Consequences and coping : Investigating client, co-worker and senior colleague incivility within veterinary practice

The data presented within this paper are not available publicly due to ethical and confidentiality constraints. The data will be shared by the corresponding author privately upon request.Peer reviewedPublisher PD

Is nonoperative treatment effective for acute Achilles tendon rupture?

Q: Is nonoperative treatment effective for acute Achilles tendon rupture? Evidence-based answer: YES. Nonoperative and open surgical interventions provide equal long-term functional outcomes of the affected Achilles tendon and ankle (strength of recommendation [SOR], A; based on 2 meta-analyses and a separate randomized controlled trial [RCT]). Although nonoperative management is associated with increased risk of re-rupture, it confers lower risk for complications including wound infection and nerve injury (SOR, A; based on meta-analysis and separate RCT). Select individuals—high-performing athletes or those who otherwise require near-baseline strength and function of their Achilles tendon—would likely benefit from surgical intervention (SOR, A; based on meta-analysis and consensus recommendations). Patients with comorbid conditions that would put them at greater risk for postoperative complications should be advised to consider nonoperative treatment of acute Achilles tendon rupture (SOR, C; based on consensus opinion).Sabrina Silver, DO, CAQSM; Stephanie Fulleborn, MD; Nolan Feola, MD; Sydney Giblin, MD, Uniformed Services University, Bethesda, MD (Drs. Silver and Fulleborn); Eglin AFB Family Medicine Residency, FL (Drs. Silver, Fulleborn, Feola, and Giblin)Includes bibliographical reference

Elk River Chain of Lakes Watershed Management Plan

The Elk River Chain of Lakes (ERCOL) watershed is located in northwestern Michigan in the Lower Peninsula. It is the largest sub-watershed of the Grand Traverse Bay watershed and covers over 500 square miles of land, has over 60 square miles of open water, and 200 miles of shoreline. The lakes and streams found in this watershed are some of the most pristine inland waterbodies in the entire country and provide a multitude of recreational and economic benefits for both full time residents and tourist. Despite continual efforts to protect the watershed, emerging issues such as land development pressures, invasive species, failing septic systems, and barriers to hydrologic connectivity threaten to impair these waters and degrade their ecological and economic treasures. The SNRE team developed a comprehensive watershed management plan under the guidance of Tip of the Mitt Watershed Council and in conjunction with local lake associations and the ERCOL Watershed Plan Implementation Team (ERCOL-WPIT). The team’s efforts included: conducting road stream crossing and streambank erosion surveys across the watershed, leading town hall meetings, performing a priority parcel analysis, and generating spatial analysis reference sets and maps. Ultimately, the ERCOL Watershed Protection Plan will be submitted for approval by the Michigan Department of Environmental Quality (DEQ) and the US Environmental Protection Agency (EPA).The lessons learned on restoration and protection can be carried over to similar geographies throughout the Great Lakes region, to cumulatively protect and enhance Great Lakes’ water quality and ecosystems.Master of ScienceNatural Resources and EnvironmentUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/117589/1/2016-04-18_ERCOL_Final.pd

2009 Alaska Health Workforce Vacancy Study

Alaska continues to experience health professional shortages. The state has long had a deficient “supply side” characterized by insufficient numbers of key health workers whose recruitment, retention, and training have been impeded by Alaska’s remoteness, harsh climate, rural isolation, low population density, and scarce training resources. Alaska is the only state without a pharmacy school and lacks its own dental and physical therapy schools as well. Health professional shortages can be decreased through the start of new training programs, the expansion of existing programs, and the improvement of the effectiveness of recruitment and retention efforts. However, strategic planning and the execution of such programs require valid and accurate data. To this end, stakeholders such as the Alaska Mental Health Trust Authority (AMHTA) and Alaskan's For Access to Health Care (ACCESS), along with schools and departments within the University of Alaska Anchorage (UAA), funded the Alaska Center for Rural Health-Alaska’s AHEC (ACRH) and the Institute of Social and Economic Research (ISER) to conduct a comprehensive health workforce study during winter and spring of 2009. This report highlights employers’ needs for employees to fill budgeted positions. This is different from a needs assessment that would take into account population demographics and disease incidence and prevalence. This health workforce study is an assessment of health manpower shortage based on budgeted staff positions and their vacancies in organizations throughout the state. Respondents included part-time positions, which resulted in our counting full-time equivalent (FTE) rather than individuals (“bodies”). In situations where a position was divided among more than one occupation (e.g., Dental Assistant and Billing Clerk), we asked the respondent to count the position under which they considered the position’s “primary occupation.” This was a point-in-time cross-sectional study. Recently filled vacancies or imminent vacancies were not counted. Positions filled by relief/temporary/locum/contract health workers were counted as vacancies only if these workers were temporarily filling a currently vacant, budgeted position. Due to budget and time constraints, we were not able to conduct a trend analysis that is a comparison of this study’s findings and the prior 2007 study. The key questions this study sought to answer were (1) How many budgeted positions, either full- or part-time, existed in organizations providing health services in Alaska? (2) How many of these budgeted positions were currently vacant? (3) What was the vacancy rate? (4) How many of the organizations that employ these occupations hired new graduates of training programs? (5) How many of the currently vacant budgeted positions (#2) could be filled by new graduates of training programs? (6) What were the mean and maximum length of time, expressed in months, that the vacancies have existed? (7) What were the principal, underlying causes of vacancies? The study was designed in consultation with an advisory group that included AMHTA, ACCESS, and UAA. The study targeted 93 health occupations. The unit of analysis was the employment site by organization type, which allowed for the allocation of positions and vacancies by geographic region. For each employer, we identified the staff person most knowledgeable about hiring and vacancies. In large organizations this meant that one employer might provide information about multiple sites and organization types; smaller employers were responsible for only a single site.Alaska Mental Health Trust Authority. Alaskan's for Access to Health Care. University of Alaska Fairbanks, Tanana Valley campus Telemedicine program. University of Alaska Anchorage, Community and Technical College. University of Alaska Anchorage, School of Nursing.Acknowledgements / Executive Summary / Table of Contents / Problem and Rationale / Methodology / Limitations of Study / Findings / Appendix A. List of Health Occupations / Appendix B. Health Workforce Surveys / Appendix C. Cover Letter Accompanying Survey Forms / Appendix D. Confidence Intervals for Positions, Vacancies, Number of Vacancies Filled with New Graduates, and Length of Longest Vacancy in Months / Appendix E. Tables of Samples and Estimates of Positions, Vacancies, Vacancy Rates, Number of Vacancies Filled with New Graduates, Mean and Maximum Length of Longest Vacancy in Months / Appendix F. Tables of Occupations Sorted By Estimates of Positions, Vacancies, Vacancy Rates, Number of Vacancies Filled with New Graduates, Mean and Maximum Length of Longest Vacancy in Month

Protocol for the Northern Manhattan Diabetes Community Outreach Project. A randomised trial of a community health worker intervention to improve diabetes care in Hispanic adults

ObjectiveHispanics in the USA are affected by the diabetes epidemic disproportionately, and they consistently have lower access to care, poorer control of the disease and higher risk of complications. This study evaluates whether a community health worker (CHW) intervention may improve clinically relevant markers of diabetes care in adult underserved Hispanics.Methods and analysisThe Northern Manhattan Diabetes Community Outreach Project (NOCHOP) is a two-armed randomised controlled trial to be performed as a community-based participatory research study performed in a Primary Care Setting in Northern Manhattan (New York City). 360 Hispanic adults with poorly controlled type 2 diabetes mellitus (haemoglobin A1c >8%), aged 35–70 years, will be randomised at a 1:1 ratio, within Primary Care Provider clusters. The two study arms are (1) a 12-month CHW intervention and (2) enhanced usual care (educational materials mailed at 4-month intervals, preceded by phone calls). The end points, assessed after 12 months, are primary = haemoglobin A1c and secondary = blood pressure and low-density lipoprotein-cholesterol levels. In addition, the study will describe the CHW intervention in terms of components and intensity and will assess its effects on (1) medication adherence, (2) medication intensification, (3) diet and (4) physical activity.Ethics and disseminationAll participants will provide informed consent; the study protocol has been approved by the Institutional Review Board of Columbia University Medical Center. CHW interventions hold great promise in improving the well-being of minority populations who suffer from diabetes mellitus. The NOCHOP study will provide valuable information about the efficacy of those interventions vis-à-vis clinically relevant end points and will inform policy makers through a detailed characterisation of the programme and its effects.Clinical trial registration numberNCT00787475 at clinicaltrials.gov

Grown, Printed, and Biologically Augmented: An Additively Manufactured Microfluidic Wearable, Functionally Templated for Synthetic Microbes

Despite significant advances in synthetic biology at industrial scales, digital fabrication challenges have, to date, precluded its implementation at the product scale. We present, Mushtari, a multimaterial 3D printed fluidic wearable designed to culture microbial communities. Thereby we introduce a computational design environment for additive manufacturing of geometrically complex and materially heterogeneous fluidic channels. We demonstrate how controlled variation of geometrical and optical properties at high spatial resolution can be achieved through a combination of computational growth modeling and multimaterial bitmap printing. Furthermore, we present the implementation, characterization, and evaluation of support methods for creating product-scale fluidics. Finally, we explore the cytotoxicity of 3D printed materials in culture studies with the model microorganisms, Escherichia coli and Bacillus subtilis. The results point toward design possibilities that lie at the intersection of computational design, additive manufacturing, and synthetic biology, with the ultimate goal of imparting biological functionality to 3D printed products.National Science Foundation (U.S.) (DGE1144152)United States. Department of Energy (DE-SC0012658

Synthetic photosynthetic consortia define interactions leading to robustness and photoproduction

Background: Microbial consortia composed of autotrophic and heterotrophic species abound in nature, yet examples of synthetic communities with mixed metabolism are limited in the laboratory. We previously engineered a model cyanobacterium, Synechococcus elongatus PCC 7942, to secrete the bulk of the carbon it fixes as sucrose, a carbohydrate that can be utilized by many other microbes. Here, we tested the capability of sucrose-secreting cyanobacteria to act as a flexible platform for the construction of synthetic, light-driven consortia by pairing them with three disparate heterotrophs: Bacillus subtilis, Escherichia coli, or Saccharomyces cerevisiae. The comparison of these different co-culture dyads reveals general design principles for the construction of robust autotroph/heterotroph consortia. Results: We observed heterotrophic growth dependent upon cyanobacterial photosynthate in each co-culture pair. Furthermore, these synthetic consortia could be stabilized over the long-term (weeks to months) and both species could persist when challenged with specific perturbations. Stability and productivity of autotroph/heterotroph co-cultures was dependent on heterotroph sucrose utilization, as well as other species-independent interactions that we observed across all dyads. One destabilizing interaction we observed was that non-sucrose byproducts of oxygenic photosynthesis negatively impacted heterotroph growth. Conversely, inoculation of each heterotrophic species enhanced cyanobacterial growth in comparison to axenic cultures. Finally, these consortia can be flexibly programmed for photoproduction of target compounds and proteins; by changing the heterotroph in co-culture to specialized strains of B. subtilis or E. coli we demonstrate production of alpha-amylase and polyhydroxybutyrate, respectively. Conclusions: Enabled by the unprecedented flexibility of this consortia design, we uncover species-independent design principles that influence cyanobacteria/heterotroph consortia robustness. The modular nature of these communities and their unusual robustness exhibits promise as a platform for highly-versatile photoproduction strategies that capitalize on multi-species interactions and could be utilized as a tool for the study of nascent symbioses. Further consortia improvements via engineered interventions beyond those we show here (i.e., increased efficiency growing on sucrose) could improve these communities as production platforms. Electronic supplementary material The online version of this article (doi:10.1186/s13036-017-0048-5) contains supplementary material, which is available to authorized users

Abiotic and Biotic Soil Characteristics in Old Growth Forests and Thinned or Unthinned Mature Stands in Three Regions of Oregon

We compared forest floor depth, soil organic matter, soil moisture, anaerobic mineralizable nitrogen (a measure of microbial biomass), denitrification potential, and soil/litter arthropod communities among old growth, unthinned mature stands, and thinned mature stands at nine sites (each with all three stand types) distributed among three regions of Oregon. Mineral soil measurements were restricted to the top 10 cm. Data were analyzed with both multivariate and univariate analyses of variance. Multivariate analyses were conducted with and without soil mesofauna or forest floor mesofauna, as data for those taxa were not collected on some sites. In multivariate analysis with soil mesofauna, the model giving the strongest separation among stand types (P = 0.019) included abundance and richness of soil mesofauna and anaerobic mineralizable nitrogen. The best model with forest floor mesofauna (P = 0.010) included anaerobic mineralizable nitrogen, soil moisture content, and richness of forest floor mesofauna. Old growth had the highest mean values for all variables, and in both models differed significantly from mature stands, while the latter did not differ. Old growth also averaged higher percent soil organic matter, and analysis including that variable was significant but not as strong as without it. Results of the multivariate analyses were mostly supported by univariate analyses, but there were some differences. In univariate analysis, the difference in percent soil organic matter between old growth and thinned mature was due to a single site in which the old growth had exceptionally high soil organic matter; without that site, percent soil organic matter did not differ between old growth and thinned mature, and a multivariate model containing soil organic matter was not statistically significant. In univariate analyses soil mesofauna had to be compared nonparametrically (because of heavy left-tails) and differed only in the Siskiyou Mountains, where they were most abundant and species rich in old growth forests. Species richness of mineral soil mesofauna correlated significantly (+) with percent soil organic matter and soil moisture, while richness of forest floor mesofauna correlated (+) with depth of the forest floor. Composition of forest floor and soil mesofauna suggest the two groups represent a single community. Soil moisture correlated highly with percent soil organic matter, with no evidence for drying in sites that were sampled relatively late in the summer drought, suggesting losses of surface soil moisture were at least partially replaced by hydraulic lift (which has been demonstrated in other forests of the region)