Inequalities in the management of diabetic kidney disease in UK primary care: A cross-sectional analysis of a large primary care database

AIMS

To determine differences in the management of diabetic kidney disease (DKD) relevant to patient sex, ethnicity and socio-economic group in UK primary care.

METHODS

A cross-sectional analysis as of January 1, 2019 was undertaken using the IQVIA Medical Research Data dataset, to determine the proportion of people with DKD managed in accordance with national guidelines, stratified by demographics. Robust Poisson regression models were used to calculate adjusted risk ratios (aRR) adjusting for age, sex, ethnicity and social deprivation.

RESULTS

Of the 2.3 million participants, 161,278 had type 1 or 2 diabetes, of which 32,905 had DKD. Of people with DKD, 60% had albumin creatinine ratio (ACR) measured, 64% achieved blood pressure (BP, <140/90 mmHg) target, 58% achieved glycosylated haemoglobin (HbA1c, <58 mmol/mol) target, 68% prescribed renin-angiotensin-aldosterone system (RAAS) inhibitor in the previous year. Compared to men, women were less likely to have creatinine: aRR 0.99 (95% CI 0.98-0.99), ACR: aRR 0.94 (0.92-0.96), BP: aRR 0.98 (0.97-0.99), HbA1c : aRR 0.99 (0.98-0.99) and serum cholesterol: aRR 0.97 (0.96-0.98) measured; achieve BP: aRR 0.95 (0.94-0.98) or total cholesterol (<5 mmol/L) targets: aRR 0.86 (0.84-0.87); or be prescribed RAAS inhibitors: aRR 0.92 (0.90-0.94) or statins: aRR 0.94 (0.92-0.95). Compared to the least deprived areas, people from the most deprived areas were less likely to have BP measurements: aRR 0.98 (0.96-0.99); achieve BP: aRR 0.91 (0.8-0.95) or HbA1c : aRR 0.88 (0.85-0.92) targets, or be prescribed RAAS inhibitors: aRR 0.91 (0.87-0.95). Compared to people of white ethnicity; those of black ethnicity were less likely to be prescribed statins aRR 0.91 (0.85-0.97).

CONCLUSIONS

There are unmet needs and inequalities in the management of DKD in the UK. Addressing these could reduce the increasing human and societal cost of managing DKD.

Evaluation of breast tumor morphologies from African American and Caucasian patients

The primary aim of this research was to investigate potential differences of breast tumor morphologies across African American and Caucasian racial groups by utilizing machine learning (ML) and artificial intelligence (AI) methods. While breast cancer disparities can partially be attributed to social determinants of health, tumor biology also contributes to survival outcomes. The rate of breast tumor growth is largely dependent on the extracellular matrix (ECM). Current research suggests the cellular components of the ECM may vary among racial and ethnic populations, and this may contribute to the incidence of cancer in African Americans. We utilized a supervised AI method to evaluate morphological differences between African American and Caucasian breast cancer tumors. Images used for analysis were downloaded from the Cancer Genome Atlas (TCGA) biorepository stored in the NIH Genomic Data Commons (GDC) data portal. We designed an ML classifier using the AlexNet model provided in PyTorch's torchvision package. The model was pre-trained and adapted via transfer learning resulting in a classification accuracy of 92.1% when using our breast cancer tumor image database split into 80% of training set and 20% of testing set. We interpreted the results of the AlexNet and ResNet50 models using LIME and saliency mapping as the explainers. Based on the images from our bi-racial testing set, this study confirmed significant variations of tumor and ECM regions in the different racial groups evaluated. Based on these findings, further analysis and characterization may provide new insight into disparities associated with the incidence of breast cancer.

Adaptations to water stress and pastoralism in the Turkana of northwest Kenya

The Turkana people inhabit arid regions of east Africa-where temperatures are high and water is scarce-and they practice subsistence pastoralism, such that their diet is primarily composed of animal products. Working with Turkana communities, we sequenced 367 genomes and identified 8 regions putatively involved in adaptation to water stress and pastoralism. One of these regions includes a putative enhancer for STC1-a kidney-expressed gene involved in the response to dehydration and the metabolism of purine-rich foods such as red meat. We show that STC1 is induced by antidiuretic hormone in humans, is associated with urea levels in the Turkana themselves, and is under strong selection in this population (s∼0.041). This work highlights that partnerships with subsistence-level groups can lead to new models of human physiology with biomedical relevance.

Elbow arthroplasty in trauma-current concepts review

Introduction

Despite advancements in modern locking plate technology, distal humerus fractures in the elderly remain difficult to treat. A subset of fractures in this osteoporotic bone includes multiple, shallow articular fragments that renders fixation unreliable, precluding early motion and acceptable functional outcomes. Arthroplasty, in the form of either Total Elbow Arthroplasty (TEA) or Distal Humeral Hemiarthroplasty (DHH) are alternative treatment options in this cohort and are being increasingly used.

Methods

This article reviews the use of TEA or DHH for acute distal humerus fracture, including patient selection, pre-operative planning, surgical approach, implant positioning, rehabilitation, outcomes and complications.

Results

Arthroplasties are being increasingly used for acute distal humerus fractures, however they introduce potential complications not seen with fixation. Due care must be employed to correct implant positioning which is a function of implant rotation, implant length and implant sizing. We describe a robust technique for epicondyle repair in DHH and unlinked TEA to avoid instability. Outcomes of DHH and TEA for acute distal humerus fracture are encouraging, however further long-term outcome and comparative data regarding arthroplasty is required.

Conclusions

Short to medium term outcomes demonstrate that both DHH and TEA are valuable options for selected patients, although attention to technique is required to minimise potential complications.

Student Perceptions of Academic Integrity: A Qualitative Study of Understanding, Consequences, and Impact

Background

Academic integrity (AI) is of increasing importance in higher education. At the same time, students are becoming more consumer-oriented and more inclined to appeal against, or complain about, a penalty imposed for a breach of AI. This combination of factors places pressure on institutions of higher education to handle alleged breaches of AI in a way acceptable to students that motivates them to continue to engage with their studies.

Method

Students (n = 8) were interviewed to discover their perceptions of the process for dealing with breaches of AI. All students were based in one university in a very diverse area of London which has many first-generation students from non-traditional academic backgrounds.

Results

Students reported strong emotional reactions featuring high levels of anxiety and stress. Some found the process to be threatening and demotivating and questioned continuation on their course of study, while others used more adaptive coping strategies. Students also went to great pains to make it clear that their own, and their friends', breaches of AI were unintentional, while expressing the view that other people were deliberately cheating and should be penalised.Key recommendations include: support for students to re-engage after the intervention; support for students to develop effective self-regulatory learning strategies and time management; provision of specific examples to clarify what is, and is not, acceptable academic practice; recognition of the strong emotions likely to be invoked, especially if accompanied by declarations of unintentionality.

The relationship between attitudes to human rights and to animal rights is partially mediated by empathy

Veganism has become increasingly popular in recent years in many countries including the UK and the USA. Studies have found that vegans tend to be female, lower in Right-Wing Authoritarianism (RWA) and Social Dominance Orientation (SDO), and higher in feminist perspectives (FPS). Study 1 (n = 311) investigated the relationships among meat consumption, ethical veganism (using a custom-written scale), RWA, SDO, and FPS, in a series of questionnaires completed online. RWA, SDO, and meat consumption correlated together in one group of variables; FPS and ethical veganism correlated together in a distinct group. In Study 2 participants also completed the Toronto Empathy Questionnaire (TEQ) as a potential mediator variable. The relationship between RWA, SDO, and FPS as predictors, and ethical veganism as target, was partially mediated by empathy. This pattern of results suggests that individuals who hold egalitarian and inclusive views as regards human-human relationships also tend to have similar views as regards human-animal relationships, with empathy as an underlying common factor.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Exaggeration of PFS by blinded, independent, central review (BICR)

BACKGROUND

Recent published studies have shown meaningful discrepancies between local investigator and blinded, independent, central review (BICR) assessed median progression-free survival (PFS). When the local review but not BICR shows progression, generally, no further assessments are carried out and patients are censored in the BICR analysis, leading to violation of the statistical assumptions of independence between censoring and outcome used in survival analysis methods.

METHODS

We carried out a simulation study to assess methodological reasons behind these discrepancies and corroborated our findings in a case study of three BRCA-mutated ovarian cancer trials. We briefly outline possible methodological solutions that may lead to improved estimation of the BICR medians.

RESULTS

The Kaplan-Meier (KM) curve for the BICR PFS can often be exaggerated. The degree of bias is largest when there is reasonably strong correlation between BICR and local PFS, especially when PFS is long compared with assessment frequency. This can result in an exaggeration of the medians and their difference; however, the hazard ratio (HR) is much less susceptible to bias. Our simulation shows that when the true BICR median PFS was 19 months, and patients assessed every 12 weeks, the estimated KM curves were materially biased whenever the correlation between BICR and local PFS was 0.4 or greater. This was corroborated by case studies where, in the active arm, the BICR median PFS was between 6 and 11 months greater than the local median PFS. Further research is required to find improved methods for estimating BICR survival curves.

CONCLUSIONS

In general, when there is a difference between local and BICR medians, the true BICR KM curve is likely to be exaggerated and its true median will probably lie somewhere between the observed local and BICR medians. Presentation of data should always include both BICR and local results whenever a BICR is carried out.

Studies on the behaviour and control of phlebotomine sandflies using experimental houses

Programmes for the control of phlebotomine sandflies (Diptera: Psychodidae), the vectors of leishmaniases, mainly target adults because larval breeding sites are generally unknown or inaccessible. To determine how blood-questing sandfly females enter homes and to develop means for their control, an experimental house (EH) was constructed in a village endemic for cutaneous leishmaniasis. Initially, carbon dioxide (CO₂ )-baited suction traps were installed inside the EH to attract and capture sandflies. For other experiments, the windows of the EH were fitted with CO₂ -baited window entrance traps (WETs) that allow each window to be considered as a separate unit. The majority of captures inside the EH and in WETs consisted of Phlebotomus sergenti, a species that enters inhabited houses relatively infrequently. Analyses of collections in WETs and in sticky traps on external walls showed that sandflies entered windows having landed previously on the wall below or either side of the window. Shelves constructed below windows significantly reduced the numbers of sandflies that entered both the EH and inhabited houses. The lining of internal walls with insecticide-impregnated fabric significantly increased mortality rates of sandflies captured inside the EH. To reduce the biting burden imposed by phlebotomine sandflies, several control measures must be integrated and sustained.

CRP polymorphisms and DNA methylation of the AIM2 gene influence associations between trauma exposure, PTSD, and C-reactive protein

BACKGROUND

Recent studies have implicated inflammatory processes in the pathophysiology of posttraumatic stress disorder (PTSD). C-reactive protein (CRP) is a widely-used measure of peripheral inflammation, but little is known about the genetic and epigenetic factors that influence blood levels of C-reactive protein (CRP) in individuals with PTSD.

METHODS

Participants were 286 U.S. military veterans of post-9/11 conflicts (57% with current PTSD). Analyses focused on single nucleotide polymorphisms (SNPs) in the CRP gene and DNA methylation at cg10636246 in AIM2-a locus recently linked to CRP levels through results from a large-scale epigenome-wide association study.

RESULTS

PTSD was positively correlated with serum CRP levels with PTSD cases more likely to have CRP levels in the clinically-elevated range compared to those without a PTSD diagnosis. Multivariate analyses that controlled for white blood cell proportions, genetic principal components, age and sex, showed this association to be mediated by methylation at the AIM2 locus. rs3091244, a functional SNP in the CRP promoter region, moderated the association between lifetime trauma exposure and current PTSD severity. Analyses also revealed that the top SNPs from the largest genome-wide association study of CRP conducted to date (rs1205 and rs2794520) significantly interacted with PTSD to influence CRP levels.

CONCLUSIONS

These findings provide new insights into genetic and epigenetic mechanisms of inflammatory processes in the pathophysiology of PTSD and point to new directions for biomarker identification and treatment development for patients with PTSD.

BDNF genotype is associated with hippocampal volume in mild traumatic brain injury

The negative long-term effects of mild traumatic brain injury (mTBI) have been a growing concern in recent years, with accumulating evidence suggesting that mTBI combined with additional vulnerability factors may induce neurodegenerative-type changes in the brain. However, the factors instantiating risk for neurodegenerative disease following mTBI are unknown. This study examined the link between mTBI and brain-derived neurotrophic factor (BDNF) genotype, which has previously been shown to regulate processes involved in neurodegeneration including synaptic plasticity and facilitation of neural survival through its expression. Specifically, we examined nine BDNF single-nucleotide polymorphisms (SNPs; rs908867, rs11030094, rs6265, rs10501087, rs1157659, rs1491850, rs11030107, rs7127507 and rs12273363) previously associated with brain atrophy or memory deficits in mTBI. Participants were 165 white, non-Hispanic Iraq and Afghanistan war veterans between the ages of 19 and 58, 110 of whom had at least one mTBI in their lifetime. Results showed that the BDNF SNP rs1157659 interacted with mTBI to predict hippocampal volume. Furthermore, exploratory analysis of functional resting state data showed that rs1157659 minor allele homozygotes with a history of mTBI had reduced functional connectivity in the default mode network compared to major allele homozygotes and heterozygotes. Apolipoprotein E (APOE) was not a significant predictor of hippocampal volume or functional connectivity. These results suggest that rs1157659 minor allele homozygotes may be at greater risk for neurodegeneration after exposure to mTBI and provide further evidence for a potential role for BDNF in regulating neural processes following mTBI.

Emotional responses to disfigured faces and Disgust Sensitivity: An eye-tracking study

Facial disfigurement attracts attention and evokes negative emotion, but evidence is lacking for a link between these two reactions. The present experiment ( n = 29) investigated emotional and attentional reactions to photographs of people with disfigured faces. An eye-tracker was used to measure fixation on internal expressive features and on the forehead. Disfigurement to the internal expressive features invoked a stronger emotional reaction than disfigurement to the forehead. Attention in the area of disfigurement was associated with negative emotion (embarrassment, sympathy, disgust, repulsion) as well as surprise. Attention to the disfigurement, and negative emotion, was related to the trait of Disgust Sensitivity.

Visual sign phonology: insights into human reading and language from a natural soundless phonology

Among the most prevailing assumptions in science and society about the human reading process is that sound and sound-based phonology are critical to young readers. The child's sound-to-letter decoding is viewed as universal and vital to deriving meaning from print. We offer a different view. The crucial link for early reading success is not between segmental sounds and print. Instead the human brain's capacity to segment, categorize, and discern linguistic patterning makes possible the capacity to segment all languages. This biological process includes the segmentation of languages on the hands in signed languages. Exposure to natural sign language in early life equally affords the child's discovery of silent segmental units in visual sign phonology (VSP) that can also facilitate segmental decoding of print. We consider powerful biological evidence about the brain, how it builds sound and sign phonology, and why sound and sign phonology are equally important in language learning and reading. We offer a testable theoretical account, reading model, and predictions about how VSP can facilitate segmentation and mapping between print and meaning. We explain how VSP can be a powerful facilitator of all children's reading success (deaf and hearing)-an account with profound transformative impact on learning to read in deaf children with different language backgrounds. The existence of VSP has important implications for understanding core properties of all human language and reading, challenges assumptions about language and reading as being tied to sound, and provides novel insight into a remarkable biological equivalence in signed and spoken languages. WIREs Cogn Sci 2016, 7:366-381. doi: 10.1002/wcs.1404 For further resources related to this article, please visit the WIREs website.

Rational Thinking and Belief in Psychic Abilities: It Depends on Level of Involvement

Previous research has shown that lay believers in psychic abilities are more prone to intuitive thinking, less inclined to rational thinking, and have an external locus of control, compared to non-believers. Psychic practitioners, however, may have different characteristics. Psychic practitioners ( n = 31; M age = 42.7 yr., SD = 13.1), lay believers ( n = 33; M age = 33.0 yr., SD = 10.3), and non-believers ( n = 31; M age = 34.4 yr., SD = 15.4) completed questionnaires measuring thinking styles, locus of control, and psychic belief. Comparisons of lay believers with non-believers confirmed previous observations: believers had a higher propensity for intuitive thinking, lower propensity for rational thinking, and more external locus of control. In contrast, practitioners were equivalent to non-believers in rational thinking and had the highest internal locus of control. This highlights the importance of considering level of involvement with psychic practice in understanding the thinking styles of believers. Results suggested that practitioners may have rationalized their beliefs and constructed a coherent model of psychic phenomena that satisfies a propensity for rational thinking within a community of belief.

Abstract P6-08-06: Use of an NIH PROMIS® instrument to identify predictors of fatigue in breast cancer patients receiving adjuvant chemotherapy

Background: Fatigue is one of the most common side effects of treatment for breast cancer (BC). This study used a daily diary approach to investigate the course of fatigue in BC patients receiving adjuvant chemotherapy. We examined clinical (BSA, menopausal status, stage, hemoglobin levels) and self-reported biopsychosocial factors (anxiety, depression, pain, physical and social functioning) as predictors of fatigue after chemotherapy infusion.

Methods: We enrolled 28 stage I (39%), II (50%), and III (11%) BC patients (mean age = 48.9 years, SD = 9.7) receiving standard adjuvant chemotherapy. Fatigue was assessed over 14 consecutive days (day −2 to +11) using a modified version of the NIH Patient-Reported Outcomes Measurement Information System (PROMIS®) fatigue short-form. Putative predictors of fatigue were assessed in the week prior to infusion. Anxiety and depression were measured with computerized adaptive testing. Pain, physical functioning, and social functioning were assessed using PROMIS global health items. Clinical variables were abstracted from patients' medical records. Analyses used individual growth curve modeling to examine overall levels of post-infusion fatigue and rates of change (amplitude) in daily fatigue over a 14-day period prior to the next infusion.

Results: Daily fatigue varied considerably over the 14 day study period, following a sinusoidal pattern. Fatigue T-scores increased from near-normal values (mean = 53) by about 1 SD (p &lt; .001) during the first 3 days post-infusion (mean = 62), peaked on days 3–6, and decreased to near-normal (mean = 53) by day 11. Higher baseline anxiety, depression, pain and problems with physical functioning independently predicted higher overall fatigue levels during the post-infusion period (p &lt; .001). In addition, baseline pain and physical functioning predicted distinct patterns of change in fatigue scores (p &lt; .05). Fatigue showed a steep rise and fall in patients with less pain and better physical functioning at baseline, rapidly returning to pre-infusion levels. Fatigue was more constant in patients with greater pain and worse physical functioning at baseline. These patients reported higher fatigue scores prior to infusion but experienced fewer dynamic changes in response to chemotherapy. Medical variables and social functioning were not associated with baseline fatigue levels or changes in fatigue.

Conclusions: This study demonstrates that BC patients with greater anxiety, depression, pain or poor physical functioning at baseline are at risk for prolonged and severe fatigue during treatment with chemotherapy. Patients with low pain and high physical functioning experience sharper changes in fatigue after infusion with quick return to baseline. The NIH PROMIS questionnaire provides a powerful quantitative method to identify predictors of chemotherapy-related fatigue. Identification of these predictors is critical for effective management of patient expectations and the development of targeted interventions to improve tolerance and functioning during adjuvant chemotherapy for breast cancer.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-08-06.

Attentional Effects of Masked Famous Faces (But Not Names) and Subjective Evaluations of a Target Person

Two experiments are reported using a 1986 version of the dot-probe paradigm of MacLeod, Mathews, and Tata, in which the masked subliminal faces of famous persons were differentially associated with attention depending on participants' attitudes toward the famous person. There was attentional avoidance of the faces of persons invoking high disgust (Exp. 1, n = 20) or dislike (Exp. 2) but attentional orientation toward the faces of persons invoking low disgust or liking. In Exp. 2 ( n = 28), this effect was apparent for the faces but not the names of famous persons, despite evidence that the famous names were recognised without awareness. The aversion of attention from faces, but not the names of famous persons who are regarded in a negative light but who are not particularly threatening, may suggest an automatic tendency to avoid making eye contact with an undesirable person thereby avoiding unwanted social interaction.

Drink a little; take a few drugs: do nurses have knowledge to identify and manage in-patients at risk of drugs and alcohol?

INTRODUCTION AND AIMS

The widespread use of alcohol and other drugs poses particular problems during hospitalisation. Although nurses have been identified as an appropriate group to screen patients and provide acute and ongoing management to people with drug and alcohol-related problems, rates of screening are low. The aims of this study were to identify current practices for screening by nurses working in medical and surgical wards, determine their knowledge relating to problems associated with substance use and identify their self-reported skills in managing patients with drug- and alcohol-related problems.

DESIGN AND METHODS

A chart audit of medical records was completed and a survey was distributed to nurses working in the study wards.

RESULTS

Screening for alcohol and drug use was documented on only 22/79 medical records, and detailed information about quantity and duration of use was recorded in only nine. Overall, the nurses reported that they had little knowledge about substance use problems, and felt that they lacked skills to care adequately for these patients.

DISCUSSION AND CONCLUSIONS

The results of this study suggest a need for a comprehensive training and education to ensure that nurses are familiar with policies and protocols for management of patients and to assist nurses to provide evidence-based care and make appropriate referrals to specialist services.

Developing a curriculum statement based on clinical practice: genetics in primary care

BACKGROUND

Advances in medical genetics are increasingly being incorporated into clinical management outside specialist genetic services. This study was therefore undertaken to develop learning outcomes in genetics for general practice specialty training, using methods to ensure the knowledge, skills, and attitudes relevant to genetics in primary care were identified.

AIM

To identify key knowledge, skills, and attitudes in genetics and to synthesise these into learning outcomes to assist training in genetics for primary care.

DESIGN OF STUDY

Delphi survey and review by expert group.

SETTING

Primary care practices and Regional Genetics Centre in the West Midlands region of the UK.

METHOD

A modified Delphi survey involved GP trainers, programme directors, and geneticists (n = 60). The results, along with results from a survey of GP registrars, were reviewed by an expert group, which included GPs, geneticists, and educationalists.

RESULTS

Core genetics topics for GPs were identified, prioritised, and developed into competency statements in the style of the curriculum structure of the Royal College of General Practitioners.

CONCLUSION

The development of the GP curriculum statement Genetics in Primary Care was based on a study of educational needs, incorporating the views of practitioners (GP trainers, programme directors, and registrars) and specialists (clinical geneticists). This inclusive approach has enabled the identification of learning outcomes which directly reflect clinical practice.

Search for flavor-changing-neutral-current d meson decays

We study the flavor-changing-neutral-current process c-->u micro(+) micro(-) using 1.3 fb(-1) of pp[over ] collisions at square root s = 1.96 TeV recorded by the D0 detector operating at the Fermilab Tevatron Collider. We see clear indications of the charged-current mediated D(s)(+) and D(+)-->phipi(+) --> micro(+)micro(-)pi(+) final states with significance greater than 4 standard deviations above background for the D(+) state. We search for the continuum neutral-current decay of D(+)-->pi(+) micro(+) micro(-) in the dimuon invariant mass spectrum away from the phi resonance. We see no evidence of signal above background and set a limit of B(D(+) --> pi(+) micro(+) micro(-))<3.9 x 10(-6) at the 90% C.L. This limit places the most stringent constraint on new phenomena in the c--> u micro(+) micro(-) transition.

Use of treatment records and lung lesion scoring to estimate the effect of respiratory disease on growth during early and late finishing periods in South African feedlot cattle

Growth, morbidity, and slaughter data from 2,036 calves in 2 South African feedlots were used to estimate the effect of bovine respiratory disease (BRD) and of lung lesion type and extent on growth during the early (processing to d 35) and late (d 35 to slaughter) finishing periods. Calves were weighed at processing (d 5 after arrival), on d 35, and at slaughter after a mean of 137 d on feed. All calves were monitored twice daily and were treated for BRD if rectal temperature was > 40 degrees C or if other specific signs of BRD were present. After slaughter, the occurrence and extent of parenchymal bronchopneumonic lesions and pleural adhesions were recorded. Subclinical BRD (never treated but with lung lesions at slaughter) occurred in 29.7% and clinical BRD in 22.6% of calves. Lung lesions were present in 43% of calves at slaughter; 8.6% had parenchymal lesions and 38.8% had pleural adhesions. Using a combined case definition (treated for BRD and/or lung lesions present at slaughter), the incidence of BRD was 52.5%. During the early finishing period, clinical BRD reduced ADG by 216 g (P < 0.001), subclinical BRD reduced ADG by 91 g (P < 0.001), and the combined effect of BRD was a 143 g reduction in ADG (P < 0.001). After d 35, animals treated for BRD tended to grow faster than those with subclinical BRD (P = 0.11), indicating that treatment was generally successful in reducing economic losses. The extent of bronchopneumonic lesions at slaughter was not associated with reduced growth during the early finishing period (P = 0.27), but extensive lesions reduced ADG by 88 g during the late period (P = 0.02). In contrast, the extent of pleural adhesions was not associated with reduced growth rate during the late finishing period (P = 0.37) but was strongly associated with reduced ADG before d 35; there was a 101 g reduction (P < 0.001) and a 220 g reduction (P = 0.01) for adhesions involving < 50% and > 50% of the pleural surfaces, respectively. Thus, although the presence of bronchopneumonic lesions and pleural adhesions at slaughter were both associated with reductions in overall ADG, they were indicative of production losses having occurred at different times during the finishing period. The overall effect of BRD was a 24 g reduction in ADG (P = 0.02) and a 5.1 d increase in days on feed (P < 0.001). The hidden cost of reduced growth rate due to BRD amounted to $3.41 per calf with clinical or subclinical BRD, or $1.79 per animal entering the feedlot.