Dexamethasone prescribing for cancer pain between palliative care and radiation oncology.

PURPOSE: Dexamethasone is a commonly prescribed corticosteroid by both palliative care physicians and radiation oncologists for the treatment of metastatic cancer pain. However, clinical evidence for dexamethasone dose and efficacy is lacking, and prescribing between these different specialties may be influenced by other factors. This study investigates the dexamethasone prescriptions of palliative care physicians and radiation oncologists for cancer pain and their prescription rationales. METHODS: Palliative care physicians and radiation oncologists in British Columbia, Canada, were surveyed on their preferred dexamethasone prescription in response to 4 case vignettes of patients with metastatic cancer and asked to choose a rationale from a list of options which were then categorized as "habit-based," "results-based," or "evidence-based." Response frequencies between the specialties were compared with odds ratios. RESULTS: The total daily dose and duration of dexamethasone prescriptions were similar between the specialties. Palliative care physicians were significantly more likely than radiation oncologists to prescribe a single daily dose of dexamethasone rather than a divided dose (OR 3.3 [95% CI 2.0-5.5]). This significant difference persisted when separately analyzing results at different total daily doses. Both specialties were more likely to select habit-based rationales rather than evidence-based rationales, with no significant difference between specialties. CONCLUSION: These findings show that dexamethasone prescriptions are habit-based and that prescribing habits are different between palliative care physicians and radiation oncologists. Interventions based on these findings could potentially prevent unequal patient care. Further qualitative investigations of physician perceptions are indicated to better understand habit-based corticosteroid prescribing patterns.

Birth conditions affect the longevity of Holstein offspring.

Studies of dairy cow longevity usually focus on the animal life after first calving, with few studies considering early life conditions and their effects on longevity. The objective was to evaluate the effect of birth conditions routinely collected by Dairy Herd Improvement agencies on offspring longevity measured as length of life and length of productive life. Lactanet provided 712,890 records on offspring born in 5,425 Quebec dairy herds between January 1999 and November 2015 for length of life, and 506,066 records on offspring born in 5,089 Quebec dairy herds between January 1999 and December 2013 for length of productive life. Offspring birth conditions used in this study were calving ease (unassisted, pull, surgery, or malpresentation), calf size (small, medium, or large), and twinning (yes or no). Observations were considered censored if the culling reason was "exported," "sold for dairy production," or "rented out" as well as if the animals were not yet culled at the time of data extraction. If offspring were not yet culled when the data were extracted, the last test-day date was considered the censoring date. Conditional inference survival trees were used in this study to analyze the effect of offspring birth conditions on offspring longevity. The hazard ratio of culling between the groups of offspring identified by the survival trees was estimated using a Cox proportional hazard model with herd-year-season as a frailty term. Five offspring groups were identified with different length of life based on their birth condition. Offspring with the highest length of life [median = 3.61 year; median absolute deviation (MAD) = 1.86] were those classified as large or medium birth size and were also the result of an unassisted calving. Small offspring as a result of a twin birth had the lowest length of life (median = 2.20 year; MAD = 1.69) and were 1.52 times more likely to be culled early in life. Six groups were identified with different length of productive life. Offspring that resulted from an unassisted or surgery calving and classified as large or medium when they were born were in the group with the highest length of productive life (median = 2.03 year; MAD = 1.63). Offspring resulting from a malpresentation or pull in a twin birth were in the group with the lowest length of productive life (median = 1.15 year; MAD = 1.11) and were 1.70 times more likely to be culled early in life. In conclusion, birth conditions of calving ease, calf size, and twinning greatly affected offspring longevity, and such information could be used for early selection of replacement candidates.

Erratum: Dallago et al. Keeping Dairy Cows for Longer: A Critical Literature Review on Dairy Cow Longevity in High Milk-Producing Countries. Animals 2021, 11, 808.

In the original article [...].

Integrated Decision Support Systems (IDSS) for Dairy Farming: A Discussion on How to Improve Their Sustained Adoption.

Dairy farm decision support systems (DSS) are tools which help dairy farmers to solve complex problems by improving the decision-making processes. In this paper, we are interested in newer generation, integrated DSS (IDSS), which additionally and concurrently: (1) receive continuous data feed from on-farm and off-farm data collection systems and (2) integrate more than one data stream to produce insightful outcomes. The scientific community and the allied dairy community have not been successful in developing, disseminating, and promoting a sustained adoption of IDSS. Thus, this paper identifies barriers to adoption as well as factors that would promote the sustained adoption of IDSS. The main barriers to adoption discussed include perceived lack of a good value proposition, complexities of practical application, and ease of use; and IDSS challenges related to data collection, data standards, data integration, and data shareability. Success in the sustainable adoption of IDSS depends on solving these problems and also addressing intrinsic issues related to the development, maintenance, and functioning of IDSS. There is a need for coordinated action by all the main stakeholders in the dairy sector to realize the potential benefits of IDSS, including all important players in the dairy industry production and distribution chain.

Keeping Dairy Cows for Longer: A Critical Literature Review on Dairy Cow Longevity in High Milk-Producing Countries.

The ability of dairy farmers to keep their cows for longer could positively enhance the economic performance of the farms, reduce the environmental footprint of the milk industry, and overall help in justifying a sustainable use of animals for food production. However, there is little published on the current status of cow longevity and we hypothesized that a reason may be a lack of standardization and an over narrow focus of the longevity measure itself. The objectives of this critical literature review were: (1) to review metrics used to measure dairy cow longevity; (2) to describe the status of longevity in high milk-producing countries. Current metrics are limited to either the length of time the animal remains in the herd or if it is alive at a given time. To overcome such a limitation, dairy cow longevity should be defined as an animal having an early age at first calving and a long productive life spent in profitable milk production. Combining age at first calving, length of productive life, and margin over all costs would provide a more comprehensive evaluation of longevity by covering both early life conditions and the length of time the animal remains in the herd once it starts to contribute to the farm revenues, as well as the overall animal health and quality of life. This review confirms that dairy cow longevity has decreased in most high milk-producing countries over time and its relationship with milk yield is not straight forward. Increasing cow longevity by reducing involuntary culling would cut health costs, increase cow lifetime profitability, improve animal welfare, and could contribute towards a more sustainable dairy industry while optimizing dairy farmers' efficiency in the overall use of resources available.

Origin of Enhanced Cyclability in Covalently Modified LiMn1.5Ni0.5O4 Cathodes.

High-voltage lithium-ion cathode materials exhibit exceptional energy densities; however, rapid capacity fade during cell cycling prohibits their widespread utilization. Surface modification of cathode-active materials by organic self-assembled monolayers (SAMs) has emerged as an approach to improve the longevity of high-voltage electrodes; however, the surface chemistry at the electrode/electrolyte interphase and its dependence on monolayer structure remains unclear. Herein, we investigate the interplay between monolayer structure, electrochemical performance, and surface chemistry of high-voltage LiMn1.5Ni0.5O4 (LMNO) electrodes by the application of silane-based SAMs of variable length and chemical composition. We demonstrate that the application of both hydrophobic and hydrophilic monolayers results in improved galvanostatic capacity retention relative to unmodified LMNO. The extent of this improvement is tied to the structure of the monolayer with fluorinated alkyl-silanes exhibiting the greatest overall capacity retention, above 96% after 100 charge/discharge cycles. Postmortem surface analysis reveals that the presence of the monolayer enhances the deposition of LiF at the electrode surface during cell cycling and that the total surface concentration correlates with the overall improvements in capacity retention. We propose that the enhanced deposition of highly insulating LiF increases the anodic stability of the interphase, contributing to the improved galvanostatic performance of modified electrodes. Moreover, this work demonstrates that the modification of the electrode surface by the selection of an appropriate monolayer is an effective approach to tune the properties and behavior of the electrode/electrolyte interphase formed during battery operation.

Marginal structural Cox model to estimate the causal effect of clinical mastitis on Québec dairy cow culling risk.

Health disorders, such as milk fever, displaced abomasum, or retained placenta, as well as poor reproductive performance, are known risk factors for culling in dairy cows. Clinical mastitis (CM) is one of the most influential culling risk factors. However the culling decision could be based either on the disease status or on the current milk yield, milk production being a significant confounder when modelling dairy cow culling risk. But milk yield (and somatic cell count) are time-varying confounders, which are also affected by prior CM and therefore lie on the causal pathway between the exposure of interest, CM, and the outcome, culling. Including these time-varying confounders could result in biased estimates. A marginal structural model (MSM) is a statistical technique allowing estimation of the causal effect of a time-varying exposure in the presence of time-varying covariates without conditioning on these covariates. The objective of this paper is to estimate the causal effect on culling of CM occurring between calving and 120 days in milk, using MSM to control for such time-varying confounders affected by previous exposure. A retrospective longitudinal study was conducted on data from dairy herds in the Province of Québec, Canada, by extracting health information events from the dairy herd health management software used by most Québec dairy producers and their veterinarians. The data were extracted for all lactations starting between January 1st and December 31st, 2010. A total of 3952 heifers and 8724 cows from 261 herds met the inclusion criteria and were used in the analysis. The estimated CM causal hazard ratios were 1.96 [1.57-2.44] and 1.47 [1.28-1.69] for heifers and cows, respectively, and as long as causal assumptions hold. Our findings confirm that CM was a risk factor for culling, but with a reduced effect compared to previous studies, which did not properly control for the presence of time-dependent confounders such as milk yield and somatic cell count. Cows experienced a lower risk for CM, with milk production having more influence on culling risk in cows than heifers.

Culling from the herd's perspective-Exploring herd-level management factors and culling rates in Québec dairy herds.

The relationship between cows' health, reproductive performance or disorders and their longevity is well demonstrated in the literature. However these associations at the cow level might not hold true at the herd level, and herd-level variables can modify cow-level outcomes independently of the cows' characteristics. The interaction between cow-level and herd-level variables is a relevant issue for understanding the culling of dairy cows. However it requires the appropriate group-level variables to assess any contextual effect. Based on 10 years of health and production data, the objectives of this paper are:(a) to quantify the culling rates of dairy herds in Québec; (b) to determine the profiles of the herds based on herd-level factors, such as demographics, reproduction, production and health indicators, and whether these profiles can be related to herd culling rates for use as potential contextual variables in multilevel modelling of culling risk. A retrospective longitudinal study was conducted on data from dairy herds in Québec, Canada, by extracting health information events from the dairy herd health management software used by most Québec producers and their veterinarians. Data were extracted for all lactations taking place between January 1st, 2001 and December 31st, 2010. A total of 432,733 lactations from 156,409 cows out of 763 herds were available for analysis. Thirty cow-level variables were aggregated for each herd and years of follow-up, and their relationship was investigated by Multiple Factor Analysis (MFA). The overall annual culling rate was 32%, with a 95% confidence interval (CI) of [31.6%,32.5%]. The dairy sale rate by 60 days in milk (DIM) was 3.2% [2.8%,3.6%]. The annual culling rate within 60 DIM was 8.2% [7.9%,8.4%]. The explained variance for each axis from the MFA was very low: 14.8% for the first axis and 13.1% for the second. From the MFA results, we conclude there is no relationship between the groups of herd-level indicators, demonstrating the heterogeneity among herds for their demographics, reproduction and production performance, and health status. However, based on Principal Component Analysis (PCA), the profiles of herds could be determined according to specific, single, herd-level indicators independently. The relationships between culling rates and specific herd-level variables within factors were limited to livestock sales, proportion of first lactation cows, herd size, proportion of calvings occurring in the fall, longer calving intervals and reduced 21-day pregnancy rates, increased days to first service, average age at first calving, and reduced milk fever incidence. The indicators found could be considered as contextual variables in multilevel model-building strategies to investigate cow culling risk.

Culling from the actors' perspectives-Decision-making criteria for culling in Québec dairy herds enrolled in a veterinary preventive medicine program.

The series of events leading to the decision to cull a cow is complex, involving both individual-level and herd-level factors. While the decision is guided by financial returns, it is also influenced by social and psychological factors. Research studies on the motivational and behavioural aspects of farmers' decision utility are sparse, and nonexistent regarding culling expectations and its decision process. Our goal was to identify shared criteria on culling decisions held by dairy producers and farm advisers, with the help of the Q-methodology. Forty-one dairy producers and 42 advisers (17 veterinarians, 13 feed mill advisers, and 12 dairy herd improvement (DHI) advisers) undertook a Q-sort with 40 statements that represented a range of views about cow and herd health, production performance, management issues, and material factors that might impact their culling decision-making process. The sorts were analysed by-person using factor analysis and oblimin rotation. A single view on culling could be identified among dairy producers that can be extended to dairy farm advisers, who showed two variations of the same well-structured, uni-dimensional decision-making process. Udder health, milk production performance, and milk quota management were the key criteria for the culling decision. Farm management parameters (debts, amortization, employees, milking parlour capacity, herd size) did not play any role in the decision process. Three key differences were, however, identified between producers and the two types of advisers. One group of advisers followed the recommendations from mathematical models, where pregnancy is a major determinant of a cow's value. They assessed the cow in a more abstract way than did the other participants, still taking into account udder health and milk production, but adding economic considerations, like the availability of financial incentives and an evaluation of the post-partum health of the cow. Dairy producers were also more concerned about producing healthy and safe milk, which might reflect a different value given to dairy farming than by advisers. Very different degrees of importance were given to animal welfare by the three groups, which could represent different views on the attributed relationships between dairy farmers and their animals. Our findings suggest that dairy producers and their advisers hold a general common view regarding culling decision-making. However there are significant differences between producers and advisers, and among advisers. Understanding and managing these differences is important for assisting the change management processes required to increase farm profitability, and call for further investigation.

Contextual herd factors associated with cow culling risk in Québec dairy herds: A multilevel analysis.

Several health disorders, such as milk fever, displaced abomasum, and mastitis, as well as impaired reproductive performance, are known risk factors for the removal of affected cows from a dairy herd. While cow-level risk factors are well documented in the literature, herd-level associations have been less frequently investigated. The objective of this study was to investigate the effect of cow- and herd-level determinants on variations in culling risk in Québec dairy herds: whether herd influences a cow's culling risk. For this, we assessed the influence of herd membership on cow culling risk according to displaced abomasum, milk fever, and retained placenta. A retrospective longitudinal study was conducted on data from dairy herds in the Province of Québec, Canada, by extracting health information events from the dairy herd health management software used by most Québec dairy producers and their veterinarians. Data were extracted for all lactations starting between January 1st and December 31st, 2010. Using multilevel logistic regression, we analysed a total of 10,529 cows from 201 herds that met the inclusion criteria. Milk fever and displaced abomasum were demonstrated to increase the cow culling risk. A minor general herd effect was found for the culling risk (i.e. an intra-class correlation of 1.0% and median odds ratio [MOR] of 1.20). The proportion of first lactation cows was responsible for this significant, but weak herd effect on individual cow culling risk, after taking into account the cow-level factors. On the other hand, the herd's average milk production was a protective factor. The planning and management of forthcoming replacement animals has to be taken into consideration when assessing cow culling risks and herd culling rates.