Antibiotic residues in goats milk following intramammary treatment

Two lactational intramammary antibiotic preparations (cloxacillin and oxytetracycline) were each used to treat eight goats by intramammary infusion in one half. The rate of release of the antibiotics was monitored by a diffusion assay based on the sensitive organism Bacillus stearothermophilus var. calidolactis. Cloxacillin was still detectable 156 hours after the final treatment while oxytetracycline was undetectable 108 hours following treatment. A small but significant amount of antibiotic was translocated between treated and untreated halves of the udder in both cases.     

Antimicrobial susceptibilities of Mycoplasma isolated from bovine mastitis in Japan

Mycoplasma spp. are highly contagious pathogens and intramammary Mycoplasma infection is a serious issue for the dairy industry. As there is no effective vaccine for Mycoplasma infection, control depends on good husbandry and chemo‐antibiotic therapy. In this study, antimicrobial susceptibility of Mycoplasma strains recently isolated from cases of bovine mastitis in Japan was evaluated by minimum inhibitory concentration (MIC). All Mycoplasma bovis strains were sensitive to pirlimycin, danofloxacin and enrofloxacin, but not kanamycin, oxytetracycline, tilmicosin or tylosin. M. californicum and M. bovigenitalium strains were sensitive to pirlimycin, danofloxacin, enrofloxacin, oxytetracycline, tilmicosin and tylosin, but not to kanamycin. This is the first report to describe the MIC of major antimicrobial agents for Mycoplasma species isolated from bovine mastitis in Japan.     

The Ability of the Enzyme‐Linked Immunosorbent Assay to Detect Antibody against Staphylococcus aureus in Milk following Experimental Intramammary Infection

Changes in the milk antibody levels against Staphylococcus aureus were measured at the start of an experimental intramammary instillation of either S. aureus (Study I) or Staphylococcus hyicus (Study II). A commercial enzyme‐linked immunosorbent assay system was used. Twenty‐one Holstein cows were enrolled in Study I and 15 Holstein cows were used in Study II. Pathogen instillation began 21 days before the start of the non‐lactating period. Cows received intramammary antibiotic treatment in all quarters immediately after the last milking, the start of the non‐lactating period. Lacteal secretions were collected before the start of the non‐lactating period, and during the immediate postpartum period in both studies, and during the non‐lactating period in Study I. Milk was cultured for mastitis pathogens and S. aureus antibody levels and somatic cell counts were determined from all samples. There was an approximate 2‐week delay in the elevation in antibody levels in response to the instillation of S. aureus. Antibody levels remained elevated in cows with S. aureus intramammary infections postpartum, but were below threshold in cows where intramammary infections were cured during the non‐lactating period. Antibody levels were elevated by S. hyicus intramammary infections, remained elevated for the first 12 days postpartum, but were below threshold by day 21 postpartum. Cows with incipient intramammary S. aureus infections might be misclassified as false negatives by the antibody test. However, results suggest that cows with S. hyicus intramammary infections that were not cured would not be misclassified if milk is withheld from test for the first 30 days postpartum, as recommended by the manufacturer of the test.     

Residue persistence in sheep milk following antibiotic therapy

Drug residues in milk supplies may have public health implications and can interfere in the manufacture of dairy products, such as cheese. In Spain, most ewe milk production is destined for cheese making, often using raw milk. This study analyses the main factors influencing antibiotic depletion time in lactating dairy sheep. 42, Manchega ewes were distributed into three groups, each receiving a different treatment (cephalexin intramammary infusion, penicillin G intramuscular, and oxytetracycline intravenous injections). During and after the recommended withdrawal period, milk samples were taken at each milking. A microbiological inhibition test (Brilliant Black Reduction, BRT) was used to screen all samples and antibiotic withholding times were established using a logistic regression model. The response to the BRT method in milk from individual ewes treated showed that the effect of the milking order was significant (P<0.001) with the three antibiotics. However the only influence on milk yield was with the intramammary treatment (P<0.005). The BRT method was found to be very sensitive, particularly to the two beta-lactamic antibiotics.     

Incidence of mastitis in beef cows after intramuscular administration of oxytetracycline

There is limited information on the value of antibiotic therapy for mastitis in beef cows. Effects of antibiotic treatment at weaning and the subsequent calving on calf weaning weight, milk somatic cell counts, milk components, and intramammary infection were studied in beef cows. Additionally, effects of number of infected mammary quarters, number of dry mammary quarters, type of intramammary pathogen, and parity on response variables were determined. Cows (n = 192) were randomly assigned to treatments in a 2 x 2 factorial arrangement; factors were time of treatment (weaning and after calving) and treatment (vehicle and vehicle plus antibiotic). Oxytetracycline (LA-200) or vehicle was administered intramuscularly following collection of quarter milk samples at weaning and calving. Percentage of infected cows and quarters averaged 43.4 and 16.4%, respectively, at calving and increased (P < 0.05) to 53.7 and 29.7% at weaning. Calves from cows with one or two dry quarters weighed 12.7 kg less (P < 0.05) at 90 d after calving and 18.7% less (P < 0.05) at 212 d after calving than calves from cows with no dry quarters. Calves from cows with three or four infected quarters weighed 17.5 kg less (P < 0.05) at 90 d and 25.5 kg less (P < 0.05) at weaning than calves from cows with two or fewer infected quarters. Infections by Staphylococcus aureus and coagulase-negative staphylococci were the most common and accounted for 67 and 78% of the infections. Percentages of infected cows and quarters, infections caused by S. aureus, and dry quarters increased (P < 0.05) with parity. No differences were found among antibiotic treatments for any of the response variables studied. Intramuscular oxytetracycline was not effective in the control of mastitis in beef cows under the conditions of the study.     

The prophylactic effect of a dry-cow antibiotic against Streptococcus uberis

The prophylactic use of a dry-cow antibiotic for reducing the incidence of mastitis due to Streptococcus uberis was studied in four seasonally calving dairy herds involving 378 cows. The treatment was a long-acting dry-cow antibiotic preparation administered immediately after the last milking of lactation. New intramammary infections were identified by comparing the bacteriological status of quarters at drying off with that after calving, or through manual udder palpation during the dry period. The administration of dry-cow antibiotic to uninfected quarters at drying off reduced the overall incidence of new infections with Streptococcus uberis from 12.3% for untreated quarters to 1.2% of quarters (p<0.01). The reduction was significant (p<0.01) for both dry-period and post-calving infections. The susceptibility of uninfected quarters to new infection by Streptococcus uberis appeared to be unrelated to the infection status of a cow at drying off. Clinical infections during the dry period were most prevalent (97%) in quarters identified as having open teat canals. Fewer open teat canals (p<0.05) were observed among antibiotic treated quarters over the first 4 weeks of the dry period. Treated quarters had a lower (p<0.05) incidence of new clinical infection during the ensuing lactation and lower somatic cell counts. This did not affect production levels of milk, milk fat or protein. The results clearly indicated a prophylactic benefit for the dry cow antibiotic treatment against new Streptococcus uberis infections during the dry period.     

Potentiation of antibiotic activity by EDTA-tromethamine against three clinically isolated Gram-positive resistant bacteria. Anin vitro investigation

Thein vitro synergistic effects of combinations of EDTA-tromethamine and five antimicrobial agents (ampicillin, cephalexin, oxytetracycline, streptomycin and sulphadimethoxine) on three clinically isolated Gram-positive bacteria (Staphylococcus aureus, Staphylococcus hominis andStreptococcus faecium) were investigated. The bacteria had been isolated from three cases of canine otitis resistant to -lactam antibiotic therapy. The antimicrobial activity was evaluated by measuring the minimal inhibitory concentration for the antibiotics alone or in combination with EDTA-tromethamine. EDTA-tromethamine potentiated the activity of cefalexin againstS. aureus andS. hominis, of oxytetracycline againstS. aureus andS. faecium and of streptomycin againstS. faecium. No significant effects were noted on the activity of oxytetracycline againstS. hominis. The remaining combinations gave a slight synergistic effect. As previously shown for Gram-negative resistant bacteria, these data suggest that the association of EDTA-tromethamine and appropriate antibiotic therapy may be useful to overcome persistent infections of soft tissues in domestic animals.Abbreviations cfu colony forming units - EDTA ethylenediaminetetraacetic acid - MIC minimal inhibitory concentration - tromethamine tris(hydroxymethyl)- aminomethane Part of this paper was communicated at the XLVI Congress of the Italian Society of Veterinary Sciences, Venice, 30 September – 3 October 1992     

Efficacy of various treatment regimens, using liposomal streptomycin in cows with brucellosis

Thirty cows naturally infected with Brucella abortus were treated by various routes, using free or liposomal streptomycin or a combination of liposomal streptomycin and a long-acting oxytetracycline preparation. Of 21 cows treated with liposomal streptomycin alone, 3 (14%) were culture negative and 3 had 10 or fewer bacterial colonies isolated from tissues obtained at necropsy. Thirteen (62%) cows continued to shed organisms in udder secretions and were considered treatment failures. Of 9 cows that were given a combination of liposomal streptomycin and long-acting oxytetracycline, 5 (56%) were cured, 3 had 10 or fewer colonies on culture plates of tissue after necropsy and only 1 continued to shed B abortus in udder secretions after treatment. Eleven cows were given streptomycin liposomes by intramammary infusion with or without IM administration of long-acting oxytetracycline. The most effective regimen consisted of 2 intramammary infusions of streptomycin liposomes and 2 doses of oxytetracycline administered IM. Of 5 cows treated thusly, 2 were cured and all others had fewer than 10 B abortus colonies isolated from tissues obtained at necropsy.     

Comparison of penicillin, oxytetracycline, and trimethoprim-sulfadoxine in the treatment of acute undifferentiated bovine respiratory disease

Penicillin, oxytetracycline, and a trimethoprimsulfadoxine combination were compared as first choice antibiotics for the treatment of acute bovine respiratory disease in weaned beef calves. There was no statistical difference in the mortality losses due to respiratory disease; however, the case fatality rate in the trimethoprim-sulfadoxine treatment group (3%) was markedly lower than in the penicillin (10%) and oxytetracycline (8%) treatment groups. The trimethoprim-sulfadoxine group also had statistically fewer treatment days compared to the penicillin and oxytetracycline groups (p < 0.05). Inclusion of mortality costs in the calculation of treatment costs demonstrated that treatment of the trimethoprimsulfadoxine group was appreciably less costly than treatment of the other groups. Temperature response abnormalities, defined as either an elevation in temperature or a failure of temperature to drop from one treatment day to the next, were associated with a relapse rate of approximately 50%. In vitro antibiotic sensitivity testing of Pasteurella haemolytica isolated from pretreatment nasal swabs was not a useful predictor of treatment success of antimicrobials.     

Randomized clinical trial to evaluate the effectiveness of enrofloxacin as a second‐line antibiotic for treatment of acute Escherichia coli mastitis

The objective of the present study was to evaluate the effectiveness of enrofloxacin (ERFX) as a second‐line antibiotic for treatment of acute Escherichia coli (E. coli) mastitis. Forty‐two cows with naturally occurring acute E. coli mastitis were enrolled. On the first day of treatment (day 0), empirically selected antibiotics (oxytetracycline: n = 32, kanamycin: n = 10) were administered. Although systemic signs improved in 10 cows (first‐line group), the signs remained unchanged or worsened in 32 cows on day 1, including two cows that were found dead. The 30 surviving cows were randomly assigned to second‐line groups constituting an ERFX group (n = 19) or a control group (n = 11) that was treated with other antibiotics. Response to each treatment was evaluated by measuring clinical signs from day 0 to day 3, subsequent quarter milk recovery, and the 60‐day survival rate. Appetite on day 3 was significantly better in the ERFX group compared to the control group. No significant differences were observed in the 60‐day survival rate or the subsequent milk recovery between the ERFX group and the control group. Thus, the use of ERFX as a second‐line antibiotic for the treatment of acute E. coli mastitis could induce a rapid appetite recovery.     

Acute coliform mastitis in buffaloes (Bubalus bubalis): Clinical findings and treatment outcomes

This report was delineated to study the clinical, bacteriological and therapeutic aspects concerned with acute coliform mastitis in buffaloes. Bacteriological examination of 80 quarter milk samples obtained aseptically from 56 buffaloes with acute mastitis revealed that coliform bacteria was the most common pathogen (45 cases) followed by Staphylococcus aureus (seven cases) then Streptococcus uberis (three cases), and Streptococcus agalactiae (one case). Clinically, hotness, swelling and painful reaction with serous excretion containing clots was recorded in buffaloes with coliform mastitis. The efficacy of ceftiofur was evaluated in the treatment of buffaloes with acute coliform mastitis. Parenteral ceftiofur neither improved clinical signs nor returned milk to pre-infection production level, whereas intramammary ceftiofur and combination of intramammary with parenteral ceftiofur improved the clinical signs in 10/15 and 12/15 buffaloes, respectively. On quarter level, 3/17, 12/17 and 15/21 quarters recovered in groups received parenteral, intramammary and combination therapy, respectively. This study demonstrates that systemic ceftofur is not effective in the treatment of clinical coliform mastitis in buffaloes.     

Demonstration of non-inferiority of a novel combination intramammary antimicrobial in the treatment of clinical mastitis

AIM: To test the non-inferiority of a novel combination intramammary product containing penicillin and cloxacillin to a reference intramammary product containing oxytetracycline, oleandomycin, neomycin and prednisolone with regard to bacteriological cure and clinical cure.

METHODS: Clinical cases of mastitis were sourced from 30 spring-calving dairy farms in the Southland region of New Zealand. Affected quarters were infused three times at 24 hourly intervals with either the novel combination product containing 1?g penicillin and 200?mg cloxacillin, or a reference product containing 200?mg oxytetracycline, 100?mg oleandomycin, 100?mg neomycin and 5?mg prednisolone. Cows were enrolled when a farmer detected a case of clinical mastitis. Milk samples were collected for microbiological culture immediately before treatment (Day 0) and on Days 9, 16 and 23. Bacteriological cure was compared for 187 and 178 quarters treated with the reference and novel product, respectively, and clinical cure was compared for 235 and 223 quarters, respectively. Non-inferiority was assessed by calculating the difference in cure rates between the two products and constructing a 95% CI around the difference, using the variance inflation factor to account for herd level clustering. The non-inferiority margin was 20% for both bacteriological and clinical cure. Generalising estimating equation models were used to determine predictor variables.

RESULTS: The bacteriological cure percentage, adjusted to account for herd-level clustering, was 8.5 (95% CI=?1.7–21.8)% higher for quarters treated with the novel than the reference product. The adjusted clinical cure percentage was 0.3 (95% CI=?11.2–12.0)% higher for clinical quarters treated with the novel than the reference product. Bacterial species was the only covariate for bacteriological cure (p=0.003), and quarter score at enrolment (indicating udder inflammation) was the only covariate for clinical cure (p=0.032) in the multivariable models.

CONCLUSION: The novel combination product was demonstrated to be non-inferior to the reference product with regards to both bacteriological cure and clinical cure.

CLINICAL RELEVANCE: Clinicians treating mastitis now have access to this novel combination intramammary product, and demonstration of its non-inferiority compared to the existing reference product will provide options for treatment approaches. The novel product contains fewer antimicrobials; which are of a narrower spectrum of activity.     

Study of serum drug levels in calves following intramuscular administration of three tetracycline drug preparations

Three antibiotic formulations, oxytetracycline (A) in propylene glycol and oxytetracycline (B) in polyvinyl pyrrolidine and pyrrolidino-methyltetracycline in an oil suspension were given to calves by the intramuscular route. Only oxytetracycline (A) appeared to cause much pain after injection.

The half-time elimination (t_½cl) for oxytetracycline (A) was 14.000 ± 3.580 h for oxytetracycline (B) 10.290 ±5.159 h and for pyrrolidinomethyltetracycline 8.160 ± 0.920 h. The rate of elimination `beta slope” for oxytetracycline (A) was 0.052 ± 0.012 h⁻¹ for oxytetracycline (B) 0.077 ± 0.261 h⁻¹ and for pyrrolidinomethyltetracycline 0.086 ± 0.010 h⁻¹. The Y intercept of the “beta” elimination slope C_os (μg/mL) for oxytetracycline (A) was 2.490 ± 1.040, for oxytetracycline (B) 3.463 ± 1.874 and for pyrrolidinomethyltetracycline 2.852 ± 1.360.

Pyrrolidinomethyltetracycline appeared to have a two component elimination curve, however, only the “beta slope” was used for the calculations.

     

Effects of intramammary infusion of Bifidobacterium breve on mastitis pathogens and somatic cell response in quarters from dairy cows with chronic subclinical mastitis

The present study assessed the effects of intramammary infusion of Bifidobacterium breve (B. breve) on mastitis‐causing pathogens and on the somatic cell counts (SCC) in lactating cows with chronic subclinical mastitis. The bacteriological cure rates of 42 quarters from 42 cows infected with Staphylococcus aureus, Corynebacterium bovis, coagulase‐negative staphylococci, and environmental streptococci were 18.2% (2/11), 14.3% (1/7), 58.8% (10/17), and 28.6% (2/7), respectively, on day 14 after B. breve infusion. In a second trial, B. breve was infused into 18 quarters from 18 cows with chronic subclinical mastitis from which pathogens had not been isolated; the rates of quarters showing SCC > 50 × 10⁴ cells/ml prior to B. breve infusion that decreased to < 30 × 10⁴ cells/ml after infusion were significantly (p < .01) increased to 61.1% (11/18) on day 14 compared to that prior to infusion (0/18). The intramammary infusion of B. breve appears to be a non‐antibiotic approach for elimination of minor pathogens and decreasing SCC in quarters with chronic subclinical mastitis in dairy cows.     

In vitro activity of danofloxacin, tylosin and oxytetracycline against mycoplasmas of veterinary importance

The activities of danofloxacin, a novel fluoroquinolone, and two other antimicrobials were determined in vitro against field isolates of seven Mycoplasma species of veterinary importance isolated from cattle, swine and poultry in five European countries. The minimum inhibitory concentrations (MIC) of danofloxacin, tylosin and oxytetracycline were determined against a total of 68 isolates. Danofloxacin showed excellent activity against isolates of all Mycoplasma species (range 0·008 to 0·5 μg ml⁻¹), but in some isolates there was evidence of reduced sensitivity to tylosin (range 0·008 to 2·0 μg ml⁻¹) and oxytetracycline (range 0·008 to over 16·0 μg ml⁻¹). Danofloxacin was more active than other antimicrobials against, M hyopneumoniae, M dispar and M bovigenitalium, and showed activity similar to that of tylosin against M bovis and M gallisepticum. Tylosin was the most active against M synoviae and M hyosynoviae. Generally, oxytetracycline showed the poorest activity, but was superior to tylosin against M bovigenitalium. A second (final) MIC reading was taken for all isolates 14 or 21 days after the initial reading, and MIC values rose during that time. However, the increase seen in danofloxacin values (typically one to two dilutions) was less than that seen for tylosin and oxytetracycline. It is concluded that danofloxacin is highly active in vitro against all of the Mycoplasma species tested, and thus shows great potential for the treatment of respiratory and other infections caused by Mycoplasma species in cattle, pigs and poultry.     

Modelling the concentration-time relationship in milk from cattle administered an intramammary drug

Whittem, T., Whittem, J. H., Constable, P. D. Modelling the concentration–time relationship in milk from cattle administered an intramammary drug. J. vet. Pharmacol. Therap.  35 , 460–471. Antimicrobial drugs are often infused directly through the streak canal into the bovine udder for the treatment or prevention of mastitis. These infusions have two major problems: drug residues in milk and variable antimicrobial efficacy. Both problems are influenced by the pharmacokinetics of intramammary delivery and elimination of drugs. This pharmacokinetics does not conform to the assumptions of traditional first‐order mamillary pharmacokinetic models. To help understand drug delivery into and elimination from the udder, a new approach to pharmacokinetic modelling of the udder is proposed. This new model was used to predict the movement of drug within the udder and the concentrations of drug achieved within physiological compartments of the udder. These predictions were examined using computer modelling. The model was evaluated using data from in vivo intramammary infusion of cefuroxime. The model predicts that changes in milking efficiency (residual volume), milk productivity and milking frequency can impact both the drug residue persistence and the time that milk drug concentrations exceed the minimum inhibitory concentrations for pathogens. The model provides a new tool for future evaluation of intramammary dosing studies.     

Anti-inflammatory therapy in acute endotoxin-induced bovine mastitis

Acute mastitis was induced in lactating cows by intramammary challenge with 10 g of Escherichia coli lipopolysaccharide. The cows were monitored clinically prior to and for 96 hours after challenge. Milk production, complete blood counts, serum enzyme activities and milk indicators of inflammation were evaluated.Endotoxin challenge was in 7 groups of 3 cows each. Within the groups, cows were randomly assigned to 3 intravenous treatments: saline controls, steroid (one dose of dexamethasone at 0.44 mg/kg) and non-steroidal agent (two doses of flunixin meglumine at 1.1 mg/kg, 8 h apart).Anti-inflammatory therapy reduced rectal and mammary gland surface temperatures. Milk production was significantly reduced (p<0.05) in cows treated with dexamethasone. Although dexamethasone treatment produced significant increases (p<0.05) in blood leukocytes and segmented neutrophils, milk somatic cell concentrations were not significantly altered. Flunixin meglumine did not alter milk production or blood or milk leukocytes.     

A Study on Postpartum Metritis in Iraqi Buffalo Cows: Bacterial Causes and Treatment

The objectives of the present study were to determine the relationship between bacteriological findings, clinical signs and histopathological changes in postpartum metritis. Evaluation of the treatment efficiency of using systemic or intra‐uterine infusion of antibiotics with some hormonal preparations for the treatment of postpartum metritis. Data were collected from 50 buffalo cows with history of calving of more than 1 month. All buffaloes were subjected to detailed clinical examination including external inspection, vaginoscopy and transrectal palpation of the cervix, uterus and ovaries. Swabs for bacteriology and biopsies for histopathology were collected from uterine lumen from each buffalo included in the present study. Bacteria identified using API systems following aerobic and anaerobic cultures. Vaginal mucus scored for character, odour and estimation of polymorphonuclear cells (PMNs). Treatment conducted using oxytetracycline in local intrauterine infusion or systemically with hormonal treatment including prostaglandinF2α (PGF2α) and oestradiol benzoate. Results revealed that the most predisposing factor for postpartum uterine infection was retained placenta and toxic puerperal metritis. The most prevalent bacteria in uterine lumen were Escherichia coli, Archanobacterium pyogenes, Bacteroides fragilis and Fusobacterium necrophorum the most prevalent bacteria in buffaloes with postpartum metritis. A. pyogenes and F. necrophorum were an important pathogens causing severe uterine inflammation as found in histopathological examinations. Buffaloes with postpartum metritis showed good clinical cure when oxytetracycline injected systemically with PGF2α. Intrauterine infusion of oxytetracycline had no advantage for the treatment of uterine infection in buffalo cows with postpartum metritis. PGF2α improved clinical cure of buffaloes with postpartum metritis.     

An Experimental Trial of Oxytetracycline as a Therapy for Black Spermatophore Disease in Penaeus vannamei

Abstract

The efficacy of oxytetracycline was assessed as a potential therapy for male reproductive tract syndrome in a population of 160 previously affected, pond-reared, adult Penaeus vannamei. All animals were individually tagged, and the severity of disease was assessed grossly 2 weeks before, during, and 4 weeks after feed medicated with oxytetracycline hydrochloride was administered. Bacterial cultures indicated that more Vibrio sp. were isolated from animals with melanized spermatophores than from animals with normal spermatophores at the same site. Vibrio alginolyticus was the most common bacterial isolate, and the bacterial isolates were sensitive to oxytetracycline. A t-test analysis of the mean lesion severity scores showed no significant difference between the control animals and animals that received the medicated feed. A significant difference in severity scores among designated severity groups (low, medium, high; P < 0.01) was maintained throughout the experiment. Overall, the trend in all severity groups was a gradual increase in severity over time. These results suggest that this case of male reproductive tract syndrome was not responsive to oxytetracycline therapy. In addition, these results provide further evidence of a noninfectious primary etiology.     

Comparison of common antibiotic therapies for haemophilus pleuropneumonia in pigs

Three experiments were done to evaluate some antibiotic therapies that are used commonly to treat pigs infected with Haemophilus pleuropneumoniae. Haemophilus-free piglets, 12 weeks of age, were challenged in a chamber with an aerosol of H. pleuropneumoniae serotype 1 and were medicated with antibiotics at various times before or after challenge. Antibiotic formulations which are commonly used to treat pneumonia in swine were used. They were chloramphenicol, penicillin, and a long-acting formulation of oxytetracycline given intramuscularly; and oxytetracycline, chloramphenicol and spiromycin (investigated as a potentially useful antibiotic) given in solution as the sole source of drinking water. Infection, disease (death, fever, gross lung lesions) and growth rate were measured in pigs following experimental challenge.