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With input costs on the rise, researchers and producers, alike, are seeking alternative management strategies for profitable and sustainable beef production. Studies suggest that supplemental feed provided to grazing cattle may be used to offset some of the cost. However, there is a lack of knowledge on the extent of supplemental feeding programs in the southeastern US and which feeds may be used in these programs. Thus, the objective of this study was to better understand supplemental feeding practices and choices among beef producers in the southeastern US. To address this objective, a 24-question survey was distributed through Extension and commodity organizations to beef producers across the Southeast. This survey received 118 complete responses. The majority of respondents operated cow-calf production systems (65.6%) on either tall fescue or bermudagrass pastures (32.7 and 28.0%, respectively). Approximately 88% of these producers employed some type of supplemental feeding strategy, but there is no clear decision on whether commodity or byproduct feedstuffs were preferred. The leading commodity used was corn (61.4%), while common byproducts included whole cottonseed, corn gluten feed, and soybean hulls (17.1, 16.6, and 14.4%, respectively). At the end of the survey, the participants were asked to submit a sample of their byproduct supplements to have a nutritive analysis completed to better understand what nutritional components the products they are feeding contain and how they may vary from place to place. Some of the products that were sent in include whole cottonseed, cotton byproduct, corn gluten meal, distillers grain, chicken litter, and others. The nutritional test being run on these samples included crude protein and fiber analysis. The crude protein of the samples received ranged from 13.3% to 30.3% with an average of 21.5%. The fiber profile received ranged from 45.5% to 76.3% with an average of 59.9%. With the information recorded from these tests, recommendations can be provided on different feeding methods in both commercial settings as well as research settings. [ABSTRACT FROM AUTHOR]

Age-related decline in vision may contribute to the development of fear of falling (FOF) behavior and reduced mobility, which are related to increased fall risk in older adults. To investigate the inter-relationship between vision impairment, physical mobility performance, and FOF behavior in community-dwelling older adults. A total of 400 participants from community centers (267 females; age = 74.8 (6.4), range = 65–97 years) participated in this cross-sectional study. Presence of age-related eye diseases (e.g. macular degeneration, cataracts, glaucoma, and retinopathy) and visual acuity (VA) was assessed. Physical mobility and FOF avoidance behavior were assessed using the Timed Up-and-Go (TUG) test and the Fear of Falling Avoidance Behavior Questionnaire (FFABQ). The inter-relationships between parameters were analyzed using mediation model analysis. Significant decreases in mobility performance were observed in those with eye disease (eye disease = 9.56 [5.2] sec, no eye disease = 8.54 [2.75] sec; p =.037) and FOF avoidance behavior (avoiders = 12.87 [6.04] sec, non-avoiders = 8.51 [3.56] sec; p <.001). Furthermore, FOF behavior was found to significantly influence the inter-relationship between presence of eye disease and TUG performance (p =.004). VA alone had no significant effect on mobility (p =.69). The presence of eye disease and the associated FOF behavior was related to decreased mobility and potentially increased fall risk. We recommend clinicians to inquire about the presence of eye disease and FOF behavior to identify risk factors related to falls in older adults. [ABSTRACT FROM AUTHOR]

Aim: To evaluate changes in in‐hospital mortality rate following implementation of a comprehensive electronic medical record (EMR) system. Methods: Before and after study of 355,709 hospital discharges, over an 8‐year period, at a paediatric teaching hospital. The major outcome measures were crude number of in‐hospital deaths, deaths per 1000 discharges, and standardised mortality ratio. Results: Primary analysis of data from 2 years before and 2 years after EMR go‐live showed a reduction in absolute mortality of 33 deaths, a reduction in the mortality rate of 0.48 per 1000 discharges (95% CI 0.09, 0.88 per 1000): and a relative 22% decrease (95% CI: 4%, 36%, P = 0.02) in deaths per 1000 discharges from 2.20 to 1.72. There was also a reduction in standardised mortality ratio of 47% (95% CI: 18%, 66%, P = 0.004). Post‐hoc analysis of mortality rates for an additional 2‐year pre‐intervention period indicated that these changes in the mortality rate were not part of a pre‐existing downward trend. Further analysis of an additional 20‐month post‐intervention period suggests that the reduced mortality rate has been sustained. Conclusion: We documented evidence of a clinically important decrease in in‐hospital mortality rate following the implementation of a modern comprehensive EMR system in an Australian paediatric teaching hospital. The study does not prove a causal relationship, and it is possible that other factors explain some, or all, of this difference, but no changes in the hospital population or other major interventions were identified as alternative explanations for this observed change. [ABSTRACT FROM AUTHOR]

Creating ensiled forage on a laboratory-scale is a tedious and cumbersome process. One must ensure an anaerobic environment for the success of the fermentation while also striving to replicate field-scale conditions. The objective of this experiment was to determine the effect of laboratory-scale silo type on nutritive value and fermentation profiles of grass-legume silage. This experiment was conducted as a generalized complete block design. There was one treatment factor (silo type) with 11 levels: field-scale baleage control (CON), miniature wrapped baleage (MINI), large fermentation bucket (6GAL), small fermentation bucket (2GAL), miniature silo (PVC), pint-sized Mason-type jar with "BurpLid" (BURP), pint-sized Mason-type jar with Ball-brand fermentation lid (BALL), pint-sized Mason-type jar with an airlock lid (LOCK), single-layered vacuum-sealed bag using a chamber-style sealer (CHMB), double-layered vacuum-sealed bag using a chamber-style sealer (HCHMB), single-layered vacuum-sealed bag using a suction-style sealer (FOOD), or double-layered vacuum-sealed bag using a suction-style sealer (HFOOD). Harvest served as the random blocking factor. Forage was harvested from a single alfalfa-bermudagrass pastures at the Wiregrass Research and Extension Center in Headland, AL. Forage was cut 24 h before collection and allowed to sun-cure. After allocation to treatment, samples were allowed to ferment for 56 d. Following fermentation, samples were assayed for NDF, ADF, ADL, CP, pH, mold, and yeast. Dunnett's test revealed a difference (P < 0.05) from CON for NDF, ADF, and pH. Samples from PVC had 26% greater NDF and 45% greater ADF than CON (58 and 37%, respectively). Samples from BALL were 3 units greater and samples from LOCK were 2 units greater in pH than CON (4.8). When comparing alternative treatments exclusive of CON, there were differences (P ≤ 0.01) in NDF, ADF, ADL, pH, and mold counts among treatments. Results are interpreted to mean that BALL and LOCK are not effective representatives of field-scale silage production due to lack of pH drop, while PVC alters the fiber profiles. All other methods showed promise as prospects for laboratory silage procedures. [ABSTRACT FROM AUTHOR]

Aim: Low-value care (LVC) is common. We aimed, using infants presenting to a major tertiary paediatric hospital with bronchiolitis between April 2016 and July 2018, to: (i) assess rates of chest X-ray (CXR) and medication use; (ii) identify associated factors; and (iii) measure the harm of not performing these practices.Methods: We extracted data from the electronic medical record for all children aged 1-12 months given a diagnosis of bronchiolitis in the emergency department. Factors potentially associated with LVC practices were extracted, including patient demographics, ordering physician characteristics, order indication, medications prescribed and admission ward. To assess for harm, a radiologist, blinded to CXR indication, reviewed all CXRs ordered over the winter of 2017 for infants with bronchiolitis.Results: A CXR was ordered for 439 (11.2%) infants, most commonly to rule out consolidation and collapse (65%). CXRs were more likely to be ordered for admitted infants (40.9% admitted to the general medical ward), and 62% were ordered by emergency department staff. Salbutamol was prescribed for 9.3% (n = 199). Amongst those who had a CXR, 28% were prescribed an antibiotic compared to 2.1% for those who did not. In an audit of 98 CXRs ordered over the winter of 2017, there were no CXR findings that meaningfully affected patient outcomes.Conclusion: Using electronic medical record data, we found that CXR and medication use in bronchiolitis were higher than expected given our hospital guideline advice. Future research needs to understand why and develop interventions to reduce LVC. [ABSTRACT FROM AUTHOR]