Mastitis in beef cows and the effects of supplemental β-carotene on milk parameters

Belmont red and Brahman cows (n = 50) were allocated to one of two groups to determine if β-carotene supplementation could reduce the incidence of mastitis and consequently improve calf productivity from birth to weaning. Both groups received a molasses-based supplement ad libitum; the treatment group supplement was fortified with ROVIMIX® β-carotene and ROVIMIX® E50 whereas the control group were provided access to the molasses supplement only. Blood samples were collected from cows pre and post calving and from calves when 84 ± 0.4 days old to measure plasma β-carotene concentration (PCC). Milk samples were collected 7 and 84 days post calving and at weaning and analysed for somatic cell count (SCC) and composition. Supplementation had no significant (P > 0.05) effect on SCC, calf PCC, calf LW gain and LW at weaning. Supplemented cows had significantly (P < 0.05) higher PCC compared with unsupplemented cows (4.9 ± 0.36 v. 3.9 ± 0.24 mg/L, respectively) at weaning. Cows commenced the study in an above-average condition, and combined with unseasonal green forage it is concluded that β-carotene supplementation has no effect on mastitis or calf weaning weight.

Bell-inequality violation with a triggered photon-pair source

Here we demonstrate, for the first time, violation of Bell's inequality using a triggered quantum dot photon-pair source without post-selection. Furthermore, the fidelity to the expected Bell state is increased above 90% using temporal gating to reject photons emitted at times when collection of uncorrelated light is more probable. A direct measurement of a CHSH Bell inequality is made showing a clear violation, highlighting that a quantum dot entangled photon source is suitable for communication exploiting nonlocal quantum correlations.

The North West Diabetic Pregnancy Audit: a practical system for multi-centre diabetic pregnancy audit

AIMS

Improving care for women with pre-gestational diabetic pregnancy is a core objective of the St Vincent Declaration and the Diabetes National Service Framework. The aim was to develop a practicable collaborative audit methodology for pre-gestational diabetic pregnancy.

METHODS

In 1999, care professionals in the north-west of England agreed standards and a simple monthly data collection system. Annual reports are compiled to summarize compliance with the standards. Each hospital receives an individualized report comprising tables and funnel plots that allow between-hospital comparisons.

RESULTS

Data on pre-gestational diabetic pregnancies are collated from 30 maternity units. Funnel plots and tables presented in the annual reports highlight any large differences between hospitals in booking and outcome measures for diabetic pregnancies.

CONCLUSIONS

The annual audit reports allow the assessment of current management and outcomes for diabetic pregnancies at a regional and local level. These reports help to identify areas where diabetic pregnancy care requires further attention.

Coherence of an entangled exciton-photon state

We study the effect of the exciton fine-structure splitting on the polarization entanglement of photon pairs produced by the biexciton cascade in a quantum dot. Entanglement persists despite separations between the intermediate energy levels of up to 4 microeV. Measurements show that entanglement of the photon pair is robust to the dephasing of the intermediate exciton state responsible for the first-order coherence time of either single photon. We present a theoretical framework incorporating the effects of spin scattering, background light, and dephasing. We distinguish between the first-order coherence time, and a parameter which we measure for the first time and define as the cross-coherence time.

Biphoton interference with a quantum dot entangled light source

We demonstrate optical interferometry beyond the limits imposed by the photon wavelength using 'triggered' entangled photon pairs from a semiconductor quantum dot. Interference fringes of the entangled biphoton state reveals a periodicity half of that obtained with the single photon, and much less than that of the pump laser. High fringe visibility indicates that biphoton interference is less sensitive to decoherence than interference of two sequential single photons. The results suggest that quantum interferometry may be possible using a semiconductor LED-like device.

The cochlear-carotid interval: anatomic variation and potential clinical implications

BACKGROUND AND PURPOSE

A temporal bone CT study in a patient with episodic mid-tone sensorineural hearing loss and tinnitus demonstrated absence of bone between the petrous internal carotid artery and the basal turn of the cochlea. The potential implications with respect to increasingly popular cochlear implant surgery compelled us to retrospectively analyze a series of temporal bone CT scans to establish typical measurements for this region, which we termed the "cochlear-carotid interval" (CCI).

METHODS

After IRB exemption, 2 observers independently measured the bony interval between the cochlea and the petrous internal carotid artery canal on coronal images from 30 consecutive temporal bone CT studies. The 1-mm thick coronal images were either acquired directly or were reconstructed from an axial dataset acquired at 0.75 or 0.6 mm section thickness. All measurements were performed by using electronic calipers on a Sienet MagicView VE 42 Siemens PACS station. Mixed model analysis of variance was used to evaluate differences between readers and sides with respect to the mean CCI but adjusted for age and accommodating the correlation among observations generated for the same subject.

RESULTS

The patient in our case report had a right CCI of 0.2 mm and left CCI of 0.0 mm. In the other 30 patients, the right CCI ranged from 0.2 to 3.8 mm (mean, 1.2 +/- 0.8 mm; median, 0.9) and the left CCI from 0.2 to 5.0 mm (mean, 1.1 +/- 0.9 mm; median, 0.8). The CCI did not exhibit a significant association with subject age (P = .1336), and there were no significant differences between readers (P = .824) or sides (P = .350) in terms of mean CCI.

CONCLUSION

The CCI varies widely between patients and may be as small as zero. Analysis of anatomic relationships suggests a potential relationship between small CCI and mid-tone sensorineural hearing loss, as in our reported patient. Preoperative knowledge of thin or absent bone between the cochlea and petrous carotid canal may help prevent inadvertent penetration of the carotid canal during cochlear implant surgery.

A semiconductor source of triggered entangled photon pairs

Entangled photon pairs are an important resource in quantum optics, and are essential for quantum information applications such as quantum key distribution and controlled quantum logic operations. The radiative decay of biexcitons-that is, states consisting of two bound electron-hole pairs-in a quantum dot has been proposed as a source of triggered polarization-entangled photon pairs. To date, however, experiments have indicated that a splitting of the intermediate exciton energy yields only classically correlated emission. Here we demonstrate triggered photon pair emission from single quantum dots suggestive of polarization entanglement. We achieve this by tuning the splitting to zero, through either application of an in-plane magnetic field or careful control of growth conditions. Entangled photon pairs generated 'on demand' have significant fundamental advantages over other schemes, which can suffer from multiple pair emission, or require post-selection techniques or the use of photon-number discriminating detectors. Furthermore, control over the pair generation time is essential for scaling many quantum information schemes beyond a few gates. Our results suggest that a triggered entangled photon pair source could be implemented by a simple semiconductor light-emitting diode.

A novel technique for post-pyloric feeding tube placement in critically ill patients: a pilot study

Delivery of enteral nutrition in critically ill patients is often hampered by gastric stasis necessitating direct feeding into the small intestine. Current techniques for placement of post-pyloric feeding catheters are complex, time consuming or both, and improvements in feeding tube placement techniques are required. The Cathlocator is a novel device that permits real time localisation of the end of feeding tubes via detection of a magnetic field generated by a small electric current in a coil incorporated in the tip of the tube. We performed a pilot study evaluating the feasibility of the Cathlocator system to guide and evaluate the placement of (1) nasoduodenal feeding tubes, and (2) nasogastric drainage tubes in critically ill patients with feed intolerance due to slow gastric emptying. A prospective study of eight critically ill patients was undertaken in the intensive care unit of a tertiary hospital. The Cathlocator was used to (1) guide the positioning of the tubes post-pylorically and (2) determine whether nasogastric and nasoduodenal tubes were placed correctly. Tube tip position was compared with data obtained by radiology. Data are expressed as median (range). Duodenal tube placement was successful in 7 of 8 patients (insertion time 12.6 min (5.3-34.4)). All nasogastric tube placements were successful (insertion time 3.4 min (0.6-10.0)). The Cathlocator accurately determined the position of both tubes without complication in all cases. The Cathlocator allows placement and location of an enteral feeding tube in real time in critically ill patients with slow gastric emptying. These findings warrant further studies into the application of this technique for placement of post-pyloric feeding tubes.

Comparison of processes and intermediate outcomes between South Asian and European patients with diabetes in Blackburn, north-west England

BACKGROUND

Diabetes and its complications are more prevalent among South Asians than people of European origin and there is some evidence that patients of South Asian origin with diabetes receive poorer quality care.

METHODS

Longitudinal study of patients with diabetes in Blackburn, UK. Processes of care indicators [measurement of blood pressure (BP), cholesterol and glycosolated haemoglobin (HbA1c)] and values of these intermediate outcomes were extracted for all patients registered on a diabetes information system for the period 1995-2001. Differences in processes of care indicators and intermediate outcomes between ethnic groups were estimated after adjusting for the potential confounding factors of sex, age and socioeconomic status (SES). Generalized estimating equations were used to model trends and to test for differences in trends over time.

RESULTS

Process of care was similar in South Asian and European patients. Mean BP and cholesterol concentration fell during the study period. South Asians had a higher level of HbA1c throughout the study period. South Asians had lower levels of BP and cholesterol in 1995 but the differences diminished or were abolished over time. SES did not explain differences between ethnic groups. Analyses stratified by baseline levels of intermediate outcomes (above or within target) demonstrated improvements among above target patients were greater among European patients.

CONCLUSIONS

Processes of care indicators are similar in diabetic patients of South Asian and European origin, irrespective of SES. However, there are worrying differences in improvements over time in the intermediate outcomes, and glycaemic control remained poorer among patients of South Asian origin patients throughout.

Quartz crystal microbalance-based measurements of shear-induced senescence in human embryonic kidney cells

Fluid shear and other mechanical forces play an important role in the normal biophysical, biochemical, and gene regulatory responses of vertebrate tissue that are reflected in the expression of normal cell differentiation, growth, and function. Despite some promising work reported on the application of the quartz crystal microbalance (QCM) to both prokaryote and eukaryote cells over the last decade, QCM has yet to be successfully applied to cells in culture under conditions of flow-induced shear. In this study, high sensitivity QCM in conjunction with fluid modelling was used to monitor the onset of senescence in immortalised human embryonic kidney cells under laminar shear stresses of between 0.04 and 335 dyne/cm(2). The feasibility of this approach as a means of quantification and characterisation of cell physiological response and adhesion are explored and discussed.

Specialist general practitioners and diabetes clinics in primary care: a qualitative and descriptive evaluation

AIMS

The aim of this study was to evaluate an innovative approach to the provision of primary care-based diabetes services in Bradford, UK. The service model differs from others in comprising 19 clinics which offer a specialist service, intermediate between primary and secondary care, to all patients within the Bradford area.

METHODS

The study included: analysis of referral, attendance and register data; questionnaires to general practitioners (GPs) and specialist clinic providers; qualitative interviews with clinic and other professional staff and patients; and an economic analysis.

RESULTS

The 19 clinics adopt a range of organizational models. In the first 3 1/2 years, 2415 patients were referred. There was a significant reduction in out-patient attendances at hospital, but also a significant increase in overall patient attendances. Specialist clinic patients differed from hospital patients in being older and having had diabetes for longer since diagnosis. Ten of the 14 clinics run by practising GPs attracted more referrals from within their practices than from outside. GPs and patients across the city believed the clinics were valuable, the main benefits being geographical accessibility, availability of specialists in a community setting, short waiting times for first appointments at most clinics, and continuity of staff. Their reservations included a lack of strategic planning in the location of clinics, long waiting times at some clinics, and poor communication at some clinics with referring GPs. The cost of the primary care clinics is similar to hospital clinics.

CONCLUSIONS

This model of specialist primary care services offers an opportunity to develop diabetes services that are convenient to patients, popular with practitioners, and increase capacity. However, the shortcomings as well as the advantages of the model need to be addressed if it is to be implemented elsewhere or for other patient groups.

Variations in process and outcomes of diabetes care by socio-economic status in Salford, UK

AIMS/HYPOTHESIS

Our aim was to investigate trends in provision and outcomes of care by socio-economic status among patients with diabetes in Salford, United Kingdom.

METHODS

Salford is a deprived urban area in North West England. Data for people with diabetes who were younger than 20 years of age (4034 patients in the year 1993 and 5671 by the year 2000) were extracted from the Diabetes Information System. Age-standardised means, proportions and attainment of targets were calculated for: processes of care indicators, intermediate outcomes and prescribing of preventive drug treatments in 1993 to 1994 and in 2000 to 2001 by quintiles of Townsend deprivation score. We did comparisons of means and proportions using age-adjusted linear regression and of trends using generalised estimating equations. Rate ratios for first microvascular and first macrovascular complication were estimated from proportional hazards models.

RESULTS

Marked improvements occurred in all indicators. For patients managed in primary care, blood pressure and cholesterol measurement increased from 53% to 64% (p<0.001) and 27% to 61% (p<0.001) respectively; whilst mean systolic blood pressure decreased from 147 to 140 mmHg (p<0.001) and cholesterol concentrations from 6.0 to 5.1 mmol/l (p<0.001). Mean HbA(1c) increased from 7.8 to 8.1% (p<0.001). Prescribing of aspirin, anti-hypertensive and lipid-lowering drugs increased greatly. Trends varied little by socio-economic status. Patients from more affluent areas generally received more frequent clinical monitoring and preventive treatments, and had a lower BMI (29.5 vs 30.2 kg/m(2); p=0.009) and HbA(1c) (7.8 vs 8.2% p=0.006), though risks of first microvascular or macrovascular complications were similar.

CONCLUSION/INTERPRETATION

Improvements in process and outcomes of care are possible for patients from all socio-economic groups. Socio-economic deprivation does not preclude high quality diabetes care.

A protocol for improved glycaemic control following corticosteroid therapy in diabetic pregnancies

AIMS

Diabetic pregnancies have an increased risk of respiratory distress syndrome (RDS) and preterm delivery. Antenatal corticosteroids can prevent RDS but induce acute severe hyperglycaemia. We have developed a protocol which prevents hyperglycaemia and can be used easily by ward staff.

METHODS

Intramuscular dexamethasone is given in two doses 12 h apart. Subcutaneous insulin and diet are continued but from the first dexamethasone dose until 12 h after the second, supplementary intravenous insulin is infused according to hourly blood glucose measurements. The protocol incorporates four graded sliding scales. The initial scale is selected according to the patient's current subcutaneous insulin dose and advanced if the blood glucose is > or = 10.1 mmol/l for 2 consecutive hours.

RESULTS

In a 10-month period eight (three gestational, five pre-gestational) women received antenatal corticosteroids from a total of 37 diabetic pregnancies. The median amount of supplementary intravenous insulin required was 74 U (range 32-88 U); the median glucose values achieved were 5.8-8.9 mmol/l. Seventy-five percent of glucose measurements were within an acceptable range of 4-10 mmol/l. Only one baby developed RDS.

DISCUSSION

Large amounts of supplementary intravenous insulin are needed to achieve even moderate glycaemic control. This protocol enables routine ward staff to manage this successfully.

The evolution of diabetes information systems

Diabetes information systems have already evolved rapidly in recent years along a developmental pathway initiated by the St Vincent Declaration, fuelled by the rapid pace of IT development in the 1990s and now endorsed by the emerging NHS information strategy. They will be central to the delivery of 'patient-centred' care and essential to supporting and monitoring the diabetes national service framework implementation. Widespread experience has identified three key principles. Firstly the need for a core data set that supports both service delivery and quality development. Secondly, because of the multiprofessional, multisector nature of diabetes care, there is a need to reconcile information from many diverse sources into unitary diabetes care records. Thirdly the crucial importance of making data collection a by-product of every day care delivery (i.e. no duplicate data entry). The work of many local innovators, allied to the increasing experience of the Diabetes UK sponsored UKDIABS project has generated substantial expertise. With the aid of new extraction/analysis tools such as QUIDS and a consistent approach to assessment, this work has hopefully laid secure foundations for monitoring the implementation of the national service framework. Furthermore, parallel developments under the aegis of the National electronic Library for Health (NeLH) should enable those involved with diabetes care to access relevant knowledge and information with ease. Increasingly user friendly ways by which patients can interact with their electronic records and linked knowledge sources will create many new opportunities. Diabetes information systems are likely to be at the forefront of diabetes care delivery in the future, providing patients and professionals with timely and accurate data for the organization and delivery of care.

In-patient management of diabetes mellitus and patient satisfaction

AIMS

To devise a system for assessing in-patient glycaemic control and care satisfaction in diabetic patients admitted to hospital for reasons other than their diabetes.

METHODS

Consecutive January to March 2001 case-notes were reviewed. Admissions with acute metabolic complications, acute myocardial infarction and pregestational or gestational diabetes were excluded. Glycaemic control, frequency of blood monitoring and management of hyperglycaemia were recorded. The diabetes treatment satisfaction questionnaire was used to assess preadmission satisfaction with care. Post-admission a 12-stem questionnaire was used to assess satisfaction with in-patient diabetes management.

RESULTS

Hypoglycaemia was common. Although none developed a hyperglycaemic emergency, high blood glucose was prevalent and, frequently, persistent hyperglycaemia or recurrent hypoglycaemia was not acted on appropriately. The overall score for in-patient satisfaction with treatment was fair (4.1 +/- 1.8 on a six-point scale; 6 = very satisfied and 1 = very dissatisfied). Scores were higher among patients on surgical wards than on medical wards (P = 0.008), but satisfaction did not vary when patients were stratified according to sex, age and mode of treatment.

CONCLUSION

Current systems are not achieving satisfactory in-patient glycaemic control and there is poor satisfaction with medical in-patient diabetes care. Following changes intended to produce improvements, this assessment system can be used recurrently to monitor in-patient care and satisfaction.