Učinkovitost zatvaranja sisnih kanala kao prevencija novih intramamarnih infekcija u mliječnih krava tijekom suhostaja

The aim of our study was to evaluate the effect of an internal teat sealant infused upon drying off on the incidence of new intra-mammary infections (IMI) during the dry period in dairy cattle. Due to the non-availability of the product on the Indian market, the product was prepared in a laboratory using bismuth subnitrate and liquid paraffin. A total of 64 quarters free from infection on culture were selected for the study at 60 days before the expected date of parturition. The quarters were randomly divided into two groups (group A and group B), with 32 quarters in each group. The group A quarters were infused with teat sealant at the time of drying off, and the quarters in group B were kept as the control and no treatment was provided to them. Milk samples from all the selected quarters were subjected to cultural examination at the time of drying off and 1-3 days post calving. The incidence of new IMI’s between drying off and calving was significantly lower for group A quarters when compared to group B quarters (12.5% vs 34.4%). The incidence of new IMI’s in group A and group B quarters was significantly lower for Streptococcus uberis (3.13% vs 18.75%) and Streptococcus dysgalactiae (3.13% vs 12.5%). The study concluded that infusion of teat sealant at drying off is helpful in lowering the incidence of new IMI’s during the dry period.Cilj ovog istraživanja bio je procijeniti učinak zatvaranja sisnih kanala na incidenciju infekcija vimena (IMI) mliječnih krava za vrijeme suhostaja. Zbog nedostupnosti komercijalnih preparata na indijskom tržištu, proizvod za zatvaranje sisnih kanala je pripravljen u laboratoriju upotrebom bizmut-subnitrata i tekućeg parafina. Za istraživanje su odabrane 64 četvrti vimena u kojima bakteriološkom kulturom nije bilo utvrđene infekcije 60 dana prije očekivanog teljenja. Četvrti su nasumično podijeljene u dvije skupine (skupina A i skupina B) sa po 32 četvrti u svakoj skupini. U skupini A, tijekom suhostaja, kravama su zatvoreni sisni kanali, dok u kontrolnoj skupini B nije proveden nikakav tretman. Uzorci mlijeka iz svih skupina podvrgnuti su testiranju bakteriološkom kulturom u vrijeme suhostaja i 1 – 3 dana poslije teljenja. Incidencija intramamarnih infekcija između suhostaja i teljenja bila je znakovito niža u skupini A u usporedbi sa skupinom B (12,5 % prema 34,4 %). Incidencija novih intramamarnih infekcija u skupinama A i B bila je znakovito niža za Streptococcus uberis (3,13 % prema 18,75 %) i Streptococcus dysgalactiae (3,13 % prema 12,5 %). Rezultati istraživanja pokazuju da zatvaranje sisnih kanala u suhostaju pomaže u smanjivanju incidencije novih intramamarnih infekcija

Preference of farmers towards private and public extension services

The main purpose of this study was to know the preference of farmers for different services provided by private and public extension agencies. In recent times involvement of private extension agencies has been increased in agricultural sector and up to some extent it has sidelined the public extension agencies, but public extension agencies have potential to do better and to reach farmers at their best. In view of this, present study was undertaken to find out the farmers’ preference towards public and private extension services in Ambala, Kurukshetra, Karnal, Hisar and Fatehabad districts of Haryana state. From each district two blocks were selected randomly and from each block two villages were selected. A manageable size of 10 farmers was selected from each village thus making total sample size of 200 farmers. Various aspects related to agricultural services provided by both public and private agencies were identified and response were obtained by putting a tick mark as per farmers’ preference for private and public agencies. On the basis of statistical tools like rank and mean score, results showed that farmers had great preference for ‘Input supply’ in private extension as compared to public extension followed by ‘Infrastructure facilities’. While for ‘Consultancy and diagnosis services’, ‘Information’ and ‘Technical services’, public extension was preferred as over the private extension

SToRytelling to Improve Disease outcomes in Gout (STRIDE-GO): A multicenter, randomized controlled trial in African American veterans with gout

BACKGROUND: Urate-lowering therapy (ULT) adherence is low in gout, and few, if any, effective, low-cost, interventions are available. Our objective was to assess if a culturally appropriate gout-storytelling intervention is superior to an attention control for improving gout outcomes in African-Americans (AAs). METHODS: In a 1-year, multicenter, randomized controlled trial, AA veterans with gout were randomized to gout-storytelling intervention vs. a stress reduction video (attention control group; 1:1 ratio). The primary outcome was ULT adherence measured with MEMSCap™, an electronic monitoring system that objectively measured ULT medication adherence. RESULTS: The 306 male AA veterans with gout who met the eligibility criteria were randomized to the gout-storytelling intervention (n = 152) or stress reduction video (n = 154); 261/306 (85%) completed the 1-year study. The mean age was 64 years, body mass index was 33 kg/m CONCLUSIONS: A culturally appropriate gout-storytelling intervention was not superior to attention control for improving gout outcomes in AAs with gout. TRIAL REGISTRATION: Registered at ClinicalTrials.gov NCT02741700

Mediation of smoking-associated postoperative mortality by perioperative complications in veterans undergoing elective surgery: data from Veterans Affairs Surgical Quality Improvement Program (VASQIP)--a cohort study

OBJECTIVE: To assess the mediation of smoking-associated postoperative mortality by postoperative complications. DESIGN: Observational cohort study. SETTING: Using data from the Veterans Affairs (VA) Surgical Quality Improvement Programme, a quality assurance programme for major surgical procedures in the VA healthcare system, we assessed the association of current smoking at the time of the surgery with 6-month and 1-year mortality. PRIMARY AND SECONDARY OUTCOME MEASURES: Using mediation analyses, we calculated the relative contribution of each smoking-associated complication to smoking-associated postoperative mortality, both unadjusted and adjusted for age, race/ethnicity, work relative value unit of the operation, surgeon specialty, American Society of Anesthesiologists class and year of surgery. Smoking-associated complications included surgical site infection (SSI), cardiovascular complications (myocardial infarction, cardiac arrest and/or stroke) and pulmonary complications (pneumonia, failure to wean and/or reintubation). RESULTS: There were 186 632 never smokers and 135 741 current smokers. The association of smoking and mortality was mediated by smoking-related complications with varying effects. In unadjusted analyses, the proportions of mediation of smoking to 6-month mortality explained by the complications were as follows: SSIs 22%, cardiovascular complications 12% and pulmonary complications 89%. In adjusted analyses, the per cents mediated by each complication were as follows: SSIs 2%, cardiovascular complications 4% and pulmonary complications 22%. In adjusted analyses for 1-year mortality, respective per cents mediated were 2%, 3% and 16%. CONCLUSIONS: Pulmonary complications, followed by cardiovascular complications and SSIs were mediators of smoking-associated 6-month and 1-year mortality. Interventions targeting smoking cessation and prevention and early treatment of pulmonary complications has the likelihood of reducing postoperative mortality after elective surgery

Development of the American College of Rheumatology Electronic Clinical Quality Measures for Gout

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143639/1/acr23500.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143639/2/acr23500-sup-0001-AppendixS1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143639/3/acr23500_am.pd

Individualized decision aid for diverse women with lupus nephritis (IDEA-WON): A randomized controlled trial.

BackgroundTreatment decision-making regarding immunosuppressive therapy is challenging for individuals with lupus. We assessed the effectiveness of a decision aid for immunosuppressive therapy in lupus nephritis.Methods and findingsIn a United States multicenter, open-label, randomized controlled trial (RCT), adult women with lupus nephritis, mostly from racial/ethnic minority backgrounds with low socioeconomic status (SES), seen in in- or outpatient settings, were randomized to an individualized, culturally tailored, computerized decision aid versus American College of Rheumatology (ACR) lupus pamphlet (1:1 ratio), using computer-generated randomization. We hypothesized that the co-primary outcomes of decisional conflict and informed choice regarding immunosuppressive medications would improve more in the decision aid group. Of 301 randomized women, 298 were analyzed; 47% were African-American, 26% Hispanic, and 15% white. Mean age (standard deviation [SD]) was 37 (12) years, 57% had annual income of <$40,000, and 36% had a high school education or less. Compared with the provision of the ACR lupus pamphlet (n = 147), participants randomized to the decision aid (n = 151) had (1) a clinically meaningful and statistically significant reduction in decisional conflict, 21.8 (standard error [SE], 2.5) versus 12.7 (SE, 2.0; p = 0.005) and (2) no difference in informed choice in the main analysis, 41% versus 31% (p = 0.08), but clinically meaningful and statistically significant difference in sensitivity analysis (net values for immunosuppressives positive [in favor] versus negative [against]), 50% versus 35% (p = 0.006). Unresolved decisional conflict was lower in the decision aid versus pamphlet groups, 22% versus 44% (p < 0.001). Significantly more patients in the decision aid versus pamphlet group rated information to be excellent for understanding lupus nephritis (49% versus 33%), risk factors (43% versus 27%), medication options (50% versus 33%; p ≤ 0.003 for all); and the ease of use of materials was higher in the decision aid versus pamphlet groups (51% versus 38%; p = 0.006). Key study limitations were the exclusion of men, short follow-up, and the lack of clinical outcomes, including medication adherence.ConclusionsAn individualized decision aid was more effective than usual care in reducing decisional conflict for choice of immunosuppressive medications in women with lupus nephritis.Trial registrationClinicaltrials.gov, NCT02319525

Defining the optimal biological monotherapy in rheumatoid arthritis: a systematic review and meta-analysis of randomised trials

Objectives To summarize and compare the benefits and harms of biological agents used as monotherapy for rheumatoid arthritis (RA) in order to inform decisions for patients who are intolerant to conventional DMARD therapy. Methods We searched MEDLINE, EMBASE, CENTRAL, and other sources for randomised trials that compared biological monotherapy with methotrexate, placebo, or other biological monotherapies. Primary outcomes were ACR50 and the number of patients who discontinued due to adverse events. Our network meta-analysis was based on mixed-effects logistic regression, including both direct and indirect comparisons of the treatment effects, while preserving the randomised comparisons within each trial. PROSPERO identifier: CRD42012002800. Results The analysis comprises 28 trials (8602 patients), including all nine biological agents approved for RA. Eight trials included “DMARD-naïve”, and 20 “DMARD-Inadequate responder” (DMARD-IR) patients. All agents except anakinra and infliximab were superior (p 0.52). However, because rituximab was evaluated in just 40 patients, our confidence in the estimates is limited. When including only DMARD-IR trials, the same statistical pattern emerged; in addition etanercept and tocilizumab were superior to abatacept. At recommended doses, both etanercept and tocilizumab were superior to adalimumab and certolizumab. No statistically significant differences among biological agents were found with respect to discontinuation due to adverse events (p > 0.068). Conclusions Evidence from randomised trials suggests that most biological agents are effective as monotherapy. Although our confidence in the estimates is limited, etanercept or tocilizumab may be the optimal choice for most patients who need treatment with biological monotherapy. However, given our limited confidence in the estimates including possibility of bias, it is appropriate to strongly weight patients׳ preferences and values in the final treatment choice