The feed value of whole crop maize silage (WCMS) depends on nutrient composition, ruminal degradability and whole tract digestibility. However, as the ruminal degradation rate is involved in physical ...regulation of feed intake, ruminal degradability of WCMS may also affect feed intake and milk production of dairy cows. Thus, the aim of this study was to examine relationships between nutrient composition, ruminal degradability, and whole tract digestibility of WCMS and feed intake and milk production of dairy cows. Nine varieties were tested in 3 consecutive years. Nutrient composition analyses included proximate analysis and determination of cell wall constituents. Whole tract digestibility was determined in vivo using wethers and ruminal degradability was examined in situ using four rumen-fistulated steers. Feed intake and milk production were measured using nine cows per variety. Cows were fed a ration consisting of 75.0% WCMS, 8.5% hay and 16.5% soya bean meal (dry matter basis) ad libitum. Variety did not influence nutrient composition, except for the concentration of ADF (ADFom), ADL and utilisable CP (uCP). In contrast, variety had a significant effect (P < 0.05) on ruminal degradability of NDF (aNDFom) and on whole tract digestibility of organic matter (OM) and non-fibre carbohydrates. Dry matter intake (DMI) of WCMS tended to be affected by variety (0.05<P < 0.10) whereas no effect on energy-corrected milk production (ECM) was observed. The year of harvest had an influence on net energy for lactation and uCP concentration, ruminal degradability and whole tract digestibility of nutrients, as well as on DMI and ECM of dairy cows. Whole tract aNDFom digestibility of WCMS was positively correlated with aNDFom concentration (R2 = 0.48) and whole tract OM digestibility (R2 = 0.58). Furthermore, ruminal OM degradability was positively correlated with DMI (R2 = 0.57) and ECM (R2 = 0.49) of dairy cows. The results indicate that ruminal degradability and whole tract digestibility have a greater impact on the feed value of WCMS than nutrient composition and should be focused on to optimise feed intake and milk production of dairy cows. Thus, maize breeders should include ruminal degradability and whole tract digestibility parameters in variety testing programs to increase the informative value of variety descriptions for farmers.
Objectives: To compare rates of falling between nursing home residents with and without dementia and to examine dementia as an independent risk factor for falls and fall injuries.
Design: Prospective ...cohort study with 2 years of follow‐up.
Setting: Fifty‐nine randomly selected nursing homes in Maryland, stratified by geographic region and facility size.
Participants: Two thousand fifteen newly admitted residents aged 65 and older.
Measurements: During 2 years after nursing home admission, fall data were collected from nursing home charts and hospital discharge summaries.
Results: The unadjusted fall rate for residents in the nursing home with dementia was 4.05 per year, compared with 2.33 falls per year for residents without dementia (P<.0001). The effect of dementia on the rate of falling persisted when known risk factors were taken into account. Among fall events, those occurring to residents with dementia were no more likely to result in injury than falls of residents without dementia, but, given the markedly higher rates of falling by residents with dementia, their rate of injurious falls was higher than for residents without dementia.
Conclusion: Dementia is an independent risk factor for falling. Although most falls do not result in injury, the fact that residents with dementia fall more often than their counterparts without dementia leaves them with a higher overall risk of sustaining injurious falls over time. Nursing home residents with dementia should be considered important candidates for fall‐prevention and fall‐injury‐prevention strategies.
Summary
Fractures have a significant impact on the quality of life for the patient in addition to an enormous indirect cost in lost productivity for our economy. While majority of fractures heal ...uneventfully, some fail to heal even after many months resulting in nonunion.
Introduction
Sternal nonunions, although rare, are particularly onerous for the patient given the magnitude of impact on quality of life.
Methods
Current treatment for fracture nonunions emphasizes various approaches to surgical fixation in addition to bone grafting. These treatments are aggressive and have a variety of drawbacks, rendering them suboptimal as a therapeutic approach.
Conclusion
Based on the success of teriparatide in animal studies to accelerate fracture healing, there is growing interest in using this drug in humans for the same purpose. We report a case of what we believe to be the first successful use of teriparatide in the healing of a sternal nonunion fracture.
Antiangiogenic agents have recently shown impressive radiological responses in high-grade glioma. However, it is not clear if the responses are related to vascular changes or due to antitumoral ...effects. The authors report the mature results of a clinical study of bevacizumab-based treatment of recurrent high-grade gliomas.
Sixty-one patients with recurrent high-grade gliomas received treatment with bevacizumab at 10 mg/ kg every 2 weeks for 4 doses in an 8-week cycle along with either irinotecan or carboplatin. The choice of concomitant chemotherapeutic agent was based on the number of recurrences and prior chemotherapy.
At a median follow-up of 7.5 months (range 1-19 months), 50 (82%) of 61 patients relapsed and 42 patients (70%) died of the disease. The median number of administered bevacizumab cycles was 2 (range 1-7 cycles). The median progression-free survival (PFS) and overall survival (OS) were 5 (95% confidence interval CI 2.3-7.7) and 9 (95% CI 7.6-10.4) months, respectively, as calculated from the initiation of the bevacizumab-based therapy. Radiologically demonstrated responses following therapy were noted in 73.6% of cases. Neither the choice of chemotherapeutic agent nor the performance of a resection prior to therapy had an impact on patient survival. Although the predominant pattern of relapse was local, 15 patients (30%) had diffuse disease.
Antiangiogenic therapy using bevacizumab appears to improve survival in patients with recurrent high-grade glioma. A possible change in the invasiveness of the tumor following therapy is worrisome and must be closely monitored.
Objective
Depression after hip fracture in older adults is associated with worse physical performance; however, depressive symptoms are dynamic, fluctuating during the recovery period. The study aim ...was to determine how the persistence of depressive symptoms over time cumulatively affects the recovery of physical performance.
Methods
Marginal structural models estimated the cumulative effect of persistence of depressive symptoms on gait speed during hip fracture recovery among older adults (n = 284) enrolled in the Baltimore Hip Studies 7th cohort. Depressive symptoms at baseline and at 2‐month and 6‐month postadmission for hip fracture were evaluated by using the Center for Epidemiological Studies Depression Scale, and persistence of symptoms was assessed as a time‐averaged severity lagged to standardized 3 m gait speed at 2, 6, and 12 months.
Results
A 1‐unit increase in time‐averaged Center for Epidemiological Studies Depression score was associated with a mean difference in gait speed of −0.0076 standard deviations (95% confidence interval CI: −0.0184, 0.0032; P = .166). The association was largest in magnitude from baseline to 6 months: −0.0144 standard deviations (95% CI: −0.0303, 0.0015; P = 0.076). Associations for the other time intervals were smaller: −0.0028 standard deviations (95% CI: −0.0138, 0.0083; P = .621) at 2 months and −0.0121 standard deviations (95% CI: −0.0324, 0.0082; P = .238) at 12 months.
Conclusion
Although not statistically significant, the magnitude of the numerical estimates suggests that expressing more depressive symptoms during the first 6 months after hip fracture has a meaningful impact on functional recovery.
With the newly gained interest in the time-of-flight method for positron emission tomography (TOF-PET), many options for pushing the time resolution to its borders have been investigated. As one of ...these options, the exploitation of the Cherenkov effect has been proposed, since it allows to bypass the scintillation process and therefore provides almost instantaneous response to incident 511 keV annihilation photons. Our simulation studies on the yield of Cherenkov photons, their arrival rate at the photon detector, and their angular distribution reveal a significant influence by Cherenkov photons on the rise time of inorganic scintillators - a key-parameter for TOF in PET. A measurement shows the feasibility to detect Cherenkov photons in this low energy range.
Preparation of coronal dentin by using a diamond rotary instrument usually results in higher bond strength values than preparation with tungsten carbide burs, but information is lacking about the ...influence of rotary instruments on root canals before the bonding of fiber posts.
The purpose of this in vitro study was to evaluate the influence of the rotary instrument used to prepare the root canal and bonding strategies on the adhesion of fiber posts to root dentin with universal adhesive systems.
Human premolars were used and divided into 8 groups according to the combination of the following factors: rotary instrument (tungsten carbide bur versus diamond rotary instrument), cementation system (single-bond versus prime and bond), and bonding method (etch-and-rinse versus self-etch). Eight teeth per group were evaluated by push-out bond strength, 4 teeth were evaluated for nanoleakage by using scanning electron microscopy (SEM), and 2 teeth were evaluated for shape by SEM. Data for bond strength and nanoleakage for each cementation system were subjected to 2-way ANOVA and Tukey honest significant differences tests (α=.05).
The highest bond strength values were observed for preparation using a diamond rotary instrument for both cementation systems. For prime and bond, the highest bond strength values were observed with the self-etch adhesion strategy, and the self-etch strategy was better for the single-bond; and the self-etch strategy was better than etch-and-rinse just after the use of a diamond instrument. In relation to nanoleakage for the cementation system, the prime and bond had the lowest values for groups using a diamond instrument and self-etch strategy. For the single bond, the adhesion strategy did not influence nanoleakage, but the rotary instrument did, with diamond rotary instruments resulting in lower values. SEM analyses showed a greater number of unobliterated tubules in the self-etch mode and a more regular surface when prepared with a diamond rotary.
To improve the adhesion of fiber posts to root canal, a diamond rotary instrument should be used, and generally, universal adhesive systems must be used in self-etch mode.
OBJECTIVES: Determine the relationship between a broad array of structure and process elements of nursing home care and (a) resident infection and (b) hospitalization for infection.
DESIGN: Baseline ...data were collected from September 1992 through March 1995, and residents were followed for 2 years; facility data were collected at the midpoint of follow‐up.
SETTING: A stratified random sample of 59 nursing homes across Maryland.
PARTICIPANTS: Two thousand fifteen new admissions aged 65 and older.
MEASUREMENTS: Facility‐level data were collected from interviews with facility administrators, directors of nursing, and activity directors; record ion; and direct observation. Main outcome measures included infection (written diagnosis, a course of antibiotic therapy, or radiographic confirmation of pneumonia) and hospitalization for infection (indicated on medical records).
RESULTS: The 2‐year rate of infection was 1.20 episodes per 100 resident days, and the hospitalization rate for infection was 0.17 admissions per 100 resident days. Except for registered nurse (RN) turnover, which related to both infection and hospitalization, different variables related to each outcome. High rates of incident infection were associated with more Medicare recipients, high levels of physical/occupational therapist staffing, high licensed practical nurse staffing, low nurses' aide staffing, high intensity of medical and therapeutic services, dementia training, staff privacy, and low levels of psychotropic medication use. High rates of hospitalization for infection were associated with for‐profit ownership, chain affiliation, poor environmental quality, lack of resident privacy, lack of administrative emphasis on staff satisfaction, and low family/friend visitation rates. Adjustment for resident sex, age, race, education, marital status, number of morbid diagnoses, functional status, and Resource Utilization Group, Version III score did not alter the relationship between the structure and process of care and outcomes.
CONCLUSIONS: The association between RN turnover and both outcomes underscores the relationship between nursing leadership and quality of care in these settings. The relationship between hospitalization for infection and for‐profit ownership and chain affiliation could reflect policies not to treat acute illnesses in house. The link between social factors of care (environmental quality, prioritizing staff satisfaction, resident privacy, and facility visitation) and hospitalization indicates that a nonmedical model of care may not jeopardize, and may in fact benefit, health‐related outcomes. All of these facility characteristics may be modifiable, may affect healthcare costs, and may hold promise for other, less‐medical, forms of residential long‐term care.
Aim
Novel minimally invasive techniques aimed to reposition the haemorrhoidal zone have been established for prolapsing haemorrhoids. We present a prospective randomized controlled trial to evaluate ...the efficacy of additional Doppler‐guided ligation of submucosal haemorrhoidal arteries (DG‐HAL) in patients with symptomatic Grade III haemorrhoids. The trial was registered as ClinicalTrials.gov identifier NCT02372981.
Method
All consecutive patients with symptomatic Grade III haemorrhoids were randomly allocated to one of the two study arms: (i) Group A, DG‐HAL with mucopexy or (ii) Group B, mucopexy alone. End‐points were postoperative pain, faecal incontinence, bleeding, residual prolapse and alterations of the vascularization of the anorectal vascular plexus. Vascularization of the anorectal vascular plexus was assessed by transperineal contrast enhanced ultrasound. Patients recorded their symptoms in a diary maintained for a month.
Results
Forty patients were recruited and randomized to the two study groups. Patients in Group A had less pain in the first two postoperative weeks. At the 12‐month follow‐up, two patients in Group A (10%) and one in Group B (5%) showed recurrent Grade III haemorrhoids (P = 0.274). No significant morphological changes were observed in the transperineal ultrasound findings between the preoperative assessment and the assessment at 1 and 6 months in either group (P > 0.05).
Conclusion
Mucopexy techniques for treating prolapsing haemorrhoids are effective, but DG‐HAL does not add significantly to the results achieved by mucopexy. Repositioning the haemorrhoidal zone is the key to success, and mucopexy should be placed at the sites of the largest visible prolapse.
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