Genomic evaluation for wellness traits in US Jersey cattle.

The number of Jersey cows in the United States has been steadily increasing in recent years according to Council on Dairy Cattle Breeding statistics. To help producers reduce the risk of health disorders in their Jersey animals, Zoetis has developed genomic predictions for wellness traits in Jersey cattle using producer-recorded data. The traits included mastitis (MAST), metritis, retained placenta, displaced abomasum (DA), ketosis, lameness, and milk fever in cows and respiratory disease, scours, and calf livability (DEAD) in calves. Phenotypic data on health events, pedigree, and genotypes were collected directly from producers upon obtaining their permission. Each trait was defined as a binary event, having a value of 1 if an animal has been recorded with a disorder and 0 otherwise. The number of phenotypic records ranged from 216,166 for DA to 628,958 for MAST for cow traits and from 186,505 for scours to 380,429 for DEAD for calf traits. The number of genotyped animals was 41,271. All traits were analyzed using a univariate threshold animal model. The model for cow wellness traits included the fixed effect of parity and random effects of herd × year × season of calving, animal, and permanent environment. The model for calf wellness traits included the fixed effect of year of birth × calving season × region and random effects of herd × year of birth and animal. A total of 45,163 SNP were used in genomic analyses. Animals genotyped with low-density chips were imputed to the required number of markers. All analyses were based on the single-step genomic BLUP. Heritabilities ranged from 0.061 for DA to 0.120 for lameness. Predicted transmitting abilities were expressed in percentage points as deviations from the average estimated probability of a disorder in the base population. Reliabilities of genomic predicted transmitting abilities had average values between 32% (DA) and 51% (MAST and DEAD). The results indicate that a direct evaluation of cow and calf wellness traits under a genomic threshold model is feasible and offers predictions with average reliabilities comparable with other lowly heritable traits for Jersey cattle.

Genomic evaluation for calf wellness traits in Holstein cattle.

Reducing calf morbidity and mortality is important for attaining financial sustainability and improving animal welfare on commercial dairy operations. Zoetis (Kalamazoo, MI) has developed genomic predictions for calf wellness traits in Holsteins that include calf respiratory disease (RESP; recorded between 0 and 365 d of age), calf scours (DIAR; recorded between 2 and 50 d of age), and calf livability (DEAD; recorded between 2 and 365 d of age). Phenotype and pedigree data were from commercial dairies and provided directly by producers upon obtaining their permission. The number of records ranged from 741,484 for DIAR to 1,926,261 for DEAD. The number of genotyped animals was 325,025. All traits were analyzed using a univariate threshold animal model including fixed effect of year of birth × calving season × region, and random effects of herd × year of birth and animal. A total of 45,425 SNP were used in genomic analyses. Animals genotyped with low-density chips were imputed to the required number of SNP. All analyses were conducted using single-step genomic BLUP implementing the "algorithm for proven and young" (APY) animals designed to accommodate very large numbers of genotypes. Estimated heritabilities were 0.042, 0.045, and 0.060 for RESP, DIAR, and DEAD, respectively. The genomic predicted transmitting abilities ranged between -8.0 and 24.0, -11.5 and 28.5, and -6.5 to 22.8 for RESP, DIAR, and DEAD, respectively. Reliabilities of breeding values were obtained by approximation based on partitioning of a function of reliability into contributions from records, pedigree, and genotypes, where the genotype contribution was approximated using the diagonal value of the genomic relationship matrix. The average reliabilities for the genotyped animals were 41.9, 42.6, and 47.3% for RESP, DIAR, and DEAD, respectively. Estimated genomic predicted transmitting abilities and reliabilities were approximately normally distributed for all analyzed traits. Approximated genetic correlations of calf wellness with Zoetis dairy wellness traits and traits included in the US national genetic evaluation were low to moderate. The results indicate that direct evaluation of calf wellness traits under a genomic threshold model is feasible and offers predictions with average reliabilities comparable to other lowly heritable traits. Genetic selection for calf wellness traits presents a compelling opportunity for dairy producers to help manage herd replacement costs and improve overall profitability.

A hip fracture nurse specialist has a positive outcome on the length of stay for patients with hip fractures.

AIM: To determine if recruitment of a hip fracture nurse specialist has a reduction in length of stay for hip fracture patients. METHOD: Primary data was extracted from the National Hip Fracture Database (NHFD). The length of stay of hip fracture patients from 2011-2014 was compared to the period 2014-17, following appointment of a hip fracture nurse specialist in 2014. RESULTS: The average length of stay in the first group (2011-2014) was 19.94 days and in the second group (2014-2017) was 16.52 days. There was a reduction of 3.42 days (17.15%) and was statistically significant. There was also a reduction in the time to surgery (1.38 days versus 1.15 days) and the crude 30-day mortality (10% versus 6.06%) both of which were statistically significant. The two groups were well-matched with regards to age, female: male ratio and severity of co-morbidities (based on American Society of Anaesthesiologists physical status classification system). CONCLUSION: The introduction of a dedicated hip fracture nurse specialist has a positive outcome on hip fracture patients by reducing length of stay, time to surgery and the crude 30-day mortality.

Exploratory examination of the utility of demoralization as a diagnostic specifier for adjustment disorder and major depression.

OBJECTIVE: Demoralization, a state of lowered morale and poor coping, has a prevalence of 13-18% among patients with advanced cancer. We surveyed clinicians' perspectives of the utility of "with demoralization" as a diagnostic specifier for adjustment and depressive disorders. METHOD: Using comparative clinical vignettes in a field survey, clinicians from a range of disciplines were asked their perception of the utility of diagnosis and treatment options. Response frequencies were compared using Cochran's Q and McNemar's tests, with sensitivity and specificity rated against expert rankings of diagnosis. Analysis of variance and paired t-tests examined significant differences in ratings of utility. RESULTS: Vignettes were assessed by 280 clinicians; 77% supported utility of the category 'adjustment disorder with demoralization' compared to 33% supporting 'adjustment disorder with anxiety' (McNemar test, p<0.001), while 83% supported the utility of 'with demoralization' for major depressive episode, matching 83% perceiving utility for 'with melancholia.' Sensitivity and specificity ratings were 77% and 94% for adjustment disorder with demoralization and 83% and 91% for major depression with demoralization. CONCLUSION: Clinicians perceived the specifier 'with demoralization' to deepen diagnostic understanding, treatment choice, and ability to communicate with clinicians and patients, particularly for the category of adjustment disorder with demoralization.

Exposure of the grass shrimp, Palaemonetes pugio, to antimicrobial compounds affects associated Vibrio bacterial density and development of antibiotic resistance.

Antimicrobial compounds are widespread, emerging contaminants in the aquatic environment and may threaten ecosystem and human health. This study characterized effects of antimicrobial compounds common to human and veterinary medicine, aquaculture, and consumer personal care products [erythromycin (ERY), sulfamethoxazole (SMX), oxytetracycline (OTC), and triclosan (TCS)] in the grass shrimp Palaemonetes pugio. The effects of antimicrobial treatments on grass shrimp mortality and lipid peroxidation activity were measured. The effects of antimicrobial treatments on the bacterial community of the shrimp were then assessed by measuring Vibrio density and testing bacterial isolates for antibiotic resistance. TCS (0.33 mg/L) increased shrimp mortality by 37% and increased lipid peroxidation activity by 63%. A mixture of 0.33 mg/L TCS and 60 mg/L SMX caused a 47% increase in shrimp mortality and an 88% increase in lipid peroxidation activity. Exposure to SMX (30 mg/L or 60 mg/L) alone and to a mixture of SMX/ERY/OTC did not significantly affect shrimp survival or lipid peroxidation activity. Shrimp exposure to 0.33 mg/L TCS increased Vibrio density 350% as compared to the control whereas SMX, the SMX/TCS mixture, and the mixture of SMX/ERY/OTC decreased Vibrio density 78-94%. Increased Vibrio antibiotic resistance was observed for all shrimp antimicrobial treatments except for the mixture of SMX/ERY/OTC. Approximately 87% of grass shrimp Vibrio isolates displayed resistance to TCS in the control treatment suggesting a high level of TCS resistance in environmental Vibrio populations. The presence of TCS in coastal waters may preferentially increase the resistance and abundance of pathogenic bacteria. These results indicate the need for further study into the potential interactions between antimicrobials, aquatic organisms, and associated bacterial communities.

Factors associated with symptom-specific psychological and functional impact among acoustic neuroma patients.

INTRODUCTION: The main purpose of this study was to investigate the psychological and functional impact attributed to acoustic neuroma symptoms. MATERIALS AND METHODS: A sample of 207 acoustic neuroma patients completed a study-specific questionnaire about the severity, frequency, and psychological and functional impact of 9 acoustic neuroma symptoms. RESULTS: The survey response rate was 56.4 per cent. All symptoms had some degree of psychological impact for the majority of participants; hearing loss was the symptom most often reported to have a severe psychological impact. The majority of respondents reported functional impact attributed to hearing loss, balance disturbance, dizziness, eye problems, headache and fatigue; balance disturbance was the symptom most often reported to have a severe functional impact. For most symptoms, psychological and functional impact were related to severity and frequency. CONCLUSION: Of the acoustic neuroma symptoms investigated, hearing loss and balance disturbance were the most likely to have a severe psychological and functional impact, respectively.

Factors associated with anxiety and depression in the management of acoustic neuroma patients.

The objectives of this study were to describe anxiety and depression levels among acoustic neuroma patients; examine differences in anxiety and depression across the acoustic neuroma management options of microsurgery, radiation and observation; and to investigate management, medical and demographic factors that might predict anxiety and depression in this patient group. A cross-sectional questionnaire was completed by 205 adults diagnosed with, or treated for, a unilateral acoustic neuroma within five years of questionnaire distribution. Median age of participants was 57.0 years, and 120 (58.5%) were female. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Clinically significant anxiety was reported by 29.8% of participants and 10.2% were depressed. Mean anxiety and depression scores did not differ from general population norms. No significant differences in anxiety and depression were found across management options. Time since management, number of symptoms and comorbid medical conditions predicted anxiety, while depression was predicted by number of symptoms. This appears to be the first study among acoustic neuroma patients in which anxiety and depression were compared across management options. Treating physicians should be aware that as the number of acoustic neuroma symptoms increases, so may the likelihood of clinically significant anxiety and depression.

A fermentation assay to evaluate the effectiveness of antimicrobial agents on gut microflora.

The measurement of gas produced as a fermentation end product in vitro was correlated with absorbance as a measure of bacterial growth and was used as a rapid screening procedure to test the antimicrobial activity of certain essential oil and tannin secondary plant metabolites on gastrointestinal microorganisms from chickens. The assay was optimised using Clostridium perfringens and Lactobacillus fermentum, and tested in antimicrobial assays against C. perfringens; the minimum inhibitory concentration for each essential oil and condensed tannin was determined. The effect of penicillin-G on C. perfringens, in both growth and fermentation assays, was similar, and for all secondary metabolites tested, concentrations that inhibited fermentation were also bacteriocidal. The assay was also used to demonstrate the effect of dietary composition and enzyme supplementation on fermentation of mixed gut microflora in vitro; results are compared with in vivo results for the same dietary treatments. The data demonstrate that the effects of bioactive secondary plant products and feed composition on individual organisms or mixed gut microflora can be tested by analysis of fermentative activity in vitro, and that this provides a rapid assay for testing potential poultry feed additives before in vivo trials.

Biochemistry of plant secondary metabolites and their effects in animals.

Plant secondary metabolites, which include a wide variety of phytochemicals, have always been constituents of the diets of man and other animals. Although a high proportion of these phytochemicals have been considered to be of little value in plants (although this view is changing), they have frequently been shown to have adverse effects on animals when ingested. The effects depend to a great extent on the chemistry of the compounds, their concentration in the diet and the amount consumed, and are further dependent on the health status of the animals. Traditionally, most studies of the effects of these compounds on animals have focused on their adverse effects and how to alleviate them. However, recent public concern about the use of synthetic compounds in animal diets to enhance performance and health and welfare issues, coupled with changes in regulations on the use of synthetic medicaments, has stimulated interest and research in the use and effects of phytochemicals in the diets of farmed animals. Phytochemicals vary in their chemistry but can be divided into hydrophilic and hydrophobic compounds, of which a wide variety of polyphenolic and terpenoid compounds, as well as alkaloids, carbohydrates and non-protein amino acids, invoke special interest. The chemistry, biochemistry and mechanisms of action of these compounds in plants and their effects in animals when ingested will be explored.

Effect of real-time magnetic endoscope imaging on the teaching and acquisition of colonoscopy skills: results from a single trainee.

BACKGROUND AND STUDY AIMS: Most trainees have little concept of the loops that occur during colonoscopy, and have difficulty in appreciating the combination of withdrawal and torquing manoeuvres that are essential to achieving complete colonoscopy. Real-time magnetic endoscope imaging (MEI) allows visualization of shaft looping, and so makes intuitive the manoeuvres necessary to straighten the colonoscope shaft. PATIENTS AND METHODS: Consecutive routine colonoscopies were performed by a single trainee (with previous experience of 15 colonoscopies). Procedures were randomly assigned to be carried out either with the trainee viewing the MEI display, or without the MEI view, which was recorded throughout all examinations. RESULTS: In total, 71 procedures were performed. To assess the trend for learning, procedures were analysed in blocks of 24 consecutive examinations (periods 1 to 3). In the first 24 procedures (period 1), the number of attempts at straightening the colonoscope and duration of looping were significantly less, and the intubation time was shorter, for examinations performed with the MEI view. In periods 2 to 3, there was a continued trend towards improved performance, but without a significant difference between procedures performed with or without MEI. CONCLUSIONS: During training, real-time colonoscope imaging using MEI appears to enhance the endoscopist's appreciation of looping and improves the learning of the manoeuvres required to straighten the colonoscope shaft. A prospective, multicentre study assessing a larger number of trainees is needed to clarify these findings.

Long-acting steroid injection after endoscopic dilation of anastomotic Crohn's strictures may improve the outcome: a retrospective case series.

BACKGROUND AND STUDY AIMS: Endoscopic balloon dilation of Crohn's strictures is widely practised, but may not result in long-term symptomatic benefit, leading to the need for repeat dilation or surgery. It is hypothesized that long-acting steroid injection into strictures after dilation may decrease the need for further stricture dilation and improve the outcome in symptomatic patients. PATIENTS AND METHODS: Patients with Crohn's disease who have had balloon dilation and triamcinolone injection performed for symptomatic anastomotic strictures were identified from endoscopy records. Case notes were reviewed to determine outcomes. RESULTS: Fourteen patients underwent a total of 26 dilations, with triamcinolone injected (median dose 20 mg, 10-40 mg) in 20 of the procedures. Seven patients (50%) had sustained remission after a single dilation and steroid injection, with a median follow-up period of 16.4 months (range 13.2-22.0 months). Four patients (28.5%) required more than one dilation (median three dilations, range two to four) to control their symptoms, with a median follow-up period of 27.8 months (range 14-32.8 months). Endoscopic management failed in three patients (21.4 %), who were referred for surgery. There were no complications due to dilation or triamcinolone injection. CONCLUSIONS: Triamcinolone injection into the stricture after dilation is safe, easy to perform, and may be a useful adjunct in the management of anastomotic Crohn's strictures. These data will require further support through a randomized and controlled trial.

Endoscopic resection of large sessile colonic polyps by specialist and non-specialist endoscopists.

BACKGROUND: Patients with large sessile colonic polyps for which endoscopic resection might be feasible are often referred directly for operation. The aim of this study was to determine the outcome of patients with such polyps diagnosed by specialist and non-specialist colonoscopists. METHODS: Patients with large (greater than 2 cm) sessile polyps detected at colonoscopy from January 1995 to July 2000 were identified. Resection technique and clinical and endoscopic outcomes were recorded. Two of the colonoscopists (B.P.S., C.B.W.) are recognized as specialists. RESULTS: Some 130 polyps were identified, 100 detected by either of two specialist endoscopists (including 14 cancers) and 30 by 14 non-specialist endoscopists (including ten cancers). Endoscopic resection of benign polyps was attempted by experts in 80 (93 per cent) of 86 cases and by non-experts in 15 of 20 cases (P = 0.03), with successful management by endoscopy alone in 61 (76 per cent) of 80 and in six of 15 cases respectively (P = 0.01). Complications occurred following three polypectomies performed by an expert (bleeding, two; pain, one) and one by a non-expert (bleeding). The estimated end-cost of management by specialists was less than half of that by non-specialists. CONCLUSION: Endoscopic resection of large sessile colonic polyps is feasible in the majority of patients and should be considered as first-line therapy. Prompt referral to a specialist endoscopist may improve outcomes by avoiding operation or enabling complete excision at a single endoscopy session.

Patient pain during colonoscopy: an analysis using real-time magnetic endoscope imaging.

BACKGROUND AND STUDY AIMS: Colonoscopy is generally perceived as being a painful procedure. Contributory factors are: stretching of the colonic wall and mesenteric attachments from looping of the instrument shaft, overinsufflation, the degree of torque or force applied to the colonoscope shaft, and patient pain threshold. The aim of this study was to determine the frequency of pain episodes experienced during diagnostic colonoscopy and the corresponding colonoscope configuration, utilizing real-time magnetic endoscope imaging (MEI). PATIENTS AND METHODS: Consecutive outpatients undergoing colonoscopy were studied. Patients with previous colonic resections were excluded. Procedures were commenced with antispasmodics only, and patient sedation was self-administered whenever significant discomfort was experienced, using a patient-controlled analgesia (PCA) syringe pump. All "demands" were correlated with the MEI record, which was subsequently analysed. RESULTS: A total of 650 demands were recorded in 102 patients. Seventy-seven percent of all demands occurred with the colonoscope tip in the sigmoid colon, 7 % in the descending colon, 6 % at the splenic flexure, 5 % in the transverse colon, and 4 % in the proximal colon. Ninety percent of all pain episodes coincided with either looping (79 %) or straightening of the colonoscope shaft (11 %); presumed overinsufflation being an infrequent cause of pain (9 %). Of the loops encountered during colonoscopy, the N-sigmoid spiral loop was associated with the majority of pain episodes (56 %). Looping was both more frequent ( P = 0.0002) and less well tolerated in women than in men ( P = 0.0140). CONCLUSIONS: This study is the first to document pain at colonoscopy accurately. Looping, particularly in the variable anatomy of the sigmoid colon, is the major cause of pain, especially in women. Use of MEI may improve pain control by facilitating the straightening of loops within the sigmoid colon, and by enabling the endoscopist to target patient analgesia.

Effect of hydrolysable and condensed tannins on growth, morphology and metabolism of Streptococcus gallolyticus (S. caprinus) and Streptococcus bovis.

Streptococcus gallolyticus (S. caprinus) was resistant in vitro to at least 7% (w/v) tannic acid and 4% (w/v) acacia condensed tannin, levels 10-fold greater than those tolerated by S. bovis. Growth of S. gallolyticus in liquid medium was characterized by a lag period which increased, and a growth rate which decreased, with increasing tannin concentration. S. gallolyticus was also more tolerant to the presence of simple phenolic acid monomers than was S. bovis, but the lag period was still concentration dependent. Gallate decarboxylase activity in S. gallolyticus was elevated in the presence of tannic acid or gallic acid but not with other phenolic acids. Scanning electron microscopic analysis showed that both the size and shape of S. gallolyticus and S. bovis changed in response to tannin but only S. gallolyticus was surrounded by an extracellular polysaccharide matrix which accumulated in a tannin-concentration-dependent fashion. Washing of the cells to remove extracellular polysaccharide increased the lag period of S. gallolyticus in the presence of 1% (w/v) tannic acid from 4 h to 6 h. In contrast, increasing extracellular polysaccharide synthesis in S. bovis did not increase its tolerance to tannic acid. These data demonstrate that S. gallolyticus has developed a number of mechanisms to reduce the potential effect of tannins on cell growth, and that these mechanisms provide the organism with a selective advantage over S. bovis when grown in the presence of tannins.

Who will look after my grandmother? Attitudes of student nurses toward the care of older adults.

A review of the literature illustrates the unpopularity of nursing in the elderly population related to other areas of nursing practice. The aim of this article is to present the findings of a research project conducted in Victoria, Australia, investigating the career preferences of undergraduate nursing students. The results indicate caring for older adults is considered the least popular area of practice for Year 1 nursing students. The reason given by students for their choices demonstrates a negative view of this type of work, largely based on inaccuracies and misconceptions. The implications of these findings for the future care of elderly individuals are discussed.

Twin-endoscope scissors resection (T-ESR): a new minimally invasive technique for performing colonic mucosectomy.

BACKGROUND: Piecemeal resection is currently the safest method for the endoscopic removal of large sessile colonic polyps. However, this method has its limitations, including the quality of the specimen received for histopathology and the need for early follow-up due to the possibility of incomplete resection and recurrence. New methods enabling en bloc resection would be advantageous in these respects. METHODS: We developed a new technique that uses endoscopic scissors and two endoscopes to perform mucosal resection in a porcine model. So far, the technique has been evaluated in two animals. RESULTS: The resection of intact mucosal specimens measuring 1.5 x 1 cm and 2.2 x 3.5 cm was achieved, with no procedural or late hemorrhage and no clinical or radiological evidence of perforation. CONCLUSION: After further development and evaluation, this technique should be suitable for the resection of large sessile colonic polyps in humans.

Effect of magnetic endoscope imaging on colonoscopy performance: a randomised controlled trial.

BACKGROUND: Colonoscopy can be technically challenging because of unpredictable colonoscope looping. Without imaging, straightening the colonoscope is sometimes difficult since the endoscopist has to guess where the tip is. Magnetic endoscope imaging (MEI), a new non-radiographical technique for picturing the colonoscope shaft in real time, could facilitate loop straightening and thus improve performance. METHODS: We assessed trainees and endoscopists with much experience of routine outpatient colonoscopy. In group 1, trainees examined 113 consecutive patients. MEI views were recorded in all examinations, but procedures were randomised to be done by two trainees, either with the endoscopist and endoscopy assistants viewing the imager display (n=58), or without the imager view (n=55). In group 2, two skilled endoscopists were randomised (as with group 1) to undertake consecutive examinations (n=183) either with (n=92) or without (n=91) the MEI view. MEI views of all procedures were analysed retrospectively. FINDINGS: In both groups, intubation times were shorter (median 11.8 min [4.3-31.5] vs 15.3 min [4-67] [group 1]; 8.0 min [2.6-40.8] vs 9.3 min [2.5-52.6] [group 2]) and number of attempts at straightening the colonoscope fewer (median 5 [0-20] vs 12 [0-57] [group 1]; 7 [0-55] vs 10 [0-80] [group 2]), when the endoscopist was able to see the imager view. In group 1, colonoscopy completion rates were also higher (100% [58] vs 89% [49]) and duration of looping was reduced (median 3 min [0-18.8] vs 5.4 min [0-44.5]) when the imager could be seen. Abdominal hand pressure was more effective when the endoscopist and endoscopy assistant could see the imager view. INTERPRETATION: MEI significantly improves performance of colonoscopy, particularly when used by trainees, or by experts in technically difficult cases; loops were straightened or controlled effectively, resulting in quick intubation times and high completion rates.