Cost Analysis of Orthoptist-Led Neurofibromatosis Type 1 Screening Clinics

Purpose

To conduct a costing study comparing orthoptist-led with consultant-led clinics screening for optic pathway gliomas (OPGs) in children with neurofibromatosis Type 1 (NF1) attending the Royal Children's Hospital (RCH), Melbourne.

Methods

Patients with NF1 examined in the orthoptist-led NF1 screening clinic and/or consultant-led clinics during the study period were identified. The workflow management software Q-Flow 6® provided data documenting patient's time spent with the orthoptist, nurse, and ophthalmologist. Time points were converted into minutes and multiplied by the cost-per-minute for each profession. A bottom-up micro-costing approach was used to estimate appointment level costs. Bootstrap simulations with 1000 replications were used to estimate 95% confidence intervals (CIs) for the difference in mean appointment time and cost between clinics.

Results

Data for 130 consultant-led clinic appointments and 234 orthoptist-led clinic appointments were extracted for analysis. The mean time per appointment for the consultant-led clinic was 45.11 minutes, and the mean time per appointment for the orthoptist-led clinic was 25.85 minutes. The mean cost per appointment for the consultant-led clinic was A $84.15 (GBP £39.60) compared to the orthoptist-led clinic at A $20.40 (GBP £9.60). This represents a mean reduction of 19.25 minutes per appointment (95% CI, -24.85 to -13.66) and a mean reduction of A $63.75 (GBP £30.00) per appointment (95% CI, (A $-75.40 to $-52.10 [GBP £ -35.48 to £ -24.52]).

Conclusion

An orthoptist-led clinic screening for OPGs in patients with NF1 can be a more cost-efficient model of care for ophthalmic screening in this patient group.

Promoting Independence Through quality dementia Care at Home (PITCH): a research protocol for a stepped-wedge cluster-randomised controlled trial

Background

Home care service providers are increasingly supporting clients living with dementia. Targeted and comprehensive dementia-specific training for home care staff is necessary to meet this need. This study evaluates a training programme delivered to care staff (paid personal carers) of clients living with dementia at home.

Methods

This study is a pragmatic stepped-wedge cluster-randomised controlled trial (SW-CRT). Home care workers (HCWs) from seven home care service providers are grouped into 18 geographical clusters. Clusters are randomly assigned to intervention or control groups. The intervention group receives 7 h of a dementia education and upskilling programme (Promoting Independence Through quality dementia Care at Home [PITCH]) after baseline measures. The control group receives PITCH training 6 months after baseline measures. This approach will ensure that all participants are offered the program. Home care clients living with dementia are also invited to participate, as well as their family carers. The primary outcome measure is HCWs’ sense of competence in dementia care provision.

Discussion

Upskilling home care staff is needed to support the increasing numbers of people living with dementia who choose to remain at home. This study uses a stepped-wedge cluster-randomised trial to evaluate a training programme (PITCH) for dementia care that is delivered to front-line HCWs.

Trial registration

anzctr.org.au; ACTRN12619000251123. Registered on 20 February 2019.

Understanding survey data available for researchers working in ageing: the CEPAR Metadata Database on Ageing

Background  For researchers working in gerontology or the demography of ageing, knowledge of and access to population-based data, which includes mature age respondents, is critical. The collection of metadata (information describing data) supports researchers in their search for relevant data. Aims  This proof-of-concept project seeks to develop a metadata database including metadata on Australian sample surveys relevant to ageing over the period 2010–2018. Data and methods  We used a five-stage approach to create the Centre for Excellence in Population Ageing Research (CEPAR) metadata database on ageing: 1) identification of in-scope survey datasets; 2) indexing the in-scope surveys; 3) scraping metadata from publicly available sources; 4) appending metadata to a master database; and 5) creation of a webtool to enable users to search and export metadata and obtain contact details for the relevant data custodian. Results  The CEPAR Metadata Database webtool is available from: https://mspgh.unimelb.edu.au/centres-institutes/centre-for-health-policy/research-group/metadata-database. Conclusions  Metadata database collections can assist researchers to identify what data has been collected (for their specific research interest in ageing), how it was collected and how to gain access to the data.

Barriers to health care reported by carers of older Australians: new evidence from the 2018 Survey of Disability, Ageing and Carers

Carers play an important role in assisting older care recipients with their daily lives and attending to their health care. Yet research has largely overlooked the barriers to health care that carers of older Australians themselves experience. This study finds that, among those attempting to access care, approximately 31.2% of carers of older Australians reported a barrier to health care, with one-third of this group reporting barriers at many points in the healthcare system. Barriers to care were considerable for those attempting to access dental, GP and medical specialist services (27.8%, 18.3% and 15.2% respectively), but lower for accessing hospital services (8.6%). People living with a disability or those in high carer distress had a minimum threefold increase in the odds of experiencing a barrier to care, with odds ratios (95% confidence intervals) of 3.35 (2.10-5.36) and 3.37 (2.33-4.88) respectively. Carers of older Australians noted cost as an important barrier to care, but between 20% and 40% cited being too busy or not having enough time to access dental, GP and medical specialist services (21%, 39% and 26% respectively). Addressing the barriers to health care reported by carers is critical not only to their own health and well-being, but also to that of care recipients.

Heterozygote carriers of mutations in the F11 gene, encoding Factor XI, have normal coagulation by thromboelastography during pregnancy

BACKGROUND

Evidence to guide clinical decision-making in pregnant women who are usually asymptomatic, but identified as heterozygote carriers of F11 mutations, is lacking. We hypothesized that women identified on prenatal screening as heterozygous for a mutation in the F11 allele would have minimal evidence of an in vitro coagulation abnormality.

METHODS

We prospectively enrolled women identified by prenatal screening as F11 mutation carriers and pregnant women who were presumed to be normal as controls. We collected blood during antepartum visits or at presentation for delivery and assessed Factor XI (FXI) coagulant activity level, as well as whole-blood coagulation, by thromboelastography.

RESULTS

F11 mutation carriers had lower serum FXI activity levels than controls (51.2 ± 8.5% vs 94.1 ± 19.4%; P <0.0001). Thromboelastography values of all control subjects and F11 mutation carriers were within the normal range. The R-time was slightly longer in F11 mutation carriers (5.3 ± 1.0 s vs 4.2 ± 0.8 s, P <0.002), but no other statistically significant differences in thromboelastogram parameters were identified between groups.

CONCLUSIONS

Despite lower FXI activity in the F11 mutation group, we found minimal differences in whole-blood measures of coagulation using thromboelastography. These findings support our hypothesis that a single copy of an F11 mutation does not produce significant evidence of an in vitro coagulation abnormality. Thromboelastography might be useful in determining the risk of neuraxial anesthesia in pregnant women, but additional work is required to establish the validity of this test.

Characterization and purification of acidocin CH5, a bacteriocin produced by Lactobacillus acidophilus CH5

AIMS

To characterize and to purify a bacteriocin produced by Lactobacillus acidophilus strain with its activity restricted to Gram-positive bacteria.

METHODS AND RESULTS

Native acidocin CH5, a bacteriocin produced by L. acidophilus CH5 an isolate from a dairy starter culture forms in MRS (Oxoid, Basingstoke, UK) broth high-molecular weight aggregates which can dissociate into smaller units (retained by 5 kDa membrane) with higher activity. Acidocin CH5 was purified using combinations of chromatographic methods based on hydrophobic and cation exchange principles and the N-terminal region was sequenced.

CONCLUSIONS

Based on our results it is evident that acidocin CH5 belongs, according to bacteriocin classification, to the class II bacteriocins with identical N-terminal amino acid sequence described in the literature previously.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study has provided further data on bacteriocin acidocin CH5 from class II with wide spectrum of antimicrobial activity atypical for bacteriocins produced by L. acidophilus sharing the same homology.

Antifungal activity of sodium acetate and Lactobacillus rhamnosus

The inhibition of molds by sodium acetate in deMan Rogosa Sharpe (MRS) medium, along with the antifungal activity of Lactobacillus rhamnosus VT1, was studied by the slope agar plate method. MRS agar prepared with and without sodium acetate was used as the agar substrate. A total of 42 strains of Aspergillus, Penicillium, Fusarium, Alternaria, Cladosporium, and Rhizopus were used to compare sensitivities to the inhibitory activity of sodium acetate and L. rhamnosus VT1. It was found that sodium acetate in MRS medium affected the growth of 33 of the 42 mold strains tested to various degrees. The highest sensitivity to sodium acetate was shown by strains of Fusarium, followed by strains of Penicillium, Aspergillus, and Rhizopus. L. rhamnosus VT1 also inhibited mold growth. A significant finding was that sodium acetate and L. rhamnosus VT1 in combination exhibited a possible synergistic action. Thirty-nine of the 42 mold strains tested were completely inhibited by the presence of both antifungal agents. This finding confirms that sodium acetate, a basic component of commercial MRS medium, has strong antifungal properties, and this must be taken into consideration when evaluating the antifungal activity of Lactobacillus cultures grown in MRS broth.

Respiratory syncytial virus infection following hematopoietic stem cell transplantation

Respiratory syncytial virus, one of the most common causes of respiratory infections in immunocompetent individuals, is frequently spread to recipients of HSCT by family members, other patients, and health care workers. In immunosuppressed individuals, progression from upper respiratory tract disease to pneumonia is common, and usually fatal if left untreated. We performed a retrospective analysis of RSV infections in recipients of autologous or allogeneic transplants. The incidence of RSV following allogeneic or autologous HSCT was 5.7% and 1.5%, respectively. Of the 58 patients with an RSV infection, 16 of 21 patients identified within the first post-transplant month, developed pneumonia. Seventy-two percent of patients received aerosolized ribavirin and/or RSV-IGIV, including 23 of 25 patients diagnosed with RSV pneumonia. In this aggressively treated patient population, three patients died of RSV disease, each following an unrelated HSCT.

The efficacy of 0.5% proparacaine stored at room temperature

OBJECTIVE

To evaluate the efficacy of 0.5% proparacaine stored at room temperature for 6 weeks.

ANIMALS STUDIED

Six normal dogs, evaluated on a weekly basis for 6 weeks.

PROCEDURE

Proparacaine stored at 4 degrees C or at room temperature, was evaluated in the right and left eye of each dog, respectively. Corneal sensitivity was assessed with a Cochet-Bonnet aesthesiometer before and after instillation of proparacaine at each time point.

RESULTS

A statistically significant difference was seen in corneal sensitivity beginning at week 3 for the eyes receiving room-temperature proparacaine compared to refrigerated proparacaine. Differences were not seen between right and left eyes before instillation of proparacaine for any time point, nor for eyes receiving refrigerated proparacaine over the 6 week study period.

CONCLUSION

Short-term storage of proparacaine at room temperature did not affect efficacy, but storage at room temperature for more than 2 weeks resulted in a decrease in drug effect.

Neural plasticity and cognitive development

It has been well documented that the effects of early occurring brain injury are often attenuated relative to later occurring injury. The traditional neuropsychological account of these observations is that, although the developing neural system normally proceeds along a well-specified maturational course, it has a transient capacity for plastic reorganization that can be recruited in the wake of injury. This characterization of early neural plasticity is limited and fails to capture the much more pervasive role of plasticity in development. This article examines the role of neural plasticity in development and learning. Data from both animal and human studies show that plasticity plays a central role in the normal development of neural systems allowing for adaptation and response to both exogenous and endogenous input. The capacity for reorganization and change is a critical feature of neural development, particularly in the postnatal period. Subtractive processes play a major role in the shaping and sculpting of neural organization. However, plasticity is neither transient nor unique to developing organisms. With development, neural systems stabilize and optimal patterns of functioning are achieved. Stabilization reduces, but does not eliminate, the capacity of the system to adapt. As the system stabilizes, plasticity becomes a less prominent feature of neural functioning, but it is not absent from the adult system. The implications of this broader view of plasticity for our understanding of development following early brain damage are discussed.

Drawing abilities in Williams syndrome: a case study

Children with Williams syndrome (WS) have been reported to exhibit an unusual cognitive profile characterized by marked preservation of linguistic abilities and poor visuospatial abilities against a backdrop of generalized mental retardation. Much of the data documenting this profile come from studies of older children and adults with WS. Very few studies have reported findings from the preschool and early school-age period. As a result, little is known about the early development of cognitive processes in children with WS. Capirci, Sabbadini, and Volterra (1996) reported data from a longitudinal case study of early language development in a young child with WS. This article presents the longitudinal profile of visuospatial abilities in this same child. Data on copying and free drawing collected over a period extending from late preschool to early school age are reported. It is clear from these data that this child does indeed exhibit deficits in visuospatial abilities. Her performance clearly improved with age, but deficits persist.

Benign outcome of RSV infection in children with cancer

BACKGROUND

High case-fatality rates have been reported among adults who develop respiratory syncytial virus (RSV) infection while being treated for oncologic diseases, particularly after bone marrow transplantation. Previous reports of RSV infection among children with primary and acquired immunodeficiencies describe increased morbidity compared with that seen in immunocompetent children, but there have been few reports describing the outcome of RSV infection specifically among pediatric oncology patients.

METHODS

We retrospectively reviewed the charts of all children being treated by the Pediatric Oncology Service at Memorial Sloan-Kettering Cancer Center who had positive tests for RSV between the Fall of 1994 and the Spring of 1998. Patients on the BMT Service were excluded from this analysis.

RESULTS

Eighteen RSV infections were identified among pediatric oncology patients, who were being treated with aggressive, predominantly alkylator-based chemotherapy for a variety of oncologic diagnoses. Nine episodes of RSV infection (50%) were treated with specific antiviral therapy. Only one death less than 100 days from the diagnosis of RSV infection occurred among these 18 patients and was attributed to progressive leukemia. The remaining patients recovered fully, although three were readmitted with respiratory symptoms within two weeks of discharge. Seven patients had concurrent infection with other pathogenic organisms.

CONCLUSIONS

In striking contrast with the outcome of RSV infection in adult oncology patients, there may be low mortality associated with RSV infection in pediatric oncology patients. It is possible that scheduled anti-neoplastic therapy need not be delayed for these patients when the diagnosis of RSV infection is made.

Use of nested polymerase chain reaction (PCR) for detection of retroviruses from formalin-fixed, paraffin-embedded uveal melanomas in cats

Thirty-six formalin-fixed, paraffin-embedded enucleated globes from cats with a diagnosis of diffuse anterior uveal melanoma were obtained. Sections of tumor were excised, deparaffinized, and subjected to nested polymerase chain reaction (PCR) to identify proviral DNA sequences from the feline leukemia virus (FeLV)-feline sarcoma virus (FeSV; 36 eyes), and the feline immunodeficiency virus (FIV; 18 eyes). All samples tested were negative for FIV DNA. Three samples were positive for FeLV-FeSV DNA. This is the first reported evidence of a possible link between naturally occurring feline anterior uveal melanoma and the presence of FeLV-FeSV DNA.

Effects of the angiotensin converting enzyme inhibitor benazepril in cats with induced renal insufficiency

OBJECTIVE

To determine effects of the angiotensin converting enzyme inhibitor benazepril in cats with induced renal insufficiency.

ANIMALS

32 cats.

PROCEDURE

Renal mass was surgically reduced, and cats were assigned to 1 of 4 eight-cat groups. Group 1 received placebo, whereas groups 2, 3, and 4 received benazepril hydrochloride orally once daily for approximately 6.5 months at the following doses: group 2, 0.25 to 0.50 mg/kg of body weight; group 3, 0.50 to 1.00 mg/kg; and group 4, 1.00 to 2.00 mg/kg. Arterial blood pressures, glomerular filtration rate (GFR), and renal plasma flow were determined before treatment and during the treatment period. Other determinants of renal hemodynamics were measured by use of micropuncture techniques. Renal biopsy specimens were examined microscopically.

RESULTS

Compared with cats that received placebo, mean systolic arterial blood pressure was significantly less and GFR significantly greater in cats that received benazepril. Glomerular capillary pressure and the ratio of efferent to afferent arteriolar vascular resistance were also significantly less in treated cats. However, histologic differences in renal specimens were not detected.

CONCLUSIONS AND CLINICAL RELEVANCE

Treatment with benazepril sustained single nephron GFR in remnant nephrons of cats with induced renal insufficiency. Administration of benazepril was also associated with a small but significant reduction in degree of systemic hypertension and an increase in whole kidney GFR. Benazepril may be an effective treatment to slow the rate of progression of renal failure in cats with renal disease.

Improved memory functioning and frontal lobe maturation between childhood and adolescence: a structural MRI study

Previous studies conducted by our group have provided evidence for age-related reductions in cortical thickness in dorsal frontal and parietal regions between childhood and adulthood, and gray matter volume increases of mesial temporal and anterior diencephalic structures. The purpose of this study was to describe neurobehavioral correlates of these brain maturational changes using morphometric analyses of brain magnetic resonance images (MRI) and two tests of cognitive abilities. Participants were 35 normal children roughly stratified by age (7 to 16 years) and sex (20 boys and 15 girls) and frontal and mesial temporal regions were anatomically defined in each subjects' MRI data. The California Verbal Learning Test-Children's Version and the Rey-Osterrieth Complex Figure test were used as measures of verbal and visuospatial memory and organizational abilities. Analyses designed to show regionally specific relationships between the brain and behavioral measures revealed interesting results. Specifically, frontal lobe gray matter thinning was more strongly predictive of delayed verbal memory functioning than was the mesial temporal lobe gray matter volume, and this relationship did not appear to be mediated by factors indexed in chronological age. Similar, but less regionally specific relationships were observed for measures of visuospatial memory abilities and frontal lobe maturation. Functional imaging studies in the literature consistently report activation in frontal regions in adults during retrieval tasks. The relationship between frontal lobe maturation and delayed recall observed here may be reflective of the children's development towards the more adult-like frontal lobe function revealed in the functional imaging studies.

Regional size reduction in the human corpus callosum following pre- and perinatal brain injury

This morphometric study examined two aspects of corpus callosum development: pediatric cortico-callosal topography and developmental neuroplasticity subsequent to perinatal brain injury. In vivo magnetic resonance imaging was used to quantify the total midsagittal cross-sectional area and five anterioposterior subregions of the callosum in 10 children with focal lesions and 86 healthy volunteer control subjects. Nine of the ten children with early injury showed a reduction in the total area of the callosum relative to matched controls. The area of the total callosum cross-section was inversely proportional to the size of lesion. All patients displayed region-specific size reduction. This regional thinning bore a topographical relationship to the lesion sites. Reduction in anterior subregions 1, 2 and 3 was respectively associated with lesions in the anterior inferior frontal area, the middle and superior frontal region, and the precentral area. Attenuation of subregion 4 corresponded to anterior parietal lesions, and thinning of subregion 5 occurred with posterior parietal injury. This cortical-callosal pattern coincides with adult and nonhuman primate mappings. Callosal thinning despite the early onset of the lesions suggests limits to developmental neuroplasticity.

Effects of 0.005% latanoprost solution on intraocular pressure in healthy dogs and cats

OBJECTIVE

To evaluate effects of daily topical ocular administration of latanoprost solution on intraocular pressure (IOP) in healthy cats and dogs.

ANIMALS

9 domestic shorthair cats and 14 dogs.

PROCEDURE

Latanoprost solution (0.005%) was administered topically to 1 eye (treated) and vehicle to the other eye (control) of all animals once daily in the morning for 8 days. Intraocular pressure was measured twice daily for the 5 days preceding treatment, and IOP, pupillary diameter, conjunctival hyperemia, and blepharospasm were measured 0, 1, 6, and 12 hours after the first 4 treatments and 0 and 12 hours after the final 4 treatments. Measurements continued twice a day for 5 days after treatment was discontinued. Aqueous flare was measured once daily during and for 5 days after the treatment period.

RESULTS

Intraocular pressure and pupillary diameter were significantly decreased in the treated eye of dogs, compared with the control eye. Mild conjunctival hyperemia was also detected, but severity did not differ significantly between eyes. Blepharospasm and aqueous flare were not detected in either eye. Intraocular pressure in cats was not significantly affected by treatment with latanoprost. However, pupillary diameter was significantly decreased in the treated eye, compared with the control eye. Conjunctival hyperemia, aqueous flare, and blepharospasm were not detected in either eye.

CONCLUSIONS AND CLINICAL RELEVANCE

Once-daily topical ocular administration of latanoprost solution (0.005%) reduced IOP in healthy dogs without inducing adverse effects but did not affect IOP in healthy cats. Latanoprost may be useful for treating glaucoma in dogs.

Feline herpesvirus

Feline herpesvirus infection is extremely common and may lead to recurring ocular disease in the adult cat. Recognition of the history and clinical signs that are consistent with FHV-1 infection is critical because diagnostic tests may be negative. Although a variety of treatment options are available, no one therapy is successful in every cat, and a small percentage of cats respond poorly to any treatment.

Canine rickettsial infections

Dogs that live in tick-infested areas are at risk for contracting rickettsial infections. Clinical signs associated with ehrlichiosis or Rocky Mountain spotted fever may be dramatic or mild. Clinicians must consider the possibility of rickettsial diseases to request laboratory tests that will permit a proper diagnosis. Specific antimicrobial therapy usually brings about clinical improvement, although some dogs may not be cleared of rickettsial organisms, even with prolonged treatment. A small percentage of dogs die of rickettsial infections, either in the acute stage or owing to chronic bone marrow suppression and generalized debilitation. Ocular lesions are an important clinical sign in canine rickettsial infections and may aid the clinician in making a diagnosis and monitoring response to therapy.

Disseminated toxoplasmosis following T cell-depleted related and unrelated bone marrow transplantation

More than 95% of reported cases of disseminated toxoplasmosis following BMT have occurred following an unmodified transplant. Most have been fatal, diagnosed at autopsy and without antemortem institution of specific therapy. From 1989 to 1999, we identified 10 cases of disseminated toxoplasmosis, in 463 consecutive recipients of a T cell-depleted (TCD) BMT. Transplants were from an unrelated donor (n = 5), an HLA-matched sibling (n = 4) or an HLA-mismatched father (n = 1). In 40%, both the donor and recipient had positive IgG titers against T. gondii pre-transplant; in 30%, only the recipient was sero-positive. Three recipients of an unrelated TCD BMT developed toxoplasmosis despite both donor and host testing negative pretransplant. All 10 patients presented with high grade fever. CNS involvement ultimately occurred in seven patients, with refractory respiratory failure and hypotension developing in nine. Eight of 10 cases were found only at autopsy, involving the lungs (n = 7), heart (n = 5), GI tract (n = 5), brain (n = 8), liver and/or spleen (n = 5). The only survivor, treated on the day of presentation with fever and headache, was diagnosed by detection of T. gondii DNA by polymerase chain reaction (PCR) performed on the blood and spinal fluid. This study demonstrates the similar incidence of toxoplasmosis following TCD BMT and that reported post T cell-replete BMT, and underscores the need for rapid diagnostic tests in an effort to improve outcome.

Sino-orbital aspergillosis in a dog

Fungal rhinitis-sinusitis with orbital involvement was diagnosed in a dog with profuse unilateral ocular and bilateral nasal discharge, enophthalmos, and a corneal descemetocele. The descemetocele was treated with a conjunctival pedicle graft. Frontal sinusotomy was performed, and clotrimazole was infused through catheters placed in the frontal sinuses and nasal cavities to saturate the tissues for 1 hour. Successful resolution of orbital infection may have been aided by a fistula between the frontal sinus and orbit that allowed delivery of clotrimazole to the orbit. The dog retained sight in the affected eye, and clinical signs of infection were not detected 14 months later, although enophthalmos and medial strabismus may have been caused by persistent postinflammatory fibrosis.

Brow suspension for treatment of ptosis and entropion in dogs with redundant facial skin folds

Brow suspension surgery was performed on 7 dogs with redundant facial skin folds, associated ptosis, and entropion. The surgical technique involved subcutaneous placement of polyester mesh strips to suspend the upper eyelid from the dorsal frontalis muscle and the underlying periosteum of the skull. Visual impairment associated with ptosis was resolved in all dogs at the 2 week reevaluation period. Upper eyelid position was maintained in 4 of 7 dogs available for long-term follow-up. One dog developed persistent draining tracts in the region of the implant, and removal of part of the implanted mesh was eventually required. Upper eyelid height in this dog, however, was maintained following mesh removal, probably because of fibrosis around the implant. Brow suspension is an option for surgical management of upper eyelid ptosis and entropion in dogs with redundant skin folds and avoids the need for facial skin fold excision.

Spatial grouping activity in children with early cortical and subcortical lesions

Spatial construction skills were examined in 3- to 5-year-old children with prenatal or perinatal focal brain injury. In earlier work, a dissociation was reported between children with injury to the right hemisphere and the left hemisphere, right-hemisphere injury resulting in significantly lower levels of performance. In the current paper, the effect of isolated unilateral subcortical injury was explored. Thirty-four children with early focal brain injury were tested in a task which required them to copy a series of simple block constructions. There were approximately equal numbers of children with right-hemisphere and left-hemisphere injury; within each of these groups approximately half of the children had injury involving only subcortical regions. Consistent with the earlier work, children with right-hemisphere injury performed significantly below children with left-hemisphere injury and the normal controls. Importantly, no differences were observed between the children with isolated subcortical injury and children with injury involving both cortical and subcortical brain areas.

Comparison of nested polymerase chain reaction, virus isolation, and fluorescent antibody testing for identifying feline herpesvirus in cats with conjunctivitis

OBJECTIVE

To compare nested polymerase chain reaction (PCR), virus isolation (VI), and fluorescent antibody (FA) testing to detect feline herpesvirus (FHV) in cats with naturally acquired conjunctivitis or respiratory tract disease, or both.

SAMPLES

Swab and microbrush specimens from the conjunctiva and throat were taken from 46 cats, allotted to 3 groups (conjunctivitis only, respiratory tract disease and conjunctivitis, and clinically normal).

PROCEDURE

Cells from microbrush specimens were digested and herpesvirus DNA was amplified, using a double round of PCR. Products were detected by use of agarose gel electrophoresis. The VI and FA tests were performed in routine manner.

RESULTS

Of 16 cats with conjunctivitis only, conjunctival specimens from 8 and throat specimens from 8 were FHV positive by PCR. None had positive results of VI or FA testing. Of 15 cats with respiratory tract disease and conjunctivitis, conjunctival specimens from 13 and throat specimens from 12 were FHV positive by PCR. A conjunctival specimen from 1 cat and throat specimens from 3 cats were FHV positive by VI. A conjunctival specimen from 1 cat was FHV positive by FA testing. Of 15 clinically normal cats, conjunctival and throat specimens from 2 cats were FHV positive by PCR; neither conjunctival nor throat specimens from these cats were FHV positive by VI or FA testing.

CONCLUSION

For cats with respiratory tract disease and conjunctivitis, or with conjunctivitis only, nested PCR was more sensitive at detecting FHV than was VI or FA testing.

CLINICAL RELEVANCE

Nested PCR is a more sensitive test than the currently available VI and FA tests for identifying FHV in cats with conjunctivitis.

Hemispheric asymmetries in global and local processing: evidence from fMRI

Functional magnetic resonance imaging (fMRI) was used to explore the brain substrate associated with global and local processing of visuospatial patterns. Systematic differences in activation, consistent with differences observed in reaction time data collected under conditions of visual hemifield presentation, were found in occipitotemporal regions of the right and left hemispheres. Within the right hemisphere, area of activation and fractional signal changes were greater under conditions of global processing than under local processing conditions. In the left hemisphere, activation to global and local input was high and comparable.

Use of nested polymerase chain reaction to identify feline herpesvirus in ocular tissue from clinically normal cats and cats with corneal sequestra or conjunctivitis

OBJECTIVE

To use a nested polymerase chain reaction (PCR) to detect feline herpesvirus (FHV-1) DNA in conjunctiva or cornea from clinically normal cats and cats with conjunctivitis or corneal sequestra.

SAMPLES

Conjunctival snip biopsy specimens from 50 cats with conjunctivitis and 50 clinically normal cats; 28 keratectomy specimens from 26 cats with sequestra, and 13 specimens from clinically normal cats.

PROCEDURE

Tissue specimens were digested, and FHV-1 DNA was amplified, using a double round of PCR. Products were visualized by use of agarose gel electrophoresis.

RESULTS

Polymerase chain reaction was positive in 27 of 50 (54%) conjunctival specimens from cats with conjunctivitis and 6 of 50 (12%) specimens from clinically normal cats. Difference in the results between cats with conjunctivitis and clinically normal cats was statistically significant. Polymerase chain reaction was positive in 5 of 28 (18%) corneal specimens from cats with sequestra and 6 of 13 (46%) clinically normal cats. Distribution of positive results between clinically normal cats and those with sequestra was not significant.

CONCLUSION

Cats with conjunctivitis were more likely to have a positive PCR result than were clinically normal cats, making it likely that FHV-1 was associated with the disease state. Herpesvirus DNA could not be detected in most corneas from cats with sequestra.

CLINICAL RELEVANCE

Polymerase chain reaction is a useful clinical test for identifying FHV-1 DNA in cats with conjunctivitis, yielding greater sensitivity over that of current available tests. Herpesvirus may be less of a cause of corneal sequestration in the commonly affected breeds, Himalayan and Persian, than other factors, such as lagophthalmos or corneal metabolic defects.

The development of drawing in children with congenital focal brain injury: evidence for limited functional recovery

Children with pre- or perinatal injury to right hemisphere (RH) brain regions show impairment of spatial integrative functions similar to that observed among adults with comparable injury. Unlike adults, children show considerable improvement with development on a range of spatial construction tasks which require spatial integration. Such gains could reflect true recovery of spatial integrative abilities. Alternatively, the improvement could be more limited in scope, reflecting the development of compensatory strategies which are task specific and allow the children to circumvent, rather than overcome, their primary spatial disorders. The studies presented here examined this distinction within the context of drawing tasks in which the child was first asked to draw a house and then an impossible house. The impossible house task was designed to examine the extent to which children rely on graphic formulas in generating organized drawings. The results showed that while all of the children with RH injury make considerable progress in free drawing into the school age period, they are very reliant on the use of graphic formulas. When given a task which requires them to alter their drawings, they did not change the spatial configuration of the depicted object. Rather they found alternate ways to render the object 'impossible'.

Children's analysis of hierarchical patterns: evidence from a similarity judgment task

Three experiments in this study examined the development of young children's analysis of spatial patterns, specifically hierarchical letter and geometric forms. In a forced choice task, 4- and 6-year-olds and adult subjects chose one of two choice forms as most similar to a target form. Specific stimulus manipulations were introduced to assess children's ability to segment and integrate hierarchically organized information under different conditions. In Experiment 1 adults served as subjects in a computerized version that provided both choice and response latency data. In Experiments 2 and 3 children and adults participated in a pencil and paper version of the forced choice task. Results showed that although children as young as 4 years of age demonstrated substantial analytic competence, their ability to integrate the parts of the spatial array to form a coherent whole was weaker and more easily disrupted than that of the older children and adults.

The influence of pattern type on children's block design performance

This study sought to determine what factors contribute to normal developmental changes in performance on the block design task. The target models were systematically varied to emphasize global, intermediate, and local pattern structures. One hundred children between 4.5 and 9 years of age were tested in the first experiment. Correct performance and error types differed significantly as a function of age and pattern type. Broken configuration errors were particularly common for the global patterns. In the second experiment, 48 children between 4.5 and 8 years of age were tested using designs with a superimposed grid (cued condition). Error rates were lower in the cued condition and broken configuration errors were less frequent. These results suggest that children have more difficulty parsing more cohesive patterns, but they can modify their strategies when the square matrix is provided by the pattern structure.

Developmental change in spatial grouping activity among children with early focal brain injury: evidence from a modeling task

Spatial construction skills were assessed in children with left (LH) or right (RH) hemisphere focal brain injury and control children. Children copied simple and complex block models which were rated on accuracy and spatial strategy. The accuracy of simple and complex constructions for 4- to 5-year-old children with LH injury was indistinguishable from 4-year-old controls. However, although they were able to produce accurate complex constructions, the processes used by children with LH injury differed from those of normal children. On both simple and complex constructions, 4- to 5-year-old children with RH injury showed evidence of developmental delay. For both accuracy and process measures, children with RH injury performed at a level comparable to normal children at 3 years. A second group of children with LH and RH injury were tested at 5 to 6 years of age. Both lesion groups were indistinguishable from 4-year-old controls in terms of accuracy. However, both children with LH and RH injury used different spatial processes than did controls. This study emphasizes the importance of distinguishing between products of behavior and the processes which underlie them. It is in the dissociation of products and process of behavior that the subtle spatial construction deficits in this population of brain-injured subjects is revealed.

Detection of Toxoplasma gondii in feline and canine biological samples by use of the polymerase chain reaction

OBJECTIVE

To develop a polymerase chain reaction (PCR) technique to identify Toxoplasma gondii DNA in biological samples from cats and dogs.

DESIGN

To artificially create samples that would mimic those acquired in a clinical setting from animals with naturally acquired toxoplasmosis. Using these samples, a PCR test to identify T gondii DNA was developed.

SAMPLE POPULATION

Feline and canine aqueous humor, CSF, serum, and blood samples.

PROCEDURE

Tachyzoites of several strains of T gondii grown in cell culture were added to feline and canine aqueous humor, CSF, serum, and blood samples. Protocols for identifying T gondii DNA by use of the PCR were developed.

RESULTS

The DNA from as few as 10 tachyzoites of T gondii could be identified in feline and canine aqueous humor, CSF, and serum samples. One hundred tachyzoites could be identified in blood samples.

CONCLUSIONS

Toxoplasma gondii can be identified in feline and canine biological samples by use of the PCR.

CLINICAL RELEVANCE

Correlation of clinical disease to T gondii serum antibodies provides only a presumptive diagnosis of toxoplasmosis. Use of PCR to detect T gondii DNA in biological samples from cats and dogs may provide a sensitive tool for the antemortem diagnosis of toxoplasmosis and may be most beneficial when used in conjunction with serum antibody titers.

Treatment of cats with ocular disease attributable to herpesvirus infection: 17 cases (1983-1993)

Medical records of 17 cats with ocular disease attributable to herpesvirus injection were reviewed. Herpesvirus infection was confirmed by a positive result on an immunofluorescent antibody test or by detection of dendritic corneal ulcers. Cats were 3 months to 23 years old (mean, 4.8 years). Sex or breed predilections were not evident. Vaccination history was available for 13 cats, 9 of which had been adequately vaccinated against feline viral rhinotracheitis, calici, and panleukopenia viruses. Six cats had a history of respiratory tract disease. Twelve cats were tested for FeLV, and 3 had positive results; 7 cats were tested for feline immunodeficiency virus, with 1 positive result. The most common ocular abnormality seen was conjunctivitis (13/17 cats), followed by dendritic corneal ulcers (10/17 cats). Keratitis was detected in 6 of 17 cats, and nondendritic corneal ulcers in 3 of 17 cats. Corneal sequestra were evident on initial examination or developed during the follow-up period in 4 of 17 cats. Keratoconjunctivitis sicca was diagnosed in 2 of 17 cats, and anterior uveitis was evident in 1 of 17 cats. All cats had 2 or more clinical ocular abnormalities associated with herpesvirus infection. Treatment with topically applied antiviral medications was instituted in 14 cats, including idoxuridine in 7, vidarabine in 4, and trifluridine in 3. Antibiotics were used topically in 10 cats, and atropine was used in 3 cats. Topical administration of corticosteroids was used in 2 cats. Recombinant human alpha-interferon was given orally to 3 cats in conjunction with topical administration of antiviral agents. In addition to medical treatment, 4 cats were treated surgically.(ABSTRACT TRUNCATED AT 250 WORDS)

Affective facial expression in infants with focal brain damage

Children are fluent affective communicators by their first birthday. The development of affective facial expression in infants with focal brain damage thus provides a promising context in which to investigate the developing neural substrates of emotions. We examined both positive and negative affective expression in 12 infants (6-24 months) with pre- or perinatal unilateral focal brain damage (6RHD and 6LHD) and their age- and gender-matched controls. Infants were videotaped in free and semi-structured tasks. Interactions were microanalytically coded, including the use of FACS. Both normal and babies with posterior LHD exhibited the full range of appropriate affective expressions. In contrast, infants with posterior RHD showed marked affective impairment to positive, but not to negative simulation.

Arterial hypertension associated with topical ocular use of phenylephrine in dogs

In 3 dogs scheduled for surgical removal of cataracts, systemic and topical treatment with antibiotics and topical ocular treatment with prednisolone, atropine, flurbiprofen, and phenylephrine were used to achieve maximal mydriasis, with minimal risk of pupillary constriction in response to surgery. Each dog developed arterial hypertension, with systolic, diastolic, and mean arterial pressures ranging from 170 to 205, 90 to 112, and 123 to 148 mm of Hg, respectively. Hypertension was treated with acepromazine maleate (0.001 to 0.005 mg/kg of body weight) i.v., decreasing arterial pressures to reference values. Phenylephrine dosages for topical use ranged from 50 to 367 times greater than the i.v. dose required to increase arterial pressure by 50% in anesthetized dogs. Although adverse sequelae to these episodes of hypertension were not noticed, this report documents the uptake of phenylephrine from topical ocular application and suggests the need for dose-response measurements for this adjunct to mydriatic treatment in dogs.

Tonometry of normal eyes in raptors

An applanation tonometer was used to estimate intraocular pressure in normal eyes of several species of raptors. No bird had active injury or illness, though some were nonreleasable to the wild because of previous injury. Mean (+/- SD) intraocular pressure was 20.6 (+/- 3.4) mm of Hg in red-tailed hawks (Buteo jamaicensis, n = 10), 20.8 (+/- 2.3) mm of Hg in Swainson's hawks (Buteo swainsoni, n = 6), 21.5 (+/- 3.0) mm of Hg in golden eagles (Aquila chrysaetos, n = 7), 20.6 (+/- 2.0) mm of Hg in bald eagles (Haliaeetus leucocephalus, n = 3), and 10.8 (+/- 3.6) mm of Hg in great horned owls (Bubo virginianus, n = 6). There was no significant difference in intraocular pressure between hawks and eagles. Mean pressure in great horned owls was significantly (P < 0.01) lower than pressure in hawks or eagles. Reliable intraocular pressure readings could not be obtained in barn owls (Tyto alba).

Infant use of relative motion as information for form: evidence for spatiotemporal integration of complex motion displays

Previous studies of infants' ability to integrate and to utilize relative motion as information for form in the absence of structural cues have primarily involved motions that are uniform in rate, direction, and path within the form to be constructed. In the present study, we examined infants' ability to integrate relative motion information from motions that are nonuniform along these dimensions, and from this integrative process to construct a coherently rotating two-dimensional form. Infants' ability to integrate nonuniform motion was measured with regard to their ability to discriminate the rotating form from a noncoherent control display containing the same absolute motions. The results showed that discrimination of the coherent and incoherent displays was not demonstrated until 7 months of age. Two additional experiments were conducted to rule out the possibility that this discrimination was based on the detection of local regions of coherence, rather than the perception of the global rotating form. In both experiments, the results did not support discrimination based exclusively on local cues alone. From the combined results of all three experiments, we conclude that infants demonstrate the capacity to integrate the information contained within nonuniform trajectories into a coherent structure by 7 months of age.

Global-local processing in preschool children

The tendency of young children to attend to global and/or local levels of hierarchically structured patterns was examined using an orientation judgment task. 3- and 4-year-old children and adults were asked to judge which way an equilateral triangle was pointing under different contextual conditions. In Experiment 1, contextual variations included overall pattern orientation, configuration alignment type, presence or absence of an immediate frame of reference, and type of local element context. The results showed that, contrary to previous reports in the literature, young children, like adults, attend to both global and local levels of a pattern. Both pattern orientation and the introduction of contextual cues affected children's judgments, and the magnitude of that effect varied with the particular contextual cue present in the stimulus array. In Experiment 2, contextual variations included overall pattern orientation and presence or absence of an internal local level element. Consistent with the results of Experiment 1, young children's orientation judgements were influenced by the addition of local level factors.