Governing health data across changing contexts: A focus group study of citizen's views in England, Iceland, and Sweden.

BACKGROUND: The governance structures associated with health data are evolving in response to advances in digital technologies that enable new ways of capturing, using, and sharing different types of data. Increasingly, health data moves between different contexts such as from healthcare to research, or to commerce and marketing. Crossing these contextual boundaries has the potential to violate societal expectations about the appropriate use of health data and diminish public trust. Understanding citizens' views on the acceptability of and preferences for data use in different contexts is essential for developing information governance policies in these new contexts. METHODS: Focus group design presenting data sharing scenarios in England, Iceland, and Sweden. RESULTS: Seventy-one participants were recruited. Participants supported the need for data to help understand the observable world, improve medical research, the quality of public services, and to benefit society. However, participants consistently identified the lack of information, transparency and control as barriers to trusting organisations to use data in a way that they considered appropriate. There was considerable support for fair and transparent data sharing practices where all parties benefitted. CONCLUSION: Data governance policy should involve all stakeholders' perspectives on an ongoing basis, to inform and implement changes to health data sharing practices that accord with stakeholder views. The Findings showed that (1) data should be used for ethical purposes even when there was commercial interest; (2) data subjects and/or public institutions that provide and share data should also receive benefits from the sharing of data; (3) third parties use of data requires greater transparency and accountability than currently exists, (4) there should be greater information provided to empower data subjects.

Characterization of Clostridium perfringens recovered from broiler chicken affected by necrotic enteritis.

Necrotic enteritis (NE) caused by Clostridium perfringens has emerged as an important disease associated with major economic losses in the poultry industry worldwide. The ban and voluntary withdraw of antimicrobial growth promoters used to control NE have resulted in resurgence of NE. Moreover, consumer demand for antibiotic free poultry product has continued to grow. The presence of the netB gene encoding for pore forming toxin in C. perfringens has been shown to be essential for pathogenesis of NE. The aim of this study was to characterize C. perfringens isolates recovered from broiler chickens affected by NE. A total of 230 isolates obtained from commercially raised broilers between 3 and 4 wk of age affected by NE were characterized using multiplex PCR (mPCR) and antibiotic susceptibility test. A subset of isolates (n = 75) were analyzed using pulsed-field gel electrophoresis (PFGE). Toxin typing using mPCR revealed that all C. perfringens isolates were toxinotype A. However, 68% (59 of 85) of the isolates from apparently healthy birds and 81% (119 of 145) from dead birds were positive for netB gene. Antimicrobial susceptibility testing using a disk diffusion method indicated that 53% of the isolates had a multidrug resistant profile that comprised of streptomycin, gentamicin, erythromycin, tetracycline, and bacitracin. PFGE analysis of 53 typeable isolates indicated a wide genetic relatedness even among isolate from the same state with the same antibiotic resistance profile. The results obtained from this study suggest that the presence of C. perfringens with netB gene in broiler chicken does not automatically result in death but other factors such as health of the bird before proliferation of virulent C. perfringens may be critical for development of NE.

Evaluation of probiotic administration on the immune response of coccidiosis-vaccinated broilers.

Probiotics are nonpathogenic bacteria that can promote bird health by reducing pathogen colonization. Researchers have previously demonstrated that the avian immune response can be modulated with probiotics, which may provide a mechanism for the reported reductions in pathogens. We examined phagocyte oxidative burst and cell proliferation of vaccinated broilers administered probiotics. We hypothesized that the combination of probiotic bacteria and a vaccine would affect immune function. Two studies were conducted to evaluate this interaction in broilers. Treatments consisted of a negative control, probiotic, vaccine, or a probiotic + vaccine. Peripheral blood was collected on d 7, 14, and 21 of age. Heterophils and monocytes were evaluated for oxidative burst and lymphocytes were assayed for proliferation. In study 1, heterophil oxidative burst was higher (P ≤ 0.05) in each treatment that received probiotic on d 14 when compared with the negative control. On d 21, an enhanced (P ≤ 0.05) heterophil oxidative burst was observed in the probiotic treatment when compared with the other treatments. On d 14, monocyte oxidative burst was greater (P ≤ 0.05) in the probiotic + vaccine treatment when compared with all other treatments. An increase (P ≤ 0.05) in lymphocyte proliferation was observed among all treatments on d 7 when compared with the negative control. Both vaccine treatments had significant lymphocyte proliferation on d 14 when compared with the negative control. In study 2, the probiotic treatment was associated with greater levels in heterophil oxidative burst on d 7 when compared with all other treatments. On d 21, an increase (P ≤ 0.05) in heterophil oxidative burst was seen in the vaccine treatment when compared with the negative control. On d 7, increased (P ≤ 0.05) monocyte oxidative burst was observed in the vaccine treatment when compared with the negative control. No significant differences were observed in lymphocyte proliferation in any of the treatment groups. These data suggest that probiotics can modulate the immune response and may play a role in vaccination.

Eimeria tenella oocyst shedding and output in cecal or fecal contents following experimental challenge in broilers.

Two experiments were conducted to determine whether Eimeria tenella oocyst output in cecal and fecal contents, lesion development, and performance characteristics were affected by ad libitum versus restricted feeding and challenge level. In experiment 1, 144 Cobb 500 males were placed in battery cages with 6 chicks/pen. On d 20, half of the battery pens were placed on feed restriction and all broilers were orally challenged with Eimeria tenella oocysts at one of 3 challenge levels (0, 5,000, or 20,000 sporulated oocysts). Cecal and fecal material were collected separately from d 4 postchallenge through d 10 postchallenge for oocysts output (oocysts shed/g) determination. Six days postchallenge, 3 broilers from each pen were removed and subjected to necropsy for lesion assessment. In experiment 2, 96 Cobb 500 males were placed in identical battery pens with 8 chicks/pen. On d 14, restricted feeding was initiated and broilers were challenged with Eimeria tenella oocysts at one of 3 challenge levels (1,000, 5,000, or 20,000 oocysts). Twenty-four hour collections of cecal and fecal material were obtained separately from d 4 postchallenge through d 10 postchallenge for oocysts per gram and total output determination. Six days postchallenge, 4 broilers from each pen were removed and subjected to necropsy for lesion assessment. In both experiments, BW gain was not affected by challenge dose in either the ad libitum-fed or restrict-fed broilers. Increased lesion development was observed with increasing challenge levels, and oocyst shedding peaked between d 7 and 9 postchallenge in both experiments. Oocyst concentration was higher in cecal droppings compared with fecal material throughout peak shedding; however, total oocyst output for the challenge period was similar between fecal material and cecal droppings.

Brain metastases in renal cell carcinoma: management with gamma knife radiosurgery.

PURPOSE: The purpose of this study was to evaluate survival and local control of brain metastases in patients with renal cell carcinoma. METHODS AND MATERIALS: From November 1993 through March 1999, 38 radiosurgical treatments using the Leksell gamma knife unit were performed on 22 patients with renal cell carcinoma. The indications for treatment were failure after whole-brain radiation therapy or de novo treatment. All radiosurgical treatments were given on an outpatient basis. The workup included computed tomography and magnetic resonance imaging. The age of the patients ranged from 38 to 80 years (median age, 60 years). The mean minimum tumor dose was 18 Gy, and the mean volume was 3.9 cc. Previous whole-brain radiation therapy was used in 11/22 (50%) patients. Four of 22 patients presented with single metastasis. Thirteen patients were treated once, one patient was treated four times and one patient seven times for new lesions. The number of lesions treated ranged from one to 21. RESULTS: One patient is al ive at 63 months of fol low-up. Twenty-one patients died, with a median survival of 8 months (range, 1-38 months). Eighteen of 21 patients died of nonneurologic causes. Overall local control was 98.5%. One patient developed radiation necrosis. CONCLUSIONS The long-term survival achieved in patients with renal cell carcinoma requires aggressive management, even in the presence of multiple brain metastases. Gamma knife radiosurgery for renal cell carcinoma is an effective noninvasive modality of treatment. It offers high local control rate and improved quality of life and survival.

Gamma knife radiosurgery in the treatment of patients with single and multiple brain metastases from carcinoma of the breast.

PURPOSE: The purpose of the study was to evaluate the results of gamma knife radiosurgery for treatment of brain metastases from carcinoma of the breast. MATERIALS AND METHODS: From December 1993 to July 1998, 68 women with breast carcinoma metastatic to the brain were treated with gamma knife radiosurgery at Miami Neuroscience Center in Coral Gables, Florida. The ages ranged from 25 to 80 years, with a median age of 52 years. Thirty-eight patients had previously received conventional modalities of treatment for brain metastases including whole-brain irradiation. A total of 110 treatments were given to the 68 women to an average of eight tumor sites per patient. Minimum doses ranged from 6 to 25 Gy to the 35% to 85% isodose line, with 95% of the prescribed minimum doses ranging from 15 to 24 Gy. Patients were treated for one to three lesions (n = 26), four to seven lesions (n = 18), and eight or more lesions (n = 24). RESULTS: The median overall actuarial survival for the entire group was 7.8 months. The actuarial survival was 32% at 1 year. The median follow-up was 7.8 months. Overall local control by lesion was 94% (485/518 lesions), and average tumor volume was 3.3 cm3. Twenty-seven (40%) of 68 eligible patients survived 1 year, nine (13%) survived 2 years, and two (3%) survived more than 3 years. Fifty-one of 56 documented deaths (91%) were unrelated to brain metastases. In a subgroup of 15 patients with single brain metastases, the average tumor volume was 16.6 cm3, and local control was 73% (11/15 lesions). The 15 patients who died had a median survival of 7.7 months (range, 3 to 45.7 months). CONCLUSIONS: Gamma knife radiosurgical treatment of patients with brain metastases from carcinoma of the breast has shifted the question of survival to that of systemic control. There was no radiation-induced dementia, and a remarkably low incidence of local failure was seen. Survival has been found to be independent of the number of lesions treated.

Effects of roxarsone and monensin on digital flexoral tendons of broiler chickens.

Roxarsone and monensin are common poultry feed additives that are used alone or in combination with other drugs to improve growth and feed utilization in young birds. The effects of monensin and roxarsone on the physiology of flexoral tendons of broiler chickens were examined to understand their relationships to leg weakness that have been occasionally associated with these drugs. Day-old chickens were fed either roxarsone or monensin for a period of 6 wk with two regimens of each of the drugs (roxarsone, 45.4 or 90.8 g/ton feed; monensin, 100 or 150 g/ton feed). None of the treatments had any adverse effect on the growth of the birds or caused any significant leg problem. Roxarsone at 45.4 g/ton caused a significant gain in body weight. The biomechanical strength of digital flexoral tendons was measured in several ways. There were no statistical differences in load at break, the modulus of elasticity, or stress or strain levels between different treatment groups and birds that received no medication. There were no differences in collagen, proteoglycan, and pyridinoline content of tendons. Sequential extraction of tendons with different solvents revealed a significant increase in the percentage of guanidine HCl extractible collagens in monensin-treated birds, and a decrease in the acid extractible collagen in both roxarsone- and monensin-treated groups. The relative content of collagen in acid extractible collagens were significantly small relative to total collagen content. Majority of collagen (84 to 90%) was extractible with pepsin. About 8 to 11% of total collagen was resistant to pepsin that was extractible with collagenase; this did not differ between treatment groups. Roxarsone treatment had no effect on the guanidine soluble collagen pool. The effect of monensin on the increase in guanidine soluble pool of collagen may relate to its disruptive effects on cellular secretory processes, which may be of significance in modulating connective tissue function in conjunction with other factors. However, in the present study, neither roxarsone nor monensin alone produced any significant leg problems nor caused any significant differences in the physiology of flexoral tendons or altered their biomechanical properties.

Intrastrain variation of lipopolysaccharide of Pasteurella multocida in turkeys.

OBJECTIVE: To document intrastrain variation of lipopolysaccharide (LPS) in Pasteurella multocida and correlate these changes with changes in determinants associated with virulence. ANIMALS: 25 broad-breasted white turkeys. PROCEDURE: Phenotypic bacterial variants were identified by lectin affinity and were assayed for adherence to epithelial cells and complement resistance in vitro. The LPS purified from these variants was subjected to polyacrylamide gel electrophoresis and lectin affinity analysis. Turkeys were challenge exposed, then observed for 1 week. At first sign of disease, or at the end of the study, turkeys were euthanatized, necropsied, and inspected for gross lesions. RESULTS: The LPS variant designated as Ricinus communis agglutinin-positive had greater adherence to epithelial cells, complement resistance, and virulence in turkeys than did the variant designated as R communis agglutinin-negative. CONCLUSIONS: Intrastrain variation of LPS exists in P multocida, and changes in LPS are correlated with changes in virulence.

Interleukin-2 is found in the synovium of psoriatic arthritis and spondyloarthritis, not in rheumatoid arthritis.

Objective of this project was to determine whether synovial expression of interleukin-2 (IL-2) in arthritis is a disease-specific phenomenon. Immunohistological examination of needle biopsies from 7 rheumatoid arthritis (RA) patients never exposed to disease modifying antirheumatic drugs (DMARDs), 13 RA patients on DMARDs, 4 patients with seronegative spondyloarthritis (SpA), and 5 psoriatic arthritis (PsA) patients. Biopsies were either snap-frozen immediately or cultured for 48 hr, with and without phytohaemagglutinin (PHA) prior to APAAP staining. In snap-frozen biopsies, IL-2 was detected in none of 18 RA samples with significant T cell infiltrates. In contrast, IL-2 was seen in 7/9 PsA/SpA samples. After culture without PHA, IL-2 was detected in 0/14 RA and 5/6 PsA/SpA samples; with PHA, IL-2 was present in 1/14 RA and 2/2 PsA/SPA samples. Synovial IL-2 protein expression appears to distinguish between RA (absent) and PsA/SpA (present). This may reflect a difference in pathophysiology between these diseases.

Anomalous primary radiation from the Leksell Gamma Knife Unit.

The Leksell Gamma Knife Unit, Type U, utilizes 201 separate 60Co sources intersecting at a common focus for radiosurgical treatment of the brain. It has been generally understood that all primary unattenuated radiation beams are confined within the protective housing during all phases of Gamma Knife operation. We have found that when the unit's shielding door is lowered for treatment, twelve primary beams exit the unit's door opening. Furthermore, in the original Gamma Knife unit design, two of the twelve primary beams failed to be attenuated by either the unit base or the unit wings. This has implications for the design of structural shielding and the protection of personnel during emergency procedures. Engineering modifications to eliminate the problem are discussed.

The effect of feed restriction and Eimeria maxima infection with or without medication on growth and feed intake in broilers.

Day-old male broiler chicks were raised in floor pens. At 4 days of age, birds in 75% of the pens were inoculated with Eimeria maxima via the feed. There were four dietary treatments: uninoculated, unmedicated control (UUC), infected, unmedicated control (IUC), infected, halofuginone-medicated (3 ppm, HM), or infected, salinomycin-medicated (66 ppm, SM). At 6 days of age, birds in 50% of the pens of each treatment were restricted for 5 days to their maintenance energy intake level. The remainder consumed feed ad libitum. Medication reduced growth from 0 to 6 days of age and feed intake was depressed, irrespective of medication, in infected birds from 0 to 21 days of age. Growth, however, was improved with intake of coccidiostat over IUC from 6 to 11 days of age but did not match UUC until 28 days of age. At 42 and 49 days of age, infected birds were lighter than UUC birds. Dressing percentage for HM and SM birds was greater than that of UUC birds at 49 days of age but HM birds also had a greater percentage of abdominal fat at both 42 and 49 days of age. Feed restriction resulted in some compensatory growth immediately following refeeding. Experimental feed:gain ratio was improved in restricted birds (1.98 versus 2.03 g:g). At 42 and 49 days of age, restricted birds were lighter than birds eating ad libitum and also had a significantly greater percentage abdominal fat. A lower breast yield was observed at 42 days of age in restricted birds.

Effects of Eimeria mitis on egg production of single-comb White Leghorn hens.

Single-comb white leghorn hens infected with either B4 or C2 strain of Eimeria mitis produced watery droppings as early as day 5 PI. E. mitis infection did not affect egg weight. However, specific gravities of the eggs produced by the hens infected with E. mitis were lower than those produced by the controls. Egg production was significantly reduced temporarily, but most birds returned to production within 14 days. Many of the birds that ceased to lay went through a complete-body molt (56% of the C2-infected hens and 20% of the B4-infected hens). Hens that ceased to lay regained considerable amounts of pigment in their skin, beaks, and shanks.

Antigenic variation among strains of Eimeria maxima and E. tenella of the chicken.

The immunogenicity and cross-protection of Eimeria maxima or E. tenella in chickens against their homologous and heterologous strains were evaluated in two experiments. The immunizing strain of E. tenella protected against itself and partially against heterologous strains. The North Carolina (NC) strains of E. tenella were more virulent than the Delmarva (DMV) strains. Growth of the unimmunized groups was depressed 66% and 32% for the NC and DMV strains, respectively. Growth of the immunized-challenged groups (DMV and NC) was depressed by 13%. The DMV E. maxima strains were more virulent than the NC strains. Growth of the unimmunized challenged groups was depressed by 47% (DMV) and 13% (NC). Results demonstrated that there are antigenic variations among strains of two species of chicken coccidia.

Pathogenicity and control of Eimeria mitis infections in broiler chickens.

The pathogenicity of two strains (B4 and C2) of Eimeria mitis was studied using young broiler chickens. Both strains of coccidia were pathogenic, and C2 strain was more virulent than B4. Growth of the broilers was depressed as early as day 3 postinoculation (PI), but the depression was greatest during days 5 and 6 PI. Feed conversion and shank skin pigment of the young broiler chickens were concomitantly affected by infections of E. mitis. Infection subsided by day 7 or 8 PI and was accompanied by a compensatory growth. The drugs effective against the infections were halofuginone, lasalocid, monensin, and nicarbazin. The least efficacious were zoalene and amprolium plus ethopabate.

Eimeria mitis: immunogenicity and cross immunity of two isolates.

The ability of two isolates of Eimeria mitis to provide protection against homologous or heterologous challenge was examined. Based on weight gain and feed efficiency of male chickens, the B4 and C2 isolates protected against both homologous and heterologous challenge. The unprotected chickens suffered severe growth depression and impairment of feed utilization. Birds were inoculated with a series of increasing immunizing doses and became immune by the sixth dose. The C2 isolate (strain) appeared to be more immunogenic than the B4 isolate (strain).

Ultrastructure of schizonts and merozoites of Eimeria mitis and E. mivati of the chicken.

Measurements of fourth-generation schizonts and merozoites of Eimeria mitis averaged 10.3 (8.7-12.4) x 7.2 (6.3-8.2) and 5.06 x 1.75 microns, respectively, whereas schizonts and merozoites of E. mivati averaged 8.0 (6.9-9.1) x 6.5 (6.2-6.8) and 5.88 x 0.75 micron, respectively. Schizonts of E. mitis had six or seven merozoites each, whereas schizonts of E. mivati had as many as 20 merozoites. The structural components of the merozoites of both species appeared similar. E. mitis parasites penetrated deeper into the host cells than E. mivati. There was usually only one E. mitis fourth-generation schizont or gamete per host cell and more than one of E. mivati per cell.

Additional details of the life history of the chicken coccidium Eimeria mitis Tyzzer, 1929.

Four asexual generations of Eimeria mitis were identified. The first three developed above the epithelial cell nuclei, but the fourth developed above and below. Meronts measured 13.8 x 16.4 microns, 16.1 x 16.4 microns, 12.1 x 14.6 microns, and 9.5 x 12.4 microns, respectively, of generations 1, 2, 3, and 4. They matured at 36, 67, 72, and 88 hr postinoculation (PI) and contain 20-24, 16-20, 10-14, and 7-10 merozoites, respectively. Merozonts measured 7.2 x 1.9 microns, 8.5 x 2.5 microns, 9.6 x 2.0 microns, and 6.75 x 2.75 microns, respectively. The first two types of meronts were deep in the crypts and epithelial cells. The third and fourth types of meronts were along the side and tip of the villi. Gametocytes developed from third and fourth generation. Gamonts were usually below the nuclei of the epithelial cells. Parasitism was primarily in the ileum, ceca, and rectum and also in the yolk-sac diverticulum.

An outbreak of urolithiasis in single-comb white Leghorn pullets.

An outbreak of urolithiasis characterized by high mortality and emaciation in a flock of leghorn pullets is reported. The etiology was not ascertained. Other signs were swollen feet associated with articulate gout. Visceral gout, atrophy, or irregular hypertrophy of the kidneys were also observed. Many birds had one or both ureters enlarged with white uroliths. Microscopic lesions were urate granulomas, necrosis and loss of kidney parenchyma associated with tubular dilation, and edematous and fibrotic interstitium.