RESUMO
In Exp. 1, Brachiaria ruziziensis (11.1 % CP) was inoculated or not with two sources of monensin, resulting in three treatments: 1) no monensin inoculation (CONT), 2) 20 mg of monensin sodium-A/kg of DM (Elanco Animal Health; MON-A), and 3) 20 mg of monensin sodium-B/kg of DM (Shandong Qilu King-Phar Pharmaceutical Co. Ltd.; MON-B). Three rumen-fistulated Jersey steers were offered a cool-season forage-based diet and were used as the rumen inoculum donors. Volatile fatty acids concentrations were evaluated at 0, 6, 12, 24, 30, and 48 h after treatment inoculation. Overall, acetate and butyrate concentrations were reduced in MON-A vs. CONT (P ≤ 0.02), whereas both monensin products reduced Ac:Pr ratio vs. CONT (P ≤ 0.01); however, MON-A also (P = 0.05) reduced the Ac:Pr ratio vs. MON-B. A treatment × hour interaction was detected for rumen propionate concentration (P = 0.01), primarily because MON-A resulted in greater propionate than CONT and MON-B at 24 and 48 h (P ≤ 0.03), but no differences were observed between CONT vs. MON-B (P ≥ 0.27). In Exp. 2, 240 Nellore bulls (initial BW = 363.2 ± 40.9 kg) were ranked and blocked according to initial BW, and within blocks animals were allotted into pens (n = 10 pens/treatment). Pens were randomly assigned into one of three treatments: 1) corn-based diet with no monensin (CONT), 2) CONT plus 28 mg of MON-A/kg of DM, and 3) CONT plus 28 mg of MON-B/kg of DM. The CONT diet was composed of sugarcane bagasse, ground corn, DDGS, urea, and a mineral-vitamin mix. The experimental period lasted 106 d and was divided into a 21-d adaptation period and an 85-d finishing phase. During the adaptation phase, both monensin sources increased (P ≤ 0.01) BW change, ADG, and F:G, as well as reduced DMI variation (P = 0.02). When the entire experimental period was evaluated, no treatment effects were detected for final BW, DMI, and ADG (P ≥ 0.26). Nonetheless, DMI variation was reduced as monensin was included (P = 0.01) and only MON-A improved the efficiency by reducing F:G vs. CONT (P = 0.05) and biological efficiency vs. MON-B (P = 0.05). Additionally, carcass ADG tended (P = 0.10) to be greater for MON-A vs. MON-B, whereas no other differences in the carcass characteristics were observed (P ≥ 0.53). In summary, the source of monensin inoculated in vitro and offered to Nellore bulls during the feedlot phase significantly affected the energetic efficiency and the performance of the animals.
RESUMO
BACKGROUND CONTEXT: Care for low back pain (LBP) is costly, fragmented and, in non-compensation populations, rarely specifically addresses factors associated with maintaining employment status or return to work (RTW). PURPOSE: This study aimed to identify modifiable independent risk factors for (1) a negative work status at presentation and (2) a change in work status during treatment in a cohort of LBP patients. The results are intended to inform improvement in best-evidence care pathways to maximize societal outcomes and overall value of a new model of care. STUDY DESIGN/SETTING: A prospective observational study was carried out. INCLUSION CRITERIA: Work-eligible, non-workers compensation patients with recurrent or persistent LBP ≥6 weeks and ≤12 months. SETTING: The Inter-professional Spine Assessment and Education Clinics (ISAEC)-a novel Government-funded shared-care model of management for LBP. METHODS: This study used the following methods: (1) Cross-sectional analysis of baseline data from the initial ISAEC consultation (t0) from December 2012 to April 2014. Work status at t0 was dichotomized as employed (E) or underemployed (UE; unemployed, modified work duty, or disability). Multivariate logistic regression modeling was used to determine independent predictors of UE status at t0. (2) Bivariate analysis of longitudinal data from t0 to 6 months (t1) to identify risk factors for work status change. Employment journey categorized into four groups: Et0/Et1-employed at t0 and employed at t1; Et0/UEt1-employed at t0 and underemployed at t1; UEt0/Et1-underemployed at t0 and employed at t1; UEt0/UEt1-underemployed at t0 and underemployed at t1. RESULTS: This study yielded the following results: (1) Initial consultation data on 462 consecutive patients (Et0=344, UEt0=118). Multivariate logistic regression identified legal claim, depression, smoking, and higher STarT Back (or Oswestry Disability Index [ODI]) score as independent risk factors for UEt0. (2) Overall UE rate did not significantly change during longitudinal analysis (n=178, UEt0=25.5%, UEt1=22.9%). However, 10.5% of Et0 became UEt1 (Et0/Et1=102, Et0/UEt1=12). Bivariate analysis identified elevated baseline ODI score as the only significant predictor variable for UEt1 in Et0 cohort (p=.0101). Conversely, ISAEC improved the employment status in 41% of UEt0 to Et1 (UEt0/Et1=16, UEt0/UEt1=23), and the absence of depression was significant for predicting RTW (p=.0001). CONCLUSIONS: From a societal perspective, employment status as an outcome measure is paramount in assessing the value of a new model of care for LBP. Mitigation strategies for the predictor variables identified will be included in ISAEC pathways to translate clinical improvement into societal added value.
