Psychological distress and convergence of own and proxy health-related quality of life in carers of adults with an intellectual disability

BACKGROUND

In adults with an intellectual disability, health-related quality of life (HRQoL) is often measured by proxy report. This cross-sectional study investigated whether the mental health of proxy raters impacts the way they rate HRQoL.

METHODS

In this study, 110 carers of adults with an intellectual disability completed measures of psychological distress (Kessler-6) and HRQoL (EQ-5D-3L) about their own HRQoL and that of the care recipient. Differences between HRQoL scores as rated by the carer about themselves and the care recipient were calculated (convergence scores) and multiple regression models were fitted to estimate the association between proxy psychological distress and convergence scores for subjective/objective HRQoL controlling for support needs of the care recipient, carer age and gender of care recipient.

RESULTS

There was a significant association between psychological distress and subjective HRQoL convergence scores (r = .92; P = 0.03; 95%; CI: -1.76 to -0.09). There was no association between psychological distress and objective HRQoL convergence scores (r = .01; CI -0.02 to 0.001; P = 0.08). The association between psychological distress and HRQoL scores was no longer present when models did not include convergence scores.

CONCLUSIONS

Carers experiencing more psychological distress tended to rate their own and the care recipients' subjective HRQoL more similarly. Objective HRQoL measures did not show this convergence in scores with increasing carer psychological distress. Findings differed when the analysis approach was changed, suggesting the results above require replication in future studies.

Effects of feeding a quebracho-chestnut tannin extract on lactating cow performance and nitrogen utilization efficiency

The effects of feeding a quebracho-chestnut tannin extract mixture on performance and nitrogen (N) utilization were assessed with 36 multiparous lactating Holstein cows (mean ± standard deviation; 706 ± 59 kg of body weight; 126 ± 20 d in milk) randomly assigned to 3 dietary treatments in a randomized complete block design. Following a 2-wk covariate adjustment period, cows were fed their assigned treatment diets for 13 wk. Rice hulls were removed from a total mixed ration with a 54:46 forage:concentrate ratio (% of dry matter; DM), and a tannin extract mixture from quebracho and chestnut trees (2:1 ratio) was included at 0, 0.45, and 1.80% of dietary DM. There was no interaction between dietary treatments and experimental week for the reported measurements except milk lactose percentage. Overall, treatments did not affect milk yield (48.6 ± 7.8 kg/d), fat- and protein-corrected milk (46.1 ± 7.6 kg/d), milk fat content (3.88 ± 0.65%) and yield (1.85 ± 0.38 kg/d), and true protein yield (1.45 ± 0.21 kg/d). However, incremental levels of tannin extracts in the diet produced a linear increase in DM intake (29.2 to 30.9 kg/d) and a linear decrease in kilograms of milk per kilogram of DM intake (1.67 to 1.57 kg/kg) and MUN (12.2 to 10.8 mg/dL). Furthermore, there was a quadratic effect of tannin extracts on milk true protein content (2.96, 3.13, and 3.00% for 0, 0.45, and 1.80% tannin extract, respectively) and a tendency for linear and quadratic response for body weight gain (0.31, 0.16, and 0.44 kg/d for 0, 0.45, and 1.80% tannin, respectively). Intake of N increased linearly (782, 795, and 820 g/d) and N utilization efficiency (milk N/intake N) decreased linearly (0.300, 0.301, and 0.275 for 0, 0.45, and 1.80% tannin, respectively). Relative to the 0% diet, 1.80% tannin extract reduced estimated urinary N excretion by 11%. In this study, adding 0.45% tannin extract to the diet reduced feed efficiency but had a positive effect on milk protein content. Feeding a tannin extract mixture from quebracho and chestnut may reduce environmental labile urinary N excretion without affecting milk yield but at the expense of a lower feed utilization efficiency.

Substance Use and Psychosocial Functioning in a Sample of Liver Transplant Recipients with Alcohol-Related Liver Disease

Despite the frequency of liver transplantation in alcoholic recipients, the burden of co-occurring psychosocial comorbidities remains poorly defined.

METHODS

A survey study was conducted to examine demographic, substance use, mental health, and social support variables among liver transplant (LT) recipients with alcoholic liver disease (ALD) (LT-ALD: n  =  67). Survey completers (n  =  67) were compared to a sample of liver transplant recipients without ALD (LT: n  =  134).

RESULTS

Survey participants (n  =  67) were predominately male, in their mid-fifties, and were retired or on disability. Alcohol consumption during the 6 months prior to transplant was reported by more than a third of participants. Alcohol consumption post-transplant was reported by 21.2% of respondents, with 4.5% of participants reporting "at-risk" levels of post-transplant alcohol use. Illicit drug use prior to transplant was reported by nearly half of participants (47.8%), and 16.4% reported illicit drug use post-transplant. Approximately half of the sample reported a history of cigarette smoking, and one-third of respondents (29.2%) reported current cigarette smoking. Participants frequently endorsed mental health symptoms consistent with moderate to severe depression (22.4%) and anxiety (17.9%).

CONCLUSIONS

Despite relatively low rates of problematic alcohol use post-transplant, there is a significant burden of disability, substance use, and psychiatric symptomatology in this population.

The ‘three-legged stool’

Many hospitals do not have a structured process of consent, the attainment of which can often be rather ‘last-minute’ and somewhat chaotic. This is a surprising state of affairs as spinal surgery is a high-risk surgical specialty with potential for expensive litigation claims. More recently, the Montgomery ruling by the United Kingdom Supreme Court has placed the subject of informed consent into the spotlight.

There is a paucity of practical guidance on how a consent process can be achieved in a busy clinical setting. The British Association of Spinal Surgeons (BASS) has convened a working party to address this need. To our knowledge this is the first example of a national professional body, representing a single surgical specialty, taking such a fundamental initiative.

In a hard-pressed clinical environment, the ability to achieve admission reliably on the day of surgery, in patients at ease with their situation and with little likelihood of late cancellation, will be of great benefit. It will reduce litigation and improve the patient experience.

Cite this article: Bone Joint J 2016;98-B:1427–30.

Gas emissions from dairy barnyards

Dairy cattle spend considerable time in outside barnyards. Nine barnyards were constructed to examine impacts of surface materials (bark, sand, soil) and timing of cattle corralling (before and after 3–14-day corralling periods) on fluxes of carbon dioxide (CO2), methane (CH4), ammonia (NH3), nitrous oxide (N2O) and CO2 equivalents (CO2eq). Surface, year, and surface*year interactions accounted for 64%, 6% and 16% of CO2 flux variability. Average CO2 flux from bark (2552 mg/m2.h) was 3.1–3.9 times greater than from sand or soil, especially after bark replenishment. Timing, year, timing*year and surface*year accounted for 40%, 17%, 14%, and 17% of CH4 variability. Average CH4 flux after corralling (10.6 mg/m2.h) was 3.8 times greater than before corralling, and 5.2 times greater the year following bark replenishment. Timing accounted for 67% of NH3 variability. After corralling, NH3 fluxes (1622 µg/m2.h) were 95 times greater than before corralling. Timing, surface, surface*timing and timing*year accounted for 33%, 10%, 24% and 13% of N2O variability. Average N2O flux after corralling (2252 µg/m2.h) was 3.7 times greater than before corralling. Surface and surface*year accounted for 71% and 16% of CO2eq variability. Average CO2eq flux from bark (3188 mg/m2.h) was 2.5–3.0 times greater than sand or soil. Greatest CO2eq flux occurred the year after bark replenishment. Tradeoffs between gas emissions, nutrient runoff and leaching, and cow comfort and health need to be assessed more fully before recommending beneficial practices for barnyard surface type and management.

Feed conversion efficiency in dairy cows: Repeatability, variation in digestion and metabolism of energy and nitrogen, and ruminal methanogens

The objective was to study repeatability and sources of variation in feed conversion efficiency [FCE, milk kg/kg dry matter intake (DMI)] of lactating cows in mid to late lactation. Trials 1 and 2 used 16 cows (106 to 368 d in milk) grouped in 8 pairs of 1 high- and 1 low-FCE cow less than 16 d in milk apart. Trial 1 determined the repeatability of FCE during a 12-wk period. Trial 2 quantified the digestive and metabolic partitioning of energy and N with a 3-d total fecal and urine collection and measurement of CH4 and CO2 emission. Trial 3 studied selected ruminal methanogens in 2 pairs of cows fitted with rumen cannulas. Cows received a single diet including 28% corn silage, 27% alfalfa silage, 17% crude protein, and 28% neutral detergent fiber (dry matter basis). In trial 1, mean FCE remained repeatedly different and averaged 1.83 and 1.03 for high- and low-FCE cows, respectively. In trial 2, high-FCE cows consumed 21% more DMI, produced 98% more fat- and protein-corrected milk, excreted 42% less manure per kilogram of fat- and protein-corrected milk, but emitted the same daily amount of CH4 and CO2 compared with low-FCE cows. Percentage of gross energy intake lost in feces was higher (28.6 vs. 25.9%), but urinary (2.76 vs. 3.40%) and CH4 (5.23 vs. 6.99%) losses were lower in high- than low-FCE cows. Furthermore, high-FCE cows partitioned 15% more of gross energy intake toward net energy for maintenance, body gain, and lactation (37.5 vs. 32.6%) than low-FCE cows. Lower metabolic efficiency and greater heat loss in low-FCE cows might have been associated in part with greater energy demand for immune function related to subclinical mastitis, as somatic cell count was 3.8 fold greater in low- than high-FCE cows. As a percentage of N intake, high-FCE cows tended to have greater fecal N (32.4 vs. 30.3%) and had lower urinary N (32.2 vs. 41.7%) and greater milk N (30.3 vs. 19.1%) than low-FCE cows. In trial 3, Methanobrevibacter spp. strain AbM4 was less prevalent in ruminal content of high-FCE cows, which emitted less CH4 per unit of DMI and per unit of neutral detergent fiber digested than low-FCE cows. Thus lower digestive efficiency was more than compensated by greater metabolic efficiencies in high- compared with low-FCE cows. There was not a single factor, but rather a series of mechanisms involved in the observed differences in efficiency of energy utilization of the lactating cows in this study.

Measures of nitrogen use efficiency and nitrogen loss from dairy production systems

In dairy production systems, tradeoffs can occur between fertilizer N applications and crop N use, feed N consumption and manure N excretion, and environmental impacts. This paper examines (i) how stocking rates affect N imports and management on dairy farms, N use efficiency (NUE; i.e., the amount of applied N incorporated into product N), and N loss; (ii) how reductions in fertilizer N and feed N may affect crop and milk production, NUE, and N loss; and (iii) why tradeoffs in N use outcomes should be considered when attempting to enhance overall NUE and reduce N loss. The Integrated Farm Simulation Model simulations of two representative dairy farm types and analyses of regional studies, long-term field experiments, and cow nutrition trials were used to demonstrate that (i) stocking rate affects cropping patterns, fertilizer and feed imports, and N loss; (ii) although fertilizer N reductions of 20 kg N ha may reduce slightly the crude protein (CP) content of corn silage (which would require purchase of additional CP supplements), this practice should not affect long-term corn yield but would reduce nitrate (NO) and nitrous oxide (NO) losses by 13 to 38%; (iii) dietary CP could be reduced on many dairy farms, which would not affect milk production but would reduce ammonia (NH) and NO emissions by 15 to 43%; and (iv) greater recognition of the tradeoffs in N use and N loss are needed to provide a better understanding of the potentials to enhance overall NUE and reduce environmental N loss from dairy production systems.

Potential use of milk urea nitrogen to abate atmospheric nitrogen emissions from wisconsin dairy farms

Urinary urea N (UUN) is the principal nitrogen (N) source controlling emissions of ammonia (NH) and nitrous oxide (NO) from dairy manure. The objectives of this study were (i) to study the integrative nature of dietary crude protein (CP) management, secretion of milk urea N (MUN), excretion of UUN, and N emissions from dairy production systems; (ii) to evaluate how associative changes in dietary CP, MUN, and UUN affect atmospheric N emissions from dairy farms; and (iii) to discuss some of the challenges and opportunities to an expanded use of MUN to enhance dietary CP use and decrease UUN excretion and N emissions from dairy farms. Milk urea N records of 37,889 cows in 197 herds in Wisconsin revealed that approximately one half of tested cows were likely consuming dietary CP in excess of requirement. Farm simulations were used to quantify the effect of dietary CP on whole-farm N emissions. At a statewide average MUN of 12.5 mg dL, 48 to 87% of UUN was emitted as NH, with the lowest loss from pasture-based farms and the greatest loss from tie-stall farms. Each 1 mg dL decrease of MUN (range, 16-10 mg dL) provided an associated daily decrease in UUN of 16.6 g per cow, which decreased NH and NO emissions from manure by 7 to 12%. Although more site-specific information is required on herd MUN-UUN relationships and more a reliable interpretation of MUN assay results is needed, monitoring of MUN may be used to enhance dietary CP use and to reduce UUN excretion and N emissions from Wisconsin dairy farms.

Short communication: Evaluation of milk urea nitrogen as a management tool to reduce ammonia emissions from dairy farms

The purpose of this study was to compile and evaluate relationships between feed nitrogen (N) intake, milk urea N (MUN), urinary urea N (UUN), and ammonia (NH(3)) emissions from dairy farms to aid policy development. Regression relationships between MUN, UUN, and NH(3) emissions were compiled from studies conducted in Wisconsin, California, and the Netherlands. Relative reductions in NH(3) emissions were calculated as percentage decreases in NH(3) emissions associated with a baseline MUN level of 14 mg/dL (prevailing industry average). For 3 studies with cows in stanchion barns, relative NH(3) emission reductions of 10.3 to 28.2% were obtained when MUN declined from 14 to 10mg/dL. Similarly, analyses of 2 freestall studies provided relative NH(3) emission reductions of 10.5 to 33.7% when MUN levels declined from 14 to 10mg/dL. The relative reductions in NH(3) emissions from both stanchion and freestall barns can be associated directly with reductions in UUN excretion, which can be determined using MUN. The results of this study may help create new awareness, and perhaps eventual industry-based incentives, for management practices that enhance feed N use efficiency and reduce MUN, UUN, and NH(3) emissions from dairy farms.

Dietary crude protein and tannin impact dairy manure chemistry and ammonia emissions from incubated soils

Excess crude protein (CP) in dairy cow diets is excreted mostly as urea nitrogen (N), which increases ammonia (NH) emissions from dairy farms and heightens human health and environmental concerns. Feeding less CP and more tannin to dairy cows may enhance feed N use and milk production, abate NH emissions, and conserve the fertilizer N value of manure. Lab-scale ventilated chambers were used to evaluate the impacts of CP and tannin feeding on slurry chemistry, NH emissions, and soil inorganic N levels after slurry application to a sandy loam soil and a silt loam soil. Slurry from lactating Holstein dairy cows (Bos taurus) fed two levels of dietary CP (low CP [LCP], 155 g kg; high CP [HCP], 168 g kg) each fed at four levels of dietary tannin extract, a mixture from red quebracho (Schinopsis lorentzii) and chestnut (Castanea sativa) trees (0 tannin [0T]; low tannin [LT], 4.5 g kg; medium tannin [MT], 9.0 g kg; and high tannin [HT], 18.0 g kg) were applied to soil-containing lab-scale chambers, and NH emissions were measured 1, 3, 6, 12, 24, 36, and 48 h after slurry application. Emissions from the HCP slurry were 1.53 to 2.57 times greater ( < 0.05) than from the LCP slurry. At trial's end (48 h), concentrations of inorganic N in soils were greater ( < 0.05) in HCP slurry-amended soils than in LCP slurry-amended soils. Emissions from HT slurry were 28 to 49% lower ( < 0.05) than emissions from 0T slurry, yet these differences did not affect soil inorganic N levels. Emissions from the sandy loam soil were 1.07 to 1.15 times greater ( < 0.05) than from silt loam soil, a result that decreased soil inorganic N in the sandy loam compared with the silt loam soil. Larger-scale and longer-term field trails are needed to ascertain the effectiveness of feeding tannin extracts to dairy cows in abating NH loss from land-applied slurry and the impact of tannin-containing slurry on soil N cycles.

Tannin extracts abate ammonia emissions from simulated dairy barn floors

Feeding more tannin and less crude protein (CP) to dairy cows may have synergistic impacts on reducing NH emissions from dairy barns. Three trials using lab-scale ventilated chambers with concrete floors were conducted to determine the impacts on NH emission of tannin and CP feeding, tannin feeding on urease activity in feces, and tannin application directly to the barn floor. For Trial 1, mixtures of feces and urine from lactating Holstein dairy cows () fed four levels (g kg) of dietary tannin extract [a mixture from red quebracho () and chestnut () trees]: 0 tannin (0T), 4.5 (low tannin [LT]), 9.0 (medium tannin [MT]), and 18.0 (high tannin [HT]); each fed at two levels (g kg) of dietary CP: 155 low CP (LCP) and 168 high CP (HCP) were applied to chambers. For Trial 2, urea solution was added to feces obtained from cows fed 0T, MT, and HT at HCP. For Trial 3, tannin amounts equivalent to those fed at 0T, MT, and HT were applied directly to feces-urine mixtures from 0T-HCP. For all trials, NH emissions were measured 1, 3, 6, 12, 24, 36, and 48 h after treatment application. For Trial 1, reductions in NH emission due to tannin feeding were greatest when fed at LCP: The LCP-LT and LCP-HT treatments emitted 30.6% less NH than LCP-0T, and the HCP-LT and HCP-HT treatments emitted 16.3% less NH than HCP-0T. For Trial 2, feeding tannin decreased urease activity in feces, resulting in an 11.5% reduction in cumulative NH loss. For Trial 3, the application of tannin directly to simulated barn floors also apparently decreased urease activity, resulting in an average reduction in cumulative NH emissions of 19.0%. Larger-scale trails are required to ascertain the effectiveness of tannin extracts in abating NH loss from dairy barn floors.

Dairy slurry application method impacts ammonia emission and nitrate in no-till corn silage

Reducing ammonia (NH3) emissions through slurry incorporation or other soil management techniques may increase nitrate (NO3) leaching, so quantifying potential losses from these alternative pathways is essential to improving slurry N management. Slurry N losses, as NH3 or NO3 were evaluated over 4 yr in south-central Wisconsin. Slurry (i.e., dairy cow [Bos taurus] manure from a storage pit) was applied each spring at a single rate (-75 m3 ha(-1)) in one of three ways: surface broadcast (SURF), surface broadcast followed by partial incorporation using an aerator implement (AER-INC), and injection (INJ). Ammonia emissions were measured during the 120 h following slurry application using chambers, and NO3 leaching was monitored in drainage lysimeters. Yield and N3 uptake of oat (Avena sativa L.), corn (Zea mays L.), and winter rye (Secale cereale L.) were measured each year, and at trial's end soils were sampled in 15- to 30-cm increments to 90-cm depth. There were significant tradeoffs in slurry N loss among pathways: annual mean NH3-N emission across all treatments was 5.3, 38.3, 12.4, and 21.8 kg ha(-1) and annual mean NO3-N leaching across all treatments was 24.1, 0.9, 16.9, and 7.3 kg ha' during Years 1, 2, 3, and 4, respectively. Slurry N loss amounted to 27.1% of applied N from the SURF treatment (20.5% as NH3-N and 6.6% as NO,-N), 23.3% from AER-INC (12.0% as NH3-N and 11.3% as NO3-N), and 9.19% from INJ (4.4% as NH3-N and 4.7% as NO3-N). Although slurry incorporation decreased slurry N loss, the conserved slurry N did not significantly impact crop yield, crop N uptake or soil properties at trial's end.

The effect of telephone counselling on reducing post-traumatic symptoms after mild traumatic brain injury: a randomised trial

BACKGROUND

Mild traumatic brain injury (MTBI) is a significant public health problem affecting approximately 1 million people annually in the USA. A total of 10-15% of individuals are estimated to have persistent post-traumatic symptoms. This study aimed to determine whether focused, scheduled telephone counselling during the first 3 months after MTBI decreases symptoms and improves functioning at 6 months.

METHODS

This was a two-group, parallel, randomised clinical trial with the outcome assessed by blinded examiner at 6 months after injury. 366 of 389 eligible subjects aged 16 years or older with MTBI were enrolled in the emergency department, with an 85% follow-up completion rate. Five telephone calls were completed, individualised for patient concerns and scripted to address education, reassurance and reactivation. Two composites were analysed, one relating to post-traumatic symptoms that developed or worsened after injury and their impact on functioning, the other related to general health status.

RESULTS

The telephone counselling group had a significantly better outcome for symptoms (6.6 difference in adjusted mean symptom score, 95% confidence interval (CI) 1.2 to 12.0), but no difference in general health outcome (1.5 difference in adjusted mean functional score, 95% CI 2.2 to 5.2). A smaller proportion of the treatment group had each individual symptom (except anxiety) at assessment. Similarly, fewer of the treatment group had daily functioning negatively impacted by symptoms with the largest differences in work, leisure activities, memory and concentration and financial independence.

CONCLUSIONS

Telephone counselling, focusing on symptom management, was successful in reducing chronic symptoms after MTBI.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov, #NCT00483444.

Season and bedding impacts on ammonia emissions from tie-stall dairy barns

Federal and state regulations are being promulgated under the Clean Air Act to reduce hazardous air emissions from livestock operations. Few data are available on emissions from livestock facilities in the USA and the management practices that may minimize emissions. The objective of this study was to measure seasonal and bedding impacts on ammonia emissions from tie-stall dairy barns located in central Wisconsin. Four chambers each housed four Holstein dairy heifers (approximately 17 mo of age; body weights, 427-522 kg) for three 28-d trial periods corresponding to winter, summer, and fall. A 4x4 Latin Square statistical design was used to evaluate four bedding types (manure solids, chopped newspaper, pine shavings, and chopped wheat straw) in each chamber for a 4-d ammonia monitoring period. Average ammonia-N emissions (g heifer(-1) d(-1)) during summer (20.4) and fall (21.0) were similar and twice the emissions recorded during winter (10.1). Ammonia-N emissions accounted for approximately 4 to 7% of consumed feed N, 4 to 10% of excreted N, and 9 to 20% of manure ammonical N. Cooler nighttime temperatures did not result in lower ammonia emissions than daytime temperatures. Ammonia emissions (g heifer(-1) d(-1)) from chambers that contained manure solids (20.0), newspaper (18.9), and straw (18.9) were similar and significantly greater than emissions using pine shavings (15.2). Chamber N balances, or percent difference between the inputs feed N and bedding N, and the outputs manure N, body weight N, and ammonia N were 105, 90, and 89% for the winter, summer, and fall trials, respectively. Relatively high chamber N balances and favorable comparisons of study data with published values of ammonia emissions, feed N intake, and manure N excretion provided confidence in the accuracy of the study results.

Nutrient budgeting as an approach to improving nutrient management on Australian dairy farms

Dairy farming in Australia continues to intensify. Increased stocking rates have resulted in increased milk production per ha, but have also required greater inputs of purchased feed and fertiliser. The imbalance between nutrient inputs, primarily as feed and fertiliser, and nutrient outputs, in milk and livestock, has resulted in significant nutrient accumulation on dairy farms and, consequently, a greater risk of nutrient loss to the environment. Nutrient budgeting is a technique used to quantify or predict nutrient deficits or surpluses, either at a whole-farm or field scale, in an attempt to improve nutrient use efficiency and reduce nutrient losses from agriculture. A broad range of nutrient budgeting approaches are used internationally, and depending on their purpose, they vary from the very simple to the very complex. Nutrient budgeting has been widely used to assist on-farm nutrient management decisions, in research to identify major nutrient pools, transformations and losses, to enable farmers to access cost-sharing support from governments, and in some countries as a major regulatory tool. The changing nature of Australian dairy operations, the increasing societal pressure on the farming community to reduce nutrient losses to water and air, and the need to provide evidence that farm practices are meeting environmental standards, justifies the need for improved nutrient management practices on Australian dairy farms. This paper describes different types of nutrient budgeting approaches used internationally and assesses the benefits of developing a practical, scientifically rigorous and nationally standardised nutrient budgeting approach for the Australian dairy industry.

Validation of Feed and Manure Data Collected on Wisconsin Dairy Farms

An on-farm study of 54 representative Wisconsin dairy farms was conducted to evaluate the influence of biophysical and socioeconomic factors on overall feed, fertilizer, and manure nutrient use. This report validates 1) how well data on cow diets, feed analyses, and milk production reflected established feed-milk-manure relationships; and 2) how well farmer-recorded data on manure land application reflected literature values of manure N and P excretion, collection, and loss. Calculated feed N and P use efficiencies (18 to 33% and 18 to 35%, respectively) fell within ranges expected for dairy farms. This suggested that our on-farm methods of data collection provided reliable information on relationships among feed N and P intake, secretions in milk, and excretion in manure. On stanchion farms, there were no differences between farmer estimates (kg/farm) of manure P collected (1,140) and land-applied (1,210) and what would be calculated from the literature (1,340). On freestall farms, there were no differences in amounts (kg/farm) of manure P collected (2,889), land-applied (2,350), or literature estimates (2,675). Manure P applications (kg/ha) to tilled cropland would be similar using either farmer estimates of manure collected and land-applied, or literature estimates. The data provided a snapshot of Wisconsin industry practices, as well as information on the range of feed and manure management practices on individual dairy farms. Improvements to data collection methods would require increased skill and training of both farmers and those responsible for assisting farmers in on-farm data collection and analyses.

Influence of Bedding Material on Ammonia Emissions from Cattle Excreta

Dairy cattle barns are a major source of NH3 emissions to the atmosphere. Previous studies have shown that the bedding material used in the barn can influence the magnitude of NH3 emissions, but little is known about which bedding characteristics are important in this respect. The aims of this study were to assess, at a laboratory scale, the relative importance of the chemical [pH, cation exchange capacity (CEC), C:N] and physical (urine absorbance capacity, bulk density) characteristics of 5 bedding materials (chopped wheat straw, sand, pine shavings, chopped newspaper, chopped corn stalks, and recycled manure solids) on NH3 emissions from dairy cattle urine. Recycled manure solids were the most absorbent of the bedding types (4.2 g of urine/g of bedding), and sand was the least (0.3 g of urine/g of bedding). When beddings were soaked in urine to their absorbance capacities, NH3 emissions over 48 h (expressed as a proportion of the urine N absorbed) were not significantly different among bedding types, despite differences in initial bedding pH, CEC, and C:N. When equal volumes of urine were applied to equal depths of dry bedding, NH3 emissions over 48 h were significantly less from sand and pine shavings (23 and 42% of applied urine N, respectively) than from chopped newspaper, chopped corn stalks, and recycled manure solids (62, 68, and 65% of applied urine N, respectively), whereas emissions from chopped wheat straw (55% applied urine N) only differed significantly from that from sand. Differences in the chemical characteristics of the beddings did not explain differences in emission; NH3 emissions increased linearly with CEC contrary to expectations, and there was no significant relationship with initial bedding pH. The physical characteristics of bedding materials were of more importance, as NH3 emissions increased linearly with absorbance capacity and decreased as the bulk density of the packed beddings increased.

A Survey of Selected Heavy Metal Concentrations in Wisconsin Dairy Feeds

Heavy metals such as zinc (Zn), copper (Cu), chromium (Cr), arsenic (As), cadmium (Cd), and lead (Pb) are potential bioaccumulative toxins of the dairy production system. The heavy metal content of dairy feeds, however, remains poorly documented, particularly in the United States. This survey determined the heavy metal content of 203 typical dairy ration components sampled from 54 dairy farms in Wisconsin. Lowest heavy metal concentrations were found in homegrown alfalfa (Medicago sativa L.) hay and haylage, and corn (Zea mays L.) grain and silage. Highest metal concentrations were found in purchased feeds, particularly mineral supplements, and to a lesser extent corn- or soybean-based concentrates. Zinc and Cu were found at the highest concentration in complete dairy (total mixed and aggregated component) rations and reflected the deliberate addition of these metals to meet animal nutrient requirements although more than half the farms fed Cu and Zn above US recommended levels. Concentrations of Cr, As, Cd, and Pb were present in much lower concentrations and decreased in the order Cr > As > Pb > Cd. No complete Wisconsin dairy ration contained heavy metal concentrations above US maximum acceptable concentrations and would be unlikely to induce any toxic effects in dairy cattle. Concentrations of Cd in complete dairy rations were closest to US maximum acceptable concentrations, suggesting the greatest potential long-term risk to exceed US maximum acceptable concentrations if whole farm levels of Cd were to increase in the future. With the exception of Pb, the main sources of Zn, Cu, Cr, As, and Cd in the complete dairy feed ration originated from imported feed. The continued importation of heavy metals in dairy feed is likely to be associated with accumulation of these metals in soils where manure is applied. Although the cycling of many heavy metals through the dairy food chain will be limited by factors such as a soil's cation exchange capacity, pH, salinity, and phytotoxicity of the metal, these may be less limiting for Cd. It is important that sources of Cd in the dairy system are identified and minimized to prevent problems associated with Cd accumulation in the dairy soil system arising over the long-term.

Dietary Manipulation in Dairy Cattle: Laboratory Experiments to Assess the Influence on Ammonia Emissions

Improvements to the efficiency of dietary nitrogen use by lactating dairy cattle can be made by altering the concentration and form of protein in the diet. This study collected urine and feces from dairy cows from selected crude protein (CP) treatments of 2 lactation studies. In the first trial, collections were made from cattle fed a diet with high (19.4%) or low (13.6%) CP content (HCP and LCP, respectively). In the second trial, collections were made from cattle fed diets in which the forage legume component was alfalfa (ALF) or birdsfoot trefoil with a low (BFTL) or high (BFTH) concentration of condensed tannins (CT). A system of small laboratory chambers was used to measure NH3 emissions over 48 h from applications of equal quantities of urine and feces to cement (simulating a barn floor) and from applications of slurries, made by combining feces and urine in the proportions in which they were excreted for each treatment, to soil. Reducing dietary CP content resulted in less total N excretion and a smaller proportion of the excreted N being present in urine; urine N concentration was 90% greater for HCP than LCP. Surprisingly, NH3 emissions from the barn floor were similar in absolute terms despite the great differences in urine urea-N concentrations, presumably because urease activity was limiting. Cumulative emissions from fresh slurries applied to soil represented 18% of applied N for both HCP and LCP. Following storage at 20 degrees C for 2 wk, cumulative emissions from LCP were much lower than for HCP, representing 9 and 25% of applied N, respectively. Emissions were also lower when expressed as a proportion of slurry total ammoniacal N (TAN) content (24 and 31%, respectively) because of treatment differences in slurry pH. Increasing CT content of the dietary forage legume component resulted in a shift in N excretion from urine to feces. Cumulative NH3 emissions from the barn floor were greater for ALF than for BFTL or BFTH. Emissions from fresh and stored slurries were in proportion to slurry TAN contents, with approximately 35% of applied TAN being lost for all treatments. Emissions expressed as a proportion of total N applied were consistently lower for BFTH than for ALF.

Comparison of estimates of first-year dairy manure nitrogen availability or recovery using nitrogen-15 and other techniques

Measurements of dairy manure nutrient availability to crops typically show great variability. Approaches that are more accurate are needed to improve manure management and reduce nutrient loss to the environment. In this study, we compared direct (15N recovery) and indirect (difference method [Diff Meth] and fertilizer equivalence [FE] approach) methods of determining first-year dairy manure N availability or recovery during three cropping seasons. A field experiment was conducted on a Plano silt loam (fine-silty, mixed, superactive, mesic Typic Argiudolls) planted to corn (Zea mays L.). Plots received either manure, fertilizer N, or no N. Microplots receiving 15N-labeled manure were also established each study year. Manure was applied to a new plot each cropping season. Whole-plant N uptake was the best crop parameter to use for FE estimates. Estimates of N availability by relative effectiveness (Rel Eff), which are derived from the Diff Meth, and FE were similar (32 and 41%, respectively) and higher than unlabeled N or 15N recovery measurements because these indices factor in N use efficiency. Measures of the Rel Eff of manure N use were highly affected by control plot N uptake. The FE approach is less influenced by control plots, but it requires the inclusion of several more treatments and use of mathematical functions to describe crop response to N. These limitations are reflected in the wide ranges obtained for N availability estimates (-60 to 148%). Although apparent N recovery by the Diff Meth (14%) or direct measurements of 15N recovery (16%) were close on average, variability tended to be much lower for the 15N method. In addition, the Diff Meth was highly dependent on initial soil conditions. Use of 15N-labeled manure, although more costly and time-consuming, provided more consistent and reliable results.

An alternative to fixation of displaced fractures of the anterior intercondylar eminence in children

Fractures of the anterior intercondylar eminence in children are relatively uncommon. There is considerable debate as to the best treatment of displaced fractures, but most methods described in the literature involve an open procedure combined with some form of fixation. Using human anatomical dissections, we have shown that the transverse meniscal ligament can become incarcerated within the fracture and act as a block to reduction. We describe an arthroscopic technique which requires no fixation device and report the results of its use in eight displaced fractures. This method gives reliable results and offers the advantage of less potential morbidity.

An alternative to fixation of displaced fractures of the anterior intercondylar eminence in children

Fractures of the anterior intercondylar eminence in children are relatively uncommon. There is considerable debate as to the best treatment of displaced fractures, but most methods described in the literature involve an open procedure combined with some form of fixation. Using human anatomical dissections, we have shown that the transverse meniscal ligament can become incarcerated within the fracture and act as a block to reduction. We describe an arthroscopic technique which requires no fixation device and report the results of its use in eight displaced fractures. This method gives reliable results and offers the advantage of less potential morbidity.

Management practice effects on phosphorus losses in runoff in corn production systems

Phosphorus losses in runoff from cropland can contribute to nonpoint-source pollution of surface waters. Management practices in corn (Zea mays L.) production systems may influence P losses. Field experiments with treatments including differing soil test P levels, tillage and manure application combinations, and manure and biosolids application histories were used to assess these management practice effects on P losses. Runoff from simulated rainfall (76 mm h(-1)) was collected from 0.83-m2 areas for 1 h after rainfall initiation and analyzed for dissolved reactive P (DRP), bioavailable P, total P (TP), and sediment. In no-till corn, both DRP concentration and load increased as Bray P1 soil test (STP) increased from 8 to 62 mg kg(-1). A 5-yr history of manure or biosolids application greatly increased STP and DRP concentrations in runoff. The 5-yr manure treatment had higher DRP concentration but lower DRP load than the 5-yr biosolids treatment, probably due to residue accumulation and lower runoff in the manure treatment. Studies of tillage and manure application effects on P losses showed that tillage to incorporate manure generally lowered runoff DRP concentration but increased TP concentration and loads due to increased sediment loss. Management practices have a major influence on P losses in runoff in corn production systems that may overshadow the effects of STP alone. Results from this work, showing that some practices may have opposite effects on DRP vs. TP losses, emphasize the need to design management recommendations to minimize losses of those P forms with the greatest pollution potential.

Self-report of extent of recovery and barriers to recovery after traumatic brain injury: a longitudinal study

OBJECTIVE

To examine the perspective of survivors of traumatic brain injury (TBI) regarding the extent and nature of their recovery over time.

DESIGN

Inception cohort, longitudinal study.

SETTING

Level I trauma center.

PARTICIPANTS

One hundred fifty-seven consecutively hospitalized individuals with TBI (mean age, 36.1 yr; 80% men) with a broad range of injury severity.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants reported the extent of their recovery and barriers to full recovery at 1, 6, and 12 months.

RESULTS

Participants reported a median return to normal at the 3 follow-up times of 65%, 80%, and 85%. After 1 month, self-reported extent of recovery correlated well with performance on the Glasgow Outcome Scale (p <.001 at 6 and 12 mo) and Wechsler Adult Intelligence Scale Performance IQ (p =.001 at 12 mo). The major reported barrier to recovery was physical difficulties, which constituted over half of the concerns at all time periods. Report of physical-related concerns decreased significantly (p =.002) over time whereas cognition-related concerns increased significantly (p =.02).

CONCLUSION

Brain injury survivors consider themselves to have greater recovery than previously reported by clinicians or family members, consider physical problems a significant factor in their recovery, and appear to become more aware of cognitive impairments over time.

The Distress and Risk Assessment Method (DRAM)

Our aim was to judge the influence of preoperative psychological disturbance on the outcome of lumbar discectomy. We evaluated 66 patients, before and after operation, using a self-administered questionnaire. Disability was assessed using the Oswestry disability index and psychological disturbance the Distress and Risk Assessment Method (DRAM) score. Patients were classified as normal, at risk or distressed, and the outcome of surgery in the three groups was compared at a follow-up of six months.

The mean self-reported preoperative disability was significantly higher in those with psychological disturbance. A total of 54 patients (82%) returned completed postoperative questionnaires. Postoperative disability scores at six months were not significantly different in the three risk groups. Psychological disturbance improved after surgery. Our study suggests that the early outcome of lumbar discectomy is not affected by preoperative psychological disturbance. We conclude that a patient with a symptomatic prolapsed intervertebral disc should not be denied surgery on the basis of preoperative psychological assessment.

The distress and risk assessment method (DRAM)

Our aim was to judge the influence of preoperative psychological disturbance on the outcome of lumbar discectomy. We evaluated 66 patients, before and after operation, using a self-administered questionnaire. Disability was assessed using the Oswestry disability index and psychological disturbance the Distress and Risk Assessment Method (DRAM) score. Patients were classified as normal, at risk or distressed, and the outcome of surgery in the three groups was compared at a follow-up of six months. The mean self-reported preoperative disability was significantly higher in those with psychological disturbance. A total of 54 patients (82%) returned completed postoperative questionnaires. Postoperative disability scores at six months were not significantly different in the three risk groups. Psychological disturbance improved after surgery. Our study suggests that the early outcome of lumbar discectomy is not affected by preoperative psychological disturbance. We conclude that a patient with a symptomatic prolapsed intervertebral disc should not be denied surgery on the basis of preoperative psychological assessment.

Immunolocalization and expression of prohibitin, a mitochondrial associated protein within the rat ovaries

This study was designed to determine the cellular distribution and pattern of expression for the mitochondria-associated protein, prohibitin, during the transitional stages of follicular differentiation within the rat ovary. Immunohistochemical staining techniques were used on frozen sections to examine the localization of prohibitin to preantral, antral, preovulatory, and atretic follicles. Prohibitin localization was also determined in corpus luteum from adult rats, in addition to those from infant and juvenile ovaries, before and after gonadotropin stimulation. Western and Northern blotting techniques were used for qualitative and quantitative assessment of prohibitin expression levels within the ovary. Prohibitin was localized within granulosa cells of infant and juvenile ovaries in a relatively heterogeneous staining pattern. The oocyte also exhibited robust prohibitin expression at all stages of follicular development. In addition, strong prohibitin expression was evident in the corpus luteum as well as in follicles undergoing atresia. Additional data derived from studies involving a GnRH-agonist indicate that increases in prohibitin protein expression correlate with the initial events of apoptosis. Collectively, these results support a growth regulatory role for prohibitin within the rat ovary. Therefore, we propose that prohibitin may serve as an important regulator of granulosa cell fate during follicular development.

Cytochemical demonstration of sites of hydrogen peroxide generation and increased vascular permeability in isolated pig hearts after ischaemia and reperfusion

Isolated pig hearts, subsequently perfused with pig or human blood, were prepared for the cytochemical demonstration of sites of hydrogen peroxide generation and increased vascular permeability. Oxidant stress was associated with ultrastructural changes commonly seen following myocardial reperfusion. In addition, the precipitation of cerium perhydroxide following perfusion with physiological saline containing cerium chloride suggested the vascular endothelium and leukocytes as sources of oxidants. This was associated with rapid penetration of horseradish peroxidase through the intercellular clefts of the vascular endothelium into the interstitial space, suggesting increased vascular leakiness at these sites. The rapid penetration of horseradish peroxidase was observed at all monitored periods of reperfusion with pig or human blood. This indicates that the increased permeability occurred during the ischaemic period and continued during reperfusion. Morphological damage was greatest in pig hearts reperfused with whole human blood and this was attenuated if the blood was preabsorbed to remove antibodies prior to reperfusion. We conclude that oxidant stress was initiated during ischaemia and continued during reperfusion in this model.

Capillary surface area is reduced and tissue thickness from capillaries to myocytes is increased in the left ventricle of streptozotocin-diabetic rats

The left ventricles of normal and diabetic rats, fixed by vascular perfusion were examined using modern stereological techniques to quantify changes in the morphology accompanying streptozotocin-induced diabetes. The heart weight to body weight ratio increased in diabetic rats whilst left ventricular volume remained unchanged. Papillary muscles from the diabetic animals showed prolonged time to peak tension and relaxation, and altered sensitivity to adrenalin and calcium. The apparent cardiomyopathy observed when body weight loss exceeds heart weight loss in experimental diabetes was accompanied by specific pathological changes in the composition of the left ventricle. In the diabetic animals the volume of extracellular components increased threefold and the volume of capillaries fell. The surface density and total surface area of capillaries was reduced, and oxygen diffusion distance to myocyte mitochondria increased. The volume fraction of myocyte mitochondria was reduced during streptozotocin-induced diabetes.

Bony transfixion of the median nerve following Colles' fracture. A case report

Reported herein is the case of a 45-year-old man with a Colles' fracture complicated by median nerve transfixion by a bony spike. This seems not to have been reported previously and reinforces the belief that early median nerve exploration should be performed if there is nerve dysfunction associated with a volar bony spike on the postreduction roentgenograms.

Factors influencing the result of posterior spinal fusion in the treatment of adolescent idiopathic scoliosis

Sixty-six consecutive patients with adolescent idiopathic scoliosis treated by posterior spinal fusion using Harrington distraction compression instrumentation were followed for a minimum of 3 years. Initial surgical correction was satisfactory, but during the follow-up period, mean 4.4 years (3-5 years), there was a loss of correction. Several factors (age, sex, the number of vertebrae in the fusions, and the use of cross wires) were important influences on correction. A method of assessing the balance of a posterior spinal fusion is described that is useful when assessing radiographs.

New clinical test for fracture of the scaphoid

The authors noted that in patients with scaphoid fractures pronation of the affected wrist followed by ulnar deviation produces pain in the anatomic snuff box that is not present in those without a scaphoid fracture. They therefore evaluated this test prospectively in 73 patients. The test gave a 52% positive predictive value and a 100% negative predictive value. They recommend that the test may be used with confidence in the emergency department to exclude a scaphoid fracture in patients with clinical features suggesting scaphoid injury but a normal x-ray film. Use of this test would reduce the number of patients whose wrists are needlessly immobilized in a scaphoid cast.

Metastatic carcinoid of bone. Report of two cases and review of the literature

The skeletal manifestations of malignant carcinoid seem not to have been reported in the orthopedic literature. Bronchial and hindgut carcinoid tumors are less numerous than midgut tumors but metastasize to bone much more frequently. Carcinoid skeletal deposits are usually osteoblastic and most commonly affect the axial skeleton. The radiologic appearance is frequently indistinguishable from prostatic skeletal metastases or chronic sclerosing osteomyelitis. Two cases of skeletal metastases from midgut carcinoid are reported to demonstrate that metastases from carcinoid should be considered in the differential diagnosis of either bone malignancy or chronic sclerosing osteomyelitis.

Intra-articular knee injuries in racquet sports. A review of 128 arthroscopies

Within the last decade, there has been a significant increase in racquet sport participation. The authors report that in a 5-year period, 17% of the injuries seen in a busy sports injuries clinic were associated with racquet sports, and over half of these were injuries to the knee. The findings are reported of those patients requiring knee arthroscopy, and the patterns of injury sustained are identified. Injuries to the knee in racquet sports are largely unavoidable and are inherent to the nature of the game.

Recurrent ureteric obstruction in association with Henoch-Schönlein purpura

The most common urological manifestation of Henoch-Schönlein purpura is focal proliferative glomerulonephritis. Ureteric obstruction as a consequence of the disease has been reported in children but is rare. We report an adult male patient with Henoch-Schönlein purpura causing unilateral, bi-focal, recurrent ureteric obstruction. We speculate that ureteric involvement in Henoch-Schönlein purpura may be more common than hitherto suspected and that even with a demonstrable obstructive episode, consideration must be given for an initial conservative approach.

Decreased circumcision rate with videotaped counseling

Despite the lack of medical indication for routine circumcision in the newborn, neonatal circumcision continues to be done on the vast majority of male infants in the United States. A trial of videotaped "informed consent" counseling was undertaken to determine whether such counseling could affect the parental choice about circumcision. We studied the circumcision frequency rate (CFR) after videotape counseling. We compared it to the rates following standard oral counseling. Videotaped counseling, in contrast to the standard physician-parent oral counseling, significantly reduced the incidence of parents' requests for routine neonatal circumcision.

Bacterial and viral pathogens causing fever in infants less than 3 months old

We studied 182 sick, febrile (temperature greater than 38 degrees C) infants less than 3 months of age, who presented at our Tripler Army Medical Center, Honolulu, during a one-year period, to determine the relative causes of fever in this age group. Blood, cerebrospinal fluid, urine, nasopharyngeal secretions, and stool specimens were cultured for bacterial and viral pathogens. Paired acute and convalescent sera were collected to serologically confirm infection in infants from whom viral isolations were obtained only from the nasopharynx or stool. A viral pathogen was isolated in 75 infants (41%) and a bacterial pathogen was isolated in 27 infants (15%). Nonpolio enteroviruses were the most common pathogens demonstrated. They were isolated from 64 infants (35%), and 40 (62%) of these infants had aseptic meningitis, the most frequently made diagnosis. Urinary tract infection was the most common bacterial infection observed. It occurred in 20 infants (11%) and was most often seen without associated pyuria in uncircumcised male infants. Salmonellosis, the second most common bacterial infection, was observed in six infants (3%), and two of these did not have diarrhea or other gastrointestinal tract symptoms. No infant had septicemia and only one infant had bacterial (group B streptococcal) meningitis.

Schizophrenic patients and their families. A survey in a psychiatric service based on a DGH unit

We identified the population of schizophrenic patients under 65 in a geographically defined area. The number using psychiatric services based on a new District General Hospital unit in the course of one year was 364, a prevalence of 2.2 per 1000 adult population. Half the patients lived in supportive private households, most often with spouses or mothers. More women than men married and retained supporters. Patients and their primary supporters were interviewed separately. The PSE Catego programme classed 47 per cent of patients as psychotic. Supporters reported disturbed behavior in 65 per cent of patients, and restricted social performance in 78 per cent. There was evidence of hardship (emotional and physical ill-health, problems with children) in 90 per cent of households. Supporters' subjective distress was directly related to the presence of psychosis and disturbed behaviour and inversely related to the duration of the illness. Drop-out and failure to take medication appeared to be causes of the relatively high prevalence of psychosis.

Septic arthritis caused by Kingella kingae

Kingella kingae is a slow-growing, fastidious gram-negative coccobacillus that is a normal inhabitant of the oropharynx of man, but it has rarely been implicated as a human pathogen. Two cases of septic arthritis caused by this organism are reported along with a review of seven previously reported cases of infections caused by this organism. Bone and joint infections predominate. Gram's-stained smears of pus from bone or joint fluid aspirate have been negative for organisms, and a delay of growth in cultures with initial difficulty in classification of the isolate is characteristic. Kingella kingae organisms have been uniformly sensitive to the penicillins and all other commonly used antibiotics that were tested. Response to treatment was good in all nine patients found to have infections caused by this organism.

Integration of modeling, monitoring and laboratory observation to determine reasons for air quality violations

An attempt was made to explain ambient air quality violations in the vicinity of industrial plants. Micrometeorology, diffusion calculaations, ambient readings, and plant engineering data are all taken into consideration to ascertain whether the plant is or is not the principal offender.Scrutiny of hi-vol filters using scanning electron microscopy for particle size analysis and particle chemical make-up as an assessment technique is also described.Case histories using the above analytical techniques are discussed.

Fit of porcelain fused-to-metal crown and bridge castings

The dimensional accuracy of porcelain fused to metal crown and bridge castings was determined on truncated cone-shaped steel dies. Ni-Cr castings produced in manufacturers' laboratories were consistently undersize, while precious metal castings were consistently oversize. Ni-Cr castings, produced in NBS laboratories using a modified investing technique, were routinely oversize.

In vitro wear response of composite resin, amalgam, and enamel

A two-body, wear-testing method was developed and the test results were used for comparing and ranking the rate of wear for an amalgam, an experimental composite resin, and a commercial composite resin. The ranking of wear found by this method was the same as that shown by clinical research for the rate of wear of amalgam and commercial composite resin.