Multicenter Ozone Study in oldEr Subjects (MOSES): Part 1. Effects of Exposure to Low Concentrations of Ozone on Respiratory and Cardiovascular Outcomes.

INTRODUCTION: Exposure to air pollution is a well-established risk factor for cardiovascular morbidity and mortality. Most of the evidence supporting an association between air pollution and adverse cardiovascular effects involves exposure to particulate matter (PM). To date, little attention has been paid to acute cardiovascular responses to ozone, in part due to the notion that ozone causes primarily local effects on lung function, which are the basis for the current ozone National Ambient Air Quality Standards (NAAQS). There is evidence from a few epidemiological studies of adverse health effects of chronic exposure to ambient ozone, including increased risk of mortality from cardiovascular disease. However, in contrast to the well-established association between ambient ozone and various nonfatal adverse respiratory effects, the observational evidence for impacts of acute (previous few days) increases in ambient ozone levels on total cardiovascular mortality and morbidity is mixed.Ozone is a prototypic oxidant gas that reacts with constituents of the respiratory tract lining fluid to generate reactive oxygen species (ROS) that can overwhelm antioxidant defenses and cause local oxidative stress. Pathways by which ozone could cause cardiovascular dysfunction include alterations in autonomic balance, systemic inflammation, and oxidative stress. These initial responses could lead ultimately to arrhythmias, endothelial dysfunction, acute arterial vasoconstriction, and procoagulant activity. Individuals with impaired antioxidant defenses, such as those with the null variant of glutathione S-transferase mu 1 (GSTM1), may be at increased risk for acute health effects.The Multicenter Ozone Study in oldEr Subjects (MOSES) was a controlled human exposure study designed to evaluate whether short-term exposure of older, healthy individuals to ambient levels of ozone induces acute cardiovascular responses. The study was designed to test the a priori hypothesis that short-term exposure to ambient levels of ozone would induce acute cardiovascular responses through the following mechanisms: autonomic imbalance, systemic inflammation, and development of a prothrombotic vascular state. We also postulated a priori the confirmatory hypothesis that exposure to ozone would induce airway inflammation, lung injury, and lung function decrements. Finally, we postulated the secondary hypotheses that ozone-induced acute cardiovascular responses would be associated with: (a) increased systemic oxidative stress and lung effects, and (b) the GSTM1-null genotype. METHODS: The study was conducted at three clinical centers with a separate Data Coordinating and Analysis Center (DCAC) using a common protocol. All procedures were approved by the institutional review boards (IRBs) of the participating centers. Healthy volunteers 55 to 70 years of age were recruited. Consented participants who successfully completed the screening and training sessions were enrolled in the study. All three clinical centers adhered to common standard operating procedures (SOPs) and used common tracking and data forms. Each subject was scheduled to participate in a total of 11 visits: screening visit, training visit, and three sets of exposure visits, each consisting of the pre-exposure day, the exposure day, and the post-exposure day. The subjects spent the night in a nearby hotel the night of the pre-exposure day.On exposure days, the subjects were exposed for three hours in random order to 0 ppb ozone (clean air), 70 ppb ozone, and 120 ppm ozone, alternating 15 minutes of moderate exercise with 15 minutes of rest. A suite of cardiovascular and pulmonary endpoints was measured on the day before, the day of, and up to 22 hours after, each exposure. The endpoints included: (1) electrocardiographic changes (continuous Holter monitoring: heart rate variability [HRV], repolarization, and arrhythmia); (2) markers of inflammation and oxidative stress (C-reactive protein [CRP], interleukin-6 [IL-6], 8-isoprostane, nitrotyrosine, and P-selectin); (3) vascular function measures (blood pressure [BP], flow-mediated dilatation [FMD] of the brachial artery, and endothelin-1 [ET-1]; (4) venous blood markers of platelet activation, thrombosis, and microparticle-associated tissue factor activity (MP-TFA); (5) pulmonary function (spirometry); (6) markers of airway epithelial cell injury (increases in plasma club cell protein 16 [CC16] and sputum total protein); and (7) markers of lung inflammation in sputum (polymorphonuclear leukocytes [PMN], IL-6, interleukin-8 [IL-8], and tumor necrosis factor-alpha [TNF-α]). Sputum was collected only at 22 hours after exposure.The analyses of the continuous electrocardiographic monitoring, the brachial artery ultrasound (BAU) images, and the blood and sputum samples were carried out by core laboratories. The results of all analyses were submitted directly to the DCAC.The variables analyzed in the statistical models were represented as changes from pre-exposure to post-exposure (post-exposure minus pre-exposure). Mixed-effect linear models were used to evaluate the impact of exposure to ozone on the prespecified primary and secondary continuous outcomes. Site and time (when multiple measurements were taken) were controlled for in the models. Three separate interaction models were constructed for each outcome: ozone concentration by subject sex; ozone concentration by subject age; and ozone concentration by subject GSTM1 status (null or sufficient). Because of the issue of multiple comparisons, the statistical significance threshold was set a priori at P < 0.01. RESULTS: Subject recruitment started in June 2012, and the first subject was randomized on July 25, 2012. Subject recruitment ended on December 31, 2014, and testing of all subjects was completed by April 30, 2015. A total of 87 subjects completed all three exposures. The mean age was 59.9 ± 4.5 years, 60% of the subjects were female, 88% were white, and 57% were GSTM1 null. Mean baseline body mass index (BMI), BP, cholesterol (total and low-density lipoprotein), and lung function were all within the normal range.We found no significant effects of ozone exposure on any of the primary or secondary endpoints for autonomic function, repolarization, ST segment change, or arrhythmia. Ozone exposure also did not cause significant changes in the primary endpoints for systemic inflammation (CRP) and vascular function (systolic blood pressure [SBP] and FMD) or secondary endpoints for systemic inflammation and oxidative stress (IL-6, P-selectin, and 8-isoprostane). Ozone did cause changes in two secondary endpoints: a significant increase in plasma ET-1 (P = 0.008) and a marginally significant decrease in nitrotyrosine (P = 0.017). Lastly, ozone exposure did not affect the primary prothrombotic endpoints (MP-TFA and monocyte-platelet conjugate count) or any secondary markers of prothrombotic vascular status (platelet activation, circulating microparticles [MPs], von Willebrand factor [vWF], or fibrinogen.).Although our hypothesis focused on possible acute cardiovascular effects of exposure to low levels of ozone, we recognized that the initial effects of inhaled ozone involve the lower airways. Therefore, we looked for: (a) changes in lung function, which are known to occur during exposure to ozone and are maximal at the end of exposure; and (b) markers of airway injury and inflammation. We found an increase in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) after exposure to 0 ppb ozone, likely due to the effects of exercise. The FEV1 increased significantly 15 minutes after 0 ppb exposure (85 mL; 95% confidence interval [CI], 64 to 106; P < 0.001), and remained significantly increased from pre-exposure at 22 hours (45 mL; 95% CI, 26 to 64; P < 0.001). The increase in FVC followed a similar pattern. The increase in FEV1 and FVC were attenuated in a dose-response manner by exposure to 70 and 120 ppb ozone. We also observed a significant ozone-induced increase in the percentage of sputum PMN 22 hours after exposure at 120 ppb compared to 0 ppb exposure (P = 0.003). Plasma CC16 also increased significantly after exposure to 120 ppb (P < 0.001). Sputum IL-6, IL-8, and TNF-α concentrations were not significantly different after ozone exposure. We found no significant interactions with sex, age, or GSTM1 status regarding the effect of ozone on lung function, percentage of sputum PMN, or plasma CC16. CONCLUSIONS: In this multicenter clinical study of older healthy subjects, ozone exposure caused concentration-related reductions in lung function and presented evidence for airway inflammation and injury. However, there was no convincing evidence for effects on cardiovascular function. Blood levels of the potent vasoconstrictor, ET-1, increased with ozone exposure (with marginal statistical significance), but there were no effects on BP, FMD, or other markers of vascular function. Blood levels of nitrotyrosine decreased with ozone exposure, the opposite of our hypothesis. Our study does not support acute cardiovascular effects of low-level ozone exposure in healthy older subjects. Inclusion of only healthy older individuals is a major limitation, which may affect the generalizability of our findings. We cannot exclude the possibility of effects with higher ozone exposure concentrations or more prolonged exposure, or the possibility that subjects with underlying vascular disease, such as hypertension or diabetes, would show effects under these conditions.

Patient preference: a comparison of electronic patient-completed questionnaires with paper among cancer patients.

In this study, we compared cancer patients preference for computerised (tablet/web-based) surveys versus paper. We also assessed whether the understanding of a cancer-related topic, pharmacogenomics is affected by the survey format, and examined differences in demographic and medical characteristics which may affect patient preference and understanding. Three hundred and four cancer patients completed a tablet-administered survey and another 153 patients completed a paper-based survey. Patients who participated in the tablet survey were questioned regarding their preference for survey format administration (paper, tablet and web-based). Understanding was assessed with a 'direct' method, by asking patients to assess their understanding of genetic testing, and with a 'composite' score. Patients preferred administration with tablet (71%) compared with web-based (12%) and paper (17%). Patients <65 years old, non-Caucasians and white-collar professionals significantly preferred the computerised format following multivariate analysis. There was no significant difference in understanding between the paper and tablet survey with direct questioning or composite score. Age (<65 years) and white-collar professionals were associated with increased understanding (both P = 0.03). There was no significant difference in understanding between the tablet and print survey in a multivariate analysis. Patients overwhelmingly preferred computerised surveys and understanding of pharmacogenomics was not affected by survey format.

Socioeconomic status and lifestyle behaviours in cancer survivors: smoking and physical activity.

PURPOSE: Smoking cessation and increased physical activity (pa) have been linked to better outcomes in cancer survivors. We assessed whether socioeconomic factors influence changes in those behaviours after a cancer diagnosis. METHODS: As part of a cross-sectional study, a diverse group of cancer survivors at the Princess Margaret Cancer Centre (Toronto, ON), completed a questionnaire about past and current lifestyle behaviours and perceptions about the importance of those behaviours with respect to their health. The influence of socioeconomic indicators on smoking status and physical inactivity at 1 year before and after diagnosis were assessed using multivariable logistic regression with adjustment for clinico-demographic factors. RESULTS: Of 1222 participants, 1192 completed the smoking component. Of those respondents, 15% smoked before diagnosis, and 43% of those smokers continued to smoke after. The proportion of survivors who continued to smoke increased with lower education level (p = 0.03). Of the 1106 participants answering pa questions, 39% reported being physically inactive before diagnosis, of whom 82% remained inactive afterward. Survivors with a lower education level were most likely to remain inactive after diagnosis (p = 0.003). Lower education level, household income, and occupation were associated with the perception that pa had no effect or could worsen fatigue and quality of life (p ≤ 0.0001). CONCLUSIONS: In cancer survivors, education level was a major modifier of smoking and pa behaviours. Lower socioeconomic status was associated with incorrect perceptions about pa. Targeting at-risk survivors by education level should be evaluated as a strategy in cancer survivorship programs.

The Self-Injury Questionnaire: evaluation of the psychometric properties in a clinical population.

This paper presents the findings, from a clinical study, on the reliability and validity of a new measure for intentions in self-harm behaviour, the Self-Injury Questionnaire (SIQ). Eighty-three patients, who had presented to an emergency department with an episode of self-harm/suicidal behaviour, were given the SIQ as part of a battery of measures to evaluate differentiation in self-harm intentions based upon a history of childhood physical and/or sexual abuse. The internal consistency for the total scale was strong (alpha = 0.83). Construct validity demonstrated significant correlations with standardized measures. A principle component analysis of responses yielded a five-factor solution with 'affect regulation' items loading on the first factor. Cronbach's alphas were adequate for each subscale (alpha = 0.72-0.77). These preliminary findings indicate that the SIQ is a valid and reliable measure for research in an acute self-harming population.

Measuring the wellbeing of family caregivers using the time trade-off technique.

In the absence of a quality of life instrument which is applicable to the caregivers of elderly relatives and amenable to a cost-utility analyses, the Caregiver Quality of Life Instrument (CQLI) was developed using Torrance's time trade-off technique. The CQLI was administered to 30 family caregivers and 10 relatives of well elderly. Utility scores were obtained for three standardized caregiver situations and the subject's own state. The CQLI could be completed by almost all subjects. Good test-retest reliability was established. The subjects were able to discriminate between degrees of caregiver wellbeing using standardized states and the CQLI scores discriminated among groups of subjects. The CQLI detected within-subject change in caregivers whose relatives received institutional respite care. The CQLI appears to be feasible, reliable, valid, and responsive to change. Further CQLI applications and research are recommended.

Effects of an abilities-focused program of morning care on residents who have dementia and on caregivers.

OBJECTIVE: To conduct a controlled investigation to examine the effects of an abilities-focused program of morning care on the interaction behaviors and functioning of residents with dementia and on caregivers' interaction behaviors and perceptions of caregiving. DESIGN: A quasi-experimental, repeated measures design. SETTING: The study was conducted on four, nursing-home-level cognitive supports units in a geriatric care center. One of the units was randomly selected as the experimental unit; the other three served as controls. PARTICIPANTS: The final sample consisted of 40 residents (20 each in the experimental and three control groups) and 44 caregivers (16 on the experimental unit and 28 on the three control units). INTERVENTION: An educational program on delivering abilities-focused morning care, designed by the authors, was provided to caregivers on the experimental unit. MEASUREMENTS: Measures were taken at baseline and at 3 and 6 months postintervention with regard to residents' interaction behaviors, level of agitation, and level of function and to caregivers' interaction behaviors, perceived ease of caregiving, and level of stress. RESULTS: Repeated measures analysis of variance (RM-ANOVA) was used to compare the experimental and control groups in regard to changes in the outcomes over time. Results indicated that the abilities-focused program had statistically significant effects on (a) residents' personal attending and calm/functional behaviors, level of agitation, and levels of overall and social function, and (b) caregivers' verbal relevance and personal attending, relaxed, and social/flexible behaviors. CONCLUSIONS: The evidence suggests that both residents and caregivers benefit from morning care that is oriented toward the abilities of people with dementia.

A randomized trial of family caregiver support in the home management of dementia.

A randomized trial of family caregiver support for the home management of older people suffering from moderate to severe progressive irreversible dementia was conducted in an urban center in southern Ontario. Thirty caregivers were allocated to receive the experimental intervention consisting of: caregiver-focused health care, education about dementia and caregiving, assistance with problem solving, regularly scheduled in-home respite, and a self-help family caregiver support group. Thirty control subjects received conventional community nursing care. Before completion of the intervention, 18 (30%) were withdrawn, almost equally from each group. The most frequent reason was long-term institutionalization of the demented relative (n = 10). At baseline, caregivers in both groups were suffering from above-average levels of depression and anxiety. After the six-month intervention period, we found neither experimental nor control group improved in these areas. However, the experimental group showed a clinically important improvement in quality of life, experienced a slightly longer mean time to long-term institutionalization, found the caregiver role less problematic, and had greater satisfaction with nursing care than the control group.

Development of a provisional reference human cord serum standard for alpha-fetoprotein determination.

A lyophilized human cord serum secondary reference standard (988 vials of 1 mL/vial) has been prepared at the Laboratory Centre for Disease Control (L.C.D.C.) in Ottawa to assist in the standardization of AFP determinations. HBSAG-negative lots of cord serum were used to prepare the standard. The moisture content of the freeze-dried material was less than 0.5 percent. AFP mass calibration standards were prepared by direct weighing in duplicate of highly purified freeze-dried material. Two RIA calibration runs were conducted on the reference cord serum employing the WHO First International Standard for AFP (72/225) and L.C.D.C. mass standards. Parallelism of dose response curves within assays was demonstrated between reference cord serum and mass standards and between the latter and the WHO standard. The mean WHO kIU of AFP per vial of reference serum (+/- coefficient of variation) was 63.0 +/- 6.4 and the mean mass of AFP determined as micrograms per vial was 80.7 +/- 7.9. A small-scale (pilot) interlaboratory calibration of the reference cord serum in mass units resulted in heterogeneous AFP estimates which ranged from 54.4 to 80.7 micrograms/vial. Greater uniformity of the latter results was noted following conversion of the mass estimates to WHO international units conversion factors provided by several laboratories.

Dietary survey of low-income, rural families in Iowa and North Carolina. II. Family distribution of dietary adequacy.

Distribution patterns of Iowa and North Carolina families for dietary adequacy at various income levels were compared according to: (a) two family dietary standards, based on the 1968 Recommended Dietary Allowance and the Ten-State Nutrition Survey dietary standards, and (b) two income standards, family income and per capita income. A 24-hr. recall method was used to collect the dietary data. Nutrients studied included: protein, calcium, iron, vitamin A, ascorbic acid, thiamin, and riboflavin. Clear differences emerged in family distribution patterns by the two dietary standards and by the two income standards. Comparison of family distribution patterns for dietary intake by the two standards showed that percentages of families with poor nutrient intakes were lower by Ten-State evaluation than for the recommended allowance evaluation, except for protein and iron. For example, the percentage of families with poor calcium intakes, by Ten-State criteria, was approximately half that measured by the recommended allowances. While, according to the latter, calcium was the most limiting nutrient in many family diets, vitamin A was most limiting by Ten-State evaluation. The proportions of families with poor ascorbic acid, thiamin, and riboflavin intakes were also lower by Ten-State standards. While the iron adequacy remained approximately the same by both dietary standards, the percentage of families with poor protein intakes was higher by the Ten-State criteria. A higher percentage of families at each income level had fair and good diets by Ten-State comparison. Family distribution patterns for intakes of individual nutrients at various family income levels demonstrated a positive relationship between nutritional intake and income. Proportions of families with poor nutrient intakes according to per capita income tended to increase with the income level. For both income standards, the percentages of families with good and fair diets in the total family sample gradually increased with income. Percentages of Iowa families with fair and good diets at various income levels were, in general, higher than those of North Carolina families. The lowest and the highest percentages of families with poor diets of two population groups were higher for per capita income distribution than for family income distribution.

Dietary survey of low-income, rural families in Iowa and North Carolina. III. Contribution of food groups to nutrients.

Percentage contributions of specific food groups indicated in the Basic 4 to protein, calcium, vitamin A, and ascorbic acid in one day's diets of thirty-five Iowa families and twenty-five North Carolina families are reported. All members of the families ate all meals at home. Their diets met or exceeded two-thirds of the 1968 Recommended Dietary Allowances for seven nutrients. Data were collected by the 24-hr. recall method. While the percentage contribution of the meat group to protein intake of the North Carolina families ranged from zero to 84 per cent, that of the Iowa group was from 35 to 85 per cent. The range for the percentage contribution of the milk group to calcium intake of North Carolina families was similar; however, in the Iowa group the range was from 2 to 97 per cent. The vitamin A-rich fruit and vegetable group contributed from zero to 99 per cent for the North Carolina families of vitamin A intake and from zero to 88 per cent for the Iowa group. Ascorbic acid-rich fruits and vegetables contributed from zero to 100 per cent of the ascorbic acid intake of the Iowa group and from zero to 95 per cent in North Carolina families. The results support the argument that the exclusive use of the "Daily Food Guide" or the "Basic 4" to assess nutritional intake of diets may produce biased in formation.

Dietary survey of low-income, rural families in Iowa and North Carolina. I. Research procedures.

Methods used in assessing the dietary intake of selected low-income, rural families are described. The sample consisted of 668 families randomly selected from predetermined locations in Iowa and North Carolina. A 24-hr. recall method supplemented with food models was used in gathering data on family food intake. The nutritional "adequacy" of the family diets was then evaluated according to family composition and the 1968 Recommended Dietary Allowances. The adequacy of individual nutrients was also evaluated by the same criteria. Nutrients studied included: protein, calcium, iron, vitamin A, ascorbic acid, thiamin, and riboflavin. The selection of the method in relation to opinions of previous investigators is discussed.

Disaggregating regional variations in mortality by cause of death: a case study of the Republic of Ireland.

Significant regional disparities in life expectancy were found in a previous study of Irish mortality. An attempt is made in the present paper to assess the relative importance of each of the major causes of death to an understanding of regional disparities in total mortality, using a specially devised index known as a partial standardised mortality ratio. It is found that regional disparities created by each of the major causes of death tend to have a reinforcing effect, although cerebrovascular diseases tend to conform less closely to the patterns established by the other major causes (viz. cardiovascular diseases, malignant neoplasms and respiratory diseases). Cardiovascular diseases exert the strongest influence upon the overall pattern, but malignant neoplasms exert a much stronger influence than might be expected given the number of deaths from cancer. Regional disparities are stronger for males than for females, suggesting lines for further causal investigation.

Hypothesized foetal and early life influences on adult heart disease mortality: an ecological analysis of data for the Republic of Ireland.

Spatial disparities in the prevalence of heart disease are frequently explained in terms of adult lifestyle factors (e.g. diet, smoking, alcohol consumption, stress, exercise, etc.). However, research in recent years suggests an alternative explanation: namely, that the risk of heart disease in adult life may be influenced either by living conditions shortly after birth or by foetal development before birth. This paper outlines the evolution of this line of thought, and tests whether these hypotheses are consistent with ecological data for deaths from ischaemic heart disease between 1981 and 1990 and infant deaths between 1916 and 1935 in the Republic of Ireland. Support for the hypotheses is found to be ambiguous. Possible interpretations of these findings are discussed, paying particular attention to the anomalous nature of infant mortality in Ireland between 1916 and 1935.

Dementia caregiving: the role of the primary care physician.

BACKGROUND: Family and friends play an important role in caring for individuals with dementia living in the community. In preparation for the Canadian Consensus Conference on Dementia held in Montreal, Canada in February 1998, the subject of dementia caregiving was reviewed in order to provide primary care physicians with some guidelines for their practice. The review was updated in June 2000 in preparation for this article. METHOD: Pertinent English-language publications and resources from the Alzheimer Society of Canada were reviewed from 1985 onwards. Findings related to the consequences of caregiving, services for caregivers and recommendations regarding the role of the primary care physician were reviewed. FINDINGS: Dementia caregivers experience many positive and negative consequences of caregiving. Some comprehensive services for caregivers have been shown to delay institutionalization and reduce negative consequences of caregiving. The primary care physician has a role to play in working with families and should address the following issues: 1) education about dementia; 2) psychological support for caregivers; 3) assistance mobilizing caregiver social support networks. CONCLUSION: Primary care physicians have an important role to play in acknowledging and supporting the caregiving provided by family and friends to individuals with dementia.

Bis-[2[(tetrahydro-2H-pyran-2-yl)thio]phenyl]diazine: A new colorimetric reagent for mercury.

The synthesis of bis-[2-[(tetrahydro-2H-pyran-2-yl)thio]phenyl] diazine is reported and its potential as a spectrophotometric reagent for Hg(2+) is explored. The dye reacts in 1:1 stoichiometry with Hg(2+) and the product of this reaction, which is extracted into chloroform, has a molar absorptivity of 3.20 x 10(3) l.mole(-1).cm(-1) at 525 nm and obeys Beer's law in the range 0-50 ppm Hg(2+).

Synthesis of some new o-thioazo ligands and evaluation of their metallochromic properties.

The synthesis of several new o-thioazo derivatives of p-cresol and 2-naphthol is reported, as well as their spectral properties, acid dissociation constants, and potential as metallochromic reagents. All the ligands form complexes with CU(2+) and Ni(2+). o-Mercaptoazo complexes of Fe(3+) and Cu(2+) with molar absorptivities of 3.83 x 10(4) and 3.58 x 10(4) l.mole(-1) cm(-1), respectively, are described.

Factors influencing patients' informational needs at time of hospital discharge.

The relationship between patients' perceived informational needs and selected sociodemographic and illness-related variables were examined in a sample of 301 adult medical and surgical patients preparing for discharge from an acute care setting. Marital status, living arrangements and chronicity of illness had no influence on the importance of informational needs as measured by the Patient Learning Need Scale (PLNS). More informational needs were identified by females than males, and those with malignant as opposed to benign disease. Length of time spent in the hospital, number of discharge medications, and patient perception of the influence of the illness on life were positively correlated with informational needs at the time of discharge.

Urticaria, vasculitis, hypocomplementemia, and immune-complex glomerulonephritis.

Recurrent urticaria with cutaneous vasculitis is a systemic immune disorder of unknown origin. We studied a 33-year-old woman with this syndrome. She also had hypocomplementemia, circulating immune complexes, arthritis, and immune-complex glomerulonephritis.

Studies on the utilization of leaf protein concentrates as a protein source in poultry nutrition.

Spray-dried leaf protein concentrate prepared from Red Clover and alfalfa with low or high saponin content were evaluated by studying their effect on growth and feed efficiency of broiler chicks at the 40% level. Excellent growth and feed efficiency were recorded when 40% of low saponin alfalfa protein concentrate (APC) prepared from fresh alfalfa was incorporated in the diets. Saponin in APC estimated by hemolysis test was an important factor affecting the growth, feed efficiency, and mortality of chicks. Analysis of variance showed no significant (P less than .05) difference in body weight gain between Red Clover protein concentrate and low saponin APC. A significant reduction in body weight gain of both broiler and egg type chicks was observed when 40 parts of wet alfalfa protein concentrate were incorporated in the diets. A combination of 30 parts of wet alfalfa protein concentrate (wet APC) and rice bran in a broiler diet did not adversely affect growth. Supplementation of additional vitamins did not improve gain in body weight when 40 parts of wet APC and rice bran were included in the diet. Supplementation of vitamin E seems to be crucial when higher levels of wet APC and rice bran are included in broiler diets.

Nutritional value of aerobically fermented poultry manure and offal (Fermway) for broiler chicks.

The nutritional value of two samples of an aerobically fermented poultry product (Fermway) were evaluated for broiler chicks. Fermway is a combination of broiler house litter and offal from a broiler processing plant. A significant (P less than .05) growth stimulation was obtained with one sample at 8 to 16% of the diet. Feed efficiency generally improved, but the effect was not significant. Gizzard weight was also significantly increased.