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J W Larsen

Publications and source records attributed to J W Larsen.

At least 19 recordsLinked to original sources
PubMed2000

Prevention of perinatal group B streptococcal infection: current controversies.

Group B streptococcus (GBS) is the most frequent cause of neonatal sepsis in the United States. The Centers for Disease Control and Prevention (CDC) issued guidelines for its prevention in 1996. This article details areas of controversy with those guidelines and offers recommendations for resolution. We recommend that a prevention policy be adopted by all hospitals. If a screening-based policy is chosen, compliance is essential. Penicillin is the antibiotic of choice for GBS prevention. Increasing resistance to clindamycin and erythromycin might eliminate them as alternative choices in patients allergic to penicillin. Group B streptococcal prophylaxis might not be necessary in women who have repeat elective cesarean delivery. In asymptomatic women, a positive urine culture for GBS should be considered clinically equivalent to a positive vaginal or rectal sample for screening. Neonatal sepsis caused by organisms other than GBS must be monitored carefully by all hospitals providing obstetrics services.

Antibiotic Prophylaxis↗
PubMed2000

First-trimester Down syndrome screening using dried blood biochemistry and nuchal translucency.

OBJECTIVE: To assess the effectiveness of free beta-hCG, pregnancy-associated plasma protein A, and nuchal translucency in a prospective first-trimester prenatal screening study for Down syndrome and trisomy 18. METHODS: Risks were calculated for Down syndrome and trisomy 18 based on maternal age and biochemistry only (n = 10,251), nuchal translucency only (n = 5809), and the combination of nuchal translucency and biochemistry (n = 5809). RESULTS: The study population included 50 Down syndrome and 20 trisomy 18 cases. Nuchal translucency measurement was done on 33 Down syndrome and 13 trisomy 18 cases. Down syndrome screening using combined biochemistry and ultrasound resulted in a false-positive rate of 4.5% (95% confidence interval [CI] 3.9%, 5.2%) and detection rate of 87.5% (95% CI 47%, 100%) in patients under age 35 years. In older patients, the false-positive rate was 14.3% (95% CI 12.7%, 15. 8%) and detection rate was 92% (95% CI 74%, 99%). For trisomy 18 screening, the false-positive rate was 0.4% (95% CI 0.24%, 0.69%) and detection rate was 100% (95% CI 40%, 100%) in younger patients, whereas in older patients the false-positive rate was 1.4% (95% CI 0. 9%, 2.0%) and detection rate was 100% (95% CI 66%, 100%). Using modeling, at a fixed 5% false-positive rate, the Down syndrome detection rate was 91%. Conversely, at a fixed 70% Down syndrome detection rate, the false-positive rate was 1.4%. CONCLUSION: First-trimester screening for Down syndrome and trisomy 18 is effective and offers substantial benefits to clinicians and patients.

Adult↗
PubMed2000

The relationship between the rate of intake of trichostrongylid larvae and the occurrence of diarrhoea and breech soiling in adult merino sheep.

BACKGROUND AND OBJECTIVE: A hypersensitive inflammatory response, associated with the ingestion of trichostrongylid larvae, is a major cause of diarrhoea and soiling of the breech with faeces in adult Merino sheep ('hypersensitivity scours'). This response is characterised by an infiltration of eosinophils and altered lymphocyte populations in the gut of affected sheep. The objective of this study was to investigate the numbers of Ostertagia circumcincta and Trichostrongylus vitrinus infective larvae that were needed to induce diarrhoea in adult Merino sheep grazing improved pastures. METHOD: Sheep from three farms were categorised as either being susceptible, or not susceptible, to hypersensitivity scours, then transported to an experimental farm and grazed on pastures with low numbers of trichostrongylid infective larvae. They were ranked by farm of origin and previous worm egg count, then systematically allocated to one of five dose-rate groups and infected with 0, 2, 4, 10 or 20 x 10(3) trichostrongylid infective larvae per week for 13 weeks. RESULTS: In sheep selected as being susceptible to hypersensitivity scours, the lowest dose rate of infective larvae (2000 per week) was as effective in inducing diarrhoea as the highest dose rate (20,000 per week). In contrast, even the highest larval dose did not induce diarrhoea in sheep selected as not susceptible to hypersensitivity scours. Sheep selected with an increased susceptibility to hypersensitivity scours also had a significantly higher amount of moisture in their faeces at all times except during summer. CONCLUSIONS: The apparent lack of a threshold dose of trichostrongylid infective larvae needed to induce hypersensitivity scours suggests that even improved worm control programs, which substantially decrease the ingestion of larvae, may not be able to reduce the prevalence of hypersensitivity scours or the severity of breech soiling. Controlled-release anthelmintic capsules will control breech soiling but are often not a cost-effective strategy. Thus, genetic selection of less susceptible sheep is probably the best long-term option for the control of hypersensitivity scours, and the assessment of faecal moisture may be a convenient marker of susceptibility to this syndrome.

Animals↗
PubMed1999

The pathogenesis and control of diarrhoea and breech soiling in adult Merino sheep.

Diarrhoea and soiling of the breech with faeces ('winter scours') is a serious problem in adult Merino sheep grazing improved pastures in south-eastern Australia during winter and spring. This occurs even on farms where gastro-intestinal nematodes are effectively controlled. It was shown that winter scours was associated with the ingestion of trichostrongylid larvae, and that host factors were important in determining susceptibility to this syndrome. No differences were detected in the protective immune response of affected and unaffected sheep to gut nematodes. However, affected sheep had a hypersensitive inflammatory reaction in the pylorus and upper jejunum, characterised by the infiltration of significantly more eosinophils and changed lymphocyte populations. The changes in the lymphocyte populations included a reduced number of CD8+ cells, increased CD4+:CD8+ T-cell ratio, and significantly reduced numbers of cells reacting to interferon-gamma. High doses of infective larvae (20,000/week of Ostertagia circumcincta and Trichostrongylus vitrinus) did not induce diarrhoea in sheep not susceptible to winter scours. In contrast, only low doses (2000/week) initiated scouring in sheep selected as being susceptible to winter scours. Therefore, even considerably improved worm control programmes, including the selection of sheep with increased resistance to gut nematodes, will not prevent winter scours. Rather, phenotypic culling and genetic selection, to remove sheep susceptible to the hypersensitivity inflammatory response, is proposed as the most suitable long-term control strategy.

Animal Husbandry↗
PubMed1999

Effectiveness of small workshops for improving farmers' knowledge about ovine footrot.

OBJECTIVE: To determine sheep farmers' attitudes to and beliefs about ovine footrot, and to improve their knowledge about the diagnosis, control and eradication of this disease. METHOD: Eighteen workshops, involving 291 farmers, were conducted across Victoria in the spring of 1996. The workshops were designed as small-group discussions with a maximum attendance of 20 farmers to encourage active participation. All participants completed questionnaires before each workshop and 12 to 40 weeks after the last workshop. RESULTS: Before the workshops the farmers had a poor understanding of the principles of diagnosis, control and eradication of footrot. For example, only 50% knew the footrot organism survived in soil for less than 7 days, over two-thirds did not know the reason for paring sheep's feet during an eradication program, and only 31% realised cattle were a potential source of footrot infection for sheep. After the workshops, understanding about footrot was significantly improved; 87% said Dichelobacter nodosus survived in soil less than 7 days, 71% knew the reason for paring sheep's feet and 64% realised that cattle were a potential source of footrot infection. As well as improved knowledge, change of attitude among farmers is fundamentally important if virulent footrot is to be successfully controlled and eradicated. The workshops successfully initiated this process; 40% of farmers thought the workshops changed their attitudes to footrot, while 37% said they gained an increased understanding of other people's opinions about the disease. CONCLUSION: Farmers' poor understanding of ovine footrot is a constraint to the programs aimed at controlling this disease. Small group workshops may be an effective way to influence farmers' attitudes and beliefs, and could facilitate the effectiveness of regulatory disease control programs.

Animals↗
PubMed1998

Comparison of urinary free beta (hCG) and beta-core (hCG) in prenatal screening for chromosomal abnormalities.

To evaluate the potential utility of free beta (hCG) and beta-core (hCG) in a prenatal screening protocol for Down syndrome we analysed these markers in dried maternal urine specimens from 163 control, 13 Down syndrome and 5 trisomy 18 pregnancies from 8 to 25 weeks' gestation. All results are reported after normalization for urinary creatinine determined by modified Jaffe reagent assay. The correlation of urinary free beta (hCG) and urinary beta-core (hCG) was 0.61 in controls and 0.93 in Down syndrome. Median MoM values in Down syndrome were 2.42 for urinary free beta (hCG) and 2.40 for beta-core (hCG). In trisomy 18 the Median MoM was 0.35 and 0.34 for free beta (hCG) and beta-core (hCG), respectively. The degree of elevation observed in DS cases with urinary free beta (hCG) is consistent with previous reports. Studies of beta-core (hCG) in Down syndrome have yielded discrepant results. In this study, beta-core (hCG) in Down syndrome is lower than values observed in early reports but consistent with more recent reports.

Chorionic Gonadotropin, beta Subunit, Human↗
PubMed1996

Prenatal maternal dried blood screening with alpha-fetoprotein and free beta-human chorionic gonadotropin for open neural tube defect and Down syndrome.

OBJECTIVE: Our purpose was to evaluate second-trimester prenatal screening for open neural tube defects and Down syndrome by use of dried blood specimen collection and transport. STUDY DESIGN: A prospective study of 7497 dried blood specimens from patients <35 years old was performed. Specimens were assayed for maternal blood alpha-fetoprotein and free beta-human chorionic gonadotropin. Patient-specific risks for both disorders were calculated and used to determine whether further evaluation was indicated. The study included an evaluation of the median and SD of analyte multiple of the median levels. RESULTS: The initial positive rate for open neural tube defect was 4.4% adjusted to 2.7% after ultrasonographic revision and collection of a second sample. The initial positive rate for Down syndrome was 3.6% adjusted to 2.8% after ultrasonographic revision. All seven cases of open neural tube defect were detected within the increased risk group. Six of 8 (75%) cases of Down syndrome were detected. The median alpha-fetoprotein multiple of the median was 3.5 in open neural tube defect cases and 0.6 in Down syndrome cases. The median free beta-human chorionic gonadotropin multiple of the median was 2.4 in Down syndrome cases. The SD (log e) of alpha- fetoprotein and free beta-human chorionic gonadotropin in 5868 unaffected white patients was 0.4022 and 0.5635, respectively. CONCLUSION: Second-trimester dried blood screening for open neural tube defects and Down syndrome can achieve screening efficiency comparable to serum-based protocols with distinct advantages over the conventional method of blood collection.

Adult↗
PubMed1996

First-trimester Down syndrome screening: free beta-human chorionic gonadotropin and pregnancy-associated plasma protein A.

OBJECTIVE: Our purpose was to determine the feasibility of a first-trimester Down syndrome screening protocol including free beta-human chorionic gonadotropin and pregnancy-associated plasma protein A. STUDY DESIGN: First-trimester maternal blood samples from 22 Down syndrome and 483 control cases were assayed for free beta-human chorionic gonadotropin and pregnancy-associated plasma protein A by enzyme-linked immunosorbent assay procedures. False-positive and detection rates were determined on the basis of Down syndrome risks calculated from the levels of biochemical markers and maternal age. Because 11 of the 22 Down syndrome cases were from older pregnancies (> or = 35 years old), rates were recalculated with the United States age distribution of live births to get a more representative estimate of false positives and detection efficiency. RESULTS: The median free beta-human chorionic gonadotropin and pregnancy-associated plasma protein A levels in cases of Down syndrome was 2.09 (95% confidence interval 1.69 to 2.62) and 0.405 multiples of the median (95% confidence interval 0.28 to 0.67), respectively. At a 5.0% false-positive rate, 15 (68.2%) Down syndrome cases were detected. By the use of the age distribution of live births, 63% of cases could be expected to be detected at a 5.0% false-positive rate. CONCLUSION: First-trimester free beta-human chorionic gonadotropin and pregnancy-associated plasma protein A screening for Down syndrome can achieve detection rates as high as those associated with alpha-fetoprotein and human chorionic gonadotropin or alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol screening in the second trimester. Prospective studies are needed to further assess first-trimester screening.

Biomarkers↗
PubMed1995

Enhanced twin pregnancy detection within an open neural tube defect and Down syndrome screening protocol using free-beta hCG and AFP.

We have applied our multimarker approach of maternal serum alpha-fetoprotein (AFP) and free-beta human chorionic gonadotropin (hCG) for Down syndrome screening to multiple gestations to assess its efficacy for improved detection of twin and triplet pregnancies. This study matched 225 cases of twin pregnancy and 39 cases of triplet pregnancy each with ten singleton pregnancies based on gestational week, race, time to receive sample, time of year of sample, and geographical area. The ratios of the MOM for each group at the tenth, 50th, and 90th percentiles were compared by the Wilcoxon test. Risks for twins were calculated using Bayes' rule, the age-related incidence of twins, and the levels of AFP and free-beta hCG. The tenth, 50th and 90th percentiles of free-beta hCG MOMs in twin and triplet cases were 0.85, 1.99, and 4.51, and 1.38, 2.78, and 4.07, respectively. For AFP, the MOMs at these percentiles were 1.26, 1.91, and 2.99, and 2.02, 2.68, and 5.30, respectively. The twin and triplet distributions for each marker were statistically significantly different from the singleton distributions (P < 0.0001) and from each other (P = 0.0012). At a twin risk cut-off of 1 in 50, 77.4 per cent of all twin gestations can be detected in a second-trimester AFP and free-beta hCG screening protocol with 5.1 per cent of singleton pregnancies falsely identified as at risk for twins. Our dual marker protocol for mid-trimester pregnancy screening combining AFP and free-beta hCG can identify over 77 per cent of twin pregnancies in women less than 35 years of age. This benefit may contribute to an improved outcome of pregnancy by early detection of multiple gestation.

Biomarkers↗
PubMed1995

Advent of maternal serum markers for Down syndrome screening.

Trisomy 21, or Down syndrome, is the most common serious autosomal chromosome aberration in which affected individuals survive beyond infancy. The association between advancing maternal age and increased risk of trisomy 21 is well known, and pregnant women older than 35 years at delivery are routinely offered invasive prenatal diagnostic testing. More recently, the use of maternal serum markers in the second trimester of pregnancy to predict the risk of trisomy 21 for women under the age of 35 has received intensive analysis. Maternal serum alpha-fetoprotein (MSAFP) was the first of these markers to be identified, and an inverse correlation between MSAFP level and risk of trisomy 21 was noted. A second marker, unconjugated estriol (uE3), has also been studied, and a correlation between low uE3 and trisomy 21 has been demonstrated, with a high level of correlation between AFP and uE3. The addition of uE3 to the screening protocol has not consistently improved detection rates, possibly because of its high correlation with AFP. A strong association of human chorionic gonadotropin (hCG) and Down syndrome was reported. This analyte is the most sensitive one in use today, although controversy exists regarding the best form of the analyte to use for trisomy 21 prediction. Several groups of investigators advocate measurement of total hCG, while others feel that measurement of the free-beta subunit of the molecule offers greater detection ability. The maximum detection rate that has been reported is 80 percent with a 5 percent false-positive rate using a combination of MSAFP, free-beta hCG, and maternal age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Johne's disease in alpacas (Lama pacos) in Australia.

Johne's disease was diagnosed in 10 alpacas (Lama pacos) in Australia between February 1993 and May 1994. Eight of the animals were between 12 and 24 months of age, one was a 6-year-old female, and one was a 4-year-old male. Five, including the 6-year-old and the 4-year-old alpacas, showed weight loss and diarrhoea before death or slaughter. The other cases showed no clinical signs of Johne's disease but 4 gave a positive result on faecal culture and one gave a positive result on testing with the caprine AGID assay and had acid-fast organisms in its faeces. At necropsy, all cases had grossly enlarged mesenteric lymph nodes. Johne's disease was diagnosed after histological examination of the lymph nodes with conventional culture and polymerase chain reaction testing of tissue samples. This report outlines the clinical, epidemiological, and pathological findings in these cases.

Animals↗
PubMed1995

Production losses in Merino ewes and financial penalties caused by trichostrongylid infections during winter and spring.

The productivity of Merino ewes treated with ivermectin and a controlled-release capsule containing albendazole was compared with untreated ewes grazing the same pastures on each of 3 farms. Treated breeding ewes had significantly increased greasy fleece weights (GFW, 6.5% and 7.1%) compared with untreated breeding ewes, on 2 of 3 farms but treatment caused no significant increase in the GFW of non-breeding ewes. Other benefits of treatment on all farms were a significant increase in body weight gain (from 1.7 to 3.7 kg) and a significant decrease in the weight of dag removed at crutching (from 42 to 622 g). These benefits occurred despite the presence on each farm of worms resistant to benzimidazoles. One disadvantage of treatment was an increase in mean fibre diameter of wool from treated ewes of from 0.12 to 0.41 microns. This increase reduces the value of the wool. Partial budgets indicated a net loss of from 8 to 62 cents per ewe for treatment. However, potential benefits such as increased growth rate and wool production from lambs of treated ewes were not included in the analysis. On one farm ewes were classified as 'susceptible' to severe dag if they had a dag score > or = 4 at the time of capsule treatment. Ewes classified as 'susceptible' were about 7 times more likely to develop severe dag than were other ewes. There was no significant difference between the GFW of untreated 'susceptible' ewes and untreated ewes not classified as 'susceptible'.(ABSTRACT TRUNCATED AT 250 WORDS)

Albendazole↗
PubMed1994

Diarrhoea in merino ewes during winter: association with trichostrongylid larvae.

A study on 3 farms, each having a preventive strategy for the control of nematode infections, determined the risk factors associated with diarrhoea among Merino ewes in winter. Comparisons were made among groups of mated and unmated ewes with and without treatment with controlled-release capsules containing albendazole. Diarrhoea was assessed from the accumulations of faeces around the breech (dag score) and related to worm egg counts, total worm counts and histopathological findings. The overall prevalence of severe dag in ewes not treated with a capsule was 26% (221/844). In comparison, only 2.7% of treated ewes had severe dag. The adjusted odds ratio on each farm indicated that untreated ewes were between 12 and 16 times more likely to be affected with severe dag than ewes treated with a capsule. The effect of lactation was significant on only one farm whereas initial body weight had no significant effect. There was no significant association between worm egg counts and the occurrence of severe dag. There were significantly more eosinophils in the small intestine of ewes affected with severe dag compared with unaffected ewes. There were no significant differences in mast cell and globule leucocyte numbers between affected and unaffected ewes. This study provides strong evidence that the main cause of diarrhoea among Merino ewes grazing winter and early spring pastures is the ingestion of trichostrongylid larvae even by sheep that have a well-developed protective immune response to these parasites. New strategies for the control of nematode infections are needed to prevent diarrhoea and dag formation in adult sheep.

Animals↗
PubMed1993

Economic impact of hospitalizations for lower abdominal adhesiolysis in the United States in 1988.

Much has been written about adhesion formation and prevention. Little is known about the number and cost of hospitalizations during which adhesiolysis is performed. This report describes the number of hospitalizations and days of care attributable to adhesiolysis in the United States and estimates the costs associated with these stays. The cost per hospital day and associated surgeons' fees are based on prevailing nationwide charges. During 1988, there were 281,982 hospitalizations during which adhesiolysis was performed, accounting for 948,727 days of inpatient care. These hospitalizations were responsible for an estimated $1,179.9 million in expenditures, of which $925.0 million was associated with hospital costs and $254.9 million with surgeons' fees. This estimate does not include outpatient costs and indirect costs. The results of this study demonstrate substantial costs associated with hospitalizations for adhesiolysis. Further understanding and prevention of adhesions may help to reduce unnecessary morbidity and mortality rates.

Abdomen↗
PubMed1992

Diagnosis of abnormalities of the human fetus during the first, second, and third trimesters.

Clinical teratologists will have new challenges during the 1990s as birth defects are diagnosed more frequently than in previous decades. Malformations and genetic disorders will be diagnosed in utero during all three trimesters of pregnancy. The teratologist may participate in or lead a multispecialty group to give the involved family optimal interpretation of test results, counseling, and recommendations regarding subsequent clinical management.

Congenital Abnormalities↗