Lipid and glucose abnormalities and associated factors among children living with HIV in Asia.

BACKGROUND: Children living with HIV (CLHIV) on prolonged antiretroviral therapy (ART) are at risk for lipid and glucose abnormalities. Prevalence and associated factors were assessed in a multicentre, Asian longitudinal paediatric cohort. METHODS: CLHIV were considered to have lipid or glucose abnormalities if they had total cholesterol ≥200 mg/dL, high-density lipoprotein (HDL) ≤35 mg/dL, low-density lipoprotein (LDL) ≥100 mg/dL, triglycerides (TG) ≥110 mg/dL, or fasting glucose >110 mg/dL. Factors associated with lipid and glucose abnormalities were assessed by logistic regression. RESULTS: Of 951 CLHIV, 52% were male with a median age of 8.0 (interquartile range [IQR] 5.0-12.0) years at ART start and 15.0 (IQR 12.0-18.0) years at their last clinic visit. 89% acquired HIV perinatally, and 30% had ever used protease inhibitors (PIs). Overall, 225 (24%) had hypercholesterolemia, 105 (27%) low HDL, 213 (58%) high LDL, 369 (54%) hypertriglyceridemia, and 130 (17%) hyperglycemia. Hypercholesterolemia was more likely among females (versus males, aOR 1.93, 95% CI 1.40-2.67). Current PIs use was associated with hypercholesterolemia (current use: aOR 1.54, 95% CI 1.09-2.20); low HDL (current use: aOR 3.16, 95% CI 1.94-5.15; prior use: aOR 10.55, 95% CI 2.53-43.95); hypertriglyceridemia (current use: aOR 3.90, 95% CI 2.65-5.74; prior use: aOR 2.89, 95% CI 1.31-6.39); high LDL (current use: aOR 1.74, 95% CI 1.09-2.76); and hyperglycemia (prior use: aOR 2.43, 95% CI 1.42-4.18). CONCLUSION: More than half and one-fifth of CLHIV have dyslipidemia and hyperglycemia, respectively. Routine paediatric HIV care should include metabolic monitoring. The association between PIs use and dyslipidemia emphasizes the importance of rapidly transitioning to integrase inhibitor-containing regimens.

Comparable safety profile between neuro-oncology procedures involving stereotactic needle biopsy (SNB) followed by laser interstitial thermal therapy (LITT) and LITT alone procedures.

INTRODUCTION: Tissue diagnosis through stereotactic needle biopsy (SNB) is often needed prior to laser interstitial thermal therapy (LITT). Whether these procedures should be performed in the same surgery or in separate settings remain unclear. As a first step to address this question, we assess safety profile of procedures involving LITT alone versus SNB + LITT. METHODS: Using International Classification of Disease (ICD) codes, we queried the National Readmissions Database (NRD, 2010-2018) for malignant brain tumor patients who underwent either (1) LITT alone or (2) elective LITT in combination with SNB (SNB + LITT). Survey regression methods were utilized. Additionally, the procedural outcome of LITT or SNB + LITT performed by the senior surgeon (2014-2022) were reviewed. RESULTS: During the study period, an estimated 678 malignant brain tumor patients underwent LITT alone versus 373 patients that underwent SNB + LITT. Patients undergoing LITT and SNB + LITT exhibited statistically comparable median lengths of hospital stay (IQR; LITT = 2 day [1, 3]; SNB + LITT = 1 day [1, 3]; p = 0.405) and likelihood of routine discharge (LITT = 73.5%; SNB + LITT = 81.1%; p = 0.068). The odds of 30-day medical or neurological readmissions were comparable between LITT and SNB + LITT treated patients (all p ≥ 0.793). In the single surgeon experience of 218 procedures performed over an eight year period (2014-2022), the complications (LITT = 3.9%; SNB + LITT = 2.6%, p = 0.709), discharge within 48 h (LITT = 84.5%; SNB + LITT = 87.8%; p = 0.556), routine discharge (LITT = 91.3%; SNB + LITT = 93.9%; p = 0.604), and unplanned 30-day readmission (LITT = 3.9%; SNB + LITT = 1.7%; p = 0.423) were similarly comparable between LITT and SNB + LITT. CONCLUSION: The length of hospital stay, the likelihood of routine discharge, and 30-day readmission for malignant brain tumor patients who underwent LITT and SNB + LITT were comparable.

Rates of operative intervention for infection after synthetic or autologous cranioplasty: a National Readmissions Database analysis.

OBJECTIVE: The aim of this study was to characterize the clinical utilization and associated charges of autologous bone flap (ABF) versus synthetic flap (SF) cranioplasty and to characterize the postoperative infection risk of SF versus ABF using the National Readmissions Database (NRD). METHODS: The authors used the publicly available NRD to identify index hospitalizations from October 2015 to December 2018 involving elective ABF or SF cranioplasty after traumatic brain injury (TBI) or stroke. Subsequent readmissions were further characterized if patients underwent neurosurgical intervention for treatment of infection or suspected infection. Survey Cox proportional hazards models were used to assess risk of readmission. RESULTS: An estimated 2295 SF and 2072 ABF cranioplasties were performed from October 2015 to December 2018 in the United States. While the total number of cranioplasty operations decreased during the study period, the proportion of cranioplasties utilizing SF increased (p < 0.001), particularly in male patients (p = 0.011) and those with TBI (vs stroke, p = 0.012). The median total hospital charge for SF cranioplasty was $31,200 more costly than ABF cranioplasty (p < 0.001). Of all first-time readmissions, 20% involved surgical treatment for infectious reasons. Overall, 122 SF patients (5.3%) underwent surgical treatment of infection compared with 70 ABF patients (3.4%) on readmission. After accounting for confounders using a multivariable Cox model, female patients (vs male, p = 0.003), those discharged nonroutinely (vs discharge to home or self-care, p < 0.001), and patients who underwent SF cranioplasty (vs ABF, p = 0.011) were more likely to be readmitted for reoperation. Patients undergoing cranioplasty during more recent years (e.g., 2018 vs 2015) were less likely to be readmitted for reoperation because of infection (p = 0.024). CONCLUSIONS: SFs are increasingly replacing ABFs as the material of choice for cranioplasty, despite their association with increased hospital charges. Female sex, nonroutine discharge, and SF cranioplasty are associated with increased risk for reoperation after cranioplasty.

Strangulation ileus caused by malposition of the ureter.

Ileus is one of the most severe diagnoses of the group of acute abdomen events. Some patients with certain forms of bowel obstruction respond well to conservative therapy. However, the diagnosis of strangulation ileus can be delayed in some situations, resulting in high morbidity and mortality in such cases. Our paper presents the case of an 81-year-old female patient who developed an ileus shortly after ureteral stent placement due to obstructive hydroureteronephrosis. The strangulation of the small intestine was caused by an atypical position of the right ureter in the abdominal cavity.

Bayesian emulation and history matching of JUNE.

We analyze JUNE: a detailed model of COVID-19 transmission with high spatial and demographic resolution, developed as part of the RAMP initiative. JUNE requires substantial computational resources to evaluate, making model calibration and general uncertainty analysis extremely challenging. We describe and employ the uncertainty quantification approaches of Bayes linear emulation and history matching to mimic JUNE and to perform a global parameter search, hence identifying regions of parameter space that produce acceptable matches to observed data, and demonstrating the capability of such methods. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.

Readmission risk of malignant brain tumor patients undergoing laser interstitial thermal therapy (LITT) and stereotactic needle biopsy (SNB): a covariate balancing weights analysis of the National Readmissions Database (NRD).

PURPOSE: Despite procedural similarities between laser interstitial thermal therapy (LITT) and stereotactic needle biopsy (SNB), LITT induces delayed, pro-inflammatory responses not associated with SNB that may increase the risk of readmission within 30- or 90- days. Here, we explore this hypothesis. METHODS: We queried the National Readmissions Database (NRD, 2010-18) for malignant brain tumor patients who underwent elective LITT or SNB using International Classification of Diseases codes. Readmissions were defined as non-elective inpatient hospitalizations. Survey regression methods and a weighted analysis were utilized to adjust for demographic and clinical differences between LITT and SNB cohorts. RESULTS: During the study period, an estimated 685 malignant brain patients underwent elective LITT and 15,177 underwent elective SNB. Patients undergoing LITT and SNB exhibited comparable median lengths of hospital stay [IQR; LITT = 2 (1, 3); SNB = 1 (1, 2); p = 0.820]. Likelihood of routine discharge was not significantly different between the two procedures (p = 0.263). No significant differences were observed in the odds of 30- or 90-day unplanned readmission between the LITT and SNB cohorts after multivariable adjustment (all p ≥ 0.177). The covariate balancing weighted analysis confirmed comparable 30 or 90-day readmission risk between LITT and SNB treated patients (all p ≥ 0.201). CONCLUSION: The likelihood of 30- and 90-day readmission for malignant brain tumor patients who underwent LITT or SNB are comparable, supporting the safety profile of LITT as therapy for malignant brain cancers.

Persistent Racial Disparities in Deep Brain Stimulation for Parkinson's Disease.

We sought to determine whether racial and socioeconomic disparities in the utilization of deep brain stimulation (DBS) for Parkinson's disease (PD) have improved over time. We examined DBS utilization and analyzed factors associated with placement of DBS. The odds of DBS placement increased across the study period, whereas White patients with PD were 5 times more likely than Black patients to undergo DBS. Individuals, regardless of racial background, with 2 or more comorbidities were 14 times less likely to undergo DBS. Privately insured patients were 1.6 times more likely to undergo DBS. Despite increasing DBS utilization, significant disparities persist in access to DBS. ANN NEUROL 2022;92:246-254.

Enhanced nitrate reductase activity offers Arabidopsis ecotype Landsberg erecta better salt stress resistance than Col-0.

The nitrogen utilization efficiency of plants varies depending on the plant species. In modern agriculture, nitrogen fertilizer is used to increase crop production, with the amount of fertilizer addition increasing steadily worldwide. This study included the two most used ecotypes of Arabidopsis thaliana, Landsberg erecta (Ler) and Col-0, which were used to identify differences at the molecular level. We found that the efficiency of nitrogen utilization and salt stress resistance differed between these two ecotypes of the same species. We demonstrated distinct salt stress resistance between Ler and Col-0 depending on the differences in nitrate level, which was explained by different regulation of the NIA2 gene expression in these two ecotypes. Our results demonstrate that the genes and promoters regulate expression of these genes and contribute to trait differences. Further studies are required on genes and promoter elements for an improved understanding of the salinity stress resistance mechanism in plants.

Pattern of technology diffusion in the adoption of stereotactic laser interstitial thermal therapy (LITT) in neuro-oncology.

PURPOSE: Understanding factors that influence technology diffusion is central to clinical translation of novel therapies. We characterized the pattern of adoption for laser interstitial thermal therapy (LITT), also known as stereotactic laser ablation (SLA), in neuro-oncology using the National Inpatient Sample (NIS) database. METHODS: We identified patients age ≥ 18 in the NIS (2012-2018) with a diagnosis of primary or metastatic brain tumor that underwent LITT or craniotomy. We compared characteristics and outcomes for patients that underwent these procedures. RESULTS: LITT utilization increased ~ 400% relative to craniotomy during the study period. Despite this increase, the total number of LITT procedures performed for brain tumor was < 1% of craniotomy. After adjusting for this time trend, LITT patients were less likely to have > 2 comorbidities (OR 0.64, CI95 0.51-0.79) or to be older (OR 0.92, CI95 0.86-0.99) and more likely to be female (OR 1.35, CI95 1.08-1.69), Caucasian compared to Black (OR 1.94, CI95 1.12-3.36), and covered by private insurance compared to Medicare or Medicaid (OR 1.38, CI95 1.09-1.74). LITT hospital stays were 50% shorter than craniotomy (IRR 0.52, CI95 0.45-0.61). However, charges related to the procedures were comparable between LITT and craniotomy ($1397 greater for LITT, CI95 $-5790 to $8584). CONCLUSION: For neuro-oncology indications, LITT utilization increased ~ 400% relative to craniotomy. Relative to craniotomy-treated patients, LITT-treated patients were likelier to be young, female, non-Black race, covered by private insurance, or with < 2 comorbidities. While the total hospital charges were comparable, LITT was associated with a shorter hospitalization relative to craniotomy.

Development and validation of a model for predicting 18-month mortality in type 2 myocardial infarction.

BACKGROUND: Despite the poor prognosis in patients with type 2 myocardial infarction (MI), no prospective data on risk stratification exists. The aim of this study was to develop and validate a model for prediction of 18-month mortality of among patients with type 2 MI (T2MI) and compare its performance with GRACE and TARRACO scores. METHODS: The prospective observational study included 712 consecutive patients diagnosed with MI undergoing coronary angiography <24 h between January 2017 and December 2018. Diagnosis of T2MI was adjusted according to Third universal definition. A prognostic model was developed by using Bayesian approach and logistic regression analysis with identifying predictors for mortality. The model was validated by bootstrap validation. Comparison performance between scores using Delong test. RESULTS: T2MI was identified in 174 (24.4%) patients. The median age of patients was 69 years, 52% were female. The mortality rate was 20.1% at 18 months. Prior MI, presence of ST elevation, hemoglobin level at admission, Charlson comorbidity index and were independently associated with 18-month mortality. The model to predict 18-month mortality showed excellent discrimination (optimism corrected c-statistic = 0.822) and calibration (corrected slope = 0.893). GRACE and TARRACO scores had moderate discrimination [c-statistic = 0.748 (95% CI 0.652-0.843) and 0.741, 95% CI 0.669-0.805), respectively] and inferior compared with model (p = 0.043 and 0.037, respectively). CONCLUSIONS: The risk of mortality among T2MI patients could be accurately predicted by using common clinical characteristics and laboratory tests. Further studies are required with external validation of nomogram prior to clinical implementation.

Concordance and Prognostic Relevance of Angiographic and Clinical Definitions of Myocardial Infarction Type.

BACKGROUND: Atherothrombosis is the principal mechanism of type 1 (T1) myocardial infarction (MI), while type 2 (T2) MI is typically diagnosed in the presence of triggers (anemia, arrhythmia, etc.). We aimed to evaluate the proportions of T1 vs. T2 MI based on angiographic and clinical definitions, their concordance and prognosis. METHODS: Consecutive MI patients [n = 712, 61% male; age 64.6 ± 12.3 years] undergoing coronary angiography were classified according to the presence of atherothrombosis and identifiable triggers. Association of angiographic and clinical MI type criteria with adverse outcomes (Time follow-up was 1.5 years) was evaluated. Predictive ability of GRACE risk score for all-cause mortality was then assessed. RESULTS: Atherothrombosis and clinical triggers were identified in 397 (55.6%) and 324 (45.5%) subjects, respectively. Only 247 (34.7%) patients had "true" T1MI (atherothrombosis+ / triggers-); 174 (24.4%) were diagnosed with "true" T2MI (atherothrombosis- / triggers+), while 291 (40.9%) had discordant clinical and angiographic characteristics. All-cause mortality in T2MI (20.1%) patients was higher than in T1MI (9.3%), P = 0.002. Presence of triggers [odds ratio (OR) 2.4, 95% CI 1.5-3.6, P < 0.0001] but not atherothrombosis [OR 0.8, 95% confidence interval (CI) 0.5-1.3, P = 0.26] was associated with worse prognosis. GRACE score is a better predictor of death in T1MI vs. T2MI: area under curve 0.893 (95% CI 0.830-0.956) vs 0.748 (95% CI 0.652-0.843), P = 0.013. CONCLUSION: Angiographic and clinical definitions of MI type are discordant in a substantial proportion of patients. Clinical triggers are associated with all-cause mortality. Predictive performance of GRACE score is worse in T2MI patients.

Effect of sample type and the use of high or low fishmeal diets on bacterial communities in the gastrointestinal tract of Penaeus monodon.

In shrimp aquaculture, manufactured diets that include various supplements and alternative fishmeal ingredients are increasingly being used and their effect on the gastrointestinal (GI) microbiota studied. However, dietary effects on different shrimp GI samples are not known. We investigated how a high (HFM) or low (LFM) fishmeal diet affects bacterial communities from different sample types collected from Penaeus monodon gastrointestinal tract. Bacterial communities of the stomach, intestine tissue and intestine digesta were assessed using 16s rRNA gene sequencing. The feed pellets were also assessed as a potential source of bacteria in the GI tract. Results showed substantial differences in bacterial communities between the two diets as well as between the different sample types. Within the shrimp GI samples, stomach and digesta communities were most impacted by diet, while the community observed in the intestine tissue was less affected. Proteobacteria, Firmicutes and Bacteroidetes were the main phyla observed in shrimp samples, with enrichment of Bacteroidetes and Firmicutes in the LFM fed shrimp. The feed pellets were dominated by Firmicutes and were largely dissimilar to the shrimp samples. Several key taxa were shared however between the feed pellets and shrimp GI samples, particularly in the LFM fed shrimp, indicating the pellets may be a significant source of bacteria observed in shrimp GI samples. In summary, both diet and sample type influenced the bacterial communities characterised from the shrimp GI tract. Thus, it is important to consider the sample type collected from the GI tract when investigating dietary impacts on gut bacterial communities in shrimp. KEY POINTS: • Shrimp gastrointestinal communities are influenced by diet and sample type. • The low fishmeal diet enriched bacteria that aid in polysaccharide metabolism. • Feed pellets can be a source of bacteria-detected gastrointestinal tract of shrimp.

A Proof of Concept for Applying the Radicchi Index (hf) to Compare Academic Productivity and Scientific Impact Among Medical Specialties.

Many indices have been developed to assess the impact of scientific publications by investigators, disciplines, and institutions. The h-index has emerged as a leading tool in the assessment of the productivity of authors. Differences in publication and citation opportunity among specialties create inappropriate conclusions when the h-index is used to compare authors across different disciplines. An alternative, the Radicchi index, hf, has been proposed to assess the impact of publications across disciplines. We curated a database of all articles published from 2002 to 2015 from the 3 highest impact factor medical journals: New England Journal of Medicine (NEJM), the Lancet, and the Journal of American Medical Association (JAMA). With this database, articles were categorized into medical subspecialties. We calculated the respective h-index and Radicchi index of each specialty. We found that the Radicchi index eliminated variability associated with publication and citation opportunity between different specialties when compared to the h-index. The Radicchi index is a useful measure of scientific impact and productivity that advances the h-index by allowing interspecialty comparisons. There remains a need to define a researcher's specialty designation especially if he/she conducts multidisciplinary research.

Ipsilateral ureteroureterostomy for ureteral duplication anomalies: predictors of adverse outcomes.

INTRODUCTION AND OBJECTIVE: Ipsilateral ureteroureterostomy (UU) has gained popularity for treating ureteral duplication (UD) associated with obstruction or vesicoureteral reflux (VUR). Several studies have demonstrated its high success rate and low morbidity. This study aimed to identify the predictors of adverse outcomes associated with UU. STUDY DESIGN: A retrospective chart review was conducted for patients with UD treated with UU at the study institution. Patients with less than 6 months of follow-up were excluded. Charts were reviewed for demographics, pre-operative imaging, surgical indications, operative notes, and follow-up data. Pre-operative and intra-operative variables were tested for association with adverse outcomes including unplanned surgery, worsening hydronephrosis, and febrile UTI recurrence. RESULTS: A total of 35 patients underwent UU for UD between 2009 and 2017 at the study institution. The majority (33/35) had a distal anastomosis. A concomitant re-implantation of the recipient ureter was performed in 9 (25.7%) patients. After a median follow-up of 36.7 months, adverse outcomes developed in 9 patients (25.7%). No further surgery was required in 88.6% of the subjects. Adverse outcomes were associated with female gender (p = 0.048) and hydronephrosis of both upper and lower moieties (p = 0.015) and were more likely associated with ectopic ureteroceles (50%, p = 0.074) and having a concomitant re-implant performed (44.4%, p = 0.19) (table). DISCUSSION: In this study, the low re-operation rates of UU for treating UD in patients with ectopic ureters or intravesical ureteroceles was demonstrated. The majority of patients with ectopic ureteroceles treated with UU and concomitant ureteral re-implantation had worsening hydronephrosis of both moieties and recurrent febrile UTI in the absence of mechanical obstruction. Interestingly, some of them had progression of hydronephrosis after excision of the upper pole. While worsening of hydronephrosis of the recipient moiety after UU was historically attributed to yo-yo reflux, most of the study patients did not have worsening hydronephrosis despite having distal anastomosis. Therefore, mechanical obstruction should be ruled out, and any underlying bladder dysfunction should be aggressively managed in patients with worsening hydronephrosis or recurrent UTI after UU before considering additional surgery. CONCLUSION: Ureteroureterostomy is a successful option for UD with a low risk of adverse events in patients with ectopic ureters or intravesical ureteroceles. However, it should be cautiously considered in patients with hydronephrosis of both moieties, with ectopic ureteroceles, or if a concomitant re-implant is needed.

The impacts of hammer-mill screen size and grain particle size on the performance of broiler chickens offered diets based on two red sorghum varieties.

1. The two red grain sorghums were extensively characterised. Kafirin, polyphenolic compounds, free, conjugated and bound phenolic acids, phytate concentrations and starch pasting profiles were determined. 2. The experiment consisted of a 2 × 4 factorial array of dietary treatments comprising two red sorghum varieties (Tiger and Block I) ground through 4 hammer-mill screen sizes (2.0, 3.2, 4.8 6.0 mm) prior to incorporation into nutritionally equivalent diets. Eight steam-pelleted dietary treatments were each offered to 7 replicates (6 male Ross 308 birds per cage) from 7 to 28 d post-hatch. 3. Effects of dietary treatments on growth performance, relative gizzard and pancreas weights, nutrient utilisation, apparent starch and protein (N) digestibility coefficients and disappearance rates from 4 small intestinal segments were determined. 4. The 2.0-mm hammer-mill screen generated an average geometric mean particle size of 794 µm and the 6.0-mm screen a mean particle size of 1405 µm. However, hammer-mill screen size did not influence weight gain or FCR. The 6.0-mm screen size generated significantly higher starch and protein (N) digestibility coefficients in the distal jejunum and distal ileum than the 2.0-mm hammer-mill screen. 5. Tiger sorghum was superior to Block I sorghum, as significant advantages were observed for feed conversion ratios (3.25%), AME (0.37 MJ), ME:GE ratios (4.15%), AMEn (0.53 MJ), distal ileal starch digestibility coefficients (2.46%) and protein (N) digestibility coefficients in the distal jejunum (4.66%), proximal ileum (1.96%) and distal ileum (2.16%). The inferior Block I sorghum contained more kafirin (67.1 versus 51.3 g/kg), phytate (9.79 versus 8.40 g/kg), total phenolic compounds (4.68 versus 4.12 mg GAE/g), flavan-4-ols (7.98 versus 5.04 ABS/ml/g), total phenolic acids (554 versus 402 µg/g) and total ferulic acid (375 versus 281 µg/g) in comparison to Tiger sorghum.

Creation of an External Ventricular Drain Registry from a Quality Improvement Project.

BACKGROUND: External ventricular drains (EVDs) are a serious source of morbidity and mortality. Data for interventions proven to reduce risk of infections are lacking. Single-center studies are limited in studying procedures that mitigate infection, but bundled protocols have demonstrated utility. A collaborative EVD registry was designed to facilitate local quality improvement projects to be implemented at any location using standardized data collection instruments through resident collaboration to reduce and study EVD infection and prevention. METHODS: A bundled protocol and comprehensive implementation program were developed as a quality improvement project to reduce ventriculostomy-associated infections. Standardized data collection forms were created for multi-institutional participation in an EVD registry. Retrospective and prospective patient data were documented in an electronic procedural registry, which was designed to capture variation among multiple institutions. RESULTS: Two infections were found in 1924 EVD-days before protocol implementation; no infections were found in 700 EVD-days after protocol implementation. Baseline epidemiology of EVDs was calculated in preparation for comparison. A resident-driven EVD consortium, now with 5 other member institutions, was founded to collect data for an EVD registry fed by individual site quality improvement initiatives. CONCLUSIONS: The ventriculostomy-associated infection rate at the University of Minnesota is low compared with the literature. Rationally bundled protocols have mounting evidence but do not allow for identifying effective individual components. Through the registry described here, others can join the EVD consortium to contribute data to facilitate comparative effectiveness research with minimal investment.

Healthy People 2020: assessment of pharmacists' priorities.

OBJECTIVE: The purpose of this study was to assess perceptions of pharmacy educators on the priorities and roles of pharmacists in meeting the Healthy People 2020 objectives. STUDY DESIGN: Cross-sectional, qualitative online national survey. METHODS: A comprehensive literature review identified documented roles and responsibilities of pharmacists in addressing the 42 topic areas in Healthy People 2020. From this, a 14-item survey was developed to identify priorities of categories to improve the health of the nation and importance of the pharmacist role to achieve the objectives. The survey was sent electronically to the members of the Public Health Special Interest Group of the American Association of Colleges of Pharmacy in May and June 2014. RESULTS: Participants identified the following Healthy People 2020 categories as most important in improving the health of the nation: chronic diseases, health care services, lifestyle, prevention/well-being, and environmental factors. They identified the following Healthy People 2020 categories as possessing the most important roles for pharmacists in working to improve the health of the nation: chronic diseases, health care services, lifestyle, prevention/well-being, and infectious disease. CONCLUSIONS: There exists great congruence between top categories of importance and those that the pharmacist can impact to improve the health of the nation. The results of this study can guide efforts to educate and activate pharmacists as interprofessional team members improving health locally and globally.

Inclusion levels and modes of whole grain incorporation into wheat-based rations differentially influence the performance of broiler chickens.

1. The objective was to compare three whole grain (WG) inclusion levels (7.5, 15 and 30%) offered to broiler chickens by three modes of WG incorporation: (i) pre-pellet WG inclusion, (ii) post-pellet WG inclusion as a blend of WG and pelleted concentrate and (iii) post-pellet WG inclusion where WG and pelleted concentrate were provided in separate feed trays against a ground-grain, wheat-based control diet. 2. Ten dietary treatments were offered to 6 replicate cages (6 birds per cage) of male Ross 308 chickens from 7 to 28 d post-hatch. The effects of treatment on relative gizzard weights, gizzard contents, pancreatic weights and pH of gizzard digesta were monitored. Parameters of growth performance, nutrient utilisation (apparent metabolisable energy [AME], metabolisable to gross energy [ME:GE] ratios, nitrogen [N] retention and N-corrected AME [AMEn]), apparent starch and protein (N) digestibility coefficients and disappearance rates in for small intestinal segments and concentrations of free amino acids in plasma taken from the anterior mesenteric vein were determined. 3. Whole grain feeding (WGF) did not influence weight gain, but 30% post-pellet blended and 15 and 30% post-pellet separated treatments significantly depressed (P < 0.05) feed intakes while the 30% post-pellet separated treatment improved (P < 0.01) feed conversion ratios (FCR). WGF regimes significantly increased relative gizzard weights. 4. Overall, WGF generated profound responses in AME, ME:GE ratios, N retention and AMEn that were highly correlated with relative gizzard weights. In general, WGF improved starch and protein (N) digestibilities and again there were some correlations with these outcomes and relative gizzard weights. 5. Post-pellet WG inclusions where WG and pelleted concentrate were offered separately provided chickens with the opportunity to choice feed. Birds showed a preference for the relatively high-protein pelleted concentrate and at 30% WG, this resulted in an improvement in FCR of 7.69% (1.260 versus 1.365; P < 0.001) relative to the ground-grain control diet.

Effects of dietary supplementation of Lactobacillus rhamnosus or/and Lactococcus lactis on the growth, gut microbiota and immune responses of red sea bream, Pagrus major.

Pagrus major fingerlings (3·29 ± 0·02 g) were fed with basal diet (control) supplemented with Lactobacillus rhamnosus (LR), Lactococcus lactis (LL), and L. rhamnosus + L. lactis (LR + LL) at 10(6) cell g(-1) feed for 56 days. Feeding a mixture of LR and LL significantly increased feed utilization (FER and PER), intestine lactic acid bacteria (LAB) count, plasma total protein, alternative complement pathway (ACP), peroxidase, and mucus secretion compared with the other groups (P < 0.05). Serum lysozyme activity (LZY) significantly increased in LR + LL when compared with the control group. Additionally, fish fed the LR + LL diet showed a higher growth performance (Fn wt, WG, and SGR) and protein digestibility than the groups fed an individual LR or the control diet. Superoxide dismutase (SOD) significantly increased in LR and LR + LL groups when compared with the other groups. Moreover, the fish fed LR or LL had better improvement (P < 0.05) in growth, feed utilization, body protein and lipid contents, digestibility coefficients (dry matter, protein, and lipid), protease activity, total intestine and LAB counts, hematocrit, total plasma protein, biological antioxidant potential, ACP, serum and mucus LZY and bactericidal activities, peroxidase, SOD, and mucus secretion than the control group. Interestingly, fish fed diets with LR + LL showed significantly lower total cholesterol and triglycerides when compared with the other groups (P < 0.05). These data strongly suggest that a mixture of LR and LL probiotics may serve as a healthy immunostimulating feed additive in red sea bream aquaculture.