The REACH (Resiliency, Engagement, and Accessibility for Comorbid HIV/PTSD/SUD populations) Protocol: Using a Universal Screener to Improve Mental Health and Enhance HIV Care Outcomes

Among people living with HIV (PLWH), 50% report substance use disorders (SUDs), and 30-61% report posttraumatic stress disorder (PTSD). Comorbid PTSD/SUD/HIV has been linked to faster HIV progression and twice the rate of death, lower medical adherence and retention, and increased viral load compared to PLWH without co-occurring PTSD or SUD. A critical first step in establishing comprehensive mental health services for PLWH is the implementation of an evidence-based screening protocol for PTSD and SUDs to facilitate referrals to specialty mental health providers. Guided by the Consolidated Framework for Implementation Research, this mixed-methods study aimed to examine the feasibility of delivering the REACH (Resiliency, Engagement, and Accessibility for Comorbid HIV/PTSD/SUD populations) Screening protocol. Three case managers were instructed to provide the REACH screening electronically to all patients that they saw for enrollment or re-enrollment appointments over 3 months (n=102). Of the 70 patients who completed the screener, 27% had clinically significant PTSD symptoms and 48.6% had SUD concerns. Qualitative feedback revealed themes related to beliefs about SU and PTSD, attitudes toward screening, comfort in the discussion of SU and PTSD, and referral and treatment considerations. Discussion includes lessons learned for implementation of this assessment of PTSD/SUD in PLWH as a novel approach to increase mental health engagement and promote health equity, with the potential long-term impact of improving HIV care outcomes via ameliorating mental health/SUD, and implications for prevention of HIV transmission. Implementation science can be leveraged to understand the gap in the utilization of existing evidence-based screening tools in HIV care settings.

Intervention development in occupational research: an example from the printing industry

BACKGROUND

Intervention development research is an essential prerequisite of any study that attempts to determine whether specific interventions work to prevent work related injury and illness.

METHODS

Focus groups (n = 5) and direct observational studies (n = 21) of printers were used to elicit key issues that would aid the development of subsequent interventions. Transcripts from these were analysed by standard qualitative methods to identify common and related themes.

RESULTS

The views of managers differed significantly from those of print workers in a number of areas, and working practices did not always follow policy. The majority of printers did not perceive dermatitis to be a major problem, although many complained of dry hands. Other key results included: the lack of skin care policy in most companies; poor understanding of the nature, causes, and treatment of dermatitis; low priority of dermatitis within health and safety concerns; little or no provision of occupational health services, particularly skin checks; variability in provision of and access to appropriate skin protection; and lack of accessible washing facilities.

CONCLUSIONS

As a result it was decided to evaluate the implementation of four

INTERVENTIONS

provision of (1) skin checks and treatment advice; (2) gloves of the correct type and size, and use of an after-work cream; (3) information on dermatitis within the printing industry; and (4) development of best practice skin care policy.

Reproduction of proventriculitis in commercial and specific-pathogen-free broiler chickens

Proventriculitis was studied by experimentally reproducing the disease in broiler chickens. One-day-old infectious bursal disease virus (IBDV) and infectious bronchitis virus (IBV) antibody positive commercial broilers and 1-day-old antibody negative specific-pathogen-free (SPF) broilers were orally gavaged with proventricular homogenates produced from the proventriculi of broilers with proventriculitis. At 7 and 14 days, both commercial and SPF broilers had enlargement of the proventriculus with necrosis of the glandular epithelium and lymphocytic infiltrates in the proventricular glands. SPF broilers exposed to the proventricular homogenates developed infectious bursal disease, and IBDV was detected by reverse transcriptase-polymerase chain reaction (RT-PCR). They also were positive by RT-PCR to IBV and developed nephritis. Commercial broilers developed mild nephritis but not bursal disease and were negative for IBDV and positive for IBV by RT-PCR. Both homogenate-inoculated commercial and SPF chickens were negative for reovirus and Newcastle disease virus by RT-PCR and variably positive for adenovirus by PCR. Bacteria were not identified in histologic sections, nor were they isolated from affected proventriculi. Indirect fluorescent antibody assay using convalescent sera detected intracytoplasmic staining in the proventricular glandular epithelial cells. Examination of thin sections of proventriculi using electron microscopy identified virus-like particles approximately 120 nm in diameter within the cytoplasm of these cells at 7 days after inoculation. Passage of proventricular homogenate filtrates in chicken embryos for virus isolation caused stunting, and allantoic fluid from these eggs was positive for IBV by RT-PCR.

Mortality in the UK industrial silica sand industry: 1. Assessment of exposure to respirable crystalline silica

AIMS

To develop a job-exposure matrix (JEM) from personal and static respirable crystalline silica (RCS) measurements in UK industrial silica sand workers.

METHODS

A total of 2429 personal and 583 static RCS dust samples were collected using cyclone samplers at seven UK quarries between 1978 and 2000. These data were combined, and analysis of variance using general linear models was used to evaluate the effect of quarry, job, and year on RCS concentrations, and facilitate the creation of five quarry and three time categories with similar exposure levels by comparing the least-square GM RCS concentrations.

RESULTS

The overall geometric mean (GM) RCS concentration was 0.09 mg/m3 (geometric standard deviation 3.9). Silica flour and dry job categories tended to have the highest RCS exposure and 13.3% of all samples exceeded the UK maximum exposure level of 0.3 mg/m3. RCS levels generally decreased over time.

CONCLUSIONS

Data have been collected and used to develop a JEM for UK industrial silica sand workers between 1978 and 2000. Although there were some limitations in the data and certain assumptions were made, the use of available data to estimate exposure quantitatively is an improvement over the use of qualitative and surrogate measures of exposure. The continual collection of dust measurements in the industry is essential to facilitate the exploration of exposure-response relations that may exist between silica and silicosis, lung cancer, and other diseases.

Mortality in the UK industrial silica sand industry: 2. A retrospective cohort study

AIMS

To evaluate the mortality experience of a cohort of employees in the UK silica sand industry exposed to respirable crystalline silica (RCS).

METHODS

A retrospective cohort mortality study followed all workers to 2001 with at least one year's employment at one of seven UK silica sand producing quarries between 1950 and 1986. Each worker was assigned a job category and cumulative exposure to RCS was estimated using a job-exposure matrix.

RESULTS

A total of 764 deaths were identified in 2703 cohort members. The overall mortality rate for the cohort was lower than would be expected in the general population. Mortality from circulatory and respiratory disease was also less than expected, but death due to pneumoconiosis was slightly raised (two deaths). Mortality from all cancers was slightly decreased. Mortality was not raised in any job category. Cancer mortality was raised at one quarry due to a significant increase in lung (standardised mortality rate (SMR) 162.0, 95% CI 113.5 to 224.3) and bladder (SMR 366.5, 95% CI 167.6 to 695.7) cancers. Mortality from lung cancer and other causes did not show a trend with cumulative exposure to RCS.

CONCLUSIONS

This study did not show any consistent relation between RCS exposure (in the absence of other known carcinogens) and the development of lung cancer. This contrasts with a number of studies that have shown positive findings in similar and related industries.

Proventriculitis in broiler chickens: immunohistochemical characterization of the lymphocytes infiltrating the proventricular glands

Broiler chickens with transmissible proventriculitis have severe lymphocytic infiltration of the proventricular glands. The distribution of T cells and B cells in these infiltrates was studied histopathologically, and their identity was confirmed immunohistochemically (CD3, CD4, CD8, and B cells). To reproduce this disease, 1-day-old commercial boilers were orally gavaged with homogenized proventriculi from broilers with proventriculitis. Resulting lesions were examined at both acute (7 days postinoculation [i]) and chronic (14 and 21 dpi) time points. Lymphocytic infiltrates in the proventricular glands and the mucosal lamina propria were present at all time points and were most prominent and demarcated at 14 dpi. T and B lymphocytes were present during acute and chronic proventriculitis, but their distribution varied within the glands. Lymphocytic infiltrates in the proventricular glands and in the lamina propria were predominantly CD3+T cells, and most of these were also CD8+. B cells and CD4+ T cells formed aggregates in chronic proventriculitis. Thus, both cell-mediated and humoral immune responses are induced during transmissible proventriculitis, and the cell-mediated immune response is morphologically greater.

Proventriculitis in broiler chickens: effects of immunosuppression

Proventriculitis in broilers causes carcass condemnation when swollen proventriculi tear during evisceration. The cause of this proventriculitis is unknown, but several infectious agents have been associated with it. One such agent, infectious bursal disease virus (IBDV), has been implicated as a cause of proventriculitis, but a direct effect of this virus on the proventriculus has not been proven. The role of IBDV in proventriculitis may be indirect as a result of its ability to cause immunosuppression. The objective of this study was to understand how immunosuppression affects the incidence of proventriculitis in broiler chickens. Immunosuppression was induced in commercial and specific-pathogen-free broiler chickens using chemicals (cyclophosphamide and cyclosporin) or virus (IBDV). All groups were then exposed to a proventricular homogenate produced from diseased birds. At 7 and 14 days postinoculation, the incidence of proventriculitis in these groups was compared to that produced by homogenate exposure in immunocompetent broilers. All birds exposed to the proventricular homogenate from diseased birds developed proventriculitis. Cyclophosphamide and IBDV, both B cell suppressors, did not significantly affect the incidence or characteristics of the proventriculitis observed, although they did have an effect on the size of the proventriculus at 7 days postinoculation. Chickens immunosuppressed with cyclosporin, a T cell suppressor, developed more severe lesions and had a higher incidence of proventriculitis. These findings indicate that both B and T cells are involved in the immune response against proventriculitis, but cell-mediated immunity appears to have a more important role in controlling the disease. IBDV affects both humoral and cellular immunity in the chicken, so although under experimental conditions it didn't have a major effect on proventriculitis, it may explain why control of IBDV in the field seems to reduce the incidence of proventriculitis.

Evaluation of the protection conferred by commercial vaccines against the California 99 isolate of infectious bronchitis virus

An infectious bronchitis virus (IBV) was isolated from commercial broilers from the state of California exhibiting respiratory distress, inflamed tracheas, airsaculitis, and edematous lungs. After reverse transcriptase-polymerase chain reaction (RT-PCR), the California isolate exhibited an identical restriction fragment length polymorphism (RFLP) pattern to some isolates obtained from California, known as California 99 isolates. Commercial Mass-Conn and Mass-Ark vaccines were used to vaccinate commercial broiler chickens via eye drop once at 1 or 10 days of age or twice at 1 and 10 days of age. At 27 days of age the birds were challenged via eye drop with the isolated IBV California 99 strain. Protection was measured by failure to reisolate the challenge virus from tracheas 5 days postchallenge and complemented withthe tracheal and epithelium thickness scores. When the Mass-Ark vaccine was included in the vaccination programs, there was protection against challenge with the IBV California 99 isolate. The Mass-Conn vaccine conferred protection when used once at 1 day of age and twice at 1 and 10 days of age. However, no total protection was achieved when used as the only vaccine at 10 days of age, since one of the replicates was positive for virus isolation. Significant differences (P < 0.05) in the epithelium thickness and tracheal scores were observed between the unvaccinated-unchallenged group and the groups vaccinated once or twice with the Mass-Conn vaccine. Based on these results, all chickens were protected against the California 99 isolate when the IBV Arkansas type was used as a vaccine.

Hypoglycemia spiking mortality syndrome in broilers with rickets and a subsequent investigation of feed restriction as a contributing factor

Several cases of elevated mortality with neurologic signs in 14-to-16-day-old broilers were presented to the Poultry Diagnostic and Research Center from one local integrated company. Suspected of "spiking mortality" associated with hypoglycemia, blood glucose levels were <150 mg/dl overall, with several birds with blood glucose levels as low as 30 mg/dl. Tissues, submitted for histopathology, revealed rickets in 50% of the birds. Virus isolation and serology for reovirus and infectious bursal disease virus were negative. After evaluation of these cases, a brief investigation was conducted to determine the effects of feed restriction on the induction of rickets and resulting hypoglycemia. One-hundred 1-day-old broilers were randomly assigned to three treatment groups of: 1) ad libitum feed, 2) 25% restriction, and 3) 50% restriction. Restriction began on the fifth day of age and continued to 21 days of age. Samples collected during the course of the study included whole blood for blood glucose measurements and proximal tibiotarsus for histopathologic examination for rickets. We were unable to reproduce the clinical signs of spiking mortality, neurologic changes, or hypoglycemia experimentally. Histopathology of the growth plates of the proximal tibiotarsus did indicate mild changes consistent with rickets, but the changes were not significant between treatment groups.

Detection of infectious laryngotracheitis virus in formalin-fixed, paraffin-embedded tissues by nested polymerase chain reaction

Infectious laryngotracheitis virus (ILTV) is routinely diagnosed by histopathologic examination of trachea, eyelid, and lung tissues. Lesions consistent with infectious laryngotracheitis (ILT) infection include syncytial cell formation with intranuclear inclusion bodies. These changes are present during the acute phase of infection. To increase the sensitivity of detecting ILT, a nested polymerase chain reaction (PCR) was developed for detection of ILTV DNA. Nested PCR assay was specific for the amplification of ILTV DNA and did not amplify a variety of other avian pathogens. To further validate the ability of this assay to detect ILT, nested PCR was performed in formalin-fixed, paraffin-embedded tissues from 35 cases of respiratory disease. Of the 35 cases, 12 were considered ILT suspects on the basis of initial clinical observation. Eleven of the 12 ILT-suspect cases were diagnosed as ILT, and the remaining 24 were diagnosed as nonspecific tracheitis (NST) by histopathologic examination. Histopathologically positive samples were confirmed by direct fluorescent antibody test and virus isolation. Of the 11 ILT-positive cases, 10 were positive by nested PCR. In addition, ILTV DNA was detected in 7 of the 24 samples diagnosed as NST upon histopathologic examination. Therefore, by nested PCR, ILTV DNA was detected in tissues independently of the presence of syncytial cells, intranuclear inclusions, or both. ILT nested PCR is a specific and sensitive assay capable of detecting ILT at different stages of infection and can be utilized in combination with histopathological examination to accelerate the diagnosis of ILT infection.

Cardiomyopathy in broiler chickens congenitally infected with avian leukosis virus subgroup J

Dilated cardiomyopathy and ascites in broiler chickens are frequently associated with rapid growth and pulmonary hypertension, but can be associated with some avian leukosis virus (ALV) infections. The novel subgroup J of ALV has a high cardiac tropism, but dilated cardiomyopathy has not been reported previously. We report a dilated cardiomyopathy incidence of 11.1% in broiler chickens congenitally infected with ALV subgroup J (ALV-J). Gross lesions included severe body weight suppression, cardiomegaly with biventricular dilation, right ventricular hypertrophy, visceral congestion, and ascites. Cardiac myocytes and Purkinje fibers contained 2- to 10-microm intracytoplasmic magenta inclusions that contained ALV-J-specific nucleic acid. Ultrastructurally, inclusions contained ribosomes and immature virions and were associated with myofibril disruption and disarray. Peracute centrilobular hepatic necrosis was present in most cases. ALV-J-associated cardiomyopathy may involve a direct viral effect on cardiac myocytes and Purkinje fibers.

Localization of avian leukosis virus subgroup J in naturally infected chickens by RNA in situ hybridization

The novel subgroup J of avian leukosis virus (ALV-J) has emerged as a significant cause of myeloid neoplasia and weight suppression in broiler chickens. We investigated viral tropism using RNA in situ hybridization (ISH) in naturally infected chickens. Formalin-fixed tissues were collected from 12-day-old embryos (seven infected, two control) and from 0-week-old (four infected, one control), 3-week-old (five infected, one control), 6-week-old (five infected, one control), and 9-week-old (10 infected, two control) chickens naturally infected with ALV-J in ovo. A 636-base antisense riboprobe complementary to the 3' and 5' ends of the pol and env viral genes, respectively, was constructed. Strong positive staining was present in cardiac myocytes, Purkinje fibers, vascular and pulmonary smooth muscle, renal glomeruli, distal tubules, and pituitary glands. Light staining was present in gastrointestinal smooth muscle, thyroid and adrenal glands, and follicular medullae in the cloacal bursa. Staining was not present in any hematopoietic precursors. Tissues from newly hatched chicks exhibited the strongest and most consistent staining, whereas staining in embryos was minimal. RNA ISH confirmed the presence of ALV-J-specific nucleic acid within cytoplasmic inclusions in cardiac myocytes, Purkinje fibers, pituitary glands, and renal glomeruli. Viral tropism for cardiac myocytes and Purkinje fibers may relate pathogenetically to the cardiomyopathy and congestive heart failure described in index chicken flocks infected with ALV-J. Viral tropism for endocrine organs may relate pathogenetically to the weight suppression associated with infection.

Heterophil function and resistance to staphylococcal challenge in broiler chickens naturally infected with avian leukosis virus subgroup J

Avian leukosis virus subgroup J has a high tropism for myeloid lineage cells and frequently induces neoplastic transformation of myelocytes. The impact of congenital avian leukosis virus subgroup J infection on the function of circulating heterophils and susceptibility to staphylococcal infection was investigated. Six-week-old broiler chickens negative for exogenous avian leukosis viruses or congenitally infected with avian leukosis virus subgroup J were inoculated intravenously with 10(6) colony-forming units of Staphylococcus aureus, and pre- and postinoculation heterophil function was assessed. All chickens developed a leukocytosis with heterophilia after inoculation, but total leukocyte and heterophil counts were significantly higher in leukosis-negative chickens than in virus-infected chickens. Tenosynovitis was more severe in leukosis-negative chickens, and 2/10 (20%) of the virus-infected chickens had no histologic evidence of tenosynovitis. Osteomyelitis in the tibiotarsus or tarsometatarsus developed in 5/10 (50%) of the chickens in each group. S. aureus was recovered from the hock joint of 6/10 (60%) of the chickens in each group. Heterophils from all chickens exhibited similar phagocytic ability pre- and postinoculation. Heterophils from virus-infected chickens exhibited less bactericidal ability preinoculation than did heterophils from leukosis-negative chickens. However, postinoculation bactericidal ability was similar in both groups. Avian leukosis virus subgroup J provirus was present in heterophils isolated from congenitally infected chickens. Heterophils isolated from broiler chickens congenitally infected with avian leukosis virus subgroup J exhibit no significant functional deficits, and infected and uninfected chickens exhibit similar susceptibility to staphylococcal infection.

The possible effects on health, comfort and safety of aircraft cabin environments

A consultation was undertaken to investigate the views and concerns of stakeholders in the aircraft industry about the possible harmful effects on personal health, comfort and safety of aircraft cabin environments. Stakeholders were identified from a variety of sources including Government agencies, the Internet, House of Lords inquiry, and suggestions of interviewees. They represented: aircraft crews, aircraft constructors and engineers, government departments and authorities, holiday/flight companies, insurance companies, non-governmental organisations, occupational health physicians, passenger representatives, and independent researchers and consultants. Eighty-seven were contacted of which 57 were interviewed over the telephone using a semi-structured questionnaire. Their concerns were transcribed into a standard format and analysed qualitatively. Key stakeholders, along with Government officials, were invited to a workshop to discuss and prioritize the issues raised during the interviews. The main concerns expressed by the participants fell into five main areas: deep vein thrombosis, air quality, infection, cosmic radiation, and jet lag and work patterns. In addition, a number of safety concerns were raised as well as comments on the provision of appropriate advice to passengers. It was generally felt that further research was required on each of these subjects, as well as an improvement in the quality, quantity and availability of information provided for passengers prior to boarding a flight.

Pathology and histopathology of gossypol toxicity in broiler chicks

Two experiments were conducted to determine the toxicity, pathology, and histopathology of purified gossypol in broiler chicks. Gossypol was added to broiler feed at 0, 100, 200, and 400 mg/kg of feed in Experiment 1 and at 0, 800, and 1600 mg/kg of feed in Experiment 2. Day-old broiler chicks were fed these diets from 1 to 21 days in Experiment 1 and from 1 to 23 days in Experiment 2. In Experiment 1, body weight and feed intake at 21 days were not significantly affected by dietary gossypol. However, chicks fed gossypol at 400 mg/kg of feed had poor feed conversion ratio compared with the other treatment. Feed conversion ratios were 1.493, 1.564, 1.471, and 1.60 for chicks fed gossypol at 0, 100, 200, and 400 mg/kg of feed, respectively (Experiment 1). Chicks fed 400 mg/kg gossypol also had mild perivascular lymphoid aggregate formations and bilary hyperplasia in the liver. In Experiment 2, gossypol at 1600 mg/kg resulted in 28.1% mortality. Gossypol at 800 and 1600 mg/kg feed resulted in significant decreases in body weight and feed intake of chicks. The average body weights of 23-day-old chicks in Experiment 2 were 676, 224, and 111 g for 0, 800, and 1600 mg/kg gossypol, respectively. Feed conversion ratios of chicks fed 800 and 1600 mg/kg gossypol were significantly higher than those of chicks fed control diets (1.383 vs. 1.564 vs. 1.745 for 0, 800, and 1600 mg/kg gossypol, respectively). Plasma iron and hematocrit values were significantly reduced by gossypol at 800 and 1600 mg/kg of feed. Enlarged gallbladder was the only gross pathology symptom associated with gossypol levels. Severe cases of perivascular lymphoid aggregate formation, biliary hyperplasia, and hepatic cholestasis were observed in chicks fed 800 and 1600 mg/kg of gossypol in feed. No gossypol-related changes were observed in kidney tissues of chicks. These results show that gossypol is toxic to broiler chicks at high levels. This study also shows that histopathologic changes in liver due to gossypol also occur at levels lower than the levels that affect body weight.

Passive antibody to Bartonella henselae protects against clinical disease following homologous challenge but does not prevent bacteremia in cats

We challenged cats transfused with anti-Bartonella serum and kittens born to antibody-positive queens with Bartonella henselae to determine the contribution of antibodies to the control of B. henselae in cats. In both experiments, antibody-positive cats were protected from clinical disease but passive antibody to the homologous strain of B. henselae did not prevent bacteremia.

Chicken embryo lethality assay for determining the virulence of avian Escherichia coli isolates

Multiple isolates of Escherichia coli from clinical cases of colibacillosis and E. coli from the intestinal tracts of normal broilers at slaughter were assayed by the embryo lethality test to determine their virulence. The assay was repeated five times in order to establish reproducibility and determine the statistical parameters of the test. This study showed that the inoculation of approximately 100 colony-forming units in the allantoic cavity of 12-day-old embryos discriminated between virulent and avirulent E. coli isolates. Gross lesions included cranial and skin hemorrhages in addition to encephalomalacia in embryos inoculated with virulent isolates. Abnormalities were observed by microscopic examination of the heart, brain, and liver in embryos inoculated with virulent isolates. Analysis of data indicated that the length of the test should be 4 days. In the virulent group, day 2 postinoculation had the most significant death patterns. Sample size calculations indicated that 11 embryos are sufficient for the assay. On the basis of death rates, isolates considered to be avirulent had an embryo death rate of <10%, moderately or secondary pathogens had a 10%-29% death rate, and virulent isolates had a death rate of >29%. An important aspect of this assay is the accessibility of good-quality fertile embryonated eggs.

Peptic ulcer bleeding: accessory risk factors and interactions with non-steroidal anti-inflammatory drugs

AIMS

To determine risk factors for peptic ulcer bleeding other than non-steroidal anti-inflammatory drugs (NSAIDs). Methods-Data on possible antecedent risk factors obtained in a large case control study of 1121 patients admitted to hospitals in Glasgow, Newcastle, Nottingham, Oxford, and Portsmouth with bleeding peptic ulcers were compared with the same information obtained in 989 population controls. Data were analysed by logistic regression with the calculation of odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

From a logistic regression model, oral anticoagulants (OR 7. 8; 95% CI 2.8-21.5), previous peptic ulcer (3.8; 2.6-4.9), treatment for heart failure (5.9; 2.3-13.1), oral corticosteroid use (2.7; 1. 3-4.5), treatment for diabetes (3.1; 1.2-4.3), and current smoking (1.6; 1.2-2.0) were all independent risk factors. No association was found with use of calcium channel antagonists. Odds ratios for concomitant NSAID usage were multiplicative with the exception of current smoking.

CONCLUSIONS

Some 45% of admissions for peptic ulcer bleeding in England and Wales in those aged 60 or more are calculated to be attributable to, or associated with, these accessory risk factors, which, together with those associated with aspirin or other NSAID use will account for over 80% of predisposing factors to ulcer bleeding.

Pathogenic effects on domestic poultry of a mycoplasma gallisepticum strain isolated from a wild house finch

Mycoplasma gallisepticum (MG) has been isolated from wild house finches. The pathogenic effects of MG finch strain (K4058) and MG R-strain were compared after exposure of chickens and turkeys. Gross and histologic lesions, reisolation of the organism, serology, and clinical disease were evaluated. Milder histologic and gross lesions, in addition to lower serologic titers, occurred in birds inoculated with the finch strain. Mortality, concurrent with clinical and gross respiratory signs and lesions, was observed only in chickens challenged with R-strain. Both the MG finch strain and MG R-strain were recovered from the respective challenge groups at 14 and 28 days postexposure. The results show that MG isolated from wild house finches may infect domestic poultry species but causes only mild disease and is less virulent than MG R-strain. Commercial enzyme-linked immunosorbent assay kits best detected the serologic response of chickens and turkeys to the MG finch strain.

A method of assessing female breast morphometry and its clinical application

A series of reproducible measurements have been developed with reference to a single midline datum that describe the position of key landmarks on the female breast. Measurements were made on a 'normal' population of 60 subjects content with their breast shape in order to (1) produce 'normal' reference data for breast shape in a population of varying weight and height; and (2) to evaluate factors which may influence the measurements. The findings show that the vertical positions of the measurements migrate inferiorly with increasing age. With increasing weight, the landmarks (except the medial end of the inframammary crease) migrate inferolaterally. Areolar diameter decreases with increasing age and increases with increasing weight. Only one of the 12 bilateral breast measurement parameters shows a significant mean difference between the right and left breast. However, in a proportion of subjects, individual measurements show fluctuating asymmetry. Subsequently, measurements were made of the breasts of women attending with requests for either reduction (n = 25) or augmentation (n = 6) mammaplasty. Compared with the 'normal' population, the group requesting reduction mammaplasty differed significantly in the majority of measurements. The group of patients requesting breast augmentation showed fewer differences compared with the 'normal' population. The average BMI of women requesting augmentation mammaplasty was significantly less and that of women requesting reduction mammaplasty significantly greater than the normal population. In conclusion, a simple and reproducible method of morphometric measurement of the female breast is described. Application of this method suggests that patients requesting reduction or augmentation mammaplasty on the NHS represent a significant deviation from 'normal' morphometry and do not simply have a subjective distortion of their own body image.

Body weight suppression in broilers naturally infected with avian leukosis virus subgroup J

Broiler progeny were hatched from avian leukosis virus (ALV)-negative and ALV subgroup J (ALV-J)-positive breeders. ALV-J infection in progeny was identified by p27 antigen capture enzyme-linked immunosorbent assay and reverse transcriptase-polymerase chain reaction specific for ALV-J performed on serum or plasma samples obtained at hatch. Hatch weights did not differ between ALV-negative broilers and ALV-J-positive broilers. Body weights of ALV-J-positive broilers were 64.4% of those of ALV-negative broilers at 1 wk of age. At 8 wk of age, weights of broilers with congenital ALV-J infection were still only 63.8% of those of ALV-negative broilers. No other concurrent pathogen was detected in either group of broilers. These findings indicate that congenital ALV-J infection is associated with significant weight suppression in broilers in the absence of other pathogens.

Methicillin-resistant Staphylococcus aureus in burns patients--why all the fuss?

Procedures designed to limit spread of methicillin-resistant Staphylococcus aureus (MRSA) in burns units demand time and resources. To assess the significance of MRSA in burns patients we performed a retrospective review of MRSA colonization in in-patients over a 41-month period at the North Trent Sub-regional Burns Unit. Patients were compared with MRSA free controls, matched for age and percentage body surface area (BSA) burn and admitted during the same time period. Length of stay, number of operations and deaths were outcome indicators. All patients managed non-operatively were excluded, leaving 40 MRSA patients and 46 controls. There was no statistical difference between the two groups with regard to number of operations (p= 0.07), duration of admission (p = 0.12) or mortality (p = 0.09). Of the control group, 83% had wound swabs positive for methicillin-sensitive Staphylococcus aureus (MSSA). there was no statistical difference in any outcome variables between this sub-group of controls and MRSA patients. Colonization with S. aureus (both MRSA and MSSA) was associated with larger burns (p<0.05), twice as many operative procedures (p<0.05) and prolonged admissions (p<0.01). Mortality was unaltered by staphylococcal colonization (p = 0.8). Although our study lacks power, we would suggest that methicillin resistance per se is not associated with increased morbidity or mortality in burns patients.

Intravascular cartilaginous emboli in the spinal cord of turkeys

A flock of 15-wk-old tom turkeys experienced an acute onset of paresis and ataxia in 75% of the birds after handling. Cartilaginous emboli were found in the spinal cord vasculature from one of five turkeys at this initial presentation. Most of the flock recovered within 6 days, but 3% remained paretic. Myelomalacia was present in three turkeys that failed to recover. Two of these turkeys had cartilaginous and osseous emboli within the medullary spaces of the vertebral bodies, internal vertebral venous sinuses, and spinal cord. The third turkey had vascular and spinal cord necrosis consistent with thrombosis and resultant ischemia. These changes suggest that turkeys may be susceptible to a syndrome analogous to fibrocartilaginous embolism of the spinal cord in mammals. The articular cartilage of the vertebral body endplate may be the source of the emboli. The turkeys with emboli had articular cartilage defects consisting of matrix eosinophilia, chondrocyte loss, multicellular cluster formation, cartilage detachment, and cartilage clefts. Cartilaginous emboli in the spinal cord should be considered as a potential cause for acute paresis and ataxia, especially in flocks with preexisting abnormalities of the vertebral articular cartilage surfaces.

The occurrence of ambient temperature-regulated adhesins, curli, and the temperature-sensitive hemagglutinin tsh among avian Escherichia coli

Escherichia coli establishes a secondary respiratory tract infection in birds following inhalation of contaminated dust and litter particles. Escherichia coli express adhesins under conditions reflective of the ambient temperatures present in poultry houses. These microbial adhesins allow E. coli to attach to cell types that it initially encounters in the respiratory tract. Ambient temperature-regulated adhesins represent a new class of bacterial hemagglutinins that include pili and the thin, aggregative, flexible filaments known as "curli." This study examines the occurrence of the ambient temperature-regulated adhesins, curli (crl, csgA), and an avian-specific, temperature-sensitive hemagglutinin, tsh, among avian and mammalian E. coli isolates. The avian hemagglutinin gene tsh was present in approximately 46% of clinical avian E. coli isolates. This gene was not detected among commensal E. coli isolated from healthy broiler chickens. Unlike tsh, curli genes were ubiquitous among E. coli. However, curli were observed in only half of the avian E. coli examined by electron microscopy. Curli were not present among several nonavian E. coli positive for crl and csgA. Approximately 25% of avian E. coli isolates agglutinated chicken erythrocytes when bacteria were grown at room temperature. Hemagglutination was not specific to E. coli isolated from poultry. Presence of either tsh or curli genes was not indicative of an isolate's ability to agglutinate chicken red blood cells. No discernible structures were observed mediating attachment of the bacteria to chicken red blood cells. An additional avian-specific hemagglutinin appears to be present among avian E. coli.

Colonization of the chicken trachea by an avirulent avian Escherichia coli transformed with plasmid pHK11

Recombinant plasmid pHK11 was transformed into an avirulent, wild-type avian Escherichia coli (E. coli Av) in order to study the plasmid's effect on colonization of the chicken trachea. The transformant (E. coli Av + pHK11) produced colicin V (ColV), had type F1 fimbriae, and was motile. The E. coli Av recipient possessed type F1 fimbriae but was nonmotile; it did not produce ColV. Four-day-old chicks were inoculated in the trachea with 100 microliters of an overnight culture (approximately 10(8) colony-forming units) of E. coli Av, E. coli Av + pHK11, or sterile brain-heart infusion (BHI) broth. A group of uninoculated chicks was also included. Samples of the trachea were taken on days 4 and 10 postinoculation and compared histologically and bacteriologically. Birds inoculated with E. coli Av + pHK11 had enhanced tracheal colonization and showed increased histologic changes as compared with those inoculated with E. coli Av or BHI broth or uninoculated controls. These results indicate that production of ColV and motility enhance the colonization of the trachea and may be involved in the cause of pathologic lesions.

Spiking mortality of turkey poults: 2. Effect of six different in vitro disinfection techniques on organ homogenates capable of reproducing SMT

Spiking mortality of turkeys (SMT) is an infectious disease of 5-to-25-day-old turkey poults characterized by acute enteritis and bursal and thymic atrophy. It is reproducible by exposure to organ homogenates or contaminated litter. We studied methods potentially useful for decontamination of turkey houses contaminated with SMT. Organ homogenates capable of producing SMT and containing turkey intestinal coronavirus were exposed in vitro for 5 hr to either 5.0% NaCl, pH 2.0, pH 12, 1.0% formaldehyde, 57 C, or lyophilization. Results were assessed by oral gavage of treated inocula into 1-day-old turkeys and measurement of subsequent coronavirus shedding, growth rate, feed conversion, and mortality from 1 to 21 days of age. Formaldehyde treatment rendered the inoculum nonpathogenic, whereas other treatments failed to ameliorate its negative effects.

Spiking mortality of turkey poults: 1. Experimental reproduction in isolation facilities

Spiking mortality of turkeys (SMT) is an infectious disease of 5-to-25-day-old turkey poults characterized by acute enteritis and bursal and thymic atrophy. Brooding 1-day-old poults on litter taken from naturally occurring cases successfully reproduced SMT 5 days postexposure. Oral exposure to an organ homogenate made of tissue samples from naturally occurring cases successfully reproduced SMT 5 days postinoculation. Coronaviruses were present in intestinal and bursal contents taken from poults with naturally occurring SMT. They were also present 5 days after exposure in the experimentally reproduced disease. Severe intestinal villus atrophy, bursal follicular lymphoid depletion, and thymic cortical atrophy were present histologically in naturally occurring SMT and in SMT reproduced by either experimental method.

Mortality pattern among biological research laboratory workers

A cohort study was conducted to investigate the mortality of individuals employed by biological research institutes in the UK. The inclusion criteria were met by 12,703 individuals, of whom 95% were traced (11,502 alive, 395 deaths, 246 embarkations). All-cause mortality was significantly reduced in men (standardised) mortality ratio (SMR) 55 and women (SMR 52). Mortality was also significantly reduced for circulatory and respiratory diseases, and overall there was low mortality from malignant neoplasms. SMRs exceeded 100, but were not statistically significant, for infective and parasitic diseases. There were no statistically significant raised SMRs for any cancer site. Workers were categorised as ever worked in a laboratory (laboratory workers) and never worked in a laboratory (non-laboratory workers). The all-cause SMR was significantly reduced in both groups, as was mortality from circulatory and respiratory diseases. The SMR for malignant neoplams was also significantly reduced in laboratory workers. On the basis of follow-up to 31 December 1994, there is no evidence of any overall increased risk of mortality in biological research laboratory workers. However, the power of the analysis is limited by the young age of many cohort members and short duration of follow-up. Follow-up is continuing and the data will be reanalysed once more deaths have accumulated.

Copper sulfate toxicosis in commercial laying hens

A flock of 51-week-old leghorn hens experienced a 16% drop in egg production in a single week. The layer ration contained 1477 ppm copper from the addition of copper sulfate. Severe oral ulcers were present in the pharynx. Oral ulcers, reduced feed intake, and a drop in egg production occurred when a ration containing 1437 ppm copper was evaluated experimentally.

Deletrocephalus dimidiatus infestation in an adult rhea (Pterocnemia pennata)

Infection with the nematode Deletrocephalus dimidiatus was found in the distal small and proximal large intestines of a 30-month-old female rhea that had died after a prolonged illness. Numerous strongyle-like eggs were found on fecal flotation. Possible treatments include fenbendazole (60 ppm in water) and ivermectin (200 mg/kg). Preventive measures such as artificial incubation, segregation of chicks from adults, and placing chicks in uncontaminated environments may help slow or stop the transmission of the parasite.

Bordetella avium: an opportunistic pathogen in Leghorn chickens

Experiments were conducted in order to produce bordetellosis in specific-pathogen-free (SPF) leghorn chickens. In the first and second of three experiments, young turkeys and chickens, respectively, were allotted into groups and challenged at 2 weeks of age with one of seven different isolates of Bordetella avium and two isolates of B. avium-like bacteria. Isolates of B. avium with the smooth colony type were pathogenic in turkeys but not in chickens. The B. avium-like bacteria and B. avium isolates with rough colonial morphology were nonpathogenic. In the third experiment, SPF leghorn chicks were vaccinated at 1 day of age with infectious bronchitis virus, Newcastle disease virus, or both and then challenged with B. avium at 7 days of age. Chickens vaccinated and then challenged with B. avium showed clinical signs and lesions similar to bordetellosis in turkeys. No clinical signs were observed in unchallenged chickens. Thus, we conclude that B. avium is an opportunistic pathogen in SPF leghorn chickens.

Effect of calcium/phosphorus imbalance in the ration on flock performance in two broiler flocks in north Georgia

Five- and six-day-old broilers from two flocks experiencing excessive mortality were submitted for necropsy. Rickets was diagnosed based on clinical signs of lameness and on gross and histopathologic lesions. Because of a confirmed feed mill error, these flocks had been fed a starter ration with a high calcium/phosphorus ratio (either 7.7:1 or 3.5:1). After debate concerning the profitability of salvaging the remaining birds in the affected flocks, the starter feed was replaced at 7 days of age. At processing, the affected flocks had weighted averages of body weight and feed conversion of 1.71 kg and 1.88, respectively; these averages compared favorably with the company averages of 1.72 kg and 1.87. The majority of the mortality in the affected flocks occurred during the first week. This case report demonstrates that it may be advantageous for a producer to salvage chicks that have been affected severely with rickets at less than 1 week of age.

Middle ear symptoms while flying. Ways to prevent a severe outcome

In an era when air travel is commonplace, middle ear block is not unusual. Educating patients about the simple techniques they can perform at the first signs of a problem may save a business trip or vacation from becoming a trip to the emergency department and a train ride home. The most important preventive measure is to avoid flying when symptoms of upper respiratory tract infection are present. When this is not possible, passengers should yawn, swallow, or chew to relieve pressure in the middle ear. Use of the Valsalva maneuver and decongestants or antihistamines may be helpful. Serve or unremitting ear block may require the use of the Politzer bag or a myringotomy.

Bordetella avium hemagglutination and motility mutants: isolation, characterization, and pathogenicity

Transposon mutagenesis was used to produce Bordetella avium mutants, which were screened for the lack of potential virulence factors, including a hemagglutinin, flagella, pili, and toxins. A mini-Tn10 transposon containing a kanamycin-resistance gene was introduced into the chromosomal DNA of the virulent 002/S isolate by electroporation. A hemagglutination-negative (HA-) mutant and a motility-negative mutant were obtained. Southern blot analysis showed that only the motility-negative mutant contained the transposon, whereas the HA- mutant was a spontaneous kanamycin-resistant mutant. Both mutants were stable in vitro and in vivo. Following inoculation of 2-week-old poults, the HA- mutant was determined to be less virulent than the 002/S parent, whereas the motility-negative mutant was similar in virulence to the 002/S parent. These results indicate that the hemagglutinin of B. avium is a virulence factor, but motility does not appear to contribute to virulence.

Intestinal diverticulum in a turkey

A normal 21-day-old British United Turkey of America had an intestinal diverticulum. The diverticulum, which affected all layers of the intestinal wall, arose on the mesenteric surface of the ileum midway between the yolk sac and the cecal tonsils. The general structure of the diverticulum resembled the normal histological appearance of the ileum, although a progressive atrophy of the wall occurred throughout the length of the diverticulum. No metaplasia, inflammation, or tumor was observed.

Acute hemorrhagic enterocolitis in ratites: isolation of eastern equine encephalomyelitis virus and reproduction of the disease in ostriches and turkey poults

Two emus died with acute hemorrhagic enterocolitis. Eastern equine encephalomyelitis (EEE) virus was isolated in Vero cells from non-pooled samples of brain and intestine. Enterocolitis with splenic and hepatic necrosis was reproduced by intramuscular or oral inoculation of this isolate in two ostriches and three turkey poults.

Fumonisin toxicity in turkey poults

The effects of dietary fumonisin B1 were evaluated in young turkey poults. The experimental design consisted of 3 treatments, with 24 female turkey poults allotted randomly per treatment. Day-old poults were fed diets containing 0 mg (feed control), 100 mg, and 200 mg fumonisin B1/kg feed for 21 days. Body weight gains and efficiency of feed conversion decreased linearly with increasing dietary fumonisin. Liver, kidney, and pancreas weights increased linearly with increasing dietary fumonisin, and spleen and heart weights decreased. Serum aspartate aminotransferase levels increased with increasing dietary fumonisin, and serum cholesterol; alkaline phosphatase, mean cell volume, and mean cell hemoglobin all decreased. Biliary hyperplasia, hypertrophy of Kupffer's cells, thymic cortical atrophy, and moderate widening of the proliferating and degenerating hypertrophied zones of tibial physes were present in poults fed diets containing fumonisin B1. Results indicate that fumonisin B1, from Fusarium moniliforme culture material, is toxic in young poults, and the poult appears to be more sensitive to fumonisin than the broiler chick.

Polymerase chain reaction and a biotin-labeled DNA probe for detection of infectious bronchitis virus in chickens

Polymerase chain reaction (PCR) and a biotin-labeled DNA probe were used to amplify and detect the genome of infectious bronchitis virus (IBV) from tracheal swabs taken from chickens that were experimentally inoculated with the IBV Beaudette, Arkansas, and Gray strains. The viral genome was successfully detected by PCR and confirmed by dot-hybridization assay using a biotin-labeled DNA probe on days 1, 3, 9, and 14 after exposure. Direct electron microscopy (EM) analysis was used to compare the ability of the two tests to detect IBV from the same tracheal swab samples. The EM analysis did not detect IBV in four of eight necropsy groups that were positive using PCR and the biotin-labeled DNA probe. Although histopathological lesions were observed in the tracheas, no clinical signs or specific antibody response were observed in the birds. The virus was also detected in the allantoic fluid of embryonating chicken eggs that had been inoculated with field samples suspected to be IBV. The field samples were passed four to six times in embryonating eggs, and 10 of 17 samples were positive using PCR and the biotin-labeled probe.

Toxicosis in broiler chicks due to excess dietary ethoxyquin

A commercial broiler company experienced a sudden increase of mortality in four flocks at two separate locations. Affected houses had red dust on inside walls and on the equipment. Affected chickens were 10 to 18 days old. Grossly, chickens had pale, swollen kidneys, dark-brown enlarged livers, and urates in joint spaces. Histologically, the kidneys had multifocal proximal tubular necrosis, the livers had dilated sinusoids, biliary hyperplasia, and accumulation of brown pigment in hepatocytes and bile ducts. One starter ration was analyzed, and it contained 6500 mg ethoxyquin/kg. The red dust in the houses and the brown pigment in livers were interpreted to be ethoxyquin. Clinical signs and histologic lesions were reproduced experimentally with 12,500 mg ethoxyquin/kg feed.

Fumonisin toxicity in broiler chicks

The effects of dietary fumonisin B1 were evaluated in young broiler chicks. The experimental design consisted of 5 treatments each with 9 randomly allotted male broiler chicks. Day-old chicks were fed diets containing 0 (feed control), 100, 200, 300, or 400 mg fumonisin B1/kg feed for 21 days. Response variables measured were chick performance, organ weights, serum biochemistry, and histologic parameters. Body weights and average daily gain dramatically decreased with increasing dietary fumonisin B1, and liver, proventriculus, and gizzard weights increased. Diarrhea, thymic cortical atrophy, multifocal hepatic necrosis, biliary hyperplasia, and rickets were present in chicks fed diets containing fumonisin B1. Serum calcium, cholesterol, and aspartate aminotransferase levels all increased at higher fumonisin dietary levels. Results indicate that fumonisin, from Fusarium moniliforme culture material, is toxic in young chicks.

Filamentous forms of Bordetella avium: culture conditions and pathogenicity

Difficulties in preparing suitable antigen for the microagglutination (MA) test led to the discovery of a filamentous form of Bordetella avium. Broth media high in nutrients, vigorous shaking, and incubation at 37 C appeared to promote the development of filamentous forms of the organism. Peptone broth did not induce the development of filamentous forms. Eleven different isolates having both smooth and rough colony types were tested and observed to form filaments of various lengths. Filamentous forms of B. avium hemagglutinated guinea pig erythrocytes were motile, had pili and flagella, and were stable up to the fourth or fifth passage in broth media, at which time a predominance of typical coccobacillus organisms were observed. Filamentous forms of B. avium originating from smooth-colony types were pathogenic in turkey poults, whereas the filamentous forms of B. avium originating from rough-colony types were not pathogenic.

Fumonisin mycotoxicosis in broilers: performance and pathology

Fusarium moniliforme culture material containing fumonisin B1 at 300 mg/kg was incorporated into a broiler starter ration and fed ad libitum to 1-day-old broiler chicks for 2 weeks in two experiments. Clinical features of the disease produced included diarrhea, a 19% reduction in body weight, a 30% increase in relative liver weight, and a worsening of feed conversion by 20 points at 2 weeks of age. Histologically, chicks fed fumonisin had multifocal hepatic necrosis, biliary hyperplasia, muscle necrosis, intestinal goblet-cell hyperplasia, and rickets. Simultaneous feeding of 0.5% aluminosilicate had no effect on the clinical disease or lesions. The clinical disease and lesions induced mimicked those of a viral enteritis.

Teenage conception and contraception in the English regions

Nationally available data on teenage fertility, family planning care and mortality were analysed to determine the relationship between teenage conception, availability of abortion and family planning care, and an indicator of socioeconomic disadvantage--the Standardized Mortality Ratio (SMR). In the 14 regions of England the strongest correlate of teenage conception and of the proportion of teenage conceptions aborted was female all-causes SMR. High levels of provision of NHS abortion services and uptake of family planning clinic care did not significantly reduce teenage fertility. Provision of traditional family planning services obviously plays an important role in preventing teenage pregnancy, but innovation in this service coupled with a concerted effort to reduce social disadvantage might have a greater impact on teenage fertility in England.

Lung capacity of males from the Ok Tedi region, Western Province, Papua New Guinea

Ninety-three men, representatives of the Wopkaimin, Ningerum and Awin ethnic groups in the Ok Tedi region of Western Province, Papua New Guinea, had their forced expiratory volume in one second and forced vital capacity measured. No differences were observed between any of the groups studied, though volumes were small and tended to be slightly greater in those living nearer Tabubil and the Ok Tedi mine, and in nonsmokers. Mean adjusted volumes were smaller than those for other Papua New Guineans and Europeans.

Cutaneous neoplasia in 340 cats

A total of 340 cases of cutaneous neoplasia were diagnosed in 340 of 3,564 cats that were examined by biopsy or necropsy during a 41-month period from January 1, 1986 through May 31, 1989. Eighteen types of tumor occurred, but four types comprised 77% of the cases. These were basal cell tumor, 89 cases (26%, mean age 10.3); mast cell tumor, 72 cases (21%, mean age 8.6); squamous cell carcinoma, 52 cases (15%, mean age 11.6); and fibrosarcoma, 50 cases (15%, mean age 10.2). For each of these four types of tumors, peak number of cases occurred in cats older than 10 years. Mast cell tumor was the only tumor diagnosed in cats younger than 1 year. The head was the most common site for basal cell tumors, mast cell tumors, and squamous cell carcinomas. The legs were the most common location of fibrosarcomas. Siamese cats had approximately three times as many mast cell tumors as statistically expected, but only one-fourth as many squamous cell carcinomas. Breed predilection for other skin tumors was not apparent. Sex predilection was not detected for any skin tumor.

Microscopic lesions of naturally occurring and experimental "spiking mortality" in young broiler chickens

Tissues from five chickens from each of 44 flocks affected with "spiking mortality" were examined histologically. Tissues from these chickens were characterized by: multifocal necrosis of hepatocytes with congestion and blood lake formation; severe lymphocyte necrosis in the bursal medulla, thymic cortex, and gut-associated lymphoid tissues; acute necrotic vasculitis in the alimentary serosa and liver; rickets; and air-sac disease in survivors. No specific etiology was identified in sections examined.