Barriers to Successful Discharge After Cardiac Surgery: A Focus Group Study and Cross-Sectional Survey.

At present, there is a lack of information on patient and caregiver values, and perceived priorities and barriers, to guide successful post-discharge recovery. This was a single center, multiple methods study that investigated patient, caregiver, and health care provider perceptions of the discharge process after cardiac surgery. Themes emerging from focus group discussions with patients and caregivers were used to develop surveys relating to values, barriers, and challenges relating to the discharge process. Thirty-two patients (n = 16) and caregivers (n = 16) participated in four separate focus groups. Four themes emerged from these discussions: (1) a lack of understanding about what the discharge process entails and when discharge is appropriate, (2) issues relating to the information provided to patients at the time of discharge, (3) participant experiences with the health care system, and (4) the experiences of caregivers. Seventy-eight patients, 34 caregivers, 53 nurses and/or other allied health professionals, and 8 surgeons completed the cross-sectional surveys. The most important component of the discharge process for patients and caregivers was "knowing what to do in an emergency." Health care providers less accurately identified what caregivers perceived as the most important aspects of the discharge process.Statements relating to informational barriers to discharge were the most discordant among patient and caregiver respondents. After discharge, patients and caregivers identified the need for longer-term follow up with the surgeon and more support in the community. Incorporation of patient and caregiver values to guide the post-cardiac surgery discharge process is essential to promote successful recovery.

Dietary essential oils improve feed efficiency and hepatic antioxidant content of broiler chickens.

The aim of this study was to test the hypothesis of an improved growth, dietary nutrient availability and overall health of broiler chickens reared on recycled litter when fed a standardised combination of essential oils (EO; carvacrol, cinnamaldehyde and capsicum oleoresin). To assess the effect of dietary treatments, feed intake, weight gain, feed efficiency, availability of dietary nutrients and energy, villus morphometry, excreta sialic acid concentration, hepatic antioxidants and serum amyloid A (SAA) when fed to broiler chickens were evaluated. Counts of Eimeria spp. oocysts were also determined in excreta samples. Four experimental diets were offered, including two basal control diets based on either wheat or maize that contained 215 g CP/kg and 12.13 MJ/kg metabolisable energy and another two diets using the basal control diets supplemented with the EO combination at 100 mg/kg diet. Each diet was fed to eight floor pens, containing two birds each, following randomisation. Birds fed the EO-supplemented diets had an improved (P0.05) were observed in villus morphometry, sialic acid secretion, number of oocysts and SAA. Feeding the EO improved (P<0.05) the retention of dietary Ca and Na. Compared with maize, feeding wheat-based diets improved the retention coefficients for Ca, P and Na (P<0.05). Feeding dietary EO improved (P<0.05) the concentrations of the hepatic antioxidants, including carotene, coenzyme Q10 and total vitamin E. The hepatic concentration of carotene of the maize-fed birds was 55.6% greater (P<0.05) compared with the wheat-fed birds. These results demonstrated that the addition of a standardised combination of EO in wheat- and maize-based diets provided benefits in terms of feed efficiency, mineral retention and antioxidant status of the birds when reared on recycled litter.

Effect of inorganic or organic copper fed without or with added sulfur and molybdenum on the performance, indicators of copper status, and hepatic mRNA in dairy cows.

The effect of inorganic (INORG) or organic (ORG) Cu, fed without (-) or with (+) additional S and Mo on Cu status and performance was examined using 56 early lactation dairy cows in a 2×2 factorial study design. Supplementary Cu was added as either CuSO4 or BioplexCu (Alltech Inc., Nicholasville, KY) to provide an additional 10mg of Cu/kg of dry matter (DM), with S added at 1.5g/kg of DM and Mo at 6.8mg/kg of DM to reduce Cu bioavailability. The basal ration was composed of corn and grass silages (2:1 respectively, DM basis) and straight feeds. Cows commenced the study at wk 7 of lactation and remained on treatment for 16 wk. An interaction existed between Cu source and added S and Mo on DM intake, with cows offered INORG- Cu having an increased intake compared with those offered INORG+ or ORG- Cu. Milk yield averaged 35.4kg/d, and was 5% higher with milk fat content 6% lower in cows fed INORG compared with ORG Cu, but milk fat yield, energy-corrected milk yield, and milk protein content did not differ between treatments. A trend existed for cows to have a higher body weight gain when offered ORG compared with INORG Cu. Cows fed diets containing INORG Cu had a higher milk concentration of C17:0 and C18:3n-3 compared with those fed diets containing ORG Cu. Cows fed added S and Mo had a lower milk concentration of C17:0 and C18:0 compared with those that were not supplemented. No effect was observed of dietary treatment on plasma Cu concentration, which averaged 13.1 µmol/L, except during wk 12 when cows receiving added S and Mo had a lower concentration. No effect was observed of Cu source on mean plasma Mo concentrations, but during wk 16 cows offered INORG Cu had a higher concentration than those offered ORG Cu. Hepatic Cu levels decreased by approximately 0.9mg/kg of DM per day when fed additional S and Mo, but no effect of Cu source was observed. A trend existed for hepatic ATPase, Cu++ transporting, beta polypeptide (ATP7B) to be upregulated in cows when fed S and Mo along with ORG but not INORG Cu. In conclusion, the inclusion of an ORG compared with an INORG source of Cu reduced milk yield but increased milk fat concentration and body weight gain, with no effect on energy-corrected milk yield. Little effect was observed of dietary Cu supply on plasma mineral concentration, liver mRNA abundance, or milk fatty acid profile, whereas the addition of S and Mo reduced hepatic Cu concentrations.

The effect of fish oil supplementation of pregnant and lactating ewes on milk production and lamb performance.

Supplementation of pregnant ewes with long-chain n-3 polyunsaturated fatty acids (PUFA) demonstrably improves indicators of neonatal lamb vigour, potentially improving the number of lambs reared per ewe. The present study investigated the effect of supplementing ewes with fish oil and vitamin E (α-tocopherol acetate) throughout both pregnancy and lactation on the performance of lactating ewes and sucking lambs. Forty-eight ewes were supplemented with one of four concentrates containing either Megalac or fish oil plus a basal (50 mg/kg) or supranutritional (500 mg/kg) concentration of vitamin E from 6 weeks pre-partum until 4 weeks post partum in a two-by-two factorial randomised-block design. All concentrates were formulated to contain approximately 60 g/kg supplemental fatty acids. Ewes were housed, penned on sawdust and offered straw ad libitum. Blood samples were taken from ewes and lambs at intervals throughout the experiment and milk samples were obtained at 21 days into lactation. There was no notable effect of dietary vitamin E concentration upon ewe or lamb performance. Ewe dry-matter (DM) intake and yield were unaffected by dietary treatment, although ewes fed fish oil lost less weight during lactation (-1.88 kg compared with -3.97 kg for Megalac-supplemented ewes; P < 0.01). Milk fat concentrations (67.3 g/kg compared with 91.8 g/kg; P < 0.01) and yields (6.65 g/h v. 9.26 g/h; P < 0.01) were reduced in ewes fed fish oil and these decreases were associated with lower litter-growth rates (0.49 g/day compared with 0.54 g/day; P < 0.05). Milk protein yield was increased by fish oil supplementation (3.82 g/h) compared with Megalac supplementation (3.28 g/h; P < 0.05); moreover, there was an interaction between fat source and vitamin E concentration in that both protein concentration and yield were significantly lower in milk from ewes fed treatment with Megalac + basal vitamin E (MB) compared with the other three treatments. Fish oil supplementation increased the concentrations of C18:1 trans-, cis-9, trans-11 conjugated linoleic acid (CLA), C20:5 (n-3) and C22:6 (n-3) within ewe plasma, milk and lamb plasma. The mechanisms by which fish oil supplementation affects milk composition warrants further investigation.

Apparent metabolisable energy and digestibility of shea (Vitellaria paradoxa) fat, cocoa (Theobroma cacao) fat and soybean oil in broiler chicks.

1. The objective of this experiment was to determine and compare the apparent lipid digestibility coefficient and apparent metabolisable energy (AME) value of shea nut (Vitellaria paradoxa, Gaertn.) fat in broiler chickens with that of soybean oil and cocoa fat. 2. One hundred and sixty 13-d-old male broiler chicks were used in a randomised complete block design. The fats were added at 30, 60 and 90 g/kg to a basal diet. A tenth dietary treatment was the basal feed with no added fats or oils. The birds were fed on the diets for 8 d and all droppings were collected for the final 4 d. 3. The mean coefficient of apparent lipid digestibility for shea fat (0.58) was similar to that of cocoa fat (0.54) but lower than that of soybean oil (0.95). There was evidence of a lipid x concentration interaction with the 90 g/kg shea fat diet having low lipid digestibility (0.43). 4. There was an interaction between the effects of dietary lipid concentration and test lipid on AME but, at dietary levels of 60 g/kg and below, the AME of shea fat (22.0 MJ/kg DM) and cocoa fat (26.4 MJ/kg DM) was significantly lower than that of soybean oil (39.8 MJ/kg DM).

Sensitivities and specificities of premier E. coli O157 and premier EHEC enzyme immunoassays for diagnosis of infection with verotxin (Shiga-like toxin)-producing Escherichia coli. The SYNSORB Pk Study investigators.

This study describes the performance of two rapid enzyme immunoassays, Premier E. coli O157 and Premier EHEC (Meridian Diagnostics Inc., Cincinnati, Ohio) for the detection in stools of Escherichia coli O157 and verotoxins (Shiga-like toxins), respectively. Both tests were performed on stools from 876 children presenting to eight emergency departments with diarrhea. Standard culture, including E. coli O157:H7 isolation, was performed, and paired sera were taken for anti-O157-lipopolysaccharide antibody determination. Stools from patients enrolled in the study, and those yielding discordant results, were sent to a reference laboratory for repeat testing and further investigation, including cytotoxicity and non-O157 verotoxin-producing E. coli culture. Results were classified as field results (obtained in the eight site laboratories) and resolved results (obtained after repeat testing in the central laboratory). The "gold standard" for sensitivity of both tests and for specificity of Premier E. coli O157 was isolation of E. coli O157:H7 or a fourfold anti-O157 antibody rise. Specimens positive by the Premier EHEC test and negative for E. coli O157 culture were examined for non-O157 verotoxin-producing E. coli. The field sensitivity of Premier E. coli O157 was 86%, that of Premier EHEC was 89%, and the specificity of Premier E. coli O157 was 98%. Ten of 13 discordant Premier E. coli O157 results were reassigned as true results after repeat testing. Ten non-O157 verotoxin-producing E. coli isolates were recovered from Premier EHEC-positive, E. coli O157 culture-negative stools. Only one specimen gave an unequivocally false-positive Premier EHEC result. Both tests are highly sensitive and are specific if correctly performed. The Premier EHEC test will be particularly valuable as a practical routine test for the detection of non-O157 verotoxin-producing E. coli.

Virion protein sequence variation among Australian isolates of turnip yellow mosaic tymovirus.

The virion protein genes, and 3' untranslated regions, of six variants of turnip yellow mosaic tymovirus (TYMV) that produced different symptoms in their native host Cardamine robusta and in Chinese cabbage plants, have been sequenced. The sequences have been compared with each other, and with the same region of the pBL-16 clone of the Blue Lake isolate of TYMV. The sequences of the virion protein genes differed by a mean of 1.89% (range 0-2.82%), and the encoded proteins by a mean of 1.71% (range 0-3.17%). The nucleotide differences were confined to the 5'-most 60% of the gene, whereas there were amino acid differences only among residues 12 to 29 and residue 102 (numbered from the N-terminus) of the virion protein involving only hydrophobic residues at the surface of the protein. The amino acid and nucleotide differences between the seven isolates did not correlate with differences in the symptoms they caused, but confirmed earlier estimates of genetic variability in the wild populations of the virus.

Infectious eggplant mosaic tymovirus and ononis yellow mosaic tymovirus from cloned cDNA.

Eggplant mosaic virus (EMV) and ononis yellow mosaic virus (OYMV) are two tymoviruses that have ssRNA genomes of about 6.2 kb and 6.3 kb, and which infect solanaceous and leguminous hosts, respectively. Full-length cDNA clones of these viruses were constructed with a T7 promoter adjacent to the 5' terminus of the DNA copy of the viral genome, and with unique restriction endonuclease sites at the 3' terminus. This allowed RNA to be transcribed from the DNA encoding the genome. The transcript RNA was infectious when inoculated to Nicotiana glutinosa (for EMV) and Pisum sativum (for OYMV). These clones, together with clones of turnip yellow mosaic tymovirus, which infects brassicas, have been used to construct hybrids in which the virion protein gene was exchanged between EMV or OYMV and turnip yellow mosaic virus. These and other hybrids are being used to investigate the molecular basis for host range differences in tymoviruses.

Bacterial contamination at abdominal hysterectomy: a comparison of staple closure with regular suture closure of the vaginal wall.

Bacterial contamination of the pelvis from the vagina at abdominal hysterectomy is assumed to be a major cause of infectious complications. A pilot study was completed to compare the bacterial contamination that occurred when the vaginal vault was closed using an automatic stapling technique with a regular suture method. The findings suggested that there was considerably less contamination using the staple technique and that infectious complications were associated with heavy bacterial contamination from the vagina. More extensive studies of this association are needed to confirm the presented data.

Enzyme immunoassay of gentamicin with the Abbott ABA-100 analyzer.

The enzyme immunoassay of gentamicin using "EMIT" reagents was adapted to take advantage of the small reagent volume required by the Abbott ABA-100. The method increases fourfold the maximum number of tests per kit. The correlation with the bacterial inhibition method was 98%.

Variations in interferon production by lymphocytes from patients with chronic lymphatic leukaemia.

In a group of patients with chronic lymphatic leukaemia leucocyte cultures showed a diminished capacity to synthesize interferon when compared with controls. The leucocyte culture with the lowest capacity to synthesize interferon came from the patients with the highest peripheral blood lymphocyte counts and vice versa. These results are presented as indirect evidence that T lymphocytes are more competent producers of interferon than B lymphocytes.