Variation among faecal egg counts following natural nematode infection in Scottish Blackface lambs

Faecal egg counts were examined in 2 flocks of naturally infected Scottish Blackface sheep in southern and central Scotland. The distribution of mean counts was right skewed and similar to a gamma distribution. The counts varied with month, with mean counts rising from May to July, then falling but rising again in October, although data within each year did not always show such a clear pattern. There was no significant difference in mean egg count between the 2 farms examined. The distribution of egg count variances was also right skewed and conformed to a gamma distribution. There was a strong relationship between the mean and the variance for each population, implying that variation among populations in variances largely mirrored variation in mean egg counts. Populations with high mean egg counts and variances did not necessarily have more adult nematodes but had a greater number of adult nematodes from species other than Teladorsagia circumcincta, particularly Cooperia spp., Trichostrongylus axei and Trichostrongylus vitrinus. The contribution of different parasite species to the egg count explains the relatively poor and inconsistent fit of the negative binomial distribution to faecal egg counts in lambs.

Problem-based learning: Is anatomy a casualty?

INTRODUCTION

The teaching of medical anatomy is changing. Medical schools worldwide are moving away from dissection and lectures to a more integrated course, where basic science and clinical skills are taught simultaneously. Medical students on these integrated courses have reported a lack of confidence in their basic science knowledge, especially concerning anatomy. Our aim was to perform a randomised controlled trial (RCT) to compare anatomical knowledge of two groups of second-year medical students, the first group taught on a traditional course, the second on an integrated course.

MATERIALS AND METHODS

Testing was done using a Questionnaire in a "True/False" format. There were 80 students in each group. There was no penalty for an incorrect answer. The test was performed under examination conditions. Papers were marked under blind conditions. Results were analysed using a Student's t test analysis.

RESULTS

Those students taught on a traditional course exhibited a significantly higher level of basic anatomical knowledge (p<0.001) than those taught on an integrated course. The students taught on an integrated course showed a much greater range of results.

CONCLUSIONS

Students taught on a traditional course have a higher level of anatomical knowledge than those taught on an integrated course. Our results differ from previous studies done in Europe which show no difference between the courses.

Tobacco use in popular movies during the past decade

OBJECTIVE

The top 50 commercially successful films released per year from 1991 to 2000 were content coded to assess trends in tobacco use over time and attributes of films predictive of higher smoking rates.

DESIGN

This observational study used media content analysis methods to generate data about tobacco use depictions in films studied (n = 497). Films are the basic unit of analysis. Once films were coded and preliminary analysis completed, outcome data were transformed to approximate multivariate normality before being analysed with general linear models and longitudinal mixed method regression methods.

MAIN OUTCOME MEASURES

Tobacco use per minute of film was the main outcome measure used. Predictor variables include attributes of films and actors. Tobacco use was defined as any cigarette, cigar, and chewing tobacco use as well as the display of smoke and cigarette paraphernalia such as ashtrays, brand names, or logos within frames of films reviewed.

RESULTS

Smoking rates in the top films fluctuated yearly over the decade with an overall modest downward trend (p < 0.005), with the exception of R rated films where rates went up.

CONCLUSIONS

The decrease in smoking rates found in films in the past decade is modest given extensive efforts to educate the entertainment industry on this issue over the past decade. Monitoring, education, advocacy, and policy change to bring tobacco depiction rates down further should continue.

The relationship between IgA activity against 4th-stage larvae and density-dependent effects on the number of 4th-stage larvae ofTeladorsagia circumcinctain naturally infected sheep

The number ofTeladorsagia circumcincta4th-stage larvae in naturally infected lambs from a single farm varied among lambs and among different years. Within each year the distribution of 4th-stage larvae among lambs was similar to that expected from a negative binomial distribution. The ratio of 4th-stage larvae to adultT. circumcinctawas low in two years with a low mean intensity of infection but high in two years with a higher mean intensity of infection. The negative binomial distribution is defined by the mean and byk, a parameter that measures dispersion;kwas low when mean infection intensity was low but higher when mean infection intensity was high. Askis an inverse index of overdispersion this indicated that the distribution of 4th-stage larvae was more overdispersed at low levels of infection. In a combined analysis, the number of adultT. circumcinctaand the plasma IgA activity against 4th-stage larvae were both associated with increased numbers of 4th-stage larvae. There was a statistical interaction between the number of adults and IgA activity that moderated their combined effect.

The effect of shaft flexibility on junior golfers' performance

The aims of this study were to examine the effect of shaft flexibility on the performance of junior golfers and to determine whether there is a relationship between golfers' physical characteristics (16 anthropometric measures, age, experience, strength), performance and shaft flexibility. We assessed the performance of 30 male golfers, aged 7-10 years, with three 7-iron golf clubs of different shaft flexibility at a driving range. The performance parameters measured for equipment evaluation were ball distance achieved, shot dispersion and impact position of the ball on the clubface. The results suggest that there is no particular shaft flex suitable for the age group considered and that experience, strength and arm span are the significant factors when selecting optimal shaft flexibility for children.

Microsatellite identification and characterization in peanut ( A. hypogaea L.)

A major constraint to the application of biotechnology to the improvement of the allotetraploid peanut, or groundnut ( Arachis hypogaea L.), has been the paucity of polymorphism among germplasm lines using biochemical (seed proteins, isozymes) and DNA markers (RFLPs and RAPDs). Six sequence-tagged microsatellite (STMS) markers were previously available that revealed polymorphism in cultivated peanut. Here, we identify and characterize 110 STMS markers that reveal genetic variation in a diverse array of 24 peanut landraces. The simple-sequence repeats (SSRs) were identified with a probe of two 27648-clone genomic libraries: one constructed using PstI and the other using Sau3AI/ BamHI. The most frequent, repeat motifs identified were ATT and GA, which represented 29% and 28%, respectively, of all SSRs identified. These were followed by AT, CTT, and GT. Of the amplifiable primers, 81% of ATT and 70.8% of GA repeats were polymorphic in the cultivated peanut test array. The repeat motif AT showed the maximum number of alleles per locus (5.7). Motifs ATT, GT, and GA had a mean number of alleles per locus of 4.8, 3.8, and 3.6, respectively. The high mean number of alleles per polymorphic locus, combined with their relative frequency in the genome and amenability to probing, make ATT and GA the most useful and appropriate motifs to target to generate further SSR markers for peanut.

Current patterns of referral in breast disease

The aim was to audit symptomatic referrals to this breast unit in 1998, in order to ascertain the main diagnosis in relation to age, and thereby identify the percentage and age of patients who were reassured and discharged without investigation. 3199 general practitioner referrals were seen in 1998. Of these, 8.7% (n=274) were diagnosed as cancer and 91.3% (n=2925) were given a non-malignant diagnosis. In those under 40 years, only 18 patients of the 1231 seen were diagnosed with cancer, and only one of these was younger than 30 years (29 years). Twenty-seven per cent (n=333) of women under 40 were diagnosed as normal, and of these 14% (n=174) had no investigation. We confirm the recommendations of the guidelines issued by the Department of Health, that in younger women without discrete lumps or family history, clinical examination and reassurance is adequate. This audit should therefore empower general practitioners, to confidently reassure the younger patient, without a discrete lump.

Exploring knowledge and attitudes about emergency contraceptive pills among university students in Jamaica. A qualitative approach

Emergency contraceptive pills (ECPs) are an important option for university students who may be at high risk for unplanned pregnancies. In the Caribbean, little research has been carried out on university student's knowledge and opinions of this method. This study uses qualitative methodology to explore knowledge and opinions on ECPs among university students attending The University of the West Indies (UWI) Mona campus. We conducted eight focus groups (n = 71) with female and male university students at The University of the West Indies, Kingston, Jamaica, in March 2000. The group discussions lasted approximately two hours. We tape-recorded discussions and then transcribed and analyzed them by coding responses according to themes. General knowledge of ECPs was high, but students lacked specific information about the method such as its time frame and its mechanism of action. Most students supported the method, especially after learning correct information. However, several students were concerned about its side effects and the potential for abuse or irresponsible use by young adults. Although the university students in this study lacked detailed information about ECPs, their opinion toward the method was favourable. We suggest further research to investigate the prevalence of misinformation about the method among other groups of Jamaicans.

Duloxetine (Cymbalta™), a dual inhibitor of serotonin and norepinephrine reuptake

A series of naphthalenyloxy-arylpropylamines have been prepared and are demonstrated to be inhibitors of both serotonin and norepinephrine reuptake. One member of this series, duloxetine (Cymbalta) has proven to be effective in clinical trials for the treatment of depression.

Feasibility, accuracy and optimal location for oesophageal core temperature measurements using the ProSeal laryngeal mask airway drain tube

We determined the feasibility, accuracy and optimal location of oesophageal core temperature measurements using the ProSeal laryngeal mask airway drain tube. Thirty normothermic anaesthetized ventilated adults (ASA 1 to 2, aged 18 to 80 years) were studied. Temperatures were recorded using a thermistor at six different locations (middle of drain tube and at 0 to 20 cm distal to the drain tube in 5 cm increments) and compared to nasopharyngeal (thermistor) and aural (infrared tympanic thermometer) reference core temperatures. The temperature probe was successfully inserted into the oesophagus in all patients at the first attempt. Oesophageal temperature increased with depth from 0 to 5 cm (35.2 v 35.9, P < 0.0001) and 5 to 10 cm (35.9 v 36.3, P < 0.01), but was unchanged from 10 to 15 cm (36.3 v 36.6) and 15 to 20 cm (36.6 v 36.7). Aural temperature was higher than nasopharyngeal temperature (36.8 v 36.0, P < 0.0001). Aural temperature was 0.89 to 1.59 degrees C higher than the oesophagus at 0 to 5 cm and 0.21 to 0.30 degree C higher than the oesophagus at 15 to 20 cm. Nasopharyngeal temperature was 0.06 to 0.76 degree C higher than the oesophagus at 0 to 5 cm and 0.62 to 0.84 degree C lower than the oesophagus at 15 to 20 cm. The lowest temperature was in the mid-point of the drain tube (34.7). We conclude that oesophageal core temperature measurement is feasible and accurate using the ProSeal laryngeal mask airway. The optimal location for the temperature probe is at 15 to 20 cm.

Clinical assessment of a generic DNA amplification assay for the identification of respiratory adenovirus infections

BACKGROUND

respiratory adenoviruses are common, often resulting in serious sporadic and epidemic infections and impaired immunity can dramatically increase their severity. They are now thought capable of establishing latency. Diagnosis by culture is slow while direct antigen detection by immunofluorescence lacks sensitivity. Molecular diagnosis can be both rapid and sensitive but the genetic heterogeneity of adenoviruses poses problems.

OBJECTIVES

to design a generic adenovirus nested polymerase chain amplification assay designed to be capable of detecting all respiratory adenoviruses. This was achieved through optimised thermal cycling and the development of a generic degenerate primer set targeting the adenovirus hexon gene.

STUDY DESIGN

this was a cross-sectional study on 172 respiratory specimens from hospital-based patients, and one from a general practice, in Northern Ireland. A comparison was made between the amplification assay, virus culture and immunofluorescence.

RESULTS

the nested polymerase chain reaction (nPCR) assay had a generic capacity for adenovirus detection and an analytical sensitivity of 6.4x10(2) copies/ml. Using an expanded gold standard (defined as a true positive or a true negative where a specimen was positive or negative by at least two of the study assays, respectively), PCR had a clinical sensitivity and specificity of 46/46 (100%) and 15/126 (91.3%), respectively. Patients with acute respiratory adenovirus infections were more likely to be male (chi(2), p=0.005) and to present with a fever (chi(2), p=0.02) than patients diagnosed with another respiratory virus. Co-infection was identified in 12/172 patients.

CONCLUSIONS

the nested amplification assay proved highly sensitive in both the analytical and clinical settings for the detection of respiratory adenovirus infections.

Pain tolerance in upper limb disorders: findings from a community survey

AIMS

To test the hypothesis that non-specific upper limb pain arises from altered pain perception with reduced tolerance of sensory stimuli.

METHODS

Subjects undergoing clinical examination as part of a community based survey of upper limb disorders were invited to return for an assessment of pain tolerance. A standardised algorithm was used to classify the 94 participants according to whether they had specific upper limb disorders (n = 22), non-specific arm pain (n = 15), or no arm pain (n = 57). Pain tolerance was assessed at three anatomical sites in each arm in response to electrocutaneous stimulation with alternating currents up to a maximum of 10 mA at three frequencies (5, 250, and 2,000 Hz). A proportional odds model was used to compare pain tolerance thresholds according to sex, age, and diagnosis.

RESULTS

Women were less tolerant of pain than men (OR 0.13) and tolerance also declined with age (OR for one year increase in age 0.97). After allowance for sex and age, there was no indication that pain tolerance was lower in subjects with non-specific arm pain than in those with specific upper limb disorders or those who had no arm pain.

CONCLUSIONS

The study hypothesis was not supported. However, before the hypothesis is dismissed, it should be tested further in patients with more severe and disabling arm pain.

Adjunctive treatment of decompression illness with a non-steroidal anti-inflammatory drug (tenoxicam) reduces compression requirement

We report a randomized trial examining adjunctive administration of the NSAID, tenoxicam, to divers suffering with DCI. 180 subjects were graded for severity on admission and randomized according to a stratified random number schedule. Subjects were recompressed and treatment continued daily until symptom stabilization or complete resolution. Tenoxicam 20 mg or a placebo preparation was administered at the first air break during the initial recompression and continued daily for seven days. The subjects were assessed using a recovery status score at the completion of treatment and at 4-6 weeks. The proportion of patients with mild residual symptoms at discharge and final follow-up was not significantly different (discharge placebo 30% versus tenoxicam 37%, P=0.41; six weeks placebo 20% versus tenoxicam 17%, P=0.58). There was a significant reduction in the number of treatments required to achieve discharge (median treatments placebo 3, tenoxicam 2, P=0.01). 61% of patients in the tenoxicam group required less than 3 compressions, versus 40% in the placebo group (P=0.01, RRR 33 % [95%CI 9%-56%], NNT=5 [95%CI 3-18]). There was no evidence of increased complications of treatment in the tenoxicam group. When given this NSAID, patients with DCI require fewer hyperbaric oxygen (HBO2) sessions to achieve a standard clinical end-point and there is likely to be an associated cost saving.

Cholangiocarcinoma in primary sclerosing cholangitis: risk factors and clinical presentation

BACKGROUND

Primary sclerosing cholangitis (PSC) confers a high risk of cholangiocarcinoma (CC) development. Since patients at risk of CC may be selected for early liver transplantation, it is a challenge to identify any predisposing factors. We compared the presentation and natural history of a large number of PSC patients with and without later CC development to identify features associated with risk of CC.

METHODS

Clinical and laboratory data from presentation and follow-up were collected from 394 PSC patients from five European countries. The cohort included 48 (12.2%) patients with CC.

RESULTS

CC was diagnosed within the first year after diagnosis of PSC in 24 (50%) cases and in 13 (27%) patients at intended liver transplantation. Jaundice, pruritus, abdominal pain and fatigue were significantly more frequent at diagnosis of PSC in the group that developed CC, but not after exclusion of cases diagnosed within the first year. Inflammatory bowel disease was diagnosed at least 1 year before PSC more often among patients with CC development than among those without (90% and 65%, respectively: P = 0.001). The duration of inflammatory bowel disease before diagnosis of PSC was significantly longer in patients who developed CC than in the remaining group (17.4 years and 9.0 years, respectively: P=0.009 in multivariate analysis).

CONCLUSIONS

A high proportion of CC cases is diagnosed within the first year after diagnosis of PSC. A long history of inflammatory bowel disease is a risk factor for CC development.

Eosinophilia as a marker of resistance to Teladorsagia circumcincta in Scottish Blackface lambs

Faecal egg counts and peripheral blood eosinophil counts were taken from Scottish Blackface lambs following natural, predominantly Teladorsagia circumcincta infection. Peripheral eosinophil concentrations were higher in animals with lower egg counts but only in lambs that were at least 3 months of age. The reduced egg counts were due to reduced fecundity of T. circumcincta; there was no association with the number of adult T. circumcincta. Associations with the number of parasites from other species of gastrointestinal nematodes appeared to be neutral or favourable. Estimated heritabilities for eosinophil concentrations in 4- and 5-month-old lambs were 0.48 +/- 0.16 and 0.43 +/- 0.17, respectively. Therefore, under defined circumstances, eosinophil concentrations may be a useful indicator of resistance to predominantly T. circumcincta infection.