Factors associated with antimicrobial resistant enterococci in Canadian beef cattle: A scoping review

IntroductionAntimicrobial resistance (AMR) is a global health concern, occurring when bacteria evolve to render antimicrobials no longer effective. Antimicrobials have important roles in beef production; however, the potential to introduce AMR to people through beef products is a concern. This scoping review identifies factors associated with changes in the prevalence of antimicrobial-resistant Enterococcus spp. applicable to the Canadian farm-to-fork beef continuum.MethodsFive databases (MEDLINE, BIOSIS, Web of Science, Embase, and CAB Abstracts) were searched for articles published from January 1984 to March 2022, using a priori inclusion criteria. Peer-reviewed articles were included if they met all the following criteria: written in English, applicable to the Canadian beef production context, primary research, in vivo research, describing an intervention or exposure, and specific to Enterococcus spp.ResultsOut of 804 screened articles, 26 were selected for inclusion. The included articles discussed 37 factors potentially associated with AMR in enterococci, with multiple articles discussing at least two of the same factors. Factors discussed included antimicrobial administration (n = 16), raised without antimicrobials (n = 6), metal supplementation (n = 4), probiotics supplementation (n = 3), pen environment (n = 2), essential oil supplementation (n = 1), grass feeding (n = 1), therapeutic versus subtherapeutic antimicrobial use (n = 1), feeding wet distiller grains with solubles (n = 1), nutritional supplementation (n = 1) and processing plant type (n = 1). Results were included irrespective of their quality of evidence.DiscussionComparability issues arising throughout the review process were related to data aggregation, hierarchical structures, study design, and inconsistent data reporting. Findings from articles were often temporally specific in that resistance was associated with AMR outcomes at sampling times closer to exposure compared to studies that sampled at longer intervals after exposure. Resistance was often nuanced to unique gene and phenotypic resistance patterns that varied with species of enterococci. Intrinsic resistance and interpretation of minimum inhibitory concentration varied greatly among enterococcal species, highlighting the importance of caution when comparing articles and generalizing findings.Systematic Review Registration[http://hdl.handle.net/1880/113592

Library and Informatics Training May Improve Question Formulation among Public Health Practitioners, A Review of: Eldredge, Jonathan D., Richard Carr, David Broudy, and Ronald E. Voorhees. “The Effect of Training on Question Formulation among Public Health Practitioners: Results from a Randomized Controlled Trial.” Journal of the Medical Library Association 96.4 (2008): 299‐309.

Objective – To determine whether providing library and informatics training to public health professionals would increase the number and sophistication of work‐related questions asked by these workers.Design – Randomized controlled trial.Setting – New Mexico Department of Health.Subjects – Public health professionals from a variety of professions, including “administrators, disease prevention specialists, epidemiologists, health educators, nurses, nutritionists, physicians, program directors, and social workers” (301). Only staff from the New Mexico Department of Health were eligible to participate.Methods – All subjects received a three‐hour training session on finding evidence based public health information, with a focus on using PubMed. Two sessions were offered, two weeks apart. Participants were randomized to either an intervention group, which received instruction on the first date, or a control group, which received instruction on the second date. The intervening two weeks constitute the study period, in which both groups were surveyed by e‐mail about their work‐related question generation. Three times per week, subjects received e‐mail reminders asking them to submit survey responses regarding all questions that had arisen in their practice, along with information about their attempts to answer them. Questions were tallied, and totals were compared between the two groups. Questions were also analysed for level of sophistication, and classified by the investigators as either “background” questions, which are asked when one has little knowledge of the field, and can usually be answered using textbooks or other reference sources, or “foreground” questions, which are often asked when an individual is familiar with the subject, and looking for more sophisticated information that is usually found in journals and similar sources. This scheme for classifying questions was developed by Richardson and Mulrow.Main Results – The investigators found differences in both the number and sophistication of the questions asked between the control and intervention groups. The control group averaged only 0.69 questions per participant during the two‐week observation period, while the intervention group averaged 1.24 questions. Investigators also found that a higher percentage of the questions asked by the intervention group were foreground questions (50.0%, versus 42.9% for the control group). However, when two‐tailed t‐test analysis was performed on both the frequency of questions and the level of sophistication, the findings were not statistically significant within a 95% confidence interval.Conclusion – This study suggests that library and informatics training for public health professionals may increase the number of questions that they ask on work‐related topics, and also the sophistication of these questions. However, more studies need to be done to confirm these findings. The authors suggest that replication of the study would be useful, particularly as Hurricanes Katrina and Rita interfered with their ability to recruit and retain participants. They also suggest that studies be conducted on other training methods to see which are most effective at motivating users to seek information. Finally, the authors suggest that a prospective cohort study might be a useful method for predicting the effect of training on participants’ motivation to pursue answers to their questions

Free Access Does Not Necessarily Encourage Practitioners to Use Online Evidence Based Information Tools. A Review of: Buchan, H., Lourey, E., D’Este, C., & Sanson-Fisher, R. (2009). Effectiveness of strategies to encourage general practitioners to accept an offer of free access to online evidence-based information: A randomised controlled trial. Implementation Science, 4, article 68.

<b>Objectives </b>– To determine which strategies were most effective for encouraging general practitioners (GPs) to sign up for free access to an online evidence based information resource; and to determine whether those who accepted the offer differed in their sociodemographic characteristics from those who did not.<br><b>Design</b> – Descriptive marketing research study.<br><b>Setting</b> – Australia’s public healthcare system.<br><b>Subjects</b> – 14,000 general practitioners (GPs) from all regions of Australia.<br><b>Methods</b> – Subjects were randomly selected by Medicare Australia from its list of GPs that bill it for services. Medicare Australia had 18,262 doctors it deemed eligible; 14,000 of these were selected for a stratified random sample. Subjects were randomized to one of 7 groups of 2,000 each. Each group received a different letter offering two years of free access to BMJ Clinical Evidence, an evidence based online information tool. Randomization was done electronically, and the seven groups were stratified by age group, gender, and location. The interventions given to each group differed as follows:<br>• Group 1: Received a letter offering 2 years of free access, with no further demands on the recipient.<br>• Group 2: Received a letter offering 2 years of free access, but on the condition that they complete an initial questionnaire and another one at 12 months, as well as allowing the publisher to provide de-personalized usage data to the researchers.<br>• Group 3: Same as Group 2, but with the additional offer of an online tutorial to assist them with using the resource.<br>• Group 4: Same as Group 2, but with an additional pamphlet with positive testimonials about the resource from Australian medical opinion leaders.<br>• Group 5: Same as Group 2, but with an additional offer of professional development credits towards their required annual totals.<br>• Group 6: Same as Group 2, but with an additional offer to be entered to win a prize of $500 towards registration at a conference of the winner’s choice.<br>• Group 7: A combination of the above interventions. The group received the opinion leaders’ pamphlet, the online tutorial, and eligibility for professional development points.<br>The online survey and usage data from Groups 2 through 7 was to be analyzed as part of a companion study, and is not reported in this article.To protect the privacy of individual subjects, Medicare Australia mailed out the offers and provided the authors with anonymized data, in table format, on response status by intervention group and by the following sociodemographic variables: age, gender, geographic remoteness as determined by the Accessibility/Remoteness Index of Australia (ARIA), country of graduation, and years since graduation. Baseline characteristics were compared between the intervention groups, and then response rates were also compared between intervention groups and between the above-mentioned variables to see whether any of these variables affected the likelihood of practitioners being interested in an online evidence based tool. All comparisons were done using a chi-square test.<br><b>Main Results</b> – Overall, 2,105 subjects returned their acceptance forms, out of the total sample of 14,000 (15%). The true acceptance rate was 12.5%, however, when adjusted for the number of subjects in Groups 2 through 7 who went on to complete the online questionnaire.There was a statistically significant difference in response rates between the seven groups, with the greatest acceptance rate (27%) coming from Group 1 (who received only the letter of offer, with no experimental demands). The other groups averaged a response rate of 10% collectively, with the lowest rates (8.0% and 8.5% respectively) from Group 5 (offer of professional development points) and Group 7 (combination of interventions).The large sample size offered adequate power to detect differences in characteristics between responders and non-responders. The study found that responders were more likely to be younger, male, recent graduates, and practising in less remote locations. Among responders, there were no statistically significant differences in most of these characteristics among the seven groups, with the exception of time since graduation, which varied somewhat.<br><b>Conclusion</b> –The authors conclude that funding of access to free online resources for large groups of practitioners may not be cost-effective if calculations of cost are based on total eligible populations rather than on the number of practitioners who may be interested. They also conclude that the low response rates generated by their offer indicate a need to find ways to increase GPs’ interest in using online evidence based tools and in accessing best practice evidence. Further research into how to achieve behaviour change among practitioners may be needed

Connecting the dots between extreme ideologies, "parent choice," and education privatization in Alberta and Canada

Privatization of public education in North America has long been influenced by two schools of conservative thought: neoliberalism, which seeks to create a marketplace for public services in which individuals choose the option they judge to be in their best interests and government's role is limited as much as possible to simply funding these choices; and neoconservatism, which believes that education should seek to uphold traditional religious and social values. These two strains are divided in terms of their view of how much control government should seek over education, but united in their agreement that funding should "follow the student" to the option of the parents' choice. Recently, far-right conservative groups in the U.S. and Canada have been inciting a moral panic over "gender ideology" in schools, and in particular transgender students. Under cover of this moral panic and the accompanying call to recognize "parent rights," the right is organizing to gain greater influence over public education through legislation and through the election of conservative candidates to school boards, even as it seeks greater privatization options for families who wish to opt out of public education. While this trend has been noticeable in Alberta for some time, it appears to be spreading to the rest of Canada as well