Holstein calves fed a milk replacer with a direct fed microbial (DFM) and a starter containing a botanical extract or a DFM alone or in combination.

Botanical extracts (BE; Apex, Adisseo, North America) have demonstrated enhanced DMI and improved gut health, while direct fed microbials (DFM), such as Lactobacillus acidophilus fermentation product (EX: Excell, Pacer Technology, Inc.), has demonstrated improved gut health and growth performance of growing Holstein calves. The hypothesis was this combination may be synergistic to neonatal calf growth performance and intestinal health. Eighty, 2-5-d old Holstein bull calves were blocked by BW and randomly assigned to one of 8 treatments arranged in a 2 × 4 factorial using a randomized complete block design. The main factors were milk replacer (MR) without (Control) and with EX added at 5 g/d fed and calf starter (CS). The CS containing no additives (Control); CS containing BE at 496 mg/kg; CS containing EX at 2.50 g/kg; and CS containing BE and EX at the same inclusion rates. The MR were fed 2x/d at 0630 and 1800 h along with free choice CS (amounts and orts weighed d) and water. Weaning occurred after d 42 for the 56-d experiment. No MR by CS main effects interactions were detected for BW, ADG, CS intake, total DMI, feed efficiency or body frame gain parameters. The BW gain (38.0 and 39.3 kg for control and EX, respectively) for MR main effect was similar for calves fed both MR, while CS main effects (38.7, 39.7, 39.2, and 37.2 kg for control, BE, EX, and BE&EX, respectively) was similar among all CS. Gains in body length (10.6 and 10.8 cm), hip width (4.5 and 4.5 cm), withers height, (10.5 and 10.6 cm) heart girth (18.6 and 19.9 cm) and body length (9.1 and 7.9 cm) were similar for calves fed both MR, while CS main effects for hip height (10.5, 10.2, 10.3, and 10.9 cm), hip width (4.7, 4.6, 4.4, and 4.3 cm) withers height (10.7, 10.9, 10.3 and 10.6 cm), heart girth (19.9, 18.9, 18.9, and 19.4 cm), and body length (11.7, 9.1, 8.3, and 8.4 cm) were similar. Total days of a fecal score = 0 was greater for calves fed Control MR and BE CS compared with calves fed Contol MR and the combination of BE&EX with calves fed the remaining treatments being intermediated and similar. This study demonstrated little calf growth performance and health benefits when feeding a BE or EX alone or in combination compared with calves fed control.

Does Anterior Cervical Spine Surgery Increase the Likelihood of Developing Obstructive Sleep Apnea? A Pearldiver Study.

OBJECTIVES: Literature is sparse on the development of obstructive sleep apnea (OSA) after anterior cervical spine surgery and includes few case reports. Our objective is to evaluate the role of anterior cervical spine surgery as a risk factor for developing OSA. METHODS: A retrospective cohort study was performed utilizing the M157 subset of the PearlDiver national database. Two matched cohorts of patients were identified based on anterior cervical spine surgery using CPT codes. ICD-9 and 10 was used to identify patients who developed OSA within one year time frame in both the cohorts. Relative risk of OSA was calculated for the study and risk factors for developing OSA in the cohort of anterior cervical surgery were evaluated using logistic regression. RESULTS: The 2 cohorts contained 277,475 patients each. The 1-year incidence rate of OSA in those who undergo anterior cervical spine surgery is 3.5% and is 3.1% in the control group. The relative risk of OSA in the surgery group is 1.13 times compared to the control. Multilevel cervical spine surgery and surgery performed for spondylosis had a higher risk of developing OSA. CONCLUSIONS: Anterior cervical spine surgery is associated with an increased risk of developing OSA within one year of surgery. Timely diagnosis and management of OSA in patients who underwent anterior cervical spine surgery can help prevent morbidity and improve quality of life (QOL).

Effects of Essential Oil and/or Encapsulated Butyrate on Fecal Microflora in Neonatal Holstein Calves.

This study was conducted to investigate the effects of feeding oregano essential oil, butyrate, and its mixture on the intestinal microbial diversity of calves. A completely randomized experimental design was used. Sixty-four healthy neonatal Holstein female calves with birth weight ≥ 35 kg were randomly divided into one control and three treatments (16 calves per group). The control group was fed normally, and the treatment group was fed oregano essential oil, butyrate, and their mixture, respectively. The experiment lasted for 70 days, and the lactation period lasted for 56 days. On days 55 and 70, rectal fecal samples from five calves were collected from each group for 16S rRNA amplification and sequencing. The results showed as follows: (1) the three treatments had no significant effects on the intestinal microbial community diversity, community uniformity, and community pedigree diversity of calves (p > 0.05). (2) At the phylum level, Firmicutes, Bacteroidota, Spriochatetota, Actinobacteriota, Firmicutes, and Bacteroidota gates of the main bacteria were detected in feces. (3) At the genus level, the top ten species with relative abundance detected are: norank_ F_Muribaaculaceae, Ruminococcus, unclassified_ F_ Lachnospiraceae, UCG-005, Prevotelaceae_NK3B31_Group, Prevotella, Bacteroides, Rikenellaceae_RC9_Gut_Group, and Faecalibacterium, Alloprevotella. (4) LEfSe analysis results show that the species with significant differences in the control group were f__Lachnospiraceae, o__Lachnospirales, o__Coriobacteriales, and c__Coriobacteriia, g__Megasphaera; in the essential oil group were g__Lachnospiraceae_AC2044_group, o__Izemoplasmatales, g__norank_f__norank_o__Izemoplasmatales, and f__norank_o__Izemoplasmatales; in the sodium butyrate group were g__Lachnospiraceae_NK4A136_group, and g__Sharpea, g__Fournierella; in the mixed group were g__Flavonifractor, and g__UBA1819. (5) The functional prediction analysis of calf gut microbes, found on the KEGG pathway2, shows that essential oil significantly improved membrane transport, Sodium butyrate inhibits lipid metabolism and improves the body's resistance to disease. (p < 0.05). (6) The effects of each treatment on the intestinal microbial structure of calves did not last for 14 days after the treatment was stopped. In conclusion, the addition of oregano essential oil, butyrate, and its mixtures to milk fed to calves can modulate the microbial structure, and it is recommended that oregano essential oil and butyrate be used separately, as a mixture of the two can increase the rate of diarrhea in calves.

Comparison of growth performance and tissue cobalt concentrations in beef cattle fed inorganic and organic cobalt sources.

Cobalt is an essential trace mineral required for ruminal vitamin B12 synthesis, but sources differ in ruminal microbial utilization, i.e., cobalt carbonate is poorly water soluble, whereas acetate and lactate forms are water soluble. Reports comparing organic cobalt lactate to other cobalt salts are lacking. The study objective was to determine if feeding cobalt lactate at two inclusion rates resulted in similar growth performance and tissue cobalt concentrations as the carbonate and acetate forms used in feeds. One hundred Angus cross bred steers weighing 385 ±â€…20 kg were randomly assigned to one of five treatments. Cattle were fed a basal diet plus: 1) cobalt carbonate to supply cobalt at 30 mg/steer/d, 2) cobalt acetate to supply cobalt at 30 mg/steer/d, 3) cobalt acetate to supply cobalt at 60 mg/steer/d, 4) cobalt lactate to supply cobalt at 30 mg/steer/d, and 5) cobalt lactate to supply cobalt at 60 mg/steer/d. Cattle were fed according to industry standards until body fat deposition was visually deemed to grade USDA Choice, which was 92 and 117 d for each of the 2 blocks, respectively. Steers were harvested and carcass measurements recorded along with sampling of adipose, heart, kidney, liver, and muscle for tissue cobalt concentrations. Three statistical contrasts consisted of: 1: inorganic (cobalt carbonate) vs. organic (cobalt acetate and lactate); 2: cobalt acetate vs. cobalt lactate; and 3: feeding rate of 30 vs. 60 mg/steer/d cobalt. Body weight gains, average daily gains, dry matter intake, and feed conversions were similar (P > 0.10) for steers fed all cobalt sources and feeding rates. Hot carcass weight, yield grade, back fat thickness, and ribeye area were similar (P > 0.10) among steers fed all cobalt sources and inclusion rates. Liver, kidney, muscle, and adipose cobalt concentrations were similar (P > 0.08) for steers fed inorganic vs. organic cobalt sources. Feeding cobalt lactate compared with cobalt acetate did not affect (P > 0.10) liver, kidney, heart, muscle, and adipose tissue cobalt concentrations. Feeding 60 mg/steer/d cobalt compared with 30 mg/steer/d increased (P < 0.01) liver, kidney, heart, and adipose tissue cobalt concentrations, while muscle was a tendency (P < 0.06). The study demonstrated that feeding soluble cobalt lactate, a new cobalt source, resulted in similar growth performance, carcass characteristics, and tissue cobalt concentrations when compared with cobalt acetate and carbonate.

First Direct Observation of Collider Neutrinos with FASER at the LHC.

We report the first direct observation of neutrino interactions at a particle collider experiment. Neutrino candidate events are identified in a 13.6 TeV center-of-mass energy pp collision dataset of 35.4 fb^{-1} using the active electronic components of the FASER detector at the Large Hadron Collider. The candidates are required to have a track propagating through the entire length of the FASER detector and be consistent with a muon neutrino charged-current interaction. We infer 153_{-13}^{+12} neutrino interactions with a significance of 16 standard deviations above the background-only hypothesis. These events are consistent with the characteristics expected from neutrino interactions in terms of secondary particle production and spatial distribution, and they imply the observation of both neutrinos and anti-neutrinos with an incident neutrino energy of significantly above 200 GeV.

Mindfulness Applications: Can They Serve as a Stress, Anxiety, and Burnout Reduction Tool in Orthopaedic Surgery Training? A Randomized Control Trial.

Stress and burnout are prevalent within the orthopaedic surgery community. Mindfulness techniques have been shown to improve wellness, yet traditional courses are generally time-intensive with low surgeon utilization. We sought to determine whether the introduction of a simple mindfulness-based phone application would help decrease stress, anxiety, and burnout in orthopaedic surgery residents. Methods: Twenty-four residents participated in this prospective, randomized controlled trial. After simple 1:1 randomization, the treatment group received access to a mindfulness-based phone application for 2 months while the control group did not receive access. All participants completed the Perceived Stress Scale, Generalized Anxiety Disorder-7, and Maslach Burnout Inventory with emotional exhaustion (EE), depersonalization (DP), and personal accomplishment subscores to measure stress, anxiety, and burnout at baseline and after 2 months. Paired t tests were used to compare baseline scores and conclusion scores for both groups. Results: There was no difference in baseline burnout scores between groups, but the treatment group had higher stress and anxiety scores at baseline. On average, the treatment group spent approximately 8 minutes per day, 2 days per week using the mindfulness application. After 2 months, the treatment group had significantly decreased stress (mean = -7.42, p = 0.002), anxiety (mean = -6.16, p = 0.01), EE (mean = -10.83 ± 10.72, p = 0.005), and DP (mean = -5.17 ± 5.51, p = 0.01). The control group did not have any significant differences in stress, anxiety, or burnout subscores. Conclusions: Use of a mindfulness-based phone app for 2 months led to significant reductions in stress, anxiety, and burnout scores in orthopaedic surgery residents. Our results support the use of a mindfulness-based app to help decrease orthopaedic resident stress, anxiety, and burnout. Benefits were seen with only modest use, suggesting that intensive mindfulness training programs may not be necessary to effect a change in well-being. The higher baseline stress and anxiety in the treatment group may suggest that mindfulness techniques are particularly effective in those who perceive residency to be more stressful. Level of Evidence: I.

Crossing the cervicothoracic junction: an evaluation of radiographic alignment, functional outcomes, and patient-reported outcomes.

OBJECTIVE: There is currently no consensus regarding the appropriate lower instrumented vertebra (LIV) for multilevel posterior cervical fusion (PCF) constructs between C7 and crossing the cervicothoracic junction (CTJ). The goal of the present study was to compare postoperative sagittal alignment and functional outcomes among adult patients presenting with cervical myelopathy undergoing multilevel PCF terminating at C7 versus spanning the CTJ. METHODS: A single-institution retrospective analysis (January 2017-December 2018) was performed of patients undergoing multilevel PCF for cervical myelopathy that involved the C6-7 vertebrae. Pre- and postoperative cervical spine radiographs were analyzed for cervical lordosis, cervical sagittal vertical axis (cSVA), and first thoracic (T1) vertebral slope (T1S) in two randomized independent trials. Modified Japanese Orthopaedic Association (mJOA) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores were used to compare functional and patient-reported outcomes at the 12-month postoperative follow-up. RESULTS: Sixty-six consecutive patients undergoing PCF and 53 age-matched controls were included in the study. There were 36 patients in the C7 LIV cohort and 30 patients in the LIV spanning the CTJ cohort. Despite significant correction, patients undergoing fusion remained less lordotic than asymptomatic controls, with a C2-7 Cobb angle of 17.7° versus 25.5° (p < 0.001) and a T1S of 25.6° versus 36.3° (p < 0.001). The CTJ cohort had superior alignment corrections in all radiographic parameters at the 12-month postoperative follow-up compared with the C7 cohort: increase in T1S (ΔT1S 14.1° vs 2.0°, p < 0.001), increase in C2-7 lordosis (ΔC2-7 lordosis 11.7° vs 1.5°, p < 0.001), and decrease in cSVA (ΔcSVA 8.9 vs 5.0 mm, p < 0.001). There were no differences in the mJOA motor and sensory scores between cohorts pre- and postoperatively. The C7 cohort reported significantly better PROMIS scores at 6 months (22.0 ± 3.2 vs 11.5 ± 0.5, p = 0.04) and 12 months (27.0 ± 5.2 vs 13.5 ± 0.9, p = 0.01) postoperatively. CONCLUSIONS: Crossing the CTJ may provide a greater cervical sagittal alignment correction in multilevel PCF surgeries. However, the improved alignment may not be associated with improved functional outcomes as measured by the mJOA scale. A new finding is that crossing the CTJ may be associated with worse patient-reported outcomes at 6 and 12 months of postoperative follow-up as measured by the PROMIS, which should be considered in surgical decision-making. Future prospective studies evaluating long-term radiographic, patient-reported, and functional outcomes are warranted.

Comparison of Single-Level Posterior Cervical Foraminotomy to Anterior Cervical Discectomy and Fusion for Radiculopathy.

BACKGROUND: Posterior cervical foraminotomy (PCF) and anterior cervical discectomy and fusion (ACDF) are 2 commonly used surgical approaches to address cervical radiculopathy. Demonstrating superiority in clinical outcomes and durability of one of the approaches could change clinical practice on a large scale. This is the largest reported single-institutional retrospective cohort of single-level PCFs compared with single-level ACDFs for cervical radiculopathy. METHODS: Patients undergoing either ACDF or PCF between 2014 and 2021 were identified using Current Procedural Terminology codes. Medical records were reviewed for demographics, surgical characteristics, and reoperations. Statistical analysis included t tests for continuous characteristics and c2 testing for categorical characteristics. RESULTS: In total, 236 single-level ACDFs and 138 single-level PCFs were included. There was no significant difference in age (51.0 vs 51.3 years), body mass index (BMI; 28.6 vs 28.1), or Charlson Comorbidity Index (1.89 vs 1.68) between patients who underwent ACDF and those who underwent PCF. There was no difference in the rate of reoperation (5.1% vs 5.1%), time to reoperation (247 vs 319 days), or reoperation for recurrent symptoms (1.7% vs 2.9%) for ACDF vs PCF. Hospital length of stay (LOS) was longer for ACDF compared with PCF (1.65 vs 1.35 days, P = 0.041), and the overall readmission rate after ACDF was 20.8% vs 10.9% after PCF (P = 0.014). CONCLUSIONS: Overall reoperation rates or reoperation for recurrent symptoms between ACDF and PCF were not significantly different, demonstrating that either procedure effectively addresses the indication for surgery. There was a significantly longer LOS after ACDF than PCF, and readmission rates at 90 days and 1 year were higher after ACDF.

Should patients with lumbar stenosis and grade I spondylolisthesis be treated differently based on spinopelvic alignment? A retrospective, two-year, propensity matched, comparison of patient-reported outcome measures and clinical outcomes from multiple sites within a single health system.

BACKGROUND: Degenerative lumbar spondylolisthesis is one of the most common pathologies addressed by surgeons. Recently, data demonstrated improved outcomes with fusion in conjunction with laminectomy compared to laminectomy alone. However, given not all degenerative spondylolistheses are clinically comparable, the best treatment option may depend on multiple parameters. Specifically, the impact of spinopelvic alignment on patient reported and clinical outcomes following fusion versus decompression for grade I spondylolisthesis has yet to be explored. PURPOSE: This study assessed two-year clinical outcomes and one-year patient reported outcomes following laminectomy with concomitant fusion versus laminectomy alone for management of grade I degenerative spondylolisthesis and stenosis. The present study is the first to examine the effect of spinopelvic alignment on patient-reported and clinical outcomes following decompression alone versus decompression with fusion. STUDY DESIGN/SETTING: Retrospective sub-group analysis of observational, prospectively collected cohort study. PATIENT SAMPLE: 679 patients treated with laminectomy with fusion or laminectomy alone for grade I degenerative spondylolisthesis and comorbid spinal stenosis performed by orthopaedic and neurosurgeons at three medical centers affiliated with a single, tertiary care center. OUTCOME MEASURES: The primary outcome was the change in Patient-Reported Outcome Measurement Information System (PROMIS), Global Physical Health (GPH), and Global Mental Health (GMH) scores at baseline and post-operatively at 4-6 and 10-12 months postoperatively. Secondary outcomes included operative parameters (estimated blood loss and operative time), and two-year clinical outcomes including reoperations, duration of postoperative physical therapy, and discharge disposition. METHODS: Radiographs/MRIs assessed stenosis, spondylolisthesis, pelvic incidence, lumbar lordosis, sacral slope, and pelvic tilt; from this data, two cohorts were created based on pelvic incidence minus lumbar lordosis (PILL), denoted as "high" and "low" mismatch. Patients underwent either decompression or decompression with fusion; propensity score matching (PSM) and coarsened exact matching (CEM) were used to create matched cohorts of "cases" (fusion) and "controls" (decompression). Binary comparisons used McNemar test; continuous outcomes used Wilcoxon rank-sum test. Between-group comparisons of changes in PROMIS GPH and GMH scores were analyzed using mixed-effects models; analyses were conducted separately for patients with high and low pelvic incidence-lumbar lordosis (PILL) mismatch. RESULTS: 49.9% of patients (339) underwent lumbar decompression with fusion, while 50.1% (340) received decompression. In the high PLL mismatch cohort at 10-12 months postoperatively, fusion-treated patients reported improved PROs, including GMH (26.61 vs. 20.75, p<0.0001) and GPH (23.61 vs. 18.13, p<0.0001). They also required fewer months of outpatient physical therapy (1.61 vs. 3.65, p<0.0001) and had lower 2-year reoperation rates (12.63% vs. 17.89%, p=0.0442) compared to decompression-only patients. In contrast, in the low PLL mismatch cohort, fusion-treated patients demonstrated worse endpoint PROs (GMH: 18.67 vs. 21.52, p<0.0001; GPH: 16.08 vs. 20.74, p<0.0001). They were also more likely to require skilled nursing/rehabilitation centers (6.86% vs. 0.98%, p=0.0412) and extended outpatient physical therapy (2.47 vs. 1.34 months, p<0.0001) and had higher 2-year reoperation rates (25.49% vs. 14.71%,p=0.0152). CONCLUSIONS: Lumbar laminectomy with fusion was superior to laminectomy in health-related quality of life and reoperation rate at two years postoperatively only for patients with sagittal malalignment, represented by high PILL mismatch. In contrast, the addition of fusion for patients with low-grade spondylolisthesis, spinal stenosis, and spinopelvic harmony (low PILL mismatch) resulted in worse quality of life outcomes and reoperation rates.

Association of Thoracic MRI Findings With Specialty and Training.

STUDY DESIGN: Retrospective. OBJECTIVE: To compare the rate of positive pathology on thoracic MRI ordered by surgical spine specialists to those ordered by nonsurgical spine specialists. METHODS: Outpatient thoracic MRIs from January-March 2019 were evaluated from a single academic health care system. Studies without a known ordering provider, imaging report, or patients with known presence of malignancy, multiple sclerosis, recent trauma, or surgery were excluded (n = 320). Imaging studies were categorized by type of provider placing the order (resident, attending, or advanced practice practitioner) and department. MRIs were deemed positive if they showed relevant pathology that correlated with indication for exam as determined by a radiologist. One-sided chi-squared analysis was performed to determine statistical significance. RESULTS: Overall, our data demonstrated 17.2% of studies with positive pathology. Compared to nonspecialty clinicians, subspecialists showed 35/184 (19.0%) positivity rate versus the non-specialist with 20/136 (14.7%) positivity rate (P = .156). Posthoc analysis demonstrated that surgical specialists who order thoracic MRIs yield significantly higher positivity rates at 19/79 (24.0%) compared to nonsurgical specialists at 36/241 (14.9%) (P < .05). Overall, neurosurgery demonstrated the highest rate of positive thoracic MRIs at 14/40 (35.0%). Comparison between the rate of positivity between physicians and advanced practitioners was insignificant (P > .05). CONCLUSIONS: Clinical diagnosis of symptomatic thoracic spine degenerative disease requires an expert physical exam combined with careful attention to radiology findings. Although the percent of relevant pathology on thoracic MRI is low, our data suggests evaluation by a surgical specialist should precede ordering a thoracic spine MRI.

The female to male calf sex ratio is associated with the number of services to achieve a calf and parity of lactating dairy cows.

Commercial dairy producers may get frustrated by the lower ratio of female to male calves born because female calves are more valuable than bull calves. Our objective was to determine if parity or stage of lactation at the time of breeding, using conventional semen, influenced the sex of the calf. Data from the University of Illinois and the University of New Hampshire dairy herds were collected and summarized for calf sex, the number of services to achieve a calf and the lactation number when conception of that calf occurred. Logistical regression procedures were used to analyze the dataset via version 9.4 of SAS. The final dataset contained 2,987 calvings, which consisted of 1,406 females and 1,581 males (47.1% and 52.9% for females and males, respectively). The frequency distribution of the number of services to achieve a calf was highest for the first service and progressively declined with increasing services (52.06%, 21.66%, 10.75%, 6.66%, 4.22%, and 4.65% for 1 to 6 services, respectively). The frequency distribution of calvings by lactation number was greatest for first lactation cows becoming pregnant with their second calf and declined with increasing parity (35.49%, 28.22%, 17.01%, 9.61%, 5.02%, 2.51%, 1.14%, 0.70%, and 0.30% for lactation numbers 1 to 9, respectively). Logistic stepwise regression indicated that the number of services to achieve a calf was significant in predicting the ratio of female to male calves. Calculation of odds ratios indicated that as the lactation number increased the likelihood of getting a bull calf decreased. Parity, services, and parity by services interaction were significant for cows having a greater number of parities and cows with a greater number of services yielding more heifer calves. However, an interaction occurred where cows with greater number of services along with greater parities more likely to have a bull calf. These data provide evidence that increasing the number of services to achieve a calf and increasing age of the cow increased the probability of a heifer calf being born. These data indicate that cows with greater parties (lesser cull rate) are more likely to produce heifer calves.

The Impact of Social Determinants of Health on 30 and 90-Day Readmission Rates After Spine Surgery.

BACKGROUND: Since its 2012 inception, the U.S. Centers for Medicare & Medicaid Services Hospital Readmissions Reduction Program (HRRP) has espoused cost-effective health-care delivery by financially penalizing hospitals with excessive 30-day readmission rates. In this study, we hypothesized that socioeconomic factors impact readmission rates of patients undergoing spine surgery. METHODS: In this study, 2,830 patients who underwent a spine surgical procedure between 2012 and 2018 were identified retrospectively from our institutional database, with readmission (postoperative day [POD] 0 to 30 and POD 31 to 90) as the outcome of interest. Patients were linked to U.S. Census Tracts and ZIP codes using the Geographic Information Systems (ArcGIS) mapping program. Social determinants of health (SDOH) were obtained from publicly available databases. Patient income was estimated at the Public Use Microdata Area level based on U.S. Census Bureau American Community Survey data. Univariate and multivariable stepwise regression analyses were conducted. Significance was defined as p < 0.05, with Bonferroni corrections as appropriate. RESULTS: Race had a significant effect on readmission only among patients whose estimated incomes were <$31,650 (χ2 = 13.4, p < 0.001). Based on a multivariable stepwise regression, patients with estimated incomes of <$31,000 experienced greater odds of readmission by POD 30 compared with patients with incomes of >$62,000; the odds ratio (OR) was 11.06 (95% confidence interval [CI], 6.35 to 15.57). There were higher odds of 30-day readmission for patients living in neighborhoods with higher diabetes prevalence (OR, 3.02 [95% CI, 1.60 to 5.49]) and patients living in neighborhoods with limited access to primary care providers (OR, 1.39 [95% CI, 1.10 to 1.70]). Lastly, each decile increase in the Area Deprivation Index of a patient's Census Tract was associated with higher odds of 30-day readmission (OR, 1.40 [95% CI, 1.30 to 1.51]). CONCLUSIONS: Socioeconomically disadvantaged patients and patients from areas of high social deprivation have a higher risk of readmission following a spine surgical procedure. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Racial Differences in Patients Undergoing Anterior Cervical Discectomy and Fusion: A Multi-Site Study.

STUDY DESIGN: This was a retrospective chart review. OBJECTIVE: The objective of this study was to examine disparities within patients undergoing anterior cervical discectomy and fusion (ACDF) at a multi-site tertiary referral center with specific focus on factors related to length of stay (LOS). SUMMARY OF BACKGROUND DATA: There are previously described racial disparities in spinal surgery outcomes and quality metrics. METHODS: A total of 278 consecutive patients undergoing ACDF by 8 different surgeons over a 5-year period were identified retrospectively. Demographic data, including age at time of surgery, sex, smoking status, and self-identified race [White or African American (AA)], as well as surgical data and postoperative course were recorded. Preoperative health status was recorded, and comorbidities were scored by the Charlson Comorbidity Index. Univariable and multivariable linear regression models were employed to quantify the degree to which a patient's LOS was related to their self-identified race, demographics, and perioperative clinical data. RESULTS: Of the 278 patients who received an ACDF, 71.6% (199) self-identified as White and 28.4% (79) identified as AA. AA patients were more likely to have an ACDF due to myelopathy, while White patients were more likely to have an ACDF due to radiculopathy (P=0.001). AA patients had longer LOS by an average of half a day (P=0.001) and experienced a larger percentage of extended stays (P=0.002). AA patients experienced longer overall operation times on average (P=0.001) across all different levels of fusion. AA race was not an independent driver of LOS (ß=0.186; P=0.246). CONCLUSIONS: As hypothesized, and consistent with previous literature on racial surgical disparities, AA race was associated with increased LOS, increased operative times, and increased indication of myelopathy in this study. Additional research is necessary to evaluate the underlying social determinants of health and other factors that may contribute to this study's results. LEVEL OF EVIDENCE: Level III.

Racial and Social Determinants of Health Disparities in Spine Surgery Affect Preoperative Morbidity and Postoperative Patient Reported Outcomes: Retrospective Observational Study.

STUDY DESIGN: Retrospective observational study. OBJECTIVE: To elucidate racial and socioeconomic factors driving preoperative disparities in spine surgery patients. SUMMARY OF BACKGROUND DATA: There are racial and socioeconomic disparities in preoperative health among spine surgery patients, which may influence outcomes for minority and low socioeconomic status (SES) populations. METHODS: Presenting, postoperative day 90 (POD90), and 12-month (12M) outcome scores (PROMIS global physical and mental [GPH, GMH] and visual analog scale pain [VAS]) were collected for patients undergoing deformity arthrodesis or cervical, thoracic, or lumbar laminotomy or decompression/fusion; these procedures were the most common in our cohort. Social determinants of health for a patient's neighborhood (county, zip code, or census tract) were extracted from public databases. Multivariable linear regression with stepwise selection was used to quantify the association between a patient's preoperative GPH score and sociodemographic variables. RESULTS: Black patients presented with 1 to 3 point higher VAS pain scores (7-8 vs. 5-6) and lower (worse) GPH scores (6.5-10 vs. 11-12) than White patients (P < 0.05 for all comparisons); similarly, lower SES patients presented with 1.5 points greater pain (P < 0.0001) and 3.5 points lower GPH (P < 0.0001) than high SES patients. Patients with lowest-quartile presenting GPH scores reported 36.8% and 37.5% lower (worse) POD-90 GMH and GPH scores than the highest quartile, respectively (GMH: 12 vs. 19, P < 0.0001; GPH: 15 vs. 24, P < 0.0001); this trend extended to 12 months (GMH: 19.5 vs. 29.5, P < 0.0001; GPH: 22 vs. 30, P < 0.0001). Reduced access to primary care (B = -1.616, P < 0.0001) and low SES (B = -1.504, P = 0.001), proxied by median household value, were independent predictors of worse presenting GPH scores. CONCLUSION: Racial and socioeconomic disparities in patients' preoperative physical and mental health at presentation for spine surgery are associated adversely with postoperative outcomes. Renewed focus on structural factors influencing preoperative presentation, including timeliness of care, is essential.Level of Evidence: 3.

Postoperative Prescription of Low-dose Narcotics Yields Equivalent Pain Outcomes Compared to High-dose Narcotics in Opioid-naïve Patients Undergoing Spine Surgery.

STUDY DESIGN: Retrospective cohort study at a single institution. Patients undergoing specific, elective spinal procedures between 2012 and 2018. OBJECTIVE: The aim of thi stsudy was to investigate the relationship between opioid prescriptions during the immediate, post-discharge period, and patient-reported pain outcomes. SUMMARY OF BACKGROUND DATA: Medically prescribed opiates contribute to the opioid crisis, manifesting in significant mortality and economic burden. Although opioids are a mainstay of pain amelioration following spinal surgery, prescription practices are heterogeneous. METHODS: Inclusion criteria included: patients who underwent one of 10 spinal procedures (Table 1); patients with preoperative, postoperative day (POD 1, and POD 30 pain scores reported on the visual analog scale (VAS); patients discharged without a complicated perioperative course. Opioids were converted to morphine milligram equivalents per day (MME/day) using a standard reference table. χ2, Kruskal-Wallis, and logistic regression were utilized to investigate associations between clinical variables and postoperative pain scores. Univariate and multivariable linear regression models with Stepwise selection (cut off: P = 0.05) were employed as appropriate on POD 30 VAS pain scores. RESULTS: Smoking status and postoperative LOS were associated with opioid prescription doses. Patients prescribed opioids <40 MME/day, equivalent to five tablets of 5 mg oxycodone/day, showed no significant difference in POD 30 VAS score (ß coefficient: 0.095, P  = 0.752) when compared to patients who received the highest-dose opioids (>80 MME/day-equivalent to 10 tablets of 5 mg oxycodone/day). Adjusted multivariable logistic regression analysis revealed that postoperative opioid dosage/prescription was not a significant predictor of patients reporting at least 50% pain improvement, suggesting that 40 MME/day is sufficient to maintain patient satisfaction. CONCLUSION: Patients receiving the lowest dosage of opioid prescriptions with sufficient nonopiate analgesics did not report worse pain relief at POD 30 compared to those receiving higher opioid prescriptions. In light of the opioid epidemic, this study supports initial dosing recommendations by the American Society for Addiction Medicine.Level of Evidence: 3.

Supplementing additional cobalt as cobalt lactate in a high-forage total mixed ration fed to late-lactation dairy cows.

Cobalt lactate is a highly soluble ruminal Co source. Prior research evaluating higher Co feeding rates demonstrated increased ruminal fiber digestion. Feeding high-forage (>70%) rations to late-lactation dairy cows to enhance income over feed cost could potentially benefit from higher ruminal-soluble Co inclusion rates to enhance ruminal fiber and nutrient digestibility. Twenty-four late-lactation [238 ± 68.8 d in milk (DIM) and 36.4 ± 5.4 kg/d milk] Holstein dairy cows (10 primiparous and 14 multiparous) were blocked by milk yield, DIM, and parity, and randomly assigned to 1 of 2 treatments. Treatments were (1) control, CoCO3 total mixed ration (TMR) containing 12.5 mg/cow per day of cobalt (cobalt carbonate), and (2) cobalt lactate (Co-LAC), same CoCO3 TMR but containing an additional 50 mg/cow per day of Co, via a 1% cobalt lactate product (CoMax, Ralco Inc.). The basal TMR was 70% forage [60% alfalfa baleage and 40% corn silage on a dry matter (DM) basis] and 30% of the respective experimental grain mix on a DM basis. Cows were fed the CoCO3 TMR during the 7-d covariate period, followed by 4 wk of data collection when CoCO3 and Co-LAC TMR were fed. Milk production (26.2 and 25.8 kg/d for CoCO3 and Co-LAC, respectively) and dry matter intake (DMI; 22.9 and 23.1 kg/d) were similar for cows fed both Co treatments. Production of milk fat (1.02 and 1.09 kg/d), milk protein (0.87 and 0.91 kg/d), and lactose (1.17 and 1.26 kg/d) were similar for cows fed both treatments. Body weights (684 and 674 kg) were similar for cows fed both treatments. Rumen ammonia concentrations (15.8 and 12.3 mg/dL) were lower for cows fed Co-LAC compared with cows fed CoCO3 (15.8 mg/dL). Ruminal molar acetate concentrations (59.5 and 61.1%) were greater for cows fed Co-LAC compared with cows fed CoCO3. Feeding additional Co as cobalt lactate in the TMR did not enhance lactational performance (milk production, composition, DMI, or body weight changes) when fed a high-forage TMR but altered ruminal fermentation with decreased ruminal ammonia and increased ruminal acetate concentrations.

Adaptation and withdrawal of feeding dried Aspergillus oryzae fermentation product to dairy cattle and goats on in vitro NDF digestibility of selected forage sources.

Nutritional fermentation aids [dried Aspergillus oryzae fermentation product (AO)] are used in livestock production to increase nutrient digestion and production efficiency. The objective was to determine AO impact on neutral detergent fiber (NDF) degradation of selected forage sources (FS). A series of in vitro fermentation experiments were conducted using rumen fluid (RF) from rumen fistulated dairy heifers or dairy goats evaluating AO at 0.0, 0.3, or 0.6 g/L inclusion rates. In experiment I, the optimum AO concentration using alfalfa hay (AH), Bermuda grass (BG) hay, and peanut skins (PS) was determined via 48-h in vitro neutral detergent fiber digestion (IVNDFd). In experiment II, 0.0 g/L and 0.3 g/L AO were used to determine in vitro dry matter digestion (IVDMD), in vitro organic matter digestion (IVOMD), IVNDFd, and NDF digestion kinetics. In experiment III, in vivo AO ruminal adaptation (AD) and withdrawal (WD) times were determined for both dairy heifers and goats on IVDMD, IVOMD, IVNDFd, and NDF digestion kinetics. In experiment I, IVNDFd was similar using RF from dairy heifers or goats with IVNDFd being increased 10%, 28%, and 23% for AH, BG, and PS, respectively, at 0.3 g/L of AO compared with 0.0 g/L AO, while adding 0.6 g/L AO reduced IVNDFd among all FS. In experiment II, IVNDFd was greater when adding 0.0 g/L AO compared with 0.3 g/L AO using dairy goat RF (26.7% and 37.6%, respectively) among all FS. The mean retention time and 50% digestion times were greater, while digestion rate was lower for PS compared to AH and BG. In vitro dry matter (DM) and organic matter (OM) digestibilities were greater with AO for AH and BG compared to PS but varied with RF donor source. In experiment III, in vitro DM digestibility increased then decreased with adaptation time, while AO withdrawal increased digestion of DM, OM, and NDF. The NDF digestion kinetics were similar across all FS (AH, BG, and PS), which resulted in no clear determination of AO adaptation and withdrawal times needed for AO efficacy. The optimal AO inclusion rate was determined to be 0.3 g/L for improving in vitro NDF digestion, but subsequent experiments could not confirm that inclusion rate. Inclusion rates greater than 0.3 g/L depressed NDF degradation, which should be avoided due to depression of NDF digestion. Sourcing ruminal fluid from dairy heifers or goats for conducting in vitro fermentations resulted in similar DM, OM, and NDF digestion and NDF degradation kinetics.

Feeding Sheep Cobalt and Oregano Essential Oil Alone or in Combination on Ruminal Nutrient Digestibility, Fermentation, and Fiber Digestion Combined With Scanning Electron Microscopy.

The feeding of Co lactate (Co), an essential oil blend (EO; oregano), or a combination of Co and EO (EOC) may improve nutrient digestion of corn silage-based rations. In four separate studies, Co, EO, or EOC was fed at 0, 4, and 7 g/days to nine rumen fistulated rams arranged in a replicated 3 × 3 Latin square design. The fourth study evaluated the carrier at 0, 4, and 7 g/day. In each ram, fresh ensiled corn silage, leaf, and husk were placed in individual nylon bags inserted through the ruminal cannula and removed after 48 h. Rams fed increasing carrier rates demonstrated similar (P > 0.10) nutrient digestibilities and ruminal pH and volatile fatty acid concentrations. Feeding Co at 4 and 7 g/day increased (P < 0.05) digestibility of DM (59.4, 63.9, and 62.4% for 0, 4, and 7 g/day, respectively), NDF (59.4, 63.9, and 62.4%), and hemicellulose (HC; 56.2, 63.6, and 65.9%) compared with rams fed 0 g/day, while CP digestibility (46.4, 49.9, and 57.8%) was improved (P < 0.05) in rams fed 7 g/day compared with those fed 0 and 4 g/day. Rams fed 4 g/day EO digested greater (P < 0.05) HC (64.1, 71.4, and 69.1%) than rams fed 0 g/day, while rams fed 7 g/day were intermediate and similar (P > 0.10). Rams fed the EOC combination at 4 and 7 g/day demonstrated greater (P < 0.05) digestibilities of DM (57.7, 60.0, and 60.0%), NDF (21.4, 28.8, and 27.7%), and ADF (24.3, 33.3, and 34.4%) than rams fed 0 g/day. The SEM and SM techniques visually demonstrated minor evidence of husk and leaf digestibility in rams across the three experiments when fed 0 g/day of Co, EO, or EOC; rams fed 4 g/day of Co, EO, or EOC exhibited varying visual signs of leaf digestion with some palisade tissue, spongy tissue, and whole vein structure remaining, while in rams fed 7 g/day, only the vein structure remained. Results demonstrated that feeding Co, EO, or EOC at 4 or 7 g/day enhanced ruminal nutrient digestion and fermentation parameters, which was visually confirmed via SEM and SM.