Grief, Social Support, Spirituality, and Depressive Symptoms Among Older Adults in Assisted Living in Kansas.

PURPOSE: The purpose of this study was to explore the roles of grief, social support, as well as spirituality on the depressive symptoms of older adults in assisted living in Kansas. This study tested three hypotheses: a high level of grief will be related to a high level of depressive symptoms; high levels of social support (family, friends, and significant persons) will be associated with a low level of depressive symptoms; and high levels of spiritual experience and coping will be associated with a low level of depressive symptoms. METHODS: This study recruited 316 older adult residents aged 65 or over from seven assisted living facilities in Kansas. This cross-sectional survey was done by face-to-face interviews using the purposive sampling method. Hierarchical multiple regression was used to test the three sets of variables in relation to depressive symptoms: socio-demographics, social support factors, and spiritual factors. RESULTS: Participants' mean age was 82.6 years, ranging from 65 to 102; 70.9% were female. Married participants consisted of 18.7%, and over 64% were widowed. Hierarchical multivariate regression results indicated that a high level of grief was significantly related to a high level of depressive symptoms. On the other hand, high levels of social support from friends and spiritual coping were significantly associated with a low level of depressive symptoms. DISCUSSION AND CONCLUSION: Assisted living facilities may consider developing appropriate bereavement, social support, and spiritual intervention programs, which will alleviate the depression issues of older adult residents after the COVID-19 pandemic.

Certified Nurse-Midwives in Rural Kansas Hospitals: A Survey of Senior Hospital Administrators.

INTRODUCTION: Little is known about the nurse-midwifery workforce in rural Kansas hospitals, despite Kansas facing a shortage of primary care physicians providing maternity care rurally. This study investigated the current number of hospitals with certified nurse-midwives (CNMs) with privileges to attend births in Kansas hospitals located in frontier, rural, and densely settled rural counties and anticipated trends in the size of the CNM workforce at hospitals over the next 5 years. METHODS: Electronic surveys were distributed to senior hospital administrators at 94 hospitals in rural Kansas from June to July 2019. The survey included both open and closed-ended questions related to scope of CNM privileges, collaborative agreements, and forecasted trends in the CNM workforce in rural Kansas. RESULTS: Fifty-six hospitals completed the survey. Only one hospital reported having CNM-attended births. Twenty-eight of 37 hospital administrators agreed CNMs should have collaborative agreements with physicians. Most respondents did not anticipate the number of CNMs with privileges to increase at their hospitals over the next 5 years. DISCUSSION: Future research should focus on understanding the factors limiting CNM expansion in rural Kansas, because CNMs represent an untapped, additional maternity care workforce for rural Kansas.

Preserving osteopathic antiquity through historical pamphlets and postcards.

During the late nineteenth and early twentieth centuries, osteopathic information was circulated by way of pamphlets and postcards. Several osteopathic historical pamphlets and postcards from the D'Angelo Library collection have been researched and digitized in order to preserve these osteopathic artifacts and highlight their historical significance for the current profession.

The Kansas University DHA Outcomes Study (KUDOS) clinical trial: long-term behavioral follow-up of the effects of prenatal DHA supplementation.

BACKGROUND: Docosahexaenoic acid (DHA) is a long-chain polyunsaturated fatty acid that has been linked to improved vision and cognition in postnatal feeding studies and has been consistently associated with reduction of early preterm birth in prenatal supplementation trials. This is a report of the first long-term follow-up of infants from mothers receiving prenatal DHA supplementation in a US cohort. OBJECTIVE: Our objective was to evaluate the efficacy of the prenatal supplementation on both global and granular longitudinal assessments of cognitive and behavioral development. METHODS: In a randomized double-blind clinical trial, mothers received either 600 mg/d of DHA or a placebo beginning at 14.5 weeks of gestation and capsules were provided until delivery. Children from those pregnancies were followed by cognitive and behavioral assessments administered from 10 mo through 6 y of age. From 301 mothers in the initial study, ∼200 infants completed the longitudinal schedule. RESULTS: Although this intervention had been shown to reduce high-risk pregnancies and improve visual attention in infants during the first year, only a few positive long-term effects of prenatal DHA supplementation emerged from analyses of this follow-up. Increases in maternal blood DHA during pregnancy were related to verbal and full scale intelligence quotient (IQ) scores at 5 and 6 y, but these effects disappeared after controlling for SES. Maternal blood DHA concentrations at delivery were unrelated to outcomes, although maternal DHA at enrollment was related to productive vocabulary at 18 mo. CONCLUSIONS: Although prenatal DHA supplementation substantially reduced early preterm birth and improved visual attention in infancy in this sample, no consistent long-term benefits were observed into childhood. Increases in maternal blood DHA concentration in pregnancy were related to higher IQs but this effect was confounded with SES and disappeared when SES was statistically controlled. This trial was registered at http://www.clinicaltrials.gov as NCT00266825 and NCT02487771.

A retrospective study comparing outcomes in a midwestern US population after introduction of IADPSG guidelines for gestational diabetes.

OBJECTIVE: More evidence is required to endorse the 1-step approach for gestational diabetes mellitus (GDM) for clinical practice. Since 2010, our department has pragmatically allowed faculty to self-select the guidelines they use to screen and diagnose GDM. We sought to compare the maternal and neonatal outcomes from these two simultaneous cohorts. STUDY DESIGN: We performed a retrospective cohort study of all singleton pregnancies delivered between October 2011 and -November 2013 at our hospital. Patients were excluded if they had preexisting diabetes, were not screened or screened inappropriately, or their fetus had congenital anomalies. Patients were grouped by their screening strategy, and maternal and neonatal outcomes were analyzed. RESULTS: The 1-step group had a higher incidence of GDM (21.6% versus 5.0%). Initial results suggested higher rates of neonatal hypoglycemia, phototherapy for hyperbilirubinemia, and a lower rate of gestational HTN. After adjustment, these differences disappeared, but a lower rate of large for gestational age (LGA) infants was discovered (adjusted odds ratios (aOR) 0.78). CONCLUSION: The picture remains unclear as to whether the 1-step approach is associated with significantly improved outcomes compared with the 2-step approach. We did find a lower risk for a LGA infant in our 1-step cohort, but it is unlikely that the 1-step approach would be cost-effective due to the absence of other improved outcomes.

Variation in coordination of care reported by breast cancer patients according to health literacy.

BACKGROUND: Health literacy is the ability to perform basic reading and numerical tasks to function in the healthcare environment. The purpose of this study is to describe how health literacy is related to perceived coordination of care reported by breast cancer patients. METHODS: Data were retrieved from the Patient-Centered Outcomes Research Institute-sponsored "Share Thoughts on Breast Cancer" Study including demographic factors, perceived care coordination and responsiveness of care, and self-reported health literacy obtained from a mailed survey completed by 62% of eligible breast cancer survivors (N = 1221). Multivariable analysis of variance was used to characterize the association between presence of a single healthcare professional that coordinated care ("care coordinator") and perceived care coordination, stratified by health literacy level. RESULTS: Health literacy was classified as low in 24% of patients, medium in 34%, and high in 42%. Women with high health literacy scores were more likely to report non-Hispanic white race/ethnicity, private insurance, higher education and income, and fewer comorbidities (all p < 0.001). The presence of a care coordinator was associated with 17.1% higher perceived care coordination scores among women with low health literacy when compared to those without a care coordinator, whereas a coordinator modestly improved perceived care coordination among breast cancer survivors with medium (6.9%) and high (6.2%) health literacy. CONCLUSION: The use of a single designated care coordinator may have a strong influence on care coordination in patients with lower levels of health literacy.

Advancing health equity through the National Comprehensive Cancer Control Program.

Achieving health equity requires addressing social determinants of health. Promoting health equity as it relates to cancer control is one of six priorities of the National Comprehensive Cancer Control Program (NCCCP). This article describes recent activities implemented by three NCCCP awardees (North-west Portland Area Indian Health Board, Kansas, Michigan) and the CDC-funded National Behavior Health Network (NBHN), whose aim is to reduce health disparities among those with mental health and/or substance disorders. North-west Portland administered tribal surveys to help better understand tribal cancer-related risk factors, health behaviors, provide baseline data to support their cancer plan, and obtain resources for targeted interventions. Kansas established a health equity workgroup with a vision of addressing health equity through implementation and uptake of activities among all Kansans. Michigan provided trainings in health equity and social justice and developed health equity learning labs. As a result of the successful implementation of the NBHN's Community of Practice, individuals currently living with mental illness and/or substance disorders have had increased access to tobacco cessation and other cancer support services. These efforts and key opportunities for public health practitioners and their partners to increase engagement in cancer health equity are summarized in this article.

Campylobacter Prevalence and Quinolone Susceptibility in Feces of Preharvest Feedlot Cattle Exposed to Enrofloxacin for the Treatment of Bovine Respiratory Disease.

Campylobacter spp. can be pathogenic to humans and often harbor antimicrobial resistance genes. Data on resistance in relation to fluoroquinolone use in beef cattle are scarce. This cross-sectional study of preharvest cattle evaluated Campylobacter prevalence and susceptibility to nalidixic acid and ciprofloxacin in feedlots that previously administered a fluoroquinolone as primary treatment for bovine respiratory disease. Twenty fresh fecal samples were collected from each of 10 pens, in each of five feedlots, 1-2 weeks before harvest. Feces were cultured for Campylobacter using selective enrichment and isolation methods. Genus and species were confirmed via PCR. Minimum inhibitory concentrations (MICs) of ciprofloxacin and nalidixic acid were determined using a micro-broth dilution method and human breakpoints. Antimicrobial use within each pen was recorded. Data were analyzed using generalized linear mixed-models (prevalence) and survival analysis (MICs). Overall, sample-level prevalence of Campylobacter was 27.2% (272/1000) and differed significantly among feedlots (p < 0.01). Campylobacter coli was the most common species (55.1%; 150/272), followed by Campylobacter hyointestinalis (42.6%; 116/272). Within-pen prevalence was not significantly associated with the number of fluoroquinolone treatments, sex, body weight, or metaphylaxis use, but was associated with the number of days cattle were in the feedlot (p = 0.03). The MICs for the majority of Campylobacter isolates were above the breakpoints for nalidixic acid (68.4%; 175/256) and for ciprofloxacin (65.6%; 168/256). Distributions of MICs for nalidixic acid (p ≤ 0.01) and ciprofloxacin (p ≤ 0.05) were significantly different among feedlots, and by Campylobacter species. However, fluoroquinolone treatments, sex, body weight, days on feed, and metaphylaxis were not significantly associated with MIC distributions within pens. We found no evidence that the number of fluoroquinolone treatments within feedlot pens significantly affected the within-pen fecal prevalence or quinolone susceptibilies of Campylobacter in feedlots that used a fluoroquinolone as primary treatment for bovine respiratory disease.

Maternal Vitamin D Status and Infant Infection.

Maternal vitamin D status during pregnancy may modulate fetal immune system development and infant susceptibility to infections. Vitamin D deficiency is common during pregnancy, particularly among African American (AA) women. Our objective was to compare maternal vitamin D status (plasma 25(OH)D concentration) during pregnancy and first-year infections in the offspring of African American (AA) and non-AA women. We used medical records to record frequency and type of infections during the first year of life of 220 term infants (69 AA, 151 non-AA) whose mothers participated in the Kansas University DHA Outcomes Study. AA and non-AA groups were compared for maternal 25(OH)D by Mann-Whitney U-test. Compared to non-AA women, AA women were more likely to be vitamin D deficient (<50 nmol/L; 84 vs. 37%, p < 0.001), and more of their infants had at least one infection in the first 6 months (78.3% and 59.6% of infants, respectively, p = 0.022). We next explored the relationship between maternal plasma 25(OH)D concentration and infant infections using Spearman correlations. Maternal 25(OH)D concentration was inversely correlated with the number of all infections (p = 0.033), eye, ear, nose, and throat (EENT) infections (p = 0.043), and skin infection (p = 0.021) in the first 6 months. A model that included maternal education, income, and 25(OH)D identified maternal education as the only significant predictor of infection risk in the first 6 months (p = 0.045); however, maternal education, income, and 25(OH)D were all significantly lower in AA women compared to non-AA women . The high degree of correlation between these variables does not allow determination of which factor is driving the risk of infection; however, the one that is most easily remediated is vitamin D status. It would be of value to learn if vitamin D supplementation in this at-risk group could ameliorate at least part of the increased infection risk.

An empirically derived dietary pattern associated with breast cancer risk is validated in a nested case-control cohort from a randomized primary prevention trial.

BACKGROUND & AIMS: We reported an association between cytologic atypia, a reversible biomarker of breast cancer risk, and lower omega-3/omega-6 fatty acid ratio in blood and breast tissue. Our goal was to develop and validate a dietary pattern index in this high-risk sample of U.S. women, and test its capacity to predict incidence in a nested case-control cohort of Canadian women from a randomized trial of a low-fat dietary intervention for primary prevention of breast cancer. METHODS: Food intake was measured by food frequency questionnaire in the U.S. sample (n = 65) and multiple dietary recalls in the Canadian sample (n = 220 cases; 440 controls). Principal component analysis identified a dietary pattern associated with atypia. We measured differences among dietary pattern tertiles in (a) fatty acid composition in blood lipids and breast tissue in the U.S. sample, and (b) risk of breast cancer subtypes in the Canadian cohort. Registered under ClinicalTrials.gov Identifier: NCT00148057. RESULTS: A Modern diet was characterized as consuming more grains, dairy, and sugar and less vegetables, fish and poultry; these women had lower tissue omega-3 fatty acids and higher omega-6 and trans fatty acids. The low-fat intervention increased the likelihood of a Modern diet after randomization. A Modern diet at baseline and post-randomization was associated with estrogen-receptor negative (ER-) breast cancer risk among those at least 160 cm tall. A Traditional diet (the reciprocal of Modern) at baseline was associated with lower ER-positive (ER+) risk in the comparison group, but not the low-fat intervention group. CONCLUSIONS: A Modern diet (high in grains, dairy, and sugar and low in vegetables, fish, and poultry) is associated with ER- breast cancer risk among taller women. Recommending dietary fat reduction may have untoward effects on breast cancer risk.

Addressing Rural Health Challenges Head On.

Providing health care to patients and families living in rural America presents significant challenges, but comes with unique rewards. The physician who chooses a rural life typically cares for an underserved and aging population, which is often less healthy and affluent than its urban and suburban counterparts. At the same time, rural clinicians feel deeply connected to their patients and their communities. Physicians cite strong doctor-patient relationships as a primary motivator to practice in a rural setting, in addition to lower cost of living and slower pace of life1. Those who choose primary care specialties also enjoy the challenge of caring for multiple, interrelated aspects of health for their patients and community. During Kansas City University of Medicine and Biosciences' (KCU) century-long history, we have offered our osteopathic medical students the opportunity to learn in rural areas during the third and fourth years. As our new, state-of-the-art medical school campus opens in Joplin, Missouri, we will build on our commitment to rural health by offering first- and second-year KCU-Joplin students training opportunities in rural settings, and expanding third- and fourth-year rural clinical rotations. The rich experience to learn rural medicine offers the potential to connect medical students, patients and community in new and exciting ways, building on the firm foundation of osteopathic medical training grounded in strong patient-centered primary care.

Multisite Evaluation of APEX for Water Quality: II. Regional Parameterization.

Phosphorus (P) Index assessment requires independent estimates of long-term average annual P loss from fields, representing multiple climatic scenarios, management practices, and landscape positions. Because currently available measured data are insufficient to evaluate P Index performance, calibrated and validated process-based models have been proposed as tools to generate the required data. The objectives of this research were to develop a regional parameterization for the Agricultural Policy Environmental eXtender (APEX) model to estimate edge-of-field runoff, sediment, and P losses in restricted-layer soils of Missouri and Kansas and to assess the performance of this parameterization using monitoring data from multiple sites in this region. Five site-specific calibrated models (SSCM) from within the region were used to develop a regionally calibrated model (RCM), which was further calibrated and validated with measured data. Performance of the RCM was similar to that of the SSCMs for runoff simulation and had Nash-Sutcliffe efficiency (NSE) > 0.72 and absolute percent bias (|PBIAS|) < 18% for both calibration and validation. The RCM could not simulate sediment loss (NSE < 0, |PBIAS| > 90%) and was particularly ineffective at simulating sediment loss from locations with small sediment loads. The RCM had acceptable performance for simulation of total P loss (NSE > 0.74, |PBIAS| < 30%) but underperformed the SSCMs. Total P-loss estimates should be used with caution due to poor simulation of sediment loss. Although we did not attain our goal of a robust regional parameterization of APEX for estimating sediment and total P losses, runoff estimates with the RCM were acceptable for P Index evaluation.

Using Single Free Sorting and Multivariate Exploratory Methods to Design a New Coffee Taster's Flavor Wheel.

The original Coffee Taster's Flavor Wheel was developed by the Specialty Coffee Assn. of America over 20 y ago, and needed an innovative revision. This study used a novel application of traditional sensory and statistical methods in order to reorganize the new coffee Sensory Lexicon developed by World Coffee Research and Kansas State Univ. into scientifically valid clusters and levels to prepare a new, updated flavor wheel. Seventy-two experts participated in a modified online rapid free sorting activity (no tasting) to sort flavor attributes of the lexicon. The data from all participants were compiled and agglomeration hierarchical clustering was used to determine the clusters and levels of the flavor attributes, while multidimensional scaling was used to determine the positioning of the clusters around the Coffee Taster's Flavor Wheel. This resulted in a new flavor wheel for the coffee industry.

Effect of ractopamine hydrochloride and zilpaterol hydrochloride on cardiac electrophysiologic and hematologic variables in finishing steers.

OBJECTIVE To investigate the effects of dietary supplementation with the ß-adrenoceptor agonists ractopamine hydrochloride and zilpaterol hydrochloride on ECG and clinicopathologic variables of finishing beef steers. DESIGN Randomized controlled trial. ANIMALS 30 Angus steers. PROCEDURES Steers were grouped by body weight and randomly assigned to receive 1 of 3 diets for 23 days: a diet containing no additive (control diet) or a diet containing ractopamine hydrochloride (300 mg/steer/d) or zilpaterol hydrochloride (8.3 mg/kg [3.8 mg/lb] of feed on a dry-matter basis), beginning on day 0. Steers were instrumented with an ambulatory ECG monitor on days -2, 6, 13, and 23, and continuous recordings were obtained for 72, 24, 24, and 96 hours, respectively. At the time of instrumentation, blood samples were obtained for CBC and serum biochemical and blood lactate analysis. Electrocardiographic recordings were evaluated for mean heart rate and arrhythmia rates. RESULTS Steers fed zilpaterol or ractopamine had greater mean heart rates than those fed the control diet. Mean heart rates were within reference limits for all steers, with the exception of those in the ractopamine group on day 14, in which mean heart rate was high. No differences in arrhythmia rates were identified among the groups, nor were any differences identified when arrhythmias were classified as single, paired, or multiple (> 2) beats. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that dietary supplementation of cattle with ractopamine or zilpaterol at FDA-approved doses had no effect on arrhythmia rates but caused an increase in heart rate that remained within reference limits.

Polyoxyethylene Tallow Amine, a Glyphosate Formulation Adjuvant: Soil Adsorption Characteristics, Degradation Profile, and Occurrence on Selected Soils from Agricultural Fields in Iowa, Illinois, Indiana, Kansas, Mississippi, and Missouri.

Polyoxyethylene tallow amine (POEA) is an inert ingredient added to formulations of glyphosate, the most widely applied agricultural herbicide. POEA has been shown to have toxic effects to some aquatic organisms making the potential transport of POEA from the application site into the environment an important concern. This study characterized the adsorption of POEA to soils and assessed its occurrence and homologue distribution in agricultural soils from six states. Adsorption experiments of POEA to selected soils showed that POEA adsorbed much stronger than glyphosate; calcium chloride increased the binding of POEA; and the binding of POEA was stronger in low pH conditions. POEA was detected on a soil sample from an agricultural field near Lawrence, Kansas, but with a loss of homologues that contain alkenes. POEA was also detected on soil samples collected between February and early March from corn and soybean fields from ten different sites in five other states (Iowa, Illinois, Indiana, Missouri, Mississippi). This is the first study to characterize the adsorption of POEA to soil, the potential widespread occurrence of POEA on agricultural soils, and the persistence of the POEA homologues on agricultural soils into the following growing season.

Reducing Iron Deficiency in 18-36-months-old US Children: Is the Solution Less Calcium?

Objectives National surveys consistently identify iron deficiency (ID) in US children between 1 and 3 years of age, when the brain is rapidly developing and vulnerable to the effects of ID. However, controversy remains as to how best to recognize and prevent ID in young children, in part because of the multiple potential etiologies. The objective of this project was to assess ID in children and identify potential individual dietary predictors of status. Methods We examined three biomarkers of ID [soluble transferrin receptor (sTfR) and serum ferritin (SF), and body iron (calculated from sTfR and SF)] against parent-provided dietary calcium and iron intake for eight-three 18-36 month old children from middle class families. Results Using literature-based cutoffs, fourteen children (16.9 %) had at least one indicator of ID: low SF(<10 µg/l, 7.2 %), negative body iron (<0 mg/kg, 7.2 %) or elevated sTfR (>8.4 µg/ml, 13.2 %). All children consumed more than the Dietary Reference Intake (DRI) Estimated Average Requirement of 3 mg/d iron. The mean iron intake of children identified with ID approximated the Recommended Dietary Allowance of 7 mg/d. Most children (81 %) consumed above the DRI Adequate Intake of 500 mg/d of calcium. Calcium intakes were generally high and predicted lower body iron (p = 0.0005), lower SF (p = 0.0086) and higher sTfR (p = 0.0176). Conclusions for Practice We found rates of ID similar to US national averages. Dietary calcium intake predicted lower iron status more than deficits in iron intake. Teaching parents to balance calcium and iron intake in toddlers could be a strategy to prevent ID.

Effects of Making Art and Listening to Music on Symptoms Related to Blood and Marrow Transplantation.

PURPOSE/OBJECTIVES: To understand the benefits of making art and listening to music and whether those activities may be beneficial for reducing symptoms associated with blood and marrow transplantation. 
. DESIGN: A randomized, three-group, pre-/post-pilot design.
. SETTING: Outpatient Blood and Marrow Transplant Clinic at the University of Kansas Cancer Center in Kansas City.
. SAMPLE: 39 adults aged from 22-74 years receiving blood and marrow transplantations.
. METHODS: Participants were randomly assigned to one of three groups. MAIN RESEARCH VARIABLES: Therapy-related symptoms, state anxiety, and physiologic distress.
. FINDINGS: Of the 39 participants, 14 were randomized to the control group, 14 to the art group, and 11 to the diversional music group. No significant differences in age, gender, ethnicity, or diagnosis existed between groups. No statistical differences were found between groups on all measures following the intervention. 
. CONCLUSIONS: Although the results of the current study did not indicate significant differences, healthcare professionals may still consider creative therapies as a viable option for patients within hospital or outpatient clinics because they do not require specialty training or costly resources, and they may be an enjoyable activity to occupy time for patients and caregivers.
. IMPLICATIONS FOR NURSING: Art making and music listening are safe and desirable for patients undergoing blood and marrow transplantation in an outpatient clinic. Nurses might consider partnering with therapists to offer these creative therapies as diversion during treatment.

Cholecalciferol v. ergocalciferol for 25-hydroxyvitamin D (25(OH)D) repletion in chronic kidney disease: a randomised clinical trial.

Patients with chronic kidney disease (CKD) demonstrate complex mineral metabolism derangements and a high prevalence of vitamin D deficiency. However, the optimal method of 25-hydroxyvitamin D (25(OH)D) repletion is unknown, and trials analysing the comparative efficacy of cholecalciferol and ergocalciferol in this population are lacking. We conducted a randomised clinical trial of cholecalciferol 1250µg (50 000 IU) weekly v. ergocalciferol 1250µg (50 000 IU) weekly for 12 weeks in forty-four non-dialysis-dependent patients with stage 3-5 CKD. The primary outcome was change in total 25(OH)D from baseline to week 12 (immediately after therapy). Secondary analyses included the change in 1,25-dihydroxyvitamin D (1,25(OH)2D), parathyroid hormone (PTH), D2 and D3 sub-fractions of 25(OH)D and 1,25(OH)2D and total 25(OH)D from baseline to week 18 (6 weeks after therapy). Cholecalciferol therapy yielded a greater change in total 25(OH)D (45·0 (sd 16·5) ng/ml) v. ergocalciferol (30·7 (sd 15·3) ng/ml) from baseline to week 12 (P<0·01); this observation partially resulted from a substantial reduction in the 25(OH)D3 sub-fraction with ergocalciferol. However, following cessation of therapy, no statistical difference was observed for total 25(OH)D change from baseline to week 18 between cholecalciferol and ergocalciferol groups (22·4 (sd 12·7) v. 17·6 (sd 8·9) ng/ml, respectively; P=0·17). We observed no significant difference between these therapies with regard to changes in serum PTH or 1,25(OH)2D. Therapy with cholecalciferol, compared with ergocalciferol, is more effective at raising serum 25(OH)D in non-dialysis-dependent CKD patients while active therapy is ongoing. However, levels of 25(OH)D declined substantially in both arms following cessation of therapy, suggesting the need for maintenance therapy to sustain levels.

Vitamin D status of psychiatric inpatients at a community teaching hospital in the Midwest.

BACKGROUND: Vitamin D deficiency is a re-emerging epidemic in North America. It is increasingly linked to the pathology of cognition and mental illness and is also common in psychiatric patients. AIMS: This study was designed to determine the prevalence of vitamin D deficiency among psychiatric inpatients in Kansas City, to explore the association between vitamin D status and clinical characteristics, and to identify the association of medical problems related to vitamin D deficiency in mental illness. METHODS: In this descriptive study we recruited 52 psychiatric inpatients at a community teaching hospital in Kansas City between August and November 2013. A vitamin D-deficient state was defined as serum 25-hydroxyvitamin D (25-(OH) D) level ≤ 20 ng/mL. In addition to descriptive statistics, the Student t-test and Pearson test were used in the study. RESULTS: A total of 15 patients (28.8%) were classified as deficient, 20 patients (38.5%) had an insufficiency, 17 patients (32.7%) were categorized as sufficient. Interestingly, there was a statistically significant difference in 25-(OH) D levels between African Americans and Caucasians (t = -2.216, p = 0.03) but no significant relationship between 25-(OH) D level and gender, major psychiatric diagnoses, type 2 diabetes mellitus or obesity. There was also no correlation between 25-(OH) D level and age, body mass index or haemoglobin A1C. CONCLUSIONS: Low 25-(OH) D level was found in a high percentage of psychiatric inpatients in Kansas City. Screening for vitamin D deficiency could be a routine work-up for psychiatric inpatients. Vitamin D supplement for African American inpatients with low vitamin D levels could be considered.

Effects of the Programmed Nutrition Beef Program on feedlot performance and carcass characteristics.

The objective of this study was to examine the effects of alternative finishing strategies on feedlot performance and carcass characteristics. Beef steers (64 pens; 8 steers/pen) were allocated to a randomized complete block design with a 2 × 2 factorial treatment arrangement. Factor 1 consisted of diet, with cattle fed a conventional (CON) diet or a diet consisting of Programmed Nutrition Beef Program (PN) supplements. The PN treatment included Programmed Nutrition Beef Receiver fed from d 1 through 20 of feeding and Programmed Nutrition Beef Finisher fed from d 21 to harvest. Factor 2 evaluated the presence (EGP+) or absence (EGP-) of exogenous growth promotants (ExGP) in the production system. Steers in the EGP+ treatments were initially implanted with Component E-S, reimplanted with Component TE-IS, and fed 400 mg·animal·dof ractopamine hydrochloride for the final 28 d before harvest. Steers were harvested on d 175, and strip loins were removed from 2 carcasses selected at random from each pen for transport to Kansas State University. One 1.27-cm-thick steak was removed from the anterior face for proximate and long-chain fatty acid analysis. There were no diet × ExGP interactions ( > 0.10) for feedlot performance except for DMI ( = 0.02). Steers in the PN/EGP+ treatment consumed more feed than all other treatments ( < 0.05). Both diet and ExGP affected DMI ( < 0.05), with PN and EGP+ steers consuming more feed than their contemporaries. Gain:feed and ADG were unaffected ( > 0.10) by diet, but ExGP improved these measures ( < 0.01). There were no diet × ExGP interactions for carcass characteristics except KPH fat and percentages of yield grade 3 and 4 carcasses ( < 0.05). Diet affected total incidence of liver abscesses because PN steers had a greater ( = 0.05) incidence of liver abscesses than steers in the CON treatment. Diet did not affect the other carcass characteristics ( > 0.10). Use of ExGP increased ( < 0.05) HCW, LM area, and 12th-rib fat but did not affect ( > 0.10) marbling score. Using ExGP reduced the percentage carcasses grading Premium Choice ( < 0.05). No diet × ExGP interactions or diet effects were detected for long-chain fatty acid profiles ( > 0.10). Use of ExGP increased ( < 0.05) the ratio of saturated:unsaturated fatty acids. In summary, the alternative feeding strategy presented in this study produced similar feedlot performance and carcass characteristics compared with a conventional feedlot system.