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Studies demonstrate higher rates of cardiovascular death among psychiatric patients. Psychotropic medication can prolong the QT interval, increasing the risk of potentially fatal torsade de pointes. Guidelines recommend monitoring QT intervals for patients on psychotropic medication. The QT interval needs to be corrected for heart rate using a correction formula. The most commonly used is Bazett's. However, it becomes less accurate at lower and higher heart rates. Different formulae should be used in such cases. We noted that different formulae gave different QTc intervals for the same ECG posing a clinical management dilemma.
To evaluate different QTc correction formulae.
To find out if using different QTc correction formulae produces consistently different intervals, according to the formula, for a cohort of patients’ ECGs.
We reviewed 36 ECGs from a cross section of forensic female patients on psychotropic medication.
For each ECG we recorded the ECG calculated QTc and heart rate.
We manually calculated the QTc using Bazett, Fridericia, Hodges and Framingham formulas.
Different formulae produced consistently variable QTc intervals. The discrepancy was greatest at lower and higher heart rates. Many patients had high heart rates making the discrepancy pertinent to our patient cohort.
Psychotropic medication is adjusted according to QTc thresholds which are stipulated in guidelines. At present guidelines do not recommend which QT correction formula to use. Different formulae give different QTc intervals. Our results demonstrate the need for a consensus to be reached and included in guidelines to ensure consistent and safe practice.
Health expectancies, taking into account both quality and quantity of life, have generally been based on disability and physical functioning.
To compare mental health expectancies at age 25 and 55 based on common mental disorders both across countries and between males and females.
Mental health expectancies were calculated by combining mortality data from population life tables and the age-specific prevalence of selected common mental disorders obtained from the European Study of the Epidemiology of Mental Disorders (ESEMeD).
For the male population aged 25 (all countries combined) life expectancy was 52 years and life expectancy spent with a common mental disorder was 1.8 years (95% CI 0.7-2.9),3.4% of overall life expectancy. In comparison, for the female population life expectancy at age 25 was higher (57.9 years) as was life expectancy spent with a common mental disorder (5.1 years, 95% CI 3.6-6.6) and as a proportion of overall life expectancy, 8.8%. By age 55 life expectancy spent with a common mental disorder had reduced to 0.7 years (males) and 2.3 years (females).
Age and gender differences underpin our understanding of years spent with common mental disorders in adulthood. Greater age does not mean living relatively more years with common mental disorder. However, the female population spends more years with common mental disorders and a greater proportion of their longer life expectancy with them (and with each studied separate mental disorder).
Crossbreeding is common practice in commercial pig production as one way to increase lean growth and improve meat quality (Visscher et al., 2000). Reducing disease is another way to help improve growth rate in pigs. Porcine circovirus type 2 (PCV2) has devastated the pig industry in recent years. PCV2 infection increases mortality and reduces growth rate as it acts as an immunosuppressant thereby making pigs more susceptible to co-infections (Kixmöller et al 2008). Keeping disease at low levels has been achieved by improving husbandry standards, biosecurity, minimising presence of other pathogens and use of antibiotics. However vaccines against PVC2 are now available. The aim of this study was to investigate the effects of sire genotype and PCV2 vaccine on growth performance and body composition of pigs.
A complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval.
The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has set forth a comprehensive list of complications associated with the treatment of patients with congenital cardiac disease, related to cardiac, pulmonary, renal, haematological, infectious, neurological, gastrointestinal, and endocrinal systems, as well as those related to the management of anaesthesia and perfusion, and the transplantation of thoracic organs. The objective of this manuscript is to examine the definitions of operative morbidity as they relate specifically to the pulmonary system. These specific definitions and terms will be used to track morbidity associated with surgical and transcatheter interventions and other forms of therapy in a common language across many separate databases.
As surgical survival in children with congenital cardiac disease has improved in recent years, focus has necessarily shifted to reducing the morbidity of congenital cardiac malformations and their treatment. A comprehensive list of pulmonary complications is presented. This list is a component of a systems-based compendium of complications that will standardize terminology and thereby allow the study and quantification of morbidity in patients with congenital cardiac malformations. Clinicians caring for patients with congenital cardiac disease will be able to use this list for databases, initiatives to improve quality, reporting of complications, and comparing strategies of treatment.
It is anticipated that there will be a significant increase in the quantity of co-products available from the biofuel industry for use in animal feed. The co-products are the result of either biodiesel or bioethanol production. Biodiesel is produced from oil. One of the main sources of oil is oil seed rape but other oil seeds such as sunflower, Crambe and Camelina sativa (Cottrill et al., 2007) may be used. Bioethanol is produced from the fermentation of sugar which is either added directly to the process or obtained from the digestion of starch. The co-products produced include glycerol (glycerine or glycerin) from the production of biodiesel and dried distillers grains with solubles (DDGS) from the production of bioethanol from starch.
The amount of a bulky food that an animal can eat depends on its capacity for bulk and the bulk content of the food. For pigs between 12 and 40kg the capacity for food bulk was found to be directly proportional to liveweight (Kyriazakis and Emmans, 1995). The way in which the capacity for bulky foods changes with weight above 40 kg is not clear; there is no a priori reason to assume that the scaling rule proposed for young pigs will hold in heavier pigs. The applicability of the work in young pigs for use in more mature pigs needs investigation, to develop predictive equations for the whole relevant weight range. An experiment was designed to determine how the capacity for bulk changed with weight; the objective was to develop a relationship between the capacity for food bulk and liveweight.
The effects of different energy sources in the lactation diet on sow and piglet performance were assessed in association with effects on the metabolic state of the sow around peak lactation. Either maize starch (S) or soya-bean oil (F) was added to a basal diet to provide 0·34 of total digestible energy (DE) intake, such that the experimental diets provided the same daily intakes of DE and crude protein. Twenty-four multiparous sows were allocated between two groups at farrowing, each given one of the two dietary treatments for a lactation period of 28 days. Sow weight and backfat (P2) as well as individual piglet weights were measured on a weekly basis. Litter sizes were standardized to 10 piglets. Milk samples were collected from sows on days 8, 12, 17, 21 and 25 of lactation to measure milk composition and prolactin concentrations. Blood samples were taken via an ear vein catheter from a subsample (7 S, 6 F) of sows on day 14 of lactation; two pre- and seven post-feeding samples were taken at 60-min intervals to measure plasma prolactin, insulin, glycerol, triglyceride, non-esterified fatty acid, urea, b-hydroxybutyrate and glucose concentrations. There was no effect of energy source on sow weight or P2 loss or on subsequent weaning-to-oestrus interval. Sows offered starch weaned more piglets than sows offered soya-bean oil (9·4 v. 8·4, P < 0·05). Litter weight gains were higher for S than F sows in week 3 of lactation (2·2 v. 1·7 kg/day, P < 0·05), irrespective of litter size. Significantly increased plasma urea and b-hydroxybutyrate concentrations and lower post-prandial increases in plasma glucose and insulin concentrations were observed in F sows around peak lactation. Neither milk nor plasma prolactin concentrations were significantly affected by dietary treatments. The metabolic indices indicated that the F diet was more limiting in dietary glucose availability, which was associated with impaired milk yield as indicated by poorer litter performance. In conclusion, this study suggests that starch is superior to fat as an energy source in sow lactation diets, particularly in the later stages of lactation.
We need to improve our understanding of the factors that are important for the control of food intake on high bulk foods. The study of short term feeding behaviour (STFB) may help to do this. The objective of this experiment was to study the effects of giving foods differing in bulk content on the STFB of growing pigs. It was expected that the foods would result in different levels of daily intake and that this would be reflected as differences in STFB between the foods. Two hypotheses were developed based on ideas about the way in which a physical constraint to intake could arise. H1; there would be less diurnal variation in feeding on high bulk foods that limit intake. H2; feeding patterns on bulky foods would be less flexible than those on a control food when feeding time is limited by reducing time of access to the feeder.
The objective of this experiment was to provide a severe test of the two frameworks currently available for understanding and predicting voluntary food intake. Framework 1 predicts that an animal will eat at a level that will allow potential performance to be achieved subject to its capacity to deal with a constraint, such as the bulk content of the food, not being exceeded. In framework 2 intake is seen as that which will allow some biological efficiency, such as the ratio of net energy intake per litre of oxygen consumed, to be maximised (Tolkamp and Ketelaars, 1992). The frameworks differ in their prediction of the effect that a period of prior feeding on a high bulk food (severely limiting) will have upon the subsequent intake of foods of differing bulk content. Framework 1 predicts that the intake of a low bulk food, that is non limiting, but not that of a moderate bulk food, that is limiting, will be increased under such circumstances. Framework 2 predicts that intake will be increased regardless of the type of food being fed as long as the Metabolisable Energy of that food is utilised more efficiently.
Two trials were conducted to examine the influence of dietary oil type and rate of inclusion on fatty acid profiles of adipose tissue and eating quality of griddled pork. Trial 1 was based on three sources high in specific fatty acids: palm oil (palmitic acid), tallow (stearic acid) and linseed oil (linolenic acid) each at three rates of inclusion (palm at 44·6, 88·7 and 133·3 g/kg; tallow at 44·1, 87·6 and 131·7g/kg; linseed oil at 40·1, 79·8 and 120·0g/kg into a synthetic fat-free diet. Trial 2 was based on systematic replacement of soya-bean oil (incorporated at a rate of 0, 34, 69 and 104 g/kg diet) with olive oil (rate of 62, 46, 29 and 13 g/kg diet) to alter dietary concentrations of oleic acid. Diets were offered to pigs over the live-weight range 55 to 90 kg. Samples of subcutaneous fat were analysed for fatty acid composition and samples of loin assessed for meat quality with taste panels. There were no significant effects (P > 0·05) of treatment on daily live-weight gain, food conversion ratio or gross carcass composition, with the exception of anterior loin fat for trial 1 (P < 0·05) although not in a manner that was consistent between treatments and, in trial 2, anterior loin fat, minimum loin fat and posterior loin fat (all P < 0·05) but, again, not consistently between treatments allowing no meaningful conclusions to be drawn. Fatty acid profiles of adipose tissue reflected dietary levels to a variable degree, the more so with oleic acid and the greatest for linoleic and linolenic acids. The quality of the pig meat as measured by sensory analysis was related to the fatty acid profile in the situation where the most extreme changes in fatty acid profile occurred, as was apparent for the diets based upon linseed oil. No other major influences on meat quality were obtained.
The extent to which young sows, which still have a strong drive to continue maternal growth, partition nutrients from body reserves towards milk production, may be influenced by their genetic growth target. Modern genotype sows, with a high mature body protein mass, are thus particularly challenged. It has been suggested that to optimise their metabolic state for expressing lactational potential they will have to achieve a satisfactory proportion of their mature body protein mass before farrowing. This could be constrained by current feeding and breeding regimes. To test this hypothesis, gilts of genotypes differing in their body protein:lipid content were given the choice between a low and a high protein diet during rearing and pregnancy, and their intake, subsequent performance and metabolic state in lactation were measured.
Currently there are two theoretical frameworks for the prediction of feed intake of animals. The first considers feed intake to be a consequence of the animal eating to achieve its genetic potential (Kyriazakis and Emmans, 1999). When potential performance is not achieved it is because feed intake is being constrained, for example through the bulkiness of the feed or the hotness of the environment. The second framework considers feed intake to be an outcome of some process of optimisation so that intake is that which allows the maximisation of biological efficiency (Tolkamp and Ketelaars, 1992). The two frameworks differ in their predictions of the effect of temperature on the intake of bulky feeds. In the first, feed intake on bulky feeds is seen as a function of the type of feed; in the second, feed intake is a function of both the type of feed and the environment. The first framework predicts that in the cold the intake of low, but not high, bulk feeds will increase. The second framework predicts that in the cold intake will be increased regardless of the type of feed offered. This experiment was designed to provide a severe test of the two feed intake theories.
The effect of feeding different sources of dietary fibre at varying rates of inclusion on the concentrations of skatole and indole in the backfat of finishing pigs and their subsequent carcass quality was studied. Sugar-beet pulp (SBP) and straw (S) were selected because of their assumed widely differing hind-gut fermentability characteristics. They were individually and in combination added to a diet at three rates of inclusion designed to provide concentrations of 40, 80 and 120 g non-starch polysaccharide (NSP) per kg. The digestible energy (DE) contents varied between the three levels of inclusion of NSP but were formulated to a lysine: energy ratio of 0.625 g: MJ DE with other amino acids being in the same individual proportion to lysine. The nine experimental diets were offered to 10 replicate (five entire males and five females) pigs of initial live weight 55 kg. Food intakes were adjusted between treatment to ensure that energy and nutrient intakes were common. Animals were slaughtered on reaching 85 kg live weight. Adipose tissue was analysed for skatole and indole and meat quality characteristics assessed. No significant differences in performance were detected although carcasses from animals given sugar-beet pulp were significantly fatter. There were significant correlations between the level of skatole in the backfat and the following eating quality characteristics: skatole odour intensity of the fat, abnormal odour intensity of fat, abnormal odour intensity of lean and abnormal flavour intensity of lean with correlations coefficients of 0·656 , 0·709 , 0·496 and 0·523 respectively (coefficients >0.276; P < 0·05). The range in skatole levels in the backfat were attributable substantially to very high levels found in three boars. No significant correlations were found between indole concentrations in the backfat and eating quality characteristics. However no effects of dietary NSP type or inclusion level on the eating quality characteristics of pig meat, with pigs given diets on the basis of equal energy and nutrient intakes, were detected.
Starch and fat are the two major energy sources available for sow lactation diets. Fat is more energy dense and can be used to maximise energy intakes, particularly in sows with low appetite. However, the quantity of milk produced in sows has been associated with milk lactose production and the main precursor for lactose is glucose, for which dietary starch is the major source. It is therefore important to know the consequences of using a glucose deficient energy source, such as fat, compared to starch in lactation diets. The following experiment was designed to assess energy sources in lactation diets at an isocaloric level in determining sow and piglet performance, in association with the effects of dietary glucose availability on the metabolic state of the sow around peak lactation.
Reproductive failure, especially in young sows, is the major contributor to the steady rise in sow culling and mortality rates in recent years. There is now considerable interest in the nutrition of the gilt and its effect on production characteristics and subsequent reproductive performance. Both fat, and more recently lean tissue, have been postulated to play singularly important roles. The objective of the current study was to use production performance criteria of both primiparous and multiparous animals to estimate the proportions of fat and lean tissue mobilised during lactation.
Ninety two animals, forty five gilts and forty seven third parity sows, based at the University commercial pig unit, were used in this study. All animals were weighed and monitored for P2 backfat depth on entry to the farrowing house, during lactation and, finally, at weaning. The data for each individual animal was then used to calculate, by linear regression, the daily rate of loss of both body weight and P2 backfat depth during lactation. These responses were then utilized to calculate the weight and P2 backfat level of each animal on days 1 and 28 of lactation.
Relationships between sow nutrition, milk yield, milk composition and piglet performance during lactation have been studied in numerous experiments. However, the subsequent effects of these pre-weaning factors on post-weaning piglet performance are less well studied. Commonly a growth check in piglets in response to weaning is noted, but to date it is unknown why some piglets do better than others in this period. The present experiment explored some of the pre-weaning factors that could explain the variability in piglet post-weaning growth.
The performance of piglets from 41 litters was monitored during a lactation period of 26 days. Litter size was standardised to 10 piglets, which were not offered creep food. Piglets were weighed individually on a weekly basis from farrowing to weaning at 26 days. Daily litter milk intake was estimated by a weigh-suckle-weigh technique in 24 litters on 4 occasions at 5 day intervals across lactation. On the day after each of these days, the composition of milk was determined from milk samples obtained by hand milking following oxytocin injection. Litter milk intake and composition of milk were used to calculate the mean daily piglet nutrient intakes during lactation. After weaning some piglets were sacrificed for the analysis of body composition and 310 piglets out of the 41 litters were penned in litter groups in controlled environment flat decks for two weeks to monitor daily group feed intakes and weekly individual growth rates.
In general apparent ileal digestibility values of amino acids are lower than apparent faecal digestibility values (Just, 1980) and since nitrogen entering the large intestine may not be utilised by the pig (Zebrowska, 1973) apparent ileal digestibility values should offer a better estimation of the nutritive value of dietary protein. However, for this to be confirmed it must be demonstrated that such values when used in diet formulation are more accurate predictors of pig performance. Therefore, a trial was conducted to examine whether the detrimental effect of heat treated fish meal on pig performance could be reduced by formulating diets based upon either apparent faecal or ileal amino acid digestibility values.
Feeding regimes in commercial practice do not always meet precisely the changing nutritional requirements of growing pigs. Increasing the number of feeds offered (phase feeding) or, alternatively, allowing the animals to select their own diet from a choice of foods may improve the balance between nutrient supply and animal requirements. The aim of this experiment was to compare 8 feeding strategies from weaning to slaughter at 90kg.
It is well established that the fatty acid combustion of adipose issue in pigs (non-ruminants) may be manipulated by changes in the fatty acid profile of the diets. The objective of this program of work was to quantify the responses of adipose depots of finishing pigs to changes in the level and profile of dietary fatty acids and to relate these changes to the sensory quality of meat as determined by taste panel.