Light microscopic observations of the ruminal papillae of cattle on diets with divergent forage to cereal ratios.

High levels of supplementation with cereal increases production rates in cattle but can increase incidence of disease, ranging from mild indigestion to acute ruminal acidosis and death. Therefore, there is motivation to determine biological markers which can be used to identify whether animals have been, or are being fed, sufficient or excessive cereals. This study aimed to describe light microscopic findings from animals being fed diverse dietary cereal proportions and to test the performance of a novel rumen epithelial scoring system. Rumen wall tissue samples were obtained from the abattoir from 195 cattle from 11 Scottish farms and processed for histological examination. Light microscopic examination was used to characterise ruminal epithelial response to dietary challenge. Secondary objectives included describing the distribution of immune-related cells in bovine ruminal epithelium and assessing the use of a modified Elastin Martius Scarlet Blue stain (EMSB) for histological examination of the rumen epithelium. Cells staining positive for cluster of differentiation 3 were distributed mainly in the lower layers of the stratum basale and were found in higher densities in animals offered lower cereal proportion diets. Cells staining positive for major histocompatibility complex class 2 (MHCII) were most common in perivascular locations and in the junction between the lower stratum basale and the propria-submucosa. The density of MHCII positive staining cells was higher in animals on lower cereal diets. The level of supplementation with cereal was also associated with the thickness of the stratum corneum (SCT) and stratum granulosum (SGT), the integrity of the stratum corneum and sloughing of cornified cells. There were no advantages in using EMSB stain over haematoxylin and eosin (H&E) in this scoring system. We concluded that a scoring system that included only SCT, SGT and a measure of the loss of appearance of intercellular space allowed differentiation of groups of animals according to the level of cereal supplementation.

Postmortem observations on rumen wall histology and gene expression and ruminal and caecal content of beef cattle fattened on barley-based rations.

Sub-acute ruminal acidosis (SARA) can reduce the production efficiency and impair the welfare of cattle, potentially in all production systems. The aim of this study was to characterise measurable postmortem observations from divergently managed intensive beef finishing farms with high rates of concentrate feeding. At the time of slaughter, we obtained samples from 19 to 20 animals on each of 6 beef finishing units (119 animals in total) with diverse feeding practices, which had been subjectively classified as being high risk (three farms) or low risk (three farms) for SARA on the basis of the proportions of barley, silage and straw in the ration. We measured the concentrations of histamine, lipopolysaccharide (LPS), lactate and other short-chain fatty acids (SCFAs) in ruminal fluid, LPS and SCFA in caecal fluid. We also took samples of the ventral blind sac of the rumen for histopathology, immunohistopathology and gene expression. Subjective assessments were made of the presence of lesions on the ruminal wall, the colour of the lining of the ruminal wall and the shape of the ruminal papillae. Almost all variables differed significantly and substantially among farms. Very few pathological changes were detected in any of the rumens examined. The animals on the high-risk diets had lower concentrations of SCFA and higher concentrations of lactate and LPS in the ruminal fluid. Higher LPS concentrations were found in the caecum than the rumen but were not related to the risk status of the farm. The diameters of the stratum granulosum, stratum corneum and of the vasculature of the papillae, and the expression of the gene TLR4 in the ruminal epithelium were all increased on the high-risk farms. The expression of IFN-γ and IL-1ß and the counts of cluster of differentiation 3 positive and major histocompatibility complex class two positive cells were lower on the high-risk farms. High among-farm variation and the unbalanced design inherent in this type of study in the field prevented confident assignment of variation in the dependent variables to individual dietary components; however, the CP percentage of the total mixed ration DM was the factor that was most consistently associated with the variables of interest. Despite the strong effect of farm on the measured variables, there was wide inter-animal variation.

Fostering collaboration by understanding physician behavior: the cancer program perspective.

To build collaborative relations with physicians, which are particularly desirable in cancer programs, hospital administrators must first understand the intrinsic differences between the ways physicians and hospital administrators operate. Administrators' failure to understand physicians' behavior can hamper the development of such programs. Relations between physicians and hospitals have traditionally been good, and while hospital administrators and physicians have approached health care from different perspectives, their activities have generally been mutually supportive. Over the last decade, however, health care payment reform has exacerbated differences in hospitals' and physicians' goals and expectations, and these differences have begun to threaten the traditional collaborative relationship between hospitals and physicians. This report is intended for hospital administrators who wish to strengthen their relationships with their physicians and thereby develop a more comprehensive approach to the delivery of cancer care services. It identifies specific physician behavioral tendencies and analyzes their potential impact on the delivery of patient-centered cancer care. It also examines the ways physicians' attitudes and behaviors develop, as well as the reasons physicians may find themselves in conflict with other health care providers. Finally, it reviews current factors affecting physician/hospital relations and suggests ways hospitals and their medical staffs can develop mutually supportive, collaborative activities.

Ethnicity and intergenerational perceptions of family solidarity.

Intergenerational interaction between matched pairs of older parents and their middle-aged offspring were explored in this research, comparing Mennonites and non-Mennonites. Middle-aged respondents replied to a mailed questionnaire, and their parents were interviewed. Five dimensions of family solidarity were compared between the generations, with the result that middle-aged offspring typically report less family solidarity than do their parents. These results are explained in terms of the concept of the "developmental stake."

The implementation and advantages of product-line management in cancer programs.

During the next decade, hospitals will continue to experience changes in case mix, technology, and reimbursement. The incidence of cancer will increase, and cancer patients are projected to become a larger portion of the overall treatment population served by hospitals. Because the term "cancer" refers to a complex group of diseases treated by many specialties, it is imperative that hospital administrators familiarize themselves with this product-line and address the clinical, financial, and programmatic issues inherent in this large, difficult-to-manage patient population. In contrast to traditional departmental organizations where a number of services, such as nursing and respiratory therapy, are used independently to treat a specific patient, product-line management examines the appropriateness and utilization of all services used to treat a specific group of patients. This organizational approach to cancer treatment has been successful in improving the quality of care, promoting physician bonding, increasing market share, and maximizing resource utilization. This special report focuses on the implementation and advantages of product-line management in cancer care, and will discuss the organizational issues, the process of developing a product-line, and major problems.

Social problems of women patients in a private obstetrics and gynecology clinic.

Patients present or exhibit problems other than physical ones to their physicians and need access to some type of assistance for them. Over a 1 year period, women patients were referred to and seen by the medical social worker employed by a private obstetrics and gynecology clinic. Their social problems were studied by content analysis of patients' records, patients' social services cards, and monthly social services summaries. Results showed that 163 women exhibited 288 social problems consisting of three major types, financial, marital, and emotional. Various relationships were shown between the type of social problem and the primary reason the patient visited the clinic. It was also shown that if a patient has a financial problem, she is more likely to have a greater number of social problems than are other patients.

Distribution of anticonvulsant drugs in gray and white matter of human brain.

Gray and white matter were obtained during neurosurgical therapy of focal epilepsy from 17 patients. In 10 patients, receiving only phenobarbital, the drug was uniformly distributed between gray and white matter. Phenytoin concentrations averaged 1.4-fold greater in white matter than in gray matter when expressed per gram wet weight of tissue. The gray matter/plasma ratio of phenytoin was approximately 2-fold greater than that of phenobarbital. Carbamazepine levels were also slightly greater in white matter. The data revealed wide differences between drugs in the relative concentrations in gray and white matter, which must be taken into account in any quantitative studies of anticonvulsant drug levels in the brain.

Correlation between red cell and free plasma phenytoin levels in renal disease.

Free phenytoin levels were determined in a group of patients with renal disease treated by hemodialysis or transplantation and in epileptic patients who were otherwise healthy. A highly significant correlation was observed between free drug levels and the phenytoin content of red blood cells in both groups. Considerable fluctuation in free phenytoin levels was observed during long-term maintenance hemodialysis. After transplantation, the degree of abnormality in plasma protein binding was not related to the functional adequacy of the cadaveric allografts. Free phenytoin levels must be monitored in patients with renal disease.