The effect of temperature on first feeding, growth and survival of larval witch flounder, Glyptocephalus cynoglossus

Witch flounder Glyptocephalus cynoglossus has recently been identified as a candidate species for aquaculture in the northeastern United States and the Canadian Atlantic Provinces. This study investigated the optimal temperatures for witch flounder larval first feeding and for long term larval culture from hatching through metamorphosis. Maximum first feeding occurred between 15.0 and 16.2 C. Larvae did not survive beyond first feeding when reared at mean temperatures of 5.1, 10.4, or 19.5 C and were unable to initiate feeding at mean rearing temperatures below 6.0 C. At a rearing temperature of 15.0 C in 16‐L tanks, mean larval survival to 60 days post hatch (dph) was 14.1%. Mean overall length‐specific growth rate for larvae reared to 60 dph at 15.0 C was 3.5%/d and mean absolute growth was 0.62 mm/d. Subsequent larval growth at 15.6 C began to taper off towards 70 dph at the onset of weaning which overlapped with larval metamorphosis. Growth plateaued at 85 dph, followed by a rebound between 90 and 95 dph. Survival was 100% when weaning onto a dry, pelleted diet was initiated at 70 dph with a 10‐d live diet co‐feeding period. These results are favorable and encourage the further pursuit of commercial witch flounder culture

Taking Well-Being Seriously – Our Clinical Learning Environment (CLE) Partnership Strategy

Introduction/Background Physician well-being has become a national issue as it impacts patient safety and quality of care, workforce and culture. Nationally and within our health care system there are multiplying discussions and emerging initiatives around well-being from the ACGME’s Symposium of Physician Well-Being and AHME’s webinars and academy conference to the AAMC’s and AIAMC’s annual meeting and workshops. The number of options and evidence-based strategies are bewildering. How much do you focus on the individual? What role does the environment redesign play? How can we turn these evolving discussions into an opportunity for GME? At Aurora Health Care, we have utilized our CLER-established partnerships - composed of system, hospital, physician education and GME leaders - to identity “shared pain points” and implement a consistent strategy across our hospitals/programs. Hypothesis/Aim Statement To utilize our CLER Synergy Group to coalesce and leverage the system/hospital well-being across the continuum of medical education. Methods Working with CLER synergy partners, resident council and physician education leaders we sought to identify current/pending initiatives around physician well-being. The synergy group reviewed the initiatives to determine initiatives that would cut across all levels of physician training. Results Through our CLER Synergy group, chaired by our DIO, we are partnering with CMO’s, Medical Education Continuum Leaders, Resident Council & GME Leaders, and experts in well-being and medical education. Our multi-pronged strategy includes: Well-being is included as one of four options for GME Shared Noon Conference resident/faculty program teams to meet quality improvement project options during 2016-2017 Assessment of Physicians and Residents/Fellows use of nationally available/established burnout inventory Make clinician satisfaction and well-being GME quality indicators Design and implement a CME – Performance Improvement Clinical Quality Improvement (CQI) activity (Part IV MOC Points) well-being initiative requiring both individual and environment change metrics available to all physicians and medical students Leverage well-being programs under development within the system (e.g., Employee Health) Utilizing data from burnout inventory to Identify and implement well-being initiatives using a train-the-trainer model for GME program leaders through a GME retreat Conclusions Utilizing our CLER Synergy Group to address physician well-being allows GME to be placed in a key leadership role within the organization as we align our initiatives with hospital/system priorities

Common genetic variation and performance on standardized cognitive tests

One surprising feature of the recently completed waves of genome-wide association studies is the limited impact of common genetic variation in individually detectable polymorphisms on many human traits. This has been particularly pronounced for studies on psychiatric conditions, which have failed to produce clear, replicable associations for common variants. One popular explanation for these negative findings is that many of these traits may be genetically heterogeneous, leading to the idea that relevant endophenotypes may be more genetically tractable. Aspects of cognition may be the most important endophenotypes for psychiatric conditions such as schizophrenia, leading many researchers to pursue large-scale studies on the genetic contributors of cognitive performance in the normal population as a surrogate for aspects of liability to disease. Here, we perform a genome-wide association study with two tests of executive function, Digit Symbol and Stroop Color-Word, in 1086 healthy volunteers and with an expanded cognitive battery in 514 of these volunteers. We show that, consistent with published studies of the psychiatric conditions themselves, no single common variant has a large effect (explaining >4–8% of the population variation) on the performance of healthy individuals on standardized cognitive tests. Given that these are important endophenotypes, our work is consistent with the idea that identifying rare genetic causes of psychiatric conditions may be more important for future research than identifying genetically homogenous endophenotypes

Management of Bacteriuria in Veterans Affairs Hospitals.

BackgroundBacteriuria contributes to antibiotic overuse through treatment of asymptomatic bacteriuria (ASB) and long durations of therapy for symptomatic urinary tract infections (UTIs), yet large-scale evaluations of bacteriuria management among inpatients are lacking.MethodsInpatients with bacteriuria were classified as asymptomatic or symptomatic based on established criteria applied to data collected by manual chart review. We examined frequency of treatment of ASB, factors associated with treatment of ASB, durations of therapy, and frequency of complications including Clostridium difficile infection, readmission, and all-cause mortality within 28 days of discharge.ResultsAmong 2225 episodes of bacteriuria, 64% were classified as ASB. After excluding patients with non-UTI indications for antibiotics, 72% of patients with ASB received antibiotics. When evaluating only patients not meeting SIRS criteria, 68% of patients with ASB received antibiotics. The mean (±SD) days of antibiotic therapy for ASB, cystitis, CA-UTI and pyelonephritis were 10.0 (4.5), 11.4 (4.7), 12.0 (6.1), and 13.6 (5.3), respectively. In sum, 14% of patients with ASB were treated for greater than 14 days, and fluoroquinolones were the most commonly used empiric antibiotic for ASB [245/691 (35%)]. Complications were rare but more common among patients with ASB treated with antibiotics.ConclusionsThe majority of bacteriuria among inpatient veterans is due to ASB with high rates of treatment of ASB and prolonged durations of therapy for ASB and symptomatic UTIs

Family Caregiving for Persons with Heart Failure at the Intersection of Heart Failure and Palliative Care: A State-of-the-Science Review

Many of the 23 million individuals with heart failure (HF) worldwide receive daily, unpaid support from a family member or friend. Although HF and palliative care practice guidelines stipulate that support be provided to family caregivers, the evidence base to guide care for this population has not been comprehensively assessed. In order to appraise the state-of-the-science of HF family caregiving and recommend areas for future research, the aims of this review were to summarize (1) how caregivers influence patients, (2) the consequences of HF for caregivers, and (3) interventions directed at HF caregivers. We reviewed all literature to December 2015 in PubMed and CINAHL using the search terms “heart failure” AND “caregiver.” Inclusion criteria dictated that studies report original research of HF family caregiving. Articles focused on children or instrument development or aggregated HF with other illnesses were excluded. We identified 120 studies, representing 5700 caregivers. Research on this population indicates that (1) caregiving situations vary widely with equally wide-ranging tasks for patients to help facilitate their health behaviors, psychological health and relationships, and quality of life (QoL); (2) caregivers have numerous unmet needs that fluctuate with patients’ unpredictable medical status, are felt to be ignored by the formal healthcare system, and can lead to distress, burden, and reduced QoL; and (3) relatively few interventions have been developed and tested that effectively support HF family caregivers. We provide recommendations to progress the science forward in each of these areas that moves beyond descriptive work to intervention development and clinical trials testing