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Background Previous work on sickness absence has shown that conversations about return to work can be challenging. The perception of competing interests and multiple stakeholders in the return to work process may also complicate and erode trust, further impacting health and well-being. Aims This study aims to explore the themes arising from the experiences of physicians and patients on the impact of health and return to work. The goal was to use these results to develop a Medical Readers' Theatre workshop focusing on negotiating challenging return to work scenarios to serve as an educational support for stakeholders. Methods Semi-structured interviews were conducted with 19 physicians and 15 patients from the Canadian Maritime Provinces on their experiences in return to work following an injury or illness. Interviews were recorded, transcribed and thematically analysed. Using the emergent themes, an educational workshop in the modality of Readers' Theatre was developed. Results The findings confirm there are multiple stakeholders involved in the return to work process and the factors influencing successful return are not always medically related. Six recurring themes were identified for the patient group and five for the physicians', allowing the development of storylines and four return to work scenarios. The scenarios have been used in teaching sessions. Conclusions The themes reinforced that challenges in return to work are not always medical in nature. This Readers' Theatre adopts perspectives of patients, physicians and other stakeholders whilst focusing on return to work with the goal of providing engagement in reflective and purposeful discussion. [ABSTRACT FROM AUTHOR]

Mexican wolves (Canis lupus baileyi) share their range with a number of sympatric carnivores, many of which are a concern to livestock producers because they can prey on livestock. Determining which predator species is responsible for killing livestock is important for determining appropriate management actions and for the conservation of Mexican wolves. A variety of information can be used to decipher which carnivore species was responsible for making a kill, and mandibular (upper) and maxillary (lower) intercanine width measurements (i.e. bite mark analysis) can aid this process. No research has been conducted to validate the usefulness of bite mark analysis; thus, we used dentition measurements from Mexican wolves, coyotes (Canis latrans), feral dogs (Canis familiaris), bobcats (Lynx rufus), mountain lions (Puma concolor), and gray foxes (Urocyon cinereoargenteus) and an overlap coefficient to evaluate the degree of overlap in intercanine width between these species. We found that larger carnivore species had greater overlap than smaller carnivores, feral dogs overlapped widely with all the medium-to-large carnivores, and upper and lower intercanine width measurements provided similar information. Our data indicated that when investigating livestock depredations for Mexican wolves, bite mark analyses should be evaluated along with additional forensic evidence due to the overlap between many of the carnivore species, and that measurements between 28 and 35 mm have the greatest uncertainty because this range overlaps with feral dogs, mountain lions, and coyotes. [ABSTRACT FROM AUTHOR]

The objective of this research was to evaluate effects of replacing sorghum x Sudangrass hay with ground juniper in gestating ewe supplements on pre- and postpartum growth performance, serum metabolites and hormonal concentrations, milk fatty acid composition, and progeny preweaning performance. In a completely randomized design, commercial Rambouillet ewes (age = 3 to 5 yr; initial BW = 65.2 ± 1.6 kg) on a base diet of long-stem sorghum x Sudangrass hay were assigned to 1 of 4 dietary supplements in which ground juniper replaced 0% (CNTL), 33% (18JUN), 66% (36JUN), or 100% (54JUN) of the ground sorghum x Sudangrass hay in a pelleted supplement with ground juniper from d 38 ± 4 of gestation to 2 d postpartum. Treatment DM diet intake overall (g/kg BW) in ewes receiving no juniper was similar (P ≥ 0.38) to that of those receiving increasing concentrations of juniper. Changes in ewe BW and BCS were similar (P ≥ 0.24) in ewes throughout gestation. All serum metabolites and hormones were within normal clinical ranges; however, serum IGF-1 decreased linearly (P = 0.003), alanine increased (linear; P = 0.003), and serum Na decreased (linear; P = 0.049) as the percentage of juniper increased in the diet. Ewe milk fatty acid composition was similar (P > 0.05) for the majority of fatty acids across treatment groups, with the exception of arachidonic acid (C20:4n6) being greater (P < 0.02) in 54JUN vs. CNTL ewe milk. Lamb birth weights were similar (P = 0.13), whereas lamb ADG tended to differ (quadratic; P = 0.06) from d 0 to 14, with 18JUN being the least. At weaning, BW tended (P = 0.09) to linearly decrease in lambs born to ewes consuming greater concentrations of juniper but were not different (P = 0.26) between CNTL and 18JUN, 36JUN, and 54JUN. Results indicated that feeding increasing levels of ground juniper in supplements did not negatively alter ewe performance or serum metabolites and hormones measured pre- and postpartum. Lamb birth weight and preweaning performance appeared unaffected by maternal consumption of ground juniper containing supplements. Results also provide novel information regarding the effects of plant secondary compound consumption throughout pregnancy on ewe and progeny performance and health. [ABSTRACT FROM AUTHOR]

Worldwide, native predators are killed to protect livestock, an action that can undermine wildlife conservation efforts and create conflicts among stakeholders. An ongoing example is occurring in the western United States, where wolves (Canis lupus) were eradicated by the 1930s but are again present in parts of their historic range. While livestock losses to wolves represent a small fraction of overall livestock mortality, the response to these depredations has resulted in widespread conflicts including significant efforts at lethal wolf control to reduce impacts on livestock producers, especially those with large-scale grazing operations on public lands. A variety of nonlethal methods have proven effective in reducing livestock losses to wolves in small-scale operations but in large-scale, open-range grazing operations, nonlethal management strategies are often presumed ineffective or infeasible. To demonstrate that nonlethal techniques can be effective at large scales, we report a 7-year case study where we strategically applied nonlethal predator deterrents and animal husbandry techniques on an adaptive basis (i.e., based on terrain, proximity to den or rendezvous sites, avoiding overexposure to techniques such as certain lights or sound devices that could result in wolves losing their fear of that device, etc.) to protect sheep (Ovis aries) and wolves on public grazing lands in Idaho. We collected data on sheep depredation mortalities in the protected demonstration study area and compared these data to an adjacent wolf-occupied area where sheep were grazed without the added nonlethal protection measures. Over the 7-year period, sheep depredation losses to wolves were 3.5 times higher in the Nonprotected Area (NPA) than in the Protected Area (PA). Furthermore, no wolves were lethally controlled within the PA and sheep depredation losses to wolves were just 0.02% of the total number of sheep present, the lowest loss rate among sheep-grazing areas in wolf range statewide, whereas wolves were lethally controlled in the NPA. Our demonstration project provides evidence that proactive use of a variety of nonlethal techniques applied conditionally can help reduce depredation on large open-range operations. [ABSTRACT FROM AUTHOR]

Background: the care of older people with dementia is often complicated by physical comorbidity and polypharmacy, but the extent and patterns of these have not been well described. This paper reports analysis of these factors within a large, cross-sectional primary care data set. Methods: data were extracted for 291,169 people aged 65 years or older registered with 314 general practices in the UK, of whom 10,258 had an electronically recorded dementia diagnosis. Differences in the number and type of 32 physical conditions and the number of repeat prescriptions in those with and without dementia were examined. Age-gender standardised rates were used to calculate odds ratios (ORs) of physical comorbidity and polypharmacy. Results: people with dementia, after controlling for age and sex, had on average more physical conditions than controls (mean number of conditions 2.9 versus 2.4; P < 0.001) and were on more repeat medication (mean number of repeats 5.4 versus 4.2; P < 0.001). Those with dementia were more likely to have 5 or more physical conditions (age-sex standardised OR [sOR] 1.42, 95% confidence interval (CI) 1.35-1.50; P < 0.001) and were also more likely to be on 5 or more (sOR 1.46; 95% CI 1.40-1.52; P < 0.001) or 10 or more repeat prescriptions (sOR 2.01; 95% CI 1.90-2.12; P < 0.001). Conclusions: people with dementia have a higher burden of comorbid physical disease and polypharmacy than those without dementia, even after accounting for age and sex differences. Such complex needs require an integrated response from general health professionals and multidisciplinary dementia specialists. [ABSTRACT FROM AUTHOR]

Urbanization alters landscapes and ecosystem processes that result in negative impacts for many species. However, urbanization also creates novel environments that certain species, including carnivores, are able to exploit. Coyotes (Canis latrans) are 1 example of a species capable of exploiting urban environments throughout North America and, in some cases, becoming involved in human-coyote conflict. As part of a comprehensive study of human-coyote coexistence in the Denver metropolitan area of Colorado, we investigated the spatial ecology of coyotes to determine movement and activity patterns relative to the urban matrix. We examined home-range size, habitat use, and resource selection for 22 coyotes monitored with GPS collars during 2012-2014. Mean (± SD) home-range size of resident coyotes (11.6 ± 11.0 km2) was smaller than ranges of transient coyotes (200.7 ± 232.4 km2). Home-range size did not vary by season or sex, but resident coyotes during the day (7.2 ± 10.5 km2) had smaller home ranges than during the night (11.3 ± 10.8 km2). Coyotes had high percentages of developed lands (44.5 ± 18.9%) within their home ranges, contrary to previous studies of urban coyotes. However, the percentage of coyote locations in natural lands (48.9 ± 22.4%) was higher than in developed lands (20.6 ± 11.7%). Homerange size of residents was not related to either the percentage of developed lands or altered lands within home ranges. Coyotes selected natural lands over developed lands, and they increased activity at night. Although coyotes were able to thrive in home ranges containing large amounts of development, they continued to avoid areas with high human activity by primarily residing in areas with natural land cover. Similar to urban areas throughout the Northern Hemisphere, coyotes in the Denver metropolitan area have become efficiently adapted to a highly developed landscape, reflecting the flexible nature of this opportunistic carnivore. [ABSTRACT FROM AUTHOR]

The association between exposure to head injury and increased risk of neurodegenerative disease, specifically chronic traumatic encephalopathy (CTE), is widely recognized. Historically, this was largely considered a phenomenon restricted to boxers, with more recent case series identifying further 'high risk' individuals, such as former American footballers, or military personnel. However, in all cases thus far reported, it is clear that it is the exposure to head injury which is associated with increased dementia risk, and not the circumstances or environment of exposure. As such, there is considerable potential for under-recognition of CTE in patients presenting with neurodegenerative disease, particularly where head injury exposure might have been historical and through sport. This article reviews current understanding of CTE and, via an illustrative case in rugby union, highlights the value of a detailed history on head injury and also draws attention to imaging studies in assessing patients with neurodegenerative disease. [ABSTRACT FROM AUTHOR]

Rising feed costs and recurring feed shortages necessitate the investigation into alternative and underutilized feed resources. Nutritional characteristics of Juniperus species are either unknown or limited to leaves and ground material from small stems. Therefore, the objective was to quantify nutritional characteristics, 48-h true IVDMD (tIVDMD), microbial gas production, and secondary compound characteristics of entire woody plant material of 4 Juniperus species-- Juniperus pinchotii, Juniperus monosperma, Juniperus ashei, and Juniperus virginiana--at immature and mature stages of growth. Immature plants had greater CP concentrations and lower NDF concentrations (P < 0.001) than mature plants regardless of species. Mature plants also had greater (P < 0.001) concentrations of ADF compared with immature plants with the exception of J. virginiana. In general, immature J. pinchotii, J. monosperma, and J. ashei had greater (P < 0.02) tIVDMD and total 48-h and asymptotic gas production than mature plants. Immature J. monosperma and J. pinchotii plants were more digested (tIVDMD; P < 0.001) than immature J. virginiana and J. ashei, but tIVDMD did not differ in mature plant material across species. Condensed tannins (CT) were greater (P < 0.001) in immature J. pinchotii and J. ashei than mature plants; differences in CT concentrations among immature species were also detected (P < 0.04). Volatile oil yields were similar across maturity and species with 1 exception: immature J. pinchotii yielded more (P < 0.02) volatile oil than mature material. Volatile oil composition across species varied and contained a range of 65 to 70 terpene compounds. The dominant terpenes across species were generally greater (P < 0.05) in immature vs. mature plant material with the exception of J. virginiana. Labdane acids were negligible in J. pinchotii, J. ashei, and J. virginiana and greater in J. monosperma (P < 0.001). Ground material from mature juniper species, although inferior in nutritional quality compared with immature plants, is comparable to traditional lowquality roughage ingredients. Given that J. pinchotii has been successfully fed in lamb feedlot diets, the similarities of J. pinchotii, J. ashei and J. monosperma suggest that all three species have potential to be effective roughage ingredients. [ABSTRACT FROM AUTHOR]

Newborn lambs depend on their dams for passive transfer of immunoglobulins, primarily IgG, for protection from harmful pathogens until their own immunological defenses have developed. Previous studies have suggested that supplementation with Se results in a modest increase in IgG concentration in serum of newborn calves and lambs. To evaluate the effect of the Se source and supplementation rate in ewes during pregnancy on passive transfer of IgG to their lambs, 210 Polypay, Suffolk, or Suffolk x Polypay cross ewes were divided into 7 treatment groups (n = 30 each) and drenched weekly with no Se, at the maximum FDA-allowed concentration with inorganic Na-selenite or organic Se-yeast (4.9 mg Se/wk), or with inorganic Na-selenite and organic Se-yeast at supranutritional concentrations (14.7 and 24.5 mg Se/wk). Ewe serum IgG concentrations were measured within 30 d of parturition, ewe colostrum and lamb serum IgG concentrations were measured at parturition before suckling, and lamb serum IgG concentrations were measured again at 48 h postnatal. Ewes receiving 24.5 mg Se/wk tended to have or had, independent of Se source, greater colostral IgG concentrations than ewes receiving4.9mg Se/wk overall (81.3 vs. 66.2 mg/mL; P= 0.08) and for Polypay ewes only (90.1 vs. 60.7 mg/mL; P = 0.03). Polypay ewes receiving Se-yeast at 24.5 mg Se/wk transferred a greater calculated total IgG amount to their lambs than Polypay ewes receiving Se-yeast at 4.9 mg Se/wk (15.5 vs. 11.6 g; P = 0.02), whereas the converse was true (interaction between Se source and dose concentration; P = 0.03) for Polypay ewes receiving inorganic Na-selenite at 24.5 mg Se/wk vs. Na-selenite at 4.9 mg/wk (11.6 vs. 15.7 g; P=0.08). Our results suggest that supranutritional Se supplementation of Polypay ewes during pregnancy increases colostral IgG concentrations but that the optimal supplementation rate for IgG transfer from ewe to lamb may differ for Na-selenite and Se-yeast. [ABSTRACT FROM AUTHOR]

Selenium is an essential micronutrient in sheep, and deficiency can limit lamb growth and survival. To evaluate how different chemical forms of Se administered to mature ewes at comparative dosages affect ewe and progeny performance, 240 ewes were divided into 8 treatment groups (n = 30 each) and drenched weekly with no Se; at the maximum FDA-allowed concentration with inorganic Na-selenite or organic Se-yeast (4.9 mg Se/wk); with inorganic Na-selenate (8.95 mg Se/wk); or with inorganic Na-selenite and organic Se-yeast at supranutritional concentrations (14.7 and 24.5 mg Se/wk, respectively). The treatment period started approximately 2 wk before breeding and lasted for 62.5 wk. Ewes of the no-Se and Se-yeast groups continued treatments for another 21 to 24 wk through a second lambing season. Chemical form or dosage of Se did not affect ewe reproductive performance based on proportion of ewes lambing in each treatment group, or number of lambs born, nursed, or weaned per ewe (all P > 0.10). Ewes receiving the highest supplementation rate of Se-yeast at 24.5 mg Se/wk had higher BCS (scale 1 to 5) at the end of yr 1 (2.95 vs. 2.66; P = 0.05) than ewes receiving Se-yeast at 4.9 mg Se/wk. Performance was better in lambs from ewes receiving Se-yeast at 24.5 mg Se/wk than in lambs from ewes receiving Se-yeast at 4.9 mg Se/wk or no Se. In yr 1, lambs from ewes receiving Se-yeast at 24.5 vs. 4.9 mg Se/wk were heavier at 120 d of age (37.0 vs. 34.2 kg; P = 0.05). In yr 2, lambs from ewes receiving Se-yeast at 24.5 mg Se/wk were or tended to be heavier at 60 d of age than lambs from ewes receiving no Se (21.2 vs. 19.0 kg; P = 0.04) or lambs from ewes receiving Se-yeast at 4.9 mg Se/wk (19.2 kg; P = 0.09). This effect was more pronounced in ewes raising multiple lambs. We conclude that supranutritional supplementation of ewes with Se-yeast at 24.5 mg Se/wk improves lamb growth and ewe health without negatively affecting reproductive performance. [ABSTRACT FROM AUTHOR]

Adequate Se transfer from ewes to lambs is important to prevent Se-deficiency diseases. To evaluate how different chemical forms of Se administered at comparative dosages to mature ewes affect Se status of their lambs, 240 ewes were divided into 8 treatment groups (n = 30 each) and drenched weekly (at an amount equal to their summed daily intake) with no-Se (controls); at recommended amounts (4.9 mg of Se/wk) with inorganic Na-selenite, inorganic Na-selenate, or organic Se-yeast; or at supranutritional amounts (14.7 and 24.5 mg of Se/wk) with Na-selenite or Se-yeast for 1 yr. Weekly drenching of Se was effective at increasing (P < 0.002) Se concentrations in ewe colostrum and milk at 30 d of lactation and in improving (P < 0.001) the Se status of lambs (whole-blood and serum-Se concentrations at birth, and skeletal-muscle Se concentrations at 14 d of age). Selenium concentrations in lacteal secretions were greater in ewes drenched with Se-yeast (colostrum: 374, 436, and 982 ng/mL at 4.9, 14.7, and 24.5 mg of Se/wk, respectively; milk: 26, 39, 64 ng/mL) compared with ewes drenched with Naselenite (colostrum: 204, 334, 428 ng/mL; milk: 16, 21, 24 ng/mL), and were also greater (P < 0.001) in their lambs. Selenium concentrations continued to increase (P < 0.001) in lamb whole blood (558 and 695 ng/ mL at 14.7 and 24.5 rng of Se/wk, respectively), serum (126, 183 ng/mL), and skeletal muscle (991, 1,696 ng/ mL) with supranutritional concentrations of Se-yeast, whereas Se concentrations did not differ in whole blood (304, 332 ng/mL), serum (77, 85 ng/mL), or skeletal muscle (442, 482 ng/mg) of lambs from ewes drenched with 14.7 or 24.5 mg of Se/wk of Na-selenite. We conclude that weekly oral drenching of ewes during gestation and lactation with organic Se-yeast results in a more efficient transfer of Se (over a wide range of supplementation rates) from ewe to lamb than does inorganic Na-selenite. [ABSTRACT FROM AUTHOR]

Predation can be a critical factor influencing recovery of endangered species. In most recovery efforts lethal and nonlethal influences of predators are not sufficiently understood to allow prediction of predation risk, despite its importance. We investigated whether landscape features could be used to model predation risk from coyotes (Canis latrans) and great horned owls (Bubo virginianus) on the endangered black-footed ferret (Mustela nigripes). We used location data of reintroduced ferrets from 3 sites in South Dakota to determine whether exposure to landscape features typically associated with predators affected survival of ferrets, and whether ferrets considered predation risk when choosing habitat near perches potentially used by owls or near linear features predicted to be used by coyotes. Exposure to areas near likely owl perches reduced ferret survival, but landscape features potentially associated with coyote movements had no appreciable effect on survival. Ferrets were located within 90 m of perches more than expected in 2 study sites that also had higher ferret mortality due to owl predation. Densities of potential coyote travel routes near ferret locations were no different than expected in all 3 sites. Repatriated ferrets might have selected resources based on factors other than predator avoidance. Considering an easily quantified landscape feature (i.e., owl perches) can enhance success of reintroduction efforts for ferrets. Nonetheless, development of predictive models of predation risk and management strategies to mitigate that risk is not necessarily straightforward for more generalist predators such as coyotes. [ABSTRACT FROM AUTHOR]

Black bears (Ursus americanus) forage selectively in natural environments. To determine if bears also forage selectively for anthropogenic resources we analyzed data on vehicles broken into by bears from Yosemite National Park, California. We classified vehicles into 9 categories based on their make and model and collected data on use (2001-2007) and availability (2004-2005). From 2001 to 2007 bears broke into 908 vehicles at the following rates: minivan (26.0%), sport-utility vehicle (22.5%), small car (17.1%), sedan (13.7%), truck (11.9%), van (4.2%), sports car (1.7%), coupe (1.7%), and station wagon (1.4%). Only use of minivans (29%) during 2004-2005 was significantly higher than expected (7%). We discuss several competing hypotheses about why bears selected minivans. [ABSTRACT FROM AUTHOR]

The Tibet-TPO project in Dharamsala, North India aims to provide culturally sensitive psychosocial support to Tibetan refugees. In this study we have examined the cultural and spiritual constructions of mental distress of Tibetan exiles from a secondary analysis of previously published data. Tibetans refugees' constructions of mental distress were intimately linked to cultural, religious and political factors. Family and religious support were regarded as key coping strategies, yet many new refugees lacked both family support and detailed knowledge and understanding of Tibetan Buddhism. Not all of those interviewed were positive about ‘western approaches’ to dealing with mental distress, but those using the service seemed to do so in a pragmatic and integrative way. We conclude that culturally sensitive psychosocial support can usefully ‘fill a gap’, especially for new refugees who lack both family support and access to, or understanding of, traditional religious coping mechanisms. [ABSTRACT FROM AUTHOR]

Hermit Warblers (Dendroica occidentalis) sing distinct dialects of type I songs, the most common song before pairing. Eight dialects were identified and described in a 22 900 km² area in southwestern Oregon and northern California. The dialects were well defined geographically with contact areas between dialects seldom extending more than 6 km. Gaps in forested habitat of ≥10 km separated several dialects, but within forested areas dialect boundaries did not conform to obvious habitat, elevation, or geographic boundaries. Few songs containing syllables or phrases from more than one dialect were identified, and birds incorporating elements from two different dialects inhabited areas close to the common boundary between the two. Multivariate analysis showed that birds in neighboring areas had dialects most similar in structure, but a more complex history of dialect development or origin is suggested in other areas. [ABSTRACT FROM AUTHOR]

Gender identification of sexually monomorphic mammals can be difficult. We used analysis of zinc-finger protein (Zfx and Zfy) DNA regions to detennine gender of 96 beavers (Castor canadensis) from 3 areas and used these results to verify gender determined in the field. Gender was correctly determined for 86 (89.6%) beavers. Incorrect assignments were not attributed to errors in any one age or sex class. Although methods that can be used in the field (such as morphological methods) can provide reasonably accurate gender assignments in beavers, the genetic method might be preferred in certain situations. [ABSTRACT FROM AUTHOR]

Presents a study that examined the differences among species in food-hoarding behavior of desert rodents. Materials and methods; Data collection and analysis; Results.

Although the use of cutoffs in heuristic decision strategies has been widely discussed, few studies have attempted to identify which cutoffs will be used in a particular decision. In this article it is proposed that decision makers choose cutoffs that maximally discriminate retained and rejected alternatives in terms of utility. Thus, cutoff selection is influenced by the utility structures that the decision maker has for salient attributes of the alternatives. A model is tested in which cutoffs are assumed to be positioned where the difference in utility between the two attribute levels that span the cutoff is greatest. Utilities are measured by conjoint analysis and cutoffs are identified by concurrent protocols. The proposed relationships are generally supported; however, the nature of the errors in the model's predications suggests a modification in which cutoff placement is more conservative. A second model with more conservative cutoffs is shown to work well in specific decisions, but does not generally predict cutoffs better than the original model. In addition, the outcomes from heuristic choice processes were often optimal. Decision makers who use cutoffs may select them rationally, with the expectation of making the best choice as well as simplifying a decision. [ABSTRACT FROM AUTHOR]

Background Soccer is a high-speed contact sport with risk of injury. Despite long-standing concern, evidence to date remains inconsistent as to the association between playing professional-level soccer and lifelong musculoskeletal consequences. Aims The objectives were to assess risk of osteoarthritis in former professional soccer players compared to matched general population controls, and subsequently assess associated musculoskeletal disorders which may contribute to, or result from, osteoarthritis—specifically meniscal injury and joint replacement. Methods We conducted a retrospective cohort study using national electronic health records (EHRs) on a cohort of 7676 former professional soccer players aged 40 or over at recruitment, matched on year of birth, sex (all male) and socio-economic status with 23 028 general population controls. Outcomes of interest were obtained by utilizing individual-level record linkage to EHRs from general hospital inpatient and day-case admissions. Results Compared to controls, former soccer players showed a greater risk of hospital admission for osteoarthritis (hazard ratio [HR] 3.01; 95% confidence interval [CI] 2.80–3.25; P  < 0.001). This increased risk appeared age dependant, normalizing over age 80 years and reflective of increased risk of lower limb osteoarthritis. Further, risk of hospital admissions for meniscal injury (HR 2.73; 95% CI 2.42–3.08; P  < 0.001) and joint replacement (HR 2.82; 95% CI 2.23–3.57; P  < 0.001) were greater among former soccer players. Conclusions We report an increased risk of lower limb osteoarthritis in former soccer players when compared with matched population controls. The results of this research add data in support of lower limb osteoarthritis among former soccer players representing a potential industrial injury. [ABSTRACT FROM AUTHOR]

Background community-based complex interventions for older adults have a variety of names, including Comprehensive Geriatric Assessment, but often share core components such as holistic needs assessment and care planning. Objective to summarise evidence for the components and effectiveness of community-based complex interventions for improving older adults' independent living and quality of life (QoL). Methods we searched nine databases and trial registries to February 2022 for randomised controlled trials comparing complex interventions to usual care. Primary outcomes included living at home and QoL. Secondary outcomes included mortality, hospitalisation, institutionalisation, cognitive function and functional status. We pooled data using risk ratios (RRs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs). Results we included 50 trials of mostly moderate quality. Most reported using holistic assessment (94%) and care planning (90%). Twenty-seven (54%) involved multidisciplinary care, with 29.6% delivered mainly by primary care teams without geriatricians. Nurses were the most frequent care coordinators. Complex interventions increased the likelihood of living at home (RR 1.05; 95% CI 1.00–1.10; moderate-quality evidence) but did not affect QoL. Supported by high-quality evidence, they reduced mortality (RR 0.86; 95% CI 0.77–0.96), enhanced cognitive function (SMD 0.12; 95% CI 0.02–0.22) and improved instrumental activities of daily living (ADLs) (SMD 0.11; 95% CI 0.01–0.21) and combined basic/instrumental ADLs (SMD 0.08; 95% CI 0.03–0.13). Conclusions complex interventions involving holistic assessment and care planning increased the chance of living at home, reduced mortality and improved cognitive function and some ADLs. [ABSTRACT FROM AUTHOR]

Introduction the identification and management of frailty occurs mostly in primary care. Several different models of care exist. This study aimed to assess the impact of a new General Practitioner (GP)-led modified Comprehensive Geriatric Assessment (CGA) on service delivery, healthcare utilisation and patient outcomes. Method patients with moderate–severe frailty (electronic Frailty Index score > 0.24) in Newbattle Medical Practice, Scotland, were eligible for a novel intervention (MidMed) in which an additional GP performed a modified CGA and was directly accessible for appointments. The recruits to the intervention (MidMed) group were compared with those waiting to be enrolled (non-MidMed). Outcomes included unscheduled hospital admissions, primary care consultations, continuity of care (Usual Provider of Care (UPC) index), outpatient attendances and mortality. Adjusted rate ratios (aRR), for MidMed compared to non-MidMed, were estimated using regression models adjusting for demographics and healthcare utilisation histories. Results 510 patients were included: 290 MidMed (mean(SD) age 80.1(7.6)years; 59.6% female) and 220 non-MidMed (75.4(8.6)years; 57.7% female). Median follow-up was 396 days. aRR(95%CI) was 0.46(0.30–0.71) for >1 admission, 0.62(0.41–0.95) >1 Emergency Department (ED) attendance and 1.52(1.30–1.75) for use of primary care, with no difference in outpatient appointments or mortality. Continuity of care was better for the MidMed group (MidMed UPC 0.77(SD 0.19), non-MidMed 0.41(0.18), P  < 0.001). Conclusion this GP-led service for frail patients was associated with lower risk of hospital readmission/ED reattendance, greater use of primary care and improved continuity of care. More detailed evaluation of novel primary care frailty services, over longer time-periods, including robust randomised controlled trials, are needed. [ABSTRACT FROM AUTHOR]

Background: The Consultation and Relational Empathy (CARE) measure is a patient-reported measure of physician empathy which is widely used internationally. The Japanese version of the CARE measure has very high internal reliability, suggesting that a shorter version may have adequate validity and reliability.Objective: To investigate a valid shorter version of the Japanese CARE measure.Methods: We conducted a pilot study using secondary analysis of previous data obtained from 9 general practitioners and 252 patients and used to develop the Japanese CARE measure. All 1,023 possible combinations of the Japanese CARE items (n = 1-10) were candidates for the short measure. The internal consistency (Cronbach's alpha) and the correlations between candidate short questionnaires and the original questionnaire were calculated. After selecting the most valid short questionnaire, inter-rater reliability was determined using generalizability theory, and construct validity (Spearman's rho) was determined using patient satisfaction.Results: Two items were selected for a pilot shorter version: item 6 "Showing care and compassion" and item 9 "Helping you to take control." These showed high internal consistency and correlations with the 10-item measure (Cronbach's alpha = 0.920, correlation = 0.979). Forty-five questionnaires per doctor allowed us to reliably differentiate between practitioners. The construct validity for the pilot short measure was high (Spearman's rho 0.706, P < 0.001).Conclusion: We generated a pilot 2-item version of the Japanese CARE measure. This pilot 2-item version provides a basis for future validation studies of short CARE measures in other languages. [ABSTRACT FROM AUTHOR]

Purpose: Empathy is the ability to communicate an understanding of an individual's subjective experience. It plays a vital role in the physician-patient relationship and improves clinical outcomes. This increases the importance of measuring and studying empathy in the clinical setting. The Consultation and Relational Empathy (CARE) is a 10-item questionnaire that measures patient assessment of physician's empathy in primary care. To our knowledge, there are no validated measures of empathy in the clinical setting in Arabic. This study aims at validating the CARE in Arabic.Methods: Data collection took place between October 2019 and February 2020. A total of 220 patients completed the questionnaire which consisted of the 10 CARE items, participants' opinions regarding the importance of each item, demographic information, and information about the consultation. The reliability and validity of the Arabic CARE were measured using Cronbach alpha, item-total correlations, and factor analysis. Construct validity was measured based on the overall patient satisfaction, and their satisfaction with the length of the consultation.Results: High Cronbach alpha and item-total correlation reveal the internal consistency and homogeneity of the Arabic version. Our findings showed significant positive correlations between CARE score and each of the characteristics: overall satisfaction with the consultation, duration of the consultation, patients' satisfaction with consultation duration and whether they would recommend the doctor to others.Conclusion: The Arabic version of the CARE measure appears to be valid and reliable. It is available for use in research, education, and assessment of physicians' empathy. [ABSTRACT FROM AUTHOR]

Questions and problems that emerged during operational conservation of black-footed ferrets (Mustela nigripes) have been addressed by a wide variety of studies. Early results from such studies often were communicated orally during meetings of recovery groups and in written form using memoranda, unpublished reports, and theses. Typically, implementation of results preceded their publication in widely distributed journals. Many of these studies eventually were published in journals, and we briefly summarize the contents of 8 volumes and special features of journals that have been dedicated to the biology of ferrets and issues in ferret recovery. This year marks the 30th anniversary of rediscovery of the black-footed ferret, and the 7 papers of the following Special Feature summarize data collected over nearly that span of time. [ABSTRACT FROM AUTHOR]

Background. The Patient Enablement Instrument (PEI) was developed to measure patients’ enablement, which is an indicator of the effectiveness of a primary care consultation; however, to date, the PEI has not been tested in Asian populations. [ABSTRACT FROM PUBLISHER]

Objective To evaluate the effect of perioperative meloxicam IV 30 mg on opioid consumption in primary total knee arthroplasty (TKA). Design Multicenter, randomized, double-blind, placebo-controlled trial. Subjects In total, 181 adults undergoing elective primary TKA. Methods Subjects received meloxicam 30 mg or placebo via an IV bolus every 24 hours, the first dose administered prior to surgery as part of a multimodal pain management protocol. The primary efficacy parameter was total opioid use from end of surgery through 24 hours. Results Meloxicam IV was associated with less opioid use versus placebo during the 24 hours after surgery (18.9 ± 1.32 vs 27.7 ± 1.37 mg IV morphine equivalent dose; P  <   0.001) and was superior to placebo on secondary endpoints, including summed pain intensity (first dose to 24 hours postdosing, first dose to first assisted ambulation, and first dose to discharge) and opioid use (48–72 hrs. 0–48 hrs. 0–72 hrs. hour 0 to end of treatment, and the first 24 hours after discharge). Adverse events (AEs) were reported for 69.9% and 92.0% of the meloxicam IV and placebo groups, respectively; the most common AEs were nausea (40% vs. 59%), vomiting (16% vs 22%), hypotension (14% vs 15%), pruritus (15% vs 11%), and constipation (11% vs 13%). Conclusions Perioperative meloxicam IV 30 mg as part of a multimodal analgesic regimen for elective primary TKA reduced opioid consumption in the 24-hour period after surgery versus placebo and was associated with a lower incidence of AEs typically associated with opioid use. [ABSTRACT FROM AUTHOR]

Background little is known about the relationship between multimorbidity and social care use (also known as long-term care). The aim of this study was to assess the relationship between receipt of formal social care services and multimorbidity. Methods this retrospective data linkage, observational study included all individuals over the age of 65 in the population of Scotland in financial years 2014–15 and 2015–16 (n  = 975,265). The main outcome was receipt of social care measured by presence in the Scottish Social Care Survey. Logistic regression models were used to assess the influence of multimorbidity, age, sex and socioeconomic position on the outcome reporting average marginal effects (AME). Findings 93.3% of those receiving social care had multimorbidity, 16.2% of those with multimorbidity received social care compared with 3.7% of those without. The strongest magnitudes of AME for receiving social care were seen for age and multimorbidity (respectively, 50 and 18% increased probability comparing oldest to youngest and most severe multimorbidity to none). A 5.5% increased probability of receiving social care was observed for the most-deprived compared with the least-deprived. Interpretation higher levels of social care receipt are observed in those with increasing age, severe multimorbidity and living in more deprived areas. Multimorbidity does not fully moderate the relationship between social care receipt and either age or deprivation. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 65-year-old South Asian woman with numerous lesions on her limbs. The patient has been administered with oral prednisolone after she was diagnosed with lobular panniculitis, however rapid recurrence of the lesions occurred following her decision to stop the medicine. Dermatomyositis (DM) has been suggestive based on the histopathological features of the lesions. The condition of the patient improves due to the combination of methotrexate and prednisolone.

Background Multimorbidity, the coexistence of multiple health conditions, is a growing public health challenge. Research and intervention development are hampered by the lack of consensus regarding defining and measuring multimorbidity. The aim of this systematic review was to pool the findings of systematic reviews examining definitions and measures of multimorbidity. Methods Medline, Embase, PubMed and Cochrane were searched from database inception to February 2017. Two authors independently screened titles, abstracts and full texts and extracted data from the included papers. Disagreements were resolved with a third author. Reviews were quality assessed. Results Of six reviews, two focussed on definitions and four on measures. Multimorbidity was commonly defined as the presence of multiple diseases or conditions, often with a cut-off of two or more. One review developed a holistic definition including biopsychosocial and somatic factors as well as disease. Reviews recommended using measures validated for the outcome of interest. Disease counts are an alternative if no validated measure exists. Conclusions To enable comparison between studies and settings, researchers and practitioners should be explicit about their choice of definition and measure. Using a cut-off of two or more conditions as part of the definition is widely adopted. Measure selection should be based on tools validated for the outcome being considered. Where there is no validated measure, or where multiple outcomes or populations are being considered, disease counts are appropriate. [ABSTRACT FROM AUTHOR]

Effects of using ground woody plants in Rambouillet wether lamb feedlot diets on growth performance, blood serum, and rumen parameters were evaluated. A randomized design study was used with 2 feeding periods (70% concentrate diet from d 0 to 27 [Period 1] and 86% concentrate diet from d 28 to 57 [Period 2]); the concentrate portion of the diets mainly consisted of dried distiller's grains with solubles and sorghum grain. Lambs were individually fed 6 diets that differed only by roughage source (n = 8 animals/ treatment; 32.9 ± 3.2 kg initial BW): either cottonseed hulls (CSH; control) or ground wood consisting of redberry juniper (RED), blueberry juniper (BLUE), one-seeded juniper (ONE), or eastern red cedar (ERC) Juniperus spp. or honey mesquite (MESQ; Prosopis glandulosa). Using ground wood vs. CSH as the roughage source did not affect (P > 0.12) BW. There tended to be a treatment x day interaction (P = 0.07) for lamb DMI, attributed to Period 1 when DMI was greater (P < 0.05) for lambs fed CSH vs. RED, ONE, ERC, or MESQ during the first 14 d and greater (P < 0.05) during d 14 to 28 vs. lambs fed ERC. Overall, ADG was less for lambs fed ERC (P < 0.10) or MESQ (P < 0.05) vs. lambs fed CSH, but G:F was similar (P > 0.10) among all lambs. Dietary treatments did not affect (P > 0.15) ruminal pH, but treatment x day interactions (P < 0.05) were observed for rumen fluid ammonia N or molar proportions of propionate and butyrate; few differences were observed within day. However, overall, lambs fed RED or MESQ had greater (P < 0.05) total rumen VFA than lambs fed CSH. A treatment x day interaction (P = 0.04) was observed for the acetate:propionate ratio, but no differences (P > 0.10) were observed within day. Treatment x day interactions (P < 0.05) were observed for blood serum glucose, γ-glutamyl transferase, the albumin:globulin ratio, total bilirubin, β-hydroxybutyrate, P, Cl, and Mg, with most results being less for lambs fed the woodbased diets than for lambs fed the CSH diets. Results suggested that even though lamb DMI was reduced during the growing period when diets contained 30% ground woody products (RED, ONE, ERC, and MESQ), animal health and rumen fluid parameters were not negatively affected by ground woody plants. [ABSTRACT FROM AUTHOR]

Background: Empathy is an essential skill in doctor-patient communication with positive effects on compliance, patient satisfaction and symptom duration. There are no validated patient-rated empathy measures available in Dutch.Objective: To investigate the validity and reliability of a Dutch version of the Consultation and Relational Empathy (CARE) Measure, a widely used 10-item patient-rated questionnaire of physician empathy.Methods: After translation and back translation, the Dutch CARE Measure was distributed among patients from 19 general practitioners in 5 primary care centers. Tests of internal reliability and validity included Cronbach's alpha, item total correlations and factor analysis. Seven items of the QUality Of care Through the patient's Eyes (QUOTE) questionnaire assessing 'affective performance' of the physician were included in factor analysis and used to investigate convergent validity.Results: Of the 800 distributed questionnaires, 655 (82%) were returned. Acceptability and face validity were supported by a low number of 'does not apply' responses (range 0.2%-11.9%). Internal reliability was high (Cronbach's alpha 0.974). Corrected item total correlations were at a minimum of 0.837. Factor analysis on the 10 items of the CARE Measure and 7 QUOTE items resulted in two factors (Eigenvalue > 1), the first containing the CARE Measure items and the second containing the QUOTE items. Convergent construct validity between the CARE Measure and QUOTE was confirmed with a modest positive correlation (r = 0.34, n = 654, P < 0.001).Conclusion: The findings support the preliminary validity and reliability of the Dutch CARE Measure. Future research is required to investigate divergent validity and discriminant ability between doctors. [ABSTRACT FROM AUTHOR]

Multimorbidity is common and is associated with poor mental health and high mortality. Nevertheless, no studies have evaluated whether mental health may affect the survival of people with multimorbidity. We investigated the association between perceived stress and mortality in people with multimorbidity by following a population-based cohort of 118,410 participants from the Danish National Health Survey 2010 for up to 4 years. Information on perceived stress and lifestyle was obtained from the survey. We assessed multimorbidity using nationwide register data on 39 conditions and identified 4,229 deaths for the 453,648 person-years at risk. Mortality rates rose with increasing levels of stress in a dose-response relationship (P-trend < 0.0001), independently of multimorbidity status. Mortality hazard ratios (highest stress quintile vs. lowest) were 1.51 (95% confidence interval (CI): 1.25, 1.84) among persons without multimorbidity, 1.39 (95% CI: 1.18,1.64) among those with 2 or 3 conditions, and 1.43 (95% CI: 1.18, 1.73) among those with 4 or more conditions, when adjusted for disease severities, lifestyle, and socio-economic status. The numbers of excess deaths associated with high stress were 69 among persons without multi-morbidity, 128 among those with 2 or 3 conditions, and 255 among those with 4 or more conditions. Our findings suggested that perceived stress contributes significantly to higher mortality rates in a dose-response pattern, and more stress-associated deaths occurred in people with multimorbidity. [ABSTRACT FROM AUTHOR]

Effects of using ground redberry juniper and dried distillers grains with solubles (DDGS) in Rambouillet lamb (n = 45) feedlot diets on growth, blood serum, fecal, and wool characteristics were evaluated. In a randomized design study with 2 feeding periods (Period 1 = 64% concentrate diet, 35 d; Period 2 = 85% concentrate diet, 56 d), lambs were individually fed 5 isonitrogenous diets: a control diet (CNTL) that contained oat hay but not DDGS or juniper or DDGS-based diets in which 0 (OJUN), 33 (33JUN), 66 (66JUN), or 100% (100JUN) of the oat hay was replaced by juniper. During Period 1, lambs fed CNTL had greater (P <0.05) DMI and ADG and tended to have greater (P < 0.10) G:F than lambs fed OJUN or lambs fed DDGS-based diets. Lamb DMI, ADG, and G:F quadratically increased (P < 0.008) as juniper increased in the DDGS-based diets. During Period 2, lambs fed CNTL had greater (P < 0.05) DMI than lambs fed OJUN or lambs fed DDGS-based diets, but ADG was similar (P > 0.41). Compared to OJUN, lambs fed CNTL had similar (P = 0.12) G:F and tended to have less G:F (P = 0.07) than lambs fed DDGS-based diets. Among lambs fed DDGS-based diets, DMI was similar (P > 0.19), ADG increased linearly (P = 0.03), and G:F tended to decrease quadratically (P = 0.06) as juniper increased in the diet. Serum IGF-1, serum urea N (SUN), and fecal N were greater (P < 0.05) and serum Ca and P and fecal P were similar (P >0.13) for lambs fed CNTL vs. lambs fed DDGS-based diets (CNTL). Within lambs fed DDGS-based diets, SUN increased quadratically (P = 0.01) and fecal N increased linearly (P = 0.004), which can partially be attributed to increased dietary urea and condensed tannin intake. Most wool characteristics were not affected, but wool growth per kilogram of BW decreased quadratically (P = 0.04) as percentage of juniper increased in the DDGS-based diets. When evaluating the entire 91-d feeding trial, results indicated that replacing all of the ground oat hay with ground juniper leaves and stems in lamb growing and finishing diets is not detrimental to animal performance and that DDGS-based diets can reduce total feedlot costs, as compared to sorghum grain and cottonseed meal-based diets. However, compared to using juniper or oat hay as the sole roughage source, using both during the growing period (Period 1) enhanced growth performance and further reduced total feedlot costs. [ABSTRACT FROM AUTHOR]

Aim To assess the efficacy and safety of the selective oxytocin receptor antagonist epelsiban in the treatment of premature ejaculation ( PE). Methods Double-blind, randomized, parallel-group, placebo-controlled, stopwatch-monitored, phase 2, multicenter study ( GSK557296; NCT01021553) conducted in men (N = 77) 18-55 years of age, with PE defined as per International Society for Sexual Medicine consensus definition. Patients provided informed consent prior to a 4-week un-medicated run-in to determine baseline intravaginal ejaculatory latency times ( IELT) recorded in an electronic diary. Patients needed to make a minimum of four intercourse attempts and have a mean IELT <65 seconds to be considered for randomization. Men with moderate-to-severe erectile dysfunction were excluded from the study. Eligible patients were randomized to placebo, epelsiban 50 mg, or 150 mg, taken 1 hour before sexual activity. Active treatment IELT times were recorded in an electronic diary, along with subjective measures of intercourse satisfaction, over an 8-week treatment period. The Modified Index of Premature Ejaculation and International Index of Erectile Function were completed at study visits. Main Outcome Measures Stopwatch timed IELT recordings and a modified version of the patient-reported outcome questionnaire the IPE were used in this study to determine the effect of epelsiban when taken orally prior to intercourse in subjects diagnosed with PE. Results The baseline (mean) IELT for patients pretreatment was (0.52, 0.63, and 0.59 minutes) for placebo, epelsiban 50 mg and 150 mg, respectively. On-treatment, average geometric least squares means of the median IELT values (mean) were slightly higher in the 50 mg and 150 mg groups (0.72 and 0.69 minutes), respectively, vs. the placebo group (0.62 minutes). Headache was the most common adverse event, and rates were similar across all groups. Conclusions Epelsiban 50 mg and 150 mg were well tolerated, but did not result in a clinically or statistically significant change in IELT in men with PE, compared with placebo. Shinghal R, Barnes A, Mahar KM, Stier B, Giancaterino L, Condreay LD, Black L, and McCallum SW. Safety and efficacy of epelsiban in the treatment of men with premature ejaculation: A randomized, double-blind, placebo-controlled, fixed-dose study. J Sex Med 2013;10:2506-2517. [ABSTRACT FROM AUTHOR]

Although the essentiality of dietary Se for sheep has been known for decades, the chemical source and Se dosage for optimal health remain unclear. In the United States, the Food and Drug Administration (FDA) regulates Se supplementation, regardless of the source of Se, at 0.3 mg of Se/kg of diet (as fed), which is equivalent to 0.7 rng of Se/d or 4.9 rng of Se/wk per sheep. The objectives of this study were to evaluate the effects of Se source (inorganic vs. organic) and supplementation rate (FDA vs. supranutritional rates of 14.7 and 24.5 rng of Se/wk) on whole-blood (WB) and serum-Se concentrations. Mature ewes (n = 240) were randomly assigned to 8 treatment groups (n 30 each) based on Se supplementation rate (4.9, 14.7, and 24.5 mg of Se∙.wk-1∙sheep-1) and source [Naselenite, Na-selenate (4.9 mg/wk only), and organic Se-yeast] with a no-Se control group (0 mg of Se/ wk). Treatment groups were balanced for healthy and footrot-affected ewes. For 1 yr, ewes were individually dosed once weekly with 0, 4.9, 14.7, or 24.5 mg of Se, quantities equivalent to their summed daily supplementation rates. Serumand WB-Se concentrations were measured every 3 mo in all ewes; additionally, WB-Se concentrations were measured once monthly in one-half of the ewes receiving 0 or 4.9 mg of Se/wk. Ewes receiving no Se showed a 78.8. and 58.8% decrease (P < 0.001) in WB(250 to 53 ng/mL) and serum(97 to 40 ng/mL) Se concentrations, respectively, over the duration of the study. Whole-blood Se decreased primarily during pregnancy (-57%; 258 to 111 ng/mL) and again during peak lactation (-44%; 109 to 61 ng/mL; P < 0.001). At 4.9 rng of Se/wk, Se-yeast (364 ng/mL, final Se concentration) was more effective than Na-selenite (269 ng/mL) at increasing WB-Se concentrations (P < 0.001). Supranutritional Se-yeast dosages increased WB-Se concentrations in a dose-dependent manner (563 ng/mL, 14.7 mg of Se/wk; 748 ng/mL, 24.5 mg of Se/wk; P < 0.001), whereas WB-Se concentrations were not different for the Na-selenite groups (350 ng/ mL, 14.7 rng of Se/wk; 363 ng/mL, 24.5 mg of Se/wk) or the 4.9 mg of Se/wk Se-yeast group (364 ng/mL). In summary, the dose range whereby Se supplementation increased blood Se concentrations was more limited for inorganic Na-selenite than for organic Se-yeast. The smallest rate (FDA-recommended quantity) of organic Se supplementation was equally effective as supranutritional rates of Na-selenite supplementation in increasing WB-Se concentrations, demonstrating the greater oral bioavailability of organic Se. [ABSTRACT FROM AUTHOR]

Background. The Consultation and Relational Empathy (CARE) Measure is a validated patient-rated measure of consultation quality in the UK. [ABSTRACT FROM PUBLISHER]

Discusses the effects of preclinical dementia in the normative test samples of the elderly. Definition of pre-clinical and clinical dementia; Method used to obtain `robust' norms; Computation of age-adjusted norms; Disadvantages of conventional norms; Important implications of the study; Methods in improving samples free from contamination.