Maternity Ultrasound in the Republic of Ireland 2016; A Review.

Antenatal ultrasound, comprising of a dating ultrasound in the late first trimester followed by a fetal anomaly scan, is a recognised and necessary component of good antenatal care. We conducted a telephone survey of all 19 obstetric units to ascertain the status of maternity ultrasound provision in Ireland. Fetal anomaly ultrasound is offered universally to all women in 7/19 (37%) units, selectively to some women in 7/19 (37%) units and not offered at all in the remaining 5/19 (26%) units. Overall ? 41,700 (64%) women receive a fetal anomaly ultrasound nationally. Universal first trimester ultrasound, performed in a dedicated ultrasound department by a suitably qualified sonographer, is offered to 47% of women nationally. This study highlights the lack of development in Irish maternity ultrasound services over the last decade. Substantial investment by health care policy makers is urgently needed.

Enhanced fertility prediction of cryopreserved boar spermatozoa using novel sperm function assessment.

Due to reduced fertility, cryopreserved semen is seldom used for commercial porcine artificial insemination (AI). Predicting the fertility of individual frozen ejaculates for selection of higher quality semen prior to AI would increase overall success. Our objective was to test novel and traditional laboratory analyses to identify characteristics of cryopreserved spermatozoa that are related to boar fertility. Traditional post-thaw analyses of motility, viability, and acrosome integrity were performed on each ejaculate. In vitro fertilization, cleavage, and blastocyst development were also determined. Finally, spermatozoa-oviduct binding and competitive zona-binding assays were applied to assess sperm adhesion to these two matrices. Fertility of the same ejaculates subjected to laboratory assays was determined for each boar by multi-sire AI and defined as (i) the mean percentage of the litter sired and (ii) the mean number of piglets sired in each litter. Means of each laboratory evaluation were calculated for each boar and those values were applied to multiple linear regression analyses to determine which sperm traits could collectively estimate fertility in the simplest model. The regression model to predict the percent of litter sired by each boar was highly effective (p < 0.001, r(2) = 0.87) and included five traits; acrosome-compromised spermatozoa, percent live spermatozoa (0 and 60 min post-thaw), percent total motility, and the number of zona-bound spermatozoa. A second model to predict the number of piglets sired by boar was also effective (p < 0.05, r(2) = 0.57). These models indicate that the fertility of cryopreserved boar spermatozoa can be predicted effectively by including traditional and novel laboratory assays that consider functions of spermatozoa.

An analysis of survey data by size of the breeding herd for the reproductive management practices of North American sow farms.

A survey was performed to assess whether reproductive management differed among small-sized (Sm, <500 sows), medium-sized (M, 501 to 2,000 sows), and large-sized (Lg, 2,001 to 8,000 sows) farms (n=113). Farms with 501 to 4000 sows/barn were most frequent with sows kept in stalls on 90% of farms. More Lg farms (P<0.05) functioned as breed to wean and more Sm and M as farrow to finish. More Sm and Lg farms weaned at >21 d, whereas M farms were more likely to wean at 18 to 21 d (P<0.05). More Lg farms had farrowing rates above 89% than Sm and M farms (P<0.05), and culling rates above 40% were more frequent on M and Lg farms than on S. On M and Lg farms, sows were bred in larger batches, using lower person to sow ratios, and with more people required than on Sm farms (P<0.05). More (P<0.05) M and Lg farms spent time moving sows and on records, but hours devoted to estrous detection, breeding, and other tasks did not differ among farms (P>0.10). More M and Lg farms used more boars for estrus detection, rotated boars, and controlled boar movement than Sm farms (P<0.05). Farm size also influenced semen sourcing, number of doses received, and frequency of semen delivery (P<0.05). More M and Lg farms performed AI in the presence of a boar, left the AI rod in after AI, checked for returns, and diagnosed pregnancy than Sm farms (P<0.05). Start of boar exposure after weaning began on 69% of farms within 2 d, occurring most often in the AM, but with exposure times varying from 1 to 5 min/sow. Semen was thermally protected for 50% of farms receiving shipments, and semen storage was consistent among farms. For AI, service occurred within minutes to hours after detection of estrus on 61% of farms. During AI, procedures such as back-pressure were required, whereas techniques such as hands-free AI were prohibited on most farms. Sow movement was allowed only once at 4 wk after breeding on 50% of farms, and pregnancy diagnosis occurred at 3 to 5 wk on 78% of farms. Most sows were allowed ≥1 chance for breeding after conception failure before culling. Incidence of fail to farrow was <5% and litter size was 10 to 13 pigs on >82% of farms. Summer infertility was observed on 69% of farms with estrus and pregnancy failures the leading causes. Over 70% of farms reported a technician effect on fertility. These results suggest that reproductive management of farms in key areas related to weaning, breeding, gestation, and labor use could be a source of variation in reproductive performance.

The roles of community pharmacists in cardiovascular disease prevention and management.

There is ample evidence in the international literature for pharmacist involvement in the prevention and management of cardiovascular disease (CVD) conditions in primary care. Systematic reviews and meta-analyses have confirmed the significant clinical benefits of pharmacist interventions for a range of CVD conditions and risk factors. Evidence generated in research studies of Australian community pharmacist involvement in CVD prevention and management is summarised in this article.Commonwealth funding through the Community Pharmacy Agreements has facilitated research to establish the feasibility and effectiveness of new models of primary care involving community pharmacists. Australian community pharmacists have been shown to effect positive clinical, humanistic and economic outcomes in patients with CVD conditions. Improvements in blood pressure, lipid levels, medication adherence and CVD risk have been demonstrated using different study designs. Satisfaction for GPs, pharmacists and consumers has also been reported. Perceived 'turf' encroachment, expertise of the pharmacist, space, time and remuneration are challenges to the implementation of disease management services involving community pharmacists.

Measuring the primary care experiences of low-income and minority patients.

This article describes a community-based survey of patients' experiences in community and migrant health centers that was designed to (1) develop a method to measure patients' experiences and (2) create a national database of patient experiences. The project succeeded in surveying the most difficult-to-reach poor and minority populations (mainly Medicaid and uninsured populations) in medically underserved areas, although more than 10% lack ready access to a telephone, another 22% do not speak English well enough to be interviewed in English, and many have limited literacy. We analyzed the responses from 3 perspectives: (1) demographics and health status, (2) dimensions of care, and (3) patient progress through the community and migrant health center system.

Intervention-based assessment: rates of evaluation and eligibility for specific learning disability classification.

Intervention-based assessment, a systematic form of prereferral intervention, represents a viable alternative to "test and place" models for identifying and teaching children with a variety of learning-related problems in schools. Data obtained from 13 schools participating for a third year in a pilot study of statewide implementation of intervention-based assessment suggested that, in comparison to a prior prereferral intervention model, fewer children are evaluated and found eligible for special education. Of those children receiving intervention-based assessment, a slight decrease occurs in the percentage classified as specifically learning disabled.