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OBJECTIVES Quality improvement (QI) requires data, indicators, and national benchmarks. Knowledge about the usefulness of Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) data are lacking. We examined quality leader and frontline staff perceptions about patient experience measurement and use of Child HCAHPS data for QI. METHODS We surveyed children’s hospital leaders and staff about their use of Child HCAHPS for QI, including measures from other studies. We compared scale and item means for leaders and staff and compared means to other studies. RESULTS Almost all leaders, but only one-third of staff, received reports with Child HCAHPS data. Leaders found the data more useful for comparisons to other hospitals than did staff. Both agreed on the validity of Child HCAHPS scores and used these data for improving pediatric care experiences. They agreed the data accurately reflect their hospital’s quality of care, provide specific information for QI, and can be used to improve pediatric care experiences. They also agreed on approaches to improve Child HCAHPS scores. Among staff, QI was reported as essential to their daily work and that Child HCAHPS data were integral to QI. CONCLUSIONS As uptake of the Child HCAHPS survey increases, our study of one medium-sized, urban children’s hospital revealed that leaders and staff believe Child HCAHPS provides actionable metrics for improvement. Our study fills a gap in research about the use of Child HCAHPS for pediatric QI. A multisite evaluation would provide further information about how the Child HCAHPS survey can improve care.

Background: End-of-life care is increasing as the US population ages. Approaches to providing high-quality end-of-life care vary across setting, diseases, and populations. Several data collection tools measure patient and/or caregiver care experiences at end of life and can be used for quality improvement. Previous reviews examined palliative care improvements or available measures but none explicitly on improving care experiences. We reviewed literature on improving patient and/or caregiver end-of-life care experiences. Design: We searched U.S. English-language peer-reviewed and grey literature after 2000 on adult end-of-life care experiences. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for quantitative studies, Enhancing Transparency in Reporting the Synthesis of Qualitative Research approach for qualitative studies, and Assessment of Multiple Systematic Reviews tool for the literature reviews. Setting: Palliative and hospice care. Population: Full-text abstraction of 84 articles, identifying 16 articles. Measures: Patient and/or caregiver end-of-life care experiences (captured through administrative data or direct report). Results: Articles examined palliative care experiences across settings; none studied hospice care experiences. Patients and/or caregivers assessed overall care experiences, clinician–staff interactions, provider communication, respect and trust, timeliness of care, spiritual support, caregiver knowledge of care plans, or bereavement support. Efforts aimed at improving end-of-life care experiences are limited and show mixed results. Conclusions: Literature on improving patient and/or caregiver end-of-life care experiences is emerging and focused on palliative care experiences. Evidence on improving hospice care experiences is lacking. Research on strategies for improving end-of-life care experiences should go beyond overall care experiences to include specific aspects of palliative and hospice care experiences.

Summary Background In many countries, healthcare-associated infections (HAIs) are problematic in long-term aged care living facilities. In the United States (US), HAIs occur frequently in nursing homes (NHs). Identifying effective practices for state Departments of Health (DOHs) to help NHs improve infection prevention and control and reduce HAIs is necessary. Aim As a first step, the objective was to systematically examine and catalogue the variations in state intentions and activities related to HAI prevention in NHs. Methods An environmental scan of state DOH websites, HAI plans, and HAI state infographics was conducted. Data were collected on 16 items across three domains: (1) intentions to reduce HAIs in NHs, (2) actions to reduce HAIs in NHs, and (3) website usability. Findings State infection control support for NHs varied widely. Most states (92%) mentioned NHs in their HAI plans and 76% included NHs in their infographic. Half has an HAI prevention advisory council, while one-third had a state HAI prevention collaborative. Only 57% of HAI plans that mentioned NHs included training materials on HAI reduction. The most common training available was on antibiotic stewardship. Conclusion Many US states have room for improvement in the support they provide NHs regarding infection prevention and control. Specific areas of improvement include: (1) increased provision of training materials on HAI reduction, (2) focusing training materials on common HAIs, and (3) NH engagement in collaboratives aimed at HAI reduction. More research is needed linking DOH activities to resident outcomes.

Background: Infections are common occurrences at end of life that are associated with high rates of morbidity and mortality among frail elderly individuals. The problem of infections in nursing homes has led to a subsequent overuse and misuse of antibiotics in this already-frail population. Improving palliative care in nursing homes has been proposed as a key strategy to reduce the use of antibiotics. Aim: The aim of this study was to describe the current status of how nursing homes integrates palliative care and infection management at end of life across the nation. Design: This is a cross-sectional survey of nationally representative US nursing homes. Setting/participants: Between November 2017 and October 2018, a survey was conducted with a nationally representative random sample of nursing homes and 892 surveys were completed (49% response rate). The weighted study sample represented 15,381 nursing homes across the nation. Results: Most nursing homes engaged in care plan documentation on what is important to residents (90.43%) and discussed spiritual needs of terminally ill residents (89.50%). In the event of aspiration pneumonia in terminally ill residents, 59.43% of nursing homes responded that resident would be transferred to the hospital. In suspected urinary tract infection among terminally ill residents, 66.62% of nursing homes responded that the resident will be treated with antibiotics. Conclusion: The study found wide variations in nursing home palliative care practices, particularly for timing of end-of-life care discussions, and suboptimal care reported for antibiotic usage. Further education for nursing home staff on appropriate antibiotic usage and best practices to integrate infection management in palliative care at the end of life is needed.

OBJECTIVE To examine the content and actionability of written comments from parents and guardians on the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) survey. METHODS We coded 548 narrative text comments linked to demographic information from the Child HCAHPS survey from July 2017 to December 2020 about inpatient pediatric care at an urban children’s hospital-within-a-hospital at an academic medical center. We developed initial codes based on research findings and the content of the Child HCAHPS survey, and also added codes that emerged from the comments. We performed directed and conventional content analysis. RESULTS Most comments were positive and provided by the child’s mother. About half referred to content on the Child HCAHPS survey, primarily on being treated with courtesy and respect or explaining care at discharge. Comments about other topics most frequently provided a narrative rating of the provider or described whether providers were caring and friendly. Thirty-nine percent of comments were deemed sufficiently specific to make improvements (ie, actionable) in inpatient pediatric care; negative comments or comments about care for sicker patients were more often actionable. CONCLUSIONS Child HCAHPS comments provided rich detail and a large portion were deemed actionable. Comments also provided insights into topics both on the survey itself and on many other inpatient pediatric issues raised by parents and guardians. More research is needed on the value of Child HCAHPS comments, the association between Child HCAHPS open-ended and closed-ended responses, and how quality leaders and frontline staff use comments to improve inpatient pediatric care.

EXECUTIVE SUMMARY Hospitals, physician groups, and other healthcare providers are investing in improved patient care experiences. Prior reviews have concluded that better patient care experiences are associated with less healthcare utilization and better adherence to recommended prevention and treatment, clinical outcomes, and patient safety within hospitals. No comprehensive review has examined the business case for investing in patient experiences. This article reviews the literature on associations between patient experience-measured from the perspective of patients and families-and business outcomes, including patient allegiance and retention, complaints, lawsuits, provider job satisfaction, and profitability. We searched U.S. English-language peer-reviewed articles from January 1990 to July 2019. We followed the preferred reporting items for systematic reviews and meta-analyses guidelines and undertook a full-text review of 564 articles, yielding the inclusion of 40 articles. Our review found that patients with positive care experiences are more likely to return to the same hospital and ambulatory settings for future healthcare needs, retain their health plan, and voice fewer complaints. Associations between patient experiences and profitability or provider job satisfaction were limited/mixed. This suggests that providers can pursue better patient care experiences for the intrinsic value to patients, while also recognizing it is good for intermediate business outcomes: specifically increased recommendations, better patient retention, and fewer complaints. Nursing and physician care, broadly defined, are the only specific aspects of patient experience consistently associated with retention, with evidence pointing to communication and trust as parts of care linked to the intent to return. These aspects of patient experience are also the largest contributors to the overall ratings of a provider or facility.

Objectives In the U.S., home health agencies (HHAs) provide essential services for patients recovering from post-acute-care and older adults who are aging in place. During the COVID-19 pandemic, HHAs may face additional challenges caring for these vulnerable patients. Our objective was to explore COVID-19 preparedness of U.S. HHAs and compare results by urban/rural location. Design Cross-sectional study. Setting/Participants Using a stratified random sample of 978 HHAs, we conducted a 22-item online survey from April 10 to 17, 2020. Methods Summary statistics were computed; open-ended narrative responses were synthesized using qualitative methods. Results Similar to national data, most responding HHAs (n=121, 12% response rate) were for-profit and located in the South. A majority of HHAs had infectious disease outbreaks included in their emergency preparedness plan (76%), a staff member in charge of outbreak/disaster preparedness (84%), and had provided their staff with COVID-19 education and training (97%). More urban HHAs had cared for confirmed and recovered COVID-19 patients than rural HHAs, but urban HHAs had less capacity to test for COVID-19 than rural HHAs (9% vs 21%). Most (69%) experienced patient census declines and had a current and/or anticipated supply shortage. Rural agencies were impacted less than urban agencies. HHAs have already rationed (69%) or implemented extended use (55%) or limited reuse (61%) of personal protective equipment (PPE). Many HHAs reported accessing supplemental PPE from state/local resources, donations, and do-it-yourself efforts; more rural HHAs had accessed these additional resources compared to urban HHAs. Conclusions/Implications This survey reveals challenges that HHAs are having in responding to the COVID-19 pandemic, particularly among urban agencies. Of greatest concern are the declines in patient census, which drastically impact agency revenue, and the shortages of PPE and disinfectants. Without proper protection, HHA clinicians are at risk of self-exposure and viral transmission to patients and vulnerable family members., Brief summary This survey of U.S. home health agencies identified specific challenges that agencies are having, as well as mitigating strategies they are using, while providing care to patients in their homes during the COVID-19 pandemic.

CONTEXT:Achieving high-quality patient-centered care requires assessing patient and family experiences to identify opportunities for improvement. With the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey, hospitals can assess performance and make national comparisons of inpatient pediatric experiences. However, using patient and family experience data to improve care remains a challenge.OBJECTIVE:We reviewed the literature on best practices for monitoring performance and undertaking activities aimed at improving pediatric patient and family experiences of inpatient care.DATA SOURCES:We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsychINFO.STUDY SELECTION:We included (1) English-language peer-reviewed articles published from January 2000 to April 2019; (2) articles based in the United States, United Kingdom, or Canada; (3) articles focused on pediatric inpatient care; (4) articles describing pediatric patient and family experiences; and (5) articles including content on activities aimed at improving patient and family experiences. Our review included 25 articles.DATA EXTRACTION:Two researchers reviewed the full article and abstracted specific information: country, study aims, setting, design, methods, results, Quality Improvement (QI) initiatives performed, internal reporting description, best practices, lessons learned, barriers, facilitators and study implications for clinical practice, patient-experience data collection, and QI activities. We noted themes across samples and care settings.RESULTS:We identified 10 themes of best practice. The 4 most common were (1) use evidence-based approaches, (2) maintain an internal system that communicates information and performance on patient and family experiences to staff and hospital leadership, (3) use experience survey data to initiate and/or evaluate QI interventions, and (4) identify optimal times (eg, discharge) and modes (eg, print) for obtaining patient and family feedback. These correspond to adult inpatient best practices.CONCLUSIONS:Both pediatric and adult inpatient best practices rely on common principles of culture change (such as evidence-based clinical practice), collaborative learning, multidisciplinary teamwork, and building and/or supporting a QI infrastructure that requires time, money, collaboration, data tracking, and monitoring. QI best practices in both pediatric and adult inpatient settings commonly rely on identifying drivers of overall ratings of care, rewarding staff for successful implementation, and creating easy-to-use and easy-to-access planning and QI tools for staff.

Objectives As shared decision making (SDM) has received increased attention as a method to improve the patient-centeredness of emergency department (ED) care, we sought to determine patients' desired level of involvement in medical decisions and their perceptions of potential barriers and facilitators to SDM in the ED. Methods We surveyed a cross-sectional sample of adult ED patients at three academic medical centers across the United States. The survey included 32 items regarding patient involvement in medical decisions including a modified Control Preference Scale and questions about barriers and facilitators to SDM in the ED. Items were developed and refined based on prior literature and qualitative interviews with ED patients. Research assistants administered the survey in person. Results Of 797 patients approached, 661 (83%) agreed to participate. Participants were 52% female, 45% white, and 30% Hispanic. The majority of respondents (85%-92%, depending on decision type) expressed a desire for some degree of involvement in decision making in the ED, while 8% to 15% preferred to leave decision making to their physician alone. Ninety-eight percent wanted to be involved with decisions when "something serious is going on." The majority of patients (94%) indicated that self-efficacy was not a barrier to SDM in the ED. However, most patients (55%) reported a tendency to defer to the physician's decision making during an ED visit, with about half reporting they would wait for a physician to ask them to be involved. Conclusion We found that the majority of ED patients in our large, diverse sample wanted to be involved in medical decisions, especially in the case of a "serious" medical problem, and felt that they had the ability to do so. Nevertheless, many patients were unlikely to actively seek involvement and defaulted to allowing the physician to make decisions during the ED visit. After fully explaining the consequences of a decision, clinicians should make an effort to explicitly ascertain patients' desired level of involvement in decision making.

Objective No methodologically robust system exists for capturing consumer-generated patient safety reports. To address this challenge, we developed and pilot-tested a prototype consumer reporting system for patient safety, the Health Care Safety Hotline. Design Mixed methods evaluation. Setting The Hotline was implemented in two US healthcare systems from 1 February 2014 through 30 June 2015. Participants Patients, family members and caregivers associated with two US healthcare systems. Intervention A consumer-oriented incident reporting system for telephone or web-based administration was developed to elicit medical mistakes and care-related injuries. Main Outcomes Measures Key informant interviews, measurement of website traffic and analysis of completed reports. Results Key informants indicated that Hotline participation was motivated by senior leaders' support and alignment with existing quality and safety initiatives. During the measurement period from 1 October 2014 through 30 June 2015, the home page had 1530 visitors with a unique IP address. During its 17 months of operation, the Hotline received 37 completed reports including 20 mistakes without harm and 15 mistakes with injury. The largest category of mistake concerned problems with diagnosis or advice from a health practitioner. Hotline reports prompted quality reviews, an education intervention, and patient follow-ups. Conclusion While generating fewer reports than its capacity to manage, the Health Care Safety Hotline demonstrated the feasibility of consumer-oriented patient safety reporting. Further research is needed to understand how to increase consumers' use of these systems.

OBJECTIVE: We sought to assess the frequency, content, and quality of shared decision making (SDM) in the emergency department (ED), from patients’ perspectives. METHODS: Utilizing a cross-sectional, multisite approach, we administered an instrument, consisting of two validated SDM assessment tools—the CollaboRATE and the SDM-Q-9—and one newly developed tool to a sample of ED patients. Our primary outcome was the occurrence of SDM in the clinical encounter, as defined by participants giving “top-box” scores on the CollaboRATE measure, and the ability of patients to identify the topic of their SDM conversation. Secondary outcomes included the content of the SDM conversations, as judged by patients, and whether patients were able to complete each of the two validated scales included in the instrument. RESULTS: After exclusions, 285 participants from two sites completed the composite instrument. Just under half identified as female (47%) or as white (47%). Roughly half gave top-box scores (i.e., indicating optimal SDM) on the CollaboRATE scale (49%). Less than half of the participants were able to indicate a decision they were involved in (44%), although those who did gave high scores for such conversations (73/100 via the SDM-Q-9 tool). The most frequently identified decisions discussed were admission versus discharge (19%), medication options (17%), and options for follow-up care (15%). CONCLUSIONS: Fewer than half of ED patients surveyed reported they were involved in SDM. The most common decision for which SDM was used was around ED disposition (admission vs. discharge). When SDM was employed, patients generally rated the discussion highly.

Introduction There is an increasing call for developing validity evidence in medical education assessment. The literature lacks a practical resource regarding an actual development process. Our workshop teaches how to apply principles of validity evidence to existing assessment instruments and how to develop new instruments that will yield valid data. Methods The literature, consensus findings of curricula and content experts, and principles of adult learning guided the content and methodology of the workshop. The workshop underwent stringent peer review prior to presentation at one international and three national academic conferences. In the interactive workshop, selected domains of validity evidence were taught with sequential cycles of didactics, demonstration, and deliberate practice with facilitated feedback. An exercise guide steered participants through a stepwise approach. Using Likert-scale items and open-response questions, an evaluation form rated the workshop's effectiveness, captured details of how learners reached the objectives, and determined participants' plans for future work. Results The workshop demonstrated generalizability with successful implementation in diverse settings. Sixty-five learners, the majority being clinician-educators, completed evaluations. Learners rated the workshop favorably for each prompt. Qualitative comments corroborated the workshop's effectiveness. The active application and facilitated feedback components allowed learners to reflect in real time as to how they were meeting a particular objective. Discussion This feasible and practical educational intervention fills a literature gap by showing the medical educator how to apply validity evidence to both existing and in-development assessment instruments. Thus, it holds the potential to significantly impact learner and, subsequently, patient outcomes.

Introduction Curricular innovations are invaluable to the improvement of medical education programs, and thus, their dissemination to broader audiences is imperative. However, medical educators often struggle to translate innovative ideas into scholarly pursuits due to a lack of experience or expertise in selecting outcome measures that demonstrate impact. A recent national call for increased focus on outcome measures for medical education research highlights the need for more training in this area. Methods We developed a 2-hour interactive workshop to improve educator ability to identify outcome measures for educational innovations. This workshop was delivered at a national pediatrics educational conference and at three local institutional faculty development sessions. Results Participants were diverse in terms of experience, expertise, and roles within their educational programs. Participants rated the workshop positively in each setting and identified next steps in developing their own products of educational scholarship. Discussion This workshop can provide faculty and faculty developers with a template for developing a skill set in identifying outcome measures and pairing them with educational innovations.

Past research has examined the relative impact of family and peers on adolescent behavior, but very little research has examined it in relation to youth dating violence. Eight hundred and sixty-five adolescents, primarily urban Latino youth, completed self-administered surveys at school. Multivariate analyses indicated that exposure to prior family violence was not significantly associated with adolescents’ aggressive expression of anger or their acceptance of cross-gender aggression. However, current conflict—either family or peer—was associated with adolescent behavior and attitudes, with the exception that current peer conflict was not significantly associated with adolescents’ acceptance of male on female aggression. Parental monitoring and attachment were not found to be moderators of these relationships. Implications for dating violence interventions and future directions for research are explored.

Cells were harvested from four rumen locations in four 2- to 3-yr-old ewes fed fescue hay to determine whether cell origin has an effect on cellular VFA metabolism. Tissue (approximately 150 cm2) was excised from the anterior cranial pillar, ventral sac floor, caudal pillar surface, and dorsal sac ceiling. Cells were isolated using serial tryptic digestion. One milliliter of isolate was incubated for 2 h in 6 mL of medium containing 25 mM propionate and 10 mM butyrate. Incubations were terminated at 0, 30, 60, 90, and 120 min and analyzed for beta-hydroxybutyrate, acetoacetate, lactate, and pyruvate. Cell yield was 22, 22, 24, and 14 (+/- 6) x 106 cells/mL, and viability was 92, 92, 94, and 87% for anterior cranial pillar, ventral sac floor, caudal pillar surface, and dorsal sac ceiling, respectively. All metabolite concentrations and ratios of redox pairs increased throughout the incubations, indicating continuous cellular activity. Final 2-h concentrations (nmol/10(6) cells) were 123, 113, 163, and 158 (+/- 35) for beta-hydroxybutyrate; 38, 42, 24, and 45 (+/- 10) for acetoacetate; 25.3, 20.6, 10.1, and 20.4 (+/- 5.6) for lactate; and 2.54, 0.98, 1.06, and 1.31 (+/- 0.61) for pyruvate in the anterior cranial pillar, ventral sac floor, caudal pillar surface and dorsal sac ceiling incubations, respectively. Origin of rumen tissue had no significant effect on metabolite production, indicating that cellular location is not a critical factor that affects rate of rumen epithelial cell VFA metabolism under these specific in vitro conditions.

Sixteen Holstein calves were used in a completely randomized design to evaluate effects of dry feed intake and time after feeding on concentration of selected peripheral blood metabolites. Calves entered the study at 13 (SD = 2.9) d of age and were fed milk replacer (10% of BW) twice daily to weaning at 28 (Grain) or 84 (Milk) d and calf starter from 1 (Grain) or 56 (Milk) d. Blood was sampled every 14 d at 0 and 2 h after the morning feeding and analyzed for beta-hydroxybutyrate (beta HBA), glucose, nonesterified fatty acids, urea N, L(+) lactate, and VFA. Blood beta HBA and VFA increased with increasing dry feed intake, but particularly at 2 h postfeeding. Molar proportion of VFA as acetate declined and propionate and butyrate increased with increasing feed intake. Glucose at 2 h postfeeding declined after weaning to levels lower than 0-h values. Prefeeding glucose concentrations increased with increasing grain intake. Lactate declined throughout the study without effect of treatment or time after feeding. Data indicate that marked changes occur with increasing grain intake and time after feeding. Increased blood beta HBA seems to be a response to alimentary ketogenesis.

The chemical composition and protein quality of 11 alternative protein sources (chicken products, blood products, enzyme-hydrolyzed fish protein concentrate, soybean meal, and spray-dried pork liver) were determined, and an experiment was conducted to determine palatability and digestibility of processed red blood cell-containing diets. Chicken protein sources differed in concentrations of CP, acid-hydrolyzed fat, and total AA (TAA) by 20, 31, and 24%, respectively, and GE by 1.7 kcal/g. Blood protein sources varied little in acid-hydrolyzed fat and GE concentrations, but concentrations of CP and TAA differed by 11 and 8%, respectively. Protein solubility of chicken and blood protein source categories averaged 57 and 69%, respectively. Protein solubility of enzyme-hydrolyzed fish protein concentrate, soybean meal, and spray-dried pork liver was 53, 67, and 26%, respectively. Based on calculations from immobilized digestive enzyme assay values, lysine digestibility averaged approximately 80.4 and 81.7% for blood and chicken protein sources, respectively. Lysine digestibility values for soybean meal and spray-dried pork liver were 89 and 77%, respectively. A chick protein efficiency ratio (PER) assay showed that chicken protein sources had high protein quality values, as the PER ranged from 2.7 to 5.3, whereas blood protein sources had poor protein quality (PER values less than 1.5). Enzyme-hydrolyzed fish protein concentrate, spray-dried pork liver, and soybean meal had high protein quality (PER values greater than 2.8). In the dog palatability and digestibility experiments, a corn and chicken-based diet supplemented with either 0 or 3% processed red blood cells was tested. The palatability test showed that dogs consumed more of the diet that contained 0% vs. 3% processed red blood cells. The intake ratio for the 3% processed red blood cells diet was 0.34. Nutrient digestibilities did not differ, except for CP, where the digestibility was greater (P = 0.01) for dogs consuming the 0% processed red blood cells diet. These data suggest that chemical composition and quality of alternative protein sources differ greatly among ingredients within the same category. Palatability data suggest that a processed red blood cells-containing diet is not highly palatable but, when this diet was offered as only one food, dogs demonstrated no aversion response but some decrease in protein digestion.

1. The naturally occurring compounds curcumin (CUR), 3,3'-diindolylmethane (DIM), isoxanthohumol (IXN), 8-prenylnaringenin (8PN), phenethyl isothiocyanate (PEITC) and sulforaphane (SFN) protect animals against chemically induced tumours. Putative chemoprotective mechanisms include modulated expression of hepatic biotransformation enzymes. However, few, if any, studies have used human primary cells as test models. 2. The present study investigated the effects of these phytochemicals on the expression of four carcinogenesis-relevant enzymes--cytochrome P450 (CYP)1A1 and 1A2, NAD(P)H:quinone oxidoreductase (NQO1) and glutathione S-transferase A1 (GSTA1)--in primary cultures of freshly isolated human hepatocytes. 3. Quantitative RT-PCR analyses demonstrated that CYP1A1 was up-regulated by PEITC and DIM in a dose-dependent manner. CYP1A2 transcription was significantly activated following DIM, IXN, 8PN and PEITC treatments. DIM exhibited a remarkably effective induction response of CYP1A1 (474-, 239- and 87-fold at 50, 25 and 10 microM, respectively) and CYP1A2 (113-, 70- and 31-fold at 50, 25 and 10 microM, respectively), that was semiquantitatively reflected in protein levels. NQO1 expression responded to PEITC (11 x at 25 microM), DIM (4.5 x at 50 microM) and SFN (5 x at 10 microM) treatments. No significant effects on GSTA1 transcription were seen. 4. The findings show novel and unexpected effects of these phytochemicals on the expression of human hepatic biotransformation enzymes that play key roles in chemical-induced carcinogenesis.

Four nonlactating, nonpregnant, mature ewes equipped with multiple venous and arterial catheters were used to evaluate the influence of propionate as a satiety signal in ruminants. Our experiment was a 4 x 4 Latin square with portal infusion (physiological saline [Sa] or sodium propionate [Pr]) and DE intake (Lo, 63% of maintenance requirement, or Hi, 200% of maintenance requirement) as factors. One 240-min infusion of Pr (1 mmol/min) or Sa into the portal vein began at approximately 0800 on d 8 of each 8-d period. Feed intake was measured and hepatic blood was sampled every 30 min during infusion. Intake of DM and digestible energy (DEI) during infusion were not affected by infusion or diet and were most rapid at 30 min postfeeding. Average 30-min DMI and DEI were 539 g and 1,484 kcal, respectively, at 240 min. Cumulative DMI and DEI were unaffected by infusion but tended to be greater with Lo. After 30 min, animals tended to consume Lo at a greater rate than Hi, suggesting that satiety was delayed. Insulin concentration was increased (P less than .02) when animals consumed Hi (36.1 mU/liter) vs Lo (16.8 mU/liter) and was elevated (P less than .01) at 30 and 60 min postfeeding when animals were infused with Pr. Plasma acetate tended to be reduced with Pr infusion. Plasma Pr tended to increase with Pr infusion, especially when sheep were fed Lo. Satiety, DMI, and DEI were not affected by Pr infusion in this study.

In three experiments, weanling pigswere used to investigate the effect of feeding .5%galactosyl lactose in a simple corn-soy diet on nutrientdigestibility, selected ileal microbial concentrations,fermentation acids, and performance. In Exp. 1, 2021-d-old weaned pigs in two replicate trials were fedeither a 19% CP corn and soybean meal diet or asimilar diet containing .5% galactosyl lactose. Fecesand urine were collected over a 3-wk period todetermine apparent CP and energy digestibilities.Apparent digestibilities of CP and energy were notdifferent between treatments. In Exp. 2, 2414-d-old nursing pigs were cannulated at the terminalileum and fed the diets described above after weaningat 21 d of age. Ileal samples were collected at 20, 23,27, 30, 34, 37, and 41 d of age. Samples were assayedfor VFA, lactate, and selected microflora. Ileal fermen-tation acid concentrations and selected microflorawere affected by age of pig but were not differentbetween feed treatments. In Exp. 3, 91 21- to24-d-old weaned pigs were fed the control and testdiets already described; intake, BW gain, and feedefficiency were determined for 9 wk after weaning.Intake was greater in pigs fed galactosyl lactose, butADG and gain/feed did not differ between treatments.Inclusion of galactosyl lactose in weanling pig dietsdid not affect protein or energy digestibility,microflora, short-chain fatty acids, or performance ofyoung pigs.Key Words: Pigs, Oligosaccharides, Volatile Fatty Acids, IleumJ. Anim. Sci. 1997. 75:1009–1016

AS POINTED out by Quigley (1944), commercial poultrymen have in some instances associated blue comb or pullet disease with wheat feeds. It has also been pointed out by Quigley (1944), that there is a significant difference in germination between wheats associated with the appearance of pullet disease and wheats which were found to be not associated with the appearance of the disease. Wheat samples regarded as positive for the appearance of pullet disease had a mean germination of 68.3 percent, and those regarded as negative had a mean germination of 89.4 percent. The purpose of this paper is to present evidence that wheats being fed to flocks when blue comb developed have a different microflora from wheats not associated with blue comb. The association of feed stuffs with certain animal diseases is not new, and it is necessary to call attention to only one outstanding and pertinent case—that concerning . . .

THE heavy feeding of wheat in many sections of the country and the continued incidence of “pullet disease” or “blue comb” in widespread areas would seem to justify an interim report and discussion of a limited number of field observations and experimental work conducted by the author at the Maryland Agricultural Experiment Station. The condition known as pullet disease (also termed X disease, blue comb, new wheat disease) was first described by Beaudette (1929) but despite the efforts of several investigators to transmit the condition from bird to bird, none appears to have succeeded. The possible exception is Waller (1942) who announced the isolation of a virus from acute cases which was not capable of producing death, hence he was unable to identify the virus as the sole etiological agent in pullet disease. Other investigators have proceeded without success along similar lines, and to the present time it is considered . . .

THE reported success of the chemical dichloro-diphenyl-trichlorethane, hereinafter known as DDT, as an insecticide, and its possible use around poultry houses and hatcheries, prompted an investigation as to its safety and effectiveness. It was observed early in the investigation that DDT was effective against lice, so attempts were made to develop a satisfactory method of flock treatment for these parasites. This work was started in August 1944. Since it is known that mammals and fish show substantial variability to the toxic effects of DDT, it was considered necessary in this work to study its toxicity to poultry, to hatching eggs or developing embryos, but above all to study the usefulness and limitations of DDT, and to acquire experience in its application to practical poultry problems. No experiments were conducted with solutions of DDT in oil and no recommendations are made for the use of this type of material. All data . . .

THE rapid changes in the poultry industry are evident to all who are engaged in it, but they are especially apparent to those whose experience spans 10, 15, 25 or more years. The operation of poultry production and the distribution of our products, is undergoing the same change apparent in most of agriculture,—indeed in almost all kinds of business, and we find fewer units, but larger ones. Both vertical and horizontal integration is coming into the poultry picture very rapidly, and the advent of the contract system of producing turkeys, broilers and eggs has been described as nothing short of revolutionary in agricultural history. The changes which we see are producing concentrations of capital, administrative responsibility, and expenditures for advertising and promotion, which are large and substantial. This is true both within the poultry industry, and in closely allied contributing industries, as feed, equipment, and drugs. In turn this . . .

RESISTANCE to disease is a variable factor. Operating together with changes in organism virulence, it is responsible for the severity of any given disease attack. Experimental evidence bringing more light to bear upon the conditions under which pullorum resistance varies may prove a valuable aid to brooding and flock management. Rettger, Kirkpatrick, and Stoneburn showed that pullorum resistance varies with age. Roberts and Card demonstrated the variation of pullorum resistance caused by genetic factors. These authors determined, among other things, that “Selection was effective in producing strains of domestic fowl more resistant than . . . unselected stocks in respect to infection by Salmonella pullora.” The same investigators also noted an increase of resistance under natural conditions in the presence of infection. They reported that among flocks of the Chia Gi variety in the vicinity of Peiping, China, pullorum reactors were present while no evidence of pullorum infection could be . . .

IN TEACHING, as in research, government, business, and other activities of man, a progressive society must constantly appraise educational techniques, procedures, and policies. Such is the price of progress. One area where appraisal and re-evaluation is in order is the well known procedure known as live poultry judging. Since there can be more than one interpretation of the scope of judging, we will limit our discussion to comparative consideration of evidence of health, productivity of meat or eggs, together with minimum breed requirements to keep our breeds intact. Included are all visible economic factors; excluded are many of the details known generally as belonging peculiarly to “fancy” poultry. The objection to judging that one may hear is that its importance in relation to breeding and genetics has declined, hence by implication, training in judging is a waste of student time and energy. We regret that to us this viewpoint represents …

A 2-year study was made of numbers of body lice, Menacanthus stramineus (Nitzsch), on Maryland Flightless chickens divided into 10 flocks of 11 layers and 1 male per floor pen. Estimates on degree of infestation were made on 5 or more occasions following artificial infestation using a subjective score of 0 to 10. Evidence is submitted of pronounced and consistent variation in louse numbers in the same pen. Significant differences in louse scores in 1960–61 and 1961–62 were found for dam families, but sire families revealed no differences. This suggests a dam influence in body chemistry, or behavioristic characters, or both.

It does not seem to be recognized sufficiently among operators of incubators and other precision temperature equipment that the flexible gas wafer thermostat is affected by barometric pressure as well as by temperature changes. An increase in barometric pressure has the effect of compressing the wafer slightly, this compression acting the same as a decrease in temperature; consequently, the machine responds by building up heat to compensate for the increase in pressure upon the control wafer. This resulting change in the temperature of the incubator is therefore an additional variation to the normal lag between the “make” and “break” of the control mechanism. PROCEDURE The observations herein recorded were made upon a standard, well-known incubator in good mechanical condition. The thermometer used was a number 19245-B made by the Central Scientific Company, and was graduated in 1/10°C. increments, but could be read fairly easily to 1/100°C. increments by means of . . .

Need was experienced for an individual feed hopper suitable for experimental work in laying cages to permit accurate, frequent, and convenient measurement of feed consumption. The hopper (Figures 1 and 2) shown was designed to accomplish these objectives, and it has proven satisfactory in practice. It has high flares on both ends to prevent birds from reaching around or over same to eat from their neighbor's trough. When filled to a level that minimizes feed wastage, its capacity is about 500 gms. The over all length (8″ in our design) must be such as to prevent a bird from reaching between the cage partition and the feeder. The design shown is for the “Hart-ford” laying cage. Other small changes in design might be necessary for other makes, including adjustment of height to permit eggs to roll past the feeder. *

The work of Hoffman (1961), Sherman and Ross (1960, 1961, 1962), Dorough et al. (1961), Furman et al. (1962), outlines the possibility of using systemic insecticides for poultry, but the principal benefit was in the control of larvae of the housefly, Musca domestica L. An exception was Sherman and Ross (1962). A systemic effect, resulting in the death of a mite species was shown for Sevin by Furman and Pieper (1962). Hoffman (1961) reported a partial control of lice after administering Ruelene in a single dose. In the foregoing, comparatively large single doses were used, or when continuous feeding was employed, comparatively high levels of the insecticide were used. Some toxicity was occasionally shown. There would therefore seem to be room for an insecticide to be fed for longer periods of time at lower levels. Certainly there seemed to be a need for knowledge of the control of other species…

The shape of the spur of the capon is in general described as differing somewhat from the cock, notably in being longer and more pointed. Spur growth also is favored in absence of the gonads, see, for example, Goodale (1918), Domm (1927). Goodale considers the larger body size of the capon as due to continued growth of the bones and associated structures and as reflecting the persistence of certain juvenile qualities: this would suggest a prolongation of the growth period rather than accelerations within it. Observations to this effect specifically regarding the spur have not been noted in the literature. The measurements recorded in the present brief communication were planned to compare spur length in the cockerel, slip, and capon at successive ages and also to outline changes of shape developing in the spurs of the three groups at these same periods. For this purpose, in addition to spur length, . . .

The onset of an attack of “bluecomb” or “pullet disease” in a flock of New Hampshires at the Poultry Experimental Farm of the University of Maryland, and the statements of Jungherr (1942) and Beaudette (1942) that poultrymen in their areas may call this trouble “wheat disease” or “new wheat disease,” and a similar and firm conviction in the minds of certain Maryland commercial poultrymen, promoted this preliminary study of the role of wheat in the development of this disease. At the outset it was realized that the elements of an experiment were partially lacking since the condition had been developing in the flock for several weeks before it was definitely diagnosed, therefore, in the affected New Hampshires the comparative effect of wheat versus corn can only be interpreted during the typically long recovery phase of the trouble. The flocks reported are two in number, pen 7 with 99 pullets and . . .

Brief descriptions of a vacuum evaporator, which overcomes the difficulty in decontamination after use with radoactive and toxic metals, and methods for its use are given. (auth)

A field report requested information on the effects of Malathion an organic phosphate insecticide, on egg quality. Harding and Quigley (1956) applied Malathion dust to litter at various rates and found that it did not affect hatchability and residues were not detected in eggs. Gaafar and Turk (1956) dusted three-week-old chicks for four successive weeks with this same compound and they found it did not affect feed intake and no signs of toxicity were observed. The literature does not reveal any investigations on the effect of this insecticide on egg quality. Therefore, it appears that information in this area is pertinent before any conclusions can be drawn on test results. Eight pens, each with a total area of 63 sq. ft., were selected for this study, four of which were treated with 4% Malathion. Each pen contained 15 White Leghorn hens on an all-mash diet. The insecticide was carefully applied . . .

D-aianine (DAL) and diaminopimelic acid (DAP) were compared as markers to estimate propor- tion of bacterial N in total N reaching the abomasum of young calves. Sixteen Holstein bul/calves fed complete pelleted starter or unpelleted starter plus hay and weaned at 4 or 8 wk of age were fitted with ruminal and abomasal cannulas and sampled twice weekly from 2 to 11 wk of age. Iso- lated ruminal bacterial ceils contained more DAL than DAP at all weeks and averaged 7.0 and 5.4 mg N/g N, respectively. Weekly mean marker concentrations were highly correlated (.89) in ruminal bacteria, except at 3 wk of age. Concentration of DAL in abomasal digesta was greater than that of DAP at all weeks and averaged 5.2 and 2.4 mg N/g N, respectively. Weekly mean DAL correlated with DAP .61 in abomasal digesta and correlated .57 and .89 with starter intake, respec- tively. The proportion of bacterial N in total abomasal N was greater at all weeks when estimated by DAL than by DAP and averaged 77% and 46%, respectively. Estimates by DAL exceeded 100% in several cases and reflected large variation in analytical estimates. Estimates by DAL and DAP correlated .33 and .92 with starter intake. D-alanine was not an acceptable bacterial marker in this study. (Key Words: Calves, Bacteria, Markers, Alanine, Diaminopimelic acid, Protein.)