Algorithm development for individualized precision feeding of supplemental top dresses to influence feed efficiency of dairy cattle.

Individualized, precision feeding of dairy cattle may contribute to profitable and sustainable dairy production. Feeding strategies targeted at optimizing efficiency of individual cows, rather than groups of animals with similar characteristics, is a logical goal of individualized precision feeding. However, algorithms designed to make feeding recommendations for specific animals are scarce. The objective of this study was to develop and test 2 algorithms designed to improve feed efficiency of individual cows by supplementing total mixed rations (TMR) with varying types and amounts of top-dressed feedstuffs. Twenty-four Holstein dairy cows were assigned to 1 of 3 treatment groups as follows: a control group fed a common TMR ad libitum, a group fed individually according to algorithm 1, and a group fed individually according to algorithm 2. Algorithm 1 used a mixed-model approach with feed efficiency as the response variable and automated measurements of production parameters and top-dress type as dependent variables. Cow was treated as a random effect, and cow by top-dress interactions were included if significant. Algorithm 2 grouped cows based on top-dress response efficiency structure using a principal components and k-means clustering. Both algorithms were trained over a 36-d experimental period immediately before testing, and were updated weekly during the 35-d testing period. Production performance responses for dry matter intake (DMI), milk yield, milk fat percentage and yield, milk protein percentage and yield, and feed efficiency were analyzed using a mixed-effects model with fixed effects for feeding algorithm, top dress, week, and the 2- and 3-way interactions among these variables. Milk protein percentage and feed efficiency were significantly affected by the 3-way interaction of top dress, algorithm, and week, and DMI tended to be affected by this 3-way interaction. Feeding algorithm did not affect milk yield, milk fat yield, or milk protein yield. However, feeding costs were reduced, and hence milk revenue increased on the algorithm-fed cows. The efficacy of feeding algorithms differed by top dress and time, and largely relied on DMI shifts to modulate feed efficiency. The net result, for the cumulative feeding groups, was that cows in the algorithm 1 and 2 groups earned over $0.45 and $0.70 more per head per day in comparison to cows on the TMR control, respectively. This study yielded 2 candidate approaches for efficiency-focused, individualized feeding recommendations. Refinement of algorithm selection, development, and training approaches are needed to maximize production parameters through individualized feeding.

Breeding animals to feed people: The many roles of animal reproduction in ensuring global food security.

As the population grows and shifts demographically, the resulting increase in demand for beef and milk necessitates improvements in the sustainability of ruminant livestock production systems. Ruminant livestock contribute to ensuring global food security because they have the ability to up-cycle non-human-edible products into meat and milk products with notable nutritional value. However, ruminant livestock also pose a challenge to global food sustainability because they are resource-intensive to produce and contribute substantially to agricultural greenhouse gas emissions. As such, improving environmental impacts of ruminant livestock production globally is an essential goal. There are a number of strategies that can be employed to enhance sustainability of ruminant production systems; however, improving reproductive efficiency is among the more efficient, because an increase in reproductive success will reduce the number of cows needed to produce a target quantity of beef. This reduction in the cow herd size helps limit the number of unproductive animals retained in the herd, thereby reducing the environmental maintenance cost of livestock production. Additionally, proper application of reproductive technologies enables faster and more targeted advances in genetic gains, which can be leveraged to produce phenotypes that are resource-use-efficient and well-adapted to their production environment. Optimizing reproductive efficiency can be accomplished through improved genetic selection for fertility and fecundity; applying more effective use of assisted reproductive technologies; and coupling reproductive and nutritional management to optimize likelihood of reproductive success. Collectively, applying these approaches will be essential when working to ensure ruminant livestock's contribution to global food security.

Edge-on adsorption of multi-chain functional alkanes stabilizes noncovalent monolayers on MoS2.

Modified long-chain alkanes are often used to functionalize graphene and MoS2 noncovalently, with the goal of controlling the substrate electronic structure or interactions with the environment. Alkyl chain adsorption enthalpy is lower on MoS2 than on graphite; the decreased molecule-substrate interaction strength suggests utility for monolayer structures that increase stability through other means. Previously, we have found that diyne phospholipid monolayers on HOPG are more stable toward solution processing than monolayers of single-chain amphiphiles. Here, we show that this is also true for assembly on MoS2, but that the additional stability appears to arise from edge-on adsorption, producing monolayers in which alkyl chains form two stacked layers on the substrate.

Wet distillers grains plus solubles concentration in steam-flaked-corn-based diets: Effects on feedlot cattle performance, carcass characteristics, nutrient digestibility, and ruminal fermentation characteristics.

Two experiments were conducted to determine the effects of wet distillers grain plus solubles (WDG; <15% sorghum grain) concentration in steam-flaked corn (SFC) diets on feedlot performance, carcass characteristics, ruminal fermentation, and diet digestibility. In Exp. 1, six hundred crossbred steers (364 ± 35 kg of BW) were used in a randomized complete block design with 8 replications/treatment. Dietary treatments consisted of a dry-rolled corn (DRC) control diet without WDG, a SFC control without WDG, and SFC with 4 WDG concentrations (15, 30, 45, 60% DM basis) replacing SFC, cottonseed meal, urea, and yellow grease. Final BW, ADG, G:F, HCW, and 12th-rib fat depth were greater (P ≤ 0.05) for SFC compared with DRC. Dry matter intake tended (P = 0.06) to be greater for DRC compared with SFC. Final BW, ADG, G:F, HCW, 12th-rib fat depth, and marbling score decreased linearly (P < 0.01) with increasing WDG concentration. In Exp. 2, six ruminally and duodenally cannulated crossbred steers (481 ± 18 kg of BW) were used in a 6 × 6 Latin square design using the same diets as Exp. 1. Ruminal, postruminal, and total tract OM and NDF digestibility were not different (P > 0.14) for DRC compared with SFC. Ruminal and total tract starch digestibility were greater (P < 0.01) for SFC compared with DRC. Dry matter and OM intake were not different (P ≥ 0.43) among WDG treatments. Ruminal and total tract OM digestibility decreased linearly (P < 0.01) with increasing WDG concentration. Intake, ruminal digestibility, and total tract digestibility of NDF increased linearly (P < 0.01) with increasing WDG concentration. Starch intake decreased linearly (P < 0.01) with increasing WDG concentration. Ruminal starch digestibility increased (P = 0.01) with increasing concentration of WDG. Total tract starch digestibility decreased quadratically (P < 0.01) with increasing concentration of WDG. Feeding SFC improved steer performance compared with DRC. The concentration of WDG and corn processing method influences nutrient digestibility and ruminal fermentation. The addition of WDG in SFC-based diets appears to negatively affect animal performance by diluting the energy density of the diet.

Transgenic expression of 15-lipoxygenase 2 (15-LOX2) in mouse prostate leads to hyperplasia and cell senescence.

15-Lipoxygenase 2 (15-LOX2), a lipid-peroxidizing enzyme, is mainly expressed in the luminal compartment of the normal human prostate, and is often decreased or lost in prostate cancer. Previous studies from our lab implicate 15-LOX2 as a functional tumor suppressor. To better understand the biological role of 15-LOX2 in vivo, we generated prostate-specific 15-LOX2 transgenic mice using the ARR2PB promoter. Unexpectedly, transgenic expression of 15-LOX2 or 15-LOX2sv-b, a splice variant that lacks arachidonic acid-metabolizing activity, resulted in age-dependent prostatic hyperplasia and enlargement of the prostate. Prostatic hyperplasia induced by both 15-LOX2 and 15-LOX2sv-b was associated with an increase in luminal and Ki-67(+) cells; however, 15-LOX2-transgenic prostates also showed a prominent increase in basal cells. Microarray analysis revealed distinct gene expression profiles that could help explain the prostate phenotypes. Strikingly, 15-LOX2, but not 15-LOX2sv-b, transgenic prostate showed upregulation of several well-known stem or progenitor cell molecules including Sca-1, Trop2, p63, Nkx3.1 and Psca. Prostatic hyperplasia caused by both 15-LOX2 and 15-LOX2sv-b did not progress to prostatic intraprostate neoplasia or carcinoma and, mechanistically, prostate lobes (especially those of 15-LOX2 mice) showed a dramatic increase in senescent cells as revealed by increased SA-betagal, p27(Kip1) and heterochromatin protein 1gamma staining. Collectively, our results suggest that 15-LOX2 expression in mouse prostate leads to hyperplasia and also induces cell senescence, which may, in turn, function as a barrier to tumor development.

Relation between literacy and HIV treatment knowledge among patients on HAART regimens.

Successful management of HIV requires patient understanding and ability to act on treatment information. We examined the relationship between patient literacy and understanding of HIV treatment. Literacy, knowledge of CD4 count and viral load, and correct identification of HIV medications in regimen were evaluated in 204 patients receiving care in Shreveport, Louisiana and Chicago, Illinois. One-third of patients had limited literacy skills. These patients were less able to describe CD4 count (p < 0.001), viral load (p < 0.001) and to correctly identify medications in their regimen (p < 0.001). In the multivariate analysis, limited literacy was an independent predictor of poor understanding of CD4 count (OR 2.9, 95% CI: 1.3-6.3) and viral load (OR 4.1, 95% CI: 1.9-8.8). For correct medication identification, a significant interaction was found between number of HIV medications and literacy level. Among patients taking only 1-2 HIV medications, 100% of higher literate patients were able to identify their medications, compared to none of the lower literate patients prescribed three or more HIV medications. Patients with limited literacy skills may lack essential knowledge related to their HIV treatment. Clinicians may require additional training for improving communication with these patients.

Health literacy and patient knowledge in a Southern US HIV clinic.

Pharmaceutical management of HIV infection is complex, and proper adherence to antiretroviral regimens is contingent on active patient involvement in treatment. We examined the relationship between patient understanding of HIV and its treatment and health literacy. Structured interviews were conducted with 157 HIV-infected individuals receiving care at a community-based clinic in Shreveport, Louisiana, USA. In all, 48% of patients were reading below a 9th grade level. One-third of patients could not name their HIV medications and this was significantly related to low literacy (P < 0.01). Two-thirds of those reading below the 9th grade level did not know how to take their medications correctly (P < 0.05), and 75% did not know the meaning of a CD4 count or viral load (P < 0.001). Patients with low literacy skills were more likely to state that their physician was their sole source of HIV information (P < 0.005). Physicians may require training to appropriately convey health information to patients of low literacy.

Smoking status, reading level, and knowledge of tobacco effects among low-income pregnant women.

BACKGROUND: Smoking during pregnancy increases the health risks of the unborn child as well as the mother. Although smoking rates for the population as a whole have declined drastically in the past generation, since 1992 there has been an increase in smoking among women, teenagers, and adults living in poverty. The purpose of this study was to assess reading level, tobacco knowledge, attitudes, and practices of tobacco use among pregnant adult and adolescent women in the public health system in north Louisiana. METHODS: A convenience sample of 600 pregnant women was interviewed in person in the Obstetrics Clinics at Louisiana State University Health Sciences Center at Shreveport and E.A. Conway in Monroe. The structured interview contained detailed questions about smoking practices, tobacco knowledge, and attitudes. Reading was assessed using the Rapid Estimate of Adult Literacy in Medicine. Smoking practices were assessed by self-report and verified by measuring urine cotinine levels. The Cochran-Mantel-Haenszel test was used to estimate the relationship between reading level and knowledge and attitude; multiple logistic regression was used to determine which variable(s) predicted current smoking practices. RESULTS: Knowledge about the effects of smoking and concern about the health effect of smoking on their baby varied significantly by reading level, with participants with higher reading levels having more knowledge and greater concern. Smoking practices did not vary by reading level even when race, age, and living with a smoker were controlled. Race was a significant determinant of smoking practices, with more white women reporting currently smoking during pregnancy than African Americans (34% vs 8%). CONCLUSIONS: Reading level was related to knowledge about health effects of smoking. Women with higher reading levels were also more concerned about the adverse health effects of smoking on themselves and their babies. However, reading level was not correlated with smoking prevalence. The most significant determinant of smoking was race (with whites smoking significantly more than African Americans).

The role of inadequate health literacy skills in colorectal cancer screening.

Colorectal cancer is ideally suited for early detection strategies that are likely to improve survival rates. Screening with either a fecal occult blood test (FOBT) or flexible sigmoidoscopy has been shown to identify precancerous polyps or cancers in early stages. However, persons with limited education and of lower socioeconomic status infrequently participate in screening programs in general and have very low rates of colorectal screening. Low literacy, which is common among persons with limited education and low income, may be an overlooked factor in understanding patients' decision making about colorectal cancer screening. This article provides information from focus groups about colorectal cancer screening, which we examine in the context of relevant literature on cancer screening and literacy. Using the health belief model, we examine the association between inadequate health literacy skills and low rates of colorectal cancer screening. The theoretical model also provides insights into strategies for improving knowledge, attitudes, and beliefs and screening rates for this challenging patient population.

Childhood vaccine risk/benefit communication in private practice office settings: a national survey.

UNLABELLED: Communication about childhood vaccine risks and benefits has been legally required in pediatric health care for over a decade. However, little is known about the actual practice of vaccine risk/benefit communication. OBJECTIVES: This study was conducted to identify current practices of childhood vaccine risk/benefit communication in private physician office settings nationally. Specifically, we wanted to determine what written materials were given, by whom, and when; what information providers thought parents wanted/needed to know, the content of nurse and doctor discussion with parents, and the time spent on discussion. We also wanted to quantify barriers to vaccine risk/benefit discussion and to prioritize materials and dissemination methods preferred as solutions to these barriers. METHODS: We conducted 32 focus groups in 6 cities, and then administered a 27-question cross-sectional mailed survey from March to September 1998, to a random national sample of physicians and their office nurses who immunize children in private practices. Eligible survey respondents were active fellows of the American Academy of Pediatrics or American Academy of Family Physicians in private practice who immunized children and a nurse from each physician's office. After 3 mailings, the response rate was 71%. RESULTS: Sixty-nine percent of pediatricians and 72% of family physicians self-reported their offices gave parents the Centers for Disease Control and Prevention Vaccine Information Statement, while 62% and 58%, respectively, gave it with every dose. In ~70% of immunization visits, physicians and nurses reported initiating discussion of the following: common side effects, when to call the clinic and the immunization schedule. However, physicians reported rarely initiating discussion regarding contraindications (<50%) and the National Vaccine Injury Compensation Program (<10%). Lack of time was considered the greatest barrier to vaccine risk/benefit communication. Nurses reported spending significantly more time discussing vaccines with parents than pediatricians or family physicians (mean: 3.89 vs 9.20 and 3.08 minutes, respectively). Both physicians and nurses indicated an additional 60 to 90 seconds was needed to optimally discuss immunization with parents under current conditions. Stratified analysis indicated nurses played a vital role in immunization delivery and risk/benefit communication. To improve vaccine risk/benefit communication, 80% of all providers recommended a preimmunization booklet for parents and approximately one half recommended a screening sheet for contraindications and poster for immunization reference. The learning method most highly endorsed by all providers was practical materials (80%). Other desirable learning methods varied significantly by provider type. CONCLUSIONS: There was a mismatch between the legal mandate for Vaccine Information Statement distribution and the actual practice in private office settings. The majority of providers reported discussing some aspect of vaccine communication but 40% indicated that they did not mention risks. Legal and professional guidelines for appropriate content and delivery of vaccine communication need to be clarified and to be made easily accessible for busy private practitioners. Efforts to improve risk/benefit communication in private practice should take into consideration the limited time available in an office well-infant visit and should be aimed at both the nurse and physician.

Osteomas of the internal auditory canal: a report of two cases.

OBJECTIVES: To determine the optimal medical or surgical treatment of osteomas of the internal auditory canal (IAC) as well as their growth characteristics. STUDY DESIGN: Information was obtained from case histories, images from computed tomography and magnetic resonance imaging, surgical and pathologic findings, and long-term clinical results. METHODS: Two patients, along with 10 additional patients reported in the literature, with osteomas of the IAC with varying symptoms were studied. Clinical history, audiometric and vestibular test results, and radiographic studies were reviewed on all patients. Histopathologic examination of the surgical specimens confirmed the presence of osteomas. The clinical outcomes were studied to determine if the preoperative symptoms had resolved. RESULTS: Eight of 12 patients underwent surgical removal of their IAC osteomas. Three of eight patients had total resolution of all symptoms. Three patients had improvement of their sensorineural hearing loss. Five patients had resolution of their dizziness. Four patients noted resolution of their tinnitus. In the absence of auditory symptoms, vestibular symptoms may be controlled with medical therapy. Long term follow-up of the two patients discussed showed little or no growth over a 4- to 5-year period. CONCLUSIONS: Surgical intervention may be warranted to remove an osteoma of the IAC if symptoms are present. Patients should be made aware that symptoms may or may not improve. Continuation of symptoms may be a result of chronic compression of the auditory and vestibular nerves.

Students' perceptions and reported use of their memories after a memory-improvement course.

23 college students who had taken a memory-improvement course completed a questionnaire at three different times: the beginning of the course, the end of the course, and two months after the end of the course. The questionnaire assessed the students' perceptions of their memory abilities, e.g., how good their memories were and how confident they were in their memories and knowledge about their memories, and their reported use of the memory techniques; it did not assess actual memory performance or ability. The students' responses to the questionnaire were compared with those of 23 control students who completed the questionnaire at the same three times. The memory students reported more positive changes in how they perceived their memory abilities and knowledge, and these reported changes in perceptions were still evident two months later. The students also reported that they were still using their memory techniques two months later.

Low literacy and violence among adolescents in a summer sports program.

PURPOSE: To investigate the relationship between inadequate literacy and violent behavior among adolescents. METHODS: This descriptive study involved a convenience sample of 386 adolescents who participated in a summer track and field and literacy program serving youths in low-income neighborhoods in Shreveport, Louisiana, during 1994-1996. Self-reported violence was measured using the Youth Risk Behavior Survey (YRBS) and reading grade levels were measured by the Slosson Oral Reading Test-Revised (SORT-R). RESULTS: Youths ranged in age from 11 to 18 years; 66% were male, and 86% were African-American. Forty-three percent of adolescents tested had below-grade reading levels (> or = 2 grades). Participants with below-grade reading skills had higher rates of self-reported violent behaviors compared with those reading at grade level. When gender, race, and age were controlled for, adolescents reading below grade level were significantly more likely to report carrying weapons [odds ratio (OR) = 1.9; 95% confidence interval (CI) 1.1-3.5], carrying guns (OR = 2.6; CI 1.1- 6.2), to have been in a physical fight at school (OR = 1.7; CI 1.1-2.6), and to have been in a physical fight resulting in injuries requiring treatment (OR = 3.1; CI 1.6-6.1). In addition, youths reading below grade level were significantly more likely to be threatened at school with a weapon (OR = 2.1; CI 1.2-3.7) and to report missing days of school in the previous 30 days because they felt unsafe at school (OR = 2.3; CI 1.3-4.3). In characterizing the violence related behaviors, we found that low reading-level adolescents were more likely to be both aggressor/perpetrator and victim (44% vs. 32%; p = .02) and less likely to be only a victim (6% vs. 12%; p = .04) compared to adolescents with grade-appropriate reading skills. CONCLUSIONS: Below-grade-level reading was significantly related to violence behaviors among adolescents who volunteered for a summer track and field program. Longitudinal studies are needed to further investigate the relationship of below-grade-level reading and aggressive/perpetrator and victim behaviors.

QOL and outcomes research in prostate cancer patients with low socioeconomic status.

The VA Cancer of the Prostate Outcomes Study (VA CaPOS) is collecting quality-of-life (QOL) information from prostate cancer patients, spouses, and physicians at six VA medical centers. Currently, 601 men with prostate cancer are included in the study, most of whom are of low socioeconomic status and over half of whom are African-American. Quality-of-life responses were most favorable for newly diagnosed patients, intermediate for those with stable metastatic disease, and poorest for those with progressive metastatic disease. Patients could not provide reliable estimates of their own preferences for future QOL states but responded reliably to questions phrased as a comparison of the preferences of two hypothetical patients. High out-of-pocket costs for hormonal therapies, lack of health insurance, and a belief that the non-VA system offered poorer services were the most common reasons for patient transferral to the VA system. Satisfaction with medical care was generally high. While African-American patients were more likely to have advanced prostate cancer at diagnosis, after adjustment for differences in health literacy, race was no longer a significant predictor of advanced disease. The VA CaPOS provides useful information on health status and patient satisfaction of VA prostate cancer patients. Long-term evaluations are needed to detect clinically meaningful QOL information as the disease progresses.

Practical assessment of adult literacy in health care.

Low literacy is a pervasive and underrecognized problem in health care Approximately 21% of American adults are functionally illiterate, and another 27% have marginal literacy skills. Such patients may have difficulty reading and understanding discharge instructions, medication labels, patient education materials, consent forms, or health surveys. Properly assessing the literacy level of individual patients or groups may avoid problems in clinical care and research. This article reviews the use of literacy assessments, discusses their application in a variety of health care settings, and cites issues providers need to consider before testing. The authors describe informal and formal methods of screening for reading and comprehension in English and Spanish including the Rapid Estimate of Adult Literacy in Medicine, the Wide Range Achievement Test-3, the Cloze procedure, the Test of Functional Health Literacy in Adults, and others. Practical implications and recommendations for specific use are made.

Relation between literacy, race, and stage of presentation among low-income patients with prostate cancer.

PURPOSE: Diagnosis of advanced prostate cancer is a major health problem, especially among low-income men. Opportunities vary for early detection of prostate cancer for low-income black and white men because of financial, cultural, and social factors. In this study, we evaluated the association of poor literacy skills with higher rates of presentation of advanced stages of prostate cancer among low-income black and white men who received care in equal-access medical systems. PATIENTS AND METHODS: Literacy and stage at diagnosis of prostate cancer were evaluated in 212 low-income men who received medical care in Shreveport, LA, and Chicago, IL. The patients' literacy was assessed with the Rapid Estimate of Adult Literacy in Medicine (REALM), an individually administered reading screening test designed specifically for use in the medical setting. Logistic regression models were used to evaluate predictors of metastatic disease at presentation as a function of patient age, race, literacy, and city. RESULTS: Whereas black men were almost twice as likely to present with stage D prostate cancer (49.5% v 35.9%; P < .05), they were significantly more likely to have literacy levels less than sixth grade (52.3% v 8.7%; P < .001). However, after adjustment for differences in literacy, age, and city, race was not a significant predictor of advanced-stage prostate cancer. CONCLUSION: Low literacy may be an overlooked but significant barrier to the diagnosis of early-stage prostate cancer among low-income white and black men. The development of culturally sensitive, low-literacy educational materials may improve patient awareness of prostate cancer and improve the frequency of diagnosis of early-stage cancer.

Fighting and weapon-carrying among seventh-grade students in Massachusetts and Louisiana.

PURPOSE: The purpose of this study was to compare attitudes toward violence and weapon-carrying among seventh-grade students in three dissimilar U.S. communities. A second focus was to determine students' understanding of their parents' violence-related guidance and behavior. METHODS: Five hundred sixty-seven seventh-grade students (48% male, 46% white, 35% African-American, 13% Latino) completed a self-administered questionnaire in May or October 1991. RESULTS: Thirty-four percent of the students had fought at least once, and 7% more than four times during the previous month. Also, within that period, 5% had skipped school owing to fear of violence. Students whose parents used nonviolent disciplinary techniques fought less frequently than those whose parents relied on hitting and more violent disciplinary methods (p < 0.001). Fighting was significantly more common among students who believe their parents want them to fight if insulted (p = 0.001). Students who reported that they try to stay out of fights usually succeeded (p = 0.001). Those students who more frequently participated in and observed fighting were more likely to carry a weapon (p = 0.001). CONCLUSIONS: Fighting is a frequent occurrence in the lives of seventh-grade students. Students' understanding of their parents' attitudes and behavior correlate strongly with violent behavior. While many students feel that weapons confer safety, those students who actually carry weapons are much more likely to fight.

Self-reported characterization of seventh-grade students' fights.

PURPOSE: To determine the characteristics of recent fights among seventh-grade students at public middle schools in three dissimilar U.S. communities. METHODS: The study sample was composed of 289 seventh-grade students at public middle schools in three U.S. communities who participated in fights during the previous 6 months. Students at each site completed a self-administered two-part questionnaire (developed for this study) in May or October 1991. Pearson Chi-square test was performed to determine the association among characteristics of the fights, weapon use, and injury severity. RESULTS: One or more weapons were present at 43% of the fights, weapons were used to threaten or injure in 23%, and stab or gunshot wounds were reported in 10%. Fights with five or more participants or with participants who were intoxicated or gang members involved more weapon use and more severe injury (p < 0.02). There was more frequent weapon use occurring away from home and school (p < 0.01). Spectators were present at 87% of the fights, and when they attempted to mediate or end the fighting, injury severity was lower. Students who often carry a weapon were much more likely to report involvement in fights in which weapons were used and to suffer more severe injuries (p < 0.02). CONCLUSIONS: Seventh-graders' fights frequently involve the threat and actual use of weapons. The large number of participants and spectators at many of the fights with the most severely injurious outcomes implies that social factors and not exclusively poor conflict resolution skills are important factors precipitating fights among seventh-grade students.

Presentation and reading level of sleep brochures: are they appropriate for sleep disorders patients?

OBJECTIVE: Sleep-disorders patients must be given information and health education they understand. The purpose of this study was twofold: (1) to assess suitability of American Sleep Disorders Association and National Sleep Foundation patient education brochures; and (2) to assess one widely used brochure, using patient input and patient literacy level, as a model for development of future materials. DESIGN: Twelve American Sleep Disorders Association and National Sleep Foundation brochures were assessed for reading level using Grammatik, and for design, presentation, and motivating qualities using the Suitability Assessment of Materials (SAM). Patient literacy level was assessed using the Rapid Estimate Of Adult Literacy in Medicine (REALM). SETTING: The Louisiana State University Medical Center sleep clinic, faculty private sleep clinic, and in the sleep center laboratory. PATIENTS OR PARTICIPANTS: During the months of February-May 1997, 170 sleep disorders patients, 39% African American, 59% white participated in the study. Participants ranged in age from 18-73 years, with a mean age of 46. MEASUREMENTS AND RESULTS: Suitability scores for the 12 brochures indicate that none scored in the superior range, 83% scored adequate, and 17% scored not suitable. Ninety-four percent of the brochures were written on a 12th grade level or higher, yet 37% of the sleep patients tested were reading at less than a 9th grade level. Low-level readers were significantly more likely than their higher-reading-level counterparts to report that a brochure was too long (22% vs 12%; p < .05), and that they would need help reading it (44% vs 3%; p < .001). CONCLUSIONS: Patients need sleep information given to them on a level they understand. When developing and selecting appropriate materials, reading level, length, and suitability of written material should be considered.