Foram realizados dois estudos para avaliar aditivos alternativos aos antibióticos na produção de bezerros leiteiros em sistema de desaleitamento precoce. No primeiro experimento, foram avaliados os efeitos de mananoligossacarídeos (Bio-Mos®) quanto ao desempenho e parâmetros sanguíneos indicativos de desenvolvimento ruminal, além da via de fornecimento do aditivo. Foram utilizados 24 bezerros da raça Holandês, todos machos inteiros, em delineamento inteiramente casualizado distribuídos nos seguintes tratamentos: 1) controle; 2) mananoligossacarídeo (4 g/d Bio-Mos®, Alltech Biotech.) fornecido via concentrado inicial; 3) mananoligossacarídeo (4 g/d Bio-Mos®, Alltech Biotech.) fornecido via sucedâneo lácteo. Os animais foram alocados em abrigos individuais, com livre acesso a água, e passaram a receber 4L/d da dieta líquida, dividida em 2 refeições até o desaleitamento na sexta semana, e concentrado incial ad libitum. Diariamente, foi realizada avaliação do escore fecal. Semanalmente, foram realizadas pesagens, medidas de crecimento corporal e colheitas de sangue, para a determinação de glicose, N-uréico e -hidroxibutirato (BHBA) até a oitava semana, quando se encerrou o período experimental. Não foi observada diferença significativa (P>0,05) entre os tratamentos ou interação Tratamento x Idade para os parâmetros de consumo, ganho de peso, crescimento corporal e parâmetros sanguíneos. Entretanto, foi observado efeito de Idade para todos os parâmetros avaliados (P<0,0001). O escore fecal também não foi afetado pelos tratamentos, no entanto, os animais recebendo MOS via sucedâneo lácteo apresentaram médias numericamente menores nas duas primeiras semanas de vida, demonstrando menor ocorrência de diarréia. Não foram observados efeitos significativos (P>0,05) de tratamento ou da interação tratamento x Idade nas concentrações plasmáticas de glicose, N-uréico ou BHBA. No entanto, houve efeito de Idade nos parâmetros plasmáticos, sendo observadas concentrações crescentes de N-uréico e BHBA, indicando adequado desenvolvimento ruminal. No segundo experimento, foi avaliada a inclusão de substâncias húmicas no concentrado inicial e seus efeitos no desempenho e desenvolvimento ruminal. Foram utilizados 20 animais, todos machos inteiros, em delineamento experimental blocos completos aleatorizados, distribuídos nos seguintes tratamentos: 1) controle; 2) substâncias húmicas (SH, NutriHume®), fornecido via concentrado inicial. O manejo nutricional e os parâmetros avaliados foram os mesmos do primeiro experimento. Entretanto, os animais foram desaleitados na oitava semana de idade e foram abatidos para análise do desenvolvimento do trato digestório superior. Não houve efeito significativo (P>0,05) dos tratamentos ou da interação Tratamento x Idade para os parâmetros consumo de concentrado, ganho de peso ou medidas de crescimento corporal, embora tenha ocorrido efeito de Idade (P<0,0001). O escore fecal também não foi afetado pela inclusão de substâncias húmicas (P>0,05), embora os animais tenham apresentado com grande frequência escores que indicam ocorrência de diarréia. Não houve efeito da inclusão de substâncias húmicas (p>0,05) para as medidas morfométricas do trato digestório superior, número, largura ou altura de papilas do epitélio ruminal. Nas condições em que os experimentos foram realizados, os aditivos alternativos não apresentaram efeitos benéficos no desempenho, no desenvolvimento ruminal ou na saúde geral de bezerros leiteiros em aleitamento. / Two studies were conducted to evaluate alternative additives to replace antibiotics on dairy calves production under early-weaning program. On the first trial, the addition of mannanoligosaccharides (MOS) in the diet of dairy calves on performance and plasma parameters indicative of rumen development, as well as the route of administration, milk replacer or starter feed, were evaluated. Twenty-four male Holstein calves were utilized in a completely randomized design. Calves were distributed in the following treatments: 1) control; 2) mannanoligosaccharides (4 g / d Bio-Mos®, Alltech Biotech.) via starter feed; 3) mannanoligosaccharides ( 4 g / d Bio-Mos®, Alltech Biotech.) delivered via milk replacer. The animals were housed in individual hutches, with free access to water, and received 4L / d liquid diet, split into 2 meals, until weaning at six weeks, and starter feed ad libitum. Fecal scores were evaluated daily. Weekly calves were weighted and growth measurements and blood samples for glucose, urea-N and -hidroxibutyrate (BHBA) were taken until the eighth week of age, when the experimental period ended. There was no significant (P> 0.05) effect of treatment or treatment x age interaction for intake, weight gain or body growth. However, there was an age significant effect for all evaluated parameters (P <0.0001). The fecal score was not affected by treatments; however, animals fed MOS via milk replacer presented averages numerically smaller in the first two weeks of life, showing a lower incidence of diarrhea. No significant effects (P>0.05) of treatment or the interaction treatment x age were also observed for plasma concentration of glucose, urea-N or BHBA. However a significant age effect was observed for plasma parameters, with increasing concentrations for urea-N and BHBA, suggesting adequate rumen development. On the second trial, the inclusion of humic substances in the starter and its effects on performance and rumen development were evaluated. Twenty Holstein male calves were used in a completely randomized block design and distributed in two treatments according to inclusion of humic substances in the concentrate starter: 1) Control; 2) Humic substances (Nutrihume®). Nutritional management and evaluated parameters were the same as described for the first trial. However, calves were weaned at the eighth week of age and slaughtered for rumen development evaluation. There were significant effect (P>0.05) for treatment or the interaction treatment x age for concentrate intake, weight gain or growth measurements. Fecal scores were also not affected (P>0.05) by the inclusion of humic substances, even though calves presented frequently high fecal scores, indicating high incidence of diarrhea. There were no significant effects (P>0.05) of humic substances inclusion on the rumen morphometrics measures and papillae number, height or width. On the conditions of these studies, the alternative additives presented no beneficial effects on performance, rumen development or general health of milk-fed dairy calves.

Les pratiques d’élevage courantes effectuées en production vache-veau sont nécessaires, mais certaines d’entre elles peuvent causer de la douleur ou du stress aux animaux. Les données disponibles sur la façon dont elles sont réalisées ainsi que sur les stratégies en place qui réduisent l'impact négatif sur le bien-être animal dans les élevages vache-veau du Québec sont rares. Les objectifs de cette étude étaient donc 1) de décrire la façon dont les producteurs vache-veau réalisent les pratiques d'élevage courantes associées à la douleur et au stress (gestion du vêlage, castration, écornage, identification des animaux, sevrage et euthanasie); 2) d'évaluer l'utilisation de stratégies alternatives et de méthodes de gestion de la douleur ainsi que d’identifier les facteurs associés avec leur utilisation; et 3) de déterminer si ces pratiques sont en conformité avec les recommandations et les exigences décrites dans les normes canadiennes. Un questionnaire bilingue en ligne et sur papier administré en 2019 évaluant les pratiques des entreprises réalisées en 2018 a été rempli par 156 producteurs vache-veau de différentes régions du Québec. Dans l'ensemble, les entreprises avaient une médiane de 36,5 vaches adultes. Après un vêlage difficile assisté, 44,4% des producteurs ont déclaré avoir utilisé une méthode de gestion de la douleur pour au moins une vache ou un veau. La castration à l’élastique était la méthode de castration la plus commune (97,4%). La principale méthode d'écornage utilisée par les répondants était la pâte caustique (43,4%). Au total, 39,7% et 16,4% des producteurs ont administré un médicament pour la gestion de la douleur à au moins un veau lors de l'écornage et de la castration, respectivement. Aucun répondant n'a rapporté avoir marqué au fer des bovins. Le sevrage par séparation complète était la méthode de sevrage la plus répandue (54,2%). La mort naturelle due à une maladie chronique ou à la vieillesse était le type de décès à la ferme le plus courant chez les vaches adultes (40,9%). Environ un tiers des répondants (28,8%) a euthanasié au moins un animal en 2018. L’arme à feu était la méthode d'euthanasie la plus utilisée (63,6%). Les pratiques mises en œuvre étaient pour la plupart conformes aux normes de l’industrie canadienne du bœuf. L'utilisation de méthodes de gestion de la douleur ainsi que la prise de décision d'euthanasier en temps opportun représentent les principales lacunes à combler pour améliorer le bien-être des animaux dans les entreprises vache-veau du Québec. / Common husbandry practices that are carried out in cow-calf production are necessary, but some of these practices can cause pain or stress to animals. Data availability on how they are performed as well as the strategies that reduce the negative impact on animal welfare implemented in Quebec cow-calf operations are sparse. The objectives of this study were therefore 1) to describe how cow-calf producers perform common husbandry practices normally associated with pain and stress (calving management, castration, dehorning, animal identification, weaning, and euthanasia); 2) to assess the use of alternative strategies and pain mitigation practices as well as factors associated with their use; and 3) to determine if these practices are in compliance with the recommendations and requirements described by the Canadian guidelines. An online and paper-based bilingual questionnaire administered in 2019 evaluating on-farm practices carried out in 2018 was completed by 156 Quebec cow-calf producers from different regions. Overall, operations had a median of 36.5 adult cows. After an assisted difficult calving, 44.4% of producers reported having given pain mitigation at least to a cow or a calf. Band castration was the most used castration method (97.4%). More than half of respondents (62.5%) reported having > 75% of polled calves. The main dehorning method used by respondents was caustic paste (43.4%). A total of 39.7% and 16.4% of producers administered a pain mitigation drug to at least one of their calves undergoing dehorning or castration, respectively. No respondent reported the use of iron branding for cattle. Traditional abrupt weaning was the most reported weaning method (54.2%). Natural death from chronic disease or old age was the most common type of on-farm death in adult cows (40.9%). Less than a third of respondents euthanized at least one animal (28.8%) in 2018. The gunshot was the most reported euthanasia method (63.6%). As hypothesized, practices carried out were mostly in compliance with the Canadian beef industry guidelines. The use of pain mitigation practices and stress-reducing methods as well as timely euthanasia decisions represent the main shortcomings that should be addressed to improve the welfare of animals in Quebec cow-calf operations.

Bakgrund: Under året 2020 spreds Covid 19-viruset och en global pandemi bröt ut. Patienterna som vårdades på intensivvårdsavdelningar hade symtom i form av respiratorisk insufficiens och vårdades i respirator. Intensivvårdssjuksköterskorna ställdes inför en ny patientkategori med avvikande symtom och reaktioner på behandling. Att träna ur patienter från respirator är en tidskrävande process som kräver förberedelser och planering. Hänsyn ska tas till flera faktorer, både fysiska, psykiska och miljömässiga. Syfte: Syftet var att beskriva intensivvårdssjuksköterskors upplevelser av urträningsprocessen vid respiratorbehandling av patienter med Covid-19.Metod: En intervjustudie med kvalitativ ansats gjordes och författarna analyserade materialet genom kvalitativ innehållsanalys. Totalt medverkade 10 intensivvårdssjuksköterskor i studien. Huvudresultat: Huvudkategorierna som framkom ur resultatet var ”intensivvårdssjuksköterskans nya erfarenheter och utmaningar under urträningsprocessen” ” Det kollegiala stödet är viktigt” samt ”behov av tydligare struktur för personalen under urträningsprocessen”. Det essentiella som identifierades var intensivvårds-sjuksköterskornas upplevelse av att arbeta med en ny och dittills okänd patientkategori, de upplevde det som en utmaning både yrkesmässigt och känslomässigt. De emotionella känslorna som intensivvårds-sjuksköterskan upplevde att hon ställdes inför var uppgivenhet, meningsfullhet, tålamodsprövning och svårigheten av att se patienterna lida av ångest. Det kollegiala stödet var betydelsefullt under den här perioden men bristen på fysioterapeuter, riktlinjer och kontinuitet identifierades.Slutsats: Att inte kunna förlita sig på sin tidigare kunskap gällande patientens vård upplevdes som frustrerande och osäkert eftersom Covid-19 är och var en ny sjukdom. Genom att utarbeta riktlinjer, upprätthålla en god kollegial stämning, skapa högre tillgänglighet av fysioterapeuter samt att vårdarbetet genomsyras av kontinuitet så kan patientsäkerheten öka, arbetsmiljön optimeras och intensivvårdssjuksköterskan kan känna en högre grad av säkerhet i sitt arbete. Det identifierades både organisatoriska och patientrelaterade faktorer som eventuellt kan ha påverkat längden på urträningsprocessen från respirator. / Background: During 2020, COVID-19 spread across the globe resulting in a pandemic. Patients that required intensive care suffered from respiratory insufficiency and were put on mechanical ventilation support. Intensive care unit (ICU) nurses were exposed to a new category of patients with unfamiliar symptoms and unpredictable reactions to treatment. Weaning patients from mechanical ventilation is a time consuming process that requires preparation and planning. Consideration needs to be taken to both physiological and psychological factors. Aim: To describe the ICU nurses´experiences on weaning patients with Covid-19 from mechanical ventilation. Method: An interview study with qualitative approach was used and the authors analyzed the material through context analysis. A total of 10 ICU nurses participated in the study. Results: The Category that appeared from the result was ”ICU nurses new experience and challengesin the weaningprocess” “The collaboration with the teams is important” and “ The need for better structure under the weaningprocess”. The essential that was identified was the ICU nurses´experience from working with a new and until then unknowncategory of patients, they experienced it as a challenge, both professional and emotional. Emotions that the ICU nurses´felt was a feeling of resignation, meaningfullness, patience testing and the struggle of seeing patients with anxiety. The support from colleagues was signficant under this period but the lack of physiotherapists, guidelines and need of continuity in the care for the patients was identified. Conclusion: To not be able to rely on ones previous knowledge about patients caregiving was frustrating and uncerting because the Covid 19 was a new type of disease. By developing guidelines, maintaining good teamwork, create a higher availability of physiotherapists and to let the caregiving of patients contain continuitycan the patient safety be increased, the working evironment can be optimized and the ICU nurse can feel a higher experience of surety in her work. It was identified that the organizational and patient related factors could have prolonged the weaning process from mechanical ventilation.

Bakgrund: Avvänjning från respirator är en stor del av intensivvården. Där övergången från att andas med hjälp av respirator till att hitta den egna spontana andningen är en komplex uppgift för intensivvårdsjuksköterskan och kräver både tid och kompetens. Syfte: Syftet var att beskriva intensivvårdssjuksköterskans erfarenheter av vuxna patienters avvänjning från respirator. Metod: Kvalitativ design med semistrukturerade intervjufrågor användes. Studien innehöll totalt åtta stycken deltagare från två sjukhus i Sverige. Innehållsanalys med induktiv ansats användes vid analysen. Resultat: När analysen var klar framkom 5 stycken kategorier. Kategorierna var: Att förbereda och informera patienten, att patienten inte är stressad, att använda avvägningsprotokoll, betydelse av samarbete och kommunikation samt patientens tid i respiratorn har betydelse. Resultatet belyste sjuksköterskans erfarenheter kring en individuell vård, samarbetet och kommunikation. Diskussion: Ett protokoll som efterföljs har visat sig förbättra avvänjningen för patienten, samtidigt bör en individuell planering finnas med. Kommunikationen och närhet med patienten är viktig för att kunna åtgärda oro och stress och skapa trygghet. Slutsats: Resultatet påvisade att det var viktigt med kommunikation mellan intensivvårdssjuksköterskan, patienten och läkaren. Det var också viktigt att ge patienten bra förutsättningar till att lyckas med avvänjningen. / Background: Weaning from the respirator is a large part of intensive care. The transition from breathing with the help of a respirator to finding its own spontaneous breathing is a complex task for the intensive care nurse and requires both time and competence. Aim: To describe the intensive care nurse's experience of adult patients weaning from respirator. Method: Qualitative design with semi-structured interview questions was used. The study included a total of eight participants from two hospitals in Sweden. Content analysis with inductive approach was used in the analysis. Results: When the analysis was completed, five categories. The categories were: Prepering and informing the patient, that the patient is not stressed, using balancing protocols, importance of cooperation and communication and the patient´s time in the respirator is important. The result highlighted the nurseś experiences regarding individual care, cooperation and communication. Discussion: A protocol that was followed has been shown to improve the respitory weaning for the patient while at the same time a individual planning should be involved. Communication and vicinity for the patient are important in order to be able to remedy anxiety and stress and create security. Conclusion: The result showed that communication between the intensive care nurse, the patient and the doctor is important. It is also important to give the patient the best possible conditions to succeed in weaning. / <p>Godkännandedatum: 2019-11-08</p>

Les variations entre les nourrissons quant à la vitesse à laquelle ils atteignent l'indépendance nutritionnelle affectent les trajectoires de développement des nourrissons et entraînent des différences entre les femelles au niveau de la performance reproductive. Le moment des transitions alimentaires, notamment l'âge auquel les nourrissons commencent à consommer des aliments solides et l'âge du sevrage (c'est-à-dire le dernier allaitement avec transfert de lait), est difficile à déterminer par l'observation chez les primates sauvages. Il est difficile de distinguer le moment où les nourrissons se livrent à une mise en bouche exploratoire de celui où ils ingèrent réellement des aliments solides, et de déterminer si les contacts observés avec les mamelons reflètent une lactation continue, car les petits sevrés peuvent s'allaiter de confort (sans transfert de lait). Les isotopes stables de carbone et d'azote (δ13C, δ15N, %N) dans les fèces ou les poils peuvent être utilisés pour déterminer les transitions alimentaires. Alors que les isotopes stables fécaux sont sensibles à l'échantillonnage occasionnel d'aliments solides et montrent une forte variation quotidienne, les isotopes stables des poils montrent un amalgame de l'apport alimentaire sur quelques mois. Pour atténuer les limites des isotopes stables fécaux et de l'observation, j'ai appliqué des analyses δ13C, δ15N, %N à la kératine des fils de poils (0-7 ans, N = 169 échantillons de poils) collectés auprès de mères et de nourrissons chimpanzés sauvages (Pan troglodytes) à Ngogo, en Ouganda. En 2013-2014 et 2018, les poils ont été collectés de manière non invasive lorsqu'ils se collaient aux excréments, ou sur le sol après que les mères et les nourrissons se soient toilettés ou reposés. Premièrement, mon objectif était d'utiliser une combinaison de techniques visuelles (longueur et diamètre des fils de poils), associées à des isotopes stables des poils pour distinguer les fils de poils maternels des fils de poils infantiles. Deuxièmement, mon objectif était de déterminer l'âge précis auquel la contribution relative de la nourriture solide l'emporte sur la contribution relative du lait dans le régime alimentaire des bébés chimpanzés sauvages afin de suivre les processus d'alimentation transitoire et de sevrage. Les mèches de cheveux du nourrisson n'ont pas pu être distinguées des mèches de cheveux de la mère en utilisant uniquement des techniques visuelles. Les longueurs (cm) et les diamètres (μm) des poils de la mère et du nourrisson ne présentaient pas de différences suffisamment importantes et cohérentes pour pouvoir être utilisées seules pour distinguer les poils. Cependant, les poils des mères et des nourrissons se sont avérés plus fins et plus courts que ceux des mâles adultes (~20 μm de moins pour les nourrissons). Pour évaluer les limites des isotopes stables fécaux et de l'observation, des analyses δ13C, δ15N, %N ont été appliquées à la kératine de mèches de cheveux (0-7 ans, N = 169 échantillons de cheveux) collectées auprès de mères et de nourrissons chimpanzés sauvages (Pan troglodytes) à Ngogo, en Ouganda. Les nourrissons ≤ 2 ans présentaient le plus grand rapport d'isotopes stables de carbone et d'azote (δ13C et δ15N). Les nourrissons âgés de 1.5 à 2 ans présentaient des ratios moyens de δ13C (-22,2 permil, ‰) et de δ15N (9,2‰) supérieurs à ceux des nourrissons ≤ 1.5 ans (valeur moyenne de δ13C de -23,2‰, valeur moyenne de δ15N de 8,6‰). Cela indique que les nourrissons ≤ 2 ans avaient un régime alimentaire global dominé par le lait maternel et consommaient moins d'aliments végétaux solides par rapport aux nourrissons plus âgés (δ13C de -23.8 ‰, δ15N de 7.4 ‰). Le changement dans les rapports δ13C une fois que les nourrissons ont dépassé 2 ans a suggéré que les nourrissons ont incorporé une plus grande quantité d'aliments solides dans leur régime alimentaire vers cet âge, ce qui pourrait être le moment où le processus de sevrage a commencé. Nous n'avons pas pu évaluer l'âge de la fin du sevrage, et nous aurons besoin à l'avenir de plus d'échantillons de poils de nourrissons plus âgés pour établir quand le sevrage se termine chez les chimpanzés. Cette étude peut être utilisée dans les évaluations futures des régimes alimentaires des primates, et pour déterminer les âges précis des transitions alimentaires chez les chimpanzés, ce qui fournira des données de base pour reconstruire le chemin évolutif qui a conduit à l'histoire de vie unique (sevrage précoce, fécondité élevée) des humains. / Variation between infants in the speed in which they reach nutritional independence affects infant developmental trajectories and leads to differences between females in reproductive output. Timings of feeding transitions, including the age infants begin consuming solid food, and age at the weaned event (i.e. last nursing bout with milk transfer), are difficult to determine both obervsationally and behaviourally in wild primates. It is difficult to distinguish when infants engage in exploratory mouthing versus actual ingestion of solid food, and to identify if observed nipple contacts reflect continued lactation, as weanlings can comfort nurse (without milk transfer). Stable carbon and nitrogen isotopes (δ13C, δ15N, %N) in feces or hair can be used to determine feeding transitions. While fecal stable isotopes are sensitive to occasional sampling of solid food and show high day-to-day variation, hair stable isotopes show an overall average of dietary intake over a few months. To assess fecal stable isotope and observational limitations, δ13C, δ15N, %N analyses were applied to keratin of hair strands (0-7 years, N = 169 hair samples) collected from wild chimpanzee (Pan troglodytes) mothers and infants at Ngogo, Uganda. In 2013-2014 and 2018, hairs were collected non-invasively when they stuck to feces, or from the ground after mothers and infants groomed or rested. First, my goal was to use a combination of visual techniques (hair strand length and diameter), combined with hair stable isotopes to distinguish maternal hair strands from infant ones. Second, my goal was to determine the precise age when the relative contribution of solid food outweighs the relative contribution of milk in the infant diet of wild chimpanzees to track the processes of transitional feeding and weaning. Infant hair strands could not be distinguished from maternal hair strands using only visual techniques. The lengths (cm) and diameters (μm) of maternal versus infant hair strands did not show great enough and consistent differences that could alone be used to distinguish the hairs. However, maternal and infant hair strands proved to be thinner and shorter to that of adult male hair (~20 μm lower for infants). I therefore relied on the stable isotope values themselves to distinguish the hairs, as infant hairs were enriched in the heavy carbon and nitrogen isotopes compared to their mothers. Infants ≤ 2.0 years old had the greatest ratio of stable carbon and nitrogen isotopes (δ13C and δ15N). Infants between 1.5 and 2.0 years old had greater average ratios of δ13C (-22.2 permil, ‰) and δ15N (9.2 ‰) than infants ≤ 1.5 years old (δ13C mean value of -23.2 ‰, δ15N mean value of 8.6 ‰). This indicated that infants ≤ 2.0 years old had an overall diet dominated by maternal milk and consumed less solid plant foods compared to older infants (δ13C mean value of -23.8 ‰, δ15N mean value of 7.4 ‰). The change in δ13C ratios once infants surpassed two years old suggested that infants incorporated a greater amount of solid food into their diet near this age. This indicated that the weaning process begins at approximately two years old. As the age of the weaned event remained unassessed, more hair samples are required from older infants to establish when weaning ends in chimpanzees. This study can be used in future assessments of primate diets, and to determine precise ages at feeding transitions in chimpanzees, which will provide basic data to reconstruct the evolutionary path that led to the unique life history (early weaning, high fecundity) of humans.

La présente étude visait à déterminer les effets de l'âge de sevrage sur les performances de croissance, le développement du rumen et le microbiote chez les chevreaux alpins. Soixante-douze chevreaux ont été assignés au hasard par paires mâle et femelle à l'un des trois traitements. 1) sevrage précoce (EW), à l'âge de 6 semaines, 2) sevrage moyen (MW), à l'âge de 8 semaines (MW) et 3) sevrage tardif (LW), à 10 semaines d’âge (LW). Le lait de remplacement a été proposé ad libitum jusqu'à la semaine de sevrage, où le lait a été réduit de 12.5 % par jour pendant sept jours. Deux semaines après la naissance, du concentré, du foin et de l'eau ont été offerts à volonté jusqu'à l'âge de 12 semaines où les chevreaux ont été abattus. La consommation a été enregistrée quotidiennement et le poids corporel (PC) a été enregistré chaque semaine. Pour évaluer le développement du rumen, des échantillons de sang ont été prélevés pendant tout l'essai et analysés pour le β-hydroxybutyrate sanguin (BHB) et les acides gras non estérifiés (NEFA). Les mesures ruminales ont été prises à la semaine 12 avec les trente-six mâles seulement. Le contenu du rumen a été obtenu pour l'analyse de la composition bactérienne en utilisant la région V4 du gène de l'ARNr 16S et la qPCR a été utilisée pour quantifier les bactéries, les protozoaires et les champignons. Les papilles du rumen ont été analysées dans 4 régions du rumen : atrium du rumen (RA), sac ventral (VS), Cul-de-sac caudo-dorsal (DS) et Cul-de-sac caudo-ventral (VBS). Les chevreaux sevrés à 10 semaines, contre 8 semaines et 6 semaines avaient un gain quotidien moyen plus élevé pour la semaine post-sevrage (0.35 vs. 0.24 vs. 0.24 kg/j) et étaient plus lourds à la 12e semaine (27.44 vs. 25.45 vs. 24.07 kg, P< .05). Chez les animaux LW, le PC n'a pas été affecté pendant la période post-sevrage; probablement en raison d'un apport élevé en énergie métabolisable (EM) causé par la stratégie de sevrage contrairement à ce que nous observons chez les animaux EW et MW. Les taux sanguins de BHB ont augmenté au moment du sevrage pour tous les traitements, mais étaient plus élevés chez les chevreaux EW par rapport aux chevreaux MW (+ 21 %) et LW (+ 41 %) (P< .05). Les taux sanguins de NEFA chez les chevreaux EW ont augmenté au sevrage et étaient plus élevés que MW (+ 40 %) et LW (+ 101 %) chez les chevreaux (P< .05), suggérant une mobilisation plus prononcée du tissu adipeux chez les chevreaux sevrés précocement au sevrage. La population de microbiote en post-sevrage a montré que si le sevrage était retardé, l'abondance des bactéries totales semblait augmenter (P< .05) par rapport aux animaux EW, tandis que les protozoaires et les champignons diminuaient pour les LW. L'âge du sevrage semble induire des modifications du microbiote ruminal au cours du post-sevrage. Les mesures d'absorptiométrie à rayons X à double énergie (DEXA) des carcasses ont été utilisées comme indication de la récupération de la composition des graisses après le sevrage. Le tissu adipeux (%) dans LW était (9.4%) et EW était (7.2%) plus élevé par rapport à MW (P< .05). La surface totale de la papille était plus grande chez les chevreaux LW, par rapport aux chevreaux MW (+ 49 %) et EW (+ 22 %) (P< .05). Globalement, le sevrage des chevreaux à l'âge de 10 semaines a limité l'impact négatif d'un sevrage précoce sur la croissance et le développement du rumen de la race alpine. / The present study aimed to determine the effects of weaning age on growth performance, rumen development and microbiota composition in Alpine goat kids. Seventy-two kids were randomly assigned in pairs male and female to one of three treatments. 1) early weaning, at 6 wk of age (EW), 2) medium weaning, at 8 wk of age (MW) and 3) late weaning, at 10 wk of age (LW). Milk replacer (MR) was offered ad libitum until the step-down wk, when milk was reduced by 12.5% per day for seven days. Two wk after birth, starter ration, hay, and water were offered ad libitum until 12 wk of age where kids were slaughtered. Feed intake was recorded daily, and body weight (BW) was recorded weekly. To evaluate rumen development, blood samples were taken during the whole trial and analyzed for blood β-hydroxybutyrate (BHB) and non-esterified fatty acids (NEFA). Ruminal measurements such as papillae, VFAs and microbiota were taken at wk 12 with only thirty-six males. Rumen contents were obtained for bacteria composition analysis using the V4 region of the 16S rRNA gene and qPCR was used to quantify bacteria, protozoa and fungi. Rumen papillae were obtained for histological analysis in 4 rumen areas: rumen atrium (RA), ventral sac (VS), caudodorsal blind sac (DS), and caudoventral blind sac (VBS). Kids weaned at 10 wk, compared with 8 wk and 6wk had higher average daily gain for the wk postweaning (0.35 vs. 0.24 vs. 0.24 kg / d) and were heavier at wk 12 (27.44 vs. 25.45 vs. 24.07 kg, P< .05). In LW animals, BW was not affected during post weaning period; possibly due to high metabolizable energy (ME) intake caused by the weaning strategy contrary to what was observed in EW and MW animals. Blood levels of BHB increased at weaning time for all treatments but were higher in EW compared to MW (+21%) and LW (+41%) kids (P< .05). Blood levels of NEFAs in EW kids spiked at weaning and were higher than MW (+ 40%) and LW (+101%) in kids (P< .05), suggesting a more pronounced adipose tissue mobilization in early weaned kids at weaning. Microbiota population in postweaning showed that while weaning was delayed, abundance of total bacteria seemed to increase (P< .05) compared with EW animals, whereas protozoa and fungi decreased for LW. Weaning age influences the ruminal microbiota during postweaning. Dual-energy X-ray absorptiometry (DEXA) measurements of carcasses were used as an indication of fat composition recovery in post-weaning. Fat tissue (%) in LW was (9.4%), and EW was (7.2%) higher compared to MW (P< .05). The total papilla surface area was greater in LW, compared to MW (+49%) and EW (+22%) kids (P< .05). Overall weaning kids at 10 wk of age limited the negative impact of earlier weaning on growth and rumen development in the Alpine breed.

Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome exhibited by infants born to mothers with opioid use disorder (OUD). The American College of Obstetricians and Gynecologists and other professional societies endorse opioid agonist pharmacotherapy (MATs) as the optimal treatment for OUD during pregnancy. This study focuses on impact of weaning of MAT drugs on the incidence of NAS and neonatal birth outcomes among babies born to women with opioid exposure. The study population included eighty-six pregnant women with OUD, divided in to weaning and non-weaning groups based on their choice to wean the MATs during pregnancy. Univariate analysis was performed between the clinical and demographic variables of both groups. Multivariate analysis was performed to find the association between outcome variables and predictor variables. All analyses were conducted using SAS version 9.4. The study identified a significant negative correlation (p-value: 0.0099) between weaning from MATs and NAS incidence. The study showed significant correlations of weaning with shorter LOS (p-value: 0.0036) and higher birth weights (p-value: 0.0408). Weaning emerged as a significant predictor for decreasing the incidence of NAS and improving the neonatal outcomes. Logistic regression confirmed weaning as a protective factor (odds ratio: 4.881 CI: 1.3, 18.1). The intricacies of weaning of MATs in the context of OUD during pregnancy present profound health and ethical considerations for both mothers and infants. The investigation into NAS incidence among infants born to women with OUD revealed a significant association with weaning from MATs during pregnancy. The study highlights the potential benefits of weaning, offering insights into optimized neonatal care and efficient healthcare resource utilization.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

INTRODUÇÃO: A redução automática da pressão de suporte (PS) baseada na freqüência respiratória, ou MRV (mandatory rate ventilation) é um modo ventilatório disponível no ventilador Taema-Horus. A hipótese do estudo é que o MRV utilizado no desmame é tão efetivo quanto o desmame manual em pacientes em pós-operatório na unidade de terapia intensiva (UTI). MÉTODOS: Ao chegar à UTI, após a cirurgia, os pacientes eram randomizados em dois grupos: desmame manual ou automático. O desmame manual consistiu na redução manual da PS a cada 30 minutos mantendo a relação freqüência respiratória sobre volume corrente menor do que 80, até a PS de 5-7 cmH2O. O desmame automático baseou-se na freqüência respiratória alvo de 15 respirações por minuto (o ventilador diminui automaticamente, a PS em 1 cmH2O a cada 4 ciclos respiratórios, se o paciente mantiver a freqüência respiratória abaixo deste valor). O objetivo primário do estudo foi comparar a duração do processo de desmame. Secundariamente verificamos o nível de PS, freqüência respiratória, volume corrente, índice de freqüência respiratória sobre volume corrente, pressão positiva expiratória final, fração inspirada de oxigênio e saturação de oxigênio requeridos durante o processo de desmame. Verificamos também necessidade de reintubação e necessidade de ventilação não invasiva nas primeiras 48 horas após a extubação. RESULTADOS: Não houve diferença estatística significativa entre os 53 pacientes selecionados em cada grupo quanto ao sexo (p=0541), idade (p=0,585) e tipo de cirurgia (p=0,172). Dezenove pacientes foram excluídos durante o protocolo (quatro no grupo manual e quinze no grupo automático, p<0,05). Nove pacientes do grupo automático foram excluídos do protocolo por não se adaptarem ao modo de desmame automático. Oitenta e sete pacientes concluíram o estudo, quarenta e nove pacientes foram desmamados manualmente e trinta e oito automaticamente. A duração do processo de desmame foi de 205,41±181,27 minutos (de 30 a 840 minutos) no grupo manual, e 157,33±129,98 minutos (de 30 a 545 minutos) no grupo automático. Não houve diferença estatística significante quanto ao tempo de desmame entre os dois grupos. O nível de PS foi maior (p<0,001) e freqüência respiratória foi menor (p=0,0098) no modo MRV comparado ao modo manual, durante o processo de desmame. Não houve necessidade de reintubação em nenhum dos grupos. Houve necessidade de ventilação não invasiva em dois pacientes do grupo manual (p=0,505), ambos sofreram cirurgia cardíaca. CONCLUSÃO: A redução automática da PS foi efetiva e pode ser utilizada no desmame de pacientes no pós-operatório na unidade de terapia intensiva, se o paciente se adaptar ao algoritmo do MRV / Introduction: Automatic pressure support reduction based on a target respiratory frequency or MRV is available in the TAEMA-HORUS ventilator for the weaning process in the ICU setting. We hypothesized that MRV is as effective as manual weaning in post-operative ICU patients. Methods: There were 106 patients selected, in the post-operative period in a prospective, randomized, controlled protocol. When the patients arrived in the ICU after surgery, they were randomly assigned to traditional weaning, consisted of the manual reduction of pressure support every thirty minutes, keeping the RR/TV(L) < 80 till 5-7 cmH20 of PSV. Alternatively, they were assigned to automatic weaning, referring to MRV set with a respiratory frequency target of 15 breaths per minute (the ventilator automatically decreased the PSV level by 1 cmH20 every 4 respiratory cycles, if the patients RR was less than 15 per minute). The primary endpoint of the study was the duration of the weaning process. Secondary endpoints were levels of pressure support, respiratory rate, tidal volume (mL), RR/VT (L), PEEP levels FiO2 and SpO2 required during the weaning process, the need for reintubation and the need for non-invasive ventilation in the 48 hours after extubation. Results: There were no statistically significant differences between the 53 patients selected for each group regarding gender (p=0.541), age (p=0.585) and type of surgery (p=0.172). Nineteen patients were excluded during the trial (4 in the PSV group and 15 in the MRV group, p<0.05). Eighty-seven patients concluded the study, forty-nine patients were weaned manually and thirtyeight automatically. The weaning duration process was 205.41 ± 181.27 minutes (30 to 840 minutes) for the manual group and 157. 33± 129.98 minutes (30 to 545 minutes) for MRV group (p=0.167). PSV levels were significantly higher and RR was lower in MRV compared to that of the PSV manual reduction (p<0.05). Reintubation was not required in either group. NIV was necessary for two patients, in the manual group after cardiac surgery (p=0.505). Conclusion: The automatic reduction of pressure support was effective and can be useful for weaning patients in the post-operative period in the ICU, if the patient is receptive to the MRV algorithm

INTRODUÇÃO: A literatura tem postulado que a ventilação por pressão positiva não invasiva (VNI) pode facilitar o desmame de um grupo específico de pacientes. O objetivo deste estudo foi comparar a utilização da VNI como método alternativo na supressão da ventilação mecânica no pós-operatório de cirurgia cardíaca. MÉTODOS: Neste estudo prospectivo controlado e randomizado, foram estudados 100 pacientes submetidos a cirurgia de revascularização do miocárdio ou cirurgia valvar. Os pacientes foram admitidos na Unidade de Terapia Intensiva (UTI), sob ventilação mecânica e randomizados posteriormente em grupo estudo (n= 50), que utilizou VNI com dois níveis pressóricos após extubação, e grupo controle (n= 50), que utilizou a técnica convencional de supressão da ventilação mecânica. Foram analisados os tempos correspondentes à anestesia, cirurgia, circulação extracorpórea e ventilação mecânica na UTI. As variáveis gasométricas, hemodinâmicas e radiológicas foram avaliadas antes e após a extubação. RESULTADOS: Os grupos controle e estudo apresentaram comportamento semelhante quanto ao tempo de desmame ventilatório e as outras variáveis estudadas não apresentaram diferença estatística. A utilização da VNI por 30\' após a extubação, nos pacientes com atelectasias, promoveu diferença significativa na PaCO2 no grupo coronariano e na PaO2 no grupo submetido à cirurgia valvar. CONCLUSÃO: O tempo para supressão da ventilação mecânica foi similar nos grupos. Fatores extrísecos interferiram na evolução do desmame. O uso da VNI por 30 minutos após extubação apresentou diferença estatisticamente significante nas variáveis gasométricas em pacientes com atelectasias / INTRODUCTION: It was postulated that noninvasive positive pressure ventilation (NPPV) could facilitate ventilatory weaning in specific patients. The aim was to compare NPPV as alternative ventilatory weaning method with a standard ventilatory weaning protocol in the immediate postoperative period of cardiac surgery. METHODS: One hundred consecutive patients submitted to coronary artery bypass grafting or valvar surgery were addmitted in the Intensive Care Unit (ICU) and mechanicanically ventilated. They were randomly assigned to a study group (n=50) wich use NPPV witn bilevel presssure in the airways and a control group (n=50) witch used the conventional weaning thecnique. The outcome measures were anestesie, surgery, cardiopulmonar bypass and mechanical ventilation time. Arterial blood gases, hemodynamics and chest X-rays were assessed pre and post extubation. RESULTS: Weaning times were similar in both groups, and no differences were found in the studied variables. There were statistic significance considering PaCO2 in coronary and PaO2 in valvar group using NPPV 30\' after extubation, when atelectasis was detected. CONCLUSION: The ventilatory weaning time was similar in both groups. Extrinsics factors had interfered in weaning evolution. NPPV use during 30\' after extubation had statistical significance in gasometric variables in patients with athelectasis