Private healthcare sector spine surgery: patient and surgeon profiles from a large open medical scheme in South Africa.

Background It is generally understood that the profile of spine surgery varies by setting, based on factors such as the age profile of the population, the economic context and access to healthcare. Relatively little is known about the profile of spine surgery in South Africa, although one previous report from the public healthcare sector suggested a high burden of trauma and infection-related surgery. To our knowledge, there has been no formal investigation in the private sector. A holistic understanding of spine surgery within our setting may be beneficial for applications such as resource allocation and informing the training needs of future specialists.   Objectives To provide insight into spinal surgery in the South African private healthcare sector by describing spine surgery characteristics within a large open medical scheme, including both patient and surgeon profiles.   Methods This retrospective review included adult inpatient spine surgeries funded by the largest open medical scheme in South Africa between 2008 and 2017. An anonymized dataset extracted from the scheme records included patient demographics, ICD-10 codes, procedure codes and surgeon specialization. Descriptive patient and surgery data were presented. Furthermore, the association between patient and surgery factors and surgeon specialization was investigated using univariate and multivariate analyses.   Results A total of 49,576 index spine surgeries were included. The largest proportion of surgeries involved members 40-59 years old (n=23,543, 48%), approximately half involved female members (n=25,293, 51%) and most were performed by neurosurgeons (n=35,439, 72%). At least 37,755 (76%) surgeries were for degenerative pathology, 2,100 (4%) for trauma and 242 (0.5%) for infection. Adjusted risk ratios (aRR) significantly associated with orthopaedic surgeon specialization included cervical spine region aRR = 0.49 (95% C.I. 0.39-0.61), trauma aRR = 1.50 (95% C.I. 1.20-1.88), deformity aRR = 1.77 (95% C.I. 1.33-2.35) and blood transfusion aRR = 1.46 (95% C.I. 1.12-1.91).   Conclusion Spine surgery in South Africa's largest open medical scheme was dominated by surgery for degenerative pathology in older adults and was performed largely by neurosurgeons. This constituted a stark contrast to a previous report from the public sector and highlighted a mismatch between exposure during public sector registrar training and private practice post-specialization. The findings support the need for private-public collaboration as well as the importance of spine fellowships for all specialists intending to practice spine surgery.

Management of haematoma after thyroid surgery: systematic review and multidisciplinary consensus guidelines from the Difficult Airway Society, the British Association of Endocrine and Thyroid Surgeons and the British Association of Otorhinolaryngology, Head and Neck Surgery.

Haematoma after thyroid surgery can lead to airway obstruction and death. We therefore developed guidelines to improve the safety of peri-operative care of patients undergoing thyroid surgery. We conducted a systematic review to inform recommendations, with expert consensus used in the absence of high-quality evidence, and a Delphi study was used to ratify recommendations. We highlight the importance of multidisciplinary team management and make recommendations in key areas including: monitoring; recognition; post-thyroid surgery emergency box; management of suspected haematoma following thyroid surgery; cognitive aids; post-haematoma evacuation care; day-case thyroid surgery; training; consent and pre-operative communication; postoperative communication; and institutional policies. The guidelines support a multidisciplinary approach to the management of suspected haematoma following thyroid surgery through oxygenation and evaluation; haematoma evacuation; and tracheal intubation. They have been produced with materials to support implementation. While these guidelines are specific to thyroid surgery, the principles may apply to other forms of neck surgery. These guidelines and recommendations provided are the first in this area and it is hoped they will support multidisciplinary team working, improving care and outcomes for patients having thyroid surgery.

Bright light shows promise in improving sleep, depression, and quality of life in women with breast cancer during chemotherapy: findings of a pilot study.

Sleep and fatigue-associated symptoms are prominent during chemotherapy. The purpose of this pilot study was to examine bright light effects on sleep disruption, fatigue, daytime sleepiness, depression, and quality of life (QOL) in women with stage I-III breast cancer undergoing chemotherapy. In this 2-group randomized controlled trial (NCT02658708), participants were randomized to receive either blue-green light of 12,000 lux (experimental) or dim red light of 5 lux (control). Light therapy was self-administered using a light visor cap at home. Both groups received 30-minute daily light therapy for 21 consecutive days following the 2nd cycle of chemotherapy. Sleep quality, fatigue, daytime sleepiness, depression, and QOL were self-reported, and nocturnal sleep was monitored by ambulatory polysomnography before the initiation of chemotherapy (baseline) and following the light intervention (posttest). Relative change was assessed at posttest controlling for pretest scores. At posttest, the experimental group self-reported significantly shorter sleep latency than controls (10 vs. 20 min, p = .045) consistent with polysomnography findings (14 vs. 63 min). Polysomnography also revealed longer total sleep time (467 vs. 315 min) and higher sleep efficiency (74% vs. 58%) in experimental vs. controls. Participants receiving bright light experienced a 30% relative decrease in depression, while there was a 24% increase in the controls. The experimental group reported substantially fewer increases in symptom intensity than controls (33% vs. 166%). These findings suggest that bright light likely improved sleep quality and depression and mitigated worsening intensity of symptoms during the first three cycles of chemotherapy. However, features of bright light, e.g., treatment duration, frequency, and timing in relation to chemotherapy treatment require further investigation.

Interprofessional QI Training Enhances Competency and QI Productivity Among Graduates: Findings From Nationwide Children's Hospital.

PURPOSE: Significant resources are expended on quality improvement (QI) training courses. The authors sought to determine whether education provided in QI course training improves self-assessed QI content competence and QI-related productivity among course graduates. METHOD: "Quality Improvement Essentials" is a four-month didactic and experiential course designed to prepare multidisciplinary professionals to participate in and lead QI efforts at Nationwide Children's Hospital (NCH). This study used a milestone-based self-assessment survey of graduates from 2012 to 2014 to gauge change in participants' self-assessed QI competency after course completion. Four competency domains were evaluated: QI knowledge; testing and implementing change using teams; data management and analysis; and spreading and sustaining science. Metrics for assessing individual QI productivity were presentation or publication of QI work outside NCH; local, regional, or national QI teaching; serving on a local, regional, or national QI committee; appointment as a QI leader; involvement in an internal or external QI collaborative; and leading a maintenance of certification Part IV project approved by NCH. RESULTS: Course participation more than doubled participants' self-assessed QI competence across all four domains. Gains continued after the course, increasing with time rather than degrading. Self-assessed competency increase was significantly associated with increased QI productivity. CONCLUSIONS: Self-assessed QI competence dramatically improved after participation in an educational course and continued to increase over time. Increased self-assessed QI competency correlated with increased individual QI productivity. Further studies are necessary to fully evaluate "return on investment" for this type of course.

A Low Dose of Dietary Quercetin Fails to Protect against the Development of an Obese Phenotype in Mice.

The purpose of this study was to examine the effect of a 40% high-fat diet (HFD) supplemented with a dietary attainable level of quercetin (0.02%) on body composition, adipose tissue (AT) inflammation, Non-Alcoholic Fatty-Liver Disease (NAFLD), and metabolic outcomes. Diets were administered for 16 weeks to C57BL/6J mice (n = 10/group) beginning at 4 weeks of age. Body composition and fasting blood glucose, insulin, and total cholesterol concentrations were examined intermittently. AT and liver mRNA expression (RT-PCR) of inflammatory mediators (F4/80, CD206 (AT only), CD11c (AT only) TLR-2 (AT only), TLR-4 (AT only), MCP-1, TNF-α, IL-6 (AT only), and IL-10 (AT only)) were measured along with activation of NFκB-p65, and JNK (western blot). Hepatic lipid accumulation, gene expression (RT-PCR) of hepatic metabolic markers (ACAC1, SREBP-1, PPAR-γ), protein content of Endoplasmic Reticulum (ER) Stress markers (BiP, phosphorylated and total EIF2α, phosphorylated and total IRE1α, CHOP), and hepatic oxidative capacity were assessed (western blot). Quercetin administration had no effect at mitigating increases in visceral AT, AT inflammation, hepatic steatosis, ER Stress, decrements in hepatic oxidative capacity, or the development of insulin resistance and hypercholesterolemia. In conclusion, 0.02% quercetin supplementation is not an effective therapy for attenuating HFD-induced obesity development. It is likely that a higher dose of quercetin supplementation is needed to elicit favorable outcomes in obesity.

High-fat diets rich in saturated fat protect against azoxymethane/dextran sulfate sodium-induced colon cancer.

High-fat-diet (HFD) consumption is associated with colon cancer risk. However, little is known about how the lipid composition of a HFD can influence prooncogenic processes. We examined the effects of three HFDs differing in the percentage of total calories from saturated fat (SF) (6, 12, and 24% of total caloric intake), but identical in total fat (40%), and a commercially available Western diet (26 and 41% saturated and total fat, respectively) on colon cancer development using the azoxymethane (AOM)/dextran sulfate sodium (DSS) murine model. A second dose-response experiment was performed using diets supplemented with the saturated-fatty-acid (SFA)-rich coconut oil. In experiment 1, we found an inverse association between SF content and tumor burden. Furthermore, increased SF content was associated with reduced inflammation, increased apoptosis, and decreased proliferation. The second dose-response experiment was performed to test whether this effect may be attributed to the SF content of the diets. Consistent with the initial experiment, we found that high SF content was protective, at least in male mice; there was a decrease in mortality in mice consuming the highest concentration of SFAs. To explore a potential mechanism for these findings, we examined colonic mucin 2 (Muc2) protein content and found that the HFDs with the highest SF content had the greatest concentration of Muc2. Our data suggest that high dietary SF is protective in the AOM/DSS model of colon cancer, which may be due, at least in part, to the ability of SF to maintain intestinal barrier integrity through increased colonic Muc2.

Endoscopic lumbar discectomy under local anesthesia may be an alternative to microdiscectomy: A single centre's experience using the far lateral approach.

OBJECTIVES: Since the turn of the century, minimally invasive surgery has become increasingly widespread. Discectomy surgery has evolved from wide open to microscopic and now endoscopic. This study aims to demonstrate that transforaminal endoscopic discectomy is an alternative and safe approach for degenerative disk surgery. PATIENTS AND METHODS: Two year retrospective assessments of patients who underwent transforaminal endoscopic discectomy at a tertiary neurosurgical center in the United Kingdom by a single surgeon. Under strict confidentiality, data was collected from online patient data and PACS systems. Patient feedback was achieved using phone call follow up and clinic appointments. Standard statistical analysis was performed. RESULTS: 201 patients had endoscopic discectomy and the mean age was 41 years. Male:female ratio was 1.3:1.0. Mean time of onset of symptoms was 5.5 months and the most common level was L4/5 (53%). All endoscopic discectomies were performed under local anesthesia. Theater time was on average 110 min. 10 patients were lost to follow up. 95% of patients were discharged within 7h post operatively. Visual acuity score of the pain dropped from an average of 7/10 pre-operatively to 0-1/10 in 95% of patients two weeks post operatively. 87% patients went back to their normal daily activities within two weeks. There were no cases of CSF leak, hematoma formation or wound infection. 1% of patients developed a nerve root injury. 6% of patients had recurrent herniation and require microdiscectomy. CONCLUSION: Endoscopic discectomy can be an alternative approach to microdiscectomy. While it can take more expertise to perform endoscopic discectomy, our data shows that the far lateral endoscopic discectomy using the TESSYS technique has comparable outcomes to microdiscectomy.

Combination antibiotic treatment of serious methicillin-resistant Staphylococcus aureus infections.

Outcomes from methicillin-resistant Staphylococcus aureus (MRSA) infections are relatively poor, at least in part due to the limitations of vancomycin (the current standard treatment for MRSA). Combination antibiotic treatment for MRSA infections is an attractive alternative as it could address most of vancomycin's shortcomings, including poor tissue penetration, slow bacterial killing, and emerging resistance in some strains of MRSA. However, the theoretical promise of combination therapy for MRSA infections has not been borne out in most in vitro and animal studies. Multiple combinations have been tested and have been either antagonistic, indifferent, or have had conflicting findings in various studies. This includes combinations of two primarily active agents (such as vancomycin plus daptomycin or linezolid), or the addition of gentamicin or rifampin to either vancomycin or daptomycin. However, hope on this front has come from an unexpected quarter. Although MRSA is by definition inherently resistant to nearly all ß-lactam antibiotics, this class of drugs has consistently shown evidence of synergy with either daptomycin or vancomycin in over 25 separate in vitro studies, and a limited number of animal and human observational studies. However, there are currently insufficient data to recommend ß-lactam combination therapy in routine clinical use. Results of current and planned randomized controlled trials of this strategy are awaited.

Effects of adding supplemental tallow to diets containing distillers dried grains with solubles on fatty acid digestibility in growing pigs.

An experiment was conducted to measure the apparent ileal digestibility (AID) and apparent total tract digestibility (ATTD) of fatty acids in diets containing 0 or 30% corn distillers dried grains with solubles (DDGS) and 0, 5, or 10% tallow. Barrows (n = 24; initial BW = 25 kg) were surgically fitted with a T-cannula at the distal ileum. Pigs (n = 4/diet) were randomly assigned to diets: corn-soybean meal control (CON), CON plus 5% tallow (5T0D), CON plus 10% tallow (10T0D), CON plus 30% DDGS (0T30D), CON plus 5% tallow and 30% DDGS (5T30D), and CON plus 10% tallow and 30% DDGS (10T30D). Eight replicates per treatment were achieved by randomizing diets among pigs for a second collection period. Each pig was fed their respective diet for a 5-d adaptation period followed by 3-d fecal collection and 2-d ileal digesta collection periods. The AID and ATTD of fatty acids was calculated using the index method and acid-insoluble ash as an indigestible marker. When tallow was added to diets with 0% DDGS, there was no effect on AID of palmitic acid (C16:0) or SFA, while AID of stearic acid (C18:0) was increased (66.87% for CON, 72.06% for 5T0D, and 76.81% for 10T0D; P < 0.01). However, when diets contained 30% DDGS, the AID of all SFA was reduced as levels of tallow increased C16:0 (77.62% for 0T30D, 69.66% for 5T30D, and 68.43% for 10T30D), C18:0 (85.87% for 0T30D, 64.08% for 5T30D, and 61.25% for 10T30D), and SFA (79.88% for 0T30D, 68.23% for 5T30D, and 66.29% for 10T30D). The AID of MUFA was not affected when tallow was added to diets with 30% DDGS but actually increased in 5T0D and 10T0D. The amount of apparent ileal digested fatty acids increased with the addition of DDGS and tallow regardless of their digestibility. Amounts of ileal digested MUFA and PUFA increased when both DDGS (P < 0.01) and tallow (P < 0.01) were included in the diet compared to when either ingredient was excluded. For ileal digestible SFA, an interaction (P < 0.01) between DDGS and tallow was observed. Interactions between DDGS and tallow were observed for ATTD of all fatty acids (P < 0.01), except for linoleic acid and PUFA, which were not affected by dietary treatment. The amount of ileal digestible PUFA increased with tallow addition independent from the inclusion level of DDGS and it was a function the dietary concentration of the fatty acid. Adding tallow to corn-soybean based diets increased the amount of digested SFA, but in diets with DDGS, the increment in amount of ileal digestible SFA was less prominent due to lesser digestibility of SFA.

Effects of adding supplemental tallow to diets containing 30% distillers dried grains with solubles on growth performance, carcass characteristics, and pork fat quality in growing-finishing pigs.

Crossbred pigs (n = 315) were blocked by initial BW (6.8 ± 1.1 kg) and randomly assigned to 1 of 4 dietary treatments to evaluate the effects of dietary inclusion of tallow and corn distillers dried grains with solubles (DDGS) on pig growth, carcass traits, and pork fat quality. Diets consisted of a corn-soybean meal control diet (CON) and another 3 corn-soybean meal diets containing 5% tallow (T), 30% DDGS (D), or 5% tallow plus 30% DDGS (TD) in a 2 × 2 factorial arrangement of treatments. Diets were formulated to contain similar levels of available P and standardized ileal digestible Lys:ME among treatments. Pigs were housed in 40 pens, with 7 to 8 pigs per pen, to provide 10 replicates per treatment. Overall ADG did not differ among treatments. Compared with CON (2.76 kg/d) and T (2.59 kg/d), feeding 30% DDGS reduced the ADFI (interaction, P > 0.05) of pigs when fed with 5% tallow (2.45 kg/d for TD) but not when fed alone (2.76 kg/d for D). There was no effect of DDGS on overall G:F, but pigs fed diets with tallow had greater (P < 0.01) G:F (0.4) than pigs fed no tallow (0.37). Feeding tallow increased (P < 0.01) HCW, carcass yield, and backfat depth of pigs independent of DDGS. Feeding DDGS reduced (P < 0.01) belly firmness, as measured by belly flop angle, independent of tallow (D = 71.8° and TD = 57.7° vs. CON = 134.0° and T = 113.4°) and tallow also tended to reduce belly firmness (P < 0.10). Feeding DDGS and tallow reduced the concentration of SFA in belly fat, while the concentration of MUFA were increased (P < 0.01) by feeding tallow but not DDGS. Conversely, feeding DDGS increased (P < 0.01) the concentration of PUFA in belly fat but there was no effect of tallow. An interaction (P = 0.03) between DDGS and tallow for iodine value (IV) of belly fat was observed, in which addition of tallow or DDGS increased the IV of belly fat (64.22 for T and 71.22 for D vs. 59.01 for CON) but addition of both reduced IV (67.88 for TD). The IV of belly fat and backfat were correlated (P < 0.01) with the IV product of the diet fed in phase 3 (r = 0.49 and r = 0.81, respectively). In conclusion, adding 5% tallow to 30% DDGS diets improved G:F and carcass yield while reducing the IV of belly fat. However, pork fat firmness as measured by belly flop angle was not improved.

Zebrafish and clean water technology: assessing soil bioretention as a protective treatment for toxic urban runoff.

Urban stormwater contains a complex mixture of contaminants that can be acutely toxic to aquatic biota. Green stormwater infrastructure (GSI) is a set of evolving technologies intended to reduce impacts on natural systems by slowing and filtering runoff. The extent to which GSI methods work as intended is usually assessed in terms of water quantity (hydrology) and quality (chemistry). Biological indicators of GSI effectiveness have received less attention, despite an overarching goal of protecting the health of aquatic species. Here we use the zebrafish (Danio rerio) experimental model to evaluate bioinfiltration as a relatively inexpensive technology for treating runoff from an urban highway with dense motor vehicle traffic. Zebrafish embryos exposed to untreated runoff (48-96h; six storm events) displayed an array of developmental abnormalities, including delayed hatching, reduced growth, pericardial edema, microphthalmia (small eyes), and reduced swim bladder inflation. Three of the six storms were acutely lethal, and sublethal toxicity was evident across all storms, even when stormwater was diluted by as much as 95% in clean water. As anticipated from exposure to cardiotoxic polycyclic aromatic hydrocarbons (PAHs), untreated runoff also caused heart failure, as indicated by circulatory stasis, pericardial edema, and looping defects. Bioretention treatment dramatically improved stormwater quality and reversed nearly all forms of developmental toxicity. The zebrafish model therefore provides a versatile experimental platform for rapidly assessing GSI effectiveness.

Quercetin supplementation attenuates the progression of cancer cachexia in ApcMin/+ mice.

Although there are currently no approved treatments for cancer cachexia, there is an intensified interest in developing therapies because of the high mortality index associated with muscle wasting diseases. Successful treatment of the cachectic patient focuses on improving or maintaining body weight and musculoskeletal function. Nutraceutical compounds, including the natural phytochemical quercetin, are being examined as potential treatments because of their anti-inflammatory, antioxidant, and anticarcinogenic properties. The purpose of this study was to determine the effect of quercetin supplementation on the progression of cachexia in the adenomatous polyposis coli (Apc)(Min/+) mouse model of colorectal cancer. At 15 wk of age, C57BL/6 and male Apc(Min/+) mice were supplemented with 25 mg/kg of quercetin or vehicle solution mix of Tang juice and water (V) daily for 3 wk. Body weight, strength, neuromuscular performance, and fatigue were assessed before and after quercetin or V interventions. Indicators of metabolic dysfunction and inflammatory signaling were also assessed. During the treatment period, the relative decrease in body weight in the Apc(Min/+) mice gavaged with V (Apc(Min/+)V; -14% ± 2.3) was higher than in control mice gavaged with V (+0.6% ± 1.0), control mice gavaged with quercetin (-2% ± 1.0), and Apc(Min/+) mice gavaged with quercetin (Apc(Min/+)Q; -9% ± 1.3). At 18 wk of age, the loss of grip strength and muscle mass shown in Apc(Min/+)V mice was significantly attenuated (P < 0.05) in Apc(Min/+)Q mice. Furthermore, Apc(Min/+)V mice had an induction of plasma interleukin-6 and muscle signal transducer and activator of transcription 3 phosphorylation, which were significantly (P < 0.05) mitigated in Apc(Min/+)Q mice, despite having a similar tumor burden. Quercetin treatment did not improve treadmill run-time-to-fatigue, hyperglycemia, or hyperlipidemia in cachectic Apc(Min/+) mice. Overall, quercetin supplementation positively affected several aspects of cachexia progression in mice and warrants further exploration as a potential anticachectic therapeutic.

Dietary quercetin reduces chemotherapy-induced fatigue in mice.

PURPOSE: While fatigue is the most commonly reported symptom of chemotherapy, there are currently no effective treatments for chemotherapy-induced fatigue (CIF). We used a mouse model to examine the benefits of quercetin on CIF as measured by voluntary wheel running activity and sought to determine whether quercetin may be associated with a decrease in inflammation and/or anemia. METHODS: Mice were assigned to 1 of 4 groups: placebo-vehicle (Plac-PBS), placebo-5-fluorouracil (Plac-5FU), quercetin-vehicle (Quer-PBS), or quercetin-5-fluorouracil (Quer-5FU). All mice were given a daily injection of either 60 mg/kg of 5-FU or phosphate buffered saline (PBS) for 5 days. Quercetin (0.02%) treatment was administered in the food 3 days prior to 5-FU administration and for the duration of the experiment (ie, days -2 to 14). A second group of mice was sacrificed at 5 and 14 days post initial injection for assessment of monocyte chemoattractant protein-1 (MCP-1) and anemia. RESULTS: Voluntary wheel running was reduced in both the Plac-5FU and Quer-5FU groups following 5-FU injection (P < .05). However, the Quer-5FU group recovered to baseline levels by approximately day 7, whereas the Plac-5FU group remained suppressed. MCP-1 was significantly elevated at 14 days in Plac-5FU (P < .001), but no changes were seen with Quer-5FU. Treatment with 5-FU resulted in anemia at both 5 days and 14 days; however, quercetin blocked this effect at 14 days (P < .001). CONCLUSION: These results demonstrate the beneficial effect of quercetin on improving recovery of voluntary physical activity following 5-FU treatment, which may be linked to a decrease in inflammation and anemia.

Concepts relating magnetic interactions, intertwined electronic orders, and strongly correlated superconductivity.

Unconventional superconductivity (SC) is said to occur when Cooper pair formation is dominated by repulsive electron-electron interactions, so that the symmetry of the pair wave function is other than an isotropic s-wave. The strong, on-site, repulsive electron-electron interactions that are the proximate cause of such SC are more typically drivers of commensurate magnetism. Indeed, it is the suppression of commensurate antiferromagnetism (AF) that usually allows this type of unconventional superconductivity to emerge. Importantly, however, intervening between these AF and SC phases, intertwined electronic ordered phases (IP) of an unexpected nature are frequently discovered. For this reason, it has been extremely difficult to distinguish the microscopic essence of the correlated superconductivity from the often spectacular phenomenology of the IPs. Here we introduce a model conceptual framework within which to understand the relationship between AF electron-electron interactions, IPs, and correlated SC. We demonstrate its effectiveness in simultaneously explaining the consequences of AF interactions for the copper-based, iron-based, and heavy-fermion superconductors, as well as for their quite distinct IPs.

Live production and carcass characteristics of broilers fed a blend of poultry fat and corn oil derived from distillers dried grains with solubles.

Corn distillers dried grains with solubles (DDGS) are now being further processed to remove corn oil, which may be used as a dietary energy source for poultry. The objectives of this study were to compare the effects of a poultry fat (PF) and a new DDGS-derived corn oil blend (CO) on live performance and carcass characteristics of 49-d-old broilers. Four corn-soybean meal based diets were formulated with differing blends of PF and CO. All diets contained the same percentage of total fat, but differed in the fat source. One diet had the sole source of fat as PF (100:0% PF:CO) and was then replaced with 25% CO, 75% CO, and a 100% replacement of CO. Each of the diets was fed in a 3-phase feeding program to 6 replicate pens. At day of hatch, Ross × Ross 708 broilers were randomly allocated to 24 pens composed of 42 birds of equal sex. On d 49, 10 birds from each pen were processed, and carcass, abdominal fat pad, and breast muscle components were determined. There were no significant differences in live performance for the starter phase (0-18 d). For the grower phase (19-35 d), birds fed 75:25% PF:CO significantly (P ≤ 0.05) increased BW, BW gain, and decreased feed conversion compared with the control (100:0% PF:CO). Birds fed 0:100% PF:CO also observed similar improvements in BW, BW gain, and feed conversion during the grower phase. There were no significant differences for the finisher phase (36-48 d). On d 49, live weights for birds fed the 0:100% PF:CO diets were significantly lower compared with other treatments. A trend for lower carcass and breast weights and increased abdominal fat was also observed for birds fed the 0:100% PF:CO. The addition of CO led to significant improvements in pellet durability for grower and finisher pellets. The results of this study indicate that DDGS-derived CO can be used to partially replace PF in broiler diets without any detrimental effects.

A comprehensive environmental assessment approach to engineered nanomaterials.

The anticipated benefits of engineered nanomaterials (ENMs) should be weighed against their possible negative impacts. Comprehensive environmental assessment (CEA) provides a means of evaluating such trade-offs in a holistic and systematic manner. CEA consists of both a framework for organizing information and a process for using collective judgment to identify and prioritize the issues presented by ENMs. As a meta-assessment approach, CEA is designed to assist both research planners and risk managers by building on various assessment and analytic tools used by risk assessors. Given the immature state of the science for ENMs, CEA is currently being primarily used for prioritizing research directions. Therefore, highlights of case studies of selected ENM applications are presented to illustrate how CEA has been applied thus far to help guide research efforts to support future assessment efforts. In addition, CEA is discussed in relation to topical subjects, such as sustainability, transparency, and stakeholder engagement. Finally, comparisons to other life cycle-based assessment approaches directed at ENMs are noted.

Comprehensive environmental assessment: a meta-assessment approach.

With growing calls for changes in the field of risk assessment, improved systematic approaches for addressing environmental issues with greater transparency and stakeholder engagement are needed to ensure sustainable trade-offs. Here we describe the comprehensive environmental assessment (CEA) approach as a holistic way to manage complex information and to structure input from diverse stakeholder perspectives to support environmental decision-making for the near- and long-term. We further note how CEA builds upon and incorporates other available tools and approaches, describe its current application at the U.S. Environmental Protection Agency, and point out how it could be extended in evaluating a major issue such as the sustainability of biofuels.

Soy protein isolate modified metabolic phenotype and hepatic Wnt signaling in obese Zucker rats.

We have previously shown that soy protein isolate (SPI) with intact phytoestrogen content prevented obesity-related dysfunction. Recent data have suggested that soy ingredients may act as regulators of adipogenic programming in adipose tissue (AT) and liver. Thus, the current study was undertaken to determine whether the beneficial effects of SPI are linked to changes in adipogenic regulators, such as the Wnt signaling cascade. For this, lean (LZR) and obese Zucker (OZR) rats were provided isocaloric and isonitrogenous diets containing SPI, sodium caseinate, or dairy whey protein for 17 weeks. At termination, SPI increased body weight and total adiposity in rodents, which corresponded with an increase in both adipocyte size and number. Furthermore, markers of inflammation, hypercholesterolemia, and hepatic steatosis were all reduced in OZR rats provided SPI. Transcript abundance of several canonical and noncanonical Wnt signaling intermediates in liver, but not AT, was distinctly modified by SPI. Collectively, these data confirm the protective SPI attenuated obesity-related metabolic dysfunction conceivably through regulation of adipogenic programming, as evident by changes in AT morphology and hepatic Wnt signaling. Collectively, this study confirmed the potential utilization of soy protein and its bioactive ingredients for prevention and treatment of obesity-related comorbidities.

Effect of replacing solvent-extracted canola meal with high-oil traditional canola, high-oleic acid canola, or high-erucic acid rapeseed meals on rumen fermentation, digestibility, milk production, and milk fatty acid composition in lactating dairy cows.

The objective of this experiment was to investigate the effects of replacing conventional, solvent-extracted canola meal (control; CTRL) with high oil content; conventional, mechanically extracted canola meal (CMEC); high-oleic, low polyunsaturated fatty acid (FA) canola meal (HOLL); and high-erucic acid, low-glucosinolate rapeseed meal (RPS) on rumen function, digestibility, milk production, and milk FA composition in lactating dairy cows. The experimental design was a replicated 4×4 Latin square with 8 lactating dairy cows. Four of the cows were ruminally cannulated. All oilseed meals were included at approximately 12 to 13% of dietary dry matter (DM). Crude protein and fat concentrations (% of DM) of the meals were 43 and 3.1%, 32.8 and 16.1%, 45.2 and 13.7%, and 34.3 and 17.9% for CTRL, CMEC, HOLL, and RPS, respectively. All diets were formulated to supply net energy of lactation in excess of requirements. The CMEC and RPS diets were predicted to be about 1% deficient in metabolizable protein. Relative to the CTRL, inclusion of high-oil seed meals in the diet lowered ruminal acetate concentration and the molar acetate:propionate ratio and decreased DM intake. Milk yield generally followed DM intake and was lower for CMEC and RPS than the CTRL. Treatments had no effect on milk composition, other than an increase in milk urea nitrogen concentration for HOLL. Fat-corrected milk (3.5%) feed efficiency was increased by HOLL and RPS compared with CTRL. Urinary urea nitrogen losses were increased by HOLL, which, as a consequence, increased the ammonia-emitting potential of manure. The ratio of milk N-to-N intake was greater for CMEC and RPS. Replacing solvent-extracted canola meal with the high-oil meal decreased milk fat 12:0, 14:0, 16:0, and total saturated FA content and enhanced cis-9 18:1 and total monounsaturated FA concentrations. Relative to the CTRL, canola increased total trans FA in milk, whereas inclusion of HOLL in the diet increased trans-11 18:1 and cis-9, trans-11 CLA content. The RPS increased milk fat cis-13 22:1 content from 0.07 to 2.33 g/100g of FA. In conclusion, HOLL or RPS, which are likely to come from small-scale biodiesel plants where oil is cold pressed without hexane extraction, fed at levels at or above 12 to 13% of dietary DM may decrease feed intake and milk production, but can be used to alter milk FA composition in lactating dairy cows.