Frequency of non-generalized tonic clonic seizures in a referral population of dogs.

Absence seizures are a type of generalized onset seizure associated in humans with brief activity interruptions, unresponsiveness and staring. Absence seizures are infrequently reported in veterinary patients, visually indistinguishable from focal seizures, and so may be grouped as non-generalized tonic clonic seizures (non-GTCS). The objective of this retrospective study was to provide a preliminary understanding of the frequency of non-GTCS in dogs and estimate its prevalence by evaluating the distribution of seizure types presented to a referral hospital over 4 years (May 2017-April 2021), as determined from the medical record history and electroencephalography (EEG) diagnostic testing where available. A total of 528 cases were included via a medical record search for dogs with epilepsy and/or seizures presented to the neurology or emergency services. Cases were categorized into seizure types based on reported clinical signs. Each year, 53-63 % of seizure cases were described as generalized tonic clonic seizures (GTCS), 9-15 % GTCS with additional events and 29-35 % suspected non-GTCS. EEG confirmed absence seizures in 12 of 44 EEGs, 5 cases having a history of GTCS and seven without prior GTCS. This preliminary study suggests that non-GTCS may be relatively common as one third of seizure cases in the referral population presented with non-GTCS clinical signs. Prospective studies using EEG are merited to definitively determine the prevalence of these different seizure types in dogs. Acknowledging the impact of these seizures will improve awareness, aiding veterinarians in their recognition, diagnosis and potential treatment options.

Restoration of anticoccidial sensitivity to a commercial broiler chicken facility in Canada.

Increasing resistance of Eimeria species to anticoccidial medications is an issue in the broiler chicken industry. Using drug-sensitive strains in live-coccidiosis vaccines has been shown to improve anticoccidial effectiveness in US-based broiler production. In Canada, litter is removed between flocks, which differ from the US industry practice. Thus, we investigated the use of drug-sensitive vaccine strains in a Canadian broiler production facility with suspected anticoccidial resistance. Weekly fecal samples were collected from flocks before, during, and after vaccine seeding to determine oocyst shedding patterns; following the vaccine seeding, OPG counts from similar aged birds were lower than flocks before live-coccidiosis vaccine use. Eimeria species isolates, collected before and after vaccine seeding, were used in 2 anticoccidial sensitivity tests to evaluate their susceptibility to commercially available anticoccidial medications; a low-dose challenge to define parasite replication, and a high-dose challenge to monitor broiler performance. In both experiments, isolates collected after seeding were more susceptible to almost every anticoccidial medication evaluated compared with the isolates collected before seeding. These results demonstrate an improvement in sensitivity to many anticoccidials after the use of live-coccidiosis vaccines at this facility. However, the regulated removal of litter at the end of each flock required under Canadian broiler chicken production management rules could limit the establishment of vaccine-strain Eimeria species in broiler facilities and could shorten the longevity of improved drug sensitivity observed in this study.

Comparison of calculation methods used for the determination of anthelmintic resistance in sheep in a temperate continental climate.

This study compared results obtained with five different fecal egg count reduction (FECR) calculation methods for defining resistance to ivermectin, fenbendazole, and levamisole in gastrointestinal nematodes of sheep in a temperate continental climate: FECR1 and FECR2 used pre-and posttreatment fecal egg count (FEC) means from both treated and control animals, but FECR1 used arithmetic means, whereas FECR2 used geometric means; FECR3 used arithmetic means for pre- and posttreatment FECs from treated animals only; FECR4 was calculated using only arithmetic means for posttreatment FECs from treated and control animals; and FECR5 was calculated using mean FEC estimates from a general linear mixed model. The classification of farm anthelmintic resistance (AR) status varied, depending on which FECR calculation method was used and whether a bias correction term (BCT, i.e., half the minimum detection limit) was added to the zeroes or not. Overall, agreement between all methods was higher when a BCT was used, particularly when levels of resistance were low. FECR4 showed the highest agreement with all the other FECR methods. We therefore recommend that small ruminant clinicians use the FECR4 formula with a BCT for AR determination, as this would reduce the cost of the FECRT, while still minimizing bias and allowing for comparisons between different farms. For researchers, we recommend the use of FECR1 or FECR2, as the inclusion of both pre- and posttreatment FECs and use of randomly allocated animals in treatment and control groups makes these methods mathematically more likely to estimate the true anthelmintic efficacy.

Comparison of calculation methods used for the determination of anthelmintic resistance in sheep in a temperate continental climate.

This study compared results obtained with five different fecal egg count reduction (FECR) calculation methods for defining resistance to ivermectin, fenbendazole, and levamisole in gastrointestinal nematodes of sheep in a temperate continental climate: FECR1 and FECR2 used pre- and posttreatment fecal egg count (FEC) means from both treated and control animals, but FECR1 used arithmetic means, whereas FECR2 used geometric means; FECR3 used arithmetic means for pre- and posttreatment FECs from treated animals only; FECR4 was calculated using only arithmetic means for posttreatment FECs from treated and control animals; and FECR5 was calculated using mean FEC estimates from a general linear mixed model. The classification of farm anthelmintic resistance (AR) status varied, depending on which FECR calculation method was used and whether a bias correction term (BCT, i.e., half the minimum detection limit) was added to the zeroes or not. Overall, agreement between all methods was higher when a BCT was used, particularly when levels of resistance were low. FECR4 showed the highest agreement with all the other FECR methods. We therefore recommend that small ruminant clinicians use the FECR4 formula with a BCT for AR determination, as this would reduce the cost of the FECRT, while still minimizing bias and allowing for comparisons between different farms. For researchers, we recommend the use of FECR1 or FECR2, as the inclusion of both pre- and posttreatment FECs and use of randomly allocated animals in treatment and control groups makes these methods mathematically more likely to estimate the true anthelmintic efficacy.

The use of a tongue tie alters laryngohyoid position in the standing horse.

REASONS FOR PERFORMING STUDY: The use of tongue ties in racing is common, yet there are few data to support their efficacy. In order to make appropriate recommendations for clinical practice and policy on tongue ties, data documenting their effect on upper airway structure are necessary. OBJECTIVES: To determine the effect of a tongue tie on the resting laryngohyoid position of the standing horse. STUDY DESIGN: Experimental study. METHODS: Twelve normal Standardbred horses were subjected to ultrasonographic measures of laryngohyoid position during 3 phases of tack application: Phase I--halter and lead; Phase II--bit, bridle, harness and check applied; and Phase III--as in Phase II but with the tongue tie added. RESULTS: Compared to Phase I, during Phase III with the application of a tongue tie a significant difference between lingual process position was noted both rostrally and caudally (P<0.001 and P<0.001), such that the tongue tie resulted in an increase in lingual process depth. The tongue tie in Phase III resulted in a decrease in depth of the thyroid cartilage and basihyoid bone compared to the Phase I location (P = 0.007 and P = 0.0047). CONCLUSION: The use of a tongue tie has a significant effect on the basihyoid and thyroid cartilage positions in the standing horse. POTENTIAL RELEVANCE: This is the first report documenting a difference in laryngohyoid morphology following the application of a tongue tie, providing evidence that the use of a tongue tie has a measurable effect on upper airway structure. The functional implications of this finding are yet to be elucidated.

Technical note: comparison of 3 methods for analyzing areas under the curve for glucose and nonesterified fatty acids concentrations following epinephrine challenge in dairy cows.

The objective of the study was to compare 3 methods for calculating the area under the curve (AUC) for plasma glucose and nonesterified fatty acids (NEFA) after an intravenous epinephrine (EPI) challenge in dairy cows. Cows were assigned to 1 of 6 dietary niacin treatments in a completely randomized 6 × 6 Latin square with an extra period to measure carryover effects. Periods consisted of a 7-d (d 1 to 7) adaptation period followed by a 7-d (d 8 to 14) measurement period. On d 12, cows received an i.v. infusion of EPI (1.4 µg/kg of BW). Blood was sampled at -45, -30, -20, -10, and -5 min before EPI infusion and 2.5, 5, 10, 15, 20, 30, 45, 60, 90, and 120 min after. The AUC was calculated by incremental area, positive incremental area, and total area using the trapezoidal rule. The 3 methods resulted in different statistical inferences. When comparing the 3 methods for NEFA and glucose response, no significant differences among treatments and no interactions between treatment and AUC method were observed. For glucose and NEFA response, the method was statistically significant. Our results suggest that the positive incremental method and the total area method gave similar results and interpretation but differed from the incremental area method. Furthermore, the 3 methods evaluated can lead to different results and statistical inferences for glucose and NEFA AUC after an EPI challenge.

Quantitative morphology of the equine laminar junction in relation to capsule shape in the forehoof of Standardbreds and Thoroughbreds.

REASONS FOR PERFORMING STUDY: Differences in hoof morphology have largely been underappreciated in the literature until recently, and it is these that hold the key to interpreting functional adaptation in the hoof. HYPOTHESES: Primary laminar morphology correlates with hoof capsule shape; and breeds with different hoof shapes and loadings show different patterns of correlation. METHODS: Seventeen measurements of capsule shape and 3 of primary epidermal laminae (PEL) morphology (spacing, orientation and curvature) were made on right and left front hooves from 27 Standardbred and 25 Thoroughbred horses, and tested for breed differences. Three laminar variables (spacing, orientation and curvature) were measured on each hoof for samples of 25 PEL in 5 circumferential and 4 proximodistal locations. Pairwise correlations of capsular and laminar measurements were compared within breeds. Significant correlations were mapped onto the 20 sampling sites. RESULTS: Capsule shape differed significantly between breeds in 7 measurements and in a multivariate test. Between breeds, PEL differed in orientation and spacing primarily at the medial quarters and heels, and in curvature at both quarters (P<0.05). Significant correlations between several pairs of capsule and laminar variables were found at sample locations that differed markedly between breeds. CONCLUSIONS: Laminar morphology, hoof capsule shape and correlations between them differ between Standardbreds and Thoroughbreds. These results support the concept that remodelling of PEL is, at least in part, stimulated and directed by varying stress or strain levels in the laminar junction. POTENTIAL RELEVANCE: Understanding the biological responses of hoof tissues to stress should add to the ability to prevent lameness involving the hoof and maintain its health.

Evaluation of the Dairy Comp 305 module "Cow Value" in two Ontario dairy herds.

The study was conducted to evaluate how the "Cow Value" module of Dairy Comp 305 (Valley Agricultural Software, Tulare, CA) performed under commercial conditions. The "Cow Value" module, COWVAL, computes a farm-specific net present value relative to an average replacement heifer for each cow in the milking and dry herd, which allows a ranking of the cows on the farm compared with replacing her with a typical replacement heifer on that farm. The average replacement heifer is used as the baseline for comparison and has a COWVAL of $0. Retaining a cow with a negative COWVAL is projected to be less profitable than replacing that cow with a new heifer. The objectives of the study were to explore trends in COWVAL over and during multiple lactations for the same cows; to describe factors that influence changes in COWVAL from one monthly Dairy Herd Improvement test to the next; and to evaluate the behavior of COWVAL after it drops below a baseline of $0 during the lifetime of a cow. Monthly Dairy Comp 305 backup cow files from 2 On-tario dairy herds between December 1999 and Decem-ber 2005 were used to generate COWVAL and list production, reproduction, and disease data for the milking cows. In total, 1,463 cows and 20,071 tests were analyzed. Within the first 60 d in milk (DIM), COWVAL was unstable and showed large fluctuations over a range of several thousand Canadian dollars (Can$). After 60 DIM COWVAL was relatively stable. The variability from month to month became less as the lactation progressed and the risk of a change in reproductive status decreased. The reproductive status of the cow influ-enced COWVAL: fresh, open, and pregnant cows had a greater COWVAL than cows declared "do not breed." As parity increased, there was a tendency toward lower COWVAL and smaller monthly changes in COWVAL. The COWVAL of 170 cows dropped below the baseline of $0 after 60 DIM. The COWVAL of 54% of those cows remained below $0, whereas 31.6% had a subsequent COWVAL > $500 (Can$). Farm management should not rely exclusively on COWVAL for culling decisions, particularly for cows that have not had at least 3 milk tests.

The effect of lead poisoning on hematologic and biochemical values in trumpeter swans and Canada geese.

BACKGROUND: Lead is a persistent contaminant in the environment, and waterfowl are susceptible to lead toxicity from ingestion of lead pellets and fishing weights. Lead affects numerous physiologic processes through inhibition of enzyme activity and protein function, but its effects on commonly assessed avian blood values are incompletely understood. OBJECTIVES: Our aim was to evaluate hematologic and biochemical changes associated with blood lead concentrations in trumpeter swans and Canada geese. METHODS: Data for CBCs, plasma biochemical profiles (total protein, albumin, glucose, cholesterol, total bilirubin, calcium, phosphorus, gamma-glutamyltransferase [GGT], aspartate aminotransferase, lactate dehydrogenase, glutamate dehydrogenase, creatine kinase, amylase, and lipase), and whole blood lead concentrations were retrospectively analyzed for 69 trumpeter swans and 52 Canada geese. Laboratory data obtained prospectively from an additional 20 trumpeter swans also were included. RBC morphology was semiquantitated in blood smears from 70 of the birds. Data were analyzed initially by ANOVA and covariance. A statistical model then was constructed to determine the relationship between each parameter and lead concentration. RESULTS: In both avian species, PCV, hemoglobin concentration, and MCHC decreased significantly (P < .05) with increasing blood lead concentration. Uric acid concentration and GGT activity were increased in trumpeter swans and phosphorus concentration was decreased in Canada geese in association with high blood lead concentration (P < .05). CONCLUSIONS: Lead toxicosis induced significant changes in the values of commonly measured hematologic parameters in waterfowl. These changes may be useful indicators of severe lead intoxication during routine laboratory assessment. Changes in clinical chemistry values, although statistically significant, were too inconsistent to serve as indicators of lead toxicosis.

The effect of glucocorticoids on canine lymphocyte marker expression and apoptosis.

BACKGROUND: Glucocorticoids are commonly administered to dogs for the treatment of inflammatory disorders, autoimmunity and cancers such as lymphoma. Despite evidence of clinical efficacy, understanding of the effects of glucocorticoids on cells of the canine immune system is limited. HYPOTHESIS: Glucocorticoids affect the expression of phenotypic markers on canine lymphocytes and induce apoptosis. ANIMALS: Fifteen healthy mixed breed dogs. METHODS: Prospective randomized study. Prednisone was administered orally for 3 days, and cells aspirated from the popliteal lymph node before prednisone administration, and on days 1, 3, 10, 17, 24, and 38, were labeled with antibodies against canine CD3, CD4, CD8alpha, CD18, CD21, CD45, CD45RA, and CD90 molecules, and analyzed by flow cytometry. Additional samples were cultured in media with prednisolone for 24 hours and analyzed by cytometry for marker expression, and by gel electrophoresis for DNA fragmentation. RESULTS: Treatment of dogs with glucocorticoids resulted in reduced (p < or = .05) proportions of CD3 (days 1, 3, 17, and 24), CD4 (days 3 and 10), CD21 (day 1, 3, and 38), CD45RA (day 17) and CD90 (days 1, 10, and 17) expressing lymphocytes, and reduced intensity of CD18 (day 17) and CD45 (day 17 and 24) molecules on nodal lymphocytes. Culture oflymphocytes with prednisolone for 24 hours caused a significant reduction in the expression of all markers (p < or = .05) and DNA fragmentation. CONCLUSIONS AND CLINICAL IMPORTANCE: Glucocorticoids significantly alter the expression of phenotypic markers on canine lymphocytes, and in vitro induce apoptosis. These findings identify potential mechanisms for clinical immunosuppression from glucocorticoid treatment.

Reticulocyte changes after experimental anemia and erythropoietin treatment of horses.

Availability of recombinant human erythropoietin (EPO) has facilitated use to enhance red blood cell production, and therefore aerobic performance, in human and equine athletes. Recombinant human EPO promotes growth and differentiation of equine erythroid precursor cells, but in some horses repeat administration induces immune interference with endogenous EPO resulting in fatal anemia. Although blood reticulocyte parameters acquire unique changes in humans treated with EPO, with manual enumeration methods, horses were not considered to release reticulocytes from the bone marrow into circulation, even under severe erythropoietic stress. The goals of this study were to determine whether reticulocytes could be detected and characterized in horses that are anemic or have been treated with EPO using a modern hematology analyzer. Anemia was induced in six horses by removal of 30 ml of blood/kg of body wt over 24 h. After 28 days, the horses were treated twice with 55 U/kg of EPO (Eprex), and after 65 days they were treated thrice with 73 U/kg of EPO. Blood samples were analyzed with the ADVIA120 instrument every 3-5 days and bone marrow samples 7 days after anemia and EPO treatments. Analysis of blood reticulocyte parameters by ANOVA in a randomized complete block design determined that anemia and EPO induced significant (P < or = 0.05) increases in red cell distribution width and reticulocyte mean cell volume. Parameters changed only after EPO treatment were cellular hemoglobin concentration mean, mean cell volume, reticulocyte concentration, proportion of macrocytic reticulocytes, and reticulocyte cellular hemoglobin. These findings indicate that horses under erythropoietic stress and after EPO treatment release reticulocytes with unique characteristics into circulation.

Components of variation of surface hoof strain with time.

The relative contribution of a number of random and fixed variables to variation in surface strain magnitudes on the hoof capsule was assessed for healthy feet under normal conditions. Principal strains were recorded in vivo from 5 rosette gauges glued around the circumference of the right forefeet of 4 horses on 4 occasions over a 9 month period. Recordings were made at every other trimming and reshoeing. During each session, gauges were positioned with a template for repeatability. Strains were recorded at the trot and canter (at consistent speeds), for straight motion and turns, and before and after the hoof was trimmed and reset. Up to 30 strides were recorded for each combination of these variables. ANOVAs were performed on midstance strains of 7008 strides to determine the relative contributions to strain variation of individual horse, test day, gait and direction combined as one factor, gauge position on the hoof, trimming, interstride variability and the interactions among these factors. The ANOVA model explained 87% of the variation, of which approximately 84% was due to fixed effects and 16% to random effects. Circumferential position of the gauges and several of the interactions including this term were by far the greatest contributors to strain variation. Differences among gauge positions, individuals and gait + direction are consistent with previous work. This study has added the relative effects, which are small but significant, of trimming on a regular basis and of time. The change in strain magnitudes with trimming was different for each horse, which leads to the possibility that over- and underuse may have to be quantified on an individual basis.

Evaluation of accuracy and reliability of indirect calorimetry for the measurement of resting energy expenditure in healthy dogs.

OBJECTIVE: To assess accuracy and reliability of open-flow indirect calorimetry in dogs. ANIMALS: 13 clinically normal dogs. PROCEDURE: In phase 1, oxygen consumption per kilogram of body weight (VO2/kg) was determined in 6 anesthetized dogs by use of open-flow indirect calorimetry before and after determination of VO2/kg by use of closed-circuit spirometry. In phase 2, four serial measurements of VO2 and carbon dioxide production (VCO2) were obtained in 7 awake dogs by use of indirect calorimetry on 2 consecutive days. Resting energy expenditure (REE) was calculated. RESULTS: Level of clinical agreement was acceptable between results of indirect calorimetry and spirometry. Mean VO2/kg determined by use of calorimetry before spirometry was significantly greater than that obtained after spirometry. In phase 2, intraclass correlation coefficients (ICC) for REE and VO2 were 0.779 and 0.786, respectively, when data from all 4 series were combined. When the first series was discounted, ICC increased to 0.904 and 0.894 for REE and VO2, respectively. The most reliable and least variable measures of REE and VO2 were obtained when the first 2 series were discounted. CONCLUSIONS AND CLINICAL RELEVANCE: Open-flow indirect calorimetry may be used clinically to obtain a measure of VO2 and an estimate of REE in dogs. Serial measurements of REE and VO2 in clinically normal dogs are reliable, but a 10-minute adaption period should be allowed, the first series of observations should be discounted, multiple serial measurements should be obtained, and REE.

Comparison of test characteristics of urine dipstick and urinalysis at various test cutoff points.

STUDY OBJECTIVE: We compare the test characteristics of urine dipstick and urinalysis at various test cutoff points in women presenting to emergency departments and an intermediate care center with symptoms of urinary tract infection. METHODS: This was a prospective, observational study of adult women presenting to 1 of 2 community hospital EDs or an intermediate care center with dysuria, urgency, or urinary frequency on history, or suprapubic or costovertebral angle tenderness on examination. Patients who had taken antibiotics in the past 72 hours, had indwelling Foley catheters, symptomatic vaginal discharge, diabetes mellitus, immunodeficiency disorders, or were unable to provide a reliable history were excluded. The patient's clean-catch or catheterized urine specimen was tested immediately by a nurse using a Multistix 9 SG reagent strip. A second aliquot was sent within 1 hour of collection to the hospital laboratory, where a semiautomated microscopic urinalysis and a urine culture were performed. A positive urine culture was defined as more than 100,000 colonies of 1 or 2 uropathogenic bacteria per mL of urine at 48 hours. Dipstick and urinalysis data were compared with urine culture results. Sensitivity, specificity, and predictive values were calculated at various definitions of a positive test, or "test cutoff points," for combinations of leukocyte esterase, nitrite, and blood on dipstick and for RBCs and WBCs on urinalyses. The probability of an erroneous decision to withhold treatment on the basis of a negative test result was defined as "undertreatment," or 1 minus the negative predictive value. "Overtreatment" was defined as 1 minus the positive predictive value. RESULTS: Three hundred forty-three patients were enrolled in this study. Twelve patients were withdrawn because of missing laboratory results. Forty-six percent (152/331) of patients had positive urine cultures. If urine dipstick results are defined as positive when leukocyte esterase or nitrite is positive or blood is more than trace, the overtreatment rate is 47% (156/331) and the undertreatment rate is 13% (43/331). If urinalysis results are defined as positive when WBCs are more than 3 per high-power field or RBCs are more than 5 per high-power field, the overtreatment rate is 44% (146/331) and the undertreatment rate is 11% (36/331). Matched pairs of test characteristics were identified when the analysis was repeated using more than 10,000 colonies per mL as a positive culture. CONCLUSION: In this patient population, similar overtreatment and undertreatment rates were identified for various test cutoff points for urine dipstick tests and urinalysis. Although a urine dipstick may be equivalent to a urinalysis for the diagnosis of urinary tract infection, the limitations in the diagnostic accuracy of both tests should be incorporated into medical decisionmaking.

Spinal arteriovenous malformations: a review with case illustrations.

Spinal arteriovenous malformations are united by the existence of arteriovenous shunting but are quite heterogeneous in terms of pathology. Until recently, the pathological confusion has been such that management has been poorly understood and this is magnified by the rarity of the lesions. Type 1 AVMs, where the fistula is located in the dura, usually present with a venous hypertensive myelopathy and are relatively easily dealt with surgically. Type 2 AVMs, most closely mimicking the parenchymal AVMs of the brain, usually present with haemorrhage and may be surgically remediable but with much greater risk than the type 1 lesions. Type 3 AVMs, with a diffuse location through both the cord and extra-CNS tissue, usually present early in life with a myelopathy and are often untreatable. Type 4 AVMs, with a fistula located on the pial surface of the cord, usually present with a venous hypertensive myelopathy or subarachnoid haemorrhage, can be treated relatively easily by surgery when small but may be better treated endovascularly when the fistula is large. The purpose of this review is to summarise the current pathological, clinical and management literature with illustrative cases underscoring the important features of this heterogeneous disorder.

Morphology of the laminar junction in relation to the shape of the hoof capsule and distal phalanx in adult horses (Equus caballus).

The purpose was to investigate whether differences in equine hoof shape, which are inferred to alter foot function, are accompanied by differences in morphology of the laminar junction. Ten fore feet from adult horses were segregated into normal and low-angle groups, depending on the dorsal angle of the hoof wall. Twenty measurements of external hoof shape and four of the enclosed distal phalanx were tested for differences between groups, and for intragroup correlations. Three measurements of laminar morphology (spacing, orientation and degree of bend) were recorded for samples of up to 50 primary epidermal laminae at each of 20 sample sites. Sites were distributed over the foot in 5 circumferential columns and 4 proximodistal rows. Intergroup differences were investigated, as were correlations among sample sites of the laminar variables with the shape measurements. Results show differences in hoof shape between groups (but not bone shape) and laminar morphology. Six shape measurements are significantly different between groups: dorsal angle, medial and lateral angles, lateral sole width, solar circumference, and dorsal length. In the normal group, shape measurements show patterns of correlation among regions of the hoof, and between hoof and bone measurements. In the low-angle group, shape correlations occur largely within one region of the hoof (the heels) and in the bone measurements. Laminar spacing tends to be nonsignificantly greater in the low-angle group, while variances for laminar spacing and orientation are significantly greater in this group. Laminar spacing correlates with bone width and coronary circumference (CC) of the hoof in the normal group, but only with CC in the low-angle group. When taken as a whole, and interpreted in light of a model of foot mechanical function, the results appear to indicate a deterioration in structural coherence of the foot in the low-angle group.

Key issues to address with bottle-feeding.

Proper feeding during a baby's first year of life is crucial for a sound nutritional foundation. Because of this, there are several issues that must be addressed to ensure the child is fed properly. First, bottle-feeding moms should not be made to feel guilty about their feeding decision. It is also important to review feeding practices to avoid overfeeding and encourage positive nurturing techniques. Mothers should learn the key signals to watch for from their baby, such as sleep patterns and bowel movements. Also, it is crucial to teach parents the essential issues related to preparing bottles, such as cleaning the bottles and nipples and properly mixing the formula.

Understanding cultural differences when advising mothers about feeding choices.

Cultural teachings and practices greatly influence a mother's feeding decisions. It is important for all health care professionals to understand the cultures within their community and how various beliefs impact infant nutrition. For example, studies have shown the African American and Hispanic mothers are more likely to gain feeding information from family members. There are significant misconceptions being passed down through the generations which can lead to serious nutritional problems, such as overfeeding and the early introduction of cow's milk and food.