Effect of fiber inclusion in the rearing diets and energy concentration of the laying diets on productive performance and egg quality of brown egg-laying hens from 18 to 46 weeks of age

Una práctica común para mejorar el consumo de alimento en gallinas jóvenes al inicio de la puesta consiste en aumentar el contenido de fibra de las dietas de recría. La inclusión de fibra podría favorecer la adaptación del tracto gastrointestinal (TGI) del ave para tener un mayor consumo durante la fase de puesta, lo que puede mejorar la productividad de las gallinas. El diseño experimental fue completamente al azar con un modelo factorial con 12 tratamientos con 6 dietas en la fase de recría (0-17semanas) y 2 dietas en la fase de puesta (17-46 semanas). Dos de las dietas de la fase de recría se basaron en cebada o maíz y las 4 dietas restantes se agruparon en un modelo factorial 2x2 con 2 fuentes de fibra (paja y pulpa de remolacha) incluidas a niveles de 2 ó 4% en la dieta a base de maíz. En la fase de puesta, la mitad de las pollitas de estos 6 tratamientos se alimentaron con dietas con 2.650 kcal AMEn / kg y la otra mitad con 2.750 kcal AMEn / kg, con el mismo contenido de nutrientes por unidad de energía. No se encontraron interacciones entre las dietas de fase de recría y las de fase de puesta. El tipo de dieta en la fase de recría no afectó a la productividad de las gallinas o al peso relativo (% peso vivo) del TGI, el pH del contenido de la molleja, o la longitud relativa de las gallinas (cm / kg de peso vivo) o del intestino delgado. Las gallinas alimentadas con la dieta alta en energía durante la fase de puesta comieron menos alimento (P <0,001), pero presentaron mejor índice de conversión (P <0,01) y una mayor ganancia de peso (P <0.05) que las gallinas alimentadas con la dieta baja en energía. La calidad del huevo no se vio afectada por el tratamiento a excepción de la incidencia de huevos sucios, que fue mayor (P <0,001) para la dieta baja en energía. En conclusión, ni el tipo de cereal ni la inclusión de fuentes de fibra en las dietas de recría, afectaron al desarrollo del TGI ni a la producción de las gallinas a 46 semanas de edad. Además, el uso de dietas de alta energía durante la fase de puesta reduce el consumo medio diario y mejora el índice de conversión, sin afectar a la producción de huevos o al peso del huevo

The impact of verbal encouragement during the repeated agility speed training on internal intensity, mood state, and physical enjoyment in youth soccer players

Objective: Verbal encouragement (VE) can be used by coaches to boost morale and commitment during training exercises. This investigation aimed to study the impacts of VE given by coaches on the physiological aspects, players' internal intensity, mood, and perceived enjoyment of youth soccer players during repeated agility speed training (RAS). Methods: A total of 17 male youth soccer players (mean +/- SD; age: 13.8 +/- 0.4 years; body mass: 59.1 +/- 6.7 kg; height: 170.0 +/- 6.2 cm; training experience: 5.1 +/- 0.7 years) participated, in a randomized order, in two experimental training sessions that consisted of a RAS (i.e., the Illinois course) either with VE (RAS-E) or without VE (RAS-NE), with a 7-day interval between the testing sessions. Heart rate (HR) was registered throughout the exercise. The rating of perceived exertion, blood lactate concentration [La], and perceived enjoyment were measured after each training session. The mood state was recorded before and after each protocol. Results: HR mean (Cohen's coefficient d = 0.45, small), %HRmax (d = 0.37, small), HR peak (d = 0.66, moderate), [La] (d = 0.56, small), and the PACES score (d = 2.8, very large) were higher in RAS-E compared to RAS-NE (all, P < 0.001). Compared to the RAS-E trial, the RAS-NE trial showed higher fatigue (P < 0.01), tension (P < 0.05), anger (0.05), total mood score (P < 0.001), and lower vigor (P < 0.001). Conclusion: Coaches may use VE during RAS to improve psychophysiological responses, mood state, and perceived enjoyment in youth soccer players

The impact of verbal encouragement during the repeated agility speed training on internal intensity, mood state, and physical enjoyment in youth soccer players

OBJECTIVE Verbal encouragement (VE) can be used by coaches to boost morale and commitment during training exercises. This investigation aimed to study the impacts of VE given by coaches on the physiological aspects, players' internal intensity, mood, and perceived enjoyment of youth soccer players during repeated agility speed training (RAS). METHODS A total of 17 male youth soccer players (mean ± SD; age: 13.8 ± 0.4 years; body mass: 59.1 ± 6.7 kg; height: 170.0 ± 6.2 cm; training experience: 5.1 ± 0.7 years) participated, in a randomized order, in two experimental training sessions that consisted of a RAS (i.e., the Illinois course) either with VE (RAS-E) or without VE (RAS-NE), with a 7-day interval between the testing sessions. Heart rate (HR) was registered throughout the exercise. The rating of perceived exertion, blood lactate concentration [La], and perceived enjoyment were measured after each training session. The mood state was recorded before and after each protocol. RESULTS HR mean (Cohen's coefficient d = 0.45, small), %HRmax (d = 0.37, small), HR peak (d = 0.66, moderate), [La] (d = 0.56, small), and the PACES score (d = 2.8, very large) were higher in RAS-E compared to RAS-NE (all, P < 0.001). Compared to the RAS-E trial, the RAS-NE trial showed higher fatigue (P < 0.01), tension (P < 0.05), anger (0.05), total mood score (P < 0.001), and lower vigor (P < 0.001). CONCLUSION Coaches may use VE during RAS to improve psychophysiological responses, mood state, and perceived enjoyment in youth soccer players

The impact of verbal encouragement during the repeated agility speed training on internal intensity, mood state, and physical enjoyment in youth soccer players

ObjectiveVerbal encouragement (VE) can be used by coaches to boost morale and commitment during training exercises. This investigation aimed to study the impacts of VE given by coaches on the physiological aspects, players' internal intensity, mood, and perceived enjoyment of youth soccer players during repeated agility speed training (RAS).MethodsA total of 17 male youth soccer players (mean ± SD; age: 13.8 ± 0.4 years; body mass: 59.1 ± 6.7 kg; height: 170.0 ± 6.2 cm; training experience: 5.1 ± 0.7 years) participated, in a randomized order, in two experimental training sessions that consisted of a RAS (i.e., the Illinois course) either with VE (RAS-E) or without VE (RAS-NE), with a 7-day interval between the testing sessions. Heart rate (HR) was registered throughout the exercise. The rating of perceived exertion, blood lactate concentration [La], and perceived enjoyment were measured after each training session. The mood state was recorded before and after each protocol.ResultsHR mean (Cohen's coefficient d = 0.45, small), %HRmax (d = 0.37, small), HR peak (d = 0.66, moderate), [La] (d = 0.56, small), and the PACES score (d = 2.8, very large) were higher in RAS-E compared to RAS-NE (all, P &lt; 0.001). Compared to the RAS-E trial, the RAS-NE trial showed higher fatigue (P &lt; 0.01), tension (P &lt; 0.05), anger (0.05), total mood score (P &lt; 0.001), and lower vigor (P &lt; 0.001).ConclusionCoaches may use VE during RAS to improve psychophysiological responses, mood state, and perceived enjoyment in youth soccer players

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone