Central Vestibular Dysfunction in Head Injury.

OBJECTIVES: This study aims to provide an overview of dizziness post head injury in those with prominent features for central vestibular dysfunction (CVD) in comparison to those with a post-traumatic peripheral vestibular etiology. STUDY DESIGN: Retrospective. SETTING: University Health Network (UHN) Workplace Safety and Insurance Board (WSIB) database from 1988 to 2018 were evaluated for post-traumatic dizziness. METHODS: The UHN WSIB neurotology database (n = 4291) between 1998 and 2018 was retrospectively studied for head-injured workers presenting with features for CVD associated with trauma. All patients had a detailed neurotological history and examination, audiovestibular testing that included video nystagmography (VNG) and cervical vestibular-evoked myogenic potentials (cVEMPs). Imaging studies including routine brain and high-resolution temporal bone computed tomography (CT) scans and/or intracranial magnetic resonance imaging (MRI) were available for the majority of injured workers. RESULTS: Among 4291 head-injured workers with dizziness, 23 were diagnosed with features/findings denoting CVD. Complaints of imbalance were significantly more common in those with CVD compared to vertigo and headache in those with peripheral vestibular dysfunction. Atypical positional nystagmus, oculomotor abnormalities and facial paralysis were more common in those with CVD. CONCLUSION: Symptomatic post-traumatic central vestibular injury is uncommon. It occurred primarily following high-impact trauma and was reflective for a more severe head injury where shearing effects on the brain often resulted in diffuse axonal injury. Complaints of persistent imbalance and ataxia were more common than complaints of vertigo. Eye movement abnormalities were highly indicative for central nervous system injury even in those with minimal change on CT/MRI.

Effectiveness of vestibular rehabilitation therapy in patients with idiopathic Cerebellar Ataxia with Bilateral Vestibulopathy (iCABV).

OBJECTIVE: To evaluate the benefit of vestibular rehabilitation therapy (VRT) in the management of patients with idiopathic cerebellar ataxia with bilateral vestibulopathy (iCABV). BACKGROUND: iCABV is a hindbrain degenerative disorder with impairment of both central and peripheral vestibular pathways. There is combined failure of four compensatory eye movement systems including the vestibulo-ocular reflex (VOR), optokinetic reflex, smooth pursuit and the visually enhanced vestibulo-ocular reflex (VVOR). Phenotypic presentation includes postural and gait instability, oscillopsia and dizziness with active head movement. The benefit of VRT in iCABV patients has not been established. METHODS: A retrospective review was performed on a cohort of twelve patients diagnosed with iCABV in a multidisciplinary neuro-otology clinic. All participated in VRT and completed their suggested course of VRT. The following clinical measures were assessed before starting and after finishing VRT: 1) Dizziness Handicap Inventory (DHI), 2) Activities-Specific Balance Confidence (ABC) Scale, 3) Catastrophization scale, 4) Positive Affective Negative Affective Score (PANAS), 5) Dynamic Gait Index (DGI) and 6) Modified Clinical Test of Sensory Interaction in Balance (mCTSIB). The number of falls historically was recorded in addition to gait speed (ft./sec). RESULTS: Following VRT, patients were found to have improved balance on mCTSIB (condition 4 : 7 vs 18 seconds, P = 0.04) and a better postural stability with a reduced number of falls (p = 0.01). No statistically significant improvement was seen in the DHI, ABC, Catastrophization scale, DGI, PANAS and gait speed (p > 0.05). CONCLUSIONS: iCABV patients who underwent VRT were found to have a better postural stability and reduced risk of falls. VRT was not found to significantly improve patients' overall subjective perception of their symptoms or their psychological status.

Exploring Farmers' Reasons for Antibiotic Use and Misuse in Pig Farms in Brazil.

Stressful management that makes farmed pigs susceptible to infections is associated with high antibiotic use (AMU) and resistance (AMR). Pig farmers are key stakeholders to support the international agenda pushing AMU restrictions. We interviewed 58 pig farmers on AMU/AMR, biosecurity, veterinary assistance, disease prevention and treatment, aiming to understand practices and attitudes towards the AMU/AMR problem. Farmers described a reliance on antibiotics to prevent and treat disease while neglecting biosecurity measures. We identified inappropriate AMU practices (high use of broad-spectrum antibiotics, incorrect dosage or treatment length) and unrestricted access to antibiotics, which encouraged imprudent AMU. Nevertheless, most farmers considered this AMU legitimate to guarantee herd productivity and showed unpreparedness and resistance to changing AMU practices, perceiving limitations (economic, sanitary and inspection) more easily than alternatives to reduce AMU. Agro-industries and foreign markets were mentioned, and internal consumers dismissed as potential motivators for behavioral changes. Importantly, farmers' economic, technical and social factors may limit their autonomy to change practices. We conclude that the observed distancing of pig farmers from the AMU/AMR problem limits the efficiency of policies aiming for a prudent AMU. Our study indicates a need for education, training and behavior change nudging that should include other stakeholders beyond farmers.

The influence of light-curing time on fluoride release, surface topography, and bacterial adhesion in resin-modified glass ionomer cements: AFM and SEM in vitro study.

Reinforced glass ionomer cements have been widely used in pediatric dentistry to prevent dental caries. However, the influence of biomaterial light-curing and its anti-cariogenic effects remain unclear. This study evaluates the influence of the light-curing time on fluoride release, surface topography, and bacterial adhesion in two types of resin-modified glass ionomer cements (RMGICs). One hundred disks were made, and samples were divided into two groups (n = 50 per group), according to each dental material (Vitremer™ and Ketac™ N100), and also divided into different light-cured times (10, 20, 30, 40, and 60 s). They were placed in phosphate-buffered saline solution (PBS) to measure the fluoride release. Subsequently, an independent sample of RMGICs per group was examined using atomic force microscopy (AFM). Four disks per group were incubated in a brain heart infusion (BHI) medium that was inoculated with Streptococcus mutans GS5 to evaluate the bacterial adhesion by 3-4, [5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide cell viability assay (MTT assay). The fluoride release was related to the light-curing time and gradually decreased as the light-curing time increased in both materials. Surface topography in Vitremer™ presents more irregular surfaces than Ketac™ N100. For S. mutans adhesion, the smallest number of cells per milliliter (cell/ml) was found at 40 s for Vitremer™ and at 30 s for Ketac™ N100. Thus, the shorter light-curing times allowed for major fluoride release in both materials. However, the RMGICs showed different patterns of bacterial adhesion according to the brand and light-curing time.

Lameness on Brazilian pasture based dairies - Part 2: Conversations with farmers and dairy consultants.

A farmer or a dairy consultant's ability to identify and properly treat lame dairy cows is key to managing lameness on farms. However, this ability is dependent on their knowledge and perceptions regarding lameness. To date these topics are poorly understood in all dairy systems. To our knowledge, this is the first study that uses a qualitative approach to describe the perception of lameness in Brazilian pasture-based dairy farms. The aim of this study was firstly, to contextualize farmers and dairy consultants' culture and knowledge on the topic of lameness and, secondly, to understand how these factors may influence lameness management on the farms. In-depth face-to-face semi-structured interviews were done with participating farm owners (n = 21) and dairy consultants (n = 13). Thematic analyses of the interview content provided evidence that the dairy community's overarching culture around lameness acts as a barrier preventing positive actions targeting lameness control and prevention. The emerging themes identified indicate that lameness is a vague, ill-defined concept among both farmers and dairy consultants working in this region. There was a shared belief that pasture-based systems have a low risk for lameness. Furthermore, the prevailing culture for tackling lameness was reactive, particularly in the case of lame cows affected by physical trauma or environmental factors. Treatment was frequently delayed and the misuse of antibiotics was evident. Described community culture was rationalised via the cognitive dissonance and health belief models. We suggest that increased dialogue, including educational efforts within the community, may lead to increased sensitivity of risk perception of lameness within the community and in turn trigger appropriate diagnosis and treatment of lame cows.

A comparison of the estrous behavior of Holstein-Friesian cows when cubicle-housed and at pasture.

This study compared estrous behavior of dairy cows kept in cubicle housing and fed a total mixed ration diet (HOUSED treatment) with that of cows kept at pasture with concentrate supplementation (PASTURE treatment). Behavior was compared both in the 48 h around standing estrus and during the standing estrus period. The 23 spring-calving Holstein-Friesians in each treatment were observed directly three times per day for nine weeks. The occurrence of nine selected behaviors associated with estrus was recorded during 20 min observation sessions. Twelve standing estrus events from each treatment were selected for analysis of the frequency of these nine behaviours over the 48 h around standing estrus. Milk progesterone profiles were used to confirm the dates of standing estrus events. Attempting to mount other cows, sniffing the anogenital region of other cows, resting the chin on other cows, receiving chin rests and head-to-head butts all showed significant changes in frequency in the 48 h around standing estrus in both treatments, reaching a peak during standing estrus (P ≤ 0.05). Mounting other cows increased significantly in the PASTURE treatment around standing estrus (P < 0.001), but not in the HOUSED treatment. The frequency of ano-genital sniffs received by the animals in the PASTURE treatment also increased significantly around standing estrus (P < 0.01) but not in the HOUSED treatment. When the animals were in standing estrus there was a significantly higher frequency of standing to be mounted in PASTURE than in HOUSED cows (median (q1, q3) PASTURE = 2.5 (1.0, 3.0), HOUSED = 0.0 (0.0, 1.0)) (P < 0.01), but no difference in the frequency of the other eight sexual behaviors recorded. HOUSED cows did not exhibit the same increase in mounting during the standing estrus period as PASTURE cows and received fewer mounts in observation sessions during standing estrus. These results have implications for the use of estrus detection systems that rely solely on mounting behavior in cubicle-housed dairy cows.

Estrus detection and estrus characteristics in housed and pastured Holstein-Friesian cows.

This study compared three methods of estrus detection and characteristics of standing estrus between dairy cows kept in cubicle housing and fed a total mixed ration diet (HOUSED treatment) and those kept at pasture with concentrate ration supplementation (PASTURE treatment). The 23 spring-calved Holstein-Friesians in each treatment were monitored by three estrus detection methods simultaneously-visual observations, tail paint and radiotelemetry (HeatWatch)-for 9 wk. Milk progesterone profiles were used to determine the dates of true standing estrus events. All three detection methods had a higher efficiency of estrus detection in the PASTURE treatment than in the HOUSED treatment (P < 0.001), but there was no difference in the accuracy of estrus detection between the two treatments (P > 0.05). Within each treatment there was no difference between the efficiency and accuracy of the three methods (P > 0.05). HeatWatch was as efficient as visual observations at detecting standing estrus events. However, during visual observation sessions all occasions when animals were observed standing to be mounted were not recorded by HeatWatch. More cows expressed sub-estrus events and fewer expressed standing estrus events in the HOUSED than in the PASTURE treatment (P < 0.05). The interval between parturition and the second standing estrus was longer in the HOUSED treatment than in the PASTURE treatment (P < 0.05). All three detection methods were much less effective in the HOUSED than in the PASTURE treatment. This is because all of the detection methods tested relied solely on standing to be mounted and this was reduced in the HOUSED cows. Alternative approaches to estrus detection are needed for cows kept indoors on concrete.