This study investigated the hypothesis that the particulate content of milk, as monitored with particle counters, is correlated to the health status of lactating dairy cows, in particular the condition mastitis. Twenty Holstein cows were monitored from the very first day of clinical mastitis outbreak until complete recovery from the disease. During the experiment, the changes in particle behaviour in all four quarters and mixture of milk from all of them were measured. For each sample the following parameters were measured: somatic cell count, fat content, lactose and protein concentration, number and size distribution of milk particles, electric conductivity and diameter of milk fat globules. In total over thirty mastitis outbreaks were observed and monitored throughout, including the first phase of this study when over three thousand samples of foremilk were collected and examined. An operational protocol and particle monitoring device were designed with the help of a commercial company Facility Monitoring Systems Ltd (FMS), Malvern. A particle counter and Peak Height Analyser (PHA) were used to monitor particulate content of milk and a compound phase contrast microscope was used to identify milk particles by photographic visualisation and to establish their diameter. It was observed that the number of particles, milk fat globule diameter and somatic cell counts were stable during periods without udder inflammation. Mastitis caused great changes in these parameters. Both milk particulate size and number were significantly affected by clinical and subclinical form of inflammation (change to the particulate behaviour). It was observed that the changes to the volume median diameter (VMD) of fat globules became evident a few days before clinical signs were present. Results obtained from a particle counter and the PHA were in agreement with data obtained by microscopy. Major changes were recorded in the number of total particles in milk before and during the outbreak of mastitis. Further research showed that changes took place in the pattern of particulate behaviour without visible signs of disease; additional data established that subclinical mastitis can be also identified through the monitoring of particles in milk. In summary monitoring of the behaviour (changes to size and number) of milk fag globules (MFG) can be used as an early indicator of the onset of mastitis. In addition data collected during study produced strong evidence supporting the theory of the interdependence of the quarters within the udder. It was found that the coefficient of correlation for size and number of particles for all four quarters within the udder was statistically significant. Particle counts and the VMD values behaviour were similar for the four quarters. This relationship was observed for all monitored animals. Moreover, the same relationship was also observed during both clinical and subclinical outbreaks of mastitis. Somatic cell count was affected only in an infected quarter while particulate content of milk ―responded‖ to disease in all four quarters within the udder (even if only one was infected). These results were the most surprising and unexpected outcome, suggesting that four quarters within the udder work together as one organ not four separate units. It was observed that the mean MFG cannot be used as a baseline to test individual animal deviations due to the unique particle profile of each observed animal. In all monitored animals particle counts obtained from PHA was found to be in the range of 1011 to 1013 with an average of 1012 particles per ml. The number of particles recorded in mastitis for one animal was at the healthy level for another. The particle pattern became a finger print for each animal and therefore MFG behaviour cannot be compared between animals. Following the first phase of the study the monitoring period was set at 15 to 20 days. This protocol allowed for minimising the influence of any other parameters on particles, which may influence the outcome of an experiment e.g. the number of particles in single samples detected by the particle counter. It was also essential to understand how the age, nutrition and stage of lactation might influence the particles and affect the results. Therefore two animals were chosen to be examined during their lactation. The analysed data did not present enough evidence to establish the relationship between nutrition and milk fat globules size and number. However to better understand this association additional studies should be carried out. Further work is required to optimise the monitoring device and build a fully automated system which will allow collecting and analysing data from the whole herd. This study proposed that particle pattern is unique for each animal – like a finger print. More research is needed to better understand the mechanism behind milk fat globules synthesis during inflammation. The results obtained during this study provide new evidence with regard to physiological changes within the udder before and during mastitis outbreak and supported the theory of interdependence between quarters within udder. The particle count in milk can be used as an indicator of the health status of the single animal. Combined the PHA and microscope can be used as a new tool to determine and monitor the particle count in milk. The understanding of the particulate behaviour will help to minimise the chance of mastitis outbreak by early detection and also to reduce the chance of the cross-contamination between animals during the milking process. Milk fat globule size and number can be used as an efficient indicator of the onset of mastitis.

A methodology for ageing foetal and neonatal cattle is developed, involving radiographic examination of infant mandibles for early developmental stages in molariform teeth; tooth-wear methodologies are imprecise at this stage before wear commences. Known-age modern bovine foetal and neonate material are collected as a control assemblage for method development (n=73); six Neolithic to Norse era assemblages from Orkney are examined using the modified technique together with standard tooth-wear analysis and other methodologies. Foetal and died-at-birth material is diagnosed at most sites using the new technique, together with a range of other peri-natal age-groups. Ageing at this early stage is highly relevant in the diagnosis of milking as a palaeoeconomy: the accepted view is that unwanted (male) calves were slaughtered to maximise milk for human consumption, hence a surfeit of neonate calf remains, as at the study sites. The diagnosis of foetal and died-at-birth material challenges this view, suggesting that attritional causes may have contributed to deaths at this stage. Although milking was probably carried out at most of the study sites, this may have been combined with slaughter of cattle for meat in a pragmatic exploitation strategy. Literary research shows possible attritional causes of abortion and early death in calves, in particular dietary insufficiency in pregnant cows, microbial infections, and also inadequate colostrum uptake. Additionally, research is used to consider the challenges to health that early milking might have posed, to the calf as mentioned, but also to the cow, where three main health issues are highlighted: infertility, mastitis and lameness.

<p>Care and treatment of women with inflammatory symptoms of the breast during lactation</p><p>Inflammation of the breast during lactation causes considerable discomfort to mothers and carries a risk of early abandonment of breastfeeding. Little is known about the effects of care interventions, including acupuncture, used for these mothers or about mothers’ experiences of the complaint. Aim: to study care and treatment given at a midwife-led breastfeeding clinic to mothers with inflammatory symptoms of the breast during lactation, to gain knowledge of mothers’ experiences of being afflicted by breast inflammation and to investigate factors which may be associated with the development of breast abscess. Methods: method triangulation was used to study different aspects of the phenomenon of inflammatory symptoms of the breast during lactation; two randomised controlled trials I (n = 88) and II (n = 210), a descriptive study III (n = 210), an interview study with a Grounded Theory approach IV (n = 14), and a population-based register study V (n = 1,454,068 singleton deliveries). Results: mothers’ symptoms were more effectively relieved when acupuncture was used but acupuncture treatment did not shorten contact with health services. Nine percent (I) and 15 % (II) respectively, of mothers were prescribed antibiotics. Twelve percent experienced renewed symptoms requiring health care contact within 6 weeks (III). Seven mothers (0.1% of breastfeeding mothers) developed breast abscess, which was comparable to the figure in the population-based study (V). The presence of Group B streptococci in the breast milk was related to longer contact with health care (II). Mothers’ “will to breastfeed” may make it possible for them to withstand physical and emotional difficulties caused by the illness. Mothers considered access to clinical expertise to be an important factor in their care (IV). Primiparous mothers, those over the age of 30 years and those who give birth after 41 weeks gestation appear to be at a significantly increased risk for the development of breast abscess (V).</p><p>Conclusions: mothers’ symptoms were more effectively dissipated when acupuncture treatment was used. However, acupuncture treatment did not shorten mothers’ contact with health care services. Interventions, including acupuncture treatment for relief of symptoms may help mothers to withstand their discomfort and await the body’s own anti-inflammatory response and therefore make it possible to substantially reduce the use of antibiotic therapy for this group. The results indicate a need for a better understanding of the influence on breastfeeding of hormones administered to birthing and breastfeeding women. The availability of immediate clinical expertise is an important factor for these mothers, which health care planners should be aware of. Information on potential breastfeeding problems should be improved.</p><p>Key words: acupuncture, antibiotics, breast abscess, breastfeeding, care interventions, inflammatory symptoms, lactation mastitis</p> / <p>Vård och behandling av kvinnor med inflammation i brösten under amningsperioden</p><p>Bröstinflammation orsakar stort obehag för ammande mödrar och innebär en risk för att amning avslutas i förtid. Det finns ringa kunskap om effekterna av interventioner, inkluderande akupunktur, som används vid vård av dessa kvinnor. Det saknas även kunskap om mödrarnas upplevelser av bröstinflammation. Syfte: att studera vård och behandling av kvinnor med bröstinflammation vid en amningsmottagning ledd av barnmorskor, att utveckla kunskap om mödrars upplevelser av att vara drabbad av bröst inflammation samt att undersöka faktorer som kan ha betydelse för utvecklandet av bröstabscess. Metoder: metodtriangulering användes för att studera olika aspekter av fenomenet bröstinflammation under amningsperioden; två randomiserade kontrollerade studier I (n = 88) and II (n = 210), en deskriptiv studie III (n = 210), en intervjustudie med en grounded theory ansats IV (n = 14) och en populationsbaserat registerstudie V (n = 1 454 068 enkelbörds förlossningar). Resultat: mödrarnas symptom lindrades mer effektivt med akupunktur akupunkturbehandling men förkortade inte deras kontakt med vården. Nio procent (I) respektive 15 % (II) av mödrarna fick antibiotika. Tolv procent fick recidiv vilket föranledde kontakt med vården inom 6 veckor (III). Sju mödrar (0,1 % av ammande mödrar) utvecklade bröstabscess (II), vilket överensstämde med resultat i den populationsbaserade studien (V). Förekomsten av Grupp B streptococcer i bröstmjölken var relaterad till längre vårdkontakt (II). Mödrarnas viljan att amma kan göra det möjligt för dem att uthärda fysiska och emotionella svårigheter som sjukdomen innebär (IV). Tillgång till klinisk expertis var en viktig del av vården för dessa kvinnor. Att vara förstföderska kan innebära en något större risk för utveckling av bröstabscess. Mödrar över 30 år samt de som föder efter graviditetsvecka 41 har också en ökad risk för abscess (V).</p><p>Slutsatser: mödrarnas symptom lindrades mer effektivt när akupunktur användes. Kontakten med vården blev dock inte förkortad av akupunkturbehandling. Interventioner som inkluderar akupunkturbehandling kan tillåta mödrar att invänta kroppens anti-inflammatoriska respons och kan därför möjliggöra en avsevärd minskning av antibiotika terapi för dessa mödrar. Resultaten visar behov av att bättre förstå hur amning påverkas av hormoner administrerade till kvinnor under förlossningsarbete och amningen. Tillgång till omedelbar klinisk expertis är en viktig faktor för dessa mödrar vilket hälso- och sjukvårdsplanerare bör vara medvetna om. Förbättrad information angående potentiella amningsproblem bör eftersträvas.</p><p>Nyckelord: akupunktur, amning, antibiotika, bröstabscess, bröstinflammation, interventioner, mastit, mjölkstockning</p>

Care and treatment of women with inflammatory symptoms of the breast during lactation Inflammation of the breast during lactation causes considerable discomfort to mothers and carries a risk of early abandonment of breastfeeding. Little is known about the effects of care interventions, including acupuncture, used for these mothers or about mothers’ experiences of the complaint. Aim: to study care and treatment given at a midwife-led breastfeeding clinic to mothers with inflammatory symptoms of the breast during lactation, to gain knowledge of mothers’ experiences of being afflicted by breast inflammation and to investigate factors which may be associated with the development of breast abscess. Methods: method triangulation was used to study different aspects of the phenomenon of inflammatory symptoms of the breast during lactation; two randomised controlled trials I (n = 88) and II (n = 210), a descriptive study III (n = 210), an interview study with a Grounded Theory approach IV (n = 14), and a population-based register study V (n = 1,454,068 singleton deliveries). Results: mothers’ symptoms were more effectively relieved when acupuncture was used but acupuncture treatment did not shorten contact with health services. Nine percent (I) and 15 % (II) respectively, of mothers were prescribed antibiotics. Twelve percent experienced renewed symptoms requiring health care contact within 6 weeks (III). Seven mothers (0.1% of breastfeeding mothers) developed breast abscess, which was comparable to the figure in the population-based study (V). The presence of Group B streptococci in the breast milk was related to longer contact with health care (II). Mothers’ “will to breastfeed” may make it possible for them to withstand physical and emotional difficulties caused by the illness. Mothers considered access to clinical expertise to be an important factor in their care (IV). Primiparous mothers, those over the age of 30 years and those who give birth after 41 weeks gestation appear to be at a significantly increased risk for the development of breast abscess (V). Conclusions: mothers’ symptoms were more effectively dissipated when acupuncture treatment was used. However, acupuncture treatment did not shorten mothers’ contact with health care services. Interventions, including acupuncture treatment for relief of symptoms may help mothers to withstand their discomfort and await the body’s own anti-inflammatory response and therefore make it possible to substantially reduce the use of antibiotic therapy for this group. The results indicate a need for a better understanding of the influence on breastfeeding of hormones administered to birthing and breastfeeding women. The availability of immediate clinical expertise is an important factor for these mothers, which health care planners should be aware of. Information on potential breastfeeding problems should be improved. Key words: acupuncture, antibiotics, breast abscess, breastfeeding, care interventions, inflammatory symptoms, lactation mastitis / Vård och behandling av kvinnor med inflammation i brösten under amningsperioden Bröstinflammation orsakar stort obehag för ammande mödrar och innebär en risk för att amning avslutas i förtid. Det finns ringa kunskap om effekterna av interventioner, inkluderande akupunktur, som används vid vård av dessa kvinnor. Det saknas även kunskap om mödrarnas upplevelser av bröstinflammation. Syfte: att studera vård och behandling av kvinnor med bröstinflammation vid en amningsmottagning ledd av barnmorskor, att utveckla kunskap om mödrars upplevelser av att vara drabbad av bröst inflammation samt att undersöka faktorer som kan ha betydelse för utvecklandet av bröstabscess. Metoder: metodtriangulering användes för att studera olika aspekter av fenomenet bröstinflammation under amningsperioden; två randomiserade kontrollerade studier I (n = 88) and II (n = 210), en deskriptiv studie III (n = 210), en intervjustudie med en grounded theory ansats IV (n = 14) och en populationsbaserat registerstudie V (n = 1 454 068 enkelbörds förlossningar). Resultat: mödrarnas symptom lindrades mer effektivt med akupunktur akupunkturbehandling men förkortade inte deras kontakt med vården. Nio procent (I) respektive 15 % (II) av mödrarna fick antibiotika. Tolv procent fick recidiv vilket föranledde kontakt med vården inom 6 veckor (III). Sju mödrar (0,1 % av ammande mödrar) utvecklade bröstabscess (II), vilket överensstämde med resultat i den populationsbaserade studien (V). Förekomsten av Grupp B streptococcer i bröstmjölken var relaterad till längre vårdkontakt (II). Mödrarnas viljan att amma kan göra det möjligt för dem att uthärda fysiska och emotionella svårigheter som sjukdomen innebär (IV). Tillgång till klinisk expertis var en viktig del av vården för dessa kvinnor. Att vara förstföderska kan innebära en något större risk för utveckling av bröstabscess. Mödrar över 30 år samt de som föder efter graviditetsvecka 41 har också en ökad risk för abscess (V). Slutsatser: mödrarnas symptom lindrades mer effektivt när akupunktur användes. Kontakten med vården blev dock inte förkortad av akupunkturbehandling. Interventioner som inkluderar akupunkturbehandling kan tillåta mödrar att invänta kroppens anti-inflammatoriska respons och kan därför möjliggöra en avsevärd minskning av antibiotika terapi för dessa mödrar. Resultaten visar behov av att bättre förstå hur amning påverkas av hormoner administrerade till kvinnor under förlossningsarbete och amningen. Tillgång till omedelbar klinisk expertis är en viktig faktor för dessa mödrar vilket hälso- och sjukvårdsplanerare bör vara medvetna om. Förbättrad information angående potentiella amningsproblem bör eftersträvas. Nyckelord: akupunktur, amning, antibiotika, bröstabscess, bröstinflammation, interventioner, mastit, mjölkstockning