FlyBoss: a web-based flystrike information and decision support system

The FlyBoss system consists of comprehensive information on flystrike management and control, programs for assisting decision making, and sortable lists of products for preventing and treating flystrike. Readily accessible, up-to-date, best-practice information on flystrike is essential for effective, humane and economic management of flystrike by Australian wool producers, particularly those who are phasing out mulesing and those looking to adopt optimal insecticidal fly-control strategies. FlyBoss provides information on breeding and management to reduce flystrike susceptibility, effective methods of treating existing flystrike and flystrike prevention programs. The FlyBoss decision aids, which are based on simulation models and incorporate local weather data and sheep susceptibility factors, can assist sheep farmers who wish to optimise sheep management, chemical treatment and non-chemical options to minimise the risk of flystrike. FlyBoss also contains comprehensive information on fly biology, sheep and environmental factors associated with flystrike and information on appropriate chemicals for various situations. FlyBoss draws on expertise from organisations throughout Australia to provide the sheep industry with easily accessible, current and locally targeted information on flystrike management. The present report briefly describes the development of FlyBoss and associated workshops and provides an overview of current recommendations for the control and prevention of flystrike.

Body piercing: more than skin deep

Young adult populations (18-25 years of age) throughout the world have latched onto the mainstream trend of body piercing. Best health care practices for these individuals involves the knowledge of proper procedural techniques, postsite care, common complications, and treatment modalities.

Ethical issues in radiology: perspectives from the Christian tradition

The Christian ethical tradition introduces a number of key values into the clinical context. Moreover, although some denominational differences exist, these are essentially differences of emphasis rather than of substance. Among the central values which the Christian tradition promotes are: the dignity of the person, the individual as embodied spirit and the importance of the common good. Within the evolving discourse, social justice considerations have come to the fore as a critical concern within bioethics. In radiology, like most fields of clinical practice, practitioners frequently encounter conflicts and tensions of an ethical nature. Moreover, the manner in which these conflicts are articulated, conceptualised and ultimately resolved will depend, not only on how the scientific data are analysed and interpreted, but also on how different ethical frameworks are invoked in these disputes. The concern in this brief paper is to discuss the Christian ethical tradition as it is expressed in Roman Catholic and 'Protestant' denominations in the western church, considering the values and norms that underlie Christian ethical engagements with applied questions.

How often is a low 5-min Apgar score in term newborns due to asphyxia?

OBJECTIVE

To evaluate how often low 5-min Apgar scores (AS(5-min)) at term are associated with asphyxia.

STUDY DESIGN

A cohort- and case-control study, including all 183 term infants with AS(5-min) below 7 born at Lund University Hospital during 1993-2002, antepartum deaths excluded. The control group included 183 randomly selected term newborns with AS(5-min) 9-10. Cardiotocography (CTG) traces were assessed blinded to group and outcome. Obstetric and pediatric files were reviewed.

RESULTS

After excluding infants with severe malformations, indications of hypoxia were found at the following rates in cases with AS(5-min) below 4 (N = 30), scores 4-6 (N = 143), and controls (N = 182)-abnormal admission CTG: 38%, 8% and 0.6%; abnormal CTG before birth: 88%, 69% and 18%; obstetrical catastrophe: 28%, 6% and 0.6%; interventions for fetal distress: 83%, 48% and 9%; cord artery pH below 7.15: 69%, 54% and 7%; hypoxic ischemic encephalopathy or hypoxic death: 70%, 14% and none. All differences between each case group and controls were statistically significant (p < 0.0001).

CONCLUSIONS

In the absence of severe malformations, the vast majority of AS(5-min) below 4, and at least half of scores 4-6 could be attributed to birth asphyxia. Signs of hypoxia usually appeared during labor, but were present at admission in 38% of cases with AS(5-min) below 4.

Development and validation of a food-frequency questionnaire for the determination of detailed fatty acid intakes

Objective:

To validate a fat intake questionnaire (FIQ) developed to assess habitual dietary intake while focusing on the assessment of detailed fatty acid intake including total trans unsaturated fatty acids (TUFA).

Design:

An 88 food item/food group FIQ was developed using a meal pattern technique. Validation was achieved by comparison with dietary intake assessed by a modified diet history (DH) in a cross-over design. Eighty-four individuals supplied adipose tissue biopsies for linoleic acid and total TUFA analysis as an independent validation of the FIQ and DH.

Setting:

Medical Centre, Dublin Airport, Republic of Ireland.

Subjects:

One hundred and five healthy volunteers (43 females and 62 males aged 23–63 years).

Results:

Significant correlations (P < 0.0005) were achieved for intakes of energy (0.78), total fat (0.77), saturated fat (0.77), monounsaturated fat (0.63), polyunsaturated fat (0.73), TUFA (0.67) and linoleic acid (0.71) assessed by the FIQ compared with the DH. Linoleic acid intake assessed by the FIQ and the DH was significantly correlated with adipose tissue concentrations (r = 0.58 and 0.49, respectively; P<0.005); however, total TUFA intake was poorly correlated with adipose tissue concentrations (r = 0.17 and 0.10 for FIQ and DH, respectively).

Conclusions:

The FIQ compared favourably with the DH in assessing habitual diet, in particular fatty acid intake. In addition, the FIQ was successfully validated against the linoleic acid composition of adipose tissue, an independent biomarker of relative fatty acid status. The FIQ could therefore be used as an alternative to the DH as it is a shorter, less labour-intensive method.

Development and validation of a food-frequency questionnaire for the determination of detailed fatty acid intakes

OBJECTIVE

To validate a fat intake questionnaire (FIQ) developed to assess habitual dietary intake while focusing on the assessment of detailed fatty acid intake including total trans unsaturated fatty acids (TUFA).

DESIGN

An 88 food item/food group FIQ was developed using a meal pattern technique. Validation was achieved by comparison with dietary intake assessed by a modified diet history (DH) in a cross-over design. Eighty-four individuals supplied adipose tissue biopsies for linoleic acid and total TUFA analysis as an independent validation of the FIQ and DH.

SETTING

Medical Centre, Dublin Airport, Republic of Ireland.

SUBJECTS

One hundred and five healthy volunteers (43 females and 62 males aged 23-63 years).

RESULTS

Significant correlations (P<0.0005) were achieved for intakes of energy (0.78), total fat (0.77), saturated fat (0.77), monounsaturated fat (0.63), polyunsaturated fat (0.73), TUFA (0.67) and linoleic acid (0.71) assessed by the FIQ compared with the DH. Linoleic acid intake assessed by the FIQ and the DH was significantly correlated with adipose tissue concentrations (r=0.58 and 0.49, respectively; P<0.005); however, total TUFA intake was poorly correlated with adipose tissue concentrations (r=0.17 and 0.10 for FIQ and DH, respectively).

CONCLUSIONS

The FIQ compared favourably with the DH in assessing habitual diet, in particular fatty acid intake. In addition, the FIQ was successfully validated against the linoleic acid composition of adipose tissue, an independent biomarker of relative fatty acid status. The FIQ could therefore be used as an alternative to the DH as it is a shorter, less labour-intensive method.

Canine eruption into grafted alveolar clefts: A retrospective study

BACKGROUND

The contemporary treatment of cleft lip and palate involves a sequence of surgical procedures and orthodontic management. Alveolar bone grafting (ABG) is usually undertaken after orthodontic expansion of the maxillary segments between the ages of eight and 12 years. Two of the important goals of alveolar bone grafting are the provision of bony support for the eruption of the canine and the closure of residual oro-nasal fistulae. The purpose of this study was to retrospectively evaluate the root development and eruption of the canine following ABG.

METHODS

Group 1: radiographic and clinical records of a sample of 19 cleft patients who underwent alveolar bone grafting procedures, performed between 1996 and 1999 were reviewed. Group 2: a random sample of 15 cleft patients attending for routine dental review were clinically examined. The age of patient, degree of root development and eruption status of the canine, and presence of oronasal fistulae pre and post alveolar bone grafting were evaluated.

RESULTS

Most cleft canines had continued root development and descended in the alveolus towards eruption following ABG. Four canine teeth (8 per cent) were impacted and required surgical exposure and orthodontic treatment following failure of eruption. Closure of anterior oro-nasal fistulae at the time of grafting was maintained post-operatively.

CONCLUSIONS

This study demonstrated that canine root development and eruption continued satisfactorily through grafted alveolar clefts in most cases and closure of anterior oro-nasal fistulae was achieved in all cases.

Broviac central venous catheters inserted via the saphenous or femoral vein in the NICU under local anesthesia

We present our experience with 92 Broviac central venous catheters inserted into 84 infants over a 31-month period. Our technique specifies placement in the neonatal intensive care unit under local anesthesia, with insertion to the inferior vena caval-atrial junction via the saphenous or femoral vein, with a subcutaneous tunnel to an exist site on the anterior thigh. We conclude this technique to be safe, efficient, convenient, cost-effective, and minimally uncomfortable to the infant, with no increase in morbidity or mortality in comparison to previously described methods.

Family perspective on the necessity for advance medical directives

Although our parents made no written advance medical directives before becoming terminally ill, with the support of the nursing staff we were able to assist them in their quest for a natural death with dignity. This article presents some of the dilemas faced by families in making end-of-life decisions. The author acknowledges the importance of permission for and support of the decision making by other health care providers, and reflects that advance directives would have facilitated the process.

Effects of ethaverine hydrochloride on the walking tolerance of patients with intermittent claudication

The effect of ethaverine hydrochloride on exercise tolerance of patients with intermittent claudication was evaluated in a double-blind, placebo-controlled study conducted at three sites. Forty-five patients with symptoms of occlusive arterial insufficiency of the lower extremities were randomly assigned to receive ethaverine 200 mg or placebo four times daily. The patients were evaluated biweekly for 12 weeks with treadmill claudication tests, patient and investigator assessments of symptom severity, and reports of adverse reactions. Doppler ankle/brachial pressure ratios were recorded for 26 patients. Walking tolerance improved for patients in both groups during the course of the study. Increases in distance-to-claudication were significantly greater for patients receiving ethaverine after 6, 8, 10, and 12 weeks of therapy. Ankle/brachial pressure index after exercise was unchanged in both groups. Incidence of adverse reactions was similar for the two groups. Although patients were generally unaware of any improvement in symptoms, the investigators judged significant relief of claudication among those receiving ethaverine compared to those receiving placebo. It was concluded that ethaverine safely increased distance-to-claudication in patients with intermittent claudication.

Readability testing of auxiliary labels

Using a word familiarity index, we studied pharmacy auxiliary labels and selected brief information sheets to determine the reading difficulty of these forms of written communication, which cannot be evaluated by traditional readability testing methods. Results of the study show that 11.2 percent of the 110 words selected from these information sources are above the eighth-grade reading level. The word familiarity index also identified multiple meanings of words and appears to be a valuable tool for evaluating written information that is not suitable for traditional readability testing.

A comparison of pharmaceutical manufacturers as a source of drug information to a telephone inquiry: generic vs brand

A telephone survey was conducted to evaluate and compare drug information received from the pharmaceutical manufacturer in response to a drug interaction question concerning concurrent administration of tetracycline and cimetidine. This study assumes that the pharmaceutical company may often be consulted by the hospital pharmacist seeking information about a particular medication. Forty-five pharmaceutical companies, all marketing tetracycline products, were selected for the study. A conversation protocol was utilized. It was designed to assure consistency and evaluate information received for accuracy, response time, clinical judgement offered, and referrals. Forty pharmaceutical manufacturers responded: 18 brand manufacturers and 22 generic companies. Eleven companies provided information on the interaction identified. Five manufacturers stated that there were no contraindications to concurrent administration of the drugs, one company identified a similar interaction, and five manufacturers successfully provided information identifying the interaction with supportive documentation. Two of the five companies offered clinical judgement as to the clinical significance of the interaction. Both reached different conclusions. The mean time of all phone calls was 4.29 minutes (range 0.39 to 15.41 minutes). The investigator was referred to outside sources by twelve companies. In this study, brand manufacturers performed better than generic companies. Results indicate that few manufacturers are organized to answer drug information requests involving current information sources in a response to a telephone request.