Prediction of intramuscular fat content and shear force in Texel lamb loins using combinations of different X-ray computed tomography (CT) scanning techniques.

Computed tomography (CT) parameters, including spiral computed tomography scanning (SCTS) parameters, intramuscular fat (IMF) and mechanically measured shear force were derived from two previously published studies. Purebred Texel (n = 377) of both sexes, females (n = 206) and intact males (n = 171) were used to investigate the prediction of IMF and shear force in the loin. Two and three dimensional CT density information was available. Accuracies in the prediction of shear force and IMF ranged from R2 0.02 to R2 0.13 and R2 0.51 to R2 0.71 respectively, using combinations of SCTS and CT scan information. The prediction of mechanical shear force could not be achieved at an acceptable level of accuracy employing SCTS information. However, the prediction of IMF in the loin employing information from SCTS and additional information from standard CT scans was successful, providing evidence that the prediction of IMF and related meat eating quality (MEQ) traits for Texel lambs in vivo can be achieved.

Patient experience and overall satisfaction after emergency abdominal surgery.

BACKGROUND: There is a growing recognition of the importance of patient experience in healthcare, however little is known in the context of emergency abdominal surgery. This study sought to quantify the association between patient experience and overall satisfaction. METHODS: Patient demographics, operation details and 30-day clinical outcome data of consecutive patients undergoing emergency abdominal surgery were collected. Data was collected using validated Patient Reported Experience Measures (PREMs) questionnaires. Categorical data were tested using Mann Whitney U test. Multivariable regression was used to determine independent factors associated with satisfaction. RESULTS: In a well-fitting multivariable analysis (R2 = 0.71), variables significantly associated with a higher global satisfaction score were "sufficient information given about treatment" (ß = 0.86, 95% CI 0.01-1.70, p = 0.047), "sufficient explanation of risks and benefits of surgery" (ß = 1.26, 95% CI 0.18-2.34, p = 0.020), "absence of night-time noise" (ß = 1.35, 95% CI 0.56-2.14, p = 0.001) and "confidence and trust in nurses" (ß = 1.51, 95% CI 0.54-2.49, p = 0.003). CONCLUSIONS: Overall patient satisfaction was strongly associated with perceptions of good communication and transfer of information. Confidence and trust in the clinical team is an important determinant of patient experience. Improving the ward environment by reducing noise at night may also improve the overall experience and satisfaction in emergency surgery.

The Influence of Clinical and Patient-Reported Outcomes on Post-surgery Satisfaction in Cholecystectomy Patients.

BACKGROUND: Patient-reported outcomes (PROMs) and post-operative satisfaction have become a growing focus of surgical outcome evaluation and are considered key components of the movement towards patient-centred care. The aim was to compare the association of traditional clinical outcome measures and PROMs with post-surgery satisfaction in cholecystectomy patients. METHODS: Patients who had undergone elective or emergency cholecystectomy for gallstone disease were sent validated PROM questionnaires, and telephone follow-up was performed in all cases. Categorical data were compared with the Chi-square and Fisher's exact tests. Satisfaction was investigated using a "top-box" approach, and multivariable logistic regression was performed for factors significantly (p < 0.05) associated with satisfaction in univariable analyses. RESULTS: A total of 234 patients underwent cholecystectomy between 1 March 2014 and 1 May 2014, and 147 patients (63%) completed the questionnaire. 104/147 (71%) reported being "very satisfied" with their surgical outcome. In univariable analyses, satisfaction showed significant association with an absence of hospital-recorded 30-day complications (OR = 4.11, 95% CI 1.29-13.84), but not re-attendance, readmission, or length of stay. In a multiple regression analysis, no traditional clinical outcome measures were associated with satisfaction. By contrast, self-perceived health (OR = 4.04, 95% CI 1.44-11.86), the absence of patient-reported wound pain (OR = 6.11, 95% CI 1.83-21.74), and a return to normal leisure activities (OR = 11.14, 95% CI 2.61-55.26) were associated with satisfaction. CONCLUSION: PROMs are the major determinants of patient satisfaction following cholecystectomy. When assessing outcomes following cholecystectomy, the measurement of clinical outcomes alone is inadequate and should be supplemented by the use of PROMs.

Prediction of intramuscular fat content using CT scanning of packaged lamb cuts and relationships with meat eating quality.

Novel, multi-object X-ray computed tomography (CT) methodologies can individually analyse vacuum-packed meat samples scanned in batches of three or more, saving money and time compared to scanning live animals. If intramuscular fat (IMF), as a proxy for meat quality, can be predicted with similar accuracies as in live lambs, this method could be used to grade on quality, or to inform breeding programmes. Lamb loin cuts from commercial carcasses (n=303), varying in fat and conformation grade, were vacuum-packed and CT scanned, then tested for meat quality traits and by a trained taste panel. Tissue density values measured by CT, alongside carcass and loin weights, predicted IMF with moderate accuracy (R2 0.36), but did not accurately predict shear force or sensory traits. Juiciness and flavour increased linearly with IMF, whilst texture and overall liking increased to an optimum between 4 and 5% IMF. Samples predicted by CT as having >3% IMF scored significantly higher for sensory traits, than those predicted as <3% IMF.

Influence of age and body mass on the response of adolescent male pigs to anaesthesia.

Age and body mass affect a human's response to drugs, including anaesthetics. In pigs, such effects, if they occur, are likely to be pronounced: commercial breeds have been selected for rapid growth, meaning rapid body composition and mass change with age. Thirty-six male pigs were anaesthetised for CT scanning on three occasions (S1-3) when aged 105, 137 and 166 days and when mean (±sd) masses were 57.2±4.4, 88.4±6.2 and 114.7±7.6 kg, respectively. Medetomidine (5 µg/kg), azaperone (1 mg/kg), ketamine (5 mg/kg) and midazolam (0.25 mg/kg) were combined and injected intramuscularly. The times when pigs became recumbent (R1) and remained so (RP) were recorded. If venous cannulation was not possible five minutes after recumbency, 2-3 per cent isoflurane in a 1:2 O2/N2O mixture was delivered by mask until cannulation was possible and then discontinued. If anaesthetic depth was inadequate for CT scanning, a full dose (midazolam 0.25 mg/kg, ketamine 2 mg/kg) or half dose of induction agents was administered intravenously. During recovery from anaesthesia, the times at first movement (M1), first standing attempt (S1) and successful sustained standing (SP) were recorded. The relationship between mass and time (minutes) from injection to each end point was assessed using regression analysis and linear mixed-effect models (LMEM); LMEM were used to assess isoflurane and intravenous anaesthetic effects. Analysis using LMEM showed no significant relationships between mass and the times from injection to the five end points. Isoflurane reduced the time to M1, S1 and SP (P<0.037); intravenous agents had no effect on S1 or SP (P>0.585) but increased the time from injection to M1 (P<0.001). In conclusion, age and mass do not influence the response of commercially bred pigs to the intravenous anaesthetic combination described.

Prediction of intramuscular fat levels in Texel lamb loins using X-ray computed tomography scanning.

For the consumer, tenderness, juiciness and flavour are often described as the most important factors for meat eating quality, all of which have a close association with intramuscular fat (IMF). X-ray computed tomography (CT) can measure fat, muscle and bone volumes and weights, in vivo in sheep and CT predictions of carcass composition have been used in UK sheep breeding programmes over the last few decades. This study aimed to determine the most accurate combination of CT variables to predict IMF percentage of M. longissimus lumborum in Texel lambs. As expected, predicted carcass fat alone accounted for a moderate amount of the variation (R(2)=0.51) in IMF. Prediction accuracies were significantly improved (Adj R(2)>0.65) using information on fat and muscle densities measured from three CT reference scans, showing that CT can provide an accurate prediction of IMF in the loin of purebred Texel sheep.

Effects of low protein diets on pigs with a lean genotype 2. Compositional traits measured with computed tomography (CT).

The effects on compositional changes across the growing-finishing period (40-115 kg) of feeding pig diets with different protein and amino acid levels were investigated using CT scanning (at 60, 85 and 115 kg live weight). Pigs of a lean commercial genotype were fed a commercial control regime (C), or a low protein regime with either high (LP1) or low (LP2) essential amino acid levels, all balanced for net energy. In vivo CT measurements agreed well with post-slaughter sample joint dissection results for carcass tissue weights/proportions, and CT-measured muscle density predicted intramuscular fat accurately. Pigs on C and LP1 regimes did not differ significantly in composition during growth. However, pigs on the LP2 regime had significantly more fat (in carcass, internal and intra-muscular depots) and less muscle, from 85 kg onwards. Although fat levels differed depending on diet regime (LP2>others), proportions of fat in different body depots were unaffected.

Sexual health of adults working in pornographic films.

We report the frequency of sexually transmitted infections (STIs) diagnosed in performers in the adult pornographic film industry. Over a 13 month period, 445 STI screens were performed in 115 patients, 56 women and 59 men. All reported unprotected sex during filming. Seventy-five percent (86) had at least one sexual partner outside work, and 90% used condoms inconsistently with them. Women worked exclusively with women (23%), men only (38%) or both genders (39%). Almost all men (97%) worked exclusively heterosexually. Thirty-eight percent (44/115) were diagnosed with 77 STIs, including non-specific urethritis (51), gonorrhoea (10), chlamydia (6) and genital warts (6). Gonorrhoea was found exclusively at the pharynx in three heterosexual men. There were no cases of HIV, syphilis, hepatitis B or hepatitis C. Monthly screening and certification is a working requirement for this population but STIs are common in an industry where unprotected sex is the norm.

Effects of the Texel muscling quantitative trait locus on carcass traits in crossbred lambs.

Texel muscling quantitative trait locus (TM-QTL) is a QTL on chromosome 18, originally identified in purebred UK Texel sheep, which was reported to increase ultrasonically measured muscle depth at the third lumbar vertebra by around 4% to 7%. The objective of the present study was to comprehensively evaluate the TM-QTL and to determine whether it could provide benefits to the UK sheep industry through increased carcass meat yield in crossbred slaughter lambs. Effects of this QTL on a range of carcass traits, including those measured in vivo and by dissection, were evaluated in heterozygous carrier and non-carrier lambs produced by crossing heterozygous carrier Texel rams with non-carrier Mule (Bluefaced Leicester × Scottish Blackface) ewes from a lowland flock. The TM-QTL was found to increase loin muscling in crossbred lambs at a given live weight or carcass weight, as measured by ultrasound, X-ray computed tomography (CT) and carcass dissection. Depth of M. longissimus lumborum (MLL) was greater in TM-QTL carrier lambs compared to non-carriers as measured by both ultrasound at the third lumbar vertebra (+4.5%; P = 0.033) and CT scanning at the fifth lumbar vertebra (+6.7%; P = 0.004). Width and area of MLL measured using CT were also greater in TM-QTL carrier lambs compared to non-carriers (+3.0%; P = 0.013 and +5.1%; P = 0.047, respectively). Loin muscle volume measured using CT was greater in TM-QTL carriers than in non-carriers (+5.9%; P = 0.005) and the dissected weight of the MLL was +7.1% greater in TM-QTL carriers compared to non-carriers (P < 0.001). The proportion of the total carcass lean meat yield (LMY) that was contained within the loin region was slightly higher in TM-QTL carriers than in non-carriers (0.154 v. 0.145; P = 0.006). However, TM-QTL was found to have no significant effect on the total weight or proportion of LMY or of saleable meat yield in the carcass measured by dissection, or on muscling in the hind leg measured by CT or dissection. This work has verified that the inheritance of TM-QTL is associated with increased loin muscling in crossbred lambs, as has previously been reported for purebred Texel lambs.

Relationships between lamb carcass quality traits measured by X-ray computed tomography and current UK hill sheep breeding goals.

Genetic parameters were estimated between current UK hill sheep breeding goals and lamb carcass composition and muscularity traits derived using X-ray computed tomography (CT). To produce these estimates, a total of 648 lambs from two hill farms were CT scanned at weaning (ca 120 days of age), over 3 years, and total weights of carcass muscle (MUSC), fat (CFAT) and bone (BONE) and internal fat (IFAT) were predicted. Previously derived muscularity indices were also calculated for the hind leg (HLMI) and lumbar (LRMI) regions, to assess muscle shape. Data for current breeding goals (lamb performance and maternal traits) were also included from a total of 10 297 lamb records and 12 704 ewe records. Heritabilities were estimated for each trait and genetic and phenotypic correlations were calculated between each CT trait and other lamb or ewe traits. Moderate to high positive genetic correlations were found between CT-predicted tissue weights and breeding goals, which were also weights (lamb weaning weight, carcass weight, mature ewe weight, average weight of lambs reared by the ewe). CFAT was positively genetically correlated with ultrasound backfat depth at weaning (UFD) and subjective fatness grade at slaughter (MLCF), suggesting that carcass fat could be decreased using selection on any of these predictors. Ultrasound muscle depth at weaning (UMD) and subjective conformation score at slaughter (MLCC) had high genetic correlations with the muscularity indices (HLMI and LRMI), but correlations with MUSC were not significantly different from zero. This implies that selection to improve MLCC is likely to be increasing the 'roundness' of muscle shape in the high-priced carcass region, but having little impact on total lean meat yield. Correlations of CT traits with the other ewe traits (number of lambs weaned, number of lambs lost, longevity, fleece weight) were generally small or not significantly different from zero. The genetic parameters generated in this study can now be used in selection index calculations to assess the benefits of including lamb CT traits in future selection programmes for hill sheep.

Is it time for the virtual chaperone in genitourinary medicine clinics?

The General Medical Council recommends that chaperones must be offered during intimate examinations. Implementation of these guidelines may serve to protect both patients and staff within the genitourinary (GU) medicine clinic, but is likely to have major ramifications from a practical, financial and staffing perspective. The Virtual Chaperone (VC) is an objective device making audio and visual recordings of patients' consultations and examinations. Information cannot be manipulated and is encrypted for security. It would not replace the human chaperone. This study investigated the attitudes of GU medicine staff and patients to the VC in an inner city sexual health clinic. Voluntary, anonymized questionnaires were distributed to all members of the multidisciplinary team and 200 patients. The patient response rate was 90% (n = 180). Only 40% of respondents felt the VC was acceptable in GU medicine clinics. Two-thirds felt unsure or were against the VC recording during consultations, and fewer wished the examination to be recorded. Most opted to switch off the video entirely. Almost 50% of respondents felt that the VC was designed to protect staff, whereas only 41% thought it would protect patients. The staff response rate was 69% (n = 35). Almost three-quarters of respondents were unsure or felt the device was unacceptable. Less than half would feel comfortable with the VC recording during consults. Overall, three-quarters of respondents were either unsure or did not support the introduction of the VC. There was a clear feeling (>80%) that the VC would protect staff and patients, 71% indicating that the trust would also benefit. Despite its success in other outpatient specialties, GU medicine staff and patients do not favour the introduction of the VC.

Accuracy of in vivo muscularity indices measured by computed tomography and their association with carcass quality in lambs.

Assessments of muscle mass and skeletal dimensions by Computed Tomography (CT) enable the development of new muscularity indices for the hind leg (HL) and lumbar region (LR) in lambs. Compared to previous CT muscularity indices, the accuracy was much higher with the new index in the HL (correlations between CT and dissection indices of 0.89 vs 0.51). The accurate measurement of femur length by CT used in the calculation of the new HL index made an important contribution to the higher accuracy of the index. The improvement in accuracy was smaller for the LR (0.55 vs 0.44). The association of CT muscularity indices and carcass quality in Texel and Scottish Blackface lambs showed that improved muscularity is not phenotypically correlated with detrimental effects on carcass composition. CT muscularity indices provide an alternative method to improve carcass conformation and leanness, using measurements that at a constant weight are independent of fatness.

Microscopy and culture for Trichomonas vaginalis: are both required?

Many genitourinary medicine clinics have stopped routinely performing both wet preparation microscopy and cultures to diagnose Trichomonas vaginalis (TV). Our directorate stopped microscopy when screening asymptomatic women. This audit considers whether both tests continue to be warranted for symptomatic female patients. The discrepancy between microscopy and culture results leads us to recommend that both remain necessary. Sampling standardization and improved documentation are discussed.

In vivo prediction of internal fat weight in Scottish Blackface lambs, using computer tomography.

From a calibration trial involving computer tomography (CT) scanning and dissection of 45 lambs, a prediction equation was derived to estimate total internal fat weight in Scottish Blackface lambs from measurements taken on cross-sectional CT images. Using data from two cross-sectional images (at the hip and loin) internal fat can be predicted with relatively high accuracy (adjusted R(2) = 62.2%, r = 0.79). The derived equation was then used to predict internal fat weights in a further 427 Scottish Blackface lambs from a separate trial. Phenotypic correlations were calculated between predicted internal fat weight and weights of total carcass fat, muscle and bone, predicted using previously derived equations. When considering absolute tissue weights, adjusted for fixed effects, internal fat showed the strongest positive correlation with carcass fat (0.58), followed by muscle (0.36), and then by bone (0.32). When tissue weights were adjusted for fixed effects and total carcass weight (so considering tissue weights relative to size), internal fat showed a lower correlation with carcass fat weight (0.36) and negative correlations with muscle (-0.35) and bone (-0.19). These results provide the basis for more complex studies of relationships (phenotypic and genetic) between internal fat in hill lambs and economically important traits, such as carcass composition and survival of lambs, and tissue levels in different depots in hill ewes.

The effect of parity and environmental restriction on behavioural and physiological responses of pre-parturient pigs.

There is increasing evidence that restriction of pre-parturient behaviour in pigs is stress-inducing, characterised by an elevation in hypothalamic-pituitary-adrenal (HPA) activity in gilts. To determine whether pigs adapt to behavioural restriction, through modification of nest-building behaviour, we studied pre-parturient pigs in either farrowing crates (no bedding, n=7) or straw-bedded pens (n=7) in their first (gilts) and second (sows) parity, with physiological measurements being taken in the second parity. Observations and blood sampling were carried out during the pre-parturient phase. Crated pigs changed posture more often than penned pigs (F(1,12)=7.06, P<0.05), with the number of posture changes reducing across parities in both environments. The reduction in posture changing was more apparent in the crated sows which may indicate that attempted nest-building behaviour of sows with prior experience of farrowing crates is less fragmented. The crated pigs spent a greater proportion of time sitting across both parities (F(1,12)=9.4, P<0.01), and spent less time manipulating available substrates (F(1,12)=10.67, P<0.05). There was a tendency for penned pigs to spend a greater proportion of time standing (F(1,12)=3.77, P=0.076) with peak nesting behaviour occurring earlier in relation to parturition than in crated pigs. In addition penned sows performed more floor-directed behaviour than penned gilts, and at an earlier stage in relation to parturition. However, crated sows also performed peak nest-building earlier than crated gilts. Plasma cortisol profiles indicated elevated HPA activity in crated sows during the pre-parturient period (F(42,303)=1.43, P<0.05) suggesting increased physiological stress, however, the difference between crated and penned sows was less than that previously seen in gilts. The increased range of pre-parturient behaviours seen in the penned sows suggests that experience may result in an 'improvement' in their nest-building behaviour: earlier preparation of the nest site and then subsequent manipulation of substrates. The crated sows appeared to show some behavioural adaptation to the crate environment; earlier peak in floor directed behaviour and total substrate directed behaviour, reduced posture changing. In conclusion the nest-building behaviour of pigs is modified over parities with adaptation to the behavioural restrictions imposed by the farrowing crate. However, this adaptation, through prior experience, does not completely reduce the elevation in HPA activity previously reported in pre-parturient crated gilts.

Effect of human immunodeficiency virus-1 protease inhibitors on the clearance of human herpesvirus 8 from blood of human immunodeficiency virus-1-infected patients.

The effect of human immunodeficiency virus-1 protease inhibitors on the frequency of human herpesvirus 8 DNA detection from peripheral blood of human immunodeficiency virus-positive persons was evaluated. Thirty-three human immunodeficiency virus-seropositive male patients were studied longitudinally. DNA from open reading frame 26 of the human herpesvirus 8 genome was amplified by the polymerase chain reaction from the CD45+ fraction of peripheral blood before and after the introduction of protease inhibitor therapy. Human herpesvirus 8 IgG status, CD4+ cell counts, and human immunodeficiency virus-1 plasma viral load were also assessed before and after therapy. When both reverse transcriptase inhibitor and protease inhibitor treatment were introduced at the same time, there was an increase in CD4+ T cell counts (P=0.0041), a decrease in human immunodeficiency virus plasma load (P=0.0584), and a decrease in the detection rate of human herpesvirus 8 DNA (P=0.0077). Introducing protease inhibitor to patients already receiving reverse transcriptase inhibitor treatment was associated with an increase in CD4+ T cell counts (P=0.0003), a decrease in human immunodeficiency virus plasma viral load (P=0.0911), and a decrease in the human herpesvirus 8 detection rate (P=0.0412). No significant changes in the titters of anti-human herpesvirus 8 IgG were observed. Treatment with human immunodeficiency virus-1 protease inhibitors is therefore associated with the clearance of human herpesvirus 8 DNA from peripheral blood of human immunodeficiency virus-infected patients. The concomitant decrease in the human immunodeficiency virus plasma load and increase in the peripheral CD4+ cell count suggest that an amelioration in the immune defect following reduction in the burden of human immunodeficiency virus-1 infection is responsible for the clearance of human herpesvirus 8 by protease inhibitors.

Lesbians and cervical screening.

Confusion exists in clinical practice about whether lesbians should be offered routine cervical smears. We found cervical smear abnormalities in a sample of 624 lesbians, including those who had never been sexually active with men. These findings suggest that lesbians should be routinely offered cervical cytology as part of the national screening programme. Evidence of human papilloma virus (HPV) infection in the 'exclusively lesbian' group indicates that sexual transmission of HPV may occur between women. The belief by some lesbians that they have less need for cervical smears, coupled with poor uptake of cervical screening by a significant proportion, demonstrates a need for education of lesbians and health service providers.