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Accreditation of veterinary inspection systems.

Accreditation of Veterinary Services could be a key factor in facilitating international recognition of certificates. For this to occur, accreditation must be conducted within the international normative framework on compliance evaluation. The EN 45004 standard for inspection bodies is the most appropriate organisational reference. It makes a clear distinction between the technical activity of inspection, and decisions which fall within the competence of public authorities. However, there are few international normative texts describing inspection methods, which is a major obstacle to the development of a widely recognised accreditation system. Organisations that accredit inspection bodies exist in many countries, but there are no agreements on multilateral recognition. This paper describes the accreditation cycle and outlines the possibilities for accrediting networks or individual sites.

Accreditation↗

A reinforcement learning-enhanced fuzzy multi-objective equilibrium optimization framework for multiple sequence alignment.

Multiple sequence alignment (MSA) is a fundamental task in bioinformatics, underpinning comparative genomics, structural analysis, and evolutionary inference. However, MSA remains a challenging multi-objective optimization problem due to the need to simultaneously maximize alignment accuracy, preserve conserved regions, and control gap proliferation, particularly in large and heterogeneous sequence collections. In this work, we propose MOFSACEO-MSA, a novel hybrid optimization framework for multiple sequence alignment that integrates a fuzzy multi-objective evaluation scheme with the Equilibrium Optimizer (EO) and a Soft Actor-Critic (SAC)-based adaptive control mechanism. The proposed framework formulates MSA as a dynamic multi-objective optimization problem, in which alignment quality is assessed using complementary residue-level and column-level criteria, including Sum-of-Pairs score, column conservation, entropy, and gap statistics. Fuzzy membership functions are employed to harmonize competing objectives into a unified optimization landscape, while EO provides robust global exploration. To further enhance adaptability, SAC dynamically regulates key EO parameters during the search process, enabling an effective balance between exploration and exploitation across datasets of varying size and heterogeneity. Extensive experiments werew conducted on diverse biological sequence datasets, with a primary focus on RNA benchmarks, including structured families from Rfam, large-scale repositories from RNAcentral and GenBank, and organism-specific tRNA datasets from GtRNAdb. Comparative evaluations against classical alignment tools (ClustalW, MAFFT, MUSCLE, PRANK, KAlign, and T-Coffee), metaheuristic methods (SAGA, Sequoya and EAFSA), and a reinforcement learning-based approach (RLALIGN) demonstrate that MOFSACEO-MSA consistently achieves competitive or superior Sum-of-Pairs scores while significantly reducing gap proportions and maintaining compact alignment lengths. Notably, the proposed framework exhibits improved robustness on large and highly heterogeneous datasets, where existing methods often suffer from excessive gap insertion or unstable convergence. Overall, MOFSACEO-MSA provides a flexible and extensible optimization paradigm that effectively bridges evolutionary search and reinforcement learning for high-quality multiple sequence alignment, with demonstrated effectiveness on challenging RNA alignment tasks.

Sequence Alignment↗

The genetic testing of children for cancer susceptibility: ethical, legal, and social issues.

Genetic testing for cancer susceptibility raises many ethical, legal, and social concerns, particularly when testing children is also considered. The complexity of defining medical and psychosocial risks and benefits of genetic predisposition testing for multifactorial disorders, like cancer, is discussed. Presumed incompetence of children and adolescents and questionable ability of many adults to understand complex genetic information raise informed consent questions. Guidelines can aid professionals but there must also be a means of evaluating individual cases. Further research is needed to determine optimal methods of educating children and adults about genetic issues and to discriminate factors which contribute to satisfaction with decision-making about genetic testing. Legal issues and practical considerations are examined involving a duty to warn family members about genetic susceptibility and to recontact previously-tested individuals as knowledge advances. Recommendations are offered concerning roles for social scientists and legal scholars in ethical integration of genetic testing into our medical and social framework.

Adolescent↗

Nurse practitioners: a contract for change and excellence in nursing.

The role of the Nurse Practitioner has been in existence in a variety of contexts and within a broad range of the scope of their practice throughout the world for a number of years. Many nurses work at this advanced level of clinical practice without the acknowledgement f the very important and responsible role that they play within the healthcare setting. Although the United States and United Kingdom have recognised the role of the advanced Nurse Practitioner for a number of years, there still exists confusion and disagreement as to their scope of practice. There is uncertainty and anxiety as to where the role boundaries between nursing and medical and allied health professionals begin and end. The role of the Nurse Practitioner in Australia has not been without its problems in the developmental stage of its creation. New South Wales finally achieved recognition of the role this year after a decade of negotiation. This has culminated in the acceptance for the development of 40 Nurse Practitioner positions across the State. The first of these was accepted in the Far West Area Health Service in May 2001. The Far West Area Health Service created a five-year plan, which addresses the development of nurses preparing for authorisation, the creation of Nurse Practitioner positions in the remote communities, the creation of clinical guidelines to support advanced practice and the evaluation process for both the positions and the nurses. The objective of this approach is to ensure effective implementation of these advanced nursing positions in the remote communities of New South Wales. The Nurse Practitioner role needs to respond to the individual, the family and the community, utilising advanced clinical skills and remaining responsive to the changes in health care within a primary health care framework, which is essential for combating the complex health care issues in remote areas (NSW Health 2000).

Australia↗

["And it is always recommended"--educational concepts and expertise in nursing practice].

This article presents the results of a qualitative empirical study of interaction between teachers and students during lessons in nursing training, focussing in particular on the perspectives of nursing didactics. It examines whether the classes warrant appropriate preparation for beginners with regard to the complex demands of professional practice. The presentation focuses on a widespread educational concept named "rule-orientation". This category summarises those communication patterns of teachers which create rules for operating in typical nursing situations and which are presented as benchmarks for professional practice. Limitations associated with this concept are (1) lacking science-based justification of those operation rules, (2) the communication of standards and recipes instead of clinical judgement, and (3) the partial resolution of intrinsically contradictious demands in nursing practice. Three nursing didactical target dimensions for nursing education are being concretised as a referential framework for class-related decisions that can contribute to better qualify nursing students for professional practice.

Benchmarking↗

Nurse-led elective cardioversion: an evidence-based practice review.

By posing a clinical practice question, this article aims to document and explore the published evidence base supporting nurse-led cardioversion. A literature review was undertaken to determine the best evidence for practice. Five articles and two conference abstracts describing practice were found to be pertinent to the question. Description of the methodology used was a weakness of all the articles studied, with only one article purported to be framed as a research study. The remainder describe a planned change in nursing practice to encompass the delivery of a service previously, organizationally viewed as, physician led. Evaluations of practice were descriptive and supported by audit data in most articles, however, appropriate evidential comparisons were not offered. These articles were critically appraised in relation to safety and efficacy. Whilst the evidence may be seen to be limited and weak, it does add credence to the notion that a nurse with a suitable experiential background and knowledge base can make a significant contribution to the care of this group of patients. It is clearly evident that further developments in practice should be framed within a research context to support and strengthen the evidence base. Four prominent themes emerged from the review, 'change milieu', 'reshaping boundaries', 'nurse-led', 'efficacy of practice', which are modelled into a conceptual framework. Nursing roles are expanding within the cardiological setting, affording practitioners unprecedented practice opportunities within a supportive organizational framework, however, these roles must be subject to appropriate evaluation in order to continue informing a robust evidence base.

Benchmarking↗

Nutritional health promotion for older adults, where is the content?

PURPOSE: To describe nurse practitioners' (NPs') educational experiences related to older adult nutrition and eating abilities. DATA SOURCES: Descriptive research with written survey data collected from 80 gerontological NPs recruited from a national nursing conference. CONCLUSIONS: Older adults' nutritional health has been related to acute illness, pressure sore development, prolonged hospital stays, and other health problems. Current literature suggests that although nutrition screening and intervention promote older adults' health, practitioners may not consistently receive education on this content. Participants indicated that gerontological-nutrition content was important, that it was missing from their educational programs, and that it needed to be a part of the NP curriculum. Specific nutrition content concerns were organized by the categories (a) disease and functional issues, (b) psychosocial support and environmental impact, and (c) health care team and system considerations. IMPLICATIONS FOR PRACTICE: NP programs need to self-evaluate for adequate and appropriate nutrition screening and intervention content. Frameworks such as those developed by the Nutrition Screening Initiative and others provide beginning guidance for further content development.

Aged↗

Putting CATS/APEL accreditation into practice.

Expanding opportunities mean that many nurses wish to update and extend their knowledge. A comprehensive framework for credit accumulation is needed. All practitioners must record their professional development in a personal profile or portfolio.

Accreditation↗

Mental health assessment/mental status examination.

More than one-half of primary care patients have mental health symptoms or disorders. As health insurers are forced to cover mental disorders on parity with physical illness, the number of patients with mental health complaints will increase. Nurse practitioners must increase their skills in assessing, diagnosing, and treating mental disorders. This article provides a framework for mental health assessment, especially mental status examination. A method for improving mental health assessment skill is suggested.

Clinical Competence↗

Two-level Haseman-Elston regression for general pedigree data analysis.

The Haseman-Elston (HE) (Haseman and Elston [1972] Behav Genet 2:3-19) method is widely used in genetic linkage studies for quantitative traits. We propose a new version of the HE regression model, a two-level HE regression model (tHE) in which the variance-covariance structure of family data is modeled under the framework of multiple-level regression. An iterative generalized least squares (IGLS) algorithm is adopted to handle the varying variance-covariance structures across families in a simple fashion. In this way, the tHE can compete favorably with any current version of HE in that it can naturally make use of all the trait information available in any general pedigree, simultaneously incorporate individual-level and pedigree-level covariates, marker genotypes for linkage (i.e., the number of allele shared identically by descent [IBD]), and marker alleles for association. Under the assumption of normality, the method is asymptotically equivalent to the usual variance component model for detecting linkage. For the situation where the assumption of normality is critical, a robust globally consistent estimator of the quantitative trait locus (QTL) variance is available. Complex genetic mechanisms, including gene-gene interaction, gene-environmental interaction, and imprinting, can be directly modeled in this version of HE regression.

Genetic Diseases, Inborn↗

[The attitude of medical students to psychiatric patients].

Numerous studies conducted during the past decades indicate that the public's attitude toward the mentally ill is strongly prejudiced. Since the attitude of the general public also has an effect on community-based psychiatric care, we must ask how public opinion might be influenced. One possible approach could be through so called key community leaders--those who are highly respected in society because of their competence in a particular area. Doctors belong to this group of people. For this reason we questioned medical students, as future key community leaders, with respect to their attitudes toward the mentally ill within the framework of their first contact with psychiatric patients during their studies. In order to make a direct comparison possible, we interviewed a sample of the Mannheim population who live in a part of the city where a variety of complementary facilities have been set up. The comparison shows that medical students do not have a more positive attitude toward the mentally ill; in fact, in certain areas they have an even more negative attitude toward the mentally ill than the general population has. We were not able to establish what effect teaching has with respect to changing attitudes.

Adolescent↗

Predicting faecal indicator fluxes using digital land use data in the UK's sentinel Water Framework Directive catchment: the Ribble study.

The Ribble drainage basin is the single UK sentinel study area chosen for examining the implementation of the EU Water Framework Directive (WFD 20/60/EC). The study which has generated the data for this paper was initiated to quantify 'catchment-derived' fluxes of faecal indicators originating from both point and diffuse sources to inform the competent authorities on the potential for, and prioritization of, further options for reducing the faecal indicator loadings to this crucial coastal environment. It represents the first UK drainage basin-scale 'profile' of faecal indicator sources as recommended by WHO [1999. Health Based Monitoring of Recreational Waters: The Feasibility of a New Approach; the "Annapolis Protocol". World Health Organisation Geneva, Switzerland; 2003. Guidelines for Safe Recreational-Water Environments Volume 1: Coastal and Fresh-Waters. World Health Organisation Geneva, Switzerland] and incorporated into current drafts of the revised Bathing Water Directive [Anon, 2004. Council of the European Communities Amended proposal for a Directive of the European Parliament and of the Council concerning the management of bathing water quality. Brussels 23rd June]. This paper focuses on the relationships between land use and faecal indicator organism concentrations in surface waters within this very large drainage basin (1583 km2) containing some extensive urban areas. A geographical information system comprising readily available digital elevation, remotely sensed land cover and digital map data was used to generate the land use variables for subcatchments draining to 41 locations across the study area. Presumptive concentrations of coliforms, Escherichia coli and enterococci (colony forming unit (cfu) 100 ml(-1)) were measured at each location on at least 20 occasions over a 44-day period within the 2002 bathing season. The sampling programme targeted hydrograph events. Hydrometric records were used to allocate results as either base flow or high flow. At each site, geometric mean faecal indicator organism concentrations were significantly elevated at high flow compared to base flow. Stepwise regression modelling produced statistically significant models predicting geometric mean base and high-flow faecal indicator organism concentrations from land use variables (r2: 49.5-68.1%). The dominant predictor variable in each case was the proportion of built-up land in subcatchments, suggesting that this land use type, with associated sewage-related inputs, is a critical source of faecal indicator organisms in this drainage basin.

Biomarkers↗

Competing demands in psychosocial care. A model for the identification and treatment of depressive disorders in primary care.

A considerable body of knowledge noe exists in the area of depressive disorders in primary care. Primary care clinicians appear to identify less than half of patients with major depressive disorder and adequately treat only a portion of those they identify. However, recent research suggests that identification and treatment of depressive disorders in primary care is a far more complex process than previously assumed. The presence of significant differences in patient expectations, the process of care, and the clinical epidemiology of depression between psychiatric and primary care settings makes it difficult to interpret existing studies of primary care clinician performance. This paper describes an alternative conceptual model for the identification and management of depression in primary care which incorporates the concept of "competing demands" derived from the preventive services literature. The central premise of this model is that primary care encounters present competing demands for the attention of the clinician and that there is not enough time to address each demand. The identification and treatment of depression represents an active choice from multiple clinician and patient priorities such as treatment of acute illness, provision of preventive services, and response to patient requests. Choice is influenced by three sets of interrelated "domains," representing the clinician, the patient, and the practice ecosystem. Each domain is indirectly influenced by the general policy environment. Detection and treatment of depression in this model occurs over time as clinicians work through these competing demands. Although the competing demands model contains many unproven elements, it is likely to have a great deal of "face validity" for practicing primary care clinicians, and its validity can be empirically tested. Using the model as a framework to guide inquiry into the identification and management of depression and other mood disorders in primary care may lead to the discovery of more creative and effective solutions to the problem of underdiagnosis and undertreatment.

Antidepressive Agents↗

Defining effective community support for long-term psychiatric patients according to behavioural principles.

OBJECTIVE: The purpose of this article is to define the characteristics of effective support in community mental health settings for patients with serious and persistent mental illness. METHOD: A broad literature providing empirical evidence on competent caregiver behaviours and styles is selectively reviewed. Relevant findings from family caregiver research and studies of social environments that enhance skill development in people with intellectual disabilities are incorporated, within a cognitive-behavioural framework. RESULTS: Six important domains are identified which represent positive caregiver styles: acceptance, creating a positive atmosphere, expectations of change, responsiveness, normalisation and educativeness. CONCLUSION: The characteristics hypothesised to be critical for caregivers and support workers are defined in a general way that can allow for individualisation according to the goals of the programs and the cultural priorities of staff and patients. Further empirical validation of these characteristics would enable community mental health services to provide more specialised clinical treatments.

Cognitive Behavioral Therapy↗

Ruminosignatures associated with methane emissions and feed efficiency across geographies and cattle breeds.

The cattle rumen microbiota represents a complex and dynamic ecosystem whose organization and relationship to host phenotypes are important for food security and environmental sustainability. We analyzed rumen microbiota profiles from 2496 cattle representing five breeds and production systems across five countries, identifying microbial co-abundance groups termed Ruminosignatures. We detected 14 distinct Ruminosignatures, including 2 observed across all populations dominated by Prevotella and UBA2810. Additional Ruminosignatures showed breed- and diet-specific patterns and collectively explained 96%-99% of variance in rumen microbial composition. Integrative cross-country analysis confirmed 10 out of 14 Ruminosignatures identified in cohort-specific analyses. Several Ruminosignatures were associated with methane emissions and feed efficiency traits and were partially under host genetic control, with heritability estimates ranging from 0.09 to 0.58. Structural equation modeling revealed consistent negative genetic and phenotypic correlations between the UBA2810-dominated Ruminosignature (RS_UBA2) and methane emissions across cohorts (rg = -0.40 to -0.65), with structural coefficients concordant in sign across all populations, supporting the expected direction of phenotypic response to selection on RS_UBA2. Meta-analysis confirmed positive associations of RS_UBA2 with average daily gain and negative associations with methane-related traits and feed conversion ratio. Functional genome-based predictions suggested RS_UBA2 may reduce methanogenesis through alternative hydrogen utilization pathways competing with methanogenic archaea. Production system type influenced both Ruminosignature occurrence and relationships with host phenotypes, emphasizing the relevance of context-specific strategies for microbiome modulation. Our findings highlight the potential of the Ruminosignatures framework for microbiome-informed breeding programs aimed at improving feed efficiency while reducing the environmental impact of cattle production.

Animals↗

Analysis of long repeats in bacterial genomes reveals alternative evolutionary mechanisms in Bacillus subtilis and other competent prokaryotes.

Prokaryotic genomes seem to be optimized toward compactness and have therefore been thought to lack long redundant DNA sequences. However, we identified a large number of long strict repeats in eight prokaryotic complete genomes and found that their density is negatively correlated with genome size. A detailed analysis of the long repeats present in the genome of Bacillus subtilis revealed a very strict constraint on the spatial distribution of repeats in this genome. We interpret this as the hallmark of selection processes leading to the addition of new genetic information. Such addition is independent of insertion sequences and relies on the nonspecific DNA uptake by the competent cell and its subsequent integration in the chromosome in a circular form through a Campbell-like mechanism. Similar patterns are found in other competent genomes of Gram-negative bacteria and Archaea, suggesting a similar evolutionary mechanism. The correlation of the spatial distribution of repeats and the absence of insertion sequences in a genome may indicate, in the framework of our model, that mechanisms aiming at their avoidance/elimination have been developed.

Antigenic Variation↗

Developmental care in the newborn intensive care unit.

Developmental care is a framework that encompasses all care procedures as well as social and physical aspects in the newborn intensive care unit. Its goal is to support each individual infant to be as stable, well-organized, and competent as possible. The infant's physiologic and behavioral expression of current functioning is seen as the reliably available guide for caregivers to estimate the infant's current strengths, vulnerabilities, and thresholds to disorganization; to identify the infant's own strategies and efforts in collaborating toward best progress; and to implement care in a way that enhances the infant's stability and competence. The family is understood to be the infant's primary coregulator. It is the caregivers' responsibility to maximize opportunities to enhance each infant's and family's strengths and reduce apparent stressors. Studies of the effectiveness of developmental care also identify implications for staff education and challenges for nursery-wide implementation.

Caregivers↗

Efficacy of an anterior as compared with a posterior laparoscopic partial fundoplication: results of a randomized, controlled clinical trial.

OBJECTIVE: The aim of the study was to compare the efficacy and mechanical consequences of 2 partial fundoplications performed laparoscopically under the framework of a randomized, controlled clinical trial. SUMMARY BACKGROUND DATA: Although laparoscopic total fundoplication procedures have proven their effectiveness in the control of gastroesophageal reflux, problems remain with the functional consequences after a supra-competent gastric cardia high-pressure zone. Partial fundoplications have been found to be associated with fewer mechanical side effects. PATIENTS AND METHODS: During a 2-year period, 95 patients with gastroesophageal reflux disease were enrolled into a randomized, controlled single-institution clinical trial comparing a partial posterior (Toupét, n = 48) fundoplication and an anterior partial wrap (Watson, n = 47). All patients were assessed postoperatively at predefined time points, and the 12-month follow-up data are presented in terms of clinical results and 24-hour pH monitoring variables. RESULTS: Both patient groups were strictly comparable at the time of randomization. All operations were completed laparoscopically, and no serious complications were encountered. During the first postoperative year, a difference regarding the control of reflux symptoms was observed in favor of the posterior fundoplication. Esophageal acid exposure (% time pH <4) was substantially reduced by both operations but to a significantly lower level after a Toupét compared with the Watson partial fundoplication (1.0 +/- 0.3 vs. 5.6 +/- 1.1 mean +/- SEM; p < 0.001). Postfundoplication symptoms were infrequently recorded with no difference between the groups. CONCLUSIONS: When performing a laparoscopic partial fundoplication, the posterior modification (Toupét) offers advantages in terms of better reflux control compared with an anterior type (Watson).

Adult↗