Awareness and perceived barriers to the adoption of best management practices for the transportation of lactating cull dairy cows of dairy producers in Ontario.

The objectives of this study were to understand dairy farmers' awareness and perceived barriers to the implementation of best management practices (BMP) for the transportation of lactating culled cows being moved to auction or abattoir. An invitation to participate was emailed to all dairy farms in Ontario, Canada. Responses to this invitation were used to recruit additional participants through criterion purposive snowball sampling. In total, 28 dairy producers participated in one of 5 semi-structured focus groups. All focus groups were audio recorded, transcribed verbatim, and analyzed with applied thematic analysis. Four themes were identified including 1) transfer of responsibility, 2) interpersonal relationships, 3) juggling priorities, and 4) complexities of long-term planning. While individual participant knowledge varied, participants described misconceptions that other producers held surrounding transport duration and distances, or the number of possible sales points for lactating culled cows. Participants did not agree whether the producer's responsibility ended once the cow left their property or if shared responsibility remained among all stakeholders from the farm to the final destination. Participants discussed the importance of existing trusted relationships with local cattle transporters and veterinarians to ensure information on best practices are shared. Participants also discussed how business pressures (e.g., production demands, space limitations) often challenge their ability to dry off lactating cows before transport; however, participants mentioned the degree of milk production may influence the destination of their animal (e.g., direct to slaughter for animals with high milk production). Some participants described a dynamic balance between business pressures and the potential for declining welfare of the animals under consideration to be culled during lactation. Participants posited that producers who did not prioritize proactive herd management and producers nearing retirement had limited long-term planning for culling individual cows, which might lead to transport of vulnerable or unfit animals. Finally, the lack of access to transportation direct to local slaughter was identified as an important barrier to adherence with the BMP for cull cows. In summary, many participants did not have an accurate understanding of what happens to cull cows after departing the farm and were unsure if they maintained a level of responsibility for an animal after being transported from their farm. Given the priority placed by participants on trusted interpersonal relationships, greater availability of peer-to-peer training of farmers and professional accreditation of animal transporters in addition to structural changes to increase local slaughter capacity may increase implementation of BMP and enhance lactating cull cow welfare.

Attitudes and professional values of veterinarians and veterinary students towards positive welfare states for dairy cattle.

Research that involves agricultural animal welfare has typically aimed to improve welfare by decreasing disease, distress, and pain. Positive welfare does not necessarily occur with the absence of suffering but in combination with opportunities for behaviors or affective states desired by animals. Our objectives were to describe Canadian bovine veterinarians' and veterinary students' attitudes, professional normative values, and perceived ability to promote positive welfare for dairy cows, and to explore participants' provided rationale. With an online cross-sectional survey, Canadian veterinary practitioners (n = 78) and veterinary students (n = 148) were asked, on a 7-point Likert scale, about their attitudes, perceived professional normative values, and perceived ability of veterinarians to promote positive welfare for dairy cows. We used an applied thematic analysis approach within the qualitative description methodology to analyze participants' open-ended text responses. Quantitatively, participants had very favorable attitudes (mean ± SE; 6.3 ± 0.04) and perceived favorable values (5.7 ± 0.06) in the veterinary community toward positive welfare opportunities for dairy cows. Three themes were identified to explain the professional normative values: influences from within the veterinary profession, influences from outside the veterinary profession, and personal views of participants. Participants were confident that veterinarians could suggest positive welfare opportunities for dairy cows (6.1 ± 0.06) but were uncertain that the decision to suggest these opportunities to producers was within a veterinarian's control (4.3 ± 0.11) and were not confident that implementation of positive welfare opportunities was under a veterinarian's control (2.1 ± 0.07). Three themes were identified to explain the barriers to veterinarians promoting positive welfare opportunities for dairy cows: not practical to implement, resistance to change, and concern for the animal. Participants stated that many positive welfare opportunities were impractical or expensive to implement. We conclude that positive attitudes and positive professional values exist in the veterinary community toward positive welfare for dairy cows but that much uncertainty exists regarding a veterinarian's ability to influence change to current practices.

The SAGES Fundamental Use of Surgical Energy program (FUSE): history, development, and purpose.

BACKGROUND: Adverse events due to energy device use in surgical operating rooms are a daily occurrence. These occur at a rate of approximately 1-2 per 1000 operations. Hundreds of operating room fires occur each year in the United States, some causing severe injury and even mortality. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) therefore created the first comprehensive educational curriculum on the safe use of surgical energy devices, called Fundamental Use of Surgical Energy (FUSE). This paper describes the history, development, and purpose of this important training program for all members of the operating room team. METHODS: The databases of SAGES and the FUSE committee as well as personal photographs and documents of members of the FUSE task force were used to establish a brief history of the FUSE program from its inception to its current status. RESULTS: The authors were able to detail all aspects of the history, development, and national as well as global implementation of the third SAGES Fundamentals Program FUSE. CONCLUSIONS: The written documentation of the making of FUSE is an important contribution to the history and mission of SAGES and allows the reader to understand the idea, concept, realization, and implementation of the only free online educational tool for physicians on energy devices available today. FUSE is the culmination of the SAGES efforts to recognize gaps in patient safety and develop state-of-the-art educational programs to address those gaps. It is the goal of the FUSE task force to ensure that general FUSE implementation becomes multinational, involving as many countries as possible.

Craniopharyngioma presenting during pregnancy 4 years after a normal magnetic resonance imaging scan: case report.

OBJECTIVE AND IMPORTANCE: Craniopharyngiomas, epithelial tumors of the hypothalamic and pituitary region, are thought to have congenital origins. It has been postulated that hormonal influences may stimulate growth in adults. This report describes a case and reviews the literature. CLINICAL PRESENTATION: The case is discussed of a 39-year-old woman who experienced symptoms from a craniopharyngioma diagnosed during a pregnancy that resulted from in vitro fertilization. A magnetic resonance imaging scan performed 4 years previously had disclosed nothing abnormal. INTERVENTION: The patient underwent a right frontotemporal craniotomy with total resection of the suprasellar tumor, which was dissected from the pituitary stalk. CONCLUSION: This case suggests a possible link in the adult patient between the growth of this supposedly congenital tumor and hormonal stimulation.

Health status and practices of urban Caribbean Latinos with diabetes mellitus.

Although Caribbean Latinos are more likely than non-Hispanic whites to develop diabetes, their health status has been poorly characterized. Information on diabetes management, metabolic control, dietary habits, and diabetes knowledge was gathered from a group of urban Caribbean Latinos with diabetes in order to characterize the nutritional behaviors, diabetes attitudes, health perceptions, and metabolic control of this high risk group. Interviews and medical record reviews were conducted among seventy low-income urban Caribbean Latinos with type 2 diabetes mellitus. Patients attending outpatient clinics were interviewed by bilingual interviewers. Medical records were reviewed to ascertain prevalence of diabetes-related complications, medications, and metabolic parameters. Participants were primarily Spanish-speaking and of Puerto Rican origin. Eighty-one percent were unemployed, and only 27% had completed high school or higher educational levels. Average hemoglobin A1c was 10.6%. Among those with hypertension and hyperlipidemia, many were not receiving treatment. Participants' estimation of their own degree of metabolic control was poor, as was their understanding of desirable blood glucose and weight goals. A second evening meal was common. Diets were higher in fat and sugar content than currently recommended. More effective treatment strategies for both patients and providers are needed to improve glycemic control and cardiovascular risk factors among indigent urban Caribbean Latinos. Essential features of such strategies for patient programs include culturally appropriate dietary counseling and low literacy materials to better communicate glycemic and weight goals and dietary guidelines. Provider education is needed regarding established guidelines and cultural influences on diabetes-related practices.

Use of focus groups to explore nutrition practices and health beliefs of urban Caribbean Latinos with diabetes.

OBJECTIVE: Although Caribbean Latinos are two to three times more likely than non-Hispanic whites to develop diabetes, cultural influences on nutrition and health are poorly understood. To provide insight into important features of diabetes prevention and management, we conducted focus groups to explore nutrition practices and health beliefs. RESEARCH DESIGN AND METHODS: Thirty low-income urban Caribbean Latinos with non-insulin-dependent diabetes mellitus (NIDDM) and four family members participated in four focus group interviews that were conducted in Boston and Cambridge, Massachusetts. Interviews were conducted in Spanish, were tape recorded, and were led and analyzed by Latino professionals from a community-based health organization. RESULTS: Consistent themes described by participants were feelings of social isolation, little understanding of long-term consequences of diabetes, fatalism regarding the course of the disease, multiple barriers to diet and exercise interventions, skepticism regarding the value of preventive health behaviors, prevalent use of traditional nonmedical remedies, and a clear need for culturally sensitive health-care providers and services. CONCLUSIONS: The information from focus groups provides useful information for planning innovative intervention programs for chronic disease risk reduction that emphasize practical skills development, family/peer networks, empowerment techniques, and bilingual providers. We conclude that the focus group technique can be used effectively with low-income, urban minority populations to provide information on lifestyle behaviors and beliefs regarding chronic diseases that impact on health and nutritional status.

The effect of glucagon on rat cardiac cyclic AMP, phosphorylase a and force of contraction.

Glucagon produced dose-dependent increases in cyclic AMP, contractile force and % phosphorylase a when injected into isolated perfused rat hearts. Time-response experiments demonstrated that the increase in cyclic AMP occurred prior to changes in the other two parameters. All glucagon effects were enhanced by perfusion of the hearts with 1.0 mM theophylline although contractile force was affected less than the other 2 events. The data lend support to the concept that increases in cyclic AMP may be involved in the inotropic effect of glucagon. It should be noted, however, that the cyclic AMP increases produced by glucagon were considerably less than those previously noted with either the catecholamines or histamine.