A decade of data linkage in Western Australia: strategic design, applications and benefits of the WA data linkage system.

OBJECTIVES: The report describes the strategic design, steps to full implementation and outcomes achieved by the Western Australian Data Linkage System (WADLS), instigated in 1995 to link up to 40 years of data from over 30 collections for an historical population of 3.7 million. Staged development has seen its expansion, initially from a linkage key to local health data sets, to encompass links to national and local health and welfare data sets, genealogical links and spatial references for mapping applications. APPLICATIONS: The WADLS has supported over 400 studies with over 250 journal publications and 35 graduate research degrees. Applications have occurred in health services utilisation and outcomes, aetiologic research, disease surveillance and needs analysis, and in methodologic research. BENEFITS: Longitudinal studies have become cheaper and more complete; deletion of duplicate records and correction of data artifacts have enhanced the quality of information assets; data linkage has conserved patient privacy; community machinery necessary for organised responses to health and social problems has been exercised; and the commercial return on research infrastructure investment has exceeded 1000%. Most importantly, there have been unbiased contributions to medical knowledge and identifiable advances in population health arising from the research.

On being understood: clarity and jargon in radiation protection.

While much of the language used to express the concepts of radiation protection works effectively, there are many ill-chosen names and phrases and much jargon that permeate our professional speech and writing. From the oxymoron "internal exposure" to the "snarl word" "decay," there is much room for improvement. This essay identifies many of the problems and suggests solutions. We examine the kinds of confusions that can result from using familiar words with unfamiliar meanings and the need for neology. We offer insights into specific and unambiguous naming of physical quantities and explore the seemingly unlimited kinds of "dose." We disaggregate exposure from irradiation following intakes, and unmask units like "gram rad per microcurie hour." We call for a definition of radiation weighting factor that doesn't result in a violation of the law of conservation of energy. We examine the subtleties of distinguishing between radiation and radioactive materials. Some words, such as "exposure," have multiple meanings, while at other times there are different words or phrases with the same meaning, such as "critical level" and "decision level" or "detection level" and "minimum detectable amount." Sometimes phrases are used whose meaning is unclear or not agreed upon, such as "lower limit of detection." Sometimes there are words that are simply not apt, such as "disintegration" applied to the emission of a subatomic particle from a nucleus.

Biological effects of inhaled 239PuO2 in Beagles.

Seven groups of 8-24 Beagle dogs, exposed to (239)PuO(2) aerosols by inhalation [mean initial lung depositions (ILD) of 0.0, 0.14, 0.63, 3.2, 13, 44 and 210 kBq] were observed throughout their lives to determine tissues at risk and dose-effect relationships. The mean average pulmonary retention half-time of (239)Pu was 1,192 days. Most (70%) of the plutonium recovered at death in dogs surviving >10 years after exposure was found in the thoracic lymph nodes with ∼15% in lung, ∼10% in liver and ∼2% in bone. Eight dogs at the highest exposure levels died from radiation pneumonitis prior to a minimal 3-year latency period after exposure for the observation of lung tumors, with the first succumbing 337 days after exposure. Of 108 plutonium-exposed Beagles with ILD <100 kBq, 51 (47%) had lung tumors with significantly increased incidence in those dogs with total lung dose of ≥1.1 Gy at death. The primary non-neoplastic effects observed were lymphopenia, atrophy and fibrosis of the thoracic lymph nodes, radiation pneumonitis and pulmonary fibrosis, and bacterial pneumonia. Lesions of the thoracic lymph nodes were observed in 98 of 108 exposed dogs, but there were no primary neoplasms of the lymph nodes. Bacterial pneumonia was observed in 13 plutonium-exposed dogs and was the most notable non-neoplastic cause of death, with survival nearly the same as that of controls. Setting of dose limits on the basis of detrimental effects commonly considers and differentiates between stochastic and deterministic effects, raising the question of whether the non-neoplastic effects found in this study were deterministic. The International Commission on Radiation Protection (ICRP), National Council on Radiation Protection & Measurements (NCRP), and similar organizations generally consider effects that increase in incidence and severity to meet the definition of deterministic. We demonstrated the radiation dose-related nature of effects such as pneumonitis and fibrosis graphically and lymphopenia numerically, rather than by quantified estimates. It is clear, however, that both incidence and severity increased with ILD and radiation dose and should be considered as deterministic effects.

Using a panel of immunomarkers to define homologies in Mammalian brains.

Brain mapping has relied on a small number of routine chemical stains for many decades. The advent of immunomarkers has had a major impact on the ability to define homologous nuclei from one species to another. The first atlas to present a panel of immunomarkers was that of Paxinos et al. (1999a,b) in the adult rat brain. The markers used were parvalbumin, calbindin, calretinin, SMI32, tyrosine hydroxylase, and NADPH diaphorase (plus nissl and acetylcholinesterase). The 'signature' of a nucleus of interest in a new species can be tested against the findings in the rat. Since the pattern of immunomarkers seems to be conserved in mammalian evolution, such extrapolations can be made with reasonable confidence. A marmoset brain stained with a comprehensive set of immunomarkers has recently been published on the internet (Tokuno et al., 2009) and we are in the process of defining nuclear homologies in this brain by comparison with the same markers in the rat. In this article, we present an example (mapping the amygdala in the marmoset) which demonstrates the application of this immunomarker panel in defining homologies. The technique is particularly valuable in situations where little data on hodology or electrophysiology are available.

Human infestation with bird mites in Wollongong.

This is a report of a case of bird mite infestation which occurred in Wollongong in mid-December 1996. The individual suffered hundreds of bites, most of which were marked by itchy red papules 3-4 mm in diameter. Tiny mobile parasites (< 1 mm) collected from the skin and adjacent bedroom wall were identified as bird mites from the family Gamasidae, most probably from the genus Ornithonyssus. The source of the infestation was a starling nest under the eaves adjacent to the bedroom. The report summarises the ways bird mite bites can be distinguished from other insect and arachnid bites. If bird mite infestation is not correctly diagnosed, families who attempt to repeatedly treat it as if it were lice or scabies may incur considerable expense until the source of infestation is eliminated.