Enteral Nutrition for the Intubated Adult Intensive Care Unit Patient Prior to General Anesthesia: a Scoping Review Protocol.

REVIEW QUESTION: The objectives of this scoping review are to examine and map fasting times for adult intubated intensive care unit (ICU) patients prior to general anesthesia and patient outcomes following the cessation of enteral nutrition, to examine and conceptually map the evidence, and identify any gaps.Specifically, the review questions are

Using Resident-Based Hazing Programs to Reduce Human-Coyote Conflicts in Urban Environments

Abstract The concept of hazing (aversive conditioning) is often promoted as a tool for reducing human-coyote (Canis latrans) conflicts in urban environments. Little scientific evidence exists on the effectiveness of hazing, particularly hazing applied by residents (i.e., community-level hazing). Wildlife professionals question if residents will properly and consistently apply hazing techniques and if hazing impacts coyote behavior over short- and long-term periods. We describe two separate efforts designed to encourage residents to haze coyotes in the Denver Metro Area; a citizen-science program and an open space hazing trial. Both efforts were intended to be management techniques that either could be deployed or are already commonly deployed by urban coyote managers. In addition to educating residents about how, when, and how to quantify individual coyote response to hazing efforts, the citizen-science program measured methods used for and short-term impacts of resident-based hazing and the overall impact of resident involvement in the program. The open space hazing trial measured the impact of on-site education tools and begins to assess if posted signs and on-site education efforts change visitor acceptance and behavior around coyote hazing. The citizen-science program targeted a highly engaged audience and required a significant investment of time and attention for both managers and residents. The open space hazing trial targeted the casual park visitor and required little to no investment of time and attention for both managers and residents. The citizen-science program produced 207 trained citizen-scientists that generated 96 documented hazing events. Voice, noise and approach were the hazing methods most commonly deployed by participants. Citizen-scientists recorded hazing responses varying from rapid fleeing of the area to approaching the person doing the hazing, with the most common response being the coyote leaving the area. In the presence of domestic dogs, hazing was less effective. Citizen-scientists reported improved understanding and acceptance of coyote management tools as well as increased confidence and capacity to deal with human-coyote conflict in their community. For the open space hazing trial, we provided non-personal hazing education using signs, email, and social media as well as staffed education stations in two urban open space parks with highly visible coyotes and prior histories of coyote conflict. Based on self-reported (n=495) results, most park visitors indicated they would haze a coyote in the future and that the educational effort influenced their decision to haze or not

Evaluating Lethal and Nonlethal Management Options for Urban Coyotes

Human-coyote conflict in urban environments is a growing issue in cities throughout the United States with the primary problem being the development of problem individuals that are overly bold and aggressive with people and pets. Little research has focused on management options to deal with this conflict. We better define lethal and nonlethal management strategies associated with proactive and reactive management of coyotes with an emphasis on management of problem individuals. We then provide data from research in the Denver Metropolitan Area (DMA) that focused on reactive lethal removal of problem coyotes and reactive nonlethal hazing (i.e., community-level hazing, a commonly recommended strategy that we better define). The primary lethal management strategy being used in the DMA is to remove problem coyotes only when severe conflict (primarily threats to people) occurs. From 2009-2014 there were 27 removal events (4.5/year) with the average number of coyotes removed per event being 2.1 (range 1 – 11) and the average number of coyotes removed per year being 9.3. The estimated percentage of coyotes removed per year from the population was between 1.0 and 1.8%. We also measured recurrence of conflict (i.e., length of time until another severe conflict occurred in the vicinity of a removal event) as a measure of efficacy. Of the 27 removals, there were nine with recurrence with an average of 245 days (range 30-546) between removals, and 18 events without recurrence and with a mean time since conflict event of 1,042 days (range 133-2,159). For our community-level hazing experiment we used wildlife cameras to record activity of both people and coyotes at four sites (two treatment and two control). At treatment sites with prior history of conflict, we educated and encouraged people to haze visible coyotes and hypothesized that hazing would decrease the activity overlap between people and coyotes on treatment sites. We recorded over 50,000 independent sightings of people and coyotes and found activity overlap between humans and coyotes to be either similar or greater on treatment sites compared to control sites. Our results indicate that reactive nonlethal hazing as conducted in this study was ineffective in reducing human-coyote activity overlap. However, due to a variety of reasons we detail below, we encourage readers to interpret the hazing results with caution. We conclude that reactive lethal removal of problem individuals is an effective means of managing conflict and that proactive nonlethal strategies are critical as well

Surveying the Current State of International Outreach in Radiology Training Programs

Purpose: Over the past decade, there has been an increased level of attention focused on improving radiology’s contributions to global health programs in resource-restricted areas of the world. This has led to the formation of new organizations and international imaging partnerships. As a result, there have been related publications and guidelines, which has increased awareness and interest amongst current and prospective radiology trainees. Methods and Materials: With this survey of residency program directors, we set out to: 1) examine current opinions of and experience with integrating international and outreach opportunities into their training curriculum; and 2) to analyze these data to inform strategies for growing opportunities within training programs nationwide. Results: The majority (51%) of programs participating in the survey have interest in participating in international projects and 64% feel they add value to resident education. Only about a quarter (27%) of programs, however, have had residents participate in radiology-related international projects over the last five years, and even fewer (18.8%) have established international elective opportunities. However, the majority of programs (58.3%) have some faculty who are involved in international radiology. Conclusion: The reported interest in international educational and service opportunities among residency training programs is much greater than current levels of participation. A much larger percentage of responding programs have faculty involved in international work than residents, despite the acknowledged benefits and interes

Predictors and pathways of language and motor development in four prospective cohorts of young children in Ghana, Malawi, and Burkina Faso

BackgroundPrevious reviews have identified 44 risk factors for poor early child development (ECD) in low- and middle-income countries. Further understanding of their relative influence and pathways is needed to inform the design of interventions targeting ECD.MethodsWe conducted path analyses of factors associated with 18-month language and motor development in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements (iLiNS) Project in Ghana (n = 1,023), Malawi (n = 675 and 1,385), and Burkina Faso (n = 1,122). In two cohorts, women were enrolled during pregnancy. In two cohorts, infants were enrolled at 6 or 9 months. In multiple linear regression and structural equation models (SEM), we examined 22 out of 44 factors identified in previous reviews, plus 12 additional factors expected to be associated with ECD.ResultsOut of 42 indicators of the 34 factors examined, 6 were associated with 18-month language and/or motor development in 3 or 4 cohorts: child linear and ponderal growth, variety of play materials, activities with caregivers, dietary diversity, and child hemoglobin/iron status. Factors that were not associated with child development were indicators of maternal Hb/iron status, maternal illness and inflammation during pregnancy, maternal perceived stress and depression, exclusive breastfeeding during 6 months postpartum, and child diarrhea, fever, malaria, and acute respiratory infections. Associations between socioeconomic status and language development were consistently mediated to a greater extent by caregiving practices than by maternal or child biomedical conditions, while this pattern for motor development was not consistent across cohorts.ConclusionsKey elements of interventions to ensure quality ECD are likely to be promotion of caregiver activities with children, a variety of play materials, and a diverse diet, and prevention of faltering in linear and ponderal growth and improvement in child hemoglobin/iron status

Primary care transformation in Scotland:qualitative evaluation of the views of patients

BackgroundThe new Scottish GP contract introduced in April 2018 aims to improve quality of care through expansion of the multidisciplinary team (MDT) to enable GPs to spend more time as expert medical generalist with patients with complex needs.AimTo explore patients’ views on the changes in general practice in Scotland since the inception of the new contract.Design and SettingQualitative study with 30 patients (10 living in urban deprived areas, 10 living in urban affluent/mixed urban areas, and 10 living in remote and rural areas).MethodsIn-depth semi-structured interviews with thematic analysis. ResultsPatients were generally unaware of the new GP contract, attributing recent changes in general practice to the COVID-19 pandemic. Ongoing concerns included access to GP consultations (especially face-to-face ones), short consultation length with GPs, and damage to continuity of care and the GP-patient relationship. Most patients spoke positively about consultations with MDT staff but still wanted to see a known GP for health concerns that they considered potentially serious. These issues were especially concerning for patients with multiple complex problems, particularly those from deprived areas. ConclusionFollowing the introduction of the new Scottish GP contract, patients in our sample were accepting of first contact care from the MDT but still wanted continuity of care and longer face-to-face consultations with GPs. These findings suggest that the expert generalist role of the GP is not being adequately supported by the new contract, especially in deprived areas, though further quantitative research is required to confirm this. Key words: Primary care transformation, reform, GP contract, patients’ views, multimorbidity, deprivation<br/

The Lantern Vol. 11, No. 1, December 1942

• Friends of the Aquarium • Espionage • Fuss-Budget • Dress Blues • Alone • One Easy Lesson in How Not to Study • A Thumbtack Sketch • One Star • A Colonial Inn • Thoughts on a Dark Day • Query • Paul Revere and the World He Lived In • Sunsetshttps://digitalcommons.ursinus.edu/lantern/1028/thumbnail.jp

Cardiovascular disease risk profile and microvascular complications of diabetes: comparison of Indigenous cohorts with diabetes in Australia and Canada

<p>Abstract</p> <p>Background</p> <p>Indigenous populations of Australia and Canada experience disproportionately high rates of chronic disease. Our goal was to compare cardiovascular (CVD) risk profile and diabetes complications from three recent comprehensive studies of diabetes complications in different Indigenous populations in Australia and Canada.</p> <p>Methods</p> <p>We compared participants from three recent studies: remote Indigenous Australians (2002-2003, n = 37 known diabetes), urban Indigenous Australians (2003-2005, n = 99 known diabetes), and remote Aboriginal Canadians (2001-2002, n = 188 known diabetes).</p> <p>Results</p> <p>The three groups were similar for HbA1c, systolic BP, diabetes duration. Although leaner by body-mass-index criteria, remote Indigenous Australians displayed a more adverse CVD risk profile with respect to: waist-hip-ratio (1.03, 0.99, 0.94, remote Indigenous Australians, urban Indigenous Australians, remote Canadians, p < 0.001); HDL-cholesterol (0.82, 0.96, 1.17 mmol/L, p < 0.001); urine albumin-creatinine-ratio (10.3, 2.4, 4.5 mg/mmol); and C-reactive protein. With respect to diabetes complications, microalbuminuria (50%, 25%, 41%, p = 0.001) was more common among both remote groups than urban Indigenous Australians, but there were no differences for peripheral neuropathy, retinopathy or peripheral vascular disease.</p> <p>Conclusions</p> <p>Although there are many similarities in diabetes phenotype in Indigenous populations, this comparison demonstrates that CVD risk profiles and diabetes complications may differ among groups. Irrespective, management and intervention strategies are required from a young age in Indigenous populations and need to be designed in consultation with communities and tailored to community and individual needs.</p

Assessing the association of the HNF1A G319S variant with C-reactive protein in Aboriginal Canadians: a population-based epidemiological study

<p>Abstract</p> <p>Background</p> <p>C-reactive protein (CRP), a biomarker of inflammation, has been associated with increased risk of developing cardiovascular disease. Common variants of the hepatocyte nuclear factor 1A (<it>HNF1A) </it>gene encoding HNF-1α have been associated with plasma CRP in predominantly European Caucasian samples. <it>HNF1A </it>might therefore have an impact on vascular disease and diabetes risk that is mediated by CRP. In an Aboriginal Canadian population, a private polymorphism, <it>HNF1A </it>G319S, was associated with increased prevalence of type 2 diabetes. However, it has not been investigated whether this association is mediated by CRP. We aimed to investigate whether CRP was mediating the association between <it>HNF1A </it>G319S and type 2 diabetes in an Aboriginal Canadian population with a high prevalence of diabetes.</p> <p>Methods</p> <p>A total of 718 individuals who participated in a diabetes prevalence and risk factor survey were included in the current analysis. Participants were genotyped for <it>HNF1A </it>G319S. Fasting plasma samples were analyzed for CRP. Fasting plasma glucose and a 75-g oral glucose tolerance test were obtained to determine type 2 diabetes.</p> <p>Results</p> <p>The prevalence rate of type 2 diabetes was 17.4% (125/718) using the 1999 World Health Organization definition and was higher among S319 allele carriers compared to G/G homozygotes (p < 0.0001). Among participants without type 2 diabetes, CRP levels were higher among G/G homozygotes (1.64 [95% confidence interval 1.35-2.00] mg/l) than in S319 carriers (1.26 [1.04-1.54] mg/l) (p = 0.009) after adjustment for age, sex, 2-h post-load glucose, waist circumference, and serum amyloid A. CRP levels were elevated among those with diabetes after similar adjustment (4.39 [95% confidence interval 3.09-6.23] and 4.44 [3.13-6.30] mg/L, respectively), and no significant difference in CRP was observed between S319 carriers and non-carriers (p = 0.95).</p> <p>Conclusions</p> <p>CRP levels were lower in S319 allele carriers of the <it>HNF1A </it>gene compared to non-carriers among individuals without diabetes, but this difference was not present among those with diabetes, who uniformly had elevated CRP levels. Therefore, while <it>HNF1A </it>appears to influence CRP concentrations in the non-diabetic state, chronic elevation of CRP is unlikely mediating the association between the <it>HNF1A </it>polymorphism and the high prevalence of type 2 diabetes in this Aboriginal population.</p

Evaporative Gasoline Emissions and Asthma Symptoms

Attached garages are known to be associated with indoor air volatile organic compounds (VOCs). This study looked at indoor exposure to VOCs presumably from evaporative emissions of gasoline. Alaskan gasoline contains 5% benzene making benzene a marker for gasoline exposure. A survey of randomly chosen houses with attached garages was done in Anchorage Alaska to determine the exposure and assess respiratory health. Householders were asked to complete a health survey for each person and a household survey. They monitored indoor air in their primary living space for benzene, toluene, ethylbenzene and xylenes for one week using passive organic vapor monitoring badges. Benzene levels in homes ranged from undetectable to 58 parts per billion. The median benzene level in 509 homes tested was 2.96 ppb. Elevated benzene levels in the home were strongly associated with small engines and gasoline stored in the garage. High concentrations of benzene in gasoline increase indoor air levels of benzene in residences with attached garages exposing people to benzene at levels above ATSDR’s minimal risk level. Residents reported more severe symptoms of asthma in the homes with high gasoline exposure (16%) where benzene levels exceeded the 9 ppb