Comparing nasopharyngeal apnoeic oxygenation at 18 l/min to preoxygenation alone in obese patients - A randomised controlled study.

STUDY OBJECTIVE: Investigate a low-cost, nasopharyngeal apnoeic oxygenation technique, establish its efficacy, and compare it to preoxygenation only in an obese population. The study's hypothesis was that nasopharyngeal apnoeic oxygenation at 18 l.min-1 would significantly prolong safe apnoea time compared to preoxygenation alone. DESIGN: Randomised controlled study. SETTING: Theatre complex of a resource constrained hospital. PATIENTS: 30 adult, obese (BMI ≥ 35 kg.m-2) patients presenting for elective surgery. Patients with limiting cardio-respiratory disease, suspected difficult airway, risk of aspiration, and that were pregnant, were excluded. Patients were allocated by block randomisation in a 1:2 ratio to a preoxygenation-only (No-AO) and an intervention group (NPA-O2). INTERVENTIONS: All patients were preoxygenated to an Et-O2 > 80%, followed by a standardised induction. The intervention group received oxygen at 18 l.min-1 via the nasopharyngeal catheter intervention. The desaturation process was documented until an SpO2 of 92% or 600 s was reached. MEASUREMENTS: Baseline demographic and clinical characteristics were collected. The primary outcome was safe apnoea time, defined as the time taken to desaturate to an SpO2 of 92%. Secondary outcomes were rate of carbon dioxide accumulation and factors affecting the risk of desaturation. MAIN RESULTS: The study was conducted in a morbidly obese population (NoAO = 41,1 kg.m-2; NPA-O2 = 42,5 kg.m-2). The risk of desaturation was signifantly lower in the intervention group (Hazzard Ratio = 0,072, 95% CI[0,019-0,283]) (Log-Rank test, p < 0.001). The median safe apnoea time was significantly longer in the intervention group (NoAO = 262 s [IQR 190-316]; NPA-O2 = 600 s [IQR 600-600]) (Mann-Whitney-U test, p < 0.001). The mean rate of CO2 accumalation was significantly slower in the intervention group (NoAO = 0,47 ± 0,14 kPa.min-1; NPA-O2 = 0,3 ± 0,09 kPa.min-1) (t-test, p = 0.003). There were no statistically significant risk factors associated with an increased risk of desaturation found. CONCLUSIONS: Nasopharyngeal apnoeic oxygenation at 18 l/min prolongs safe apnoea time, compared to preoxygenation alone, and reduces the risk of desaturation in morbidly obese patients. CLINICAL TRIAL REGISTRATION: PACTR202202665252087; WC/202004/007.

A statistical evaluation of associations between reproductive performance and milk composition and animal factors on grazing dairy cows in two New Zealand dairy farms.

AIMS: To determine if milk composition, milk yield, live weight, live weight change, breed and heterosis are associated with reproductive performance in dairy cows from two dairy farms under New Zealand grazing conditions. METHODS: Milk composition was determined in herd tests from 205 Holstein-Friesian (F), 77 Jersey (J) and 351 F × J crossbred cows from two Massey University dairy herds in the 2016 and 2017 production seasons. Mating occurred from October to December in each production season. The start of breeding to first service (SBFS), start of breeding to conception (SBCO), submission rate at 21 days (SR21), pregnancy rate at 21 (PR21) and 42 days (PR42) were calculated for each cow. These traits were analysed using mixed linear models that included fixed effects for herd, production season, regression coefficients of deviation from median calving date, lactation number, proportion of F, F × J heterosis, energy-corrected milk yield (ECMY), percentages of fat, protein and lactose, milk urea nitrogen (MUN), live weight and change in live weight, with random effects for cow and residual error. The variables with binomial distribution were analysed using logistic regression. RESULTS: Deviation from the herd's median calving date had a significant effect (p < 0.05) on all reproductive traits. Proportion of F was significant (p = 0.022) on PR21, and F × J heterosis effects were significant on PR21 (p = 0.049) and PR42 (p = 0.046). F cows had 17.8% higher PR21 than J cows, and F × J cows had higher reproductive performance than the mean of the two purebreeds. ECMY was negatively associated with SBFS (p = 0.001) and SBCO (p = 0.001) and positively associated with PR21 (p = 0.002) and PR42 (p = 0.001). Protein percentage was positively associated (p < 0.05) with PR21 and PR42, whereas lactose percentage was negatively associated (p < 0.05) with PR21 and PR42. Cows gaining live weight were more likely to become pregnant within 21 days of the start of breeding (p = 0.020). Milk urea nitrogen was negatively associated (p = 0.042) with SR21. CONCLUSIONS AND CLINICAL RELEVANCE: This study confirms that breed, heterosis, ECMY, protein and lactose percentages, live weight change and calving date are associated with the reproductive performance of grazing cows. Results from this study contrast with the historical antagonism between milk production and reproductive performance in dairy cattle, demonstrating that well managed cows can achieve high levels of production and good reproductive performance. MUN was not associated with reproductive performance traits, except with SR21.

Characteristics of feed efficiency within and across lactation in dairy cows and the effect of genetic selection.

The objective of the present study was to investigate the phenotypic inter- and intra-relationships within and among alternative feed efficiency metrics across different stages of lactation and parities; the expected effect of genetic selection for feed efficiency on the resulting phenotypic lactation profiles was also quantified. A total of 8,199 net energy intake (NEI) test-day records from 2,505 lactations on 1,290 cows were used. Derived efficiency traits were either ratio based or residual based; the latter were derived from least squares regression models. Residual energy intake (REI) was defined as NEI minus predicted energy requirements based on lactation performance; residual energy production (REP) was defined as net energy for lactation minus predicted energy requirements based on lactation performance. Energy conversion efficiency was defined as net energy for lactation divided by NEI. Pearson phenotypic correlations among traits were computed across lactation stages and parities, and the significance of the differences was determined using the Fisher r-to-z transformation. Sources of variation in the feed efficiency metrics were investigated using linear mixed models, which included the fixed effects of contemporary group, breed, parity, stage of lactation, and the 2-way interaction of parity by stage of lactation. With the exception of REI, parity was associated with all efficiency and production traits. Stage of lactation, as well as the 2-way interaction of parity by stage of lactation, were associated with all efficiency and production traits. Phenotypic correlations among the efficiency and production traits differed not only by stage of lactation but also by parity. For example, the strong phenotypic correlation between REI and energy balance (EB; 0.89) for cows in parity 3 or greater and early lactation was weaker for parity 1 cows at the same lactation stage (0.81), suggesting primiparous cows use the ingested energy for both milk production and growth. Nonetheless, these strong phenotypic correlations between REI and EB suggested negative REI animals (i.e., more efficient) are also in more negative EB. These correlations were further supported when assessing the effect on phenotypic performance of animals genetically divergent for feed intake and efficiency based on parental average. Animals genetically selected to have lower REI resulted in cows who consumed less NEI but were also in negative EB throughout the entire lactation. Nonetheless, such repercussions of negative EB do not imply that selection for negative REI (as defined here) should not be practiced, but instead should be undertaken within the framework of a balanced breeding objective, which includes traits such as reproduction and health.

Genetics of alternative definitions of feed efficiency in grazing lactating dairy cows.

The objective of the present study was to estimate genetic parameters across lactation for measures of energy balance (EB) and a range of feed efficiency variables as well as to quantify the genetic inter-relationships between them. Net energy intake (NEI) from pasture and concentrate intake was estimated up to 8 times per lactation for 2,481 lactations from 1,274 Holstein-Friesian cows. A total of 8,134 individual feed intake measurements were used. Efficiency traits were either ratio based or residual based; the latter were derived from least squares regression models. Residual energy intake (REI) was defined as NEI minus predicted energy requirements [e.g., net energy of lactation (NEL), maintenance, and body tissue anabolism] or supplied from body tissue mobilization; residual energy production was defined as the difference between actual NEL and predicted NEL based on NEI, maintenance, and body tissue anabolism/catabolism. Energy conversion efficiency was defined as NEL divided by NEI. Random regression animal models were used to estimate residual, additive genetic, and permanent environmental (co)variances across lactation. Heritability across lactation stages varied from 0.03 to 0.36 for all efficiency traits. Within-trait genetic correlations tended to weaken as the interval between lactation stages compared lengthened for EB, REI, residual energy production, and NEI. Analysis of eigenvalues and associated eigenfunctions for EB and the efficiency traits indicate the ability to genetically alter the profile of these lactation curves to potentially improve dairy cow efficiency differently at different stages of lactation. Residual energy intake and EB were moderately to strongly genetically correlated with each other across lactation (genetic correlations ranged from 0.45 to 0.90), indicating that selection for lower REI alone (i.e., deemed efficient cows) would favor cows with a compromised energy status; nevertheless, selection for REI within a holistic breeding goal could be used to overcome such antagonisms. The smallest (8.90% of genetic variance) and middle (11.22% of genetic variance) eigenfunctions for REI changed sign during lactation, indicating the potential to alter the shape of the REI lactation profile. Results from the present study suggest exploitable genetic variation exists for a range of efficiency traits, and the magnitude of this variation is sufficiently large to justify consideration of the feed efficiency complex in future dairy breeding goals. Moreover, it is possible to alter the trajectories of the efficiency traits to suit a particular breeding objective, although this relies on very precise across-parity genetic parameter estimates, including genetic correlations with health and fertility traits (as well as other traits).

Inter-relationships among alternative definitions of feed efficiency in grazing lactating dairy cows.

International interest in feed efficiency, and in particular energy intake and residual energy intake (REI), is intensifying due to a greater global demand for animal-derived protein and energy sources. Feed efficiency is a trait of economic importance, and yet is overlooked in national dairy cow breeding goals. This is due primarily to a lack of accurate data on commercial animals, but also a lack of clarity on the most appropriate definition of the feed intake and utilization complex. The objective of the present study was to derive alternative definitions of energetic efficiency in grazing lactating dairy cows and to quantify the inter-relationships among these alternative definitions. Net energy intake (NEI) from pasture and concentrate intake was estimated up to 8 times per lactation for 2,693 lactations from 1,412 Holstein-Friesian cows. Energy values of feed were based on the French Net Energy system where 1 UFL is the net energy requirements for lactation equivalent of 1kg of air-dry barley. A total of 8,183 individual feed intake measurements were available. Energy balance was defined as the difference between NEI and energy expenditure. Efficiency traits were either ratio-based or residual-based; the latter were derived from least squares regression models. Residual energy intake was defined as NEI minus predicted energy to fulfill the requirements for the various energy sinks. The energy sinks (e.g., NEL, metabolic live weight) and additional contributors to energy kinetics (e.g., live weight loss) combined, explained 59% of the variation in NEI, implying that REI represented 41% of the variance in total NEI. The most efficient 10% of test-day records, as defined by REI (n=709), on average were associated with a 7.59 UFL/d less NEI (average NEI of the entire population was 16.23 UFL/d) than the least efficient 10% of test-day records based on REI (n=709). Additionally, the most efficient 10% of test-day records, as defined by REI, were associated with superior energy conversion efficiency (ECE, i.e., NEL divided by NEI; ECE=0.55) compared with the least efficient 10% of test-day records (ECE=0.33). Moreover, REI was positively correlated with energy balance, implying that more negative REI animals (i.e., deemed more efficient) are expected to be, on average, in greater negative energy balance. Many of the correlations among the 14 defined efficiency traits differed from unity, implying that each trait is measuring a different aspect of efficiency.

Treatment of early caries lesions using biomimetic self-assembling peptides--a clinical safety trial.

OBJECTIVE: We previously reported that a rationally designed biomimetic self-assembling peptide, P11-4, nucleated hydroxyapatite de novo and was apparently capable of in situ enamel regeneration following infiltration into caries-like lesions. Our present aim was to determine the safety and potential clinical efficacy of a single application of P11-4 on early enamel lesions. MATERIALS AND METHODS: Fifteen healthy adults with Class V 'white spot' lesions received a single application of P11-4. Adverse events and lesion appearances were recorded over 180 days. RESULTS: Patients treated with P11-4 experienced a total of 11 adverse events during the study, of which two were possibly related to the protocol. Efficacy evaluation suggested that treatment with P11-4 significantly decreased lesion size (p = 0.02) after 30 days and shifted the apparent progression of the lesions from 'arrested/progressing' to 'remineralising' (p <0.001). A highly significant improvement in the global impression of change was recorded at day 30 compared with baseline (p <0.001). CONCLUSIONS: The results suggest that treatment of early caries lesions with P11-4 is safe, and that a single application is associated with significant enamel regeneration, presumably by promoting mineral deposition within the subsurface tissue.

Repair of calvarial defects in rats by prefabricated, degradable, long fibre composite implants.

We report results from an initial small animal study designed to provide information on the biocompatibility of a novel biodegradable composite designed for craniomaxillofacial reconstruction. Rat calvarium was chosen as a clinically analogous model, which allowed comparison between experimental groups (PCL alone, PCL/phosphate glass, or PCL/bioglass implants) and control groups (empty defects or bone grafted defects). All animals recovered well from surgery and no clinical complications were observed. Histological assessment indicated a lack of inflammatory response. The amount of new bone formation at the dural aspect of the implant was statistically significantly higher in the PCL/phosphate glass group than the other experimental groups. This study confirms, in a clinically analogous model, the promise of the novel PCL/phosphate glass composite material. Work is planned toward manufacturing scale up and clinical trials.

Effect of automatic cluster remover settings on production, udder health, and milking duration.

This study evaluated the effect of 4 criteria for determining the end-point of milking on milk yield, milk composition, completeness of milking-out, teat skin condition, somatic cell count (SCC), and the incidence of clinical mastitis (CM) in pasture-based dairy cows milked over 35 wk. The objective was to reduce milking duration without affecting milk production, SCC, or CM. Milking end-point treatments were as follows: cluster removed at a milk flow rate of 0.2 kg/min (ACR200); cluster removed at a milk flow rate of 0.4 kg/min (ACR400); cluster removed at a milk flow rate of 0.2 kg/min or at a maximum cluster attachment time from d 5 of lactation (MaxTEarly); and cluster removed at a milk flow rate of 0.2 kg/min until an average of 63+/-21 d in milk, then cluster removed at a milk flow rate of 0.2 kg/min or a maximum cluster attachment time (MaxTPeak). Maximum cluster attachment times were set at 7.5 min and 5.4 min for morning and afternoon milkings, respectively. Cows (approximately 94/treatment) were assigned to treatment at calving and milked twice daily at intervals of 9 and 15 h. Milking duration was shorter for ACR400, MaxTEarly, and MaxTPeak compared with ACR200. During wk 1 to 15, milk, protein, and lactose yields were less for MaxTEarly than for ACR400 and MaxTPeak, but not different from ACR200. During wk 16 to 35 and over the entire experiment, total milk, fat, protein, and lactose yields did not differ among treatments. Teat condition did not differ among the 4 treatments. Postmilking strip yield in wk 12 was greatest for MaxTEarly and least for ACR200; at wk 27, however, treatment had no effect on the completeness of milking-out. No differences were observed in either teat condition or the proportion of cows with at least 1 case of CM during the 35 wk. Somatic cell count was low across all treatments, but highest for ACR400. Increasing the automatic cluster remover threshold setting from 0.2 to 0.4 kg/min decreased milking duration without affecting milk production, CM, or teat condition. Combining a cluster removal milk flow threshold setting with a maximum cluster attachment time, when applied from either early lactation or from peak lactation, reduced milking duration without affecting milk production, CM, or SCC. Both strategies have potential to improve milking efficiency in dairy herds in which premilking preparation is minimal.

Milking cows once daily influences behavior and udder firmness at peak and mid lactation.

Our aim was to evaluate the effects of once-daily milking on the welfare of dairy cows in a pastoral-based farming system. There are concerns that cows milked only once daily may experience discomfort associated with udder distension. We evaluated the behavior, including lying time and postures, grazing patterns, and kicking behavior in the parlor, and measures of udder firmness in cows milked once daily in 2 experiments: 1) at peak lactation, comparing cows milked once (1x) or twice-daily (2x) from the time of calving (n = 4 groups; 1x and 2x treatments); and 2) during the transition from 2x to 1x milking at mid lactation (n = 12 groups; 1x, 2x, and 2x to 1x treatments or TRANS). At peak lactation, cows milked 1x were more likely to lie with their hind legs touching the body than cows milked 2x. There were no differences in udder firmness (1x: 10.0 vs. 2x: 9.9 +/- 0.13 g of force) or kicking (1x: 25 vs. 2x: 24 +/- 7.8%) behavior in the parlor. In the second experiment, milking frequency was reduced from 2x to 1x and this change resulted in an increase in udder firmness (1 x: 9.1, 2x: 9.3, and TRANS: 9.5 +/- 0.14 g of force). Despite these differences in udder firmness, lying time (1x: 10.1, 2x: 9.5, and TRANS: 9.6 +/- 0.38 h/24 h), postures, and concentrations of fecal glucocorticoid metabolites (1x: 10.0, 2x: 10.5, and TRANS: 10.4 +/- 0.49 ng/g of feces in the 3 d after transition) in cows milked 1x or 2x were similar. Although milking frequency did not influence total time spent grazing, the diurnal grazing pattern of cows milked 2x was disrupted by afternoon milking at both peak and mid lactation. Cows milked 2x were able to compensate for this by grazing more after the return to pasture (DIM 153 to 155, 1x: 52 vs. 2x: 66 +/- 6.2 min/90 min of grazing). Cows milked 1x had slightly longer strides than 2x cows at mid lactation (1x: 0.73, 2x: 0.70, and TRANS: 0.70 +/- 0.014 strides/m). In conclusion, under our experimental conditions, we found no overt changes in behavior or physiology to indicate that the welfare of cows milked 1x is impaired.

The psychosocial impact of the implantable cardioverter defibrillator: a meta-analytic review.

OBJECTIVE: The implantable cardioverter defibrillator (ICD) has become the treatment of choice for ventricular arrhythmia (VA; abnormal heart rhythms) and the prevention of sudden cardiac death (SCD). Recent clinical trials have shown the ICD to be superior to anti-arrhythmic medication in reducing mortality; however, research has suggested that ICD recipients experience poor psychosocial adjustment following implantation of the device. This aim of this study was to identify the key psychological characteristics associated with ICD implantation and to establish whether poor psychosocial outcome can be attributed directly to the device and its therapy. METHOD: Studies which reported valid and reliable measures of psychological functioning in ICD patients and appropriate comparison groups were considered for inclusion in a meta-analytic review. A systematic search of electronic databases and reference lists identified 20 studies which fulfilled the inclusion criteria. RESULTS: There were no significant differences in psychosocial outcome between ICD patients and drug-maintained VA patients or between pre- and post-implant ICD patients. However, ICD patients reported significantly worse psychological functioning and physical functioning than other cardiac controls. CONCLUSION: These findings suggest that poor psychosocial outcome in ICD patients may occur as a result of variables associated with the underlying VA condition, rather than as a direct response to implantation of the device and its therapy. This holds important implications for the development and implementation of psychological interventions for patients experiencing VA, in preference to ICD-specific programmes.

Diagnosis of acute thoracic aortic dissection in the emergency department.

In this article we try to determine how frequently emergency physicians (EPs) suspected the diagnosis in acute aortic dissection (AD). In this retrospective descriptive study, we identified all patients with the final diagnosis of AD initially evaluated in 1 of 3 emergency departments (EDs) over a 5-year period. Patients were included if AD was not suspected before ED evaluation. Patients undergoing thoracic aorta imaging as the initial ED study were defined as suspected AD. Forty-three patients totaling 44 presentations were identified. EPs suspected AD in 19 of 44 presentations. EPs suspected AD in 12 of 14 (86%) cases of chest and back pain and in 5 of 11 (45%) of chest pain. Thirteen of 39 (33%) painful presentations involved abdominal pain; EPs suspected AD in 1 of 13 (8%). EPs suspected the diagnosis in 43% of acute AD; location of pain was most predictive of a suspected diagnosis.

Isolation of Salmonella from ovaries and oviducts from whole carcasses of spent hens.

Spent hens containing hard-shelled eggs were obtained to study the influence of sample collection and sample preparation methodology on the detection of Salmonella in ovaries. Four hundred eighteen birds from 19 flocks were collected, and the carcasses were opened aseptically within 8-12 hours of collection. A sample set containing hard-shelled egg, ovary, and oviduct section were collected from each carcass, and surface contaminants were removed from ovaries with polyoxyethylene ether. Three of 19 flocks (15.8%) and six of 407 ovary samples were positive for Salmonella; two oviduct samples were positive (0.5%). No eggs were Salmonella-positive. Single and multiple serotypes were detected in ovaries. Results indicated that Salmonella recovery rates can be significantly affected by speed in processing samples after collection, by cleanliness of the tissue-collection environment (laboratory vs. slaughter plant), and by removal of surface contaminants.

Frequency of Salmonella enteritidis and other salmonellae in the ceca of spent hens at time of slaughter.

A study was conducted to determine the frequency of Salmonella enteritidis (SE) and other Salmonella serovars in the cecal contents of spent laying hens at a hen-processing plant in the southeastern United States over a 4 1/2-month period, from October 1990 through February 1991. A total of 1920 pooled cecal samples (three ceca per sample) from 38 flocks representing 23 producers were obtained and tested for the presence of SE and other Salmonella serovars. A total of 359 samples (18.7%) from 37 of the 38 flocks (97.4%) showed characteristic reactions for salmonellae on triple sugar iron agar (TSIA) slants. Twenty-nine of the 359 Salmonella-positive samples (8.1%) were Group D-positive, all of which were found to be SE on further serotyping. The SE-positive samples were from seven of the 38 flocks (18.4%); four flocks originated from the USDA/APHIS-designated Northern Region of the United States, and three were from the Southeastern Region. Serotyping of the 330 TSIA-positive Group-D negative Salmonella revealed 37 different serovars. S. heidelberg, the predominant serovar, was identified in 49.1% of these isolates.

Effects of calcium availability on the release of ovine choriomammotropin from cotyledonary cells incubated in vitro.

1. In this study, we examined the basal release of choriomammotropin (oCM) from monolayer cultures of cotyledonary cells obtained from ewes at different gestational ages. 2. oCM release increased with gestational age and displayed a similar profile to the concentration of oCM observed in maternal plasma. 3. Release of oCM was significantly (P less than 0.05; n = 9) increased in calcium-depleted medium, and by treatment with either phospholipase C (0.125 units/ml) or KCl (50 mM). 4. The calcium antagonist MgCl (12 mM) and the calcium channel-blocking agents verapamil (50 microM) and nefidipine (10 microM) all significantly stimulated oCM release. 5. These data are consistent with the suggestion that oCM release is inversely related to extracellular calcium concentration.

Young children's attitudes and perceptions of older adults.

Children ages four to seven judged relative ages of unfamiliar adults from photographs and chose photographs of adults in response to sociometric items. Age discrimination was highly accurate by age six. Children identified older adults as sad, lonely and not busy, but older adults were bypassed on items like "knows a lot" and preferences for teachers. In interviews, most of the children accurately identified older people by relying on physiognomic cues. Most described their grandparents as examples of known older people and expressed positive views of the activities they share. Images of passivity, and of older people engaged in domestic, but not "outside" work were also present. Children's attitudes were found to parallel those held by older adults in recent polls; older children in the sample were more likely to hold stereotypical images. Two-thirds of the children preferred not to grow old. Contact of children with older adults other than their grandparents was limited, especially in work settings or schools. It was concluded that deliberate programming in preschools and elementary schools is important to offset early ageist attitude formation.