National neonatal weight policy survey

This survey was conducted to review the current practice regarding frequency of weight measurement in neonatal units in the Republic of Ireland, and whether these practices are in keeping with best practice as described in the literature. There was an 88.5% (23 of 26) response rate to this survey. 6 (26%) units had a written policy, and 16 (70%) had an unwritten agreed practice. In the Vermont Oxford Network's potentially better practices daily weight measurements on newborn infants are recommended until the infant is stable and growing and then alternate day measurements The most common practices in this survey were to weigh infants on alternate days, this occurred in 9 (39%) units, and twice weekly in 6 (26%). Less than 31% of units had a separate policy for those less than 30 weeks, on assisted ventilation, or transitioning to enteral feeds. Most weigh infants on alternate days, and plot weights weekly, which is in keeping with best practice. Few units have separate policies for specific subgroups as is recommended in the limited literature. Consensus guidelines should be developed and promoted nationally.

Irish neonatal mortality statistics for 2004 and over the past 17 years: how do we compare internationally?

In the past 17 years neonatal mortality survey has provided important data on the trends in deaths of all live born infants born in Southern Ireland who are greater than 500 g birth weight and who die within the first 28 days of life. The aims of this study were to report neonatal mortality data for Southern Ireland for 2004, to examine trends in neonatal mortality over the past 17 years and compare Irish Neonatal Mortality rates to other countries around the world. The neonatal mortality rate for 2004 was 2.9/1000 with a corrected NMR of 1.9/1000. The response rate to the survey was 100%. Prematurity is now the leading cause of neonatal mortality representing a change from previous years. Deaths related to asphyxia have remained largely unchanged. When compared to international figures Ireland compares favourably to other countries around the world.

A national survey of current practice in the management of very low and extremely low birth weight infants: is there a role for national guidelines?

Substantial variation exists in the use of a number of post natal interventions and procedures between neonatal intensive care units. This study examined current practice in the management of commonly encountered problems in very low and extremely low birth weight infants in the eight regional units in Ireland, and was intended to determine whether support exists for the development of national practice guidelines. Ninety one percent of people surveyed returned a completed questionnaire, 76% of respondents believed it would be both worthwhile and practical to develop national practice guidelines. We therefore recommend, that a working group for the establishment of national practice guidelines for the management of VLBW infants be set up.

Rail signallers' assessments of their satisfaction with different shift work systems

This paper describes rail employee views on shift-work systems obtained from administration of the Rail Ergonomics Questionnaire (REQUEST) to a large sample of rail professionals in Great Britain, achieving a response rate of 83%. Results from signallers, the largest occupational grouping in the survey (n = 3230), are presented. ANOVA has been used to investigate the effects of different aspects of the shift patterns (the length of shift and the speed and direction of rotation of shifts) and the effects of age on the ratings of satisfaction with the shift system. The findings from the analyses indicate preferences for the 12-h shift system over the 7-9-h rotating shift system. There were no main effects of the direction of rotation of shifts, though there were significant interactions between the direction of rotation of shifts, the numbers of consecutive shifts and the age of respondents. There is a need for clear data addressing the impact on workers of key shift-related parameters such as shift length, direction of rotation of shifts, numbers of consecutive shifts and personal factors such as age. This paper presents findings of the effects of these key shift and personal parameters and their interactions on respondents' ratings of satisfaction with the shift system, using data collected with REQUEST in a national survey of rail signallers.

Use of monensin controlled-release capsules to reduce methane emissions and improve milk production of dairy cows offered pasture supplemented with grain

We examined the effects of monensin, provided by controlled-release capsules, on the enteric methane emissions and milk production of dairy cows receiving ryegrass pasture and grain. In a grazing experiment, 60 Holstein-Friesian cows were assigned randomly to 1 of 2 groups (control or monensin). Cows in the monensin group received 2 controlled-release capsules, with the second capsule administered 130 d after the first. Milk production was measured for 100 d following insertion of each capsule. The sulfur hexafluoride tracer gas technique was used to measure enteric methane emissions for 4 d starting on d 25 and 81 after insertion of the first capsule, and on d 83 after insertion of the second capsule. All cows grazed together as a single herd on a predominantly ryegrass sward and received 5 kg/d of grain (as-fed basis). In a second experiment, 7 pairs of lactating dairy cows (control and monensin) were used to determine the effects of monensin controlled-release capsules on methane emissions and dry matter intake. Methane emissions were measured on d 75 after capsule insertion by placing cows in respiration chambers for 3 d. Cows received fresh ryegrass pasture harvested daily and 5 kg/d of grain. The release rate of monensin from the capsules used in both experiments was 240 +/- 0.072 mg/d, determined over a 100-d period in ruminally cannulated cows. The monensin dose was calculated to be 12 to 14.5 mg/kg of dry matter intake. There was no effect of monensin on methane production in either the grazing experiment (g/d, g/kg of milk solids) or the chamber experiment (g/d, g/kg of dry matter intake). In the grazing study, there was no effect of monensin on milk yield, but monensin increased milk fat yield by 51.5 g/d and tended to increase milk protein yield by 18.5 g/d. Monensin controlled-release capsules improved the efficiency of milk production of grazing dairy cows by increasing the yield of milk solids. However, a higher dose rate of monensin may be needed to reduce methane emissions from cows grazing pasture.

Incomplete milking has no detectable effect on somatic cell count but increased cell count appears to increase strip yield

Milking regimes that can greatly shorten the milking duration of slow-milking cows to improve labour productivity can also result in less complete milking for some cows. There is also a common belief and limited experimental evidence that incomplete milking of subclinically infected cows can cause increased somatic cell count (SCC). To test for this possible detrimental effect of shorter milking regimes, ‘complete’ milking [to automatic cluster remover (ACR) setting of 300 mL/min] and ‘incomplete’ milking (to an ACR setting of 800 mL/min) were applied sequentially to 45 cows over 7 weeks. Incomplete milking resulted in an average of 0.3 L of extra milk being left in the udders, but there was no significant increase in quarter SCC in either infected or uninfected udder quarters. Change in SCC was not related to change in strip yield induced by incomplete milking treatment. In contrast, cow strip yield was positively related to SCC, or the number of infected quarters/cow, regardless of the applied ACR treatment. These apparently contradictory findings are reconciled by noting that infection causes both high strip yields (via uneven yielding quarters) and high SCC. It is concluded that, contrary to popular belief, high SCC, as an indicator of infection, causes high strip yield and that increasing strip yield does not increase cell count.

Supplementation with whole cottonseed reduces methane emissions and can profitably increase milk production of dairy cows offered a forage and cereal grain diet

The experimental objective was to determine if whole cottonseed (WCS) could be used as a dietary supplement to reduce enteric methane emissions and profitably increase milk production from dairy cattle over the summer period when pasture is limited in quantity and has a low nutritive value. Fifty lactating cows, ~200 days in milk, were randomly allocated to one of two groups (control or WCS). Cows were offered lucerne hay (in the morning) and pasture silage (in the afternoon) made from a predominantly ryegrass sward in one group for 5 weeks. The hay and silage were placed on the ground in a bare paddock. Cows in each group were also individually offered cracked grain in a feed trough at 3 kg DM/cow.day at milking times. In addition, at milking times, cows in the WCS group were individually offered 2.7 kg DM/cow.day of untreated WCS with their grain supplement. Measurements of methane emissions (n = 12), using the SF6 tracer technique, were made in weeks 3 and 5 after the commencement of feeding treatments. Supplementation with WCS significantly reduced methane emissions by 12% (g/cow.day) and by 21% (g/cow.kg milk solids) and significantly increased yield of milk (n = 25) by 15%, milk fat by 19% and milk protein by 16%. WCS had no effect on concentration of milk fat or lactose, but resulted in a significant 3% decrease in protein concentration. WCS appears to be a promising supplement for reducing methane emissions and increasing milk production from dairy cattle when pasture is limited in quantity and has a low nutritive value.

Methane Emissions from Dairy Cows Measured Using the Sulfur Hexafluoride (SF6) Tracer and Chamber Techniques

Our study compared methane (CH4) emissions from lactating dairy cows measured using the sulfur hexafluoride (SF6) tracer and open-circuit respiration chamber techniques. The study was conducted using 16 lactating Holstein-Friesian cows. In each chamber, the cow was fitted with the SF6 tracer apparatus to measure total CH4 emissions, including emissions from the rectum. Fresh ryegrass pasture was harvested daily and fed ad libitum to each cow with a supplement of 5 kg of grain/d. The CH4 emissions measured using the SF6 tracer technique were similar to those using the chamber technique: 331 vs. 322 g of CH4/d per cow. The accuracy of the SF6 tracer technique was indicated by considering the ratio of the CH4 emission measured using the SF6 tracer to the emission measured using the chamber for each cow on each day. The calculated ratio of 102.3% (SE = 1.51) was not different from 100%. A higher variability within cow between days was found for the SF6 tracer technique [coefficient of variation (CV) = 6.1%] than for the chamber technique (CV = 4.3%). The variability among cows was substantially higher than within cows, and was higher for the SF6 technique (CV = 19.6%) than for the chamber technique (CV = 17.8%). Our CH4 emission data were compared with whole-animal chamber studies conducted in Canada and Ireland. In the Canadian study the SF6 technique did not measure CH4 emissions from the rectum and emissions were 8% lower than those measured using the chamber, indicating that emissions from the rectum may be greater than previously measured (1%). The relationship between CH4 emission and dry matter intake was examined for our data and for that reported in the Canadian study. There was a difference in the slopes of the regressions derived from our data and that from Canada; 17.1 vs. 20.8 g of CH4/kg of dry matter intake. A difference between the 2 locations was expected based on the difference in diet composition for these 2 studies. The SF6 tracer technique is reasonably accurate for inventory purposes and for evaluating the effects of mitigation strategies on CH4 emissions.

Benchmarking comparison survey of regional neonatal units

There are currently eight regional neonatal units in Ireland; three in Dublin and one each in Cork, Limerick, Galway, Drogheda and Waterford. Previous studies have shown a significant variation in the provision of care and services between such units. In July 2005, a postal questionnaire was distributed to a focus group of staff in the eight regional units. The objective was to identify issues of significant concern in current neonatology practice in Ireland. Eighteen people were surveyed in this focus group and we had an overall response rate of almost 78%. All of the respondents felt that there was a difference between practises in the neonatal units and greater than 90% perceived these to be significant. We believe that this study has identified the desire for standardisation of neonatology practises in Ireland and that this may be achieved by the introduction of a Nationwide Newborn Network.

A simple statistical model to estimate precision of 300-day milk and fat production for dairy cows

In this paper we use a statistical model to examine the relative precision of lactation milk yield and milk fat yield, under various production recording regimes with different metering and sampling precision, recording frequencies combined with empirical daily variations in milk yield and fat composition. The analysis shows that if traditional monthly production recording was performed with devices of International Committee for Animal Recording (ICAR) precision, the resultant coefficient of variation (CV) for lactation yields of milk and fat would be 2.22 and 4.81%, respectively. These values are determined primarily by measurement frequency coupled with the natural daily biological variations in animal milk yield and fat composition. Meter and sampler precision play a relatively minor role. For example, our model shows that if the devices had double the CV prescribed by ICAR, the milk and fat yield CV would increase by only 0.20 and 0.19%, respectively. These are minute losses of precision. If the ICAR precision standards for meters and samples were relaxed, it could encourage development of innovative metering and sampling technologies that could provide much more cost-effective and convenient ways for farmers to conduct production recording.

What information patients require on graduated compression stockings

Graduated compression stockings are used prophylactically on a variety of patients within acute hospitals. Anecdotal evidence suggests patients have a limited understanding of this treatment. The aim of this qualitative study was to explore patients' experiences of compression stockings and to ascertain perceptions of their use. Information was gathered using telephone interviews from a sample of 12 adults who had been patients within the past 2 months, and who had worn compression stockings for more than 48 hours. The results showed that patients received little or no information from healthcare staff regarding compression stockings, but that they did have knowledge from other sources, such as long-haul flight advice. This raises issues of informed consent and patient empowerment and highlights the need for both verbal and written information. The information gained informed a patient information leaflet, which was developed in partnership with a patient focus group.

Assessing intervention effects in a community-based trial to reduce self-harm: A methodological case study

This paper considers the assessment of the impact of a community-based randomized controlled trial to reduce repeat deliberate self-harm. It considers the drawbacks in simplistic applications of conventional significance testing procedures, as well as possible failures regarding the statistical assumptions underlying such tests. Instead, the paper considers how relevant prior information might be incorporated within a fully Bayesian-model-based assessment procedure. The model includes a latent trait approach to patient morbidity; controlling for morbidity and other patient characteristics enhances the impact of the intervention (measured by a hazard rate ratio). If allowance is made for external information (e.g. ethical approval of the treatment), the weight of evidence shifts towards a positive intervention effect.

Cytochrome c nitrite reductase: from structural to physicochemical analysis

The recent structural characterization of the NrfA from Escherichia coli provides a framework to rationalize the spectroscopic and functional properties of this enzyme. Analyses by EPR and magnetic CD spectroscopies have been complemented by protein-film voltammetry and these are discussed in relation to the essential structural features of the enzyme.

Perinatal factors influencing survival in extremely low-birthweight infants

The majority of deaths in normally formed infants occur in extremely low birth weight infants (< 1000 g). Survival rates for these infants have improved greatly but still vary from centre to centre and accurate local outcome figures are important for counselling parents and upholding standards of care. In the Rotunda Hospital, Dublin, over the 6 year period from 1 January 1990 to 31 December 1995, there were 34 474 deliveries over 500 g birthweight. One hundred and twenty-six of these were normally formed infants between 500 g and 999 g. Our objective was to analyse the factors influencing survival in these extremely low birthweight (ELBW) infants. Overall survival in the group was 63%. The most significant factors influencing survival to 28 days were gestation and birthweight. Survival increased from 33% at 24 weeks to 100% at 28 weeks' gestation and from 29% at 500-599 g to 87% at 900-999 g birthweight. Having controlled for gestational age, none of the following variables had a significant effect on survival: year of birth; gender; multiple pregnancy; 1-minute Apgar score; maternal age; parity; use of antenatal steroids; a history of antepartum haemorrhage, pre-eclamptic toxaemia or prolonged rupture of membranes. A 5-min Apgar score > 5 increased the chance of survival by 3.97 (95% CI: 1.46- 10). Both mode of delivery and incidence of chorioamnionitis had an influence on survival which varied according to the gestational age. A larger cohort of survivors would illustrate the effect of these variables more clearly.

Work-related stress among paediatric non-consultant hospital doctors

There have been many reports of Non-Consultant Hospital Doctors (NCHDs) deciding to leave hospital medicine in pursuit of a career with better hours and lifestyle such as general practice. It is not known, however, how widespread feelings of dissatisfaction are in paediatrics and whether work-related stress is a contributing factor. A postal survey of NCHDs in paediatric posts throughout the country was conducted in November 2000. Data collected included demographic and personal details. NCHDs were also asked their level of stress in relation to their daily work, patient-care, hospital environment and dealing with other staff members using an incremental scale from 1 to 5 (5 most stressed). 69% (71/103) of the questionnaires were returned. Equal numbers of males and females responded (48% vs 52%). 51% (36/71) of the NCHDs were registrars; 51% (36/71) were working within Dublin. More than three-quarters had graduated from a European Union (EU) medical school (77%, 55/71). While the majority (79%, 56/71) were either satisfied or very satisfied with paediatrics as their chosen specialty, 79% (56/71) admitted to work-related stress causing job dissatisfaction with 71% (50/71) having experienced 3 or more stressful situations in the previous week. 56% (41/71) graded their occupational stress level at 4 or 5. Routine non-medical work and poor job prospects were the main factors causing job dissatisfaction. With regard to daily duties, the situations causing stress were acute emergency situations (51%, 36/71), being solely responsible for patients when on-call (52%, 19/36) and making decisions after a night on-call (76%, 50/67). The general attitudes of nursing staff were stressful to 40% (28/71) with 39% (27/71) stating having a difference of opinion with a nurse at least once every week. Relating to consultants was moderately stressful to 26% (19/71) and very stressful to 4% (3/71). Uncomfortable sleeping quarters and having insufficient time for meals were noted to be at least moderately stressful (stress levels 3 to 5) for 70% (50/71) and 92% (65/71) respectively. 59% (42/71) felt that their social life was greatly affected by their work. 68% (48/71) have considered leaving paediatrics with almost half (48%, 23/48) considering this seriously or very seriously. More than half stated that their alternative career choice would be general practice (61%, 29/48). The results of our survey show that work-related stress is common among paediatric NCHDs and is associated mainly with long working hours, sub-optimal on-call conditions, and dealing with very ill patients.

Effects of breathing air containing 3% carbon dioxide, 35% oxygen or a mixture of 3% carbon dioxide/35% oxygen on cerebral and peripheral oxygenation at 150 m and 3459 m

The effects of gas mixtures comprising supplementary 3% carbon dioxide, 35% oxygen or a combination of 3% CO(2) plus 35% O(2) in ambient air have been compared on arterial blood gases, peripheral and cerebral oxygenation and middle cerebral artery velocity (MCAV) at 150 m and on acute exposure to 3459 m in 12 healthy subjects. Breathing 3% CO(2) or 35% O(2) increased arterial blood oxygen at both altitudes, and the CO(2)/O(2) combination resulted in the most marked rise. MCAV increased on ascent to 3459 m, increasing further with 3% CO(2) and decreasing with 35% O(2) at both altitudes. The CO(2)/O(2) combination resulted in an increase in MCAV at 150 m, but not at 3549 m. Cerebral regional oxygenation fell on ascent to 3459 m. Breathing 3% CO(2) or 35% O(2) increased cerebral oxygenation at both altitudes, and the CO(2)/O(2) combination resulted in the greatest rise at both altitudes. The combination also resulted in significant rises in cutaneous and muscle oxygenation at 3459 m. The key role of carbon dioxide in oxygenation at altitude is confirmed, and the importance of this gas for tissue oxygenation is demonstrated.

Evidence for separate disease phenotypes in intestinal Crohn's disease

Background

This study investigated the hypothesis that separate phenotypes of Crohn's disease exist which display differing patterns of recurrence with a tendency to preservation of phenotype between serial operations.

Methods

Some 483 abdominal operations (278 patients) were identified from a prospectively compiled database. Patterns of recurrence (reoperation) were analysed by Kaplan–Meier plots and log rank tests according to disease phenotype (perforated, stenosed or ulcerated). Serial operations were analysed by agreement of phenotype and microscopic features of disease using kappa statistics and correlation coefficients.

Results

There was no significant difference in recurrence according to disease phenotype (median reoperation-free survival time 43·0, 50·2 and 47·9 months for perforated, stenosed and ulcerated types respectively; log rank χ2 = 3·5, P = 0·18). There was poor agreement in phenotype between serial operations (κ = 0·22 for first/second operation and κ = 0·15 for second/third operation) and no significant correlation between pathological features was identified (r between −0·19 and 0·48).

Conclusion

No evidence was found for the existence of separate disease phenotypes with differing natural histories or underlying pathological characteristics.

Can pre-colposcopy sessions reduce anxiety at the time of colposcopy? A prospective randomised study

The main objective of this prospective randomised study was to evaluate whether offering pre-colposcopy group sessions reduces anxiety at the time of colposcopy. We also examined whether this strategy improved knowledge about abnormal smears and colposcopy and improved satisfaction with the colposcopy service provided. One hundred and forty-seven women undergoing colposcopy for the first time were randomised into two groups. The control group (n = 75) received conventional management. The study group (n = 72), in addition to conventional management, were invited to attend a pre-colposcopy group session led by a trained colposcopy nurse. Questionnaires were used to determine state anxiety inventory scores and knowledge scores at the time of randomisation, immediately before colposcopy and 6 weeks after the clinic visit. Satisfaction questionnaires were completed 6 weeks after the clinic visit. We found that women attending colposcopy clinics are anxious. Those women who attended the pre-colposcopy session had improved knowledge scores (P = 0.039) at the time of colposcopy and satisfaction (P = 0.037). However, the intervention failed to significantly reduce anxiety at the time of colposcopy (P > 0.05).

Near-infrared spectroscopy in the assessment of cerebral oxygenation at high altitude

Hypoxia plays a key role in the pathogenesis of acute mountain sickness (AMS), but individual susceptibility is variable and cerebral symptoms do not always correlate with PaO2 measurements. Cerebral hypoxia may be more relevant than PaO2. We studied trends in cerebral regional oxygen saturation by the technique of near-infrared spectroscopy in 20 subjects ascending rapidly to 4680 m. Subjects were enrolled in a placebo-controlled, double-blind trial of medroxyprogesterone for the prevention of AMS. The fall in cerebral oxygen saturation was less than in the periphery. At 4680 m, cerebral oxygenation correlated with peripheral saturation but not with PaCO2 or with cerebral symptoms scores. At 4680 m, subjects on medroxyprogesterone had higher cerebral and peripheral saturation compared with those on a placebo. We conclude that cerebral oxygenation monitored with the Critikon 2020 system provided important information on the complex relationship of hypoxia to AMS and that other factors, such as changes in blood flow or capillary permeability, may be equally important.