Impact of an alternate feeding program on broiler breeder pullet behavior, performance, and plasma corticosterone.

Broiler breeders are commonly feed restricted using some variation of skip-a-day feeding to prevent excessive body weight (BW) gain and poor flock uniformity that results in lower production levels. However, the level of feed restriction has increased leading to negative effects on broiler breeder welfare. Research needs to be conducted to evaluate alternative feeding programs to diminish the negative impact of restricted feeding on bird welfare. This research examined pullets that were fed soybean hulls (alternate day feeding, ATD) on the off day of a traditional skip-a-day feeding program in comparison to the standard skip-a-day program (SAD). The 2 dietary feeding treatments each had 3 replicate pens of 210 pullets each and were fed from wk 5 to 21 of age. Nitrogen-corrected true metabolizable energy and digestible amino acid coefficients of soybean hulls were determined. Body weight in the ATD feed program was significantly higher (P < 0.001) than the birds on the SAD feed program until 16 wk of age. Feed allocations for the SAD feeding program was increased at 11 wk of age to achieve similar BW prior to photo stimulation. The ATD feed program significantly improved BW uniformity of the birds for weeks 8, 12, 16, and 20. Hens fed on the SAD feed program had a lower mean egg production than the hens fed on the ATD program. There were significant differences on plasma corticosterone concentrations between the feeding days (24 or 48 h after feeding) in both feed programs. There was a shift in the behavior of the birds with significant differences in the feeding, foraging, and comfort behaviors between the feeding programs on the same feed day. Overall, feeding the ATD females soybean hulls on the off feed day improved the BW uniformity and egg production, but further research will be needed to determine potential differences in nutrient utilization or behavior of the pullets that positively impacted this flock performance.

A review on development of novel strategies for controlling Salmonella Enteritidis colonization in laying hens: fiber-based molt diets.

Limiting Salmonella Enteritidis from table eggs can involve intervention approaches at several levels of the production cycle, beginning at the hatchery and ending at the processing or table egg production facilities. Likewise, interventions that limit Salmonella Enteritidis dissemination can be implemented at various stages during the life cycle of infection of Salmonella in the laying hen. However, achieving complete elimination of Salmonella infestation in egg products has remained elusive. There is a multitude of reasons for this, including adaptability of the organism, virulence properties, and persistence. Likewise, environmental factors in the layer house such as transmission routes, reservoirs, and feed sources can influence the exposure of susceptible laying hens to Salmonella Enteritidis. Consequently, successful applications of control measures depend not only on the timing of when they are applied but also on effective surveillance to detect frequency and level of infection of Salmonella. Several studies demonstrated that molt induction by feed withdrawal altered the immune system and the gastrointestinal tract of hens, making them susceptible to Salmonella Enteritidis colonization of the gastrointestinal tract. To alleviate this, the development of alternative methods to induce a molt became necessary. The use of several fiber-containing diets was shown to effectively induce a molt with alfalfa-based diets being the most extensively studied. Further reduction of Salmonella Enteritidis levels in eggs will probably require application of multiple interventions at several steps during egg production and processing as well as a better understanding of the mechanisms used by Salmonella Enteritidis to persist in laying flocks.

Epilepsy surgery in children under 3 years.

PURPOSE: Resective epilepsy surgery in early childhood has become an important treatment option for selected infants and children with epilepsy. We describe experience and clinical outcomes of children under 3 years undergoing epilepsy surgery at Great Ormond Street Hospital (GOSH). METHODS: All children under 36 months of age who had resective surgery for the purpose of treating epilepsy within the GOSH epilepsy surgery programme were ascertained using a departmental database. Aetiology, post-operative seizure frequency, pre and post-operative cognitive function, long-term complications and re-operation rates were analysed by retrospective examination of clinical records. RESULTS: Forty-two children were included in our cohort with a median age at surgery of 20 months (range 3-36 months). Surgical procedures comprised 25 functional hemispherectomies, two anatomical hemispherectomies, four multilobar resections, seven lobar resections and four focal resections. 7/42 (17%, 95% CI 8-31%) children underwent re-operation. 20/42 (48%, 95% CI 33-62%) children achieved seizure freedom. 18/42 (43%, 95% CI 29-58) demonstrated an improvement in seizure frequency and no children had an increase in seizure frequency. Post-operative complications included subsequent shunt procedure in 5/25 (20%, 95% CI 9-39%) children undergoing hemispherectomy. There were no mortalities. In 23 children pre- and post-operative DQ or IQ was determinable allowing longitudinal comparison. Five children had a decrease in DQ/IQ >15 and two children had an increase DQ/IQ >15. DISCUSSION: Epilepsy surgery in children under 3 years of age offers suitable candidates a good chance of significantly improved seizure outcome which compares with rates in older cohorts.

Foodborne Salmonella ecology in the avian gastrointestinal tract.

Foodborne Salmonella continues to be a major cause of salmonellosis with Salmonella Enteritidis and S. Typhimurium considered to be responsible for most of the infections. Investigation of outbreaks and sporadic cases has indicated that food vehicles such as poultry and poultry by-products including raw and uncooked eggs are among the most common sources of Salmonella infections. The dissemination and infection of the avian intestinal tract remain somewhat unclear. In vitro incubation of Salmonella with mammalian tissue culture cells has shown that invasion into epithelial cells is complex and involves several genetic loci and host factors. Several genes are required for the intestinal phase of Salmonella invasion and are located on Salmonella pathogenicity island 1 (SPI 1). Salmonella pathogenesis in the gastrointestinal (GI) tract and the effects of environmental stimuli on gene expression influence bacterial colonization and invasion. Furthermore, significant parameters of Salmonella including growth physiology, nutrient availability, pH, and energy status are considered contributing factors in the GI tract ecology. Approaches for limiting Salmonella colonization have been primarily based on the microbial ecology of the intestinal tract. In vitro studies have shown that the toxic effects of short chain fatty acids (SCFA) to some Enterobacteriaceae, including Salmonella, have resulted in a reduction in population. In addition, it has been established that native intestinal microorganisms such as Lactobacilli provide protective mechanisms against Salmonella in the ceca. A clear understanding of the key factors involved in Salmonella colonization in the avian GI tract has the potential to lead to better approach for more effective control of this foodborne pathogen.

The effects of alfalfa-based molt diets on skeletal integrity of white leghorns.

Sixty White Leghorn hens were assigned to 1 of 6 treatments: pretrial control (PC), full fed (FF), 9-d feed withdrawal (FW), 90% alfalfa-10% layer ration (A90), 80% alfalfa-20% layer ration (A80), and 70% alfalfa/30% layer ration (A70). For the PC, hens were killed and bones collected immediately before light restriction. The FF hens were also subjected to light restriction. After hens were fasted or fed different molting treatment diets for 9 d, they were fed a maintenance diet for 14 d. At 23 d postmolt, hens were killed and bones collected. Feed intakes per hen of the FF, A90, A80, and A70 treatments during a 9-d molting period were 97, 17, 44, and 46 g, respectively. Tibia dry weight of the PC was greater than the FF group. The PC group had significantly greater tibia ash weight than the FF, FW, A90, and A80 groups. Tibia ash concentration of the PC group was significantly greater than the FF, A90, and A80 groups. Humerus dry weights of the PC group were greater than the other groups except for hens on FW. Humerus ash weight was lower for FF hens as compared with PC hens, but other molting treatments had humerus ash weights similar to PC hens. Tibia mineral content and density of the PC were significantly greater than the other treatments. The FF group exhibited significantly lower humerus mineral content and density compared with those of the PC group. The PC and A70 hens exhibited significantly greater ultimate bending moment and ultimate stress compared with the FF and A90 hens. The modulus of elasticity of the PC hens was greater than that of the FF and A90. There were no significant differences in modulus of elasticity among the PC, FW, A80, and A70 hens. In conclusion, hens at 23 d postmolt experienced deterioration in skeletal integrity. This decrease in bone quality occurred in all molted hens. However, A70 and A80 alfalfa-fed hens retained mechanical properties of bones compared with the pretrial control.

Behavioral responses of laying hens to different alfalfa-layer ration combinations fed during molting.

Induced molting by feed withdrawal has been a common practice in the commercial layer industry and usually involves the removal of feed for a period of up to 14 d. However, this is a practice that is believed to adversely influence the welfare of the hens and there is a need to examine behavioral responses to alternative molt regimens. The behavioral patterns of hens on 90% alfalfa:10% layer ration, 80% alfalfa:20% layer ration, and 70% alfalfa:30% layer ration molt diets were compared with feed withdrawal (FW) hens, and fully fed (FF) hens. The White Leghorn laying hens were approximately 54 wk old and were placed in 3 identical climate-controlled rooms. The hens were individually housed in 2-tier wire battery cages and provided treatment rations and water ad libitum. Nonnutritive pecking, walking, drinking, feeder activity, preening, aggression, and head movement were quantified during two 10-min periods each day for 6 hens from each treatment. Over the 9-d treatment period, hens in the FW, 70% alfalfa:30% layer ration, and 80% alfalfa:20% layer ration groups spent significantly more time walking than hens in the 90% alfalfa:10% layer ration group. The FF and 70% alfalfa:30% layer ration hens spent half as much time preening, whereas the FW hens displayed nearly twice as much nonnutritive pecking when compared with other treatments. Most differences in head movements occurred at the beginning of the molt period, whereas during the last half of molt, alfalfa-fed hens exhibited feeder activity similar to FF hens, and all were significantly higher than that of FW hens. After some initial adjustment by the hens, consumption of alfalfa molt diets appeared to reduce nonnutritive pecking behavior, which is characteristically associated with FW hens.

Behavior of laying hens on alfalfa crumble molt diets.

Several dietary alternatives to feed withdrawal have been proposed to induce a molt in laying hens. This study compared the behavior of laying hens on an alfalfa crumble diet (ALC) to hens that were either on a conventional layer diet (FF) or hens that had feed withdrawn (FW) during a 9-d trial. Each treatment consisted of 24 hens (3 hens per battery cage), and treatment began after a 2-week acclimation period. Video cameras connected to a digital multiplexer recorded the behavior of the hens. The percentages of observations performing nonnutritive pecking, feeder activity, drinking, walking, preening, head movement, and aggression were quantified for two 10-min periods at daily intervals. The FF hens spent significantly more (P < or = 0.05) time drinking than the other treatments, whereas FW hens displayed the most head movements. From d 1 through 7, FW hens walked less than ALC hens except on d 8 when FW hens walked more than ALC and FF hens. On d 4 and 6, the FW hens spent an increased amount of time preening compared with FF hens until the last few days of the molt period. For the most part, FW hens generally displayed more nonnutritive pecking than ALC and FF hens throughout the molt period. However, FW hen visits to the feeders declined as the trial proceeded, whereas ALC and FF hens generally spent more time at the feeder. In summary, the ALC diet showed potential as an alternative to FW for inducing a molt in laying hens based on reduced nonnutritive pecking behavior, head movements, and greater feeding activity.

Immunological cell and serum metabolite response of 60-week-old commercial laying hens to an alfalfa meal molt diet.

The practice of induced molting involves the restriction of light, feed removal and optionally water for 5-14 days. However, there is growing concern regarding feed removal and animal welfare issues. With this in mind, alternative diets have been developed to produce similar molting effects as that of feed deprivation. Alfalfa, which largely consists of insoluble fiber, can be used as a molting diet. In this study, heterophil and lymphocyte counts, serum chemistry, and organ weight parameters were evaluated in hens that were deprived of feed or fed alfalfa during a nine day induced molt. Full-fed hens were used as the control. Blood serum parameters assessed included calcium, magnesium, glucose, total protein, ketone bodies, uric acid, and cholesterol. White blood cells were counted and categorized by cell type. On the ninth day of the trial, the hens were euthanized and the liver, spleen, heart, intestine, pancreas, ovary, oviduct, and kidney were collected and weighed. On day 8 birds molted with alfalfa or by feed deprivation had significantly higher (P<0.05) levels of ketone bodies and cholesterol and lower levels of calcium, and magnesium compared to the full-fed hens while birds molted by feed deprivation exhibited significantly lower levels of uric acid. Birds molted by both methods exhibited significant reductions in ovary, oviduct, liver and pancreas weights and increased spleen weights when compared to the non-molted hens. On days 0, 2, and 6 there were no significant differences (P>0.05) in either heterophil or lymphocyte percentages. However, heterophil percentages were higher in feed withdrawal birds than full-fed birds on day 4 but lymphocyte percentages were higher in full-fed birds compared to feed withdrawal birds. On day 8 of the induced molt lymphocyte percentages were higher from full-fed birds when compared to feed withdrawal birds but no significant differences were detectable for heterophil percentages. Based on reproductive organ weight loss and changes in serum and immunological responses of birds during molt, it appears that alfalfa meal can be an effective molt induction alternative.

Growth and genetic responses of Salmonella Typhimurium to pH-shifts in an anaerobic continuous culture.

Salmonella infection of chickens that leads to potential human foodborne salmonellosis continues to be a concern. Changes in the pH of poultry gastrointestinal tract could influence Salmonella growth and virulence response. In the current study, growth responses of a chicken isolate Salmonella enterica serovar Typhimurium (ST) to three incremental pH-shifts (6.17-7.35) in continuous cultures (CC) were evaluated. The expression of rpoS and hilA was determined by real time-polymerase chain reaction (RT-PCR) as well. Increases in pH resulted in higher cell protein concentrations, glucose disappearance, and glucose and ATP yields. Although with some inconsistency between the two trials, the data indicated that the ammonia release into media was favored by low pH. The pH shifts did not significantly affect acetate biosynthesis. No consistent trends of pH influence on propionate and butyrate production could be detected. In all three pH shifts, relative expression of hilA was dominant at 0h which represented CC steady state. In pH shift 7.35-6.86 (Trial 1), the relative expression of rpoS at time 0 and 1h were over five-fold higher than after 3 and 6h of growth. Overall, the results suggest that ST physiology is altered by changes in pH, which could be determinant factors for ST survival in the poultry gastrointestinal ecosystems.

Molting in Salmonella enteritidis-challenged laying hens fed alfalfa crumbles. III. Blood plasma metabolite response.

The objective of this study was to examine an alfalfa crumble diet as an alternative molt diet and compare the physiological response of hens to the responses of feed-deprived molted hens. Hens >50 wk old were placed into 6 treatment groups (12 hens per group in trial 1 and 10 hens per group in trial 2): nonmolted Salmonella enterica serovar Enteritidis positive (FF+), nonmolted Salmonella Enteritidis negative (FF-), feed withdrawal Salmonella Enteritidis positive (FW+), FW Salmonella Enteritidis negative (FW), alfalfa Salmonella Enteritidis positive (ALC+), and ALC Salmonella Enteritidis negative (ALC-). Each hen in the Salmonella Enteritidis-positive groups was challenged on the fourth day of the study with 1 mL of 10(6)-cfu Salmonella Enteritidis. Blood was collected on d 2, 5, 9, and 12 of the trial. Blood plasma was collected and metabolite concentrations were analyzed for glucose, calcium, cholesterol, uric acid, total protein, and triglycerides. The feed intakes of the FF hens were 4- to 6-fold greater (P

Molting in Salmonella enteritidis-challenged laying hens fed alfalfa crumbles. IV. Immune and stress protein response.

Immunological responses of molting hens either infected or not infected with Salmonella enterica serovar Enteritidis were compared in 2 trials with Single Comb White Leghorn hens >50 wk old. The hens were placed into 6 treatment groups with 12 hens per group: nonmolted Salmonella Enteritidis positive (FF+), non-molted Salmonella Enteritidis negative (FF-), feed withdrawal Salmonella Enteritidis positive (FW+), FW Salmonella Enteritidis negative (FW-), alfalfa Salmonella Enteritidis positive (ALC+), and ALC Salmonella Enteritidis negative (ALC-). Each hen in the Salmonella Enteritidis-positive groups was challenged on d 4 of the study with 1 mL of 10(6)-cfu Salmonella Enteritidis, and diets were administered for 12 d. Blood samples were collected on d 2, 5, 9, and 12, and blood smears were enumerated for heterophil to lymphocyte (H:L) ratios. Serum samples were also analyzed for alpha(1)-acid glycoprotein (AGP) levels and antibody level. On d 12, hens were euthanized and bile samples from the gall bladder and sections of the ileum and the ceca were collected, and an ELISA was used to determine the intestinal, serum, and bile antibody responses. The FW+ hens produced more (P

Molting in Salmonella Enteritidis-challenged laying hens fed alfalfa crumbles. II. Fermentation and microbial ecology response.

The objective of this study was to examine microbial population shifts and short-chain fatty acid (SCFA) responses in the gastrointestinal tract of Salmonella Enteritidis-challenged molted and nonmolted hens fed different dietary regimens. Fifteen Salmonella-free Single Comb Leghorn hens (>50 wk old) were assigned to 3 treatment groups of 5 birds each based on diet in 2 trials: 100% alfalfa crumbles (ALC), full-fed (FF, nonmolted) 100% commercial layer ration, and feed withdrawal (FW). A forced molt was induced by either a 12-d alfalfa diet or FW. In all treatment groups, each hen was challenged by crop gavage orally 4 d after molt induction with a 1-mL inoculum containing 10(6) cfu of Salmonella Enteritidis. Fecal and cecal samples (d 4, 6, 8, 11, and necropsy on d 12) were collected postchallenge. Microbial population shifts were evaluated by PCR-based 16S ribosomal RNA gene amplification and denaturing gradient gel electrophoresis, and SCFA concentrations were measured. Total SCFA in fecal and cecal contents for FW molted hens were generally lower (P < or = 0.05) in the later stages of the molt period when compared to ALC and FF treatment groups. The overall trend of SCFA in cecal and fecal samples exhibited similar patterns. In trials 1 and 2, hens molted with ALC diet generally yielded more similar amplicon band patterns with the FF hens in both fecal and cecal samples by the end of the molting period than with FW hens. The results of these studies suggest that ALC molted hens supported microflora and fermentation activities, which were more comparable to FF hens than FW hens by the end of the molting period.

Molting in Salmonella enteritidis-challenged laying hens fed alfalfa crumbles. I. Salmonella enteritidis colonization and virulence gene hilA response.

The objectives of this study were to enumerate Salmonella enterica serovar Enteritidis colonization in fecal, cecal, and internal organs, and to compare the level of virulence gene expression (hilA) of experimentally challenged laying hens fed different dietary molt-induction regimens. Twelve Salmonella-free Single Comb Leghorn hens (>50 wk old) hens were randomly assigned to each of 6 treatment groups designated based on diet in 2 trials: 1) feed withdrawal Salmonella Enteritidis-positive (FW+), 2) fully fed Salmonella Enteritidis-positive (FF+), 3) 100% alfalfa crumble Salmonella Enteritidis-positive (ALC+), 4) feed withdrawal Salmonella Enteritidis-negative, 5) fully fed Salmonella Enteritidis-negative, and 6) 100% alfalfa crumble Salmonella Enteritidis-negative. A forced molt was induced by a 12-d alfalfa diet and a feed-withdrawal regimen. On d 4 of the molt, all hens in groups 1, 2, and 3 were challenged by crop gavage with 1 mL of inocula containing approximately 10(6) cfu of nalidixic acid- and novobiocin-resistant Salmonella Enteritidis (phage type 13A). At the conclusion of both trials, all hens were euthanized and Salmonella Enteritidis colonization was enumerated in the cecal contents, liver, spleen, and ovaries. In addition, fecal (d 4 and 8) and cecal samples (necropsy at d 12) were collected postchallenge from treatment groups 1, 2, and 3 (Salmonella Enteritidis-positive) to quantify hilA expression by PCR. In both trials, all nonchallenged birds were Salmonella Enteritidis-negative; therefore, no further analysis was done. In trial 1, a 2-fold reduction in Salmonella Enteritidis colonization was observed in the ALC+ hens (log10 Salmonella Enteritidis of 1.99) compared with the FW+ hens (log(10) Salmonella Enteritidis of 3.89). In trial 2, a 4-fold reduction in Salmonella Enteritidis colonization was observed in the ALC+ hens (log(10) Salmonella Enteritidis of 1.27) compared with the FW+ hens (log(10) Salmonella Enteritidis of 5.12). In trial 2, Salmonella Enteritidis colonization in spleens was higher (P 0.05). In trial 2, hilA expression in FW+ hens was higher (P

Comparison of in vitro fermentation and molecular microbial profiles of high-fiber feed substrates incubated with chicken cecal inocula.

High fiber and nonstarch polysaccharide-based poultry diets have received more interest recently for retaining or promoting beneficial gastrointestinal microbial populations. The objective of this study was to investigate and compare the in vitro potential fermentability of high-fiber feed substrates (HFFS) by laying hen cecal microflora. Feed sources examined included soybean meal, soybean hull, beet pulp, wheat middlings, ground sorghum, cottonseed meal, 100% alfalfa meal, 90% alfalfa + 10% commercial layer ration, 80% alfalfa + 20% commercial layer ration, and 70% alfalfa + 30% commercial layer ration. Cecal contents and HFFS were incubated anaerobically in serum tubes at 39 degrees C for 24 h. Samples from 2 trials were analyzed at 0 and 24 h for short-chain fatty acids (SCFA). Short-chain fatty acids in samples at 0 h were subtracted from 24-h samples to determine the net production of SCFA. In both trials involving HFFS incubations with cecal inocula, acetate production was highest followed by propionate and butyrate whereas isobutyrate and isovalerate production were in trace amounts. In trial 2, detectable valerate production appeared to consistently occur with alfalfa-based HFFS. It was clear that SCFA production was largely dependent upon HFFS, because cecal inoculum alone yielded little or no detectable SCFA production. For HFFS incubations without cecal inocula, acetate production was highest; propionate and butyrate were similar, and isobutyrate, valerate, and isovalerate production were in trace amounts. Polymerase chain reaction-based denaturing gradient gel electrophoresis results from both trials indicated 69 and 71% similarity for comparison of all feed mixtures in trials 1 and 2, respectively. All alfalfa-based HFFS yielded a higher similarity coefficient in trial 2 than in trial 1 with a band pattern of 90% similarity; diets containing 90% alfalfa + 10% commercial layer ration and 80% alfalfa + 20% commercial layer ration in trial 2 formed a subgroup with a 94% microbial similarity coefficient. These data suggest that high fiber sources may contribute to the fermentation and microbial diversity that occurs in the ceca of laying hens.

Specimen Validity Testing SVT) - Effects of Oxidizing Agents on Drugs in Urine and Procedures for Detection.

Since the inception of the drug-testing program in the U.S. Armed Forces in 1982, urine adulteration with the intent to conceal drug use has been a serious problem to forensic scientists. Initially, drug users tried almost anything that was available at the collection sites. Soon they recognized that certain chemicals could be used to destroy some drugs and interfere with the testing procedures. Some drug analytes, in particular morphine and 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid, a metabolite of delta-9-tetrahydrocannabinol, could not be detected in presence of some oxidizing agents. As the use of adulterants increased, specimen validity testing was introduced by the Department of Health and Human Services in 2004. While specific reagents could be used to test nitrite, chromate, and iodine, test procedures for many other oxidizing agents were not available. In an attempt to detect most oxidants, a different approach has been introduced to identify urines adulterated with oxidizing adulterants. In this approach, the oxidizing property of normal urine is compared with that of urine containing oxidizing agents. In the procedure, samples are allowed to interact with excess ferrous (Fe2+) ions and then with chromogenic compounds. In the presence of oxidants, Fe2+ ions with low reduction potential (E0 0.771 V) are immediately oxidized to ferric (Fe3+) ions, which then change the chromogenic compounds to colored chromogens. Specific spectral pattern and intensity are the keys in quantification of oxidants in urine (milliEquivalent/liter, mE/L). The method appeared to be promising in differentiating normal urine from urine adulterated with oxidizing agents. Some oxidizing adulterants in urine are unstable. If reduced, it could be reconverted to the oxidizing agents and tested by the general oxidant test.

NICE guidelines and the epilepsies: how should practice change?

The care and provision for children and adults with epilepsy and their carers has recently been under scrutiny with a series of reports highlighting concerns and calling for change. The National Institute for Clinical Excellence (NICE) published recommendations for management of adults and children in October 2004. Although recommendations were often specific and practical they did not include precise details regarding their implementation. Key recommendations and their implications are discussed in this review.

Comparison of a dedicated children's seizure clinic to mixed general paediatric clinics.

BACKGROUND: In the light of recent recommendations regarding the current management of children with possible epilepsy in the UK, different models of care are compared using an existing validated audit tool. METHODS: The initial clinical assessment process, investigation, management and communication regarding children referred with suspected epilepsy to general paediatric clinics or a paediatric seizure clinic was compared using the British Paediatric Neurology Association (BPNA) audit tool. Results Ninety-three children were included in the comparison. The history and description of the episodes was better documented in the Seizure Clinic (SC). Children's early development (79% vs. 50%) and school performance (86% vs. 42%) were better documented in the SC. Documentation of possible side effects relating to newly prescribed anti-epileptic drugs was poor in both groups (33% vs. 15%). CONCLUSIONS: Differences between models of epilepsy care can be detected using audit tools although there are some methodological limitations of this particular study. Future similar studies as well as informing local practice can add to the debate on the appropriate way forward in improving the care for children with epilepsy.

Improving diagnostic yield of biliary brushings cytology for pancreatic cancer and cholangiocarcinoma.

Biliary brushings are currently the best accepted method to obtain a cytological diagnosis of pancreatic cancer or cholangiocarcinoma. The technique has good specificity but poor sensitivity. Two dedicated pathologists reviewed 137 consecutive biliary brushings from 127 patients between February 1997 and February 2000. The ultimate diagnosis was determined by review of radiology, operative diagnosis and patient outcome. The sensitivity, specificity, positive predictive value and negative predictive value of the original results and the review results were calculated and compared. Additional diagnostic categories 'suspicious' and 'atypical possibly benign' were included on review. After review, the sensitivity improved from 49.4% to 89.0% and the specificity remained 100%. The use of the additional diagnostic category 'suspicious' increased the sensitivity to 90.4%, at the expense of a fall of the specificity to 66.7%. We conclude that review by two dedicated pathologists and additional diagnostic categories can improve the diagnostic accuracy of biliary brushings.

An observational study investigating the health provision for children with epilepsy within secondary schools in the East Midlands, UK.

BACKGROUND: Epilepsy is a common medical condition affecting many children in mainstream education. The practice of local secondary schools and the health service with regard to pupils with epilepsy was examined. The extent to which these children had activities at schools restricted and the schools' perception of the health service with regard to epilepsy was explored. METHOD: A structured interview was conducted with selected staff members from mainstream secondary schools in East Midlands region, UK. RESULTS: Fourteen out of 17 schools participated. Fifty-seven children were identified from a total pupil population of 14 534. Seven schools used the DOH/DfEE (The Department of Health/Department for Education and Employment) 'Supporting Pupils with Medical Needs' publication as a resource. No schools created individual health care plans for children with epilepsy. Six out of seven schools reported appropriate provision for children during swimming activities. The commonest restriction was related to computer use. Nine schools stated a need for more training for staff members with regard to seizure management. CONCLUSIONS: Schools rely heavily on obtaining medical information from non-medical sources. Individual health care plans for children with epilepsy are not commonly undertaken. Few children had any restriction or special provision placed upon them because of their epilepsy except in the area of computer use. Further action is needed to consider how the system for providing for such children can be improved so that each child's individual health needs can be satisfactorily met.