Treatment of equine keratomycosis, part 1: selection of appropriate therapy based on clinical presentation and diagnostic testing improves clinical outcomes.

OBJECTIVE: To determine clinical outcome, treatment costs, and hospitalization duration in horses treated for keratomycosis and identify ophthalmic examination and diagnostic results associated with these outcomes. METHODS: This was a retrospective study of 126 equine keratomycosis cases between 2004 and 2020 with fungal infection confirmed on cytology, culture, and/or histopathology and a minimum of 1-month follow-up. Details of the ophthalmic examination, diagnostic test results, and treatment and cost outcomes were recorded. Outcomes of interest were analyzed by treatment type. The relationship of patient and diagnostic test variables to the outcomes of interest was determined via logistic and linear regression models. RESULTS: Globe retention and positive visual outcome occurred in 82.5% and 78.9% of medically and 88.4% and 85.5% of surgically treated cases, respectively. While not statistically significant, there were more positive clinical outcomes with surgery; in recent years, the globe and vision were preserved in 94.7% of cases following penetrating keratoplasty. The choice to pursue surgery was related to lesion depth. Medical treatment was associated with statistically shorter hospitalization times and lower total and hospitalization invoices compared to all surgical treatments. Diagnosis of stromal abscess was associated with higher total invoice and longer hospitalization times compared to ulcerative keratomycosis, although clinical outcomes were similar. CONCLUSIONS: Overall positive clinical outcomes were achieved despite the severity of the disease in many cases, highlighting the need for appropriate treatment selection based on clinical presentation. CLINICAL RELEVANCE: Expanding knowledge of clinical decision-making, treatment options, and associated clinical and financial outcomes may further improve outcomes for equine keratomycosis patients.

Conservative management of canine cleft palate can be a viable treatment option: 65 cases (2006-2023).

OBJECTIVE: To evaluate nonsurgical management outcomes of cleft palate (CP) in dogs and identify any association between cleft size, prevalence of clinical signs, and quality of life (QoL). METHODS: 65 dogs treated conservatively for CP from January 2006 through December 2023 were retrospectively identified. Diet, activity, medical history, and QoL were recorded for dogs that survived to the transition to solid food. Results were compared to those from 24 control dogs. Measurements of cleft area, width, and percentage of the hard palate occupied by the cleft were made with the use of calibrated photographs. Clefts were divided into 3 types: wide throughout, wide rostrally, and slit throughout. RESULTS: Sneezing was the most frequent clinical sign (43 of 65 over the past month, 34 of 65 when most affected). There was a greater frequency of material lodging in the cleft in the wide-throughout clefts (13 of 16 dogs) compared to the slit-throughout clefts (7 of 19 dogs). Veterinary removal of material was required in 10 of 68 episodes (7 of 31 dogs). There was no correlation between cleft size and prevalence of clinical signs or QoL. Sixty-three percent of dogs had a perfect QoL on a weighted scale, while 83.3% had a perfect score on a visual analog scale. Sixty-four of 65 owners would adopt another dog with a CP. CONCLUSIONS: Measures of QoL were favorable among dogs treated conservatively for CP. CLINICAL RELEVANCE: Conservative management appears to be a viable option for treatment of CPs in some dogs.

Treatment of equine keratomycosis, part 2: reporting common systemic and ocular complications to enhance decision-making for equine clinicians and owners.

OBJECTIVE: The primary aims were to provide descriptive data on systemic and ocular complications associated with the treatment of equine keratomycosis. The secondary aims were to determine if complication rates differ between treatment types or are related to surgical and anesthetic factors. METHODS: The study was a retrospective evaluation of 126 cases between 2004 and 2020 with confirmed fungal infection and recorded incidence of complications during hospitalization and surgical intervention if pursued. Additional information recorded included the size of the donor graft if utilized, time under general anesthesia, and prescribed medications. Fisher exact and χ2 tests were used to evaluate complication frequency differences. Logistic regression models determined the effects of donor graft size, anesthesia time, and duration of hospitalization on complication rates. RESULTS: Hypercreatininemia followed by colic were the most frequent systemic complications in the medical treatment group. Colic and conjunctival graft dehiscence were the most frequent systemic and ocular complications in all surgery treatment groups, respectively. The frequency of systemic complications did not vary between treatment groups, although colic rates were significantly higher following general anesthesia. All colic cases were resolved with supportive care. Donor graft size, anesthesia time, and duration of hospitalization did not impact complication frequency. The mainstays of medical therapy included topical fluoroquinolones, topical voriconazole, topical atropine, oral NSAIDS, and oral gastroprotectants. CONCLUSION: Treatment of keratomycosis is associated with a range of complications. Colic remains a significant risk, with increased frequency reported following general anesthesia. CLINICAL RELEVANCE: Reporting common complications associated with treatment aids in decision-making for equine clinicians and owners.

Expanding the invertebrate medicine toolbox: evaluation of opisthosoma tonometry as a novel diagnostic tool for arachnids.

OBJECTIVE: The objective of this study was to analyze the use of rebound tonometry, as a noninvasive diagnostic tool, in arachnids. METHODS: 5 juvenile (yearling) female and 1 juvenile male curlyhair tarantulas (Tliltocatl albopilosus, previously Brachypelma albopilosum) were used to track estimated ventral opisthosoma pressures over a 9-month period of time. Younger, growing animals were selected as they are more likely than adults to go through multiple molts throughout the 9 months of the study length. An iCare TONOVET TV01 rebound tonometer was used to measure the estimated ventral opisthosoma pressures of the spiders. Measurements were obtained from the ventral opisthosoma, 1 of the thinnest areas of exocuticle throughout the body. Readings were obtained once per week from the ventral opisthosoma for the first 2 months, then once every 2 weeks for 1 month, then back to once per week for the remainder of the study. Additional measurements were obtained following each ecdysis, after a 2% body weight sampling of hemolymph, and at the end of the study to evaluate readings in response to induction of general anesthesia with 5% isoflurane gas and oxygen flow at 2 L/min for 10 minutes. RESULTS: The average of all estimated ventral opisthosoma pressure when spiders were not in molt was 26.19 mm Hg (SD, 3.54), with a statistically significant decrease postmolt to an average of 15.31 mm Hg (SD, 3.81), followed by a gradual increase back to premolt pressures over a 3-week period with an average of 22 days (SD, 1.93). Estimated ventral opisthosoma pressures decreased post hemolymph removal. There is not sufficient evidence that estimated ventral opisthosoma pressures changed over time following the anesthesia. CLINICAL RELEVANCE: This study demonstrates that tonometry can be used to generally assess the estimated ventral opisthosoma pressure, which could correlate with where a spider is in an ecdysis cycle.

Exploring Demographic and Cognitive Predictors of Self-Management in Quasi-Randomized Fall Prevention Intervention for Older Adults With and Without Traumatic Brain Injury.

OBJECTIVE: Changes in health behavior are key to maintaining health, safety, and independence of older adults. The purpose of this study was to explore factors impacting training in self-management and behavior change in older adults with and without traumatic brain injury (TBI), informing efforts to improve safety and independent function. METHODS: Forty-one older adults, 19 with TBI, completed a self-regulation intervention (mental contrasting with implementation intentions; MCII) to promote fall prevention behavior change. Participant outcomes were related to single and recurring behavior changes; implementation outcomes were measured as modifications to treatment. RESULTS: Although participants with TBI performed more poorly on tests of neurocognitive function, there were no differences in behavior change rates following MCII, suggesting the treatment worked similarly for participants with and without TBI. Across both groups, those with higher executive function scores were more likely to complete recurring behavior changes. Participants with higher stress, higher Fall Risk Scores, or history of TBI were more likely to need modifications to treatment. CONCLUSIONS: This quasi-experimental pilot study describes cognitive and psychosocial predictors that may be critical for participation and success in health behavior change and self-management of fall prevention for older adults with and without TBI.

Ultrasound biomicroscopy in dogs suggests postoperative ocular hypertension may be associated with ciliary cleft changes related to cataract surgery.

OBJECTIVE: To determine whether novel pre- and postsurgical ultrasound biomicroscopy (UBM) measurements of the canine ciliary cleft (CC) are associated with postoperative ocular hypertension (POH) following cataract surgery and to explore the relationship between intraocular pressure and CC UBM measurements. METHODS: Following pharmacologic mydriasis, UBM images were obtained from 31 client-owned dogs before elective cataract surgery, immediately postsurgery, and 4 to 6 hours following surgery or while experiencing POH ≥ 25 mm Hg. Presurgery and the pre- to postsurgery change in CC measurements were assessed for association with POH using individual mixed-effects logistic regression models and forward variable selection models. Linear mixed-effects models were used to evaluate the relationship of intraocular pressure to UBM measurements within the same eye across multiple time points. RESULTS: Presurgical measurements were not predictive of POH development. An increase in pectinate ligament distance and CC area from presurgical baseline to immediate postsurgical measurement was associated with reduced odds of developing POH, while increasing CC length (from apex to mid point on the pectinate ligament) from pre- to postsurgery and immature cataracts was associated with increased odds of POH. CONCLUSIONs: The change in CC morphology following cataract surgery appears more impactful in the development of POH than individual variations in presurgery CC measurements. Several changes in the CC dimensions following surgery appear associated with POH risk. CLINICAL RELEVANCE: This understanding of a potential mechanism of POH development opens new avenues for researching preventative measures associated with modifying surgical techniques to influence CC morphology following cataract surgery.

Temperature has a greater effect than salinity on microbial survival in saltwater from a single equine hydrotherapy unit.

OBJECTIVE: To determine the ability of bacteria commonly isolated from equine limb wounds to survive in saltwater obtained from an equine hydrotherapy unit at different salinity concentrations and temperatures. METHODS: Saltwater samples were obtained over a 2-week period (January 22, 2024 to February 2, 2024) from an equine hydrotherapy unit used for clinical patients, kept at either full salinity per manufacturer recommendations or diluted to half salinity to mimic the dilution that likely occurs in the clinical setting between cases when holding tanks are replenished with tap water only. Samples were then autoclaved to eliminate preexisting bacterial contamination before individual inoculation with Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus zooepidemicus. Each inoculated sample was maintained at 2, 22, or 44 °C to represent typical holding tank conditions. The bacterial concentration was determined at each condition every 24 hours up to and including 96 hours. The lower limit of detection was set at 1 CFU/mL. RESULTS: Salinity did not affect bacterial survival. Bacterial concentrations generally decreased with increasing temperature over time. Escherichia coli, S aureus, and S zooepidemicus concentrations decreased to the lower limit of detection at 44 °C by 24 to 48 hours, while P aeruginosa concentrations significantly decreased over 24 hours but remained well above the lower limit of detection. CONCLUSIONS: Common bacterial isolates of equine limb wounds can survive in typical saltwater hydrotherapy conditions. CLINICAL RELEVANCE: Further investigation is warranted to determine the clinical relevance of these findings including protocols for hydrotherapy unit disinfection, wastage of treatment water, and case inclusion/exclusion criteria.

Particulate matter from wildfire smoke in northern Colorado appears to be associated with conjunctivitis in dogs.

OBJECTIVE: To evaluate ocular surface parameters in dogs with normal eyes when exposed to 3 different air quality index (AQI) categories corresponding to levels of normal air pollutants ("good," 0 to 50; "moderate," 51 to 100) and wildfire smoke ("smoke," 101 to 150). ANIMALS: 15 privately owned dogs. METHODS: A prospective cohort study with dogs living in northern Colorado. Ocular surface parameters (conjunctival chemosis and hyperemia, Schirmer tear test-1, tear film break-up time, fluorescein stain, conjunctival microbiology, etc) were evaluated when the AQI was reported in 1 of the 3 categories (good, moderate, and smoke) for 3 consecutive days. The AQI and air pollutant levels (particulate matter < 2.5 µm in diameter [PM2.5], ozone, etc) were retrieved from the AirNow database. RESULTS: Due to scheduling conflicts, only 7 dogs were examined during the smoke category. Average AQI in the 3 categories were good, 44.1; moderate, 73.7; and smoke, 103.7. The odds for more severe hyperemia and more severe chemosis for smoke were 5.39 and 7,853.02 times the odds, respectively, when compared to good AQI. Additionally, the odds for more severe chemosis were 34,656.62 times the odds for smoke when compared to moderate AQI. A significant relationship was found between chemosis and PM2.5. CONCLUSION: Exposure to increased AQI related to wildfire smoke caused a significant increase in conjunctivitis. The significant relationship between chemosis and PM2.5 could indicate that PM2.5 in wildfire smoke is associated with an inflammatory factor. CLINICAL RELEVANCE: Preventive measures (eg, use of eyewash, artificial tears, or eye protection) for dogs that are exposed to wildfire smoke should be instituted to decrease the risk of ocular irritation.

Ego Function Assessment and Internet Addiction.

This study examined the relationship between trauma, ego functioning, and internet addiction. We recruited 323 participants via Amazon Mechanical Turk, a crowdsourcing platform that can be used for survey research. We gave participants the Internet Addiction Test, the Life Events Checklist, the Ego Function Assessment questionnaire, and a demographic questionnaire. Our results indicate that 41.5% reported no internet addiction, with the majority of our sample reporting behaviors that were consistent with internet addiction: mild internet addiction = 37.8%, moderate internet addiction = 19.8%, and severe internet addiction = 0.9%. The constrictive factor of ego functioning was significantly worse in those with internet addiction. Path analysis showed that the constrictive factor of ego functioning partially mediated the relationship between a self-reported history of trauma and the presence of self-reported internet addiction.

Cancer Rehabilitation: Impact on Breast Cancer Survivors' Work Ability and Health-Related Quality of Life.

BACKGROUND: Breast cancer survivors (BCSs) report persistent, diminished ability to work, and decreased health-related quality of life (HRQoL). Cancer rehabilitation interventions (physical therapy or occupational therapy [PT/OT]) aim to improve these outcomes, but little is known about their impact in the community. METHODS: This retrospective, pre-post, uncontrolled study examined cases of younger BCSs (age <65 years) who attended cancer-specialized PT/OT over a 2-year period. Outcomes and covariates (age, race, US region, payer type, number of visits, length of care [weeks]) were extracted from electronic medical records. Patient-reported outcomes were overall-Work Ability Score (WASoverall), physical-WAS (WASphysical), and mental-WAS (WASmental) and PROMIS Global Physical Health (GPH), Global Mental Health (GMH), Physical Function (PF), and Ability to Participate in Social Roles and Activities (SRA). We used linear mixed effect models to examine pre- to post-rehabilitation change overall, and separately, while controlling for covariates. RESULTS: PT/OT cases (NPT=758; NOT=140) had a mean [SD] age of 51.39 [8.49] years and attended approximately 12 visits (IQR, 8.0-19.0) over 10.71 weeks (IQR, 6.14-17.00). Overall, work ability outcomes (WASoverall: +1.79; WASphysical: +0.78; WASmental: +0.47; all P<.001) and HRQoL outcomes improved significantly (GPH: +5.38; GMH: +2.90; PF: +5.17; SRA: +5.83; all P<.001), and average change on each HRQoL outcome exceeded the minimal important change (2 points). Outcome scores were similar at each timepoint for both PT and OT cases (all P>.05) and both groups improved significantly (all P<.01). CONCLUSIONS: In this large study of the impact of cancer-specialized, community-based PT and OT, younger BCSs reported significant improvement in ability to work and HRQoL. Although more research is needed, these findings suggest improved access to PT/OT could improve work ability and HRQoL for younger BCSs.

Cancer rehabilitation services for older women with breast cancer: Impact on health-related quality of life outcomes.

BACKGROUND: Older breast cancer survivors (BCS, age ≥ 65) are vulnerable to experiencing persistent symptoms and associated declines in health-related quality of life (HRQOL). In research trials, cancer rehabilitation interventions (physical or occupational therapy, PT/OT) have been shown to enhance HRQOL, but the impact of community-based PT/OT services for older BCS is unknown. We performed a retrospective, observational study to better understand the impact of PT/OT services on the HRQOL of older BCS. METHODS: Outcomes and covariates were extracted from the outpatient rehabilitation medical record. HRQOL outcomes included: PROMIS® global physical health (GPH), global mental health (GMH), physical function (PF), and ability to participate in social roles and activities (SRA). Linear mixed-effect models were used to examine change in HRQOL outcomes and explore the influence of patient age and service type (PT/OT). ICD-10 codes were examined and compared between service types to describe the impairments treated. RESULTS: PT/OT cases (N = 694) were 71.79 ± 5.44 years old and participated in a median of 11 visits (IQR: 7.0-17.25) over 9.71 weeks (IQR: 6.29-15.29). Most (84.4%) attended PT (n = 579; 84%) versus OT (n = 115; 16%). Overall, significant improvement was observed in each HRQOL outcome (GPH: +3.00, p < 0.001; GMH: +1.80, p < 0.001; PF: +1.97, p < 0.001; SRA: +2.34, p < 0.001). Service type influenced only GPH (p = 0.041); mean improvement was +3.24 (SE: 0.290, p < 0.001) for PT cases and + 1.78 for OT cases (SE: 0.651, p = 0.007). PT cases commonly received treatment for weakness/atrophy, pain, walking, and posture; OT cases commonly received treatment for lymphedema and scarring/fibrosis. No age effects were observed. CONCLUSIONS: In this large study of older BCS who participated in community-based PT/OT services across the United States, we observed significant improvements in HRQOL outcomes that are important to older BCS and their providers. Although more research is needed, these findings suggest that improved access to PT/OT could help address unmet HRQOL needs among this population.

Opinions regarding equine veterinarian attire and attributes: results of a horse owner survey.

OBJECTIVE: To investigate potential equine clients' perceptions of equine veterinarians based on attire. SAMPLE: 763 horse owners/lessees. METHODS: Participants were invited to complete a survey shared mainly via equestrian social media pages between August and October 2022.1-3 Survey participants were shown pictures of a male veterinarian and a female veterinarian in 7 outfits ranging from casual to business attire and were asked to score the veterinarian on 7 traits: easygoing attitude, friendliness, compassion, trustworthiness, professionalism, competence, and cost of services. The survey asked which of the traits were most valued in an equine veterinarian, as well as whether various aspects of appearance including tattoos, piercings, and hair dyed a nonorganic color were acceptable for equine veterinarians. RESULTS: Of the 2,655 individuals who opened the survey, 763 responses were included. Respondents were predominantly female (743/763 [97.4%]) from rural areas (493/763 [64.6%]). Only 37.1% (283/763) of respondents agreed that what a veterinarian wears influences their confidence in them. The highest-ranked traits in an equine veterinarian were knowledge/competency (mean ± SD, 1.46 ± 0.98), followed by trustworthiness (2.34 ± 1.08) and compassion (3.50 ± 1.20), with coveralls and scrubs being the preferred attire clients associated with these attributes (with the exception of compassion, for which polo shirt/jeans was the preferred attire). T-shirt/jeans was consistently ranked lowest by respondents in association with these attributes, except in the area of compassion, where polo shirt/black pants was ranked lowest. CLINICAL RELEVANCE: Our findings suggested the attire and appearance of equine veterinarians can impact client perceptions, with veterinarians wearing scrubs and coveralls associated with higher competency and trustworthiness.

Involvement of veterinary students in the placement of intravenous catheters in adult horses in a teaching hospital does not significantly increase the rate of catheter complications.

OBJECTIVE: To determine whether student involvement in intravenous catheter (IVC) placement increases the risk for complications and to report the rate and types of complications associated with IVCs in adult horses in a university teaching hospital. ANIMALS: 455 IVCs placed in 394 horses. METHODS: Data relevant to IVC placement and removal were retrieved from an electronic medical record search including records of adult horses from January 1 to December 31, 2022. Data retrieved from records included the role of the individual who prepared the site and placed the IVC, site of IVC placement, and type of IVC. The reason for removal of the IVC and presence or absence of detectable changes within the vein at the time of removal were documented in addition to clinical data, allowing for classification of each case. Data were reviewed retrospectively, and statistical analyses were performed using mixed-effects logistic regression models. Significance was set at P ≤ .05. RESULTS: The overall rate of complications was 15.6%, and the most common type of complication was swelling of the vein. Students were involved in 87 of 455 IVC site preparations and placements, and there were no statistically significant differences in complication rates between IVC sites prepared or placed by veterinary students versus nonstudent personnel. CLINICAL RELEVANCE: Veterinary personnel and clients may be hesitant to allow student involvement in IVC placement in horses, but these data suggest that student involvement does not increase the risk of IVC complications.

Identifying delay in glymphatic clearance of labeled protons post-acute head trauma utilizing 3D ASL MRI (arterial spin labeling): a pilot study.

This study correlated mild traumatic brain injury (mTBI) cognitive changes with ASL-MRI glymphatic clearance rates (GCRs) and recovery with GCR improvement. mTBI disrupts the blood brain barrier (BBB), reducing capillary mean transit time and GCRs. mTBI is clinically diagnosed utilizing history/examination findings with no physiologic biomarkers. 3D TGSE (turbo-gradient spin-echo) pulsed arterial spin-labeling 3T MRI with 7 long inversion times (TIs) assessed the signal clearance of labeled protons 2800-4000 ms postlabeling in bifrontal, bitemporal, and biparietal regions within 7 days of mTBI and once clinically cleared to resume activities. The Sport Concussion Assessment Tool Version 5 (SKAT5) and Brief Oculomotor/Vestibular Assessment evaluated injured athletes' cognitive function prior to MRIs. The pilot study demonstrated significant GCRs improvement (95% CI - 0.06 to - 0.03 acute phase; to CI-recovery CI 0.0772 to - 0.0497; P < 0.001 in frontal lobes; and parietal lobes (95% CI - 0.0584 to - 0.0251 acute; CI - 0.0727 to - 0.0392 recovery; P = 0.024) in 9 mTBI athletes (8 female, 1 male). Six age/activity-matched controls (4 females, 2 males) were also compared. mTBI disrupts the BBB, reducing GCR measured using the 3D ASL MRI technique. ASL MRI is a potential noninvasive biomarker of mTBI and subsequent recovery.

Persistent long-term habitat use by Florida manatees at Fort Pierce, Florida from 1997 to 2020.

To survive cold winters, Florida manatees (Trichechus manatus latirostris) depend on artificial (i.e., power plants) and natural warm water sources such as springs and passive thermal basins. Passive thermal basins can provide critical habitat for manatees for short or extended periods of time. The Henry D. King Powerplant in Fort Pierce, Florida discharged warm water into Moore's Creek until it went offline in 1995. However, it is unknown to what degree manatees continue to occupy this area and how environmental factors influence their occurrence in the creek. To explore this, we examined the habitat use of Florida manatees in Moore's Creek after the shutdown from November 1997 to March 2020 from daily counts of manatees. In addition, we correlated local environmental data (ambient air, temperature, salinity) to assess if Moore's Creek had properties indicative of a passive thermal basin. Results indicated there was not an increase or decrease in habitat use over twenty years in the Creek. The consistent use of Moore's Creek over the study period suggests that this habitat possesses thermal and freshwater resources to support manatee occurrence long-term. These findings provide robust support for the importance of this habitat and passive thermal basins for Florida manatees.

Error reporting in a large animal veterinary teaching hospital identifies medication errors occur most often in the prescribing phase of therapy.

OBJECTIVE: To identify the rate at which medication errors occurred over a 2-year period in a large animal veterinary teaching hospital and describe the types of errors that occurred. SAMPLE: 226 medication errors over 6,155 large animal visits occurred during the study period. Multiple errors may have affected the same patient. METHODS: Medication error reports from March 1, 2021, to March 31, 2023, were reviewed retrospectively and classified by species, type of drug, and month and day of the week the error occurred. Errors were categorized according to multiple previously developed systems to allow for comparison to other studies. RESULTS: 226 medication errors occurred over 6,155 patient visits in a 2-year period: 57.5% (130/226) were identified by a dedicated large animal pharmacist, and 64.2% (145/226) of errors were identified and corrected before reaching the patient. Prescription/medication order errors (58.4% [132/226]) occurred significantly more often than errors in medication preparation (21.7% [49/226]; P < .001) and administration (19.6%; P < .001). Antibiotics (48.7% [110/226]) and NSAIDs (17.7% [40/226]) were the drug classes most involved in errors. CLINICAL RELEVANCE: Most medication errors in this study occurred in the ordering/prescribing phase. This is similar to reports in human medicine, where standardized medication error reporting strategies exist. Developing and applying similar strategies in veterinary medicine may improve patient safety and outcome.

A systems approach using Diversity Outbred mice distinguishes the cardiovascular effects and genetics of circulating GDF11 from those of its homolog, myostatin.

Growth differentiation factor 11 (GDF11) is a member of the TGF-ß protein family that has been implicated in the development of cardiac hypertrophy. While some studies have suggested that systemic GDF11 protects against cardiomyocyte enlargement and left ventricular wall thickening, there remains uncertainty about the true impact of GDF11 and whether its purported effects are actually attributable to its homolog myostatin. This study was conducted to resolve the statistical and genetic relationships among GDF11, myostatin, and cardiac hypertrophy in a mouse model of human genetics, the Diversity Outbred (DO) stock. In the DO population, serum GDF11 concentrations positively correlated with cardiomyocyte cross-sectional area, while circulating myostatin levels were negatively correlated with body weight, heart weight, and left ventricular wall thickness and mass. Genetic analyses revealed that serum GDF11 concentrations are modestly heritable (0.23) and identified a suggestive peak on murine chromosome 3 in close proximity to the gene Hey1, a transcriptional repressor. Bioinformatic analyses located putative binding sites for the HEY1 protein upstream of the Gdf11 gene in the mouse and human genomes. In contrast, serum myostatin concentrations were more heritable (0.57) than GDF11 concentrations, and mapping identified a significant locus near the gene FoxO1, which has binding motifs within the promoter regions of human and mouse myostatin genes. Together, these findings more precisely define the independent cardiovascular effects of GDF11 and myostatin, as well as their distinct regulatory pathways. Hey1 is a compelling candidate for the regulation of GDF11 and will be further evaluated in future studies.

Assessing health disparities in foods and beverages served in early care and education programs across Georgia.

BACKGROUND: Obesity disproportionately impacts children who are Black and Hispanic, those who live in rural communities and those who have low income. Predisposition to obesity early in life is profoundly impacted by feeding habits during the preschool years. The early care and education (ECE) setting impacts children's health by providing daily meals. OBJECTIVE: The goal of this study was to identify whether or not health disparities in foods and beverages served in ECE programs in Georgia exist based on socioeconomic, demographic and geographic variables. METHODS: A random sample was drawn from 3054 ECE programs across the state of Georgia. The likelihood of serving specific foods and beverages in ECE programs in the previous day was measured. Percentages and frequencies, logistic regressions, Spearman's rho and Odds ratio tests determined outcomes. RESULTS: A total of 974 surveys were returned. Data were stratified based on the income level of the participant families, race of enrolled children and geographic location of the ECE program. Disparities existed between programs based on race of enrolled children and geographic location. For example, although the odds of providing sweets increased by 0.6% as the percentage of Black children enrolled increased, the provision of healthier foods, such as the odds of providing fruits (P = .001), vegetables (P = .001) and protein (P = .001) also increased. However, after results were adjusted for covariates findings did not remain significant. CONCLUSIONS: Future research focused on evaluating the foods and beverages provided in ECE programs and the relationship of how income, race and location are related may provide further understanding about the disproportionate childhood obesity rates in America.

Fecal Lactoferrin Predicts Primary Nonresponse to Biologic Agents in Inflammatory Bowel Disease.

INTRODUCTION: Fecal lactoferrin (FL) is a timely and accurate marker of inflammation in ulcerative colitis (UC) and Crohn's disease (CD). The aim of this study was to verify whether FL can predict primary nonresponse (PNR) to biologic agents during induction. METHODS: Retrospective outcome review in 27 patients (13 with CD and 14 with UC) tested for baseline FL and retested within a week after the first and second induction doses. Clinical/biochemical outcomes were evaluated at end of induction and at follow-up (3-24 months). RESULTS: Compared to baseline, changes of the Harvey-Bradshaw (CD) and Partial Mayo Scoring (UC) indices at end of induction separated responders (18/27 or 67%) from nonresponders (9/17 or 33%). In all patients, the initial FL value at induction decreased compared to baseline, continuing to decrease after the following dose in clinical responders while bouncing back in the others. Models targeting the 2 consecutively decreased FL values or the second FL value compared to baseline or the second FL value compared to the first were able to accurately predict response at end of induction. Follow-up assessment confirmed clinical remission in initial responders (with FL values reduced on the average by 94 ± 10% compared to baseline). CONCLUSIONS: In CD and UC patients during induction with biologic agents, early FL measurements accurately separate clinical responders from those experiencing PNR. The method described here offers several potential advantages over other strategies to assess and manage these patients.

Beverage Policy Implementation by Child and Adult Care Food Program Participation and Program Type: A Statewide Examination in Georgia.

BACKGROUND: The child care setting is a promising venue to establish healthy habits and promote obesity prevention. One major contributor to weight gain among young children is high intake of sugar-sweetened beverages (SSBs). Increasing access to water and other healthy beverages is a viable strategy to reduce childhood obesity. The goal of our study was to investigate implementation of the beverage policies in child care programs in Georgia (GA) by Child and Adult Care Food Program (CACFP) participation and program type. METHODS: The study employed a cross-sectional design. A statewide survey was conducted using the GA Child Care Wellness Survey. A random sample of 3054 child care programs was obtained. Programs were stratified by six state regions to acquire a representative sample. RESULTS: A total of 974 surveys were returned. Sixty-seven percent of the respondents were enrolled in CACFP. Programs participating in CACFP (96%) were less likely to serve SSBs (x2(2) = 15.309, p < 0.001), than non-CACFP programs (90%). CACFP programs were more likely to serve low-fat or fat-free milk to 2-5-year olds than non-CACFP programs (87% vs. 35%, p < 0.001). Family child care homes were significantly more likely to comply with serving only whole milk to 1 year olds (66%; p < 0.001) than other program types. All program types had low compliance with implementing water policies. CONCLUSIONS: Study outcomes provide vital information on the implementation of beverage policies that can inform beverage policy training, with the ultimate goal of reducing obesity risk and promoting healthier diets among preschool children in GA.