Summary of the 2001-02 Pennsylvania H7N2 low pathogenicity avian influenza outbreak in meat type chickens.

H7N2 low-pathogenicity (LP) avian influenza (AI) virus was isolated from chickens submitted to the Pennsylvania Animal Diagnostic Laboratory System on December 4 and 5, 2001. The cases were from two broiler breeder flocks in central Pennsylvania that had clinical signs of an acute, rapidly spreading respiratory disease. Seroconversion to AI virus was detected on follow-up sampling. Subsequently, H7N2 LPAI virus was isolated in five different broiler flock cases submitted between December 14, 2001, and January 3, 2002. Clinical signs and lesions in broilers, when present, were compatible with multicausal respiratory disease. With the exception of one broiler flock that was processed, birds from all of the virus positive flocks were euthanatized in-house within 11 days of the original case submission date. Increased surveillance of poultry flocks within 10-mile radius zones centered at the foci of the positive farms continued until March 1, 2002. No additional cases were detected.

Nephropathogenic infectious bronchitis in Pennsylvania chickens 1997-2000.

Nephropathogenic infectious bronchitis (NIB) was diagnosed in 28 infectious bronchitis virus (IBV)-vaccinated commercial chicken flocks in Pennsylvania from December 1997 to July 2000. Early dinical signs were increased flock mortality and urinary water loss (polyuria and pollakiuria) leading to wet litter. Daily mortality ranged from 0.01% in layers to 2.45% in broilers, with total broiler mortality as high as 23%. Severe renal swelling and accumulation of urates in the tubules were commonly seen. Visceral gout and urolithiasis were less frequently observed. Histopathologic changes included characteristic tubular epithelial degeneration and sloughing with lymphoplasmacytic interstitial nephritis. Minimal respiratory disease signs were noted in broilers. Egg production and shell quality declined in layers. Confirmatory diagnosis of NIB was made by IBV antigen-specific immunohistochemical staining of the renal tubular epithelium and virus isolation. Sequencing of the S1 subunit gene of 21 IBV isolates showed the NIB outbreak to be associated with two unique genotypes, PA/Wolgemuth/98 and PA/171/99. The cases from which the genotypes were isolated were clinically indistinguishable. The NIB viruses were unrelated to previously recognized endemic strains in Pennsylvania and were also dissimilar to each other. Genotype PA/Wolgemuth/98 was isolated almost exclusively during the first 14 mo of the outbreak, whereas PA/171/99 was recovered during the final 18 mo. The reason for the apparent replacement of PA/Wolgemuth/98 by PA/171/99 is not known.

Feldenkrais sensory imagery and forward reach.

To investigate the effect of sensory imagery on subsequent movement, a unilateral Fleldenkrais lesson of imaging a soft bristle brush passing over one half of the body and in which no movement occurred, was given to 12 naive subjects. Forward flexion for each side of the body was measured at a sit-and-reach box. For 8 and 10 subjects who reported the perception of a side as being longer and lighter following the sensory imagery, there was also a significant increase in the forward flexion range on that side.

Experimental reproduction of a spiking mortality syndrome of turkeys.

Two-day-old turkey poults were inoculated with either a chicken embryo homogenate used previously to produce spiking mortality syndrome in chickens (the "Oakwood Agent") or an intestine-pancreas homogenate collected from field turkeys with the syndrome known as spiking mortality of turkeys. Twelve days postinoculation, the mean plasma insulinlike growth factor-1 (IGF-1) level and mean body weights were significantly depressed, and the mean plasma growth hormone level was significantly elevated, in the poults receiving the turkey-derived homogenate (P < or = 0.0003), as was previously reported in chickens with spiking mortality syndrome. The depression in plasma IGF-1 levels may explain the runting seen in poults that survive spiking mortality of turkeys in the field. Following a 4-hr fast and a brief cool water spraying, poults exhibited clinical signs indistinguishable from those of chicks with spiking mortality syndrome. However, plasma glucose levels in the affected poults were within the normal range, unlike chickens with spiking mortality syndrome. Immunohistochemistry on formalin-fixed intestines, ceca, and bursae produced positive staining using an arenavirus antibody in epithelial cells of poults inoculated with the turkey homogenate and those inoculated with the Oakwood Agent. Tissues of uninoculated controls were negative. Poults inoculated with the Oakwood Agent did not show noticeable disease.

Experimental reproduction of hypoglycemia-spiking mortality syndrome in broiler chickens with the use of homogenized brains containing arenaviruslike particles.

Severe hypoglycemia-spiking mortality syndrome was experimentally reproduced in broiler chicks. Inoculum was homogenized brains from 28-day-old commercial broiler chicks with central nervous system signs (50% [v/v] in phosphate-buffered saline with 2% fetal calf serum). Oral inoculations of 1.2 ml of the homogenate were given at 1 day of age to broiler chicks (n = 15). Fourteen days later, chicks were fasted and stressed with a 2-sec cool water spray. Six chicks (40%) developed clinical signs of spiking mortality syndrome and were severely hypoglycemic. Uninoculated control chicks (n = 15) from the same hatch, also fasted and stressed simultaneously, were unaffected. Examination of a banded fraction produced from the inoculum with the use of transmission electron microscopy with negative staining revealed viruslike particles indistinguishable from arenavirus particles stained and examined simultaneously. Avian encephalomyelitis virus was isolated by one of three laboratories attempting virus isolation with the use of embryonating chicken eggs.

Oncofetal fibronectin: new insight into the physiology of implantation and labor.

Oncofetal fibronectin is a newly studied protein produced by the trophoblast and is present in plasma and cervicovaginal secretions of pregnant women as labor approaches or when they have certain complications of pregnancy. Alterations in levels of oncofetal fibronectin occur in preterm labor, postterm pregnancy, and pregnancy-induced hypertension. Determining the presence or absence of full-term and preterm labor often is difficult in the clinical setting, and decision-making sometimes is hindered by the lack of a specific biochemical marker for labor. Oncofetal fibronectin may become a clinical indicator or predictor of true labor, preterm labor, or some complications of pregnancy. Assay techniques that identify clinically meaningful levels of oncofetal fibronectin are being developed and investigated and soon may be available to screen and identify pregnant women at risk. Research findings suggest new paths for investigation that may lead to important interventions in health care directed at identifying and decreasing maternal and neonatal morbidity and mortality. This article reviews pertinent aspects of placentation and the rationale for using oncofetal fibronectin detection as a clinical marker for abnormal pregnancy states.

Surgical clips in planning the electron boost in breast cancer: a qualitative and quantitative evaluation.

PURPOSE: To evaluate, qualitatively and quantitatively, the role of surgical clips in planning the tumor bed electron boost in patients undergoing breast conserving surgery and radiotherapy. METHODS AND MATERIALS: In 50 patients, the excision cavity boundaries were marked by clips at surgery. The electron boost field was first planned using clinical information, aiming to achieve a margin of 2 cm, and its accuracy evaluated by screening the surgical clips and, if necessary, adjusting the field to encompass all clips with 2 cm margins. Orthogonal radiographs were take with solder wire delineating the clinical and screened fields and the scar. Hypothetical clinical and radiological fields, with 1 and 3 cm margins, were reconstructed on the radiographs. RESULTS: The clinical field was inadequate in 34 patients (68%). The precision of each clinical setup was quantified by two indices. The Normal Tissue Index defined the percentage of the clinical field comprised of tissue, beyond the tumor bed, not at high risk of local recurrence, and gave an estimate of potential spring of normal tissue: median 14.6% (range 0-83.0), 17 out of 50 > 25%; median 13% (range 0-70.7), 12 out of 50 > 25%; median 9.7% (range 0-59.8), 10 out of 50 > 25%, for 1, 2, and 3 cm margins, respectively. The Geographical Miss Index defined the percentage of the radiologically defined field, at high risk of local recurrence, not predicted by the clinical field, and gave an estimate of the extent of geographical miss: median 32.9% (range 0-83.5), 28 out of 50 > 25%; median 26.1% (range 0-69.8%), 26 out of 50 > 25%; median 18.6% (range 0-60.3), 20 out of 50 > 25%, for 1, 2, and 3 cm margins, respectively. The median distance from the scar midpoint to the furthest clip was 3.8 (range 1.2-8.1) cm. The median maximal clip depth was 3.1 (range 1.4-5.2) cm. CONCLUSION: (a) Electron boost field planning by clinical landmarks alone was inaccurate in 68% of cases. (b) Quantitative measures, based on margins of 1, 2, and 3 cm, revealed that in 20-34% of patients more than one-quarter of the clinical field covered tissue at low risk of local recurrence, and in 40-56% of patients less than three-quarters of the final radiological field was predicted clinically. (c) The relative positions of the scar and clips may be widely disparate. (d) Clip depth measurements reveal a significant risk of underdosing at depth.

Experimental reproduction of severe hypoglycemia and spiking mortality syndrome using field-derived and embryo-passaged preparations.

The clinical signs, enteritis, weight depression, and hypoglycemia of spiking mortality syndrome were experimentally reproduced in broiler breeders and broiler chicks. Inocula included 1) virus-like particles from intestines of chicks with spiking mortality syndrome that had been banded in a discontinuous Renograffin gradient, 2) homogenized darkling beetles collected from litter of farms where spiking mortality syndrome had occurred repeatedly, and 3) homogenized embryos which had been inoculated with the Renograffin-banded material. Arkansas variant infectious bronchitis virus and arenavirus-like particles were identified in the inocula. Serology on samples from surviving chicks suggested the presence of an avian encephalomyelitis virus in one of the inocula. One-day-old (n = 172) and 2.5-day-old (n = 30) chicks were inoculated orally, and some were also injected intraperitoneally or subcutaneously, with 0.5 ml of the inocula. Twelve to fourteen days postinoculation, chicks were fasted for 4-6 hours, then briefly stressed with a cool water spray. Within 1.5 hours, inoculated chicks began dying with severe hypoglycemia and clinical signs of spiking mortality syndrome. Body weights were significantly depressed. Uninoculated controls (n = 130) from the same hatches, also fasted and stressed, were unaffected clinically and were not hypoglycemic. One group (n = 52) of inoculated chicks exposed to a controlled lighting program was unaffected clinically, had significantly higher mean plasma glucose levels, and had significantly less body weight depression than chicks exposed to continuous lighting. We concluded that exposure to controlled amounts of light/darkness can ameliorate much of the hypoglycemia, mortality, and runting-stunting associated with spiking mortality syndrome of chickens. The significance of the viruses and virus-like particles detected in the inocula is currently under investigation.

Physiologic and electrocardiographic changes occurring in broilers reared at simulated high altitude.

An experiment was conducted to determine whether differences in the electrocardiograms (EKGs) of broilers reared at simulated high altitude from the day of hatch can be used to predict which birds are developing ascites. In three replicate experiments, conducted with 100 broilers per replicate, birds were reared at a simulated altitude of 3000 meters or at ambient atmospheric pressure. Lead I, II, and III EKGs were obtained from all birds on days 0, 14, 28, and 42. No consistent significant differences were seen on day 0 in the amplitude of the R or S wave or total amplitude of the QRS complex when broilers that developed ascites while being reared at simulated high altitude were compared with unaffected birds reared at simulated high altitude and with birds reared at ambient atmospheric pressure. On days 14 and 28, the average amplitude of the S wave and the total amplitude of the QRS complex were significantly higher in the ascites group than in the two other groups. Packed cell volumes were significantly higher in birds reared at simulated high altitude at all sampling days (days 14, 28, and 42) than in those reared at ambient atmospheric pressure, and they were significantly higher in the ascites group on day 28 than in the two other groups. Birds in the ascites group weighed significantly less than the two other groups by day 14, and this trend persisted.

Framework for analyzing an ethical problem and conducting an ethical consultation.

Clinical ethics are an intrinsic aspect of practice in health care settings. However, health care professionals may have minimal training in ethics and communication. Clinical ethics committees, with a multidisciplinary composition, are in a position to offer clinical consultative services from a collaborative framework. Using this framework, as well as standard guidelines for conducting an ethics consultation, most often elicits essential beliefs, values, concerns, and opinions pertinent to the case at hand. Through enhancement of the communication process, group consensus is usually achieved. The framework guiding the consultation and communication process is delineated and illustrated through case analysis.

Maternal hypothermia: implications for obstetric nurses.

Hypothermia, a core body temperature of less than 95 degrees F (35 degrees C), is a common intraoperative complication among adult patients and may occur in obstetric patients. Obstetric patients are predisposed to hypothermia because of vasodilation from pregnancy, administration of anesthetics and pharmacologic agents, and inherent blood loss with rapid fluid replacement during delivery. Morbidity associated with hypothermia occurs from complications such as hypotension, cardiac arrhythmias, increased oxygen consumption or respiratory depression, and disseminated intravascular coagulation. Interventions include preventive measures such as maintaining reasonable ambient room temperatures, avoiding infusion of cold solutions, and promptly assessing postoperative temperature, as well as corrective measures--rewarming the patient, placing the patient on dry surfaces, minimizing additional heat loss, and providing external heat sources.

Induction of oral lesions in broiler chicks by supplementing the diet with copper.

Copper sulfate was added to the diet of broiler chickens from 1 day to 3 weeks of age at the rate of 0.05% to 0.20% in order to evaluate its influence on the incidence of oral lesions. Both the incidence and severity of oral lesions showed a significant linear increase as the concentration of copper sulfate increased. Adding a level of sulfate equivalent to that produced by the highest level of copper sulfate failed to induce oral lesions. The severity of gizzard erosion also increased as the concentration of copper increased. Dietary copper sulfate supplementation should be considered a possible cause of oral lesions seen during the necropsy of avian species.

Observations on colonial phenotypic variation in Bordetella avium.

Two forms of Bordetella avium colonial morphology on artificial media were observed. The smooth colonial morphology is convex, with an entire edge, and has a glistening mucoid appearance when cultured on 5% bovine blood agar or tryptic soy agar. On the same media, the rough morphology has a crenated edge, a flat surface, and sometimes a wrinkled or ground-glass appearance to the surface. Colonial morphology remained stable when cultures were passaged at 37 C every 48 hours. When different salts or crystal violet were added to the media, the colonial morphology of seven different isolates did not change. Following storage at 4 C on agar, B. avium isolates switched between the smooth and rough colonial morphology, indicating that this is a reversible process. Generally, bacteria with the smooth colonial morphology were motile on sulfide indole motility (SIM) media, whereas bacteria with the rough colonial morphology were non-motile. Only the isolates with the smooth colony type colonized the upper respiratory tract of turkeys, caused clinical signs of the disease, and elicited an agglutinating antibody titer by 21 days postexposure.

Transcutaneous electrical nerve stimulation at acupuncture points in the induction of uterine contractions.

The effectiveness of transcutaneous electrical stimulation at acupuncture points for increasing uterine contractions in 20 post-dates pregnant women was assessed in a controlled study. Subjects were randomly assigned to either a treatment condition, consisting of the application via surface electrodes of a 30-Hz current to the points "spleen 6" (lower leg) and "liver 3" (foot), or a placebo condition, in which the equipment was attached but not activated. The frequency and strength of uterine contractions were monitored for 1 hour prior to stimulation and then for the final 2 hours of a 4-hour test period. A significant increase in frequency and strength of uterine contractions was found in the electrically stimulated women compared with the placebo-group women. The possible physiologic mechanisms underlying this effect, and its implication for labor induction, are discussed.

Care of the neonate with erythroblastosis fetalis.

Erythroblastosis fetalis, hemolytic disease of the newborn, occurs when an isoimmunized mother produces antibodies that cross the placenta and cause hemolysis of fetal red blood cells. This hemolysis can be accompanied by severe anemia, ascites, pleural and pericardial effusions, congestive heart failure, and neurological damage with resultant perinatal mortality. Rh isoimmunization in pregnancy still occurs in spite of the advent of Rh immune globulin. This article describes the complex management and nursing implications associated with caring for the neonate with erythroblastosis fetalis.

Percutaneous umbilical blood sampling.

Percutaneous umbilical blood sampling (PUBS) provides a new and exciting method for assessment and management of certain fetal disorders. This procedure offers direct access to the fetal circulation for obtaining blood samples or for transfusing the fetus in utero. Although investigational, PUBS offers treatment approaches that were not previously available. This ability to treat the fetus in utero can prolong pregnancy, resulting in decreased prematurity and mortality rates for infants with erythroblastosis fetalis. This article describes the PUBS procedure and the indications for PUBS and discusses the nursing implications associated with the care of women undergoing PUBS.