A qualitative survey approach to investigating beef and dairy veterinarians' needs in relation to technologies on farms

Globally, farmers are being increasingly encouraged to use technologies. Consequently, veterinarians often use farm data and technologies to provide farmers with advice. Yet very few studies have sought to understand veterinarians' perceptions of data and technologies on farms. The aim of this study was to understand veterinarians' experiences and opinions on data and technology on beef and dairy farms. An online qualitative survey was conducted with a convenience sample of 36 and 24 veterinarians from the United Kingdom and Ireland, respectively. The data were analysed using reflexive thematic analysis to generate four themes: (1) Improving veterinary advice through data; (2) Ensuring stock person skills are retained; (3) Longevity of technology; and (4) Solving social problems on farms. We show that technologies and data can make veterinarians feel more confident in the advice they give to farmers. However, the quality and quantity of data collected on cattle farms were highly variable. Furthermore, veterinarians were concerned that farmers can become over-reliant on technologies by not using their stockperson skills. As herd sizes increase, technologies can help to improve working conditions on farms with multiple employees of various skillsets. Veterinarians would like innovations that can help them to demonstrate their competence, influence farmers' behaviour, and ensure sustainability of the beef and dairy industries.

A living lab approach to understanding dairy farmers' needs of technologies and data to improve herd health: Focus groups from 6 European countries

For successful development and adoption of technology on dairy farms, farmers need to be included in the innovation process. However, the design of agricultural technologies usually takes a top-down approach with little involvement of end-users at the early stages. Living Labs offer a methodology that involve end-users throughout the development process and emphasize the importance of understanding users' needs. Currently, exploration of dairy farmers' needs of technologies has been limited to specific types of technology (e.g., smartphone apps) and adult cattle. The aim of this study was to use a Living Lab approach to identify dairy farmers' needs of data and technologies to improve herd health and inform innovation development. Eighteen focus groups were conducted with, in total, 80 dairy farmers from Belgium, Ireland, the Netherlands, Norway, Sweden, and the UK. Data were analyzed using Template Analysis and 6 themes were generated which represented the fundamental needs of autonomy, comfort, competence, community and relatedness, purpose, and security. Farmers favored technologies that provided them with convenience, facilitated their knowledge and understanding of problems on farm, and allowed them to be self-reliant. Issues with data sharing and accessibility, and usability of software were barriers to technology use. Furthermore, farmers were facing problems around recruitment and management of labor and needed ways to reduce stress. Controlling aspects of the barn environment, such as air quality, hygiene, and stocking density, was a particular concern in relation to youngstock management. In conclusion, the findings suggest that developers of farm technologies may want to include farmers in the design process to ensure a positive user experience and improve accessibility. The needs identified in this study can be used as a framework when designing farm technologies to strengthen need satisfaction and reduce any potential harm toward needs.

Exploration of reasons for primary care testing (the Why Test study): a UK-wide audit using the Primary care Academic CollaboraTive

BACKGROUND

Rates of blood testing have increased over the past two decades. Reasons for testing cannot easily be extracted from electronic health record databases.

AIM

To explore who requests blood tests and why, and what the outcomes of testing are in UK primary care.

DESIGN AND SETTING

A retrospective audit of electronic health records in general practices in England, Wales, Scotland, and Northern Ireland was undertaken.

METHOD

Fifty-seven clinicians from the Primary care Academic CollaboraTive (PACT) each reviewed the electronic health records of 50 patients who had blood tests in April 2021. Anonymised data were extracted including patient characteristics, who requested the tests, reasons for testing, test results, and outcomes of testing.

RESULTS

Data were collected from 2572 patients across 57 GP practices. The commonest reasons for testing in primary care were investigation of symptoms (43.2%), monitoring of existing disease (30.1%), monitoring of existing medications (10.1%), and follow up of previous abnormalities (6.8%); patient requested testing was rare in this study (1.5%). Abnormal and borderline results were common, with 26.6% of patients having completely normal test results. Around one-quarter of tests were thought to be partially or fully unnecessary when reviewed retrospectively by a clinical colleague. Overall, 6.2% of tests in primary care led to a new diagnosis or confirmation of a diagnosis.

CONCLUSION

The utilisation of a national collaborative model (PACT) has enabled a unique exploration of the rationale and outcomes of blood testing in primary care, highlighting areas for future research and optimisation.

Extracorporeal membrane oxygenation during pregnancy and peripartal. An international retrospective multicenter study

INTRODUCTION

Extracorporeal Membrane Oxygenation (ECMO) may be used in the setting of pregnancy or the peripartal period, however its utility has not been well-characterized. This study aims to give an overview on the prevalence of peripartel ECMO cases and further assess the indications and outcomes of ECMO in this setting across multiple centers and countries.

METHODS

A retrospective, multicenter, international cohort study of pregnant and peripartum ECMO cases was performed. Data were collected from six ECMO centers across three continents over a 10-year period.

RESULTS

A total of 60 pregnany/peripartal ECMO cases have been identified. Most frequent indications are acute respiratory distress syndrome (n = 30) and pulmonary embolism (n = 5). Veno-venous ECMO mode was applied more often (77%). ECMO treatment during pregnancy was performed in 17 cases. Maternal and fetal survival was high with 87% (n = 52), respectively 73% (n = 44).

CONCLUSIONS

Various emergency scenarios during pregnancy and at time of delivery may require ECMO treatment. Peripartal mortality in a well-resourced setting is rare, however emergencies in the labor room occur and knowledge of available rescue therapy is essential to improve outcome. Obstetricians and obstetric anesthesiologists should be aware of the availability of ECMO resource at their hospital or region to ensure immediate contact when needed.

How do Funeral Practices Impact Bereaved Relatives' Mental Health, Grief and Bereavement? A Mixed Methods Review with Implications for COVID-19

Those who are bereaved during the current COVID-19 pandemic are subject to restrictions on funeral sizes and practices. We conducted a rapid review synthesising the quantitative and qualitative evidence regarding the effect of funeral practices on bereaved relatives’ mental health and bereavement outcomes. Searches of MEDLINE, PsycINFO, KSR Evidence, and COVID-related resources were conducted. 805 records were screened; 17 studies of variable quality were included. Current evidence regarding the effect of funeral practices on bereaved relatives’ mental health and bereavement outcomes is inconclusive. Five observational studies found benefits from funeral participation while six did not. However, qualitative research provides additional insight: the benefit of after-death rituals including funerals depends on the ability of the bereaved to shape those rituals and say goodbye in a way which is meaningful for them. Findings highlight the important role of funeral officiants during the pandemic. Research is needed to better understand the experiences and sequalae of grief and bereavement during COVID-19.

11 Mortality Rates for Patients Admitted to Complex Care/Care of the Elderly Wards At Southmead Hospital, Bristol

Background

Existing data examining mortality rates following inpatient hospital admissions in the United Kingdom is either condition specific or examining all inpatient mortality based on single time point audits. This clinical effectiveness project aimed to assess 1, 3, 6 and 12 month mortality rates in patients admitted to complex care/care of the elderly (CC/CotE) wards at Southmead hospital, Bristol

Methods

Data were collected by the trust's Business Insider department and analysed by the authors. All patients admitted to the four CC/CotE wards from July-December 2017 were included. Data collected included age, gender, date of admission, length of stay, date of discharge, and date of death if applicable.

Results

2673 patients were admitted to CC/CotE wards from July-December 2017. 42.72% of patients were male, mean age of patients was 82.46 years. Mean length of stay was 16.68 days, with mean length of stay on CC/CotE ward specifically 9.08 days. 292 (10.92%) of patients died during the index admission. Overall mortality rates were:1 month: 11.34% (303 patients)3 month: 21.59% (577 patients)6 month: 30.15% (806 patients)12 month: 38.53% (1030 patients)

12 month mortality increased with age from 75 upwards (34.04% in 75-79 years, 42.94% 85-89 years, 50.27% 95-99 years, 66.67% 100-104 years) but was similar in those aged 65-69 and 70-74 (29.41% and 28.18% respectively).

Discussion

An improved understanding of mortality rates in patients admitted under CC/CotE may aid clinicians' ability to prognosticate. Appreciating that over a third of CC/CotE patients are potentially in the last year of life provides further impetus to begin advanced care planning discussions during inpatient admissions.

Mortality rates in teaching hospital complex care wards in England: a retrospective audit

OBJECTIVE

Existing data examining mortality rates following inpatient hospital admissions in the UK are either condition specific or examining all inpatient mortality based on single time point audits. This clinical effectiveness project aimed to assess mortality rates in patients admitted to complex care (CC) wards managed by geriatricians at Southmead hospital, Bristol.

METHODS

Data were collected by the trust's audit department and analysed by the authors. All patients admitted to the four CC wards from July to December 2017 were included. Data collected included age, gender, date of admission, length of stay, date of discharge and date of death if applicable.

RESULTS

2673 patients were admitted to CC wards from July to December 2017. 42.72% of patients were men, and mean age of patients was 82.46 years. Mean length of stay was 16.68 days. 292 (10.92%) of patients died during the index admission. Overall mortality rates were: (1) 1 month: 11.34% (303 patients); (2) 3 months: 21.59% (577 patients); (3) 6 months: 30.15% (806 patients); (4) 12 months: 38.53% (1030 patients). 12-month mortality increased with age from 75 upwards (34.04% in 75-79 years, 42.94% in 85-89 years, 50.27% in 95-99 years, 66.67% in 100-104 years) but was similar in those aged 65-69 and 70-74 years (29.41% and 28.18%, respectively).

CONCLUSIONS

An improved understanding of mortality rates in patients requiring an admission under geriatricians may aid clinicians' ability to prognosticate. Appreciating that over a third of these patients are potentially in the last year of life provides further impetus to begin advance care planning discussions during inpatient admissions.

Applicability of three alternative instruments for food authenticity analysis: GMO identification

Ensuring foods are correctly labelled for ingredients derived from genetically modified organisms (GMOs) is an issue facing manufacturers, retailers, and enforcement agencies. DNA approaches for the determination of food authenticitys often use the polymerase chain reaction (PCR), and PCR products can be detected using capillary or gel electrophoresis. This study examines the fitness for purpose of the application of three laboratory electrophoresis instruments (Agilent Bioanalyzer 2100, Lab901 TapeStation, and Shimadzu MCE-202 MultiNA) for the detection of GMOs using PCR based on a previously validated protocol. Whilst minor differences in the performance characteristics of bias and precision were observed, all three instruments demonstrated their applicability in using this protocol for screening of GMO ingredients.

Perductal electrolytic ablation of the porcine pancreas: A minimally invasive option-studies of morbidity and mortality

BACKGROUND

Pancreatic cancer has a dismal prognosis. Few patients are suitable for surgical resection, leaving the majority requiring symptom palliation. Current palliative techniques such as surgical bypass and endoscopic retrograde cholangiopancreatography (ERCP) are imperfect. A novel palliative therapy combining the symptom control of surgical bypass with the minimally invasive nature of ERCP is required.

METHODS

Perductal electrolytic ablation of pancreatic tissue, in a porcine model, was performed. There were two survival groups of 2 weeks (n = 4) and 8 weeks (n = 4). Postoperatively, serum biochemistry, amylase and C-reactive protein (CRP) were assessed. Histological examination of the pancreas, lungs, and kidneys was performed to determine the presence of acute pancreatitis or systemic inflammatory response.

RESULTS

An immediate transient increase in both amylase and CRP was seen. Although pancreatic histology demonstrated localised necrosis at the electrolytic site at 2 weeks, there was no evidence of generalized pancreatitis or a systemic inflammatory response at either 2 or 8 weeks.

CONCLUSIONS

This study suggests that, although there is localized pancreatic necrosis and transient hyperamylasemia, perductal pancreatic electrolytic ablation is safe, with neither generalized pancreatitis nor a systemic inflammatory response, in the medium and long term. Although performed in normal porcine pancreas, because of the absence of a large-animal model of pancreatic cancer, this study suggests that electrolytic pancreatic ablation is safe. This technique may have a role in the palliation of pancreatic cancer, especially if delivered via a minimally, invasive approach, and warrants further investigation.

Patients' health-related quality-of-life and health state values for motor neurone disease/amyotrophic lateral sclerosis

Motor neurone disease (MND) has a severe impact on patient quality of life, especially in later stages of the disease. This study assesses the health-related quality of life (HRQL) of MND patients, and for the first time elicits health state values from patients for their present health state. A structured interview was conducted with 77 patients. Patients completed a disease specific health status measure (ALSAQ-40), a generic health status measure (EuroQol EQ-5D), a visual analogue scale (VAS) and a standard gamble (SG) exercise. The ALSAQ-40 was sensitive to disease severity. Patients' mean VAS rating of their own health ranged from 0.74 for stage 1 (early) disease severity (n = 15), to 0.37 for stage 4 (late stage) disease severity (n = 19). Utilities elicited via SG varied from a mean of 0.79 for stage 1 disease severity to a mean of 0.45 for stage 4 disease severity. The EQ-5D derived single index ranged from a mean of 0.63 for stage 1 disease severity to a mean of -0.01 for stage 4 disease severity. This study demonstrates that it is feasible and practical to obtain health state values from MND patients and it provides evidence that patients place a high value on their HRQL, even in cases where health status is very poor.

Palliation of pancreatic cancer using electrolytic ablation

BACKGROUND

Inoperable pancreatic cancer has a dismal prognosis. Palliation involves either stenting or surgical bypass. Stenting does not relieve gastric outlet obstruction, and surgical bypass is a major procedure. A minimally invasive procedure is needed that relieves both gastric outlet and biliary obstruction, with the potential for relieving pain.

METHODS

In an experimental model, pancreatic electrolysis was investigated. The pancreatic duct was cannulated via a transduodenal approach with an electrode catheter. In 6 animals an electrolytic "lesion" was created using a direct current generator. Six animals were controls. The local and systemic effects of electrolysis were assessed using histological and biochemical parameters.

RESULTS

The pancreatic duct was cannulated in all animals and treatment was uneventful. Electrolytic lesions comprised a central area of necrosis with a sharp demarcation between necrotic and viable pancreas. All animals developed transient hyperamylasemia after electrolysis. There was no significant difference between treatment and controls. Importantly, no animal had clinical, biochemical, or histological evidence of pancreatitis.

CONCLUSIONS

This experimental study suggested that electrolytic palliation of inoperable pancreatic cancer via the gastrointestinal tract is potentially safe. In patients, this treatment could be performed during endoscopic retrograde cholangiopancreatography and may have therapeutic advantages when compared to stenting or biliary bypass.

Patients' health-related quality of life and utilities associated with different stages of amyotrophic lateral sclerosis

OBJECTIVES

Amyotrophic lateral sclerosis (ALS) is a devastating disease that has serious consequences in terms of impairments and disabilities, which are expected to impact on health-related quality of life (HRQL). The aim of the present study was to assess self-reported health status and HRQL, as well as patients' own valuation of their present health state in a sample of patients with different levels of severity of ALS.

METHODS

Structured interviews were conducted with 77 patients with different levels of disease severity. Patients completed a disease-specific health status measure (ALSAQ-40), a generic health status measure (EuroQol EQ-5D), visual analogue scale (VAS) rating of current health and a standard gamble (SG) exercise to provide health state utilities for their own health state.

RESULTS

The results from the ALSAQ-40 and EQ-5D descriptive system indicate that patients' HRQL decreases systematically with increasing severity of disease. Patients' mean VAS rating of their own health ranged from 0.74 for stage 1 (early) disease severity, to 0.37 for stage 4 (late stage) disease severity. Utilities elicited via SG were systematically higher than VAS scores and ranged from a mean of 0.79 for stage 1 disease severity to a mean of 0.45 for stage 4 disease severity.

Cost effectiveness of treatment options in advanced breast cancer in the UK

OBJECTIVE

To compare clinical and economic study data for docetaxel, paclitaxel and vinorelbine in the treatment of anthracycline-resistant advanced breast cancer.

STUDY DESIGN AND METHODS

A Markov decision-analysis model to simulate the clinical course of a 'typical' patient with advanced breast cancer during salvage chemotherapy was updated with response rates and adverse effect rates from phase III clinical trial data for docetaxel, paclitaxel and vinorelbine. Costs were taken from UK national databases and hospitals. Utilities were estimated from 30 oncology nurses in the UK using the standard gamble method.

PERSPECTIVE

National Health Service.

RESULTS

When compared with other chemotherapeutic agents, docetaxel has been shown to increase response rate, time to progression and survival in patients with advanced breast cancer. In the base-case analysis, the incremental cost-utility ratio for docetaxel versus paclitaxel was pound1995 per quality-adjusted life year (QALY) gained (1998 values). The incremental cost-utility ratio for docetaxel versus vinorelbine was pound14 055 per QALY gained. In the comparison with vinorelbine, docetaxel provided the equivalent of an additional 92 days of perfect health. Sensitivity analyses confirmed the robustness of the model and the validity of the base-case analysis results. Even in the worst case scenarios, docetaxel remained cost effective compared with paclitaxel and vinorelbine.

CONCLUSIONS

These findings support the use of the taxoids, notably docetaxel, in the management of advanced breast cancer.

Histone phosphorylation during sea urchin development

Studies on histone phosphorylation during transitions in chromatin structure occurring in vivo during spermatogenesis and early embryogenesis in sea urchins are reviewed and evaluated in the light of recent studies on histone phosphorylation occurring during chromatin synthesis in frog egg extracts in vitro and evidence that protein kinases and phosphatases play direct roles in the regulation of cellular structure. Sperm-specific histone variants Sp H1 and Sp H2B are maintained as phosphorylated derivatives N and O/P throughout spermatogenesis and early embryogenesis and egg specific histone variants CS H1 and CS H2A are phosphorylated during early embryogenesis. These developmental correlations provide clues about the roles of histone phosphorylation in control of chromatin structure in vivo and provide a basis for the interpretation of data obtained from in-vitro sperm chromatin remodeling in egg extracts and from biochemical studies on the effects of histone phosphorylation on DNA binding. The potential consequences for chromatin structure of the various histone phosphorylation events observed in sea urchins and frog egg extracts are discussed.

The determination of the flour improver potassium bromate in bread by gas chromatographic and ICP-MS methods

The development and application of two methods for determining bromate in bread are described. A gas chromatographic (GC) method which relied on the formation of a volatile derivative of bromate gave a detection limit of 12 micrograms/kg. Duplicate analyses agreed well but recovery from breads spiked with bromate were low and averaged 30% for brown bread and 42% for white bread. Further studies indicated that this was caused by the derivatization reaction being suppressed by components of the sample and reagents used in their preparation. After taking both these factors into account, a recovery of 80% could be achieved. The GC method was used to carry out a survey of retail bread samples in 1989. Bromate was found in all six unwrapped breads analysed (median 35 micrograms/kg, range 17-317 micrograms/kg), whilst for 22 wrapped breads, seven were found to contain bromate (median < 12 micrograms/kg, range < 12-238 micrograms/kg). A second method of analysis employing inductively coupled plasma-mass spectrometry (ICP-MS) was developed which provided independent confirmation of the presence of bromate in these retail samples. The method gave a mean recovery of 71% from five spiked samples and a detection limit of 20 micrograms/kg. The GC and ICP-MS methods were compared by performing replicate analyses of a bread sample prepared with bromate-treated flour. Quantitative agreement between the two techniques was good. The precision of the ICP-MS technique (CV 12%) proved better than that found for the GC method (CV 18%). The Potassium Bromate (Prohibition as a Flour Improver) Regulation 1990 came into force on 1 April 1990 (Statutory Instrument 1990 Number 399).(ABSTRACT TRUNCATED AT 250 WORDS)

Molecular dissection of mutations at the heterozygous thymidine kinase locus in mouse lymphoma cells

The mouse lymphoma L5178Y TK+/- 3.7.2C cell line allows quantitation of induced TK(+/-)----TK-/- mutations at the heterozygous thymidine kinase (Tk) locus. TK-/- mutant colonies show a bimodal size distribution, reflecting a difference in the growth rates of the two size classes that is hypothesized to result from different degrees of genetic damage. The two homologous chromosomes 11 containing the alleles of the Tk gene in L5178Y 3.7.2C TK+/- cells are distinguishable at the cytogenetic level. We find, in addition, that the two alleles are distinguishable at the molecular level because of an Nco I restriction fragment length polymorphism at the 3' end of the gene. In a set of 51 large-colony and 48 small-colony TK-/- mutants induced by ionizing radiation or by chemical mutagens, we find that 78, including all except one of the small-colony mutants, have lost the Tk+ allele and that some of these have two to four copies of the remaining Tk- allele. Nineteen of the large-colony TK-/- mutants that do not show Tk+ allele loss show no other structural changes detectable at the level of Southern blot analysis. One shows a partial deletion. The variety of mutagenic lesions recorded at the heterozygous Tk locus may be representative of events observed in human malignancy and may include a wider range of mutagenic events than can be observed at hemizygous test loci.

Mutagenicity of azo dyes in the Salmonella/microsome assay using in vitro and in vivo activation

The mutagenicity of 6 azo dyes, including direct black 38 (DB38), direct black 19 (DB19), direct brown 95 (DB95), solvent yellow 3 (SY3), trypan blue (TPB), and food black 2 (FB2), was examined in the Salmonella/microsome assay. The effect of chemical azo reduction (dithionite) and in vivo metabolism on the mutagenicity of the dyes was also studied. In vivo azo-dye metabolites were isolated from the urine of rats intubated with dyes by XAD-2 column chromatography. Urinary metabolites from all the treated animals, except animals treated with FB2, induced frame-shift mutations in strains TA1538 and TA98 in the presence of liver S9 activation. The control urine did not increase the incidence of revertants in strains TA1538 and TA98. Thus, XAD-2 chromatography can be used to isolate genotoxic metabolites from the urine of animals intubated with azo dyes.