Relationship between daily rumination time and estrus of dairy cows.

The aim of the study was to investigate whether rumination time (RT) was related to estrus in dairy cattle. On 4 farms, cows were equipped with a microphone-based sensor system that allowed continuous recording (in blocks of 2 h) of RT. The analyzed data set consisted of 265 verified estrus cycles of 224 animals with artificial insemination leading to conception. The day of estrus (d 0) was defined as the day when estrus was identified either by measurement of physical activity or by visual observation. In estrous cows, RT was significantly reduced. With a duration of 355 min/d, the minimum RT was found on the day of estrus compared with the base level of 429 min/d during the reference period (the mean of 3 d before and 3 d after estrus). The average decrease in RT was 17% (74 min), ranging between -71 and +16% among animals. Herd and parity affected the RT decrease during estrus. Among the 4 analyzed herds, the RT decrease of cows in estrus ranged between 14% (60 min/d) and 24% (94 min/d). The decrease in RT was more pronounced in primiparous than in mature cows. In conclusion, RT is reduced on the day of estrus on average. The RT decrease during estrus was characterized by high variation among cows.

A Cross-Sectional Audit of Nutrition and Health Claims on Dairy Yoghurts in Supermarkets of the Illawarra Region of New South Wales, Australia.

Health and nutrition claims are used by consumers to guide purchasing decisions. In consequence, monitoring and evaluation of such claims to ensure they are accurate and transparent is required. The aim of this study was to investigate the use of nutrition and health claims on dairy-yoghurt products within select Australian supermarkets and assess their compliance with the revised Food Standards Code (FSC). Nutrition, health, and related claims on yoghurt products were assessed in a cross-sectional audit of five supermarkets in the Illawarra region of New South Wales. Claim prevalence, type, and compliance were assessed and products were compared against current rating measures. A total of n = 340 dairy yoghurt products were identified. Most products (97.9%) carried at least one nutrition and/or health claim, with nutrition-content claims (93.9%) the most prevalent. Most products (n = 277) met the nutrient profiling scoring criterion; while 87.9% of products did not carry the health star rating. Almost all claims surveyed (97.4%) were compliant with the FSC. Health and nutrition claims are highly prevalent across yoghurt categories, with the majority of these compliant with regulations. The ambiguity surrounding the wording and context of claims challenges researchers to investigate consumers' interpretations of health messaging within the food environment.

Review: Behavioral signs of estrus and the potential of fully automated systems for detection of estrus in dairy cattle.

Efficient detection of estrus is a permanent challenge for successful reproductive performance in dairy cattle. In this context, comprehensive knowledge of estrus-related behaviors is fundamental to achieve optimal estrus detection rates. This review was designed to identify the characteristics of behavioral estrus as a necessary basis for developing strategies and technologies to improve the reproductive management on dairy farms. The focus is on secondary symptoms of estrus (mounting, activity, aggressive and agonistic behaviors) which seem more indicative than standing behavior. The consequences of management, housing conditions and cow- and environmental-related factors impacting expression and detection of estrus as well as their relative importance are described in order to increase efficiency and accuracy of estrus detection. As traditional estrus detection via visual observation is time-consuming and ineffective, there has been a considerable advancement of detection aids during the last 10 years. By now, a number of fully automated technologies including pressure sensing systems, activity meters, video cameras, recordings of vocalization as well as measurements of body temperature and milk progesterone concentration are available. These systems differ in many aspects regarding sustainability and efficiency as keys to their adoption for farm use. As being most practical for estrus detection a high priority - according to the current research - is given to the detection based on sensor-supported activity monitoring, especially accelerometer systems. Due to differences in individual intensity and duration of estrus multivariate analysis can support herd managers in determining the onset of estrus. Actually, there is increasing interest in investigating the potential of combining data of activity monitoring and information of several other methods, which may lead to the best results concerning sensitivity and specificity of detection. Future improvements will likely require more multivariate detection by data and systems already existing on farms.

[Delirium and delirium management in critically ill patients]. / Delir und Delirmanagement bei kritisch kranken Patienten.

Delirium in critically ill patients is a common entity in the intensive care unit (ICU) and is an expression of the cerebral organ dysfunction of the patient. The hallmark signs are disturbed consciousness and cognition in combination with inattentiveness and alterations in perception, which are manifested within a time interval of hours to days during treatment on the ICU. Delirium has been shown to have negative effects on patient short-term and long-term outcome parameters and increases morbidity and mortality. Despite its significance in many cases delirium remains inadequately diagnosed during routine treatment by ICU personnel. There are two validated and easily applicable scales for the standardized diagnosis of delirium: the confusion assessment method for the ICU (CAM-ICU) and the intensive care delirium screening checklist (ICDSC). These are simple to apply by medical as well as non-medical personnel. The therapy of delirium is mostly determined by non-pharmacological measures aiming at early identification, reorientation and mobilization of the patient, improving cerebral activity and establishing adequate wake-sleep cycles. There is only sparse evidence for pharmacological treatment of delirium; however, the choice of sedative agent has a proven effect on the incidence and duration of delirium in the ICU.

A newly created splice donor site in exon 25 of the MyBP-C gene is responsible for inherited hypertrophic cardiomyopathy with incomplete disease penetrance.

BACKGROUND: Hypertrophic cardiomyopathy is a myocardial disorder resulting from inherited sarcomeric dysfunction. We report a mutation in the myosin-binding protein-C (MyBP-C) gene, its clinical consequences in a large family, and myocardial tissue findings that may provide insight into the mechanism of disease. METHODS AND RESULTS: History and clinical status (examination, ECG, and echocardiography) were assessed in 49 members of a multigeneration family. Linkage analysis implicated the MyBP-C gene on chromosome 11. Myocardial mRNA, genomic MyBP-C DNA, and the myocardial proteins of patients and healthy relatives were analyzed. A single guanine nucleotide insertion in exon 25 of the MyBP-C gene resulted in the loss of 40 bases in abnormally processed mRNA. A 30-kDa truncation at the C-terminus of the protein was predicted, but a polypeptide of the expected size ( approximately 95 kDa) was not detected by immunoblot testing. The disease phenotype in this family was characterized in detail: only 10 of 27 gene carriers fulfilled diagnostic criteria. Five carriers showed borderline hypertrophic cardiomyopathy, and 12 carriers were asymptomatic, with normal ECG and echocardiograms. The age of onset in symptomatic patients was late (29 to 68 years). In 2 patients, outflow obstruction required surgery. Two family members experienced premature sudden cardiac death, but survival at 50 years was 95%. CONCLUSIONS: Penetrance of this mutation was incomplete and age-dependent. The large number of asymptomatic carriers and the good prognosis support the interpretation of benign disease.

[Resuscitation]. / Reanimation.

The primary aim of cardiopulmonary resuscitation after cardiac arrest is to achieve the return of spontaneous circulation (ROSC). However, following ROSC the clinical and neurologic outcome is mainly influenced by adequate treatment in the postresuscitation period. There are several novel recommendations in the current 2010 guidelines of the European Resuscitation Council (ERC) concerning advanced life support (ALS). In addition to established standards for mechanical, electrical (defibrillation), and pharmacological resuscitation during the initial phase, the guidelines moreover deal with recommendations for standardized therapy in the postresuscitation period. Major aspects concerning the therapy of the postcardiac arrest syndrome include temperature management with therapeutic hypothermia, mechanical ventilation and the extent of oxygenation and blood glucose control. Thus, the initial cardiopulmonary resuscitation and the following postresuscitation treatment have to be considered as merging therapy concepts. Only a standardized therapeutic approach in these different phases of treatment will result in successful resuscitation with high rates of survival and good neurologic outcome.

Characterization of a strain of methicillin-resistant Staphylococcus aureus (EMRSA-15) by conventional and molecular methods.

A strain of methicillin-resistant Staphylococcus aureus (MRSA), EMRSA-15, was isolated in both the Midlands and south-east of England. This strain could be distinguished from another, very similar strain, found in the north of England, by both conventional and molecular typing. Conventional typing allowed distinction between the Midlands and southern variants of EMRSA-15, while molecular typing (pulse-field gel electrophoresis) allowed recognition of local variants in the south. In this investigation conventional and molecular typing methods were complementary.

Control of an outbreak of an epidemic methicillin-resistant Staphylococcus aureus also resistant to mupirocin.

An epidemic methicillin-resistant Staphlococcus aureus (EMRSA-3) appeared in a District hospital in June 1989 as part of a regional outbreak. The dynamics of the outbreak were complex and involved patient transfer between hospitals and wards. Control measures followed UK guidelines and included the use of nasal mupirocin. During these efforts a mupirocin-resistant MRSA [MuMRSA: mupirocin minimum inhibitor concentration (MIC) > 256 mg/L] emerged, probably in a patient who had been given eight mupirocin courses over nine months. The MuMRSA had a narrower phage-typing pattern than EMRSA-3, but was indistinguishable by pulsed-field gel electrophoresis of SmaI chromosomal restriction enzyme digests and its susceptibility pattern to other antibiotics. The results of in vitro curing and gene probing indicated that mupirocin resistance was encoded on a 48 Md plasmid. MuMRSA spread occurred in 12 patients and 11 staff. The affected patients were nursed on the same ward. The strain was eradicated from patients with oral ciprofloxacin and rifampicin, triclosan skin treatment and nasal fusidic acid and bacitracin cream. The control of the outbreak had significant medical, social and financial implications. Fortunately, there were alternative topical agents to mupirocin, an agent which has played such a key role in MRSA eradication in recent years.

Nosocomial spread of Staphylococcus aureus showing intermediate resistance to methicillin.

A nosocomial outbreak of infection and colonization involving six patients and caused by a strain of Staphylococcus aureus showing intermediate resistance to methicillin (MIC = 4-8 mg l-1) is described. The outbreak was associated with skin-carriage of the epidemic strain by a nurse suffering from severe eczema. The reduced susceptibility of the outbreak strain to methicillin was associated with beta-lactamase production. Elimination or inhibition of beta-lactamase activity produced a two-fold decrease in methicillin MIC. There was no evidence for the presence of either penicillin-binding protein 2a or the corresponding mec gene, which mediate resistance in fully methicillin-resistant strains.

Surgical correction of hypertrophic obstructive cardiomyopathy with combined myectomy, mobilisation and partial excision of the papillary muscles.

A modified surgical technique for correction of hypertrophic obstructive cardiomyopathy (HOCM) with extended myectomy together with mobilisation and partial excision of papillary muscles was performed between 1/79 and 12/92 in 58 severely symptomatic patients refractory to medical treatment. Low hospital mortality rate (1.7%) and perioperative complication rate, an equally low linear mortality 1.4% per patient year and excellent functional status (77% class I or II NYHA) of the patients at follow-up demonstrate the necessity of a comprehensive approach for correction of severely symptomatic patients with HOCM and the feasibility of our operative strategy.

[Dying with/despite a pacemaker]. / Sterben mit/trotz Schrittmachers.

Death of intensive care unit (ICU) patients with cardiovascular implantable electronic devices (CIED) is a common scenario in the ICU. Given the demographic trends and the increasing implantation rate of such devices reinforces the fact that ICU physicians must be aware of the burden and consequences of these systems in the end of life care of dying patients. The possible deactivation of a CIED confronts the responsible physicians with particularly complex clinical, ethical, and legal problems. Most deaths are often preceded by a long illness trajectory and finally by altering the therapeutic goals. Withholding or withdrawing therapy are the results of these processes. General agreement exists that ICD deactivation in dying patients may be ethically permissible. The patient's consent is mandatory. The practices and attitudes associated with pacemaker deactivation differ significantly from those associated with ICD deactivation. It is therefore crucial to be aware of the legal situation in the jurisdiction in which the physician is practicing. The decision to deactivate CIEDs should be part of a well deliberated and transparent process. Ethical and legal guidance should be readily available to counsel and support these difficult decisions.

Influence of estrus on dry matter intake, water intake and BW of dairy cows.

The objectives of this study were to analyze whether dry matter intake (DMI), water intake (WI) and BW were influenced by estrus. A second objective was to determine whether correlations exist among these traits in non-estrous days. Data collection included 34 Holstein-Friesian cows from the research farm 'Haus Riswick' of the Agricultural Chamber North Rhine-Westphalia, Germany. On an individual basis, daily DMI and daily WI were measured automatically by a scale in the feeding trough and a WI monitoring system, respectively. BW was determined by a walk-through scale fitted with two gates - one in front and one behind the scale floor. Data were analyzed around cow's estrus with day 0 (the day of artificial insemination leading to conception). Means during the reference period, defined as days -3 to -1 and 1 to 3, were compared with the means during estrus (day 0). DMI, WI and BW were affected by estrus. Of all cows, 85.3% and 66.7% had reduced DMI and WI, respectively, on day 0 compared with the reference period. Lower BW was detected in 69.2% of all cows relative to the reference period. During the reference period, average DMI, WI and BW were 23.0, 86.6 and 654.8 kg. A minimum DMI of 20.4 kg and a minimum BW of 644.2 kg were detected on the day of estrus, whereas the minimum WI occurred on the day before estrus. After estrus, DMI, WI and BW returned to baseline values. Intake of concentrated feed did not seem to be influenced by estrus. Positive correlations existed between daily DMI and daily WI (r=0.63) as well as between cows' daily BW and daily WI (r=0.23). The results warrant further investigations to determine whether monitoring of DMI, WI and BW may assist in predicting estrus.

[The chronic critically ill patient from the cardiologist's perspective]. / Der chronisch kritisch kranke Patient aus der Perspektive des Kardiologen.

In recent years the prognosis and survival of chronic and acute heart failure (HF) patients has been steadily improving; however, many patients develop advanced chronic HF which is characterized by worsening of symptoms, unplanned hospital admission due to acute decompensation, development of complications, such as life-threatening arrhythmia and shorter life span. Optimal medical therapy is supplemented by interventional cardiology, cardiovascular implantable electronic devices (CIEDs), minimally invasive valve replacement or repair, circulatory mechanical support and heart transplantation. Medical indications and informed consent are essential prerequisites for successfully implementing treatment goals. For patients who are incapable of decisions a legally defined surrogate decision-maker has the same right to refuse or request the withdrawal of treatment as the patient would have if the patient had decision-making capability. As the use of circulatory mechanical support becomes increasingly more prevalent, ethical issues are likely to arise at an increasing rate, as will social and legal ramifications. The concept of turning off an implanted device as death nears is challenging because of ethical and technical concerns. The same holds true for CIEDs. A palliative care approach is applicable to heart failure patients and is particularly relevant to those with advanced disease. Palliative care should be integrated as part of a team approach to comprehensive HF care and should not be reserved for those who are expected to die within days or weeks.

[Cardiac biomarkers in the critically ill]. / Kardiale Biomarker bei kritisch Kranken.

Cardiac biomarkers in intensive care medicine are an excellent complement to existing clinical and diagnostic information in specific diseases. Due to their lack of specificity, the diagnostic properties of common cardiac biomarkers, such as natriuretic peptides and cardiac troponins, remain ambiguous, while their prognostic value has already been proven. In addition, there are several promising new biomarkers that might contribute to a "multimarker strategy" in the critically ill patient in the future, but further evaluation is still required.