Climate change and land-use change impacts on future availability of forage grass species for Ethiopian dairy systems.

Forage grasses are central feed resources for livestock globally. In Ethiopian dairy systems, they serve as feed sources during both wet and dry seasons, yet escalating climate change could threaten forage supply. Here, we investigate projected climate change impacts on three forage grasses currently recommended for Ethiopian dairy systems. We determine areas of geographical suitability for each species using three climate projections generated by General Circulation Models (GCMs) and calculate their ability to meet predicted dry matter demand under four scenarios for livestock intensification and land availability. By 2050, Buffel grass (Cenchrus ciliaris) is likely to be negatively affected by climate change in regions such as Tigray, while Rhodes grass (Chloris gayana) and Napier grass (Cenchrus purpureus) may have improved suitability under future climates. Our findings suggest that feed demands could theoretically be met by production of these forage grasses under current and future climates. However, if land availability is reduced and herd composition shifts towards higher-productivity exotic breeds, forage resources will not meet cattle demand even with improved agronomic management.

Genetic Diversity and Population Structure of a Rhodes Grass (Chloris gayana) Collection.

Rhodes grass (Chloris gayana Kunth) is one of the most important forage grasses used throughout the tropical and subtropical regions of the world. Enhancing the conservation and use of genetic resources requires the development of knowledge and understanding about the existing global diversity of the species. In this study, 104 Rhodes grass accessions, held in trust in the ILRI forage genebank, were characterized using DArTSeq markers to evaluate the genetic diversity and population structure, and to develop representative subsets, of the collection. The genotyping produced 193,988 SNP and 142,522 SilicoDArT markers with an average polymorphic information content of 0.18 and 0.26, respectively. Hierarchical clustering using selected informative markers showed the presence of two and three main clusters using SNP and SilicoDArT markers, respectively, with a cophenetic correction coefficient of 82%. Bayesian population structure analysis also showed the presence of two main subpopulations using both marker types indicating the existence of significant genetic variation in the collection. A representative subset, containing 21 accessions from diverse origins, was developed using the SNP markers. In general, the results revealed substantial genetic diversity in the Rhodes grass collection, and the generated molecular information, together with the developed subset, should help enhance the management, use and improvement of Rhodes grass germplasm in the future.

Progress and Challenges in Ex Situ Conservation of Forage Germplasm: Grasses, Herbaceous Legumes and Fodder Trees.

Forages provide an important livestock feed resource globally, particularly for millions of smallholder farmers, and have important roles in natural resource management and carbon sequestration, reducing soil erosion and mitigating the effects of climate change. Forage germplasm remains the basis for the selection and development of new, higher-yielding and better adaptedgenotypes to meet the increasing demand for livestock feed. Rapid rates of genetic erosion of forage diversity due to land-use change from natural pastures and rangelands to crop production to meet the food security requirements of a growing global population, together with pressures from a changing climate, highlight the necessity for ex situ seed conservation of forage genetic resources to provide germplasm for use by future generations. Whilst many forage species have orthodox seeds, the diverse range of genera and species which provide forage is a challenge in terms of the wide scope of information and understanding on conservation methods that genebank managers require-particularly for tropical forages, many of which are comparatively under-researched. We review the challenges to the conservation of tropical forage species by seed in ex situ genebanks and provide information on optimum methods for their management.

Author Correction: Genotyping by sequencing provides new insights into the diversity of Napier grass (Cenchrus purpureus) and reveals variation in genome-wide LD patterns between collections.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Genotyping by sequencing provides new insights into the diversity of Napier grass (Cenchrus purpureus) and reveals variation in genome-wide LD patterns between collections.

Napier grass is an important tropical forage-grass and of growing potential as an energy crop. One-hundred-five Napier grass accessions, encompassing two independent collections, were subjected to genotyping by sequencing which generated a set of high-density genome-wide markers together with short sequence reads. The reads, averaging 54 nucleotides, were mapped to the pearl millet genome and the closest genes and annotation information were used to select candidate genes linked to key forage traits. 980 highly polymorphic SNP markers, distributed across the genome, were used to assess population structure and diversity with seven-subgroups identified. A few representative accessions were selected with the objective of distributing subsets of a manageable size for further evaluation. Genome-wide linkage disequilibrium (LD) analyses revealed a fast LD-decay, on average 2.54 kbp, in the combined population with a slower LD-decay in the ILRI collection compared with the EMBRAPA collection, the significance of which is discussed. This initiative generated high-density markers with a good distribution across the genome. The diversity analysis revealed the existence of a substantial amount of variation in the ILRI collection and identified some unique materials from the EMBRAPA collection, demonstrating the potential of the overall population for further genetic and marker-trait-association studies.

Long-term evaluation of sound localisation in single-sided deaf adults fitted with a BAHA device.

OBJECTIVE: To perform a long-term evaluation of the localisation capabilities in the horizontal plane of single-sided deaf patients fitted with a BAHA device. DESIGN: Single-centre retrospective study. PARTICIPANTS: Twenty-one adults with single-sided deafness (SSD) with normal hearing in the contralateral ear (pure tone average <20 dB, SDS > 90%) rehabilitated with a Cochlear BAHA device from 2003 to 2012 on the deaf side over a median follow-up of 8 years. OUTCOME MEASURES: The task used in this paper is a sound localisation identification task with a set-up of seven loudspeakers on a semi-circular array at 30-degree intervals performed at three periods: before BAHA, initially and at last follow-up. Our main criterion of judgement was the root-mean-square (RMS) localisation error. In addition, the Bern Benefit in Single-Sided Deafness Questionnaire (BBSS) was administered. RESULTS: The mean RMS localisation error was initially estimated at 64° without any rehabilitation (for a chance level RMS estimated at 81°). Initially, with the BAHA device, the RMS localisation error dropped to 51°. At the last follow-up evaluation, a significant decrease at 23° was noted. Concerning the Bern Questionnaire, 19% of the patients (n = 4) did not report any change (score of 0), 33% (n = 7) are satisfied (score of +1 or +2) and 48% (n = 10) are very satisfied with the BAHA device (score better than +3). CONCLUSION: Improvement of sound localisation in the horizontal plane for some SSD patients is likely related to altered processing of monaural spectral cues. The time needed to learn to use the azimuth-dependent spectral cues takes time. Long-term follow-up should be considered for studies investigating sound localisation performance.

Caregivers of patients with cancer fatigue: a high level of symptom burden.

Fatigue is the problematic symptom identified by patients with cancer. However, fatigue has not been widely examined in caregivers of patients with cancer. In this study, 131 caregivers of patients diagnosed with advanced stage cancer and actively receiving radiotherapy reported experiencing the most difficulties with fatigue (mean 46.9; on a 0-100 scale, with a 10-point difference having clinical meaning) at baseline and at a 6-month follow-up (mean 48.3). This is in sharp contrast to other domains of quality of life and functioning being rated in the 60s, 70s and 80s by the caregivers of patients with cancer. Given the level of fatigue reported by the caregivers of patients with cancer, if confirmed by other investigators in larger and more diverse samples, interventions targeting caregiver fatigue should be explored.

Genetic diversity in Napier grass (Pennisetum purpureum) cultivars: implications for breeding and conservation.

Napier grass is an important forage crop for dairy production in the tropics; as such, its existing genetic diversity needs to be assessed for conservation. The current study assessed the genetic variation of Napier grass collections from selected regions in Eastern Africa and the International Livestock Research Institute Forage Germplasm-Ethiopia. The diversity of 281 cultivars was investigated using five selective amplified fragment length polymorphism (AFLP) markers and classical population genetic parameters analysed using various software. The number of bands generated was 216 with fragments per primer set ranging from 50 to 115. Mean percentage polymorphic loci was 63.40. Genetic diversity coefficients based on Nei's genetic diversity ranged from 0.0783 to 0.2142 and Shannon's information index ranged from 0.1293 to 0.3445. The Fst value obtained was moderately significant (Fst = 0.1688). Neighbour-joining analysis gave two distinct clusters which did not reflect geographical locations. Analysis of molecular variance showed all variance components to be highly significant (P < 0.001), indicating more variation within (91 %) than between populations (9 %). Results suggested moderate genetic differentiation among Napier grass populations sampled, which could imply a high germplasm exchange within the region. The AFLP markers used in this study efficiently discriminate among cultivars and could be useful in identification and germplasm conservation.

Randomized controlled trial of maintaining quality of life during radiotherapy for advanced cancer.

BACKGROUND: Psychosocial interventions often address only 1 domain of quality of life (QOL), are offered to patients with early-stage cancer, do not include the caregiver, and are delivered after cancer treatment has been completed. METHODS: In the current randomized controlled trial, 131 patients with advanced cancer who received radiotherapy and their caregivers were randomly assigned to either a 6-session, structured, multidisciplinary intervention arm or a standard care arm. The average age of the patients was 58 years, the majority were male (63%), and tumor types varied (gastrointestinal [37%], brain [22%], head and neck [16%], lung [13%], and other [12%]). The six 90-minute sessions addressed the 5 domains of QOL: cognitive, physical, emotional, social, and spiritual. The in-person intervention was followed by 10 brief telephone counseling sessions that took place over the next 6 months. RESULTS: Of the 117 patients who completed the study, overall QOL (assessed by Functional Assessment of Cancer Therapy-General [FACT-G]) at week 4 was significantly higher in the intervention group (n = 54) compared with the standard arm control group (n = 63) (75.2 vs 68.7; P = .02). The 10 brief telephone contacts did not appear to impact QOL because at week 27 the groups had identical QOL (means of 77.6 and 77.7, respectively). There was no effect of the intervention noted on caregiver QOL. CONCLUSIONS: Participating in a 6-session multidisciplinary intervention was found to be effective in maintaining the QOL of patients with advanced cancer who were actively receiving radiotherapy. The QOL and symptom burden of this population is striking, making it important to identify effective QOL strategies to implement in conjunction with cancer care.

Hardware removal after fracture fixation procedures in the femur.

BACKGROUND: The purpose of this study was to conduct an examination of internal fixation of femoral fractures in a large national database. The study aims were to determine the percentage of fixation procedures that result in hardware removal in a single year and to assess differences in the likelihood for hardware removal procedures using patient characteristics. METHODS: The 2007 Nationwide Inpatient Sample was used to quantify all patients who received an open reduction and internal fixation procedure for a fracture of the femur and all patients with a removal of implanted devices from the femur. The differences in patient characteristics between both groups were assessed using statistical methods. RESULTS: Internal fixation of the femur was reported in 30,943 patients. Hardware removals were reported in 4,886 patients. The removal rate for the year was estimated to be 15.8%. Treatment failure was most often because of mechanical complications (18.7%), osteoarthritis (14.3%), nonunion (13.9%), refracture (10.9%), and other implant-oriented complications (10.1%). Males and younger patients composed a significantly higher percentage of removal procedures than fixation procedures (p < 0.0001 for both). Removal rates were lower in Self-Pay and Medicare patients, while the opposite was true for Medicaid and private insurance/HMO patients (p < 0.0001). CONCLUSION: The results of this study suggest that gender, age, and insurance status may influence the likelihood of an implant removal procedure. Given that removal was more likely in males and younger patients, and most often because of mechanical and implant-oriented complications, patient activity and weight bearing are likely leading factors in implant removal.

Instrumentation constructs in pediatric patients undergoing deformity correction correlated with Scoliosis Research Society scores.

STUDY DESIGN: Data collected prospectively from the Prospective Pediatric Scoliosis Study (PPSS) were analyzed statistically to address the hypothesis that covered specific aspects of treatment and its outcome. OBJECTIVE: To assess and contrast Scoliosis Research Society (SRS) outcome scores for patients assigned to one of three types of spinal instrumentation constructs. The study hypothesis was that the instrumentation strategy that provides the best curve correction will be associated with the best SRS scores. SUMMARY OF BACKGROUND DATA: Surgical treatment of scoliosis has evolved over time using implants and surgical techniques; however, quality of life indicators have not typically been analyzed to assess whether surgery and instrumentation will improve quality of life in pediatric patients. METHODS: Patients were assigned to one of three instrumentation groups depending on the type of construct used. The Scoliosis Research Society's SRS-30 survey was used to measure patient outcomes comparing preoperative results to a 2-year follow-up. RESULTS: Changes in the SRS Pain, Activity, Appearance, Mental, Satisfaction, and SRS Total domains did not differ significantly among instrumentation groups for any time intervals. However, analysis of SRS Pain did show a significant change over time for all instrumentation patterns. The analysis of SRS Activity showed a significant change over time for all instrumentation patterns preoperatively to 2 years postoperatively. Analysis of SRS Appearance showed a significant change over time for all groups but no difference between instrumentation groups. The analysis of SRS Mental based on instrumentation types showed a significant change over time, but only the pedicle screw group's change was statistically significant. Finally, analysis of SRS Satisfaction by instrumentation type showed a statistically significant change over time for all instrumentation patterns. CONCLUSION: There were no statistically significant baseline differences among the three instrumentation construct groups based on mean scores for the six SRS domains. None of the SRS domains had differences among the instrumentation constructs in change scores or significant differences among the instrumentation constructs.

Complications and hardware removal after open reduction and internal fixation of humeral fractures.

BACKGROUND: The purpose of this study was to review internal fixation of humerus fractures using a large national database and assess the incidence of implant removal procedures based on patient characteristics. METHODS: The 2007 Nationwide Inpatient Sample was used to identify two different sets of patients: (1) all patients who received an open internal fixation procedure for a fracture of the upper end, shaft, or lower end of the humerus; and (2) all patients with a removal of implanted devices from the humerus. Patient variables included age, gender, race/ethnicity, median household income, patient geographic region, metropolitan location, and primary expected payor. The differences of characteristics between both groups were determined using χ, Fisher's exact, or unpaired t tests. RESULTS: Open reduction with internal fixation was reported in 7,391 patients. Hardware removals were reported in 751 patients who were determined to have an associated diagnosed complication. From these numbers, the "failure" removal rate as a percentage of the total number of procedures for the year was 10.2%. Nonunion (17.5%) and Mechanical Complication of the Implant (16.2%) were the most common complications. Both payor (p=0.0023) and age (p<0.0001) were found to have significantly different distributions among the open reduction with internal fixation and removal groups. CONCLUSION: These results suggest that the age of the patient and the patient's ability to pay may influence the likelihood of an implant removal procedure. The results will help identify patients who are at high risk for revision and who may benefit from preventative care.

National hardware removal rate associated with internal fixation of facial fractures.

PURPOSE: There has not been a broad national examination of complications and demographics of facial trauma reduction procedures. The literature has reported acceptable and unacceptable hardware removal rates in localized populations. MATERIALS AND METHODS: The 2007 Nationwide Inpatient Sample was used to determine all plate removal procedures associated with common complications from facial reductions. Statistical analysis was used to compare the differences in demographics of the reduction procedure and removal procedure groups. RESULTS: Some form of open fixation was reported in 4,879 patients. Plate removals associated with complications were reported in 246 patients. The "failure" removal rate as a percentage of the total number of open procedures for the year was 5.0%. Gender, race, age, primary payer, and median income of the patient were determined to significantly affect the likelihood for hardware removal due to complications. CONCLUSION: These results suggest that decreased lower bone quality and ability to pay affect the chances that a particular patient will undergo a hardware removal procedure. There is a strong possibility that the reported removal rate underestimates the actual failure rate of the procedures and devices used to treat facial trauma.

Therapeutic exercise during outpatient radiation therapy for advanced cancer: Feasibility and impact on physical well-being.

OBJECTIVE: To characterize the feasibility of delivering a structured physical therapy (PT) program as part of a multidisciplinary intervention to patients undergoing outpatient radiation therapy for advanced cancer. DESIGN: A single-blinded, randomized, controlled trial at a quaternary medical center outpatient clinic. One hundred three adults undergoing radiation therapy for advanced cancer with prognoses > or =6 mos and 5-yr survival estimates < or =50% were randomized to usual care or participation in eight 90-min, multidisciplinary interventional sessions with 30 mins of each session devoted to PT. PT consisted of truncal and limb isodynamic strengthening targeting major upper- and lower-limb muscle groups as well as education and provision with instructional materials. Physical well-being and fatigue were assessed with Linear Analog Scale of Assessment. The Profile of Mood States-Short form, including Fatigue-Inertia and Vigor-Activity subscales, was also administered. RESULTS: PT session attendance was 89.3%. Relative to baseline, mean physical well-being Linear Analog Self Assessment scores at week 4 improved in the intervention group, 0.4 (SD, 23.6), and declined significantly in the control group, -10.0 (SD, 21.5) (P = 0.02). Fatigue and vigor were not significantly different between the groups. All intergroup differences had resolved at 8 and 27 wks. Baseline characteristics were not associated with the magnitude or direction of change in outcomes related to physical functioning. CONCLUSIONS: Delivery of a standardized resistive exercise PT intervention is feasible during outpatient radiation therapy and is associated with preserved physical well-being. However, benefits were not sustained, and fatigue was not affected.

Measuring spiritual quality of life in patients with cancer.

There is no one established approach to the measurement of spiritual quality of life (QOL). Available instruments are based on various theoretical components. We used a multi-instrument approach to measure the spiritual domain of QOL that adds to our understanding of a participant self-definition of spiritual QOL. In total, 103 participants with advanced cancer receiving radiation therapy were enrolled in this study. Most were Caucasian, male, and had advanced lung, head and neck, or gastrointestinal cancer. Two instruments, the Spiritual Well-Being Linear Analogue Self Assessment (SWB LASA) and the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp-12), were used to measure spiritual QOL at enrollment and 4, 8, and 27 weeks after enrollment. Analyses included descriptive statistics, Spearman correlations, stepwise multiple regression, and repeated measures analysis of variance. There was a strong association between SWB LASA and FACIT-Sp-12 total scores. However, FACIT-Sp-12 items defining SWB LASA scores varied over time. Two to three of the FACIT-Sp-12 items explained approximately two thirds of the variance in the SWB LASA scores at each time point with the exception of 4 weeks after enrollment. SWB scores were strongly associated with all QOL domains. In research and clinical care, SWB must be treated as a complex concept that has the potential to change over time. Although a single-item measure of SWB provides valuable information and is strongly associated with the multiple item FACIT-Sp-12, our more detailed inquiry using the FACIT-Sp-12 provides additional guidance for the design and timing of spiritual support interventions.

Role of a medical social worker in improving quality of life for patients with advanced cancer with a structured multidisciplinary intervention.

UNLABELLED: BACKGROUND: Patients with advanced cancer face multiple challenges to their quality of life (QOL). The goal of this study was to investigate the impact of participation in a multidisciplinary intervention, including a social service component, on improving the QOL of patients with advanced cancer undergoing radiation therapy. DESIGN: A total of 115 participants with newly diagnosed advanced stage cancer, who were receiving radiation therapy, were randomly assigned to either participate in an 8-session structured multidisciplinary intervention or to receive standard care. Each 90-minute session was led by either a psychologist or psychiatrist and co-led with a nurse, physical therapist, chaplain, and/or social worker. The sessions were designed to address the domains that impact QOL: emotional, spiritual, physical, and social domains (support, community resources, financial and legal issues, and advance directives). QOL was assessed, at baseline, 4 (end of treatment), 8 and 27 weeks. The primary endpoint was overall QOL assessed on a 0-100 scale at Week 4. RESULTS: A total of 115 patients were enrolled from October 2, 2000 to October 28, 2002. Overall QOL at Week 4 averaged 10 points higher in the intervention group than in the control group (80 vs. 70 points, p = 0.047) which was an increase of 3% from baseline in the intervention group versus a decrease of 9% in the control group (p = 0.009). Of the subscores reflecting patient's opinion regarding their QOL, there was improvement in all social domains which contributed to the overall improvement in QOL. Significant changes from baseline to Week 4 scores were seen in the areas of financial concerns (p = 0.025) and legal issues (p = 0.048). CONCLUSIONS: A social work component within a structured multidisciplinary intervention results in significant advantages in the social domain of QOL, and contributes to clinically meaningful improvements in the overall QOL for patients with advanced cancer undergoing active medical treatment. Numerous studies have documented the financial burdens and social changes that may occur with the diagnosis of cancer. However, previous research has not examined the role of a social worker in providing financial, social, and legal education, in a structured multidisciplinary intervention, and its direct impact on QOL. Outlined in this paper is the role of the medical social worker in a clinical trial, how education was provided and strategies for future interventions. doi:10.1300/J077v25n04_07.

Improving the quality of life of geriatric cancer patients with a structured multidisciplinary intervention: a randomized controlled trial.

OBJECTIVE: To examine the potential impact of elderly age on response to participation in a structured, multidisciplinary quality-of-life (QOL) intervention for patients with advanced cancer undergoing radiation therapy. METHODS: Study design was a randomized stratified, two group, controlled clinical trial in the setting of a tertiary care comprehensive cancer center. Subjects with newly diagnosed cancer and an estimated 5-year survival rate of 0%-50% who required radiation therapy were recruited and randomly assigned to either an intervention group or a standard care group. The intervention consisted of eight 90-min sessions designed to address the five QOL domains of cognitive, physical, emotional, spiritual, and social functioning. QOL was measured using Spitzer uniscale and linear analogue self-assessment (LASA) at baseline and weeks 4, 8, and 27. RESULTS: Of the 103 study participants, 33 were geriatric (65 years or older), of which 16 (mean age 72.4 years) received the intervention and 17 (mean age 71.4 years) were assigned to the standard medical care. The geriatric participants who completed the intervention had higher QOL scores at baseline, at week 4 and at week 8, compared to the control participants. SIGNIFICANCE OF RESULTS: Our results demonstrate that geriatric patients with advanced cancer undergoing radiation therapy will benefit from participation in a structured multidisciplinary QOL intervention. Therefore, geriatric individuals should not be excluded from participating in a cancer QOL intervention, and, in fact, elderly age may be an indicator of strong response to a QOL intervention. Future research should further explore this finding.

Quality of life of caregivers of patients with advanced-stage cancer.

There has been much research documenting the impact of having a loved one diagnosed with advanced cancer, but little is known about how to reduce care-giver burden. In this randomized controlled trial, the authors examined the potential relationship of an advanced cancer patient's participation in an 8-session, structured, multidisciplinary intervention on the care-giver's burden and quality of life (QOL). Although the patients randomly assigned to the intervention (n = 54) demonstrated improved QOL compared to the control condition (n = 49) participants (P < .05), there was no evidence that improving the patient's QOL made an impact on the caregiver's level of burden or the care-giver's QOL. Further investigation is warranted in this area, including interventions specifically designed and targeted to both reduce caregiver burden and to improve caregiver QOL.

Impacting quality of life for patients with advanced cancer with a structured multidisciplinary intervention: a randomized controlled trial.

PURPOSE: The primary goal of this study was to evaluate the feasibility and effectiveness of a structured, multidisciplinary intervention targeted to maintain the overall quality of life (QOL), which is more comprehensive than psychosocial distress, of patients undergoing radiation therapy for advanced-stage cancer. PATIENTS AND METHODS: Radiation therapy patients with advanced cancer and an estimated 5-year survival rate of 0% to 50% were randomly assigned to either an eight-session structured multidisciplinary intervention arm or a standard care arm. The eight 90-minute sessions addressed the five domains of QOL including cognitive, physical, emotional, spiritual, and social functioning. The primary end point of maintaining overall QOL was assessed by a single-item linear analog scale (Linear Analog Scale of Assessment or modified Spitzer Uniscale). QOL was assessed at baseline, week 4 (end of multidisciplinary intervention), week 8, and week 27. RESULTS: Of the 103 participants, overall QOL at week 4 was maintained by the patients in the intervention (n = 49), whereas QOL at week 4 significantly decreased for patients in the control group (n = 54). This change reflected a 3-point increase from baseline in the intervention group and a 9-point decrease from baseline in the control group (P = .009). Intervention participants maintained their QOL, and controls gradually returned to baseline by the end of the 6-month follow-up period. CONCLUSION: Although intervention participants maintained and actually improved their QOL during radiation therapy, control participants experienced a significant decrease in their QOL. Thus, a structured multidisciplinary intervention can help maintain or even improve QOL in patients with advanced cancer who are undergoing cancer treatment.