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The study evaluated the effects of nutritional strategies on broilers challenged with Eimeria from d 14 to 26. A total of 840 Cobb male broilers were fed five diets in a 2 × 5 factorial arrangement: 1) nutrient adequate diet (PC; 0.84% calcium [Ca], 0.42% available phosphorus [avP]); 2) Ca-P deficient diet (NC; 0.64% Ca, 0.22% avP); 3) NC + 1500 FTU/kg phytase of diet (NC + PHY); 4) NC + 5000 IU/kg 25-hydroxycholecalciferol of diet (NC + 25OHD); and 5) NC with both supplements (NC + PHY + 25OHD), with and without Eimeria challenge. All treatments had six replicate cages with 14 birds per cage. At 5 days post inoculation (DPI), the challenged birds exhibited higher serum fluorescein isothiocyanate-d (FITC-d) levels than the unchallenged birds (P

Mycotoxins, particularly deoxynivalenol (DON), are common contaminants in feed ingredients such as corn distiller's dried grains with solubles (DDGS) and pose significant risks to poultry health. This study investigated the effects of feeding naturally DON contaminated DDGS on growth performance, body composition, immunological response, and gastrointestinal health in young pullets. A total of 360, 4-week-old Hy-Line W36 pullets were randomly assigned to diets with increasing levels of naturally DON contaminated DDGS (0, 5, 10, 15, and 20%) over 28 days, resulting in dietary DON concentrations ranging from below the limit of quantification to 15.4 ppm. Diets with DON concentration exceeding 8.9 ppm, corresponding to 15% and 20% DDGS inclusion, resulted in significantly lower body weight gain (BWG) and feed intake (FI) from experimental day 14 to day 28 compared to DON concentration below 5.9 ppm (0, 5 and 10% DDGS groups; P = 0.024 and P = 0.007, respectively). Body composition analysis showed a higher tissue fat percentage in the 20% DDGS group (15.4 ppm DON) by day 28 compared to lower inclusion levels (P = 0.021). Immunologically, a significant increase in the CD4+:CD8+ ratio in spleen was observed in the 20% DDGS group compared to the 0% DDGS group (P = 0.013), whereas both 15 and 20% DDGS inclusion levels significantly increased the ratio in cecal tonsil (P < 0.001). Additionally, interleukin 1β (IL-1β) expression significantly increased in the cecal tonsil by day 28 with 15 and 20% DDGS inclusions (P = 0.002). Gut health was compromised as gut permeability increased linearly with increasing DDGS inclusion (linear, P = 0.043), aligning with significant alterations in the expression of the tight junction protein occludin (OCLN; P = 0.007). Antioxidant responses in the liver showed increased superoxide dismutase (SOD) activity in early exposure (day 13, P = 0.038), followed by decreased SOD activity (P = 0.001) and reduced glutathione (GSH) levels (P < 0.001) by day 28. In conclusion, feeding DON-contaminated DDGS at higher inclusion levels (15% and 20%) with final diet DON concentrations exceeding 8.9 ppm over 28 days adversely affects growth performance, immune function, and gut integrity in young pullets.

ABSTRACT: The global egg industry is rapidly transitioning to cage-free egg production from conventional cages. Hens housed in cage-free systems have an increased prevalence of keel damage that could lead to reduced egg production and compromised well-being. The objective of this study was to determine the effects of dietary supplementation of n-3 fatty acids and vitamin D3 on keel damage in hens housed in multi-tier aviary systems (AV). Brown hens were placed in 4 AV system rooms after rearing at 17 wk of age (woa) with each room containing 576 birds. At 12 woa, rooms were randomly assigned to a dietary treatment of flaxseed oil, fish oil, vitamin D3, or control. Focal birds (36 per treatment) were longitudinally examined for keel damage using quantitative computed tomography (QCT) at nine timepoints from 16 to 52 woa. Three-dimensional digital twins of the keels were created from the QCT scans and visually assessed for damage. An overall keel severity score was recorded as well as the location, direction, and severity of each deviation or fracture. Severity was ranked on a 0 to 5 scale with 0 being no damage and 5 being severe. Damage scores were analyzed utilizing odds ratios with main effects of age and treatment. At 16 woa, 80% of hens had overall keel scores of 0 and 20% had scores of 1. At 52 woa, all hens had damage, with 31% having a score of 1, 61% scored 2 to 3, and 8% scored 4 to 5. Most fractures were not observed until peak lay. Dietary treatments did not affect likelihood of fracture incidences, but younger birds had lower odds of incurring keel fractures than older birds (P < 0.0001). The initial incidences of keel deviations occurred earlier than fractures, with most birds obtaining a keel deviation by 28 woa. Keel damage was not able to be prevented, but the age at which keel fractures and deviations initiate appear to be different, with deviations occurring during growth and fractures during lay.

ABSTRACT: A 35-d study investigated the impact of dietary supplementation with Arginine (Arg) or branched-chain amino acids (BCAA) of broilers receiving low-protein diets whilst infected with mixed Eimeria species. All birds were given the same starter (d0–10) and finisher (d28–35) diets. The 4 grower diets used were a positive control (PC) with adequate protein (18.5%), a low protein diet (NC;16.5% CP), or the NC supplemented with Arg or BCAA. Supplemental AA was added at 50% above the recommended levels. The treatments were in a 4 × 2 factorial arrangement, with 4 diets, with or without Eimeria inoculation on d14. Birds and feed were weighed after inoculation in phases: prepatent (d14–17), acute (d18–21), recovery (d22–28), and compensatory (d29–35). Ileal digesta, jejunum, and breast tissue were collected on d21, 28, and 35. There was no diet × Eimeria inoculation on growth performance at any phase. Infected birds weighed less and consumed less feed (P < 0.05) in all phases. In the prepatent and acute phases, birds on the Arg diets had higher weight gain (P < 0.05) and lower FCR, similar to PC, when compared to NC and BCAA-fed ones. Infection reduced AA digestibility on d21 and 28 (Met and Cys). However, birds that received supplemental AA had higher digestibility (P < 0.05) of their respective supplemented AA on d 21 only. Infected birds had lower (P < 0.05) BO + AT and higher PEPT1 expression on d21. There was a diet × Eimeria interaction (P = 0.004) on gene expression at d28; 4EBP1 genes were significantly downwardly expressed (P < 0.05) in birds fed Arg diet, irrespective of infection. Infected birds exhibited an upward expression (P < 0.05) of Eef2 on d21 and d28 but experienced a downward expression on d35. Supplemental Arg and BCAA had variable effects on growth performance, apparent ileal AA digestibility, and genes of protein synthesis and degradation, but the effect of Arg on promoting weight gain, irrespective of the Eimeria challenge, was more consistent.

Fisseha Zewdu Amdie,1,2 Monakshi Sawhney,2 Kevin Woo2 1School of Nursing, University of Gondar, Gondar, Ethiopia; 2School of Nursing, Queen’s University, Kingston, Ontario, CanadaCorrespondence: Fisseha Zewdu Amdie, Email fmzewdu@gmail.comAbstract: Chronic disease prevention and management requires a lifelong commitment and adherence to lifestyle modifications, monitoring of symptoms, medication use, and other forms of therapy. Treatment adherence is a crucial and complex concept in patient care provision, and it requires the voluntary active involvement of patients for the best possible outcome. Multiple factors, which may or may not be under the patient’s control, can influence treatment adherence. However, adherence or non-adherence to a certain treatment is predominantly influenced by one’s sense of agency, values, beliefs, attitudes, and willpower. It is evident that mental states appear to influence patients’ decision-making, and the best treatment outcome occurs when a patient identifies their goals, needs, and desires and exercises their decision-making and free will during the course of receiving care. The role of healthcare providers is critical in promoting treatment adherence, thereby enhancing patient outcomes. Thus, this paper highlights the importance of promoting a sense of agency and integrating patients’ values, beliefs, attitudes, and intentions during the provision of healthcare. It is indispensable to recognize the individual’s ability and initiative to control and manage their illness in the face of challenging socioeconomic and cultural reality. On logical grounds, it is not enough to appreciate the value of free will and mental states, it is also essential to empower and cultivate an individual patient’s willpower to make a well-informed, free decision based on their mental state for the most optimal treatment outcomes.Keywords: free will, willpower, treatment, adherence, compliance

Fisseha Zewdu Amdie,1,2 Marian Luctkar-Flude,2 Erna Snelgrove-Clarke,2 Monakshi Sawhney,2 Shitaye Alemu,3 Kevin Woo2 1School of Nursing, University of Gondar, Gondar, Ethiopia; 2School of Nursing, Queen’s University, Kingston, Ontario, Canada; 3Department of Internal Medicine, University of Gondar, Gondar, EthiopiaCorrespondence: Fisseha Zewdu Amdie, Email fmzewdu@gmail.comIntroduction: Diabetes mellitus is a rapidly growing global public health problem; the number of adults with diabetes is expected to increase from 424.9 million in 2017 to 628.6 million in 2045. Approximately 80% of diabetic patients live in low- and middle-income countries where access to care may be limited. For example, in Ethiopia, diabetes care is often rudimentary, and formal, structured diabetes education is almost non-existent. One potential solution to the lack of diabetes management education for patients could be virtual simulation-based diabetes education incorporating the contextual realities of patients in Ethiopia. Despite its great potential to improve glycemic control, delay diabetes-related complications and reduce mortality associated with diabetes, the feasibility of virtual simulation-based diabetes self-management education has not been studied in low- and middle-income settings.Objective: The purpose of the current study is to evaluate the feasibility of a virtual simulation-based Diabetes Foot Care Education (DFCE) program among adult patients with diabetes in Ethiopia.Methods: A randomized controlled feasibility study including participants from University of Gondar Referral Hospital (UoGRH) will be conducted. A sample of 40 participants will be recruited, of which 20 participants will receive the virtual simulation-based education program, and the other 20 participants will continue with their usual diabetes care. After the education program, a questionnaire and structured interview will be used to explore the feasibility (acceptability, practicality) and the potential impact of virtual simulation-based DFCE intervention in patients with diabetes. Data will be analyzed using SPSS version 25 using descriptive statistics, independent t-tests, paired sample t-test, and factorial ANOVA at significance levels of less than 0.05.Discussion: Our study seeks to understand the perceived usefullness and usability of virtual simulation-based diabetes foot care education on behavioural (diabetes foot-care knowledge, foot self-care practices, and foot self-care efficacy). Furthermore, the study will provide insight to assist in the development of technologically assisted and contextually designed DFCE programs.Trial Registration Number: NCT04841291 (ClinicalTrials.gov Identifier).Keywords: diabetes mellitus, feasibility, acceptability, practicability, foot care, Ethiopia

Abdullah Baharudin,1 Amir Hamzah Abdul Latiff,2 Kent Woo,3 Felix Boon-Bin Yap,4 Ing Ping Tang,5 Kin Fon Leong,6 Wai Seong Chin,7 De Yun Wang8 1Department of Otorhinolaryngology – Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; 2Allergy & Immunology Centre, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; 3Allergy and Immunology Clinic, Gleneagles Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; 4Department of Dermatology, Sunway Medical Centre, Bandar Sunway, Selangor, Malaysia; 5Department of Otorhinolaryngology – Head and Neck Surgery, Faculty of Medicine & Health Sciences, University Malaysia Sarawak, Kuching, Sarawak, Malaysia; 6Department of Dermatology, Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; 7Pediatric Clinic, Dr Chin’s Child Specialist Clinic, Kuala Lumpur, Malaysia; 8Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeCorrespondence: Abdullah BaharudinDepartment of Otorhinolaryngology – Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan 16150, MalaysiaEmail baharudin@usm.myAbstract: H1-antihistamines are recognized to be effective for conditions such as allergic rhinitis and chronic spontaneous urticaria. However, management of such conditions in the real-world primary care setting may be challenging due to diverse patient-specific considerations, the wide range of antihistamines available, choice of other treatment modalities, and the complexity of interpreting specialist treatment algorithms. Despite regular updates to international guidelines, regional/national surveys of healthcare professionals show a clear gap between guidelines and real-world practice, particularly at the primary care level. This article thus presents the consensus opinion of experts from relevant specialties in Malaysia – allergology, pediatrics, otorhinolaryngology, and dermtology – on harmonizing the use and choice of antihistamines in primary care. Patient profiling is recommended as a tool to guide primary care practitioners in prescribing the appropriate antihistamine for each patient. Patient profiling is a three-step approach that involves 1) identifying the individual’s needs; 2) reviewing patient-specific considerations; and 3) monitoring treatment response and referral to specialists in more severe or difficult-to-treat cases. Concurrently, guidelct 3ines should be reviewed and updated periodically to include recommendations that are easily actionable for primary care practitioners.Keywords: antihistamines, primary care, patient profiling, Malaysia

The response to amino acid (AAs) supplementation on broiler production, carcass and meat traits and nitrogen in the excreta during the early growth period was evaluated. Two experiments were performed during 1–28 d (245 birds, experiment 1) and 1–21 d of age (455 birds, experiment 2). In both experiments, the positive control (PC) diet had 22.5% crude protein (CP) and the negative control group (NC) diet had around 18% CP with the same methionine (Met) plus lysine (Lys) concentration as the PC diet. In experiment 1, the NC diet was fed to the other five groups supplemented with synthetic amino acids, such as L-arginine (Arg), L-threonine (Thr), L-valine (Val), L-isoleucine (Ile) or all these AAs, respectively. In experiment 2, the NC diet was formulated to contain 18% CP with either corn–soybean meal and animal protein or with only vegetable protein. Both NC diets were offered to the other ten groups with synthetic amino acids such as L-Arg, L-Thr, L-Val, L-tryptophan (Trp) or a combination of all these AAs plus L-isoleucine (Ile), respectively. In conclusion, broilers fed 18% CP supplemented with DL-Met plus L-Lys showed lower performance and a European production efficiency value (EPEV); Arg, Thr and Val addition improved growth, the feed conversion ratio and EPEV of the diets containing animal protein only, but broiler performance and EPEV was lower than with PC, indicating that DL-Met, L-Lys, L-Arg, L-Thr and L-Val supplementation may be limited in low-protein diets. Furthermore, a low-protein diet supplemented with amino acids did not affect the survivability of broilers up to 28 days of age.

A 42-day study was conducted to explore the application of supplemental amino acids (AA) in low-protein diets with soybean meal (SBM), canola meal (CM) or corn distillers dried grain with solubles (cDDGS) as the main protein feedstuffs. The responses of interest were growth performance, carcass yield, whole-body composition, litter ammonia and litter N. On d 0, a total of 540 Cobb 500 (off-sex) male broilers were allocated to 36 floor pens. All the birds received one starter diet that met nutrient requirements during the first 10d. Thereafter, six experimental diets were provided in grower and finisher phases. The diets included a positive control (PC): a corn–SBM diet with adequate protein. The protein level of the negative control (NC) was decreased by 45 g/kg relative to the PC. The next two diets had the same protein levels as the NC but with cDDGS added at 50 or 125 g/kg. The last two diets had the same CP as the NC but with CM added at 50 or 100 g/kg. All the low-protein diets had the same level of standardized ileal digestible indispensable AA according to Cobb 500 recommended level. Gly and Ser were added as sources of non-specific N. The dietary protein reduction in corn–SBM diets at both phases decreased (p < 0.05) weight gain and increased (p < 0.05) feed conversion ratio (FCR). Increasing levels of cDDGS or CM, at a constant CP level, linearly decreased (p < 0.05) the weight gain and feed intake, whereas increasing CM level linearly increased (p < 0.05) FCR in the grower and finisher phases. The eviscerated and carcass yields decreased, whereas the fat yield increased (p < 0.05) with reduced protein in corn–SBM diet. Increasing levels of cDDGS and CM at a constant CP level quadratically decreased (p < 0.05) the eviscerated weight, whereas the fat weight linearly decreased (p < 0.05) with increasing levels of cDDGS and CM. The birds receiving the PC diet had a lower (p < 0.05) lean muscle (%) and a higher fat (%) compared to birds receiving the NC diet at d 21. However, on d42, birds receiving the PC diet had decreased (p < 0.05) bone mineral density, bone mineral content and lean weight compared to those receiving the NC diet. The litter ammonia increased (p < 0.05) with the increasing levels of protein in the SBM diets. In conclusion, 50 g/kg inclusion levels of CM and cDDGS at the same low-protein levels as SBM produced a similar growth response to the NC, whereas higher levels were detrimental. Hence under the conditions of the current experiment, complete replacement of SBM with DDGS or CM in low-protein diets was not feasible.

Introduction: Although colorectal cancer (CRC) screening is effective in preventing colon cancer, it remains underused by Asian Americans. Because Chinese Americans often use traditional Chinese medicine (TCM), we conducted a pilot study to explore the fea