Influence of Energy Balance on Reproductive Performance and Milk Production of Dairy Cows at Pre-partum and Early Lactation Periods

Abstract: The objective of this study was to evaluate the influence of energy balance in dairy cows at pre-partum and early lactation periods on their subsequent reproductive and productive performance. High producing, Ayrshire cows were randomly selected from the heavy pregnant, dry cow herd of Ambewela dairy farm in Up-Country, Sri Lanka. The serum NEFA (non esterifie fatty acid) and milk BHBA (beta hydroxyl butyric acid) concentrations were used as indicators of energy status of the cows. Days for the first AI, open days and conception rate were used to evaluate the reproductive performance. Sub-clinical ketosis (milk BHBA≥200 µmol/L) was recorded among 25 and 31.25% cows at 5 days pre-partum and during 100 days post-partum periods, respectively. Further, they took significantly longer period to reach the first AI and showed significantly greater (p<0.0001) open days compared to the cows those did not show signs of sub-clinical ketosis (milk BHBA<100 µmol/L) during the period. Cows those recorded≥200 µmol/L BHBA level in milk during the lactation period from 10 to 60 days took longest period for the first AI and had the highest open days. Only 36% cows were pregnant at 100 days post-partum. Further, none of the cows showed sub-clinical ketosis during 100 days post-partum was pregnant. They had higher circulating NEFA levels at 5 days pre-partum and 10 days post-partum periods and significantly lower (p<0.05) in milk production compared to their pregnant counterparts. This study indicated that the magnitude and duration of the prepartum energy status (i.e., negative energy balance) has a detrimental effect on subsequent reproductive and productive performances in high producing dairy cows

Practices and Perspectives in Cardiopulmonary Resuscitation Attempts and the Use of Do Not Attempt Resuscitation Orders: A Cross-sectional Survey in Sri Lanka.

Objective: The objective of this study is to describe the characteristics of in-hospital cardiopulmonary resuscitation (CPR) attempts, the perspectives of junior doctors involved in those attempts and the use of do not attempt resuscitation (DNAR) orders. Methods: A cross-sectional telephone survey aimed at intern doctors working in all medical/surgical wards in government hospitals. Interns were interviewed based on the above objective. Results: A total of 42 CPR attempts from 82 hospitals (338 wards) were reported, 3 of which were excluded as the participating doctor was unavailable for interview. 16 (4.7%) wards had at least 1 patient with an informal DNAR order. 42 deaths were reported. 8 deaths occurred without a known resuscitation attempt, of which 6 occurred on wards with an informal DNAR order in place. 39 resuscitations were attempted. Survival at 24 h was 2 (5.1%). In 5 (13%) attempts, CPR was the only intervention reported. On 25 (64%) occasions, doctors were "not at all" or "only a little bit surprised" by the arrest. Conclusions: CPR attempts before death in hospitals across Sri Lanka is prevalent. DNAR use remains uncommon

Is the 2015 eye care service delivery profile in Southeast Asia closer to universal eye health need!

Purpose: The year 2015 status of eye care service profile in Southeast Asia countries was compared with year 2010 data to determine the state of preparedness to achieve the World Health Organization global action plan 2019. Methods: Information was collected from the International Agency for Prevention of Blindness country chairs and from the recent PubMed referenced articles. The data included the following: blindness and low vision prevalence, national eye health policy, eye health expenses, presence of international non-governmental organizations, density of eye health personnel, and the cataract surgical rate and coverage. The last two key parameters were compared with year 2010 data. Results: Ten of 11 country chairs shared the information, and 28 PubMed referenced publications were assessed. The prevalence of blindness was lowest in Bhutan and highest in Timor-Leste. Cataract surgical rate was high in India and Sri Lanka. Cataract surgical coverage was high in Thailand and Sri Lanka. Despite increase in number of ophthalmologists in all countries (except Timor-Leste), the ratio of the population was adequate (1:100,000) only in 4 of 10 countries (Bhutan, India, Maldives and Thailand), but this did not benefit much due to unequal urban-rural divide. Conclusion: The midterm assessment suggests that all countries must design the current programs to effectively address both current and emerging causes of blindness. Capacity building and proportionate distribution of human resources for adequate rural reach along with poverty alleviation could be the keys to achieve the universal eye health by 2019. Keywords: Eye care delivery; Southeast Asia; Universal eye health

Comparison of Technical Efficiency and Socio-economic Status in Animal-crop Mixed Farming Systems in Dry Lowland Sri Lanka

Pre-tested, structured questionnaires covered management aspects, inputs, outputs, socio-economic situations and constraints in dairy farming among Semi-intensive (SIFS) and Extensive farming systems (EFS) in dry-lowland Sri Lanka. Parametric data were analyzed using two-tailed‘t’ and ‘Z’ tests, and non-parametric values were analyzed using Chi-square and Fisher’s extract tests. Cobb-Douglas model was used to calculate meta-frontier and system-specific frontiers. Returns in SIFS are lower than EFS. Labor costs are 91.72% and 87.26% in EFS and SIFS respectively. Counting family labor, SIFS has no comparative surplus. Excluding this, dairying is profitable even in SIFS. Dairying provides EFS family insurance where selling animals increases income. Discouragement of this in SIFS impacts negatively on sustainable income. Integration is comparatively minimal in EFS. Established with the best practices and technologies available, SIFS requires external resources to enhance efficiencies. If all EFS farmers achieved best farmer TE, output could increase by 45.09%. Similarly, SIFS output could increase by 57.08%. Farmer education and training programs contribute to improved production efficiency. Grassland scarcity and low productivity affect output adversely; poor veterinary and extension services are major constraints. Farmers consider dairying as profitable, which secures its future. Contrastingly, 35.19% of farmers believe it is low status, preferring professional jobs despite lower comparative incomes

Applicability of the APACHE II model to a lower middle income country

To determine the utility of APACHE II in a low-and middle-income (LMIC) setting and the implications of missing data.Patients meeting APACHE II inclusion criteria admitted to 18 ICUs in Sri Lanka over three consecutive months had data necessary for the calculation of APACHE II, probabilities prospectively extracted from case notes. APACHE II physiology score (APS), probabilities, Standardised (ICU) Mortality Ratio (SMR), discrimination (AUROC), and calibration (C-statistic) were calculated, both by imputing missing measurements with normal values and by Multiple Imputation using Chained Equations (MICE).From a total of 995 patients admitted during the study period, 736 had APACHE II probabilities calculated. Data availability for APS calculation ranged from 70.6% to 88.4% for bedside observations and 18.7% to 63.4% for invasive measurements. SMR (95% CI) was 1.27 (1.17, 1.40) and 0.46 (0.44, 0.49), AUROC (95% CI) was 0.70 (0.65, 0.76) and 0.74 (0.68, 0.80), and C-statistic was 68.8 and 156.6 for normal value imputation and MICE, respectively.An incomplete dataset confounds interpretation of prognostic model performance in LMICs, wherein imputation using normal values is not a suitable strategy. Improving data availability, researching imputation methods and developing setting-adapted and simpler prognostic models are warranted

Capacity building for critical care training delivery: Development and evaluation of the Network for Improving Critical care Skills Training (NICST) programme in Sri Lanka.

Objectives To deliver and evaluate a short critical care nurse training course whilst simultaneously building local training capacity. Research Methodology A multi-modal short course for critical care nursing skills was delivered in seven training blocks, from 06/2013-11/2014. Each training block included a Train the Trainer programme. The project was evaluated using Kirkpatrick’s Hierarchy of Learning. There was a graded hand over of responsibility for course delivery from overseas to local faculty between 2013 and 2014. Setting Sri Lanka Main Outcome Measures Participant learning assessed through pre/post course Multi-Choice Questionnaires. Results A total of 584 nurses and 29 faculty were trained. Participant feedback was consistently positive and each course demonstrated a significant increase (p ≤ 0.0001) in MCQ scores. There was no significant difference MCQ scores (p = 0.186) between overseas faculty led and local faculty led courses. Conclusions In a relatively short period, training with good educational outcomes was delivered to nearly 25% of the critical care nursing population in Sri Lanka whilst simultaneously building a local faculty of trainers. Through use of a structured Train the Trainer programme, course outcomes were maintained following the handover of training responsibility to Sri Lankan faculty. The focus on local capacity building increases the possibility of long term course sustainability</p

Capacity building for critical care training delivery: Development and evaluation of the Network for Improving Critical care Skills Training (NICST) programme in Sri Lanka.

Objectives To deliver and evaluate a short critical care nurse training course whilst simultaneously building local training capacity. Research Methodology A multi-modal short course for critical care nursing skills was delivered in seven training blocks, from 06/2013-11/2014. Each training block included a Train the Trainer programme. The project was evaluated using Kirkpatrick’s Hierarchy of Learning. There was a graded hand over of responsibility for course delivery from overseas to local faculty between 2013 and 2014. Setting Sri Lanka Main Outcome Measures Participant learning assessed through pre/post course Multi-Choice Questionnaires. Results A total of 584 nurses and 29 faculty were trained. Participant feedback was consistently positive and each course demonstrated a significant increase (p ≤ 0.0001) in MCQ scores. There was no significant difference MCQ scores (p = 0.186) between overseas faculty led and local faculty led courses. Conclusions In a relatively short period, training with good educational outcomes was delivered to nearly 25% of the critical care nursing population in Sri Lanka whilst simultaneously building a local faculty of trainers. Through use of a structured Train the Trainer programme, course outcomes were maintained following the handover of training responsibility to Sri Lankan faculty. The focus on local capacity building increases the possibility of long term course sustainability</p