Feeding Dairy Cattle

MIost farmers realize that good dairy cows will produce more milk when properly fed than when fed scant rations. However, many dairy cows in Iowa receive rations that will not allow them even to approach a profitable level of production. There are several reasons why cows are underfed. The chief reason is that a majority of men, while they know that increased feed will result in more milk, arc not yet convinced that this increased yield will justify the feed cost. They believe that a low feed cost is the ultimate aim in profitable dairying. Economy and thrift in selecting rations are indispensible for profit; extravagance and wasteful expenditures for unnecessary feeds are to be avoided; yet such false economy as allows a cow little better than a starvation ration is deplorable. Successful dairymen had to learn the value of good feeding before they were able to succccd

Capons in Iowa

Interest in capon production is rapidly increasing in Iowa, the top-ranking state in poultry and egg production. Chickens are found on more than 93 percent of all farms in the state, and in 1939, there were more than 43 million chickens produced on Iowa farms. Due to this widespread production, a large number of broilers, fryers and roasters are marketed annually from the state. This abundant seasonal supply, marketed during a relatively short period, is one of the causes of the seasonal decline in prices of young chickens. Therefore, instead of marketing all of the young cockerels when prices are low it would be advantageous to caponize some of these birds for later sale or for home consumption. This would help maintain higher price levels for broilers and would extend the poultry income to a period when few sales are normally made. This bulletin will present information concerning the various phases of capon production and marketing

Raising Dairy Calves

In the Corn Belt it costs approximately $100 to raise a heifer calf from birth to producing age. About three-fourths of this charge is for feed; the rest is for labor, housing and other items. The attitude that the raising of heifers is a too expensive practice is held by some dairymen with grade herds who are located in the denser dairy regions where whole milk is· the product sold and feed prices are usually high. Farmer-dairymen, who sell cream and have skim milk available, and breeders of purebreds generally do not question the advisability of raising heifers. Purebred heifers cost but little, if any, more to raise than grades and have about twice their value

Validation of population-based disease simulation models: a review of concepts and methods

Abstract Background Computer simulation models are used increasingly to support public health research and policy, but questions about their quality persist. The purpose of this article is to review the principles and methods for validation of population-based disease simulation models. Methods We developed a comprehensive framework for validating population-based chronic disease simulation models and used this framework in a review of published model validation guidelines. Based on the review, we formulated a set of recommendations for gathering evidence of model credibility. Results Evidence of model credibility derives from examining: 1) the process of model development, 2) the performance of a model, and 3) the quality of decisions based on the model. Many important issues in model validation are insufficiently addressed by current guidelines. These issues include a detailed evaluation of different data sources, graphical representation of models, computer programming, model calibration, between-model comparisons, sensitivity analysis, and predictive validity. The role of external data in model validation depends on the purpose of the model (e.g., decision analysis versus prediction). More research is needed on the methods of comparing the quality of decisions based on different models. Conclusion As the role of simulation modeling in population health is increasing and models are becoming more complex, there is a need for further improvements in model validation methodology and common standards for evaluating model credibility

Individual and Regional-level Factors Contributing to Variation in Length of Stay After Cerebral Infarction in Six European Countries

Using patient-level data for cerebral infarction cases in 2007, gathered from Finland, Hungary, Italy, the Netherlands, Scotland and Sweden, we studied the variation in risk-adjusted length of stay (LoS) of acute hospital care and 1-year mortality, both within and between countries. In addition, we analysed the variance of LoS and associations of selected regional-level factors with LoS and 1-year mortality after cerebral infarction. The data show that LoS distributions are surprisingly different across countries and that there is significant deviation in the risk-adjusted regional-level LoS in all of the countries studied. We used negative binomial regression to model the individual-level LoS, and random intercept models and ordinary least squares regression for the regional-level analysis of risk-adjusted LoS, variance of LoS, 1-year risk-adjusted mortality and crude mortality for a period of 31-365 days. The observed variations between regions and countries in both LoS and mortality were not fully explained by either patient-level or regional-level factors. The results indicate that there may exist potential for efficiency gains in acute hospital care of cerebral infarction and that healthcare managers could learn from best practices. Copyright (c) 2015 John Wiley & Sons, Ltd

Developing new ways of measuring the quality and impact of ambulance service care: the PhOEBE mixed-methods research programme

Background Ambulance service quality measures have focused on response times and a small number of emergency conditions, such as cardiac arrest. These quality measures do not reflect the care for the wide range of problems that ambulance services respond to and the Prehospital Outcomes for Evidence Based Evaluation (PhOEBE) programme sought to address this. Objectives The aim was to develop new ways of measuring the impact of ambulance service care by reviewing and synthesising literature on prehospital ambulance outcome measures and using consensus methods to identify measures for further development; creating a data set linking routinely collected ambulance service, hospital and mortality data; and using the linked data to explore the development of case-mix adjustment models to assess differences or changes in processes and outcomes resulting from ambulance service care. Design A mixed-methods study using a systematic review and synthesis of performance and outcome measures reported in policy and research literature; qualitative interviews with ambulance service users; a three-stage consensus process to identify candidate indicators; the creation of a data set linking ambulance, hospital and mortality data; and statistical modelling of the linked data set to produce novel case-mix adjustment measures of ambulance service quality. Setting East Midlands and Yorkshire, England. Participants Ambulance services, patients, public, emergency care clinical academics, commissioners and policy-makers between 2011 and 2015. Interventions None. Main outcome measures Ambulance performance and quality measures. Data sources Ambulance call-and-dispatch and electronic patient report forms, Hospital Episode Statistics, accident and emergency and inpatient data, and Office for National Statistics mortality data. Results Seventy-two candidate measures were generated from systematic reviews in four categories: (1) ambulance service operations (n = 14), (2) clinical management of patients (n = 20), (3) impact of care on patients (n = 9) and (4) time measures (n = 29). The most common operations measures were call triage accuracy; clinical management was adherence to care protocols, and for patient outcome it was survival measures. Excluding time measures, nine measures were highly prioritised by participants taking part in the consensus event, including measures relating to pain, patient experience, accuracy of dispatch decisions and patient safety. Twenty experts participated in two Delphi rounds to refine and prioritise measures and 20 measures scored ≥ 8/9 points, which indicated good consensus. Eighteen patient and public representatives attending a consensus workshop identified six measures as important: time to definitive care, response time, reduction in pain score, calls correctly prioritised to appropriate levels of response, proportion of patients with a specific condition who are treated in accordance with established guidelines, and survival to hospital discharge for treatable emergency conditions. From this we developed six new potential indicators using the linked data set, of which five were constructed using case-mix-adjusted predictive models: (1) mean change in pain score; (2) proportion of serious emergency conditions correctly identified at the time of the 999 call; (3) response time (unadjusted); (4) proportion of decisions to leave a patient at scene that were potentially inappropriate; (5) proportion of patients transported to the emergency department by 999 emergency ambulance who did not require treatment or investigation(s); and (6) proportion of ambulance patients with a serious emergency condition who survive to admission, and to 7 days post admission. Two indicators (pain score and response times) did not need case-mix adjustment. Among the four adjusted indicators, we found that accuracy of call triage was 61%, rate of potentially inappropriate decisions to leave at home was 5–10%, unnecessary transport to hospital was 1.7–19.2% and survival to hospital admission was 89.5–96.4% depending on Clinical Commissioning Group area. We were unable to complete a fourth objective to test the indicators in use because of delays in obtaining data. An economic analysis using indicators (4) and (5) showed that incorrect decisions resulted in higher costs. Limitations Creation of a linked data set was complex and time-consuming and data quality was variable. Construction of the indicators was also complex and revealed the effects of other services on outcome, which limits comparisons between services. Conclusions We identified and prioritised, through consensus processes, a set of potential ambulance service quality measures that reflected preferences of services and users. Together, these encompass a broad range of domains relevant to the population using the emergency ambulance service. The quality measures can be used to compare ambulance services or regions or measure performance over time if there are improvements in mechanisms for linking data across services. Future work The new measures can be used to assess different dimensions of ambulance service delivery but current data challenges prohibit routine use. There are opportunities to improve data linkage processes and to further develop, validate and simplify these measures. Funding The National Institute for Health Research Programme Grants for Applied Research programme

Making Possible the Impossible

This recording is part of the Marsh Chapel Audio Collection.A sermon focusing on Mary, the mother of Jesus. Scriptures 7:10-14, Psalm 40, Luke 1:28-38

ORGANIZE OR PERISH : THE TRANSFORMATION OF NEBRASKA NURSING EDUCATION, 1888--1941

Between 1888 and 1926, seventy nurse training schools opened in Nebraska. By 1938, fifty-seven were closed. The transformation of Nebraska nursing education from haphazardly organized apprenticeship programs in dozens of hospitals to highly organized programs in thirteen schools is of interest to educational, women\u27s, medical, and Progressive Era historians. Professional nursing, an occupation derived from women\u27s domestic sphere, emerged at the height of an organizational revolution associated with Progressive Era emphases on workplace specialization, bureaucratization, standardization, and rationalization. The organizational revolution, legislative reform, and the professionalization ambitions of elite national and local nursing leaders shaped Nebraska nursing education before World War II, particularly through the office of the State Director of Nursing Education and through statutory specification of National League of Nursing Education curricula. (Nebraska was one of only three states to legally require NLNE standards). Training school record books and Nebraska Board of Nursing inspection reports provided major sources of information about Nebraska\u27s nursing students and programs. Most Nebraska nursing students before World War II came from small towns and rural areas and entered urban training schools. Attrition rates hovered at fifty percent, and most students who left training were dismissed, without hearing, for minor rule infractions. Affiliation requirements formed an important part of training in smaller schools. For many years schools sent students to large general hospitals in Denver, Chicago, Minneapolis, and Kansas City in order to meet state and NLNE standards. The thirteen training schools that survived tended to be well-organized and managed by a superintendent who had stayed with the school for several years. Nursing students\u27 education before entering training school gradually improved, as did student living conditions, health, and training school experiences, but some constants remained, notably school disciplinary methods and student exploitation as cheap labor offering a peculiar and valuable service to the hospital