human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The main objectives of this prospect i ve cohort study were a ) to describe lameness prevalence at drying off in large high producing New York State herds based on visual locomotion score ( VLS ) and identify potential cow and herd level risk factors , and b ) to develop a model that will predict the probability of a cow developing claw horn disruption lesions ( CHDL ) in the subsequent lactation using cow level variables collected at drying off and /or available from farm management software . Data were collected from 23 large commercial dairy farms located in upstate New York . A total of 7,687 dry cows , that were less than 265 days in gestation , were enrolled in the study . Farms were visited between May 2012 and March 2013 , and cows were assessed for body condition score ( BCS ) and VLS . Data on the CHDL events recorded by the farm employees were extracted from the Dairy-Comp 305 data base , as well as information regarding the studied cows ’ health events , milk production , and reproductive records throughout the previous and subsequent lactation period . Univariable analyses and mixed multivariable logistic regression models were used to analyse the data at the cow level . The overall average prevalence of lameness ( VLS > 2 ) at drying off was 14 % . Lactation group , previous CHDL , mature equivalent 305-d milk yield ( ME305 ) , season , BCS at drying off and sire PTA for strength were all significantly associated with lameness at the drying off ( cow-level ) . Lameness at drying off was associated with CHDL incidence in the subsequent lactation , as well as lactation group , previous CHDL and ME305 . These risk factors for CHDL in the subsequent lactation were included in our predictive model and adjusted predicted probabilities for CHDL were calculated for all studied cows . ROC analysis identified an optimum cut-off point for these probabilities and using this cut-off point we could predict CHDL incidence in the subsequent lactation with an overall specificity of 75 % and sensitivity of 59 % . Using this approach , we would have detected 33 % of the studied population as being at risk , eventually identifying 59 % of future CHDL cases . Our predictive model could help dairy producers focusing their efforts on CHDL reduction by implementing aggressive preventive measures for high risk cows This paper describes the development and testing of a lameness control programme ( LCP ) for heifers on dairy farms . The LCP , which is based on the analysis of hazards and critical control points ( HACCP ) , was tested via a r and omised intervention study on 60 farms . Tangible hazards for each farm were identified , allotted to 11 categories of proximate hazard and scored on each farm to quantify the risks presented by each hazard . Feet were inspected for signs of claw horn disease and infection , such as digital dermatitis . Intervention was generally ineffective , primarily through failure to implement the LCP . However , retrospective analysis was able to demonstrate highly significant associations between risks attached to proximate hazards and probabilities of lameness and foot lesions , allowing the severity of these hazards to be ranked . The most significant proximate hazards of environmental origin were prolonged st and ing on concrete , st and ing in wet slurry and factors that cause claw trauma . The most severe proximate hazards however were those associated with failures of management , especially poor claw condition and inadequate foot care . Overall farm risks ( OFR ) were estimated by summing the products of the generic severity for proximate hazards with on-farm risks . Changes in OFR were significantly related to changes in outcome ( lameness and lesions ) Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more A 2-year experiment on the effect of claw trimming on hoof health was performed in 77 Swedish dairy herds ( 3444 dairy cattle ) selected on herd size , breed composition and membership in the official milk-recording scheme . In the autumn , cows within each herd were blocked according to breed , parity and stage of lactation and allocated to two treatments : autumn trimming ( AT ) or no autumn trimming ( NAT ) . Outcome variables were claw measurements and prevalence of hoof lesions and lameness ( measured at spring trimming ) and the need for hoof treatments between scheduled trimmings . At spring trimming , NAT cows had longer and shallower claws than AT cows . The average net growth of the toe wall was greater for AT than for NAT cattle , with a marked variation between housing systems . Most hoof lesions present at AT had disappeared at the subsequent spring trimming . Controlled for clustering by herd-within-year and for the effects of individual- and herd-level covariates , AT cattle at spring trimmings had significantly lower odds of lameness ( OR=0.66 ) and of haemorrhages of the sole or white-line ( OR=0.86 ) , sole ulcer ( OR=0.59 ) and white-line fissure or double sole (OR=0.71)-but not of moderate-to-severe heel-horn erosion or dermatitis ( OR=0.96 ) . Acute hoof treatments between claw trimmings were more common in the NAT group ( OR=2.02 ) Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies This study was carried out to detect differences in locomotion and feeding behavior in lame ( group L ; n = 41 ; gait score ≥ 2.5 ) and non-lame ( group C ; n = 12 ; gait score ≤ 2 ) multiparous Holstein cows in a cross-sectional study design . A model for automatic lameness detection was created , using data from accelerometers attached to the hind limbs and noseb and sensors attached to the head . Each cow ’s gait was videotaped and scored on a 5-point scale before and after a period of 3 consecutive days of behavioral data recording . The mean value of 3 independent experienced observers was taken as a definite gait score and considered to be the gold st and ard . For statistical analysis , data from the noseb and sensor and one of two accelerometers per cow ( r and omly selected ) of 2 out of 3 r and omly selected days was used . For comparison between group L and group C , the T-test , the Aspin-Welch Test and the Wilcoxon Test were used . The sensitivity and specificity for lameness detection was determined with logistic regression and ROC- analysis . Group L compared to group C had significantly lower eating and ruminating time , fewer eating chews , ruminating chews and ruminating boluses , longer lying time and lying bout duration , lower st and ing time , fewer st and ing and walking bouts , fewer , slower and shorter strides and a lower walking speed . The model considering the number of st and ing bouts and walking speed was the best predictor of cows being lame with a sensitivity of 90.2 % and specificity of 91.7 % . Sensitivity and specificity of the lameness detection model were considered to be very high , even without the use of halter data . It was concluded that under the conditions of the study farm , accelerometer data were suitable for accurately distinguishing between lame and non-lame dairy cows , even in cases of slight lameness with a gait score of 2.5 Claw horn disruption lesions ( CHDL ) are a major cause of lameness in dairy cattle and are likely a result of excessive forces being applied to the germinal epithelium that produces the claw horn . The digital cushion is a connective tissue structure , containing depots of adipose tissue , that sits beneath the distal phalanx and has been shown to be thicker in fatter cows . Body condition score ( BCS ) loss is a risk factor for CHDL , and one possible explanation is that fat is mobilized from the digital cushion during negative energy balance , causing the digital cushion to thin and lose force-dissipating capacity , leading to disruption of claw horn growth . This prospect i ve cohort study investigated the association between measures of body fat and sole soft tissue ( SST ) thickness ( a combined measure of the corium and digital cushion beneath the distal phalanx ) in a longitudinal manner . The  SST  of 179 cows in 2 high-yielding dairy herds were measured at 5 assessment points between 8 wk before and 35 wk postcalving . The BCS , back fat thickness ( BFT ) , and lesion incidence were recorded . Data were analyzed in a 4-level mixed effects regression model , with the outcome being SST thickness beneath the flexor tuberosity of the distal phalanx . Data from 827 assessment points were available for analysis . The overall mean of SST was 4.99 mm ( st and ard deviation : 0.95 ) . The SST was thickest 8 wk before calving ( 5.22 mm , st and ard deviation : 0.91 ) and thinnest 1 wk postcalving ( 4.68 mm , st and ard deviation : 0.87 ) , suggesting an effect of calving on SST . The BFT was positively correlated with SST in the model with a small effect size ( a 10 mm decrease in BFT corresponded with a 0.13 mm decrease in SST ) , yet the nadir of BFT was 11.0 mm at 9 to 17 wk postcalving ( when SST was ∼4.95 mm ) , rather than occurring with the nadir of SST immediately after calving . The SST also varied with other variables [ e.g. , cows that developed a sole ulcer or severe sole hemorrhage during the study had thinner SST ( -0.24 mm ) ] , except when a sole ulcer was present , when it was thicker ( + 0.53 mm ) . Cows that developed lesions had a thinner digital cushion before the lesion occurrence , which became thickened with sole ulcer presence , perhaps representing inflammation . Furthermore , although BFT was correlated with SST over time , SST may also have been influenced by other factors such as integrity of the suspensory apparatus , which could have a major effect on CHDL . Measures of body fat likely contributed to having thin SST , but other factors including calving , herd , and lesion presence also had an effect Lameness is a severe welfare problem and a production-limiting disease in dairy farming . The objectives of this study were to determine prevalence of lameness and investigate cow- and herd-level factors associated with lameness in dairy cows housed in freestall barns in 3 Canadian provinces . A purposive sample of 40 Holstein-Friesian cows was selected from each of 141 dairy farms in Québec , Ontario , and Alberta . In total , 5,637 cows were scored once for lameness ( presence of limping when walking ) . Data collected included information on individual cows ( hock lesions , claw length , body condition score , parity , days in milk , and milk production ) , management practice s ( floor and stall cleaning routine , bedding routine , and footbath practice s ) , and facility design ( stall dimensions , stall base and bedding type , width of feed alley , flooring type , and slipperiness ) hypothesized to be risk factors for lameness . Multilevel mixed logistic regression models were constructed ( including farm as a r and om effect and province as a fixed effect ) . Herd-level lameness prevalence ranged from 0 to 69 % ( mean = 21 % ) . Lameness prevalence increased with increasing parity ; compared with first parity , cows in parity 2 , 3 , and ≥ 4 had 1.6 , 3.3 , and 4 times , respectively , higher odds of being lame . Furthermore , the odds of lameness were 1.6 times greater in cows with low body condition score ( ≤ 2.5 ) than in cows with a higher body condition score . In addition , injured hocks and overgrown claws were associated with 1.4- and 1.7-fold increased odds of being lame , respectively , whereas every 1 kg increase in daily milk production was associated with a 3 % decrease in the odds of being lame . Lameness prevalence was higher in herds with ≤ 100 cows , but lower in barns with a s and or dirt stall base , or with bedding ≥ 2 cm deep . Cows exposed to very slippery floors had 2 times the odds of being lame compared with cows exposed to nonslippery floors . We attributed the wide range of lameness prevalence to the great variability in facilities and management practice s among farms . Finally , we inferred that the prevalence of lameness could be decreased by improving management of multiparous , thin , or injured cows and by adopting management practice s intended to improve cow comfort , namely the floor 's slip resistance and the stall 's lying surface A field study was conducted to examine effects of oral biotin supplementation for up to 18 mo on risks of lameness in dairy cows . The study included a total of 900 cattle from five dairy farms in Gloucestershire , southwest U.K. , in a within-herd r and omized control trial . The data from this trial were used in this paper to investigate the impact of parity and duration of supplementation with oral biotin at 20 mg/d on white line disease ( WLD ) lameness . Analysis of the data indicated that WLD increased with increasing parity independent of biotin supplementation from approximately two cases per 100 cow years in primiparous cows to 15.5 cases per 100 cow years in all multiparous 
    Output:
    
agent
A higher risk of being lame was found for the presence of claw overgrowth , the first 120 days in milk , larger herd sizes , and increasing parity .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The main objectives of this prospect i ve cohort study were a ) to describe lameness prevalence at drying off in large high producing New York State herds based on visual locomotion score ( VLS ) and identify potential cow and herd level risk factors , and b ) to develop a model that will predict the probability of a cow developing claw horn disruption lesions ( CHDL ) in the subsequent lactation using cow level variables collected at drying off and /or available from farm management software . Data were collected from 23 large commercial dairy farms located in upstate New York . A total of 7,687 dry cows , that were less than 265 days in gestation , were enrolled in the study . Farms were visited between May 2012 and March 2013 , and cows were assessed for body condition score ( BCS ) and VLS . Data on the CHDL events recorded by the farm employees were extracted from the Dairy-Comp 305 data base , as well as information regarding the studied cows ’ health events , milk production , and reproductive records throughout the previous and subsequent lactation period . Univariable analyses and mixed multivariable logistic regression models were used to analyse the data at the cow level . The overall average prevalence of lameness ( VLS > 2 ) at drying off was 14 % . Lactation group , previous CHDL , mature equivalent 305-d milk yield ( ME305 ) , season , BCS at drying off and sire PTA for strength were all significantly associated with lameness at the drying off ( cow-level ) . Lameness at drying off was associated with CHDL incidence in the subsequent lactation , as well as lactation group , previous CHDL and ME305 . These risk factors for CHDL in the subsequent lactation were included in our predictive model and adjusted predicted probabilities for CHDL were calculated for all studied cows . ROC analysis identified an optimum cut-off point for these probabilities and using this cut-off point we could predict CHDL incidence in the subsequent lactation with an overall specificity of 75 % and sensitivity of 59 % . Using this approach , we would have detected 33 % of the studied population as being at risk , eventually identifying 59 % of future CHDL cases . Our predictive model could help dairy producers focusing their efforts on CHDL reduction by implementing aggressive preventive measures for high risk cows This paper describes the development and testing of a lameness control programme ( LCP ) for heifers on dairy farms . The LCP , which is based on the analysis of hazards and critical control points ( HACCP ) , was tested via a r and omised intervention study on 60 farms . Tangible hazards for each farm were identified , allotted to 11 categories of proximate hazard and scored on each farm to quantify the risks presented by each hazard . Feet were inspected for signs of claw horn disease and infection , such as digital dermatitis . Intervention was generally ineffective , primarily through failure to implement the LCP . However , retrospective analysis was able to demonstrate highly significant associations between risks attached to proximate hazards and probabilities of lameness and foot lesions , allowing the severity of these hazards to be ranked . The most significant proximate hazards of environmental origin were prolonged st and ing on concrete , st and ing in wet slurry and factors that cause claw trauma . The most severe proximate hazards however were those associated with failures of management , especially poor claw condition and inadequate foot care . Overall farm risks ( OFR ) were estimated by summing the products of the generic severity for proximate hazards with on-farm risks . Changes in OFR were significantly related to changes in outcome ( lameness and lesions ) Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more A 2-year experiment on the effect of claw trimming on hoof health was performed in 77 Swedish dairy herds ( 3444 dairy cattle ) selected on herd size , breed composition and membership in the official milk-recording scheme . In the autumn , cows within each herd were blocked according to breed , parity and stage of lactation and allocated to two treatments : autumn trimming ( AT ) or no autumn trimming ( NAT ) . Outcome variables were claw measurements and prevalence of hoof lesions and lameness ( measured at spring trimming ) and the need for hoof treatments between scheduled trimmings . At spring trimming , NAT cows had longer and shallower claws than AT cows . The average net growth of the toe wall was greater for AT than for NAT cattle , with a marked variation between housing systems . Most hoof lesions present at AT had disappeared at the subsequent spring trimming . Controlled for clustering by herd-within-year and for the effects of individual- and herd-level covariates , AT cattle at spring trimmings had significantly lower odds of lameness ( OR=0.66 ) and of haemorrhages of the sole or white-line ( OR=0.86 ) , sole ulcer ( OR=0.59 ) and white-line fissure or double sole (OR=0.71)-but not of moderate-to-severe heel-horn erosion or dermatitis ( OR=0.96 ) . Acute hoof treatments between claw trimmings were more common in the NAT group ( OR=2.02 ) Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies This study was carried out to detect differences in locomotion and feeding behavior in lame ( group L ; n = 41 ; gait score ≥ 2.5 ) and non-lame ( group C ; n = 12 ; gait score ≤ 2 ) multiparous Holstein cows in a cross-sectional study design . A model for automatic lameness detection was created , using data from accelerometers attached to the hind limbs and noseb and sensors attached to the head . Each cow ’s gait was videotaped and scored on a 5-point scale before and after a period of 3 consecutive days of behavioral data recording . The mean value of 3 independent experienced observers was taken as a definite gait score and considered to be the gold st and ard . For statistical analysis , data from the noseb and sensor and one of two accelerometers per cow ( r and omly selected ) of 2 out of 3 r and omly selected days was used . For comparison between group L and group C , the T-test , the Aspin-Welch Test and the Wilcoxon Test were used . The sensitivity and specificity for lameness detection was determined with logistic regression and ROC- analysis . Group L compared to group C had significantly lower eating and ruminating time , fewer eating chews , ruminating chews and ruminating boluses , longer lying time and lying bout duration , lower st and ing time , fewer st and ing and walking bouts , fewer , slower and shorter strides and a lower walking speed . The model considering the number of st and ing bouts and walking speed was the best predictor of cows being lame with a sensitivity of 90.2 % and specificity of 91.7 % . Sensitivity and specificity of the lameness detection model were considered to be very high , even without the use of halter data . It was concluded that under the conditions of the study farm , accelerometer data were suitable for accurately distinguishing between lame and non-lame dairy cows , even in cases of slight lameness with a gait score of 2.5 Claw horn disruption lesions ( CHDL ) are a major cause of lameness in dairy cattle and are likely a result of excessive forces being applied to the germinal epithelium that produces the claw horn . The digital cushion is a connective tissue structure , containing depots of adipose tissue , that sits beneath the distal phalanx and has been shown to be thicker in fatter cows . Body condition score ( BCS ) loss is a risk factor for CHDL , and one possible explanation is that fat is mobilized from the digital cushion during negative energy balance , causing the digital cushion to thin and lose force-dissipating capacity , leading to disruption of claw horn growth . This prospect i ve cohort study investigated the association between measures of body fat and sole soft tissue ( SST ) thickness ( a combined measure of the corium and digital cushion beneath the distal phalanx ) in a longitudinal manner . The  SST  of 179 cows in 2 high-yielding dairy herds were measured at 5 assessment points between 8 wk before and 35 wk postcalving . The BCS , back fat thickness ( BFT ) , and lesion incidence were recorded . Data were analyzed in a 4-level mixed effects regression model , with the outcome being SST thickness beneath the flexor tuberosity of the distal phalanx . Data from 827 assessment points were available for analysis . The overall mean of SST was 4.99 mm ( st and ard deviation : 0.95 ) . The SST was thickest 8 wk before calving ( 5.22 mm , st and ard deviation : 0.91 ) and thinnest 1 wk postcalving ( 4.68 mm , st and ard deviation : 0.87 ) , suggesting an effect of calving on SST . The BFT was positively correlated with SST in the model with a small effect size ( a 10 mm decrease in BFT corresponded with a 0.13 mm decrease in SST ) , yet the nadir of BFT was 11.0 mm at 9 to 17 wk postcalving ( when SST was ∼4.95 mm ) , rather than occurring with the nadir of SST immediately after calving . The SST also varied with other variables [ e.g. , cows that developed a sole ulcer or severe sole hemorrhage during the study had thinner SST ( -0.24 mm ) ] , except when a sole ulcer was present , when it was thicker ( + 0.53 mm ) . Cows that developed lesions had a thinner digital cushion before the lesion occurrence , which became thickened with sole ulcer presence , perhaps representing inflammation . Furthermore , although BFT was correlated with SST over time , SST may also have been influenced by other factors such as integrity of the suspensory apparatus , which could have a major effect on CHDL . Measures of body fat likely contributed to having thin SST , but other factors including calving , herd , and lesion presence also had an effect Lameness is a severe welfare problem and a production-limiting disease in dairy farming . The objectives of this study were to determine prevalence of lameness and investigate cow- and herd-level factors associated with lameness in dairy cows housed in freestall barns in 3 Canadian provinces . A purposive sample of 40 Holstein-Friesian cows was selected from each of 141 dairy farms in Québec , Ontario , and Alberta . In total , 5,637 cows were scored once for lameness ( presence of limping when walking ) . Data collected included information on individual cows ( hock lesions , claw length , body condition score , parity , days in milk , and milk production ) , management practice s ( floor and stall cleaning routine , bedding routine , and footbath practice s ) , and facility design ( stall dimensions , stall base and bedding type , width of feed alley , flooring type , and slipperiness ) hypothesized to be risk factors for lameness . Multilevel mixed logistic regression models were constructed ( including farm as a r and om effect and province as a fixed effect ) . Herd-level lameness prevalence ranged from 0 to 69 % ( mean = 21 % ) . Lameness prevalence increased with increasing parity ; compared with first parity , cows in parity 2 , 3 , and ≥ 4 had 1.6 , 3.3 , and 4 times , respectively , higher odds of being lame . Furthermore , the odds of lameness were 1.6 times greater in cows with low body condition score ( ≤ 2.5 ) than in cows with a higher body condition score . In addition , injured hocks and overgrown claws were associated with 1.4- and 1.7-fold increased odds of being lame , respectively , whereas every 1 kg increase in daily milk production was associated with a 3 % decrease in the odds of being lame . Lameness prevalence was higher in herds with ≤ 100 cows , but lower in barns with a s and or dirt stall base , or with bedding ≥ 2 cm deep . Cows exposed to very slippery floors had 2 times the odds of being lame compared with cows exposed to nonslippery floors . We attributed the wide range of lameness prevalence to the great variability in facilities and management practice s among farms . Finally , we inferred that the prevalence of lameness could be decreased by improving management of multiparous , thin , or injured cows and by adopting management practice s intended to improve cow comfort , namely the floor 's slip resistance and the stall 's lying surface A field study was conducted to examine effects of oral biotin supplementation for up to 18 mo on risks of lameness in dairy cows . The study included a total of 900 cattle from five dairy farms in Gloucestershire , southwest U.K. , in a within-herd r and omized control trial . The data from this trial were used in this paper to investigate the impact of parity and duration of supplementation with oral biotin at 20 mg/d on white line disease ( WLD ) lameness . Analysis of the data indicated that WLD increased with increasing parity independent of biotin supplementation from approximately two cases per 100 cow years in primiparous cows to 15.5 cases per 100 cow years in all multiparous 
    Output:
    