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Sheep (Ovis aries) are stoic, prey animals that have evolved to mask signs of pain and vulnerability, making behavioural indicators of poor welfare difficult to detect. Body condition scoring (BCS) remains one of the most practical, animal-based indicators of chronic undernutrition and compromised welfare in grazing ruminants. Disruption of the incisor apparatus due to dental disorders or tooth loss can impair grazing efficiency, resulting in reduced nutritional intake and contributing to poor body condition. Despite this, there has been little research into the prevalence or welfare impact of dental disorders in sheep. This preliminary study aimed to assess the prevalence of incisor wear in extensively grazed Dohne Merino ewes, examine its distribution across age groups, and evaluate associations with bodyweight and BCS. A total of 818 ewes aged 2 to 10 years were evaluated during routine husbandry. Incisor wear was scored based on dentine exposure using a 0–3 ordinal scale. BCS was determined through hands-on palpation, and liveweight was recorded. Wear affecting more than one-third of tooth enamel was present in at least one incisor in 99% of ewes over five years of age. Greater incisor wear was significantly associated with lower bodyweight and BCS in ewes over two years, irrespective of age. These findings underscore the potential role of incisor wear as a contributing factor to nutritional compromise and welfare risk in older sheep. Monitoring incisor health may facilitate more accurate welfare assessments and enhance management strategies in extensive systems.
Rapid molecular diagnostics, such as the BIOFIRE® Blood Culture Identification 2 (BCID2) panel, have improved the time to pathogen identification in bloodstream infections. However, accurate interpretation and antimicrobial optimization require Infectious Disease (ID) expertise, which may not always be readily available. GPT-powered chatbots could support antimicrobial stewardship programs (ASPs) by assisting non-specialist providers in BCID2 result interpretation and treatment recommendations. This study evaluates the performance of a GPT-4 chatbot compared to ASP prospective audit and feedback interventions.
Methods:
This prospective observational study assessed 43 consecutive real-world cases of bacteremia at a 399-bed VA Medical Center from January to May 2024. The GPT-chatbot utilized “chain-of-thought” prompting and external knowledge integration to generate recommendations. Two independent ID physicians evaluated chatbot and ASP recommendations across four domains: BCID2 interpretation, source control, antibiotic therapy, and additional diagnostic workup. The primary endpoint was the combined rate of harmful or inadequate recommendations. Secondary endpoints assessed the rate of harmful or inadequate responses for each domain.
Results:
The chatbot had a significantly higher rate of harmful or inadequate recommendations (13%) compared to ASP (4%, p = 0.047). The most significant discrepancy was observed in the domain of antibiotic therapy, where harmful recommendations occurred in up to 10% (p <0.05) of chatbot evaluations. The chatbot performed well in BCID2 interpretation (100% accuracy) but provided more inadequate responses in source control consideration (10% vs. 2% for ASP, p = 0.022).
Conclusions:
GPT-powered chatbots show potential for supporting antimicrobial stewardship but should only complement, not replace, human expertise in infectious disease management.
The transition from conventional cage systems to cage-free egg production in China remains limited despite apparently increasing consumer demand for cage-free eggs. This study interviewed 15 large-scale Chinese egg producers using cages and/or cage-free systems (i.e. single-, multi-tier and free-range) to investigate the perceived challenges and opportunities during the transition. The cage farms’ scales range from 110,000 to 30 million, while the cage-free farms keep between 12,000 and 300,000 laying hens. Drawing upon the COM-B model of the Behaviour Change Wheel, this study explored how producers’ Capabilities, Opportunities, and Motivations impact decision-making processes. Key findings reveal that cage and cage-free producers considered consumer demand and profitability as primary drivers for adopting cage-free systems. While free-range producers were more confident in the market, barn system producers faced greater uncertainty due to limited engagement from corporate buyers. Moreover, these cage-free producers believed reliable certification and labelling schemes to be critical for building consumer trust and ensuring the success of cage-free operations. All the participants perceived access to sufficient land and financial resources to be essential for a successful transition. While most studies propose education as a long-term strategy to promote the growth of the cage-free egg sector, our findings are the first to highlight that engaging corporate buyers and establishing trustworthy certification schemes are the most crucial short-term interventions required to drive the development of large-scale cage-free farms and support sustained improvements in animal welfare in China.
This compendium of essential works clarifies that the Australian Army’s force structure is organic and constantly changing. It provides a starting point for quickly acquiring new capabilities at short notice when required to meet emerging threats and challenges. The Army’s response to realising government direction and investment in new capabilities is being examined via a series of options under the Army Objective Force. It involves a careful and deliberate program of analysis that will provide a framework to develop the Army of the future. Readers can be assured that the Australian Army’s future is informed through understanding of its past – understanding that is provided to the Army’s planners today through contributions such as this.
Exploring and using remote segments of complex karst systems represents the incorporation of one of the wildest and most demanding natural environments into the cultural fabric of Neolithic-Chalcolithic village-based communities in the Levant. The unique preservation of an early fifth-millennium bce activity phase in Har Sifsof Cave in northern Israel allows for a detailed investigation of an early case of human interaction with the deep underground in this region. The study of archaeological assemblages, environmental and speleological data and spatial distribution of cultural remains form the basis for interpreting the activity inside the cave in the context of fertility cults. The rituals conducted in Har Sifsof Cave revolve around the agricultural cycle of cereal grains and include the interment of multiple individuals, some of whom were buried in remote cul-de-sac passages. The emergence of complex caves as favourable off-settlement arenas dedicated to ritual activity during the later stages of Neolithization marks a conscious effort of ‘domestication’ of these unique wildscapes, while sowing the seeds for the enduring connection observed in later Levantine societies between mortuary rituals, fertility and the underground.
Rodriguez-Nava et al. present a proof-of-concept study evaluating the use of a secure large language model (LLM) approved for healthcare data for retrospective identification of a specific healthcare-associated infection (HAI)—central line-associated bloodstream infections—from real patient data for the purposes of surveillance.1 This study illustrates a promising direction for how LLMs can, at a minimum, semi-automate or streamline HAI surveillance activities.
Subject-Sensitive Invariantism (SSI) and Epistemic Contextualism (EC) are rival theories in epistemology. Both involve shifting epistemic standards, but they differ in how they explain this shiftiness. SSI is primarily a metaphysical thesis about the knowledge relation, whereas EC is primarily a semantic thesis about knowledge attributions. This paper revisits some of the central problems faced by SSI, especially those concerning Dutch books and third-person knowledge ascriptions. The main aim is to show that existing responses that stay true to SSI do not succeed, leaving SSI in serious jeopardy. Some strategies put forward by, or on behalf of, SSI-friendly philosophers fare better. But these involve forsaking central features of SSI, ceding ground to EC, and falling back on a defense of impurism. I sketch what such an impurist fallback position might look like and argue that the more ground it cedes to EC, the more attractive it will be. It is shown that such an impurist, contextualist position can handle all the difficulties I discuss in relation to SSI. The paper concludes by briefly considering what new challenges this kind of position faces instead.
Antimicrobial stewardship programs (ASPs) aim to mitigate antimicrobial resistance (AMR) by optimizing antibiotic use including reducing unnecessary broad-spectrum therapy. This study evaluates the impact of ASP funding and resources on the use of broad-spectrum antibiotics in Ontario hospitals.
Methods:
We conducted a cross-sectional study of antimicrobial use (AMU) across 63 Ontario hospitals from April 2020 to March 2023. The Ontario ASP Landscape Survey provided data on ASP resourcing and antibiotic utilization. The main outcome was the proportion of all antibiotics that were broad-spectrum, defined as: fluoroquinolones; third-generation cephalosporins; beta-lactam/beta-lactamase inhibitors; carbapenems; clindamycin; and parenteral vancomycin. Secondary outcomes included the proportions of individual antibiotic classes listed above and anti-pseudomonal agents. Statistical analysis involved logistic regression to determine the odds ratio (OR) of the association between ASP funding/resourcing and broad-spectrum antibiotic use.
Results:
Among 63 hospitals, 48 reported designated ASP funding/resources. Median broad-spectrum antibiotic use was 52.5%. ASP funding/resources was not associated with overall broad-spectrum antibiotic use (0.97, 95% CI: 0.75–1.25, P = 0.79). However, funding was associated with lower use of fluoroquinolones (OR 0.67, 95% CI: 0.46–0.96, P = 0.03), clindamycin (OR 0.69, 95% CI: 0.47–1.00, P = 0.05), and anti-pseudomonal agents (OR 0.76, 95% CI: 0.59–0.98, P = 0.03).
Conclusion:
The presence of designated funding and resources for hospital ASPs is linked to reduced use of specific broad-spectrum antibiotics but not overall broad-spectrum antibiotic use. Enhancing ASP resourcing may be an important factor in limiting targeted antibiotic use, thereby increasing the effectiveness of efforts to mitigate AMR.
Between the late second and the early fourth century CE, several empresses received the title Mater Castrorum, either in official documents, inscriptions, and coinage or in unofficial honorific or dedicatory inscriptions erected by subjects. Scholars have assumed the title was indicative of a tight-knit relationship between the empresses and the soldiers. Recent studies of the numismatic and epigraphic evidence, however, have demonstrated that, at least in the cases of the early Matres Castrorum, the title was not descriptive of an actual relationship with the military. These studies argue it was the product of dynastic propaganda that prepared a smooth path for successors. Given this new, demonstrated understanding of the title’s original purpose this chapter investigates how the title fits into ideologies that emperors “negotiated” with the constituencies in the Empire. Based on the evidence, we conclude that the meaning and use of the Mater Castrorum title changed over time according to the agenda of those who employed it. The evolution of the title is not surprising, but as with so many aspects of investigations into women and the military, the complexities of its use have not previously been conceived of in this way.
In mammals, DNA methylation (DNAme) erasure and reinstatement during embryo development and germline establishment are sensitive to the intrauterine environment. Maternal intake of a high-fat diet (HFD), associated with excessive gestational weight gain, has transgenerational effects on offspring health, which may be mediated by changes in DNAme in the germline. Here, we tested the impact of a maternal HFD on embryonic germline DNAme erasure using a rat strain that expresses green fluorescent protein specifically in germ cells. DNAme was analysed by methyl-seq capture in germ cells collected from male and female F1 gonads at gestational day 16. Our data show that although HFD induced global hypomethylation in both sexes, DNAme erasure in female germ cells was more advanced compared to male germ cells. The delay in DNAme erasure in males and the greater impact of HFD suggest that male germ cells are more vulnerable to alterations by exogenous factors.
Antibiotic overuse for asymptomatic bacteriuria is common in older adults and can lead to harmful outcomes including antimicrobial resistance. Our objective was to evaluate the impact of a simple scoring tool on urine culturing and antibiotic prescribing for adults with presumed urinary tract infections (UTI).
Design:
Quasi-experimental study using interrupted time series with segmented regression to evaluate urine culturing and urinary antibiotic use and length of stay (LOS), acute care transfers, and mortality 18 months before and 16 months after the intervention.
Setting:
134-bed complex continuing care and rehabilitation hospital in Ontario, Canada.
Participants:
Nurses, nurse practitioners, physicians, and other healthcare professionals.
Intervention:
A multifaceted intervention focusing on a 6-item mnemonic scoring tool called the BLADDER score was developed based on existing minimum criteria for prescribing antibiotics in patients with presumed UTI. The BLADDER score was combined with ward- and prescriber-level feedback and education.
Results:
Before the intervention, the mean rate of urine culturing was 12.47 cultures per 1,000 patient days; after the intervention, the rate was 7.92 cultures per 1,000 patient days (IRR 0.87; 95% CI, 0.67–1.12). Urinary antibiotic use declined after the intervention from a mean of 40.55 DDD per 1,000 patient days before and 25.96 DDD per 1,000 patient days after the intervention (IRR 0.68; 95% CI, 0.59–0.79). There was no change in mean patient LOS, acute care transfers, or mortality.
Conclusions:
The BLADDER score may be a safe and effective tool to support improved diagnostic and antimicrobial stewardship to reduce unnecessary treatment for asymptomatic bacteriuria.
Rapid Tranquilisation (RT) is the parenteral (intramuscular) administration of medication to calm or sedate an agitated, violent or aggressive patient in a timely and safe manner. This audit specifically looks at the clinical practice in the use of rapid tranquilisation in inpatient MHSOP against trust policy. The aim of this audit is to assess the effectiveness of RT and if other methods of de-escalation are being utilized first to provide better care for patients and utilize the least restrictive management options possible.
Methods
The audit was registered, and care was taken to uphold ethics, access patient information appropriately, and to ensure that data collected was both relevant and ensured confidentiality. All incidents of RT were identified across both wards of Auckland Park Hospital from the period of August to October 2023. DATIX numbers were identified to show incidents of RT from the specified period, these numbers were used to identify patient ID with liaison with relevant staff members. Patient ID was used to review the incident, specifically to investigate de-escalation techniques documented and effectiveness of RT. Only parenteral RT incidents were included to assess if appropriate measures were taken beforehand.
Results
A total of six Incident reports were identified over the three-month period. In all cases the choice and dose of the medication was within the current recommendations. 33% of incidents utilised promethazine 25mg while the other 66% utilised lorazepam either 1mg or 500mcg. All patients had baseline observations recorded on NEWS chart prior to the incident, however only 33% of incidents involved full recordings of observations at appropriate intervals on the NEWS chart. The reason for this in all cases was due to patient refusing observations which was documented. There were no documented side effects but 33% of incidents involved a raised NEWS score post RT. In all cases the NEWS score resolved spontaneously within the post RT monitoring period. In 100% of incidents de-escalation techniques were utilised and documented and evidence of post RT debrief with the patient was shown. 66% of incidents involved a medication review post RT as per recommendations.
Conclusion
Guidelines are being followed with good effect regarding RT in MHSOP. It is important to always undertake nonpharmacological de-escalation methods prior to considering RT which is reflected in the low numbers of RT during this period. Recommendations are made to follow local guidance as well as to exhaust nonpharmacological de-escalation methods to reduce the need for RT.
The escalating threat of antimicrobial resistance (AMR) necessitates impactful, reproducible, and scalable antimicrobial stewardship strategies. This review addresses the critical need to enhance the quality of antimicrobial stewardship intervention research. We propose five considerations for authors planning and evaluating antimicrobial stewardship initiatives. Antimicrobial stewards should consider the following mnemonic ABCDE: (A) plan Ahead using implementation science; (B) Be clear and thoroughly describe the intervention by using the TidIER checklist; (C) Use a Checklist to comprehensively report study components; (D) Select a study Design carefully; and (E) Assess Effectiveness and implementation by selecting meaningful outcomes. Incorporating these recommendations will help strengthen the evidence base of antimicrobial stewardship literature and support optimal implementation of strategies to mitigate AMR.
Although sheep are commonly transported long distances, and sheep welfare during transport is a topic of research and policy discussion, the subject of their fatigue during transport has been under-researched. The current qualitative study, focused on the EU and UK, aimed to critically analyse stakeholder views on issues relating to sheep fatigue, including behavioural indications of fatigue, the interplay between fatigue and other factors, and the practicalities of identifying fatigue in commercial transport conditions. Insight into stakeholder perceptions of these issues could contribute to the body of knowledge regarding sheep fatigue during transport, potentially playing a part in future efforts to improve fatigue understanding and detection. Eighteen experts from different stakeholder groups were interviewed. Reflexive thematic analysis of interview data yielded four themes and three sub-themes. The first theme, “Let’s anthropomorphise it a little bit”, underscores the pervasiveness of anthropomorphism and suggests using it in a conscious and deliberate way to drive stakeholder engagement and policy change. The second theme, “We think that they’re like we are and they’re not”, cautions against wholesale transfer of human experiences to animals. The third theme, ‘See the whole animal’, advocates using Qualitative Behaviour Analysis (QBA), proven reliable in other contexts, to deepen and enrich our current understanding of fatigue. The fourth theme, ‘Fatigue “never comes up”’, highlights the fact that fatigue is rarely if ever discussed in the context of sheep transport. These themes suggest several avenues for future research, including developing QBA-based assessments for fatigue to improve welfare during transport.
To evaluate inter-physician variability and predictors of changes in antibiotic prescribing before (2019) and during (2020/2021) the coronavirus disease 2019 (COVID-19) pandemic.
Methods:
We conducted a retrospective cohort analysis of physicians in Ontario, Canada prescribing oral antibiotics in the outpatient setting between January 1, 2019 and December 31, 2021 using the IQVIA Xponent data set. The primary outcome was the change in the number of antibiotic prescriptions between the prepandemic and pandemic period. Secondary outcomes were changes in the selection of broad-spectrum agents and long-duration (>7 d) antibiotic use. We used multivariable linear regression models to evaluate predictors of change.
Results:
There were 17,288 physicians included in the study with substantial inter-physician variability in changes in antibiotic prescribing (median change of −43.5 antibiotics per physician, interquartile range −136.5 to −5.0). In the multivariable model, later career stage (adjusted mean difference [aMD] −45.3, 95% confidence interval [CI] −52.9 to −37.8, p < .001), family medicine (aMD −46.0, 95% CI −62.5 to −29.4, p < .001), male patient sex (aMD −52.4, 95% CI −71.1 to −33.7, p < .001), low patient comorbidity (aMD −42.5, 95% CI −50.3 to −34.8, p < .001), and high prescribing to new patients (aMD −216.5, 95% CI −223.5 to −209.5, p < .001) were associated with decreases in antibiotic initiation. Family medicine and high prescribing to new patients were associated with a decrease in selection of broad-spectrum agents and prolonged antibiotic use.
Conclusions:
Antibiotic prescribing changed throughout the COVID-19 pandemic with overall decreases in antibiotic initiation, broad-spectrum agents, and prolonged antibiotic courses with inter-physician variability. These findings present opportunities for community antibiotic stewardship interventions.
Many veterinary practices around the world do not meet basic post-operative cat care, thereby compromising cat welfare. Understanding why the appropriate care is not always given is important. The current study used a mixed methods approach of two phases, to investigate the barriers Malaysian veterinarians face in seeking to provide good cat care in practice. Phase 1 involved a survey consisting of 14 questions which were divided into three sections (demographic details, basic management and barriers experienced by practices) and emailed to 143 Malaysian veterinarians. While for phase 2, 20 interviews were undertaken (recruited from the survey sample) to further elaborate on the results. A Thematic Analysis was conducted to extract the main barriers experienced by participants. A total of 49 veterinarians completed the survey. Over half of the respondents were senior veterinarians (i.e. those with two or more years in practice) (53.1%; n = 26) who were aware of the basic environmental provisions that cats need post-surgery such as bedding and toileting facilities (57.1%; n = 28). Cost (47%; n = 23) was the biggest restriction to good care provision. Interview findings showed that participants were aware of comfortable post-surgery environments helping recovery, but barriers were highlighted: workload factors and a lack of understanding of cat pain behaviours and associated stress. This suggested that participants had the knowledge required to provide good cat care but experienced difficulties putting this into practice. Therefore, to improve cat welfare in veterinary practice, instead of focusing purely on education, interventions to increase good cat care could include targeted elements that support behaviour change to overcome the barriers.
We sought to evaluate the impact of antibiotic selection and duration of therapy on treatment failure in older adults with catheter-associated urinary tract infection (CA-UTI).
Methods:
We conducted a population-based cohort study comparing antibiotic treatment options and duration of therapy for non-hospitalized adults aged 66 and older with presumed CA-UTI (defined as an antibiotic prescription and an organism identified in urine culture in a patient with urinary catheterization documented within the prior 90 d). The primary outcome was treatment failure, a composite of repeat urinary antibiotic prescribing, positive blood culture with the same organism, all-cause hospitalization or mortality, within 60 days. We determined the risk of treatment failure accounting for age, sex, comorbidities, and healthcare exposure using log-binomial regression.
Results:
Of 4,436 CA-UTI patients, 2,709 (61.1%) experienced treatment failure. Compared to a reference of TMP-SMX (61.9% failure), of those treated with fluoroquinolones, 56.3% experienced failure (RR 0.91, 95% CI: 0.85–0.98) and 60.9% of patients treated with nitrofurantoin experienced failure (RR 1.02, 95% CI: 0.94–1.10). Compared to 5–7 days of therapy (treatment failure: 59.4%), 1–4 days was associated with 69.5% failure (RR 1.15, 95% CI: 1.05–1.27), and 8–14 days was associated with a 62.0% failure (RR 1.05, 95% CI: 0.99–1.11).
Conclusions:
Although most treatment options for CA-UTI have a similar risk of treatment failure, fluoroquinolones, and treatment durations ≥ 5 days in duration appear to be associated with modestly improved clinical outcomes. From a duration of therapy perspective, this study provides reassurance that relatively short courses of 5–7 days may be reasonable for CA-UTI.