Ethno-Cultural Considerations in Cardiac Patients' Medication Adherence.

We aimed to develop an in-depth understanding about factors that influence cardiac medication adherence among South Asian, Chinese, and European White cardiac patients. Sixty-four patients were purposively sampled from an ongoing study cohort. Interviews were audio-recorded and transcribed for analyses. Physicians' culturally sensitive communication and patients' motivation to live a symptom-free and longer life enhanced adherence. European Whites were motivated to enhance personal well-being and enjoy family life. South Asians' medication adherence was influenced by the desire to fulfill the will of God and family responsibilities. The Chinese were motivated to avoid pain, illness, and death, and to obey a health care provider. The South Asians and Chinese wanted to ultimately reduce medication use. Previous positive experiences, family support, and establishing a routine also influenced medication adherence. Deterrents to adherence were essentially the reverse of the motivators/facilitators. This analysis represents an essential first step forward in developing ethno-culturally tailored interventions to optimize adherence.

Locomotion dynamics of hunting in wild cheetahs.

Although the cheetah is recognised as the fastest land animal, little is known about other aspects of its notable athleticism, particularly when hunting in the wild. Here we describe and use a new tracking collar of our own design, containing a combination of Global Positioning System (GPS) and inertial measurement units, to capture the locomotor dynamics and outcome of 367 predominantly hunting runs of five wild cheetahs in Botswana. A remarkable top speed of 25.9 m s(-1) (58 m.p.h. or 93 km h(-1)) was recorded, but most cheetah hunts involved only moderate speeds. We recorded some of the highest measured values for lateral and forward acceleration, deceleration and body-mass-specific power for any terrestrial mammal. To our knowledge, this is the first detailed locomotor information on the hunting dynamics of a large cursorial predator in its natural habitat.

Avian maternal response to chick distress.

The extent to which an animal is affected by the pain or distress of a conspecific will depend on its capacity for empathy. Empathy most probably evolved to facilitate parental care, so the current study assessed whether birds responded to an aversive stimulus directed at their chicks. Domestic hens were exposed to two replicates of the following conditions in a counterbalanced order: control (C; hen and chicks undisturbed), air puff to chicks (APC; air puff directed at chicks at 30 s intervals), air puff to hen (APH; air puff directed at hen at 30 s intervals) and control with noise (CN; noise of air puff at 30 s intervals). During each test, the hens' behaviour and physiology were measured throughout a 10 min pre-treatment and a 10 min treatment period. Hens responded to APH and APC treatments with increased alertness, decreased preening behaviour and a reduction in eye temperature. No such changes occurred during any control period. Increased heart rate and maternal vocalization occurred exclusively during the APC treatment, even though chicks produced few distress vocalizations. The pronounced and specific reaction observed indicates that adult female birds possess at least one of the essential underpinning attributes of empathy.

The impact of chronic environmental stressors on growing pigs, Sus scrofa (Part 1): stress physiology, production and play behaviour.

Commercially farmed animals are frequently housed in conditions that impose a number of concurrent environmental stressors. For pigs housed indoors, elevated levels of mechanical noise, atmospheric ammonia and low light intensities are commonplace. This experiment examined the effects on growing pigs of chronic exposure to combinations of commercially relevant levels of these potential stressors. Four-week-old hybrid female pigs (n = 224) were housed under experimentally manipulated conditions of nominally either <5 or 20 ppm atmospheric concentration of ammonia (24 h), a light intensity of 40 lux or 200 lux (12 h) and mechanical noise at either ⩽60 or 80 dB(A) (24 h) for 15 weeks in a fully factorial arrangement (23) of treatments. The response of pigs to these environmental factors was assessed using a suite of physiological, production and behavioural measures. These included indicators of hypothalamic-pituitary-adrenal (HPA) axis activation such as salivary cortisol and adrenal morphometry, as well as body weight, food conversion efficiency and general health scores. Play behaviour was recorded as it is thought to be inversely related to stress. Chronic exposure to ammonia produced the strongest effect, shown by lower concentrations of salivary cortisol and larger adrenal cortices in the pigs reared under 20 ppm ammonia, which may have been indicative of a period of HPA activation leading to a downregulation of cortisol production. The pigs in the ammoniated rooms also performed less play behaviour than pigs in non-ammoniated rooms. There was evidence for an interaction between high noise and ammonia on the health scores of pigs and for brighter light to ameliorate the effect of ammonia on salivary cortisol. However, there was no measurable impact of these potential stressors on the productivity of the pigs or any of the other physiological parameters measured. We conclude that there should be little concern in terms of performance about the physical stressors tested here, within current European Union legal limits. However, 20 ppm ammonia may have had an adverse influence on the well-being of growing pigs. In this study, all other aspects of the pigs' husbandry were optimal; therefore, it is possible that under less favourable conditions, more pronounced effects of ammonia, noise and dim light would be observed.

The impact of chronic environmental stressors on growing pigs, Sus scrofa (Part 2): social behaviour.

The effects of common and concurrent environmental stressors on the social behaviour of farm animals are poorly understood. Here, we report the results of a multifactorial experiment designed specifically to examine the individual, additive or interactive effects of elevated ammonia, noise and low light (LL) levels on the social behaviour of growing pigs. Social behaviour was measured in terms of the nature, frequency and duration of both initiated and response behaviours for 4 weeks following mixing of the groups. General activity patterns, group cohesion and social discrimination were also examined as a function of the environmental treatments. Elevated concentrations of atmospheric ammonia (∼20 v. <5 ppm) and LL intensity (∼40 v. 200 lux) had the most pronounced effects, particularly on the nature of social interactions, with pigs under these conditions showing more aggression in the early stages of the experiment. In addition, pigs exposed to a high level of mechanical noise representative of artificial ventilation (∼80 v. 40 dB [A]) were less submissive to aggressive acts, while pigs in ∼20 ppm ammonia showed more reciprocated aggression when in coincident LL (<40 lux). The results indicate that atmospheric ammonia at commonly experienced concentrations may undermine social stability, particularly in the presence of low lighting, though the mechanisms are currently unknown. These findings have implications for the welfare of growing pigs and hence policy makers and farmers alike, with respect to the improvement of welfare in intensive pig farming.

Remote monitoring of electroencephalogram, electrocardiogram, and behavior during controlled atmosphere stunning in broilers: implications for welfare.

This study examined the welfare implications of euthanizing broilers with 3 gas mixtures relevant to the commercial application of controlled atmosphere stunning (CAS). Birds were implanted/equipped with electrodes to measure brain activity (electroencephalogram, EEG) and heart rate. These signals were recorded using a purpose-built telemetry-logging system, small enough to be worn by each bird in a spandex backpack. The birds were euthanized in a scaled-down CAS apparatus consisting of a conveyor belt passing through 2 compartments. Three gas environments were applied (8 birds per treatment): 1) anoxia (N(2) with <2% residual O(2), in both compartments), 2) hypercapnic anoxia (N(2) with 30% CO(2) and <2% residual O(2), in both compartments), and 3) a 2-phase approach with a hypercapnic hyperoxygenated anesthetic phase (40% CO(2), 30% O(2), and 30% N(2), in the first compartment, 80 s) followed by a second euthanasia phase (80% CO(2) in air, in the second compartment). All 3 CAS approaches effectively achieved nonrecovery states, and time to loss of consciousness for each bird was determined by visual determination of isoelectric EEG and by calculation of the correlation dimension of the EEG. Hypercapnic anoxia resulted in rapid unconsciousness and death; both anoxic treatments were associated with early onset prolonged wing flapping and sustained tonic convulsions as displayed in the electrophysiological recordings. These responses were seen in the period when consciousness remained a possibility. Hypercapnic hyperoxygenation (the 2-phase approach) was associated with respiratory disruption, but this treatment eliminated initial clonic convulsions in the stunning process, and tonic convulsions were not seen. These results suggest that the presence of O(2) in the first stage of CAS is associated with an absence of potentially distressing behavioral responses. The respiratory discomfort associated with hypercapnic hyperoxygenation is an issue. We propose that this may be compensated by a more gradual induction to unconsciousness, which eliminates the impact of other potentially negative experiences.

A survey of stress levels, self-perceived health and health-related behaviours of UK dental practitioners in 2005.

OBJECTIVE: To record stress levels and self-perceived health and health-related behaviours of dentists. DESIGN AND METHOD: A questionnaire was sent to a random sample of 1,000 BDA members in April 2005. Respondents were questioned about self-perceived general health, medicine and drug use, tobacco and alcohol use, self-perceived general well-being, sexual health, occupational health, physical activity and nutrition. There were also some questions about women's health. Results were compared to a BDA study of dental professionals' health and well-being carried out in 1996. RESULTS: A response rate of 55% was achieved (545 replies). Two-thirds (67%) of respondents considered themselves in very good or excellent health and 53% were happy and interested in life. Only 42% were free from pain and discomfort and 26% experienced levels of pain that prevented them from taking part in a few or some activities. The majority (86%) had very or fairly stressful lives but most (83%) were either very or somewhat satisfied with their lives. Nearly all respondents (90%) planned to take action to improve their health during the 12 months following the survey: popular actions planned included increasing exercise (58%) and losing weight (42%). Very few respondents used tobacco (4% daily and 4% occasionally) and most (59%) said that only a few of their friends smoked: 36% had no tobacco-using friends. Only 3% of respondents had never had alcohol. The Short Michigan alcohol screening test revealed that 6% of dentists had a drink problem and 9% had alcoholic tendencies. The most common factors contributing to stress at work were patient demands (75%), practice management/staff issues (56%), fear of complaints/litigation (54%) and non-clinical paperwork (54%). More than half (53%) of respondents were relatively inactive during the day but 57% took some form of physical exercise at least 3-4 times per week. Nearly half (49%) of respondents felt that their level of physical activity was very likely or somewhat likely to cause them health problems. CONCLUSION: In spite of the dramatic recent changes to dentistry, the differences between the results of this study and the results of the research carried out in 1996 are minimal. Claims that dentistry is a dangerously stressful occupation are not justified and dentists seem to be as well and happy as other professional groups. There is however, a slight increase in the use of alcohol. Stress management and personal and professional awareness training should be included in the undergraduate curriculum, so that threats to physical and mental well-being which might occur during a dentist's professional life may be avoided or addressed.

Shirley Glasstone Hughes Memorial Prize for Dental Research: an evaluation of the output 15 years after the Trust's inception.

In May 2005, a decision was taken by the Shirley Glasstone Hughes (SGH) Foundation trustees to suspend investments in research for one year, to allow a review of the outcomes of SGH research funding over the past 15 years. Money was instead directed to the BDA Research Unit, to employ a staff member who would conduct the evaluation under the supervision of the BDA Scientific Adviser. The evaluation focused on three aspects of the research produced: 1) relevance to primary dental care, 2) scientific quality and impact on the research community, and 3) grant recipients' feelings about SGH funding and whether the mechanisms of supporting research could be improved. The methods used included questioning BDA members about the research they found of interest and relevance, checking research outputs against standardised quality criteria, examining impact factors and citation rates (relative to the funding received) and questioning grant recipients about their experience with SGH funding. The results implied that the fund had largely been spent on research themes felt to be relevant to practice by BDA members. In addition, the publication rate, publication quality, impact and citation indices demonstrated the SGH research work to be largely of high quality. Recipients of the fund indicated several factors which might improve the experience of receiving funding and possibly also improve the research output. It can be concluded that the SGH funds have largely been well spent but that it is worth considering implementing changes which would make the research findings of greater relevance to clinical practice.

Controlled atmosphere stunning of broiler chickens. I. Effects on behaviour, physiology and meat quality in a pilot scale system at a processing plant.

1. The effects of controlled atmosphere stunning on the behaviour, physiology and carcase and meat quality of broiler chickens were studied experimentally in a pilot scale plant. 2. Gas mixtures tested were: single phase anoxic mixture (90% Ar in air, <2% O(2)); single phase hypercapnic anoxic mixture (60% Ar, 30% CO(2) in air, <2% O(2)); and biphasic hypercapnic hyperoxygenation mixture (anaesthetic phase, 40% CO(2), 30% O(2), 30% N(2); euthanasia phase, 80% CO(2), 5% O(2), 15% N(2)). 3. Anoxic stunning resulted in the least respiratory disruption, mandibulation and motionlessness, but most head shaking, leg paddling and twitching. Loss of posture occurred soonest with hypercapnic anoxia with the earliest and most twitching and wing flapping in individuals and earliest leg paddling. Biphasic birds were most alert, exhibited most respiratory disruption and mandibulation, and had the latest loss of posture and fewest, but longest bouts of wing flapping and least leg paddling and twitching. 4. Significant and sudden bradycardia and arrhythmia were evident with all gas mixtures and were not related solely to anoxia or hypercapnia. Birds stunned by Ar anoxia showed a slightly more gradual decline from baseline rates, compared with hypercapnic mixtures. 5. Few differences were found between gas mixes in terms of carcase and meat quality. Initial bleeding rate was slowest in biphasic-stunned birds, but total blood loss was not affected. Acceleration of post-mortem metabolism in anoxic-stunned birds was not sufficient to allow de-boning within 5 h without the risk of tough meat. 6. On welfare grounds and taking into account other laboratory and field studies, a biphasic method (using consecutive phases of anaesthesia and euthanasia) of controlled atmosphere stunning of broilers is potentially more humane than anoxic or hypercapnic anoxic methods using argon or nitrogen.

Controlled atmosphere stunning of broiler chickens. II. Effects on behaviour, physiology and meat quality in a commercial processing plant.

1. The effects of controlled atmosphere stunning on behavioural and physiological responses, and carcase and meat quality of broiler chickens were studied experimentally in a full scale processing plant. 2. The gas mixtures tested were a single phase hypercapnic anoxic mixture of 60% Ar and 30% CO(2) in air with <2% O(2), and a biphasic hypercapnic hyperoxygenation mixture, comprising an anaesthetic phase, 40% CO(2), 30% O(2), 30% N(2), followed by an euthanasia phase, 80% CO(2), 5% O(2), 15% N(2). 3. Birds stunned with Ar + CO(2) were more often observed to flap their wings earlier, jump, paddle their legs, twitch and lie dorsally (rather than ventrally) than those stunned with CO(2) + O(2). These behaviours indicate a more agitated response with more severe convulsions during hypercapnic anoxia, thereby introducing greater potential for injury. 4. Heart rate during the first 100 s of gas stunning was similar for both gases, after which it remained constant at approximately 230 beats/min for CO(2) + O(2) birds whereas it declined gently for Ar + CO(2) birds. 5. In terms of carcase and meat quality, there appeared to be clear advantages to the processor in using CO(2) + O(2) rather than Ar + CO(2) to stun broiler chickens, for example, a much smaller number of fractured wings (1.6 vs. 6.8%) with fewer haemorrhages of the fillet. 6. This study supports the conclusions of both laboratory and pilot scale experiments that controlled atmosphere stunning of broiler chickens based upon a biphasic hypercapnic hyperoxygenation approach has advantages, in terms of welfare and carcase and meat quality, over a single phase hypercapnic anoxic approach employing 60% Ar and 30% CO(2) in air with <2% O(2).

Tobacco cessation activities of UK dentists in primary care: signs of improvement.

OBJECTIVE: To investigate attitudes and opinions of the members of the British Dental Association towards implementing tobacco cessation strategies in dental practices. DESIGN AND METHOD: Questions about tobacco and tobacco cessation were asked on the September 2002 BDA Omnibus survey. The survey was sent out to a random sample of 1,500 BDA members, excluding retired members, overseas members and students. After two reminder circulations, 870 completed questionnaires were received, giving a response rate of 58%. RESULTS: The survey results revealed good awareness amongst respondents of the health risks of tobacco. One fifth of respondents said that patients had asked them for advice on tobacco cessation. The majority (64%) of respondents stated that they gave advice on tobacco cessation 'fairly regularly' or 'always' (whether asked or not) and 37% of respondents recommended over-the-counter nicotine replacement therapy. Overall, 68% of respondents agreed that offering patients advice about tobacco cessation was the duty of every dentist. The most common barriers to a successful tobacco cessation campaign were perceived to be the amount of time required, lack of reimbursement, lack of training, lack of patient education materials and lack of knowledge of available referral resources. Nearly all respondents (92%) said that their practice was a completely smoke-free environment, and 66% of respondents had never used tobacco. The majority of respondents displayed patient education materials in their practice waiting/reception areas less than 60% of the time, and nearly a quarter (23%) never had them available. The survey revealed that most respondents did not feel particularly well prepared to assist patients in quitting tobacco, but 70% of respondents said they would be willing to cooperate with a campaign to inform all tobacco using patients about the advantages of tobacco cessation. Respondents felt that leaflets for patients, staff training and posters in the practice would contribute to the success of the campaign. CONCLUSION: Members of the dental team are very willing to implement tobacco cessation strategies in the dental practice. Most dentists feel that promotion of tobacco cessation is an important part of the duty of a dentist, but they feel inadequately prepared to deliver such advice. The major barriers to delivering successful tobacco cessation campaigns are the amount of time required, lack of reimbursement, lack of training, lack of patient education materials and lack of knowledge of available referral resources. The majority of dentists have received no training in tobacco cessation strategies. They feel that staff training and free availability of more patient education materials (leaflets, posters, etc) would help promote the success of such a campaign.

Mutations in the c-erbA beta 1 gene: do they underlie euthyroid fibromyalgia?

Fibromyalgia, a chronic condition of widespread pain, stiffness, and fatigue, has proven unresponsive to drugs, the use of which is based on the 'serotonin-deficiency hypothesis'. An alternative hypothesis-failed transcription regulation by thyroid hormone-can explain the serotonin deficiency and other objective findings and symptoms of euthyroid fibromyalgia. Virtually every feature of fibromyalgia corresponds to signs or symptoms associated with failed transcription regulation by thyroid hormone. In hypothyroid fibromyalgia, failed transcription regulation would result from thyroid-hormone deficiency. In euthyroid fibromyalgia, failed transcription regulation may result from low-affinity thyroid hormone receptors coded by a mutated c-erbA beta 1 gene, yielding partial peripheral resistance to thyroid hormone. The hypothesis of this paper is that, in euthyroid fibromyalgia, a mutant c-erbA beta 1 gene (or alternately, the c-erbA alpha 1 gene) results in low-affinity thyroid-hormone receptors that prevent normal thyroid hormone regulation of transcription. As in hypothyroidism, this would cause a shift toward alpha-adrenergic dominance and increases in both cyclic adenosine 3'-5'-phosphate phosphodiesterase and inhibitory Gi proteins. The result would be tissue-specific hypothyroid-like symptoms despite normal circulating thyroid-hormone levels.

Evaluation of a rheumatoid arthritis patient education program: impact on knowledge and self-efficacy.

We have evaluated the effects of an education program on the knowledge and self-efficacy of 51 rheumatoid arthritis patients, using two previously validated questionnaires. At completion of the program, both knowledge and self-efficacy were significantly improved and this was maintained at follow-up. However, there was no correlation between knowledge and self-efficacy at baseline and follow-up, suggesting that these variables improved independently of each other. We conclude that education programs are a worthwhile means of improving the non-medical causes of morbidity in rheumatoid arthritis patients and that the two instruments utilized are a valuable means of both demonstrating effectiveness and quality assurance.

Papillary cystadenocarcinoma of the bile ducts resulting in hemobilia.

Cystadenocarcinoma is a rare tumor of the intrahepatic and a very rare tumor of the extrahepatic biliary system. In the reported cases, abdominal swelling is the most common presenting symptom, followed by right upper quadrant mass. Melena was the initial presenting symptom in the present case. Bleeding into the second part of the duodenum was observed only during the third diagnostic esophagogastroduodenoscopy. Hemobilia was suspected because of abnormal liver enzymes and a mass in the left lobe of the liver on computerized tomography. At laparotomy, we suspected that the mass was a hemangioma. Cystadenocarcinoma diagnosis was made only by histopathological examination.