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Background. Early intervention in psychosis (EIP) services target the early manifestation of psychosis and provide multidisciplinary care. They demonstrate effectiveness and cost-effectiveness. Implementation of EIP services is inconsistent and piecemeal. This systematic review and narrative synthesis aims to identify barriers and facilitators to EIP service implementation. Methods. We conducted an electronic search of databases (EMBASE, Medline, Web of Science, and PsychINFO) to detect papers reporting EIP service implementation findings and associated barriers and facilitators. The search occurred between June to August 2020, and again in January 2021. Articles meeting inclusion criteria were extracted and narratively synthesized. A quality assessment was conducted using the Mixed Methods Appraisal Tool. Results. Twenty-three studies were selected. The most common study design was descriptive accounts of implementation. Patient age ranged varied from 14 to 35 years. We identified three barrier and facilitator domains: (a) system; (b) services; and (c) staff, and a range of subdomains. The most frequent subdomains were “funding” and “strength of collaboration and communication between EIP and outside groups and services”. Associations between domains and subdomains were evident, particularly between systems and services. Conclusions. A range of barriers and facilitators to EIP implementation exist. Some of these are generic factors germane across health systems and services, while others are specific to EIP services. A thorough prior understanding of these challenges and enablers are necessary before implementation is attempted. Accounting for these issues within local and national contexts may help predict and increase the likelihood of services’ success, stability, and longevity. [ABSTRACT FROM AUTHOR]

Background: Fungal otitis externa is prevalent in tropical and sub-tropical climates; however, over the past two decades, there has been a reported increase in the prevalence of otomycosis in paediatric patients from more temperate climates. This study aimed to review the children diagnosed with otomycosis at the University Hospital Limerick with reference to frequency, causative organism, predisposing factors and management. Methods: A retrospective review was conducted of paediatric patients from 2001 to 2015. Patients with positive fungal ear swabs and a diagnosis of otomycosis were identified. Results: Ninety-three patients were positive for candida (mean age, 5.8 years), 10 patients were positive for aspergillus (mean age, 9.1 years) and 1 patient had mixed fungal infection containing both fungi. There was a positive correlation between a diagnosis of otomycosis and prior treatment with topical fluoroquinolones (r = 0.8; p < 0.01). Conclusion: The incidence of otomycosis has been increasing since 2001, which correlates with an increase in the use of topical fluoroquinolones. Previous studies identify aspergillus as the commonest causative fungi; however, this study found that candida was the commonest isolated fungi in the paediatric population. [ABSTRACT FROM AUTHOR]

With the escalation of hospital-acquired infections by multidrug resistant bacteria, understanding antibiotic resistance is of paramount importance. This study focuses on the β-lactamase gene, bla OXA-58, an important resistance determinant identified in a patient-facing hospital wastewater system. This study aimed to characterize the behaviour of the OXA-58 enzyme when expressed using a non-native plasmid and expression host. bla OXA-58 was cloned using a pET28a(+)/ Escherichia coli BL21(DE3) expression system. Nitrocefin hydrolysis and antimicrobial susceptibility of OXA-58-producing cells were assessed against penicillin G, ampicillin, meropenem, and amoxicillin. bla OXA-58 conferred resistance to amoxicillin, penicillin G, and ampicillin, but not to meropenem. This was unexpected given OXA-58's annotation as a carbapenemase. The presence of meropenem also reduced nitrocefin hydrolysis, suggesting it acts as a competitive inhibitor of the OXA-58 enzyme. This study elucidates the phenotypic resistance conferred by an antimicrobial resistance gene (ARG) obtained from a clinically relevant setting and reveals that successful functional expression of ARGs is multifaceted. This study challenges the reliability of predicting antimicrobial resistance based solely on gene sequence alone, and serves as a reminder of the intricate interplay between genetics and structural factors in understanding resistance profiles across different host environments. [ABSTRACT FROM AUTHOR]

Background: Functional neurological disorder (FND), previously known as conversion disorder, is common and often results in substantial distress and disability. Previous research lacks large sample sizes and clinical surveys are most commonly derived from neurological settings, limiting our understanding of the disorder and its associations in other contexts. We sought to address this by analysing a large anonymised electronic psychiatric health record dataset. Methods: Data were obtained from 322 patients in the South London and Maudsley NHS Foundation Trust (SLaM) who had an ICD-10 diagnosis of motor FND (mFND) (limb weakness or disorders of movement or gait) between 1 January 2006 and 31 December 2016. Data were collected on a range of socio-demographic and clinical factors and compared to 644 psychiatric control patients from the same register. Results: Weakness was the most commonly occurring functional symptom. mFND patients were more likely to be female, British, married, employed pre-morbidly, to have a carer and a physical health condition, but less likely to have had an inpatient psychiatric admission or to receive benefits. No differences in self-reported sexual or physical abuse rates were observed between groups, although mFND patients were more likely to experience life events linked to inter-personal difficulties. Conclusions: mFND patients have distinct demographic characteristics compared with psychiatric controls. Experiences of abuse appear to be equally prevalent across psychiatric patient groups. This study establishes the socio-demographic and life experience profile of this understudied patient group and may be used to guide future therapeutic interventions designed specifically for mFND. [ABSTRACT FROM AUTHOR]

Stroke mimics form a significant proportion of cases in acute stroke services and some present with functional neurological disorder. Little is known about the prevalence or clinical characteristics of functional stroke mimics (FSMs). A systematic literature search and meta‐analysis were carried out on published studies reporting suspected stroke and stroke mimic rates; 114 papers met the inclusion criteria of which 70 provided an FSM rate. Random‐effects models estimated prevalence rates across settings and moderators of FSM rate. Pooled proportions indicated that 25% [95% confidence intervals (CI), 22–27%] of suspected stroke cases were stroke mimics. Within the 67 studies providing positive FSM rates, FSMs represented 15% (95% CI, 13–18%) of stroke mimics and 2% (95% CI, 2–3%) of suspected strokes. FSMs were younger and more likely to be female, and presented more with weakness/numbness but less with reduced consciousness or language problems. Stratified analyses suggested higher stroke mimic rates in primary care versus acute settings (38% vs. 12%) but higher FSM rates in stroke units compared with primary care (24% vs. 12%). Functional rates were higher in studies that were descriptive, retrospective and in patients receiving thrombolysis. Several studies reported the proportion of functional stroke patients presenting to stroke services. FSMs have discernible demographic and clinical characteristics, but there is a conspicuous lack of evidence on their presentation or guidance for treatment. The social and psychological mechanisms underlying FSM presentations need more accurate quantification to help inform stroke pathways and improve care for these patients. [ABSTRACT FROM AUTHOR]

Dual-fuel engines present an opportunity to increase the electric efficiency and fuel flexibility of combined-heat-and-power (CHP) units. It is becoming increasingly important to find alternative liquid fuels, which can be used as a pilot fuel is such units. While being able to be produced from renewable sources, polyoxymethylenedimethylethers (PODE , OME or POMDME) also provide promising combustion characteristics, such as reducing particle matter emissions (PM). However, little knowledge exists regarding the utilisation of these fuels in full-scale engines, as used in CHP-units. Therefore, we investigated the performance, combustion behaviour and exhaust emissions of a dual-fuel CHP-engine operating with biomethane as main fuel and a 50/50-PODE-blend and neat diesel as pilot fuel. The injection behaviour of the PODE -diesel-blends was investigated on a common-rail-injection test-bench. When replicating small injection quantities, as required for pilot injection, the injection rate was found to be almost identical when comparing diesel and the PODE -diesel-blend. The pilot fuel quantity showed to be decisive for performance and emissions of the engine. When keeping the injected energy equal between the PODE-blend and diesel, the NO X -emissions increased by up to 45% and the PM-emissions decreased by up to 67%, while the efficiency of the engine increased by up to 2.5%. • Dual fuel CHP unit running on biomethane and PODE-diesel blend as pilot fuel. • Almost identical injection rate of diesel and PODE-blend when injecting small quantities. • Decrease of PM emissions when using PODE-diesel-blend as pilot fuel. • Increase of BTE when using PODE-diesel blend as pilot fuel. • Gas combustion is faster when PODE-diesel-blend is used as pilot fuel. [ABSTRACT FROM AUTHOR]

Because negative energy balance (EB) contributes to transition-period immune dysfunction in dairy cows, dietary management strategies should aim to minimize negative EB during this time. Prepartum diets that oversupply energy may exacerbate negative EB in early lactation, with detrimental effects on immune function. However, with lower body condition score (BCS) cows, it has been shown that offering concentrates in addition to a grass silage-based diet when confined during an 8-wk dry period resulted in increased neutrophil function in early lactation. The aim of this study was to examine if similar benefits occur when concentrate feeding was restricted to a 4-wk period prepartum. Twenty-six multiparous and 22 primiparous Holstein-Friesian cows were offered ad libitum access to medium-quality grass silage until 28 d before their predicted calving dates (actual mean of 32 d prepartum; standard deviation = 6.4). At this time multiparous cows had a mean BCS of 2.9 (standard deviation = 0.12) and primiparous cows a mean BCS of 3.0 (standard deviation = 0.14) on a 1 to 5 scale. Cows were then allocated in a balanced manner to 1 of 2 treatments (13 multiparous cows and 11 primiparous cows on each treatment): silage only (SO) or silage plus concentrates (S+C) until calving. Cows on SO were offered the same grass silage ad libitum. Cows on S+C were offered an ad libitum mixed ration of the same grass silage and additional concentrates in a 60:40 dry matter (DM) ratio, which provided a mean concentrate DM intake (DMI) of 4.5 kg/cow per d. After calving, all cows were offered a common mixed ration (grass silage and concentrates, 40:60 DM ratio) for 70 d postpartum. Offering concentrates in addition to grass silage during the 4 wk prepartum increased prepartum DMI (12.0 versus 10.1 kg/cow per d), EB (+40.0 versus +10.6 MJ/cow per d), and body weight (BW; 640 versus 628 kg), and tended to increase BCS (3.02 versus 2.97). However, postpartum DMI, milk yield, milk composition, BW change, BCS change, serum nonesterified fatty acid, and β-hydroxybutryrate concentrations, health, and corpus luteum measures were unaffected by treatment. The in vitro assays of neutrophil phagocytosis, neutrophil oxidative burst, and interferon gamma production, conducted on blood samples obtained at d 14 prepartum and d 3, 7, 14, and 21 postpartum, were unaffected by treatment. Primiparous cows had higher phagocytic fluorescence intensity at d 14 prepartum and d 3 and 7 postpartum; a higher percentage of neutrophils undergoing oxidative burst at d 3, 7, and 21 postpartum; and a higher oxidative burst fluorescence intensity at d 14 prepartum and d 7, 14, and 21 postpartum compared with multiparous cows. This suggests that neutrophil function of primiparous cows was less sensitive to the changes occurring during the transition period than that of multiparous cows. In conclusion, offering concentrates during the 4-wk period prepartum had no effect on postpartum DMI, milk yield, body tissue mobilization, EB, measures of neutrophil or lymphocyte function, health, or corpus luteum activity. [ABSTRACT FROM AUTHOR]

When cows with a "higher" body condition score (BCS) are oversupplied with energy during the dry period, postpartum energy balance is normally reduced, which can have a detrimental effect on immune competence and increase the infectious disease risk. However, within grassland-based systems higher yielding cows frequently have a low BCS at drying off. The effects on performance, health, and metabolic and immune functions of providing additional energy to cows with low BCS during the dry period is less certain. To address this uncertainty, 53 multiparous Holstein-Friesian cows (mean BCS of 2.5; 1-5 scale) were allocated to 1 of 2 treatments at dry-off: silage only or silage plus concentrates. Cows on the silage-only treatment were offered ad libitum access to medium-quality grass silage. Cows on the silage-plus-concentrate treatment were offered ad libitum access to a mixed ration comprising the same grass silage plus concentrates [in a 75:25 dry matter (DM) ratio], which provided a mean concentrate DM intake of 3.0 kg/cow per day. Postpartum, cows were offered a common mixed ration comprising grass silage and concentrates (in a 40:60 DM ratio) for a 70-d period. Offering concentrates during the dry period increased DM intake, tended to increase energy balance, and increased body weight (BW) and BCS gain prepartum. Offering concentrates during the dry period increased BW and BCS loss postpartum and tended to increase milk fat percentage and serum nonesterified fatty acid concentration, but it did not affect postpartum DM intake, energy balance, and milk yield. Although the percentage of phagocytosis-positive neutrophils did not differ, neutrophils from cows on the silage-plus-concentrate treatment had higher phagocytic fluorescence intensity at 1 and 2 wk postpartum and higher phagocytic index at 1 wk postpartum. Serum haptoglobin concentrations and IFN-γ production by pokeweed mitogen stimulated whole blood culture were unaffected by treatment, although haptoglobin concentrations increased and IFN-γ production decreased peripartum. Offering concentrates during the dry period increased the incidence of lameness postpartum, although other health and fertility parameters were unaffected. In conclusion, supplementing low BCS cows with concentrates during the dry period had no effect on performance and fertility and resulted in a higher neutrophil phagocytic index at 1 wk postpartum and an increased incidence of lameness compared with offering cows a grass silage-only diet prepartum. [ABSTRACT FROM AUTHOR]

Development of effective methane (CH4) mitigation strategies for grazing sheep requires accurate prediction tools. The present study aimed to identify key parameters influencing enteric CH4 emissions and develop prediction equations for enteric CH4 emissions from sheep offered fresh grass. The data used were collected from 82 sheep offered fresh perennial ryegrass (Lolium perenne) as sole diets in 6 metabolism experiments (data from non-grass-only diets were not used). Sheep were from breeds of Highlander, Texel, Scottish Blackface, and Swaledale at the age of 5 to 18 mo and weighing from 24.5 to 62.7 kg. Grass was harvested daily from 6 swards on contrasting harvest dates (May to December). Before the commencement of each study, the experimental sward was harvested at a residual height of 4 cm and allowed to grow for 2 to 4 wk. The feeding trials commenced when the grass sward was suitable to zero grazing (average grass height = 15 cm), thus offering grass of a quality similar to what grazing animals would receive under routine grazing management. Sheep were housed in individual pens for 14 d and then moved to individual calorimeter chambers for 4 d. Feed intake, fecal and urine outputs, and CH4 emissions were measured during the final 4 d. Data were analyzed using the REML procedure to develop prediction equations for CH4 emissions. Linear and multiple prediction equations were developed using BW, DMI, GE intake (GEI), and grass chemical concentrations (DM, OM, water-soluble carbohydrates [WSC], NDF, ADF, nitrogen [N], GE, DE, and ME) as explanatory variables. The mean CH4 production was 21.1 g/kg DMI or 0.062 MJ/MJ GEI. Dry matter intake and GEI were much more accurate predictors for CH4 emissions than BW (P < 0.001, r2 = 0.86 and r2 = 0.87 vs. r2 = 0.09, respectively). Adding grass DE and ME concentrations and grass nutrient concentrations (e.g., OM, N, GE, NDF, and WSC) to the relationships between DMI or GEI and CH4 emissions improved prediction accuracy with R2 values increased to 0.93. Models based on farm-level data, for example, BW and grass nutrient (i.e., DM, GE, OM, and N) concentrations, were also developed and performed satisfactorily (P < 0.001, R2 = 0.63). These models can contribute to improve prediction accuracy for enteric CH4 emissions from sheep grazing on ryegrass pasture. [ABSTRACT FROM AUTHOR]

A diverse range of concentrate allocation strategies are adopted on dairy farms. The objectives of this study were to examine the effects on cow performance [dry matter (DM) intake (DMI), milk yield and composition, body tissue changes, and fertility] of adopting 2 contrasting concentrate allocation strategies over the first 140 d of lactation. Seventy-seven Holstein-Friesian dairy cows were allocated to 1 of 2 concentrate allocation strategies at calving, namely group or individual cow. Cows on the group strategy were offered a mixed ration comprising grass silage and concentrates in a 50:50 ratio on a DM basis. Cows on the individual cow strategy were offered a basal mixed ration comprising grass silage and concentrates (the latter included in the mix to achieve a mean intake of 6 kg/cow per day), which was formulated to meet the cow's energy requirements for maintenance plus 24 kg of milk/cow per day. Additional concentrates were offered via an out-of-parlor feeding system, with the amount offered adjusted weekly based on each individual cow's milk yield during the previous week. In addition, all cows received a small quantity of straw in the mixed ration part of the diet (approximately 0.3 kg/cow per day), plus 0.5 kg of concentrate twice daily in the milking parlor. Mean concentrate intakes over the study period were similar with each of the 2 allocation strategies (11.5 and 11.7 kg of DM/cow per day for group and individual cow, respectively), although the pattern of intake with each treatment differed over time. Concentrate allocation strategy had no effect on either milk yield (39.3 and 38.0 kg/d for group and individual cow, respectively), milk composition, or milk constituent yield. The milk yield response curves with each treatment were largely aligned with the concentrate DMI curves. Cows on the individual cow treatment had a greater range of concentrate DMI and milk yields than those on the group treatment. With the exception of a tendency for cows on the individual cow treatment to lose more body weight to nadir than cows on the group treatment, concentrate allocation strategy had little effect on either body weight or body condition score over the experimental period. Cows on the individual cow treatment had a higher pregnancy rate to first and second service and tended to have a higher 100-d in calf rate than cows on the group treatment. This study demonstrates that concentrate allocation strategy had little effect on overall production performance. [ABSTRACT FROM AUTHOR]

The aim of the present study was to assess the effects of Holstein-Friesian (HF) and Norwegian (N) dairy cattle genotypes on lameness parameters in dairy cattle within different production systems over the first 2 lactations. Following calving, HF (n = 39) and N (n = 45) heifers were allocated to 1 of 3 systems of production (high level of concentrate, low level of concentrate, and grass-based). High- and low-concentrate animals were continuously housed indoors on a rotational system so that they spent similar amounts of time on slatted and solid concrete floors. Animals on the grass treatment grazed from spring to autumn in both years of the study, so that most animals on this treatment grazed from around peak to late lactation. Claw health was recorded in both hind claws of each animal at 4 observation periods during each lactation as follows: 1) -8 to 70 d postcalving, 2) 71 to 150 d postcalving, 3) 151 to 225 d postcalving, and 4) 226 to 364 d postcalving. Sole lesions, heel erosion, axial wall deviation, sole length of the right lateral hind claw (claw length), right heel width, and right lateral hind heel height were recorded as well as the presence of digital dermatitis. The N cows had lower (better) white line and total lesion scores than HF cows. Cows on the high- and low-concentrate treatments had better sole and total lesion scores than cows on the grass treatment. The HF cows had better locomotion scores than N cows. Breed and production system differences were observed with respect to claw conformation, including claw length, heel width, and heel height. Digital dermatitis was associated with worse sole lesion scores and interacted with production system to influence white line lesion scores and maximum heel erosion scores. This study shows that genetic, environmental, and infectious factors are associated with hoof pathologies in dairy cows. [ABSTRACT FROM AUTHOR]

Factor XI (FXI) deficiency is associated with bleeding after invasive procedures. Risks of human plasma-derived FXI replacement products include transfusion transmitted infection, thrombosis and fluid overload. This study was designed to test the hypothesis that recombinant factor VIIa (rFVIIa) is an effective haemostatic agent in patients with FXI deficiency undergoing surgery. Fourteen FXI deficient patients [five severely deficient (FXI:C <20 U dL−1) and nine partially deficient (FXI:C 20–70 U dL−1] received rFVIIa to prevent surgical bleeding during five major, four minor and six dental procedures. Minor surgical and dental procedures were covered with two doses of rFVIIa (90 μg kg−1 i.v.), the first pre-operatively and the second 4 h postoperatively. Major surgery was covered with 90 μg kg−1 i.v. two hourly for the first 24 h and four hourly for the second 24 h. Oral tranexamic acid was given for 7 days postoperatively. Effective haemostasis was observed in all cases and no alternative haemostatic agents or blood transfusions were required. Three adverse events were recorded; an acute cerebrovascular accident in a patient with a history of cardiovascular disease, an allergic reaction and local phlebitis. In this study, rFVIIa was an effective alternative to plasma-derived FXI replacement for the prevention of surgical bleeding in FXI deficient patients but rFVIIa may not be suitable for patients with pre-existing risk factors for thrombosis. [ABSTRACT FROM AUTHOR]

Crop evapotranspiration (ETc) was measured over a clean-cultivated, mature navel orange orchard with microsprinkler irrigation located near Lindsay, California. Hourly mean latent heat flux density was determined as the residual of the energy balance equation with measured net radiation, soil heat flux density and sensible heat flux density estimated using the surface renewal method. The ETc was compared with ETo calculated using hourly weather data and the ASCE-EWRI Penman-Monteith equation. Following pruning and topping of the trees in the spring of 2001, the Kco values slowly increased as the canopy developed in the following season. An average Kco=0.82 was observed. In the following year, the mean summertime value increased to about Kco=0.95, and in 2003 and 2004, the summertime value averaged near Kco=1.00, which is somewhat higher than observed for drip irrigated trees in southwestern Arizona and considerably higher than reported in the widely used Food and Agricultural Organization of the United Nations publications that were based on infrequent surface irrigation. [ABSTRACT FROM AUTHOR]

Virologists are expecting a flu pandemic within the next decade. Nicola O'Connell and Amanda Block explain the preparations that primary care needs to make now if it is to cope with the predicted outbreak. [ABSTRACT FROM AUTHOR]

Summary. Surgical resection is the only definitive treatment for haemophilic pseudotumour. For patients with high-responding factor (F)VIII inhibitors, the lack of reliable by-passing agents in the past has meant that surgery has been avoided in favour of conservative measures. The development of recombinant factor VIIa (rFVIIa) has revolutionized the management of surgery in these patients. We document the first successful report of the surgical resection of a massive pseudotumour in a patient with high responding FVIII inhibitors using rFVIIa to achieve haemostasis. Serial post-operative measurements indicated that FVII coagulation activity (FVII:C) levels were more sensitive to rFVIIa dose changes than the prothrombin time. [ABSTRACT FROM AUTHOR]

Background: COVID-19 public health measures like handwashing and social distancing can help stem the spread of the virus. Adherence to guidelines varies between individuals. This study aims to identify predictors of non-adherence to social distancing and handwashing guidelines. Methods: A cross-sectional weekly telephone survey was conducted over eight weeks (11/06/2020-05/08/2020). The sample included adults resident on the island of Ireland (75:25 split between ROI and NI). Data were collected on demographics, threat perceptions, fear of COVID-19, response efficacy and selfefficacy, response cost and social norms, COVID-19 behaviours, mood, loneliness, and self-reported health. Results: 3011 participants were surveyed. Handwashing non-adherers were more likely to be male (OR: 5.2, 95% CI: 2.4 - 11.3), to have higher levels of loneliness (OR: 1.86, 95% CI: 1.1 - 3.1), and higher perceptions of handwashing costs (OR: 3.4, 95% CI: 2.2 - 5.2). Those reporting rarely engaging in social distancing were more likely to be members of lower socioeconomic groups, to be younger (OR: 0.97, 95% CI: 0.96 - 0.98), male (OR: 1.67, 95% CI: 1.1 - 2.5), healthcare workers (OR: 1.98, 95% CI: 1.1 - 3.4), to report lower mood (OR: 1.72, 95% CI: 1.3 - 2.2), were less likely to live in households with people aged under-18 (OR: 0.75, 95% CI: 0.6 - 0.9), and to have lower fear of COVID-19 (OR: 0.79, 95% CI: 0.6 - 0.9). Conclusions: Non-adherers to handwashing differ from social distancing non-adherers. Public health messages should target specific demographic groups and different messages are necessary to improve adherence to each behaviour. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "Characteristics of patients with motor functional neurological disorder in a large UK mental health service" which appeared in the 18 February 2019 issue.

Breast milk can occasionally transmit serious viral and bacterial infections to preterm infants. We present three cases of late-onset neonatal sepsis, including one that resulted in death, occurring in preterm infants. The likely source of the microorganisms in all three cases was expressed breast milk. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the effect of genetic merit of the national Irish maternal index and genotype (i.e. beef vs. beef x dairy [BDX]) of beef cows and subsequent performance of their progeny. With the exception that high genetic merit cows produced 0.57 kg more milk and tended to have 0.04 of a lower body condition score (BCS), no significant differences were observed between cows of diverse genetic merit. Differences between contrasting cow genotype were apparent. Beef cows were 50 kg heavier and had a BCS 0.27 greater than BDX cows. The BDX cows produced 1.67 kg more milk and had a greater 24-d submission rate than beef cows. Calves generated from BDX cows were 19 kg heavier at weaning and were worth €51 more than progeny generated from beef cows. Beef cow progeny, however, had 0.77 of a greater conformation score at slaughter than BDX. While differences were observed across cows of different replacement strategies, results from the current study showed that genetic selection for national maternal index had no effect on the overall performance of suckler cows in a pasture-based spring-calving system. [ABSTRACT FROM AUTHOR]

Better patient communication may be key to improving osteoporosis treatment adherence. [ABSTRACT FROM AUTHOR]

Background: Early intervention in psychosis (EIP) supports people who are experiencing their first episode of psychosis (FEP). A new Model of Care (MoC) for EIP services was launched in Ireland in 2019. Three EIP demonstration sites were chosen to test this MoC through a 'hub and spoke' approach. These services were a new way of organising care for people experiencing FEP, based upon a recovery model of care, and which sought to standardise care, improve access by clinically led multidisciplinary teams. This included newly created EIP keyworker roles whereby keyworkers assumed responsibilities regarding assessment, comprehensive individual care planning and coordination of care. Methods: A mixed methods design utilising the UK Medical Research Council's process evaluation framework. Purposive sampling techniques were utilised. Descriptive analyses and logistic regression were performed to examine how increased keyworker engagement influenced the use of other psychosocial interventions within the EIP demonstration sites. Thematic analyses was used for qualitative data. Results: There was a strong positive relationship between keyworker contacts and psychosocial interventions offered. Specifically, the odds of achieving at least monthly engagement with cognitive behavioural therapy for psychosis (CBTp; (5.76 (2.43–13.64), p < 0.001), and behavioural family therapy (BFT; (5.52(1.63–18.69, p < 0.006)) increased by fivefold with each additional monthly keyworker contact. For individual placement support (IPS) each additional monthly keyworker contact was associated with a three-fold increase in the odds of achieving monthly attendance with IPS (3.73 (1.64–8.48), p < 0.002). Qualitative results found that the EIP keyworker role as viewed by both service users and staff as a valuable nodal point, with a particular emphasis on care coordination and effective communication. Conclusions: This study advances the understanding of keyworker effects through qualitative evidence of keyworkers functioning as a "linchpin" to the service, while the positive response association between keyworker contacts and engagement with other services provides quantitative support for keyworkers reducing the organisational or structural barriers to service access. Given the importance of these positions, health systems should ensure that EIP programmes identify qualified and experienced staff to fill these roles, as well as allocate the appropriate funding and protected time to support keyworker engagement and impact. [ABSTRACT FROM AUTHOR]

Lower stocking densities (SD) are sometimes used in windowed houses for broilers as part of systems designed to produce high-welfare products. However, there is little scientific information on the effects of SD on welfare-related measures in broilers in windowed houses, and on whether these effects are influenced by environmental enrichment. Commercial windowed broiler chicken houses were assigned to 4 target SD (30, 32, 34, and 36 kg/m2) and 2 levels of access to string [+S (one piece per 1,000 birds/house), -S] in a 4 × 2 factorial arrangement. Treatments were applied in one of 4 houses on each of 2 farms, and replicated over 10 production cycles. Levels of lying behavior, apparent fear-related behavior, and gait score were observed in wk 3 to 5. The incidence and severity of dermatitis lesions were assessed at d 30 and at slaughter. Environmental and production performance parameters also were measured. No significant treatment effects were obtained for levels of lying or fear-related behavior, final body weight, presence of dermatitis lesions at slaughter, or percentage of downgraded carcasses. There were no significant treatment effects on measures of gait, but the percentage of birds with a gait score of ≥2 tended to increase at higher SD. The severity of dermatitis lesions at d 30 increased with increasing SD, and was significantly greater at densities of 34 and 36 kg/m2 than of 30 kg/m2. Litter moisture content was not significantly affected by treatment, which may have reflected a numerical decline in water consumption with increasing SD. Results suggest that increasing SD is a risk factor for more severe dermatitis; however, increasing density from 30 to 32 kg/m2 did not significantly affect this variable. In addition, the proportion of lame birds, levels of lying behavior, and performance were not significantly affected by increasing SD. Providing suspended string at typical commercial levels did not have beneficial effects on welfare-related measures, and further research should perhaps investigate effects of greater levels of provision. [ABSTRACT FROM AUTHOR]

Background: Programmes for early intervention (EIP) in psychosis for people experiencing a first episode of psychosis (FEP) have been found to be both clinically and cost effective. Following the publication of a new EIP model of care (MoC) in Ireland, the aim of this research is to describe how people participated in and responded to the MoC including service users, family members, HSE clinical staff and HSE management. Methods: Qualitative design using the UK Medical Research Council’s process evaluation framework. Purposive sampling techniques were used. A total of N = 40 key informant semi-structured interviews were completed which included clinical staff (N = 22), health service managers and administrators (N = 9), service users (N = 8) and a family member (N = 1). Thematic analyses were conducted. Results: Unique features of the EIP service (e.g., speed of referral/assessment, multidisciplinary approach, a range of evidence-based interventions and assertive MDT follow up) and enthusiasm for EIP were identified as two key factors that facilitated implementation. In contrast, obstacles to staff recruitment and budget challenges emerged as two primary barriers to implementation. Conclusions: The findings from this research provide real world insights into the complexity of implementing an innovative service within an existing health system. Clear and committed financial and human resource processes which allow new innovations to thrive and be protected during their initiation and early implementation phase are paramount. These elements should be considered in the planning and implementation of EIP services both nationally in Ireland and internationally. [ABSTRACT FROM AUTHOR]

Suboptimal image quality presents a challenge for the use of cone-beam CT (CBCT) in adaptive radiotherapy (ART). It hinders accurate structure delineation and precise dose calculation. In this work, we evaluated enhanced CBCT images reconstructed using an AI-based scatter correction model and compared it with a deep learning (DL)-based synthetic CT (sCT) model for pelvic cancer patients. Two advanced models were utilized for CBCT image enhancement: one employing deep AI-based scatter correction during CBCT reconstruction (recon CBCT), and the other leveraging a DL-based Generative Adversarial Network (CycleGAN) to produce sCT images. Ten independent datasets of pelvic RT patients (6 male, 4 female) were used for evaluation. A systematic evaluation of CBCT images generated by these models was conducted, including: 1) comparison of Hounsfield unit (HU) values to the planning CT (refCT), 2) analysis of line intensity profiles for corresponding regions across clinical CBCT, recon CBCT, sCT, and refCT images to highlight HU discrepancies, 3) assessment of organ at risks (OARs) DL-based auto-segmentation performance using commercial software, 4) evaluation of image quality metrics such as Pearson correlation coefficient (PCC) and Root Mean Square differences (RMSE) and 4) planning tool-based dose calculation accuracy for 3D global gamma analysis for a criterion of 3%/3mm (> 95%) was performed by rigid registration to the refCT. In cases of large patients with truncated CBCT volumes, identical volumes on CBCT and refCT were utilized for analysis. Contour quality was compared to the refCT using Dice and Jaccard similarity coefficients and mean distance to agreement (MDA). The models were executed within 20 to 40 seconds. The HU values of various pelvis OARs delineated on recon CBCT and sCT closely matched the refCT values and fell within acceptable HU tolerances for bone and soft tissues based on published recommendations (AAPM/IAEA/ESTRO/IAPM). Line profile affirmed consistent intensity with the refCT throughout the anatomy for both the recon CBCT and sCT, confirming preserved CBCT anatomy. Additionally, comparable mean values for Dice (0.82 vs. 0.84), Jaccard (0.70 vs. 0.73), and MDA (3.05 vs. 2.41 mm) were obtained for recon CBCT and sCT, respectively, relative to refCT for bone, femoral heads, lymph nodes, and prostate, indicating robust auto-segmentation performance. While a better image quality in terms of PCC (recon CBCT vs. sCT: 0.74±0.05 vs. 0.85±0.03) and RMSE (recon CBCT vs. sCT: 554±29 vs 385±29) was observed for sCT images, both recon CBCT and sCT passed the gamma analysis (recon CBCT vs. sCT: 98±1% vs. 99±1%). Enhanced reconstructed CBCT using AI based scatter correction is comparable to DL-based sCT. The improved preservation of anatomical structures, HU consistency, and dose accuracy in the pelvic region is promising for precise and efficient online ART on conventional c-arm linacs, which can eliminate or reduce the need for sCT. [ABSTRACT FROM AUTHOR]

Nitrogen excretion from sheep production systems is an important source of nitrate, ammonia, and nitrous oxide responsible for groundwater pollution and global warming. The present study aimed to identify key parameters influencing N utilization efficiency and develop prediction equations for manure N, feces N, and urine N outputs in sheep. Data used were collected from 82 sheep offered fresh perennial ryegrass (Lolium perenne) as the sole diet in 6 metabolism experiments (data from non-grassonly diets were not used). Sheep were from breeds of Highlander, Texel, Scottish Blackface, and Swaledale at the age of 5 to 18 mo and weighing from 24.5 to 62.7 kg. Herbage was harvested daily from 6 swards of contrasting harvest dates (May to December), offering wide variation in feed value to cover the range that would be offered in most practical farm situations. Before the commencement of each study, the experimental sward was harvested at a residual height of 4 cm and allowed to grow for 2 to 4 wk to target an average pregrazing sward height in a range of 8 to 15 cm depending on the time of year. Sheep were housed in individual pens for 14 d and then transferred to individual metabolism crates for 4 d with feed intake and feces and urine outputs measured. Data were analyzed using the linear mixed model procedure to develop prediction equations for feces N, urine N, and manure N outputs using N intake, herbage chemical composition, and digestibility with effects of sex, breed, and experimental periods removed. Nitrogen intake was the best single predictor for N output in feces, urine, and manure, and the r² value for prediction of manure N output was greater than those for feces N and urine N (0.86 vs. 0.70 and 0.77, respectively; P < 0.001). Animal BW and herbage DM, ether extract, NDF, ADF, water soluble carbohydrate, and DE concentrations and N digestibility were also used to predict N outputs because N intake may not be available in commercial practice. The prediction equations for N utilization efficiency indicated that increasing feeding level and ME concentration and reducing N concentration could improve N utilization efficiency and shift N excretion into feces rather than urine (P < 0.001). The equations developed in the current study provide an approach for sheep producers to quantify N excretion against production and, consequently, to develop their own mitigation strategies to reduce the environmental impact of sheep production systems. [ABSTRACT FROM AUTHOR]

BACKGROUND Moderate-to-severe hemophilia B is treated with lifelong, continuous coagulation factor IX replacement to prevent bleeding. Gene therapy for hemophilia B aims to establish sustained factor IX activity, thereby protecting against bleeding without burdensome factor IX replacement. METHODS In this open-label, phase 3 study, after a lead-in period (≥6 months) of factor IX prophylaxis, we administered one infusion of adeno-associated virus 5 (AAV5) vector expressing the Padua factor IX variant (etranacogene dezaparvovec; 2×1013 genome copies per kilogram of body weight) to 54 men with hemophilia B (factor IX activity ≤2% of the normal value) regardless of preexisting AAV5 neutralizing antibodies. The primary end point was the annualized bleeding rate, evaluated in a noninferiority analysis comparing the rate during months 7 through 18 after etranacogene dezaparvovec treatment with the rate during the lead-in period. Noninferiority of etranacogene dezaparvovec was defined as an upper limit of the two-sided 95% Wald confidence interval of the annualized bleeding rate ratio that was less than the noninferiority margin of 1.8. Superiority, additional efficacy measures, and safety were also assessed. RESULTS The annualized bleeding rate decreased from 4.19 (95% confidence interval [CI], 3.22 to 5.45) during the lead-in period to 1.51 (95% CI, 0.81 to 2.82) during months 7 through 18 after treatment, for a rate ratio of 0.36 (95% Wald CI, 0.20 to 0.64; P<0.001), demonstrating noninferiority and superiority of etranacogene dezaparvovec as compared with factor IX prophylaxis. Factor IX activity had increased from baseline by a least-squares mean of 36.2 percentage points (95% CI, 31.4 to 41.0) at 6 months and 34.3 percentage points (95% CI, 29.5 to 39.1) at 18 months after treatment, and usage of factor IX concentrate decreased by a mean of 248,825 IU per year per participant in the post-treatment period (P<0.001 for all three comparisons). Benefits and safety were observed in participants with predose AAV5 neutralizing antibody titers of less than 700. No treatment-related serious adverse events occurred. CONCLUSIONS Etranacogene dezaparvovec gene therapy was superior to prophylactic factor IX with respect to the annualized bleeding rate, and it had a favorable safety profile. [ABSTRACT FROM AUTHOR]

Forty-eight lowland lambs were used in a completely randomized design (23-d period) with a factorial arrangement of treatments: 2 breeds (Highlander vs. Texel) ? 3 sexes (female vs. intact male vs. wether) ? 2 diets (fresh grass vs. fresh grass plus 0.5 kg/d pelleted concentrate). Animals (n = 48) were approximately 5 mo old and 36 ± 5.0 kg BW at the commencement of the study with 4 lambs for each breed-sex-diet combination. Fresh grass was harvested daily from the first regrowth of perennial ryegrass sward and offered ad libitum with a similar growth stage throughout the experiment. The animals were individually housed in pens and fed experimental diets for 19 d before being transferred to individual calorimeter chambers for a further 4 d with feed intake, fecal and urine outputs, and methane (CH4) emissions measured. Lambs offered 0.5 kg/d concentrate had greater DM and energy (i.e., GE, DE and ME) intake, BW, and CH4 production (g/d) and greater N intake, fecal and manure N outputs, and fecal N per N intake than those given only fresh grass (P < 0.05). However, diets had no effect on CH4 emission rates (i.e., CH4/DMI [P = 0.408] and CH4 energy/GE intake [P = 0.821]). Texels produced more CH4/DMI (g/kg) than Highlanders (P = 0.044), and sex had no effect on CH4/DMI (g/kg; P = 0.101). Neither breed nor sex had an effect on N utilization efficiency (P > 0.05). The results reflected that high-quality forages may play a role similar to concentrate in mitigation of enteric CH4 emissions. The effects of sex and breed on rumen function require further investigation to understand relationships with CH4 emissions and N excretion in sheep. [ABSTRACT FROM AUTHOR]

Colorectal cancer is a leading cause of cancer death in the USA and Europe with symptoms that mimick other far more common lower gastrointestinal (GI) disorders. This difficulty in separating colorectal cancer from these other diseases has driven researchers to search for an effective, non-invasive screening technique. Current state-of-the-art method of Faecal Immunochemical Testing achieving sensitivity ~90%, unfortunately the take-up in the western world is low due to the low patient acceptability of stool samples. However, a wide range of cancers have been distinguished from each-other and healthy controls by detecting the gas/volatile content emanating patient biological media. Dysbiosis afforded by certain disease states may be expressed in the volatile content of urine – a reflection of the gut bacteria′s metabolic processes. A new electronic nose instrument was developed at the University of Warwick to measure the gas/volatile content of urine headspace, based on an array of 13 commercial electro-chemical and optical sensors. An experimental setup was arranged for a cohort of 92 urine samples from patients of colorectal cancer (CRC), irritable bowel syndrome (IBS) and controls to be run through the machine. Features were extracted from response data and used in Linear Discriminant Analysis (LDA) plots, including a full 3-disease classification and one focussing on distinguishing CRC from IBS. The latter case was tested by the success of re-classification using an ( n −1) K-nearest neighbour algorithm, showing 78% sensitivity and 79% specificity to CRC. [ABSTRACT FROM AUTHOR]

Despite several advantages of cone-beam computed tomography (CBCT) in image guided radiation therapy, its application in adaptive radiotherapy has been limited. Current CBCT image quality hinders accurate dose calculation and structure delineation. In this work, we evaluated an improved thoracic synthetic CT (sCT) deep learning model for CBCT images. An enhanced Cycle Generative Adversarial Network (CycleGAN) model with structure constraints model trained on 80 thoracic datasets from two institutions was utilized to generate sCT images from CBCT. To enhance accuracy, the model incorporated a structural similarity index map (SSIM)-weighted L1-loss feature, facilitating pixel-level precision. Seven independent datasets for lung cancer patients were used to evaluate the model. Hounsfield unit (HU) comparisons on various organs at risk (OARs) between sCT and planning CT (ref CT) were examined to ensure dose accuracy within 1% based on established guidelines. An FDA cleared commercially available deep learning auto-segmentation algorithm (Contour Protégé AI, MIM® software) was used for structure delineation. Contour quality was assessed using Dice and Jaccard similarity coefficients, and mean distance to agreement (MDA). Dose was calculated using a Monte Carlo based algorithm and 3D global gamma analysis was performed on sCT dose against the original planned refCT dose with agreement indices of 2%/2mm (>90%) and 3%/3mm (>95%). The model was executed in a research tool from a precision radiation medicine company installed on an Intel® Xeon® Gold 6132 Processor (2.6 GHz, 128 GB RAM) and took less than 30 seconds to generate sCT images. The median ± standard deviation HU values between the sCT and ref CT for thoracic structures were as follows: Aorta (5 ± 1), Bone (10 ± 13), Esophagus (7 ± 3), heart (5 ± 4), left lung (19 ± 23), right lung (5 ± 27) and spinal cord (6 ± 1). The HU differences were within acceptable published tolerances, for instances the HU recommendations are ± 50, ± 170 and ± 50 for lung, bone, and soft tissues, respectively as per European Society of Radiotherapy and Oncology (ESTRO). Mean ± standard deviation Dice, Jaccard, and MDA between the refCT and sCT were (0.84 ± 0.09), (0.73 ± 0.13), and (2.45 ± 0.88) respectively, demonstrating robust auto-segmentation performance. All the cases passed the gamma analysis with mean gamma passing rates of 96 ± 2% and 99 ± 1% for 2%/2 mm and 3%/3 mm, respectively. The enhanced cycleGAN-based model generated high resolution sCT from CBCT, enabling accurate structure delineation and dose calculations. Improved sCT is critical for online adaptive radiotherapy and can eliminate the need for patient re-simulation for offline adaptive radiotherapy. [ABSTRACT FROM AUTHOR]

Single fraction palliative radiotherapy is resource intensive, often requiring several hours to prepare and multiple table transfers for patients in pain. MR Linacs support online adaptation with high soft tissue contrast images. However, a typical MR-guided radiotherapy (MRgRT) workflow is often more complex than conventional RT workflows. We investigate here the feasibility of using an online MR-guided scan-plan-treat workflow for emergency palliation. An anthropomorphic phantom and three heathy volunteers were included in the study. Abdominothoracic breath held 3D T1 Dixon images were acquired at end expiration on a 1.5T MR Linac. Target volumes (vertebral bodies) were constructed on in-phase Dixon images. Deep learning (DL)-based synthetic CT images were derived from standardized, opposed-phase Dixon images using a 2D cycleGAN model trained using 154 images. The synthetic CT was then thresholded to create air, bone, and unspecified tissue contours, which were then transferred to the in-phase Dixon image. Reference plans designed to deliver 800 cGy in one fraction were created on the in-phase Dixon images using a 3D AP/PA beam arrangement in offline treatment planning software, with electron densities (ED) extracted from the synthetic CT. Approved reference plans were then promoted and configured in electronic patient information management system. A treatment session was initiated and in-phase 3D T1 Dixon verification images were acquired and sent to online treatment planning software. The Adapt-To-Position (ATP) workflow was performed using segment aperture morphing (Adapt Segments). Approved adaptive plans were then downloaded and delivered. The total time required to perform the workflow was recorded. The total time to complete the online MRgRT scan-plan-treat workflow, including reference and verification imaging, synthetic CT generation, contouring, reference and adaptive planning, software-based QA checks, and delivery of 800 cGy, was 18.5 minutes in phantom and 23.5 +/- 2.9 minutes (mean +/- standard deviation) for the healthy volunteers. Use of the DL synthetic CT removed dependence on prior diagnostic CT images for ED assignment. Average reference and ATP plan Dmax values were 113.2% and 114.2% of the prescription dose, respectively. Average reference and ATP plan target D95% values were 755.4 cGy and 759.1 cGy, respectively. Small shifts (<5 mm), introduced through the automated couch insertion process in offline treatment planning software and detected when registering verification images to reference images in online treatment planning software, were compensated with the Adapt Segments mode. Emergency palliation using an online MR-guided scan-plan-treat workflow is feasible. Despite increased complexity, online MRgRT scan-plan-treat workflows can be performed in under 30 minutes, minimizing resources, time, and number of table transfers for patients in pain. [ABSTRACT FROM AUTHOR]

Despite extensive utilisation in epidemiological investigations of animal health, to date there has been little consideration of the value of abattoir meat inspection as a pig welfare surveillance tool. This study measured the prevalence of tail-docking, tail biting, carcase condemnations and associated financial losses of the latter (Northern Ireland only) in 36,963 pigs slaughtered in six abattoirs from the Republic of Ireland and Northern Ireland in July and August 2010. Over 99 per cent of inspected pigs had been tail-docked, while 58.1 per cent and 1.03 per cent had detectable and severe tail lesions, respectively. Producer losses resulting from carcase condemnation were estimated to be €0.37 per pig slaughtered. Enhanced capture and utilisation of meat inspection data for use in animal welfare surveillance schemes has the potential to drive improvements in production efficiency and animal welfare. However, significant differences were detected in the prevalence of carcase condemnation conditions between abattoirs and judiciaries (Republic and Northern Ireland). This reflects variation in the criteria and methods of data capture used in meat inspection in different abattoirs. Thus, the meat inspection process needs to be standardised and reformed before it can be reliably utilised in large-scale pig welfare surveillance schemes. [ABSTRACT FROM AUTHOR]

Twenty-eight Holstein Friesian dairy heifers were assigned to 1 of 2 treatments after calving. These experimental heifers were introduced to an established group of resident cows either between 0600 and 0800 h (i.e., after morning milking, a.m.) or between 1600 and 1800 h (i.e., after evening milking, p.m.). The size of the resident group remained constant at 18 animals (12 multiparous cows and 6 primiparous cows). There were 5 replicate or resident groups in total, and 2 to 3 nonexperimental primiparous cows in each group were replaced by a.m. and by p.m. heifers as they calved. Fresh total mixed ration was provided daily between 1000 and 1030 h, and concentrate feed was offered in the milking parlor. The behavior of the experimental heifers was assessed over a 2-h period immediately after mixing into the resident group, and also after feed provision during the first month in the group. In addition, time spent lying was assessed each week for 1 mo using data loggers attached over 24-h periods. The lying behavior and location of the entire group was also assessed by direct observations during the 2-h period before evening milking on 2 consecutive days each week for 1 mo. The time spent feeding by experimental heifers was recorded automatically using computerized feeding gates. Milk production, milk cortisol concentrations, and changes in body condition and body weight were also assessed over the first month after calving. Heifers in the a.m. treatment spent longer in receipt of aggressive behaviors such as threats, butts, and chases immediately after mixing compared with those in the p.m. treatment. During the feeding periods, heifers in the a.m. treatment were observed feeding for longer, showed less pen exploration, and also received more butts. No significant treatment effects were shown on overall feed intake levels, milk yield, milk cortisol concentrations, body weight, or body condition score loss. However, feed intakes were higher in the a.m. treatment during the second week after mixing, and automated recordings showed that a.m. animals spent longer average periods of time feeding. No significant treatment differences were shown in overall time spent lying, with heifers in both treatments lying for less than 4 h during the first 24 h in the group. Observations of the entire group showed that p.m. heifers spent less time lying than resident animals or a.m. heifers. In conclusion, the reduction in received aggression and the lack of adverse effects on performance (milk production and weight and condition loss) suggest that heifers should be introduced to the main dairy herd after evening rather than morning milking. Further research to determine the relative importance of time of day and time since feeding on behavior immediately after mixing would be beneficial. [ABSTRACT FROM AUTHOR]

The aim of this trial was to determine the effect of aerial perches on keel bone injuries and tibia bone characteristics in free-range laying hens. The relationship between keel bone injuries and individual bird parameters, such as weight, girth, wing:girth ratio, feather coverage, and tibia bone characteristics, was also assessed. Five commercial free-range houses, each containing between 7,000 and 8,000 birds, were used. The houses and range areas were divided in half; in half of the house, birds had access to aerial perches (P) and in the other half, they did not (NP). On 13 occasions between 17 and 70 wk of age, 20 birds per treatment were randomly selected from the slatted area and palpated for keel bone injury. At 72 wk of age, 30 birds per treatment in each of 4 houses were selected at random, weighed, and then euthanized. Girth and wing area and feather coverage were measured. The keel and left tibia bones were removed and keel bones were scored for injury. Tibia bones were weighed and diameter, length, breaking strength, and ash content recorded. Results indicated that access to aerial perches did not affect tibia bone measures (P > 0.05). Average palpated keel bone score increased with age of the hens (P < 0.001) but was not significantly affected by perch treatment (P > 0.05). There was a significant interaction between treatment and farm on keel bone injuries measured at dissection (P < 0.05), with the probability of birds having high keel-damage scores increasing in the perched treatment in some farms but not others. In general, as the keel bone injury score measured at dissection increased, the breaking strength (P < 0.001) and ash content (P < 0.05) of the tibia bone decreased. It is suggested that individual variation in bone strength contributes to differences in susceptibility to keel injury. No relationship existed between keel-injury score measured at dissection and individual parameters, such as weight, girth, or wing:girth ratio (P > 0.05), although feather coverage tended to decline with increasing keel damage (P < 0.06). [ABSTRACT FROM AUTHOR]

The aim of this study was to compare a split marketing (SM) strategy, in which the heaviest pigs in a group are removed and slaughtered earlier than the others, with an all-out (AO) marketing strategy, in which all pigs are removed from the pen simultaneously and slaughtered on the same day, in terms of welfare, performance, and carcass traits of noncastrated (i.e., intact) male and female pigs. The experimental treatments were arranged in a 2 x 2 factorial array with 1) marketing strategy (SM vs. AO) and 2) sex (males vs. females), which yielded 4 treatment groups of 14 pigs (73.1 ± 4.8 kg): male SM, male AO, female SM, and female AO (7 replicates/group). Pigs in AO groups were all slaughtered after 6 wk on trial, whereas in SM groups the 3 heaviest pigs were removed and slaughtered 2 wk before the remainder of the group, which were slaughtered at the same time as the AO pigs. Pigs were fed a liquid diet from a long trough 3 times daily. Behavioral observations were conducted before and after SM, the day of SM, and 1 and 2 wk later. Behavior was' recorded both during and between feed events, and skin lesions were scored on all, except the 3 pigs removed from SM groups before and 2 wk after SM. Growth performance, feed efficiency, and carcass traits were recorded. The number of aggressive interactions during feed events decreased after the 3 pigs were removed from SM groups. This reduction in aggressive interactions was observed on the day of SM in male groups (before SM: 24.3 vs. the day of SM: 14.7, SED = 3.31, P < 0.05 for interaction) and in subsequent observations in female groups (before SM: 21.4 vs. days after SM: 13.4, SED 3.31, P < 0.05 for interaction). However, SM had no effect on behaviors recorded between feed events or on the number and severity of skin lesions (P > 0.10). There were no differences between the 11 remaining pigs in SM groups and the 14 pigs in AO groups in terms of growth performance, feed efficiency, and carcass traits of female or intact male pigs (P> 0.10). However, reduced within-pen CV in carcass weight was detected in pigs from SM groups compared with pigs from AO groups (8.6 vs. 10.9, SEM = 0.72, P < 0.05). Therefore, in restrictively fed pigs, a SM strategy improved the welfare of both female and intact male pigs by reducing aggressive interactions during feeding but had no effect on performance or carcass traits. [ABSTRACT FROM AUTHOR]

The purpose of this study was to show the significance of a positive Propionibacterium acnes sample around a joint replacement. Records from the microbiology laboratory data over a 3-year period were reviewed to identify patients with prosthetic joints from whom Propionibacterium acnes was isolated at least once. The medical records of all those patients were retrieved and the demographic, clinical, microbiological and haematological data were collected and examined. The preoperative values of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded. Fifty patients underwent a routine revision of a joint arthroplasty; six patients had a joint aspiration. Only one patient had further revision surgery for infection. The preoperative values of ESR and CRP were very variable. The presence of a positive sample around a joint arthroplasty is of uncertain significance. Further studies are needed in order to establish uniform criteria for the diagnosis of infection caused by Propionibacterium acnes. [ABSTRACT FROM AUTHOR]

Ursodeoxycholic acid is an approved therapy for hepatobiliary disorders but in infants and children compliance is compromised because it is formulated exclusively as capsules, or tablets.To determine the pharmacokinetics and bioequivalence of a new liquid formulation of ursodeoxycholic acid (Ursofalk suspension) with a standard capsule (Ursofalk) in a randomized, unblinded, crossover designed study of 24 healthy adults.Equivalence was based on single bolus oral plasma pharmacokinetics and biliary ursodeoxycholic acid enrichments after repeat doses. Biliary bile acid composition and hydrophobicity index were also compared. Ursodeoxycholic acid was measured in duodenal bile by high-performance liquid chromatography and in plasma by mass spectrometry.The mean percentage biliary ursodeoxycholic acid enrichment after administration of the suspension was not significantly different from that obtained with capsules (44.2 ± 11.7% vs. 46.9 ± 10.2%, respectively). The equivalence ratio was 0.94 (95% CI: 0.8–1.1), establishing bioequivalence between suspension and capsules. Both formulations reduced the biliary hydrophobicity index and no differences in bile acid composition were observed between formulations. The plasma pharmacokinetics of both formulations was similar and the tolerability of the suspension was excellent.A new liquid formulation of ursodeoxycholic acid suitable for paediatric patients is pharmacologically bioequivalent to capsules when given as single, or repeated oral doses. [ABSTRACT FROM AUTHOR]

The welfare status of an animal is dependent on its ability to cope and exist in harmony with its environment, such that good physical and psychological health is maintained. Improving animal welfare is an increasingly important aspect of livestock production systems due, in a large extent, to increased consumer concerns about animal production practices. Animal welfare is an integrated part of quality assurance programmes for sustainable animal production, considering that welfare, health, management, economy, consumer acceptance and environmental impact are interdependent. The major welfare concerns in the livestock industry in recent years relate to the rearing and management of dairy calves, the welfare of the dairy cow, effect of husbandry management procedures on the welfare of beef cattle, rearing of sows in gestation and farrowing crates, and the broiler (meat) chicken sector. The paper will focus on scientific research underpinning these welfare concerns, with a particular focus on research conducted on the island of Ireland. [ABSTRACT FROM AUTHOR]

• PODE shows an almost identical injection behavior compared to base diesel fuel. • The deviations from cycle to cycle are very small. • A correlation between the discharge coefficient and the Reynolds number for different energizing times was determined empirically. • PODE could be used as a suitable replacement for diesel as pilot fuel in dual fuel engines. The aim of this study was to investigate the hydraulic stability of micro injections when using polyoxymethylene dimethyl ether (PODE) as pilot fuel for a dual fuel heavy-duty stationary engine. A two-layered 8-hole solenoid injector with an injection angle of 75° was used for the investigation. The challenge with regard to the investigated type of diesel-ignited gas engines is that the injector has to provide a stable injection for both full-diesel mode and dual fuel mode. The stability of the injection was evaluated using the following values: The injection rate, injection gravimetric quantity, injected amount of energy, standard deviation of the injection quantity, coefficient of variation of the injected quantity, the momentum flux, injection duration and injection delay at various pressures and energizing times with neat base diesel fuel, neat PODE and a 50- vol-% PODE-diesel-blend. PODE was found to have a similar gravimetric total injection rates of all holes compared to base diesel fuel with almost the same standard deviation. At higher injection pressures and longer energizing times, the influence of the fuel on the injection quantity becomes more relevant. The influence of the fuel on the injection delay and injection duration was found to be small. An empiric correlation between the discharge coefficient and the Reynolds number was determined which can be used to calculate the discharge coefficient. In summary, we can conclude that with regard to the hydraulic injection characteristics, PODE could be used as a suitable replacement for diesel as pilot fuel in dual fuel engines. [ABSTRACT FROM AUTHOR]

Background and aims: Blood culture (BC) remains gold standard for the evaluation and diagnosis of neonatal sepsis. Time when BC becomes positive and the type of microorganism isolated are crucial in deciding the antimicrobial management. Likely pathogenicity of organisms growing in BC could potentially be predicted based on the "time to positivity" (TTP). We aimed to estimate the predictive value of isolating a likely pathogenic organism depending on TTP; evaluate the aetiological trend and neonatal mortality rate due to culture-proven neonatal sepsis for over a decade and verify whether the application of a "36 hour rule" to discontinue empiric antibiotics in well newborn infants with negative BC would be safe.Methods: Retrospective review of BC results over a 14-year period from a regional neonatal unit in Ireland. Laboratory data were independently extracted in relation to BC results from the laboratory information management system (LIMS-iLAB). Neonatal mortality data were collected from multiple sources. Statistical analysis included logistic regression, chi-square, and Mann-Whitney U-test.Results: Over a 14-year period 11,432 neonatal BC specimens were incubated of which 605 (5.3%) turned positive. Overall, the commonest organism grown was coagulase-negative Staphylococcus (CoNS), 416 (68.8%). Main pathogenic organisms were Staphylococcus aureus 23 (3.8%), Enterococcus spp. 22 (3.6%), E.coli 21 (3.5%), group B Streptococcus (GBS) 18 (3.0%), and Klebsiella species 9 (1.5%). Gram-negative organisms had the shortest TTP, with Klebsiella spp. having a median TTP of 10 h and E. coli 11 h. For Gram-positives, GBS had a median TTP of 12 h, Enterococcus species 14 h, with S. aureus growing at a median time of 15 h. All of the Klebsiella spp. and other Coliforms were detected within 24 h, with, 95.2% of E.coli, 94.4% of GBS, 95.5% of Enterococci, and 95.7% of S. aureus, flagging positive in 24 h. Using logistic regression the omnibus test of the coefficients in the resulting model was significant (p < .001). Our observed coefficient (β) for TTP was 0.144; shorter the TTP higher was the likelihood of isolating a pathogenic organism, with an odds ratio (OR) of 1.155. We also report a relatively low blood culture proven sepsis-specific neonatal mortality rate of 0.403/1000 live births and in all such instances observed TTP was less than 24 h.Conclusion: Duration of this study exceeds that of most of the neonatal blood culture TTP analysis published to-date. A shorter TTP is an important adjunct to suggest the growth of a pathogenic organism while managing suspected neonatal sepsis. TTP if < 24 h per se would not necessarily confirm the growth of a highly pathogenic organism; however, if a positive growth is likely to happen for a significant neonatal pathogen, in more than 98% the TTP would be within 24 h. This offers the clinician more of negative predictive value than a positive one; when there is no growth in BC. Our observation on TTP reiterate the National Institute of Health and Care Excellence (NICE) guideline of discontinuation of empiric antibiotics after 36 h in and clinically well and BC negative newborn infants. [ABSTRACT FROM AUTHOR]

Introduction: Primary breast abscesses occur in <1% of non-lactating women, rising to 11% in women with lactational mastitis. In patients undergoing breast cancer surgery, the inflammatory response to post-operative surgical site infection (SSI) has been implicated in recurrence. Anti-microbial resistance increasingly hampers treatment in each group.Aims: Describe the demographic and predisposing characteristics of patients with primary breast abscesses and secondary infections, identify the microbial and antimicrobial patterns and formulate an evidence-based protocol for treating breast infections.Methods: Retrospective cohort study of all breast infections (primary and post-operative) treated at UHL from 2014 to 2017. Data collected from microbiology databases and patient records was analysed using Minitab V18.Results: 537 cultures from 108 patients were analysed. 47 (43.5%) had primary abscesses, 12 (11.1%) were lactational and 49 (45.4%) were post-operative SSI. For primary infections, the mean age was 41.9 (±12.2) and reinfection rate 33%. For SSIs the mean age was 51.8 (±14.52) and reinfection rate 11.8%. Overall, 29.3% were smokers, 6.4% diabetic and 2.9% pregnant. 60 (43%) patients required radiological drainage and 2 (1%) surgical drainage. 57.5% had mixed growth. The most common isolate was Staphylococcus aureus; cultured in 16.7% of primary abscesses and 24% of SSIs. 13 empiric antibiotic regimes were prescribed before 26.4% of patients changed to 12 different targeted regimes.Conclusion: Breast infections are frequently polymicrobial with a wide variety of organisms isolated, suggesting the need for broad spectrum coverage until culture results become available. Based on our local culture results, the addition of clindamycin to flucloxacillin would provide excellent empiric coverage for all categories of breast infection. An evidence-based treatment guideline is required and should be formulated in close collaboration with microbiology specialists. [ABSTRACT FROM AUTHOR]

In clinical workflows for radiation therapy (RT) using integrated MRI-linear accelerator devices, quick, low-resolution images are often acquired for on-board setup imaging to minimize treatment times. However, for patients with head and neck cancer (HNC), these quick setup images are not always sufficient for discrimination of target structures and organs at risk (OAR). In this study, we investigate a deep learning (DL) approach to synthetically generate high resolution scans from low resolution scans, which we hypothesize are not significantly different from ground-truth high resolution scans. Paired T2-weighted 2-minute MRI scans (2mMRI) and 6-minute MRI scans (6mMRI) acquired during the same imaging session were collected for 39 cases (36 patients with HNC; 3 volunteers). 21 cases were used to train a 2D DL generative adversarial network that utilized 2mMRI as input and 6mMRI as output. 18 cases were used to test the performance of the model. Global intensity metrics (normalized mean squared error [NMSE], structural similarity index [SSIM], and peak signal to noise ratio [PSNR]) were calculated between synthetic 6mMRI and ground-truth 6mMRI for all test cases. Additionally, a HNC OAR DL auto-segmentation model previously trained on independent 2mMRI was used to segment the right parotid gland, left parotid gland, and mandible on synthetic 6mMRI, ground-truth 6mMRI, and ground-truth 2mMRI for all test cases. Dice similarity coefficient (DSC) values were calculated between ground-truth 2mMRI and either synthetic 6mMRI or ground-truth 6mMRI for each OAR; Wilcoxon signed rank tests were applied between DSC values of the synthetic 6mMRI and the ground-truth 6mMRI for each OAR to determine any significant differences. Each synthetic 6mMRI took approximately 5-10 seconds to generate. Mean (standard deviation) NMSE, SSIM, and PSNR values for test cases were 0.44 (0.06), 0.90 (0.03), and 33.35 (1.60), respectively. The DSC values comparing synthetic vs. ground-truth 6mMRI auto-segmented OARs were 0.80 (0.07) vs. 0.81 (0.11), 0.83 (0.07) vs. 0.82 (0.14), and 0.82 (0.08) vs. 0.84 (0.08) for the right parotid gland, left parotid gland, and mandible, respectively; DSC values were not significantly different (p>0.05 for all OARs). We demonstrate DL-generated synthetic 6mMRI that have low global intensity value differences compared with ground-truth 6mMRI. Moreover, auto-segmented OARs demonstrate non-significant differences when evaluated using paired synthetic or ground-truth 6mMRI. Future analysis will include the incorporation of additional training data, utilization of bias field correction, and application of human Turing test evaluation. Our study facilitates the clinical incorporation of MR-guided HNC adaptive RT using reduced acquisition times. [ABSTRACT FROM AUTHOR]

The contribution of the intestinal tract to differences in residual feed intake (RFI) has been inconclusively studied in chickens so far. It is also not clear if RFI-related differences in intestinal function are similar in chickens raised in different environments. The objective was to investigate differences in nutrient retention, visceral organ size, intestinal morphology, jejunal permeability and expression of genes related to barrier function, and innate immune response in chickens of diverging RFI raised at 2 locations (L1: Austria; L2: UK). The experimental protocol was similar, and the same dietary formulation was fed at the 2 locations. Individual BW and feed intake (FI) of chickens (Cobb 500FF) were recorded from d 7 of life. At 5 wk of life, chickens (L1, n = 157; L2 = 192) were ranked according to their RFI, and low, medium, and high RFI chickens were selected (n = 9/RFI group, sex, and location). RFI values were similar between locations within the same RFI group and increased by 446 and 464 g from low to high RFI in females and males, respectively. Location, but not RFI rank, affected growth, nutrient retention, size of the intestine, and jejunal disaccharidase activity. Chickens from L2 had lower total body weight gain and mucosal enzyme activity but higher nutrient retention and longer intestines than chickens at L1. Parameters determined only at L1 showed increased crypt depth in the duodenum and jejunum and enhanced paracellular permeability in low vs. high RFI females. Jejunal expression of IL1B was lower in low vs. high RFI females at L2, whereas that of TLR4 at L1 and MCT1 at both locations was higher in low vs. high RFI males. Correlation analysis between intestinal parameters and feed efficiency metrics indicated that feed conversion ratio was more correlated to intestinal size and function than was RFI. In conclusion, the rearing environment greatly affected intestinal size and function, thereby contributing to the variation in chicken RFI observed across locations. [ABSTRACT FROM AUTHOR]

The article discusses several options for the treatment of a rare bleeding disorder called Acquired Von Willebrand Syndrome (AVWS) resulting from reduction in plasma von Willebrand Factor (VWF). According to the author, intravenous immunoglobulin, plasmapheresis and immunomodulatory drugs can be used for treatment instead of desmopressin (DDAVP) and tranexamic acid. AVWS can be found in patients with no previous personal or family history of Von Willebrand Disease (VWD).

Eikenella corrodens has been noted as a causative organism in both neonatal and perinatal sepsis. Positivity of blood cultures at birth among preterm infants may be influenced by the maternal use of peripartum antimicrobials and a normal C-reactive protein result within the first 24 hours need not always reflect the absence of fetal invasion by the highly pathogenic organisms. For these reasons, supportive and adjunctive approaches such as appropriately collected placental swabs for culture would be of value in optimizing the antimicrobial choice for sick preterm infants during the early neonatal period. Fetal infection by E. corrodens detected by placental swab culture influencing antimicrobial management of an extremely premature infant with sepsis is described. Management of the youngest premature survivor with the lowest birthweight among the reported cases in English language of neonatal E. corrodens infection is summarized and literature is reviewed. The value of placental swab, which is often underused, is highlighted in this review. [ABSTRACT FROM AUTHOR]

1. The objective of this study was to investigate differences in growth performance, serum intermediary metabolites, acute-phase proteins and white blood cells in low, medium and high–residual feed intake (RFI) chickens. It was also assessed if the environment affects the feed efficiency (FE) and FE-related performance and serum profiles of chickens. 2. Individual body weight (BW) and feed intake (FI) were recorded from d 7 of life. At 5 weeks of age, female and male broiler chickens (Cobb 500) were selected according to their RFI (L1: Austria; L2: UK;n = 9/RFI group, sex and locatity -45on) and blood samples were collected. 3. Chickens at L1 had similar FI but a 15% higher BW gain compared to chickens at L2. The RFI values of female chickens were −231, 8 and 215 g and those of male chickens −197, 0 and 267 g for low, medium and high RFI, respectively. 4. Location affected serum glucose, urea, cholesterol, non-esterified fatty acids (NEFA) and ovotransferrin in females, and serum glucose and triglycerides in male chickens. Serum uric acid and NEFA linearly increased from low to high RFI in females, whereas in males, cholesterol showed the same linear response from low to high RFI. Serum alpha-1-acid glycoprotein and blood heterophil-to-lymphocyte ratio linearly increased by 35% and 68%, respectively, from low to high RFI but only in male chickens at L1. 5. Regression analysis showed significant positive relationships between RFI and serum uric acid (R2 = 0.49) and cholesterol (R2 = 0.13). 6. It was concluded that RFI-related variation in serum metabolites of chickens was largely similar for the two environments and that serum metabolite patterns could be used to predict RFI in chickens. [ABSTRACT FROM AUTHOR]

SUMMARY Background Real-world studies of the emergency reversal of warfarin using 4-factor prothrombin complex concentrate (PCC) report unwarranted delays. The delay to receiving PCC was ≥ 8 h in 46·7% of patients with warfarin-associated bleeding (PWAB) treated with a variable PCC dosing protocol in our retrospective audit. Objective To report the impact of a simplified PCC dosing protocol on the interval to reversal of anticoagulation. Methods We developed a PCC dosing protocol standardising the initial PCC dose and simplifying dosing calculations. Study end points were the proportion of PWAB achieving international normalised ratio (INR) ≤1·5 and treated within 8 h of presentation, respectively. Results Of 17, 15 (88·2%) PWABs achieved a post-treatment INR ≤ 1·5; 14 of 17 (82·4%) PWABs were reversed within 8 h. Median intervals between triage and PCC request and PCC request and start of infusion (administration interval) were 126 min (range 39-520) and 30 min (range 5-100), respectively. Compared with the retrospective cohort, RAPID is associated with an improved administration interval (mean 37·7 vs 76 min, P = 0·031) and the proportion of PWABs treated within 30 min (58·8 vs 6·7%, P = 0·009). Conclusion The RAPID protocol reduces unwarranted delays without compromising efficacy. [ABSTRACT FROM AUTHOR]

Background The diagnosis of colorectal cancer ( CRC) can be difficult as symptoms are variable with poor specificity. Thus, there is a quest for simple, non-invasive testing that can help streamline those with significant colonic pathology. Aim To assess using faecal immunochemical test for haemoglobin (FIT) or faecal calprotectin ( FCP) to detect CRC and adenoma in symptomatic patients referred from primary care. Methods A total of 799 referred for urgent lower gastrointestinal investigations were prospectively recruited. Of these, 430 completed colonic investigations and returned stool samples, and were included in the final statistical analysis. Faecal immunochemical test for haemoglobin was performed on HM- JACKarc analyser (Kyowa Medex, Tokyo, Japan), and FCP by the EliA Calprotectin immunoassay (Thermo Fisher Scientific, Waltham, United States). Results The negative predictive value ( NPV) using FIT alone or both markers ( FIT and FCP) in combination was similar at 99% for CRC, with a sensitivity and specificity of 84% and 93%, respectively. FIT measurements were significantly higher in left-sided colonic lesions compared with the right side; 713 vs. 94; P = 0.0203). For adenoma, the NPV using FIT alone, or both markers ( FIT and FCP) in combination, was similar at 94% with a sensitivity and specificity of 69% and 56%, respectively. Conclusions Undetectable faecal immunochemical test for haemoglobin is sufficiently sensitive to exclude colorectal cancer, with higher values in left-sided lesions. FCP in combination does not appear to provide additional diagnostic information. Further studies to determine the health economic benefits of implementing faecal immunochemical test for haemoglobin in primary care are required. [ABSTRACT FROM AUTHOR]

The article reports a case of severe haemophilia A and X-linked moyamoya syndrome in a 37-year-old male patient. It is noted that the combined disorder resulted from a single genetic event, a gross deletion of ~250 kb telomeric involving a portion of F8 gene and adjacent genes. Results of the patient's genetic investigation and chromosomal analysis, which include polymerase chain reaction amplification, as well as the clinical features of X-linked moyamoya syndrome are discussed.

Two experiments were conducted to examine the 'long-term' effect of feed space allowance and period of access to feed on dairy cow performance. In Experiment 1, three horizontal feed space allowances (20, 40 and 60 cm cow−1) were examined over a 127-d period (14 cows per treatment). In Experiment 2, 48 dairy cows were used in a continuous design (10-week duration) 2 × 2 factorial design experiment comprising two horizontal feed space allowances (15 and 40 cm cow−1), and two periods of access to feed (unrestricted and restricted). With the former, uneaten feed was removed at 08·00 h, while feeding took place at 09·00 h. With the latter, uneaten feed was removed at 06·00 h, while feeding was delayed until 12·00 h. Mean total dry-matter ( DM) intakes were 19·0, 18·7 and 19·3 kg cow−1 d−1 with the 20, 40 and 60 cm cow−1 treatments in Experiment 1, and 18·1 and 18·2 kg cow−1 d−1 with the 'restricted feeding time' treatments, and 17·8 and 18·1 kg d−1 with the 'unrestricted feeding time' treatments (15 and 40 cm respectively) in Experiment 2. None of milk yield, milk composition, or end-of-study live weight or condition score were significantly affected by treatment in either experiment ( P > 0·05), while fat + protein yield was reduced with the 15-cm treatment in Experiment 2 ( P < 0·05). When access to feed was restricted by space or time constraints, cows modified their time budgets and increased their rates of intake. [ABSTRACT FROM AUTHOR]