Calf care personnel on dairy farms and their educational opportunities.

As dairy herd sizes become larger and the organization of the business more complex, targeting communication and education to enhance animal care becomes more difficult. The purpose of this study was to describe selected demographics of calf care employees on large (>500 animals) and small (<501 animals) dairy farms that raise their own calves. Two to 8 individuals per farm involved with calf care, including owners, veterinarians, and calf managers, feeders, and treaters, were interviewed in either English or Spanish. Interviews were conducted in person on 53 dairy farms located in Arizona, Idaho, New York, Oregon, and Washington State. The number of preweaned calves on the farm ranged from 9 to 1,500 (median = 93). A total of 224 individuals were interviewed across 8 job titles. As farm size increased, personnel structure became more complex. Farms with >100 preweaned calves were 15 times more likely to have a calf manager title compared with farms with ≤100 preweaned calves. Eight farms designated the same person as calf manager, treater, and feeder, all with ≤100 preweaned calves. Thirty-two (60%) of the farms had at least 1 full-time calf feeder. Almost 30% of owners and over 40% of veterinarians interviewed were over 50 yr of age, whereas over 40% of the calf managers, feeders, and treaters were under 30 yr of age. Seventy-three percent of feeders and 72% of treaters spoke Spanish at home. For languages in which interviewees were comfortable speaking, more than 30% of owners and 33% of veterinarians were comfortable communicating in Spanish. For calf care employees, 60% of calf managers, 42% of feeders, and 38% of treaters were bilingual (English and Spanish), but most (72%) preferred to be interviewed in Spanish. The level of education varied by job title for those interviewed, but most of the calf care team had high school or less education. However, some diversity was observed in educational background within job title with almost 38% of the calf managers having at least some college education. The majority of feeders (88%) and treaters (83%) reported being trained by another employee and 66 and 58%, respectively, had not received any continuing education in the previous year. With the amount of diversity seen on these farms, understanding employees' educational backgrounds, language, and generational differences may be valuable when developing training for new procedures for animal health or other aspects of animal care.

Predicting the pain continuum after adolescent idiopathic scoliosis surgery: A prospective cohort study.

BACKGROUND: Chronic postsurgical pain (CPSP) affects half a million children annually in the United States, with dire socioeconomic consequences, including long-term disability into adulthood. The few studies of CPSP in children are limited by sample size, follow-up duration, non-homogeneity of surgical procedure and factors evaluated. METHODS: In a prospective study of 144 adolescents undergoing a single major surgery (spine fusion), we evaluated demographic, perioperative, surgical and psychosocial factors as predictors of a continuum of postsurgical pain: immediate, pain maintenance at 2-3 months (chronic pain/CP) and persistence of pain a year (persistent pain/PP) after surgery. RESULTS: We found an incidence of 37.8% and 41.8% for CP and PP. CP and acute pain were both significant predictors for developing PP (p-value <0.001 and 0.003). Preoperative pain and higher postoperative opioid requirement was significantly associated with CP (p = 0.015, p = 0.002), while Childhood Anxiety Sensitivity Index (p = 0.002) and surgical duration (p = 0.014) predicted PP. The final regression models had reasonable predictive accuracy (c-statistic of 0.73 and 0.83 for CP and PP, respectively). Anxiety scores and catastrophizing for child and parent were found to be significantly correlated (p = 0.005, p = 0.013 respectively). Pain trajectories revealed that 65% of patients who developed PP reported CP and high pain trends; however, 33% of those who developed PP could not be identified using solely pain criteria. CONCLUSION: Persistent postsurgical pain in children is a significant problem. It can be predicted in part by combinations of psychological and clinical variables, which may provide evidence-based measures to prevent development of CPSP in the future. SIGNIFICANCE: In a homogeneous cohort of adolescents undergoing spine fusion, we report a high incidence of persistent postsurgical pain (41.8%) predicted by child anxiety, perioperative pain, and surgical duration. Our results stress timely preventive and therapeutic strategies.

Molecular and genetic characterisation of the host-protective oncosphere antigens of taeniid cestode parasites.

Highly effective recombinant vaccines have been developed against Taenia ovis infection in sheep, Taenia saginata infection in cattle, Taenia solium infection in pigs, Echinococcus granulosus and Echinococcus multilocularis infections in a variety of intermediate host species. These vaccines have been based on the identification and expression in Escherichia coli of antigens derived from the oncosphere life cycle stage, contained within the parasites' eggs. Investigation of the molecular aspects of these proteins and the genes encoding them have revealed a number of common features, including the presence of a predicted secretory signal sequence, and one or two copies of a fibronectin type III domain, each encoded by separate exons within the associated gene. Evidence has been obtained to confirm glycosylation of some of these antigens. Ongoing investigations will shed light on the biological roles played by the proteins within the parasites and the mechanism by which they make the parasites vulnerable to vaccine-induced immune responses.

Clinical and epidemiologic features of mumps meningoencephalitis and possible vaccine-related disease.

All cases of mumps meningoencephalitis diagnosed at our institution during the past 15 years were reviewed. There were 24 cases, 16 between 1973 and 1977, 3 between 1978 and 1985 and 5 in 1986 to 1988. Four of the recent cases occurred 19 to 26 days after receipt of a new mumps vaccine (Urabe Am 9 strain) released in Canada in 1986. The remaining 20 cases were clustered in winter and spring. The average age was 6.2 years and the ratio of males to females was 5:1. Clinical presentations were fever (90%), vomiting (90%), meningismus (70%), headache (65%), parotitis (50%) and seizures (30%). The mean cerebrospinal fluid white blood cell count was 513/mm3 (lymphocyte predominance); 55% of patients had a cerebrospinal fluid protein level of greater than 0.4 g/liter, and the cerebrospinal fluid:blood glucose ratio was greater than 0.4 in all. Two patients had adverse sequelae. The clinical and laboratory features of these cases were not significantly different from the vaccine-associated cases.

The detection and diagnosis of early occult and minimal breast cancer.

This article has attempted to describe the present status of efforts toward routine detection of breast cancer at a stage when it is readily curable and to point out, not only the potentials of screening programs, but also the problems and difficulties that beset them. We believe that efficient, safe screening and accurate early diagnosis are achievable and that trial directed toward this end should not only continue but expand. We see no other avenue that offers as bright a prospect for a meaningful reduction in breast cancer mortality and the monstrous toll--medical, emotional, sociologic and monetary--it exacts.

Institutional Review Board evaluation of neuroscience protocols involving human subjects.

We analyzed our Institutional Review Board's (IRB) critiques of neuroscience protocols to identify areas of difficulty for investigators. Minutes from IRB meetings were reviewed, and criticisms were collated under applicable Code of Federal Regulations sections, coalescing into four categories: procedural issues, protocol critique, consent critique, and patient rights. Better communication with research subjects would have avoided a majority (66%) of criticisms. Procedural criticisms could have been reduced by adherence to IRB technical requirements. The small number of protocol design criticisms suggests either a lack of rigor in committee analysis or reliance on prior reviewers; it may also reflect the ongoing debate about the role of the IRB in evaluating scientific merit.

Comparison of two-surface and multiple-surface scoring methodologies for in vitro microleakage studies.

Investigators differ on the use of a two-surface or multiple-surface scoring methodology in sectional microleakage studies. This study compared microleakage scores using both two-surface and multiple-surface scoring methods for two preparation types and two different dentin bonding agents. Twenty freshly extracted molars each received one box-shaped and one V-shaped restoration on the mesial or distal surface. Each restoration was cut occlusogingivally into four sections, yielding eight surfaces for scoring. Surfaces were marked to identify central (I), lateral (II), and end (III) locations, then scored by two calibrated raters. The Wilcoxon Matched-Pairs Signed-Rank Test showed a statistically significant difference (p less than or equal to 0.05) in median microleakage scores obtained by an end two- surface and multiple-surface evaluation for V-shaped preparations restored with Scotchbond 2, P-50. No other statistically significant comparisons were detected. Results suggest that microleakage may be more extreme at end surfaces and that these end surfaces should be scored so that an accurate microleakage value could be assigned to composite restorations.

Use of preformed hydroxylapatite blocks for grafting in genioplasty procedures.

Dense hydroxylapatite is a synthetic, biocompatible, immunologically inert material that can establish a chemical union with bone when placed in intimate contact in histologic studies. The following is a preliminary report of the use of preformed dense, non-resorbable hydroxylapatite blocks as a grafting material for use in advancement and vertical lengthening of the bony chin associated with orthognathic surgical procedures. In rare instances where an autogenous bone graft would be required for vertical lengthening without any advancement of bony pogonion, the need is obviated by utilization of the hydroxylapatite solid block.

Preformed hydroxylapatite blocks for palatal grafting in orthognathic surgery.

Hydroxylapatite has been used as a bone substitute for ridge augmentation, ridge maintenance and periodontal defects for many years. This is a preliminary report of the use of hydroxylapatite blocks as a grafting material in midpalatal splits in orthognathic surgery. With the advent of hydroxylapatite blocks, the need for autogenous bone grafting will, in most cases, be obviated.

The detection and diagnosis of early, occult and minimal breast cancer.

Radical mastectomy as originally conceived at the turn of the century consisted of complete removal of the breast tissue, the overlying skin, the pectoral muscles, the intervening lymphatics and the axillary lymph nodes. The aim was logical but initially the results were poor. Only 41% of the 76 patients in Halsted's original series were without disease at the end of 3 years. The principal reason for this was the advanced stage of disease in the patients selected for treatment. By contrast, Gilbertsen, using clinical examination alone, surveyed women 45 years of age or older and found that of 32 patients with breast cancers detected by the screening procedure, 24 had no axillary lymph node involvement. The absolute 5-year survival rate of this group was 96%, which approaches the anticipated survival of comparable women free of breast cancer. Those with positive lymph nodes had an absolute survival rate of 75% at 5 years. Further, of 13 patients observed for 10 years, the survival rate for those without node involvement was 90% and for patients with node involvement was 33%. Patients treated at the Barnes Hospital in St. Louis between 1912 and 1933 were contrasted with similarly treated patients at the Barnes Hospital and the Ellis Fischel Cancer Hospital from 1940 to 1955. A poorer survival rate in the earlier series was related primarily to the greater frequency of advanced and larger tumors. That a significant reduction in breast cancer mortality can be achieved is becoming increasingly apparent. Among survey-detected breast cancers in the study conducted by the Health Insurance Plan of Greater New York, the 6-year mortality was half of that of controls. This reduction is even more impressive when one considers that among these patients were many with full invasive, mass-forming carcinomas at the time of initial screening. A recent report by Wanebo, Huvos and Urban discusses the treatment of prognostically favorable forms of breast cancer by modified radical mastectomy. It is possible to select from among their patients those who fit the definition of minimal breast cancer. In this group the 5-year survival rate was 97% and the 10-year survival rate was 95%. Only 1 patient died of breast cancer in 10 years. In another reported group of 65 patients with intraductal carcinoma only, there were no deaths due to breast cancer in 10 years. Should the NCI-ACS demonstration projects show, as now seems probable, that community screening programs can be effective in early breast cnacer detection, it is to be anticipated that widespread public demand for screening facilities will follow. This may present insurmountable logistic and economic problems. The total number of radiologists in the United States is not sufficient to screen annually the total population of women over age 40, or even over age 50. There is great need for the development of criteria for the ready identification of that segment of the population in which most of the cancers would be found...

Retentive strength of acid-etched anterior fixed partial dentures: an in vitro comparison of attachment techniques.

Acid-etched fixed partial dentures are a rational alternative to other forms of removable prostheses because additional strength and increased resistance to fracture are achieved when the acrylic pontic is bonded with composite resin to natural tooth abutments.

In vitro retentive strength of fixed bridges constructed with acrylic pontics and an ultraviolet-light-polymerized resin.

The in vitro retentive strength of 24 test bridges was studied. The bridges were maxillary canine to central incisor spans, and an acrylic pontic replaced the lateral incisors. The pontic was retained by a resin polymerized with ultraviolet light. The mean forces necessary to dislodge the pontic bonded to natural teeth in the three-unit bridges were determined to be 41.5 lb for a force applied toward the incisal edge and 55.8 lb for a force applied toward the gingival ridge. A promising clinical application of this technique is suggested.

Surface morphology and chemical characterization of abrasion/erosion lesions.

PURPOSE: To describe the dentin surface morphology of abrasion/erosion lesions and to chemically characterize in vivo samples of sclerotic dentin. MATERIALS AND METHODS: Baseline polyvinylsiloxane impressions of eight in vivo caries-free lesions were taken. Dentin was collected from retention grooves for FTIR photoacoustic spectroscopic analysis. The cavity preparation was etched for 30 seconds with 37% phosphoric acid, rinsed, and dried. Impressions were taken of the etched surfaces. Epoxy resin dies were made of baseline and etched impressions, sputter-coated and examined at x1000 with the SEM. RESULTS: Lateral dentin tubule orientation was observed at gingival margins and on occlusal walls. Open cross-sectional tubules were seen at the depth of the groove. The mineral/protein ratio in the FTIR/PAS spectra of in vivo unetched sclerotic dentin samples suggested an increased mineral content.

Vitamin E deficiency in dogs with retinal pigment epithelial dystrophy.

The role of vitamin E deficiency in the development of retinal pigment epithelial dystrophy was investigated in 11 cocker spaniels and four other dogs. The concentration of alpha-tocopherol was measured by high performance liquid chromatography in plasma samples obtained from the affected dogs and from 28 ophthalmoscopically normal, healthy control dogs. The mean (sd) plasma alpha-tocopherol concentration in the normal dogs was 20.2 (7.1) microg/ml, compared with 1.14 (0.67) microg/ml in the 11 affected cocker spaniels. The difference between the two groups remained highly significant when the alpha-tocopherol concentrations were expressed relative to the concentrations of the plasma lipids cholesterol and triglycerides. Low plasma concentrations of alpha-tocopherol were observed in the four affected dogs of other breeds, but the finding was not so consistent. The plasma lipid concentrations were normal in the affected dogs. The deficiency of alpha-tocopherol in the affected dogs appeared to be primary, because there was no clinical, biochemical or pathological evidence of underlying disease, or any indication of a dietary deficiency which might have contributed to the low concentrations of alpha-tocopherol.

Fracture strength of Class I versus Class II restored premolars tested at the marginal ridge. 2. Cavosurface bonding and cavosurface plus internal enamel bonding.

The purpose of this study was to test the difference between the strength of the marginal ridge of extracted teeth with a Class I composite resin restoration and the strength of the marginal ridge of teeth with a Class II amalgam restoration with retention grooves. A statistically significant difference in fracture strengths was found among groups. No statistically significant difference was found among restored preparations, beveling technique, and restorative material. Statistically significant differences in fracture strength were found between the whole tooth group and treatment groups; between the whole tooth group and Class II amalgam restoration group; and between the unrestored tooth preparation group and all other tooth groups.

Misattribution in a fearful situation following different modes of arousal.

52 female college students were exposed to procedures expected to produce some physical or emotional arousal (viewing a sexually-explicit film or riding an exercise bicycle) and were subsequently asked to approach a snake, of which they had previously reported being afraid. Their performance was compared to that of control subjects who had been exposed to non-arousing tasks (viewing a film about sunspots or reading an article about exercise). The prediction that prior arousal would produce misattribution and reduce snake avoidance was not supported.

The physician's alternative career transition model: a stepwise approach.

The recent intense focus on marketplace reform has stimulated a reassessment of career planning options for some physicians. These socioeconomic changes have created unique opportunities beyond the traditional arenas of clinical practice and medical management for physicians to leverage their medical degrees and experiences in the business world. This paper presents three case reports of physician executives who have successfully pursued medically related business career options, each following different motivations at various stages of their medical careers. It then discusses the Physicians' Alternative Career Transition (PACT) model developed by the authors to assist other physicians who are considering making transitions into business-related careers. The PACT model is based on four critical steps for practicing physicians to make these transitions successfully: an internal self-evaluation process, an external environmental evaluation process, seeking the best "career match," and securing the career match.

Dispelling myths: a study of PMS and relationship satisfaction.

For more than 50 years, professional literature has linked premenstrual tension (PMS) with psychoemotional symptoms, without addressing how women's roles and development may be related to PMS. This article's research examines aspects of a relationship that exemplify three reported psychoemotional concerns present in PMS women: marital-, sexual- and family-relationship satisfaction. Twenty-six PMS clients of a nurse practitioner and 26 non-PMS women completed three questionnaires about relationship satisfaction. Statistically, PMS subjects reported significantly more dissatisfaction with marital and sexual relationships. No effects linked to age were found. Results are explained within the context of women's development and roles, and implications are discussed for clinicians who provide health care to clients with PMS.