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To report feasibility, early outcomes and challenges of implementing a 14-day threshold for undertaking surgical tracheostomy in the critically ill coronavirus disease 2019 patient.
Twenty-eight coronavirus disease 2019 patients underwent tracheostomy. Demographics, risk factors, ventilatory assistance, organ support and logistics were assessed.
The mean time from intubation to tracheostomy formation was 17.0 days (standard deviation = 4.4, range 8–26 days). Mean time to decannulation was 15.8 days (standard deviation = 9.4) and mean time to intensive care unit stepdown to a ward was 19.2 days (standard deviation = 6.8). The time from intubation to tracheostomy was strongly positively correlated with: duration of mechanical ventilation (r(23) = 0.66; p < 0.001), time from intubation to decannulation (r(23) = 0.66; p < 0.001) and time from intubation to intensive care unit discharge (r(23) = 0.71; p < 0.001).
Performing a tracheostomy in coronavirus disease 2019 positive patients at 8–14 days following intubation is compatible with favourable outcomes. Multidisciplinary team input is crucial to patient selection.
We conducted a systematic review and network meta-analysis to determine the comparative efficacy of antibiotics used to control bovine respiratory disease (BRD) in beef cattle on feedlots. The information sources for the review were: MEDLINE®, MEDLINE In-Process and MEDLINE® Daily, AGRICOLA, Epub Ahead of Print, Cambridge Agricultural and Biological Index, Science Citation Index, Conference Proceedings Citation Index – Science, the Proceedings of the American Association of Bovine Practitioners, World Buiatrics Conference, and the United States Food and Drug Administration Freedom of Information New Animal Drug Applications summaries. The eligible population was weaned beef cattle raised in intensive systems. The interventions of interest were injectable antibiotics used at the time the cattle arrived at the feedlot. The outcome of interest was the diagnosis of BRD within 45 days of arrival at the feedlot. The network meta-analysis included data from 46 studies and 167 study arms identified in the review. The results suggest that macrolides are the most effective antibiotics for the reduction of BRD incidence. Injectable oxytetracycline effectively controlled BRD compared with no antibiotics; however, it was less effective than macrolide treatment. Because oxytetracycline is already commonly used to prevent, control, and treat BRD in groups of feedlot cattle, the use of injectable oxytetracycline for BRD control might have advantages from an antibiotic stewardship perspective.
Vaccination against putative causal organisms is a frequently used and preferred approach to controlling bovine respiratory disease complex (BRD) because it reduces the need for antibiotic use. Because approximately 90% of feedlots use and 90% of beef cattle receive vaccines in the USA, information about their comparative efficacy would be useful for selecting a vaccine. We conducted a systematic review and network meta-analysis of studies assessing the comparative efficacy of vaccines to control BRD when administered to beef cattle at or near their arrival at the feedlot. We searched MEDLINE, MEDLINE In-Process, MEDLINE Daily Epub Ahead of Print, AGRICOLA, Cambridge Agricultural and Biological Index, Science Citation Index, and Conference Proceedings Citation Index – Science and hand-searched the conference proceedings of the American Association of Bovine Practitioners and World Buiatrics Congress. We found 53 studies that reported BRD morbidity within 45 days of feedlot arrival. The largest connected network of studies, which involved 17 vaccine protocols from 14 studies, was included in the meta-analysis. Consistent with previous reviews, we found little compelling evidence that vaccines used at or near arrival at the feedlot reduce the incidence of BRD diagnosis.
Excavations of pre-pottery levels at Gua Talimbue and Gua Sambagowala in Southeast Sulawesi, Indonesia, have yielded nearly 4kg of baked-clay fragments, half of which exhibit intentional patterning. The fragments appear to derive from clay hearths. Here, the authors link the patterning on Early Holocene (c. 9900–8800 cal BP) fragments with the intention to enhance the appearance of the hearths’ rims. During the Mid/Late Holocene (c. 4500–2000 cal BP), patterning shifts to the interior surfaces. The effort and specialised skills required to impress patterns on these hearths is, to date, unique in the archaeology of pre-Neolithic Island Southeast Asia.
The role that vitamin D plays in pulmonary function remains uncertain. Epidemiological studies reported mixed findings for serum 25-hydroxyvitamin D (25(OH)D)–pulmonary function association. We conducted the largest cross-sectional meta-analysis of the 25(OH)D–pulmonary function association to date, based on nine European ancestry (EA) cohorts (n 22 838) and five African ancestry (AA) cohorts (n 4290) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium. Data were analysed using linear models by cohort and ancestry. Effect modification by smoking status (current/former/never) was tested. Results were combined using fixed-effects meta-analysis. Mean serum 25(OH)D was 68 (sd 29) nmol/l for EA and 49 (sd 21) nmol/l for AA. For each 1 nmol/l higher 25(OH)D, forced expiratory volume in the 1st second (FEV1) was higher by 1·1 ml in EA (95 % CI 0·9, 1·3; P<0·0001) and 1·8 ml (95 % CI 1·1, 2·5; P<0·0001) in AA (Prace difference=0·06), and forced vital capacity (FVC) was higher by 1·3 ml in EA (95 % CI 1·0, 1·6; P<0·0001) and 1·5 ml (95 % CI 0·8, 2·3; P=0·0001) in AA (Prace difference=0·56). Among EA, the 25(OH)D–FVC association was stronger in smokers: per 1 nmol/l higher 25(OH)D, FVC was higher by 1·7 ml (95 % CI 1·1, 2·3) for current smokers and 1·7 ml (95 % CI 1·2, 2·1) for former smokers, compared with 0·8 ml (95 % CI 0·4, 1·2) for never smokers. In summary, the 25(OH)D associations with FEV1 and FVC were positive in both ancestries. In EA, a stronger association was observed for smokers compared with never smokers, which supports the importance of vitamin D in vulnerable populations.
Early detection of karyotype abnormalities, including aneuploidy, could aid producers in identifying animals which, for example, would not be suitable candidate parents. Genome-wide genetic marker data in the form of single nucleotide polymorphisms (SNPs) are now being routinely generated on animals. The objective of the present study was to describe the statistics that could be generated from the allele intensity values from such SNP data to diagnose karyotype abnormalities; of particular interest was whether detection of aneuploidy was possible with both commonly used genotyping platforms in agricultural species, namely the Applied BiosystemsTM AxiomTM and the Illumina platform. The hypothesis was tested using a case study of a set of dizygotic X-chromosome monosomy 53,X sheep twins. Genome-wide SNP data were available from the Illumina platform (11 082 autosomal and 191 X-chromosome SNPs) on 1848 male and 8954 female sheep and available from the AxiomTM platform (11 128 autosomal and 68 X-chromosome SNPs) on 383 female sheep. Genotype allele intensity values, either as their original raw values or transformed to logarithm intensity ratio (LRR), were used to accurately diagnose two dizygotic (i.e. fraternal) twin 53,X sheep, both of which received their single X chromosome from their sire. This is the first reported case of 53,X dizygotic twins in any species. Relative to the X-chromosome SNP genotype mean allele intensity values of normal females, the mean allele intensity value of SNP genotypes on the X chromosome of the two females monosomic for the X chromosome was 7.45 to 12.4 standard deviations less, and were easily detectable using either the AxiomTM or Illumina genotype platform; the next lowest mean allele intensity value of a female was 4.71 or 3.3 standard deviations less than the population mean depending on the platform used. Both 53,X females could also be detected based on the genotype LRR although this was more easily detectable when comparing the mean LRR of the X chromosome of each female to the mean LRR of their respective autosomes. On autopsy, the ovaries of the two sheep were small for their age and evidence of prior ovulation was not appreciated. In both sheep, the density of primordial follicles in the ovarian cortex was lower than normally found in ovine ovaries and primary follicle development was not observed. Mammary gland development was very limited. Results substantiate previous studies in other species that aneuploidy can be readily detected using SNP genotype allele intensity values generally already available, and the approach proposed in the present study was agnostic to genotype platform.
Introduction: Patients presenting to the Emergency Department (ED) may require clarification of their goals of care (GOC) to ensure they receive treatments aligned with their values. However, these discussions can be difficult to conduct for multiple reasons, including lack of time in a busy ED, competing priorities and a limited relationship with the patient. Few studies have examined the perceived challenges faced by Emergency Physicians in conducting GOC discussions. This study sought to contextualize and discern the barriers and facilitators to having these conversations as reported by Emergency physicians. Methods: An interdisciplinary team of Emergency Medicine, Palliative Care and Internal Medicine providers developed an online survey comprised of multiple choice, Likert-scale and open-ended questions to explore four domains of GOC discussions: training; communication; environment; and personal beliefs. Invitations and scheduled reminders were sent to 275 ED physicians at six academic sites in a Canadian urban centre, including 49 EM residents. Results: 105 (46%) staff physicians and 23 (47%) residents responded with similar representation from all sites. Differences were reported in the frequency of GOC discussions: 59% of staff physicians conduct several per month whereas 65% of residents conduct less than one per month. Most agreed that GOC discussions are within their scope of practice (92%), they feel comfortable (96%), and are adequately trained (73%) to have them; however, 66% reported difficulty initiating GOC discussions. 73% believed that admitting services should conduct GOC discussions, yet acuity was noted in the comments as a major determinant with initiating GOC discussions by ED physicians. Main barriers identified were lack of time, chaotic environment, lack of advanced directives and the inability to reach substitute decision makers. 54% of respondents indicated that the availability of 24-hour Palliative Care consults would facilitate GOC discussions in the ED. Conclusion: Emergency physicians are prepared to conduct goals of care discussions, but often believe they should instead be conducted by the patient’s admitting service. Multiple perceived barriers to goals of care discussion in the ED were identified, and a majority of respondents felt that the availability of Palliative Care in the ED may facilitate these discussions.
Over 300 cases of acute toxoplasmosis are confirmed by reference testing in England and Wales annually. We conducted a case-control study to identify risk factors for Toxoplasma gondii infection to inform prevention strategies. Twenty-eight cases and 27 seronegative controls participated. We compared their food history and environmental exposures using logistic regression to calculate odds ratios (OR) and 95% confidence intervals in a model controlling for age and sex. Univariable analysis showed that the odds of eating beef (OR 10·7, P < 0·001), poultry (OR 6·4, P = 0·01) or lamb/mutton (OR 4·9, P = 0·01) was higher for cases than controls. After adjustment for potential confounders a strong association between beef and infection remained (OR 5·6, P = 0·01). The small sample size was a significant limitation and larger studies are needed to fully investigate potential risk factors. The study findings emphasize the need to ensure food is thoroughly cooked and handled hygienically, especially for those in vulnerable groups.
Infectious bovine keratoconjunctivitis (IBK) is a common and important disease of calves. Without effective vaccines, antibiotic therapy is often implemented to minimize the impact of IBK. This review updates a previously published systematic review regarding comparative efficacy for antibiotic treatments of IBK. Available years of Centre for Biosciences and Agriculture International and MEDLINE databases were searched, including non-English results. Also searched were the American Association of Bovine Practitioners and World Buiatrics Congress conference proceedings from 1996 to 2016, reviews since 2013, reference lists from relevant trials, and U.S. Food and Drug Administration New Animal Drug Application summaries. Eligible studies assessed antibiotic treatment of naturally-occurring IBK in calves randomly allocated to group at the individual level. Outcomes of interest were clinical score, healing time, unhealed ulcer risk, and ulcer surface area. A mixed-effects model comparing active drug with placebo was employed for all outcomes. Heterogeneity was assessed visually and using Cochran's Q-test. Thirteen trials assessing nine treatments were included. Compared with placebo, most antibiotic treatments were effective. There was evidence that the treatment effect differed by day of outcome measurement. Visually, the largest differences were observed 7–14 days post-treatment. These results indicate improved IBK healing with many antibiotics and suggest the need for randomized trials comparing different antibiotic treatments.
This paper illuminates how national eating disorder (ED) policy translates into day-to-day practice by exploring how ED services are experienced by those who deliver and use them.
A mixed-methods approach was used, which combined qualitative and quantitative techniques. The paper collates data from three studies: (i) an interview study exploring the lived experiences of young people with EDs (n=8), their parents (n=5) and their healthcare professionals (n=3); (ii) a national survey of health professionals’ perspectives on existing ED services (n=171); (iii) a nationwide survey of secondary-school students’ eating concerns and patterns of help-seeking (n=290).
The qualitative interviews with young people and their parents revealed feelings of isolation and helplessness. Young people expressed interest in patient support groups, while parents desired greater support for the family unit. Parents were highly critical of available services, particularly in relation to access. These criticisms were echoed in the survey of healthcare professionals, who reported many barriers to delivering effective care. Clinicians were almost unanimous in calling for care pathways to be clarified via a standardised treatment protocol. The survey of adolescents indicated widespread reluctance to seek help regarding eating concerns: over one-third expressed concern about their own eating habits, but half of these had not divulged their concerns to anyone. Participants’ preferred pathways of help-seeking revolved around family and friends, and adolescents were unsure about routes of access to professional support.
The research demonstrates that many aspects of national ED policy have not been implemented in practice. The paper highlights specific gaps and suggests ways they can be redressed.
Accurate and complete reporting of study methods, results and interpretation are essential components for any scientific process, allowing end-users to evaluate the internal and external validity of a study. When animals are used in research, excellence in reporting is expected as a matter of continued ethical acceptability of animal use in the sciences. Our primary objective was to assess completeness of reporting for a series of studies relevant to mitigation of pain in neonatal piglets undergoing routine management procedures. Our second objective was to illustrate how authors can report the items in the Reporting guidElines For randomized controLled trials for livEstoCk and food safety (REFLECT) statement using examples from the animal welfare science literature. A total of 52 studies from 40 articles were evaluated using a modified REFLECT statement. No single study reported all REFLECT checklist items. Seven studies reported specific objectives with testable hypotheses. Six studies identified primary or secondary outcomes. Randomization and blinding were considered to be partially reported in 21 and 18 studies, respectively. No studies reported the rationale for sample sizes. Several studies failed to report key design features such as units for measurement, means, standard deviations, standard errors for continuous outcomes or comparative characteristics for categorical outcomes expressed as either rates or proportions. In the discipline of animal welfare science, authors, reviewers and editors are encouraged to use available reporting guidelines to ensure that scientific methods and results are adequately described and free of misrepresentations and inaccuracies. Complete and accurate reporting increases the ability to apply the results of studies to the decision-making process and prevent wastage of financial and animal resources.
Salmonella enterica subsp. enterica serovar Dublin is an uncommon cause of human salmonellosis; however, a relatively high proportion of cases are associated with invasive disease. The serotype is associated with cattle. A geographically diffuse outbreak of S. Dublin involving nine patients occurred in Ireland in 2013. The source of infection was not identified. Typing of outbreak associated isolates by pulsed-field gel electrophoresis (PFGE) was of limited value because PFGE has limited discriminatory power for S. Dublin. Whole genome sequencing (WGS) showed conclusively that the isolates were closely related to each other, to an apparently unrelated isolate from 2011 and distinct from other isolates that were not readily distinguishable by PFGE.
To compare mental health (MH) outcomes of and service use by children born under 1500 g in Ireland with a matched control group.
Using a retrospective cohort design, semi-structured and standardised MH assessments were conducted with parents, teachers and youth.
A total of 64 of 127 surviving children from a very low birth weight (VLBW) cohort from a National Maternity Hospital participated at a mean age of 11.6 years (s.d. 1.0), along with 51 matched controls. More VLBW children received clinical or borderline scores when rated by parents [χ2 (1, n=114)=7.3, p=0.007] or youths [χ2 (1, n=114)=4.83, p=0.028], but not by teachers [χ2 (1, n=114)=1.243, p=0.463]. There was no increase in the use of MH services. A main effect of birth weight remained on the parent Strengths and Difficulties Questionnaire [F (1, 88)=5.07, p<0.05) after controlling for intelligence quotient (IQ) and socio-economic status (SES), but only on hyperactivity in males. SES, rather than IQ or birth weight, predicted identification of problems by teachers [F (1, 82)=6.99, p=0.01).
Teachers miss MH difficulties and are influenced more by SES than by IQ or birth weight. This has implications for MH service access. Initial perinatal investment needs to be matched with ongoing surveillance and psychoeducation to ensure that disorders are recognised early and offered appropriate interventions.
This study examines aspects of healthcare professionals’ knowledge and attitudes about eating disorders (EDs), which might impede the effective detection or treatment of EDs in Ireland.
A total of 1,916 healthcare professionals were invited to participate in a web-based survey. Participants were randomly allocated to view one of five vignettes depicting a young person with symptoms consistent with anorexia nervosa, bulimia nervosa, binge-eating disorder, depression or type 1 diabetes. Study-specific questions examined participants’ responses to the vignettes and ED knowledge and experience.
In total, 171 clinicians responded (9% response rate). Participants had an average of 15.8 years of clinical experience (s.d.=9.2) and included psychiatrists, GPs, psychologists and counsellors. Although participants’ knowledge of EDs was moderately good overall, responses showed poor recognition of the symptoms of EDs compared with depression [χ2 (4, n=127)=20.17, p<0.001]. Participants viewed EDs as chronic disorders that primarily affected females. Participants believed that clinicians like working with patients with depression and diabetes more than with AN patients [F (4,101)=5.11, p=0.001]. Among the professionals surveyed, psychiatrists were the most knowledgeable about EDs [F (4,82)=9.18, p<0.001], and were more confident in their ability to diagnose and treat EDs than professionals of all other disciplines, except psychologists [F (4,85)=8.99, p<0.001]. Psychiatrists were also the most pessimistic about ED patients’ long-term life prospects [χ2 (4, n=65)=15.84, p=0.003].
This study recommends that specific attention should be given to EDs in professional educational programmes across healthcare disciplines. This training should not be restricted to improving healthcare professionals’ knowledge of EDs, but should also strive to increase service-providers’ awareness of how their own potentially stigmatising attitudes can undermine engagement with treatment.