Defining Short-Term Accommodation for Animals

The terms short-term, temporary, and transitional are related but can have different contexts and meanings for animal husbandry. The definitions and use of these terms can be pivotal to animal housing and welfare. We conducted three separate literature searches using Google Scholar for relevant reports regarding short-term, temporary, or transitional animal husbandry, and analysed key publications that stipulate relevant periods of accommodation. English Government guidance regarding acceptable short-term, temporary, or transitional accommodation for animals varies widely from <1 day to 3 months; whereas independent scientific criteria and guidance use typical periods of hours to several days. Stipulations regarding acceptable short-term, temporary, or transitional accommodation, notably among English Government guidance, which we focused on in this study, were highly inconsistent and lacked scientific rationale. The definitions and use of terms for both formal and other guidance should be limited to precautionary time frames within one circadian cycle, i.e., periods of <24 h. At ≥24 h, all animals at all facilities should be accommodated in conditions that are consistent with long-term housing, husbandry, and best practices.

Illuminating the transitional habitus of the early career health science professional as postgraduate supervisor

Background

Early career health science professionals often find themselves in a transitional space when moving from a health science professional role to academia. The role of a postgraduate supervisor is especially troublesome. Transitional spaces often bring uncertainty and perceived or real threats, fear, worry, anxiety and stress. Without support, the result could be detrimental to the mental health of the early career as postgraduate supervisors, thereby impacting their professional identity formation.

Aim

To understand the underlying elements that shaped the early career health science professional as postgraduate supervisors’ habitus and how these features play out in their postgraduate supervision practice.

Setting

The research study was carried out at an Open and Distance e-Learning University (ODeL) and a residential university.

Methods

Visual elicitation methods in the form of seven drawings were used as data. Pierre Bourdieu’s concepts of habitus and hexis were used as a theoretical lens, and structural analysis with analytical memoing was used to interrogate the drawings.

Results

Early career health science professional as postgraduate supervisors’ bodily habitus presented as fragmented or yet to be formed along with other entanglements, such as emotions, language, power and material arrangements.

Conclusion

These features enable policymakers, employee assistance practitioners, educational developers and experienced academics to consider the changes and structural forces that need to be addressed to support early career health science professional as postgraduate supervisors.

Contribution

A creative means of exploring the inner world of the early career health science professional as postgraduate supervisors is undertaken. In doing so, the research article potentially illuminates what has up to now been ‘unsaid’.

Adolescent Tillaux Fractures: A Systematic Review of the Literature

The Tillaux fracture is an uncommon injury to the anterolateral distal tibial epiphysis. It occurs during a distinct time period when adolescent patients are transitioning to skeletal maturity. Owing to its rarity, the optimal management strategy for this fracture is not well-described. The aim of this review was to assess the outcomes of operatively and nonoperatively managed displaced adolescent Tillaux fractures. We analysed articles from The Cochrane Library, PubMed, MEDLINE, and EMBASE databases that met our predetermined inclusion and exclusion criteria according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. A descriptive data analysis was performed. A total of 461 articles were identified from the data search, of which 13 articles were included for full-text analysis. Five of these studies reported recognised patient outcome measures and the remaining eight reported on radiographic follow-up. The reported studies included a total of 114 patients with Tillaux fractures; 58.8% of patients were female and 34.2% were male. Mean ages ranged from 12.5 to 15 years, with the youngest patient being 12 years old and the oldest 17 years old. Overall mean follow-up was 42.8 months. Of the patients, 40.4% were treated with open reduction internal fixation (ORIF), 14.9% with closed reduction internal fixation (CRIF), and 1.8% arthroscopically. The remainder were treated nonoperatively. Outcome measures were excellent for all patients irrespective of operative management choice. Follow-up radiographic deformity was only evident in Tillaux fractures that were managed nonoperatively; deformity included poor joint congruity, angular deformity, and tibial shortening. These nonoperative patients have a residual fracture displacement of 2 mm. There were no reported instances of premature physeal closure for any patient. This review shows that excellent patient outcomes have been reported for different methods of operative fixation, however, study sizes are small and data is sparse. Further robust comparative studies are required to identify definitive conclusions. The use of established clinical and radiographic outcome measures will help improve the quality of future studies for this relatively rare injury.

Development and Implementation of a Nurse-Led Model of Care Coordination to Provide Health-Sector Continuity of Care for People With Multimorbidity: Protocol for a Mixed Methods Study

Background

Innovative strategies are required to reduce care fragmentation for people with multimorbidity. Coordinated models of health care delivery need to be adopted to deliver consumer-centered continuity of care. Nurse-led services have emerged over the past 20 years as evidence-based structured models of care delivery, providing a range of positive and coordinated health care outcomes. Although nurse-led services are effective in a range of clinical settings, strategies to improve continuity of care across the secondary and primary health care sectors for people with multimorbidity have not been examined.

Objective

To implement a nurse-led model of care coordination from a multidisciplinary outpatient setting and provide continuity of care between the secondary and primary health care sectors for people with multimorbidity.

Methods

This action research mixed methods study will have two phases. Phase 1 includes a systematic review, stakeholder forums, and validation workshop to collaboratively develop a model of care for a nurse-led care coordination service. Phase 2, through a series of iterative action research cycles, will implement a nurse-led model of care coordination in a multidisciplinary outpatient setting. Three to five iterative action research cycles will allow the model to be refined and further developed with multiple data collection points throughout.

Results

Pilot implementation of the model of care coordination commenced in October 2018. Formal study recruitment commenced in May 2019 and the intervention and follow-up phases are ongoing. The results of the data analysis are expected to be available by March 2020.

Conclusions

Nursing, clinician, and patient outcomes and experiences with the nurse-led model of care coordination will provide a template to improve continuity of care between the secondary and primary health care systems. The model template may provide a future pathway for implementation of nurse-led services both nationally and internationally.

International Registered Report Identifier (IRRID)

DERR1-10.2196/15006

Challenges and Opportunities for Consistent Classification of Human B Cell and Plasma Cell Populations

The increasingly recognized role of different types of B cells and plasma cells in protective and pathogenic immune responses combined with technological advances have generated a plethora of information regarding the heterogeneity of this human immune compartment. Unfortunately, the lack of a consistent classification of human B cells also creates significant imprecision on the adjudication of different phenotypes to well-defined populations. Additional confusion in the field stems from: the use of non-discriminatory, overlapping markers to define some populations, the extrapolation of mouse concepts to humans, and the assignation of functional significance to populations often defined by insufficient surface markers. In this review, we shall discuss the current understanding of human B cell heterogeneity and define major parental populations and associated subsets while discussing their functional significance. We shall also identify current challenges and opportunities. It stands to reason that a unified approach will not only permit comparison of separate studies but also improve our ability to define deviations from normative values and to create a clean framework for the identification, functional significance, and disease association with new populations.

Effectiveness and analysis of factors predictive of discharge to home in a 4-year cohort in a residential transitional care unit

OBJECTIVE

The aim of this study was to evaluate the effectiveness and identify factors predictive of home discharge in a cohort of patients admitted to the residential Transitional Aged Care Program (r-TACP) after a stay in an acute hospital.

METHODS

A retrospective observational cohort study of patients admitted to a single r-TACP unit between 1 January 2014 and 31 December 2017 was carried out. Baseline patient characteristics and discharge outcomes were analyzed.

RESULTS

Three hundred sixty-nine patients were admitted during the study period. The discharge outcomes were as follows: 68% returned home, 17% went onto residential care, 14% were readmitted to hospital, and 1% died. Factors associated with not returning home were increased age, increased comorbidities, and lower Barthel Index on admission to the r-TACP.

CONCLUSION

Our r-TACP is an effective program that successfully returns the majority (67.8%) of older patients home after an acute hospital admission. Older patients with greater comorbidities and poorer baseline functional status in our program were less likely to return home.

Phenotypic and functional alterations of regulatory B cell subsets in adult allergic asthma patients

BACKGROUND

IL-10-producing regulatory B cells (Bregs) are widely ascribed immune regulatory functions. However, Breg subsets in human asthma have not been fully investigated.

OBJECTIVE

We studied Breg subsets in adult allergic asthma patients by assessing two major parameters, frequency and IL-10 expression. We then investigated factors that affect these two parameters in patients.

METHODS

Peripheral blood mononuclear cells (PBMCs) of adult allergic asthma patients (N = 26) and non-asthmatic controls (N = 28) were used to assess the frequency of five subsets of transitional B cells (TBs), three subsets of CD24^high CD27⁺ B cells and B1 cells. In addition to clinical data, IL-10 expression by individual Breg subsets was assessed by flow cytometry.

RESULTS

Asthma patients had decreases of CD5⁺ and CD1d⁺ CD5⁺ , but an increase of CD27⁺ TBs which was significant in patients with moderate asthma (60 < FEV1 < 80). Regardless of asthma severity, there was no significant alteration in the frequencies of 6 other Breg subsets tested. However, we found that oral corticosteroid (OCS) significantly affected the frequency of Bregs in Breg subset-specific manners. OCS decreased CD5⁺ and CD1d⁺ CD5⁺ TBs, but increased CD27⁺ TBs and CD10⁺ CD24^high CD27⁺ cells. Furthermore, OCS decreased IL-10 expression by CD27⁺ TBs, all 3 CD24^high CD27⁺ B cell subsets (CD5⁺ , CD10⁺ and CD1d⁺ ) and B1 cells. OCS-mediated inhibition of IL-10 expression was not observed in the other Breg subsets tested.

CONCLUSION & CLINICAL RELEVANCE

Alterations in the frequency of Bregs and their ability to express IL-10 are Breg subset-specific. OCS treatment significantly affects the frequency as well as their ability to express IL-10 in Breg subset-specific manners.

Integrating Preclinical and Clinical Models of Negative Urgency

Overwhelming evidence suggests that negative urgency is robustly associated with rash, ill-advised behavior, and this trait may hamper attempts to treat patients with substance use disorder. Research applying negative urgency to clinical treatment settings has been limited, in part, due to the absence of an objective, behavioral, and translational model of negative urgency. We suggest that development of such a model will allow for determination of prime neurological and physiological treatment targets, the testing of treatment effectiveness in the preclinical and the clinical laboratory, and, ultimately, improvement in negative-urgency-related treatment response and effectiveness. In the current paper, we review the literature on measurement of negative urgency and discuss limitations of current attempts to assess this trait in human models. Then, we review the limited research on animal models of negative urgency and make suggestions for some promising models that could lead to a translational measurement model. Finally, we discuss the importance of applying objective, behavioral, and translational models of negative urgency, especially those that are easily administered in both animals and humans, to treatment development and testing and make suggestions on necessary future work in this field. Given that negative urgency is a transdiagnostic risk factor that impedes treatment success, the impact of this work could be large in reducing client suffering and societal costs.

Transitional B Cells in Early Human B Cell Development - Time to Revisit the Paradigm?

The B cell repertoire is generated in the adult bone marrow by an ordered series of gene rearrangement processes that result in massive diversity of immunoglobulin (Ig) genes and consequently an equally large number of potential specificities for antigen. As the process is essentially random, the cells exhibiting excess reactivity with self-antigens are generated and need to be removed from the repertoire before the cells are fully mature. Some of the cells are deleted, and some will undergo receptor editing to see if changing the light chain can rescue an autoreactive antibody. As a consequence, the binding properties of the B cell receptor are changed as development progresses through pre-B ≫ immature ≫ transitional ≫ naïve phenotypes. Using long-read, high-throughput, sequencing we have produced a unique set of sequences from these four cell types in human bone marrow and matched peripheral blood, and our results describe the effects of tolerance selection on the B cell repertoire at the Ig gene level. Most strong effects of selection are seen within the heavy chain repertoire and can be seen both in gene usage and in CDRH3 characteristics. Age-related changes are small, and only the size of the CDRH3 shows constant and significant change in these data. The paucity of significant changes in either kappa or lambda light chain repertoires implies that either the heavy chain has more influence over autoreactivity than light chain and/or that switching between kappa and lambda light chains, as opposed to switching within the light chain loci, may effect a more successful autoreactive rescue by receptor editing. Our results show that the transitional cell population contains cells other than those that are part of the pre-B ≫ immature ≫ transitional ≫ naïve development pathway, since the population often shows a repertoire that is outside the trajectory of gene loss/gain between pre-B and naïve stages.

Synoptic weather typing applied to air pollution mortality among the elderly in 10 Canadian cities

BACKGROUND

Synoptic circulation patterns (large-scale weather systems) affect ambient levels of air pollution, as well as the relationship between air pollution and human health.

OBJECTIVE

To investigate the air pollution-mortality relationship within weather types and seasons, and to determine which combination of atmospheric conditions may pose increased health threats in the elderly age categories.

METHODS

The relative risk of mortality (RR) due to air pollution was examined using Poisson generalized linear models (GLMs) within specific weather types. Analysis was completed by weather type and age group (all ages, ≤64, 65-74, 75-84, ≥85 years) in ten Canadian cities from 1981 to 1999.

RESULTS

There was significant modification of RR by weather type and age. When examining the entire population, weather type was shown to have the greatest modifying effect on the risk of dying due to ozone (O3). This effect was highest on average for the dry tropical (DT) weather type, with the all-age RR of mortality at a population weighted mean (PWM) found to be 1.055 (95% CI 1.026-1.085). All-weather type risk estimates increased with age due to exposure to carbon monoxide (CO), nitrogen dioxide (NO2), and sulphur dioxide (SO2). On average, RR increased by 2.6, 3.8 and 1.5% for the respective pollutants between the ≤64 and ≥85 age categories. Conversely, mean ozone estimates remained relatively consistent with age. Elevated levels of air pollution were found to be detrimental to the health of elderly individuals for all weather types. However, the entire population was negatively effected by air pollution on the hot dry (DT) and hot humid (MT) days.

CONCLUSIONS

We identified a significant modification of RR for mortality due to air pollution by age, which is enhanced under specific weather types. Efforts should be targeted at minimizing pollutant exposure to the elderly and/or all age groups with respect to weather type in question.

Scalp meningioma

Primary extracranial meningiomas occur very rarely. We present a rare case of extracranial meningioma of the transitional variant which was excised satisfactorily. There was no suggestion of any connection to the intracranial compartment or cranial nerves. The underlying galea was uninvolved, suggesting the true extracranial nature of this tumour. This rare diagnosis should nonetheless be kept in the differential diagnosis of scalp tumors.