Large Specialist Research Articles

Feeding habits of extant and fossil canids as determined by their skull geometry

AbstractThe canids belong to one of the most prominent families of mammalian carnivores. Feeding adaptations of extant species is well documented by field observations; however, we are still missing palaeoecological insights for many enigmatic fossil specimens. We employ geometric morphometrics to quantify skull size and shape in extant and fossil members of the Canini tribe, inclusive of jackals and wolf‐like taxa. Skull data are tested to identify correlates of dietary adaptations in extant species for predicting adaptations in fossils. Main vectors of shape variation correlate with the relative skull‐palatal length, the position of the upper carnassial tooth and the anterior tip of the secondary palate. Allometry occurs in the palatal shape but size explains only a small fraction (about 4%) of shape variance. Although we quantified only palatal and tooth shape for the inclusion of fragmentary fossils, discriminant function analysis successfully classify extant Canini in dietary groups (small, medium and large prey specialist) with 89% of accuracy. The discriminant functions provide insights into many enigmatic specimens such as Eucyon adoxus (=small prey), fossil jackal‐like from Koobi Fora formation (=small prey) and the Plio‐Pleistocene Old World canid guild (Canis etruscus, C. arnensis and Lycaon falconeri). Clearly, both skull size and shape are excellent predictors of feeding habits in Canini thus also provide information about fossil taxonomic affinities.

Management of paediatric tuberculosis in leading UK centres: unveiling consensus and discrepancies

Large specialist paediatric TB clinics in the UK. To evaluate clinical practice and compare with national and international guidelines. A survey based on an electronic questionnaire on the management of latent tuberculous infection (LTBI) and tuberculosis (TB) disease was conducted in 13 specialist paediatric TB clinics. The consensus and discrepancies were evaluated by descriptive analysis. Practice was reportedly different when choosing age limits for preventive treatment for TB contacts with initially negative tuberculin skin tests (TSTs), interpretation of TST results and use of interferon-gamma release assays (IGRAs) in the context of LTBI. In relation to management of children with TB disease, practices varied for duration of treatment of osteoarticular TB, monitoring for ethambutol ocular toxicity and use of pyridoxine. There was limited experience with multidrug-resistant TB (MDR-TB), and over half of the clinics monitored MDR-TB contacts without giving preventive treatment. The survey showed heterogeneity in several aspects of clinical care for children with TB. Available paediatric TB guidelines differ substantially, explaining the wide variations in management of childhood TB. Prospective paediatric studies are urgently required to inform and standardise clinical practice, especially in the context of evolving drug resistance.

The effect of clozapine on premature mortality: an assessment of clinical monitoring and other potential confounders.

Clozapine can cause severe adverse effects yet it is associated with reduced mortality risk. We test the hypothesis this association is due to increased clinical monitoring and investigate risk of premature mortality from natural causes. We identified 14 754 individuals (879 deaths) with serious mental illness (SMI) including schizophrenia, schizoaffective and bipolar disorders aged ≥ 15 years in a large specialist mental healthcare case register linked to national mortality tracing. In this cohort study we modeled the effect of clozapine on mortality over a 5-year period (2007–2011) using Cox regression. Individuals prescribed clozapine had more severe psychopathology and poorer functional status. Many of the exposures associated with clozapine use were themselves risk factors for increased mortality. However, we identified a strong association between being prescribed clozapine and lower mortality which persisted after controlling for a broad range of potential confounders including clinical monitoring and markers of disease severity (adjusted hazard ratio 0.4; 95% CI 0.2–0.7; p = .001). This association remained after restricting the sample to those with a diagnosis of schizophrenia or those taking antipsychotics and after using propensity scores to reduce the impact of confounding by indication. Among individuals with SMI, those prescribed clozapine had a reduced risk of mortality due to both natural and unnatural causes. We found no evidence to indicate that lower mortality associated with clozapine in SMI was due to increased clinical monitoring or confounding factors. This is the first study to report an association between clozapine and reduced risk of mortality from natural causes.

A RETROSPECTIVE MERGER ANALYSIS IN THE U.K. VIDEOGAME MARKET

We study the effect of a merger in a dynamic high-technology industry—the videogame market—which is characterized by the frequent introduction of new products. To assess the impact of the merger between two large specialist retailers in the United Kingdom—Game Group PLC and Games Station Limited—we perform a difference-in-differences analysis comparing the price evolution of the merging parties with that of their 7 major competitors on an original sample of 196 videogames belonging to 6 different consoles. The results of our econometric analyses suggest that there has been a reduction in the general level of prices of both new and pre-owned games after the merger. This decline has been more marked for the merging parties, which suggests that the merger between Game Group PLC and Games Station Limited did not lead to a substantial lessening of competition; rather, it is consistent with the existence of efficiency gains.

Virtual Reconstruction and Prey Size Preference in the Mid Cenozoic Thylacinid, Nimbacinus dicksoni (Thylacinidae, Marsupialia)

Thylacinidae is an extinct family of Australian and New Guinean marsupial carnivores, comprizing 12 known species, the oldest of which are late Oligocene (∼24 Ma) in age. Except for the recently extinct thylacine (Thylacinus cynocephalus), most are known from fragmentary craniodental material only, limiting the scope of biomechanical and ecological studies. However, a particularly well-preserved skull of the fossil species Nimbacinus dicksoni, has been recovered from middle Miocene (∼16-11.6 Ma) deposits in the Riversleigh World Heritage Area, northwestern Queensland. Here, we ask whether N. dicksoni was more similar to its recently extinct relative or to several large living marsupials in a key aspect of feeding ecology, i.e., was N. dicksoni a relatively small or large prey specialist. To address this question we have digitally reconstructed its skull and applied three-dimensional Finite Element Analysis to compare its mechanical performance with that of three extant marsupial carnivores and T. cynocephalus. Under loadings adjusted for differences in size that simulated forces generated by both jaw closing musculature and struggling prey, we found that stress distributions and magnitudes in the skull of N. dicksoni were more similar to those of the living spotted-tailed quoll (Dasyurus maculatus) than to its recently extinct relative. Considering the Finite Element Analysis results and dental morphology, we predict that N. dicksoni likely occupied a broadly similar ecological niche to that of D. maculatus, and was likely capable of hunting vertebrate prey that may have exceeded its own body mass.

G98(P) Susceptibility to Varicella Zoster in children with cystic fibrosis

IntroductionVaricella zoster virus (VZV) infection can result in significant morbidity in patients with cystic fibrosis (CF), and the risk of severe pulmonary complications rises with age. This is a greater...

Susceptibility to varicella zoster of children with cystic fibrosis

Varicella zoster virus (VZV) infection can result in significant morbidity in patients with cystic fibrosis (CF), and the risk of severe pulmonary complications rises with age [[1]MacDonald N.E. Morris R.F. Beaudry P.H. Varicella in children with cystic fibrosis.Pediatr Infect Dis J. 1987; 6: 414-416Crossref PubMed Scopus (10) Google Scholar]. This is a greater concern in those receiving systemic corticosteroids, which in the case of CF is most often given for acute allergic bronchopulmonary aspergillosis (ABPA). Severe complications such as pneumonitis, secondary bacterial infections, and liver failure may occur despite prompt treatment with antiviral agents. The seroprevalence of VZV antibodies in CF children is unknown, although in the general population >80% of children over 6 years of age have evidence of immunity [[2]Vyse A.J. Gay N.J. Hesketh L.M. Morgan-Capner P. Miller E. Seroprevalence of antibody to varicella zoster virus in England and Wales in children and young adults.Epidemiol Infect. 2004; 132: 1129-1134Crossref PubMed Scopus (60) Google Scholar]. We aimed to investigate the seroprevalence of VZV antibodies in children attending our large paediatric specialist CF centre, whether or not there was a history of chicken pox. In 2011 we started routine testing for VZV antibodies in 6 year olds at their annual review. This age was selected in view of the low prevalence of ABPA under that age and the chance that children would already have had chicken pox. Evidence of immunity to VZV was determined by VZV IgG antibodies ≥0.9 IU/L (measured by a VIDAS VZV IgG enzyme-linked fluorescent immunoassay). In 2012 the prevalence of ABPA in our CF clinic was 9%, 96% of which was aged 6 and above. As this was a new policy, we also tested older children in order to cover the whole clinic. We identified all children in our CF clinic aged ≥6 years at August 2012, and collected data on VZV immunity 12 months later, thus ensuring that children aged ≥6 years at the initial time-point would have had an annual review. We asked general practitioners to vaccinate patients with a negative result. There were 232 patients aged ≥6 years. 178 patients (77%) in this cohort had been tested for evidence of VZV immunity within the year. Of these, n = 22 (12%) had no evidence of VZV antibodies and were therefore susceptible to chickenpox (Fig. 1). In our paediatric CF population, the prevalence of VZV antibodies was similar to that reported for the general population. However, unlike the general population, children with CF are at greater risk of serious complications from varicella infection. In contrast to other groups of patients with chronic diseases whose treatment may result in immunosuppression, there is no UK-wide specific recommendation for VZV immunization in CF. Vaccination against VZV before immune compromise has been used as a strategy to prevent VZV complications in patients starting immunosuppressive therapy [[3]Levin M.J. Varicella vaccination of immunocompromised children.J Infect Dis. 2008; 197: S200-S206Crossref PubMed Scopus (47) Google Scholar]. We suggest screening for VZV antibodies in children with CF at 6 years and offering vaccination for those found to be seronegative.

Clinical practice in febrile neutropenia risk assessment and granulocyte colony-stimulating factor primary prophylaxis of febrile neutropenia in Poland.

Aim of the studyThe first aim was to investigate the knowledge and awareness of oncologists concerning febrile neutropenia (FN) risk assessment and indications for granulocyte colony-stimulating factor (G-CSF) primary prophylaxis (PP), based on current therapeutic guidelines (PTOK and EORTC). The second aim was to educate the oncologists on best practices for risk assessment and neutropenia management.Material and methodsThe project participants included 169 oncologists from 7 regions working in large specialist oncological centres, university hospitals, regional and city hospitals, specialist outpatient clinics, and oncological wards in small local hospitals. The participants completed a questionnaire based on seven prepared clinical cases of patients with different tumour types and patient characteristics, receiving chemotherapy (CT), and with different levels of FN risk. Participants answered questions related to FN risk assessment and G-CSF use. After completing the questionnaire, the participants proceeded to an educational module in which they were provided with an analysis of correct diagnostic and therapeutic procedures according to the PTOK and EORTC guidelines.Results and ConclusionsFebrile neutropenia risk assessment was found to be a routine procedure performed for over 90% of the clinical cases by the participant oncologists. However, the FN risk assessment of clinical cases was correct and consistent with therapeutic guidelines in only 65% of responses. Indications for G-CSF PP were properly identified in 76% of responses and it appeared that indications for G-CSF PP were more likely to be correctly identified in patients receiving high-risk or low-risk regimens than in those receiving intermediate-risk regimens, where the decision to give G-CSF PP is based on additional assessment of patient risk factors. The vast majority of participants who correctly identified the need for PP administered G-CSF in accordance with the dose and schedule recommended by PTOK and EORTC.

People matter: tomorrow's workforce for tomorrow's world.

The focus of any health service, now and into the future, should be people delivering safe, quality care to people; care that covers not just diagnosis and treatment, but the whole experience that patients and their carers have of the service. Workforce development, the process by which the current and future workforce is planned and trained, must be related to current and future patterns of service delivery and take account of financial reality. It cannot exist in isolation. Despite employing 1.3 million people, upon whom up to 70% of its budget is spent, the NHS has been curiously relaxed about the workforce development of both its staff in training and of those trained staff who, with the impact of demographic change and the increasing speed of technological progress, will need to adapt to new ways of working and learn new skills. Given that the NHS has been repeatedly criticised by the Health Select Committee for its failure to link workforce planning and development with service and financial planning, and that inadequate staffing has been a feature of a number of recent organizational failures, how is this to be achieved? Some NHS organisations have been shown to be poor employers with a culture of bullying and fear and the use of suspensions and financial settlements bound to gagging clauses to remove whistleblowers. Gender and ethnic discrimination is an issue not yet fully resolved. Furthermore with the demographic changes around the increasing needs of an elderly population, the introduction of new technology and the increasing interdependency of health and social care, there is a need for a clear vision as to how the future NHS will be structured and developed. Fewer large specialist centres are likely, combined with local, community oriented integrated services with appropriate specialist support. Decisions need to be taken about this in time to give workforce development processes time to plan the best skill mix combinations and to develop clinicians and managers who can orchestrate NHS activities on a whole system basis rather than in the exclusively specialised silos we see today.

Clinical practice in secondary prophylaxis and management of febrile neutropenia in Poland: results of the febrile neutropenia awareness project.

Aim of the studyThis paper presents the second part of the GoPractice project involving oncologists from seven Polish provinces. The aim of this part of the project was to assess the knowledge of oncologists on indications for granulocyte colony-stimulating factor (G-CSF) secondary prophylaxis (SP) of febrile neutropenia (FN) and FN management based on current therapeutic guidelines (Polish Society of Clinical Oncology [PTOK] and European Organisation for Research and Treatment of Cancer [EORTC]).Material and methodsThe project involved 169 oncologists from 7 regions working in large specialist oncological centers, university hospitals, regional and city hospitals, specialist outpatient clinics and oncological wards in small, local hospitals. The participants completed a questionnaire based on 7 prepared clinical cases of patients with different tumor types and patient characteristics, receiving chemotherapy (CT) with different levels of FN risk. Participants answered questions related to FN risk assessment and G-CSF use as secondary prophylaxis (SP) and for the management of FN. After completing the questionnaire, the participants proceeded to an educational module in which they were provided with an analysis of correct diagnostic and therapeutic procedures according to the PTOK and EORTC guidelines.Results and ConclusionsIndications for G-CSF SP were generally well recognized: in nearly 90% of responses, oncologists assessed correctly indications/lack of indications for secondary prophylaxis, in accordance with guideline recommendations and Experts’ opinion. However, the use of daily G-CSFs was often recommended by the study participants for the management of FN. This clinical practice is contradictory to PTOK and EORTC recommendations and may unnecessarily increase treatment costs. Changing this clinical approach may be achieved through regular training to improve guideline adherence.

The landscape genetics of syntopic topminnows (Fundulus notatusandF. olivaceus) in a riverine contact zone

The metapopulation dynamics of a species are influenced by the spatial arrangement of preferred habitats across a landscape. Increasing habitat patchiness can result in greater population subdivision, leading to more pronounced population genetic structure. Therefore, even subtle differences in habitat preferences among species could lead to substantial differences in genetic structure. Members of the Fundulus notatus species complex of topminnows include a headwater specialist and a large river specialist with broadly overlapping geographical distributions. Both species are often found in the same drainage systems, but partially isolated by divergent habitat preferences. The purpose of this research was to determine whether distribution along a stream continuum in a contact zone influences population genetic patterns in two species of topminnow (Fundulus olivaceus and Fundulus notatus). Fish were collected in the summers of 2010–2012, and habitat data were collected in summer 2012, within all major tributaries of the Saline River in southern Illinois. In total, 523 fish were genotyped using seven microsatellite loci to assess genetic variation. Species distributions in F. notatus and F. olivaceus were associated with habitat factors that covaried with cumulative drainage area. Populations of F. olivaceus showed a greater level of genetic structure reflected in a significant pattern of isolation by distance, while populations of F. notatus showed no such pattern. Spatial autocorrelation analysis revealed that at an individual level, both species became increasingly divergent with waterway distance. Overall, clear interspecific differences in habitat preferences were translated into measurable but relatively subtle differences in population genetic structure.

A re-audit of paediatric ENT services in England and Wales

ObjectivesENT has a high paediatric workload. National recommendations for provision of paediatric surgical services are provided by three key documents produced by the Department of Health and Royal Colleges of Surgeons and Anaesthetists. This second cycle audit assesses the current state of paediatric services in ENT departments in England and Wales based on these recommendations and whether progress has been made since the first audit in 2003. MethodsA hyperlinked web-based questionnaire was e-mailed to ENT consultants in 164 ENT departments. The questionnaire addressed key areas recommended in the guidelines – theatre and anaesthetic provisions, inpatient/outpatients facilities and staff training. The responses were categorised according to hospital type – teaching hospitals, large or small district general hospitals and specialist stand-alone hospitals. ResultsAn overall response rate of 56% was achieved. Children's ward facilities remained high across all types of hospitals, with most having dedicated paediatric medical cover and specialised staff. There was an improvement in the number of staff qualified to provide paediatric life support. The level of anaesthetic supervision and expertise in theatres improved, as did the overall level of post-operative management. However, the provision of acute pain services remained relatively low. ConclusionsOverall there has been an improvement in the provision of paediatric surgical services in accordance with the guidelines but there remains variability in some aspects relating to the size of the hospital.

USE OF SERVICES FOR MULTIPLE SCLEROSIS PATIENTS ACCORDING TO EDSS

IntroductionClinical services supporting patients with Multiple Sclerosis (MS) represents a significant proportion of the work load for a modern department of neurology. However planning for development of specialist services in...

They Played the Merger Game: A Retrospective Analysis in the UK Videogames Market

We study the effect of a merger in a dynamic high-technology industry–the videogame market– which is characterized by frequent introduction of new products. To assess the impact of the merger between two large specialist retailers in the UK, we perform a difference-in-differences analysis comparing the price evolution of the merging parties to that of their 7 major competitors on an original sample of 196 videogames belonging to six different consoles. The results of our econometric analyses suggest that there has been a reduction in the general level of prices of both new and pre-owned games after the merger. This decline has been more marked for the merging parties, which suggests that the merger between Game and Gamestation did not lead to a substantial lessening of competition; rather it is consistent with the existence of efficiency gains.

Veterinary Record Case Reports – filling a gap

THIS month sees the launch of Veterinary Record Case Reports , an exciting new addition to the expanding group of BVA journals published by the prestigious BMJ with its long heritage of excellence in medical publishing. Until now there has been limited opportunity to publish veterinary case reports, as most journals, including Veterinary Record , will only publish large and notable case series or single cases of exceptional novelty or significance. Thus, this initiative presents a real opportunity for colleagues outside large specialist referral centres, universities and research institutes to launch their publishing careers. Indeed, we will be encouraging reports of cases from first-opinion practice, less usual areas of practice and from the extramural studies of …

Veterinary Record Case Reports

Welcome to Veterinary Record Case Reports, an exciting new addition to the expanding group of BVA journals published by the prestigious BMJ with its long heritage of excellence in medical...

They Played the Merger Game: A Retrospective Analysis in the UK Videogames Market

We study the effect of a merger in a dynamic high-technology industry–the videogame market– which is characterized by frequent introduction of new products. To assess the impact of the merger between two large specialist retailers in the UK, we perform a difference-in-differences analysis comparing the price evolution of the merging parties to that of their 7 major competitors on an original sample of 196 videogames belonging to six different consoles. The results of our econometric analyses suggest that there has been a reduction in the general level of prices of both new and pre-owned games after the merger. This decline has been more marked for the merging parties, which suggests that the merger between Game and Gamestation did not lead to a substantial lessening of competition; rather it is consistent with the existence of efficiency gains.

Deaths in childhood from cystic fibrosis: 10-year analysis from two London specialist centres

IntroductionDeath in childhood from cystic fibrosis (CF) is now an uncommon event in the UK. We wished to assess the circumstances surrounding deaths (and lung transplantation) in the modern era...

The view from below: ‘lock-in’ and local procurement in the African gold mining sector

Through linkage creation, commodity extraction has the capacity to support local industrial production and capabilities building. Drawing on the experience of supplying inputs into the East African gold mining industry, this paper examines the constraints experienced by local suppliers arising from the purchasing procedures of large mining corporations and specialist construction companies contracted to construct these mines. Lead firms become locked-in to particular ways of working which minimise the opportunities that local suppliers have in providing products and services. After reviewing the situation for local mining suppliers in East Africa, the paper examines ways in which lead firms, the suppliers themselves and others (governments and industry associations) can better support local supplier involvement.

Diet of the Critically Endangered Brown Spider Monkey (Ateles hybridus) in an Inter‐Andean Lowland Rainforest in Colombia

Brown spider monkeys (Ateles hybridus) are one of the least known and more threatened primates in the Neotropics. Recognized as a species about a decade ago, field studies on these endangered primates have mainly focused on estimating local population densities. Since 2006, we habituated a group of wild brown spider monkeys at Serranía de Las Quinchas, Colombia, and studied their feeding ecology during 2.5 years using focal "subgroup" sampling, and conducted phenological surveys in order to estimate habitat-wide fruit availability. Based on 847 hr of behavioral follows, brown spider monkeys spent approximately 25% of their time in feeding activities, and fed from fruits and leaves on at least 123 plant species. Ripe fruits were the most important item in the diet of A. hybridus at Las Quinchas comprising 92% of their feeding time. Probably due to the minor variation in the monthly proportion of fruits in brown spider monkey's diet throughout this study, there was no relation between habitat-wide fruit availability and the proportion of fruit included in their monthly diet. The diet of brown spider monkeys at Las Quinchas is toward the high end of fruit intake, even within other wild spider monkeys' populations, suggesting that these endangered primates might also be facing the challenges of being a large bodied fruit specialist under a regional scenario of habitat loss and fragmentation.