The World Health Organization's Frontline Support to Countries During the COVID-19 Pandemic in 2020.

The World Health Organization (WHO) declared the SARS-CoV-2 outbreak a Public Health Emergency of International Concern (PHEIC) on January 30, 2020. WHO rapidly scaled up its response including through its 149 country offices to support Member States prepare for and respond to the COVID-19 pandemic. This article describes the frontline role of the WHO Country Offices (WCOs) and demonstrates that WHO utilized its existing country presence to deliver its global program of work during this unprecedented emergency. Using data collected from the 2020 WHO COVID-19 Strategic Preparedness and Response Plan monitoring and evaluation framework assessments, plus data collected in a quantitative survey completed by 149 WCOs during 2020, this article describes how WHO supported national authorities and partners through leadership, policy dialogue, strategic support, technical assistance, and service delivery, in line with WHO's current 5-year strategic plan, the WHO 13th General Programme of Work 2019-2023. Country level case studies were used to further illustrate actions taken by WCOs. WHO's achievements notwithstanding, the Organization faced several key challenges in the first year of the response. Recommendations to enhance WHO presence in countries for future emergency prevention, preparedness and response, from several independent reviews, were presented to the World Health Assembly in May 2021 and relevant recommendations are presented in this article.

Evaluation of the use of ketoprofen for the treatment of digital dermatitis in dairy cattle: A randomised, positive controlled, clinical trial.

BACKGROUND: The objective of this study was to evaluate the benefits of administering ketoprofen to cows suffering from active digital dermatitis (DD). METHODS: 158 cows presented with active DD (M1, M2 or M4.1 stage) were randomly allocated to either the control or the treatment group. All cows were treated with topical application of oxytetracycline spray. The treatment group also received an intramuscular injection of ketoprofen (3 mg/kg, Ketofen 10%, Ceva Animal Health). Cows were mobility scored just before they were treated and then again one week later. Information regarding their daily milk production was also collected. RESULTS: Animals in the control group were at 2.57 (95% confidence interval (CI): 0.82-8.01, p = 0.10) times higher odds to be lame at the second evaluation compared to those that received ketoprofen as well. This was a numeric but not statistically significant difference. When only cows that were lame prior to treatment were considered, cows that did not receive ketoprofen were at 20.20 (95% CI: 1.40-291.29, p = 0.03) higher odds of remaining lame week post-treatment comparing to cows that did receive ketoprofen. Freshly calved and lame at enrolment cows in the treatment group produced 58.38 ± 1.85 kg per day the week after treatment comparing to freshly calved and lame at enrolment controls that produced 47.89 ± 1.81 kg per day (p < 0.05). CONCLUSION: The addition of ketoprofen in the treatment of active DD lesions may be beneficial for animal welfare and for animal productivity.

Paediatric rotational abnormalities: A primer.

BACKGROUND: Idiopathic rotational abnormalities of the lower limb have been studied extensively in children through to adulthood, but there remains concern among parents and the community whether a normal variant is pathological. OBJECTIVE: The aim of this article is to draw attention to deformities in the transverse plane and to highlight the variation in normal over time, and according to sex. DISCUSSION: Rotational malalignment of the lower limb can be a rare cause of pain in the hip, knee, ankle and foot. Understanding common presentation and physical examination findings is the first step in diagnosing and, ultimately, managing symptomatic rotational abnormalities in children and adolescents.

Ovine infectious keratoconjunctivitis in sheep: the farmer's perspective.

The objective of this study was to gather current, farmer-reported data on the frequency of occurrence, risk factors and treatment practices for the sheep eye disease, ovine infectious keratoconjunctivitis (OIKC). A questionnaire regarding eye disease in sheep was completed by 135 farmers from four livestock markets. Most farmers (87%) had observed OIKC in their flock, 88% of these within the last 2 years. Farmers reported observing most cases in the winter months (51%) and fewest in the summer (10%). They proposed housing and forage feeding from racks as factors associated with OIKC. A variety of treatment protocols were used by farmers. The three most popular treatments used were: cloxacillin eye ointment, intramuscular oxytetracycline injection and topical tetracycline spray applied to the eye. Only 62% of treatments were considered very effective by the farmers, with no difference in farmer perceived efficacy between these three most commonly used treatments (p=0.6). Farmers used 15 different terms to describe a photograph of a sheep with OIKC, including many colloquial terms. We hypothesise that this could result in communication problems between veterinary surgeons and farmers.

Associations between age at first calving and subsequent lactation performance in UK Holstein and Holstein-Friesian dairy cows.

Lactation records from 396,534 pedigree Holstein and Holstein-Friesian primiparous cows from 6,985 UK milk recorded herds, calving for the first time during the period between the 1st of January 2006 and the 31st of December 2008, were examined in order to determine the associations between age at first calving (AFC) and subsequent production, udder health, fertility and survivability parameters. Heifers were grouped by AFC into single month classes ranging from 21 to 42 months. Mixed effects multivariable regression modelling was used for data analysis. Mean and median AFC were 29.1 and 28 months respectively. Within the study, only 48,567 heifers (12.3% of the studied population) calved for the first time at 24 months of age or younger. 162,157 heifers (40.9%) were 30 months or older at their first calving. An increased AFC was associated with increased first lactation milk, fat and protein yields. The lowest predicted mean 305-day yield (6,617kgs; 95% confidence interval (CI): 6,546-6,687 kgs) was recorded for the 21 month AFC class, significantly lower than any other class. The 36 month AFC class had the highest predicted mean (7,774 kgs; 95% CI: 7,737-7,811 kgs). However, an increased AFC was also associated with increased calving interval and increased first lactation somatic cell count (SCC). Animals calving at 21 months had a predicted mean lactation SCC of 72,765 (95% CI: 68427-77378). Animals calving at 36 months of age had a predicted mean lactation SCC of 86,648 (95% CI: 84,499-88,853). Importantly, an increased AFC was also associated with decreased lifetime daily milk yield and decreased likelihood of calving for a second successive time. Animals calving at 22 months of age had a predicted mean daily lifetime milk yield of 15.24 kgs (95% CI: 15.06-15.35); animals calving at 36 months of age had a predicted mean daily lifetime milk yield of 12.83 kgs (95% CI: 12.76-12.91). Our results highlight the importance of achieving a lower age at first calving which was here associated with improved udder health, increased lifetime daily milk yield, improved reproductive performance and increased likelihood of calving for a second time.

Randomised clinical trial evaluating the effect of different timing and number of fixed timed artificial inseminations, following a seven-day progesterone-based protocol, on pregnancy outcomes in UK dairy heifers.

The objective of this study was to determine the effect on pregnancy outcome of either inseminating heifers twice (at 48 and 72 hours after withdrawal of a controlled internal drug release insert (CIDR) containing progesterone) or once (56 hours after CIDR withdrawal) following a seven-day CIDR synchronisation protocol. Dairy heifers (n=267) from five farms, with an age range of 388-736 days, were randomly assigned to one of two treatment groups (group A heifers were inseminated twice; group B heifers were inseminated once). Both groups received a CIDR on day (D) 0 and an intramuscular injection of d-cloprostenol on D6; the CIDR was withdrawn on D7. Measurements of withers height, body condition score and hearth girth (used to estimate weight) were taken on D0. The diameter of the largest follicles and corpora lutea was recorded on both D0 and D6. Data were analysed with the use of multivariable logistic regression modelling. Treatment group and farm were not statistically significantly associated with pregnancy per treatment (P/T). Age and dominant follicle size on D6 were significantly associated with P/T. Heifers with the largest dominant follicle sizes (16-22 mm) were 5.54 times less likely to be pregnant than those heifers with the smallest dominant follicles (8-10 mm) on D6. It was shown that the cost associated with inseminating heifers twice after a seven-day CIDR synchronisation protocol is not justified.

The Holy See on sexual and reproductive health rights: conservative in position, dynamic in response.

The Holy See has engaged extensively in United Nations negotiations on issues concerning sexual and reproductive health rights as they have emerged and evolved in a dynamic global agenda over the past two decades. A meta-narrative review of the mission's official statements was conducted to examine the positions, discourses and tensions across the broad range of agendas. The Holy See represents a fundamentally conservative and stable position on a range of sexual and reproductive health rights concerns. However, the mission has been dynamic in the ways in which it has forwarded its arguments, increasingly relying upon secularised technical claims and empirical evidence; strategically interpreting human rights norms in ways consistent with its own position; and framing sexuality and reproduction in the context of "the family". Seen in the broader context of a "religious resurgence" in international relations, and in light of the fact that the Holy See has frequently sought to form alliances with conservative State and non-State actors, these findings make an important contribution to understanding the slow progress as well as the potential obstacles that lie ahead in the battle to realise sexual and reproductive health rights in a changing global political environment.

Functional definition and characterization of acute traumatic coagulopathy.

OBJECTIVE: To identify an appropriate diagnostic tool for the early diagnosis of acute traumatic coagulopathy and validate this modality through prediction of transfusion requirements in trauma hemorrhage. DESIGN: Prospective observational cohort study. SETTING: Level 1 trauma center. PATIENTS: Adult trauma patients who met the local criteria for full trauma team activation. Exclusion criteria included emergency department arrival >2 hrs after injury, >2000 mL of intravenous fluid before emergency department arrival, or transfer from another hospital. INTERVENTIONS: None. MEASUREMENTS: Blood was collected on arrival in the emergency department and analyzed with laboratory prothrombin time, point-of-care prothrombin time, and rotational thromboelastometry. Prothrombin time ratio was calculated and acute traumatic coagulopathy defined as laboratory prothrombin time ratio >1.2. Transfusion requirements were recorded for the first 12 hrs following admission. MAIN RESULTS: Three hundred patients were included in the study. Laboratory prothrombin time results were available at a median of 78 (62-103) mins. Point-of-care prothrombin time ratio had reduced agreement with laboratory prothrombin time ratio in patients with acute traumatic coagulopathy, with 29% false-negative results. In acute traumatic coagulopathy, the rotational thromboelastometry clot amplitude at 5 mins was diminished by 42%, and this persisted throughout clot maturation. Rotational thromboelastometry clotting time was not significantly prolonged. Clot amplitude at a 5-min threshold of ≤35 mm had a detection rate of 77% for acute traumatic coagulopathy with a false-positive rate of 13%. Patients with clot amplitude at 5 mins ≤35 mm were more likely to receive red cell (46% vs. 17%, p < .001) and plasma (37% vs. 11%, p < .001) transfusions. The clot amplitude at 5 mins could identify patients who would require massive transfusion (detection rate of 71%, vs. 43% for prothrombin time ratio >1.2, p < .001). CONCLUSIONS: In trauma hemorrhage, prothrombin time ratio is not rapidly available from the laboratory and point-of-care devices can be inaccurate. Acute traumatic coagulopathy is functionally characterized by a reduction in clot strength. With a threshold of clot amplitude at 5 mins of ≤35 mm, rotational thromboelastometry can identify acute traumatic coagulopathy at 5 mins and predict the need for massive transfusion.

Hemostatic effects of fresh frozen plasma may be maximal at red cell ratios of 1:2.

BACKGROUND: Damage control resuscitation targets acute traumatic coagulopathy with the early administration of high-dose fresh frozen plasma (FFP). FFP is administered empirically and as a ratio with the number of packed red blood cells (PRBC). There is controversy over the optimal FFP:PRBC ratio with respect to outcomes, and their hemostatic effects have not been studied. We report preliminary findings on the effects of different FFP:PRBC ratios on coagulation. METHODS: This is a prospective observational cohort study of trauma patients requiring >4 U of PRBCs. Blood was drawn before and after each 4-U PRBC interval for prothrombin time and analysis by rotational thromboelastometry. Interval change in coagulation parameters were compared with the FFP:PRBC ratio received during each interval. RESULTS: Sixty 4-U PRBC intervals from 50 patients were available for analysis. All measures of coagulation deteriorated with low FFP:PRBC ratios (<1:2). Maximal hemostatic effect was observed in the 1:2 to 3:4 group: 12% decrease in prothrombin time (p=0.006), 56% decrease in clotting time (p=0.047), and 38% increase in maximum clot firmness (p=0.024). Transfusion with ≥1:1 ratio did not confer any additional improvement. There was a marked variability in response to FFP, and hemostatic function deteriorated in some patients exposed to 1:1 ratios. The beneficial effects of plasma were confined to patients with coagulopathy. CONCLUSIONS: Interim results from this prospective study suggest that FFP:PRBC ratios of ≥1:1 do not confer any additional advantage over ratios of 1:2 to 3:4. Hemostatic benefits of plasma therapy are limited to patients with coagulopathy.