Utilizing extracorporeal membrane oxygenation and surfactant in the management of severe acute respiratory distress syndrome due to hydrocarbon pneumonitis.

Severe cases of hydrocarbon aspiration requiring Extracorporeal Membrane Oxygenation (ECMO) are rarely reported in pediatrics, and 90% of hospitalized patients have a relatively benign clinical course. We describe a 14 month-old female with accidental hydrocarbon ingestion and aspiration due to organic makeup brush cleaner that suffered severe ARDS and multiorgan failure, successfully managed with ECMO and surfactant. She was decannulated after a total of 72 hours on ECMO, extubated on hospital day 15 (HD 15), and discharged home in her normal state of health after one month in the hospital. ECMO and adjunctive therapies such as surfactant may be helpful in the management of severe hydrocarbon pneumonitis and there are limited reports of ECMO as a supportive method for these pediatric patients.

Providing elevated structures in the pullet rearing environment affects behavior during initial acclimation to a layer aviary.

Spatial abilities of hens are particularly sensitive to development during early life. Experiences in pullet housing may have lasting consequences on adult hens' movements in cage-free environments. We tested whether opportunities to access elevated spaces during rearing improved hens' use of a multitiered aviary. Female Dekalb White pullets were reared in either floor pens (FL), single-tiered aviaries (ST), or 2-tiered aviaries (TT; n = 5 pens/environment) through 16 wk of age. Rearing structures were replaced with identical multitiered aviaries at 17 wk. The distribution of the flock within the aviary and the vertical transitions of 10 focal hens/pen across the aviary were determined from videos recorded during their first (D1) and seventh (D7) day of aviary access, as well as at 19, 23, and 27 wk of age. Prevalence of floor eggs was recorded weekly from 17 to 28 wk of age. On D1, more ST and TT hens utilized the aviary during the daytime (P = 0.0077), made more vertical transitions when searching for a roosting spot in the evening (P = 0.0021), and maintained a consistent distance traveled during transitions compared to FL hens (P = 0.02). These differences disappeared by D7, except that ST and TT hens continued to roost on the highest perches of the aviary more (P < 0.0001) than FL hens through 27 wk of age. FL hens laid more floor eggs than ST and TT hens for the first 2 wk of lay (P < 0.0001). The majority (97.9%) of vertical transitions was controlled. Uncontrolled transitions were highest at D1 and decreased by D7 (P = 0.0009) and were not affected by rearing (P = 0.33). The results suggest that hens reared with minimal height are hesitant to use the laying hen aviaries when they are first transferred. They acclimate within 1 to 2 wk, but continue to roost less in the highest accessible level.

A tagged visual analog scale is a reliable method to assess keel bone deviations in laying hens from radiographs.

Laying hens often suffer from keel bone damage (KBD) that includes pathologies with different etiologies, like diverse forms of fractures and deviations. Since KBD is a problem in all countries and housing systems, methods for the assessment of deviations are urgently needed. Comparisons between genetic lines and between studies are important to detect underlying mechanisms. Field researchers often use palpation as a low-cost and feasible technique for the assessment of KBD. In contrast to palpation, radiography is effective and highly precise at least in detecting keel bone fractures. The aim of this study was to: i) develop a scoring system to assess keel bone deviations from radiographs, ii) to assess inter- and intra-observer reliability of this scoring system, and iii) to investigate whether fractures and deviations of the keel are correlated. In total, 192 hens were used for the investigation. Digital radiographs were taken and evaluated for all hens after slaughter. We developed a tagged visual analog scale with two extreme images as anchors and four intermediate tags, resulting in six images representing the range from "no deviation" to "highly deviated" on a 10 cm line. Eleven participants scored 50 radiographs of keels with varying degree of severity, whereas five images were scored twice to assess intra-observer reliability. Intraclass correlation coefficient for inter-observer reliability was 0.979 with a confidence interval of 0.968 < ICC < 0.987 (F49,268 = 54.2, p < 0.0001). Intraclass correlation coefficient for intra-observer reliability was 0.831 with a confidence interval of 0.727 < ICC < 0.898 (F54,55 = 10.8, p < 0.0001). Individual intra-observer reliability ranged from 0.6 to 0.949. The Spearman correlation showed a strong positive correlation of fractures and deviations (s roh= 0.803, p < 0.001). The tagged visual analog scale could be a reliable instrument for the scoring of keel bone deviations. Our results support the assumption that the majority of highly deviated keels suffer from fractures as well. Further research is needed to investigate the correlation of palpation scores with the evaluation on radiographs.

Recognizing Pediatric ARDS: Provider Use of the PALICC Recommendations in a Tertiary Pediatric ICU.

BACKGROUND: For almost 50 years, pediatricians used adult guidelines to diagnose ARDS. In 2015, specific criteria for pediatric ARDS were defined. However, it remains unclear how frequently providers recognize pediatric ARDS and whether recognition affects adherence to consensus recommendations. METHODS: This was a mixed-method, retrospective study of mechanically ventilated pediatric subjects after the release of the pediatric ARDS recommendation statement. Pediatric ARDS cases were identified according to the new criteria. Provider recognition was defined by documentation in the medical record. Pediatric ARDS subjects with and without provider recognition were compared quantitatively according to clinical characteristics, adherence to lung-protective ventilation (LPV), adjunctive therapies, and outcomes. A qualitative document analysis (QDA) was performed to evaluate knowledge and beliefs surrounding the Pediatric Acute Lung Injury Consensus Conference recommendations. RESULTS: Of 1,983 subject encounters, pediatric ARDS was identified in 321 (16%). Provider recognition was present in 97 (30%) cases and occurred more often in subjects who were older, had worse oxygenation deficits, or were bone marrow transplant recipients. Recognition rates increased each studied year. LPV practices did not differ based on provider recognition; however, subjects who received it were more likely to experience permissive hypoxemia and adherence to extrapulmonary recommendations. Ultimately, there was no differences in outcomes between the provider recognition and non-provider recognition groups. Three themes emerged from the QDA: (1) pediatric ARDS presents within a complex, multidimensional context, with potentially competing organ system failures; (2) similar to historical conceptualizations, pediatric ARDS was often considered a visual diagnosis, with measures of oxygenation unreferenced; and (3) emphasis was placed on non-evidence-based interventions, such as pulmonary clearance techniques, rather than on consensus recommendations. CONCLUSIONS: Among mechanically ventilated children, pediatric ARDS was common but recognized in a minority of cases. Potential opportunities, such as an opt-out approach to LPV, may exist for improved dissemination and implementation of recommended best practices.

The Utility of Scatter Feeding as Enrichment: Do Broiler Chickens Engage with Scatter-Fed Items?

In recent years, welfare certification companies have encouraged the use of scatter feeding as enrichment material, though there is little scientific evidence to support a scatter feeding program. This study aimed to understand the impact of scatter feeding on the foraging behavior of broilers. One hundred eighty Ross 308 chicks were allocated into six treatment groups (six replicates/treatment). Broilers were scatter fed dried mealworms, whole wheat, shredded cabbage, alfalfa pellets, wood shavings, or no scatter feeding, respectively. Enrichment was provided on the first three days of each week. Total foraging, active foraging, and feeding were observed for one-hour periods immediately after scattering, 2 h later, and 6 h later. In all groups, broilers increased both total (p = 0.001) and active (p = 0.001) foraging, though this was most pronounced in the dried mealworm group. Across all groups, active foraging decreased with age (p = 0.001). The mealworm group also showed a corresponding decrease in feeding during hour one compared to the later hours (p = 0.001). These results did not provide evidence that scatter feeding encourages foraging behavior, except for a short-term effect of a high value feed item. This finding suggests that the item scattered and the delivery method should be studied further.

Data-Based Variables Used as Indicators of Dairy Cow Welfare at Farm Level: A Review.

During the last years, the interest in data-based variables (DBVs) as easy-to-obtain, cost-effective animal welfare indicators has continued to grow. This interest has led to publications focusing on the relationship between DBVs and animal welfare. This review compiles 13 papers identified through a systematic literature search to provide an overview of the current state of research on the relationship between DBVs and dairy cow welfare at farm level. The selected papers were examined regarding their definition of animal welfare and classified according to this definition into three categories: (a) papers evaluating DBVs as predictors of animal welfare violations, (b) papers investigating the relationship between DBVs and animal-based measurements, and (c) papers investigating the relationship of DBVs to scores of welfare assessments like the Welfare Quality protocol or to overall welfare scores at farm level. In addition, associations between DBVs and indicators of animal welfare were extracted, grouped by the type of DBV, and examined for replications that may confirm the associations. All the identified studies demonstrated associations between DBVs and animal welfare. Overall, the first indications of a possible suitability of DBVs for predicting herds with animal welfare violations as well as good or poor animal welfare status were given. The evaluation of relationships between DBVs and animal-based measurements (ABMs) found mortality-based DBVs to be frequently associated with ABMs. However, owing to varying definitions of animal welfare, the use of different variants of DBVs, and different methods used to assess DBVs, the studies could only be compared to a limited extent. Future research would benefit from a harmonisation of DBVs and the use of valid measurements that reflect the multidimensionality of welfare. Data sources rarely investigated so far may have the potential to provide additional DBVs that can contribute to the monitoring of cow welfare at farm level.

SCRATCH Trial: An Initiative to Reduce Excess Use of High-Flow Nasal Cannula.

OBJECTIVES: We aimed to reduce unnecessary use of high-flow nasal cannula (HFNC) at lower flow rates through the implementation of a standard daily trial off HFNC at a medium-sized academic center. METHODS: We used an interprofessional quality improvement collaboration to develop and implement interventions to reduce HFNC waste in children aged 1 month to 24 months with bronchiolitis who were admitted to the inpatient ward or ICU. Key interventions included development and implementation of the Simple Cannula/Room Air Trial for Children (SCRATCH Trial), a standard trial off HFNC for eligible infants. Process measures were selected as metrics of use of the newly developed trial. The primary outcome measure was hours of treatment with ≤8 L per minute (LPM) of HFNC. Additional outcome measures included total hours of treatment with HFNC and length of stay. RESULTS: A total of 271 patients were included in this study, 131 in the preimplementation group and 140 in the postimplementation group. The mean hours of treatment below our a priori determined waste line (≤8 LPM of HFNC) decreased from 36.3 to 16.8 hours after SCRATCH Trial implementation, and mean length of stay decreased from 4.1 to 3.0 days. CONCLUSIONS: The SCRATCH Trial was successfully implemented across hospital units, with a significant reduction in hours on ≤8 LPM of flow. Rapid discontinuation of HFNC appears feasible and may be associated with a shorter length of stay.

Perch Positioning Affects both Laying Hen Locomotion and Forces Experienced at the Keel.

The aim of this study was to assess the effect of perch positioning on laying hens' locomotion and the resulting energy experienced at the keel. Twenty Nick Chick and 20 Brown Nick hens were trained to transition from a platform to a perch in several configurations. Three variables of perch positioning were tested in a 2 × 2 × 2 factorial design: direction (upward vs. downward), angle (flat vs. steep), and distance (50 cm vs. 100 cm). All hens were tested for five jumps of each treatment combination at 27-28 weeks of age. As predicted, we found steep angles and long distances to result in higher peak forces and impulse during take-off, flight, and landing; longer latency to jump; a higher likelihood to perform balancing movements; and a longer latency to peck at the provided food reward. The effect of perch positioning on locomotion and force at the keel during downwards jumps and flight was more pronounced in Brown Nick hens than in Nick Chick hens. Although we cannot state how the observed forces at the keel relate to the risk for keel bone fractures, our results indicated that optimizing perch positioning can reduce accumulated forced at the keel and consequent risk for fracture due to unsuccessful transitions.

Radiographic Evaluation of Keel Bone Damage in Laying Hens-Morphologic and Temporal Observations in a Longitudinal Study.

The keel bone of commercially kept laying hens is known to be frequently affected by morphologic changes such as fractures and deformations with important implications for animal welfare. To detect morphologic changes, various methods such as palpation, computed tomography, and ultrasound are available, though radiography allows for the greatest level of detail in combination with the most ease of use. To explore the benefits of radiography in providing objective data on keel fractures from the age of 22-61 weeks within a single laying period, the keel bones of 75 Lohmann Brown and 75 Lohmann Selected Leghorns were radiographed every 3 to 5 weeks. Type, location, angulation, dislocation, callus formation, and healing process were assessed descriptively for each lesion. Ninety-nine percent of the animals showed at least one keel bone lesion during the study and 97% of the animals had at least one keel bone fracture. In 77% of the cases, the caudal third of the keel bone was affected. The fracture types were transverse and oblique (88%), comminuted, and butterfly. Further lesions were sclerosis, new bone formation and angulation. For each keel bone, an average of three fractures (3.09 ± 1.80) was detected at the end of the study. The described radiographic protocol for keel bone lesions was suitable for longitudinal, on-site examinations in conscious laying hens. Our results also indicate that keel bone fractures are more frequent than reported in earlier studies. The described radiographic examination protocol can be used to perform comparative studies of palpatory findings, or to assess the clinical significance of different fracture types which require a high level of detail.

Pullet Rearing Affects Collisions and Perch Use in Enriched Colony Cage Layer Housing.

Hens reared in aviaries (AVI) as pullets have improved spatial abilities compared to hens reared in non-enriched cages (CON). However, this effect on behavior has been shown only to 23 weeks of age. Lohmann LSL-Lite hens were reared in either CON or AVI until 19 weeks of age and then moved into enriched colony cages (ECC) containing two elevated perches of different heights (n = 6 ECC/treatment). Focal hens (3 per ECC) were fitted with tri-axial accelerometers to record acceleration events at 21, 35, and 49 weeks of age. Video recordings from each age were used to identify behaviors associated with acceleration events as well as the proportion of hens utilizing perches. CON hens experienced more acceleration events (p = 0.008) and more collisions (p = 0.04) than AVI hens during the day at 21 and 35 weeks of age. The total proportion of hens perching at night was similar between treatments across most time points, but fewer CON hens used the high perch compared to AVI hens throughout the study (p = < 0.001). Rearing in aviaries influences hen behavior out to peak lay for collisions and out to mid-lay for perch height preference in ECC.

Improving intra- and inter-observer repeatability and accuracy of keel bone assessment by training with radiographs.

Assessing keel bone damage reliably and accurately is a requirement for all research on this topic. Most commonly, assessment is done on live birds by palpation and is therefore prone to bias. A 2-day Training School of the COST Action "Identifying causes and solutions of keel bone damage in laying hens" with 16 participants of variable experience was held where palpation of live hens was followed by consulting corresponding radiographic images of keel bones. We hypothesized that the inter-observer and intra-observer repeatabilities as well as the agreement between palpation and assessment from the radiograph (considered as the accuracy) would increase from day 1 to 2. Repeatability estimates were calculated using the R-package rptR and the change in level of accuracy on day 1 and 2 was analyzed with generalized linear models. As predicted, the inter-observer repeatabilities of the assessments of the fractures and deviations were improved by training, but this improvement differed for fractures and deviations between the cranial, middle, and caudal parts of the keel bone. Intra-observer repeatabilities before training also differed between the different parts of the keel bone and were highest for fractures at the caudal part of the keel bone. The training affected the accuracy of palpation to different degrees for the different parts of the keel bone. A training effect was found for the caudal part of the keel bone in regard to fractures and deviations, but for fractures the training effect was missing for the cranial part and for deviations it was missing for the middle part of the keel bone. In conclusion, the training school involving radiographs improved inter-observer repeatabilities in the diagnosis of fractures and deviations of keel bones and thus had the potential to lead to more comparable results among research groups.

Improving intra- and inter-observer repeatability and accuracy of keel bone assessment by training with radiographs.

Assessing keel bone damage reliably and accurately is a requirement for all research on this topic. Most commonly, assessment is done on live birds by palpation and is therefore prone to bias. A 2-day Training School of the COST Action "Identifying causes and solutions of keel bone damage in laying hens" with 16 participants of variable experience was held where palpation of live hens was followed by consulting corresponding radiographic images of keel bones. We hypothesized that the inter-observer and intra-observer repeatabilities as well as the agreement between palpation and assessment from the radiograph (considered as the accuracy) would increase from day 1 to 2. Repeatability estimates were calculated using the R-package rptR and the change in level of accuracy on day 1 and 2 was analyzed with generalized linear models. As predicted, the inter-observer repeatabilities of the assessments of the fractures and deviations were improved by training, but this improvement differed for fractures and deviations between the cranial, middle, and caudal parts of the keel bone. Intra-observer repeatabilities before training also differed between the different parts of the keel bone and were highest for fractures at the caudal part of the keel bone. The training affected the accuracy of palpation to different degrees for the different parts of the keel bone. A training effect was found for the caudal part of the keel bone in regard to fractures and deviations, but for fractures the training effect was missing for the cranial part and for deviations it was missing for the middle part of the keel bone. In conclusion, the training school involving radiographs improved inter-observer repeatabilities in the diagnosis of fractures and deviations of keel bones and thus had the potential to lead to more comparable results among research groups.

Keel bone fractures affect egg laying performance but not egg quality in laying hens housed in a commercial aviary system.

The aim of this study was to investigate the effect of keel bone fracture (KBF) severity and healing activity on individual productivity of laying hens. Focal hens (75 Lohmann Selected Leghorn (LSL), 75 Lohmann Brown (LB)) were housed alongside non-focal hens in 10 identical pens containing a commercial aviary system (15 focal hens per pen). Eggs of focal hens were identified by orally administering a dye on 3 consecutive days, resulting in a hen-specific color pattern in the yolk. Eggs were collected at 7 time points (37 to 61 weeks of age; WOA) for 5 d to determine individual laying performance and to assess egg quality. Radiographs were performed to score KBF severity on a continuous scale. Healing activity was scored as inactive, healing, or fresh. Linear mixed effects models were used for statistical analyses. We found an association between KBF severity and reduced egg laying performance with increasing age (P = 0.005). At 37 WOA, egg laying performance was similar across KBF severities, whereas at 61 WOA, performance in hens with the highest observed KBF severity was 16.2% lower than in hens without fractures. Hens with fresh fractures had a lower performance than hens with healing and inactive fractures at 37 WOA but higher performance at 61 WOA (P = 0.02). Egg quality parameters were not affected by fractures but were associated with an age × hybrid interaction (egg mass: P = 0.039, shell breaking strength: P = 0.03, shell width: P = 0.001). In conclusion, hens could maintain high performance irrespective of fracture severity until shortly after peak of lay, but seemed to redirect available resources towards fracture healing if a fresh fracture was present. At the end of lay, the negative effect of KBF fracture severity on individual production amplified indicating that hens were no longer able to cope with the physiological challenge of a fracture.

A Reliable Method to Assess Keel Bone Fractures in Laying Hens From Radiographs Using a Tagged Visual Analogue Scale.

Up to 97% of laying hens housed in aviary systems are affected by keel bone fractures. Due to the scope of the problem, multiple efforts investigating causes and consequences of fractures have been conducted. The most frequently used techniques to detect fractures lack accuracy and provide only vague information (palpation) or cannot be conducted longitudinally (dissection). Radiographic imaging overcomes these weaknesses as it allows longitudinal observations and provides detailed information for individual fractures of which a single keel may have several at different locations and of different origins. However, no standardized system exists to assess fracture severity from radiographs if multiple fractures are present. The aim of this study was therefore to test the reliability of a scoring system assessing the aggregate severity of multiple fractures, taking into account the characteristics of all present fractures (e.g., locations, callus formation, width of fracture gaps). We developed a scoring system based on a tagged visual analogue scale, ranging from score 0 (no fracture) to score 5 (extremely severe) with intermediate tags for scores 1, 2, 3, and 4. A catalog of example scores was provided to describe the range of each score visually. An online tutorial with an introduction, training and scoring session was completed by 14 participants with varying experience involving laying hens and keel bone damage. For inter-observer reliability, we found an Intraclass correlation coefficient (ICC) of 0.985 with a 95% confidence interval of 0.974 < ICC < 0.993 (average-rating, absolute-agreement, two-way random-effects model). Intraclass correlation coefficient for intra-observer reliability was 0.923 with a 95% confidence interval of 0.879 < ICC < 0.951 (single-rating, absolute-agreement, two-way mixed-effects model). Intra-observer reliability ranged from 0.704 to 1.0 indicating excellent agreement and similar ratings across and within participants. Further, high ICCs suggest that the introduction and the training sessions provided were adequate tools to prepare observers for the assessment task despite various backgrounds of the participants. Nonetheless, the validity of this scoring system needs to be investigated further in order to link responses of interest and biological relevance with the specific severity values resulting from our scoring system.

Susceptibility to keel bone fractures in laying hens and the role of genetic variation.

Keel bone fractures are a well-known welfare problem in modern commercial laying hen systems. The present study sought to identify genetic variation in relation to keel bone fracture susceptibility of 4 distinct crossbred and one pure line, and by extension, possible breeding traits. Susceptibility to fractures were assessed using an ex vivo impact testing protocol in combination with a study design that minimized environmental variation to focus on genetic differences. The 5 crossbred/pure lines differed in their susceptibility to keel bone fractures with the greatest likelihood of fracture in one of the 3 commercial lines and the lowest susceptibility to fractures in one of the experimental lines. Egg production at the hen-level did not differ between the crossbred/pure lines (P > 0.05), though an increased susceptibility to keel bone fractures was associated with thinner eggshells and reduced egg breaking strength, a pattern consistent among all tested crossbred/pure lines. Our findings suggest an association between egg quality and bone strength which appeared to be independent of crossbred/pure line. The findings indicate the benefit of the impact methodology to identify potential breeding characteristics to reduce incidence of keel fracture as well as the potential relationship with eggshell quality.

Space Allowance of the Littered Area Affects Lying Behavior in Group-Housed Horses.

Horses can sleep while standing; however, recumbency is required for rapid eye movement (REM) sleep and therefore essential. Previous research indicated a minimal duration of recumbency of 30 min per 24 h to perform a minimal duration of REM sleep. For group-housed horses, suitable lying area represents a potentially limited resource. In Switzerland, minimal dimensions for the space allowance of the littered area are therefore legally required. To assess the effect of different space allowances of the littered area on lying behavior, 38 horses in 8 groups were exposed to 4 treatments for 11 days each; T0: no litter provided, T0.5: 0.5× minimal dimensions, T1: minimal dimensions, and T1.5: 1.5× minimal dimensions. Non-littered areas were covered with hard rubber mats. Lying behavior was observed during the last 72 h of each treatment. The total number of lying bouts per 24 h was similar in treatments providing litter, whereas in treatment T0, recumbency occurred only rarely (F1,93 = 14.74, p = 0.0002) with the majority of horses lying down for less than 30 min per 24 h ([Formula: see text], p = 0.0006). Overall, the total duration of recumbency per 24 h increased with increasing dimensions of the littered area, whereby the effect attenuated between treatment T1 and T1.5 in high-ranking horses but continued in low-ranking horses (F1,91 = 3.22, p = 0.076). Furthermore, low-ranking horses showed considerably more forcedly terminated lying bouts in treatments T0.5 and T1, but were similar to high-ranking horses in T1.5 (F1,76 = 8.43, p = 0.005). Nonetheless, a number of individuals showed durations of recumbency of less than 30 min per 24 h even in treatment T1.5. The lying behavior was dependent on the availability of a soft and deformable surface for recumbency. A beneficial effect of enlarged dimensions of the littered area was shown by increased durations of recumbency and decreased proportion of forcedly terminated lying bouts in low-ranking horses. Taking this into account, it became evident that the minimal dimensions for the littered area as implemented in the Swiss animal welfare legislation do not ensure undisturbed lying behavior for all members of a given group.