most (68%) felt that it was the patient's responsibility to notify at-risk relatives. CONCLUSIONS: Most colorectal adenoma patients younger than 60 years are unaware of the familial implications of their diagnosis and therefore unlikely to notify at-risk FDRs.

On-site screening sigmoidoscopy promotes long-term utilization but fails as a venue for training primary care endoscopists.

BACKGROUND & AIMS: "Academic detailing" is an effective strategy for promoting the use of screening sigmoidoscopy by primary care physicians. The primary objectives of this study were to determine whether the sustained presence of an "outside" university-based gastroenterologist performing on-site screening sigmoidoscopy promoted long-term utilization and whether the provision for on-site sigmoidoscopy was an effective venue for training primary care endoscopists. METHODS: Nine urban community health centers, including 4 intervention and 5 control sites, participated in a nonrandomized controlled trial conducted over 3 years. RESULTS: By the end of year 3, overall self-reported use of screening sigmoidoscopy increased by 61% for the intervention group vs. only 25% for the comparison group (P = 0.001). Ninety-seven percent of those reporting compliance referred 1 or more asymptomatic average-risk patients for screening examinations. Only 2 of 83 (2.4%) eligible providers completed on-site training and continued performing screening examinations independently. The major barriers to participation included lack of interest, lack of time to learn or perform sigmoidoscopy, concerns about technical competence, and lack of need because of on-site availability. CONCLUSIONS: Maintenance of on-site screening sigmoidoscopy services performed by an outside gastroenterologist promotes long-term utilization but fails as venue for training primary care endoscopists. Alternative strategies for expanding capacity are needed.

Family history and colorectal cancer screening: a survey of physician knowledge and practice patterns.

OBJECTIVES: Risk stratification is essential to effective implementation of colorectal cancer (CRC) screening strategies. The objectives of this study were to assess and compare the current knowledge and practice patterns of gastroenterologists and primary care physicians regarding familial risk of CRC. METHODS: We conducted a survey of regional gastroenterologists and a sample of university- and community-based primary care physicians. The survey instrument assessed physician knowledge of screening recommendations and current practices for individuals with family histories of CRC, adenomatous polyps (APs), familial adenomatous polyposis (FAP), and hereditary nonpolyposis cancer (HNPCC). The instrument also elicited data about familial risk assessment, documentation, and notification of at-risk family members. RESULTS: Thirty-five gastroenterologists (65%) and 58 primary care physicians (92%) completed the survey. Most gastroenterologists and primary care physicians (85% vs 72%) chose age 40 as the appropriate age to begin screening for a family history of CRC, but relatively few (37% vs 36%) recommended screening at age 40 for a family history of APs. Gastroenterologists were significantly more likely to recommend screening for FAP at puberty (80% vs 27%, p < 0.001) and for HNPCC at age 25 (73% vs 50%, p = 0.04). Colonoscopy was the preferred screening strategy by both groups for family histories of CRC (97%), HNPCC (97%), and APs (77%); primary care physicians also preferred colonoscopy for family histories of CRC (72%) and HNPCC (76%) but flexible sigmoidoscopy plus fecal occult blood testing for a family history of APs (38%). Gastroenterologists were more likely to recommend genetic testing for persons at risk of FAP (91% vs 71%, p = 0.03) and HNPCC (72% vs 57%, p = 0.18), routinely inquire about a family history of CRC or APs (93% vs 63%, p < 0.001), and recommend notification of at-risk first-degree relatives with family histories of CRC (94% vs 55%, p < 0.001) or AP (53% v.s 6%, p < 0.001). CONCLUSION: Although gastroenterologists are more likely than primary care physicians to elicit a family history of colorectal neoplasia and implement appropriate screening strategies, overall compliance with recommended guidelines and notification of at-risk relatives are suboptimal. Novel approaches for improving awareness of the available screening guidelines are needed.