Molecular characterisation of the sheep scab mite, Psoroptes ovis

Sheep scab is a highly contagious ectoparasitic disease that is caused by infestation with the mite, Psoroptes ovis (Acari: Psoroptidae). The disease is an important welfare issue due to the clinical symptoms induced, which include intense pruritis and severe exudative dermatitis. The host response is typical of an immediate hypersensitivity reaction however, there has been little definition of the antigens present in the mites to date. The main aims of this study were to identify the allergens associated with the sheep scab mites, and to determine the main antigens present.The proteases present in the water-soluble (SI) and membrane associated (S2) P. ovis extracts were characterised because of their allergenic potential by analogy with other organisms, particularly house dust mites. This was conducted using a combination of substrate gels and protein degradation assays. Substantial protease activity was present with cysteine proteases dominating, although aspartyl and metallo-proteases were also present. These proteases were found to degrade many substrates found in the mites' natural habitat, e.g. gelatin, collagen, fibronectin, and haemoglobin. The proteases were not inhibited by antibody from animals with a current infestation, however, this does not rule out the possibility that these proteases are targets for the host immune response.A complementary DNA (cDNA) library was prepared from mixed stage mites in a lambda TriplEx2 vector, for the dual purpose of immunoscreening and expressed sequence tag (EST) analysis. Immunoscreening was carried out using sera from animals which had been immunised and protected against mite challenge with mite extracts and 48 cDNA clones were selected. Of these, six were recognised in a differential immunoscreen using sera from strongly protected animals compared with sera from weakly protected animals. Subsequent sequence analysis established that these clones had homology to myosin or myosin-based proteins.The EST analysis of 500 randomly selected cDNA clones identified many novel proteins and this study focused attention on the allergens, proteases and antioxidant enzymes. Eight different allergens were identified including homologues of the major house dust mite (Dermatophagoides spp.) allergens. The group 2 allergens, e.g. Der f2, were most abundant in the EST dataset. Cathepsin B and L cysteine proteases were identified as well as several antioxidant enzymes, e.g. glutathione S-transferase, superoxide dismutase and thioredoxin peroxidase, which may help to protect the mite from toxic free radicals released in the host lesion.This study has shown that there are a range of proteases present in P. ovis mites. Eight putative allergens and three classes of antioxidant enzymes were also identified. These results provide an insight into the physiology of the mite, and the aetiology of the disease

Systematic exploration of local reviews of the care of maternal deaths in the UK and Ireland between 2012 and 2014: A case note review study

Objectives Local reviews of the care of women who die in pregnancy and post-birth should be undertaken. We investigated the quantity and quality of hospital reviews. DesignAnonymised case notes review. Participants All 233 women in the UK and Ireland who died during or up to 6 weeks after pregnancy from any cause related to or aggravated by pregnancy or its management in 2012-2014. Main outcome measures The number of local reviews undertaken. Quality was assessed by the composition of the review panel, whether root causes were systematically assessed and actions detailed. Results The care of 177/233 (76%) women who died was reviewed locally. The care of women who died in early pregnancy and after 28 days post-birth was less likely to be reviewed as was the care of women who died outside maternity services and who died from mental health-related causes. 140 local reviews were available for assessment. Multidisciplinary review was undertaken for 65% (91/140). External involvement in review occurred in 12% (17/140) and of the family in 14% (19/140). The root causes of deaths were systematically assessed according to national guidance in 13% (18/140). In 88% (123/140) actions were recommended to improve future care, with a timeline and person responsible identified in 55% (77/140). Audit to monitor implementation of changes was recommended in 14% (19/140). Conclusions This systematic assessment of local reviews of care demonstrated that not all hospitals undertake a review of care of women who die during or after pregnancy and in the majority quality is lacking. The care of these women should be reviewed using a standardised robust process including root cause analysis to maximise learning and undertaken by an appropriate multidisciplinary team who are given training, support and adequate time

Systematic exploration of local reviews of the care of maternal deaths in the UK and Ireland between 2012 and 2014:a case note review study

ObjectivesLocal reviews of the care of women who die in pregnancy and post-birth should be undertaken. We investigated the quantity and quality of hospital reviews.DesignAnonymised case notes review.ParticipantsAll 233 women in the UK and Ireland who died during or up to 6 weeks after pregnancy from any cause related to or aggravated by pregnancy or its management in 2012–2014.Main outcome measuresThe number of local reviews undertaken. Quality was assessed by the composition of the review panel, whether root causes were systematically assessed and actions detailed.ResultsThe care of 177/233 (76%) women who died was reviewed locally. The care of women who died in early pregnancy and after 28 days post-birth was less likely to be reviewed as was the care of women who died outside maternity services and who died from mental health-related causes. 140 local reviews were available for assessment. Multidisciplinary review was undertaken for 65% (91/140). External involvement in review occurred in 12% (17/140) and of the family in 14% (19/140). The root causes of deaths were systematically assessed according to national guidance in 13% (18/140). In 88% (123/140) actions were recommended to improve future care, with a timeline and person responsible identified in 55% (77/140). Audit to monitor implementation of changes was recommended in 14% (19/140).ConclusionsThis systematic assessment of local reviews of care demonstrated that not all hospitals undertake a review of care of women who die during or after pregnancy and in the majority quality is lacking. The care of these women should be reviewed using a standardised robust process including root cause analysis to maximise learning and undertaken by an appropriate multidisciplinary team who are given training, support and adequate time

Midwives’ perspectives of continuity based working in the UK: A cross-sectional survey

Objective: UK policy is advocating continuity of midwife throughout the antenatal, intrapartum and postnatal period in order to improve outcomes. We explored the working patterns that midwives are willing and able to adopt, barriers to change, and what would help midwives to work in continuity models of care.Design: A cross-sectional survey.Setting: 27 English maternity providers in the seven geographically-based ‘Early Adopter’ sites, which have been chosen to fast-track national policy implementation. Participants: All midwives working in the ‘Early Adopter’ sites were eligible to take part.Method: Anonymous online survey disseminated by local and national leaders, and social media, in October 2017. Descriptive statistics were calculated for quantitative survey responses. Qualitative free text responses were analysed thematically.Findings: 798 midwives participated (estimated response rate 20% calculated using local and national NHS workforce headcount data for participating sites). Being willing or able to work in a continuity model (caseloading and/or team)was lowest where this included intrapartum care in both hospital and home settings (35%, n = 279). Willingness to work in a continuity model of care increased as the range of intrapartum care settings covered decreased (home births only 45%, n = 359; no intrapartum care at all 54%, n = 426). A need to work on the same day each week was reported by 24% (n = 188). 31% (n = 246) were currently working 12 h shifts only, while 37% (n = 295) reported being unable to work any on-calls and/or nights. Qualitative analysis revealed multiple barriers to working in continuity models: the most prominent was caring responsibilities for children and others. Midwives suggested a range of approaches to facilitate working differently including concessions in the way midwife roles are organised, such as greater autonomy and choice in working patterns.Conclusions: Findings suggest that many midwives are not currently able or willing to work in continuity models, which includes care across antenatal, intrapartum and postnatal periods as recommended by UK policy.Implications for Practice: A range of approaches to providing continuity models should be explored as the implementation of ‘Better Births’ takes place across England. This should include studies of the impact of the different models on women, babies and midwives, along with their practical scalability and cost

P-glycoprotein-9 and macrocyclic lactone resistance status in selected strains of the ovine gastrointestinal nematode, Teladorsagia circumcincta

The Teladorsagia circumcincta P-glycoprotein-9 (Tci-pgp-9) gene has previously been implicated in multiple-anthelmintic resistance in this parasite. Here we further characterise genetic diversity in Tci-pgp-9 and its possible role in ivermectin (IVM) and multi-drug resistance using two UK field isolates of T. circumcincta, one susceptible to anthelmintics (MTci2) and the other resistant to most available anthelmintics including IVM (MTci5). A comparison of full-length Tci-pgp-9 cDNA transcripts from the MTci2 and MTci5 isolates (∼3.8 kb in both cases) indicated that they shared 95.6% and 99.5% identity at the nucleotide and amino acid levels, respectively. Nine non-synonymous SNPs were found in the MTci5 sequences relative to their MTci2 counterparts. Twelve genomic sequence variants of the first internucleotide binding domain of Tci-pgp-9 were identified and up to 10 of these were present in some individual worms, strongly supporting previous evidence that amplification of this gene has occurred in T. circumcincta. On average, fewer distinct sequence variants of Tci-pgp-9 were present in individual worms of the MTci5 isolate than in those of the MTci2 isolate. A further reduction in the number of sequence variants was observed in individuals derived from an IVM-treated sub-population of MTci5. These findings suggest that Tci-pgp-9 was under purifying selection in the face of IVM treatment in T. circumcincta, with some sequence variants being selected against

Community postnatal care delivery in England since Covid-19 : a qualitative study of midwifery leaders' perspectives and strategies.

COVID-19 impacted negatively on maternity care experiences of women and staff. Understanding the emergency response is key to inform future plans. Before the COVID-19 pandemic, experts highlighted concerns about UK community postnatal care, and its impact on long-term health, wellbeing, and inequalities. These appear to have been exacerbated by the pandemic. To explore community postnatal care provision during and since the pandemic across a large diverse UK region. A descriptive qualitative approach. Virtual semi-structured interviews conducted November 2022-February 2023. All regional midwifery community postnatal care leaders were invited to participate. 11/13 midwifery leaders participated. Three main themes were identified: Changes to postnatal care (strategic response, care on the ground); Impact of postnatal care changes (staff and women's experiences); and Drivers of postnatal care changes in (COVID-19, workforce issues). Changes to postnatal care during the pandemic included introduction of virtual care, increased role of Maternity Support Workers, and moving away from home visits to clinic appointments. This has largely continued without evaluation. The number of care episodes provided for low and high-risk families appears to have changed little. Those requiring additional support but not deemed highest risk appear to have been most impacted. Staffing levels influenced amount and type of care provided. There was little inter-organisation collaboration in the postnatal pandemic response. Changes to postnatal care provision introduced more efficient working practices. However, evaluation is needed to ensure ongoing safe, equitable and individualised care provision post pandemic within limited resources

Fitness costs of parasites explain multiple life history tradeoffs in a wild mammal

Reproduction in wild animals can divert limited resources away from immune defence, resulting in increased parasite burdens. A longstanding prediction of life history theory states that these parasites can harm the individual, reducing the organism's subsequent fitness and producing reproduction-fitness tradeoffs. Here, we examined associations among reproductive allocation, immunity, parasitism, and subsequent fitness in a wild population of individually identified red deer ( Cervus elaphus ). Using path analysis, we investigated whether costs of lactation for downstream survival and fecundity were mediated by changes in strongyle nematode count and mucosal antibody levels. Lactating females exhibited increased parasite counts, which were in turn associated with substantially decreased fitness in the following year in terms of overwinter survival, fecundity, subsequent calf weight, and parturition date. This study offers observational evidence for parasite regulation of multiple life history tradeoffs, supporting the role of parasites as an important mediating factor in wild mammal populations.The anonymised data files are present in the `DataList.rds` object; the scripts will run the path analysis and generate the figures, using these datasets. Funding provided by: Natural Environment Research CouncilCrossref Funder Registry ID: http://dx.doi.org/10.13039/501100000270Award Number: NE/L00688X/1Funding provided by: Natural Environment Research CouncilCrossref Funder Registry ID: http://dx.doi.org/10.13039/501100000270Award Number: NE/L002558/1Noninvasive faecal collection from the Isle of Rum red dee

Development of a novel Bluetooth Low Energy device for proximity and location monitoring in grazing sheep

Monitoring animal location and proximity can provide useful information on behaviour and activity, which can act as a health and welfare indicator. However, tools such as global navigation satellite systems (GNSS) can be costly, power hungry and often heavy, thus not viable for commercial uptake in small ruminant systems. Although, developments in Bluetooth Low Energy (BLE) could offer another option for animal monitoring, BLE signal strength can be variable, and further information is needed to understand the relationship between signal strength and distance in an outdoor environment and assess factors which might affect its interpretation in on-animal scenarios. A calibration of a purpose-built device containing a BLE reader, alongside commercial BLE beacons, was conducted in a field environment to explore how signal strength changed with distance and investigate whether this was affected by device height, and thus animal behaviour. From this calibration, distance prediction equations were developed whereby beacon distance from a reader could be estimated based on signal strength. BLE as a means of localisation was then trialled, firstly using a multilateration approach to locate 16 static beacons within an ∼5 400 m2 section of paddock using 6 BLE readers, followed by an on-sheep validation where two localisation approaches were trialled in the localisation of a weaned lamb within ∼1.4 ha of adjoining paddocks, surrounded by 9 BLE readers. Validation was conducted using one days’ worth of data from a lamb fitted with both a BLE beacon and separate GNSS device. The calibration showed a decline in signal strength with increasing beacon distance from a reader, with a reduced range and earlier decline in the proportion of beacons reported at lower reader and beacon heights. The distance prediction equations indicated a mean underestimation of 12.13 m within the static study, and mean underestimation of 1.59 m within the on-sheep validation. In the static beacon localisation study, the multilateration method produced a mean localisation error of 22.02 m, whilst in the on-sheep validation similar mean localisation errors were produced by both methods – 19.00 m using the midpoint and 23.77 m using the multilateration method. Our studies demonstrate the technical feasibility of localising sheep in an outdoor environment using BLE technology, however, potential commercial application of such a system would require improvements in BLE range and accuracy