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PASTOR represents an innovative development in the study of resilience. This commentary highlights how PASTOR can help both clarify critical questions in and benefit from engaging with new research in personality science on behavioral flexibility across situations in addition to stability over time, and also clarify the relationship between resilience and posttraumatic growth.
To characterize the current state of Canadian emergency medicine (EM) resident research and develop recommendations to promote excellence in this area.
Methods
We performed a systematic review of MEDLINE, Embase, and ERIC using search terms relevant to EM resident research. We conducted an online survey of EM residency program directors from the Royal College of Physicians and Surgeons of Canada (RCPSC) and College of Family Physicians of Canada (CFPC). An expert panel reviewed these data, presented recommendations at the Canadian Association of Emergency Physicians 2014 Academic Symposium, and refined them based on feedback received.
Results
Of 654 potentially relevant citations, 35 articles were included. These were categorized into four themes: 1) expectations and requirements, 2) training and assessment, 3) infrastructure and support, and 4) dissemination. We received 31 responses from all 31 RCPSC-EM and CFPC-EM programs. The majority of EM programs reported requiring a resident scholarly project; however, we found wide-ranging expectations for the type of resident research performed and how results were disseminated, as well as the degree of completion expected. Although 93% of RCPSC-EM programs reported providing formal training on how to conduct research, only 53% of CFPC-EM programs reported doing so. Almost all programs (94%) reported having infrastructure in place to support resident research, but the nature of support was highly variable. Finally, there was marked variability regarding the number of resident-published abstracts and manuscripts.
Conclusions
Based on the literature, our national survey, and discussions with stakeholders, we offer 14 recommendations encompassing goals, expectations, training, assessment, infrastructure, and dissemination in order to improve Canadian EM resident research.
The lesions associated with the migration of the larvæ of Ascaris megalocephala through the tissues of the host were studied in rabbits, guinea pigs and mice. In addition to studying the changes in those organs directly invaded by the larvæ in the course of migration, an organ remote from the migratory route but exposed to the action of any toxic products elaborated by the larvæ was also examined. In each case therefore, sections were prepared from (a) liver, (b) lungs and (c) kidneys.
1. A preliminary account is given of certain serological investigations carried out on a rabbit fed with the embryonated eggs of Ascaris megalocephala.
2. By means of the complement-fixation test it has been shown that a definite immunity response occurs in the first five weeks of the infection.
Since the introduction of carbon tetrachloride for the treatment of the hookworm infestations of man it has been ascertained that in certain conditions fatal poisoning may follow oral administration of the drug. If carbon tetrachloride is given in cases of alcoholic cirrhosis of the liver, or if alcohol is taken immediately after the drug, severe gastro-intestinal symptoms are to be anticipated with death in two or three days. Davis (1924) showed that in dogs the toxicity of the drug was intimately associated with certain dietetic factors. He found that a high carbohydrate diet enabled the liver to withstand relatively large doses of the drug. High protein diets also protected the liver against injury (although less efficiently than carbohydrate) but an “all-fat” diet was invariably associated with extensive damage to the hepatic parenchyma. Lambert (1923) while carrying out hookworm treatment on a large scale in Fiji found that where a patient was heavily infested with Ascaris lumbricoides as well as with hookworm it was unwise to exhibit carbon tetrachloride without first getting rid of the ascarids.
Bilharziasis is unquestionably one of the major parasitic diseases of Southern Africa where both the urinary and intestinal forms occur. When it presents in the classical form, the diagnosis either from the clinical or laboratory viewpoint is seldom a major problem; but when, as so often happens, the presenting features have little in common with the accepted text-book descriptions of the disease, diagnosis becomes a matter of considerable difficulty.
High-yielding dairy cows are at risk of injuries causing lameness due to the hard, abrasive nature or slipperiness of the usual concrete floor surface (Cook et al., 2004). These problems can be exacerbated by the milking procedure that includes crowding of cows and possible sharp turns at the entrance and exit of the parlour. Rubber mats on walkways have been shown to reduce injury (Rushen and Passillé, 2006) and are preferred by cows to a concrete or slatted surface (Telezhenko et al., 2007). A recent installation of rubber matting in the milking stalls of a 15 cows per side (30-30) rapid exit parlour provided an opportunity to observe potential effects on cow behaviour. The mats were introduced to one side at a time and then to both sides and the aim was to determine whether the rubber matting had any significant effects on social interaction immediately prior to entering the milking stalls and the time taken for 15 cows to take their places.
There is a trend in the UK towards larger dairy herds increasing the number of cows per stockperson and reducing available time for routine observations. A slightly difficult calving can have an economic loss of £110 with up to £400 for a difficult calving (McGuirk et al, 2007). These losses are incurred in lost milk production, increased labour costs and delayed calving to conception interval. Therefore, it would be advantageous for the stockpersons to have an automated alert of the onset of calving as soon as possible to allow assistance to be given if required and to highlight cows for observation.
The peri-parturient period is unsettling for dairy cows as they move from the dry period, through parturition, cow-calf separation and into the milking herd. The changes in physiological state, environment and social grouping through this period are likely to be particularly manifest in primiparous cows. Lactating dairy cows may be expected to spend up to 13.8 hours/day lying (Tucker and Weary, 2007), this has been shown to alter through the peri-parturient period (Huzzey et al (2005). The mean lying time for healthy cows at this farm was 11 hours day (Blackie et al, 2008).
The aim of the present study was to assess the changes in activity levels of first parity cows before and after calving as compared to their multiparous herd mates.
Lameness can be assessed using locomotion scoring; however, this method is time consuming and an automated method of detecting lameness is needed. Studies have shown that in conventionally-managed dairy herds, lame cows spend more time lying down than non-lame cows (e.g. Singh et al, 1993). However, there are limited data available for high producing zero-grazed dairy cattle in the UK. IceTags™ are activity monitors which use an electronic accelerometer to determine the percent of time spent standing, lying or active and have been validated in a study by Munksgaard et al (2006). The aim of the present study was to assess the impact of lameness on lying behaviour of high yielding, zero-grazed, Holstein dairy cows and to assess the potential use of lying time to detect lameness.
Kinematic assessment of gait has been widely used in sports and equine science, this method gives objective and accurate information on the movement of the subject. Most locomotion scoring systems incorporate stride length however this is subjective and is difficult to compare observers. Kinematic studies have shown that cows with sole ulcers have a shorter stride length than those showing no hoof lesions (Flower et al, 2005). Telezhenko and Bergsten (2005) found a similar effect with moderately lame cows having a shorter stride length measured objectively from footprints than non lame cows. Increased locomotion score can also affect the tracking distance of the animal (Telezhenko and Bergsten, 2005). The aim of this study was to assess the effect of increasing locomotion score on stride length and tracking distance of Holstein dairy cows in early lactation.
Locomotion scoring is an important tool to detect dairy cow lameness. A number of locomotion scoring systems use the posture of the back to identify lame cows (score 3). For example Sprecher et al (1997) suggested the presence of an arched back standing and walking indicates lameness. Flower and Weary (2006) developed this system to score cows while walking where a score 3 cow has a more severely arched back than a score 2 cow. However to date no work has been published characterising the degree of arching of the spine observed in lame animals and its relationship with foot lesions. This is important in the early detection of lameness and could be incorporated into locomotion scoring systems to improve the objectivity. The aim of this study was to assess the effect of foot lesions on spine posture of Holstein dairy cows in early lactation by motion analysis.
To assess the influence of prophylactic selective bowel decontamination (SBD) on the spectrum of microbes causing bloodstream infection (BSI).
Design:
The microbes causing BSI in neutropenic patients of a hematologic ward (HW) and a bone marrow transplantation unit (BMTU), respectively, were compared by retrospective analysis of blood culture results from January 1996 to June 2003.
Setting:
A 30-bed HW (no SBD) and a BMTU including a 7-bed normal care ward and an 8-bed intensive care unit (SBD used) of a 2,200-bed university teaching hospital.
Results:
The overall incidences of bacteremia in the HW and the BMTU were similar (72.6 vs 70.6 episodes per 1,000 admissions; P = .8). Two hundred twenty episodes of BSI were recorded in 164 neutropenic patients of the HW and 153 episodes in 127 neutropenic patients of the BMTU. Enterobacteriaceae (OR, 3.14; CI95, 1.67–5.97; P = .0002) and Streptococcus species (OR, 2.04; CI95, 1.14–3.70; P = .015) were observed more frequently in HW patients and coagulase-negative staphylococci more frequently in BMTU patients (OR, 0.15; CI95, 0.09–0.26; P< .00001). No statistically significant differences were found for gram-negative nonfermentative bacilli (P = .53), Staphylococcus aureus (P = .21), Enterococcus species (P = .48), anaerobic bacteria (P = .1), or fungi (P = .50).
Conclusions:
SBD did not lead to a significant reduction in the incidence of bacteremia, but significant changes in microbes recovered from blood cultures were observed. SBD should be considered when empiric antimicrobial therapy is prescribed for suspected BSI.