Production and economic responses to intensification of pasture-based dairy production systems.

Production from pasture-based dairy farms can be increased through using N fertilizer to increase pasture grown, increasing stocking rate, importing feeds from off farm (i.e., supplementary feeds, such as cereal silages, grains, or co-product feeds), or through a combination of these strategies. Increased production can improve profitability, provided the marginal cost of the additional milk produced is less than the milk price received. A multiyear production system experiment was established to investigate the biological and economic responses to intensification on pasture-based dairy farms; 7 experimental farmlets were established and managed independently for 3 yr. Paddocks and cows were randomly allocated to farmlet, such that 3 farmlets had stocking rates of 3.35 cows/ha (LSR) and 4 farmlets had stocking rates of 4.41 cows/ha (HSR). Of the LSR farmlets, 1 treatment received no N fertilizer, whereas the other 2 received either 200 or 400 kg of N/ha per year (200N and 400N, respectively). No feed was imported from off-farm for the LSR farmlets. Of the 4 HSR farmlets, 3 treatments received 200N and the fourth treatment received 400N; cows on 2 of the HSR-200N farmlet treatments also received 1.3 or 1.1 t of DM/cow per year of either cracked corn grain or corn silage, respectively. Data were analyzed for consistency of farmlet response over years using mixed models, with year and farmlet as fixed effects and the interaction of farmlet with year as a random effect. The biological data and financial data extracted from a national economic database were used to model the statement of financial performance for the farmlets and determine the economic implications of increasing milk production/cow and per ha (i.e., farm intensification). Applying 200N or 400N increased pasture grown per hectare and milk production per cow and per hectare, whereas increasing stocking rate did not affect pasture grown or milk production per hectare, but reduced milk production per cow. Importing feed in the HSR farmlets increased milk production per cow and per hectare. Marginal milk production responses to additional feed (i.e., either pasture or imported supplementary feed) were between 0.8 and 1.2 kg of milk/kg of DM offered (73 to 97 g of fat and protein/kg of feed DM) and marginal response differences between feeds were explained by metabolizable energy content differences (0.08 kg of milk/MJ of metabolizable energy offered). The marginal milk production response to additional feed was quadratic, with the greatest milk production generated from the initial investment in feed; 119, 99, and 55 g of fat and protein were produced per kilogram of feed DM by reducing the annual feed deficit from 1.6 to 1.0, 1.0 to 0.5, and 0.5 to 0 t of DM, respectively. Economic modeling indicated that the marginal cost of milk produced from pasture resulting from applied N fertilizer was less than the milk price; therefore, strategic use of N fertilizer to increase pasture grown increased farm operating profit per hectare. In comparison, operating profit declined with purchased feed, despite high marginal milk production responses. The results have implications for the strategic direction of grazing dairy farms, particularly in export-oriented industries, where the prices of milk and feed inputs are subject to the considerable volatility of commodity markets.

Human copy number polymorphic genes.

Recent large-scale genomic studies within human populations have identified numerous genomic regions as copy number variant (CNV). As these CNV regions often overlap coding regions of the genome, large lists of potentially copy number polymorphic genes have been produced that are candidates for disease association. Most of the current data regarding normal genic variation, however, has been generated using BAC or SNP microarrays, which lack precision especially with respect to exons. To address this, we assessed 2,790 candidate CNV genes defined from available studies in nine well-characterized HapMap individuals by designing a customized oligonucleotide microarray targeted specifically to exons. Using exon array comparative genomic hybridization (aCGH), we detected 255 (9%) of the candidates as true CNVs including 134 with evidence of variation over the entire gene. Individuals differed in copy number from the control by an average of 100 gene loci. Both partial- and whole-gene CNVs were strongly associated with segmental duplications (55 and 71%, respectively) as well as regions of positive selection. We confirmed 37% of the whole-gene CNVs using the fosmid end sequence pair (ESP) structural variation map for these same individuals. If we modify the end sequence pair mapping strategy to include low-sequence identity ESPs (98-99.5%) and ESPs with an everted orientation, we can capture 82% of the missed genes leading to more complete ascertainment of structural variation within duplicated genes. Our results indicate that segmental duplications are the source of the majority of full-length copy number polymorphic genes, most of the variant genes are organized as tandem duplications, and a significant fraction of these genes will represent paralogs with levels of sequence diversity beyond thresholds of allelic variation. In addition, these data provide a targeted set of CNV genes enriched for regions likely to be associated with human phenotypic differences due to copy number changes and present a source of copy number responsive oligonucleotide probes for future association studies.

The development of a prototype measure of the co-production of health in routine consultations for people with long-term conditions.

OBJECTIVES: (i) To develop a prototype measure of co-production of health (CPH) in consultations for people with long-term conditions (LTCs); and (ii) to undertake initial validation of it, using a measure of patient-centred care, as defined by the Roter interaction analysis system (RIAS). METHODS: Mixed methods were applied. A qualitative study gathered 11 experts' views on what comprised CPH behaviours. These were operationalised and a prototype measure applied to a convenience sample of 50 video-recorded consultations involving clinicians trained in self-management support and patients with LTCs at health services in six UK locations. RESULTS: Twenty-two CPH behaviours were identified. High frequencies of CPH behaviours in consultations were associated with greater patient-centeredness, less clinician verbal dominance, and more patient communication control in comparison to consultations where CPH behaviours were less frequent. CONCLUSION: Although the CPH tool is promising, further testing is required in order to improve reliability and validity. PRACTICAL IMPLICATIONS: In the future, the measure could be used to test interventions to promote patient participation in decision making about self-management.

Mesenchymal renal tumors in infancy: a reappraisal.

Eight cases of primary mesenchymal renal tumor in infants under one year of age were studied. The patients' ages ranged from one day to seven months; all but one were diagnosed within the first three months of life. There were four typical congenital mesoblastic nephromas. Two malignant mesenchymal, one intermediate case of difficult classification designated as "cellular variant" of congenital mesoblastic nephroma, and one hemangioendothelioma. All patients were alive and free of tumor 3 9/12 to 18 10/12 years after surgery. Of the four infants with congenital mesoblastic nephroma, one was treated by tumor excision alone; nearly 13 years later this patient was free of tumor. A high degree of cellularity and a high nucleus-cytoplasm ratio were features that characterized the tumor diagnosed as "cellular variant" of congenital mesoblastic nephroma. A sarcomatous gross appearance with cavitation necrosis was seen in the two instances of malignant mesenchymal nephroma; one of these metastasized to the lung, whereas in the other, though no metastases developed, all the histologic details of the previous case were reproduced, including distinct foci of necrosis and a high mitosis rate. Mesenchymal renal tumors in young infants constitute a set more heterogeneous than has been previously assumed. They should not be considered uniformly benign. As a group, they span the whole spectrum between benign, morphologically quiescent lesions, clinically and pathologically intermediate or indeterminate ones, and outright malignant tumors with a high risk of distant spread.

Cystic nephroma: morphologic spectrum and implications.

Among 216 primary renal tumors collected from a pediatric population in metropolitan Chicago, 6 instances corresponded in multiloculated cystic masses conforming to the diagnostic criteria of so-called cystic nephroma. Histopathologically, the component tissues were entirely mature in 2 cases, but in the remaining 4 the septa between cysts contained variable amounts of primitive or embryonic tissues; in one of these, a grossly visible mass formed a nodule of typical Wilms tumor. Our experience agrees with previous reports that favor closer structural similarity of these lesions to nephroblastoma than to any known form of cystic malformation. This concept has important consequences on the therapeutic approach to preoperatively diagnosed multilocular cystic masses of the kidney, and supports the idea that nephrectomy is the treatment of choice. Metastases or local recurrence have not been reported in cases of cystic nephroma.

Health outcomes of women exposed to household alcohol abuse: a Family Practice Training Site Research Network (FPTSRN) study.

BACKGROUND: There is a paucity of knowledge about the effects of exposure to alcohol abuse in the household on women who do not abuse alcohol. The purpose of this study was to determine whether women who did not abuse alcohol demonstrated any health-related adverse effects because they lived with family members who did abuse alcohol. METHODS: This study was a historical prospective survey of female patients at five primary care practices. Survey instruments included the CAGE questionnaire, a five-item screening test for exposure to alcoholism, and the Medical Outcomes Study 36-item Short Form Health Survey (MOS SF-36). Patient records were examined for specific diagnoses. RESULTS: A total of 267 patients completed the questionnaires and had complete medical records available for analysis. Forty-two (15.7%) potential alcohol abusers were excluded from the sample leaving a working total of 225; 70 (31.1%) were potentially exposed to alcoholism in the household. Women exposed to alcohol abuse in the home did not experience an increased risk for the medical diagnoses studied, but they did demonstrate decreased health-related quality of life as measured by the MOS-SF-36 for the following scales: role physical (P = .025), role emotional (P = .038), social functioning (P = .001), bodily pain (P = .016), and mental health (P = .040). CONCLUSIONS: Women exposed to alcohol abuse in the household are more likely to perceive themselves as less healthy. Although they may not have received a clinical diagnosis of depression, they are more likely to feel depressed. The extent to which subjects' health-related quality of life is influenced by exposure to alcohol abuse suggests that the medical diagnosis may be insensitive as a description of health status in this population.

Undifferentiated sarcoma of the kidney: a tumor of childhood with histopathologic and clinical characteristics distinct from Wilms' tumor.

The pathological and clinical features of 123 patients with Wilms' tumor diagnosed between 1961 and 1977 were analyzed. A subgroup of nine patients with distinctive histology characterized by the presence of exclusively sarcomatous elements was identified. These patients were indistinguishable clinically from the other patients with Wilms' tumor and were treated as Wilms' tumor. The rate of recurrence in this group of sarcomatous Wilms' tumor was very high (7/9) and long-term disease-free survival correspondingly low )3/9 free of disease from 15 months to nine years) when compared to the patients with classical Wilms' tumor (50% recurrence rate and 71% currently free of disease). In addition, patients with metastases (seven of seven patients with recurrence had skeletal involvement as contrasted to one of 50 patients with metastatic classical Wilms' tumor). We conclude that the "sarcomatous Wilms' tumor" represents a distinct clinicopathological entity identifiable morphologically at diagnosis, best described as renal sarcoma and that in the future optimal treatment of this disease may vary somewhat from the treatment of classical Wilms' tumor.

Food-dependent exercise-induced anaphylaxis.

This article describes four cases of exercise-induced anaphylaxis occurring only in temporal relationship to the ingestion of food. One individual developed anaphylaxis if exercise followed the ingestion of any food within 2 hr. Three other individuals had symptoms only if celery was ingested in relation to exercise. Skin reactivity to fresh celery extracts was demonstrated in all three individuals. The episodes were prevented by avoidance of food ingestion in relation to exercise. This syndrome appears to be a variant of exercised-induced anaphylaxis.

Evidence of spinal cord injury in an infant delivered by cesarean section. A case report.

A 3-month-old female infant is reported with upper spinal cord injury at birth. Breech presentation and hyperextension of head were observed 1 week prior to delivery. She was delivered by elective cesarean section. The absence of fetal movements 1 day prior to delivery and the uneventful cesarean section strongly suggest a spinal cord injury in utero secondary to hyperextension of the neck.

Antigens of Aspergillus fumigatus. II. Electrophoretic and clinical studies.

Cell sap (CS) and culture filtrate (CF) preparations of Aspergillus fumigatus strains Ag-507, Ag-515, and Ag-534 were analysed by two dimensional electrophoresis (2-DE; i.e., first dimension isoelectric focusing, second dimension sodium dodecyl sulphate gradient pore gel), which enabled detection of strain- and species-specific components. In CS preparations it was shown that CS2, a fraction isolated from strain Ag-507 by gel filtration, consists of the major protein components in the CS of the three A. fumigatus strains tested. Culture filtrate preparations of the three A. fumigatus strains analysed by 2-DE exhibited patterns dissimilar to the CS patterns, as well as to each other, presumably due to proteolysis. Culture filtrate preparations are therefore a less reliable source of standardized antigens than CS preparations. CS2 has a major component with a mol. wt. of approximately 150,000 and an sapp of 6.3 S. CS2 reacts on immunoelectrophoresis, producing one major precipitin arc with aspergilloma or allergic bronchopulmonary aspergillosis (ABPA) patient sera. Antibody titres of the IgG and IgA classes to CS2, as measured by enzyme-linked immunosorbent assay (ELISA), were demonstrated to be similar in aspergilloma and ABPA patients; IgG titres were higher than IgA. Similar titres were also obtained utilizing sera of patients that did or did not exhibit precipitating antibodies to CS2. In the diagnosis of ABPA, skin tests with CS2 were comparable in specificity to currently available commercial preparations. Importantly, CS2 is a standardized major antigenic preparation of the CS of three A. fumigatus strains which has been shown to be diagnostically useful.