Pre-insemination prediction of dystocia in dairy cattle.

Dystocia or difficult calving in cattle is detrimental to the health of the afflicted cows and has a negative economic impact on the dairy industry. The goal of this study was to create a data-driven tool for predicting the calving difficulty of non-heifer cows using input variables that are known prior to the moment of insemination. Compared to past studies, we excluded input variables that can only be known during or after insemination, such as birth weight and gestation length. This makes the model suitable for informing mating decisions that could reduce the incidence of difficult calvings or mitigate their consequences. We used a dataset consisting of 131,527 calving records of Holstein cattle, from which we derived a total of 274 phenotypic features and estimated breeding values. The distribution of classes in the dataset was 96.7 % normal calvings, and 3.3 % difficult calvings. We used a gradient boosted trees (XGBoost) as the learning model and a bagging ensemble approach to deal with the extreme class imbalance. The model achieved an average area under the ROC curve of 0.73 on unseen test data. Using feature importance analysis, we identified a number of features that have a high discriminatory value for calving difficulty, including maternal and paternal breeding values, and past phenotypic measurements of the cow.

Results of Nonoperative Treatment for Symptomatic Tarsal Coalitions.

INTRODUCTION: Recommendations for the initial treatment (nonoperative measures to surgical excision) of symptomatic tarsal coalitions vary. Because nonoperative outcomes are poorly established, we retrospectively evaluated their success in preventing surgery and achieving pain relief for pediatric patients with symptomatic tarsal coalitions. MATERIALS AND METHODS:  A retrospective study of pediatric patients with symptomatic tarsal coalitions treated at a single institution was undertaken. Clinical notes were examined for treatment methods, response to treatment, and need for additional procedures. A statistical analysis was performed using the chi-square and Mann-Whitney U tests. RESULTS:  Fifty symptomatic tarsal coalitions (mean patient age, 11.4 years; range, 8.1-17.9) were treated with nonoperative measures. Surgery was not required in 79% of calcaneonavicular and 62% of talocalcaneal coalitions. Pain relief was achieved in 53% of 81 nonoperative treatment trials. Continuous immobilization via casting, intermittent immobilization via walking boot, and supportive measures were not significantly different in pain relief (p = 0.35) or preventing surgery (p = 0.62). CONCLUSION:  Nonoperative treatment methods have the potential to achieve pain relief and prevent or delay surgery for symptomatic tarsal coalitions. However, some families may elect to forgo nonoperative measures knowing that surgery may eventually be required.

The Educational Opportunities Provided by a Pediatric Orthopedic Urgent Case Review Conference: Keep Score to Provide a Better Experience.

OBJECTIVE: To evaluate the distribution of conditions presented at a case conference to assess resident educational exposure to acute pediatric orthopedic conditions. DESIGN: Retrospective review of emergency department and inpatient consultations presented at a daily pediatric orthopedic case conference over a 3-year period. Consultations were divided into 3-month resident rotation blocks for analysis. SETTING: Tertiary children's hospital in the southern United States which host residents from 2 orthopedic surgery residency programs. PARTICIPANTS: The case conference is attended by pediatric orthopedic surgeons, 1 pediatric orthopedic fellow, and 4 PGY III/IV residents. RESULTS: A total of 1762 consultations were presented at the conference. The consultations were obtained for traumatic injuries, 86.5% (1524/1762); infections, 7.7% (136/1762); and congenital/other problems, 5.8% (102/1762). The 3 most common consultations per rotation were fractures: both-bone forearm (mean, 46.1; range: 24-64), supracondylar humerus (mean, 23.8; range: 17-31), and distal radius (mean, 13.8; range: 7-33). Less common consultations per rotation were septic arthritis (mean, 1.6; range: 0-5), child abuse (mean, 1.3; range: 0-5), Monteggia fracture (mean, 0.3; range: 0-1), compartment syndrome (mean, 0.2; range: 0-1) and patella sleeve fracture (mean, 0.1; range: 0-1). CONCLUSIONS: There was a large disparity between conditions in the number of times presented and reviewed within a 3-month rotation at the daily case conference, with some important conditions not being discussed at all in each rotation. This finding documents a disadvantage of case conferences based on limiting discussion to current patients, and highlights an opportunity for educational improvement.