Epidemiological insights into the burden of feline upper respiratory tract infections in Queensland RSPCA shelters

INTRODUCTION

Feline upper respiratory tract infection (FURTI) is a severe problem in animal shelters where there is high turnover of populations and compromised immunity. This retrospective cohort study explores associations of potential animal-based and environmental-based factors with the risk of FURTI, where a previously modelled infection classification is used as the outcome of interest. The study type is a retrospective cohort and the measures of association include Odds Ratios and conditional predictions.

OBJECTIVES

To gain epidemiological insights into variation in FURTI using retrospective data from one of Australia's leading animal shelters.

METHODS

We stratified FURTI by admission and environmental variables. Predicted infection status, obtained using a machine-learning classifier trained on clinical text (accuracy 0.95 [CI 0.92, 0.97]), was used as the outcome of interest. Prior assumptions were represented by a causal framework or a direct acyclic graph (DAG), which informed creation of multiple Bernoulli models with an observational and prior component.

RESULTS

We analysed 43,431 feline entries over 8 years. Males were 1.24 (95% CI 1.19 to 1.31) times more likely than females to be classified as positive, while already desexed animals were only 0.68 (95% CI 0.60 to 0.72) as likely to be classified as positive compared to those not desexed on entry. Cats (>4 months) were twice as likely (95% CI 1.91 to 2.09) as kittens (0-4 months) to be classified positive. Animals entering the shelter as seized by the inspectorate (n = 415) were more likely to be classified positive compared to animals from other sources. Predicted infection probability increased in winter and showed a linear pattern with how full the shelter was.

CONCLUSION

This study estimates the association between animal and environmental variables of interest and FURTI classification status, thus better interpreting the distribution of disease as predicted by a previously uninterpretable model. This analysis gives much needed insight into the types of changes in an animal's environment that can impact final animal outcomes.

Using a gradient boosted model for case ascertainment from free-text veterinary records

Case ascertainment for prevalence and incidence studies from veterinary clinical data poses a major challenge because medical notes are not consistently structured or complete. Using natural language processing (NLP) and machine learning, this study aimed to obtain accurate case recognition for feline upper respiratory tract infections (primarily caused by viruses such as feline herpes virus (FHV-1) and feline calici virus (FCV), and bacteria such as Chlamydophila felis, Mycoplasma felis and Bordetella bronchiseptica using retrospective electronic veterinary records from the Royal Society for Prevention of Cruelty to Animals, Queensland (RSPCA Qld). Data cleaning and NLP on eight years of free-text veterinary records from RSPCA Queensland was carried out to derive text-based predictors. The NLP steps included sorting records by length of stay, vectorising, tokenising and spell checking against a bespoke veterinary database. A gradient boosted model (GBM) was trained to predict the probability of each animal having a diagnosis of upper respiratory infection. A manually annotated dataset was used for training the algorithm to learn dominant patterns between predictors (frequencies of n-grams) and responses (manual binary case classification). The GBM's performance was tested against an out of sample validation dataset, and model agnostics were used to interrogate the model's learning process. The GBM used patient-level frequencies of 1250 unique n-grams as predictor variables and was able to predict the probability of cases in the validation dataset with an accuracy of 0.95 (95% CI 0.92, 0.97) and F1 score of 0.96. Predictors that exerted the highest influence on the model included frequencies of "doxycycline", "flu", "sneezing", "doxybrom" and "ocular". The trained GBM was deployed on the full dataset spanning eight years, comprising 60,258 clinical entries. The prevalence in the full dataset was predicted to be 23.59%, which is in line with domain expertise from practicing veterinarians at the shelter. Case ascertainment is a crucial step for further epidemiological study of cat flu. Ultimately, this tool can be extended to other clinical procedures, conditions, and diseases such as intensive care treatment due to snake bites and tick paralysis, physical injuries such as orthopaedic fractures or chest injuries and labour-intensive infectious diseases like parvovirus, canine cough, and ringworm, all of which require prolonged quarantine and care.

Mechanical biofilm disruption causes microbial and immunological shifts in periodontitis patients

Periodontitis is characterized by subgingival biofilm dysbiosis, inflammation and tissue destruction. Current treatment involves mechanical biofilm disruption known as non-surgical periodontal therapy (NSPT). This study sought to characterise the impact of treatment on microbial diversity and overall community, and the parallel impact on host inflammation in the oral cavity. Fourty-two periodontitis patients were included in this study, with periodontal clinical parameters, subgingival plaque and saliva samples collected at baseline and 90 days after treatment. Salivary cytokines were quantified, and subgingival plaque was analysed using 16S rRNA sequencing. After treatment, there were marked health-associated alterations in microbial composition and diversity, including differential abundance of 42 genera and 61 species. These changes were accompanied by substantial clinical improvement (pockets ≥ 5 mm, 27.50% to 9.00%, p < 0.001) and a decrease in salivary IL-1β (p < 0.001)-a putative marker of periodontal inflammation. Despite significant reductions in disease associated anaerobes, several genera (Fusobacterium, Prevotella, Tanenerella, Treponema) remained present and formed a distinct subnetwork associated with residual disease. Collectively, this study shows that current periodontal treatment results in partial restoration of a healthy microbial ecosystem, but features of biofilm dysbiosis and host inflammation remain in some patients, which were surprisingly independent of clinical response.

Understanding the Relationship between Intention and Cat Containment Behaviour: A Case Study of Kitten and Cat Adopters from RSPCA Queensland

In Australia, cat owners are encouraged to keep their pet cats contained on their property at all times. This study explores the relationship between the intentions and behaviours of 72 kitten and cat adopters from a RSPCA Queensland animal shelter, to provide a more in-depth understanding of the factors influencing the adoption of cat containment behaviours. At the time of adoption, 64 participants (89%) indicated they were intending to keep their cat fully contained. Eight weeks after adoption, 63 participants (87%) reported they were doing so (59 who had stated their intention at the time of adoption, and 4 who had not). We found cat owner containment behaviour was moderately correlated with containment intentions. For some of the participants when it came to enacting this behaviour, their intentions and the provided education information was not enough to overcome the more compelling capability, opportunity and motivational factors which presented themselves once they got home. We were able to identify these factors and suggest additional behaviour change strategies that would assist. Although it is important to provide cat adopters with advice about how to contain their cats properly, these results also highlight the importance of focusing attention on other behaviour change strategies that address the particular barriers faced by some cat-owners who are unsuccessful in keeping their cat contained on their property.

Breast cancer and cytomegalovirus

PURPOSE

To determine whether cytomegalovirus is causally associated with breast cancer and whether cytomegalovirus should be categorised as an oncogenic virus.

METHODS

We undertook a review of published epidemiological and laboratory studies, using established causal criteria: Bradford Hill criteria to determine whether cytomegalovirus is associated with breast cancer; and Evans/Mueller criteria to determine whether cytomegalovirus should be categorised as an oncogenic virus.

RESULTS

Although there are inconsistencies in the findings of published epidemiological and laboratory studies, these may be explained by factors such as: differences in timing of blood samples, differences in selection of cases and controls, or high cytomegalovirus seroprevalence among participants in the epidemiological studies; and, in the laboratory studies, differences in sample preparations, age of sample, whether or not paired breast cancer and normal breast tissue samples were used, differences in the tests, primers and/or antibodies used, differences in histological types of breast cancer studied, and/or features of the virus.

CONCLUSIONS

Overall, the results of published studies of cytomegalovirus and breast cancer suggest cytomegalovirus is a causal factor for at least some types of breast cancer. If the evidence for a link between cytomegalovirus and breast cancer continues to strengthen, further research could lead to: targeted screening; therapy using antiviral drugs; and, perhaps, primary prevention of a significant proportion of breast cancer. Vaccination against viruses has already been shown to be effective in preventing cervix and liver cancer; cytomegalovirus vaccines are already under development.

Characteristics and Outcomes of Dogs Admitted into Queensland RSPCA Shelters

Simple Summary

An up-to-date and comprehensive understanding of the characteristics and outcomes of dogs entering shelters is required for implementing targeted strategies to reduce euthanasia of healthy and treatable dogs in Australia. Currently, there are few up-to-date Australian data published on dogs entering shelters, and their outcomes. Of dogs entering the Royal Society for Prevention of Cruelty to Animals, Queensland shelters in 2014, the majority (58%) were strays and 26% were puppies. Only 18% of dogs >6 months were desexed. Most dogs were reclaimed (32%) or adopted (43%). Strategies targeted to locations and breeds overrepresented by admissions are required to reduce shelter admissions, particularly of strays and unwanted litters.

Abstract

Over 200,000 stray and surrendered dogs are admitted to shelters and municipal facilities in Australia each year, and approximately 20% are euthanized. Contemporary, comprehensive data on the characteristics and outcomes of dogs entering shelters are required to reduce shelter admissions and euthanasia. However, there are currently limited up-to-date data published on dog admission into shelters. A retrospective single cohort study was conducted to describe the characteristics and outcomes of the dog population entering Royal Society for Prevention of Cruelty to Animals, Queensland (RSPCA-QLD) shelters in 2014 (n = 11,967). The majority of dog admissions were strays from the public (24%) or from municipal councils (34%). Just over a quarter of admissions were puppies, 18% of adults (>6 months) were desexed, and the majority of admissions were crossbred dogs (92%). The majority of owner surrenders (86%) were due to human-related reasons. Most dogs were reclaimed (32%) or adopted (43%) and aggression was the most common reason for euthanasia of adult dogs (45%). Low-cost or free desexing and identification programs targeted to areas and breeds contributing to high intake, and increased support services for owners at risk of surrendering their dog, should be trialed to determine their cost effectiveness in reducing shelter admissions and euthanasia.

Ultrasound as a Visual Feedback Aid for the Hearing-Impaired

Ultrasound was explored as a visual feedback aid to assist in improving the speech of the deaf and hard of hearing. A mechanical sector real-time scanner produced images of the volunteer's tongue while a speech pathologist provided therapeutic intervention. Pre and postarticulation tests were administered to evaluate change in speech.

Ultrasound as a visual feedback aid may be potentially useful for improving articulation problems for some hearing-impaired speakers. Further research with this population needs to be carried out to explore the practicality of using ultrasound as a visual feedback aid and to gather quantitative data on the long-term effects of learning.

This study has demonstrated that typical real-time sector ultrasound scanners, of the type found in the field today, can be modified to produce useful images of the human tongue during speech production. It is yet unknown what specific type of scanner as well as frequency range is best suited for tongue placement imaging.

Predicting Outcome in Patients with Acute Coronary Syndrome: Evaluation of B-Type Natriuretic Peptide and the Global Registry of Acute Coronary Events (GRACE) Risk Score

Background

Accurate risk stratification soon after admission for patients with acute coronary syndromes (ACS) is vital in guiding management. Clinical risk scores and B-type natriuretic peptide (BNP) can predict mortality and re-infarction in ACS, but it is unknown whether BNP provides prognostic information over and above that of the clinical risk scores.

Methods

142 unselected patients with ACS were prospectively studied. BNP was measured and patients were stratified according to BNP and Global Registry of Acute Coronary Events (GRACE) score. In-hospital and 30-day events were characterised.

Results

20.4% of ACS subjects had ST-elevation myocardial infarction (MI), 14.1%, non-ST elevation MI and 65.5% unstable angina. Elevated BNP predicted inhospital and 30-day heart failure (p<0.01), and the risk of in-hospital recurrent ACS (p<0.05). Increasing GRACE score predicted in-hospital recurrent ACS (p<0.05), heart failure (p<0.001), arrhythmias (p<0.05) and angioplasty (p<0.05). GRACE score also predicted 30-day heart failure (p<0.05). In contrast, the predictive accuracy of troponin elevation was less robust.

Conclusion

BNP and the GRACE score predict complementary outcomes from ACS, but both predicted heart failure. BNP is a powerful indicator of heart failure in patients with ACS and provides prognostic information above and beyond conventional biomarkers and risk scores.

Reasons People Surrender Unowned and Owned Cats to Australian Animal Shelters and Barriers to Assuming Ownership of Unowned Cats

Most cats surrendered to nonhuman animal shelters are identified as unowned, and the surrender reason for these cats is usually simply recorded as "stray." A cross-sectional study was conducted with people surrendering cats to 4 Australian animal shelters. Surrenderers of unowned cats commonly gave surrender reasons relating to concern for the cat and his/her welfare. Seventeen percent of noncaregivers had considered adopting the cat. Barriers to assuming ownership most commonly related to responsible ownership concerns. Unwanted kittens commonly contributed to the decision to surrender for both caregivers and noncaregivers. Nonowners gave more surrender reasons than owners, although many owners also gave multiple surrender reasons. These findings highlight the multifactorial nature of the decision-making process leading to surrender and demonstrate that recording only one reason for surrender does not capture the complexity of the surrender decision. Collecting information about multiple reasons for surrender, particularly reasons for surrender of unowned cats and barriers to assuming ownership, could help to develop strategies to reduce the number of cats surrendered.

Numbers and Characteristics of Cats Admitted to Royal Society for the Prevention of Cruelty to Animals (RSPCA) Shelters in Australia and Reasons for Surrender

Despite high numbers of cats admitted to animal shelters annually, there is surprisingly little information available about the characteristics of these cats. In this study, we examined 195,387 admissions to 33 Australian RSPCA shelters and six friends of the RSPCA groups from July 2006 to June 2010. The aims of this study were to describe the numbers and characteristics of cats entering Australian RSPCA shelters, and to describe reasons for cat surrender. Data collected included shelter, state, admission source, age, gender, date of arrival, color, breed, reproductive status (sterilized or not prior to admission), feral status and surrender reason (if applicable). Most admissions were presented by members of the general public, as either stray animals or owner-surrenders, and more kittens were admitted than adults. Owner-related reasons were most commonly given for surrendering a cat to a shelter. The most frequently cited owner-related reason was accommodation (i.e., cats were not allowed). Importantly, although the percentage of admissions where the cat was previously sterilized (36%) was the highest of any shelter study reported to date, this was still lower than expected, particularly among owner-surrendered cats (47%). The percentage of admissions where the cat was previously sterilized was low even in jurisdictions that require mandatory sterilization.

Innate recognition of apoptotic cells: novel apoptotic cell-associated molecular patterns revealed by crossreactivity of anti-LPS antibodies

Cells dying by apoptosis are normally cleared by phagocytes through mechanisms that can suppress inflammation and immunity. Molecules of the innate immune system, the pattern recognition receptors (PRRs), are able to interact not only with conserved structures on microbes (pathogen-associated molecular patterns, PAMPs) but also with ligands displayed by apoptotic cells. We reasoned that PRRs might therefore interact with structures on apoptotic cells - apoptotic cell-associated molecular patterns (ACAMPs) - that are analogous to PAMPs. Here we show that certain monoclonal antibodies raised against the prototypic PAMP, lipopolysaccharide (LPS), can crossreact with apoptotic cells. We demonstrate that one such antibody interacts with a constitutively expressed intracellular protein, laminin-binding protein, which translocates to the cell surface during apoptosis and can interact with cells expressing the prototypic PRR, mCD14 as well as with CD14-negative cells. Anti-LPS cross reactive epitopes on apoptotic cells colocalised with annexin V- and C1q-binding sites on vesicular regions of apoptotic cell surfaces and were released associated with apoptotic cell-derived microvesicles (MVs). These results confirm that apoptotic cells and microbes can interact with the immune system through common elements and suggest that anti-PAMP antibodies could be used strategically to characterise novel ACAMPs associated not only with apoptotic cells but also with derived MVs.

False-Name Manipulations in Weighted Voting Games

Weighted voting is a classic model of cooperation among agents in decision-making domains. In such games, each player has a weight, and a coalition of players wins the game if its total weight meets or exceeds a given quota. A player's power in such games is usually not directly proportional to his weight, and is measured by a power index, the most prominent among which are the Shapley-Shubik index and the Banzhaf index.In this paper, we investigate by how much a player can change his power, as measured by the Shapley-Shubik index or the Banzhaf index, by means of a false-name manipulation, i.e., splitting his weight among two or more identities. For both indices, we provide upper and lower bounds on the effect of weight-splitting. We then show that checking whether a beneficial split exists is NP-hard, and discuss efficient algorithms for restricted cases of this problem, as well as randomized algorithms for the general case. We also provide an experimental evaluation of these algorithms. Finally, we examine related forms of manipulative behavior, such as annexation, where a player subsumes other players, or merging, where several players unite into one. We characterize the computational complexity of such manipulations and provide limits on their effects. For the Banzhaf index, we describe a new paradox, which we term the Annexation Non-monotonicity Paradox.

Ectopic lymphoid tissue formation in the lungs of mice infected with Chlamydia pneumoniae is associated with epithelial macrophage inflammatory protein-2/CXCL2 expression

Infection with Chlamydia pneumoniae (Cp) accounts for around 10% of community acquired bacterial pneumonia and has been associated with other chronic inflammatory conditions. We describe a C57/Bl6 murine model of Cp lung infection characterized by a dose-dependent, resolving neutrophilia followed by lymphocytic infiltration of the lungs. By 21 days post-infection, mice exhibit a T helper type 1 (Th1) polarized serum antibody response with local mucosal antibody secretion and organization of ectopic lymphoid tissue which persisted in the absence of detectable Cp DNA. Macrophage inflammatory protein (MIP)-2/CXCL2, which recruits neutrophils and lymphocytes and is associated with ectopic lymphoid tissue formation, was secreted in the lungs post-infection. In vitro, lung epithelial cells up-regulated MIP-2/CXCL2 in response to both rough lipopolysaccharide (reLPS) and Cp infection. We conclude that Cp infection can have long-term inflammatory effects on tissue that persist after clearance of active infection.

Intra-testicular injection of adenoviral constructs results in Sertoli cell-specific gene expression and disruption of the seminiferous epithelium

Spermatogenesis is a complex process that cannot be modelled in vitro. The somatic Sertoli cells (SCs) within the seminiferous tubules perform a key role in supporting maturation of germ cells (GCs). Progress has been made in determining what aspects of SC function are critical to maintenance of fertility by developing rodent models based on the Cre/LoxP system; however, this is time-consuming and is only applicable to mice. The aim of the present study was to establish methods for direct injection of adenoviral vectors containing shRNA constructs into the testis as a way of inducing target-selective knock-down in vivo. We describe here a series of experiments using adenovirus expressing a green fluorescent protein (GFP) transgene. Injection via the efferent ductules resulted in SC-specific expression of GFP; expression levels paralleled the amount of infective viral particles injected. At the highest doses of virus seminiferous tubule architecture were grossly disturbed and immune cell invasion noted. At lower concentrations, the expression of GFP was variable/negligible, the seminiferous tubule lumen was maintained but stage-dependent GC loss and development of numerous basal vacuoles was observed. These resembled intercellular dilations of SC junctional complexes previously described in rats and may be a consequence of disturbances in SC function due to interaction of the viral particles with the coxsackie/adenovirus receptor that is a component of the junctional complexes within the blood testis barrier. In conclusion, intra-testicular injection of adenoviral vectors disturbs SC function in vivo and future work will therefore focus on the use of lentiviral delivery systems.

Oriented immobilisation of engineered single-chain antibodies to develop biosensors for virus detection

Single chain variable fragment (scFv) molecules were selected from a synthetic phage display library then cloned into a generic vector for expression of the scFv fused to the light chain constant domain of human immunoglobulin with a C-terminal cysteine residue (scFvC(L)cys). A heterobifunctional maleimide linker was synthesised and a strategy for functionalization of gold with the scFvC(L)cys fusion proteins elaborated. Successful covalent attachment of functional scFvC(L)cys was demonstrated using a surface plasmon resonance-based sensor. The results showed that the immobilised scFvC(L)cys molecules were functional and specific binding curves (with response relative to the concentration of virus antigen) were obtained over more than 25 cycles of binding and dissociation. ScFv molecules lacking the C-terminal cysteine performed poorly in similar experiments. The work demonstrates the feasibility of using simple scFv selection and cloning procedures combined with oriented immobilisation of scFvC(L)cys fusion proteins for robust antigen sensing surfaces in immunosensor or other biotechnological applications.

Attitudes toward integration of complementary and alternative medicine with hospital-based care

OBJECTIVE

To characterize those who have used, expect to use, or are opposed to the use of holistic therapies, especially in a conventional medical (hospital) setting. SAMPLE DESCRIPTION AND METHODS: Cross-sectional survey of a random sample of Hamilton-Wentworth residents between March and June 1998 (n = 416; response rate, 63%); analysis used logistic regression.

RESULTS

Thirty-seven percent (37%) used at least one holistic therapy in the previous year: the three most common were chiropractic, massage, and herbal/phytology. The three most common reasons for use were general health, fatigue, and arthritis. Thirty-three percent (33%) would use holistic therapy in the future. Barriers to use were lack of information, perceived ineffectiveness, and cost; approximately 40% agreed they would only use holistic therapies with medical advice. Approximately 13% were opposed to holistic therapy and objected to its use in hospitals. Younger age, preference for holistic therapy over conventional medicine, and prior use of holism independently predicted high likelihood for future use. Lower income and high self-perceived health were associated with negative attitude toward use of holistic therapies in hospital.

CONCLUSION

Most respondents would accept integration of holistic techniques into a hospital; therapies would be more acceptable if there were clear evidence of their efficacy. A few might find their opinion of a sponsoring hospital lowered by such integration.

Carbon dioxide transport by proteic and facilitated transport membranes

Membrane separation of gases is governed by the permeability of each species across the membrane. The ratio of permeabilities yields the selectivity. Use of certain organic carriers in facilitated transport membranes and the CO2 converting enzyme carbonic anhydrase (CA) in proteic and facilitated transport membranes allows a dramatic increase in CO2 selectivity over other gases. CA has a low Km (9 mM), which we predicted would allow it to scavenge CO2 to very low partial pressures. Our goal was to determine if CA could remove CO2 from an environment at levels of 0.1% or less. Prior measurements of CO2 transport across thin supported liquid membranes showed that addition of CA enhanced CO2 flux by 3- to 100-fold. Proteic films use bifunctional reagents (e.g., glutaraldehyde) to cross-link the enzyme forming a gel. Bovine serum albumin (BSA) is often added for structural stability. Using such a preparation we examined the ability of proteic films to improve CO2 selectivity and to scavenge CO2 from a mixed gas stream. Proof-of-concept results, measured by mass spectrometry, showed a fivefold improvement in CO2 capture rate with maximal improvement at CO2 values of 1% partial pressure difference in the presence of 0 atm absolute difference. At 0.1% CO2 the membrane exhibited a 76% improvement over controls. At 0.3% CO2 the improvement is about threefold. CA proteic membranes exhibit selectivity for CO2 over oxygen and nitrogen in excess of three orders of magnitude. A CA-based proteic or facilitated transport membrane should readily achieve CO2 partial pressures of 0.05% under CELSS conditions. In addition to proteic membranes we are exploring direct immobilization of engineered CA to ultra-high-permeability teflon membranes. Site-directed mutagenesis was used to add functional groups while retaining full enzymatic activity. These results provide a basis for development of far more efficient CO2 capture proteic and facilitated transport membranes with increased selectivity to values closer to 100-fold at 1% CO2. The result will be CO2 selectivity at 0.1% on the order of 400-fold. These results exceed those obtained with other technologies.

Selection of HCV NS5A quasispecies during IFN therapy in patients with chronic HCV

Interferon treatment of chronic hepatitis C virus infection is successful in a minority of patients. The sequence of the interferon sensitivity determining region (ISDR) of the NS5A protein may determine the outcome of therapy in patients infected with HCV genotype 1. To determine whether IFN treatment caused selection of ISDR quasispecies and whether sequences bearing the putative IFN-resistance motif (HCV-J sequence) were selected, we examined amino acid changes in the ISDR in patients with HCV of different genotypes with and without therapy. We found that the ISDR sequence was highly variable and variability was greatest in patients with HCV of genotype 1. IFN treatment was found to exert a selection pressure on ISDR quasispecies, but the putative interferon-resistant variant was not enriched in patients of any genotype. Hence factors other than the sequence of the ISDR region played a role in the IFN resistance of these patients.

A novel deletion mutation within the carboxyl terminus of the copper-transporting ATPase gene causes Wilson disease

In patients with Wilson disease (WD), an autosomal recessive disorder, toxic accumulation of copper results in fatal liver disease and irreversible neuronal degeneration. ATP7B, the gene mutated in WD, contains 21 exons and encodes a copper-transporting ATPase. In this study, all exons of the ATP7B gene of nine WD patients were screened for alterations by conventional mutation detection enhancement (MDE) heteroduplex analysis, followed by direct sequencing of the regions that showed heteroduplex formation. For the first time, a novel deletion mutation (4193delC) in exon 21, causing a frameshift leading to premature truncation of the protein was detected in four of nine patients. The 4193delC removes several signals within the carboxyl terminal domain that may disrupt trafficking of ATP7B protein through trans-Golgi network at the cellular level.

A randomised controlled trial of the caries-preventive efficacy of a chlorhexidine-containing varnish in high-caries-risk adolescents

A professionally applied two-stage chlorhexidine varnish, Chlorzoin((R)), was developed to achieve sustained release and minimise the problems of staining and bad taste associated with chlorhexidine mouthrinses. The primary aim of this randomised controlled clinical trial was to assess the efficacy of Chlorzoin in reducing the caries increment in high-caries-risk adolescents. Secondary aims included investigating the effect of compliance upon caries increment, the effect of Chlorzoin upon salivary mutans streptococci levels and assessing the benefit of individual dental health advice by dental auxiliaries in a community setting. 1,240 children, initially aged 11-13 years, assessed to be at high caries risk were recruited into the trial. The trial design involved four arms: an observational group, a control group, an active (Chlorzoin) varnish group and a placebo varnish group. All subjects were examined annually by a calibrated examiner who was blind to the group allocation. Three-year caries increments were calculated using clinical, clinical and fibre-optic transillumination, and clinical and bitewing data sets. The results indicated that the use of Chlorzoin had an initial effect on mutans streptococci levels but that no long-term reduction in caries increment or mutans streptococci infection could be detected. One reason for this lack of efficacy may have been the regimen of reduced frequency of varnish applications after the initial period. Children who followed the protocol and, therefore, were seen regularly by dental auxiliaries had a lower caries increment than those who did not. This finding was independent of varnish allocation. In summary, under this regimen, Chlorzoin has been found to be effective in decreasing salivary mutans streptococci but ineffective as a caries-preventive agent in high-risk Scottish children when applied pragmatically in a community setting.

Immunocontraception with zona pellucida proteins

The prospect of an immunological approach to contraception that would disrupt the process of fertilisation itself has resulted in a considerable interest into research in this area. It has been known for some time that antibodies raised against the zona pellucida (ZP) can suppress fertility very effectively. However, the initial optimism of this approach has been marred by the appearance of an ovarian pathology characterised by disruption of folliculogenesis and depletion of the primordial follicle pool. Adverse auto-immune reactions have been observed in the ovaries of mice after the induction of immunity with mouse ZP3 epitopes. However, this was associated with lymphocytic infiltration of the ovarian stroma, which could be circumvented by careful selection of B-cell epitopes to induce reversible infertility. In order to identify similar epitopes on primate ZP3, epitope-mapping studies were performed and incorporated into chimeric vaccines that included a promiscuous T-helper cell epitope. Both single and triple peptide vaccines have been evaluated in vivo and no detrimental effects on ovarian function were observed. The resulting high titre antibodies bound exclusively to the ZP of marmoset and human ovarian sections and could suppress in vitro human sperm-egg binding by approximately 60%, but did not prevent pregnancy in actively immunised female marmosets. Thus, considerable research is still required to identify a combination of ZP3 epitopes that will induce infertility free of any unwanted side effects.

Validity and community utility of the Canadian Occupational Performance Measure

This study addressed the validity and community utility of the Canadian Occupational Performance Measure (COPM) (Law et al., 1991; 1994; 1998): a measure that now represents a national standard in clinical practice and research in occupational therapy in Canada. The study employed a crossectional design. Participants for the study were former consumers of occupational therapy services, recruited from the Queen's University catchment area (Kingston, North Bay, Oshawa, Perth, Peterborough). A sample of 61 disabled individuals living in the community were recruited. Each individual was sent a package of self-administered measures including the Satisfaction with Performance Scaled Questionnaire, the Reintegration to Normal Living Index, the Life Satisfaction Questionnaire, and the Perceived Problems List. An interview was also arranged with the project coordinator, which was based on the COPM and the Consumer Utility Questionnaire. Multivariate analyses showed that construct validity was supported; scores on the COPM were significantly related to theoretically related constructs: satisfaction with performance, reintegration to normal living and life satisfaction. In addition, criterion validity was supported. A majority of participants (53%), when asked about problems of daily living, spontaneously reported at least one of the problems raised on the COPM. Community utility was evaluated highly by participants, 75% of whom found the COPM useful in identifying and rating their problems, and 100% of whom reported no problems in understanding the COPM.

Hepatitis C virus NS5A protein inhibits interferon antiviral activity, but the effects do not correlate with clinical response

BACKGROUND & AIMS

Patients with chronic hepatitis C virus infection are commonly treated with interferon alfa (IFN-alpha), but the long-term response rate is poor. A region of NS5A of hepatitis C virus genotype 1 (the ISDR) has been associated with treatment outcome in some patients. NS5A binds to and inhibits PKR in vitro and inhibits IFN-alpha in human cells. We examined the effects of the NS5A protein from patients who did or did not respond to IFN-alpha to determine whether NS5A from IFN-alpha nonresponders inhibited the effects of IFN-alpha in vitro.

METHODS

We cloned NS5A from patients who had well-characterized responses to IFN-alpha and expressed them in a human fibroblast cell line under the control of an inducible promoter. The NS5A expression levels were controlled, and the effects of different proteins on the protective actions of IFN-alpha against encephalomyocarditis virus were investigated.

RESULTS

NS5A expression blocked the antiviral effects of IFN-alpha in human cells. This inhibition was dependent on the level of NS5A expression. Although ISDR changes gave only small differences in IFN-alpha inhibition, clones derived from a patient who did not respond to IFN-alpha and one who did respond to treatment differed greatly: the clones from a patient with response to IFN-alpha were much more inhibitory than those derived from the patient with no response.

CONCLUSIONS

The inhibition of the antiviral effects of IFN-alpha by NS5A is not regulated exclusively by the ISDR, and the effects of NS5A in vitro do not correlate with treatment outcomes.

Improving the quality of decision-making in health care management: a project report from the Nevada/Bohemia health management education partnership

Health care is a data-sensitive and data-rich industry. Designers of health administration curricula recognize that future health care providers and managers must be trained to use available analytical and database information technology (IT) to transform these data into information helpful to the decision-maker. However, as the data available to administrators and clinicians proliferates, additional skills are needed to select data that is pertinent and useful. This paper presents the results of the collaboration of partners from Bohemia and University of Nevada and focuses on three areas: threats to the effective use of data to support health care decision-making;. health care decision support research and training strategies; future cross-disciplinary collaboration in health care decision support. Advanced IT methods have the potential to assist clinical and managerial decision-making. If further discussion is stimulated about the introduction of advanced IT methods into the health care management curriculum and research agenda, this paper will achieve its goal.

The significance of Erb-b2 immunostaining in cervical cancer

OBJECTIVE

The aim of this study was to assess the relationship between survival and erb-b2 immunohistochemical staining in patients with early stage cervical carcinoma.

METHODS

Archival specimens for 126 patients with stage IB/IIA cervical carcinoma treated with radical hysterectomy and bilateral pelvic node dissection (RH-BPND) were retrieved and submitted to immunohistochemistry for ERBB2 expression. The association between positive results and poor survival was assessed in a multivariate analysis.

RESULTS

Erb-b2 immunostaining was significantly associated with poor survival (P = 0.0284) but less so than parametrial extension (P = 0.0014) and nodal disease (P = 0.0106). Tumor type (squamous/adenosquamous/adenocarcinoma) and the status of surgical margins were not significantly associated with survival.

CONCLUSIONS

These results supported further investigations of ERBB2 expression as a marker of high-risk disease in patients treated with RH-BPND.

In the queue for coronary artery bypass grafting: patients' perceptions of risk and 'maximal acceptable waiting time'

OBJECTIVES

To elicit patients' maximal acceptable waiting times (MAWT) for non-urgent coronary artery bypass grafting (CABG), and to determine if MAWT is related to prior expectations of waiting times, symptom burden, expected relief, or perceived risks of myocardial infarction while waiting.

METHODS

Seventy-two patients on an elective CABG waiting list chose between two hypothetical but plausible options: a 1-month wait with 2% risk of surgical mortality, and a 6-month wait with 1% risk of surgical mortality. Waiting time in the 6-month option was varied up if respondents chose the 6-month/lower risk option, and down if they chose the 1-month/higher risk option, until the MAWT switch point was reached. Patients also reported their expected waiting time, perceived risks of myocardial infarction while waiting, current function, expected functional improvement and the value of that improvement.

RESULTS

Only 17 (24%) patients chose the 6-month/1% risk option, while 55 (76%) chose the 1-month/2% risk option. The median MAWT was 2 months; scores ranged from 1 to 12 months (with two outliers). Many perceived high cumulative risks of myocardial infarction if waiting for 1 (upper quartile, > or = 1.45%) or 6 (upper quartile, > or = 10%) months. However, MAWT scores were related only to expected waiting time (r = 0.47; P < 0.0001).

CONCLUSIONS

Most patients reject waiting 6 months for elective CABG, even if offered along with a halving in surgical mortality (from 2% to 1%). Intolerance for further delay seems to be determined primarily by patients' attachment to their scheduled surgical dates. Many also have severely inflated perceptions of their risk of myocardial infarction in the queue. These results suggest a need for interventions to modify patients' inaccurate risk perceptions, particularly if a scheduled surgical date must be deferred.

Design and evaluation of a ZP3 peptide vaccine in a homologous primate model

The concept of a safe, immunocontraceptive vaccine using the zona pellucida glycoprotein 3 (ZP3) as an immunogen has been marred by the appearance of ovarian dysfunction in several species. However, careful selection of epitopes on mouse ZP3 have demonstrated that it is possible to segregate contraceptive bone marrow-derived (B)-cell epitopes from the cytotoxic thymus-derived (T)-cell epitopes thought to be responsible for inducing ovarian disease. B-cell epitopes on marmoset ZP3 (mstZP3) were identified by epitope mapping studies. Using a panel of polyclonal antibodies against recombinant mstZP3, an immunodominant epitope mstZP3(301-320) was identified. A chimeric peptide was co-linearly synthesized incorporating this sequence with a promiscuous tetanus toxoid T-helper cell epitope. Using the common marmoset (Callithrix jacchus) as an animal model, we have compared the consequences of active immunization with homologous recombinant mstZP3 and mstZP3(301-320) chimeric peptide vaccine. Long-term infertility was achieved using mstZP3 but at the expense of ovarian function. In contrast, no disruption to ovarian function was observed following mstZP3(301-320) immunization. Antibodies to this peptide immunolocalized to the zona pellucida of both marmoset and human ovarian sections and inhibited human sperm-zona binding by approximately 60% in vitro. However, in-vivo studies indicated that targeting a single ZP3 epitope was insufficient to reliably and consistently achieve a contraceptive effect.

The effect of a sodium lauryl sulfate-free dentifrice on patients with recurrent oral ulceration

OBJECTIVE

Sodium lauryl sulphate (SLS) is the most commonly used detergent in dentifrices. Recent reports have suggested that it may exacerbate conditions with compromised epithelial integrity. The aim of this study was to compare the effect of an SLS-free dentifrice and an SLS-containing dentifrice on recurrent oral ulceration (ROU).

DESIGN

A double-blind crossover clinical trial was carried out during which subjects used an SLS dentifrice for 8 weeks and an SLS-free dentifrice for 8 weeks. Each phase was preceded by a 2-week washout period.

SETTING

A UK dental teaching hospital.

SUBJECTS AND METHODS

Forty-seven subjects completed the trial. They were all in the age range 10-62 years, had regularly recurrent oral ulceration reporting at least one to two ulcers per month and had normal levels of vitamin B12, ferritin and folate.

MAIN OUTCOME MEASURES

The trial phases were compared for the following ulcer parameters--number of ulcer days, total pain scores, number of ulcer episodes, and number of ulcers. Additional parameters compared were the number of ulcers per episode, ulcer duration, total pain per episode and ulcer size.

RESULTS

None of the ulcer parameters measured was significantly affected by the use of the SLS-free dentifrice as compared with the SLS dentifrice.

CONCLUSION

SLS-free dentifrice had no significant effect on ulcer pattern in the ROU study group.

Molecular basis of sperm-egg interaction and the prospects for immunocontraception

As the molecular basis of sperm-egg interaction is resolved, so new opportunities are created for the development of immunological approaches to disrupt the process of conception. Thus, realisation that the zona glycoprotein, ZP3, serves as a specific receptor for spermatozoa, has prompted a detailed examination of its contraceptive potential. In primate models, recombinant ZP3 has been shown to suppress fertility very efficiently, however this efficacy is tempered by the appearance of adverse side-effects involving accelerated primordial follicle depletion and a lymphocytic infiltration of the ovarian stroma. Synthetic peptides encoding B-cell epitopes have been found to circumvent the lymphocyte response although the effectiveness of such reagents in preventing the loss of primordial follicles has not yet been determined. The induction of active immunity against sperm-specific antigens has also been shown to generate long term infertility in both males and females. Molecular and immunological techniques are now being used to produce a rapidly expanding list of unique sperm antigens which are currently being evaluated to determine their potential contribution to the development of safe, effective, contraceptive vaccines.