Establishment of biochemical reference values for backyard chickens in Colorado (Gallus gallus domesticus).

BACKGROUND: Previous literature pertaining to biochemical RIs of domestic chickens has primarily focused on commercial production flocks and not backyard birds. OBJECTIVE: We aimed to establish biochemistry RIs for privately-owned backyard chickens (Gallus gallus domesticus) using reference laboratory equipment. METHODS: Samples were collected from 123 presumably healthy adult chickens between 2017 and 2019 from 22 different flocks in Colorado. Heparinized blood was obtained, and a biochemistry profile was evaluated, including sodium, potassium, chloride, calcium, phosphorous, uric acid, AST, CK, glucose, cholesterol, and total protein. Reference values were created according to current American Society for Veterinary Clinical Pathology recommendations. RESULTS: Differences in measurand intervals compared with previous literature were found for sodium, calcium, total protein, potassium, phosphorus, uric acid, and glucose. Hens were found to have higher median calcium (17.9 mg/dL vs 11.2 mg/dL [P = .0001]), total protein (5.2 g/dL vs 4.8 g/dL [P = .0046]), and potassium (3.80 mEq/L vs 3.48 mEq/L [P = .0267]) concentrations, as well as lower sodium (155 mEq/L vs 158 mEq/L [P = .0046]) concentrations, calculated osmolalities (310 mOsm/kg vs 314 mOsm/kg [P = .0249]), and AST (165 U/L vs 194 U/L [P = .0121]) activities, than roosters. Seasonal variation was found between summer and winter samples for median sodium (144 mEq/L vs 148 mEq/L [P = .0008]), chloride (111.8 mEq/L vs 113.5 mEq/L [P = .0033]) concentrations, calculated osmolalities (306 mOsm/kg vs 311 mOsm/kg [P = <.0001]), and AST (185 U/L vs 159 U/L [P = .0053]) and CK (1098 U/L vs 770 U/L [P = .0007]) activities. CONCLUSIONS: This study presents biochemical reference values for backyard chickens in Colorado that can be a basis for evaluations in similar settings.

Haematological indices and haematinic levels after mini gastric bypass: a matched comparison with Roux-en-Y gastric bypass.

Many surgeons believe mini gastric bypass (MGB) is more likely to cause micronutrient malabsorption compared to Roux-en-Y gastric bypass (RYGB). Till date, there is no published study evaluating haematological indices and haematinic levels in patients undergoing MGB and comparing these with a matched cohort of RYGB. Two hundred patients who underwent MGB between October 2012 and October 2015 were matched to 200 patients who underwent RYGB for age, sex, body mass index and time of surgery. We then compared haemoglobin, mean corpuscular volume, iron, ferritin, vitamin B12 and folic acid levels preoperatively and at 6 monthly intervals after surgery until 2 years. The percentage total weight loss was significantly higher in the MGB group compared to the RYGB group at all time points. At 2 years, MGB and RYGB both led to an increase in anaemia rates but the difference was only significant for MGB group. Compared to RYGB, MGB patients were more likely to be anaemic at 2 years, although the difference was not significant statistically (16.6% vs. 12.7%; P value = 0.55). There was a trend for lower iron and folate levels in MGB group compared to RYGB group but the difference was statistically significant at some of the time periods only (significantly lower folate at 6 and 12 months and lower iron at 6 months in the MGB group). MGB leads to a significant increase in anaemia rates in a supplemented cohort. There is a trend towards lower iron and folate levels and higher anaemia rates in MGB group in comparison with RYGB. Larger studies with longer follow-up should evaluate results of MGB with a shorter biliopancreatic limb.

Advanced diagnostic genetic testing in inherited retinal disease: experience from a single tertiary referral centre in the UK National Health Service.

In 2013, as part of our genetic investigation of patients with inherited retinal disease, we utilized multigene panel testing of 105 genes known to cause retinal disease in our patient cohorts. This test was performed in a UK National Health Service (NHS) accredited laboratory. The results of all multigene panel tests requested between 1.4.13 and 31.8.14 were retrospectively reviewed. All patients had been previously seen at Moorfields Eye Hospital, London, UK and diagnosed with an inherited retinal dystrophy after clinical examination and detailed retinal imaging. The results were categorized into three groups: (i) Testing helped establish a certain molecular diagnosis in 45 out of 115 (39%). Variants in USH2A (n = 6) and RP1 (n = 4) were most common. (ii) Definitive conclusions could not be drawn from molecular testing alone in 13 out of 115 (11%) as either insufficient pathogenic variants were discovered or those identified were not consistent with the phenotype. (iii) Testing did not identify any pathogenic variants responsible for the phenotype in 57 out of 115 (50%). Multigene panel testing performed in an NHS setting has enabled a molecular diagnosis to be confidently made in 40% of cases. Novel variants accounted for 38% of all identified variants. Detailed retinal phenotyping helped the interpretation of specific variants. Additional care needs to be taken when assessing polymorphisms in genes that have been infrequently associated with disease, as historical techniques were not as rigorous as contemporary ones. Future iterations of sequencing are likely to offer higher sensitivity, testing a broader range of genes, more rapidly and at a reduced cost.

Muscles and their role in episodic tension-type headache: implications for treatment.

BACKGROUND AND OBJECTIVE: Tension-type headache (TTH) imposes a heavy burden on the global population but remains incompletely understood and poorly managed. DATABASES AND DATA TREATMENT: Here, we review current knowledge of peripheral factors involved in the mechanism of TTH and make recommendations for the treatment of episodic TTH based on these. RESULTS: Peripheral activation or sensitization of myofascial nociceptors is most probably involved in the development of muscle pain and the acute episode of TTH. Repetitive episodes of muscle pain may sensitize the central nervous system resulting in progression of TTH to the chronic form. Thus, muscular factors may be responsible not only for the acute headache episode but also for chronification of the disorder. Simple analgesics and non-steroidal anti-inflammatory drugs are the mainstays of management of individual headache episodes. Ibuprofen 400 mg and aspirin 1000 mg are recommended as drugs of first choice based on treatment effect, safety profile and costs. Non-pharmacological therapies include electromyographic biofeedback, physiotherapy and muscle relaxation therapy. Future studies should aim to identify the triggers of peripheral nociception and how to avoid peripheral and central sensitization. There is a need for more effective, faster acting drugs for acute TTH. CONCLUSION: Muscular factors play an important role in episodic TTH. Ibuprofen 400 mg and aspirin 1000 mg are recommended as drugs of first choice.

A modified Delphi consensus study to identify UK osteopathic profession research priorities.

There is an increasing emphasis to take an evidence-based approach to healthcare. To obtain evidence relevant to the osteopathic profession a clear research direction is required based on the views of stakeholders in the osteopathic profession. A modified Delphi consensus approach was conducted to explore the views of osteopaths and patients regarding research priorities for osteopathy. Osteopaths and patients were invited to complete an online questionnaire survey (n = 145). Round 1 requested up to 10 research priority areas and the rationale for their selection. All of the themes from Round 1 were fed back verbatim, and in Round 2 participants were asked to rank the importance of the research priorities on a 5-point Likert scale. Finally, in Round 3 participants were asked to rank the importance of a refined list of research topics which had reached consensus. Descriptive analysis and use of Kendall's coefficient of concordance enabled interpretation of consensus. The response rate for Round 1 was 87.9% and identified 610 research priority areas. Round 2 identified 69 research themes as important, and Round 3 identified 20 research priority topic areas covering four themes: effectiveness of osteopathic treatment (7 areas prioritised), role of osteopathy: the management of four conditions were prioritised, risks with osteopathic treatment (two areas prioritised) and outcomes of osteopathic treatment (two areas prioritised). The findings will be taken forward to develop the research strategy for osteopathy.

A profile of osteopathic care in private practices in the United Kingdom: a national pilot using standardised data collection.

Increasing interest is being shown in osteopathy on a national and international basis. Since little prospective data had been available concerning the day-to-day practice of the profession, a standardised data collection tool was developed to try and address this issue. The tool development process has been described in an earlier paper. The standardised data collection (SDC) tool underwent national piloting between April and July 2009 in United Kingdom private practices. Osteopaths volunteered to participate and collected data on consecutive new patients or patients presenting with a new symptom episode for a period of one month; follow-up data were collected for a further two months. A total of 1630 completed datasets from the SDC pilot were analysed by the project team. Data generated from the national pilot showed that lumbar symptoms were the most commonly presented in patients (36%), followed by cervical spine (15%), sacroiliac/pelvic/groin (7.9%), head/facial area (7%), shoulder (6.8%), and thoracic spine (6%). A total of 48.8% of patients reported comorbidities, the most common being hypertension (11.7%), followed by asthma (6.6%), and arthritis (5.7%). Outcome data were collected looking at the patients' response to treatment, and any form of treatment reactions. The profiling information collected using the SDC tool provides a contemporary picture of osteopathic practice in the United Kingdom.

Development of a data collection tool to profile osteopathic practice: use of a nominal group technique to enhance clinician involvement.

INTRODUCTION: Little is known about the profile of osteopathic care in the United Kingdom (UK). To address this, a standardised data collection (SDC) tool was developed to record patient-based data within private practice. METHODS: The development of the SDC tool took place within a national network of research groups (hubs) created by the National Council for Osteopathic Research (NCOR); nominal groups were created from the hub network. A Nominal Group Technique (NGT) was used to promote maximum involvement by clinicians and increase ownership of the process: this approach encouraged generation of ideas around specific topics. Following several rounds of iteration, a draft tool was created, followed by a three stage testing process to identify omissions, unnecessary jargon, ambiguities, and any regional differences. RESULTS: The tool developed for a national use by UK osteopaths consisted of 65 items. These were divided into specific sections for patient or clinician completion. The section for patient completion collected data concerning demographic and symptom data. Clinicians provided data concerning treatment provided, advice to promote self-management and avoidance of symptom recurrence, outcome information, service data concerned with waiting times, the number of treatments delivered, and the necessity for referral. CONCLUSION: The tool development process produced a data collection tool aimed to collect snapshot data across the osteopathic profession. The national pilot of the tool will identify changes required, and any barriers to its use by busy professionals.

Novel therapies for children with acute myeloid leukaemia.

Significant improvements in survival for children with acute myeloid leukaemia (AML) have been made over the past three decades, with overall survival rates now approximately 60-70%. However, these gains can be largely attributed to more intensive use of conventional cytotoxics made possible by advances in supportive care, and although over 90% of children achieve remission with frontline therapy, approximately one third in current protocols relapse. Furthermore, late effects of therapy cause significant morbidity for many survivors. Novel therapies are therefore desperately needed. Early-phase paediatric trials of several new agents such as clofarabine, sorafenib and gemtuzumab ozogamicin have shown encouraging results in recent years. Due to the relatively low incidence of AML in childhood, the success of paediatric early-phase clinical trials is largely dependent upon collaborative clinical trial design by international cooperative study groups. Successfully incorporating novel therapies into frontline therapy remains a challenge, but the potential for significant improvement in the duration and quality of survival for children with AML is high.

Testing the effect of specific orders to provide oral liquid nutritional supplements to nursing home residents: a quality improvement project.

OBJECTIVES: To improve nursing home (NH) staff delivery of oral liquid nutritional supplements between meals to residents with a history of weight loss. DESIGN: Pre-Post intervention study. SETTING: Two skilled nursing homes. PARTICIPANTS: Eighteen long term care residents. INTERVENTION: At baseline all participants had a non-specific physician's order to receive a nutritional supplement. The intervention consisted of specifying the physician's order as follows: "Give 4 oz high protein supplement at 10 am, 2 pm, and 7 pm". MEASUREMENTS: Research staff conducted direct observations for two days during and between meals for a total of 4 days, or 12 possible observation periods per participant before and one week following the intervention. Research staff documented NH staff delivery of snacks (including high protein supplements) and amount consumed (fluid ounces) for the high protein supplements using a standardized protocol during each observation period. RESULTS: Before the specific order was written participants were offered any type of snack an average of 1.82 times per day and a high protein supplement 0.59 times per day. After the specific order was written participants were offered any type of snack an average of 1.59 times per day and a high protein supplement 0.91 times per day. There were no statistically significant differences in the average number of times snacks or supplements were offered before and after the specific order was written. The proportion of snacks offered that were high protein supplements did increase after the specific order was written (p<0.001). When a high protein supplement was provided, most residents consumed 100% of it. CONCLUSIONS: Oral liquid nutritional supplements were not provided consistent with orders in NH practice. The specificity of the order related to type of supplement and time of delivery did not influence when and how often supplements are provided to residents but it did influence the type of nutritional supplement offered.

[Decisions in conditional situation and theory of mind in schizotypy]. / Décisions en situation probabiliste et théorie de l'esprit dans la schizotypie.

INTRODUCTION: Theory of mind (ToM) is defined as a capacity to infer mental states, intentions, and emotions in others. Two principal theories in the field of cognitive psychology have tried to explain mechanisms underlying this capacity. Theory-theory hypothesizes that people interpret cues from others in social interactions with a folk psychology composed of data about social human behavior. In contrast, Simulation-Theory proposes a capacity to take different perspectives and mentally simulate others' behavior. As a result, one could guess a person's intention or emotion by comparison with his state of mind when he/she behaves in the same way. BACKGROUND: Difficulties in ToM have been frequently observed in schizotypal subjects and subjects with schizophrenia. Some authors have proposed that this impairment could lead to persecution delusions or be linked with disorganized thought. A tendency to make choices with few cues in conditional situation has also been observed in both populations. When they are asked to make a decision about cues they can choose to see or not, schizotypal subjects and patients with schizophrenia tend to make up their mind after significantly less cues than control subjects. This tendency has been called "jump to conclusion". OBJECTIVE: Our study tests the correlation between low performances at a ToM task and a tendency to jump to conclusion in conditional situation. PARTICIPANTS: We tested this hypothesis with 25 participants scoring high on a social anhedonia scale (J Abnorm Psychol 85 (1976) 374-382), one of the main characteristics of schizotypy, and with 20 control participants. Participants were students with a mean age of 20. We included in the experimental group, subjects with a score on social anhedonia scale superior to 17 for females and 19 for males, and seven for control participants (modal score). METHODS: We used "jar and beads", a conditional reasoning task. Two jars are presented to a participant: a white one containing 85% of white beads and 15% of black beads, and a black one filled with the opposite ratio. The participant has to decide from which jar comes successive beads shown to him. Dependent measure is the number of beads seen before decision. ToM task is an adaptation from (Schizophr Res 17 (1995) 5-13). Twenty short interactions between two characters are read to a participant. For example: John has a phone call with a friend for one hour. He says: "My mother ought to call me in a few minutes". QUESTION: What does John really mean? Cue: John adds: "I could call you tomorrow morning". QUESTION: What does John want to do? RESULTS: Results show significantly lower performances at the ToM task in experimental than in control participants (52.36 (S.D., 6.73) vs. 59.05 (S.D., 1.60); t, 4.33; p<0.001; maximum possible, 60). The experimental group asked for significantly less cues to conclude in the conditional situation (2.22-S.D., 1.29). Mean number of beads asked for in the control group was 3.05 (S.D., 1.30) and t, 2.13; p<0.05. There was no correlation between performances at conditional reasoning task and ToM task. We observed this absence of correlation in all of the participants and in the experimental and control groups separately. DISCUSSION: Absence of relationship between performances in both tasks may be attributed to a discrepancy between experimental and ecological contexts for conditional reasoning task. During interpersonal relationships, search for cues in order to make a decision about others' intentions and mental states represents a real cost in terms of energy and time. These costs are absent in the "jar and beads situation". Moreover, people with social anhedonia may attribute a special value of quickly understanding personal interactions. This conditional reasoning task does not imply this parameter. CONCLUSION: Ecological decision in conditional reasoning tasks could be approached by adding a system of points to spend, asking for more cues, or to earn, finally finding the correct answer. Decision would then depend on the ratio between possible gains, by guessing or not the correct answer, and the cost of searching for more cues before making a decision.

Use of complementary therapies by Australian women with breast cancer.

International research suggests complementary therapy usage is common in women with breast cancer. Comparable data do not exist for Australia. A self-completed questionnaire was used to survey Australian women with breast cancer about their usage of complementary therapies. The survey was mailed to members of two breast cancer consumer advocacy groups, and assessed type of therapy used, reasons for use, and sources of information about complementary therapies. Of 367 respondents with breast cancer, 87.5% had used complementary therapies, with many using four or more therapies. Most commonly used were vitamin supplements (54.2%), support groups (49.8%), massage (41.4%) and meditation (38.7%). Common reasons for use included improving physical (86.3%) and emotional (83.2%) wellbeing and boosting the immune system (68.8%). Women sought information about complementary therapies from a variety of sources. The range of therapies used and the diverse reasons for use emphasise the need for reliable, evidence-based information about complementary therapies for women and clinicians.

Virtual colonoscopy training and accreditation: a national survey of radiologist experience and attitudes in the UK.

AIM: Expert consensus recommends directed training and possibly in the future, formal accreditation before independent virtual colonoscopy (VC) reporting. We surveyed radiologists' experience of VC training, compared with barium enema, and assessed attitudes towards accreditation. MATERIALS AND METHODS: A questionnaire was sent to 78 consultant radiologists from 72 centres (65 National Health Service hospitals; seven independent primary screening centres) offering a VC service. RESULTS: Fifty-four (69%) eligible radiologists responded. They had interpreted 18,152 examinations (range 3-1500) in total versus 232,350 (13 times more) barium enemas. Twenty-two (41%) deemed their VC training as inadequate [including five (45%) of screening centre radiologists], and only 14 (26%) had attended a training workshop due to lack of availability (54%) or financial/study leave constraints (24%). Eleven (20%) radiologists routinely double-reported VC examinations versus 37 (69%) barium enemas, yet 21 (39%) considered requirements for VC training were greater than barium enema. Thirty-eight (70%) favoured accreditation beyond internal audit for VC versus 15(28%) for barium enema. Of these 38, seven (18%) favoured "one-off," and 18 (47%) periodic testing, with 16 (42%) favouring external audit alone or in combination with testing. Overall, 42 (78%) considered specific accreditation for reporting screening examinations appropriate and 45 (83%) respondents preferred a national radiological organization to regulate such a scheme. CONCLUSION: There is wide variability in reporting experience and recommendations for VC training have not been widely adopted, in part due to limited access to dedicated workshops. UK radiologists are generally in favour of VC accreditation, governed by a national radiology organization.

Problems with HIV/AIDS prevention, care and treatment in Togo, West Africa: professional caregivers' perspectives.

This paper used accounts of professional caregivers to HIV/AIDS patients in Lomé, Togo, West Africa to explore the impacts of cultural, institutional and socio-economic factors in the fight against HIV/AIDS. Thirteen health professionals and 17 non-health professionals who work with people living with HIV/AIDS were interviewed in June and July 2002 in Lomé, Togo. The study found that, in Togo there are some cultural, socio-economic and institutional practices that put Togolese at risk of contracting HIV and complicate the care of those who become infected. People with HIV/AIDS face socio-economic, emotional and psychological battles as they attempt to deal with their physical health and the social reactions to such a stigmatizing disease. Thus, in order to contain the spread of HIV/AIDS, people living with HIV/AIDS, family caregivers, traditional healers as well as the public must be educated about the importance of preventing the disease and how each group can help achieve success in its control. Interventions in prevention and care should be designed with an awareness of these structural factors that contribute to the spread of AIDS and compromise the quality of care given to those who become infected.

Randomised, double-blind, placebo-controlled trial to assess the potential of cannabinoid receptor stimulation in the treatment of dystonia.

Cannabis may have medicinal uses in a variety of diseases. The neural mechanisms underlying dystonia involve abnormalities within the basal ganglia-in particular, overactivity of the lateral globus pallidus (GPl). Cannabinoid receptors are located presynaptically on GABA terminals within the GPi, where their activation reduces GABA reuptake. Cannabinoid receptor stimulation may thus reduce overactivity of the GPl and thereby reduce dystonia. A double-blind, randomised, placebo-controlled, crossover study using the synthetic cannabinoid receptor agonist nabilone in patients with generalised and segmental primary dystonia showed no significant reduction in dystonia following treatment with nabilone.