Genetic analysis of a maternal assistance score in sheep.

Maternal behaviour is important for lamb survival, as ewes perform many behaviours that affect the chances of a lamb surviving. Collecting maternal behaviour data directly at lambing is time-consuming and not considered suitable for acquiring the large volumes of data that would be required for using as selection criteria within commercial breeding flocks. The aim of this study was to investigate if a simple scoring system is heritable and assesses the expression of behaviours that reduce the probability of lamb mortality. Ewe behaviour was scored on a 3-point Maternal Assistance Score (MAS): (1) the ewe shows a high level of maternal interest (assumed if no intervention required); (2) the ewe shows limited interest in her lamb; and (3) the ewe shows no interest in her lamb. A total of 19 453 MAS were collected over 12 years, across 24 farms (including both indoor and outdoor lambing systems) and 12 different breed lines that make up the Innovis breeding programme. Ewe parity, breed, number of lambs carried, flock, lambing batch, lambing day within flock and pre-mating weight all had a significant effect on MAS (P < 0.05). The maternal assistance score was shown to be heritable (h2 = 0.05) and repeatable (0.10), positively genetically correlated to lambing difficulty (rg = 0.29) and amount of assistance the lamb required to suckle from the ewe (rg = 0.88), and negatively genetically correlated with the number of lambs successfully reared (rg = 0.49). This study shows that an easy-to-measure score can be used by shepherds with large breeding flocks, based on whether the ewe requires further assistance to support her lamb rearing. The score could be used in breeding programmes to select for lamb rearing ability in the future and potentially lead to an improvement in lamb welfare through a reduction in mortality.

Review: Exploring the use of precision livestock farming for small ruminant welfare management.

Small ruminant (sheep and goat) production of meat and milk is undertaken in diverse topographical and climatic environments and the systems range from extensive to intensive. This could lead to different types of welfare compromise, which need to be managed. Implementing Precision Livestock Farming (PLF) and other new or innovative technologies could help to manage or monitor animal welfare. This paper explores such opportunities, seeking to identify promising aspects of PLF that may allow improved management of welfare for small ruminants using literature search (two reviews), workshops in nine countries (France, Greece, Ireland, Israel, Italy, Norway, Romania, Spain, and the United Kingdom) with 254 stakeholders, and panels with 52 experts. An investigation of the main welfare challenges that may affect sheep and goats across the different management systems in Europe was undertaken, followed by a prioritisation of animal welfare issues obtained in the nine countries. This suggested that disease and health issues, feed access and undernutrition/malnutrition, maternal behaviour/offspring losses, environmental stressors and issues with agonistic behavioural interactions were important welfare concerns. These welfare issues and their indicators (37 for sheep, 25 for goats) were categorised into four broad welfare indicator categories: weight loss or change in body state (BWC), behavioural change (BC), milk yield and quality (MY), and environmental indicators (Evt). In parallel, 24 potential PLF and innovative technologies (8 for BWC; 10 for BC; 4 for MY; 6 for Evt) that could be relevant to monitor these broad welfare indicator categories and provide novel approaches to manage and monitor welfare have been identified. Some technologies had the capacity to monitor more than one broad indicator. Out of the 24 technologies, only 12 were animal-based sensors, or that could monitor the animal individually. One alternative could be to incorporate a risk management approach to welfare, using aspects of environmental stress. This could provide an early warning system for the potential risks of animal welfare compromise and alert farmers to the need to implement mitigation actions.

A Comparison of Tenosynovial and Transverse Carpal Ligament Biopsy for Amyloid Detection in Open Carpal Tunnel Release.

PURPOSE: Our purpose was to compare differences in the incidence of amyloid deposition in tenosynovium (TS) versus transverse carpal ligament (TCL) biopsies obtained during open carpal tunnel release. We hypothesized that the incidence of amyloid would be similar between TCL and TS when obtaining both specimens from the same patient. METHODS: All primary, elective open carpal tunnel release cases that underwent biopsy for amyloid between January 2022 and September 2023 were reviewed. Tenosynovial and TCL specimens were independently evaluated by a pathologist to assess for amyloid. Demographic data were collected, and incidence of amyloid deposition was compared between the two samples. Agreement statistics, sensitivity, and specificity were calculated for TCL, using TS as the reference standard. RESULTS: A total of 196 cases met either Tier 1 (n=180) or Tier 2 (n=16) biopsy criteria. Forty-eight cases were excluded for missed biopsies or laboratory processing errors, leaving 148 cases available for analysis. Amyloid deposition was present in 31 out of 148 (21%) TS specimens and 33 out of 148 (22%) TCL specimens. Overall, the results of the TS biopsy agreed with TCL biopsy in 138 out of 148 cases (93%). In the 10 cases for which the results of the TCL and TS biopsy differed, six cases had (+) TCL and (-) TS, and four cases had amyloid deposition in TS without evidence of deposition in the TCL. Sensitivity and specificity values for the TCL specimen were 87% and 95%, respectively. Positive and negative predictive values were 82% and 97%, respectively. CONCLUSIONS: For cases of open carpal tunnel release undergoing biopsy, amyloid deposition was noted in 21% of TS specimens and 22% of TCL specimens. Results of TS and TCL biopsies obtained from the same patient agreed in 93% of cases. Single-source biopsy for amyloid represents a reasonable diagnostic approach. Future cost analyses should be performed to determine whether the addition of two biopsy sources to improve diagnostic accuracy is justified. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Sensitivity, Specificity, and Reliability of the CTS-6 for Carpal Tunnel Syndrome Administered by Medical Assistants.

PURPOSE: The CTS-6 can be used clinically to diagnose carpal tunnel syndrome (CTS) and has demonstrated high levels of interrater reliability when administered by nonexpert clinicians. Our purpose was to assess sensitivity (Sn), specificity (Sp), and interrater reliability of the CTS-6 when administered by medical assistants (MAs). METHODS: A series of patients presenting to an academic, upper-extremity surgery clinic were screened using CTS-6 between May and June of 2023. The CTS-6 was first administered by one of seven MAs and then by one of four fellowship-trained upper-extremity surgeons. In addition to recording baseline demographics, the results of each of the six history and examination components of the CTS-6 were recorded, as was the cumulative CTS-6 score (0-26). Surgeons were blinded to the scores obtained by the MAs. Interrater reliability (Cohen's kappa) was determined between the groups with respect to the diagnosis of CTS and the individual CTS-6 items. Sensitivity/specificity was calculated for the MA-administered CTS-6, using the score obtained by the surgeon as the reference standard. A CTS-6 score >12 was considered diagnostic of CTS. RESULTS: Two hundred eighteen patients were included, and 26% had a diagnosis of CTS. The MA group demonstrated a Sn/Sp of 84%/91% for the diagnosis of CTS. Interrater reliability was substantial (Cohen's kappa: 0.72, 95% confidence interval: 0.62-0.83) for MAs compared with hand surgeons for the diagnosis of CTS. For individual CTS-6 components, agreement was lowest for the assessment of two-point discrimination (fair) and highest for the assessment of subjective numbness (near perfect). CONCLUSIONS: The CTS-6 demonstrates substantial reliability and high Sn/Sp when administrated by MAs in an upper-extremity clinic. These data may be used to inform the development of CTS screening programs and future investigations in the primary care setting. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.

Foregoing Preoperative Antibiotics in Clean, Implant-Based Hand Surgery Does Not Increase Postoperative Infectious Risks.

Purpose: Although data support foregoing preoperative antibiotics for outpatient, soft-tissue procedures, there is a paucity of evidence regarding antibiotics for implant-based hand procedures. The purpose of this investigation was to assess early postoperative infectious concerns for patients undergoing implant-based hand surgery, regardless of preoperative antibiotic use. Methods: A retrospective cohort analysis was performed consisting of all patients undergoing implant-based hand procedures between January 2015 and October 2021. Primary outcomes included antibiotic prescription or reoperation for infection within 90 days of surgery. Demographics (age, gender, body mass index, diabetes, and smoking status) and hand surgery procedure type were recorded. To account for differences in baseline characteristics between patients who did and did not receive preoperative antibiotics, covariate balancing was performed with subsequent weighted logistic regression models constructed to estimate the effect of no receipt of preoperative antibiotics on the need for postoperative antibiotics. In a separate logistic regression analysis, patients' baseline characteristics were evaluated together as predictors of postoperative antibiotic prescription. Results: One thousand eight hundred sixty-two unique procedures were reviewed with 1,394 meeting criteria. Two hundred thirty-six patients (16.9%) were not prescribed preoperative antibiotics. Overall, 54 (3.87%) and 69 (4.95%) patients received antibiotics within 30 and 90 days of surgery, respectively. One patient (0.07%) underwent reoperation. There were no differences in the rates of 30- and 90-day postoperative antibiotic prescriptions between the two groups. After covariant balancing of risk factors, patients not prescribed preoperative antibiotics did not display significantly higher odds of requiring postoperative antibiotics at 30 or 90 days. Logistic regression models showed male gender, temporary Kirschner wire fixation, and elevated body mass index were associated with increased postoperative antibiotics at 30 and 90 days. Conclusions: For implant-based hand procedures, there was no increased risk in postoperative antibiotic prescription or reoperation for patients who did not receive preoperative antibiotics. Type of study/level of evidence: Therapeutic III.

A Comparison of Amyloid Deposition in Endoscopic and Open Carpal Tunnel Release.

PURPOSE: Previous investigations assessing the incidence of amyloidosis detected with biopsy during carpal tunnel release (CTR) have focused on open CTR (OCTR). Prior authors have suggested that biopsy may be more technically challenging during endoscopic carpal tunnel release (ECTR). Our purpose was to compare differences in the incidence of amyloid deposition detected during ECTR versus OCTR. METHODS: We reviewed all primary ECTR and OCTR during which a biopsy for amyloid was obtained between February 2022 and June 2023. All procedures were performed by five upper-extremity surgeons from a single institution. Congo red staining was used to determine the presence of amyloid deposition in either the transverse carpal ligament (TCL) or tenosynovium. All positive cases underwent subtype analysis and protein identification through liquid chromatography-tandem mass spectrometry. Baseline demographics were recorded for each case, and the incidence of positive biopsy was compared between ECTR and OCTR cases. RESULTS: A total of 282 cases were included for analysis (143 ECTR and 139 OCTR). The mean age was 67 years, and 45% of cases were women. Baseline demographics were similar except for a significantly higher incidence of diabetes in OCTR cases (13% vs 33%). Overall, 13% of CTR cases had a positive biopsy. There was a statistically significant difference in the incidence of amyloid deposition detected during biopsy in ECTR cases (3.5%) compared with OCTR cases (23%). CONCLUSIONS: Biopsy performed during ECTR may result in a lower incidence of amyloid detection. Future basic science investigation may be necessary to determine histologic differences between tenosynovium proximal and distal to the leading edge of the TCL. When surgeons plan a biopsy during surgical release of the carpal tunnel, an open approach may be advantageous. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Pandemic impacts and experiences after disaster in Australia: qualitative study of compound impacts following the Black Summer bushfires.

BACKGROUND: The first cases of the COVID-19 pandemic in Australia were recorded in January 2020, which was during the 'Black Summer' bushfires of 2019-20 and prior to additional disasters in some regions. Few studies have considered the compound impact of disasters and the pandemic. AIMS: To improve understanding of the impact on mental health and well-being of the pandemic in disaster-affected communities. METHOD: We conducted semi-structured interviews (n = 18) with community members and online focus groups (n = 31) with help providers from three regions of rural Australia affected by bushfires and the pandemic. RESULTS: Six themes were produced: (a) 'Pulling together, pulling apart', describing experiences after bushfires and prior to impacts of the pandemic; (b) 'Disruption of the 'normal response', encompassing changes to post-disaster recovery processes attributed to the pandemic; (c) 'Escalating tensions and division in the community', describing impacts on relationships; (d) 'Everywhere you turn you get a slap in the face', acknowledging impacts of bureaucratic 'red tape'; (e) 'There are layers of trauma', highlighting intersecting traumas and pre-existing vulnerabilities; and (f) 'Where does the help come from when we can't do it?', encompassing difficulties accessing services and impacts on the helping workforce. CONCLUSIONS: This study furthers our understanding of compound disasters and situates pandemic impacts in relation to processes of adjustment and recovery from bushfires. It highlights the need for long-term approaches to resilience and recovery, investment in social infrastructure, multi-component approaches to workforce issues, and strategies to increase mental health support and pathways across services.

Statistical Literacy in Hand and Upper-Extremity Patients.

Purpose: Statistical literacy is the ability of a patient to apply basic statistical concepts to their health care. Understanding statistics is a critical component of shared decision making. The purpose of this investigation was to define levels of statistical literacy in an upper-extremity (UE) patient population. We aimed to determine if patient demographics would be associated with statistical literacy. Methods: An electronic survey was administered to a consecutive series of UE patients at a single institution. We recorded baseline demographics, Single Assessment Numeric Evaluation scores, the Berlin Numeracy Test (BNT), and General Health Numeracy Test. We also included a surgical risk question, which asked: "Approximately 3% of patients who get carpal tunnel surgery develop an infection. If 100 patients get this surgery, how many would you expect to develop an infection?" A covariate-controlled adjusted odds ratio reflecting the association between each statistical literacy outcome measure and patient characteristics was reported. Results: A total 254 surveys were administered, 148 of which were completed and included. Fifty percent of respondents had a high-school education or less. For the BNT, 78% scored in the bottom quartile, and 52% incorrectly answered all questions. For the General Health Numeracy Test, 34% answered 0 or 1/6 questions correctly. For the surgical risk question, 24% of respondents answered incorrectly. Respondents who had a college or graduate degree had 2.62 times greater odds (95% confidence interval, 1.09-6.32) of achieving a BNT score in a higher quartile than patients who did not have a college or graduate degree. Conclusions: Overall levels of statistical literacy are low for UE patients. Clinical relevance: When engaging in management discussions and shared decision making, UE surgeons should assume low levels of statistical literacy. Consideration of alternative formats, such as frequencies, video-based materials, and pictographs, may be warranted when discussing outcomes and risks of surgical procedures.

Parity and housing effects on the behavioural and hypothalamic-pituitary-adrenal axis responses of pregnant ewes.

It is common in many countries for sheep to be housed during winter from mid-gestation until lambing to protect ewes and lambs from adverse conditions and improve late gestation nutritional management. Keeping ewes indoors, however, has its own challenges as the animals may be mixed with unfamiliar conspecifics, have limited floor and feeding space, experience changes to their diet and increased handling by humans. Therefore, the objective of this study was to investigate the effect of variation in housing management (space allowance and social stability) on the behaviour and hypothalamic-pituitary-adrenal (HPA) axis responses of pregnant ewes from mid-to-late gestation (weeks 11-18 of pregnancy). Seventy-seven ewes (41 primiparous, 36 multiparous) were divided into two groups: 'Control' and 'Restricted space and mixed' (RS-Mix), where RS-Mix ewes were allocated half the amount of space (1.27 vs 2.5 m2 for RS-Mix and Control, respectively) and feedface (concentrate feeder space) allowance (36 vs 71 cm per ewe) given to the Control group and were also subjected to two social mixing events. Aggressive behaviour at the feedface and time spent standing, lying, walking, feeding and ruminating were recorded and faecal samples were collected for assessment of faecal glucocorticoid metabolite (FGM) concentrations. Higher aggression was observed in RS-Mix ewes during the first week of observation (P = 0.044), which gradually declined to the same level as Control ewes by the end of the study (P = 0.045). RS-Mix ewes were significantly less likely to be able to freely join the feedface compared to Controls (P = 0.022). No other significant treatment effects on aggressive behaviour or FGM during gestation were found. RS-Mix ewes displayed significantly higher ruminating behaviour at week 18 of gestation compared to Control ewes (P < 0.001), but no other effects were seen on general pen behaviour. However, the effect of indoor housing had a significant impact on primiparous ewes, who had lower weight gain (P = 0.015) and higher FGM concentrations (P = 0.014) compared to multiparous ewes regardless of treatment group. The data suggest that, although no sustained effects on behaviour or HPA axis responses were seen with the differences in space and feeder allowance or social stability at the levels used in this study, inexperienced (primiparous) ewes may find indoor housing more stressful; and are less able to adapt compared to multiparous ewes. These effects may influence the behaviour of the ewe at lambing time, and her offspring.

The Effect of an Intraoperative Real-Time Counter on Radiation Exposure Events During Operative Treatment of Distal Radius Fractures.

PURPOSE: Occupational radiation exposure can have adverse health consequences for surgeons. The purpose of this study was to determine if utilization of an intraoperative, real-time radiograph counter results in decreased radiation exposure events (REEs) during open reduction and internal fixation (ORIF) of distal radius fractures (DRFs). METHODS: We reviewed all cases of isolated ORIF DRFs performed at a single center from January 2021 to February 2023. All cases performed on or after January 1, 2022 used an intraoperative radiograph counter, referred to as a "shot-clock" (SC) group. Cases prior to this date were performed without a SC and served as a control group (NoSC group). Baseline demographics, fracture, and surgical characteristics were recorded. Final intraoperative radiographs were reviewed to record reduction parameters (radial inclination, volar tilt, and ulnar variance). REEs, fluoroscopy exposure times, and total radiation doses milligray (mGy) were compared between groups. RESULTS: A total of 160 ORIF DRF cases were included in the NoSC group, and 135 were included in the SC group. The NoSC group had significantly more extra-articular fractures compared with the SC group. Reduction parameters after ORIF were similar between groups. The mean number of REEs decreased by 48% in the SC group. Cases performed with the SC group had significantly lower total radiation doses (0.8 vs 0.5 mGy) and radiation exposure times (41.9 vs 24.2 seconds). Mean operative times also decreased for the SC group (70 minutes) compared with that for the NoSC group (81 minutes). CONCLUSIONS: A real-time intraoperative radiograph counter was associated with decreased REEs, exposure times, and total radiation doses during ORIF DRFs. Cases performed with a SC had significantly shorter operative times without compromising reduction quality. Using an intraoperative SC counter during cases requiring fluoroscopy may aid in decreasing radiation exposure, which serves as an occupational hazard for hand and upper-extremity surgeons. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Readability of Online Hand and Upper Extremity Patient Resources.

Background Online patient resources regarding hand and upper extremity topics published by professional societies are written at a level that exceeds that of the average reader. Methodology Online patient resources focused on hand and upper extremity topics published by the American Society for Surgery of the Hand (ASSH), the American Association for Hand Surgery (AAHS), and the American Academy of Orthopaedic Surgeons (AAOS) were reviewed. The reading material from each topic page was analyzed using the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) formulas. The reading level (FKGL) of each topic page was compared against an eighth-grade reading level, which corresponds to the average US reading level. Results A total of 170 online patient resources were reviewed, including 84 from the ASSH, 74 from the AAOS, and 12 from the AAHS. Overall, the mean FKGL was 9.1, and the mean FRE was 57.3. Overall, 50% of all hand and upper extremity online resources were written at or below an eighth-grade reading level. Pairwise testing revealed topic pages written by the ASSH had lower FKGL compared to those written by the AAHS (p = 0.046). Conclusions Online patient resources focused on hand and upper extremity topics are, on average, written at a level that exceeds the ability of the average reader. Comparisons between organizations showed a statistical, but not clinical, difference in readability measures. An emphasis on improving readability should be maintained as professional organizations continue to develop their online patient resources.

Results of single-incision distal biceps tendon repair for early-career upper-extremity surgeons.

Background: The purpose of this investigation was to assess surgical outcomes after distal biceps tendon (DBT) repair for upper-extremity surgeons at the beginning of their careers, immediately following fellowship training. We aimed to determine if procedure times, complication rates, and clinical outcomes differed during the learning curve period for these early-career surgeons. Methods: All cases of DBT repairs performed by 2 fellowship-trained surgeons from the start of their careers were included. Demographic data as well as operative times, complication rates, and patient reported outcomes were retrospectively collected. A cumulative sum chart (CUSUM) analysis was performed for the learning curve for both operative times and complication rate. This analysis continuously compares performance of an outcome to a predefined target level. Results: A total of 78 DBT repairs performed by the two surgeons were included. In the CUSUM analysis of operative time for surgeon 1 and 2, both demonstrated a learning curve until case 4. In CUSUM analysis for complication rates, neither surgeon 1 nor surgeon 2 performed significantly worse than the target value and learning curve ranged from 14 to 21 cases. Mean Disabilities of Arm, Shoulder, and Hand score (QuickDASH) (10.65 ± 5.81) and the pain visual analog scale scores (1.13 ± 2.04) were comparable to previously reported literature. Conclusions: These data suggest that a learning curve between 4 and 20 cases exists with respect to operative times and complication rates for DBT repairs for fellowship-trained upper-extremity surgeons at the start of clinical practice. Early-career surgeons appear to have acceptable clinical results and complications relative to previously published series irrespective of their learning stage.

The Reliability of the CTS-6 for Examiners With Varying Levels of Clinical Experience.

PURPOSE: To assess the interrater reliability of the CTS-6 for examiners with varying levels of clinical expertise. We also aimed to analyze this instrument's sensitivity (Sn) and specificity (Sp), using the CTS-6 score obtained by a hand surgeon as a reference standard. METHODS: Three examining groups consisting of medical students, occupational hand therapists, and hand surgeons examined a consecutive series of patients in an academic upper-extremity clinic. A total of 3 examiners (1 from each group) recorded a CTS-6 score for each patient. The examiners were blinded to the scores from the other groups. The interrater reliability was determined between the groups with respect to the diagnosis of CTS and the individual CTS-6 components. Sn and Sp were calculated for each of the groups using the CTS-6 obtained by the hand surgeons as the reference standard. RESULTS: Two hundred seven patients were included. For the diagnosis of CTS (CTS-6 score of 12 or greater as determined by a hand surgeon), there was substantial agreement between the 3 groups (Fleiss kappa 0.73; 95% CI [0.65 -0.82]; P < .05). For individual CTS-6 components, the agreement between the groups was highest for assessing subjective numbness and lowest for assessing a Tinel sign (Fleiss kappa of 0.77 and 0.49, respectively). The Sn/Sp for diagnosing CTS was 87%/91% for the medical student group and 81%/95% for the occupational hand therapist group. CONCLUSIONS: The CTS-6 can be reliably used as a screening and diagnostic tool for CTS by clinicians with a variety of experience levels and without specific fellowship training in upper-extremity surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic I.

The Ability of Upper Extremity Surgeons to Assess Patient's Functional Status.

PURPOSE: To compare surgeon and patient assessment of upper extremity functional status at the time of initial consultation. We hypothesized that surgeons and patients demonstrate low levels of agreement with respect to assessing pain scores, functional status, and self-efficacy. METHODS: One hundred forty-three consecutive new patients were evaluated by 1 of 5 fellowship-trained upper extremity surgeons. Patients completed a Numeric Pain Rating Scale as well as the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE), Pain Interference (PI), and Self-Efficacy (SE) instruments. Surgeons provided their own estimates of patient function on each questionnaire at the conclusion of the visit and were blinded to the results of the patient-reported outcome measures (PROMs) for the duration of the study. Estimation errors, which represent the absolute value of the difference between the patient's actual score and the surgeon's estimated score on each questionnaire, were calculated for each questionnaire. RESULTS: As a group, surgeons assumed that the PROMIS UE and SE scores were higher than the patients' actual scores and assumed that patients had lower PROMIS PI scores than were actually reported. Mean estimation errors for all PROMIS instruments were greater than 10 points and larger than the SD for these instruments in the general population. CONCLUSIONS: Upper extremity surgeons demonstrate difficulty assessing their patient's self-reported functional status, pain interference, and level of self-efficacy during initial consultations. CLINICAL RELEVANCE: Although formalized PROMs are infrequently administered in orthopedic clinics, increased utilization of these questionnaires would allow for a more accurate baseline functional assessment. When evaluating new patients in the outpatient clinic, surgeons should recognize the potential limitations of their assessments of patient-reported function.

Technology, Social Media, and Telemedicine Utilization for Rural Hand and Upper-Extremity Patients.

PURPOSE: To define technology and social media use among rural upper-extremity patients. In addition, we aimed to assess how patients use social media in relation to health care and their willingness to participate in telemedicine programs. METHODS: An anonymous multiple-choice written survey was administered to 550 upper-extremity patients at 4 rural outreach clinics. Demographic information was obtained, as was social media use, habits and interests. We compared both users and nonusers of social media to define demographic differences between these groups. RESULTS: A total of 412 patients completed surveys and were included in our analysis (75%); 225 reported using social media (55%). Of the respondents, 67% had a high school education or less and 60% reported an income of less than $50,000/y with an unemployment rate of 58%. In addition, 28% reported not owning a smartphone and 20% lacked home Internet access. Multivariable regression demonstrated that age, female sex, and home Internet access were all independently associated with increased social media use. Facebook was the most frequently used social media platform. Moreover, 42% were interested in telemedicine and social media users were significantly more likely to be interested in telemedicine programs compared with non-social media users. CONCLUSIONS: Within a population of rural and economically disadvantaged upper-extremity patients, 55% currently use social media; 32% used these platforms to research health conditions. Whereas younger female patients with home Internet access were more likely to use social media, older patients were more likely to use these platforms to research health conditions. CLINICAL RELEVANCE: As more health information moves on-line and as telemedicine programs continue to evolve, some rural upper-extremity patients may still have technological barriers in the form of smartphone and computer ownership as well as a lack of home Internet access.

Opioid Versus Nonopioid Analgesia After Carpal Tunnel Release: A Randomized, Prospective Study.

Background: The purpose of this investigation was to compare pain control and patient satisfaction for conventional postoperative opioid analgesia and nonopioid multimodal analgesia after elective open or endoscopic carpal tunnel release (CTR). Methods: As part of a randomized, prospective study, patients undergoing primary, elective CTR were randomized to receive either postoperative opioids or nonopioid medications as part of a multimodal pain control strategy. Patients currently taking opioids were excluded. Patients completed a postoperative pain journal and completed the shortened version of the Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH), Boston Carpal Tunnel Questionnaire, Numeric Pain Rating Scale (NPRS), and satisfaction ratings at their 2-week visit. Results: A total of 68 patients were included. Preoperatively, there were no statistically significant differences between the 2 groups with respect to pain scores, coping skills, or carpal tunnel symptoms. At 2 weeks postoperatively, patients in the nonopioid group had lower average NPRS and QuickDASH scores. Patients who took opioids consumed an average of 5 pills. No patient randomized to the nonopioid group required any opioids. Patients in the nonopioid group demonstrated lower early postoperative NPRS scores. Patient satisfaction with their pain control regimen and outcome was not significantly different between the 2 groups at any time point. Conclusions: Nonopioid medications as part of a perioperative pain control strategy demonstrate improved pain scores compared with opioid medications with similar patient satisfaction and functional outcomes. Considering the risks associated with the use of opioid analgesics, we recommend against prescribing opioids after CTR, particularly in patients not currently taking narcotic medications.

Mycoplasma species in vaginas of dairy cows before and after exposure to bulls and their association with conception.

Mycoplasma species can colonize the urogenital tract of dairy cattle. However, interrelationships between Mycoplasma spp. and reproductive performance in dairy herds are unclear. In this study, we measured apparent prevalences of Mycoplasma spp. in the vaginas of dairy cows (n = 629) pre- and post-bull exposure in dairy herds with and without Mycoplasma bovis clinical disease (n = 5 herds), and assessed associations between variables describing reproductive performance and consequent Mycoplasma spp. isolation. Mycoplasma spp. were infrequently isolated from the vagina pre- (1.9%; 12/629) and post-bull (3.2%; 20/629) exposure. Of the mycoplasmas isolated, Mycoplasma bovigenitalium was isolated most frequently (87.5%; 28/32), followed by Mycoplasma californicum (9.3%; 3/32). Mycoplasma bovis was only isolated from one cow. We were unable to provide any evidence of venereal transmission of M. bovis in cows in M. bovis-infected herds that use natural service bulls. There was an insufficient number of cows with Mycoplasma spp. in the vagina pre-bull exposure to assess effects on subsequent reproductive performance. Cows that had not conceived before post-bull exposure sampling had much greater odds (odds ratio 14.8; 95% confidence interval 4.2 to 52.3) of having a Mycoplasma sp. isolated from the vagina at this time compared with those that had conceived. Also, within those that had conceived, delayed conception increased the odds of having a Mycoplasma spp. isolated from the vagina at the post-bull exposure sampling by a factor of 1.62 for every additional week not pregnant. The likely cause of these findings is that cows that remain not pregnant for longer are more likely to be served by a bull (likely repeatedly) and subsequently become colonized with a Mycoplasma sp. (mostly M. bovigenitalium) through venereal transmission. In dairy herds that use bulls, there is a greater chance of isolating a Mycoplasma sp. (mostly M. bovigenitalium) after a period of bull breedings from the vaginas of cows that have remained nonpregnant for longer during the bull breeding period.

Mycoplasma bovis and other Mollicutes in replacement dairy heifers from Mycoplasma bovis-infected and uninfected herds: A 2-year longitudinal study.

Replacement dairy heifers exposed to Mycoplasma bovis as calves may be at risk of future clinical disease and pathogen transmission, both within and between herds; however, little information is available about these risks. We conducted a 2-yr longitudinal (panel) study starting with 450 heifer calves reared to weaning in 8 herds (7 M. bovis infected with clinical disease, 1 uninfected) under the same ownership. After weaning, heifers were commingled and managed with non-study heifers at a single heifer rearing facility. Nose, conjunctival, and vaginal swabs were collected along with a blood sample at weaning, prebreeding, precalving, and approximately 1 mo postcalving. Additionally, a colostrum sample was collected upon calving and a composite milk sample was collected 1 mo postcalving. The swabs, colostrum, and milk samples were cultured for Mycoplasma spp., and serum from the blood was evaluated for serological evidence of exposure to M. bovis using an ELISA. Despite a high M. bovis ELISA seroprevalence at weaning in the heifers from the 7 M. bovis-infected herds with clinical disease [72% (289/400); range by herd: 28-98%], M. bovis was isolated from only 4% (16/400) of the same heifers at the same time. In heifers from the uninfected herd at weaning, M. bovis seroprevalence was 2% (1/50) and M. bovis was not detected by culture. Mycoplasma bovis was isolated from 0.5% (2/414) of heifers at prebreeding, 0% (0/374) of heifers at precalving, and 0.3% (1/356) of heifers 1 mo postcalving. The nose was the predominant anatomical site of M. bovis colonization (74%; 14/19 culture positives). A single heifer (from an M. bovis-infected herd with clinical disease) was repeatedly detected with M. bovis in its nose at weaning, prebreeding, and postcalving samplings. This demonstrates the possibility, albeit rare, of a long-term M. bovis carrier state in replacement heifers exposed to M. bovis as calves, up to at least 1 mo after entry into the milking herd. No M. bovis clinical disease was detected in any heifer from weaning through to the end of the study (approximately 1 mo after calving). Acholeplasma spp. were commonly isolated throughout the study. Mycoplasma bovigenitalium, Mycoplasma bovoculi, and Mycoplasma bovirhinis were isolated infrequently. Mycoplasma bovis seroprevalences at prebreeding, precalving, and postcalving samplings were 27% (112/414), 12% (46/374), and 18% (65/356), respectively. Overall, the results show that replacement heifers from groups exposed to M. bovis preweaning can become colonized with M. bovis and that colonization can, uncommonly, be present after their first calving. For groups of 50 or more heifers exposed to M. bovis preweaning, there is at least a nontrivial probability that the group will contain at least 1 shedding heifer postcalving.

The Handshake Test: A Nonverbal Assessment of Coping Strategies and Functional Status in Patients with Atraumatic Upper-Extremity Conditions.

Background: Maladaptive coping strategies can lead to less functional improvement after upper-extremity surgery. It remains uncertain how well surgeons can recognize signs of less effective coping strategies in patients in the absence of formalized questionnaires. Our purpose is to determine if the "Handshake Test" can be used to identify patients with less effective coping strategies. We hypothesize that a simple physical examination finding (a refusal or inability to shake hands) is associated with higher pain level, maladaptive coping strategies and decreased functional status. Methods: We prospectively analyzed 246 consecutive new patients presenting to one of three surgeons with atraumatic upper-extremity conditions. Patients completed a pain scale (NPRS) and PROMIS instruments including Self-Efficacy (SE) for Managing Symptoms, Pain Interference (PI) and Upper Extremity (UE). Each surgeon recorded a refusal to shake hands as part of a normal greeting, referred to as a "positive Handshake Test". Results: 200 patients (81%) patients completed all outcome measures and were included in our analysis. 8% demonstrated a positive Handshake Test. Patients with a positive Handshake Test were more likely to use tobacco; otherwise baseline demographics were similar between the two groups. Patients with a positive Handshake Test demonstrated higher pain scores (NPRS and PROMIS PI), lower levels of self-efficacy and worse self-reported functional status on the PROMIS UE. Conclusions: For patients with atraumatic upper-extremity conditions, those with a positive Handshake Test report higher pain levels, lower self-efficacy, and decreased self-reported functional status than patients who can perform a handshake. This simple test can aid in identifying patients with less effective coping strategies, allowing surgeons to guide patients towards interventions to improve both illness behavior and functional outcomes.Level of Evidence: II.

The effect of elemental Zn boluses on concentrations of Zn in serum and faeces of South American camelids.

Aims: To monitor the effect of using long-acting Zn boluses on the Zn status of a group of South American camelids, using measurements of concentrations of Zn in faeces and serum. Methods: As part of a facial eczema (FE) prevention programme, 15 camelids were treated with long-acting Zn boluses designed for preventing FE in sheep. Based on bodyweight, 13 alpacas (Vicugna pacos) received two boluses (26.4 g Zn/bolus) and two llamas (Lama glama) received three boluses. In order to monitor Zn status, measurements were made of concentrations of Zn in serum and faeces immediately prior to bolus treatment (Week 0) and 4, 6, 8 and 10 weeks later. Gamma glutamyl transferase (GGT) activity in serum was measured at Weeks 0 and 8. Results: Two alpacas regurgitated the boluses; in one case the animal was quickly re-treated but this was not possible in the second animal. Mean concentrations of Zn in faeces were higher at all time points compared to Week 0 (p < 0.001). Peak concentrations were measured at Week 8, and concentrations >120 mg/kg fresh weight (FW), suggested as being protective in calves, were only measured in all (13/13) treated camelids at Week 6. Mean concentrations of Zn in serum differed between weeks of sampling but changes were not consistent, and concentrations did not exceed 18 µmol/L following treatment. There was no evidence of a natural sporidesmin challenge during the study period and activity of GGT in serum of all animals was <45 IU/L. Conclusions: Treatment with Zn boluses significantly increased concentrations of Zn in faeces but not in serum, but peak concentrations in faeces were only detected 8 weeks after treatment. Clinical Relevance: The delay in achieving concentrations of Zn in faeces which were associated with protection against FE in calves, combined with the difficulties of administering boluses to camelids, means that we do not believe that Zn boluses should be used as the primary method for preventing FE in camelids. We recommend that FE prevention in camelids should focus on minimising spore production in pasture through the use of fungicides, grazing management and alternative forages, with boluses only used when it is thought that these methods are unlikely to provide sufficient protection against FE. Such use should always be under the guidance of a veterinarian and monitoring of serum GGT activity should be used to ensure that FE control is being achieved.