Effects of external ambient temperature at loading, journey duration and flock characteristics on the dead-on-arrival rate in broiler chickens transported to slaughter in Great Britain.

Broiler mortality during transport and lairage, prior to slaughter, has negative welfare and economic implications. Knowledge of the factors affecting the dead-on-arrival (DOA) rate can help identify risk-mitigating strategies. The objectives of this study were to determine the DOA rate in broiler chickens transported to slaughter in Great Britain and associated risk factors. Requested data for all loads of broilers transported to slaughter by 5 large British commercial companies on 57 randomly-selected dates in 2019 were obtained and combined with weather data extracted from the Met Office MIDAS Open database. The DOA rate was described overall and per load using summary descriptive statistics. Mixed-effects Poisson regression was used to evaluate considered flock-, journey- and weather-related risk factors. Results were reported as incidence rate ratios (IRR) and 95% confidence intervals (CI). On the selected dates, 25,476 loads transported 146,219,189 broilers to slaughter. The overall mean DOA rate was 0.08%. The median DOA rate per load was 0.06% (interquartile range 0.03-0.09%; range 0.00-17.39%). Multiple risk factors were identified including loading temperature and catch method. At relative humidity ≤80%, the DOA rate was 16.89 (95% CI 15.25-18.70, P < 0.001) times higher for loads loaded in external ambient temperatures >30.0°C compared to those loaded in temperatures between 10.1°C and 15.0°C. When relative humidity was >80%, there was a 43% increase in DOA rate for loads loaded in temperatures below freezing compared to those loaded in temperatures between 10.1°C and 15.0°C (IRR 1.43, 95% CI 1.35-1.52, P < 0.001). The DOA rate was 32% higher for loads caught mechanically compared to those caught manually (IRR 1.32, 95% CI 1.23-1.42, P < 0.001). The overall DOA rate was lower than that previously reported in Great Britain and for other European countries. Most identified risk factors had a marginal effect, however, loading temperatures >30°C substantially increased DOA rate. Internal thermal environmental conditions were not evaluated. Avoidance of loading during periods of hot weather would improve the welfare of, and reduce economic losses in, broiler chickens.

New Distribution Records of Biting Midges of the Genus Culicoides (Diptera: Ceratopogonidae) Latreille, Culicoides bergi and Culicoides baueri, in Southern Ontario, Canada.

Some species of Culicoides Latreille (Diptera: Ceratopogonidae) can be pests as well as pathogen vectors, but data on their distribution in Ontario, Canada, are sparse. Collecting this baseline data is important given ongoing, accelerated alterations in global climate patterns that may favor the establishment of some species in northern latitudes. Culicoides spp. were surveyed using UV light traps over two seasons in 2017 and 2018 at livestock farms in southern Ontario, Canada. Two Culicoides spp. not previously recorded in Canada were identified, C. bergi and C. baueri, representing new country and provincial records. Unlike some congenerics, these two species are not currently recognized as vectors of pathogens that pose a health risk to humans, livestock or wildlife in North America. However, the possibility that these Culicoides species may have recently expanded their geographic range, potentially in association with climate and/or landscape changes, warrants ongoing attention and research. Furthermore, our results provoke the question of the potential undocumented diversity of Culicoides spp. in Ontario and other parts of Canada, and whether other Culicoides spp. may be undergoing range expansion. The current and future distributions of Culicoides spp., and other potential vectors of human, agricultural, and wildlife health significance, are important to identify for proper disease risk assessment, mitigation, and management.

Description of veterinary events and risk factors for fatality in National Hunt flat racing Thoroughbreds in Great Britain (2000-2013).

BACKGROUND: No large-scale studies have described veterinary events occurring in National Hunt (NH) flat racing or investigated risk factors for fatality in this race type. OBJECTIVES: To describe injuries and conditions requiring veterinary attendance on race day and to determine risk factors for racehorse fatality in NH flat racing in Great Britain. STUDY DESIGN: Retrospective cohort study (2000-2013). METHODS: Information from all NH flat races held over the study period, including horse, race and veterinary event report details, was combined. Veterinary events were described by type and anatomical structure(s) affected. Incidence per 1000 starts were calculated for all veterinary events and by event group, and stratified by certain horse- and race-level variables. Risk factors for fatality were determined using multivariable logistic regression modelling. RESULTS: Over the 14-year study period, 544 veterinary events were recorded, providing an overall incidence of 13.0 events per 1000 starts. The most common events were bone injuries (23.5%) and tendon or ligament injuries (16.4%). A fatal outcome was recorded for 117 horses (21.5% of all events), resulting in an incidence of 2.9 deaths per 1000 starts. Odds of fatality were 4.33 (95% confidence interval [CI] 1.59-11.82; P = 0.02) times higher in races restricted to conditional jockeys compared to those that were not. Horses starting in their first race experienced 1.44 (95% CI 1.00-2.08; P = 0.05) times the odds of death compared to those that had raced before. MAIN LIMITATIONS: Classification of veterinary events frequently relied upon presumptive diagnosis. CONCLUSIONS: This study provides a benchmark for the ongoing surveillance of veterinary events in NH flat racing. These results support the phasing out of NH flat races restricted to conditional jockeys and highlight the need for further work to establish why NH flat racing Thoroughbreds competing in their first race are at increased risk for death.

Is use of multiple antihypertensive agents to achieve blood pressure control associated with adverse pregnancy outcomes?

OBJECTIVE: We assessed whether requiring >1 medication for blood pressure control is associated with adverse pregnancy outcomes. STUDY DESIGN: Retrospective cohort of 974 singletons with chronic hypertension at a tertiary care center. Subjects on >1 antihypertensive agent were compared with those on one agent <20 weeks gestational age with results stratified by average blood pressure (<140/90 and ⩾140/90 mm Hg) from prenatal visits. The primary maternal outcome was preeclampsia; the primary neonatal outcome was small for gestational age (<10th percentile). RESULT: Among women with blood pressure ⩾140/90 mm Hg, women on multiple agents had the greatest risk of preeclampsia, severe preeclampsia, antenatal admissions to rule out preeclampsia, preterm birth <35 weeks and composite neonatal adverse outcomes. CONCLUSION: Compared with use of a single agent when blood pressure is ⩾140/90 mm Hg, use of multiple agents increases adverse risks, while no such finding exists when blood pressure is controlled below 140/90 mm Hg.

Trans-obturator tape for incontinence: a 3-year follow-up.

AIM: To assess operative and functional outcomes, including morbidity, after using the trans-obturator tape for stress incontinence. PATIENTS AND METHODS: The first 24 consecutive patients undergoing trans-obturator tape insertion in a single centre were included in this retrospective study. All patients were female with a mean age of 63 (range 40-83) years. Fifteen patients (62.5%) suffered from pure stress incontinence, and 9 patients (37.5%) had mixed incontinence. Of the latter, 2 patients also had nocturnal enuresis. Each patient was followed up for between 3 and 12 months postoperatively and again at 36 months. The patients were assessed by clinical examination, ultrasound for residual urinary volume, and subjective satisfaction which was assessed at 3 and 12 months. At 36 months, all patients completed a validated incontinence questionnaire (International Consultation on Incontinence Questionnaire: ICIQ) which assessed female lower urinary tract symptoms and their impact on the quality of life. RESULTS: All operations were performed under epidural anaesthesia in day surgery, and the mean operative time was 20 (range 15-38) min. Nineteen patients (79.2%) showed significant improvement postoperatively, with 16 of those (66.6%) being completely cured of their incontinence. The remaining 5 patients (20.8%) were considered to have had failed procedures. There were no vascular, bladder, or urethral injuries. One patient had perforation of the vaginal fornix, and 3 patients developed vaginal erosion. CONCLUSIONS: The trans-obturator tape is a safe and effective treatment for stress incontinence and has a low morbidity after a 3-year follow-up period; however, it should only be performed by clinicians with the relevant surgical expertise and experience in treating female incontinence.

Prenatal development of hypothalamic neuropeptide systems in the nonhuman primate.

In the rodent, arcuate nucleus of the hypothalamus (ARH)-derived neuropeptide Y (NPY) and proopiomelanocortin (POMC) neurons have efferent projections throughout the hypothalamus that do not fully mature until the second and third postnatal weeks. Since this process is likely completed by birth in primates we characterized the ontogeny of NPY and melanocortin systems in the fetal Japanese macaque during the late second (G100), early third (G130) and late third trimesters (G170). NPY mRNA was expressed in the ARH, paraventricular nucleus (PVH), and dorsomedial nucleus of the hypothalamus (DMH) as early as G100. ARH-derived NPY projections to the PVH were initiated at G100 but were limited and variable; however, there was a modest increase in density and number by G130. ARH-NPY/agouti-related peptide (AgRP) fiber projections to efferent target sites were completely developed by G170, but the density continued to increase in the postnatal period. In contrast to NPY/AgRP projections, alphaMSH fibers were minimal at G100 and G130 but were moderate at G170. This study also revealed several significant species differences between rodent and the nonhuman primate (NHP). There were few NPY/catecholamine projections to the PVH and ARH prior to birth, while projections were increased in the adult. A substantial proportion of the catecholamine fibers did not coexpress NPY. In addition, cocaine and amphetamine-related transcript (CART) and alpha-melanocyte stimulating hormone (alphaMSH) were not colocalized in fibers or cell bodies. As a consequence of the prenatal development of these neuropeptide systems in the NHP, the maternal environment may critically influence these circuits. Additionally, because differences exist in the neuroanatomy of NPY and melanocortin circuitry the regulation of these systems may be different in primates than in rodents.

Continuing metformin when starting insulin in patients with Type 2 diabetes: a double-blind randomized placebo-controlled trial.

AIMS: To test the effect of continuing metformin on weight gain and glycaemic control in patients with poorly controlled Type 2 diabetes who need to start insulin. METHODS: Patients with Type 2 diabetes on maximum tolerated oral agents referred for insulin conversion were recruited from hospital diabetes clinics into a double-blind randomized placebo-controlled trial. The 183 participants received metformin or placebo, titrated up to 2 g a day or maximum tolerated dose, with insulin started according to local practice. The main outcome measures were weight change over 12 months, HbA1c, insulin dose, frequency of hypoglycaemia, treatment satisfaction, and well-being. RESULTS: Over 12 months, metformin was associated with less weight gain than placebo [mean 6.1 kg vs. 7.6 kg; adjusted difference 1.5 kg (95% confidence interval 0.2-2.9); P=0.02], a greater reduction in HbA1c[1.5% vs. 1.3%; adjusted difference 0.5% (0.1-0.9); P=0.02] and a lower insulin requirement [62 units vs. 86; adjusted difference 25 units (15-34); P<0.001], but also more hypoglycaemia [relative risk of any episode 1.24 (1.02-1.1); P=0.03]. Treatment satisfaction improved more in patients on metformin than on placebo (P<0.001), as did the positive well-being score (P=0.02). CONCLUSIONS: Metformin decreases weight gain, lowers insulin requirement, and improves glycaemic control, and should be continued in patients with Type 2 diabetes who transfer to insulin.

Stomal complications of ileal conduits are significantly higher when formed in women with intractable urinary incontinence.

PURPOSE: The ileal conduit is held to be the safest and simplest form of urinary diversion. There are few reports about long-term problems after ileal conduit formation, especially intractable urinary incontinence in females. We reviewed long-term stomal complications in patients with an ileal conduit. MATERIALS AND METHODS: Notes on 93 consecutive patients in whom an ileal conduit was created were reviewed. Information was collected on patient demographics, indications for an ileal conduit and long-term complications, in particular parastomal and incisional hernias, stomal retraction, stenosis or prolapse and the development of a redundant loop. Mean followup available was 63.4 months (range 1 to 434). RESULTS: A total of 33 males with a mean age of 60.1 years (range 2 to 78) and 60 females with a mean age of 48.2 years (range 4 to 79) underwent ileal conduit diversion. The main indications for an ileal conduit were intractable incontinence in 44 patients (47%), cancer in 31 (33%) and interstitial cystitis in 8 (9%). In male, continent female and incontinent female patients A parastomal hernia developed in 3 (9%), 2 (9.5%) and 12 (31%), an incisional hernia developed in 1 (3%), 1 (4.8%) and 2 (5%), stomal retraction developed in 0, 2 (9.5%) and 12 (31%), stomal stenosis developed in 0 (0%), 1 (4.8%) and 6 (15.4%), and a redundant loop developed in 0 (0%), 2 (9.5%) and 5 (12.8%), respectively. A total of 23 patients (24.7%) required further surgery for stomal problems with 13 (57%) requiring more than 1 reoperation, of whom 9 were incontinent females. CONCLUSIONS: An ileal conduit is associated with a stomal complication rate of 34.4% (61% in incontinent females and 18% in other patients) and a 4.3% incisional hernia rate. Reoperation is required for stomal complications in 24.7% of cases. Stomal complication rates and reoperation rates vary by sex and the indication for ileal conduit, and they are significantly higher for those performed for intractable urinary incontinence in females.

The morbidity of buccal mucosal graft harvest for urethroplasty and the effect of nonclosure of the graft harvest site on postoperative pain.

PURPOSE: We assess the medium and long-term morbidity of buccal mucosal graft (BMG) harvest for urethroplasty, and evaluate the effect of nonclosure of the graft harvest site on postoperative pain. MATERIALS AND METHODS: A questionnaire was mailed to 110 men who underwent BMG urethroplasty between January 1, 1997 and August 31, 2002. Demographic data and side effects of BMG harvest, including oral pain, sensation and intake, were assessed postoperatively. A prospective study was then performed to compare 20 unselected men whose BMG donor site was closed with a group of 20 men in whom it was left open using a 5-point analog pain score that was completed twice daily for the first 5 postoperative days. RESULTS: A total of 49 men with a median age of 49 years (range 23 to 73) returned questionnaires relating to 57 BMG harvests. Of the graft harvests 47 (83%) were associated with postoperative pain, which was worse than expected in 24 (51%). Of the 57 patients 51 (90%) resumed oral liquid intake within 24 hours and 44 (77%) resumed normal diet within 1 week. Postoperative side effects included perioral numbness in 39 (68%) patients with 15 (26%) having residual numbness after 6 months, initial difficulty with mouth opening in 38 (67%) with 5 (9%) having persistent problems, changes in salivation in 6 (11%) and mucous retention cyst that required excision in 1 (2%). The men in the prospective donor site study had a median age of 51 years (range 24 to 70). Mean pain score for patients with donor site closure was 3.68 and was significantly higher than that for patients without donor site closure (2.26, p < 0.01). CONCLUSIONS: Buccal mucosal graft harvest is not a pain-free procedure. Closure of the harvest donor site appears to worsen this pain and it may be best to leave harvest sites open. The main long-term complications are perioral numbness, persistent difficulty with mouth opening and change in salivary function.

Ultrasound treatment acceleration of solvent extraction for fumigant residues from wheat.

Concerns about consumer and worker safety and the fate of fumigants have fuelled strong efforts to determine their residues in foodstuffs. Fumigants are usually extracted from commodities with solvent at room temperature (25 degrees C). In this paper, solvent extraction of methyl bromide, phosphine, carbonyl sulfide, and carbon disulfide using ultrasonic acceleration or heating was evaluated. Wheat samples plus solvent, in gas-tight bottles, were placed in an ultrasonic chamber or an oven (50 degrees C), and fumigants were released into the headspace over the solvent. Completeness of extraction was demonstrated within 2 h for ultrasonic extraction, 7-20 h for 50 degrees C heating, and 8-35 h for room temperature extraction. The rapidity of extraction was mainly due to ultrasonic vibration rather than increased temperature.

Cost-minimization analysis of simvastatin versus atorvastatin for maintenance therapy in patients with coronary or peripheral vascular disease.

BACKGROUND: Previous health economic studies have demonstrated the cost-effectiveness of simvastatin in the treatment of coronary heart disease (CHD) based on clinical results of the Scandinavian Simvastatin Survival Study. A prior analysis evaluated the "cost of getting to goal," but ignored all costs after titration. However, when evaluating the cost-effectiveness of long-term therapies, it is important to consider the maintenance costs as well. OBJECTIVE: The purpose of this study was to evaluate the maintenance costs of treatment with simvastatin versus that of treatment with another more recently available statin, atorvastatin, in a European context. METHODS: We assessed the long-term maintenance cost of simvastatin versus atorvastatin in terms of the cost of reducing low-density lipoprotein cholesterol (LDL-C) levels to the recommended goals based on a previously published clinical trial in patients with CHD. The analysis focused on the patients in the original clinical trial who were randomized to treatment with simvastatin or atorvastatin. Patients began therapy with 10 mg of simvastatin or atorvastatin; the dose of study drug was titrated every 12 weeks up to 40 mg simvastatin or 80 mg atorvastatin, with the addition of up to 8 g/d of cholestyramine until a modified European Atherosclerosis Society LDL-C goal (<2.84 mmol/L) was reached. As there was no significant difference between the 2 groups in resource utilization for adverse events, only drug costs were included. The calculated average annual maintenance cost was based on the distribution of the final daily dosing regimens and the public drug prices for each regimen. Individual country analyses were conducted using each local currency. RESULTS: There was no significant difference between groups in the percentage of patients reaching their LDL-C goal over the study period (80% for simvastatin-treated pa- tients vs 89% for atorvastatin-treated patients, P = 0.135). However, the cost of maintaining a similar percentage of patients at their appropriate LDL-C levels was significantly lower in the simvastatin group compared with the atorvastatin group in 13 of the 17 countries assessed. In the remaining 4 countries, there was a cost advantage for simvastatin, but it did not reach statistical significance. CONCLUSIONS: Across Europe there was a significant reduction in the cost of maintaining patients at their appropriate LDL-C levels with simvastatin versus atorvastatin. The results of this analysis, along with the proven clinical benefits of simvastatin, support the use of this drug as the treatment of choice in the secondary prevention of CHD.

Quantitative assessment of a circulating depolarizing factor in shock.

Sustained depolarization of cell membranes and cellular edema are known to accompany various forms of circulatory shock and probably contribute to hypovolemia and cellular dysfunction. It has been proposed that a circulating protein is responsible for these effects. In the present study we have confirmed the existence of a circulating depolarizing factor (CDF) in hemorrhagic shock, burn shock, sepsis, and cardiopulmonary bypass. Plasma samples from pigs or sheep in shock were quantitatively assayed for depolarizing activity using a microelectrode method on rat diaphragm in vitro. The depolarizing effect of CDF in vitro was similar in magnitude to that of shock in situ. We conclude that CDF can entirely account for membrane depolarization during shock. The depolarizing effect of CDF was dose-dependent and saturable; it could be reversed by rinsing the diaphragm with Ringer's or control plasma. CDF activity was detectable in plasma within 5 min after a severe scald and gradually increased over the next 25 min. Resuscitation of hemorrhaged pigs, but not burned sheep, eliminated plasma CDF activity.

Early programming of T cell populations responding to bacterial infection.

The duration of infection and the quantity of Ag presented in vivo are commonly assumed to influence, if not determine, the magnitude of T cell responses. Although the cessation of in vivo T cell expansion coincides with bacterial clearance in mice infected with Listeria monocytogenes, closer analysis suggests that control of T cell expansion and contraction is more complex. In this report, we show that the magnitude and kinetics of Ag-specific T cell responses are determined during the first day of bacterial infection. Expansion of Ag-specific T lymphocyte populations and generation of T cell memory are independent of the duration and severity of in vivo bacterial infection. Our studies indicate that the Ag-specific T cell response to L. monocytogenes is programmed before the peak of the innate inflammatory response and in vivo bacterial replication.

The need for a second dose of ceftriaxone in febrile infants age 4-8 weeks.

OBJECTIVE: To determine if a second intramuscular injection of ceftriaxone was necessary in febrile infants who meet low-risk criteria for outpatient therapy. SETTING: Children's Hospital Emergency Department. PATIENTS: Febrile infants 4-8 weeks of age. METHODS: Outpatient treatment criteria included non-toxic appearance, no identifiable source for infection on physical examination, CSF WBC > or = 10/mm3, peripheral WBC < or = 15,000/mm3, normal UA, and normal chest radiograph study, if obtained. Additional requirements included a reliable caretaker and re-evaluation in 24 hours. Infants who met these criteria received intramuscular ceftriaxone 50 mg/kg with instructions to follow-up in 24 hours. At the follow-up visit, infants with no identifiable source for infection and negative cultures received a second dose of intramuscular ceftriaxone and were discharged. Cultures were read at 48 hours and at the conclusion of the study. Medical records were reviewed to identify delayed complications. RESULTS: 172 infants were enrolled. The mean age was 45 days. All CBC, UA, CSF analyses were normal. Chest radiographs were obtained in 56 (30%) infants; all were normal. One (.05%) patient was admitted at the follow-up visit. The mean time to follow-up was 25 hours. Two positive cultures were identified at the re-evaluation visit; one blood culture grew Salmonella and a urine culture grew E. coli. The CSF cultures were all negative at follow-up and remained negative. CONCLUSION: Febrile infants 4-8 weeks of age who meet outpatient therapy criteria and have negative cultures and no identifiable source for infection at 24 hours may not require the second dose of intramuscular ceftriaxone.

MHC class I restricted T cell responses to Listeria monocytogenes, an intracellular bacterial pathogen.

Studies of the murine immune response to infection with the intracellular bacterial pathogen Listeria monocytogenes have provided a wealth of information about innate and acquired immune defenses in the setting of an infectious disease. Our studies have focused on the MHC class I restricted, CD8+ T cell responses of Balb/c mice to L. monocytogenes infection. Four peptides that derive from proteins that L. monocytogenes secretes into the cytosol of infected cells are presented to cytotoxic T lymphocyte (CTL) by the H2-Kd major histocompatibility complex (MHC) class I molecule. We have found that bacterially secreted proteins are rapidly degraded in the host cell cytosol by proteasomes that utilize, at least in part, the N-end rule to determine the rate of degradation. The MHC class I antigen processing pathway is remarkably efficient at generating peptides that bind to MHC class I molecules. The magnitude of in vivo T cell responses, however, is influenced to only a small degree by the amount of antigen or the efficiency of antigen presentation. Measurements of in vivo T cell expansion following L. monocytogenes infection indicate that differences in the sizes of peptide-specific T cell responses are more likely owing to differences in the repertoire of naive T cells than to differences in peptide presentation. This notion is supported by our additional finding that dominant T cell populations express a more diverse T cell receptor (TCR) repertoire than do subdominant T cell populations.

H2-M3-restricted T cells in bacterial infection: rapid primary but diminished memory responses.

Major histocompatibility complex (MHC) class Ib molecules have been implicated in CD8(+) T cell-mediated defenses against intracellular bacterial infection, but the relative importance of MHC class Ib-restricted T cells in antimicrobial immunity is unknown. In this report, we use MHC tetramers to characterize T cell responses restricted by H2-M3, an MHC class Ib molecule that selectively presents N-formyl peptides. We find that sizeable H2-M3-restricted T cell responses, occurring earlier than MHC class Ia-restricted T cell responses, are mounted after primary infection with the intracellular bacterium Listeria monocytogenes. These H2-M3-restricted T cells are cytolytic and produce interferon gamma. However, after a second L. monocytogenes infection, H2-M3-restricted memory T cell responses are minor in comparison to the much larger MHC class Ia-restricted responses. This first direct characterization of an MHC class Ib-restricted T cell response indicates that CD8(+) T cells responding to L. monocytogenes infection can be divided into two groups: H2-M3-restricted responses, which provide rapid and quantitatively substantial effector function during primary infections but contribute relatively little to memory responses, and MHC class Ia-restricted responses, which expand later during primary infection but form memory T cells that respond rapidly and dramatically in response to subsequent infections by the same pathogen.

Expression of a type II collagen-specific TCR transgene accelerates the onset of arthritis in mice.

Animal models of autoimmune diseases have been instrumental in advancing our understanding of autoimmunity in humans. Collagen-induced arthritis in mice is an autoimmune disease model of rheumatoid arthritis, which is MHC class II restricted and CD4 T cell dependent. To better understand the fundamental role of T cells in arthritis, we have generated a transgenic mouse carrying the rearranged Valpha11.1 and Vbeta8.2 TCR chain genes isolated from a type II collagen (CII)-specific T cell hybridoma. Cell surface analysis indicated that Vbeta8.2 chain was expressed on the surface of nearly all peripheral T cells. Analysis of T cell subsets in transgenic mice revealed a profound skewing in peripheral T cells towards the CD4 population. Although peripheral T cells were not tolerant to CII and responded to CII stimulation in vitro, transgenic mice did not develop spontaneous arthritis. However, a rapid onset of arthritis with severe clinical signs was detected in transgenic mice after immunization with CII in complete Freund's adjuvant. Histological analysis of inflamed joints showed a great resemblance to arthritic joints in man. This unique transgenic mouse model provides valuable insights into the mechanism of arthritis and into potential specific immune interventions.

Profiling linguistic outcomes in young children after cochlear implantation.

OBJECTIVE: To summarize the results of cost-utility analyses of pediatric cochlear implantation (PCI) in the United Kingdom. METHOD: Analyses were based on measured costs of health care and measured educational placements, but on estimates of the gain utility which results from PCI and estimates of the costs of educational placements. RESULTS: The cost-utility ratio calculated from the costs of health care falls on the margin of the range considered acceptable within the British health-care system. If estimates of cost-savings associated with educational placements are also considered, the resulting ratio is similar to that of other therapies provided within the British health-care system. CONCLUSION: The analysis is highly sensitive to assumptions about future costs and benefits. There is a need to reduce the number of assumptions by measuring those values which are currently estimated: in particular, the gain in utility associated with PCI and the costs of different educational placements.

Prevalence of hyperandrogenemia among nonhirsute oligo-ovulatory women.

OBJECTIVE: To test the hypothesis that oligo-ovulatory ovulation is associated with hyperandrogenemia in the absence of other clinical signs of androgen excess. DESIGN: Retrospective cohort controlled. SETTING: Tertiary care university-based outpatient clinic. PATIENT(S): Thirty-two consecutive nonhirsute oligo-ovulatory women and 37 healthy eumenorrheic controls. INTERVENTION(S): All study subjects underwent a physical exam and blood sampling in the follicular phase of the menstrual cycle. MAIN OUTCOME MEASURE(S): Serum was assayed for total T, sex hormone-binding globulin (SHBG), androstenedione (A), and DS, and the free T level was calculated. RESULT(S): Mean free T was higher and SHBG was lower in oligo-ovulatory patients compared with controls. The oligo-ovulatory patients were subdivided according to severity of menstrual abnormalities into those with cycles < 45 days (n = 19, oligo-ovulatory-short) and > or = 45 days (n = 13, oligo-ovulatory-long). Oligo-ovulatory-long and -short patients had similar mean DS, A, and total T levels; but mean free T was higher and SHBG was lower in oligo-ovulatory-long patients compared with either oligo-ovulatory-short women or controls. Five of 13 (38%) oligo-ovulatory-long patients had at least one abnormal androgen value compared with 1 of 19 (5%) oligo-ovulatory-short patients, which was a significant difference. CONCLUSION(S): Approximately 40% of nonhirsute oligo-ovulatory women with cycle intervals > or = 45 days demonstrate at least one abnormally elevated androgen level, suggesting that they may have a discrete form of the polycystic ovary syndrome. Furthermore, this data brings into question the sensitivity of hirsutism as a marker for hyperandrogenemia.

Early passive acquisition in Inuktitut.

Passive structures are typically assumed to be one of the later acquired constructions in child language. English-speaking children have been shown to produce and comprehend their first simple passive structures productively by about age four and to master more complex structures by about age nine. Recent crosslinguistic data have shown that this pattern may not hold across languages of varying structures. This paper presents data from four Inuit children aged 2;0 to 3;6 that shows relatively early acquisition of both simple and complex forms of the passive. Within this age range children are productively producing truncated, full, action and experiential passives. Some possible reasons for this precociousness are explored including adult input and language structure.