Take-Home Naloxone Program Implementation: Lessons Learned From Seven Chicago-Area Hospitals.

Despite consensus recommendations from the American College of Emergency Physicians (ACEP), the Centers for Disease Control and Prevention, and the surgeon general to dispense naloxone to discharged ED patients at risk for opioid overdose, there remain numerous logistic, financial, and administrative barriers to implementing "take-home naloxone" programs at individual hospitals. This article describes the recent collective experience of 7 Chicago-area hospitals in implementing take-home naloxone programs. We highlight key barriers, such as hesitancy from hospital administrators, lack of familiarity with relevant rules and regulations in regard to medication dispensing, and inability to secure a supply of naloxone for dispensing. We also highlight common facilitators of success, such as early identification of a "C-suite" champion and the formation of a multidisciplinary team of program leaders. Finally, we provide recommendations that will assist emergency departments planning to implement their own take-home naloxone programs and will inform policymakers of specific needs that may facilitate dissemination of naloxone to the public.

Long-term effects of alum-treated litter, untreated litter and NH4NO3 application on phosphorus speciation, distribution and reactivity in soils using K-edge XANES and chemical fractionation.

Whereas soil test information on the fertility and chemistry of soils has been important to elaborate safe and sound agricultural practices, micro-scale information can give a whole extra dimension to understand the chemical processes occurring in soils. The objective of this study was to evaluate the effects that the consecutive application of untreated poultry litter, alum-treated litter or ammonium nitrate (NH4NO3) had on P solubility in soils over 20 years. For this, we used soil test data, sequential chemical fractionation (SCF) of P, and P K-edge XANES and µ-fluorescence spectroscopies. Water extractable P data indicated that application of alum to poultry litter was a very effective treatment for reducing P solubility. On the basis of our SCF of P data, P was primarily found within the 0.1 M NaOH pool across the applied rates and regardless of the treatment, where application of alum-treated litter accounted for as much as 59 ±â€¯2% of the total, followed by NH4NO3, 49 ±â€¯4%, and untreated litter, 40 ±â€¯2%. It was also shown that in soils where alum-treated litter was applied, the Resin pool accounted for 10 ±â€¯1% of the total, followed by NH4NO3, 13 ±â€¯4%, and untreated litter, 18 ±â€¯2%, indicating that P was less readily available in soils where alum-treated litter was applied. Phosphorus XANES indicated that P was predominantly associated to Fe > Al > Ca > organic molecules, regardless of the treatment or applied rates, though the formation of PoAl complexes was only found in soils that received application of alum-treated litter and was positively related to the applied rates. The combination of P-XANES with SCF or µ-fluorescence data was shown to provide valuable information about P reactivity and distribution in soils and should thus be used to address the fate of applied P amendments in soils.

First-in-human phase 1 study of margetuximab (MGAH22), an Fc-modified chimeric monoclonal antibody, in patients with HER2-positive advanced solid tumors.

Background: Margetuximab is an anti-HER2 antibody that binds with elevated affinity to both the lower and higher affinity forms of CD16A, an Fc-receptor important for antibody dependent cell-mediated cytotoxicity (ADCC) against tumor cells. A Phase 1 study was initiated to evaluate the toxicity profile, maximum tolerated dose (MTD), pharmacokinetics, and antitumor activity of margetuximab in patients with HER2-overexpressing carcinomas. Patients and methods: Patients with HER2-positive breast or gastric cancer, or other carcinomas that overexpress HER2, for whom no standard therapy was available, were treated with margetuximab by intravenous infusion at doses of 0.1-6.0 mg/kg for 3 of every 4 weeks (Regimen A) or once every 3 weeks (10-18 mg/kg) (Regimen B). Results: Sixty-six patients received margetuximab (34 patients for Regimen A and 32 patients for Regimen B). The MTD was not reached for either regimen. Treatment was well-tolerated, with mostly Grade 1 and 2 toxicities consisting of constitutional symptoms such as pyrexia, nausea, anemia, diarrhea, and fatigue. Among 60 response-evaluable patients, confirmed partial responses and stable disease were observed in 7 (12%) and 30 (50%) patients, respectively; 26 (70%) of these patients had received prior HER2-targeted therapy. Tumor reductions were observed in over half (18/23, 78%) of response-evaluable patients with breast cancer including durable (>30 weeks) responders. Ex vivo analyses of patient peripheral blood mononuclear cell samples confirmed the ability of margetuximab to support enhanced ADCC compared with trastuzumab. Conclusions: Margetuximab was well-tolerated and has promising single-agent activity. Further development efforts of margetuximab as single agent and in combination with other therapeutic agents are ongoing. Trial Registration ID: NCT01148849.

Syndrome surveillance of fentanyl-laced heroin outbreaks: Utilization of EMS, Medical Examiner and Poison Center databases.

OBJECTIVE: Describe surveillance data from three existing surveillance systems during an unexpected fentanyl outbreak in a large metropolitan area. METHODS: We performed a retrospective analysis of three data sets: Chicago Fire Department EMS, Cook County Medical Examiner, and Illinois Poison Center. Each included data from January 1, 2015 through December 31, 2015. EMS data included all EMS responses in Chicago, Illinois, for suspected opioid overdose in which naloxone was administered and EMS personnel documented other criteria indicative of opioid overdose. Medical Examiner data included all deaths in Cook County, Illinois, related to heroin, fentanyl or both. Illinois Poison Center data included all calls in Chicago, Illinois, related to fentanyl, heroin, and other prescription opioids. Descriptive statistics using Microsoft Excel® were used to analyze the data and create figures. RESULTS: We identified a spike in opioid-related EMS responses during an 11-day period from September 30-October 10, 2015. Medical Examiner data showed an increase in both fentanyl and mixed fentanyl/heroin related deaths during the months of September and October, 2015 (375% and 550% above the median, respectively.) Illinois Poison Center data showed no significant increase in heroin, fentanyl, or other opioid-related calls during September and October 2015. CONCLUSION: Our data suggests that EMS data is an effective real-time surveillance mechanism for changes in the rate of opioid overdoses. Medical Examiner's data was found to be valuable for confirmation of EMS surveillance data and identification of specific intoxicants. Poison Center data did not correlate with EMS or Medical Examiner data.

Canine Nervous System Lymphoma Subtypes Display Characteristic Neuroanatomical Patterns.

Primary and secondary nervous system involvement occurs in 4% and 5%-12%, respectively, of all canine non-Hodgkin lymphomas. The recent new classification of canine malignant lymphomas, based on the human World Health Organization classification, has been endorsed with international acceptance. This histological and immunocytochemical classification provides a unique opportunity to study the histologic anatomic distribution patterns in the central and peripheral nervous system of these defined lymphoma subtypes. In this study, we studied a cohort of 37 dogs with lymphoma, which at necropsy had either primary (n = 1, 2.7%) or secondary (n = 36; 97.3%) neural involvement. These T- (n = 16; 43.2%) or B-cell (n = 21; 56.8%) lymphomas were further classified into 12 lymphoma subtypes, with predominant subtypes including peripheral T-cell lymphoma (PTCL) or diffuse large B-cell lymphoma (DLBCL), respectively. This systematic study identified 6 different anatomically based histologically defined patterns of lymphoma infiltration in the nervous system of dogs. Different and distinct combinations of anatomical patterns correlated with specific lymphoma subtypes. Lymphoma infiltration within the meningeal, perivascular, and periventricular compartments were characteristic of DLBCL, whereas peripheral nerve involvement was a frequent feature of PTCL. Similarly cell counts above 64 cells/µL in cerebrospinal samples correlated best with marked meningeal and periventricular lymphoma infiltration histologically. Prospective studies are needed in order to confirm the hypothesis that these combinations of histological neuroanatomic patterns reflect targeting of receptors specific for the lymphoma subtypes at these various sites.

Effects of Grazing Management and Buffer Strips on Metal Runoff from Pastures Fertilized with Poultry Litter.

Metal runoff from fields fertilized with poultry litter may pose a threat to aquatic systems. Buffer strips located adjacent to fields may reduce nutrients and solids in runoff. However, scant information exists on the long-term effects of buffer strips combined with grazing management on metal runoff from pastures. The objective of this study was to assess the 12-yr impact of grazing management and buffer strips on metal runoff from pastures receiving poultry litter. The research was conducted using 15 watersheds (25 m wide and 57 m long) with five treatments: hayed (H), continuously grazed (CG), rotationally grazed (R), rotationally grazed with a buffer strip (RB), and rotationally grazed with a fenced riparian buffer strip (RBR). Poultry litter was applied annually in spring at 5.6 Mg ha. Runoff samples were collected after every rainfall event. Aluminum (Al) and iron (Fe) concentrations were strongly and positively correlated with total suspended solids, indicating soil erosion was the primary source. Soluble Al and Fe were not related to total Al and Fe. However, there was a strong positive correlation between soluble and total copper (Cu) concentrations. The majority of total Cu and zinc was in water-soluble form. The CG treatment had the highest metal concentrations and loads of all treatments. The RBR and H treatments resulted in lower concentrations of total Al, Cu, Fe, potassium, manganese, and total organic carbon in the runoff. Rotational grazing with a fenced riparian buffer and converting pastures to hayfields appear to be effective management systems for decreasing concentrations and loads of metals in surface runoff from pastures fertilized with poultry litter.

Long-term Effects of Grazing Management and Buffer Strips on Soil Erosion from Pastures.

High grazing pressure can lead to soil erosion in pastures, causing increased sediment delivery to waterways. The objectives of this research were to evaluate the impact of grazing management and buffer strips on soil erosion by assessing soil physical properties, hydrology, and sediment loads from pastures fertilized with broiler litter. Field studies were conducted for 12 yr on 15 small watersheds. Five management strategies were evaluated: hayed (H), continuously grazed (CG), rotationally grazed (R), rotationally grazed with a buffer strip (RB), and rotationally grazed with a fenced riparian buffer (RBR). Broiler litter was applied every year at a rate of 5.6 Mg ha. Bulk density and penetration resistance were highest for CG watersheds. Runoff volumes, sediment concentrations, and loads were lowest for the H and RBR treatments and highest for CG. Average runoff amounts were 48, 84, 77, 60, and 81 mm yr for the H, R, RB, RBR, and CG treatments, respectively. Annual average sediment loads were 25, 30, 58, 71, and 110 kg ha for H, RBR, R, RB, and CG, respectively. The Revised Universal Soil Loss Equation, Version 2 was reasonably effective at predicting soil loss for the R, RB, and RBR treatments, but it greatly overpredicted soil loss from the CG and H treatments. Converting a pasture to a hay field or using rotational grazing in conjunction with a fenced riparian buffer appear to be effective options for reducing soil erosion and runoff to waterways from pasture soils.

Meningococcal disease: has the battle been won?

Meningococcal disease is a worldwide life-threatening infection associated in many cases with debilitating long-term sequelae, both within the military and civilian populations. Military recruits are at a higher risk of acquiring this infection due to numerous factors, such as young recruits in the age group 18-25 years, high carriage rates of meningococci, communal and crowed living quarters and global deployment or training in regions with different meningococcal serogroup epidemiology. Although these increased risk factors among young recruits remain, the increased incidence of disease is now historic. Numerous outbreaks have been reported among military personnel, however although the incidence of the disease continues to decrease, there are still sporadic cases. The non-specific symptoms, sudden onset and rapid progression of the infection results in a limited time frame to both diagnose and successfully treat the patient. Many developments have been made in relation to the microbiological diagnosis of the disease, particularly in the era of molecular diagnostics, which have the potential to diagnose the infection more quickly. Developments in vaccinology, and in particular with relation to biotechnology and reverse vaccinology, have led to the availability of new meningococcal vaccines, further enabling disease prevention. This paper outlines the history of meningococcal disease in relation to the military and highlights the new developments in both diagnostics and vaccination, which have the potential to diagnose, treat and control meningococcal disease in a more efficient manner.

Exploring attitudes toward eating disorders among elite athlete support personnel.

To date, little is known about the beliefs, attitudes, and experiences of athlete support personnel (ASP) working in elite sport toward disordered eating (DE) and eating disorders (EDs). This study seeks to explore this area of mental health, employing an attribution model of stigma as a conceptual lens. Interviews were undertaken with 14 service providers (seven males and seven females) working in high-performance sport in Ireland. In contrast to previous research in the general population, findings revealed that sport-based personnel, in the main, did not hold the individual responsible for the development of their eating disorder. The predominant emotional response of those who had worked with an athlete with a known or suspected eating disorder was anxiety and worry. In line with the findings of previous studies with other health professionals, negative views on the prognosis of those with EDs were expressed by the ASP. Furthermore, confidentiality was found to be a significant barrier to bringing athletes' disclosure of problematic eating or exercise behavior to the fore. The findings of this study add to the limited research exploring attitudes toward EDs in sport and highlights the importance of greater education and openness toward this particular mental health problem.

Clonality Testing in Veterinary Medicine: A Review With Diagnostic Guidelines.

The accurate distinction of reactive and neoplastic lymphoid proliferations can present challenges. Given the different prognoses and treatment strategies, a correct diagnosis is crucial. Molecular clonality assays assess rearranged lymphocyte antigen receptor gene diversity and can help differentiate reactive from neoplastic lymphoid proliferations. Molecular clonality assays are commonly used to assess atypical, mixed, or mature lymphoid proliferations; small tissue fragments that lack architecture; and fluid samples. In addition, clonality testing can be utilized to track neoplastic clones over time or across anatomic sites. Molecular clonality assays are not stand-alone tests but useful adjuncts that follow clinical, morphologic, and immunophenotypic assessment. Even though clonality testing provides valuable information in a variety of situations, the complexities and pitfalls of this method, as well as its dependency on the experience of the interpreter, are often understated. In addition, a lack of standardized terminology, laboratory practices, and interpretational guidelines hinders the reproducibility of clonality testing across laboratories in veterinary medicine. The objectives of this review are twofold. First, the review is intended to familiarize the diagnostic pathologist or interested clinician with the concepts, potential pitfalls, and limitations of clonality testing. Second, the review strives to provide a basis for future harmonization of clonality testing in veterinary medicine by providing diagnostic guidelines.

Cutaneous Lymphoma at Injection Sites: Pathological, Immunophenotypical, and Molecular Characterization in 17 Cats.

Feline primary cutaneous lymphomas (FPCLs) account for 0.2% to 3% of all lymphomas in cats and are more frequently dermal nonepitheliotropic small T-cell tumors. Emergence of FPCL seems unrelated to feline leukemia virus (FeLV) serological positivity or to skin inflammation. A total of 17 cutaneous lymphomas with a history of vaccine injection at the site of tumor development were selected from 47 FPCLs. Clinical presentation, histology, immunophenotype, FeLV p27 and gp70 expression, and clonality were assessed. A majority of male (12/17), domestic short-haired (13/17) cats with a mean age of 11.3 years was reported. Postinjection time of development ranged from 15 days to approximately 9 years in 5 cats. At diagnosis, 11 of 17 cats had no evidence of internal disease. Lymphomas developed in interscapular (8/17), thoracic (8/17), and flank (1/17) cutaneous regions; lacked epitheliotropism; and were characterized by necrosis (16/17), angiocentricity (13/17), angioinvasion (9/17), angiodestruction (8/17), and peripheral inflammation composed of lymphoid aggregates (14/17). FeLV gp70 and/or p27 proteins were expressed in 10 of 17 tumors. By means of World Health Organization classification, immunophenotype, and clonality, the lesions were categorized as large B-cell lymphoma (11/17), anaplastic large T-cell lymphoma (3/17), natural killer cell-like (1/17) lymphoma, or peripheral T-cell lymphoma (1/17). Lineage remained uncertain in 1 case. Cutaneous lymphomas at injection sites (CLIS) shared some clinical and pathological features with feline injection site sarcomas and with lymphomas developing in the setting of subacute to chronic inflammation reported in human beings. Persistent inflammation induced by the injection and by reactivation of FeLV expression may have contributed to emergence of CLIS.

Copper and Zinc Runoff from Land Application of Composted Poultry Litter.

Regions with long-term animal manure applications based on nitrogen (N) requirements have concerns regarding elevated nutrient levels. Most attention has focused on phosphorus (P), but heavy metal accumulation has received attention due to perceived environmental concerns. Composting is a potential management practice that can reduce total manure mass and volume while creating a stabilized product that has less odor and fewer pathogens. However, composting animal manures can lead to high N loss via ammonia volatilization and increased concentrations of nonvolatile nutrients. The objective of this study was to measure copper (Cu) and zinc (Zn) concentrations in runoff water from plots fertilized with composted and fresh poultry litter. Seven treatments were evaluated in the first year: (i) unfertilized control, (ii) fresh poultry litter, (iii) normal compost (no amendment), (iv) composted litter with alum, (v) composted litter with phosphoric acid, (vi) composted litter with a microbial mixture, and (vii) composted litter with alum + microbial mixture. Six of these treatments were evaluated in Year 2 (alum + microbial mixture was not evaluated in Year 2). Rainfall simulators were used to produce a 5 cm h storm event sufficient in length to cause 30 min of continuous runoff. Concentrations of Cu and Zn were elevated in compost compared with fresh poultry litter. However, metal concentrations in compost did not correlate well with metal concentrations in runoff water and may have been affected by compost maturity and amendment. Total Cu and Zn concentrations in runoff water did not differ between alum-amended compost and fresh poultry litter in each year.

Impact of Pratylenchus penetrans on Establishment of Red Raspberry.

The plant-parasitic nematode, Pratylenchus penetrans, is a major constraint to red raspberry (Rubus idaeus) production. To determine the impact of P. penetrans on the establishment and productivity of eight raspberry cultivars, R. niveus, and R. leucodermis, plants were grown in fumigated and nonfumigated soil. Then, soil and root populations of P. penetrans and plant productivity (vigor, cane height, biomass, and yield) were monitored over 2 years. In a separate experiment, the role that soil type plays in mediating P. penetrans populations and raspberry establishment was investigated. At 6 and 12 months after planting, population densities of P. penetrans were lower in fumigated than in nonfumigated soil; this trend continued 18 months after planting. All cultivars and R. leucodermis were found to be extremely susceptible to damage caused by P. penetrans. By the end of the experiment, yield was the most sensitive indicator of plant productivity among cultivars, with losses in nonfumigated soil ranging from 63 to 100% of those observed in fumigated soil. However, there was no difference in the productivity of R. niveus plants grown in nonfumigated versus fumigated soils. Results also indicated that the damage potential of P. penetrans was greater on sandy loam versus silt loam soils. The total plant biomass of 'Meeker' raspberry was 46% lower in a sandy loam soil containing P. penetrans compared with soil without P. penetrans; this trend was not observed consistently in a silt loam soil. Despite the fact that soil fumigation is increasingly more limited by regulations, this study shows the utility of fumigation in reducing P. penetrans populations for a sufficient period of time to ensure that newly planted raspberry seedlings can become successfully established.

Chromosomal ampC mutations in cefpodoxime-resistant, ESBL-negative uropathogenic Escherichia coli.

AmpC ß-lactamase is an enzyme commonly produced by Escherichia coli that causes resistance to cephalosporins and penicillins. Enzyme production is controlled by the strength of the promoter encoded by the chromosomal ampC gene, with the level of production affected by the presence of certain mutations in this region. This study sets out to determine the prevalence of ampC promoter mutations present in a group of uropathogenic E. coli strains. A total of 50 clinical strains of E. coli were collected from urine samples between June 2011 and November 2011. Strains were investigated for the presence of mutations in the chromosomal ampC promoter region by amplification and sequencing of a 271 bp product. The presence of ampC-carrying plasmids derived from other species was also determined, to exclude these from further analysis. ampC-carrying plasmids were found in 10 of the 50 strains, all of which were of the CIT-type. Analysis of the chromosomal ampC promoter region in the 40 remaining strains showed mutations at 16 different positions, with 18 different genotype patterns detected overall. The most common ampC chromosomal mutation, present in 25 of 40 strains, was a T --> A transition at position -32. This mutation has been shown by others to increase enzyme production by up to 46-fold. Altogether, three separate mutations (-32, -42 and -13ins) were present in 90% of the 40 non-plasmid strains, indicating a strong association with the resistance observed. It appears, therefore, that the majority of AmpC-mediated resistance in E. coli can be accounted for by just three point mutations in the chromosome.

Corpus callosum changes in euthymic bipolar affective disorder.

BACKGROUND: Changes in corpus callosum area and thickness have been reported in bipolar disorder. Imaging and limited neuropathological data suggest possible abnormalities in myelination and/or glial function. AIMS: To compare corpus callosum area, thickness and magnetic resonance imaging (MRI) T1 signal intensity in patients with bipolar disorder and healthy controls. METHOD: A total of 48 patients with euthymic bipolar disorder and 46 healthy controls underwent MRI analysis of callosal midsagittal area, callosal thickness and T1 signal intensity. RESULTS: The bipolar group had smaller overall and subregional callosal areas and correspondingly reduced callosal width than the control group. Age correlated negatively with callosal area in the control group but not in the bipolar group. Signal intensity was higher in women than in men in both groups. Signal intensity was reduced in women, but not in men, in the bipolar group. CONCLUSIONS: Observed differences probably relate to diagnosis rather than mood state and bipolar disorder appears to result in morphometric change that overrides changes seen in normal ageing. Intensity changes are consistent with possible altered myelination or glial function. A gender-dependent factor appears to operate and to interact with diagnosis.

Forward shift of feeding buzz components of dolphins and belugas during associative learning reveals a likely connection to reward expectation, pleasure and brain dopamine activation.

For many years, we heard sounds associated with reward from dolphins and belugas. We named these pulsed sounds victory squeals (VS), as they remind us of a child's squeal of delight. Here we put these sounds in context with natural and learned behavior. Like bats, echolocating cetaceans produce feeding buzzes as they approach and catch prey. Unlike bats, cetaceans continue their feeding buzzes after prey capture and the after portion is what we call the VS. Prior to training (or conditioning), the VS comes after the fish reward; with repeated trials it moves to before the reward. During training, we use a whistle or other sound to signal a correct response by the animal. This sound signal, named a secondary reinforcer (SR), leads to the primary reinforcer, fish. Trainers usually name their whistle or other SR a bridge, as it bridges the time gap between the correct response and reward delivery. During learning, the SR becomes associated with reward and the VS comes after the SR rather than after the fish. By following the SR, the VS confirms that the animal expects a reward. Results of early brain stimulation work suggest to us that SR stimulates brain dopamine release, which leads to the VS. Although there are no direct studies of dopamine release in cetaceans, we found that the timing of our VS is consistent with a response after dopamine release. We compared trained vocal responses to auditory stimuli with VS responses to SR sounds. Auditory stimuli that did not signal reward resulted in faster responses by a mean of 151 ms for dolphins and 250 ms for belugas. In laboratory animals, there is a 100 to 200 ms delay for dopamine release. VS delay in our animals is similar and consistent with vocalization after dopamine release. Our novel observation suggests that the dopamine reward system is active in cetacean brains.

A review of histiocytic diseases of dogs and cats.

Histiocytic proliferative disorders are commonly observed in dogs and less often cats. Histiocytic disorders occur in most of the dendritic cell (DC) lineages. Canine cutaneous histiocytoma originates from Langerhans cells (LCs) indicated by expression of CD1a, CD11c/CD18, and E-cadherin. When histiocytomas occur as multiple lesions in skin with optional metastasis to lymph nodes and internal organs, the disease resembles cutaneous Langerhans cell histiocytosis of humans. Langerhans cell disorders do not occur in feline skin. Feline pulmonary LCH has been recognized as a cause of respiratory failure due to diffuse pulmonary infiltration by histiocytes, which express CD18 and E-cadherin and contain Birbeck's granules. In dogs and cats, histiocytic sarcomas (HS) arise from interstitial DCs that occur in most tissues of the body. Histiocytic sarcomas begin as localized lesions, which rapidly disseminate to many organs. Primary sites include spleen, lung, skin, brain (meninges), lymph node, bone marrow, and synovial tissues of limbs. An indolent form of localized HS, progressive histiocytosis, originates in the skin of cats. Hemophagocytic HS originates in splenic red pulp and bone marrow macrophages in dogs and cats. In dogs, histiocytes in hemophagocytic HS express CD11d/CD18, which is a leuko-integrin highly expressed by macrophages in splenic red pulp and bone marrow. Canine reactive histiocytic diseases, systemic histiocytosis (SH) and cutaneous histiocytosis, are complex inflammatory diseases with underlying immune dysregulation. The lesions are dominated by activated interstitial DCs and lymphocytes, which invade vessel walls and extend as vasocentric infiltrates in skin, lymph nodes, and internal organs (SH).

Factors affecting arsenic and copper runoff from fields fertilized with poultry litter.

Arsenic (As) and copper (Cu) runoff from fields fertilized with poultry litter has received increasing attention in recent years, although it is not known if heavy metal runoff from poultry litter poses a significant threat to the environment. The objective of this study was to determine the main factors affecting As and Cu concentrations in runoff water from pastures receiving poultry litter applications. Rainfall simulation studies were conducted to determine the effects of the following treatments on metal runoff: (i) aluminum sulfate (alum) additions, (ii) diet modification using phytase or high available phosphorus corn, (iii) fertilizer type, (iv) poultry litter application rate, and (v) time until the first runoff event occurs after poultry litter application. Results showed that alum additions to poultry litter significantly decreased As and Cu concentrations in runoff water. Copper concentrations were highest in runoff from poultry litter from birds fed phytase diets compared with other diets; however, this effect may have been a result of wet storage conditions rather than diet. Triple superphosphate applications resulted in the lowest heavy metal concentrations in runoff water among all fertilizer treatments, while normal poultry litter resulted in the highest concentrations. Arsenic and Cu concentrations increased in runoff water as poultry litter application rates increased and decreased with increasing time until the first runoff event. These data indicate that adding alum to poultry litter, a cost-effective best management practice, which also results in lower P runoff and ammonia emissions, may also be an effective tool in reducing metal runoff.