Seropositivity to Campylobacter and association with abortion and lamb mortality in maiden ewes from Western Australia, South Australia and Victoria.

This case-control study investigated associations between Campylobacter fetus or Campylobacter jejuni titre and reproductive outcomes in 22 flocks of Merino and non-Merino maiden ewes aged 1-2 years old. Campylobacter titres were also determined for multiparous ewes aged 3 years or older on the same farms. C. fetus 'positivity' (titre ≥1:80) was detected for 12% (57/462; 95% confidence interval [95% CI] 9.6 to 15.6) of maiden ewes and 31% (65/210; 95% CI 25.0 to 37.4) of mature ewes. The odds for failing to rear a lamb in C. fetus-'exposed' maiden ewes (titre ≥1:10) was 2.01 times that of seronegative ewes (95% CI 1.09 to 3.77; P = 0.027), but there was no association between C. fetus-'positivity' (titre ≥1:80) and failure to rise (OR 1.69; 95% CI 0.77 to 3.76; P = 0.191). C. fetus abortions were confirmed with microbial culture in one maiden ewe flock. In this flock, C. fetus titres fluctuated and often waned by lamb marking, highlighting the value of necropsies during abortion investigations. C. jejuni-'positivity' (titre ≥1:80) was detected for 44% (204/462; 95% CI 39.7 to 48.7) maiden ewes, but odds of failing to rear were decreased for C. jejuni-'positive' ewes (OR 0.52; 95% CI 0.32 to 0.83; P = 0.007). The association between Campylobacter serology and the reproductive outcome was inconsistent in these flocks. Serology should be considered in the context of other risk factors and used in conjunction with other strategies to investigate the impact of Campylobacter exposure on ewe reproductive performance such as monitoring for abortions and lamb necropsies to determine aetiological diagnosis, and vaccination trials.

Mob size of single-bearing or twin-bearing Merino ewes at lambing may not influence lamb survival when feed-on-offer is high.

Limited research has suggested that higher lambing densities increase interference from foreign ewes at lambing which disrupts the ewe-lamb bond and compromises lamb survival. This may be particularly evident in mobs of twin-bearing ewes compared to single-bearing ewes because a greater number of lambs are born per day. Therefore, we hypothesised that; (i) decreasing the mob size of ewes at lambing has a greater impact on the survival of twin-born lambs than single-born lambs; (ii) the relationship between mob size and lamb survival can be explained by differences in the rate of interaction with foreign ewes and lambs at lambing; and (iii) ewes will utilise a limited area of the paddock at lambing and thus lambing density will be defined by the distribution of ewes in the paddock rather than the paddock area. Merino ewes were allocated into a 2×2 factorial combination of ewe pregnancy status (single- or twin-bearing) and mob size (high (n=130 ewes) or low (n=50 ewes)) on day 140 from the start of joining. Each treatment had two replicates excepting the low mob size for twins which had a third replicate. Ewes lambed at a stocking rate of 11 ewes/ha. Feed-on-offer during lambing exceeded 2400 kg dry matter (DM)/ha. Ewe-lamb behaviour was observed and dead lambs were autopsied over 11 days during the peak of lambing. The distribution of ewes in each paddock was recorded every 2 h during daylight hours by counting the number of ewes occupying 2500 m2 grids. The proportion of ewes and their newborn progeny which interacted with foreign ewes at lambing did not differ between the high and low mob sizes for single- (24.9% v. 20.8%) or twin-bearing ewes (14.3% v. 19.6%; P=0.74). Similarly, interaction with foreign lambs did not differ between the high and low mob sizes for single- (14.5% v. 25.2%) and twin-bearing ewes (34.5% v. 26.4%; P=0.44). The distribution of ewes within the paddock did not differ between treatments (P=0.95). On average, single-bearing ewes which lambed at the high and low mob sizes occupied 34% and 36% of the paddock during daylight hours, and the corresponding values for twin-bearing ewes were 40% and 43%. Survival of twin-born lambs was lower than single-born lambs (75.3% v. 87.9%; P<0.01), however, lamb survival was not influenced by mob size regardless of birth type. These results suggest that higher mob sizes may not compromise lamb survival when feed-on-offer during lambing exceeds 2400 kg DM/ha.

Supplementation of Merino ewes with vitamin E plus selenium increases α-tocopherol and selenium concentrations in plasma of the lamb but does not improve their immune function.

Vitamin E and selenium have been reported to improve immune function across a range of species. Ewes lambing on poor-quality dry pasture in autumn in Western Australia are at risk of being deficient in vitamin E and selenium at lambing thus predisposing their lambs to deficiencies and increasing the risk of infection and disease. This study tested the hypotheses that (i) supplementation of autumn-lambing ewes with vitamin E plus selenium in late gestation will increase the concentrations of vitamin E and selenium in plasma in the ewe and lamb and (ii) that the increased concentrations of vitamin E and selenium in plasma in the lambs will improve their innate and adaptive immune responses and thus survival. Pregnant Merino ewes were divided into a control group (n=58) which received no supplementation or a group supplemented with vitamin E plus selenium (n=55). On days 111, 125 and 140 of pregnancy ewes in the vitamin E plus selenium group were given 4 g all-rac-α-tocopherol acetate orally. On day 111 the ewes were also given 60 mg of selenium as barium selenate by subcutaneous injection. The concentrations of α-tocopherol and selenium were measured in ewes and/or lambs from day 111 of pregnancy to 14 weeks of age±10 days (weaning). Immune function of the lamb was assessed by analysing the numbers and phagocytic capacities of monocytes and polymorphonuclear leucocytes and plasma IgG and anti-tetanus toxoid antibody concentrations between birth and 14 weeks of age±10 days. Maternal supplementation with vitamin E plus selenium increased the concentration of α-tocopherol in plasma (1.13 v. 0.67 mg/l; P<0.001) and selenium in whole blood (0.12 v. 0.07 mg/l; P<0.01) of the ewes at lambing compared with controls. Supplementation also increased the concentration of α-tocopherol (0.14 v. 0.08 mg/l; P<0.001) and selenium (0.08 v. 0.05 mg/l; P<0.01) in lambs at birth compared with controls. There was no significant effect of supplementation on immune function or survival in the lambs.

Antibiotic dosing in obesity: the search for optimum dosing strategies.

Global obesity has nearly doubled and is now a common occurrence in high-income and developing countries. The World Health Organization estimates that more than 1.4 billion adults are obese. Although the prevalence of obesity is increasing over the last decades, pharmacokinetic evaluations are still conducted in individuals with a body weight of approximately 70 kg. Morbid obesity is associated with several pathophysiological changes that can profoundly affect drug distribution and clearance. There are currently no specific dosing recommendations for antibiotics in obese patients, making dosing suggestions primarily based on pharmacokinetic characteristics of the medications and dosing recommendations in other disease states. Understanding of the pharmacokinetic alterations and maximum doses of antibiotics safely used is paramount to appropriate treatment in the obese population.

Friction-formed liquid droplets.

The formation of nanoscale liquid droplets by friction of a solid is observed in real-time. This is achieved using a newly developed in situ transmission electron microscope (TEM) triboprobe capable of applying multiple reciprocating wear cycles to a nanoscale surface. Dynamical imaging of the nanoscale cyclic rubbing of a focused-ion-beam (FIB) processed Al alloy by diamond shows that the generation of nanoscale wear particles is followed by a phase separation to form liquid Ga nanodroplets and liquid bridges. The transformation of a two-body system to a four-body solid-liquid system within the reciprocating wear track significantly alters the local dynamical friction and wear processes. Moving liquid bridges are observed in situ to play a key role at the sliding nanocontact, interacting strongly with the highly mobile nanoparticle debris. In situ imaging demonstrates that both static and moving liquid droplets exhibit asymmetric menisci due to nanoscale surface roughness. Nanodroplet kinetics are furthermore dependent on local frictional temperature, with solid-like surface nanofilaments forming on cooling. TEM nanotribology opens up new avenues for the real-time quantification of cyclic friction, wear and dynamic solid-liquid nanomechanics, which will have widespread applications in many areas of nanoscience and nanotechnology.

Optometrists referrals for glaucoma assessment: a prospective survey of clinical data and outcomes.

AIM: The aim of this study is to determine the outcomes following referral for glaucoma from routine optometric practice and the positive predictive value (PPV). METHODS: A prospective study of 441 referrals for glaucoma in the Portsmouth area was performed over 6 months. A positive outcome was defined when the patient had the diagnosis of glaucoma made or if there was a high index of suspicion of glaucoma requiring follow-up. The PPV was determined from positive outcome number/referral number. RESULTS: The overall PPV was 0.37 (95% confidence interval 0.33-0.42). Open-angle glaucoma (OAG) was confirmed in 33 (7%) patients. A diagnosis of ocular hypertension was made in 49 (11%) patients and glaucoma suspect in 92 (21%) referrals. Two-thirds of optometrists recorded all 3 assessments: fields, intraocular pressure (IOP) and disc appearance, a figure representing 293 referrals (PPV 0.37). However the greatest referral accuracy was seen when only discs and IOPs were recorded (PPV 0.47). When all three tests were given as reasons for suspicion for glaucoma, the PPV was 0.71. The number of patients diagnosed with OAG from Portsea Island during the study period was 7, whereas the expected number of diagnosed patients was 29. CONCLUSION: Wider use of perimetry by optometrists and increased reporting of all three tests has not led to an increase in PPV. There remain a considerable number of undiagnosed patients with glaucoma in the population.

Bilateral radial hemimelia, polydactyly and cardiomegaly in two cats.

CASE DESCRIPTION: Two feline littermates were presented to the Auburn University Small Animal Clinic at the age of approximately 10 weeks. Both cats had varus thoracic limb deformities bilaterally and pelvic limb polydactyly. CLINICAL FINDINGS: Radiographs revealed bilateral radial hypoplasia (hemimelia), generalised cardiomegaly, and pelvic limb polydactyly. TREATMENT AND OUTCOME: No treatment was instituted. Cardiopulmonary changes will be monitored periodically. CLINICAL RELEVANCE: The heritability of radial hemimelia has been suggested, but has yet to be proven. In utero environmental causes (teratogens) are another possible cause of congenital radial hemimelia. The presence of bilateral pelvic limb polydactyly, bilateral radial hemimelia, and generalised cardiomegaly in feline littermates may offer more information on the origins of this orthopaedic disorder and the potential undesirable results that can occur when breeding polydactyl cats or cats affected by radial hemimelia.

The formation of carbon nanostructures by in situ TEM mechanical nanoscale fatigue and fracture of carbon thin films.

A technique to quantify in real time the microstructural changes occurring during mechanical nanoscale fatigue of ultrathin surface coatings has been developed. Cyclic nanoscale loading, with amplitudes less than 100 nm, is achieved with a mechanical probe miniaturized to fit inside a transmission electron microscope (TEM). The TEM tribological probe can be used for nanofriction and nanofatigue testing, with 3D control of the loading direction and simultaneous TEM imaging of the nano-objects. It is demonstrated that fracture of 10-20 nm thick amorphous carbon films on sharp gold asperities, by a single nanoscale shear impact, results in the formation of <10 nm diameter amorphous carbon filaments. Failure of the same carbon films after cyclic nanofatigue, however, results in the formation of carbon nanostructures with a significant degree of graphitic ordering, including a carbon onion.

MRT letter: full-tilt electron tomography with a piezo-actuated rotary drive.

Piezoelectric nanoactuation, which is rapidly becoming established as state-of-the-art positioning control in transmission electron microscopy (TEM), is extended here to include a rotational degree of freedom. A piezoelectric goniometer with both translational and rotary drive action has been designed with high level of miniaturization to fit into a standard TEM specimen holder shaft without compromising any of the performance of the default TEM goniometer and without any modifications to the TEM. Enhanced functionality of such a goniometer-in-goniometer is outlined and experimental results for electron tomography of nanostructures over a full tilt range of views, without any missing angles, are demonstrated.

Nitrous oxide inhalation anaesthesia in the presence of intraocular gas can cause irreversible blindness.

Nitrous oxide inhalation sedation is frequently used in dental and other surgical procedures. We report the case of a patient with intraocular gas who developed sudden elevation in intraocular pressure and blindness as a result of nitrous oxide anaesthesia. All medical and dental personnel administering nitrous oxide inhalation should be aware that this is contraindicated in patients with intraocular gas.

The anatomy demonstrator of the future: an examination of the role of the medically-qualified anatomy demonstrator in the context of tomorrow's doctors and modernizing medical careers.

In 1993, the UK General Medical Council published Tomorrow's Doctors leading to a nationwide restructuring of undergraduate medical courses. Traditional courses with distinct pre-clinical and clinical phases gave way to a more integrated approach to undergraduate medical education, with an emphasis on the quality and variety of teaching provided. More than a decade after Tomorrow's Doctors, postgraduate medical training is being transformed. Modernising Medical Careers is leading to the introduction of a two-year Foundation Programme, with subsequent streamlined specialist training. In the context of these changes, we consider how the creation of posts for medically-qualified anatomy demonstrators would present an opportunity to fulfil needs in both undergraduate education and postgraduate training. We outline the threats facing established posts, and how these problems may be resolved. We hope that this overview of the challenges facing undergraduate and postgraduate education in the UK, with particular reference to anatomy, may offer some useful insight to teachers and learners in other countries. We conclude that the role of the medically-qualified anatomy demonstrator has proved valuable in the context of Tomorrow's Doctors, and that this role can evolve and expand as part of the 21st century "modern medical career."

Operating conditions for ocular surgery under general anaesthesia: an eccentric problem.

PURPOSE: To describe and examine the observation that eccentric eye positions may develop under certain general anaesthetic conditions and negatively impact upon operating conditions during ocular surgery. METHODS: A case series description with historical review followed by a 2-week prospective observational survey examining the general anaesthetic techniques utilized during ocular surgery and the associated development of an eccentric eye position. RESULTS: A total of 52 cases were studied, of which four developed eccentric eye positions. 50% of patients received effective muscle relaxation. Without muscle relaxants, the incidence of eccentric eye positioning was 18%. CONCLUSIONS: Eccentric ocular positions are likely to occur in light planes of general anaesthesia. In the case of ocular surgery, this phenomenon may create surgical difficulty and increase the risk of complication and patient morbidity. Arguments for the planned use of balanced general anaesthesia with non-depolarizing muscle relaxants are presented.

Colostrum induced phenotypic and trafficking changes in maternal mononuclear cells in a peripheral blood leukocyte model for study of leukocyte transfer to the neonatal calf.

The relationship between the colostral environment and the function of leukocytes in colostrum is not clearly defined. This study examined the effects of defatted, acellular colostrum (AC) on the phenotype of peripheral blood mononuclear cells (PBMC) and their capacity to enter the circulation of neonatal calves after ingestion as a model of this relationship. Maternal PBMC were exposed to medium alone or medium supplemented with 25% AC. Expression of CD11a, CD11b, CD11c, CD43, CD49d, CD49e, and CD62L was assessed on freshly isolated and treated PBMC. Exposure to AC increased the percentage of cells expressing CD11a, CD11c and CD43, but decreased the percentage of cells expressing CD62L relative to freshly isolated PBMC. The density of expression of CD11b and CD11c was reduced, but increased for CD43 after exposure to AC relative to freshly isolated PBMC. Density of CD62L expression and percentage of cells expressing CD11a and CD43 were significantly different for cells treated with AC relative to medium alone. Further, these changes could not be attributed to occult bacterial contamination of the AC, as treatment of PBMC with LPS in the same medium yielded none of the observed changes. Maternal PBMC (treated as described) were labeled with the fluorescent tracer, PKH26-GL, and fed to neonatal calves within 6 h of birth. The circulation of these cells in the neonate was monitored by flow cytometry. We observed that: (1) cells exposed to AC, but not medium alone, entered the circulation; (2) peak trafficking occurred 12-24 h after ingestion; (3) a large fraction of labeled cells appeared in the neonatal circulation; and (4) labeled cells disappeared from circulation by 36 h after ingestion. This study indicates that exposure to the colostral environment induced phenotypic changes facilitating trafficking of colostral cells into the neonate.

Neurotrophic keratopathy and diabetes mellitus.

Diabetes mellitus is frequently associated with microvascular complications such as retinopathy, nephropathy, and peripheral neuropathy. Neurotrophic keratopathy occurs in response to a neuropathy of the ophthalmic division of the trigeminal nerve. Rarely has diabetic neurotrophic keratopathy been described. This paper discusses the ophthalmic histories of three patients who presented with diabetic neurotrophic keratopathy. In one patient the corneal ulceration was the sole presenting feature of his diabetes. We discuss the need for increased vigilance in the ophthalmic community for suspecting diabetes in patients with unexplained corneal epithelial disease.

Systematic assessments of need and care planning in severe mental illness: cluster randomised controlled trial.

BACKGROUND: Surveys have shown high levels of unmet need in representative samples of people with severe mental illness. Introducing standardised needs assessment into the care planning process might reduce these needs and improve outcome. AIMS: To determine whether feedback from a standardised assessment of need enhances the effectiveness of care planning and whether exposing care coordinators to feedback on some patients improves their care of other patients. METHOD: A single-blind, cluster randomised trial involving a within-cluster individually randomised arm: patients' needs were evaluated using the Cardinal Needs Schedule and the findings were fed back to their care coordinators under the care programme approach. A total of 304 patients were recruited from 72 care coordinators and 242 patients (79.6%) were reassessed at 12 months. RESULTS: The only significant effect of the intervention was on patient satisfaction. Patients cluster-randomised to receive feedback were more satisfied than controls, but patients individually randomised to receive feedback were not. CONCLUSIONS: Standardised needs assessment did not substantially enhance care planning in this trial. However, giving care coordinators some experience of feedback from a standardised assessment of need could improve satisfaction.

Early Intervention for psychosis.

BACKGROUND: Proponents of early intervention have argued that outcome might be improved if more therapeutic effort were focused on the early stages of schizophrenia. Early intervention in schizophrenia has two elements that are distinct from standard care: early detection and phase-specific treatment. Both elements may be offered in addition to standard care, or may be provided by a specialised early intervention team. Early intervention is now well established as a therapeutic approach in America, Europe and Australasia, but it is unclear how far early detection, phase-specific treatments, and the use of early intervention teams are underpinned by evidence of effectiveness. OBJECTIVES: This review aims to evaluate the effects of: i. early detection and treatment of people with prodromal symptoms; ii. the use of early intervention teams for people in their first episode of psychosis; and iii. phase-specific treatments for people in their first episode of psychosis. SEARCH STRATEGY: We searched CINAHL (1982-2002), The Cochrane Controlled Trials Register (November 2001), The Cochrane Schizophrenia Group Register (July 2003), EMBASE (1980-2002), MEDLINE (1966-2002), PsycINFO (1967-2002), reference lists and contacted the European First Episode Network (2003). SELECTION CRITERIA: Randomised controlled trials designed to prevent progression to psychosis in people showing prodromal symptoms, or improve outcome for people with first episode psychosis. Eligible interventions, alone and in combination, included early detection, phase-specific treatments, and care from specialised early intervention teams. Non-randomised trials would only have been included if they had been studies of the effects of early detection strategies in reducing the duration of untreated psychosis (since this issue cannot be addressed by simple randomisation). DATA COLLECTION AND ANALYSIS: Data were extracted independently by two reviewers and cross-checked. Relative risks (RR) and 95% confidence intervals (CI) were calculated for dichotomous data. Weighted mean differences (WMD) were calculated for continuous data. MAIN RESULTS: In theory, seventeen different comparisons are possible, but the review only identified three studies that met inclusion criteria. One small trial (n=59) was concerned with a phase-specific intervention (low dose risperidone and cognitive behavioural therapy) for people with prodromal symptoms. This group were significantly less likely to develop psychosis at 6 month follow up than people who only received care from a specialised team which did not involve phase-specific treatment (n=59, 1 RCT, RR 0.27 CI 0.08 to 0.89, NNT 4 CI 2 to 20). This effect was not significant at 12 month follow up (n=59, 1 RCT, RR 0.54 CI 0.23 to 1.30). Another trial found that people in their first episode receiving a phase-specific intervention (family therapy) plus out patient care did have reduced admission rates care compared with those who received only outpatient care (n=83, 1 RCT, RR 0.28 CI 0.13 to 0.62, NNT 3 CI 2 to 6). The applicability of this finding was, however, questionable.Finally, one last study (n=76), comparing phase-specific intervention (family therapy) plus specialised team with specialised team for people in their first episode of schizophrenia found no difference between intervention and control groups at 12 months for the outcome of relapse but confidence intervals were wide (n=76, RR 1.06 CI 0.31 to 3.65). REVIEWERS' CONCLUSIONS: We identified insufficient trials to draw any definitive conclusions, although five ongoing trials should report shortly. The substantial international interest in early intervention offers an opportunity to make major positive changes in psychiatric practice, but this opportunity may be missed without a concerted international programme of research to address key unanswered questions.