Giant solitary fibrous tumour: an uncommon approach for an uncommon tumour.

Complete surgical resection of a giant solitary fibrous tumour of the pleura can be challenging. We describe our technique for dealing with one such tumour. A clamshell incision proved inadequate for visualising the extent of the tumour. An additional lower sternotomy incision was then made, which significantly improved exposure. With the aid of cardiopulmonary bypass, it was then possible to mobilise and completely excise the tumour. Complete resection remains the mainstay of treatment for such pleural-based tumours. Every attempt must be made to achieve this, including any modification of the traditional approach if required.

Effect of maturity at harvest for whole-crop barley and oat on dry matter intake, sorting, and digestibility when fed to beef cattle.

The objectives were to evaluate the effect of harvest maturity of whole-crop oat (Study 1) and whole-crop barley (Study 2) on forage intake and sorting, ruminal fermentation, ruminal digestibility, and total tract digestibility when fed to beef heifers. In Study 1, 3 ruminally cannulated heifers (417 ± 5 kg) were used in a 3 × 3 Latin square design with 24-d periods. Whole-crop oat forage harvested at the late milk (LMILK), hard dough (HD), or ripe (RP) stages was fed for ad libitum intake and heifers were supplemented (1% of BW) with alfalfa pellets, barley grain, canola meal, and a mineral and vitamin pellet. Maturity at harvest for whole-crop oat did not affect ( ≥ 0.058) forage intake, DE intake, amount of forage refused, ruminal short-chain fatty acid concentration, or digestibility of DM, OM, NDF, and ADF. Ruminal starch digestibility decreased ( < 0.001) from 92.6% at the LMILK stage to 90.0% at the RP stage, with total tract starch digestibility decreasing ( = 0.043) from 95.8% at the LMILK stage to 94.8% at the RP stage. Ruminal CP digestibility was reduced at the HD stage compared with the LMILK and RP stages ( < 0.001). Mean ruminal pH was greatest for the LMILK stage (6.36; = 0.003) compared with the HD and RP stages (6.30 and 6.28, respectively). In Study 2, 6 ruminally cannulated heifers (273 ± 16 kg) were used in a replicated 3 × 3 Latin square design with 24-d periods. Dietary treatments included ad libitum access to whole-crop barley harvested at the LMILK, HD, or RP stage and a constant rate (0.8% BW) of supplement containing alfalfa pellets, barley grain, canola meal, and a mineral and vitamin pellet. Dry matter intake, ruminal content mass, and feeding behavior were not affected by harvest maturity ( ≥ 0.16). There was a decrease in total tract digestibility of DM, OM, and NDF observed at the HD stage compared with the LMILK and RP stages ( ≤ 0.004). Ruminal NDF digestibility decreased from 69.7% at the LMILK stage to 54.4% at the HD stage and 54.9% at the RP stage ( = 0.001), whereas ruminal ADF digestibility decreased from 70.0% at the LMILK stage to 44.4% at the HD stage and 42.5% at the RP stage ( = 0.002). Minimum and mean ruminal pH were least for the LMILK stage, intermediate at the RP stage, and greatest at the HD stage ( = 0.016 and = 0.031, respectively). These data suggest that despite reductions in ruminal digestibility of NDF and ADF with advancing maturity, harvesting whole-crop oat and barley forage at the HD and RP stages of maturity did not negatively affect DMI, fermentation characteristics, or DE relative to whole-crop cereal forage harvested at the LMILK stage.

Identification of sensory attributes, instrumental and chemical measurements important for consumer acceptability of grilled lamb Longissimus lumborum.

In this study, important eating quality attributes that influence consumer liking for grilled lamb loin have been identified using preference mapping techniques. The eating quality attributes identified as driving the consumer liking of lamb loin steaks were "tenderness", "sweet flavour", "meaty aftertaste", "roast lamb flavour" and "roast lamb aftertaste". In contrast, the texture attribute "rubbery" and the flavour attributes "bitter flavour" and "bitter aftertaste" had a negative influence on consumer perceptions. Associations were observed between eating quality and a number of instrumental and chemical measurements. Warner Bratzler Shear Force showed an association with "rubbery" texture and a negative association with "tenderness" and consumer liking scores. The compounds, glucose, glucose-6-phosphate, inosine, inosine monophosphate and adenosine monophosphate were associated with the attributes, "sweet flavour","meaty aftertaste", "roast lamb flavour", "roast lamb aftertaste" and with consumer scores for liking of lamb which is probably caused by the role some of these compounds play as precursors of flavour and as taste compounds.

Effect of maturity at harvest on yield, chemical composition, and in situ degradability for annual cereals used for swath grazing.

The objective of this study was to determine how harvest maturity of whole-crop cereals commonly used in swath grazing systems in western Canada affects yield, chemical composition, and in situ digestibility. We hypothesized that the increase in yield with advancing maturity would not offset the decline in digestibility and, thus, the yield of effectively degradable DM (EDDM) would decline with advanced stages of maturity. Four replicate plots of barley (Hordeum vulgare L.; cv. CDC Cowboy), millet (Panicum milliaceum; cv. Red Proso), oat (Avena sativa L., spp.; CDC Weaver), and wheat (Triticum aestivum L.; cv. 07FOR21) were grown, with a subsection in each replicate harvested at 4 different maturities: head elongation, late milk, hard dough, and fully mature. At each stage of maturity, the wet and DM yields, and chemical composition (DM, OM, NDF, crude fat, and nonfiber carbohydrates; NFC) were determined. Whole-crop samples were ground (2-mm screen) and weighed into nylon bags (pore size of 53 ± 10 µm), and duplicate incubation runs were conducted by crop type. For each incubation run, nylon bags were randomly allocated (randomized by field replication, stage of maturity, and incubation time) to 1 of 7 heifers (32 bags/heifer during each run). Degradation rates were determined using a first-order kinetic model and data were analyzed with stage of maturity as a fixed effect and plot as a random effect. The DM, OM, and NFC yields increased linearly for barley and oat (P < 0.001), and increased quadratically for millet and wheat (P ≤ 0.025). Neutral detergent fiber yield increased linearly for barley (P = 0.005) and quadratically for millet, oat, and wheat (P = 0.044). There were no changes in CP yield observed for barley, millet, or oat with advancing maturity, but there was a linear increase observed for wheat (P = 0.002). The NFC concentration increased linearly for barley, millet, and oat (P < 0.001), and quadratically for wheat (P < 0.001), whereas the EDDM concentration decreased quadratically for millet, oat, and wheat (P = 0.003). The degradation rate of NDF decreased linearly with advancing maturity (P ≤ 0.014) for millet, oat, and wheat, but was not affected for barley (P = 0.13). The yield EDDM increased linearly for barley and oat (P < 0.001), and increased quadratically for millet and wheat (P ≤ 0.025). These findings suggest that harvesting whole-crop annual cereals at the hard dough and mature stages may maximize the yield of EDDM.

Aspects of training in clinical medical sciences in dentistry (human disease): recent graduates' perspectives from a UK dental school.

Teaching the management of medical emergencies is an important part of most courses in Clinical Medical Sciences in Dentistry (Human Disease). The aim of this study was to examine which medical emergencies graduates from the School of Dental Sciences at Newcastle University had experienced 1 year after qualification and their perceptions of their ability to assess a patient's fitness for treatment or to manage a medical emergency. The study instrument was a computer readable questionnaire. Very few emergencies had been experienced in general practice at this stage of their career, but all respondents either strongly agreed or agreed that their training had adequately equipped them to assess a patient's medical history and deal with medical emergencies. There were, however, aspects of the course that upon reflection that clearly needed to be addressed, including the use of different teachers for aspects of the medical emergency teaching.

Development and preliminary evaluation of a psychosocial intervention for modifying psychosocial risk factors associated with foot re-ulceration in diabetes.

Diabetic foot ulcers are a common, chronic and costly complication of Diabetes, with the greatest risk for ulceration being previous ulceration. Previous approaches to reducing re-ulceration risk have not, however, considered the psychosocial factors which may influence this risk. We reviewed the existing evidence in this area and developed a therapeutic model which informed the content, structure and format of a psychosocial intervention designed to modify the psychosocial risk factors associated with re-ulceration. The intervention was subjected to a qualitative evaluation in a feasibility study which involved a randomised controlled trial in which 10 individuals were randomised to receive the intervention and 5 individuals to usual care. Individuals in both arms participated in in-depth qualitative interviews after the first 10 weeks of the intervention and again after the final maintenance session. The intervention was perceived as acceptable and patients' reported evidence of sustained change in several of the psychosocial risks identified in the therapeutic model. These observations were supported in the descriptive findings obtained from questionnaires measuring mood, cognitions, behaviour and social support. The intervention appears to offer an acceptable and effective way of modifying the psychosocial risk factors associated with re-ulceration.

Does empathy change in first-year dental students?

INTRODUCTION: Professionalism is a central tenet of the dental undergraduate curriculum. Dental undergraduate curricula and standards expect the dentist to put the patient's interests first, and in this respect, an important attitude is empathy. OBJECTIVE: This study examined the self-reported empathy levels of first-year dental students before and after an early analytical exposure to behavioural sciences and the clinical encounter. METHOD: First-year dental undergraduates were given an attitudinal questionnaire to complete before and after the behavioural science course. The questionnaire consisted of the HP version of the Jefferson Scale of Physician Empathy and the Patient-Practitioner Orientation Scale. Paired non-parametric tests and Spearman's Rho correlations, along with simple descriptive statistics, were used to test the statistical significance of observations. RESULTS: A total of 66 paired questionnaires were returned, giving a response rate of 75%. There were no correlations between age and total mean score of JSPE or PPOS, and no gender differences. There was a significant increase (P<0.01) in empathy as measured by the JSPE between pre- and post-course scores. The PPOS did not record any significant change in the sharing, caring or total scale scores pre- to post-course. CONCLUSION: The modified JSPE has potential utility in assessing the cognitive-affective aspect of dental students' empathy. Using the JSPE, short-term measurable empathy changes can be detected in first-year dental undergraduates after the structured and assessed analytical introduction to the clinical encounter and environment.

Mapping of the oat crown rust resistance gene Pc91.

Crown rust is an important disease of oat caused by Puccinia coronata Corda f. sp. avenae Eriks. Crown rust is efficiently and effectively managed through the development of resistant oat varieties. Pc91 is a seedling crown rust resistance gene that is highly effective against the current P. coronata population in North America. The primary objective of this study was to develop DNA markers linked to Pc91 for purposes of marker-assisted selection in oat breeding programs. The Pc91 locus was mapped using a population of F7-derived recombinant inbred lines developed from the cross 'CDC Sol-Fi'/'HiFi' made at the Crop Development Centre, University of Saskatchewan. The population was evaluated for reaction to P. coronata in field nurseries in 2008 and 2009. Pc91 mapped to a linkage group consisting of 44 Diversity Array Technology (DArT) markers. DArTs were successfully converted to sequence characterized amplified region (SCAR) markers. Five robust SCARs were developed from three non-redundant DArTs that co-segregated with Pc91. SCAR markers were developed for different assay systems, such that SCARs are available for agarose gel electrophoresis, capillary electrophoresis, and Taqman single nucleotide polymorphism detection. The SCAR markers accurately postulated the Pc91 status of 23 North American oat breeding lines.

A genome-screen experiment to detect quantitative trait loci affecting resistance to facial eczema disease in sheep.

Facial eczema (FE) is a secondary photosensitization disease arising from liver cirrhosis caused by the mycotoxin sporidesmin. The disease affects sheep, cattle, deer and goats, and costs the New Zealand sheep industry alone an estimated NZ$63M annually. A long-term sustainable solution to this century-old FE problem is to breed for disease-resistant animals by marker-assisted selection. As a step towards finding a diagnostic DNA test for FE sensitivity, we have conducted a genome-scan experiment to screen for quantitative trait loci (QTL) affecting this trait in Romney sheep. Four F(1) sires, obtained from reciprocal matings of FE resistant and susceptible selection-line animals, were used to generate four outcross families. The resulting half-sib progeny were artificially challenged with sporidesmin to phenotype their FE traits measured in terms of their serum levels of liver-specific enzymes, namely gamma-glutamyl transferase and glutamate dehydrogenase. In a primary screen using selective genotyping on extreme progeny of each family, a total of 244 DNA markers uniformly distributed over all 26 ovine autosomes (with an autosomal genome coverage of 79-91%) were tested for linkage to the FE traits. Data were analysed using Haley-Knott regression. The primary screen detected one significant and one suggestive QTL on chromosomes 3 and 8 respectively. Both the significant and suggestive QTL were followed up in a secondary screen where all progeny were genotyped and analysed; the QTL on chromosome 3 was significant in this analysis.

Changes in the provision of post-exposure prophylaxis for HIV after sexual exposure following introduction of guidelines and publicity campaigns.

In July 2004, British Association of Sexual Health and HIV (BASHH) published guidelines for post-exposure prophylaxis following sexual exposure (PEPSE) and the Terence Higgins Trust (THT) launched a campaign promoting PEPSE among men who have sex with men (MSM). We evaluated subsequent changes in PEPSE attendances. Individuals requesting PEPSE in 2004 were identified from clinic databases. Comparisons of clinical data, exposure characteristics and follow-up were made pre and post campaign. Data were available for 197/216 (91%) PEP attendances. The proportion requesting PEP following sexual exposure increased significantly following the campaign. The majority commencing PEPSE were MSM, with the proportion of MSM increasing significantly from 36/46 (78%) pre to 76/80 (95%) following the campaign. Most prescriptions were in high-risk groups and within guidelines. Times to initiation and completion rates were unchanged. Access to PEPSE following the THT campaign and introduction of BASHH guidelines increased. Promotion of earlier initiation of PEPSE and improvement of completion and follow-up is required.

Prediction of in-hospital mortality and length of stay using an early warning scoring system: clinical audit.

This aim of this study was to assess the impact of the introduction of a standardised early warning scoring system (SEWS) on physiological observations and patient outcomes in unselected acute admissions at point of entry to care. A sequential clinical audit was performed on 848 patients admitted to a combined medical and surgical assessment unit during two separate 11-day periods. Physiological parameters (respiratory rate, oxygen saturation, temperature, blood pressure, heart rate, and conscious level), in-hospital mortality, length of stay, transfer to critical care and staff satisfaction were documented. Documentation of these physiological parameters improved (P<0.001-0.005) with the exception of oxygen saturation (P=0.069). The admission early warning score correlated both with in-hospital mortality (P<0.001) and length of stay (P=0.001). Following the introduction of the scoring system, inpatient mortality decreased (P=0.046). Staff responding to a questionnaire indicated that the scoring system increased awareness of illness severity (80%) and prompted earlier interventions (60%). A standardised early warning scoring system improves documentation of physiological parameters, correlates with in-hospital mortality, and helps predict length of stay.

Fine mapping of genes on sheep chromosome 1 and their association with milk traits.

On the basis of comparative mapping between cattle/sheep and human for milk trait quantitative trait loci (QTL) on BTA3/OAR1, annexin A9 (ANXA9) and solute carrier family 27 (fatty acid transporter), member 3 (SLC27A3) were selected as candidate genes for fat content (FC) in sheep milk. Two other genes in the same region, cingulin (CGN) and acid phosphatase 6, lysophosphatidic (ACP6), were also considered. DNA fragments of 1931 and 2790 bp corresponding to ANXA9 and SLC27A3 respectively were isolated, and 14 and 6 single nucleotide polymorphisms (SNPs) respectively were found in each gene. ANXA9, SLC27A3, CGN and ACP6 were localized to chromosome 1 between INRA006 and AE57 by linkage mapping using the International Mapping Flock. Across-family analyses of a daughter design comprising 13 sire families revealed significant sire and SLC27A3 genotype-nested-within-sire effects for FC. Within-family analyses indicated significant regression coefficients for FC in four of six heterozygous sires. These results could reflect the existence of a QTL for FC linked to SLC27A3 in sheep.

PYY3-36 as an anti-obesity drug target.

The neuropeptide Y (NPY)/peptide YY (PYY) system has been implicated in the physiology of obesity for several decades. More recently ignited enormous interest in PYY3-36, an endogenous Y2-receptor agonist, as a promising anti-obesity compound. Despite this interest, there have been remarkably few subsequent reports reproducing or extending the initial findings, while at the same time studies finding no anti-obesity effects have surfaced. Out of 41 different rodent studies conducted (in 16 independent labs worldwide), 33 (83%) were unable to reproduce the reported effects and obtained no change or sometimes increased food intake, despite use of the same experimental conditions (i.e. adaptation protocols, routes of drug administration and doses, rodent strains, diets, drug vendors, light cycles, room temperatures). Among studies by authors in the original study, procedural caveats are reported under which positive effects may be obtained. Currently, data speak against a sustained decrease in food intake, body fat, or body weight gain following PYY3-36 administration and make the previously suggested role of the hypothalamic melanocortin system unlikely as is the existence of PYY deficiency in human obesity. We review the studies that are in the public domain which support or challenge PYY3-36 as a potential anti-obesity target.

Positional and functional characterisation of apoptosis related genes belonging to the BCL2 family in sheep.

Apoptosis is a process whereby cells die in a controlled manner and it is involved in animal development, tissue homeostasis and a variety of diseases. The B-cell lymphoma 2 family proteins are central regulators of intracellular apoptotic signalling cascades. This work describes the isolation of cDNA and genomic fragments from five sheep BCL2 related genes: BCL2, BCL2L1, BCL2L2, BAX and MCL1. Transcript sequences showed a high homology with BCL2 related genes from other species. Three cattle BAC probes containing the homologous BCL2, BCL2L1 and BCL2L2 genes were identified and used for comparative FISH mapping in sheep. BCL2 was localised in OAR23q27, BCL2L1 in OAR13q22 and BCL2L2 in OAR7q15-->q21. Intron polymorphisms were used for linkage mapping of BAX and MCL1, which were mapped on OAR14 and OAR1 respectively. Moreover, a BCL2L1 pseudogene was also identified and linkage mapped on OAR2. The expression of these genes was analysed in mammary gland, ovary, intestine and brain which are target tissues for sheep pathological processes where apoptosis is involved.

Ovine alpha-amylase genes: isolation, linkage mapping and association analysis with milk traits.

On the basis of comparisons between cattle and sheep genome mapping information the ovine alpha-amylase gene was examined as a possible genetic marker for milk traits in sheep. The objective of the present study was to isolate, map and determine whether this gene is a candidate gene for milk traits. DNA fragments (832 and 2360 bp) corresponding to two different AMY genes were isolated, and one SNP in intron 3 and one GTG deletion in exon 3 of the 2360 bp DNA fragment were found. The 2360 bp ovine AMY DNA fragment was located on chromosome 1 by linkage mapping using the International Mapping Flock. No association was found between estimated breeding values for milk yield, protein and fat contents and AMY genotypes in a daughter design comprising 13 Manchega families with an average of 29 daughters (12-62) per sire.

Physiology: does gut hormone PYY3-36 decrease food intake in rodents?

Batterham et al. report that the gut peptide hormone PYY3-36 decreases food intake and body-weight gain in rodents, a discovery that has been heralded as potentially offering a new therapy for obesity. However, we have been unable to replicate their results. Although the reasons for this discrepancy remain undetermined, an effective anti-obesity drug ultimately must produce its effects across a range of situations. The fact that the findings of Batterham et al. cannot easily be replicated calls into question the potential value of an anti-obesity approach that is based on administration of PYY3-36.

Diana Children's Community Service and service co-ordination.

BACKGROUND: The Diana Service and the multi-agency service co-ordination project in Leicester, Leicestershire and Rutland were established to address the needs of children with complex needs. The Mary Seacole Research Centre at De Montfort University in Leicester evaluated the services over a period of approximately 1 year. METHODS: Predominantly qualitative methods were used. Different approaches to sampling were employed and in both cases a range of data collection tools were utilized, e.g. written questionnaires, personal face-to-face interviews, focus group, non-participant observation and information from professional records. RESULTS: The findings suggest that both services are making a considerable contribution towards ensuring that effective collaboration within and between services occurs. This makes a real difference to the lives of children and families.

Bone density in sheep: genetic variation and quantitative trait loci localisation.

Bone density (BD) is an important factor in osteoporotic fracture risk in humans. However, BD is a complex trait confounded by environmental influences and polygenic inheritance. Sheep provide a potentially useful model for studying differences in BD, as they provide a means of circumventing complex environmental factors and are a similar weight to humans. The aims of this study were to establish whether there is genetic variation in BD in sheep and then to localise quantitative trait loci (QTLs) associated with this variation. We also aimed to evaluate the relationship between fat and muscle body components and BD in sheep. Results showed that there was significant (P < 0.01) genetic variation among Coopworth sheep sires for BD. This genetic difference was correlated (P < 0.01) with body weight and muscle mass. A number of QTLs exceeding the suggestive threshold were identified (nine in total). Of these, two (chromosomes 1, P < 0.05; chromosome 24, P < 0.01) were significant using genome-wide permutation significance thresholds (2000 iterations). The position of the QTL on chromosome 24 coincided with a number of other body composition QTLs, indicating possible pleiotropic effects or the presence of multiple genes affecting body composition at that site. This study shows that sheep are potentially a useful model for studying the genetics of BD.

Younger people in dementia care: a review of service needs, service provision and models of good practice.

This paper reviews the literature on younger people (under 65 years of age) with dementia, in dementia care. Seventy-four relevant papers were identified by use of a search strategy derived from the methodology of systematic reviews, the majority of which originated in the UK (69, 93.2%). The need for specialist, flexible, age-appropriate, and dedicated services was a central theme in the literature. A person-centred approach was advocated within an individual or 'tailor made' model of care. However, the available evidence suggests that this model of good practice is not currently reflected in the majority of services provided in the United Kingdom. Overall, the literature argues that the needs of younger people with dementia are best served by inter-agency collaboration, early assessment, and an awareness of individual needs. Clearly, these proposals could usefully serve anybody with dementia, irrespective of age. However, aside from a few prevalence studies, and some exploratory work with small numbers of service users, little in the way of empirical work is available. The recommendations that have been made regarding dementia services for younger people are based largely on the practical experience of professionals and paid carers, rather than scientific evidence.