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The use of frequency-based criteria to detect harmful substance use in adolescents is rare despite its potential to identify young people at risk. We compared high school students who use high amounts of substances to students with lower levels (or nil) of use across health and well-being indicators to explore the feasibility of this kind of categorization. Based on survey questions from Youth'12, a cross-sectional adolescent health survey involving 3% (8,500) of New Zealand high school students, we selected criteria indicative of substance use that would warrant specialist alcohol and other drugs (AOD) treatment. Two sets of "high-use" criteria (e.g., drinking "alcohol most days a week or more") for both older and younger adolescents were selected. Eleven percent of students met criteria for "high use," with higher rates in males and older students. Rates of high use were similar across high-, medium- and low-deprivation neighborhoods. Binge alcohol use (9.2%) was the predominant form of "high use." Students with "high use" reported poorer health outcomes across numerous areas including mental health, physical health, risk behaviors, and access to health care. Only 5% of "high-use" students had accessed an AOD service. The wide range of negative health outcomes associated with a high level of substance use suggests that brief screening focusing on the level of substance use may help in identifying young people at risk. Simple and brief processes may improve the uptake and implementation of screening in primary care and other settings, and further research in this area is recommended.

mHealth interventions promise the economic delivery of evidence-based mental health treatments like cognitive behavioural therapy (CBT) to populations that struggle to access health services, such as adolescents and in New Zealand, Māori and Pasifika youth. Unfortunately engagement with digital therapies is poor; modularisation and gamification have potential to increase their appeal. Gamifying CBT involves selecting suitable interventions, adapting them to a digital format while applying gamification principles. We describe the design and development of Quest - Te Whitianga, an app that encourages the user to learn CBT skills via a series of activities and games. A variety of approaches including consultation with clinicians, reference to best-practice literature, focus groups and interactive workshops with youth were used to inform the co-design process. Clinicians worked iteratively with experienced game designers to co-create a youth CBT digital intervention. The Quest modular app is set on an ocean and the user travels between islands to learn six evidence-based skills. These include a relaxation/mindfulness activity, activity planning, a gratitude journal plus problem solving and communication skills training. We describe the theoretical and design aspects of each module detailing the gamified features that aim to increase user engagement. In the near future we will be testing the app and the principles discussed in this paper via a randomised-controlled trial. Keywords: Digital cognitive behavioural therapy, Gamification, Smartphone treatment, Adolescent, Mental health

Enterohaemorrhagic Escherichia coli (EHEC) serotype O157:H7 is carried asymptomatically by cattle gastrointestinal tract and the inclusion of distillers grains solids (DGS) in feed is thought to be a factor in the prevalence and persistence of EHEC O157 in a herd. The present study surveys the faecal prevalence of E. coli O157 in cattle processed at an abattoir in the Upper Midwest and its association with environmental factors and feeding practices. Faecal samples were collected from pre-processing cows during a 1-year period. E. coli O157 prevalence was estimated isolation of putative positives and confirmation of isolates by immunoassay and multiplex virulence genes PCR analysis. Overall, E. coli O157 was confirmed in 11.2% of samples. Prevalence during winter was the highest at 14% followed by summer (11.6%) and declined to less than 8% the rest of the year. Winter was the only season that had a statistically significant effect on prevalence. As a category unto itself, DGS feeding before arrival had no significant influence on faecal prevalence. However, we found a significant interaction of DGS feeding and summer. This observation is extremely relevant because it corroborates a previous study and suggests possible feeding practices to abate EHEC O157 presence during harvest.

Ajay R Bharti,1 Steven Paul Woods,2 Ronald J Ellis,3 Mariana Cherner,2 Debra Rosario,3 Michael Potter,3 Robert K Heaton,2 Ian P Everall,4 Eliezer Masliah,5 Igor Grant,2 Scott L Letendre1 On behalf of the Translational Methamphetamine AIDS Research Center Group 1Department of Medicine, 2Department of Psychiatry, 3Department of Neurosciences, University of California San Diego, San Diego, CA, USA; 4Department of Psychiatry, University of Melbourne, Victoria, Australia; 5Department of Pathology, University of Californa San Diego, San Diego, CA, USA Background: Human immunodeficiency virus (HIV) and methamphetamine use commonly affect neurocognitive (NC) functioning. We evaluated the relationships between NC functioning and two fibroblast growth factors (FGFs) in volunteers who differed in HIV serostatus and methamphetamine dependence (MAD). Methods: A total of 100 volunteers were categorized into four groups based on HIV serostatus and MAD in the prior year. FGF-1 and FGF-2 were measured in cerebrospinal fluid by enzyme-linked immunosorbent assays along with two reference biomarkers (monocyte chemotactic protein [MCP]-1 and neopterin). Comprehensive NC testing was summarized by global and domain impairment ratings. Results: Sixty-three volunteers were HIV+ and 59 had a history of MAD. FGF-1, FGF-2, and both reference biomarkers differed by HIV and MAD status. For example, FGF-1 levels were lower in subjects who had either HIV or MAD than in HIV– and MAD– controls (P=0.003). Multivariable regression identified that global NC impairment was associated with an interaction between FGF-1 and FGF-2 (model R2=0.09, P=0.01): higher FGF-2 levels were only associated with neurocognitive impairment among subjects who had lower FGF-1 levels. Including other covariates in the model (including antidepressant use) strengthened the model (model R2=0.18, P=0.004) but did not weaken the association with FGF-1 and FGF-2. Lower FGF-1 levels were associated with impairment in five of seven cognitive domains, more than FGF-2, MCP-1, or neopterin. Conclusion: These findings provide in vivo support that HIV and MAD alter expression of FGFs, which may contribute to the NC abnormalities associated with these conditions. These cross-sectional findings cannot establish causality and the therapeutic benefits of recombinant FGF-1 need to be investigated. Keywords: biomarker, cerebrospinal fluid, fibroblast growth factor, HIV, methamphetamine, HIV-associated neurocognitive disorders, HAND, neurocognitive impairment

Background and Aims. Obesity is a risk factor for colorectal neoplasia. We examined the influence of obesity and metabolic syndrome (MetS) on prevalence of neoplasia at screening colonoscopy. Methods. We evaluated 2020 subjects undergoing first screening colonoscopy. Body mass index (BMI) was calculated at enrolment. Hyperlipidemia (HL), hypertension (HT), and diabetes mellitus (DM) were identified. Details of colonoscopy, polypectomy, and histology were recorded. Odds for adenomas (A) and advanced adenomas (ADV) in overweight (BMI 25.1–30) and obese (BMI > 30) subjects were assessed by multinomial regression, adjusted for covariates. Analyses included relationships between HL, HT, DM, age, tobacco usage, and neoplasia. Discriminatory power of HT, HL, DM, and BMI for neoplasia was assessed by binary logistic regression. Odds were calculated for neoplasia in each colonic segment related to BMI. Results. A and ADV were commoner in overweight and obese males, obese females, older subjects, and smokers. HL, HT, and DM were associated with increased odds for neoplasia, significantly for A with hypertension. BMI alone predicted neoplasia as well as HT, HL, DM, or combinations thereof. All segments of the colon were affected. Multiple polyps were particularly prevalent in the obese. Conclusions. Obesity and MetS are risk factors for colonic neoplasia in a Canadian population.

Abstract Since 1994, Irish cattle have been exposed to greater risks of acquiring Mycobacterium avium subspecies paratuberculosis (MAP) infection as a consequence of the importation of over 70,000 animals from continental Europe. In recent years, there has been an increase in the number of reported clinical cases of paratuberculosis in Ireland. This study examines the prevalence of factors that promote the introduction and within-herd transmission of Mycobacterium avium subspecies paratuberculosis (MAP) on selected Irish dairy farms in the Cork region, and the association between these factors and the results of MAP screening tests on milk sock filter residue (MFR). A total of 59 dairy farms, selected using non-random methods but apparently free of endemic paratuberculosis, were enrolled into the study. A questionnaire was used to collect data about risk factors for MAP introduction and transmission. The MFR was assessed on six occasions over 24 months for the presence of MAP, using culture and immunomagnetic separation prior to polymerase chain reaction (IMS-PCR). Furthermore, blood samples from all entire male and female animals over one year of age in 20 herds were tested by ELISA. Eighteen (31%) farms had operated as closed herds since 1994, 28 (47%) had purchased from multiple sources and 14 (24%) had either direct or indirect (progeny) contact with imported animals. Milk and colostrum were mixed on 51% of farms, while 88% of farms fed pooled milk. Thirty (51%) herds tested negative to MFR culture and IMS-PCR, 12 (20%) were MFR culture positive, 26 (44%) were IMS-PCR positive and seven (12%) were both culture and IMS-PCR positive. The probability of a positive MFR culture was significantly associated with reduced attendance at calving, and with increased use of individual calf pens and increased (but not significantly) if mulitiple suckling was practised. There was poor agreement between MFR culture and MFR IMS-PCR results, but moderate agreement between MFR culture and ELISA test results. This study highlights a lack of awareness among Irish dairy farmers about the effect of inadequate biosecurity on MAP introduction. Furthermore, within-herd transmission will be facilitated by traditional calf rearing and waste management practices. The findings of viable MAP in the presence of known transmission factors in non-clinically affected herds could be a prelude to long-term problems for the Irish cattle and agri-business generally.

An experiment was conducted to evaluate the impact of feeding bio-fuel co-products on ruminal fermentation characteristics and composition of omasal digesta flow. Four ruminally cannulated Holstein steers (371 ± 5 kg) were used in a 4 × 4 Latin Square design. Omasal sample collection and triple marker technique was used to quantify fatty acid omasal flow. Treatments were applied as a 2 × 2 factorial where a steam flaked corn (SFC) basal diet (DGS-N CG-N) was replaced with 40% of diet DM as corn distillers grains (DGS; DGS-Y CG-N) or 10% of diet DM as crude glycerin (DGS-N CG-Y) or 40% of diet DM distillers grains and 10% of diet DM as crude glycerin (DGS-Y CG-Y). No effects were observed for the interaction of DGS and glycerin on measured rumen characteristics. Dietary inclusion of glycerin decreased (P = 0.05) ruminal content 4-h post feeding on a DM basis but did not influence DMI (P = 0.64). Feeding DGS had no effect (P = 0.34) on particulate passage to the omasum (kg/d) in spite of greater (P = 0.04) DMI. Feeding DGS reduced flow rate (% of rumen volume/h) (P = 0.05) but did not affect total VFA concentration (P = 0.46) or average ruminal pH (P = 0.72). No differences (P > 0.05) were observed in ruminal parameters when feeding glycerin, besides ruminal particulate content (kg) on DM basis (P = 0.05). An interaction of DGS and glycerin affected intake of stearic (P < 0.01), linoleic (P < 0.01), and linolenic acid (P < 0.01). An interaction of DGS and glycerin did not affect individual fatty acid flow with respect to intake for stearic (P = 0.17), linoleic (P = 0.18), or linolenic acid (P = 0.66). Dietary inclusion of glycerin had no impact on g of linolenic (P = 0.16) or linoleic (P = 0.32) acid transformed. A trend was identified for cattle fed diets with glycerin to have increased (P = 0.07) grams of conjugated linoleic acid (CLA; C18:2 cis -9, trans -11) per gram of linoleic acid intake, with no impact on the percent of saturated fat (P = 0.44) or unsaturated fat (P = 0.43) in omasal flow. For cattle fed diets with DGS, fewer grams of linoleic (P < 0.01) and linolenic (P < 0.01) were present in digesta flow per gram of intake. Inclusion of DGS in the treatment diets also increased (P < 0.01) stearic acid flow (g) and CLA flow (g) per gram of stearic and linoleic acid intake, respectively. Observed differences in CLA proportion post fermentation may indicate interrupted biohydrogenation when glycerin is fed. [ABSTRACT FROM AUTHOR]

An experiment was conducted to determine the effect of substituting modified corn distillers grains with solubles (DGS) or crude soy glycerin (CG) for steam–flaked corn (SFC) in finishing diets on growth performance and carcass characteristics. Treatments were arranged as a 2 × 2 factorial with DGS (0% or 40%) and CG (0% or 10%) replacing dietary SFC in a basal diet. Growth performance and carcass traits were measured on 48 individually fed crossbred yearling cattle (21 steers and 27 heifers; 380 ± 37 kg). Cattle were randomly allotted to 48 Calan gate bunks. After the first 28 days, nine animals were removed from the study for health reasons or observed confirmation of consumption of feed from unassigned Calan gate bunk (n = 39). After the feeding period, cattle were harvested in two groups on day-124 and day-173. No DGS × CG interactions were observed (P > 0.10) for any dependent growth performance or carcass characteristic variable tested. Cattle-fed DGS as 40% of diet dry matter (DM) had greater (P < 0.01) dry matter intake (DMI), while CG inclusion at 10% of diet DM did not affect DMI (P = 0.16). Carcass–adjusted average daily gain (ADG) was not affected by DGS (P = 0.73) or CG (P = 0.28). Decreased (P = 0.03) carcass–adjusted gain-to-feed (G:F) was observed as the main effect of DGS. Greater DMI resulting from feeding DGS as 40% of diet DM appears to have driven the tendency for reduced G:F. Hot carcass weight, longissimus muscle area, 12th rib fat depth, yield grade, and marbling score were not (P > 0.10) influenced by DGS or CG. However, kidney, pelvic, fat (KPH) was increased (P = 0.01) when cattle were fed DGS as 40% of diet DM. Based on the findings presented, it is concluded that CG can substitute up to 10% of SFC in the diet without negatively affecting cattle growth performance or carcass characteristics, regardless of DGS inclusion as 40% of the diet DM. [ABSTRACT FROM AUTHOR]

Three cases of coexisting ulcerative colitis and Crohn’s disease are presented. In the first case, the patient had a long-standing history of ulcerative proctitis before developing Crohn’s colitis. In the two remaining cases, the patients presented initially with Crohn’s disease of the ileum and, subsequent to resection, developed ulcerative colitis. Well-documented cases of patients diagnosed with both ulcerative colitis and Crohn’s disease are rare. The literature on such cases is reviewed, and the controversy over whether ulcerative colitis and Crohn’s disease are two distinct diseases is explored.