Substance use and help-seeking among justice-involved young people in Queensland and Western Australia: A cross-sectional survey of 14-17-year-olds

INTRODUCTION

This study investigated substance use and help-seeking among justice-involved young people to inform and improve service provision during and after contact with the justice system.

METHODS

Young people (14-17 years) in the community with current or prior contact with the justice system were recruited in Queensland and Western Australia, Australia using purposive sampling between 2016 and 2018. A cross-sectional survey was delivered by computer-assisted telephone interview. Information was collected on sociodemographic and health factors; lifetime and frequency of use of alcohol, tobacco and other drugs; and use of health services related to substance use and mental health.

RESULTS

Of the 465 justice-involved young people surveyed, most had used alcohol (89%), tobacco (86%) or other drugs (81%). Of the latter, cannabis use was most prevalent (79%), followed by ecstasy (26%) and amphetamine (22%). Young people engaging in higher risk drug use (daily use, injecting use) were more likely to also have an alcohol use disorder, be disengaged from education, unemployed, have attempted suicide and experienced incarceration. Of the cohort, 24% had received treatment at an alcohol and drug service in the past year and 30% had seen a health professional about emotional/behavioural problems. Males and Aboriginal and Torres Strait Islander young people were less likely to have sought professional help.

CONCLUSION

The high levels of substance use and disproportionate levels of help-seeking observed in this study illustrate the importance of delivering tailored, comprehensive and coordinated trauma-informed and culturally safe alcohol and drug services to justice-involved young people.

The sexual behaviours of adolescents aged between 14 and 17 years involved with the juvenile justice system in Australia: A community-based survey

Objectives

To overcome key knowledge gaps in relation to justice involved and vulnerable young people and their sexual health and to compare this group with their peers from other youth health surveys in Australia to determine the extent of the issues.

Methods

Young people, aged between 14 and 17 years, who had ever been or were currently involved with the criminal justice system were purposively sampled. The survey was anonymous and delivered using Computer Assisted Telephone Interview (CATI).

Results

A total of 465 justice involved MeH-JOSH young people, aged between 14 and 17 years, participated in the study: 44% Aboriginal and/or Torres Strait Islander (Indigenous) and 37% not attending school. Of the total valid responses, 76% (n = 348) reported having ever had sex, with sexual initiation at a median age of 14 years. We compared these data with their peers in other Australian surveys and found that young people in our study had a higher engagement in sex and start having sex at a younger age, reporting more sexual partners at all ages.

Conclusions

The sexual behaviours of young people involved in the justice system in this study suggest they may be at a greater risk for sexually transmissible infections than their age-matched peers in the general population. Policymakers should elevate them to a priority population for targeting sexual health services and health promotion.

[Patentability of an antibody: evolution of rules and practices and prospects]

Les anticorps monoclonaux représentent aujourd’hui la classe médicamenteuse la plus importante en termes de ventes mondiales. L’obtention d’une protection par brevet de ces molécules est donc cruciale. Une dynamique active de dépôts de demandes de brevets pour protéger les inventions que ces molécules représentent existe donc autant dans l’industrie que dans le monde de la recherche académique. Cependant, les demandeurs doivent faire face à des difficultés récurrentes pour obtenir des brevets de portée importante et faire valoir leurs droits devant les tribunaux. Les trois critères les plus débattus autour des revendications d’anticorps sont : la suffisance/clarté de l’invention, la nouveauté et l’activité inventive. L’objectif de cet article est donc de faire un état des lieux de la pratique en la matière.

Psychiatric problems of detainees under the Anti-Terrorism Crime and Security Act 2001

Aims and Method

To provide a composite view of the impact of indefinite detention under the Anti-Terrorism Crime and Security Act 2001. Until recently, a number of detainees had been detained under this legislation since December 2001. The impact of this on eight detainees and three of their spouses is examined through qualitative analysis of 48 reports and documents compiled by 11 psychiatrists and 1 psychologist.

Results

Detention has had a severe adverse impact on the mental health of all detainees and the spouses interviewed. All were clinically depressed and a number had post-traumatic stress disorder. The indefinite nature of detention was a major factor in their deterioration.

Clinical Implications

The use of indefinite detention without trial has severe adverse consequences that may pose insurmountable problems for the prison healthcare system.

Ecobat: An online resource to facilitate transparent, evidence-based interpretation of bat activity data

Acoustic surveys of bats are one of the techniques most commonly used by ecological practitioners. The results are used in Ecological Impact Assessments to assess the likely impacts of future developments on species that are widely protected in law, and to monitor developments’ postconstruction. However, there is no standardized methodology for analyzing or interpreting these data, which can make the assessment of the ecological value of a site very subjective. Comparisons of sites and projects are therefore difficult for ecologists and decision‐makers, for example, when trying to identify the best location for a new road based on relative bat activity levels along alternative routes. Here, we present a new web‐based, data‐driven tool, Ecobat, which addresses the need for a more robust way of interpreting ecological data. Ecobat offers users an easy, standardized, and objective method for analyzing bat activity data. It allows ecological practitioners to compare bat activity data at regional and national scales and to generate a numerical indicator of the relative importance of a night's worth of bat activity. The tool is free and open‐source; because the underlying algorithms are already developed, it could easily be expanded to new geographical regions and species. Data donation is required to ensure the robustness of the analyses; we use a positive feedback mechanism to encourage ecological practitioners to share data by providing in return high quality, contextualized data analysis, and graphical visualizations for direct use in ecological reports.

Evidence of increasing public participation in advance care planning: a comparison of polls in Alberta between 2007 and 2013

BACKGROUND

Advance care planning (ACP) encompasses both verbal and written communications expressing preferences for future health and personal care and helps prepare people for healthcare decision-making in times of medical crisis. Healthcare systems are increasingly promoting ACP as a way to inform medical decision-making, but it is not clear how public engagement in ACP activities is changing over time.

METHODS

Raw data from 3 independently conducted public polls on ACP engagement, in the same Canadian province, were analysed to assess whether participation in ACP activities changed over 6 years.

RESULTS

Statistically significant increases were observed between 2007 and 2013 in: recognising the definition of ACP (54.8% to 80.3%, OR 3.37 (95% CI 2.68 to 4.24)), discussions about healthcare preferences with family (48.4% to 59.8%, OR 1.41 (95% CI 1.17 to 1.69)) and with healthcare providers (9.1% to 17.4%, OR 1.98 (95% CI 1.51 to 2.59)), written ACP plans (21% to 34.6%, OR 1.77 (95% CI 1.45 to 2.17)) and legal documentation (23.4% to 42.7%, OR 2.13 (95% CI 1.75 to 2.59)). These remained significant after adjusting for age, education and self-rated health status.

CONCLUSIONS

ACP engagement increased over time, although the overall frequency remains low in certain elements such as discussing ACP with healthcare providers. We discuss factors that may be responsible for the increase and provide suggestions for healthcare systems or other public bodies seeking to stimulate engagement in ACP.

The trouble with Martin O'Meara

OBJECTIVE

The objective of this article is to highlight the pitfalls of translating historical cases of wartime psychiatric trauma into modern post-traumatic stress disorder (PTSD).

METHOD

We examined all available primary sources relating to the case of Martin O'Meara VC (1885-1935).

RESULTS

We found that O'Meara's symptoms are not consistent with a diagnosis of PTSD.

CONCLUSIONS

It is more likely that O'Meara developed a form of schizoaffective disorder, or long-lasting trauma-induced psychosis, after World War I.

Here and Now Aboriginal Assessment: background, development and preliminary evaluation of a culturally appropriate screening tool

OBJECTIVE

Assessment of Aboriginal social and emotional wellbeing (SEWB) is a complex and challenging task, in part due to a lack of suitable assessment tools. This paper reports the development and evaluation of a culturally appropriate screening tool called the Here and Now Aboriginal Assessment (HANAA).

METHOD

The initial phase included development of a glossary of Aboriginal terms and concepts relating to SEWB. The glossary was used to identify 10 key HANAA domains, which included physical health, sleep, mood, suicide risk and self harm, substance use, memory, unusual experiences, functioning, life stressors and resilience. Evaluation of the HANAA included exploration of its cultural applicability, feasibility, reliability and validity.

RESULTS

The HANAA was well accepted by study participants and easily implemented by assessors. Reliability was good, with inter-rater agreements between Aboriginal and non-Aboriginal assessors measured by Kappa statistics ranging from 0.5 to 1.0. There was also a good agreement between assessors and treating clinicians in identifying the main presenting problem and recommended course of action.

CONCLUSION

The HANAA is a culturally appropriate and useful tool for the screening of SEWB among Aboriginal adults. It can also be used for teaching and training purposes of mental health and other professionals working with Aboriginal people.

The Impact of Contact With Suicide-Related Behavior in Prison on Young Offenders

Background: Prison suicide rates are high, and suicide-related behaviors (SRBs) higher, but effects of contact with such behaviors in prison have not previously been examined. Aims: To compare the mental state of young men witnessing a peer’s suicide-related behavior in prison with that of men without such experience, and to test for factors associated with morbidity. Method: Forty-six male prisoners (age 16–21 years) reporting contact with another’s suicide-related behavior in prison were interviewed 6 months after the incident, with validated questionnaires, as were 44 without such contact at least 6 months into their imprisonment. Results: Significantly higher levels of psychiatric morbidity and own suicide-related behaviors were found in the witness group, even after controlling for their higher levels of family mental illness and pre-exposure experience of in-prison bullying. Some personal factors were associated with higher morbidity; incident and institutional factors were not. Conclusions: Findings of heightened vulnerabilities among young men exposed to suicide-related behaviors in prison suggest a need for longitudinal study to clarify temporal relationships and inform strategies to prevent or limit development of morbidity and further harm.

Anti-viral therapy for prevention of perinatal HBV transmission: extending therapy beyond birth does not protect against post-partum flare

BACKGROUND

Antepartum anti-viral therapy (AVT) is often administered to prevent perinatal transmission of hepatitis B virus (HBV) infection. Little is known about the effect of AVT on post-partum flare rates and severity.

AIM

To examine whether extending AVT beyond birth influences the post-partum course.

METHODS

One hundred and one pregnancies in 91 women with HBV DNA levels ≥log 7 IU/mL were included. AVT (initially lamivudine, later tenofovir disoproxil fumarate) was commenced from 32 weeks gestation and stopped soon after birth and at 12 weeks post-partum. Outcomes according to post-partum treatment duration were examined: Group 1 = AVT ≤4 weeks (n = 44), Group 2 = AVT >4 weeks (n = 43), Group 3 = no AVT (n = 14).

RESULTS

The majority of women were HBeAg+ (97%), median age 29 years, baseline HBV DNA log 8.0 IU/mL and follow-up 48 weeks post-partum. Post-partum treatment duration was 2 weeks for Group 1 and 12 weeks for Group 2, P < 0.01. Flare rates were not significantly different: Group 1 = 22/44 (50%), Group 2 = 17/43 (40%) and Group 3 = 4/14 (29%), P = 0.32. Onset of flare was similar at 8/10/9 weeks post-partum for Groups 1/2/3 respectively, P = 0.34. The majority of flares spontaneously resolved. HBeAg seroconversion (n = 1/5/1 in Groups 1/2/3, P = 0.27) was not associated with treatment duration or the occurrence of a post-partum flare.

CONCLUSIONS

Post-partum flares are common and usually arise early after delivery. They are often mild in severity and most spontaneously resolve. Extending anti-viral therapy does not protect against post-partum flares or affect HBeAg seroconversion rates.

How mental health clinicians want to evaluate the care they give: a Western Australian study

OBJECTIVES

To explore how Western Australian mental health clinicians want to evaluate their care. METHODS; Using a participatory action research framework, 10 senior psychiatrists and 11 clinical nurse specialists working in an inpatient mental health setting participated in individual interviews, focus groups and meetings. All interviews were de-identified during transcription and transcripts and field notes were analysed for common themes.

RESULTS

Participants identified what they wanted to measure, how they wanted to measure it and how these changes could be implemented. Clinicians stressed the importance of measuring context (physical, clinical and service) and process as well as outcome, and of evaluating care at an individual and service level with consumer involvement. What is known about the topic? Completion rates of mandatory national outcome measures in mental health in Australia are variable and clinicians have mixed views as to their value. Several barriers have been identified as to their use including clinical, resource and ownership issues. What does this paper add? Some studies have identified areas of good practice and elicited practical suggestions for improvement but few have asked clinicians how they actually want to evaluate the care they provide. This study explored how mental health clinicians wanted to evaluate their care, using a participatory action research framework that encouraged participants to pinpoint problems and issues, account for their social context and develop actions to address them. What are the implications for practitioners? Clinicians were enthusiastic for high quality care and evaluation, but pessimistic about their ability to introduce sustainable change. Establishing and supporting active and responsible leadership at service level may solve this, as may encouraging local standard setting and benchmarking in collaboration with consumers and carers.

Personality disorder and criminal behaviour: what is the nature of the relationship?

PURPOSE OF REVIEW

There is a well established association between personality disorder and offending but the nature of the relationship is less well understood. We reviewed the recent literature on personality disorder and offending, picking out studies that examined the relationship between the two.

RECENT FINDINGS

Cluster A, B and C personality disorders are each associated with different types of offences. Although rates of personality disorder are high in all serious offenders, the role played by personality disorder may be greater in some offences than others, for example, in rapists compared with child molesters, men who kill their fathers rather than their mothers, men who kill their children compared with mothers who kill their children; and in less severe stalking behaviour compared with those who get convictions. Three articles suggested frameworks for understanding how personality disorder may interact with other factors to contribute to offending.

SUMMARY

Frameworks that integrate personality traits; comorbid problems such as substance misuse, mood disorders and attention deficit hyperactivity disorder (ADHD) symptoms; motivation for offending; maladaptive cognitions; beliefs and attitudes; anger and arousal; and situational factors are helpful when considering risk assessment, risk management and treatment. More empirical research is needed to test these theories.

Design and validation of a highly discriminatory 10-locus Y-chromosome STR multiplex system

The Y-chromosome STRs (short tandem repeat) markers are routinely utilized in the resolution of forensic casework related to sexual assault. For this, the forensic community has adopted a set of eleven (core) Y-STR that is incorporated in all commercial diagnostic systems. Our previous studies of Y-STR polymorphisms in the South African population identified low levels of diversity and discrimination capacity for many commercial marker sets, determining a limited applicability of these systems to the local population groups. To overcome this shortcoming, we designed a Y-STR 10-plex system that shows higher discriminatory capacity (DC) than available commercial systems. The markers were selected from a population group of 283 individuals with African, European and Asian ancestry genotyped at 45 Y-STRs, applying an optimization based selection procedure to achieve the highest possible DC with the minimal number of markers. The 10-plex was satisfactorily subjected to developmental validation tests following the SWGDAM guidelines and shows potential for its application to genealogical and evolutionary studies.

Platelet and other tests followed sequentially for 14 days after operation

Nineteen patients were studied twice before and sequentially from 1 h to 14 days after operations lasting about 1 h. Eighteen tests were carried out, ideally on all the nine occasions blood collections were planned. Only significant changes are summarized. Immediately after the operation the plasma PF4 and beta TG were raised in parallel suggesting some platelet 'release' had occurred. At this time platelet aggregation to ADP and collagen had decreased by 57% to 64% and the plasma cyclic AMP had doubled. Next day these abnormalities had returned towards normal. By day 2 the fibrinogen and the heparin neutralizing activity were maximal; they returned towards normal by day 14. On day 14, when presumably all platelets present at operation had been removed the new platelets were 53% more numerous and 9.5% smaller; they contained 23% less PF4 and 42% less serotonin and 5-HT uptake was decreased, but the total amount of 5-HT and PF4 in the circulation probably remained constant. In summary these operations transitorily upset platelet function for a few hours and the platelets formed postoperatively were abnormal.

Covalent attachment of proteins to peptidoglycan

Bacterial surface proteins are key players in host-symbiont or host-pathogen interactions. How these proteins are targeted and displayed at the cell surface are challenging issues of both fundamental and clinical relevance. While surface proteins of Gram-negative bacteria are assembled in the outer membrane, Gram-positive bacteria predominantly utilize their thick cell wall as a platform to anchor their surface proteins. This surface display involves both covalent and noncovalent interactions with either the peptidoglycan or secondary wall polymers such as teichoic acid or lipoteichoic acid. This review focuses on the role of enzymes that covalently link surface proteins to the peptidoglycan, the well-known sortases in Gram-positive bacteria, and the recently characterized l,d-transpeptidases in Gram-negative bacteria.

Elder abuse: campaign seeks to raise awareness and improve action

This article, brought to you in association with Help the Aged, highlights the issue of elder abuse, and calls for nurses' involvement in recognizing and dealing with the problem.

Sexual attitudes, experience and relationships amongst patients in a high security hospital

BACKGROUND

Detention in high security hospitals tends to last several years during patients' early adulthood, yet romantic partnerships and sexuality have been little studied.

AIMS

To study such relationships among these inpatients.

METHOD

Patients were engaged in a confidential, purpose-designed semi-structured interview concerning their relationships and their views on those of others.

RESULTS

Seven (of 10) women and 18 (of 24) men gave interviews. All but one had previously been sexually active. No previous relationship lasted into high security but half (15) reported a new relationship. Most emphasized the importance of caring in respect of sexual activity but sexual intimacy short of intercourse was reported. Most (17) could describe 'safe sex' practices, but few (5) had ever followed them. At least half had experienced seriously abusive sexual relationships in childhood.

CONCLUSIONS

Patients appeared able to talk reliably about their romantic and sexual relationships, their interest in which did not cease on incarceration. Findings suggest that it is important for staff to have accurate information on these to ensure safety and adequate support.

Identification of the Bacillus anthracis (gamma) phage receptor

Bacillus anthracis, a gram-positive, spore-forming bacterium, is the etiological agent of anthrax. It belongs to the Bacillus cereus group, which also contains Bacillus cereus and Bacillus thuringiensis. Most B. anthracis strains are sensitive to phage gamma, but most B. cereus and B. thuringiensis strains are resistant to the lytic action of phage gamma. Here, we report the identification of a protein involved in the bacterial receptor for the gamma phage, which we term GamR (Gamma phage receptor). It is an LPXTG protein (BA3367, BAS3121) and is anchored by the sortase A. A B. anthracis sortase A mutant is not as sensitive as the parental strain nor as the sortase B and sortase C mutants, whereas the GamR mutant is resistant to the lytic action of the phage. Electron microscopy reveals the binding of the phage to the surface of the parental strain and its absence from the GamR mutant. Spontaneous B. anthracis mutants resistant to the phage harbor mutations in the gene encoding the GamR protein. A B. cereus strain that is sensitive to the phage possesses a protein similar (89% identity) to GamR. B. thuringiensis 97-27, a strain which, by sequence analysis, is predicted to harbor a GamR-like protein, is resistant to the phage but nevertheless displays phage binding.

Postmenopausal hormone therapy: from monkey glands to transdermal patches

The climacteric is not a condition of the modern age, although with increased life expectancy over the centuries, more women will experience this physiological transition. As women are living longer there is a greater expectation that good health will be maintained through to the late decade. Thus the potential long-term adverse health consequences of using hormonal therapies (HTs) to alleviate menopausal symptoms are of considerable concern for women and medical practitioners. This concern is often the basis for a decision whether or not to use HT. We have reviewed the history of knowledge of the menopause and the development of HT for the treatment of climacteric complaints. We have also summarised the current evidence for specific benefits and risks of HT. Data indicate that postmenopausal HT is appropriate for the management of vasomotor symptoms, but that HT should not be prescribed for the prevention of cardiovascular disease or dementia. HT does prevent bone loss and osteoporotic fracture; however, use for this purpose remains controversial. The risk of breast cancer with HT varies according to the preparation used, such that oestrogen without concurrent progestin appears to convey little, or possibly even no significant breast cancer risk. There is insufficient information regarding the long-term use of non-oral HT, low-dose HT or novel compounds such as tibolone or the selective oestrogen receptor modulators with respect to breast cancer and cardiovascular risk for specific recommendations to be made.

Liver transplantation for a hilar inflammatory myofibroblastic tumor

A 7-yr-old boy presented with obstructive jaundice secondary to an inflammatory myofibroblastic tumor centered on the hepatic hilum and extending into the liver. The tumor was further complicated by portal vein phlebitis and occlusion. Attempted resection of the tumor with portal vein reconstruction and bilioenteric drainage was unsuccessful and he required urgent orthotopic liver transplantation. In contrast to more peripheral inflammatory myofibroblastic tumors in the liver, hilar lesions are locally aggressive, causing occlusive portal phlebitis and biliary obstruction. Successful management may include the need for liver transplantation.

Young male prisoners in a Young Offenders' Institution: their contact with suicidal behaviour by others

Prison suicide rates are increasing. The impact of witnessing a suicide or how many people do so is unknown. The aim of this study was to find how many young people detained in a Young Offenders' Institution (YOI) have had contact with another's suicide attempt and to test for association between this and own self-harming behaviour. A questionnaire, developed for the project, was distributed within a YOI. 74% (355/480) responded. One hundred and fifty-one (43%) of the young men reported that they knew someone who had attempted suicide, 48 of them knowing someone who had thereby died. The contact with a non-fatal suicide attempted by others was associated with own self-harm (OR 1.73, CI 1.39-21.4, p<0.01); contact with completed suicide had no such association. The most important factor that increased the chance of knowing a suicide attempter was actual length of time spent in prison up to the time of the study; 95 (63%) of the young men with such contact had it in prison. No other significant vulnerability factors were identified. It seems likely that imprisonment is a specific vulnerability factor for self-harm, one explanation being that it increases the risk of exposure to a contact with suicidal behaviour by others. Further work is called for to test relationships between such exposure and own behaviour over time, and to gather first hand accounts from the young men in such circumstances in order to understand the meaning for them of the contact with suicidal behaviour by others. This would inform appropriate intervention strategies, and could save much morbidity, and even mortality.

Summary of the 2001-02 Pennsylvania H7N2 low pathogenicity avian influenza outbreak in meat type chickens

H7N2 low-pathogenicity (LP) avian influenza (AI) virus was isolated from chickens submitted to the Pennsylvania Animal Diagnostic Laboratory System on December 4 and 5, 2001. The cases were from two broiler breeder flocks in central Pennsylvania that had clinical signs of an acute, rapidly spreading respiratory disease. Seroconversion to AI virus was detected on follow-up sampling. Subsequently, H7N2 LPAI virus was isolated in five different broiler flock cases submitted between December 14, 2001, and January 3, 2002. Clinical signs and lesions in broilers, when present, were compatible with multicausal respiratory disease. With the exception of one broiler flock that was processed, birds from all of the virus positive flocks were euthanatized in-house within 11 days of the original case submission date. Increased surveillance of poultry flocks within 10-mile radius zones centered at the foci of the positive farms continued until March 1, 2002. No additional cases were detected.

A review of the 1996-98 nonpathogenic H7N2 avian influenza outbreak in Pennsylvania

The nonpathogenic avian influenza (AI) outbreak in Pennsylvania began in December 1996 when there was a trace back from a New York live bird market to a dealer's flock. A total of 18 commercial layer flocks, two commercial layer pullet flocks, and a commercial meat turkey flock were diagnosed with nonpathogenic AI (H7N2) viral infection with an economic loss estimated at between 3 and 4 million dollars. Clinical histories of flocks infected with the disease included respiratory disease, elevated morbidity and mortality throughout the house, egg production drops, depression, and lethargy. A unique gross lesion in the commercial layers was a severe, transmural oviduct edema with white to gray flocculent purulent material in the lumen. Layer flocks on two separate premises were quarantined but permitted to remain in the facilities until cessation of virus shed was determined through virus isolation. Several months later, clinical AI appeared again in these flocks. It is not known whether the recurrence of disease in these cases is due to persistence of the organism in the birds or the environment. In addition to serologic testing and virologic testing by chicken embryo inoculation, an antigen capture enzyme immunoassay was evaluated as a diagnostic tool for AI. Research projects related to disinfection, burial pits, and geographical system technology were developed because of questions raised concerning transmission, diagnosis, and control of nonpathogenic AI (H7N2).

Epidemiology, Production Losses, and Control Measures Associated with an Outbreak of Avian Influenza Subtype H7N2 in Pennsylvania (1996–98)

An outbreak of H7N2 low-pathogenicity (LP) avian influenza (AI) occurred in a two-county area in Pennsylvania from December of 1996 through April of 1998. The outbreak resulted in infection of 2,623,116 commercial birds on 25 premises encompassing 47 flocks. Twenty-one (one premise with infection twice) of the twenty-five infected premises housed egg-laying chickens and one premise each had turkeys, layer pullets, quail, and a mixed backyard dealer flock. Despite dose proximity of infected flocks to commercial broiler flocks, no infected broilers were identified. Experimentally, when market age broilers were placed on an influenza-infected premise they seroconverted and developed oviduct lesions. The outbreak was believed to have originated from two separate introductions into commercial layer flocks from premises and by individuals dealing in sales of live fowl in the metropolitan New York and New Jersey live-bird markets. Source flocks for these markets are primarily in the northeast and mid-Atlantic areas, including Pennsylvania. Mixed fowl sold include ducks, geese, guinea hens, quail, chukar partridges, and a variety of chickens grown on perhaps hundreds of small farms. Infections with the H7N2 AI virus were associated with variable morbidity and temporary decreases in egg production ranging from 1.6% to 29.1% in commercial egg-laying chickens. Egg production losses averaged 4.0 weeks duration. Mortality ranged from 1.5 to 18.3 times normal (mean of 4.3 times normal). Duration of mortality ranged from 2 to 13 weeks (average of 3.9 weeks) in flocks not depopulated. Lesions observed were primarily oviducts filled with a mucous and white gelatinous exudates and atypical egg yolk peritonitis. Quarantine of premises and complete depopulation were the early measures employed in control of this outbreak. Epidemiological studies suggested that depopulation furthered the spread of influenza to nearby flocks. Thereafter, later control measures included quarantine, strict biosecurity, and controlled marketing of products.

Validation of Egg Yolk Antibody Testing as a Method to Determine Influenza Status in White Leghorn Hens

Determination of the avian influenza (AI) status of a flock has traditionally been done by detection of serum antibodies. However, for many diseases, detection of antibodies in egg yolk has been effective in monitoring the disease status of laying flocks. This study compared the utility of egg yolk vs. serum for determining AI status in laying hen flocks. Specific-pathogen-free white leghorn hens were inoculated via the respiratory tract with a low-pathogenic H7N2 AI virus or sterile allantoic fluid or subcutaneously with an inactivated oil emulsion vaccine produced from the same AI virus or normal allantoic fluid. Antibody levels were determined by the agar gel immunodiffusion (AGID) test, the hemagglutination-inhibition (HI) test, and the enzyme-linked immunosorbent assay (ELISA). Anti-influenza antibodies were detected in sera of all live virus-inoculated hens by day 7 postinoculation (PI) (AGID and ELISA tests), but detection of antibodies in egg yolk was delayed by a few days, with all being positive by day 14 PI. Sera from all vaccinated hens were positive by day 14 PI (AGID and ELISA tests), and egg yolk was positive by day 18 PI. The HI test was less sensitive than the ELISA and AGID tests in detecting anti-influenza antibodies in both sera and yolk. Serum and yolk from all control birds remained negative throughout the study. These studies show that currently used serologic tests can detect antibodies in serum and yolk samples from hens exposed to live AI virus or from those that have been vaccinated. Antibody is detected earlier in the serum than in the yolk and antibody is detected earlier from birds exposed to a live infection compared to birds vaccinated with an inactivated oil emulsion vaccine.

Protection of chickens after live and inactivated virus vaccination against challenge with nephropathogenic infectious bronchitis virus PA/Wolgemuth/98

Protection provided by live and inactivated virus vaccination against challenge with the virulent nephropathogenic infectious bronchitis virus (NIBV) strain PA/Wolgemuth/98 was assessed. Vaccinations with combinations of live attenuated strains Massachusetts (Mass) + Connecticut (Conn) or Mass + Arkansas (Ark) were given by eyedrop to 2-wk-old specific-pathogen-free leghorn chickens. After live infectious bronchitis virus (IBV) vaccination, some chickens at 6 wk of age received an injection of either an oil emulsion vaccine containing inactivated IBV strains Mass + Ark or an autogenous vaccine prepared from NIBV PA/Wolgemuth/98. Challenge with PA/Wolgemuth/98 was given via eyedrop at 10 wk of age. Serum IBV enzyme-linked immunosorbent assay antibody geometric mean titers (GMTs) after vaccination with the combinations of live attenuated strains were low, ranging from 184 to 1,354, prior to NIBV challenge at 10 wk of age. Both inactivated vaccines induced an anamnestic response of similar magnitudes with serum GMTs of 6,232-12,241. Assessment of protection following NIBV challenge was based on several criteria virus reisolation from trachea and kidney and renal microscopic pathology and IBV-specific antigen immunohistochemistry (IHC). Live attenuated virus vaccination alone with combinations of strains Mass + Conn or Mass + Ark did not protect the respiratory tract and kidney of chickens after PA/Wolgemuth/98 challenge. Chickens given a live combination vaccination of Mass + Conn and boosted with an inactivated Mass + Ark vaccine were also susceptible to NIBV challenge on the basis of virus isolation from trachea and kidney butshowed protection on the basis of renal microscopic pathology and IHC. Live IBV-primed chickens vaccinated with an autogenous inactivated PA/Wolgemuth/98 vaccine had the highest protection against homologous virulent NIBV challenge on the basis of virus isolation.

Coeliac disease and liver dysfunction

The spectrum and pathogenesis of liver dysfunction in coeliac disease (CD) is reviewed. CD and liver disease share common risk factors, and consequences of CD may cause liver dysfunction. Liver dysfunction should be sought in CD, and its aetiology explored when abnormalities persist after gluten exclusion. CD should be excluded in patients with unexplained liver dysfunction before being labelled "cryptogenic".

Nephropathogenic infectious bronchitis in Pennsylvania chickens 1997-2000

Nephropathogenic infectious bronchitis (NIB) was diagnosed in 28 infectious bronchitis virus (IBV)-vaccinated commercial chicken flocks in Pennsylvania from December 1997 to July 2000. Early dinical signs were increased flock mortality and urinary water loss (polyuria and pollakiuria) leading to wet litter. Daily mortality ranged from 0.01% in layers to 2.45% in broilers, with total broiler mortality as high as 23%. Severe renal swelling and accumulation of urates in the tubules were commonly seen. Visceral gout and urolithiasis were less frequently observed. Histopathologic changes included characteristic tubular epithelial degeneration and sloughing with lymphoplasmacytic interstitial nephritis. Minimal respiratory disease signs were noted in broilers. Egg production and shell quality declined in layers. Confirmatory diagnosis of NIB was made by IBV antigen-specific immunohistochemical staining of the renal tubular epithelium and virus isolation. Sequencing of the S1 subunit gene of 21 IBV isolates showed the NIB outbreak to be associated with two unique genotypes, PA/Wolgemuth/98 and PA/171/99. The cases from which the genotypes were isolated were clinically indistinguishable. The NIB viruses were unrelated to previously recognized endemic strains in Pennsylvania and were also dissimilar to each other. Genotype PA/Wolgemuth/98 was isolated almost exclusively during the first 14 mo of the outbreak, whereas PA/171/99 was recovered during the final 18 mo. The reason for the apparent replacement of PA/Wolgemuth/98 by PA/171/99 is not known.

Identification, sequence analysis, and phylogeny of the immediate early gene 1 of the Trichoplusia ni single nucleocapsid polyhedrosis virus

Substantial research has been conducted on the immediate early I (ie-1) genes from the prototype baculovirus Auographa californica multicapsid nuclear polyhedrosis virus (AcMNPV) and the Orgyia pseudotsugata multicapsid nuclear polyhedrosis virus (OpMNPV). In both cases ie-1 gene products have been implicated in transcriptional activation and repression. In this study an ie-1 homolog was identified from Trichoplusia ni single nucleocapsid polyhedrosis virus (TniSNPV). Nucleotide sequence analysis indicated that the TniSNPV ie-1 gene consists of a 2,217 nucleotide open reading frame (ORF), encoding a protein with a molecular mass of 84.464 kDa. This represents the largest baculovirus ie-1 gene characterised to date. Of the seven ie-1 homologs identified to date, the TniSNPV ie-1 shared most sequence similarity with the ie-1 gene of Spodoptera exigua MNPV (SeMNPV) (41%). At the nucleotide level, expected TATA and CAGT motifs were found to precede each ie-1 ORE. At the protein level, it was confirmed that the N-termini are poorly conserved, but share the characteristic of having a high proportion of acidic amino acids. In addition it was found that N-terminal regions significantly matched the SET domain in the Swiss-Prot prosite database. The C-terminal regions of the deduced IE-1 sequences were found to be substantially more conserved than the N-termini. Several conserved motifs were identified in the C-terminal sequences. A phylogenetic tree of nine baculovirus IE-1 proteins was constructed using maximum parsimony analysis. The phylogenetic estimation of the ie-1 genes shows that TniSNPV is a member of the previously described lepidopteran NPV group II and it is most closely related to SeMNPV.

Epstein-Barr virus infection in paediatric liver transplant recipients: detection of the virus in post-transplant tonsillectomy specimens

AIMS

Post-transplant lymphoproliferative disease (PTLD) is an important and serious complication in transplant patients. Recent studies have suggested that quantitative assessment of Epstein-Barr virus (EBV) infection in transplant patients might help to identify those at risk of developing PTLD. Therefore, tonsils from paediatric liver transplant recipients were studied for evidence of EBV infection.

METHODS

Tonsils were studied by in situ hybridisation for the detection of the small EBV encoded nuclear RNAs (EBERs). The phenotype of EBV infected cells was determined by double labelling in situ hybridisation and immunohistochemistry. The expression of viral latent and lytic antigens was determined by immunohistochemistry. Tonsils from patients without known immune defects were studied as controls.

RESULTS

Tonsils from transplant patients showed pronounced follicular hyperplasia and minor paracortical hyperplasia. In situ hybridisation revealed variable numbers of EBV infected B cells in the tonsils from transplant patients (range, 2-1000/0.5 cm(2); mean, 434/0.5 cm(2); median, 105/0.5 cm(2)). Lower numbers were detected in the control tonsils (range, 1-200/0.5 cm(2); mean, 47/0.5 cm(2); median, 9/0.5 cm(2)). The latent membrane protein 1 (LMP1) of EBV was not detected and there were only rare cells in two cases showing expression of the EBV encoded nuclear antigen 2 (EBNA2). There was no evidence of lytic infection. None of the patients developed PTLD within a follow up period of up to five years.

CONCLUSIONS

These data indicate that tonsillar enlargement in paediatric liver transplant patients does not necessarily imply a diagnosis of PTLD. Furthermore, the presence of increased numbers of EBV infected cells in tonsils from liver transplant recipients by itself does not indicate an increased risk of developing PTLD.

Corneodesmosin expression in psoriasis vulgaris differs from normal skin and other inflammatory skin disorders

SUMMARY

Corneodesmosin (Cdsn) is a late differentiation epidermal glycoprotein putatively involved in keratinocyte adhesion. The Cdsn gene lies within the susceptibility region on chromosome 6p21.3 (PSORS1) for psoriasis, a common chronic disfiguring skin disease. A particular allelic variant of Cdsn has a strong association with psoriasis. Therefore, genetically and biologically, Cdsn is a possible candidate gene for psoriasis susceptibility. To investigate a potential role for Cdsn in psoriasis pathogenesis, protein expression studies were performed by quantitative immunohistochemistry on normal skin, psoriatic skin (lesional and nonlesional), and other skin disorders using monoclonal antibodies (G36-19 and F28-27). In normal and nonlesional skin, Cdsn was expressed in stratum corneum and one or two layers of superficial stratum granulosum. In lesional psoriasis, there was a significant increase in Cdsn expression, which was observed in multiple layers of stratum spinosum and in stratum corneum. The expression pattern varied from granular, cytoplasmic immunoreactivity to cell surface labeling with weakly immunoreactive cytoplasm. In chronic atopic dermatitis, lichen planus, mycosis fungoides, and pityriasis rubra pilaris, Cdsn immunoreactivity was confined to stratum corneum and upper stratum granulosum with no stratum spinosum immunoreactivity. Immunoelectron microscopy of normal and lesional psoriatic skin demonstrated Cdsn release concomitant with involucrin incorporation into cell envelopes and completed before mature envelope formation. Extracellular release of Cdsn occurred at a lower level of the epidermis in psoriasis than normal skin. These protein expression studies provide evidence of altered Cdsn expression in psoriasis consistent with a role of Cdsn in disease pathogenesis. Further functional and genetic studies of Cdsn are justified to determine its role as a potential psoriasis-susceptibility factor.

Detection of acute bee paralysis virus and black queen cell virus from honeybees by reverse transcriptase pcr

A reverse transcriptase PCR (RT-PCR) assay was developed for the detection of acute bee paralysis virus (ABPV) and black queen cell virus (BQCV), two honeybee viruses. Complete genome sequences were used to design unique PCR primers within a 1-kb region from the 3' end of both genomes to amplify a fragment of 900 bp from ABPV and 700 bp from BQCV. The combined guanidinium thiocyanate and silica membrane method was used to extract total RNA from samples of healthy and laboratory-infected bee pupae. In a blind test, RT-PCR successfully identified the samples containing ABPV and BQCV. Sensitivities were approximately 1,600 genome equivalents of purified ABPV and 130 genome equivalents of BQCV.

Examination of the screening properties of the personality diagnostic questionnaire 4+ (PDQ-4+) in a prison population

There is a high prevalence of personality disorder in most prison populations. Many pass through the system undiagnosed. A screening instrument would improve identification. This study examined the screening properties of the Personality Diagnostic Questionnaire-4+ (PDQ-4+) in prisoners convicted of violent and sexual offenses. A sample of British prisoners completed the self-report PDQ-4+ and were interviewed using the Structured Clinical Interview for DSM-IV Axis II disorders. When used to generate a total score, the PDQ-4+ had an acceptable overall accuracy as measured by the area under the Receiver Operating Characteristics (ROC) curve. The PDQ-4+ appears to have the properties suitable for use as a screening instrument, particularly when screening for the presence or absence of personality disorder rather than for individual personality disorder categories. A graph is presented from which choices of cut-off score for different combinations of sensitivity and specificity can be made. A cut off total score of 25 or above yielded near optimal sensitivity and specificity. The suggested cut off score for this population is lower than that previously suggested.

Management of a pregnant patient with Graves' disease complicated by thionamide-induced neutropenia in the first trimester

A 31-year-old woman presented with neutropenia due to thionamide drug therapy for Graves' disease. She also reported 8 weeks of amenorrhoea and had a positive pregnancy test. Her drug therapy was discontinued and her neutropenia resolved uneventfully. The hyperthyroidism recurred a week later. After consideration of all treatment options, it was decided to observe until 14 weeks when an elective thyroidectomy was planned. Mother and fetus were monitored closely and both tolerated moderate hyperthyroidism well. At 14 weeks the patient underwent a total thyroidectomy after rendering her euthyroid with a short course of sodium ipodate. Labour was induced at 41 weeks. Delivery was complicated by fetal distress and precipitated a forceps delivery. A 3250 g male infant was born with poor Apgar score and required 2 h of ventilation. At 1 year, the child had reached all developmental milestones at appropriate times. Both mother and fetus may tolerate moderate thyrotoxicosis well in early pregnancy, an alternative that should be considered when thionamide drug therapy is contraindicated.