Periparturient and early lactation performance and metabolism of replacement Holstein-Friesian heifers out-wintered on fodder beet or perennial ryegrass compared with winter housing

The effect of winter feeding system on the periparturient performance and early milk production and metabolism of pregnant Holstein‐Friesian dairy heifers destined for a high‐output, total mixed ration (TMR)‐based system was examined. Forty‐eight, 23 ± 0.4‐month‐old, in‐calf Holstein‐Friesian heifers were assigned to one of three treatments: out‐wintered on perennial ryegrass and grass silage (G), out‐wintered on fodder beet and grass silage (F) or housed and fed grass silage and concentrate (H). The study commenced in November 2013, with heifers on treatment for 91 days, housed from 6 weeks prior to parturition and fed a dry cow TMR. Postpartum performance and metabolism were monitored for 12 weeks. Prepartum, average daily gain was lower in heifers receiving G at 0.95 kg d−1 cow−1 than F or H (1.24 and 1.11 kg d−1 cow−1 respectively). Body condition score of heifers that received G was also lower compared with treatments F or H both pre‐ and postpartum. Prepartum, plasma β‐hydroxybutyrate concentrations were lowest in animals receiving treatment H, highest in F and intermediate in G, but did not differ between treatment postpartum. Milk yield averaged 30.7 kg d−1 cow−1 and was not affected by treatment, but milk fat content was lowest in animals that received F (35.4, 37.1 and 37.9 g/kg for F, G and H respectively). The results indicate that out‐wintering in‐calf dairy heifers on fodder beet or perennial ryegrass is a viable alternative to winter housing in high‐output TMR‐based milk production systems in a temperate region

Commercial practice of out-wintering dairy heifers in Great Britain

The majority of dairy cattle in Great Britain (GB) are housed during winter but replacement heifers are out-wintered on some farms, a practice that may reduce the need for high capital-cost housing and facilitate herd expansion. Dairy farmers that were out-wintering replacement heifers in GB in 2012 were surveyed to determine current practice and attitudes. A typical system involved heifers strip grazing pasture or a crop, with baled grass silage as supplementary feed; strongly resembling outdoor wintering systems in New Zealand. Many used more than one grazed forage; predominantly, pasture on 68%, kale on 53% and fodder beet on 33% of farms. Supplementary feed was 44% of the diet in younger, and 35% in older heifers. Although farms were approximately three times larger than the national average and 60% were expanding, expanding herd size was not the primary reason for out-wintering, with the main reasons being to reduce cost and improve animal health and welfare. Farmers that out-wintered heifers typically reported good animal average dairy gain of 0.6 kg/d and high body condition, however, this contrasts with some measured performance in GB. Farmers may benefit from accurate feed allocation and monitoring heifer live weight during winter to ensure high performance

Mineral status, metabolism and performance of dairy heifers receiving a combined trace element bolus and out-wintered on perennial ryegrass, kale or fodder beet

The effects of a cobalt (Co), copper (Cu), selenium (Se), and iodine (I) trace-mineral ruminal bolus on the mineral status and performance of out-wintered, pregnant dairy heifers was investigated. Nine commercial farms grazing pasture (G), kale (K), or fodder beet (F) were used (n=3 per forage), with forty heifers on each farm randomly allocated to not receive (B-) or receive (B+) two combined mineral boluses. Mean plasma Co concentrations were 0.021 and 0.041 µmol/L in B- and B+ respectively (p 0.05), however condition score was higher (p < 0.05) in B+ at the end of the study. It is concluded that the provision of a trace mineral bolus increased plasma concentrations of the minerals supplied, with the greatest benefits in animals grazing kale, but these increases were not translated into improved performance

Performance, milk fatty acid composition and behaviour of high-yielding Holstein dairy cows given a limited grazing period

The effects of a limited grazing period on the performance, behaviour and milk composition of high‐yielding dairy cows were examined. A total of 56 Holstein cows yielding 44.7 ± 0.42 kg/day were allocated to one of four treatments in one of two, 4‐week periods. Treatments were as follows: control (C)—cows housed and offered TMR ad libitum; early grazing (EG)—cows grazed for 6 hr after morning milking then housed; delayed grazing (DG)—cows returned to housing for 1 hr after morning milking followed by grazing for 6 hr, then housed; restricted TMR (RT)—cows grazed for 6 hr after morning milking, then housed and fed TMR at 75% of ad libitum. Intake of TMR was highest in cows receiving C, intermediate in EG and DG, and lowest in RT at 26.9, 23.6, 24.7 and 20.3 kg DM/day respectively. Pasture intake was similar in cows receiving EG or DG, but was higher in RT at 2.4, 2.0 and 3.5 kg DM/day respectively. Milk yield was similar between cows receiving C, EG or DG, but lowest in RT at 45.7, 44.2, 44.9 and 41.7 kg/cow, respectively, while milk fat content of C18:3 n‐3 was increased by grazing. Cows in C spent more than 55 min/day longer lying and had three additional lying bouts/day, while lying bouts were shorter than for cows receiving EG, RT or DG. It is concluded that high‐yielding cows can be grazed for 6 hr/day with little impact on performance, provided TMR is available ad libitum when housed

Applying the Behavior Change Technique Taxonomy to Four Multicomponent Childhood Obesity Interventions

Applying the Behavior Change Technique Taxonomy has the potential to facilitate identification of effective childhood obesity intervention components. This article evaluates the feasibility of coding Childhood Obesity Prevention and Treatment Consortium interventions and compares reliability between external taxonomy-familiar coders and internal intervention-familiar coders. After training, coder pairs independently coded prespecified portions of intervention materials. An adjudication process was used to explore coding discrepancies. Reliability between internal and external coders was moderate (prevalence and bias-adjusted kappa.38 to.55). Reliability for specific target behaviors varied with substantial agreement for physical activity (.63 to.76) and moderate for dietary intake (.44 to.63). Applying the taxonomy to these interventions was feasible, but agreement was modest. Coding discrepancies highlight the importance of refining coding to capture the complexities of childhood obesity interventions, which often engage multiple recipients (e.g., parents and/or children) and address multiple behaviors (e.g., diet, physical activity, screen time)

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods: We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings: Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation: Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding: Bill & Melinda Gates Foundation

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries