To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This paper will present a dynamic Variable Rate Irrigation System developed by the University of Georgia. The system consists of the EZZone management zone delineation tool, the UGA Smart Sensor Array (UGA SSA) and an irrigation scheduling decision support tool. An experiment was conducted in 2015 and 2016 in two different peanut fields to evaluate the performance of using the UGA SSA to dynamically schedule Variable Rate Irrigation (VRI). For comparison reasons strips were designed within the fields. These strips were irrigated according to either UGA SSA or Irrigator Pro recommendations. The results showed that Irrigator Pro is a conservative irrigation method which results in high yields. On the other hand the UGA SSA recommendations worked very well with the VRI system and in both years it recommended an average of 25% less irrigation water than the Irrigator Pro.
Background: Dysphagia is a common and devastating complication after acute stroke. Percutaneous endoscopic gastrostomy (PEG) tubes are often placed for persistent dysphagia. However, little is known regarding outcomes after PEG tube placement. Methods: We used a 10-year Ontario Stroke Registry to shed light on the clinical outcomes of patients with PEG tube insertion after ischemic stroke or intracranial hemorrhage compared to patients with only NG tubes, including rate of pneumonia, disability, and mortality. Results: Using propensity score matching, 1,793 patients were successfully matched and had similar baseline characteristics. Compared with NG, patients with PEG had a higher rate of pneumonia (32.6% vs. 20.6%; RR 1.59), higher disability at discharge (modified Rankin Scale Score 3-5; 74.0% vs. 65.4%; RR 1.13), and higher rate of long-term care placement (27.1% vs. 9.3%; RR 2.9). >From stroke onset, there was a lower rate of death in patients with PEG compared to NG at 30 days (15.3% vs. 34.3%; RR 0.45) but no difference at 2 years (52.8% vs. 53.5%; RR 0.99, p=0.71). *All significant p <0.0001. Conclusions: In conclusion, PEG tube placement after stroke may prolong survival in patients with poor outcomes. Our study provides a framework for discussions between physicians, patients, and families with regards to expected prognosis after PEG tube placement.
Background: In patients with acute stroke, nasogastric (NG) tubes are commonly inserted for feeding when dysphagia is identified, and percutaneous endoscopic gastrostomy (PEG) tubes are placed for severe or persistent dysphagia. However, little is known regarding predictors of PEG insertion. Methods: We used the Ontario stroke registry from 2003-2013 to identify baseline characteristics of all patients with NG or PEG tube insertion after stroke. We used multiple logistic regression with backwards selection to determine variables that were independent predictors of PEG tube insertion during admission. Results: 4002 patients with NG and 1903 patients with PEG were included in the analysis. Independent predictors of PEG were: Age (80+ vs. <60; odds ratio [OR] 1.70), past history of stroke (OR 1.17), higher stroke severity (severe vs. mild stroke; OR 1.37), stroke unit admission (OR 1.46), and dysphagia screening (OR 1.52). Factors associated with reduced odds of PEG insertion were: Prior history of peptic ulcer disease (OR 0.70), prior independence (OR 0.78), dementia (OR 0.76), palliative status (OR 0.49), and thrombolysis (OR 0.66). *All p<0.01 Conclusions: The strongest predictors of PEG were older age, higher stroke severity, stroke unit admission and dysphagia screening. Patients with dementia had reduced odds of PEG. Thrombolysis also reduced odds of PEG and may be protective.
Introduction: Data regarding adverse events (AEs) (unintended harm to the patient from health care provided) among children seen in the emergency department (ED) are scarce despite the high risk setting and population. The objective of our study was to estimate the risk and type of AEs, and their preventability and severity, among children treated in pediatric EDs. Methods: Our prospective cohort study enrolled children <18 years of age presenting for care during 21 randomized 8 hr-shifts at 9 pediatric EDs from Nov 2014 to October 2015. Exclusion criteria included unavailability for follow-up or insurmountable language barrier. RAs collected demographic, medical history, ED course, and systems level data. At day 7, 14, and 21 a RA administered a structured telephone interview to all patients to identify flagged outcomes (e.g. repeat ED visits, worsening/new symptoms, etc). A validated trigger tool was used to screen admitted patients’ health records. For any patients with a flagged outcome or trigger, 3 ED physicians independently determined if an AE occurred. Primary outcome was the proportion of patients with an AE related to ED care within 3 weeks of their ED visit. Results: We enrolled 6377 (72.0%) of 8855 eligible patients; 545 (8.5%) were lost to follow-up. Median age was 4.4 years (range 3 months to 17.9 yrs). Eight hundred and seventy seven (13.8%) were triaged as CTAS 1 or 2, 2638 (41.4%) as CTAS 3, and 2839 (44.7%) as CTAS 4 or 5. Top entrance complaints were fever (11.2%) and cough (8.8%). Flagged outcomes/triggers were identified for 2047 (32.1%) patients. While 252 (4.0%) patients suffered at least one AE within 3 weeks of ED visit, 163 (2.6%) suffered an AE related to ED care. In total, patients suffered 286 AEs, most (67.9%) being preventable. The most common AE types were management issues (32.5%) and procedural complications (21.9%). The need for a medical intervention (33.9%) and another ED visit (33.9%) were the most frequent clinical consequences. In univariate analysis, older age, chronic conditions, hospital admission, initial location in high acuity area of the ED, having >1 ED MD or a consultant involved in care, (all p<0.001) and longer length of stay (p<0.01) were associated with AEs. Conclusion: While our multicentre study found a lower risk of AEs among pediatric ED patients than reported among pediatric inpatients and adult ED patients, a high proportion of these AEs were preventable.
Introduction: Multiples barriers to appropriate analgesia are reported in the paediatric emergency department (PED), including limited accessibility to effective strategies. Our objective: was to evaluate the improvement in the accessibility of pain and anxiety management strategies in Canadian PEDs, after the creation of a national pediatric pain Quality Improvement Collaborative (QIC), through Pediatric Emergency Research Canada (PERC). Methods: In 2013, the TRAPPED 1 survey was administered to Canadian PEDs, in order to evaluate what resources were in place for pain and anxiety management. A pain QIC was then created to stimulate the implementation of new strategies, through information sharing between PEDs. In 2015, the TRAPPED 2 cross sectional survey was administered. Its focus was to evaluate the improvement in the accessibility of specific strategies reported by each centre, after participating in this QIC, and working to implement change within their own PEDs. Results: All 15/15 Canadian PEDs responded to the TRAPPED 1 survey in 2013 and 11 agreed to participate in the national pain QIC. In-person, phone meetings, follow up surveys and email communications were employed for information sharing. Strategies identified by the QIC to be newly introduced in individual centres were educational initiatives, distraction options, nurse-initiated protocols and intranasal (IN) medications. All 15 PEDs completed the TRAPPED 2 survey. Compared to 2013, an increased number of PEDs used face-based pain scales (14/15 vs 6/15) and behavioural scales (5/15 vs 1/15) for pain assessment in 2015. Use of reminder posters on pain management at triage increased from 4/15 to 6/15 PEDs. Availability of tablets for distraction increased from 4/15 to 10/15 PEDs. Nurse-initiated protocols for topical anesthetic and oral sucrose (for needle procedures) increased from 10/15 to 12/15 sites and from 12/15 to 14/15 sites respectively. Availability of IN medications increased; fentanyl from 9/15 to 14/15 sites and midazolam from 8/15 to 10/15 sites. Ten of the 11 PEDs involved in the QIC strategy reported the implementation of at least one of their own identified strategies. Conclusion: This study suggests that the use of a QIC may improve the introduction of new strategies to reduce pain and anxiety in EDs. QICs may also be helpful to other centres when introducing new strategies.
Impaired neuropsychological function and differences in facial emotion
processing are features of major depression. Some aspects of these
functions may change during treatment and may be useful in assessing
treatment response, even at an early stage of treatment.
To examine early and later changes in neuropsychological functioning and
facial emotion processing as potential markers of treatment response in
In total, 68 newly admitted in-patients with a primary diagnosis of major
depression and 50 healthy controls completed an assessment, including
mood ratings, neuropsychological measures and facial emotion processing
measures at three time points (baseline, 10–14 days and 6 weeks).
Pervasive neuropsychological impairment was evident at baseline in
patients with depression compared with healthy controls. During 6 weeks
of treatment, only simple reaction time, verbal working memory and the
recognition of angry facial expressions showed differential change in
those whose depression responded to treatment compared with treatment
non-responders in the depression group. None of the measures showed a
significant difference between treatment responders and non-responders at
Despite significant impairment in neuropsychological functioning in the
depression group, most measures failed to differentiate between treatment
responders and non-responders at 10–14 days or at 6 weeks. Simple
reaction time, verbal working memory and recognition of angry facial
expressions may be useful in assessing response in severe depression but
probably not at an early stage.
An estimate of the benefits which would result from a ban on the sale of non-pasteurized milk in Scotland has been assessed by costing a recent outbreak of milk-borne salmonellosis in the Grampian Region.
The cost of such a ban would not exceed the benefits under any but the most severe assumptions about the values attached to intangible benefits
The objectives of the present study were to examine relationships between methane (CH4) output and animal and dietary factors, and to use these relationships to develop prediction equations for CH4 emission from beef cattle. The dataset was obtained from 108 growing-to-finishing beef steers in five studies and CH4 production and energy metabolism data were measured in indirect respiration calorimeter chambers. Dietary forage proportion ranged from 29.5% to 100% (dry matter (DM) basis) and forages included grass silage, fresh grass, dried grass and fodder beet. Linear and multiple regression techniques were used to examine relationships between CH4 emission and animal and dietary variables, with the effects of experiment or forage type removed. Total CH4 emission was positively related to live weight (LW), feeding level and intake of feed (DM and organic matter) and energy (gross energy (GE), digestible energy (DE) and metabolisable energy (ME)) (P < 0.001), while CH4/DM intake (DMI) was negatively related to energy digestibility and ME/GE (P < 0.05 or less). Using LW alone to predict CH4 emission produced a poor relationship when compared to DMI and GE intake (GEI) (R2 = 0.26 v. 0.68 and 0.70 respectively). Adding feeding level, dietary NDF concentration and CP/ME or feeding level, energy digestibility and ME/GE to support LW resulted in a R2 of 0.66 or 0.84. The high R2 (0.84) was similar to that obtained using DMI or GEI together with energy digestibility and ME/GE as predictors. Further inclusion of dietary forage proportion and ADF and NDF concentration to the multiple relationships using GEI as the primary predictor resulted in a R2 of 0.87. These equations were evaluated through internal validation, by developing a range of similar new equations from two-thirds of the present data and then validating these new equations with the remaining one-third of data. The validation indicated that addition of energy digestibility and ME/GE to support LW with feeding level, DMI and GEI considerably increased the prediction accuracy. It is concluded that CH4 emission of beef steers can be accurately predicted from LW plus feeding level, DMI or GEI together with energy digestibility and ME/GE. The dataset was also used to validate a range of prediction equations for CH4 production of cattle published elsewhere.
A collaborative exercise, supervised by the World Health Organisation, was set up to compare ELISAs used for the serological detection of Salmonella enteritica serotype Enteritidis in chickens. The aim was to ascertain how far agreement could be reached on the interpretation of optical density readings for high titre, intermediate titre and low titre sera. Two sets of sera were sent to 14 participants. The first set compared high, medium and low titre sera raised in specified-pathogen-free and commercial broiler breeder chickens. The second set comprised 20 sera of different antibody titres raised in commercial birds reared under laboratory conditions and sent blind. Both indirect and double-antibody sandwich blocking ELISAs were used with a number of different detecting antigens. With a few exceptions good agreement was reached on the interpretation of results obtained from high and low titre sera from the optical density obtained with a single serum dilution. Differences were observed in the interpretation of medium titre sera. The results suggested that most ELISAs produce reasonably comparable results and that practical problems may arise from interpretation of the results mainly as a result of the choice of the criteria used for differentiating sera obtained from infected and uninfected chickens. These problems are discussed.
Empty body (EB) composition data from 146 lactating Holstein–Friesian dairy cows were analysed, with cows selected from a large herd to represent a wide range of animal factors including parity, live weight (LW), body condition score (BCS), milk yield and stage of lactation. The objectives of the study were to examine possible relationships between EB composition and live animal characteristics and to develop prediction equations for EB weight (EBW) and EB composition. EBW was strongly related to LW with a R2 of 0·90, and addition of BCS and stage of lactation increased the R2 to 0·93 and reduced the s.e. value from 19·8 to 16·8. There was a strong relationship between LW and EB mass of crude protein (CP) or water (R2=0·89 or 0·85), and addition of BCS, milk yield and stage of lactation as supporting predictors gave little improvement in the relationship between LW and EB mass of CP or water. Similar results were also obtained for the prediction of EB ash mass, but the relationship between EB ash mass and LW or a combination of LW and parity was relatively poor (R2=0·59 or 0·63). However, including BCS and milk yield as supporting predictors in the linear relationship between LW and EB masses of lipid (0·51 v. 0·79) and dry matter (DM) (0·79 v. 0·91) and total gross energy (GE) content (0·66 v. 0·85) considerably increased the R2 values. Similar linear and multiple relationships were also developed to predict EB component proportions of lipid, CP, GE, DM and water, and the R2 values were much smaller than those for EB component masses. The equations for prediction of EB component masses were evaluated through internal validation, by developing a range of similar new equations from two-thirds of the present data and then validating these new equations with the remaining one-third of data. The validation indicated that addition of other live animal factors to support LW to predict EBW and EB masses of lipid, GE and DM considerably increased the prediction accuracy, but had little effect on the prediction accuracy for EB masses of CP, water and ash. It is concluded that in lactating dairy cows, LW is a very good predictor of EB masses of CP and water. Accurate prediction of EBW and EB masses of lipid, GE and DM can be obtained using LW together with BCS, milk yield and stage of lactation.
For fifteen years oral ciprofloxacin has been the standard treatment for malignant otitis externa, a sometimes fatal osteomyelitis of the skull base usually caused by Pseudomonas aeruginosa. Resistance to ciprofloxacin is developing. Over a 16-month period, we saw five cases where malignant otitis externa progressed, with the development of cranial nerve palsies in four cases, despite oral ciprofloxacin. Prolonged intravenous antibiotic therapy became necessary. One case was managed largely as an out-patient, but four patients spent many weeks in hospital. Only two cases had diabetes and this was monitored and controlled. Pseudomonas aeruginosa was isolated in four of the five cases, but antibiotic sensitivity to ciprofloxacin was not determined. In one case a later isolate was tested and found to be ciprofloxacin resistant. Progress was monitored by serial C-reactive protein (CRP) and white cell count. For diagnosis and assessing response to treatment we considered serial magnetic resonance imaging or computed tomography more useful than isotope bone scan. There must be a readiness to use intravenous antibiotics, as a response to ciprofloxacin can no longer be assumed. Bacterial isolates must be tested for sensitivity to antibiotics including ciprofloxacin, and further biopsy and culture are essential if treatment fails.
The accurate prediction of body composition of dairy cows is important for developing appropriate nutritional and management regimes. The objective of the present study was to develop prediction equations for empty body (EB) composition of lactating dairy cows using body weight and other live animal data.