Longitudinal Impacts of Precision Greenness on Alzheimer's Disease.

BACKGROUND: The potential for greenness as a novel protective factor for Alzheimer's disease (AD) requires further exploration. OBJECTIVES: This study assesses prospectively and longitudinally the association between precision greenness - greenness measured at the micro-environmental level, defined as the Census block - and AD incidence. DESIGN: Older adults living in consistently high greenness Census blocks across 2011 and 2016 were compared to those living in consistently low greenness blocks on AD incidence during 2012-2016. SETTING: Miami-Dade County, Florida, USA. PARTICIPANTS: 230,738 U.S. Medicare beneficiaries. MEASUREMENTS: U.S. Centers for Medicare and Medicaid Services Chronic Condition Algorithm for AD based on ICD-9 codes, Normalized Difference Vegetation Index, age, sex, race/ethnicity, neighborhood income, and walkability. RESULTS: Older adults living in the consistently high greenness tertile, compared to those in the consistently low greenness tertile, had 16% lower odds of AD incidence (OR=0.84, 95% CI: 0.76-0.94, p=0.0014), adjusting for age, sex, race/ethnicity, and neighborhood income. Age, neighborhood income and walkability moderated greenness' relationship to odds of AD incidence, such that younger ages (65-74), lower-income, and non-car dependent neighborhoods may benefit most from high greenness. CONCLUSIONS: High greenness, compared to low greenness, is associated with lower 5-year AD incidence. Residents who are younger and/or who reside in lower-income, walkable neighborhoods may benefit the most from high greenness. These findings suggest that consistently high greenness at the Census block-level, may be associated with reduced odds of AD incidence at a population level.

The impact and indications for Oncotype DX on adjuvant treatment recommendations when third-party funding is unavailable.

OBJECTIVES: Industry-supported decision impact studies demonstrate that Oncotype Dx (ODX) changes treatment recommendations (TR) in 24-40% of hormone receptor+/HER2- patients. ODX is not reimbursed by third-party payers in Australia, potentially resulting in more selective use. We sought to evaluate the impact of self-funded ODX on TRs. METHODS: Data collected included demographics, tumor characteristics, indication for ODX and pre- and post-recurrence score (RS) TR. Primary endpoint was frequency of TR change and associations with TR change were sought. RESULTS: Eighteen physicians contributed 382 patients (median age 54). A total of 232 (61%) of tumors were T1 and were grade 1, 2 and 3 in 49 (13%), 252 (66%) and 79 (21%). A total of 257 (67%) were node negative. Assay indications were: confirm need for chemotherapy (CT) (36%), confirm omission of CT (40%) and genuine equipoise (24%). RS was low (≤17) in 55%, intermediate (18-31) in 36% and high (≥32) in 9%. Thirty-eight percent of patients had TR change post-ODX. Sixty-five percent of patients recommended CT pre-ODX changed to hormone therapy alone (HT)-more likely if lower grade and if ER and/or PR > 10%. Fourteen percent of patients with pre-ODX TR for HT added CT-more likely if ER and/or PR ≤10% and if Ki67 > 15% Overall, TR for CT decreased from 47% to 24%. CONCLUSION: Patient-funded ODX changed TRs in 38% of patients, de-escalating 65% from CT to HT and adding CT to 14% of those recommended HT. These changes were greater than an industry-funded study suggesting that physicians can identify situations where the assay may influence decisions.

Preweaned heifer management on US dairy operations: Part V. Factors associated with morbidity and mortality in preweaned dairy heifer calves.

The objective of this study was to evaluate morbidity and mortality in preweaned dairy heifer calves based on different health, feeding, and management practices, as well as environmental factors. This study was conducted as part of the calf component of the National Animal Health Monitoring System's Dairy 2014 study, which included 104 dairy operations in 13 states. The calf component was an 18-mo longitudinal study focused on dairy heifer calves from birth to weaning; data were collected on 2,545 calves. The percentage morbidity for all calves enrolled in the study was 33.9%. Backward elimination model selection was used after univariate screening to determine which management practices and environmental factors significantly affected morbidity and mortality. The final morbidity model included birth weight, serum IgG concentration, ventilation type, and average temperature-humidity index (THI) during the preweaning period. After controlling for other independent variables in the model, calves born at a higher birth weight had a lower predicted risk of morbidity than calves with a lower birth weight. An increase in serum IgG concentration was associated with decreased morbidity. Calves housed in positive- or cross-ventilated systems had a 2.2 times higher odds of developing disease compared with calves housed in natural ventilation systems. Average THI during the preweaning period was inversely correlated with morbidity; as THI increased, the predicted morbidity risk decreased. The percent mortality for all calves enrolled in the study was 5.0%. The final mortality model included birth weight, serum IgG concentration, amount of fat/day in the liquid diet, and morbidity. After controlling for other independent variables in the model, calves born at a higher birth weight had a lower risk of mortality. An increase in serum IgG concentration decreased the risk of mortality. The odds of mortality were 3.1 times higher in calves fed ≤0.15 kg of fat/d in the liquid diet compared with calves fed ≥0.22 kg of fat/d. The odds of mortality were 4.7 times higher in calves that experienced any disease throughout the preweaning period than in calves with no disease. In summary, morbidity and mortality were both associated with birth weight and serum IgG concentration. Additionally, morbidity was associated with ventilation type and average monthly THI, and mortality was associated with amount of fat per day in the liquid diet and morbidity.

Estimating milk yield and value losses from increased somatic cell count on US dairy farms.

Milk loss due to increased somatic cell counts (SCC) results in economic losses for dairy producers. This research uses 10 mo of consecutive dairy herd improvement data from 2013 and 2014 to estimate milk yield loss using SCC as a proxy for clinical and subclinical mastitis. A fixed effects regression was used to examine factors that affected milk yield while controlling for herd-level management. Breed, milking frequency, days in milk, seasonality, SCC, cumulative months with SCC greater than 100,000 cells/mL, lactation, and herd size were variables included in the regression analysis. The cumulative months with SCC above a threshold was included as a proxy for chronic mastitis. Milk yield loss increased as the number of test days with SCC ≥100,000 cells/mL increased. Results from the regression were used to estimate a monetary value of milk loss related to SCC as a function of cow and operation related explanatory variables for a representative dairy cow. The largest losses occurred from increased cumulative test days with a SCC ≥100,000 cells/mL, with daily losses of $1.20/cow per day in the first month to $2.06/cow per day in mo 10. Results demonstrate the importance of including the duration of months above a threshold SCC when estimating milk yield losses. Cows with chronic mastitis, measured by increased consecutive test days with SCC ≥100,000 cells/mL, resulted in higher milk losses than cows with a new infection. This provides farm managers with a method to evaluate the trade-off between treatment and culling decisions as it relates to mastitis control and early detection.

Associations between housing and management practices and the prevalence of lameness, hock lesions, and thin cows on US dairy operations.

The objective of this study was to determine the association among different housing and management practices on the prevalence of lameness, hock lesions, and thin cows on US dairy operations. This study was conducted as part of the National Animal Health Monitoring System's Dairy 2014 study, which included dairy operations in 17 states. Size categories were assigned as follows: small (30-99 cows), medium (100-499 cows), and large (≥500 cows). Trained assessors visited 191 dairy operations from March through July 2014 and recorded locomotion and hock scores (on a 3-point scale), and the number of thin cows (body condition score ≤2.25) from a total of 22,622 cows (average 118 cows per farm). The majority of cows (90.4%) were considered to be sound (locomotion score = 1), 6.9% were mild/moderately lame (locomotion score = 2), and 2.7% were severely lame (locomotion score = 3). Similarly, most cows (87.3%) had no hock lesions (hock score = 1), 10.1% had mild lesions (hock score = 2), and 2.6% had severe hock lesions (hock score = 3). A low percentage of cows (4.2%) were thin. Univariate comparisons were performed using PROC LOGLINK, which accounts for study design and weighting. Variables meeting the univariate screening criterion of P < 0.20 were eligible for entry into multivariable models. Statistical significance in the multivariable models was declared at P < 0.05. Large operations had a lower within-herd prevalence of cows with locomotion score ≥2 and locomotion score = 3 compared with small or medium-sized operations. Operations on which cows were kept primarily on pasture had a lower percentage of locomotion score = 3 than those housed in freestall or open/dry lot operations. The use of sand bedding was associated with a lower within-herd prevalence of locomotion score ≥2 than straw/hay or dry/composted manure as the primary bedding material. Sand bedding was also associated with a lower within-herd prevalence of locomotion score = 3 than other bedding types except for rubber mats or mattresses. Operations that housed cows in an open/dry lot had a lower percentage of hock score ≥2 and hock score = 3 than other housing types. Providing sprinklers for heat abatement and having a nutritionist balance rations for cows was associated with a lower percentage of thin cows. Results from this study highlight management practices that may reduce the prevalence of lameness, hock lesions, and thin cows on dairy operations in the United States.

Prevalence of failure of passive transfer of immunity in newborn heifer calves and associated management practices on US dairy operations.

Failure of passive transfer of immunity (FPT) in dairy replacement calves has been linked to increased neonatal morbidity and mortality and long-term decreases in productivity. The purpose of this study was to estimate the prevalence of FPT in US dairy heifer calves in 2007 and to use nationally representative data to investigate associations of FPT with colostrum and calf management practices. A cross-sectional study was conducted by the USDA's National Animal Health Monitoring System between January and August 2007. Producers from 394 operations in 17 states completed survey questions about colostrum and calf management practices, and serum samples were collected from 1,816 healthy heifer calves on those operations. Serum immunoglobulin G (IgG) levels were determined by radial immunodiffusion, and calves were classified as having FPT if the IgG concentration was less than 10 mg/mL. To investigate associations between FPT and management practices, a multivariable analysis was completed using a weighted logistic regression model. The estimated prevalence of FPT in US dairy heifer calves was 19.2%. The odds of FPT were higher for calves on operations that pooled colostrum [odds ratio (OR = 2.2)], allowed nursing (OR = 2.4), or hand fed colostrum more than 4 h after birth (OR = 2.7). The odds of FPT were also higher for calves on operations that did not provide a source of heat during cold weather for calves experiencing a dystocia (OR = 1.6), would not seek veterinary assistance when unable to correctly position a calf for delivery (OR = 2.6), or did not routinely monitor serum proteins in calves as a measure of passive transfer (OR = 13.8). The prevalence of FPT in dairy heifer calves has decreased in the last 15 yr, so progress has been made in this important area of calf management. This study identified several management practices associated with FPT that could be targeted for educational campaigns or further research.

Factors associated with occurrence and recovery of nonambulatory dairy cows in the United States.

The primary objective of this study was to compare characteristics of US dairy operations that had one or more nonambulatory cows (unable to rise for any period of time) (cases) with operations that had no nonambulatory cows (controls) during 2004. A secondary objective was to describe factors associated with recovery of the last nonambulatory cow on the operation during 2004. Case dairy operations (n = 1,822) more often fed a total mixed ration [odds ratio (OR) = 2.0; confidence interval (CI): 1.1-3.4], produced more than 9,090 kg of milk (OR = 2.8; CI: 1.8-4.5), and were more likely to be of medium to large herd size (100 or more head of adult cows, OR = 3.7; CI: 2.2-6.2) compared with control dairies (n = 151). Compared with operations where the predominant flooring surface on which lactating cows stood or walked in winter was pasture, operations where pasture was not the predominant surface were at increased risk of having nonambulatory cows (OR = 4.7; CI: 2.2-10.2). Cows nonambulatory for less than 24 h were more likely to recover compared with cows nonambulatory for 24 h or more (OR = 3.0; CI: 2.0-4.4). Cows that received calcium, phosphorus, or potassium while non-ambulatory were more likely to recover (OR = 3.6; CI: 2.1-6.1) than cattle that did not receive these treatments. Cattle that were not repositioned periodically were more likely to recover (OR = 2.1; CI: 1.4-3.1), as were cattle that were not treated by a veterinarian before becoming nonambulatory (OR = 1.9; CI: 1.1-3.3). These findings are consistent with prolonged recumbency and prior history of health issues, respectively. Nonambulatory cattle with hypocalcemia were more likely to recover (OR = 6.0; CI: 3.4-10.7) compared with nonambulatory cows with all other causes of a nonambulatory condition (analyzed collectively as a single variable but including cancer, clinical mastitis, digestive conditions, metabolic imbalances, neurological problems, respiratory disease, other, unknown). The results of this study reveal that the majority of US dairy operations have at least one nonambulatory dairy cow over the course of a year. Additionally, individual animal factors associated with being nonambulatory may lead to improved identification and treatment of animals that are nonambulatory for a prolonged period. From the perspective of recovery, considering euthanasia is appropriate for cows that have been nonambulatory for more than 24 h.

Assessment of muscle blood flow by laser-Doppler flowmetry during hemorrhage in SHR.

Skeletal muscle blood flow was assessed via laser-Doppler flowmetry (LDF) in the gracilis muscle of anesthetized 12- to 15-wk-old spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto (WKY) control rats subjected to graded hemorrhage. Tissue perfusion was assessed at 20 specific sites in the muscle before and 20 min after each of five successive 1-ml withdrawals of blood. Mean LDF signals recorded from the gracilis muscle of SHR and WKY were similar during the prehemorrhage control period. After hemorrhage, mean arterial pressure and calculated vascular resistance of the gracilis muscle were higher in SHR than in WKY, and SHR exhibited a greater reduction of LDF signal in response to hemorrhage than WKY. Although SHR and WKY had a similar number of low flow sites (LDF signal less than 0.17 V) during the control period, successive blood volume withdrawals led to a significantly greater increase in the number of poorly perfused areas in the muscles of the hypertensive animals. The results of this study suggest that LDF is a useful tool to assess tissue perfusion during circulatory stress and that hemorrhage causes a greater decrease in skeletal muscle blood flow in SHR than in WKY. More severe reductions in tissue perfusion may contribute to the reduced ability of hypertensive animals to survive after hypotensive hemorrhage.

An ALARA approach to the radiological control of foodstuffs following an accidental release.

This article presents a methodology based on two complementary approaches, thus allowing a selection of maximal concentration in foodstuffs for determining appropriate countermeasures. The first approach is based on a minimal and maximal per capita intervention level and takes into account the annual intake of each product. The second one is based on a cost-benefit analysis, comparing the advantages of a countermeasure concerning those products presenting a contamination higher than a given maximal concentration (in terms of reduction of cost of the detriment associated with the risk), with its drawbacks (in terms of cost of the products) in order to select the "ALARA" maximal concentration. This second approach is used as a complement to the first one. The results obtained through these two approaches are given for four products (milk, meat, fresh vegetables, and corn) and two nuclides (Cs-137 and I-131). These are presented for various scenarios: one or various products contaminated by one or various radionuclides. It is concluded that these two approaches are complementary, the first one being related to individual risk and the second to collective risk. Therefore, these approaches are both of interest in the context of the elaboration of modalities for the radiological control of foodstuffs following an accidental release and both methods may be useful for determining appropriate countermeasures.