Keel bone damage (KBD) in laying hens is an important welfare problem in both conventional and organic egg production systems. We aimed to identify possible risk factors for KBD in organic hens by analysing cross-sectional data of 107 flocks assessed in eight European countries. Due to partly missing data, the final multiple regression model was based on data from 50 flocks. Keel bone damage included fractures and/or deviations, and was recorded, alongside with other animal based measures, by palpation and visual inspection of at least 50 randomly collected hens per flock between 52 and 73 weeks of age. Management and housing data were obtained by interviews, inspection and by feed analysis. Keel bone damage flock prevalences ranged from 3% to 88%. Compiled on the basis of literature and practical experience, 26 potential associative factors of KBD went into an univariable selection by Spearman correlation analysis or Mann–Whitney U test (with P<0.1 level). The resulting nine factors were presented to stepwise forward linear regression modelling. Aviary v. floor systems, absence of natural daylight in the hen house, a higher proportion of underweight birds, as well as a higher laying performance were found to be significantly associated with a higher percentage of hens with KBD. The final model explained 32% of the variation in KBD between farms. The moderate explanatory value of the model underlines the multifactorial nature of KBD. Based on the results increased attention should be paid to an adequate housing design and lighting that allows the birds easy orientation and safe manoeuvring in the system. Furthermore, feeding management should aim at sufficient bird live weights that fulfil breeder weight standards. In order to achieve a better understanding of the relationships between laying performance, feed management and KBD further investigations are needed.

Feather pecking (FP) in laying hens is an important animal welfare problem in practice, despite extensive research and increasing sources of advice for farmers. We aimed to give an overview over results from experimental and epidemiological studies. We included noncage systems, covering the rearing and laying phase. The investigated factors were categorised into those with either good, contentious or no evidence regarding preventive effects on FP. Moreover, we wanted to know to what extent recommendations for farmers are based on this scientific evidence. We extracted 62 potential preventive factors from 88 experimental and 21 epidemiological studies. 17 factors during rearing, and 32 factors during the laying phase significantly affected the risk to develop FP or plumage damage (PD). Factors were counted as significant if other studies found no or at most one opposite result. Seven factors during rearing and 16 factors during laying were confirmed by more than one study, with no or at most one opposite result. Provision of dry litter on the floor and sufficiently high perches during rearing and laying or a high use of the free range area during the laying phase were among these influencing factors. In the reviewed 15 practice recommendations, almost all of these factors have been taken up, although no recommendation comprises all factors and most miss more than the half of them. This leaves ample room for improvement of the recommendations. On the other hand, they altogether recommend 15 contentious as well as eight non-significant or 12 not yet investigated factors for which further scientific investigation is necessary. Keywords: Laying hens; Feather pecking; Plumage damage; Recommendations 'damaging feather pecking' or 'plumage damage' were included. In addition, reference lists of retrieved papers were searched for further studies. Recommendations were sought using the internet search engine 'Google' with the keywords 'laying hens' and 'feather pecking' which were used in combination with 'recommendations', 'management guidelines' or 'references'. Also, the German keywords 'Federpicken' and 'Legehennenhaltung' were applied in combination with 'Empfehlungen', 'Prävention', 'Managementempfehlungen', or 'Haltungsempfehlungen'. Selection criteria for the recommendations were that they must be freely available, that they covered rearing, placement or the laying period and that they are related to non-cage systems.

In the European research project HealthyHens, welfare indicators as well as husbandry and management conditions were recorded in 107 organic laying hen farms in eight countries. Farms were visited at peak and end of lay. Egg production was on average comparable to breeder specifications. A mean mortality of 5.7% and mean prevalences of footpad lesions of 30.5%, keel bone damage of 44.5%, 57.3% of flocks with on average >200 Ascarid eggs per gram faeces and 28.2% of flocks with >100 mites/trap were recorded. A large variation between flocks indicated options for improvement. Based on the results, the following measures can be recommended: (i) decreasing mite and worm infestation and (ii) providing an attractive covered veranda, because of their association with decreased mortality; (iii) maximising access to the free range, because of its relation to decreased A. galli infection and less injurious pecking; (iv) feeding sufficient protein levels and (v) providing adequate litter as preventive measure against feather pecking and cannibalism; (vi) ensuring that the birds have sufficient weight and (vii) preventing accidents by adequate hen house facilities and light conditions to reduce keel bone damage. These primarily management-based measures have the potential to improve bird welfare both in terms of behavioural and health aspects.

Keel bone damage (KBD) can be found in all commercial laying hen flocks with a wide range of 23% to 69% of hens/flock found to be affected in this study. As KBD may be linked with chronic pain and a decrease in mobility, it is a serious welfare problem. An automatic assessment system at the slaughter line could support the detection of KBD and would have the advantage of being standardized and fast scoring including high sample sizes. A 2MP stereo camera combined with an IDS imaging color camera was used for the automatic assessment. A trained human assessor visually scored KBD in defeathered hens during the slaughter process and compared results with further human assessors and automatic recording. In a first step, an algorithm was developed on the basis of assessments of keel status of 2287 hens of different genetics with varying degrees of KBD. In two optimization steps, performance data were calculated, and flock prevalences were determined, which were compared between the assessor and the automatic system. The proposed technique finally reached a sensitivity of 0.95, specificity of 0.77, accuracy of 0.86 and precision of 0.81. In the last optimization step, the automatic system scored on average about 10.5% points lower KBD prevalences than the human assessor. However, a proposed change of scoring system (setting the limit for KBD at 0.5 cm deviation from the straight line) would lower this deviation. We conclude that the developed automatic scoring technique is a reliable and potentially valuable tool for the assessment of KBD.

Laying hens often suffer from keel bone damage (KBD) that includes pathologies with different etiologies, like diverse forms of fractures and deviations. Since KBD is a problem in all countries and housing systems, methods for the assessment of deviations are urgently needed. Comparisons between genetic lines and between studies are important to detect underlying mechanisms. Field researchers often use palpation as a low-cost and feasible technique for the assessment of KBD. In contrast to palpation, radiography is effective and highly precise at least in detecting keel bone fractures. The aim of this study was to: i) develop a scoring system to assess keel bone deviations from radiographs, ii) to assess inter- and intra-observer reliability of this scoring system, and iii) to investigate whether fractures and deviations of the keel are correlated. In total, 192 hens were used for the investigation. Digital radiographs were taken and evaluated for all hens after slaughter. We developed a tagged visual analog scale with two extreme images as anchors and four intermediate tags, resulting in six images representing the range from “no deviation” to “highly deviated” on a 10 cm line. Eleven participants scored 50 radiographs of keels with varying degree of severity, whereas five images were scored twice to assess intra-observer reliability. Intraclass correlation coefficient for inter-observer reliability was 0.979 with a confidence interval of 0.968 &lt; ICC &lt; 0.987 (F49,268 = 54.2, p &lt; 0.0001). Intraclass correlation coefficient for intra-observer reliability was 0.831 with a confidence interval of 0.727 &lt; ICC &lt; 0.898 (F54,55 = 10.8, p &lt; 0.0001). Individual intra-observer reliability ranged from 0.6 to 0.949. The Spearman correlation showed a strong positive correlation of fractures and deviations (sroh= 0.803, p &lt; 0.001). The tagged visual analog scale could be a reliable instrument for the scoring of keel bone deviations. Our results support the assumption that the majority of highly deviated keels suffer from fractures as well. Further research is needed to investigate the correlation of palpation scores with the evaluation on radiographs.

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Purpose Pathologic complete response is associated with longer disease-free survival and better overall survival after neoadjuvant chemotherapy in breast cancer patients. We, therefore, evaluated factors influencing pathologic complete response. Methods Patients receiving neoadjuvant chemotherapy from 2015 to 2018 at the Saarland University Hospital were included. Patients’ age, tumor stage, tumor biology, genetic mutation, recurrent cancer, discontinuation of chemotherapy, and participation in clinical trials were extracted from electronic medical records. Binary logistic regression was performed to evaluate the influence of these factors on pathologic complete response. Results Data of 183 patients were included. The median patient’s age was 54 years (22–78). The median interval between diagnosis and onset of chemotherapy was 28 days (14–91); between end of chemotherapy and surgery 28 days (9–57). Sixty-two patients (34%) participated in clinical trials for chemotherapy. A total of 86 patients (47%) achieved pathologic complete response. Patient’s age, genetic mutation, recurrent cancers, or discontinuation of chemotherapy (due to side effects) and time intervals (between diagnosis and onset of chemotherapy, as well as between end of chemotherapy and surgery) did not influence pathologic complete response. Patients with high Ki67, high grading, Her2 positive tumors, as well as patients participating in clinical trials for chemotherapy had a higher chance of having pathologic complete response. Patients with Luminal B tumors had a lower chance for pathologic complete response. Conclusion Particularly patients with high risk cancer and patients, participating in clinical trials benefit most from chemotherapy. Therefore, breast cancer patients can be encouraged to participate in clinical trials for chemotherapy.

Background The development and approval of disease modifying treatments have dramatically changed disease progression in patients with spinal muscular atrophy (SMA). Nusinersen was approved in Europe in 2017 for the treatment of SMA patients irrespective of age and disease severity. Most data on therapeutic efficacy are available for the infantile-onset SMA. For patients with SMA type 2 and type 3, there is still a lack of sufficient evidence and long-term experience for nusinersen treatment. Here, we report data from the SMArtCARE registry of non-ambulant children with SMA type 2 and typen 3 under nusinersen treatment with a follow-up period of up to 38 months. Methods SMArtCARE is a disease-specific registry with data on patients with SMA irrespective of age, treatment regime or disease severity. Data are collected during routine patient visits as real-world outcome data. This analysis included all non-ambulant patients with SMA type 2 or 3 below 18 years of age before initiation of treatment. Primary outcomes were changes in motor function evaluated with the Hammersmith Functional Motor Scale Expanded (HFMSE) and the Revised Upper Limb Module (RULM). Results Data from 256 non-ambulant, pediatric patients with SMA were included in the data analysis. Improvements in motor function were more prominent in upper limb: 32.4% of patients experienced clinically meaningful improvements in RULM and 24.6% in HFMSE. 8.6% of patients gained a new motor milestone, whereas no motor milestones were lost. Only 4.3% of patients showed a clinically meaningful worsening in HFMSE and 1.2% in RULM score. Conclusion Our results demonstrate clinically meaningful improvements or stabilization of disease progression in non-ambulant, pediatric patients with SMA under nusinersen treatment. Changes were most evident in upper limb function and were observed continuously over the follow-up period. Our data confirm clinical trial data, while providing longer follow-up, an increased number of treated patients, and a wider range of age and disease severity.