Response to novel feed in dairy calves is affected by prior hay provision and presentation method.

Animals raised in environments that prevent natural foraging opportunities may have difficulty adapting to novelty, such as feeding and management changes. Our objective was to evaluate how early provision and presentation of forage in dairy calves affected response to novel TMR (total mixed ration; grain and alfalfa) at weaning. Holstein heifer calves were housed individually in a covered outdoor hutch with an attached uncovered wire-fenced pen on sand bedding. Calves were fed a diet of starter grain and milk replacer (5.7-8.4L/d step-up) via a bottle (Control, n = 9) or given additional access to mountaingrass hay presented either in a bucket (Bucket, n = 9), or PVC pipe feeder (Pipe, n = 9). Treatments were applied from birth through 50 d of age, when step-down weaning began. All calves had 3 buckets and a pipe feeder provided in their uncovered pen area. On d 50, each calf was briefly blocked inside their hutch. TMR was put in the 3rd bucket that previously contained hay (Bucket) or was empty (Control, Pipe). The calf was released from the hutch and video-recorded for 30 min. Neophobia towards TMR was affected by prior experience with presentation: Bucket calves began eating TMR faster than Pipe and Control (P≤0.012) and showed the fewest number of startle responses (P = 0.004). Intake was similar across groups (P = 0.978), suggesting this apparent neophobia was transient, but Control calves took longer to eat than Bucket (P<0.001) and Pipe (P = 0.070) calves and were less likely to give up on eating to lie down instead. These results suggest that previous experience with hay improves processing ability when presented with novel TMR. Overall, response to a novel feed is affected by both early life experience, such as opportunities to process forage, and the presentation of the feed itself. Calves also appear motivated to access forage, evidenced by transient neophobia, high intake, and persistence in feeding by naïve calves.

Patient Preferences for Diagnostic Testing in the Emergency Department: A Cross-sectional Study.

BACKGROUND: Diagnostic testing is common during emergency department (ED) visits. Little is understood about patient preferences for such testing. We hypothesized that a patient's willingness to undergo diagnostic testing is influenced by the potential benefit, risk, and personal cost. METHODS: We conducted a cross sectional survey among ED patients for diagnostic testing in two hypothetical scenarios: chest pain (CP) and mild traumatic brain injury (mTBI). Each scenario defined specific risks, benefits, and costs of testing. The odds of a participant desiring diagnostic testing were calculated using a series of nested multivariable logistic regression models. RESULTS: Participants opted for diagnostic testing 68.2% of the time, including 69.7% of CP and 66.7% of all mTBI scenarios. In the CP scenario, 81% of participants desired free testing versus 59% when it was associated with a $100 copay (difference = 22%, 95% confidence interval [CI] = 16% to 28%). Similarly, in the mTBI scenario, 73% of adult participants desired free testing versus 56% when charged a $100 copayment (difference = 17%, 95% CI = 11% to 24%). Benefit and risk had mixed effects across the scenarios. In fully adjusted models, the association between cost and desire for testing persisted in the CP (odds ratio [OR] = 0.33, 95% CI = 0.23 to 0.47) and adult mTBI (OR = 0.47, 95% CI = 0.33 to 0.67) scenarios. CONCLUSIONS: In this ED-based study, patient preferences for diagnostic testing differed significantly across levels of risk, benefit, and cost of diagnostic testing. Cost was the strongest and most consistent factor associated with decreased desire for testing.

Risk, Benefit, and Cost Thresholds for Emergency Department Testing: A Cross-sectional, Scenario-based Study.

BACKGROUND: While diagnostic testing is common in the emergency department, the value of some testing is questionable. The purpose of this study was to assess how varying levels of benefit, risk, and costs influenced an individual's desire to have diagnostic testing. METHODS: A survey through Amazon Mechanical Turk presented hypothetical clinical situations: low-risk chest pain and minor traumatic brain injury. Each scenario included three given variables (benefit, risk, and cost), that was independently randomly varied over four possible values (0.1, 1, 5, and 10% for benefit and risk and $0, $100, $500, and $1,000 for the individual's personal cost for receiving the test). Benefit was defined as the probability of finding the target disease (traumatic intracranial hemorrhage or acute coronary syndrome). RESULTS: One-thousand unique respondents completed the survey. With an increased benefit from 0.1% to 10%, the percentage of respondents who accepted a diagnostic test went from 28.4% to 53.1%. (odds ratio [OR] = 3.42; 95% confidence interval [CI] = 2.57-4.54). As risk increased from 0.1% to 10%, this number decreased from 52.5% to 28.5%. (OR = 0.33; 95% CI = 0.25-0.44). Increasing cost from $0 to $1,000 had the greatest change of those accepting the test from 61.1% to 21.4%, respectively (OR = 0.15; 95% CI = 0.11-0.2). CONCLUSIONS: The desire for testing was strongly sensitive to the benefits, risks, and costs. Many participants wanted a test when there was no added cost, regardless of benefit or risk levels, but far fewer elected to receive the test as cost increased incrementally. This suggests that out-of-pocket costs may deter patients from undergoing diagnostic testing with low potential benefit.

Does spouse participation influence quality of life reporting in patients with Parkinson's disease?

PURPOSE: To investigate whether patient-spouse co-reporting (patient reporting with assistance from their spouse) results in the same ratings of health-related quality of life (HRQoL) as patient ratings without co-reporting, and to assess whether mutuality of the marital relationship is a determinant of co-reported ratings. Patients are the best source of HRQoL; however, co-reporting is common in clinical settings, but has not been compared to independent patient reporting of HRQoL. METHODS: Fifty-nine Parkinson's disease (PD) patient-spouse pairs completed the Short Form Health Status Survey (SF-12), measuring mental and physical HRQoL. Initially, the patient and spouse completed the SF-12 independently (about the patient). Then, patient-spouse pairs completed the SF-12 together assessing the patient's HRQoL. Patients and spouses independently completed the Mutuality Scale rating the intimacy of their relationship. RESULTS: Patients rated physical HRQoL higher (M = 46.6) than spouses alone (M = 43.4, p < 0.01) and co-reporting (M = 44.8, p < 0.05). Co-reporting rated physical HRQoL in between that of patients and spouses, (p < 0.05). Spouses who reported greater mutuality showed greater concordance with the patient regarding the patient's mental HRQoL (B = -0.43, p < 0.05). CONCLUSION: Consistency of the mode of completion of HRQoL instruments is important since co-reporting may alter HRQoL ratings in PD and lead to inaccurate conclusions. Mutuality is a mediator of mental HRQoL.