Development of mathematical models to predict calcium, magnesium and selenium excretion from lactating Holstein cows

The aim of this study was to develop and evaluate mathematical models that predict mineral excretion, particularly calcium (Ca), magnesium (Mg) and selenium (Se), from lactating dairy cows. Mineral excretion can be affected by several dietary factors. A deficiency in Ca or Mg application to pasture, among other factors, can contribute to grass tetany or wheat pasture poisoning in cows, whereas an excess can cause runoff into water supplies. Manure application with high Se concentration can also result in runoff, causing the bioaccumulation of selenium in aquatic ecosystems, wetland habitats and estuaries, leading to toxic levels in fish. A database composed of studies relating to mineral utilisation in lactating dairy cows conducted after and including the year 2000 was compiled. A meta-analysis was conducted with the aim of creating multiple empirical equations to predict Ca, Mg and Se excretion from lactating dairy cows. Calcium intake, feed Ca content, milk yield, milk protein content and acid detergent fibre content in diet were positively and linearly related to Ca excretion. Dietary crude protein content and milk fat content were negatively related to Ca excretion. Magnesium intake, feed Mg content and milk yield were positively and linearly related to Mg excretion. Selenium content of diet and dry matter intake were linearly and positively related to Se excretion. Two sets of models were developed using or excluding the intake variable and both sets of models were evaluated with independent data originating from commercial herd or individual animals. In general, intake measurements improved prediction when evaluated with independent datasets (root mean square prediction error = 8% to 19% vs 14% to 26% of the average observed value). There were substantial mean biases, particularly those evaluated with data from a commercial farm, perhaps due to inaccurate feed intake measurements. Although there was generally good agreement between predicted and observed mineral excretion, model development and evaluation would benefit from an expanded database.

Treatment of moderate-to-severe atopic eczema in adults within the U.K.: results of a national survey of dermatologists

BACKGROUND

Little is known about U.K. dermatologists' treatment approaches towards adult patients with recalcitrant moderate-to-severe atopic eczema.

OBJECTIVES

We wanted to learn about (i) treatment approaches used for this disease in the U.K.; (ii) factors that influence treatment decisions and (iii) perceived gaps in evidence on treatment safety and efficacy, and priorities for future trials.

METHODS

We conducted an online survey of consultant-level dermatologists in the U.K.

RESULTS

Sixty-one respondents from over 30 centres reported on management of moderate-to-severe atopic eczema in adults, outwith the context of an acute flare. Phototherapy or psoralen-ultraviolet A was the most common therapeutic modality chosen first line (46%), and this was usually narrowband ultraviolet B. Systemic therapy was chosen as a first-line approach by 36% of dermatologists. Azathioprine was the commonest drug reported being used as first line followed by oral corticosteroids, ciclosporin and methotrexate. Methotrexate was the most common second-line treatment of respondents. The key factors that influenced decision making on the use of phototherapy and systemic agents were the respondent's clinical experience, results of baseline tests (systemic agents) and knowledge of both efficacy and acute and chronic side-effect profiles. The most important evidence gaps identified were the relative effectiveness of treatments, the alternatives to current approaches and the safety of long-term maintenance treatment. With regard to future trials, respondents suggested that priority should be given to studies involving methotrexate.

CONCLUSIONS

While survey study designs have limitations, we found that phototherapy, in particular narrowband ultraviolet B, was respondents' preferred first-line treatment for adults with recalcitrant moderate-to-severe atopic eczema, perhaps reflecting access to, and clinical experience of, this approach. Azathioprine is widely used as a longer-term maintenance treatment.

An investigation into breast imaging as part of the undergraduate (UG) education of diagnostic radiography students in the UK

INTRODUCTION

How mammography is incorporated into undergraduate (UG) radiography training may influence student perception of the speciality and its potential as a future career option. An overview is provided of the academic and clinical content of UG radiography courses relating to mammography across the UK.

METHODS

Using mixed methods and an iterative, inductive approach supplying quantitative and qualitative data, we identify any variations and discuss possible causes which may help influence future training strategies. A self-designed questionnaire containing open and closed questions was sent online using SurveyMonkey™ to course leaders of all Higher Education Institutions (HEIs) offering BSc (Hons) Diagnostic Radiography courses in the UK. Responses were analysed for trends which were further explored by semi structured telephone interviews. These were transcribed and evaluated using a thematic analysis, the themes being categorised and coded.

RESULTS

19 of 24 (79%) HEIs responded to the questionnaire. Follow up telephone interviews were conducted with five course leaders to further explore themes. Academic teaching ranged from 3 to 25 h over the 3 year course. Compared to other specialities 10 (53%) HEIs spent less time on mammography with 12 (63%) citing HCPC standards as the reason. 11 (65%) HEIs sent students on mammography placements, 2 (12%) sent females only. Placement times ranged between 2 days and 2 weeks. Influences included availability of expert teaching and relationship with clinical departments.

CONCLUSION

There is variation in undergraduate exposure to mammography. Students views should be sought to add validity to these findings.

A national follow-up survey of UK graduates opinion of undergraduate oral surgery teaching

INTRODUCTION

A national follow-up survey was undertaken to determine whether dental graduates from 2009 perceived that their undergraduate oral surgery education had equipped them for general dental practice 4 years after graduating.

MATERIALS AND METHODS

Graduates from the same 13 United Kingdom dental schools who had taken part in the original survey were invited to take part in this follow-up online survey. Their contact details were identified via the general dental council register, social media and alumni groups.

RESULTS

In total, 161 responded (2009b) which represents 16% of the graduates of the original survey in 2009a. A similar percentage of these respondents perceived that the teaching in oral surgery had given them sufficient knowledge to undertake independent practice (83% and 79% in 2009a and 2009b, respectively). Most respondents (99% in both years) reported confidence in undertaking simple forceps exodontia. Confidence in surgical exodontia was poor in both surveys, but one area that appeared improved in the follow-up related to the sectioning of teeth (84% in 2009b compared with 49% in 2009a). Areas of weakness identified in 2009 were reported to be improved in the follow-up.

CONCLUSION

This follow-up survey supports the findings of the original survey. Future longitudinal studies would allow institutions to identify possible weaknesses in their curriculum and to track the career development of their graduates and facilitate robust data collection.

Eletriptan Treatment of Migraine in Patients Switching from Barbiturate-Containing Analgesics: Results from a Multiple-Attack Study

The aim of this study was to examine efficacy and tolerability of eletriptan in patients switched from barbiturate-containing combinations (Fiorinal®, Fioricet®). Migraineurs ( n = 160) meeting IHS criteria, with unsatisfactory response in the past year to butalbital-containing combinations, treated up to 16 attacks over 3 months with eletriptan 40 mg. Assessments included headache response and pain-free rates and functional impairment at baseline and 2 h postdose, and global ratings of treatment satisfaction at 24 h. At 2 h postdose, average headache response and pain-free rates were 71% (95% CI, 69-74%) and 37% (95% CI, 35-40%), respectively; 68.5% of patients (95% CI, 65-72%) reported functional response. Within-patient analysis found no efficacy diminution over time (no tolerance). Average headache recurrence rate was 20% (95% CI, 18-23%). Eletriptan was well-tolerated; 6 (3.7%) patients discontinued due to adverse events. There were no serious treatment-related adverse events. We conclude that in poor responders to butalbital-caffeine combinations, switching to eletriptan 40 mg was well-tolerated and efficacious.

Context aware falls risk assessment: A case study comparison

This paper describes three retrospective case studies to illustrate the potential clinical value of a system capable of capturing objective gait metrics and environment data from older adults with a history of falls while they go about their daily lives. Participants in this study wore an inertial sensor above each ankle and a wearable camera around their neck for seven consecutive days. Selected metrics are presented to illustrate scenarios where the data collected by the system could be of clinical value. Evidence suggests that obtaining objective gait metrics and environment data from older adults may not only allow healthcare professionals to assess gait more accurately, but also to design treatment plans and falls prevention strategies that are more specifically tailored to each individual.

Context focused older adult mobility and gait assessment

This paper presents an initial overview of insights gained into how older adults mobilize in the home and community, based on data from inertial sensors which were worn by study participants over a 7-day period. The addition of a wearable camera provided additional contextual information which can be used to assess mobility and understand the factors that influence it in the free living environment. Seven days of data collected from a group of older adults who had experienced one or more falls in the previous six months was compared to that of a control group with no history of falling. Results showed that both groups spent relatively little time walking in challenging environmental conditions, and that the fallers spent significantly less time walking under regular conditions (no effect on gait) and outdoors. Analysis of gait metrics showed that the fallers were slightly slower in general, and more noticeable differences were observed when the participants were regrouped according to mobility levels determined from baseline assessments using traditional methods.