Factors associated with occurrence and recovery of nonambulatory dairy cows in the United States.

The primary objective of this study was to compare characteristics of US dairy operations that had one or more nonambulatory cows (unable to rise for any period of time) (cases) with operations that had no nonambulatory cows (controls) during 2004. A secondary objective was to describe factors associated with recovery of the last nonambulatory cow on the operation during 2004. Case dairy operations (n = 1,822) more often fed a total mixed ration [odds ratio (OR) = 2.0; confidence interval (CI): 1.1-3.4], produced more than 9,090 kg of milk (OR = 2.8; CI: 1.8-4.5), and were more likely to be of medium to large herd size (100 or more head of adult cows, OR = 3.7; CI: 2.2-6.2) compared with control dairies (n = 151). Compared with operations where the predominant flooring surface on which lactating cows stood or walked in winter was pasture, operations where pasture was not the predominant surface were at increased risk of having nonambulatory cows (OR = 4.7; CI: 2.2-10.2). Cows nonambulatory for less than 24 h were more likely to recover compared with cows nonambulatory for 24 h or more (OR = 3.0; CI: 2.0-4.4). Cows that received calcium, phosphorus, or potassium while non-ambulatory were more likely to recover (OR = 3.6; CI: 2.1-6.1) than cattle that did not receive these treatments. Cattle that were not repositioned periodically were more likely to recover (OR = 2.1; CI: 1.4-3.1), as were cattle that were not treated by a veterinarian before becoming nonambulatory (OR = 1.9; CI: 1.1-3.3). These findings are consistent with prolonged recumbency and prior history of health issues, respectively. Nonambulatory cattle with hypocalcemia were more likely to recover (OR = 6.0; CI: 3.4-10.7) compared with nonambulatory cows with all other causes of a nonambulatory condition (analyzed collectively as a single variable but including cancer, clinical mastitis, digestive conditions, metabolic imbalances, neurological problems, respiratory disease, other, unknown). The results of this study reveal that the majority of US dairy operations have at least one nonambulatory dairy cow over the course of a year. Additionally, individual animal factors associated with being nonambulatory may lead to improved identification and treatment of animals that are nonambulatory for a prolonged period. From the perspective of recovery, considering euthanasia is appropriate for cows that have been nonambulatory for more than 24 h.

Cost analysis of unilateral and bilateral pallidotomy for Parkinson's disease.

With the rapid increase in provision of deep brain stimulation for Parkinson's disease, the efficacy of pallidotomy in symptom alleviation appears to be increasingly ignored. We demonstrate that lesional surgery is effective with benefit over a significant period of time with very significant societal cost savings. Such studies are essential for future planning of services so that maximum numbers of patients can benefit from surgery, both lesional and neuromodulation, as deemed appropriate.