Dairy cows value an open area for lying down.

As dairy cows are being housed for longer periods, with all-year-round housing growing in popularity, it is important to ensure housed environments are meeting the needs of cows. Dairy cows are motivated to access open lying areas, although previous motivation studies on this topic have confounded surface type and location (i.e. pasture outdoors vs cubicles indoors). This study measured cow motivation for lying down on an indoor open mattress (MAT; 9 m x 5 m) compared to indoor mattress-bedded cubicles, thus removing the confounding factor of surface type and location. This was repeated for an identically sized indoor deep-bedded straw yard (ST), to investigate whether surface type affected motivation for an open lying area. Thirty Holstein-Friesian dairy cows were housed in groups of 5 (n = 5 x 6) in an indoor robotic milking unit with access to six mattress-bedded cubicles. To assess motivation, cows were required to walk increasing distances via a one-way indoor raceway to access the open lying areas: Short (34.5 m), followed by Medium (80.5 m) and Long (126.5 m). Cows could choose to walk the raceway, leading to the MAT or ST, to lie down or they could lie down on the cubicles for 'free'. Overall, cows lay down for longer on the open lying areas at each distance compared to the cubicles, with cows lying down slightly longer on ST than MAT, although lying times on the open lying areas did decrease at the Long distance. However, cows were still lying for >60% of their lying time on the open lying areas at the Long distance. This study demonstrates that cows had a high motivation for an open lying area, the provision of which could better cater for the behavioural needs of housed dairy cows and improve housed dairy cow welfare.

Dairy cow trade-off preference for 2 different lying qualities: Lying surface and lying space.

Lying down is an important behavior for cows, contributing to their health and welfare. With dairy cows being housed for increasingly longer periods, if not year-round, it is important to ensure that dairy cow lying comfort is not compromised when they are housed. The aim of this study was to assess cow preference for 2 different qualities of lying area that appear to be important to cows-surface type and an open lying space-to better understand how to optimize lying comfort for cows when housed. Twenty-four Holstein dairy cows were used during the study, which took place in Scotland from July to November 2018. The study consisted of 6 experimental periods, each lasting a total of 21 d. Cows were tested 4 at a time and individually housed in their own test pen. Each pen had 3 lying surfaces: sand, mattress, and straw (2.4 m × 2.4 m each) with a freestall in the middle of each, which could be removed. Cows were given access to one surface at a time (training period) with a freestall for 2 d, and then given a choice of all 3 surfaces for 2 d. When given the choice with freestalls in position, cows spent, on average, the largest amount of their lying time on straw (46.6 ± 7.8%) followed by mattress (44.3 ± 12.4%). Freestalls were then removed and the training and choice phase was repeated on the following day, with cows, on average, spending the most time lying on straw (64.4 ± 7.2%). Finally, a freestall was refitted onto each cow's most preferred surface and the cows were given a choice between lying on their most preferred surface with a freestall (P1 + freestall) or on their second or third preferred surface without a freestall (P2 + open and P3 + open, respectively) for 3 d. During this final trade-off stage, of the 19 cows for which data were available, 14 cows chose to give up the opportunity to lie down on their most preferred surface to have more space on P2 + open and P3 + open, 3 cows chose to lie down on P1 + freestall, and 2 cows made no clear choice. Overall, cows spent the largest amount of their total lying time on their second most preferred surface as an open lying space (65.7 ± 6.9%) compared with their preferred surface with a freestall (20.5 ± 5.9%) and their third preferred surface as an open lying space (13.8 ± 3.7%). The results indicate that when lying down, these dairy cows value an open lying space more than the lying surface.

Neurocognition and the Suicidal Process.

Early thinking about cognitive process and suicidal behaviors tended to focus on the immediate situation surrounding the individual - typically the underlying psychiatric condition that was seen as leading to his or her distress. However, we now know that the cognitive processes involved in a range of suicidal thoughts and behaviors can exert a significant impact on the expression or development of these behaviors, even without an environmental stressor or psychiatric condition. In this chapter, we summarize theoretical perspectives that led to this realization and explore the current understanding of the link between cognition and suicide from recent research and clinical findings. We present these findings first by psychiatric disorder, then by cognitive domains, and finally by specific suicidal construct in order to highlight the importance of these factors in determining the role of cognition in the suicidal process.Within and across psychiatric disorders, certain cognitive processes - negativistic thinking, impulsivity, cognitive rigidity, and altered emotional processing - are frequently found to be linked to suicidal thoughts and behaviors. Overall cognitive performance, decreased processing speed, executive dysfunction, and negative biases in memory and attention have also been linked to suicidal thoughts and behaviors. However, these findings do not hold true for all populations. There seems to be a role both for cognitive distortions (such as hopelessness) and neurocognitive deficits (such as poor overall cognitive performance, slower processing speed, and executive dysfunction) in the suicidal process, which warrant further exploration both separately and together.

Cows with paratuberculosis (Johne's disease) alter their lying behavior around peak lactation.

Paratuberculosis or Johne's disease (JD) is a fatal chronic enteritis that causes detrimental effects on production and health and significantly reduces the welfare of cattle. Control of JD is highly desirable, but single milk ELISA testing may not be sensitive enough to identify all affected animals, particularly in the early stages of the disease. The objective of this study was to compare the activity of JD-positive (JD5) to JD-negative (JD0) cows from calving until wk 20 of lactation. The study was conducted at Harper Adams University, United Kingdom, using 42 multiparous [3.1 ± 0.22 (mean ± standard error of the mean); range: 2-7 lactations] Holstein Friesian cows, fitted with an IceQube accelerometer (IceRobotics Ltd., Edinburgh, UK) on the back left leg. The sensors recorded data on lying and standing time, steps, and motion index with a granularity of 15 min. In addition, start and stop times for lying bouts, and exact lying bout durations were recorded, which permits calculation of the number of lying bouts. Every 3 mo the cows were milk sampled and subsequently tested for JD using an ELISA. Cows in the infection group JD0 were classed as JD negative and cows in the infection group JD5 were classed as JD positive. Johne's-positive cows [JD5; n = 21 (repeat ELISA positive)] were matched to negative cows [JD0; n = 21 (repeat ELISA negative)] based on lactation number and age. Around peak lactation we found differences in lying behavior. The JD5 cows spend less time lying/d during wk 7 to 11 of lactation. The largest difference observed was around wk 8 of lactation, with JD5 cows spending, on average, 2 h/d less time lying down than JD0 cows (9.3 ± 0.33 vs. 11.3 ± 0.61 h/d, respectively). The JD5 cows also had fewer lying bouts per day from wk 7 to 15 of lactation (excluding wk 13), and during wk 11 and 12 average lying bout duration was longer for JD5 cows compared with JD0 cows. No differences were observed in steps per day, milk yield, BCS, and mobility score between JD5 and JD0 cows from calving to wk 20 of lactation. As far as we are aware, this is the first study to show changes in activity of JD-positive cows. The results show that activity data from leg-mounted accelerometers has the potential to help identify JD-positive cows, although more research is required.

Severe childhood trauma and clinical and neurocognitive features in schizotypal personality disorder.

OBJECTIVE: Literature suggests that childhood trauma increases vulnerability for schizophrenia-spectrum disorders, including schizotypal personality disorder (SPD). Yet, it remains unexplored whether childhood trauma predicts symptom load and the level of neurocognitive functioning in SPD. METHOD: We included 225 individuals with SPD and 127 healthy controls. Childhood trauma was evaluated using the Childhood Trauma Questionnaire, and schizotypal traits were assessed using the Schizotypal Personality Questionnaire. Standard neurocognitive assessments covered six cognitive domains. RESULTS: All types of reported childhood trauma were significantly associated with SPD, in a linear fashion. Severe sexual abuse showed the greatest magnitude of association with higher cognitive-perceptual load (e.g., ideas of reference, odd belief or magical thinking); severe emotional neglect was associated with interpersonal scores (e.g., excessive social anxiety, constricted affect) within the SPD group. SPD individuals who reported severe trauma showed worse cognitive functioning (i.e., working memory, verbal/visual learning and memory, as well as verbal fluency). CONCLUSIONS: Particular severe childhood trauma types were associated with higher cognitive-perceptual and interpersonal symptoms in SPD, along with worse cognitive functioning. These findings highlight the need for clinicians to enquire about childhood trauma in SPD patients, since unaddressed early adverse experiences may carry long-term negative consequences.

Fatty acid profile of milk for determining reproductive status in lactating Holstein Friesian cows.

Large percentages of dairy cows do not express behavioural signs of oestrus. Faecal and urine fatty acid concentrations increase during oestrus. The objective of the present study was to determine the milk FA profile of dairy cows during the oestrous and dioestrous periods and the relationship with behavioural signs on the day of oestrus. The activity of 32 Holstein Friesian cows was measured continuously using GEA Rescounter ll pedometers (GEA Farm Technologies, Düsseldorf, Germany) and IceQubes (IceRobotics Ltd., Edinburgh, UK). Milk samples were collected on the day of oestrus and on day 14 of the subsequent oestrous cycle and analysed for FA concentration using gas chromatography (GC) and milk composition was also determined. All cows were artificially inseminated within 12 h of the onset of oestrus. On the day of oestrus, the concentration of acetic acid (P < 0.001), valeric acid (P = 0.016), caproic acid (P < 0.001) and myristoleic (P = 0.035) were greater in milk compared to day 14. On day 14 milk arachidonic acid concentration, however, was greater (P = 0.004) compared to the day of oestrus. Also, on day 14 arachidonic acid concentration was greater (P = 0.002) in non-pregnant compared to pregnant cows. In conclusion, the results of this study indicate there are changes in the concentrations of some milk FA during oestrus and dioestrus in lactating dairy cows.

Gender differences and similarities in aggression, suicidal behaviour, and psychiatric comorbidity in borderline personality disorder.

OBJECTIVE: We examined gender differences and similarities in aggression, impulsivity, suicidal behaviour, and psychiatric comorbidity in men and women with borderline personality disorder (BPD) compared with healthy controls. METHOD: A community sample of 511 participants (healthy controls: 81 men and 82 women; BPD patients: 145 men and 203 women) were rigorously characterized using structured diagnostic interviews and symptom severity assessments. RESULTS: In comparison with women with BPD, men were less educated, had higher total Barratt Impulsivity Scale (BIS), BIS-motoric impulsiveness and BIS-non-planning impulsiveness subscale, total Buss-Perry Aggression Questionnaire (BPAQ), and BPAQ-physical aggression subscale scores. Men with BPD were more likely to have comorbid narcissistic, antisocial, paranoid, and schizotypal personality disorders, alcohol and substance use disorders but less likely to have dependent and obsessive-compulsive personality disorders compared to women with BPD. There was a trend toward higher maximum lethality of suicide attempts in men suicide attempters compared with women suicide attempters but no difference between men and women with regard to the proportion of suicide attempters or the number of suicide attempts. CONCLUSION: Men with BPD are more impaired and may be at higher risk of dying by suicide compared to women with BPD.

[Outcome of intensive medical care for inflammatory rheumatic diseases]. / Outcome intensivmedizinischer Betreuung bei rheumatischen Erkrankungen.

BACKGROUND AND OBJECTIVE: Very little is known about the outcome of patients with inflammatory rheumatic diseases in intensive care units (ICU). This retrospective study investigated the results of intensive medical treatment in these patients and the reliability of scoring systems used for the prediction of survival. MATERIAL AND METHODS: A case group consisting of 50 patients suffering from inflammatory rheumatic diseases was generated by analysis of patient records from the ICU at the University Hospital for Internal Medicine in Halle (Saale) in the years 2001-2010. The APACHE II score and SAPS II were used to estimate the probable mortality rate. The data were compared to those of a control group consisting of 72 patients treated on the ICU and suffering from non-inflammatory joint diseases. RESULTS: In the case group a higher mortality rate (38 % vs. 20.8 %) and a higher frequency of respiratory, nephrogenic and cardiovascular complications were observed. In addition, these patients more often underwent artificial ventilation (66 % vs. 35 %) and had a higher rate of infections (74 % vs. 40.3 %) compared to the control group. In patients with inflammatory rheumatic diseases the SAPS II was not useful for correctly predicting mortality, whereas the APACHE II score showed sufficient agreement with the actual mortality rate. CONCLUSION: Patients with inflammatory rheumatic diseases displayed a poorer outcome compared with the control group in the course of the intensive care treatment. Universally applied scoring systems used to predict mortality are of limited value in this patient population.

Exploring the social and interpersonal experiences of South Asian women with a diagnosis of Systemic Lupus Erythematosus.

Systemic Lupus Erythematosus (SLE) negatively impacts life quality, disproportionately affecting women and UK ethnic minorities. The study aimed to explore how UK South Asian women with SLE make sense of their social and interpersonal experiences, within the context of their ethnicity and perceived cultural influences. A qualitative design was employed to collect data from a homogenous sample of six South Asian women with SLE. Semi-structured interviews elicited participants' experiences of living with SLE and data were analysed using Interpretative Phenomenological Analysis. Master themes were (1) 'SLE: Complexities and Ironies', (2) 'The Power of SLE', (3) 'A Sense of Personal Responsibility and Accountability', (4) 'Essential Relationships: Qualities and Consequences' and (5) 'Struggling in Public View'. Findings revealed that illness, function and emotion were experienced as interrelated, and psychosocial issues were a powerful feature in SLE illness processes. Body image concerns, difficulties maintaining roles and the perceived views of others, triggered embarrassment and withdrawal, negatively influencing social function and relationships. Interestingly, explicit references to ethnicity and culture were minimal, suggesting that for these women, the key features of experience tended to reflect those of other SLE groups. These findings call for an integrated, biopsychosocial and multidisciplinary approach to health care provision in this area.

Preference and behavior of lactating dairy cows given free access to pasture at two herbage masses and two distances.

A number of factors influence dairy cow preference to be indoors or at pasture. The study reported here investigated whether herbage mass and distance affects preference and if continuously housed cows exhibited behavioral and production differences compared to cows that had free access to pasture. Dairy cows (n = 16) were offered a free choice of being in cubicle housing (1.5 cubicles/cow) or at pasture with a high (3,000 ± 200 kg DM/ha) vs. low (1,800 ± 200 kg DM/ha) herbage mass. A control group (n = 16) was confined to cubicle housing for the duration of the study. Each herbage mass was offered at either a near (38 m) or far (254 m) distance in a 2 × 2 factorial crossover design to determine motivation to access pasture. Overall, dairy cows expressed a partial preference to be at pasture, spending 68.7% of their time at pasture. This was not affected (P > 0.05) by herbage mass. Both grass intake (P = 0.001) and grazing time (P = 0.039) was greater when cows were offered the high herbage mass. Neither total mixed ration intake (P > 0.05) nor milk yield (P > 0.05) was affected by herbage mass or distance. Additionally, no interaction existed between herbage mass and distance (P > 0.05). Distance affected preference: overall time on pasture was greater at the near distance (P = 0.002); however, nighttime use was not affected by distance (P = 0.184). Housed cows produced less milk than free-choice cows and this was potentially due to a combination of decreased lying time in housed cows (P < 0.001) and grass intake (1.22 kg/d) in free-choice cows. This study shows that herbage mass is not a major factor driving dairy cow preference for pasture, but distance does affect preference for pasture during the day. Additionally, there are clear production and welfare benefits for providing cows with a choice to be at pasture or cubicle housing over being continuously housed. Further research is necessary to quantify the effect of lying time on milk yields.

Smart technologies for detecting animal welfare status and delivering health remedies for rangeland systems.

Although the emerging field of precision livestock farming (PLF) is predominantly associated with intensive animal production, there is increasing interest in applying smart technologies in extensive rangeland systems. Precision livestock farming technologies bring the possibility of closely monitoring the behaviour, liveweight and other parameters of individual animals in free-ranging systems. 'Virtual fencing', ideally based on positive reinforcement, i.e. rewarding animals for moving in a specified direction, has the potential to gently guide foraging livestock towards areas of vegetation identified by remote sensing. As well as reducing hunger, this could be integrated with weather forecasting to help ensure that animals are automatically directed to areas with appropriate shelter when adverse weather is forecast. The system could also direct animals towards handling facilities when required, reducing the fear and distress associated with being mustered. The integration of the various data collected by such a 'virtual shepherd' system should be able to rapidly detect disease and injury, and sick animals could then be automatically shepherded to an enclosure for treatment. In general, rangeland livestock already have the freedom to express normal behaviour, but PLF technologies could facilitate this. By bringing levels of monitoring and control normally associated with intensive production to rangeland systems, PLF has the potential, with appropriate adoption, to enhance the capacity of rangeland livestock production systems to meet key areas of welfare concern highlighted by the Five Freedoms.

The motivation of dairy cows for access to pasture.

Several factors influence whether dairy cattle prefer to be indoors or at pasture, including weather conditions and milk yield, but it is unclear how motivated cows are for access to pasture. One way to measure motivation is to require the animal to work (e.g., walk different distances) for access to a resource. This study investigated whether pasture access located 60, 140, or 260m from the indoor housing would affect the proportion of time dairy cows spent at pasture. Thirty-two Holstein-Friesian dairy cows were used during the study, which took place in the United Kingdom from May to July 2010. The experiment consisted of four 18-d experimental periods, with 8 cows in each period, which were further divided into 2 groups of 4 cows. Following a training period, the cows were randomly allocated to distances of 60, 140, or 260m to pasture over three 4-d measurement periods. A video camera was used to record time spent indoors and outdoors 24h/d, and manual behavior observations (0700 to 2200h) took place 6 times during each period to record how the cows spent their time in each location. The video data showed that cows spent, on average, 57.8% (±3.44) of their time outside (either at pasture or on the track). One-sample t-tests revealed that this value was different from 0% (t=16.80), 50% (t=2.26), and 100% (t=-12.28). Analysis of the percentage time spent outside revealed that distance did not influence nighttime pasture use (2100 to 0430h; F2,8=0.16; 81.0% vs. 81.0% vs. 76.7%, for 60m vs. 140m vs. 260m, respectively). In contrast, during the day (0700 to 2100h; from behavior observations), time spent at pasture declined as distance increased; that is, cows spent more time at pasture when they had to walk 60m (F2,80=10.09) than when they had to walk 140 or 260m (45.3% vs. 27.4% vs. 21.2%, respectively). Time spent at pasture decreased on rainy days (y=-1.0672x + 59.646, R(2)=0.09, n=48d), but the indoor temperature-humidity index (THI), the outdoor THI, and body condition score did not influence time spent outside. Under the climatic conditions of the current study in the United Kingdom, cows had a partial preference for pasture, which was influenced by distance to pasture during daytime but not at night. This shows that dairy cows were more motivated to access pasture at night compared with during the day.

N-acetyl-L-cysteine protects against inhaled sulfur mustard poisoning in the large swine.

CONTEXT: Sulfur mustard is a blister agent that can cause death by pulmonary damage. There is currently no effective treatment. N-acetyl-L-cysteine (NAC) has mucolytic and antioxidant actions and is an important pre-cursor of cellular glutathione synthesis. These actions may have potential to reduce mustard-induced lung injury. OBJECTIVE: Evaluate the effect of nebulised NAC as a post-exposure treatment for inhaled sulfur mustard in a large animal model. MATERIALS AND METHODS: Fourteen anesthetized, surgically prepared pigs were exposed to sulfur mustard vapor (100 µg.kg⁻¹), 10 min) and monitored, spontaneously breathing, to 12 h. Control animals had no further intervention (n = 6). Animals in the treatment group were administered multiple inhaled doses of NAC (1 ml of 200 mg.ml⁻¹ Mucomyst™ at + 30 min, 2, 4, 6, 8, and 10 h post-exposure, n = 8). Cardiovascular and respiratory parameters were recorded. Arterial blood was collected for blood gas analysis while blood and bronchoalveolar lavage fluid were collected for hematology and inflammatory cell analysis. Urine was collected to detect a sulfur mustard breakdown product. Lung tissue samples were taken for histopathological and post-experimental analyses. RESULTS: Five of six sulfur mustard-exposed animals survived to 12 h. Arterial blood oxygenation (PaO2) and saturation levels were significantly decreased at 12 h. Arterial blood carbon dioxide (PaCO2) significantly increased, and arterial blood pH and bicarbonate (HCO3⁻) significantly decreased at 12 h. Shunt fraction was significantly increased at 12 h. In the NAC-treated group all animals survived to 12 h (n = 8). There was significantly improved arterial blood oxygen saturation, HCO3⁻ levels, and shunt fraction compared to those of the sulfur mustard controls. There were significantly fewer neutrophils and lower concentrations of protein in lavage compared to sulfur mustard controls. DISCUSSION: NAC's mucolytic and antioxidant properties may be responsible for the beneficial effects seen, improving clinically relevant physiological indices affected by sulfur mustard exposure. CONCLUSION: Beneficial effects of nebulized NAC were apparent following inhaled sulfur mustard exposure. Further therapeutic benefit may result from a combination therapy approach.

Effects of providing total mixed rations indoors and on pasture on the behavior of lactating dairy cattle and their preference to be indoors or on pasture.

Grazing is considered a normal behavior for dairy cattle, although they may not be able to meet their nutritional requirements from grazing alone, and so to sustain higher yields requires access to a total mixed ration (TMR). The study aim was to provide dairy cows with access to TMR indoors and on pasture to establish influence on behavior and preference for each location. The study took place from August to November, 2009, using 36 late-lactation Holstein-Friesian dairy cows. The cows were allocated to 1 of 3 26-d study periods (n=12×3). Within each period the cows were further divided into a control (n=6) or treatment (n=6) group using a crossover design, where the cows were changed between the control and treatment group after 13 d. Treatment cows had access to TMR indoors and on pasture, whereas control cows only had access to TMR indoors. Following a.m. and p.m. milkings the cows were taken to a point equidistant between indoors and pasture and given the choice of going to pasture (1.5 ha) or to a freestall barn. Between milkings the cows had free access between the locations. Initial choice was recorded and a video camera was used to record time spent in each location. Behavior observations were recorded to establish how the cows spent their time during the day. To determine what factors influenced preference, weather conditions, milk yield, body condition score, and lameness were recorded. Initially, the cows chose indoors following milking (96.4±0.80%). Overall, the cows expressed a partial preference for pasture (71.1±1.82%), which was different from 100, 50, and 0%. Study period influenced preference with cows spending less time on pasture as the season progressed (86.7 vs. 68.3 vs. 58.3% for study periods 1, 2, and 3, respectively). Providing the cows with TMR outdoors did not affect pasture use, but resulted in an increase in TMR intake of 2.2±0.41 kg of dry matter/d. The cows spent more time on pasture as the temperature-humidity index indoors (55.6±0.92) and outdoors (54.6±0.82) increased, but rainfall and milk yield did not influence preference. Cows with lameness score >1.5 spent more time indoors (35.4±4.52 vs. 25.2±2.64% for cows with >1.5 vs. ≤1.5 lameness score, respectively). In conclusion, the cows expressed a partial preference for pasture, which was not influenced by providing TMR on pasture.

Exposure-response effects of inhaled sulfur mustard in a large porcine model: a 6-h study.

CONTEXT: Inhalation of sulfur mustard (HD) vapor can cause life-threatening lung injury for which there is no specific treatment. A reproducible, characterized in vivo model is required to investigate novel therapies targeting HD-induced lung injury. MATERIALS AND METHODS: Anesthetized, spontaneously breathing large white pigs (~50 kg) were exposed directly to the lung to HD vapor at 60, 100, or 150 µg/kg, or to air, for ~10 min, and monitored for 6 h. Cardiovascular and respiratory parameters were recorded. Blood and bronchoalveolar lavage fluid (BALF) were collected to allow blood gas analysis, hematology, and to assay for lung inflammatory cells and mediators. Urine was collected and analyzed for HD metabolites. Histopathology samples were taken postmortem (PM). RESULTS: Air-exposed animals maintained normal lung physiology whilst lying supine and spontaneously breathing. There was a statistically significant increase in shunt fraction across all three HD-exposed groups when compared with air controls at 3-6 h post-exposure. Animals were increasingly hypoxemic with respiratory acidosis. The monosulfoxide ß-lyase metabolite of HD (1-methylsulfinyl-2-[2(methylthio)ethylsulfonyl)ethane], MSMTESE), was detected in urine from 2 h post-exposure. Pathological examination revealed necrosis and erosion of the tracheal epithelium in medium and high HD-exposed groups. CONCLUSION: These findings are consistent with those seen in the early stages of acute lung injury (ALI).

Regional anaesthesia for limb surgery: a review of anaesthetists' beliefs and practice in the Oxford region.

We conducted a postal survey of 210 anaesthetists in the Oxford region to determine their views and practice regarding the timing of regional anaesthesia when combined with general anaesthesia for adults undergoing limb surgery and to compare the results with those obtained in a similar survey conducted in 2001. Of the 151 respondents (72% response rate), 102 (68%) regularly combined regional and general anaesthesia for adult limb surgery. Over 80% believed that central neuraxial blocks should be performed before general anaesthesia. This matched their current practice, marking a change from 2001. Significantly fewer anaesthetists believed it necessary to perform peripheral nerve blocks before general anaesthesia than in 2001, marking another significant change in practice. Overall, the results indicate an increased popularity of regional blocks in combination with general anaesthesia when compared with 2001 practice, which we believe is related to high quality advanced training modules now on offer to senior trainees in the Oxford region.

Psoas abscess: diagnosis and treatment.

Psoas abscess is an uncommon presentation on the acute medical take. However recognition and appropriate treatment is essential. This review is designed to highlight the clinical features, microbiology, diagnostic tests and treatment for this condition. In order to illustrate some of the pitfalls and complexities in the management of psoas abscess we have included a case history of a patient who was recently treated in our department.

Use of three-dimensional animation for regional anaesthesia teaching: application to interscalene brachial plexus blockade.

BACKGROUND: Using commercial computer graphics software (TrueSpace), we constructed a virtual-reality model for teaching interscalene brachial plexus block. This tool combines the clarity of schematic drawings and the clinical relevance of video clips and live demonstrations. The aim is to accelerate learning and aid retention of relevant information. METHOD: We made a series of continuous short virtual-reality animations demonstrating the steps to perform an interscalene block. Superficial structures were made transparent to show the anatomical relevance of landmarking and needle manipulation. The clips were presented to delegates at a training course in Oxford. Delegates were surveyed to ascertain whether or not the presentation enhanced their understanding of anatomy and regional block technique. Before and after the presentation, delegates indicated surface landmarking, needle angulation, and movement on photographs of the lateral and anterolateral neck views of two volunteers. The markings were analysed by two independent assessors and rated as 'good', 'bad', or 'ungradeable'. The percentage improvement for each skill group was calculated and McNemar's test applied. RESULTS: Of 24 respondents, the majority thought that the presentation enhanced their understanding of the anatomical (87.5%) and technical principles (79.2%) of interscalene blocks. Analysis of the marked photographs showed an overall 24.1% improvement in landmarking skills after the teaching presentation (P<0.001). Changes were significant in moderately experienced skill groups (P<0.001) but not for the very experienced (P>0.5) and the inexperienced skill groups (P<0.1). There was 76.3% concordance in scoring between the two assessors. CONCLUSION: Three-dimensional animation is a promising new tool to accelerate the learning of regional anaesthetic techniques.

Corroboration of in utero MRI using post-mortem MRI and autopsy in foetuses with CNS abnormalities.

AIMS: To corroborate the findings of in utero magnetic resonance imaging (MRI) with autopsy and post-mortem MRI in cases of known or suspected central nervous system (CNS) abnormalities on ultrasound and to compare the diagnostic accuracy of ante-natal ultrasound and in utero MRI. METHODS: Twelve pregnant women, whose foetuses had suspected central nervous system abnormalities underwent in utero MRI. The foetuses were imaged using MRi before autopsy. The data were used to evaluate the diagnostic accuracy of in utero MRI when compared with a reference standard of autopsy and post-mortem MRI in 10 cases and post-mortem MRI alone in two cases. RESULTS: The diagnostic accuracy of antenatal ultrasound and in utero MRI in correctly characterizing brain and spine abnormalities were 42 and 100%, respectively. CONCLUSION: In utero MRI provides a useful adjuvant to antenatal ultrasound when assessing CNS abnormalities by providing more accurate anatomical information. Post-mortem MRI assists the diagnosis of macroscopic structural abnormalities.