Visual Attention of Anesthesia Providers in Simulated Anesthesia Emergencies Using Conventional Number-Based and Avatar-Based Patient Monitoring: Prospective Eye-Tracking Study

Background: Inadequate situational awareness accounts for two-thirds of preventable complications in anesthesia. An essential tool for situational awareness in the perioperative setting is the patient monitor. However, the conventional monitor has several weaknesses. Avatar-based patient monitoring may address these shortcomings and promote situation awareness, a prerequisite for good decision making. Objective: The spatial distribution of visual attention is a fundamental process for achieving adequate situation awareness and thus a potential quantifiable surrogate for situation awareness. Moreover, measuring visual attention with a head-mounted eye-tracker may provide insights into usage and acceptance of the new avatar-based patient monitoring modality. Methods: This prospective eye-tracking study compared anesthesia providers' visual attention on conventional and avatar-based patient monitors during simulated critical anesthesia events. We defined visual attention, measured as fixation count and dwell time, as our primary outcome. We correlated visual attention with the potential confounders: performance in managing simulated critical anesthesia events (task performance), work experience, and profession. We used mixed linear models to analyze the results. Results: Fifty-two teams performed 156 simulations. After a manual quality check of the eye-tracking footage, we excluded 57 simulations due to technical problems and quality issues. Participants had a median of 198 (IQR 92.5-317.5) fixations on the patient monitor with a median dwell time of 30.2 (IQR 14.9-51.3) seconds. We found no significant difference in participants' visual attention when using avatar-based patient monitoring or conventional patient monitoring. However, we found that with each percentage point of better task performance, the number of fixations decreased by about 1.39 (coefficient -1.39; 95% CI -2.44 to -0.34; P=.02), and the dwell time diminished by 0.23 seconds (coefficient -0.23; 95% CI: -0.4 to -0.06; P=.01). Conclusions: Using eye tracking, we found no significant difference in visual attention when anesthesia providers used avatar-based monitoring or conventional patient monitoring in simulated critical anesthesia events. However, we identified visual attention in conjunction with task performance as a surrogate for situational awareness. Keywords: Anesthesia; avatar based model; eye-tracking technology; patient monitoring; patient simulation; perioperative; simulated anesthesia; situation awareness; task performance; visual attention

Determining the Amino Acid Digestibility of Soybean Meal from Different Midwest Soybean Varieties Fed to Broilers

At hatch, 240 one-day old Cobb500 male broilers were placed in battery cages to determine soybean meal (SBM) apparent ileal digestibility (AID) of amino acids (AA). There were 6 broilers per cage and 10 replicates per treatment. A common corn-SBM crumble starter diet was fed from d 0 to 10 with experimental mash diets fed from d 10 to 18 with SBM as the only source of AA. Dietary treatments consisted of 1 of 4 soybean sources varying in quality determined by crude protein (CP) content and processed into SBM. Dietary treatments consisted of a commercially processed SBM with 47% CP (CSBM) or experimentally processed SBM with 42% CP (42SBM), 49% (49SBM), or 52% CP (52SBM). Two sources consisted of soybeans from a similar region and were processed either commercially (CSBM) or experimentally (49SBM) solvent extracted at Texas A&M University. Additional sources included a low quality (42SBM) and highquality (52SBM) soybean, experimentally solvent extracted into SBM at a pilot-scale facility at Texas A&M University. Dietary treatments were dextrose and SBM-based, and consisted of 1 of 4 SBM sources included in diets formulated to 20% CP. On d 18, broilers were euthanized by CO2 inhalation and ileal samples were collected for determination of AID of AA. Soybean meal processed from low, medium, and high CP soybeans resulted in increased concentrations of crude protein and indispensable AA. Individual SBM samples indicated that SBM with higher CP had lower NDF. Data were analyzed using the GLIMMIX procedure in SAS 9.4, with cage as the experimental unit, cage location as the blocking factor with Tukey-Kramer adjustment for multiple comparisons used. For soybeans grown in a similar region, broilers fed CSBM, processed conventionally, had increased (P \u3c 0.05) AID of total AA, Arg, His, Lys, and Thr compared to 49SBM, processed experimentally. Increasing the CP content of SBM from 42SBM, and 49SBM, to 52SBM increased (P \u3c 0.05) AID of total AA, Arg, His, Leu, Lys, Thr, and Val. Broilers fed CSBM, 49SBM, and 52SBM had increased (P \u3c 0.001) Ile, Met, Phe, and Trp compared to broilers fed 42SBM. In conclusion, CSBM and 49SBM were sourced from a similar location but processed either commercially or experimentally, respectively. Commercially processed SBM had improved AID AA compared to the experimentally processed SBM. Additionally, SBM with increasing concentrations of CP and AA had improved AID of AA

Effect of Soybean Meal from Different Midwest Soybean Varieties on Growth Performance of Broilers

At hatch, 360 one-d old Cobb500 male broilers were placed in battery cages to determine the effect of soybean meal (SBM) from different Midwest soybean varieties on growth performance of broilers. There were 6 broilers per cage and 15 replicates per treatment. Dietary treatments cons0isted of 1 of 4 soybean sources varying in quality determined by crude protein (CP) content and processed into SBM. Two sources consisted of soybeans from a similar region and processed either commercially solvent extracted or experimentally solvent extracted at Texas A&M University. Additional sources included a low quality and high quality soybean, experimentally solvent extracted into SBM at Texas A&M University. Therefore, dietary treatments consisted of a commercially processed SBM with 47% CP (CSBM), or experimentally processed SBM with 42% CP (42SBM), 49% CP (49SBM), or 52% CP (52SBM). Diets were formulated to 1.05% digestible Lys and balanced using digestible AA values previously determined. Added dietary fat provided by vegetable oil was kept constant in the formulation across treatments. Data were analyzed using the GLIMMIX procedure in SAS 9.4, with cage as the experimental unit, cage location as the blocking factor with Tukey-Kramer adjustment for multiple comparisons used. From d 0 to 18, body weight gain (BWG) and d 18 BW increased (P \u3c 0.001) in broilers fed CSBM, compared to 42SBM, 49SBM, and 52SBM. Broilers fed the CSBM had increased (P \u3c 0.001) ADFI, compared to 42SBM and 52SBM, with 49SBM intermediate. There was no evidence for feed conversion ratio (FCR) differences in broilers fed 42SBM, 49SBM, and 52SBM. There was no evidence for difference among broilers fed experimentally processed soybean meal; however, there were increases in diet cost of $28.81 and 5.41 per ton for the 42SBM and 49SBM, respectively, compared to 52SBM. Feed cost per bird decreased (P \u3c 0.001) in birds fed 52SBM ($0.244) compared to CSBM ($0.271) and 42SBM ($0.266) with 49SBM ($0.256) intermediate, CSBM and 42SBM. Therefore, the lower inclusion of 52SBM in the diet could be used to maintain growth performance with potential cost savings

Determining Amino Acid Digestibility of Soybean Meal from South Carolina Soybean Varieties Fed to Broilers

At hatch, 240 male broilers (Ross 308, Aviagen, Sallisaw, OK) were placed in batteries (Petersime Brood Unit, Gettysburg, OH) for a 15-d study to evaluate amino acid digestibility of soybean meal (SBM) from specialty variety soybeans grown in South Carolina. There were 10 replicates per treatment and 6 broilers per cage. Broilers were given a common corn and soybean meal-based diet from d 0 to 9. On d 9, broilers were weighed, and cages were allotted to 1 of 4 dietary treatments within location block. Dietary treatments consisted of 1 of 4 soybean sources varying in quality determined by crude protein (CP) content and processed into SBM. Two sources consisted of soybeans from a similar region and processed either commercially solvent extracted or experimentally solvent extracted at Texas A&M University. Therefore, dietary treatments consisted of a commercially processed SBM with 44% CP (CON) or experimentally processed SBM with 50% CP (PCON), 52% CP (52SBM), or 56% CP (56SBM). Assay diets were dextrose and SBM-based, formulated to supply 20% dietary CP with titanium dioxide as an indigestible marker. On d 15, broilers were euthanized by CO2 inhalation and ileal samples were collected for determination of apparent ileal digestibility (AID) of AA. Data were analyzed using the GLIMMIX procedure in SAS v. 9.4 (SAS Institute Inc., Cary, NC), with pen as the experimental unit, pen location as the blocking factor and adjusted using Tukey-Kramer multiple comparisons. Broilers fed CON and 56SBM had increased (P \u3c 0.003) digestibility of total AA, Arg, His, Lys, Thr, and Trp compared to those fed PCON and 52SBM. Digestibility of Ile and Phe increased (P \u3c 0.001) in broilers fed 56SBM compared to CON and 52SBM, while PCON was intermediate to CON and 52SBM. Broilers fed 56SBM had increased (P \u3c 0.001) digestibility of Leu compared to all other sources. Digestibility of Met increased (P = 0.007) in broilers fed CON and 56SBM compared to 52SBM and there was no evidence for differences between those fed PCON and all other sources. Broilers fed CON and 56SBM had increased (P \u3c 0.001) digestibility of Val compared to PCON and 52SBM, with no evidence for differences between those fed CON and PCON. In conclusion, broilers fed commercially processed SBM had improved AA digestibility compared to those fed experimentally processed soybeans from a similar region. The high CP (57% CP) SBM variety had increased AA digestibility compared to the PCON and 52SBM

Evaluating Hammermill Tip Speed, Air Assist, and Screen Hole Diameter on Ground Corn Characteristics

Whole yellow dent #2 corn was ground using two 43 mm Andritz hammermills (Model: 4330-6, Andritz Feed & Biofuel, Muncy, PA; JBS Live Pork LLC Feed Mill, Fremont, IA). Both mills discharged to a shared plenum where samples were collected via a sample port. Each mill was equipped with 72 hammers and 300 HP motors on a variable frequency drive (VFD). Corn was ground on 3 separate days to create replication and treatments were randomized within replication. Treatments were arranged in a 3 × 3 × 3 factorial design with 3 tip speeds (12,383, 16,323, and 20,263 ft/min); 3 screen hole diameters (6/64, 10/64, and 16/64 in.); and 3 air assist system fan RPM’s (60, 80, and 100% of fan motor load). Samples of each treatment were collected and analyzed for moisture, particle size, and flowability characteristics. Particle size analysis was completed using a 13-sieve stack with the inclusion of sieve agitators and flow agent. Flowability characteristics were evaluated using a composite flow index (CFI), which includes percent compressibility, angle of repose (AoR), and critical orifice diameter (COD). Data were analyzed as a 3 × 3 × 3 factorial using the PROC GLIMMIX procedure of SAS with grinding run as the experimental unit and sample collection day as a blocking factor. There were no 3-way interactions for screen hole diameter × hammer tip speed × air flow for the geometric mean diameter (dgw) or any flowability characteristics of ground corn. There was a 3-way interaction for particle size standard deviation (Sgw), (linear screen hole diameter × linear hammer tip speed × linear air flow, P = 0.029). There was a linear screen hole diameter × linear hammer tip speed interaction (P = 0.001) for dgw. When tip speed increased from 12,383 to 20,263 ft/min, the rate of decrease in dgw was greater as screen hole diameter increased from 6/64 to 16/64 in. An interaction of screen hole diameter and hammer tip speed (linear × linear, P = 0.040) was also observed for the CFI. The CFI results increased with increasing screen hole diameter when corn was ground using a hammer tip speed of 12,383 ft/min but no differences were observed as tip speed increased to 16,323 and 20,263 ft/min. An interaction of screen hole diameter and hammer tip speed (quadratic × quadratic, P = 0.001) was observed for mill motor load. Mill motor load decreased as screen hole diameter increased from 6/64 in. to 16/64 in., but increased as hammer tip speed was increased with the most significant reductions being observed as tip speed increased from 12,383 ft/min to 16,323 ft/min on the 6/64 in. screen. In conclusion, hammer tip speed and air flow rate are viable options for adjusting ground material characteristics when grinding using a hammermill, alongside the traditional screen variations. Along with the range of particle sizes capable of being produced, an increased level of accuracy can also be achieved with hammer tip speed and air flow adjustments with minimal down time necessary for screen changes

Effects of the Pelleting Process on Diet Formulations with Varying Levels of Crystalline Amino Acids and Reducing Sugars on Nursery Pig Growth Performance

Pelleting swine feed and the use of crystalline amino acids and by-product ingredients can potentially create ideal conditions that further facilitate the Maillard browning reaction. The Maillard reaction combines an amino group of a free amino acid and a carbonyl group of a reducing sugar (RS), making the amino acid less available. The objective of this study was to determine the effects of pelleting swine diets containing free amino acids and reducing sugars at high temperatures on nursery pig growth performance. A total of 360 pigs (initially 25.0 lb; Line 200 × 400; DNA, Columbus, NE) were used in a study evaluating the effect of crystalline AA, reducing sugars, and feed form on growth performance of nursery pigs. Treatments were arranged in a 2 × 2 × 2 factorial with main effects of crystalline AA concentration (low vs. high), reducing sugars (RS; low vs. high), and diet form (mash vs. pellet). Diets were formulated with low or high crystalline AA and low or high reducing sugars provided by co-product ingredients, DDGS and bakery meal. Diets were pelleted to a conditioning temperature of 187.5°F. When pigs weighed approximately 25 lb, they were weighed, and pens were randomly assigned treatments. There were 9 replications per treatment and 5 pigs per pen. There were no 3-way or 2-way interactions. For the main effect of form, there was no evidence of difference in ADG, and ADFI increased (P = 0.001) in pigs fed mash diets compared to pellets. Feed efficiency and caloric efficiency improved (P = 0.001) in pigs fed pelleted diets compared to mash diets. For the main effect of crystalline AA, there was no evidence of difference in ADG or F/G; however, pigs fed high crystalline AA had increased (P = 0.024) ADFI compared to those fed low crystalline AA diets. For the main effect of RS inclusion, pigs fed low RS diets had increased (P \u3c 0.041) ADG and ADFI compared to pigs fed high RS inclusion diets. There was an improvement (P = 0.019) in F/G and caloric efficiency for pigs fed high RS inclusion diets compared to those fed low RS diets. There was no evidence of difference in IOFC for form, crystalline AA, or RS. In conclusion, there was no evidence of interactions between diet types, indicating that increasing amounts of crystalline AA and RS did not increase the Maillard reaction or reduce growth performance when pelleting diets by using the reported conditions. Pigs fed pelleted diets had similar ADG and an 8% improvement in F/G compared to those fed mash diets. Pigs fed the high RS diets had reduced feed intake, which resulted in reduced gain and improved feed and caloric efficiency. Additionally, pigs fed high AA diets had increased feed intake

The Change Up Project : using social norming theory with young people to address domestic abuse and promote healthy relationships

This paper presents the findings of a secondary analysis of data collected during a pilot project, Change Up, which used a social norming approach (SNA) to address domestic violence and abuse (DVA) with young people aged 13–14. A SNA is based upon a well-articulated theory of behavior and evidence-based methodology for addressing social justice issues. This reflects a paradigm shift focusing upon strengths and positives, rather than pathologizing behaviours. Adopting a SNA, the Change Up project comprised a baseline survey followed by the intervention (workshop and peer-to-peer campaign), ending with a post-intervention survey. It was delivered in two high schools in a UK city between 2015 and 16. A secondary analysis of the survey data collected during the surveys and qualitative data collected at the end of each workshop was undertaken and this is reported here. Change Up data illustrates that most young people in the sample thought that DVA is unacceptable. There was, however, a gender difference in the norms held about the social acceptability of girls using physical violence against boys (and vice versa). The analysis of Change Up data indicates that a social norming approach to DVA programs aimed at young people can be successful in promoting attitude and behaviour change. It also highlights a continuing need for young people’s education about relationships and gender equality

Epidermal Stem Cells Are Defined by Global Histone Modifications that Are Altered by Myc-Induced Differentiation

Activation of Myc induces epidermal stem cells to exit their niche and differentiate into sebocytes and interfollicular epidermis, a process that is associated with widespread changes in gene transcription. We have identified chromatin modifications that are characteristic of epidermal stem cells and investigated the effects of Myc activation. Quiescent stem cells in the interfollicular epidermis and the hair follicle bulge had high levels of tri-methylated histone H3 at lysine 9 and H4 at lysine 20. Chromatin in both stem cell populations was hypoacteylated at histone H4 and lacked mono-methylation of histone H4 at lysine 20. Myc-induced exit from the stem cell niche correlated with increased acetylation at histone H4 and transiently increased mono-methylation at lysine 20. The latter was replaced by epigenetic modifications that are largely associated with chromatin silencing: di-methylation at histone H3 lysine 9 and histone H4 lysine 20. These modifications correlated with changes in the specific histone methyltransferases Set8 and Ash-1. The Myc-induced switch from mono- to di-methylated H4K20 required HDAC activity and was blocked by the HDAC inhibitor trichostatin A (TSA). TSA treatment induced a similar epidermal phenotype to activation of Myc, and activation of Myc in the presence of TSA resulted in massive stimulation of terminal differentiation. We conclude that Myc-induced chromatin modifications play a major role in Myc-induced exit from the stem cell compartment

Stem cell function and stress response are controlled by protein synthesis.

Whether protein synthesis and cellular stress response pathways interact to control stem cell function is currently unknown. Here we show that mouse skin stem cells synthesize less protein than their immediate progenitors in vivo, even when forced to proliferate. Our analyses reveal that activation of stress response pathways drives both a global reduction of protein synthesis and altered translational programmes that together promote stem cell functions and tumorigenesis. Mechanistically, we show that inhibition of post-transcriptional cytosine-5 methylation locks tumour-initiating cells in this distinct translational inhibition programme. Paradoxically, this inhibition renders stem cells hypersensitive to cytotoxic stress, as tumour regeneration after treatment with 5-fluorouracil is blocked. Thus, stem cells must revoke translation inhibition pathways to regenerate a tissue or tumour.This work was funded by Cancer Research UK (CR-UK), Worldwide Cancer Research, the Medical Research Council (MRC), the European Research Council (ERC), and EMBO. Research in Michaela Frye's laboratory is supported by a core support grant from the Wellcome Trust and MRC to the Wellcome Trust-Medical Research Cambridge Stem Cell Institute.This is the author accepted manuscript. The final version is available from Nature Publishing Group via http://dx.doi.org/10.1038/nature1828

The opposing transcriptional functions of Sin3a and c-Myc are required to maintain tissue homeostasis.

How the proto-oncogene c-Myc balances the processes of stem-cell self-renewal, proliferation and differentiation in adult tissues is largely unknown. We explored c-Myc's transcriptional roles at the epidermal differentiation complex, a locus essential for skin maturation. Binding of c-Myc can simultaneously recruit (Klf4, Ovol-1) and displace (Cebpa, Mxi1 and Sin3a) specific sets of differentiation-specific transcriptional regulators to epidermal differentiation complex genes. We found that Sin3a causes deacetylation of c-Myc protein to directly repress c-Myc activity. In the absence of Sin3a, genomic recruitment of c-Myc to the epidermal differentiation complex is enhanced, and re-activation of c-Myc-target genes drives aberrant epidermal proliferation and differentiation. Simultaneous deletion of c-Myc and Sin3a reverts the skin phenotype to normal. Our results identify how the balance of two transcriptional key regulators can maintain tissue homeostasis through a negative feedback loop