Exposure of cows to a short-day photoperiod (SDPP; 8 h light:16 h dark) during a 60-d dry period increases milk yield in the subsequent lactation compared with cows exposed to a long-day photoperiod (LDPP; 16 h light:8 h dark). Whereas the traditional recommendation for dry period length is 60 d, recent studies indicate that the dry period length can be reduced without depressing the yield in the next lactation. However, the optimal duration of the dry period appears to be between 40 and 60 d, because fewer than 30 d could result in a significant loss of milk production. Our main objective was to determine whether treatment with SDPP combined with a reduced dry period length of 42 d would increase milk yield in the next lactation relative to treatment with LDPP, even though SDPP exposure was limited to 42 d. Multiparous Holstein cows (n = 40) were randomly assigned to 1 of 2 treatments during the dry period: LDPP or SDPP. Each treatment group (n = 20) was balanced according to the previous 305-d mature equivalent milk yield. To quantify plasma prolactin (PRL) concentration, blood samples were collected weekly during the dry period. Dry matter intake (DMI) was recorded during the dry period. Health was monitored weekly during the dry period and at calving. During lactation, milk yield and DMI were recorded for 120 and 42 d, respectively. Cows exposed to SDPP calved 4.8 d earlier than cows exposed to LDPP and days dry averaged 37 and 42 d for cows exposed to SDPP and LDPP, respectively. Cows on SDPP consumed more dry matter (17.0 +/- 1.1 kg/d) during the dry period than did cows on LDPP (15.9 +/- 1.1 kg/d), but DMI after parturition did not differ. In the first 42 d of lactation, cows exposed to SDPP and LDPP consumed 18.0 and 17.7 +/- 1.4 kg/d, respectively. The periparturient PRL surge was greater in cows exposed to LDPP (22.6 +/- 3.2 ng/mL) than in those exposed to SDPP (17.1 +/- 4.1 ng/mL). Milk yield was inversely related to the magnitude of the periparturient PRL surge, but was directly related to the expression of PRL-receptor mRNA in lymphocytes during the dry period. Through 120 d of lactation, cows exposed to SDPP when dry produced more milk (40.4 +/- 1.1 kg/d) than cows exposed to LDPP (36.8 +/- 1.1 kg/d). These results support the concept that SDPP, combined with a targeted 42-d dry period, increases milk yield in the subsequent lactation, relative to a 42-d dry period combined with LDPP, and that exposure to 42 d of SDPP in the dry period is sufficient to increase milk yield in the next lactation.
Study design An online questionnaire. Objectives To gauge spinal cord injury (SCI) specialists' assessment of their communications with general practitioners (GPs). To determine whether economic or health-care system-related factors enhance or inhibit such communication. Setting A collaboration of co-authors from a health-care system. Methods An online survey interrogating a number of aspects of communication between SCI specialists and GPs was developed, distributed, and made available for 4 months. Responses were analyzed for the entire cohort then according to descriptions of participants' home nations' economies and the type of health-care delivery systems in which they work. Results A total of 88 responses were submitted. The majority (64%) were from nations with developed economies, a plurality (47.1%) were from countries that offer universal health coverage, and half used a combination of paper and electronic health records. A majority of respondents (61.8%) reported routinely communicating with their patients' GPs, but most (53.4%) rated those communications as only "fair". The most commonly listed barriers to communication with GPs were lack of time (46.3%) and a perceived lack of receptivity by GPs (26.9%). Nearly all respondents (91.6%) believed that the care they provide would be enhanced by improved communication with GPs. Participants who used electronic means of communication were more likely to communicate with GPs and to describe those interactions as "positive". Conclusions Although there are a number of barriers to communication between SCI specialists and GPs, most SCI specialists are eager for such inter-physician communication and believe it would enhance their care they deliver.
In this work, the construct of care in the context of midwifery is empirically researched in an innovative approach. With the help of the facet theory, care is operationalised by extracting individual observable parts in order to be able to compare the construct with the normative ideas of midwives about their own work. For this purpose, a questionnaire is developed and applied, which is evaluated using various forms of multidimensional scaling. To validate the results, they are compared with the content-analytical evaluation of problem-centred interviews. The research approach described is relevant for all disciplines in which care can be understood as a central phenomenon.
People living with disabilities have difficulties accessing and obtaining health care, and the care they receive is often inequitable compared to that offered to people without disabilities. This disparity is partly due to insensitivity by health care providers, but lack of provider education in the care of people with disabilities is a persistent and prevalent problem. Approach: Starting in July, 2021, Thomas Jefferson University will offer a one-year clinical fellowship in the care of people with disabilities. Available to graduates of Internal Medicine and Family Medicine residency programs and housed in our Department of Rehabilitation Medicine, the fellowship is intended to train physicians to provide medical care to people with a variety of disabilities while preparing them to help institutions offer more accessible and comprehensive care. This manuscript describes the fundamental features of this novel training program, and how the authors reached consensus on its central aims, clinical rotations, curricula, and supporting experiences. Expected Outcomes: In the first 3 years of the fellowship, program leaders will track: 1) learners' knowledge of a variety of secondary effects of disability; 2) learners' comfort in assessing co-occurring and secondary conditions of disabilities and in providing clinical care to people with disabilities; 3) learners' academic output, satisfaction with the fellowship, and employability, and; 4) the financial feasibility of sustaining the training program.
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