Administration of acetylsalicylic acid after parturition in lactating dairy cows under certified organic management: Part I. Milk yield, milk components, activity patterns, fertility, and health.

Parturition is a natural process that gradually progresses from one stage to the next. However, around 5% of dairy cows will experience dystocia, which is considered to be a painful and stressful event. Studies have reported positive effects on cow performance and welfare after treatment with nonsteroidal anti-inflammatory drugs during the first postpartum days. The objectives were to assess the effects of acetylsalicylic acid administration after calving on (1) milk yield and components, (2) daily activity patterns, (3) reproductive performance, and (4) health in lactating dairy cows under certified organic management. Cows from 3 organic herds were enrolled. Within 12 h after parturition, cows were blocked by parity and calving ease and randomly assigned to 2 treatments: (1) aspirin (ASP; n = 278), in which cows received 4 consecutive treatments every 12 h with acetylsalicylic acid (100 mg/kg; 2 boluses) or (2) placebo (PLC, n = 285), in which cows received 4 treatments every 12 h with gelatin capsules (2 capsules) filled with water. Daily milk yield for the first 30 d in milk (DIM) and monthly milk yield, fat, protein, and somatic cell count (SCC) data from the first 5 Dairy Herd Improvement Association tests were collected. Activity patterns were measured using activity data loggers in the first 7 DIM. Clinical disease events (60 DIM) and fertility data were collected from on-farm computer records. Statistical analysis was performed using the MIXED (milk yield, components, and activity), LIFETEST (fertility), and GLIMMIX (health) procedures of SAS (SAS Institute Inc., Cary, NC). Overall, ASP cows produced 1.82 kg/d more milk than PLC cows during the first 30 DIM. Interestingly, cows that experienced dystocia and received ASP produced 4.48 kg/d more milk compared with cows in the PLC group that experienced dystocia. Cows treated with ASP had lower somatic cell count during the first 5 Dairy Herd Improvement Association tests. There were no differences in daily lying time, lying bouts, and lying bout duration between the ASP and PLC groups. However, cows in the ASP group had 587,64 steps/d more compared with PLC cows. In addition, ASP cows tended to require fewer days (ASP = 113.76 ± 4.99 d; PLC = 125.36 ± 4.74 d) and needed fewer services (ASP = 1.86 ± 0.21 services; PLC = 2.19 ± 0.24 services) to become pregnant compared with PLC cows. There were no differences in clinical disease events between treatments. Results from this study suggest that treating cows with ASP after calving may help improve milk yields and udder health, increase activity, and enhance fertility in dairy cattle under certified organic management.

Administration of acetylsalicylic acid after parturition in lactating dairy cows under certified organic management: Part II. Biomarkers of nociception, inflammation, and stress.

The objective was to assess the effect of oral administration of acetylsalicylic acid after calving on the concentrations of substance P (SP), haptoglobin (HP), and cortisol in lactating dairy cows. Holstein dairy cows (n = 152) from 3 organic herds were included. At parturition, cows were blocked by parity [multiparous (MULT) and primiparous (PRIM)] and calving ease [eutocia (EUT) and dystocia (DYS)] and were randomly assigned to 1 of 2 treatment groups: aspirin (ASP; n = 76), in which within 12 h after parturition cows received 4 treatments with acetylsalicylic acid (100 mg/kg; 2 boluses) at 12-h intervals, or placebo (PLC; n = 76), in which within 12 h after parturition cows received 4 consecutive treatments with gelatin capsules (2 capsules) containing water 12 h apart. Blood samples were collected immediately before treatment and at 12, 24, 36, 48, and 168 h (7 DIM) for assessment of circulating concentration of SP, HP, and cortisol. Based on farm records, cows were classified in the following clinical disease categories: no clinical disease event (NO-EVT), a single clinical disease event (SI-EVT), and more than 1 clinical disease event (MU-EVT). The study data were analyzed as a randomized complete block design using mixed multiple linear and logistic regression models. With regard to HP, there was a tendency for an interaction between treatment and parity, where MULT cows treated with ASP had lower concentration of HP compared with MULT cows treated with PLC (ASP = 124.33 ± 6.83 µg/mL; PLC = 143.9 ± 7.24 µg/mL). Analysis by calving ease showed that cows with DYS had higher concentrations of HP (DYS = 159.17 ± 5.97 µg/mL; EUT = 138.72 ± 6.22 µg/mL) and SP (only at 168 h; DYS = 64.99 pg/mL, 95% confidence interval, CI: 2.68-2.81; EUT = 60.33 pg/mL, 95% CI: 2.91-3.06) after calving compared with EUT cows. Regardless of treatment, PRIM cows had higher concentrations of SP (MULT = 55.11 pg/mL, 95% CI: 1.27-1.30; PRIM = 57.62 pg/mL, 95% CI: 1.99-2.06), HP (MULT = 134.14 ± 4.96 µg/mL; PRIM = 163.75 ± 7.76 µg/mL), and cortisol (MULT = 18.65 µg/mL, 95% CI: 1.02-1.05; PRIM = 21.92 µg/mL, 95% CI: 1.67-1.74) compared with MULT cows. In addition, cows that experienced SI-EVT or MU-EVT had higher concentrations of HP (NO-EVT = 134.13 ± 5.95 µg/mL; SI-EVT = 142.68 ± 7.32 µg/mL; MU-EVT = 170.03 ± 9.42 µg/mL) and cortisol (NO-EVT = 17.86 µg/mL, 95% CI: 1.20-1.24; SI-EVT = 21.01 µg/mL, 95% CI: 1.61-1.67; MU-EVT = 22.01 µg/mL, 95% CI: 2.08-2.18) compared with cows with NO-EVT recorded. Results from this study suggest that a short-duration anti-inflammatory therapy after calving reduced HP in MULT cows but may not have effects on SP and cortisol concentrations. Calving ease and parity affected the concentrations of markers of inflammation, nociception, and stress regardless of treatment. Further research is warranted to assess anti-inflammatory strategies aimed at decreasing inflammation and stress in DYS and PRIM cows and therefore improve welfare and performance of these high-priority groups.

Effects of sample size on neutral detergent fiber digestibility of triticale forages using the Ankom DaisyII Incubator system.

Accurate and precise determinations of fiber digestibility are essential for proper diet formulation for dairy cows. Our objectives were 3-fold: (1) regress in vitro neutral detergent fiber digestibility (NDFD) values from 48 triticale forages determined at multiple endpoints ranging from 12 to 240 h with Ankom DaisyII Incubator system (Ankom Technology Corp., Macedon, NY) methods using 0.25- or 0.50-g sample sizes on concentrations of fiber-related analytes or growth stage; (2) directly compare NDFD values determined with 0.25- or 0.50-g sample sizes by Ankom methods after 12-, 24-, 30-, 48-, 144-, or 240-h incubations; and (3) compare NDFD values determined by Ankom methods after 30 and 48 h of incubation with those determined by traditional sealed-tube procedures obtained from a commercial laboratory. Generally, plant growth stage, which was quantified with a linear model suitable for serving as an independent regression variable, proved to be a better predictor variable for NDFD than neutral detergent fiber or acid detergent lignin. For direct comparisons of 0.25- and 0.50-g sample sizes using Ankom methods, the regression relationship for a 30-h incubation was explained by a linear model [Y = 1.206x - 1.1; coefficient of determination (R2) = 0.933], in which the slope differed from unity, but the intercept did not differ from 0. After a 48-h incubation, a linear model (Y = 1.014x + 7.1; R2 = 0.964) indicated that the slope did not differ from unity, but the intercept was >0. A linear regression (Y = 1.040x - 1.8; R2 = 0.861) of the 30-h incubation results obtained by Ankom methods using the 0.25-g sample size on those from the commercial laboratory indicated the slope and intercept did not differ from unity or 0, respectively. A similar relationship was obtained from the 48-h incubation (Y = 1.021x - 3.4; R2 = 0.866). Relationships were poorer when the 0.50-g sample size was used by Ankom methods, particularly for the 30-h incubation, where the slope (0.824) was less than unity. Generally, NDFD values were greater for the 0.25-g sample size by Ankom methods, especially with 24-, 30-, and 48-h incubation times, and agreement with traditional sealed-tube methods was improved with the smaller sample size. Synchronization of results between Ankom and traditional methods needs to be further verified across a wider range of forages and harvest/preservation methods before definitive recommendations can be made.

Randomised clinical trial: anti-viral activity of ANA773, an oral inducer of endogenous interferons acting via TLR7, in chronic HCV.

BACKGROUND: The ANA773 is an oral prodrug of a small-molecule toll-like receptor (TLR)7 agonist. Preclinical and healthy volunteer clinical studies with ANA773 have demonstrated induction of endogenous interferon-α (IFN-α) of multiple subtypes, which supports the potential utility in the treatment of chronic hepatitis C virus (HCV) infection. AIM: To examine safety, tolerability, pharmacodynamics, pharmacokinetics and anti-viral activity of ANA773. METHODS: The ANA773 was investigated in a double-blind, placebo-controlled study in 34 patients chronically infected with HCV of any genotype. Patients were treatment-naïve or had relapsed following previous interferon-based treatment. This dose escalation study was composed of four dose groups (800, 1200, 1600 and 2000mg). In each group, six to eight patients received ANA773 and two received placebo. Patients were dosed with ANA773 every-other-day for either 28 days (800, 1200 or 1600mg) or 10days (2000mg). RESULTS: Mild to moderate adverse events were reported, with an increase in frequency and intensity with increasing dose. No serious AEs were reported and there were no early discontinuations. There were dose-related increases in various markers of IFN-α response. The mean maximum change in serum HCV RNA level from baseline was -0.34, -0.29, -0.40, -0.97 and -1.26log(10) in the placebo, 800, 1200, 1600 and 2000mg cohorts, respectively. At the 2000mg dose, ANA773 significantly (P=0.037) reduced serum HCV RNA levels (range: 0.14 to -3.10log(10) ). CONCLUSION: The ANA773 was generally well tolerated and resulted in a dose-related IFN-dependent response leading to a significant decrease in serum HCV RNA levels in the 2000mg dose group.

Technical note: a near-infrared reflectance spectroscopy technique to predict particle size of starch within corn silage.

Starch particle size characteristics of 81 diverse corn silage samples, which included 27 combinations of hybrid, planting dates, and harvest dates subjected to 3 different degrees of kernel processing, were determined via vertical shaking through 9 screens with nominal square apertures of 19.0, 13.2, 9.5, 6.7, 4.75, 3.35, 2.36, 1.18, and 0.6 mm and a pan. Starch content of dry matter remaining on each screen and on the pan for each corn silage was determined, and geometric mean particle size (GMPS, mum), starch particles(SP)/g, starch surface area (SSA, cm(2)/g), kernel processing score (KPS), % starch < 4.75 mm, and the percentage of total starch remaining on each screen of the vertical shakers were calculated. Near-infrared reflectance spectra were obtained by scanning 3 types of samples: 1 mm of dried ground corn silage; whole undried, unground corn silage; and undried, unground corn silage that passed through a 19-mm screen. Calibrations to predict GMPS, SP, SSA, and KPS characteristics of corn silage starch were attempted from each spectral origin. Calibrations to predict GMPS, SP, SSA, KPS, and the percentage of total starch retained on screens of the vertical shaker was unattainable (R(2) < 0.45) using spectra obtained from 1 mm of dried ground corn silage or whole undried, unground corn silage. However, reasonable near-infrared reflectance spectra equations (R(2) > 0.81) for GMPS, SSA, and KPS were attained using spectra from undried, unground corn silage that passed through a 19-mm screen. This technique holds promise as a rapid and efficient method to determine particle size characteristics of starch within corn silage.

Utility of near-infrared reflectance spectroscopy to predict nutrient composition and in vitro digestibility of total mixed rations.

Total mixed ration (TMR) samples (n = 110) were analyzed for dry matter (DM), crude protein (CP), soluble CP, neutral detergent fiber (NDF), NDF CP, starch, ash, fat, total ethanol-soluble carbohydrate, and nonfiber carbohydrate (NFC). Rapidly and slowly degraded and undegraded in situ CP fractions and in vitro DM, organic matter, and NDF digestibility were determined on each TMR. The TMR were scanned using near-infrared reflectance spectroscopy (NIRS); spectra were retained with NIRS calibration and cross-validation statistics were determined using partial least squares regression methods. The CP, NDF, starch, in vitro DM, and in vitro indigestible NDF contents of TMR were predicted by NIRS with good degrees (R2 >0.85) of accuracy with proportionally low standard errors of prediction. Moderate utility of NIRS to predict the NFC (R2 = 0.83) and fat content (R2 = 0.81) of TMR was observed. Rapidly, slowly, and undegraded in situ CP fractions in TMR were not well predicted by NIRS. Similarly, soluble CP, NDF CP, total ethanol-soluble carbohydrate, and in vitro NDF digestibility (% of NDF) were not well predicted by NIRS. Ratios of nutrient range to reference laboratory method error were calculated and found to be positively related (R2 = 0.84) to NIRS predictability of a given TMR nutrient, suggesting some laboratory procedures were not precise enough to yield suitable NIRS predictions. Data suggest that NIRS has utility to predict basic nutrients such as CP, NDF, starch, NFC, and fat in TMR. However, difficulty was observed using NIRS in predicting key biological nutrients in TMR such as in situ CP fractions and in vitro NDF digestibility. Difficulty of NIRS in predicting these nutrients is related to the level of reference method error in relationship to the range of nutrient values in TMR, but other sources of prediction error may exist.

Fishing for pleiotropic QTLs in a polygenic sea.

The application of factor analysis to human genetics has the potential to discover the coordinated control of multiple traits by common environment, common polygenes, or a single major gene. Classical factor analysis explains the covariation among the components of a random vector by approximating the vector by a linear transformation of a small number of uncorrelated factors. In the current paper we show how factor analysis dovetails with the classical variance decompositions of biometrical genetics. To explore the relationships between related quantitative variables, and avoid complicated positive definiteness constraints, we employ Cholesky and factor analytic decompositions. We derive an ECM algorithm and a competing quasi-Newton algorithm for estimating parameters by maximum likelihood and propose tactics for selecting initial parameter values. We also show how parameter asymptotic standard errors under these parameterizations propagate to asymptotic standard errors of the underlying variance components. Our genetic analysis program Mendel, which now incorporates the program Fisher, has performed well on a variety of data sets. We illustrate our methods, algorithms, and models on two data sets: a bivariate quantitative genetic example using total finger ridge count data and a multivariate linkage example using insulin resistance data.

Short communication: Effect of dietary protein on growth and nitrogen balance of Holstein heifers.

A growth study and a companion N balance study were conducted to evaluate the effect of dietary protein on growth and N utilization of postpubertal Holstein heifers. Forty heifers (398 +/- 9.4 kg) were fed one of four diets containing 8, 11, 13, or 15% crude protein (CP) for 121 d. Body measurements were taken at the beginning and end of the experimental period. Blood was collected via jugular vein every 28 d and evaluated for serum protein, albumin, and urea nitrogen. Curvilinear relationships were observed between dietary CP and gains in wither height and hip width, with maximal gains occurring at 13% CP. Feeding heifers higher amounts of dietary CP resulted in linear increases in heart girth gain, serum protein, albumin, and blood urea nitrogen. In the companion N balance study, feeding increasing amounts of dietary CP to heifers resulted in linear increases in N intake, fecal-N, urinary-N, and absorbed-N. There was a numerical trend towards maximal N retention in heifers fed diets containing 13% CP. Curvilinear relationships also were observed between dietary CP and dry matter, organic matter, and CP digestibility with maximal nutrient digestibilities occurring when heifers were fed diets containing 13% CP. Data suggest 13% dietary CP was optimal for postpubertal (400 kg) Holstein heifers.

Shortening the questionnaire for identifying children with chronic conditions: what is the consequence?

OBJECTIVE: To determine whether a reduced item set can identify children who have chronic conditions with a level of at least 90% accuracy compared with the complete Questionnaire for Identifying Children With Chronic Conditions (QuICCC). BACKGROUND: The QuICCC was developed to operationalize a conceptually based, noncategorical definition of chronic conditions developed by Stein et al. It contains 39 item sequences administered to a parent that assess 3 types of consequences: functional limitations; reliance on compensatory mechanisms or assistance; and service use or need above usual for age. The QuICCC has been validated and widely adopted as a means of identifying children without using a diagnosis checklist, but there is considerable interest in shortening it. DESIGN/METHODS: Through secondary analyses of 3 data sets (Ns = 1265, 1388, and 4831), we identified a short list of items that identified >90% of children who were identified by the 39-item QuICCC. We administered these 16 items to 2 new samples of parents. In Study 1 we administered the 16 items in the shortened version first, followed by the other 23 items, and compared the results on the short and reordered long versions. In Study 2, the 39- and 16-item versions were each administered, one in person and the other by phone, in random order to the same respondent within a 2-week period. These data were analyzed to compare the short and longer versions at the 2 time points and within the single, longer 39-item format (simultaneous data). RESULTS: In Study 1 (N = 630) only 4 children were missed by the 16-item version who were identified by the longer version (sensitivity 98.6%; specificity 100%; positive predictive value 100%; negative predictive value 98.8% kappa 0.987). In Study 2 (N = 552), no children were missed by the 16-item subset of the 39 items when looking at the simultaneous data. When the two forms were administered 2 weeks apart, the 16-item version had a sensitivity of 87%, specificity of 90%, positive predictive value of 93%, negative predictive value of 82%, and kappa of 0.78 compared with the longer QuICCC. These results correspond exactly to the data obtained in a 2-week test-retest study for the QuICCC itself. The new form (the QuICCC-R) takes <2 minutes to administer on average (range 1-4 minutes) compared with 7 to 8 minutes for the full QuICCC. CONCLUSIONS: The results met our criteria for agreement, and we conclude that the QuICCC-R is a satisfactory alternative for screening populations. However, the full QuICCC has other applications beyond screening that may not apply to the QuICCC-R, the shorter version.

The use of parent report to assess the quality of care in primary care visits among children with asthma.

OBJECTIVE: To determine the accuracy of parent report and the accuracy of the medical record in documenting physician performance of elements of pediatric asthma care in the primary care setting. METHODS: A convenience sample of 79 English-speaking parents of 4--12-year old children with asthma presenting to medical center--affiliated inner-city primary care pediatric clinics in the Bronx, Dallas, and Chicago was enrolled, and the office visit was audiotaped. Parents were interviewed 1--16 days after the visit by telephone. OUTCOME MEASURES: Accuracy of parent report was the primary outcome. The "reference standard" was an independent evaluation of the audiotaped record of the primary care visit. The National Asthma Education and Prevention Program was used as a guide to select data elements to assess quality of pediatric asthma care during primary care visits. RESULTS: Sufficient documentation was significantly (P <.001) less likely to be present in the medical record than in the follow-up interview for each element of care. When these elements were combined into a cumulative score, 71% of parent interviews but only 37% of medical records scored > or = 5 (out of a possible 6), with 29% of medical records scoring < 3. Parents were able to accurately report (concordance of parent data with audiotape reference standard) whether or not the visit had included performance of 5 of the 6 elements of care. CONCLUSIONS: Our study suggests that parent telephone interview within 2 weeks after the visit is more accurate than the medical record for documentation of the quality of asthma care in pediatric primary care visits. The medical record was not sufficient to assess the quality of primary care related to asthma, primarily because of missing data. Therefore, our data suggest that assessing quality of care using the medical record will not only bias the findings in the direction of more deficient care but will also make improvement in care more difficult. Further validation of our strategy for using parent report to assess the quality of care in primary care visits will require its application in a variety of other primary care settings.

Pulmonary hemosiderosis in scimitar syndrome after prolonged management of pulmonary hypertension.

OBJECTIVE: To report a fatal outcome from pulmonary hemosiderosis in an infant with scimitar syndrome after prolonged pulmonary vasodilator therapy. DESIGN: Case report. SETTING: A tertiary care pediatric intensive care unit. SUBJECT: An infant with scimitar syndrome. INTERVENTIONS: Treatment included redirection of anomalous right pulmonary venous drainage and closure of atrial septal defect, assisted ventilation via tracheostomy, and protracted nitric oxide and prostacyclin therapy until his death at 1 yr of age. RESULTS: Inhaled nitric oxide (iNO) and/or prostacyclin (PGI(2)) were administered for 6.5 months. Numerous echocardiograms demonstrated good control of pulmonary pressures and no evidence of pulmonary venous obstruction. Repeated attempts to slowly wean from the pulmonary vasodilators resulted in return of pulmonary pressures to systemic levels. Although there was no clinically apparent hemoptysis, pulmonary infiltrates worsened, prompting an open-lung biopsy that revealed pulmonary hemosiderosis. During the last 4 days of the patient's life, the pulmonary hypertensive crises with suprasystemic pressures and pulmonary infiltrates worsened regardless of aggressive vasodilator therapy with iNO, PGI(2), alkalinization, and isoproterenol. Vasodilator therapy was withdrawn and the patient rapidly died. CONCLUSION: We achieved long-term control of pulmonary hypertension with iNO and/or PGI(2) without apparent tachyphylaxis or other major reported side effects. Although pulmonary hypertension was successfully controlled with prolonged iNO and intravenous PGI(2) administration in this patient with scimitar syndrome, the patient died of hypoxemic respiratory failure from pulmonary hemosiderosis. Early evaluation of roentgenographic infiltrates for hemosiderosis and potential lung transplantation in similar patients may be warranted.

Metabolic acidosis, rhabdomyolysis, and cardiovascular collapse after prolonged propofol infusion.

The authors present the hospital course of a 13-year-old girl with a closed head injury who received a prolonged infusion of propofol for sedation and, subsequently, died as a result of severe metabolic acidosis, rhabdomyolysis, and cardiovascular collapse. The patient had been treated for 4 days at a referring hospital for a severe closed head injury sustained in a fall from a bicycle. During treatment for elevations of intracranial pressure, she received a continuous propofol infusion (100 microg/kg/min). The patient began to exhibit severe high anion gap/low lactate metabolic acidosis, and was transferred to the pediatric intensive care unit at the authors' institution. On arrival there, the patient's Glasgow Coma Scale score was 3 and this remained unchanged during her brief stay. The severe metabolic acidosis was unresponsive to maximum therapy. Acute renal failure ensued as a result of rhabdomyolysis, and myocardial dysfunction with bizarre, wide QRS complexes developed without hyperkalemia. The patient died of myocardial collapse with severe metabolic acidosis and multisystem organ failure (involving renal, hepatic, and cardiac systems) approximately 15 hours after admission to the authors' institution. This patient represents another case of severe metabolic acidosis, rhabdomyolysis, and cardiovascular collapse observed after a prolonged propofol infusion in a pediatric patient. The authors suggest selection of other pharmacological agents for long-term sedation in pediatric patients.

How well does the questionnaire for identifying children with chronic conditions identify individual children who have chronic conditions?

BACKGROUND: The Questionnaire for Identifying Children With Chronic Conditions (QuICCC) is an instrument based on a conceptual noncategorical definition that uses parental responses to identify children with chronic conditions for epidemiological purposes. OBJECTIVES: To determine whether the QuICCC is sufficiently valid, sensitive, and specific to be used to identify individual children as having a chronic condition or disability; whether parents are accurate enough that their answers to QuICCC items can be accepted as valid; and what kinds of errors in classification occur when the QuICCC is used to identify children with chronic conditions. METHODS: The sample consisted of 424 children who were patients of 9 physicians in separate practice settings throughout New England. Each physician was briefly trained in the conceptual definition on which the QuICCC is based and then was asked to identify 25 children in his or her practice who met the definition and 25 children who did not meet the definition. The QuICCC was administered to the parents of these children by blinded interviewers via telephone. The QuICCC classification was compared with physician categorization. Discrepant cases were then followed up by asking physicians and parents to answer the original questions a second time. RESULTS: Complete data were available on 379 (89.4%) of 424 children. There was agreement on 89% (kappa = 0.78). The sensitivity was 94%; specificity, 83%; positive predictive value, 86%; and negative predictive value, 92%. Of the 42 discordant cases, 30 parent reports on the QuICCC qualified the child as having a chronic condition when the physician classified the child as being without such a condition. Fewer (n = 12) discrepancies occurred because physicians identified children with chronic conditions that the QuICCC failed to identify. When the questions were readministered at follow-up, physicians corrected errors in rating in 9 cases; mothers changed their answers in 5 instances. In 13 instances the issues were known to both parties and appeared to arise in the "gray zone" or boundary area, where there was disagreement over whether a particular child qualified using the theoretical definition. For 11 children identified as having a chronic condition only by the parent's responses to the QuICCC, physician report appeared to be inaccurate primarily due to the physician's lack of information. In 3 cases where the physician reported the child to have a chronic condition, but the parent did not, the physician appeared to be correct. Follow-up data were incomplete on 1 child. CONCLUSIONS: These data support the validity of parent-generated information for the evaluation of health status. Although these findings should be replicated, this study suggests that the QuICCC may be applicable also as a screening tool for individual child identification, provided that several sources of error are considered.

Do pediatricians recognize mothers with depressive symptoms?

OBJECTIVE: To determine whether pediatric health care providers recognize maternal depressive symptoms and to explore whether maternal, provider, and visit characteristics affect pediatric providers' ability to recognize inner-city mothers with depressive symptoms. DESIGN: A cross-sectional study was conducted at a hospital-based, inner-city, general pediatric clinic. Two groups of participants completed questionnaires, each unaware of the other's responses: 1) mothers who brought their children ages 6 months to 3 years for health care maintenance or a minor acute illness and 2) pediatric health care providers (attending pediatricians, pediatric trainees, and nurse practitioners). The mothers' questionnaire consisted of sociodemographic items and a self-administered assessment of depressive symptoms using the Psychiatric Symptom Index (PSI). Pediatric providers assessed child, maternal, and family functioning and documented maternal depressive symptoms. Criteria for positive identification of a mother by the pediatric health care provider were met if the provider reported one or more maternal symptoms (from a 10-item list of depressive symptoms), a rating of 4 or less on a scale of functioning, a yes response to the question of whether the mother was acting depressed, or a response that the mother was somewhat to very likely to receive a diagnosis of depression. RESULTS: Of 338 mothers who completed the questionnaire, 214 (63%) were assessed by 1 of 60 pediatric providers. Seventy-seven percent of surveys were completed by the child's designated pediatric provider. The mean visit length was 23 minutes. Mothers primarily were single, were black or Hispanic, and had a mean age of 26 years (15-45 years). Almost 25% of mothers were living alone with their children. Eighty-six (40%) mothers scored >/=20 on the PSI, representing high symptom levels. Of these, 25 were identified by pediatric providers (sensitivity = 29%). A total of 104 of 128 mothers with a PSI score <20 were identified as such by providers (specificity = 81%). Pediatric providers were more likely to identify mothers who were <30 years old, living alone, and on public assistance. Also, mothers who were assessed by the child's own primary provider or by an attending pediatrician were more likely to be identified accurately than were mothers whose children were seen by a pediatric trainee or a nurse practitioner. CONCLUSIONS: Pediatric health care providers did not recognize most mothers with high levels of self-reported depressive symptoms. Pediatricians may benefit from asking directly about maternal functioning or by using a structured screening tool to identify mothers who are at risk for developing depressive symptoms. In addition, training pediatric providers to identify mothers with depressive symptoms may be beneficial.

The relationship between psychosocial factors and asthma morbidity in inner-city children with asthma.

OBJECTIVE: Children living in the inner city are affected disproportionately by asthma morbidity and mortality. Previous research has shown that behavioral and psychosocial factors affect asthma morbidity in children. The National Cooperative Inner-City Asthma Study investigated the factors that contribute to asthma morbidity among inner-city children. This article examines the relationship between psychosocial factors and asthma morbidity in this population. METHODS: A total of 1528 English- and Spanish-speaking children 4 to 9 years of age with asthma and their primary caretakers were recruited from 8 research centers in 7 metropolitan inner-city areas in the United States. Psychosocial variables were assessed at baseline and included measures of child and caretaker mental health, caretaker's problems with alcohol, life stress, social support, and parenting style. Morbidity measures were evaluated at baseline and at 3-, 6-, and 9-month follow-up intervals. These included number of hospitalizations and unscheduled visits for asthma in the past 3 months and number of days of wheeze and functional status in the previous 2-week period. RESULTS: Of the psychosocial variables assessed, mental health had the strongest relationship to children's asthma morbidity. Children whose caretakers had clinically significant levels of mental health problems were hospitalized for asthma at almost twice the rate as children whose caretakers did not have significant mental health problems. Children with clinically significant behavior problems had significantly more days of wheeze and poorer functional status in the follow-up period. CONCLUSION: Psychosocial factors, particularly the mental health of children and caretakers, are significant factors in predicting asthma morbidity. They may need to be included in intervention programs aimed at decreasing asthma morbidity in inner-city children with asthma in order for these programs to be successful.

Perceived role restriction and depressive symptoms in mothers of children with chronic health conditions.

This study examined role restriction in 365 inner-city mothers of 5- to 8-year-old children with chronic health conditions and tested whether it could account for a previously reported relationship between children's functional limitations and maternal psychological distress. Functional limitations in the children were related to maternal role restriction with sociodemographic factors controlled. Children's functional limitations also independently predicted maternal Depression subscale scores in a regression model. Adding role restriction to this model significantly increased explained variance in Depression scores, indicating that it also is directly related to maternal distress symptoms. However, adding role restriction only slightly reduced the impact of functional limitations in the model, suggesting that it plays a small role, if any, in explaining the relationship between the other two variables. Because perceived role restriction independently predicts maternal depressive symptoms and represents a potentially modifiable risk factor, it warrants attention as a useful target for intervention.

Sociodemographic and condition-related characteristics associated with conduct problems in school-aged children with chronic health conditions.

OBJECTIVE: To examine whether sociodemographic and condition-related characteristics are associated with conduct problems in children with chronic health conditions. DESIGN: Cross-sectional survey. PARTICIPANTS: Mothers of children 5 to 8 years old with diverse chronic health conditions who received care at 2 large urban medical centers. MEASURES: Mothers responded to a face-to-face structured interview that included the Eyberg Child Behavior Inventory, the Psychiatric Symptom Index, and questions about sociodemographic and health condition-related characteristics. RESULTS: Of the 356 children assessed, 138 (38.8%) had conduct problems as defined by criteria of the Eyberg Child Behavior Inventory. In logistic regression analyses, conduct problems were associated with younger child age, mother having a husband or partner unrelated to her child, poorer perceived prognosis, child having a learning disability, and maternal self-report of high emotional distress on the Psychiatric Symptom Index. Conduct problems were not related to child sex, maternal ethnicity or education, family receiving welfare, or a wide range of condition-related factors, including age at diagnosis, visibility to others, need to watch for sudden changes, presence of mobility or sensory-communication problems, using medication or equipment, annual hospitalizations, or physician visits. CONCLUSIONS: Conduct problems in children with chronic health conditions appear to be associated more closely with their sociodemographic and family characteristics than with condition-related risk factors. Additional research remains to be done on the ways that maternal adjustment, diagnosis-specific condition characteristics, and other risk factors influence children's behavior.

Predicting the effect of proteolysis on ruminal crude protein degradation of legume and grass silages using near-infrared reflectance spectroscopy.

Two studies were conducted to assess whether routine applications of near infrared reflectance spectroscopy could predict the effects of silage proteolysis on ruminal crude protein (CP) degradation of legume and grass silages. A preliminary study was conducted to assess the effect of laboratory drying method on ruminal CP degradation of silages. Thirty legume and grass silages were freeze-, oven-, or microwave-dried and incubated in situ in the ventral rumen of three ruminally cannulated cows for 24 h. Freeze-drying was considered least likely to alter ruminal CP degradation of the silages; therefore, oven- and microwave-drying were compared using first-order regression with freeze-drying. Oven-drying for 48 h at 55 degrees C compared favorably (R2 = 0.84) with freeze-drying. Microwave-drying resulted in a large bias (2.84 g/10(-1) kg of CP) and was poorly related (R2 = 0.48) to freeze-drying. In a second study, alfalfa and timothy were cut at three maturities and allowed to wilt for 0, 10, 24, 32, 48, and 54 h. Forages were ensiled in triplicate cylindrical mini silos and allowed to ferment for 120 d. After fermentation, silages were oven-dried, ground, and scanned on a near-infrared reflectance spectrophotometer. Duplicate, dried, 2-mm ground silage samples were incubated in the ventral rumen of three ruminally cannulated cows for 24 h. Forage species, maturity, and wilting time significantly affected 24-h ruminal CP degradation of the silages. Near-infrared reflectance spectroscopy accurately predicted (R2 = 0.91) 24-h ruminal CP degradation of silages. Data suggest near-infrared reflectance spectroscopy can accurately assess the effects of forage species, maturity, and wilting time (proteolysis) on 24-h ruminal CP degradation of legume and grass silages.

Prediction of laboratory and in situ protein fractions in legume and grass silages using near-infrared reflectance spectroscopy.

Legume and grass silage samples (n = 121) were collected from commercial forage testing laboratories (trial 1). Samples were dried at 55 degrees C for 48 h, ground, scanned on a near-infrared reflectance spectrophotometer, and analyzed for crude protein (CP), soluble CP, acid detergent fiber (ADF) CP, and neutral detergent fiber (NDF) CP by wet chemistry methods. Sixty samples were selected for calibration development, and the remaining samples were used for equation validation. Near-infrared reflectance spectroscopy accurately predicted the CP content of the silages (R2 = 0.96), but prediction of soluble CP, ADF CP, and NDF CP was markedly less accurate. The coefficients of determination and standard errors of calibration for CP, ADF CP, NDF CP (percentage of DM), and soluble CP (percentage of CP) were as follows (0.96 and 0.80, 0.77 and 0.24, 0.72 and 0.71, and 0.82 and 4.40). In a second study, legume and grass silage samples (n = 32) were dried at 55 degrees C and ground (2 mm). Duplicate dacron bags containing 5 g of silage were incubated in the ventral rumen of three ruminally cannulated cows for 0, 3, 6, 12, 24, 48, and 72 h. In situ protein fractions, including rapidly degraded protein, slowly degraded protein, undegradable protein, degradation rate, and rumen-undegradable protein, were determined. Original samples were reground (1 mm) and scanned. Previously defined near-infrared spectroscopy calibration procedures were conducted. Coefficients of determination for in situ CP fractions were R2 > 0.92 with the exception of degradation rate (R2 = 0.87). Data suggest that in situ protein fractions are better predicted by near-infrared reflectance spectroscopy than by laboratory protein fractions.

Development of a novel system to estimate protein degradability in legume and grass silages.

Five trials were conducted to develop a system to estimate rumen-undegradable protein (RUP) of legume and grass silages using near infrared reflectance spectroscopy. In situ procedures were the reference method used to determine silage RUP content. Trials 1, 2, and 3 were devoted to improving in situ procedures. In trial 1, alfalfa silage with and without heat treatment was incubated ruminally in 30 cows. The standard deviation of in situ RUP attributable to cow and diet was 0.82 and 3.80 g/10(-1) kg of crude protein (CP) for the unheated and heated alfalfa, respectively. Based on trial 1, it was determined that 8 cows would be required to establish RUP standards. In trial 2, low (13.3 g/10(-1) kg of CP) and high (44.5 g/10(-1) kg of CP) RUP standards were developed using eight ruminally cannulated cows. In trial 3, 11 new RUP standards were developed by mixing trial 2 RUP standards together. The RUP standards were used to employ a calibration curve technique in ruminally cannulated cows. The technique was employed in four ruminally cannulated cows to estimate RUP contents of 121 silages, and RUP values were used for near-infrared reflectance spectroscopic analysis in trial 4. Trial 4 procedures yielded a calibration for RUP content of silages with an R2 of 0.84 and a standard error of calibration of 1.55 g/10(-1) kg of CP. In trial 5, the equation was tested on 300 silage samples. The mean predicted RUP content was 21.8 g/10(-1) kg of CP. Data suggest near-infrared reflectance spectroscopy can predict RUP content of silages.