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The aim of this study was to investigate using existing image recognition techniques to predict the behavior of dairy cows. A total of 46 individual dairy cows were monitored continuously under 24 h video surveillance prior to calving. The video was annotated for the behaviors of standing, lying, walking, shuffling, eating, drinking and contractions for each cow from 10 h prior to calving. A total of 19,191 behavior records were obtained and a non-local neural network was trained and validated on video clips of each behavior. This study showed that the non-local network used correctly classified the seven behaviors 80% or more of the time in the validated dataset. In particular, the detection of birth contractions was correctly predicted 83% of the time, which in itself can be an early warning calving alert, as all cows start contractions several hours prior to giving birth. This approach to behavior recognition using video cameras can assist livestock management.

The aim of this study was to assess the duration and frequency of behavioral observations of pregnant ewes as they approached lambing. An understanding of behavioral changes before birth may provide opportunities for enhanced visual monitoring at this critical stage in the animal’s life. Behavioral observations for 17 ewes in late pregnancy were recorded during two separate time periods, which were 4 to 6 weeks before lambing and before giving birth. It was normal farm procedure for the sheep to come indoors for 6 weeks of close monitoring before lambing. The behaviors of standing, lying, walking, shuffling and contraction behaviors were recorded for each animal during both time periods. Over both time periods, the ewes spent a large proportion of their time either lying (0.40) or standing (0.42), with a higher frequency of standing (0.40) and shuffling (0.28) bouts than other behaviors. In the time period before giving birth, the frequency of lying and contraction bouts increased and the standing and walking bouts decreased, with a higher frequency of walking bouts in ewes that had an assisted lambing. The monitoring of behavioral patterns, such as lying and contractions, could be used as an alert to the progress of parturition.

The aim of this study was to characterize calving behavior of dairy cows and to compare the duration and frequency of behaviors for assisted and unassisted dairy cows at calving. Behavioral data from nine hours prior to calving were collected for 35 Holstein-Friesian dairy cows. Cows were continuously monitored under 24 h video surveillance. The behaviors of standing, lying, walking, shuffle, eating, drinking and contractions were recorded for each cow until birth. A generalized linear mixed model was used to assess differences in the duration and frequency of behaviors prior to calving for assisted and unassisted cows. The nine hours prior to calving was assessed in three-hour time periods. The study found that the cows spent a large proportion of their time either lying (0.49) or standing (0.35), with a higher frequency of standing (0.36) and shuffle (0.26) bouts than other behaviors during the study. There were no differences in behavior between assisted and unassisted cows. During the three-hours prior to calving, the duration and bouts of lying, including contractions, were higher than during other time periods. While changes in behavior failed to identify an association with calving assistance, the monitoring of behavioral patterns could be used as an alert to the progress of parturition.

IntroductionLaryngeal dysfunction can present as a spectrum of clinical presentations, including Inducible laryngeal obstruction (ILO) and/or Chronic Cough (CC). ILO and CC can occur following an initial viral insult (Hull et al). In our Tertiary Airways service, we noted an increase in the numbers of referrals for patients with upper airway and laryngeal symptoms following infection with Covid-19.AimsTo describe the clinical presentations of patients referred to our service with laryngeal and upper airway symptoms following Covid-19 infection.MethodsReferrals received between April 2020 and May 2022 with suspected laryngeal dysfunction (ILO, CC or heightened laryngeal sensitivity) following Covid infection were reviewed. Electronic records were searched for referral information, demographic details, and assessment results.Results66 (18%) referrals out of 362 received within the time period were for symptoms following infection with Covid-19. 57 patients (86%) had no premorbid laryngeal difficulties before Covid-19 infection. Mean age was 53 (range 27–75), and 71% were female. 98% were of White British ethnicity.Reason for referral was categorised into four types, with 34 patients having more than one reason cited.To date, 38 of the 66 patients have had laryngoscopic assessment, which confirmed ILO for 26 patients. 21 of the 26 (80%) did not have ILO before Covid-19 infection. 13 of the 26 patients with ILO had suspected ILO on referral, whilst 13 did not. A binary logistic regression using referral reason as the predictor for ILO was non-significant, indicating that no specific referral reason predicted subsequent ILO diagnosis with laryngoscopy.Abstract P223 Table 1ConclusionsIn line with the literature, viral insult can lead to laryngeal hypersensitivity and hyperresponsiveness, which can manifest as a clinical spectrum, including ILO. New presentation with ILO was common in patients assessed for upper airway symptoms post-Covid-19. Correlation between referral reason and assessment outcome was poor, therefore assessment via laryngoscopy is essential to confirm diagnosis before intervention. Patients from minority ethnic groups were not referred to the service, despite being at higher risk of medical complications following Covid-19.

IntroductionOur tertiary Airways service offers assessment and treatment for Inducible Laryngeal Obstruction (ILO), (breathing difficulties due to inappropriate adduction of the larynx on inspiration). Speech and Language therapy (SLT) is identified as the ‘cornerstone’ of treatment for ILO.During the Covid-19 pandemic, we produced an online information and therapy resource to support as an adjunct to virtual therapy by SLTs. This included educational information about ILO, videos to support understanding and instructions on how to complete the SLT airway control techniques, as well as symptom monitoring measures.This paper summarises patient feedback on the resource.MethodsAn online survey was sent to 312 patients who had received the resource to support their virtual consultations.Survey questions gathered both quantitative and qualitative data based on Kirkpatrick’s (1993) model of training evaluation, focusing on: Reaction, Learning, Behaviour and Results.Results69 patients (49 females, 19 males, median age= 64, age range=26–78) completed the survey (22% response rate).The resource was rated highly by patients for quality, interest and engagement (Reaction), and for learning from it. Diagrams and demonstration videos helped them understand ILO (Learning) and practice therapy techniques outside of therapy sessions (Behaviour) and were rated as the most helpful aspects of the resource. Following use of the resource 76% reported that their ILO symptoms were either ‘better’ or ‘a lot better’ (Results). Having the resource always accessible online was described as very useful, due to offering a reminder of techniques and to help explain ILO to others.ConclusionDigital resources are a useful adjunct to remote ILO therapy, and continue to be used in our service to support face to face, as well as virtual SLT sessions for the treatment of ILO.

Introduction and ObjectivesPatients referred our tertiary airways service are assessed for potential causation of complex breathlessness, including differential diagnosis of asthma and inducible laryngeal obstruction (ILO).Newman et al (1995) found associations between particular patient variables when comparing patients with asthma and ILO. Further investigation of these and other variables may aid in differential diagnosis and understanding triggers and characterisation of ILO compared to asthma.MethodsRecords for 70 patients with sole diagnoses of either asthma (n=34) or ILO (n=36) were reviewed to investigate patterns of association between a large range of variables relating to these conditions, including demographics, co-morbidities, hospital utilisation and medical treatment. Non-parametric statistics were used to compare diagnosis against categorical, interval and ratio data relating to these variables.ResultsA number of significant associations were found between diagnosis and patient characteristics, summarised in table 1.Results showed that certain demographic variables, co-morbidities and medical treatments differentiated these two groups.Abstract P51 Table 1Patient characistics according to diagnosisConclusionsBy continuing to characterise common clinical characteristics of ILO in comparison to asthma, it is hoped that differentiation from asthma and index of suspicion for ILO will be highlighted to help further understand this clinical condition that co-exists and can mimic asthma.It is of particular interest in the ILO only group that documented symptoms of anxiety were lower than in the group with only asthma, which may help to dispel a common held belief that people with ILO have high anxiety burden.

Introduction and ObjectivesInducible Laryngeal Obstruction (Ilo) is poorly understood, in terms of aetiology and onset by patients and clinicians. Patients presenting to our Tertiary Airways service commonly seek an understanding of the causes and triggers of their Ilo episodes. This study aims to develop a taxonomy of categories of patient-reported onset factors for Ilo from a sample of patients with confirmed Ilo on laryngoscopy, referred to our service.MethodWithin a nine month period, 103 patients referred to the Airways service (76% female, 24% male; age range 15–86 years (median=52)) with endoscopically-confirmed Ilo were asked to report historical factors contemporaneous with the initial onset of Ilo symptoms. A retrospective analysis of patient notes was also conducted to identify co-morbidities and additional onset factors. Single or multiple onset factors for each patient were collected, which were coded into initial themes. From these themes, second-order onset categories were developed which incorporated factors reported by all participants.ResultsThirteen initial onset themes were developed. These included psychological factors (25% of patients), upper respiratory tract infections (23%), reflux (17%), chest infections (14%), medical conditions (12%) and surgery (10%). These were then refined into a taxonomy of five categories of onset factors:Respiratory Tract Infections and Viruses (40% of patients)Underlying Medical Conditions, e.g., rhinitis with post nasal drip, reflux (34%)Psychological difficulties (25%)Irritants, e.g., medication (23%)Exercise (7%)Only one patient had onset factors in multiple categories, indicating that these categories are largely independent of each other. The prevalence of certain onset factors was mediated to some degree by age, e.g., medical conditions were more frequent factors for older participants, whereas exercise was a more common factor in younger participants.ConclusionsThis study demonstrates patient-reported onset factors for Ilo can be usefully translated into a detailed taxonomy based on specific conditions/triggers. This understanding may be useful in furthering our understanding, both of common trigger and onset factors that can be communicated to patients, and may help to inform therapeutic interventions aimed at the active self-management of Ilo.

IntroductionSymptoms of breathlessness in people referred to a Tertiary Airways and Severe Asthma service may be due to a variety of treatable conditions, including asthma, inducible laryngeal obstruction (Ilo) and breathing pattern disorder (BPD).Previous research has shown overlap between asthma and Ilo (Low et al, 2011), and between asthma and BPD (Boulding et al., 2016). In clinical practice, overlap between Ilo and BPD is also common, but this has not been consistently shown in research.Aims and objectivesTo explore the incidence of Ilo, asthma and BPD and the overlap between these conditions in a sample of patients referred to a tertiary airways service, and to investigate patient characteristics associated with each condition.MethodsPatient notes were reviewed for people referred to a tertiary airways service for symptoms of breathlessness over an 18 month period. Assessment information was collated for patients (n=306) diagnosed with asthma, Ilo and/or BPD.ResultsOf the 306 patients, 235 (77%) were diagnosed with Ilo via videolaryngoscopy, 177 (58%) were diagnosed with asthma, and 83 (27%) were diagnosed with BPD.There was significant overlap between the three conditions, with 186 patients (52%) having at least two conditions. The most common overlap was between asthma and Ilo (30% of patients), followed by Ilo and BPD (11%). In contrast, only 3% of patients in this sample had both asthma and BPD. All three conditions were seen in 9% of patients.A visual representation of overlap is presented in figure 1 below:Of the three conditions, Ilo most commonly co-occurred with asthma, whilst BPD most commonly co-occurred with Ilo. When BPD co-occurred with asthma, this was most commonly seen together with Ilo.ConclusionsThis study showed high levels of overlap between conditions that can contribute to symptoms of breathlessness. This emphasises the importance of a multi-professional assessment and optimisation of comorbid treatable traits, such as Ilo and BPD. It may also serve as a reminder for a timely referral for specialist assessment and management of treatable traits to avoid the potential of morbidity, increased healthcare utilisation and over-medication in severe and difficult to treat asthma.

IntroductionThe differential diagnosis of refractory breathlessness can be challenging, involving a systematic assessment of potential causes and aggravating co-morbidities. The index of suspicion for referral for specialist assessment of conditions such as Inducible Laryngeal Obstruction (Ilo) may be heightened using available clinical assessment tools, for example, the Inspiratory arm of the flow volume loop (FVL). Sterner (2009) found Ilo to be the most common diagnosis in patients with a consistently abnormal inspiratory loop. Morris & Christopher (2013) found 52% of patients with Ilo had flattened inspiratory loop. The current gold standard for objectively assessing for Ilo is Laryngoscopy.Aims and objectivesTo investigate the presence of an abnormal inspiratory FVL in a sample of patients with symptoms of breathlessness, and to analyse whether this is a predictor of specific causes of breathlessness.MethodsPatient notes and FVL results were reviewed according to characteristic abnormalities of the inspiratory curve (flattened, absent and truncated) for people referred to a tertiary airways service for symptoms of breathlessness over a 22 month period. Assessment information was collated for patients (n=324) diagnosed with asthma, Ilo or both. Patient demographics and detailed assessment information were compared across these groups to look for potential patterns and predictors.Results59% of patients with Ilo (with or without asthma) had an abnormal inspiratory FVL, compared to 42% of patients without Ilo. For patients with Ilo as their sole diagnosis, 62% had an abnormal FVL. A chi-square analysis showed that an abnormal inspiratory FVL was significantly more common in patients with a diagnosis of Ilo (χ2= 4.47; p≤0.05) compared to patients without.A binary logistic regression assessed the relationship between an abnormal inspiratory FVL and Ilo diagnosis. The model was significant (χ 2 =5.1 (1, N=324) p=0.02) indicating that FVL was a significant predictor of Ilo, and odds ratios suggested that patients with Ilo were twice as likely to have an abnormal loop.ConclusionsIn patients with breathlessness symptoms that are refractory to optimal medical treatment, observation of the FVL may indicate the potential for further specialist assessment for Ilo with provocation videolaryngoscopy.

IntroductionIn our Tertiary Airways service, we assess for contributors of complex breathlessness, such as asthma and inducible laryngeal obstruction (ILO). Tey et al (2017) studied inhaled mannitol for investigation of laryngeal and bronchial hyper-responsiveness, and concluded inhaled mannitol can be used to induce ILO. Previous studies found abnormalities of the inspiratory flow volume loop (FVL) can indicate need for further investigation of ILO.ObjectivesTo assess if mannitol challenge testing (MCT) is a useful adjunct in the assessment of ILO, and to measure inter-rater reliability between professionals.MethodsWe reviewed 41 consecutive patient records undergoing both MCT and laryngoscopy (undertaken separately) over 15 months. An “upshift” of inspiratory FVL between baseline and maximal dose of inhaled mannitol was taken as indicative of provoking ILO. Ratings of the inspiratory FVL were conducted independently by two speech and language therapists (SLT 1 and 2), a consultant physician and a Respiratory physiologist.ResultsOf 41 patients, 25 (61%) had confirmed diagnosis of ILO. Agreement between laryngoscopic diagnosis of ILO and rating of the inspiratory FVL following MCT varied between raters. FVL ratings by SLT 1 agreed with laryngoscopy results 31 times (80%), compared to 27 (68%) agreements by SLT 2, 22 (59%) by the physician and 20 (54%) by the physiologist.Kappa statistics showed moderate agreement between laryngoscopy and FVL for SLT 1 (k=.55), but weak agreement for SLT 2 (k=.34) and no agreement for the physician or physiologist.A binary logistic regression assessed the relationship between laryngoscopy outcome and FVL ratings by SLT 1. The model was significant (χ 2 = 12.44 (1, N=41) p=.002) indicating that FVL predicted laryngoscopy outcome, and explained between 24% and 33% of the variance.ConclusionsIn assessment for causation of breathlessness, observations of the inspiratory arm of the FVL during MCT may provide clues to the experienced clinician. MCT has potential to be a useful adjunct in the assessment for ILO. However, due to poor inter-rater reliability, further studies are needed to improve our understanding.Further prospective studies are needed, ideally with MCT and concurrent laryngoscopy to further investigate the utility in assessment for ILO.