Effects of routine treatment with nonsteroidal anti-inflammatory drugs at calving and when lame on the future probability of lameness and culling in dairy cows: A randomized controlled trial

Claw horn lesions (CHL) are reported as the most common cause of lameness in intensive dairy systems. Despite their prevalence, the underlying pathological mechanisms and preventive strategies for CHL remain poorly understood. Recent advances have pointed to the role of inflammation in disease aetiopathogenesis. Moderating inflammation from first calving may lead to long-term benefits and a viable intervention for treating and preventing disease. We conducted a 34-mo randomized controlled trial to investigate the effects of routine treatment with the nonsteroidal anti-inflammatory drug ketoprofen at calving and during treatment for lameness, on the future probability of lameness and culling, caused by exposure to normal farm conditions. A cohort of dairy heifers were recruited from a single, commercial dairy herd between January 8, 2018, and June 22, 2020, and randomly allocated to one of 4 treatment groups before first calving. The lactating herd was lameness scored every 2 wk on a 0 to 3 scale, to identify animals that became lame (single score ≥2a) and hence required treatment. Animals in group 1 received a therapeutic trim and a hoof block on the sound claw (if deemed necessary) every time they were treated for lameness. Animals in group 2 received the same treatment as group 1 with the addition of a 3-d course of ketoprofen (single dose daily) every time they were treated for lameness. Animals in group 3 received the same treatment as group 2 with the addition of a 3-d course of ketoprofen (single dose daily) starting 24 to 36 h after each calving. Animals in group 4 received a 3-d course of ketoprofen (single dose daily) every time they were identified with lameness. No therapeutic trim was administered to this group, unless they were identified as severely lame (a single score ≥3a). Animals were followed for the duration of the study (ending October 23, 2020). Probability of lameness was assessed by a lameness outcome score collected every 14 d. Data on culling was extracted from farm records. One hundred thirty-two animals were recruited to each group, with data from 438 animals included in the final analysis (111 in group 1, 117 in group 2, 100 in group 3, and 110 in group 4). Mixed effect logistic regression models were used to evaluate the effect of treatment group on the ongoing probability of lameness. Compared with the control group (group 1), animals in group 3 were less likely to become lame (odds ratio: 0.66) and severely lame (odds ratio: 0.28). A Cox proportional hazards survival model was used to investigate the effect of treatment group on time to culling. Compared with group 1, animals in groups 2 and 3 were at reduced risk of culling (hazard ratios: 0.55 and 0.56, respectively). The lameness effect size we identified was large and indicated that treating a cohort of animals with the group 3 protocol, would lead to an absolute reduction in population lameness prevalence of approximately 10% and severe lameness prevalence of 3%, compared with animals treated in accordance with conventional best practice (group 1).

A history of lameness and low body condition score is associated with reduced digital cushion volume, measured by magnetic resonance imaging, in dairy cattle

Claw horn lesions (CHL) are the result of a failing of the functional anatomy of the hoof in dairy cows. The digital cushion is understood to be a vital structure in the prevention of CHL. Claw horn lesions have previously been shown to lead to pathological change to the pedal bone; however, their effects on the digital cushion are unknown. The primary aim of this study was to examine associations between the history of CHL through an animal's life and the structure of the digital cushion at slaughter using magnetic resonance imaging. The retrospective cohort study resulted in the scanning of 102 pairs of hindfeet, collected from adult Holstein dairy cows culled from a research herd, using a 3-Tesla research-grade magnetic resonance imaging scanner. Volume and fat measurements were calculated for each digital cushion within each claw from a modified Dixon Quant sequence. Animal-level variables were constructed around the animals' lactating lifetime, with lameness scores and body condition score collected at least every 2 wk. The combined volume of digital cushion in the lateral claws was used as the outcome variable in multivariable linear models. The volume of the digital cushion was negatively associated with the number of lameness events or CHL recorded. Furthermore, animals with body condition score >3, culled later in lactation, or of a greater body weight were more likely to have a higher volume of digital cushion in the lateral claws. We propose that the observations made in the current study are the effects of a range of factors broadly associated with genetic, developmental, and disease-related inputs. Our understanding of how we can select for genetically more robust animals and how we can precondition the hoof before first calving needs to be improved to reduce the risk of future CHL in adult dairy cattle. Furthermore, understanding optimal treatment regimens and their effect on hoof anatomy may reduce the recurrence of CHL in the current lactation and future lactations.

Morphology, adipocyte size, and fatty acid analysis of dairy cattle digital cushions, and the effect of body condition score and age

The digital cushion is an essential part of maintaining a healthy foot, working to dissipate foot strike and body weight forces and lameness from claw horn disruption lesions. Despite the importance of the digital cushion, little is known about the basic anatomy, adipocyte morphology, and fatty acid composition in relation to age, limb position, and body condition score. In total, 60 claws (from 17 cows) were selected and collected from a herd, ensuring that body condition score data and computed micro-tomography were known for each animal. Digital cushion tissue underwent histological staining combined with stereology, systematic random sampling, and cell morphology analysis, in addition to lipid extraction followed by fatty acid analysis. The results describe digital cushion architecture and adipocyte sizes. Adipocyte size was similar across all 4 claws (distal left lateral and medial and distal right lateral and medial) and across the ages (aged 2-7 yr); however, animals with body condition score of 3.00 or more at slaughter had a significantly increased cell size in comparison to those with a score of less than 2.50. Of 37 fatty acid methyl esters identified, 5 differed between either the body condition score or different age groups. C10:0 capric acid, C14:0 myristic acid, C15:0 pentadecanoic acid, and C20:0 arachidic acid percentages were all lesser in lower body condition score cows, whereas C22:1n-9 erucic acid measurements were lesser in younger cows. Saturated fatty acid, monounsaturated fatty acid, and polyunsaturated fatty acid percentages were not altered in the different claws, ages, or body condition score groups. Triglyceride quantities did not differ for claw position or age but had decreased quantities in lower body condition score animals. Digital cushion anatomy, cellular morphology, and fatty acid composition have been described in general and also in animals with differing ages, body condition scores, and in the differing claws. Understanding fat deposition, mobilization, and composition are essential in not only understanding the roles that the digital cushion plays but also in preventing disorders and maintaining cattle health and welfare.

Abstract P3-10-08: Breast cancer in octogenarians: Presentation and treatment affect mortality

Background: Breast cancer incidence increases in age. Unfortunately, elderly patients are often under-treated and under-diagnosed affecting their overall survival with limited availability of clinical trial data.

Patients and Methods: We used data from our cancer registry and our state cancer registry to evaluate cases of breast cancer diagnosed between the years 2005 and 2010 with follow up data available to date to examine the method of diagnosis (mammogram vs. palpable abnormality), age at diagnosis, stage at diagnosis, type of surgery, receptor status, treatment received, and survival. We then were able to use our state database which contained data regarding causality of death. Based on the data available we were able to evaluate the impact of the method of diagnosis and treatment on patient mortality.

Results: A total of 495 octogenerian breast cancer patients were diagnosed between 2005 and 2010. The median age at diagnosis was 85 with a range of 81-102. Out of the 495 patients 55% were diagnosed with a mammogram and 41% by palpable abnormality. The patients who presented with a palpable mass were more likely to die of breast cancer (26%) than the patients who presented with a screening abnormality (9%). The patients with a screening abnormality also had a longer survival (30.0 month) among patients who died from breast cancer as opposed to those who presented with a palpable abnormality who died from breast cancer (16.7 months). While the number of patients dying from other causes was similar (65% screened vs. palpable) the patients with palpable findings had a shorter survival (30.5 months) compared to those detected by screening (48.9 months).

Table 1: Comparison of outcomes between screen detected and physical exam detected breast cancer patientsOutcomeScreenedPalpableDied of Breast Cancer9% (30.0 months)26% (16.7 months)Died of Other Causes65% (48.9 months)60% (30.5 months)Still Alive25.6% (66.9 months)10% (51.0 months)

There was an improvement in survival among patients who presented with a palpable mass and were treated with endocrine therapy (17.3 vs 11%). This improvement did not extend to the screened population (24.3% vs 29%), although the patients who died from breast cancer had an overall longer survival (35.4 months vs 27.3 months). There was also an improvement in survival among patients who received radiation therapy in both the screened (33% vs. 22%) and palpable (22.5% vs 11.1%) groups. Only 6% of patients in the entire study received chemotherapy.

Effect of presentation and treatment on survivalModalityScreened/TreatedPalpable/TreatedScreened/ No TreatmentPalpable/No TreatmentRadiation33% (29.6 months)22.5% (10 months)22% (27 months)11.1% (20 months)Endocrine24.3% (35.4 months)17.3% (15.7 months)29% (27.3 months)11% (18.5 months)

Conclusion: Our data support continued use of screening mammography in patients who are at good surgical risk into their 80's. The patients who were diagnosed with symptoms fared worse than the patients who had their cancer discovered on routine imaging. There was an improvement in patients who were treated with adjuvant endocrine and radiation therapy although the rationale behind providing or excluding treatment cannot be discerned from this retrospective registry study.

Citation Format: Wilson JP, Gadiyaram V, Blumencranz PW. Breast cancer in octogenarians: Presentation and treatment affect mortality [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-10-08.

Hip Fractures Risk in Older Men and Women Associated With DXA-Derived Measures of Thigh Subcutaneous Fat Thickness, Cross-Sectional Muscle Area, and Muscle Density

Mid-thigh cross-sectional muscle area (CSA), muscle attenuation, and greater trochanter soft tissue thickness have been shown to be independent risk factors of hip fracture. Our aim was to determine whether muscle and adipose tissue measures derived from dual-energy X-ray absorptiometry (DXA) scans would have a similar risk association as those measured using other imaging methods. Using a case-cohort study design, we identified 169 incident hip fracture cases over an average of 13.5 years among participants from the Health ABC Study, a prospective study of 3075 individuals initially aged 70 to 79 years. We modeled the thigh 3D geometry and compared DXA and computed tomography (CT) measures. DXA-derived thigh CSA, muscle attenuation, and subcutaneous fat thickness were found to be highly correlated to their CT counterparts (Pearson's r = 0.82, 0.45, and 0.91, respectively; p < 0.05). The fracture risk of men and women were calculated separately. We found that decreased subcutaneous fat, CT thigh muscle attenuation, and appendicular lean mass by height squared (ALM/Ht(2)) were associated with fracture risk in men; hazard ratios (HR) = 1.44 (1.02, 2.02), 1.40 (1.05, 1.85), and 0.58 (0.36, 0.91), respectively, after adjusting for age, race, clinical site, body mass index (BMI), chronic disease, hip bone mineral density (BMD), self-reported health, alcohol use, smoking status, education, physical activity, and cognitive function. In a similar model for women, only decreases in subcutaneous fat and DXA CSA were associated with hip fracture risk; HR = 1.39 (1.07, 1.82) and 0.78 (0.62, 0.97), respectively. Men with a high ALM/Ht(2) and low subcutaneous fat thickness had greater than 8 times higher risk for hip fracture compared with those with low ALM/Ht(2) and high subcutaneous fat. In women, ALM/Ht(2) did not improve the model when subcutaneous fat was included. We conclude that the DXA-derived subcutaneous fat thickness is a strong marker for hip fracture risk in both men and women, especially in men with high ALM/Ht(2).

Living near a freeway is associated with lower bone mineral density among Mexican Americans

We hypothesized that chronic exposures to traffic combustion products may lower bone mineral density (BMD). We found that proximity to freeways was associated with reduced BMD. Our findings suggest that traffic-related pollution may contribute to the occurrence of osteopenia and osteoporosis.

INTRODUCTION

Adults residing in rural areas have been linked with higher BMD. We aimed to determine if this difference is due in part to air pollution by examining the relationships between traffic metrics and ambient air pollution with total body and pelvic BMD.

METHODS

Mexican American adults (n = 1,175; mean 34 years; 72 % female) who had participated in the BetaGene study of air pollution, obesity, and insulin resistance were included in this analysis. Total body and pelvic BMD were estimated using dual-energy X-ray absorptiometry. Traffic and ambient air pollutant exposures were estimated at residences using location and ambient monitoring data. Variance component models were used to analyze the associations between residential distance to the nearest freeway and ambient air pollutants with BMD.

RESULTS

Residential proximity to a freeway was associated with lower total body BMD (p-trend = 0.01) and pelvic BMD (p-trend = 0.03) after adjustment for age, sex, weight, and height. The adjusted mean total body and pelvic BMD in participants living within 500 m of a freeway were 0.02 and 0.03 g/cm(2) lower than participants living greater than 1,500 m from a freeway. These associations did not differ significantly by age, sex, or obesity status. Results were similar after further adjustment for body fat and weekly physical activity minutes. Ambient air pollutants (NO2, O3, and PM2.5) were not significantly associated with BMD.

CONCLUSIONS

Traffic-related exposures in overweight and obese Mexican Americans may adversely affect BMD. Our findings indicate that long-term exposures to traffic may contribute to the occurrence of osteoporosis and its consequences.

Ratio of trunk to leg volume as a new body shape metric for diabetes and mortality

BACKGROUND

Body shape is a known risk factor for diabetes and mortality, but the methods estimating body shape, BMI and waist circumference are crude. We determined whether a novel body shape measure, trunk to leg volume ratio, was independently associated with diabetes and mortality.

METHODS

Data from the National Health and Nutritional Examination Survey 1999-2004, a study representative of the US population, were used to generate dual-energy X-ray absorptiometry-derived trunk to leg volume ratio and determine its associations to diabetes, metabolic covariates, and mortality by BMI category, gender, and race/ethnicity group.

RESULTS

The prevalence of pre-diabetes and diabetes increased with age, BMI, triglycerides, blood pressure, and decreased HDL level. After adjusting for covariates, the corresponding fourth to first quartile trunk to leg volume ratio odds ratios (OR) were 6.8 (95% confidence interval [CI], 4.9-9.6) for diabetes, 3.9 (95% CI, 3.0-5.2) for high triglycerides, 1.8 (95% CI, 1.6-2.1) for high blood pressure, 3.0 (95% CI, 2.4-3.8) for low HDL, 3.6 (95% CI, 2.8-4.7) for metabolic syndrome, and 1.76 (95% CI, 1.20-2.60) for mortality. Additionally, trunk to leg volume ratio was the strongest independent measure associated with diabetes (P<0.001), even after adjusting for BMI and waist circumference. Even among those with normal BMI, those in the highest quartile of trunk to leg volume ratio had a higher likelihood of death (5.5%) than those in the lowest quartile (0.2%). Overall, trunk to leg volume ratio is driven by competing mechanisms of changing adiposity and lean mass.

CONCLUSIONS

A high ratio of trunk to leg volume showed a strong association to diabetes and mortality that was independent of total and regional fat distributions. This novel body shape measure provides additional information regarding central adiposity and appendicular wasting to better stratify individuals at risk for diabetes and mortality, even among those with normal BMI.

Total and regional body volumes derived from dual-energy X-ray absorptiometry output

Total body volume is an important health metric used to measure body density, shape, and multicompartmental body composition but is currently only available through underwater weighing or air displacement plethysmography (ADP). The objective of this investigation was to derive an accurate body volume from dual-energy X-ray absorptiometry (DXA)-reported measures for advanced body composition models. Volunteers received a whole body DXA scan and an ADP measure at baseline (N = 25) and 6 mo (N = 22). Baseline measures were used to calibrate body volume from the reported DXA masses of fat, lean, and bone mineral content. A second population (N = 385) from the National Health and Nutrition Examination Survey was used to estimate the test-retest precision of regional (arms, legs, head, and trunk) and total body volumes. Overall, we found that DXA-volume was highly correlated to ADP-volume (R² = 0.99). The 6-mo change in total DXA-volume was highly correlated to change in ADP-volume (R² = 0.98). The root mean square percent coefficient of variation precision of DXA-volume measures ranged from 1.1% (total) to 3.2% (head). We conclude that the DXA-volume method can measure body volume accurately and precisely, can be used in body composition models, could be an independent health indicator, and is useful as a prospective or retrospective biomarker of body composition.

Improved 4-compartment body-composition model for a clinically accessible measure of total body protein

BACKGROUND

Muscle wasting is a consequence of many primary conditions including sarcopenia, cachexia, osteoporosis, HIV/AIDS, and chronic kidney disease. Unfortunately, there is not a clinically accessible method to measure total body protein, which is the functional mass of muscle.

OBJECTIVE

We sought to derive a simple method to measure total body protein by using dual-energy X-ray absorptiometry (DXA) and bioimpedance analysis (BIA).

DESIGN

We retrospectively analyzed a clinical convenience sample of individuals with numerous metabolic conditions from the Monash Medical Centre, Melbourne, Australia, who had a concurrent protein measure by using neutron activation analysis-derived protein (NAA-TBPro), water measure by using BIA, and whole-body DXA scan. The study was split into calibration and validation data sets by using simple random sampling stratified by sex, BMI category, and age decade. We generated a protein estimate direct-calibration protein (DC-TBPro) derived from BIA water, bone mass, and body volume. We compared NAA-TBPro with DC-TBPro and 2 protein estimates from the literature, one that used the DC-TBPro equation with fixed coefficients [4-compartment Lohman method for analysis of total body protein (4CL-TBPro)] and another that used fat-free mass, age, and sex [Wang equation-derived protein (W-TBPro)].

RESULTS

A total of 187 participants [119 women; mean (±SD) age: 37.0 ± 15.4 y; mean (±SD) BMI (in kg/m(2)) 24.5 ± 7.7] were included. When plotted against NAA-TBPro, DC-TBPro had the highest correlation [coefficient of determination (R(2)) = 0.87], lowest root mean squared error (RMSE; 0.87 kg), and fewest outliers compared with 4CL-TBPro (R(2) = 0.75; RMSE = 1.22 kg) and W-TBPro (R(2) = 0.80; RMSE = 1.10 kg).

CONCLUSIONS

A simple method to measure total body protein by using a DXA system and BIA unit was developed and compared with NAA as proof of principle. With additional validation, this method could provide a clinically useful way to monitor muscle-wasting conditions.

Dual-energy X-ray absorptiometry-based body volume measurement for 4-compartment body composition

BACKGROUND

Total body volume (TBV), with the exclusion of internal air voids, is necessary to quantify body composition in Lohman's 4-compartment (4C) model.

OBJECTIVE

This investigation sought to derive a novel, TBV measure with the use of only dual-energy X-ray absorptiometry (DXA) attenuation values for use in Lohman's 4C body composition model.

DESIGN

Pixel-specific masses and volumes were calculated from low- and high-energy attenuation values with the use of first principle conversions of mass attenuation coefficients. Pixel masses and volumes were summed to derive body mass and total body volume. As proof of concept, 11 participants were recruited to have 4C measures taken: DXA, air-displacement plethysmography (ADP), and total body water (TBW). TBV measures with the use of only DXA (DXA-volume) and ADP-volume measures were compared for each participant. To see how body composition estimates were affected by these 2 methods, we used Lohman's 4C model to quantify percentage fat measures for each participant and compared them with conventional DXA measures.

RESULTS

DXA-volume and ADP-volume measures were highly correlated (R(2) = 0.99) and showed no statistically significant bias. Percentage fat by DXA volume was highly correlated with ADP-volume percentage fat measures and DXA software-reported percentage fat measures (R(2) = 0.96 and R(2) = 0.98, respectively) but were slightly biased.

CONCLUSIONS

A novel method to calculate TBV with the use of a clinical DXA system was developed, compared against ADP as proof of principle, and used in Lohman's 4C body composition model. The DXA-volume approach eliminates many of the inherent inaccuracies associated with displacement measures for volume and, if validated in larger groups of participants, would simplify the acquisition of 4C body composition to a single DXA scan and TBW measure.

Use of antidepressant agents and the risk of type 2 diabetes

PURPOSE

To determine whether there is an association between antidepressant use and the risk of developing type 2 diabetes.

METHODS

This study was a retrospective cohort analysis using the Texas Medicaid prescription claims database. Data were extracted for new users of either antidepressant agents (exposed) or benzodiazepines (unexposed) from January 1, 2002 through December 31, 2009. Patients aged 18-64 years without a prior history of diabetes were included. Cox proportional hazards regression was used to examine the association between diabetes incidence among exposed and unexposed groups, while controlling for demographic and clinical covariates.

RESULTS

Among the total study population (N = 44,715), the majority were in the exposed (N = 35,552) versus the unexposed (N = 9,163) group. A total of 2,943 patients (6.6%) developed type 2 diabetes during the follow-up period. Antidepressant use was associated with an increase in the risk of diabetes when compared to benzodiazepine use (adjusted hazard ratio [HR] 1.558, 95% confidence interval [CI] 1.401-1.734). The association was observed with tricyclic antidepressants (TCAs; HR 1.759, 95% CI 1.517-2.040), serotonin-norepinephrine reuptake inhibitors (SNRIs; HR 1.566. 95% CI 1.351-1.816), selective serotonin reuptake inhibitors (SSRIs; HR 1.481, 95% CI 1.318-1.665), and "other" antidepressants (HR 1.376; 95% CI 1.198-1.581).

CONCLUSIONS

The results of this study suggest that antidepressant use is associated with an increased risk of diabetes. This association was observed with use of TCAs, SNRIs, SSRIs, and "other" antidepressants.

Hydraulics of Asteroxylon mackei, an early Devonian vascular plant, and the early evolution of water transport tissue in terrestrial plants

The core of plant physiology is a set of functional solutions to a tradeoff between CO(2) acquisition and water loss. To provide an important evolutionary perspective on how the earliest land plants met this tradeoff, we constructed a mathematical model (constrained geometrically with measurements of fossils) of the hydraulic resistance of Asteroxylon, an Early Devonian plant. The model results illuminate the water transport physiology of one of the earliest vascular plants. Results show that Asteroxylon's vascular system contains cells with low hydraulic resistances; these resistances are low because cells were covered by scalariform pits, elliptical structures that permit individual cells to have large areas for water to pass from one cell to another. Asteroxylon could move a large amount of water quickly given its large pit areas; however, this would have left these plants particularly vulnerable to damage from excessive evapotranspiration. These results highlight a repeated pattern in plant evolution, wherein the evolution of highly conductive vascular tissue precedes the appearance of adaptations to increase water transport safety. Quantitative insight into the vascular transport of Asteroxylon also allows us to reflect on the quality of CO(2) proxy estimates based on early land plant fossils. Because Asteroxylon's vascular tissue lacked any safety features to prevent permanent damage, it probably used stomatal abundance and behavior to prevent desiccation. If correct, low stomatal frequencies in Asteroxylon reflect the need to limit evapotranspiration, rather than adaptation to high CO(2) concentrations in the atmosphere. More broadly, methods to reveal and understand water transport in extinct plants have a clear use in testing and bolstering fossil plant-based paleoclimate proxies.

Motives, Values and Moral Judgments

This study examined McClelland's (1981) hypothesis that operant and respondent measures of personality are orthogonal and assess different dimensions of personality structure. An operant measure of motives, a sentence completion test, and two respondent measures of cognitive schema variables, the Rokeach Value Survey and the Defining issues Test, were administered to 311 subjects. As predicted and in support of McClelland's hypothesis, 69% of the correlations between the respondent measures were significant at the alpha .05 level of probability versus 14% of the correlations between the operant and respondent measures. Further, within the domain of cognitive schema variables, it was theoretically possible to predict which values would correlate with different levels of moral judgment. The findings were discussed in terms. of their implications for person x situation models of social interaction and the prediction of criterion variables from typologies of personality.

The Relationship of CPI Measures of Interpersonal Adequacy to Safety and Esteem Motives

This study was concerned with establishing the relationship of CPI measures of interpersonal adequacy to SCT measures of safety and esteem motives. A large number of students were given the SCT and 56 safety-oriented and 56 esteem-oriented subjects were selected and and given the dominance (Do), capacity for status (Cs), self-acceptance (Sa) and sense of well-being (Wb) subscales of the CPI. As predicted the results indicated that esteem-oriented subjects scored higher on all the CPI measures of interpersonal adequacy.

Effectiveness of research training workshop taught by traditional and video-teleconference methods in a developing country

The developing countries are currently facing a double burden of communicable and non-communicable diseases. Physician-scientists, trained in patient care and research skills are crucial in performing cutting-edge clinical research in the developing countries. A major unmet challenge has been the lack of local expertise and the increasing problem of 'brain drain'. The current study was an effort to present and assess a model of research training to health-care professionals in Pakistan in order to increase the research skills. The objective of the current study was to assess the effectiveness of two different methods of research training. An epidemiologic research training workshop was offered to health-care professionals in Pakistan by face-to-face (F2F) and video-teleconferencing (VTC) methods. A total of 38 F2F and 18 VTC participants were included in the workshop which was conducted by research faculty from the University of Pittsburgh. To assess knowledge, pre- and post-test were done. Within each group, paired sample T-test showed significant improvement in scores after the completion of workshop (p<0.001 for F2F and VTC). In the F2F group, mean scores increased from 11.13 (pre-test) to 15.08 (post-test) and in the VTC group, scores increased from 10.67 (pre-test) to 13.22 (post-test). Two sample T-test was found statistically significant (p<0.001). We present a model for training physicians in public health by providing in-house research skills training which can be used to strengthen the local capacity and reduce increasing problems of brain drain.

Animal models of tinnitus

There are few physiological data available on the origin and nature of tinnitus. It is not even known whether tinnitus associated with cochlear pathology is a manifestation of increased or decreased activity in the cochlear nerve. In previous investigations of cochlear pathology, the spontaneous neural activity has generally been found to be depressed. In the present experiments, an animal model has been established by the administration of sodium salicylate in doses producing blood concentrations that evoke tinnitus in humans. Under these conditions, changes occur in cochlear nerve-fibre thresholds and tuning, similar to those obtained in other types of cochlear pathology. However, under salicylate, the distribution of spontaneous discharge shifts significantly to higher rates than normal. These changes are accompanied in some, but not all, fibres by changes in the temporal patterns of discharge suggestive of excitation. In the second animal model studied, a normal guinea-pig that had a naturally occurring continuous tonal emission, analogous to that recently recorded in human "physiological" tinnitus, was investigated in detail. The emitted signal was recorded in the ear-canal acoustic pressure and in the round-window potential. Several lines of evidence point to the signal as being cochlear in origin, including: its resistance to muscular paralysis and section of the stapedius muscle; the effects of changes in middle-ear pressure; its reversible elimination by hypoxia; and its suppression by tones of higher frequency.

Acoustic correlates of tonal tinnitus

A sensitive microphone has been developed which can pick up tonal signals (spontaneous acoustic emissions) in the sealed ear-canal of certain subjects. Various properties of these frequency components suggest that they arise from an active, frequency-selective self-limiting feedback process within the cochlea and that they rely on internal reflection from the middle ear. An external tone can synchronize, frequency-lock, suppress of frequency-shift the acoustic component. These interactions are frequency-dependent in a way suggestive of cochlear tuning properties. Positive or negative middle-ear pressure can also influence the components by increasing their frequency and in some cases can enhance one component at the expense of a neighbouring one. Some subjects hear these components as tinnitus and can report on the measured changes. Other subjects do not hear the measured signals, which otherwise behave similarly. A third group of subjects have tinnitus but no objective sound can be detected. In this last group there are, nevertheless, sometimes notches or other discontinuities in the audiogram which correspond to their tinnitus pitch-matches. It appears likely that the recordable type of tinnitus is essentially non-pathological and represents hypersensitivity of the system, whereas the non-recordable type might be associated with local pathological changes at the end-organ or more centrally.

Use of antihypertensive medications among United States veterans newly diagnosed with hypertension

OBJECTIVES

Most patients with hypertension need combination therapy to reach adequate blood pressure control. The objective of this study was to assess type, duration of, and adherence to antihypertensive therapies among veterans, focusing on the use of combination therapies.

RESEARCH DESIGN AND METHODS

The design of the study was a retrospective cohort analysis of electronic medical and pharmacy records from the Central Texas Veterans Health Care System (CTVHCS). Data were extracted for adults newly identified with hypertension between 1995 and 2003. Drug utilization was measured as a time-dependent variable; thus, the use of combination therapies was captured for any given day for each patient in the sample. Medication adherence was assessed using medication possession ratios (MPR), calculated by the number of days of therapy dispensed to a patient divided by the number of days between subsequent prescriptions.

RESULTS

The average age of the participants (n = 11 187) was 60.7 (standard deviation (SD): 12.7). Half (50.1%) of the patients could be categorized as having controlled blood pressure. Veterans were followed for an average of 3.6 years (total of 51 549 person-years). Overall, 29 561 treatment episodes were identified, an average of about 2.6 per patient. Over 40% (41.6%) of these episodes involved one medication only, but patients frequently used dual (26.9%) and three or more (15.9%) therapies in combination. The frequency of prescribed antihypertensive therapies, as well as the length of, and adherence to, these therapies were described. Descriptively, medication adherence appeared to be lower among patients who received therapy for longer duration, indicating higher probability of missed doses and more frequent therapy changes.

CONCLUSIONS

New information can be gained on the utilization of antihypertensive medications by using time-dependent variables. Understanding the type of combination therapies, the length of and adherence to these therapies, along with the observed blood pressure control rates will provide important new insights into the management of hypertensive patients. Limitations of the study arise primarily from the use of electronic medical records and the information that is contained within the datasource, and generalizability of the findings beyond the study sample.

Recirculating gravel filters: high-performance treatment at low cost for two small communities

Wastewater from small communities often has a greater environmental impact than conventional on-site treatment systems can mitigate, yet the flow rate is too low to achieve economies of scale with municipal treatment processes. As a result, the cost of wastewater treatment is often beyond the financial means of the community, in terms of capital costs and annual operational costs. The recirculating gravel filter (RGF) is an attached-growth treatment process for wastewater from small communities. In the RGF process, pre-settled wastewater is recirculated through a gravel filter bed, while a biofilm on the filter media oxidizes the organic matter and ammonia. Effluent from the RGF process has equivalent or lower concentrations of BOD5, TSS and ammonia nitrogen as effluent from other wastewater treatment processes typically employed in small communities. Two small communities in Washington State, USA, have selected the RGF process for wastewater treatment, due to low operational costs, simplicity of equipment, and high effluent quality. For the two communities, the RGF wastewater treatment facilities were estimated to have somewhat lower construction costs and significantly lower annual operational costs than the alternatives evaluated. Low annual operational expenses are important for wastewater system sustainability in small communities.

Fusarium species of the Gibberella fujikuroi complex and fumonisin contamination of pearl millet and corn in Georgia, USA

This study was designed to identify and compare the Fusarium species of the Gibberella fujikuroi complex on pearl millet (Pennisetum glaucum (L.) R. Br) and corn (Zea mays L.) crops grown in southern Georgia, and to determine their influence on potential fumonisin production. Pearl millet and corn samples were collected in Georgia in 1996, 1997 and 1998. Three percent of the pearl millet seeds had fungi similar to the Fusarium species of the G. fujikuroi species complex. One hundred and nineteen representative isolates visually similar to the G. fujikuroi species complex from pearl millet were paired with mating population A (Fusarium verticillioides (Sacc.) Nirenberg), mating population D (F. proliferatum (Matsushima) Nirenberg) and mating population F (F. thapsinum (Klittich, Leslie, Nelson and Marasas) tester strains. Successful crosses were obtained with 50.4%, 10.1% and 0.0% of these isolates with the A, D and F tester strains, while 39.5 of the isolates did not form perithecia with any tester strains. Two of the typical infertile isolates were characterized by DNA sequence comparisons and were identified as Fusarium pseudonygamai (Nirenberg and O'Donnell), which is the first known isolation of this species in the United States. Based on the pattern of cross-compatibility, conidiogenesis, colony characteristics and media pigmentation, a majority of the infertile isolates belong to this species. Fumonisins FB(1) and FB(2) were not detected in any of the 81 pearl millet samples analyzed. The species of the G. fujikuroi species complex were dominant in corn and were isolated from 84%, 74% and 65% of the seed in 1996, 1997 and 1998, respectively. Representative species of the G. fujikuroi species complex were isolated from 1996 to 1998 Georgia corn survey (162, 104 and 111 isolates, respectively) and tested for mating compatibility. The incidence of isolates belonging to mating population A (F. verticillioides) ranged from 70.2% to 89.5%. Corn survey samples were assayed for fumonisins, and 63% to 91% of the 1996, 1997 and 1998 samples were contaminated. The total amount of fumonisins in the corn samples ranged from 0.6 to 33.3 microg/g.

Root-Knot Nematode Resistance in Pearl Millet From West and East Africa

Resistance to Meloidogyne incognita is important to provide stability to pearl millet production and to reduce nematode populations that can damage crops grown in rotation with pearl millet. The objectives of this study were to determine whether resistance to M. incognita exists in pearl millet from West and East Africa, and to determine if heterogeneity for resistance exists within selected cultivars. Resistance was assessed as nematode egg production per gram of root in greenhouse trials. Seventeen pearl millet cultivars of diverse origin were evaluated as bulk (S₀) populations. All African cultivars expressed some level of resistance. P3Kollo was among the least resistant of the African cultivars, Zongo and Gwagwa were intermediate, and SoSat-C88 was among the most resistant. Thirty selfed (S₁) progeny selections from SoSat-C88, Gwagwa, Zongo, and P3Kollo were evaluated for heterogeneity of resistance within cultivar. Reactions were verified in 13 S₂ progeny of each of the four cultivars. In S₁ evaluations, each of these cultivars was heterogeneous for resistance. Progeny reaction varied from highly resistant to highly susceptible. Patterns of apparent segregation of resistance varied among the four cultivars. Discreet resistant and susceptible phenotypes were identified in Zongo progeny, and it was estimated that two dominant genes for resistance segregated in this cultivar. Averaged across progenies, egg production on the four cultivars was less (P ≤ 0.001) than on the susceptible hybrid HGM-100, but was not different from resistant hybrid TifGrain 102. Reproduction of M. incognita on the S₂ progeny tended to confirm the results from inoculations of S₁ progeny. Heritability of nematode reproduction (standardized as the ratio of the value to HGM-100) determined by parent-offspring regression was 0.54. Realized heritability determined by divergent selection was 0.87.

Host-specific Variation in Infection by Toxigenic Fungi and Contamination by Mycotoxins in Pearl Millet and Corn

Pearl millet is widely consumed in regions of Africa and Asia, and is increasingly being grown as an alternative grain in drought-prone regions of the United States. Pearl millet and corn were grown in dryland conditions at Tifton, Georgia, USA and grains were compared for pre-harvest infection by potentially toxigenic fungi and contamination by mycotoxins. Corn hybrids Agripro 9909 and Pioneer 3146, and pearl millet Tifgrain 102 were grown in 2000 and 2001; pearl millet HGM 100 was included in the test in 2001. Hybrids were sown on multiple planting dates in each year to induce variation in flowering time. Host species differed in the frequency of isolation of potentially toxigenic fungal species in both years. Across years, corn hybrids were more prone to infection by Aspergillus flavus Link (maximum isolation frequency = 8.8%) and Fusarium moniliforme Sheldon sensu lato (maximum isolation frequency = 72.8%), with corresponding greater concentrations of aflatoxins (maximum concentration = 204.9 microg kg(-1)) and fumonisins (maximum concentration = 34,039 microg kg(-1)). Pearl millet was more prone to infection by F. semitectum Berk. & Ravenel (maximum isolation = 74.2%) and F. chlamydosporum Wollenweb & Reinking (maximum isolation = 33.0%), and contamination by moniliformin (maximum contamination = 92.1 microg kg(-1)). Beauvericin (maximum concentration = 414.6 microg kg(-1)) was present in both hosts. Planting date of corn affected aflatoxin and beauvericin contamination in 2000, and fumonisin concentration in 2001. The observed differences in mycotoxin contamination of the grains, which are likely due to host-specific differences in susceptibility to pre-harvest mycoflora, may affect food safety when the crops are grown under stress conditions.

Testicular pain as the initial presentation of testicular neoplasms

OBJECTIVES

Testicular neoplasms are reported to present with testicular pain in 0.01-10% of patients. The diagnosis of tumour may, therefore, not be considered immediately with this mode of presentation, leading potentially to delays in diagnosis and poorer prognosis or scrotal exploration for suspected torsion. The objective of this study was to assess the incidence of pain as the presentation of testicular neoplasms.

PATIENTS AND METHODS

A retrospective case note analysis of all patients undergoing radical orchidectomy over an 11-year period in Hull, UK was performed. Data on presenting symptoms, histology and clinical stage were collected.

RESULTS

It was found that 23.5% of all patients analysed (27 of 115) presented with testicular pain, but that this did not appear to correlate with any particular histological sub-type of neoplasm or stage of disease. However, those presenting with germ cell tumours and testicular pain were more likely to suffer disease relapse than those presenting with painless testicular enlargement (1 6% compared to 2.6%).

CONCLUSIONS

Testicular neoplasms should be considered earlier in patients presenting with testicular pain, as this may be more common than previously reported.

Evaluation of Pearl Millet Grain Hybrids for Resistance to Meloidogyne spp. and Leaf Blight Caused by Pyricularia grisea

Pearl millet, Pennisetum glaucum, has potential as a grain crop in the southeastern United States. Our objectives were to (i) determine the resistance and/or tolerance of pearl millet hybrids to Meloidogyne incognita race 3 and M. arenaria race 1; (ii) compare reproduction of Meloidogyne spp. on pearl millet and corn; and (iii) determine the disease severity of leaf blight caused primarily by Pyricularia grisea. In a field naturally infested with M. incognita, experimental pearl millet hybrids with inbreds 114 and 117 as the pollinators had fewer numbers of second-stage juveniles and more severe leaf blight than did HGM-100, a nematode-susceptible hybrid; hybrids with inbred 115 as the pollinator were similar to HGM-100 in both nematode numbers and foliar disease severity. Grain yields in pearl millet were greater in plots treated with 1,3-dichloropropene than in control plots and were negatively correlated with leaf blight severity. In a greenhouse experiment, both M. incognita and M. arenaria produced fewer eggs on pearl millet hybrids with pollinators 114, 117, 101, 102, and 103 than on hybrid HGM-100. Reproduction of M. incognita was less on the resistant pearl millet hybrids than on corn. Because both M. incognita and P. grisea can reduce grain yield of pearl millet, hybrids developed for the southeastern United States should be resistant to both pathogens.

Fungi Associated with the Stalk Rot Complex of Pearl Millet

Stalk rot is frequently observed in maturing, rust-infected pearl millet (Pennisetum glaucum). Fungi were isolated from internal stalk tissue, and their association with node discoloration and rust infection at different stages of plant maturity was determined to gain a greater understanding of stalk rot etiology. In 1995, stalk rot was observed in a breeding population of pearl millet. Stalks of 10 rust-infected plants were collected on each of three dates during grain fill. Frequency of symptomatic, discolored nodes was higher in the later sampling dates. Stalk sections from 119 discolored nodes were surface sterilized and plated onto agar media. Fungi most frequently isolated from symptomatic nodes were Bipolaris setariae (isolated from 47% of discolored nodes), Fusarium semitectum (28.6%), and F. moniliforme sensu lato (23.5%). Isolation frequency of these fungi differed (P < 0.05) with sampling date. In 1996 and 1997, the hybrid HGM 100 was evaluated at two dates of planting in each year. Ten stalks were sampled at each of four growth stages: panicle emergence, stigma emergence, milk, and hard dough. A total of 140 stalks was assessed for rust severity and for internal stalk discoloration at the nodes. The frequency of discolored nodes increased with plant maturation and was correlated (P < 0.01) with severity of rust infection. All nodes were plated on an agar medium, and a total of 1,512 isolates from 30 fungal genera or species were isolated from the 1,540 nodes of the sampled stalks. F. moniliforme was isolated most frequently (isolated from 23.5% of all nodes). Frequency of isolation of F. moniliforme from nodes within stalks increased with advancing maturity in the earlier dates of planting, but was not correlated with rust infection. B. setariae (isolated from 9.2% of all nodes) was more frequently isolated from plants at the dough stage in three plantings, and was correlated (P < 0.01) with rust severity. Trends in the frequency of isolation of other fungi were inconsistent between planting dates or among growth stages. Frequency of isolation of F. semitectum (isolated from 11.0% of all nodes) and Alternaria spp. (6.9% of all nodes) was correlated (P < 0.05) with rust severity. Frequency of isolation of Curvularia spp. (isolated from 7.0% of all nodes) was negatively correlated (P < 0.05) with rust severity. Isolation of Alternaria spp. and B. setariae was more frequently associated with node discoloration than was isolation of the other fungi. Stalk rot of pearl millet is the result of a complex of several fungi whose incidence was influenced by rust infection, plant maturation, and environmental factors associated with differences among years and dates of planting.

Inpatient utilization of medical services associated with peripheral arterial disease-related inpatient procedures in the Department of Defense

The objective of this study was to describe the inpatient procedural medical care utilization the first 10 years after initial inpatient confirmation of peripheral arterial disease (PAD). A retrospective review was carried out of the computer records of all the army beneficiaries of the Department of Defense healthcare system since 1971. Over 8000 subjects with an initial inpatient confirmation of PAD between January 1, 1980 and December 31, 1985 were reviewed for 10 years following the initial visit. The utilization of PAD-related invasive procedures gradually increased over the first 8 years, and rose sharply in the ninth and tenth years after initial diagnosis, while the utilization of examination procedures was highest in the first, fifth to seventh, ninth and tenth years. Procedures involving bypass and amputation had the highest utilization among invasive procedures, while procedures involving arteriography and ultrasonography accounted for 88% of all examination procedures. Bypass and repair of vessel procedures gradually rose throughout the 10 years after initial diagnosis, while amputations and skin grafts remained relatively constant. Procedures involving arteriography rose until year 5 and then tapered off, while utilization of ultrasonography rose in year 7 and tapered off. These results suggest that PAD-related studies should consider the progression of the disease past the fifth year after the initial inpatient visit for PAD when measuring a change in outcomes.

Rhabdomyolysis and HMG-CoA reductase inhibitors

OBJECTIVE

To review rhabdomyolysis and discuss the role of hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) and their interactions with other agents in precipitating this condition, and to present case reports of statin-induced rhabdomyolysis.

DATA SOURCE

Relevant clinical literature was accessed using MEDLINE (January 1985-October 2000). The following search terms were used: rhabdomyolysis, adverse events, drug interactions, statins, and HMG-CoA reductase inhibitors.

DISCUSSION

Rhabdomyolysis occurs when extensive muscle damage results in the release of cellular contents into systemic circulation. Major complications include acute renal failure, cardiac abnormalities, and compartment syndrome. Treatment of rhabdomyolysis is supportive, with the primary aim of preventing renal and cardiac complications. Statin monotherapy or combination therapy may result in myopathy, which rarely progresses to rhabdomyolysis. The mechanism for drug interactions with the statins involves their property of lipid or water solubility. This characteristic determines the degree of hepatoenteric or renal metabolism of the statins. All statins except pravastatin undergo metabolism via the cytochrome P450 enzyme system. Other pharmacologic agents that are also metabolized via this pathway may interact with the statins and cause rhabdomyolysis. The risk of statin-induced rhabdomyolysis is increased significantly when statins are used concomitantly with such drugs as fibrates, cyclosporine, macrolide antibiotics, and azole antifungals.

CONCLUSIONS

Rhabdomyolysis is a rare but clinically important adverse event of statin monotherapy or combination therapy. Thorough understanding of this condition may help prevent or minimize adverse health outcomes in patents receiving statin therapy.

Theoretical perspectives of traumatic stress and debriefings

The purpose of this article was to attempt to identify and examine the core set of elements or factors which are germane to understanding the process and effects of traumatic stress and psychological debriefings. Before these factors are addressed, relevant questions regarding the nature, level of care, and implementation of debriefings are raised. A person-environment interactional model is used to explain the typologies of traumatic events and stressor dimensions. Factors considered fundamental to crisis response, goals common to debriefings, and the need to recognize the diversity of traumatic events are then reviewed.

Dynamic multiline population approach to resistance gene management

ABSTRACT The dynamic multiline population breeding strategy integrates principles from the gene stacking and multiline approaches and allows application of the multiline strategy to cross-pollinated hybrid crops. Experiments were conducted to evaluate the effectiveness of the breeding approach. Backcross derivatives of pearl millet Tift 23DB were developed with rust resistance from 18 Burkina Faso landraces, 3 Pennisetum glaucum subsp. monodii accessions, and 2 elite inbreds (1 from India and 1 from the United States). Four cycles of open pollination were made, the last two in the field in rust epidemics. Cytoplasmic male-sterile (CMS) counterparts of the populations in the A(4) cytoplasm were included and advanced simultaneously with the B population. Hybrids with Tift 383 were produced on CMS cycles 1 (C1) through C4. Frequency of hybrid seedlings with resistance increased with each cycle, and frequencies averaged 18 to 38% in C1 to C4 hybrids, respectively, when inoculated with five single-uredinium isolates of Puccinia substriata var. indica. The hybrid populations and Tifleaf (TL)1 and TL2 were evaluated in three yield trials in 1998 to 1999. Disease-free forage dry matter yields did not differ among hybrids. Across trials, area under the disease progress curve (AUDPC) of TL1 and TL2 averaged 1,307, C1 and C2 averaged 914, and C3 and C4 averaged 604. Final severities of TL1 and TL2 averaged 67%, C1 and C2 averaged 47%, and C3 and C4 averaged 30%. When analyzed by regression analysis, AUDPC was reduced 12.2%, final rust severity was reduced 13.3%, and digestible biomass was increased 4.1% per cycle.

Journal article content as a predictor of commitment to change among continuing medical education respondents

BACKGROUND

Journal reading is a time-tested means of continuing medical education (CME) among physicians. Asking physicians to make a written statement of commitment to change has been shown to increase the likelihood of eventual change in practice behavior when used in conjunction with CME lectures. We describe the type and medical content of articles responsible for commitment to change comments among readers of a large circulation primary care journal.

METHODS

Response to the question "what change(s) do you plan to make in your practice as a result of reading the articles in this issue?" were analyzed from CME response cards associated with six issues (1 year's publication) of the Archives of Family Medicine. Responses indicating a commitment to change were analyzed to characterize the type and content of articles responsible for their generation.

RESULTS

During the 1-year study period, original contributions (reports of research trials) dealing with medicine and preventive medicine content accounted for the greatest number of comments. After adjusting for the frequency of article type and content, special articles and those dealing with complementary medicine accounted for the highest number of comments on a per-article basis.

FINDINGS

Family physicians make commitment to change statements on the basis of a broad range of journal articles. Certain articles are more likely to generate statements of commitment to planned changes in practice.

Satisfaction with a computerized practitioner order-entry system at two military health care facilities

User satisfaction with a computerized practitioner order-entry (POE) system at two military health care facilities was studied. A survey was mailed in May 1998 to providers authorized to enter drug orders into the Composite Health Care System (CHCS) (including two clinical pharmacists) and pharmacy staff members at two department of defense (DOD) medical treatment facilities. Of 189 questionnaires with the potential to be returned completed, 112 were usable, for a net response rate of 59.3%. The internal consistency of the survey items measuring user satisfaction (Cronbach's alpha) was 0.86. The typical respondent was male, was employed by the DOD, had fair to excellent computer and typing skills, had received eight hours or less of training on the CHCS POE system, had been using the system for two years or less, and had been a health care practitioner for 10 years or less. Overall, users were satisfied with the POE system (mean +/- S.D. rating of 3.78 +/- 0.87 on a 5-point scale where 5 represented the highest satisfaction level). Satisfaction was correlated most strongly with ratings of the POE system's efficiency. Nonphysicians were more satisfied, on average, than physicians. No significant relationship was found between other individual characteristics and satisfaction. Qualitative analysis reinforced the finding that users were interested in efficiency issues. Overall, users at two military health care facilities were satisfied with a computerized POE system. Satisfaction was most strongly correlated with the perceived efficiency of the system.

Influence of a nontraditional master's degree on graduates' career paths

Graduates' assessments of the University of Texas at Austin's nontraditional M.S. degree program in pharmacy administration were studied. A survey was constructed to assess the impact of the master's program on career advancement, to examine why pharmacists enrolled in the program, and to determine if the curriculum provided knowledge or developed skills that were practical or beneficial. The survey was mailed in April 1999 to all persons who had completed the program between 1990 and 1998. A total of 56 graduates responded, for a response rate of 90.3%. The three reasons for entering the program most frequently cited as most important were career advancement, personal development, and the desire to change job responsibilities. Thirty-four respondents (60.7%) reported receiving a promotion or changing jobs for a higher position while they were enrolled in the program or after completing it. Of these 34 respondents, 29 (85.3%) attributed their promotion or new job to the master's degree. On average, graduates reported that the knowledge and skills obtained through the program had been useful in their practice. The benefits of the program that were cited most frequently were management skills, competencies in areas of pharmacy business, opportunity to advance career, job satisfaction, and competitive advantage when applying for a job. A nontraditional master's degree program in pharmacy administration had a positive impact on the career paths of graduates.

Resistance to Striga hermonthica in Wild Accessions of the Primary Gene Pool of Pennisetum glaucum

ABSTRACT Resistance to Striga hermonthica in 274 wild Pennisetum glaucum subsp. monodii and stenostachyum accessions was evaluated at Samanko, Mali in 1997 and 1998, and at Cinzana, Mali and Sadoré, Niger in 1998. Data recorded included number of striga plants per plot at least three times during the season, date of striga emergence, number of Pennisetum plants, Pennisetum anthesis date, and downy mildew incidence (caused by Sclerospora graminicola). Across trials, the average maximum number of striga per host plant ranged from 0.9 to 8.3. Average days to striga emergence ranged from 54 to 68 days across trials, and was negatively correlated (P < 0.01) with maximum striga within trials. Days to Pennisetum flowering ranged from 54 to 74 days across trials. Host flowering was correlated (P </= 0.05) positively with maximum striga at Samanko in 1997 and 1998, but negatively at Cinzana. Downy mildew incidence ranged from 10 to 32% across trials, and was negatively correlated with maximum striga in three trials. Days to striga emergence and Pennisetum flowering were significant covariates affecting maximum striga values, but downy mildew incidence was not. Least squares means of maximum striga across trials averaged 5.7, and ranged from -0.2 to 19.1 striga per host plant. Broad-sense heritability of observed maximum striga was estimated to be 0.55. Agar-gel assays conducted in the laboratory were ineffective in identifying differences in stimulating striga seed germination among selected accessions. Variables not directly related to genetic resistance can affect maximum striga emergence in the field, and their identification may allow more effective resistance screening.

Preventing PTSD in trauma survivors

This article highlights some of the core issues in the prevention of PTSD in trauma survivors. A review of some of the noteworthy research is presented along with new directions for research, training, education, and social planning efforts.

Resistance to extinction of conditioned odor perceptions: evaluative conditioning is not unique

A tasteless odor will smell sweeter after being sampled by mouth with sucrose and will smell sourer after being sampled with citric acid. This tasty-smell effect was found in experiments that compared odor-taste and color-taste pairings. Using odors and colors with minimal taste (Experiment 1), the authors found that repeated experience of odor-taste mixtures produced conditioned changes in odor qualities that were unaffected by intermixed color-taste trials (Experiment 2). An extinction procedure, consisting of postconditioning presentations of the odor in water, had no detectable effect on the changed perception of an odor (Experiments 3 and 4). In contrast, this procedure altered judgments about the expected taste of colored solutions. Evaluative conditioning (conditioned changes in liking) is claimed to be resistant to extinction. However, these results suggest that resistance to extinction in odors is related to the way they are encoded rather than to their hedonic properties.

The use of water-soluble contrast in evaluating clinically equivocal small bowel obstruction

This study seeks to determine whether a 6-hour abdominal radiograph after oral Gastrografin is a reliable indicator for nonoperative treatment in patients with a clinically equivocal small bowel obstruction. We collected retrospective data from medical records. Patients who received a Gastrografin transit time (GGTT) study between January 1995 and September 1998 were included in the study. Patients who did not appear to be obvious operative candidates, but had signs of intestinal obstruction, underwent a GGTT study. Serial plain abdominal radiographs were taken. If the contrast was in the colon within 6 hours, then the result was negative. A total of 418 GGTT studies were reviewed. Contrast reached the colon within 6 hours in 283 (68%) patients, and 247 (88%) of these patients were managed nonoperatively. The positive predictive value, negative predictive value, sensitivity, and specificity of Gastrografin reaching the colon within 6 hours were 48, 87, 64, and 78, respectively. False negatives included high-grade partial obstructions that ultimately required surgery. Recent operation preceded the GGTT in 128 (31%) cases. Of these 128 patients, only 17 (14%) received an operation. Although the decision to operate or not should never be based on a GGTT study alone, GGTT studies are of significant help in the clinical management of patients suspected to have a small bowel obstruction. GGTT allows for the judicious selection of the appropriate patient for nonoperative management. GGTT studies are cost effective, safe, and clinically useful when attempting to treat patients conservatively.

Resistance to extinction of conditioned odor perceptions: evaluative conditioning is not unique

A tasteless odor will smell sweeter after being sampled by mouth with sucrose and will smell sourer after being sampled with citric acid. This tasty-smell effect was found in experiments that compared odor-taste and color-taste pairings. Using odors and colors with minimal taste (Experiment 1), the authors found that repeated experience of odor-taste mixtures produced conditioned changes in odor qualities that were unaffected by intermixed color-taste trials (Experiment 2). An extinction procedure, consisting of postconditioning presentations of the odor in water, had no detectable effect on the changed perception of an odor (Experiments 3 and 4). In contrast, this procedure altered judgments about the expected taste of colored solutions. Evaluative conditioning (conditioned changes in liking) is claimed to be resistant to extinction. However, these results suggest that resistance to extinction in odors is related to the way they are encoded rather than to their hedonic properties.

Weight loss and elevated gluconeogenesis from alanine in lung cancer patients

BACKGROUND

The role of gluconeogenesis from protein in the pathogenesis of weight loss in lung cancer is unclear.

OBJECTIVE

Our aim was to study gluconeogenesis from alanine in lung cancer patients and to analyze its relation to the degree of weight loss.

DESIGN

In this cross-sectional study, we used primed-constant infusions of [6,6-(2)H(2)]-D-glucose and [3-(13)C]-L-alanine to assess whole-body glucose and alanine turnover and gluconeogenesis from alanine in weight-losing (WL, n = 9) and weight-stable (WS, n = 10) lung cancer patients and healthy control (n = 15) subjects.

RESULTS

Energy intake and plasma alanine concentrations did not differ significantly among the subject groups. Mean (+/-SEM) whole-body glucose production was significantly higher in WL than in WS and control subjects (0.74 +/- 0.06 compared with 0.55 +/- 0.04 and 0.51 +/- 0.04 mmol*kg(-)(1)*h(-)(1), respectively, P < 0.01). Alanine turnover was significantly elevated in WL compared with WS and control subjects (0.57 +/- 0.04 compared with 0.42 +/- 0.05 and 0.40 +/- 0.03 mmol*kg(-)(1)*h(-)(1), respectively, P < 0.01). Gluconeogenesis from alanine was significantly higher in WL than in WS and control subjects (0.47 +/- 0.04 compared with 0.31 +/- 0.04 and 0.29 +/- 0.04 mmol*kg(-)(1)*h(-)(1), respectively, P < 0.01). The degree of weight loss was positively correlated with glucose and alanine turnover and with gluconeogenesis from alanine (r = 0.45 for all, P < 0.01).

CONCLUSIONS

Aberrant glucose and alanine metabolism occurred in WL lung cancer patients. These changes were related to the degree of weight loss and not to the presence of lung cancer per se.

Dactuliophora Leaf Spot of Pearl Millet in Niger and Mali

Pearl millet (Pennisetum glaucum (L.) R. Br.) fields and cultivar trials in Sadoré, Niger, and Samanko, Mali, were surveyed in late August 1999 Most plants were in the late stem elongation to panicle exertion stage Local open-pollinated cultivars, experimental hybrids, and inbreds had disease severities of up to 10% of foliage diseased, with most severe disease on lower leaves. Individual, young, brown necrotic lesions averaged 2 × 1 mm and were surrounded by circular to irregular purple watersoaked margins 1 to 7 mm wide. Lesions expanded in irregular concentric rings, with zones of necrosis often separated by zones of green tissue Mature, individual lesions averaged 4.3 × 1.9 cm. Entire leaves could be blighted by coalescing lesions. No sclerotia were observed in young lesions, but sclerotia consistently developed and were macroscopically visible in necrotic tissues of older lesions. Sclerotia were oblong to pyriform (averaging 178 × 124 mm) and borne on erumpent, cup-shaped sclerotiophores. When incubated under high humidity, sterile gray mycelia grew rapidly from necrotic lesions up to a distance of ≈5 mm on the lower leaf surface, which likely resulted in the large concentric zones necrosis. Fungal characteristics and symptoms were consistent with disease caused by Dactuliophora elongata Leakey (1,2). Based on observations at the International Pearl Millet Downy Mildew Virulence Nursery in Mali, it is likely that resistance to D. elongata exists. Leaf spot of pearl millet caused by D. elongata has been reported only in Nigeria (1,2). Our observations confirm that the pathogen also is present on pearl millet Niger and Mali. References: (1) C. L. A. Leakey. Trans. Br. Mycol. Soc. 47:341, 1964. (2) P. D. Tyagi Proc. Ind. Acad. Sci. (Plant Sci.) 94:407, 1985.

Current care of hepatitis C-positive patients by primary care physicians in an integrated delivery system

BACKGROUND

Infection with the hepatitis C virus (HCV) is an emerging health problem in the United States. Management of this condition in asymptomatic patients remains controversial.

METHODS

A questionnaire was mailed in November 1997 to all primary care physicians caring for adults (internists and family physicians) in an integrated health delivery system regarding the current approach to screening, diagnosis, and management of HCV infection. Charts of patients whose tests were positive for HCV were audited in selected practice sites to document care received by those patients.

RESULTS

Most physicians (70%) reported ordering alanine aminotransferase (ALT) measurements to screen for HCV infection as part of a complete checkup. Each physician diagnosed an average of 3.1 new cases of HCV infection per year. Patients received widely divergent advice regarding prognosis, precautions to prevent transmission, and treatment. More than one half of the physicians advised their patients that the condition was serious (68%) and to abstain from alcohol (56%) and use condoms in monogamous relationships (62%). In caring for HCV-positive patients, more than three quarters of physicians reported recommending a liver biopsy to patients who had elevated ALT levels, and observing clinically, without liver biopsy, those patients who had normal ALT levels. A chart audit, however, showed less-aggressive intervention. Approximately one third of HCV-positive patients with elevated ALT levels had been seen by a gastroenterologist and had had a liver biopsy. Physicians in practice longer were less likely to recommend treatment with interferon-alpha. Of those patients whose physicians reported they would recommend biopsy and treatment with interferon-alpha, only 36% had a documented liver biopsy in their charts, and 29% had documented interferon-alpha treatment. Only 1.6% and 3.0% of patients, respectively, had received the recommended hepatitis A and hepatitis B vaccines.

CONCLUSIONS

Approaches to screening, diagnosis, and management of HCV infection by primary care physicians vary greatly. There appears to be a considerable population of patients in primary care settings who continue to receive conservative management of asymptomatic HCV infection.

Procedure costs and outcomes associated with pharmacologic management of peripheral arterial disease in the Department of Defense

This study was undertaken to determine if differences existed between pharmacologic treatments of peripheral arterial disease (PAD) with respect to PAD-related costs and health care outcomes in the United States Department of Defense health care system. We performed a retrospective review of hospital and prescription data to explore the effects of at least 90 days of aspirin, pentoxifylline, papaverine, or dipyridamole on 4 PAD-related outcomes: number of PAD-related invasive procedures (INV), number of PAD-related examination procedures (EXM), number of PAD-related hospitalization days (HDAYS), and cost of PAD-related procedures (COST) during 5 years. A covariate representing the number of PAD-related hospitalizations before the study period was used to attempt to control for severity of disease state. General linear models were used in the analyses. A statistically significant difference was seen between treatment groups for a linear combination of INV, EXM, HDAYS, and COST when controlling for past PAD-related hospitalizations (P < 0.014). A statistically significant relationship existed between treatment groups and INV (P < 0.041). The pentoxifylline treatment group had a statistically significant higher covariate-adjusted mean INV compared with the aspirin treatment group (P < 0.043). Also, PAD-related past hospitalizations were significantly related to EXM (P < 0.006). Our results appear to support the use of aspirin as a preventive treatment in PAD compared with pentoxifylline or dipyridamole.

Disease Resistance and Biomass Stability of Forage Pearl Millet Hybrids with Partial Rust Resistance

The expression of partial resistance to Puccinia substriata var. indica and its contribution to digestible biomass production in forage pearl millet hybrids were evaluated in field experiments at Tifton, GA. Inbreds Tift 383, Tift 65, and nine inbreds with partial resistance selected from the cross Tift 383 × 'ICMP 501' were crossed to Tift 23DA₄. The parental inbreds and hybrids were evaluated in natural epidemics in 1996 and 1997. Because of maturity differences among the lines, slope of the regression of logit rust severity on time (apparent infection rate) and area under the disease progress curve (AUDPC) calculated for a defined interval of plant growth (10 days before to 20 days after anthesis) and adjusted for initial rust severity at 10 days prior to anthesis were the most useful indicators of resistance. Inbred resistance was not a reliable predictor of hybrid resistance when evaluated by either variable. Hybrids were evaluated for biomass production in 1996 and 1997 in a split-plot design, with hybrids as main plots and nontreated or chlorothalonil fungicide-treated as subplots. Differences existed among hybrids for AUDPC and for digestible dry matter yield (DDMY) and its components. Over all hybrids, the response between DDMY and final rust severity was described by logarithmic regression. Two clusters of hybrids were identified by cluster analysis of disease-related data from both experiments. The cluster of susceptible hybrids tended to have a lower DDMY and were less stable over year × treatment environments than the cluster of partially resistant hybrids. Lodging in nontreated plots in 1997 primarily occurred in susceptible hybrids. Although resistance was expressed in certain hybrids, greater levels of partial resistance are needed to provide adequate protection against DDMY losses.

Increasing complexity of resistance in host populations through intermating to manage rust of pearl millet

ABSTRACT Pearl millet inbreds Tift 23DB, Tift 85DB, PS748BC, and Tift 89D(2) were used to develop three categories of host mixtures (physical mixtures, random-mated populations, and mixtures of two-way and three-way crosses) representing different levels of complexity of resistance through increased heterogeneity within populations and through stacking of resistance genes within the heterogeneous populations. The potential of these mixtures to reduce rust epidemics was evaluated in the field. Area under the disease progress curves (AUDPCs) of all physical mixtures were less than the mean of the components in 1995 and were less than the mean of the components for five of the six mixtures in 1997. In 1996, AUDPCs of the physical mixtures were consistently greater than the mean of their components. AUDPCs of the random-mated mixtures and the mixtures of crosses were consistently less than the mean of the components in 1996 and 1997, with reductions ranging from 12 to 71%. Dry matter yield (DMY) of physical mixtures relative to the mean DMY of the components was inconsistent, ranging from 18% less to 50% more than the mean of the components. The random-mated populations and the mixtures of crosses yielded 18 to 40% more DMY than the mean yield of the pure stands of their components.

A comparison of antihypertensive medication utilization before and after guideline changes using the Department of Defense Prescription Database

OBJECTIVE

To determine changes in the proportion of antihypertensive medication utilization, distributed by medication classes, associated with the Fifth Report of the Joint National Committee (JNC V) guideline changes and the Department of Defense Pharmacoeconomic Center's recommendations to follow JNC V guidelines in presumed newly treated hypertensive patients.

DESIGN

A 43-month, longitudinal, retrospective analysis using data from the Department of Defense Uniformed Services Prescription Database.

SETTING

Seven outpatient US military sites.

PATIENTS

Eligible patients (n = 7277) included those from seven military sites, aged 20-49 years, who were: (1) active-duty members of the US Armed Forces, (2) active-duty members' family members, (3) retired members of the US Armed Forces, and (4) US Armed Forces retired members' family members.

MAIN OUTCOME MEASURE

Proportion of antihypertensive medication utilization, distributed by medication class over the 43-month study period.

METHODOLOGY

Segmented time series analysis was used for each of the following four medication classes: angiotensin-converting enzyme inhibitors, beta-blockers, calcium-channel blockers, and diuretics.

RESULTS

Segmented time series analyses revealed no significant differences in utilization of the four medication classes that corresponded to published guidelines outlining initial antihypertensive therapy.

CONCLUSIONS

It appeared that JNC V guidelines and recommendations of the Pharmacoeconomic Center to follow JNC V had little effect on the utilization of prescription medication classes studied.

First Report and Epidemics of Buffelgrass Blight Caused by Pyricularia grisea in South Texas

A blight on buffelgrass, Cenchrus ciliaris L., has been observed for several years in south Texas and Mexico. The disease did not reach epidemic proportions until 1996. The causal agent, identified as Pyricularia grisea (Cooke) Sacc., is a common pathogen of grasses and other cultivated crops. Several Pennisetum spp. have been reported as hosts of Pyricularia spp.; this is the first report of buffelgrass as a host of this pathogen (1,2). Pathogenicity of P. grisea on buffelgrass was confirmed by greenhouse inoculations of 2-month-old buffelgrass plants with conidia washed with distilled water from monoconidial isolations of the pathogen, grown on potato dextrose agar, from infected leaves collected in several locations in south Texas and Mexico. Plants were placed for 8 h every night inside a plastic enclosure with a humidifier, simulating the high relative humidity conditions prevalent during the epidemic. Typical lesions developed after 7 days. The pathogen was re-isolated from the lesions after 10 days, fulfilling Koch's postulates. Conidia harvested from the sporulating samples were hyaline, transversely septate, with one to three septa, most of them having two. Conidia were obpyriform, with hylum often protuberant, measuring 20.6 to 26.3 μm in length and 8.5 to 10.1 μm wide. These measurements are consistent with those given for Pyricularia spp. by Ellis (1). Conidiophores were hyaline, single, slender, and unbranched. Initial symptoms were dark, discolored spots on the leaf that developed into tan, round to elliptical, necrotic lesions with a dark red border and a yellow, chlorotic halo. With increasing severity, lesions can coalesce, killing the entire leaf blade. Under heat and moisture stress, leaves with few lesions and yellow discoloration will wilt completely. Except for the presence of distinct lesions, wilted plants appear to be suffering from severe drought stress or herbicide injury. Losses vary from a few lesions to wilted whole plants and entire pastures. The pathogen also reduces the quantity and quality of seed by infecting involucres of the head. In the absence of the disease, even under severe moisture or drought stress, buffelgrass is able to thrive. Common T-4464 buffelgrass, which is highly susceptible to P. grisea, was introduced into south Texas in the late 1940s and is currently grown on 8 to 10 million acres in south Texas and Mexico. Buffelgrass reproduces by obligate apomixis, in which seeds are formed without sexual fertilization. Consequently, the progeny are genetically identical to the maternal parent. The monoculture of this grass with its unique type of reproduction encompasses millions of acres with genetically identical plants. Interaction of inoculum with weather conditions (nights with 8 to 10 h of more than 75% relative humidity) in 1996, 1997, and the late summer of 1998 produced epidemics of buffelgrass blight throughout south Texas and northern Mexico. P. grisea was also isolated from lesions on grassburr Cenchrus incertus M. A. Curtis collected throughout the area. References: (1) M. B. Ellis 1971. Dematiaceous hyphomycetes. Commonwealth Mycological Institute, Kew, Surrey, England. (2) D. F. Farr et al. 1989. Fungi of Plants and Plant Products in the United States. American Phytopathological Society, St. Paul, MN.

Molecular markers for rust and pyricularia leaf spot disease resistance in pearl millet

Pearl millet [Pennisetum glaucum (L.) R.Br.] is a warm-season grass used for food, feed, fodder and forage, primarily in countries of Africa and India but grown around the world. The two most-destructive diseases to pearl millet in the United States are rust (caused by Puccinia substriata var. indica) and pyricularia leaf spot (caused by Pyricularia grisea). Genes for disease resistance to both pathogens have been transferred into agronomically acceptable forage and grain cultivars. A study was undertaken to identify molecular markers for three rust loci and one pyricularia resistance locus. Three segregating populations were screened for RAPDs using random decamer primers and for RFLPs using a core set of probes detecting single-copy markers on the pearl millet map. The rust resistance gene Rr 1 from the pearl millet subspecies P. glaucum ssp. monodii was linked 8.5 cM from the RAPD OP-G8350. The linkage of two RFLP markers, Xpsm108 (15.5 cM) and Xpsm174 (17.7 cM), placed the Rr 1 gene on linkage-group 3 of the pearl millet map. Rust resistance genes from both Tift 89D2 and ICMP 83506 were placed on linkage-group 4 by determining genetic linkage to the RFLP marker Xpsm716 (4.9 and 0.0 cM, respectively). Resistance in ICMP 83506 was also linked to the RFLP marker Xpsm306 (10.0 cM), while resistance in Tift 89D2 was linked to RAPD markers OP-K19350 (8.8 cM) and OP-O8350 (19.6 cM). Fragments from OP-K19 and OP-O8 in the ICMP 83506 population, and Xpsm306 in the Tift 89D2 population, were monomorphic. Only one RAPD marker (OP-D11700, 5.6 cM) was linked to pyricularia leaf spot resistance. Attempts to detect polymorphisms with rice RFLP probes linked to rice blast resistance (Pyricularia oryzae; syn=P. grisea) were unsuccessful.

Duty-related stressors and PTSD symptoms in suburban police officers

This study examined the effects of duty-related stress on police officers. Using a sample of 100 suburban police officers, an anonymous questionnaire requested demographic information and included a measure of duty-related stressors, SCL-90-R, the Posttraumatic Stress Disorder scale of the Impact of Events Scale-Revised, and a locus of control scale. Also assessed was whether Critical Incident Stress Debriefing was experienced. The results showed significant correlations between scores on duty-related stress, somatization, and symptoms of PTSD. 13% of the sample met the DSM-IV (1994) diagnostic criteria for PTSD. Results of the regression analysis showed the best predictors for the diagnosis of PTSD were associated with the factor of Exposure to Death and Life Threat, which corresponds to the DSM-IV AI criteria. Finally, 63% of the respondents stated that a critical incident debriefing would be beneficial following an extremely stressful event related to duty.

Patterns of antihypertensive use among patients in the US Department of Defense database initially prescribed an angiotensin-converting enzyme inhibitor or calcium channel blocker

The US Department of Defense recently assembled electronic records of outpatient prescriptions dispensed through the Uniformed Services Prescription Database Project (USPDP) going back to 1990. The objectives of this portion of a larger study were: (1) to examine longitudinally the patterns of antihypertensive drug use during the first year of therapy in patients whose initial therapy was with an angiotensin-converting enzyme (ACE) inhibitor or a calcium channel blocker (CCB); (2) to determine continuous and noncontinuous users of antihypertensive drugs; and (3) to estimate the direct medication costs for each pattern of medication use. Filtering criteria for patient and prescription identification were developed, because the USPDP contains no records of confirmatory diagnoses of hypertension. Once data filters were implemented, information for 771 patients was analyzed. An ACE inhibitor was the initial therapy for 328 patients, accounting for 1935 antihypertensive medication prescription fills, and a CCB was the initial therapy for 443 patients, accounting for 2459 fills (including refills). Slightly more than half of the patients (n = 401, 52.0%) were classified as continuous users (> or = 80% medication-possession ratio [supply of medication in days divided by the number of days in the 12-month study period]). In the first year, 177 of these continuous users (44.1%) had no change in therapy in the first year, 49 (12.2%) had an increase in dose, 8 (2.0%) had a decrease in dose, 15 (3.7%) had a change to a different therapeutic class of antihypertensive medication, 14 (3.5%) were changed to a different medication in the same therapeutic class, 20 (5.0%) had a new medication added to the regimen, and 118 (29.4%) had complex regimens involving more than one change. For continuous users, the mean medication supply in days was 354.6, and the average time before a medication change was 152.1 days for those continuous users who had one change in therapy. The overall average wholesale price (AWP) and average manufacturer price (AMP) for continuous users during 1 year of therapy were $471.31 and $378.51, respectively. For those patients whose therapy was changed to an ACE inhibitor/CCB combination and who were continuous users, the average AWP was $598.47 per year ($492.05 AMP). Once the change from monotherapy to an ACE inhibitor/CCB combination occurred in continuous users, AWP costs per member per month increased by approximately $22.00 ($18.00 AMP). Over half of the patients whose initial therapy was an ACE inhibitor or CCB had at least one change in their first year of therapy. Research into the reasons for these changes and their outcomes is needed.