Management of neonatal hypoglycaemia in a tertiary maternity unit-A multidisciplinary quality improvement project

AIM

Improved identification and treatment of infants at risk of hypoglycaemia using evidence-based guidelines.

METHODS

Design: Prospective, multidisciplinary quality improvement project (QIP).

SETTING

Tertiary maternity hospital, Dublin (2016-2023).

SUBJECTS

Infants at risk for neonatal hypoglycaemia.

INTERVENTION

Plan-Do-Study-Act methodology. A hospital-wide survey and ongoing audit informed our initiatives including staff education, antenatal maternal education and standardisation of equipment. Our guidelines were continually evaluated and updated based on emerging evidence.

MAIN OUTCOME MEASURES

Neonatal unit (NNU) admissions, adherence to guidelines and use of glucose gel.

RESULTS

NNU admissions decreased by 70%, from 3% (118/3883) to 0.9% (34/3806 infants). The number requiring an IV glucose bolus reduced from 25% (29/118) to 6% (2/34). Improved antenatal education, antenatal expression of colostrum and early and frequent feeding also contributed to a reduction in glucose gel use of 94% (1009 tubes in 2018-v-62 in 2022). There were no adverse side effects related to hypoglycaemia.

CONCLUSION

Our QIP resulted in a significant reduction in NNU admissions leading to significant cost reductions and NNU workload. More importantly, this resulted in less maternal-infant separation and potentially less parental anxiety and a more supportive environment for breastfeeding. These low-cost initiatives can be implemented in other tertiary maternity hospitals to improve maternity and newborn care.

Effects of algal supplementation in feed to broiler breeders on transfer of nutrients and antibodies to chicks and quality of hatchlings

Breeder nutrition is an important factor for chick quality since the chick embryo relies on nutrients available in the egg for growth and development. In addition, the egg is providing the chick with important antibodies that are vital during the first weeks of life. Brown algae contains several bioactive compounds, and dietary supplementation with algal extracts have shown improved gut health and immune responses in both pigs and poultry. The aim of this study was to investigate if feeding the brown algae Saccharina latissima, intact or as an extract, to broiler breeders can affect breeder hens' antibody responses to vaccination, egg quality and transfer of antibodies and nutrients to the egg and thereby improve the quality of newly hatched chicks. Forty-five hens and nine roosters of the parent lines of the fast-growing broiler Ross 308 were included in the experiment where hens were 31 weeks at the start. The hens were housed individually and fed one of three dietary treatments for seven weeks; (a) control, (b) addition of 0.6% algal meal or (c) addition of 0.08% algal extract. The hens were given a booster vaccination against infectious bronchitis virus (IBV) 21 days after the start of experiment. During experimental days 32-42, hens were naturally mated every 5th day and hatching eggs were collected. A total of 255 chicks were hatched, and chick quality was assessed. Moreover, on chick day three, blood was collected from 48 focal chickens and total immunoglobulin Y levels and specific titres to IBV in serum were determined. The results showed that feeding the brown algae Saccharina latissima, intact or as an extract to broiler breeders did not affect egg production, egg quality, antibody responses to vaccination or transfer of antibodies from hen to chick. However, feeding intact algae significantly increased the levels of iodine and decreased the level of selenium in the eggs and resulted in a lower proportion of chicks with maximum quality score. Interestingly, algal feeding, both intact and as an extract, increased the abdominal fat pad in broiler breeders by about 17% without affecting BW. In conclusion, supplementation of broiler breeder diets with algal extract from Saccharina latissima, but not intact algal meal is a promising dietary strategy to increase the abdominal fat pad without causing any adverse effects on nutrient level in eggs or chick quality.

Gambling helpline contacts during COVID-19-related availability restrictions: an interrupted time series analysis

OBJECTIVES

Gambling causes significant public health harms that are addressed in the help service network. Helplines are the most widely used service among those experiencing harms. The COVID-19 pandemic changed the global gambling landscape. This study assesses the effect of COVID-19-related restrictions on help-seeking for gambling via helplines.

STUDY DESIGN

We analysed data of national helplines in Sweden, Finland, and Denmark before and during the pandemic. The countries differed in their restrictions on the availability and accessibility of gambling during the pandemic.

METHODS

We performed an interrupted time series analysis of contact and web traffic data to helplines in Sweden, Finland, and Denmark before and during the COVID-19 pandemic (2017-2021). We also compared forecasted time series to the actual data to assess change.

RESULTS

The results show diverging patterns across the three countries. In Sweden, the number of helpline contacts remained stable throughout COVID-19, but there was an increasing trend in website visits. In Finland, the number of contacts declined during the first wave but rebounded during the second wave. Website visitation increased moderately. In Denmark, the number of contacts to the helpline soared over the COVID-19 period.

CONCLUSIONS

The diverging results suggest that help-seeking behaviour is likely to be impacted by differing policy approaches to gambling availability and limit-setting, visibility of helplines, and the prevalence of different forms of gambling in the three Nordic countries before and during the pandemic. This has implications for a preventive public health approach for gambling.

Effects of access to feed, water, and a competitive exclusion product in the hatcher on some immune traits and gut development in broiler chickens

This study evaluated the effect of access to feed, water, and the competitive exclusion (CE) product Broilact®, administered in the hatcher, on broiler performance, caecal microbiota development, organ development, intestinal morphology, serum levels of IgY and vaccine-induced antibody responses.In total, 250 chicks were hatched in a HatchCare^TM hatcher and divided into four groups, given access to feed, water and the CE product sprayed on the chicks (CEs); access to feed, water, and the CE product in water (CEw); access to feed and water (Cpos); or no access to feed and water (Cneg) in the hatcher. At the research facility, 10 chicks per hatching treatment were euthanized for organ measurements. The remaining 200 chicks were randomly distributed to 20 pens. On d 11, all birds were vaccinated against avian pneumovirus (APV). Three focal birds per pen were blood-sampled weekly for quantification of IgY and serum antibodies to APV. On d 11 and 32, two birds per replicate pen were euthanised for organ measurements and sample collection. Feed intake and body weight were recorded weekly.Delayed access to feed and water reduced weight gain and feed intake early in life. At the end of the study, no differences in body weight remained.There were some early effects on organs, with depressed intestinal development and higher relative gizzard weight for the Cneg group at placement. No treatment effects on the immune traits measured were detected. The relative abundance of seven bacterial genera differed between treatment groups at d 11 of age. The results suggested that chickens are capable of compensating for 40 h feed and water deprival post-hatch. Provision of Broilact® did not have any persistent performance-enhancing properties, although different outcomes under rearing conditions closer to commercial production cannot be ruled out.

Integument, mortality, and skeletal strength in extended production cycles for laying hens - effects of genotype and dietary zinc source

1. This study on long-life layers, covering the period 20-100 weeks of age, investigated longitudinal effects on mortality, layer integument, and skeletal properties in Bovans White (BoW) and Lohmann Selected Leghorn Classic (LSL), with or without supplementation with dietary organic zinc (Zn).2. Two experiments, using 1440 layers in furnished small group cages (FC) and 1836 layers in a traditional floor housing system (Floor), were run in parallel. Each replicate consisted of five adjacent cages containing eight hens in each FC, or a pen with 102 layers in the Floor group.3. Mortality was recorded daily. Integument and keel bone condition were scored at 35, 55, 85, and 100 weeks of age on 20% of the layers. Tibial strength was recorded from 933 layers at 100 weeks. Statistical analyses were performed on replicate means, with four to five and nine replicates per combination of hybrid and diet in Floor and FC groups, respectively.4. Cumulative mortality was 9.6% and 16.3% in FC and Floor, respectively, and increased in the latter part of the production cycle, particularly in the Floor group.5. In FC, LSL had inferior feather cover, less keel bone deviation, and shorter claws than BoW. In Floor, LSL had superior feather cover, less severe vent wounds, more bumble foot, and cleaner plumage than BoW. In both production systems, claws grew longer and keel bone deviation became more severe with age.6. In FC, layers fed organic Zn had lower body weight and less keel bone deviation at 100 weeks of age.7. In conclusion, keel bone integrity, claw length, and mortality rate are potential threats to welfare in long-life layers. Feather pecking is a problem that needs addressing at an early stage in the production period. On the whole, organic Zn did not improve welfare conditions in long-life layers.

Effect of hatching time on time to first feed intake, organ development, enzymatic activity and growth in broiler chicks hatched on-farm

The conventional commercial hatcheries used today do not allow the newly hatched chicks to consume feed or water. Combined with natural variation in hatching time, this can lead to early hatched chicks being feed-deprived for up to 72 h before being unloaded at the rearing site. This study investigated the effects of hatching time on time to first feed intake and development of organs, digestive enzymes and productivity in terms of growth and feed conversion ratio in chicks hatched on-farm. Chicks were divided into three hatching groups (early, mid-term and late), and assessed over a full production cycle of 34 days. The results revealed that chicks remain inactive for a considerable amount of time before engaging in eating-related activities. Eating activity of 5% (i.e. when 5% of birds in each hatching group were eating or standing close to the feeder) was recorded at an average biological age (BA) of 25.4 h and a proportion of 50% birds with full crop was reached at an average BA of 30.6 h. Considering that the hatching window was 35 h in this study, the average chick probably did not benefit from access to feed and water immediately post-hatch in this case. At hatch, mid-term hatchlings had a heavier small intestine (30.1 g/kg bw) than both early (26.4 g/kg bw) and late (26.0 g/kg bw) hatchlings. Relative length of the small intestine was shorter in late hatchlings (735 cm/kg bw) than in mid-term (849 cm/kg bw) and early (831 cm/kg bw) hatchlings. However, the relative weight of the bursa fabricii was greater in mid-term (1.30 g/kg bw) than in early hatchlings (1.01 g/kg bw). At hatch, late hatchlings were heavier than early and mid-term hatchlings (P < 0.05), but by 3 days of age early hatchlings were heavier than mid-term and late hatchlings (P < 0.01). The only effect persisting throughout the study was a difference in the relative weight of the small intestine, where late hatchlings had heavier intestines than early hatchlings (P < 0.05). Thus, while there were differences between hatching groups, this study showed that the hatchlings seemed capable of compensating for these as they grew.

Effect of a targeted treatment strategy against Ascaridia galli on egg production, egg quality and bird health in a laying hen farm

Worm control is an important aspect of the successful management of the egg production industry. Of particular concern is Ascaridia galli, which at high parasite loads affect health and production in layers. Application of a targeted treatment strategy (TT) to control A. galli has shown promise. The purpose of this study was to explore the effect of such a strategy on welfare indicators and production performance of layers. Six flocks (F1-6) on a commercial farm were allocated to three treatment groups. Flocks F1 and F4 were treated (TT) with fenbendazole at 22, 27 and 36 weeks post-placement (WPP). Flocks F2 and F5 were treated at 27 WPP (conventional treatment, CT) and hens in flocks F3 and F6 served as untreated (UT) control groups. At 19, 35 and 45 WPP twenty-five hens plus thirty eggs per flock were randomly selected. Hens were weighed and their plumage conditions (PC) were assessed. The eggs were subjected to various external and interior quality analyses. Production data such as number of eggs/hen/week, egg mass and feed conversion ratio (FCR) were calculated from raw data obtained from all flocks on a weekly basis. The number of eggs/hen/week, egg mass and FCR were higher (P < 0.05) in the TT flocks and hens had better PC both at 35 and 45 WPP compared with other flocks. No differences in body weight and physical egg quality were observed between groups except for egg shell strength which was higher (P < 0.05) in the CT flocks. These data suggest that better production performance and plumage, which suggests improved health, can be achieved through the application of a TT strategy. The insights gained from this research should help to justify the extra cost and labor associated with the TT strategy.

Silage and haylage as forage in slow and fast-growing broilers - effects on performance in Campylobacter jejuni infected birds

1. This study investigated the effects of daily intake of silage or haylage on broiler production performance and organ development. Furthermore, effects of daily intake of Lactobacillus plantarum either via silage or by supplemented drinking water, on Campylobacter jejuni loads in faeces were studied. 2. To test this, a 42-d experiment using Ross 308 and a 63-d experiment with Rowan Rangers hybrids, were performed. Silage inoculated with L. plantarum strain 256 and haylage were fed in total mixed rations with mixtures of 85% of pellets and 15% of respective forage (DM-based weight). Feed intake (FI), forage intake, body weight (BW) and feed conversion ration (FCR) were monitored weekly. Mortality was recorded daily, and organ weights were registered at slaughter. Quantification of C. jejuni was performed by colony counts from faecal samples after culture on agar plates. 3. There was a negative effect of haylage on BW and FI in the fast-growing Ross 308 hybrid. Silage had a negative effect on BW only on week four and six. Water inoculated with L. plantarum 256 increased BW in the starter period. Interestingly, no significant adverse effect of forage inclusion was observed in the Rowan Ranger birds. 4. Relative weight of the emptied gizzard was higher in both Ross 308 and Rowan Ranger birds fed haylage and silage than in the control group. In Ross 308 birds, both forages significantly reased the relative weight of gizzard with digestive content when compared to birds fed solely pellets. 5. In both studies, higher consumption of silage than haylage was observed. 6. In conclusion, daily intake of L. plantarum 256 either via silage or supplemented in drinking water, was not effective in reducing the shedding of C. jejuni in either Ross 308 or Rowan Ranger hybrids at the end of the rearing period.

Body growth, intestinal morphology and microflora of quail on diets supplemented with micronised wheat fibre

1. Particle size reductions of fibre-rich materials alter structure, functional and digestive properties. To determine the effects of using fibre as an additive in Japanese quail rations on performance and gut physiology, a trial using micronised wheat fibre (MWF) at levels of 0.0, 5, 10 and 15 g/kg in feed was conducted. 2. Growth rate and feed efficiency were significantly improved when diets contained MWF while feed intake was not affected by levels of the fibre. As MWF content increased, the relative weight of gizzard and gastrointestinal tract (GIT) significantly increased whereas liver relative weight significantly decreased. 3. MWF inclusion significantly increased relative length of gut segments, villi height, villus thickness, the villi height to crypt depth proportion in jejunum and ileum and the number of goblet cells in different parts of intestine. 4. Tibia weight, length and ash content were increased linearly with rising MWF inclusion. Litter moisture was affected by MWF inclusions in a quadratic manner. The colony forming unit (CFU/g) of Streptococci spp. in ileal digesta was decreased with increasing MWF inclusion levels in the diet. 5. In conclusion, MWF can be used as a feed additive in quail diets and its inclusion in feed resulted in better performance, beneficial changes in intestinal microbial counts and improvements in small intestine morphology.

Welfare indicators in laying hens in relation to nest exclusion

Consumer concerns about the welfare of laying hens are increasing, leading to increased interest in identifying reliable ways to assess welfare. The present study evaluated invasive and non-invasive welfare indicators in relation to a stressful challenge. The study included 126 Lohmann Selected Leghorn hens housed in furnished cages. Welfare indicators were measured between 61 and 70 wk of age in birds excluded from their nests for 5 consecutive d and control birds that had continuous access to nests. Baseline recordings were carried out in both groups prior to and post exclusion period. The assessed indicators were: corticosterone metabolites in droppings (FCM), corticosterone concentration in yolk, corticosterone concentration in plasma, irregularities of eggshells, heterophil to lymphocyte (H:L) ratio, tonic immobility duration, and feather cover. Behavioral observations showed that the birds had a clear preference for using the secluded nest sites, confirming that they were likely to perceive nest exclusion as an undesirable experience. Further, elevated levels of FCM in droppings, yolk corticosterone concentrations, H:L ratios and irregular eggshells were detected in both nest deprived and control birds during the exclusion. This suggests that these indicators were able to detect an increased stress response arising from nest deprivation, and it is hypothesized that the stress spread to birds in adjacent cages with access to nests. There was a positive and consistent correlation between FCM in droppings and eggshell irregularities, also supporting the use of eggshell irregularities as a potential non-invasive welfare indicator. However, the pattern of the stress response varied between indicators and correlations were generally few and inconsistent, highlighting the complexity of the relationship among welfare indicators.

Welfare and performance in layers following temporary exclusion from the litter area on introduction to the layer facility

When introduced to the laying facility, pullets are sometimes temporarily excluded from the litter area in order to help them locate food and water, and to prevent floor-laid eggs. This procedure is not permitted in Sweden, because it involves denying access to both litter and space, which may have a negative effect on bird welfare. The present study investigated how the welfare and performance of layers were affected by this temporary exclusion on introduction of hens to the laying facility. The study included 600 floor-reared Dekalb White layers obtained at 16 wk age and housed in 6 groups of 100 in a conventional single-tier floor-laying system. Birds were either given full access to the litter area during the whole study or were excluded from the litter area during the first 2 wk after transfer to the laying facility. From 18 to 72 wk age, birds in both treatments had full access to the litter area. Excluding birds from the litter area for 2 wk resulted in better feather cover and reduced fearfulness, according to novel object and tonic immobility tests. Furthermore, birds initially excluded from the litter area produced eggs with a lower proportion of shell irregularities than birds with full access to the litter area throughout. No difference was found in corticosterone metabolites in droppings rate of lay, mortality, or proportion of floor-laid eggs. In conclusion, none of the parameters studied indicated that the welfare of laying hens was compromised by temporary exclusion from the litter area on introduction to the laying facility. In fact, some of the data suggested that bird welfare had improved.

Corticosterone metabolites in laying hen droppings-Effects of fiber enrichment, genotype, and daily variations

There is growing interest and concern for animal welfare in commercial poultry production. To evaluate stress and welfare in an objective and noninvasive way, fecal corticosterone metabolites (FCM) in droppings can be analyzed. However, the influence of diet, genotype, and daily variations in FCM and production of droppings in laying hens has been poorly investigated. This study examined the effect of insoluble fiber by adding 3% ground straw pellets to the feed to Lohmann Selected Leghorn (LSL) and Lohmann Brown (LB) hens housed in furnished cages between 20 and 40 wk of age. In total, 960 hens were included in the study. Droppings were collected 4 times per day for 3 consecutive days and analyzed by corticosterone immunoassay. Biological validation confirmed the ability of the assay to detect changes in FCM levels. Inclusion of straw pellets in the feed increased FCM concentration in both hen genotypes and increased excretion rate of FCM in LB hens. The LB hens also produced greater amounts of droppings than LSL hens. Both FCM levels and production of droppings varied during the day, although no distinct diurnal rhythm was found. These findings demonstrate that when using FCM to evaluate stress and welfare in laying hens, many factors (e.g., diet, genotype used, and so on) need to be taken into account to allow accurate interpretation of the results. In addition, under certain conditions, excretion rate of FCM might be more appropriate to use compared with FCM concentration.

Production performance and proportion of nest eggs in layer hybrids housed in different designs of furnished cages

The aim of the study was to compare use of nests, production performance, and egg quality in 4 designs of furnished cages (FC) housing 8 (T8), 10 (T10), 20 (T20), or 40 (T40) layers. The FC housing 8 and 10 hens were commonly used in commercial egg production in Sweden, whereas the cages housing 20 and 40 hens constituted new designs, at present not allowed in Sweden. The FC also differed in design and location of litter facilities. The study comprised 2 full production cycles (20-72 wk of age). Trial 1 included 588 Hy-Line White W98 and 460 Hy-Line Brown layers, and trial 2 used 572 Lohmann Selected Leghorn and 588 Lohmann Brown layers. In accordance with Swedish prohibition, beak treatment was not conducted. In both trials production parameters and mortality were considered normal and levels were unaffected by cage design. Deaths attributable to cannibalistic pecking were rare. Overall, exterior egg quality was superior in T8 compared with T20 and T40, whereas T10 generated intermediate results. Genotype differences were found in production performance, exterior egg quality, and use of nests. In T8 and T10 at least 95% of the eggs were laid in nest whereas in T20 and T40 a considerable percentage of eggs were laid on the litter mat, constituting the litter facility in those cage models. Additional lighting of litter mats (trial 2) had no effect on layers' choice of site for egg laying. Dividing T40 cages in 2 identical cage halves by a rear partition with pop holes had no effect on any of the traits measured. In conclusion, housing larger groups of non-beak-treated hens together in FC is possible, with acceptable levels of production and mortality, provided that cannibalism does not develop. The inferior egg quality in T20 and T40, likely caused by the large proportions of misplaced eggs, needs to be considered in the further development of those cage designs.

Cardiac safety of docetaxel/cyclophosphamide/trastuzumab (DCH) as adjuvant therapy for HER-2 (+) early stage breast cancer

e11577

Background: The addition of trastuzumab to adjuvant chemotherapy is standard for Her2(+) breast cancer. In our practice, adjuvant docetaxel/cyclophosphamide (DC) + 1 yr of trastuzumab is offered to pts with low-risk Her2(+) disease. Although the HERA trial allowed the use of a variety of chemotherapy regimens to combine with trastuzumab, it predates the acceptance of DC as an adjuvant care-standard and therefore the safety profile of DCH has not been reported. Methods: We conducted a two-center, retrospective cohort study including all pts treated with adjuvant DCH between 12/06 and 3/08 to assess its safety profile. Using the CTCAE criteria, records were screened for toxicity from DCH initiation to the present. The primary outcome was cardiac toxicity defined as clinical CHF or a confirmed significant LVEF decline (≥ 16% decrease in EF from baseline or EF < 50% + ≥ 10% decrease from baseline). Results: 27 pts, mean age 54, were identified with a median follow-up of 23.4 months (range 12.2- 42.0 months). The mean tumor size was 1.4 cm (0.5–4.3 cm) with 84% hormone receptor(+), 96% node(-) and 100% Her2(+) by FISH or IHC. 52% of pts received DCH concurrently and 48% received trastuzumab following DC. Baseline mean EF was 65% (53–86%). EF assessments were performed every 3 months/pt. 7.4% and 11.1% of pts had a prior history of anthracycline exposure or cardiac disease respectively. 11.1% of pts experienced a significant LVEF decline occurring on ≥ 2 sequential EF measurements. The trastuzumab discontinuation rate was 3.7% (1 pt). No pt developed clinical CHF. 88% of pts have now completed trastuzumab therapy. 33% of pts received pegfilgrastim with chemotherapy. 25% of pts experienced grade III-IV neutropenia. Grade III-IV anemia and thrombocytopenia were not observed. Trastuzumab-related infusion reactions were observed in 1 pt and did not warrant drug discontinuation. At this time all pts are alive and no patient has experienced disease recurrence. Conclusions: The DCH regimen, given in sequence or concomitantly, appears to be a safe and effective adjuvant treatment for women with Her2(+) disease. Along with docetaxel/carboplatin/trastuzumab, DCH represents another acceptable non-anthracycline containing regimen for low-risk, Her2(+) pts.

No significant financial relationships to disclose.

Effects of litter substrate and genotype on layers' use of litter, exterior appearance, and heterophil:lymphocyte ratios in furnished cages

Effects of sand versus sawdust as a litter bath substrate in furnished cages for laying hens were studied. The study used 112 Hy-Line White (HYW) and 140 Hy-Line Brown (HYB) layers housed in 18 furnished cages with 14 hens in each cage, generating 4 or 5 replicates per combination of genotype and litter substrate. Traits studied were mortality, feather cover, hygiene of hens, pecking wounds, heterophil/lymphocyte ratios, and hens' use of litter baths. Hens' litter bath use was measured by direct observations and by use of the passive integrated transponder technique. The latter technique allowed for recording of an individual hen's visits to litter baths during the 420-d study. There were no indications of differences between sand and sawdust as litter substrates in mortality rates, exterior appearance, or heterophil/lymphocyte ratios. Litter baths with sand or sawdust were occupied to the same extent but dustbathing behaviors were more frequently seen in baths with sawdust. Hens of both lines visited the litter bath to the same extent but HYB performed more dustbathing. There was large variation in the number of days that individual hens visited litter baths; in fact, 30% of the hens never entered litter baths, whereas some hens visited baths almost every day. The HYB hens had inferior feather cover compared with HYW, indicating that feather pecking occurred more frequently in cages with brown hens. The HYW hens had lower body weight, longer claws, and more comb wounds than HYB. In conclusion, sawdust seems to be an acceptable alternative to sand as a litter substrate in furnished cages.

Pop hole passages and welfare in furnished cages for laying hens

1. This study included two designs of furnished cages for 16 hens; H-cages divided into two apartments by a partition with pop holes in the middle of the cage, and fully open O-cages, without a partition. The hypothesis was that in this rather large group of birds the pop hole partition would benefit the birds by allowing them to avoid or escape from potential cannibals, feather-peckers or aggressive hens. All cages had two nests, two perches and one litter box. 2. A total of 10 cages (5 H and 5 O) were stocked with Lohmann Selected Leghorn (LSL) and 8 cages (4 H and 4 O) with Hy-Line W36. No birds were beak-trimmed. 3. Heterophil/lymphocyte (H/L) ratios, duration of tonic immobility (TI) and exterior appearance (scoring of plumage condition and wounds at comb or around cloaca) were used as indicators of well-being. Total mortality and deaths due to cannibalism were also recorded. 4. Visits to nests and passages through partition pop holes were studied in samples of 35 and 21 birds, respectively, using a technique based on passive integrated transponder (PIT) tags. 5. Cage design (H- vs O-cage) had no effect on the welfare traits chosen. 6. Hy-Line birds showed higher H/L ratios, longer duration of TI and better plumage condition than LSL birds. These differences are discussed in terms of stress thresholds and copying strategies. 7. On days when a hen made visits to nests, the visiting frequency was 1.4 and the total time in the nest was 41 min on average. Hens made use of the pop hole passages between 1 and 8 times per hen and day. 8. Overall low levels of aggression, lack of injuries or deaths due to cannibalism, and plumage condition indicating moderate feather pecking, together imply a low need to escape. The pop holes were used frequently and birds distributed well between compartments showing that the system worked well. However, at this group size there was no evidence in the measured traits that H-cages provided a better housing environment.

Effect of nest design, passages, and hybrid on use of nest and production performance of layers in furnished cages

Production performance, including egg quality, and proportion of eggs laid in nests were studied in furnished experimental cages incorporating nests, litter baths, and perches. The study comprised a total of 972 hens of two genotypes: Lohmann Selected Leghorn (LSL) and Hy-Line White. The birds were studied from 20 to 80 wk of age, and conventional four-hen cages were included as a reference. In furnished cages for six hens, the effects of 30 or 50% vs. 100% nest bottom lining (Astro turf) were studied with LSL hens. Nest bottom lining had no significant effect on egg production or proportions of cracked or dirty eggs, but the use of nests was significantly higher in cages incorporating nests with 100% lining, compared with 50 or 30%. The two hybrids were compared when housed in large, group-furnished cages for 14 or 16 hens of two designs; with a rear partition with two pop holes or fully open, i.e., no rear partition. LSL birds produced significantly better and had a significantly lower proportion of cracked eggs. There was no difference between H- and O-cages, either in production or in egg quality. LSL birds laid a significantly lower proportion of eggs in the nests, especially in O-cages, implying a significant hybrid x cage interaction. When housed in conventional cages, the hybrids did not differ in proportion of cracked eggs but differed in production traits. It was concluded that with the present nest design, the proportion of nest bottom lining cannot be reduced without affecting birds' use of nests, but the proportion did not affect exterior egg quality. The effect of genotype should be considered in the further development of furnished cages.

Egg quality in furnished cages for laying hens--effects of crack reduction measures and hybrid

Egg quality, egg production, and hen use of facilities, with respect mainly to proportion of eggs laid in nests and bird locations after lights-out, were studied in furnished-cage models for six or eight birds. In these cages, most of the eggs are laid in the 25 cm wide nest, i.e., egg laying is concentrated to a much smaller area compared with conventional cages. The study (20 to 80 wk of age) used 1,296 hens of three genotypes Hy-Line White, Hy-Line Brown, and Lohmann Selected Leghorn. Conventional four-hen cages were included as a reference. We separately studied the effects on the proportion of eggs cracked by egg saver wires in front of the egg cradle, long nest curtains, and position of nest opening (rear or front) with 30 or 100% of the nest bottom being lined with AstroTurf. Egg saver wires and long nest curtains lowered the proportions of cracked eggs significantly by softly catching and reducing the speed of the eggs before entering the egg cradle. The position of the nest opening affected none of the measured parameters. Less lining in the bottom of the nest, i.e., a reduction to 30% coverage, resulted in significantly higher proportions of dirty eggs and lower proportions of eggs laid in nests. Hybrid differences were found in most of the measured traits. We concluded that devices like egg savers and long nest curtains are effective measures in reducing cracks in furnished cages, where egg laying is concentrated to a much smaller area than in conventional cages. Reduction of the bottom lining to 30% makes nests less attractive to birds laying eggs.

Acute renal failure and neurotoxicity following oral acyclovir

OBJECTIVE

To report a case of acute renal failure and neurotoxicity following administration of oral acyclovir.

DATA SOURCES

Medical record of the patient, case reports identified by MEDLINE.

DATA EXTRACTION

Data were abstracted from relevant published data by Johnson and reviewed by the remaining authors.

CASE SUMMARY

A 69-year-old woman was diagnosed with herpes zoster and oral acyclovir was prescribed by her local physician. After approximately two days the patient was taken to the emergency department of a local hospital with signs of acute confusion and acute renal failure. Medications included oxycodone/acetaminophen, alprazolam, prazepam, and digoxin. Pertinent laboratory abnormalities included serum digoxin 4.1 mumol/L, white blood cell count 17.6 x 10(9)/L, blood urea nitrogen (BUN) 24 mmol/L of urea, and serum creatinine 305 mumol/L (patient baseline is 11 mmol/L of urea and 91.5 serum creatinine mumol/L, respectively). Because of increasing lethargy and a focal seizure, she was transferred to our institution. Despite an extensive workup, no organic cause of her altered mental status and acute renal failure was identified. Four days after discontinuation of the acyclovir, without specific intervention, the patient's mental status improved and her BUN and serum creatinine concentrations had decreased to 21 mmol/L of urea and 190.6 mumol/L, respectively. On day 5, the patient was alert and oriented to name, place, year, and month. On day 9, her renal function and mental status had returned to baseline and she was discharged.

CONCLUSIONS

Acute renal failure and neurotoxicity are usually associated with intravenous acyclovir. The temporal relationship between the initiation of oral acyclovir therapy and the onset of adverse events, supported by published data of a few similar cases, strongly implicate oral acyclovir as the cause of this patient's acute renal failure and neurotoxicity. This case suggests that elderly patients with mild increased serum creatinine concentrations may be at increased risk and should be monitored closely for signs and symptoms of acute renal failure and neurotoxicity.

[Relationship of screening and differential diagnosis--a critical study of methods exemplified by the psychologic-neurologic questionnaire and a diagnostic psychologic follow-up program]

Considering the necessity to examine the utility of screening tests in the field the results of the Psychological-neurological Questionnaire and a specific neurotoxic test battery were compared. The statistical analysis with crosstables and discrimant analysis showed satisfying classification results. To increase the sensitivity of the screening test procedure it is necessary to include performance tests.

[Relationship between internal lead exposure and psychologic performance after occupational medicine interventions]

In order to investigate the influence of hygienic measures (mobilisation yield of lead in urine by CaEDTA, part-time work) on psychological performance 23 lead exposed workers have been psychodiagnostically investigated twice along with biological monitoring (blood lead level, erythrocyte protoporphyrine). In the pre-post comparison 4 of the 6 performance ranges measured showed distinct performance improvements, which could be shown to be statistically significant for group comparisons and in most individual cases. Parameters sensitive to changes were in the motor-sensory choice reaction, concentration and memory while subjective estimations of well-being exhibited no changes. Also after discussing methodological questions (influence of age, test repetition) the changes are interpreted in the direction of a possible reversibility of neurotoxic effects as a consequence of hygienic interventions.

Determination of the toxicity of cyclotriphosphazene hydraulic fluid by 21-day repeated inhalation and dermal exposure

Cyclotriphosphazene (CTP) ester is one of a series of compounds developed for use as a fire-resistant hydraulic fluid. The most significant routes of industrial exposure to hydraulic fluids are dermal, because of spills or leaks, and aerosol inhalation from pressurized system leaks. This study was designed to evaluate the toxic effects associated with repeated or continuous exposure to CTP by both dermal and inhalation routes. Male and female Fischer 344 (F-344) rats were exposed for 3 weeks to air alone, or to 0.25, 0.50, or 1.00 mg CTP/L. No deaths or signs of toxic stress occurred during the exposure period. A depression in mean body weight gain and increases in numbers of pulmonary alveolar macrophages and renal hyaline droplets were noted in both genders. Male and female New Zealand White (NZW) rabbits were treated dermally for 3 weeks with mineral oil, or 0.25, 0.50, or 1.00 g CTP/kg. No toxic effects were noted in either gender of rabbits.

[Psychological effects of long-term occupational whole body vibration]

Long-term effects of occupational whole-body vibration (WBV) on psychic performance and on well-being have hardly been described in the literature to date. However, they cannot be excluded, since numerous findings exist on impairments of performance and of well-being in experimentally conditioned short-term effects. Within the framework of comprehensive clearing-up diagnostics in occupational health, 20 male subjects with many years of occupational exposure to WBV were investigated according to a standardized psychodiagnostic programme of methods. The highest rate of pathological findings resulted in the areas of visual perception speed and subtle motory speed of movements. Furthermore, the results are evidence for an interrelation between the duration of exposure and disturbances in the areas of attention, as well as of sensomotory selection responses. As a whole, the results essentially affect the same psychological variables as the results of the short-term studies, but are to be evaluated with reservations on methodological grounds.

Neurotoxicity assessment of O-ethyl-O'-(2-diisopropylaminoethyl) methylphosphonite (QL) in hens

O-ethyl-O'-(2-diisopropylaminoethyl) methylphosphonite (QL), an intermediate in the formation of ethyl S-2-diisopropylaminoethyl methylphosphonothiolate, was evaluated for neurotoxicity in the adult hen. Birds were given a single oral dose of QL ranging from 635 to 6080 mg kg-1. The QL-treated hens were observed for up to 24 h after dosing for acute toxicologic effects and over a 24 d post-dose period for evaluation of delayed neurotoxicity. The oral LD50 in hens is 1186 mg kg-1. Neurologic dysfunction, as evidenced by motor incapacitation, was observed at 6 days and thereafter after treatment with QL. Neurotoxic esterase (NTE) activity was not inhibited at 24 h after exposure to compound. Neural damage, multifocal in nature, was noted in the peripheral nervous system of QL-treated hens at dose levels greater than or equal to 635 mg kg-1, oral dose. These findings indicate neural damage tendencies following QL exposure.

Modulation of venom-induced leukocyte histamine release by mononuclear cells: effect of venom immunotherapy

Leukocyte histamine release and blood mononuclear cell proliferative responses to venoms were evaluated in nine patients with sting anaphylaxis. The effect of venom-activated mononuclear cells on the autologous mononuclear cell proliferative response and venom-induced leukocyte histamine release was also studied before and on maintenance immunotherapy. The mononuclear cell proliferative response was low (specific incorporations less than 2.0) and antigen nonspecific both before and during maintenance immunotherapy. Venom-induced in vitro leukocyte histamine release did not change significantly with immunotherapy. However, when patients were on maintenance immunotherapy, venom-activated mononuclear cells cocultured with autologous leukocytes significantly (p less than 0.05) suppressed venom-induced histamine release. The suppressive effect of mononuclear cells was antigen specific and enhanced by in vitro mononuclear cell activation. Suppression of leukocyte histamine release by mononuclear cells extends the regulatory potential of these cells and may identify an additional mechanism by which immunotherapy protects Hymenoptera-sensitive individuals against systemic anaphylaxis.

Network theory in autoimmunity. In vitro suppression of serum anti-DNA antibody binding to DNA by anti-idiotypic antibody in systemic lupus erythematosus

Regulation of serum anti-DNA antibody in systemic lupus erythematosus (SLE) by an antiidiotypic antibody was evaluated. Various sera from SLE patients in active and inactive states of their disease, as well as sera from normal individuals, were first completely depleted of anti-DNA and of DNA by affinity chromatography. The suppressive capacity of equimolar concentrations of the various depleted sera (blocking sera) on target lupus sera were determined. The target sera were from lupus patients with known DNA-binding capacity. Blocking sera from inactive SLE suppressed the binding of autologous anti-DNA antibody to [(3)H]DNA (n = 19,P < 0.01). Blocking sera from active SLE (n = 19), as well as human serum albumin, did not suppress. Sera from normal donors who had no contact with lupus patients or with lupus sera did not suppress (n = 14, P > 0.5), whereas those from normal donors who had contact with lupus patients or sera did suppress the binding (n = 5,P < 0.02). The anti-anti-DNA antibody suppressive activity in the inactive lupus serum was shown to be localized within the F(ab')(2) portion of immunoglobulin (Ig)G and could not be removed upon adsorption by normal human gammaglobulin. Furthermore, immune complexes could be detected by a Clq binding assay when the inactive lupus blocking sera were incubated with the anti-DNA antibody containing target sera. The specificity of the suppressive serum factor was shown by its inability to block the binding of tetanus toxoid to antitetanus antibody and its ability to block the binding of DNA to F(ab')(2) fragments of active lupus IgG. Regulation of serum anti-DNA antibody levels by anti-antibodies could induce and maintain disease remission in lupus patients and prevent disease expression in normals.

The Effect of Bacterial Contamination and Aging on the Volatility of Mercury in Urine Specimens

The effect of specimen aging on the recovery of mercury from urine samples was investigated. It was found that in some aged specimens the addition of concentrated sulfuric acid to the urine without cooling resulted in a large loss of mercury. This phenomenon is presumed to be due to enhanced volatility of the mercury caused by bacterial action. This loss can be avoided by adding a suitable preservative to the urine, by chilling the urine while the concentrated sulfuric acid is being added, or, most conveniently, by using 50% (V/V) sulfuric acid in place of the concentrated acid. It was also found that the use of a reflux condenser is unnecessary when urine is being oxidized by heating with sulfuric acid and potassium permanganate.