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Hypophysectomy specimens from 16 dogs with pituitary adenoma were evaluated with periodic acid-Schiff (PAS), reticulin, and immunohistochemistry for adrenocorticotrophic hormone (ACTH), melanocyte stimulating hormone (MSH), growth hormone (GH), and Ki-67. The reticulin network was obliterated in all adenomas. One adenoma expressed ACTH and GH. Eight corticotroph adenomas were basophilic to chromophobic, and PAS- and ACTH-positive. Seven melanotroph adenomas were distinguished from corticotroph adenomas by expression of MSH. Pituitary-dependent hypercortisolism was diagnosed in 5 of 8 dogs with corticotroph and 4 of 7 with melanotroph adenoma. Pituitary height/brain area (P/B) ratio was elevated in all dogs. Previous canine hypophysectomy studies suggested that melanotroph adenomas were larger and carried a worse prognosis than corticotroph adenomas; however, in this study, corticotroph adenomas in comparison to melanotroph adenomas were larger (median P/B ratio: 1.06 versus 0.76), more proliferative (median Ki-67 index: 9.47% versus 1.99%), and associated with shorter survival (median: 300 versus 793 days). Recommended immunohistochemistry for PAS-positive pituitary adenomas includes ACTH and MSH to distinguish corticotrophs from melanotrophs and Ki-67 for proliferation index.

Objectives To determine whether the prevalence of cognitive limitation (CL) among Americans ages 55 to 69 years changed between 1998 and 2014, and to assess the trends in socioeconomic disparities in CL among groups defined by race/ethnicity, education, income, and wealth. Method Logistic regression using 1998-2014 data from the biennial Health and Retirement Study, a nationally representative data set. CL is defined as a score of 0-11 on a 27-point cognitive battery of items focused on memory. Socioeconomic status (SES) measures are classified as quartiles. Results In models controlling for age, gender, and previous cognitive testing, we find no significant change over time in the overall prevalence of CL, widening disparities in limitation by income and, in some cases, wealth, and improvements among non-Hispanic whites but not other racial/ethnic groups. Discussion Among people 55-69, rates of CL are many times higher for groups with lower SES than those with higher SES, and recent trends show little indication that the gaps are narrowing.

OBJECTIVE To assess effects of major abdominal surgery on serum cortisol and aldosterone and plasma canine ACTH (cACTH) concentrations. ANIMALS 39 healthy dogs undergoing laparotomy during veterinary student surgical laboratories. PROCEDURES Blood samples were obtained before and at completion of surgery. Serum cortisol and aldosterone and plasma cACTH concentrations were measured by use of validated radioimmunoassays. Changes in concentrations (postoperative concentration minus preoperative concentration) were calculated. Data were analyzed by use of the Wilcoxon signed rank test, Pearson correlation analysis, and Mann-Whitney rank sum test. RESULTS Cortisol, aldosterone, and cACTH concentrations increased significantly from before to after surgery. Although cortisol and aldosterone concentrations increased in almost all dogs, cACTH concentrations decreased in 6 of 32 (19%) dogs. All dogs had preoperative cortisol concentrations within the reference range, but 24 of 39 (62%) dogs had postoperative concentrations above the reference range. A correlation between the change in cACTH concentration and the change in cortisol concentration was not detected. CONCLUSIONS AND CLINICAL RELEVANCE Laparotomy caused a significant increase in serum cortisol and aldosterone concentrations. In most dogs, but not all dogs, plasma cACTH concentrations increased. Lack of correlation between the change in cACTH concentration and the change in cortisol concentration suggested that increased postoperative cortisol concentrations may have been attributable to ACTH-independent mechanisms, an early ACTH increase that caused a sustained cortisol release, or decreased cortisol clearance. Further studies are indicated to evaluate the effects of various anesthetic protocols and minimally invasive surgical techniques on the stress response.

To optimize the histologic evaluation of hypophysectomy specimens, sections of 207 canine pituitary glands (196 postmortem, 11 hypophysectomy specimens) were reviewed. Adenohypophyseal proliferation was the most common (n = 79) lesion. Proliferative lesions were sparsely to densely granulated; the granules were usually basophilic to chromophobic and periodic acid-Schiff-positive. Adenohypophyseal proliferation was classified as hyperplasia (n = 40) if ≤2 mm diameter with intact reticulin network, as microadenoma (n = 22) for 1–5 mm homogeneous nodules with lost reticulin network, or as macroadenoma (n = 17) for larger tumors. Craniopharyngeal duct cysts were common incidental lesions and the only lesion in 15 dogs. Uncommon diagnoses included lymphoma (n = 4), hemorrhagic necrosis (n = 4), metastatic carcinoma (n = 3), hypophysitis (n = 3), ependymoma (n = 2), craniopharyngioma (n = 2), and 1 case each of metastatic melanoma, pituicytoma, gliomatosis, germ cell tumor, meningioma, and atrophy. The pituitary histologic diagnosis was associated with hyperadrenocorticism (HAC; P < .001) and adrenocortical histologic diagnosis ( P = .025). Both HAC and adrenocortical hyperplasia showed a positive trend with the degree of adenohypophyseal proliferation. The association of adrenocortical hyperplasia with HAC was not significant ( P = .077). Dogs with adenohypophyseal proliferations were older than dogs with normal pituitary glands ( P < .05). Brachycephalic breeds were overrepresented among dogs with pituitary macroadenoma or craniopharyngeal duct cysts, but the association was not statistically significant ( P = .076). Adenohypophyseal hyperplasia was more common than adenoma among postmortem specimens, but was unexpected in >80% of cases. Pituitary macroadenoma was the most common diagnosis in hypophysectomy specimens.

Objectives The disablement process can be viewed conceptually as a progression from disease to impairment to functional limitation and finally disability (frequently operationalized as activity limitation). This article assesses the extent to which early phases of the process are associated with individual-level disability trajectories by age. Method We use data from seven waves of the Health and Retirement Study, 1998 to 2010, to investigate for individuals aged 65-84 years how baseline sociodemographic characteristics and self-reported disease, pain, and functional limitation (physical, cognitive, or sensory) are related to the dynamics of limitations in activities of daily living (ADLs). Our modeling approach jointly estimates multiperiod trajectories of ADL limitation and mortality and yields estimates of the number of, shapes of, and factors associated with the most common trajectories. Results Individual probability of ADL limitation can best be described by three common trajectories. In comparison with disease, pain, and functional limitation, sociodemographic characteristics have weak associations with trajectory group membership. Notably, neither sex nor education is strongly associated with group membership in multivariate models. Discussion The analysis confirms the importance of the early phases of the disablement process and their relationships with subsequent trajectories of activity limitation.

Objectives Identify common trajectories of physical functional limitation and mortality among Taiwanese 50 and older as they age, link these to underlying transitions in onset, recovery, and mortality, and assess associations between trajectories and a set of risk factors. Method Longitudinal data from 4 waves of the Survey of Health and Living Status of the Middle-Aged and Elderly in Taiwan, collected between 1996 and 2007, are analyzed using a summary measure indicating difficulty with one or more of 7 physical functions. A group-based trajectory model identifies common trajectories. Shorter term transition probabilities that underlie multiperiod trajectories are examined. Multinomial regression associates risk factors with trajectory group membership. Results Best fitting the data is a model with 3 groups characterized as early, mid, and late onset of limitation. Roughly half the population follows the trajectory of mid onset and a quarter each of the other 2. Females and those least educated are most likely to belong to the early-onset group. Discussion The analysis advances understanding of late-life functioning by focusing on the heterogeneity of functional limitation experience, appropriately accounting for the relation between functional limitation and mortality and linking long-term patterns with short-term changes in functional limitation.

Background Maximal aldosterone secretion in healthy dogs occurs 30 minutes postadrenocorticotropin (ACTH; 5 μg/kg IV) stimulation. The effect of trilostane and mitotane on aldosterone at that time is unknown. Objectives To assess the effect of trilostane and mitotane in dogs with pituitary-dependent hyperadrenocorticism on aldosterone secretory reserve. To determine if aldosterone concentration correlates with electrolyte concentrations. Animals Serum collected from 79 client-owned dogs and 33 stored samples. Methods Client-owned dogs had ACTH stimulation tests with cortisol concentrations measured at 0 and 60 minutes and aldosterone concentrations measured at 0, 30, and 60 minutes. Stored samples had aldosterone concentrations measured at 0 and 60 minutes. Ten historical clinically healthy controls were included. All had basal sodium and potassium concentrations measured. Results The aldosterone concentrations in the mitotane- and trilostane-treated dogs at 30 and 60 minutes post-ACTH were significantly lower than in clinically healthy dogs; no significant difference was detected in aldosterone concentration between 30 and 60 minutes in treated dogs. However, a significantly higher percentage of dogs had decreased aldosterone secretory reserve detected at 30 minutes than at 60 minutes. At 30 minutes, decreased secretory reserve was detected in 49% and 78% of trilostane- and mitotane-treated dogs, respectively. No correlation was detected between aldosterone and serum electrolyte concentrations. Conclusions and Clinical Importance Decreased aldosterone secretory reserve is common in trilostane- and mitotane-treated dogs; it cannot be predicted by measurement of serum electrolyte concentrations. Aldosterone concentration at 30 minutes post-ACTH stimulation identifies more dogs with decreased aldosterone secretory reserve than conventional testing at 60 minutes.

Background Lowering the cosyntropin dose needed for ACTH stimulation would make the test more economical. Objectives To compare the cortisol response to 1 and 5 μg/kg cosyntropin IV in dogs being screened for hyperadrenocorticism (HAC) and in dogs receiving trilostane or mitotane for pituitary-dependent HAC. Animals Healthy dogs (n = 10); client-owned dogs suspected of having HAC (n = 39) or being treated for pituitary-dependent HAC with mitotane (n = 12) or trilostane (n = 15). Procedures In this prospective study, healthy dogs had consecutive ACTH stimulation tests to ensure 2 tests could be performed in sequence. For the first test, cosyntropin (1 μg/kg IV) was administered; the second test was initiated 4 hours after the start of the first (5 μg/kg cosyntropin IV). Dogs suspected of having HAC or being treated with mitotane were tested as the healthy dogs. Dogs receiving trilostane treatment were tested on consecutive days at the same time post pill using the low dose on day 1. Results In dogs being treated with mitotane or trilostane, the 2 doses were pharmacodynamically equivalent (90% confidence interval, 85.1–108.2%; P = 0.014). However, in dogs suspected of having HAC, the doses were not pharmacodynamically equivalent (90% confidence interval, 73.2–92.8%; P = 0.37); furthermore, in 23% of the dogs, clinical interpretation of test results was different between the doses. Conclusions and Clinical Relevance For dogs suspected of having HAC, 5 μg/kg cosyntropin IV is still recommended for ACTH stimulation testing. For dogs receiving mitotane or trilostane treatment, a dose of 1 μg/kg cosyntropin IV can be used.

Objectives This study examines changes in functional and activity limitations 1998–2012 for individuals 55–69. Methods Logistic models are used to estimate trends in limitations in vision, hearing, physical and cognitive functioning, IADLs, and ADLs. Additional models assess the extent to which trends are associated with and differ by education, smoking, and BMI. Results Changes in prevalence of limitations in vision, hearing, cognitive functioning, and ADLs are not statistically significant. Limitations in physical functioning declined by 0.37% per year. IADL limitations increased by 1.33% per year, but most of the increase occurred between 2008 and 2010/2012, and are associated with economic hardship during the Great Recession. Increases in education are especially beneficially associated with trends in limitations, but reductions in smoking also appear to be advantageous for some outcomes. Increases in BMI are associated with trends in physical functioning, IADL, and ADL limitation. Discussion For Americans 55–69, functional and activity limitations were largely unchanged 1998–2012. Our results suggest that if educational attainment had not increased, most functional and activity limitations potentially could have worsened substantially. Future change in educational attainment is not expected to be so positive. Continued monitoring of trends in activity limitations might well include greater focus on the explanatory roles of environmental factors, including economic circumstances.

This article updates trends from five national U.S. surveys to determine whether the prevalence of activity limitations among the older population continued to decline in the first decade of the twenty-first century. Findings across studies suggest that personal care and domestic activity limitations may have continued to decline for those ages 85 and older from 2000 to 2008, but generally were flat since 2000 for those ages 65–84. Modest increases were observed for the 55- to 64-year-old group approaching late life, although prevalence remained low for this age group. Inclusion of the institutional population is important for assessing trends among those ages 85 and older in particular.

BackgroundRecently, late-life disability rates have declined in several countries of the Organisation for Economic Co-operation, but no national-level trend analysis for England has been available. The authors provide such analysis, including measures both early and late in the disablement process, and the authors investigate the extent to which temporal trends are associated with population changes in socioeconomic position (SEP).MethodsThe authors fit logistic models of trends in self-reports and nurse measures of 16 health indicators, based on cross-sectional data from those aged 65 years and older from the 1992 to 2007 Health Survey for England.ResultsOverall, prevalence rates of limitations in seeing, hearing and usual activities declined (pConclusionsRecent trends in late-life health and functioning in England have been mixed. A better understanding of which specific activities pose challenges, how the environment in which activities are conducted influences functioning and the causes of relatively worse trends for some SEP groups is needed.

This analysis offers the first strong evidence of trends in late-life disability in an emerging economy. For the population of Taiwan aged 65 and older, consistent measures of limitations in seeing, hearing, physical functions, instrumental activities of daily living (IADLs), and activities of daily living (ADLs) were available for three to six survey waves, depending on the outcome, from 1989 to 2007. Limitations in seeing, hearing, and IADLs declined substantially, but trends were mixed for physical functions and flat for ADLs. The remarkable reduction in difficulty telephoning, an IADL, may reflect changes in telecommunications infrastructure and highlights the roles of environment and technology in disability outcomes. Trends for urban residents were more advantageous than those for rural residents for seeing and hearing, but less so for physical functions and IADLs. Were it not for the substantial increase in educational attainment, trends in all outcomes would have been less favourable.

The decline in late-life disability prevalence in the United States was one of the most important developments in the well-being of older Americans in the 1980s and 1990s, but there is no guarantee that it will continue into the future. We review the past literature on trends in disability and other health indicators and then estimate the most recent trends in biomarkers and limitations for both the population aged 65 and older and those aged 40 to 64, the future elderly. We then investigate the extent to which trends in education, smoking, and obesity can account for recent trends in limitations and discuss how these three factors might influence future prospects for late-life health. We find that improvements in the health of the older population generally have continued into the first decade of the twenty-first century. The recent increase in the proportion of the younger population needing help with activities of daily living is concerning, as is the doubling of obesity in the last few decades. However, the increase in obesity has recently paused, and favorable trends in education and smoking are encouraging.

THE consequences of declines in mortality for the health and functioning of the nation's older adults have been the subject of much interest over the last quarter century. Indeed, spurred by Manton, Corder, and Stallard's (1993) analysis of the National Long Term Care Survey, a vast literature has developed that explicitly focuses on trends in health and disability in late life. Although initially there was disagreement, a consensus has emerged among researchers in the field that there have been improvements in most measures of late-life functioning (see, e.g., Crimmins, 2004; Cutler, 2001; Freedman, Martin, & Schoeni, 2002; Freedman et al., 2004; Kramarow, Lubitz, Lentzner, & Gorina, 2007; Manton, Gu, & Lamb, 2006; Waidmann & Liu, 2000). A recent report by the Institute of Medicine on the future of disability in America (Field & Jette, 2007) suggests that despite these improvements, the numbers of adults with disabilities will likely swell in the coming years as the large Baby Boom generation—those born during the years 1946–1964—reaches the ages associated with the highest rates of morbidity and disability. Undoubtedly, such a trend would have important implications for the provision of medical and social services, for the ability of future older adults to participate fully in society, including the workplace, and more generally for their quality of life. However, although the number of adults reaching older ages and thus experiencing elevated risks for debilitating conditions will certainly grow, there is debate about whether the Baby Boom cohort will enter later life with better or worse age-specific rates of morbidity and disability than earlier cohorts. Only a handful of studies have taken up the question of trends in health and functioning of the adult population in the decades approaching retirement, and results have been conflicting. One study, using data from the National Health Interview Survey (NHIS), found from 1984 to 1996 an increase in the prevalence of needing help with personal care and routine household activities among adults aged 40–49 and 50–59 years, although the rates of such disability were very low (Lakdawalla, Bhattacharya, & Goldman, 2004). Another study, by Zack, Moriarty, Stroup, Ford, and Mokdad (2004), using data from the Behavioral Risk Factor Surveillance System (BRFSS), found an increase from 1993 to 2001 in the proportion of those aged 35–44, 45–54, and 55–64 years who reported poor or fair health. A third study, which relied on data from the Health and Retirement Study (HRS), suggested worse health and functioning among people aged 51–56 years in 2004 compared with 1992 (Soldo, Mitchell, Tfaily, & McCabe, 2007). However, Weir (2007) concluded from his analysis of the same cohorts using a different recode of the HRS data that although early Baby Boomers were more likely to report poor or fair health than the cohort born 12 years earlier, objectively their overall health and functioning were similar. Other recent analyses of health trends among the middle-aged adult population have been more positive. Using the NHIS, Martin, Schoeni, Freedman, and Andreski (2007) found a downward trend from 1982 to 2003 in reports of poor or fair health among adults aged 40–49 and 50–59 years. Mortality rates among adults also have continued to decline in recent decades (National Center for Health Statistics, 2007). Several lessons have emerged from studying late-life health and functioning trends that are relevant to this new and growing literature focused on adults under age 65 years. First, trends are best assessed over a relatively long time horizon with multiple observations (Freedman et al., 2002); given annual variation, two data points may not necessarily constitute a trend (Crimmins, 1996). Second, different measures may move in different directions (Crimmins, 1996, 2004). For example, despite declines in most measures of late-life disability, reports of many chronic conditions among older adults have increased in recent decades (Crimmins, 2004; Crimmins & Saito, 2000; Freedman & Martin, 2000; Freedman, Martin, Schoeni, & Cornman, 2007). There are many reasons for such divergences, not the least of which is that no single indicator is a pure measure of health. For example, self-reports of chronic diseases may be influenced by access to health care, which in turn is a function of socioeconomic status. Moreover, indicators of functioning reflect the gap between an individual's capacity and the environment in which activities are carried out. Accordingly, breadth of measurement is important before drawing conclusions about the health and functioning of a cohort. Third, care must be taken to ensure that methodological threats to validity—such as low response rates, use of screening questions, changes in question wording, changes in response rates, or omission of important groups such as the institutionalized population—do not bias conclusions (Freedman et al., 2002). In this paper, we heed these lessons and expand on existing studies by assessing trends in mortality and multiple nonclinical indicators of health and functioning (including general health status, health conditions, physical functional limitations, and need for help with daily activities); by using annual data spanning from one to more than two decades, depending on the measure; and by covering the full age range of the Baby Boom. Our goal is to investigate whether the health and functioning of Baby Boomers are better or worse than those of previous cohorts in middle age.

In societies in which families are highly integrated, the education of family members may be linked to survival. Such may be the case in Taiwan, where there are large gaps in levels of education across generations and high levels of resource transfers between family members. This study employs 14 years of longitudinal data from Taiwan to examine the combined effects of the education of older adults and their adult children on the mortality outcomes of older adults. We use nested Gompertz hazard models to evaluate the importance of the education of an older adult and his or her highest-educated child after controlling for socioeconomic, demographic, and health characteristics at baseline. To gain further insight, we fit additional models based on the sample stratified by whether older adults report serious diseases at baseline. The results indicate that the educational levels of both older adults and children are associated with older adult mortality, but children’s education appears more important when we examine the mortality of only those older adults who already report a serious disease. This finding suggests that there may be different roles for education in the onset versus the progression of a health problem that may lead to death.

Relationships among socio-demographic characteristics general assessments of health and old-age mortality are well established in developed countries. There is also an increasing focus on the connection between early-life experiences and latelife health. This paper tests these and other associations using representative survey data from Taiwan on the population aged 60 and older in 1989 1993 and 1996 that have been linked to data on deaths between 1989 and 1999 from a national death registry. The study also explores the possible influence of Taiwan’s Universal Health Insurance Program instituted in 1995 and whether or not the survival of some groups of older people may have been differentially enhanced. Mortality is modeled using Gompertz regression. Multiple survey waves are employed to construct time-varying covariates. Some results verify findings of past studies; others are new. Effects of education are attenuated after the introduction of some health indicators. Functional and global assessments of health have stronger associations with mortality than do self-reports of health behaviors or particular chronic conditions such as diabetes. Mainlanders have higher survival than others. The survival of older adults with the greatest number and severity of functional limitations improved over the 1990s suggesting a possible beneficial influence of the insurance program. (authors)

Background Iatrogenic hypothyroidism (IH) after treatment of hyperthyroidism can impair renal function. No study compared the efficacy of measurement of serum free thyroxine by equilibrium dialysis (fT4ed) or thyroid-stimulating hormone (TSH) concentrations for monitoring cats receiving methimazole. Objectives To (1) compare the ability of total T4 and fT4ed concentrations in conjunction with TSH to define thyroid function in hyperthyroid cats receiving methimazole, (2) determine the prevalence of IH in cats receiving methimazole, and (3) examine the relationship between thyroid axis hormones and serum creatinine concentration. Animals One hundred and twenty-five serum samples from hyperthyroid cats receiving methimazole and total T4 concentrations ≤3.9 μg/dL. Methods Total T4, fT4ed, and TSH concentrations were measured to evaluate thyroid status and serum creatinine concentration was measured to assess renal function. A low total T4 or fT4ed concentration in combination with an increased TSH concentration defined IH. Results Forty-one cats (33%) had increased TSH concentrations. Of cats with total T4 and fT4ed concentrations below the reference range, 68% and 73%, respectively, had TSH concentrations above the reference range. Only 18% of cats with a normal TSH concentration had an increased serum creatinine concentrations as compared to 39% of those with increased TSH concentrations (P

Objectives. This study explored whether improvements in cognitive functioning occurred during the 1990s among older Americans and investigated several possible explanations for such changes. Methods. Using the 1993 Asset and Health Dynamics of the Oldest Old study ( N 5 7,443) and 1998 Health and Retirement Survey ( N 5 7,624), this study examined aggregate changes in the proportion of the noninstitutionalized population aged 70 and older with severe cognitive impairment. Impairment was measured for self-respondents using a modified version of the Telephone Interview Cognitive Screen; for proxy respondents, ratings of memory and judgment were used. Logistic regression was used to investigate potential explanations for aggregate changes. Results. The percentage of older Americans with severe cognitive impairment declined from 6.1% in 1993 to 3.6% in 1998 ( p , .001). The decline was statistically significant among self-respondents but not among those with proxy interviews. Improvements between 1993 and 1998 were not explained by shifts in demographic and socioeconomic factors or by changes in the prevalence of stroke, vision, or hearing impairments. Discussion. As a group, older persons, especially those well into their 80s, appear to have better cognitive functioning today than they did in the early 1990s.

Objective—To determine the lowest ACTH dose that would induce a significant increase in serum cortisol concentration and identify the time to peak cortisol concentration in healthy neonatal foals. Design—Prospective randomized crossover study. Animals—11 healthy neonatal foals. Procedures—Saline (0.9% NaCl) solution or 1 of 4 doses (0.02, 0.1, 0.25, and 0.5 μg/kg [0.009, 0.045, 0.114, and 0.227 μg/lb]) of cosyntropin (synthetic ACTH) was administered IV. Serum cortisol concentrations were measured before and 10, 20, 30, 60, 90, 120, 180, and 240 minutes after administration of cosyntropin or saline solution; CBCs were performed before and 30, 60, 120, and 240 minutes after administration. Results—Serum cortisol concentration was significantly increased, compared with baseline, by 10 minutes after cosyntropin administration at doses of 0.1, 0.25, and 0.5 μg/kg. Serum cortisol concentration peaked 20 minutes after administration of cosyntropin at doses of 0.02, 0.1, and 0.25 μg/kg, with peak concentrations 1.7, 2.0, and 1.9 times the baseline concentration, respectively. Serum cortisol concentration peaked 30 minutes after cosyntropin administration at a dose of 0.5 μg/kg, with peak concentration 2.2 times the baseline concentration. No significant differences were detected among peak serum cortisol concentrations obtained with cosyntropin administration at doses of 0.25 and 0.5 μg/kg. Cosyntropin administration significantly affected the lymphocyte count and the neutrophil-to-lymphocyte ratio. Conclusions and Clinical Relevance—Results suggested that in healthy neonatal foals, the lowest dose of cosyntropin to result in significant adrenal gland stimulation was 0.25 μg/kg, with peak cortisol concentration 20 minutes after cosyntropin administration.

To examine the safety and feasibility of using lyophilized platelets (LYO) and fresh platelet concentrate (FRESH) in bleeding thrombocytopenic dogs.Preliminary prospective randomized clinical trial.Two private referral centers and 3 university teaching hospitals.Thirty-seven dogs with a complaint of hemorrhage associated with thrombocytopenia (platelet count70 × 10(9) /L [70,000/μL], a hematocrit15%, and that had received neither vincristine nor platelet-containing transfusions within 72 h of enrollment were studied.Animals were randomized to receive LYO or FRESH, dosed according to weight. Physical examination, complete blood counts, and coagulation testing (prothrombin time and activated partial thromboplastin time) were performed at enrollment. Physical examinations were also performed immediately post transfusion, and at 1 and 24 h after transfusion. Complete blood counts were repeated immediately post transfusion and at 24 h. Collected data included bleeding score (BLS), response to transfusion, adverse reactions, hospitalization time, need for additional transfusions, survival to discharge, and 28-d survival.Twenty-two dogs received LYO and 15 received FRESH. There was no difference between groups in age, weight, BLS, platelet count, white blood cell count, hematocrit, or presence of melena. There was no difference between groups in transfusion reaction rates, the need for additional transfusions, 24-h BLS, hospitalization time, survival to discharge, or 28-d survival.Transfusion of LYO was feasible and associated with a low transfusion reaction rate in this limited study of thrombocytopenic canine patients presenting with mild-to-severe hemorrhage. LYO were easy to use and provided storage advantages over FRESH. Further study of this product, including examination of efficacy and platelet life span, is warranted.

This article uses a group-based modeling approach to jointly estimate disability and mortality trajectories over time based on data from the population aged 80 and older in China, and explores relations of demographic, socioeconomic, and early-life characteristics to membership in gender-specific trajectory groups. A three-group model best fits the data for both males and females. For most groups, predicted numbers of limitations in activities of daily living (ADLs) increase with age, but the pace is gradual in some cases and rapid in others. For each gender, the estimated mortality probability trajectories for the three groups follow a hierarchy that is related to the predicted ADL counts at age 80. Only a few characteristics predict trajectory-group membership. Prior nonagricultural occupation is associated with less favorable disability trajectories for both genders. For females, rural residence, a greater number of children ever born, and having a father who did not work in agriculture are associated with more favorable trajectories. For a small group of males who received education, disability is moderate but changes little with age. Findings may reflect heterogeneity of survival among the least advantaged, as well as a possible expansion of morbidity among a small advantaged group.

Objective—To determine the lowest ACTH dose that would induce a maximum increase in serum cortisol concentration in healthy adult horses and identify the time to peak cortisol concentration. Design—Evaluation study. Animals—8 healthy adult horses. Procedures—Saline (0.9% NaCl) solution or 1 of 4 doses (0.02, 0.1, 0.25, and 0.5 μg/kg [0.009, 0.045, 0.114, and 0.227 μg/lb]) of cosyntropin (synthetic ACTH) were administered IV (5 treatments/horse). Serum cortisol concentrations were measured before and 30, 60, 90, 120, 180, and 240 minutes after injection of cosyntropin or saline solution; CBCs were performed before and 30, 60, 120, and 240 minutes after injection. Results—For all 4 doses, serum cortisol concentration was significantly increased, compared with the baseline value, by 30 minutes after administration of cosyntropin; no significant differences were detected among maximum serum cortisol concentrations obtained in response to administration of doses of 0.1, 0.25, and 0.5 μg/kg. Serum cortisol concentration peaked 30 minutes after administration of cosyntropin at a dose of 0.02 or 0.1 μg/kg, with peak concentrations 1.5 and 1.9 times, respectively, the baseline concentration. Serum cortisol concentration peaked 90 minutes after administration of cosyntropin at a dose of 0.25 or 0.5 μg/kg, with peak concentrations 2.0 and 2.3 times, respectively, the baseline concentration. Cosyntropin administration significantly affected WBC, neutrophil, and eosinophil counts and the neutrophil-to-lymphocyte ratio. Conclusions and Clinical Relevance—Results suggested that in healthy horses, administration of cosyntropin at a dose of 0.1 μg/kg resulted in maximum adrenal stimulation, with peak cortisol concentration 30 minutes after cosyntropin administration.

Objective—To evaluate the effects of oral administration of anti-inflammatory dosages of prednisone for 28 days on serum aldosterone, cortisol, and electrolyte concentrations in clinically normal dogs. Animals—10 dogs. Procedures—On days 1 through 28, 5 dogs received prednisone (0.55 mg/kg, PO, q 12 h) and 5 dogs received similar treatments with a placebo (empty capsules). Serum cortisol and aldosterone concentrations before and after ACTH stimulation testing and serum electrolyte concentrations were measured before (day 0 [baseline]), during (days 7, 14, 21, and 28), and after (days 35 and 42) treatment. Results—At baseline, variables did not differ between the 2 groups. Serum cortisol concentrations before and after ACTH stimulation testing did not change from baseline values in placebo-treated dogs. In prednisone-treated dogs, serum chloride and corrected chloride concentrations were significantly lower on days 7, 14, 21, and 28 and serum bicarbonate concentrations were significantly higher on days 14, 21, and 28, compared with baseline values. Serum cortisol concentrations before and after ACTH stimulation testing were significantly lower than baseline values during prednisone treatment. Serum aldosterone concentration after ACTH stimulation testing was significantly lower than baseline on day 35 (ie, 1 week after discontinuation of prednisone treatment) but returned to baseline by day 42 in prednisone-treated dogs. Conclusions and Clinical Relevance—Administration of anti-inflammatory dosages of prednisone caused significant changes in serum chloride, bicarbonate, and cortisol concentrations in clinically normal dogs. Although ACTH-stimulated serum aldosterone concentrations were unchanged from baseline during glucocorticoid administration, values decreased after treatment cessation but quickly returned to baseline values.

Although still below 2 percent, the proportion of people ages 50–64 who reported needing help with personal care activities increased significantly from 1997 to 2007. The proportions needing help with routine household chores and indicating difficulty with physical functions were stable. These patterns contrast with recently reported declines in disability among the population ages 65 and older. Particularly concerning among those ages 50–64 are significant increases of limitations in specific mobility-related activities, such as getting into and out of bed and climbing ten steps. Musculoskeletal conditions remained the most commonly cited as causes of disability at these ages. There were also substantial increases in the attributions of disability to depression, diabetes, and nervous system conditions.

Objective—To evaluate pituitary-adrenal function in critically ill dogs with sepsis, severe trauma, and gastric dilatation-volvulus (GDV). Design—Cohort study. Animals—31 ill dogs admitted to an intensive care unit (ICU) at Washington State University or the University of Pennsylvania; all dogs had acute critical illness for < 48 hours prior to admission. Procedures—Baseline and ACTH-stimulated serum cortisol concentrations and baseline plasma ACTH concentrations were assayed for each dog within 24 hours after admission to the ICU. The change in cortisol concentrations (Δ-cortisol) was calculated for each dog. Morbidity and mortality data were recorded for each patient. Results—Overall, 17 of 31 (55%) acutely critically ill dogs had at least 1 biochemical abnormality suggestive of adrenal gland or pituitary gland insufficiency. Only 1 (3%) dog had an exaggerated response to ACTH stimulation. Dogs with Δ-cortisol ≤ 83 nmol/L were 5.7 times as likely to be receiving vasopressors as were dogs with Δ-cortisol > 83 nmol/L. No differences were detected among dogs with sepsis, severe trauma, or GDV with respect to mean baseline and ACTH-stimulated serum cortisol concentrations, Δ-cortisol, and baseline plasma ACTH concentrations. Conclusions and Clinical Relevance—Biochemical abnormalities of the hypothalamic-pituitary-adrenal axis indicative of adrenal gland or pituitary gland insufficiency were common in critically ill dogs, whereas exaggerated responses to ACTH administration were uncommon. Acutely ill dogs with Δ-cortisol ≤ 83 nmol/L may be more likely to require vasopressors as part of the treatment plan.

Objective—To characterize the magnitude and duration of the antibody response against human albumin (HA) in critically ill and healthy dogs. Design—Cohort and cross-sectional study. Animals—Fourteen critically ill dogs that received 25% HA as part of their treatment protocol, 2 healthy dogs with no known previous exposure to HA that received 2 infusions of 25% HA (positive control dogs), and 47 healthy dogs and 21 critically ill dogs with no known exposure to HA (negative control dogs). Procedures—An ELISA to detect IgG against HA was developed. Serum samples were obtained from the critically ill dogs prior to infusion of HA, at the time of hospital discharge, and 4 to 6 weeks and 6 months after HA administration. Serum samples were obtained at 2- to 4-week intervals from both positive control dogs for 101 weeks. A single serum sample was obtained from each of the negative control dogs. Results—All 14 critically ill dogs developed serum IgG against HA. Peak antibody response was detected 4 to 6 weeks after HA administration. In both positive control dogs, IgG against HA was detected 10 days after HA administration and continued past 97 weeks. The peak antibody response was detected at 3 weeks in 1 dog and at 9 weeks in the other. Five of the 68 (7%) negative control dogs had a positive antibody response. Conclusions and Clinical Relevance—Results suggested that dogs developed a pronounced IgG response following exposure to HA and that some dogs with no history of HA administration were positive for anti-HA IgG.

Investigations into the reasons for declines in late-life disability have largely focused on the role of contemporaneous factors. Adopting a life-course perspective as a backdrop, in this paper we ask whether there also has been a role for selected early- and mid-life factors in the decline, and if so whether these factors have been operating through changes in the risks of disability onset or recovery. Drawing on five waves from 1995 to 2004 of the U.S. Health and Retirement Study, we found for the 75 years and older population in the United States that the prevalence of difficulty with activities of daily living (ADL) declined from 30.2% in 1995 to 26.0% in 2004, whereas the trend in difficulty with instrumental activities of daily living (IADL) was flat. Onset of ADL limitations also was reduced during this period while recovery increased. Changes in the educational composition of the older population were linked to declines in the prevalence of ADL limitations, but there were also modest contributions of changes in mother's education, self-rated childhood health, and lifetime occupation. Declines in late-life vision impairments and increases in wealth also contributed substantially to the downward trend, and had chronic conditions not increased, it would have been even larger. Reductions in the onset of ADL limitations were partly driven by changes in educational attainment of respondents and their mothers and, in late-life, better vision and wealth. In contrast, the recovery trend was not accounted for by changes in early- or mid-life factors. We conclude that early- and mid-life factors have contributed along with late-life factors to U.S. late-life disability trends mainly through their influence on the onset of, rather than recovery from, limitations.

Case Description—6 healthy dogs given human albumin solution as part of a study were examined following development of an immediate hypersensitivity reaction (1 dog) and signs suggestive of a type III hypersensitivity reaction (all 6 dogs). Clinical Findings—All 6 dogs were healthy prior to administration of human albumin solution. One dog developed signs of an immediate hypersensitivity reaction, characterized by vomiting and facial edema, during administration of human albumin solution. All 6 dogs developed signs of a delayed adverse reaction 5 to 13 days after administration of human albumin solution. Initial clinical signs included lethargy, lameness, edema, cutaneous lesions indicative of vasculitis, vomiting, and inappetance. Treatment and Outcome—In the dog with signs of immediate hypersensitivity, signs resolved after administration of human albumin solution was discontinued and diphenhydramine was administered. Supportive treatment was provided after dogs developed signs of a delayed adverse reaction. Four dogs recovered, but 2 dogs died despite treatment. All 6 dogs were found to have antihuman albumin antibodies. There was no evidence of contamination of the human albumin solution. Clinical Relevance—Findings suggest that administration of human albumin solution in healthy dogs with normal serum albumin concentrations may result in signs of a type III hypersensitivity reaction.

In September 2002, a technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population. The 12-person panel prepared estimates from five national data sets and investigated methodological sources of the inconsistencies among the population aged 70 and older from the early 1980s to 2001. Although the evidence was mixed for the 1980s and it is difficult to pinpoint when in the 1990s the decline began, during the mid- and late 1990s, the panel found consistent declines on the order of 1%–2.5% per year for two commonly used measures in the disability literature: difficulty with daily activities and help with daily activities. Mixed evidence was found for a third measure: the use of help or equipment with daily activities. The panel also found agreement across surveys that the proportion of older persons who receive help with bathing has declined at the same time as the proportion who use only equipment (but not personal care) to bathe has increased. In comparing findings across surveys, the panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results were important to consider. The implications of the findings for policy, national survey efforts, and further research are discussed.

TWO years ago, Freedman, Aykan, and Martin (2001) reported that the percentage of older Americans with severe cognitive impairment had declined significantly from 6.1% in 1993 to 3.6% in 1998. These apparent improvements were not explained by changes in demographic and socioeconomic composition or the prevalence of stroke, vision, or hearing impairments. We concluded cautiously that older persons appeared to have better cognitive functioning at the end of the decade. In a companion piece (Freedman, Aykan, & Martin, 2002), we showed that these results were robust to a variety of assumptions about missing data, loss to follow-up, and the institutional population, and called for replication with future waves of the Health and Retirement Study (HRS). In today’s issue of the Journal, Rodgers, Ofstedal, and Herzog (2003) provide this much-needed analysis of additional HRS waves. They conclude, quite the opposite—that there appears to have been little improvement—and call for future studies based on other data sources. Like so many other scientific matters of import, the question of late-life cognitive trends is not easily answered and researchers have called for additional investigation. Yet we are left to wonder: Will analyses of additional data sources bring us closer to the truth or simply add to the confusion? These three analyses of the HRS join a small but growing set of studies of national trends in late-life cognition. Rodgers and colleagues (2003) refer to several studies that draw upon the National Long Term Care Survey, which points to declines in dementia among the chronically disabled from the early 1980s through mid-1990s. In addition, using the 1986 and 1993 National Mortality Followback Studies, Liao, McGee, Cao, and Cooper (2000) showed significant declines in cognitive dysfunction in the last year of life for men aged 65–84 years and women aged 65 years and older. In sum, thus far two surveys suggest improvements, and a third provides inconsistent evidence that appears sensitive to analytic decisions. As in the disability-trend literature, analysis of additional waves and data sources (such as the National Health Interview Survey, which recently added cognition measures) does not guarantee that the ‘‘truth’’ will be forthcoming. During the last decade, for example, inconsistencies have emerged regarding trends in limitations in activities of daily living (ADLs; Freedman, Martin, & Schoeni, 2002). The seven surveys that have provided relevant information offer various strengths and weaknesses and differ in their definitions of disability, the age groups covered, time periods, modes of data collection, rules about proxy involvement, inclusion of institutional population, and effectiveness in minimizing loss to follow-up and nonresponse. A similar set of variations exist for the four national surveys that now include questions on cognition. These varied survey design features are compounded by the distinct analytic decisions made by authors about nonresponse and coding of measures. Rodgers and colleagues (2003), for example, cite several analytic differences between their study and the studies by Freedman and colleagues (2001, 2002)—the treatment of sampled persons for whom proxies responded, the imputation methods for missing data, and the use of different cutoffs to identify those with severe impairment. A fourth key difference that appears especially important in the analysis by Rodgers and colleagues—controlling for prior testing—could not be incorporated into the two-wave comparisons (Freedman et al., 2001, 2002). Without additional sensitivity analyses, it is impossible to sort out how these analytic decisions contribute to the inconsistencies. Moreover, measuring cognitive functioning may be even more challenging than measuring limitations in ADLs or related underlying physical limitations for three reasons. First, cognitive impairment is a complex, multidimensional concept encompassing disruptions of memory, language function, motor activity execution, object recognition, abstract thinking, information processing, spatial orientation, and judgment. Yet these concepts are not easily separated or measured, and despite several reliable clinical screens for dementia, no universally accepted survey instrument has emerged. The wide variation in measurement approaches—from proxy-assessments of memory to tests of recall for those able to participate in a survey—will inevitably complicate comparisons. Second, the mere presence of cognitive impairment increases the need for a proxy. On the basis of the analysis by Freedman and colleagues (2001), for Journal of Gerontology: SOCIAL SCIENCES Copyright 2003 by The Gerontological Society of America 2003, Vol. 58B, No. 6, S347–S349

OBJECTIVES: This study explored the role of various chronic conditions in explaining recent improvements in functioning among older Americans. METHODS: We used the Supplements on Aging to the 1984 and 1994 National Health Interview Surveys to examine changes among Americans 70 years and older in reports of chronic conditions and functional limitations. We decomposed functioning changes into condition-related components, controlling for demographic shifts. RESULTS: The percentage of older Americans with upper- and lower-body limitations declined from 5.1% and 34.2%, respectively, in 1984 to 4.3% and 28.5% in 1995, and the average number of lower body limitations decreased. During the same period, reports of 8 of 9 chronic conditions increased, but many of these conditions had less debilitating effects on functioning. Reductions in the debilitating effects of various chronic conditions--particularly arthritis--are important in explaining declines in limitations experienced by older Americans. CONCLUSIONS: Earlier diagnosis and improved treatment and management of chronic conditions, rather than prevention, may be important contributing factors to improvements in upper- and lower-body functioning among older Americans.

OBJECTIVES: This report documents trends in functional limitations among older Americans from 1984 to 1993 and investigates reasons for such trends. METHODS: We applied logistic regression to data for noninstitutionalized Americans aged 50 years and older from the Survey of Income and Program Participation. We focused on 4 functional limitation measures unlikely to be affected by changes in role expectations and living environments: reported difficulty seeing words in a newspaper, lifting and carrying 10 pounds, climbing a flight of stairs, and walking a quarter of a mile. RESULTS: We found large declines in the crude prevalence of functional limitations, especially for those 80 years and older. Generally, changes in population composition explained only a small portion of the downward trends. Once changes in population composition and mobility-related device use were considered for difficulty walking, significant improvements in functioning remained for the 65- to 79-year-old group. CONCLUSIONS: Changes in population composition, device use, survey design, role expectations, and living environments do not appear to account completely for improvements in functioning. We infer that changes in under-lying physiological capability--whether real or perceived--likely underlie such trends.

Using data from the 1988 Mainichi Newspaper/Nihon University National Family Survey, we analyzed the living arrangements and attitudes toward inheritance of Japanese aged 60 and over. Logit analysis indicates that living arrangements are influenced by gender, age, marital status, education, urban residence, and number of living children. Log-linear modeling of inheritance attitudes shows that living with married children, lower educational attainment, and living in a traditionally agricultural area are associated with favoring bequests to eldest sons, as opposed to bequests to all children equally or to whoever takes care of the elderly person. The results are consistent with modernization theory of gerontology and convergence theory of family sociology in that elderly persons with more "modern" characteristics are more likely to depart from prewar ideals of living with married children and preferring bequests to eldest sons only.

Objectives. We addressed three questions: Have recent improvements in old-age disability been mirrored in changes in self-reported general health status? Are general health status trends similar for younger and older Americans? Have changes in general health status been uniform across demographic and socioeconomic groups? Methods. Using logistic regression, we analyzed data from the 1982–2003 National Health Interview Surveys (n ¼ 1,445,872 aged 18–69; n ¼ 178,384 aged 70 and older). Results. The proportion of people aged 70 and older reporting disability declined at 1.38% per year and the proportion 70 and older reporting poor/fair health declined at 1.85% per year. There was less of a decline in reports of poor/fair health at younger ages. Trends for the 18–69 population showed widening health disparities by income but narrowing of the race/ ethnicity and education gaps. In the older population, there was no change for those aged 80–84 and 85 and older, the race/ ethnicity gap persisted, and both education and income differentials widened over time. Discussion. Declines in proportions reporting poor/fair health among the older population in recent decades mirror declines in disability. Although the younger population has not experienced such progress, its prevalence of poor/fair health is low throughout the 21-year analysis period. Of concern are the growing socioeconomic disparities in health for both younger and older populations.

This article reviews some of the demographic characteristics of population aging and the elderly populations in 14 Asian countries: health and life expectancy; sex ratio, marital status, and living arrangements; and rural versus urban residence, labor force participation, retirement, and income. It also focuses on current programs for the elderly populations in Asia and discusses three general issues of importance in the development of aging policies: (a) to what extent should the West be used as a model; (b) what should be the role of the family versus the government in caring for elderly people who cannot care for themselves; and (c) should eligibility for programs be based on age or need?