Effectiveness of a Faculty Development Program in Fostering Interprofessional Education Competencies

AbstractBackground: To determine the effectiveness of a faculty development program offered to clinical faculty in fostering interprofessional education competencies.Methods and Findings: A pre-post randomized control group design was used in which only one of two cohorts of clinical faculty received an interprofessional educational intervention. Both cohorts then facilitated case-based interprofessional education sessions for student learners. A variety of outcome measures were used to assess differences between groups in terms of knowledge, skills, and attitudes related to interprofessional education and practice. No significant differences were noted between the control and intervention groups.Conclusions: The use of a pre-post randomized control group design to measure effectiveness of an educational intervention should be considered to demonstrate the impact of educational interventions

Effects of paylean (ractopamine⋅HCl) on finishing pig growth and variation

A total of 336 pigs were used in a 21-day trial to determine the effect of Paylean (9.0 g/ton Ractopamine·HCl) on finishing pig growth and variation. Pigs were allotted based on weight so that all pens had the same initial weight and degree of variation within the pen. Pigs fed Paylean had greater ADG and better feed efficiency than control-fed pigs (P<0.05). However, no differences in pen coefficient of variation were observed (P>0.70). The results suggest that adding Paylean to the diet improves finishing pig growth performance but does not affect weight variation within the pen

Evaluation of different soy protein concentrate sources on growth performance of weanling pigs

Three experiments were conducted using 486 weanling pigs (216 in Experiment 1; 210 in Experiment 2; 60 in Experiment 3) to determine the effects of different soy protein concentrate (SPC) sources on growth performance. Soy protein concentrate source 1 is dried with a torus disk following the concentration of soy proteins. This drying procedure will generate some degree of heat and possibly mechanical forces somewhat similar to extrusion processing (Soycomil P®, ADM). Soy protein concentrate source 2 is dried by a different process, and then it is moist extruded (Profine E, Central Soya). Therefore, the objective of our study was to determine the relative feeding value of the different SPC sources compared with a complex diet containing milk and other specialty proteins (no soy protein), or a diet containing 40% soybean meal. In Experiment 1, each SPC source (28.6%) replaced all the soybean meal (SBM) in the control diet on a lysine basis. Pigs fed the diet containing 40% SBM had similar performance to pigs fed the milk-protein based diet from d 0 to 14. Pigs fed either SPC source had lower ADG and ADFI compared to pigs fed either the diet containing 40% SBM or the milkprotein based diet. Pigs fed the diet containing 40% SBM and SPC from source 2 had better F/G than pigs fed the milk-protein based diet or SPC from source 1. In Experiment 2, either all or half of the soybean meal was replaced by the 28.6 or 14.3% SPC from source 1 and 2. From d 0 to 14 and d 0 to 28, an SPC source by level interaction was observed for ADG (P<0.01) and ADFI (P<0.07). Replacing soybean meal with SPC from source 1 did not influence pig performance. However, replacing soybean meal with SPC from source 2 resulted in a quadratic (P<0.05) improvement in ADG with performance being improved for the diet containing 14.3% SPC, but no benefit to replacing all the soybean meal with SPC. Replacing soybean meal with SPC from either source influenced feed efficiency in a quadratic (P<0.01) manner with feed efficiency being optimal for pigs consuming the diet with half the soybean meal replaced by SPC. Because replacing all of the soybean meal with SPC reduced ADFI in Experiments 1 and 2, we hypothesized that pigs may not prefer the taste of a diet with a high inclusion rate of SPC (28.6%). To test this theory, a 7-day preference test was conducted to determine feed intake of weanling pigs provided the option of consuming diets containing either 40% soybean meal or 28.6% SPC (from source 2). Average daily feed intake was 0.41 and 0.01 lb for the 40% soybean meal and 28.6% soy protein concentrate diets, respectively (P<0.0001). The poor intake of the SPC diet may indicate a palatability problem when high levels of SPC are included in the diet. Our results suggest replacing a portion of the soybean meal in the diet with SPC from source 2 improves ADG and feed efficiency; however, high levels (28.6%) of SPC should not be included in the diet

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

The Problematization of Sexuality among Women Living with HIV and a New Feminist Approach for Understanding and Enhancing Women’s Sexual Lives

In the context of HIV, women’s sexual rights and sexual autonomy are important but frequently overlooked and violated. Guided by community voices, feminist theories, and qualitative empirical research, we reviewed two decades of global quantitative research on sexuality among women living with HIV. In the 32 studies we found, conducted in 25 countries and composed mostly of cis-gender heterosexual women, sexuality was narrowly constructed as sexual behaviours involving risk (namely, penetration) and physiological dysfunctions relating to HIV illness, with far less attention given to the fullness of sexual lives in context, including more&nbsp;positive and rewarding experiences such as satisfaction and pleasure. Findings suggest that women experience declines in sexual activity, function, satisfaction, and pleasure following HIV diagnosis, at least for some period. The extent of such declines, however, is varied, with numerous contextual forces shaping women’s sexual well-being. Clinical markers of HIV (e.g., viral load, CD4 cell count) poorly predicted sexual outcomes, interrupting widely held assumptions about sexuality for women with HIV. Instead, the effects of HIV-related stigma intersecting with inequities related to trauma, violence, intimate relations, substance use, poverty, aging, and other social and cultural conditions primarily influenced the ways in which women experienced and enacted their sexuality. However, studies framed through a medical lens tended to pathologize outcomes as individual “problems,” whereas others driven by a public health agenda remained primarily preoccupied with protecting the public from HIV. In light of these findings, we present a new feminist approach for research, policy, and practice toward understanding and enhancing women’s sexual lives—one that affirms sexual diversity; engages deeply with society, politics, and history; and is grounded in women’s sexual rights

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Effects of increasing CA:P ratio in diets containing phytase on growth performance of grow-finish pigs

We used 144 growing-finishing pigs (72 barrows and 72 gilts; initially 85 lb) to determine the effects of calcium to total phosphorus (Ca:P) ratio on growth performance. Pigs were housed in an environmentally regulated finishing building with two pigs per pen and nine pens per sex per treatment in a randomized complete block design. Pigs were blocked by initial weight and sex, and then allotted to one of four dietary treatments. The dietary treatments were corn-soybean meal-based diets fed in three phases. In each phase, diets consisted of a 1:1; 1.25:1; 1.5:1, and 2:1 Ca:P ratio. Diets were formulated to contain 0.44%, 0.39%, and 0.34% phosphorus from 70 to 130, 130 to 190, and 190 to 250 lb, respectively. All diets contained 0.05% phytase, providing 300 FTU/kg of feed. For the overall experiment, increasing Ca:P ratio decreased ADG (quadratic P<0.03) and ADFI (linear P<0.05). However, the greatest decrease in ADG and ADFI was observed when Ca:P increased from 1.5:1 to 2:1. Feed to gain was not affected by Ca:P ratio. These results suggest that in growing-finishing diets containing 300 FTU/kg phytase, a Ca:P ratio greater then 1.5:1 will decrease ADG and ADFI