Chordicoccus furentiruminis, gen. nov., sp. nov., a novel succinic acid producing bacterium isolated from a steer on a high grain diet

This study presents MP1D12^T (=NRRL B-67553^T=NCTC 14480^T), an isolate from the ruminal content of an Angus steer fed a high grain diet. Phenotypic and genotypic traits of the isolate were explored. MP1D12^T was found to be a strictly anaerobic, catalase-negative, oxidase-negative, coccoid bacterium that frequently grows in chains. Analysis of metabolic products as a result of carbohydrate fermentation showed succinic acid as the major organic acid produced with lactic acid and acetic acid as minor products. Phylogenetic analysis of MP1D12^T based on 16S rRNA nucleotide sequence and amino acid sequences from the whole genome presents a divergent lineage from other members in the family Lachnospiraceae. 16S rRNA sequence comparison, whole genome average nucleotide identity digital DNA-DNA hybridization and average amino acid identity results suggest that MP1D12^T represents a novel species in a novel genus within the family Lachnospiraceae. We propose the creation of the genus Chordicoccus in which MP1D12^T represents the type strain for the novel species Chordicoccus furentiruminis.

Community Choir Improves Vocal Production Measures in Individuals Living with Parkinson's Disease

OBJECTIVES

Parkinson's disease (PD) is a neurodegenerative disease leading to motor impairments and dystonia across diverse muscle groups including vocal muscles. The vocal production challenges associated with PD have received considerably less research attention than the primary gross motor symptoms of the disease despite having a substantial effect on quality of life. Increasingly, people living with PD are discovering group singing as an asset-based approach to community building that is purported to strengthen vocal muscles and improve vocal quality.

STUDY DESIGN/METHODS

The present study investigated the impact of community choir on vocal production in people living with PD across two sites. Prior to and immediately following a 12-week community choir at each site, vocal testing included a range of vocal-acoustic measures, including lowest and highest achievable pitch, duration of phonation, loudness, jitter, and shimmer.

RESULTS

Results showed that group singing significantly improved some, though not all, measures of vocal production. Group singing improved lowest pitch (both groups), duration (both groups), intensity (one group), and jitter (one group) and shimmer (both groups).

CONCLUSIONS

These findings support community choir as a feasible and scalable complementary approach to managing vocal production challenges associated with PD.

366 Effect of Native Rumen Bacteria Supplementation in Methane Emissions, Growth Performance, and Carcass Characteristics of Feedlot Cattle

To evaluate the effect of supplementing feedlot cattle with native rumen bacteria (NRB; Prevotella albensis, Succinivibrio dextrinosolvens, and Chordicoccus furentiruminis) in growth performance, carcass characteristics and gas emissions, Angus × SimAngus-crossbred (body weight (BW) 353 ± 64 kg) steers (n = 32) and heifers (n = 48) were used in randomized complete block design. Cattle stratified by BW were randomly assigned to 4 pens (2/treatment) and fed a corn silage-based diet for 49 d (backgrounding) followed by a ground corn-based diet for 84 d (finishing). When reaching desired finished BW, cattle were harvested. Diets were offered ad libitum and with (WNB) or without (CON) the inclusion of NRB feed supplement. Measurements of CH4 emissions were taken using the GreenFeed system (n = 12/ treatment). All data were analyzed as a mixed procedure (Table 1). There was a treatment (P ≤ 0.05) effect for CH4 emissions yield [g/kg dry matter intake (DMI)] and intensity [g/kg average daily gain (ADG)] during the growing period. Including NRB in the diet during growing, decreased CH4 emissions yield and intensity by 13.5% and 29%, respectively. During the first 84-d period on the finishing diet (d133), feeding NRB increased (P = 0.02) the ADG and tended to increase (P = 0.10) DMI. At d133, cattle fed NRB tended (P = 0.06) to be heavier than cattle in the CON treatment. Days on feed (DOF) was 9 days longer for CON animals than those of WNB animals (P = 0.04). No other differences (P ≥ 0.25) were detected throughout the experimental period and no differences (P ≥ 0.11) were observed in carcass characteristics. Results from this study indicate that feeding NRB decreased methane yield and intensity in the backgrounding period, improved finishing performance of beef cattle, and decreased DOF

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771 LET’S TALK ABOUT RESUS. DO WE DO IT? WHO DOES IT? WHAT ARE THE OUTCOMES?

Introduction

Discussing preferences around cardiopulmonary resuscitation (CPR) is recommended to patients who wish to discuss this, or where there is foreseeable risk of life-threatening clinical deterioration. Our team felt that we discussed this routinely for our inpatients but wished to investigate how we did this, when we did this, why decisions were made and who led these discussions.

Methods

We retrospectively reviewed the electronic patient notes of 118 patients recently discharged from elderly medicine between February and November 2020 and recorded demographic details, co-morbidities and outcomes of discussions regarding resuscitation.

Results

100/118 patients had a RESPECT form documenting preferences. Of these 100 patients, 97% had a DNACPR recommendation, 2 had a ‘for resuscitation’ recommendation and one was undecided. 69% of patients had their preferences recorded during the current admission. 43% of discussions were led by a tier 1/2 doctor. 21% of discussions were led by a tier 3 doctor. 23% of discussions were led by a consultant. It was unclear who had led the discussion 13% of the time. 29/97 patients had a DNACPR due to their wishes. 16/97 patients had a DNACPR based on clinical grounds that it would not succeed. 33/97 patients had a DNACPR on the grounds that burden outweighed risks and they had capacity In 19/97 patients the reason for DNACPR was not clearly documented. There were 6 discussions where there was distress or disagreement—all of the discussions resulted in DNACPR recommendation 1 patient had a DNACPR reversed during their admission and none were reversed afterwards.

Conclusion

Systematically discussing preferences around resuscitation is feasible and rarely results in distress. The majority of patients have a recommendation for DNACPR and discussions are led by ‘junior’ doctors.

329 Supplementing Native Rumen Microorganisms Improves Feedlot Steer Digestive Health and Performance

The rumen microbiome functions as a synchronized entity that digests feed in order to provide nutrients for its host. High-concentrate diets destabilize the rumen microbiome by biasing the community towards microorganisms that readily ferment simple carbohydrates resulting in decreased pH, increased CO2, and an increased solvent concentration in the rumen content. This chemical shift interrupts rumen fermentation and can lead to the development of metabolic diseases that negatively impact animal performance. This study evaluated the benefit of a daily, in-feed microbial feed supplement (MFS; Magnius, Native Microbials Inc, San Diego, CA) containing three native rumen microbes (Chordicoccus ruminifurens ASCUSBF65, Prevotella albensis ASCUSBF41, and Succinivibrio dextrinosolvens ASCUSBF53) on commercial feedlot steer performance and rumen microbiome composition. The trial was conducted by HMS Veterinary Development in Reedley, CA using 200 steers in 20 pens over 109 days with a 2x2 factorial design (with and without step-up period x with and without MFS). The without step-up group was directly fed the finisher ration (94% concentrate, 0.95 Mcal/lb NEm), while the step-up group was adapted to the finisher ration over a period of 21 days. Rumen microbiome samples were collected via stomach tubing periodically throughout the trial. At the end of 109 days, the FCR of the animals receiving MFS were significantly lower than the control animals (7.67% improvement, P = 0.013) in the step-up group, although no significant differences were observed in ADG and DMI. No significant performance differences were observed in the group without a step-up (Table 1). The relationship between rumen pH, dissolved CO2, and the observed changes in the microbiome suggest a potential interplay between acetogenesis and methanogenesis where CO2 consuming bacteria may be important in improving rumen digestive health. Collectively, these results suggest that feeding native rumen microorganisms can improve rumen resilience and health of high-grain consuming cattle.

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Ruminococcus bovis sp. nov., a novel species of amylolytic Ruminococcus isolated from the rumen of a dairy cow

This study describes JE7A12^T (=ATCC TSD-225^T=NCTC 14479^T), an isolate from the ruminal content of a dairy cow. Phenotypic and genotypic traits of the isolate were explored. JE7A12^T was found to be a strictly anaerobic, catalase-negative, oxidase-negative, coccoid bacterium that grows in chains. The API 50 CH carbon source assay detected fermentation of d-glucose, d-fructose, d-galactose, glycogen and starch. HPLC showed acetate to be the major fermentation product as a result of carbohydrate fermentation. Phylogenetic analysis of JE7A12^T based on 16S rRNA nucleotide sequence and amino acid sequences from the whole genome indicated a divergent lineage from the closest neighbours in the genus Ruminococcus. The results of 16S rRNA sequence comparison, whole genome average nucleotide identity (ANI) and DNA G+C content data indicate that JE7A12^T represents a novel species which we propose the name Ruminococcus bovis with JE7A12^T as the type strain.

PSII-11 Effect of a feed supplement composed of native rumen microorganisms on feedlot steer digestive health

Feedlot cattle that receive high grain diets are prone to developing rumen acidosis. The rumen microbiome is a critical part of feed digestion, and thus naturally occurring, native rumen microorganisms may alleviate digestive distress. A daily, in feed microbial feed supplement (MFS) (Magnius, ASCUS Biosciences Inc, San Diego, CA) containing three native rumen microbes (Chordacoccus ruminofurens, Prevotella albensis, and Succinivibrio dextrinosolvens) was evaluated. Seventy-five commercial feedlot steers (Johnson Research, LLC, Parma, Idaho) were split into three treatment groups, 25 control, 25 low-dose (3E8 cells/steer/day), and 25 high-dose (3E9 cells/steer/day). The study included three periods: acclimation (28 days), grow-out period 1 (68 days), and grow-out period 2 (73 days). The animals were individually penned for the acclimation and grow-out period 1, and were collapsed into 7–9 steers per pen for grow-out period 2. The finishing ration for grow-out period 2 was also adjusted to 89.77% concentrate (DM) from 85.56% during grow-out period 1. No significant performance differences among treatment groups were observed during grow-out period 1. In grow-out period 2, the average daily weight gain of mid-weight steers was significantly higher (P = 0.04) in animals receiving a high-dose of MFS than controls. Additionally, the rumen pH of experimental steers were significantly higher than the controls (P < 0.001) during grow-out period 2. The rumen microbiome shifts further supported the observed pH differences. A strong (R2 >0.6) and significant negative correlation (P < 0.001) was observed between rumen pH and rumen dissolved %CO2 in all three treatment groups throughout the study. This is consistent with literature reporting that rumen CO2 accumulation may contribute significantly to rumen acidosis. These findings demonstrate the promise of using microbial based feed supplements in the improvement of feedlot cattle digestive health and performance.

Abstract 130: Characterization of the tumor microenvironment using single cell transcriptomics of triple negative breast cancer allografts treated with doxorubicin

It is currently unclear how stromal components affect drug response and the emergence of drug resistance, in primary tumors. To determine how individual cells within the stroma of triple negative breast cancer (TNBC) allografts respond to chemotherapy, we used single cell sequencing to profile individual cells present in murine tumors with or without exposure to doxorubicin (Dox). Dox is a common chemotherapeutic agent used to treat breast cancer which inhibits breast cancer proliferation by intercalating into DNA and preventing topoisomerase II activity. Several autonomous processes have been implicated in the development of chemoresistance yet the impact of stromal and immune cells on tumor progression is still poorly understood. In this study, TNBC 4T1 cell line were utilized to generate murine allograft tumors in immunocompetent BALB/c mice. Tumor composition was analyzed via single cell RNA sequencing after 3 and 7 days of doxorubicin chemotherapeutic regiment mimicking clinical treatment.

Using Cell Ranger single cell software suite and Seurat R toolkit, single cell transcriptomic analysis identified the cellular composition of tumors through expression of cell-type specific genes. Stromal cell types such as endothelial, fibroblast and epithelial cells were assessed and quantified in the tumor microenvironment. Immune cell types including neutrophils, monocytes, macrophages, T-cells and B-cells were also identified in the stroma and the responses to doxorubicin treatment was determined based on the gene expression changes. In this study, cancer-associated fibroblasts and non-canonical tumor associated macrophage subpopulations are of particular interest. As expected, we found both qualitative and quantitative changes in specific subpopulations of stromal cells in response to Dox exposure.

Identification of stromal and immune cell sub-types could also lead to improved diagnostic capabilities and tumor susceptibilities. Future studies modulating non-cancerous cells in the tumor microenvironment may increase efficacy of chemotherapeutics. Further elucidating the specific cellular subpopulations within the tumor microenvironment that shift in response to drug exposure may provide new therapeutic avenues. Understanding changes in cell populations within the drug exposed tumor microenvironment can aid in future drug development to specifically target cells least sensitive to chemotherapy exposure.

This study received funding from LLNL LDRD grant 19-SI-003. This work was conducted under the auspices of the USDOE by LLNL (DE-AC52-07NA27344).

Citation Format: Nicholas Hum, Aimy Sebastian, Sean Gilmore, Elizabeth K. Wheeler, Matthew A. Coleman, Gabriela G. Loots. Characterization of the tumor microenvironment using single cell transcriptomics of triple negative breast cancer allografts treated with doxorubicin [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 130.

The games they play: Observations of children with autism spectrum disorder on the school playground

The playground may be an important context to examine the social functioning of children with autism spectrum disorder. Previous literature on playground peer engagement has used quantitative methods, but there is limited research using qualitative observations to understand the nuances of playground behavior. Using a mixed-methods approach, 55 elementary school-aged children with autism spectrum disorder who are primarily included in general education settings were observed on the school playground using the Playground Observation of Peer Engagement. Quantitative and qualitative data were examined using a mixed-methods approach. The results showed that children with autism spectrum disorder: engage in solitary and peripheral activities; demonstrate appropriate initiations and responses to peers; display self-stimulatory, motoric behaviors most frequently during solitary activities; and often have neutral affect on the playground. These findings suggest that intervention and supports for children with autism spectrum disorder may be important to deliver at recess to address peer engagement.

Emotional labor and professional practice in sports medicine and science

The aim of this study was to explore how sport medicine and science practitioners manage their emotions through emotional labor when engaging in professional practice in elite sport. To address the research aim a semistructured interview design was adopted. Specifically, eighteen professional sport medicine and science staff provided interviews. The sample comprised sport and exercise psychologists (n=6), strength and conditioning coaches (n=5), physiotherapists (n=5), one sports doctor and one generic sport scientist. Following a process of thematic analysis, the results were organized into the following overarching themes: (a) factors influencing emotional labor enactment, (b) emotional labor enactment, and (c) professional and personal outcomes. The findings provide a novel contribution to understanding the professional demands faced by practitioners and are discussed in relation to the development of professional competencies and the welfare and performance of sport medics and scientists.

Provision of Rehabilitation Services in Residential Care Facilities: Evidence From a National Survey

OBJECTIVE

To examine the association between organizational factors and provision of rehabilitation services that include physical therapy (PT) and occupational therapy (OT) in residential care facilities (RCFs) in the United States.

DESIGN

A cross-sectional, observational study conducted using a national sample from the 2010 National Survey of Residential Care Facilities conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics.

SETTINGS

U.S. RCFs.

PARTICIPANTS

RCFs (N=2302; weighted sample, 31,134 RCFs).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The association between characteristics of the facilities, director and staff, and residents, and provision of PT and OT services was assessed using multivariate logistic regression analyses.

RESULTS

Among all RCFs in the United States, 43.9% provided PT and 40.0% provided OT. Medicaid-certified RCFs, larger-sized RCFs, RCFs with a licensed director, RCFs that used volunteers, and RCFs with higher personal care aide hours per patient per day were more likely to provide both PT and OT, while private, for-profit RCFs were less likely to provide PT and OT. RCFs with a higher percentage of white residents were more likely to provide PT, while RCFs with chain affiliation were more likely to provide OT.

CONCLUSIONS

Less than half of the RCFs in the United States provide PT and OT, and this provision of therapy services is associated with organizational characteristics of the facilities. Future research should explore the effectiveness of rehabilitation services in RCFs on residents' health outcomes.

Use of biologic nanolipoprotein particles containing monophosphoryl lipid A as a novel intranasal vaccine platform for Bacillus anthracis

There is considerable interest in developing a novel Bacillus anthracis vaccine that improves upon the shortcomings of the licensed vaccine for broader, more rapid protection of the population. Ideally, a vaccine would recognize the spore in addition to having anti-toxin effects as well as induce robust mucosal and lung-associated immunity for early recognition and clearance. Here, we investigate nanolipoprotein particles (NLPs) containing the Toll-like receptor 4 agonist monophosphoryl lipid A (MPLA) as a platform for intranasal vaccination against Bacillus anthracis. Modified lipids enabled attachment of disparate spore and toxin protein antigens. Intranasal vaccination of mice with B. anthracis antigen-MPLA-NLP constructs vs. delivery with free MPLA induced robust IgG and IgA responses in serum and in bronchoalveolar and nasal lavage. Typically, a single dose sufficed to induce sustained antibody titers over time. Robust T cell responses to various spore antigens were also detected in the lung. When multiple immunizations were required, specific antibodies were detected earlier in the boost schedule with MPLA-NLP-mediated delivery than with free MPLA. Administering combinations of constructs induced robust responses to all incorporated antigens, indicating potential for a multivalent vaccine preparation. Experiments to determine the efficacy of multivalent vaccine preparations against inhalational B. anthracis challenge are ongoing. In summary, the NLP platform enhances humoral, cellular and mucosal responses to intranasal immunization, indicating promise for NLPs as a flexible, robust vaccine platform against B. anthracis and potentially other inhalational pathogens.

A single-center evaluation of the risk for colonization or bacteremia with piperacillin-tazobactam- and cefepime-resistant bacteria in patients with acute leukemia receiving fluoroquinolone prophylaxis

Fluoroquinolone prophylaxis is indicated to prevent neutropenic fever in patients with acute leukemia. However, fluoroquinolone use has been associated with development of multi-drug-resistant Pseudomonas aeruginosa and extended spectrum β-lactamase producing gram-negative bacilli. Due to a presumed risk of multi-drug resistance associated with fluoroquinolone prophylaxis, patients admitted to our hospital with neutropenic fever receive empiric carbapenem therapy until cultures are negative for 72 h or identification of an organism. Our study seeks to identify the incidence of multi-drug-resistant organism colonization and bacteremia among patients who receive fluoroquinolone prophylaxis and to evaluate duration of empiric carbapenem therapy. A retrospective review of adult patients with acute leukemia receiving a fluoroquinolone as outpatient infection prophylaxis, admitted to our tertiary cancer center for treatment of neutropenic fever was completed. Surveillance and blood cultures were reviewed for antibiotic resistance. Duration of empiric carbapenem therapy was reviewed. One hundred patients and 177 admissions for neutropenic fever were included. Six patients harbored a piperacillin-tazobactam-resistant organism found during routine surveillance. Among these patients, two bacteremias were identified, one of which was a piperacillin-tazobactam-resistant organism. Five bacteremias were identified among 83 patients with negative surveillance cultures. Among the bloodstream infections, five organisms isolated were fluoroquinolone resistant. No cefepime-resistant organism was isolated on surveillance or bloodstream cultures. Adherence to the institution guideline of narrowing antibiotics after 72 h of negative cultures occurred in only 13% of neutropenic fever cases. The average duration of carbapenem therapy in 177 neutropenic fever episodes was 4.4 days. Our findings show that among our patient population, there is a low risk of bacteremia with a piperacillin-tazobactam-resistant or cefepime-resistant organism. However, prompt de-escalation of carbapenem therapy needs to be reiterated within hospital practice.

The Input Signal Step Function (ISSF), a standard method to encode input signals in SBML models with software support, applied to circadian clock models

Time-dependent light input is an important feature of computational models of the circadian clock. However, publicly available models encoded in standard representations such as the Systems Biology Markup Language (SBML) either do not encode this input or use different mechanisms to do so, which hinders reproducibility of published results as well as model reuse. The authors describe here a numerically continuous function suitable for use in SBML for models of circadian rhythms forced by periodic light-dark cycles. The Input Signal Step Function (ISSF) is broadly applicable to encoding experimental manipulations, such as drug treatments, temperature changes, or inducible transgene expression, which may be transient, periodic, or mixed. It is highly configurable and is able to reproduce a wide range of waveforms. The authors have implemented this function in SBML and demonstrated its ability to modify the behavior of publicly available models to accurately reproduce published results. The implementation of ISSF allows standard simulation software to reproduce specialized circadian protocols, such as the phase-response curve. To facilitate the reuse of this function in public models, the authors have developed software to configure its behavior without any specialist knowledge of SBML. A community-standard approach to represent the inputs that entrain circadian clock models could particularly facilitate research in chronobiology.

What is the biological basis of pattern formation of skin lesions?

Pattern recognition is at the heart of clinical dermatology and dermatopathology. Yet, while every practitioner of the art of dermatological diagnosis recognizes the supreme value of diagnostic cues provided by defined patterns of 'efflorescences', few contemplate on the biological basis of pattern formation in and of skin lesions. Vice versa, developmental and theoretical biologists, who would be best prepared to study skin lesion patterns, are lamentably slow to discover this field as a uniquely instructive testing ground for probing theoretical concepts on pattern generation in the human system. As a result, we have at best scraped the surface of understanding the biological basis of pattern formation of skin lesions, and widely open questions dominate over definitive answer. As a symmetry-breaking force, pattern formation represents one of the most fundamental principles that nature enlists for system organization. Thus, the peculiar and often characteristic arrangements that skin lesions display provide a unique opportunity to reflect upon--and to experimentally dissect--the powerful organizing principles at the crossroads of developmental, skin and theoretical biology, genetics, and clinical dermatology that underlie these--increasingly less enigmatic--phenomena. The current 'Controversies' feature offers a range of different perspectives on how pattern formation of skin lesions can be approached. With this, we hope to encourage more systematic interdisciplinary research efforts geared at unraveling the many unsolved, yet utterly fascinating mysteries of dermatological pattern formation. In short: never a dull pattern!

An outbreak of multi-resistant Shigella sonnei in a long-stay geriatric nursing centre

An outbreak of Shigella sonnei infection in a long-stay nursing centre was detected during routine surveillance of notifications in July 1999. Subsequent investigations identified 13 cases of multi-resistant S. sonnei infection affecting nine staff, three community members associated with the centre and one resident of the centre. Each isolate of S. sonnei was genetically indistinguishable. The outbreak investigation identified contact with residents with vomiting and diarrhoea as a significant risk factor for infection amongst staff providing nursing care. This association, and the duration of the outbreak over several months, suggests that transmission was most likely person-to-person. This outbreak demonstrates the importance of infection control policies and hygiene measures in long-stay nursing facilities.

Cross-species amplification of soybean (Glycine max) simple sequence repeats (SSRs) within the genus and other legume genera: implications for the transferability of SSRs in plants

We investigated the transferability of 31 soybean (Glycine max) simple sequence repeat (SSR) loci to wild congeners and to other legume genera. Up to 65% of the soybean primer pairs amplified SSRs within Glycine, but frequently, the SSRs were short and interrupted compared with those of soybeans. Nevertheless, 85% of the loci were polymorphic within G. clandestina. Cross-species amplification outside of the genus was much lower (3%-13%), with polymorphism restricted to one primer pair, AG81. AG81 amplified loci in Glycine, Kennedia, and Vigna (Phaseoleae), Vicia (Vicieae), Trifolium (Trifolieae), and Lupinus (Genisteae) within the Papilionoideae, and in Albizia within the Mimosoideae. The primer conservation at AG81 may be explained by its apparent proximity to the seryl-tRNA synthetase gene. Interspecific differences in allele size at AG81 loci reflected repeat length variation within the SSR region and indels in the flanking region. Alleles of identical size with different underlying sequences (size homoplasy) were observed. Our findings and the emerging patterns in other plant studies suggest that in contrast to animals, successful cross-species amplification of SSRs in plants is largely restricted to congeners or closely related genera. Because mutations in both the SSR region and the flanking region contribute to variation in allele size among species, knowledge of DNA sequence is essential before SSR loci can be meaningfully used to address applied and evolutionary questions.

Hospitalization and mortality of diabetes in older adults. A 3-year prospective study

OBJECTIVE

In light of increased fatality from acute events and the increased frequency of chronic complications, life expectancy might well be shortened in older patients with diabetes. The current studies investigated factors affecting the likelihood of dying or being hospitalized in older patients with diabetes.

RESEARCH DESIGN AND METHODS

A total of 135 older patients with diabetes were followed for 3 years after predictive factors were evaluated and compared with a cohort of patients without diabetes.

RESULTS

Mortality was only 3,250 per 100,000 patient-years, similar to that for patients without diabetes, but the frequency of hospitalizations was more than twice as high in patients with diabetes. Five factors predicted hospitalization and death. Of these, the geriatric depression score was the best predictor of these poor outcomes.

CONCLUSIONS

Older patients with diabetes were hospitalized more often than those without diabetes, but mortality was similar. Dysphoria is a major predictor of poor outcomes in older patients with diabetes.

Effects of sexual intercourse on maximal aerobic power, oxygen pulse, and double product in male sedentary subjects

It is well known that athletes in the United States are told to abstain from sexual intercourse prior to athletic competition. The rationale for such a policy appears to be related to the hypothesis that sexual intercourse decreases the athletes' ability to perform efficiently and/or maximally. But the effect that sexual intercourse may have on exercise performance has not been examined widely. Very likely, the restrictions placed on athletes have little to do with the athletes' physiological ability to substain a particular exercise intensity and/or perform maximally. The purpose of this study was to determine the effects of sexual intercourse 12 hours prior to maximal treadmill exercise on aerobic power, oxygen pulse, and double product (i.e., an index of relative cardiac work). Eleven male subjects were tested on the treadmill with and without prior sexual intercourse. The results from the maximal exercise tests showed that aerobic power, oxygen pulse, and double product were not different. Therefore, the data suggest that it is justified to dismiss the point of view that sexual intercourse decreases maximal exercise performance.

The cardiovascular effects of high-dose butorphanol-nitrous oxide anaesthesia before and during operation

The cardiovascular effects of high doses of butorphanol (0.3-0.45 mg . kg-1) plus 60 per cent N2O anaesthesia were measured at unconsciousness, following tracheal intubation, and immediately before and at one and ten minutes after surgical stimulation in 17 A.S.A. class I and II patients undergoing elective gastric or gall bladder surgery. Butorphanol and N2O produced unconsciousness with only small decreases in heart rate and cardiac output but did not result in sufficient analgesia to block or treat stimulation of the cardiovascular system secondary to tracheal intubation or surgical incision, even when supplemented with additional butorphanol to high cumulative dose levels (1.0 mg . kg-1). The data suggest that even high dose butorphanol - N2O anaesthesia requires supplementation with other anaesthetics or anaesthetic adjuvants to prevent cardiovascular stimulation during general abdominal surgery.