bluuebunny/crossref_metadata_2025 huggingface dataset:
Achievable benchmarks of care: the ABCTMs of benchmarking
Authors: Weissman Norman W. , Allison Jeroan J. , Kiefe Catarina I. , Farmer Robert M. , Weaver Michael T. , Williams O. Dale , Child Ian G. , Pemberton Judy H. , Brown Kathleen C. , Baker C. Suzanne
Published: March 2003

Abstract: Benchmarking is generally considered to be an important tool for quality improvement. Traditional approaches to benchmarking have relied on subjective identification of ‘leaders in the field’. We derive an objective, reproducible and attainable Achievable Benchmark of Care (ABCTM) by measuring and analysing performance on process‐of‐care indicators. Three characteristics of the ABCTM that we deem essential are: (1) benchmarks represent a measurable level of excellence; (2) benchmarks are demonstrably attainable; (3) benchmarks are derived from data in an objective, reproducible and predetermined fashion. From these characteristics it follows that (4) providers with high performance are selected to define a level of excellence in a predetermined fashion, but (5) providers with high performance on small numbers of cases do not influence unduly benchmark levels. We use the ‘pared mean’ to operationalize the ABCTM. Roughly, the pared mean summarizes the performance of top‐ranked providers whereby at least 10% of the patient pool across all providers is included. Bayesian estimators for adjustment of performance of providers with small sample sizes are used to rank providers. Randomized controlled trials to assess the independent effect of the ABCTM in quality improvement projects are under way. We have developed a methodology objectively and reproducibly to derive a level of excellent, attainable performance, based on measured performance by a group of providers. The ABCTM can be applied to groups of providers in communities, to institutions and departments within them, or to individual practitioners.
Judging the ‘weight of evidence’ in systematic reviews:introducing rigour into the qualitative overview stage by assessing Signal and Noise
Authors: Edwards Adrian , Mrcgp Glyn Elwyn , Hood Kerry , Rollnick Stephen
Published: March 2003

The ‘weight of evidence’ in a topic area can be judged by assessing the ‘Signal’ from available research publications and tempering the importance attached by the level of ‘Noise’ (the inverse of methodological quality). This assessment process has validity and reliability and can be applied to the ‘qualitative overview’ stage of systematic reviews. This enables the important themes and areas of relevance to the research question to be identified. Important findings from individual papers may also be identified providing further information which may not be evident from quantitative analysis. The findings from these more qualitative stages of analysis complement, but do not replace, quantitative analysis.
Public health in the undergraduate medical curriculum – can we achieve integration?
Authors: Stone David H.
Published: March 2003

Abstract

Public health is widely regarded by medical students as peripheral or even irrelevant to the acquisition of clinical knowledge and skills. This paper attempts to set out some of the reasons for this, to encourage innovative approaches to integrating public health with clinical teaching and to offer a theoretical framework of integrated public health education for curriculum development and evaluation. The points of convergence between public health and clinical practice should not be regarded as self‐evident. A practical demonstration of the application of public health principles to clinical problem solving may be the most effective means of overcoming resistance. Almost anywhere that clinical services are provided is suitable for this purpose. Community clinics, health centres or general practices have obvious appeal but acute hospitals have important advantages arising from students’ preoccupation with clinical medicine. The main aim of integrated public health teaching is to facilitate the students’ acquisition of knowledge, skills and attitudes that promote the effective application of public health approaches to clinical practice. The interrelationships between clinical practice and public health may be represented in the form of a grid. The vertical headings are the clinical skills that relate to the different stages of the natural history of disease – from the pre‐disease state through diagnosis, treatment and follow up. The horizontal headings describe four key public health dimensions: epidemiology, behaviour/lifestyle, environment and health policy. The text in the boxes suggests appropriate topics for discussion. The grid is also potentially useful for course documentation and content evaluation.
Do we face a fourth paradigm shift in medicine – algorithms in education?
Authors: Eitel Florian , Kanz Karl‐Georg , Hortig Dipl. ‐Ing Elzbieta , MA Arthur Tesche
Published: March 2003

Medicine has evolved toward rationalization since the Enlightenment, favouring quantitative measures. Now, a paradigm shift toward control through formalization can be observed in health care whose structures and processes are subjected to increasing standardization. However, educational reforms and curricula do not yet adequately respond to this shift. The aim of this article is to describe innovative approaches in medical education for adapting to these changes. The study design is a descriptive case report relying on a literature review and on a reform project’s evaluation. Concept mapping is used to graphically represent relationships among concepts, i.e. defined terms from educational literature. Definitions of ‘concept map’, ‘guideline’ and ‘algorithm’ are presented. A prototypical algorithm for organizational decision making in the project’s instructional design is shown. Evaluation results of intrinsic learning motivation are demonstrated: intrinsic learning motivation depends upon students’ perception of their competence exhibiting path coefficients varying from 0.42 to 0.51. Perception of competence varies with the type of learning environment. An innovative educational format, called ‘evidence‐based learning (EBL)’ is deduced from these findings and described here. Effects of formalization consist of structuring decision making about implementation of different learning environments or about minimizing variance in teaching or learning. Unintended effects of formalization such as implementation problems and bureaucracy are discussed. Formalized tools for designing medical education are available. Specific instructional designs influence students’ learning motivation. Concept maps are suitable for controlling educational quality, thus enabling the paradigm shift in medical education.
Meaning and measurement: an inclusive model of evidence in health care
Authors: Upshur Ross E.G. , VanDenKerkhof Elizabeth G. , Goel Vivek
Published: March 2003

Evidence‐based approaches are assuming prominence in many health‐care fields. The core ideas of evidence‐based health care derive from clinical epidemiology and general internal medicine. The concept of evidence has yet to be analysed systematically; what counts as evidence may vary across disciplines. Furthermore, the contribution of the social sciences, particularly qualitative methodology, has received scant attention. This paper outlines a model of evidence that describes four distinct but related types of evidence: qualitative‐personal; qualitative‐general; quantitative‐general and quantitative‐personal. The rationale for these distinctions and the implications of these for a theory of evidence are discussed.
A critique of hypertension treatment trials and of their evaluation
Authors: Robertson John I.S.
Published: March 2003

Progressive improvements in antihypertensive drug therapy over the past four decades have provided clear benefits in limiting cardiovascular complications. Unfortunately, and largely inexplicably, the inclusion in meta‐analyses of defective trials plus the employment of inappropriate diagnostic criteria for adverse coronary events have led to spurious, exaggerated claims for the advantages of such treatment. The consequence has been a devaluation of the very real worth of prophylactic drug therapy for hypertension.
Evidence‐based medicine, guidelines, personality types, relatives and absolutes
Authors: Welsby Philip D.
Published: March 2003

There is an epidemic of guidelines but very little evidence‐based information has been assembled to tell us exactly how guidelines are best implemented. Guidelines, although very valuable, are essentially a reductionistic attempt to simplify the complexities of medicine. Clinicians may appreciate that each guideline should be prefaced by a statement that ‘what follows may not be applicable to all patients’ but there seems little doubt that guideline adherence will be used to assess quality of care by those unfamiliar with the complexities.
Beyond evidence‐based medicine: bridge‐building a medicine of meaning
Authors: Buetow S.
Published: March 2003

Contesting that a debate on evidence‐based health care has taken place, this article charts three paths to the future: continuing avoidance of debate by proponents of evidence‐based medicine (EBM); conflict, which the EBM movement courts and critics have espoused, and dialogue. The last portal allows for integration, which would end the disagreement between EBM and its critics and make a debate unnecessary. In search of integration, I sketch a bridge whose construction requires not compromise but a win– win approach. The bridge is a medicine of meaning (MOM). Consolidating multiple pillars of evidence to unify questions that are not necessarily the same for protagonists and critics of EBM, a MOM contends that the purpose or meaning of
medicine is always healing and helping, and each party finds meaning in medicine by contributing to this common purpose in its own distinctive way.
Developing a measure of patient access to primary care: the access response index (AROS)
Authors: Elwyn Glyn , Jones Wendy , Rhydderch Melody , Edwards Peter
Published: March 2003

Access to appointments in primary care is not routinely measured, and there is no one standardized method for doing so. Any measurement tool has to take account of the dynamic status of appointment availability and the definitional problems of appointment types. The aim of this study was to develop and trial a method for measuring access that is valid, reliable, quick and provides a daily longitudinal record of access on an organizational basis (not for individual clinicians). Using the results of a literature review and following discussions with clinicians and managers a tool was designed following agreed specifications. After initial adjustments of the tool a feasibility study tested the acceptability of a data collection exercise on 11 practices of varying types, over a 4‐ to 8‐week period. The development phase led to the design of a tool named the access response index (AROS). The method was well received in the practices, with a low incidence of missed days and only one practice failing to return data. The index measures the number of days’ wait to the next available appointment with any general practitioner. The inclusion in the score of urgent appointments was abandoned due to definitional problems. A 5‐day moving average was chosen to represent the data in graph form to demonstrate overall trends. AROS is a useful tool usable in any practice, and our feasibility study points to it being widely acceptable in the field. Data are represented in clear graphical daily format, either just for one practice or as an anonymous composite graph with other practices in the locality.
Effects of tributyltin and hypoxia on the progression of Perkinsus marinus infections and host defence mechanisms in oyster, Crassostrea virginica (Gmelin)
Authors: Anderson R. S. , Brubacher L. L. , Calvo L. Ragone , Unger M. A. , Burreson E. M.
Published: March 2003

Oysters, Crassostrea virginica (Gmelin), naturally infected by the protozoan parasite Perkinsus marinus in the field were exposed for 6 weeks to tributyltin (TBT), hypoxia, or to both stressors simultaneously. The TBT‐exposed oysters continuously bioaccumulated TBT, reaching about 4 mg kg−−1 dry weight by 6 weeks; hypoxic oysters were exposed to water containing an average dissolved oxygen level of about 3 mg L−−1. Untreated control oysters suffered about 30% cumulative mortality by 6 weeks as a result of the progression of their P. marinus infections. The TBT treatment alone produced no additional mortality; however, cumulative mortality in hypoxic oysters was elevated. Mortality among oysters receiving both TBT and hypoxia significantly exceeded that caused by either stressor alone, suggesting a synergistic effect. In an attempt to identify immunotoxicological mechanisms underlying stress‐related augmentation of P. marinus infections, defence‐related immune functions were measured at 3 and 6 weeks in control and treated oysters. In general, the total number of haemocytes increased as the infections progressed, and the TBT and hypoxic treatments also caused significant additional increments in some samples. However, oxygen‐dependent (reactive oxygen species) and oxygen‐independent (lysozyme) antimicrobial host defence mechanisms appeared to be largely unaffected by TBT and/or hypoxia. This may be explained by the death of those oysters with marked immunological lesions prior to sampling or by the actual lack of treatment effects.
Isolation of salmon pancreas disease virus (SPDV) from farmed Atlantic salmon, Salmo salar L., in Scotland
Authors: Rowley H. M. , Doherty C. E. , McLoughlin M. F. , Welsh M. D.
Published: March 2003

A toga‐like virus was recently isolated in the present authors' laboratory from Atlantic salmon during an outbreak of PD in Ireland (Nelson, McLoughlin, Rowley, Platten & McCormick 1995). When inoculated into Atlantic salmon post‐smolts, this virus, known as salmon pancreas disease virus (SPDV), caused pathological changes in the pancreas, heart and skeletal muscle which were indistinguishable from those observed in natural outbreaks of PD (McLoughlin, Nelson, Rowley, Cox & Grant 1996). In 1996 a serological survey was carried out to determine the presence and distribution of antibodies to SPDV in Irish, Scottish and Norwegian farm‐reared Atlantic salmon (McLoughlin, Rowley & Doherty 1998). The results of this survey indicated that SPDV is present in the major European salmon‐producing countries. The present paper describes the first isolation of SPDV from farm‐reared, PD‐affected Atlantic salmon in Scotland.
Histopathology in fish: proposal for a protocol to assess aquatic pollution
Authors: Bernet D. , Schmidt H. , Meier W. , Burkhardt‐Holm P. , Wahli T.
Published: March 2003

Water pollution induces pathological changes in fish. As an indicator of exposure to contaminants, histology represents a useful tool to assess the degree of pollution, particularly for sub‐lethal and chronic effects. However, a standardized method for the description and assessment of histological changes, mainly for use in freshwater fish, is still lacking. In this paper, the present authors propose a standardized tool for the assessment of histological findings which can be applied to different organs. The methodology is based on two factors: (1) the extension of a pathological change is rated with a ‘score value’; and (2) the pathological importance of this alteration is defined as an ‘importance factor’. The sum of the multiplied score values and importance factors of all diagnosed changes results in different indices. With these indices, statistical analysis can be carried out. Assessment methods for the gills, liver, kidney and skin are described.
Experimental host range and histopathology of white spot syndrome virus (WSSV) infection in shrimp, prawns, crabs and lobsters from India
Authors: Rajendran K. V. , Vijayan K. K. , Santiago T. C. , Krol R. M.
Published: March 2003

Experimental studies were conducted by injecting or feeding white spot syndrome virus (WSSV) derived from infected shrimp, Penaeus monodon (Fabricius), collected from the south‐east coast of India, to five species of shrimp, two species of freshwater prawns, four species of crabs and three species of lobsters. All species examined were susceptible to the virus. Experimental infections in the shrimp had the same clinical symptoms and histopathological characteristics as in naturally infected P. monodon. A cumulative mortality of 100% was observed within 5–7 days in shrimp injected with WSSV and 7–9 days in shrimp fed with infected tissue. Two species of mud crab, Scylla sp., survived the infection for 30 days without any clinical symptoms. All three species of lobsters, Panulirus sp., and the freshwater prawn, Macrobrachium rosenbergii (De Man), survived the infection for 70 days without clinical symptoms. However, bioassay and histology using healthy P. monodon revealed that crabs, prawns and lobsters may act as asymptomatic carriers/reservoir hosts of WSSV. This is the first report to suggest the carrier/reservoir capacity of these hosts through histological and bioassay evidences. Ultrastructural details of the virus in experimentally infected shrimp, P. vannamei, (Boone), were also studied.
Two isolates of sea bass, Dicentrarchus labrax L., nervous necrosis virus with distinct genomes
Authors: Thiéry R. , Arnauld C. , Delsert C.
Published: March 2003

Diagnosis by reverse‐transcriptase polymerase chain reaction (RT‐PCR) amplification using previously published primers specific for the capsid protein gene of fish nodaviruses detected an isolate of sea bass, Dicentrarchus labrax L., nervous necrosis (SBNNV) from the French Mediterranean coast, but did not detect an isolate from the Atlantic coast. The capsid protein coding sequence of the nodavirus of both isolates was cloned. Sequence analysis revealed that the Mediterranean isolate was identical to the sequence previously published for SBNNV, while the Atlantic isolate is related, but carried numerous substitutions, in particular in the region used for RT‐PCR diagnosis. A new primer set was tested which detected the viral genome of the Atlantic isolate. Using the new primer set, PCR amplification of a range of 10‐fold dilutions of a plasmid containing the capsid protein gene of the Atlantic isolate showed that the limit of detection of the assay was between 10 and 100 copies of plasmid.
Cloning, characterization, and insertional inactivation of a major extracellular serine protease gene with elastolytic activity from Aeromonas hydrophila
Authors: Cascón A , Fregeneda J , Aller M , Yugueros J , Temprano A , Hernanz C , Sánchez M , Rodríguez‐Aparicio L. , Naharro G.
Published: March 2003

The gene ahpA from Aeromonas hydrophila AG2 encoding an extracellular serine protease, named AhpA, was cloned in pUC18 plasmid. Nucleotide sequence analysis revealed an open reading frame of 1875 bp encoding a 625 amino‐acid protein with a molecular weight of 67 567 Da. The gene ahpA was efficiently expressed in Escherichia coli C600 and in the non‐proteolytic A. salmonicida masoucida, which was able to overproduce the 64‐kDa protease found in the culture supernatant. The N‐terminal amino acid sequence of the purified protein revealed a perfect match with the deduced DNA sequence starting at AAT (Asn‐25), indicating that AhpA is synthesized as a pre‐enzyme with a 24‐amino‐acid signal peptide and a 601‐amino‐acid mature extracellular protease. Purified protease had an optimum pH of 7.5 and its activity was strongly inhibited by PMSF, a serine protease inhibitor. The protease hydrolysed casein and elastin. The amino acid sequence of AhpA was highly homologous to A. salmonicida serine protease AspA. Inoculation of A. hydrophila ahpA mutant into trout suggests that the major AhpA secreted protease is not essential for virulence.
Comparative studies of Danish Flavobacterium psychrophilum isolates: ribotypes, plasmid profiles, serotypes and virulence
Authors: Madsen L , Dalsgaard I
Published: March 2003

Ribotyping and plasmid profiling were carried out on 299 Danish Flavobacterium psychrophilum isolates from farmed rainbow trout, Oncorhynchus mykiss (Walbaum). The isolates had been characterized biochemically and serologically in another study. The isolates were very homogeneous, 254 isolates had the same ribotype A (restriction enzyme EcoRI) and 284 isolates harboured one 3.3 kb plasmid. Seventy‐five per cent of the F. psychrophilum isolates had ribotype A, one 3.3 kb plasmid and belonged to either serotype Th or Fd. Virulence studies with representatives of the dominant groups classified such isolates as virulent, and an extra small or large plasmid did not change the virulence level. A relationship between the serotypes Fd and Th, certain ribotypes, and virulence was found. The isolates belonging to serotype FpT and to ribotype B were less virulent. Only a few isolates with other ribotypes were found and these were also less virulent. Isolates that did not have the 3.3 kb plasmid were also less virulent. The virulent isolates all harboured the 3.3 kb plasmid; however, there was no clear correlation between virulence and plasmid content as a 3.3 kb plasmid was also found in less virulent isolates.
Two iridovirus‐susceptible cell lines established from kidney and liver of grouper, Epinephelus awoara (Temminck & Schlegel), and partial characterization of grouper iridovirus
Authors: Lai Y‐S , Murali S , Ju H‐Y , Wu M‐F , Guo I‐C , Chen S‐C , Fang K , Chang C‐Y
Published: March 2003

Two iridovirus‐susceptible cell lines were established and characterized from grouper Epinephelus awoara kidney and liver tissues. These cell lines have been designated GK and GL, respectively. The cells multiplied well in Leibovitz's L‐15 medium, supplemented with 10% foetal bovine serum, at temperatures between 20 and 32 °C, and have been subcultured more than 120 times, becoming continuous cell lines. The cell lines consist of a heterogeneous mixture of fibroblastic and epithelial cells. The viability of cells, stored frozen in liquid nitrogen (−196 °C), was 95% after 1 year. Chromosome morphologies of GK and GL cells were homogeneous. Both cell lines were susceptible to grouper iridovirus, and yielded high titres of up to 108 TCID50 mL−1. In addition, both cell lines effectively replicated the virus, which could be purified to homogeneity by cesium chloride gradient centrifugation. Electron microscopy studies showed that purified virus particles were 170±10 nm in diameter, and were hexagonal in shape. Virus‐infected cells showed an abundance of virus particles inside the cytoplasm. These results show that the GK and GL cell lines effectively replicate grouper iridovirus, and can be used as a tool for studying fish iridoviruses.
Detection of nodavirus in barramundi, Lates calcarifer (Bloch), using recombinant coat protein‐based ELISA and RT–PCR
Authors: Huang  , Tan  , Chang  , Munday  , Mathew  , Ngoh  , Kwang
Published: March 2003

The coat protein encoded by the nodavirus RNA2 gene originally isolated from greasy grouper, Epinephelus tauvina, was cloned, expressed as a recombinant polyhistidine‐tailed fusion protein and characterized by immunoblot analysis. The purified recombinant protein was used to develop an indirect enzyme‐linked immunosorbent assay (ELISA) to detect body exudate and plasma antibodies against the coat protein in both experimentally infected and commercial barramundi. In addition, the nucleotide sequence was employed to develop a RT–PCR detection assay based on the T4 region. The results showed that the virus could be detected as early as 3 days post‐infection by RT–PCR while antibodies against the recombinant coat protein were detectable on day 6 post‐infection. Among 112 commercial barramundi samples collected from October 1999 to April 2000, 9% showed positive ELISA results which were further verified by Western blot.
Herpes‐like virus infections in hatchery‐reared bivalve larvae in Europe: specific viral DNA detection by PCR
Authors: Renault  , Arzul
Published: March 2003

Periodic losses in oyster hatcheries are regularly reported in Europe. Herpes‐like virus infections seem to play a key role. Polymerase chain reaction (PCR) was used to investigate the presence of herpes‐like virus DNA in larval samples belonging to different bivalve species from different geographical origins. Seventeen samples of the 81 analysed appeared positive for the herpes‐like virus DNA by PCR. These results confirm previous data indicating that herpes‐like virus infections occur in commercial French hatcheries. Polymerase chain reaction positive results were also obtained for bivalve larval samples originating from Spain and the UK. The number of virus DNA positive samples depended on the primer pair used. The primer pair C2/C6 appears well adapted for herpes‐like virus DNA detection because of processing ease and great sensitivity. Positive samples were observed in four bivalve species: Crassostrea gigas, Ostrea edulis, Ruditapes decussatus and Ruditapes philippinarum. Herpes‐like virus DNA detection is reported in larval R. decussatus for the first time. Many samples in which viral DNA was detected by PCR correspond to larval batches presenting mortalities. Herpes‐like viruses may be one of the causative agents of mortalities observed in bivalve hatcheries.
In vivo study of phagocytosis, intracellular survival and multiplication of Flavobacterium psychrophilum in rainbow trout, Oncorhynchus mykiss (Walbaum), spleen phagocytes
Authors: Decostere A , D'Haese E , Lammens M , Nelis H , Haesebrouck F
Published: March 2003

The intracellular behaviour of a Flavobacterium psychrophilum strain, ingested by spleen phagocytes of rainbow trout, Oncorhynchus mykiss, of different ages, was assessed in vivo. Three groups of rainbow trout weighing 1 g (aged 10 weeks), 25 g (aged 20 weeks) and 300 g (aged 15 months), respectively, were injected intraperitoneally with 1 × 106 cfu of a F. psychrophilum strain. It was found that only fry, aged 10 weeks, displayed clinical signs and suffered mortality. Bacteriological colony plating of different organs demonstrated that the spleen and to a lesser extent the kidney of only the fry were affected. The number of colony forming units per gram of spleen tissue increased with time. No bacteria were found in the trout aged 5 months and older. Light microscopical examination and epifluorescence microscopy revealed that the fry spleen phagocytes contained an increasing number of viable intracellular F. psychrophilum bacteria over time. Again, no bacteria were encountered in the phagocytes collected from older fish.
Screamer disease in Atlantic salmon, Salmo salar L., in Chile
Authors: Roberts R J , Hardy R W , Sugiura S H
Published: March 2003

Investigation of cranial and spinal deformities in Atlantic salmon smolts from Chile immediately after sea transfer, over two successive crops, demonstrated ankylosis of the mandibular articulation, spinal foreshortening, fracture of vertebrae and rarefaction of osseous and cartilaginous tissues including the operculum. As a result the mouth was permanently agape and opercula could be folded back on themselves. All affected fish had been transferred to sea water at 20 °C plus and fed on particular commercial diets. Fish in cooler areas, or on diets high in vitamin C and phosphorus in the high temperature zone, were clinically normal. The condition has not recurred following dietary adjustment.
Gill disease of marine fish caused by infection with Neoparamoeba pemaquidensis
Authors: Munday B L , Zilberg D , Findlay V
Published: March 2003

Amoebic gill disease (AGD) of maricultured salmonids, turbot, Scophthalmus maximus (L.), European seabass, Dicentrarchus labrax (L.), and sharpsnout seabream, Diplodus puntazzo (Cetti), caused by Neoparamoeba pemaquidensis has been reported from Australia (Tasmania), Ireland, France, Chile, North America (Washington State and California) and Spain. Of the salmonids, Atlantic salmon, Salmo salar L., appears to be the most susceptible with rainbow trout, Oncorhynchus mykiss (Walbaum), also suffering significant disease. Only minor outbreaks have been reported in coho, O. kisutch (Walbaum), and chinook salmon, O. tshawytscha (Walbaum). The disease now accounts for 10–20% of production costs of Atlantic salmon in Tasmania and has lead to temporary abandonment of culture of this species in parts of Spain. It is of lesser, but still significant, importance in other countries. Much is known about the pathology of AGD but the pathophysiology of the disease is poorly understood. There is evidence that non‐specific immunity is involved in fish acquiring resistance to AGD, but no unequivocal evidence exists for protection as a result of specific immune responses. To date, for salmonids, the only effective treatment for AGD is a freshwater bath. Control procedures based on modification of management strategies have been minimal and virtually unresearched.
Cardiac morphology in relation to amoebic gill disease history in Atlantic salmon, Salmo salar L.
Authors: Powell M D , Nowak B F , Adams M B
Published: March 2003

Fish from cages with histories of heavy and light amoebic gill disease (AGD) outbreaks were harvested and the morphology, histology and activities of lactate dehydrogenase determined. Although fish with a history of heavy AGD were smaller, their heart somatic indices were similar to those of fish with a history of light AGD. However, morphometrically the ratios of ventricle axis length and width and axis length and height were significantly higher, and there was an overall thickening of the muscularis compactum in the ventricle of fish with heavy AGD history. There was no difference in the lactate dehydrogenase activity of the ventricle muscle in the two fish groups. These results suggest that the change in ventricle shape associated with AGD was a possible compensation for an increased afterload where the lengthening of the ventricle was compensated for by an increase in muscle thickness, but without any overall ventricular hypertrophy or gain in ventricular mass. This suggests that AGD may be associated with cardiovascular compromise in affected fish.
Observation of virus particles in the spleen, kidney, gills and erythrocytes of Atlantic salmon, Salmo salar L., during a disease outbreak with high mortality
Authors: Graham D A , Curran W , Rowley H M , Cox D I , Cockerill D , Campbell S , Todd D
Published: March 2003

An annual disease problem with high levels of mortality in Atlantic salmon, Salmo salar L., on a freshwater farm was investigated. In 2000, mortalities began early in October and peaked in December, being unevenly distributed between tanks. Histopathological changes included severe hyperplasia of gill epithelium, with fusion of secondary lamellae, and extensive necrosis of the haematopoietic centres in the kidney and spleen, the latter being consistent with a diagnosis of phagocytolytic syndrome (PCLS). Moribund fish were anaemic, with multiple, circular basophilic inclusion bodies, 1–2 μm in diameter and suggestive of erythrocytic inclusion body syndrome (EIBS), being observed on blood smears. Thin section electron microscopy (EM) revealed primarily membrane‐bound aggregates of non‐enveloped virus particles (73 ± 7 nm) with an electron dense core (35 ± 3 nm) in spleen, kidney and gill tissue and the erythrocytes therein. These particles had morphology and distribution consistent with those previously described separately for both EIBS and PCLS. Virus isolation attempts in a wide range of cell lines were unsuccessful. In the absence of suitable alternative infectious or environmental explanations, it is postulated that the aetiology was primarily viral, with possible contributory secondary environmental factors. It is further hypothesized that the agents of EIBS and PCLS may be the same or closely related viruses.
Experimental transmission of encephalopathy and retinopathy induced by nodavirus to sea bream, Sparus aurata L., using different infection models
Authors: Aranguren R , Tafalla C , Novoa B , Figueras A
Published: March 2003

The transmission of viral encephalopathy and retinopathy (VER) was investigated in juvenile sea bream, Sparus aurata L. Two different infection routes [intraperitoneal (i.p.) and intramuscular injection (i.m.)] were tested at two different temperatures (20 and 26 °C) using sea bream of mean weight 0.7, 2 and 4 g, as well as an immersion challenge performed at 26 °C with sea bream of 0.7 g. Successful transmission of the disease was only achieved by i.m. injection. Mortalities of 100% occurred in sea bream of 0.7 g at day 15 post‐infection and 47% in sea bream of both 2 and 4 g at day 30 post‐infection in all the experimental infections at 26 °C. No mortalities were ever observed with infections at 20 °C. When mortalities were observed, the virus was detected by immunoperoxidase staining in the SSN‐1 cell line inoculated with tissues from infected fish. Histological examination of both normal and infected fish showed a vacuolization in the bipolar and granular layers of the retina of the infected sea bream. This is the first experimentally induced transmission of VER in sea bream. Differences were observed at the time of disease onset depending on water temperature, the route of infection and the age of the juvenile fish.
Edwardsiella ictaluri bacteraemia elicits shedding of Aeromonas hydrophila complex in latently infected channel catfish, Ictalurus punctatus (Rafinesque)
Authors: Nusbaum K E , Morrison E E
Published: March 2003

Edwardsiella ictaluri is a primary bacterial pathogen of channel catfish, Ictalurus punctatus, and the causative agent of enteric septicaemia of catfish. Edwardsiella ictaluri is known to gain entry to the host by infection of the nares, gastrointestinal tract, and gills, and to disseminate to organs via an as yet uncharacterized acute bacteraemia. In this study, fluorescent microscopy showed E. ictaluri on the gill within 5 min of immersion challenge and E. ictaluri could also be isolated from the circulation within 5 min. When removed to clean water, catfish cleared circulating bacteria within 15 min and the blood remained free of E. ictaluri until its reappearance at the 12 h post‐infection sampling. However, Aeromonas hydrophila, the aetiological agent of motile aeromonad septicaemia, appeared within the circulation 7 h post‐challenge with E. ictaluri and was detected in all fish at 12 h post‐infection. Only 20% of fish carried A. hydrophila in the trunk kidney that could be detected by plate culture on Rimler–Shotts agar; however, 100% of challenged and stress‐control fish were A. hydrophila complex positive at 24 h post‐challenge. These results suggest that although the catfish is capable of clearing its circulation of E. ictaluri, superinfection with latent A. hydrophila may enhance clinical signs of edwardsiellosis. This is the first report of a bacterial superinfection appearing in fish.
Histopathological survey of diseases and pathogens present in redclaw crayfish, Cherax quadricarinatus (Von Martens), cultured in Ecuador
Authors: Romero X , Jiménez R
Published: March 2003

A histopathological survey of commercial farms in Ecuador culturing redclaw crayfish, Cherax quadricarinatus (Von Martens), revealed the presence of different viral, bacterial and non‐infectious pathologies. A total of 536 animals from 27 different farms were analysed during a 3‐year period; 25, 154 and 357 specimens in 1995, 1996 and 1997, respectively. From the total sampled, a virus referred to as Cherax quadricarinatus bacilliform virus (CqBV) had a prevalence of 44% in animals examined during 1996 and 33% in 1997. A rickettsia‐like organism (RLO) was detected in five specimens sampled from three different farms in 1995. This RLO was detected in 36 and 12% of samples analysed in 1996 and 1997, respectively, and was the infectious agent most frequently associated with mortalities above 60%. Co‐infection by CqBV and the RLO was observed in 18 and 3% of the crayfish examined in 1997 and 1998, respectively. Five specimens out of 25 examined presented no sign of an infectious agent during 1995. The proportion of specimens testing negative by histopathology to known or suspected infectious agents was 25 and 32% in 1996 and 1997, respectively. Although different infectious agents were present in cultured crayfish, farms in general had overall survivals higher than 50% in most ponds. Other conditions observed included an intracellular prokaryotic organism, iron granules in the R and F cells of the hepatopancreas, different species of epibionts on the surface of the gills and body, and two cases of haemocytic enteritis. Two cases of serious mortality in different farms were associated with the presence of Cowdry type A inclusions, pyknosis, karyorrhexis and haemocytic infiltration in the stomach hypodermis and the antennal gland.
Attitudes, intention and habit: their role in predicting actual consumption of fats and oils
Authors: Saba A. , Di Natale R.
Published: March 2003

Objective: To explore which are the most important predictors of actual consumption of olive oil, seeds oil and butter.Method: A sample of 909 subjects (> 14 years of age) completed a questionnaire assessing attitudes and beliefs towards the consumption of olive oil, seeds oil and butter. These subjects were part of a larger sample of individuals who participated in a nation‐wide food consumption survey in Italy. The frame of reference for questionnaire design was based on the Ajzen & Fishbein theory of reasoned action. Also, a measure of habit was included. The Ajzen & Fishbein model including habit was evaluated by using Structural Equation Models, well‐known as LISREL procedures.Results: Principal component analyses of the beliefs multiplied by the corresponding evaluations showed that the beliefs were not unitary but tended to differentiate between ‘beliefs on healthiness of foods’ and ‘beliefs on gaining weight’ for olive and seeds oil, whereas more homogeneous beliefs were observed for butter. Intention was found to have a positive and significant effect on the consumption of each of the three types of foods. Habit outweighed attitudes in the impact on intention of consuming, whereas it did not enter as a direct predictor of behaviour for all three types of food.Conclusions: The findings of the present study confirm the predictive validity of behavioural intention in relation to the observation of actual consumption of olive oil, seeds oil and butter. Also, it shows that habit was more important than attitudes in influencing behavioural intention.
Development, validity and reliability of the Derby Nutritional Score
Authors: Goudge D. R. , Williams A. , Pinnington L. L.
Published: March 2003

Background: The Derby Nutritional Score (DNS) is a new instrument which has been developed to screen the nutritional status of all adult patients on admission to hospital. In this article we describe the rationale for its development and report the findings of two related studies in which the validity and inter‐rater reliability of the instrument were evaluated.
Methods: Eighty‐nine patients were screened by nursing staff on admission using the DNS and were assessed within 8 h by an experienced senior dietitian using a Dietetic Assessment Scale (DAS). In the reliability study, 70 patients were screened by five experienced nurses within 8 h of admission.
Results: Moderately good agreement (kappa=0.6) was reached between scores obtained using the DNS and ratings obtained by the DAS. Similarly, agreement between pairs of nurses with respect to classification of nutritional risk was found to be high (median kappa=0.7).
Conclusion: The DNS appears to be a valid and reliable instrument which can be administered accurately and relatively quickly by trained nursing staff to identify patients at risk of malnutrition.
Anorexia and anxiety in advanced malignancy: the relative problem
Authors: Hawkins C.
Published: March 2003

Background and aims Anorexia is frequently reported by patients with advanced malignancy and can be a source of considerable distress. This study was designed to quantify the anxiety related to anorexia in both patients and their relatives. Predisposing factors were also evaluated. A questionnaire was used to quantify anorexia in 145 patients with advanced malignancy and to examine demographic and disease factors associated with anorexia. Anxiety consequent to anorexia was also evaluated for patients and their relatives.

Results Anorexia amongst patients was reported by 115 patients (79%) and 83/101 (82%) of their relatives. Anorexia was found to be associated with upper gastrointestinal malignancy, metastatic disease and short estimated prognosis. Only 41 anorectic patients (36%) reported anxiety as a consequence of their anorexia compared with 72 (87%) of their relatives. Certain patient groups (younger age and community location) were more likely to report anxiety related to anorexia.

Conclusions The potential influence of anxiety on management decisions is discussed. The frequency of anxiety reported amongst relatives may reflect an unmet need. This may be an area for improving practice.
Diet in a group of 18‐month‐old children in South West England, and comparison with the results of a national survey
Authors: Cowin I. , Emmett P. ,   and the ALSPAC study team
Published: March 2003

ObjectiveTo investigate the normal range of nutrient intakes and food consumption patterns in 18‐month‐old children.

Subjects1026 children resident in South West England, forming part of the Children in Focus (CIF) research cohort.

MethodsDiet was assessed using a 3‐day unweighed dietary record. Nutrient and food intakes were compared with the dietary reference values and with the results of a British survey of preschool children – the National Diet and Nutrition Survey (NDNS).

ResultsIntakes of energy and nearly all nutrients were significantly higher in boys than in girls. Intakes of energy were slightly above the estimated average requirements. For most nutrients the mean and median intakes were well above the Reference Nutrient Intakes (RNI). The exceptions were vitamin D, iron and zinc. Nutrient intakes in CIF were very similar to those in the NDNS except for carotene, calcium, vitamin D and iodine, where intakes were considerably higher in CIF, and sugar intake which was lower in CIF. Intakes of most foods were similar in the two surveys. However, consumption of milk, yoghurt and fromage frais and baby foods was higher in CIF, intakes of most fruit and vegetables was somewhat higher, and intakes of savoury snacks and sugar confectionery were lower. In addition, there were differences between the two groups in the types of meat and meat products consumed.

ConclusionsThese children are unlikely to be deficient in any nutrients, with the possible exceptions of iron, zinc and vitamin D. The use of vitamin D supplements and the inclusion of iron‐ and zinc‐rich foods in the diets of preschool children should be encouraged. These data will be important in assessing the influence of early diet on subsequent health and development.
Three consecutive (1993, 1995, 1997) surveys of food intake, nutritional attitudes and knowledge, and lifestyle in 1000 French children, aged 9–11 years
Authors: Bellisle F. , Rolland‐Cachera M.‐F. ,   the Kellogg Scientific Advisory Committee ‘Child and Nutrition’
Published: March 2003

Background & Aims The lifestyle of children in developed societies is susceptible to rapid changes and these may affect the nutritional status of children. Reduced physical activity and changes in diet have been proposed as contributing factors to the growth in childhood overweight and obesity. The aim of this study was to assess trends in the food‐related behaviour and markers of activity/inactivity in French 9–11‐year‐old children.

Methods Three successive surveys (1993, 1995, 1997) were carried out in samples of 1000 French children, aged 9–11 years. Sociodemographic, anthropometric and food‐related parameters were obtained for each child, using standardized questionnaire administered by trained interviewers.

Results Previous‐day reports of food intake by the child revealed a strong persistence of the traditional French meal structure. Breakfast was eaten by 97% of children. Over the three surveys, an increasing percentage of reported breakfasts contained at least one dairy food, one cereal food, and one fruit or juice (from 11% to 17%). Almost all children had lunch, which occurred at the school cafeteria for one‐third of the subjects. The afternoon snack, a traditional meal for French children, was consumed by 86–88% of the samples. Almost all children had dinner (99%), most often at home and in the company of all family members (73–87%). Lunches and dinners were composed of several courses presented in succession, as is usual in France. The foods most preferred by the children were often rich in sugar and/or fat (fried potatoes, ice cream, nut spread, chocolate, cake, etc.). The children could list ‘healthy foods’ competently. They also demonstrated knowledge of terms used in nutrition (e.g. calories, fats) and were aware of possible links between intake of certain substances and disease. In families of higher socio‐economic strata (income, education of parents) more time was devoted to sports by the children.

Over the three surveys, linear trends indicated more exercise time per week and less television viewing. A high risk of obesity was likely in very sedentary children whose proportion (33%) was stable over the 1993–1997 period.

Conclusions In general the traditional French pattern of eating persisted among these children. Although there were signs of movement towards a more complete breakfast, less television and more exercise in active children, a substantial proportion of children engaged in no sports activity outside school hours. Maintaining appropriate weight is therefore difficult in view of the plentiful supply of food available to children. Inactive children are at high risk of obesity and should be encouraged to adopt a more active lifestyle
An ethnic comparison of eating attitudes and associated body image concerns in adolescent South African schoolgirls
Authors: Caradas A. A. , Lambert E. V. , Charlton K. E.
Published: March 2003

Objective

The purpose of this study was to investigate whether differences exist in eating attitudes and body shape concerns amongst adolescent schoolgirls representing South Africa’s ethnically and culturally diverse population currently undergoing epidemiological transition.

Method

A questionnaire survey, including the Eating Attitudes Test, Body Shape Questionnaire and a Body Silhouette Chart, was administered to 228 South African schoolgirls (60 black, 83 mixed race and 85 white) aged 15–18 years from five secondary schools in the greater Cape Town area.

Results

Black girls had significantly higher mean BMI values (24.1 (3.3)) than either white (21.9 (3.0)) or mixed race girls (22.1 (3.7)) (P < 0.05). Controlling for differences in BMI, white subjects scored significantly higher on the Body Shape Questionnaire than did mixed race or black subjects, whereas no ethnic differences were found for Eating Attitude Test scores. A comparable percentage (mean=18.8%) of black, mixed race and white girls had scores indicative of eating disorder pathology on the Eating Attitudes Test, while a higher percentage of white, compared to mixed race and black, girls had abnormal scores on the Body Shape Questionnaire (33%, 26% and 20%, respectively; P < 0.05). The ideal body size desired by white girls was significantly smaller than that of the mixed race or black samples. Dissatisfaction with present body size was significantly higher in white, compared to black or mixed race girls (P < 0.001).

Conclusion

These findings suggest that the prevalence of abnormal eating attitudes is equally common in South African schoolgirls from different ethnic backgrounds. White girls exhibit greater body image concerns and body image dissatisfaction than mixed race or black individuals. These findings reinforce the notion that eating disorders are culture‐reactive rather than culture‐bound phenomena and provide insight into the extent of eating‐related problems and body image issues in developing societies.