Enhancing routine HIV and STI testing among young men who have sex with men: primary outcomes of the get connected clinical randomized trial (ATN 139).

BACKGROUND: Regular HIV and STI testing remain a cornerstone of comprehensive sexual health care. In this study, we examine the efficacy of Get Connected, a WebApp that combines test locators with personalized educational resources, in motivating young men who have sex with men (YMSM) to undergo regular HIV and STI testing. METHODS: Participants were randomly placed in one of two conditions. The first condition included the full version of GC (GC-PLUS), which included content tailored to users' psychosocial characteristics (e.g., age, race/ethnicity, relationship status, HIV/STI testing history). The second condition served as our attention-control and only included the testing locator (GC-TLO) for HIV/STI testing services. Participants were recruited from three cities (Houston, Philadelphia, and Atlanta) characterized by high HIV incidence. Assessments were collected at 1, 3-, 6-, 9- and 12-month follow-ups. RESULTS: Both versions of GC were acceptable and efficacious in increasing routine HIV and STI testing over a 12-month period. 40% of the sample reported testing at least twice, with no main effects observed across the two intervention arms (OR = 1.11; 95% CI: 0.69, 1.80), p =.66). Greater intervention effects were observed among YMSM who engaged more frequently with the intervention, with regional differences observed. CONCLUSIONS: Our findings underscore the need to cater to the diverse needs of YMSM through multilevel approaches. Broadly, mHealth HIV/STI testing interventions, such as Get Connected, would benefit from matching technologies to the local context to have the greatest impact. TRIAL REGISTRATION: This study is registered on ClinicalTrials.gov (NCT03132415).

Examining HIV Stigma, Depression, Stress, and Recent Stimulant Use in a Sample of Sexual Minority Men Living with HIV: An Application of the Stigma and Substance Use Process Model.

Sexual minority men (SMM) with HIV are disproportionately impacted by stigma and mental health disorders. Guided by the Stigma and Substance Use Process Model, we evaluated how HIV stigma impacts mental health outcomes among SMM with HIV. Data were drawn from Thrive With Me, an RCT of an mHealth intervention targeting ART adherence among SMM with HIV. Path analyses tested the relationships between HIV stigma, depression, stress, and recent stimulant use. Overall, 49.1% (194/401) had depression symptoms, 68.8% (276/401) had moderate-to-high stress, and 28.1% (111/401) had detectable stimulant use in urine samples at baseline. In path analyses, baseline internalized HIV stigma was associated with depression and stress 5-months post-baseline and enacted stigma was associated with recent stimulant use 11-months post-baseline. We identified internalized and enacted HIV stigma, but not anticipated stigma, as potentially important intervention targets for stimulant use, depression, and stress among SMM with HIV.

Meal patterns of weaned dairy calves are affected by previous dietary experience and associated with competition surrounding individual feed bins.

The objective of this study was to evaluate how meal patterns of recently weaned and group-housed dairy calves are subject to effects of previous dietary experience and associated with competition for feed. During the preweaning period, Holstein heifer and bull calves were provided diets differing in provision and presentation of forage as follows: (1) pelleted starter only (n = 12), (2) starter and chopped coastal bermudagrass provided in separate buckets (n = 13), (3) starter and chopped coastal bermudagrass mixed together in the same bucket (n = 15), or (4) starter, chopped coastal bermudagrass, and liquid molasses mixed together in 1 bucket (n = 13). At 58 ± 2 (mean ± standard deviation) days of age, following weaning, calves were mingled between treatments and moved into group housing in weekly age-based cohorts (7 ± 2 calves/group; 8 groups total), and all were provided the mixed diet (without molasses). Within group pens, calves were fed individually using the Calan Broadbent feeding system (American Calan Inc.). Calves were monitored for 1 wk following introduction to the group pen. Feed intake was measured daily. Behavioral data, describing feeding times and competition for feed, were recorded continuously for 48 h beginning after a 5-d adaptation to the group pen. Calves previously provided starter only had longer, less frequent meals than calves previously provided forage in any form, and they tended to consume less feed compared with those previously provided starter and hay separately, with calves previously provided mixed diets having intermediate intakes. We observed occurrences of displacements at bins, which were followed by replacements and feed stealing on some occasions, where 34% of calves consumed feed from a bin assigned to another calf on at least 1 occurrence, and 64% of calves were stolen from at least once. Competition at feed bins was not affected by previous dietary treatments, but was associated with meal patterns. Actor displacement rate was negatively associated with meal frequency and duration, but calves that were displaced more often were those that spent more time feeding. These results suggested a possible carryover effect of previous exposure to forage on postweaning meal patterns following a dietary change. Further, we found that competitive behavior varied considerably between individuals, occurring frequently despite feeding calves using individually-assigned feeding bins, and was associated with meal characteristics. These results highlighted the importance of considering both previous dietary experience and social factors when evaluating feeding behavior.

Effects of forage presentation and addition of molasses-based liquid feed on dairy calf dietary selection and feed sorting of mixed diets.

The objective of this study was to examine the effects of including a molasses-based liquid feed on sorting of a mixed diet of starter and hay, and to compare the nutrient composition of the ration consumed by calves offered hay and starter according to different feed presentations. Holstein bull and heifer calves were exposed for the first 8 wk of life to 1 of 3 feed presentation treatments: (1) starter and hay provided in separate buckets (n = 15), (2) a mixed diet of 80% starter and 20% hay (n = 16), or (3) a mixed diet containing the same ratio of starter and hay, with inclusion of 10% (as-is basis) liquid molasses (n = 14). Calves received 8 L/d of pasteurized waste milk and were weaned over a 10-d period beginning at 42 d of age. Intake was recorded daily and calves were weighed weekly. Fresh and refused feed were sampled on 3 consecutive days during wk 4 and 6 of the preweaning period and wk 8 immediately postweaning. Sorting was assessed through nutrient analysis of the feed samples, with additional sorting indices reflective of sorting for starter and hay components calculated based on weighted averages of individual nutrient intakes as a percent of predicated intakes. Dry matter intake and average daily gain did not differ among treatments. During the preweaning period, addition of molasses to the mixed diet did not affect the extent of feed sorting, with calves provided both mixed diets sorting, on average, in favor of starter and against hay. Postweaning, addition of molasses tended to reduce the extent of feed sorting, although calves on both treatments persisted in sorting for starter and against hay. Across treatments, there was an association between the pre- and postweaning extent of feed sorting, suggesting a degree of individual consistency in sorting behavior. Calves provided starter and hay separately consumed a diet consisting of approximately 18 to 19% hay preweaning and 14% hay postweaning, and generally had greater fiber intake and lower intake of nonfiber carbohydrates compared with calves provided a mixed diet. These results indicate that addition of molasses slightly reduced sorting during the postweaning period only. On average, calves provided both mixed diets sorted their feed in favor of starter and against hay, which mirrored dietary selection exhibited by calves offered hay and starter separately.

Effects of access to stationary brushes and chopped hay on behavior and performance of individually housed dairy calves.

Providing individually housed dairy calves with opportunities for a greater range of natural behaviors, including foraging and grooming, has broad benefits for their behavioral development and performance. We evaluated the effects of providing hay and stationary brushes on performance and time engaged in feeding, grooming, and nonnutritive oral behaviors. Holstein calves were individually housed and assigned at 14 d of age to 1 of 4 treatments providing: a stationary brush (n = 10), chopped coastal bermudagrass hay (n = 9), both a stationary brush and chopped bermudagrass (n = 10), or no brushes nor additional feed (n = 10). Calves had ad libitum access to calf starter and water and were provided 8 L/d pasteurized waste milk fed in 2 meals via a teat bucket. Beginning at 43 d of age, calves were weaned across 10 d. Solid feed intake was measured daily, and growth parameters and cleanliness were measured weekly. Behavioral data were collected on 2 consecutive days at 25 ± 3 d, recorded continuously from video within daylight for 12 h. Provision of hay tended to increase solid feed intake and average daily gain during weaning, and calves provided a brush had improved coat cleanliness during weaning. Calves performed nonnutritive oral behavior, primarily directed toward the pen, with peaks in these abnormal behaviors around milk feeding. The duration of teat-directed nonnutritive sucking was reduced by access to either hay or a brush, compared with neither (3.2 vs. 6.8 min/12 h observation). Provision of a brush reduced pen-directed sucking (38.4 vs. 59.0 min/12 h observation), particularly at milk-feeding time, and also reduced standing time around milk feeding. Self-grooming was not affected by brush or hay access, but provision of the brush increased total time engaged in grooming behaviors (52.9 vs. 40.2 min/12 h observation). These results support benefits of accommodating natural foraging and grooming behaviors, yet reveal a high prevalence of nonnutritive oral behaviors in dairy calves. Overall, these findings underline the importance of environmental complexity in early rearing environments, and compel further consideration of behavioral needs of dairy calves to reduce the development of abnormal behaviors.

Measuring behavior patterns and evaluating time-sampling methodology to characterize brush use in weaned beef cattle.

With growing interest in provision of brushes for cattle and the implications of brush use for behavioral development and welfare, there is a need to validate methodology for quantifying grooming behavior. Our objectives were to characterize patterns of brush use, including bouts, diurnal activity, and individual variability over 24-h periods, and to validate time-sampling methodologies to characterize these traits, including instantaneous recording at various time intervals and continuous recording for subsets of the day. Data sets from previous experiments involving steers (experiment 1; n = 18) and heifers (experiment 2; n = 64), consisting of start and end times of brush use continuously recorded from video, were used to analyze brush use. We extrapolated data sets representative of a range of instantaneous recording intervals and compared daily brush duration and bout characteristics with corresponding values from continuous recording using linear regression. To assess validity of sampling subsets of the day, we selected 2-h time periods representative of different functional parts of the day and compared hourly brush rates with continuous data using Spearman's rank order correlation (rs). Brush use was variable among individuals. All steers used the brush in experiment 1, but 17% (n = 11 of 64) of heifers in experiment 2 did not. Bout analysis revealed that individuals used the brush for an average of 7 to 8 brush bouts lasting 4 to 6 min, leading to an average of 24 and 36 min/d for experiments 1 and 2, respectively. Cattle used the brush mainly during daylight hours, with peaks around sunrise, sunset, and the afternoon. Instantaneous recording at intervals less than 1 to 3 min, depending on the experiment, provided good estimates of daily brush use duration (R2 > 0.95 and slope and intercept not different from 1 and 0, respectively), but intervals >3 min were less reliable. For bout characteristics, the intercept of the modeled line differed from 0 for most recording intervals for both experiments, and the slope differed from 1 for recording intervals >30 s in experiment 1, suggesting that time sampling may have underestimated true values. Of the 2-h periods compared with 24 h of observation, 1800 to 2000 h was most highly correlated (rs = 0.84) for experiment 1, and 1800 to 2000 h and 1400 to 1600 h were the most highly correlated (rs = 0.71 and 0.74, respectively) for experiment 2 with daily values. When using time-sampling methods to characterize brush use, we suggest that the recording interval used and time of day observed should be carefully considered, as time sampling at an interval of 1 to 3 min may measure daily brush use duration, but continuous recording may be required to capture bout characteristics.

Evaluating effects of providing hay on behavioral development and performance of group-housed dairy calves.

Providing access to forage has been shown to influence feeding behavior and non-nutritive oral behavior in individually housed calves, and these effects may be enhanced or altered in calves reared in social housing. We evaluated the effect of hay provision on the behavioral development and performance of group-housed dairy calves. Holstein calves (n = 32) were group-housed (4 calves per group) at 17 ± 3 (mean ± SD) d of age. All calves were provided milk replacer (8 L/d) via an automated milk feeder and pelleted starter and water ad libitum. Pens were randomly assigned to receive either chopped coastal Bermuda grass in buckets adjacent to the starter trough (starter and hay, STH; n = 4 pens), or no additional feed (starter only, ST; n = 4 pens). Calves were weaned through a 10-d stepdown program beginning at 46 d of age. Intake of solid feed and hay were recorded daily, and body weights were measured weekly. The behavior of 2 focal calves per pen was recorded continuously from video for 12 h on 2 consecutive days during each of wk 4, 6, and 7 of life, to measure solid feed intake time, grooming, and pen-directed sucking. Hay provision influenced total feed intake, with calves provided hay having greater total solid feed intake in the week before weaning (0.79 vs. 0.55 kg/d, STH vs. ST, respectively; SE = 0.19). Average daily gain (ADG) was similar during the pre-weaning period but tended to be greater for STH calves during weaning. Calves in pens provided hay also had fewer unrewarded visits to the milk feeder during weaning (12.5 vs. 21.1 visits per 12 h, STH vs. ST, respectively; SE = 3.59) and performed less pen-directed sucking (9.11 vs. 19.3 min per 12 h, STH vs. ST, respectively; SE = 2.86). Self-grooming time and bout characteristics evolved differently between treatments over time, with pens of calves provided hay having a greater increase in frequency and duration of self-grooming bouts during weaning. Overall, we found that providing hay to pre-weaned calves resulted in behavioral and performance benefits, including greater total feed intake and reductions in pen-directed sucking, suggesting that access to hay may improve calf welfare.

Characterizing grooming behavior patterns and the influence of brush access on the behavior of group-housed dairy calves.

Group housing allows for dairy calves to perform social grooming behavior; however, the use of mechanical brushes may influence how calves groom themselves and others. Our objectives were, first, to characterize the bout characteristics of brush use, self-grooming, and allogrooming in calves and, second, to evaluate the effects of access to a rotating brush on grooming behavior. Holstein heifer and bull calves (n = 32) were group-housed (4 calves/group) at 2 wk of life (17 ± 3 d of age; mean ± standard deviation) and followed to wk 7 of life. Pens were assigned to receive either a rotating brush (BR; n = 4 pens) or no brush (CON; n = 4 pens). Behavior was recorded continuously for 12 h for 2 focal calves/pen on 2 d during wk 4, 6, and 7 of life. We performed a bout analysis by fitting a mixture of normal distributions to the log10-transformed frequency distribution of the intervals between recorded periods of behavior. We calculated bout criteria for brush use (125.9 s), allogrooming (125.9 s), and self-grooming (a mixture of 3 normal distributions provided the best fit for these data, providing 2 bout criteria: a shorter (micro) bout criterion of 50.1 s and a longer (macro) criterion of 1,000 s). Brush use was consistent across weeks, and calves used the brush for 20.5 ± 6.1 min/12 h observation period, in 31.1 ± 1.7 bouts (mean ± SE). The frequency and duration of allogrooming bouts did not differ between treatments and across time. The BR calves tended to self-groom more than CON calves (16.3 vs. 14.3 min/12 h; BR vs. CON; SE = 0.68), and time spent self-grooming decreased across weeks. The frequency and duration of self-grooming micro bouts did not differ between treatments, but BR calves had shorter, more frequent self-grooming macro bouts (10.58 vs. 9.46 bouts; BR vs. CON; SE = 0.24). In summary, we determined that bout criteria could be fitted to grooming behaviors, which may be useful when characterizing these behaviors in future work, and that providing access to a rotating brush influenced self-grooming behavior in group-housed calves.

Short communication: Effects of mammary biopsy in the dry period on activity and feeding behavior of dairy cows.

In dairy cattle, mammary biopsies are commonly used to study development and function of the mammary gland. The objective of this study was to investigate changes in activity and feeding patterns following the mammary biopsy procedure. Pregnant, nonlactating Holstein dairy cows (20 d before expected calving date) were exposed to either (1) a biopsy procedure, in which a mammary tissue sample (60 × 4 mm in diameter) was obtained from cows (n = 9) using a biopsy tool from the rear left quarter, following administration of a sedative (xylazine, 20 µg/kg of body weight) and local anesthetic (3 mL of lidocaine), or (2) a sham procedure, in which cows (n = 8) were removed from the pen and restrained for a similar duration of time as for the biopsy procedure. Behavior of cows was monitored for 5 d, beginning on the day following biopsy (approximately 14 h after the procedure). Cows were fitted with accelerometers to record daily lying time, lying bout frequency, and lying side. Daily individual feed intake was recorded using the Calan Broadbent feeding system, and feeding time and meal characteristics were determined from a subset of cows (n = 6 per treatment) using a change-of-state data logger to record the times the cows were accessing the feed bunk. Total daily lying time did not differ between treatments [13.9 h/d; standard error (SE) = 0.56], but biopsied cows had more frequent, shorter lying bouts on the biopsied side on d 1 following the procedure (6.67 vs. 4.25 bouts/d, SE = 1.03, and 70.0 vs. 97.0 min/bout, SE = 8.6; left vs. right side), whereas control cows had no side preference. We found no effects of treatment on feed intake and feeding time but, on the first day after treatment, biopsied cows had meals that were more frequent (7.2 vs. 4.6 meals/d; SE = 0.93) and tended to be shorter (28.2 vs. 60.9 min/meal; SE = 11.8) than control cows. In conclusion, we did not detect effects of mammary biopsy on feed intake or lying time during our time frame of observation, but activity patterns were altered, which could be indicative of increased overall restlessness and specific pain in the biopsied quarter.

Farm and abattoir sources of Carnobacterium species and implications for lamb meat spoilage.

AIMS: To investigate the transmission route of Carnobacterium from the farm environment to the meat-manufacturing plant and potential risk for meat spoilage. METHODS AND RESULTS: A sheep farm-level survey of Carnobacterium, consisting of 150 environmental and animal (no 100) associated samples, was carried out on two farms. A further 20 lamb carcass samples were taken from an abattoir servicing one of the farms. The majority of Carnobacterium maltaromaticum isolates were associated with fleece followed by hard sheep contact surfaces, rectal-anal mucosal swabs and carcasses. Enterobacterial repetitive intergenic consenus PCR (ERIC-PCR) profiling revealed four distinct ERIC types. Each ERIC type was found on both farms, three of which were also found on lamb carcasses. CONCLUSIONS: Enterobacterial repetitive intergenic consenus PCR was effective at demonstrating within-species variability in C. maltaromaticum. This study provides initial information showing that farm sources maybe an important transmission route of Carnobacterium for contamination of lamb carcasses and subsequently the meat processing environment. SIGNIFICANCE AND IMPACT OF THE STUDY: Data on distribution, diversity, sources and transmission routes for meat product contamination is limited for spoilage bacteria. This study highlights the importance of good hygienic slaughter practices and cleaning routines to remove accumulated detritus from the handling of animals that may lead to cross-contamination.

Blind esophageal brushing offers a safe and accurate method to monitor inflammation in children and young adults with eosinophilic esophagitis.

Patients with eosinophilic esophagitis (EoE) require frequent evaluation of mucosal inflammation via endoscopy. Instead of endoscopy, mucosal evaluation in adults with esophageal cancer and candidiasis is achieved using a cytology brush inserted through a nasogastric tube (NGT). We conducted a prospective cross-sectional study in children and young adults scheduled for routine esophagogastroduodenoscopy (EGD) where in Phase 1, we performed esophageal brushing through the endoscope under direct visualization and in Phase 2, we inserted the brush through a Cortrak® NGT prior to endoscopy. Eosinophil-derived neurotoxin (EDN) measured by ELISA in the samples extracted from brushes was validated as the sensitive biomarker. We collected 209 esophageal brushing samples from 94 patients and we found that EDN in brushing samples collected via EGD or NGT was significantly higher in patients having active EoE (n = 81, mean EDN 381 mcg/mL) compared with patients having gastroesophageal reflux disease (n = 31, mean EDN 1.9 mcg/mL, P = 0.003), EoE in remission (n = 47, mean EDN 3.7 mcg/mL, P = 0.003), or no disease (n = 50, mean EDN 1.1 mcg/mL, P = 0.003). EDN at a concentration of ≥10 mcg/mL of brushing sample was found to accurately detect active EoE. NGT brushing did not cause any significant adverse effects. We concluded that blind esophageal brushing using an NGT is a fast, less invasive, safe, and well-tolerated technique compared with EGD to detect and monitor EoE inflammation using EDN as the sensitive biomarker.

Characterizing social behavior, activity, and associations between cognition and behavior upon social grouping of weaned dairy calves.

Weaned dairy calves are commonly exposed to changing physical and social environments, and ability to adapt to novel management is likely to have performance and welfare implications. We characterized how behavioral responses of weaned heifer calves develop over time after introduction to a social group. Previously individually reared Holstein heifer calves (n = 15; 60 ± 5 d of age; mean ± standard deviation) were introduced in weekly cohorts (5 ± 3 new calves/wk) to an existing group on pasture (8 ± 2 calves/group). We measured activity and behavior on the day of initial introduction and after 1 wk, when calves were exposed to regrouping (addition of younger calves and removal of older calves from the pen). Upon introduction, calves had 2 to 3 times more visits to each region of the pasture; they also spent more time at the back of the pasture, closest to where they were introduced and furthest from the feeding area (25.13 vs. 9.63% of observation period, standard error = 5.04), compared with behavior after 1 wk. Calves also spent less time feeding (5.0 vs. 9.6% of observation period, standard error = 0.82) and self-grooming (0.52 vs. 1.31% of observation period; standard error = 0.20) and more time within 1 to 3 body lengths of another calf (16.3 vs. 11.9% of observation period, standard error = 2.3) when initially grouped. We also explored whether behavioral responses to initial postweaning grouping might be associated with individual differences in behavioral flexibility. To evaluate this, we assessed cognition of individually housed calves (n = 18) at 5 wk of age using a spatial discrimination task conducted in a T-maze to measure initial learning (ability to learn the location of a milk reward) and reversal learning (ability to relearn location of the milk reward when it was switched to opposite arm of the maze). Calves were categorized by reversal learning success (passed, n = 6, or failed, n = 8). Calves that passed the reversal learning stage of the cognitive task spent less time at the back of the pen (9.3 vs. 27.4% of observation period, standard error = 5.5) and tended to have lower latency to feed (121.8 vs. 306.2 min; standard error = 96.4) on the day of introduction compared with calves that failed reversal learning. Overall, we found that initial introduction to social grouping had a marked influence on behavior of weaned calves that decreased over time. Further, these results suggest that individual variability in cognitive ability may be predictive of behavioral responses and ability to adapt to a novel environment.

The effect of milk-feeding method and hay provision on the development of feeding behavior and non-nutritive oral behavior of dairy calves.

We investigated the interactive effects of common feeding management factors on the development of feeding and non-nutritive oral behaviors in preweaned calves through the weaning transition. Calves were randomly assigned to 1 of 3 treatments that differed by milk-feeding method (teat or bucket) and ad libitum access to chopped timothy hay: control, milk provided by bucket and no access to hay (CON; n = 10); milk provided by bucket and access to hay (H; n = 10); milk provided via a teat and access to hay (TH; n = 10). Calves had ad libitum access to concentrate and water, and were fed 6 L/d of pasteurized waste milk, divided into 2 meals. All calves were weaned by removing the second milk meal for 9 ± 2 d, beginning at 36 d of age. Daily concentrate and hay intake were recorded, and calves were weighed weekly to measure growth. We recorded the behavior of all calves using 2 s time-lapse video during time periods that encompassed milk meals, from 6000 h to 1000 h and 1600 h to 2000 h, on 2 consecutive focal days in wk 2 and 4. We continuously monitored lying time and activity using electronic data loggers. During the preweaning period, hay selection by H and TH calves was subject to a treatment × week interaction, with TH calves increasing hay intake to a greater extent over time. Similarly, we observed a tendency for a treatment × week interaction for hay dry matter intake. Before weaning, concentrate intake was subject to a treatment × week interaction, increasing to a greater extent over time for H and TH calves, but was greater overall for CON calves. As predicted, milk-feeding method and hay provision influenced the proportion of time devoted to feeding and non-nutritive behaviors. The CON calves spent the greatest amount of time performing non-nutritive sucking directed at the pen, TH calves the least, and H calves intermediate amounts. Considering the time TH calves sucked on their teat when milk was not present in addition to the time they spent sucking on pen fixtures, the total amount of time spent performing sucking behavior was similar between treatments. Although intake was similar across the weaning transition, CON calves had greater average daily gain than H calves, and TH calves were intermediate. Providing access to hay and milk via a teat during the milk-feeding stage decreased non-nutritive oral behaviors and influenced feeding behavior.

In utero exposure to heat stress during late gestation has prolonged effects on the activity patterns and growth of dairy calves.

Exposure to heat stress during late gestation exerts negative carryover effects on the postnatal performance of the calf. In this study, we evaluated the health, growth, and activity patterns of calves born to cows exposed to heat stress (HT, provided only shade, n = 31) or cooling (CL, fans, soakers, and shade, n = 29) during late gestation (∼46 d, maternal dry period). Calves' body weight, rectal temperature, suckling reflex, and movement scores were recorded at birth, and calves were fed 6.6 L of maternal colostrum in 2 meals. Blood samples were collected at birth (before feeding), 24 h after birth, and at d 10 and 28 of age. Calves were housed in individual pens, fed pasteurized milk (6 L/d), and had ad libitum access to grain and water until weaning (49 d). Activity was assessed during the first week of life (wk 1), at weaning (wk 7), and in the first week postweaning (wk 8) using electronic data loggers. Health and body weight were monitored weekly. At birth, calves born to CL cows were heavier (41.9 vs. 39.1 ± 0.8 kg), their temperature was lower (38.9 vs. 39.3 ± 0.08°C), and they were more efficient at absorbing IgG than HT calves. Suckling reflex and movement score at birth were not different between groups, but calves born to CL cows spent more time (50 min/d) standing in the first week of life as a result of longer standing bouts. In wk 7 and 8, calves born to CL cows had less frequent standing bouts than HT heifers, but CL heifers maintained greater total daily standing time (36 min/d) due to longer (7 min/bout) standing bouts. All calves were healthy, but HT heifers tended to have higher (looser) fecal scores on d 10. Heifers born from CL cows gained 0.2 kg/d more from birth to weaning, weighed 4 kg more at weaning, and had greater concentrations of IGF-1 than HT calves, particularly on d 28. In utero heat stress during late gestation had immediate and prolonged effects on passive immunity, growth, and activity patterns in dairy calves.

Staged multidisciplinary step-up management for necrotizing pancreatitis.

BACKGROUND: Some 15 per cent of all patients with acute pancreatitis develop necrotizing pancreatitis, with potentially significant consequences for both patients and healthcare services. METHODS: This review summarizes the latest insights into the surgical and medical management of necrotizing pancreatitis. General management strategies for the treatment of complications are discussed in relation to the stage of the disease. RESULTS: Frequent clinical evaluation of the patient's condition remains paramount in the first 24-72 h of the disease. Liberal goal-directed fluid resuscitation and early enteral nutrition should be provided. Urgent endoscopic retrograde cholangiopancreatography is indicated when cholangitis is suspected, but it is unclear whether this is appropriate in patients with predicted severe biliary pancreatitis without cholangitis. Antibiotic prophylaxis does not prevent infection of necrosis and antibiotics are not indicated as part of initial management. Bacteriologically confirmed infections should receive targeted antibiotics. With the more conservative approach to necrotizing pancreatitis currently advocated, fine-needle aspiration culture of pancreatic or extrapancreatic necrosis will less often lead to a change in management and is therefore indicated less frequently. Optimal treatment of infected necrotizing pancreatitis consists of a staged multidisciplinary 'step-up' approach. The initial step is drainage, either percutaneous or transluminal, followed by surgical or endoscopic transluminal debridement only if needed. Debridement is delayed until the acute necrotic collection has become 'walled-off'. CONCLUSION: Outcome following necrotizing pancreatitis has improved substantially in recent years as a result of a shift from early surgical debridement to a staged, minimally invasive, multidisciplinary, step-up approach.

A three-year follow-up study of the development of joint contractures in 131 patients with systemic sclerosis.

OBJECTIVES: To analyse the correlation between the number of joint-contractures and other major clinical findings in a follow-up study of 131 patients with systemic sclerosis (SSc). METHODS: The range of motion of joints (ROM), HAQ-DI, and the major clinical characteristics were assessed. RESULTS: A high frequency of contractures (ROM<75% of the normal) were present at baseline in small joints of the hand (82%), wrists (75%), and shoulders (50%). ROM of the dominant side hand was significantly more decreased compared to the non-dominant side. The number of the upper extremity contractures correlated positively with ESR (p<0.01), CRP (p<0.01), HAQ-DI (p<0.01), and negatively with forced vital capacity (FVC) (p<0.05). The number of contractures was not significantly different in cases with early (≤ 4 years) and late disease duration in both the limited and diffuse subgroups. During the three-year follow-up period, an increase in the number of joint contractures (ROM<75%) was associated with an increase of ESR, modified Rodnan's skin score, and the European Scleroderma Study Group Activity Index by multiple linear regression analysis. Univariate analysis over a six-year period demonstrated poor outcome in patients with more than ten contractures, or more than four contractures of unilateral hand-joints. CONCLUSIONS: Contractures predominantly develop during the early years following disease onset in both SSc subgroups. Inflammation and skin-involvement are significant contributing factors for the development of contractures. The dominant hand may be more pronouncedly impaired compared to the non-dominant side. A high number of joint-contractures might be an unfavourable prognostic factor in SSc.

Lipid and non-lipid cardiovascular risk factors in postmenopausal type 2 diabetic women with and without coronary heart disease.

BACKGROUND: Coronary heart disease (CHD) is the leading cause of death in diabetic women. In addition to hyperglycemia, other factors may contribute to the excessive cardiovascular risk. AIM: In this study we evaluated common and emerging risk factors in a selected group of postmenopausal type 2 diabetic women with (n = 36) and without CHD (n = 59), not taking lipid-lowering medications. METHODS: Clinical and lifestyle data were collected, and metabolic and lipid profile, as well as fasting plasma levels of total homocysteine (tHcy), folate, vitamin B12, C-reactive protein (hsCRP), interleukin 6 (IL-6), and vascular cell adhesion molecule-1 (VCAM-1) were measured in all participants. RESULTS: Age, menopause and diabetes duration, family history for cardiovascular disease, prevalence of hypertension and current insulin use were greater in diabetic women with than without CHD (P < 0.05 for all comparisons). CHD women also showed higher levels of triglycerides, small dense LDL (sdLDL), remnant-like particle cholesterol, tHcy, and VCAM-1, and a lower creatinine clearance (P < 0.05 all). Conversely, the two groups were comparable for BMI, waist circumference, smoking habit, fasting plasma glucose, HbA1c, total cholesterol, low-density lipoprotein cholesterol (LDL-C), HDL cholesterol, folate, vitamin B12, hsCRP and IL-6 levels. At multivariate analysis, lower creatinine clearance (OR = 0.932, P = 0.017) and higher sdLDL serum concentration (OR = 1.224, P = 0.037) were the strongest risk factors associated with CHD in this population, whereas no significant association was noted with LDL-C. CONCLUSIONS: Our data suggest that beyond LDL-C, a lower creatinine clearance and more subtle alterations of LDL particles, together with a constellation of several well known and emerging cardiovascular risk factors, are stronger contributors to the high CHD risk of diabetic women.

B-cell depletion extends the survival of GTKO.hCD46Tg pig heart xenografts in baboons for up to 8 months.

Xenotransplantation of genetically modified pig organs offers great potential to address the shortage of human organs for allotransplantation. Rejection in Gal knockout (GTKO) pigs due to elicited non-Gal antibody response required further genetic modifications of donor pigs and better control of the B-cell response to xenoantigens. We report significant prolongation of heterotopic alpha Galactosyl transferase "knock-out" and human CD46 transgenic (GTKO.hCD46Tg) pig cardiac xenografts survival in specific pathogen free baboons. Peritransplant B-cell depletion using 4 weekly doses of anti-CD20 antibody in the context of an established ATG, anti-CD154 and MMF-based immunosuppressive regimen prolonged GTKO.hCD46Tg graft survival for up to 236 days (n = 9, median survival 71 days and mean survival 94 days). B-cell depletion persisted for over 2 months, and elicited anti-non-Gal antibody production remained suppressed for the duration of graft follow-up. This result identifies a critical role for B cells in the mechanisms of elicited anti-non-Gal antibody and delayed xenograft rejection. Model-related morbidity due to variety of causes was seen in these experiments, suggesting that further therapeutic interventions, including candidate genetic modifications of donor pigs, may be necessary to reduce late morbidity in this model to a clinically manageable level.

Characterizing substance use typologies and their association with HIV viral load outcomes: A latent class analysis among sexual minority men living with HIV.

BACKGROUND: Racially diverse sexual minority men (SMM) are disproportionately impacted by the U.S. HIV epidemic. Substance use, particularly stimulant use, may impact viral suppression for SMM living with HIV. The current study sought to characterize patterns of substance use via latent class analysis (LCA) and test associations between those patterns and future viral load outcomes, among SMM living with HIV. METHODS: Data were drawn from Thrive With Me (TWM), an RCT of an mHealth intervention targeting ART adherence among SMM living with HIV. LCA was performed with six dichotomous indicators of substance use, derived from validated measures and urinalysis results, to determine substance use classes at baseline. Bivariate and multivariable logistic regression models tested associations between baseline substance use classes and HIV viral load 5-months post-baseline. RESULTS: Among 383 SMM living with HIV, we identified a three-class model of substance use fit best: low probability substance use (81.3 %), high probability hazardous alcohol, marijuana, and cocaine use (7.5 %), and high probability methamphetamine and amphetamine use (11.2 %). Additionally, the high probability amphetamine use class was less likely to be virally suppressed at 5-month follow-up compared to the low probability substance use class [Adjusted Odds Ratio = 3.34, 95 % Confidence Interval = 1.39-7.99, p = .0069]. CONCLUSION: We identified that some patterns of substance use (i.e., methamphetamine and amphetamine use), but possibly not others (e.g., alcohol, marijuana, and cocaine use), are potentially important intervention targets for improving HIV-related outcomes among racially diverse SMM living with HIV.

The interferon-induced helicase IFIH1 Ala946Thr polymorphism is associated with type 1 diabetes in both the high-incidence Finnish and the medium-incidence Hungarian populations.

AIMS/HYPOTHESIS: The rs1990760 polymorphism (Ala946Thr) of interferon induced with helicase C domain 1 (IFIH1) has been proposed to associate with type 1 diabetes. In this study, association between IFIH1 Ala946Thr and type 1 diabetes was investigated in two distinct white populations, the Hungarians and Finns. METHODS: The rs1990760 polymorphism was genotyped in 757/509 Hungarian/Finnish childhood-onset cases, 499/250 Hungarian/Finnish control individuals and in 529/924 Hungarian/Finnish nuclear family trios. Disease association was tested using case-control and family-based approaches. A meta-analysis of data from 9,546 cases and 11,000 controls was also performed. RESULTS: In the Hungarian dataset, the A allele was significantly more frequent among cases than among controls (OR 1.29, 95% CI 1.10-1.52; p = 0.002). Combined analysis of Hungarian and Finnish datasets revealed a strong disease association (OR 1.235, 95% CI 1.083-1.408; p = 0.002). Furthermore, the A allele was significantly overtransmitted in both family trio datasets (p = 0.017 in Hungarians; p = 0.007 in Finns). The A allele was increased in Hungarian vs Finnish cases (64.9% vs 60.8% in Finns; p = 0.003). The meta-analysis yielded a significant effect for IFIH1 rs1990760 A allele on type 1 diabetes risk (OR 1.176, 95% CI 1.130-1.225; p = 5.3 x 10(-15)) with significant heterogeneity between effect sizes across the studied populations (p = 0.023). CONCLUSIONS/INTERPRETATION: This study represents the first independent confirmation of the association between type 1 diabetes and the IFIH1 gene in Hungarian and Finnish populations. Summarising the data published so far, a clear association between the Ala946Thr polymorphism and type 1 diabetes was detected, with an apparent difference in the contribution to disease susceptibility in different populations of European ancestry.