Effect of replacing a portion of inorganic chloride trace minerals with trace mineral amino acid complexes

The objective was to determine whether replacing a portion of inorganic chloride trace minerals and cobalt carbonate in the diet with AA complexes of trace minerals and cobalt glucoheptonate will improve lactating cow performance, feed efficiency, and calf performance. In a clinical trial, 69 Holstein cows entering second lactation and greater were randomly assigned to 1 of 2 treatments, with the total dietary trace mineral concentration the same between treatments, starting 1 wk after dry off (50 to 57 d before expected parturition) until 154 d in milk (DIM): (1) an inorganic chloride trace mineral (ITM) blend consisting of Zn (75 mg/kg), Mn (65 mg/kg), and Cu (10 mg/kg) as hydroxychlorides and Co (1 mg/kg) as carbonate (n = 37) or (2) partial replacement of ITM with AA complexes of Zn (40 mg/kg), Mn (20 mg/kg), and Cu (3.5 mg/kg) and Co glucoheptonate (1 mg/kg; AATM; Availa-Dairy, Zinpro Corp.; n = 32). Dry matter intake (DMI) was recorded daily from enrollment through wk 8, and milk yields were recorded daily from calving through wk 22. Milk composition and body weights (BW) were collected weekly. Serum samples were analyzed for albumin (Alb), cholesterol (Chol), total bilirubin (Bili), aspartate aminotransferase (AST), haptoglobin, β-hydroxybutyrate (BHB), and Ca. A liver health index (LHI) was calculated based on Bili, Chol, and Alb concentrations. A liver functionality index (LFI) was calculated to standardize changes in Alb, Chol, and Bili from 4 to 29 DIM. Greater LHI and LFI indicate better health status. Colostrum was analyzed for IgG and Brix, and calf serum was analyzed for IgG. Calf growth was monitored through 9 wk of age (AATM: n = 12, ITM: n = 10). Data were analyzed using SAS software with mixed effects models and repeated-measures analysis, when applicable. Survival analysis for pregnancy by 154 DIM was analyzed by Cox proportional and Kaplan-Meier hazards models. Disorder incidence was tested with Fisher's exact test. Prepartum DMI as a percent of BW was lower in cows fed AATM and not significant postpartum. Cows fed AATM produced more milk from wk 1 to 8 and from wk 1 to 22. Energy-corrected milk yield and colostrum measures did not significantly differ between treatments. A treatment by time interaction was seen for AST and BHB; cows fed AATM tended to have lower AST concentrations at 28 DIM and lower concentrations in BHB through 29 DIM, though not statistically significant. Cows fed AATM had greater LHI at 4 DIM. Haptoglobin, Ca, LFI, hazard of pregnancy, risk to first service, survival curves, or services per pregnancy did not significantly differ. Calf serum IgG and birth weight did not significantly differ between treatments. Calves from dams fed AATM had greater average daily gain than calves from dams fed ITM. Overall, cows fed AATM during the dry period and early lactation had improved postpartum performance and potential health improvements.

Epidemiology of bovine colostrum production in New York Holstein herds: Cow, management, and environmental factors

Adequate supply of high-quality colostrum is essential for calf health. Colostrum production, at first milking, varies between animals and seasons, but herd-level and management associations with colostrum production have not been well described. Our objectives were to (1) describe colostrum production and colostrum handling practices and (2) to identify individual cow, herd management, and environmental factors associated with colostrum production. A convenience sample of 19 New York Holstein dairy farms (620 to 4,600 cows) were enrolled in this observational study to describe colostrum production and to evaluate cow, management, and prepartum environmental factors associated with colostrum yield and Brix %. Herd owners or managers were given a colostrum management questionnaire, and farm personnel recorded individual colostrum yield and Brix % for primiparous (PP; n = 5,978) and multiparous (MPS; n = 13,228) cows between October 2019 and February 2021. Temperature, relative humidity, and light intensity were measured by sensors placed in each farm's close-up dry cow pens for the entire length of the study. Median colostrum yield for each farm ranged from 2.5 to 7.6 kg for PP and 4.0 to 7.7 kg for MPS cows. Mean Brix % from each farm ranged from 22.2 to 27.9% for PP and 22.0 to 28.8% for MPS cows. Lowest colostrum yield from PP animals was associated with calf sex (female) and colostrum Brix % (≤22%). Greatest colostrum yield from MPS cows was associated with colostrum Brix % (≤22%), calf sex (twin), dry period length (>67 d), gestation length (283-293 d), an alive calf, second parity, previous lactation length (>344 d) and previous lactation 305-d mature equivalent milk yield (>13,091 kg), heat and humidity exposure area under the curve (AUC) 7 d before calving (>69.2 average temperature-humidity index per 30-min interval), and light intensity AUC 14 d before calving (>154.2 average lux per 15-min interval). Greatest colostrum Brix % from PP animals was associated with calf sex (male), an alive calf, and light intensity AUC 14 d before calving (≤64.0 average lux per 15-min interval). Greatest colostrum Brix % from MPS cows was associated with dry period length (>67 d), an alive calf, 305-d mature equivalent milk yield of previous lactation (≤15,862 kg), gestation length (274-282 d), colostrum yield (<6 kg), fifth or greater parity, and heat and humidity exposure AUC 7 d before calving (≤50.1 average temperature-humidity index per 30-min interval). Dairy producers can use this information to recognize the variation in colostrum production and alter colostrum management programs in anticipation of periods of low production or quality.

Treating the most vulnerable: A discursive review of experimental pain in Alzheimer's disease

AIM

The purpose of this manuscript is to summarize research on how experimental pain is experienced by adults with Alzheimer's disease (AD) and to translate results into implications for nurses.

DESIGN

This discursive review synthesizes the results of three previous research studies exploring experimental pain in adults with AD.

METHODS

Using a series of fictional clinical vignettes, the authors discuss how the results from three previous papers using acute experimental pain can potentially be translated into clinical practice. The authors also introduce the reader to the concept of research-related psychophysics using introductory definitions and concepts with the impetus to encourage other nurses to consider this research methodology.

RESULTS

Pain characteristics in AD that differ from cognitively intact controls must be explored to properly address pain in this population. Nurses are well positioned to address these issues in order to provide a high quality of care to adults with AD.

Posterior Retinotomy vs Perfluorocarbon Liquid to Aid Drainage of Subretinal Fluid During Primary Rhegmatogenous Retinal Detachment Repair (PRO Study Report No. 10)

Purpose:

This work compares posterior retinotomy vs perfluorocarbon liquid (PFCL) for subretinal fluid (SRF) drainage during pars plana vitrectomy for primary rhegmatogenous retinal detachment (RRD).

Methods:

In this large, multicenter, retrospective comparative study, 2620 patients underwent pars plana vitrectomy (with or without scleral buckle) for uncomplicated RRD. Patients for whom SRF was drained via the primary break without retinotomy or PFCL were excluded; those who required both retinotomy and PFCL were similarly excluded. Remaining patients were separated into “retinotomy” and “PFCL” cohorts. Subgroup analysis was conducted for macula-on and macula-off subgroups. Postoperative outcomes were analyzed and compared.

Results:

A total of 760 eyes (82.7%) had retinotomy and 159 eyes (17.3%) had PFCL for drainage of SRF, and baseline characteristics between the 2 groups were similar. Postoperative analysis showed similar outcomes between the retinotomy and PFCL cohorts, including final visual acuity ( P = .19), redetachment rate ( P = .30), anatomic success ( P = .28), presence of postoperative epiretinal membrane ( P = .75), and other macular pathologies ( P > .99). Subgroup analysis yielded similar outcomes for macula-on and macula-off subgroups. Postoperative presence of retained PFCL was 2.4%, possibly a factor in the slightly higher number of subsequent surgical procedures ( P = .03) in the PFCL cohort.

Conclusions:

Postoperative outcomes for retinotomy vs PFCL during RRD repair are comparable, aside from slightly greater number of subsequent surgical procedures needed in the PFCL cohort. Our analysis suggests both techniques are reasonable tools in the repair of macula-on or macula-off RRD.

Primary Retinal Detachment Outcomes Study: Pseudophakic Retinal Detachment Outcomes: Primary Retinal Detachment Outcomes Study Report Number 3

PURPOSE

This study evaluates outcomes of comparable pseudophakic rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV) or PPV with scleral buckle (PPV-SB).

DESIGN

Multicenter, retrospective, interventional cohort study.

PARTICIPANTS

Data were gathered from patients from multiple retina practices in the United States with RRD in 2015.

METHODS

A large detailed database was generated. Pseudophakic patients with RRD managed with PPV or PPV-SB were analyzed for anatomic and visual outcomes. Eyes with proliferative vitreoretinopathy, giant retinal tears, previous invasive glaucoma surgery, and ≤90 days of follow-up were excluded from outcomes analysis. Single surgery anatomic success (SSAS) was defined as retinal attachment without ongoing tamponade and with no other RRD surgery within 90 days.

MAIN OUTCOME MEASURES

Single surgery anatomic success and final Snellen visual acuity (VA).

RESULTS

A total of 1158 of 2620 eyes (44%) with primary RRD were pseudophakic. A total of 1018 eyes had greater than 90 days of follow-up. Eyes with proliferative vitreoretinopathy, previous glaucoma surgery, and giant retinal tears were excluded, leaving 893 pseudophakic eyes eligible for outcome analysis. A total of 461 (52%) were right eyes. A total of 606 patients (67%) were male, with a mean age of 65±11 years. Pars plana vitrectomy and PPV-SB as the first procedure were performed on 684 eyes (77%) and 209 eyes (23%), respectively. The mean follow-up was 388±161 days, and overall SSAS was achieved in 770 eyes (86%). Single surgery anatomic success was 84% (577/684) for PPV and 92% (193/209) for PPV-SB. The difference in SSAS between types of treatment was significant (P = 0.009). In eyes with macula-on RRD, SSAS was 88% in eyes treated with PPV and 100% in eyes treated with PPV-SB (P = 0.0088). In eyes with macula-off RRD, SSAS was 81% in eyes treated with PPV and 89% in eyes treated with PPV-SB (P = 0.029). Single surgery anatomic success was greater for PPV-SB than PPV for inferior (96% vs. 82%) and superior (90% vs. 82%) detachments. Mean final VA was similar for PPV (20/47) and PPV-SB (20/46; P = 0.805).

CONCLUSIONS

In pseudophakic RRDs, SSAS was better in patients treated with PPV-SB compared with PPV alone, whereas visual outcomes were similar for both groups.

Bioturbation by a reintroduced digging mammal reduces fuel loads in an urban reserve

Digging animals may alter many characteristics of their environment as they disrupt and modify the ground's surface by creating foraging pits or burrows. Extensive disturbance to the soil and litter layer changes litter distribution and availability, potentially altering fuel loads. In many landscapes, including peri-urban areas, fire management to reduce fuel loads is complex and challenging. The reintroduction of previously common digging animals, many of which are now threatened, may have the added benefit of reducing fuel loads. We experimentally examined how the reintroduction of a marsupial bandicoot, quenda (Isoodon fusciventer), altered surface fuel loads in an urban bush reserve in Perth, Western Australia. Foraging activities of quenda (where they dig for subterranean food) were substantial throughout the reserve, creating a visibly patchy distribution in surface litter. Further, in open plots where quenda had access, compared to fenced plots where quenda were excluded, quenda foraging significantly reduced litter cover and litter depth. Similarly, estimated surface fuel loads were nearly halved in open plots where quenda foraged compared to fenced plots where quenda were absent (3.6 cf. 6.4 Mg/ha). Fire behavior modeling, using the estimated surface fuel loads, indicated the predicted rate of spread of fire were significantly lower for open plots where quenda foraged compared to fenced plots under both low (29.2 cf. 51.4 m/h; total fuels) and high (74.3 cf. 130.4 m/h; total fuels) fire conditions. Although many environments require fire, including the bushland where this study occurred, fire management can be a considerable challenge in many landscapes, including urban bushland reserves, which are usually small and close to human infrastructure. The reintroduction of previously common digging species may have potential value as a complimentary tool for reducing fuel loads, and potentially, fire risk.

Effects of feeding synthetic zeolite A during the prepartum period on serum mineral concentration, oxidant status, and performance of multiparous Holstein cows

The objective of this study was to determine the effects of feeding synthetic zeolite A for 3 wk before expected calving on peripartal serum mineral concentrations, hypocalcemia, oxidant status, and performance. Holstein cows (n = 55) entering their second or greater lactations were assigned randomly to 1 of 2 dietary treatments starting 21 d before expected calving: control (CON: 40% corn silage, 33% wheat straw, and 27% concentrate; n = 29) or experimental [EXP: CON plus zeolite A (X-Zelit, Protekta Inc., Lucknow, ON, Canada/Vilofoss, Graasten, Denmark; n = 26) at an inclusion rate of 3.3% of dry matter, targeting 500 g/d as-fed]. Cows were fed the same postpartum diet and housed in individual tiestalls through 28 d in milk. Cows fed EXP had higher serum Ca concentrations as parturition approached and during the immediate postpartum period. Serum P concentrations were lower for the EXP-fed cows during the prepartum period and the first 2 d of lactation, whereas serum Mg concentrations were lower than those of the CON-fed cows only during the immediate periparturient period. Cows fed EXP had decreased prevalence of subclinical hypocalcemia (SCH) from d -1 through 3 relative to day of parturition, with the largest difference occurring within the first day postpartum. Prepartum dry matter intake tended to be decreased and rumination was decreased in cows fed EXP; however; postpartum dry matter intake, rumination, milk yield, milk component yield, and colostrum measurements did not differ between treatments. Cows fed EXP tended to have increased hazard of pregnancy by 150 d in milk when controlling for parity compared with CON-fed cows; potential reproductive benefits merit further study. This study demonstrated that zeolite A supplementation during the prepartum period results in markedly improved serum Ca concentrations around parturition and similar postpartum performance compared with controls and is effective at decreasing hypocalcemia in multiparous Holstein cows.

Effect of rumen-protected branched-chain amino acid supplementation on production- and energy-related metabolites during the first 35 days in milk in Holstein dairy cows

Essential AA are critical for multiple physiological processes. Branched-chain AA (BCAA) supplementation has beneficial effects on body weight, lipogenesis, and insulin resistance in several species. The BCAA are used for milk and body protein synthesis as well as being oxidized by the tricarboxylic acid cycle to produce ATP during catabolic states. The objective was to evaluate the effect of rumen-protected BCAA (375 g of 27% l-Leu, 85 g of 48% l-Ile, and 91 g of 67% l-Val) with or without propylene glycol (PG) oral administration on milk production, dry matter intake, nonesterified fatty acids, β-hydroxybutyrate, and plasma urea nitrogen during the first 35 d in milk (DIM) in dairy cattle. Multiparous Holstein cows were enrolled in blocks of three 28 d before expected calving and assigned randomly to either the control or 1 of 2 treatments. The control (n = 26) received 200 g/d of dry molasses, the BCAA treatment (n = 23) received BCAA mixed with 200 g/d of dry molasses from calving until 35 DIM, and the BCAA plus PG (BCAAPG) treatment (n = 25) received BCAA mixed with 200 g/d of dry molasses from calving until 35 DIM plus 300 mL of PG once daily from calving until 7 DIM. Postpartum, dry matter intake least squares means (LSM; 95% confidence interval) were 20.7 (19.9, 21.7), 21.3 (20.4, 22.3), and 21.9 (20.9, 22.8) kg for control, BCAA, and BCAAPG, respectively. Milk yield (1-35 DIM) LSM were 41.7 (39.4, 44.0), 42.7 (40.3, 45.0), and 43.7 (41.4, 46.0) kg for control, BCAA, and BCAAPG, respectively. Energy-corrected milk LSM were 50.3 (46.8, 53.7), 52.4 (48.9, 55.8), and 52.9 (49.5, 56.4) kg for control, BCAA, and BCAAPG, respectively. Milk urea nitrogen LSM in milk for control, BCAA, and BCAAPG were 8.60 (8.02, 9.22), 9.70 (9.01, 10.45), and 9.75 (9.08, 10.47) mg/dL. Plasma urea nitrogen concentrations LSM for control, BCAA, and BCAAPG were 8.3 (7.7, 8.9), 10.1 (9.4, 10.9), and 9.6 (9.4, 10.3) mg/dL, respectively. The numbers of plasma samples classified as hyperketonemia were 77, 44, and 57 in control, BCAA, and BCAAPG, respectively. The BCAA supplementation increased plasma urea nitrogen and milk urea nitrogen, free valine concentration in plasma, and decreased hyperketonemia events during the postpartum period.

The effect of source of supplemental dietary calcium and magnesium in the peripartum period, and level of dietary magnesium postpartum, on mineral status, performance, and energy metabolites in multiparous Holstein cows

The objective of this study was to determine the effects of feeding different supplemental sources of Ca and Mg in the peripartum period, and different dietary levels of Mg postpartum, on plasma mineral status, performance, and aspects of energy metabolism in transition dairy cows. Multiparous Holstein cows (n = 41) were used in a completely randomized design with a 2 × 2 factorial arrangement of treatments starting at 28 d before expected parturition. Main effects were source assignments (CS = common sources of supplemental Ca and Mg, or MA = a blend of common and commercial mineral sources with supplemental minerals primarily from a commercial Ca-Mg dolomite source; MIN-AD, Papillon Agricultural Company Inc., Easton, MD) beginning at 21 d before due date; cows were further randomized within source treatments to 1 of 2 levels of Mg supplementation (LM = formulated postpartum diet Mg at 0.30% of dry matter (DM), or HM = formulated postpartum diet Mg at 0.45% of DM) beginning within 1 d after parturition. Final treatment groups included the following: common source, low Mg (CS-LM, n = 11); common source, high Mg (CS-HM, n = 11); MIN-AD, low Mg (MA-LM, n = 10); and MIN-AD, high Mg (MA-HM, n = 9). Treatment diets were fed and data collected through 42 d in milk. Postpartum plasma Mg concentrations tended to be higher for cows fed HM and cows fed CS, but no effects were observed on peripartum plasma Ca concentrations. Peripartum plasma P concentrations were higher for cows fed MA. Dry matter intake (DMI) in the prepartum period was higher for cows fed MA (CS = 15.9 vs. MA = 16.8 kg/d) and postpartum DMI was higher in some groups depending on week. Plasma nonesterified fatty acid concentrations were lower for cows fed MA during both the prepartum and postpartum periods. A source by level interaction was observed for postpartum plasma β-hydroxybutyrate (BHB) concentrations such that cows fed CS-LM had numerically higher BHB and cows fed MA-LM had numerically lower BHB (geometric means; CS-LM = 7.9, CS-HM = 6.9, MA-LM = 6.3, and MA-HM = 7.3 mg/dL) than cows fed the other 2 treatments. Higher milk fat yield, milk fat content, and fat- and energy-corrected yield during wk 1 for cows fed MA resulted in source by week interactions for these outcomes. This study demonstrated that varying supplemental Ca and Mg sources and feeding rates had minimal effect on plasma Ca status despite differences in plasma Mg and P concentrations. Effects on DMI and plasma energy metabolites suggest an opportunity for strategic use of mineral sources in the transition period to promote metabolic health.

A Randomized Controlled Trial to Compare Computer-assisted Motivational Intervention with Didactic Educational Counseling to Reduce Unprotected Sex in Female Adolescents

STUDY OBJECTIVE

To examine a computer-assisted, counselor-guided motivational intervention (CAMI) aimed at reducing the risk of unprotected sexual intercourse. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a 9-month, longitudinal randomized controlled trial with a multisite recruitment strategy including clinic, university, and social referrals, and compared the CAMI with didactic educational counseling in 572 female adolescents with a mean age of 17 years (SD = 2.2 years; range = 13-21 years; 59% African American) who were at risk for pregnancy and sexually transmitted diseases. The primary outcome was the acceptability of the CAMI according to self-reported rating scales. The secondary outcome was the reduction of pregnancy and sexually transmitted disease risk using a 9-month, self-report timeline follow-back calendar of unprotected sex.

RESULTS

The CAMI was rated easy to use. Compared with the didactic educational counseling, there was a significant effect of the intervention which suggested that the CAMI helped reduce unprotected sex among participants who completed the study. However, because of the high attrition rate, the intent to treat analysis did not demonstrate a significant effect of the CAMI on reducing the rate of unprotected sex.

CONCLUSION

Among those who completed the intervention, the CAMI reduced unprotected sex among an at-risk, predominantly minority sample of female adolescents. Modification of the CAMI to address methodological issues that contributed to a high drop-out rate are needed to make the intervention more acceptable and feasible for use among sexually active predominantly minority, at-risk, female adolescents.

Effects of monensin and starch level in early lactation diets on indices of immune function in dairy cows

The objective of this study was to evaluate the effect of dietary starch level and monensin on immune function. Prior to parturition, primiparous (n=21) and multiparous (n=49) Holstein cows were fed a common controlled energy close-up diet with a daily topdress of either 0 or 400 mg/d monensin. From 1 to 21 d in milk (DIM), cows were fed a high-starch (HS; 26.2% starch) or low-starch (LS; 21.5% starch) total mixed ration with a daily topdress of either 0 or 450 mg of monensin/d continuing with prepartum topdress assignment. From 22 through 63 DIM, all cows were fed HS and continued with assigned topdress treatment until 63 DIM. Endometrial cytology and whole-blood immune function were assessed at 8 DIM and on 1 d between 40 and 60 DIM. At 8 DIM, cows fed HS had an increased percentage (%) of phagocytic monocytes and tended to have a greater phagocytosis index (% of positive cells × mean fluorescence intensity) in monocytes compared with cows fed LS. At 8 DIM, cows fed HS also tended to have a higher percentage of monocytes involved in oxidative burst and a higher monocyte oxidative burst index compared with LS cows. At 8 DIM, blood polymorphonuclear neutrophils (PMN) isolated from cows fed monensin during the periparturient period tended to have higher PMN glycogen content compared with control cows. At 40 to 60 DIM, the incidence of cytological endometritis as diagnosed by uterine cytology was not affected by dietary treatment. However, at 40 to 60 DIM, cows fed monensin had an increased percentage of Escherichia coli-stimulated PMN, tended to have a greater percentage of monocytes involved in oxidative burst, and tended to have an increased E. coli-stimulated monocyte oxidative burst index. At 40 to 60 DIM, blood PMN isolated from cows fed HS during early lactation had higher PMN glycogen content compared with cows fed LS during early lactation. Overall, results suggest that feeding higher starch diets postpartum and peripartal supplementation with monensin may have some beneficial effects on immune function, although uterine cytology was not affected by treatment.

Metabolism of early-lactation dairy cows as affected by dietary starch and monensin supplementation

The objective of this study was to evaluate the effect of dietary starch content and monensin (MON) on metabolism of dairy cows during early lactation. Before parturition, primiparous (n=21) and multiparous (n=49) Holstein cows were fed a common controlled-energy close-up diet with a daily topdress of either 0 or 400mg/d monensin. From d 1 to 21 postpartum, cows were fed a high-starch (HS; 26.2% starch, 34.3% neutral detergent fiber, 22.7% acid detergent fiber, 15.5% crude protein) or low-starch (LS; 21.5% starch, 36.9% neutral detergent fiber, 25.2% acid detergent fiber, 15.4% crude protein) total mixed ration with a daily topdress of either 0mg/d monensin (CON) or 450mg/d monensin (MON), continuing with prepartum topdress assignment. From d 22 through 63 postpartum, all cows were fed HS and continued with the assigned topdress treatment until d 63. Cows fed HS had higher plasma glucose and insulin and lower nonesterified fatty acids (NEFA) than cows fed LS during d 1 to 21 postpartum. Cows fed LS had elevated early-lactation β-hydroxybutyrate (BHBA) compared with cows fed HS. Cows fed HS had greater insulin resistance and increased plasma haptoglobin in the early lactation period. There was no effect of MON on postpartum plasma NEFA. Cows fed MON had higher plasma glucose compared with CON cows, which was driven by a MON × parity interaction in which primiparous cows fed MON had greater plasma glucose concentrations than cows fed CON. Cows fed MON had lower plasma BHBA compared with CON, which was contributed to by a MON × parity interaction in which primiparous cows fed MON had lower BHBA concentrations than CON. Starch treatment had no effect on overall liver triglyceride content. Primiparous cows fed MON had increased liver triglyceride content compared with CON primiparous cows, and multiparous cows fed MON had decreased liver triglyceride content compared with CON cows. Multiparous cows fed LS with MON had higher liver glycogen content than multiparous cows fed the LS without MON, with no effect of MON treatment for multiparous cows fed HS. There was no effect of starch or MON treatment on liver capacity to oxidize propionate to CO2, and effects of starch on gluconeogenesis were not significant. Cows fed MON tended to have greater capacity to convert propionate to glucose than CON. Supplementation with MON increased the ratio of glucose to CO2, which indicated that cows fed MON had a greater propensity to convert propionate to glucose. Overall, cows fed more propiogenic diets in early lactation (high starch or monensin) exhibited improved energy metabolism during early lactation.

Immune cell function assay does not identify biopsy-proven pediatric renal allograft rejection or infection

Management of pediatric renal transplant patients involves multifactorial monitoring modalities to ensure allograft survival and prevent opportunistic infection secondary to immunosuppression. An ICFA, which utilizes CD4 T-cell production of ATP to assess immune system status, has been used to monitor transplant recipients and predict susceptibility of patients to rejection or infection. However, the validity of this assay to reflect immune status remains unanswered. In a two-yr retrospective study that included 31 pediatric renal transplant recipients, 42 patient blood samples were analyzed for immune cell function levels, creatinine, WBC (white blood cell) count, immunosuppressive drug levels, and viremia, concurrent with renal biopsy. T-cell ATP production as assessed by ICFA levels did not correlate with allograft rejection or with the presence or absence of viremia. ICFA levels did not correlate with serum creatinine or immunosuppressive drug levels, but did correlate with WBC count. The ICFA is unreliable in its ability to reflect immune system status in pediatric renal transplantation. Further investigation is necessary to develop methods that will accurately predict susceptibility of pediatric renal transplant recipients to allograft rejection and infection.

Impact of quantitative feedback and benchmark selection on radiation use by cardiologists performing cardiac angiography

Audit of and feedback on both group and individual data provided immediately after the point of care and compared with realistic benchmarks of excellence have been demonstrated to drive change. This study sought to evaluate the impact of immediate benchmarked quantitative case-based performance feedback on the clinical practice of cardiologists practicing at a private hospital in Brisbane, Australia. The participating cardiologists were assigned to one of two groups: Group 1 received patient and procedural details for review and Group 2 received Group 1 data plus detailed radiation data relating to the procedures and comparative benchmarks. In Group 2, Linear-by-Linear Association analysis suggests a link between change in radiation use and initial radiation dose category (p=0.014) with only those initially 'challenged' by the benchmarks showing improvement. Those not 'challenged' by the benchmarks deteriorated in performance compared with those starting well below the benchmarks showing greatest increase in radiation use. Conversely, those blinded to their radiation use (Group 1) showed general improvement in radiation use throughout the study compared with those performing initially close to the benchmarks showing greatest improvement. This study shows that use of non-challenging benchmarks in case-based radiation risk feedback does not promote a reduction in radiation use; indeed, it may contribute to increased doses. Paradoxically, cardiologists who are aware of performance monitoring but blinded to individual case data appear to maintain, if not reduce, their radiation use.

Further evidence that fundamental-frequency difference limens measure pitch discrimination

Difference limens for complex tones (DLCs) that differ in F0 are widely regarded as a measure of periodicity-pitch discrimination. However, because F0 changes are inevitably accompanied by changes in the frequencies of the harmonics, DLCs may actually reflect the discriminability of individual components. To test this hypothesis, DLCs were measured for complex tones, the component frequencies of which were shifted coherently upward or downward by ΔF = 0%, 25%, 37.5%, or 50% of the F0, yielding fully harmonic (ΔF = 0%), strongly inharmonic (ΔF = 25%, 37.5%), or odd-harmonic (ΔF = 50%) tones. If DLCs truly reflect periodicity-pitch discriminability, they should be larger (worse) for inharmonic tones than for harmonic and odd harmonic tones because inharmonic tones have a weaker pitch. Consistent with this prediction, the results of two experiments showed a non-monotonic dependence of DLCs on ΔF, with larger DLCs for ΔF's of ± 25% or ± 37.5% than for ΔF's of 0 or ± 50% of F0. These findings are consistent with models of pitch perception that involve harmonic templates or with an autocorrelation-based model provided that more than just the highest peak in the summary autocorrelogram is taken into account.

PD04-07: Cognitive Function and Reproductive Hormones in Women Receiving Anastrozole

Background: The effects of adjuvant hormonal therapy on hormone levels may contribute to deterioration in cognitive function experienced by women with breast cancer. Estrogen receptors are present throughout the central nervous system. Estrogen binding increases ChAT, synaptogenesis and dendritic spine density in the hippocampus and hypothalamus and decreases monoamine oxidase activity. Aromatase inhibitors, such as anastrozole, interrupt estrogen biosynthesis resulting in profound estrogen reductions. We studied whether changes in reproductive hormone levels mediate changes in cognitive function in 3 cohorts of postmenopausal women; women with breast cancer who receive chemotherapy+anastrozole (CA; n=41) or anastrozole only (AO; n=50)] and age and education matched healthy women (n=44).

Methods: We assessed cognitive function and reproductive hormones (E2, LH, FSH) before therapy and at 6, 12 and 18 months post-therapy initiation. A battery of neuropsychological measures was used to assess multiple cognitive domains. Using mixed effects modeling, we analyzed changes in hormone levels from pretreatment to 6, 12 and 18 months post-therapy initiation and then explored intercorrelations between changes in hormone levels and cognitive function at all timepoints.

Results: Women were an average 59.3 years of age with an average 14.9 years of education. No significant group-by-time effects were found for LH. However, we found significant group by time effects for E2 when comparing CA with controls (p=.0002) and AO with controls (p&lt;.0001) and for FSH when comparing AO with controls (p=.03). We found that E2 declined from pretreatment in the breast cancer groups as follows; CA [E2 declined from pretreatment to immediately post-chemotherapy (p = .09), and at 6 (p=.0002) and 12 (p=.014) months post anastrozole initiation, and AO [E2 declined from pretreatment to 6 (p&lt;.0001), 12 (p=.004) and 18 (p&lt;.0001) months post-anastrozole initiation]. We also found increases in FSH in the AO group from pretreatment to 6 (p=.002) and 12 (p=.05) months. No significant within-group changes for E2, FSH, or LH were observed for controls.

For the full sample, the intercorrelations revealed that reductions in E2 were related to poorer psychomotor efficiency from baseline to 18 months post-baseline (rs=.358, p=.02). For the AO group, reductions in E2 were related to poorer executive function (r=.600, p= 002) from 6 to 12 months post-anastrozole initiation and poorer psychomotor efficiency (r=.453, p=.07) from pretreatment to 18 months post-anastrozole initiation. For the CA group, reductions in E2 were marginally significantly related to poorer attention (r=.307, p=.08) from pretreatment to post-chemotherapy; and to poorer executive function from pretreatment to 6 months (r=.446, p=.06) and 12 months (r=.651, p=.03) post-anastrozole initiation. No significant relationships between changes in E2 levels and cognitive function were found in the controls.

Conclusions: Reductions in E2 may be related to cognitive deterioration in women with breast cancer. Further examination of these relationships is needed to confirm the results and determine whether these relationships persist through the remainder and after the conclusion of therapy.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD04-07.

P4-12-02: The Association of Anastrozole Adherence and Cognitive Function in Breast Cancer

Background: Women with breast cancer experience deterioration in cognitive function with adjuvant therapy. Little is known about whether declines in cognitive function are associated with nonadherence to oral hormonal therapy over time. We investigated anastrozole adherence over time and its association with cognitive function over the first 12 months of therapy in women with breast cancer.

Methods: Using a prospective cohort design, 169 women with early stage breast cancer were monitored for 12 months 1) continuously for their adherence to anastrozole using electronic event monitoring and 2) objectively for cognitive function via a neuropsychological battery every 6 months for the first 12 months of hormonal therapy. Adherence data were summarized monthly as to the number of doses taken as the percentage of prescribed doses taken and the timing of doses taken as the percentage of days with correct intake and the percentage of doses with correct timing. Six cognitive factors, derived via exploratory factor analysis applied to the neuropsychological battery, were used for analysis. Data were analyzed using descriptive and longitudinal methods.

Results: Participants were white (n=166, 98.2%), well-educated (Mean=15.1 years; SD=2.9, range=10-26) and on average 61.1 years of age (SD=5.9, range=46-75). Most had stage 1 breast cancer (n=123, 72.8%) and were prescribed anastrozole either alone (n=110, 65.1%) or immediately after chemotherapy (n=59, 34.9%). Initial levels of adherence were fairly high based on number of (Mean=89.1, SD=27.1, range=0-111.1) and timing of doses taken (Days with correct intake: Mean=86.4, SD=26.8, range=0-100; Doses with correct timing: Mean=83.6, SD=29.8, range=0-100); however, adherence decreased over the first 12 months of therapy (p&lt;.05) in terms of the number of and timing of doses taken and regardless of chemotherapy use. Specifically, we found a linear decrease for the percentage of prescribed doses taken (linear: t=-2.97, p=.0035); however, nonlinear declines were observed for both the percentage of days with correct intake (linear: t=-3.33, p=.0011; quadratic: t=2.10, p=.0371) and the percentage of doses taken at the correct time (linear: t=-3.38, p=.0009; quadratic: t=2.28, p=.0242), suggesting a slowing of the rate of decline in adherence related timing of doses for months 9 through 12. We found that a decrease in executive functioning was related to lower percentages of prescribed doses taken (p=.06) and doses taken at the correct time (p=.06) from pretreatment to 6 months post-anastrozole initiation and even greater evidence (p&lt;.05) from pretreatment to 12 months post-anastrozole initiation. From 7 to 12 months post-anastrozole initiation, we found that a decrease in visual learning and memory was related to lower percentages of prescribed doses taken (p=.04), days with correct intake (p=.04), and doses taken at the correct time (p=.03), while a decrease in attention was related to a lower percentage of days with correct intake (p=.04).

Conclusions: These results suggest that breast cancer survivors who experience deterioration in cognitive function tend to have lower adherence. Efforts should be made to develop interventions to compensate for declines in cognitive function and to improve anastrozole adherence.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-12-02.

The carbon balance of Africa: synthesis of recent research studies

The African continent contributes one of the largest uncertainties to the global CO(2) budget, because very few long-term measurements are carried out in this region. The contribution of Africa to the global carbon cycle is characterized by its low fossil fuel emissions, a rapidly increasing population causing cropland expansion, and degradation and deforestation risk to extensive dryland and savannah ecosystems and to tropical forests in Central Africa. A synthesis of the carbon balance of African ecosystems is provided at different scales, including observations of land-atmosphere CO(2) flux and soil carbon and biomass carbon stocks. A review of the most recent estimates of the net long-term carbon balance of African ecosystems is provided, including losses from fire disturbance, based upon observations, giving a sink of the order of 0.2 Pg C yr(-1) with a large uncertainty around this number. By comparison, fossil fuel emissions are only of the order of 0.2 Pg C yr(-1) and land-use emissions are of the order of 0.24 Pg C yr(-1). The sources of year-to-year variations in the ecosystem carbon-balance are also discussed. Recommendations for the deployment of a coordinated carbon-monitoring system for African ecosystems are given.

Regional grey matter shrinks in hypertensive individuals despite successful lowering of blood pressure

Objective

To determine whether reduction in brain grey matter volume associated with hypertension persisted or was remediated among hypertensive patients newly treated over the course of a year.

Methods

Forty-one hypertensive patients were assessed over the course of a one-year successful anti-hypertensive treatment. Brain areas identified previously in cross-sectional studies as differing in volume between hypertensive and normotensive individuals were examined with a semi-automated measurement technique (ALP, automated labeling pathway). Volumes of grey matter regions were computed at baseline and after a year of treatment and compared to archival data from normotensive individuals.

Results

Reductions in regional grey matter volume over the follow-up period were observed despite successful treatment of blood pressure. The comparison group of older, but normotensive individuals showed no significant changes over a year in the regions tested in the treated hypertensive group.

Conclusions

These novel results suggest that essential hypertension is associated with regional grey matter shrinkage and successful reduction of blood pressure may not completely counter that trend.

Biomedical risk factors for decreased cognitive functioning in type 1 diabetes: an 18 year follow-up of the Diabetes Control and Complications Trial (DCCT) cohort

AIMS/HYPOTHESIS

In patients with type 1 diabetes, there has been concern about the effects of recurrent hypoglycaemia and chronic hyperglycaemia on cognitive function. Because other biomedical factors may also increase the risk of cognitive decline, this study examined whether macrovascular risk factors (hypertension, smoking, hypercholesterolaemia, obesity), sub-clinical macrovascular disease (carotid intima-media thickening, coronary calcification) and microvascular complications (retinopathy, nephropathy) were associated with decrements in cognitive function over an extended time period.

METHODS

Type 1 diabetes patients (n = 1,144) who had completed a comprehensive cognitive test battery at entry into the Diabetes Control and Complications Trial were re-assessed at a mean of 18.5 (range: 15-23) years later. Univariate and multivariable models examined the relationship between cognitive change and the presence of micro- and macrovascular complications and risk factors.

RESULTS

Univariate modelling showed that smoking history was modestly associated with decrements in learning, memory, spatial information-processing and psychomotor efficiency; hypertension was associated with only psychomotor slowing. Multivariable modelling demonstrated that HbA(1c) level, and retinal and renal complications were each independently associated with decrements in psychomotor efficiency. In contrast, no macrovascular risk factors were significant after correcting for multiple comparisons. No interactions were found between these predictors and sex, severe hypoglycaemic events or presence of the APOE ε4 allele.

CONCLUSIONS/INTERPRETATION

In relatively healthy, middle-aged adults with type 1 diabetes who had been followed for an average of 18.5 years, long-term metabolic control and microvascular factors are independently associated with a decline in cognitive function specifically affecting measures of psychomotor efficiency.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00360893.

Preliminary evidence for brain complications in obese adolescents with type 2 diabetes mellitus

AIMS/HYPOTHESIS

Central nervous system abnormalities, including cognitive and brain impairments, have been documented in adults with type 2 diabetes who also have multiple co-morbid disorders that could contribute to these observations. Assessing adolescents with type 2 diabetes will allow the evaluation of whether diabetes per se may adversely affect brain function and structure years before clinically significant vascular disease develops.

METHODS

Eighteen obese adolescents with type 2 diabetes and 18 obese controls without evidence of marked insulin resistance, matched on age, sex, school grade, ethnicity, socioeconomic status, body mass index and waist circumference, completed MRI and neuropsychological evaluations.

RESULTS

Adolescents with type 2 diabetes performed consistently worse in all cognitive domains assessed, with the difference reaching statistical significance for estimated intellectual functioning, verbal memory and psychomotor efficiency. There were statistical trends for executive function, reading and spelling. MRI-based automated brain structural analyses revealed both reduced white matter volume and enlarged cerebrospinal fluid space in the whole brain and the frontal lobe in particular, but there was no obvious grey matter volume reduction. In addition, assessments using diffusion tensor imaging revealed reduced white and grey matter microstructural integrity.

CONCLUSIONS/INTERPRETATION

This is the first report documenting possible brain abnormalities among obese adolescents with type 2 diabetes relative to obese adolescent controls. These abnormalities are not likely to result from education or socioeconomic bias and may result from a combination of subtle vascular changes, glucose and lipid metabolism abnormalities and subtle differences in adiposity in the absence of clinically significant vascular disease. Future efforts are needed to elucidate the underlying pathophysiological mechanisms.

Shift in sleep apnoea type in heart failure patients in the CANPAP trial

In patients with heart failure (HF), the predominant type of sleep apnoea can change over time in association with alterations in circulation time. The aim of this study was to determine whether, in some patients with HF, a spontaneous shift from mainly central (>50% central events) to mainly obstructive (>50% obstructive events) sleep apnoea (CSA and OSA, respectively) over time coincides with improvement in left ventricular ejection fraction (LVEF). Therefore, sleep studies and LVEFs of HF patients with CSA from the control arm of the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure (CANPAP) trial were examined to determine whether some converted to mainly OSA and, if so, whether this was associated with an increase in LVEF. Of 98 patients with follow-up sleep studies and LVEFs, 18 converted spontaneously to predominantly OSA. Compared with those in the nonconversion group, those in the conversion group had a significantly greater increase in the LVEF (2.8% versus -0.07%) and a significantly greater fall in the lung-to-ear circulation time (-7.6 s versus 0.6 s). In patients with HF, spontaneous conversion from predominantly CSA to OSA is associated with an improvement in left ventricular systolic function. Future studies will be necessary to further examine this relationship.

The associations of apolipoprotein E and angiotensin-converting enzyme polymorphisms and cognitive function in Type 1 diabetes based on an 18-year follow-up of the DCCT cohort

AIMS

Specific polymorphisms of the apolipoprotein E (APOE) and angiotensin-converting enzyme (ACE) genes appear to increase risk for Alzheimer's disease and cognitive dysfunction in the general population, yet little research has examined whether genetic factors influence risk of cognitive dysfunction in patients with Type 1 diabetes. The long-term follow-up of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) population provides an opportunity to examine if specific genetic variations in APOE and ACE alter risk for cognitive decline.

METHODS

Neurocognitive function in Type 1 diabetic subjects from the DCCT/EDIC study was assessed at DCCT entry and re-assessed approximately 18 years later, using a comprehensive cognitive test battery. Glycated haemoglobin (HbA(1c)) and the frequency of severe hypoglycaemic events leading to coma or seizures were measured over the 18-year follow-up. We determined whether the APO epsilon4 and ACE intron 16 indel genotypes were associated with baseline cognitive function and with change over time, and whether they conferred added risk in those subjects experiencing severe hypoglycaemic events or greater glycaemic exposure.

RESULTS

None of the APOE or ACE polymorphisms were associated with either baseline cognitive performance or change in cognition over the 18-year follow-up. Moreover, none of the genotype variations altered the risk of cognitive dysfunction in those subjects with severe hypoglycaemic episodes or high HbA(1c).

CONCLUSIONS

In this sample of young and middle-aged adults with Type 1 diabetes, APO epsilon4 and ACE D alleles do not appear to increase risk of cognitive dysfunction.

The effects of type 1 diabetes on cerebral white matter

AIM/HYPOTHESIS

Studies investigating the structure, neurophysiology and functional outcomes of white matter among type 1 diabetes patients have given conflicting results. Our aim was to investigate the relationship between type 1 diabetes and white matter hyperintensities.

METHOD

We assessed white matter integrity (using magnetic resonance imaging), depressive symptoms and neuropsychological function in 114 type 1 diabetes patients and 58 age-matched non-diabetic controls.

RESULTS

Only Fazekas grade 1 and 2 white matter hyperintensities were found among 114 long-duration, relatively young diabetes patients; the severity of lesions did not differ substantially from 58 healthy controls. White matter hyperintensities were not associated with depressive history or with clinical characteristics of diabetes, including retinopathy, severe hypoglycaemia or glycaemia control.

CONCLUSIONS/INTERPRETATION

Our data do not support an association between diabetes characteristics and white matter hyperintensities among relatively young type 1 diabetes participants.

Neurological manifestations of electrical trauma

Some degree of neurological impairment is often found in patients following electrical injury. A wide range of neurological impairments can occur including peripheral neuropathies, chronic pain syndromes, brain injury and rarely severe paralytic syndromes. Outcome is difficult to accurately predict. The symptoms can present immediately or be delayed in onset. They can also be temporary, permanent or get progressively worse with time. The neurological impairment resulting from the current often comprises a substantial proportion of the morbidity associated with such injuries. It is known that electrical current can cause nerve injury, however, the primary etiology of such damage is yet to be elucidated. An unusual case of transient paralysis after high voltage burn associated with severe hypokalemia provides unique insight into a potential mechanism for nerve injury following electrical trauma.

Effect of continuous positive airway pressure on ventricular ectopy in heart failure patients with obstructive sleep apnoea

BACKGROUND

Obstructive sleep apnoea (OSA) elicits a number of cardiovascular perturbations that could lead acutely or chronically to increased ventricular ectopy in patients with heart failure (HF). We tested the hypothesis that treatment of OSA with continuous positive airway pressure (CPAP) in patients with HF would reduce the frequency of ventricular premature beats (VPBs) during sleep in association with reduced sympathetic nervous system activity.

METHODS

Following optimisation of medical treatment, 18 HF patients with OSA and >10 VPBs per hour of sleep were randomised to a control group (n = 8) or a treatment group who received CPAP (n = 10). The frequency of VPBs and urinary norepinephrine (noradrenaline) concentrations during total sleep time were determined at baseline and after 1 month.

RESULTS

Control patients did not experience any significant changes in apnoea-hypopnoea index (AHI), mean nocturnal O(2) saturation, or the frequency of VPBs. In contrast, there was a significant reduction in AHI (p<0.001), an increase in minimum O(2) saturation (p = 0.05), a reduction in urinary norepinephrine concentrations (p = 0.009), and a 58% reduction in the frequency of VPBs during total sleep (from mean (SE) 170 (65) to 70 (28) per hour, p = 0.011) after 1 month of CPAP treatment.

CONCLUSIONS

In patients with HF, treatment of co-existing OSA by CPAP reduces the frequency of VPBs during sleep. These data suggest that reductions in VPBs and other ventricular arrhythmias through treatment of OSA might improve the prognosis in patients with HF.

Changes in cognitive function after neuronal cell transplantation for basal ganglia stroke

Reported is the change in cognitive function after neuronal cell transplantation as a treatment for basal ganglia stroke. Nine subjects (two controls, seven transplants), all over 2 years post stroke, completed a comprehensive neuropsychological test battery prior to and 6 months after treatment. Four transplanted subjects who had strokes in the nondominant hemisphere showed marked improvement on the Rey Complex Figure, a test of visuospatial/constructional ability and nonverbal memory.

Effects of Dry Cow Grouping Strategy and Prepartum Body Condition Score on Performance and Health of Transition Dairy Cows

Multiparous Holstein cows (n = 337) on two commercial dairy farms were used to determine the effects of feeding a close-up diet for 21 (treatment S) or 60 d (treatment L). Milk yield was not affected by treatment; however, cows fed treatment S tended to have increased yields of fat, 3.5% fat-corrected milk, and protein during the first 5 mo of their subsequent lactation compared to treatment L. Cows fed treatment L gained more body condition score (BCS) during the dry period and had longer days to first service. As a secondary objective, relationships of BCS at dry off and subsequent performance were evaluated. Cows with initial BCS < or =3.0 (thinner) tended to produce more milk during early lactation than cows with initial BCS > or = 3.25 (fatter). A trend for an interaction of treatment and initial BCS existed for milk yield such that thinner cows fed treatment S produced the most milk and fatter cows fed treatment S produced the least amount of milk; cows fed treatment L regardless of BCS produced an intermediate amount of milk. Subsequent reproductive performance was similar among thinner and fatter cows. These data indicate that 2 group nutritional strategies for dry cows are preferred, and BCS at dry off should be considered when determining grouping and nutritional strategies for dry cows. Furthermore, moderately thin cows at dry off do not have impaired performance during their subsequent lactation compared to cows of greater BCS.

BDNF and COMT Polymorphisms: Relation to Memory Phenotypes in Young Adults With Childhood-Onset Mood Disorder

Recent investigations in several species have suggested a role for brain-derived neurotrophic factor (BDNF) in memory, which may be mediated by the influence of BDNF on neuronal plasticity in the hippocampus. BDNF polymorphisms have also been associated with mood disorders. Catechol-O-methyltransferase (COMT) metabolizes dopamine and has been implicated in prefrontal function, another area of the brain relevant for memory. In a sample of 63 young adults with a history of childhood-onset mood disorder, we typed three BDNF polymorphisms, including the BDNF Val66Met single nucleotide polymorphism (SNP), and the COMT Val108/158Met SNP. Multivariate analysis of variance was used to test the association between BDNF and COMT markers and measures of declarative memory. Variants at the three BDNF markers and one COMT marker were not associated with declarative memory function p-values ranged from 0.25 to 0.98. Higher IQ (F = 6.18, df = 4, 58, p = 0.0003) and female gender (F = 4.41, df = 4, 58, p = 0.0035) were associated with more optimal performance on the memory tasks. This study did not provide evidence supporting an association between BDNF and COMT genes and declarative memory phenotypes.

Phosphorus Feeding Levels and Critical Control Points on Dairy Farms

A viable and cost-effective approach to managing P on dairy farms is to minimize excess P in diets, which in turn leads to less excretion of P in manure without impairing animal performance. A questionnaire survey was conducted, coupled with on-site feed and fecal sample collection and analysis on dairy farms in New York, Pennsylvania, Delaware, Maryland, and Virginia. The purpose was to assess dietary P levels and to identify critical control points pertaining to P feeding management. Survey responses, 612 out of 2500 randomly selected farms, revealed a wide range of dietary P concentrations for lactating cows, from 3.6 to 7.0 g/kg of feed DM. The mean was 4.4 g/kg, which was 34% above the level recommended by the NRC for 27.9 kg milk/d, the mean milk yield in the survey. Higher P concentrations in diets were not associated with higher milk yields (n = 98, R2 = 0.057 for the survey farms; n = 92, R2 = 0.043 for farms selected for on-site sampling). However, higher dietary P led to higher P excretion in feces (n = 75, R2 = 0.429), with much of the increased fecal P being water soluble. Phosphorus concentrations in diet samples matched closely with P concentrations in formulated rations, with 67% of the feed samples deviating <10% from the formulations. On 84% of the survey farms, ration formulation was provided by professionals rather than producers themselves. Most producers were feeding more P than cows needed because it was recommended in the rations by these consultants. In conclusion, P fed to lactating cows averaged 34% above NRC recommendations; to reduce excess dietary P, ration formulation is the critical control point.

Cognitive efficiency declines over time in adults with Type 1 diabetes: effects of micro- and macrovascular complications

AIMS/HYPOTHESIS

Mild cognitive dysfunction is not uncommon in adults with Type 1 diabetes, but its pathogenesis remains unclear. Previous cross-sectional studies had suggested that microangiopathy might affect brain integrity and lead to "central neuropathy." To assess the relationship between changes in cognitive performance and the incidence of new micro- and macrovascular complications, 103 young and middle-aged adults (mean age: 40 yrs) with childhood-onset Type 1 diabetes were followed over a 7-year period, and were compared to 57 demographically-similar adults without diabetes.

METHODS

All subjects completed a comprehensive battery of neurocognitive tests on two occasions. Diabetic subjects also received repeated medical assessments to diagnose the onset of clinically significant complications.

RESULTS

Relative to control subjects, diabetic adults showed significant declines on measures of psychomotor efficiency; no between-group differences were evident on learning, memory, or problem-solving tasks. The development of proliferative retinopathy and autonomic neuropathy during the follow-up period predicted decline in psychomotor speed (p<0.01), as did incident macrovascular complications (p<0.05), systolic blood pressure at follow-up (p<0.01), and duration of diabetes (p<0.01).

CONCLUSION/INTERPRETATION

This study shows that cognitive efficiency may decline over time in diabetic adults, and that this neurocognitive change may be linked, at least in part, to the occurrence of complications like proliferative retinopathy and elevated blood pressure. Therapeutic interventions that reduce the risk of vascular complications may have a similarly beneficial effect on the brain and reduce the risk of neurocognitive dysfunction in diabetic patients.

Severe hypokalemia as a cause of acute transient paraplegia following electrical shock

Transient lower extremity paralysis has been previously reported following high voltage electrical injury. The following case report describes an unusual presentation of transient acute flaccid lower extremity paralysis following a high voltage electrical injury associated with profound hypokalemia and acid/base abnormalities similar to the periodic paralysis syndrome. The patient's symptoms resolved with correction of severe hypokalemia. Potential mechanisms for a metabolic neuromuscular disorder induced by electrical injury are proposed.

Images of conspecifics as categories to be discriminated by pigeons and chickens: Slides, video tapes, stuffed birds and live birds

Four experiments investigated the discrimination of images of conspecifics by pigeons; in Experiment 1, chickens were also used as subjects, and images of allospecifics were also used as discriminative stimuli. In Experiment 1, chickens were successfully trained to discriminate slides of pigeons, pictures of one bird being positive stimuli and pictures of another bird being negative; and pigeons were similarly trained to discriminate slides of chickens. However, an attempt to train pigeons to discriminate slides of pigeons only succeeded with one bird out of six. Pigeons were slower to learn chicken slides, and chickens were slower to learn pigeon slides, than chickens were to learn chicken slides in a previous experiment. In Experiment 2, a dishabituation technique was used to demonstrate that pigeons readily discriminate individual live pigeons. In Experiment 3, an attempt was made to test habituation to life-size moving video images of pigeons, but these images did not elicit any natural social responses from the subject pigeons. In Experiment 4 pigeons were trained in a discrimination in which the objects to be discriminated were two different stuffed pigeons. No pigeon learned this discrimination. The experiments give some evidence that chickens are better at discriminating images of individuals than pigeons. No single feature seems to be sufficient for pigeons to discriminate between conspecifics, but the combination of features that is required remains unknown.

CD18 dependency of transendothelial neutrophil migration differs during acute pulmonary inflammation

Neutrophil extravasation during inflammation can occur either by a mechanism that requires the neutrophil integrin complex, CD18, or by an alternative CD18-independent route. Which of the two pathways is used has been shown to depend on the site and nature of the inflammatory insult. More recent evidence suggests that selection may also depend on whether inflammation is chronic or acute, but why this is the case remains unknown. Using an in vitro model that supports both migratory mechanisms, we examined the CD18 dependency of migration of neutrophils isolated from patients with either chronic or acute pulmonary infection. Chronic neutrophils were found to behave like normal neutrophils by migrating to IL-8 and leukotriene B(4) using the CD18-independent pathway, but to the bacterial product, FMLP, using the CD18-dependent route. In contrast, migration of acute neutrophils to all of these stimuli was CD18 dependent. Normal neutrophils could be manipulated to resemble acute neutrophils by exposing them to FMLP before migration, which resulted in a "switch" from the CD18-independent to -dependent mechanism during migration to IL-8 or leukotriene B(4). Although treatment of normal neutrophils with FMLP caused selective down-regulation of the IL-8 receptor, CXCR2, and acute neutrophils were found to have less CXCR2 than normal, a functional relationship between decreased CXCR2 and selection of CD18-dependent migration was not demonstrated. Results indicate that selection of the CD18-dependent or -independent migration mechanism can be controlled by the neutrophil and suggest that the altered CD18 requirements of acute neutrophils may be due to priming in the circulation during acute infection.

Prenatal tobacco effects on neuropsychological outcomes among preadolescents

This study evaluated the relationships between maternal smoking during pregnancy and 10-year-old children's performance on measures of learning, memory, and problem-solving. In this prospective cohort study, mothers were recruited from an urban prenatal clinic in 1982 and 1983 and observed from their fourth prenatal month until the time of the study. At the 10-year visit, 593 children and mothers were evaluated. The prevalence of tobacco use was high in this cohort: 54.3%, 53.3%, and 60% of the women smoked in the first trimester, third trimester, and 10-year assessment, respectively. After controlling statistically for other prenatal substance use, current tobacco, other substance use variables, and multiple sociodemographic covariates, prenatal tobacco exposure was significantly associated with deficits in learning and memory. Specifically, prenatal tobacco exposure was associated with deficits in verbal learning and design memory, as well as slowed responding on a test of eye-hand coordination. In addition, these children demonstrated a reduced ability for flexible problem solving and more impulsivity, as indicated by an increase in perseverative responses on a card-sorting test. Prenatally exposed children did not show attention deficits or increased activity on a continuous performance test.

Cognitive function and reproductive hormones in adjuvant therapy for breast cancer: a critical review

Deterioration in cognitive function-particularly learning, memory, and attention-has been reported by women with breast cancer who receive adjuvant chemotherapy. Deficits in cognitive function reported by women with breast cancer are similar to those experienced by women as a consequence of natural or surgical menopause. The basis of these deteriorations may include reductions in reproductive hormone levels, particularly estrogens and progesterones, that occur as a result of adjuvant chemotherapy. This paper critically examines the literature related to the impact of adjuvant chemotherapy and reproductive hormone changes on cognitive function in women with breast cancer and suggests direction for future research in this area. The paper proposes a framework for investigation of the problem and discusses the challenges associated with the conduct of this research.

Arginine and ornithine kinetics in severely burned patients: increased rate of arginine disposal

Arginine serves multiple roles in the pathophysiological response to burn injury. Our previous studies in burn patients demonstrated a limited net rate of arginine de novo synthesis despite a significantly increased arginine turnover (flux), suggesting that this amino acid is a conditionally indispensable amino acid after major burns. This study used [15N2-guanidino-5,5-2H2]arginine and [5-13C]ornithine as tracers to assess the rate of arginine disposal via its conversion to and subsequent oxidation of ornithine; [5,5-2H2]proline and [5,5,5-2H3]leucine were also used to assess proline and protein kinetics. Nine severely burned patients were studied during a protein-free fast ("basal" or fast) and total parenteral nutrition (TPN) feedings. Compared with values from healthy volunteers, burn injury significantly increased 1) fluxes of arginine, ornithine, leucine, and proline; 2) arginine-to-ornithine conversion; 3) ornithine oxidation; and 4) arginine oxidation. TPN increased arginine-to-ornithine conversion and proportionally increased irreversible arginine oxidation. The elevated arginine oxidation, with limited net de novo synthesis from its immediate precursors, further implies that arginine is a conditionally indispensable amino acid in severely burned patients receiving TPN.

Adherence in chronic disease

Nonadherence to treatment regimen is a prevalent problem of patients with chronic disorders. Approximately half of the patients with a chronic disease have problems following their prescribed regimen to the extent that they are unable to obtain optimum clinical benefit. This chapter reviews the state of knowledge regarding adherence to chronic disease regimens across the life span and demonstrates that the extent and nature of the adherence problems are similar across diseases, across regimens, and across age groups. Adherence to the commonly prescribed regimens is addressed, including pharmacological therapies, therapeutic diets, and therapeutic exercise. Randomized, controlled studies focusing on various educational, behavioral, cognitive, and affective interventions to improve adherence are included. Based on this review, further work is needed to better understand and improve adherence. New strategies for analysis and measurement will support these needed advances in the field of adherence.

Memory performance and the apolipoprotein E polymorphism in a community sample of middle-aged adults

The apolipoprotein E genotype (APOE) is an established risk factor for Alzheimer disease, with the age-at-onset occurring earlier in individuals having at least one APOE epsilon 4 allele, relative to the APOE epsilon 3 or APOE epsilon 2 isoforms. Moreover, nondemented older adults with the APOE epsilon 4 allele also show diminished cognitive performance, particularly on tests of learning and memory, and an accelerated decline in memory performance with increasing age. The current investigation extends the study of the APOE epsilon 4 allele and cognitive performance to healthy, middle-aged adults. A community sample of 220 non-Hispanic Caucasian men and women, aged 24-60 (average age = 46), were genotyped for the APOE polymorphism and completed a battery of neuropsychological tests. Multivariate analyses were conducted on measures of verbal learning and memory (e. g., learning a list of words and recalling them 30 min later), visual memory (e.g., reproducing a previously copied figure from memory), and attention span (e.g., repeating long lists of digits), after adjustments for age, and estimated IQ. Results indicated that performance on learning and memory tasks was significantly poorer in adults having any APOE epsilon 4 allele, relative to adults with APOE epsilon 2 and epsilon 3 genotypes (P <.01). Attention span did not differ by genotype. These findings, the first in a sample of middle-aged adults, suggest that the APOE polymorphism is a marker for age-related decline in memory (detectable prior to overt, clinical manifestations of memory loss), and/or a marker for individual differences in memory ability across the life span. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:707-711, 2000.

Why is learning and memory dysfunction in Type 2 diabetes limited to older adults?

Review of the literature on the cognitive correlates and consequences of Type 2 diabetes reveals two very intriguing findings. Not only are verbal learning and memory skills most likely to be disrupted as compared to other cognitive skills (e.g. attention, executive function; psychomotor efficiency), but these mnestic deficits appear to be restricted to individuals with diabetes who are older than 60-65 years of age. Middle-aged adults with either Type 2 or Type 1 diabetes are apparently protected insofar as researchers have only infrequently reported learning and memory impairments in that age group. Why do older adults have such an increased risk of diabetes-associated memory dysfunction? In our view, this phenomenon is a consequence of a synergistic interaction between diabetes-related metabolic derangements and the structural and functional changes occurring in the central nervous system (CNS) that are part of the normal ageing process. To critically evaluate that possibility, we summarise what is known about learning and memory dysfunction in the adult with diabetes, examine the extent to which chronic hyperglycaemia may adversely affect the integrity of the CNS, and selectively review the literature on age-associated changes in brain morphology and cognitive function, paying special attention to the threshold theory of cognitive impairment.

Cutaneous herpetic infections complicating burns

Many people harbor herpes simplex virus, often with a known history of "cold sores". During the relatively immunosuppressed state associated with a serious burn, recrudescence of such infections can occur. We report four adults and two children who developed severe herpetic ulceration, over the face and neck in five patients and in a partial thickness wound in one patient. Herpetic infection was diagnosed by culture and direct immunofluorescence testing and treatment was immediately instituted with systemic and topical Acylovir(R) (Zovirax, Glaxo Wellcome). Ulceration healed under treatment and did not leave visible scarring in any of the patients. Although these infections are rapidly progressive, they respond to prompt treatment with antiviral chemotherapy. Rapidly progressive vesicles and ulceration appearing on the face or in the wounds of burn patients should prompt immediate evaluation for herpetic infection.