Potential involvement of Neospora caninum in naturally occurring ovine abortions in New Zealand.

Neospora caninum is an obligate intracellular parasite and is recognised as the leading cause of bovine abortion worldwide. Natural infection with N. caninum has been described in sheep but it has generally not been regarded as a significant cause of abortion. Recently, there have been several New Zealand cases of foetal abortions where N. caninum was detected which strongly suggested the involvement of Neospora in these abortions. However, there is minimal information about the prevalence of N. caninum infection naturally occurring in New Zealand sheep flocks and particularly its impact on reproduction success. Thus, this present study provides preliminary data on the role that Neospora is playing in ovine reproductive failure by establishing the prevalence of N. caninum antibodies and DNA in ewe blood and foetal material present in 21 New Zealand sheep farms with ongoing unexplained abortion problems and 10 farms with consistently high fertility levels. The results of this study demonstrated an overall seroprevalence of 1.4% which varied between Aborting/non-pregnant (1.8%), age-matched pregnant controls (0.6%) and high fertility (2.1%) ewes. However, despite the variation observed, there was no statistical difference between the three groups. In addition, Neospora DNA was detected by PCR in 13% of submitted foetal brains and in ewe blood from aborting/non-pregnant (6.9%), age-matched pregnant controls (3.6%) and high fertility pregnant (2.1%) ewes. When the PCR results were considered with the IFAT and IDEXX ELISA results, there was no correlation between serology positive and PCR positive blood samples. Taken together, these results reveal that reliance on ELISA-based serology or PCR alone may underestimate the involvement of Neospora. Furthermore, determining the involvement of Neospora appears to require a multi-facetted approach where diagnostic methods and serological cut-off values may need to be adjusted as further information about the effect of natural infections with N. caninum in the ovine host is elucidated.

Dose-titration challenge of young pregnant sheep with Neospora caninum tachyzoites.

Pregnant ewe lambs (7-8 months old at breeding) were inoculated intravenously at 90 days after joining with the ram with 50, 5 x 10(3), 10(6), or 10(8)Neospora caninum tachyzoites and outcomes were compared to a control group. Seroconversion was measured by indirect fluorescent antibody test (IFAT) at fortnightly intervals and by enzyme-linked immunosorbent assay (ELISA) at 28 days post-challenge. Seroconversion (by IFAT) occurred in all animals except for 2 sheep in the lowest dose group, including the 9 sheep in the control group. IFAT antibody titres rose and fell rapidly, peaking at 1:800 and in 8 animals was negative within 7 days of abortion. ELISA results more closely reflected infection dose and outcome of pregnancy than IFAT serology did. All 10 ewes in each of the 2 highest dose groups aborted, 5 of 10 ewes in the mid-dose group aborted and no ewes in the lowest dose or control groups aborted. Histological lesions consistent with N. caninum infection were seen in the brains of all 25 aborted lambs, as well as in 2 live-born premature lambs from the group receiving 5 x 10(3) tachyzoites and 2 clinically normal lambs (one from the control group). Polymerase chain reaction (PCR) detected N. caninum DNA in a variety of tissues from lambs, aborted foetuses and dams including 3 of 9 ewe-lamb pairs from the control group. The results from this study showed a strong relationship between challenge dose of N. caninum tachyzoites, the sample to positive (S/P) percentage in an ELISA test 28 days after challenge and pregnancy outcome. IFAT results did not correlate well with the level of challenge or the outcome of pregnancy and their relevance in studies of this kind should be questioned.

The internervous safe zone for incision of the capsule of the hip. A cadaver study.

In order to determine the potential for an internervous safe zone, 20 hips from human cadavers were dissected to map out the precise pattern of innervation of the hip capsule. The results were illustrated in the form of a clock face. The reference point for measurement was the inferior acetabular notch, representing six o'clock. Capsular branches from between five and seven nerves contributed to each hip joint, and were found to innervate the capsule in a relatively constant pattern. An internervous safe zone was identified anterosuperiorly in an arc of 45 degrees between the positions of one o'clock and half past two. Our study shows that there is an internervous zone that could be safely used in a capsule-retaining anterior, anterolateral or lateral approach to the hip, or during portal placement in hip arthroscopy.

Impact of the Choice on Termination of Pregnancy Act on maternal morbidity and mortality in the west of Pretoria.

AIM: To evaluate the impact of the Choice on Termination of Pregnancy Act on maternal morbidity and mortality in the west of Pretoria. SETTING: Indigent South Africans managed in two public hospitals in the west of Pretoria. METHOD: Data were collected on all abortions (incomplete or induced) treated in the hospitals in the study area in 1997-1998 and 2003-2005. All cases of severe acute maternal morbidity and maternal deaths due to abortion were identified for these time periods. Data exclude referrals from outside the west of Pretoria. OUTCOME MEASURES: The case fatality rate (CFR), mortality index (MI) and maternal mortality ratio (MMR) due to abortions. RESULTS: In 1997-1998 there were 2 050 abortions, of which 80.2% were regarded as being incomplete, and in 2003-2005 there were 3 999 abortions, of which 42.8% were regarded as incomplete. Twenty-four women who were critically ill due to complications of abortion presented in 1997-1998 (a rate of 3.05/1 000 births), compared with 50 (2.76/1 000 births) in 2003-2005. There were 5 deaths in 1997-1998 (CFR of 2.4/1 000 abortions) compared with 1 death in 2003-2005 (CFR 0.25/1 000 abortions) (p = 0.01, relative risk (RR) 0.1, 95% confidence interval (CI) 0.01 - 0.89). The MI fell from 21.7% to 2.0% (p = 0.02, RR 0.1, 95% CI 0.01 - 0.89). The MMR was 63.6/100 000 births in 1997-1998 compared with 5.54/100 000 in 2003-2005 (p = 0.017, RR 0.09, 95% CI 0.01 - 0.74). CONCLUSION: The introduction of the Choice on Termination of Pregnancy Act has been associated with a massive reduction in women presenting with incomplete abortions. The prevalence of critically ill women due to complications of abortion has not changed, but the CFR, MI and MMR have declined significantly.

Measurement and control of dissolved carbon dioxide in mammalian cell culture processes using an in situ fiber optic chemical sensor.

At high viable cell concentrations in large-scale mammalian cell culture processes, the accumulation of dissolved carbon dioxide (dCO(2), typically quantified as an equilibrium gas-phase concentration) becomes problematic as a result of low CO(2) removal rates at reduced surface-to-volume ratios. High dCO(2) concentrations have previously been shown to inhibit cell growth and product formation in mammalian cells and to alter the glycosylation pattern of recombinant proteins. Therefore, reliable monitoring and control of dCO(2) are important for successful large-scale operation. Off-line measurements by instruments such as blood gas analyzers (BGA) are constrained by the low frequency of data collection and cannot be used for on-line control. In a preliminary evaluation of the YSI 8500 in situ sensor, a response time (t(90%)) of 6 min, sensitivity of 0.5% CO(2) (3.6 mmHg), and linearity of measurement (R(2) = 0.9997) between the equivalent gas-phase partial pressure of 0-180 mmHg (0% and 25% CO(2)) were established. Measurements were found to be unaffected by culture pH and typical mammalian cell culture concentrations of glucose, glutamine, glutamate, lactate, and ammonium. The sensor withstood repeated sterilization and cleaning cycles. The reliability of this sensor was demonstrated in microcarrier-based Chinese hamster ovary (CHO) cell perfusion cultures at reactor scales of 30, 40, 340, and 2000 L and was successfully implemented in a dCO(2) control strategy using N(2) sparging.

Growth, biomass allocation and photosynthesis of invasive and native Hawaiian rainforest species.

Growth, biomass allocation, and photosynthetic characteristics of seedlings of five invasive non-indigenous and four native species grown under different light regimes were studied to help explain the success of invasive species in Hawaiian rainforests. Plants were grown under three greenhouse light levels representative of those found in the center and edge of gaps and in the understory of Hawaiian rainforests, and under an additional treatment with unaltered shade. Relative growth rates (RGRs) of invasive species grown in sun and partial shade were significantly higher than those for native species, averaging 0.25 and 0.17 g g-1 week-1, respectively, while native species averaged only 0.09 and 0.06 g g-1 week-1, respectively. The RGR of invasive species under the shade treatment was 40% higher than that of native species. Leaf area ratios (LARs) of sun and partial-shade-grown invasive and native species were similar but the LAR of invasive species in the shade was, on average, 20% higher than that of native species. There were no differences between invasive and native species in biomass allocation to shoots and roots, or in leaf mass per area across light environments. Light-saturated photosynthetic rates (Pmax) were higher for invasive species than for native species in all light treatments. Pmax of invasive species grown in the sun treatment, for example, ranged from 5.5 to 11.9 µmol m-2 s-1 as compared with 3.0-4.5 µmol m-2 s-1 for native species grown under similar light conditions. The slope of the linear relationship between Pmax and dark respiration was steeper for invasive than for native species, indicating that invasive species assimilate more CO2 at a lower respiratory cost than native species. These results suggest that the invasive species may have higher growth rates than the native species as a consequence of higher photosynthetic capacities under sun and partial shade, lower dark respiration under all light treatments, and higher LARs when growing under shade conditions. Overall, invasive species appear to be better suited than native species to capturing and utilizing light resources, particularly in high-light environments such as those characterized by relatively high levels of disturbance.

Postoperative radiographs or thermal prints after internal fixation of fractures? A study of DHS fixation of hip fractures.

Immediate postoperative radiographs confirm the quality of reduction and fixation of fractures. This information is already available from the image intensifier and can be saved as hard copy thermal prints. If thermal prints give the surgeon the necessary patient and clinical information them immediate postoperative radiography should not be required. In this retrospective study of 20 hip fractures treated by dynamic hip screw (DHS) fixation, plain radiographs and thermal prints were compared for the patient and clinical information they contained. Thermal prints were found to be deficient in some areas but, nevertheless, can potentially replace postoperative radiographs in many orthopaedic procedures saving time, money and radiation exposure.

Septic arthritis in haemophilia.

Septic arthritis has been regarded as rare in haemophiliacs, but its incidence may have increased since HIV infection has become widespread in these patients. We describe six cases treated at one haemophilia unit over a two-year period and discuss their investigation, diagnosis and treatment. Four of the patients were seropositive to anti-HIV.

The effects of market structure and bargaining position on hospital prices.

PPOs and HMOs have gained widespread acceptance due in part to the belief that excess capacity and competitive market conditions can be leveraged to negotiate lower prices with health care providers. We investigated prices obtained in different types of markets by the largest PPO in California. Our findings indicate that greater hospital competition leads to lower prices. Furthermore, as the importance of a hospital to the PPO in an area increases, the price rises substantially. Our testing of alternative methods for defining hospital geographic markets reveals that the common practice of using counties to define the market leads to an underestimate of the price-increasing effects of a merger.

Investor-owned and not-for-profit hospitals. A comparison based on California data.

The growth of investor-owned hospital-management companies represents the most dramatic change in the hospital industry in recent years. Whereas supporters of investor-owned chains suggest that their growth is attributable to operating efficiencies, critics suggest that it has resulted from pricing and marketing strategies. Using data supplied by the California Health Facilities Commission, we compared the economic performance of investor-owned and not-for-profit hospitals in California. There were three principal findings. First, during the study period both costs and charges were higher in for-profit than in not-for-profit hospitals, measured on the basis of either patient-days or admissions. Second, the for-profit chains have used aggressive marketing and pricing strategies to generate high rates of profitability and growth. Finally, the payer class of patients did not differ specifically according to the hospital-ownership category. We conclude that the recent dramatic growth of investor-owned hospital chains is attributable to the employment of managerial strategies that were well suited to the reimbursement system in effect during the period studied. As a result of recent changes in federal and state reimbursement, many of these reimbursement-maximization strategies have become obsolete. Whether the investor-owned chains will be able to adapt rapidly to this new reimbursement environment remains to be seen.