Parity and housing effects on the behavioural and hypothalamic-pituitary-adrenal axis responses of pregnant ewes

It is common in many countries for sheep to be housed during winter from mid-gestation until lambing to protect ewes and lambs from adverse conditions and improve late gestation nutritional management. Keeping ewes indoors, however, has its own challenges as the animals may be mixed with unfamiliar conspecifics, have limited floor and feeding space, experience changes to their diet and increased handling by humans. Therefore, the objective of this study was to investigate the effect of variation in housing management (space allowance and social stability) on the behaviour and hypothalamic-pituitary-adrenal (HPA) axis responses of pregnant ewes from mid-to-late gestation (weeks 11-18 of pregnancy). Seventy-seven ewes (41 primiparous, 36 multiparous) were divided into two groups: 'Control' and 'Restricted space and mixed' (RS-Mix), where RS-Mix ewes were allocated half the amount of space (1.27 vs 2.5 m2 for RS-Mix and Control, respectively) and feedface (concentrate feeder space) allowance (36 vs 71 cm per ewe) given to the Control group and were also subjected to two social mixing events. Aggressive behaviour at the feedface and time spent standing, lying, walking, feeding and ruminating were recorded and faecal samples were collected for assessment of faecal glucocorticoid metabolite (FGM) concentrations. Higher aggression was observed in RS-Mix ewes during the first week of observation (P = 0.044), which gradually declined to the same level as Control ewes by the end of the study (P = 0.045). RS-Mix ewes were significantly less likely to be able to freely join the feedface compared to Controls (P = 0.022). No other significant treatment effects on aggressive behaviour or FGM during gestation were found. RS-Mix ewes displayed significantly higher ruminating behaviour at week 18 of gestation compared to Control ewes (P < 0.001), but no other effects were seen on general pen behaviour. However, the effect of indoor housing had a significant impact on primiparous ewes, who had lower weight gain (P = 0.015) and higher FGM concentrations (P = 0.014) compared to multiparous ewes regardless of treatment group. The data suggest that, although no sustained effects on behaviour or HPA axis responses were seen with the differences in space and feeder allowance or social stability at the levels used in this study, inexperienced (primiparous) ewes may find indoor housing more stressful; and are less able to adapt compared to multiparous ewes. These effects may influence the behaviour of the ewe at lambing time, and her offspring.

Atmospheric pollution, soil nutrients and climate effects on Mucoromycota arbuscular mycorrhizal fungi

Fine root endophyte mycorrhizal fungi in the Endogonales (Mucoromycota arbuscular mycorrhizal fungi, M‐AMF) are now recognized as at least as important globally as Glomeromycota AMF (G‐AMF), yet little is known about the environmental factors which influence M‐AMF diversity and colonization, partly because they typically only co‐colonize plants with G‐AMF. Wild populations of Lycopodiella inundata predominantly form mycorrhizas with M‐AMF and therefore allow focussed study of M‐AMF environmental drivers. Using microscopic examination and DNA sequencing we measured M‐AMF colonization and diversity over three consecutive seasons and modelled interactions between these response variables and environmental data. Significant relationships were found between M‐AMF colonization and soil S, P, C:N ratio, electrical conductivity, and the previously overlooked micronutrient Mn. Estimated N deposition was negatively related to M‐AMF colonization. Thirty‐nine Endogonales Operational Taxonomic Units (OTUs) were identified in L. inundata roots, a greater diversity than previously recognized in this plant. Endogonales OTU richness correlated negatively with soil C:N while community composition was mostly influenced by soil P. This study provides first evidence that M‐AMF have distinct ecological preferences in response to edaphic variables also related to air pollution. Future studies require site‐level atmospheric pollution monitoring to guide critical load policy for mycorrhizal fungi in heathlands and grasslands.

Non-invasive Detection of Persistent Cortical Hypoxia in Multiple Sclerosis Using Frequency Domain Near-Infrared Spectroscopy (fdNIRS)

There may be a relationship between hypoxia and inflammation, which is important in the outcomes of a wide array of human diseases. Multiple sclerosis (MS) is one such disease. There is evidence that hypoxia may influence inflammation in MS. We showed previously that about 40% of participants with MS had hypoxia in the cortical grey matter using frequency-domain near-infrared spectroscopy (fdNIRS). In this study, we aimed to determine if hypoxia in MS persists chronically (for a year or more) by measuring at baseline and ≥12 months later. We found that hypoxia persists for at least a year in 80% of participants with MS. As more individuals remained hypoxic than returned to normoxia, the development of hypoxia may relate to disease progression.

The effect of orthopaedic surgeons' and interventional radiologists' availability on the priority treatment sequence for hemodynamically unstable pelvic fractures: a survey of US Level I trauma centers

BACKGROUND

Most guidelines recommend both pelvic packing (PP) and angioembolization for hemodynamically unstable pelvic fractures, however their sequence varies. Some argue to use PP first because orthopaedic surgeons are more available than interventional radiologists; however, there is no data confirming this.

METHODS

This cross-sectional survey of 158 trauma medical directors at US Level I trauma centers collected the availability of orthopaedic surgeons and interventional radiologists, the number of orthopaedic trauma surgeons trained to manage pelvic fractures, and priority treatment sequence for hemodynamically unstable pelvic fractures. The study objective was to compare the availability of orthopaedic surgeons to interventional radiologists and describe how the availability of orthopaedic surgeons and interventional radiologists affects the treatment sequence for hemodynamically unstable pelvic fractures. Fisher's exact, chi-squared, and Kruskal-Wallis tests were used, alpha = 0.05.

RESULTS

The response rate was 25% (40/158). Orthopaedic surgeons (86%) were on-site more often than interventional radiologists (54%), p = 0.003. Orthopaedic surgeons were faster to arrive 39% of the time, and interventional radiologists were faster to arrive 6% of the time. There was a higher proportion of participants who prioritized PP before angioembolization at centers with above the average number (> 3) of orthopaedic trauma surgeons trained to manage pelvic fractures, as among centers with equal to or below average, p = 0.02. Arrival times for orthopaedic surgeons did not significantly predict prioritization of angioembolization or PP.

CONCLUSIONS

Our results provide evidence that orthopaedic surgeons typically are more available than interventional radiologists but contrary to anecdotal evidence most participants used angioembolization first. Familiarity with the availability of orthopaedic surgeons and interventional radiologists may contribute to individual trauma center's treatment sequence.

Willingness to pay for policies to reduce future deaths from climate change: evidence from a British survey

OBJECTIVES

Without urgent action, climate change will put the health of future populations at risk. Policies to reduce these risks require support from today's populations; however, there are few studies assessing public support for such policies. Willingness to pay (WtP), a measure of the maximum a person is prepared to pay for a defined benefit, is widely used to assess public support for policies. We used WtP to investigate whether there is public support to reduce future health risks from climate change and if individual and contextual factors affect WtP, including perceptions of the seriousness of the impacts of climate change.

STUDY DESIGN

A cross-sectional British survey.

METHODS

Questions about people's WtP for policies to reduce future climate change-related deaths and their perceptions of the seriousness of climate change impacts were included in a British survey of adults aged 16 years and over (n=1859). We used contingent valuation, a survey-based method for eliciting WtP for outcomes like health which do not have a direct market value.

RESULTS

The majority (61%) were willing to pay to reduce future increases in climate change-related deaths in Britain. Those regarding climate change impacts as not at all serious were less willing to pay than those regarding the impacts as extremely serious (OR 0.04, 95% CI 0.02-0.09). Income was also related to WtP; the highest-income group were twice as likely to be willing to pay as the lowest-income group (OR 2.14, 95% CI 1.40-3.29).

CONCLUSIONS

There was public support for policies to address future health impacts of climate change; the level of support varied with people's perceptions of the seriousness of these impacts and their financial circumstances. Our study adds to evidence that health, including the health of future populations, is an outcome that people value and suggests that framing climate change around such values may help to accelerate action.

Maintaining social care provision in the context of financial austerity

There is significant national interest in tackling issues surrounding the needs of vulnerable children and adults. At the same time, UK cities are under significant financial strain, as local government financial settlements (the distribution of central government resources) decrease in real terms and yet urban populations, which draw on local government services, continue to grow. This study focusses on the city of Birmingham, the UK's largest and most populous city outside of London. In a data-led study, using data derived from personal social care records, we analyse the management and delivery of social care services by Birmingham City Council, which itself is the largest local authority in Europe. This research employs state-of-the-art data analytic techniques to analyse six years of Birmingham City Council social care data, to identify: (i) Service cost profiles over time; (ii) Geographic dimensions to service demand and delivery; (iii) Patterns in the provision of services, which may assist with future service planning and provision and (iv) The extent to which data value and data protection interact. In response to recent fiscal challenges, Birmingham City Council is expected to make savings of £815 million over the 9-year period 2011/12 to 2019/20. Delivering savings of this scale, whilst protecting and safeguarding the most vulnerable citizens within a growing urban population, is one of the biggest challenges facing the UK's second largest city.

Patient perceptions of clear/almost clear skin in moderate-to-severe plaque psoriasis: results of the Clear About Psoriasis worldwide survey

BACKGROUND

Therapeutic advances have made the achievement of clear/almost clear skin possible for many patients with moderate-to-severe plaque psoriasis.

OBJECTIVE

To determine patient perceptions of the impact of psoriasis and of attaining clear/almost clear skin.

METHODS

Global survey of patients with moderate-to-severe psoriasis.

RESULTS

A total of 8338 patients from 31 countries participated. The majority (57%) had not achieved self-assessed clear/almost clear skin with their current therapy, and 56% of those who had not met this goal believed it would be impossible to do so. Among the patients who had clear/almost clear skin, 73% had not initiated their current treatment until >1 year after psoriasis diagnosis, and 28% had to wait >5 years. Eighty-four percent of all respondents experienced discrimination and/or humiliation due to psoriasis, and many reported negative effects on work, intimate relationships, sleep and mental health. Patients without clear/almost clear skin reported that such achievement would open new possibilities, such as swimming (58%), a wider choice of clothing (40%), and meeting new people (26%). A limitation of this study, as with any survey-based research, is that selection and recall bias may have been present. Additionally, respondent definitions of clear/almost clear skin were subjective and may have varied.

CONCLUSION

Despite the importance of clear/almost clear skin to psoriasis patients, most are still not achieving it, and many are unaware it is possible.

Exploring knowledge, attitudes and experience of genitourinary symptoms in women with early breast cancer on adjuvant endocrine therapy

Clinical trials of adjuvant endocrine therapy in women with early breast cancer have consistently reported that genitourinary symptoms are common. However, little is known about women's experiences of genitourinary symptoms, their views about the symptoms and how they impact on their lives. The aim of this study was to explore knowledge, attitudes and experiences of genitourinary symptoms among women receiving adjuvant endocrine therapy for early breast cancer. Thirty-two semi-structured interviews were conducted and subjected to a rigorous qualitative analysis. Genitourinary symptoms were commonly reported to negatively impact on personal, social and physical activities, were often attributed to anxiety and stress and were a source of embarrassment. Women also commented on the limited information available or provided regarding the potential genitourinary adverse effects of adjuvant endocrine therapy. There was a general lack of awareness that their symptoms could be associated with or exacerbated by adjuvant endocrine therapy. Women indicated a preference to receive information and advice about potential management options from either their general practitioner or specialist. These findings underscore the importance of improving communication and increasing awareness among both clinicians and patients about the potential impact of adjuvant endocrine therapy on genitourinary symptoms.

Changes in gait which occur before and during the adolescent growth spurt in children treated by selective dorsal rhizotomy

This paper presents long term follow up results from 17 children (6 girls, 11 boys, GMFCS levels II-IV), treated by means of selective dorsal rhizotomy (SDR). The particular focus is on the effect of the adolescent growth spurt on patients who had previously undergone SDR. The children were all assessed using 3D gait analysis, in combination with clinical examination at three time points-before SDR surgery (PRE), after SDR surgery when pre-adolescent (POST1) and post-adolescence (POST2). The total follow up period to POST2 was 8 years 6 months for girls and 9 years 5 months for boys. All children maintained or improved their GMFCS level. Positive changes in ranges of motion and gait were observed at POST1 and these were generally maintained over adolescence to POST2. The mean Gait Profile Score (GPS) had improved by 3.2 points (14.7-11.5) at POST1, with a non-significant deterioration of 0.3 over the adolescent growth spurt. These positive results reflect the total package of care for the children, involving careful pre-operative selection by a multidisciplinary team and post-operative management including intensive physiotherapy and maintenance in tuned ankle foot orthoses. Fifty-nine per cent of children had some additional orthopaedic surgery, mostly bony procedures. The overall benefits arising from their management need to be considered in the light of the likely deterioration experienced by this patient group. The results of this study support the use of SDR as part of a management strategy for carefully selected children with cerebral palsy with the aim of optimizing gait at skeletal maturity.

Behavioral and physiological responses of primiparous sows to mixing with older, unfamiliar sows

Pigs are mixed into new social groups at various stages of production, and this study investigated the response of gilts to mixing with older unfamiliar sows. Four groups of 6 gilts and 1 group of 5 gilts were housed in stable groups until the most recently bred female reached d 39 of gestation. Then, stable groups were split such that 15 gilts remained in their home pens (CON) and 14 gilts were mixed (MIX) with 3 multiparous sows for 1 wk (M1), returned to the home pen for 1 wk, and then mixed with 3 different sows for 1 wk (M2). Continuous behavioral observations of gilt location in the pen, posture, aggressive, and other social interactions were made from the start of M1 and M2 for 5 h. Five-minute scans of location, posture, and behavior as well as salivary cortisol measurements were taken before, during, and after each mix week, whereas skin lesions were counted before and after each mix. During the mixed period, MIX gilts spent more (P ≤ 0.009) time in the individual feeding stalls, ventral lying, sitting, involved in aggression, and idle and less (P < 0.001) time in the straw-bedded area, lateral lying, and performing exploratory behavior (chewing, nosing, and rooting) than CON gilts. Additionally, MIX gilts had greater (P < 0.001) salivary cortisol concentrations and accumulated more (P < 0.001) skin lesions during mixing sessions compared to CON gilts. Mixed gilts in M2 spent more (P ≤ 0.013) time in the feeding stalls and ventral lying and less (P ≤ 0.029) time standing and in the dunging passageway compared to M1. Compared to M1, gilts had lower (P < 0.001) salivary cortisol concentrations and fewer (P ≤ 0.027) lesions in front and middle regions of the body during M2. During M2, salivary cortisol concentration was positively correlated with time spent in the dunging passageway (Spearman's rank correlation [rs] = 0.650, P = 0.022) and negatively correlated with time spent in the feeding stalls (rs = -0.762, P = 0.004). Results indicated that gilts adapted their behavior during M2 by using the feeding stalls more, and they became less active, especially when interacting with the sows. Despite this adaptation in M2, lesions and salivary cortisol in M IX gilts were much greater than in CON gilts, highlighting the severity of mixing gilts with multiparous sows.

Microbial contamination of domiciliary nebulisers and clinical implications in chronic obstructive pulmonary disease

Background and purpose

Domiciliary nebulisers are widely used in chronic obstructive pulmonary disease (COPD) but nebuliser cleaning practice has not been assessed in patients with COPD who are often elderly and may have severe disease and multiple comorbidities. We aimed to evaluate microbial contamination of home nebulisers used by patients with COPD.

Methods

Random microbiological assessment of domiciliary nebulisers was undertaken together with an enquiry into cleaning practices. We also examined the effectiveness of the trust-wide cleaning instructions in eradicating isolated microorganisms in a laboratory setting.

Results

The mean age of patients in this study was 71 (range 40–93) years, and in 68% of patients a large number of significant comorbidities were present. Forty-four nebuliser sets were obtained and 73% were contaminated with microorganisms at >100 colony forming units/plate. Potentially pathogenic bacteria colonised 13 of the 44 nebulisers (30%) and organisms isolated included Pseudomonas aeroginosa, Staphylococcus aureus, multidrug resistant Serratia marcesans, Escherichia coli and multiresistant Klebsiella spp, Enterobacteriaceae and fungus Fusarium oxysporum. Washing of nebuliser masks, chambers and mouthpieces achieved complete eradication of Gram-positive bacterial and fungal flora. Gram-negative organisms were incompletely eradicated, which may be attributed to the presence of biofilms. We also found that in patients with pathogenic organisms cultured on the nebuliser sets, there was a higher probability of occurrence of a COPD exacerbation with a mean number of exacerbations of 3.3 (SD=1) per year in the group in whom pathogens were isolated compared with 1.7 (SD=1.2) exacerbations per year in those whose sets grew non-pathogenic flora (p=0.02).

Conclusions

Nebulisers contaminated with microorganisms are potential reservoirs delivering serious pathogens to the lung. Relationships between nebuliser contamination, clinical infection and exacerbations require further examination, but is a potential concern in elderly patients with COPD with comorbidities who fail to effectively maintain reasonable standards of nebuliser cleanliness.

Regional scale gradients of climate and nitrogen deposition drive variation in ectomycorrhizal fungal communities associated with native Scots pine

Ectomycorrhizal fungi commonly associate with the roots of forest trees where they enhance nutrient and water uptake, promote seedling establishment and have an important role in forest nutrient cycling. Predicting the response of ectomycorrhizal fungi to environmental change is an important step to maintaining forest productivity in the future. These predictions are currently limited by an incomplete understanding of the relative significance of environmental drivers in determining the community composition of ectomycorrhizal (ECM) fungi at large spatial scales. To identify patterns of community composition in ECM fungi along regional scale gradients of climate and nitrogen deposition in Scotland, fungal communities were analysed from 15 seminatural Scots pine (Pinus sylvestris L.) forests. Fungal taxa were identified by sequencing of the ITS rDNA region using fungal-specific primers. Nonmetric multidimensional scaling was used to assess the significance of 16 climatic, pollutant and edaphic variables on community composition. Vector fitting showed that there was a strong influence of rainfall and soil moisture on community composition at the species level, and a smaller impact of temperature on the abundance of ectomycorrhizal exploration types. Nitrogen deposition was also found to be important in determining community composition, but only when the forest experiencing the highest deposition (9.8 kg N ha(-1)  yr(-1) ) was included in the analysis. This finding supports previously published critical load estimates for ectomycorrhizal fungi of 5-10 kg N ha(-1)  yr(-1) . This work demonstrates that both climate and nitrogen deposition can drive gradients of fungal community composition at a regional scale.

Probing the location of displayed cytochrome b562 on amyloid by scanning tunnelling microscopy

Amyloid fibres displaying cytochrome b562 were probed using scanning tunnelling microscopy (STM) in vacuo. The cytochromes are electron transfer proteins containing a haem cofactor and could, in principle, mediate electron transfer between the tip and the gold substrate. If the core fibres were insulating and electron transfer within the 3D haem network was detected, then the electron transport properties of the fibre could be controlled by genetic engineering. Three kinds of STM images were obtained. At a low bias (<1.5 V) the fibres appeared as regions of low conductivity with no evidence of cytochrome mediated electron transfer. At a high bias, stable peaks in tunnelling current were observed for all three fibre species containing haem and one species of fibre that did not contain haem. In images of this kind, some of the current peaks were collinear and spaced around 10 nm apart over ranges longer than 100 nm, but background monomers complicate interpretation. Images of the third kind were rare (1 in 150 fibres); in these, fully conducting structures with the approximate dimensions of fibres were observed, suggesting the possibility of an intermittent conduction mechanism, for which a precedent exists in DNA. To test the conductivity, some fibres were immobilized with sputtered gold, and no evidence of conduction between the grains of gold was seen. In control experiments, a variation of monomeric cytochrome b562 was not detected by STM, which was attributed to low adhesion, whereas a monomeric multi-haem protein, GSU1996, was readily imaged. We conclude that the fibre superstructure may be intermittently conducting, that the cytochromes have been seen within the fibres and that they are too far apart for detectable current flow between sites to occur. We predict that GSU1996, being 10 nm long, is more likely to mediate successful electron transfer along the fibre as well as being more readily detectable when displayed from amyloid.

Complex design of dissipation signals in non-contact atomic force microscopy

Complex interplay between topography and dissipation signals in Non-Contact Atomic Force Microscopy (NC-AFM) is studied by a combination of state-of-the-art theory and experiment applied to the Si(001) surface prone to instabilities. Considering a wide range of tip-sample separations down to the near-contact regime and several tip models, both stiff and more flexible, a sophisticated architecture of hysteresis loops in the simulated tip force-distance curves is revealed. At small tip-surface distances the dissipation was found to be comprised of two related contributions due to both the surface and tip. These are accompanied by the corresponding surface and tip distortion approach-retraction dynamics. Qualitative conclusions drawn from the theoretical simulations such as large dissipation signals (>1.0 eV) and a step-like dissipation dependent on the tip-surface distance are broadly supported by the experimental observations. In view of the obtained results we also discuss the reproducibility of NC-AFM imaging.

Precise orientation of a single C60 molecule on the tip of a scanning probe microscope

We show that the precise orientation of a C(60) molecule which terminates the tip of a scanning probe microscope can be determined with atomic precision from submolecular contrast images of the fullerene cage. A comparison of experimental scanning tunneling microscopy data with images simulated using computationally inexpensive Hückel theory provides a robust method of identifying molecular rotation and tilt at the end of the probe microscope tip. Noncontact atomic force microscopy resolves the atoms of the C(60) cage closest to the surface for a range of molecular orientations at tip-sample separations where the molecule-substrate interaction potential is weakly attractive. Measurements of the C(60)-C(60) pair potential acquired using a fullerene-terminated tip are in excellent agreement with theoretical predictions based on a pairwise summation of the van der Waals interactions between C atoms in each cage, i.e., the Girifalco potential [L. Girifalco, J. Phys. Chem. 95, 5370 (1991)].

Angiotensin Receptor Blockers in Clinical Practice — Implications of the ONTARGET Study

Hypertension and cardiovascular disease remain the major causes of premature morbidity and mortality. Following a diagnosis of hypertension, treatment with antihypertensive medication will almost invariably be lifelong. Even when prescribed treatment, many patients remain above blood pressure goals, and this is particularly common in patients at high risk of cardiovascular events due to the presence of other risk factors such as diabetes mellitus. An important cause of this failure is medication nonadherence, which is particularly common with treatments that have side-effects. Antihypertensive drugs do not make the patient feel better in the short term, but side-effects often occur immediately. The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) is highly relevant to clinical practice because it demonstrated that the angiotensin receptor blocker (ARB) telmisartan is as effective as the proven angiotensin-converting enzyme inhibitor ramipril in preventing cardiovascular events in high-risk patients, while being better tolerated. Evidence of the advantages of telmisartan in the management of cardiovascular morbidity suggest, therefore, that it might be a better treatment option for hypertensive patients and that switching to generic ARBs may not always be best.

Genetic parameters of piglet survival and birth weight from a two-generation crossbreeding experiment under outdoor conditions designed to disentangle direct and maternal effects

Multivariate Bayesian linear-threshold models were used to estimate genetic parameters of peri- and postnatal piglet survival and individual birth weight of piglets reared under outdoor conditions. Data of 21,835 individual piglet observations were available from a 2-generation crossbreeding experiment selected for direct and maternal genetic effects of postnatal piglet survival on piglet and dam levels, respectively. In the first generation, approximately one-half of the Landrace sires used were selected for large or average breeding values of maternal genetic effects on postnatal piglet survival, whereas in the second generation the Large White sires used were selected for direct genetic effects of the same trait. Estimates of direct and maternal heritability were 0.21 and 0.15, 0.24 and 0.14, and 0.36 and 0.28 for piglet survival at birth and during the nursing period, and individual birth weight, respectively. In particular, direct heritabilities are substantially larger than those from the literature estimated for indoor-reared piglets, suggesting that genetic effects of these traits are substantially greater under outdoor conditions. Direct or maternal genetic correlations between survival traits or with birth weight were small (ranging from 0.06 to 0.17), indicating that peri- and postnatal survival are genetically under rather different control, and survival was only slightly positively influenced by birth weight. There were significant (P < 0.05) negative genetic correlations between direct and maternal genetic effects within each of the analyzed traits ranging from -0.36 to -0.45, which have to be considered when selecting for piglet survival. Adjustment of traits for litter size or inclusion of genetic groups showed insignificant effects on the magnitude of the estimated genetic parameters. The magnitude of genetic parameters suggested that there is substantial potential for genetic improvement of survival traits and birth weight in direct and maternal genetic effects, especially when piglets are kept under outdoor conditions.

Investigating the behavioural and physiological indicators of neonatal survival in pigs

Survival is reduced in low birth weight piglets, which display poor thermoregulatory abilities and are slow to acquire colostrum. Our aim was to identify additional behavioural and physiological indicators of piglet survival incorporating traits reflective of both the intrauterine and extrauterine environment. Data were collected from 135 piglets from 10 Large White x Landrace sows to investigate which physiological measurements (e.g. individual placental traits), and which behavioural measurements (e.g. the quantification of piglet vigour), were the best indicators of piglet survival. Generalised linear models confirmed piglet birth weight as a critical survival factor. However, with respect to stillborn mortality, piglet shape and size, as measured by ponderal index (birth weight/(crown-rump length)(3)), body mass index (birth weight/(crown-rump length)(2)), respectively, and farrowing birth order were better indicators. With respect to live-born mortality, postnatal survival factors identified as crucial were birth weight, vigour independent of birth weight, and the latency to first suckle. These results highlight the importance of the intrauterine environment for postnatal physiological and behavioural adaptation and identify additional factors influencing piglet neonatal survival.

Social inequalities in preterm birth in Scotland 1980-2003: findings from an area-based measure of deprivation

OBJECTIVE

The preterm birth rate in Scotland has been increasing in recent years. Although preterm birth rates show a social gradient, it is unclear how this gradient has been affected by the overall increase. We examined time trends in singleton live preterm birth rates in relation to area-based socio-economic indicators.

DESIGN

Population-based retrospective cohort study.

SETTING

Scotland.

PARTICIPANTS

All singleton live births delivered in Scottish hospitals between 1980 and 2003 (n= 1 423 993).

MAIN OUTCOME MEASURES

Singleton live preterm birth rates in each deprivation quintile were derived. Subgroup analyses of those born moderately preterm (32-36 weeks), very preterm (28-31 weeks) and extremely preterm (24-27 weeks) were performed.

RESULTS

The rate of singleton live preterm births increased from 49.7 per 1000 live births in the 5-year period 1980-84 to 56.1 per 1000 in the 4-year period 2000-03, a relative increase of 12.9%. A marked social gradient was apparent at all time periods: relative indices of inequality were 1.63 (95% CI 1.38-1.92) in 1980-84 and 1.55 (1.44-1.66) in 2000-03. Similar social gradients existed for all gestational age subgroups. Smoking status at first antenatal contact and increased obstetric intervention, possibly reflecting improvements in fetal monitoring and neonatal care, appeared to explain some but not all the social gradient.

CONCLUSIONS

Social inequalities in preterm birth were apparent in Scotland between 1980 and 2003. In addition to helping pregnant women to stop smoking, other means to reduce social inequalities are required.

A qualitative study of the physical, social and attitudinal environments influencing the participation of children with cerebral palsy in northeast England

PURPOSE

The social model of disability considers participation to be determined by the social, attitudinal and physical environments experienced by an individual. This study aims to ascertain from families of children with cerebral palsy the features of such environments which facilitate or restrict participation.

METHOD

Thirteen in-depth interviews using a topic guide were conducted with the parents of children with cerebral palsy. Interviews were tape-recorded, transcribed and analysed with NVivo software.

RESULTS

The main themes emerging from the interviews were the importance of mobility, transport, support by and to parents and attitudes of individuals and institutions towards children. Most parents did not raise the policies and legislation determining participation barriers, although these are also likely to be influential.

CONCLUSIONS

This study confirms the importance of the environment for the participation of children with cerebral palsy. Statutory agencies need to attend the attitudes and policies in their organization in order to plan the inclusive environments which parents report will facilitate their child's participation. This study also contributes to the development of a tool to quantify the environment to allow the development of models to determine the environments which maximize children's participation.

How might districts identify local barriers to participation for children with cerebral palsy?

OBJECTIVES

To explore how data about participation and the local environment might be used to identify barriers to participation for children with cerebral palsy.

METHODS

Participation is measured at 5 years of age using the six domains of the lifestyle assessment questionnaire. Individual child score profiles are compared with expected patterns from similar children and with the use of relevant services. Average scores for districts are compared with selected local authority performance indicators. Self-completion questionnaires are used to solicit information on barriers from families of children.

RESULTS

Individual children who have poorer-than-expected participation scores and those who make less-than-expected use of relevant services can be identified. Children who live in districts with more facilities for the disabled appear to have better social participation scores. Common local barriers as well as specific access problems for individuals are revealed by simple questionnaires to families. Attitudes of strangers and staff in public places, lack of suitable transport and the presence of stairs are important barriers in many settings.

CONCLUSIONS

Environmental barriers for children with cerebral palsy can be identified and related to their participation.

Intrauterine growth restriction and fetal body composition

OBJECTIVE

To assess the differences in fetal body compartments between fetuses with normal growth and those with reduced intrauterine growth, during the third trimester, through ultrasonographic determination of subcutaneous tissue thickness (SCTT).

METHODS

Twenty-eight patients were enrolled into this case control study carried out at 30-31 weeks' gestation. Two study groups were matched for maternal age and pregestational body mass index: controls (n = 14) and intrauterine growth-restricted (IUGR) fetuses (n = 14). Routine ultrasound-derived biometric parameters (head circumference, abdominal circumference, femur length and humerus length) were measured. Additionally, the mid-arm fat mass and lean mass (MAFM and MALM), the mid-thigh fat mass and lean mass (MTFM and MTLM), the abdominal fat mass (AFM) and the subscapular fat mass (SSFM) were measured. The Mann-Whitney U-test and Student's t-test were used to compare the two groups.

RESULTS

The abdominal circumference and the humerus were significantly smaller in IUGR fetuses than in controls. Most of the SCTT values were different in the two groups. The SSFM (3.6 +/- 1.1 vs. 2.6 +/- 0.7 mm; P = 0.011), the AFM (5.1 +/- 0.7 vs. 4 +/- 1 mm; P = 0.01), the MAFM (3.5 +/- 0.9 vs. 2.2 +/- 0.8 cm2; P < 0.01) and MALM (2.1 +/- 0.4 vs. 1.7 +/- 0.5 cm2; P = 0.029) were all significantly greater in fetuses with normal development compared to those with growth restriction.

CONCLUSIONS

During the third trimester, SCTT (with the exception of MTFM and MTLM) is reduced in fetuses with IUGR. Furthermore, MALM is lower in growth-restricted fetuses, confirming that the parameters measured in this study are affected in IUGR fetuses. Our findings indicate that specific changes in fetal body compartments occur as a result of chronic metabolic impairment.

Case gender and severity in cerebral palsy varies with intrauterine growth

BACKGROUND

There is an unexplained excess of cerebral palsy among male babies. There is also variation in the proportion of more severe cases by birth weight. It has recently been shown that the rate of cerebral palsy increases as intrauterine size deviates up or down from an optimum about one standard deviation heavier than population mean weight-for-gestation.

AIMS

To determine whether the gender ratio or the severity of cases also varies with intrauterine size.

METHODS

A total of 3454 cases of cerebral palsy among single births between 1976 and 1990 with sufficient data to assign case severity (based on intellectual impairment and walking ability) and to compare weight-for-gestation at birth to sex specific fetal growth standards, were aggregated from nine separate registers in five European countries.

RESULTS

The greater the degree to which growth deviates either up or down from optimal weight-for-gestation at birth, the higher is the rate of cerebral palsy, the larger is the proportion of male cases, and the more severe is the functional disability. Compared to those with optimum growth the risk of more severe cerebral palsy in male babies is 16 times higher for those with a birth weight below the 3rd centile and four times higher when birth weight is above the 97th centile. In contrast, for mild cerebral palsy in female babies the excess risks at these growth extremes are about half these magnitudes.

CONCLUSIONS

Among singleton children with cerebral palsy, abnormal intrauterine size, either small or large, is associated with more severe disability and male sex.

Snoring, not just a social nuisance

Snoring is a very common source of complaints from partners and neighbours. Snorers themselves are less likely to be affected, unless they have associated daytime sleepiness caused by the sleep disruption from obstructive sleep apnoea. There is increasingly firm evidence that obstructive sleep apnoea is associated with hypertension, cardiovascular, cerebrovascular and metabolic problems such as insulin resistance, even at mild levels which may not cause much daytime somnolence. In addition, the central and obstructive apnoeas found in cardiac failure affect heart muscle function. Treatment of the apnoea improves blood pressure and cardiac function and is likely to have a beneficial effect on mortality. Since obstructive sleep apnoea is common it should be sought by appropriate questioning in these patient groups. The treatments for obstructive sleep apnoea are effective but cumbersome and this remains a challenge if patients do not achieve obvious early benefits such as reduction in sleepiness or breathlessness.

A new method for characterizing carotid plaque: multiple cross-sectional view echomorphology

PURPOSE

This study compares the ability of computer-derived B-mode ultrasound gray-scale measurements from a single longitudinal view (SLV) versus multiple cross-sectional views (MCSV) to differentiate symptomatic from asymptomatic carotid plaque causing more than 70% stenosis.

METHOD

Seventy-four internal carotid artery (ICA) stenoses (70%-99%; 33 asymptomatic, 41 symptomatic within 3 months) were imaged to obtain the "best" SLV and five to eight MCSV images at 5 mm intervals from the carotid bifurcation. Digitized sonograms were computerized and normalized to the gray scale median (GSM) of blood (0) and vessel adventitia (200). Plaque GSM was determined for each frame (image analysis, MATLAB 5.3). General risk factors for stroke and plaque echogenicity (SLV GSM; minimum MCSV GSM; cross-sectional axial heterogeneity (highest minus lowest MCSV GSM) were determined for each group.

RESULTS

Risk factors for stroke were similar in both groups, as was mean SLV GSM: symptomatic, 34 (95% confidence interval [CI], 24.8-43.0), asymptomatic, 43 (CI, 32.6-53.2); P =.1. Minimum MCSV GSM was lower for symptomatic plaque: 7 (CI, 4.2-9.8] vs 18.3 (CI, 12.2-24.5); P =.002. Greater axial GSM heterogeneity was present in symptomatic plaque: 34.5 (CI, 27.2-41.9) vs 16 (CI, 11.0-20.8); P =.0001.

CONCLUSIONS

MCSV cross-sectional imaging that enables objective assessment of regional plaque echolucency and heterogeneity is more sensitive than SLV sonography for differentiating symptomatic from asymptomatic plaque.