Economic impact of different strategies to use sex-sorted sperm for reproductive management in seasonal-calving, pasture-based dairy herds.

To maximize efficiency, profitability, and societal acceptance of modern dairy production, it is important to minimize the production of male dairy calves with poor beef merit. One solution involves using sex-sorted sperm (SS) to generate dairy replacements and breeding all other cows to an easy-calving, short-gestation bull with good beef merit. We used the Pasture Based Herd Dynamic Milk Model to investigate the effect of herd fertility and use of SS on farm net profit in a herd of 100 cows. This was completed by simulating herds with differing fertility performance (good, average, poor), and differing farm reproductive management [conventional semen (CONV) or SS with varying pregnancy per artificial insemination (P/AI) relative to CONV (i.e., relative P/AI 100%, 85%, and 70%)]. As an additional consideration, the method of allocating SS to cows was also examined. The first option used SS on random heifers and cows (S). The second option used SS on heifers and targeted high-fertility cows (SSel). The final option was similar to SSel, but used a fixed-time artificial insemination (AI) protocol to facilitate AI on the farm mating start date (SSync). For CONV, dairy breed semen was used for AI until 50 animals were pregnant (50% chance of a female calf), whereas for S, SSel, or SSync the target number of animals successfully conceiving with SS was set at 28 (based on assumed 90% chance of a female calf from pregnancies derived from SS). Beef breed semen was used on all other dams. The results indicated that the biggest effect on farm net profit was not based on whether or not SS was used, but instead was most affected by the overall fertility performance of the herd. Total farm profit decreased by 10% between the good and average fertility herds, and decreased by a further 12% between the average and poor fertility herds. In almost all situations, when the relative P/AI with SS was ≥85%, use of SS led to an overall increase of the farm net profit. There was an economic benefit of using either SSel or SSync compared with S for the average and poor fertility herds but not for the good fertility herd, highlighting an interaction between SS P/AI and overall herd fertility as well as management practices. If the relative P/AI with SS was <70%, the use of SS led to a decrease in profitability in all simulations except for SSync, highlighting the importance of a good management strategy for use of SS. The findings in this study indicated that SS has significant potential to help facilitate greater integration between the dairy and beef production sectors, as well as increase farm profitability when used appropriately.

Reproductive efficiency and survival of Holstein-Friesian cows of divergent Economic Breeding Index, evaluated under seasonal calving pasture-based management.

The objective of the current study was to examine phenotypic fertility performance and survival, and to gain insight into underlying factors that may contribute to greater fertility performance in 2 divergent genetic groups (GG) of Holstein-Friesian, selected using the Irish Economic Breeding Index (EBI). The GG were evaluated across 3 spring calving pasture-based feeding treatments (FT) over 4 yr. The 2 divergent GG were (1) high EBI; representative of the top 5% nationally (elite), and (2) EBI representative of the national average (NA). In each year, 90 elite and 45 NA cows were randomly allocated to 1 of 3 FT: control, lower grass allowance, and high concentrate. No interaction between GG and FT was observed for any of the measures of fertility investigated. The elite cows achieved significantly greater pregnancy rate to first service (+14.9 percentage points), and significantly greater pregnancy rates after 21, 42, and 84 d of breeding (+17.3, +15.2, and +9.6 percentage points, respectively) compared with NA. The number of services per cow was fewer for elite (1.57) compared with NA (1.80). The interval from mating start date to pregnancy was significantly shorter for elite cows compared with NA. The elite cows maintained greater mean body condition score than NA throughout the study (2.91 vs. 2.72), and had greater body condition score at calving, artificial insemination, and drying off compared with NA. The elite cows had greater mean circulating concentrations of insulin-like growth factor-1 compared with NA. No significant effect was observed of GG on commencement of luteal activity, or progesterone profile variables. Greater survival to the start of fifth lactation was observed for elite cows. The elite cows were 43% less likely to be culled than NA by the beginning of the fifth lactation. The results highlight the success of the Economic Breeding Index to deliver reproductive performance and longevity consistent with industry targets across a range of seasonal pasture-based FT. The results also clearly demonstrate the potential of appropriate genetic selection to reverse negative fertility trends incurred during previous decades of selection for milk production alone.

Applications and cost benefits of sexed semen in pasture-based dairy production systems.

Sexed semen technology is now commercially available in many countries around the world, and is primarily used in dairy cattle breeding. Sperm are sorted by flow cytometry on the basis of a 4% difference in DNA content between sperm containing X and Y chromosomes. Despite reliably producing a 90% gender bias, the fertility of the sexed semen product is compromised compared with conventional semen. The negative implications of the reduced fertility of sexed semen are amplified in seasonal systems of dairy production, as the importance of fertility is greater in these systems compared with year-round calving systems. A review of the literature indicates that conception rates (CR) to 1st service with frozen-thawed sexed semen are ~75% to 80% of those achieved with conventional frozen-thawed semen. Preliminary results from a large-scale field trial carried out in Ireland in 2013 suggest that significant improvements in the performance of sexed semen have been made, with CR of 87% of those achieved with conventional semen. The improved fertility of a sexed semen product that delivers a 90% gender bias has considerable implications for the future of breeding management in pasture-based dairy production systems. Sexed semen may facilitate faster, more profitable dairy herd expansion by increasing the number of dairy heifer replacements born. Biosecurity can be improved by maintaining a closed herd during the period of herd expansion. In a non-expansion scenario, sexed semen may be used to increase the value of beef output from the dairy herd. The replacement heifer requirements for a herd could be met by using sexed semen in the 1st 3 weeks of the breeding season, with the remaining animals bred to beef sires, increasing the sale value over that of a dairy bull calf. Alternatively, very short gestation sires could be used to shorten the calving interval. Market prices have a considerable effect on the economics of sexed semen use, and widespread use of sexed semen should be restricted to well managed herds that already achieve acceptable herd fertility performance.

Expanding the dairy herd in pasture-based systems: the role of sexed semen use in virgin heifers and lactating cows.

A model was developed to examine the effects of sexed semen use in virgin heifers and lactating cows on replacement heifer numbers and rate of herd expansion in a seasonal dairy production system. Five separate herds were established according to the type of semen used: conventional frozen-thawed (Conv), sexed fresh semen used in lactating cows for the first 3 wk of the breeding season (SFre1), sexed frozen-thawed semen used in lactating cows for the first 3 wk of the breeding season (SFro1), sexed fresh semen used in lactating cows for the first 6 wk of the breeding season (SFre2), or sexed frozen-thawed semen used in lactating cows for the first 6 wk of the breeding season (SFro2). In the SFro1, SFre1, SFro2, and SFre2 herds, sexed semen was used for the first and second artificial insemination in virgin heifers. Pregnancy rates achieved with sexed fresh and sexed frozen-thawed semen were assumed to be 94 and 75% of those achieved with conventional frozen-thawed semen, respectively. Initial herd size was 100 cows, which was maintained for the first 2 yr of the 15-yr simulation, after which all available replacement heifers were retained to facilitate herd expansion. Two different scenarios of land availability were examined for each of the 5 herds: land available allowed expansion to a maximum herd size of 150 cows (S1), or land available allowed expansion to a maximum herd size of 300 cows (S2). Once maximum herd size was reached, sexed semen use was discontinued and all excess heifer calves were sold at 1 mo old. All capital expenditure associated with expansion was financed with a 15-yr loan. Each of the 10 different options was evaluated in terms of annual farm profit, annual cash flow, and total discounted net profit. The use of fresh sexed semen generated more replacement heifers, leading to faster herd expansion compared with frozen-thawed sexed semen and conventional frozen-thawed semen. Maximum herd size under S1 was reached in yr 5, 5, 4, 5, and 7 for the SFre1, SFro1, SFre2, SFro2, and Conv herds, respectively. Under S2, maximum herd size was reached in yr 8, 10, 7, 9, and 14 for the SFre1, SFro1, SFre2, SFro2, and Conv herds, respectively. Total discounted net profit under S1 for the SFre2 herd was €4,130, €38,869, €47,231, and €52,089 greater compared with the SFre1, SFro1, Conv, and SFro2 herds, respectively. Under S2, discounted net profit for the SFre2 herd was €44,204, €255,524, €280,373, and €325,815 greater compared with the SFre1, SFro1, SFro2, and Conv herds, respectively. The negative effects of the sexed frozen-thawed semen on herd fertility reduced farm profitability and will prevent its widespread use in lactating cows.

Expanding the dairy herd in pasture-based systems: the role for sexed semen use on virgin heifers.

A model was developed to examine the effects of sexed semen use on replacement heifer numbers and rate of herd expansion in a seasonal dairy production system. Three separate herds were established according to the type of semen used on virgin heifers: conventional frozen-thawed (Conv), sexed fresh (SFre), or sexed frozen-thawed (SFro). In the model, sexed semen was used for the first and second inseminations in heifers only. Pregnancy rates achieved with sexed fresh and sexed frozen-thawed semen were assumed to be 94% and 75% of those achieved with conventional frozen-thawed semen, respectively. Initial herd size was 100 cows, which was maintained for the first 2 yr of the 15-yr simulation, after which all available replacement heifers were retained to facilitate herd expansion. Two different scenarios of land availability (S1 and S2) were examined for each of the 3 herds using different semen types: land available allowed expansion to a maximum herd size of 150 cows (S1) or 300 cows (S2). Once maximum herd size was reached, sexed semen use was discontinued and all excess heifer calves were sold at 1 mo of age. All capital expenditure associated with expansion was financed with a 15-yr loan. Each of the different options was evaluated in terms of annual farm profit, annual cash flow, and total discounted net profit. The analysis was completed at a milk price of € 0.27/L, and sensitivity around milk price was carried out at € 0.22/L and € 0.32/L. The use of SFre generated more replacement heifers and thus faster herd expansion compared with SFro and Conv semen. Maximum herd size was reached in yr 5, 6, and 7 under S1, and in yr 10, 12, and 14 under S2 for SFre, SFro, and Conv herds, respectively. Total discounted net profit under S1 for the SFre herd was € 19,929 greater than that of the SFro herd and € 41,852 greater than that of the Conv herd. Under S2, discounted net profit for the SFre herd was € 138,587 greater than that of the SFro herd and € 239,987 greater than that of the Conv herd. All 3 herds suffered negative cash flows for extended periods under both S1 and S2 at the lower milk price of € 0.22/L, although cash flows were most negative in the SFre herd. The use of sexed semen, in particular fresh sexed semen, in dairy heifers facilitates faster and more profitable expansion compared with the use of conventional frozen-thawed semen. Financial pressures caused by low milk price were greatest when the rate of expansion was highest.

Is the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) effective for preterm infants with intrauterine growth restriction?

OBJECTIVE: This study investigates the effectiveness of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) on neurobehavioral and electrophysiological functioning of preterm infants with severe intrauterine growth restriction (IUGR). STUDY DESIGN: Thirty IUGR infants, 28 to 33 weeks gestational age, randomized to standard care (control/C=18), or NIDCAP (experimental/E=12), were assessed at 2 weeks corrected age (2wCA) and 9 months corrected age (9mCA) in regard to health, anthropometrics, and neurobehavior, and additionally at 2wCA in regard to electrophysiology (EEG). RESULT: The two groups were comparable in health and anthropometrics at 2wCA and 9mCA. The E-group at 2wCA showed significantly better autonomic, motor, and self-regulation functioning, improved motility, intensity and response thresholds, and reduced EEG connectivity among several adjacent brain regions. At 9mCA, the E-group showed significantly better mental performance. CONCLUSION: This is the first study to show NIDCAP effectiveness for IUGR preterm infants.

Extended lactations in a seasonal-calving pastoral system of production to modulate the effects of reproductive failure.

This study was conducted to determine whether extending the calving interval (CI) to 24 mo would be an alternative to culling and replacing cows that had failed to become pregnant. Forty-six nonpregnant lactating cows were assembled in November 2004 and assigned to receive either 3kg (low) or 6kg (high) of concentrate supplement and a basal diet of grass silage and maize silage over the winter period (13 wk). Cows returned to pasture in late March and received 1kg of concentrate/d until dry-off (milk yield <5 kg/d). Cumulative milk production was calculated from calving to the end of November 2004 (12-mo CI) and from the start of December 2004 until dry off in 2005 (extended lactation part of 24-mo CI). High winter feeding resulted in greater milk production over the winter confinement (20.0+/-0.3 vs. 17.8+/-0.3 kg/d for high and low winter feeding, respectively) and had a carryover effect during the remainder of the 24-mo CI period (5,177 vs. 4,686kg; SEM=173kg). At the end of the study, cows were ranked on cumulative milk solids and separated into 3 groups (R1, R2, and R3). During the 24-mo CI, milk yields were 7,287, 6,267, and 5,273kg (SEM=308kg) in yr 1, and 5,738, 4,836, and 4,266 (SEM=241kg) in yr 2 for R1, R2, and R3, respectively. Eighty-five percent of the cows became pregnant during the breeding season of yr 2, with a conception rate to first service of 52%. An economic analysis of different ranks with a 12-mo CI, a 24-mo CI, and an annualized herd effect, which compared an efficient spring calving system with 30% recycled cows in R1 and 10% recycled cows in R3, was carried out. Farm profit was reduced by 60% and 65% at a milk price of 22.3 euro-cents (c)/L with the corresponding values of 17% and 30% for a milk price of 30 c/L, respectively, when R1 and R3 systems were compared with an efficient spring milk (12-mo CI) production system. Within a spring system where 30% and 10% of R1 and R3 animals were subjected to extended lactations, the profit difference was reduced compared with an efficient spring system, The results indicated that lactations with a 24-mo CI may be a viable alternative to culling nonpregnant cows and be economically more suited to higher producing cows.

Realising resource efficiency in the management of healthcare waste from the Cornwall National Health Service (NHS) in the UK.

The quantities of waste generated by the healthcare sector in the United Kingdom (UK) have been shown to be amongst the highest in Europe. Based on a case study undertaken within the Cornwall NHS (National Health Service) in the UK, this paper reports on the results of waste minimisation trials. The schemes were able to achieve significant waste reductions in both clinical and domestic waste quantities. Indeed, a reduction in domestic bag waste in the range of 1.6-33.4%, with an average of 14.8% was realised. For clinical waste, the reduction ranged from 1.8% to 38.3%, at an average of 15.7%, with net cost benefits of nearly US$ 25,000 over the period of 1-3 years. The outcomes suggest that significant resource and financial efficiencies can be attained, but due to the many factors involved, there is a need to focus both on containment and logistics, as well as social factors for success.

Patterns of medical practice in cystic fibrosis: part I. Evaluation and monitoring of health status of patients. Investigators and Coordinators of the Epidemiologic Study of Cystic Fibrosis.

This report characterizes patterns of evaluation and monitoring of the health status of patients with cystic fibrosis (CF) as observed in the Epidemiologic Study of Cystic Fibrosis (ESCF), and compares these practices to published guidelines. All patients (18,411) who enrolled in ESCF at 194 study sites in the United States and Canada from December 1, 1993 to December 31, 1995 were considered for study. Patients enrolled before January 1, 1995 with >/=1 healthcare encounters during 1995 (12,631) were included in the analysis. Patients enrolled after January 1, 1995 (5,266), or who died (354), withdrew from the study (128), or were lost to follow-up (21) were excluded. Frequency of encounters (outpatient and hospital), spirometry, respiratory tract cultures, and chest radiographs were recorded during a 1-year period (1995) and analyzed by gender, age, severity of lung disease, and presence of any Pseudomonas species in the respiratory tract. The 12,631 patients had 53,024 outpatient visits. In 57.5% of patients, the recommended criteria of >/=4 total visits per year were met. Only 27.4% of all patients had >/=4 routine visits; 3.1% had only sick visits, and 59.0% had no sick visits. One third (34.6%) were hospitalized at least once, for a total of 8,561 hospitalizations. Older patients with lower pulmonary function and Pseudomonas in their respiratory tract had fewer routine visits and more sick visits, and were hospitalized more than were younger patients. In three fourths (75.8%) of patients the recommended criterion of two spirometry assessments per year was met, whereas in 79.3% the criterion of one culture was met, and in 68.3% the criterion of one radiograph/year was met. We conclude that in the majority of CF patients, the recommended criteria for routine evaluation and monitoring were met. However, in a rather substantial number they were not. An increase in the utilization of healthcare resources was observed in patients with more severe disease. This information will help to establish benchmarks for future quality assessment programs.

Expanding access and choice for health care consumers through tax reform.

A refundable tax credit for the uninsured would complement the existing job-based health insurance system while letting people keep their job-based coverage if they wish. Among the wide variety of design options for a tax credit, policy and political analysis does not reveal an obvious choice, but a tax credit based on a percentage of spending may have a slight advantage. Congress should give states maximum flexibility to use existing funding sources to supplement the value of a federal tax credit and encourage the use of techniques to create stable insurance pools.

Child protection or professional self-preservation by the baby nurses? Public health nurses and child protection in Ireland.

An exploratory, focus group methodology was used to elicit the views of public health nurses (PHNs) on the topic of child welfare and protection in the context of new legislation and evolving child care policy in Ireland. The nurses' views were considerably at variance with the officially stated commitment to inter-disciplinary collaboration and coordination within the Community Care Programmes of Ireland's regional health boards. The PHNs feared that involvement in child care proceedings of a social control or adversarial nature would compromise them in terms of their traditional curative and preventive health roles, and, on this basis, argued that social workers should retain the bulk, if not all, of the responsibility for such child care activity. The nurses also defined their work roles in terms of their own traditional, professional commitment to individuals, families and communities, and felt less bound by or even aware of the corporate responsibility of their employing health board. It is concluded that the enactment of new legislation and allocation of additional resources do not resolve the issues of inter-disciplinary collaboration in this area.

Court-ordered assessment: impact of maternal noncompliance in child maltreatment cases.

Parental noncompliance to court orders is associated with several factors that jeopardize safe and stable child care. We advanced three hypotheses: (1) maternal noncompliance to court-ordered assessment is associated with loss of child custody; (2) noncompliance is related to court clinic custody recommendations; and (3) noncompliance is stable across child protection and court clinic settings. Based on a sample of 56 court-referred child maltreatment cases, all hypotheses were confirmed. Results are discussed in terms of: (a) maternal noncompliance as a marker for high-risk child care; (b) our limited understanding of the phenomenal meaning of noncompliance; and (c) the dearth of empirically derived intervention methods.

A comprehensive system for value accounting in psychiatry.

This article describes a clinical management tool, the Value Accounting System, developed for use by a national organization of psychiatric treatment facilities. The system integrates patient case-mix variables with data on services provided, key administrative and clinical processes, clinical effectiveness, and cost/price. A comprehensive database links critical quality information with fiscal information, yielding a management tool that is national in scope, standardized, and versatile enough (1) to address general questions of the effectiveness and value of psychiatric services and (2) to provide an empirical base for rational, clinical management decision making. Descriptive data are presented from an attempt to establish a database and implement the system. The management and scientific potential of the Value Accounting System to improve the quality and efficiency of mental health services are discussed.

Child maltreatment: the collaboration of child welfare, mental health, and judicial system.

The alliance of child welfare, mental health, and legal systems has received little empirical attention, despite the magnitude of its impact on children and families. We examined the congruence of child protection agencies legal positions, court clinic recommendations, and judicial dispositions in a sample of 59 contested child maltreatment cases. Placement recommendations/decisions among all three systems were highly correlated, although the relationship was not so strong as to undermine the independence of any one system. Where there was disagreement between successive evaluations, it was in the direction of enhancing family integrity and parental access rights. We advanced three hypotheses to account for our findings: (a) changes in successive recommendations reflect the increasing sophistication of the assessment process; (b) changes reflect increasing distance from the family's ecology and are therefore increasingly ill informed; and (c) the changes are purely probabilistic, reflecting a drift toward the societal status quo.

Scintigraphic assessment of colonic function during defaecation.

The aim of this study was to develop a method by which rectal and colonic activity could be examined during defaecation under physiological conditions, in order to evaluate whether the colon plays a role in defaecation. Subjects presented to the Nuclear Medicine department on the day following ingestion of oral In-111 labelled DTPA, when they developed the normal urge to defaecate. Defaecation took place in a private room while dynamic scintigraphy of the rectum and colon was recorded. Fourteen subjects were studied (8 normal subjects, 4 with constipation, 2 with irritable bowel syndrome). In 13 subjects the left colon was visualized during defaecation and emptying was clearly observed in 12. The right colon was visualised in 11 subjects and emptying was seen in 7. Mean percentage segmental evacuation was right colon 20%, left colon 32% and rectum 66%. Colonic emptying occurs during defaecation, which is not a process of rectal evacuation only. This has implications for the understanding of the pathophysiology of obstructed defaecation.

The FEHBP as a model for a new Medicare program.

The deficiencies of the Medicare program are rooted in its defined-benefit structure and in its use of price controls. Medicare should be transformed into a defined cash contribution made to beneficiaries' private plans or to the traditional Medicare program. The Federal Employees Health Benefits Program (FEHBP) is essentially such a system and is a good model for Medicare reform. The FEHBP has been highly successful at holding down costs while offering a wide range of benefits and types of plans. Its features for consumer information and plan standards also would be useful in a reformed Medicare program.