James Lind Alliance research priorities: what role do carbohydrates, fats and proteins have in the management of Type 2 diabetes, and are there risks and benefits associated with particular approaches?

AIMS

To assess the role played by carbohydrates, fat and proteins in the management of Type 2 diabetes.

BACKGROUND

Diabetes research tends to reflect the interests of academics or the pharmaceutical industry, rather than those of people living with Type 2 diabetes. The James Lind Alliance and Diabetes UK addressed this issue by defining the research priorities of people living with Type 2 diabetes. Three of the top 10 research priority questions focused on lifestyle.

METHODS

A narrative review was undertaken with a structured search strategy using three databases. Search terms included the three macronutrients and Type 2 diabetes. No restrictions were placed on macronutrient quantity or length of study follow-up. Outcomes included changes in HbA_1c , body weight, insulin sensitivity and cardiovascular risk.

RESULTS

There is no strong evidence that there is an optimal ratio of macronutrients for improving glycaemic control or reducing cardiovascular risk. Challenges included defining the independent effect of macronutrient manipulation and identifying the effects of macronutrients, independent of foods and dietary patterns. Extreme intakes of macronutrients may be associated with health risks.

CONCLUSIONS

It is challenging to formulate food-based guidelines from studies based on macronutrient manipulation. Structured education should be offered to support individuals in discovering their optimal, individual dietary approach. Recommendations for dietary guidelines should be expressed in terms of foods and not macronutrients.

Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes

A summary of the latest evidence-based nutrition guidelines for the prevention and management of diabetes is presented. These guidelines are based on existing recommendations last published in 2011, and were formulated by an expert panel of specialist dietitians after a literature review of recent evidence. Recommendations have been made in terms of foods rather than nutrients wherever possible. Guidelines for education and care delivery, prevention of Type 2 diabetes, glycaemic control for Type 1 and Type 2 diabetes, cardiovascular disease risk management, management of diabetes-related complications, other considerations including comorbidities, nutrition support, pregnancy and lactation, eating disorders, micronutrients, food supplements, functional foods, commercial diabetic foods and nutritive and non-nutritive sweeteners are included. The sections on pregnancy and prevention of Type 2 diabetes have been enlarged and the weight management section modified to include considerations of remission of Type 2 diabetes. A section evaluating detailed considerations in ethnic minorities has been included as a new topic. The guidelines were graded using adapted 'GRADE' methodology and, where strong evidence was lacking, grading was not allocated. These 2018 guidelines emphasize a flexible, individualized approach to diabetes management and weight loss and highlight the emerging evidence for remission of Type 2 diabetes. The full guideline document is available at www.diabetes.org.uk/nutrition-guidelines.

Birthweight, HIV exposure and infant feeding as predictors of malnutrition in Botswanan infants

BACKGROUND

A better understanding of the nutritional status of infants who are HIV-Exposed-Uninfected (HEU) and HIV-Unexposed-Uninfected (HUU) during their first 1000 days is key to improving population health, particularly in sub-Saharan Africa.

METHODS

A cross-sectional study compared the nutritional status, feeding practices and determinants of nutritional status of HEU and HUU infants residing in representative selected districts in Botswana during their first 1000 days of life. Four hundred and thirteen infants (37.3% HIV-exposed), aged 6-24 months, attending routine child health clinics, were recruited. Anthropometric, 24-h dietary intake and socio-demographic data was collected. Anthropometric Z-scores were calculated using 2006 World Health Organization growth standards. Modelling of the determinants of malnutrition was undertaken using logistic regression.

RESULTS

Overall, the prevalences of stunting, wasting and being underweight were 10.4%, 11.9% and 10.2%, respectively. HEU infants were more likely to be underweight (15.6% versus 6.9%), (P < 0.01) and stunted (15.6% versus 7.3%), (P < 0.05) but not wasted (P = 0.14) than HUU infants. HEU infants tended to be formula fed (82.5%), whereas HUU infants tended to breastfeed (94%) for the first 6 months (P < 0.001). Significant predictors of nutritional status were HIV exposure, birthweight, birth length, APGAR (appearance, pulse, grimace, activity and respiration) score and mother/caregiver's education with little influence of socio-economic status.

CONCLUSIONS

HEU infants aged 6-24 months had worse nutritional status compared to HUU infants. Low birthweight was the main predictor of undernutrition in this population. Optimisation of infant nutritional status should focus on improving birthweight. In addition, specific interventions should target HEU infants aiming to eliminate growth disparity between HEU and HUU infants.

Meaning in Life in Earlier and Later Older-Adulthood: Confirmatory Factor Analysis and Correlates of the Meaning in Life Questionnaire

OBJECTIVE

To validate the Meaning in Life Questionnaire (MLQ) in earlier and later older-adulthood, and examine its correlates.

METHOD

Participants in earlier ( n = 341, M age = 68.5) and later older-adulthood ( n = 341, M age = 78.6) completed the MLQ and other measures. Confirmatory multigroup analysis, correlations, and regression models were conducted.

RESULTS

A two-factor (presence and search), eight-item model of the MLQ had a good fit and was age-invariant. Presence and search for meaning were largely unrelated. Meaning was associated with life satisfaction, well-being across a range of domains, and psychological resources. Searching for meaning correlated negatively with these variables, but to a lesser degree in later older-adulthood.

DISCUSSION

The MLQ is valid in older-adulthood. Meaning in life is psychologically adaptive in older-adulthood. Searching for meaning appears less important, especially in later older-adulthood. Findings are discussed in the context of aging and psychosocial development.

Diagnostic value of neutrophil-lymphocyte and albumin-globulin ratios in canine soft tissue sarcoma

OBJECTIVE

To investigate the ability of neutrophil-to-lymphocyte ratio and albumin-to-globulin ratio to differentiate soft tissue sarcoma from benign soft tissue tumours.

METHODS

A retrospective study of pretreatment haematology and biochemistry in dogs diagnosed with soft tissue sarcoma or benign soft tissue tumours. The neutrophil-to-lymphocyte ratio and albumin-to-globulin ratio were compared between the two groups. In dogs diagnosed with soft tissue sarcoma, the relationship of neutrophil-to-lymphocyte ratio and albumin-to-globulin ratio to histological tumour grade (I to III) was assessed.

RESULTS

In the dogs with soft tissue sarcoma (n=22), the neutrophil-to-lymphocyte ratio was significantly increased and the albumin-to-globulin ratio decreased compared to those with benign soft tissue tumours (n=14). The neutrophil-to-lymphocyte ratio and albumin-to globulin ratio were not useful as predictors of tumour grade in dogs diagnosed with soft tissue sarcoma.

CLINICAL SIGNIFICANCE

Pretreatment neutrophil-to-lymphocyte ratio and albumin-to globulin ratio may aid with diagnosis and optimal treatment planning. Further investigation into their prognostic implications is warranted.

Childhood cruelty to animals in China: the relationship with psychological adjustment and family functioning

BACKGROUND

The current study broadened the general scope of research conducted on childhood cruelty to animals by examining the association between psychological adjustment, family functioning and animal cruelty in an Eastern context, China.

METHOD

The mothers and fathers of 729 children attending primary school in Chengdu, China participated in this study. Each parent completed the Strengths and Difficulties Questionnaire, the Chinese Family Assessment Instrument, and the Children's Attitudes and Behaviours towards Animals questionnaire.

RESULTS

Findings from an actor partner interdependence model demonstrated that parents' ratings of family functioning and of their child's externalizing coping style predicted only modest amounts of variance in animal cruelty. In particular, parents' ratings of their child's externalizing coping style most consistently predicted animal cruelty. Family functioning, fathers' ratings in particular, played a minor role, more so for boys compared with girls.

CONCLUSION

This study provided the first insight into childhood animal cruelty in China, and suggests that further research may enhance our understanding of these phenomena.

Docetaxel plus cetuximab as second-line treatment for docetaxel-refractory oesophagogastric cancer: the AGITG ATTAX2 trial

BACKGROUND

Cetuximab can reverse chemotherapy resistance in colorectal cancer. This study evaluated the efficacy and safety of the combination of docetaxel and cetuximab as a second-line treatment in docetaxel-refractory oesophagogastric cancer.

METHODS

Patients received docetaxel 30 mg m(-2) on days 1 and 8, every 3 weeks and cetuximab 400 mg m(-2) on day 1, then 250 mg m(-2) weekly. Biomarker mutation analysis was performed.

RESULTS

A total of 38 patients were enrolled. Response rates were PR 6% (95% CI 2-19%), s.d. 43% (95% CI 28-59%). Main grade 3/4 toxicities were febrile neutropenia, anorexia, nausea, diarrhoea, stomatitis, and acneiform rash. Median progression-free and overall survival were 2.1 and 5.4 months, respectively. A landmark analysis showed a trend to improved survival times with increased grade of acneiform rash. No KRAS, BRAF or PIK3CA mutations were observed.

CONCLUSION

Cetuximab and docetaxel achieve modest responses rates, but maintain comparable survival times to other salvage regimens with low rates of toxicity.

Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes

This article summarizes the Diabetes UK evidence-based guidelines for the prevention of Type 2 diabetes and nutritional management of diabetes. It describes the development of the recommendations and highlights the key changes from previous guidelines. The nutrition guidelines include a series of recommendations for the prevention of Type 2 diabetes, nutritional management of Type 1 and Type 2 diabetes, weight management, management of microvascular and macrovascular disease, hypoglycaemia management, and additional considerations such as nutrition support, end-of-life care, disorders of the pancreas, care of the older person with diabetes, nutrition provided by external agencies and fasting. The evidence-based recommendations were graded using the Scottish Intercollegiate Guidelines Network methodology and, in a small number of topic areas, where strong evidence was lacking, the recommendations were reached by consensus. The Diabetes UK 2011 guidelines place an emphasis on carbohydrate management and a more flexible approach to weight loss, unlike previous guidelines which were expressed in terms of recommendations for individual nutrient intakes. Additionally, the guidelines for alcohol have been aligned to national recommendations. The full evidence-based nutrition guidelines for the prevention and management of diabetes are available from: http://www.diabetes.org.uk/nutrition-guidelines.

Obesity and gestational diabetes

The prevalence of both obesity and gestational diabetes mellitus (GDM) is increasing worldwide. GDM affects about 7% of all pregnancies and is defined as any degree of impaired glucose tolerance during gestation. The presence of obesity has a significant impact on both maternal and fetal complications associated with GDM. These complications can be addressed, at least in part, by good glycaemic control during pregnancy. The significance and impact of obesity in women with GDM are discussed in this article, together with treatment options, the need for long-term risk modification and postpartum follow-up.

Cytotoxic drug use in treatment of dogs and cats with cancer by UK veterinary practices (2003 to 2004)

OBJECTIVES

To describe the range and frequency of cytotoxic drugs prescribed within UK veterinary practices to treat dogs and cats with cancer, determine the effect of practice demographic variables on this practice and determine the frequency with which intravenous catheters were used during administration of parenteral cytotoxic drugs.

METHODS

A postal survey of 1838 veterinary practices providing care for dogs and cats within the UK.

RESULTS

Prescription of cytotoxic drugs to treat dogs and cats with cancer during the preceding 12 months was reported by 70.8 per cent practices. The most widely prescribed agents were cyclophosphamide (65.4 per cent) and vincristine (63.5 per cent). Twenty-three per cent of responding practices had prescribed an antitumour antibiotic and 8.3 per cent had prescribed a platinum agent. The median frequency of prescription was between once a month and once every three months. Increasing frequency and range of cytotoxic drug prescription were associated with practice employment of higher numbers of veterinary surgeons and increased levels of pet insurance among practice clients. Almost a quarter of practices administering vesicant parenteral cytotoxic drugs failed to always use intravenous catheters to do so.

CLINICAL SIGNIFICANCE

Prescription of cytotoxic drugs, and therefore the potential for occupational exposure of staff, was widespread among UK veterinary practices providing care for dogs and cats.

Retrospective evaluation of the long-term outcome of non-surgical management of 74 dogs with clinical hip dysplasia

The long-term outcome for dogs treated non-surgically for clinical signs of canine hip dysplasia were evaluated retrospectively; 74 dogs were evaluated by a postal questionnaire sent to their owners, and 24 of these were also evaluated by a veterinary clinical examination. A total of 11 outcome variables were evaluated. Depending on the variable assessed, between 31 (41.9 per cent) and 49 (66.2 per cent) of the dogs remained clinically affected according to their owner's assessment, and between 17 (70.8 per cent) and 23 (95.8 per cent) of the 24 dogs had abnormalities attributed to hip osteoarthritis according to the veterinary assessment. Orthopaedic abnormalities other than hip dysplasia affected 17 of the 24 dogs. Long-term medications had been prescribed for the treatment of clinical signs associated with hip dysplasia in 41 of the 74 dogs.

Assessment of middle ear disease in the dog: a comparison of diagnostic imaging modalities

OBJECTIVES

To compare radiography and ultrasound for the assessment of the tympanic bulla against computed tomography results.

METHODS

Thirty-one dogs had dorsoventral, left and right lateral oblique and rostrocaudal open mouth radiographs compared with ultrasound images and computed tomography scans of the tympanic bullae.

RESULTS

Radiography was superior to ultrasonography for the evaluation of the middle ear. However, computed tomography assessment was best predicted by a combination of radiographic and ultrasonographic findings.

CLINICAL SIGNIFICANCE

A combination of radiography and ultrasound can provide a more accurate assessment of the bulla than either of them alone. Ultrasound may have a role in the evaluation of middle ear disease in the dog. Results are operator dependent and not reproducible with current recording techniques.

The prevalence and recognition of major depression among low-level aged care residents with and without cognitive impairment

Previous research has demonstrated a high level of depression in nursing homes. The current study was designed to determine the prevalence of depression, using a structured diagnostic interview, among older people with and without mild-moderate cognitive impairment residing in low-level care facilities. The results demonstrated that, consistent with previous research in nursing homes, 16.9% of older people were diagnosed with major depressive disorder. Less than half of these cases had been detected or treated. Individuals with moderate cognitive impairment were more likely to be depressed, but cognitive impairment did not appear to act as a strong impediment to the detection of depression by general practitioners. A low awareness of their use of antidepressant medications was demonstrated among older people prescribed this treatment, including those with normal cognitive function. Reasons for the poor recognition of depression among older people are discussed.

Role of personal factors in women's self-reported weight management behaviour

The aim of this study was to investigate the role of motivation, anxiety and self-efficacy in self-reported behaviour that may be important for weight loss and weight maintenance. One hundred and twenty-nine females aged 18-81 years were recruited from a variety of social, sporting venues and work places within a local community. Participants completed questionnaires assessing their levels of participation and perseverance in weight management activities, their motivation levels, their anxiety levels (State Anxiety Inventory) and their levels of self-efficacy for weight management behaviours. Motivation was found to play a major role in participation in weight management activities. Anxiety and self-efficacy played no significant role. The findings are discussed in relation to previous studies, and directions for future studies are indicated. It is argued that the level of motivation is a key factor that should be taken into account for each individual engaging in women's weight management programmes, and that further research should be undertaken to identify other relevant factors.

Inherited myopathy of great Danes

A hereditary, non-inflammatory myopathy occurring in young great Danes with distinctive histological features in muscle biopsy specimens is reviewed. Onset of clinical signs is usually before one year of age and both sexes are affected. Clinical signs are characterised by exercise intolerance, muscle wasting, and an exercise-induced tremor. Although most affected dogs have a severe form of the disease, occasional dogs may have a less pronounced form and survive into adulthood with an acceptable quality of life. Litters containing affected puppies are born to clinically unaffected parents, and an autosomal recessive pattern of inheritance is likely. All recorded cases have had fawn or brindle coat coloration. Elevated serum creatinine kinase concentrations and spontaneous electrical activity in skeletal muscles are frequently found. While originally reported (Targett and others 1994) as a central core myopathy in this breed, the histochemical characteristics of the distinct cytoarchitectural structures differ from those of the well-characterised central core myopathy in human beings. In fact, these structures differ from any known myopathy in human beings and likely represents a unique non-inflammatory myopathy affecting dogs. Until this myopathy is characterised further, the name inherited myopathy in great Danes is suggested.

Cohort study of COX-1 and COX-2 expression in canine rectal and bladder tumours

OBJECTIVES

To determine the role that cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) play in malignant transformation in canine transitional cell carcinoma and rectal tumours.

METHODS

Histological sections of 21 canine rectal adenocarcinomas and 18 canine transitional cell carcinomas were stained for COX-1 and COX-2. Mann-Whitney non-parametric tests were applied to determine if there was any relationship between the percentage of cells expressing COX-1 or COX-2, and between COX-1 and COX-2 staining intensity and age, breed or sex.

RESULTS

For rectal adenocarcinomas, 19.0 per cent of the sections were negative for COX-1 and COX-2. A further 38.1 per cent of the sections were negative for COX-2 but positive for COX-1, and 38.1 per cent of the sections had rare or occasional single cells positive for COX-2. No significant differences were found in COX staining when compared with age, breed or sex. For transitional cell carcinomas, all of the sections were positive for COX-1 and COX-2. For COX-2 staining, 16.7 per cent had more than 30 per cent positive cells. For COX-1 staining, 38.9 per cent had more than 30 per cent positive cells. There was a significant increase in the percentage of COX-1 positive cells in small breed dogs (P = 0.0337).

CLINICAL SIGNIFICANCE

The variations in COX expression reported in this study may explain the differences in the clinical response of transitional cell carcinomas and rectal adenocarcinomas following treatment with non-steroidal anti-inflammatory drugs.

Use of reconstructed computed tomography for the assessment of joint spaces in the canine elbow

OBJECTIVES

To assess the accuracy of reconstructed computed tomography for imaging canine elbow joint spaces.

METHODS

Computed tomography scans of eight cadaveric elbows were obtained and reconstructed computed tomography images were formatted in the dorsal and sagittal planes. Humeroradial and humeroulnar joint space measurements were obtained from these images. Intra-observer and inter-observer variations in joint space measurements were assessed, as was the effect of specimen positioning (inter-image variation). After freezing, four elbows were sectioned in the dorsal plane and four in the sagittal plane. In addition to visual comparison of the frozen sections with reconstructed computed tomography images, joint space measurements were obtained from frozen sections and compared with those from reconstructed computed tomography images. Variation was assessed using statistical calculations and graphical techniques.

RESULTS

Both inter-image and intra-observer analyses revealed good agreement and low variation between data sets. Inter-observer correlation was only moderate, though variation was low. Visually, the reconstructed computed tomography images accurately reflected the frozen section anatomy. Agreement between frozen section and reconstructed computed tomography joint space measurements was good, with minimal variation.

CLINICAL SIGNIFICANCE

These results indicate that reconstructed computed tomography is capable of accurately imaging elbow joint spaces and precise joint space measurements can be obtained. Reconstructed computed tomography may be useful for determining joint space measurements and detecting elbow incongruencies in dogs with elbow dysplasia.

Effects of medetomidine and medetomidine-butorphanol combination on Schirmer tear test 1 readings in dogs

Medetomidine is a commonly used sedative in veterinary medicine whether administered alone or in combination with an opioid such as butorphanol. There are no previous studies that look at the effects of this drug on sequential Schirmer tear test (STT) 1 readings in dogs, including effects on tear production after reversal of the drug. The present study looked at two groups of 10 dogs each that were sedated with intravenous medetomidine or a combination of medetomidine and butorphanol. All dogs had tear readings taken presedation, 15 min postsedation, and 15 min after reversal of medetomidine with atipamezole. Results revealed that intravenous sedation with medetomidine and medetomidine-butorphanol in dogs with no history of ophthalmic disease and presedation STT 1 readings above 15 mm/min, causes a significant decrease in tear production that is measurable at 15 min postsedation. Readings returned to near presedation values within 15 min postreversal in most cases. It is therefore recommended that all eyes be treated with a tear substitute from the time the sedative is given until at least 15 min after reversal.

Prevalence of radiographic signs of degenerative joint disease in a hospital population of cats

The prevalence of radiographic signs of degenerative joint disease (including appendicular osteoarthritis) among a hospital population of 218 cats was 33.9 per cent (74 cats), and the prevalence of signs of appendicular joint osteoarthritis was 16.5 per cent (36 cats). Half of the cases of appendicular joint osteoarthritis had no apparent radiographic or historical cause, and clinical signs of lameness were recorded in only six of them, all of which had an apparent radiographic cause. The 74 cats with radiographic signs of degenerative joint disease were on average significantly older than the 144 cats in which there were no radiographic signs of the disease.

A comparison of adherence by four strains of Staphylococcus intermedius and Staphylococcus hominis to canine corneocytes collected from normal dogs and dogs suffering from atopic dermatitis

The aim of this study was to compare the adherence of four strains of Staphylococcus intermedius and a single strain of Staphylococcus hominis to corneocytes from both normal dogs and dogs suffering from atopic dermatitis. Cells from the skin surface, corneocytes, were collected from 10 normal dogs and 10 dogs suffering from atopic dermatitis. Four strains of S. intermedius, three isolated from canine pyoderma skin lesions (strains A, B and C), and one isolated form from canine synovial membrane sample from a case of septic arthritis (strain D) were compared. S. hominis, which is not normally associated with canine disease, was also evaluated for its ability to adhere to canine corneocytes. S. hominis did not adhere to canine corneocytes. All four strains of S. intermedius adhered well to canine corneocytes collected from both normal and atopic dogs. All strains of S. intermedius showed statistically greater adherence to corneocytes collected from atopic dogs compared with those collected from normal dogs. It was concluded that the adherence assay employed here showed that S. hominis does not adhere to canine corneocytes, S. intermedius adheres preferentially to atopic corneocytes.

The humane collection of fetal bovine serum and possibilities for serum-free cell and tissue culture

Fetal bovine serum (FBS) is a common supplement to in vitro culture media. A workshop was organized to discuss whether or not fetuses might suffer when blood is withdrawn, and to discuss serum replacement methods. When bovine fetuses are exposed after slaughter of the dam, they can suffer only if they inflate their lungs with air and increase their blood oxygen to levels compatible with awareness. Preventing fetuses from breathing air or killing them by an efficient method, according to clearly defined safeguards, ensures that fetal blood collection is humane. Since serum is a supplement of unknown composition, which could be contaminated with unwanted factors, there are scientific and safety reasons for omitting FBS from culture media. Several media have been developed in which minimal or no animal derived components are present. Also, different cell types have been adapted to serum-free media. As yet, no standard serum free media are present, and each cell type requires its own medium composition. Among other recommendations, the establishment of a public database with information on cell types and their serum-free medium composition is proposed.

Immunoassays to detect the serum antibody response of cattle to infection with Salmonella Typhimurium definitive type 104 and following vaccination with Bovivac S

AIMS

To use ELISA and immunoblotting assays to examine the serum antibody response of cattle infected with Salmonella Typhimurium DT104 and following vaccination with Bovivac S.

METHODS AND RESULTS

Three hundred and twenty-nine cattle, including 16 shedding multiresistant Salmonella Typhimurium DT104, were screened for serum antibodies binding to O=1, 4, 5, 12 lipopolysaccharide (LPS) antigens before and after vaccination with Bovivac S. Sera with an ELISA reading of 0.9A405 or above were shown to contain antibodies, of the IgG-class only, to the LPS of Salmonella Typhimurium using immunoblotting. Prior to vaccination, only 11 cattle had serum IgG-class antibodies to the O=4, 5 LPS antigens, and of these one also had antibodies to outer membrane proteins and H=i flagellar antigens. Following vaccination, 87 out of 315 cattle developed serum antibodies to the LPS of Salmonella Typhimurium.

CONCLUSIONS

Evidence of infection of cattle with Salmonella Typhimurium was readily obtained with an LPS-based ELISA in association with an immunoblotting procedure, supplementing existing bacteriological procedures. This enabled the detection of an increase in the number of cattle with serum antibodies to Salmonella Typhimurium LPS following vaccination with Bovivac S.

SIGNIFICANCE AND IMPACT OF THE STUDY

The immunoassays described provided evidence of infection with Salmonella Typhimurium and served as a valuable adjunct to established bacteriology.

The development of a screening questionnaire for childhood cruelty to animals

Childhood cruelty to animals may be a marker of poor prognosis amongst conduct disordered children. However, other than semistructured interviews with parents or children, there are no screening instruments for this behavior. The aim of this study was to develop such an instrument. In the first phase of the study, a parent-report questionnaire, Children's Attitudes and Behaviors Towards Animals (CABTA) was designed and piloted on 360 elementary school children, enabling community norms and a factor structure for the instrument to be derived. In the second phase, the questionnaire was completed by the parents of a small sample of children (N = 17) to establish its test-retest reliability. In the third phase of the study, the CABTA was completed by the parents of 19 children who had been diagnosed with either a Disruptive Behavioral Disorder or Attention Deficit Hyperactivity Disorder, and the results were compared with the outcome of a semistructured interview with parents regarding their child's behavior toward animals. The results of the various phases of the study indicated that the CABTA consists of two factors. Typical and Malicious Cruelty to animals, and is a reliable and valid tool for detecting childhood cruelty to animals. Possible use and adaptations of the CABTA as a screening instrument in clinical and community samples are discussed.

Osteopenia and other radiographic signs in canine hyperadrenocorticism

The specificity of conventional radiography in assessing canine hyperadrenocorticism was evaluated by comparing the Incidence of related radiographic findings in 24 hyperadrenocorticoid, 15 diabetic and 20 hypothyroid dogs. Hyperadrenocorticoid dogs showed significantly more perihilar bronchial mineralisation than other groups. There was no significant variation between the disease groups with respect to obesity, hepatomegaly, contour of the caudoventral hepatic margin, peripheral bronchial mineralisation or osteopenia. Adrenal mineralisation and calcinosis cutis were rare findings observed only in hyperadrenocorticoid dogs. The effect of obesity on the radiographic appearance of bone was studied using a dissected lumbar spine from a canine cadaver. An osteopenic effect could be demonstrated by superimposition of a 10 cm-thick fat block. The low specificity of almost all common signs in canine hyperadrenocorticism and the low incidence of characteristic findings demonstrate the limited potential of radiography in assessing this condition. Radiographic assessment of bone density is unreliable because of artefactual osteopenic effects of high kVp settings necessary in obese dogs.

Neonatal cerebral ischaemia with elevated maternal and infant anticardiolipin antibodies

A baby girl born by elective lower segment caesarean section was found to have left-sided focal seizures at 48 hours after birth. Her mother had previously had a neonatal death at 26 weeks' gestation and another child born at 32 weeks' gestation had a congenital right hemiplegia with a left middle cerebral artery infarct on CT scan. The mother had raised anticardiolipin IgG antibodies at the time of delivery of her second child, with no thrombotic symptoms. Therefore, during this pregnancy, she had been treated with low molecular weight heparin and aspirin. The baby's mother had raised IgG and IgM anticardiolipin antibodies and the baby had IgG anticardiolipin antibodies at the upper range of normal 4 days after delivery. The seizures were controlled with phenobarbitone and phenytoin. CT and MRI scans showed evidence of cerebral ischaemia. A repeat MRI scan at 4 months of age was normal, anticonvulsants were discontinued, and her latest neurological examination at 5 months was normal.

Pathogenicity of cyathostome infection

Cyathostomes are now the principle parasitic pathogen of the horse: a remarkable transformation during the last 25 years from virtual obscurity to focus of attention in equine parasitology. This rise to prominence coincides with the marked decrease in prevalence of large strongyle infections as a result of widespread use of modern anthelmintic compounds. On the basis that strongyle-associated diseases continue to commonly occur in the absence of these large strongyle species, clinical attention has turned to the pathogenicity of cyathostomes. Although many horses harbour burdens of tens of thousands of cyathostomes without developing detectable illness, these parasites can result in an inflammatory enteropathy affecting the caecum and colon. Although the principle clinical effect of cyathostomosis is weight loss, affected individuals may exhibit other signs including diarrhoea and/or subcutaneous oedema and/or pyrexia. Clinical cyathostomosis occurs more commonly in young horses in late winter/early spring but there is lifelong susceptibility to cyathostomes and they can cause clinical disease in any age of horse during any season. Animals with cyathostomosis often develop hypoalbuminaemia and/or neutrophilia but there are no clinicopathological features specific for the disease. Experimental infections with cyathostomes have resulted in both clinical and pathological features similar to those of naturally-occuring cyathostomosis cases. From the experimental infection studies, it is evident that cyathostomes are pathogenic at times of both penetration into and emergence from the large intestinal mucosa. An unusual feature of cyathostome biology is the propensity for arrested larval development within the large intestinal mucosa for more than 2 years. From limited studies it appears that this arrested larval development is favoured by: feedback from luminal to mucosal worms; larger size of challenge dose of larvae and trickle (versus single bolus) infection. During arrested larval development cyathostomes have minimal susceptibility to all anthelmintic compounds, thus, limiting the effectiveness of therapeutic and/or control strategies. Although, the relative importance of individual cyathostomes is not known, the development of species-specific DNA methods for identification of cyathostomes provides a means by which the pathogenicity of different species might be established.

Quantification of Spatial Correlation in Porous Media and Its Effect on Mercury Porosimetry

In many porous media the grains are packed in a disordered manner, rather than in regular lattices. Theoretical treatments of the properties of these media often assume that because there is no regular lattice, the pore space between grains is completely spatially disordered. Here we present an analysis of a real granular medium (a close packing of equal spheres) which shows that, contrary to the popular assumption, the pore space is spatially correlated. The origin of this pore space correlation is the strong spatial correlation of grain locations, which is a feature of all dense granular media. Our analysis relies on physically representative network models of the pore space constructed from knowledge of the grain locations. Simulated drainage experiments on these networks agree with mercury porosimetry experiments in simple sandstones, whereas simulations in uncorrelated but otherwise identical networks do not. Thus the spatial correlation inherent in the pore space of simple porous media significantly affects mercury porosimetry. Deriving pore size distributions from mercury porosimetry without considering spatial correlation can give misleading results. The likelihood of error is compounded if such pore size distributions are used to estimate transport coefficients such as permeability, diffusivity, and electrical conductivity.

Support groups for children in alternate care: a largely untapped therapeutic resource

Children in alternate care often have adjustment problems that manifest in various aspects of their lives. Individual therapy is often assumed to be the desired intervention, but resources seldom permit one-to-one therapy for these disturbances. The authors argue that groupwork should be considered as a possible treatment of choice. Not only is it likely to be more economical than individual therapy, it has the inherent advantage of telling children in care that they are not alone, and that other children have similar experiences and feelings. It also allows them to develop their own support network. Such groups appear to have been underutilized in work with children in out-of-home care. This article describes such a group and its outcome. Various techniques were developed to achieve specified aims. The techniques appeared to be successful. Further work on such groups and more specific evaluation is called for.

Mistletoe in homoeopathic cancer treatment

Mistletoe, or 'iscador' as its homoeopathic preparation is called, has been found beneficial in treating patients with some forms of cancer. It can be used with conventional treatments.

Familial spastic paraplegia, bilateral sensorineural deafness, and intellectual retardation associated with a progressive nephropathy

We present a family in which at least four persons have evidence of an inherited disorder comprising a variable spastic paraplegia, bilateral sensorineural deafness, intellectual retardation, and a progressive nephropathy. Focal segmental proliferative lesions with sclerosis suggestive of mesangial IgA nephropathy (Berger's disease) were found on renal renal biopsy in two affected persons. The glomerular basement membrane showed none of the changes characteristic of Alport's syndrome. Males and females are affected and the segregation of the disease is consistent with dominant transmission.