Tracheoesophageal Fistula With Esophageal Atresia: A Case Series.

Tracheoesophageal fistula (TEF) with or without esophageal atresia (EA) results from maldevelopment of the trachea and esophagus during maturation of the primitive foregut. EA/TEF commonly presents shortly after birth because of increased oral secretions and the inability to advance a nasogastric or orogastric tube to the proper depth. Given that prenatal diagnosis is uncommon and early intervention is important to reduce morbidity and mortality risk, early recognition and diagnosis are imperative. We present a case series of two neonates diagnosed with EA/TEF, type "C" and type "E," born at low-acuity centers, who required transport to a tertiary center for surgical support. The pathophysiology as well as types of TEFs, symptomology, stabilization goals, corrective treatment, and long-term implications will be examined. Finally, the educational needs of parents and caregivers will be discussed.

Short Communication: Association between neonatal calf diarrhea and lying behaviors.

The objective of this study was to determine the association of neonatal calf diarrhea (NCD) with step activity and lying behaviors in pre-weaned dairy calves. Calves were housed in individual hutches for the first 6 days of life, and then moved into a group pen. On the day of birth, calves (n = 30) were fitted with an accelerometer, and step activity and lying behaviors were recorded. Calves were assigned a fecal score (FS) twice daily using a 0 to 3 scale, and were diagnosed with NCD (n = 10) when the score was a 3. To ensure the only association noted was due to NCD, calves that had any other health complications were excluded from analyses (n = 1). Calves with NCD were pair matched by age, breed, and birthdate to a healthy calf. Day 0 was designated as the date of NCD diagnosis. Calves with NCD spent less time lying (P < 0.05) and displayed more lying bouts (P < 0.05) of a shorter duration (P < 0.01) than healthy calves. Specifically, calves with NCD displayed more lying bouts on days -7 (P < 0.05), -6 (P < 0.01), -5 (P < 0.01), -4 (P < 0.01), and -3 (P < 0.05). Similarly, lying bout duration was shorter for calves with NCD on days -6 (P < 0.05), -5 (P < 0.05), -4 (P < 0.01), and -3 (P < 0.01). Additional research is needed to examine if these tools can be used to identify diseased calves prospectively.

Dairy producers in the Southeast United States are concerned with cow care and welfare.

This research communication addresses the hypothesis that Southeast dairy producers' self-reported bulk tank somatic cell count (BTSCC) was associated with producers' response to three statements (1) 'a troublesome thing about mastitis is the worries it causes me,' (2) 'a troublesome thing about mastitis is that cows suffer,' and (3) 'my broad goals include taking good care of my cows and heifers.' Surveys were mailed to producers in Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, and Virginia (29% response rate, N = 596; final analysis N = 574), as part of a larger survey to assess Southeastern dairy producers' opinions related to BTSCC. Surveys contained 34 binomial (n = 9), Likert scale (n = 7), and descriptive (n = 18) statements targeted at producer self-assessment of herd records, management practices, and BTSCC. Statements 1 and 2 were assessed on a 5-point Likert scale from 'strongly disagree' to 'strongly agree.' Statement 3 was assessed on a 5-point Likert scale from 'very unimportant' to 'very important.' Reported mean BTSCC for all participants was 254 500 cells/ml. Separate univariable logistic regressions using generalized linear mixed models (SAS 9.4, Cary, NC, USA) with a random effect of farm, were performed to determine if BTSCC was associated with probability for a producer's response to statements. If BTSCC was significant, forward manual addition was performed until no additional variables were significant (P ≤ 0.05), but included BTSCC, regardless of significance. Bulk tank somatic cell count was associated with 'a troublesome thing about mastitis is the worries it causes me,' but not with Statements 2 or 3. This demonstrates that >75% of Southeastern dairy producers are concerned with animal care and cow suffering, regardless of BTSCC. Understanding Southeast producers' emphasis on cow care is necessary to create targeted management tools for herds with elevated BTSCC.

An Update on the Effect of Clinical Mastitis on the Welfare of Dairy Cows and Potential Therapies.

Despite the widespread implementation of mastitis control programs, mastitis is the most common and one of the costliest diseases in the dairy industry, with broad-ranging impacts and consequences. Recent technological advances have allowed researchers to assess the effects of mastitis on animal behavior and welfare, and the efficacy of mastitis treatments. Several nonsteroidal anti-inflammatory drugs are available as supportive therapies for clinical mastitis. This article focuses on recent advances in the assessment, therapy, and effects of mastitis on cow behavior and welfare.

Serum and Synovial Fluid Serum Amyloid A Response in Equine Models of Synovitis and Septic Arthritis.

OBJECTIVE: To investigate the serum and synovial fluid serum amyloid A (SAA) response in equine models of synovitis and septic arthritis and to compare handheld and validated immunoturbidometric assays for SAA quantification. STUDY DESIGN: Controlled, experimental study. ANIMALS: Healthy adult horses (n = 9). METHODS: Synovitis (n = 4) and septic arthritis (n = 5) were induced using lipopolysaccharide and Staphylococcus aureus, respectively, and serial serum and synovial fluid samples were collected. Serial synovial fluid cytology was performed for both models and synovial fluid from the septic arthritis model was submitted for bacterial culture. Serum and synovial fluid SAA were quantified by handheld test and immunoturbidometric assay. Cytologic and SAA data were compared within and between models (mixed model ANOVA) and results of SAA assays were compared using category-by-category analysis (weighted kappa coefficient). RESULTS: Synovial fluid total nucleated cell counts and total protein increased significantly following induction of both models. Serum and synovial fluid SAA remained normal in synovitis horses and increased significantly in septic arthritis horses. Serum SAA increased more rapidly than synovial fluid SAA. Agreement was 98% when SAA concentrations were low (<50 µg/mL) but the assays diverged when concentrations were greater than ∼100 µg/mL. Overall, there was good category-by-category agreement between SAA assays (weighted kappa = 0.824). CONCLUSION: Serum and synovial fluid SAA may be useful adjuncts in diagnosing septic arthritis in horses. SAA concentrations for the assays diverged and examination using a larger sample size is needed before direct numeric comparisons between the assays can be made.

Using cultural immersion as the platform for teaching Aboriginal and Torres Strait Islander health in an undergraduate medical curriculum.

INTRODUCTION: In 2011 Bond University was looking for innovative ways to meet the professional standards and guidelines in Aboriginal and Torres Strait Islander health in its Bachelor of Medicine, Bachelor of Surgery (MBBS) curriculum. In 2012 Bond piloted a compulsory cultural immersion program for all first year students, which is now a usual part of the MBBS program. METHODS: Three phases were included - establishing an Indigenous health group, determining the Aboriginal and Torres Strait Islander educational content based on the professional standards and developing nine educational sessions and resources - as well as significant administrative processes. The cultural immersion was piloted in 2012 with 92 first year medical students. Following refinements it was repeated in 2013 with 95 students and in 2014 with 94 students. A comprehensive evaluation process was undertaken that included a paper-based evaluation form using a five-point Likert scale, as well as a confidential talking circle evaluation. The response rate was 95.4% (n=271, pooled cohort). Data were entered separately into SPSS and annual reports were written to the Faculty. Descriptive statistics are reported alongside themed qualitative data. RESULTS: The three combined student evaluation results were extremely positive. Students (n=271) strongly agreed that the workshop was well organised (M=4.3), that the facilitators contributed very positively to their experience (M=4.3), and that they were very satisfied overall with the activity (M=4.2). They agreed that the eight overall objectives had been well met (M=3.9-4.3). The nine sessions were highly evaluated with mean ratings of between 3.9 and 4.8. The 'best thing' about the immersion identified by more than half of the students was overwhelmingly (n=140) the Storytelling session, followed by bonding with the cohort, the Torres Strait Islander session and learning more about culture. The item identified as needing most improvement was the food (n=87), followed by the accommodation (n=65). CONCLUSIONS: The use of immersion in the early part of a cultural awareness program for medical students provides an extremely valuable platform from which to launch more detailed information about the history of Aboriginal and Torres Strait Islander Australia and its impact on the current health status of Aboriginal and Torres Strait Islander Australians. Doing this in a safe, supportive cross-cultural environment with highly skilled facilitators is essential. Key to success is strong leadership, commitment and support from Faculty level, a structured educational program and educating all staff and students about its importance throughout the journey.

Parental Involvement and Work Schedules: Time with Children in the United States, Germany, Norway, and the United Kingdom.

We examine variation in parents' time with children by work schedule in two-parent families, utilizing time use surveys from the United States (2003), Germany (2001), Norway (2000), and the United Kingdom (2000) (N = 6,835). We find that American fathers working the evening shift spend more time alone with children regardless of mothers' employment status, whereas this association is conditional on mothers' employment in the United Kingdom and Germany. We find no evidence that Norwegian fathers working the evening shift spend more time alone with children. We conclude that a consequence of evening work often viewed as positive for children - fathers spending more time with children - is sensitive to both household employment arrangements and country context.

New Fathers? Residential Fathers' Time with Children in Four Countries.

We examine variation in employed fathers' time with children ages zero to 14, utilizing time use surveys from the United States (2003), Germany (2001), Norway (2000), and the United Kingdom (2000). We examine levels of father involvement and mechanisms associated involvement on both weekdays (N = 4,192) and weekends (N = 3,024). We find some evidence of "new fathers" on weekends in all countries. Fathers spend more time on interactive care and more time alone with children on weekends than on weekdays. Only Norwegian fathers, however, increase both their participation in and time spent on physical care. American and British fathers' time with children, however, is more responsive to partners' employment.

Assessment and management of pain in dairy cows with clinical mastitis.

It is clear that clinical mastitis has severe detrimental effects on the animal and negative economic impacts for dairy producers. However, pain associated with clinical mastitis, generally, is not measured and not treated. Attention to behavioral and physiologic indicators should be used to monitor animal health. New technologies may allow dairy producers to identify clinical mastitis in its very early stages, or even before clinical changes occur. Furthermore, automated measures of activity, such as step counts and lying time, show promise as predictors of clinical problems. These new technologies, in addition to other automated measures, have the potential for improving the screening methods for preclinical mastitis and accurately predicting the onset of a clinical mastitis event. With this opportunity for very early detection of infection, there is a potential for early intervention with NSAID therapy, which may allow for maximum efficacy from its use. Despite which specific NSAID is used, it is clear that the benefits on temperature, rumen function, SCC, milk production, behavior, and pain sensitivity in animals during mastitis indicate that this therapy has a role throughout the dairy industry. As the health and well-being of dairy cattle continue to be scrutinized by consumer groups, it is essential that the alleviation of any perceived pain or discomfort associated with clinical mastitis should be addressed.