Pediatric Oncology Hospice: A Comprehensive Review.

Pediatric hospice is a new terminology in current medical literature. Implementation of pediatric hospice care in oncology setting is a vast but subspecialized field of research and practice. However, it is accompanied by substantial uncertainties, shortages and unexplored sections. The lack of globally established definitions, principles, and guidelines in this field has adversely impacted the quality of end-of-life experiences for children with hospice needs worldwide. To address this gap, we conducted a comprehensive review of scientific literature, extracting and compiling the available but sparse data on pediatric oncology hospice from the PubMed database. Our systematic approach led to development of a well-organized structure introducing the foundational elements, highlighting complications, and uncovering hidden gaps in this critical area. This structured framework comprises nine major categories including general ideology, population specifications, role of parents and family, psychosocial issues, financial complications, service locations, involved specialties, regulations, and quality improvement. This platform can serve as a valuable resource in establishing a scientifically reliable foundation for future experiments and practices in pediatric oncology hospice.

Effect of forage types differing in undigested neutral detergent fiber concentration and forage inclusion rate on reticulo-ruminal motility and fermentation, total tract barrier function, and blood metabolites of finishing beef heifers.

This study evaluated the effects of forages (BarS vs. STR) that differ in the uNDF concentration and FI rate on ruminal fermentation, total tract barrier function, reticulo-ruminal motility, and blood metabolites of beef heifers. Six ruminally cannulated Hereford × Simmental heifers (699 ± 69.1 kg BW) were used in a 6 × 6 Latin square (26 d periods) with a 2 × 3 factorial treatment arrangement. However, 1 heifer was removed from the study after period 2 due to health problems unrelated to treatment, resulting in an incomplete 6 × 6 Latin square design. Barley grain-based diets were formulated using BarS or wheat STR to alter uNDF (7.1% vs. 8.5% DM) with FI rates of 5%, 10%, or 15% of DM. There were limited interactions between the forage type and FI. DM intake was not affected (P ≥ 0.10) by forage type or FI. Use of STR vs. BarS increased uNDF intake (P < 0.001). Increasing FI increased (P < 0.001) uNDF intake for those fed 15% forage. Ruminal pH was not affected (P ≥ 0.10) by forage type; however, cattle fed 5% FI had lesser (P = 0.017) mean ruminal pH and maximum pH (P = 0.018) than those fed 10% and 15% of forage. The total SCFA concentration was not affected by forage type (P = 0.84) but cattle fed the 5% FI rate had lesser (P < 0.001) molar proportion of acetate when compared with cattle fed 10% and 15% forage. Increasing the FI rate decreased the molar proportion of propionate (P < 0.001). Feeding STR relative to BarS decreased (P = 0.041) the reticulo-ruminal contraction duration. In contrast, cattle fed the 10% and 15% FI rates had a greater (P = 0.028) contraction frequency with lower (P = 0.048) contraction area than those fed 5% forage. Plasma glucose, serum insulin, and serum amyloid A were not affected by forage type or FI rate (P ≥ 0.10). Cattle fed 15% forage had lesser (P = 0.040) concentration of serum haptoglobin when compared with cattle fed 5% or 10% forage. In conclusion, forage type used to affect the dietary uNDF concentration, and FI rate act independently suggesting that the provision of STR to increase uNDF reduces reticulo-ruminal contraction duration and total tract permeability but may not affect ruminal pH. Increasing the FI increased dietary uNDF, stabilized ruminal pH, stimulated more frequent reticulo-ruminal contractions, and may decrease the permeability of the gastrointestinal tract and systemic inflammation.

As a strategy to improve performance, feedlot cattle are often fed diets containing a high proportion of grain with minimal forage. However, diets with insufficient fiber may predispose cattle to nutritional disorders, such as ruminal acidosis, which leads to poor performance and increases production costs. Given the growing concern regarding minimal fiber requirement, the present study was designed to investigate the effects of forages differing in undigested neutral detergent fiber (uNDF; barley silage [BarS] vs. straw [STR]) concentration and forage inclusion (FI) rate (5%, 10%, or 15% of dietary dry matter [DM]) on reticulo-ruminal motility and fermentation, total tract barrier function, and blood metabolites of beef cattle. The inclusion of STR increased uNDF intake and rumination rate, but decreased reticulo-ruminal contraction duration, with no effect on ruminal pH and total short-chain fatty acid (SCFA) concentration. Decreasing the FI rate decreased uNDF intake, ruminating time, ruminal pH, and reticular contraction frequency, but increased the molar proportion of propionate and concentration of serum haptoglobin. In conclusion, forage type and FI rate act independently suggesting that providing forages that increase dietary uNDF may stimulate the frequency of reticulo-ruminal contractions without affecting ruminal pH. However, increasing FI inadvertently increased dietary uNDF, stabilized ruminal pH, increased rumination time, stimulated ruminal contractions, and decreased indicators of systemic inflammation.

Effect of physically effective neutral detergent fiber and undigested neutral detergent fiber on eating behavior, ruminal fermentation and motility, barrier function, blood metabolites, and total tract digestibility in finishing cattle.

This study evaluated the effects of physically effective neutral detergent fiber (peNDF) and undigested neutral detergent fiber (uNDF) on eating behavior, ruminal fermentation and motility, barrier function, blood metabolites, and total tract nutrient digestibility for finishing cattle. Six Simmental heifers (668 ± 28.4 kg BW) were used in a replicated 3 × 3 Latin square (21 d periods) balanced for carry-over effects. Treatments included a control (CON; Table 1) with no forage peNDF and minimal uNDF (peNDF: 0.0%, and uNDF: 4.88 ± 0.01; 95.15% barley grain, 4.51% vitamin and mineral supplement, and 0.34% urea on a DM basis). Pelleted wheat straw (PELL) was included at 10% of dietary DM by replacing barley grain to provide added uNDF but no forage peNDF (peNDF: 0.00%, and uNDF: 6.78 ± 0.02%). Finally, chopped wheat straw (STR) was included as a replacement for pelleted wheat straw to provide forage peNDF and uNDF (peNDF: 1.74 ± 0.06%, and uNDF: 6.86 ± 0.03%). Dry matter intake was not affected (P = 0.93) by treatments. Cattle fed CON spent less time ruminating (P = 0.010) and had less meals/d (P = 0.035) when compared with cattle fed STR, with those fed PELL being intermediate but not different from other treatments. Cattle fed CON had lesser ruminal pH (P = 0.020), and a greater duration that pH was < 5.5 (P = 0.020) as compared to cattle fed STR, with those fed PELL being intermediate but not different. Cattle fed CON and PELL had greater total short-chain fatty acid concentration (P = 0.003) and molar proportion of propionate (P < 0.001) when compared with cattle fed STR. Cattle fed STR had greater (P = 0.010) total ruminal pool size when compared with cattle fed CON and PELL. Cattle fed CON had greater (P = 0.043) duration between ruminal contractions when compared with cattle fed STR, with those fed PELL being intermediate. Cattle fed CON had greater serum amyloid A (P = 0.003) and haptoglobin (P < 0.001) concentration when compared with the other treatments. Cattle fed CON had greater dry matter (P < 0.001) digestibility when compared with the other treatments. In conclusion, inclusion of PELL and STR impacted eating behavior, but only STR affected ruminal fermentation, ruminal motility, systemic inflammation, and total tract nutrient digestibility in finishing cattle. These results are interpreted to suggest that the combination of peNDF and uNDF may be better than uNDF alone to adequately capture biological effects of NDF in high-concentrate diets.

Normally forages are included at minimal levels when formulating finishing cattle diets due to lower digestibility and higher operational and economic costs than concentrates. However, insufficient fiber may increase the risk of nutritional disorders such as ruminal acidosis, negatively impacting health, and consequently growth performance of feedlot cattle. An understanding of the minimum forage requirement and the constituent factors that best explain that requirement can help to promote health and performance while minimizing cost. The present study compared the effects of physically effective neutral detergent fiber (peNDF) and undigested neutral detergent fiber (uNDF) in concentrate-based finishing diets. Feeding more peNDF increased ruminating time and ruminal pH, but decreased time between ruminal contractions, total short-chain fatty acid concentration, and the molar proportion of propionate when compared with feeding a diet with minimal peNDF and uNDF. Responses to feeding uNDF with no peNDF were generally intermediate but not different from other treatments. In addition, feeding more peNDF decreased indicators of systemic inflammation and dry matter digestibility when compared with the diet with less peNDF or uNDF. In conclusion, peNDF, or at least the combination of peNDF and uNDF may be better than uNDF alone to stimulate rumination and ruminal motility, thereby stabilizing ruminal pH. Using both peNDF and uNDF may be useful in characterizing the value of fiber in finishing diets fed to feedlot cattle.

The effects of feeding benzoic acid and/or active dry yeast (Saccharomyces cerevisiae) on fatty acid composition, sensory attributes, and retail shelf-life of beef longissimus thoracis.

Fifty-nine Angus-cross steers (492 ± SD 36 kg) were arranged in a randomized complete block design and assigned to the following dietary treatments for the final 106 days of the finishing phase: no supplementation (CON), 0.5% benzoic acid (ACD), 3 g/steer/d active dry Saccharomyces cerevisiae (YST), or both [0.5% benzoic acid and 3 g/steer/d S. cerevisiae (AY)]. Steers were slaughtered at a commercial facility where longissimus thoracis (IMPS #107 Beef Rib) samples were retrieved and evaluated for fatty acid composition, sensory attributes, and shelf-life during a simulated retail display period. Data (N = 57) were analyzed using dietary treatment as a fixed effect, blocking weight at the beginning of the study as a random effect, and steer as the experimental unit. Muscle pH and proximate composition (moisture and intramuscular lipid) for longissimus samples were not different (P ≥ 0.39) among dietary treatments. Most fatty acid profile values and calculations were not different among dietary treatments (P ≥ 0.10); however, the n-6:n-3 ratio differed (P = 0.01), with ACD samples having lower n-6:n-3 compared with CON and YST samples while AY samples were intermediate and not different from other dietary treatments. The trained sensory panel did not detect differences among dietary treatments (P ≥ 0.23) for juiciness, beef flavor intensity, or off-flavor intensity; however, they did score AY samples as chewier than ACD samples with CON and YST samples intermediate and not different from other dietary treatments. Yet, tenderness was not different when scored by trained panelists (P = 0.10) or measured instrumentally (P = 0.21). Total color change tended to differ (P = 0.09) during the 12-d simulated retail display period with AY samples experiencing less color change compared with YST samples, while CON and ACD samples were intermediate and not different from other dietary treatments. Lipid oxidation (as measured with TBARS) tended to differ (P = 0.08) following the 12-d simulated retail display period with ACD and AY samples experiencing lower levels of oxidation compared with CON, while YST samples were intermediate and not different from other dietary treatments. Overall, these results suggest there were no negative impacts on meat quality when finishing steers were supplemented with either benzoic acid or S. cerevisiae, and there may even be advantages for fatty acid composition and oxidative stability when steers were supplemented with benzoic acid.

Oversupplying metabolizable protein during late gestation to beef cattle does not influence ante- or postpartum glucose-insulin kinetics but does affect prepartum insulin resistance indices and colostrum insulin content.

The objective of this study was to evaluate whether oversupplying metabolizable protein (MP) during late gestation influences glucose and insulin concentrations, and insulin resistance (IR) in late gestation and early lactation. Crossbred Hereford, first-lactation heifers were individually fed diets to supply 133% (HMP, n = 11) or 100% (CON, n = 10) of their predicted MP requirements for 55 ± 4 d (mean ± SD) prior to calving. All heifers received a common lactation ration formulated to meet postpartum requirements (103% MP and 126% ME). After feed was withheld for 12 h, cattle underwent an intravenous glucose tolerance test (IVGTT) on days -6.7 ± 0.9 and 14.3 ± 0.4 by infusing a 50% dextrose solution (1.36 g glucose/kg BW0.75) through a jugular catheter with plasma collected at -10, 0 (immediately after infusion), 5, 10, 15, 20, 25, 30, 45, 60, 75, 90, and 120 min, respective to the infusion. Glucose and insulin concentrations were assessed. Insulin resistance indices (homeostasis model of insulin resistance [HOMA-IR], quantitative insulin sensitivity check index [QUICKI], revised quantitative insulin sensitivity check index [RQUICK], and RQUICKI incorporating serum beta-hydroxybutyrate concentrations [RQUICKIBHB]) were calculated from measurements of serum non-esterified fatty acids and beta-hydroxybutyrate and plasma glucose and insulin concentrations on days -34 ± 4, -15 ± 4, 7 ± 1, 28 ± 3, 70 ± 3, and 112 ± 3. Colostrum samples were collected within an hour of calving (prior to suckling) and analyzed for insulin concentration. Data were analyzed as a randomized block design using the PROC GLIMMIX of SAS, accounting for repeated measurements when necessary. Baseline (-10 min) plasma glucose and insulin concentrations were elevated (P ≤ 0.038) for HMP heifers during the antepartum IVGTT, but not (P ≥ 0.25) during the postpartum IVGTT. Plasma glucose and insulin concentrations throughout the antepartum or postpartum IVGTT did not differ (P ≥ 0.18) by prepartum treatment, nor did other glucose and insulin IVGTT parameters (i.e., max concentration and time to reach max concentration, nadir values, clearance rates and half-lives, area-under-the-curve, and insulin sensitivity index; P ≥ 0.20). Antepartum IVGTT IR indices indicated that HMP heifers were more (P ≤ 0.011) IR than their counterparts. Similarly, the prepartum HOMA-IR was greater (P = 0.033) for HMP heifers, suggesting increased IR. Postpartum IR indices did not (P ≥ 0.25) indicate that prepartum MP consumption impacted postpartum IR. Colostrum insulin concentration was increased (P = 0.004) by nearly 2-fold for HMP relative to CON heifers. These data demonstrate that prepartum MP overfeeding alters baseline glucose-insulin concentrations in late-pregnant beef heifers and increases colostrum insulin content without having carry-over effects on postpartum glucose-insulin concentrations and IR.

Genome-wide association study for meat tenderness in beef cattle identifies patterns of the genetic contribution in different post-mortem stages.

The beef tenderization process during the post-mortem period is one of the most important sensorial attributes and it is well-established. The aim of this study was to identify the genetic contribution pattern to meat tenderness at 7-(LMD7), 14-(LMD14), and 21-(LMD21) days post-mortem. The heritabilities for LMD7 (0.194), LMD14 (0.142) and LMD21 (0.048) are well established in the population evaluated here. However, its genetic contribution in terms of genomic candidate regions is still poorly understood. Tenderness was measured in the Longissiums thoracis using Warner-Bratzler shear force in the three post-mortem periods. A total of 4323 crossbred beef cattle were phenotyped and genotyped using the Illumina BovineSNP50K. The percentage of the total genetic variance was estimated using the weighted single-step genomic best linear unbiased prediction method. The main candidate windows for LMD7 were associated with proteolysis of myofibrillar structures and the weakening endomysium and perimysium. Candidate windows for LMD14 and LMD21 were mapped in bovine QTLs for body composition, height and growth. Results presented herein highlight, the largest contribution of proteolysis related processes before 14-days post-mortem and body composition characteristics in later stages for meat tenderness.

The effects of feeding benzoic acid and/or live active yeast (Saccharomyces cerevisiae) on beef cattle performance, feeding behavior, and carcass characteristics.

Fifty-nine Angus-cross finishing steers were used to evaluate benzoic acid, active dry yeast (Saccharomyces cerevisiae), or a combination of benzoic acid and active dry yeast when supplemented in a high-grain finishing diet on live animal performance, feeding behavior, and carcass characteristics. Steers were fed a high-grain diet for the final 106 d of finishing. Treatments were as follows: no additional supplementation (CON), 0.5% benzoic acid (ACD), 3 g per head per day active dry S. cerevisiae (YST), or both 0.5% benzoic acid and 3 g/head per day S. cerevisiae (AY). Steers were weighed every 14 d, and ultrasound was performed for rib and rump fat thickness at the beginning (day 1), middle (day 57), and end (day 99) of the experiment. Insert feeding stations were used to collect individual feeding behavior data and DMI daily throughout. Blood samples were collected on days 21 and 22 and days 99-101 to assess plane of nutrition and metabolism. Ruminal fluid samples were collected by oral gavage 4 wk prior to slaughter. Carcass characteristics were examined at a federally inspected slaughter facility. Data were analyzed using PROC GLIMMIX of SAS with initial body weight (BW) as a covariate. Benzoic acid supplementation increased (P = 0.002) overall dry matter intake (DMI) compared to YST and CON steers, which may be due to a faster eating rate (P ≤ 0.008). Animal performance parameters (BW, average daily gain, feed conversion, and ultrasound fat depth) were not different (P ≥ 0.11) among treatment groups. Aspartate aminotransferase concentration was greatest (P ≤ 0.01) for YST steers, which may have been reflected in numerically greater liver abscesses. Carcass traits did not differ (P ≥ 0.33) among treatment groups. Ruminal pH was greater (P = 0.006) for ACD steers than AY steers (pH of 6.16 vs. 5.66, respectively), which indicated that there may be an interactive effect between benzoic acid and active dry yeast. To summarize, steers fed a high-grain finishing diet supplemented with benzoic acid, active dry yeast, or both benzoic acid and active dry yeast had similar growth performance and carcass characteristics compared to those without supplementation. However, the addition of benzoic acid alone increased DMI, variation in DMI, eating rate, and ruminal pH. Future studies are warranted to further investigate the impacts of benzoic acid on the ruminal environment of feedlot cattle.

ASAS-NANP SYMPOSIUM: Applications of machine learning for livestock body weight prediction from digital images.

Monitoring, recording, and predicting livestock body weight (BW) allows for timely intervention in diets and health, greater efficiency in genetic selection, and identification of optimal times to market animals because animals that have already reached the point of slaughter represent a burden for the feedlot. There are currently two main approaches (direct and indirect) to measure the BW in livestock. Direct approaches include partial-weight or full-weight industrial scales placed in designated locations on large farms that measure passively or dynamically the weight of livestock. While these devices are very accurate, their acquisition, intended purpose and operation size, repeated calibration and maintenance costs associated with their placement in high-temperature variability, and corrosive environments are significant and beyond the affordability and sustainability limits of small and medium size farms and even of commercial operators. As a more affordable alternative to direct weighing approaches, indirect approaches have been developed based on observed or inferred relationships between biometric and morphometric measurements of livestock and their BW. Initial indirect approaches involved manual measurements of animals using measuring tapes and tubes and the use of regression equations able to correlate such measurements with BW. While such approaches have good BW prediction accuracies, they are time consuming, require trained and skilled farm laborers, and can be stressful for both animals and handlers especially when repeated daily. With the concomitant advancement of contactless electro-optical sensors (e.g., 2D, 3D, infrared cameras), computer vision (CV) technologies, and artificial intelligence fields such as machine learning (ML) and deep learning (DL), 2D and 3D images have started to be used as biometric and morphometric proxies for BW estimations. This manuscript provides a review of CV-based and ML/DL-based BW prediction methods and discusses their strengths, weaknesses, and industry applicability potential.

Effect of silage source, physically effective neutral detergent fiber, and undigested neutral detergent fiber concentrations on performance and carcass characteristics of finishing steers.

This study was designed to evaluate the effect of silage source (barley vs. wheat silage) when harvested at two chop lengths (low vs. high physically effective neutral detergent fiber [peNDF]) and when barley silage was partially replaced with straw to increase the undigested neutral detergent fiber (uNDF) concentration on performance and carcass characteristics of finishing steers. Four hundred and fifty yearling commercial crossbred steers with an initial body weight (BW) of 432 ± 30.5 kg were allocated to 30 pens and fed diets containing 90% concentrate:10% forage for 123 d in a completely randomized block design with a 2 × 2 + 1 factorial arrangement. Treatments included 1) barley silage (BarS) with low peNDF (LpeNDF); 2) BarS with high peNDF (HpeNDF); 3) BarS with straw to yield a diet with LpeNDF + uNDF; 4) wheat silage (WhS) LpeNDF; and 5) WhS HpeNDF. There were no silage × peNDF interactions for dry matter intake (DMI), average daily gain (ADG), or gain to feed ratio (G:F), but cattle fed WhS LpeNDF had a lower (P < 0.01) proportion of yield grade 3 and a greater proportion in yield grade 2 carcasses than cattle fed BarS LpeNDF or HpeNDF and WhS HpeNDF. Cattle fed WhS LpeNDF had greater (P = 0.02) incidence of severe liver abscesses when compared with cattle fed BarS LpeNDF or HpeNDF and WhS HpeNDF. Cattle fed BarS consumed less (P < 0.01) uNDF as a percentage of BW, had increased (P = 0.02) ADG, heavier (P = 0.02) hot carcass weight, with greater (P = 0.01) back fat thickness, and (P < 0.01) incidence of minor liver abscesses when compared with cattle fed WhS. Feeding HpeNDF did not affect DMI, ADG, or G:F, but increased (P = 0.02) marbling score and reduced (P < 0.01) the proportion AA quality grade and increased (P < 0.01) those classified as AAA when compared with cattle fed LpeNDF. Cattle fed low uNDF had lesser (P < 0.01) uNDF intake as a percentage of BW, greater dressing percentage (P = 0.01), had a lower (P < 0.01) proportion of carcasses in yield grade 2, and a greater (P < 0.01) proportion of carcasses in yield grade 3 when compared with cattle fed high uNDF. Thus, silage source, peNDF, and uNDF content do not impact DMI or G:F when diets contain 10% forage, but BarS relative to WhS as well strategies increasing the peNDF concentration may increase ADG, HCW, back fat thickness, dressing percentage, marbling score, and carcasses classified as quality grade AAA. Future research is needed to evaluate the usefulness of peNDF and uNDF in rations for finishing cattle.

Lessons from animal nutritionists: dietary amino acid requirement studies and considerations for healthy aging studies.

Dietary restriction (DR) increases median life span and protects against age-related disease. Improved longevity can be achieved by restriction of dietary energy, protein, or amino acids (AAs), such as methionine (Met). Met requirements have been defined using methodologies that measure the dose response to Met when all other dietary variables are held constant and with outcomes focused on protein turnover. Here, we cover protein and sulfur AA requirements and discuss the terms "deficient," "optimal," and "excess" and how these need to be considered. We additionally discuss the effect of methyl-donating compounds on sulfur AA metabolism and outcomes. We will discuss how the mechanistic target of rapamycin complex 1 (mTORC1) signaling network regulates protein turnover, lipogenesis and cell growth, proliferation, differentiation, and metabolism in response to hormones, AAs, and cellular energy status. Inhibition of mTORC1 signaling with rapamycin or genetic mutation increases median life span in model organisms, and mTORC1 inhibition may be responsible for some of the life span-extending effects of DR. Finally, we discuss how the sulfur AAs may regulate aspects of reactive oxygen species (ROS) mitigation. Overall, we suggest that approaches evaluating AA intake need to consider whole-body protein synthesis and measures related to tissue-specific and whole-body metabolism that have been associated with longevity.

'I woke up after I joined Stepping Stones': meanings of an HIV behavioural intervention in rural South African young people's lives.

Evaluation of the Stepping Stones human immunodeficiency virus (HIV) prevention programme in South Africa showed sustained reduction in men and women's herpes simplex type 2 virus incidence and male violence, but no impact on HIV in women. Companion qualitative research was undertaken to explore how participants made meaning from the programme and how it influenced their lives. In-depth interviews were conducted with 10 men and 11 women before the intervention (one to three interviews per person). Then 9-12 months later, 18 follow-up interviews and 4 focus groups were held. Stepping Stones empowered participants and engendered self-reflection, in a process circumscribed by social and cultural context. Participants generally sought to be 'better', rather than 'different', men and women. Men shaped a more benign patriarchy, i.e. less violent and anti-social, and sought to avoid potential risks, ranging from imprisonment, witchcraft to HIV. While some women showed greater assertiveness and some agency in HIV risk reduction, most challenged neither their male partners nor the existing cultural norms of conservative femininities. This may explain the lack of impact of the intervention on HIV in women, since they lacked the power to embrace a greater feminist consciousness. Stepping Stones might be more effective for women when combined with other structural interventions.