Correction to: Global dietary calcium intake among adults: a systematic review.

The original Electronic Supplementary Material file 3 contained an erroneous reference for Mali. A link to the corrected file is provided here.

Distal-less 3 haploinsufficiency results in elevated placental oxidative stress and altered fetal growth kinetics in the mouse.

Distal-less 3 (Dlx3)(-/-) mice die at E9.5 presumably due to an abnormal placental phenotype including reduced placental vasculature and secretion of placental growth factor. To examine the role of Dlx3 specifically within the epiblast, Dlx3 conditional knockout mice were generated using an epiblast-specific Meox2(CreSor) allele. Dlx3(-/fl), Meox2(CreSor) animals were born at expected frequencies and survived to weaning providing indirect evidence that loss of Dlx3 within the trophoectoderm plays a critical role in fetal survival in the Dlx3(-/-) mouse. We next examined the hypothesis that loss of a single Dlx3 allele would have a negative impact on placental and fetal fitness. Dlx3(+/-) mice displayed reduced fetal growth beginning at E12.5 compared with Dlx3(+/+) controls. Altered fetal growth trajectory occurred coincident with elevated oxidative stress and apoptosis within Dlx3(+/-) placentas. Oral supplementation with the superoxide dismutase mimetic, Tempol, rescued the fetal growth and placental cell death phenotypes in Dlx3(+/-) mice. To determine the potential mechanisms associated with elevated oxidative stress on the Dlx3(+/-) placentas, we next examined vascular characteristics within the feto-placental unit. Studies revealed reduced maternal spiral artery luminal area in the Dlx3(+/-) mice receiving water; Dlx3(+/-) mice receiving Tempol displayed maternal spiral artery luminal area similar to control Dlx3(+/+) mice. We conclude that reduced Dlx3 gene dose results in diminished fetal fitness associated with elevated placental cell oxidative stress and apoptosis coincident with altered vascular remodeling. Administration of antioxidant therapy ameliorated this feto-placental phenotype, suggesting that Dlx3 may be required for adaptation to oxidative stresses within the intrauterine environment.

Hyperplastic goitre and mortality in captive-reared black stilts ( Himantopus novaezelandiae ).

AIM: To study the gross, histopathological and clinico-pathological findings in cases of hyperplastic goitre in sub-adult captive- reared black stilts following their release on riverbeds in the south Canterbury region of New Zealand. METHODS: Necropsies were undertaken on the recovered carcasses of 48 black stilts over a 3-year period (1997-1999). The cause of death was determined, and thyroid glands were examined histopathologically and compared with those of free-living pied stilts. Concentrations of triiodothyronine (T3) and thyroxine (T4) in the serum of sub-adult and adult stilts were measured before and after iodine supplementation. RESULTS: The main causes of death of captive-reared black stilts following release were trauma, predation and starvation. An increase in size of the thyroid gland due to follicular hyperplasia and dilation was seen in all birds with intact thyroid glands (n=27). Dysplastic follicular changes such as epithelial desquamation, lipid deposition and haemorrhage were common in a large proportion of individuals with goitre. Dietary supplementation with iodine greatly improved survival rates in sub-adults following release, and significantly increased concentrations of T3 and T4 in serum. CONCLUSIONS: Subclinical goitre due to thyroid hyperplasia and dysplasia was the cause of hypothyroidism and this contributed to the poor survival of released sub-adult black stilts raised in captivity. Iodine supplementation of the diet of captive adults and sub-adults resulted in increased concentrations of T3 and T4 in serum and improved survivability.

Effects of dry period length on milk production and health of dairy cattle.

Holstein cows (n = 781) in a commercial dairy herd were used in a randomized design to evaluate 2 dry period (DP) management strategies on milk production, milk components, milk quality, colostrum quality, and incidence of metabolic disorders. Cows were randomly assigned to a traditional 55 d (T) or shortened 34 d (S) DP. Cows assigned to T were fed a low-energy diet until 34 d before expected calving at which time all cows were fed a moderate-energy transition diet until calving. Postpartum, cows assigned to T produced more milk and tended to produce more solids-corrected milk than cows on S. Treatment differences in milk and solids-corrected milk yield were accounted for by cows in their second lactation. Milk fat percentage did not differ between treatments, but milk protein percentage was greater for cows assigned to S. Colostrum quality measured as IgG concentration did not differ between management strategies. Somatic cell score and cases of mastitis were not affected by management strategy. There was a tendency for prepartum nonesterified fatty acid (NEFA) to be lower for cows assigned to T compared with S. However, postpartum, cows assigned to S had significantly lower NEFA concentrations than those assigned to T. The incidences of ketosis, retained placenta, displaced abomasum, and metritis did not differ between treatments. Postpartum energy balance, as indicated by plasma NEFA, may have been improved for cows assigned to S; there was no detectable effect on animal health.

Use of the vacuum extractor by midwives--what has changed in the last decade?

This article provides an update on use of vacuum extraction by certified nurse-midwives (CNMs) and certified midwives (CMs). Research findings from the last decade relevant to the training and use of vacuum extractors are reviewed along with professional guidelines and legal implications.

Maternal nutritional risk factors for small for gestational age babies in a developed country: a case-control study.

AIMS: To assess the effect of maternal diet during pregnancy on the risk of delivering a baby who is small for gestational age (SGA). METHODS: Case-control study of 844 cases (SGA) and 870 controls (appropriate size for gestational age (AGA)). Only term (37+ completed weeks of gestation) infants were included. Retrospective food frequency questionnaires were completed at birth on the diet at the time of conception and in the last month of pregnancy. RESULTS: At the time of conception, mothers of AGA infants ate significantly more servings of carbohydrate rich food and fruit, and were more likely to have taken folate and vitamin supplements than mothers of SGA infants. There was some evidence that mothers of AGA infants also ate more servings of dairy products, meat, and fish (0.05 < p < 0.1). However, after adjustment for maternal ethnicity, smoking, height, weight, hypertension, and occupation, fish intake (p = 0.04), carbohydrate-rich foods (p = 0.04), and folate supplementation (p = 0.02) were associated with a reduced risk of SGA. In the last month of pregnancy, only iron supplementation was associated with a reduced risk of SGA (p = 0.05) after adjustment for potential confounders. CONCLUSIONS: This study suggests that small variations in maternal diets within the normal range during pregnancy in developed countries are associated with differences in birth weight.

A magnetic resonance imaging based method for measurement of tissue iron concentration in liver arterially embolized with ferrimagnetic particles designed for magnetic hyperthermia treatment of tumors.

Rabbit liver was loaded with ferrimagnetic particles of gamma -Fe2 O3 (designed for magnetic hyperthermia treatment of liver tumors) by injecting various doses of a suspension of the particles into the hepatic artery in vivo. Proton transverse relaxation rate (R(2)) images of the livers in vivo, excised, and dissected were generated from a series of single spin-echo images. Mean R(2) values for samples of ferrimagnetic-particle-loaded liver dissected into approximate 1 cm cubes were found to linearly correlate with tissue iron concentration over the range from approximately 0.1 to at least 2.7 mg Fe/g dry tissue when measured at room temperature. Changing the temperature of ferrimagnetic-particle-loaded samples of liver from 1 degrees C to 37 degrees C had no observable effect on tissue R(2) values. However, a small but significant decrease in R(2) was found for control samples containing no ferrimagnetic material on raising the temperature from 1 degrees C to 37 degrees C. Both chemically measured iron concentrations and mean R(2) values for rabbit livers with implanted tumors tended to be higher than those measured for tumor-free liver. This study indicates that tissue R(2) measurement and imaging by nuclear magnetic resonance may have a useful role in magnetic hyperthermia therapy protocols for the treatment of liver cancer.

Corn pollen deposition on milkweeds in and near cornfields.

The density of corn pollen on leaves of milkweed plants inside and outside of cornfields was measured in several studies from different localities. The purpose was to obtain a representative picture of naturally occurring pollen densities to provide a perspective for laboratory and field studies of monarch larvae feeding on milkweed leaves with Bt corn pollen. Pollen density was highest (average 170.6 grains per cm(2)) inside the cornfield and was progressively lower from the field edge outward, falling to 14.2 grains per cm(2) at 2 m. Inside the cornfield, and for each distance from the field edge, a frequency distribution is presented showing the proportion of leaf samples with different pollen densities. Inside cornfields, 95% of leaf samples had pollen densities below 600 grains per cm(2) and the highest pollen density observed was 1400 grains per cm(2), which occurred in a study with a rainless anthesis period. All other studies had rainfall events during the anthesis period. A single rain event can remove 54-86% of the pollen on leaves. Leaves on the upper portion of milkweed plants, where young monarch larvae tend to feed, had only 30-50% of the pollen density levels of middle leaves.

An audit of the investigation and use of anti-D immunoglobulin prophylaxis in Tayside.

OBJECTIVES: To audit the implementation of national guidelines on the investigation and management of RhD disease in Tayside. SETTING: Tayside region. DESIGN: An eight month retrospective audit. RESULTS: Two hundred and eighty eight completed pregnancies in RhD negative women were observed from a total of 1879 deliveries. Of these, 120 RhD negative and 169 RhD positive babies were delivered from women who had not previously been sensitised. At delivery, anti-D was used appropriately in all cases. Of those assessed to require anti-D (n = 168), 91% received it within 24 hours of delivery. In 59 RhD negative subjects, 75 potential sensitising events occurred antenatally. In 45 of these, the event occurred after 20 weeks gestation and 44 received appropriate anti-D. In 11 (23.7%) of these, no foetomaternal haemorrhage assessment was carried out. CONCLUSION: Despite a significant increase in awareness of antenatal prophylaxis since a previous audit in the region, there is still a significant failure to request FMH assessments following potential antenatal sensitising episodes and after delivery. During the audit period, an EDTA plasma gell-based antibody detection system was commissioned in the region. This has allowed the introduction of internal laboratory referral for FMH assessment. This has allowed accurate knowledge on the possible occurrence of FMH at delivery, but has not had a significant impact on antenatal events.

The ethics of alternative medicine therapies.

It is estimated that 42% of the American public is using some form of alternative medicine, which reflects the changing needs and values in our society. Unfortunately, Western medicine has failed to see alternative medicine as complementary and integrative with conventional medicine. This is due to the fact that there is very little scientific data available regarding the safety, efficacy, optimal dosage and side-effects or interactions of these alternative medicine therapies. Many physicians dismiss a patient's questions concerning alternative medicine because the physician believes it is "quackery," without any proof to support this claim. This violates the patient's right to full disclosure of all possible treatment options and encourages patients to use these therapies without their physician's knowledge. As a result, it is estimated that 46% of those using alternative medicine do so without the supervision of their primary care physicians or alternative medicine practitioners. At the present time there is no regulatory process to ensure the safety and efficacy of these alternative medicine therapies. Manufacturers do not have to prove that their product works, but they must ensure that their product is not harmful. The combination of failure to inform physicians of usage and the possibility of adverse reactions with prescription drugs is placing the lives of many Americans in jeopardy. Ethically, consumers have the right to use alternative medicine therapies as a matter of autonomy, but they also have the duty not to harm themselves. To ensure their safety, alternative medicine therapies must be evaluated in regards to safety and efficacy so that they can be integrated into conventional medicine. The Federal Drug Administration has the ethical responsibility to take the lead in this area. To protect the common good, there is a need to know not only what alternative medicine can do for us but what it can do to us.

The ethics of medical marijuana: government restrictions vs. medical necessity.

Marijuana is listed by the Drug Enforcement Agency (DEA) as an illegal Schedule I drug which has no currently accepted medical use. However, on March 17, 1999, 11 independent scientists appointed by the Institute of Medicine reported that medical marijuana was effective in controlling some forms of pain, alleviating nausea and vomiting due to chemotherapy, treating wasting due to AIDS, and combating muscle spasms associated with multiple sclerosis. There was also no evidence that using marijuana would increase illicit drug use or that it was a "gateway" drug. Despite this evidence the DEA refuses to reclassify marijuana as a Schedule II drug, which would allow physicians to prescribe unadulterated and standardized forms of marijuana. After reviewing the pertinent scientific data and applying the principle of double effect, there is a proportionate reason for allowing physicians to prescribe marijuana. Seriously ill patients have the right to effective therapies. To deny patients access to such a therapy is to deny them dignity and respect as persons.

Zinc supplementation and bone growth in pubertal girls.

We supplemented the diets of 47 peripubertal girls with zinc (15 mg/day) or placebo for 6 weeks. Zinc supplementation increased serum zinc. Insulin-like growth factor I and biochemical markers of bone turnover did not change, albeit dietary zinc was below the reference level (in 94% of individuals).

A medical readiness model of health assessment or well-being in first-increment air combat command medical personnel.

We used a medical readiness model of health assessment based on the Neuman systems model, a comparative-descriptive design, to assess the health or state of well-being of Air Combat Command medical personnel. Group I consisted of 636 personnel actively participating in medical readiness training, and group II consisted of 127 personnel assigned to a medical treatment facility that recently returned from overseas deployment. In group I, statistically significant differences in developmental, psychological, and sociocultural elements of health varied according to military rank, mobility status, or previous overseas deployment experience. The spiritual element of health differed statistically in both groups according to military rank. The uncertainties of mobility status, lack of previous deployment experience, and contrasts in military rank increased stress. Recommendations include realistic mobility training concentrating on essential job performance elements, leadership providing clear and open channels of communication, and dealing effectively with the emotional impact of humanitarian assistance missions.

A novel drug screening assay for papillomavirus specific antiviral activity.

Discovery and development of human papillomavirus (HPV) specific antiviral agents have been hampered by the lack of an in vitro assay permissive to HPV replication. An experimental assay system for monitoring HPV-11 DNA replication has been optimized for use as a papillomavirus antiviral drug screening tool. Cloned HPV DNA was introduced into SCC-4 cells by electroporation and viral DNA replication monitored by Southern blot. Kinetic studies demonstrated an increased HPV genome copy number with time. Viral DNA replicated as episomal, unit length genome and remained episomal after multiple passages. These data suggested the basis for an in vitro replication assay for evaluating the antiviral activity of potential chemotherapeutic agents directly on HPV. This model was used to investigate antiviral activities of current anti-HPV therapies such as 5-fluorouracil (5-FU) and alpha-interferon (alpha-IFN) and potential therapies such as sodium butyrate, 5-bromo-20-deoxyuridine (BrdU) and antisense oligonucleotides. HPV- 11 replication is significantly inhibited by BrdU and sodium butyrate; however 5-FU and alpha-IFN did not give consistent dose response results. Finally, ISIS 2105, a 20-mer phosphorothioate antisense oligonucleotide, which targets HPV-11 E2 gene product, showed potent antiviral activity in this assay with an IC50 of approximately 70 nM.

Replacement of alfalfa neutral detergent fiber with a combination of nonforage fiber sources.

Sixteen Holstein cows in midlactation were used in a 4 x 4 Latin square design to determine the effect of replacing alfalfa neutral detergent fiber (NDF), with NDF from a combination of whole linted cottonseed, dried distillers grains, and wheat middlings. The four diets were a basal control diet that was low in forage and fiber [(5.9 g of corn silage NDF and 6.1 g of alfalfa NDF/100 g of dry matter (DM)], a normal forage diet (low forage plus 10 g of additional alfalfa NDF/100 g of DM), and two low forage diets with either 5 or 10 g of NDF from the nonforage fiber sources added per 100 g of DM. Milk yield, milk protein yield, and milk protein percentage were higher, and milk fat percentage and fat yield were lower, for cows fed the low forage diets than for those fed the alfalfa control diet that was higher in fiber. Among the low forage diets, dry matter intake, milk fat percentage, and fat yield all increased linearly as NDF content increased. The ratio of acetate to propionate in the rumen and rumination times were greater for the normal forage control diet than for the high nonforage fiber diet. Added NDF from these nonforage fiber sources increased milk fat percentage and yield, but this increase was less than the NDF from alfalfa and less than predicted. In agreement with results of similar previous trials, milk protein yield and percentage were increased when alfalfa NDF was replaced with fiber from nonforage fiber sources.

The early bactericidal activity of rifabutin in patients with pulmonary tuberculosis measured by sputum viable counts: a new method of drug assessment.

The activity of rifabutin and rifampicin against rapidly growing, extra-cellular Mycobacterium tuberculosis in cavity walls was measured by counting colony-forming units (cfu) in the sputum of 74 patients with newly diagnosed, severe pulmonary tuberculosis during the first 2 days of daily chemotherapy. The fall in counts, (log10 cfu/mL sputum/day), was termed the early bactericidal activity (EBA). The EBA, a highly reproducible measure within groups of 10-13 patients, was -0.015 for a low EBA reference group (who received no chemotherapy) and 0.495 for a high EBA reference group (who received 300 mg isoniazid daily). The EBAs in patients receiving 300 and 600 mg rifabutin were 0.014 and 0.075, and for those taking 150, 300 and 600 mg rifampicin 0.021, 0.150 and 0.204, respectively. Weight-for-weight, the ratio rifabutin to rifampicin producing the same EBA was estimated to be 2.73 (95% confidence limits 1.96-3.78). Determination of the EBA is a rapid and economical method of comparing the potency in human lesions of drugs of the same type before embarking on a conventional clinical trial.

Effectiveness of neutral detergent fiber in whole cottonseed and dried distillers grains compared with alfalfa haylage.

Sixteen Holstein cows in midlactation were used in a 4 x 4 Latin square design to determine the effect of replacing alfalfa NDF with NDF from whole, linted cottonseed or dried distillers grains. Low and high fiber control diets (13 and 19% of dietary DM from alfalfa haylage NDF, respectively) were compared with diets designed to contain 13% of DM from alfalfa haylage NDF plus 6% of DM from either cottonseed NDF or distillers grains NDF. Dry matter intake, milk yield, and milk protein yield were lower from the high fiber control diet. Milk fat percentage was lower for the low fiber control diet. The cottonseed diet was equal to the high fiber control diet in stimulating rumination. Rumen acetate to propionate ratio was higher for the high fiber control and cottonseed diets. Replacing alfalfa with either of these high fiber by-product feeds increased feed intake and yields of milk fat and protein. The effectiveness of the NDF in distillers grains and cottonseed was not significantly different from that of alfalfa NDF for maintaining milk fat yield. Whole cottonseed and dried distillers grains appear to be good sources of effective fiber for maintaining milk fat test when they are substituted for alfalfa haylage fiber in lactating cow rations.