Perceptions of dairy cow-handling situations: A comparison of public and industry samples

Inappropriate cattle handling poses a reputational threat to the dairy industry. To enhance social sustainability, handling practices must resonate with societal values about animal care. However, it has yet to be determined to what extent industry and public stakeholders differ in their perception of common cattle handling situations. We administered an online survey to samples of dairy industry (IND) and public (PUB) stakeholders to examine how they perceive a variety of cow-handling scenarios ranging from positive to negative in terms of effects on animal welfare. Participants were presented with 12 brief videos depicting a range of realistic cow-handling situations and responded to measures designed to assess their attitudes and beliefs about each scenario, their perception of the emotional response of the cows depicted in each scenario, as well as their own personal emotional response. Preexisting beliefs about cow treatment on US dairy farms and demographic data, including self-reported dairy consumption, were also collected and analyzed. Before viewing the videos, 52.9% of PUB (vs. 79.0% of IND) believed cows were treated well while 27.2% (vs. 9.0% of IND) believed cows were treated badly. Within IND, believing cows were treated badly was more common among nonwhites, those with greater formal education, more liberal politics, or from urban or suburban environments. In PUB, female and younger participants were more likely to believe cows were treated badly before viewing the videos. In both samples, participants with more positive preexisting beliefs about dairy cow treatment in the US reported consuming dairy products more frequently. In both PUB and IND, scenarios which were rated more positively for attitudes or for the cows' or respondents' emotional experiences were also perceived as more common. Within a given cow-handling scenario, qualitative attitudes (i.e., a positive, negative, or neutral valence) did not differ between the samples. In both samples, at the participant level, overall attitudes toward cow-handling scenarios were highly correlated with both their personal emotional response to the scenario and their perception of the cows' emotional responses. Although the participants' overall personal emotional responses did not differ between the samples, IND rated cows as experiencing more negative emotions overall. The consensus between industry and public stakeholders around dairy cow-handling practices observed in this study could provide a common starting point for addressing other, more contentious animal welfare issues.

Universal DNA methylation age across mammalian tissues

Aging, often considered a result of random cellular damage, can be accurately estimated using DNA methylation profiles, the foundation of pan-tissue epigenetic clocks. Here, we demonstrate the development of universal pan-mammalian clocks, using 11,754 methylation arrays from our Mammalian Methylation Consortium, which encompass 59 tissue types across 185 mammalian species. These predictive models estimate mammalian tissue age with high accuracy (r > 0.96). Age deviations correlate with human mortality risk, mouse somatotropic axis mutations and caloric restriction. We identified specific cytosines with methylation levels that change with age across numerous species. These sites, highly enriched in polycomb repressive complex 2-binding locations, are near genes implicated in mammalian development, cancer, obesity and longevity. Our findings offer new evidence suggesting that aging is evolutionarily conserved and intertwined with developmental processes across all mammals.

Provision of High Protein Foods Slows the Age-Related Decline in Nutritional Status in Aged Care Residents: A Cluster-Randomised Controlled Trial

OBJECTIVES

Malnutrition, particularly protein insufficiency, is common in institutionalised older adults and increases morbidity, mortality, and costs. We aimed to determine whether 12 months supplementation using high-protein foods (milk, cheese, yoghurt) prevents malnutrition in older adults.

DESIGN

Cluster randomised control study.

SETTING

Sixty Australian aged care facilities.

PARTICIPANTS

Older adults living in aged care homes (n=654, mean age 86.7±7.2 years, 72% females). Intervention Facilities randomly allocated to a high-protein (n=30 intervention) or regular (n=30 controls) menu.

MEASUREMENTS

Nutritional status assessed using the Mini Nutrition Assessment (MNA) tool and fasting morning blood samples (n=302) assayed for haemoglobin (Hb) and albumin. Food intake was monitored 3-monthly using visual plate waste assessment. Measurements at baseline and month 12 were analysed using random effects model accounting for clustering (facility), repeated measure and confounders.

RESULTS

Addition of 11g of protein as 1.5 servings of high-protein foods daily preserved nutritional status that deteriorated in controls [MNA screen (-0.68, 95%CI: -1.03, -0.32, p<0.001) and total (-0.90, 95%CI: -1.45, -0.35, p=0.001) scores], resulting in group differences in MNA screen (0.62, 95%CI: 0.17, 1.06, p=0.007) and total (0.81, 95%CI: 0.11, 1.51, p=0.023) scores and group difference in Hb (3.60g/L, 95%CI: 0.18, 7.03, p=0.039), the net result of preservation with intervention (0.19g/L, 95%CI: -2.04, 2.42, p=0.896) and a decline in controls (-3.41g/L, 95%CI: -6.01, -0.82, p=0.010). No group differences were observed for serum albumin.

CONCLUSION

Consumption of high-protein foods is a pragmatic approach to maintaining nutritional status in older adults in aged-care.

7 Characterization of Feeder Cattle Behavior Using an Integrated Machine Vision Learning System

Animal behavior can be a valuable indicator of the health and welfare status of an animal. Current assessments of cattle behavior in commercial settings rely upon human observers who are only capable of observing a relatively small proportion of animals for a small proportion of time. Moreover, the mere presence of human observers may alter normal behavioral patterns, making data difficult to interpret. To overcome these challenges, we developed a machine vision learning system to monitor cattle behavior on a commercial feedlot. Using continuous data collected from solar powered cameras, we set out to characterize the standing and lying patterns of feedlot cattle. A series of solar powered cameras were installed on a single pen of calves at a commercial feedlot (n=280; mean weight = 632lbs +/- 45). To characterize standing and lying behavior, a neural network model (YOLOv5) was trained and applied to pen images captured every 5 minutes during the day for weeks 2-20 of the feeding period (n=19,152). Algorithm precision and recall were 96% and 92%, respectively. Standing and lying behaviors showed a pattern of temporal cyclicity with the greatest proportion of cows standing at 0800 (92%) and 1700 (96%). The mean proportion of animals observed lying down increased during the feeding period (wk 2-8=36%; wk 9-14=39% and wk 15-20=45%). Machine vision learning systems can be an accurate and efficient means of quantifying behavioral patterns in commercial environments. Future work will examine how environmental and management factors (e.g. weather, pen moves) and morbidity alter behavioral patterns throughout the feeding period.

Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial

OBJECTIVE

To assess the antifracture efficacy and safety of a nutritional intervention in institutionalised older adults replete in vitamin D but with mean intakes of 600 mg/day calcium and <1 g/kg body weight protein/day.

DESIGN

Two year cluster randomised controlled trial.

SETTING

60 accredited residential aged care facilities in Australia housing predominantly ambulant residents.

PARTICIPANTS

7195 permanent residents (4920 (68%) female; mean age 86.0 (SD 8.2) years).

INTERVENTION

Facilities were stratified by location and organisation, with 30 facilities randomised to provide residents with additional milk, yoghurt, and cheese that contained 562 (166) mg/day calcium and 12 (6) g/day protein achieving a total intake of 1142 (353) mg calcium/day and 69 (15) g/day protein (1.1 g/kg body weight). The 30 control facilities maintained their usual menus, with residents consuming 700 (247) mg/day calcium and 58 (14) g/day protein (0.9 g/kg body weight).

MAIN OUTCOME MEASURES

Group differences in incidence of fractures, falls, and all cause mortality.

RESULTS

Data from 27 intervention facilities and 29 control facilities were analysed. A total of 324 fractures (135 hip fractures), 4302 falls, and 1974 deaths were observed. The intervention was associated with risk reductions of 33% for all fractures (121 v 203; hazard ratio 0.67, 95% confidence interval 0.48 to 0.93; P=0.02), 46% for hip fractures (42 v 93; 0.54, 0.35 to 0.83; P=0.005), and 11% for falls (1879 v 2423; 0.89, 0.78 to 0.98; P=0.04). The risk reduction for hip fractures and falls achieved significance at five months (P=0.02) and three months (P=0.004), respectively. Mortality was unchanged (900 v 1074; hazard ratio 1.01, 0.43 to 3.08).

CONCLUSIONS

Improving calcium and protein intakes by using dairy foods is a readily accessible intervention that reduces the risk of falls and fractures commonly occurring in aged care residents.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12613000228785.

502 Late-Breaking: Tongue Rolling Behavior in a Large U.S. Dairy Herd

Stereotypic behavior is repetitive, invariant behavior with no obvious goal or function and may indicate negative welfare. Non-nutritive oral behaviors are the most common form of stereotypic behavior in captive ungulates and these include tongue rolling where the cow’s tongue is extended, moving inside and outside of the mouth while the cow is not eating. We assessed the prevalence of tongue rolling in a large commercial dairy herd located in the United States by video recording cattle (n = 10,000) during three consecutive milkings on two rotary milking parlors. Associations between tongue rolling behavior, breed, age, days in milk, pregnancy status and milk production were assessed. In total, 29% percent (2,931) of cows were observed tongue rolling on the rotary parlor during at least one milking; 6% (613) were observed tongue rolling during two milkings; and 1.6% (164) were observed tongue rolling during all three sampling periods. Breed was the only variable associated with tongue rolling in the rotary parlor with nearly twice the proportion of Jersey (33%) vs Jersey X Holstein (17%) exhibiting tongue rolling behavior (P &lt; 0.0001). The higher incidence of tongue rolling among Jersey vs Jersey X Holstein cattle within a shared environment suggests a strong genetic component that warrants further investigation. Validated sampling strategies for assessing tongue rolling in dairy cattle are needed.

Outcomes of an Equine Assisted Learning Curriculum to Support Well-Being of Medical Students and Residents

Objectives of this study were to evaluate an equine assisted learning (EAL) curriculum designed for medical students and resident physicians, and to determine impacts of the curriculum on participant perceptions of burnout and well-being. The EAL curriculum incorporated evidence-based skills and concepts to increase happiness and/or resilience. A pre/post intervention design was used, with 18 EAL participants receiving the curriculum within their month-long community based primary care clerkship elective, and 10 control (CTL) participants who did not receive the curriculum within their clerkship elective. Three waves of surveys tested participant responses before, immediately after, and 3 months after the intervention. Patient Health Questionnaire-4 (PHQ-4) screened for depression and anxiety, and Maslach Burnout Inventory- Human Services Survey for Medical Personnel (MBI) addressed burnout. Analysis of covariance evaluated differences between EAL and CTL groups. EAL participants rated the curriculum highly (9.2 on a 10-point scale). The evaluations were overwhelmingly positive with participants able to identify key concepts that were most helpful, how they would apply those concepts to patient care and interactions with colleagues, and how the horses added value to their learning experience. Significant positive effects of EAL on burnout were identified in terms of improved MBI personal achievement scores, as well as a trend towards improved well-being scores. There was also a trend (P < .08) towards PHQ-4 depression scores to be lower in EAL group at T3. In conclusion, this study is the first to provide AU: quantitative evidence of positive outcomes associated with an EAL curriculum designed to strengthen well-being in medical students and resident physicians.

PSV-2 An exploration of sociality among pre-weaned beef calves

Preferential relationships have been reported between individual cows within a herd. However, less is known about the ontogeny of preferential relationships between calves and subsequent bonding behavior. The objective of this study was to characterize these relationships in pre-weaned beef calves, with the hypothesis that calves form preferential relationships with one another prior to weaning. Ten weeks prior to commencing formal observations, forty mature Angus cows and their calves were randomly selected from a research herd, balanced for calf sex and allocated to one of two grazing paddocks approximately 12 acres in size. Two weeks prior to weaning, direct observations of calf behavior were performed over period of 12 days, using instantaneous scan sampling between 0700-1230h or 1300-1830h, resulting in 6 scans per calf/day X 12 days (72 scans/calf). For each calf, the identity and proximity (in calf lengths) of the calf in closest proximity (aka nearest neighbor) was noted, as well as behavior. The ethogram included calf behavior (grazing, nursing, lying, drinking, locomotion, social contact and standing idle), and sociality was categorized as being within 5 calf lengths of another calf. Sociality was observed in 60% of all scans, and sociality of individual calves ranged from 47% to 72% of the scans observed (72 scans/calf). The statistical model investigating sociality included calf sex and the interaction of day and paddock. Sociality was equally likely in bulls and heifers (0.59 +/- 0.1; p=0.80). A significant day by paddock interaction was also identified (p=0.001), but no obvious trends were apparent. In conclusion, preliminary results provide support for individual differences in sociality of pre-weaned beef calves prior to weaning. Further analysis will explore if preferential relationships exist between individual calves, and how these might be associated with different behavioral states.

A dynamic approach to estimate the probability of exposure of marine predators to oil exploration seismic surveys over continental shelf waters

The ever-increasing human demand for fossil fuels has resulted in the expansion of oil exploration efforts to waters over the continental shelf. These waters are largely utilized by a complex biological community. Large baleen whales, in particular, utilize continental shelf waters as breeding and calving grounds, foraging grounds, and also as migration corridors. We developed a dynamic approach to estimate the likelihood that individuals from different populations of blue whales Balaenoptera musculus and humpback whales Megaptera novaeangliae could be exposed to idealized, simulated seismic surveys as they move over the continental shelf. Animal tracking data for the different populations were filtered, and behaviors (transit and foraging) were inferred from the tracks using hidden Markov models. We simulated a range of conditions of exposure by having the source of noise affecting a circular area of different radii (5, 25, 50 and 100 km), moving along a gridded transect of 270 and 2500 km2 at a constant speed of 9 km h-1, and starting the simulated surveys every week of the year. Our approach allowed us to identify the temporal variability in the susceptibility of the different populations under study, as we ran the simulations for an entire year, allowing us to identify periods when the surveys would have an intensified effect on whales. Our results highlight the importance of understanding the behavior and ecology of individuals in a site-specific context when considering the likelihood of exposure to anthropogenic disturbances, as the habitat utilization patterns of each population are highly variable.

321 Socio-demographic factors associated with attitudes towards animals among first-year veterinary students

Veterinarians are seen as experts in matters relating to animal welfare and ethics. However, relatively little is known about veterinary students’ attitudes and beliefs towards animals. To begin to address this gap, we surveyed the freshman class of veterinary students at a major U.S. veterinary college (n = 125) to examine their views on the ethics of various forms of animal use, their beliefs about the extent to which different species are capable of experiencing emotions (AKA ‘belief in animal mind’) and their beliefs about the degree to which humans and non-human animals are similar. The 20-item attitudes towards animal scale showed high internal consistency (a = 0.91, CI95 [95% Confidence Interval] 0.89, 0.93). Preliminary multiple regression analyses indicated female (vs male) students held more positive attitudes toward animals (b = 0.35, P = .005). Growing up in a household where animals were raised for food was associated with less positive attitudes (b = -0.30, P = .006). More liberal political ideology was associated with more positive attitudes towards animals (b = 0.17, P = &lt; .0001). Female students also believed animals were capable of experiencing a greater diversity of emotions (b = 126.96, P = 0001). Neither socioeconomic status (P = 0.65) nor having a pet as a child (P = 0.12) were associated with attitudes towards animals or belief in animal mind. However, childhood pet ownership was associated with greater perceived similarity between human and non-human animals (b = 1.38, P = 0.01). Subsequent analyses will assess whether taking a required, introductory course in animal welfare has any effect on these measures. Eventually these data could provide baseline information for longitudinal analyses exploring how student attitudes and beliefs about animals are affected as they progress through the veterinary curriculum.

Public attitudes toward genetic modification in dairy cattle

Genetic modification has been used to create dairy cattle without horns and with increased resistance to disease; applications that could be beneficial for animal welfare, farm profits, and worker safety. Our aim was to assess how different stated purposes were associated with public attitudes toward these two applications using a mixed methods approach. Using an online survey, U.S. participants were randomly assigned to one of ten treatments in a 2 (application: hornless or disease-resistant) x 5 (purposes: improved animal welfare, reduced costs, increased worker safety, all three purposes, or no purpose) factorial design. Each participant was asked to read a short description of the assigned treatment (e.g. hornlessness to improve calf welfare) and then respond to a series of questions designed to assess attitude toward the treatment using 7-point Likert scales (1 = most negative; 7 = most positive). Responses of 957 participants were averaged to creative an attitude construct score. Participants were also asked to explain their response to the treatment. Qualitative analysis of these text responses was used to identify themes associated with the participants’ reasoning. Participant attitudes were more favorable to disease resistance than to hornlessness (mean ± SE attitude score: 4.5 ± 0.15 vs. 3.7 ± 0.14). In the ‘disease-resistance’ group participants had more positive attitudes toward genetic modification when the described purpose was animal welfare versus reduction of costs (contrast = 1.00; 95% CI = 0.12–1.88). Attitudes were less favorable to the ‘hornless’ application if no purpose was provided versus when the stated purpose was either to improve animal welfare (contrast = 0.95; 95% CI = 0.26–1.64) or when all purposes were provided (contrast = 0.88; 95% CI = 0.19–1.58). Similarly, attitudes were less positive when the stated purpose was to reduce costs versus either improving animal welfare (contrast = 0.86; 95% CI = 0.09–1.64) or when all purposes were provided (contrast = 0.79; 95% CI = 0.02–1.56). Quantitative and qualitative analysis indicated that both the specific application and perceived purpose (particularly when related to animal welfare) can affect public attitudes toward genetic modification.

A-35 Assessing the Impact of Expressive Language on Performance on Conners’ Continuous Performance Test 3rd Edition (CPT3) in Inpatients with Aphasia

Objective

The current study examined the impact of expressive language difficulties, assessed by the Neuropsychological Assessment Battery (NAB) naming subtest, on the Conners’ Continuous Performance Test-Third edition (CPT3) in an inpatient acquired brain injury (ABI) population.

Method

A sample of 19 individuals (female n = 3, male n = 16) was evaluated through an inpatient ABI rehabilitation program. Two groups based on diagnosed aphasia (n = 7) versus no aphasia (n = 12) were used. Ages ranged from 15 to 67 (M = 38.37, SD = 16.55) and had an average level of education of 14.9 years.

Results

One-way ANOVAs were used to determine how expressive language impacts performance on the CPT3. As expected, statistically significant results revealed that having aphasia yields a lower score on NAB naming F(1,17) = 11.435, p = .004. Individuals who did not have aphasia had a higher number of Perseverations, F(1,17) = 5.295, p = .034. No differences were noted between Omissions F(1,17) = 2.060, p = .169, Commissions F(1,17) = 3.090, p = .097, and Hit Reaction Time F(1,17) = .434, p = .519.

Conclusions

In our sample, patients with and without aphasia had similar reaction times and similar performances for omissions and commissions. The aphasia group, with significantly worse expressive language abilities, did not score significantly worse on any of the CPT3-related indices. Our study supports previous literature that CPT3 is an appropriate attention measure for individuals with aphasia but adds to the literature in providing evidence for use of the measure with an acute inpatient population with aphasia. While the results are promising, our sample is small and future research would be stronger with a larger sample with more specific information provided regarding the types of aphasia.

Hot and bothered: Public attitudes towards heat stress and outdoor access for dairy cows

On many dairy farms cows are kept indoors. Providing outdoor access is often considered desirable, but housing can protect animals from aversive climatic conditions. For example, by providing shade and fans, indoor housing can protect cows from heat stress they might otherwise experience on open pasture. This study tested how public attitudes to cattle rearing varied when participants were experimentally assigned to different scenarios using a 2 x 2 factorial design varying pasture versus indoor housing with or without heat stress. Participants (n = 581) were randomly assigned to a single scenario, and attitudes in response to the scenario were measured using a Likert scale (1 = "strongly disagree" to 5 = "strongly agree"). We also asked open-ended questions allowing participants to explain their responses. Participants responded most positively to the scenario that provided both pasture access and protection from heat stress (Likert 4.1±0.08), and least positively to scenario with indoor housing and heat stress (Likert 2.2±0.08). However, when the different animal welfare attributes were in conflict (i.e. naturalness as provided by pasture, and biological functioning/affective state as associated with protection from heat stress), participants placed priority on the latter: they were more supportive of the scenario providing indoor housing that protected cows from heat stress (Likert 3.5±0.08), than they were of a pasture rearing system that exposed cows to heat stress (Likert 2.4±0.08). Open-ended responses indicated that participants viewed the lack of protection from heat stress as a failure in the farmer's duty of care towards the cow. We conclude that participants valued both access to pasture and protection from heat stress for dairy cows, but prioritized protecting animal from heat stress when these features were in conflict.

'More than a feeling': An empirical investigation of hedonistic accounts of animal welfare

Many scientists studying animal welfare appear to hold a hedonistic concept of welfare -whereby welfare is ultimately reducible to an animal's subjective experience. The substantial advances in assessing animal's subjective experience have enabled us to take a step back to consider whether such indicators are all one needs to know if one is interested in the welfare of an individual. To investigate this claim, we randomly assigned participants (n = 502) to read one of four vignettes describing a hypothetical chimpanzee and asked them to make judgments about the animal's welfare. Vignettes were designed to systematically manipulate the descriptive mental states the chimpanzee was described as experiencing: feels good (FG) vs. feels bad (FB); as well as non-subjective features of the animal's life: natural living and physical healthy (NH) vs. unnatural life and physically unhealthy (UU); creating a fully-crossed 2 (subjective experience) X 2 (objective life value) experimental design. Multiple regression analysis showed welfare judgments depended on the objective features of the animal's life more than they did on how the animal was feeling: a chimpanzee living a natural life with negative emotions was rated as having better welfare than a chimpanzee living an unnatural life with positive emotions. We also found that the supposedly more purely psychological concept of happiness was also influenced by normative judgments about the animal's life. For chimpanzees with positive emotions, those living a more natural life were rated as happier than those living an unnatural life. Insofar as analyses of animal welfare are assumed to be reflective of folk intuitions, these findings raise questions about a strict hedonistic account of animal welfare. More generally, this research demonstrates the potential utility of using empirical methods to address conceptual problems in animal welfare and ethics.

Institutional transparency improves public perception of lab animal technicians and support for animal research

The use of animals in research is controversial and often takes place under a veil of secrecy. Lab animal technicians responsible for the care of animals at research institutions are sometimes described as performing 'dirty work' (i.e. professions that are viewed as morally tainted), and may be stigmatized by negative perceptions of their job. This study assessed if transparency affects public perceptions of lab animal technicians and support for animal research. Participants (n = 550) were randomly assigned to one of six scenarios (using a 3x2 design) that described identical research varying only the transparency of the facility (low, high) and the species used (mice, dogs, cows). Participants provided Likert-type and open-ended responses to questions about the personal characteristics (warmth, competence) of a hypothetical lab technician 'Cathy' and their support for the described research. Quantitative analysis showed participants in the low-transparency condition perceived Cathy to be less warm and were less supportive of the research regardless of animal species. Qualitative responses varied greatly, with some participants expressing support for both Cathy and the research. These results suggest that increasing transparency in lab animal institutions could result in a more positive perception of lab animal researchers and the work that they do.

Tail Docking and Ear Cropping Dogs: Public Awareness and Perceptions

Tail docking and ear cropping are two surgical procedures commonly performed on many dog breeds. These procedures are classified as medically unnecessary surgeries whose purpose is primarily cosmetic. Available attitude research surrounding these controversial practices has been limited to surveys of veterinarians and dog breeders familiar with both practices. The aim of this project was to: 1) assess public awareness of tail docking and ear cropping, 2) determine whether physical alteration of a dog affects how the dog, and 3) owner are perceived. In Experiment 1 awareness was measured using a combination of both explicit and implicit measures. We found that 42% of participants (n = 810) were unable to correctly explain the reason why tail docked and ear cropped dogs had short ears and tails. Similarly, an implicit measure of awareness (‘nature vs nurture task’), found that the majority of participants believed short tails and erect ears were a consequence of genetics rather than something the owner or breeder had done. The results obtained in Experiment 2 (n = 392) provide evidence that ear cropped and tail docked dogs are perceived differently than an identical dog in its ‘natural’ state. Modified dogs were perceived as being more aggressive, more dominant, less playful and less attractive than natural dogs. Experiment 3 (n = 410) is the first evidence that owners of modified dogs are perceived as being more aggressive, more narcissistic, less playful, less talkative and less warm compared to owners of natural dogs. Taken together, these results suggest that although a significant proportion of subjects appear unaware of the practices of tail docking and ear cropping in dogs, these procedures have significant impacts on how modified dogs and their owners are perceived by others.

Relationships Among Rheological, Sensory Texture, and Swallowing Pressure Measurements of Hydrocolloid-Thickened Fluids

The objective of this study was to examine the relationships among three categories of measurements (rheological, sensory texture, and swallowing pressure) from fluids thickened to two different viscosities with 15 different hydrocolloids. Fluids at viscosities of 300 and 1500 cP (at 30 s(-1)) were targeted because these are the viscosities corresponding to the barium standards used in radiographic dysphagia diagnosis. Within the low viscosity (nectar) fluids (300 cP), the sensory properties thickness, stickiness, adhesiveness, mouth coating, and number of swallows were highly positively correlated with each other and highly positively correlated with the flow behavior index, n value (an indicator of shear-thinning behavior). Within the higher viscosity (thin honey) fluids (1500 cP), the sensory textures of adhesiveness, stickiness, mouth coating, and number of swallows correlated positively with rheological measures of n value. Swallowing pressures measured in the anterior oral cavity correlated negatively with the consistency coefficient k [shear stress/(shear rate) (n) ]. Samples that were more shear thinning (lower n values, higher k values) were generally perceived as less thick, with less adhesive properties (stickiness, adhesiveness, mouthcoating, and number of swallows). This information can be useful for selecting thickeners for people with dysphagia. A desirable thickener for many dysphagic patients would be one that allowed for a safe swallow by being viscous enough to reduce airway penetration, yet pleasant to drink, having the minimal perceived thickness and mouthcoating associated with greater shear thinning.

Clinical features, microbiology and surgical outcomes of infective endocarditis: a 13-year study from a UK tertiary cardiothoracic referral centre

BACKGROUND

Infective endocarditis (IE) causes substantial morbidity and mortality. Patient and pathogen profiles, as well as microbiological and operative strategies, continue to evolve. The impact of these changes requires evaluation to inform optimum management and identify individuals at high risk of early mortality.

AIM

Identification of clinical and microbiological features, and surgical outcomes, among patients presenting to a UK tertiary cardiothoracic centre for surgical management of IE between 1998 and 2010.

DESIGN

Retrospective observational cohort study.

METHODS

Clinical, biochemical, microbiological and echocardiographic data were identified from clinical records. Principal outcomes were all-cause 28-day mortality and duration of post-operative admission.

RESULTS

Patients (n = 336) were predominantly male (75.0%); median age 52 years (IQR = 41-67). Most cases involved the aortic (56.0%) or mitral (53.9%) valves. Microbiological diagnoses, obtained in 288 (85.7%) patients, included streptococci (45.2%); staphylococci (34.5%); Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella (HACEK) organisms (3.0%); and fungi (1.8%); 11.3% had polymicrobial infection. Valve replacement in 308 (91.7%) patients included mechanical prostheses (69.8%), xenografts (24.0%) and homografts (6.2%). Early mortality was 12.2%, but fell progressively during the study (P = 0.02), as did median duration of post-operative admission (33.5 to 10.5 days; P = 0.0003). Multivariable analysis showed previous cardiothoracic surgery (OR = 3.85, P = 0.03), neutrophil count (OR = 2.27, P = 0.05), albumin (OR = 0.94, P = 0.04) and urea (OR = 2.63, P < 0.001) predicted early mortality.

CONCLUSIONS

This study demonstrates reduced post-operative early mortality and duration of hospital admission for IE patients over the past 13 years. Biomarkers (previous cardiothoracic surgery, neutrophil count, albumin and urea), predictive of early post-operative mortality, require prospective evaluation to refine algorithms, further improve outcomes and reduce healthcare costs associated with IE.

Management of impacted wisdom teeth: teaching of undergraduate students in UK dental schools

INTRODUCTION

Wisdom tooth removal is one of the most common oral surgical procedures performed across the world. The aim of this study was to gauge the teaching and training of impacted wisdom teeth in undergraduate dental programmes across the UK. The objectives were to identify consistencies and variations in theoretical instructions and clinical training as well as approaches to management of impacted wisdom teeth.

METHODS

This was a cross-sectional survey utilising an online questionnaire. A purposefully designed pro forma with open- as well as closed-ended questions was used. The questionnaire was hosted online on the school's blackboard academic suite (Emily). Prior to conducting the study, approval was gained from the Research and Ethics Committee, and all the ethical principles pertaining to data protection were strictly followed. E-mail invitations were sent to oral surgery leads in all dental schools in the UK. The participants were provided with an information sheet, and an informed consent was obtained. The participants were invited by e-mail to complete the questionnaire online voluntarily.

RESULTS

A total of 16 dental schools offering an undergraduate course in dentistry in the UK, 13 responded positively. (response rate = 81.25%). In majority of dental schools, this subject is taught in the 4th and 5th years. A pre-clinical competency on phantom heads is a requirement in six schools, whilst only one school requires the students to pass a clinical competency. The clinical exposure of students to wisdom tooth surgery is quite variable. Although the dental schools are fairly consistent in their teaching with regard to the indications for surgical intervention, diagnostic/treatment modalities as well as the post-operative care, interesting variations were also observed.

CONCLUSIONS

This study, perhaps the first of its kind, provides useful insights into management of impacted wisdom teeth, as taught in the undergraduate dental programmes across the UK.

Consuming two additional serves of dairy food a day significantly improves energy and nutrient intakes in ambulatory aged care residents: a feasibility study

OBJECTIVES

[corrected] Low-level aged-care residents are at risk of malnutrition. Oral supplements and fortified foods used to treat malnutrition in the elderly require special preparation and administration by staff. Therefore we aimed to determine if increasing dairy food intake in residents by two serves per day would improve energy and nutrient intakes and prevent malnutrition in residents.

DESIGN

Prospective intervention study.

SETTING

2 intervention and 2 control low-level aged-care facilities in Melbourne, Australia.

PARTICIPANTS

130 residents (n = 68 intervention, 78% female, mean age 86.5 years).

INTERVENTION

This feasibility study was a 4-week intervention where menus were modified to include at least two additional serves of dairy food/day. Control facilities consumed from their regular menus.

MEASUREMENTS

Mean macro- and micro-nutrient intakes before and after intervention and over the same time period in controls were recorded using observed intake (food served minus waste) and changes over time determined using paired t-tests. Comparison in proportion of residents meeting nutritional requirements was determined using Chi-square distribution test.

RESULTS

Following intervention, daily increases in mean energy intake (900kJ, P<0.001), protein intake (+25g, P<0.0001), proportion of energy from protein (+4%, P<0.0001) and proportion of estimated energy requirements (EER) (+18%, P<0.0001) were observed, while proportion of energy from fat decreased (-3%, P<0.0001). In controls mean energy intake remained below the EER, and protein intake remained unchanged. Increases in mean daily micronutrient intakes were observed for numerous nutrients including calcium (+679mg, P<0.0001), vitamin D (+1.4μg, P<0.0001), phosphorus (+550mg, P<0.0001), and zinc (+2.8mg, P<0.0001), which remained unchanged in control residents. Calcium and zinc intakes achieved recommended intake levels on the higher dairy diet, but were below recommended levels in controls. Mean sodium intakes remained unchanged. During intervention a greater proportion of residents achieved the EER for energy and the RDI for protein and calcium compared to controls.

CONCLUSION

Two additional serves of dairy food can significantly improve nutrient intake in aged-care residents and its ease of provision makes it a viable option to potentially prevent malnutrition.

Molecular mechanics of cardiac myosin-binding protein C in native thick filaments

The heart's pumping capacity results from highly regulated interactions of actomyosin molecular motors. Mutations in the gene for a potential regulator of these motors, cardiac myosin-binding protein C (cMyBP-C), cause hypertrophic cardiomyopathy. However, cMyBP-C's ability to modulate cardiac contractility is not well understood. Using single-particle fluorescence imaging techniques, transgenic protein expression, proteomics, and modeling, we found that cMyBP-C slowed actomyosin motion generation in native cardiac thick filaments. This mechanical effect was localized to where cMyBP-C resides within the thick filament (i.e., the C-zones) and was modulated by phosphorylation and site-specific proteolytic degradation. These results provide molecular insight into why cMyBP-C should be considered a member of a tripartite complex with actin and myosin that allows fine tuning of cardiac muscle contraction.

The impact of age and gender on papillary thyroid cancer survival

CONTEXT

Thyroid cancer predominately affects women, carries a worse prognosis in older age, and may have higher mortality in men. Superimposed on these observations is the fact that most women have attained menopause by age 55 yr.

OBJECTIVE

The objective of the study was to determine whether men contribute disproportionately to papillary thyroid cancer (PTC) mortality or whether menopause affects PTC prognosis.

DESIGN

Gender-specific mortality was normalized using age-matched subjects from the U.S. population. Multivariate Cox proportional hazard regression models incorporating gender, age, and National Thyroid Cancer Treatment Cooperative Study Group stage were used to model disease-specific survival (DSS).

PARTICIPANTS AND SETTING

Patients were followed in a prospective registry.

MAIN OUTCOME MEASURE

The relationships between gender, age, and PTC outcomes were analyzed.

RESULTS

The unadjusted hazard ratio (HR) for DSS for women was 0.40 [confidence interval (CI) 0.24-0.65]. This female advantage diminished when DSS was adjusted for age at diagnosis and stage with a HR encompassing unity (HR 0.72, CI 0.44-1.19). Additional multivariate models of DSS considering gender, disease stage, and various age groupings showed that the DSS for women diagnosed at under 55 yr was improved over men (HR 0.33, CI 0.13-0.81). However, the HR for DSS increased to become similar to men for women diagnosed at 55-69 yr (HR 1.01, CI 0.42-2.37) and at 70 yr or greater (HR 1.17, CI 0.48-2.85).

CONCLUSIONS

Although the overall outcome of women with PTC is similar to men, subgroup analysis showed that this composite outcome is composed of two periods with different outcomes. The first period is a period with better outcomes for women than men when the diagnosis occurs at younger than 55 yr; the second is a period with similar outcomes for both women and men diagnosed at ages greater than 55 yr. These data raise the question of whether an older age cutoff would improve current staging systems. We hypothesize that older age modifies the effect of gender on outcomes due to menopause-associated hormonal alterations.

Relationship between diabetes risk and admixture in postmenopausal African-American and Hispanic-American women

AIMS/HYPOTHESIS

Type 2 diabetes is more prevalent in African-Americans (AFAs) and Hispanic-Americans (HAs) than in European-Americans. We assessed whether continental admixture was correlated with diabetes risk in these high-risk groups.

METHODS

We estimated the proportion of sub-Saharan African (AFR), Amerindian (AMI) and European admixture using 92 ancestry-informative marker genotypes in 16,476 AFA and HA women from the Women's Health Initiative. Cox regression models were used to examine the association between admixture and diabetes risk, with and without accounting for socioeconomic status (SES) and adiposity measurements.

RESULTS

AFR admixture was significantly associated with diabetes risk in AFA women when adjusting for entry age, neighbourhood SES and BMI or waist/hip ratio (WHR) (all p < 0.0001). In HA women, AMI admixture had significant associations with diabetes risk that remained significant after adjustment for SES and BMI (all p < 0.0005). In both AFAs and HAs, SES showed significant negative associations while BMI or WHR had significant positive associations with diabetes risk, with and without adjustment for genetic admixture.

CONCLUSIONS/INTERPRETATION

In AFAs, admixture, SES and BMI/WHR each independently contribute to diabetes risk after accounting for each of the other factors; in HAs, admixture, SES and BMI each independently contribute to diabetes risk after accounting for each of the other factors, whereas admixture is not significantly associated with diabetes risk after accounting for SES and WHR. The findings emphasise the importance of considering both genetic and environmental causes in the aetiology of type 2 diabetes.

Oral clefts and behavioral health of young children

OBJECTIVES

This study examined the behavioral health of young children with oral clefts, and effects of satisfaction with facial appearance, cleft team care, number of cleft-related surgeries, and socioeconomic status (SES).

SUBJECTS AND METHODS

The study included a population-based sample of 104 children aged 2-12 years with isolated oral clefts from the state of Iowa. Behavior was evaluated with the Child Behavior Checklist or the Pediatric Behavior Scale 30, depending on age, compared with normative samples.

RESULTS

Risks of behavioral problems were not significantly different from normative samples except for higher inattention/hyperactivity risks at age 6-12 years. Low satisfaction with facial appearance was associated with behavioral problems in all domains, except aggression. Team-care effects were not associated with behavioral problems. Number of cleft-related surgeries was associated with increased anxiety/depression and somatic symptom risks. Higher SES was associated with reduced inattention/hyperactivity, aggressive/oppositional behavior, and somatic symptoms.

CONCLUSIONS

Most children with oral clefts may have similar behavioral health outcomes to unaffected children, except for increased inattention/hyperactivity risks at older ages. However, low satisfaction with facial appearance, increased exposure to surgeries, and lower SES may significantly increase behavioral problems. Also, the findings emphasize the need to study the representation of behavioral health professionals on cleft teams and access to behavioral health care.

Exemestane for primary prevention of breast cancer in postmenopausal women: NCIC CTG MAP.3—A randomized, placebo-controlled clinical trial

LBA504

Background: Limited efficacy and serious toxicities have limited uptake of tamoxifen or raloxifene as preventatives of breast cancer. Aromatase inhibitors (AIs) prevent contralateral breast cancers more than tamoxifen in adjuvant trials and have fewer serious side effects. This is the first report of an AI used in primary prevention. Methods: NCIC CTG MAP.3 is a randomized trial designed to detect a 65% reduction in annual incidence of invasive breast cancer (IBC) on exemestane (E) versus placebo (P). Eligible postmenopausal women had ≥ one of the following risk factors: Gail score >1.66%, prior ADH, ALH, LCIS or DCIS with mastectomy, age over 60. Health-related and menopause-specific quality of life (QOL) were assessed by SF-36 and MENQOL questionnaires. Results: From 2004-2010, 4,560 women were randomized: age 62.5 yrs (37-90); Gail Score 2.3 % (0.6-21); BMI 28.0 kg/m2 (15.9-65.4). Risk factors included: age >60 yrs (49%); Gail score >1.66 (40%); and prior ADH, ALH, LCIS or DCIS with mastectomy (11%). At median follow-up of 35 months there were 11 IBCs on E and 32 on P (annual incidence 0.19% vs 0.55%; HR= 0.35, 95% CI 0.18-0.70, p = 0.002); ductal (10E/27P), lobular (1E/5P). Most tumors were ER positive (7E/27P); Her2/neu negative (10E/26P); TNM stage T1 (8E/28P), N0 (7E/22P), M0 (11E/30P). E was superior in all subgroups: by Gail score, age, BMI, prior LCIS and DCIS. The annual incidence rate of IBC or DCIS was 0.35% E and 0.77% P (HR=0.47;95% CI 0.27-0.79; p = 0.004) based on 64 IBCs or DCISs (20E/44P). Clinical bone fractures, osteoporosis, hypercholesterolemia or cardiovascular events were equal in both arms. No clinically meaningful differences in QOL were detected. Conclusions: Exemestane significantly reduced invasive and pre-invasive breast cancers in postmenopausal women at increased risk for breast cancer with no serious toxicities. Exemestane should be considered a new option for primary prevention of breast cancer. Supported by the Canadian Cancer Society; Pfizer Inc. PEG supported in part by Avon Foundation.