Roscommon University Hospital

Experimental results are presented on the emissions from a single combustion chamber stove burning wood, coal and processed fuels. This technique was used to permit comparisons to be made of the influence of different fuel types without it being influenced by the effects of secondary combustion. Measurements were made of CO, NOx and fine particulates during the major phases of combustion, namely flaming and smouldering. Measurements of the particulates were made in two ways: firstly using a gravimetric total particulate measurement and secondly using a cyclone technique to give PM2.5 and PM10 size fractions. Smoke emissions from the different fuels were very dependent on the phase of combustion especially for the total particulate results, where flaming phase emissions were much higher than in the smouldering phase. It was found that the particulate emission factors for the wood fuels were dependent on the volatile content whilst the coals followed a different pattern. NOx was linearly dependent on the fuel-N content for all the fuel types, but the relationship for biomass is different from that for coal. CO emissions were very dependent on the combustion phase.

PURPOSE: We recently reported that anionic phospholipids, principally phosphatidylserine, become exposed on the external surface of viable vascular endothelial cells in tumors, possibly in response to oxidative stresses present in the tumor microenvironment. In the present study, we tested the hypothesis that a monoclonal antibody directed against anionic phospholipids might exert antitumor effects by causing vascular damage in tumors. EXPERIMENTAL DESIGN: A new mouse immunoglobulin G3 monoclonal antibody, 3G4, was raised that binds anionic phospholipids in the presence of serum or beta2-glycoprotein I. The antibody was tested for its ability to localize to tumor vessels and exert antitumor effects in mice. RESULTS: 3G4 recognized anionic phospholipids on the external membrane of H(2)O(2)-treated endothelial cells and in vitro. It localized specifically to tumor vascular endothelium and to necrotic tumor cells after injection into severe combined immunodeficient mice bearing orthotopic MDA-MB-435 tumors. Treatment with 3G4 retarded the growth of four different tumors in mice. It reduced the growth of established orthotopic MDA-MB-231 and MDA-MB-435 human breast tumors in mice by 75% and 65% respectively, large L540 human Hodgkin's tumors by 50%, and small syngeneic Meth A fibrosarcomas by 90%. Histologic examination revealed vascular damage, a reduction in vascular density, and a reduction in tumor plasma volume. Treatment with 3G4 induced the binding of monocytes to tumor endothelium and infiltration of macrophages into MDA-MB-435 and MDA-MB-231 tumors. No toxicity to the mice was observed. CONCLUSIONS: 3G4 localizes specifically to complexes of anionic phospholipids and serum proteins on the surface of vascular endothelial cells in tumors in mice. This results in damage to tumor vasculature and suppression of tumor growth.

Objectives To evaluate the effectiveness of the computerized CBT (cCBT) programme, MoodGYM, for the reduction in symptoms of general psychological distress (the primary outcome), depression, anxiety, stress, and impaired daily functioning. Design A randomized controlled trial, with a waiting list control condition, in a routine clinical setting. Methods Participants were 149 public mental health service users (aged 18–61 [ M = 35.3 years; SD = 10.3]) waiting for interventions. Self‐report outcome measures were administered online at baseline and post‐intervention (i.e., after 32 days). Results After high dropout rates, a post‐intervention completers analysis examined 28 MoodGYM participants and 38 waiting list control participants. MoodGYM was significantly more effective than the waiting list control for the reduction of symptoms of general psychological distress ( F [1, 64] = 4.45; p < .05) and stress ( F [1, 64] = 5.35; p < .05) but not depression, anxiety, or impaired daily functioning. Conclusions Due to their high associated dropout rates, self‐help cCBT programmes such as MoodGYM should not be provided as front‐line treatments. However, as it is likely to be agreeable and beneficial to some service users, perhaps self‐help cCBT should be provided as an additional treatment option. Practitioner points Computerized CBT has predominantly been evaluated in ‘efficacy’ trials which often include motivated, self‐referred participants unrepresentative of clinical populations. Multi‐site recruitment in the present trial allowed participants with characteristics typical of public mental health service users across Ireland to be included. MoodGYM's effectiveness was demonstrated for the primary outcome, general psychological distress symptoms, and one of four secondary outcomes (i.e., stress symptoms). However, 56.3% of MoodGYM participants (and 85% of males) dropped out of the study, limiting the validity of findings. Feedback to MoodGYM (for those who engaged with it) was generally positive (e.g., 68% of respondents would recommend MoodGYM to a friend if they needed some help). However, 73% of MoodGYM participants did not complete all five sessions. Due to their limited effectiveness and high associated dropout rates, self‐help cCBT programmes such as MoodGYM should not be provided as front‐line treatments, in place of higher intensity interventions such as one‐to‐one psychotherapy. However, as it is likely to be agreeable and beneficial to some service users, self‐help cCBT is perhaps best offered as an additional treatment option.

Calfhood diseases have a major impact on the economic viability of cattle operations. A three part review series has been developed focusing on calf health from birth to weaning. In this paper, the last of the three part series, we review disease prevention and management with particular reference to pneumonia, focusing primarily on the pre-weaned calf. Pneumonia in recently weaned suckler calves is also considered, where the key risk factors are related to the time of weaning. Weaning of the suckler calf is often combined with additional stressors including a change in nutrition, environmental change, transport and painful husbandry procedures (castration, dehorning). The reduction of the cumulative effects of these multiple stressors around the time of weaning together with vaccination programmes (preconditioning) can reduce subsequent morbidity and mortality in the feedlot. In most studies, calves housed individually and calves housed outdoors with shelter, are associated with decreased risk of disease. Even though it poses greater management challenges, successful group housing of calves is possible. Special emphasis should be given to equal age groups and to keeping groups stable once they are formed. The management of pneumonia in calves is reliant on a sound understanding of aetiology, relevant risk factors, and of effective approaches to diagnosis and treatment. Early signs of pneumonia include increased respiratory rate and fever, followed by depression. The single most important factor determining the success of therapy in calves with pneumonia is early onset of treatment, and subsequent adequate duration of treatment. The efficacy and economical viability of vaccination against respiratory disease in calves remains unclear.

BACKGROUND: Person Focused Training is introduced as a model of service delivery for people with severe challenging behaviours. It is defined as training and supporting staff to conduct functional assessments and to design and implement positive behavioural support for specific individuals with challenging behaviours. METHOD: Longitudinal outcome data are presented from 138 behaviour support plans developed by staff over a seven year period were analysed to determine reductions in frequency of challenging behaviours. Degree of behaviour change was determined across topography of behaviour, gender, age, level of disability, location of residence and role of course participant. RESULTS: Results indicate that the implementation by staff of behaviour support plans are associated with significant improvement in 77% of cases at an average follow-up of 22 months after implementation of support plans. Only location of residence was identified as related to reduction in challenging behaviours with large residential centres being associated with lower rates of behavioural improvement. CONCLUSIONS: It is argued that Person Focused training may represent an alternative to existing models of supporting individuals with challenging behaviours. The implications of front-line staff designing and implementing behaviour support plans for the organisation of services and the role of the clinical psychologist are considered.

This pilot study explored the effects of a mindfulness meditation intervention on nurses’ perceived stress and compassion. A quasi-experimental pre-test/post-test design was used. Nurses ( n = 90) working at three university teaching hospitals completed the Perceived Stress Scale and Compassion Scale at the beginning of the training and 64 completed the scales at the end of the training. The 64 matched data sets were analysed using the t -test, chi-square test and analysis of variance. The findings indicated that the nurses’ perceived stress was significantly reduced after the intervention. Notably, compassion scores were increased after the intervention, and this finding was significant for nurses working at one of the hospitals. There were no significant differences between results from a 6-week and an 8-week mindfulness intervention. The results suggest that mindfulness meditation training can impact positively on nurses’ perceived stress and also enhance nurses’ compassion. Mindfulness may well be a suitable self-care, stress-management intervention that can effectively teach nurses coping skills to assist them in managing the daily stressors inherent in their home and work life.

OBJECTIVES: This paper discusses the increasing incidence of mental health problems in Pakistan, and specifically in the Swat Valley, in relation to the growing insurgency and current violence in Pakistani society. The paper argues that the health care system's response in Pakistan is not adequate to meet the current challenges and that changes in policy are needed to build mental health care services as an important component of the basic health package at primary care level in the public sector. METHOD: This paper reviews the existing mental health situation in Pakistan with reference to the findings of a case study in the Swat Valley in Khyber Pukhtoonkhwa Pakistan. The figures presented in the case study are used to support the need for an integrated national mental health policy. CONCLUSION: Mental health care needs to be incorporated as a core service in primary care and supported by specialist services. There is a strong need to provide adequate training for general practitioners and postgraduate training for mental health professionals to meet the current demands. A collaborative network between stakeholders in the public and private sector, as well as non-governmental organisations are required that promotes mental health care and advocates for changes in mental health policy.

The SCORE (Systemic Clinical Outcome and Routine Evaluation) is a 40-item questionnaire for completion by family members 12 years and older to assess outcome in systemic therapy. This study aimed to investigate psychometric properties of two short versions of the SCORE and their responsiveness to therapeutic change. Data were collected at 19 centers from 701 families at baseline and from 433 of these 3-5 months later. Results confirmed the three-factor structure (strengths, difficulties, and communication) of the 15- and 28-item versions of the SCORE. Both instruments had good internal consistency and test-retest reliability. They also showed construct and criterion validity, correlating with measures of parent, child, and family adjustment, and discriminating between clinical and nonclinical cases. Total and factor scales of the SCORE-15 and -28 were responsive to change over 3-5 months of therapy. The SCORE-15 and SCORE-28 are brief psychometrically robust family assessment instruments which may be used to evaluate systemic therapy.

CONTEXT: The increased uptake of evidence from systematic reviews is advocated because of their potential to improve the quality of decision making for patient care. Systematic reviews can do this by decreasing inappropriate clinical variation and quickly expediting the application of current, effective advances to everyday practice. However, research suggests that evidence from systematic reviews has not been widely adopted by health professionals. Little is known about the facilitators to uptake of research evidence from systematic reviews and meta-analyses. OBJECTIVE: To review the facilitators to the uptake by decision makers, of evidence from systematic, meta-analyses and the databases containing them. SEARCH STRATEGY: We searched 19 databases covering the full range of publication years, utilised three search engines and also personally contacted investigators. Grey literature and knowledge translation research was particularly sought. Reference lists of primary studies and related reviews were also searched. SELECTION CRITERIA: Studies were included if they reported on the views and perceptions of decision makers on the uptake of evidence from systematic reviews, meta-analyses and the databases associated with them. One investigator screened titles to identify candidate articles, and then two reviewers independently assessed the relevance of retrieved articles to exclude studies that did not meet the inclusion criteria. Quality of the included studies was also assessed. DATA EXTRACTION: Using a pre-established taxonomy, two reviewers described the methods of included studies and extracted data that were summarised in tables and then analysed. Differences were resolved by consensus. RESULTS: Of articles initially identified, we selected unique published studies describing at least one facilitator to the uptake of evidence from systematic reviews. The 15 unique studies reported 10 surveys, three qualitative investigations and two mixed studies that addressed potential facilitators. Five studies were from Canada, four from the UK, three from Australia, one from Iran and one from South-east Asia (Indonesia, Malaysia, Thailand and the Philippines), with one study covering both Canada and UK. In total, the 15 studies covered eight countries from four continents. Of 2495 participants in the 15 studies, at least 1343 (53.8%) were physicians. Perceived facilitators to the use of evidence from systematic reviews varied. The 15 studies yielded 54 potential facilitators to systematic review uptake. The five most commonly reported perceived facilitators to uptake of evidence from systematic reviews were the following: the perception that systematic reviews have multiple uses for improving knowledge, research, clinical protocols and evidence-based medicine skills (6/15); a content that included benefits, harms and costs and is current, transparent and timely (6/15); a format with a 1:3:25 staged access and executive summary (5/15); training in use (4/15); and peer-group support (4/15). CONCLUSION: The results expand our understanding of how multiple factors act as facilitators to optimal clinical practice. This systematic review reveals that interventions to foster uptake of evidence from systematic reviews, meta-analyses and The Cochrane Library can build on a broad range of facilitators.

BACKGROUND: Demand for GP services in the Republic of Ireland (RoI) is increasing, and the resultant escalation in workload demands is an issue of growing concern. Accordingly, the accurate measurement and description of GP workload is essential to inform future healthcare planning. AIM: To provide a real-time measurement of GP workload with respect to hours worked and of proportional time expenditure on typical workload activities. DESIGN AND SETTING: A prospective study among GPs in the RoI that took place from January 2019 to March 2019. METHOD: Participants were invited to enrol in the study by direct email invitation and via notifications posted within GP-specific monthly journals; online forums; and a social media platform. Participants used a time-management software program to self-record workload activity in real time over 6 weeks. RESULTS: In total, 123 GPs were included for final analyses with a total of 8930 hours of activity recorded. The mean duration of a two-session day (excluding break-time) was 9.9 hours (95% confidence interval [CI] = 9.7 to 10.0; interquartile range [IQR] 7.9 to 13.9). Of this time, 64% was spent on clinical consultations. In total, 25.4% of activity was recorded outside the hours of 9.00 am and 5.00 pm. An average of 12.4 face-to-face consultations were completed per session of activity. The mean duration of a 10-session week was greatest for the partner (50.8 hours; 95% CI = 49.8 to 51.9) and >55-year-old (50.8 hours; 95% CI = 49.3 to 52.2) demographics, relative to their respective colleagues. CONCLUSION: To the authors' knowledge, this is the first study to provide an objective, accurate, and granular real-time measurement of GP workload in the RoI, demonstrating the significant volume and variety of work undertaken by GPs in the RoI.

OBJECTIVES: To examine the psychological and social impact of the COVID-19 pandemic on patients with established anxiety disorders during a period of stringent mandated social restrictions. METHODS: Semi-structured interviews were conducted with 30 individuals attending the Galway-Roscommon Mental Health Services with an International Classification of Diseases diagnosis of an anxiety disorder to determine the impact of the COVID-19 restrictions on anxiety and mood symptoms, social and occupational functioning and quality of life. RESULTS: Twelve (40.0%) participants described COVID-19 restrictions as having a deleterious impact on their anxiety symptoms. Likert scale measurements noted that the greatest impact of COVID-19 related to social functioning (mean = 4.5, SD = 2.9), with a modest deleterious effect on anxiety symptoms noted (mean = 3.8, SD = 2.9). Clinician rated data noted that 8 (26.7%) participants had disimproved and 14 (46.7%) participants had improved since their previous clinical review, prior to commencement of COVID-19 restrictions. Conditions associated with no 'trigger', such as generalised anxiety disorder, demonstrated a non-significant increase in anxiety symptoms compared to conditions with a 'trigger', such as obsessive compulsive disorder. Psychiatric or physical comorbidity did not substantially impact on symptomatology secondary to COVID-19 mandated restrictions. CONCLUSIONS: The psychological and social impact of COVID-19 restrictions on individuals with pre-existing anxiety disorders has been modest with only minimal increases in symptomatology or social impairment noted.

Continuous flow chemistry is often viewed as a very simple concept on paper, however scientists with significant flow chemistry experience will highlight a number of challenges that need to be overcome. Critical for the successful development of any flow process is a high level of understanding of potential pitfalls that may be encountered. A collaborative and multi‐disciplinary team of chemists and chemical engineers is essential in the development of a process from lab scale through to production. This Minireview will identify and highlight relevant risks and their subsequent mitigation strategies to ensure successful flow processing.

OBJECTIVE: Little is known about the barriers, facilitators and interventions that impact on systematic review uptake. The objective of this study was to identify how uptake of systematic reviews can be improved. SELECTION CRITERIA: Studies were included if they addressed interventions enhancing the uptake of systematic reviews. Reports in any language were included. All decisionmakers were eligible. Studies could be randomised trials, cluster-randomised trials, controlled-clinical trials and before-and-after studies. DATA SOURCES: We searched 19 databases including PubMed, EMBASE and The Cochrane Library, covering the full range of publication years from inception to December 2010. Two reviewers independently extracted data and assessed quality according to the Effective Practice and Organisation of Care criteria. RESULTS: 10 studies from 11 countries, containing 12 interventions met our criteria. Settings included a hospital, a government department and a medical school. Doctors, nurses, mid-wives, patients and programme managers were targeted. Six of the studies were geared to improving knowledge and attitudes while four targeted clinical practice. SYNTHESIS OF RESULTS: Three studies of low-to-moderate risk of bias, identified interventions that showed a statistically significant improvement: educational visits, short summaries of systematic reviews and targeted messaging. Promising interventions include e-learning, computer-based learning, inactive workshops, use of knowledge brokers and an e-registry of reviews. Juxtaposing barriers and facilitators alongside the identified interventions, it was clear that the three effective approaches addressed a wide range of barriers and facilitators. DISCUSSION: A limited number of studies were found for inclusion. However, the extensive literature search is one of the strengths of this review. CONCLUSIONS: Targeted messaging, educational visits and summaries are recommended to enhance systematic review uptake. Identified promising approaches need to be developed further. New strategies are required to encompass neglected barriers and facilitators. This review addressed effectiveness and also appropriateness of knowledge uptake strategies.

WHAT IS KNOWN ABOUT THE SUBJECT?: The Advancing Recovery in Ireland (ARI) project (Health Service Executive, 2012) promotes recovery-orientated services. A previous study of Irish mental health practitioners (Cleary & Dowling ) identified the need to improve knowledge and attitudes towards recovery. To facilitate implementation of ARI and monitor progress, this study provided a 'benchmark' of current knowledge and attitudes to recovery. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE?: The study provides important baseline information on recovery knowledge and attitudes which can be used to assess the impact of the ARI Project. It also provides valuable information that can be compared to recovery approaches employed in other countries. Despite the increased emphasis on recovery in Ireland, knowledge and attitudes of health care practitioners towards recovery remain relatively unchanged between 2007 and 2013. Working in dual settings, being a non-nurse, and training was associated with better RKI scores. Training appears to be the strongest factor in predicting better recovery knowledge. The findings suggest that knowledge levels and attitude changes following education may not be sustained over time and ongoing training may be required. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is considerable scope to improve recovery knowledge. Key recommendations include the need for more recovery training, evaluate whether training translates into clinical practice, using 'Recovery Champions', introducing peer support workers and developing local policies and protocols to support recovery practice. ABSTRACT: Introduction A study of Irish mental health practitioners (Cleary & Dowling ) identified the need to improve knowledge and attitudes towards recovery. This led to the Advancing Recovery in Ireland Project (ARI) which promoted recovery-orientated services and a need to 'benchmark' progress. There is little evidence regarding the types of educational interventions that maintain positive recovery knowledge and attitudes in providers. Aim The study assessed current knowledge and attitudes to recovery. Methods The methodology of Cleary & Dowling () was replicated. A survey was administered to practitioners (n = 337) using the adapted Recovery Knowledge Inventory (RKI) (Cleary & Dowling ). Results No significant differences were found in recovery scores compared to Cleary & Dowling () or by level of experience. Working in dual settings, being a non-nurse, and training was associated with better recovery scores. Significantly more respondents had received training in recovery (40% versus 23%) compared to Cleary & Dowling (). Training appears to be the strongest factor predicting better recovery knowledge. Conclusions There is considerable scope to improve recovery knowledge. Key recommendations include the need for more recovery training, using 'Recovery Champions', introducing peer support workers and developing local policies and protocols to support recovery working.

Numerous complications and increased operating times were reported with ultrasonically assisted lipoplasty in the first several months after introduction of the technology in the United States. The purpose of this study was to review early reported complications and management regimens, evaluate possible causes of problems, and apply indications and techniques to attempt to minimize complications during an initial experience with this technique beginning in January of 1997. Seven specific indications and modifications of existing techniques were developed and applied to an initial clinical series of 70 consecutive patients who underwent ultrasound-assisted suction lipoplasty between January 10, 1997, and August 1, 1997. Follow-up ranged from 1 to 7 months. No perioperative or postoperative complication occurred in any patient in this series. In this series of ultrasound-assisted lipoplasty cases, application of the following criteria resulted in a series of 70 patients with 1 to 7-month follow-up without complications: (1) selecting patients with well localized fat deposits who were no more than 20 percent above their ideal body weight; (2) infusing a solution of Ringer's Lactate containing 1 cc of 1:1000 epinephrine per 1000 cc into the area of fat removal, stopping infusion when the tissues first become firm, not infusing to marked tissue turgor or skin induration; (3) restricting the level of energy application to a minimum of 1 cm from the undersurface of the dermis; (4) limiting ultrasonic energy application in each area to approximately 1 minute per estimated 100 cc of total aspirate in a wet to superwet environment; (5) not performing ultrasound-assisted lipoplasty in the same area as another procedure that could potentially compromise tissue vascularity; (6) using a Lysonix 2000 generator and 5-mm golf tee tip probe at a power setting of 8 to apply ultrasonic energy to the area of fat removal, ceasing energy application when tissue resistance to the passage of the probe decreases and moving the cannula as rapidly as tissue resistance allows; and (7) using a standard elastic garment without adherent foam or other materials for 2 weeks postoperatively, encouraging all normal activity immediately, and restricting aerobic activities for 2 weeks.

AIMS: Pre-pregnancy care programmes can help to reduce morbidity and mortality associated with pregnancy in women with diabetes. However, uptake of a free pre-pregnancy care programme along the Irish Atlantic seaboard was only 30%. This study sought to better understand why women with diabetes mellitus (Type 1 and Type 2) choose to attend pre-pregnancy care services and to identify perceived barriers to attendance. METHODS: A participative health research method called the participative research process was used to facilitate 14 women with diabetes mellitus to create 'webs of ideas' on the reasons for attendance and non-attendance at a pre-pregnancy care programme, and potential solutions for each obstacle. RESULTS: The participants identified information on the risks of pregnancy as crucial for all childbearing women with diabetes, as lack of information was a major obstacle to attendance at pre-pregnancy care programmes. Practical constraints such as childcare difficulties and work commitments were also identified. Participants stressed that health practitioners need to focus on positive aspects of pregnancy and childbearing rather than focusing solely on the problematic aspects for women with diabetes mellitus. CONCLUSIONS: Women with diabetes need support and reassurance about their ability to control blood glucose and have a successful pregnancy while coping with the multiple challenges inherent in diabetes management and pregnancy. To increase uptake of pre-pregnancy care, a norm needs to be established that situates pre-pregnancy care as something every woman with diabetes will do, whether or not she is actively contemplating becoming a mother at the time. Active use of social media and facilitating peer support should be encouraged in pre-pregnancy services to facilitate attendance. The time has come to incorporate the skills of a clinical psychologist in the delivery of a pre-pregnancy service.

Sulfoxides are a class of organic compounds that find wide application in medicinal and organic chemistry. Several biocatalytic approaches have been developed to synthesise enantioenriched sulfoxides, mainly by exploiting oxidative enzymes. Recently, the use of reductive enzymes such as Msr and Dms has emerged as a new, alternative method to obtain enantiopure sulfoxides from racemic mixtures. In parallel, novel oxidative approaches, employing nonclassical solvents such as ionic liquids (ILs) and deep eutectic solvents (DESs), have been developed as greener and more sustainable biocatalytic synthetic pathways. This minireview aims highlights the recent advances made in the biocatalytic synthesis of enantioenriched sulfoxides by employing such unconventional approaches.

Previous research has suggested substantial variation in prevalence rates of psychiatric disorders in individuals with intellectual disability (ID) and also differential patterns of associations between psychiatric disorders and challenging behaviors in people with ID. The aim of this study was to determine the prevalence rate of specific psychiatric disorders and challenging behaviors and the relationship between them in a community-based sample of individuals with ID. A community-based sample of 159 adults primarily with mild and moderate ID was surveyed for the presence of psychiatric disorders and challenging behaviors using the Behavior Problem Inventory and the Psychiatric Assessment Schedule (PAS-ADD). Individuals who met threshold on the PAS-ADD were subsequently evaluated using the Mini PAS-ADD Interview. Screening for psychiatric disorders using the PAS-ADD indicated a prevalence rate of 10%. There was a large discrepancy between the overall rate of challenging behaviors (45%) and the rate of psychiatric disorders identified by the Mini PAS-ADD Interview (6%). However, the rate of more severe behavior problems (8%) was closer to the rate of psychiatric disorders (6%). Thirty-one percent of people with severe challenging behaviors also were rated as having psychiatric disorders and odd ratio analysis indicates that individuals with severe challenging behaviors are substantially more likely to present with a psychiatric disorder. However, the relationship between different topographies of challenging behaviors and discrete diagnostic categories of psychiatric disorders appears to be unclear. This study reports a low prevalence of psychiatric disorders in a community-based population. The presence of severe challenging behaviors appears to have some association with psychiatric disorders but does not appear specific to discrete diagnostic categories. Clinicians and researchers need to debate the validity of considering challenging behaviors atypical manifestations of psychiatric disorders.

OBJECTIVE: To evaluate whether a hospital-based mentoring program could significantly increase short- and longer-term emergency obstetrics and neonatal care (EmONC) knowledge and skills among health providers. METHODS: In a prospective before-and-after study, 20 mentors were trained using a specially-created EmONC mentoring and training program at Bwaila Hospital in Lilongwe, Malawi. The mentors then trained an additional 114 providers as mentees in the curriculum. Mentors and mentees were asked to complete a test before initiation of the training (Pre-Test), immediately after training (Post-Test 1), and at least 6 months after training (Post-Test 2) to assess written and practical EmONC knowledge and skills. Mean scores were then compared. RESULTS: Scores increased significantly between the Pre-Test and Post-Test 1 for both written (n=134; difference 22.9%, P<0.001) and practical (n=125; difference 29.5%, P<0.001) tests. Scores were still significantly higher in Post-Test 2 than in the Pre-Test for written (n=111; difference 21.0%, P<0.001) and practical (n=103; difference 29.3%, P<0.001) tests. CONCLUSION: A hospital-based mentoring program can result in both short- and longer-term improvement in EmONC knowledge and skills. Further research is required to assess whether this leads to behavioral changes that improve maternal and neonatal outcomes.

BACKGROUND: Bovine respiratory disease (BRD) remains among the leading causes of death of cattle internationally. The objective of this study was to identify risk factors associated with exposure to BRD pathogens during the peri-weaning period (day (d)-14 to d 14 relative to weaning at 0) in dairy bull calves using serological responses to these pathogens as surrogate markers of exposure. Clinically normal Holstein-Friesian and Jersey breed bull calves (n = 72) were group housed in 4 pens using a factorial design with calves of different breeds and planes of nutrition in each pen. Intrinsic, management and clinical data were collected during the pre-weaning (d - 56 to d - 14) period. Calves were gradually weaned over 14 days (d - 14 to d 0). Serological analysis for antibodies against key BRD pathogens (BRSV, BPI3V, BHV-1, BHV-4, BCoV, BVDV and H. somni) was undertaken at d - 14 and d 14. Linear regression models (for BVDV, BPI3V, BHV-1, BHV-4, BCoV and H. somni) and a single mixed effect random variable model (for BRSV) were used to identify risk factors for changes in antibody levels to these pathogens. RESULTS: BRSV was the only pathogen which demonstrated clustering by pen. Jersey calves experienced significantly lower changes in BVDV S/P than Holstein-Friesian calves. Animals with a high maximum respiratory score (≥8) recorded significant increases in H. somni S/P during the peri-weaning period when compared to those with respiratory scores of ≤3. Haptoglobin levels of between 1.32 and 1.60 mg/ml at d - 14 were significantly associated with decreases in BHV-1 S/N during the peri-weaning period. Higher BVDV S/P ratios at d - 14 were significantly correlated with increased changes in serological responses to BHV-4 over the peri-weaning period. CONCLUSIONS: Haptoglobin may have potential as a predictor of exposure to BHV-1. BRSV would appear to play a more significant role at the 'group' rather than 'individual animal' level. The significant associations between the pre-weaning levels of antibodies to certain BRD pathogens and changes in the levels of antibodies to the various pathogens during the peri-weaning period may reflect a cohort of possibly genetically linked 'better responders' among the study population.