Wave-Based Outcomes Comparison of Hospitalized COVID-19 Patients: A Retrospective Multicenter Cohort Study From Rural Appalachia.

BACKGROUND: There has been little to no characterization of the pandemic's effects on rural Central Appalachia, in which health disparities in the pre-COVID-19 era have historically plagued. This is the first study to compare wave-based differences in outcomes of hospitalized patients with COVID-19 in the rural Appalachian region. This study aims to provide a more comprehensive understanding of the effects of the COVID-19 pandemic on large rural communities and Appalachia. METHODS: This is a retrospective cohort study of hospitalized patients with COVID-19 between April 2020 and June 2022, which includes 13 Appalachian Regional Healthcare (ARH) hospitals. The primary outcome of the study was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) stay, need for mechanical ventilation, length of hospital stay, 1-30-day re-admittance, 30-60-day re-admittance, and thromboembolism incidence risk. RESULTS: The second wave of infections during the pandemic demonstrated the highest mortality with higher odds of affecting younger patients. The third wave demonstrated similar mortality to the first wave. Elderly patients and patients with chronic morbidities demonstrated the highest mortality and morbidity and the highest requirement for mechanical ventilation across the three waves. Vaccination lowered the odds of mechanical ventilation and ICU stay. CONCLUSIONS: This study comprehensively characterizes the impact of the COVID-19 pandemic in rural regions of Appalachian Kentucky and West Virginia. Future studies comparing differences between rural and urban geographies may be able to distinguish whether the disparities in these regions played a role in the impact on residents.

Challenges and Opportunities in One Health: Google Trends Search Data.

Google Trends data can be informative for zoonotic disease incidences, including Lyme disease. However, the use of Google Trends for predictive purposes is underutilized. In this study, we demonstrate the potential to use Google Trends for zoonotic disease prediction by predicting monthly state-level Lyme disease case counts in the United States. We requested Lyme disease data for the years 2010-2021. We downloaded Google Trends search data on terms for Lyme disease, symptoms of Lyme disease, and diseases with similar symptoms to Lyme disease. For each search term, we built an expanding window negative binomial model that adjusted for seasonal differences using a lag term. Performance was measured by Root Mean Squared Errors (RMSEs) and the visual associations between observed and predicted case counts. The highest performing model had excellent predictive ability in some states, but performance varied across states. The highest performing models were for Lyme disease search terms, which indicates the high specificity of search terms. We outline challenges of using Google Trends data, including data availability and a mismatch between geographic units. We discuss opportunities for Google Trends data for One Health research, including prediction of additional zoonotic diseases and incorporating environmental and companion animal data. Lastly, we recommend that Google Trends be explored as an option for predicting other zoonotic diseases and incorporate other data streams that may improve predictive performance.

Prevalence and Factors of Self-medication with Antibiotics in Claiborne County, Tennessee.

Introduction: Antimicrobial resistance (AMR) is a serious concern to public health, causing an estimated 35,000 deaths annually in the U.S. Misuse of antimicrobials increases the rate of AMR. Self-medication with antibiotics (SMA) is a primary contributor to AMR that can be addressed through education. SMA has been reported at rates of 3% to 66% in the U.S. but has not been evaluated in Appalachia.1 Low health literacy and barriers to accessing care have been correlated with SMA and are common in many areas of Appalachia. Purpose: This study aims to assess factors associated with SMA, demographic differences in knowledge of / beliefs about SMA, and describe practices and beliefs of those who self-medicate in the Cumberland Gap region. Methods: Structured interviews were conducted in a rural health clinic and in a dental office to ascertain demographic information, knowledge of appropriate antibiotic use, and behaviors associated with self-medication. Inferential statistics (chi-squared, Fisher's exact, and ANOVA tests) were conducted. Results: In the last 3 years, 41% of the 78 respondents had practiced SMA. A higher percentage of those who believed that antibiotics are used to treat viral infections have self-treated compared to those who did not hold that belief. Of those who SMA, convenience was the most common reason, while the common symptoms treated were congestion and fever. Implications: The current study provides a first estimate of SMA in the Central Appalachian Region and finds the prevalence to be higher than previously reported in other regions of the U.S. Future studies could include larger, more representative samples and longitudinal study designs to confirm these findings.

CANINE HEARTWORM INFECTION AND PROPHYLAXIS USE AMONG PET CARETAKERS FROM THE CUMBERLAND GAP REGION OF TENNESSEE, USA.

The prevalence of infection with canine heartworm (CHW), Dirofilaria immitis, continues to increase across the United States, regardless of the availability of effective and affordable prophylactic products. Current reports of CHW prevalence as estimated by the Companion Animal Parasite Council (CAPC) are thought to under-represent the true magnitude of the issue because pet dogs that do not receive regular veterinary care are often excluded. This study estimated the prevalence of CHW in pet dogs and associated prophylaxis use in pet dogs in the Cumberland Gap Region with a combined doorstep diagnostic testing approach and caretaker survey. Dogs tested (n = 258) during the summers of 2018 and 2019 revealed a 2.3% (6/258) prevalence in the pet dog population with 33% (2/6) being microfilaremic. Questionnaire data from caretaker interviews revealed that 41.8% (108/258) of the dogs were not receiving CHW prophylaxis. Significant predictors of CHW prophylaxis use identified through logistic regression included pet caretaker awareness of CHW as an important health issue and the use of veterinary services in the year preceding participation in the survey. These results underscore the importance of veterinary-mediated client interaction to create risk awareness of CHW disease and association with prophylaxis compliance.

Inferential implications of normalizing binomial proportions in a structural equation model: A simulation study motivated by feedlot data.

Most commercial software for implementation of structural equation models (SEM) cannot explicitly accommodate outcome variables of binomial nature. As a result, SEM modeling strategies of binomial outcomes are often based on normal approximations of empirical proportions. Inferential implications of these approximations are particularly relevant to health-related outcomes. The objective of this study was to assess the inferential implications of specifying a binomial variable as an empirical proportion (%) in predictor and outcome roles in a SEM. We addressed this objective first by a simulation study, and second by a proof-of-concept data application on beef feedlot morbidity to bovine respiratory disease (BRD). We simulated data on body weight at feedlot arrival (AW), morbidity count for BRD (Mb), and average daily gain (ADG). Alternative SEMs were fitted to the simulated data. Model 1 specified a directed acyclic causal diagram with morbidity fitted as a binomial outcome (Mb) and as a proportion (Mb_p) predictor. Model 2 specified a similar causal diagram with morbidity fitted as a proportion for both outcome and predictor roles within the network. Structural parameters for Model 1 were accurately estimated based on the nominal coverage probability of 95 % confidence intervals. In turn, there was poor coverage for most morbidity-related parameters under Model 2. Both SEM models showed adequate empirical power (>80 %) to detect parameters not equal to zero. Model 1 and Model 2 produced predictions that were reasonable from a management standpoint, as determined by calculating the root mean squared error (RMSE) through cross-validation. However, interpretability of parameter estimates in Model 2 was impaired due to the model misspecification relative to the data generation. The data application fitted SEM extensions, Model 1 * and Model 2 * , to a dataset from a group of feedlots in the Midwestern US. Models 1 * and 2 * included explanatory covariates, specifically percent shrink (PS), backgrounding type (BG), and season (SEA). Lastly, we tested if AW exerted both direct and BRD-mediated indirect effects on ADG using Model 2 * . In Model 1 * , mediation was not testable due to the incomplete path from morbidity as a binomial outcome through Mb_p as a predictor to ADG. Model 2 * supported a minor morbidity-mediated mechanism between AW and ADG, though parameter estimates were not directly interpretable. Our results indicate normal approximation to a binomial disease outcome in a SEM may be a viable option for inference on mediation hypotheses and for predictive purposes, despite limitations in interpretability due to inherent model misspecification.

Factors associated with heartworm preventative use in the golden retriever lifetime study.

Introduction: Heartworm disease is preventable with use of heartworm preventatives, but the reported prevalence of heartworm preventative use in the United States is low, some estimates falling around 50% of dogs. However, there are very few estimates of prevalence and its associated factors. Methods: We aimed to estimate prevalence and evaluate factors, including vaccination status, demographics, lifestyle, physical conditions, medications and supplements, and environment and living conditions, for their association with heartworm preventative use in a large dataset from the Golden Retriever Lifetime Study (N = 2,998). Due to the large number of predictors evaluated, we built a bootstrapped elastic net logistic regression model, which is robust to overfitting and multicollinearity. Variables were evaluated by calculating covariate stability (>80%) and statistical significance (p<0.02). Results: In our sample, the prevalence of heartworm use was 39.5%. In our elastic net model, receiving vaccinations (rabies, Bordetella, or any other vaccine), being located in the Southern U.S., being altered, having an infectious disease or ear/ nose/throat system disease diagnosis, being on heartworm preventatives in the past, currently being on tick preventative, having sun exposure in an area with concrete flooring, living in a house with more rooms with carpeted floors, and spending time on hardwood flooring inside were associated with greater odds of heartworm preventative use. Supplementation use and being in the top quartile of height were associated with lower odds of heartworm preventative use. Discussion: The explanatory factors we identified can be used to improve client communication. In addition, target populations for educational interventions and outreach can be identified. Future studies can validate the findings in a more diverse population of dogs.

Outcomes of Heart Failure in COVID-19 Patients: An Appalachian Experience.

Background: The Southeastern rural areas of the USA have a higher prevalence of heart failure (HF). Coronavirus disease 2019 (COVID-19) infection is associated with poor outcomes in patients with HF. Our study aimed to compare the outcomes of hospitalized HF patients with and without COVID-19 infection specifically in rural parts of the USA. Methods: We conducted a retrospective cohort study of HF patients with and without COVID-19 hospitalized in Southeastern rural parts of the USA by using the Appalachian Regional Healthcare System. Analyses were stratified by waves from April 1, 2020 to May 31, 2021, and from June 1, 2021 to October 19, 2021. Results: Of the 14,379 patients hospitalized with HF, 6% had concomitant COVID-19 infection. We found that HF patients with COVID-19 had higher mortality rate compared to those without COVID-19 (21.8% versus 3.8%, respectively, P < 0.01). Additionally, hospital resource utilization was significantly higher in HF patients with COVID-19 compared to HF patients without COVID-19 with intensive care unit (ICU) utilization of 21.6% versus 13.8%, P < 0.01, mechanical ventilation use of 17.3% versus 6.2%, P < 0.01, and vasopressor/inotrope use of 16.8% versus 7.9%, P < 0.01. A lower percentage of those with COVID-19 were discharged home compared to those without a COVID-19 diagnosis (63.4% versus 72.0%, respectively). There was a six-fold greater odds of dying in the first wave and seven-fold greater odds of dying in the second wave. Conclusions: Our study confirms previous findings of poor outcome in HF patients with COVID-19. There is a need for review of healthcare resources in rural hospitals which already face numerous healthcare challenges.

Predictive Models for Weekly Cattle Mortality after Arrival at a Feeding Location Using Records, Weather, and Transport Data at Time of Purchase.

Feedlot mortality negatively affects animal welfare and profitability. To the best of our knowledge, there are no publications on predictive models for weekly all-cause mortality in feedlot cattle. In this study, random forest models to predict weekly mortality for cattle purchase groups (n = 14,217 purchase groups; 860,545 animals) from arrival at the feeding location (Day 1) to Day 42 and cumulative mortality from Day 43 until slaughter were built using records, weather, and transport data available at the time of purchase. Models were evaluated by calculating the root mean squared error (RMSE) and accuracy (as defined as the percent of purchase groups that had predictions within 0.25% and 0.50% of actual mortality). The models had high accuracy (>90%), but the RMSE estimates were high (range = 1.0% to 4.1%). The best predictors were maximum temperature and purchase weight, although this varied by week. The models performed well among purchase groups with low weekly mortality but performed poorly in high mortality purchase groups. Although high mortality purchase groups were not accurately predicted utilizing the models in this study, the models may potentially have utility as a screening tool for very low mortality purchase groups after arrival. Future studies should consider building iterative models that utilize the strongest predictors identified in this study.

Predictors of Mortality for Patients with COVID-19 in the Rural Appalachian Region.

BACKGROUND: The prevalence and outcome of coronavirus disease 2019 (COVID-19) in rural areas is unknown. METHODS: This is a multi-center retrospective cohort study of hospitalized patients diagnosed with COVID-19 from April 5, 2020 to December 31, 2020. The data were extracted from 13 facilities in the Appalachian Regional Healthcare system that share the same electronic health record using ICD-10-CM codes. RESULTS: The number of patients diagnosed with COVID-19 per facility ranged from 5 to 535 with a median of 106 patients. Total mortality was 11.4% and ranged from 0% to 22.6% by facility (median: 9.0%). Non-survivors had a greater prevalence of congestive heart failure (CHF), hypertension, type 2 diabetes mellitus, stroke, transient ischemic attack (TIA), and pulmonary embolism. Patients who died were also more likely to have had chronic obstructive pulmonary disease (COPD), acute respiratory failure (ARF), liver cirrhosis, chronic kidney disease (CKD), dementia, cancer, anemia, and opiate dependence. CONCLUSION: The aging population, multiple co-morbidities, and health-related behaviors make rural patients vulnerable to COVID-19. A better understanding of the disease in rural areas is crucial, given its heightened vulnerability to adverse outcomes.

Serum Vitamin D Is Associated with Antioxidant Potential in Peri-Parturient Cows.

Dairy cows experience increased oxidative stress during periods of transition such as at the cessation of lactation and around the periparturient period, thus increasing disease risk. Despite routine supplementation of transition cow diets with certain vitamins in an attempt to mitigate oxidative stress, there is no currently available data directly linking vitamin supplementation with antioxidant potential (AOP) in transition cows. The objective of this study was to determine the association between serum vitamins and biomarkers of oxidative stress in healthy cows. Blood samples were collected from 240 cows at dry off (DO), close up (CU), and 2-10 days post-calving (DIM2-10). Blood samples were analyzed for vitamins (A, D, E), ß-carotene, reactive oxygen species (ROS), and AOP. Spearman correlations and mixed linear regression models were used to assess associations between vitamins and measures of oxidant status. Vitamin D concentrations were positively associated with AOP at the CU and DIM2-10. Based on the positive association with AOP, additional in-vitro studies were conducted that showed vitamin D mitigated barrier integrity loss in endothelial cells during oxidative stress. These results indicate for the first time that vitamin D may have a role in promoting antioxidant potential in transition dairy cows.

COVID-19 Vaccine Acceptance Among Rural Appalachian Healthcare Workers (Eastern Kentucky/West Virginia): A Cross-Sectional Study.

Introduction The success of a vaccination program is dependent on vaccine efficacy and the number of people vaccinated. Healthcare workers are the first to receive the COVID-19 vaccine based on CDC phase 1a recommendations and are a point of contact for information for patients, so they must be well-educated on common misconceptions about the vaccine. Objective To identify acceptance/refusal rates of COVID-19 vaccine, reasons for refusal, and to understand the impact of demographics, work environment, and comorbidities on vaccine acceptance. Methods A cross-sectional study of 1076 healthcare employees in Rural Appalachian utilizing electronic and paper-based 12 question surveys from December 10, 2020, through December 20, 2020, followed up to April 2021. Results Within our study, 52.3% of our healthcare workers would accept vaccination with higher age, male gender, physicians, and those who receive annual flu vaccines more likely to accept vaccination. The most common reason for refusal was unknown side effects (88.5%). The second reason for refusal at 33.5% was waiting for someone else to take the vaccine first. In February 2021, the percentage of our healthcare workers who were vaccinated was 48%, which then increased to 55% in March 2021. By April 2021, the vaccination percentage of our healthcare workers reached 59%. Conclusions In order to predict how the public percentage of vaccination would be, healthcare workers need to address concerns about side effects from the vaccines and encourage the public to get the vaccines since healthcare workers themselves had already received the vaccines and can educate the patients on how they did after getting the shots.

The impact of gel fingernail polish application on the reduction of bacterial viability following a surgical hand scrub.

OBJECTIVE: To determine the effect of gel nail polish application on the reduction of bacterial viability immediately after a surgical hand scrub. STUDY DESIGN: Randomized controlled trial. SAMPLE POPULATION: Ten fingernails each from 40 female health care professionals and students. METHODS: Participants' fingernails were randomized to receive no polish or gel nail polish during a manicure from a licensed manicurist. One day and 14 days after manicure, participants' fingernails were sampled before and after a surgical hand scrub with chlorhexidine gluconate. The samples for each fingernail were serially diluted, plated on a Trypsin sheep blood agar and MacConkey's agar plate, and incubated for 36 h. For each plate, bacterial colony forming units (CFU)/ml were determined. Mixed linear models were used to assess factors associated with the logarithmic reduction of viable bacterial counts from pre- to post-surgical scrub. RESULTS: In the final model, no association was detected between gel nail polish and reduction of viable bacterial count (p = .09). On Day 14, among longer nail lengths (2 to <3-mm and ≥3-mm), surgical scrubs resulted in greater reduction in bacterial counts in left-handed than right-handed participants (p < .01). Increasing nail length was correlated with increased CFU/ml post-scrubbing (p < .001). CONCLUSION: Application of gel nail polish did not seem to affect the ability of surgical scrub to reduce bacterial viability 1 and 14 days after a manicure. CLINICAL IMPACT: This study does not provide evidence to prevent application of gel nail polish on short fingernails in surgeons prior to surgical hand scrub with chlorhexidine gluconate.

Weather conditions associated with death attributed to bovine respiratory disease complex in high-risk auction market-sourced male beef calves.

OBJECTIVE: To evaluate associations between weather conditions and management factors with the incidence of death attributable to bovine respiratory disease complex (BRDC) in high-risk auction-sourced beef calves. ANIMALS: Cohorts (n = 3,339) of male beef calves (545,866) purchased by 1 large cattle feeding operation from 216 locations and transported to 1 of 89 feeding locations (backgrounding location or feedlot) with similar management protocols. PROCEDURES: Associations between weather conditions and management factors on the day of purchase (day P) and during the first week at the feeding location and cumulative BRDC mortality incidence within the first 60 days on feed were estimated in a mixed-effects negative binomial regression model. RESULTS: Significant factors in the final model were weaning status; degree of commingling; body weight; transport distance; season; precipitation, mean wind speed, and maximum environmental temperature on day P; environmental temperature range in the first week after arrival at the feeding location; and interactions between distance and wind speed and between body weight and maximum environmental temperature. Precipitation and wind speed on day P were associated with lower cumulative BRDC mortality incidence, but wind speed was associated only among calves transported long distances (≥ 1,082.4 km). Higher mean maximum temperature on day P increased the incidence of cumulative mortality among calves with low body weights (< 275.5 kg). CONCLUSIONS AND CLINICAL RELEVANCE: Several weather conditions on day P and during the first week after arrival were associated with incidence of BRDC mortality. The results may have implications for health- and economic-risk management, especially for high-risk calves and calves that are transported long distances.

Random-effects linear model application to herd-level assessment of bovine hepatic trace mineral concentrations.

To evaluate the utility of random-effects linear modeling for herd-level evaluation of trace mineral status, we performed a retrospective analysis of the results for trace mineral testing of bovine liver samples submitted to the Michigan State University Veterinary Diagnostic Laboratory between 2011 and 2017. Our aim was to examine random-effects models for their potential utility in improving interpretation with minimal sample numbers. The database consisted of 1,658 animals distributed among 121 herds. Minerals were assayed by inductively coupled plasma-mass spectroscopy, and included cobalt, copper, iron, molybdenum, manganese, selenium, and zinc. Intraclass correlation coefficients for each mineral were significantly different (p < 0.001) from zero and ranged from 0.38 for manganese to 0.82 for selenium, indicating that the strength of herd effects, which are presumably related to diet, vary greatly by mineral. Analysis of the distribution and standard errors of best linear unbiased predictor (BLUP) values suggested that testing 5-10 animals per herd could place herds within 10 percentile units across the population of herds with 70-95% confidence, the confidence level varying among minerals. Herd means were generally similar to BLUPs, suggesting that means could be reasonably compared to BLUPs with respect to the distributions reported here. However, caution in interpreting means relative to BLUPs should be exercised when animal numbers are small, the standard errors of the means are large, and/or the values are near the extremes of the distribution.

Rumination time around dry-off relative to the development of diseases in early-lactation cows.

Monitoring rumination time (RT) around the time of calving is an effective way of identifying cows at risk of disease in early lactation. However, this only allows for the identification of cows a few days before the onset of clinical signs; thus, effective preventive measures cannot be implemented. Recent research has suggested that biomarkers of immune and metabolic function measured at dry-off (DO) can predict higher disease risk in early lactation. Nevertheless, the extent to which RT around DO is associated with early-lactation disease risk remains unexplored. Thus, the objective of this study was to compare RT in the weeks before and after DO between cows that did and did not experience health disorders in early lactation. For this, we conducted an observational retrospective cohort study utilizing the records available from a large commercial dairy herd in which RT is recorded daily using an automated system. Daily RT from -7 to +14 d relative to DO from 2,258 DO cycles and their respective health records in the first 60 d in milk were used. Differences in RT between animals with and without a disease history were tested with the Student t-test with Bonferroni adjustment. Mixed linear regression analyses were performed to assess differences in RT around DO and the association of RT with the occurrence of mastitis, metritis, retained placenta, hyperketonemia, lameness, hypocalcemia, pneumonia, and displaced abomasum. Rumination time decreased abruptly at DO and remained lower for 3 to 4 d compared with the days before DO. On average, cows affected by hyperketonemia and lameness ruminated 9.83 ± 6.40 and 15.00 ± 6.08 min/d less than unaffected cows, respectively. Cows that developed lameness in the first 60 d in milk showed reduced RT from 1 to 3 d following DO compared with cows that were not diagnosed with lameness in early lactation. However, RT around DO was not associated with the occurrence of the other health disorders studied here. Our results demonstrate that DO is a stressful event for dairy cows resulting in decreased RT for several days. Furthermore, the association between RT around DO and some early-lactation diseases suggests that RT could be a useful tool to identify at-risk cows early enough to allow for preventive interventions. Further studies should investigate the diagnostic utility of incorporating RT data early in the dry period in the disease prediction algorithms of rumination sensors.

COVID-19 Experiences, Behaviors, Beliefs, and Well-Being Among Students and Employees at a University In Rural Appalachia: A Cross-Sectional Study.

Introduction: In response to the coronavirus disease (COVID-19) pandemic, most universities experienced drastic operational changes with shifts to online learning, work-from-home policies, and social distancing measures. These changes have caused concern for social isolation and mental health. Purpose: This cross-sectional study explores differences in COVID-19 experiences, behaviors, beliefs, and well-being among students and employees (faculty and staff) at a rural Appalachian university. Methods: Data were collected with an online anonymous survey in September-October 2020 using convenience sampling. The survey measured multiple domains including COVID-19-related (1) beliefs, (2) symptoms and diagnoses, (3) exposure and preventive behavior, and (4) social, mental, and financial health. Chi-square tests and linear regression models were used to determine differences in survey responses between students and employees. Results: The final sample used for analysis included 416 respondents. The majority of respondents believed COVID-19 was a serious disease and followed mask and social distancing guidelines, although employees were more likely to adhere to mask and social distancing guidelines compared to students. Most of the respondents (>50%) reported feeling more stressed, anxious, and sad since the pandemic began. Students were more impacted by the pandemic compared to employees as measured by the mental, social, and financial impact scale. A limitation of this study was that convenience sampling was used instead of a probability sampling technique, which limits the inference that can be made from the results. Implications: There may be a need for greater mental health support among university employees and students. However, future studies should confirm these findings.

Serum retinol, ß-carotene, and α-tocopherol as biomarkers for disease risk and milk production in periparturient dairy cows.

The effectiveness of using serum vitamin concentrations as biomarkers to predict diseases in dairy cows during the periparturient period is not well known. The objective of this study was to evaluate the association between serum ß-carotene, retinol, and α-tocopherol concentrations and periparturient cow diseases in commercial dairies. We measured serum concentrations of these vitamin-active compounds at dry-off and during close-up (approximately 3 wk before calving) and early lactation (approximately 7 d post-calving), and we examined their association with clinical diseases in the first 30 d in milk. Diseases were diagnosed by trained personnel and recorded using database software. Blood samples were taken from 353 cows from 5 different farms over a 3-yr period. Blood samples were analyzed for ß-carotene, retinol, α-tocopherol, and cholesterol. We built separate mixed logistic regression models for each disease outcome: hyperketonuria, lameness, mastitis, uterine diseases (retained placenta or metritis), and an aggregate outcome. For the aggregate outcome, a cow was considered positive if she had one or more of the following: hyperketonuria, lameness, mastitis, uterine disease, pneumonia, milk fever, or displaced abomasum. Concentrations of all 3 fat-soluble vitamins decreased significantly in early lactation relative to the 2 prepartum sampling times. Serum retinol concentrations at close-up and early lactation were negatively associated with odds of developing postpartum hyperketonuria. At early lactation, cows with uterine disease had lower serum retinol concentrations than cows without uterine disease. Similarly, lower serum retinol concentrations were associated with greater odds of having any one disease in the aggregate outcome. First-test 305-d mature-equivalent milk yield was positively correlated with increased serum α-tocopherol and negatively correlated with ß-carotene concentrations. This study demonstrates the potential for serum ß-carotene, retinol, and α-tocopherol to serve as biomarkers for disease risk.

Cardiorespiratory Fitness as a Mediator of the Association between Physical Activity and Overweight and Obesity in Adolescent Girls.

Background: Overweight and obesity (OW/OB) continue to be prominent health issues among adolescent girls. However, little is known about the interrelationships between physical activity (PA), cardiorespiratory fitness (CRF), and OW/OB in this population. The objective of this study was to examine whether CRF mediates the relationship between PA and OW/OB in adolescent girls. Methods: Moderate-to-vigorous PA (MVPA), CRF, BMI, and percentage body fat (% BF) were measured in adolescent girls (N = 1519), aged 10-14 years, from 24 urban middle schools located in the Midwestern United States. Structural equation modeling was used to determine whether CRF is a mediator of the association between MVPA and OW/OB (measured as both BMI and % BF). Multigroup analyses were used to determine whether race, puberty, or socioeconomic status moderate the mediation models. Results: The indirect effect of MVPA through CRF on OW/OB was significant for both BMI (p < 0.01) and % BF (p < 0.01), indicating that CRF is a complete mediator between MVPA and OW/OB. Both race and puberty significantly (p < 0.05) moderated the mediation between MVPA and OW/OB. Conclusions: This study demonstrates that CRF is improved by increasing MVPA, and the improvement in CRF results in lower BMI and % BF among adolescent girls.

Prospects for predictive modeling of transition cow diseases.

Transition cow diseases can negatively impact animal welfare and reduce dairy herd profitability. Transition cow disease incidence has remained relatively stable over time despite monitoring and management efforts aimed to reduce the risk of developing diseases. Dairy cattle disease risk is monitored by assessing multiple factors, including certain biomarker test results, health records, feed intake, body condition score, and milk production. However, these factors, which are used to make herd management decisions, are often reviewed separately without considering the correlation between them. In addition, the biomarkers that are currently used for monitoring may not be representative of the complex physiological changes that occur during the transition period. Predictive modeling, which uses data to predict future or current outcomes, is a method that can be used to combine the most predictive variables and their interactions efficiently. The use of an effective predictive model with relevant predictors for transition cow diseases will result in better targeted interventions, and therefore lower disease incidence. This review will discuss predictive modeling methods and candidate variables in the context of transition cow diseases. The next step is to investigate novel biomarkers and statistical methods that are best suited for the prediction of transition cow diseases.

Breastfeeding and Risk of Metabolic Syndrome in Children and Adolescents: A Systematic Review.

BACKGROUND: The beneficial effect of breastfeeding on individual components of the metabolic syndrome in children and adolescents has been reported, but it is unknown if there is an association between being breastfed and metabolic syndrome as a whole. Research aim: This systematic review was performed to assess quality and strength of evidence for the association between being breastfed and the development of metabolic syndrome in children and adolescents. METHODS: Articles were obtained from searches using PubMed and Embase databases, as well as from secondary searches through reference lists. Study quality was assessed using a three-level quality rating system. RESULTS: Of 11 studies reviewed, 7 found a protective association between breastfeeding and metabolic syndrome and 4 found no association. There was no clear dose-response relationship between duration of breastfeeding and metabolic syndrome risk and insufficient evidence to demonstrate an added effect of being exclusively breastfed. The overall quality of the articles was moderate. In general, lower quality articles found no significant association, whereas higher quality articles found a significant association. CONCLUSION: Our review demonstrated a limited amount of high-quality research on the relationship between being breastfed and development of metabolic syndrome in children and adolescents. The evidence presented in this review suggests that being breastfed may be protective against metabolic syndrome, but further research with improvements in study design, such as improved measurement of breastfeeding and the use of prospectively collected data, will improve our understanding of this relationship.