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There is no single ultrasound probe available that allows visualization of all airway structures in children of all ages. In larger children above approximately 8 years of age, the linear medium-to-high frequency (5–14 MHz) transducer is suitable for imaging superficial airway structures (within 0–5 cm beneath the skin surface). The curved low-frequency transducer (~4.0 MHz) is most suitable for obtaining sagittal and parasagittal views of the tongue and structures in the submandibular and supraglottic regions, mainly because of its wider field of view. Linear transducers, which are used for assessment of the upper airways, provide excellent images of superficial structures, such as ribs and the pleura, but deeper structures can be difficult to assess. A micro-convex transducer (~8.0 MHz) is a good all-round transducer for focused ultrasonographic examination of the lungs, since most micro-convex transducers have an acceptable image quality of both superficial (pleura) and deeper structures (e.g., lung consolidation, atelectasis). Furthermore, micro-convex transducers are often small, which makes it easier to access the posterior thoracic wall, when the patient can only be examined in the supine position. An alternative to the micro-convex transducer for examination of the lungs is the curved low-frequency transducer (~4.0 MHz), which also has an acceptable image quality of both superficial and deeper structures. Since visualization of superficial and deep structures is needed, it is important to continuously optimize transducer frequency to obtain the best possible images. The presence or absence of artifacts are an important part of lung ultrasonography; hence, one should be mindful to deactivate any image optimization software that is inherently built into newer ultrasound machines as this would remove or diminish the presence of these useful artifacts when performing lung ultrasonography.
Sow litter sizes have increased, subjecting more small piglets to intra-uterine growth restriction (IUGR). Research on the development and growth of IUGR pigs is limited. The objective of this study was to compare the body composition and organ development of IUGR pigs at weaning, and to estimate their growth performance from birth to 30 kg. A total of 142 IUGR and 142 normal piglets were classified at birth based on their head morphology. At weaning, 20 IUGR and 20 normal piglets were collected, a whole-body dual-energy x-ray absorption scan was performed, and the piglets were euthanized for organ measurements. Body weight (BW) was measured weekly from birth to 30 kg, rectal temperature and whole-blood glucose levels were measured weekly from birth to weaning, and blood samples were collected at days 7, 14 and 21 for IGF-1 analysis. Results showed that IUGR pigs have a similar percentage of adipose tissue (P > 0.05) compared to normal pigs at 24 days of age. Organs were smaller (P < 0.001) in IUGR pigs than in normal pigs, whereas brain, liver, lungs and adrenal glands were relatively larger (P < 0.05) in relation to the BW of IUGR pigs. Average birth weight (BiW) of normal pigs was greater (P < 0.001) compared with IUGR pigs (1.38 v. 0.75 kg), and the average daily gain (ADG) of IUGR pigs was reduced from day 0 to 14, day 0 to 28 (weaning) and from weaning to 30 kg compared to normal pigs. From birth to weaning at day 28, IUGR piglets had a 72.9 g/day greater fractional ADG (FADG) in relation to their BiW (P < 0.05), but FADG did not differ (P > 0.05) from weaning to 30 kg. Rectal temperature of IUGR piglets was greater (P < 0.05) on day 7 compared with normal piglets, and, even though blood glucose levels were decreased (P < 0.001) in IUGR piglets at day 0, neither glucose nor IGF-1 concentrations differed (P > 0.05) between IUGR and normal piglets. In conclusion, IUGR piglets exhibited some relatively larger organs at weaning compared to normal pigs, but body composition was similar between IUGR and normal pigs. In addition, IUGR pigs had a reduced ADG from birth to 30 kg, and, although they exhibited a greater FADG during nursing, IUGR pigs still require six additional days to reach a BW of 30 kg in comparison to normal pigs.
This paper reviews the effects of extended lactation (EXT) as a strategy in dairy cattle on milk production and persistency, reproduction, milk quality, lifetime performance of the cow and finally the economic effects on herd and farm levels as well as the impact on emission of greenhouse gas at product level. Primiparous cows are able to produce equal or more milk per feeding day during EXT compared with a standard 305-d lactation, whereas results for multiparous cows are inconsistent. Cows managed for EXT can achieve a higher lifetime production while delivering milk with unchanged or improved quality properties. Delaying insemination enhances mounting behaviour and allows insemination after the cow’s energy balance has become positive. However, in most cases EXT has no effect or a non-significant positive effect on reproduction. The EXT strategy sets off a cascade of effects at herd and farm level. Thus, the EXT strategy leads to fewer calvings and thereby expected fewer diseases, fewer replacement heifers and fewer dry days per cow per year. The optimal lifetime scenario for milk production was modelled to be an EXT of 16 months for first parity cows followed by an EXT of 10 months for later lactations. Modelling studies of herd dynamics indicate a positive effect of EXT on lifetime efficiency (milk per dry matter intake), mainly originating from benefits of EXT on daily milk yield in primiparous cows and the reduced number of replacement heifers. Consequently, EXT also leads to reduced total meat production at herd level. For the farmer, EXT can give the same economic return as a traditional lactation period. At farm level, EXT can contribute to a reduction in the environmental impact of dairy production, mainly as a consequence of the reduced production of beef. A wider dissemination of the EXT concept will be supported by methods to predict which cows may be most suitable for EXT, and clarification of how milking frequency and feeding strategy through the lactation can be organised to support milk yield and an appropriate body condition at the next calving.
Free fatty acid (FFA) concentrations can be elevated in raw milk due to improper handling and management at the dairy farm, and high concentrations of FFA can lead to off flavors in milk. This study aimed to describe how the herd production system, milking system, feeding and technological factors impact on FFA concentrations in bulk tank milk. FFA concentrations in bulk milk samples from 259 organic and 3326 conventional herds were analyzed by FT-IR during one year. The FFA content was significantly lower in bulk milk from organic than conventional herds. This was most evident during the summer half-year when the organic cows graze pasture. Bulk milk from automatic milking systems (AMS) and tie-stalls contained greater concentrations of FFA than any other milking parlor systems. In AMS, high milking frequency was found to be the most significant contributor to elevated FFA content in milk. Moreover, a strong interaction was found between milking interval and production system (organic vs. conventional). The technical factors, pre-cooling, onset time for cooling after milk inlet, contact between milk and agitation also impacted on the FFA concentration, whereas other technical factors including centrifugal pump type, length and height of pumping line and type of AMS manufacturer were found to be without significant effect on FFA. Feeding variables, based on feeding plans and evaluation, only explained a small part of the variation in bulk milk FFA. Overall, this study demonstrated that AMS compared to other milking system contributes significantly to increased FFA concentration in bulk tank milk, and within AMS high milking frequency contributes to increased FFA concentration.
The HTA Core Model® was developed to improve the transferability of health technology assessment (HTA) between settings. The model has been used by HTA agencies but is also of interest to manufacturers, for improving internal evidence generation and communicating with other HTA stakeholders. To establish if the model is fit for purpose from an industry perspective, the pharmaceutical company Roche, collaborating with the European Network for HTA (EUnetHTA), conducted an assessment of the model.
A questionnaire was developed to evaluate all assessment elements in the HTA Core Model v2.0 for their usefulness in meeting payers’ evidence needs and demonstrating value. The questionnaire was completed by country affiliate teams working in evidence generation and reimbursement submissions for pharmaceuticals. Survey results were discussed in workshops to ensure consistency and alignment between teams.
The questionnaire was completed by six teams. An additional team from global pricing and market access participated in workshops. Model domains pertaining to the health problem and current technology use, technology description, clinical effectiveness, and economic value were considered most important because they meet payers’ evidence needs. Overall, the model was considered useful to improve the efficiency of HTA evidence generation, share evidence internally, and communicate value to payers and HTA agencies.
From an industry perspective, the HTA Core Model provides a useful framework and common terminology for efficient generation of transferable HTA evidence. The timeliness, efficiency, and transparency of HTA processes could be improved by a more standardized approach to HTA across settings.
To explore determinants of serum 25-hydroxyvitamin D (s-25(OH)D) during autumn in young, Caucasian children not consuming vitamin D-fortified foods or supplements, and explore differences in sun behaviours between pre-school and school children.
In September–October, s-25(OH)D was measured by LC–MS/MS; physical activity, sun behaviours and vitamin D intake were assessed with questionnaires.
Baseline data from the ODIN Junior trial at 55°N.
Children aged 4–8 years (n 130), of whom 96% gave blood samples.
Physical activity and sun behaviours are associated with s-25(OH)D in young children. Identifying factors influencing autumn s-25(OH)D is relevant to optimize levels before sun exposure diminishes. Strategies to reduce risk of inadequacy should consider risk of skin cancer and sunburn, and could include fortification and/or vitamin D supplementation.
Multi-analyte assays with algorithmic analyses (MAAAs) use combinations of circulating and clinical markers including omics-based sources for diagnostic and/or prognostic purposes. Assessing MAAAs is challenging under existing health technology assessment (HTA) methods or practices. We undertook a scoping review to explore the HTA methods used for MAAAs to identify the criteria used for clinical research and reimbursement purposes.
This review included only non-companion (stand-alone) tests that are actionable and that have been evaluated by leading HTA or insurer/reimbursement bodies up to September 2017.
Twenty-five reports and articles evaluating seventeen MAAAs were examined, most of which have been developed in oncology. The two main models used were the EUnetHTA Core model and the Evaluation of Genomic Applications in Practice and Prevention ACCE framework. Clinical validity and utility criteria were used, as were economic, ethical, legal, and social aspects. Economic evidence on MAAAs was scarce, and there is no consensus on whether the perspectives used are sufficiently broad to include all relevant stakeholders.
Clinical utility and efficiency were the most used criteria, with stronger evidence needed linking the use of the algorithm with the clinical outcomes in real-life practice. HTA bodies must as well consider questions related to the analytical validity of MAAAs or with organizational aspects. The two main models, the EUnetHTA Core model and the ACCE framework, could be adapted to the assessment of MAAAs.
Rumen fermentation and splanchnic metabolism affect the relationship between the chemical composition of the feed and the nutrients available to the mammary gland and other peripheral tissues in the dairy cow. Conventional feed evaluation systems don’t allow the nutritionist to design diets based on the demand for specific nutrients, but primarily base predicted animal responses on the energy content of digested organic matter. In a nutrient based feed evaluation system (NBFE) the chemical composition of the feed and monitoring of ruminal variables in real time can be used as input to simulation models describing fermentation and intermediary metabolism. The aim of the system is to analyse/evaluate dietary adjustments according to specific metabolic needs of the dairy cows under specified physiological conditions. It’s mandatory that NBFE systems account for all major nutrient fractions absorbed and metabolised in the dairy cow. Short-chain fatty acids (SCFA) have been particularly troublesome in this respect because it generally has been assumed that a large proportion of ruminally absorbed SCFA is metabolised by the rumen epithelium and therefore is not available to the liver or peripheral tissues. The aim of this presentation is to review the interrelations between ruminal production, portal absorption, and peripheral availability of SCFA in the ruminant and to discuss how the metabolism of SCFA might be incorporated into future NBFE systems.
Glacier surges tend to be initiated in relatively small regions, then propagate down-glacier, up-glacier and/or across-glacier. The processes controlling patterns and rates of surge propagation, however, are incompletely understood. In this paper, we focus on patterns of surge propagation in two confluent glaciers in Svalbard, and examine possible causes. One of these glaciers, Bakaninbreen, surged in 1985–95. The surge propagated ∽7 km down-glacier, but did not cross the medial moraine onto the other glacier, Paulabreen. When Paulabreen surged between 2003 and 2005, the surge wave travelled several km down-glacier, but its lateral boundary stayed very close to the medial moraine. The confluent glaciers formerly extended into a fjord, and bathymetric mapping and historical observations show that an active subglacial conduit has existed between Bakaninbreen and Paulabreen since at least the early 20th century. The existence of a persistent subglacial conduit below the medial moraine was confirmed when we entered and mapped a Nye channel at the confluence of Bakaninbreen and Paulabreen. We argue that the conduit acts as a barrier to surge propagation. If pressurized water below one branch of the glacier system reaches the conduit, water can be readily evacuated, preventing its propagation into the other branch.
In 2005 an airborne survey was carried out from a Twin Otter aircraft at Pâkitsup Akuliarusersua (Paakitsoq) near Ilulissat in West Greenland. The survey aimed to measure ice thickness with a 60 MHz coherent radar and surface elevation with a scanning laser altimeter. Positioning information came from multiple on-board differential GPS units and an inertial navigation system. The region surveyed covers >80km along the ice margin and has a total area of ~2700km2 with varying density of measurements: the between-track distance was ~1 km near the margin, increasing to ~3km away from the margin. Regional high-resolution maps of basal topography under the Greenland ice sheet are useful for resolving important glaciological and hydrological questions and for enhancing related process studies, such as the influence of basal meltwater on ice dynamics. The ice-sheet margin in this region is also currently under consideration for hydropower development and has a long and continuing history of glaciological investigations, lately with emphasis on the connection between surface meltwater formation and surface velocity of the ice sheet. Here we present a new regional map of the surface and basal topography of the ice-sheet margin and discuss some of the implications for reported observations at Swiss Camp.
In recent years it has been common after disasters and terrorist events to offer bereaved families the opportunity to visit the place where their loved ones died. Many report that such visits are beneficial in processing their loss. Various factors, both cognitive (eg, counteracting disbelief) and existential or emotional (eg, achieving a sense of closeness to the deceased), are associated with the experienced benefit. Nonetheless, exacerbations of trauma and grief reactions (eg, re-enactment fantasies) are common, with some of the bereaved also reporting adverse reactions after the visit. Subsequently, proper preparations are a prerequisite before such visits take place. This article describes how to optimize collective visits to the site of death after disasters or terrorist events for bereaved families. Important questions—for example, concerning those who should be responsible for organizing a visit and those who should be invited, the timing of the visit, what can be done at the site, the need for support personnel, and other practical issues—are discussed and general guidelines are recommended. (Disaster Med Public Health Preparedness. 2018;12:523–527)
Clinical depression is accompanied by changes in sleep patterning, which is controlled in a circadian fashion. It is thus desirable that animal models of depression mirror such diurnally-specific state alterations, along with other behavioral and physiological changes. We previously found several changes in behavior indicative of a depression-like phenotype in offspring of rats subjected to repeated, variable prenatal stress (PNS), including increased locomotor activity during specific periods of the circadian cycle. We, therefore, investigated whether PNS rats also exhibit alterations in sleep/wakefulness behavior around the change from light-to-dark phase. Control and PNS Sprague–Dawley rats were implanted with electrodes for continuous monitoring of electroencephalic activity used to determine behavioral state. The distribution of slow-wave sleep (SWS), rapid eye movement sleep (REMS) and wakefulness was compared for periods before and after lights were turned off, between baseline conditions and after exposure to an acute stressor. Both REMS and SWS amounts were increased in PNS rats relative to control animals in the beginning of the dark phase. REMS changes were due to an increase in REMS bout number, rather than in bout duration. During this circadian time period, we did not find any sex differences in the state changes. These results indicate that PNS affects baseline sleep patterning in both male and female rats around active-phase onset.
Predictions of tracks of occultations of stars by minor planets give a strong test of the accuracy of observations, star places, and dynamical theories. A critical discussion of the 1983 September 11 occultation of 14 Piscium by (51) Nemausa shows that the systematic regional errors of fundamental stars introduce errors in the long-term predictions of occultations that are larger than relativistic effects.
T.N. Thiele participated in the astrographic conference in Paris 1887 and was the first theoretician to reduce and analyse the photographic plates of the Henry brothers. He was an enthusiastic supporter of photographic astrometry because of its elimination of personal errors. However, for different reasons he did not want the Copenhagen Observatory to take responsibility for a Carte du Ciel zone. Thiele's life and work and his plans for the development of astrometry are presented.
Ice sounding with radar is a well-established technique for the retrieval of ice depth, and provides information on ice structures and layering. Airborne radar ice sounders suffer from off-nadir surface clutter that masks the signal from bedrock and ice layers with unwanted but simultaneously received surface reflections. This is of importance for future satellite ice-sounding missions, as the spaceborne geometry leads to strong surface clutter even for deep subsurface returns. This paper presents analysis and comparison of different clutter-suppression techniques applied to data acquired with the European Space Agency's P-band POLarimetric Airborne Radar Ice Sounder (POLARIS). The 4 m long antenna of POLARIS enables simultaneous reception of up to four across-track channels. It was operated in 2011 over Antarctica at a high flight altitude of 3200 m. Different coherent weighting techniques of the receive channels were used to suppress the surface ‘clutter’. However, with a channel spacing of 1.4 times the wavelength, the grating lobe imposes a limitation to the off-nadir angular range in which clutter can be effectively attenuated. Results of ice sounding over Jutulstraumen glacier are described, where we demonstrate a clutter suppression of up to 10 dB.
Frequent BW monitoring of growing pigs can be useful for identifying production (e.g. feeding), health and welfare problems. However, in order to construct a tool which will properly recognize abnormalities in pigs’ growth a precise description of the growth process should be used. In this study we proposed a new model of pig growth accounting for daily fluctuations in BW. Body weight measurements of 1710 pigs (865 gilts and 843 barrows) originating from five consecutive batches from a Danish commercial farm were collected. Pigs were inserted into a large pen (maximum capacity=400) between November 2014 and September 2015. On average, each pig was observed for 42 days and weighed 3.6 times a day when passing from the resting to feeding area. Altogether, 243,160 BW measurements were recorded. A multilevel model of pig growth was constructed and fitted to available data. The BW of pigs was modeled as a quadratic function of time. A diurnal pattern was incorporated into the model by a cosine wave with known length (24 h). The model included pig effect which was defined as a random autoregressive process with exponential correlation. Variance of within-pigs error was assumed to increase with time. Because only five batches were observed, it was not possible to obtain the random effect for batch. However, in order to account for the batch effect the model included interactions between batch and fixed parameters: intercept, time, square value of time and cosine wave. The gender effect was not significant and was removed from the final model. For all batches, morning and afternoon peaks in the frequency of visits to the feeding area could be distinguished. According to results, pigs were lighter in the morning and heavier in the evening (minimum BW was reached around 1000 h and maximum around 2200 h). However, the exact time of obtaining maximum and minimum BW during the day differed between batches. Pigs had access to natural light and, therefore, existing differences could be explained by varying daylight level during observations periods. Because the diurnal amplitude for pig growth varied between batches from 0.9 to 1.4 kg, BW monitoring tools based on frequent measurements should account for diurnal variation in BW of pigs. This proposed description of growth will be built into a monitoring tool (a dynamic linear model) and applied to farm data in future studies.
Ice deformation and basal motion characterize the dynamical behavior of the Greenland ice sheet (GrIS). We evaluate the contribution of basal motion from ice deformation measurements in boreholes drilled to the bed at two sites in the western marginal zone of the GrIS. We find a sustained high amount of basal motion contribution to surface velocity of 44–73% in winter, and up to 90% in summer. Measured ice deformation rates show an unexpected variation with depth that can be explained with the help of an ice-flow model as a consequence of stress transfer from slippery to sticky areas. This effect necessitates the use of high-order ice-flow models, not only in regions of fast-flowing ice streams but in all temperate-based areas of the GrIS. The agreement between modeled and measured deformation rates confirms that the recommended values of the temperature-dependent flow rate factor A are a good choice for ice-sheet models.
The surveillance of Clostridium difficile (CD) in Denmark consists of laboratory based data from Departments of Clinical Microbiology (DCMs) sent to the National Registry of Enteric Pathogens (NREP). We validated a new surveillance system for CD based on the Danish Microbiology Database (MiBa). MiBa automatically collects microbiological test results from all Danish DCMs. We built an algorithm to identify positive test results for CD recorded in MiBa. A CD case was defined as a person with a positive culture for CD or PCR detection of toxin A and/or B and/or binary toxin. We compared CD cases identified through the MiBa-based surveillance with those reported to NREP and locally in five DCMs representing different Danish regions. During 2010–2014, NREP reported 13 896 CD cases, and the MiBa-based surveillance 21 252 CD cases. There was a 99·9% concordance between the local datasets and the MiBa-based surveillance. Surveillance based on MiBa was superior to the current surveillance system, and the findings show that the number of CD cases in Denmark hitherto has been under-reported. There were only minor differences between local data and the MiBa-based surveillance, showing the completeness and validity of CD data in MiBa. This nationwide electronic system can greatly strengthen surveillance and research in various applications.