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Biomedical subjects

C M Williams

Publications and source records attributed to C M Williams.

At least 37 records · Page 2Linked to original sources

Synergistic efects of opioid and cannabinoid antagonists on food intake.

RATIONALE: Central cannabinoid systems have been implicated in appetite regulation through the hyperphagic effects of exogenous and endogenous cannabinoids. These effects may involve activation of reward systems and be mediated in part by opioidergic processes. OBJECTIVE: Cannabinoid-opioid interactions in feeding were examined by testing the combined effects on food intake of sub-anorectic doses of selective antagonists for CB1 and opioid receptors. METHODS: Male rats (n = 8) received subcutaneous injections of naloxone (0, 0.1, 0.5, 1.0 mg/kg) and SR141716 (0, 0.1, 0.5, 1.0 mg/kg) before l-h, nocturnal food (chow) intake tests. RESULTS: Neither naloxone nor SR141716 reliably affected feeding when administered alone. By contrast, combined administration of the two antagonists significantly suppressed chow intake at each dose combination. Joint administration of the highest doses of each antagonist suppressed intake by 73%, a significantly greater effect than produced by either naloxone (32%) or SR141716 alone (17%). CONCLUSION: The data reveal a synergistic interaction between the effects of naloxone and SR141716 on feeding, provide further evidence of important functional relationships between endogenous cannabinoid and opioid systems, and strengthen the postulated role for endocannabinoids in reward processes contributing to the normal control of appetite.

Animals↗

Second meal effect: modified sham feeding does not provoke the release of stored triacylglycerol from a previous high-fat meal.

The present study was carried out to determine whether cephalic stimulation, associated with eating a meal, was sufficient stimulus to provoke the release of stored triacylglycerol (TAG) from a previous high-fat meal. Ten subjects were studied on three separate occasions. Following a 12 h overnight fast, subjects were given a standard mixed test meal which contained 56 g fat. Blood samples were taken before the meal and for 5 h after the meal when the subjects were randomly allocated to receive either water (control) or were modified sham fed a low-fat (6 g fat) or moderate-fat (38 g fat) meal. Blood samples were collected for a further 3 h. Compared with the control, modified sham feeding a low- or moderate-fat meal did not provoke an early entry of TAG, analysed in either plasma or TAG-rich lipoprotein (TRL) fraction (density <1.006 kg/l). The TRL-retinyl ester data showed similar findings. A cephalic phase secretion of pancreatic polypeptide, without a significant increase in cholecystokinin levels, was observed on modified sham feeding. Although these data indicate that modified sham feeding was carried out successfully, analysis of the fat content of the expectorant showed that our subjects may have accidentally ingested a small amount of fat (0.7 g for the low-fat meal and 2.4 g for the moderate-fat meal). Nevertheless, an early TAG peak following modified sham feeding was not demonstrated in the present study, suggesting that significant ingestion of food, and not just oro-sensory stimulation, is necessary to provoke the release of any TAG stored from a previous meal.

Adult↗

Use of water-miscible retinyl palmitate as markers of chylomicrons gives earlier peak response of plasma retinyl esters compared with oil-soluble retinyl palmitate.

Delayed peak response of plasma retinyl esters (RE) relative to plasma triacylglycerols (TAG) and apolipoprotein (Apo) B-48 responses following a fat load supplemented with vitamin A raised doubts about the use of vitamin A to label dietary-derived lipids and lipoproteins. The present study compared the use of water-miscible and oil-soluble retinyl palmitate (RP) as markers of dietary-derived lipoproteins in healthy subjects along with the measurements of postprandial plasma TAG and ApoB-48 responses to investigate whether the delayed peak response observed was due to delayed intestinal output of RE from oil-based solutions. Nine healthy female subjects were given a standard test meal containing a dose (112 mg) of RP in either water-miscible or oil-soluble form in random order, on two separate occasions after a 12 h overnight fast. The results showed that the mean plasma RE concentrations reached a peak significantly later than mean plasma TAG and ApoB-48 concentrations when oil-soluble RP was consumed, whereas plasma RE peaked earlier relative to plasma TAG and ApoB-48 responses when water-miscible RP was used. The results suggested a more rapid absorption with a significantly higher and earlier peak response of plasma RE when water-miscible RP was consumed. This was in contrast to the delayed initial appearance and later sustained higher concentrations of plasma RE during the late postprandial period when oil-soluble RP was consumed. The RE response to the water-miscible RP showed better concordance with plasma TAG response than that of oil-soluble RP.

Adult↗

Dietary monounsaturated fatty acids and haemostasis.

Diets high in monounsaturated fatty acids (MUFA) are increasingly being recommended as a highly-effective cholesterol-lowering strategy in populations at risk of CHD. However, the need for a re-appraisal of the benefits of diets rich in MUFA became apparent as a result of recent studies showing that meals high in olive oil cause greater postprandial activation of blood coagulation factor VII than meals rich in saturated fatty acids. The present review evaluates the evidence for the effects of MUFA-rich diets on fasting and postprandial measurements of haemostasis, and describes data from a recently-completed long-term controlled dietary intervention study. The data show that a background diet high in MUFA has no adverse effect on fasting haemostatic variables and decreases the postprandial activation of factor VII in response to a standard fat-containing meal. Since the same study also showed a significant reduction in the ex vivo activation of platelets in subjects on the high-MUFA diet, the overall findings suggest that there is no reason for concern regarding adverse haemostatic consequences of high-MUFA diets.

Cardiovascular Diseases↗

Prolonged effects of modified sham feeding on energy substrate mobilization.

BACKGROUND: Vagal stimulation in response to nutrients is reported to elicit an array of digestive and endocrine responses, including an alteration in postprandial lipid metabolism. OBJECTIVE: The objective of this study was to assess whether neural stimulation could alter hormone and substrate metabolism during the late postprandial phase, with implications for body fat mobilization. DESIGN: Vagal stimulation was achieved by using the modified sham feeding (MSF) technique, in which nutrients are chewed and tasted but not swallowed. Ten healthy subjects were studied on 3 separate occasions, 4 wk apart. Five hours after a high-fat breakfast (56 g fat), the subjects were given 1 of 3 test meals allocated in random order: water, a lunch containing a modest amount of fat (38 g), or MSF (38 g fat). Blood was collected for 3 h poststimulus for hormone and metabolite analyses. RESULTS: Plasma insulin and pancreatic polypeptide concentrations peaked at 250% and 209% of baseline concentrations within 15 min of MSF. The plasma glucose concentration increased significantly (P = 0.038) in parallel with the changes observed in the plasma insulin concentration. The nonesterified fatty acid concentration was significantly suppressed (P: = 0.006); maximum suppression occurred at a mean time of 114 min after MSF. This fall in nonesterified fatty acid was accompanied by a fall in the plasma glucagon concentration from 122 to 85 pmol/L (P = 0.018) at a mean time of 113 min after MSF. CONCLUSIONS: Effects on substrate metabolism after MSF in the postprandial state differ from those usually reported in the postabsorptive state. The effects of MSF were prolonged beyond the period of the cephalic response and these may be relevant for longer-term metabolic regulation.

Adult↗

Long-pulsed Nd:YAG laser-assisted hair removal in pigmented skin: a clinical and histological evaluation.

OBJECTIVE: To determine the safety and effectiveness of a long-pulsed Nd:YAG laser at 1064 nm in effecting long-term hair reduction in patients with darkly pigmented skin. DESIGN: Nonrandomized before-after clinical and histological trial. SETTING: Private practice, ambulatory care facility. PATIENTS: Twenty women with skin phototypes IV through VI and dark brown to black terminal hair on the face, axillae, or legs. INTERVENTION: A series of 3 long-pulsed (50-millisecond) 1064-nm Nd:YAG laser treatments at fluences ranging from 40 to 50 J/cm(2) were delivered to the identified treatment areas on a monthly basis by a single operator. MAIN OUTCOME MEASURES: Global clinical grading scores of comparable before-after treatment photographs were determined by 2 independent medical assessors during each laser session and 1, 3, 6, and 12 months postoperatively. A dermatopathologist reviewed unmarked histological specimens obtained at baseline, immediately after the initial laser treatment, and at 1 and 6 months after the final laser session. RESULTS: Substantial hair reduction was seen after each of the 3 treatment sessions. Prolonged hair loss was observed 12 months after the final laser treatment (70%-90% hair reduction). Axillary hair was substantially more responsive to laser irradiation than was hair located on the legs and face. Adverse effects included mild to moderate treatment pain and rare occurrences of vesiculation and transient pigmentary alteration without fibrosis or scarring. Histological tissue changes mirrored clinical response rates, with evidence of selective follicular injury without epidermal disruption. CONCLUSION: The long-pulsed 1064-nm Nd:YAG laser is a safe and effective method of long-term hair reduction in patients with darkly pigmented skin.

Adult↗

Technologies to address air quality issues impacting animal agriculture.

The continued productivity, profitability and sustainability of animal production agriculture in most parts of the world will be dependent upon implementation of effective technologies and management practices to mitigate perceived and documented environmental impacts resulting from confined animal operation emissions. North Carolina State University Animal and Poultry Waste Management Center (APWMC) program efforts to identify such technologies through support of research, development and demonstration projects involve collaborative efforts with approximately 20 other universities (nationally and internationally). Many of these projects are well beyond the laboratory developmental stage and some are yielding encouraging results. Performance data, to date, has shown that swine manure treatment systems including a covered in-ground anaerobic digester, a sequencing batch reactor, and an upflow biological aerated filter system significantly improved odor emission variables.

Agriculture↗

Beneficial nutritional properties of olive oil: implications for postprandial lipoproteins and factor VII.

Previous research concerning protective cardiovascular properties of olive oil has focussed on the beneficial consequences on blood cholesterol levels of substituting dietary saturated fatty acids with oleic acid. Despite evidence implicating raised circulating triglycerides in the postprandial state in the pathogenesis of atherosclerosis and thrombosis, little research had been conducted to investigate effects of monounsaturated fatty acids on postprandial events. In a case control study of southern (n = 30) versus northern European (n = 30) men, significant differences in postprandial triglyceride and apolipoprotein (apo) B-48 response were observed, with evidence of attenuated and potentially beneficial responses in the Southern Europeans. In a randomised controlled study manufactured foods typical of the Northern European food culture, were used to deliver diets rich in either saturated or monounsaturated fatty acids (from olive oil). During the period of the olive oil enriched diet, LDL-cholesterol levels were 15% lower (p < 0.001) than during the saturated fat diet. Postprandial triglyceride response was shifted towards the profile seen in southern European men and the postprandial activation of factor VII, as well as the production of factor VII antigen, was reduced on the olive oil diet. The study demonstrated significant improvements in biomarkers for cardiovascular disease in subjects osed to high olive oil diets (Southern Europeans) or transferred to such diets in the short term (Northern European volunteers). The study produced novel findings with respect to potential mechanisms by which diets high in monounsaturated fatty acids (MUFA) can reduce population risk of cardiovascular disease.

Adult↗

Mast cells can amplify airway reactivity and features of chronic inflammation in an asthma model in mice.

The importance of mast cells in the development of the allergen-induced airway hyperreactivity and inflammation associated with asthma remains controversial. We found that genetically mast cell-deficient WBB6F(1)-W/W(v) mice that were sensitized to ovalbumin (OVA) without adjuvant, then challenged repetitively with antigen intranasally, exhibited much weaker responses in terms of bronchial hyperreactivity to aerosolized methacholine, lung tissue eosinophil infiltration, and numbers of proliferating cells within the airway epithelium than did identically treated WBB6F(1)-+/+ normal mice. However, W/W(v) mice that had undergone selective reconstitution of tissue mast cells with in vitro-derived mast cells of congenic +/+ mouse origin exhibited airway responses that were very similar to those of the +/+ mice. By contrast, W/W(v) mice that were sensitized with OVA emulsified in alum and challenged with aerosolized OVA exhibited levels of airway hyperreactivity and lung tissue eosinophil infiltration that were similar to those of the corresponding +/+ mice. Nevertheless, these W/W(v) mice exhibited significantly fewer proliferating cells within the airway epithelium than did identically treated +/+ mice. These results show that, depending on the "asthma model" investigated, mast cells can either have a critical role in, or not be essential for, multiple features of allergic airway responses in mice.

Allergens↗

Lack of association between lipaemia and central adiposity in subjects with an atherogenic lipoprotein phenotype (ALP).

OBJECTIVE: To investigate the associations between indices of adiposity and cardiovascular risk factors in individuals with an atherogenic lipoprotein phenotype (ALP). SUBJECTS: Fifty-five men, aged 34-69 y, body mass index (BMI) 22-35 kg/m2, with an ALP lipid profile (triglycerides (TG) 1.5-4.0 mmol/l, HDL<1.1 mmol/l; %LDL-3>40% total LDL). DESIGN: Each participant provided a fasting blood sample and underwent an 8 h postprandial assessment and had anthropometric measurements taken. OUTCOME MEASURES: BMI, waist circumference (W), waist-to-hip ratio (W/H), sum of skinfolds (SSK), fasting and postprandial concentrations of glucose, insulin and plasma lipids, post-heparin lipase activity, and apoE genotype. RESULTS: The expected positive associations between BMI, W and SSK and fasting and postprandial insulin were observed (r=0.42-0.65). Little association between glucose responses and any measures of adiposity was evident. Unexpectedly, there were no positive associations between measures of central adiposity (W and W/H) and fasting and postprandial TG responses, with a trend towards negative associations in this study group (TG AUC vs W, r=-0.23, P=0.097; TG IAUC vs W/H, r=-0.26, P=0.068). Subgroup analysis indicated that lack of a positive association between central adiposity and postprandial TG values was more evident in those with one E4 allele (r=-0.42, P=0.077) relative to non-E4 carriers (r=-0.16, P=0.430). The expected positive associations between insulin and TG responses were not observed (r=-0.03 to -0.36). CONCLUSION: In this ALP group the expected positive association between TG responses and a centralized distribution of body fat was not observed, particularly in individuals with an apoE4 genotype. Our findings are not in line with the view that there is a clear causal relationship between insulin resistance and the lipid abnormalities associated with ALP.

Abdomen↗

The diverse potential effector and immunoregulatory roles of mast cells in allergic disease.

Mast cells are of hematopoietic origin but typically complete their maturation in peripheral connective tissues, especially those near epithelial surfaces. Mast cells express receptors that bind IgE antibodies with high affinity (FcepsilonRI), and aggregation of these FcepsilonRI by the reaction of cell-bound IgE with specific antigens induces mast cells to secrete a broad spectrum of biologically active preformed or lipid mediators, as well as many cytokines. Mast cells are widely thought to be essential for the expression of acute allergic reactions, but the importance of mast cells in late-phase reactions and chronic allergic inflammation has remained controversial. Although it is clear that many cell types may be involved in the expression of late-phase reactions and chronic allergic inflammation, studies in genetically mast cell-deficient and congenic normal mice indicate that mast cells may be critical for the full expression of certain features of late-phase reactions and may also contribute importantly to clinically relevant aspects of chronic allergic inflammation. Moreover, the pattern of cytokines that can be produced by mast cell populations, and the enhancement of such cytokine production in mast cells that have undergone IgE-dependent up-regulation of their surface expression of FcepsilonRI, suggests that mast cells may contribute to allergic diseases (and host defense) by acting as immunoregulatory cells, as well as by providing effector cell function.

Animals↗

Differences in glucose-dependent insulinotrophic polypeptide hormone and hepatic lipase in subjects of southern and northern Europe: implications for postprandial lipemia.

BACKGROUND: This study was an extension of a previous study that showed different lipemic responses to standard test meals in subjects from southern and northern Europe. OBJECTIVE: The aim was to determine in 32 healthy young men from northern and southern Europe whether differences in the secretion of insulin and glucose-dependent insulinotrophic polypeptide (GIP) might explain these findings through the actions of these hormones on lipoprotein lipase. DESIGN: We investigated in a randomized, single-blind, crossover study the effects of 2 test meals of identical macronutrient composition but different saturated fatty acid (SFA) and monounsaturated fatty acid (MUFA) contents on postprandial GIP, insulin, the ratio of incremental triacylglycerol to apolipoprotein B-48 (a marker of chylomicron size), and the activity of postheparin lipases. RESULTS: Fasting and postprandial GIP concentrations and postheparin hepatic lipase activities were significantly higher in the southern Europeans (P < 0.001 and P < 0.02, respectively). Lipoprotein lipase activity after the SFA-rich meal was significantly higher in the northern Europeans (P < 0.01). HL activity 9 h after the SFA-rich meal and the area under the curve (AUC) for the postprandial insulin response correlated with the AUC for the postprandial GIP response [r = 0.44 (P < 0.04) and r = 0.46 (P < 0.05), respectively]. There were no significant differences in chylomicron size between the 2 groups for either meal, but when the groups were combined there was a significant difference in chylomicron size between the SFA- and MUFA-rich meals (P < 0.05), which could be due to the formation of larger chylomicrons after the MUFA-rich meal. CONCLUSION: The significantly higher GIP and insulin responses and HL activities in southern Europeans may provide an explanation for our previous report of attenuated postprandial triacylglycerol and apolipoprotein B-48 responses in them.

Adult↗

Modest doses of beta-glucan do not reduce concentrations of potentially atherogenic lipoproteins.

BACKGROUND: In 1997, the US Food and Drug Administration passed a unique ruling that allowed oat bran to be registered as the first cholesterol-reducing food at a dosage of 3 g beta-glucan/d. OBJECTIVE: The effects of a low dose of oat bran in the background diet only were investigated in volunteers with mild-to-moderate hyperlipidemia. DESIGN: The study was a double-blind, placebo-controlled, randomized, parallel study. Sixty-two healthy men (n = 31) and women (n = 31) were randomly allocated to consume either 20 g oat bran concentrate (OBC; containing 3 g beta-glucan) or 20 g wheat bran (control) daily for 8 wk. Fasting blood samples were collected at weeks -1, 0, 4, 8, and 12. A subgroup (n = 17) was studied postprandially after consumption of 2 meals (containing no OBC or wheat bran) at baseline and after supplementation. Fasting plasma samples were analyzed for total cholesterol, HDL cholesterol, triacylglycerol, glucose, and insulin. LDL cholesterol was measured by using the Friedewald formula. The postprandial samples were anlayzed for triacylglycerol, glucose, and insulin. RESULTS: No significant difference was observed in fasting plasma cholesterol, LDL cholesterol, glucose, or insulin between the OBC and wheat-bran groups. HDL-cholesterol concentrations fell significantly from weeks 0 to 8 in the OBC group (P = 0.05). There was a significant increase in fasting glucose concentrations after both OBC (P = 0.03) and wheat-bran (P = 0.02) consumption. No significant difference was found between the OBC and wheat-bran groups in any of the postprandial variables measured. CONCLUSIONS: A low dosage of beta-glucan (3 g/d) did not significantly reduce total cholesterol or LDL cholesterol in volunteers with plasma cholesterol concentrations representative of a middle-aged UK population.

Adult↗

Relationship of climate, ethnicity and socioeconomic status to Kawasaki disease in San Diego County, 1994 through 1998.

BACKGROUND: Kawasaki disease (KD) is the most common cause of acquired heart disease in children in the United States. By monitoring trends in patient numbers and demographics during a 5-year period, we were able to explore the relationship between climate, ethnicity, socioeconomic status and susceptibility to KD. METHODS: We conducted active surveillance for all patients hospitalized with KD in San Diego County from 1994 through 1998. Data on seasonal variation in monthly rainfall and temperature were obtained from the US Meteorological Service. Patient sex, age, date of admission and self-reported ethnicity were identified from patient medical records. Socioeconomic status was assessed on the basis of insurance status among patients hospitalized at a single institution. RESULTS: During the 5-year period there were 169 cases of KD in San Diego County. The overall annual incidence of KD in children < 5 years of age ranged from 8.0 to 15.4/100 000. KD incidence was inversely associated with average monthly temperature (r = -0.47, P < 0.001) and positively associated with average monthly precipitation (r = -0.52, P < 0.001). Asian/Pacific Islanders < 5 years of age were 2.7 times as likely and Hispanics were one-third as likely to be hospitalized for KD than children from all other ethnic groups combined. Children with private or military insurance in all ethnic groups were more likely to have a diagnosis of KD than children with government assistance or no insurance. After controlling for insurance status, only Asian/Pacific Islanders remained at increased risk (rate ratio, 2.14) for KD relative to all other ethnic groups combined. CONCLUSION: KD is a common childhood vasculitis of unknown etiology. The skewed ethnic distribution and seasonality are consistent with the hypothesis that KD is an infectious disease that is influenced by environmental and genetic factors.

California↗

ApoE polymorphism and fish oil supplementation in subjects with an atherogenic lipoprotein phenotype.

The study assessed the efficacy of fish oil supplementation in counteracting the classic dyslipidemia of the atherogenic lipoprotein phenotype (ALP). In addition, the impact of the common apolipoprotein E (apoE) polymorphism on the fasting and postprandial lipid profile and on responsiveness to the dietary intervention was established. Fifty-five ALP males (aged 34 to 69 years, body mass index 22 to 35 kg/m(2), triglyceride [TG] levels 1.5 to 4.0 mmol/L, high density lipoprotein cholesterol [HDL-C] <1.1 mmol/l, and percent low density lipoprotein [LDL]-3 >40% total LDL) completed a randomized placebo-controlled crossover trial of fish oil (3.0 g eicosapentaenoic acid/docosahexaenoic acid per day) and placebo (olive oil) capsules with the 6-week treatment arms separated by a 12-week washout period. In addition to fasting blood samples, at the end of each intervention arm, a postprandial assessment of lipid metabolism was carried out. Fish oil supplementation resulted in a reduction in fasting TG level of 35% (P<0.001), in postprandial TG response of 26% (TG area under the curve, P<0.001), and in percent LDL-3 of 26% (P<0.05). However, no change in HDL-C levels was evident (P=0.752). ANCOVA showed that baseline HDL-C levels were significantly lower in apoE4 carriers (P=0.035). The apoE genotype also had a striking impact on lipid responses to fish oil intervention. Individuals with an apoE2 allele displayed a marked reduction in postprandial incremental TG response (TG incremental area under the curve, P=0.023) and a trend toward an increase in lipoprotein lipase activity relative to non-E2 carriers. In apoE4 individuals, a significant increase in total cholesterol and a trend toward a reduction in HDL-C relative to the common homozygous E3/E3 profile was evident. Our data demonstrate the efficacy of fish oil fatty acids in counteracting the proatherogenic lipid profile of the ALP but also that the apoE genotype influences responsiveness to this dietary treatment.

Adult↗

High dietary copper improves odor characteristics of swine waste.

We conducted two experiments to determine the effects of dietary copper concentration and source on odor characteristics of swine waste. In both experiments, 192 weanling gilts and barrows were allotted to 24 pens. Pens were randomly assigned to one of six dietary treatments, consisting of control (10 ppm Cu as cupric sulfate, CuSO4), 66 or 225 ppm Cu as CuSO4, or 33, 66, or 100 ppm Cu as cupric citrate (Cucitrate). An antibiotic was included in the diets for Exp. 1, but not Exp. 2. On d 28, fecal samples were randomly obtained from one pig per pen and stored at -20 degrees C until preparation and evaluation by an odor panel. The odor panel consisted of 10 individuals, and each panelist evaluated the odor intensity, irritation intensity, and odor quality of the samples. In Exp. 1, the odor and irritation intensity of the feces were lower (P < .05) from animals consuming diets containing 225 ppm Cu as CuSO4 and 66 or 100 ppm Cu as Cu-citrate compared to the control. The odor quality of the waste from animals consuming diets containing 225 ppm Cu as CuSO4 and 66 or 100 ppm Cu as Cu-citrate was improved (P < .05) compared to the 33 ppm Cu treatment. In Exp. 2, the odor intensity of the feces of pigs receiving diets supplemented with all concentrations of Cu-citrate was lower (P < .05) than that of feces from the control animals. Irritation intensity of the feces was not affected by treatment. Odor quality of waste of pigs supplemented with 225 ppm Cu from CuSO4 and all concentrations of Cu-citrate was improved (P < .05) compared to that of waste of the control pigs. Two gilts and two barrows from each nursery pen in Exp. 1 were continued through the growing-finishing phase on their respective experimental diets. The growing-finishing phase lasted 103 d, and fecal samples were randomly obtained from one pig per pen at the completion of the phase. During the growing-finishing phase, the odor intensity and the irritation intensity of the feces were lower (P < .05) from pigs supplemented with 66 and 225 ppm Cu as CuSO4 and 66 and 100 ppm Cu from Cu-citrate than from the control pigs. The odor quality of the waste was improved (P < .05) in all animals receiving supplemental Cu. These data indicate an improvement in odor characteristics of swine waste with the supplementation of Cu. In addition, lower concentrations of an organic nonsulfate Cu source resulted in similar odor characteristics of swine waste as 225 ppm CuSO4.

Animal Feed↗

Development and implementation of a geriatric care/case management program in a military community-based family medicine residency.

This article discusses how the development of a longitudinal geriatric assessment form facilitated a case management program in identifying high-risk frail elders within a military family practice clinic. A careful review of geriatric assessment tools was performed. From this review, a model geriatric assessment form was developed. A "SWOT" (strengths, weaknesses, opportunities, and threats) analysis of the family medicine department was completed to determine if the environment was ready for case management. Analysis of the SWOT data revealed that the environment was favorable for a population-based approach to case management. Results of this initial study are encouraging. The new longitudinal geriatric assessment form has assisted family practice residents in organizing problems and data while seeing elderly patients. As a direct result, higher-risk frail elders have been identified for closer evaluation and follow-up. Future goals are to measure outcomes-based data and to refine the geriatric assessment process.

Aged↗

Management and utilization of poultry wastes.

Waste by-products such as excreta or bedding material that are generated by the worldwide annual production of more than 40 million metric tons (t) of poultry meat and 600 billion eggs are generally land applied as the final step of a producer's waste management strategy. Under proper land application conditions, the nutrients and organisms in poultry wastes pose little environmental threat. Environmental contamination occurs when land application of poultry wastes is in excess of crop utilization potential, or is done under poor management conditions causing nutrient loss from environmental factors such as soil erosion or surface runoff during rainfall. Environmental parameters of concern are N, P, and certain metals (Cu and Zn in particular), as well as pathogenic microorganisms that may be contained in poultry waste. The biochemical cycle of N is very dynamic, and N contained in poultry waste may either be removed by crop harvest, leave the animal production facility, waste treatment lagoon, or application field as a gas (NH3, NO, NO2, N2O, or N2), or, due to its mobility in soil, be transported in organic or inorganic N forms in the liquid state via surface runoff or leaching into groundwater. Elevated concentrations of NO3-N in groundwater used for human consumption is a health risk to infants that are susceptible to methemoglobinemia. An environmental impact resulting from elevated NO3-N is eutrophication of surface waters. Ammonia loss from poultry waste is an environmental concern because of volatilized wet and dry deposits of NH3 into nitrogen-sensitive ecosystems. Phosphorus in poultry wastes may contribute to environmental degradation by accelerating the process of eutrophication. Unlike N, P is very immobile in soil and must first be transported to a surface water environment to have an environmental impact. It is generally accepted, however, that this nutrient affects receiving waters via transport in eroding soil as sediment-bound P or in surface runoff as soluble inorganic or organic P. Numerous studies have reported that excess P contained in land-applied manures may contribute to eutrophication. Soils containing P concentrations that greatly exceed the agronomic potential of crops may require years or even decades to return to levels that are crop limiting for this nutrient. Environmental concerns include the capacity of such soils to adsorb new P and the amount of P loss from these soils from erosion, runoff, drainage, or leaching to groundwater. Although much information is available regarding the loss of P from agricultural fields from erosion and runoff, less information is available regarding P losses from fields receiving poultry wastes. However, studies have shown that there are many challenges to controlling P losses from fields receiving manures. In addition, subsurface transport of P resulting from repeated application of poultry manure onto soils that are artificially drained is an environmental concern where drainage waters enter or interact with water bodies sensitive to eutrophication. Trace elements such as As, Co, Cu, Fe, Mn, Se, and Zn are often added in excess to poultry feed to increase the animal's rate of weight gain, feed efficiency, and egg production and to prevent diseases. Because most of the excess trace elements are not absorbed by the bird, the concentration of elements excreted in the manure will reflect dietary overformulation. Because trace elements are generally required in very small quantities for crop growth and, like P, are immobile in most soil types, their concentrations will increase with repeated land application of poultry wastes. Of particular concern are accumulations of Cu and Zn in certain soil types utilized for certain crops. Copper and Zn toxicity for some crops have been documented in some areas receiving repeated land-applied poultry wastes. A potential environmental concern relative to poultry litter and trace elements in receiving soils involves the transpor

Animal Feed↗