Characterizing the attitudes and motivations of Ontario dairy producers toward udder health.

Considerable research has focused on identifying risk factors for intramammary infections, yet mastitis remains a pervasive disease on dairy farms. Increasingly, researchers are appreciating the role of dairy producer mindset in determining management style and thus udder health status of the herd. The objective of this study was to explore the attitudes and motivations of Ontario dairy farmers toward udder health in herds with varying bulk milk somatic cell count (BMSCC). In December 2011, 5 focus groups were conducted across Ontario, Canada, with independent groups of dairy producers representing low, medium, and high BMSCC herds. Groups were established based on producer's weighted BMSCC levels as recorded over the summer of 2011. A semi-structured interview guide was followed to discuss topics relating to udder health. Thematic analysis was performed on the interview transcripts. Generally, producers noted management techniques (specifically culling infected cows and monitoring BMSCC), a perceived wealth of information on mastitis control, and a proactive whole-herd management approach engender the perception of control over mastitis. Producers in the low BMSCC group were confident in their level of knowledge and control of mastitis in their herds, whereas high BMSCC producers generally felt lower levels of control. Several areas were identified by producers that counteract this perception, contributing to perceived low levels of control over mastitis. Participants identified that at certain times they do not understand the cause of BMSCC on their farm. This attitude was especially prominent in the high BMSCC group. Other times, producers cited improper sample handling, seasonal issues, perceived milk culture shortcomings, and low herd size as factors that limited their control over mastitis in their herds. Though producers generally have high levels of self-efficacy beliefs when it comes to udder health management, the perception still exists that, under certain situations, mastitis is uncontrollable. This highlights the fact that educational and extension efforts need to focus on ensuring that producers employ proven mastitis diagnostic, prevention, and treatment practices in a systematic manner, with realistic expectations.

Studying the relationship between on-farm environmental conditions and local meteorological station data during the summer.

High ambient heat and humidity have profound effects on the production, health, profitability, and welfare of dairy cattle. To describe the relationship between summer temperature and relative humidity in the barn and determine the appropriateness of using meteorological station data as a surrogate for on-farm environmental monitoring, a study was conducted on 48 farms in Ontario, Canada, over the summer (May through September) of 2013. Within-barn environmental conditions were recorded using remote data loggers. These values were compared with those of the closest official meteorological station. In addition, farm-level characteristics and heat-abatement strategies were recorded for each farm. Environmental readings within the barn were significantly higher than those of the closest meteorological station; however, this relationship varied greatly by herd. Daily temperature-humidity index (THI) values within the barn tended to be 1 unit higher than those of the closest meteorological station. Numerically, 1.5 times more mean daily THI readings were in excess of 68 (heat stress threshold for lactating dairy cows) in the barn, relative to the closest meteorological station. In addition, tiestalls, herds that were allowed access to pasture, and herds that had no permanent cooling strategy for their cows had the highest mean and maximum daily THI values. Minimum daily THI values were almost 4 units higher for tiestall relative to freestall herds. Overall, due to farm-specific and unpredictable variability in magnitude of environmental differences between on-farm and meteorological station readings, researchers attempting to study the effects of environment on dairy cows should not use readings from meteorological stations because these will often underestimate the level of heat stress to which cows are exposed.

Exploring the characteristics and dynamics of Ontario dairy herds experiencing increases in bulk milk somatic cell count during the summer.

Regionally aggregated bulk milk somatic cell count (BMSCC) data from around the world shows a repeatable cyclicity, with the highest levels experienced during warm, humid seasons. No studies have evaluated this seasonal phenomenon at the herd level. The objectives of this study were to define summer seasonality in BMSCC on an individual herd basis, and subsequently to describe the characteristics and dynamics of herds with increased BMSCC in the summer. The data used for this analysis were from all dairy farms in Ontario, Canada, between January 2000 and December 2011 (n≈4,000 to 6,000 herds/yr). Bulk milk data were obtained from the milk marketing board and consisted of bulk milk production, components (fat, protein, lactose, other solids), and quality (BMSCC, bacterial count, inhibitor presence, freezing point), total milk quota of the farm, and milk quota and incentive fill percentage. A time-series linear mixed model, with random slopes and intercepts, was constructed using sine and cosine terms as predictors to describe seasonality, with herd as a random effect. For each herd, seasonality was described with reference to 1 cosine function of variable amplitude and phase shift. The predicted months of maximal and minimal BMSCC were then calculated. Herds were assigned as low, medium, and high summer increase (LSI, MSI, and HSI, respectively) based on percentiles of amplitude in BMSCC change for each of the 4 seasons. Using these seasonality classifications, 2 transitional repeated measures logistic regression models were built to assess the characteristics of MSI and HSI herds, using LSI herds as controls. Based on the analyses performed, a history of summer BMSCC increases increased the odds of experiencing a subsequent increase. As herd size decreased, the odds of experiencing HSI to MSI in BMSCC increased. Herds with more variability in daily BMSCC were at higher odds of experiencing MSI and HSI in BMSCC, as were herds with lower annual mean BMSCC. Finally, a negative association was noted between filling herd production targets and experiencing MSI to HSI in BMSCC. These findings provide farm advisors direction for predicting herds likely to experience increases in SCC over the summer, allowing them to proactively focus udder health prevention strategies before the high-risk summer period.

Endogenous CO2 ice mixture on the surface of Europa and no detection of plume activity.

Jupiter's moon Europa has a subsurface ocean beneath an icy crust. Conditions within the ocean are unknown, and it is unclear whether it is connected to the surface. We observed Europa with the James Webb Space Telescope (JWST) to search for active release of material by probing its surface and atmosphere. A search for plumes yielded no detection of water, carbon monoxide, methanol, ethane, or methane fluorescence emissions. Four spectral features of carbon dioxide (CO2) ice were detected; their spectral shapes and distribution across Europa's surface indicate that the CO2 is mixed with other compounds and concentrated in Tara Regio. The 13CO2 absorption is consistent with an isotopic ratio of 12C/13C = 83 ± 19. We interpret these observations as indicating that carbon is sourced from within Europa.

Short communication: Bulk milk somatic cell penalties in herds enrolled in Dairy Herd Improvement programs.

The objective of this study was to determine the effect of somatic cell count (SCC) monitoring at the cow level through Dairy Herd Improvement (DHI) programs on the risk of bulk tank SCC (BTSCC) penalties. For the year 2009, BTSCC for all producers in Ontario were examined, for a total of 2,898 DHI herds, 1,186 non-DHI herds, and 48,250 BTSCC records. Two penalty levels were examined, where BTSCC exceeded 499,000 (P500) and 399,000 (P400) cells/mL. Data were modeled first to determine the odds of a BTSCC exceeding a set penalty threshold and second to determine the odds of incurring a penalty under the Ontario Milk Act. All data were modeled as a generalized mixed model with a binary link function. Random effects included herd, fixed effects included season of BTSCC (summer, May to September, and winter, October to April), total milk shipped per month (L), fat paid per month (kg), protein paid per month (kg), and participation or not in the DHI program. The likelihood of a BTSCC exceeding a penalty threshold in a non-DHI herd compared with a DHI herd was significantly greater than 1 at both penalty levels, where the odds ratios were estimated to be 1.42 [95% confidence interval (CI): 1.19 to 1.69] and 1.38 (95% CI: 1.25 to 1.54) for P500 and P400, respectively. The likelihood of incurring a BTSCC penalty (where 3 out of 4 consecutive BTSCC exceeded penalty thresholds) was not significantly different at P500; however, it was significantly different for P400, where the odds ratio was estimated to be 1.42 (95% CI: 1.12 to 1.81).

Milk production and somatic cell counts: a cow-level analysis.

The objectives of this study were to quantify the relationship between 24-h milk loss and lactation milk loss due to mastitis at the cow level. For the year 2009, individual cow test-day production records from 2,835 Ontario dairy herds were examined. Each record consisted of 24-h milk and component yields, stage of lactation (days in milk, DIM), somatic cell count (SCC, ×10(3) cells/mL) and parity. The modeling was completed in 2 stages. In stage 1, for each animal in the study, the estimated slope from a linear regression of 24-h milk yield (kg), adjusted for DIM, the quadratic effect of DIM, and the 24-h fat yield (kg) on ln(SCC) was determined. In stage 2, the estimated slope were modeled using a mixed model with a random component due to herd. The fixed effects included season (warm: May to September, cool: October to April), milk quartile class [MQ, determined by the rank of the 24-h average milk yield (kg) over a lactation within the herd] and parity. The estimated slopes from the mixed model analysis were used to estimate 24-h milk loss (kg) by comparing to a referent healthy animal with an SCC value of 100 (×10(3) cells/mL) or less. Lactation milk loss (kg) was then estimated by using estimated 24-h milk loss within lactation by means of a test-day interval method. Lactation average milk loss (kg) and SCC were also estimated. Lastly, lactation milk loss (kg) was modeled on the log scale using a mixed model, which included the random effect of herd and fixed effects, parity, and the linear and quadratic effect of the number of 24-h test days within a lactation where SCC exceeded 100 (×10(3) cells/mL; S100). The effect of SCC was significant with respect to 24-h milk loss (kg), increasing across parity and MQ. In general, first-parity animals in the first MQ (lower milk yield animals) were estimated to have 45% less milk loss than later parity animals. Milk losses were estimated to be 33% less for animals in first parity and MQ 2 through 4 than later parity animals in comparable MQ. Therefore, the relative level of milk production was found to be a significant risk factor for milk loss due to mastitis. For animals with 24-h SCC, values of 200 (×10(3) cells/mL), 24-h milk loss ranged from 0.35 to 1.09 kg; with 24-h SCC values of 2,000 (×10(3) cells/mL), milk loss ranged from 1.49 to 4.70 kg. Lactation milk loss (kg) increased significantly as lactation average SCC increased, ranging from 165 to 919 kg. The linear and quadratic effect of S100 was a significant risk factor for lactation milk loss (kg), where greatest losses occurred in lactations with 5 or more 24-h test days where SCC exceeded 100 (×10(3) cells/mL).

Diagnosing intramammary infections: comparison of multiple versus single quarter milk samples for the identification of intramammary infections in lactating dairy cows.

The objective was to examine the potential benefits of using different combinations of multiple quarter milk samples compared with a single sample for diagnosing intramammary infections (IMI) in dairy cattle. Data used in the analyses were derived from 7,076 samples from 667 quarters in 176 cows in 8 herds in 4 locations (Minnesota/Wisconsin, n=4; Prince Edward Island, n=2; Ontario, n=1; New York, n=1). Duplicate quarter milk samples were collected at morning milking for 5 consecutive days. Cows were evenly distributed between early postparturient and mid- to late-lactation cows. All samples were frozen for shipping and storage, thawed once, and cultured in university laboratories using standardized procedures consistent with National Mastitis Council guidelines. The presence of specific pathogens was confirmed and identified using the API identification system (bioMerieux, Marcy l'Etoile, France) in each laboratory. A previously developed gold standard was applied to the first sample from d 1, 3, and 5 to classify infected quarters. The data were analyzed separately for coagulase-negative staphylococci (CNS) and Streptococcus spp. Various combinations of test results from d 2 and 4 were used in the test evaluation. These consisted of single samples (n=4), 2 sets of duplicate samples (2 samples collected on the same day), 2 sets of consecutive samples (2 samples collected 2 d apart), and 2 sets of triplicate samples (2 samples on the same day and a third sample 2 d apart). Series interpretation of duplicate or consecutive samples (i.e., positive=same pathogen isolated from both samples) resulted in the highest specificity (Sp; CNS Sp=92.1-98.1%; Streptococcus spp. Sp=98.7-99.6%), but lowest sensitivity (Se; CNS Se=41.9-53.3%; Streptococcus spp. Se=7.7-22.2%). Parallel interpretation of duplicate or consecutive samples (i.e., positive=pathogen isolated from either) resulted in the highest Se (CNS Se=70.8-80.6%; Streptococcus spp. Se=31.6-48.1%), but lowest Sp (CNS Sp=72.0-77.3%; Streptococcus spp. Sp=89.5-93.3%). The difference in estimates between single and duplicate samples was larger than between single and consecutive samples. Overall, triplicate samples provided the best combination of Se and Sp, but compared with a single sample, provided only a modest gain in Sp and little or no gain in Se.

Genetic parameters of milking frequency and milk production traits in Canadian Holsteins milked by an automated milking system.

Twice-a-day milking is currently the most frequently used milking schedule in Canadian dairy cattle. However, with an automated milking system (AMS), dairy cows can be milked more frequently. The objective of this study was to estimate genetic parameters for milking frequency and for production traits of cows milked within an AMS. Data were 141,927 daily records of 953 primiparous Holstein cows from 14 farms in Ontario and Quebec. Most cows visited the AMS 2 (46%) or 3 (37%) times a day. A 2-trait [daily (24-h) milking frequency and daily (24-h) milk yield] random regression daily animal model and a multiple-trait (milk, fat, protein yields, somatic cell score, and milking frequency) random regression test-day animal model were used for the estimation of (co)variance components. Both models included fixed effect of herd x test-date, fixed regressions on days in milk (DIM) nested within age at calving by season of calving, and random regressions for additive genetic and permanent environmental effects. Both fixed and random regressions were fitted with fourth-order Legendre polynomials on DIM. The number of cows in the multiple-trait test-day model was smaller compared with the daily animal model. Heritabilities from the daily model for daily (24-h) milking frequency and daily (24-h) milk yield ranged between 0.02 and 0.08 and 0.14 and 0.20, respectively. Genetic correlations between daily (24-h) milk yield and daily (24-h) milking frequency were largest at the end of lactation (0.80) and smallest in mid-lactation (0.27). Heritabilities from the test-day model for test-day milking frequency, milk, fat and protein yield, and somatic cell score were 0.14, 0.26, 0.20, 0.21, and 0.20, respectively. The genetic correlation was positive between test-day milking frequency and official test-day milk, fat, and protein yields, and negative between official test-day somatic cell score and test-day milking frequency.

An analysis of the relationship between bulk tank milk quality and wash water quality on dairy farms in Ontario, Canada.

The objective of this study was to identify regions at high risk for bacterial water or milk contamination, as well as risk factors associated with high bacteria counts in raw milk in Ontario, Canada. Between 2003 and 2004, the Dairy Farmers of Ontario (DFO) tested water samples from 5,421 farms in Ontario for the presence of Escherichia coli and coliforms. The water samples were collected as "point-of-use" samples, meaning that each sample was taken from a tap or water hose in the milk house as soon as the water was turned on. Routine, monthly raw milk bacterial counts were determined by DFO using BactoScan (Foss, Hillerød, Denmark). BactoScan data were retrieved from DFO for all of the farms with water test results. The prevalence of samples with E. coli and coliforms in water and elevated bacteria counts in raw milk was 13.6, 53.8, and 2.8%, respectively. The spatial analysis, using a scan statistic, revealed 1 coliform and 3 E. coli clusters of contaminated water, but no clusters of elevated milk bacteria counts in raw milk in southern Ontario. The coliform water contamination cluster was the largest, with a radius of approximately 200 km. Regression analysis indicated that risk factors associated with the occurrence of high levels of bacteria in raw milk were elevated average monthly somatic cell count, increased total milk production, cooler seasons of the year, and the presence of E. coli in wash water.

Milking-to-milking variability for milk yield, fat and protein percentage, and somatic cell count.

The main objectives were to analyze milking-to-milking variability in milk yield, fat and protein percentages, and somatic cell count (SCC). Additional objectives were to investigate the factors that affect variation in milk fat percentage and to study the seasonal variations in milk, fat, and protein yields and SCC. A total of 16 farms (14 milked 2x and 2 milked 3x) across Canada participated in a 5-d milk-sampling study, with 27,328 milk samples collected and analyzed for fat and protein yields and SCC. Descriptive statistics for both 2x and 3x herds for milk yield and fat and protein percentages followed a typical pattern throughout lactation, and the somatic cell linear scores were higher in early lactation for first-lactation cows (4.7 vs. 3.8) but were higher at the end of lactation for cows in second lactation or greater (5.1 vs. 4.9). The 2x herds had higher milk yields in the morning (approximately 17 vs. approximately 14 kg), whereas the 3x herds had the lowest milk yields in the morning, and yields peaked at the evening milking (approximately 9 vs. approximately 11.2 kg). A herd management questionnaire was distributed to participating producers to investigate the relationship between management variables and variations in milk fat percentage over the 5-d sampling period. Data from the questionnaire determined that milking period had a significant effect on milk fat in 2x herds, with fat percentage 1.11% lower in the morning compared with the evening milking period. Seasonal differences in milk, fat, and protein yields were investigated in 910 cows on 3 farms, with 5,517 fat and 5,534 protein samples. The seasonal differences in fat yield [summer = 1.02 +/- 1.05 kg/d (SEM); winter = 1.19 +/- 1.05 kg/d] and protein yield (summer = 0.85 +/- 1.05 kg/d; winter = 0.96 +/- 1.05 kg/d) were significant only for first lactation. Understanding the variability in milk yield, fat and protein percentages, and SCC is important when making management decisions and in milk-recording programs.

A total merit selection index for Ontario organic dairy farmers.

Organic standards require changes in management practices so that health, fertility, and overall fitness are more important than on conventional dairy farms and require different selection objectives. A survey involving 18 (40%) Ontario organic dairy farms was carried out to collect data on their production systems, breeding policies, and concerns. Compared with conventional farms, organic farms had lower milk production, lower replacement rate, higher somatic cell count, and a much higher rate of crossbreeding. Actual culling rate was 21%, and the main causes were fertility, mastitis, feet and legs, production, and old age. The major areas of concern expressed by organic dairy farmers were related to grazing traits, fertility, health, and longevity. An organic total merit index was developed based on the subjective scores for traits with a genetic evaluation in Canada. The relative weights of production to fitness traits (28:72) were substantially different from those in the Canadian Lifetime Profit Index (54:46), but similar to those used in conventional indices in Sweden and Denmark and in the Swiss organic index. The overall weight on health traits was 2.5 times higher in the organic index and, among fitness traits, the emphasis was substantially higher for lactation persistency, somatic cell score, and body capacity. Correlations between the organic index and Lifetime Profit Index were 0.88 for all bulls proven in Canada, 0.70 for the top 1,000, and 0.65 for the top 100, indicating that a different group of bulls would rank at the top of these 2 indices. When the top 100 bulls for either index were compared, those selected for the organic index were about 0.5 standard deviations lower for all yield traits, but were much better for body capacity and somatic cell score, and 0.25 standard deviations higher for herd life, feet and legs, udder conformation, and lactation persistency. Given the small population size, a separate breeding program for an organic management system is not viable in the foreseeable future. However, the organic index would allow producers to rank proven bulls in accordance with their perceived needs.

Agreement of predicted 305-day milk yields relative to actual 305-day milk weight yields.

The objectives of this study were to compare the multiple trait prediction (MTP) model estimate of 305-d lactation yield with the 305-d daily milk yield data from on-farm automated meters and software and to examine the accuracy of electronic identification (ID). Twenty-four-hour milk and component yields are calculated by using milk weights and samples collected 8 to 10 times/yr by Dairy Herd Improvement (DHI) organizations. Daily milk weights were collected from cows on 20 Canadian farms that used parlor milking systems with electronic ID and that were enrolled in a regular DHI program. A total of 10,175 DHI test days from 1,103 cows with complete 305-d lactation yields were entered into the MTP model, and lactation yields were predicted. Test days were grouped into first, second, and third and greater lactations and within each lactation group, days in milk were categorized in 3 stages (5 to 60, 61 to 120, and 120 to 305 d in milk) for a total of 9 classes. Agreement analysis was used to compare the 305-d sum of daily milk to the MTP 305-d lactation yield predictions by using inputs from test days throughout the lactations. Results indicated that the MTP model overestimated lactation yields across all parity groups, ranging from 310 to 1,552 kg in parity 1, 640 to 2,000 kg in parity 2, and 567 to 1,476 kg in parity 3 and greater. A preliminary examination of electronic ID accuracy was conducted on 4 farms. Two electronic ID systems were examined for cow ID accuracy by verifying the ID number appearing in the parlor with the corresponding ear tag number. There were no ID errors on 3 of 4 farms tested and only a very small number of errors (3/80) on the fourth farm, indicating that the electronic ID systems used in milking parlors identify cows accurately.

Investigation of the Occurrence of Porcine Reproductive and Respiratory Virus in Swine Herds Participating in an Area Regional Control and Elimination Project in Ontario, Canada.

The main goal of this study was to investigate the occurrence of porcine reproductive and respiratory syndrome virus (PRRSV)-specific genotypes in swine sites in Ontario (Canada) using molecular, spatial and network data from a porcine reproductive and respiratory syndrome (PRRS) regional control project. For each site, location, animal movement service provider (truck companies), PRRSV status and sequencing data of the open reading frame 5 (ORF5) were obtained. Three-kilometre buffers were created to evaluate neighbourhood characteristics for each site. Social network analysis was conducted on swine sites and trucking companies to assemble the network and define network components. Three different PRRSV genotypes were used as outcomes for statistical analysis based on the region's phylogenetic tree of the ORF5. Multivariable exact logistic regression was conducted to investigate the association between being positive for a specific genotype and two main exposures of interest: (i) having at least one neighbour within three km also positive for the same genotype outside the production system and (ii) having at least one positive site for the same genotype in the same truck network component outside the production system. Results showed that the importance of area spread and truck network on PRRSV occurrence differed according to genotype. Additionally, the Ontario PRRS database appears suitable for conducting regional disease investigations. Finally, the use of relatively new tools available for network, spatial and molecular analysis could be useful in investigation, control and prevention of endemic infectious diseases in animal populations.

The effect of a single early high-dose vitamin D supplement on fracture union in patients with hypovitaminosis D: a prospective randomised trial.

AIMS: To evaluate the effect of a single early high-dose vitamin D supplement on fracture union in patients with hypovitaminosis D and a long bone fracture. PATIENTS AND METHODS: Between July 2011 and August 2013, 113 adults with a long bone fracture were enrolled in a prospective randomised double-blind placebo-controlled trial. Their serum vitamin D levels were measured and a total of 100 patients were found to be vitamin D deficient (< 20 ng/ml) or insufficient (< 30 ng/mL). These were then randomised to receive a single dose of vitamin D3 orally (100 000 IU) within two weeks of injury (treatment group, n = 50) or a placebo (control group, n = 50). We recorded patient demographics, fracture location and treatment, vitamin D level, time to fracture union and complications, including vitamin D toxicity. Outcomes included union, nonunion or complication requiring an early, unplanned secondary procedure. Patients without an outcome at 15 months and no scheduled follow-up were considered lost to follow-up. The t-test and cross tabulations verified the adequacy of randomisation. An intention-to-treat analysis was carried out. RESULTS: In all, 100 (89%) patients had hypovitaminosis D. Both treatment and control groups had similar demographics and injury characteristics. The initial median vitamin D levels were 16 ng/mL (interquartile range 5 to 28) in both groups (p = 0.885). A total of 14 patients were lost to follow-up (seven from each group), two had fixation failure (one in each group) and one control group patient developed an infection. Overall, the nonunion rate was 4% (two per group). No patient showed signs of clinical toxicity from their supplement. CONCLUSIONS: Despite finding a high level of hypovitaminosis D, the rate of union was high and independent of supplementation with vitamin D3. Cite this article: Bone Joint J 2017;99-B:1520-5.

Short communication: Comparison of protocols to estimate twenty-four-hour fat and protein percentages for herds with a robotic milking system.

Currently, different protocols are used in various countries to estimate the 24-h fat and protein percentages for dairy cows that are milked with an automatic milking system. These protocols include estimating 24-h fat and protein percentages from 1) single samples from all animals in the herd; 2) single samples of fat adjusted for covariates and single samples of protein unadjusted for covariates; or 3) all samples (adjusted and unadjusted) collected on test days where test days vary in length from 10 to 18 h. The accuracy of estimated component percentages in predicting observed percentages was determined via agreement analysis for four protocols. Analysis of the data suggests collecting all samples (unadjusted for covariates) during a sampling period of at least 16 h on test day to be the most accurate protocol when estimating 24-h fat and protein percentages in herds with automatic milking systems.

Cervical screening history in patients with early stage carcinoma of the cervix.

This study aimed to examine whether a decade of heightened publicity on issues relating to cervical screening has changed the screening profile of women presenting with cervical cancer at the National Maternity Hospital. The screening history of 100 women diagnosed with early/surgically treated cervical cancer between 1998 and 2002 was compared with a similar study conducted in 1982 /1990. The percentage of women never screened was similar - 24 %( 2002) and 23% (1990). The interval between last recorded smear and diagnosis of disease was greater than 5 years in 45.6% and 41.7% respectively. Overall 60% of women in the recent period had either failed to avail of screening or were not screened within 5 years of diagnosis compared with 64% in 1990. Multiparous women comprised 90% of the study group and 50% of those inadequately screened were attending their general practitioner on a regular basis - therefore affording a potential for opportunistic screening The current method of screening has failed in this group and has not improved in 10 years despite of increased population awareness and greater opportunities for screening than ever before and would support an argument for a National Screening Program.

Systematic review and meta-analyses of the effect of lipid emulsion on microbial growth in parenteral nutrition.

BACKGROUND: As lipid in parenteral nutrition (PN) purportedly enhances microbial growth, recommendations limit infusion of lipid PN (or lipid emulsion) from a single container to 24h (48h for lipid-free PN). However, the associated evidence base is ambiguous. AIM: To examine factors affecting microbial growth in PN. METHODS: A systematic review with meta-analyses examined effects of nutrients on microbial growth in PN infusates over a 48-h period using the growth ratio {GR=log10[colony-forming units (cfu)/mL at 48h/cfu/mL at time zero]}. FINDINGS: Factors influencing GR in PN included glucose, microbial species, temperature, osmolarity, presence of vitamins, trace elements and lipid, and amino acid profile. Using unmatched datasets (N=306), a general linear model found that lipid inclusion in PN represented 3.3% of the variability, which was less than that due to glucose concentration (5.8%), microbial species (35.3%) and microbe-infusate interaction (4.4%). Using matched datasets (N=38 pairs), lipid inclusion in PN represented 5.4% of the variability (P=0.076), which was less than that due to glucose concentration (8.5%; P=0.025), microbial species (75.5%; P<0.001) and microbe-infusate interaction (13.3%; P=0.382). Using meta-analyses of matched datasets, the presence of lipid in PN at fixed glucose concentrations did not significantly increase GR of Candida albicans, Escherichia coli or Staphylococcus epidermidis (P=0.352, P=0.025 and P=0.494, respectively; overall P=0.175). CONCLUSION: Lipid inclusion in PN is only one of several factors that may influence microbial growth in PN. Any recommendations about the duration of PN infusion from a single container should account for all these factors, and should be weighted according to microbial species likely to contaminate PN.

Impact of definition and procedures used for absent blood culture data on the rate of intravascular catheter infection during parenteral nutrition.

BACKGROUND: Diagnosis of intravascular catheter infection may be affected by the definition and procedures applied in the absence of blood culture data. AIM: To examine the extent to which different definitions of catheter infection and procedures for handling absent blood culture data can affect reported catheter infection rates. METHODS: Catheter infection rates were established in a cohort of hospitalized patients administered parenteral nutrition according to three clinical and four published definitions. Paired and unpaired comparisons were made using available case analyses, sensitivity analyses and intention-to-categorize analyses. FINDINGS: Complete data were available for each clinical definition (N = 193), and there were missing data (4.1-26.9%) for the published definitions. In an available case analysis, the catheter infection rate was 13.0-36.8% for the clinical definitions and 2.1-12.4% for the published definitions. For the published definitions, the rate was 1.6-32.1% in a sensitivity analysis and 11.4-16.9% in an intention-to-categorize analysis, with suggestion of bias towards a higher catheter infection rate in those with missing data, in keeping with the analyses of the clinical definitions. For paired comparisons, the strength of agreement between definitions varied from 'poor' (Cohen's kappa <0.21) to 'very good' (Cohen's kappa ≥0.81). CONCLUSION: The use of different definitions of catheter infection and procedures applied in the absence of blood culture data produced widely different catheter infection rates, which could compromise measurements or comparisons of service quality or study outcome. As such, there is a need to establish and use a valid, consistent and practical definition.

Network, cluster and risk factor analyses for porcine reproductive and respiratory syndrome using data from swine sites participating in a disease control program.

The objectives of this study were to describe networks of Ontario swine sites and their service providers (including trucking, feed, semen, gilt and boar companies); to categorize swine sites into clusters based on site-level centrality measures, and to investigate risk factors for porcine reproductive and respiratory syndrome (PRRS) using information gathered from the above-mentioned analyses. All 816 sites included in the current study were enrolled in the PRRS area regional control and elimination projects in Ontario. Demographics, biosecurity and network data were collected using a standardized questionnaire and PRRS status was determined on the basis of available diagnostic tests and assessment by site veterinarians. Two-mode networks were transformed into one-mode dichotomized networks. Cluster and risk factor analyses were conducted separately for breeding and growing pig sites. In addition to the clusters obtained from cluster analyses, other explanatory variables of interest included: production type, type of animal flow, use of a shower facility, and number of neighboring swine sites within 3km. Unadjusted univariable analyses were followed by two types of adjusted models (adjusted for production systems): a generalizing estimation equation model (GEE) and a generalized linear mixed model (GLMM). Results showed that the gilt network was the most fragmented network, followed by the boar and truck networks. Considering all networks simultaneously, approximately 94% of all swine sites were indirectly connected. Unadjusted risk factor analyses showed significant associations between almost all predictors of interest and PRRS positivity, but these disappeared once production system was taken into consideration. Finally, the vast majority of the variation on PRRS status was explained by production system according to GLMM, which shows the highly correlated nature of the data, and raises the point that interventions at this level could potentially have high impact in PRRS status change and/or maintenance.

Systematic review and meta-analysis of the risk of microbial contamination of parenteral doses prepared under aseptic techniques in clinical and pharmaceutical environments: an update.

BACKGROUND: Administration of parenteral doses with microbial contamination can lead to infective morbidity or death. AIM: To test whether aseptic preparation of parenteral doses or additives to sterile doses undertaken in dedicated pharmaceutical rather than clinical environments reduces the risk of microbial dose contamination. METHODS: Data identified from a systematic review were examined using random effects meta-analyses, and t-tests were used to compare dose contamination frequencies. FINDINGS: In all, 16,552 doses from 34 studies (33 records) were identified. For all the data combined there was a significantly higher frequency of contamination of doses prepared in clinical than in pharmaceutical environments {3.7% [95% confidence interval (CI): 2.2, 6.2; N = 10,272 doses] vs 0.5% (95% CI: 0.1, 1.6; N = 6280 doses); P = 0.007}. Contamination of doses was significantly higher when prepared as individual lots than as part of a batch in pharmaceutical environments [2.1% (95% CI: 0.7, 5.8; N = 168 doses) vs 0.2% (95% CI: 0.1, 0.9; N = 6112 doses); P = 0.002]. There was a significantly higher frequency of dose contamination if additions were made to sterile parenteral doses in clinical environments [risk ratio: 2.121 (95% CI: 1.093, 4.114); P = 0.026]. The overall quality of the studies was judged to be low. CONCLUSION: Reported rates of parenteral dose contamination were orders of magnitude higher than accepted reference standards, which may increase infection risk. The limited evidence on contamination rates supports dose preparation in pharmaceutical rather than clinical environments, and does not support batch preparation in clinical environments.