Seasonal variability in otariid energetics: implications for the effects of predators on localized prey resources.

Otariids, like other wild mammals, contend with a wide variety of energetic demands across seasons. However, due to the cryptic behaviors of this marine group, few studies have been able to examine longitudinal energetic costs or the potential impact of these costs on seasonal or annual prey requirements. Here we evaluated the changes in energy demand and intake of female California sea lions (Zalophus californianus) during reproductive (n=2 sea lions) and nonreproductive (n=3) periods. Monthly measurements included resting metabolic rate, blood hormone levels, body condition (blubber thickness and body mass), and caloric intake for adult sea lions throughout molting, late pregnancy, lactation, and postweaning. We found that maintenance energy demands decreased from 32.0 to 23.1 MJ d(-1) before pupping, remaining stable at 19.4+/-0.6 MJ d(-1) during lactation and postweaning. Energy intake rates to meet these demands showed marked changes with activity level and the reproductive cycle, reaching a peak intake of 3.6 times baseline levels during lactation. Translating this into prey demands, we find that 20,000 reproductively active females on San Nicolas Island rookeries would maximally require 4,950 metric tons of Pacific whiting during a month of the breeding season. This localized impact is reduced significantly with postbreeding dispersal and demonstrates the importance of considering spatial and temporal factors driving the energetic requirements of predators when designing marine protected areas.

Running energetics of the North American river otter: do short legs necessarily reduce efficiency on land?

Semi-aquatic mammals move between two very different media (air and water), and are subject to a greater range of physical forces (gravity, buoyancy, drag) than obligate swimmers or runners. This versatility is associated with morphological compromises that often lead to elevated locomotor energetic costs when compared to fully aquatic or terrestrial species. To understand the basis of these differences in energy expenditure, this study examined the interrelationships between limb morphology, cost of transport and biomechanics of running in a semi-aquatic mammal, the North American river otter. Oxygen consumption, preferred locomotor speeds, and stride characteristics were measured for river otters (body mass=11.1 kg, appendicular/axial length=29%) trained to run on a treadmill. To assess the effects of limb length on performance parameters, kinematic measurements were also made for a terrestrial specialist of comparable stature, the Welsh corgi dog (body mass=12.0 kg, appendicular/axial length=37%). The results were compared to predicted values for long legged terrestrial specialists. As found for other semi-aquatic mammals, the net cost of transport of running river otters (6.63 J kg(-1)min(-1) at 1.43 ms(-1)) was greater than predicted for primarily terrestrial mammals. The otters also showed a marked reduction in gait transition speed and in the range of preferred running speeds in comparison to short dogs and semi-aquatic mammals. As evident from the corgi dogs, short legs did not necessarily compromise running performance. Rather, the ability to incorporate a period of suspension during high speed running was an important compensatory mechanism for short limbs in the dogs. Such an aerial period was not observed in river otters with the result that energetic costs during running were higher and gait transition speeds slower for this versatile mammal compared to locomotor specialists.

[Early detection of exacerbation of lung infections in patients with cystic fibrosis by means of daily spirometry]. / Früherkennung pulmonaler Infektexazerbationen bei Patienten mit zystischer Fibrose mittels täglicher Spirometrie.

UNLABELLED: The clinical course of cystic fibrosis is characterised by pulmonary involvement with mucus retention, chronic pulmonary infection and parenchymal inflammation. Recurrent infectious exacerbations are usually accompanied by a fall in lung volumes. This pilot study investigated whether exacerbations can be detected early by daily spirometry. Ten patients with cystic fibrosis (5 female; 5 male; mean age 24.9 years) performed daily spirometry using a portable transtelephonic spirometer (Spirophone). Infectious exacerbations were diagnosed on clinical grounds and treated without knowledge of the spirometry results. Data of 9 patients recorded over a period of 5-11 months were analysed. One patient was excluded due to non-compliance. A total of 20 infectious exacerbations occurred during the observation period. A fall of at least 20% in one or more of the following parameters was observed in 90% (18/20) of exacerbations: FVC, FEV1, PEF, and FEF25/75. A daily drop in lung volumes of 0.7% to 1.2% was recorded beginning at a median of 33 (20 to 120) days before infectious exacerbations were diagnosed. There was a 2-3% daily improvement in spirometric data under treatment with antibiotics. CONCLUSION: Daily spirometry allows early recognition of pulmonary infectious exacerbations in patients with cystic fibrosis. Daily spirometry may be used as an indicator for early antibiotic treatment.

[Clinical features of primary ciliary dyskinesia]. / Klinik der primären ziliären Dyskinesie.

Primary ciliary dyskinesia is a recessively inherited group of disorders with abnormal ciliary activity leading to disturbed mucociliary clearance. Clinical manifestations as early as the first year of life are recurrent rhinitis, otitis media, sinusitis and lower respiratory tract infections. Another typical presentation is situs inversus. Biopsy of the ciliated mucosa in the nose or bronchi is required for study by vital microscopy and electronmicroscopy to confirm the diagnosis. Early diagnosis is important for initiation of rigorous treatment involving physiotherapy, inhalation with beta 2-mimetics and prompt antibiotic treatment to prevent irreversible damage such as bronchiectasis. Compared with cystic fibrosis the prognosis is better, because older children can compensate the absent mucociliary clearance with always-functioning cough clearance.

Comparison of immunogenicity and safety of a virosome influenza vaccine with those of a subunit influenza vaccine in pediatric patients with cystic fibrosis.

The objective of this study was to compare the immunogenicity and safety of a single-dose regimen and a two-dose regimen of a trivalent virosome influenza vaccine (Inflexal Berna V) with those of a trivalent subunit influenza vaccine (Influvac) in children and adolescents with cystic fibrosis (CF). In an open, randomized, multicenter study with parallel groups, 11 young children with CF (1 to 6 years old) and 53 older children and adolescents with CF (>6 years old) were randomly assigned to one of the following immunization regimens: virosome vaccine at 0.5 ml on study day 0 or 0.25 ml on days 0 and 28 or a standard regimen of subunit vaccine, i. e., 0.5 ml on day 0 for older children and 0.25 ml on days 0 and 28 for younger children. Safety assessments, i.e., recording of systemic and local adverse events (AEs) and vital signs, were made for a 5-day observation period after each immunization. Hemagglutination inhibition (HI) titers were determined at baseline and 4 weeks after the single-dose and the two-dose immunizations, respectively. Immunogenicity was assessed according to the criteria of the European Agency for the Evaluation of Medicinal Products (EMEA). Both vaccines induced comparable HI antibody titers. Seroconversion (> or =4-fold rise in HI antibody titers, reaching a titer of > or =1:40) was achieved in 41 to 100% of the participants. Seroprotection (HI titer, > or =1:40) and a >2.5-fold increase in geometric mean titers were achieved in 100% of the participants. Thus, all three EMEA requirements for influenza vaccine efficacy were met by all treatment groups and for both vaccines. The virosome vaccine, when administered as a single dose, seemed to induce superior immunogenicity compared with the standard pediatric two-dose regimen. Totals of 42 and 57% of vaccinees receiving virosome and subunit vaccines, respectively, reported at least one local AE (predominantly pain). Totals of 84 and 71% of subjects receiving virosome and subunit vaccines, respectively, complained in response to questions of at least one systemic AE (mainly cough, fatigue, coryza, or headache). The majority of events were mild or moderate and lasted 1 or 2 days only. No obvious relationship was found between AE reporting rate and vaccine formulation, age group, or dose regimen. The relatively high AE reporting rate seemed to be partly related to the symptomatology of the underlying CF disease. In summary, the virosome and subunit vaccines induced in both age groups and against all three influenza strains an efficient immune response and were well tolerated by the children and adolescents with CF.

Determinants of health care costs and patterns of care of asthmatic patients in Switzerland.

OBJECTIVE: To investigate whether medical resource utilisation, costs and clinical status were influenced by: (1) type of physician (specialist versus GP); (2) treatment modality (on-demand vs long-term continuous therapy); (3) labour force participation; (4) insurance coverage (private vs statutory); (5) geographic area (urban vs rural). MATERIAL AND METHODS: Chart reviews in the last 5 patients seen by treating physicians. Direct medical expenditure included charges for hospitalisation, outpatient services, physicians' services and medication, whereas indirect costs included the value of time lost from work. RESULTS: The overall annual mean cost per patient in 589 patients was CHF 2600 [95% confidence interval: 1956; 3245]. Costs in 117 children were CHF 824 [531; 1116], and CHF 3041 [2244; 3837] in adults. Compared with pulmonologists, adults treated by GPs had a higher rate of hospital admissions, equal specialist referrals and more days off work. Hospital admissions in children were similar in GPs and paediatricians. Total direct costs were highest for internists, followed by GPs. Pulmonologists incurred the lowest direct costs in adults compared to GPs or internists (p < 0.05). Total costs for children were equal for GPs and paediatricians. Differences in costs between on-demand and long-term prophylactic treatment were: CHF 834 [318; 1351] versus CHF 1856 [1488; 2224], (p = 0.002). Highest total costs were observed for unemployed patients and those receiving disability payments. Patients with supplementary insurance cover had a lower overall resource utilisation rate and costs than patients without: CHF 2284 [95% CI: 535; 4034] versus CHF 2670 [1844; 3496] (p = 0.8). Total costs were CHF 2319 [1660; 2979] for patients treated in cities and CHF 3062 [1742; 4382] in rural areas (p < 0.0001) as well as lower in the German-speaking part of the country (CHF 2320 [1743; 2897]) than in the French-speaking region (CHF 3610 [1479; 5740] [p < 0.005]). CONCLUSIONS: Factors determining higher resource utilisation and costs are: treatment by non-specialists, long-term continuous treatment, the absence of supplementary health care insurance, treatment in rural areas, and treatment in the French-speaking cantons.

The economic burden of asthma: direct and indirect costs in Switzerland.

Asthma mortality increased in Switzerland between 1980 and 1994. This study aimed to assess the economic burden of asthma in this country. Chart reviews were conducted for the last five patients seen for asthma in physician practices in 1996 and 1997. Direct expenditures and indirect costs for asthma-related morbidity were determined. A total of 589 patient charts were completely analysed, including 117 children's charts, obtained from 120 office-based physicians. The annual direct medical costs were CHF 1,778 and the mean annual indirect costs were CHF 1,019 per patient for all patients. The total estimated cost of asthma in Switzerland in 1997 was nearly CHF 1,252 million. Direct medical expenditures approached CHF 762 million, or 61% of the total. In 1997, the indirect costs for asthma were estimated to have exceeded CHF 490 million. Of these costs CHF 123 million (25%) was associated with morbidity and nearly CHF 368 million (75%) was associated with looking after asthmatic patients who had to be cared for at home. This study provides evidence that asthma is a major healthcare cost factor in Switzerland, amounting to approximately CHF 1,200 million per year. The data suggest that cost savings can be achieved by improving primary care for asthma in an ambulatory setting.

Fibreoptic bronchoscopy in sedated infants facilitated by an airway endoscopy mask.

Fibreoptic bronchoscopy (FB) is frequently associated with a decline in PaO2, whose degree and duration can be substantial especially in infants. The effect of a face mask, which allows the administration of 100% oxygen and continuous positive airway pressure during FB, on the incidence and severity of hypoxaemia was studied in thirty-one consecutive infants. Sedation was provided by intravenous propofol titrated to allow patient comfort. A transient fall in SpO2 <95% was recorded in 6/31 patients during endoscopy of the upper airway (lasting 1.6+/-1.1 min) and in 11/31 patients during endoscopy of the lower airways (lasting 1.4+/-1.1 min). Capillary blood gas analysis before and after endoscopy of the lower airways demonstrated an increase in the PCO2 6.4+/-1.3 to 7.3+/-1.4 kPa (49+/-10 to 56+/-11 mmHg). The risk of hypoxaemia in sedated infants breathing spontaneously is low when 100% oxygen and continuous positive airway pressure are administered during FB

Akuter Effekt von inhalativem Stickstoffmonoxid auf die Oxygenation bei Kindern mit Virus-induzierter, hypoxämischer Ateminsuffizienz.

Background: Inhaled nitric oxide (iNO) has been used to improve oxygenation in adults and children with acute respiratory distress syndrome (ARDS) since several years. Previous studies on the effect of iNO in patients with ARDS were usually lumped together with respect to causation. Methods: We describe the acute effect of iNO in 4 children (age 4-54 months) suffering from acute, virus-induced, hypoxemic respiratory failure. Inhaled NO was administered at a dose of 20 ppm during the first hour and subsequently decreased to a dose of 5 ppm. The effects on oxygenation were assessed by changes in arterial oxygen tension and in the oxygenation index at one and 4 hours after initiating iNO therapy. Results: Inhaled NO dramatically improved oxygenation in 3 of 4 children and reduced the oxygenation index by more than 30%. One patient showed no improvement in oxygenation, but a significant reduction in pulmonary vascular resistance. Discussion: Although previous studies have failed to show any benefit of iNO on the survival rate of children with ARDS, we believe that its use can be justified if the improvement in oxygenation helps to stabilise the patient during the acute stage of hypoxemic respiratory failure.

Use of a polyvalent bacterial lysate in patients with recurrent respiratory tract infections: results of a prospective, placebo-controlled, randomized, double-blind study.

Respiratory tract infections (RTIs) are the most common infections in humans, and it is difficult to effectively treat patients with increased susceptibility to these ailments. LW 50020 (Luivac; Paspat oral), an oral immunomodulator consisting of the antigens of seven bacteria commonly involved in RTIs, has been developed for the induction of specific and nonspecific immune responses of the mucosa-associated lymphoid tissue. In this placebo-controlled study, the efficacy and safety of the tablet formulation of LW 50020 were evaluated in children and adults with recurrent RTIs. Tablets were taken once daily during two periods of 4 weeks each, interrupted by a treatment-free interval of 4 weeks. The main endpoint of the study, a clinical severity score that evaluated treatment benefits, was significantly lower in the second study period in patients treated with the bacterial lysate compared to patients given placebo. A comparison of the infection rates in the first and second study periods of patients treated with LW 50020 revealed a placebo-corrected reduction of 39% in children and a placebo-corrected reduction of 44% in adolescents and adults. The placebo-corrected duration of infections was shortened by 47% in children and by 55% in older patients. No serious drug-related side effects occurred. This study demonstrated that the oral bacterial immunomodulator LW 50020 is efficacious in treating patients with recurrent RTIs.

Mild CF in a delta F508/R347H compound heterozygote woman: does the manifestation of this genotype differ in the two sexes?

A woman with unusually mild cystic fibrosis (CF) and normal sweat chloride levels is reported to have delta F508 deletion on one CF chromosome and the rare mutation R347H on the other, the first known female with this mutation. Of the other eight cases with R347H mutation mentioned in the literature, all five patients whose age and sex were given in the reports were men and had congenital bilateral absence of vas deferens (CBAVD). Considering these data, it is not unrealistic to assume that R347H associates more frequently than other CF mutations with CBAVD, which would mean that the clinical significance of this mutation might differ in males and females.