Realization of breeding values for milk fatty acids in relation to seasonal variation in organic milk.

Prediction of detailed milk fatty acid (FA) composition by mid-infrared spectroscopy (MIRS) offers possibilities for high-throughput indirect measurements of detailed milk compositional parameters through the milk testing system, which can be used to differentiate the FA profile by genetics or specific management or on dairies for milk quality evaluation. Since 2015, milk samples from all Danish dairy cows under milk testing have been recorded using MIRS. The MIRS software from the FOSS Application Note 64 was used to predict contents of 7 FA groups and 4 individual FA. Data generated from the application note have been used to estimate breeding values for sires for percentage of saturated fat (SFA%) in milk. To investigate whether extreme SFA% breeding values of sires were reflected in the detailed milk FA profile from their daughters, milk samples from 194 cows in 7 organic herds were collected and the detailed FA composition measured by gas chromatography. From each cow, milk samples were collected twice to explore specific seasonal effects of pasture-based diets in relation to sires' estimated breeding value (EBV) for MIRS-predicted SFA% (MIRS-SFA%). The results showed a significant difference in SFA% measured from GC (GC-SFA%) in milk from daughters of sires having high SFA% EBV compared with daughters of sires having low SFA% EBV. The EBV group (low or high) also significantly affected most FA except C13:0, C15:0, C17:0, and C18:1 trans-11. Contents of SFA with even chain-lengths were all higher in the high EBV group, whereas C14:1, C16:1, and the other unsaturated C18 FA had a higher content in the low EBV group. All FA were significantly affected by season. The SFA% decreased from indoor spring feeding to summer pasture, as did FA with chain length ≤16 carbons, whereas long-chain FA (>C17) all increased during summer pasture. The results show that use of MIRS-predicted EBV for SFA% will most likely display a correlated response on the detailed FA composition in milk. In the current study, the combined action of feeding and genetics resulted in a 10 percentage-point difference on average when comparing milk SFA% from daughters of high SFA% EBV sires during indoor spring feeding from one farm to milk SFA% from daughters of low SFA% EBV sires during summer from another farm.

Nonoccupational postexposure prophylaxis for exposure to HIV in New York State emergency departments.

We investigate emergency department (ED) directors' knowledge of protocols and practices for nonoccupational postexposure prophylaxis (nPEP) after potential exposure to HIV after sexual assault and consensual sexual exposures in New York State (NYS) EDs. Every ED director in NYS was queried through an electronic survey about protocols, antiretroviral drugs supplied, resources and barriers to implementation. They were also asked for retrospective data, including the number and type of cases seen and percentage in which nPEP was initiated. One hundred eighty-eight of 207 ED directors (91%) responded. One hundred seventy-eight (95%) have a protocol for sexual assault and 111 (59%) have a protocol for voluntary sexual exposure. After sexual assault, 163 ED directors (87%) reported that they typically initiate nPEP in the ED; 25 (13%) either write a prescription only or refer to another facility. After voluntary sexual exposure 132 (70%) typically initiate nPEP in the ED; 55 (29%) either write a prescription only or refer to another facility (p < 0.001). Self-reported ED data indicate that 3439 sexual assault exposures and 6858 voluntary sexual exposures and were seen in NYS EDs in 2005. The nPEP initiation rate was 65% (2244/3439) for sexual assault exposures and 43% (2931/6858) for consensual sexual exposures (p < 0.001). These results suggest that NYS nPEP guidelines are not widely implemented, and raise several important public health policy issues, including access to medication and follow-up care. Our results indicated resources, primarily number of dedicated staff, and physician education as two major factors contributing to this problem.