Combined Open Surgical and Endovascular Management of a Giant Posterior Cerebral Artery Aneurysm: 2-Dimensional Operative Video.

A 17-year-old female patient presented with worsening intractable headaches which were initially diagnosed as migraine headaches. The patient's headaches were refractory to medical management and continued to worsen in both severity and frequency. Computed tomography angiography and digital subtraction angiography demonstrated a giant posterior cerebral artery aneurysm with contributions from the internal carotid artery through the posterior communicating artery. During the surgical planning period, the patient continued to have worsening headaches, intractable nausea, vomiting, left upper extremity weakness, and associated visual obfuscations. Repeated angiography revealed spontaneous thrombosis of the posterior communicating artery contribution with additional sudden onset hemianopsia on balloon test occlusion of the posterior cerebral artery, prompting urgent surgical intervention. A right subtemporal approach was used for a superficial temporal artery to posterior cerebral artery bypass, followed by coil occlusion of the aneurysm inlet at the posterior cerebral artery on postoperative day 1. The patient consented to the procedure. Postoperative angiography demonstrated successful superficial temporal artery to posterior cerebral artery anastomosis with occluded posterior cerebral artery after coiling. At 1-year follow-up, the patient remained neurologically intact with a patent bypass and regression of the trapped aneurysm. We present this case to demonstrate the successful management of a complex posterior cerebral artery aneurysm with both surgical bypass and endovascular parent artery coil occlusion.1-6.

Microsurgical Management of Internal Carotid Artery Bifurcation Aneurysm After Failure of Endovascular Coiling and Flow Diversion: 2-Dimensional Operative Video.

We describe the case of a 51-year-old woman who underwent craniotomy and surgical clipping of a large internal carotid bifurcation aneurysm that was refractory to treatment with 2 rounds of endovascular coiling and internal carotid artery (ICA) to middle cerebral artery pipeline placement. The patient initially presented in 2004 with a 3-week history of sudden-onset headache with associated nausea. Computed tomography and lumbar puncture on presentation in 2004 were negative for subarachnoid hemorrhage. Digital subtraction angiography, however, demonstrated a large left ICA bifurcation aneurysm. The decision was made to proceed with endovascular coiling of the aneurysm. Six-month and 1-year follow-up imaging showed incomplete resolution of the aneurysm, and retreatment coiling was completed in 2005. After recoiling in 2005, the patient was lost to follow-up. During this period, she underwent pipeline placement from the ICA to the middle cerebral artery across the A1 segment at a different institution. Two years after flow diversion, the patient was referred back to our institution with further worsening of the aneurysm. Our surgical team opted for craniotomy and surgical clipping given the limited management options that this extremely complex case now presented. The patient consented to the procedure. Postoperative imaging demonstrated marked improvement in aneurysm severity. Although the current neurosurgical trend favors endovascular treatment over craniotomy, this case shows the vital importance of craniotomy and aneurysm clipping in the treatment of select patients. We also provide high-quality operative video of aneurysm clipping.1-7.

Technical Nuances of Anterior Column Construction for the Treatment of Osteomyelitis-Induced Cervical Kyphoscoliotic Deformity: An Operative Video Illustration.

Pyogenic vertebral osteomyelitis is a bacterial infection of the vertebral body often caused by hematogenous spread from a distant site with 3%-11% of cases affecting the cervical spine.1,2 Patients at risk for osteomyelitis are intravenous drug users, patients with diabetes, patients in dialysis, and males older than 50 years of age. In severe cases where infection causes osseous destruction of the vertebral column lending to a loss of normal sagittal and coronal plane alignment, neurologic impairment, or spinal instability, surgical correction may be required.3 A 38-year-old woman with a medical history of intravenous drug use presented with a 1-week history of progressive paresthesias, subjective loss of lower extremity sensation, and severe right upper extremity weakness. Neurologic examination was notable for significant weakness in the right deltoids, biceps, and triceps. Magnetic resonance imaging cervical spine revealed significant kyphosis at C4-C5 secondary to destruction of the C4 and C5 vertebral bodies and anterior and posterior epidural fluid collection at C2-C3 and C7-T1, respectively. Surgery was proposed through a combined anteroposterior approach with head and neck surgeons. Anteriorly, she underwent a C2-C3 and C6-C7 ACDF and C4, C5 corpectomies (Video 1). The patient was then transitioned to the prone position and underwent C3-T3 posterior fusion with instrumentation and C3-C7 laminectomies. Correction of sagittal imbalance should restore normal physiologic spinal alignment while promoting a successful fusion.4 The patient was discharged to acute rehabilitation after an uneventful postoperative course. At 5-month follow-up, she has regained antigravity strength in right upper extremity and reports significant reduction in neck pain.

Location-specific technical nuances of spinal meningioma resection: an operative video case series.

The objective of this video was to demonstrate technical nuances of intradural spinal meningioma (ISM) resection through a high-quality surgical video. The authors describe 3 patients with ISM in the cervicomedullary, cervical, and thoracic regions. Patients underwent surgery in the prone position with laminectomy, dorsal durotomy, and then resection of the mass. Case 1 required a suboccipital craniectomy and dissection of the tumor away from the vertebral artery. In case 2, special emphasis is placed on sectioning the dentate ligament with cord rotation. Case 3 highlights meticulous circumferential arachnoid release and the use of ultrasound. Patients saw significant neurological improvement postoperatively. This video provides clear instruction on location-specific technical nuances of ISM removal.

Surgical strategies for the treatment of deformity-associated cervical spondylotic stretch myelopathy: a case series with technically nuanced illustrative operative videos.

OBJECTIVE: The aim of this study was to elucidate the vital role of anterior-only osteotomies for rigid cervical kyphosis causing stretch myelopathy by using illustrative cases and high-definition intraoperative videos. METHODS: The authors describe 4 select patients who underwent anterior-only osteotomies within a 2-year time frame and demonstrate the nuances of each case with unique operative videos. RESULTS: Outcomes for each of the cases demonstrated marked improvement in cervical spine alignment relative to preoperative conditions. Postoperative CT scans and upright radiographs for case 1 at 8 months demonstrated complete reduction of the kyphotic deformity and restoration of the C2 slope. In case 2, the 2-year postoperative radiographs showed significant realignment of the cervical spine, and the patient made significant neurological improvement since the operation, specifically in hand dexterity, balance, neck pain, and the ability to comfortably achieve and maintain a horizontal gaze. For case 3, postoperative upright radiographs revealed marked improvement in the patient's cervical sagittal alignment. The 4-month follow-up was also notable for substantial improvement in postural neck pain, bilateral upper extremity strength, and continued improvements in dexterity. Case 4 also demonstrated an excellent outcome with unkinking of the patient's spinal cord and correction of her sagittal plane deformity, as shown on her 5-month postoperative upright radiographs. CONCLUSIONS: Deformity-associated cervical spondylotic stretch myelopathy often leads to devastating neurological decline and can significantly decrease quality of life. Carefully selected cases of circumferentially rigid cervical kyphosis can be successfully corrected with anterior-only osteotomies followed by posterior fixation while avoiding back-front-back operations.

Nursing interventions in palliative care in the intensive care unit: A systematic review.

CONTEXT: Patients in palliative care are found in different places where care is provided, including the intensive care environment with important role of the nursing staff. OBJECTIVE: The aim of this systematic review was to answer the following question: which nursing interventions are aimed to the palliative care patients who are in the intensive care unit (ICU). DATA SOURCES: US National Library of Medicine (PUBMED), Virtual Health Library (BVS), SciELO, The Cochrane Library (Cochrane) and Lilacs databases were used. DATA EXTRACTION: After applying inclusion and exclusion criteria in accordance with the PRISMA method, a total of 36 entries published between 2010 and 2020 were used. DATA ANALYSIS: The records extracted were analyzed from a qualitative approach, so no statistical analysis was carried out. RESULTS: The findings demonstrated that the interventions that focus on promoting the patient's autonomy and respect their needs on ICU involves effective communication, promoting shared decision with patient and family, individualize care for each patient including the family on the daily care and decisions, maintaining basic nursing care as hygiene and comfort and encouraging self-care, as well as the involvement of nursing palliative care specialists the care is important. Other interventions included promoting a continuing education program for the nursing staff and other professionals involved in caring for patients in palliative care at ICU. CONCLUSION: This review highlighted the need for specific nursing interventions aimed at palliative care patients at ICU to promote patient autonomy and the focus on patient needs, always sharing decisions with the patient and family. However, it showed that there is a need for the continuous training of the nursing staff because factors such as the nurses' lack of technical-scientific knowledge and, concomitantly, the absence of a standardized and specific intervention model linked to a bureaucratic system, make it difficult to carry out a specialized care for this type of patient.

Respiratory virus infections in decedents in a large, urban medical examiner's office.

OBJECTIVE: Most respiratory virus surveillance relies on medically attended respiratory illness, but an understanding of the true patterns of infection independent of care-seeking behaviour would enhance clinical and public health responses to respiratory virus outbreaks. We evaluated the potential of decedent surveillance by estimating the burden of respiratory virus infection in decedents in a large, urban medical examiner's office. STUDY DESIGN: Observational. METHODS: In 2020-2022, we tested nasopharyngeal swabs from 4121 decedents in Detroit, Michigan for 15 respiratory viruses, including SARS-CoV-2, respiratory syncytial virus, and influenza virus A and B. We analysed infection prevalence over time and by age, sex, race/ethnicity, and manner of death. RESULTS: Of 4113 valid tests, 30.2% were positive for at least one virus, and 6.1% were positive for multiple viruses. All viruses were detected except for influenza A/H1N1 and influenza B. The most prevalent viruses were SARS-CoV-2 (15.7%), rhinovirus (11.2%), and adenovirus (4.9%), which were detected in all months. Most viruses exhibited decreasing prevalence with age, higher prevalence among Black and Hispanic than among White decedents and lower prevalence among deaths from natural causes; SARS-CoV-2 was a notable exception to the patterns by age and manner of death, instead reflecting community trends in catchment counties. CONCLUSIONS: There was high prevalence and diversity of respiratory viruses in decedents entering a large, urban medical examiner's office. Decedent surveillance could offer a clearer picture of the true underlying burden of infection, motivating public health priorities for intervention and vaccine development, and augmenting data for real-time response to respiratory virus outbreaks.

Nursing interventions in palliative care in the intensive care unit: A systematic review / Intervenciones de enfermería en cuidados paliativos en la unidad de cuidados

Context: Patients in palliative care are found in different places where care is provided, including the intensive care environment with important role of the nursing staff. Objective: The aim of this systematic review was to answer the following question: which nursing interventions are aimed to the palliative care patients who are in the intensive care unit (ICU). Data sources: US National Library of Medicine (PUBMED), Virtual Health Library (BVS), SciELO, The Cochrane Library (Cochrane) and Lilacs databases were used. Data extraction: After applying inclusion and exclusion criteria in accordance with the PRISMA method, a total of 36 entries published between 2010 and 2020 were used. Data analysis: The records extracted were analyzed from a qualitative approach, so no statistical analysis was carried out. Results: The findings demonstrated that the interventions that focus on promoting the patient's autonomy and respect their needs on ICU involves effective communication, promoting shared decision with patient and family, individualize care for each patient including the family on the daily care and decisions, maintaining basic nursing care as hygiene and comfort and encouraging self-care, as well as the involvement of nursing palliative care specialists the care is important. Other interventions included promoting a continuing education program for the nursing staff and other professionals involved in caring for patients in palliative care at ICU...(AU)

Contexto: Los pacientes en cuidados paliativos se encuentran en varios lugares, incluso en cuidados intensivos, y las enfermeras tienen un papel importante en el cuidado de este tipo de pacientes. Objetivo: Esta revisión sistemática buscó responder a la siguiente pregunta: ¿Cuáles son las intervenciones de enfermería dirigidas a los pacientes en cuidados paliativos en la unidad de cuidados intensivos (UCI)?. Fuentes de datos: Biblioteca Nacional de Medicina de EE. UU. (PUBMED), Biblioteca Virtual de Salud (BVS), SciELO, The Cochrane Library y Lilacs. Extracción de datos: Aplicación de los criterios de inclusión y exclusión según el método PRISMA, totalizando 36 estudios publicados entre 2010 y 2020. Análisis de datos: Los datos extraídos se analizaron con un enfoque cualitativo, por lo que no se realizó ningún análisis estadístico. Resultados: Las intervenciones que promueven la autonomía del paciente y respetan sus necesidades en la UCI involucran: comunicación efectiva, decisión compartida de individualizar el cuidado e incluir a la familia en el cuidado. Se debe mantener la higiene, el confort y la promoción del autocuidado, involucrando equipos de especialistas en cuidados paliativos, impulsando programas de educación continua para enfermeras de cuidados intensivos y otros profesionales implicados. Conclusión: Son necesarias intervenciones enfermeras dirigidas a pacientes con cuidados paliativos en la UC para promover la autonomía y satisfacer las necesidades del paciente, compartiendo siempre las decisiones con el paciente y su familia, y asimismo es necesaria la formación continua de las enfermeras en factores como el desconocimiento técnico-científico de este colectivo y, concomitantemente, la ausencia de un modelo estandarizado de intervención vinculado a un sistema burocrático. Todo ello dificulta la atención especializada a este tipo de pacientes.(AU)

Behavioral and physiological responses to an inspired-air supplemental cooling system for dairy cows in free-stall housing.

During heat stress, dairy cows spend less time lying down to dissipate heat. Heat stress abatement strategies generally target cows outside of their resting areas. However, cooling cows while in their stalls could help alleviate heat stress without compromising lying behavior. The objective of this study was to assess the effects of an inspired-air supplemental cooling system (SCS) on respiration rate, rectal temperatures, lying behavior, rumination time, and milk production (energy-corrected milk, ECM) of lactating dairy cows. A free-stall pen was retrofitted with custom stall partitions to deliver cooled air and mist. The pen, including the stall platform, was divided into two separate sides. Twenty-eight lactating Holstein cows were randomly sorted into two groups, each housed on one side of the experimental pen. Cows experienced four treatments (control, CTRL; cooled air, AIR; mist, MIST; cooled air and mist, AIR + MIST) in a four-treatment, four-period, two-sequence crossover design, with each period lasting seven days. Cooled air was provided continuously, and mist was cycled 3 min on, 12 min off from 0900 to 2100 h. Respiration rates were observed hourly between 0900 and 1500 h, and only measurements recorded while cows were lying down were used in the analysis. Rectal temperatures of 16 focal cows were recorded at 1545 h once per day. Lying behavior and rumination were recorded continuously, and milk yields recorded twice daily were used to calculate ECM. Throughout the experimental period, the average temperature-humidity index was 66.4 ± 6.07. During the MIST treatment, the respiration rate was lower than the CTRL (45.7 vs 49.0 ± 1.92 breaths/min) and AIR (45.7 vs 48.7 ± 1.92 breaths/min). CTRL and AIR did not differ (48.7 vs 49.0 ± 1.92 breaths/min), and MIST and AIR + MIST (45.7 vs 47.1 ± 1.92 breaths/min) did not differ. All other variables were not significantly different between treatments. In conclusion, the SCS appeared to be tolerated by cows and shows the potential to assist in alleviating heat stress. The cooling capacity needs to be evaluated under more extreme environmental conditions causing heat stress than those experienced during this study. Further testing is required to determine the cooled air temperature specifications and mist delivery frequency.

Transillumination of an Anterior Fontanelle Dermoid Cyst.

Dermoid cysts are slowly growing benign lesions of ectodermal tissue that often occur in the anterior fontanelle. Clinicians often rely on a negative transillumination test to begin the process of correctly diagnosing a dermoid cyst. However, here the authors present a case of a 7-month-old girl who presents with a transilluminating dermoid cyst.

Surgical instruments and catheter damage during ventriculoperitoneal shunt assembly.

OBJECTIVE: Current surgical techniques use common surgical instruments for sterile shunt assembly. This study investigated the impact of using these techniques and surgical instruments on the mechanical integrity of the ventriculoperitoneal shunt system, specifically shunt catheters. METHODS: The authors conducted failure testing on 85 rifampin-coated catheters and 85 barium-impregnated catheters using 5 different surgical instruments and 2 different surgical techniques. In technique A, the distal end of the catheter was pushed onto the shunt valve inlet connector with the surgical instrument. In technique B, the catheter was pulled over the inlet connector. One hundred sixty catheters underwent 10-repetition-maximum testing, in which the catheter either failed before completion of 10 consecutive assembly/disassembly repetitions or the catheter completed 10 consecutive repetitions. The authors also conducted 100-repetition-maximum tests on 5 barium-impregnated and 5 rifampin-coated catheters using technique A. RESULTS: Catheter failure rates were significantly different among the different instruments used in assembly (p ≤ 0.001). Post hoc analysis showed that using mosquito forceps with shods resulted in a significantly lower catheter failure rate than the other instruments (p < 0.0005). The catheter failure rate of technique A was significantly lower than that of technique B (5% vs 81%, p < 0.001). There was no statistical difference between the failure rates of the barium and rifampin catheters (42% vs 44%, p = 0.9), but the barium catheters outperformed the rifampin catheters in the 100-repetition-maximum trials (p = 0.02). Instrument type (p = 0.0232) and catheter type (p = 0.0096) were both significant factors in determining the number of assembly/disassembly repetitions needed to cause catheter failure. It took an average of 2.79 repetitions of assembly/disassembly to cause catheter failure. DeBakey forceps had significantly lower mean repetitions to failure (mean 1.38) than the Gerald forceps without teeth (mean 2.73, p = 0.05) and bayonet (mean 3.25, p = 0.02). CONCLUSIONS: This study was the first of its kind to analyze how physical manipulation affects the mechanical integrity of ventriculoperitoneal shunt components. The authors demonstrated a significantly lower shunt catheter failure rate when mosquito forceps with shods and technique A were used in assembly. Moreover, the authors established that use of DeBakey forceps resulted in failure with fewer assembly/disassembly repetitions than use of the Gerald and bayonet forceps, suggesting that DeBakey forceps are the most damaging instrument.

Truncation of MAT1-2-7 Deregulates Developmental Pathways Associated with Sexual Reproduction in Huntiella omanensis.

The MAT1-1-1 and MAT1-2-1 genes are thought to be the master regulators of sexual development in most ascomycete fungi, and they are often essential for this process. In contrast, it has been suggested that the secondary mating-type genes act to calibrate the sexual cycle and can be dispensable. Recent functional characterization of genes such as Aspergillus fumigatus MAT1-2-4, Huntiella omanensis MAT1-2-7, and Botrytis cinerea MAT1-1-5 has, however, shown that these secondary genes may play more central roles in the sexual pathway and are essential for the production of mature fruiting structures. We used a comparative transcriptome sequencing (RNA-seq) experiment to show that the truncation of MAT1-2-7 in the wood inhabiting H. omanensis residing in the Ceratocystidaceae is associated with the differential expression of approximately 25% of all the genes present in the genome, including the transcriptional regulators ste12, wc-2, sub1, VeA, HMG8, and pro1. This suggests that MAT1-2-7 may act as a transcription factor and that ΔMAT1-2-7 mutant sterility is the result of layered deregulation of a variety of signaling and developmental pathways. This study is one of only a few that details the functional characterization of a secondary MAT gene in a nonmodel species. Given that this gene is present in other Ceratocystidaceae species and that there are diverse secondary MAT genes present throughout the Pezizomycotina, further investigation into this gene and others like it will provide a clearer understanding of sexual development in these eukaryotes. IMPORTANCE Secondary mating-type genes are being described almost as quickly as new fungal genomes are being sequenced. Understanding the functions of these genes has lagged behind their description, in part due to limited taxonomic distribution, lack of conserved functional domains, and difficulties with regard to genetic manipulation protocols. This study aimed to address this by investigating a novel mating-type gene, MAT1-2-7, for which two independent mutant strains were generated in a previous study. We characterized the molecular response to the truncation of this gene in a nonmodel, wood-infecting fungus and showed that it resulted in widespread differential expression throughout the transcriptome of this fungus. This suggests that secondary MAT genes may play a more important role than previously thought. This study also emphasizes the need for further research into the life cycles of nonmodel fungi, which often exhibit unique features that are very different from the systems understood from model species.

One key to fit all locks? Routine internal drainage to minimize seromas during thigh lift surgeries.

INTRODUCTION: Obesity is a worldwide epidemic. Complication rates after body contouring surgeries in massive weight loss patients were quite high, with seroma development being the second most common complication, reported rates averaging 15%-40%, Methods described to reduce the annoying high rate of seroma did not have a statistically significant difference in reducing seromas. METHODS: Our aim was to find a universal solution that could be used with any body-contouring surgery to manage seromas. We tried this novel technique initially on thigh lifts. Instead of wading in the jungle of methods aiming at preventing seromas, we contemplated a drainage channel that would continuously drain any fluid accumulation. The idea was borrowed from the hypothesis of Thompson on lymphoedema management. By excising an area of deep fascia overlying the Vastus Medialis muscle, the muscle would be directly exposed to any seroma fluid and would imbibe it as blotting paper. Furthermore, this technique would open new drainage channels between the superficial and deep lymphatics. This technique was tried in 20 patients, with the excision of deep fascia carried only in one limb. The other limb was left as a control. Rates of seroma formation were noted and duration before it dried up. FINDINGS: This technique significantly reduced the incidence of detected seromas and the amount of seroma fluid. CONCLUSION: This technique reduced the incidence of seroma formation, and is recommended for routine use during all thigh lift surgeries.

Development of a novel stall design for dairy cattle: Part II. The effect of minimal stall partitioning on lying behavior, rumination, stall cleanliness, and preference.

Free-stalls for dairy cows promote cleanliness, provide cows with a defined space to lie down, and decrease labor and bedding required for maintenance. However, current stall features can restrict behavior and reduce stall use. The objective of this study was to assess the short-term effect of a novel free-stall design (flexible single-bar partition, no neck rail, increased slope) on stall cleanliness and the lying behavior, rumination, milk production, and preferences of dairy cows in comparison to standard free-stalls (metal loop partitions, neck rail). In the first experiment, 60 Holstein cows were randomly divided into two groups and switched between standard and novel stalls in a replicated crossover design with four 7-day periods. Lying behavior and rumination were recorded continuously. Milk yields were recorded 2x/day, and stall cleanliness scores were collected on the last four days of weeks 3 and 4. The second experiment was a 6-day preference test where 14 cows from experiment 1 were given free access to 16 standard and 16 novel stalls. Lying behavior was recorded continuously. On day 6, standing, perching, and intention, lying, and rising movements were recorded. In experiment 1, cows spent 12 min less time lying down (14.1 vs 14.3 ± 0.48 h/d), had one fewer lying bouts (8.8 vs 9.8 ± 0.23 bouts/d), and had longer lying bouts by 6 min (1.4 vs 1.5 ± 0.05 h/bout) in novel stalls. Rumination time (547.3 vs 548.9 ± 4.66 min/d) and milk yield (35.0 vs 35.2 ± 0.51 kg/d) did not differ between stall types. However, novel stalls were more than twice as soiled as standard stalls (32.8 vs 14.2 ± 1.38% of rear half soiled). In experiment 2, the cows most recently housed in the novel stalls showed a clear preference for lying down in those stalls, whereas cows most recently housed in standard stalls showed no preference. Intention and lying down movements were longer in standard stalls when other cows were present in diagonally opposite stalls, but were similar between stall types when not occupied. All cows preferred standing in novel stalls. Novel stalls may have improved stall use compared to standard free-stalls, and the design requires further development to address cleanliness concerns. Future work is required to provide comfortable stalls without sacrificing cleanliness.

Development of a novel stall design for dairy cattle: Part I. The effect of an increased slope on lying behavior, rumination, cleanliness, and preference.

The longitudinal slope of a stall is important for positioning cows in the stall and maintaining cleanliness of the stall surface. The objectives of this study were to determine the short-term effect of increasing free-stall slope from 4.5% to 9.3% on dairy cow lying behavior, rumination, milk production, cleanliness, and preference. In experiment 1, 60 multiparous Holstein cows were divided randomly into two groups and exposed to a 4.5% stall slope (standard in the research facility) and a 9.3% stall slope in a replicated crossover design with four 7-day periods. Each group of cows were housed in a pen with 30 free-stalls and switched between treatments weekly. Lying behavior and rumination were recorded continuously, milk yields were recorded twice per day, and cleanliness scores were collected on the last day of each week. Experiment 2 consisted of an 8-day preference test conducted with 14 cows from experiment 1 in an experimental pen with 32 stalls (16 stalls with a 4.5% slope and 16 stalls with a 9.3% slope). Continuous video monitoring was used to record time spent lying, standing, and perching in each treatment during the last 5 days, and lying time was used to assess preference. In experiment 1, cows spent 12 min/day less time lying down (12.8 vs 12.6 ± 0.28 h/d) and had 0.6 more bouts/day (9.5 vs 10.1 ± 0.38 no./d) with a shorter duration by 6 min/day (1.4 vs 1.3 ± 0.03 h/bout) in stalls with a 9.3% slope. Rumination was 5.5 min less per day in stalls with a 9.3% slope (578.4 vs 572.9 ± 16.56 min/d) and milk yield did not differ between treatments (33.6 vs 33.4 ± 0.78 kg/d). Stall slope did not affect cow cleanliness (1.6 vs 1.6 ± 0.05 points on a 1-5 scale). In experiment 2, cows showed no clear preference for lying, standing, or perching in either stall slope (4.5% and 9.3%) when given a choice. These results indicate that increasing stall slope from 4.5% to 9.3% marginally altered lying behavior, but did not interfere with stall use or influence cow preferences.

The effect of statin therapy on disease-related outcomes in idiopathic pulmonary fibrosis: A systematic review and meta-analysis.

BACKGROUND: Idiopathic pulmonary fibrosis is a progressive disease and antifibrotic therapies do not reverse existing fibrosis. There has been emerging evidence of potential role for statins in idiopathic pulmonary fibrosis. The aim of this review is to synthesise the evidence on the efficacy of statins in idiopathic pulmonary fibrosis, focusing on associations with all-cause mortality, disease-specific mortality and change in pulmonary function. METHODS: Medline and Embase were reviewed to identify relevant publications. Studies were selected if they examined disease-related outcomes including mortality, pulmonary function and adverse events in people with idiopathic pulmonary fibrosis receiving statin therapy. RESULTS: Five studies with a total of 3407 people with IPF were selected and analysed. The overall risk of bias of five included studies was moderate to serious. In the fixed effect meta-analysis, statin use was associated with a reduction in mortality (RR 0.8; 95% CI 0.72-0.99). However, in the random effects model, there was no longer any significant association between statin use and all-cause mortality (RR 0.87; 95% CI 0.68-1.12). There was no statistically significant association between statin use and decline in FVC % predicted. CONCLUSION: There is currently insufficient evidence to conclude the effect of statin therapy on disease-related outcomes in idiopathic pulmonary fibrosis. Considering the limitations of available literature, we would recommend a prospective cohort study with capture of dosage and preparation of statin, statin adherence and use of concurrent antifibrotic treatment. PROSPERO REGISTRATION NUMBER: CRD42019122745.

Why is mock care not a good proxy for predicting hand contamination during patient care?

BACKGROUND: Healthcare worker (HCW) behaviours, such as the sequence of their contacts with surfaces and hand hygiene moments, are important for understanding disease transmission. AIM: To propose a method for recording sequences of HCW behaviours during mock vs actual procedures, and to evaluate differences for use in infection risk modelling and staff training. METHODS: Procedures for three types of care were observed under mock and actual settings: intravenous (IV) drip care, observational care and doctors' rounds on a respiratory ward in a university teaching hospital. Contacts and hand hygiene behaviours were recorded in real-time using either a handheld tablet or video cameras. FINDINGS: Actual patient care demonstrated 70% more surface contacts than mock care. It was also 2.4 min longer than mock care, but equal in terms of patient contacts. On average, doctors' rounds took 7.5 min (2.5 min for mock care), whilst auxiliary nurses took 4.9 min for observational care (2.4 min for mock care). Registered nurses took 3.2 min for mock IV care and 3.8 min for actual IV care; this translated into a 44% increase in contacts. In 51% of actual care episodes and 37% of mock care episodes, hand hygiene was performed before patient contact; in comparison, 15% of staff delivering actual care performed hand hygiene after patient contact on leaving the room vs 22% for mock care. The number of overall touches in the patient room was a modest predictor of hand hygiene. Using a model to predict hand contamination from surface contacts for Staphylococcus aureus, Escherichia coli and norovirus, mock care underestimated micro-organisms on hands by approximately 30%.

External mechanical work in the galloping racehorse.

Horse locomotion is remarkably economical. Here, we measure external mechanical work of the galloping horse and relate it to published measurements of metabolic cost. Seven Thoroughbred horses were galloped (ridden) over force plates, under a racing surface. Twenty-six full strides of force data were recorded and used to calculate the external mechanical work of galloping. The mean sum of decrements of mechanical energy was -876 J (±280 J) per stride and increments were 2163 J (±538 J) per stride as horses were accelerating. Combination with published values for internal work and metabolic costs for galloping yields an apparent muscular efficiency of 37-46% for galloping, which would be reduced by energy storage in leg tendons. Knowledge about external work of galloping provides further insight into the mechanics of galloping from both an evolutionary and performance standpoint.

Genera of phytopathogenic fungi: GOPHY 2.

This paper represents the second contribution in the Genera of Phytopathogenic Fungi (GOPHY) series. The series provides morphological descriptions and information regarding the pathology, distribution, hosts and disease symptoms for the treated genera. In addition, primary and secondary DNA barcodes for the currently accepted species are included. This second paper in the GOPHY series treats 20 genera of phytopathogenic fungi and their relatives including: Allantophomopsiella, Apoharknessia, Cylindrocladiella, Diaporthe, Dichotomophthora, Gaeumannomyces, Harknessia, Huntiella, Macgarvieomyces, Metulocladosporiella, Microdochium, Oculimacula, Paraphoma, Phaeoacremonium, Phyllosticta, Proxypiricularia, Pyricularia, Stenocarpella, Utrechtiana and Wojnowiciella. This study includes the new genus Pyriculariomyces, 20 new species, five new combinations, and six typifications for older names.