Mycoplasma bovis testing for the screening of semen imported into New Zealand.

AIMS: To evaluate the fitness of three PCR assays for the detection of Mycoplasma bovis in dilute (extended) bovine semen, and a reverse transcriptase-PCR (RT-PCR) adaptation as a proxy for viability. MATERIALS AND METHODS: Four commercial kit-based methods for nucleic acid extraction were compared to test for the presence of PCR inhibitors in nucleic acid extracted from undiluted and diluted semen. Then, analytical sensitivity, analytical specificity, and diagnostic specificity of two real-time PCR and one conventional PCR were evaluated for the detection of M. bovis DNA in semen and compared against microbial culture. Furthermore, an RT-PCR was adapted to detect RNA only and tested on viable and non-viable M. bovis to establish its ability to discriminate between the two. RESULTS: No significant PCR inhibition was detected from the dilute semen. All DNA extraction methods except one were equivalent, regardless of semen dilution. The analytical sensitivity of the real-time PCR assays was estimated as 45.6 cfu per 200 µL semen straw (2.2 × 102 cfu/mL). The conventional PCR was 10 times less sensitive. No cross-reactivity was observed for the real-time PCR for any of the bacteria tested and the diagnostic specificity was estimated as 100 (95% CI = 94.04-100) %. The RT-PCR was poor in distinguishing between viable and non-viable M. bovis. The mean quantification cycle (Cq) values for RNA extracted from different treatments to kill M. bovis remained unchanged 0-48 hours after inactivation. CONCLUSION AND CLINICAL RELEVANCE: The real-time PCR were fit for the purpose of screening dilute semen for the detection of M. bovis to prevent incursion via importation of infected semen. The real-time PCR assays can be used interchangeably. The RT-PCR could not reliably indicate the viability of M. bovis. Based on the results from this study, a protocol and guidelines have been produced for laboratories elsewhere that wish to test bovine semen for M. bovis.

Community engagement interventions for communicable disease control in low- and lower- middle-income countries: evidence from a review of systematic reviews.

BACKGROUND: Community engagement (CE) interventions include a range of approaches to involve communities in the improvement of their health and wellbeing. Working with communities defined by location or some other shared interest, these interventions may be important in assisting equity and reach of communicable disease control (CDC) in low and lower-middle income countries (LLMIC). We conducted an umbrella review to identify approaches to CE in communicable disease control, effectiveness of these approaches, mechanisms and factors influencing success. METHODS: We included systematic reviews that: i) focussed on CE interventions; ii) involved adult community members; iii) included outcomes relevant to communicable diseases in LLMIC; iv) were written in English. Quantitative results were extracted and synthesised narratively. A qualitative synthesis process enabled identification of mechanisms of effect and influencing factors. We followed guidance from the Joanna Briggs Institute, assessed quality with the DARE tool and reported according to standard systematic review methodology. RESULTS: Thirteen systematic reviews of medium-to-high quality were identified between June and July 2017. Reviews covered the following outcomes: HIV and STIs (6); malaria (2); TB (1); child and maternal health (3) and mixed (1). Approaches included: CE through peer education and community health workers, community empowerment interventions and more general community participation or mobilisation. Techniques included sensitisation with the community and involvement in the identification of resources, intervention development and delivery. Evidence of effectiveness of CE on health outcomes was mixed and quality of primary studies variable. We found: i) significantly reduced neonatal mortality following women's participatory learning and action groups; ii) significant reductions in HIV and other STIs with empowerment and mobilisation interventions with marginalised groups; iii) significant reductions in malaria incidence or prevalence in a small number of primary studies; iv) significant reductions in infant diarrhoea following community health worker interventions. Mechanisms of impact commonly occurred through social and behavioural processes, particularly: changing social norms, increasing social cohesion and social capacity. Factors influencing effectiveness of CE interventions included extent of population coverage, shared leadership and community control over outcomes. CONCLUSION: Community engagement interventions may be effective in supporting CDC in LLMIC. Careful design of CE interventions appropriate to context, disease and community is vital.

The impact of intra-operative transoesophageal echocardiography on cardiac surgical practice.

The use of transoesophageal echocardiography during cardiac surgery has increased dramatically and it is now widely accepted as a routine monitoring and diagnostic tool. A prospective study was carried out between September 2004 and September 2007, and included all patients in whom intra-operative echocardiography was performed, 2 473 (44%) out of a total of 5 591 cases. Changes to surgery were subdivided into predictable (where echocardiographic examination was planned specifically to guide surgery) and unpredictable (new pathology not diagnosed pre-operatively). A change in the planned surgical procedure was documented in 312 (15%) cases. In 216 (69%) patients the changes were predictable and in 96 (31%) they were unpredictable. The number of predictable changes increased between 2004-5 and 2006-7 (8% vs 13%, p = 0.025). In these cases, intra-operative echocardiography was specifically requested by the surgeon to help determine the operative intervention. This has implications for consent and operative risk, which have yet to be fully determined.

A summary of the 209 PCB congener nomenclature.

Primary publications of congener numbering shorthand systems for PCB congener identification were reviewed, including the original Ballschmiter-Zell (BZ) system; recommended changes by Schulte and Malisch, and Guitart et al.; and listings by the Chemical Abstracts Service. Comparisons of the various congener numbering shorthands and chlorine substitution numberings in the structural name listings are presented. Several changes, to adhere more closely to IUPAC rules, have been incorporated into the BZ structural nomenclature, and these resulted in renumbering congeners. These corrected listings have been erroneously identified as "IUPAC" numbers, a misnomer, because IUPAC has not published a shorthand system. Guitart pointed out additional inconsistencies with IUPAC rules for nine congeners which would result in further order changes, but did not recommend renumbering, to avoid further confusion. We noted an additional error in the structural name for congener 97, named 2,2',3',4,5 using Ballschmiter and Zell nomenclature and 2,2',3,4',5' using strict IUPAC nomenclature. This renaming would cause the renumbering of the IUPAC number system reported by Guitart for isomers 91 through 98. No further changes are recommended, however. Tables summarizing each publication, and the discrepancies between them are provided in hopes of clarifying the current state of the nomenclature.

Human immunodeficiency virus (HIV)-related risk-taking behaviors in women attending inner-city prenatal clinics in the mid-west.

OBJECTIVE: Federal guidelines recommend the provision of human immunodeficiency virus education to all attendees of prenatal clinics. The current study was conducted to assess risk-taking behaviors among urban women voluntarily pursuing prenatal care. DESIGN AND SETTING: African American women attending urban prenatal clinics in Cleveland, Ohio were subjected to an extensive interview before receiving an experimental AIDS education curriculum. The interview sought detailed information regarding demographics, lifetime and recent sexual activity, condom use, and lifetime and recent illicit drug use. RESULTS: A total of 1017 women were interviewed; of those women, approximately 73% were single. The majority had a monthly income of less than $500. A total of 66% had only one partner in the past year, and almost 90% had < or = 1 partner in the past 6 months. A total of 98% identified a main partner. Nearly all subjects were at least fairly certain that this partner did not use intravenous drugs, and 71% were at least fairly certain that he was monogamous. Only 19% used condoms most or all the time. Intravenous drug use among study subjects was very infrequent. CONCLUSION: These data indicate that inner-city Cleveland women seeking prenatal care are largely monogamous around the time of their gestation, and that a history of intravenous drug use is infrequent. They suggest that prenatal counseling in urban clinics will need to address women who largely are engaged in single-partner relationships at the time of the intervention.

Adolescent life experiences as predictors of occupational attainment.

Adolescent life experiences, measured with Owen's Biographical Questionnaire (BQ), were used to predict occupational attainment 16 years to 21 years later in a sample of 1,523 college graduates. Study participants completed the BQ in either 1968 or 1970-1973 as college freshmen and subsequently reported their occupational status in 1989. Jobs were rationally clustered into 18 different categories. Separate gender analyses were conducted in which 13 BQ factors were used as predictors of occupational attainment. Effect sizes were substantially larger than those obtained in an earlier study by A. G. Neiner and W. A. Owens (1985). The usefulness of life experience data for understanding occupational choices as well as implications for college counseling are discussed.

Extraocular muscle surgery in the presence of complete paralysis of the fifth, sixth and seventh cranial nerves.

A nine-year-old boy developed paralytic left esotropia secondary to an intracranial lesion. He also exhibited total loss of function of the left fifth and seventh cranial nerves. Extraocular muscle surgery in this situation was felt to be dangerous to the operated eye. The degree of risk however could not be determined from published reports. Surgery was performed and was complicated by severe corneal ulceration. Use of a therapeutic contact lens presumedly helped in finally achieving a satisfactory result.

Acute coronary artery disease and oral contraceptives.

The Waikato Hospital experience of women admitted or seen in the Cardiology Outpatient Clinic who were under the age of 40 and whose diagnosis was a recent acute coronary occlusive episode was reviewed. It was found that there were nine admissions in eight women in this category between December 1971 and November 1973, plus one further patient who was seen with a recent acute ischaemic episode as an outpatient. The histories of these patients were reviewed and their risk factors surveyed. Of the nine women in the study, seven were taking oral contraceptives. As opposed to previous studies, not all the women in this study showed risk factors other than oral contraceptive usage. Three patients in this group taking oral contraceptives and who were thought to have definite coronary ischaemic episodes had no other major risk factor though two of the three were obese. It is thought probable that oral contraceptives containing oestrogens should be considered as a coronary risk factor in young women.

Effects of lipopolysaccharide and cyclosporin on the endocrine control of ovarian function.

The effects of stimulating the immune system with lipopolysaccharide (LPS) or suppressing the immune system with cyclosporin (CS) on reproductive functions in the female rat were investigated. Animals were either treated acutely with LPS (2 mg kg-1) or cyclosporin (20 mg kg-1) on dioestrus day 1 and 2 or treated chronically over a period of 6 days (on alternate days with LPS, daily with CS). Chronic LPS treatment induced a state of constant dioestrus and decreased circulating concentrations of progesterone and oestradiol. Chronic CS treatment induced some irregularity in the 4-day vaginal smear pattern in a minority of animals and, while it had no effect on circulating concentrations of progesterone, oestradiol concentrations were suppressed compared with those measured in pro-oestrous animals. LH responses to GnRH were reduced in both perifused pituitary fragments and cultured pituitary cells obtained from animals pretreated with either LPS or CS. In contrast, a low dose of LPS (20 micrograms kg-1) given over 6 days did not disrupt ovarian cycles and reduced, but did not abolish, the second phase primed LH response. Neither drug had a direct effect on the pituitary LH responses to GnRH, except that pituitary cells exposed to high doses of CS for periods greater than 48 h did show attenuated LH responses to GnRH. This finding was not paralleled with high doses of LPS. The differential count of ovarian follicles from histological studies showed that LPS treatment was associated with significantly fewer large preovulatory follicles, whereas animals treated with CS showed a similar distribution of follicular volumes compared with controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of tardive dyskinesia with choline and tetrabenazine.

A patient with severe tardive dyskinesia due to long-term neuroleptic medication is described. The 2 factors immediately precipitating the onset of the disorder appeared to be the administration of benzhexol hydrochloride and the sudden termination of neuroleptic therapy. the disorder was satisfactorily controlled with choline chloride and a small dose of tetrabenazine. The suggested mechanism of tardive dyskinesia is discussed.

Ultra-violet irradiation and 25-hydroxy-vitamin D levels in sick old people.

Twelve elderly patients in a rehabilitation ward were given a four-week course of ultra-violet irradiation from a Vitalux lamp. They were compared with 12 controls selected from the same ward. Treatment produced a significant elevation in plasma 25-hydroxy-vitamin D (25OHD) by the end of the second week and concentrations continued to rise over the four-week period. Subject showing the greatest response were those starting with the lowest levels of plasma 25OHD. The findings suggest that ultra-violet irradiation is an effective means of treating vitamin D deficiency in old age and that patients with the greatest degree of deficiency show the greatest response.

Women's lived experience of conceptualizing the self: implications for health care practice.

In this article we describe a unique qualitative research design in which we used our own lived experiences as the basis for understanding theories of the self. Our purpose in this study was to (a) broaden current understandings of self theory, (b) juxtapose theories of the self with lived experiences of selfhood, and (c) use these new understandings to inform health care practice. The participants were four Canadian middle-aged female academic and health care practitioners. We conducted unstructured, open-ended interviews. Through a collaborative, interpretive process, four recurring themes emerged from the women's narratives: struggling for authenticity, inner knowing, changing over time, and the contextual self. We address the need for practitioners to understand theories of the self--their own and their clients--and how these theories impact their clinical practice.