Search

Walking is a simple way to improve health through physical activity. Yet many people experience barriers to walking from a variety of physical, social, and psychological factors that impact their mobility. A challenge for managing and studying pedestrian environments is that barriers often occur at local scales (e.g., sidewalk features), yet such fine scale data on pedestrian facilities and experiences are often lacking or out of date. In response, our team developed WalkRollMap.org an online mapping tool that empowers communities by providing them with tools for crowdsourcing their own open data source. In this manuscript we highlight key functions of the tool, discuss initial approaches to community outreach, and share trends in reporting from the first nine months of operation. As of July 27, 2022, there have been 897 reports, of which 53% served to identify hazards, 34% missing amenities, and 14% incidents. The most frequently reported issues were related to sidewalks (15%), driver behavior (19%), and marked crosswalks (7%). The most common suggested amenities were sidewalks, marked crosswalks, connections (i.e., pathways between streets), and curb cuts. The most common types of incidents all included conflicts with vehicles. Data compiled through WalkRollMap.org offer unique potential for local and timely information on microscale barriers to mobility and are available for use by anyone as data are open and downloadable., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Laberee, Nelson, Boss, Ferster, Hosford, Fuller, Cloutier and Winters.)

Background: Researchers have conducted numerous studies seeking to understand how to improve the implementation of changes in health care organizations, but less focus has been given to applying lessons already learned from implementation science. Finding innovative ways to apply these findings efficiently and consistently will improve current research on implementation strategies and allow organizations utilizing these techniques to make changes more effectively., Objective: This research aims to compare a practical implementation approach that uses principles from prior implementation studies to more traditional ways of implementing change., Methods: A total of 43 addiction treatment sites in Iowa were randomly assigned to 2 different implementation strategies in a randomized comparative effectiveness trial studying the implementation of an eHealth substance use disorder treatment technology. One strategy used an adaptation of the Network for the Improvement of Addiction Treatment (NIATx) improvement approach, while the other used a traditional product training model. This paper discusses lessons learned about implementation., Results: This midterm report indicates that use of the NIATx approach appears to be leading to improved outcomes on several measures, including initial and sustained use of new technology by both counselors and patients. Additionally, this research indicates that seamlessly integrating organizational changes into existing workflows and using coaching to overcome hurdles and assess progress are important to improve implementation projects., Conclusions: At this interim point in the study, it appears that the use of the NIATx improvement process leads to better outcomes in implementation of changes within health care organizations. Moreover, some strategies used in this improvement process are particularly useful and should be drawn on more heavily in future implementation efforts., Trial Registration: ClinicalTrials.gov NCT03954184; https://clinicaltrials.gov/ct2/show/NCT03954184., (©David Gustafson Sr, Julie Horst, Deanne Boss, Kathryn Fleddermann, Nora Jacobson, Mathew Roosa, J Charles Ross, Rachel Gicquelais, Olivia Vjorn, Tracy Siegler, Todd Molfenter. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 14.07.2022.)

Objectives: To test the feasibility and preliminary effectiveness of the NIATx model for organizational change to reduce appointment no-shows in dental care settings., Methods: The NIATx Dental Pilot Study used a clustered prepost interventional design and a mixed-methods approach. Five independent dental clinics serving Medicaid enrollees were recruited. Quantitative data on the impact of the NIATx model were complemented by qualitative assessment information collected from dental staff. The NIATx model was applied through a multisite learning collaborative that engaged participating organizations in adopting targeted no-show best practices. The primary outcome measure was no-show data collected at the preintervention phase (5 months), intervention phase (7 months), and postintervention phase (3 months)., Results: Female patients were in the majority (median 54.5 percent). Mean age ranged from 8 to 50 (median 35.2) years. The median percentage for Hispanics was 11.0 percent, and the proportion of uninsured patients was 25 percent. Preintervention no-show rates ranged from 14 percent (clinic B) to 38 percent (clinic E). All clinics had lower no-show rates during the postintervention period, with decreases ranging from 1 percent (clinic B) to 13 percent (clinic E). Overall, the no-show rates decreased in the study., Conclusions: The study demonstrated the feasibility of applying the NIATx model to reduce no-show rates, with some difficulty observed with sustainability across dental practices during the postintervention period., (© 2021 American Association of Public Health Dentistry.)

Background: Substance use disorders (SUDs) in the United States cause many preventable deaths each year. Finding effective ways to manage SUDs is vital to improving outcomes for individuals seeking treatment. This has increased interest in using e-health technologies in behavioral healthcare settings. This research is part of a larger study evaluating the efficacy of the NIATx coaching intervention for implementing RISE Iowa, an e-health patient recovery app, in SUD treatment organizations and seeks to examine clinician perspectives of the barriers and facilitators to its implementation., Method: Semi-structured qualitative interviews were conducted with 13 clinicians from 9 different intervention sites involved in the study., Results: Major barriers to implementing e-health technology include inability to access the technology, lack of time for both patients and clinicians, and a perceived lack of patient motivation to make changes. Facilitators to implementation include collaboration with other staff using e-health technology and integrating technology use into typical workflows., Conclusions: Implementation of e-health technology in SUD treatment will require integrating the technology into clinical workflows and improving patient access to the technology., Competing Interests: Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Todd Molfenter is a faculty member at CHESS. In addition to his academic affiliation, Dr. Molfenter has a less than .1% ownership with CHESS Health, the organization responsible for making the A-CHESS addiction recovery app commercially available to the public. Dr. Molfenter has worked extensively with his institution to manage any conflicts of interest. An external advisory board approved all survey instruments applied, and the individuals who will conduct the data collection and interpretation for this study will have no affiliation with CHESS Health. Also, parts of the NIATx organizational change model used in part of this trial were developed by the Center for Health Enhancement System Studies (CHESS) at the University of Wisconsin–Madison, where Dr. Molfenter is a faculty member. Dr. Molfenter is also affiliated with the NIATx Foundation, the organization responsible for making the NIATx organizational change model available to the public. For this scenario, Dr. Molfenter also has an institutionally approved plan to manage potential conflicts of interest. The individuals who will conduct the data collection and interpretation for this study manuscript will have no affiliation with the NIATx Foundation. David Gustafson is a part-owner of CHESS Health, devoted to marketing information technologies to agencies that deliver addiction treatment. He is also on the board of directors of the not-for-profit NIATx Foundation, as well as a small consulting company doing business as David H. Gustafson and Associates. These relationships do not carry with them any restrictions on publication, and any associated intellectual property will be disclosed and processed according to his institution’s policies., (© The Author(s) 2021.)

Background: Teleophthalmology is a validated method for diabetic eye screening that is underutilized in U.S. primary care clinics. Even when made available to patients, its long-term effectiveness for increasing screening rates is often limited. Introduction: We hypothesized that a stakeholder-based implementation program could increase teleophthalmology use and sustain improvements in diabetic eye screening. Materials and Methods: We used the NIATx Model to test a stakeholder-based teleophthalmology implementation program, I-SITE at one primary care clinic (Main) and compared teleophthalmology use and diabetic eye screening rates with those of other primary care clinics (Outreach) within a U.S. multipayer health system where teleophthalmology was underutilized. Results: Teleophthalmology use increased post-I-SITE implementation (odds ratio [OR] = 5.73 [ p < 0.001]), and was greater at the Main than at the Outreach clinics (OR = 10.0 vs. 1.69, p < 0.001). Overall diabetic eye screening rates maintained an increase from 47.4% at baseline to 60.2% and 64.1% at 1 and 2 years post-I-SITE implementation, respectively ( p < 0.001). Patients who were younger (OR = 0.98 per year of age, p  = 0.02) and men (OR = 1.98, p  = 0.002) were more likely to use teleophthalmology than in-person dilated eye examinations for diabetic eye screening. Discussion: Our stakeholder-based implementation program achieved a significant increase in overall teleophthalmology use and maintained increased post-teleophthalmology diabetic eye screening rates. Conclusion: Stakeholder-based implementation may increase the long-term reach and effectiveness of teleophthalmology to reduce vision loss from diabetes. Our approach may improve integration of telehealth interventions into primary care.

Background: Teleophthalmology provides evidence-based, telehealth diabetic retinopathy screening that is underused even when readily available in primary care clinics. There is an urgent need to increase teleophthalmology use in the US primary care clinics. In this study, we describe the development of a tailored teleophthalmology implementation program and report outcomes related to primary care provider (PCP) adoption., Methods: We applied the 5 principles and 10 steps of the NIATx healthcare process improvement model to develop and test I-SITE (Implementation for Sustained Impact in Teleophthalmology) in a rural, the US multi-payer health system. This implementation program allows patients and clinical stakeholders to systematically tailor teleophthalmology implementation to their local context. We aligned I-SITE components and implementation strategies to an updated ERIC (Expert Recommendations for Implementing Change) framework. We compared teleophthalmology adoption between PCPs who did or did not participate in various components of I-SITE. We surveyed PCPs and clinical staff to identify the strategies they believed to have the highest impact on teleophthalmology use., Results: To test I-SITE, we initiated a year-long series of 14 meetings with clinical stakeholders (n=22) and met quarterly with patient stakeholders (n=9) in 2017. Clinical and patient stakeholder groups had 90.9% and 88.9% participant retention at 1 year, respectively. The increase in teleophthalmology use was greater among PCPs participating in the I-SITE implementation team than among other PCPs (p < 0.006). The proportion of all PCPs who used the implementation strategy of electing diabetic eye screening for their annual performance-based financial incentive increased from 0% (n=0) at baseline to 56% (n=14) following I-SITE implementation (p = 0.004). PCPs and clinical staff reported the following implementation strategies as having the highest impact on teleophthalmology use: reminders to ask patients about diabetic eye screening during clinic visits, improving electronic health record (EHR) documentation, and patient outreach., Conclusions: We applied the NIATx Model to develop and test a teleophthalmology implementation program for tailored integration into primary care clinics. The NIATx Model provides a systematic approach to engaging key stakeholders for tailoring implementation of evidence-based telehealth interventions into their local context.

Researchers have shown that children's social-emotional growth is inextricably connected to academic learning. We developed the Social-Emotional Learning Foundations (SELF) intervention, a Grade K-1 curriculum merging social-emotional learning (SEL) and literacy instruction, to promote language supported self-regulation, specifically for primary grade children at early risk for emotional or behavioral difficulties. We report findings from a pretest-posttest cluster randomized efficacy trial with one fixed between-subjects factor to test the effects of teacher-delivered SEL instruction against those of business as usual (BAU). We recruited 163 kindergarten (K) and 141 first grade teachers from 52 schools across 11 school districts within one southeastern state. Our student sample (n = 1154) consisted of 627 kindergarteners and 527 first graders identified by teachers as at risk for internalizing or externalizing emotional and behavioral problems using the Systematic Screening for Behavioral Disorders; 613 of these students participated in the SELF condition and 541 participated in the BAU condition. We randomly assigned schools to SELF or BAU and used a multilevel model with three levels (i.e., children, classrooms, schools) to analyze data on subscales of six (four teacher-report and two direct) assessments related to self-regulation, social-emotional learning, social-emotional vocabulary, and general behavioral functioning. We found positive main effects of SELF compared to BAU on all but one measure, with effect sizes (calculated using Hedges' g) ranging from 0.20 to 0.65. Findings provide evidence for guiding future SEL intervention research and informing practice to improve student outcomes, particularly for children at risk for behavior problems., (Copyright © 2021 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.)

Background: Clinician utilization of practice guidelines can reduce inappropriate opioid prescribing and harm in chronic non-cancer pain; yet, implementation of "opioid guidelines" is subpar. We hypothesized that a multi-component quality improvement (QI) augmentation of "routine" system-level implementation efforts would increase clinician adherence to the opioid guideline-driven policy recommendations., Methods: Opioid policy was implemented system-wide in 26 primary care clinics. A convenience sample of 9 clinics received the QI augmentation (one-hour academic detailing; 2 online educational modules; 4-6 monthly one-hour practice facilitation sessions) in this non-randomized stepped-wedge QI project. The QI participants were volunteer clinic staff. The target patient population was adults with chronic non-cancer pain treated with long-term opioids. The outcomes included the clinic-level percentage of target patients with a current treatment agreement (primary outcome), rates of opioid-benzodiazepine co-prescribing, urine drug testing, depression and opioid misuse risk screening, and prescription drug monitoring database check; additional measures included daily morphine-equivalent dose (MED), and the percentages of all target patients and patients prescribed ≥90 mg/day MED. T-test, mixed-regression and stepped-wedge-based analyses evaluated the QI impact, with significance and effect size assessed with two-tailed p < 0.05, 95% confidence intervals and/or Cohen's d., Results: Two-hundred-fifteen QI participants, a subset of clinical staff, received at least one QI component; 1255 patients in the QI and 1632 patients in the 17 comparison clinics were prescribed long-term opioids. At baseline, more QI than comparison clinic patients were screened for depression (8.1% vs 1.1%, p = 0.019) and prescribed ≥90 mg/day MED (23.0% vs 15.5%, p = 0.038). The stepped-wedge analysis did not show statistically significant changes in outcomes in the QI clinics, when accounting for the comparison clinics' trends. The Cohen's d values favored the QI clinics in all outcomes except opioid-benzodiazepine co-prescribing. Subgroup analysis showed that patients prescribed ≥90 mg/day MED in the QI compared to comparison clinics improved urine drug screening rates (38.8% vs 19.1%, p = 0.02), but not other outcomes (p ≥ 0.05)., Conclusions: Augmenting routine policy implementation with targeted QI intervention, delivered to volunteer clinic staff, did not additionally improve clinic-level, opioid guideline-concordant care metrics. However, the observed effect sizes suggested this approach may be effective, especially in higher-risk patients, if broadly implemented., Trial Registration: Not applicable.

Background: Systematic implementation of guidelines for opioid therapy management in chronic non-cancer pain can reduce opioid-related harms. However, implementation of guideline-recommended practices in routine care is subpar. The goal of this quality improvement (QI) project is to assess whether a clinic-tailored QI intervention improves the implementation of a health system-wide, guideline-driven policy on opioid prescribing in primary care. This manuscript describes the protocol for this QI project., Methods: A health system with 28 primary care clinics caring for approximately 294,000 primary care patients developed and implemented a guideline-driven policy on long-term opioid therapy in adults with opioid-treated chronic non-cancer pain (estimated N = 3980). The policy provided multiple recommendations, including the universal use of treatment agreements, urine drug testing, depression and opioid misuse risk screening, and standardized documentation of the chronic pain diagnosis and treatment plan. The project team drew upon existing guidelines, feedback from end-users, experts and health system leadership to develop a robust QI intervention, targeting clinic-level implementation of policy-directed practices. The resulting multi-pronged QI intervention included clinic-wide and individual clinician-level educational interventions. The QI intervention will augment the health system's "routine rollout" method, consisting of a single educational presentation to clinicians in group settings and a separate presentation for staff. A stepped-wedge design will enable 9 primary care clinics to receive the intervention and assessment of within-clinic and between-clinic changes in adherence to the policy items measured by clinic-level electronic health record-based measures and process measures of the experience with the intervention., Discussion: Developing methods for a health system-tailored QI intervention required a multi-step process to incorporate end-user feedback and account for the needs of targeted clinic team members. Delivery of such tailored QI interventions has the potential to enhance uptake of opioid therapy management policies in primary care. Results from this study are anticipated to elucidate the relative value of such QI activities.

Many cities are making significant financial investments in cycling infrastructure with the aim of making cycling safer for riders of all ages and abilities. Methods for evaluating cycling safety tend to summarize average change for a city or emphasize change on a single road segment. Few spatially explicit approaches are available to evaluate how patterns of safety change throughout a city due to cycling infrastructure investments or other changes. Our goal is to demonstrate a method for monitoring changes in the spatial-temporal distribution of cycling incidents across a city. Using cycling incident data provided by the Insurance Corporation of British Columbia, we first compare planar versus network constrained kernel density estimation for visualizing incident intensity across the street network of Vancouver, Canada. Second, we apply a change detection algorithm explicitly designed for detecting statistically significant change in kernel density estimates. The utility of network kernel density change detection is demonstrated through the comparison of cycling incident densities following the construction of two cycle tracks in the downtown core of Vancouver. The methods developed and demonstrated for this study provide city planners, transportation engineers and researchers a means of monitoring city-wide change in the intensity of cycling incidents following enhancements to cycling infrastructure or other significant changes to the transportation network., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Many biological processes depend on the sequential assembly of protein complexes. However, studying the kinetics of such processes by direct methods is often not feasible. As an important class of such protein complexes, pore-forming toxins start their journey as soluble monomeric proteins, and oligomerize into transmembrane complexes to eventually form pores in the target cell membrane. Here, we monitored pore formation kinetics for the well-characterized bacterial pore-forming toxin aerolysin in single cells in real time to determine the lag times leading to the formation of the first functional pores per cell. Probabilistic modeling of these lag times revealed that one slow and seven equally fast rate-limiting reactions best explain the overall pore formation kinetics. The model predicted that monomer activation is the rate-limiting step for the entire pore formation process. We hypothesized that this could be through release of a propeptide and indeed found that peptide removal abolished these steps. This study illustrates how stochasticity in the kinetics of a complex process can be exploited to identify rate-limiting mechanisms underlying multistep biomolecular assembly pathways., (Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Lapatinib has proven efficacy as monotherapy and in combination with capecitabine in patients with metastatic breast cancer (MBC) overexpressing HER2 and/or EGFR. Gemcitabine also has anti-tumor activity in MBC and a favourable toxicity profile. In this phase I study lapatinib and gemcitabine were combined., Methods: Female patients with advanced BC were given lapatinib once daily (QD) in 28-day cycles with gemcitabine administered on day 1, 8 and 15. Physical examinations, vital signs and blood sampling for hematology, clinical chemistry and pharmacokinetics (PK) and radiological assessments of disease were performed at regular intervals., Results: In total, 33 patients were included. Six dose-limiting toxicities were observed, mostly grade 3 increases in liver function tests. Most common toxicities were fatigue (73%), nausea (70%), diarrhea (58%), increases in ALAT and ASAT (55 and 52%, respectively) and rash (46%). The maximum tolerated dose was lapatinib 1250 mg QD with gemcitabine 1000 mg/m(2). Lapatinib and gemcitabine PK did not appear to be influenced by each other. Anti-tumor activity was observed with one patient (4%) showing complete response and six (23%) partial response., Conclusion: Despite a slightly increased toxicity profile compared to their respective monotherapies, lapatinib and gemcitabine can be safely combined while showing signs of anti-tumor activity.

Comprehensively sampled phylogenetic trees provide the most compelling foundations for strong inferences in comparative evolutionary biology. Mismatches are common, however, between the taxa for which comparative data are available and the taxa sampled by published phylogenetic analyses. Moreover, many published phylogenies are gene trees, which cannot always be adapted immediately for species level comparisons because of discordance, gene duplication, and other confounding biological processes. A new database, STBase, lets comparative biologists quickly retrieve species level phylogenetic hypotheses in response to a query list of species names. The database consists of 1 million single- and multi-locus data sets, each with a confidence set of 1000 putative species trees, computed from GenBank sequence data for 413,000 eukaryotic taxa. Two bodies of theoretical work are leveraged to aid in the assembly of multi-locus concatenated data sets for species tree construction. First, multiply labeled gene trees are pruned to conflict-free singly-labeled species-level trees that can be combined between loci. Second, impacts of missing data in multi-locus data sets are ameliorated by assembling only decisive data sets. Data sets overlapping with the user's query are ranked using a scheme that depends on user-provided weights for tree quality and for taxonomic overlap of the tree with the query. Retrieval times are independent of the size of the database, typically a few seconds. Tree quality is assessed by a real-time evaluation of bootstrap support on just the overlapping subtree. Associated sequence alignments, tree files and metadata can be downloaded for subsequent analysis. STBase provides a tool for comparative biologists interested in exploiting the most relevant sequence data available for the taxa of interest. It may also serve as a prototype for future species tree oriented databases and as a resource for assembly of larger species phylogenies from precomputed trees.

Quantitative phase (QP) images of red blood cells (RBCs), which are obtained by off-axis digital holographic microscopy, can provide quantitative information about three-dimensional (3D) morphology of human RBCs and the characteristic properties such as mean corpuscular hemoglobin (MCH) and MCH surface density (MCHSD). In this paper, we investigate modifications of the 3D morphology and MCH in RBCs induced by the period of storage time for the purpose of classification of RBCs with different periods of storage by using off-axis digital holographic microscopy. The classification of RBCs based on the duration of storage is highly relevant because a long storage of blood before transfusion may alter the functionality of RBCs and, therefore, cause complications in patients. To analyze any changes in the 3D morphology and MCH of RBCs due to storage, we use data sets from RBC samples stored for 8, 13, 16, 23, 27, 30, 34, 37, 40, 47, and 57 days, respectively. The data sets consist of more than 3,300 blood cells in eleven classes, with more than 300 blood cells per class. The classes indicate the storage period of RBCs and are listed in chronological order. Using the RBCs donated by healthy persons, the off-axis digital holographic microscopy reconstructs several quantitative phase images of RBC samples stored for eleven different periods. We employ marker-controlled watershed transform to remove the background in the RBC quantitative phase images obtained by the off-axis digital holographic microscopy. More than 300 single RBCs are extracted from the segmented quantitative phase images for each class. Such a large number of RBC samples enable us to obtain statistical distributions of the characteristic properties of RBCs after a specific period of storage. Experimental results show that the 3D morphology of the RBCs, in contrast to MCH, is essentially related to the aging of the RBCs.

A dual-wavelength digital holographic microscope to measure absolute volume of living cells is proposed. The optical setup allows us to reconstruct two quantitative phase contrast images at two different wavelengths from a single hologram acquisition. When adding the absorbing dye fast green FCF as a dispersive agent to the extracellular medium, cellular thickness can be univocally determined in the full field of view. In addition to the absolute cell volume, the method can be applied to derive important biophysical parameters of living cells including osmotic membrane water permeability coefficient and the integral intracellular refractive index (RI). Further, the RI of transmembrane flux can be determined giving an indication about the nature of transported solutes. The proposed method is applied to cultured human embryonic kidney cells, Chinese hamster ovary cells, human red blood cells, mouse cortical astrocytes, and neurons.

We present a method to automatically segment red blood cells (RBCs) visualized by digital holographic microscopy (DHM), which is based on the marker-controlled watershed algorithm. Quantitative phase images of RBCs can be obtained by using off-axis DHM along to provide some important information about each RBC, including size, shape, volume, hemoglobin content, etc. The most important process of segmentation based on marker-controlled watershed is to perform an accurate localization of internal and external markers. Here, we first obtain the binary image via Otsu algorithm. Then, we apply morphological operations to the binary image to get the internal markers. We then apply the distance transform algorithm combined with the watershed algorithm to generate external markers based on internal markers. Finally, combining the internal and external markers, we modify the original gradient image and apply the watershed algorithm. By appropriately identifying the internal and external markers, the problems of oversegmentation and undersegmentation are avoided. Furthermore, the internal and external parts of the RBCs phase image can also be segmented by using the marker-controlled watershed combined with our method, which can identify the internal and external markers appropriately. Our experimental results show that the proposed method achieves good performance in terms of segmenting RBCs and could thus be helpful when combined with an automated classification of RBCs.

Background: The objectives of this phase I study were to assess the safety and tolerability of E7080 in patients with advanced, refractory solid tumours; to determine the maximum tolerated dose (MTD) and pharmacokinetics profile of E7080; and to explore preliminary evidence of its anti-tumour efficacy., Methods: E7080 was administered orally in escalating doses on a once-daily continuous schedule in 28-day cycles to eligible patients. Samples for pharmacokinetic analyses were collected on days 1, 8, 15 and 22 of cycle 1 and day 1 of cycle 2. Anti-tumour efficacy was assessed every two cycles., Results: Eighty-two patients received E7080 in dose cohorts from 0.2 to 32 mg. Dose-limiting toxicities were grade 3 proteinuria (two patients) at 32 mg, and the MTD was defined as 25 mg. The most frequently observed cumulative toxicities (all grades) were hypertension (40% of patients), diarrhoea (45%), nausea (37%), stomatitis (32%) and vomiting (23%). Seven patients (9%) had a partial response and 38 patients (46%) had stable disease as best response. E7080 has dose-linear kinetics with no drug accumulation after 4 weeks' administration., Conclusion: E7080 is well tolerated at doses up to 25 mg per day. Encouraging anti-tumour efficacy was observed in patients with melanoma and renal cell carcinoma.

In this paper, we present an automated approach to quantify information about three-dimensional (3D) morphology, hemoglobin content and density of mature red blood cells (RBCs) using off-axis digital holographic microscopy (DHM) and statistical algorithms. The digital hologram of RBCs is recorded by a CCD camera using an off-axis interferometry setup and quantitative phase images of RBCs are obtained by a numerical reconstruction algorithm. In order to remove unnecessary parts and obtain clear targets in the reconstructed phase image with many RBCs, the marker-controlled watershed segmentation algorithm is applied to the phase image. Each RBC in the segmented phase image is three-dimensionally investigated. Characteristic properties such as projected cell surface, average phase, sphericity coefficient, mean corpuscular hemoglobin (MCH) and MCH surface density of each RBC is quantitatively measured. We experimentally demonstrate that joint statistical distributions of the characteristic parameters of RBCs can be obtained by our algorithm and efficiently used as a feature pattern to discriminate between RBC populations that differ in shape and hemoglobin content. Our study opens the possibility of automated RBC quantitative analysis suitable for the rapid classification of a large number of RBCs from an individual blood specimen, which is a fundamental step to develop a diagnostic approach based on DHM., (© 2012 Optical Society of America)

Red blood cells (RBCs) present unique reversible shape deformability, essential for both function and survival, resulting notably in cell membrane fluctuations (CMF). These CMF have been subject of many studies in order to obtain a better understanding of these remarkable biomechanical membrane properties altered in some pathological states including blood diseases. In particular the discussion over the thermal or metabolic origin of the CMF has led in the past to a large number of investigations and modeling. However, the origin of the CMF is still debated. In this article, we present an analysis of the CMF of RBCs by combining digital holographic microscopy (DHM) with an orthogonal subspace decomposition of the imaging data. These subspace components can be reliably identified and quantified as the eigenmode basis of CMF that minimizes the deformation energy of the RBC structure. By fitting the observed fluctuation modes with a theoretical dynamic model, we find that the CMF are mainly governed by the bending elasticity of the membrane and that shear and tension elasticities have only a marginal influence on the membrane fluctations of the discocyte RBC. Further, our experiments show that the role of ATP as a driving force of CMF is questionable. ATP, however, seems to be required to maintain the unique biomechanical properties of the RBC membrane that lead to thermally excited CMF.

Chloride channels represent a group of targets for major clinical indications. However, molecular screening for chloride channel modulators has proven to be difficult and time-consuming as approaches essentially rely on the use of fluorescent dyes or invasive patch-clamp techniques which do not lend themselves to the screening of large sets of compounds. To address this problem, we have developed a non-invasive optical method, based on digital holographic microcopy (DHM), allowing monitoring of ion channel activity without using any electrode or fluorescent dye. To illustrate this approach, GABA(A) mediated chloride currents have been monitored with DHM. Practically, we show that DHM can non-invasively provide the quantitative determination of transmembrane chloride fluxes mediated by the activation of chloride channels associated with GABA(A) receptors. Indeed through an original algorithm, chloride currents elicited by application of appropriate agonists of the GABA(A) receptor can be derived from the quantitative phase signal recorded with DHM. Finally, chloride currents can be determined and pharmacologically characterized non-invasively simultaneously on a large cellular sampling by DHM.

Digital holographic microscopy (DHM) is a noninvasive optical imaging technique that provides quantitative phase images of living cells. In a recent study, we showed that the quantitative monitoring of the phase signal by DHM was a simple label-free method to study the effects of glutamate on neuronal optical responses (Pavillon et al., 2010). Here, we refine these observations and show that glutamate produces the following three distinct optical responses in mouse primary cortical neurons in culture, predominantly mediated by NMDA receptors: biphasic, reversible decrease (RD) and irreversible decrease (ID) responses. The shape and amplitude of the optical signal were not associated with a particular cellular phenotype but reflected the physiopathological status of neurons linked to the degree of NMDA activity. Thus, the biphasic, RD, and ID responses indicated, respectively, a low-level, a high-level, and an "excitotoxic" level of NMDA activation. Moreover, furosemide and bumetanide, two inhibitors of sodium-coupled and/or potassium-coupled chloride movement strongly modified the phase shift, suggesting an involvement of two neuronal cotransporters, NKCC1 (Na-K-Cl) and KCC2 (K-Cl) in the genesis of the optical signal. This observation is of particular interest since it shows that DHM is the first imaging technique able to monitor dynamically and in situ the activity of these cotransporters during physiological and/or pathological neuronal conditions.

We present a novel technique for three-dimensional (3D) image processing of complex fields. It consists in inverting the coherent image formation by filtering the complex spectrum with a realistic 3D coherent transfer function (CTF) of a high-NA digital holographic microscope. By combining scattering theory and signal processing, the method is demonstrated to yield the reconstruction of a scattering object field. Experimental reconstructions in phase and amplitude are presented under non-design imaging conditions. The suggested technique is best suited for an implementation in high-resolution diffraction tomography based on sample or illumination rotation.

We propose to apply statistical clustering algorithms on a three-dimensional profile of red blood cells (RBCs) obtained through digital holographic microscopy (DHM). We show that two classes of RBCs stored for 14 and 38 days can be effectively classified. Two-dimensional intensity images of these cells are virtually the same. DHM allows for measurement of the RBCs' biconcave profile, resulting in a discriminative dataset. Two statistical clustering algorithms are compared. A model-based clustering approach classifies the pixels of an RBC and recognizes the RBC as either new or old based. The K-means algorithm is applied to the four-dimensional feature vector extracted from the RBC profile.

Background: To determine, for each of two dosing schedules, the dose-limiting toxicity (DLT) and maximum-tolerated dose (MTD) of AZD1152, an Aurora B kinase inhibitor, and to evaluate its safety, biologic activity and pharmacokinetics (PK)., Patients and Methods: Patients with advanced solid malignancies were treated with escalating doses (100-650 mg) of AZD1152, administered as a 2-h infusion every 7 days (A) or 14 days (B). Adverse events (AEs), PK variables and tumor response were assessed., Results: Fifty-nine patients were treated; 19 in schedule A and 40 in schedule B. The MTDs were 200 and 450 mg, respectively. Neutropenia (with/without fever) was the most frequent AE and DLT in each schedule. Common Terminology Criteria of Adverse Events version 3.0 grade ≥3 neutropenia and leukopenia occurred in 58% and 11% of patients, respectively, in schedule A and 43% and 20%, respectively, in schedule B. No objective tumor responses were observed at any dose or schedule, although stable disease, as defined by RECIST, was achieved in 15 patients (25%) overall. Systemic exposure to AZD1152-hQPA (active drug) was observed by 1 h into the infusion and exhibited linear PK., Conclusions: AZD1152 was generally well tolerated with neutropenia being the most frequently reported AE and DLT. Exposure to AZD1152-hQPA, the active drug of AZD1152, was linear.

The authors have developed a live-cell multimodality microscope combining epifluorescence with digital holographic microscopy; it has been implemented with a decoupling procedure allowing to separately measure from the quantitative phase important cell parameters including absolute volume, shape and integral intracellular refractive index. In combination with the numerous different specific fluorescent cellular probes, this multimodality microscopy can address important issues in cell biology. This is demonstrated by the study of intracellular calcium homeostasis associated with the change in cell volume, which play a critical role in the excitotoxicity-induced neuronal death., ((c) 2010 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Background: AZD5438 is an orally bioavailable inhibitor of cyclin E-cdk2, cyclin A-cdk2 and cyclin B-cdk1 complexes. Three phase I studies assessed the clinical safety, tolerability, pharmacokinetics and pharmacodynamics of AZD5438 when administered in different dosing schedules., Patients and Methods: AZD5438 was administered four times daily, once every 7 days (study 1), for 14 consecutive days followed by 7 days of rest (study 2), or continuously (study 3), to patients with advanced solid tumours. Dose escalation proceeded until the emergence of dose-limiting toxic effects., Results: Sixty-four patients were included across the three studies (19, 17 and 28, respectively). Nausea and vomiting were the most common adverse events. When dosed continuously, 40 mg four times daily was considered intolerable, and due to safety issues, all studies were terminated prematurely. Consequently, no intolerable dose was identified during the weekly schedule. Pharmacokinetics demonstrated dose-proportional exposure, high interpatient variability and accumulation after multiple doses. Skin biopsies indicated reduced retinoblastoma protein phosphorylation at cdk2 phospho-sites; other pharmacodynamic assessments did not reveal consistent trends., Conclusions: AZD5438 was generally well tolerated in a weekly dosing schedule, but not in continuous schedules. The clinical development programme for AZD5438 was discontinued owing to tolerability and exposure data from these studies.

Red blood cell (RBC) membrane fluctuations provide important insights into cell states. We present a spatial analysis of red blood cell membrane fluctuations by using digital holographic microscopy (DHM). This interferometric and dye-free technique, possessing nanometric axial and microsecond temporal sensitivities enables to measure cell membrane fluctuations (CMF) on the whole cell surface. DHM acquisition is combined with a model which allows extracting the membrane fluctuation amplitude, while taking into account cell membrane topology. Uneven distribution of CMF amplitudes over the RBC surface is observed, showing maximal values in a ring corresponding to the highest points on the RBC torus as well as in some scattered areas in the inner region of the RBC. CMF amplitudes of 35.9+/-8.9 nm and 4.7+/-0.5 nm (averaged over the cell surface) were determined for normal and ethanol-fixed RBCs, respectively.

The objective of this study was to evaluate the effect of growth implants on the carcass characteristics and tenderness of steers and heifers with different genetic potentials for growth, lean meat yield production, and marbling. Two experiments were conducted. Experiment 1 evaluated Angus steers sired by bulls with high EPD for retail product yield or marbling. Implant treatment was imposed randomly within sire groups. Loins (Institutional Meat Purchasing Specifications 180) were collected from each carcass and cut into three 2.54-cm steaks aged for 7, 14 and 21 d to evaluate tenderness. The second experiment evaluated steers and heifers of British and Continental breed descent. Steers and heifers were slaughtered after 120 d on feed. Loin sections were collected, and one 2.54-cm steak aged 7 d was used for tenderness analysis. When implants were used in Angus steers, HCW and LM area increased, whereas internal fat and marbling decreased (P < 0.01). In Angus steers, sire type did not affect shear force values of steaks; however, implant use significantly increased shear force values (P < 0.01). Carcasses from cattle of Continental breed descent were significantly heavier than carcasses of British breed descent with larger LM area, slightly less fat, and a reduced yield grade (P < 0.01). Also, steer carcasses were heavier than heifer carcasses with larger LM (P < 0.05), but no effect of sex on fat depth, internal fat, yield grade or marbling was observed. No significant interactions were seen between growth implant and breed or between growth implant and sex for shear force values. Shear force values were significantly less for steaks from steers and heifers of British decent compared with steers and heifers of Continental descent (P < 0.01). Steaks from implanted steers and heifers had significantly (P < 0.01) greater shear force values than steaks from steers and heifers not implanted. Use of growth implants in growing cattle resulted in significantly heavier carcass weights, larger LM area, and reduced internal fat. However, implant use also reduced the amount of marbling along with contributing to reduced tenderness. Complicating the tenderness issue is the increased shear force values reported for heifers as well as steers of Continental breed descent. Use of implants may contribute to tenderness variability because of different animal responses to implants.

As an archive of sequence data for over 165,000 species, GenBank is an indispensable resource for phylogenetic inference. Here we describe an informatics processing pipeline and online database, the PhyLoTA Browser (http://loco.biosci.arizona.edu/pb), which offers a view of GenBank tailored for molecular phylogenetics. The first release of the Browser is computed from 2.6 million sequences representing the taxonomically enriched subset of GenBank sequences for eukaryotes (excluding most genome survey sequences, ESTs, and other high-throughput data). In addition to summarizing sequence diversity and species diversity across nodes in the NCBI taxonomy, it reports 87,000 potentially phylogenetically informative clusters of homologous sequences, which can be viewed or downloaded, along with provisional alignments and coarse phylogenetic trees. At each node in the NCBI hierarchy, the user can display a "data availability matrix" of all available sequences for entries in a subtaxa-by-clusters matrix. This matrix provides a guidepost for subsequent assembly of multigene data sets or supertrees. The database allows for comparison of results from previous GenBank releases, highlighting recent additions of either sequences or taxa to GenBank and letting investigators track progress on data availability worldwide. Although the reported alignments and trees are extremely approximate, the database reports several statistics correlated with alignment quality to help users choose from alternative data sources.

Aims: To develop a molecular identification method based on ISSR fingerprints to monitor the fungal leaf pathogen Stagonospora convolvuli LA39 used to biologically control bindweeds after a field release., Methods and Results: The developed method proved to be suitable to clearly distinguish LA39 from resident Stagonospora spp. and was applied in two field experiments. First, the environmental persistence of LA39 was assessed in an overwintering experiment. LA39 could be re-isolated from infected bindweed 1 year after field application, but with very low frequency of occurrence. Secondly, LA39 was applied in an area with natural bindweed infestation and re-isolated from infected bindweed. The dispersal of LA39 during one season was poor (4-5 m)., Conclusions: ISSR fingerprinting has been shown to be a valuable tool to monitor the environmental fate of S. convolvuli in the field. It is concluded that an LA39-based mycoherbicide will have minimal environmental impact caused by the restricted mobility, poor proliferation and poor persistence over seasons of LA39., Significance and Impact of the Study: Studies about the dispersal and survival of biocontrol agents after field release as well as the development of methods needed for this purpose are indispensable for a comprehensive risk assessment for biocontrol agents.

Biological control as an alternative to chemical pesticides is of increasing public interest. However, to ensure safe use of biocontrol methods, strategies to assess the possible risks need to be developed. The production of toxic metabolites is an aspect which has so far largely been neglected in the risk assessment and the registration process for biocontrol products. We have evaluated the risks of elsinochrome A (ELA) and leptosphaerodione production by the fungus Stagonospora convolvuli LA39, an effective biocontrol agent used against bindweeds. The toxicity of the two metabolites to bacteria, protozoa, fungi and plants was evaluated in in vitro assays. The most sensitive bacteria and fungi were already affected at 0.01-0.07 microM ELA, whereas plants were far less sensitive. Leptosphaerodione was less toxic than ELA. Subsequently, it was investigated whether ELA is present in the applied biocontrol product or LA39-treated bindweed and crop plants. In plants ELA was never detected and in the biocontrol product the ELA concentration was far too low to have toxic effects even on the most sensitive organisms. We conclude that the production of ELA by biocontrol strain LA39 does not pose a risk to the environment or to the consumer.

The development of fungal biocontrol agents (BCAs) as alternatives to chemical pesticides is of increasing public interest. Tools to assess the toxicity of the secondary metabolites that these BCAs produce are often not available or existing methods have not yet been evaluated for these compounds. This study compares five different test systems, which include a representative bacterium, protozoan, arthropod and insect and human cell lines, as regards their sensitivity. It also compares the cost in time and resources for conducting the tests. Pure metabolites and crude extracts from two fungal BCAs as well as two chemical pesticides (hoestar and chlorpyrifos) and the mycotoxin patulin were employed as test compounds. All tests systems proved to be suitable for toxicity studies of metabolites from fungal BCAs and showed different grades of sensitivity to the different substances. The possibility of employing an array of test systems to determine ecotoxicological properties is discussed.

Coronaviruses are enveloped, positive-stranded RNA viruses considered to be promising vectors for vaccine development, as (i) genes can be deleted, resulting in attenuated viruses; (ii) their tropism can be modified by manipulation of their spike protein; and (iii) heterologous genes can be expressed by simply inserting them with appropriate coronaviral transcription signals into the genome. For any live vector, genetic stability is an essential requirement. However, little is known about the genetic stability of recombinant coronaviruses expressing foreign genes. In this study, the Renilla and the firefly luciferase genes were systematically analyzed for their stability after insertion at various genomic positions in the group 1 coronavirus feline infectious peritonitis virus and in the group 2 coronavirus mouse hepatitis virus. It appeared that the two genes exhibit intrinsic differences, the Renilla gene consistently being maintained more stably than the firefly gene. This difference was not caused by genome size restrictions, by different effects of the encoded proteins, or by different consequences of the synthesis of the additional subgenomic mRNAs. The loss of expression of the firefly luciferase was found to result from various, often large deletions of the gene, probably due to RNA recombination. The extent of this process appeared to depend strongly on the coronaviral genomic background, the luciferase gene being much more stable in the feline than in the mouse coronavirus genome. It also depended significantly on the particular genomic location at which the gene was inserted. The data indicate that foreign sequences are more stably maintained when replacing nonessential coronaviral genes.

Angus crossbred steers were assigned randomly to one of four finishing diets based on corn, Chinook, Logan, or H3 barley. Steers were harvested and after a 72-h chill, carcass quality and yield grade data were collected. Beef ribs were removed from 72 carcasses for further analysis. Ribs were aged in vacuum bag at 2°C for 14 days. After aging three adjacent steaks (3.18cm) were removed to determine color stability, tenderness, proximate analysis and pH. Diets fed to steers had no effect on quality and yield grade or tenderness of beef steaks. Steaks from steers fed Logan barley variety were significantly less red at 10 days of storage (Hunter a*=24.06) than steaks from steers fed the other barley varieties (Chinook a*=26.4; H3 a*=28.05) or corn (a*=26.14). Identification of barley varieties that affect color stability could result in designing diets specifically for improved color and increase the use of barley as a finishing grain.

This study evaluated the effect of barley varieties in the diets of finishing steers on carcass composition, fat, and lean color and the fatty acid profile of subcutaneous fat. Crossbred steers (391 kg initial BW) were assigned randomly to one of five finishing diets composed primarily of corn (n = 9), Morex barley (n = 9), Steptoe barley, (n = 9), or two experimental barley varieties SM3 (n = 9) and SM5 (n = 9). Grains were cracked prior to feeding. Diets were formulated (DM basis) to be isonitrogenous (2.24% N) and isocaloric (2.01 Mcal/kg NEm and 1.35 Mcal/kg NEg). Steers were slaughtered according to industry-accepted procedures when it was visually estimated that 70% of carcasses would grade USDA Choice. After a 24-h chill at 4 degrees C, carcass quality and yield grade data were collected by trained, experienced university personnel. Objective color (L*, a*, and b*) of both the LM and subcutaneous fat were measured, and samples of subcutaneous fat were removed from the 10th- to 12th-rib region for fatty acid analysis. Diet did not affect hot carcass weight (P = 0.15), fat thickness (P = 0.58), LM area (P = 0.57), percentage of internal fat (P = 0.52), yield grade (P = 0.96), marbling (P = 0.73), or quality grade (P = 0.10). However, the LM from steers fed diets formulated with Morex and SM5 barley varieties tended to be lighter (higher L* values, P = 0.08) than the LM from steers fed the corn-based diet. Additionally, fat from steers fed corn tended to be more yellow (higher Hunter b* values, P = 0.09) than fat from steers fed barley-based diets. Although grain source had only minimal effects on the fatty acid composition of subcutaneous fat samples, pentadecanoic acid (15:0) was greater (P < 0.05) in fat from steers fed SM3 and Steptoe barley varieties than in fat from steers fed corn. Stearic acid (18:0) concentrations were higher (P < 0.05) in fat samples from steers fed corn than in those fed the experimental barley lines (SM3 and SM5). Conversely, fat samples from steers fed Steptoe and SM5 barley had greater (P < 0.05) gadoleic acid (20:1) concentrations than fat from steers fed corn or Morex variety. Although the variety/line of barley included in the finishing diet may affect LM and fat color, grain-source (barley vs. corn) had little effect on beef carcass quality and yield grades and did not greatly alter the fatty acid composition of subcutaneous fat.

Background: Continuity of care has long been considered a benefit to patients of family physicians, but quantifying these benefits has been problematic. Previous studies focused on patient preferences and relationship issues, whereas evidence regarding clinical endpoints has been lacking. This study reports differences in obstetric and neonatal outcomes related to continuity in prenatal care., Methods: Using an historical prospective design, data were collected on 494 maternal-fetal dyads in two groups. One (named GAP, n = 40) received a high degree of continuity in their prenatal care, and one (named NHC, n = 454) received relatively little. Analyses were performed to determine not only the outcome differences between the groups, but also to what factor(s) these differences were attributable., Results: The continuity in prenatal care group had better outcomes in neonatal morbidity, birth weight, maternal weight gain, and both Apgar scores. None of these differences was directly attributable to continuity. Rather, continuity in prenatal care was associated with the observed increase in the number of prenatal visits, which in turn was shown to be a significant factor in the greater birth weights and maternal weight gain. None of the factors examined appears to explain the difference in neonatal morbidity., Conclusions: Women who receive prenatal care from a single physician are likely to receive more prenatal care, which is correlated with greater maternal weight gains and greater fetal birth weights.

A study was conducted on foothills rangeland to determine whether grazing patterns differed among cow breeds and to determine whether there was a relationship between individual grazing patterns and performance of beef cows. Hereford (HH), Tarentaise (TT), 3/4 Hereford x 1/4 Tarentaise (3H1T), 1/2 Hereford x 1/2 Tarentaise (HT), and 1/4 Hereford x 3/4 Tarentaise (1H3T) cows were observed during the summers of 1997 (n = 183) and 1998 (n = 159). Locations of individual cows were recorded two to three times per week during 1.5- to 2.5-h periods in the morning by observers on horseback. Statistical models included cow breed, age, and nursing status. Data from each year were analyzed separately. During 1997 and 1998, nonlactating cows were located at greater (P < 0.05) vertical distances from water than lactating cows. In 1998, nonlactating cows used steeper (P < 0.05) slopes than lactating cows. However, nonlactating cows did not travel as far horizontally from water (P < 0.05) as lactating cows in 1997. Younger cows (3 yr) traveled further (P < 0.05) from water both vertically and horizontally than older cows (5+ yr) in 1997, but not during 1998. Tarentaise and 1H3T cows were observed at greater (P < 0.05) vertical distances from water than HH cows during both years of the study. During 1998, TT and 1H3T cows used steeper (P < 0.05) slopes than HH cows. Using residual correlations, there were no consistent relationships between topographic aspects of individual grazing locations and cow weight, height, and body condition score. In 1997, cows with earlier calving dates and correspondingly heavier calf weaning weights used areas that had greater vertical distances to water; however, in 1998 there were no relationships (P > 0.05) of calving date and weaning weight with cow location. During both years, pregnant and nonpregnant cows used terrain similarly (P > 0.05), which suggests that cow reproductive performance was not related to terrain use. Grazing patterns in foothills rangeland varied among cow breeds. Performance of cows that used more rugged topography was similar to cows using gentler terrain.

Four ruminally and abomasally cannulated steers were used to evaluate the effects of barely variety on rate, site, and extent of digestion of high-concentrate diets. The treatments compared were 1) corn, 2) Gunhilde barley (GUN), Harrington barley (HAR), and 4) Medallion barley (MED). Diets were balanced to be isocaloric and isonitrogenous. Ruminal OM digestion was greater (P = .04) in steers fed corn than in those fed GUN, HAR, and MED (61.9 vs average 53.7%). No differences (P > .10) were seen in ruminal starch digestion (average 92.8%) or in starch flow to the abomasum (average 199 g/d) between diets. Total tract digestion of starch was greater (P = .09) in steers fed barley than in those fed corn (average 98.6 vs 95.7%). Total and nonammonia N presented to the abomasum were greater (P < .05) for steers fed HAR and GUN than for those fed MED and corn. Microbial N flow was lowest (P = .01) in corn-fed steers, highest in steers fed GUN and HAR, and intermediate in steers fed MED. Microbial efficiency was 59% greater (P = .03) in steers fed barley than in steers consuming corn. Ruminal acetate: propionate was lower (P = .002) in steers fed corn and HAR than in those fed GUN and MED. Compared to GUN, HAR, and MED barleys, corn had a lower (P < .03) rate (-.11 vs average -.47) and extent (15 h; 70.3 vs average 98.1%) of in situ starch disappearance. Differences in digestive characteristics found between barley varieties may contribute to differences in animal performance.

Eighty Angus x Hereford steers (average initial weight 287 kg) were used in a 168-d finishing study to evaluate the effects of barley variety on feedlot performance, diet digestion, and carcass characteristics. The four treatments compared in this completely randomized design (four pens/ treatment) were high-concentrate diets based on 1) corn, 2) Gunhilde barley (GUN), 3) Harrington barley (HAR), or 4) Medallion barley (MED). Steers consuming corn gained 10% faster (P < .01) than steers fed HAR, and HAR resulted in 8% faster (P < .01) gains than GUN or MED. Dry matter intake was greater (P < .01) for steers fed corn than for steers fed GUN, HAR, or MED, and HAR-fed steers consumed more than MED-fed steers. Efficiency (kilograms of gain/100 kg of feed) was higher (P < .05) for steers fed GUN, HAR, and MED than for corn-fed steers. Estimated NEm and NEg of barley varieties ranged from 2.32 to 2.51 Mcal of NEm/kg and 1.61 and 1.77 Mcal of NEg/kg. Carcass weight was greater (P < .01) for steers fed corn rather than HAR and greater (P < .01) for HAR-fed steers than for those fed GUN or MED. Quality grade was higher (P < .05) for HAR-fed steers than for steers fed corn, GUN, or MED. Steers fed corn had the highest (P < .01) digestible starch intake, followed by steers fed HAR, GUN, and, finally, MED, the same approximate ranking as for ADG. A diet based on Harrington barley resulted in greater DMI, ADG, and carcass quality grade compared with diets based on Gunhilde or Medallion barleys.

Quality Management [QM] processes are helping independent operators & contractors find more creative ways of doing business & enhance the quality of their products. In this roundtable, a panel of 10 QM veterans & rookies discusses specific applications of their processes, ranging from building better communications with customers to getting more for their purchasing dollars. Read ahead to learn how to make QM work for you.

We live in a time of specialized medical care. Now, patients can find myriad healthcare centers that offer state-of-the-art treatment for their particular ailments & disabilities. As therapy regimens have become more sophisticated, so has the role food & nutrition programs play in patient care. Featured on the following pages are five programs that are tailored to patients living with chemical dependencies, eating disorders, cardiovascular disease, cancer & mental illness. In each, directors & dietitians are working actively with other healthcare professionals to provide the kind of nutritional support patients need to regain their health or, in some cases, even to survive.