Nutritional recommendations of feedlot consulting nutritionists: The 2015 New Mexico State and Texas Tech University survey.

The 2015 feedlot consulting nutritionist survey is a collaborative project between New Mexico State University and Texas Tech University that focuses on summarizing the professional practices of consulting feedlot nutritionists and updates a 2007 survey. Forty-nine consulting feedlot nutritionists were asked to participate, of which 24 completed the survey. The nutritionists surveyed service over 14,000,000 cattle annually and were representatives from individual consulting practices (54.2%), corporate cattle feeding companies (20.8%), corporate feed manufacturing companies (20.8%), or a combination of consulting practices (4.2%). The survey was completed using a web-based survey tool and contained 101 questions that were divided into sections regarding general information about the consulting practice; general cattle management; receiving cattle management, diet adaption; mixers, feed mills, and feeding management; grains and grain processing; grain by-product use; roughage use; information about supplements and microingredients; liquid feed use; nutrient formulation; feed additive use; and information used as a basis for nutritional recommendations. In most cases, the results of the current survey were similar to those reported for the 2007 survey, with a few notable exceptions such as shifts in cattle numbers and preferences for specific feedstuffs. The present study introduced a number of new questions not included in the 2007 survey that focused on management strategies used in the receiving period. Data from this survey provide insight into current nutritional and management practices of consulting nutritionists and, as in past surveys, should be useful for informing national committees that make nutritional recommendations for cattle, as well as nutrition and management strategies employed within university research settings.

Effects of dietary urea concentration and zilpaterol hydrochloride on performance and carcass characteristics of finishing steers.

Cattle receiving zilpaterol hydrochloride () may recycle less N and require a greater supply of RDP. This study evaluated effects of ZH on performance and carcass characteristics of steers fed diets with increasing dietary RDP concentrations supplied as urea. Steers (429 animals; BW = 423 ± 4.5 kg) were sorted into 3 blocks according to BW and assigned to 1 of 6 treatments (6 pens per treatment) in a randomized complete block design. Treatments were a 2 × 3 factorial arrangement of either no ZH or ZH (75 mg ZH per steer daily) supplemented to finishing diets containing 0, 0.5, or 1.0% urea of dietary DM. Pen weights were recorded before treatment initiation; urea was fed for 27 d, and ZH treatments were fed for 24 d with a 3-d withdrawal period. Pen weights were recorded before transporting steers to a commercial abattoir. Continuous response variables were analyzed using the MIXED procedure and categorical data were analyzed using the GLIMMIX procedure of SAS. No ZH × dietary urea interactions ( ≥ 0.14) occurred for all performance and carcass response variables. Feeding ZH for the last 27 d (included a 3-d withdrawal period) of the finishing period increased ( < 0.01) ADG, decreased ( < 0.01) DMI, and increased ( < 0.01) G:F compared with no ZH. In addition, ZH increased HCW ( < 0.01), dressing percentage ( < 0.01), LM area ( < 0.01), and decreased ( = 0.01) yield grade. Increasing dietary urea linearly decreased ( = 0.01) ADG and DMI. A tendency for a linear decrease ( = 0.10) in HCW, and a tendency for a quadratic increase ( = 0.07) in marbling score were observed as urea increased in the diet. Results indicate that cattle supplemented with ZH do not require additional RDP in the diet, and that performance and carcass characteristics were negatively affected when urea was increased in the diet.

Stability of rating scale response category interpretations in neurological disorders.

OBJECTIVES: Unambiguous use and interpretation of rating scale data assume that response categories are interpreted and work as intended. This study investigated the stability of interpretations of commonly used patient-reported rating scale response categories among people with neurological disorders. MATERIALS AND METHODS: Forty-six people with neurological disorders (26 men; mean age, 57; Parkinson's disease, 50%; multiple sclerosis, 41%) indicated their interpretation of 21 response categories (representing frequencies, intensities and levels of agreement) on 100-mm visual analog scales (VAS) at two occasions, ≥2 weeks apart. Data were analyzed using intraclass correlation and weighted Kappa (ICC/Κw ; should be >0.4), mean/median differences, percentages agreement (PA), and the standard error of measurement (SEM). RESULTS: Most response categories had ICC/Κw values <0.4. The overall average ICC/Κw was 0.279/0.294 (frequencies, 0.224/0.255; intensities, 0.265/0.251; levels of agreement, 0.362/0.376). The mean/median difference between time points across all 21 categories was 0.43/0.5 mm (mean/median absolute difference, 3.36/9 mm). The overall average PA and SEM were 6.5% and 16.1 mm, respectively. CONCLUSIONS: Stabilities in interpretations of patient-reported rating scale response categories among people with neurological disorders were generally low. Categories expressing levels of agreement showed best results, suggesting that these may be preferable when appropriate with respect to the scale and its items. Future studies should consider response category interpretations in relation to various contexts. These observations suggest caution when interpreting raw rating scale data and argue for the use of modern rating scale methodologies such as the Rasch measurement model.

The Richmond Agitation-Sedation Scale: translation and reliability testing in a Swedish intensive care unit.

BACKGROUND: Awareness about adequate sedation in mechanically ventilated patients has increased in recent years. The use of a sedation scale to continually evaluate the patient's response to sedation may promote earlier extubation and may subsequently have a positive effect on the length of stay in the intensive care unit (ICU). The Richmond Agitation-Sedation Scale (RASS) provides 10 well-defined levels divided into two different segments, including criteria for levels of sedation and agitation. Previous studies of the RASS have shown it to have strong reliability and validity. The aim of this study was to translate the RASS into Swedish and to test the inter-rater reliability of the scale in a Swedish ICU. METHODS: A translation of the RASS from English into Swedish was carried out, including back-translation, critical review and pilot testing. The inter-rater reliability testing was conducted in a general ICU at a university hospital in the south of Sweden, including 15 patients mechanically ventilated and sedated. Forty in-pair assessments using the Swedish version of the RASS were performed and the inter-rater reliability was tested using weighted kappa statistics (linear weighting). RESULT: The translation of the RASS was successful and the Swedish version was found to be satisfactory and applicable in the ICU. When tested for inter-rater reliability, the weighed kappa value was 0.86. CONCLUSION: This study indicates that the Swedish version of the RASS is applicable with good inter-rater reliability, suggesting that the RASS can be useful for sedation assessment of patients mechanically ventilated in Swedish general ICUs.

The knee in full flexion: an anatomical study.

There has been only one limited report dating from 1941 using dissection which has described the tibiofemoral joint between 120 degrees and 160 degrees of flexion despite the relevance of this arc to total knee replacement. We now provide a full description having examined one living and eight cadaver knees using MRI, dissection and previously published cryosections in one knee. In the range of flexion from 120 degrees to 160 degrees the flexion facet centre of the medial femoral condyle moves back 5 mm and rises up on to the posterior horn of the medial meniscus. At 160 degrees the posterior horn is compressed in a synovial recess between the femoral cortex and the tibia. This limits flexion. The lateral femoral condyle also rolls back with the posterior horn of the lateral meniscus moving with the condyle. Both move down over the posterior tibia at 160 degrees of flexion. Neither the events between 120 degrees and 160 degrees nor the anatomy at 160 degrees could result from a continuation of the kinematics up to 120 degrees . Therefore hyperflexion is a separate arc. The anatomical and functional features of this arc suggest that it would be difficult to design an implant for total knee replacement giving physiological movement from 0 degrees to 160 degrees .

Light vs. heavy sedation during mechanical ventilation after oesophagectomy--a pilot experimental study focusing on memory.

BACKGROUND: To assess and compare the feasibility and stressful memories of light vs. heavy sedation during post-operative mechanical ventilation. METHODS: Randomized clinical trial in one general intensive care unit (ICU) in a Swedish university hospital. Thirty-six adults were randomly assigned to receive either light [Motor Activity Assessment Scale (MAAS) 3-4] or heavy (MAAS 1-2) sedation with continuous i.v. infusion of propofol during post-operative invasive mechanical ventilation after oesophagectomy. The patients were interviewed at the general ward 5 days post-ICU using the ICU Memory Tool and the ICU Stressful Experience Questionnaire, and 2 months post-ICU using the Impact of Event Scale Revised. Patient data and hourly recorded MAAS values were collected after the interviews. RESULTS: Seventy-four per cent of the 139 MAAS values in the light sedation group (n=18) and 79% of the 142 in the heavy sedation group (n=18) were within the targeted levels, and the median MAAS scores were 3.0 vs. 1.25, respectively. Intention-to-treat analyses showed no significant difference in the prevalence of stressful memories between groups, including endotracheal tube discomfort, presenting wide 95% confidence intervals for the difference in outcome estimates. Excluding the patients with a prolonged ICU stay (n=3), a higher prevalence of delusional memories was found in the heavy sedation group (31% vs. 0%, P=0.04). CONCLUSIONS: This small randomized-controlled pilot study suggests that a light sedation regimen during short-term post-operative mechanical ventilation after major surgery is feasible without increasing patient discomfort.

Stressful memories and psychological distress in adult mechanically ventilated intensive care patients - a 2-month follow-up study.

AIM: To investigate patients' psychological distress in relation to memory and stressful experiences in the intensive care unit (ICU), and to identify early predictors for the development of high levels of acute post-traumatic stress disorder (PTSD)-related symptoms. METHODS: A prospective cohort study was performed over 18 months in two general ICUs, including 313 intubated mechanically ventilated adults admitted for more than 24 h, 226 of whom completed the study. Patients were interviewed 5 days and 2 months post-ICU concerning their memories and psychological distress. The instruments used were the ICU Memory Tool, ICU Stressful Experience Questionnaire, Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised (IES-R). RESULTS: High symptom levels of anxiety, depression and acute PTSD 2 months post-ICU were present in 4.9%, 7.5% and 8.4% of the 226 patients, respectively. Psychological distress 2 months post-ICU was associated with experiences of the ICU rated as extremely stressful and with high levels of anxiety and depression 5 days post-ICU, but not with amnesia or delusional memories without factual recall of the ICU. Female sex, signs of agitation (increasing proportion of Motor Activity Assessment Scale scores of 4-6) and feelings of extreme fear during the ICU stay were significantly and independently associated with IES-R scores of 30 or more. CONCLUSIONS: Extremely stressful experiences of the ICU are associated with subsequent psychological distress. Female sex, agitation and extreme fear during the ICU stay seem to increase the risk of developing high levels of acute PTSD-related symptoms.

Analysis of lymph nodes for polyethylene particles in patients who have had a primary joint replacement.

Polarized light microscopy has been used for more than forty years to identify polyethylene particles in histological specimens; however, few investigators have assessed the specificity of this technique. We examined specimens from dissected lymph nodes for the presence of strongly birefringent particles resembling polyethylene. Twenty-seven patients had dissection of lymph nodes after a total joint replacement (Group 1), and a control group of eighteen patients had dissection of lymph nodes before a total joint replacement (Group 2). Specimens from both groups of lymph nodes were examined under plain and polarized light. The presence of strongly birefringent particulate debris was graded from 0 to 4. Twenty-one (78 per cent) of the twenty-seven patients in Group 1 and eight of the eighteen patients in Group 2 had strongly birefringent particles in the lymph nodes. Our results demonstrate that, in the assessment of the systemic dissemination of polyethylene in the lymphoreticular system, polarized light microscopy has important limitations. More refined techniques employing polarized light and other methods of physical and chemical analysis may be necessary to identify polyethylene particles accurately within the lymphoreticular system and periprosthetic tissue.

Acetabular revision with the Burch-Schnieder antiprotrusio cage and cancellous allograft bone.

A retrospective review of 25 patients who underwent 28 acetabular revisions with the Burch-Schnieder antiprotrusio cage (Protek, Berne, Switzerland) and cancellous allograft bone was performed. Follow-up periods averaged 33 months. Patients had averaged 2.1 prior operations per hip. Twenty-two hips had American Academy of Orthopaedic Surgeons type III (combined segmental and cavitary bone loss) acetabular deficiency. Five hips had type II (cavitary bone loss) and one hip had type I (segmental bone loss) acetabular deficiency. After surgery, 80% of the patients had mild or no pain and 80% functioned as at least a community ambulator. Radiographic analysis included a detailed study of implant migration and the degree to which the hip center and bone stock were restored. Significant component migration was documented in 14% of the acetabular reconstructions. The hip center was improved from a preoperative side-to-side difference of 12.5 mm to 4.9 mm at final evaluation (P = .01). Average medial wall bone stock was improved from 1.9 mm before surgery to 10.1 mm postrevision (P < .01). No patients required revision of the antiprotrusio cage for problems related to the acetabular reconstruction. For failed acetabular components associated with moderate to massive bone loss, the antiprotrusio cage reliably reconstituted the hip joint center and acetabular bone stock. The short-term incidence of mechanical loosening parallels that of previously reported acetabular reconstruction techniques.

Blood pressure reduction during hemodialysis correlates to intradialytic changes in plasma volume.

Blood pressure alterations during hemodialysis were related to changes in body fluid in 14 patients with chronic renal failure. Changes in plasma volume (PV) and extracellular volume (ECV) were calculated from determinations of fluid volumes before and after hemodialysis, using 125I-albumin and 51Cr EDTA respectively. Reduction in body water was estimated from body weight changes. Weight loss was 3.3 +/- 0.3 kg (range 1.8-6.0 kg). The relative reduction of fluid was greater in the ECV, 21.6 +/- 3.2%, compared to plasma volume, 6.9 +/- 1.8%. The reduction in systolic blood pressure was related to both absolute (r = 0.66, p less than 0.05) and relative PV reduction (r = 0.72, p less than 0.02). There was no correlation between blood pressure reduction and weight loss or ECV changes. Only minor alterations were found in diastolic blood pressure. Plasma volume maintenance relates to blood pressure changes. Plasma volume monitoring could be useful for improving intradialytic hemodynamic control.

Serum primary bile acids in the course of celiac disease in children.

Serum concentrations of primary bile acids (BAs) were determined in the course of celiac disease and in healthy age-matched controls. Determinations of BAs were made by radioimmunoassays after an overnight fasting and for 4 h postprandially after intake of a standardized test meal. In untreated celiac disease presenting with subtotal villous atrophy, peak concentrations of primary BAs were significantly delayed and serum levels were significantly higher than in controls. Small but significant abnormalities persisted after a period of gluten-free diet despite a normalization of mucosal morphology. Slightly pathological standard liver function tests in five patients were related to increased fasting levels but not to the postprandial pattern of BAs, indicating that the observed abnormalities postprandially were not related to liver disease. Further studies simultaneously focusing on deconjugation mechanisms, absorption, and pool sizes of BAs are required to explain the postprandial BA pattern under the course of celiac disease.

An all-polyethylene cementless tibial component. A five- to nine-year follow-up study.

An all-polyethylene cementless tibial component was used in 221 total knee arthroplasties. With one exception, failures did not occur before three years. Failure was characterized by medial subsidence of the tibial component. There was abrasion of the polyethylene on the undersurface of all components that failed. Survivorship was seven to nine years (87.1%). This study demonstrated that a flexible cementless component can function well when used with any type of bone. However, abrasion of the polyethylene that occurs from shearing forces is a concern. Polyethylene components need adequate provisions to prevent shearing or need surface treatment to prevent abrasion.

Whole body impedance measurements reflect total body water changes. A study in hemodialysis patients.

Fluid volume changes during hemodialysis was monitored by continuous whole body impedance measurements. The fluid changes recorded using this method was compared to fluid volume changes measured in plasma water (PV) using 125I-albumin, and extracellular volume (ECV) using 51Cr-EDTA before and after treatment, and total body water (TBW) changes reflected by continuous bed scale monitoring. Changes in impedance correlated to TBW changes, r = 0.80, p less than 0.001, while correlations to changes in ECV and PV were: r = 0.57 and r = 0.55, respectively, p less than 0.05. Alterations in body fluid volumes recorded with whole body impedance is best correlated to total body water changes. The use of continuous whole body impedance monitoring has been shown to offer a simple non-invasive method for recording total body water changes during hemodialysis.

Relationship between interdigestive gallbladder emptying, plasma motilin and migrating motor complex in man.

The aim of this study was to elucidate the importance of biliary output for the regulation of migrating motor complex and the release of plasma motilin. Gallbladder emptying was monitored by hepatobiliary scintigraphy, plasma motilin concentration by radioimmunoassay and gastrointestinal motility by a perfused catheter system. During a total recording time of 46 h and 20 min in 16 volunteers, we observed 29 episodes of gallbladder emptying, 27 plasma motilin peaks and 23 activity fronts (phase 3 activity) of the migrating motor complex (MMC). Twelve episodes of gallbladder emptying started in phase 1 and continued into phase 2 of the MMC. The remaining 17 episodes of gallbladder emptying started in phase 2, and three of these continued into phase 3 of the MMC. Biliary output was associated with a significant rise in plasma motilin concentration, whereas plasma motilin significantly decreased after the activity fronts. These observations may explain the well-known fluctuations of plasma motilin concentration in the fasted state. Motilin is released into the circulation as a result of biliary output, while the ensuing activity front of the MMC removes this stimulant from the proximal small bowel, resulting in a fall in plasma motilin. In conclusion, we have confirmed a temporal relationship between biliary output into the duodenum and the release of plasma motilin. The observed transition from phase 1 to phase 2 and from phase 2 to phase 3 of the MMC during gallbladder emptying episodes suggests that biliary output stimulates gastrointestinal motility in the fasted state.

The patellofemoral joint in total knee prostheses. Design considerations.

Some desirable design features of the patellofemoral joint in a total knee arthroplasty condylar prosthesis are proposed. These are that the femoral element should be grooved, have a high anterior flange, and be circular as viewed from the side. The groove should be about 5 mm deep and have relatively vertical walls. The patellar component should have a saddle-shaped articular surface matching the femur and should be countersunk into the patella. The components should be placed so as to position the joint automatically. Results with such a design are reported; loosening, wear, dislocation, and fracture have been rare. Osteolysis of the patella has not been seen after 9 years, so that the cementless press-fit fixation of an H.D.P. patellar prosthesis to date seems safe and efficacious.

Homograft bone in revision acetabular arthroplasty. A clinical and radiographic study.

Thirty-seven patients with extensive acetabular defects due to loose implants had revisions with uncemented components, the acetabulum being augmented with homograft bone. In six of these, a histological study of graft incorporation was made. At a mean follow-up of 1.5 years 34 patients were free of pain and 35 could walk for 30 minutes or longer. No graft had obviously sequestrated. Two components had radiological evidence of migration but remain asymptomatic. We conclude that cementless revision surgery with homograft supplementation of the acetabulum is clinically successful in the short-term. The long-term outcome is unknown.

Bone grafting and noncemented revision arthroplasty of the knee.

Revision of failed cemented total knee arthroplasties with cementless stemmed components and allogeneic bone grafts was performed on 22 patients, with clinical results comparable to those in primary arthroplasty. On roentgenograms, most of the allogeneic grafts appeared to be incorporated in the host bone. Various bone reactions not fitting any particular pattern, occurred around the stems.