Supplementing pre- and probiotic ingredients to feedlot steers: effects on health, growth performance, and physiological responses.

Feedlot diets are often enriched with additives to mitigate health disorders and promote cattle performance, including the feed-grade antimicrobials monensin and tylosin. However, alternative feeding strategies are warranted given the increasing regulations regarding the use of antimicrobials in feedlot diets. This study evaluated the performance, physiological, and health responses of feedlot cattle offered a synbiotic supplement (yeast-derived prebiotic + Bacillus subtilis probiotic), which replaced or was fed in conjunction with monensin and tylosin. Angus-influenced steers (n = 192) from four different cowherds were weaned on day -1 and transported (800 km) to the feedlot. Steers were allocated to 1 of 24 pens (eight steers/pen) upon arrival on day 0. Pens were assigned to receive (n = 8/treatment) a total-mixed ration (TMR) containing: (1) monensin and tylosin (RT; 360 mg/steer daily from Rumensin and 90 mg/steer daily from Tylan; Elanco Animal Health, Greenfield, IN, USA), (2) yeast-derived ingredient and B. subtilis probiotic (CC; 18 g/steer daily of Celmanax and 28 g/steer daily of Certillus; Church and Dwight Co., Inc., Princeton, NJ, USA), or (3) a combination of RT and CC (RTCC). Steers were slaughtered according to BW in four groups balanced by treatment and pens and received treatments for 252 ± 4 days. No treatment effects were detected (P ≥ 0.17) for steer BW gain and morbidity responses. Mean TMR intake was greater and gain:feed ratio was less (P ≤ 0.01) in CC compared with RT and RTCC steers. Mean plasma leptin concentration was greater (P ≤ 0.05) in CC compared with RT and RTCC steers. Steers receiving CC had greater (P ≤ 0.04) concentrations of plasma cortisol, haptoglobin, glucose, and beta-hydroxybutyrate, and less (P ≤ 0.05) concentration of non-esterified fatty acids compared with RT and RTCC steers on day 14 of the experiment. Carcass marbling was greater (P = 0.01) in CC compared with RT steers and tended to be greater (P = 0.07) in RTCC compared with RT steers. Proportion of carcasses that graded Choice or better and Longissimus muscle area were greater (P ≤ 0.05) in CC and RTCC compared with RT steers. Incidence of liver abscesses was less (P = 0.01) in RTCC compared with CC steers and tended to be less (P = 0.09) in RT compared with CC steers. Results from this experiment indicate that the synbiotic supplement may replace monensin and tylosin without reducing steer BW gain, with potential improvements to carcass quality traits.

Prevalence and predictors for postpartum sleep disorders: a nationwide analysis.

OBJECTIVE: To describe the prevalence and predictors of postpartum sleep disorders. DESIGN: A retrospective cohort study. SETTING: Postpartum. POPULATION: Commercially insured women delivering in California (USA) between 2011 and 2014. METHODS: Using the Optum Clinformatics Datamart Database. MAIN OUTCOME MEASURES: Prevalence of a postpartum sleep disorder diagnosis with and without a depression diagnosis up to 12 months following hospital discharge for inpatient delivery. We also identified predictors of a postpartum sleep disorder diagnosis using multivariable logistic regression. RESULTS: We identified 3535 (1.9%) women with a postpartum sleep disorder diagnosis. The prevalence of sleep disorder diagnoses was insomnia (1.3%), sleep apnea (0.25%), and other sleep disorder (0.25%). The odds of a postpartum sleep disorder were highest among women with a history of drug abuse (adjusted odds ratio (aOR): 2.70, 95% confidence interval (CI): 1.79-4.09); a stillbirth delivery (aOR: 2.15, 95% CI: 1.53-3.01); and chronic hypertension (aOR: 1.82; 95% CI: 1.57-2.11). A comorbid diagnosis of a postpartum sleep disorder and depression occurred in 1182 women (0.6%). These women accounted for 33.4% of all women with a postpartum sleep disorder. The strongest predictors of a comorbid diagnosis were a history of drug abuse (aOR: 4.13; 95% CI: 2.37-7.21) and a stillbirth delivery (aOR: 2.93; 95% CI: 1.74-4.92). CONCLUSIONS: Postpartum sleep disorders are underdiagnosed conditions, with only 2% of postpartum women in this cohort receiving a sleep diagnosis using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Insomnia was the most common disorder and one-third of women diagnosed with a postpartum sleep disorder had a co-morbid diagnosis of depression. Future studies are needed to improve the screening and diagnostic accuracy of postpartum sleep disorders.

Baseline brain function in the preadolescents of the ABCD Study.

The Adolescent Brain Cognitive Development (ABCD) Study® is a 10-year longitudinal study of children recruited at ages 9 and 10. A battery of neuroimaging tasks are administered biennially to track neurodevelopment and identify individual differences in brain function. This study reports activation patterns from functional MRI (fMRI) tasks completed at baseline, which were designed to measure cognitive impulse control with a stop signal task (SST; N = 5,547), reward anticipation and receipt with a monetary incentive delay (MID) task (N = 6,657) and working memory and emotion reactivity with an emotional N-back (EN-back) task (N = 6,009). Further, we report the spatial reproducibility of activation patterns by assessing between-group vertex/voxelwise correlations of blood oxygen level-dependent (BOLD) activation. Analyses reveal robust brain activations that are consistent with the published literature, vary across fMRI tasks/contrasts and slightly correlate with individual behavioral performance on the tasks. These results establish the preadolescent brain function baseline, guide interpretation of cross-sectional analyses and will enable the investigation of longitudinal changes during adolescent development.

The relation between the flexion relaxation phenomenon onset angle and lumbar spine muscle reflex onset time in response to 30 min of slumped sitting.

Viscoelastic creep of spine tissue, induced by submaximal spine flexion in sitting, can delay the onset of the flexion-relaxation phenomenon (FRP) and low back reflexes (LBR). Theoretically, these two outcome measures should be correlated; however, no studies have investigated this. This study aims to determine whether 30 min of near-maximal spine flexion will affect the onset of FRP and LBR in the lumbar erector spinae (LS) and lumbar multifidus (LM), and to examine the relation between these parameters. 15 participants were recruited (9F, 6M). Spine angle (between L1 and S2) was monitored synchronously with bilateral muscle activity in the LS (L1) and the LM (L4). FRP onset and LBR were measured in a randomized order before and after 30 min of slouched sitting. No significant difference was found for any muscle LBR onset time between pre and post-sitting (p > 0.05). A significant increase in FRP onset was found in the RLM (p = 0.016) following sitting. No significant correlation was found between the FRP and the LBR for any muscle. These results suggest that the LBR onset might not be as sensitive as an outcome measure to investigate shorter exposures of sitting as FRP.

Optimizing real time fMRI neurofeedback for therapeutic discovery and development.

While reducing the burden of brain disorders remains a top priority of organizations like the World Health Organization and National Institutes of Health, the development of novel, safe and effective treatments for brain disorders has been slow. In this paper, we describe the state of the science for an emerging technology, real time functional magnetic resonance imaging (rtfMRI) neurofeedback, in clinical neurotherapeutics. We review the scientific potential of rtfMRI and outline research strategies to optimize the development and application of rtfMRI neurofeedback as a next generation therapeutic tool. We propose that rtfMRI can be used to address a broad range of clinical problems by improving our understanding of brain-behavior relationships in order to develop more specific and effective interventions for individuals with brain disorders. We focus on the use of rtfMRI neurofeedback as a clinical neurotherapeutic tool to drive plasticity in brain function, cognition, and behavior. Our overall goal is for rtfMRI to advance personalized assessment and intervention approaches to enhance resilience and reduce morbidity by correcting maladaptive patterns of brain function in those with brain disorders.

The dangerous gamble of heparinization within two weeks of nonoperative traumatic acute subdural hematoma in patients with increased stroke risk: a case series.

BACKGROUND: In traumatic acute subdural hematoma (aSDH) management, systemic anticoagulation is contraindicated, particularly during the first 2 weeks. We present two cases of patients with nonoperative aSDH whose stroke risk led to heparinization within 2 weeks of the initial hemorrhage and examine their outcomes to illustrate the risks and benefits associated with systemic anticoagulation. MATERIALS AND METHODS: Two elderly males, on warfarin at baseline who developed traumatic nonoperative aSDH were heparinized within 2 weeks of aSDH onset. RESULTS: One patient showed a decreased SDH volume on Day 19. The second patient developed sudden onset headache with fixed/dilated pupils on Day 5. In this patient, a CT scan of the brain revealed marked enlargement of the aSDH from 0.9 to 2.4 cm with midline shift of 1.5 cm, and uncal herniation that was incompatible with life. CONCLUSION: Heparinization within two weeks of aSDH may cause SDH enlargement resulting in rapidly fatal neurologic deterioration. Further study is needed to more definitively address this issue.

Front line nurses' experiences with deteriorating ward patients: a qualitative study.

BACKGROUND: Nurses in the general ward are faced with patients who are at high risk of clinical deterioration. Having the key role in performing routine vital signs monitoring, non-registered nurses such as enrolled nurses are the front line nurses who play a pivotal role in detecting and responding to the deteriorating ward patient. AIMS: (1) To explore the experience of enrolled nurses with deteriorating patients in pre-cardiac arrest situations and (2) to identify strategies to enhance their role in caring for deteriorating ward patients. METHOD: A qualitative study using critical incident technique was conducted. Fifteen enrolled nurses who had encountered deteriorating ward patients were interviewed. Data were analysed using content analysis. FINDINGS: Three themes emerged describing enrolled nurse's experience with deteriorating patients: recognizing deterioration, responding to deterioration and taking responsibility. Two themes, including educational development and modifying clinical processes, were strategies identified to enhance the ability of enrolled nurses in recognizing and managing deteriorating patients. CONCLUSION: The study highlighted a need to enhance the ability of front line nurses in recognizing and responding to patient deterioration through nursing education and modifications of clinical processes. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nursing education could focus on increasing the awareness of the importance of performing complete vital signs monitoring and undertaking accurate interpretation of vital signs. Strategies to improve clinical processes could include the need for registered nurses to provide supervision of enrolled nurses in the interpretation of vital signs readings and share the responsibility of performing vital signs monitoring.

Predictors of referral uptake in children with disabilities in Bangladesh--exploring barriers as a first step to improving referral provision.

PURPOSE: Making services available to children with disabilities in low- and middle-income countries does not guarantee their use. This study aims to identify factors associated with the uptake of referrals in order to investigate barriers to service use. METHODS: Children with impairments identified in two districts of Bangladesh were invited to attend screening camps where their condition was confirmed; they were provided with referrals for rehabilitation and treatment services. Predictors of referral uptake were identified using logistic regression. RESULTS: Overall referral uptake was 47%, 32% in Sirajganj and 61% in Natore. There was no association between age or gender and referral uptake. Factors predictive of referral uptake were higher income in Sirajganj (OR=2.6 95%CI 1.4-5.0), and the districts combined (OR=1.6 95%CI 1.1-2.1); maternal literacy in Natore (OR=1.6 95%CI 1.0-2.5); and epilepsy in all three models (Sirajganj: OR=2.6 95%CI 1.7-4.0; Natore: OR=13.5 95%CI 6.5-28.3; Combined: OR=4.6 95%CI 3.3-6.5). Physical impairment was associated with increased odds of uptake in Sirajganj and in the combined model (OR=2.7 95%CI 1.8-4.1; OR=3.34 95%CI 2.2-5.2). CONCLUSIONS: Even when some logistical and financial assistance is available, children with impairment from low-income families may require additional support to take up referrals. There may be greater willingness to accept treatment that is locally provided, such as medication for epilepsy or therapy at village level.

Functional clinical placements: a driver for change.

The aim of the project was to create a supervised professional experience placement model involving undergraduate nursing students, families of children with intellectual disabilities and nursing lecturers. Action research provided the methodological framework for developing a new placement model. Five families with children with disabilities, nine nursing students and two nurse academics worked together through the cycles of the action research process to develop a family health promotion intervention to improve the health and wellness of the family members and reduce risk for illness. Awareness, valuing and understanding were key themes derived from the qualitative data. Findings of this project indicate that this model of university-initiated, community-focused professional experience placement is effective in achieving the competency-based learning outcomes required of undergraduate nursing students and is worthy of ongoing exploration.

Architectonic mapping of the medial region of the human orbitofrontal cortex by density profiles.

The study of architectonic differentiation in the cortex is advanced by the articulation of objective definitions based on clear features of the cortical architecture. We adopted areal density profiles as a means of sampling the cortex. On the profiles, we isolated and quantified the density of individual cortical layers. These features may serve as criteria in objective definitions in a way that builds on qualitative observations found in the classical literature. A preprocessing procedure was introduced to overcome artefacts in the density profiles caused by the partial overlap of neighboring neuronal layers and cortical folding. We applied this method to the medial half of the orbital frontal cortex in specimens drawn from 10 human postmortem brain hemispheres. The measurements successfully confirmed the existence of several qualitatively observed areas (architectonic areas 14c, 14r, 11m, 11 and 13). The selection of specific sampling parameters was justified on the basis of simultaneous measurements of the cortical morphology which demonstrate its influence on the appearance of the cortical layers. We also examined the robustness of the measuring procedure by analyzing the outcome of varying systematically the sampling parameters. We describe here a novel method of sampling the cortex for architectonic analysis and demonstrate its application on histological sections obtained from the medial half of the human orbitofrontal cortex.

Resuscitation tables: a useful tool in calculating pre-burns unit fluid requirements.

BACKGROUND: There is considerable variation in the standard of initial burn management, particularly burn surface area assessment and application of resuscitation formulae. Early aggressive management of major burns improves survival. Internationally, the Parkland formula employing lactated Ringer's solution is used for fluid resuscitation. This study aimed to assess whether Parkland fluid resuscitation tables could improve the accuracy of initial fluid requirement calculations. METHODS: The burn size had first to be determined for an adult and a child using a preshaded Lund and Browder chart. Fluid requirements then had to be calculated using the conventional Parkland formula. The burn size had to be similarly calculated for two further cases and fluid requirements calculated using resuscitation tables. The study had a sample size of 50, consisting of plastic surgery trainees, anaesthetists and burn nurse specialists. RESULTS: All the participants found the resuscitation tables to be quicker and easier to use. The burn size was correctly calculated in 72% of cases. Fluid resuscitation requirements were correct in only 55% when using the Parkland formula. The use of resuscitation tables improved the accuracy in calculating fluid requirements to 75%. CONCLUSIONS: The use of Parkland fluid resuscitation tables can improve accuracy and ease of calculation of fluid resuscitation requirements.

Return to work after burns: a qualitative research study.

As yet no qualitative research studies looking at return to work following burns have been published. The aim of this study was to investigate the "hows" and "whys" of return to work, by purposively selecting a cross-section of burns patients who returned to the same/similar job, those who returned to work but either on a part-time basis or in a different role/job and those who became or remained unemployed, and using semi-structured interviews to explore their experiences. Using matrix analysis methodology, and with the general themes that emerged from these transcripts, it was possible to place patients into 5 broad groups, the "defeated", the "burdened", the "affected", the "unchanged" and the "stronger". We anticipate that use of these general groups will be useful in targeting multi-disciplinary return to work strategies, and discuss how this qualitative research has changed practice at the Queen Victoria Hospital Burns Centre.

Does staging computered tomography change management in thick malignant melanoma?

INTRODUCTION: Histological confirmation and assessment of Breslow thickness are essential before embarking on the management plan in Malignant Melanoma (MM). Computerised Tomography (CT) is used in staging of MM in the UK according to BAD/BAPS (British Association of Dermatologists/British Association of Plastic Surgeons). Currently UK guidelines for the management of cutaneous melanoma at intermediate or high risk of recurrent disease (American Joint Cancer Committee) AJCC IIB disease or worse (Breslow 2.01-4.0mm with ulceration or Breslow >4mm) should have the following staging investigations: chest X-ray; liver ultrasonography or computed tomographic (CT) scan with intravenous contrast enhancement of chest, abdomen and pelvis; liver function tests; lactate dehydrogenase and full blood count. It has been the practice at our unit to perform a CT head and neck also as part of our staging. The aim of this study was to determine whether CT staging changed clinical management at the initial presentation scan and follow up scans. Also we aimed to see whether there was a benefit in performing CT head and neck in staging. METHOD: A retrospective case note review was performed to see whether CT staging actually changed patient clinical management on 132 cases of AJCC IIB melanoma or worse over the past six years at our unit. Clinical management changes were divided into two groups: Initial presentation CT staging and follow up CT staging. In addition numbers of metastases to body regions were recorded. RESULTS: A total of 488 CT scans were performed on 132 patients (3.7 scans per patient). Initial presentation CT staging scans picked up 1/132 (0.7%) patient with an occult metastases that changed their clinical management. Of the 356 follow up CT staging scans imaging (11/127) 8.6% of patients had metastases detected and clinical management changed. All of these patients exhibited symptoms and signs of clinical metastatic disease. Head metastases are at least as common as other regions such as the chest & abdomen and more common than in the pelvis. Neck CT did not change management. CONCLUSION: CT staging for cutaneous melanoma is not indicated unless there are signs or symptoms of metastatic disease. If there are symptoms and signs of metastatic disease than patients should be staged and we advocate that staging of AJCC IIB/C should include imaging of the head in addition to chest, abdomen and pelvis.

Malignant melanoma following scalp irradiation for tinea capitis.

X-Rays were discovered by Roentgen in 1895 and were subsequently used in the treatment of many ailments. Numerous benign skin conditions including eczema and psoriasis have historically been treated with X-rays. During the 1930s and 1940s radiotherapy was introduced as an effective treatment for scalp ringworm (tinea capitis). Over the past few years radio-induced malignancies have been reported, with basal cell carcinoma predominating. We report a very rare case of a 64-year-old male with a 9.5mm Breslow thickness melanoma occurring over 50 years following irradiation. This case highlights the presence of another risk factor in the development of melanoma. With the increasing age of this irradiated population we may continue to see further evidence of the link between melanoma and skin irradiation.

Biological Rhythms Workshop I: introduction to chronobiology.

In this chapter, we present a series of four articles derived from a Introductory Workshop on Biological Rhythms presented at the 72nd Annual Cold Spring Harbor Symposium on Quantitative Biology: Clocks and Rhythms. A diverse range of species, from cyanobacteria to humans, evolved endogenous biological clocks that allow for the anticipation of daily variations in light and temperature. The ability to anticipate environmental variation promotes optimal performance and survival. In the first article, Introduction to Chronobiology, we present a brief historical timeline of how circadian concepts and terminology have emerged since the early observation of daily leaf movement in plants made by an astronomer in the 1700s. Workshop Part IA provides an overview of the molecular basis for rhythms generation in several key model organisms, Workshop Part IB focuses on how biology built a brain clock capable of coordinating the daily timing of essential brain and physiological processes, and Workshop Part IC gives key insight into how researchers study sleep and rhythms in humans.

Biological Rhythms Workshop IA: molecular basis of rhythms generation.

Current circadian models are based on genetic, biochemical, and structural data that, when combined, provide a comprehensive picture of the molecular basis for rhythms generation. These models describe three basic elements-input pathways, oscillator, and output pathways-to which each molecular component is assigned. The lines between these elements are often blurred because some proteins function in more than one element of the circadian system. The end result of these molecular oscillations is the same in each system (near 24-hour timing), yet the proteins involved, the interactions among those proteins, and the regulatory feedback loops differ. Here, the currentmodels for the molecular basis for rhythms generation are described for the prokaryotic cyanobacterium Synechococcus elongatus as well as the eukaryotic systems Neurospora crassa, Drosophila melanogaster, Arabidopsis thaliana, and mammals (particularly rodents).