Review of the clinical diagnosis of sacroiliac dysfunction in horses - Challenges and limitations.

Sacroiliac dysfunction (SID) is a condition seen in horses associated with poor performance that affects hind limb gait and impulsion. The condition comprises pain and dysfunction but there lacks clarity around the aetiopathogenesis and whether SID encompasses abnormal joint pathology, abnormal joint movement, abnormal regional biomechanical function, joint laxity and pain, or various combinations of these that may vary over time. Clinical assessment remains challenging for equine clinicians due to the deep location of the sacroiliac joint (SIJ) and surrounding structures which limits access for palpation, diagnostic imaging and joint-specific injection. There is no recognised single reference standard diagnostic test for SID. Clinical diagnosis has been based on ruling out other causes of hind limb lameness, along with combinations of ultrasonography, scintigraphy and periarticular anaesthesia of the SIJ. Recent studies have highlighted the lack of specificity of injections targeting the SIJ, with significant dispersal of injectate into surrounding structures including around the lumbosacral joint (LSJ). Advanced imaging modalities such as computed tomography offers promise for assessment of the structure and pathology of the SIJ and surrounding bony structures. However, there is a need to improve the understanding of the significance of anatomic variation of the sacroiliac region structures, with recent studies reporting detailed anatomic variation in groups of horses with and without SID. There are also limitations around functional assessment of the joint which is still largely reliant on a thorough clinical examination. This review aims to present an update on clinical approaches to the diagnosis of horses with SID, and to consider the challenges and limitations.

Health literacy and pain neuroscience education in an interdisciplinary pain management programme: a qualitative study of patient perspectives.

Introduction: Pain neuroscience education is part of interdisciplinary pain management programs (IPMPs). To date, the role of health literacy on patients' understanding of pain neuroscience education has not sufficiently been examined. Objectives: Drawing on interviews with patients with diverse levels of health literacy, this article explores patient perspectives on pain neuroscience education. Methods: Purposively sampled patients from an IPMP were interviewed twice (waiting list and after 4 weeks). A directed qualitative content analysis was performed with the Integrated Conceptual Model of Health Literacy as an analytic framework. Results: Thirteen patients with chronic musculoskeletal pain were interviewed: 4 men and 9 women aged from 21 to 77 years with diverse educational and mostly low health literacy. One participant dropped out after baseline. Some participants gained access to health information actively; others relied on the expertise of their healthcare providers. Most participants did not seem to receive the information in the pain neuroscience education as intended, experienced difficulties with understanding the message, negatively appraised the information, and were not able to apply this in their daily lives. Health literacy levels likely played a role in this. Conclusions: Pain neuroscience education tailored to patients' health literacy levels, information needs, and learning strategies is needed.

Unmasking a silent killer: Prevalence of diagnosed and undiagnosed diabetes mellitus among people living with HIV in rural South Africa.

OBJECTIVES: To document the prevalence of impaired glucose tolerance (IGT) and undiagnosed diabetes mellitus (DM) and to identify factors associated with undiagnosed DM in people living with HIV (PLWH). METHODS: Cross-sectional study performed at Ndlovu Medical Center, Limpopo, South Africa including PLWH aged ≥18 years. Between August and November 2017, 356 HIV-positive participants were included. Information was collected on socio-demographics, DM symptoms and risk factors for DM. IGT and DM were diagnosed using random plasma glucose and/or HbA1c. Factors associated with undiagnosed DM were assessed by comparing participants with newly diagnosed DM to participants without DM. RESULTS: IGT was diagnosed in 172 (48.3%) participants. Twenty-nine (8.1%) participants met the definition of DM, of whom 17 (58.6%) were newly diagnosed. Compared to participants without DM, participants with DM were on average 5 years older, were more likely to have a positive family history for DM, were less physically active and had higher systolic blood pressure, body mass index and waist circumference. Factors associated with undiagnosed DM included age ≥45 years (odds ratio [OR] = 3.59) and physical inactivity (OR = 3.17). CONCLUSIONS: The prevalence of IGT and DM among PLWH is high and more than half of DM cases were undiagnosed. Regular screening for DM in PLWH is recommended, especially in an ageing population with additional cardiovascular disease risk factors.

A randomized study of intensified antiretroviral treatment monitoring versus standard-of-care for prevention of drug resistance and antiretroviral treatment switch.

INTRODUCTION: Standard-of-care antiretroviral treatment (ART) monitoring in low and middle-income countries consists of annual determination of HIV-RNA viral load with confirmatory viral load testing in case of viral rebound. We evaluated an intensified monitoring strategy of three-monthly viral load testing with additional drug exposure and drug resistance testing in case of viral rebound. METHODS: We performed an open-label randomized controlled trial (RCT) at a rural South African healthcare clinic, enrolling adults already receiving or newly initiating first-line ART. During 96 weeks follow-up, intervention participants received three-monthly viral load testing and sequential point-of-care drug exposure testing and DBS-based drug resistance testing in case of rebound above 1000 copies/ml. Control participants received standard-of-care monitoring according to the WHO guidelines. RESULTS: Five hundred one participants were included, of whom 416 (83.0%) were randomized at 24 weeks. Four hundred one participants were available for intention-to-treat analysis. Viral rebound occurred in 9.0% (18/199) of intervention participants and in 11.9% (24/202) of controls ( P  = 0.445). Time to detection of rebound was 375 days [interquartile range (IQR): 348-515] in intervention participants and 360 days [IQR: 338-464] in controls [hazard ratio: 0.88 (95% confidence interval (95% CI): 0.46-1.66]; P  = 0.683]. Duration of viral rebound was 87 days [IQR: 70-110] in intervention participants and 101 days [IQR: 78-213] in controls ( P  = 0.423). In the control arm, three patients with confirmed failure were switched to second-line ART. In the intervention arm, of three patients with confirmed failure, switch could initially be avoided in two cases. CONCLUSION: Three-monthly viral load testing did not significantly reduce the duration of viraemia when compared with standard-of-care annual viral load testing, providing randomized trial evidence in support of annual viral load monitoring.

Knowledge About Dementia Among Family Caregivers With a Turkish or Moroccan Immigrant Background: Development and Validation of a Dementia Knowledge Scale.

OBJECTIVE: To describe the development and validation of the Dementia Knowledge Scale (DKS) among family caregivers with a Turkish or Moroccan immigrant background. METHODS: The 11 items of the DKS, selected by professionals and people with a Turkish or Moroccan background, were translated and adapted in Turkish and Dutch. The feasibility, comprehensibility and appropriateness of the 2 language versions were examined. Subsequently, both languages were assessed among caregivers from these groups. The internal consistency of both language versions was determined by calculating Cronbach's α. The known group validity was determined by comparing mean scores between subgroups. RESULTS: Both language versions of the DKS were considered feasible, comprehensible, and appropriate. A total of 117 caregivers with a Turkish background completed the Turkish version of the DKS and 110 with a Moroccan background the Dutch version. The Turkish version showed adequate internal consistency but the Dutch version did not. No differences were found in mean scores between those with a low level of education versus those with a higher level; those who frequently provided care versus those who did so less frequently; and those who lived together with a person with dementia versus those who did not. CONCLUSIONS: The DKS is feasible, comprehensible and reliable and can be used among groups with an immigrant background. PRACTICE IMPLICATIONS: The DKS provides insight into various aspects of dementia knowledge, including knowledge about risk factors and symptoms, among caregivers with a Turkish or Moroccan background, and thereby supports the development of tailored education for these groups.

The Turkish version of the SPPIC validated among informal caregivers with a Turkish immigrant background.

BACKGROUND: This study assesses the internal consistency and known group validity of the Turkish version of the SPPIC, a measurement instrument to assess the self perceived pressure from informal care in family caregivers of people with dementia that was originally in Dutch. METHODS: The feasibility, comprehensibility and appropriateness of the Turkish SPPIC were assessed during a pilot test. Internal consistency was examined based on data from 117 family caregivers with a Turkish immigrant background by calculating Cronbach's alpha and by conducting a single-factor Confirmatory Factor Analysis (CFA). Known group validity was determined to obtain an understanding of the validity of the translated instrument, testing differences in the self-perceived pressure from informal care, depending on frequency of caregiving, living with a person with dementia and level of education. RESULTS: The pilot test showed that the translated SPPIC was considered to be feasible, comprehensible and appropriate. The internal consistency appeared to be strong (Cronbach's alpha: 0.94). The CFA indicated that the factor 'Self-perceived Pressure from Informal Care' explained varying levels of variance in the items of the SPPIC (ranging from .52 to .87). Family caregivers who provided care at least once a week and who shared a home with a person with dementia perceived a greater pressure from informal care (p = 0.007, p = 0.001). CONCLUSIONS: The Turkish translation of the SPPIC can be used in future research and practice to obtain insight into self-perceived pressure from informal care of family caregivers with Turkish immigrant backgrounds. At the same time it is recommended to conduct more research on how the measurement of self-perceived pressure from informal care in this group can be further improved.

Effects of an educational intervention on health-related quality of life among family caregivers of people with dementia with a Turkish or Moroccan immigrant background: Insights from a cluster randomised controlled trial.

OBJECTIVE: Gaining understanding of the health-related quality of life (HRQL) of family caregivers of people with dementia with Turkish or Moroccan immigrant backgrounds and to examine whether an educational peer group intervention can improve HRQL. METHODS: Understanding of HRQL and associated variables was obtained by multiple linear regression analyses. The effects of the intervention on HRQL were assessed in multilevel analyses using data collected before the start (baseline), directly after the intervention (one to two weeks after baseline) and three months after the start of the intervention. The intervention (two interactive group sessions) entailed providing information about dementia and care/support options. RESULTS: At baseline (n = 319), HRQL was moderately and significantly associated with migration background, gender, self-perceived pressure from informal care and the formal and informal support received (p < .05). The intervention had a small effect on emotional wellbeing directly after the intervention (p < .05) and on perceived general health status three months after (p < .05). CONCLUSION: Culturally sensitive peer group education on dementia and care/support options can to some extent enhance HRQL among family caregivers in the short term. PRACTICE IMPLICATIONS: The intervention as described in this study is recommended for supporting family caregivers of people with dementia with Turkish or Moroccan backgrounds.

Risk factors for loss to follow-up from antiretroviral therapy programmes in low-income and middle-income countries.

INTRODUCTION: Loss to follow-up (LTFU) rates from antiretroviral treatment (ART) programmes in low- and middle-income countries (LMIC) are high, leading to poor treatment outcomes and onward transmission of HIV. Knowledge of risk factors is required to address LTFU. In this systematic review, risk factors for LTFU are identified and meta-analyses performed. METHODS: PubMed, Embase, Psycinfo and Cochrane were searched for studies that report on potential risk factors for LTFU in adults who initiated ART in LMICs. Meta-analysis was performed for risk factors evaluated by at least five studies. Pooled effect estimates and their 95% confidence intervals (95% CI) were calculated using random effect models with inverse variance weights. Risk of bias was assessed and sensitivity analyses performed. RESULTS: Eighty studies were included describing a total of 1 605 320 patients of which 87.4% from sub-Saharan Africa. The following determinants were significantly associated with an increased risk of LTFU in meta-analysis: male sex, older age, being single, unemployment, lower educational status, advanced WHO stage, low weight, worse functional status, poor adherence, nondisclosure, not receiving cotrimoxazole prophylactic therapy when indicated, receiving care at secondary level and more recent year of initiation. No association was seen for CD4 cell count, tuberculosis at baseline, regimen, and geographical setting. CONCLUSION: There are several sociodemographic, clinical, patient behaviour, treatment-related and system level risk factors for LTFU from ART programs. Knowledge of risk factors should be used to better target retention interventions and develop tools to identify high-risk patients.

Cardiovascular Disease Burden in Rural Africa: Does HIV and Antiretroviral Treatment Play a Role?: Baseline Analysis of the Ndlovu Cohort Study.

Background HIV is associated with an increased risk of cardiovascular disease (CVD) in high-income countries. Little is known about the CVD burden in sub-Saharan Africa, where 70% of the world's HIV-positive population lives. This study aims to provide insight into the burden of CVD risk in a rural setting in sub-Saharan Africa considering HIV infection and antiretroviral therapy (ART). Methods and Results A cross-sectional analysis was conducted of the baseline of the Ndlovu Cohort study including HIV-negative and HIV-positive participants in rural South Africa between 2014 and 2017. Information was collected on demographics, socioeconomic status, and CVD risk factors. Carotid intima-media thickness measurement was performed. The influence of HIV and ART on the burden of CVD was determined by comparing HIV-positive participants who were ART naive on first-line or second-line ART with HIV-negative participants. In total, 1927 participants were included, of whom 887 (46%) were HIV positive and 54% women. The median age was 38 years. Overall, 690 participants (79%) were on ART, with 613 (89%) on first-line and 77 (11%) on second-line therapy. Participants with HIV had lower values for most of the CVD risk factors but higher C-reactive protein levels than HIV-negative participants. ART-naive, HIV-positive participants had similar carotid intima-media thickness compared with HIV-negative participants but carotid intima-media thickness was increased for participants on ART aged 30 years and older compared with HIV-negative participants. Conclusions HIV-positive participants presented with a favorable CVD risk profile compared with HIV-negative participants. However, carotid intima-media thickness was increased in HIV-positive participants on ART, indicating a higher burden of subclinical CVD for the HIV-positive population.

A Mobile Patient-Reported Outcome Measure App With Talking Touchscreen: Usability Assessment.

BACKGROUND: In the past years, a mobile health (mHealth) app called the Dutch Talking Touch Screen Questionnaire (DTTSQ) was developed in The Netherlands. The aim of development was to enable Dutch physical therapy patients to autonomously complete a health-related questionnaire regardless of their level of literacy and digital skills. OBJECTIVE: The aim of this study was to evaluate the usability (defined as the effectiveness, efficiency, and satisfaction) of the prototype of the DTTSQ for Dutch physical therapy patients with diverse levels of experience in using mobile technology. METHODS: The qualitative Three-Step Test-Interview method, including both think-aloud and retrospective probing techniques, was used to gain insight into the usability of the DTTSQ. A total of 24 physical therapy patients were included. The interview data were analyzed using a thematic content analysis approach aimed at analyzing the accuracy and completeness with which participants completed the questionnaire (effectiveness), the time it took the participants to complete the questionnaire (efficiency), and the extent to which the participants were satisfied with the ease of use of the questionnaire (satisfaction). The problems encountered by the participants in this study were given a severity rating that was used to provide a rough estimate of the need for additional usability efforts. RESULTS: All participants within this study were very satisfied with the ease of use of the DTTSQ. Overall, 9 participants stated that the usability of the app exceeded their expectations. The group of 4 average-/high-experienced participants encountered only 1 problem in total, whereas the 11 little-experienced participants encountered an average of 2 problems per person and the 9 inexperienced participants an average of 3 problems per person. A total of 13 different kind of problems were found during this study. Of these problems, 4 need to be addressed before the DTTSQ will be released because they have the potential to negatively influence future usage of the tool. The other 9 problems were less likely to influence future usage of the tool substantially. CONCLUSIONS: The usability of the DTTSQ needs to be improved before it can be released. No problems were found with satisfaction or efficiency during the usability test. The effectiveness needs to be improved by (1) making it easier to navigate through screens without the possibility of accidentally skipping one, (2) enabling the possibility to insert an answer by tapping on the text underneath a photograph instead of just touching the photograph itself, and (3) making it easier to correct wrong answers. This study shows the importance of including less skilled participants in a usability study when striving for inclusive design and the importance of measuring not just satisfaction but also efficiency and effectiveness during such studies.

Cultural Identity Confusion and Psychopathology: A Mixed-Methods Study Among Refugees and Asylum Seekers in the Netherlands.

Although there is ample empirical evidence that traumatic events, postmigration stress, and acculturation problems have a great impact on the mental health of refugees, so far no studies have included cultural identity after migration in the equation. This mixed-methods study conducted among Afghan and Iraqi refugee and asylum-seeker psychiatric patients aims to fill this gap. Associations between postmigration stress, symptoms of anxiety and depression disorders, and symptoms of posttraumatic stress disorder were significant. When differentiated for the two groups, associations with postmigration stress were no longer significant for Afghan patients, who were predominantly younger and more often single, lower educated, and without resident status compared with Iraqi patients. Qualitative results indicate that, in addition to psychopathology and postmigration stress, acculturation problems contribute to confusion of cultural identity. The findings suggest that reduction of postmigration stress and acculturation problems may clarify cultural identity and as such may contribute to posttraumatic recovery.

The association between HIV infection and pulmonary function in a rural African population.

OBJECTIVES: HIV infection has been associated with an impaired lung function in high-income countries, but the association between HIV infection and pulmonary function in Sub-Saharan Africa remains unclear. This study aims to investigate the relation between HIV infection and pulmonary function in a rural African population. METHODS: A cross-sectional study was conducted among HIV-positive and HIV-negative adults in a rural area in South Africa, as part of the Ndlovu Cohort Study. A respiratory questionnaire and post-bronchodilator spirometry were performed. Multivariable regression analysis was used to investigate whether HIV was independently associated with a decrease in post-bronchodilator FEV1/FVC ratio considering age, sex, body mass index, respiratory risk factors and a history of a pulmonary infection (tuberculosis (TB) or a pneumonia). Possible mediation by a history of pulmonary infection was tested by removing this variable from the final model. RESULTS: Two hundred and one consecutive participants were enrolled in the study in 2016, 84 (41.8%) were HIV-positive (82.1% on ART). The median age was 38 (IQR 29-51) years. Following multivariable analysis HIV was not significantly associated to a decline in post-bronchodilator FEV1/FVC ratio (ß -0.017, p 0.18). However, upon removal of a history of a pulmonary infection from the final model HIV was significantly related to post-bronchodilator FEV1/FVC ratio, ß -0.026, p 0.03. CONCLUSIONS: Pulmonary function is affected by HIV infection which most likely results from co-infection with TB or other pneumonia. Further research should focus on the influence of a pulmonary infection, most notably TB, on pulmonary function, especially as the incidence of TB is high in HIV infection.

Estimation of carcass composition using rib dissection of calf-fed Holstein steers supplemented zilpaterol hydrochloride.

A serial harvest was conducted every 28 d from 254 to 534 d on feed (DOF) to quantify changes in growth and composition of calf-fed Holstein steers (n = 115, initial body weight (BW) = 449.2 ± 19.9 kg). One-half were supplemented with the ß-2 adrenergic agonist zilpaterol hydrochloride (ZH; 8.33 mg/kg 100% dry matter (DM) basis) during the final 20 d followed by a 3-d withdrawal prior to harvest; the remainder was fed a non-ZH control (CON) ration. Five steers were randomly selected and harvested after 226 DOF which served as a reference point for modeling purposes. Fabricated carcass soft tissue was ground, mixed, and subsampled for proximate analysis. Moreover, following the traditional method of rib dissection which includes the 9th, 10th, and 11th rib contained within the IMPS 103 primal, the relationship of carcass chemical composition to 9-10-11 rib composition was evaluated. Carcasses in this investigation had more (P < 0.01) separable lean, fat, ash, and moisture concomitant with less bone and ether extract than rib dissections. However, protein levels were similar (P = 0.27) between carcasses and rib dissections. Using regression procedures, models were constructed to describe the relationship of rib dissection (RD) composition including separable lean (RDSL), separable fat (RDSF), separable bone (RDSB), ether extract (RDEE), protein (RDP), moisture (RDM), and ash (RDA) with carcass composition. Carcass lean (CL), carcass fat (CF), and carcass bone (CB) were correlated (P < 0.01) with RDSL, RDSF, and RDSB with simple r values of 0.41, 0.71, and 0.50, respectively. Chemical composition of the rib and carcass, carcass ether extract (CEE), carcass protein (CP), carcass moisture (CM), and carcass ash (CA) were correlated (P ≤ 0.01) with simple r values of 0.75, 0.31, 0.66, and 0.37, respectively. Equations to predict carcass fatness from rib dissection variables and ZH supplementation status were only able to account for 50 and 56%, of the variability of CF and CEE, respectively. Overall, the relationships quantified and equations developed in this investigation do not support use of 9/10/11 rib dissection for estimation of carcass composition of calf-fed Holstein steers.

Cultural Identity Among Afghan and Iraqi Traumatized Refugees: Towards a Conceptual Framework for Mental Health Care Professionals.

Cultural identity in relation with mental health is of growing interest in the field of transcultural psychiatry. However, there is a need to clarify the concept of cultural identity in order to make it useful in clinical practice. The purpose of this study is to unravel the complexity and many layers of cultural identity, and to assess how stress and acculturation relate to (changes in) cultural identity. As part of a larger study about cultural identity, trauma, and mental health, 85 patients from Afghanistan and Iraq in treatment for trauma-related disorders were interviewed with a Brief Cultural Interview. The interviews were analysed through qualitative data analysis using the procedures of grounded theory. The analysis resulted in three domains of cultural identity: personal identity, ethnic identity and social identity. Within each domain relationships with stress and acculturation were identified. The results offer insight into the intensity of changes in cultural identity, caused by pre-and post-migration stressors and the process of acculturation. Based on the research findings recommendations are formulated to enhance the cultural competency of mental health workers.

Objective biometric measurements of calf-fed Holstein steers fed in confinement.

Understanding the maximum slaughter size for calf-fed Holstein steers based on hip-height has become a contemporary issue in the beef processing industry. Increased carcass size, in terms of both weight and length, has outpaced the ability of some abattoirs to handle the larger animals. Moreover, some abattoirs have begun rejecting animals that exceed 147.3 cm (58 inches) at the hip, creating a challenge for Holstein cattle feeders. The objective of this study was to quantify the skeletal growth rate of calf-fed Holstein steers fed in confinement. Hip-height of calf-fed Holstein steers ( ≤ 135) was measured every 28 d from 226 to 422 d on feed. Hip-height was a dependent variable modeled via linear regression procedures utilizing days of age and BW as independent variables. Additionally, logistic regression was used to estimate the probability of a steer exceeding a hip-height of 147.3 cm (58 inches) from independent variables of days of age and BW. The linear relationship of BW to hip-height had an adjusted value of 0.7112 (Hip-height, cm = [0.0593 × BW, kg] + 109.00) and on average the calf-fed Holstein steers grew 1.0 cm for each 16.9 kg of BW gain during the finishing phase. The 10%, 50%, and 90% probability of a steer exceeding 147.3 cm (58 inches) of hip-height was achieved at 563, 653, and 743 kg of BW, respectively. The linear relationship of days of age to hip-height had an adjusted value of 0.6687 (Hip-height, cm = [0.0937 × days of age] + 104.4) and the calf-fed Holstein steers grew 1.0 cm for each 10.7 d of age during the finishing phase. The 10%, 50%, and 90% probability of a steer exceeding 147.3 cm (58 inches) of hip-height was estimated to occur at 408, 459, and 510 d of age, respectively. Knowledge of Holstein steer growth rate in relation to BW and age may allow for more accurate sorting to prevent oversized cattle arriving at the abattoir and subsequent discounts or being rejected for slaughter.

Fabrication yields of serially harvested calf-fed Holstein steers fed zilpaterol hydrochloride.

Holstein steers ( = 110) were fed zilpaterol hydrochloride (ZH) for 0 or 20 d before slaughter during a 280-d serial harvest study. Cattle were harvested every 28 d beginning at 254 d on feed (DOF) and concluding at 534 DOF. After slaughter, carcasses were chilled for 48 h and then fabricated into boneless closely trimmed or denuded subprimals, lean trim, trimmable fat, and bone. Inclusion of ZH increased cold side weight (CSW) by 10.3 kg ( < 0.01; 212.7 vs. 202.4 kg [SEM 1.96]) and saleable yield by 10.4 kg ( < 0.01; 131.9 vs. 121.5 kg [SEM 1.16]) in calf-fed Holstein steer carcasses. Additionally, saleable yield as a percentage of CSW increased ( ≤ 0.01) by 2.19% (62.64 vs. 60.45% [SEM 0.22]) for cattle supplemented with ZH. Subprimal weights were heavier ( ≤ 0.05) from cattle that received ZH except for the bottom sirloin ball tip, back ribs, and outside skirt regardless of slaughter endpoint. Yield of top round, bottom round, and knuckle was increased ( ≤ 0.01) following ZH supplementation by 0.37, 0.24, and 0.18%, respectively. Yield of the top sirloin butt, strip loin, and tenderloin was increased ( ≤ 0.01) concurrent with ZH supplementation by 0.18, 0.11, and 0.09%, respectively. Regarding the rib primal, the rib eye roll tended ( = 0.08) to had increased yield (2.80 vs. 2.72% [SEM 0.03]) with ZH supplementation; both back ribs and blade meat exhibited increased ( ≤ 0.04) yields of 0.04%. Relative to the chuck primal, increased ( ≤ 0.03) yields of shoulder clod, pectoral meat, and mock tender were observed (0.13, 0.07, and 0.04%, respectively). Yield changes for subprimal brisket, plate, and flank were limited to increased ( < 0.01) proportion of flank steak and elephant ear (cutaneous trunci), 0.07 and 0.04%, respectively. Feeding duration notably altered ( ≤ 0.01) weights and percentages of all subprimals except the brisket. Saleable yield increased ( ≤ 0.01) by 0.192 kg/d with additional DOF. Moreover, trimmable fat and bone increased ( ≤ 0.01) by 0.146 and 0.050 kg/d, respectively. These data illustrate improved saleable meat yields for calf-fed Holstein steers supplemented with ZH and provide the beef industry knowledge of fabrication yield changes throughout a wide range of harvest endpoints.

Implementation of the Cultural Formulation through a newly developed Brief Cultural Interview: Pilot data from the Netherlands.

The Outline for a Cultural Formulation (OCF) has remained underutilized in clinical practice since its publication in the DSM-IV in 1994. In the Netherlands, a Cultural Interview (CI) was developed in 2002 as a tool to facilitate use of the OCF in clinical practice. The time needed to conduct the interview, however, prevented its systematic implementation within mental health institutions. This article presents the development of a shortened and adapted version, the Brief Cultural Interview (BCI), and a pilot study on the feasibility, acceptability, and utility of its implementation with refugee and asylum seeking patients in a Dutch centre for transcultural psychiatry. Results show that the brief version scores better on feasibility and acceptability, while utility for clinical practice remains similar to that of the original CI. These results support the systematic use of the OCF in psychiatric care for a culturally diverse patient population through the application of a relatively brief cultural interview. A secondary finding of the study is that patients' cultural identity was considered by clinicians to be more relevant in the treatment planning sessions than their illness explanations.

The effect of zilpaterol hydrochloride supplementation on energy metabolism and nitrogen and carbon retention of steers fed at maintenance and fasting intake levels.

An indirect calorimetry trial examined energy metabolism, apparent nutrient digestibility, C retention (CR), and N retention (NR) of cattle supplemented with zilpaterol hydrochloride (ZH). Beef steers ( = 20; 463 ± 14 kg) blocked ( = 5) by weight and source were individually fed and adapted to maintenance energy intake for 21 d before allotment to ZH (90 mg/steer∙d) or no ß-adrenergic agonist treatment (control [CONT]) for 20 d (455 ± 14 kg at the start of treatment). Respiration chambers = 4 were used to quantify heat production (HP) during maintenance (d 12 to 16 of the ZH period) and fasting heat production (FHP; d 19 to 20 of ZH period; total 4 d of fast). Steers were harvested after a 6-d ZH withdrawal and carcasses were graded 24 h after harvest. Control cattle lost more BW ( < 0.01; 9 kg for CONT and 2 kg for ZH-treated) during maintenance whereas the BW loss of ZH-treated steers was greater ( < 0.01; 9 kg for ZH-treated and vs. 4 kg, for CONT) during FHP; no differences ( ≥ 0.76) were detected for G:F, ADG, and end BW. No differences in DMI, apparent nutrient digestibility, O consumption, or CH production ( ≥ 0.12) were detected; however, ZH-treated cattle had greater CO production during maintenance ( = 0.04; 23.6 L/kgBW for ZH-treated and 22.4 L/kg BW for CONT). Digestible energy and ME did not differ ( ≥ 0.19); however, urinary energy was greater ( = 0.05; 0.091 Mcal for CONT and 0.074 Mcal for ZH-treated) in CONT cattle. Steers treated with ZH tended to have greater HP ( = 0.09; 12.44 Mcal for ZH-treated and 11.69 Mcal for CONT), but the effect was reduced on a BW basis ( = 0.12; 0.126 Mcal/kg BW0.75 for ZH-treated and 0.120 Mcal/kg BW0.75 for CONT vs. 0.120 Mcal/kg BW). No treatment difference in FHP was observed ( ≥ 0.32) although CO production (L/steer) increased with ZH treatment ( = 0.04; 1,423 L/steer for ZH-treated and 1,338 L/steer for CONT). Control cattle excreted more ( = 0.05) N in urine (39.8 g/d for CONT and 32.4 g/d for ZH-treated); therefore, NR ( = 0.07; 22.14 g/d for ZH-treated and 14.12 g/d for CONT steers) tended to be greater for ZH-fed steers. Steers treated with ZH lost more C via CO ( = 0.04; 1,036.9 g/d for ZH-treated and 974.3 g/d for CONT) although total CR did not differ ( ≥ 0.23). Empty BW, HCW, and harvest yields (g/kg empty BW) were not different ( ≥ 0.13), whereas ZH increased dressed yield ( = 0.02; 62.12 % for ZH-treated and 60.65% for CONT) and LM area ( = 0.02; 77.81 cm for ZH-treated and vs. 70.90 cm for CONT). Separable carcass lean and actual skeletal muscle protein (SMP) were increased with ZH ( ≤ 0.04; 201.6 and 41.2 kg, respectively for ZH-treated and 196.0 and 38.4 kg, respectively for CONT). Results from this trial indicate that ZH treatment increased ( = 0.03) SMP and tended ( ≥ 0.07) to increase NR and modify HP during maintenance by increasing CO production.

Byproduct yields of serially harvested calf-fed Holstein steers fed zilpaterol hydrochloride.

A 2 × 11 factorial treatment structure was applied in a completely randomized experimental design to investigate differences in noncarcass tissue among serially harvested Holstein steers. Steers ( = 110) were randomly assigned to 1 of 2 dietary treatments: a ration supplemented with zilpaterol hydrochloride (ZH) fed at a rate of 8.3 mg/kg DM for 20 d followed by a 3-d withdrawal or a control ration with no ZH included in the diet. Within treatment, steers were assigned to harvest groups of 254, 282, 310, 338, 366, 394, 422, 450, 478, 506, or 534 d on feed (DOF) prior to initiation of the trial. Cattle fed ZH realized an empty BW (EBW) increase ( ≤ 0.03) of 2.8% (644.2 vs. 626.4 kg [SEM 5.4]) and a HCW increase of 5.0% (429.1 vs. 408.4 kg [SEM 4.0]) with a concomitant 12% reduction (45.1 vs. 51.2 kg [SEM 3.1]) in gastrointestinal contents and 2.1 percentage unit increase in dressed carcass yield (62.1 vs. 60.0% [SEM 0.01]). Additionally, ZH supplementation decreased (P ≤ 0.03) the absolute weight of the liver and kidneys by 0.3 and 0.1 kg, respectively. When noncarcass components were expressed on an empty body basis (g/kg EBW), reductions ( ≤ 0.01) in the limbs (18.8 vs. 19.5 g/kg EBW [SEM 0.1]), hide (81.1 vs. 78.1 g/kg EBW [SEM 0.7]), liver (14.2 vs. 13.2 g/kg EBW [SEM 0.2]), kidneys (2.6 vs. 2.3 g/kg EBW [SEM 0.04]), small and large intestines (74.9 vs. 69.6 g/kg EBW [SEM 1.2]), and gastrointestinal tract (119.8 vs. 113.4 g/kg EBW [SEM 1.3]) were observed with ZH supplementation. Additionally, there was a tendency ( = 0.07) for the proportion of total offal to be reduced (253.2 vs. 247.4 g/kg EBW [SEM 2.5]) with ZH supplementation. Empty BW and HCW linearly increased ( < 0.01) by 1.16 and 0.758 kg/d ( < 0.01), respectively, with additional DOF. The weight of the liver and intestines linearly increased ( < 0.01) by 0.007 and 0.133 kg/d ( < 0.01), respectively, with additional DOF. These data indicate the magnitude of change in noncarcass tissues that can be expected when calf-fed Holstein steers are supplemented with ZH.