Predicting methane emissions of individual grazing dairy cows from spectral analyses of their milk samples.

Data on the enteric methane emissions of individual cows are useful not just in assisting management decisions and calculating herd inventories but also as inputs for animal genetic evaluations. Data generation for many animal characteristics, including enteric methane emissions, can be expensive and time consuming, so being able to extract as much information as possible from available samples or data sources is worthy of investigation. The objective of the present study was to attempt to predict individual cow methane emissions from the information contained within milk samples, specifically the spectrum of light transmittance across different wavelengths of the mid-infrared (MIR) region of the electromagnetic spectrum. A total of 93,888 individual spot measures of methane (i.e., individual samples of an animal's breath when using the GreenFeed technology) from 384 lactations on 277 grazing dairy cows were collapsed into weekly averages expressed as grams per day; each weekly average coincided with a MIR spectral analysis of a morning or evening individual cow milk sample. Associations between the spectra and enteric methane measures were performed separately using partial least squares regression or neural networks with different tuning parameters evaluated. Several alternative definitions of the enteric methane phenotype (i.e., average enteric methane in the 6 d preceding or 6 d following taking the milk sample or the average of the 6 d before and after the milk sample, all of which also included the enteric methane emitted on the day of milk sampling), the candidate model features (e.g., milk yield, milk composition, and milk MIR) as well as validation strategy (i.e., cross-validation or leave-one-experimental treatment-out) were evaluated. Irrespective of the validation method, the prediction accuracy was best when the average of the milk MIR from the morning and evening milk sample was used and the prediction model was developed using neural networks; concurrently including milk yield and days in milk in the prediction model generated superior predictions relative to just the spectral information alone. Furthermore, prediction accuracy was best when the enteric methane phenotype was the average of at least 20 methane spot measures across a 6-d period flanking each side of the milk sample with associated spectral data. Based on the strategy that achieved the best accuracy of prediction, the correlation between the actual and predicted daily methane emissions when based on 4-fold cross-validation varied per validation stratum from 0.68 to 0.75; the corresponding range when validated on each of the 8 different experimental treatments focusing on alternative pasture grazing systems represented in the dataset varied from 0.55 to 0.71. The root mean square error of prediction across the 4-folds of cross-validation was 37.46 g/d, whereas the root mean square error averaged across all folds of leave-one-treatment-out was 37.50 g/d. Results suggest that even with the likely measurement errors contained within the MIR spectrum and gold standard enteric methane phenotype, enteric methane can be reasonably well predicted from the infrared spectrum of milk samples. What is yet to be established, however, is whether (a) genetic variation exists in this predicted enteric methane phenotype and (b) selection on estimates of genetic merit for this phenotype translate to actual phenotypic differences in enteric methane emissions.

Animal factors that affect enteric methane production measured using the GreenFeed monitoring system in grazing dairy cows.

Similar to all dairy systems internationally, pasture-based dairy systems are under increasing pressure to reduce their greenhouse gas (GHG) emissions. Ireland and New Zealand are 2 countries operating predominantly pasture-based dairy production systems where enteric CH4 contributes 23% and 36% of total national emissions, respectively. Ireland currently has a national commitment to reduce 51% of total GHG emissions by 2030 and 25% from agriculture by 2030, as well as striving to achieve climate neutrality by 2050. New Zealand's national commitment is to reduce 10% of methane emissions by 2030 and between 24% and 47% reduction in methane emissions by 2050. To achieve these reductions, factors that affect enteric methane (CH4) production in a pasture-based system need to be investigated. The objective of this study was to assess the relationship between enteric CH4 and other animal traits (feed intake, metabolic liveweight, energy corrected milk yield, milk urea concentration and body condition score) in a grazing dairy system. Enteric CH4 emissions were measured on 45 late lactation (213.8 ± 29 d after calving) grazing Holstein-Friesian and Holstein-Friesian × Jersey crossbred cows (Lactation number 3.01 ± 1.65, 538.64 ± 59.37 kg live weight, and 3.14 ± 0.26 body condition score) using GreenFeed monitoring equipment for 10 weeks. There was a training period for the cows to use the GreenFeed of 3 weeks before the 10 week study period. The average enteric CH4 produced in the study was 352 g ± 45.7 g per day with an animal to animal coefficient of variation of 13%. Dry matter intake averaged 16.6 kg ± 2.23 kg per day, while milk solids (fat plus protein) averaged 1.62 kg ± 0.29 kg per day. A multiple linear regression model indicated that each one unit increase in energy corrected milk yield, metabolic liveweight and milk urea concentration, resulted in an increase in enteric CH4 production per day by 3.91g, 1.74 g and 1.38 g, respectively. While each one unit increase in body condition score resulted in a decrease in 39.03 g CH4 produced per day. When combined, these factors explained 47% of the variation in CH4 production, indicating that there is a large proportion of variation not included in the model. The repeatability of the CH4 measurements was 0.66 indicating that cows are relatively consistently exhibiting the same level of CH4 throughout the study. Therefore, enteric CH4 production is suitable for phenotyping.

Intersectionality and public understandings of health inequity in England: learning from the views and experiences of young adults.

OBJECTIVES: Attempts to reduce health inequities in England frequently prioritise some equity dimensions over others. Intersectionality highlights how different dimensions of inequity interconnect and are underpinned by historic and institutionalised power imbalances. We aimed to explore whether intersectionality could help us shed light on young adults' understanding of health inequities. STUDY DESIGN: The study incorporatedqualitative thematic analysis of primary data. METHODS: Online focus groups with young adults (n = 25) aged 18-30 living in three English regions (Greater London; South Yorkshire/Midlands; North-East England) between July 2020 and March 2021. Online semistructured interviews (n = 2) and text-based communication was conducted for participants unable to attend online groups. RESULTS: Young adults described experiencing discrimination, privilege, and power imbalances driving health inequity and suggested ways to address this. Forms of inequity included cumulative, within group, interacting, and the experience of privilege alongside marginalisation. Young adults described discrimination occurring in settings relevant to social determinants of health and said it adversely affected health and well-being. CONCLUSION: Intersectionality, with its focus on discrimination and identity, can help public health stakeholders engage with young adults on health equity. An upstream approach to improving health equity should consider multiple and intersecting forms of discrimination along with their cultural and institutional drivers.

Assessment of the current performance of grazing infrastructure across Irish dairy farms.

The increased average Irish dairy herd size in a post-quota environment has put heightened pressure on grazing infrastructure. In a rotational grazing system, grazing infrastructure consists of the paddock system, which delineates the grazing areas into appropriately sized grazing parcels, and the roadway network, which connects these paddocks to the milking parlor. Where herd size has increased without corresponding adaptations to the infrastructure, farm management and roadway network performance has been affected. The links between suboptimal grazing infrastructure and roadway network efficiency are poorly understood and not widely documented. The aims of this study were to (1) analyze the effect of herd expansion and paddock size on pasture allocations per paddock, (2) identify the factors that affect the total distance walked per year, and (3) create a metric to compare the efficiency of roadway networks across farms of varying grazing platforms. A sample population of 135 Irish dairy farms with a median herd size of 150 cows was used for this analysis. Herds were split into the following 5 categories: <100 cows, 100 to 149 cows, 150 to 199 cows, 200 to 249 cows, and ≥250 cows. Herds with ≥250 cows had a greater number of paddocks per farm and rotated around the grazing paddocks more frequently, with 46% of paddocks only suitable for 12 h allocations relative to herd size, compared with just 10% to 27% of paddocks for herds with <100 cows to herds with 200-249 cows. When predicting the total distance walked per year on each study farm, the mean distance from a paddock to the milking parlor was the strongest indicator (R2 = 0.8247). Other metrics, such as herd size, have failed to account for the location of the milking parlor relative to the grazing platform. The creation of the relative mean distance from a paddock to milking parlor (RMDMP) metric allowed the calculation of a farm's roadway network efficiency for moving the herd between paddocks and the milking parlor. The analyzed farms increased their efficiency in terms of RMDMP (0.34-40.74%) as they increased herd size post quota. However, the position of new additional paddocks relative to the milking parlor substantially affected their RMDMP.

Strategies for knowledge exchange for action to address place-based determinants of health inequalities: an umbrella review.

BACKGROUND: Place-based health inequalities persist despite decades of academics and other stakeholders generating ideas and evidence on how to reduce them. This may in part reflect a failure in effective knowledge exchange (KE). We aim to understand what KE strategies are effective in supporting actions on place-based determinants and the barriers and facilitators to this KE. METHODS: An umbrella review was undertaken to identify relevant KE strategies. Systematic reviews were identified by searching academic databases (Medline, Embase, Scopus, Web of Science) and handsearching. Synthesis involved charting and thematic analysis. RESULTS: Fourteen systematic reviews were included comprising 105 unique, relevant studies. Four approaches to KE were identified: improving access to knowledge, collaborative approaches, participatory models and KE as part of advocacy. While barriers and facilitators were reported, KE approaches were rarely evaluated for their effectiveness. CONCLUSIONS: Based on these four approaches, our review produced a framework, which may support planning of future KE strategies. The findings also suggest the importance of attending to political context, including the ways in which this may impede a more upstream place-based focus in favour of behavioural interventions and the extent that researchers are willing to engage with politicized agendas.

'Dear Doctor': a randomised controlled trial of a text message intervention to reduce burnout in trainee anaesthetists.

One in four doctors in training in the UK reports feeling 'burnt out' due to their work and similar figures are reported in other countries. This two-group non-blinded randomised controlled trial aimed to determine if a novel text message intervention could reduce burnout and increase well-being in UK trainee anaesthetists. A total of 279 trainee anaesthetists (Core Training Year 2, Specialty Training Years 3 or 4) were included. All participants received one initial message sharing support resources. The intervention group (139 trainees) received 22 fortnightly text messages over approximately 10 months. Messages drew on 11 evidence-based themes including: gratitude; social support; self-efficacy; and self-compassion. Primary outcomes were burnout (Copenhagen Burnout Inventory) and well-being (Short Warwick-Edinburgh Mental Well-being Scale). Secondary outcomes were as follows: meaning in work; professional value; sickness absence; and consideration of career break. Outcomes were measured via online surveys. Measures of factors that may have affected well-being were included post-hoc, including the impact of COVID-19 (the first UK wave of which coincided with the second half of the trial). The final survey was completed by 153 trainees (74 in the intervention and 79 in the control groups). There were no significant group differences in: burnout (ß = -1.82, 95%CI -6.54-2.91, p = 0.45); well-being (-0.52, -1.73-0.69, p = 0.40); meaning (-0.09, -0.67-0.50, p = 0.77); value (-0.01, -0.67-0.66, p = 0.99); sick days (0.88, -2.08-3.83, p = 0.56); or consideration of career break (OR = 0.44, -0.30-1.18, p = 0.24). Exploratory post-hoc analysis found the intervention was associated with reduced burnout in participants reporting personal or work-related difficulties during the trial period (-9.56, -17.35 to -1.77, p = 0.02) and in participants reporting that the COVID-19 pandemic had a big negative impact on their well-being (-10.38, -20.57 to -0.19, p = 0.05). Overall, this trial found the intervention had no impact. However, given this intervention is low cost and requires minimal time commitment from recipients, it may warrant adaptation and further evaluation.

Intake, efficiency, and feeding behavior characteristics of Holstein-Friesian cows of divergent Economic Breeding Index evaluated under contrasting pasture-based feeding treatments.

The objective of the current study was to explore differences in dry matter intake, intake capacity, production efficiency, energy balance, and grazing behavior, of 2 divergent genetic groups (GG) of lactating Holstein-Friesian, selected using the Irish Economic Breeding Index (EBI). The GG were evaluated across 3 spring calving pasture-based feeding treatments (FT) over 3 yr. The 2 divergent GG were (1) high EBI, representative of the top 5% nationally (elite), and (2) EBI representative of the national average (NA). In each year 90 elite and 45 NA cows were randomly allocated to 1 of 3 FT: control, lower grass allowance, and high concentrate. Although FT did affect animal performance, there were few notable incidences of GG × FT interaction. The elite cows expressed lower daily milk yield (-1 kg) compared with NA. Elite cows did, however, express higher daily concentrations of milk fat (+3.7 g/kg) and protein (+2.1 g/kg) compared with NA. Daily yield of milk solids and net energy of lactation (NEL) was similar for both GG. Body weight (BW) was greater for NA (+13 kg) compared with elite, whereas mean body condition score was greater (+0.14) for elite compared with NA. Intake did not differ significantly between GG. Intake capacity, expressed as total dry matter intake/100 kg of BW, was greater with elite compared with NA. Production efficiency expressed as yield of milk solids per 100 kg of BW was greater with elite compared with NA, although milk solids/total dry matter intake did not differ between GG. Expressed as NEL as a proportion of net energy intake minus net energy of maintenance (NEL/NEI - NEM) and NEI/milk solids kg, indicated a slight reduction in the utilization of ingested energy for milk production with elite compared with NA. This is, however, suggested as favorable as it manifested as a more positive energy balance with elite compared with NA and so is likely to enhance robustness, increase longevity, and increase overall lifetime efficiency. Noteworthy was a consistent numerical trend toward more intense grazing activity with elite compared with NA cows, exhibited in the numerically greater grazing time (+19 min) and total number of bites per day (+2,591).

Getting shops to voluntarily stop selling cheap, strong beers and ciders: a time-series analysis evaluating impacts on alcohol availability and purchasing.

BACKGROUND: 'Reducing the Strength' (RtS) is a public health initiative encouraging retailers to voluntarily stop selling cheap, strong beers/ciders (≥6.5% alcohol by volume). This study evaluates the impact of RtS initiatives on alcohol availability and purchasing in three English counties with a combined population of 3.62 million people. METHODS: We used a multiple baseline time-series design to examine retail data over 29 months from a supermarket chain that experienced a two-wave, area-based role out of RtS: initially 54 stores (W1), then another 77 stores (W2). We measured impacts on units of alcohol sold (primary outcome: beers/ciders; secondary outcome: all alcoholic products), economic impacts on alcohol sales and substitution effects. RESULTS: We observed a non-significant W1 increase (+3.7%, 95% CI: -11.2, 21.0) and W2 decrease (-6.8%, 95% CI: -20.5, 9.4) in the primary outcome. We observed a significant W2 decrease in units sold across all alcohol products (-10.5%, 95% CI: -19.2, -0.9). The direction of effect between waves was inconsistent for all outcomes, including alcohol sales, with no evidence of substitution effects. CONCLUSIONS: In the UK, voluntary RtS initiatives appear to have little or no impact on reducing alcohol availability and purchase from the broader population of supermarket customers.

Incorporating white clover (Trifolium repens L.) into perennial ryegrass (Lolium perenne L.) swards receiving varying levels of nitrogen fertilizer: Effects on milk and herbage production.

White clover (Trifolium repens L.; clover) can offer a superior nutritional feed compared with perennial ryegrass (Lolium perenne L.; PRG) and offers an additional or alternative source (or both) of N for herbage production. The objective of this study was to investigate the effect of including clover into PRG swards receiving 150 (Cl150) or 250 kg of N/ha (Cl250) compared with a PRG-only sward receiving 250 kg of N/ha (Gr250) on herbage production, milk production, and herbage dry matter intake (DMI) in an intensive grass-based spring calving milk production system over 2 full lactations. A farm systems experiment was established in February 2013, and conducted over 2 grazing seasons [2013 (yr 1) and 2014 (yr 2)]. In February 2013 (yr 1), 42 Holstein-Friesian spring-calving dairy cows, and in February 2014 (yr 2), 57 Holstein-Friesian spring-calving dairy cows were allocated to graze the Cl150, Cl250, and Gr250 swards (n = 14 in yr 1 and n = 19 in yr 2) from February to November, at a stocking rate of 2.74 cows/ha. Herbage DMI was estimated twice in yr 1 (May and September) and 3 times in yr 2 (May, July, and September). Treatment did not have a significant effect on annual herbage production. Sward clover content was greater on the Cl150 treatment than the Cl250 treatment. The cows grazing both clover treatments (Cl250 and Cl150) produced more milk than the cows grazing Gr250 from June until the end of the grazing season. A significant treatment by measurement period interaction was observed on total DMI. In May, the cows on the Cl250 treatment had the greatest DMI. In July, the cows on the clover treatments had greater DMI than those on the Gr250 treatment, whereas in September, the cows on the Cl150 treatment had the lowest DMI. In conclusion, including clover in a PRG sward grazed by spring-calving dairy cows can result in increased animal performance, particularly in the second half of lactation. Reducing N fertilizer application to 150 kg of N/ha on grass-clover swards did not reduce herbage production compared with grass-only swards receiving 250 kg of N/ha. White clover can play an integral role in intensive grazing systems in terms of animal performance and herbage production.

Opiate use disorders and overdose: Medical students' experiences, satisfaction with learning, and attitudes toward community naloxone provision.

INTRODUCTION: Opiate use disorder is a common condition in healthcare services in Ireland, where over 200 opiate overdose deaths occur annually. There is limited addiction medicine education at undergraduate level and medical graduates may not be adequately prepared to diagnose and manage opioid use disorders and emergency drug overdose presentations. Therefore, we examined final-year medical students' learning experiences and attitudes toward opioid use disorder, overdose and community naloxone provision as an emerging overdose treatment. METHODS: We administered an anonymous paper-based survey to 243 undergraduate medical students undertaking their final professional completion module prior to graduation from University College Dublin, Ireland. Results were compared with parallel surveys of General Practitioners (GPs) and GP trainees. RESULTS: A total of 197 (82.1%) completed the survey. Just under half were male, and most were aged under 25 (63.3%) and of Irish nationality (76.7%). The students felt moderately prepared to recognise opioid use disorder, but felt less prepared to manage other aspects of its care. Most had taken a history from a patient with an opioid use disorder (82.8%), and a third had witnessed at least one opioid overdose. Although 10.3% had seen naloxone administered, most had never administered naloxone themselves (98.5%). Half supported wider naloxone availability; this was lower than support rates among GPs (63.6%) and GP trainees (66.1%). CONCLUSIONS: Our findings suggest an unmet learning need in undergraduate training on opioid use disorder, with potential consequences for patient care.

The MERIT 3 project: Alerting general practitioners to cardiac arrest in the community.

BACKGROUND: The work context of the general practitioner (GP) potentially lends itself to the provision of early community based, cardiac arrest care. GPs have traditionally encountered out of hospital cardiac arrest (OHCA) as a component of routine patient care but have not been formally linked with the statutory ambulance service. Computer aided dispatch technology now allows real time GP text message alert to nearby cardiac arrest events. AIM: To examine the feasibility, uptake and outcome of a novel scheme to alert GPs to nearby OHCA events in their communities. METHODS: GPs are recruited to voluntarily participate in a cardiac arrest text alert initiative called the 'MERIT 3' project. GPs indicate the hours during which they wish to receive OHCA text alerts, and also specify a geo-location from which they will receive alerts to OHCA events occurring within a specified radius. Data on alerts, responses, OHCA incidents and outcomes are gathered prospectively, using ambulance control and GP data and with corroborative data from the national OHCA registry. RESULTS: 423 general practices throughout Ireland were invited to participate. In the initial 12 months, 100 GPs from 85 individual practices have enrolled, 74 GPs have received alerts and 26 GPs have responded to incidents. Only 222/781 (28.4%) text alerts issued by ambulance control have proven to be recognised as cardiac arrests with resuscitation attempts. GPs have attended 51/776 (6.6%) OHCA incidents to which they have been alerted, with resuscitation undertaken in 34 cases with three survivors. CONCLUSION: Text alert activation of GPs to nearby OHCA events has proven feasible, with significant activity during the establishment period, but a low survival rate which is similar to the overall national OHCA survival rate. A high proportion of alerts do not involve resuscitation opportunities.

Recruitment Challenges and Enrollment Observations from a Community Based Intervention (Mothers In Motion) for Low-Income Overweight and Obese Women.

BACKGROUND: Mothers In Motion (MIM), a randomized controlled trial, aimed to help young, low-income overweight and obese mothers prevent weight gain by promoting stress management, healthy eating, and physical activity. This paper describes MIM recruitment challenges and reports demographic characteristics affecting enrollment. METHODS: Participants who were African American or Non-Hispanic White were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Michigan. We faced numerous recruitment challenges and learned that several strategies facilitated recruitment. Logistic regression analyses were performed to examine demographic characteristics that affect enrollment. RESULTS: Women who had a higher body mass index (BMI, OR 1.06, 95% CI 1.02 - 1.10); were at late postpartum, (OR 1.24, 95% CI 1.10 - 1.40), were breastfeeding (OR 5.0, 95% CI 2.34 -10.65); or were at early postpartum and breastfeeding (OR 0.42, 95% CI 0.22 - 0.81) were more likely to enroll than their counterparts. Compared to African American women, Non-Hispanic White women were more likely to enroll (OR 1.77, 95% CI 1.29 - 2.42). Also, women who were non-smokers (OR 0.54, 95% CI 0.40 - 0.73) or had a higher education were more likely to enroll (OR 1.21, 95% CI 1.04 - 1.42) than those who smoked or had a lower education. CONCLUSION: Future lifestyle behavioral intervention studies for similar target audiences may consider tailoring their recruitment messages based on relevant participant demographic characteristics identified as potential determinants of enrollment in this study.

Testing the impact of local alcohol licencing policies on reported crime rates in England.

BACKGROUND: Excessive alcohol use contributes to public nuisance, antisocial behaviour, and domestic, interpersonal and sexual violence. We test whether licencing policies aimed at restricting its spatial and/or temporal availability, including cumulative impact zones, are associated with reductions in alcohol-related crime. METHODS: Reported crimes at English lower tier local authority (LTLA) level were used to calculate the rates of reported crimes including alcohol-attributable rates of sexual offences and violence against a person, and public order offences. Financial fraud was included as a control crime not directly associated with alcohol abuse. Each area was classified as to its cumulative licensing policy intensity for 2009-2015 and categorised as 'passive', low, medium or high. Crime rates adjusted for area deprivation, outlet density, alcohol-related hospital admissions and population size at baseline were analysed using hierarchical (log-rate) growth modelling. RESULTS: 284 of 326 LTLAs could be linked and had complete data. From 2009 to 2013 alcohol-related violent and sexual crimes and public order offences rates declined faster in areas with more 'intense' policies (about 1.2, 0.10 and 1.7 per 1000 people compared with 0.6, 0.01 and 1.0 per 1000 people in 'passive' areas, respectively). Post-2013, the recorded rates increased again. No trends were observed for financial fraud. CONCLUSIONS: Local areas in England with more intense alcohol licensing policies had a stronger decline in rates of violent crimes, sexual crimes and public order offences in the period up to 2013 of the order of 4-6% greater compared with areas where these policies were not in place, but not thereafter.

The impact of contemporary multidisciplinary meetings on workload at a tertiary level hospital.

BACKGROUND: In recent years, multidisciplinary meetings (MDMs) have become the standard of patient care in oncologic and other speciality care pathways. The number, complexity, and diverse source of imaging studies presented continue to expand rapidly. True multidisciplinary input requires parallel support from other colleagues and diagnostic services. It is now recognised that this is the appropriate forum for key decision making and education in care algorithms, though service plans make little or no accommodation of their expanding role in addition to existing services. AIMS: We tried to objectively quantify one element of this burgeoning service. METHODS: Data were retrospectively gathered over a 6 month period, and a 5 week prospective study was then performed to examine the workload in further detail. RESULTS: Retrospectively, 199 meetings were held with 2253 clinical cases reviewed over 26 weeks. Prospectively, 52 meetings were held over 5 weeks for 13 clinical specialty areas. There were 1038 clinical case discussions. There were a total of 2122 documented individual imaging studies reviewed. Specialist registrar preparation time was 55 h (11 per week). Consultant preparation time was 67.75 h (13.55 per week). Delivery time was 57.25 h (11.45 per week). CONCLUSION: The complexity and range of cases at MDMs continue to expand, serving local and national needs, though service plans do not acknowledge their role in the working day. Our study shows just one element that clearly signals a need to take account of the new methods of delivering modern healthcare.

When is an image a health claim? A false-recollection method to detect implicit inferences about products' health benefits.

OBJECTIVE: Images on food and dietary supplement packaging might lead people to infer (appropriately or inappropriately) certain health benefits of those products. Research on this issue largely involves direct questions, which could (a) elicit inferences that would not be made unprompted, and (b) fail to capture inferences made implicitly. Using a novel memory-based method, in the present research, we explored whether packaging imagery elicits health inferences without prompting, and the extent to which these inferences are made implicitly. METHOD: In 3 experiments, participants saw fictional product packages accompanied by written claims. Some packages contained an image that implied a health-related function (e.g., a brain), and some contained no image. Participants studied these packages and claims, and subsequently their memory for seen and unseen claims were tested. RESULTS: When a health image was featured on a package, participants often subsequently recognized health claims that-despite being implied by the image-were not truly presented. In Experiment 2, these recognition errors persisted despite an explicit warning against treating the images as informative. In Experiment 3, these findings were replicated in a large consumer sample from 5 European countries, and with a cued-recall test. CONCLUSION: These findings confirm that images can act as health claims, by leading people to infer health benefits without prompting. These inferences appear often to be implicit, and could therefore be highly pervasive. The data underscore the importance of regulating imagery on product packaging; memory-based methods represent innovative ways to measure how leading (or misleading) specific images can be. (PsycINFO Database Record

Registries and Cohorts to Accelerate Early Phase Alzheimer's Trials. A Report from the E.U./U.S. Clinical Trials in Alzheimer's Disease Task Force.

The EU/US/CTAD Task Force, an international collaboration of AD investigators from industry and academia, met in Barcelona, Spain, on November 4th, 2015, to explore existing and planned patient registries and other clinical trial infrastructure meant to expedite recruitment of large numbers of participants into clinical trials and improve their productivity. The Task Force identified a number of approaches currently being tested around the world, including the use of predictive algorithms to identify individuals likely to have prodromal or preclinical AD, the establishment of clinical trial networks to streamline trials, and reforming the informed consent process to make it less burdensome to both investigators and trial participants. Multi-national systems such as the European Prevention of Alzheimer's Dementia (EPAD) and the Global Alzheimer's Platform (GAP) offer value for sponsors, trial sites, and patients by optimizing efforts to find effective disease-modifying and symptomatic treatments.

[Physiotherapy and physical therapy in pain management]. / Physiotherapie und physikalische Therapie in der Schmerzmedizin.

Patients attend physiotherapy and physical therapy (PT) due to pain problems and/or functional impairments. Although the main focus for therapists has traditionally been physical examination and treatment of tissue structures and biomechanics, over the last few decades a growing body of research has highlighted the importance of central nervous system processing and psychosocial contributors to pain perception. Treatment with PT aims to reduce disability and suffering by reducing pain and increasing tolerance to movement. In Germany, pain management conducted by physiotherapists is currently undergoing major changes. Firstly, PT education is transitioning from a vocational to a degree level and additionally new concepts for improved multidisciplinary treatment approaches are being developed. However, there still remain substantial differences between therapists working in multidisciplinary pain clinics and those following medical referral in private practices. This article provides information on how national and international impulses have contributed to the development of different concepts of passive therapies and active/functional pain rehabilitation in Germany. In the future PT will need to provide more evidence about efficiency and modes of actions for different treatment options to selectively reason the application to patients with acute, subacute and chronic pain.