Inter- and intra-observer reliability of animal welfare indicators for the on-farm self-assessment of fattening pigs.

In Germany all keepers of livestock are legally required to record animal welfare indicators as part of their on-farm self-assessment. The Association for Technology and Structures in Agriculture (Kuratorium für Technik und Bauwesen in der Landwirtschaft e.V. (KTBL)) has suggested the use of a particular set of animal welfare indicators in their publication Animal welfare indicators: Practical guide - Pigs. The aim of the present study was to evaluate the inter-observer reliability (Inter-OR) and intra-observer reliability (Intra-OR) of these indicators with respect to the welfare of fattening pigs. For the assessment of Inter-OR, three observers evaluated six KTBL animal welfare indicators. The Inter-OR of the indicators was calculated from the results using intra-class correlation coefficients (ICC). 'Excellent' Inter-OR results were found for the indicators tail length (ICC 0.89), skin lesions (ICC 0.77) and ear lesions (ICC 0.80). In contrast, the Inter-OR of the indicators tail lesions (ICC 0.46) and faecal soiling (ICC 0.47) were considered to be only 'fair' and that of the indicator lameness (ICC 0.36) as 'poor'. For the evaluation of the Intra-OR, the same three observers assessed the welfare of 162 to 200 fattening pigs using the same welfare indicators in total eight times. Again ICCs, here per indicator and observer, were used to calculate the Intra-OR. The Intra-OR of the indicators faecal soiling (ICC 0.81) and ear lesions (ICC 0.97) lay in the 'excellent' range on average. While the Intra-OR of the indicators skin lesions (ICC 0.67), tail length (ICC 0.74) and lameness (ICC 0.60) could still be considered as being 'good', the Intra-OR of the indicator tail lesions (ICC 0.52) could only be assessed as being 'fair'. From these results the significance of the KTBL indicators could be judged as follows: it is possible to use all the chosen indicators apart from the indicator tail lesions as an internal controlling instrument or as part of an internal weak-point analysis as long as the indicators are evaluated by the same person. A comparison of the indicators tail lesions, lameness and faecal soiling when assessed by different observers should be considered critically because the Inter-OR of these three indicators could only be considered as being 'poor' to 'fair'.

[Evaluation and socio-economic relevance of an integrated osteoporosis health care network]. / Evaluation und sozio-ökonomische Bewertung eines Modells zur Integrierten Versorgung zur Behandlung der Osteoporose.

During the last 6 to 7 years, integrated health care has become more and more important in Germany. In August 2005 we initiated a collaborative project involving two orthopaedic clinics in Hanover and one rehabilitation clinic in Bad Pyrmont specialising in the treatment of osteoporosis. Here, we report the results of 633 women (83 ± 7 years) and 162 men (75 ± 10 years) who participated in this programme between August 2005 and August 2012. All participants gave informed consent. All patients were supplemented with 1200 mg of calcium and 800 IU of vitamin D. Intravenous bisphosphonates were given to 91% and parathyroid hormone to 7% of the patients. Two per cent received miscellanous therapeutic agents. Follow-up visits were attended by 89% of the patients after one year and 78% after two years. During this time, a significant improvement was observed in vitamin D, parathyroid hormone and the bone marker desoxypyridinoline. DXA measurements were falsified by degenerative disease or fractures. In the men, however, a significant increase was observed in the total hip. Over the two-year period, 16 vertebral and 3 non-vertebral fractures occurred in the women. In the men, one non-vertebral and 5 vertebral fractures were noted. Among the women, 18 died and 6 were admitted to a nursing home. The corresponding figures among the men were 7 and 4, respectively. According to the figures provided by the central German institute for statistics, the death rates among the women were significantly lower than expected, whereas a tendency toward lower death rates was seen in the men. In addition, the number of new hip fractures in the women was lower than the epidemiological data suggest. This was also noted in the men. Even among the very old, a musculoskeletal rehabilitation programme combined with adequate pharmaceutical therapy may prove very successful when it comes to death rates and nursing home admissions. The latter in particular may be very expensive in the long run and our longitudinal follow-up study may demonstrate cost-effectiveness if the rehabilitation programme is commenced as early as possible.

Conserving large carnivores: dollars and fence.

Conservationists often advocate for landscape approaches to wildlife management while others argue for physical separation between protected species and human communities, but direct empirical comparisons of these alternatives are scarce. We relate African lion population densities and population trends to contrasting management practices across 42 sites in 11 countries. Lion populations in fenced reserves are significantly closer to their estimated carrying capacities than unfenced populations. Whereas fenced reserves can maintain lions at 80% of their potential densities on annual management budgets of $500 km(-2) , unfenced populations require budgets in excess of $2000 km(-2) to attain half their potential densities. Lions in fenced reserves are primarily limited by density dependence, but lions in unfenced reserves are highly sensitive to human population densities in surrounding communities, and unfenced populations are frequently subjected to density-independent factors. Nearly half the unfenced lion populations may decline to near extinction over the next 20-40 years.

Cost barriers reduce confidence in receiving medical care when seriously ill.

People need to trust that necessary care will be provided in the case of serious illness or injury, but negative experiences with the healthcare system reduce confidence. In this article, we discuss the effect of cost barriers on people's confidence in receiving safe and quality medical care when falling seriously ill in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom and the United States.

[Assessment and outcome parameters in COPD]. / Beurteilungs- und Prognosekriterien bei COPD1.

BACKGROUND: A standard outcome parameter for pharmacological trials in COPD has not yet been defined. Therefore, it is the aim of this review to evaluate frequently used parameters for their eligibility as assessment and outcome parameters in COPD. METHODS: A review of the actual scientific literature was performed. RESULTS: It is recommended to continue to rely primarily on the FEV (1), which has been used as a primary variable in the vast majority of trials. In addition, further parameters, such as FVC and IC/TLC should be determined. If available, additional information is provided by RV/TLC, K (co), PaO (2) and PaCO (2). FEV (1) is not a surrogate parameter for dyspnoea, quality of life, and exercise tolerance, which should therefore be assessed separately. Frequency and severity of exacerbations and mortality are important outcome parameters in long-term trials. Complex indices, such as the BODE index, may be superior to single variables. CONCLUSIONS: No single additional parameter has been evaluated sufficiently in order to substitute FEV (1) as the standard parameter for the assessment and outcome in COPD.

[Therapy of osteoporosis from the viewpoint of evidence-based medicine]. / Die Therapie der Osteoporose aus dem Blickwinkel einer auf Evidenz basierenden Medizin.

DEFINITION AND SOCIOECONOMIC ASPECTS: Osteoporosis is a disease characterized by low bone mass and an increased susceptibility to fractures. It represents an enormous burden for the social security systems in developed countries. In Germany, approximately two million women and 800,000 men suffer from vertebral fractures and estimates for hip fracture incidence are in the range of 70,000-130,000 per year. The resulting costs for hip fractures alone could be calculated to 3-5 billion German marks. THERAPY ACCORDING TO EVIDENCE-BASED MEDICINE (EBM): According to Sackett et al. 1996, evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external evidence from systematic research. OSTEOPOROSIS THERAPY: The goal of osteoporosis therapy is to prevent fractures and several therapeutic options are available for this disease. With respect to proven fracture benefit, however, the quality of evidence from randomized clinical trials varies substantially among therapies. From systematic research the best external evidence is available for a supplementation with calcium and vitamin D and a therapy with the bisphosphonates alendronate or risedronate, as well as the SERM raloxifene. For other therapeutic agents like fluorides, vitamin D metabolites, calcitonin, and etidronate the quality of evidence is much lower. So far, there is no evidence for other pharmaceutical therapies. Hip protectors are effective for the prevention of hip fractures.

Reproducibility of the insulin tolerance test (ITT) for assessment of growth hormone and cortisol secretion in normal and hypopituitary adult men.

OBJECTIVE: The within subject variability of the insulin tolerance test (ITT) for assessment of growth hormone (GH) status and cortisol reserve has rarely been examined, particularly in patients with hypopituitarism. This becomes important when biochemical criteria are used to determine which adults with hypopituitarism should receive GH and/or cortisol replacement. In the present study we assessed the reproducibility of GH and cortisol responses in repeated ITTs. Baseline insulin-like growth factor 1 (IGF-1) levels were also assessed for reproducibility on each occasion. DESIGN AND PATIENTS: Three consecutive ITTs were performed in seven normal adult men (ages 22-27 years) and two ITTs in 11 men with hypopituitarism and suspected GH deficiency (ages 23-48 years). MEASUREMENTS: Serum GH and IGF-1 were measured by immunoradiometric and cortisol by immunofluorimetric assays. RESULTS: In normal men group peak GH responses did not differ between the three tests. There was no correlation between individual peak values. The within subject peak GH variability was between 4.6 and 59.3%, and the overall variability in 21 tests was 35%. The lowest peak GH concentration was 70 mU/l (27 microg/l). All hypopituitary men had severe GH deficiency (all peak GH concentrations < 4 mU/l (1.5 microg/l) in both tests). There was a highly significant correlation between individual peak GH values (r = 0.95, P < 0.0001). Basal IGF-1-values in normal and hypopituitary men were highly correlated between tests (r = 0.98, P < 0.0001). The overall within subject variability of IGF-1-values was 11.9% in normal and 22.7% in hypopituitary men. In normal men group peak cortisol responses were not different between the three tests. There was a good correlation between individual peak cortisol responses in the three ITTs. The within subject peak cortisol variability (median 8.3%; range 0.7-21.5%) was significantly less than that of GH (P < 0.03) in two of three test comparisons. In hypopituitary men the within subject peak cortisol variability (median 41.6%; range 3.5-92.7%) was significantly greater (P < 0.001) than in normal men. All patients were correctly classified as cortisol deficient or normal in both ITTs. CONCLUSION: The cortisol response to repeated hypoglycaemia is very reproducible in normal men but the GH response is less so. In hypopituitary men the reproducibility of the GH response is good while that of the cortisol response is poor. However, a single ITT did not misclassify hypopituitary patients who are severely GH and/or ACTH deficient and was therefore adequate for clinical decisions regarding GH and/or cortisol replacement. Nevertheless, it remains possible that a single ITT could misclassify some hypopituitary patients with partial GH or ACTH deficiency.

Assessment of left ventricular diastolic filling in arterial hypertension: comparison of pulsed Doppler echocardiography and acoustic quantification.

We compared acoustic quantification (AQ) to Doppler echocardiography (DE) in the evaluation of left ventricular (LV) diastolic filling in 41 hypertensives and 42 controls. In hypertensives, DE showed reduced ratios of early to late diastolic velocity, AQ revealed reduced peak to late filling rate ratios, and both techniques found prolonged acceleration times indicating abnormal filling. In 22 patients with mild hypertension and less LV hypertrophy, however, all DE filling parameters were normal. In these patients AQ indicated prolonged acceleration times and early filling times. In conclusion, AQ is useful for the identification of abnormal LV filling in arterial hypertension and might be superior to DE in detection of early diastolic dysfunction.

Transgastric Doppler echocardiographic assessment of the severity of aortic stenosis using multiplane transesophageal echocardiography.

We investigated whether multiplane transesophageal Doppler echocardiography using transgastral views allows determination of pressure gadients and valve areas in patients with aortic stenosis. This technique was feasible in 35 of 39 patients (90%), with highly significant correlations with results obtained from transthoracic Doppler echocardiography and cardiac catheterization, thus offering an alternative approach for quantification of aortic stenosis.

Sensitivity of R-R variation and Valsalva ratio in assessment of cardiovascular diabetic autonomic neuropathy.

R-R variation and the Valsalva ratio are commonly used to quantitatively assess diabetic autonomic neuropathy (DAN). To assess the sensitivity of these two measures to parasympathetic ablation, 12 nondiabetic subjects were tested before and after graded doses (0.3-4.0 mg i.v.) of atropine. R-R variation was significantly reduced at 0.7 mg, whereas Valsalva ratio was not significantly smaller until the 2.0-mg dose of atropine. R-R variation continued to become progressively smaller during the 0.85-, 1.0-, and 2.0-mg doses. Valsalva ratio, but not R-R variation, was further reduced by the 4.0-mg dose. To further compare these two measures, two groups of diabetic subjects were compared with a group of nondiabetic subjects (n = 22). One group of diabetic subjects had symptoms of DAN (n = 22), and the other diabetic group had no symptoms of DAN (n = 19). In DAN subjects, both R-R variation (nondiabetic 33.2 +/- 4.3 vs. DAN 9.8 +/- 1.2, P less than .001) and the Valsalva ratio (nondiabetic 1.98 +/- 0.07 vs. DAN 1.55 +/- 0.07, P less than .001) were reduced. However, in asymptomatic subjects, R-R variation (23.2 +/- 3.9, P less than .05), but not Valsalva ratio (1.94 +/- 0.13, NS), was less than nondiabetic subjects. Even after beta-blockade, R-R variation was still less in both groups of diabetic subjects (nondiabetic 34.4 +/- 4.2 vs. DAN 7.4 +/- 1.3, P less than .001; asymptomatic 21.8 +/- 3.3, P less than .02).(ABSTRACT TRUNCATED AT 250 WORDS)

An improved method for measuring heart-rate variability: assessment of cardiac autonomic function.

Heart rate oscillates in synchrony with respiration. Several methods have been employed to assess this 'sinus arrhythmia', as an index of autonomic nervous system function. This paper proposes a new, easily computed measure, R, which is relatively resistant to the major nonrespiratory sources of variation, including premature beats, heart-rate differences among subjects, and slow trends in heart rate over time within subjects. The method can also be used more generally in any context where individuals are associated with event processes (for example, with seizures), when one requires assessment of the extent to which a point process is periodic with a particular known period.