Controlling a new plasma regime.

Success of the UK's Spherical Tokamak for Energy Production (STEP) programme requires a robust plasma control system. This system has to guide the plasma from initiation to the burning phase, maintain it there, produce the desired fusion power for the desired duration and then terminate the plasma safely. This has to be done in a challenging environment with limited sensors and without overloading plasma-facing components. The plasma parameters and the operational regime in the STEP prototype will be very different from tokamaks, which are presently in operation. During fusion burn, the plasma regime in STEP will be self-organizing, adding further complications to the plasma control system design. This article describes the work to date on the design of individual controllers for plasma shape and position, magneto hydrodynamic instabilities, heat load and fusion power. Having studied 'normal' operation, the article discusses the philosophy of how the system will handle exceptions, when things do not go exactly as planned. This article is part of the theme issue 'Delivering Fusion Energy - The Spherical Tokamak for Energy Production (STEP)'.

Fatalities and hospitalisations due to acute poisoning among New Zealand adults.

BACKGROUND: Acute poisoning accounts for a significant proportion of the total burden of disease worldwide. While the rate of poisoning fatalities in New Zealand is comparable to other industrialised countries, demographic trends in incidence, particularly including socio-economic indicators and substances involved, are less well known. AIM: To determine demographic patterns and substances related to acute poisoning fatalities and hospital admissions in New Zealand among people at the age of 25 years or older. METHODS: Records with a poisoning external cause of injury code were identified using the national mortality (1999-2008) and hospital discharge (2000-2009) databases, and population-based incidence and trends were analysed. RESULTS: The 1841 fatalities and 29 881 primary hospital admissions over the 10-year period accounted for mean annual rates of 7.1 and 115.4/100 000, respectively. The majority of deaths from acute poisoning were among males with the converse for hospitalisations for self-poisoning. While hospitalisation for intentional poisoning decreased with advancing age, admissions for unintentional poisoning increased, especially in Pacific people at the age of 65 years or older. Overall, fatality and hospitalisation rates increased with increasing deprivation. Two thirds of deaths and hospitalisations were due to intentional self-poisoning. Carbon monoxide was involved in most fatal intentional self-poisoning events, while pharmaceuticals were the main agent involved in fatal unintentional poisonings and poisoning admissions, irrespective of intent. CONCLUSIONS: The majority of hospitalisations and deaths due to poisoning in New Zealand adults are intentional self-harm episodes. A comprehensive approach to monitoring poisoning, the underlying risks and the implementation of interventions is required to minimise risks.

Tuberculosis case burden and treatment outcomes in children, adults and older adults, Vanuatu, 2007-2011.

SETTING: All five DOTS centres in Vanuatu. OBJECTIVES: To determine across the age spectrum the tuberculosis (TB) case burden, disease pattern and treatment outcomes in patients registered between 2007 and 2011. DESIGN: Retrospective cohort study involving reviews of TB registers and treatment cards. RESULTS: Of 588 TB patients, 142 (24%) were children (aged 0-14 years), 327 (56%) adults (aged 15-54 years) and 119 (20%) were older adults (aged ⩾55 years; subdivided into 55-64 and ⩾65 years); 568 were new patients, 13 had been treated previously and 7 had unknown status. Compared with adults, children with new TB had a higher prevalence of extra-pulmonary TB (75% vs. 34%, OR 5.7, 95%CI 3.6-9.0) and a lower prevalence of smear-positive pulmonary TB (11% vs. 45%, OR 0.15, 95%CI 0.1-0.3), while older adults with new TB had a higher prevalence of smear-negative pulmonary TB (38% vs. 21%, OR 2.4, 95%CI 1.5-3.8). Overall TB treatment success was 83%, but in the second category of older adults (⩾65 years) treatment success was 67% and case fatality was 18%. CONCLUSION: Children and older adults constitute 45% of the TB burden in Vanuatu. Differences in disease patterns and poorer treatment outcomes in older adults have implications for policy and practice.

Contexte : Les cinq centres DOTS du Vanuatu.Objectifs : Déterminer le fardeau de la tuberculose (TB) à travers les classes d'âge, le profil de la maladie et les résultats du traitement des patients enregistré entre 2007 et 2011.Schema : Etude de cohorte rétrospective impliquant des registres de TB et des cartes de traitement.Resultats : Sur 588 patients enregistrés, 142 (24%) étaient des enfants (âgés de 0­14 ans), 327 étaient des adultes (âgés de 15­54 ans) et 119 des adultes plus âgés (âgés de ⩾55 ans, subdivisés en 55­64 et ⩾65 ans). Parmi eux, 568 étaient des nouveaux patients, et 13 avaient déjà été traités ; pour 7 d'entre eux, le statut était inconnu. Comparés aux adultes, les enfants avec une TB nouvelle avaient une plus grande prévalence de TB extra pulmonaire (75% contre 34% ; OR 5,7 ; IC95% 3,6­9,0) et une prévalence plus faible de TB pulmonaire frottis positif (11% contre 45% ; OR 0,15 ; IC95% 0,3­0,3). Les adultes âgés de ⩾55 ans avaient une prévalence plus élevée de TB pulmonaire à frottis négatif (38% contre 21% ; OR 2,4 ; IC95% 1,5­3,8). Le succès du traitement de la TB a été de 83% pour l'ensemble du groupe, mais seulement de 67% pour les patients âgés de ⩾65 ans avec un taux de létalité de 18%.Conclusion : Les enfants et les adultes plus âgés constituent 45% du fardeau de la TB au Vanuatu. Les différences constatées en termes de profil de la maladie et de résultats thérapeutiques moins bons chez les adultes âgés ont des implications en matière de politique et de pratiques.

Marco de referencia: Los cinco centros de administración del DOTS en Vanuatu.Objetivos: Determinar la carga de morbilidad por tuberculosis (TB) en las diferentes edades, las características de la enfermedad y los desenlaces terapéuticos de los pacientes registrados entre el 2007 y el 2011.Método: Se llevó a cabo un estudio retrospectivo de cohortes con examen de los registros de TB y las tarjetas de tratamiento.Resultados: Se registraron 588 pacientes con TB, de los cuales 142 (24%) niños (de 0 a 14 años de edad), 327 (56%) adultos (de 15 a 54 años de edad) y 119 (20%) adultos (⩾55 años, divididos en 55­64 y ⩾65 años). Hubo 568 casos nuevos, 13 con antecedente de tratamiento antituberculoso y 7 cuya situación se desconocía. En comparación con los adultos, los casos nuevos de TB en los niños exhibieron una mayor prevalencia de localización extrapulmonar (75% contra 34%; OR 5,7; IC95% de 3,6 a 9,0) y una prevalencia más baja de TB con baciloscopia positiva (11% contra 45%; OR 0,15; IC95% de 0,1 a 0,3); los casos nuevos en los adultos mayores (de ⩾55 años) presentaron una prevalencia más alta de TB pulmonar con baciloscopia negativa (38% contra 21%; OR 2,4; IC95% de 1,5 a 3,8). En general, la tasa de tratamiento exitoso fue 83%, pero en los ancianos (⩾ 65 años) se alcanzó un tratamiento eficaz en el 67% y se observó un índice de letalidad de 18%.Conclusión: Los niños y los adultos mayores representan el 45% de la carga de morbilidad por TB en Vanuatu. Las diferencias en las características de la enfermedad y los desenlaces terapéuticos más desfavorables en los adultos mayores tienen consecuencias en las políticas y en la práctica clínica.

Building operational research capacity in the Pacific.

Operational research (OR) in public health aims to investigate strategies, interventions, tools or knowledge that can enhance the quality, coverage, effectiveness or performance of health systems. Attention has recently been drawn to the lack of OR capacity in public health programmes throughout the Pacific Islands, despite considerable investment in implementation. This lack of ongoing and critical reflection may prevent health programme staff from understanding why programme objectives are not being fully achieved, and hinder long-term gains in public health. The International Union Against Tuberculosis and Lung Disease (The Union) has been collaborating with Pacific agencies to conduct OR courses based on the training model developed by The Union and Médecins Sans Frontières Brussels-Luxembourg in 2009. The first of these commenced in 2011 in collaboration with the Fiji National University, the Fiji Ministry of Health, the World Health Organization and other partners. The Union and the Secretariat of the Pacific Community organised a second course for participants from other Pacific Island countries and territories in 2012, and an additional course for Fijian participants commenced in 2013. Twelve participants enrolled in each of the three courses. Of the two courses completed by end 2013, 18 of 24 participants completed their OR and submitted papers by the course deadline, and 17 papers have been published to date. This article describes the context, process and outputs of the Pacific courses, as well as innovations, adaptations and challenges.

En santé publique, la recherche opérationnelle (RO) vise à identifier des stratégies, des interventions, des outils et des connaissances susceptibles d'améliorer la qualité, la couverture, l'efficacité ou la performance de systèmes de santé. L'attention a récemment été attirée sur le manque de capacités en recherche opérationnelle des programmes de santé publique dans toutes les îles du Pacifique malgré des investissements considérables dans leur mise en œuvre. Ce manque de réflexion critique pourrait empêcher le personnel des programmes de santé de comprendre pourquoi les objectifs ne sont pas totalement atteints et entraver des progrès à long terme en santé publique. L'Union Internationale contre la Tuberculose et les Maladies Respiratoires (L'Union) a collaboré avec les agences du Pacifique pour offrir des cours de RO basés sur un modèle de formation élaboré par L≈os;Union et Médecins Sans Frontières Bruxelles-Luxembourg en 2009. Le premier a débuté en 2011 en collaboration avec l'Université nationale de Fidji, le Ministère de la santé de Fidji, l'Organisation Mondiale de la Santé et d'autres partenaires. L'Union et le Secrétariat de la Communauté Pacifique ont organisé un deuxième cours pour les participants des autres îles du Pacifique en 2012 et un cours supplémentaire destiné aux participants Fidjiens a commencé en 2013. Douze participants ont été enrôlés dans chacun des trois cours. En ce qui concerne les deux cours terminés avant la fin de 2013, 18 participants sur 24 ont terminé leur RO et soumis leurs articles avant la date limite. A ce jour, 17 articles ont été publiés. Cet article décrit le contexte, l'organisation et les résultats des cours du Pacifique ainsi que les innovations, adaptations et défis.

La meta de la investigación operativa en salud pública consiste en estudiar las estrategias, las intervenciones, los instrumentos o los conocimientos que fortalecen la calidad, la cobertura, la eficacia y el desempeño de los sistemas de salud. En tiempos recientes, se ha llamado la atención sobre la falta de capacidad de realizar investigación operativa en los programas de salud pública en todas las Islas del Pacífico, pese a una inversión considerable en la ejecución. La falta de una reflexión crítica permanente impide que el personal del programa de salud comprenda las razones por las cuales no se cumple a cabalidad con los objetivos y dificulta además el logro de beneficios a largo plazo en materia de salud pública. La Unión Internacional contra la Tuberculosis y las Enfermedades Respiratorias (La Unión) ha colaborado con entidades del Pacífico a fin de llevar a cabo cursos de investigación operativa, con base en un modelo de capacitación elaborado por La Unión y Médicos Sin Fronteras de Bruselas y Luxemburgo en el 2009. El primero de estos cursos comenzó en el 2011, en colaboración con la Universidad Nacional Fiji, el Ministerio de Salud de Fiji, la Organización Mundial de la Salud y otros asociados. La Unión y la Secretaría de la Comunidad del Pacífico organizaron un segundo curso dirigido a participantes de otros países y territorios de las Islas del Pacífico en el 2012 y en el 2013 comenzó un nuevo curso, destinado a participantes de las Islas Fiji. Cada uno de los tres cursos contó con 12 participantes. En los dos cursos terminados antes del fin de 2013, 18 de los 24 participantes completaron la investigación operativa, presentaron sus artículos dentro del término previsto en el curso y hasta la fecha, se han publicado 17 artículos científicos. En el presente artículo se describen el contexto, los procedimientos y los resultados de los cursos de las Islas del Pacífico y se comentan además las innovaciones, las adaptaciones y las dificultades encontradas.

Characteristics of government workers and association with diabetes and hypertension in the Cook Islands.

SETTING: Twenty government departments in Rarotonga, Cook Islands. OBJECTIVE: To determine the characteristics, presence of selected non-communicable disease (NCD) risk factors and prevalence of diabetes mellitus (DM) and hypertension among government workers who participated in 'wellness checks' in 2012. DESIGN: Cross-sectional study involving analysis of survey data. RESULTS: Of 598 employees, 70% were aged 25-54 years and 55% were female. Two thirds were obese (body mass index ⩾30 kg/m(2)), and 76% had low levels of fruit and vegetable consumption. Of 50 (8.4%) participants diagnosed with DM (random blood glucose ⩾11 mmol/l, fasting ⩾7 mmol/l), 30 were self-reported and 20 were based on blood glucose. Of the 206 (34.4%) diagnosed with hypertension (systolic ⩾140 and/or diastolic ⩾90), 71 were self-reported and 135 were based on blood pressure measurements. Obesity was associated with hypertension (OR 2.79, 95%CI 1.4-5.4), but not with DM. No relationship was observed between fruit and vegetable consumption and presence or absence of DM or hypertension. CONCLUSION: This study identified a high prevalence of obesity and hypertension among government employees in the Cook Islands, risk factors that are associated with NCDs such as DM and cardiovascular disease. 'Wellness checks' pave the way for interventions in workplace settings to prevent and better manage these diseases through early diagnosis, risk management, treatment and supportive public health policies.

Contexte : Vingt ministères à Rarotonga, Iles Cook.Objectifs : Déterminer les caractéristiques, la présence de facteurs de risque de plusieurs maladies non transmissibles et la prévalence du diabète (DM) et de l'hypertension chez des fonctionnaires qui ont participé aux « bilans de bien-être ¼ en 2012.Schéma : Etude transversale par analyse des données d'enquête.Résultats : Sur 598 employés, 70% avaient de 25 à 54 ans et 55% étaient des femmes. Deux tiers étaient obèses (IMC >30 kg/m2) et 76% consommaient peu de fruits et légumes. Cinquante participants avaient un DM (8,4%), 20 déclarés par eux-mêmes et 30 découverts grâce à leur glycémie (test de glycémie au hasard ⩾11 mmol/l ; à jeun ⩾7 mmol/l) ; 206 (34,4%) avaient une hypertension (systolique ⩾140 et/ou diastolique ⩾90), 71 connus et 135 en fonction de la mesure de leur pression artérielle. L'obésité était associée à l'hypertension (OR 2.79 ; IC95% 1,4­5,4) mais pas au DM. Il n'y avait pas de relation entre la consommation de fruits et légumes et la présence de DM ou d'hypertension.Conclusion : Cette étude a mis en évidence une prévalence élevée d'obésité et d'hypertension parmi les employés des ministères des îles Cook, associés à des maladies non transmissibles comme le DM et l'hypertension. Les « bilans de bien-être ¼ ouvrent la voie à des interventions sur les lieux de travail afin de prévenir et de mieux prendre en charge ces maladies grâce à un diagnostic et un traitement précoces, une gestion des risques et des politiques de santé publique favorables.

Marco de referencia: Veinte dependencias gubernamentales de Rarotonga, en las Islas Cook.Objetivos: Determinar las características sociodemográficas, la presencia de factores de riesgo de padecer algunas enfermedades no transmisibles y la prevalencia de diabetes (DM) e hipertensión arterial en los funcionarios que participaron en los 'controles de la persona sana' propuestos en el 2012.Métodos: Se llevó a cabo un estudio transversal en el cual se analizaron los datos de la encuesta.Resultados: Participaron en la encuesta 598 empleados, el 70% tenía entre 25 años y 54 años de edad y el 55% era de sexo femenino. Dos tercios de los funcionarios eran obesos (índice de masa corporal ⩾30 kg/m2) y el 76% consumía pocas de frutas y verduras. Cincuenta participantes presentaron diagnóstico de DM (8,4%) (glucosa sanguinea al azar ⩾11 mmol/l, en ayunas ⩾7 mmol/l), en 30 casos por autonotificación y en 20 con base en la glucemia; hubo 206 personas con diagnóstico de hipertensión (34,4%) (sistólica ⩾140 and/or diastólica ⩾90), de los cuales 71 autonotificados y 135 con base en mediciones de la tensión arterial. La obesidad se asoció con la hipertensión (OR 2,79; IC95% de 1,4 a 5,4), pero no con la DM. No se observó ninguna correlación entre el consumo de frutas y verduras y la presencia o ausencia de DM o hipertensión.Conclusión: Se puso en evidencia una alta prevalencia de la obesidad y hipertensión en los funcionarios de las Islas Cook, la cual se asoció con la presencia de enfermedades no transmisibles como la DM o la hipertensión. Los 'controles de la persona sana' sientan las bases de intervenciones en los lugares de trabajo, destinadas a prevenir y tratar mejor estas enfermedades mediante el diagnóstico temprano, la gestión de los riesgos, el tratamiento y la formulación de políticas de salud pública.

Mentorship for operational research capacity building: hands-on or hands-off?

Mentorship is a key feature of operational research training courses run by the International Union Against Tuberculosis and Lung Disease and Médecins Sans Frontières. During the recent South Pacific paper writing module, the faculty discussed 'hands-on' mentorship (direct technical assistance) vs. 'hands-off' mentorship (technical advice). This article explores the advantages and disadvantages of each approach. Our collective experience indicates that 'hands-on' mentorship is a valuable learning experience for the participant and a rewarding experience for the mentor. This approach increases the likelihood of successful course completion, including publishing a well written paper. However, mentors must allow participants to lead and take ownership of the paper, in keeping with a first author position.

Le tutorat est un élément clé des cours de formation à la recherche opérationnelle organisés par l'Union Internationale Contre la Tuberculose et les Maladies Respiratoires et Médecins sans Frontières. Lors du récent module consacré à la rédaction d'articles dans le Pacifique Sud, la faculté a discuté des mérites comparés du tutorat pratique (assistance technique directe) et du tutorat moins actif (conseil technique). Cet article explore les avantages et inconvénients de chaque approche. Notre expérience collective montre que le tutorat pratique est un outil d'apprentissage précieux pour le participant et une expérience gratifiante pour le tuteur. Cette approche accroit les chances que le cours soit suivi jusqu'à la fin, notamment la publication d'un article bien écrit. Les tuteurs doivent cependant laisser les participants conduire la rédaction de l'article et se l'approprier, en accord avec leur position de premier auteur.

La tutoría es una de las características principales de los cursos de capacitación en investigación operativa de la Unión Internacional Contra la Tuberculosis y Enfermedades Respiratorias y Médicos Sin Fronteras. Durante un reciente módulo en el Pacífico Sur sobre la redacción de artículos científicos, el cuerpo docente analizó las modalidades de tutoría 'práctica' (asistencia técnica directa) y tutoría 'teórica' (asesoría técnica). En el presente artículo se examinan las ventajas y desventajas de cada enfoque. Según la experiencia colectiva de los autores, la tutoría 'práctica' representa una valiosa vivencia de aprendizaje para los participantes y una experiencia enriquecedora desde el punto de vista de los tutores. Este enfoque favorece la finalización exitosa del curso, que incluye la publicación de un artículo científico bien redactado. Es importante que los tutores permitan que los participantes lideren y se apropien del artículo, en conformidad con la posición de autor principal.

Workplace injuries in Fiji: a population-based study (TRIP 7).

BACKGROUND: Workplace injury rates in low and middle-income countries are known to be high. Contemporary data on this topic from Pacific Island countries and territories are scant. AIMS: To describe the epidemiology of fatal and hospitalized workplace injuries in Fiji using a population-based trauma registry. METHODS: An analysis of data from a prospective population-based surveillance registry investigated the characteristics associated with workplace injuries resulting in death or hospital admission among people aged 15 years and older in Viti Levu, the largest island in the Republic of Fiji, from October 2005 to September 2006. Incidence rates were calculated using denominator data from the 2004-05 Fiji Employment Survey. RESULTS: One hundred and eighty-nine individuals met the study eligibility criteria (including nine deaths). This corresponded to annual injury-related hospitalization and death rates of 73.4 and 3.7 per 100 000 workers, respectively. Males accounted for 95% of injuries, and hospitalization rates were highest among those aged 15-29 years (33 per 100 000 workers). Fijian and Indian workers had similar rates of admission to hospital (38.3 and 31.8 per 100 000 workers, respectively). Fractures (40%) and 'cuts/bites/open wounds' (32%) were the commonest types of injury while 'being hit by a person or object' (34%), falls (27%) and 'cutting or piercing' injuries (27%) were the commonest mechanisms. Overall, 7% of injuries were deemed intentional. CONCLUSIONS: Acknowledging the likely underestimation of the overall burden of workplace injuries, these findings support the need to identify context-specific risk factors and effective approaches to preventing workplace injuries in Fiji.

Development and piloting of the Fiji Injury Surveillance in Hospitals System (TRIP Project-1).

INTRODUCTION: Whilst more than 90% of injury related deaths are estimated to occur in low-and-middle-income countries (LMICs), the epidemiology of fatal and hospitalised injuries in Pacific Island Countries has received scant attention. This study describes the development and piloting of a population-based trauma registry in Fiji to address this gap in knowledge. METHODS: The Fiji Injury Surveillance in Hospitals (FISH) system was an active surveillance system designed to identify injuries resulting in death or a hospital admission in Viti Levu, Fiji. During the pilot conducted over five months in 2005, Accident and Emergency registers, admission folders and morgue registers from 8 of Viti Levu's 12 hospitals, and an additional 3 hospitals in other parts of the country were reviewed by hospital staff and medical students to identify cases and extract a minimum data set that included demographic factors; the mechanism, nature and context of injury; substance use; and discharge outcomes. The system was audited to identify and redress difficulties with data quality in a manner that also supported local capacity development and training in injury surveillance and data management. RESULTS: This pilot study demonstrated the potential to collect high quality data on injuries that can pose a significant threat to life in Fiji using a mechanism that also increased the capability of health professionals to recognise the significance of injury as a public health issue. CONCLUSION: The injury surveillance system piloted provides the opportunity to inform national injury control strategies in Fiji and increase the capacity for injury prevention and more focused research addressing risk factors in the local context.

The role of alcohol in unintentional falls among young and middle-aged adults: a systematic review of epidemiological studies.

OBJECTIVE: To appraise the published epidemiological evidence quantifying the risk of falls associated with acute and usual alcohol consumption among young and middle-aged adults. DESIGN: Systematic review. DATA SOURCES: searches of electronic databases (eg, Medline, EMBASE, CINAHL, PsycINFO, Scopus), websites of relevant organisations, major injury journals, reference lists of relevant articles, and contact with experts in the field. INCLUSION CRITERIA: epidemiological studies with an English language abstract investigating alcohol use as a risk factor (exposure) for unintentional falls or related injuries among individuals aged 25-60 years. Studies were critically appraised using the GATE LITE tool. Meta-analysis was not attempted because of the heterogeneity of the eligible studies. RESULTS: Four case-control, three cohort and one case-crossover study fulfilled the inclusion criteria. The studies showed an increased risk of unintentional falls among young and middle-aged adults with increasing exposure to alcohol use. However, the magnitude of this risk varied considerably across studies with most estimates being relatively imprecise. Modest evidence of a dose-response relationship with acute alcohol use was observed. The association between usual alcohol use and fall risk was inconclusive, and evidence of a gender difference was inconsistent. CONCLUSIONS: Alcohol use appears to be an important risk factor for falls among young and middle-aged adults. Controlled studies with sufficient power that adjust effect estimates for potential confounders (eg, fatigue, recreational drug use) are required to determine the population-based burden of fall-related injuries attributable to alcohol. This can help inform and prioritize falls prevention strategies for this age group.

Histological validation of ultrasound-guided neurography in early nerve regeneration.

Ultrasound-guided near-nerve neurography is a new tool that can be used to assess nerve regeneration before reinnervation occurs. In this study, ultrasound-guided near-nerve measurements were validated against axon diameter counts in rabbits during a 15-week regeneration period after a crush lesion of their peroneal nerve. The course of the nerve was determined ultrasonically, and the active near-nerve needle electrode was maneuvered just next to the nerve under ultrasound guidance. Measured action potentials were compared with axon diameter counts from histological sections of these same nerves. A moderate to good positive correlation was found, which reached a maximum of 0.7 at a cut-off of 3 microm, corresponding to the minimal size of the myelinated axons. Our results suggest that, following a similar validation study in humans, ultrasound-guided near-nerve neurography may be clinically useful when early evaluation of nerve activity is needed.

Ultrasound-guided near-nerve neurography for early evaluation of nerve regeneration.

For early assessment of axonal outgrowth after trauma, the nerve is surgically exposed to enable compound nerve action potential (CNAP) recordings across the lesion site. Near-nerve neurography, with needle electrodes placed transcutaneously near the nerve, could be a minimally invasive alternative if the needle placement procedure and low reproducibility are improved. We developed ultrasound-guided near-nerve neurography, which facilitates needle placement, and assessed its potential for evaluating nerve regeneration. Measurements were performed at varying times after crush lesion of the peroneal nerve of 25 rabbits. To test if ultrasound-guided near-nerve signals could be measured prior to muscle reinnervation, they were compared with recordings of compound muscle action potentials. A comparison with conventional intra-operative CNAP recordings was made by measuring nerve signal amplitude with both techniques and by assessing reproducibility. In all cases where intra-operative signals could be measured, near-nerve signals were also detected. Compound nerve activity could be recorded after 5 weeks, whereas compound muscle activity appeared after approximately 8 weeks. Reproducibility was slightly better for near-nerve than for intra-operative recordings. We conclude that ultrasound-guided near-nerve neurography is able to assess nerve regeneration well before compound muscle activity can be detected. Its accuracy and reproducibility are similar to those of conventional intra-operative recordings.

Recovery of neurophysiological features with time after rat sciatic nerve repair: a magneto-neurographic study.

Experimental assessment of peripheral nerve regeneration in rats by electrophysiology is controversial due to low reproducibility of electrophysiological indicators and diminished quantitative evaluation in conventional experimental set-ups. Magnetoneurography (MNG) counteracts these drawbacks by magnetically recording electrophysiological signals ex vivo, thereby providing accurate and quantitative data. In 50 rats, sciatic nerve transection was followed by direct repair. MNG outcome parameters, footprints [static toe spread factor (TSF); function] and muscle weight (MW) were studied for their recovery pattern from 2 to 24 weeks. By using MNG, we showed that the regeneration process still continues when functional recovery (static TSF) becomes stagnant. With regression analysis, MNG parameters amplitude, amplitude area and conduction velocity (CV) demonstrated moderate significant correlation with MW, whereas CV was not significantly associated with static TSF. No significant association exists between MW and static TSF. A Kaplan-Meier survival curve revealed that autotomy/contracture of rat hind paws was not related to decreased MNG outcome values. In conclusion, this study highlights and discusses the dissimilarities between direct (MNG) and indirect (static TSF and MW) assessment techniques of the regeneration process. We emphasise the significance of MNG as a direct derivative of axon regeneration in experimental rat studies. Additionally, we stress the must for right-left ratios, as neurophysiological indicators vary with age, and we confute possible bias in footprint analysis caused by exclusion of autotomy/contracture animals.

Ultrasound imaging of the rabbit peroneal nerve.

Ultrasound imaging of peripheral nerves is increasingly used in the clinic for a wide range of applications. Although yet unapplied for experimental neuroscience, it also has potential value in this research area. This study explores the feasibility, possibilities and limitations of this technique in rabbits, with special focus on peripheral nerve regeneration after trauma. The peroneal nerve of 25 New Zealand White rabbits was imaged at varying time intervals after a crush lesion. The ultrasonic appearance of the nerve was determined, and recordings were validated with in vivo anatomy. Nerve swelling at the lesion site was estimated from ultrasound images and compared with anatomical parameters. The peroneal nerve could reliably be identified in all animals, and its course and anatomical variations agreed perfectly with anatomy. Nerve diameters from ultrasound were related to in vivo diameters (p < 0.001, R(2) = 77%), although the prediction interval was rather wide. Nerve thickenings could be visualized and preliminary results indicate that ultrasound can differentiate between neuroma formation and external nerve thickening. The value of the technique for experimental neuroscience is discussed. We conclude that ultrasound imaging of the rabbit peroneal nerve is feasible and that it is a promising tool for different research areas within the field of experimental neuroscience.

Fire-related child deaths: what do newspaper case reports tell us?

OBJECTIVE: To describe the accuracy and public health relevance of newspaper accounts of child deaths from fire-related incidents. METHODS: Domestic fire-related deaths of children aged under 15 years in Auckland, New Zealand, over a 10-year period were retrospectively identified from fire service records and the national minimum mortality dataset. Forensic pathology and fire service records were reviewed and this information was compared with reports published within 3 days of the index event in the region's sole daily newspaper. RESULTS: All 14 fatal fire-related events (19 deaths) identified using fire service records and the national minimum dataset during the study period were reported in the newspaper with a high degree of detail and accuracy. Only four news items informed readers of specific measures that could prevent such events. CONCLUSIONS: Daily newspapers can provide reliable, useful and timely surveillance data on the incidence of fire-related childhood deaths. However, these reports often represented missed opportunities to disseminate public health messages that raised awareness of sources of risk and means of preventing fire-related deaths.

Magnetoneurography: recording biomagnetic fields for quantitative evaluation of isolated rat sciatic nerves.

Magnetoneurography (MNG) is a technique to record the biomagnetic action fields of peripheral nerves. The benefits of MNG in contrast to electroneurography include the decreased signal disturbance caused by surrounding biological tissues and the use of a calibration pulse, both of which contribute to high reproducibility. MNG has proven to be a valuable tool to quantitate peripheral nerve regeneration in rabbits. However, the most commonly used model to study the peripheral nervous system is the rat sciatic nerve. Until now, the small size of the nerve impeded accurate MNG measurements in rat. This report describes a custom made recording chamber that allows accurate control of conduction distances and temperature and enables adequate MNG measurements of isolated sciatic nerves of Wistar rats. We applied biphasic stimulation with optimized grounding to reduce the stimulus artefact. A high reproducibility of signals was demonstrated. 'Ex vivo' nerve viability was assured for at least 2 h after dissection. In conclusion, MNG is a powerful tool to quantitatively evaluate the function of rat sciatic nerves and will be used for the early assessment of nerve regeneration.

The wound that nearly got away: a case presentation.

Chronic cavity wounds are not commonly seen in pediatrics, and little literature is available on their management. A pediatric patient with juvenile dermatomyositis (JDMS) who had a chronic cavity surgical wound with an enterocutaneous fistula presented a nursing challenge. The patient had complex medical and surgical problems that greatly influenced her ability to heal. Nursing management of the wounds had to be innovative and flexible to adapt to these challenges. Factors affecting the patient's wound healing included JDMS; decreased mobility; persistently low serum magnesium, zinc and albumin; malnutrition; infection; and prolonged glucocorticosteroid therapy. Nursing management of her complex wounds included the following strategies: absorption of excessive exudate, wound support, debridement, wound irrigation, wound bagging, healing by secondary intention, and control of hypergranulation.

Telephone advice about an infant given by after-hours clinics and emergency departments.

AIMS: Studies have shown that telephone calls for advice constitute a significant portion of the workload of emergency departments in the United States and the United Kingdom. Reviews of the appropriateness of telephone advice given in emergency departments in the United States indicate that the information given is often inadequate or inaccurate. We performed a study to evaluate the telephone advice given in New Zealand. METHODS: We identified 30 public hospital emergency departments and 20 private accident and emergency clinics. Twenty-six towns and cities were represented. We telephoned each of them and requested advice about the management of a fictitious febrile infant. RESULTS: We were given medical advice by 36 of the centres. In the remaining 14 the caller was referred to an oncall duty doctor or general practitioner for further information. In the 36 departments providing advice, the information was given by a doctor in 5 of the cases, by a nurse in 26, and by a receptionist or unidentified respondent in 5. On average, the caller was asked 3.76 questions about the patient before advice was given. Even if a number of questions were asked, correct advice did not necessarily follow. Thirty five of the advice givers requested the age of the infant, but 16 of them gave inadequate advice despite this knowledge. We judged the advice given to be inadequate in 16 of the 36 institutions that provided it. There was no difference in the standard of advice given by private and public institutions. DISCUSSION: This study demonstrates that there are deficiencies in the quality of telephone advice given by emergency departments and private accident and emergency clinics in New Zealand.