The Dutch province of Limburg borders the German district of Heinsberg, which had a large cluster of COVID-19 cases linked to local carnival activities before any cases were reported in the ...Netherlands. However, Heinsberg was not included as an area reporting local or community transmission per the national case definition at the time. In early March, two residents from a long-term care facility (LTCF) in Sittard, a Dutch town located in close vicinity to the district of Heinsberg, tested positive for COVID-19. In this study we aimed to determine whether cross-border introduction of the virus took place by analysing the LTCF outbreak in Sittard, both epidemiologically and microbiologically.
Surveys and semi-structured oral interviews were conducted with all present LTCF residents by health care workers during regular points of care for information on new or unusual signs and symptoms of disease. Both throat and nasopharyngeal swabs were taken from residents suspect of COVID-19, based on regional criteria, for the detection of SARS-CoV-2 by Real-time Polymerase Chain Reaction. Additionally, whole genome sequencing was performed using a SARS-CoV-2 specific amplicon-based Nanopore sequencing approach. Moreover, twelve random residents were sampled for possible asymptomatic infections.
Out of 99 residents, 46 got tested for COVID-19. Out of the 46 tested residents, nineteen (41%) tested positive for COVID-19, including 3 asymptomatic residents. CT-values for asymptomatic residents seemed higher compared to symptomatic residents. Eleven samples were sequenced, along with three random samples from COVID-19 patients hospitalized in the regional hospital at the time of the LTCF outbreak. All samples were linked to COVID-19 cases from the cross-border region of Heinsberg, Germany.
Sequencing combined with epidemiological data was able to virtually prove cross-border transmission at the start of the Dutch COVID-19 epidemic. Our results highlight the need for cross-border collaboration and adjustment of national policy to emerging region-specific needs along borders in order to establish coordinated implementation of infection control measures to limit the spread of COVID-19.
To assess health and activities of daily living (ADL) in SARS-CoV-2-positive adults with and without post-COVID-19 condition (PCC) and compare this with negative tested individuals. Furthermore, ...different PCC case definitions were compared with SARS-CoV-2-negative individuals.
All adults tested PCR positive for SARS-CoV-2 at the Public Health Service South Limburg (Netherlands) between June 2020 and November 2021 (n=41 780) and matched PCR negative individuals (2:1, on age, sex, year-quarter test, municipality; n=19 875) were invited by email. Health (five-level EuroQol five-dimension (EQ5D) index and EuroQol visual analogue scale (EQVAS)) and ADL impairment were assessed. PCC classification was done using the WHO case definition and five other common definitions.
In total, 8409 individuals (6381 SARS-CoV-2 positive; 53±15 years; 57% female; 9 (7-11) months since test) were included. 39.4% of positives had PCC by the WHO case definition (EQVAS: 71±20; EQ5D index: 0.800±0.191; ADL impairment: 30 (10-70)%) and perceived worse health and more ADL impairment than negatives, that is, difference of -8.50 points (95% CI -9.71 to -7.29; p<0.001) for EQVAS, which decreased by 1.49 points (95% CI 0.86 to 2.12; p<0.001) in individuals with PCC for each comorbidity present, and differences of -0.065 points (95% CI -0.074 to -0.056; p<0.001) for EQ5D index, and +16.72% (95% CI 15.01 to 18.43; p<0.001) for ADL impairment. Health and ADL impairment were similar in negatives and positives without PCC. Replacing the WHO case definition with other PCC definitions yielded comparable results.
Individuals with PCC have substantially worse health and more ADL impairment than negative controls, irrespective of the case definition. Authorities should inform the public about the associated burden of PCC and enable adequate support.
Manure nitrogen (N) from cattle production facilities can lead to negative environmental effects, such as contribution to greenhouse gas emissions, leaching and runoff to aqueous ecosystems leading ...to eutrophication, and acid rain. To mitigate these effects and to improve the efficiency of N use, accurate prediction of N excretion and secretions are required. A genetic algorithm was implemented to select models to predict fecal, urinary, and total manure N excretions, and milk N secretions from 3 classes of animals: lactating dairy cows, heifers and dry cows, and steers. Two tiers of model classes were developed for each category of animals based on model input requirements. A total of 6 models for heifers and dry cows and steers and an additional 2 models for lactating dairy cattle were developed. Evaluation of the models using K-fold cross validation based on all data and using the most recent 6 yr of data showed better prediction for total manure N and fecal N compared with urinary N excretion, which was the most variable response in the database. Compared with extant models from the literature, the models developed in this study resulted in a significant improvement in prediction error for fecal and urinary N excretions from lactating cows. For total manure production by lactating cows, extant and new models were comparable in their prediction ability. Both proposed and extant models performed better than the prediction methods used by the US Environmental Protection Agency for the national inventory of greenhouse gases. Therefore, the proposed models are recommended for use in estimation of manure N from various classes of animals.
This study was designed to evaluate the effects of substituting corn grain with nonforage fiber sources in diets containing soybean meal (SBM) or canola meal (CM) as the primary protein source. ...Sixteen Holstein cows were assigned to a replicated 4 × 4 Latin square design with 4 periods of 28 d each. Treatments were arranged as a 2 × 2 factorial with 2 protein sources (SBM and CM) and 2 dietary starch concentrations (21 and 27% dry matter, DM). Diets were formulated to contain 16.5% CP, and the 21% starch diets were obtained by replacing corn grain with soybean hulls and beet pulp. Protein source × starch interactions were observed for DM intake (DMI), milk fat and protein concentrations, milk protein yield, milk urea nitrogen, and feed efficiency. Cows fed CM diets had a higher DMI when dietary starch concentration was 27% compared with 21%, but those cows had DMI similar to that of cows on SBM diets regardless of the starch concentration. Milk fat percentage was decreased in cows fed CM with 27% starch compared with cows fed CM with 21% starch and cows fed SBM with 27% starch. Milk protein percentage and yield and milk lactose percentage were least in cows fed CM with 21% starch compared with the other 3 diets, but feed efficiency was greater for cows fed CM with 21% starch. Milk urea nitrogen was least in cows fed CM with 27% starch compared with the other 3 diets. Cows fed diets with 27% starch produced 2.5 kg/d more milk and 1.9 kg/d more energy-corrected milk compared with cows fed 21% starch. Digestibility of DM and organic matter was higher in cows fed SBM diets than in cows on CM diets, and cows fed 27% starch showed greater DM and organic matter digestibility than cows on 21% starch. Digestibility of neutral detergent fiber and acid detergent fiber was greater in diets with SBM than in those with CM. Molar proportion of acetate was the lowest for cows fed CM with 21% starch compared with cows fed SBM with 21% starch, with the remaining cows fed being intermediate and similar. However, propionate was highest for cows fed CM with 21% starch than for cows fed SBM with 21% starch, but the remaining treatments were intermediate and similar. Isobutyrate was greater for cows fed CM with 21% starch, which resulted in the lowest acetate:propionate ratio compared with cows fed the remaining treatments. Overall, we confirmed that the interaction of protein with starch in CM diets can sustain similar cow performance as with the SBM diets. Those making decisions about starch concentration and protein source should consider feed price when SBM or CM and different starch levels are being formulated in diets for lactating dairy cows.
A blend of essential oils (EO; carvacrol, caryophyllene, -cymene, cineole, terpinene, and thymol) and prebiotics (arabinogalactans; Stay Strong; Ralco, Inc., Marshall, MN) was designed to promote ...immunity and stimulate appetite to diminish health challenges and stresses experienced by newborn calves. It was hypothesized that calves supplemented with the medium dose (2.5 g/feeding) of the commercial EO would demonstrate the optimal response. The study objective was to determine the optimal feeding rate of EO when added to a milk replacer (MR) compared with feeding a control or a yeast cell wall additive (YCW). One hundred Holstein calves from a commercial dairy farm were blocked by birth date and randomly assigned to 1 of 5 treatments. Treatments were a control (CON), a 24:20% CP:fat (as-fed basis) MR (24:20 MR) without EO; EO mixed into the 24:20 MR at a rate of 1.25 g/feeding (EO-0.5), EO mixed into the 24:20 MR at a rate of 2.5 g/feeding (EO-1.0), or EO mixed into the 24:20 MR at a rate of 3.75 g/feeding (EO-1.5); or 24:20 MR with YCW mixed in at a rate of 2 g/calf at each feeding. The 24:20 MR was fed in a bucket 2 times/d at a rate of 0.28 kg/calf daily for 14 d, which was increased to 0.43 kg/calf at 2 times/d until d 35 and then reduced to 1 time/d at d 36 to facilitate weaning at d 42. Decoquinate was added to the MR at 41.6 mg/kg for coccidiosis control. Calves were housed in individual hutches bedded with straw with ad libitum access to a 20% CP pelleted calf starter and water. All data were analyzed using PROC MIXED as a completely random design. Calves fed EO-0.5 demonstrated greater ( < 0.05) ADG (0.65, 0.71, 0.64, 0.64, and 0.63 kg/d for the CON, EO-0.5, EO-1.0, EO-1.5, and YCW, respectively) through d 56 compared with calves fed EO-1.0 and YCW and tended ( < 0.10) to have greater ADG than calves fed the CON and EO-1.5. Total BW gains were greater ( < 0.05) for calves fed EO-0.5 compared with calves fed EO-1.0 and YCW, with calves fed the CON and EO-1.5 being intermediate and similar. Body length and wither height gains (final - initial) were greater ( < 0.05) for calves fed EO-0.5 compared with calves fed the other treatments. Hip width gains were similar ( < 0.10) among treatments. Hip height gains were increased ( < 0.05) for calves fed EO-0.5 compared with calves fed the CON, EO-1.0, EO-1.5, and YCW. These results demonstrate that supplementing EO-0.5 (1.25 g/calf daily) in a 24:20 MR may be the optimal feeding rate to enhance growth rates compared with feeding a 24:20 MR and a 24:20 MR containing YCW or other inclusion rates of EO.
Background
Emergency abdominal surgery carries a high mortality, as patients are often frail with significant comorbidity. We aimed to evaluate the association between co‐existing ischaemic vascular ...disease (IVD) and long‐term mortality in patients undergoing emergency abdominal surgery.
Methods
We included adult emergency abdominal surgical patients operated on 13 Danish hospitals between 1 January 2009 and 31 December 2010. Appendectomies were excluded. Data were retrieved from the National Patient Registry (NPR) and the Danish Anaesthesia Database. Preoperative IVD status was retrieved from NPR. We used crude and adjusted Cox regression analysis. The primary outcome was mortality within eight years. The secondary outcome was mortality within 30 days.
Results
We included 4864 patients, of which 2584 (53.7%) died within 8 years. Some 20.9% (1019/4864) had preoperative IVD. The adjusted association between preoperative IVD and mortality within 8 years was hazard ratio (HR) 1.10 (95% confidence interval CI, 1.00‐1.20; P = .045). At 30 days, this association was HR 0.97 (95% CI, 0.84‐1.13).
Conclusion
In adult major emergency abdominal surgical patients, preoperative IVD was prevalent and associated with a 10% relative increase in long‐term mortality, but not in short‐term mortality.
Feeding N in excess of requirement could require the use of additional energy to metabolize excess protein, and to synthesize and excrete urea; however, the amount and fate of this energy is unknown. ...Little progress has been made on this topic in recent decades, so an extension of work published in 1970 was conducted to quantify the effect of excess N on ruminant energetics. In part 1 of this study, the results of previous work were replicated using a simple linear regression to estimate the effect of excess N on energy balance. In part 2, mixed model methodology and a larger data set were used to improve upon the previously reported linear regression methods. In part 3, heat production, retained energy, and milk energy replaced the composite energy balance variable previously proposed as the dependent variable to narrow the effect of excess N. In addition, rumen degradable and undegradable protein intakes were estimated using table values and included as covariates in part 3. Excess N had opposite and approximately equal effects on heat production (+4.1 to +7.6 kcal/g of excess N) and retained energy (−4.2 to −6.6 kcal/g of excess N) but had a larger negative effect on milk gross energy (−52 to −68 kcal/g of excess N). The results suggest that feeding excess N increases heat production, but more investigation is required to determine why excess N has such a large effect on milk gross energy production.
Breakthrough SARS-CoV-2 infections have been reported in fully vaccinated individuals, in spite of the high efficacy of the currently available vaccines, proven in trials and real-world studies. ...Several variants of concern (VOC) have been proffered to be associated with breakthrough infections following immunization. In this study, we investigated 378 breakthrough infections recorded between January and July 2021 and compared the distribution of SARS-CoV-2 genotypes identified in 225 fully vaccinated individuals to the frequency of circulating community lineages in the region of South Limburg (The Netherlands) in a week-by-week comparison. Although the proportion of breakthrough infections was relatively low and stable when the Alpha variant was predominant, the rapid emergence of the Delta variant lead to a strong increase in breakthrough infections, with a higher relative proportion of individuals vaccinated with Vaxzevria or Jcovden being infected compared to those immunized with mRNA-based vaccines. A significant difference in median age was observed when comparing fully vaccinated individuals with severe symptoms (83 years) to asymptomatic cases (46.5 years) or individuals with mild-to-moderate symptoms (42 years). There was no association between SARS-CoV-2 genotype or vaccine type and disease symptoms. Furthermore, the majority of adaptive mutations were concentrated in the N-terminal domain of the Spike protein, highlighting its role in immune evasion. Interestingly, symptomatic individuals harbored significantly higher SARS-CoV-2 loads than asymptomatic vaccinated individuals and breakthrough infections caused by the Delta variant were associated with increased viral loads compared to those caused by the Alpha variant. In addition, we investigated the role of the Omicron variant in causing breakthrough infections by analyzing 135 samples that were randomly selected for genomic surveillance during the transition period from Delta to Omicron. We found that the proportion of Omicron vs. Delta infections was significantly higher in individuals who received a booster vaccine compared to both unvaccinated and fully vaccinated individuals. Altogether, these results indicate that the emergence of the Delta variant and in particular Omicron has lowered the efficiency of particular vaccine types to prevent SARS-CoV-2 infections and that, although rare, the elderly are particularly at risk of becoming severely infected as the consequence of a breakthrough infection.
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