Generic Health Utility Measures in Exercise Oncology: A Scoping Review and Future Directions.

Despite the evidence that exercise is effective at mitigating common side effects in adults with cancer, it is rarely part of usual cancer care. One reason for this is the lack of economic evidence supporting the benefit of exercise. Economic evaluations often rely on the use of generic utility measures to assess cost effectiveness. This review identifies and synthesizes the literature on the use of generic utility measures used to evaluate exercise interventions for adults with cancer. A systematic search of the literature from January 2000 to February 2023 was conducted using four databases (Medline, EMBASE, CINAHL, Academic Search Complete). Exercise studies involving adults with any type of cancer that used a generic utility measure were eligible for inclusion. Of the 2780 citations retrieved, 10 articles were included in this review. Seven articles included economic evaluations, with varying results. Four studies reported on cost-effectiveness; however, detailed effectiveness data derived from the generic utility measure were often not reported. Generic utility measures help to compare baseline values of and changes in health utility weights across studies and to general population norms; however, to date, they are underutilized in exercise oncology studies. Consideration should be given to the identified research evidence, population, and methodological gaps.

Advancing Pediatric Oncology Rehabilitation: Survey Findings of Health Professionals' Perceptions of Barriers to Care and a Framework for Action.

PURPOSE: To explore pediatric oncology referral practices, gather healthcare providers' perspectives of barriers to access and provision of rehabilitation service across Canada, and inform a framework for action to optimize rehabilitation care and inform future research. METHODS: A cross-sectional survey was conducted with Canadian healthcare professionals (HCPs) working in pediatric oncology. RESULTS: A total of 54 responses were received, and 34 corresponded to HCPs who refer children with cancer to rehabilitation services. Results suggest that approximately 25% of children are referred to rehabilitation services, primarily when the child presents with, or is at risk of, significant functional disability due to surgery. A primary barrier to service provision identified across HCPs included a lack of funding and resources. Medical professionals further identified a lack of specialized pediatric oncology rehabilitation services, whereas rehabilitation professionals identified the lack of pediatric oncology specific space and equipment. Identified themes from open-ended survey questions include the need for (1) dedicated funding and resources, (2) improved access, and (3) the need for specialized pediatric oncology rehabilitation services. CONCLUSION: Several barriers exist in the Canadian healthcare context that impact the delivery of rehabilitation services for children with cancer. We propose a framework for action to advance clinical care and guide future research.

Dairy farm worker milking equipment training with an E-learning system.

In many farms, the logistics of on-farm training are a limiting factor due to communication challenges in the workplace (i.e., cultural differences, language barriers, impaired listening skills) and limited access to industry professionals. The use of E-learning systems may help to improve communication and can be sensitive to cultural challenges. The objectives of this study were to (1) identify how many of the high-priority problems in the milking parlor relate to milker training in the areas of milking equipment and milking routine, (2) design and test an E-learning training system for dairy farm milkers related to milking equipment, and (3) gain feedback targeted to improve subsequent E-learning training modules. An interactive online training course on basic checks of the milking equipment was developed with a cloud-based authoring software. A total of 95 dairy farm workers on 15 commercial dairy farms in northern New York State (USA) were trained and participated in the study. Milk quality professionals performed an initial evaluation of 3 main areas: equipment analysis, milker assessment, and cow assessment. The 3 most important risk factors for mastitis were summarized for each farm. A training event was scheduled with milkers guided by a bilingual (English and Spanish) professional in milk quality. Over 50% of the farms (8/15) had one or more of the top 3 priorities involving problems with milking equipment, which milkers could have detected and reported to management. All participants completed the module, 95% stated that they felt capable of checking the equipment before milking, and 86% felt more confident in reporting equipment problems to the manager after having taken the course. There were also differences between managers' and milkers' statements on how and whether milking equipment training was offered or not on the farm. This can be explained due to the lack of or secondary to poor communication between managers and employees on training objectives and goals on the farm. Our results also show that milking equipment issues which milkers could detect and report are common on dairy farms and reinforces the need for additional milker training in this area.

ACE-Neuro: A tailored exercise oncology program for neuro-oncology patients - Study protocol.

Background: Patients with primary brain tumours (i.e., neuro-oncology patients) lack access to exercise oncology and wellness resources. The purpose of the Alberta Cancer Exercise - Neuro-Oncology (ACE-Neuro) study is to assess the feasibility of a tailored neuro-oncology exercise program for patients across Alberta, Canada. The primary outcome is to assess the feasibility of ACE-Neuro. The secondary outcome is to examine preliminary effectiveness of ACE-Neuro on patient-reported outcomes and functional fitness. Methods: Neuro-oncology patients with a malignant or benign primary brain tumour that are pre, on, or completed treatment, are >18 years, and able to consent in English are eligible to participate in the study. Following referral from the clinical team to cancer rehabilitation and the study team, participants are triaged to determine their appropriateness for ACE-Neuro and other cancer rehabilitation services (including physiatry, physiotherapy, occupational therapy, and exercise physiology). In ACE-Neuro, participants complete a tailored 12-week exercise program with pre-post assessments of patient-reported outcomes and functional fitness, and objective physical activity tracked across the 12-week program. ACE-Neuro includes individual and group-based exercise sessions, as well as health coaching. Conclusion: We are supporting ACE-Neuro implementation into clinical cancer care, with assessment of needs enabling a tailored exercise prescription.

Feasibility of Implementing Cancer-Specific Community-Based Exercise Programming: A Multi-Centre Randomized Trial.

BACKGROUND: There is growing recognition of the importance of reporting preliminary work on the feasibility of a trial. The present study aimed to assess the feasibility of (1) a proposed fitness testing battery, and (2) processes related to the implementation of cancer-specific exercise programming in a community setting. METHODS/DESIGN: A randomized controlled implementation feasibility trial was performed in advance of a large-scale implementation study. Eligible participants within 18 months of a cancer diagnosis were randomized to immediate or delayed community-based exercise at YMCA locations in Calgary and Edmonton, Canada for an 8-week period. The primary outcome for the trial was the feasibility of the physical fitness testing battery, defined as a 70% or greater completion rate across the 24-week study period. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was used to evaluate processes related to implementation of the exercise program across the two sites. RESULTS: Eighty participants were recruited, 73 (91%) completed the 8-week trial, and 68 (85%) completed the 16- and 24-week follow-ups. Sixty participants (75%) completed the full physical fitness test battery at each time point, and 59 (74%) completed the patient-reported outcome measures. Statistically significant between-group differences were found in favor of the exercise group for functional aerobic capacity, upper and lower extremity strength, and symptoms. Differences were found between the sites, however, in completion rates and processes related to program implementation. DISCUSSION: Findings suggest the need for minor adaptations to the physical fitness battery and outcome measures to better fit the community context. While findings support feasibility, context-specific challenges related to implementation processes were identified.

Nighttime compression supports improved self-management of breast cancer-related lymphedema: A multicenter randomized controlled trial.

BACKGROUND: Lymphedema is a prevalent long-term effect of breast cancer treatment associated with reduced quality of life. This study examined the efficacy of nighttime compression as a self-management strategy for women with chronic breast cancer-related lymphedema. METHODS: Th authors conducted a parallel 3-arm, multicenter, randomized trial. Women were recruited from 3 centers in Canada and randomized to group 1 (daytime compression garment alone [standard care]), group 2 (daytime compression garment plus nighttime compression bandaging), or group 3 (daytime compression garment plus the use of a nighttime compression system garment). The primary outcome was the change in excess arm volume from the baseline to 12 weeks. Participants from all groups used a nighttime compression system garment from weeks 13 to 24. RESULTS: One hundred twenty women were enrolled, 118 completed the randomized trial, and 114 completed the 24-week follow-up. The rates of adherence to nighttime compression were 95% ± 15% and 96% ± 11% in the compression bandaging and nighttime compression system groups, respectively. After the intervention, the addition of nighttime compression was found to be superior to standard care for both absolute milliliter reductions (P = .006) and percentage reductions (P = .002) in excess arm lymphedema volume. Significant within-group changes were seen for quality of life across all groups; however, no between-group differences were found (P > .05). CONCLUSIONS: The trial demonstrated a significant improvement in arm lymphedema volume from the addition of nighttime compression whether through the application of compression bandaging or through the use of a nighttime compression system garment. LAY SUMMARY: Lymphedema is swelling that occurs in the arm on the side of the surgery for breast cancer. Lymphedema occurs in approximately 21% of women. Lymphedema tends to worsen over time and can result in recurrent infections in the arm, functional impairment, and pain. Currently, treatment consists of intensive treatments to reduce the swelling followed by regular use of a compression sleeve during the day. This study examined and found a benefit from the addition of nighttime compression (whether through self-applied compression bandaging or through the use of a nighttime compression system garment) to the use of a daytime compression sleeve.

Calculating clinical mastitis frequency in dairy cows: Incidence risk at cow level, incidence rate at cow level, and incidence rate at quarter level.

The lack of standardization in reporting clinical mastitis incidence limits the ability to compare results across multiple studies without additional calculations. There is both a biological and statistical rationale for evaluating the at-risk period at the quarter level. This study aimed to: (1) to outline an applied method for calculating clinical mastitis (CM) incidence rate at the quarter level using currently available software; and (2) to present the results of three different measurements: incidence risk at cow level, incidence rate at cow level, and incidence rate at quarter level. In an open population prospective cohort of eight commercial dairy farms monitored from May 15, 2016, to May 31, 2017, all CM cases (n = 7513) were identified by trained on-farm personnel, who collected all milk samples from all quarters with visibly abnormal milk. Microbiological identification was determined by culture and MALDI-TOF. All lactating quarters were at risk for CM. A quarter was at risk for a new CM case if there was at least 14 d between a previously diagnosed case and the current case in the same quarter, or if a different pathogen was isolated in the same quarter within 14 d. A total of 17,513,429 quarters days at risk (QDAR) were estimated. A statistical software macro and Structured Query Language (SQL) were used to bring all data together. The monthly incidence rate at the cow level was 16.6 cases per 10,000 cow-days, the monthly incidence rate at the quarter level was 4.4 cases per 10,000 QDAR and the monthly incidence risk at the cow level was 4.8 cases per 100 cows. Although the evaluation of QDAR requires additional computation when compared to other methods, it might allow for a more precise evaluation of the data and a more accurate evaluation of mastitis incidence. Clearly defining the methods used to report mastitis incidence will improve our ability to discuss and learn about the differences and similarities across studies, regions, and countries.

Physical therapy interventions, other than general physical exercise interventions, in children and adolescents before, during and following treatment for cancer.

BACKGROUND: Children and adolescents diagnosed with cancer are at high risk of experiencing severe side effects from cancer treatment, many of which are amenable to physical therapy. These side effects can negatively impact a child's quality of life and ability to participate in daily activities (e.g. play and attendance at school). Researchers have evaluated physical therapy interventions in children with cancer and childhood cancer survivors. However, factors such as small sample sizes, varying intervention protocols and differences in cancer types among trials make it difficult to draw conclusions about efficacy. OBJECTIVES: The primary aim of this review was to evaluate the efficacy of physical therapy interventions - with a specific focus on symptom relief and compensation of therapy-related side effects - on the quality of life of children and adolescents diagnosed with cancer. Participants must be between the ages of 0 and 19 years at the time of the physical therapy intervention study. The intervention may occur prior to, during or following cancer treatment. The intervention must be compared to a control group of children receiving standard care, no physical therapy intervention or a comparison intervention. We have excluded general physical exercise studies where the primary aim was to improve physical fitness through aerobic, anaerobic, resistance exercise or combined physical exercise training regimens (i.e. combined aerobic and resistance exercise regimens). We have also intended to record the occurrence of any adverse effects resulting from physical therapy interventions. The secondary aims were to evaluate the efficacy of physical therapy on impairments of pain, peripheral neuropathy, balance, gait, functional abilities and mobility, motor function and performance, range of motion, strength and fatigue. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, PEDro, ongoing trial registries, conference proceedings and the reference lists of relevant studies and reviews in March 2020. We also contacted oncology rehabilitation researchers working in paediatrics in March 2020 to identify additional studies. SELECTION CRITERIA: The review included randomised controlled trials (RCTs), cross-over trials, and controlled clinical trials (CCTs) that compared the effects of physical therapy interventions to a control group, and involved children and adolescents diagnosed with cancer between the ages of 0 and 19 years at the time of the intervention. We excluded studies examining general physical exercise interventions where the primary aim was to improve physical fitness through aerobic exercise, resistance exercise or combined physical exercise training regimens (i.e. combined aerobic and resistance exercise regimens). DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We found no RCTs, cross-over trials or CCTs comparing the effects of physical therapy interventions with a focus on symptom relief and compensation of therapy-related side effects for children and adolescents between the ages of 0 and 19 years. AUTHORS' CONCLUSIONS: Results demonstrate that the evidence to date is inadequate to inform clinical practice. Recommendations for future research include the need for large-scale, high-quality designs that examine: (1) paediatric populations with same cancer types; (2) similar intervention protocols; (3) long-term outcomes; (4) physical therapy interventions (e.g. electrophysical modalities and sensory interventions); and (5) outcomes commonly impaired in children with cancer (e.g. peripheral neuropathy and gait deficits).

Description of the Characteristics of Five Bedding Materials and Association With Bulk Tank Milk Quality on Five New York Dairy Herds.

Environmental mastitis represents a major challenge on dairy farms where contagious pathogens are controlled by improved milking procedures. Therefore, research focused on the environment is important to improve udder health programs. The objectives of this prospective and descriptive study were to (1) describe bedding bacterial counts, pH, and dry matter (DM) of five different bedding types (organic: manure solids, straw, paper fiber; inorganic: sand, recycled sand) and (2) explore the association between bedding bacterial counts with bulk tank milk quality. This study took place within five conveniently selected commercial dairy herds, each with a predominant bedding material in lactating pens. Bedding samples (used n = 237; fresh n = 53) were collected monthly from July 2018 to July 2019 following a standard operating procedure (SOP) to minimize sampling variability. Additionally, a bulk tank (BT) milk sample (n = 40) was collected on the same day unless milk had been picked up prior to arrival. Both BT and bedding samples were submitted to the laboratory for culture and bacterial identification and quantification of Streptococcus spp, coliforms, and non-coliforms as well as detection of several pathogens of mastitis importance. Somatic cell count was evaluated in BT samples. Within bedding type, the correlation between bedding characteristics and bacterial counts in bedding was evaluated using Pearson correlation. Within bedding type, the correlation between bacterial counts in bedding samples and bacterial counts in BT were determined. The Kruskal-Wallis test was used to evaluate the bacterial count by bedding type and to evaluate BT somatic cell count differences based on bedding type. In fresh bedding, bacterial counts were generally higher for manure solids for all bacterial groups compared with other materials. In used samples, organic materials had the highest levels of all bacterial groups. The proportion of samples with detectable organisms of mastitis importance varied within and among herds in both bedding and BT samples throughout the study period. In bedding samples, a higher DM content had the lowest levels of bacterial growth compared with those with lower DM content. Most bedding samples were on the alkaline side within a pH range of 8-11. No relationship between bacterial counts and pH was observed. No associations between BT bacteria counts and bedding bacterial counts were observed. No association between bulk tank somatic cell counts based on bedding type were observed. Despite using an SOP for bedding sampling in an effort to consistently collect samples, we still observed a large amount of variability both within and among bedding samples. This variability may have obscured any potential association between BT milk quality and bedding type.

Physical Rehabilitation Practices for Children and Adolescents with Cancer in Canada.

Purpose: Children and adolescents with cancer who undergo cancer treatment are at high risk of developing adverse effects, many of which may be amenable to physical rehabilitation. We aimed to identify the current clinical physical rehabilitation practice patterns, services, and programmes available for children and adolescents with cancer in Canada. Method: A cross-sectional survey in English and French was conducted. Participants were health care professionals (HCPs) who provided physical rehabilitation services to children and adolescents with cancer in Canada. The survey included questions on the HCPs' practice patterns and the programmes and services they provided. Results: A total of 35 HCPs responded: 27 physical therapists (77%), 6 occupational therapists (17%), 1 exercise professional (3%), and 1 speech-language pathologist (3%). Overall, they reported activity limitations, alterations in motor performance, muscle weakness, peripheral neuropathy, and fatigue as the top priorities for rehabilitation services. HCPs believed that interventions were valuable in reducing the burden of cancer effects; however, issues such as space, resources, and lack of clinical practice guidelines were viewed as barriers to providing services. Conclusions: Paediatric oncology rehabilitation services exist in some regions in Canada. HCPs strongly support the need to develop clinical practice guidelines for paediatric oncology rehabilitation.

Objectif : les enfants et les adolescents en traitement oncologique sont très vulnérables à des effets indésirables, dont bon nombre répondent à la réadaptation physique. Les auteurs ont cherché à déterminer les modes de pratique clinique, de services et de programmes en réadaptation physique offerts aux enfants et aux adolescents atteints du cancer au Canada. Méthodologie : sondage transversal en français et en anglais. Les participants étaient des professionnels de la santé (PdS) qui donnaient des services de réadaptation physique à des enfants et des adolescents atteints du cancer au Canada. Le sondage contenait des questions sur les modes de pratique des PdS et sur les programmes et services fournis. Résultats : Au total, 35 PdS ont répondu : 27 physiothérapeutes (77 %), six ergothérapeutes (17 %), un professionnel de l'exercice (3 %) et un orthophoniste (3 %). Dans l'ensemble, ils ont déclaré que les limitations aux activités, les modifications de la performance motrice, la faiblesse musculaire, la neuropathie périphérique et la fatigue étaient les principales priorités des services de réadaptation. Selon eux, les interventions étaient utiles pour réduire le fardeau des effets du cancer, mais des problèmes comme l'espace, les ressources et l'absence de directives cliniques étaient considérés comme des obstacles aux services. Conclusions : des services de réadaptation en oncologie pédiatrique sont offerts dans certaines régions du Canada. Les PdS appuient fortement la création de directives cliniques pour la réadaptation en oncologie pédiatrique.

A Scoping Review of Physical Therapy Interventions for Childhood Cancers.

Purpose: Children and adolescents undergoing cancer treatment are at high risk of developing serious adverse effects, many of which respond to physical therapy (PT). This scoping review aims to (1) outline the state of the research involving PT for children with cancer and (2) identify gaps in the literature for future research. Method: From January 2002 to October 2017, we conducted electronic searches of three major databases and conference proceedings and checked references of screened articles. Results: A total of 12 articles were included in the review: one randomized controlled trial, one pilot randomized trial, five pilot or feasibility studies, two prospective studies, one case series, one case report, and one retrospective study. The research to date supports the feasibility of PT interventions for children with cancer, but the current evidence is not yet at a level to inform clinical practice. To better elucidate treatment protocols and assess their benefits for tumour-specific impairments, research needs to examine the effects of PT on specific impairments or for specific cancer tumour types. Conclusions: Collaborative efforts to conduct multi-centre trials are needed to further the field of paediatric oncology PT.

Objectif : les enfants et les adolescents sous traitement en oncologie sont très vulnérables à de graves événements indésirables, dont bon nombre répondent à la physiothérapie. Le présent examen exploratoire vise à 1) délimiter l'état de la recherche sur la physiothérapie chez les enfants atteints du cancer et 2) déterminer les lacunes contenues dans les publications scientifiques en vue de futures recherches. Méthodologie : de janvier 2002 à octobre 2017, les chercheurs ont fouillé trois grandes bases de données et débats de congrès et vérifié les références des articles parcourus. Résultats : au total, 12 articles ont été inclus dans l'examen exploratoire : un essai aléatoire et contrôlé, cinq projets pilotes ou études de faisabilité, deux études prospectives, une série de cas, un rapport de cas et une étude rétrospective. Jusqu'à maintenant, les recherches appuient la faisabilité d'interventions physiothérapiques pour les enfants atteints du cancer, mais les données probantes à jour ne sont pas encore suffisantes pour éclairer les pratiques cliniques. Pour mieux préparer les protocoles thérapeutiques et en évaluer les avantages à l'égard des atteintes liées aux tumeurs, il faudra réaliser des recherches sur les effets de la physiothérapie pour des atteintes précises ou des types particuliers de tumeurs cancéreuses. Conclusion : il faudra entreprendre des efforts coopératifs pour mener des recherches multicentriques qui feront progresser le secteur de la physiothérapie en oncologie pédiatrique.

Association of herd-level risk factors and incidence rate of clinical mastitis in 20 Brazilian dairy herds.

The objectives of this study were to characterize the pathogen frequency and severity of clinical mastitis (CM) in 20 dairy herds of southeastern Brazil; and to determine the incidence rate of clinical mastitis (IRCM; overall and based on specific-pathogen groups) based on quarter time at risk and its association with risk factors at the herd-level. Data were recorded in each herd for a period of 8 to 15 months. The association between herd-level risk factors and IRCM were determined by two groups of mixed regression models: one based on the overall IRCM, and five based on the following specific-pathogen groups: contagious, other Gram-positive, Gram-negative, other, and negative culture. The following herd-level risk factors were evaluated: herd size, housing system, average daily milk yield per cow, bulk milk somatic cell count (BMSCC), and bulk milk total bacterial count (BMTBC). A total of 5957 quarter-cases of CM were recorded from 2637 cows, but only 4212 cases had milk samples collected for culture. The most frequently isolated pathogens were Escherichia coli (6.6% of total cultures), Streptococcus uberis (6.1%), and Streptococcus agalactiae (5.9%). The majority of CM cases were mild (60.3%), while 34.1% were moderate and 5.6% severe. The frequency of severe CM cases was lower for those with a Gram-positive result (4.6%) compared to a Gram-negative result (11.4%). Overall, monthly mean IRCM was 9.7 cases per 10,000 quarter-days at risk (QDAR). Herds with a geometric mean BMSCC ≥ 601 × 103 cell/mL had higher overall IRCM (16/10,000 QDAR) than those with BMSCC ≤ 600 × 103 cell/mL (≤7.7/10,000 QDAR). When the specific-pathogen groups were evaluated, for contagious pathogens, variables housing (free-stalls or compost-bedded pack barns), BMSCC (≥601 × 103 cells/mL), and average daily milk yield per cow (21 and 25 Kg/d) presented the highest IRCM. Furthermore, in Gram-negative group, herds with BMTBC ≥ 31 × 103 cfu/mL had higher IRCM compared with herds with BMTBC ≤ 30 × 103 cfu/mL. Although environmental pathogens were the most common cause of CM in this study, contagious pathogens (e.g., Strep. agalactiae and Staph. aureus) are still a concern in dairy herds of Brazil. Additionally, as there were some herd-level risk factors associated with the IRCM, there may be opportunity for management strategies aiming to improve the control of CM in dairy herds.

Association between ß-hydroxybutyrate concentration at surgery for correction of left-displaced abomasum in dairy cows and removal from the herd after surgery.

OBJECTIVE: To estimate the sensitivity, specificity, likelihood ratios, and predictive values of blood ß-hydroxybutyrate (BHB) concentrations in dairy cows immediately prior to surgical correction of left-displaced abomasum (LDA) for determining associations between BHB concentration and removal from the herd ≤ 30 days after surgery and to evaluate postsurgical risk of removal for cows with the BHB concentration that had highest sensitivity and specificity for predicting this outcome. DESIGN: Prospective cohort study. ANIMALS: 136 dairy cows with LDA diagnosed between 5 and 30 days in lactation (ie, days in milk). PROCEDURES: Blood BHB concentration was measured immediately prior to surgery. All cows underwent surgical correction of LDA while standing. Follow-up information was obtained ≥ 30 days after surgery. Receiver operating characteristic curves were used to estimate a critical threshold value for BHB concentration that was associated with removal from the herd, and this value was used in Poisson regression to estimate risk ratio for the same outcome. RESULTS: While controlling for parity in the model, cows with a BHB concentration < 1.2 mmol/L at the time of LDA surgery were 2.5 times as likely (95% confidence interval, 1.3 to 5.0) to be removed from the herd ≤ 30 days after surgery, compared with cows that had a BHB concentration ≥ 1.2 mmol/L. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that blood BHB concentration in dairy cows undergoing surgical correction of LDA may potentially be a useful prognostic indicator for the likelihood of removal from the herd ≤ 30 days after surgery. Further research is needed to evaluate other risk factors that may be associated with this outcome.

Elevated non-esterified fatty acids and ß-hydroxybutyrate and their association with transition dairy cow performance.

Dairy cows pass through a period of negative energy balance as they transition from late gestation to early lactation. Poor adaptation through this period, expressed as excessively elevated concentrations of non-esterified fatty acids (NEFAs) pre- or post-partum and elevated concentrations of ß-hydroxybutyrate post-partum, increases an individual animal's risk of post-partum disease, removal from the herd, reproductive difficulty, and reduced milk production. Field studies have shown that subclinical ketosis often affects 40% of cows in a herd although the incidence can be as high as 80%. Peak incidence occurs at 5 days in milk, and cows that develop subclinical ketosis in the first week of lactation have a higher risk of negative effects and reduced milk production than cows that develop subclinical ketosis in the second week of lactation. Herds with more than a 15-20% prevalence of excessively elevated concentrations of NEFAs and ß-hydroxybutyrate in early lactation have higher rates of negative subsequent events, poorer reproduction, and lower milk yield than herds with a lower prevalence of negative energy balance. This paper reviews (1) strategies for testing of energy-related metabolites, (2) consequences of poor adaptation to negative energy balance (for individual animals and for herds), (3) treatment approaches for affected cows, and (4) economic considerations for testing and treating cows with poor adaptation to negative energy balance.

Using nonesterified fatty acids and ß-hydroxybutyrate concentrations during the transition period for herd-level monitoring of increased risk of disease and decreased reproductive and milking performance.

Dairy cows visit a state of negative energy balance (NEB) as they transition from late gestation to early lactation. At the individual level, there are several metabolic adaptations to manage NEB, including mobilization of nonesterified fatty acids (NEFA) from body fat reserves and glucose sparing for lactogenesis. Based on current pen-level feeding and management practices, strategies to minimize excessive NEB in both the individual and herd should focus on herd-level testing and management. This article reviews strategies for testing and monitoring of excessive NEB at the herd level through individual testing of 2 energy markers: NEFA and ß-hydroxybutyrate.