From accreditation to quality improvement-The Danish National Quality Programme

The Danish government launched a new National Quality Programme (NQP) in healthcare in 2015. It has changed the focus from old public management in terms of accreditation, regulation, rules and standards to new public governance focusing on delivering high quality healthcare and outcomes of value for the patients, health professionals and the Danish healthcare system. The NQP aims to strengthen the focus on continuous quality improvement and the launch of the programme was accompanied by a decision to phase out accreditation of public hospitals. The NQP includes 1) eight specific national quality goals, 2) a national educational programme for quality management, and 3) establishment of quality improvement collaboratives. Since the establishment of the NQP the indicator results have improved in several important clinical areas. However, causal conclusions related to the effect of the NQP cannot yet be made. This perspective on quality paper aims to give a short introduction to the NQP and documented outcomes.

Konsiliar- und Liaisonpsychiatrie im Allgemeinkrankenhaus

Somatische Erkrankungen werden häufig von psychischen Symptomen und Verhaltensauffälligkeiten begleitet. Andererseits weisen viele körperliche Beschwerden auch auf das Vorliegen einer larvierten psychischen Erkrankung hin. Aus diesem Grund hat in den letzten Jahren die Bedeutung der Konsiliarpsychiatrie und Psychotherapie am Allgemeinkrankenhaus deutlich zugenommen. Der vorliegende Artikel gibt einen Überblick über die Aufgaben und die Organisation der Konsiliarpsychiatrie am Allgemeinkrankenhaus. Besonderer Aspekt wird auf die Bedeutung der Konsiliarpsychiatrie für die Arbeit des somatisch tätigen Arztes gelegt. Es sollten Probleme, Arbeitsfelder und Chancen der Konsiliarpsychiatrie am Allgemeinkrankenhaus aufgezeigt werden.

Regional variation in surgery for pancreatic cancer in Denmark 2011-2015

INTRODUCTION

Surgical treatment for pancreatic cancer carries a high risk of both morbidity and mortality. Even so, it remains the best curative treatment option. In Denmark, pancreatic surgery has been extensively centralised since the millennium, but the effect of this centralisation on patient outcome has not been evaluated. This study describes regional variation within pancreatic surgery on a malignant indication, focusing on production volume, length of stay, readmission rates and mortality.

METHODS

This is a retrospective cohort study of all patients with pancreatic cancer who underwent surgical treatment in Denmark from 2011 to 2015. We obtained data from the Danish National Patient Registry and the National Pathology Data Bank on length of stay, transfers, mortality (both short and long term), age, co-morbidity, and disease stage.

RESULTS

Four hospital units performed a total of 691 surgical procedures (476 pancreaticoduodenectomies) in the study period. Production volume varied considerably across units with two units accounting for nearly 80% of surgery performed. Data revealed variation on rates of transfers and readmissions as well as disease stage and mortality (both short and long term).

CONCLUSIONS

Data suggest that mortality is linked to production volume as well as disease stage, but the small data quantity impedes rigorous statistical analysis. Further studies on the observed associations are required.

FUNDING

none.

TRIAL REGISTRATION

not relevant.

Implementation of a politically initiated national clinical guideline for cardiac rehabilitation in hospitals and municipalities in Denmark

A politically initiated national clinical guideline was launched in Denmark in 2013 to improve quality and equality of cardiac rehabilitation (CR) services. The guideline is to be implemented in both hospital and community (municipality) settings due to shared responsibility for provision of CR services. Little is known about implementation outcomes of a guideline in these two settings. We aimed to study this by determining the extent to which Danish CR services in hospitals and municipalities adhered to national recommendations following the launch of the guideline. The study employed an observational, longitudinal design. Data were gathered by a questionnaire survey to compare CR services at baseline, measured in 2013 immediately before the guideline was launched, with CR services at a two-year follow up in 2015. All Danish hospital departments offering CR services (N = 36) and all municipalities (N = 98) were included. Data were analysed using inferential statistics. Hospitals reported improvement of both content and quality of CR services. Municipalities reported no change in content of services, and lower level of fulfilment of one quality aspect. The results suggest that the guideline had different impact in hospitals and municipalities and that the differences in content and quality of services between the two settings increased in the study period, thus contradicting the guideline´s aim of uniform, evidence-based content of CR services across settings.

Bottlenose dolphin (Tursiops truncatus) sperm revisited: Motility, morphology and ultrastructure of fresh sperm of consecutive ejaculates

Computer aided sperm analysis systems allow detailed examination of sperm motility and morphology variables, which are important for the understanding of the spermatology of a species and the development of assisted reproductive techniques. Cetacean biology is too complex to study in the wild and data from captive individuals provide an important alternative for the conservation of these charismatic animals. The present study evaluates ejaculate and sperm characteristics, including sperm motility, kinematic variables and quantitative sperm morphology and ultrastructure, of consecutive ejaculates from Atlantic bottlenose dolphins (Tursiops truncatus). Sperm concentrations and total and progressive motilities were greater in the second than the first ejaculate, with all ejaculates being of very high quality (6.9-1127 × 10⁶/ml sperm concentration, 75% to 91% total motility and 89% to 96% normal sperm). Most sperm in an ejaculate (≥84%) were highly (VCL>150 μm/s) and progressively motile with very few abnormal sperm. The sperm have small heads, a short but very bulky midpiece and a long tail. Detailed sperm morphometrics using CASA indicated there were similarities from one ejaculate to the next. The large mitochondria with extensive cristae mitochondriales are tightly packed in the midpiece resulting in a large midpiece volume. All the semen and sperm characteristics indicate high quality sperm and support the assumption that a multimale mating system is present in T. truncatus.

Trophy Hunting and Sustainability: Temporal Dynamics in Trophy Quality and Harvesting Patterns of Wild Herbivores in a Tropical Semi-Arid Savanna Ecosystem

The selective nature of trophy hunting may cause changes in desirable phenotypic traits in harvested species. A decline in trophy size of preferred species may reduce hunting destination competitiveness thus compromising the sustainability of trophy hunting as a conservation tool. We explored the trophy quality and trends in harvesting patterns (i.e., 2004-2015) of Cape buffalo (Syncerus caffer), African elephant (Loxodonta africana), greater kudu (Tragelaphus strepsiceros) and sable (Hippotragus niger) in Matetsi Safari Area, northwest Zimbabwe. We used long-term data on horn and tusk size, age, quota size allocation and offtake levels of selected species. To analyse the effect of year, area and age on the trophy size, quota size and offtake levels, we used linear mixed models. One sample t-test was used to compare observed trophy size with Safari Club International (SCI) minimum score. Trophy sizes for Cape buffalo and African elephant were below the SCI minimum score. Greater kudu trophy sizes were within the minimum score threshold whereas sable trophy sizes were above the SCI minimum score between 2004 and 2015. Age at harvest for Cape buffalo, kudu and sable increased whilst that of elephant remained constant between 2004 and 2015. Quota size allocated for buffalo and the corresponding offtake levels declined over time. Offtake levels of African elephant and Greater kudu declined whilst the quota size did not change between 2004 and 2015. The quota size for sable increased whilst the offtake levels fluctuated without changing for the period 2004-2015. The trophy size and harvesting patterns in these species pose a conservation and management dilemma on the sustainability of trophy hunting in this area. We recommend: (1) temporal and spatial rotational resting of hunting areas to create refuge to improve trophy quality and maintenance of genetic diversity, and (2) introduction of variable trophy fee pricing system based on trophy size.

Mandatory national quality improvement systems using indicators: An initial assessment in Europe and Israel

INTRODUCTION

Quality improvement systems (QIS) that are based on empirical performance assessment have increasingly been implemented as a mandatory part of health systems across countries. This study aims to describe national mandatory QIS in Europe in 2014.

MATERIALS AND METHODS

Relevant national agencies for national mandatory QIS in Europe were identified through online searches and key informants. A questionnaire was compiled during a workshop with these agencies and filled out by representatives from these particular agencies.

RESULTS

Agencies in charge of national mandatory QIS in seven countries (Denmark, France, Germany, Israel, Scotland, Sweden and Switzerland) were included in the study. An analysis of QIS revealed similarities, such as the use of routine data for performance assessment and the aim to hold healthcare providers accountable. Differences relate to the different forms of feedback systems and improvement mechanisms used. Trends include the development towards greater implementation of QIS within health systems, the inclusion of the patient's perspective in performance assessment, and experiments with pay for performance-related measures.

CONCLUSION

On a country level, for health systems striving for newly implementing QIS it is recommended to start where routine data is available, add qualitative methodologies once the QIS is getting more complex, report performance data back to service providers and be patient centred. On the inter-country level exchange of information between agencies commissioned with implementing national QIS is very much needed for.

Habitat Heterogeneity Variably Influences Habitat Selection by Wild Herbivores in a Semi-Arid Tropical Savanna Ecosystem

An understanding of the habitat selection patterns by wild herbivores is critical for adaptive management, particularly towards ecosystem management and wildlife conservation in semi arid savanna ecosystems. We tested the following predictions: (i) surface water availability, habitat quality and human presence have a strong influence on the spatial distribution of wild herbivores in the dry season, (ii) habitat suitability for large herbivores would be higher compared to medium-sized herbivores in the dry season, and (iii) spatial extent of suitable habitats for wild herbivores will be different between years, i.e., 2006 and 2010, in Matetsi Safari Area, Zimbabwe. MaxEnt modeling was done to determine the habitat suitability of large herbivores and medium-sized herbivores. MaxEnt modeling of habitat suitability for large herbivores using the environmental variables was successful for the selected species in 2006 and 2010, except for elephant (Loxodonta africana) for the year 2010. Overall, large herbivores probability of occurrence was mostly influenced by distance from rivers. Distance from roads influenced much of the variability in the probability of occurrence of medium-sized herbivores. The overall predicted area for large and medium-sized herbivores was not different. Large herbivores may not necessarily utilize larger habitat patches over medium-sized herbivores due to the habitat homogenizing effect of water provisioning. Effect of surface water availability, proximity to riverine ecosystems and roads on habitat suitability of large and medium-sized herbivores in the dry season was highly variable thus could change from one year to another. We recommend adaptive management initiatives aimed at ensuring dynamic water supply in protected areas through temporal closure and or opening of water points to promote heterogeneity of wildlife habitats.

Strengthening leadership as a catalyst for enhanced patient safety culture: a repeated cross-sectional experimental study

OBJECTIVES

Current literature emphasises that clinical leaders are in a position to enable a culture of safety, and that the safety culture is a performance mediator with the potential to influence patient outcomes. This paper aims to investigate staff's perceptions of patient safety culture in a Danish psychiatric department before and after a leadership intervention.

METHODS

A repeated cross-sectional experimental study by design was applied. In 2 surveys, healthcare staff were asked about their perceptions of the patient safety culture using the 7 patient safety culture dimensions in the Safety Attitudes Questionnaire. To broaden knowledge and strengthen leadership skills, a multicomponent programme consisting of academic input, exercises, reflections and discussions, networking, and action learning was implemented among the clinical area level leaders.

RESULTS

In total, 358 and 325 staff members participated before and after the intervention, respectively. 19 of the staff members were clinical area level leaders. In both surveys, the response rate was >75%. The proportion of frontline staff with positive attitudes improved by ≥5% for 5 of the 7 patient safety culture dimensions over time. 6 patient safety culture dimensions became more positive (increase in mean) (p<0.05). Frontline staff became more positive on all dimensions except stress recognition (p<0.05). For the leaders, the opposite was the case (p<0.05). Staff leaving the department after the first measurement had rated job satisfaction lower than the staff staying on (p<0.05).

CONCLUSIONS

The improvements documented in the patient safety culture are remarkable, and imply that strengthening the leadership can act as a significant catalyst for patient safety culture improvement. Further studies using a longitudinal study design are recommended to investigate the mechanism behind leadership's influence on patient safety culture, sustainability of improvements over time, and the association of change in the patient safety culture measures with change in psychiatric patient safety outcomes.

The virgin land of quality management: a first measure of patient safety climate at the National Hospital of the Faroe Islands

PURPOSE

The Faroe Islands are formally part of the Kingdom of Denmark, but the islands enjoy extensive autonomy as home ruled. In Denmark, extensive quality management initiatives have been implemented throughout hospitals, this was not the case in the Faroese Islands in 2013. The purpose of this study is to investigate the patient safety culture in the National Hospital of the Faroe Islands prior to implementation of quality management initiatives.

METHODS

The Danish version of the Safety Attitudes Questionnaire (SAQ-DK) was distributed electronically to 557 staff members from five medical centers of the hospital, and one administrative unit. SAQ-DK has six cultural dimensions. The proportion of respondents with positive attitudes and mean scale scores were described, and comparison between medical specialties, and between clinical leaders and frontline staff was made using analysis of variance and chi-square test, respectively.

RESULTS

The response rate was 65.8% (N=367). Job satisfaction was rated most favorable, and the perceived culture of the top management least favorable. Safety climate was the dimension with the greatest variability across the 28 units. The diagnostic center had the most favorable culture of all centers. More leaders than frontline staff had positive attitudes toward teamwork and safety climate, and working conditions, respectively. Also, the leaders perceived these dimensions more positive than the frontline staff, P<0.05. Among three management levels, the unit management was perceived most favorable and the top management least favorable.

CONCLUSION

The management group is recommended to raise awareness of their role in supporting a safe and caring environment for patients and staff, moreover the leaders should ensure that every day work achieves its objectives; keeping the patients safe. Furthermore, following the development in patient safety culture over time is recommended.

The patient safety climate in Danish hospital units

INTRODUCTION

This study aimed to describe and analyse the patient safety climate in 15 Danish hospital units.

METHODS

A cross-sectional study design was applied. Patient safety culture was measured by the Danish version of the Safety Attitude Questionnaire comprising six cultural subscales. Subscale results were calculated as the percentage responders with an individual scale score of 75 point or more (range: 0-100), equivalent to %-positive, and as mean scale scores.

RESULTS

Out of 867 invited employees, 544 (63%) participated. No differences in %-positive were found between nurses and doctors, across age, gender or work experience (p > 0.05), but the difference between leaders and frontline staff was evident (p < 0.05). Perceptions varied more among individuals within the unit than between units within the hospital, and between hospitals.

CONCLUSIONS

The results provide a snapshot of how staff perceives the culture. The level of %-positives per dimension is comparable with most international findings. The higher levels of leaders who perceive the culture as positive should be further investigated in larger samples. Generally, patient safety culture should be assessed at unit level; dimensional strengths and weaknesses as well as subgroup differences should be identified, and dialogue-based methods should be applied to uncover why the culture is perceived as it is.

FUNDING

The TrygFonden provided financial support to the Danish Safer Hospital Programme, which funded this study.

TRIAL REGISTRATION

not relevant.

Quality management and perceptions of teamwork and safety climate in European hospitals

OBJECTIVE

This study aimed to investigate the associations of quality management systems with teamwork and safety climate, and to describe and compare differences in perceptions of teamwork climate and safety climate among clinical leaders and frontline clinicians.

METHOD

We used a multi-method, cross-sectional approach to collect survey data of quality management systems and perceived teamwork and safety climate. Our data analyses included descriptive and multilevel regression methods.

SETTING AND PARTICIPANTS

Data on implementation of quality management system from seven European countries were evaluated including patient safety culture surveys from 3622 clinical leaders and 4903 frontline clinicians.

MAIN OUTCOME MEASURES

Perceived teamwork and safety climate.

RESULTS

Teamwork climate was reported as positive by 67% of clinical leaders and 43% of frontline clinicians. Safety climate was perceived as positive by 54% of clinical leaders and 32% of frontline clinicians. We found positive associations between implementation of quality management systems and teamwork and safety climate.

CONCLUSIONS

Our findings, which should be placed in a broader clinical quality improvement context, point to the importance of quality management systems as a supportive structural feature for promoting teamwork and safety climate. To gain a deeper understanding of this association, further qualitative and quantitative studies using longitudinally collected data are recommended. The study also confirms that more clinical leaders than frontline clinicians have a positive perception of teamwork and safety climate. Such differences should be accounted for in daily clinical practice and when tailoring initiatives to improve teamwork and safety climate.

Accreditation and improvement in process quality of care: a nationwide study

OBJECTIVE

To examine whether performance measures improve more in accredited hospitals than in non-accredited hospital.

DESIGN AND SETTING

A historical follow-up study was performed using process of care data from all public Danish hospitals in order to examine the development over time in performance measures according to participation in accreditation programs.

PARTICIPANTS

All patients admitted for acute stroke, heart failure or ulcer at Danish hospitals.

INTERVENTION

Hospital accreditation by either The Joint Commission International or The Health Quality Service.

MEASUREMENTS

The primary outcome was a change in opportunity-based composite score and the secondary outcome was a change in all-or-none scores, both measures were based on the individual processes of care. These processes included seven processes related to stroke, six processes to heart failure, four to bleeding ulcer and four to perforated ulcer.

RESULTS

A total of 27 273 patients were included. The overall opportunity-based composite score improved for both non-accredited and accredited hospitals (13.7% [95% CI 10.6; 16.8] and 9.9% [95% 5.4; 14.4], respectively), but the improvements were significantly higher for non-accredited hospitals (absolute difference: 3.8% [95% 0.8; 8.3]). No significant differences were found at disease level. The overall all-or-none score increased significantly for non-accredited hospitals, but not for accredited hospitals. The absolute difference between improvements in the all-or-none score at non-accredited and accredited hospitals was not significant (3.2% [95% -3.6:9.9]).

CONCLUSIONS

Participating in accreditation was not associated with larger improvement in performance measures for acute stroke, heart failure or ulcer.

Improving quality of care among patients hospitalised with schizophrenia: a nationwide initiative

BACKGROUND

The effectiveness of systematic quality improvement initiatives in psychiatric care remains unclear.

AIMS

To examine whether quality of care has changed following implementation of a systematic monitoring programme of hospital performance measures.

METHOD

In a nationwide population-based cohort study, we identified 14 228 patients admitted to psychiatric departments between 2004 and 2011 from The Danish Schizophrenia Registry. The registry systematically monitors the adherence to guideline recommended processes of care.

RESULTS

The overall proportion of all relevant recommended processes of care increased from 64 to 76% between 2004 and 2011. The adherence to individual processes of care increased over time, including assessment of psychopathology using a diagnostic interview (relative risk (RR): 2.01, 95% CI: 1.51-2.68), contact with relatives (RR: 1.44, 95% CI: 1.27-1.62), psychoeducation (RR: 1.33, 95% CI: 1.19-1.48), psychiatric aftercare (RR: 1.06, 95% CI: 1.01-1.11) and suicide risk assessment (RR: 1.31, 95% CI: 1.21-1.42).

CONCLUSIONS

Quality of care improved from 2004 to 2011 among patients hospitalised with schizophrenia in Denmark.

DECLARATION OF INTEREST

None.

COPYRIGHT AND USAGE

© The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Adaption and validation of the Safety Attitudes Questionnaire for the Danish hospital setting

PURPOSE

Measuring and developing a safe culture in health care is a focus point in creating highly reliable organizations being successful in avoiding patient safety incidents where these could normally be expected. Questionnaires can be used to capture a snapshot of an employee's perceptions of patient safety culture. A commonly used instrument to measure safety climate is the Safety Attitudes Questionnaire (SAQ). The purpose of this study was to adapt the SAQ for use in Danish hospitals, assess its construct validity and reliability, and present benchmark data.

MATERIALS AND METHODS

The SAQ was translated and adapted for the Danish setting (SAQ-DK). The SAQ-DK was distributed to 1,263 staff members from 31 in- and outpatient units (clinical areas) across five somatic and one psychiatric hospitals through meeting administration, hand delivery, and mailing. Construct validity and reliability were tested in a cross-sectional study. Goodness-of-fit indices from confirmatory factor analysis were reported along with inter-item correlations, Cronbach's alpha (α), and item and subscale scores.

RESULTS

Participation was 73.2% (N=925) of invited health care workers. Goodness-of-fit indices from the confirmatory factor analysis showed: c(2)=1496.76, P<0.001, CFI 0.901, RMSEA (90% CI) 0.053 (0.050-0056), Probability RMSEA (p close)=0.057. Inter-scale correlations between the factors showed moderate-to-high correlations. The scale stress recognition had significant negative correlations with each of the other scales. Questionnaire reliability was high, (α=0.89), and scale reliability ranged from α=0.70 to α=0.86 for the six scales. Proportions of participants with a positive attitude to each of the six SAQ scales did not differ between the somatic and psychiatric health care staff. Substantial variability at the unit level in all six scale mean scores was found within the somatic and the psychiatric samples.

CONCLUSION

SAQ-DK showed good construct validity and internal consistency reliability. SAQ-DK is potentially a useful tool for evaluating perceptions of patient safety culture in Danish hospitals.

[Patient safety culture can be a driver for high clinical quality]

More and more health care organisations strive for a cost-effective, safe quality of care. Some studies have found simultaneous improved safety culture and reduction of patient harm following improvement activities like patient safety walk around, team training or multifaceted intervention programmes. There is a lack of evidence concerning the relationship between improved patient safety culture and reduction of patient harm in a Danish health-care setting. Currently a Danish validation of the Safety Attitude Questionnaire and an intervention study to improve patient safety culture is ongoing.

Feasibility of using administrative data to compare hospital performance in the EU

OBJECTIVE

To describe hospitals' organizational arrangements relevant to the abstraction of administrative data, to report on the completeness of administrative data collected and to assess associations between organizational arrangements and completeness of data submission.

DESIGN

A cross-sectional

STUDY DESIGN

utilizing administrative data.

SETTING AND PARTICIPANTS

Randomly selected hospitals from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey).

MAIN OUTCOME MEASURES

Completeness of data submission for four quality indicators: mortality after acute myocardial infarction, stroke and hip fractures and complications after normal delivery.

RESULTS

In general, hospitals were able to produce data on the four indicators required for this research study. A substantial proportion had missing data on one or more data items. The proportion of hospitals that was able to produce more detailed indicators of relevance for quality monitoring and improvement was low and ranged from 40.1% for thrombolysis performed on patients with acute ischemic stroke to 63.8% for hip-fracture operations performed within 48 h after admission for patients aged 65 or older. National factors were strong predictors of data completeness on the studied indicators.

CONCLUSIONS

At present, hospital administrative databases do not seem to be an appropriate source of information for comparison of hospital performance across the countries of the EU. However, given that this is a dynamic field, changes to administrative databases may make this possible in the near future. Such changes could be accelerated by an in-depth comparative analysis of the issues of using administrative data for comparisons of hospital performances in EU countries.

Sperm-egg interaction and functional assessment of springbok, impala and blesbok cauda epididymal spermatozoa using a domestic cattle in vitro fertilization system

The study assesses the possibility to estimate the potential fertility of post-thawed antelope (Antidorcas marsupialis), impala (Aepyceros melampus) and blesbok (Damaliscus dorcus phillipsi) epididymal sperm using homologous and heterologous IVF and the functioning of cattle IVF system to produce antelope embryos. Cauda epididymal sperm were collected from the antelope and cryopreserved under field conditions. In vitro matured domestic cow, blesbok and springbok oocytes were co-incubated in modified-Tyrode Lactate (m-TL) IVF media with springbok, impala and blesbok sperm for heterologous IVF and springbok and blesbok sperm for homologous IVF. A group of presumptive zygotes from each treatment were examined for sperm penetration and male pronuclear formation after 18h and the remainder were cultured and evaluated for embryo cleavage 22h later. The study shows that Modified Tyrode Lactate in vitro fertilization media supports survivability, capacitation and hyperactivation of springbok, impala and blesbok sperm. Springbok, impala and blesbok post-thawed epididymal spermatozoa are capable of fertilizing domestic cow oocytes under conditions that support domestic cattle IVF. Penetration, male pronuclear formation and embryo cleavage did not differ (p>0.05) between cow oocytes inseminated with sperm from springbok, impala or blesbok however these parameters were higher (p<0.05) for oocytes inseminated with bull sperm. Modified Tyrode Lactate IVF media supported homologous fertilization and embryo development in springbok and blesbok however did not support blastocyst development. These findings suggest that cattle provide a useful model for evaluating springbok, impala and blesbok post-thawed cauda epididymal sperm functionality. Domestic cattle embryo culture conditions need to be modified to promote blastosyst development in these antelope species. Such research provides an important tool in assisted reproductive technology development when high biological value material is utilized for wild species recovery plans.

The Global Genome Biodiversity Network (GGBN) Data Portal

The Global Genome Biodiversity Network (GGBN) was formed in 2011 with the principal aim of making high-quality well-documented and vouchered collections that store DNA or tissue samples of biodiversity, discoverable for research through a networked community of biodiversity repositories. This is achieved through the GGBN Data Portal (http://data.ggbn.org), which links globally distributed databases and bridges the gap between biodiversity repositories, sequence databases and research results. Advances in DNA extraction techniques combined with next-generation sequencing technologies provide new tools for genome sequencing. Many ambitious genome sequencing projects with the potential to revolutionize biodiversity research consider access to adequate samples to be a major bottleneck in their workflow. This is linked not only to accelerating biodiversity loss and demands to improve conservation efforts but also to a lack of standardized methods for providing access to genomic samples. Biodiversity biobank-holding institutions urgently need to set a standard of collaboration towards excellence in collections stewardship, information access and sharing and responsible and ethical use of such collections. GGBN meets these needs by enabling and supporting accessibility and the efficient coordinated expansion of biodiversity biobanks worldwide.

Freezing African elephant semen as a new population management tool

BACKGROUND

The captive elephant population is not self-sustaining and with a limited number of breeding bulls, its genetic diversity is in decline. One way to overcome this is to import young and healthy animals from the wild. We introduce here a more sustainable alternative method - importation of semen from wild bulls without removing them from their natural habitat. Due to the logistics involved, the only practical option would be to transport cryopreserved sperm. Despite some early reports on African elephant semen cryopreservation, the utility of this new population management tool has not been evaluated.

METHODOLOGY/PRINCIPAL FINDINGS

Semen was collected by electroejaculation from 14 wild African savanna elephant (Loxodonta africana) bulls and cryopreserved using the directional freezing technique. Sperm treatments evaluated included the need for centrifugation, the use of hen or quail yolk, the concentration of glycerol (3%, 5% or 7%) in the extender, and maintenance of motility over time after thawing. Our results suggest that dilution in an extender containing hen yolk and 7% glycerol after centrifugation best preserved post-thaw sperm motility when compared to all other treatments (P≤0.012 for all). Using this approach we were able to achieve after thawing (mean ± SD) 54.6±3.9% motility, 85.3±2.4% acrosome integrity, and 86.8±4.6% normal morphology with no decrease in motility over 1 h incubation at 37°C. Sperm cryopreserved during this study has already lead to a pregnancy of a captive female elephant following artificial insemination.

CONCLUSIONS/SIGNIFICANCE

With working techniques for artificial insemination and sperm cryopreservation of both African and Asian elephants in hand, population managers can now enrich captive or isolated wild elephant populations without removing valuable individuals from their natural habitat.

Enriching the captive elephant population genetic pool through artificial insemination with frozen-thawed semen collected in the wild

The first successful AI in an elephant was reported in 1998, using fresh semen. Since then almost 40 calves have been produced through AI in both Asian and African elephants worldwide. Following these successes, with the objective of enriching the captive population with genetic material from the wild, we evaluated the possibility of using frozen-thawed semen collected from wild bulls for AI in captivity. Semen, collected from a 36-yr-old wild African savanna elephant (Loxodonta africana) in South Africa was frozen using the directional freezing technique. This frozen-thawed semen was used for four inseminations over two consecutive days, two before and two after ovulation, in a 26-yr-old female African savanna elephant in Austria. Insemination dose of 1200 × 10(6) cells per AI with 61% motility resulted in pregnancy, which was confirmed through ultrasound examination 75, 110 and 141 days after the AI procedure. This represents the first successful AI using wild bull frozen-thawed semen in elephants. The incorporation of AI with frozen-thawed semen into the assisted reproduction toolbox opens the way to preserve and transport semen between distant individuals in captivity or, as was done in this study, between wild and captive populations, without the need to transport stressed or potentially disease-carrying animals or to remove animals from the wild. In addition, cryopreserved spermatozoa, in combination with AI, are useful methods to extend the reproductive lifespan of individuals beyond their biological lifespan and an important tool for genetic diversity management and phenotype selection in these endangered mammals.

Socioeconomic differences in quality of care and clinical outcome after stroke: a nationwide population-based study

BACKGROUND AND PURPOSE

The association among socioeconomic status, quality of care, and clinical outcome after stroke remains poorly understood. In a Danish nationwide follow-up study, we examined whether socioeconomic-related differences in acute stroke care occur and, if so, whether they explain socioeconomic differences in case-fatality and readmission risk.

METHODS

Using population-based public registries, we identified and followed all patients aged≤65 years admitted with stroke from 2003 to 2007 (n=14,545). We compared the proportion of patients receiving 7 specific processes of care according to income, educational attainment, and employment status. Furthermore, we computed 30-day and 1-year hazard ratios for death and readmission adjusted for patient characteristics and received processes of acute stroke care.

RESULTS

For low-income patients and disability pensioners, the relative risk of receiving all of the relevant processes of care was 0.82 (95% CI, 0.78 to 0.86) and 0.83 (95% CI, 0.79 to 0.87), respectively, compared with high-income patients and employed patients. Adjusted 30-day and 1-year hazard ratios for death for unemployed patients were 1.57 (95% CI, 1.25 to 1.97) and 1.58 (1.32 to 1.88), respectively, compared with employed patients. Unemployed patients also had a higher risk of readmission. The differences in mortality and readmission risk remained after controlling for received processes of acute stroke care.

CONCLUSIONS

Low socioeconomic status was associated with a lower chance of receiving optimal acute stroke care. However, the differences in acute care did not appear to explain socioeconomic differences in mortality and readmission risk.

[Measuring patient safety--why and how?]

Patient safety measurement from e.g. indicators, audits and questionnaires is used for risk management. Five years after the Danish Act on Patient Safety came into force, it remains unknown if health care is getting safer. The perspective of implementing patient safety methods for systematic monitoring is that it will become possible to continuously estimate the prevalence and incidence of patient safety problems. The lesson learnt in quality improvement is that it will pay back in terms of improvement in patient safety. For this purpose validated methods are needed.

Selection of indicators for continuous monitoring of patient safety: recommendations of the project 'safety improvement for patients in Europe'

BACKGROUND

Initiatives to improve patient safety have high priority among health professionals and politicians in most developed countries. Currently, however, assessment of patient safety problems relies mainly on case-based methodologies. The evidence for their efficiency and reproducibility, proving that safety of care has improved with their usage, is questionable. The exact incidence and prevalence of patient safety quality problems are unknown. Therefore, there is a need for firm, evidence-based methods to survey and develop patient safety and derived activities.

OBJECTIVE

The objective of this paper is to describe a method to select patient safety indicators and present the indicators derived through this process.

METHODS

The patient safety indicators were derived and recommended for use in a formalized consensus process based on literature review, targeted information gathering, expert consultation and rating procedures.

RESULTS

A total of 42 indicators, of which 28 originated from existing international indicator programmes, were selected. The processes and outcome indicators that were recommended for institutional-level use in Europe were 24, covering safety of care aspects such as culture, infections, surgical complications, medication errors, obstetrics, falls and specific diagnostic areas.

CONCLUSION

The patient safety indicators recommended present a set of possible measures of patient safety. One of the future perspectives of implementing patient safety indicators for systematic monitoring is that it will be possible to continuously estimate the prevalence and incidence of patient safety quality problems. The lesson learnt from quality improvement is that it will pay off in terms of improving patient safety.

30-days mortality in patients with perforated peptic ulcer: A national audit

Background

In 2005, The Danish National Indicator Project (DNIP) reported findings on patients hospitalized with perforated ulcer. The indicator “30-days mortality” showed major discrepancy between the observed mortality of 28% and the chosen standard (10%).

Rationale

An audit committee was appointed to examine quality problems linked to the high mortality. The purpose was to (i) examine patient characteristics, (ii) evaluate the appropriateness of the standard, and (iii) audit all cases of deaths within 30 days after surgery.

Methods

Four hundred and twelve consecutive patients were included and used for the analyses of patient characteristics. The evaluation of the standard was based on a literature review, and a structured audit was performed according to the 115 deaths that occurred.

Results

The mean age was 69.1 years, 42.0% had one co-morbid disease and 17.7% had two co-morbid diseases. 45.9% had an American Association of Anaesthetists score of 3–4. We found no results on mortality in studies similar to ours. The audit process indicated that the postoperative observation of patients was insufficient.

Discussion

As a result of this study, the standard for mortality was increased to 20%, and the new indicators for postoperative monitoring were developed. The DNIP continues to evaluate if these initiatives will improve the results on mortality.

Naturally acquired antibodies to Bacillus anthracis protective antigen in vultures of southern Africa

Sera from 19 wild caught vultures in northern Namibia and 15 (12 wild caught and three captive bred but with minimal histories) in North West Province, South Africa, were examined by an enzyme-linked immunosorbent assay (ELISA) for antibodies to the Bacillus anthracis toxin protective antigen (PA). As assessed from the baseline established with a control group of ten captive reared vultures with well-documented histories, elevated titres were found in 12 of the 19 (63%) wild caught Namibian birds as compared with none of the 15 South African ones. There was a highly significant difference between the Namibian group as a whole and the other groups (P < 0.001) and no significant difference between the South African and control groups (P > 0.05). Numbers in the Namibian group were too small to determine any significances in species-, sex- or age-related differences within the raw data showing elevated titres in four out of six Cape Vultures, Gyps coprotheres, six out of ten White-backed Vultures, Gyps africanus, and one out of three Lappet-faced Vultures, Aegypius tracheliotus, or in five of six males versus three of seven females, and ten of 15 adults versus one of four juveniles. The results are in line with the available data on the incidence of anthrax in northern Namibia and South Africa and the likely contact of the vultures tested with anthrax carcasses. It is not known whether elevated titre indicates infection per se in vultures or absorption of incompletely digested epitopes of the toxin or both. The results are discussed in relation to distances travelled by vultures as determined by new tracking techniques, how serology can reveal anthrax activity in an area and the issue of the role of vultures in transmission of anthrax.

The World Health Organization Performance Assessment Tool for Quality Improvement in Hospitals (PATH): an analysis of the pilot implementation in 37 hospitals

OBJECTIVE

To evaluate the pilot implementation of the World Health Organization Performance Assessment Tool for Quality Improvement in hospitals (PATH).

DESIGN

Semi-structured interviews with regional/country coordinators and Internet-based survey distributed to hospital coordinators.

SETTING

A total of 37 hospitals in six regions/countries (Belgium, Ontario (Canada), Denmark, France, Slovakia, KwaZulu Natal (South Africa)).

PARTICIPANTS

Six PATH regional/country coordinators and 37 PATH hospital coordinators.

INTERVENTION

Implementation of a hospital performance assessment pilot project.

OUTCOME MEASURE

Experience of regional/country coordinators (structured interviews) and experience of hospital coordinators (survey) with the pilot implementation.

RESULTS

The main achievement has been the collection and analysis of data on a set of indicators for comprehensive performance assessment in hospitals in regions and countries with different cultures and resource availability. Both regional/country coordinators and hospital coordinators required seed funding and technical support during data collection for implementation. Based on the user evaluation, we identified the following research and development tasks: further standardization and improved validity of indicators, increased use of routine data, more timely feedback with a stronger focus on international benchmarking and further support on interpretation of results.

CONCLUSIONS

Key to successful implementation was the embedding of PATH in existing performance measurement initiatives while acknowledging the core objective of the project as a self-improvement tool. The pilot test raised a number of organizational and methodological challenges in the design and implementation of international research on hospital performance assessment. Moreover, the process of evaluating PATH resulted in interesting learning points for other existing and newly emerging quality indicator projects.

Degradation of the drug diclofenac in water by sonolysis in presence of catalysts

Diclofenac, as one of the most popular antiphlogistics, is produced in great quantities. Nowadays this drug is ubiquitously present in the aquatic environment due to its resistance to biodegradation. Degradation by ultrasonic irradiation is a possibility to eliminate diclofenac from water without the addition of chemicals. The sonolysis of diclofenac in water was investigated at ultrasound frequencies of 24 kHz, 216 kHz, 617 kHz, and 850 kHz and in the presence of various catalysts (TiO2, SiO2, SnO2, and titanosilicate). The degradation of diclofenac by sonolysis of an aqueous solution at 617 kHz followed first-order kinetics. Catalysts, especially TiO2 increased the rate of degradation. Within 30 min of irradiation, the relative concentration of diclofenac decreased from 100% to 16%. By HPLC and GC-MS methods, chlorinated anilines, phenols and carboxylic acid derivatives were detected as a result of the sonolysis. About 35% of organic chlorine was transformed into inorganic chloride. Most of the identified degradation products in the sonolysis of diclofenac were the same compounds that were detected during photo-oxidation experiments with this anti-inflammatory drug.

Older patients with acute stroke in Denmark: quality of care and short-term mortality. A nationwide follow-up study

BACKGROUND AND PURPOSE

age may predict level of care and subsequent outcome among patients with stroke. We examined fulfilment of quality-of-care criteria according to age and the possible impact of any age-related differences on short-term mortality in a population-based nationwide follow-up study in Denmark.

METHODS

we identified 29,549 patients admitted with stroke between January 2003 and October 2005 in the Danish National Indicator Project (DNIP). Data on 30- and 90-day mortality were obtained from the Civil Registration System. We compared proportions of patients receiving adequate care across age groups, as measured by admission to a specialised stroke unit, administration of antiplatelet or anticoagulant therapy, examination with CT/MR scan, assessment by a physiotherapist and an occupational therapist, or assessment of nutritional risk. Further, we estimated 30- and 90-day mortality rate ratios (MRRs) across age groups, adjusted for fulfilment of quality-of-care criteria and patient characteristics.

RESULTS

the proportion of eligible patients who received adequate care declined with age for all the examined processes. The relative risk (RR) of receiving specific components of care ranged from 0.66 (95% confidence interval (CI): 0.60-0.73) to 0.97 (95% CI: 0.95-0.99) when comparing patients >80 years of age with patients < or =65 years of age. Although mortality increased with age, adjusting for the age-related differences in care did not alter the magnitude of the increase.

CONCLUSIONS

elderly stroke patients in Denmark receive a lower quality of care than do younger stroke patients, however, the age-related differences are modest for most examined quality-of-care criteria and do not appear to explain the higher mortality among older patients.

[Hospital standardised mortality ratios based on data from administrative registries. A pilot project]

INTRODUCTION

Hospital standardised mortality ratios (HSMR) are widely used in quality improvement campaigns. No data exist on whether HSMR can be computed based on Danish administrative registries. We therefore used data from Danish registries to compute HSMRs.

MATERIALS AND METHODS

By linking hospital discharge registries with the Danish Civil Registration System, we identified 77 primary discharge diagnoses that accounted for 80% of all deaths within 30 days of admission. We calculated overall death rates stratified by the 77 primary discharge diagnoses, age, gender, and type of admission and used these to compute the expected number of deaths. HSMR for each hospital was calculated as the ratio of observed to expected number of deaths.

RESULTS

Pneumonia, non-specified was the diagnosis that accounted for most deaths within 30 days after admission. The crude mortality rate varied from 5.7% to 6.3%. HSMR varied little--from 95 and 98 in Hospitals B and D to 102 and 103 in Hospitals A and C, respectively.

CONCLUSION

We found that it was possible to use data from Danish administrative registries to compute HSMR and that HSMR varied little between hospitals with comparable case-mixes.

A phase II study of YM155, a novel survivin suppressant, administered by 168 hour continuous infusion in patients with unresectable stage III or stage IV melanoma

8538

Background: In cell line studies, YM155 showed markedly potent antiproliferative activity against melanoma with 50% growth inhibition (GI50) values ranging from 0.35 nM to 910 nM. In melanoma tumor-bearing mouse xenograft models, YM155 showed significant antitumor activity including regression of tumors, at doses ranging from 1 to 10 mg/kg/day. Methods: Chemotherapy naive patients with unresectable Stage III or IV melanoma were eligible. The primary endpoint was tumor response defined by RECIST criteria. Secondary endpoints included progression-free survival and toxicity. A Simon's two stage minimax design was utilized with the first stage requiring 1 response (N=27) and a total of 2 responses required at the conclusion of stage II (N=29). Patients were considered evaluable if they completed 2 cycles. YM155 was given as a 168-hour (7-day) continuous infusion every three weeks (1 cycle) at a dose of 4.8 mg/m2/day. Results: Enrollment is complete at 34 pts in order to reach 29 evaluable with treatment ongoing. Results are available for the first 26 pts. Median age was 59 y/o, (range 29 - 88) with ECOG PS of 0–1. There is one objective response of intrabdominal lymph nodes based on Investigator assessment at Cycle 2 confirmed at Cycle 4; another patient had a minor response (24% reduction) at Cycle 6 (currently at Cycle 8). Two subjects have shown stable disease after 6 cycles and remain on study. The median number of cycles is 3 (range 1 - 9). Two of 26 pts reported a grade 3 AE considered possibly related to YM155 (chest pain - nos and catheter related thrombosis). Nineteen of 26 pts have discontinued the study (18 PD, 1 withdrew consent). Conclusions: YM155 induced responses in 2 pts and was generally well tolerated. Given this encouraging response as a single agent, studies of YM155 combined with other agents are under consideration.

[Table: see text]

Toxicity of diclofenac to Gyps vultures

Three endemic vulture species Gyps bengalensis, Gyps indicus and Gyps tenuirostris are critically endangered following dramatic declines in South Asia resulting from exposure to diclofenac, a veterinary drug present in the livestock carcasses that they scavenge. Diclofenac is widely used globally and could present a risk to Gyps species from other regions. In this study, we test the toxicity of diclofenac to a Eurasian (Gyps fulvus) and an African (Gyps africanus) species, neither of which is threatened. A dose of 0.8 mg kg(-1) of diclofenac was highly toxic to both species, indicating that they are at least as sensitive to diclofenac as G. bengalensis, for which we estimate an LD50 of 0.1-0.2 mg kg(-1). We suggest that diclofenac is likely to be toxic to all eight Gyps species, and that G. africanus, which is phylogenetically close to G. bengalensis, would be a suitable surrogate for the safety testing of alternative drugs to diclofenac.

246 IN VITRO PRODUCTION OF SPRINGBOK (ANTIDORCAS MARSUPIALIS) EMBRYOS

The objective of this experiment was to develop in vitro embryo production (IVP) technologies in springbok (Antidorcas marsupialis), a southern African antelope. Springbok, a fairly common species on game farms in parts of South Africa, may be used as a model species for gamete rescue and IVP techniques to be applied to the conservation of other threatened antelope species. Springbok belong to the family bovidae, subfamily antilopinae, tribe antilopini, which comprises about twenty species in genera Gazella, Antilope, Procapra, Antidorcas, Litocranius, and Ammodorcas. In this tribe alone, there are 4 species or subspecies that are critically endangered, 3 that are endangered, and 10 that are considered vulnerable, demonstrating the need for antelope conservation efforts. In addition, our studies contributed to the South African biological resource bank, so that banked springbok semen and embryos might be used in the future for managed genetic contribution to isolated captive or wild populations via assisted reproductive technologies. Oocytes were recovered (3 replicates) from ovaries obtained at supervised culls for management purposes in South Africa, and cultured in defined Gmat or undefined TCM-199 with FCS maturation medium for 28-30 h (Brad et al. 2004 Reprod. Fertil. Dev. 16, 223). Oocytes were fertilized with frozen-thawed springbok epididymal spermatozoa in modified SOF fertilization medium with caffeine (Herrick et al. 2004 Biol. Reprod. 71, 948–958). Eighteen hours after insemination, a randomly selected subset of the zygotes were fixed to determine fertilization success. The remaining zygotes were cultured in G1/G2 media. On Day 7 of culture, embryos were analyzed for development to the morula or blastocyst stage. A total of 259 selected oocytes were collected from 50 females (5.2 selected oocytes/female on average). There was no difference in the percentage of oocytes normally fertilized (2 pronuclei, PN) between oocytes matured in Gmat (n= 43; 12%) and those matured in TCM-199 (n= 42; 10%). There were significantly (P &lt; 0.05) more oocytes penetrated (e2 PN) when matured in TCM (50%) compared to Gmat (23%). There were no differences in embryonic cleavage or morula/blastocyst development (of total oocytes inseminated) between treatments (Gmat,n= 89, 54%, 9.0%; TCM-199, n= 85, 68%, 9.4%, respectively). In both treatments, the average blastocyst grade was 2.125 using the standard bovine grading system (Curtis, Cattle Embryo Transfer Procedure, 1991). In conclusion, in vitro oocyte maturation, fertilization, and embryo culture to the blastocyst stage is possible in springbok. Importantly, blastocysts can be produced in vitro under semi-defined conditions, demonstrating that oocyte maturation without serum does support developmental competence. This is important for the potential international movement of IVP embryos to be used for genetic management in the conservation of antelope species.

241 TIME POINTS FOR IN VITRO MATURATION OF LION (PANTHERA LEO) OOCYTES

The objective of the study was to establish a time point for successful in vitro maturation of lion (Panthera leo) oocytes using a model developed for the domestic cat (Gomez et al. 2003 Theriogenology 60, 239–251). As part of a game reserve management program, one adult free-ranging lioness (6–7 years old) and her 3 sub-adult cubs (18 months old) were chemically immobilized with 500 mg of a combination of tiletamine and zolazepam (Zolatil 100�; Virbac SA, Carras, France) by remote injection (Dan-inject�; Dan-Inject ApS, Borkop, Denmark) and within 20 min euthanized using 8 g sodium pentobarbitone (Euthapent� KruVet, SA). Ovaries collected from the adult and 2 sub-adult females were transported to a laboratory in a flask containing warm (37�C) sterile saline. Within 2 h of collection, all visible follicles were aspirated using a 21G needle attached to a 5-mL syringe. To increase the number of recovered oocytes, ovaries were minced using a scalpel blade in a 60-mm Petri dish containing warm search medium (HEPES-buffered TCM-199, 2.2 mM Ca lactate, 0.36 mM pyruvate, 2 mM glutamine, 1.12 mM cysteine, 0.3% w/v fatty acid-free BSA, and 50 �g mL-1 gentamicin). A total of 33 and 54 oocytes were recovered from the adult and sub-adult females, respectively, and cultured in 35-mm Petri dishes containing 3-mL of maturation medium (sodium bicarbonate-buffered TCM-199, 1 IU mL-1 hCG, 0.5 IU mL-1 eCG, 2.2 mM Ca lactate, 0.36 mM pyruvate, 2 mM glutamine, 1.12 mM cysteine, 0.3% w/v fatty acid-free BSA, and 50 �g mL-1 gentamicin). Petri dishes containing oocytes were enclosed in a sealed plastic bags, filled with a humidified gas mixture of 5% CO2, 5% O2, and 90% N2, and incubated at 38.8�C. After 26, 32, or 38 h of incubation, groups of 29 oocytes were fixed in 3 : 1 ethanol : acetic acid solution and stored at 4�C for 48 h. Fixed oocytes were stained with 1% w/v orcein and visualized with phase-contrast microscopy. Oocytes in telophase I or metaphase II were classified as mature. Each ovary had an average of 22.5 � 3.0 antral follicles, where 8.8 � 2.0 were 2-3 mm, and 13.8 � 1.5 were 1 mm in diameter. There were no CLs present. Out of 87 oocytes recovered, 24.0 � 3.7% had a uniform cytoplasm and &gt;3-4 layers of cumulus cells, 42.2 � 6.0% had a uniform cytoplasm and 2 or less layers of cumulus cells, and 33.8 � 9.7% had no cumulus cells attached. None of the oocytes were mature at 26 h, but at 32 h and 38 h, the percentage of matured oocytes significantly (P &lt; 0.05) increased to 63.9 � 13.9% and 80.4 � 7.1%, respectively. These results indicate that the domestic cat system used herein can be successfully applied for in vitro maturation of lion oocytes. However, unlike oocytes from a domestic cat, lion oocytes required a culture period of 32 to 38 h to reach metaphase II. Further studies are required to confirm these findings and to test fertilization rates of such matured oocytes, and their ability for further development.

Wildlife biomaterial banking in Africa for now and the future

The Wildlife Biological Resource Centre (wBRC) together with its partners in BioBank SA, have created a Biological Resource Bank (BRB) that is dedicated to the acquisition, processing, banking, using and provision of biomaterials to the scientific and conservation industry that are viable, diverse and representative of southern Africa's wildlife populations. Banked biomaterials include tissue such as muscle, kidney, fat, liver, embryos, fibroblast cultures, blood, sperm, hair, egg shells and other tissue, fluids and cells. Biomaterials are made available for research, biodiversity conservation and biotechnology development. Biomaterials are used in many disciplines, including genetics, reproduction, nutrition, and disease studies. Biomaterials from selected species are also useful for the detection and monitoring of Persistent Organic Pollutants and other potentially harmful substances found in the environment. Biomaterials are made available to third parties with prior consent from the biomaterials "owner" and only after the signing of a customised Material Transfer Agreement (MTA) or Cooperative Research and Development Agreement (CRADA). The training of staff from National and Provincial Game Reserves, Zoological Gardens, Animal Breeders and laboratories is carried out on a regular basis with the aim of securing good quality biomaterials. Sampling kits are made available to persons tasked with the collection of wildlife biomaterials. The Biobank SA consortium acts as an integrated resource centre linking partner collections. The consortium's operational arm, namely wBRC, is active in the development of relevant policy, regulations and legislation pertaining to biomaterials, including Access and Benefit Sharing systems. The main sponsor of the project is the Department of Science and Technology, National Government of South Africa.

217 QUALITY CHANGES IN POST-THAW SPRINGBOK (ANTIDORCAS MARSUPIALIS) EPIDIDYMAL SPERM MAINTAINED IN FERTILIZATION MEDIUM

The availability of gametes from the cropping of excess wildlife species provides the opportunity for the advancement of knowledge into assisted reproductive technology for possible future conservation measures. Little is known about the longevity of springbok (Antidorcas marsupialis) spermatozoa maintained in fertilization medium. The aim of this project was to determine the quality changes of post-thawed springbok spermatozoa incubated in fertilization medium by measuring plasma membrane integrity over time. Testes (n = 12) were obtained from two geographically distinct free-ranging springbok populations in South Africa. Spermatozoa were flushed from the cauda epididymides within three hours of the animals' death. Samples from an individual male were pooled, diluted to 400 × 106 sperm/mL with Biladyl (Minitüb, Tiefenbach, Germany) fraction A (no glycerol) and equilibrated in a water bath for 6 h at 4°C. An equal volume of Biladyl fraction B (containing 12% glycerol) was added to the sample to make a final concentration of 200 × 106 sperm/mL. Samples were loaded into 0.25-mL straws and frozen in liquid nitrogen vapor (5 cm above the liquid nitrogen level) for 20 min after which they were plunged into liquid nitrogen. Straws from each sample were thawed for 20 s at 36°C in a water bath. Thawed spermatozoa (100 μL) was added to 1 mL IVF-TALP medium containing heparin and PHE (Vajta et al. 1996 Theriogenology 45, 683–689) in 2-mL Nunc tubes (AEC, Amersham, South Africa) and incubated at 38.7°C, in humidified 5% CO2 balance air for 30 h. Aliquots were extracted from the incubating spermatozoa to determine plasma membrane integrity at 6-h intervals. Propidium iodide (Sigma, South Africa) at 50 ng/mL (10 min at RT) was used to evaluate membrane integrity under fluorescence microscopy at ×400, with a 450-nm excitation filter, a 510-nm dicroic beam splitter, and a 520-nm barrier filter. Cells with damaged plasma membrane have nuclei that fluorescence red. Eosin/nigrosin was also used to evaluate membrane integrity under ×400 bright-field microscopy. Cells with damaged plasma membrane stain purple-red, whereas the balance of cells remain translucent. The average post-thaw motility of spermatozoa in populations A and B was 69% (n = 6) and 68% (n = 6), respectively. Plasma membrane integrity of post-thawed springbok spermatozoa deceased steadily in IVF-TALP medium over the 30-h period (Table 1). Cryopreserved epididymal sperm derived from free-ranging springbok populations survive in IVF-TALP media and may be useful in future conservation activities where an isolated gene pool requires genetic supplementation through one or more assisted reproduction techniques such as IVF or AI. Further research is required to confirm and extend these findings. Table 1. Percentage plasma membrane integrity of post-thawed springbok sperm over time

195 CHANGES OF BLESBOK AND BLUE WILDEBEEST EPIDIDYMAL SPERM AFTER INCUBATION AT 37°C

Postmortem recovery of epididymal spermatozoa and their preservation in Biological Resource Banks is a convenient source of germplasm, providing a possible future conservation resource for selected endangered wildlife species. It is necessary to gain knowledge of the biology of the gametes of the different species, in order to define effective protocols for cryopreservation and future assisted reproductive technology application. A pilot study on the changes in blue wildebeest (Connochaetes taurinus) and blesbok (Damaliscus dorcas phillipsi) epididymal sperm was carried out in order to provide some insight into the effects of incubation at 37°C. Chemicals were aquired from Sigma (South Africa), except JC-1 (Molecular Probes, Leiden, The Netherlands). Sperm was obtained by flushing the vas deferens and cauda epididymis of 6 adult blue wildebeests and 4 adult blesbok after the breeding season using 1 mL of Biladyl (fraction A; Minitüb, Tiefenbach, Germany). Cells were washed and resuspended in buffered medium (20 mM HEPES, 197 mM NaCl, 10 mM glucose, 2.5 mM KOH). Part of each sample was analyzed and part was incubated for 1 h at 37°C, and then analyzed. Analysis consisted of: motility (% of motile sperm, TM; and % of linear sperm, LM), vitality (fluorescent dye propidium iodide, 7 μM; % of unstained cells noted after 10 min at RT: vital, VIT), mitochondrial status (fluorescent dye JC-1, 7.5 μM; % of cells with orange midpiece noted after 30 min at 37°C: active mitochondria, MIT), and induction of acrosome reaction (15 min at 37°C in buffered medium complemented with 3 mM CaCl; % of intact acrosomes noted in control: splits no ionophore, ACR, and test: splits 1 μM calcimycin, ION). Samples were assessed using phase contrast microscopy (×400; ×200 for motility). Results are showed in Table 1. No significant differences (Wilcoxon Rank Sign test) were detected, possibly due to the low number of samples. However, LM appeared to decrease after incubation. Incubaton may increase the sensitivity of blue wildebeest sperm to ionophore (ION). Motility was least for blesbok, and the decrease of LM after incubation was more apparent. This treatment may induce different physiologycal changes between the species (different LM variation). The rest of the parameters suggest that the treatment did not induce extensive cell damage. Further research must be carried out to confirm these findings. Table 1. Median values for the analyzed parameters Sponsors of this project include Vodacom, Joan St. Leger Lindburgh Charitable Trust, Tony and Lizette Lewis Foundation, Department Science and Technology (South Africa), British Airways, IMV Technologies/CBS (France), NECSA, Zeiss Microscopes, AEC-Amersham, CryoLogic (Australia), Cook Veterinary (Australia), Mazda Wildlife Fund, The Scientific Group, Genaust (Australia), and SCI – Chesapeake Chapter.