Selective treatment of clinical mastitis: Assessment of the Net Cash Impact on Dairy Farms Under Diverse Scenarios. A European Perspective.

Selective treatment of clinical mastitis (STCM) potentially reduces antimicrobial use without negative implications on cow's milk production or health. However, this approach comes with additional costs. The aim of this study was to evaluate the net cash impact (NCI) of implementing STCM compared with blanket treatment of clinical mastitis (BTCM) under different diagnostic-test turnaround times (24 h, 14 h, and 8 h) using a stochastic partial budget analysis with Monte Carlo simulation. The target population was European commercial dairy herds; therefore, the model inputs were primarily from European sources. Additionally, variables associated with dairy management programs were obtained from USDA sources, worldwide multisite clinical trials, and expert opinion. The output was calculated by subtracting the cost of STCM from the cost of BTCM and it represented the expected NCI if a herd switched from BTCM to STCM. Depending on the time-to-treatment efficiency and diagnostic-test turnaround time, the expected mean NCI, assuming that STCM has no impact on the cow's future health or production, ranged from +€8.7 to +€12.4 per case with 72.4% to 84.8% of the iterations being ≥ €0. Moreover, using the numerically favorable health and production effects of STCM reported in the literature, the expected mean NCI ranged from +€44.5 to +€48.1 per case with 93.6% to 95.4% of the iterations being ≥ €0. The variables with the greatest contribution to NCI variance were proportion of gram-positive cases (39.2% of the variance) and days out of the tank for treated cows (22.0%). However, if future cow's health and production were accounted for, culling risk (24.6%), recurrence risk (19.4%), and milk yield (10.6%) would have the greatest contribution to NCI. The sensitivity analysis indicated that farms with high clinical mastitis incidence, low proportion of gram-positive cases, large number of days out of the tank for treated cows, higher milking frequency or using automatic milking systems, not using the highest priced diagnostic tests, and having high antimicrobial treatment costs are the best candidates for STCM. Improving time-to-treatment efficiency, for example, by using a rapid diagnostic test, leads to a favorable NCI, while high daily milk yield and milk price enhances the NCI in already positive scenarios. Finally, the cash flow entirely depends on future cow's health and milk yield. In conclusion, results indicate that overall, STCM is a practice that positively impacts the NCI of many herds.

Evaluation of sensor-based health monitoring in dairy cows: Exploiting rumination times for health alerts around parturition.

The use of sensor-based measures of rumination time as a parameter for early disease detection has received a lot of attention in scientific research. This study aimed to assess the accuracy of health alerts triggered by a sensor-based accelerometer system within 2 different management strategies on a commercial dairy farm. Multiparous Holstein cows were enrolled during the dry-off period and randomly allocated to conventional (CON) or sensor-based (SEN) management groups at calving. All cows were monitored for disorders for a minimum of 10 DIM following standardized operating procedures (SOP). The CON group (n = 199) followed an established monitoring protocol on the farm. The health alerts of this group were not available during the study but were later included in the analysis. The SEN group (n = 197) was only investigated when the sensor system triggered a health alert, and a more intensive monitoring approach was implemented according to the SOP. To analyze the efficiency of the health alerts in detecting disorders, the sensitivity (SE) and specificity (SP) of health alerts were determined for the CON group. In addition, all cows were divided into 3 subgroups based on their health status and the status of the health alerts in order to retrospectively compare the course of rumination time. Most health alerts (87%, n = 217) occurred on DIM 1. For the confirmation of diagnoses, health alerts showed SE and SP levels of 71% and 47% for CON cows. In SEN cows, SE of 71% and 75% and SP of 48% and 43% were found for the detection of ketosis and hypocalcemia, respectively. The rumination time of the subgroups was affected by DIM and the interaction between DIM and the status of health alert and health condition.

Short communication: Temporal profiles of colostrum and milk haptoglobin and substance P in early lactation multiparous Holstein cows.

Milk markers have the potential to aid in the detection of cow disease in early lactation if the automation of milk analysis becomes commonplace. Characterising temporal profiles of milk markers in dairy cows will improve the understanding of basal concentrations in clinically healthy cows. The objective of this observational study was to characterise the variation and temporal profiles of colostrum and milk haptoglobin (Hp) and substance P concentrations within 21 days postcalving in clinically healthy multiparous Holstein dairy cows. Ninety Holstein dairy cows from a commercial dairy herd were included. Milk samples were collected on the day of calving (day 0), and on days 1 to 4, 7, 14, and 21 postcalving and concentrations of Hp and substance P in colostrum (days 0 to 3) and milk (days 4, 7, 14, and 21) were determined using Enzyme Linked Immunosorbent assay. Haptoglobin and substance P concentrations were, on average (raw means ± SD), 0.40 ± 0.26 µg/ml and 56.2 ± 38.7 pg/ml in colostrum, respectively, and 0.23 ± 0.23 µg/ml and 37.1 ± 27.8 pg/ml in milk, respectively. Haptoglobin and substance P were elevated and greatest 1 day postcalving (least squares mean ± SE of the mean; 0.53 ± 0.05 µg/ml and 46.5 ± 3.64 pg/ml, respectively) and substance P varied widely within 21 days postcalving. The presence of substance P in dairy cow colostrum was not documented previously. Elevated concentrations of Hp and substance P immediately postcalving may be due to physiological roles these inflammatory markers have in the dairy cow or neonate or may simply represent an accumulation in colostrum before the first milk is removed.

Considerations for environmental sustainability in clinical radiology and radiotherapy practice: A systematic literature review and recommendations for a greener practice.

INTRODUCTION: Environmental sustainability (ES) in healthcare is an important current challenge in the wider context of reducing the environmental impacts of human activity. Identifying key routes to making clinical radiology and radiotherapy (CRR) practice more environmentally sustainable will provide a framework for delivering greener clinical services. This study sought to explore and integrate current evidence regarding ES in CRR departments, to provide a comprehensive guide for greener practice, education, and research. METHODS: A systematic literature search and review of studies of diverse evidence including qualitative, quantitative, and mixed methods approach was completed across six databases. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was used to assess the included studies. A result-based convergent data synthesis approach was employed to integrate the study findings. RESULTS: A total of 162 articles were identified. After applying a predefined exclusion criterion, fourteen articles were eligible. Three themes emerged as potentially important areas of CRR practice that contribute to environmental footprint: energy consumption and data storage practices; usage of clinical consumables and waste management practices; and CRR activities related to staff and patient travel. CONCLUSIONS: Key components of CRR practice that influence environmental impact were identified, which could serve as a framework for exploring greener practice interventions. Widening the scope of research, education and awareness is imperative to providing a holistic appreciation of the environmental burden of healthcare. IMPLICATIONS FOR PRACTICE: Encouraging eco-friendly travelling options, leveraging artificial Intelligence (AI) and CRR specific policies to optimise utilisation of resources such as energy and radiopharmaceuticals are recommended for a greener practice.

Barriers and facilitators to conducting radiotherapy clinical trials: Findings from a UK survey.

INTRODUCTION: As an essential component of service delivery, radiotherapy clinical trials were championed within the NHS England service specifications. A call for a 15% increase in research and clinical trial activity, alongside a demand for equity of access for patients with cancer subsequently ensued. National understanding of current radiotherapy clinical trials operational practices is absent, but essential to help establish the current provision required to support the development of a strategic plan for implementation of NHS England's specifications. METHODS: A cross-sectional survey was developed by a multi-disciplinary team and distributed to therapeutic radiography clinical trial leads across the UK to ascertain the current provision of radiotherapy clinical trials only, including workforce resources and the trials management processes to establish a benchmark and identify potential barriers, enablers, and opportunities to increase access to clinical trials. RESULTS: Thirty-two complete responses were obtained equating to 49% of the total UK NHS departments and 74% of those departments invited. Four key findings were identified: 1) research strategy and systems, 2) participation and activity in radiotherapy clinical trials, 3) access to clinical trials at alternative departments and 4) facilitators & barriers. Overarchingly a lack of radiotherapy clinical trials strategy or supported processes were apparent across the UK, aggravating existing barriers to trial activity. CONCLUSION: It is essential for radiotherapy clinical trials to be embedded in to departmental and Trust strategy, this will help to ensure the processes and resources required for trial delivery are not only in place, but also recognised as imperative and important for patients with cancer as radiotherapy treatment delivery. IMPLICATIONS FOR PRACTICE: Failure to address the barriers or build upon the facilitators may result in UK radiotherapy departments facing challenges in achieving the 15% increase in radiotherapy clinical trial activity.

But what does it mean to us? Radiographic patients and carer perceptions of compassion.

INTRODUCTION: An increased focus on compassion was one of the recommendations in the Francis Report following an inquiry into failures of care at the Mid Staffordshire NHS Trust in 2010. Responses to the Francis report did not take up the question of what compassion meant and how its recommendations might be meaningfully implemented in radiography practice. As part of two wider doctoral research studies, the findings presented in this paper reveal patients and carers perspectives of how compassionate care is experienced, based on an exploration of their experiences, views and attitudes in order to better understand its meaning and application in radiographic practice. METHODS: A constructivist approach was taken with appropriate ethical approval. Using a combination of interviews, focus groups, co-production workshops and online discussion forums the authors explored the experiences and opinions of patients and carers about compassion in radiotherapy and diagnostic imaging. Data were transcribed and analysed thematically. RESULTS: The thematically mapped findings are presented under four sub-themes: The values of caring vs the 'business' values of the NHS, Person-centred care, Characteristics of the radiographer and Compassion in the radiographer-patient interaction. CONCLUSION: Looking at compassion through a patient's lens has highlighted how person-centred care consists of components not attributable to radiographers alone. The personal values of a radiographer must not only align with those of the profession they seek to join, but the value placed on compassion must also be reflected in the environment in which they practice. Alignment signifies patients are part of a compassionate culture. IMPLICATIONS FOR PRACTICE: Equal emphasis should be placed on both technical and caring practices in order to stop the profession being perceived as target-driven, rather than one which ensures patients are at the heart of practice.

Developing a tool to assess the health-related quality of life in calves with respiratory disease: content validation.

Bovine respiratory disease (BRD) is a major welfare and productivity issue for calves. Despite the extensive negative impacts on calf welfare and performance, BRD remains challenging to detect and treat effectively. However, the clinical signs of disease are only one aspect of the disease that is experienced by the individual. The assessment of emotional experience in animals is not straightforward, but it is increasingly recognised that the quality of behaviour and demeanour of an individual is a reflection of their internal emotional state. The aim of the present study was to complete the content validation stage of the development process for a health-related quality of life (HRQOL) tool. This was based around indicators from an existing conceptual framework containing twenty-three indicators in two domains (clinical signs and behavioural expression). The content validation stage involves engaging with key stakeholders. For this study, this took the form of a survey and discussions with focus groups, which are standard methods in this field. A survey and stakeholder focus groups were conducted to assess the usefulness of each indicator and its relevance for inclusion within a HRQOL tool. In the survey, participants were asked to rate the usefulness of each of the indicators using a 4-point scale which were then dichotomised into 'useful' and 'less useful'. Based on the 'useful' result, each indicator within the domains was ranked. A similar approach was taken with the responses from the focus groups. Focus group participants were asked to select indicators that they felt were of use and the result of this was used to rank each of the indicators. The ranks of the indicators from both the survey and the focus groups along with the transcripts from the focus groups were used to determine the indicators from each domain to include within the HRQOL tool. Indicators within the clinical signs domain that were included were nasal discharge, cough, respiratory effort, ocular appearance (discharge and vibrancy), body and head posture and ear carriage. For the domain of behavioural expression, the indicators included were movement to feed, responsiveness, spatial proximity, volume of feed intake, motivation at feed and vigour. The next stage will be to validate the construction of the HRQOL tool through its use in practice. The inclusion of indicators that allow the experiential aspects of disease to be recorded in health assessments will likely increase the ability of farmers and others to detect respiratory disease in calves.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8.

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

The Recognition of Excessive blood loss At ChildbirTh (REACT) Study: a two-phase exploratory, sequential mixed methods inquiry using focus groups, interviews and a pilot, randomised crossover study.

OBJECTIVES: To explore how childbirth-related blood loss is evaluated and excessive bleeding recognised; and to develop and test a theory of postpartum haemorrhage (PPH) diagnosis. DESIGN: Two-phase, exploratory, sequential mixed methods design using focus groups, interviews and a pilot, randomised crossover study. SETTING: Two hospitals in North West England. SAMPLE: Women (following vaginal birth with and without PPH), birth partners, midwives and obstetricians. METHODS: Phase 1 (qualitative): 8 focus groups and 20 one-to-one, semi-structured interviews were conducted with 15 women, 5 birth partners, 11 obstetricians, 1 obstetric anaesthetist and 19 midwives (n = 51). Phase 2 (quantitative): 11 obstetricians and ten midwives (n = 21) completed two simulations of fast and slow blood loss using a high-fidelity childbirth simulator. RESULTS: Responses to blood loss were described as automatic, intuitive reactions to the speed, nature and visibility of blood flow. Health professionals reported that quantifying volume was most useful after a PPH diagnosis, to validate intuitive decisions and guide ongoing management. During simulations, PPH treatment was initiated at volumes at or below 200 ml (fast mean blood loss 79.6 ml, SD 41.1; slow mean blood loss 62.6 ml, SD 27.7). All participants treated fast, visible blood loss, but only half treated slow blood loss, despite there being no difference in volumes (difference 18.2 ml, 95% CI -5.6 to 42.2 ml, P = 0.124). CONCLUSIONS: Experience and intuition, rather than blood loss volume, inform recognition of excessive blood loss after birth. Women and birth partners want more information and open communication about blood loss. Further research exploring clinical decision-making and how to support it is required. TWEETABLE ABSTRACT: During a PPH, clinical decision-making is intuitive with clinicians treating as soon as excessive loss is recognised.

Effects of testosterone on the transgender male voice.

There is sparse prospective data on the effects of testosterone therapy on the voices of transgender men (also referred to as trans men or female-to-male transsexuals). Our aim was to investigate the timing and degree of voice deepening over 12 months among an ethnically diverse sample of transgender men. This was a prospective 12-month study at an academic outpatient endocrinology clinic and speech and voice center. The participants were seven transgender men naïve to testosterone therapy. All patients received two voice assessments at baseline and one assessment at 3, 6, 9, and 12 months while on intramuscular testosterone esters. Serum testosterone and estradiol concentrations were measured at baseline and every 3 months. All seven transgender men reached a cisgender male mean fundamental frequency (MF0) within 6 months of testosterone therapy and four continued to experience a decrease after 6 months. The mean decrease in MF0 after 12 months of testosterone therapy was 6.4 semitones (49 Hz). Several patterns emerged regarding the extent and timing. For example, some participants showed no decrease in MF0 within the first 3 months of testosterone therapy, whereas others showed their greatest decrease in MF0. We concluded that transgender men who start testosterone therapy display different patterns of voice lowering. Clinicians should counsel transgender men that they may or may not experience voice lowering within the first 3 months of testosterone therapy and that the majority of voice deepening will occur within 6-9 months.

An assessment of dairy herd bulls in southern Australia: 2. Analysis of bull- and herd-level risk factors and their associations with pre- and postmating breeding soundness results.

In pasture-based, seasonally calving dairy herds of southern Australia, the mating period usually consists of an initial artificial insemination period followed by a period of natural service using herd bulls. The primary objective of this study was to identify associations between individual bull- and herd-level management factors and bull fertility as measured by a pre- and postmating bull breeding soundness evaluation (BBSE). Multivariable mixed effects logistic regression models were used to identify factors associated with bulls being classified as high risk of reduced fertility at the premating and postmating BBSE. Bulls older than 4 yr of age at the premating BBSE were more likely to be classified high risk compared with bulls less than 4 yr of age. Bulls that were in herds in which concentrates were fed before mating were more likely to be classified as high risk at the postmating BBSE compared with bulls that were in herds where concentrates were not fed. Univariable analyses also identified areas in need of further research, including breed differences between dairy bulls, leg conformation and joint abnormalities, preventative hoof blocking for bulls, and mating ratios.

An assessment of dairy herd bulls in southern Australia: 1. Management practices and bull breeding soundness evaluations.

In the pasture-based, seasonally calving dairy herds of southern Australia, the mating period usually consists of an initial artificial insemination period followed by a period of natural service using herd bulls. Bull breeding soundness evaluations (BBSE) were performed on 256 bulls from 32 dairy herds in southwest Victoria, using guidelines produced by the Australian Cattle Veterinarians, before and immediately after a single natural mating period. At the same time, herd managers were questioned regarding the management of the bulls. The objectives of this study were to describe the management practices of dairy herd bulls; to describe the causes of increased risk of reduced fertility in dairy herd bulls, as measured by a standard BBSE; and to describe the reasons for bull removal by herd managers during mating. At the premating BBSE, 19.5% of bulls were classified as high risk of reduced fertility, mostly due to physical abnormalities and reduced semen quality. At the postmating BBSE, 36.5% of bulls were classified as high risk of reduced fertility, mostly due to physical abnormalities, primarily lameness. Of the bulls used, 15.9% were removed from normal mating use by the herd manager, predominantly due to lameness and injuries. A premating BBSE is recommended in dairy herd bulls to identify bulls at risk of reduced fertility. Lameness is the most common problem in dairy herd bulls during the natural mating period, and risk factors associated with lameness in these bulls should be identified to better manage herd bulls.

Infectious reproductive disease pathogens in dairy herd bulls.

OBJECTIVE: Investigate the presence of infectious reproductive disease pathogens in dairy herd bulls in south-west Victoria, Australia, using a cross-sectional study. METHODS: Dairy herd bulls from 32 herds were sampled for bovine viral diarrhoea virus (BVDV: 256 bulls, 32 herds) prior to the natural mating period, bovine herpes virus-1 prior to (10 bulls, 5 herds) and after (118 bulls, 19 herds) the natural mating period, and for Campylobacter fetus spp. and Tritrichomonas foetus after the natural mating period (61 bulls, 7 herds). BVDV was detected from an ear-notch sample using a commercially available rapid assay ELISA, bovine herpes virus-1 and T. foetus were screened for by PCR from a penile swab and preputial sample respectively, and C. fetus spp. were screened for by culture of preputial samples. RESULTS: None of the bulls tested positive for BVDV antigen. Campylobacter fetus venerealis (or C. fetus fetus) was cultured in 6.6% (4/61) of bulls, representing 2 of the 7 (28.6%) farms that were not vaccinating bulls against bovine genital campylobacteriosis. Bovine herpes virus-1 was identified in 7.8% (10/128) bulls sampled; T. foetus was not identified in any samples. CONCLUSION: Bovine genital campylobacteriosis is present in south-western Victoria, despite longstanding recommendations to vaccinate bulls. Screening bulls for persistent infection with BVDV is probably justified, despite the absence of persistently infected bulls in this study. Further research is warranted to investigate the potential reproductive implications of BHV-1, and the presence of T. foetus.

Visible light photooxidation of nitrate: the dawn of a nocturnal radical.

Highly oxidizing nitrate radicals (NO3˙) are easily accessed from readily available nitrate salts by visible light photoredox catalysis using a purely organic dye as the catalyst and oxygen as the terminal oxidant. The interaction of the excited catalyst and nitrate anions was studied by spectroscopic methods to elucidate the mechanism, and the method was applied to the NO3˙ induced oxidation of alkynes and alcohols.

Long-range epigenetic silencing of chromosome 5q31 protocadherins is involved in early and late stages of colorectal tumorigenesis through modulation of oncogenic pathways.

Loss of tumour suppressor gene function can occur as a result of epigenetic silencing of large chromosomal regions, referred to as long-range epigenetic silencing (LRES), and genome-wide analyses have revealed that LRES is present in many cancer types. Here we utilize Illumina Beadchip methylation array analysis to identify LRES across 800 kb of chromosome 5q31 in colorectal adenomas and carcinomas (n=34) relative to normal colonic epithelial DNA (n=6). This region encompasses 53 individual protocadherin (PCDH) genes divided among three gene clusters. Hypermethylation within these gene clusters is asynchronous; while most PCDH hypermethylation occurs early, and is apparent in adenomas, PCDHGC3 promoter methylation occurs later in the adenoma-carcinoma transition. PCDHGC3 was hypermethylated in 17/28 carcinomas (60.7%) according to methylation array analysis. Quantitative real-time reverse transcription-polymerase chain reaction showed that PCDHGC3 is the highest expressed PCDH in normal colonic epithelium, and that there was a strong reciprocal relationship between PCDHGC3 methylation and expression in carcinomas (R=-0.84). PCDH LRES patterns are reflected in colorectal tumour cell lines; adenoma cell lines are not methylated at PCDHGC3 and show abundant expression at the mRNA and protein level, while the expression is suppressed in hypermethylated carcinoma cell lines (R=-0.73). Short-interfering RNA-mediated reduction of PCDHGC3 led to a decrease of apoptosis in RG/C2 adenoma cells, and overexpression of PCDHGC3 in HCT116 cells resulted in the reduction of colony formation, consistent with tumour suppressor capabilities for PCDHGC3. Further functional analysis showed that PCDHGC3 can suppress Wnt and mammalian target of rapamycin signalling in colorectal cancer cell lines. Taken together, our data suggest that the PCDH LRES is an important tumour suppressor locus in colorectal cancer, and that PCDHGC3 may be a strong marker and driver for the adenoma-carcinoma transition.