Integrating data to facilitate clinical research : a case study

The integration of routine clinical administrative activities into ongoing rigorous clinical research poses challenges for both clinicians and researchers. This case study describes the development of a responsive database system used to facilitate comprehensive longitudinal research into the outcomes of patients waiting for hip and knee replacement surgery in a large public teaching hospital. The initial research procedure was paper-based, with manual patient matching and data entry. This process was time-consuming and associated with substantial risk of error and omissions, necessitating the design of a better system. An integrated database system was designed to receive daily electronic updates of the orthopaedic waiting-list and scheduled clinic and surgery dates. Using readily available software (Microsoft Access), new patients were identified through specifying inclusion and exclusion criteria which allowed rapid and complete recruitment at time of entry to the waiting-list. The integrated system specified the appropriate timing of multiple follow-up assessments, provided prompt information on recruitment for reporting purposes and integrated multiple linked research projects within one database. Seamless exporting of data to statistical programs for analysis was also enabled. This simple integrated approach facilitated efficient execution of a longitudinal study from recruitment to statistical analysis while maximising confidentiality and minimising resources required. This case study describes the development and design of a simple system which could be easily adapted for database management in hospital or clinic-based settings according to local requirements.

Impacts of fish oil replacement in Murray cod nutrition

Fish oil use in aquacultural feeds is an unsustainable practice. This study investigated the efficacy of vegetable oil inclusion on the growth, fatty acid composition and lipid metabolism of Murray cod. Results indicate that fish oil can be substituted only partially without compromising fish growth and final quality.

Fish oil replacement in starter, grow-out, and finishing feeds for farmed aquatic animals

As aquaculture production continues to grow, there will be an increased use of lipid resources (oils and fats) alternative to fish oil for feed production. The potential for the use of these alternatives varies depending on the feeds in which they are included according to the production phase of the animals to which they are being fed. In starter feeds, where rapid growth, high survival, and normal development are critical priorities, there will remain a need for the use of lipid resources high in omega-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFA). Fish in this starter phase have a critical requirement for the n-3 LC-PUFA docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), and fish oils remain the only cost-effective source of these nutrients in the volumes required. However, the greatest demand for lipids is in those diets for the grow-out phase. Most studies on alternative lipid use with animals in this part of the production phase show positive outcomes, in that there are few studies where all the added fish oil cannot be replaced. There are some species, however, where potential replacement levels are suggested to be more conservative, and a general substitution level in this production phase of 75% has been suggested. One of the key effects noted across the grow-out phase is that all alternatives affect the flesh fatty acid characteristics by reducing the level of n-3 LC-PUFA. This issue has provoked the concept of finisher diets, whereby a high n-3 LC-PUFA content diet is fed in order to restore the desired meat fatty acid profiles. Studies examining this concept have found that the tissue triacylglycerol fatty acids were greatly modified and responded in a simple dilution process to the added oil fatty acid composition, whereas the fatty acids of tissue phospholipids were less influenced by dietary fatty acid makeup.

Bone mineral density and incidence of hip fracture in Swedish urban and rural women 1987–2002

Background and purpose Although the incidence of hip fracture during the past 50 years has increased, a break in this trend has been reported in the last decade. Whether this change is attributable to changes in bone mineral density (BMD) or whether it varies between urban and rural regions is unknown.

Methods We evaluated changes in annual hip fracture incidence in women aged ≥ 50 years in one urban population (n = 51,757) and one rural population (n = 26,446) from 1987 to 2002. We also examined secular differences in BMD (mg/cm2), evaluated by single-photon absorptiometry at the distal radius, prevalence of osteoporosis, and several other risk factors for hip fracture in one population-based sample of urban women and one sample of rural women aged 50–80 years at two time points: 1988/89 (n = 257 and n = 180, respectively) and 1998/99 (n = 171 and n = 118, respectively).

Results No statistically significant changes were evident in annual age-adjusted hip fracture incidence per 104 when analyzing all women (–0.01 per year (95% CI: –0.37, 0.35)), rural women (–0.38 per year (-1.05, 0.28)), or urban women (0.19 per year (–0.28, 0.67)). BMD (expressed as T-score) was similar in 1988/99 and 1998/99 when analyzing all women (–0.09 (–0.26, 0.09)), urban women (–0.04 (–0.27, 0.19)), or rural women (–0.15 (–0.42, 0.13)) women.

Interpretation Since no changes in age-adjusted hip fracture incidence and no differences in BMD were found during the study period, changes evident in the other risk factors for hip fracture that we investigated (such as gait velocity and balance) are either of minor importance or are counteracted by changes in other risk factors.

Replacement of RNA hairpins by in vitro selected tetranucleotides

An in vitro selection method based on the autolytic cleavage of yeast tRNAPhe by Pb2+ was applied to obtain tRNA derivatives with the anticodon hairpin replaced by four single-stranded nucleotides. Based on the rates of the site-specific cleavage by Pb2+ and the presence of a specific UV-induced crosslink, certain tetranucieotide sequences allow proper folding of the rest of the tRNA molecule, wheras others do not. One such successful tetramer sequence was also used to replace the acceptor stem of yeast tRNAPhe and the anticodon hairpin of E.coli tRNAPhe without disrupting folding. These experiments suggest that certain tetramers may be able to replace structurally non essential hairpins in any RNA.