Development of an Insulin-Prescribing Chart for Paediatric Diabetes

Aim Our aim was to design a new insulin prescribing tool in compliance with the Irish Medicines Safety Network recommendations. Methods In 2015, we undertook a review of the existing paediatric subcutaneous insulin-prescribing sheet introduced to Cork University Hospital in 2013. This involved a retrospective analysis of 15 consecutive in-patient insulin prescribing charts and a questionnaire distributed to health professionals. Following this a new insulin prescribing chart was designed and implemented in 2016 and a re-audit was performed in 2017. Results The 2017 re-audit demonstrated that the new insulin chart was viewed as easier (95% of previous users n=18) and safer (n=16) to use. There was less confusion (2017: 28%, n=11/39 vs 2015: 50%, n=17/34 2015) and the ALERT system helped staff standardise hypo/hyperglycaemia management (71%, n=28). Conclusion The new paediatric insulin prescribing chart has improved safety and ease of prescribing insulin. The colour coded quasi graph and ALERT system has made it easier to appreciate capillary blood glucose trends and manage them safely.

The perceived validity of eyewitness identification testimony: a test of the five Biggers criteria.

The U.S. Supreme Court has outlined five criteria on which evaluations of eyewitness identifications should be based (certainty, view, attention, description, and time; Neil v. Biggers, 1972). We postulated that certainty plays a qualitatively different role from the four other Biggers criteria in evaluations of eyewitness identification testimony. Specifically, we hypothesized that participants would ignore reports on other criteria when certainty was high (the certainty-trumps hypothesis), but not when certainty was low. Participants (N = 386) read a fictitious trial transcript in which three of the five Biggers criteria were manipulated (certainty, view, and attention, or certainty, description, and time) and completed a questionnaire. The certainty-trumps hypothesis was not supported. Instead, the Biggers criteria combined only as main effects, not interactions, supporting a summative hypothesis. Surprisingly, collateral effects indicated that manipulations of one criterion (e.g., certainty) affected perceptions of other criteria (e.g., attention and view) and vice versa. Implications of the results are discussed.

Visual experience, visual field size, and the development of nonvisual sensitivity to the spatial structure of outdoor neighborhoods explored by walking.

When places are explored without vision, observers go from temporally sequenced, circuitous inputs available along walks to knowledge of spatial structure (i.e., straight-line distances and directions characterizing the simultaneous arrangement of the objects passed along the way). Studies show that a life history of vision helps develop nonvisual sensitivity, but they are unspecific on the formative experiences or the underlying processes. This study compared judgments of straight-line distances and directions among landmarks in a familiar area of town by partially sighted persons who varied in types and ages of visual impairment. Those with early childhood loss of broad-field vision and those blind from birth performed significantly worse than those with early or late acuity loss and those with late field loss. Broad-field visual experience facilitates perceptual development by providing a basis for proprioceptive and efferent information from locomotion against distances and directions relative to the surrounding environment. Differences in the perception of walking, in turn, cause the observed differences in sensitivity to spatial structure.

Is C-reactive protein really useful in preterm premature rupture of the membranes?

In a prospective blind study 380 daily serum samples from 55 women with preterm premature rupture of the membranes were analysed for C-reactive protein (CRP). Although the last CRP before delivery was higher in patients with histological chorioamnionitis (P = 0.007), considerable overlap between infected and non-infected pregnancies occurred, precluding the use of CRP as a diagnostic test if published normal levels were used. When upper limits were set at 30, 35, or 40 mg/l, the last CRP before delivery proved 90, 95 and 100% specific and 88, 92 and 100% positively predictive of infection in singleton pregnancies. Such high specificities are needed to prevent inappropriate intervention based on false positive results. We therefore propose upper limits for single estimations of 30, 35, or 40 mg/l depending on the relative risks of preterm delivery versus infection at various gestational ages. In addition, consecutive values greater than 20 mg/l appeared highly predictive of infection.

Pen and field trials of a new anticoagulant rodenticide flocoumafen against the house mouse (Mus musculus L.).

The efficacy of flocoumafen, a novel anticoagulant rodenticide, was evaluated in feeding tests on confined and free-living populations of house mice (Mus musculus L.). In four pen trials, family groups of laboratory-reared wild mice were conditioned to feeding on plain foods and then offered flocoumafen at 0.005% in pinhead oatmeal bait. All 68 mice, comprising juvenile and adult animals, died within 10 days. Ten field trials were carried out, using the same formulated poison bait, against mice infesting farm buildings. Mean treatment success, estimated from live-capture and mortality data, ranged between 87.1 and 100%. The performance of flocoumafen is compared with that of difenacoum, bromadiolone and brodifacoum used at the same concentration in oatmeal bait. Flocoumafen gave an equally effective but quicker kill of mice. It is concluded that flocoumafen is a promising new rodenticide for the control of M. musculus.

Pen and field trials of flupropadine against the house mouse (Mus musculus L.).

Laboratory and field trials were conducted to determine the efficacy of the candidate rodenticide flupropadine against the house mouse (Mus musculus L.). In laboratory feeding tests, family groups of wild mice maintained in pens and conditioned to feeding on plain foods were offered flupropadine at either 0.10%, 0.15%, 0.18% or 0.20% in pinhead oatmeal bait. Overall mortalities in replicated 21-day treatments were 66/71 (93.0%), 71/79 (89.9%), 72/76 (94.7%) and 69/75 (92.0%) respectively. In 17 field trials carried out against mice infesting farm buildings, flupropadine was used at 0.10%, 0.15% and 0.18% in oatmeal bait. Mean treatment success, estimated from live-capture and mortality data, was 88.6%, 96.2% and 96.6% respectively. Flupropadine was found to be as near effective against mice as calciferol/warfarin and the second-generation anticoagulant rodenticides difenacoum, bromadiolone and brodifacoum. In further comparison with the anticoagulants, treatment with flupropadine bait achieved markedly quicker control.

Metastasizing placental site trophoblastic tumor: a case study.

The clinicopathologic features of placental site trophoblastic tumor (PSTT), a rare form of trophoblastic disease, were systematically described only relatively recently. Previously, in endometrial curettage and hysterectomy specimens, PSTT was not distinguished from choriocarcinoma or sarcoma, although in most cases the natural history had been benign. A case of biopsy-proved metastasis to para-aortic lymph nodes with radiologic evidence of lung metastasis is reported. Histologically, the tumor appeared similar to the tumors in other reported cases of PSTT. The mitotic rate was variable, being very high in a few small fragments obtained by curettage. Flow cytometric analysis of the tumor showed cells with diploid DNA content and a relatively low proliferative fraction. The tumor maintained its morphologic and functional characteristics following xenotransplantation into Balb/c nu/nu mice. In spite of a treatment regimen that included hysterectomy and multiagent chemotherapy, the patient continued to have evidence of persistent trophoblastic disease 15 months after presentation.

Laboratory trials of five rodenticides for the control of Mesocricetus auratus Waterhouse.

The efficacy of five rodenticides for use in bait against the golden hamster (Mesocricetus auratus Waterhouse) was investigated in the laboratory. The species proved to be resistant to warfarin (up to 0.5%) and difenacoum (0.005%), but brodifacoum (0.005%) gave complete mortality after three days' feeding. Calciferol (0.1%), though toxic, was significantly unpalatable. Zinc phosphide (5.0%) presented in a choice test for two days against unpoisoned feed gave 100% mortality, and appears to be the most suitable of these compounds for the control of M. auratus in the field.

Trials of the anticoagulant rodenticides bromadiolone and difenacoum against the house mouse (Mus musculus L.).

Laboratory and field trials were conducted to determine the efficacy of the anticoagulant rodenticide bromadiolone against the house mouse (Mus musculus). In laboratory feeding tests, family groups of warfarin-resistant mice maintained in pens and conditioned to feeding on plain foods were offered pinhead oatmeal bait containing bromadiolone at 0.005%. Overall mortality in replicated 21-day poison treatments was 55/58 or 94.8%. Six field trials were carried out, using the same poison bait, against mice infesting farm buildings. Treatment success, estimated from the results of census baitings conducted before and after treatment, ranged between 60.4% and 100%, mean 92.4%. In equivalent field trials using difenacoum, another newly developed anticoagulant rodenticide, the control achieved ranged between 70.2% and 100%, mean 96.0%. Five field trials, three involving bromadiolone and two difenacoum, were not completely successful and the surviving mice were removed for laboratory examination. In 21-day toxicity tests, each animal was fed the poison bait offered to it earlier in the field. Bromadiolone and difenacoum gave kills of 12/21 (57.1%) and 9/11 (81.8%) respectively. The possible emergence of mouse populations resistant to these anticoagulants is considered.

Trials of the rodenticide pyriminil against wild house mice (Mus musculus L.).

Pen field trials were conducted to assess the performance of the acute rodenticide pyriminil against the house mouse (Mus musculus L.). Four types of poison treatment were carried out using penned family groups of warfarin-resistant mice supplied with alternative plain foods. In each treatment pyriminil was included at 2% in a wholemeal flour/pinhead oatmeal/corn oil bait. Mortality was highest (46/54; 85.2%) when poison bait was offered for 4 days following 3 days of pre-baiting. The same pre-baiting and poisoning technique was adopted in five field trials carried out against mice infesting farm buildings. The efficacy of each poison treatment was estimated from the results of pre- and post-treatment census baitings; treatment success ranged between 53.7% and 96.7%, mean 80.5%. It is concluded that pyriminil treatments are best carried out after a period of pre-baiting and that when pyriminil is used in this manner it is about as effective as zinc phosphide for the control of mice.

Trials of the anticoagulant rodenticide WBA 8119 against confined colonies of warfarin-resistant house mice (Mus musculus L.).

The efficacy of the newly developed anticoagulant rodenticide WBA 8119 was evaluated against the house mouse (Mus musculus L.) using individual and family groups of warfarin-resistant animals. WBA 8119 at 0-002%, 0-005% and 0-01% in pinhead oatmeal bait gave complete kills of mice in 'no-choice' feeding tests carried out in cages and small pens. In replicated 21-day treatments on families of mice confined in larger pens conditioned to feeding on plain foods, the overall mortalities obtained using the three formulated poison baits were 71/72, 62/63 and 57/57 respectively. The results of the WBA 8119 toxicity tests are considered in relation to previous findings on other anticoagulant rodenticides, particularly difenacoum. In equivalents tests, WBA 8119 performed better than difenacoum. The data thus suport the laboratory findings that WBA 8119 is the most active anticoagulant so far tested for the control of warfarin-resistant house mice.

Trials of the anticoagulants rodenticide WBA 8119 against confined colonies of warfarin-resistant house mice (Mus musculus L.).

The efficacy of the newly developed anticoagulant rodenticide WBA 8119 was evaluated against the house mouse (Mus musculus L.) using individual and family groups of warfarin-resistant animals. WBA 8119 at 0-002%, 0-005% and 0-01% in pinhead oatmeal bait gave complete kills of mice in 'no-choice' feeding tests carried out in cages and small pens. In replicated 21-day treatments on families of mice confined in larger pens and conditioned to feeding on plain foods, the overall mortalities obtained using the three formulated poison baits were 71/72, 62/63 and 57/57 respectively. The results of the WBA 8119 toxicity tests are considered in relation to previous findings on other anticoagulant rodenticides, particularly difenacoum. In equivalent tests, WBA 8119 performed better than difenacoum. The data thus support the laboratory findings that WBA 8119 is the most active anticoagulant so far tested for the control of warfarin-resistant house mice.

Field trials of the rodenticide gophacide against wild house mice (Mus musculus L.).

The acute rodenticide gophacide was tested against urban infestations of the house mouse (Mus musculus L.) and treatment success was assessed from the results of census baitings conducted before and after each treatment. Seven of eight populations of mice living in premises where alternative food supplies were limited were successfully controlled when medium oatmeal bait containing gophacide at 0.1% was laid directly for 4 days. In further treatments against mice inhabiting more complex environments and having greater access to other foods, the performance of gophacide at 0.1% and at 0.25% in a wholemeal flour/pinhead oatmeal/corn oil bait was compared with that of zinc phosphide at 3.0% in the same bait-base. The poison treatments were conducted for 1 or 4 days and always after 3 days pre-baiting. Treatment success varied considerably irrespective of the type of treatment or of the poison used. In general, however, gophacide proved to be as effective as zinc phosphide for the control of mice.

Food preferences of wild house-mice (Mus musclus L).

The relative acceptance of various plain foods by wild house-mice (Mus musculus L.) was compared in laboratory choice tests. The palatability of glycerine and six oils, each included at 5% in pinhead oatmeal, was compared in a similar manner.The most favoured food was found to be whole canary seed (Phalaris canariensis). Pinhead oatmeal and wheat were also comparatively well accepted. Glycerine, corn oil, arachis oil and mineral oil were more palatable than either olive, linseed or cod-liver oils.The results of the choice tests are considered in relation to the use of poison baits for the control of free-living mice.

Field trials of the rodenticide 5-p-chlorophenyl silatrane against wild house mice (Mus musculus L.).

The performance of the rodenticide 5-p-chlorophenyl silatrane at 0.5% in a wholemeal flour/pinhead oatmeal/corn oil bait was compared with that of zinc phosphide at 3% in the same base in poison treatments carried out against urban infestations of the house mouse (Mus musculus L.). Each poison treatment was conducted for 1 day and after 3 days' pre-baiting. The success of the treatments was assessed from census baitings conducted before and after treatment. Treatment success varied considerably with both poisons used but in general 5-p-chlorophenyl silatrane proved to be at least as effective as zinc phosphide, a commonly used acute rodenticide for the control of mice.