This coordinated child telepsychiatry consult system for a state Medicaid division reduced outlier pediatric psychiatric medication prescribing, supported local community-delivered treatments, and reduced unnecessary hospitalizations in a financially advantageous manner that was well received by the practice community.

The study objective was to characterize effects of early gestation in utero heat stress (IUHS) on postnatal fasting heat production (FHP) and blood biomarkers associated with metabolism in growing pigs. Based on previous observation of increased postnatal core body temperature set point in IUHS pigs, we hypothesized that FHP would be altered during postnatal life because of IUHS. Pregnant first-parity gilts were exposed to thermoneutral (TN; = 4; 17.8 ± 0.1°C) or heat stress (HS; = 4; cyclical 28 to 38°C) conditions from d 30 to 60 of gestation. At weaning (21 d of age), 2 median-weight male pigs (1 barrow and 1 boar) were selected from each litter ( = 8 in utero TN [IUTN] and 8 IUHS pigs) and then housed in TN conditions based on age. Blood samples were collected at 8, 9, and 10 wk of age when pigs were in a fed state to analyze thyroxine (T4) and triiodothyronine (T3) concentrations. Pigs were trained to enter an indirect calorimeter from wk 8 through 10 of life and then acclimated over a 24-h period 1 wk prior to testing. At 12 wk of age, pigs were fasted for 24 h, and then indirect calorimetry was performed on individual pigs over a 23-h testing period to determine FHP and the respiratory quotient in 3 intervals (0900 to 1700 h, 1700 to 0000 h, and 0000 to 0800 h). Body weight was determined before and after testing and was similar for all pigs ( = 0.77; 37.0 ± 0.5 kg BW). Data were analyzed using PROC MIXED in SAS 9.4. No boar vs. barrow differences were observed with any analysis. Overall, FHP per kilogram BW was greater ( = 0.03; 12.1%) in IUHS pigs compared with IUTN pigs. Fasting heat production per kilogram BW was greater ( < 0.01; 19.8%) from 0900 to 1700 h compared with 1700 to 0000 h and 0000 to 0800 h and was greater (10.9%) from 1700 to 0000 h compared with 0000 to 0800 h. The RQ did not differ by in utero treatment ( = 0.51; 0.72 ± 0.01); however, the RQ was increased ( < 0.01; 13.0%) from 1700 to 0000 h compared with 0900 to 1700 h and 0000 to 0800 h. No other FHP and RQ differences were detected. Although no in utero treatment differences were observed for T4 ( = 0.11; 52.2 ± 6.2 ng/mL), T3 was greater overall ( = 0.04; 19.5%) in IUHS pigs than in IUTN pigs. In summary, FHP and circulating T3 were increased in IUHS pigs, and this may have implications for postnatal production efficiency in pigs gestated during hot summer months.

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The study objective was to determine whether in utero heat stress (IUHS) affects piglet physiology and behavior following common production practices. A total of 12 gilts were confirmed pregnant and allocated to either heat stress (HS; n = 6) or thermoneutral (TN; n = 6) conditions on day 30–60 of gestation. At weaning (22.5 ± 2.3 days of age), 1 boar and 1 barrow of median weight were selected from each litter and transported for approximately 7 h. Piglets were then blocked into pens (n = 2/pen) by in utero treatment (IUHS (n = 12) or in utero thermoneutral (IUTN, n = 12)) and sexual status (boar (n = 6/in utero treatment) or barrow (n = 6/in utero treatment)). Plasma cortisol, non-esterified fatty acids (NEFA), insulin and glucose were evaluated 1 day prior to transport (pre-transport) and immediately after transport (post-transport). Behavioral data were collected on day 1–7 for 60 min at four different time points each day. In utero heat stressed piglets exhibited reduced cortisol concentrations compared to IUTN piglets immediately post-transport (p = 0.04). Glucose concentrations were not affected by in utero treatment. Insulin concentrations were reduced in IUTN piglets post-transport compared to pre-transport (p = 0.002), but no differences were detected for IUHS pigs. Non-esterified fatty acids tended to be reduced overall for IUHS vs. IUTN pigs (p = 0.08). Overall, IUHS piglets performed more drinking behaviors (p = 0.02) and tended to perform more aggressive behaviors (p = 0.07) than IUTN piglets in the 7 days post-transport. In summary, there was some evidence for altered physiological and behavioral responses among IUHS piglets compared to IUTN piglets following weaning and transport.