Bypassing the post-anaesthesia care unit after elective hip and knee arthroplasty: a prospective cohort safety study.

Following knee and hip arthroplasty, transfer to a recovery area immediately following surgery and before going to ward might be unnecessary in low-risk patients. Avoiding the recovery area in this way could allow for more targeted use of resources for higher risk patients, which may improve operating theatre flow and productivity. A prospective single-centre cohort study on the safety of criteria for bypassing the post-anaesthesia care unit in elective hip and knee arthroplasty was designed. Criteria were: ASA physical status < 3; peri-operative bleeding < 500 ml; low postoperative discharge-score (modified Aldrete-score); and an uncomplicated surgical and neuraxial anaesthesia procedure. The primary outcome was the number of patients in need of secondary readmission to the post-anaesthesia care unit. Events within the first 24 postoperative hours were recorded, along with readmission and complication rates. A total of 696 patients were included, with 287 (41%) undergoing total hip arthroplasty, 274 (39%) undergoing total knee arthroplasty and 135 (19%) undergoing unicompartmental knee-arthroplasty. Of these, 207 (44%) bypassed the post-anaesthesia care unit. Patients all received multimodal analgesia without peripheral nerve blockade. Only one patient in the ward group required secondary readmission to the post-anaesthesia care unit. Within 24 h, 151 events were reported, with 41 (27%) in the ward group and 110 (73%) in the post-anaesthesia care unit group. Two events in each group occurred within 2 hours of surgery. No complications were attributed to bypassing the post-anaesthesia care unit. The use of simple pragmatic criteria for bypassing the post-anaesthesia care unit for patients undergoing knee and hip arthroplasty with spinal anaesthesia is possible and associated with significant reduction of post-anaesthesia care unit admission and without apparent safety issues. Confirmation is needed from other studies and external validity should be interpreted cautiously in centres with different peri-operative regimens, organisational and staffing structures.

High-digestible silages allow low concentrate supply without affecting milk production or methane emissions.

In this study, we tested a response function comprising responses in milk to changes in organic matter digestibility of silages and concentrate supply. We studied the effect of changes in silage digestibility and concentrate supply on milk yield, feed intake, body weight, and methane production using 60 Norwegian Red cows. The experiment was a complete randomized block design comprising 3 periods. The pre-experimental period lasted 20 d and all the cows were fed a common silage for ad libitum intake and concentrate according to yield. Next, response period 1 lasted 17 d and the cows were divided into 2 treatments, where a low-digestible silage (LDS) was fed to half of the cows, and the other half were fed a high-digestible silage (HDS). Both groups were fed silage for ad libitum silage intake. Concentrate was optimized according to the yield and type of silage offered. In this period, the effect of silage was evaluated using a mixed model, including the results from pre-experimental period, with parity as a covariate and animal as a random effect. In response period 2, which lasted 20 d, the concentrate level was evaluated by dividing the silage digestibility treatments further into 3 subgroups. Concentrate was increased by 2 kg of dry matter (DM) per day, decreased by 2 kg of DM/d, or remained unchanged. In response period 1, silage treatments were optimized to obtain similar yields and resulted in a lower concentrate offer to HDS treatment. However, the HDS treatment showed a 3.0 kg of DM/d higher total feed intake due to a higher than expected silage intake. This resulted in 3.5 kg higher energy-corrected milk (ECM). Methane emissions were similar between silage treatments, but HDS showed lower methane per kilogram of DM due to its higher intake. The effect of concentrate supply level and interaction with silage digestibility was evaluated using mixed models, including the results for response period 1, with parity as a covariate and animal as a random effect. The reduction in concentrate offer by 2 kg/d in response period 2 was compensated for by increased 1.3 kg of DM/d of silage intake for HDS, resulting in similar intake (22.1 kg of DM/d and 21.7 kg of DM/d without and with concentrate reduction, respectively) and ECM yields (29.4 and 29 kg of ECM without and with concentrate reduction, respectively). However, concentrate offer reduction could not be compensated for by increased silage intake for LDS and resulted in lower milk yields (27.5 kg of ECM). Increased concentrate showed a higher marginal ECM response (kg of ECM per kg of additional concentrate intake) for LDS (1.8 vs. 3.3 kg of ECM for HDS and LDS, respectively). Thus, the drop in milk yields could be compensated for by increased concentrate offers if LDS are fed. Total methane production increased with increased concentrate intake, regardless of silage digestibility. Methane emissions per unit of milk were affected by total DM intake rather than by changes in silage digestibility and concentrate level. The results of this study are based on short-term periods and could show differences if study periods were longer; the results should be interpreted accordingly.

A static model for estimating energy content of compound feeds in a dynamic feed evaluation system.

The objective of the study was to develop a static empirical model for the estimation of net energy content of compound feeds in a dynamic feeding system using net energy for lactation at 20 kg of dry matter intake/d (NEL20) values calculated by the Nordic Feed Evaluation System (NorFor) model. In the NorFor system, NEL20 is a standardized value used to describe net energy content of feeds. The static model would allow prediction of the net energy value of compound feeds without access to the input data needed for the dynamic models. Our hypothesis was that NEL20 values of compound feeds can be predicted using organic matter digestibility (in vitro) and chemical components of the compound feeds as input variables. For this, 75 compound feeds and their 108 associated ingredients were collected across Scandinavia for model development. The proposed best model for prediction of compound feed NEL20 included crude fat, neutral detergent fiber, digestible organic matter measured in vitro, and crude protein (urea corrected) as independent variables. Lack of additivity of chemical components between values analyzed directly in the compound feed and values calculated by the weighted sum of ingredients was detected as the main source of error in the model, emphasizing the importance of accurate chemical analysis and sampling practices. Results from practical use of the model show that it may be a valuable tool that could be used by several actors in the feeding sector using the NorFor system. Feed manufacturers could use it to monitor the net energy content in their final product, and farmers could use it to check the net energy content of the purchased compound feed. However, validation of this model against an independent set of samples is lacking in this study and its prediction performance should be further evaluated. The model will need recalibration if the feed parameters used in the dynamic model for the estimation of reference values change, as this would not be reflected in the predicted values of the created model.

Precision and additivity of organic matter digestibility obtained via in vitro multi-enzymatic method.

The enzymatic digestibility of organic matter (EDOM) method is an in vitro multi-enzymatic method for estimating the organic matter (OM) digestibility of feeds. The EDOM method previously showed high accuracy with in vivo values for compound feeds. The aim of this study was to evaluate the precision of the EDOM method and determine its additivity, compared with the long-assumed additive property of the chemical components of compound feeds. 149 feed samples, 70 commercial compound feeds and 79 associated ingredients, were analyzed in a laboratory (lab1) for OM digestibility measured by EDOM (OMDEDOM) with 2 repetitions separated in time to estimate repeatability. Of the total samples, 49 compound feeds were further analyzed in a commercial laboratory (lab2) for OMDEDOM to determine reproducibility. The 49 compounds and their 69 associated ingredients were also analyzed by lab2 for dry matter (DM), ash, crude protein (CP), neutral detergent fiber (NDF), and starch. The EDOM method resulted in an intralaboratory correlation of 98.9% and an interlaboratory correlation of 92.6%, with no significant mean bias between the 2 laboratories tested. The formulation of compound feeds, total mixed rations, and mixtures in general assumes that their nutrient content can be calculated by adding together the nutrient supply of individual ingredients. This is of great importance in the feed industry for the creation of compound feeds. Additivity of OMDEDOM for the compound feed samples was evaluated by comparing the sum of the digestible OM (DOMEDOM) of the ingredients (predicted) with DOMEDOM estimated directly in the compound feed (observed). The regression of predicted versus observed showed a coefficient of determination (R2) of 0.93 and root mean square error (RMSE) of 1.07% of total DM, with no linear bias but with a mean bias (0.83% of DM). Additivity of CP, starch, crude fat, and NDF showed an R2 of 0.95, 0.98, 0.95, and 0.93, and RMSE of 1.56, 1.90, 0.39, and 1.46% of DM, respectively, all presenting linear bias. Crude fat also presented mean bias. Although significant, all linear and mean bias for DOMEDOM and chemical components were within the acceptable error limits for declaration of feeds. The results demonstrate the high precision of the EDOM method and its additive property, which is an advantage for the estimation of OM digestibility in compound feeds. Moreover, results of the tests of chemical components confirm their additive property.

Description and evaluation of a net energy intake model as a function of dietary chewing index.

Previously, a linear relationship has been found between net energy intake (NEI) and dietary chewing index (CI) of the diet for different types of cattle. Therefore, we propose to generalize and calibrate this relationship into a new model for direct prediction of NEI by dairy cows from CI values (CINE; min/MJ of NE). Furthermore, we studied the forage-to-concentrate substitution rate in this new NEI model. To calibrate the model on a diverse set of situations, we built a database of mean intake from 14 production experiments with a total of 986 primi- and multiparous lactating dairy cows of different breeds fed 136 different diets ad libitum. The NEI were estimated by the Nordic feed evaluation system. The CINE value of diets was estimated from the intake of concentrate, intake of forage neutral detergent fiber (NDFf), particle length of forage, indigestible NDFf/NDFf, body weight, NDFf/body weight, and the content of NE in DM. We show that the slope values in this regression are proportional to the squared intercepts, giving the nonlinear equation NEI=NEI0-k×NEI0a×CINE, where the parameter k represents the decline in NEI with the increasing CINE of the diet and a was estimated to have a value of 2, implying a constant maximum daily chewing time. The intercept NEI0 in the regression of NEI on CINE may be interpreted as metabolic net energy intake capacity of the cows fed without physical constraints on intake. Based on experimental data, the maximum chewing time was estimated as 1/(4 × k). The NEI0 values were parameterized as a linear function of metabolic body size, energy-corrected milk yield (kg/d), days in milk, and days in milk squared. Prediction accuracy was evaluated by mean square prediction error (MSPE) and its decomposition into central tendency, regression, and disturbance, across and within experiments on independent data from 19 experiments including 812 primi- and multiparous lactating dairy cows of different breeds fed 80 different diets ad libitum. The NEI model predicted NEI with an MSPE of 8% of observed, and across the 19 experiments the error central tendency, error regression, and error disturbance were 4.2, 40.6, and 84.9% of MSPE, respectively. The described intake model implies a variable forage-to-concentrate substitution rate as a nonlinear function of NEI0, CINE of forage, and supplementation of concentrate.

Feeding, production, and efficiency of Holstein-Friesian, Jersey, and mixed-breed lactating dairy cows in commercial Danish herds.

The objective of this paper was to compare efficiency measures, milk production, and feed intake for lactating cows in commercial herds using different breeds and production and milking systems. To accomplish this, we used all feed evaluations made by the Danish extension service during the period November 2012 to April 2013 for 779 herds, of which 508 were Holstein-Friesian (HOL); 100 were Jersey (JER); and 171 herds were a mixture of these 2 breeds, other dairy breeds, and crossbreeds (OTH). The annually recorded, herd-average energy-corrected milk (ECM) yield was 8,716kg (JER) and 9,606kg (HOL); and average herd size was 197 cows (HOL) and 224 cows (JER). All cows were fed a total mixed or partial mixed ration supplemented with concentrate from feeding stations, housed in loose housing systems with a slatted floor, and milked in either a parlor milking unit or an automatic milking system. Energy efficiency was calculated as net energy efficiency defined as total energy demand as a percentage of energy intake and as residual feed intake defined as energy intake (net energy for lactation; NEL) minus energy requirement. Production efficiency was expressed as kilograms of ECM per kilogram of dry matter intake (DMI), kilograms of ECM per 10 MJ of net energy intake (NEL), kilograms of ECM per 100kg of BW, and kilograms of DMI per 100kg of BW. Environmental efficiency was expressed by the nitrogen efficiency calculated as N in milk and meat as a percentage of N in intake, and as enteric emission of methane expressed as kilograms of ECM per megajoule of CH4. Mean milk yield for lactating cows was 30.4kg of ECM in HOL and 3kg less in JER, with OTH herds in between. Mean NEL intake was 122 MJ in JER, increasing to 147 MJ in HOL, whereas ration energy density between breeds did not differ (6.4-6.5 MJ of NEL per kg of DMI). The NEL intake and DMI explained 56 and 47%, respectively, of variation in production (ECM) for HOL herds but only 44 and 27% for JER. Jersey had a higher efficiency than HOL and OTH, except in nitrogen efficiency, where no significant difference between breeds existed. Most of the efficiency measures were internally significantly correlated and in general highly positively correlated with milk production, whereas the correlation to DMI was less positive and for JER negative for net energy efficiency, kilograms of ECM per kilogram of DMI, and nitrogen efficiency. Only little of the variation in efficiency between herds could be explained by differences in nutrient or roughage content of DMI. This could be explained by the fact that data were collected from herds purchasing feed planning and evaluation from the extension service.

Fluorometric determination of beta-hydroxybutyrate in milk and blood plasma.

Determination of beta-hydroxybutyrate (BHBA) in blood and milk samples is an important tool in the diagnosis of ketosis in dairy cattle. Apart from semiquantitative cow-side tests, well-established laboratory methods exist for measurements in blood serum or plasma. These spectrophotometric methods are, however, neither convenient nor reliable when transferred to analyses of milk. Due to its nontransparent nature, milk needs extensive pretreatment if traditional analyses are to be used. This paper describes a fluorometric determination of BHBA that is useful without pretreatment in opaque matrices such as milk and in blood plasma. The method is easy to automate, saves labor expenses, and is inexpensive. The analytical accuracy and precision are reliable for intensive as well as large-scale analysis; for example, in-line sampling from automatic milking systems. Analysis of 2500 random milk samples showed a BHBA content ranging from 10 to 631 microM (mean 49 microM). Furthermore, selected samples (n = 295) from diagnosed ketotic animals taken on d -35 to +35 from peak level ranged from 10 to 684 microM (median 79 microM, mean 141 microM). Using the same 1240 blood plasma samples, the fluorometric method was closely correlated with a traditional spectrophotometric method (r = 0.987). Hemolysis of samples does not appear to affect the fluorometric determination of BHBA.

Quarter health, milking interval, and sampling time during milking affect the concentration of milk constituents.

Eleven Danish Holstein cows were used to examine the effects of quarter health (healthy vs. unhealthy), milking interval (12 vs. 6 h), and sampling time during milking on the concentration of 8 milk constituents [acetone, beta-hydroxybutyrate (BHBA), N-acetyl-beta-D-glucosaminidase (NAGase), somatic cell count (SCC), urea, fat, protein, and lactose]. The selection criterion was that each cow should have 2 or 3 healthy and 1 or 2 unhealthy quarters. Foremilk was collected before attaching the teat cups of the milking machinery, and thereafter, milk samples were collected automatically from each quarter every 45 s during milking. Compared with milk from healthy quarters, milk from unhealthy quarters had a higher concentration of BHBA, NAGase, SCC, and protein during the entire milking, whereas urea was higher in the last part of the milking process. Healthy quarters had a higher content of acetone and lactose during the whole milking, whereas fat was higher in the first part of the milking process. When the cows were milked at the 6-h interval, all milk constituents except lactose and protein were higher during the whole (NAGase, SCC, and urea) or part of the milking (acetone, BHBA, and fat) compared with when cows were milked at the 12-h interval. Lactose was higher in the first part of the milking at the 12-h compared with the 6-h interval, whereas protein was not affected by milking interval. beta-Hydroxybutyrate, NAGase, SCC, and fat increased during the milking process, whereas acetone, urea, protein, and lactose decreased. Foremilk was remarkably different for all constituents, except acetone, and should not be used as a representative milk sample to achieve the true level of a milk constituent. If these milk constituents are to be used in an inline management system, these effects should be taken into account.

Predicting risk of ketosis in dairy cows using in-line measurements of beta-hydroxybutyrate: a biological model.

Automated monitoring of individual cows to determine health status is a potentially valuable management tool, especially in large dairy herds. Herein is described the rationale, structure, and functionality of a biological model to predict risk of ketosis in individual cows using in-line measurements of the ketone body beta-hydroxybutyrate (BHBA) in milk. The model also uses acceleration in milk yield, body fatness at calving, diseases in current lactation, and incidences of ketosis in earlier lactations as additional risk factors for ketosis. However, the model is designed to function merely on the basis of milk BHBA in the absence of other data. Values of milk BHBA are smoothed using a state space model before these are used in calculations in the biological part of the model. The model is designed to be updated each time a new BHBA measurement or a disease occurrence is available and then uses previous and current data. Outputs of the model are the risk of ketosis (value between 0 and 1, where 0 = no risk and 1 = clinical ketosis) and how many days until the next milk sample should be taken and analyzed for BHBA. At higher risks for ketosis, more frequent milk sampling is the recommended output. Test examples from cows for which BHBA has been measured extensively were used to show the functionality of the model. The model performed equally well when reductions in sampling frequency were applied, and it was also relatively robust to the addition of up to +/- 2 residual SD of random noise in the BHBA values. This model has the potential to provide the basis for a useful disease monitoring and management tool. However, thorough validation awaits a much larger dataset and testing of the model under a variety of on-farm situations.

A time-resolved immunofluorometric assay for quantification of the bovine collectin conglutinin.

A high capacity time-resolved immunofluorometric assay (TRIFMA) for the bovine collectin conglutinin was developed. The TRIFMA was constructed as a non-competitive sandwich assay based on polyclonal antibodies as the capture reagent and a novel monoclonal antibody raised against conglutinin as the detection reagent and was set up to run on an automatic analyzer designed for the TRIFMA detection system. Polyclonal antibodies immobilized on microtiter plate wells were incubated overnight at 4 degrees C with diluted plasma samples, including quality controls (QC) and dilutions of a plasma with known conglutinin concentration. Conglutinin was sandwiched between the capture antibodies and the monoclonal antibody and the detection optimised with biotin-labelled secondary antibodies and streptavidin-Eu(3+). Plates were washed four times between each step and finally incubated with enhancement solution before measuring the fluorescence. The assay detection limit was 0.34 ng/ml and the working range 0.80 ng/ml-0.20 microg/ml. Intra-plate and inter-plate coefficients of variation (CV) were in the range of 5.0-8.3% and 6.2-7.2%, respectively, at concentrations of 3.4 and 150 ng/ml. Recovery was 90.9+/-2.4% and 98.8+/-2.5% when samples were spiked with 20 ng/ml and 100 ng/ml purified bovine conglutinin (BK). No circadian rhythm (24-h variation) in conglutinin plasma levels was observed across animals, indicating that the plasma levels were not influenced by, e.g. feeding. Samples could be stored at -20 degrees Celsius and were not sensitive to repeated freezing and thawing. In conclusion, the developed TRIFMA for bovine conglutinin is specific and reliable over a measurement range covering most situations.

Energy intake in late gestation affects blood metabolites in early lactation independently of milk production in dairy cows.

The present experiment examined the effect of offering either a high- (H) or low- (L) energy-density diet in late gestation and early lactation on physiological parameters, body condition score (BCS) and milk production in early lactation. In all, 40 multiparous Holstein cows were randomly allocated to one of four treatments in a 2 × 2 factorial design, where the factors were H- or L-energy density in a total mixed ration (TMR) both pre- and post-calving. Consequently, there were four treatment groups: HH, HL, LL and LH. The pre-calving treatment was initiated 100 days prior to expected calving; the H TMR was fed ad libitum whereas the L TMR was restricted to 10 kg dry matter/day during late lactation, and to approximately 75% of energy requirements from drying off until calving. Both diets were offered ad libitum post-calving. Feeding diet H compared to L pre-calving led to higher BCS at calving (2.68 v. 2.34, P < 0.01). Energy corrected milk yield and energy-intake post-calving were not affected by pre-calving diets. Changes in BCS and blood concentrations of non-esterified fatty acids, beta-hydroxybutyrate and glucose in early lactation showed that cows offered diet H pre-calving generally mobilised more body reserves compared to cows offered diet L pre-calving. An interaction between pre- and post-calving diets showed that cows offered diet H pre-calving had lower body tissue mobilisation when offered diet H post-calving compared to diet L. Cows offered diet L pre-calving, did not mobilise differently whether they were offered diet H or L post-calving. The pre- and post-calving diets had no effect on liver triacylglycerol, whereas liver glycogen was higher in cows on treatment HH compared to the other three treatments. Collectively, these results indicate that overfeeding should be avoided in late gestation and that a high-energy-density diet is desirable in early lactation in order to obtain a more favourable metabolic profile.

Effect of changes in diet energy density on feed intake, milk yield and metabolic parameters in dairy cows in early lactation.

The purpose of this experiment was to investigate how early lactating cows adjust their metabolism and production to acute, but moderate changes in the energy density of the diet. Sixty dairy cows were randomly assigned to one of four treatments: two change-over groups (HNH and NHN) and two control groups (HHH and NNN), where H and N refer to a high and normal energy density in the total mixed ration (TMR), respectively. The experimental period covered the first 9 weeks post calving, which was split up in three 3-week periods. Thus, cows assigned to HNH or NHN shifted TMR in weeks 4 and 7 after calving while cows assigned to HHH or NNN were fed the same TMR for all 9 weeks. Results from cows on treatment HNH were compared with group HHH while cows on treatment NHN were compared with group NNN. When the diet changed from N to H and H to N, cows increased and decreased their dry-matter intake (DMI), respectively compared with control groups. Cows adjusted milk yield accordingly to changes in DMI, although not always significantly. Energy-corrected milk yield was not significantly affected by any of the changes in the energy density of the diet but generally showed same tendencies as milk yield. Non-esterified fatty acids (NEFA), beta-hydroxybutyrate in blood and milk and triacylglycerol and glycogen content in the liver were not significantly affected by changes in the energy density of the diet, except from NEFA at one change. Glucose increased more when the diet changed from N to H and increased less when the diet changed from H to N, compared with control groups, although not always significantly. Collectively, these results suggest that cows adjust their DMI and partly milk yield according to the energy density of the diet and therefore only limited effects were observed in physiological parameters.

Diurnal variation and the effect of feed restriction on plasma and milk metabolites in TMR-fed dairy cows.

The objective was to study the diurnal variation in metabolites in plasma and milk of dairy cows fed total mixed rations (TMR) with a low-energy (LE) or high-energy content (HE) expected to give a minor and a major diurnal variation, respectively. Further, the purpose was to quantify and compare the responses in plasma and milk parameters when cows changed from ad libitum to restrictive feeding. Eight multiparous, early-lactating Danish Holstein cows were used in a cross-over design with two consecutive 14-day periods. Blood and milk samples were collected hourly on day 11 of each period and on days 12-14 of each period, the cows were fed restrictively (65% of ad libitum dry-matter intake). The concentration of beta-hydroxybutyrate (BHB) in plasma was significantly higher in the evening for cows fed the HE TMR, than for cows fed the LE TMR. There was a significant diurnal variation in BHB in milk, with the highest concentrations between milkings and the lowest concentrations at milking. Non-esterified fatty acids (NEFA) in plasma showed significant diurnal variation that was caused by high concentrations in the morning. Plasma glucose did not show any diurnal variation. It has been argued that feeding a TMR removes diurnal changes related to feeding, which is contrary to earlier diurnal studies where concentrates have been fed twice daily. Feed restriction increased (P < 0.001) NEFA and BHB in plasma by 121 and 90%, respectively, while the glucose concentration decreased (P < 0.001) by 19%. Milk concentrations of BHB, citrate and fat increased (P < 0.001) by 163, 11 and 26%, respectively, because of feed restriction, while there were no changes in milk protein and lactose. The relatively high increase in BHB during feed restriction suggests that BHB is more advantageous as a milk indicator of metabolic status in dairy cows than citrate and fat.