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Background and objectives Trinidad and Tobago is a multi-ethnic, multicultural country with an annual blood donation rate of 17 per 1000 and predominantly (87%) family/replacement (F/R) donors. A knowledge, attitudes and practice ( KAP) community survey in 2003 revealed lack of information and poor access to donation centres as barriers to voluntary non-remunerated donors ( VNRD). The survey was repeated in 2013 after a national intervention to increase VNRD failed. Materials and methods The second cross-sectional, questionnaire-based survey was administered to 816 adults in the same community. The variables assessed were sociodemographics, knowledge, attitudes and blood donation behaviour. Data analysis was performed using SPSS statistical software and Minitab 17. Chi-square was used to assign significance and logistic regression to analyse correlation between variables. Results of the two surveys were compared. Results There was no difference in the overall percentage of donors (18·8 vs. 21·1%, P = 0·337), and a low donor percentage was observed in all sociodemographic groups (7·7-31·6% vs. 10·2-31·7%). The main reason for donating blood was replacement for a relative or friend (86·0 vs. 86·9% P = 0·851). Willingness to repeat donation was high (90·6% vs. 86·4%, P = 0·006). Motivators and demotivators to donation varied among sociodemographic groups. Conclusion There was no significant change in community KAP between surveys. Anthropological studies into blood donation are needed to plan an effective revised and targeted blood donation campaign. Legal and regulatory changes must facilitate VNRD. [ABSTRACT FROM AUTHOR]

Background/objectives: Adolescents have unique nutrient requirements due to rapid growth and development. High rates of obesity in adolescents require a variety of diet interventions to achieve weight loss under clinical supervision. The aim of this study is to examine the nutritional adequacy of energy-restricted diets for adolescents.Subjects/methods: Three popular diets were modelled for 7 days and assessed by comparing the nutrient profile to the Australian Nutrient Reference Values. Three diets were: (1) a standard energy restricted diet based on current dietary guidelines; (2) a modified carbohydrate diet; and (3) a modified alternate day fasting diet.Results: Initial modelling revealed limiting nutrients (that is, not meeting the recommended intakes) across the diets. Subsequent modelling was required to achieve nutritional adequacy for all three diets. The dietary guidelines diet design met most nutrient targets except essential fatty acids before subsequent modelling, however this diet also provided the highest energy (8.8 vs 8.0 MJ and 6.8 MJ for the modified carbohydrate and modified alternate day fasting diet, respectively).Conclusions: Energy-restricted diets need careful consideration to meet nutritional requirements of adolescents. A variety of eating patterns can be adapted to achieve nutritional adequacy and energy restriction, however health practitioners need to consider adequacy when prescribing diet interventions for weight loss during adolescence. [ABSTRACT FROM AUTHOR]

Objectives: Hearing loss and ASD can both affect an individual's communication abilities. Factors associated with ASD may have an impact on the clinical management of cochlear implant users. Literature describes that individuals with autism spectrum disorder (ASD) may be less inclined to engage with other children and adults in typical social interactions with the result that they may be less interested in typical play and social/positive reinforcement used to teach a desired behaviour. There are also documented sensory stimulation tolerance issues associated with ASD. Changes in routine have also been shown to be poorly tolerated by some individuals with ASD. For a cohort of cochlear implant (CI) users who have also been diagnosed with ASD, typical assessment techniques and mapping parameters may require modification. This study reviews the clinical practices and audiometric and speech perception results of individuals with ASD who use cochlear implants. Material: A retrospective review of case records and assessment results was conducted for the cohort of CI recipients with ASD from an Australian CI clinic. A range of aetiologies and ages were represented. Methods: Map information and case notes were reviewed along with formal and informal interviews with parents and teachers for some paediatric members of the group. Results from formal testing in the clinic and from observations made when visiting the children in their educational settings were also incorporated in the retrospective analysis. Results: The CI recipients with ASD have been observed to not always tolerate maps with typical or default current levels, program settings or dynamic ranges. Lower map levels or reduced dynamic ranges were at times required. Tactile defensive behaviour related to ASD meant that some subjects did not tolerate wearing their sound processors in the standard configuration. Behavioural therapists and/or desensitization techniques were required to reintroduce sound processor use when it was interrupted for some individuals. Standard audiological tests often produced limited results for the group. Clinical case notes recorded for the subjects describe the challenges in using standard behavioural play-based or functional testing methods. An additional clinician was often needed to assist during testing. Discussions with education professionals working with these children showed that teachers may assume that either the hearing loss or ASD in isolation is contributing to a lack of speech and language development. A child's lack of typical responsiveness to speech directed at them may mean that teachers or others have little faith that the CI technology is working. Conclusions: Flexible approaches are often required when working with CI users who have ASD and will vary with how severe the autistic characteristics may be for an individual. The audiologist needs to be wary of potential for over stimulation and device rejection. Overall, a multidisciplinary team approach is needed to best support these patients and close communication with educators and other professionals can help in optimising case management. [ABSTRACT FROM AUTHOR]

BACKGROUND: By international standards, water supplies in Perth, Western Australia, contain high trihalomethane (THM) levels, particularly the brominated forms. Geographic variability in these levels provided an opportunity to examine cross-city spatial relationships between THM exposure and rates of birth defects (BDs). OBJECTIVES: Our goal was to examine BD rates by exposure to THMs with a highly brominated fraction in metropolitan locations in Perth, Western Australia. METHODS: We collected water samples from 47 separate locations and analyzed them for total and individual THM concentrations (micrograms per liter), including separation into brominated forms. We classified collection areas by total THM (TTHM) concentration: low (< 60 microg/L), medium (> 60 to < 130 microg/L), and high (>= 130 microg/L). We also obtained deidentified registry-based data on total births and BDs (2000-2004 inclusive) from post codes corresponding to water sample collection sites and used binomial logistic regression to compare the frequency of BDs aggregately and separately for the TTHM exposure groups, adjusting for maternal age and socioeconomic status. RESULTS: Total THMs ranged from 36 to 190 microg/L. A high proportion of the THMs were brominated (on average, 92%). Women living in high-TTHM areas showed an increased risk of any BD [odds ratio (OR) = 1.22; 95% confidence interval (CI), 1.01--1.48] and for the major category of any cardiovascular BD (OR = 1.62; 95% CI, 1.04--2.51), compared with women living in low-TTHM areas. CONCLUSIONS: Brominated forms constituted the significant fraction of THMs in all areas. Small but statistically significant increases in risks of BDs were associated with residence in areas with high THMs. [ABSTRACT FROM AUTHOR]

A novel sensor is demonstrated to allow a real-time measurement of the physical wear applied to the surface of an object. Two different measurement methods are presented, both utilizing the reflected power from a sacrificial chirped fibre Bragg grating to give the wear measurement. The measurement systems are simple to implement with the possibility of low cost designs depending on the application. The sensor can measure wear with a resolution of 120 µm. [ABSTRACT FROM AUTHOR]

Introduction : The introduction of datalogging into cochlear implant technology provides valuable information to facilitate optimisation of listening environments for both client and clinicans. Quality of life can be reflected in the environment scene analysis of datalogging when combined with other measurement tools including the SSQ. The importance of using a test battery to identify potential areas of improvement for clients was investigated. Method : Datalogging of 100 adult CI recipients were examined over a period of 3 months post cochlear implant device activation. During that time, the SSQ was administered and compared to preoperative SSQ measures. Results : The scene analysis of datalogging correlated with subtests on the SSQ in particular the quality and the speech scales. Trends in datalogging of various age groups were identified, in particular younger adults and older adults. This information provided a platform for counselling for adults in determining "normative data" for device use and for developing strategies to improve outcomes and performance with the CI . Conclusion: Datalogging is a quick accessible ongoing measure of factors that impact on a cochlear implant recipients quality of life. Regular review of datalogging can provide insights that can assist clinicians in supporting improvements in quality of life of their clients. It is cautioned that datalogging cannot be used in isolation and should be matched with a QOL measure such as the SSQ. [ABSTRACT FROM AUTHOR]

Background: Increases in the demand and range of cochlear implant services due to expanded criteria over the past 30 years have not correlated with increases in funding. Quality standards for CI service delivery must be maintained. This paper outlines the mapping of value stream of the CI model of service and the financial implications for ensuring standard of care is maintained whilst maximising economic efficiencies. Method: A total of 56 intervals of service delivery over a 10 year period was mapped across the journey of adult CI recipients. A review of the profit and loss of service delivery over this 10 year period based on a range of parameters cost of service, recipient and clinician numbers and appointment types. Results: Results indicated that cochlear implant services were not profitable until 5 years post cochlear implantation. All service delivery prior to that point was running at a significant loss. Costs did not even out until approximately 9 years following cochlear implantation. Five areas emerged that showed cost inefficiencies. Conclusion: Cost inefficiencies of a cochlear implant service delivery model were identified using the value stream mapping approach. This enabled steps to be taken toward implementing a more sustainable model of CI service delivery whilst maintaining good quality of care. [ABSTRACT FROM AUTHOR]

Background: An increased number of children and adults with SSD receiving cochlear implants over the past 10 years has guided clinical protocols for evaluation and ongoing management. The benefits of CI are clear for hearing in background noise, localising sound, and decreased overall listening effort. This paper will provide an outline of SCIC's protocols including pre-operative support and counselling, guidelines for device programming, & rehabilitation. Outcomes and rate of progress will also be discussed. Methods: A total of 65 people with SSD were included in this retrospective review of management pathways. This included 5 groups of children that received specialist advice, assessment and management by a multidisciplinary team. These groups included those with absent auditory nerves, benefit from conventional devices, no devices who received ongoing monitoring, children who received a CI, and those suitable for CI, but did not proceed to surgery. Results: In adults, approximately 30% of those assessed chose to use a conventional device or have no intervention. Children who received CI's for SSD comprised only 29% of the children in the entire sample of those assessed. Auditory nerve was absent in 43% of the children. Recipients showed functional benefit on one or more of the subtests of the Speech Spatial Qualities questionnaire. Methodologies for device programming and rehabilitation varied across the cohort. A review of these processes was required for ensuring protocols were addressing client need. Conclusions: Evaluation and intervention protocols for SSD must take into account the onset and duration of the hearing loss; integrity of the cochlear nerve on the affected side; benefit received from other hearing devices; current functional hearing performance, and the investment in time and resources that will be required to facilitate the integration of the acoustic hearing from the better ear and electrical hearing. [ABSTRACT FROM AUTHOR]

Introduction: There are many rehabilitation tools and programs available for adults receiving cochlear implants, with a strong emphasis on self management. Recipient suitability of technology based tools varies, hence the CI clinician must identify the most appropriate methodology for their client. Further, these tools, do not provide the opportunities to develop the social wellbeing that many recipients seek following CI. This paper will identify methods of supporting adult CI recipients through the use of available resources as well as identifying the role of direct traditional 1:1 therapy and the use of volunteers in the rehabilitation process. Method: Two to four weeks post device activation clients were screened to determine and review preoperative goals to determine rehabilitation approaches to be used. Outcomes were measured following a series of individual sessions; therapy supported through self management with support from a volunteer or a combination of both. Results : One or more of the client goals were achieved in all conditions within the period of intervention following device activation. Subjective data and self rating scores showed no significant difference regardless of the type of intervention provided. A longer term rehabilitation program was required in most of the cases which was readily accommodated through ongoing self management and volunteer support. Conclusion : A blend of post operative auditory training approaches in the acute phase following device activation was recommended for clients requiring support in their rehabilitation process. Generalisation of skills was facilitated through the use of volunteers and through self management following a period of individual sessions whereby the recipient gained confidence in their skills and abilities. This study provided a template for managing newly implanted CI recipients across the organisation to ensure that immediate and longitudinal training needs were. [ABSTRACT FROM AUTHOR]

Introduction : Longitudinal use of telepractice as a model for service delivery is reliant on integration of new technologies and practices whilst adhering to basic principles underpinning quality standards of care. This paper will focus on innovations that have made the longevity of the telepractice model possible for all aspects of CI management, with particular focus on an APP that has been designed and verified for use in measuring speech discrimination in enabling self efficacy of clients with ongoing evaluation and monitoring of performance. Method: A model to evaluate effectiveness and efficiencies of telepractice in clinical service delivery was used to evaluate evaluation, mapping and rehabilitation of CI recipients using telepractice. Clients, clinicians and facilitators in the telepractice process completed survey's questionnaires and outcomes measured to provide this information. Results :Effectiveness of speech discrimination measures were not impacted by the service model. This is consistent with longitudinal findings from the implementation of telepractice in other aspects of cochlear implant management including counselling, device mapping, and rehabilitation. Efficiencies in timeliness of service and reductions in travel time were reported. Satisfaction ratings revealed that most of the clients felt more integrated into their device management and reported a deeper understanding of their technology and the processes involved. Conclusion : Longitudinal implementation of telepractice model must readily adapt to new technologies and the evolving landscape within the field of CI. Evidence is required to ensure that any changes to the model are efficient and effective. Telepractice models will continue to evolve for all aspects of management for CI and can provide a service delivery model that can benefit a range of clients. [ABSTRACT FROM AUTHOR]

Background: Concomitant with the rise in childhood obesity there has been a significant increase in the number of adolescents with clinical features of insulin resistance and prediabetes. Clinical insulin resistance and prediabetes are likely to progress to type 2 diabetes and early atherosclerosis if not targeted for early intervention. There are no efficacy trials of lifestyle intervention in this group to inform clinical practice. The primary aim of this randomised control trial (RCT) is to determine the efficacy and effectiveness of two different structured lifestyle interventions differing in diet composition on insulin sensitivity, in adolescents with clinical insulin resistance and/or prediabetes treated with metformin.Methods/design: This study protocol describes the design of an ongoing RCT. We are recruiting 108 (54 each treatment arm) 10 to 17 year olds with clinical features of insulin resistance and/or prediabetes, through physician referral, into a multi-centred RCT. All participants are prescribed metformin and participate in a diet and exercise program. The lifestyle program is the same for all participants except for diet composition. The diets are a high carbohydrate, low fat diet and a moderate carbohydrate, increased protein diet.The program commences with an intensive 3 month dietary intervention, implemented by trained dietitians, followed by a 3 month intensive gym and home based exercise program, supervised by certified physical trainers. To measure the longer term effectiveness, after the intensive intervention trial participants are managed by either their usual physician or study physician and followed up by the study dietitians for an additional 6 months. The primary outcome measure, change in insulin sensitivity, is measured at 3, 6 and 12 months.Discussion: Clinical insulin resistance and prediabetes in the paediatric population are rapidly emerging clinical problems with serious health outcomes. With appropriate management these conditions are potentially reversible or at least their progression can be delayed. This research study is the first trial designed to provide much needed data on the effective dietary management for this cohort. This study will inform clinical practice guidelines for adolescents with clinical insulin resistance and may assist in preventing metabolic complications, type 2 diabetes and early cardiovascular disease.Trial Registration: Australian and New Zealand Clinical Trials Registration Number ACTRN12608000416392. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Delay in diagnosis of neuralgic amyotrophy in patients initially evaluated by non-neurologists," published in the November 16, 2007 issue.