Exploring stable-based behaviour and behaviour switching for the detection of bilateral pain in equines

Efficient and sensitive animal pain detection approaches are increasingly studied with the goal of improving animal welfare and monitoring the efficacy of treatment and rehabilitation. The aim of this study was to determine the potential of various behaviours as sensitive indicators of subtle inflammation states in equines. The long-term goal of this research is to understand how to objectively and remotely classify behaviours that are associated with inflammation using wearable inertial sensor technologies. This study represents a proof-of concept investigation to ascertain what behavioural indices might be important in long-term monitoring of mild bilateral inflammation and recovery with a view to translating the approach to a technology-enabled remote monitoring paradigm. Bilateral synovitis of the intercarpal joints was induced in seven equines using lipopoly saccharide (0.25 ng) at time zero. The horses were confined to stables and monitored intermittently over seven days by stable-fixed video cameras. White blood cell count, carpal circumference and food availability were recorded across the study. An ethogram was created to manually annotate behaviours from video footage following lameness induction at seven different timepoints across a 1-week period. Behaviour data were processed extracting the duration, frequency and variability of behaviours. One-way repeated measures ANOVA revealed a significant time effect for white blood cell count and behaviour switching. There were no significant changes in carpal circumferences and heart rate measures over the sampling period. Food availability appears to be an important contextual factor that should be considered in pain-related behavioural studies. We conclude that behaviour variability may be a promising indicator of subtle bilateral inflammation which should be further explored in larger controlled trials and different pain presentations. Future work will seek to optimise grouping of behaviours associated with inflammation that can be detected using wearable technologies for future remote monitoring protocols

Identifying research priorities for effective retention strategies in clinical trials

Background The failure to retain patients or collect primary-outcome data is a common challenge for trials and reduces the statistical power and potentially introduces bias into the analysis. Identifying strategies to minimise missing data was the second highest methodological research priority in a Delphi survey of the Directors of UK Clinical Trial Units (CTUs) and is important to minimise waste in research. Our aim was to assess the current retention practices within the UK and priorities for future research to evaluate the effectiveness of strategies to reduce attrition. Methods Seventy-five chief investigators of NIHR Health Technology Assessment (HTA)-funded trials starting between 2009 and 2012 were surveyed to elicit their awareness about causes of missing data within their trial and recommended practices for improving retention. Forty-seven CTUs registered within the UKCRC network were surveyed separately to identify approaches and strategies being used to mitigate missing data across trials. Responses from the current practice surveys were used to inform a subsequent two-round Delphi survey with registered CTUs. A consensus list of retention research strategies was produced and ranked by priority. Results Fifty out of seventy-five (67%) chief investigators and 33/47 (70%) registered CTUs completed the current practice surveys. Seventy-eight percent of trialists were aware of retention challenges and implemented strategies at trial design. Patient-initiated withdrawal was the most common cause of missing data. Registered CTUs routinely used newsletters, timeline of participant visits, and telephone reminders to mitigate missing data. Whilst 36 out of 59 strategies presented had been formally or informally evaluated, some frequently used strategies, such as site initiation training, have had no research to inform practice. Thirty-five registered CTUs (74%) participated in the Delphi survey. Research into the effectiveness of site initiation training, frequency of patient contact during a trial, the use of routinely collected data, the frequency and timing of reminders, triggered site training and the time needed to complete questionnaires was deemed critical. Research into the effectiveness of Christmas cards for site staff was not of critical importance. Conclusion The surveys of current practices demonstrates that a variety of strategies are being used to mitigate missing data but with little evidence to support their use. Six retention strategies were deemed critically important within the Delphi survey and should be a primary focus of future retention research

Effectiveness of Metyrapone in Treating Cushing's Syndrome: A Retrospective Multicenter Study in 195 Patients

Background: Cushing's syndrome (CS) is a severe condition with excess mortality and significant morbidity necessitating control of hypercortisolemia. There are few data documenting use of the steroidogenesis inhibitor metyrapone for this purpose. Objective: The objective was to assess the effectiveness of metyrapone in controlling cortisol excess in a contemporary series of patients with CS. Design: This was designed as a retrospective, multicenter study. Setting: Thirteen University hospitals were studied. Patients: We studied a total of 195 patients with proven CS: 115 Cushing's disease, 37 ectopic ACTH syndrome, 43 ACTH-independent disease (adrenocortical carcinoma 10, adrenal adenoma 30, and ACTH-independent adrenal hyperplasia 3). Measurements: Measurements included biochemical parameters of activity of CS: mean serum cortisol “day-curve” (CDC) (target 150–300 nmol/L); 9 am serum cortisol; 24-hour urinary free cortisol (UFC). Results: A total of 164/195 received metyrapone monotherapy. Mean age was 49.6 ± 15.7 years; mean duration of therapy 8 months (median 3 mo, range 3 d to 11.6 y). There were significant improvements on metyrapone, first evaluation to last review: CDC (91 patients, 722.9 nmol/L [26.2 μg/dL] vs 348.6 nmol/L [12.6 μg/dL]; P < .0001); 9 am cortisol (123 patients, 882.9 nmol/L [32.0 μg/dL] vs 491.1 nmol/L [17.8 μg/dL]; P < .0001); and UFC (37 patients, 1483 nmol/24 h [537 μg/24 h] vs 452.6 nmol/24 h [164 μg/24 h]; P = .003). Overall, control at last review: 55%, 43%, 46%, and 76% of patients who had CDCs, UFCs, 9 am cortisol less than 331 nmol/L (12.0 μg/dL), and 9 am cortisol less than upper limit of normal/600 nmol/L (21.7 μg/dL). Median final dose: Cushing's disease 1375 mg; ectopic ACTH syndrome 1500 mg; benign adrenal disease 750 mg; and adrenocortical carcinoma 1250 mg. Adverse events occurred in 25% of patients, mostly mild gastrointestinal upset and dizziness, usually within 2 weeks of initiation or dose increase, all reversible. Conclusions: Metyrapone is effective therapy for short- and long-term control of hypercortisolemia in CS

Anterior necrotizing scleritis after strabismus surgery in a child

Anterior necrotizing scleritis is a rare but potentially devastating complication of ocular surgery that most often occurs after cataract surgery in elderly patients who may have an underlying systemic autoimmune condition1 or, less likely, an infectious cause.2 We describe the management and outcome of a case of bilateral anterior necrotizing scleritis after postoperative infection in a 19-month-old girl who had recently undergone strabismus surgery

Effect of branched-chain fatty acids, 3-methylindole and 4-methylphenol on consumer sensory scores of grilled lamb meat

Tenderness, flavour, overall liking and odour are important components of sheepmeat eating quality. Consumer assessment of these attributes has been made for carcasses from the Information Nucleus Flock (INF) of the Cooperative Research Centre for Sheep Industry Innovation. The concentrations of three branched chain fatty acids, 4-methyloctanoic (MOA), 4-ethyloctanoic (EOA) and 4-methylnonanoic acids (compounds related to 'mutton flavour' in cooked sheepmeat) and 3-methylindole and 4-methylphenol (compounds related to 'pastoral' flavour) were determined for 178 fat samples taken from INF carcasses. Statistical modelling revealed that both MOA and EOA impacted on the 'Like Smell' consumer sensory score of the cooked meat product (P < 0.05), with increasing concentration causing lower consumer acceptance of the product. None of the compounds though had an effect on the liking of flavour. Obviously, reducing the effect of MOA and EOA on the odour of grilled lamb will improve consumer acceptance of the cooked product but other factors affecting the eating quality also need to be considered