Caudal cervical vertebral morphological variation is not associated with clinical signs in Warmblood horses

Background Variation in equine caudal cervical spine morphology at C6 and C7 has high prevalence in Warmblood horses and is suspected to be associated with pain in a large mixed-breed group of horses. At present no data exist on the relationship between radiographic phenotype and clinical presentation in Warmblood horses in a case-control study. Objectives To establish the frequency of radiographically visible morphologic variation in a large group of Warmblood horses with clinical signs and compare this with a group without clinical signs. We hypothesised that occurrence of morphologic variation in the case group would not differ from the control group, indicating there is no association between clinical signs and morphologic variation. Study design Retrospective case-control. Methods Radiographic presence or absence of morphologic variation of cervical vertebrae C6 and C7 was recorded in case (n = 245) and control horses (n = 132). Case and control groups were compared by univariable Pearson's Chi-square and multivariable logistic regression for measurement variables age, sex, breed, degenerative joint disease and morphologic variation at C6 and C7. Odds ratio and confidence intervals were obtained. A P <= 0.05 was considered statistically significant. Results Morphologic variation at C6 and C7 (n = 108/377 = 28.6%; Cases 58/245 = 23.7%; Control 50/132 = 38%) was less frequent in horses with clinical signs in univariable testing (OR 0.48, 95% CI 0.3-0.8, P = 0.001). Age, sex, breed and degenerative joint disease were not retained in the final multivariable logistic regression step whereas morphologic variation remained significantly less present in horses with clinical signs. Main limitations Possible demographic differences between equine clinics. Conclusions Morphologic variation in the caudal cervical spine was detected more frequently in horses without clinical signs. Therefore, radiographic presence of such variation does not necessarily implicate the presence of clinical signs

Social health is associated with tract-specific brain white matter microstructure in community-dwelling older adults

Background Poor social health has been linked to a risk of neuropsychiatric disorders. Neuroimaging studies have shown associations between social health and global white matter microstructural integrity. We aimed to identify which white matter tracts are involved in these associations. Methods Social health markers (loneliness, perceived social support, and partnership status) and white matter microstructural integrity of 15 white matter tracts (identified with probabilistic tractography after diffusion magnetic resonance imaging) were collected for 3352 participants (mean age 58.4 years, 54.9% female) from 2002 to 2008 in the Rotterdam Study. Cross-sectional associations were studied using multivariable linear regression. Results Loneliness was associated with higher mean diffusivity (MD) in the superior thalamic radiation and the parahippocampal part of the cingulum (standardized mean difference for both tracts: 0.21, 95% CI, 0.09 to 0.34). Better perceived social support was associated with lower MD in the forceps minor (standardized mean difference per point increase in social support: −0.06, 95% CI, −0.09 to −0.03), inferior fronto-occipital fasciculus, and uncinate fasciculus. In male participants, better perceived social support was associated with lower MD in the forceps minor, and not having a partner was associated with lower fractional anisotropy in the forceps minor. Loneliness was associated with higher MD in the superior thalamic radiation in female participants only. Conclusions Social health was associated with tract-specific white matter microstructure. Loneliness was associated with lower integrity of limbic and sensorimotor tracts, whereas better perceived social support was associated with higher integrity of association and commissural tracts, indicating that social health domains involve distinct neural pathways of the brain

Importafhankelijkheid van de varkensvlees- en aardappelindustrie

In dit rapport wordt een analyse gemaakt van de varkensvleessector. De keten wordt beschreven, ontwikkelingen in handelsstromen worden geschetst en besproken wordt hoe deze ontwikkelingen moeten worden bezien in het licht van de concurrentiekracht van de Nederlandse sector. Een soortgelijke analyse wordt ook gemaakt voor de consumptieaardappelsector: de keten wordt beschreven en handelsstromen worden in kaart gebracht. Verder wordt de rol van de verwerkende industrie belicht. Tevens wordt een interpretatie gegeven van de relatie tussen de ontwikkelingen in de handelsstromen en de Nederlandse concurrentiepositi

Increased gravitational force reveals the mechanical, resonant nature of physiological tremor

Human physiological hand tremor has a resonant component. Proof of this is that its frequency can be modified by adding mass. However, adding mass also increases the load which must be supported. The necessary force requires muscular contraction which will change motor output and is likely to increase limb stiffness. The increased stiffness will partly offset the effect of the increased mass and this can lead to the erroneous conclusion that factors other than resonance are involved in determining tremor frequency. Using a human centrifuge to increase head-to-foot gravitational field strength, we were able to control for the increased effort by increasing force without changing mass. This revealed that the peak frequency of human hand tremor is 99% predictable on the basis of a resonant mechanism. We ask what, if anything, the peak frequency of physiological tremor can reveal about the operation of the nervous system.This work was funded by a BBSRC Industry Interchange Award to J.P.R.S. and R.F.R. C.J.O. was funded by BBSRC grant BB/I00579X/1. C.A.V. was funded by A∗Midex (Aix-Marseille Initiative of Excellence

'Unbearable suffering': a qualitative study on the perspectives of patients who request assistance in dying

BACKGROUND One of the objectives of medicine is to relieve patients' suffering. As a consequence, it is important to understand patients' perspectives of suffering and their ability to cope. However, there is poor insight into what determines their suffering and their ability to bear it. PURPOSE To explore the constituent elements of suffering of patients who explicitly request euthanasia or physician-assisted suicide (EAS) and to better understand unbearable suffering from the patients' perspective. PATIENTS AND METHODS A qualitative study using in-depth face-to-face interviews was conducted with 31 patients who had requested EAS. The grounded theory approach was used to analyse the data. RESULTS Medical, psycho-emotional, socio-environmental and existential themes contributed to suffering. Especially fatigue, pain, decline, negative feelings, loss of self, fear of future suffering, dependency, loss of autonomy, being worn out, being a burden, loneliness, loss of all that makes life worth living, hopelessness, pointlessness and being tired of living were constituent elements of unbearable suffering. Only patients with a psychiatric (co)diagnosis suffered unbearably all the time. CONCLUSIONS Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become 'unbearable'. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future.This study was supported by the Dutch Cancer Society (grant number KUN2007-03736)

Factors Affecting The Efficiency Of Fox (Vulpes Vulpes) Baiting Practices On The Central Tablelands Of New South Wales

The European red fox (Vulpes vulpes L.) is a well known predator of native species and domestic stock, and is recognised as one of Australia’s most devastating vertebrate pests. Current fox management relies heavily on poisoning using baits impregnated with sodium monofluoroacetate (1080). This reliance on 1080 is likely to continue given the lack of viable alternatives for controlling foxes, so that, in the meanwhile, it is important to improve the efficiency of the current techniques. Factors affecting the susceptibility of individual foxes to bait include their ability to locate it, as well as the bait’s palatability and toxicity. The economic costs associated with using different bait types, the pattern and density of their distribution will also affect the efficiency of control programs. It is essential to examine and refine all such issues to ensure efficient use of the 1080 baiting technique. This thesis focuses generally on problems associated with management of the fox in eastern Australia. More specifically, I investigate the factors affecting the efficiency of fox baiting practices on the central tablelands of New South Wales. The study was conducted largely on agricultural lands near the town of Molong (33010’ 37”S, 148087’15”E) on the central tablelands of New South Wales. This area was chosen as it is broadly representative, in terms of land use, of a large region of eastern Australia. The highly modified, predominantly agricultural landscapes near Molong are well suited to foxes, and conflict with the predominantly pastoral community means that fox management is widely undertaken. I determined the persistence of 1080 in two commonly used bait types, Foxoff® and chicken wingettes, under different climatic and rainfall conditions. The rate of 1080 degradation did not change significantly between the central tablelands and the relatively hotter and drier western slopes. Foxoff® baits remained lethal for longer than wingettes under all conditions, although their rate of degradation generally increased with increasing rainfall. I confirmed the presence of defluorinating micro-organisms in thesoils of eastern Australia for the first time, and suggest that, following removal from the bait, 1080 would not persist in the environment for long. Bait should be attractive and highly palatable to ensure that the target species will find and consume it upon discovery. Caching, where discovered food is removed but not immediately consumed, may potentially reduce the efficacy and cost-effectiveness of baiting campaigns. I quantified the caching of chicken wingette, day-old chick and Foxoff® baits by inserting transmitters into bait material and assessing whether it was eaten or cached following removal. The intensity of caching did not change significantly between seasons. Type of bait had the largest influence on caching intensity, with a greater percentage of non-toxic Foxoff® baits (66.9%) being cached than either wingettes (5.7%) or day-old chicks (4.5%). The percentage of toxic (1080) baits cached was even greater, suggesting that 1080 bait may be less palatable, and detectable to foxes. I also investigated the use of conditioned taste aversion to reduce multiple bait uptake by foxes. Levamisole, an illness-inducing chemical, was added to bait and the fate of removed bait was again monitored via radio-telemetry. Following consumption of a levamisole-treated bait, foxes avoided eating treated baits but consumed untreated baits. I concluded that a reduction in bait consumption was achieved through learned aversion to levamisole rather than via conditioned taste aversion to baits. Adding levamisole to baits, especially non-toxic bait such as rabies vaccines, could potentially be used to reduce bait monopolisation by individual foxes. Fox density and den site preferences were assessed by investigating the distribution and density of fox natal dens on one property (9.6 km2) over three consecutive years. A total of 9 natal dens were located in 2000 and 2001, declining to 6 in 2002. No preference was shown for den sites on the basis of habitat, slope or aspect, but more dens were located under, or adjacent to cover. Assuming that each natal den represents a breeding pair and that the population sex ratio did not differ from parity (1:1), the site contained a prebreeding density of 1.9 foxes/km2 in 2000 and 2001, and 1.25 foxes/km2 in 2002. Given that the mean number of cubs is 4.0, the post-breeding density was estimated at 5.6 and 3.75 foxes/km2 in 2000/2001 and 2002, respectively. The results demonstrated that high densities of foxes occur on agricultural lands. The success and likely accuracy of the technique to monitor fox density suggests that it may be used to calibrate more efficient abundance estimates that will be essential for the strategic management of foxes in future. Pest animal management strategies are traditionally assessed for their effectiveness, with less consideration being given to the efficiency or cost of achieving the desired effect. I used cost-effectiveness analyses to compare between different baiting strategies based on the longevity, palatability and handling/replacement costs associated with each bait type. The results indicated that, when measured on a total cost-per-bait-consumed basis, wingettes and day-old chicks were the most cost-effective baits for campaigns of up to 4 weeks duration. This demonstrates the importance of including the longevity, and particularly the palatability of bait, when assessing cost-effectiveness. However, it is recognised that other factors, including the consistency of dosage and uptake by nontarget species, may be equally or more important in deciding the appropriate baiting strategy. The spatial and temporal application of fox baiting in the region overseen by the Molong Rural Lands Protection Board was examined between January 1998 and December 2002 as a case study to evaluate the apparent effectiveness of cooperative management practices. Most landholders (78.8%) did not bait for foxes during this period. Based on known dispersal distances, the effect of fox immigration into baited areas was determined. The results indicated that no areas baited for foxes were separated by a sufficient buffer distance (>9.58 km) from unbaited areas to be protected from fox immigration. This suggests that, at current levels of coordination, the effectiveness of most baiting operations in eastern Australia is compromised over the long term by fox immigration. However, it is recognised that short-term reductions in fox density may sometimes be all that are required to reduce predation to acceptable levels, especially for seasonally-susceptible prey. Ultimately, the cost-effectiveness of control should be evaluated in terms of the response of the prey rather than that of the predator. This study has highlighted deficiencies in current ‘best-practice’ baiting techniques. Specific recommendations for current baiting practices, in addition to future research, are also given. In brief, these include minimising free-feed baiting, increasing the minimum distance between bait stations, and, where possible, presenting the most palatable bait. Continued research into conditioned taste aversion, aerial baiting, and techniques to reduce caching are recommended as potential techniques to improve the efficiency of baiting practices

Performance and usability of pre-operative prediction models for 30-day peri-operative mortality risk: a systematic review

Estimating pre-operative mortality risk may inform clinical decision-making for peri-operative care. However, pre-operative mortality risk prediction models are rarely implemented in routine clinical practice. High predictive accuracy and clinical usability are essential for acceptance and clinical implementation. In this systematic review, we identified and appraised prediction models for 30-day postoperative mortality in non-cardiac surgical cohorts. PubMed and Embase were searched up to December 2022 for studies investigating pre-operative prediction models for 30-day mortality. We assessed predictive performance in terms of discrimination and calibration. Risk of bias was evaluated using a tool to assess the risk of bias and applicability of prediction model studies. To further inform potential adoption, we also assessed clinical usability for selected models. In all, 15 studies evaluating 10 prediction models were included. Discrimination ranged from a c-statistic of 0.82 (MySurgeryRisk) to 0.96 (extreme gradient boosting machine learning model). Calibration was reported in only six studies. Model performance was highest for the surgical outcome risk tool (SORT) and its external validations. Clinical usability was highest for the surgical risk pre-operative assessment system. The SORT and risk quantification index also scored high on clinical usability. We found unclear or high risk of bias in the development of all models. The SORT showed the best combination of predictive performance and clinical usability and has been externally validated in several heterogeneous cohorts. To improve clinical uptake, full integration of reliable models with sufficient face validity within the electronic health record is imperative

Learning unbiased group-wise registration (LUGR) and joint segmentation: evaluation on longitudinal diffusion MRI

Analysis of longitudinal changes in imaging studies often involves both segmentation of structures of interest and registration of multiple timeframes. The accuracy of such analysis could benefit from a tailored framework that jointly optimizes both tasks to fully exploit the information available in the longitudinal data. Most learning-based registration algorithms, including joint optimization approaches, currently suffer from bias due to selection of a fixed reference frame and only support pairwise transformations. We here propose an analytical framework based on an unbiased learning strategy for group-wise registration that simultaneously registers images to the mean space of a group to obtain consistent segmentations. We evaluate the proposed method on longitudinal analysis of a white matter tract in a brain MRI dataset with 2-3 time-points for 3249 individuals, i.e., 8045 images in total. The reproducibility of the method is evaluated on test-retest data from 97 individuals. The results confirm that the implicit reference image is an average of the input image. In addition, the proposed framework leads to consistent segmentations and significantly lower processing bias than that of a pair-wise fixed-reference approach. This processing bias is even smaller than those obtained when translating segmentations by only one voxel, which can be attributed to subtle numerical instabilities and interpolation. Therefore, we postulate that the proposed mean-space learning strategy could be widely applied to learning-based registration tasks. In addition, this group-wise framework introduces a novel way for learning-based longitudinal studies by direct construction of an unbiased within-subject template and allowing reliable and efficient analysis of spatio-temporal imaging biomarkers.Comment: SPIE Medical Imaging 2021 (oral