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Background: Metoidioplasty and phalloplasty gender-affirming surgery (MaPGAS) is increasingly performed and requires patients to make complex decisions that may lead to decisional uncertainty. This study aimed to evaluate decisional conflict in individuals considering MaPGAS., Methods: We administered a cross-sectional survey to adult participants assigned female sex at birth and considering MaPGAS, recruited via social media platforms and community health centers. We collected data on demographics, medical and surgical history, MaPGAS type considered, and the Decisional Conflict Scale (DCS). DCS scores range from 0 to 100 (>37.5 indicates greater decisional conflict). Demographic characteristics and DCS scores were compared between subgroups, using descriptive and chi-square statistics. Participants commented on MaPGAS uncertainty, and their comments were evaluated and thematically analyzed., Results: Responses from 264 participants were analyzed: mean age 29 years; 64% (n = 168) trans men, 80% (n = 210) White, 78% (n = 206) nonrural, 45% (n = 120) privately insured, 56% (n = 148) had 4 or more years of college, 23% (n = 84) considering metoidioplasty, 24% (n = 87) considering phalloplasty, and 26% (n = 93) considering metoidioplasty and phalloplasty. DCS total scores were significantly higher (39.8; P < 0.001) among those considering both MaPGAS options, as were mean ratings on the Uncertainty subscale [64.1 (SD 25.5; P < 0.001)]. Concerns surrounding complications were the top factor contributing to uncertainty and decisional conflict., Conclusions: In a cross-sectional national sample of individuals seeking MaPGAS, decisional uncertainty was the highest for those considering both MaPGAS options compared with metoidioplasty or phalloplasty alone. This suggests this cohort would benefit from focused decision support., Competing Interests: Note: Scores range from 0 to 100; a higher score indicates a more negative outcome (greater decisional conflict, feeling more uncertain and less informed). Typically, a score <25 indicates no conflict and >37.5 associated with decisional conflict/delayed decisions.The authors have no financial interest to declare in relation to the content of this article. This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (R21DK124733-02S1)., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Objective: To identify the factors that influence the mortality review process at health systems, including how mortality review is conducted, cases are adjudicated, and results are used., Methods: We conducted a qualitative analysis of the mortality review processes of 6 US health systems from February 1, 2021 to June 31, 2021. The data sources included individual and small-group semi-structured interviews with mortality review team members and a content analysis of site artifacts (eg, guiding principles, chart abstraction forms, review workflows, and clinical pathways developed from past mortality reviews). We analyzed each site's mortality review process, goals and incentives for mortality review, historical and evolving aspects of mortality review, personnel involved, and post-review use of findings., Results: Across the 6 systems, we interviewed a total of 24 mortality review experts and analyzed 26 site documents. We identified 3 thematic factors that influence mortality review processes: organizational intent, organizational structures for mortality review, and the mental models of individuals involved in the review process. Two subthemes emerged within organizational intent: (1) identifying preventable deaths to lower (clinical or financial) risk and (2) using death cases to guide system improvement. Sites varied in governance and decision rights concerning mortality review and adjudication, with 2 subthemes within organizational structures: (1) centralized-hierarchical and (2) decentralized or multidisciplinary. The analysis of mental models of participating reviewers revealed 2 themes: (1) confirmation of preventability and (2) identification of patterns or "signals.", Conclusion: Understanding the factors that influence mortality review allows health systems to better leverage mortality review for institutional improvement and to develop training that builds shared mental models to enhance the review process., Competing Interests: The authors have no conflict of interest to disclose., (© 2023 The Authors.)

Background: Gender-affirming surgical procedures, such as metoidioplasty and phalloplasty for those assigned female at birth, are complex and multistaged and involve risks. Individuals considering these procedures experience greater uncertainty or decisional conflict, compounded by difficulty finding trustworthy information., Aim: (1) To explore the factors contributing to decisional uncertainty and the needs of individuals considering metoidioplasty and phalloplasty gender-affirming surgery (MaPGAS) and (2) to inform development of a patient-centered decision aid., Methods: This cross-sectional study was based on mixed methods. Adult transgender men and nonbinary individuals assigned female at birth at various stages of MaPGAS decision making were recruited from 2 study sites in the United States to participate in semistructured interviews and an online gender health survey, which included measures of gender congruence, decisional conflict, urinary health, and quality of life. Trained qualitative researchers conducted all interviews with questions to explore constructs from the Ottawa decision support framework., Outcomes: Outcomes included goals and priorities for MaPGAS, expectations, knowledge, and decisional needs, as well as variations in decisional conflict by surgical preference, surgical status, and sociodemographic variables., Results: We interviewed 26 participants and collected survey data from 39 (24 interviewees, 92%) at various stages of MaPGAS decision making. In surveys and interviews, affirmation of gender identity, standing to urinate, sensation, and the ability to "pass" as male emerged as highly important factors for deciding to undergo MaPGAS. A third of survey respondents reported decisional conflict. Triangulation of data from all sources revealed that conflict emerged most when trying to balance the strong desire to resolve gender dysphoria through surgical transition against the risks and unknowns in urinary and sexual function, appearance, and preservation of sensation post-MaPGAS. Insurance coverage, age, access to surgeons, and health concerns further influenced surgery preferences and timing., Clinical Implications: The findings add to the understanding of decisional needs and priorities of those considering MaPGAS while revealing new complexities among knowledge, personal factors, and decisional uncertainty., Strengths and Limitations: This mixed methods study was codeveloped by members of the transgender and nonbinary community and yielded important guidance for providers and individuals considering MaPGAS. The results provide rich qualitative insights for MaPGAS decision making in US contexts. Limitations include low diversity and sample size; both are being addressed in work underway., Conclusions: This study increases understanding of the factors important to MaPGAS decision making, and results are being used to guide development of a patient-centered surgical decision aid and informed survey revision for national distribution., (© The Author(s) 2023. Published by Oxford University Press on behalf of The International Society of Sexual Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Early access to specialty palliative care is associated with better quality of life, less intensive end-of-life treatment and improved outcomes for patients with advanced cancer. However, significant variation exists in implementation and integration of palliative care. This study compares the organizational, sociocultural, and clinical factors that support or hinder palliative care integration across three U.S. cancer centers using an in-depth mixed methods case study design and proposes a middle range theory to further characterize specialty palliative care integration., Methods: Mixed methods data collection included document review, semi-structured interviews, direct clinical observation, and context data related to site characteristics and patient demographics. A mixed inductive and deductive approach and triangulation was used to analyze and compare sites' palliative care delivery models, organizational structures, social norms, and clinician beliefs and practices., Results: Sites included an urban center in the Midwest and two in the Southeast. Data included 62 clinician and 27 leader interviews, observations of 410 inpatient and outpatient encounters and seven non-encounter-based meetings, and multiple documents. Two sites had high levels of "favorable" organizational influences for specialty palliative care integration, including screening, policies, and other structures facilitating integration of specialty palliative care into advanced cancer care. The third site lacked formal organizational policies and structures for specialty palliative care, had a small specialty palliative care team, espoused an organizational identity linked to treatment innovation, and demonstrated strong social norms for oncologist primacy in decision making. This combination led to low levels of specialty palliative care integration and greater reliance on individual clinicians to initiate palliative care., Conclusion: Integration of specialty palliative care services in advanced cancer care was associated with a complex interaction of organization-level factors, social norms, and individual clinician orientation. The resulting middle range theory suggests that formal structures and policies for specialty palliative care combined with supportive social norms are associated with greater palliative care integration in advanced cancer care, and less influence of individual clinician preferences or tendencies to continue treatment. These results suggest multi-faceted efforts at different levels, including social norms, may be needed to improve specialty palliative care integration for advanced cancer patients., (© 2023. The Author(s).)

Objective: This study aimed to identify differences in patient empowerment based on biopsychosocial patient-reported measures, the magnitude of those differences, and which measures best explain differences in patient empowerment., Methods: This was a cross-sectional observational study of 6918 adults with arthritis in the US. Data were collected from March 2019 to March 2020 through the Arthritis Foundation Live Yes! INSIGHTS program. Patient empowerment, measured by the Health Care Empowerment Questionnaire, included 2 scales: Patient Information Seeking and Healthcare Interaction Results. Patient-reported outcomes were measured using the Patient Reported Outcomes Measurement Information System (PROMIS)-29 and PROMIS emotional support scale. ANOVA assessed differences between groups, and Spearman rank correlation assessed correlations between variables. Hierarchical regression analysis determined the contributions of sociodemographic characteristics, arthritis type, and patient-reported health measures in explaining patient empowerment (α = 0.05)., Results: Empowerment was lower among those who were male, older, less educated, or who had lower income, osteoarthritis, less emotional support, or better physical function, although the effect was small-to-negligible for most of these variables in the final regression models. Empowerment did not differ by race/ethnicity in unadjusted or adjusted analysis. In final regression models, emotional support contributed the most to explaining patient empowerment., Conclusion: Emotional support is important for patient empowerment. This suggests that programs that seek to improve patient empowerment should target and measure effects on emotional support., (Copyright © 2022 by the Journal of Rheumatology.)

Introduction: The use of illicit substances, including opioids, is a serious public health issue in the United States. While there are reports of the impact of the ongoing opioid crisis on adults, a new focus has emerged on how parental substance misuse (PSM) affects children. This study explored existing screening and assessment practices and services for children and families affected by PSM across different service sectors in one state. The purpose of the study was to identify opportunities for training, policy development, and practice improvement related to identifying PSM and linking children and parents to services., Methods: Interviews (n = 15) with professionals from five service sectors (mental health, primary care, schools, community programs, and law enforcement) were used to inform development of a state-wide survey of the same groups (n = 498) to assess current practices, attitudes, knowledge, and training needs related to child screening of PSM. The survey was piloted using cognitive interviewing (n = 9) before it was distributed., Results: Fewer than 20% of survey respondents reported using standardized tools specific to screening PSM. Informal assessment practices predominate, though 60% of respondents saw value in adopting more standardized PSM screening. Attitudes about PSM and screening varied among sectors but interest in training was high., Discussion: Results indicate a need for more systematic PSM screening, cross-sector training and practice discussions, and policies to support early identification of children affected by PSM. Ramifications of these findings and recommendations are discussed., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Patient empowerment can improve health-related outcomes and is important in chronic conditions, such as arthritis. This study aimed to validate the Health Care Empowerment Questionnaire (HCEQ), a patient-reported experience measure of empowerment, for use with patients with arthritis and other rheumatic diseases., Methods: The HCEQ measures Patient Information Seeking (or Involvement in Decisions) and Healthcare Interaction Results (or Involvement in Interactions) and asks respondents to answer questions in two ways: whether they feel something happened and its importance to them. Face validity was assessed through qualitative data (n = 8, nominal group technique; n = 55, focus groups). Measure structure was assessed through confirmatory factor analysis (CFA); internal consistency was also assessed (n = 9226). Test-retest reliability was assessed with sub-sample of participants (n = 182)., Results: We found adequate face validity of the HCEQ for patients with arthritis. The CFA indicated good fit to the data for the two-factor structure of the HCEQ (RMSEA = 0.075; CFI = 0.987; TLI = 0.978; SRMR = 0.026). Internal consistency was strong (α=0.94 for both subscales). Test-retest reliability was moderate for Patient Information Seeking (ICC=0.67) and good for Healthcare Interaction Results (ICC=0.77)., Conclusions: The HCEQ, with modifications, demonstrated promising psychometric properties within this sample, laying the foundation for further assessment. This work supports the HCEQ as an appropriate instrument for examining experiences with and perceived importance of empowerment in individuals with arthritis and other rheumatic conditions., Patient Contribution: Patients contributed to the assessment of face validity. As a measure of patient empowerment, the HCEQ's use can enable further participation of patients in health care., (© 2021 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Objective: Patient-reported outcome measures (PROMs) are increasingly used in clinical settings but may not provide benefits to patients outside of health encounters. The Arthritis Foundation's Live Yes! Network provides an opportunity for PROM use by individuals and the network that assists individuals with managing their arthritis between encounters. Our objective was to develop a patient-reported outcomes platform for the network, Live Yes! INSIGHTS, using mixed methods and extensive stakeholder input., Methods: A mixed methods longitudinal transformation design was used, starting with semistructured interviews to specify the main priorities of the program, literature review to identify potential PROMs, modified Delphi and nominal group technique to select final PROMs, and focus groups to guide program implementation, messaging, and use of results. We gathered input from 93 participants, including from individuals living with arthritis (74% of participants), caregivers, providers, researchers, and measurement experts., Results: Our mixed methods study resulted in the selection of Patient-Reported Outcomes Measurement Information System (PROMIS)-29, PROMIS Emotional Support Short Form v2.0, and the Health Care Empowerment Questionnaire, to be deployed through a Qualtrics platform. Triangulation of data resulted in identification of potential risks and benefits, including confidentiality, ability to personally track and share data, and an opportunity to contribute to research., Conclusion: An accessible measurement system backed by psychometrically strong PROMs, created with robust stakeholder engagement, and linked to a national patient network sets the stage for individuals with arthritis to better monitor and improve health outcomes both outside and inside health care settings and for the network to customize programming to meet needs., (© 2020 The Authors. ACR Open Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

With the recent proliferation of quality improvement (QI) and patient safety (PS) education programs, guidance is needed on how to assess the effectiveness of these programs. Without a systematic approach, evaluation efforts may end up being disjointed, lead to excess participant burden, or yield unhelpful feedback because of poor fit with program priorities. This article presents a framework for developing a multilevel evaluation infrastructure using examples from the evaluation of the national Department of Veterans Affairs Chief Resident in Quality and Safety program, a 1-year, post-accreditation program to develop leadership and teaching skills in QI and PS. It illustrates how to apply the framework to establish evaluation priorities and methods, and shares sample results and how they are used to guide program improvements and track important outcomes at multiple levels. The framework is particularly relevant to other nonaccredited advanced QI/PS programs, yet offers useful considerations for evaluating any advanced medical education program.

Trauma-informed care (TIC) initiatives in state child welfare agencies are receiving more attention, but little empirical evidence exists as to their efficacy. The purpose of this study was to assess changes in self-reported practices and perceptions of child welfare staff involved in a multifaceted, statewide TIC intervention. Ten child welfare offices were matched and randomized to an early or delayed cohort. Staff were surveyed at Time 1 prior to any intervention, Time 2 postintervention for Cohort 1, and Time 3 postintervention for Cohort 2. The survey covered six domains: trauma screening, case planning, mental health and family involvement, progress monitoring, collaboration, and perceptions of the state's overall system performance. Linear mixed modeling assessed the effect of the intervention. Cohort by time interaction was significant for three intervention targets. We demonstrate, using a rigorous study design, the mixed results of a multimodal intervention to improve trauma-informed attitudes, practices, and system performance. TIC initiatives must account for complex, dynamic contextual factors.

Objective: Caring for children in foster or adoptive care with behavioral health needs can severely stress parents, contributing to adverse outcomes for children and families. Trauma-informed services from the child welfare and mental health sectors may help prevent poor outcomes by helping children and parents identify and understand trauma and its impact on children's behavioral health and receive effective treatment. To help understand the role of trauma-informed services for the child welfare population, we examined whether trauma-informed child welfare and mental health services moderated the relationship between children's behavioral health needs and parent satisfaction and commitment., Method: The researchers analyzed data from a cross-sectional statewide survey of foster and adoptive parents (n = 512 respondents, 42% of 1,206 contacted) from one state., Results: Foster (but not adoptive) parent ratings of trauma-informed mental health services significantly moderated the relationship between children's behavioral health needs and foster and adoptive parent satisfaction and commitment. As ratings of trauma-informed mental health services increased, the association between child behavioral health needs and parent satisfaction and commitment became nonsignificant, suggesting a buffering effect. Trauma-informed child welfare services did not moderate the relationship for foster or adoptive parents., Conclusions: Leaders and policymakers are urged to promote trauma-informed mental health services for children involved with child welfare to potentially buffer foster parents against lower parenting satisfaction and commitment. More research is needed to replicate and expand on these findings and to examine the effectiveness of trauma-informed services on other relevant child and family outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Caring for children with complex needs severely stresses foster and adoptive parents, but few studies have examined their perspectives on needs and services. To examine parental views, the authors analyzed four focus groups (n = 27 participants) and one state-wide survey (n = 512 respondents, 42% of 1206 contacted) of foster and adoptive parents in one state. Results highlighted inadequate communication between providers and families, cultural and legal barriers, needs for parent training and preparation, the importance of several types of parent supports, and needs for specialized mental health treatment for the children. Surveyed parents identified children's behavior problems as their top challenge, and over half rated the availability of mental health providers who treat attachment and family as insufficient. The findings suggest specific areas in which state leaders could enhance training and supports for child welfare staff and foster and adoptive parents and improve mental health services for children in foster and adoptive care.

Unlabelled: Action Learning Collaboratives (ALCs), whereby teams apply quality improvement (QI) tools and methods, have successfully improved patient care delivery and outcomes. We adapted and tested the ALC model as a community-based obesity prevention intervention focused on physical activity and healthy eating., Method: The intervention used QI tools (e.g., progress monitoring) and team-based activities and was implemented in three communities through nine monthly meetings. To assess process and outcomes, we used a longitudinal repeated-measures and mixed-methods triangulation approach with a quasi-experimental design including objective measures at three time points., Results: Most of the 97 participants were female (85.4%), White (93.8%), and non-Hispanic/Latino (95.9%). Average age was 52 years; 28.0% had annual household income of $20,000 or less; and mean body mass index was 35. Through mixed-effects models, we found some physical activity outcomes improved. Other outcomes did not significantly change. Although participants favorably viewed the QI tools, components of the QI process such as sharing goals and data on progress in teams and during meetings were limited. Participants' requests for more education or activities around physical activity and healthy eating, rather than progress monitoring and data sharing required for QI activities, challenged ALC model implementation., Conclusions: An ALC model for community-based obesity prevention may be more effective when applied to preexisting teams in community-based organizations., (© 2015 Society for Public Health Education.)

Early luteal regression in cattle has an embryotoxic effect that is not overcome by replacement with progesterone, but is prevented by removal of the regressing CL. Two experiments were designed to test the null hypothesis that the luteal component of the embryotoxic effect is delivered by a systemic pathway. Beef heifers and cows (n = 39) received two good quality embryos, one placed into each uterine horn on Day 6 or 7 of the estrous cycle. Treated animals (n = 20) received 15 mg of PGF2alpha three times per day from Day 7 (n = 11; Experiment 1) or 5 (n = 9; Experiment 2) through 8; controls (n = 19) received saline. Progestogen replacement therapy (12 mg flurogestone acetate daily, s.c.) was provided from Day 6 (Experiment 1) or 4 (Experiment 2) until ultrasonographic diagnosis of embryo survival on Day 35 after estrus. The effects of treatment, location of the embryo and location by treatment interaction on embryo survival were tested by Chi square. In Experiment 1, there was no significant difference in embryo survival rate between PGF2alpha-treated and control recipients. In Experiment 2, only 6 of 18 embryos survived to Day 35 when transferred to animals treated with PGF2alpha compared to 12 of 18 in control animals (P< 0.05). The survival of embryos did not differ with location (adjacent or opposite to the regressing CL) or location by treatment interaction. Thus no evidence was obtained to support a local effect of the regressing CL. The embryo mortality associated with luteolytic doses of PGF2alpha in cows receiving replacement therapy with progestogen probably involves compounds that either act systemically or are transported via the uterine lumen to the uterine horn contralateral to the regressing CL.

Postpartum cows with short-lived corpora lutea produce embryos that arrive at the uterus, but pregnancy rates are low even with exogenous progestogen. Four experiments were conducted to determine whether prostaglandin (PG) F2 alpha, known to cause early luteolysis, could have a direct effect on embryonic loss. Exogenous progestogen was injected s.c. twice daily in each experiment, starting 3 or 4 days after estrus (day of estrus = Day 0). Nonlactating, cycling beef cows were mated and injected i.m. every 8 h on Days 4 through 7 (experiment 1) or 5 through 8 (experiment 3) with either 15 mg PGF2 alpha or 3 ml saline. In experiment 1, cows in a third group received 1 g flunixin meglumine i.m. every 8 h. Ten of 18 PGF2 alpha-treated cows in experiment 3 were luteectomized on Day 5. Pregnancy rates were higher (p < 0.05) in cows given saline or flunixin meglumine (5 of 7) than in cows given PGF2 alpha (1 of 5) in experiment 1, and in cows given saline (6 of 9) or given PGF2 alpha, and luteectomized (8 of 10) than in cows given PGF2 alpha (2 of 8) in experiment 3. Postpartum beef cows, mated at weaning-induced first estrus, received i.m. injections every 8 h on Days 4 through 9 of 3 ml saline or 1 g flunixin meglumine (experiment 2); 14 flunixin meglumine-treated cows were luteectomized on Day 7. Pregnancy rates were higher in cows given flunixin meglumine and luteectomized (7 of 14) than in cows given saline (4 of 15) or flunixin meglumine alone (3 of 15; p < 0.05). In experiment 4, postpartum cows were luteectomized or sham-operated on Day 5. Pregnancy rates (2 of 13 and 2 of 14, respectively) did not differ. Thus, both reduction of endogenous PGF2 alpha and luteectomy were required for embryo survival in postpartum cows with short-lived corpora lutea, whereas luteectomy alone prevented effects of exogenous PGF2 alpha in cycling cows.

Low doses of progestogens in regimens for synchronization of estrus result in persistent follicles (PF) and reduced conception rates in cattle. The effects of PF on recovery of oocytes/embryos, fertilization, and embryonic development were examined in beef cows. To produce PF, cows received a used Controlled Internal Drug Releasing device on Days 4 through 13 after pretreatment estrus (Day 0) and two injections of 20 mg prostaglandin (PG) F2 alpha, i.m., 12 h apart on Day 6 (PF; n = 20). Control cows received only PGF2 alpha on Day 6 so they would ovulate growing follicles (GF; n = 22). With this model, the largest (dominant) follicle from the first wave of follicular development was being ovulated in cows in each group. Cows were observed for estrus twice daily and were then mated to highly fertile bulls. Follicular development was monitored by ultrasonography on alternate days from Day 2 until estrus and then daily until apparent ovulation. Jugular blood samples were collected every other day from Day 2 through 6 days after mating at posttreatment estrus, when uteri were flushed nonsurgically. The ovulatory follicle, which was followed retrospectively and had been observed longer (14 +/- 1 vs. 8 +/- 1 days), was larger in PF (17.2 +/- 0.5 mm) than in GF (14.5 +/- 0.6 mm; p < 0.01). Mean estradiol-17 beta (E2) in jugular plasma during the 6 days before estrus was higher in PF than in GF (5.7 +/- 0.4 vs. 2.6 +/- 0.4 pg/ml; p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Survival rate of embryos from first ovulations of postpartum cows with SHORT (6.9 +/- 0.3 days; n = 35) or NORMAL (17.1 +/- 0.3 days; n = 42) luteal phases and quality of the embryos on Day 6 were compared. At 19 to 23 days postpartum, cows were allotted to receive a norgestomet implant for 9 days (normal luteal phase) or to serve as untreated controls (short luteal phase). Calves were weaned 7 days after initiation of treatment to induce behavioral estrus in cows for mating. In 25 cows, growth of the ovulatory follicle was monitored by ultrasonography. On Day 6 after estrus, embryos were recovered nonsurgically, and live embryos were transferred into recipient cows exhibiting normal estrous cycles. The medium used to flush the embryos from the uterus of each donor cow was assayed for prostaglandin F2 alpha (PGF2 alpha). Days from calf removal to estrus and size of ovulatory follicles at ovulation (4.1 +/- 0.3 days and 16.7 +/- 0.7 mm, respectively) did not differ between NORMAL and SHORT cows. Interval from detection of the ovulatory follicle to ovulation was longer in NORMAL (10 +/- 0.7 days) than in SHORT cows (8 +/- 0.6 days; p < 0.05). Rates of recovery of an embryo or ovum (64%), rates of fertilization (65%), and quality or stage of development of Day 6 embryos did not differ between SHORT and NORMAL cows. Overall pregnancy rate from recovered oocytes was 13% for SHORT and 32% for NORMAL cows (p = 0.06); survival of fertilized oocytes was 23% for SHORT and 47% for NORMAL cows (p = 0.08).(ABSTRACT TRUNCATED AT 250 WORDS)

Four experiments were designed to examine the contribution of the oocyte or the follicular, oviductal, or early uterine environments to low fertility associated with the first ovulation postpartum. At 17-25 days postpartum in experiments 1, 2, and 3, suckled beef cows were assigned at random to receive 6 mg norgestomet, via ear-implant, for 9 days (NOR) or to serve as controls (CON). Calves were weaned from all cows 7 days after assignment to treatment in order to induce estrus, an LH surge, ovulation, and subsequent formation of CL. As cows were detected to be in estrus, they were bred first by natural service and 12 h later by artificial insemination. In experiment 1, on Day 3 after estrus, the oviduct ipsilateral to the side of ovulation was removed and flushed for recovery of an embryo or oocyte. Rates of recovery (86%), fertilization (68%), and development of fertilized oocytes to the 4- to 8-cell stage (100%) did not differ between CON and NOR cows. In experiment 2, uteri were flushed nonsurgically on Day 6 after estrus. Rates of recovery of embryos from the uterus were similar between CON (86%) and NOR (71%) cows. In experiment 3, one half of the cows in each group (CON and NOR) were fed melengestrol acetate (MGA) beginning on Day 4 after estrus and continuing until Day 35. The remaining cows in each group served as controls. Treatment with NOR increased (p < 0.05) the proportion of cows that maintained pregnancy until Day 35 (9/22) as compared to controls (0/18).(ABSTRACT TRUNCATED AT 250 WORDS)

This study investigated whether treatment with progestagen, which improves fertility after early weaning in postpartum cows, altered concentrations of gonadotrophins or development and function of follicles. Patterns of luteinizing hormone (LH), oestradiol and follicle-stimulating hormone (FSH) and of follicular growth before first postpartum ovulation were compared in two experiments. At 17 to 25 days post partum, suckled anoestrous beef cows received an ear-implant containing 6 mg progestagen (norgestomet) for 9 days or served as untreated controls. Calves were weaned from all cows 7 days after initiation of treatment. Cows were observed for oestrous behaviour twice a day until 10 days after weaning. As expected, the proportion of anoestrous cows that formed a corpus luteum with a normal lifespan was greater (P < 0.01) in cows treated with norgestomet (Expt 1, 17 of 24; Expt 2, 18 of 22) than in control cows (Expt 1, 2 of 16; Expt 2, 3 of 18). In general, patterns of secretion of LH and oestradiol and of final growth of the preovulatory follicle did not differ between control and norgestomet-treated cows. However, there was a transient rise in FSH in association with weaning in control cows that did not occur in norgestomet-treated cows. In addition, mean LH increased more rapidly and mean oestradiol was higher during the 3 days immediately before the preovulatory surge of LH in the norgestomet-treated cows (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

The first two experiments examined the role of the uterus in low pregnancy rates of beef cows induced to ovulate by early weaning. At 20 to 25 d postpartum, one-half of the cows in Exp. 1 and 2 received a s.c. implant containing 6 mg of norgestomet (NOR) for 9 d (NOR-pretreated) and the remaining cows were untreated controls (CON). Lengths of first postpartum luteal phase after weaning of calves at d 7 after implant insertion were expected to be normal in NOR-pretreated and short in CON cows. In Exp. 1, cows of both groups received an implant containing 3 mg of NOR at d 4 after first estrus and a silastic implant with 15 or 25 mg of NOR at d 7 after first estrus. At 7 d after first estrus, two embryos were transferred into the uterus of each cow and pregnancy was diagnosed by ultrasonography at d 35. Blood samples were collected daily from onset of treatment to d 8 after estrus and then every other day to d 24. Only 4 of 22 cows were pregnant at d 35, concentrations of estradiol (E2) were elevated after luteolysis, and large follicles were present at d 35. In Exp. 2, all cows were injected with 100 mg of progesterone (P4) twice daily from d 4 to 35 after first estrus. Embryos were transferred, pregnancy was diagnosed, and blood samples were collected as in Exp. 1, except blood sampling was continued to d 34.(ABSTRACT TRUNCATED AT 250 WORDS)

The primary objective of these studies was to determine whether unilateral ovariectomy (ULO) would affect rate of loss of primordial follicles. In experiment 1, retired breeder rats, unilaterally ovariectomized and maintained on the experiment for 90 days after surgery, had fewer (p less than 0.01) primordial follicles per ovary than sham-operated controls of the same age. The purpose of experiment 2 was to determine whether time after ULO or age of rats was the critical factor necessary for increased loss of primordial follicles found after ULO in experiment 1. It was found that age was more important than time: when ULO was performed at 30 days of age, the number of primordial follicles did not decrease in ULO rats compared to controls (p greater than 0.05) before 250 days of age. Concentrations of FSH during metestrus were not greater (p greater than 0.05) in ULO rats than in controls until rats were 250 days old. There were also fewer (p less than 0.05) growing follicles per ovary in ULO than in sham-operated rats at 250 days of age. It is concluded that ULO can increase the loss of primordial follicles, but only in old rats (greater than or equal to 250 days of age).

Data were obtained on 1039 recoveries of embryos from beef cows of four breeds at two locations, in clinic and on farm. General linear models procedures were utilized to determine the effects of breed, location, age of donor, dosage of follicle stimulating hormone (FSH) and the interaction of age and FSH on the following dependent variables: 1) the mean number of ova (unfertilized oocytes and embryos) recovered; 2) the mean number and percentage of embryos (fertilized; live and dead) recovered; and 3) the mean number and percentage of transferable embryos recovered. The interaction of age of donor and dosage of FSH with breed and location prevented the pooling of data over breed and location. The mean number of ova recovered was affected by age of the donor (Charolais-in clinic), or the interaction between age of donor and dosage of FSH (Polled Hereford-in clinic and -on farm and Simmental -on farm). The mean number of embryos was affected by age of donor (Polled Hereford-in clinic), dosage of FSH (Simmental-in clinic) or their interaction (Angus-on farm). The mean number of transferable embryos was affected by age of donor (Polled Hereford-in clinic and -on farm, Simmental-in clinic and Angus-on farm). General linear models procedures were utilized to determine the effects of the embryo (stage of development and quality) and the recipient (synchrony with the donor) on the rate of pregnancy. Rate of pregnancy varied with embryo quality score and synchrony of the recipient and the embryo. In conclusion, the superovulatory response was found to be highly breed-specific, and most of the variability in embryos produced was attributed to the number of ova recovered. However, the number of ova, embryos and transferable embryos recovered was further influenced by age of the donor, dosage of FSH or their interaction.

Patterns of concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), progesterone (P4) and estradiol-17 beta (E2) during an estrous cycle were compared between 15 lactating beef cows 5 to 7 years of age (young) and 15 cows greater than or equal to 12 years of age (old). Length of estrous cycle did not differ between young and old cows (P = .06). No differences due to age were found for LH. Patterns of concentrations of P4 during the first 15 days of the cycle, of FSH during days 6 through 12 and of E2 during the follicular phase differed with age (P less than .05). An earlier (P less than .025) midcycle elevation of FSH was associated with an earlier rise and greater concentration of E2 (P less than .05) during the follicular phase in old than in young cows. Differences in FSH and P4, although subtle, were consistent with an earlier or more advanced follicular development in old cows, leading to greater secretion of E2 from the preovulatory follicle.

Two experiments were conducted to examine the hypothesis that an alteration in follicular development is associated with advancing maternal age in the absence of prolonged estrous cycles. In Experiment 1, serum and four follicles (from one ovary per rat) were collected from young and middle-aged, 4-day cycling rats on estrus or metestrus. Number and diameter of nonatretic antral follicles greater than 200 microns in diameter were determined from serial sections of the other ovary from each rat. In Experiment 2, serum and follicles (12 +/- 2) from both ovaries were collected from young and middle-aged rats on each day of a 4-day estrous cycle. All microdissected follicles were assayed for estradiol-17 beta (E2) and all sera were assayed for E2, follicle-stimulating hormone, and luteinizing hormone by radioimmunoassay. Numbers of follicles greater than 400 microns in diameter did not differ, while numbers of follicles 200-400 microns in diameter were reduced in middle-aged rats compared to young rats (Experiment 1). The mean diameter of follicles greater than 400 microns in diameter and the follicular content of E2 was greater in middle-aged than in young rats. In Experiment 2, a greater proportion of large follicles were observed in middle-aged rats than in young rats on all days, and a greater proportion of follicles with high concentrations of E2 were observed on diestrus. We interpreted these data as indicative of an early age-related change in the control of follicular recruitment, growth, and maturation.

Beagle dogs 3-7 years old were ovariectomized (n = 9) or sham operated (n = 6) and followed for 48 weeks with measurements of body weight, tibial shaft bone mineral content (BMC), and serum biochemistry. Following killing, measurements were made of bone strength and histomorphometry. Ovariectomy (OX) significantly reduced serum estrone and estradiol concentrations and their variability from month to month. There was a transient decrease in cortical BMC of the OX dogs during the first 12 postoperative weeks but no difference between the groups after 48 weeks. Serum osteocalcin was elevated, but there was little effect on serum alkaline phosphatase, Ca, P, or calcitonin. OX increased the number of tetracycline-labeled osteons in cortical bone but reduced the percent trabecular surface labeled with tetracycline. OX produced no significant changes in the composition of the bones or loss of cortical area, but a statistically significant 15% trabecular bone loss occurred in the spine. However, bone strength had not been significantly affected at the time of sacrifice.

The effects of walking and aerobic dancing on the bones of 73 recently postmenopausal women have been compared by photon absorptiometry of the distal radius with a control group who did not exercise. The period of observation was six months. Results showed that the control group and the walking group lost statistically significant amounts of bone mineral content (1.6%, and 1.7% respectively), but that the dancing group did not (0.8%). The control group did not show a significant increase in the bone width (0.9%), but both the dancing (1.3%) and walking (1.6%) groups did. Changes in the cross-sectional moment of inertia of the radius were estimated for each subject based on bone mineral content and bone width values. Both exercise groups experienced significant increases in this variable, while the control group did not. Plasma oestrogen levels were not influenced by exercise. The results support the hypothesis that mechanical loading due to exercise may be effective in preventing postmenopausal osteoporosis.

The toxic action of environmental chemicals on reproduction and the toxiclike effects of ovarian hormones have been shown by numerous investigators. Some toxic effects of environmental chemicals on reproduction are through their action on hormonal secretion. Such effects on the endocrine system could provide additional approaches to investigations of toxicity of compounds. A better understanding of interactions of environmental chemicals with the endocrine system is needed. Therefore, it becomes important for a greater exchange of information and more interaction between toxicologists and endocrinologists.

Reduction of the number of growing follicles was proposed to contribute to the decline in reproductive performance with aging (Butcher and Page, 1981). To investigate the effects of a reduced number of follicles, rats which maintained regular estrous cycles at greater than 1 yr of age had either unilateral ovariectomy (ULO) or control surgery. Irregular estrous cycles and periods of constant estrus were more frequent during a period of 90 days after ULO than in controls. Follicle-stimulating hormone (FSH) concentration in plasma collected at 0900-1100 h of the metestrus nearest to 20, 50, and 90 days after surgery was increased by ULO; in both treatment groups, FSH increased between 20 and 90 days. Compensation in ovarian weight and number of corpora lutea had occurred by 90 days after ULO. Estradiol, estrone and luteinizing hormone (LH) concentrations did not change with time or treatment. Numbers of small, medium and large antral follicles per ovary at metestrus were increased by ULO, while the number of follicles per rat was decreased. It was concluded that the reduction in ovarian tissue (which decreased the number of growing follicles) resulted in an elevation of basal FSH followed by irregularity in estrous cycles.

Female Sprague-Dawley rats underwent laporatomy during metestrus at 70 to 75 days of age or remained untreated to study the effects of surgical stress on follicular growth. Groups of rats were killed on each day of a 4-day estrous cycle, serial sections of the ovaries were prepared histologically and the number and size of follicles with one or more complete layers of cuboidal granulosa cells were determined. Since no differences due to surgery were found, the data were pooled by day of the estrous cycle (17 or 18 rats/day of cycle) for characterization and comparison of size distribution of follicles on different days of the estrous cycle. Follicles were classified as atretic or healthy and divided into groups by increments of 20 micron of diameter for graphing. Data were analyzed by analysis of variance and least squares means. Significant differences were found in the distribution of both healthy and atretic follicles among days of the estrous cycle. At least 21 follicles/ovary were recruited from less than 260 micron into greater than 260 micron in diameter between proestrus and estrus, and the follicles for ovulation were selected by diestrus. A greater number of growing follicles of 70 to 100 micron in diameter were present at diestrus. From the disappearance of follicles greater than 260 micron between estrus and proestrus, it appears that atresia is a very rapid process.

Effects of age of donor and other factors on superovulation and production of transferable embryos were investigated. Data were obtained on 987 recoveries of embryos performed between November 1980 and June 1984 by Select Embryos, Inc. The 339 Holstein donors ranged in age from 1.8 to 17.8 yr. The effects of age of donor and dose of follicle stimulating hormone (FSH) were examined using regression analysis. For on-farm recoveries, numbers of embryos, rates of fertilization, quality scores of all embryos and numbers of transferable embryos decreased (P less than .01, P less than .001, P less than .05, P less than .01, respectively) with increasing age of donor. For in-clinic recoveries, numbers of embryos plus ova recovered were affected by age of donor, dose of FSH and the interaction of the two (P less than .05). Among older donors, increasing doses of FSH were associated with an increase in the number of ova plus embryos recovered. However, among younger donors, increasing doses of FSH had a negative effect. Numbers of embryos, rates of fertilization and numbers of transferable embryos decreased (P less than .05) with advancing age and increased (P less than .05) with increasing doses of FSH. Greater numbers of ova plus embryos were recovered when treatment with FSH was begun on d 10 or 11 as compared with d 7, 8, 9, 12, 13 or 14 (P less than .001). It was concluded that an increase in age of donor had a negative influence on the success of superovulation and the production of transferable embryos, and that the response to FSH was affected by age of donor.

Three experiments were done to examine the effects of food restriction, beginning at 21 days of age, on loss of primordial follicles and on concentrations of gonadotropins and sex steroids in rats. In Experiment 1, food restriction (FR) from 21 to 51-55 days of age had no effect on number of primordial follicles, but increased the plasma concentration (p less than 0.05) of follicle stimulating hormone (FSH). (p less than 0.05). In Experiment 2, comparisons were made of groups of rats (1) fed ad libitum (AL) (2) hypophysectomized at 21 days of age and fed ad libitum (AL-HY), (3) food restriction from 21 to 52-58 days of age (FR), and (4) food restriction with twice-daily injections of follicular fluid (FR-FF). Hypophysectomy was the only treatment that decreased the loss of primordial follicles (p less than 0.001). Concentrations of FSH were decreased in AL-HY and increased in FR and FR-FF rats (144 +/- 13, 53 +/- 15, 275 +/- 30 and 359 +/- 56 ng/ml in AL, AL-HY, FR and FR-FF rats, respectively). Concentrations of luteinizing hormone (LH) were lower (p less than 0.05) in AL-HY, FR and FR-FF rats than in AL rats. In Experiment 3, AL and FR rats were unilaterally ovariectomized (ULO) at 30 days of age. Blood samples were taken 5 days prior to ULO, at ULO and at 12 h, 5 days, and 22-28 days after ULO.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of addition and/or reduction of ovarian tissue and maternal age on ovulation rates (number of corpora lutea) and embryonic development were evaluated in old, regularly cycling rats on Days 4 and 11 of gestation. Young and old control rats and old rats which were either unilaterally ovariectomized (ULO), intact with 2 additional ovaries transplanted under the kidney capsule or ULO with 2 additional ovaries transplanted under the kidney capsule were mated on proestrus of a 4- or 5-day cycle between the 3rd and 9th postoperative cycle. The percentages of normal embryos on Days 4 and 11 of gestation were decreased (P less than 0.05) in the ULO rats, while on a per ovary basis the ovulation rate and ovarian weight were significantly increased in all the ULO rats compared to the old intact rats. An increase in abnormal and retarded embryos each contributed to this decreased percentage of normal Day 4 and Day 11 embryos in the ULO rats (P less than 0.05). Transplantation of ovarian tissue into old intact and ULO rats did not affect either the ovulation rate or the percentage of normal embryos and did not reverse the detrimental effects of unilateral ovariectomy. This could be due to inadequate stimulation or function of the ovarian tissue remaining in the transplants and may arise from a smaller vascular bed and limited blood flow to the transplants. Although regularly cycling young and old control rats had similar ovulation rates, the old control animals had a decreased percentage of normal embryos on Day 11 of gestation, but not on Day 4 of gestation, compared to the young control rats. This decrease in percentage of normal Day 11 embryos in the old intact rats was due mainly to an increase in retarded rather than abnormal embryos. From this study, it is concluded that unilateral ovariectomy of old cycling rats was detrimental to embryonic development. A similar, but more gradual decrease in functional ovarian tissue with aging, could cause the increased incidence of anomalies in embryos of older females.

Effects of age of cow and a norgestomet (N) implant on number of embryos and endocrine responses to induction of superovulation were studied in old (greater than 12 yr) and young (5 to 7 yr) lactating beef cows. Seventeen cows (8 old and 9 young) received a 6-mg N ear implant on d 4 or 5 of the cycle (d 0 = estrus); the remaining 17 cows (9 old and 8 young) served as untreated controls (C). All animals were treated with 38 mg of porcine follicle-stimulating hormone (FSH-P) in decreasing dosages over a 4.5-d period beginning on d 10 or 11. Regression of the corpus luteum was induced with injections of PGF2 alpha at 0800 and 2000 on d 4 of FSH-P treatment; implants were removed at the second injection of PGF2 alpha. Cows were inseminated artificially 12 and 24 h after onset of estrus. Embryos were collected on d 7 or 8 postinsemination. Blood samples were obtained daily at 0800 from 2 d prior to initiation of treatment with FSH-P until collection of embryos. An additional sample was collected each day at 2000, from the first injection of PGF2 alpha to 1 d after onset of estrus. Samples were assayed for luteinizing hormone (LH), progesterone (P4), follicle stimulating hormone (FSH) and estradiol-17 beta (E2). Total number of embryos plus ova recovered was lower (P less than .01) in N-treated (5.2 +/- 1.1) than in C-treated (10.6 +/- 1.6) cows.(ABSTRACT TRUNCATED AT 250 WORDS)

The primary objectives of this study were to: 1) determine if removal of 1.5 ovaries from young rats would mimic reproductive characteristics that normally occur with advancing age and 2) determine if removal of 1.5 ovaries from aged rats would further advance the process of reproductive aging. Removal of 1.5 ovaries increased the number of young (P less than 0.05) and old (P less than 0.01) rats that exhibited abnormal estrous cycles. In addition, concentrations of follicle-stimulating hormone (FSH) were higher at both ages in the groups with half an ovary. The increased concentrations of FSH are consistent with a decrease in the number of growing follicles after removal of 1.5 ovaries. All groups had lower concentrations of estradiol (E2) than young controls. There was a significant increase in the number of abnormal embryos with age and removal of 1.5 ovaries when rats were mated during a 5-day estrous cycle, but there was no effect if they were mated during a 4-day estrous cycle. From the results of this study, we conclude that the reduction in ovarian tissue in young and aged rats mimicked several reproductive characteristics of advancing age. Also, an effect of aging on the hypothalamus was evident in this study.

Zygotes were transferred, on the day of fertilization, from young and old rats with 4- or 6-day oestrous cycles into the ovarian bursa of young recipients with 4-day cycles, and zygotes from young rats with 4-day cycles were transferred into young and old recipients with 4- or 6-day cycles. Young rats with 4-day cycles served as controls for both donors and recipients. An increase in length of cycle or maternal age of donor caused an increase in unfertilized and/or abnormal eggs at the pronuclear stage (non-transferred zygotes). Increased age of donor or length of cycle decreased the implantation rate observed on Day 11 of pregnancy. Likewise, increased age of recipient or length of cycle decreased implantation rate observed on Day 11 of pregnancy. The increase in both age and length of cycle of donor or recipient caused the greatest decline in implantation rate and percentage of normal embryos observed on Day 11 of pregnancy.