Psychological, social and everyday visual impact of diabetic macular oedema and diabetic retinopathy: a systematic review.

AIMS: To synthesize the evidence on the impact of diabetic retinopathy and diabetic macular oedema from the patient perspective. METHODS: A systematic literature review was conducted using MEDLINE Complete, PsycINFO, EMBASE and AMED. We included articles investigating the impact of the condition on quality of life, symptoms, visual functioning, activities of daily living, well-being, social functioning, and financial status. The studies evaluated were observational, including cross-sectional, prospective cohort and retrospective cohort designs. Outcome data were extracted and synthesized. RESULTS: Searches yielded 5114 publications. After screening, 85 studies were included, measuring the following outcomes: visual functioning (n=46); quality of life (n=22); well-being (n=16); functional status (n=5); work (n=4); and visual task performance (n=2). Diabetic retinopathy has a considerable impact on visual functioning and this is greater in people with greater disease severity. Diabetic retinopathy significantly limits activities including working, driving, walking and reading, and has the potential to have a negative impact on psychological well-being. CONCLUSIONS: Diabetic retinopathy is associated with poor self-reported visual functioning, well-being, and health-related quality of life. Ability to perform basic everyday tasks appears to diminish with disease severity. Some studies suggest impaired mobility and problems with work, but there are gaps in this evidence.

Serovars, bacteriophage types and antimicrobial sensitivities associated with salmonellosis in dogs in the UK (1954-2012).

Serovars and bacteriophage (phage) types were determined for 442 isolates of Salmonella enterica from dogs in the UK submitted to the Scottish Salmonella Reference Laboratory from 1954 to 2012. The most frequent serovars were Salmonella Typhimurium (196 isolates; 44.3 per cent), Dublin (40 isolates; 9.0 per cent), Enteritidis (28 isolates; 6.3 per cent), Montevideo (19 isolates; 4.3 per cent), Virchow (10 isolates; 2.3 per cent), Heidelberg (8 isolates; 1.8 per cent) and Derby (8 isolates; 1.8 per cent), along with 55 other recognised serovars among 127 other isolates, and six incompletely classified isolates. Serovars were frequently represented by strains commonly associated with poultry, cattle or pigs and their products. Among 196 Salmonella Typhimurium isolates from dogs, the most frequent phage types (definitive types) were the multiple antimicrobial-resistant strains DT104 (62 isolates), DT204c (18 isolates) and DT193 (8 isolates), along with antimicrobial sensitive wild finch strains DT40 (13 isolates) and DT56 variant (8 isolates). Eleven of 28 isolates of Salmonella Enteritidis were phage type 4. S enterica was frequently recovered from faecal or intestinal samples of dogs with diarrhoea, although many dogs had concurrent infection with other enteric pathogens. Salmonella Dublin was recovered from the brain and/or cerebrospinal fluid of two dogs with meningoencephalitis. Salmonella Kedougou was isolated from the joint fluid of a dog with septic arthritis. Salmonella Typhimurium and Salmonella Dublin were each recovered from the vaginas of bitches that had aborted. Isolates of Salmonella Enteritidis phage types 1, 4 and 8, Salmonella Typhimurium DT104, Salmonella Dublin and Salmonella Indiana were isolated from clinically healthy dogs in households where the same strains were recovered from human beings with diarrhoea. The pattern ampicillin-chloramphenicol-spectinomycin-streptomycin-sulfamethoxazole-tetracycline (ACSpSSuT) was the most frequent resistance phenotype and was observed in 44 (13.3 per cent) of 330 isolates. Dogs in the UK are exposed to a wide variety of serovars of S enterica, sometimes associated with clinical disease, and represent a zoonotic risk.

Plasma ropivacaine concentrations during bilateral transversus abdominis plane infusions.

BACKGROUND: The transversus abdominis plane (TAP) block is a regional anaesthetic technique that blocks abdominal wall somatic afferent nerves. We conducted a prospective observational study to evaluate the venous plasma concentrations of ropivacaine during a continuous TAP infusion. METHODS: Twenty patients who were planned to undergo intra-abdominal cavity surgery requiring a mid-line laparotomy incision were enrolled. Patients were excluded if they had a history of chronic pain, opioid tolerance, renal or hepatic impairment, or contraindication to study medications. Subjects received a standardized general anaesthetic, and at the completion of surgery, ultrasound-guided subcostal or posterior TAP blocks and catheters. A TAP infusion of 2 mg ml(-1) ropivacaine was administered for 72 h after operation. Data collection during the 72 h included morphine requirements, pain scores, and plasma ropivacaine levels. RESULTS: TAP blocks and catheters were successfully inserted in all recruited subjects. The fourth subject experienced neurological symptoms attributed to local anaesthetic toxicity, but did not have high plasma ropivacaine concentrations. However, the protocol was amended for the subsequent 16 subjects, to a weight-based dosing regimen. The range of total plasma ropivacaine concentrations was 0.98-3.41 mg litre(-1) for posterior infusions and 0.96-3.48 mg litre(-1) for subcostal infusions. Four subjects had total ropivacaine levels >3.4 mg litre(-1). The range of unbound plasma ropivacaine concentrations was 0.022-0.135 mg litre(-1) for posterior infusions and 0.031-0.120 mg litre(-1) for subcostal infusions. CONCLUSION: Given the potential for high plasma concentrations from a bilateral TAP infusion technique, attention should be paid to individualized dosing strategies.

A field evaluation of a footbathing solution for the control of digital dermatitis in cattle.

Footbathing is one of the most commonly used methods for controlling digital dermatitis (DD). A farm-based trial was undertaken using six dairy herds involving over 600 cubicle-housed Holstein-Friesian cattle. Split footbaths (length 2.2m) were used to compare the efficacy of two dips, namely, a positive control (5% copper sulphate) and a non-heavy metal-based proprietary dip. The dips were used from early January 2009 for a minimum of 103 days, bathing twice a day for 3 consecutive days every week, using one footbath (three herds) or two in line (three herds). The lesions of DD on the hind feet of cattle were scored by borescope while the animals were being milked, on three occasions (at approximately days 0, 55 and 110) and then compared both directly and by calculating the change in severity from the previous examination (when possible). Data from the 408 cows that had their feet examined for lesions on all three occasions were analysed separately. A reduction in lesion score was seen for both footbath products, but feet bathed in 5% copper sulphate improved more (OR=1.6, CI: 1.14-2.32; P<0.01), and, irrespective of solution, there was a significantly greater improvement in those herds where two footbaths were used (OR=3.39, CI: 2.07-5.19; P<0.001). Lesion improvement over time also increased with lactation number (OR=1.13, CI: 1.02-1.25; P<0.05).

Spin density projection-assisted R2 magnetic resonance imaging of the liver in the management of body iron stores in patients receiving multiple red blood cell transfusions: an audit and retrospective study in South Australia.

AIM: To assess the impact of non-invasive monitoring of liver iron concentration (LIC) on management of body iron stores in patients receiving multiple blood transfusions. METHOD: A retrospective audit was conducted on clinical data from 40 consecutive subjects with haemolytic anaemias or ineffective haematopoiesis who had been monitored non-invasively for LIC over a period of at least 1 year. LIC was measured with spin density projection-assisted proton transverse relaxation rate-magnetic resonance imaging. RESULTS: Nineteen clinical decisions were explicitly documented in the case notes as being based on LIC results. Decisions comprised initiation of chelation therapy, increasing chelator dose, decreasing chelator dose and change of mode of delivery of deferioxamine from subcutaneous to intravenous. The geometrical mean LIC for the cohort dropped significantly (P= 0.008) from 6.8 mg Fe/g dry tissue at initial measurement to 4.8 mg Fe/g dry tissue at final measurement. The proportion of subjects with LIC in the range associated with greatly increased risk of cardiac disease and death (>15 mg Fe/g dry tissue) dropped significantly (P= 0.01) from 14 of 40 subjects at initial measurement to 5 of 40 subjects at final measurement. No significant changes in the geometrical mean of serum ferritin or the proportion of subjects with serum ferritin above 2500 or 1500 µg/L were observed. CONCLUSIONS: The data are consistent with previous observations that introduction of non-invasive monitoring of LIC can contribute to a decreased body iron burden through improved clinical decision making and improved feedback to patients and hence improved adherence to chelation therapy.

Decomposition and description of the nasal cavity form.

Patient-specific studies of physiological flows rely on anatomically realistic or idealized models. Objective comparison of datasets or the relation of specific to idealized geometries has largely been performed in an ad hoc manner. Here, two rational procedures (based respectively on Fourier descriptors and medial axis (MA) transforms) are presented; each provides a compact representation of a complex anatomical region, specifically the nasal airways. The techniques are extended to furnish average geometries. These retain a sensible anatomical form, facilitating the identification of a specific anatomy as a set of weighted perturbations about the average. Both representations enable a rapid translation of the surface description into a virtual model for computation of airflow, enabling future work to comprehensively investigate the relation between anatomic form and flow-associated function, for the airways or for other complex biological conduits. The methodology based on MA transforms is shown to allow flexible geometric modeling, as illustrated by a local alteration in airway patency. Computational simulations of steady inspiratory flow are used to explore the relation between the flow in individual vs. averaged anatomical geometries. Results show characteristic flow measures of the averaged geometries to be within the range obtained from the original three subjects, irrespective of averaging procedure. However the effective regularization of anatomic form resulting from the shape averaging was found to significantly reduce trans-nasal pressure loss and the mean shear stress in the cavity. It is suggested that this may have implications in attempts to relate model geometries and flow patterns that are broadly representative.

The effects of the addition of the polyelectrolyte, poly(ethyleneimine), on the adsorption of mixed surfactants of sodium dodecylsulfate and dodecyldimethylaminoacetate at the air-water interface.

The effects of the addition of the polyelectrolyte, poly(ethyleneimine), PEI, on the adsorption of the mixed surfactants of sodium dodecylsulfate, SDS, and dodecyldimethylaminoacetate, dodecyl betaine, at the air-water interface have been investigated using neutron reflectivity and surface tension. In the absence of PEI the SDS and dodecyl betaine surfactants strongly interact and exhibit synergistic adsorption at the air-water interface. The addition of PEI, at pH 7 and 10, results in a significant modification of the surface partitioning of the SDS/dodecyl betaine mixture. The strong surface interaction at high pH (pH 7 and 10) between the PEI and SDS dominates the surface behavior. For solution compositions in the range 20/80-80/20 mol ratio dodecyl betaine/SDS at pH 7 the surface composition is strongly biased towards the SDS. At pH 10 a similar behavior is observed for a solution composition of 50/50 mol ratio dodecyl betaine/SDS. This strong partitioning in favor of the SDS at high pH is attributed to the strong ion-dipole attraction between the SDS sulfate and the PEI imine groups. At pH 3, where the electrostatic interactions between the surfactant and the PEI are dominant, the dodecyl betaine more effectively competes with the SDS for the interface, and the surface composition is much closer to the solution composition.

The role of electrolyte and polyelectrolyte on the adsorption of the anionic surfactant, sodium dodecylbenzenesulfonate, at the air-water interface.

The role of the polyelectrolyte, poly(ethyleneimine), PEI, and the electrolytes NaCl and CaCl(2), on the adsorption of the anionic surfactant, sodium dodecylbenzenesulfonate, LAS, at the air-water interface have been investigated by neutron reflectivity and surface tension. The surface tension data for the PEI/LAS mixtures are substantially affected by pH and the addition of electrolyte, and are consistent with a strong adsorption of surface polymer/surfactant complexes down to relatively low surfactant concentrations. The effects are most pronounced at high pH, and this is confirmed by the adsorption data obtained directly from neutron reflectivity. However, the effects of the addition of PEI and electrolyte on the LAS adsorption are not as pronounced as previously reported for PEI/SDS mixtures. This is attributed primarily to the steric hindrance of the LAS phenyl group resulting in a reduction in the ion-dipole attraction between the LAS sulfonate and amine groups that dominates the interaction at high pH.

Adsorption of polyelectrolyte/surfactant mixtures at the air-water interface: modified poly(ethyleneimine) and sodium dodecyl sulfate.

The adsorption of surfactant/polyelectrolyte mixtures of sodium dodecyl sulfate (SDS) and different modified poly(ethyleneimine) (PEI) polyelectrolytes at the air-water interface has been studied using neutron reflectivity and surface tension. Modification of the PEI by the addition of short ethylene oxide (EO) or propylene oxide (PO) groups is shown to have an impact upon the surface adsorption behavior. This is due to a modification of the polymer/surfactant interaction, an increase in the intrinsic surface activity of the modified polyelectrolyte, and changes in the relative importance of surface and solution complex formation. For the polyelectrolyte PEI, there is a marked change in the surface adsorption behavior between the addition of a single EO group and that of the (EO)3 group. The addition of a single EO or PO group to the PEI results in an SDS concentration and solution pH adsorption dependence that is broadly similar in behavior to that of the unmodified PEI/SDS mixture. That is, there is strong surface complexation and adsorption down to low SDS concentrations, and there is evidence of a strong interaction at high pH in addition to the strong electrostatic attraction at low pH. The addition of a larger ethylene oxide group, triethylene oxide (EO)3, results in a surface adsorption behavior that more closely resembles that of a neutral polymer/ionic surfactant mixture, similar to that observed for PEI with a larger ethylene oxide group, notably PEI-(EO)7. In that case, the adsorption of the polymer/surfactant complex is much less pronounced. The adsorption arises predominantly from competition between the polymer and surfactant and indicates a decrease in the polymer/surfactant interaction with increasing pH. That is, increasing the size of the ethylene oxide group induces a transition from a strong surface polymer/surfactant interaction to a weak polymer/surfactant interaction.

Risk of carcase contamination with Campylobacter in sheep sent for slaughter into an abattoir in Scotland.

Campylobacter species have been identified as the major cause of acute bacterial enteritis in the UK. However, the epidemiology of campylobacteriosis remains poorly understood. It has been suggested that the role of sheep in the epidemiology of Campylobacter has been underestimated. The objective of the present study was to assess the infection risk of Campylobacter in sheep meat as a potential risk for human campylobacteriosis and to establish any possible associations between the epidemiological factors considered in the study and the presence of Campylobacter on lamb carcases. The prevalence of Campylobacter obtained from faecal samples and swabs from fleeces and carcases was presented in a previous paper. Epidemiological data was collected through questionnaires in order to identify risk factors for the presence of Campylobacter on the carcases and to make recommendations, based on the results obtained, to prevent human campylobacteriosis.

The plasma levels of the endocannabinoid, anandamide, increase with the induction of labour.

OBJECTIVE: Plasma anandamide (AEA) levels have previously been shown to be elevated in labour and defective cannabinoid receptor type 1 signalling in mice has been shown to be associated with elevation of corticotrophin-releasing hormone and spontaneous onset of preterm labour. We measured plasma AEA levels in women undergoing induction of labour to define the changes during the transition from the nonlabouring to labouring state. DESIGN: A longitudinal observational study. SETTING: A large UK teaching hospital. POPULATION: Term pregnant women undergoing induction of labour. METHODS: Blood was collected from women before induction of labour and again when they were in active labour. Plasma AEA was extracted and measured using ultraperformance liquid chromatography-tandem mass spectrometry. MAIN OUTCOME MEASURES: The primary outcome variable was change in plasma AEA levels from the nonlabouring to the labouring state. The secondary outcome was induction-to-delivery interval. RESULTS: There was a 1.5-fold increase in mean plasma AEA levels from 1.20 +/- 0.57 nm in the nonlabouring state to 1.82 +/- 0.87 nm in the labouring state (P < 0.0001). Induction-to-delivery interval was predicted by both Bishop's score (P < 0.0001) and percentage change in plasma AEA levels (P < 0.0001). There was a negative correlation between the percentage change in plasma AEA level and the induction-to-delivery interval (r = - 0.28; P = 0.0481). This means that the greater the rise in the plasma AEA levels the shorter the duration of labour. CONCLUSIONS: Plasma AEA levels increase with active labour and the negative correlations between percentage change in plasma AEA levels and induction-to-delivery interval suggest that AEA is likely to be involved in the physiological mechanisms of labour. Whether this increase is essential for myometrial contraction is unclear and needs further investigation.

Inflow boundary profile prescription for numerical simulation of nasal airflow.

Knowledge of how air flows through the nasal passages relies heavily on model studies, as the complexity and relative inaccessibility of the anatomy prevents detailed in vivo measurement. Almost all models to date fail to incorporate the geometry of the external nose, instead employing a truncated inflow. Typically, flow is specified to enter the model domain either directly at the nares (nostrils), or via an artificial pipe inflow tract attached to the nares. This study investigates the effect of the inflow geometry on flow predictions during steady nasal inspiration. Models that fully replicate the internal and external nasal airways of two anatomically distinct subjects are used as a reference to compare the effects of common inflow treatments on physiologically relevant quantities including regional wall shear stress and particle residence time distributions. Inflow geometry truncation is found to affect flow predictions significantly, though slightly less so for the subject displaying more pronounced passage area contraction up to the internal nasal valve. For both subject geometries, a tapered pipe inflow provides a better approximation to the natural inflow than a blunt velocity profile applied to the nares. Computational modelling issues are also briefly outlined, by comparing quantities predicted using different surface tessellations, and by evaluation of domain-splitting techniques.

Interaction of a cationic gemini surfactant with DNA and with sodium poly(styrene sulphonate) at the air/water interface: a neutron reflectometry study.

The interactions between a dicationic gemini surfactant with a six-hydrocarbon spacer (1,2-bis(dodecyldimethyl-ammonio)hexane dibromide, C12C6C12Br2) and anionic polyelectrolyte DNA or sodium (polystyrene sulfonate) (NaPSS) at the air/solution interface have been studied and compared using neutron reflectometry together with surface tension. In the presence of the dichained cationic gemini surfactant, DNA and NaPSS display very different adsorption behaviors. The DNA/gemini mixtures show adsorption behavior very similar to that of DNA/C12TAB mixtures, with enhanced surfactant adsorption at low concentrations and thick structured layers at higher concentrations. However, for the NaPSS/gemini mixtures the amount of gemini at the surface is reduced relative to that in the absence of NaPSS at concentrations below the cmc. These differences in adsorption behavior are attributed to differences in the molecular structure and flexibility of the two polyanions. NaPSS is relatively hydrophobic and flexible enough to form bulk-phase polymer-micelle complexes with the gemini surfactant at low surfactant concentrations, whereas the adsorption of surface complexes is much less favorable because the dications on the gemini would require adjacent bulky pendant charges on the NaPSS to be oriented toward the surface. This would force the NaPSS to bend significantly whereas it is more favorable for the NaPSS to adopt an extended conformation at the surface. Thus, surfactant is actually removed from the surface to form bulk-phase complexes. In contrast with NaPSS, DNA has a far more rigid structure, and the charges on the backbone are at fixed intervals, factors that make the formation of surface DNA-monomer complexes much more favorable than bulk-phase DNA-micelle complexes. Finally, a short-chain sample of NaPSS consisting of only five to six segments adsorbs very strongly at the surface with the gemini to form more extensive layered structures than have previously been observed, consisting of approximately five sublayers.

Nature of amine-surfactant interactions at the air-solution interface.

The surface tension and adsorption behavior of polymer/surfactant mixtures of polyethyleneimine (PEI)/sodium dodecyl sulfate (SDS) is strongly dependent on pH. At both low and high pH, a strong PEI/SDS interaction gives rise to surface polymer/surfactant complex formation that results in significantly enhanced SDS adsorption at very low SDS concentrations and in multilayer formation at the interface. At low pH, this strong PEI/SDS interaction is dominated by the electrostatic attraction between the two oppositely charged species. However, at high pH the PEI is essentially neutral, and the origin of the "hydrophobic" interaction, or interaction of nonelectrostatic origin, is less clear. To investigate the origins of this interaction further, we have used neutron reflectivity and surface tension to study the pH dependence of the surface adsorption of different anionic surfactants-SDS, lithium dodecyl sulfate (LiDS), and sodium dodecyl benzene sulfonate (LAS)--in the presence of a range of small amine molecules (from ethylenediamine to pentaethylenehexamine). Analogous to that observed in PEI/SDS mixtures, the presence of amine molecules induces a strong enhancement in the surfactant adsorption at both low and high pH, which can result in extreme cases in multilayer formation at the interface. At high pH, the adsorption is highly dependent upon the amine molecular weight and is equivalent to that observed at low pH by the time the molecular weight of the amine has increased to that of pentaethylenehexamine. We attribute this nonelectrostatic interaction observed at high pH to the combined effect of a dipole-dipole interaction between the sulfate (or sulfonate) headgroup and the amine nitrogens and a cooperative hydrophobic interaction between the chains of the attached surfactants. At high pH and when there are at least six amine groups present, this effect appears to be equivalent in strength to the electrostatic attraction that dominates at low pH. These results are significant in the context of understanding the unusual nature of the PEI/surfactant interaction and of using small molecular weight additives rather than much larger molecular weight polymers to manipulate adsorption properties.

Late termination of pregnancy: a comparison of obstetricians' experience in eight European countries.

OBJECTIVE: To compare the experience and attitude of obstetricians in Europe towards late termination of pregnancy and the factors affecting their responses. DESIGN: Cluster sampling cross-sectional survey. All neonatal intensive care unit (NICU)-associated maternity units were recruited (census sampling) in Luxembourg, the Netherlands and Sweden. In France, Germany, Italy, Spain and the UK, units were selected at random. In every recruited unit, all obstetricians with at least 6 months' experience were invited to participate. SETTING: NICU-associated maternity units in eight European countries. POPULATION: Obstetricians with at least 6 months' clinical experience. METHODS: An anonymous, self-administered questionnaire was used. Multinomial logistic analysis was used to identify factors predicting the obstetricians' views about modifying the law governing late termination in their country. MAIN OUTCOME MEASURE: Obstetricians' experience of late termination of pregnancy and views about national policies. RESULTS: One hundred and five units and 1530 obstetricians participated (response rates 70 and 77% respectively). The most common indications for late termination were congenital anomalies and women's physical health. Feticide was not common except in France, Luxembourg and the UK. Active euthanasia of a liveborn was practiced in France and the Netherlands. Obstetricians in Germany were more likely to feel that late termination should be more severely restricted, the opposite was true in Spain and the Netherlands. In Italy, there was dissatisfaction with current status, but opinion was divided, reflecting views on both sides of the debate. CONCLUSIONS: This research outlines current practice in a difficult and sensitive area and suggests the need for more discussion and support for all those who were involved.

Assessment of subclinical venous catheter-related diseases in horses and associated risk factors.

A total of 102 horses that had a catheter introduced intravenously to facilitate treatment had the catheterised jugular vein and contralateral vein examined by ultrasound every 48 hours. Subclinical complications were defined by thrombus formation or thickening of the venous wall, and the data were analysed to establish risk factors for the development of these complications. The horses with a rectal temperature above 38.5 degrees C when the catheter was introduced were four times more likely to develop complications, than the horses with a lower temperature. The administration of a NSAID while the catheter was in place reduced the risk of complications developing.

Assessing techniques for disinfecting sites for inserting intravenous catheters into the jugular veins of horses.

The sites of insertion of catheters into the jugular veins of six horses were investigated to determine common isolates and to assess the effectiveness of two disinfection protocols with the hair coat left long, clipped or shaved. Skin commensals (Staphylococcus, Streptococcus and Micrococcus species) and environmental contaminants (Bacillus, Enterobacteriaceae, Aspergillus and Mucor species) were the microorganisms most frequently isolated. Chlorhexidine gluconate and povidone-iodine-based skin disinfection protocols resulted in significant reductions in the number of bacterial isolates from clipped sites. With chlorhexidine, there were no significant differences between the reductions observed at sites with the hair coat left long, clipped or shaved.