Non-dispensing pharmacists integrated into general practices as a new interprofessional model: a qualitative evaluation of general practitioners' experiences and views.

BACKGROUND: A new interprofessional model incorporating non-dispensing pharmacists in general practice teams can improve the quality of pharmaceutical care. However, results of the model are dependent on the context. Understanding when, why and how the model works may increase chances of successful broader implementation in other general practices. Earlier theories suggested that the results of the model are achieved by bringing pharmacotherapeutic knowledge into general practices. This mechanism may not be enough for successful implementation of the model. We wanted to understand better how establishing new interprofessional models in existing healthcare organisations takes place. METHODS: An interview study, with a realist informed evaluation was conducted. This qualitative study was part of the Pharmacotherapy Optimisation through Integration of a Non-dispensing pharmacist in primary care Teams (POINT) project. We invited the general practitioners of the 9 general practices who (had) worked closely with a non-dispensing pharmacist for an interview. Interview data were analysed through discussions about the coding with the research team where themes were developed over time. RESULTS: We interviewed 2 general practitioners in each general practice (18 interviews in total). In a context where general practitioners acknowledge the need for improvement and are willing to work with a non-dispensing pharmacist as a new team member, the following mechanisms are triggered. Non-dispensing pharmacists add new knowledge to current general practice. Through everyday talk (discursive actions) both general practitioners and non-dispensing pharmacists evolve in what they consider appropriate, legitimate and imaginable in their work situations. They align their professional identities. CONCLUSIONS: Not only the addition of new knowledge of non-dispensing pharmacist to the general practice team is crucial for the success of this interprofessional healthcare model, but also alignment of the general practitioners' and non-dispensing pharmacists' professional identities. This is essentially different from traditional pharmaceutical care models, in which pharmacists and GPs work in separate organisations. To induce the process of identity alignment, general practitioners need to acknowledge the need to improve the quality of pharmaceutical care interprofessionally. By acknowledging the aspect of interprofessionality, both general practitioners and non-dispensing pharmacists will explore and reflect on what they consider appropriate, legitimate and imaginable in carrying out their professional roles. TRIAL REGISTRATION: The POINT project was pre-registered in The Netherlands National Trial Register, with Trial registration number NTR-4389.

Neutrophil and Eosinophil Responses Remain Abnormal for Several Months in Primary Care Patients With COVID-19 Disease.

Introduction: Neutrophil and eosinophil activation and its relation to disease severity has been understudied in primary care patients with COVID-19. In this study, we investigated whether the neutrophil and eosinophil compartment were affected in primary care patients with COVID-19. Methods: COVID-19 patients, aged ≥ 40 years with cardiovascular comorbidity presenting to the general practitioner with substantial symptoms, partaking in the COVIDSat@Home study between January and April 2021, were included. Blood was drawn during and 3 to 6 months after active COVID-19 disease and analyzed by automated flow cytometry, before and after stimulation with a formyl-peptide (fNLF). Mature neutrophil and eosinophil markers at both time points were compared to healthy controls. A questionnaire was conducted on disease symptoms during and 3 to 6 months after COVID-19 disease. Results: The blood of 18 COVID-19 patients and 34 healthy controls was analyzed. During active COVID-19 disease, neutrophils showed reduced CD10 (p = 0.0360), increased CD11b (p = 0.0002) and decreased CD62L expression (p < 0.0001) compared to healthy controls. During active COVID-19 disease, fNLF stimulated neutrophils showed decreased CD10 levels (p < 0.0001). Three to six months after COVID-19 disease, unstimulated neutrophils showed lowered CD62L expression (p = 0.0003) and stimulated neutrophils had decreased CD10 expression (p = 0.0483) compared to healthy controls. Both (un)stimulated CD10 levels increased 3 to 6 months after active disease (p = 0.0120 and p < 0.0001, respectively) compared to during active disease. Eosinophil blood counts were reduced during active COVID-19 disease and increased 3 to 6 months after infection (p < 0.0001). During active COVID-19, eosinophils showed increased unstimulated CD11b (p = 0.0139) and decreased (un)stimulated CD62L expression (p = 0.0036 and p = 0.0156, respectively) compared to healthy controls. Three to six months after COVID-19 disease, (un)stimulated eosinophil CD62L expression was decreased (p = 0.0148 and p = 0.0063, respectively) and the percentage of CD11bbright cells was increased (p = 0.0083 and p = 0.0307, respectively) compared to healthy controls. Conclusion: Automated flow cytometry analysis reveals specific mature neutrophil and eosinophil activation patterns in primary care patients with COVID-19 disease, during and 3 to 6 months after active disease. This suggests that the neutrophil and eosinophil compartment are long-term affected by COVID-19 in primary care patients. This indicates that these compartments may be involved in the pathogenesis of long COVID.

[Involvement of patients in The Compulsory Mental Health-care Act according to health care professionals]. / Behandelaars over inspraak van patiënten en naasten met Wvggz.

BACKGROUND: In January 2020 the Compulsory Mental Healthcare Act (Dutch: Wvggz) was implemented. The Wvggz details the rights of patients with mental illness who require compulsory care. The law aims, amongst others, to improve the legal rights of patients and those close to them, for example by enabling the possibility to draw up their own action plan (AP) or care card. AIM: To explore what health care professionals think of the possibilities for involvement by patients and those close to them, enabled by the Wvggz. METHOD: A qualitative study in which health care professionals were interviewed about the possibilities for involvement by patients and those close to them. We used thematic analysis to study the data from the interviews. RESULTS: Health care professionals were positive about the idea to involve patients and those close to them, though they indicated that patients and those close to them were already involved before the law came into effect. The main difference was that their involvement was more documented, for instance patients can write their own AP or fill out a care card. Health care professionals mentioned that both the AP and the care card offer the possibility for patients and those close to them to express and realize their wishes. On the downside, not all patient groups were able to draw up their own plan of action. Furthermore, according to the health care professionals, both the action plan and care card could give patients the false impression that their wishes can always be acknowledged. CONCLUSION: Health care professionals mention that patients and those close to them were already involved before the law came into effect. However, the ways in which their involvement is arranged and documented are different.

Effects of non-dispensing pharmacists integrated in general practice on medication-related hospitalisations.

AIMS: To evaluate the effect of non-dispensing pharmacists (NDPs) integrated in general practice on medication-related hospitalisations, drug burden index and costs in patients at high risk of medication problems (being 65 years or older and using 5 or more chronic medications). METHODS: This was a multicentre, nonrandomised, controlled intervention study with pre-post comparison (2013 vs June 2014 to May 2015) in 25 general practices in the Netherlands, comparing NDP-led care (intervention) with 2 current pharmaceutical care models (usual care and usual care plus). In the intervention group, 10 specially trained NDPs were employed in general practices to take integral responsibility for the pharmaceutical care. They provided a broad range of medication therapy management services both on patient level (e.g. clinical medication review) and practice level (e.g. quality improvement projects). In the control groups, pharmaceutical care was provided as usual by general practitioners and community pharmacists, or as usual plus, when pharmacists were additionally trained in performing medication reviews. RESULTS: Overall, 822 medication-related hospitalisations were identified among 11 281 high-risk patients during the intervention period. After adjustment for clustering and potential confounders, the rate ratio of medication-related hospitalisations in the intervention group compared to usual care was 0.68 (95% confidence interval: 0.57-0.82) and 1.05 (95% confidence interval: 0.73-1.52) compared to usual care plus. No differences in drug burden index or costs were found. CONCLUSIONS: In general practices with an integrated NDP, the rate of medication-related hospitalisations is lower compared to usual care. No differences with usual care plus were found.

Exposure and ecotoxicological risk assessment of mixtures of top prescribed pharmaceuticals in Swedish freshwaters.

Surface water concentrations of 54 pharmaceuticals were predicted for seven major Swedish rivers and the Stockholm City area basins using the STREAM-EU model. These surface water concentrations were used to predict the ecotoxicological impact resulting from the exposure of aquatic organisms to this mixture of 54 pharmaceuticals. STREAM-EU model results indicated that <10 substances were present at median annual water concentrations greater than 10 ng/L with highest concentrations occurring mostly in the more densely populated area of the capital city, Stockholm. There was considerable spatial and temporal variability in the model predictions (1-3 orders of magnitude) due to natural variability (e.g. hydrology, temperature), variations in emissions and uncertainty sources. Local mixture ecotoxicological pressures based on acute EC50 data as well as on chronic NOEC data, expressed as multi-substance potentially affected fraction of species (msPAF), were quantified in 114 separate locations in the waterbodies. It was estimated that 5% of the exposed aquatic species would experience exposure at or above their acute EC50 concentrations (so-called acute hazardous concentration for 5% of species, or aHC5) at only 7% of the locations analyzed (8 out of 114 locations). For the evaluation based on chronic NOEC concentrations, the chronic HC5 (cHC5) is exceeded at 27% of the locations. The acute mixture toxic pressure was estimated to be predominantly caused by only three substances in all waterbodies: Furosemide, Tramadol and Ibuprofen. A similar evaluation of chronic toxic pressure evaluation logically demonstrates that more substances play a significant role in causing a higher chronic toxic pressure at more sites as compared to the acute toxic pressure evaluation. In addition to the three substances contributing most to acute effects, the chronic effects are predominantly caused by another five substances: paracetamol, diclofenac, ethinylestradiol, erythromycin and ciprofloxacin. This study provides regulatory authorities and companies responsible for water quality valuable information for targeting remediation measures and monitoring on a substance and location basis.

[Triage in primary care: overkill?]. / Triage in de huisartsenpraktijk: te zwaar geschut?

Based on triage during out-of-hours emergency services with physical contact with patients, the Dutch Triage Standard - a telephone triage algorithm - has been developed for use in primary care out-of-hours services. However, it is also used in the daytime setting. We argue that this tool should be evaluated by actually evaluating the telephone contacts that are backed up during triage and using the final diagnoses of these contacts as the reference standard. We have serious doubts whether the Dutch Triage Standard is an effective tool in the primary care daytime setting with its very low prevalence of high urgency. Adequate triage is time consuming, and may result in reduced accessibility thus creating critical situations. Well-evaluated pilots should precede large-scale implementation of decision support systems.

How to calculate the spatial distribution of ecosystem services--natural attenuation as example from The Netherlands.

Maps play an important role during the entire process of spatial planning and bring ecosystem services to the attention of stakeholders' negotiation more easily. As example we show the quantification of the ecosystem service 'natural attenuation of pollutants', which is a service necessary to keep the soil clean for production of safe food and provision of drinking water, and to provide a healthy habitat for soil organisms to support other ecosystem services. A method was developed to plot the relative measure of the natural attenuation capacity of the soil in a map. Several properties of Dutch soils were related to property-specific reference values and subsequently combined into one proxy for the natural attenuation of pollutants. This method can also be used to map other ecosystem services and to ultimately integrate suites of ecosystem services in one map.

Integrated Risk Assessment for WFD Ecological Status classification applied to Llobregat river basin (Spain). Part II - Evaluation process applied to five environmental Lines of Evidence.

Many indicators and indices related to a variety of biological, physico-chemical, chemical, and hydromorphological water conditions have been recently developed or adapted by scientists in order to support water managers in the Water Framework Directive (WFD) implementation. In this context, the achievement of a comprehensive and reliable Ecological Status classification of water bodies across Europe is hampered by the lack of harmonised procedures for selecting an appropriate set of indicators and integrating heterogeneous information in a flexible way. To this purpose, an Integrated Risk Assessment (IRA)(2) methodology was developed based on the Weight of Evidence approach. This method analyses and combines a set of environmental indicators grouped into five Lines of Evidence (LoE), i.e. Biology, Chemistry, Ecotoxicology, Physico-chemistry and Hydromorphology. The whole IRA methodology has been implemented as a specific module into a freeware GIS (Geographic Information System)-based Decision Support System, named MODELKEY DSS. This paper focuses on the evaluation of the four supporting LoE (i.e. Chemistry, Ecotoxicology, Physico-chemistry and Hydromorphology), and includes a procedure for a comparison of each indicator with proper thresholds and a subsequent integration process to combine the obtained output with the LoE Biology results in order to provide a single score expressing the Ecological Status classification. The approach supports the identification of the most prominent stressors, which are responsible for the observed alterations in the river basin under investigation. The results provided by the preliminary testing of the IRA methodology through application of the MODELKEY DSS to the Llobregat case study are finally reported and discussed.

Integrated risk assessment for WFD ecological status classification applied to Llobregat river basin (Spain). Part I-Fuzzy approach to aggregate biological indicators.

Water Framework Directive (WFD) requirements and recommendations for Ecological Status (ES) classification of surface water bodies do not address all issues that Member States have to face in the implementation process, such as selection of appropriate stressor-specific environmental indicators, definition of class boundaries, aggregation of heterogeneous data and information and uncertainty evaluation. In this context the "One-Out, All-Out" (OOAO) principle is the suggested approach to lead the entire classification procedure and ensure conservative results. In order to support water managers in achieving a more comprehensive and realistic evaluation of ES, an Integrated Risk Assessment (IRA) methodology was developed. It is based on the Weight of Evidence approach and implements a Fuzzy Inference System in order to hierarchically aggregate a set of environmental indicators, which are grouped into five Lines of Evidence (i.e. Biology, Chemistry, Ecotoxicology, Physico-chemistry and Hydromorphology). The whole IRA methodology has been implemented as an individual module into a freeware GIS (Geographic Information System)-based Decision Support System (DSS), named MODELKEY DSS. The paper focuses on the conceptual and mathematical procedure underlying the evaluation of the most complex Line of Evidence, i.e. Biology, which identifies the biological communities that are potentially at risk and the stressors that are most likely responsible for the observed alterations. The results obtained from testing the procedure through application of the MODELKEY DSS to the Llobregat case study are reported and discussed.

Toxicity assessment of sediments from three European river basins using a sediment contact test battery.

The toxicity of four polluted sediments and their corresponding reference sediments from three European river basins were investigated using a battery of six sediment contact tests representing three different trophic levels. The tests included were chronic tests with the oligochaete Lumbriculus variegatus, the nematode Caenorhabditis elegans and the mudsnail Potamopyrgus antipodarum, a sub-chronic test with the midge Chironomus riparius, an early life stage test with the zebra fish Danio rerio, and an acute test with the luminescent bacterium Vibrio fischeri. The endpoints, namely survival, growth, reproduction, embryo development and light inhibition, differed between tests. The measured effects were compared to sediment contamination translated into toxic units (TU) on the basis of acute toxicity to Daphnia magna and Pimephales promelas, and multi-substance Potentially Affected Fractions of species (msPAF) as an estimate for expected community effects. The test battery could clearly detect toxicity of the polluted sediments with test-specific responses to the different sediments. The msPAF and TU-based toxicity estimations confirmed the results of the biotests by predicting a higher toxic risk for the polluted sediments compared to the corresponding reference sediments, but partly having a different emphasis from the biotests. The results demonstrate differences in the sensitivities of species and emphasize the need for data on multiple species, when estimating the effects of sediment pollution on the benthic community.

Effects of Fuel Reduction Treatments on Incidence of Phytophthora Species in Soil of a Southern Appalachian Mountain Forest.

The National Fire and Fire Surrogate Study was initiated to study the effects of fuel reduction treatments on forest ecosystems. Four fuel reduction treatments were applied to three sites in a southern Appalachian Mountain forest in western North Carolina: prescribed burning, mechanical fuel reduction, mechanical fuel reduction followed by prescribed burning, and a nontreated control. To determine the effects of fuel reduction treatments on Phytophthora spp. in soil, incidences were assessed once before and twice after fuel reduction treatments were applied. Also, the efficiency of the baiting bioassay used to detect species of Phytophthora was evaluated, and the potential virulence of isolates of Phytophthora spp. collected from forest soils was determined. Phytophthora cinnamomi and P. heveae were the only two species recovered from the study site. Incidences of these species were not significantly affected by fuel reduction treatments, but incidence of P. cinnamomi increased over time. In the baiting bioassay, camellia leaf disks were better than hemlock needles as baits. P. cinnamomi was detected best in fresh soil, whereas P. heveae was detected best when soil was air-dried and remoistened prior to baiting. Isolates of P. heveae were weakly virulent and, therefore, potentially pathogenic-causing lesions only on wounded mountain laurel and rhododendron leaves; however, isolates of P. cinnamomi were virulent and caused root rot and mortality on mountain laurel and white pine plants.

[The white coat in pediatrics: link between medical history and preference for informally dressed physicians]. / De witte jas in de kindergeneeskunde: verband tussen medische voorgeschiedenis en voorkeur voor informeel geklede artsen.

OBJECTIVE: To find out if children show a preference for a doctor in a white coat or an informally dressed doctor, and what factors influence this preference. Further to determine if children show a preference for a physician of their own or of the other sex. METHOD: A series of 20 pairs of photographs showing varying combinations of a male and a female doctor in a white coat or in informal dress was presented to test subjects: 37 children without a medical history, 28 children with a minor and 16 with an extensive medical history, aged between 6 and 12 years. Out of each pair of photographs, the test subjects were invited to choose the doctor they would prefer. RESULTS: On average, the test subjects opted for a doctor in a white coat more often than for an informally dressed doctor (p < 0.05). There was a significant difference in dress preference between children with a less and with a more extensive medical history (p = 0.001): children with no medical history more often chose a doctor in a white coat. Children with an extensive medical history more frequently showed preference for informal dress. The children opted more frequently for a doctor of their own sex (p < 0.001). CONCLUSION: The preference of children for a doctor in a white coat or for an informally dressed doctor depended on their medical history. The more extensive the medical history, the more the preference shifted to an informally dressed doctor. Also, the children preferred a doctor of their own sex.

Heat production, body temperature, and body posture in west African dwarf goats infected with Trypanosoma vivax.

The relationships between heat production, body temperature, and body posture (standing/lying) were studied in goats suffering from trypanosomiasis. Sixteen goats were selected and infected with 1 x 10(6) Trypanosoma vivax parasites and 8 goats served as controls. In week 2, 4, and 6 after infection heat production, body posture, and body temperature were measured at 15-minute intervals. Heat production was higher (P < 0.01) in infected animals compared with control animals (342, respectively 306 kJ.kg- 0.75.d-1), body temperature was also higher (P < 0.001) in infected goats (39.78 degrees C, respectively 38.51 degrees C). The standing related energy costs per day were lower in infected animals (27 respectively 36 kJ.kg-0.75.d-1). Infected animals, therefore, masked part of the energy costs of infection by reducing the standing time. The heat production of infected animals was increased by 21 kJ.kg-0.75.d-1 per 1 degree C fever (7% increase). During periods of standing, body temperature increased with time, whereas during lying periods, it decreased. The number of standing periods was increased in infected animals. It was discussed whether postural behaviour is influenced by thermoregulatory mechanisms.

Changes in liver and fat depots of west African dwarf goats (Capra aegagus hircus) after an infection with T. vivax.

Nine West African dwarf goats (Capra aegagus hircus) were each infected experimentally with 3 x 10(7) Trypanosoma vivax parasites. The changes in the plasma concentration of nonesterified fatty acids (NEFA) were monitored during the infection and the level of hepatic triacylglycerols and glycogen was measured postmortem. During the infection they had higher plasma NEFA concentrations than nine uninfected control goats and at postmortem their total liver triacylglycerol and glycogen contents were found to be increased. These observations suggest that the mobilization of the goats' defense mechanisms against the T. vivax infection induced a more intensive fat mobilization resulting in changes in fat metabolism of the liver.

The effect of level of energy intake on rectal temperature and maintenance requirements of West African dwarf goats.

In two separate experiments, the digestible organic matter intake (DOMI) of adult male West African Dwarf goats was measured. Thirteen animals had unrestricted access to feed and 13 others a restricted diet of pelleted lucerne, ranging from 50% up to 140% of maintenance requirements. Four animals received ad libitum grass hay and four others had ad libitum grass straw. Every morning rectal temperature (RT) was measured before feeding. Plotted against DOMI, rectal temperature yielded the following equation as estimated for all animals (s.e.m. in brackets): RT=37.56 (+/- 0.11)+ 0.025( +/- 0.003)*DOMI, n=34, r.s.d.=0.21, R2=0.67. RT was not significantly (P>0.2) influenced by experiment, diet type or system of feeding, but was by the energy intake. The lower RT in animals with low DOMI may be related to a decrease in maintenance requirements of these animals.

Degradation of mutant influenza virus hemagglutinins is influenced by cytoplasmic sequences independent of internalization signals.

A mutant influenza virus hemagglutinin, HA+8, having a carboxyl-terminal extension of 8 amino acids that included 4 aromatic residues, was internalized within 2 min of arriving at the cell surface and was degraded quickly by a process that was inhibited by ammonium chloride. Through second-site mutagenesis, the internalization sequence of HA+8 was found to closely resemble the internalization signals of the transferrin receptor or large mannose 6-phosphate receptor. Comparison of the intracellular traffic of HA+8 and a series of other HA mutants that differed in their rates of internalization revealed a relation between the amount of the protein on the plasma membrane at steady state and the internalization rate that would be predicted if most of each protein recycled to the cell surface. However, there was no simple correlation between the internalization rate and the rate of degradation, indicating that transport to the compartment where degradation occurred was not simply a function of the concentration of the proteins in early endosomes. The internal populations of both HA+8, which was degraded with a t1/2 of 1.9 h, and HA-Y543, which was degraded with a t1/2 of 2.9 h, were found by cell fractionation and density-shift experiments to reside in early endosomes with little accumulation in lysosomes. A fluid-phase marker reached lysosomes 3-4-fold faster than these proteins were degraded. Degradation of these mutant HAs involved a rate-determining step in early endosomes that was sensitive to some feature of the protein that depended upon sequence differences in the cytoplasmic domain unrelated to the internalization signal.

The relationship between decrease in feed intake and infection with Trypanosoma congolense and T. vivax in west African dwarf goats.

Twenty-three mature dwarf goats were used to study whether there is a relationship between the decrease in feed intake for individual goats and infection with T.congolense and T. vivax. Furthermore, it was investigated how rectal temperatures and blood parameters were affected by the T. congolense infection and how changes in these parameters can be used to predict the effect of a T. vivax infection on feed intake. For individual goats a ranking correlation was found between relative dry matter intake and infection (r = 0.59; p < .05). Animals with the most marked decrease in dry matter intake during the T. congolense infection showed a smaller increase in urea and a higher increase in non esterified fatty acids and beta-hydroxy butyrate levels in their blood. Evidence was obtained that the relative decrease in dry matter intake for individual goats during a T. vivax infection can be predicted on the basis of urea and creatinine responses measured in the blood during a previous infection with T. congolense infection.

Towards a sustainable livestock production in developing countries and the importance of animal health strategy therein.

Livestock and animal health development projects have not always led to substantial increases in animal productivity or in farmers' welfare. Some have even resulted in unsustainable systems, when they were not based on an understanding of (livestock) production systems. The multipurpose functions of livestock and complex relationships between the biological, technical and social components require a systems approach, whereby nutrition, animal health, breeding, biotechnology knowhow, inputs and technologies are used to optimise resource use. The challenge for developed and developing countries is to reverse the current degradation of the environment, and arrive at sustainable increases in crop and livestock production to secure present and future food supplies. For rural development, governments should show long term commitment and political will to support the rural population in development programmes, because smallholders (including women and landless livestock keepers) represent a large labour force in developing countries. Different systems need different approaches. Pastoral systems must focus on effective management of grazing pressure of the rangelands. Communal rangelands management involves not only the development and application of technologies (e.g. feedlots, vaccination campaigns), but also land tenure policies, institutional development, economic return and a reduction in the number of people depending upon livestock. Smallholder mixed farms must aim at intensification of the total production system, in which external inputs are indispensable, but with the emphasis on optimum input-output relationships by reducing resource losses due to poor management. Resource-poor farming systems must aim at the improved management of the various livestock species in backyards and very small farms, and proper packages for cattle, buffaloes, sheep, goats, rabbits and poultry should be developed. Specialised commercial livestock farming systems (poultry, pigs, dairy or meat) can only be sustainable with adequate marketing, supply of quality feed, veterinary services, labour, management and control of pollution. Animal health programmes play a keyrole in the proposed system approach.

The effect of T. vivax infection in west African dwarf goats on energy and nitrogen metabolism.

To investigate how T. vivax affects metabolism in dwarf goats, nine wethers (infection group) given alfalfa pellets ad libitum were infected intravenously and food intake was recorded up to 49 days after infection in the infection group and in the control group (n = 9). Controls received the same diet, ad libitum before infection and in restricted amounts after infection in order to obtain similar intakes in the two groups. Digestible organic matter intake (DOMI) and nitrogen balance (NB) were determined during four balance trials. All animals were bled regularly to measure parasitaemia, packed cell volume (PCV) and a number of serum metabolites. All infected animals showed symptoms typical for T. vivax infection as judged by parasitaemia, PCV and rectal temperature. Infection had a non-uniform negative effect on food intake. Compared with controls at equal DOMI, NB was lower in infected animals, the difference being significant 4 weeks after infection. This was caused by a gradual increase in NB at equal DOMI of the control group. The NB of the ad libitum fed infected animals 2 and 4 weeks after infection was comparable to values normally found in healthy ad libitum fed dwarf goats with an equal DOMI. NEFA values in serum were significantly elevated after infection. Except for two infected animals with an extremely low food intake towards the end of the experiment, no rise in serum ketone bodies was evident. After infection, serum protein increased, differences with controls being significant 4 and 7 weeks after infection.(ABSTRACT TRUNCATED AT 250 WORDS)