Left bundle branch pacing as an alternative to biventricular pacing for cardiac resynchronisation therapy.

BACKGROUND: Left bundle branch pacing (LBBP) is a novel physiological pacing technique which may serve as an alternative to biventricular pacing (BVP) for the delivery of cardiac resynchronisation therapy (CRT). This study assessed the feasibility and outcomes of LBBP in comparison to BVP. METHODS: LBBP was attempted in 40 consecutive patients as the first-line method for delivering CRT. To evaluate LBBP versus BVP, 40 patients with identical inclusion criteria who received BVP were compared with the LBBP group. Acute success rate, complications, functional and echocardiographic outcomes as well as hospitalisation for heart failure and all-cause mortality 6 months after implantation were evaluated. RESULTS: LBBP was successfully performed in 31 (78%) patients and resulted in significant QRS narrowing (from 166 ± 16 to 123 ± 18 ms, p < 0.001), improvement in left ventricular ejection fraction (LVEF; from 28 ± 8 to 43 ± 12%, p < 0.001) and New York Heart Association functional class (from 2.8 ± 0.5 to 1.6 ± 0.6, p < 0.001) at 6 months. No LBBP-related complications occurred. Compared to BVP, LBBP resulted in a greater reduction in QRS duration (44 ± 17 vs 15 ± 26 ms, p < 0.001) with comparable absolute improvement in LVEF (15.2 ± 11.7 vs 9.6 ± 12.1%, p = 0.088). Hospitalisation for heart failure and all-cause mortality were similar in the two groups. CONCLUSIONS: LBBP is feasible and was safe in 78% of patients with favourable electrical resynchronisation and functional improvement and may serve as an alternative to BVP.

Heat stress in a temperate climate leads to adapted sensor-based behavioral patterns of dairy cows.

Most research on heat stress has focused on (sub)tropical climates. The effects of higher ambient temperatures on the daily behavior of dairy cows in a maritime and temperate climate are less studied. With this retrospective observational study, we address that gap by associating the daily time budgets of dairy cows in the Netherlands with daily temperature and temperature-humidity index (THI) variables. During a period of 4 years, cows on 8 commercial dairy farms in the Netherlands were equipped with neck and leg sensors to collect data from 4,345 cow lactations regarding their daily time budget. The time spent eating, ruminating, lying, standing, and walking was recorded. Individual cow data were divided into 3 data sets: (1) lactating cows from 5 farms with a conventional milking system (CMS) and pasture access, (2) lactating cows from 3 farms with an automatic milking system (AMS) without pasture access, and (3) dry cows from all 8 farms. Hourly environment temperature and relative humidity data from the nearest weather station of the Dutch National Weather Service was used for THI calculation for each farm. Based on heat stress thresholds from previous studies, daily mean temperatures were grouped into 7 categories: 0 = (<0°C), 1 = (0-12°C, reference category), 2 = (12-16°C), 3 = (16-20°C), 4 = (20-24°C), 5 = (24-28°C), and 6 = (≥28°C). Temperature-humidity index values were grouped as follows: 0 = (THI <30), 1 = (THI 30-56, reference category), 2 = (THI 56-60), 3 = (THI 60-64), 4 = (THI 64-68), 5 = (THI 68-72) and 6 = (THI ≥72). To associate daily mean temperature and THI with sensor-based behavioral parameters of dry cows and of lactating cows from AMS and CMS farms, we used generalized linear mixed models. In addition, associations between sensor data and other climate variables, such as daily maximum and minimum temperature, and THI were analyzed. On the warmest days, eating time decreased in the CMS group by 92 min/d, in the AMS group by 87 min/d, and in the dry group by 75 min/d compared with the reference category. Lying time decreased in the CMS group by 36 min/d, in the AMS group by 56 min/d, and in the dry group by 33 min/d. Adaptation to daily temperature and THI was already noticeable from a mean temperature of 12°C or a mean THI of 56 or above, when dairy cows started spending less time lying and eating and spent more time standing. Further, rumination time decreased, although only in dry cows and cows on AMS farms. With higher values for daily mean THI and temperature, walking time decreased as well. These patterns were very similar for temperature and THI variables. These results show that dairy cows in temperate climates begin to adapt their behavior at a relatively low mean environmental temperature or THI. In the temperate maritime climate of the Netherlands, our results indicate that daily mean temperature suffices to study the effects of behavioral adaptation to heat stress in dairy cows.

Initial experience, feasibility and safety of permanent left bundle branch pacing: results from a prospective single-centre study.

BACKGROUND: Left bundle branch (LBB) pacing is a novel pacing technique which may serve as an alternative to both right ventricular pacing for symptomatic bradycardia and cardiac resynchronisation therapy (CRT). A substantial amount of data is reported by relatively few, highly experienced centres. This study describes the first experience of LBB pacing in a high-volume device centre. METHODS: Success rates (i.e. the ability to achieve LBB pacing), electrophysiological parameters and complications at implant and up to 6 months of follow-up were prospectively assessed in 100 consecutive patients referred for various pacing indications. RESULTS: The mean age was 71 ± 11 years and 65% were male. Primary pacing indication was atrioventricular (AV) block in 40%, CRT in 42%, and sinus node dysfunction or refractory atrial fibrillation prior to AV node ablation in 9% each. Baseline left ventricular ejection fraction was < 50% in 57% of patients, mean baseline QRS duration 145 ± 34 ms. Overall LBB pacing was successful in 83 of 100 (83%) patients but tended to be lower in patients with CRT pacing indication (69%, p = ns). Mean left ventricular activation time (LVAT) during LBB pacing was 81 ms and paced QRS duration was 120 ± 19 ms. LBB capture threshold and R­wave sense at implant was 0.74 ± 0.4 mV at 0.4 ms and 11.9 ± 5.9 V and remained stable at 6­month follow-up. No complications occurred during implant or follow-up. CONCLUSION: LBB pacing for bradycardia pacing and resynchronisation therapy can be easily adopted by experienced implanters, with favourable success rates and safety profile.

The prognostic importance of MRI detected extramural vascular invasion (mrEMVI) in locally advanced rectal cancer.

BACKGROUND: MRI detected extramural vascular invasion (mrEMVI) is a poor prognostic factor in rectal cancer patients. The objectives of this study were to assess survival outcomes in patients with and without mrEMVI and to compare the prognostic value of mrEMVI with other rectal cancer features. METHODS: In a Dutch high volume rectal cancer center cohort of sixty-seven locally advanced rectal cancer patients, an independent radiologist reviewed all primary staging MRI scans. The presence of mrEMVI was correlated to tumor specific and survival outcomes. RESULTS: 20/67 patients had mrEMVI positive rectal cancer. 55% (11/20) developed metachronous metastases, compared with 23% (11/47) in the mrEMVI negative group (OR 4.0, p = 0.01). Overall survival was also decreased with a Hazard ratio of 3.3 (p = 0.01). A multivariable logistic regression with a backward selection procedure was conducted including cT-stage, c-N-stage, extramural tumor invasion depth, mesorectal fascia involvement, distance to anorectal junction, tumor length, mrEMVI, CEA level, and synchronous metastases. After stepwise removal based on p value, only positive mrEMVI remained as a single significant predictor for metachronous metastases (OR: 4.16 , p < 0.05). CONCLUSION: Positive mrEMVI is a poor prognostic factor in locally advanced rectal cancer with a 4-fold increased risk of developing metachronous metastases after surgery and a worsened overall survival. mrEMVI also appeared an independent risk factor, with a stronger prediction for metachronous metastases than other MRI-detectable tumor characteristics. mrEMVI should be incorporated in all risk stratification guidelines for rectal cancer.

Acute gastric necrosis caused by a ß-hemolytic streptococcus infection: a case report and review of the literature.

Acute necrotizing gastritis, which appears to be a variant of phlegmonous gastritis is the rarest cause of gastric necrosis. We report a case of a 57-year-old female patient with an acute necrotizing gastritis caused by a Group A ß-hemolytic streptococcus. The case presented herein is of unusual interest because only a limited number of case reports on this etiology have been published. Diagnosing infectious necrotizing gastritis remains complex because of its rarity and nonspecific clinical presentation. Nevertheless, prompt diagnosis is of high importance because necrotizing gastritis can progress rapidly into a more advanced stage causing septic shock or even death. In our opinion, early resection of necrotic gastric wall combined with adequate antimicrobial therapy is the cornerstone in treatment of necrotizing gastritis. We will present a case in which adequate medical treatment was not successful.

A randomized clinical trial of topical treatments for mild and severe udder cleft dermatitis in Dutch dairy cows.

Udder cleft dermatitis (UCD) is a skin lesion in dairy cows affecting the anterior parts of the udder, with the lesions often needing a long time to heal. The lesions can be characterized as mild or severe. The etiology of UCD is not fully understood and studies on the effectiveness of topical treatments have not been published. The objective of this study, therefore, was to conduct a randomized clinical trial to investigate the effectiveness of 2 different topical treatments, one for mild and one for severe UCD lesions, compared with untreated control groups. The treatment and control groups were randomized within herd for mild and severe UCD. The treatments were applied for a maximum period of 12 wk on 8 Dutch dairy farms. Mild UCD lesions were treated once a d 3 times a week on fixed days with a non-sting barrier film. Severe UCD lesions were first stratified into class A (lesion length <5 cm) or class B (lesion length ≥5 cm) and then randomly allocated to treatment or control groups within herd. Both severe lesion classes were treated once per day every day with an enzyme alginogel. Every week, the lesions of affected animals were inspected and photographed by the investigator. These photographs were reviewed weekly by an external wound expert who classified the lesions as mild, severe class A, severe class B, or healed. Based on this classification, the investigator judged weekly whether the lesions had improved compared with their classification of the previous week. For mild UCD lesions, improvement was defined as occurring when lesions were healed. For severe UCD lesions, improvement was defined as a transition from class B to class A, transition from any severe UCD lesion (class A or B) to a mild UCD lesion, or when the lesion was defined as healed. Data were analyzed using a discrete time survival analysis with time to first improvement as dependent variable. In total, data from 214 animals were analyzed to estimate the effectiveness of treatment. Results showed that treatment of mild UCD lesions had no influence on improvement compared with untreated lesions. Treated severe lesions, however, showed 3.4 times more improvement compared with the untreated controls. Improvement varied between herds, and cows with a parity of 5 or higher showed significantly less improvement than first parity animals. Early identification of severe UCD lesions followed by prompt treatment with an enzyme alginogel supports the healing process.

Longitudinal study of udder cleft dermatitis in 5 Dutch dairy cattle herds.

Udder cleft dermatitis (UCD) is a skin lesion in dairy cows, most often located between anterior parts of the udder and abdomen, but also found between the front quarters. A few recent studies have investigated the prevalence of UCD, but relatively little is known about its pathogenesis, clinical course, and duration. Therefore, the aim of this study was to investigate the incidence and recovery of UCD on high-prevalence herds. Five Dutch dairy herds with a UCD prevalence of at least 6% were visited weekly for 19 wk, followed by visits every other week for 26 wk. During each visit, all dry and lactating cows were inspected for the presence of UCD signs. If a UCD case was detected, the affected skin was photographed and the photo was subsequently examined by a research assistant. Cows were then classified according to the appearance of the skin into 3 categories: healthy (no photo: no signs), mild (photo: affected skin but no wound), or severe (photo: open wound). The overall mean within-herd prevalence of UCD was 38% and the overall mean incidence was 1.94 UCD episodes per 100 cow-weeks at risk. Incidence of UCD was significantly higher in cows in third or higher parity and significantly increased with DIM. Median observed duration of UCD was 16 wk. The UCD recovery was 3 times more likely for mild than for severe lesions. The probability of moving from one category to another between 2 consecutive visits was very low, indicating that rapid changes in appearance did not occur. The observed incidence of UCD was rather low, and the relatively high prevalence in the selected herds was most likely due to the long duration of lesions rather than a high incidence of new UCD cases.

Principal climatic and edaphic determinants of Culicoides biting midge abundance during the 2007-2008 bluetongue epidemic in the Netherlands, based on OVI light trap data.

Palaearctic Culicoides midges (Diptera: Ceratopogonidae) represent a vital link in the northward advance of certain arboviral pathogens of livestock such as that caused by bluetongue virus. The effects of relevant ecological factors on weekly Culicoides vector abundances during the bluetongue virus serotype 8 epidemics in the Netherlands in 2007 and 2008 were quantified within a hurdle modelling framework. The relative role of meteorological parameters showed a broadly consistent association across species, with larger catches linked to temperature-related variables and lower wind speed. Moreover, vector abundance was found to be influenced by edaphic factors, likely related to species-specific breeding habitat preferences that differed markedly amongst some species. This is the first study on Culicoides vector species in the Netherlands identified during an entomological surveillance programme, in which an attempt is made to pinpoint the factors that influence midge abundance levels. In addition to providing key inputs into risk-mitigating tools for midge-borne pathogens and disease transmission models, the adoption of methods that explicitly address certain features of abundance datasets (frequent zero-count observations and over-dispersion) helped enhance the robustness of the ecological analysis.

Estimating mosquito population size from mark-release-recapture data.

Accurate estimation of population size is key to understanding the ecology of disease vectors, as well as the epidemiology of the pathogens they carry and to plan effective control activities. Population size can be estimated through mark-release-recapture (MRR) experiments that are based on the assumption that the ratio of recaptured individuals to the total captures approximates the ratio of marked individuals released to the total population. However, methods to obtain population size estimates usually consider pooled data and are often based on the total number of marked and unmarked captures. We here present a logistic regression model, based on the principle of the well-known Fisher-Ford method, specific for MRR experiments where the information available is the number of marked mosquitoes released, the number of marked and unmarked mosquitoes caught in each trap and on each day, and the geographic coordinates of the traps. The model estimates population size, taking into consideration the distance between release points and traps, the time between release and recapture, and the loss of marked mosquitoes to death or dispersal. The performance and accuracy of the logistic regression model has been assessed using simulated data from known population sizes. We then applied the model to data from MRR experiments with Aedes albopictus Skuse performed on the campus of "Sapienza" University in Rome (Italy).

Local ischaemia does not influence anastomotic healing: an experimental study.

The role of local ischaemia in the pathogenesis of colorectal anastomotic leakage (AL) is not known. This study investigates the role of local ischaemia caused by sutures in an experimental colonic anastomosis model. 36 mice were assigned to three types of anastomosis, all using running sutures; in the first group 5 stitches were used, in the second group 12 stitches were used, and in the third group at least 30 stitches were used. After 7 days the mice were re-operated, signs of AL were scored, and coronal sections of the anastomosis were histologically analyzed. The distribution of weight was not significantly different between the three groups. Mortality was 44% and not significantly different between the groups (group 1: 5/12, group 2: 4/12, and group 3: 7/12, p = 0.72). Faecal and purulent AL were observed in 6 animals in group 1, 2 in group 2, and 3 in group 3 (group 1: 50%, group 2: 17%, and group 3: 25%, p = 0.19). The distance between the two colonic edges (group 1: 0.51 µm, group 2: 1.34 µm, and group 3: 0.53 µm, p = 0.18), the diameter of the lumen at the site of the anastomosis (group 1: 2.92 µm, group 2: 4.06 µm, and group 3: 3.2 µm, p = 0.9), and the largest diameter of the lumen proximally to the anastomosis (group 1: 2.05 µm, group 2: 3.1 µm, and group 3: 2.6 µm, p = 0.25) were not different between the groups. Histological parameters of wound healing were not significantly different for the three groups. In this study no macroscopic and microscopic differences were observed between colon anastomosis with 5 stitches versus 12 and >30 stitches. This might indicate that local ischaemia does not negatively influence colonic wound healing.

The relationship between milking interval and somatic cell count in automatic milking systems.

The aim of this study was to explore whether, during automatic milking, milking interval or its variation is related to somatic cell count (SCC), even when corrected for effects of production, lactation stage, and parity. Data on milking interval and production level were available from the automatic milking systems of 151 farms. Data on SCC, parity, and lactation stage were derived from dairy herd improvement records of the same farms. Mainly due to incomplete records, data of 100 farms were used in the final analysis. For every cow, only 1 test day was used in the final analysis. Milking interval, the coefficient of variation of milking interval, production rate, the difference in production rate between short- and long-term, parity, days in milk, and some biologically relevant interactions were used in a linear mixed model with farm as random variable to assess their association with log10-transformed SCC. None of the interactions was significantly related to SCC, whereas all main effects were, and thus, stayed in the final model. The effect of milking interval was, although significant, not very strong, which shows that the effect of milking interval on SCC is marginal when corrected for the other variables. The variation in milking intervals was positively related with SCC, showing that the variation in milking interval is even more important than the milking interval itself. In the end, this study showed only a limited association between milking interval and SCC when milking with an automatic milking system.

Prediction of the herd somatic cell count of the following month using a linear mixed effect model.

An accurate prediction of the average somatic cell count (SCC) for the next month would be a valuable tool to support udder health management decisions. A linear mixed effect (LME) model was used to predict the average herd SCC (HSCC) for the following month. The LME model included data on SCC, herd characteristics, season, and management practices determined in a previous study that quantified the contribution of each factor for the HSCC. The LME model was tested on a new data set of 101 farms and included data from 3 consecutive years. The farms were split randomly in 2 groups of 50 and 51 farms. The first group of 50 farms was used to check for systematic errors in predicting monthly HSCC. An initial model was based on older data from a different part of the Netherlands and systematically overestimated HSCC in most months. Therefore, the model was adjusted for the difference in average HSCC between the 2 sets of farms (from the previous and current study) using the data from the first group of 50 farms. Subsequently, the data from the second group of 51 farms were used to independently assess this final model. A null model (no explanatory variables included) predicted 48 and 59% of the HSCC within the predetermined range of 20,000 and 30,000 cells/mL, respectively. The final LME model predicted 72 and 81% of the HSCC of the next month correctly within these 2 ranges. These outcomes indicate that the final LME model was a valid additional tool for farmers that could be useful in their short-term decisions regarding udder health management and could be included in dairy herd health programs.

Highly selective detection of methanol over ethanol by a handheld gas sensor.

Methanol poisoning causes blindness, organ failure or even death when recognized too late. Currently, there is no methanol detector for quick diagnosis by breath analysis or for screening of laced beverages. Typically, chemical sensors cannot distinguish methanol from the much higher ethanol background. Here, we present an inexpensive and handheld sensor for highly selective methanol detection. It consists of a separation column (Tenax) separating methanol from interferants like ethanol, acetone or hydrogen, as in gas chromatography, and a chemoresistive gas sensor (Pd-doped SnO2 nanoparticles) to quantify the methanol concentration. This way, methanol is measured within 2 min from 1 to 1000 ppm without interference of much higher ethanol levels (up to 62,000 ppm). As a proof-of-concept, we reliably measure methanol concentrations in spiked breath samples and liquor. This could enable the realization of highly selective sensors in emerging applications such as breath analysis or air quality monitoring.

Sensor based eating time variables of dairy cows in the transition period related to the time to first service.

In dairy cattle, reproductive diseases and infertility are some of the most important reasons for culling, where postpartum negative energy balance (NEB) reduces reproductive performance. This single cohort observational study reports the association between eating time and the interval between calving and first service in 2036 dairy cows on 17 commercial farms in The Netherlands. Cows were equipped with a commercially available neck sensor (Nedap, Groenlo, The Netherlands), that measured the time cows spent eating, from 28 days (d) before until 28 d after parturition. Primiparous cows spent a mean of +45 minutes (min) eating time per day ante partum and +15 min eating time post partum more than multiparous cows. A Cox proportional hazard model was used to analyze eating time variables in relation to the interval between calving and first service. From 4 weeks before until 4 weeks after calving eating time variables per week were used. Weeks -4, -3 + 3 and +4 were used as weeks with stable eating time patterns and therefore the mean eating time per week and the standard deviation of the mean eating time per week were used. Weeks -2, -1, +1 and +2 were addressed as periods with unstable eating patterns and therefore the slope in eating time per week and the residual variance of the slope per week were modeled. Significant results were the mean eating time in week -4 and +3 where in both weeks higher eating time lead to a higher hazard for first service. Difference between primiparous and multiparous cows were also significant with a higher hazard for first service for primiparous cows. Week 4 post partum presented a significant difference between eating time of primiparous cows and multiparous cows. These results display how eating time variables in the transition period could be related to the interval between calving and first service, and that there is a relation between mean eating time in week -4, +3, +4 and the interval between calving and first insemination.

Factors affecting the likelihood of pregnancy and embryonic loss after transfer of cryopreserved in vitro produced equine embryos.

BACKGROUND: In vitro embryo production (IVEP) is increasingly popular but data assessing the outcome of transferred embryos are scarce. OBJECTIVES: To determine the likelihood of pregnancy and embryonic loss after transfer of frozen-thawed IVP embryos and identify factors influencing success. STUDY DESIGN: Retrospective clinical study. METHODS: Blastocysts (n = 261) were produced from immature oocytes of Warmblood mares (n = 116) by Intracytoplasmic Sperm Injection (ICSI) and in vitro culture, and cryopreserved. Thawed IVP embryos were transferred into recipient mares on day 4, 5 or 6 after ovulation. The influence of donor mare (age, reproductive history), recipient mare (age, reproductive status, management; in-house vs. outpatient, day post-ovulation), embryo (interval from ICSI to blastocyst formation) and management factors (season when ovum pickup was performed, year and method of transfer) on likelihood of pregnancy and embryonic loss was examined, and the developmental stage of the IVP embryo at the time of transfer was estimated. RESULTS: The percentage of mares pregnant 7-10, 23 and 37 days after transfer was 56% (147/261), 49% (129/261), and 48% (124/261), respectively. Development of IVP embryos after transfer equated to day 5 or 6 in vivo embryos. With the exception of year of transfer, none of the factors had an impact on the likelihood of pregnancy or embryonic loss. Nevertheless, the likelihood of pregnancy tended to be lower for IVP embryos from infertile mares or when embryos were transferred into recipient mares on day 6 after ovulation rather than on day 4 or 5. Finally, the diameter of the embryonic vesicle 7 days post transfer was lower for pregnancies that were lost compared to those that were maintained. MAIN LIMITATIONS: Small sample size in some of the donor and recipient mare categories. CONCLUSIONS: Cryopreserved IVP embryos should be transferred into recipient mares on day 4 or 5 after ovulation and a slower rate of post transfer vesicle expansion indicates a higher risk of subsequent embryonic loss The Summary is available in Portuguese - see Supporting Information.

Is there an increased risk of TB relapse in patients treated with fixed-dose combination drugs in Indonesia?

SETTING: South Sulawesi Province, Republic of Indonesia. OBJECTIVE: To compare relapse rates among tuberculosis (TB) patients treated with fixed-dose combination drugs (FDCs) and patients treated with the same regimen using loose drugs. METHODOLOGY: Between 1999 and 2001, new smear-positive TB patients were randomly allocated to treatment with four-drug FDCs or loose drugs to study differences in treatment outcomes. Although it was not in the original study design, in 2004-2005 we performed a follow-up study by home visit of cured patients. We conducted an interview and tried to collect a sputum sample from each patient. If the patient was absent or had died, a proxy interview was conducted. The sputum samples were examined by microscopy and culture. RESULTS: The overall relapse rate was 7.0% in patients who were able to produce a sputum sample. Relapse appeared to be more frequent in the FDC group compared to the loose drug group (10.1% vs. 2.7%, P = 0.074). CONCLUSION: This is the first documented long-term follow-up study of patients treated with four-drug FDCs. There is an indication that treatment of new sputum smear-positive TB patients with FDCs provides an increased risk of relapse compared to treatment with loose drugs. The long-term results of treatment with FDCs should be carefully evaluated in other settings.

The influence of cow factors on the incidence of clinical mastitis in dairy cows.

Many cow-specific risk factors for clinical mastitis (CM) are known. Other studies have analyzed these risk factors separately or only analyzed a limited number of risk factors simultaneously. The goal of this study was to determine the influence of cow factors on the incidence rate of CM (IRCM) with all cow factors in one multivariate model. Also, using a similar approach, the probability of whether a CM case is caused by gram-positive or gram-negative pathogens was calculated. Data were used from 274 Dutch dairy herds that recorded CM over an 18-mo period. The final dataset contained information on 28,137 lactations of 22,860 cows of different parities. In total 5,363 CM cases were recorded, but only 2,525 CM cases could be classified as gram-positive or gram-negative. The cow factors parity, lactation stage, season of the year, information on SCC from monthly test-day records, and CM history were included in the logistic regression analysis. Separate analyses were performed for heifers and multiparous cows in both the first month of lactation and from the second month of lactation onward. For investigating whether CM was caused by gram-positive or gram-negative pathogens, quarter position was included in the logistic regression analysis as well. The IRCM differed considerably among cows, ranging between 0.0002 and 0.0074 per cow-day at risk for specific cows depending on cow factors. In particular, previous CM cases, SCC in the previous month, and mean SCC in the previous lactation increased the IRCM in the current month of lactation. Results indicate that it is difficult to distinguish between gram-positive and gram-negative CM cases based on cow factors alone.

Caregivers' perceptions towards communication with mechanically ventilated patients: The results of a multicenter survey.

PURPOSE: The purpose of this study was to investigate ICU health care providers' perception towards communication and associated problems with mechanically ventilated (MV) patients. The primary aim was to quantify the extent of the problem and to determine its effect on patient care and job satisfaction. METHODS: A multicenter survey study was conducted among nurses, residents and intensivists of 15 ICUs in the Netherlands using an online questionnaire. RESULTS: Out of 1740 caregivers, 457 responses were received. Communication difficulties were experienced in half of the interactions with MV patients. Over 75% of participants indicated that patient care was negatively affected. Job satisfaction was negatively affected in 43% of the participants, primarily with feelings of unfulfillment (76%) and frustration (72%). Patient factors considered relevant to communication difficulties were delirium, disease severity and anxiety, among others. To facilitate communication, the use of basic gestures remained the most preferred method. CONCLUSIONS: In half of the interactions with MV patients, health care professionals experience significant communication difficulties. The respondents indicated that these difficulties frequently lead to negative effects on patient care and job satisfaction. These results emphasize the need for improvements such as the development of communication protocols, skills training and continued research into new communication methods.

Response to a Salmonella Enteritidis challenge in old laying hens with different vaccination histories.

Extending the laying period of laying hens is beneficial for economic and sustainability purposes. Because vaccines were designed with a shorter laying period envisaged, it is unclear whether current Salmonella vaccines can provide sufficient levels of protection against infection at an older age. The purpose of this experiment was to determine the efficacy of early rearing vaccination schemes against Salmonella challenge late in the laying period. There were four treatment groups: birds that had not been vaccinated (Group 1), birds vaccinated with live Salmonella Enteritidis (SE) (Group 2), with live and inactivated SE (Group 3), or with live SE and live Salmonella Typhimurium (Group 4). At the end of the laying period, the birds were transported from the laying farm to the research facility where they were orally challenged with 2.06 × 109 colony-forming units SE at around 82 wk of age. Hens were euthanized and bacteriology was performed on cecum, liver, spleen, and follicular fluid samples to determine SE colonization 7 and 14 d after challenge. Clinical and bacteriological findings of hens vaccinated with different vaccination schemes and the non-vaccinated control group were compared. No significant differences in SE colonization were found for vaccinated groups compared to the non-vaccinated control group. This may be a result of waning immunity due to the long time between vaccination and challenge. Also, as vaccination took place in the rearing period in the field, initial levels of immunity may not have been optimal due to shortcomings in the vaccination technique. Furthermore, the results of this study may have been affected by differences in age, breed, and origin between the groups. Therefore, controlled studies from early age onwards are necessary for more accurate comparisons between vaccines.

Effect of herd characteristics, management practices, and season on different categories of the herd somatic cell count.

In this study, the contribution of management practices, herd characteristics, and seasonal variables to the herd somatic cell count (SCC) was quantified in herds with low (<150,000 cells/mL), medium (150,000-200,000 cells/mL), and high (>200,000 cells/mL) herd SCC (HSCC). Selection of the variables was performed using a linear mixed effect model; HSCC was calculated as the arithmetic mean of the individual cow's SCC. The data concerning management practices were derived from 3 questionnaires on mastitis prevention and management practices on 246 Dutch dairy farms. The monthly Dairy Herd Improvement test data of these 246 farms were used to calculate the herd characteristics and seasonal effects. None of the management practices were associated with HSCC in all 3 HSCC categories. Some variables only had a significant association with HSCC in one HSCC category, such as dry premilking treatment (-9,100 cells/mL in the low HSCC category) or feeding calves with high SCC milk (11,100 cells/ mL in the medium HSCC category). Others had an opposite effect on HSCC in different HSCC categories, such as average parity (-6,400 and 11,000 cells/mL in the low and medium HSCC category, respectively) and feeding calves with fresh milk (10,300 and -9,700 cells/ mL in the low and high HSCC category, respectively). We conclude that, given the individual Dairy Herd Improvement data and information on management practices of an individual farm, it is possible to provide quantitative insight into the contribution of these different variables to the HSCC of an individual farm. Being able to provide such insight is a prerequisite for interpretation, prediction, and control of HSCC on individual dairy farms.