Validating owner-reporting of feather condition of pet Psittaciformes using photographs

Reporting of outcome variables by caregivers in welfare studies is commonplace but is open to subjective bias and so requires validation. Biases can occur in either direction: familiarity with an animal allows a deeper insight into welfare problems, but also can lead to reticence in admitting that an animal in one's care is experiencing problems. Here, we aim to validate owner-reporting of plumage condition of pet parrots, including those with self-inflicted feather-damaging behaviour (FDB), by comparing owners' scores of feather condition with those of two independent raters, blind to the owners' and each other's assessments. We surveyed pet parrot owners to collect data on basic demographics and feather condition, and requested four standardised photographs of birds. We received 259 responses (17% of the 1,521 people contacted); 78 sets of images of appropriate quality for assessment by raters were provided. Mean percentage agreement between owners' and raters' scores was mostly fair to substantial using Cohen's kappa; however, raters scored a greater proportion of feather damage than did owners. Overall, our results indicate owner-reporting of feather condition, including FDB, to be generally reliable and consistent with independent assessment of photographs. As the use of photographs can be limited by image quality, a failure to represent the long-term state of a parrot, and the potential for incorrect recording if assessed without relevant information (eg on moulting), this evidence that owner-reports can be reliable opens the door for larger-scale surveys of the extent of welfare-relevant problems.

Inflammatory breast cancer defined: proposed common diagnostic criteria to guide treatment and research

Purpose

Inflammatory breast cancer is a deadly and aggressive type of breast cancer. A key challenge relates to the need for a more detailed, formal, objective definition of IBC, the lack of which compromises clinical care, hampers the conduct of clinical trials, and hinders the search for IBC-specific biomarkers and treatments because of the heterogeneity of patients considered to have IBC.

Methods

Susan G. Komen, the Inflammatory Breast Cancer Research Foundation, and the Milburn Foundation convened patient advocates, clinicians, and researchers to review the state of IBC and to propose initiatives to advance the field. After literature review of the defining clinical, pathologic, and imaging characteristics of IBC, the experts developed a novel quantitative scoring system for diagnosis.

Results

The experts identified through consensus several “defining characteristics” of IBC, including factors related to timing of onset and specific symptoms. These reflect common pathophysiologic changes, sometimes detectable on biopsy in the form of dermal lymphovascular tumor emboli and often reflected in imaging findings. Based on the importance and extent of these characteristics, the experts developed a scoring scale that yields a continuous score from 0 to 48 and proposed cut-points for categorization that can be tested in subsequent validation studies.

Conclusion

To move beyond subjective ‘clinical diagnosis’ of IBC, we propose a quantitative scoring system to define IBC, based on clinical, pathologic, and imaging features. This system is intended to predict outcome and biology, guide treatment decisions and inclusion in clinical trials, and increase diagnostic accuracy to aid basic research; future validation studies are necessary to evaluate its performance.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10549-021-06434-x.

Cancer blues? A promising judgment bias task indicates pessimism in nude mice with tumors

In humans, affective states can bias responses to ambiguous information: a phenomenon termed judgment bias (JB). Judgment biases have great potential for assessing affective states in animals, in both animal welfare and biomedical research. New animal JB tasks require construct validation, but for laboratory mice (Mus musculus), the most common research vertebrate, a valid JB task has proved elusive. Here (Experiment 1), we demonstrate construct validity for a novel mouse JB test: an olfactory Go/Go task in which subjects dig for high- or low-value food rewards. In C57BL/6 and Balb/c mice faced with ambiguous cues, latencies to dig were sensitive to high/low welfare housing: environmentally-enriched animals responded with relative 'optimism' through shorter latencies. Illustrating the versatility of this validated JB task across different fields of research, it further allowed us to test hypotheses about the mood-altering effects of cancer in male and female nude mice (Experiment 2). Males, although not females, treated ambiguous cues as intermediate; and males bearing subcutaneous lung adenocarcinomas also responded more pessimistically to these than did healthy controls. To our knowledge, this is the first evidence of a valid mouse JB task, and the first demonstration of pessimism in tumor-bearing animals. This task still needs to be refined to improve its sensitivity. However, it has great potential for investigating mouse welfare, the links between affective state and disease, depression-like states in animals, and hypotheses regarding the neurobiological mechanisms that underlie affect-mediated biases in judgment.

Post-mortem confirmation of fetal brain abnormalities: challenges highlighted by the MERIDIAN cohort study

OBJECTIVES

To assess and analyse the concordance between post-mortem findings and in utero magnetic resonance imaging (iuMRI) in the MERIDIAN (MRI to enhance the diagnosis of fetal developmental brain abnormalities in utero) cohort.

DESIGN

Prospective cohort study.

SETTING

Fetal medicine units in the UK.

POPULATION

Pregnant women with a diagnosis of fetal brain abnormality identified on ultrasound at 18 weeks of gestation or later.

METHODS

All pregnancies from the MERIDIAN study that resulted in a abortion were included and the rate of uptake and success of post-mortem examinations were calculated. In the cases in which diagnostic information about the fetal brain was obtained by post-mortem, the results were compared with the diagnoses from iuMRI.

MAIN OUTCOME MEASURE

Outcome reference diagnosis from post-mortem examination.

RESULTS

A total of 155 from 823 pregnancies (19%) ended in a termination of pregnancy and 71 (46%) had post-mortem brain examinations, 62 of which were diagnostically adequate. Hence, the overall rate of successful post-mortem investigation was 40%, and for those cases there was a concordance rate of 84% between iuMRI and post-mortem examination. Detailed information is provided when the results of the post-mortem examination and the iuMRI study differed.

CONCLUSIONS

We have shown tissue-validation of radiological diagnosis is hampered by a low rate of post-mortem studies in fetuses aborted with brain abnormalities, a situation further compounded by a 12% rate of autopsy being technically unsuccessful. The agreement between iuMRI and post-mortem findings is high, but our analysis of the discrepant cases provides valuable clues for improving how we provide information for parents. TWEETABLE ABSTRACT: iuMRI should be considered a reliable indicator of fetal brain abnormalities when post-mortem is not performed.

0087 Childhood Naps Promote Short-Term Destabilization but Long-Term Consolidation of Emotional Memories

Introduction

Early childhood naps have been shown to support emotional memory consolidation, but this benefit only emerges the following day. It is unknown whether consolidation occurs during the nap itself, or if napping only prepares memories for overnight consolidation. In this study, we used a forced-choice recognition task to determine whether naps protect emotional memories against post-nap interference, which would indicate the occurrence of consolidation.

Methods

Preschool children (33–67 months; N=63) viewed neutral faces paired with negative or neutral descriptions. Following a nap or an equal interval awake (within-subjects, order counterbalanced, ~1 week apart), half of these participants (N=33) were presented with an interfering set of faces and descriptions, while the other half (N=30) did not receive interference. For all participants, recognition of the original faces was probed after encoding, after the nap or wake interval, and the next morning.

Results

To assess the influence of napping on changes in emotional memory, 2 (stimulus valence: negative vs. neutral) x 2 (condition: nap vs. wake) repeated-measures ANOVAs were performed. Recall of negative and neutral items did not immediately differ between the nap and wake conditions for the participants who received no interference. 24 hours later, these children trended towards recalling negative and neutral items better if they had napped the previous day (condition main effect: F(1,29)=3.539, p=0.070). In contrast, participants who received interference recalled fewer negative items than neutral items immediately following a nap (p=0.034), while this difference did not emerge following an interval awake.

Conclusion

Our results suggest that naps initially destabilize emotional memories rather than protecting them against interference. However, this initial destabilization may reflect the partial processing of memories during naps, perhaps allowing for enhanced long-term consolidation. Overall, our findings provide important insight into the mechanism of nap-dependent emotional processing.

Support

Supported by NIH R01 HL111695 and an Honors Research Grant from Commonwealth Honors College

Humans can identify cats' affective states from subtle facial expressions

Although cats' popularity as pets rivals that of dogs, cats are little studied, and people's abilities to read this apparently 'inscrutable' species have attracted negligible research. To determine whether people can identify feline emotions from cats' faces, participants (n = 6,329) each viewed 20 video clips of cats in carefully operationalised positively (n = 10) or negatively valenced states (n = 10) (cross-factored with low and high activity levels). Obvious cues (eg open mouths or fully retracted ears) were eliminated. Participants' average scores were low (11.85/20 correct), but overall above chance; furthermore, 13% of participants were individually significantly successful at identifying the valence of cats' states (scoring ≥ 15/20 correct). Women were more successful at this task than men, and younger participants more successful than older, as were participants with professional feline (eg veterinary) experience. In contrast, personal contact with cats (eg pet-owning) had little effect. Cats in positive states were most likely to be correctly identified, particularly if active rather than inactive. People can thus infer cats' affective states from subtle aspects of their facial expressions (although most find this challenging); and some individuals are very good at doing so. Understanding where such abilities come from, and precisely how cats' expressions change with affective state, could potentially help pet owners, animal care staff and veterinarians optimise feline care and welfare.

Twenty Years of Military Prehospital Care in the Eastern Sovereign Base Area, Cyprus

INTRODUCTION

The Medical Reception Station (MRS) in Dhekelia provides a prehospital emergency care (PHEC) service for the Eastern Sovereign Base Area and surrounding Cypriot towns. This service has been evaluated previously but some important aspects of care have not yet been measured. The primary aim of this study was to undertake the most comprehensive service evaluation of the demand for the PHEC service at MRS Dhekelia over a 12-month period. The secondary aim of this study was to compare findings in 2018 to those in 1995-1998 and 2013-2016.

METHODS

All calls to the PHEC team between 01/07/2017 and 30/06/2018 were reviewed and compared with previously reported data from 1995 to 1998 and 2013 to 2016. Data were collected from the occurrence book, the logbook used by the PHEC team to record the details of each call.

RESULTS

There were 164 calls to the PHEC service during the current study period. The number of activations has decreased since the 2013-2016 period but remains greater than 1995-1998. In every month there was a call to a scene where more than one casualty was present, with the highest number being nine patients at one call. More calls were received during the day (55%). There were more calls because of trauma than medical complaints (55% vs 45%). Trauma calls have reduced over 20 years. The frequency of neurological and psychiatric complaints has increased over 20 years.

CONCLUSIONS

The PHEC service at MRS Dhekelia is frequently used. The team consistently face with scenes with more than one casualty. Trauma is becoming less frequent but psychiatric and neurological complaints are increasingly common. These findings are important for training and service provision.

Neurophysiological correlates of stereotypic behaviour in a model carnivore species

Stereotypic behaviour (SB) is common in animals housed in farm, zoo or laboratory conditions, including captive Carnivora (e.g. wild ursids and felids). Neurobiological data on housing-induced SBs come from four species (macaques, two rodent species, and horses), and suggest basal ganglia (BG) dysfunction. We investigated whether similar patterns occur in Carnivora via a model, American mink, because their SB is distinctive in form and timing. We raised 32 males in non-enriched (NE) or enriched (E) cages for 2 years, and assessed two forms of SB: 1) Carnivora-typical locomotor-and-whole-body ('loco') SBs (e.g. pacing, weaving); 2) scrabbling with the forepaws. Neuronal activity was analysed via cytochrome oxidase (CO) staining of the dorsal striatum (caudate; putamen), globus pallidus (externus, GPe; internus, GPi), STN, and nucleus accumbens (NAc); and the GPe:GPi ratio (GPr) calculated to assess relative activation of direct and indirect pathways. NE mink stereotyped more, and had lower GPr CO-staining indicating relatively lower indirect pathway activation. However, no single BG area was affected by housing and nor did GPr values covary with SB. Independent of housing, elevated NAc CO-staining predicted more loco SB, while scrabbling, probably because it negatively correlated with loco SB, negatively covaried with NAc CO-staining in NE subjects. These results thus implicate the NAc in individual differences in mink SB. However, because they cannot explain why NE subjects showed more SB, they provide limited support for the BG dysfunction hypothesis for this species' housing-induced SB. More research is therefore needed to understand how barren housing causes SB in captive Carnivora.

Anatomical subgroup analysis of the MERIDIAN cohort: ventriculomegaly

OBJECTIVE

To assess the contribution of fetal magnetic resonance imaging (MRI) in fetuses of the MERIDIAN cohort diagnosed with ventriculomegaly (VM) as the only abnormal intracranial finding on antenatal ultrasound.

METHODS

This was a subgroup analysis of the MERIDIAN study of fetuses with only VM diagnosed on ultrasound in women who had a subsequent MRI examination within 2 weeks and for whom outcome reference data were available. The diagnostic accuracy of ultrasound and MRI was reported in relation to the severity of VM. The difference in measurements of trigone size on the two imaging methods and the clinical impact of adding MRI to the diagnostic pathway were also studied.

RESULTS

In 306 fetuses with VM, ultrasound failed to detect 31 additional brain abnormalities, having an overall diagnostic accuracy of 89.9% for ultrasound, whilst MRI correctly detected 27 of the additional brain abnormalities, having a diagnostic accuracy of 98.7% (P < 0.0001). There were other brain abnormalities in 14/244 fetuses with mild VM on ultrasound (diagnostic accuracy, 94.3%) and MRI correctly diagnosed 12 of these (diagnostic accuracy, 99.2%; P = 0.0005). There was a close agreement between the size of trigones measured on ultrasound and on MRI, with categorical differences in only 16% of cases, showing that MRI did not systematically overestimate or underestimate trigone size. Complete prognostic data were available in 295/306 fetuses and the prognosis category changed after MRI in 69/295 (23.4%) cases. The overall effect of MRI on clinical management was considered to be 'significant', 'major' or 'decisive' in 76/295 (25.8%) cases.

CONCLUSION

Our data suggest that a woman carrying a fetus with VM as the only intracranial finding on ultrasound should be offered an adjuvant investigation by MRI for further evaluation. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Anatomical subgroup analysis of the MERIDIAN cohort: posterior fossa abnormalities

OBJECTIVE

To assess the diagnostic and clinical contribution of fetal magnetic resonance imaging (MRI) in fetuses of the MERIDIAN cohort diagnosed with abnormalities of the posterior fossa as the only intracranial abnormality recognized on antenatal ultrasound.

METHODS

This was a subgroup analysis of the MERIDIAN study of fetuses with abnormalities of the posterior fossa (with or without ventriculomegaly) diagnosed on antenatal ultrasound in women who had MRI within 2 weeks of ultrasound and for whom outcome reference data were available. The diagnostic accuracy of ultrasound and MRI is reported, as well as indicators of diagnostic confidence and effects on prognosis and clinical management. Appropriate diagnostic confidence was assessed by the score-based weighted average method, which combines diagnostic accuracy with diagnostic confidence data.

RESULTS

Abnormalities confined to the posterior fossa according to ultrasound were found in 81 fetuses (67 with parenchymal and 14 with cerebrospinal fluid-containing lesions). The overall diagnostic accuracy for detecting an isolated posterior fossa abnormality was 65.4% for ultrasound and 87.7% for MRI (difference, 22.3% (95% CI, 14.0-30.5%); P < 0.0001). There was an improvement in 'appropriate' diagnostic confidence, as assessed by the score-based weighted average method (P < 0.0001), and a three-fold reduction in 'high confidence but incorrect diagnosis' was achieved using MRI. Prognostic information given to the women changed after MRI in 44% of cases, and the overall effect of MRI on clinical management was considered to be 'significant', 'major' or 'decisive' in 35% of cases.

CONCLUSIONS

Our data suggest that any woman whose fetus has a posterior fossa abnormality as the only intracranial finding on ultrasound should have MRI for further evaluation. This is on the basis of improved diagnostic accuracy and confidence, which impacts substantially on the prognostic information given to women as well as their clinical management. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Anatomical subgroup analysis of the MERIDIAN cohort: failed commissuration

OBJECTIVE

To assess the contribution of fetal magnetic resonance imaging (MRI) in fetuses of the MERIDIAN cohort diagnosed with either agenesis or hypogenesis of the corpus callosum (referred to collectively as failed commissuration) on antenatal ultrasound.

METHODS

This was a subgroup analysis of the MERIDIAN study of fetuses with failed commissuration (with or without ventriculomegaly) diagnosed on ultrasound in women who had MRI assessment within 2 weeks of ultrasound and for whom outcome reference data were available. The diagnostic accuracy of ultrasound and MRI was studied, as well as indicators of diagnostic confidence and effects on prognosis/clinical management. Appropriate diagnostic confidence was assessed by the score-based weighted average method, which combines diagnostic accuracy with diagnostic confidence data.

RESULTS

In the MERIDIAN cohort, 79 fetuses were diagnosed with failed commissuration on ultrasound (55 with agenesis and 24 with hypogenesis of the corpus callosum). The diagnostic accuracy for detecting failed commissuration was 34.2% for ultrasound and 94.9% for MRI (difference, 60.7% (95% CI, 47.6-73.9%), P < 0.0001). The diagnostic accuracy for detecting hypogenesis of the corpus callosum as a discrete entity was 8.3% for ultrasound and 87.5% for MRI, and for detecting agenesis of the corpus callosum as a distinct entity was 40.0% for ultrasound and 92.7% for MRI. There was a statistically significant improvement in 'appropriate' diagnostic confidence when using MRI as assessed by the score-based weighted average method (P < 0.0001). Prognostic information given to the women changed in 36/79 (45.6%) cases after MRI and its overall effect on clinical management was 'significant', 'major' or 'decisive' in 35/79 cases (44.3%).

CONCLUSIONS

Our data suggest that any woman whose fetus has failed commissuration as the only intracranial finding detected on ultrasound should have MRI examination for further evaluation. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Abstract P5-08-27: Treatment patterns and clinical outcomes in patients with hormone receptor (HR)+ HER2+ metastatic breast cancer and low vs high levels of HR positivity from the SystHERs Registry

Introduction In 2010, the cutoff for HR positivity in breast cancer was established as ≥1% of cells staining HR+, previously having varied from 1% to 10%. The impact of this change on treatment patterns and outcomes is poorly understood. SystHERs is a prospective, observational cohort registry of patients (pts) with HER2+ metastatic breast cancer (MBC) that commenced enrollment in 2012. To our knowledge, SystHERs is the largest registry to collect and analyze data for the HER2+ subgroup. We report baseline characteristics, treatment patterns, and early outcomes by %HR+ (1–9% vs 10–100%).

Methods SystHERs enrolled pts aged ≥18 years and within 6 months of HER2+ MBC diagnosis. For pts with locally-determined HR+ disease, defined as HR+ in primary or metastatic tissue, %HR+ is the highest percentage of ER+ or PR+ tissue in early breast cancer or MBC. The percentage of ER+ or PR+ cells was not reported for pts considered HR– by the investigator. Median overall survival (OS; Kaplan–Meier) and hazard ratios (Cox regression) were estimated.

Results As of Feb 1, 2016, data were available for 872 eligible pts with known HR status, of whom 608 (70%) had HR+ disease. Of the 608 pts, 53 (9%) had 1–9%HR+ and 496 (82%) had 10–100%HR+; %HR+ was not reported for 59 pts. Baseline characteristics were similar between %HR+ subgroups (Table 1).

As shown in Table 2, the 1–9%HR+ subgroup was less likely to receive first-line hormonal therapy (26%) than the 10–100%HR+ subgroup (56%). 87% and 79% of pts received chemotherapy, respectively.

Median time from MBC diagnosis was 16.5 months (range, 0.4–49.4 months). Median OS was not reached at the data cutoff. The number of deaths was 13 (25%) in the 1–9%HR+ subgroup, and 68 (14%) in the 10–100%HR+ subgroup (log-rank P=0.025). The OS hazard ratio (0.514, 95% CI 0.283–0.931) favored the 10–100%HR+ subgroup. OS did not differ significantly between pts with 1–9%HR+ vs HR– disease (log-rank P=0.582, hazard ratio 1.185, 95% CI 0.647–2.169).

Table 1. Baseline characteristics 1-9%HR+ (n=53)10-100%HR+ (n=496)HR– (n=264)Age at MBC diagnosis, median yrs (range)54 (30–86)57 (21–86)55 (28–88)Race, %   White838372Black151320Premenopausal, %282522ECOG performance status, %   04654441463942≥2878MBC diagnosis type, %   De novo404958Recurrent605142Visceral, %*686275*Non-hepatic abdominal, ascites, CNS, liver, lung, or pleural effusion sites of metastasis

Table 2. First-line treatment 1-9%HR+ (n=53)10-100%HR+ (n=496)HR– (n=264)HER2-targeted therapy, %969391Chemotherapy, %877989Hormonal therapy, %26564

Conclusions These preliminary observational data suggest potential differences in treatment patterns and survival outcomes in low vs moderate/high HR+ expressers, with the former being less likely to receive hormonal therapy (26% vs 56%). Furthermore, low HR positivity was associated with poorer OS and was similar to OS observed in pts with HR– disease.

Citation Format: Jahanzeb M, Tripathy D, Rugo H, Swain S, Kaufman PA, Mayer M, Hurvitz S, O'Shaughnessy J, Mason G, Yardley DA, Brufsky A, Chu L, Antao V, Beattie M, Yoo B, Cobleigh M. Treatment patterns and clinical outcomes in patients with hormone receptor (HR)+ HER2+ metastatic breast cancer and low vs high levels of HR positivity from the SystHERs Registry [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-08-27.

Diagnosis of fetal submicroscopic chromosomal abnormalities in failed array CGH samples: copy number by sequencing as an alternative to microarrays for invasive fetal testing

OBJECTIVES

Array comparative genomic hybridization (CGH) has become the technology of choice for high-resolution prenatal whole genome analysis. Limitations of microarrays are mainly related to the analog nature of the analysis, and poor-quality DNA can result in failed quality metrics with these platforms. We examined a cohort of abnormal fetuses with failed array CGH results using a next-generation sequencing algorithm, CNV-Seq. We assessed the ability of the platform to handle suboptimal prenatal samples and generate interpretable molecular karyotypes.

METHODS

Nine samples obtained from abnormal fetuses and one from a normal control fetus were sequenced using an Illumina GAIIx. A segmentation algorithm for sequencing data was used to determine regional copy number data on the sequencing datasets.

RESULTS

Phred quality scores were satisfactory for analysis of all samples. CNV-Seq identified both large- and small-scale abnormalities in the cohort, and normal results were obtained for fetuses for which microarray data were previously uninterpretable. No variants of uncertain significance were detected. Analysis of the digital sequencing datasets offered some advantages over array CGH output.

CONCLUSIONS

Using next-generation sequencing for the detection of genomic copy number variants may be advantageous for poor-quality, invasively-acquired prenatal samples. CNV-Seq could become a potential alternative to array CGH in this setting.

Home visit program improves technique survival in peritoneal dialysis

BACKGROUND

Peritoneal dialysis (PD) is a home therapy, and technique survival is related to the adherence to PD prescription at home. The presence of a home visit program could improve PD outcomes. We evaluated its effects on clinical outcome during 1 year of follow-up.

METHODS

This was a case-control study. The case group included all 96 patients who performed PD in our center on January 1, 2013, and who attended a home visit program; the control group included all 92 patients who performed PD on January 1, 2008. The home visit program consisted of several additional visits to reinforce patients' confidence in PD management in their own environment. Outcomes were defined as technique failure, peritonitis episode, and hospitalization. Clinical and dialysis features were evaluated for each patient.

RESULTS

The case group was significantly older (p = 0.048), with a lower grade of autonomy (p = 0.033), but a better hemoglobin level (p = 0.02) than the control group. During the observational period, we had 11 episodes of technique failure. We found a significant reduction in the rate of technique failure in the case group (p = 0.004). Furthermore, survival analysis showed a significant extension of PD treatment in the patients supported by the home visit program (52 vs. 48.8 weeks, p = 0.018). We did not find any difference between the two groups in terms of peritonitis and hospitalization rate; however, trends toward a reduction of Gram-positive peritonitis rates as well as prevalence and duration of hospitalization related to PD problems were identified in the case group. The retrospective nature of the analysis was a limitation of this study.

CONCLUSION

The home visit program improves the survival of PD patients and could reduce the rate of Gram-positive peritonitis and hospitalization. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=365168.

The use of in utero MRI to supplement ultrasound in the foetus at high risk of developmental brain or spine abnormality

OBJECTIVES

It is widely accepted that the diagnosis of foetal central nervous system (CNS) abnormalities can be improved by performing MRI examinations in utero. Most of the published literature has concentrated on pregnancies in which a developmental abnormality has been detected (or suspected) on ultrasound in an otherwise low-risk pregnancy. In this paper, we test the hypothesis that in utero MRI of the foetal brain in high-risk pregnancies will detect abnormalities not shown by ultrasound at a rate that justifies its use in clinical practice.

METHODS

100 females were recruited into the study from foeto-maternal or clinical genetic departments. They all had a foetus/child with a CNS malformation from an earlier pregnancy, which led to an increased risk of recurrence being quoted for the present pregnancy. All in utero MRI examinations were performed on 1.5 T clinical MRI systems at 18 weeks gestational age or later.

RESULTS

In 78% of cases, the ultrasound and MRI results agreed and showed no abnormality. In 13%, ultrasound and MRI described identical abnormal findings. In 9%, the ultrasound and MRI examinations had discrepant findings; in all these cases the MRI findings described more serious CNS pathology. The effects on management were judged to be major, by at least one assessor, in 7/9 of those cases.

CONCLUSION

As in many other situations involving antenatal detection of CNS abnormalities, in utero MRI should be considered in females with increased risk of foetal CNS malformation based on the results of an earlier pregnancy. Advances in knowledge In utero MRI of the foetus has an important role in antenatal diagnosis of females carrying a foetus with an increased risk of a brain abnormality.

An assessment of knowledge, attitudes and behaviour regarding the human papillomavirus

OBJECTIVES

This report is based on a study conducted in February 2010 that assessed the knowledge and attitudes toward cervical cancer and human papillomavirus (HPV) in Grenada which has a high incidence of cervical cancer.

METHODS

The participants were 71 students at the St George's University. There were 58 females and 13 males who participated in the study, a ratio of 4.5:1. Participants were asked to complete a survey on their knowledge and attitudes about HPV cervical cancer and the associated risk factors. Other evaluations of their levels of risk and Pap smear practices were also assessed.

RESULTS

The data reflected low knowledge and infrequent screening practices, from a public health perspective, when compared with developed countries. The data showed a significant deficit in knowledge of both males and females. Almost 95% of the women surveyed were able to correctly identify the purpose of a Pap smear as compared to 69.2% of the men surveyed. When the participants were asked what was the cause of cervical cancer 63.8% of women and 53.8% of males were correctly able to identify the HPV.

CONCLUSIONS

Enhanced educational programmes are needed to reduce the burden of cervical cancer that exists in Grenada.

The use of in utero MR imaging to delineate developmental brain abnormalities in multifetal pregnancies

BACKGROUND AND PURPOSE

iuMR has been shown to increase the detection rate of developmental abnormalities of the CNS, though most reports are limited to singleton pregnancies. The hypothesis tested in this study was that iuMR performed in multifetal pregnancies will show additional information about fetal CNS abnormalities in a similar proportion of cases when compared with singleton pregnancies.

MATERIALS AND METHODS

Fifty women with multifetal pregnancies were recruited consecutively carrying at least 1 fetus with a suspected developmental fetal CNS abnormality on sonography. All had iuMR at the same center by using the same MR imaging protocol. When the sonography and MR imaging reports were discrepant, 1 fetomaternal expert assessed the reports independently to predict in what percentage a change in prognosis/counseling would have occurred if iuMR was included in the diagnostic pathway.

RESULTS

There was agreement between the sonography and iuMR reports in 66% and disagreement in 34% of cases. The major cause for discrepancy was the presence or absence of the corpus callosum, which accounted for 10/17 of the disagreements. In 12/17 of the discrepant cases, the effect on management was judged to be significant.

CONCLUSIONS

We conclude that iuMR has a similar rate of discrepancy to sonography in multifetal pregnancies compared with the published data concerning singleton pregnancies. Our analysis of the effect on management shows that changes in the decision to consider termination of pregnancy would have occurred in 12/17 of the discrepant cases (ie, in 24% of our cases overall).

Brenneria salicis Associated with Watermark Disease Symptoms on Salix alba in Italy

From 1999 to 2010, withering of white willow was observed on trees growing along roads or irrigation canals in Torino, Alessandria, and Vercelli provinces of Italy, with incidence varying from 15, 25, and 30%, respectively. In spring and autumn 2008, six samples from withering branches with bark cankers were collected. On the bark surface near the cankers, iridescent traces of dried ooze were found. Tissues immediately below the cankers were dark with water-soaked, olive-colored edges. In some cases, the xylem appeared affected. Small fragments taken from the affected tissue on both edges of bark alterations and darkened vessels were crushed into mortars with sterile saline. Ten-fold serial dilutions (10^-1, 10^-2) were also performed. Aliquots of 0.1 ml were plated on nutrient agar and incubated at 25°C for 4 days. Bacterial colonies were ivory to white, circular, and bright, with a diameter of ~2 mm. Isolates were negative for Gram staining, presence of arginine dehydrolase, oxidase, phenylalanine deaminase, urease, hydrolysis of gelatin and starch, nitrate reduction, acidity from d-arabinose, cellobiose, lactose, maltose, trehalose, xylose, and pectinolytic activity on potato slices; positive for the presence of catalase and levan, fermentative metabolism of glucose, acid production from aesculin, l-arabinose, dextrose, d-galactose, inositol, d-mannitol, α-methylglucoside, raffinose, salicin and sucrose, H₂S production from cysteine, and bright yellow pigment production on autoclaved potato tissue. They were not fluorescent on King's medium B and did not induce hypersensitivity reaction on tobacco leaf. Similar results were obtained with Brenneria salicis control strain, LMG 6089, except for acid production from α-methylglucoside (negative) and l-arabinose (negative). Acid production from α-methylglucoside has been reported for the Japanese strains of B. salicis, which do not produce acidity from inositol (4). Genomic DNA was extracted (1) from three isolates, and PCR reactions were performed with Es1A and Es4B primers (2) that amplify a 553-bp fragment from the 16S rDNA of B. salicis. The isolates showed a PCR product of expected size, like the positive control LMB 6089. On the basis of colony features, biochemical tests, and the PCR assay, we conclude that the isolates belong to B. salicis, a pathogen reported in Belgium, Germany, Great Britain, the Netherlands, Hungary, Japan, and New Zealand (2,3) but, as well as watermark disease symptoms, never previously reported in Italy. In summer 2009, pathogenicity tests were performed by inoculating young, white willow plants with B. salicis suspensions of ~1 to 2 × 10⁹ CFU/ml placed with a syringe at the intersection of 1-year-old branches on the trunk. However, a year later, no symptoms of disease have been noted on the inoculated plants. According to the literature, pathogenicity tests rarely lead to the expected results because the bacterium can survive for many years in latent form, breaking out only when proper environmental conditions occur (3). Also the tests with B. salicis LMG 6089 gave negative results. Further investigation is necessary to clarify the relationships between this bacterium and the environment in causing withering of white willows in Piedmont. References: (1) W. P. Chen and T. T. Kuo. Nucleic Acids Res. 21:2260, 1993. (2) L. Hauben et al. Appl. Environ. Microbiol. 64:3966, 1998. (3) M. Maes et al. Environ. Microbiol. 11:1453, 2009. (4) Y. Sakamoto et al. Plant Pathol. 48:613, 1999.

Fetuses with ventriculomegaly diagnosed in the second trimester of pregnancy by in utero MR imaging: what happens in the third trimester?

BACKGROUND AND PURPOSE

Although MR imaging of the fetal brain has been shown to provide additional diagnostic information, the optimal timing of the study and the value of repeat studies remain unclear. The primary purpose of this study was to look for structural abnormalities of the fetal brain shown at 30-32 weeks' gestational age but not on the 20-24 weeks' study in fetuses originally referred with isolated VM. In particular, we wished to study the hypothesis that third-trimester fetal MR imaging studies would not show extra brain abnormalities compared with the second-trimester studies in this group.

MATERIALS AND METHODS

Ninety-nine women were admitted for a fetal MR study between 20-24 weeks' gestational age, and 46 of these women agreed to return for a second MR imaging examination at 30-32 weeks' gestational age. The other women were either lost to follow-up or declined the invitation to return. Two experienced observers measured the width of the trigones, and the results were compared, to test reliability. Changes in the degree of VM are reported along with changes in the diagnosis of structural brain abnormalities.

RESULTS

There was excellent reproducibility of trigone measurements between the 2 observers, with a mean absolute difference of <1 mm in the 40 fetuses that were ultimately shown to have isolated VM. Twenty-eight of 40 fetuses studied had mild VM on the first iuMR imaging examination, but in just more than half, the category of VM changed between the studies (5 had become normal-sized, 7 had progressed to moderate, 3 had become severe, and 13 remained mild). In 1 case, hypogenesis of the corpus callosum was recognized at 30-32 weeks but had not been reported on the 20-24 weeks' examination; the other 5 fetuses had brain pathology recognized on both fetal MR studies.

CONCLUSIONS

Trigone measurements can be made in a highly repeatable fashion on iuMR imaging. We have not shown any major advantage in repeating iuMR imaging at 30-32 weeks' gestation in terms of improved diagnosis of other structural brain abnormalities. With the converse of that argument, however, our data suggest that there is no advantage in delaying iuMR imaging studies to 30-32 weeks in the hope of improving detection rates.

A prospective study of fetuses with isolated ventriculomegaly investigated by antenatal sonography and in utero MR imaging

BACKGROUND AND PURPOSE

Fetal ventriculomegaly (VM) is important because of its high prevalence and high risk of association with other brain abnormalities. The purpose of this article was to investigate the hypotheses that including in utero MR imaging (iuMR) in the diagnostic pathway for fetuses with isolated VM on antenatal imaging will show other brain abnormalities in a high proportion of cases and that these will have a significant effect on clinical management.

MATERIALS AND METHODS

One hundred forty-seven pregnant women were recruited prospectively from 8 fetomaternal centers in Britain. All of the fetuses had VM diagnosed on sonography but no other abnormality. iuMR was performed, and the results of the examinations were compared with those of sonography. Two fetomaternal experts made independent assessments of the effects of any new diagnoses on clinical management.

RESULTS

Categoric assessments of ventricular size were the same in approximately 90% of fetuses. Other abnormalities were shown in 17% of fetuses. The most frequent additional brain abnormality shown on iuMR was agenesis of the corpus callosum. Severe VM was associated with an approximately 10-fold increase in the risk of another brain abnormality being present when compared with fetuses with mild VM. The most profound effects on clinical management, however, were found in cases of mild VM.

CONCLUSIONS

This work supports our hypotheses by showing a high detection rate of other brain pathology when iuMR was used to supplement antenatal sonography (17%). In a high proportion of cases, the detection of the extra pathology would have led to significant changes in clinical management.

Co- and counter-current spontaneous imbibition into groups of capillary tubes with lateral connections permitting cross-flow

A model for co- and counter-current imbibition through independent capillaries has already been developed and experiments conducted to verify the theory [E. Unsal, G. Mason, N.R. Morrow, D.W. Ruth, J. Colloid Interface Sci. 306 (2007) 105]. In this paper, the work is extended to capillaries which are connected laterally and in which cross-flow can take place. The fundamental pore geometry is a rod in an angled round-bottomed slot with a gap between the rod and a capping glass plate. The surfaces of the slot, rod and plate form capillaries and interconnecting passages which have non-axisymmetric cross-sections. Depending on the gap size either (i) a large single meniscus, (ii) two menisci one on each side of the rod, or (iii) three menisci, one between the rod and the glass additional to the ones on each side can be formed. A viscous refined oil was applied to one end of the capillaries and co-current and counter-current spontaneous imbibition experiments were performed. The opposite end was left open to the atmosphere for co-current experiments. When the gap between the rod and the plate was large, the imbibing oil advanced into the tubes with the meniscus in the largest capillary always lagging behind the two menisci in the other two smaller capillaries. For counter-current imbibition experiments the open end was sealed and connected to a sensitive pressure transducer. In some experiments, the oil imbibed into the smaller capillaries and expelled air as a series of bubbles from the end of the largest capillary. In other experiments, the oil was allowed to imbibe part way into the tubes before counter-current imbibition was started. The meniscus curvatures of the capillaries have been calculated using the Mayer and Stowe-Princen method for different cell slot angles and gap sizes using a value of zero for the contact angle. These values have been compared with actual values by measuring the capillary rise in the tubes; agreement was very close. A model for co-current and counter-current imbibition has also been developed. The significance of this model is that some hydraulic/capillary properties are common for both co-current and counter-current imbibition. The experiments give an illustration of behavior expected in a real porous material and verify the importance of the 'perfect cross-flow' modification to the 'bundle of parallel tubes' model.

A randomised trial of two methods of issuing prenatal test results: the ARIA (Amniocentesis Results: Investigation of Anxiety) trial

BACKGROUND

Many pregnant women experience anxiety while waiting for the results of diagnostic tests. Policies and practices intended to reduce this anxiety require evaluation.

OBJECTIVES

To test the following two hypotheses: * That giving amniocentesis results out on a fixed date alters maternal anxiety during the waiting period, compared with a policy of telling parents that the result will be issued "when available" (i.e. variable date). * That issuing early results from a rapid molecular test alters maternal anxiety during the waiting period, compared with not receiving any results prior to the karyotype. The effects of the two interventions on anxiety 1 month after receiving karyotype results were also examined.

DESIGN

A multicentre, randomised, controlled, open fixed sample, 2 x 2 factorial design trial, with equal randomisation.

SETTING

The prenatal diagnosis clinics in 12 hospitals in England offering amniocentesis as a diagnostic test for Down's syndrome.

SAMPLE

Two hundred and twenty-six women who had had an amniocentesis were randomised between June 2002 and July 2004. Eight women with abnormal results or test failure were excluded post-randomisation.

INTERVENTIONS

Issuing karyotype results on a prespecified fixed date, rather than issuing them as soon as they became available. Issuing karyotype results alone, or subsequent to issuing results from a rapid molecular test for the most common chromosomal abnormalities.

MAIN OUTCOME MEASURES

Average anxiety during the waiting period, calculated using daily scores from the short version of the Spielberger State-Trait Anxiety Inventory (STAI). Anxiety 1 month after receiving karyotype results, measured using the short form STAI.

RESULTS

Issuing early results from a partial but rapid test reduced maternal anxiety by a clinically significant amount during the waiting period (mean daily score 12.5 versus 14.8; scale score difference -2.36, 95% CI -1.2, -3.6), compared with receiving only the full karyotype results. There was no evidence that giving out karyotype results on a fixed or on a variable date altered maternal anxiety during the waiting period (mean daily score 13.2 versus 14.2; scale score difference -1.02, 95% CI -2.2, 0.2). One month after receiving normal karyotype results, anxiety was low in all groups, but women who had been given rapid test results tended to be more anxious than those who had not (mean single day score 9.2 versus 8.3; mean scale score difference 0.95, 95% CI -0.03, 1.9). This small to moderate effect did not reach conventional levels of statistical significance.

CONCLUSIONS

Rapid testing was a beneficial addition to karyotyping, at least in the short term. This does not necessarily imply that early results would be preferred to comprehensive ones if women had to choose between them. Because there are no clear advantages in anxiety terms of issuing karyotype results as soon as they become available, or on a fixed date, women could be given a choice between them.

Amniocentesis results: investigation of anxiety. The ARIA trial

OBJECTIVES

The Amniocentesis Results: Investigation of Anxiety (ARIA) trial tested two hypotheses: first, that giving amniocentesis results out on a fixed date alters maternal anxiety during the waiting period, compared with a policy of telling parents that the result will be issued 'when available' (i.e. a variable date), and secondly, that issuing early results from a rapid molecular test alters maternal anxiety during the waiting period, compared with not receiving any results prior to the karyotype. The effects of the two interventions on anxiety 1 month after receiving karyotype results were also examined.

DESIGN

A multi-centre, randomised, controlled, open fixed sample, 2 x 2 factorial design trial, with equal randomisation.

SETTING

Twelve hospitals in England offering amniocentesis as a diagnostic test for Down's syndrome.

PARTICIPANTS

A total of 226 women who had had an amniocentesis were randomised between June 2002 and July 2004. Eight women with abnormal results or test failure were excluded post-randomisation.

INTERVENTIONS

Issuing karyotype results on a prespecified fixed date, rather than issuing them as soon as they became available and issuing karyotype results alone, or subsequent to issuing results from a rapid molecular test for the most common chromosomal abnormalities.

MAIN OUTCOME MEASURES

Average anxiety during the waiting period, calculated using daily scores from the short version of the Spielberger State-Trait Anxiety Inventory (STAI). Recalled anxiety, measured 1 month after receiving karyotype results, using a rating scale. Anxiety at the 1-month follow-up, measured using the short-form STAI.

RESULTS

There was no evidence that giving out karyotype results on a fixed or on a variable date altered maternal anxiety during the waiting period. However, the analysis only had sufficient power to detect a moderate to large effect. Issuing early results from a partial, but rapid, test reduced maternal anxiety during the waiting period, compared with receiving only the full karyotype results. This was a moderate to large effect. In addition, group differences in recalled anxiety reflected fairly closely the differences in anxiety women had experienced while waiting for results. One month after receiving normal karyotype results, anxiety was low in all groups, but women who had been given rapid test results were more anxious than those who had not. This was a small to moderate effect.

CONCLUSIONS

Since there are no clear advantages in anxiety terms of issuing karyotype results as soon as they become available, or on a fixed date, women could be given a choice between them. Rapid testing was a beneficial addition to karyotyping, at least in the short term. This does not necessarily imply that early results would be preferred to comprehensive ones if women had to choose between them. There should be further research, including more qualitative studies, into the causes, characteristics and consequences of anxiety associated with prenatal testing. The effects of different testing regimes on short- and long-term anxiety, on the preferences of women and on the relationship between anxiety and preference should be investigated. More research is needed on the ways in which information might be used to minimise anxiety in different testing regimes. Further research is also required into the policy implications of incorporating individual preferences for different testing regimes into prenatal testing programmes.

Co-current and counter-current imbibition in independent tubes of non-axisymmetric geometry

Experiments that illustrate and quantify the basics of co- and counter-current spontaneous imbibition have been conducted in a series of simple model pore systems. The fundamental pore geometry is a rod in an angled round-bottomed slot with the rod touching a capping glass plate. The capillaries thus formed by the surfaces of the slot, rod and plate do not have circular cross-sections but more complicated geometric structures with angular corners. The tubes formed at each side of the rod connect at both ends. A viscous, refined oil was applied from one end. For co-current experiments, the opposite end was left open to the atmosphere and oil imbibed into both tubes. For counter-current experiments the opposite end was sealed and connected to a sensitive pressure transducer. Oil imbibed into the smaller capillary and expelled air as a series of bubbles from the end of the larger capillary. Bubble snap-off was observed to be rate-dependent and occurred at a lower curvature than that of the cylindrical meniscus that just fits inside the tube. Only the corners of the larger capillary filled with oil during counter-current imbibition. Meniscus curvatures were calculated using the Mayer and Stowe-Princen method and were compared with actual values by measuring the capillary rise in the tubes; agreement was close. A simple model for co-current and counter-current imbibition has also been developed and the predictions compared with the experimental results. The model results were in agreement with the experiments. The experiments demonstrate that the capillary back pressure generated by the interfaces and bubbles in counter-current imbibition can slow the process significantly.

Assessing the welfare of genetically altered mice

In 2003, under the auspices of the main UK funders of biological and biomedical research, a working group was established with a remit to review potential welfare issues for genetically altered (GA) mice, to summarize current practice, and to recommend contemporary best practice for welfare assessments. The working group has produced a report which makes practical recommendations for GA mouse welfare assessment and dissemination of welfare information between establishments using a 'mouse passport'. The report can be found at www.nc3rs.org.uk/GAmice and www.lal.org.uk/gaa and includes templates for the recommended welfare assessment scheme and the mouse passport. An overview is provided below.

Can rock climbing lead to Dupuytren's disease?

OBJECTIVES

To determine if rock climbing is a significant factor in the development of Dupuytren's disease in men, and, if so, what is the most likely related factor.

METHODS

Questionnaires were distributed to all 1100 members of the Climbers' Club of Great Britain. These detailed basic information about the climber, the presence of Dupuytren's disease, and any known risk factors for its development.

RESULTS

About half (51%) of the questionnaires were returned. The respondents were almost entirely male. It was revealed that 19.5% of male climbers had developed Dupuytren's disease. There was a significantly higher life time intensity of climbing activity in those with the disease. An earlier age of onset of the disease was found in climbers compared with the general population.

CONCLUSIONS

This study further strengthens the hypothesis that repetitive trauma to the palmar fascia predisposes to the development of Dupuytren's disease in men.