Assessment of feed and economic efficiency of dairy farms based on multivariate aggregation of partial indicators measured on field.

Many of the metrics used to evaluate farm performance are only partial indicators of farm operations, which are assumed to be best predictors of the whole farm efficiency. The main objective of this work was to identify aggregated multiple indexes of profitability using common partial indicators that are routinely available from individual farms to better support the short-term decision-making processes of the cattle-feeding process. Data were collected from face-to-face interviews with farmers from 90 dairy farms in Italy and used to calculate 16 partial indicators that covered almost all indicators currently used to target feeding and economic efficiency in dairy farms. These partial indicators described feed efficiency, energy utilization, feed costs, milk-to-feed price ratio, income over feed costs, income equal feed cost, money-corrected milk, and bargaining power for feed costs. Calculations of feeding costs were based on lactating cows or the whole herd, and income from milk deliveries was determined with or without considering the milk quality payment. Multivariate factor analysis was then applied to the 16 partial indicators to determine simplified and latent structures. The results indicated that 5 factors explained 70% of the variability. Each of the original partial indicator was associated with all factors in different proportions, as indicated by loading scores from the multivariate factor analysis. Based on the loading scores, we labeled these 5 factors as "economic efficiency," "energy utilization," "break-even point," "milk-to-feed price," and "bargaining power of the farm," in decreasing order of explained communality. The first 3 factors shared 83% of the total communality. Feed efficiency was similarly associated with factor 1 (53% loading) and factor 2 (66% loading). Only factor 4 was significantly affected by farm location. Milk production and herd size had significant effects on factor 1 and factor 2. Our multivariate approach eliminated the problem of multicollinearity of partial indicators, providing simple and effective descriptions of farm feeding economics. The proposed method allowed the evaluation, benchmarking, and ranking of dairy herd performance at the level of single farms and at territorial level with high opportunity to be used or replicated in other areas.

Assessment of simple strategies for identifying undiagnosed diabetes and prediabetes in the general population.

BACKGROUND AND AIMS: The rising tide of diabetes mellitus (DM) and prediabetes (PDM) is urgently calling for strategies easily applicable to anticipate diagnosis. We assessed the effectiveness of random capillary blood glucose (RCBG), administration of a validated DM risk questionnaire, or the combination of both. MATERIALS AND METHODS: RCBG measurement and/or questionnaire administration were offered to all individuals presenting at gazebos organized during the World Diabetes Day or similar public initiatives on diabetes awareness. Subjects with suspicious DM or PDM were invited to the Diabetes Center (DC) for laboratory confirmation (fasting plasma glucose and HbA1c). RESULTS: Among 8563 individuals without known diabetes undergoing RCBG measurement, 341 (4%) had suspicious values. Diagnosis of DM was confirmed in 36 (41.9%) of the 86 subjects who came to the DC and PDM was found in 40 (46.5%). Among 3351 subjects to whom the questionnaire was administered, 480 (14.3%) had suspicious scores. Diagnosis of DM was confirmed in 40 (10.1%) of the 397 who came to the DC and PDM was found in 214 (53.9%). These 3351 subjects also had RCBG measurement and 30 out of them had both tests positive. Among them, 27 subjects came to DC and DM was diagnosed in 17 (63.0%) and PDM was found in 9 (33.3%). CONCLUSIONS: These data suggest that RCBG definitely outperforms the questionnaire to identify unknown DM and PDM. RCBG measurement, with questionnaire as an adjunctive tool, appears to be a simple, fast, and feasible opportunistic strategy in detecting undiagnosed DM and PDM.

Development of a linear programming model for the optimal allocation of nutritional resources in a dairy herd.

A linear programming model that selects the optimal cropping plan and feeds allocation for diets to minimize the whole dairy farm feed costs was developed. The model was virtually applied on 29 high-yielding Holstein-Friesian herds, confined, total mixed ration dairy farms. The average herd size was 313.2 ± 144.1 lactating cows and the average land size was 152.2 ± 92.5 ha. Farm characteristics such as herd structure, nutritional grouping strategies, feed consumption, cropping plan, intrinsic farm limitations (e.g., silage and hay storage availability, water for irrigation, manure storage) and on farm produced forage costs of production were collected from each farm for the year 2017. Actual feeding strategies, land availability, herd structure, crop production costs and yields, and milk and feed market prices for the year 2017 were used as model inputs. Through optimization, the feeding system was kept equal to the actual farm practice. The linear program formulated diets for each animal group to respect actual herd dry matter intake and fulfill actual consumption of crude protein, rumen-degradable and rumen-undegradable fractions of crude protein, net energy for lactation, neutral detergent fiber, acid detergent fiber, forage neutral detergent fiber, and nonfiber carbohydrate. Production levels and herd composition were considered to remain constant as the nutritional requirement would remain unchanged. The objective function was set to minimize the whole-farm feed costs including cash crop sales as income, and crop production costs and purchased feed costs as expenses. Optimization improved income over feed costs by reducing herd feed costs by 7.8 ± 6.4%, from baseline to optimized scenario, the improved was explained by lower feed costs per kilogram of milk produced due to a higher feed self-sufficiency and higher income from cash crop. In particular, the model suggested to maximize, starting from baseline to optimized scenario, the net energy for lactation (+8.5 ± 6.3%) and crude protein (+3.6 ± 3.1%) produced on farm, whereas total feed cost (€/100 kg of milk) was greater in the baseline (20.4 ± 2.3) than the optimized scenario (19.0 ± 1.9), resulting in a 6.7% feed cost reduction with a range between 0.49% and 21.6%. This meant €109 ± 96.9 greater net return per cow per year. The implementation of the proposed linear programming model for the optimal allocation of the nutritional resources and crops in a dairy herd has the potential to reduce feed cost of diets and improve the farm feed self-sufficiency.

The repercussion of stopping reimbursement of olmésartan on antihypertensive drugs prescription and blood pressure control of treated hypertensive patients in France.

OBJECTIVE: Since January 2017, olmesartan-based treatments are no longer reimbursed by French health insurance. Health authorities have recommended switch to one of the "many effective, better tolerated and reimbursed alternatives". The objective of this study was to evaluate the consequences on the prescription of antihypertensive drugs in France and to evaluate the blood pressure control of treated hypertensive patients after the switch from olmesartan to another Angiotensin receptor blocker (ARB). METHODS: To evaluate antihypertensive prescriptions, the French League Against Hypertension Survey (FLAHS) was conducted in 2007, 2012 and 2017 by self-questionnaire sent by mail to a representative panel of the population living in metropolitan France aged 35 years and over. Antihypertensive treatments were grouped by pharmacological class. To evaluate blood pressure control in hypertensive patients treated with olmesartan alone or in combination, 3 home blood pressure monitoring (HBPM) were performed. The first and the second were performed without modification of the dose of olmesartan. The third was performed 1 month after the switch to another ARB. RESULTS: Antihypertensive prescriptions changed between 2007 and 2017. Beta-blockers decreased between 2007 and 2012 and then increased slightly. Between 2012 and 2017, ARB and diuretics decreased and ACE inhibitors (ACE-I) and calcium antagonist (CA) drugs increased. Blood pressure control was assessed in 82 hypertensive patients aged 63±11 years treated with olmesartan. The difference in SBP/DBP between the first 2 self-measurements was -0.96/-0.83mmHg. After therapy switch, the 3rd self-measurement showed an increase in SBP/DBP of 3.4/1.2mmHg. In the subgroup of olmesartan-treated controlled hypertensive patients, the switch to another ARB lead to uncontrolled hypertension for 20% of patients with a 12.1mmHg increase in SBP. CONCLUSION: With the halt of reimbursement of olmesartan, there was a decrease in the prescription of ARB in France. When olmersartan was replaced by another ARB, a worse blood pressure control was observed in treated hypertensive patients. The cessation of the reimbursement of olmesartan has had consequences on the treatment of hypertension in France.

[Position paper by the Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) and the Deutsche Leukämie-Forschungshilfe (DLFH) on psycho-social care for pediatric oncology and hematology patients in hospital]. / Positionspapier der Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) und der Deutschen Leukämie-Forschungshilfe (DLFH) zur psychosozialen Versorgung pädiatrisch-onkologischer und -hämatologischer Patienten in der Akutklinik.

Psychosocial Care has been an integral part of the overall treatment in pediatric oncology for 25 years. The need for it and its effectiveness are well documented in several reputable studies and psychosocial service has proved its worth in everyday clinical settings. In order to secure comparable quality standards and in consequence of reorganisations within the health-care system a position paper has been prepared and adopted by the Psychosoziale Arbeitsgemeinschaft in der Pädiatrischen Onkologie und Hämatologie (PSAPOH), the Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) and the Deutsche Leukämie-Forschungshilfe (DLFH). The following article gives a short survey of this position paper and provides insight into the goals, conditions and outcomes of psychosocial care in pediatric oncology and hematology.

Toxicity assessment of metabolites of fungal biocontrol agents using two different (Artemia salina and Daphnia magna) invertebrate bioassays.

Fungal biocontrol agents (BCAs) have been marketed for control of crop pests, weeds, and diseases. However, BCAs may produce toxic metabolites, whose presence in the formulated products, in the crops and in the environment should be considered along with the associated risk. Two invertebrate models, viz. Artemia salina and Daphnia magna were used to assess the acute toxicity of seven BCA metabolites, characterized by different chemical nature and mode of action, namely alamethicin (ALA), paracelsin (PCS), antiamoebin (AAM), gliotoxin (GTX), destruxin A (DA), oosporein (OOS), and elsinochrome A (EA). The two invertebrates were very sensitive to all the metabolites examined, except OOS. The LC50s after 24 and 36 h exposures showed the following toxicity ranks: A. salina, DA > ALA > EA > GTX > AAM > PCS (LC50s ranging from 9.78 to 40.84 microg/ml at 24 h and from 2.92 to 18.56 microg/ml at 36 h); D. magna, DA > GTX = EA > ALA > PCS > AAM (LC50s ranging from 0.20 to 24.41 microg/ml at 24h and from 0.16 to 11.98 microg/ml at 36 h). LC50 of OOS to D. magna increased dramatically in 36 h exposure, compared to 24 h exposures (5.84 and 68.40 microg/ml, respectively). A. salina and D. magna proved to be suitable models for rapid and inexpensive screening of toxicity of BCAs at an early stage of product development.

Otorhinolaryngology emergency unit care: the experience of a large university hospital in Italy.

We recorded the symptoms and disposition of every patient who visited the otorhinolaryngology emergency department at our hospital in Rome, Italy, during 1996. During that time, our ENT specialists saw 21,548 patients. Only 311 of these patients (1.4%) required immediate hospitalization, while another 2,391 patients (11.1%) received treatment and were released. The other 18,846 patients (87.5%) did not have any pathology or condition that qualified as an actual emergency, and they were examined and released, often with a prescription or instructions for home care. These patients could have easily been treated by a family physician. The fact that emergency care in Italy is rendered free of charge (unlike ambulatory care, for which fees are charged) provides patients with a strong incentive to misuse the system. Such overutilization drives up the cost of health care and stretches the capacity of the medical staff. Steps need to be taken to redirect patients who misuse emergency services to seek medical care in ambulatory care centers.

Caring for individuals using home ventilators: an appraisal by family caregivers.

This article describes a study of the effects of caregiving on family members who assumed primary responsibility for managing the care of ventilator-assisted individuals in the home. Thirteen caregivers were interviewed and five variables associated with their role were assessed: caregiving tasks, burden of caregiving, impact of caregiving, mastery of the caregiving role, and satisfaction with caregiving. Data were collected using the Caregiving Appraisal Scale (CAS), a list of caregiving tasks, and a semistructured interview. Caregivers assumed multiple responsibilities for individuals who were completely ventilator-dependent (n = 5), partially ventilator-dependent (n = 3), or nocturnally ventilated (n = 5). Caregivers reported feeling moderate levels of both the burden and the negative impact of caregiving but a positive sense of mastery and satisfaction. They described problems with home healthcare nurses, insurance coverage, and equipment suppliers. Lack of preparation, in terms of education provided by healthcare professionals, limited their ability to manage these problems quickly and effectively. Caregivers suggested that healthcare providers expand discharge planning to include provision of problem-solving strategies.

Multiple biochemical blood testing as a case-finding tool in ambulatory medical patients.

PURPOSE: The usefulness and costs of multiple biochemical blood tests as a case-finding tool in ambulatory medical patients are not well known. Recommendations are lacking or based upon results of screening asymptomatic persons. We designed a study to determine prospectively the yield, potential disadvantages, and patient charges of routine biochemical testing at our medical outpatient clinic. PATIENTS AND METHODS: Twenty-three biochemical parameters were evaluated in 493 consecutive patients. Parameters not considered indicated for diagnostic or management purposes by the staff physicians at the first visit were classified as routine tests. The main outcome measures were the number and the nature of new diagnoses leading to a new management, the number of additional tests and visits, and patient charges. RESULTS: New diagnoses resulting in new management were found in 25 patients (5%). They were mainly lipid disorders. Seven additional visits and 74 further tests were caused by abnormal results of routine tests. The net charges for the detection of the new diagnoses leading to new management were $12,682. Secondary analysis revealed that the determination of only three routine tests (cholesterol, glucose, alanine aminotransferase) would have detected all clinically important diagnoses and would have reduced the charges by 30%. CONCLUSIONS: Routine biochemical testing is a useful case-finding tool with acceptable costs in middle-aged medical outpatients of a university teaching setting. However, the spectrum of newly detected disorders leading to changes in patient management is small. The results suggest that a reduced routine battery consisting of cholesterol, glucose, and alanine aminotransferase might be preferable because it will detect the clinically important diagnoses and lead to a substantial reduction of patient charges.

Social constraints determine what is learned in the chimpanzee.

A group of six chimpanzees was placed in a social learning situation, without training. The learning task was an operant conditioning situation; that is, a subject had to pull two handles simultaneously to cause a piece of fruit to fall into the cage. Only three individuals acquired the operant behaviour. For the operant individuals, social influences on the expression of the learning task were then examined; the dominant chimpanzee during feeding had an inhibiting effect when close to the operant subjects. Depending on the subject, social factors may influence not only the specific expression of what is learnt, but also the nature of what is learnt. Chimpanzees appear to experience situations differently: they develop an individual problem-solving strategy according to their social relationships even if the experimental procedure is the same for all.