Climate change and mental health: risks, impacts and priority actions

BACKGROUND

This article provides an overview of the current and projected climate change risks and impacts to mental health and provides recommendations for priority actions to address the mental health consequences of climate change.

DISCUSSION AND CONCLUSION

The authors argue the following three points: firstly, while attribution of mental health outcomes to specific climate change risks remains challenging, there are a number of opportunities available to advance the field of mental health and climate change with more empirical research in this domain; secondly, the risks and impacts of climate change on mental health are already rapidly accelerating, resulting in a number of direct, indirect, and overarching effects that disproportionally affect those who are most marginalized; and, thirdly, interventions to address climate change and mental health need to be coordinated and rooted in active hope in order to tackle the problem in a holistic manner. This discussion paper concludes with recommendations for priority actions to address the mental health consequences of climate change.

Investigations of the nutritive value of meals of double-low rapeseed and its influence on growth performance of broiler chickens

Four experiments were carried out to study the possible differences in metabolizable energy (ME) of meals (RSM) or expeller meals (RSE) from double-low rapeseed (Expt. 1), the influence of processing on ME (Expt. 2) and on relative phosphorus (P) bioavailability (Expt. 3) in RSM, and effect of RSM inclusion on growth performance of broilers (Expt. 4). For Expt. 1, diets with 300 g/kg RSM from 11 RSM and 4 RSE varieties were fed to broilers from d 14 to 21, with excreta collection on d 19 to 21. Each treatment had 8 replicates and 3 birds per replicate. Energy metabolizability of RSM of a specialized high glucosinolate variety (V275OL) was greater (P < 0.05) than all the other varieties. In Expt. 2, two RSM varieties were processed with mild or conventional processing condition. There were no variety effects on ME, but ME and MEn were greater (P < 0.01) for RSM processed by mild processing condition. In Expt. 3, P bioavailability of RSM was determined, relative to MSP, using growth performance and tibia ash as responses. Phosphorus relative bioavailability values were greater (P < 0.05) in RSM of DK Cabernet variety processed using the mild processing condition. In Expt. 4, two RSM varieties were added to wheat-soybean meal-based diet at the rates of 50, 100, 150, or 200 g/kg and fed to broilers from d 0 to 42. Inclusion of 150 and 200 g/kg of RSM resulted in reduced weight gain and increased feed conversion ratio (FCR) compared (P < 0.01) with the lower inclusion levels during the starter phase. For the entire trial (d 0 to 42), weight gain was greater (P < 0.01) for birds receiving diets with RSM from PR46W21 variety. It was concluded from the experiments that apart from the residual ether extract content, variety differences had no impact on ME of RSM, conventional processing reduced ME and relative bio-availability of P; and that the maximum level of RSM inclusion depends on maximum growth performance level desired.

Abstract P4-08-01: Not presented

This abstract was not presented at the symposium.

Evaluation of vegetable protein in canine diets: Assessment of performance and apparent ileal amino acid digestibility using a broiler model

Recent technological advances in the human food industry with respect to meat processing have decreased the availability of animal proteins to the pet food industry which typically formulates diets with an excess of animal protein. In the long term, this is not sustainable; thus, alternative protein sources need to be investigated. This study examined three canine diets, comparing a typical animal protein-based diet (control) with two experimental diets where the animal protein was substituted in part with vegetable protein (formulated based either on total protein or amino acid content) using a broiler model. Each diet was fed to six cages each containing two birds from day 15, 18 cages in total (36 birds). Excreta were collected from days 19 to 21. On day 23, birds were euthanized and weighed, and their ileal digesta were collected and pooled for each cage. In addition, one leg per cage was collected for evaluation of muscle mass. Results showed no significant difference in animal performance (feed intake or live weight gain) or muscle to leg proportion across the diets. Birds fed the control diet and the diet balanced for amino acid content exhibited the greatest coefficients of apparent metabolizability for nitrogen (p < .001). Birds fed the diets that contained partial replacement of animal with vegetable protein generally had greater ileal digestibility of amino acids compared to birds fed the control (animal protein) diet. Analysis of excreta showed no dietary difference in terms of dry matter content; however, birds fed the diet balanced for total protein and the diet balanced for amino acid content had significantly greater excreta nitrogen than the control (p = .038). Overall, the study suggests vegetable proteins when formulated based on amino acid content are a viable alternative to animal proteins in canine diets.

Assessment of caecal parameters in layer hens fed on diets containing wheat distillers dried grains with solubles

There is much interest in quantifying the nutritional value of UK wheat distillers dried grains with solubles (W-DDGS) for livestock species. A study was designed to evaluate caecal parameters (pH, short chain fatty acids (SCFAs) and bacterial diversity) in layer hens fed on balanced diets containing graded concentrations of W-DDGS. A total of 32 layer hens (Bovans Brown strain at 27 weeks of age) were randomly allocated to one of 4 dietary treatments containing W-DDGS at 0, 60, 120 or 180 g/kg. Each treatment was fed to 8 replicate individually housed layer hens over a 5-d acclimatisation period, followed by a 4-week trial. Individual feed intakes were monitored and all eggs were collected daily for weeks 2, 3 and 4 of the trial, weighed and an assessment of eggshell "dirtiness" made. All hens were culled on d 29 and caecal pH and SCFAs measured. Polymerase chain reaction denaturing gradient gel electrophoresis of the bacterial 16 S rDNA gene was used to assess total bacterial diversity of luminal caecal content from hens fed the 0 and 180 g W-DDGS/kg diets. Unweighted pair group method with arithmetic mean (UPGMA) dendrograms were generated from DGGE banding patterns. Increasing W-DDGS dietary concentrations resulted in a more acidic caecal environment. Caecal SCFAs were unaffected by diet aside from a quadratic effect for molar proportions of isobutyric acid. Diversity profiles of the bacterial 16S rRNA gene from luminal caecal contents were unaffected by W-DDGS inclusion. The results of the current study suggest that W-DDGS can be successfully formulated into nutritionally balanced layer diets (supplemented with xylanase and phytase) at up to 180 g/kg with no detrimental effects to the caecal environment.

Uptake of tamoxifen in consecutive premenopausal women under surveillance in a high-risk breast cancer clinic

BACKGROUND

Randomised trials of tamoxifen versus placebo indicate that tamoxifen reduces breast cancer risk by approximately 33%, yet uptake is low. Approximately 10% of women in our clinic entered the IBIS-I prevention trial. We assess the uptake of tamoxifen in a consecutive series of premenopausal women not in a trial and explore the reasons for uptake through interviews.

METHODS

All eligible women between 33 and 46 years at ≥17% lifetime risk of breast cancer and undergoing annual mammography in our service were invited to take a 5-year course of tamoxifen. Reasons for accepting (n=15) or declining (n=15) were explored using semi-structured interviews.

RESULTS

Of 1279 eligible women, 136 (10.6%) decided to take tamoxifen. Women >40 years (74 out of 553 (13.4%)) and those at higher non-BRCA-associated risk were more likely to accept tamoxifen (129 out of 1109 (11.6%)). Interviews highlighted four themes surrounding decision making: perceived impact of side effects, the impact of others' experience on beliefs about tamoxifen, tamoxifen as a 'cancer drug', and daily reminder of cancer risk.

CONCLUSIONS

Tamoxifen uptake was similar to previously ascertained uptake in a randomised controlled trial (IBIS-I). Concerns were similar in women who did or did not accept tamoxifen. Decision making appeared to be embedded in the experience of significant others.

Effect of compensatory growth on forms of glycogen, postmortem proteolysis, and meat quality in pigs

The current experiment was designed to examine if a compensatory feed regimen influenced storage of glycogen forms, activity of proteolytic systems, and meat quality. Female pigs (Large White × Landrace × Duroc cross) with an initial age of 74 d were allocated to 6 feeding treatment groups (n=8 for each group). Groups then consumed feed ad libitum for 40 (A40), 42 (A42), or 82 d (A82). The compensatory growth groups were fed 0.70 of ad libitum intake for 40 d (R40) followed by refeeding for ad libitum intake for 2 (R40A2) or 42 d (R40A42). Pigs were slaughtered at the end of the restriction period (SL1), then after refeeding for 2 (SL2) and 42 d (SL3). The feeding regimen caused restricted animals at SL2 to have a decreased BW (P=0.039), with the refed animals undergoing compensatory growth by SL3 so BW was not different (P=0.829). At SL1 there was a trend for the R40 pigs to have less intramuscular fat than A40 (P=0.084). There was a trend for macroglycogen (MG; P=0.051) and a significant effect for proglycogen (ProG; P=0.014) to be greater at slaughter in R40 than A40, along with a greater postmortem decline in both MG (P=0.033) and ProG (P=0.022) over the first 2 h in R40, which was associated with the R40 having a lower pH at 24 h postmortem (P=0.043). After refeeding for 2 d (SL2), only MG of R40A2 was greater (P=0.030) than A42 and had a trend for a greater difference of decline at 24 h postmortem (P=0.091), which was associated with lower pH at 24 h (P=0.012). The data suggest that the concentrations of ProG are more labile and recovered to the concentrations of pigs fed for ad libitum intake sooner than MG. After full compensation in SL3, there was no difference for MG content (at 0 h, P=0.721; at 2 h, P=0.987; at 24 h, P=0.343), ProG content (at 0 h, P=0.879; at 2 h, P=0.946; at 24 h, P=0.459), and muscle pH (at 45 min, P=0.373; at 24 h, P=0.226). At all slaughter points, there was no difference in shear force (at SL1, P=0.101; at SL2, P=0.420; at SL3, P=0.167). There were no significant effects of the feeding regimen on micro- and milli-calpain large subunit gene expression (for micro-calpain at SL1, P=0.450; at SL2, P=0.171; at SL3, P=0.281; for milli-calpain at SL1, P=0.666; at SL2, P=0.123; at SL3, P=0.617) or the activity of the 2 proteolytic enzymes at any of the slaughter dates (for micro-calpain at SL1, P=0.238; at SL2, P =0.238; at SL3, P=0.222; for milli-calpain at SL1, P=0.296; at SL2, P=0.230; at SL3, P=0.615). In R40 there was a trend (P=0.070) for greater gene expression of caspase 3, whereas in R40A2 the increase was significant (P=0.009) relative to pigs consuming feed ad libitum. However, gene expression of the E3 ligase, MuRF1, at SL3 was less in R40A42 (P=0.019). Although compensatory growth does appear to influence the expression of various proteolytic systems, the changes do not appear to be associated with meat quality as measured by shear force.

GSK256066, an exceptionally high-affinity and selective inhibitor of phosphodiesterase 4 suitable for administration by inhalation: in vitro, kinetic, and in vivo characterization

Oral phosphodiesterase (PDE) 4 inhibitors such as roflumilast have established the potential of PDE4 inhibition for the treatment of respiratory diseases. However, PDE4 inhibitor efficacy is limited by mechanism-related side effects such as emesis and nausea. Delivering the inhibitor by the inhaled route may improve therapeutic index, and we describe 6-({3-[(dimethylamino)carbonyl]phenyl}sulfonyl)-8-methyl-4-{[3-methyloxy) phenyl]amino}-3-quinolinecarboxamide (GSK256066), an exceptionally high-affinity inhibitor of PDE4 designed for inhaled administration. GSK256066 is a slow and tight binding inhibitor of PDE4B (apparent IC(50) 3.2 pM; steady-state IC(50) <0.5 pM), which is more potent than any previously documented compound, for example, roflumilast (IC(50) 390 pM), tofimilast (IC(50) 1.6 nM), and cilomilast (IC(50) 74 nM). Consistent with this, GSK256066 inhibited tumor necrosis factor α production by lipopolysaccharide (LPS)-stimulated human peripheral blood monocytes with 0.01 nM IC(50) (compared with IC(50) values of 5, 22, and 389 nM for roflumilast, tofimilast, and cilomilast, respectively) and by LPS-stimulated whole blood with 126 pM IC(50). GSK256066 was highly selective for PDE4 (>380,000-fold versus PDE1, PDE2, PDE3, PDE5, and PDE6 and >2500-fold against PDE7), inhibited PDE4 isoforms A-D with equal affinity, and had a substantial high-affinity rolipram binding site ratio (>17). When administered intratracheally to rats, GSK256066 inhibited LPS-induced pulmonary neutrophilia with ED(50) values of 1.1 μg/kg (aqueous suspension) and 2.9 μg/kg (dry powder formulation) and was more potent than an aqueous suspension of the corticosteroid fluticasone propionate (ED(50) 9.3 μg/kg). Thus, GSK256066 has been demonstrated to have exceptional potency in vitro and in vivo and is being clinically investigated as a treatment for chronic obstructive pulmonary disease.

The identification of a novel phosphodiesterase 4 inhibitor, 1-ethyl-5-{5-[(4-methyl-1-piperazinyl)methyl]-1,3,4-oxadiazol-2-yl}-N-(tetrahydro-2H-pyran-4-yl)-1H-pyrazolo[3,4-b]pyridin-4-amine (EPPA-1), with improved therapeutic index using pica feeding in rats as a measure of emetogenicity

Clinical utility of phosphodiesterase 4 (PDE4) inhibitors as anti-inflammatory agents has, to date, been limited by adverse effects including nausea and emesis, making accurate assessment of emetic versus anti-inflammatory potencies critical to the development of inhibitors with improved therapeutic indices. In the present study we determined the in vitro and in vivo anti-inflammatory potencies of the first-generation PDE4 inhibitor, rolipram, the second-generation inhibitors, roflumilast and cilomilast, and a novel third generation inhibitor, 1-ethyl-5-{5-[(4-methyl-1-piperazinyl)methyl]-1,3,4-oxadiazol-2-yl}-N-(tetrahydro-2H-pyran-4-yl)-1H-pyrazolo[3,4-b]pyridin-4-amine (EPPA-1). The rank-order potency against lipopolysaccharide (LPS)-induced tumor necrosis factor-alpha production by human peripheral blood mononuclear cells was roflumilast (IC(50) = 5 nM) > EPPA-1 (38) > rolipram (269) > cilomilast (389), and against LPS-induced pulmonary neutrophilia in the rat was EPPA-1 (D(50) = 0.042 mg/kg) > roflumilast (0.24) > rolipram (3.34) > cilomilast (4.54). Pica, the consumption of non-nutritive substances in response to gastrointestinal stress, was used as a surrogate measure for emesis, giving a rank-order potency of rolipram (D(50) = 0.495 mg/kg) > roflumilast (1.6) > cilomilast (6.4) > EPPA-1 (24.3). The low and high emetogenic activities of EPPA-1 and rolipram, respectively, detected in the pica model were confirmed in a second surrogate model of emesis, reversal of alpha(2)-adrenoceptor-mediated anesthesia in the mouse. The rank order of therapeutic indices derived in the rat [(pica D(50))/(neutrophilia D(50))] was EPPA-1 (578) > roflumilast (6.4) > cilomilast (1.4) > rolipram (0.15), consistent with the rank order derived in the ferret [(emesis D(50))/(neutrophilia D(50))]. These data validate rat pica feeding as a surrogate for PDE4 inhibitor-induced emesis in higher species, and identify EPPA-1 as a novel PDE4 inhibitor with an improved therapeutic index.

Identification and optimisation of a novel series of pyrimidine based cyclooxygenase-2 (COX-2) inhibitors. Utilisation of a biotransformation approach

Many years of work have been invested in the identification of potent and selective COX-2 inhibitors for the treatment of chronic inflammatory pain. One issue faced by workers is the balance between the lipophilicity required for potent enzyme inhibition and the physical properties necessary for drug absorption and distribution in vivo. Frequently approaches to reduce lipophilicity through introduction of polar functionality is hampered by highly challenging chemistry to prepare key molecules. We have complemented traditional synthetic chemistry with a biotransformations approach which efficiently provided access to an array of key target molecules.

Effects of extrusion conditions on trypsin inhibitor activity of full fat soybeans and subsequent effects on their nutritional value for young broilers

1. Increasing proportions of soybeans in poultry diets have highlighted the importance of correct processing to inactivate the anti-nutritional factors present whilst maintaining protein quality. 2. Ground full fat soybeans (FFSB) were extruded using a Clextral laboratory model twin-screw extruder with 0.75 l/h of water and end barrel temperatures of 90, 110, 130 and 160 degrees C resulting in trypsin inhibitor activities (TIA) of 14.8, 9.6, 4.5 and 1.9 mg/g sample. 3. The 4 extrudates were used at three different inclusion levels: 200, 400 and 600 g/kg semi-synthetic diet and fed to male Ross broiler chicks from d 19 to d 26. Digesta samples were taken for measurement of coefficient of ileal apparent amino acid digestibility (CIAD) and both pancreas and whole bird weights were measured. 4. Concentration of ileal apparent digestible lysine was increased from 10.53 to 17.63 g/kg FFSB by increasing extrusion temperature from 90 to 160 degrees C. CIAD of lysine was also improved from 0.58 to 0.86. Other amino acids showed similar improvements in both their ileal apparent digestible concentration and CIAD. 5. Mean weight gain over 3 d increased linearly from 42 to 95 g per bird with increasing extrusion temperatures of FFSB. Pancreatic enlargement was evident after 6 d of feeding with FFSB processed at lower temperatures, even when the TIA level was at the recommended threshold of 4 mg/g. 6. The results emphasise the importance of controlled conditions during processing of FFSB for poultry diets and suggest that processing of FFSB in order to reduce TIA levels below 4 mg/g may provide significant benefits for broiler chicks.

The consequences of non-starch polysaccharide solubility and inclusion level on the health and performance of weaned pigs challenged with enterotoxigenic Escherichia coli

The inclusion of insoluble NSP (iNSP) in weaner pig diets has been reported to decrease post-weaning colibacillosis (PWC). Conversely, soluble NSP (sNSP) have been shown to exacerbate PWC. The present study investigated the effect of NSP solubility and inclusion level on the health and performance of newly weaned pigs challenged with enterotoxigenic Escherichia coli (ETEC), using NSP sources known not to affect digesta viscosity, in a 2 x 2 x 2 factorial combination of NSP solubility (iNSP v. sNSP), inclusion level (low (L; 50 g/kg) v. high (H; 150 g/kg)) and ETEC challenge (infected v. sham). Infection had no effect on pig health, but reduced performance to a larger extent in pigs on the L diets compared with those on the H diets. The inclusion of sNSP significantly decreased the occurrence of diarrhoea (P < 0.001) and improved gut health, as indicated by a lower caecal digesta pH (P = 0.008) and increased (P = 0.002) Lactobacillus:coliform ratio, when compared with the iNSP diet on day 14 post-weaning. There was no effect of NSP solubility on ETEC shedding, digesta viscosity or pig performance. Pigs on the H diets had fewer cases of diarrhoea and shed fewer ETEC than those on the L diets. Increasing NSP inclusion significantly increased colonic Lactobacillus:coliform ratio, volatile fatty acid concentration and caecal digesta viscosity, but decreased performance. These results suggest that sNSP per se are not detrimental to pig health and that increasing the concentration of NSP in weaner diets that do not increase digesta viscosity may have a beneficial effect on gut health and protect against PWC.

The cyclooxygenase-2 inhibitor GW406381X [2-(4-ethoxyphenyl)-3-[4-(methylsulfonyl)phenyl]-pyrazolo[1,5-b]pyridazine] is effective in animal models of neuropathic pain and central sensitization

The pathogenic form of the cyclooxygenase (COX) enzyme, COX-2, is also constitutively present in the spinal cord and has been implicated in chronic pain states in rat and man. A number of COX-2 inhibitors, including celecoxib and rofecoxib, are already used in man for the treatment of inflammatory pain. Preclinically, the dual-acting COX-2 inhibitor, GW406381X [2-(4-ethoxyphenyl)-3-[4-(methylsulfonyl)phenyl]-pyrazolo[1,5-b]pyridazine, where X denotes the free base], is as effective as rofecoxib and celecoxib in the rat established Freund's Complete Adjuvant model with an ED(50) of 1.5 mg/kg p.o. compared with 1.0 mg/kg p.o. for rofecoxib and 6.6 mg/kg p.o. for celecoxib. However, in contrast to celecoxib (5 mg/kg p.o. b.i.d.) and rofecoxib (5 mg/kg p.o. b.i.d.), which were without significant effect, GW406381X (5 mg/kg p.o. b.i.d.) fully reversed mechanical allodynia in the chronic constriction injury model and reversed thermal hyperalgesia in the mouse partial ligation model, both models of neuropathic pain. GW406381X, was also effective in a rat model of capsaicin-induced central sensitization, when given intrathecally (ED(50) = 0.07 mug) and after chronic but not acute oral dosing. Celecoxib and rofecoxib had no effect in this model. Several hypotheses have been proposed to try to explain these differences in efficacy, including central nervous system penetration, enzyme kinetics, and potency. The novel finding of effectiveness of GW406381X in these models of neuropathic pain/central sensitization, in addition to activity in inflammatory pain models and together with its central efficacy, suggests dual activity of GW406381X compared with celecoxib and rofecoxib, which may translate into greater efficacy in a broader spectrum of pain states in the clinic.

Identification of 2,3-diaryl-pyrazolo[1,5-b]pyridazines as potent and selective cyclooxygenase-2 inhibitors

GW406381 (8), currently undergoing clinical evaluation for the treatment of inflammatory pain is a member of a novel series of 2,3-diaryl-pyrazolo[1,5-b]pyridazine based cyclooxygenase-2 (COX-2) inhibitors, which have been shown to be highly potent and selective. Several examples of the series, in addition to possessing favourable pharmacokinetic profiles and analgesic activity in vivo, have also demonstrated relatively high brain penetration in the rat compared with the clinically available compounds, which may ultimately prove beneficial in the treatment of pain.

Diverting loop colostomy for the treatment of refractory gastrointestinal bleeding secondary to radiation proctitis

Chronic radiation proctitis is an uncommon and serious complication of radiotherapy for pelvic malignancies. It has been suggested that fecal stream diversion decreases bowel irritation, resulting in decreased rectal bleeding. We report on the outcome of patients after a diverting loop colostomy for the treatment of severe radiation proctitis. All consecutive patients with chronic proctitis treated with diverting loop colostomy for bleeding at one institution between October 1991 and June 1999 were studied. Four patients presented with rectal bleeding and diarrhea, and two patients had only bleeding. The mean dose of radiation received was 6,115.11 +/- 955.11 rad. Symptoms of chronic proctitis appeared at varying intervals of time after radiation, ranging from 14 months to 17 years. There were no operative complications. During follow-up (36 +/- 29 months), only one of nine patient continued to bleed. Four patients died during the study (cancer relapse, two patients; heart failure, one patient; one death was caused by severe radiation proctitis). Diverting sigmoid loop colostomy, when performed in properly selected patients with severe bleeding secondary to radiation proctitis refractory to medical management, is well tolerated and effective.

Aesthetic aspects of neurofibromatosis reconstruction with the vacuum-assisted closure system

Everyone agrees that any reconstructive procedure should carry with it the maximum of aesthetic considerations in order that the reconstructive procedure presents the minimal deformities. Vacuum-assisted closure-(VAC) has allowed surgeons to achieve this goal by creating the most optimal conditions for proper wound healing and thus the best aesthetic results. We present a tragic case whereby a 28-year-old Hispanic male patient with neurofibromatosis was treated for a soccer ball-sized tumor located on his upper left leg. The treatment plan consisted of partial excision with local flap coverage of the wound; however, due to persistent bleeding and tumor growth within the flap, the flap did not survive and we were left with an open wound measuring 20 x 40 cm extending from the patient's upper knee to his iliac crest. Had we attempted an autograft procedure at this time, there would scarcely have been enough donor skin areas to cover the wound. VAC was implemented in an attempt to control the bleeding and to possibly decrease the size of the wound. With the application of this procedure, the previously uncontrollable bleeding (12 units) stopped immediately, and the wound size shrank to 1/2 of its original dimensions. As a result, the area for skin grafting was decreased and was completed with 100% take. The VAC system turned out to be advantageous in achieving the most optimal conditions for our patient's wound to close and heal properly, allowing for enhancement of the aesthetic considerations for the patient.

Training background as a factor in the conversion rate of laparoscopic cholecystectomy

The present study reports findings concerning the impact of the learning environment on the conversion rate of laparoscopic cholecystectomy (LC) to open cholecystectomy (OC). At Metro-West Medical Center (Framingham, MA) seven surgeons performed 866 LCs between 1990 and 1995. Group I consisted of three surgeons who learned the procedure as part of their General Surgery Residency training, whereas the remaining four surgeons representing Group II learned the procedure through private courses. We emphasize the importance of the surgeons' training background on the conversion rates, operative times, and length of hospitalization for patients undergoing LC. The conversion rates, operative times, and complication rates were analyzed with and without a 2-year period of adjustment to compensate for the learning curve of early procedures. Operative times and conversion rates from LC to OC were lower for cases done by surgeons from Group I, even when the learning curve was corrected. The complication rates were higher for surgeons in Group II, but this did not reach statistical significance. As surgeons from Group II gained more experience their operation times and conversion rates decreased. However, there still was a statistically significant difference in favor of surgeons who learned the procedure as part of a structured curriculum. These data suggest a long-lasting influence of the learning environment on the conversion rates and operative times.

Evaluation of polyethylene terephthalate for ABO and Rh typing and alloantibody screening

BACKGROUND

For many years, hospitals and laboratories have used evacuated glass tubes for blood collection. To improve the safety of blood collection, plastic polyethylene terephthalate (PET) tubes (Vacutainer PLUS, Becton Dickinson) have been developed. The objectives of this study were to compare the accuracy of ABO grouping, Rh typing, and antibody screening of blood samples collected in plastic tubes with that in glass tubes and to determine if refrigerated blood samples collected in plastic tubes remained stable over a 28-day period.

STUDY DESIGN AND METHODS

Samples were collected from 121 volunteers, at least 30 from each of the A, B, O, and AB blood groups, in four types of Vacutainer tubes: silica-coated plastic, K(2) EDTA plastic, uncoated glass, and K(2) EDTA glass. Samples from each tube were tested for ABO group and Rh type by use of the microtyping gel identification card system and the tube method. A three-cell antibody screen was performed by the microtyping gel card technique with a monospecific IgG reagent. Initial samples were tested within 3 hours of collection. Refrigerated samples were retested for ABO and Rh type and antibody screening 1, 2, 21, and 28 days later. Agreement between test results was determined by using Cohen's Kappa statistic.

RESULTS

Complete agreement was observed between the ABO and Rh typing results in samples drawn into glass and plastic tubes of both the EDTA and nonanticoagulated type (kappa = 1.0). In retesting, there were no examples of a change in ABO or Rh type over the 28-day study period. Only two alloantibodies (1.7%) were identified in the 121 samples, and no difference was observed in alloantibody expression in either plastic or glass Vacutainer tubes over the 28-day study period.

CONCLUSION

Samples collected into the PET serum or EDTA tubes provided accurate ABO and Rh typing results that remained consistent over a 28-day period. Samples collected in these tubes also appeared to enable accurate alloantibody identification. However, the number of alloantibodies identified in this study was small, and this result should be confirmed in a larger series.

Effects of age and diet on the viscosity of intestinal contents in broiler chicks

1. A standard methodology was developed for the determination of the viscosity of digesta in broiler chickens. 2. The best variables considered for use (those which gave the most consistent results) were: digesta obtained from the foregut area (defined as the region from the pancreas to Meckel's diverticulum) using a minimum of 6 replicates and offering experimental diets for 5 d before slaughter at 25 d of age. 3. There was evidence that the viscosity of digesta obtained from the hindgut (defined as the region between Meckel's diverticulum and the ileo-caecal junction) was reduced the longer the birds were fed on one diet, suggesting possible dietary acclimatisation. Hindgut digesta viscosity from birds fed on a barley-based diet over a longer period was 10% to 30% less than that of birds fed for 5 d. 4. There was an apparent reduction in viscosity with age of bird up to 45 d of age, with hindgut digesta viscosity from birds fed on barley-based diets falling from 20.6 cps at 25 d to 9.8 cps at 45 d. 5. In an assessment of the procedure developed, the following digesta viscosities were obtained at 25 d: 3.1 cps (wheat-based diet, foregut), 19.8 cps (barley-based diet, foregut), 5.7 cps (wheat-based diet, hindgut), 22.8 cps (barley-based diet, hindgut).