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Background: Electroconvulsive therapy (ECT) involves the induction of a generalized seizure with an electrical current and has been used worldwide when treating medically refractory psychiatric illness. Here we describe a patient with no prior history or risk factors for epilepsy who developed temporal lobe epilepsy after chronic treatment of ECT. Methods: A 16-year-old right-handed boy with severe refractory depression received ECT treatment every 10 days for 8 months. Six months into his ECT treatment, the patient developed seizures and was admitted to a pediatric epilepsy monitoring unit. Results: Initial clinical events included lightheadedness, diaphoresis, and nausea with associated kaleidoscopic vision changes. Seizures progressed to confusion, fear and paranoia by the time the patient was admitted for monitoring. Long-term video EEG captured many focal seizures with impaired awareness, all originating from both temporal lobes. MRI was normal. ECT was terminated and the patient started on carbamazepine. He has been seizure free for the past 2 years on medication Conclusions: While rare, we present a case of a patient with no prior risk factors for epilepsy who developed temporal lobe epilepsy after chronic ECT treatment. Although ECT is an indispensable treatment for many medically refractory psychiatric illnesses, we suggest caution in young patient undergoing ECT.
A new species, Contarinia brassicola Sinclair (Diptera: Cecidomyiidae), which induces flower galls on canola (Brassica napus Linnaeus and Brassica rapa Linnaeus (Brassicaceae)), is described from Saskatchewan and Alberta, Canada. Larvae develop in the flowers of canola, which causes swelling and prevents opening, pod formation, and seed set. Mature larvae exit the galls, fall to the soil, and form cocoons. Depending on conditions, larvae will either pupate and eclose in the same calendar year or enter facultative diapause and emerge the following year. At least two generations of C. brassicola occur each year. Adults emerge from overwintering cocoons in the spring and lay eggs on developing canola flower buds. The galls produced by C. brassicola were previously attributed to the swede midge, Contarinia nasturtii (Kieffer) in Saskatchewan; here, we compare and list several characters to differentiate the two species.
Indigenous women and children experience some of the most profound health disparities globally. These disparities are grounded in historical and contemporary trauma secondary to colonial atrocities perpetuated by settler society. The health disparities that exist for chronic diseases may have their origins in early-life exposures that Indigenous women and children face. Mechanistically, there is evidence that these adverse exposures epigenetically modify genes associated with cardiometabolic disease risk. Interventions designed to support a resilient pregnancy and first 1000 days of life should abrogate disparities in early-life socioeconomic status. Breastfeeding, prenatal care and early child education are key targets for governments and health care providers to start addressing current health disparities in cardiometabolic diseases among Indigenous youth. Programmes grounded in cultural safety and co-developed with communities have successfully reduced health disparities. More works of this kind are needed to reduce inequities in cardiometabolic diseases among Indigenous women and children worldwide.
The particle size of the forage has been proposed as a key factor to ensure a healthy rumen function and maintain dairy cow performance, but little work has been conducted on ryegrass silage (GS). To determine the effect of chop length of GS and GS:maize silage (MS) ratio on the performance, reticular pH, metabolism and eating behaviour of dairy cows, 16 multiparous Holstein-Friesian cows were used in a 4×4 Latin square design with four periods each of 28-days duration. Ryegrass was harvested and ensiled at two mean chop lengths (short and long) and included at two ratios of GS:MS (100:0 or 40:60 dry matter (DM) basis). The forages were fed in mixed rations to produce four isonitrogenous and isoenergetic diets: long chop GS, short chop GS, long chop GS and MS and short chop GS and MS. The DM intake (DMI) was 3.2 kg/day higher (P<0.001) when cows were fed the MS than the GS-based diets. The short chop length GS also resulted in a 0.9 kg/day DM higher (P<0.05) DMI compared with the long chop length. When fed the GS:MS-based diets, cows produced 2.4 kg/day more (P<0.001) milk than when fed diets containing GS only. There was an interaction (P<0.05) between chop length and forage ratio for milk yield, with a short chop length GS increasing yield in cows fed GS but not MS-based diets. An interaction for DM and organic matter digestibility was also observed (P<0.05), where a short chop length GS increased digestibility in cows when fed the GS-based diets but had little effect when fed the MS-based diet. When fed the MS-based diets, cows spent longer at reticular pH levels below pH 6.2 and pH 6.5 (P<0.01), but chop length had little effect. Cows when fed the MS-based diets had a higher (P<0.05) milk fat concentration of C18 : 2n-6 and total polyunsaturated fatty acids compared with when fed the GS only diets. In conclusion, GS chop length had little effect on reticular pH, but a longer chop length reduced DMI and milk yield but had little effect on milk fat yield. Including MS reduced reticular pH, but increased DMI and milk performance irrespective of the GS chop length.
Introduction: Early recognition of sepsis can improve patient outcomes yet recognition by paramedics is poor and research evaluating the use of prehospital screening tools is limited. Our objective was to evaluate the predictive validity of the Regional Paramedic Program for Eastern Ontario (RPPEO) prehospital sepsis notification tool to identify patients with sepsis and to describe and compare the characteristics of patients with an emergency department (ED) diagnosis of sepsis that are transported by paramedics. The RPPEO prehospital sepsis notification tool is comprised of 3 criteria: current infection, fever &/or history of fever and 2 or more signs of hypoperfusion (eg. SBP<90, HR 100, RR24, altered LOA). Methods: We performed a review of ambulance call records and in-hospital records over two 5-month periods between November 2014 February 2016. We enrolled a convenience sample of patients, assessed by primary and advanced care paramedics (ACPs), with a documented history of fever &/or documented fever of 38.3°C (101°F) that were transported to hospital. In-hospital management and outcomes were obtained and descriptive, t-tests, and chi-square analyses performed where appropriate. The RPPEO prehospital sepsis notification tool was compared to an ED diagnosis of sepsis. The predictive validity of the RPPEO tool was calculated (sensitivity, specificity, NPV, PPV). Results: 236 adult patients met the inclusion criteria with the following characteristics: mean age 65.2 yrs [range 18-101], male 48.7%, history of sepsis 2.1%, on antibiotics 23.3%, lowest mean systolic BP 125.9, treated by ACP 58.9%, prehospital temperature documented 32.6%. 34 (14.4%) had an ED diagnosis of sepsis. Patients with an ED diagnosis of sepsis, compared to those that did not, had a lower prehospital systolic BP (114.9 vs 127.8, p=0.003) and were more likely to have a prehospital shock index >1 (50.0% vs 21.4%, p=0.001). 44 (18.6%) patients met the RPPEO sepsis notification tool and of these, 27.3% (12/44) had an ED diagnosis of sepsis. We calculated the following predictive values of the RPPEO tool: sensitivity 35.3%, specificity 84.2%, NPV 88.5%, PPV 27.3%. Conclusion: The RPPEO prehospital sepsis notification tool demonstrated modest diagnostic accuracy. Further research is needed to improve accuracy and evaluate the impact on patient outcomes.
Established methods of recruiting population controls for case–control studies to investigate gastrointestinal disease outbreaks can be time consuming, resulting in delays in identifying the source or vehicle of infection. After an initial evaluation of using online market research panel members as controls in a case–control study to investigate a Salmonella outbreak in 2013, this method was applied in four further studies in the UK between 2014 and 2016. We used data from all five studies and interviews with members of each outbreak control team and market research panel provider to review operational issues, evaluate risk of bias in this approach and consider methods to reduce confounding and bias. The investigators of each outbreak reported likely time and cost savings from using market research controls. There were systematic differences between case and control groups in some studies but no evidence that conclusions on the likely source or vehicle of infection were incorrect. Potential selection biases introduced by using this sampling frame and the low response rate are unclear. Methods that might reduce confounding and some bias should be balanced with concerns for overmatching. Further evaluation of this approach using comparisons with traditional methods and population-based exposure survey data is recommended.
Trans-10, cis-12 CLA is produced as an intermediary during the biohydrogenation of linoleic acid (C18:2 n-6) in the rumen and has been shown to be a potent inhibitor of milk fat synthesis in ruminants. The production of trans-10, cis-12 CLA in the rumen is affected by dietary concentrate: forage ratio (Kucuk et al., 2001), rumen pH and the amount and source of linoleic acid in the diet. However, the interaction between oil source, carbohydrate source and pH on the production of trans-10, cis-12 CLA is unclear (Beam et al., 2000). The objectives of the current study were to determine the effects of oil source, carbohydrate source and pH on the biohydrogenation of linoleic acid and production of trans-10, cis-12 CLA in vitro.
The interval from calving to first ovulation is a major factor affecting reproductive and productive efficiency in beef cows. While this interval is affected by pre- and post-partum nutrition, the maternal-offspring bond is generally considered to be the major cause of delayed ovulation in beef cows. The endocrine and physiological mechanisms by which these factors either singularly or interactively control the duration of the post-partum anovulatory period are not well established, although they most likely involve the regulation of pulsatile LH release. The present study sought to examine the interactive effects of pre- and post-partum nutrition on LH secretion and follicle wave dynamics following acute calf isolation and once-a-day suckling (restricted access), after emergence of the fourth follicular wave post partum.
Previous work has shown that processing whole crop wheat (WCW) at harvest increases starch digestibility (Jackson et al., 2002). However, no effect was seen in terms of milk yield. It has been suggested that the provision of a sugar source might utilise the high rumen ammonia levels found in animals receiving urea-treated whole crop wheat (Abdalla et al., 1999). Sources such as lactose have also been shown to reduce rumen protozoa numbers, increase bacterial protein supply and result in a more stable rumen pH, particularly with high starch diets (Hussain and Miller, 1999). Additionally, to date, processed whole crop wheat has not been evaluated against other alternative forages. The objective of the current experiment was, therefore, to compare processed urea treated whole crop wheat with maize silage and determine the effects of carbohydrate supplementation of whole crop wheat on intake and milk production in dairy cows.
It has previously been demonstrated that feeding urea treated whole crop wheat to dairy cows results in a significant increase in dry matter intake but has little effect on milk yield (Sutton et al, 1997). Part of the reason behind this lack of response has been attributed to a decrease in digestibility, particularly that of starch. A forage mill has recently been developed which allow the grains to be ground prior to ensiling and potentially increase their digestibility. An alternative way to increase the energy value of whole crop wheat is to increase cutting/stubble height. Work by Weller et al, (1995) demonstrated an increase in calculated ME from 10.6 to 11.2 MJ/kg DM by increasing stubble height from 10cm to 40cm. The objective of the current experiment was therefore to determine the effects of forage processing (grinding) and cutting height at harvest of urea-treated whole crop wheat on the intake, milk production and diet digestibility in dairy cows.
The prolonged interval from calving to first ovulation in beef cows is primarily due to the suckling-mediated inhibition of pulsatile LH release. Undernutrition both before and after calving also suppresses LH release, reduces ovarian follicular growth and delays ovulation. The interactive effects of these factors on the interval from calving to first ovulation in beef cows were quantified by studying the incidence of ovulation, following acute calf isolation and once-a-day suckling (restricted access), after emergence of the fourth follicular wave post partum in cows in differing body condition at calving and offered low or high planes of nutrition after calving.
The experiment was a 2 x 2 x 2 factorial design, in which the factors were body condition score at calving (Low v. Moderate), feeding level after calving (0.6 v. 1.0 MJ ME/d/kg M0.75), and restricted (once-a-day) v. ad libitum access and suckling. The experiment, duplicated at each of the four participating sites, involved 16 Simmental, 16 Sarda, 16 Brown Swiss and 16 Hereford x Friesian multi-parous cows. Follicle growth was monitored daily from day 21 post partum until the earlier of second ovulation or Day 90 post partum using transrectal ovarian ultrasonography.
Previous studies (e.g. Cia et al. 1998) have shown that modification of body composition of the prepubertal gilt has effects on responsiveness of gilts to exogenous gonadotrophin. Growing pigs are able to select a diet from different foods differing in protein:energy ratio (Dalby 1998); however there is little evidence of what effect the conflicting nutritional demands of growth and reproduction have on diet selection. The objectives of the experiment were to quantify the effects of choice feeding on responsiveness of gilts to exogenous gonadotrophin (Cia et al. 1998) and to investigate the effect of protein source on diet selection as Jones et al.(2000) have observed selection by breeding gilts against a high protein diet containing fishmeal.
Previous work with fermented whole crop wheat (WCW) silage has focussed on the effects of stage of maturity on nutritive value and milk production (Sinclair and Wilkinson 1998). An alternative means of manipulating nutritive value may be to alter the relative proportions of grain to straw by changing the cutting height at harvest. The objectives of the current experiment were to determine the effects of two cutting heights on the aerobic stability and whole tract digestibility of fermented WCW silage offered to sheep.
Winter wheat (variety Hunter) was grown as a conventional crop and harvested at a dry matter (DM) content of 450 g/kg and a Zadock growth stage of approximately 85 (soft dough). The crop was cut to leave a stubble length of either 17.9 cm (long straw, LS) or 38.2 cm (short straw, SS) prior to ensiling in separate ag-bags.
It is reported that supplementing pregnant ewes with supra-optimal levels of vitamin E improves neonatal lamb vigour and growth rate (Merrell, 1998). The biochemical mechanism behind these observations has yet to be elucidated as several studies report negligible placental vitamin E transfer in ruminants (Van Saun et al., 1989); consequently, lambs may be clinically deficient in this nutrient at birth and achieve a satisfactory vitamin E status via colostrum ingestion. Lamb vitamin E status may be further diminished by the addition of polyunsaturated fatty acids (PUFAs) to the maternal diet. However, PUFA supplementation demonstrably enhances foetal and neonatal development in human studies (Morley, 1998) although these effects have not been investigated in ruminants to any depth. The objective of this experiment was to investigate the effects of dietary vitamin E in combination with long-chain PUFA supplementation of ewes on ewe and lamb performance.
Feeding lambs diets formulated to be synchronous in terms of hourly energy and protein supply to the rumen has been reported to improve the efficiency of energy utilisation (Richardson et al. 1999). In a previous study Sinclair et al. (1995) reported that the efficiency of microbial protein production was improved when animals were fed a synchronous diet. The objectives of the present study were to investigate whether the changes in metabolism reported by Richardson et al. (1999) may be related to rumen microbial protein production and diet digestibility.
Long-chain polyunsaturated fatty acids (PUFAs) are essential components of cellular membranes and are associated with prostaglandin synthesis. Supplementing ewes with long-chain PUFAs during gestation has been demonstrated to increase gestation length and improve lamb vigour (Capper et al., 2002). Furthermore, increasing the dietary vitamin E supplied to pregnant ewes is reported to increase lamb growth rate (Gentry et al., 1992). However, fish oil supplementation during lactation may reduce milk component yield and lamb growth rate (Capper et al., 2002). The objective of this experiment was to investigate the effects of dietary long-chain PUFA and vitamin E supplementation of pregnant ewes on lamb performance.
There is anecdotal evidence that certain sheep breeds, reared in a particular way, produce unusual or characteristic tastes in cooked meat. Such effects could be linked to differences in meat fatty acid composition associated with the consumption of different diets. This study investigated eating quality and fat composition in 4 distinctively different breed x feeding system groups.
Four groups of 20 ram lambs were obtained as follows: Pure Soays (SO) finished off grass in April from commercial breeders; Pure Welsh Mountain (WM) finished off upland grass in October from ADAS Pwllpeiran; Suffolk x Mules from Harper Adams College finished off concentrates (grains) (SC) in April; and Suffolk x mules from the same source finished off grass (SG) in May. The animals were transported to Langford where they were slaughtered in Bristol University's abattoir.
The long-chain polyunsaturated fatty acids (PUFA) docosahexaenoic acid (DHA) and arachidonic acid (AA) are the most abundant fatty acids in the brain and are vital for its correct development and for that of the nervous system (Huang and Craig-Schmidt, 1996). Ruminant diets are low in DHA and its precursor alpha-linolenic acid. In addition, dietary PUFAs are substantially hydrogenated in the rumen. Consequently, it may be argued that the diets of pregnant and lactating ewes may be deficient in DHA and that a response to supplementation may be observed. Studies involving the supplementation of pregnant ewes with supraoptimal levels of vitamin E have shown that lambs born to supplemented dams are more vigorous immediately after birth and have higher liveweight gains (Merrell, 1998). The objective of this experiment was to investigate the effects of dietary long-chain PUFA in combination with vitamin E supplementation of ewes on ewe and lamb performance.
The health benefits of n -3 polyunsaturated fatty acids (PUFA) and conjugated linoleic acid (CLA) to humans are now widely recognised. Polyunsaturated fatty acids of the n -3 series such as a-linolenic acid (C18:3n -3), eicosapentaenoic acid (C20:5n -3; EPA) and docosahexaenoic acid (C22:6n -3; DHA) reduce the risk of coronary heart diseases (Department of Health, 1994). CLA has a diverse array of potential beneficial health effects which include anticarcinogenesis, antiatherogenesis, immune system modulation, antidiabetic effects and reduction of body fat accretion (Bessa et al., 2000). However, the consumption of both n -3 PUFA and CLA by humans is currently less than optimal. The current study investigates the extent to which n -3 PUFA and CLA in milk fat of lactating ewes may be enhanced by feeding diets rich in EPA and DHA.