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Medical Instructor, Dell Medical School at The University of Texas at Austin

Effects of dietary fiber and reduced crude protein on ammonia emission from laying-hen manure. Effects of dietary fiber and reduced crude protein on nitrogen balance and egg production in laying hens. Dietary inclusion level effects of distillers dried grains with solubles on broiler meat quality. Quality of egg shells and bones in laying hens fed a diet containing distillers dried grains with solubles. Effect of maize distillers dried grains with solubles and dietary enzyme supplementation on the performance of laying hens. Preliminary results of study on the use of corn and rye distillers dried grains with solubles in the laying hens nutrition. Proceedings of the 15th European Symposium on poultry nutrition, Balatonfured, Hungary, 601-603. The use of distillers dried grains plus soluble as a feed ingredient on air emissions and performance from laying hens. Therefore, it primarily partially replaces high energy ingredients, such as corn in swine diets, but can also partially replace some high protein ingredients, such as soybean meal, and inorganic phosphorus. The purpose of this chapter is to briefly describe the highlights of this comprehensive literature review, and provide an update of research results published from various studies since 2009. Along with its benefits of being a high energy and digestible phosphorus ingredient, it also appears to provide gut health benefits when fed to growing pigs. However, these limitations are easily overcome by understanding and using proper diet formulation approaches. Another possible explanation is that the reduction in performance in some of the experiments may have been due to excess nitrogen from crude protein at high dietary inclusion rates. Previous studies have shown that adding ingredients high in fiber to growing-finishing pig diets may reduce the dressing percentage because of increased gut fill and increased intestinal mass (Kass et al. Feeding diets containing high amounts of unsaturated fatty acids, particularly linoleic acid, can reduce fat firmness and increase the amount of unsaturated fatty acids in pork fat. Carcass fat iodine value can be a reasonable indicator of carcass fat quality because high iodine values result in softer bellies. Pigs fed the antimicrobial regimen reduced prevalence and severity of lesions in the jejunum, and tended to have reduced total tract lesion length. Organ weight, intestinal morphology, and fasting whole-body oxygen consumption in growing pigs fed diets containing distillers dried grains with soluble alone or in combination with a multi-enzyme supplement. Performance and phosphorus balance of pigs fed diets formulated on the basis of values for standardized total tract digestibility of phosphorus. Use of distillers dried grains with solubles and soybean hulls in nursery pig diets. Effects of dried distillers grains with soluble on carcass fat quality of finishing pigs. Corn distillers dried grains with soluble in diets for growing-finishing pigs: A cooperative study. Effects of dietary level of distiller dried grains with solubles and fat on the growth performance of growing pigs. Effects of increasing dietary glycerol and dried distillers grains with solubles on growth performance of finishing pigs. Effect of dietary distillers dried grains with solubles on performance and carcass characteristics in finishing hogs J. Determination of the impact of feeding increasing levels of corn dried distillers grains on performance of growingfinishing pigs reared under commercial conditions. Effects of dietary ingredients on manure characteristics and odorous emissions from swine. Effect of dried distillers grains with solubles on feed preference in growing pigs. Effect of abrupt introduction and removal of high and low digestibility corn distillers dried grains with solubles from the diet on growth performance and carcass characteristics of growing-finishing pigs. Utilization of distillers dried grains with solubles and phytase in sow lactation diets to meet the phosphorus requirement of the sow and reduce fecal phosphorus concentrations. Determination of P-bioavailability in corn and sorghum distillers dried grains with solubles for growing pigs. Apparent digestibility of diet components in specific segments of the gastrointestinal tract.

The following are examples of the types of technologies being researched and developed to improve ethanol yield, resulting in a variety of co-products with different nutrient composition that will eventually be available for feed use: 1. Efforts to improve the efficiency of fermentation and ethanol production of corn a) adding proteases in addition to carbohydrases (Wang et al. Dry matter, crude protein, crude fat, crude fiber, and ash concentrations for most of the known fractionated co-products are shown in Table 1. Although the amino acid concentration may slightly increase in many of the high protein fractionated co-products, the protein quality (amino acid balance) is still poor relative to the requirements of monogastric animals. The reduced fat and increased fiber content of these fractions may result in lower energy value for swine and poultry. Ethanol Production and its Co-Products Front-End Fractionation and Back-End Oil Extraction Technologies 5 they would generally have greater value in ruminant diets because the amino acid balance of corn protein is not as critical in ruminant diets as it is in swine, poultry, and aquaculture diets. Furthermore, the increased amount of readily fermentable fiber can provide a good source of energy for ruminants, and the lower fat content may allow higher dietary inclusion rates for lactating dairy cows and reduce concerns of milk fat depression at high feeding levels. Nutrient Digestibility of Selected New Corn Co-products References for scientific publications with results from feeding new, fractionated corn coproducts to various livestock and poultry species are summarized in Table 2. The majority of these studies have evaluated nutrient content and digestibility, but not maximum dietary inclusion rates or determined their effects on animal performance. Summary of published studies involving feeding new fractionated corn coproducts to livestock and poultry. Ethanol Production and its Co-Products Front-End Fractionation and Back-End Oil Extraction Technologies 6 Poultry A high protein hydrolyzed corn co-product obtained from the National Renewable Energy Laboratory was evaluated for nutrient content and digestibility, and its feeding value in turkey starter diets (Abe et al. These results indicate that new fractionation technologies used in ethanol production result in co-products that have unique nutritional properties and knowledge of their nutritional value is essential in order to assess their economic and feeding value. The standardized ileal digestibility coefficients were also high for crude protein (74. These results suggest that this yeast product can be an excellent source of energy and digestible amino acids in swine diets. Ethanol Production and its Co-Products Front-End Fractionation and Back-End Oil Extraction Technologies 8 Helembai et al. Despite differences in nitrogen retention, all of these co-products had high apparent digestible nitrogen-free extract (85. Most ingredients were obtained from various dry-grind ethanol plants with the exception of gluten meal, gluten feed, and one source of corn germ meal, which were obtained from corn wet milling plants. One feedstuff, dehulled, degermed corn is a co-product from a fractionated dry-grind process. Ethanol Production and its Co-Products Front-End Fractionation and Back-End Oil Extraction Technologies 9 the variable nutrient composition of the corn co-products is shown in Table 5. Ethanol Production and its Co-Products Front-End Fractionation and Back-End Oil Extraction Technologies 10 Table 5. Ethanol Production and its Co-Products Front-End Fractionation and Back-End Oil Extraction Technologies 11 Table 5 (continued). Ethanol Production and its Co-Products Front-End Fractionation and Back-End Oil Extraction Technologies 12 Table 6. Ethanol Production and its Co-Products Front-End Fractionation and Back-End Oil Extraction Technologies 13 Dairy Kelzer et al. A comparison of the nutrient concentrations in these corn co-products are shown in Table 8. Ethanol Production and its Co-Products Front-End Fractionation and Back-End Oil Extraction Technologies 14 Feeding Value of New, Fractionated Corn Co-Products to Livestock and Poultry Because most new fractionation technologies have not been fully implemented and are being evaluated, limited quantities of fractionated corn co-products are being produced and available commercially. As a result, there are limited published data on the efficiency and quality of these fractionated corn co-products in livestock and poultry feeds. Until such data is available, it is difficult to determine their comparative feeding value, dietary inclusion rates, and comparative nutritional and economic values. Maximum dietary inclusion rates of selected corn co-products for various species based on animal performance trials. Without this information, we assume no change in bird performance when calculating displacement ratios for these ingredients.

Cardiovascular malformations and organic solvent exposure during pregnancy in Finland. Maternal medications and environmental exposures as risk factors for gastroschisis. The impact of prenatal care in the United States on preterm births in the presence and absence of antenatal high-risk conditions. Hypothetical framework for a relationship between maternal thyroid function, nausea and vomiting of pregnancy, and congenital heart disease. Residence near hazardous waste landfill sites and risk of non-chromosomal congenital malformations. Genetic susceptibility to benzene and shortened gestation: evidence of gene-environment interaction. Immunologic effects of background exposure to polychlorinated biphenyls and dioxins in Dutch preschool children. Acute effects of total suspended particles and sulfur dioxides on preterm delivery: a community based cohort study. Congenital heart disease in relation to maternal use of Bendectin and other drugs in early pregnancy. The current update (2016) adds 34 drugs, five of which have safe-handling recommendations from the manufacturers. In 2014, a new format was developed for the list of hazardous drugs, as described below. General Approach to Handling Hazardous Drugs Early concerns about occupational exposure to antineoplastic drugs first appeared in the 1970s. Although the antineoplastic drugs remain the principal focus of the Alert, other drugs may also be considered hazardous because they are potent (small quantities produce a physiological effect) or cause irreversible effects. As the use and number of these potent drugs increase, so do opportunities for hazardous exposures among healthcare workers. For example, antineoplastic drugs such as cyclophosphamide and methotrexate have proved beneficial for treating nonmalignant diseases such as rheumatoid arthritis and multiple sclerosis. All listed drugs are considered hazardous, but safe-handling precautions can vary with the activity and the formulation of the drug. Note that many of these drugs may also pose a reproductive risk for susceptible populations (Table 1). Note that some of these drugs may also pose a reproductive risk for susceptible populations (Table 2). Group 2: Non-antineoplastic drugs that meet Group 3: Drugs that primarily pose a reproduc- 1 All hazardous drugs, regardless of the formulation, should be labeled as such to prevent improper handling. The majority of the reproductive risks associated with the drugs listed in Table 3 apply to women, but some can apply to men only (such as reduced fertility or sperm count) or to both men and women. Although all hazardous drugs should be handled according to recommended procedures, especially if they must be prepared aseptically, some populations of workers may not be at reproductive risk from handling drugs in Group 3. These include workers who are excluded from the susceptible populations for specific reasons such as age or infertility. No attempt has been made to perform risk assessments on each drug or to propose exposure limits. This guidance does not cover all possible situations but provides general recommendations for the typical handling situations in healthcare. With the increased availability of oral antineoplastic and other hazardous drugs, additional precautions are required in order to prevent worker exposure to these formulations. Some drugs defined as hazardous may not pose a significant risk of direct occupational exposure because of their dosage formulation (for example, coated tablets or capsules-solid, intact medications that are administered to patients without modification of the formulation). Counting and pouring of hazardous drugs should be done carefully, and clean equipment should be dedicated for use with these drugs. Crushing tablets or opening capsules should be avoided and liquid formulations should be used whenever possible. Defining Hazardous Drugs Hazardous drugs include those used for cancer chemotherapy, antiviral drugs, hormones, some bioengineered drugs, and other miscellaneous drugs. For example, bioengineered drugs target specific sites in the body, and although they may or may not pose a risk to healthcare workers, some may pose a risk to patients.

Triphasic waves are seen in bilateral nonevolving bursts or runs of 1 to 2 Hz frequently with an anterior predominance and an anterior to posterior lag, although they may also possess a posterior predominance, or mixed predominance. When they occur in prolonged runs, distinguishing triphasic waves from nonconvulsive status epilepticus can be difficult. The normal cardiac rhythm is usually represented by a bipolar derivation connecting the left to right chest. The burst-suppression pattern consists of stereotyped bursts, usually consisting of mixed frequencies with or without intermixed epileptiform discharges. The bursts usually recur between 2 and 10 sec and are separated by intervals of suppression that demonstrate no electrocerebral activity at normal sensitivities. Note the lack of response to somatosensory stimulation annotated by the technologist. They are unreactive to somatosensory stimulation, and are associated with an absent or diffusely slow posterior dominant rhythm. Note the right frontal and left occipital bilateral independent hemispheric discharges. This pattern is seen with severe diffuse cerebral insults such as with massive hypoxia, typically after cardiac arrest, but also can be seen with stroke, trauma, or infections. The outcome is characteristically grim, resulting in death or persistent vegetative states. It is most frequently seen in hypoxic encephalopathy, although it has been reported with brainstem lesions, and portends a poor prognosis. Etiology is the most important determinant in outcome regardless of the patterns seen. As with alpha coma, drugs and trauma carry a more favorable prognosis than hypoxic-ischemic causes. It may also be seen with posttraumatic etiologies and, in this case, usually carries a better prognosis. In addition, certain factors that may make this pattern reversible must be excluded, such as hypothermia and sedative drugs. Epilepsia partialis continua in a 41-year-old patient with subjective tingling and "twitching" noted at the corner of the left side of the mouth. When temporal discharges are found and a clinical correlate is present, these regions beyond an experiential sensation usually are projected from extratemporal sources. Depending on the region involved, seizures may begin with polyspike activity, rhythmic activity or spike-slow-wave activity. The patterns may wax and wane showing changes in frequency and amplitude as well as in spatial distribution (see above). Although seizures are usually seen unilaterally, they may be seen bilaterally, independently, or may propagate from one hemisphere to the other. They can occur after convulsive status epilepticus, or be uncovered in comatose patients with few clinical clues other than a change in mental status. Note the generalized spike-wave complexes with right lateralization in the above example. They may be high-voltage multifocal spikes and spike-wave discharges that occur singly or in salvos, unilaterally or bilaterally, and often involving the posterior temporal (language dominant) head regions. The hypnogram is a graphic representation of sleep stages achieved in an overnight polysomnogram. Later, however, at least one other channel using an occipital electrode (O1 or O2) was added to aid in determining transition to sleep. Thus, any deflection of the eyes, whether horizontal or vertical, produces an out of phase deflection. Respiratory monitoring involves assessment of airflow, respiratory effort, and oxygen saturation. Polysomnograms are the foundation for assessing the normalcy of sleep architecture, respiration, and nocturnal behavioral events. Occasionally, instead of an alpha rhythm, low-voltage, mixed-frequency activity is seen.

In contrast with these negative results for oral carcinogenicity, dermally administered phenol has been consistently observed to be a promoter. These studies have generally reported significant skin ulceration at all phenol doses tested. When the same phenol dose was administered in different volumes, higher promotion activity was exhibited by the more concentrated solution, which also produced severe skin ulceration, suggesting that some of the promotion activity may have been related to the rapid cell division in the repairation of skin damage (Salaman and Glendenning, 1957). The observed response was dose-related (Boutwell and Bosch, 1959), but marked systemic toxicity was also observed at these doses. Phenol has been observed to act synergistically with hydroquinone in the production of genotoxic effects (Marrazzini et al. Epidemiology data do not shed further light on the carcinogenic potential of phenol. However, the usefulness of each of these studies for risk assessment is limited by (depending on the study) an absence of an effect when latency was considered, a lack of a dose-response, and potential for confounding. No inhalation studies of sufficient duration to assess phenol carcinogenicity have been conducted. The carcinogenic potential of phenol via inhalation exposure has not been evaluated at all. Similar conclusions have been reached by other groups in recent assessments of the carcinogenicity of phenol. This report contains only chemicals and substances that have been reviewed and classified as known human carcinogens or as reasonably anticipated to be carcinogens. If the toxicity of phenol is due to oxidative metabolites such as hydroquinone or catechol, individuals with increased oxidative activity would also be more sensitive to phenol toxicity. In contrast, maternal toxicity occurred at a lower dose than did decreased fetal body weight in a gavage developmental toxicity study that used a divided-dosing protocol (Argus Research Laboratories, 1997). The strength of the conclusion is also weakened by the observation in another gavage rat study (Argus Research Laboratories, 1997) that decreased fetal weight occurs only at doses above those that cause decreased maternal weight gain, and the observation of decreased fetal weight in a drinking water study (Ryan et al. Only one study was located that specifically addressed age-related differences in the systemic toxicity of phenol. The data from this study suggest that neonates are more sensitive than adults and young rats may be less sensitive than adults. Alternatively, the age-related differences observed in this study could reflect inter-individual variability that was not a consequence of age. Some studies suggest that peak levels are reached during childhood, with a subsequent decrease to adult levels (Schenkman et al. If the toxic moiety is a metabolite, decreased P450 metabolism could be expected to result in decreased toxicity. Indeed, Heaton and Renwick (1991) found higher production of oxidative metabolites in young rats. These data suggest the potential for children to be more sensitive than adults to the systemic effects of phenol. These data would tend to suggest that if hydroquinone is the toxic moiety, phenol would be more toxic in males. Acute oral lethality data do suggest that phenol is more toxic to males (Thompson and Gibson, 1984). Choice of Principal Study and Critical Effect relevant to the development of the RfD are summarized in Table 2. Hematology and serum biochemical evaluations were not included in those chronic studies, but they were included in a recent twogeneration drinking water study conducted in rats (Ryan et al. The only study evaluating hematological effects in mice is a 28day drinking water study (Hsieh et al. Statistically significant decreases in erythrocyte counts were observed at the low and mid doses, but these results were considered biologically questionable in the absence of effects on hematocrit, in the absence of data addressing whether the apparent inconsistency was due to macrocytosis, and in light of the lack of support from other studies. In addition, although qualitative differences between rats and mice in immune assays are not unusual. No other studies in mice have directly evaluated effects on antibody forming cells. In light of these issues, and in the absence of other data supporting the observed effects at such low doses, the results of Hsieh et al.