Negative relationship between dry matter intake and the temperature-humidity index with increasing heat stress in cattle: a global meta-analysis.

Changes in frequency and severity of heat waves due to climate change pose a considerable challenge to livestock production systems. Although it is well known that heat stress reduces feed intake in cattle, effects of heat stress vary between animal genotypes and climatic conditions and are context specific. To derive a generic global prediction that accounts for the effects of heat stress across genotypes, management and environments, we conducted a systematic literature review and a meta-analysis to assess the relationship between dry matter intake (DMI) and the temperature-humidity index (THI), two reliable variables for the measurement of feed intake and heat stress in cattle, respectively. We analysed this relationship accounting for covariation in countries, breeds, lactation stage and parity, as well as the efficacy of various physical cooling interventions. Our findings show a significant negative correlation (r = - 0.82) between THI and DMI, with DMI reduced by 0.45 kg/day for every unit increase in THI. Although differences in the DMI-THI relationship between lactating and non-lactating cows were not significant, effects of THI on DMI varied between lactation stages. Physical cooling interventions (e.g. provision of animal shade or shelter) significantly alleviated heat stress and became increasingly important after THI 68, suggesting that this THI value could be viewed as a threshold for which cooling should be provided. Passive cooling (shading) was more effective at alleviating heat stress compared with active cooling interventions (sprinklers). Our results provide a high-level global equation for THI-DMI across studies, allowing next-users to predict effects of heat stress across environments and animal genotypes.

Efficacy and safety of levetiracetam for migraine prophylaxis: A systematic review.

WHAT IS KNOWN AND OBJECTIVE: Migraine is a common and costly neurological disorder that affects approximately 1 of every 7 people annually. Pharmacological therapy for prevention of migraine is warranted when patients experience at least 6 headache days, 4 headache days with at least some impairment or 3 headache days with severe impairment or requiring bed rest in a month. Levetiracetam is an antiepileptic drug that has the potential to be beneficial for migraine prophylaxis. The objective of this review was to assess the safety and efficacy of levetiracetam for migraine prophylaxis. METHODS: A systematic search was conducted in MEDLINE (1946-August 2017), EMBASE (1947-August 2017) and CENTRAL using the terms: migraine disorders, migraine, or headache and etiracetam or levetiracetam. Animal studies, case reports, abstracts, letters to the editor and those not written in English were excluded. RESULTS AND DISCUSSION: Eleven articles were identified for inclusion. Of the studies included, 2 were retrospective chart reviews, 4 were randomized placebo- or active comparator-controlled trials, and the remaining 5 were prospective, open-label studies. All studies found a statistically significant decrease in headache frequency per month compared to baseline or placebo when used for treatment of episodic migraine (2.96-10.9 headache/mo decrease), and 57.9%-100% of patients had at least a 50% decrease in headache frequency from baseline. Significance was not consistently demonstrated in the prophylactic treatment of chronic migraine. The most common adverse effects noted included somnolence, dizziness and behavioural effects but generally did not require discontinuation. WHAT IS NEW AND CONCLUSION: The studies included in this review indicate that levetiracetam is well-tolerated and may be an alternative treatment option for episodic migraine prophylaxis. Additional clinical evidence is necessary to establish the efficacy of levetiracetam for the prophylactic treatment of chronic migraine.

Predicting optimum crop designs using crop models and seasonal climate forecasts.

Expected increases in food demand and the need to limit the incorporation of new lands into agriculture to curtail emissions, highlight the urgency to bridge productivity gaps, increase farmers profits and manage risks in dryland cropping. A way to bridge those gaps is to identify optimum combination of genetics (G), and agronomic managements (M) i.e. crop designs (GxM), for the prevailing and expected growing environment (E). Our understanding of crop stress physiology indicates that in hindsight, those optimum crop designs should be known, while the main problem is to predict relevant attributes of the E, at the time of sowing, so that optimum GxM combinations could be informed. Here we test our capacity to inform that "hindsight", by linking a tested crop model (APSIM) with a skillful seasonal climate forecasting system, to answer "What is the value of the skill in seasonal climate forecasting, to inform crop designs?" Results showed that the GCM POAMA-2 was reliable and skillful, and that when linked with APSIM, optimum crop designs could be informed. We conclude that reliable and skillful GCMs that are easily interfaced with crop simulation models, can be used to inform optimum crop designs, increase farmers profits and reduce risks.

Measurement of U and Pu isotope ratios in hair and nail samples using extraction chromatography and multi-collector inductively coupled plasma mass spectrometry.

A bioassay capable of monitoring occupational or environmental exposure to special nuclear materials would be a useful tool for nuclear nonproliferation programs. Hair and nail are potential biomonitors of exposure to U and Pu. A method is described to measure isotope ratios of ultra-trace concentrations of U and Pu in hair and nail samples. The method uses multiple extraction chromatography resins to separate U and Pu fractions from the sample matrix. The U recovery was quantitative while the Pu recovery ranged from 81% to 109%, with a U decontamination factor of 5×10(4). Following the separation (234)U/(238)U, (235)U/(238)U and (240)Pu/(239)Pu were measured in human hair and hair and nail samples using multi-collector inductively coupled plasma mass spectrometry (MC-ICPMS). The human hair and nail samples had elevated ratios of (234)U/(238)U which could reflect exposure to naturally fractionated U.

Effect of influenza vaccination on international normalized ratio during chronic warfarin therapy.

WHAT IS KNOWN AND OBJECTIVE: Warfarin is a widely used anticoagulant, well-known for its interactions with medications and foods. Vaccinations, particularly the influenza vaccine, have been thought to potentially interfere with anticoagulation response in those on chronic warfarin. Our objective was to systematically review the literature to assess the validity and clinical significance of this association. METHODS: A primary literature search was performed using MEDLINE (1966 - June 2011) and EMBASE (1980 - June 2011). Additional studies were obtained by performing a manual bibliographical review of literature from the initial results and by searching The Cochrane Database of Systematic Reviews. All English-language, peer-reviewed publications identified were evaluated. Reviews, case studies and trials reporting anticoagulation response using an unconverted prothrombin time ratio were excluded. RESULTS AND DISCUSSION: Thirty-one abstracts were initially reviewed, and seven studies were identified for inclusion in this review. Significant changes in mean INR post-vaccination between the study and comparator groups were documented in one trial. Through subgroup analysis, another study noted that elderly patients spent more time in the subtherapeutic range post-vaccination when compared with baseline INR levels. No other significant changes in mean INR levels were documented following influenza vaccination. Adverse bleeding events reported after immunization were limited and minor in nature. WHAT IS NEW AND CONCLUSION: Overall, our review does not indicate a consistent, clinically relevant effect of influenza vaccines on INR of patients on chronic warfarin therapy. Isolated reports of variations in INR following influenza vaccination are likely due to other factors.

Process optimization of an auger pyrolyzer with heat carrier using response surface methodology.

A 1 kg/h auger reactor utilizing mechanical mixing of steel shot heat carrier was used to pyrolyze red oak wood biomass. Response surface methodology was employed using a circumscribed central composite design of experiments to optimize the system. Factors investigated were: heat carrier inlet temperature and mass flow rate, rotational speed of screws in the reactor, and volumetric flow rate of sweep gas. Conditions for maximum bio-oil and minimum char yields were high flow rate of sweep gas (3.5 standard L/min), high heat carrier temperature (∼600 °C), high auger speeds (63 RPM) and high heat carrier mass flow rates (18 kg/h). Regression models for bio-oil and char yields are described including identification of a novel interaction effect between heat carrier mass flow rate and auger speed. Results suggest that auger reactors, which are rarely described in literature, are well suited for bio-oil production. The reactor achieved liquid yields greater than 73 wt.%.

A new input device: comparison to three commercially available mouses.

This study was conducted to simultaneously compare the postural demands and performance of a new human-centred computer input device to three devices currently on the market. It was hypothesized that the new device would perform as well as the commercial devices while requiring less postural strain. A total of 24 experienced computer users performed a series of modified Steering and Fitts' Law Tests while their postural behaviour was captured using an opto-electric system. Analysis of the postural data revealed strong similarities between the new device and the commercially available devices, including some similarities that are not suggested in the literature. Analysis of the performance data reveals no significant difference between the new device and most commercial devices and suggests further examination of the difference between familiarity and mastery. This study has shown that it is possible to use the new device in a relaxed posture and yet achieve the same accuracy as commercial devices at no more postural risk than when the traditional mouse is used at a customized, ergonomic workstation.

Optimal screw diameter for interference fixation in a bone tunnel: a porcine model.

The study investigates the optimal interference screw dimensions required to secure a tendon graft in a bone tunnel. A standard 8 mm pig flexor-tendon graft was inserted into a standard open-ended 8 mm bone tunnel of a porcine distal femur and secured using either 7 mm, 8 mm or 9 mm diameter metal interference screws (Arthrex Inc, Naples, FL). The construct was tested to failure using a Shimadzu ASG 10KN Universal Material Testing Machine (Shimadzu, Tokyo, Japan). Load and mode of construct failure were recorded for 37 individual constructs. There was no significant difference in the load at failure between the 7 mm screw (192 N; range 151-232) and 8 mm screw (181 N; range 150-212) (p>0.05). There was a significant difference between the 7 mm screw and the 9 mm screw (109 N; range 67-151) (p=0.006) and between the 8 mm screw and the 9 mm screw (p=0.015). When using a 9 mm screw, 100% of the constructs failed by cut out of the graft at the tunnel opening. The 7 mm constructs failed by slippage of the tendon from the bone tunnel in 83% of cases, with only 17% failing by cut out at the tunnel opening. The 8 mm constructs demonstrated a mixture of failure modes, with slippage occurring in 58% of cases, cut out in 38% and failure of the graft substance in one case (4%). In this model, screw diameters equal to or 1 mm less than the tunnel/tendon diameter provides better fixation than using a screw 1 mm larger. The mode of failure differs for each of these screws.

Grade III acromioclavicular joint injury in Australian Rules Football.

We have reviewed fourteen Australian Rules Football players who were seen consecutively by a single surgeon with grade III acromioclavicular joint injuries between January 1993-June 1997. After discussion at initial consultation eight players elected for non-operative management and six for operative management. Two players in the non-operative group subsequently underwent surgical reconstruction after failure of non-operative treatment. The mean return time to non-contact training was 2.4 weeks (range 1-4, S.D. 1.52) in the non-operative group and 6.3 weeks (range 3.5-10, S.D. 2.99) in the operative group. However return to sports specific training (contact training) was at a mean of 20.8 weeks (range 10-32. S.D. 8.56) in the non-operative group and 13.6 weeks (range 6-24. S.D. 7.06) in the operative group. Return to competitive football matches for the non-operative group was at a mean of 26.2 weeks (range 10-34,S.D. 8.84) and 18.8 weeks (9.5-28. S.D. 8.05) for those treated operatively. These results were not statistically significant. At final follow up the subjective scores for the current overall condition of the shoulder when compared to the uninjured side, were 72.5 (range 20-100, S:D.24.9) for the non operative group and 87.3 (range 75-100, S:D.10.61) for the operative group and this difference was also not statistically significant. Conclusions in this study are limited by small numbers and lack of statistically significant results. The results show a trend towards faster return to ARF and a more satisfactory outcome for patients undergoing surgery compared to their non operative cohorts.

The posteromedial impingement lesion of the ankle. A series of six cases.

We report on a series of six cases of posteromedial impingement lesion of the ankle operated on during a 3-year period with excellent or good results and a return of the patients to preinjury levels of activity. This lesion occurs, on occasion, after a severe ankle-inversion injury in which the deep posterior fibers of the medial deltoid ligament become crushed between the medial wall of the talus and the medial malleolus. Initially, posteromedial symptoms do not predominate, compared with the symptoms of the lateral ligament disruption, and they usually resolve without specific treatment. Occasionally, however, thick, disorganized fibrotic scar tissue persists and impinges between the medial wall of the talus and the posterior margin of the medial malleolus. Clinically, the patient has persistent medial to posteromedial activity-related ankle pain after a severe inversion injury, despite a sound ankle rehabilitation program. There is deep soft tissue induration immediately behind the medial malleolus with localized tenderness and reproduction of symptomatic pain on provocative testing by palpating this site while moving the ankle into plantar flexion and inversion. The posteromedial impingement lesion has a distinct pathologic picture and can coexist with other ankle lesions that cause pain after lateral ligament injury.

Shoulder pathology associated with symptomatic acromioclavicular joint degeneration.

We report the incidence and nature of shoulder disease found in association with symptomatic degenerative change in the acromioclavicular joint in 218 shoulders. Coexisting pathologic conditions were present in 213 shoulders: rotator cuff degeneration in 176 shoulders (79 with complete thickness tears), labral tears in 72, glenohumeral degeneration in 31, and biceps tendon disease in 49. In 59 shoulders findings were unexpected. We looked specifically at 2 age groups: <50 years and > or =50 years. In the <50 years group labral tears were seen in 42% (30 of 71) and rotator cuff disease in 65% (46 of 71). Cuff tears tended to be incomplete. In the older age group only 14% (21 of 147) had an intact cuff, with 72 shoulders having a full-thickness tear. Labral tears were seen in 29% (42 of 147). We recommend that all patients undergo shoulder arthroscopy at the time of acromioclavicular surgery.

Effect of transgenic GDNF expression on gentamicin-induced cochlear and vestibular toxicity.

Gentamicin administration often results in cochlear and/or vestibular hair cell loss and hearing and balance impairment. It has been demonstrated that adenovirus-mediated overexpression of glial cell line-derived neurotrophic factor (GDNF) can protect cochlear hair cells against ototoxic injury. In this study, we evaluated the protective effects of adenovirus-mediated overexpression of GDNF against gentamicin ototoxicity. An adenovirus vector expressing the human GDNF gene (Ad.GDNF) was administered into the scala vestibuli as a rescue agent at the same time as gentamicin, or as a protective agent, 7 days before gentamicin administration. Animals in the Rescue group displayed hearing thresholds that were significantly better than those measured in the Gentamicin or Ad.LacZ/Gentamicin groups. In the Protection group, Ad.GDNF afforded significant preservation of utricular hair cells. The data demonstrated protection of the inner ear structure, and rescue of the inner ear structure and function against ototoxic insults. These experiments suggest that inner ear gene therapy may be developed as a clinical tool for protecting the ear against environmentally induced insults.

Herbicide spray drift odor: measurement and toxicological significance.

The toxicological significance of exposure of members of the public to spray drift odors of four herbicide formulations (three 2, 4-dichlorophenoxyacetic [2,4-D] acid derivatives and one MCPA [4-methyl-2-chlorophenoxyacetic acid] derivative) has been studied using a combination of novel odor measurement and classic residue analysis techniques. The mean odor concentrations, generated during the spraying of the commercial herbicide formulations under simulated aerial application conditions, were about twofold higher for 2,4-D ethylhexyl ester (22,500 OU(c)/m(3)) and MCPA (30,100 OU(c)/m(3)) than for 2,4-D butyl ester (12,400 OU(c)/m(3)) and 2,4-D amine (11,800 OU(c)/m(3)). Detailed investigations determined that the odors are due to trace manufacturing impurities and additives in the commercial formulations, whereas the herbicide active ingredients are odorless. Measured airborne herbicide active ingredient concentrations under the simulated aerial application conditions were all below their respective occupational safety and health TLV-TWA values, indicating that exposures of toxicological significance as a result of spray drift are unlikely.

Open and arthroscopic techniques for the treatment of traumatic anterior shoulder instability in Australian rules football players.

Australian Rules football (ARF) is a potentially violent, overhead, body-contact sport. We reviewed 56 shoulders in patients who sustained their initial traumatic anterior subluxation or dislocation during ARF and who underwent reconstructive surgery for traumatic anterior instability, whether by arthroscopic or by open techniques. Patients were followed up for a mean of 29.4 months after operation, and clinical evaluation was performed with the Rowe grading system. Three types of surgical procedures were performed: arthroscopic suture repair, arthroscopic Bankart repair with an absorbable polyglyconate tack, and open capsular shift with repair of the Bankart lesion. Shoulders treated with arthroscopic suture repair had a 70% rate of recurrent subluxation or dislocation on return to ARF Dislocations treated arthroscopically with the biodegradable tack had a 38% rate of recurrence of instability; three fourths of the recurrences were after minimal to moderate trauma. Shoulders treated with an open capsular shift and Bankart procedure had a 30% rate of recurrent instability, with half of the recurrences caused by violent trauma. In the open group there were no failures in patients who did not return to ARF. We suggest that arthroscopic repair in shoulders with anterior instability and recurrent dislocation does not adequately address the plastic deformation of the anterior capsule that may occur after repeated episodes of dislocation. We advocate open shoulder procedures in ARF athletes to address all areas of the capsulolabral pathologic condition and to provide the most secure repair possible with minimal chance of recurrence.

Plantar fascia release through a transverse plantar incision.

A transverse plantar incision for plantar fascial release was assessed for pain relief, numbness, and subsequent heel pad symptoms. Twenty-seven feet in 26 patients who underwent plantar fascia release were reviewed with a minimum follow-up of 2 years after surgery (average, 37.6 months). Comprehensive data were obtained on 25 feet (24 patients) (93% response rate). The plantar fascia origin was completely transected in all cases. This led to complete resolution of symptoms in 19 feet and residual minor symptoms in six feet. After 2 years, four patients had developed recurrent symptoms, two in the area of surgery and two on the dorsum of the foot, in association with a pes planus foot. Two patients had some continued persistence of heel pain after surgery, although significantly less pain than preoperatively.Thus, 76% of patients had complete relieve of there symptoms, 12% of patients had mild symptoms not affecting daily activities, and 12% of patients had moderate symptoms that limited some activities. No patient suffered heel pad symptoms or numbness after surgery. It is concluded that plantar fascia release through a transverse plantar incision is a successful procedure for long-term relief of symptoms which avoids unnecessary heel pad numbness and scar morbidity. The benefits of a transverse incision include greater intraoperative vision, to ensure adequate release and spur excision, and an incision parallel to the medial calcaneal branches of the tibial nerve.

The early results of the Brunelli procedure for trapeziometacarpal instability.

We report the results of Brunelli's abductor pollicis longus transfer for symptomatic instability of the trapeziometacarpal joint in 15 hands (14 patients) at a mean follow-up of 21 months. Patients were assessed subjectively, and objectively by an independent observer. All but one of the patients were very satisfied with the result of the operation, including the six patients who had significant degeneration of the carpometacarpal joint surface preoperatively. Four patients said they had no pain and the mean pain score overall on a visual analogue scale was 1.2 (out of a maximum of 10). Overall the outcome was rated good or excellent in 11 of the 15 thumbs.

Deliberate self-harm as a cause of persistent discharge from arthroscopic portals.

Persistent discharge and bleeding from arthroscopy portals are rare complications. We report three cases which occurred as a result of deliberate self-harm. To our knowledge the occurrence of self-inflicted injury following arthroscopy has not been reported. Although suspicion of such activity may be delayed we consider it important to be aware of the possibility of this behaviour and to seek specialist help early in order to reduce the likelihood of further permanent physical damage.

Surgeon protection: early recognition of glove perforation using a green under glove.

This paper reports the use of a double gloving system, which consists of a standard latex over glove and a green latex under glove, and aids recognition of intra-operative glove perforation during trauma surgery. Recognition of perforation is possible due to the colour of the under glove becoming more visable following ingress of fluid between the glove layers. The gloves were used in 40 consecutive operative procedures for lower limb fracture fixation. Glove perforations occurred in 48% of operations. The outer glove was perforated on 26 occasions and the under glove on two. There were no false positive colour changes but on one occasion no indication of perforation was visible. The rapidity and accuracy of colour change allowed identification of the cause of glove damage intra-operatively. This was most often due to powered instrumentation (58%).

A mechanism for entrapment of the tibialis posterior tendon in lateral subtalar dislocation.

The entrapment of the tibialis posterior tendon causing a block to reduction of lateral subtalar dislocation is recognized. The mechanism which allows tendon excursion is less clearly understood. We present a case in which extensive tearing of the musculotendinous junction of the tibialis posterior muscle occurred during tendon displacement and entrapment in lateral subtalar dislocation. In view of this previously poorly recognized finding the two theories regarding entrapment are discussed. Recognition of the cause of the tendon lengthening with an intact flexor retinaculum allows appropriate early treatment.