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The objective of this study was to use automated activity, lying, and rumination monitors to characterize prepartum behavior and predict calving in dairy cattle. Data were collected from 20 primiparous and 33 multiparous Holstein dairy cattle from September 2011 to May 2013 at the University of Kentucky Coldstream Dairy. The HR Tag (SCR Engineers Ltd., Netanya, Israel) automatically collected neck activity and rumination data in 2-h increments. The IceQube (IceRobotics Ltd., South Queensferry, United Kingdom) automatically collected number of steps, lying time, standing time, number of transitions from standing to lying (lying bouts), and total motion, summed in 15-min increments. IceQube data were summed in 2-h increments to match HR Tag data. All behavioral data were collected for 14 d before the predicted calving date. Retrospective data analysis was performed using mixed linear models to examine behavioral changes by day in the 14 d before calving. Bihourly behavioral differences from baseline values over the 14 d before calving were also evaluated using mixed linear models. Changes in daily rumination time, total motion, lying time, and lying bouts occurred in the 14 d before calving. In the bihourly analysis, extreme values for all behaviors occurred in the final 24 h, indicating that the monitored behaviors may be useful in calving prediction. To determine whether technologies were useful at predicting calving, random forest, linear discriminant analysis, and neural network machine-learning techniques were constructed and implemented using R version 3.1.0 (R Foundation for Statistical Computing, Vienna, Austria). These methods were used on variables from each technology and all combined variables from both technologies. A neural network analysis that combined variables from both technologies at the daily level yielded 100.0% sensitivity and 86.8% specificity. A neural network analysis that combined variables from both technologies in bihourly increments was used to identify 2-h periods in the 8 h before calving with 82.8% sensitivity and 80.4% specificity. Changes in behavior and machine-learning alerts indicate that commercially marketed behavioral monitors may have calving prediction potential. [ABSTRACT FROM AUTHOR]

The objective of this study was to describe the differences in freestall cleanliness and stall temperature between a barn with Dual Chamber Cow Waterbeds (DCCW; Advanced Comfort Technology, Reedsburg, WI) and a barn with rubber-filled mattresses at the University of Kentucky Coldstream Dairy Research Farm from January 18, 2012, to May 3, 2013. Stall cleanliness was measured twice weekly (n = 134) by the same 2 observers using a 0.91 m x 0.91 m wire grid containing 128 equally sized rectangles (10.16 cm x 5.08 cm). This grid was centered at the rear portion of the stall; a rectangle that was visibly wet or had any amount of feces present was defined as a dirty rectangle. Weekly stall temperature (n = 66) was measured by the same observer during a.m. milkings in the same predetermined stalls. Feces and wet sawdust were removed from the stalls before stall temperatures were acquired. Temperatures were obtained using a handheld thermometer at 30.48 cm above the stall base as determined via dual laser measurements. Stall temperature was measured on the front, middle, and back of the stall first with clean sawdust and then with the sawdust removed from the stall and wiped clean with a towel. Daily temperature-humidity index (THI) was calculated using Kentucky climate data calculated through the University of Kentucky College of Agriculture via a Campbell Scientific Inc. 23x data logger, located 5.63 km from the Coldstream Dairy Farm. Stall cleanliness was not different between the DCCW barn (26.09 ± 0.89 rectangles) and the rubber-filled mattress barn (23.70 ± 0.89 rectangles). Mean THI throughout the study was 64.39 ± 0.82. Stall temperature was different among THI categories. Temperature-humidity index categories 1 (coldest), 2, 3, and 4 (warmest) had THI ranges of 22.94 to 50.77, 50.77 to 64.88, 64.88 to 78.75, and 78.75 to 101.59, respectively. Stall temperatures (°C; least squares means ± SE) were 2.26 ± 0.30, 8.86 ± 0.30, 15.52 ± 0.30, and 20.95 ± 0.30 for THI categories 1 to 4, respectively. Stalls with rubber-filled mattresses had a lower temperature (°C) than DCCW with least squares means ± SE of 10.52 ± 0.21°C and 13.29 ± 0.21°C, respectively. The DCCW were probably significantly warmer because water holds heat well. The DCCW may have more of a heat-insulating effect compared with rubber-filled mattresses. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate commercially available precision dairy technologies against direct visual observations of feeding, rumination, and lying behaviors. Primiparous (n = 24) and multiparous (n = 24) lactating Holstein dairy cattle (mean ± standard deviation; 223.4 ± 117.8 d in milk, producing 29.2 ± 8.2 kg of milk/d) were fitted with 6 different triaxial accelerometer technologies evaluating cow behaviors at or before freshening. The AfiAct Pedometer Plus (Afimilk, Kibbutz Afikim, Israel) was used to monitor lying time. The CowManager SensOor (Agis, Harmelen, Netherlands) monitored rumination and feeding time. The HOBO Data Logger (HOBO Pendant G Acceleration Data Logger, Onset Computer Corp., Pocasset, MA) monitored lying time. The CowAlert IceQube (IceRobotics Ltd., Edinburgh, Scotland) monitored lying time. The Smartbow (Smartbow GmbH, Jutogasse, Austria) monitored rumination time. The Track A Cow (ENGS, Rosh Pina, Israel) monitored lying time and time spent around feeding areas for the calculation of feeding time. Over 8 d, 6 cows per day were visually observed for feeding, rumination, and lying behaviors for 2 h after morning and evening milking. The time of day was recorded when each behavior began and ended. These times were used to generate the length of time behaviors were visually observed. Pearson correlations (r; calculated using the CORR procedure of SAS Version 9.3, SAS Institute Inc., Cary, NC), and concordance correlations (CCC; calculated using the epiR package of R version 3.1.0, R Foundation for Statistical Computing, Vienna, Austria) evaluated association between visual observations and technology-recorded behaviors. Visually recorded feeding behaviors were moderately correlated with the CowManager SensOor (r = 0.88, CCC = 0.82) and Track A Cow (r = 0.93, CCC = 0.79) monitors. Visually recorded rumination behaviors were strongly correlated with the Smartbow (r = 0.97, CCC = 0.96), and weakly correlated with the CowManager SensOor (r = 0.69, CCC = 0.59). Visually recorded lying behaviors were strongly correlated with the AfiAct Pedometer Plus (r >0.99, CCC >0.99), CowAlert IceQube (r >0.99, CCC >0.99), and Track A Cow (r >0.99, CCC >0.99). The HOBO Data Loggers were moderately correlated (r >0.83, CCC >0.81) with visual observations. Based on these results, the evaluated precision dairy monitoring technologies accurately monitored dairy cattle behavior. [ABSTRACT FROM AUTHOR]

This study included 2 objectives. The first objective was to describe estrus-related changes in parameters automatically recorded by the CowManager SensOor (Agis Automatisering, Harmelen, the Netherlands), DVM bolus (DVM Systems LLC, Greeley, CO), HR Tag (SCR Engineers Ltd., Netanya, Israel), IceQube (IceRobotics Ltd., Edinburgh, UK), and Track a Cow (Animart Inc., Beaver Dam, WI). This objective was accomplished using 35 cows in 3 groups between January and June 2013 at the University of Kentucky Coldstream Dairy. We used a modified Ovsynch with G7G protocol to partially synchronize ovulation, ending after the last PGF2α injection (d 0) to allow estrus expression. Visual observation for standing estrus was conducted for four 30-min periods at 0330, 1000, 1430, and 2200 h on d 2, 3, 4, and 5. Eighteen of the 35 cows stood to be mounted at least once during the observation period. These cows were used to compare differences between the 6 h before and after the first standing event (estrus) and the 2 wk preceding that period (nonestrus) for all technology parameters. Differences between estrus and nonestrus were observed for CowManager SensOor minutes feeding per hour, minutes of high ear activity per hour, and minutes ruminating per hour; twice daily DVM bolus reticulorumen temperature; HR Tag neck activity per 2 h and minutes ruminating per 2 h; IceQube lying bouts per hour, minutes lying per hour, and number of steps per hour; and Track a Cow leg activity per hour and minutes lying per hour. No difference between estrus and nonestrus was observed for CowManager SensOor ear surface temperature per hour. The second objective of this study was to explore the estrus detection potential of machine-learning techniques using automatically collected data. Three machine-learning techniques (random forest, linear discriminant analysis, and neural network) were applied to automatically collected parameter data from the 18 cows observed in standing estrus. Machine learning accuracy for all technologies ranged from 91.0 to 100.0%. When we compared visual observation with progesterone profiles of all 32 cows, we found 65.6% accuracy. Based on these results, machine-learning techniques have potential to be applied to automatically collected technology data for estrus detection. [ABSTRACT FROM AUTHOR]

Organophosphoate (OP) chemicals are known to inhibit the enzyme acetylcholinesterase (AChE). Studying OP poisoning is difficult because common small animal research models have serum carboxylesterase, which contributes to animals' resistance to OP poisoning. Historically, guinea pigs have been used for this research; however, a novel genetically modified mouse strain (KIKO) was developed with nonfunctional serum carboxylase (Es1 KO) and an altered acetylcholinesterase (AChE) gene, which expresses the amino acid sequence of the human form of the same protein (AChE KI). KIKO mice were injected with 1xLD 50 of an OP nerve agent or vehicle control with or without atropine. After one to three minutes, animals were injected with 35 mg/kg of the currently fielded Reactivator countermeasure for OP poisoning. Postmortem brains were imaged on a Bruker RapifleX ToF/ToF instrument. Data confirmed the presence of increased acetylcholine in OP-exposed animals, regardless of treatment or atropine status. More interestingly, we detected a small amount of Reactivator within the brain of both exposed and unexposed animals; it is currently debated if reactivators can cross the blood-brain barrier. Further, we were able to simultaneously image acetylcholine, the primary affected neurotransmitter, as well as determine the location of both Reactivator and acetylcholine in the brain. This study, which utilized sensitive MALDI-MSI methods, characterized KIKO mice as a functional model for OP countermeasure development.

Purpose: Respiratory complications are the most significant cause of morbidity and mortality in acute cervical spinal cord injury (CSCI). The prevalence of extubation failure (EF) and factors associated with it are unclear. This research aimed to systematically synthesise and pool literature describing EF and associated risk factors in acute CSCI., Methods: A systematic review was performed using medical literature analysis and retrieval system online, cummulative index of nursing and allied health literature, excerpta medica dataBASE, and Cochrane library. Articles were screened using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A proportion meta-analysis was conducted to pool rates of EF. Odds ratios and weighted mean differences were calculated to evaluate risk factors. The R statistical software package was used., Results: Of the 347 articles that were identified, six articles satisfied the inclusion criteria (387 participants). The pooled EF rate was 20.25% (10.13-36.38%). Type of CSCI was the only statistically significant risk factor. The odds of EF occurring were 2.76 [95% confidence interval (CI): 1.14; 6.70] times greater for complete CSCI than for incomplete CSCI., Conclusions: One in five patients with acute cervical SCI fails extubation. The odds of EF occurring are almost three times greater in complete CSCI. Future research should aim to improve standard data sets and prospective evaluation of adjuvant therapy in the peri-extubation period., (Copyright © 2019 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Objective: The aim of this study was to evaluate the impact of behavior management training on nurses' confidence in managing aggressive patients., Background: Nurses are at a high risk of experiencing violence directed toward them by patients., Methods: This quality improvement project used a pre-and-post study design. A survey was administered within 1 month before behavior management training and 1 month after training, capturing participants' demographic and work characteristics, as well as their experiences with patient/visitor-perpetrated violence. Confidence was measured using the Confidence in Coping with Patient Aggression Instrument. Open-ended questions sought participants' thoughts on workplace violence prevention initiatives., Results: Thirty-eight confidence scores were assessed. Nurses' confidence in coping with patient aggression was significantly higher after behavior management training. Nurse participants described the training as "timely," "helpful," and "beneficial.", Conclusion: With an increased understanding of violent behavior stages and warning signs, a nurse is better able to manage a potentially violent situation.

Regulatory T cells (Tregs) facilitate primary and metastatic tumour growth through the suppression of anti-tumour immunity. Emerging evidence suggests a distinct role for Tregs in mediating tissue repair and barrier integrity in the lungs by IL-33 mediated production of the growth factor amphiregulin (AREG). Dependent on the type of cancer and local microenvironment, AREG may induce tumour cell proliferation, invasion, migration or resistance to apoptosis by signaling through the epidermal growth factor receptor (EGFR). We have found that IL-33 is dramatically increased in and around metastatic tumour foci in the lungs of mice bearing orthotopic murine mammary tumours. We observed that Tregs express significantly more of the IL-33 receptor, ST2, relative to conventional T cells, that ST2 + Tregs accumulate in the lungs of metastatic tumour-bearing mice, and that ST2 + Tregs produce significantly more AREG than ST2 - Tregs. The intranasal administration of recombinant IL-33 increased the proportion of AREG producing ST2 + Tregs and enhanced the level of phosphorylated EGFR in the metastatic lungs. While recombinant AREG did not impact mammary tumour cell proliferation in vitro despite inducing a dose-dependent increase in phosphorylated EGFR, intranasal administration of AREG resulted in a ten-fold increase in pulmonary metastatic tumour burden in vivo . Further, the intranasal administration of recombinant IL-33 significantly increased metastatic tumour burden in the lungs in an amphiregulin-dependent manner. These data identify ST2 + Tregs as a microenvironmental source of AREG in the lungs of mice with orthotopic metastatic mammary tumours and highlight an important role for AREG in promoting metastatic tumour growth in the lungs.

Spinal cord injury (SCI) is characterised by profound respiratory compromise secondary to the level of loss of motor, sensory and autonomic control associated with the injury. This review aims to detail these anatomical and physiological changes after SCI, and outline their impact on respiratory function. Injury-related impairments in strength substantially alter pulmonary mechanics, which in turn affect respiratory management and care. Options for treatments must therefore be considered in light of these limitations., Key Points: Respiratory impairment following spinal cord injury (SCI) is more severe in high cervical injuries, and is characterised by low lung volumes and a weak cough secondary to respiratory muscle weakness.Autonomic dysfunction and early-onset sleep disordered breathing compound this respiratory compromise.The mainstays of management following acute high cervical SCI are tracheostomy and ventilation, with noninvasive ventilation and assisted coughing techniques being important in lower cervical and thoracic level injuries.Prompt investigation to ascertain the extent of the SCI and associated injuries, and appropriate subsequent management are important to improve outcomes., Educational Aims: To describe the anatomical and physiological changes after SCI and their impact on respiratory function.To describe the changes in respiratory mechanics seen in cervical SCI and how these changes affect treatments.To discuss the relationship between injury level and respiratory compromise following SCI, and describe those at increased risk of respiratory complications.To present the current treatment options available and their supporting evidence., Competing Interests: Conflict of interest Disclosures can be found alongside this article at breathe.ersjournals.com

In the 2nd of a 3-part series on the value of patient and family advisory councils, an early adopter at a large, Magnet®-recognized healthcare system reveals ways in which an environment focused on strong partnerships, a culture of safety, and a commitment to transparency led to the creation of successful councils at multiple hospitals. The authors discuss nursing's integral role in championing and leading the councils, as well as the benefits of a strong patient-family voice in hospital operations and care processes.

In 2013, a new system chief nursing officer engaged the nursing leaders and staff in an Appreciative Inquiry process utilizing strengths, opportunities, aspirations, and results (SOAR), and a Journey of Excellence to assess and understand the current environment. The ultimate goal was to engage all nurses in strategic planning and goal setting to connect their patient care to the system strategic initiatives. This work led to the creation of a nursing vision, a revised professional practice model and greater council alignment, resulting in significant positive change and ongoing advancement throughout the system. The shared decision-making structure was key to the process with a direct connection of each council's goals, leading to the successful achievement of 34 of the 36 goals in 2 years. This article outlines the process, tools, and staff engagement strategies used to achieve system-wide success. This methodology has improved the outcomes across the organization in both small and system-wide work groups. This work can easily be replicated and adapted to help disparate staffs brought together through mergers or acquisitions to become aligned as a new team. This process, model, and framework, provides structure and results in significant outcomes that recognizes and celebrates the work of individual entities while aligning future strategies and goals.

Background: An abdominal binder (AB) is routinely used for patients who have suffered a spinal cord injury (SCI) resulting in tetraplegia. It is thought to restore abdominal pressure and consequently improve breathing capacity and reduce postural hypotension in patients who do not have functioning abdominal muscles., Objective: To examine the early effects of an AB on respiratory and speech outcomes., Methods: Thirteen individuals who sustained an acute motor complete SCI between C3 and T1 were assessed after a 6-week trial of using an elasticized AB from the time of first mobilizing in an upright wheelchair. Assessments were made using spirometry and perceptual and acoustics speech measures based on sustained phonation, sentence recitation, and passage reading., Results: Significant improvements were found in the AB-on condition for 3 of 5 respiratory parameters (vital capacity, forced vital capacity, and forced expiratory volume in 1 second). Predominantly mild voice and speech dysfunction were noted in participants. No significant difference was found for any of the acoustic and perceptual speech parameters (maximum phonation time, vocal intensity for sentence recitation, perceptual speech characteristics, or vocal quality) between the AB conditions., Conclusions: Despite the finding that an AB results in significant improvements in respiratory function for individuals with tetraplegic SCI, the current study did not provide evidence that an AB improves speech production.