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Study the Label Pediatric weight-based dosing errors

Whose scale do you trust?

A mAgAZine And ReFeRenCe TOOL FOR The heALTh indusTRy / sPRing 2009 • issue 1 • vOL. 1

This issue

In the Eyes of the Beholder

Study the Label Pediatric weight-based dosing errors

Rice Lake makes rounds

Whose scale do you trust?

Our day at the Zoo

Rapid weight gain is a marker for heart failure

In Search of the Perfect Pig

More Scale Talk from Joe

RICE LAKE mAgAzInE SPRING 2009 • health ISSue 1 • Vol. 1

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going green? if so, then receive the Rice Lake Magazine online. you’ll receive the same great stories and all the informative product details you enjoy with the printed version, but with electronic access to the maga-zine you can easily share it with employees and customers.

To Subscribe:

go to www.ricelake.com/ricelakemagazine.

Complete the online form.

it’s that easy. if you have any questions, please feel free to email us at rlmagazine@ricelake.com.

RICE LAKEONLINE MAGAZINE

Katy madden editor

Kristina Zengaffinen Art director

Caleb Olson Reporter

Welcome to the first issue of Rice Lake magazine dedicated to caregivers. In these pages you’ll find stories and information about healthy weight and the importance of accurate weighing. We hope you find this publication informative and interesting.

Rice Lake Weighing Systems is a family-owned, ISO 9001 Certified corporation and has been manufacturing and distributing weight-based measurement products and supplies since 1946. Our corporate headquarters, metrology laboratory and main manufacturing plant are in Rice Lake, Wisconsin. Additional manufacturing facilities are located in Jasper, Alabama, and Newtown, Connecticut.

Putting our customer first has made Rice Lake Weighing Systems the first choice of these industries the world over: bulk construction materials; chemical; food & beverage processing; timber, pulp & paper; manufacturing; packaging & material handling; pharmaceuticals; retail; supply chain management; transportation & logistics; utilities & waste.

Our goal is to be the first choice of the health industry as well.

Sincerely,

Mark O. Johnson President

gReeTings

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1990

1998

2007

15%-19%No Data < 10% 10%-14%20%-24% 25%-29% >30%

AverageWoman Barbie Store

Mannequin

Height 5'4" 6'0" 6'0"

Weight 145 lb 101 lb Not Available

Dress Size 11-14 4 6

Bust 36"-37" 39" 34"

Waist 29"-31" 19" 23"

Hips 40"-42" 33" 34"

Information from: ANRED: Anorexia Nervosa and Related Eating Disorders, Inc. Updated 1/16/2006

Heroic size evokes power and presence in some professions; in others the wisp rules the runway. What looks slim and elegant in one context looks asexual in others. Plumpness fetches marriage proposals in some cultures; in others, not so much. The “Rubenesque” figure is the ideal in the Islamic Republic of Mauritania.

Sharon LaFraniere reported in the International Herald Tribune (July 3, 2007):

In this patriarchal society many Mauritanian women do everything pos-sible to add flesh. Do not think in Western terms of watching the scale to add pounds. This is a ‘look’ mothers of marriageable daughters seek.

For decades, the Mauritanian version of a crash diet was a crash-feeding program, designed to create girls rounded enough to display family wealth and epitomize the Mauritanian ideal. Girls were forced to drink gallons of fat-rich camel’s or cow’s milk daily, aiming for silvery stretch marks on their upper arms. The practice was known as gavage, after the French technique of force-feeding geese to obtain foie gras.

A Mauritanian man blames men’s preferences partly on the brightly colored, head-to-toe mulafas that hide all but the most voluptuous female curves. ‘A slender woman,’ he said, ‘just looks like a stick wrapped up.’

A mother of five living in a small village carries nearly 90 kilograms, or 198 pounds, on her 1.5 meter, or 5-foot frame. Her weight makes her husband ‘very happy, of course,’ she said. But her daughters had to go on

a crash diet. ‘I took them to the cows and made them over drink and I overfed them, just a little bit, just so they could look like real Mauritanian girls. Forty days was enough to get them in the shape I wanted.’

Researchers have found a strong inverse correlation between a woman’s weight and her social and economic status (the higher the status, the lower the weight) in virtually all developed countries. When fast food is cheap and poor women are plump, then it is “in” to be thin.

The slim ideal is maintained by the high in status through diet and exercise. It is also encouraged by social mobility—slim women are more likely to “marry up,” or to marry men with higher social and economic status than their family of origin. Studies in the United States, Germany, and Britain find that upwardly mobile women are much slimmer than their counterparts who marry men of the same social class or lower.

Slim may be the ideal, even though it is not the rule. Mississippi is the plumpest state in the United States, with 32.6 percent of the population overweight. Rounding out the top five plumpest states are West Virginia, Alabama, Louisiana and South Carolina. Colorado remains the nation’s fittest state.

In a study of eating disorders in the United States, researchers found that it is growing among both men and women, and that binge-eating disorder is even more common than the better known anorexia nervosa and bulimia. The nationwide survey of more than 2,900 men and women found that 0.6 percent of the group has anorexia, 1 percent has bulimia and 2.8 percent has a binge-eating disorder.

Lifetime rates of the disorders, the researchers found, are higher in younger groups, suggesting that the problem is increasingly common. The study also reported that eating disorders are about twice as common among women as men.

When we think about those at risk for anorexia or bulimia, we visualize some impressionable adolescent girls, desperate for the razor-thin bodies seen in movies and magazines. But in recent years, psychologists across the country have noticed a rise in eating disorders among women in their 30s, 40s and 50s.

At the extreme ends of the human weight spectrum are those who are nearly held captive by excess flesh or fragile skeletal frames. The safety of these patients and the accuracy of their weighment often becomes a matter of life and death. ■

THE SPREAD OF AMERICA'S WAISTLINE

(BMI > 30, or about 30 lb overweight for 5'4" person)

Plump is Pretty Slim is SublimeOR

In the Eyes of the Beholder

vieWPOinT vieWPOinT

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Although children are prescribed medications in 30 to 50 percent of clinic visits, little is known about medication errors in ambulatory pediatrics. A recent study published by the National Library of Medicine found a number of poten-tial problems, including prescribing medication that is not labeled for use in children, discrepancies in published dosing recommendations for many medications, unclear guidelines on use of adult dosing recommendations for children of different ages and weights, and the lack of readily available docu-mented weights to determine appropri-ate weight-based doses for children.

Tenfold dosing errors in children can easily occur by misplacing a decimal point or by a trailing zero. For example, a 1.0 mg dose may be misread as a

10 mg dose and not recognized as an error by pharmacists as the 10 mg dose is still within the range of adult doses for the medication. In addition, health care providers must be aware of both pediatric dosing recommendations (to calculate a weight-based dose in mg/kg/day) and adult dosing recom-mendations (to ensure they do not exceed the maximum recommended adult dose in mg/day).

More is known about medication errors in hospitalized patients than in outpatient settings. Errors in medication ordering are the most common cause of preventable adverse drug events in hos-pitalized patients. In one adult study, half of all preventable adverse drug events occurred at the physician ordering stage, and the most common type of error was

in medication dosing. These errors occurred at a higher rate in children than in adults.

The Institute of Medicine (IOM) report on error in medicine dosing identified computerization as an important patient safety strategy. Computerized order entry, combined with advanced decision support systems, has been shown to reduce prescribing errors in hospital settings across many different drug classes.

The majority of outpatient settings do not currently use electronic prescription ordering or clinical decision support tools, and few studies have attempted to demonstrate the effectiveness of computerized prescription ordering on reducing medication errors and adverse drug events in ambulatory settings.

Published sources of pediatric dosing information differ in their recommendations for dosing ranges for children, sometimes by as much as a twofold difference in the maximum recommended dose. Furthermore, weight-based dosing often encompasses large ranges, sometimes as much as fourfold differences between the mini-mum and maximum recommended dose. Determining medication dosing errors in children is only possible with accurately documented weight in kilograms.

If a provider had meant to prescribe 25 mg/kg/day, but inadvertently calculat-ed the dose based on pounds instead of kilograms (thereby prescribing 2.2 times more medication than he or she meant to prescribe), potentially

Study the Label

Pediatric weight-basedd sing err rs

PediATRiCs

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Many medications that are used in children are most

appropriately prescribed by calculating a weight-based dose in total milligrams

per kilogram per day.

no error would be detected due to the fact that this dose would still fall well within the recommended range.

Many medications that are used for children are most appropriately pre-scribed by calculating a weight-based dose in total milligrams per kilogram

per day. In order to appropriately prescribe these medications, practitio-ners need an accurate weight. Ideally, weights would always be recorded in kilograms to avoid errors in con-verting pounds into kilograms when calculating medication doses; however, parents are often interested in their

child’s weight in pounds. In clinic visits, weights are therefore often measured and recorded in pounds in the medical record. Most retail pharmacies do not mandate inclusion of the child’s weight on written prescriptions, making it difficult for pharmacies to correctly determine if a weight-based dosing error has occurred.

Accurate weights matterThere is tremendous variation in normal weights for young children and extrapolation of a weight by age is likely to be inaccurate. In order to correctly prescribe medications, practitioners need an accurate weight. With that, they can provide the most effective dosage recommendations. ■

Clarence Zeros Out

Mistake #1Guessing WeightDosages are frequently based on weight rather than age, so know how much your child weighs. Age recommendations are only general guidelines. If a medicine has weight guidelines, use those instead.

Mistake #2Guessing DosageAlways give the exact dose recommended by the pediatrician. If a dosing cup, syringe or dropper is provided with the medicine, use it. Do not confuse tablespoons (Tbsp) and teaspoons (tsp). Use a measuring spoon rather than a kitchen spoon. When us-

ing a dropper, slowly squirt between cheek and teeth, where there are no taste buds and it is easier

to swallow.

Mistake #5Hiding MedicationsDo not hide medicine in food or drinks. The food or drink may affect how the medicine works, and your child may not get a full dose. Talk to your children about the importance of taking their medicines—and make sure they know to only take them with an adult present.

Mistake #6Not Calling Your PediatricianAsk your child’s pediatrician questions. Make sure the doctor is aware of all medicines your child is taking, including prescription and over-the-counter drugs.

Mistake #7Too Much TreatmentIf your child has a bad cough but is not sneezing, do not give medicine for sneezing. Cough and cold medicines may not work for young children, and they are not safe for children under two. Do not insist on antibiotics for every sore throat or ear infection—they only treat bacteria, not viruses. ■

Mistake #3Stopping MedicationsToo EarlyWhen medicines are prescribed for a specified period of time, give the full course—especially with antibiotics. Do not stop because your child is feeling better. That might make subsequent illnesses more difficult to treat. If you skip a dose, ask your pediatrician what to do.

Mistake #4Confusion About MedicationsFind out the purpose of each medicine, read the drug label carefully and make sure you understand it. Note the active ingredient in all the medications your child is taking. If several medications contain the same active ingredients, talk to your child’s pediatrician.

Medication Mistakes Parents Make

As long as standard units survive in an otherwise metric world, conversion problems are likely to continue. The Los Angeles Zoo lent Clarence, a 250-kilogram, 75-year-old Galapagos tortoise, to the Exotic Animal Training and Management Program at Moorpark College in Moorpark, California. The first night in his new home, Clarence wrecked it: “He just pushed one of the fence poles right over,” said Moorpark’s Chuck Brinkman in a February 9, 2001 Los Angeles Times story. The L. A. Zoo warned that Clarence was big and needed an enclosure for an animal weighing 250, so that is what the college built. Unfortunately, they assumed that the zoo meant 250 pounds, so the enclosure wasn’t adequate for holding 250-kilogram (or 550-pound) freedom-loving Clarence. ■

humOR & AdviCePediATRiCs

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Patty Thomsen, Coffey County Clinic office manager, and Joe Giglio, Rice Lake national health industry sales director

Angie Buckley, executive director of the Barron (WI) Area Community Center

Amy Andler, community health services liaison from the Cuyahoga County Board of Mental Retardation

Joe Giglio, Rice Lake’s national direc-tor for the health industry, has 20 years of experience in working with health scales. He has traveled through China, Japan, France, Germany and the United States. For many years his travels took him through Rice Lake, Wisconsin. Little did Joe know that one day he would be working for Rice Lake to introduce the world-famous industrial scale manu-facturer to the health industry.

Joe admits the job is challenging, “Rice Lake is well known and respected in the industrial world. Rice Lake’s SURVIVOR® truck and track scales, industrial and laboratory scales and line of indicators are generally considered the best money can buy. No one can touch Rice Lake’s commitment to service. Breaking into the medical field requires us to transfer that reputation for quality and service to medi-cal equipment distributors and buyers.

“Rice Lake doesn’t have that brand rec-ognition in the health field, but these people know me. They know I represent products that can be trusted. I know what physicians and clinicians are looking for: dependability and

ease of use at a reasonable price. Once they learn of Rice Lake’s long history as the leader in weight-related technology, they’ll trust Rice Lake as well.

“I am very confident that Rice Lake will enjoy the same reputation for top quality and leading technology in the health field as they do in the industrial weighing industry. That’s why I’m here.” To learn more, visit Rice Lake’s new website: www.ricelake.com/health. ■

Rice Lake makes roundsMeet JoeBurlington, KansasPatty Thomsen, office manager at Coffey County Health System Physician Clinic in Burlington, says their old scale scared little kids. “It was an eyesore, big and black, and small children were afraid to get on it. It was inaccurate weighing heavier adults. I’d say, ‘Wow! You lost 20 pounds?’ I would ask them to get back on the scale, and it would show 20 pounds the other way. We also wanted to upgrade our baby scale. So I started researching on the Internet.”

Patty called Jeramy Jackson at Electronic Scale Systems Inc. in Kansas City and discovered she could afford to purchase several scales and stay on budget. Now the clinic has a new eye-level physician scale, handrail scale, wheelchair scale and baby scale.

“The scales are quick. I like that, especially with children. They can hang onto the handrails and that helps them stay still. These scales are a huge improvement over what we had.” ■

Salt Lake City, UtahMark Hastling, field service engineer for four dialysis centers in Utah, had originally purchased a dialysis scale through a medical supply company. But the scale did not hold up to the application. Weighing patients up to several hundred pounds in heavy di-alysis chairs caused the scale to break down and require constant service.

Mark says, “The scale teeter-tottered. It would be five kilos off from one section to another. We would have it repaired and it would break down again. When we contacted the scale manufacturer, they were not concerned and definitely not service oriented. I called Rice Lake, and Roger Kimber and Pete Gallegos came over the same day.”

Pete, general manager of Utah Scale Center in Salt Lake City notes, “The original scale was being marketed as a dialysis scale but the feet didn’t have lock nuts, so they couldn’t be locked, and there was no way we could add them. We installed a 42" x 36" Rough-Deck® HP with lockable feet connected to a Rice Lake IQ plus® 355 indicator, and added a custom chrome grab rail.”

Mark is happy with the Rice Lake solution. “It’s durable and accurate. It weighs in kilos or pounds. The cost was low. And Rice Lake stands behind it. That is very important to any clinic.” ■

Cleveland, OhioAmy Andler is a community health services liaison from the Cuyahoga County Board of Mental Retardation/ Developmental Disabilities. “We were using a portable wheelchair scale out in the hallway, and people had to get out of the chair so we could weigh the chair and then get back in to be weighed in their chair. Many of our clients are fragile or high risk. It was too much movement for them and inefficient for us.”

Tim Gunn, Ohio Counting Scale Inc., suggested installing a Rice Lake Rough-Deck® and attaching the 450-pound exam table to the deck. The 420i Indica-tor is hung on the wall. The motorized exam bed can be raised to a sitting posi-tion. Clients can transfer more safely and comfortably directly to the table for examination and weighment.

“Finding a way to measure a patient’s weight without having to juggle a wheelchair or reweigh the wheelchair has been very helpful to the team in our clinic.” ■

Barron, WisconsinIt seems surprising that a community of modest size, blessed with an abun-dance of natural lakes, should also possess a community center with a huge swimming pool, hot tub, aqua massage, tanning beds, a weight room, an aerobics room, racquetball courts, and an impressive theater where the local theatrical club stages plays.

It originally came as a gift that grew. In 1988, the Wallace H. Jerome Founda-tion Inc. offered a gift of $1,000,000 to the Barron community with a challenge to raise matching funds. The commu-nity matched and surpassed the Jerome gift and went on to fund the $2.65 million project.

Angie Buckley, executive director of the center, was not pleased with their original weighing equipment. “If people leaned a certain way, the weight fluctuated. Older people had to lean back to read their weight, and suddenly they weighed five pounds more or less. Thanks to Rice Lake Weighing Systems, we now have an accurate and modern scale!” ■

PeOPLe PeOPLe

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Most people determine their weight using a scale at a physician’s office, fitness center, or weight-loss center as scales found at these sites are generally considered to be more precise than their bathroom scales at home.

Although the National Institute of Standards and Technology (NIST) has established acceptable tolerance levels for Legal-for-Trade scales used for commercial purposes (diet centers offering pay-by-weight weight-loss programs), no standards have been established by NIST or the Joint Com-mission on Accreditation of Hospitals for scales used clinically in the care of patients. Despite the lack of scale regulation for patient care, a survey of physicians suggested, for clinical purposes, scales should be precise to 1 lb per 150 lb of body weight.

One study that examined scales used by patients at a hospital concluded that many were “too inaccurate for optimal patient care.”

Of the 97 scales examined in the hospital, 62 percent would have failed to meet the NIST criteria, and 22 percent would have failed to meet the physician-imposed standards.

Another study was conducted to compare the precision of scales in physicians’ offices, fitness centers and weight-loss centers. Assessments were completed on a total of 223 scales: 94 from primary care clinics, 32 from diabetology/endocrinology clinics, 39 from weight-loss centers, and 58 from fitness centers. Scales were assessed for condition, location in facility, resting surface, and calibration history.

Relatively large inaccuracies were found at all weight levels and at all

locations in the sites. For example, at one pri-

mary care office using a 250 lb test weight, a 17.5 lb imprecision was

noted. Scales found in women’s locker rooms provided the only consistent under-estimations of weight.

A significant proportion of the scales were highly imprecise, particularly at higher weight levels. For example, at the 250 lb test weight, nearly 21 percent of the scales were off by more than 6 lb, or approximately 1 body mass index unit. Even for the 100 lb test, more than 25 percent of the measurements were off by 2 lb or more.

Scale precision was significantly related to scale location. Scales located in men’s locker rooms (typically in fitness centers) were more inexact than scales in other locations. The resting surface of the scale was significantly related to the precision of the scale. Tile surfaces produced the greatest imprecision, while carpeted surfaces produced the least measurement error, on average.

Not surprisingly, calibration of the scale in the past year resulted in scales with significantly more precise read-ings. Finally, weight-loss centers with a “pay-by-weight” distinction produced readings that were significantly more precise than other scales.

Physicians who are unaware of this source of variability in weight assess-ment would most likely assume that

a patient’s weight had changed signifi-cantly. If physicians were to assume, as in the case of heart failure, that the weight change was due to acute changes in volume status, diuretics might be inappropriately adjusted, potentially resulting in patient harm. Similar scenarios are possible in a range of settings and situations includ-ing obstetrics, pediatrics, and renal failure—all because patients were weighed on different scales on different occasions and physicians did not take into account this variability. ■

Whose scale do you trust?

A Comparison of scales Found in Physician Offices, Fitness Centers and Weight-Loss Centers

heALTh RePORT

The public health report concluded that many scales used to

measure body weight are imprecise and that scales

in health care settings are no more precise than those in other facilities. Clinical decisions based

on scales that are imprecise have the potential to cause complications

in patient care.

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Caleb Olson, reporter

When engineers at Rice Lake Weighing Systems designed the RoughDeck® series of floor scales, they set out to build something that could withstand demanding industrial abuse. Reckless forklift driving, incautious loading, and other common mistreatment scenarios were taken into account and precautions were built into the design, including welding a full 6 lb structural channel frame to a durable steel deck for increased rigidity.

Those engineers probably didn’t think a RoughDeck would be in a situation where a 486-pound silverback gorilla climbs to the highest point it can find and rockets himself down on the scale in a display of dominance. Reminiscent of a scene out of King Kong, this is one of the ways silverback gorillas at the Denver Zoo test the limits of Rice Lake’s RoughDeck.

The zoo is currently undergoing con-struction efforts to increase the quality of life for its impressive variety of ani-mals. The exhibits are being supersized and re-planned to provide a more natu-ral, open-air environment and minimize animal stress. New exhibits like the Asian Tropics are being planned. With these new and improved exhibits, scales are needed. Rice Lake RoughDecks are often being utilized for the medium- to large-sized animals including primates and lions and hyenas.

Why is it important to weigh animals at the zoo? The casual zoo visitor might think animal care is as simple as throwing a juicy T-bone steak into

the exhibit once a day and the rest will take care of itself. There is

much more science that goes into ensuring animal health.

BJ Schoeberl, curator of primates and carnivores

On LOCATiOn

at the Denver Zoo, explains “Just like in humans, monitoring weight helps in assessing proper diet amounts and health. We always try to keep our animals at optimum weights for their health and wellbeing. By monitoring weight, we can adjust diets to keep them at target body conditions.”

It turns out that animals are very simi-lar to humans in weight fluctuations – age, disease, pregnancy and change in activity levels are all contributing fac-tors to changes in weight. The animals’ diet is constantly being monitored and adjusted to compensate for these fluctuations. Exercise is also promoted by placing props, such as furniture-like platforms, ropes, and other enrichment items to encourage movement and make them “work” for food. Imagine if there were similar challenges for humans. Before getting one’s dinner, one would have to climb and swing from ropes rather than slowly inch one’s car through a drive-thru. Instead of a bacon double cheeseburger, one would be rewarded with healthy treats tailored to one’s current weight. Maybe the zoo is onto something!

If the health of an animal deteriorates because something is wrong (rather than natural factors such as old age), there is no way for them to vocalize how they feel. No Dr. Dolittle exists to translate between animals and humans. If they are depressed, anxious or sick, eating habits are often the first to change. This is their way of sending a message. Obtaining accurate weight readings are the most effective means of reading these messages this side of an animal psychic. The weights are then used to determine daily food in-take and, if needed, proper medication dosage. Getting that weighment is sometimes a challenge in itself.

Primates are smart…very smart. One look into their expressive eyes and you can tell there is more going on behind them than in most other animals. With proper incentive (applesauce, sugar-free juice, pudding, gelatin des-sert, raisins, nuts, grapes, or uncooked pasta), primates can be trained to do Photo Credit: David Parsons/Denver Zoo

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On LOCATiOn

anything, including standing on a scale. While a giant handful of uncooked pasta might not seem like the most appealing treat, if your typical daily diet consisted of a mixture of 18 pounds of primate chow and leafy greens, those crunchy macaroni noodles would suddenly look pretty good and you might be willing to stand on a scale for a few seconds to get a snack.

While their intelligence makes training easier, it is also a double-edged sword. Because the animals are so curious, they often want to monkey with the scale.

They see something interesting and want to investigate. Powerful gorilla fingers can easily turn bolts. Primates’ social awareness introduces another unique challenge. In the animal world, position in one’s pack is an important element of who one is. Especially for a leader, it is important to demonstrate alpha skills and weighing time provides the perfect opportunity to show off. “Displays are a big part of male gorilla behavior,” said BJ Schoeberl. “During display behavior, they are usually inter-

ested in making a big visual impression on whomever is watching, so the louder and bigger the actions are, the more impressive the display. They jump, bang and hit objects, including cage furniture. Sometimes the scale takes the brunt of these displays.”

One look at a silverback gorilla and it’s clear these are strong animals. Their bodies are reminiscent of a post-year-2000 Barry Bonds (plus a lot of hair), with muscles on top of muscles. One can only imagine the force being displaced on the surface of an 18" x 24" RoughDeck during an intimidating display of bashing, throwing, and jumping. Even though the heaviest gorilla is just shy of 500 pounds, 2200-pound load cells have been installed to help withstand the abuse. “Rice Lake load cells hold up incred-ibly well,” said Chad Stedman, general manager of Colorado Scale Center, who installed and maintains the zoo’s Rice Lake equipment. “Even with the occasional gorilla climbing a ladder and jumping down on the scale, the RoughDeck and load cells have held up. Primates have even tried to pick up and bend the scale. The zoo has been very happy. Before we went to Rice Lake load cells, they were going through load cells pretty quickly. The perfor-mance has really moved the zoo over to Rice Lake. Performance is proof.”

The king of the jungle shows off while standing on a Rice Lake RoughDeck. Let’s hope he doesn’t start singing – a lion’s deafening roar can be heard for up to five miles away.

A bit of Africa in Colorado! Chad Stedman admires Predator Ridge, which mimics the lions’ natural environment.

Of all the scales at the zoo (all animals are weighed at regular intervals), many require routine maintenance or frequent replacement. The Rice Lake RoughDecks are under some of the most abusive conditions yet require only occasional maintenance.

A longtime animal lover and regular zoo visitor even before the installations, Chad relished the opportunity to install Rice Lake scales at the Denver Zoo. “It was exciting to see areas that are usually

off-limits to visitors,” Chad said. “I was happy to install the RoughDecks for them because I knew they would hold up better than any other scale.” Animal weighments normally are done in a special room where the animals are not visually exposed. This helps reduce anxiety on the more social species like primates. However, some species are not as sensitive to onlookers.

The zoo’s Predator Ridge exhibit is a world-class, large, open-air environ-ment mimicking a natural setting for the pride of lions who live there. Ten-foot-tall mounds were constructed so the lions can be “king of the hill” and get a lay of the land. Selected rocks are electronically wired for heat, providing a premiere napping locale. Nearby animals are rotated, stimulating the lions’ olfactory sense just as it would in the wild. Making the animals feel more at home is an effort to decrease the stress of captivity and increase their overall health.

Continued on page 20

The weekly lion weighing has been transformed into a public experience.

Photo Credit: David Parsons/Denver Zoo

Photo Credit: David Parsons/Denver Zoo

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Rapid weight gain is a marker for heart failureRice Lake, Wisconsin

Teresa Simpson, director of nursing at Heritage Manor in Rice Lake, pointed out a surprising benefit of their new chair scale: “It’s quiet! I suppose because it is so well constructed. When you are weighing residents at 6 A.M. you don’t want to go clanging down the hallways. Our old scale was so loud to transport, plus it was inaccurate at higher weights.”

Silence is not the only virtue. Teresa reports, “It’s easy to transport and keep clean, and it’s rechargeable. It has really streamlined the whole weighing pro-cess.” Streamlining the process makes life easier all around. There are 90 residents at Heritage Manor. Most are weighed weekly, some daily, and others may be weighed three times a week to monitor fluid retention.

According to an American Heart Association report, weight gain is a marker of heart failure decompen-sation. In a recent study, data was collected over an 18-month period from 134 case patients with a heart failure hospitalization, and 134 control patients without a heart failure hospi-talization. Patients were weighed at the same time each morning after urinat-ing, before eating or drinking, and wearing the same amount of clothing. Any weight gain of at least five pounds during the course of three days prompted a change in therapy or other appropriate action.

Why? Because the study showed that clinically important increases in body weight begin at least one week before hospitalization for heart failure. Moreover, during this time period,

the risk of heart failure hospitalization increases with increasing amounts of weight gain. In contrast, weight gain was not observed before hospitaliza-tion for causes other than heart failure. The study represents basic clinical re-search that generates evidence to guide decision making for surveillance of weights in patients with heart failure.

geRiATRiCs

In addition to weight gain, patients with heart failure may experience a range of other symptoms, includ-ing shortness of breath, fatigue, and leg swelling. Future studies will be needed that focus on the relationships between these symptoms and body weight fluctuations as they relate to heart failure. ■

Teresa Simpson, director of nursing at Heritage Manor in Rice Lake

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Modern agricultural operations that raise livestock for food and animal products must have precision weighing equipment to measure and promote optimal animal wellbeing from start to finish. Mosdal Scale Systems Inc., in Broadview, Montana, has been manufacturing custom-designed feed-ing and weighing equipment since 1976 and they have been a Rice Lake custom-er for more than two decades.

Thelmer Mosdal was in the hog busi-ness when he built his own feed cart because nothing was available that met his standards. Then he built one for his neighbor (still in working condition three decades later). Soon Thelmer sold the hogs to concentrate on feed carts. Toward that goal, he built his own metal shear, ironworker, hydraulic leaf brake, pipe bender, roller, band saw, and press brake (still in working condition).

At the heart of Mosdal Scale’s success stands Grace Mosdal, Thelmer’s wife, business partner, sales director, public relations director, office manager, and baker of cinnamon buns. She smiles to remember all the scale systems that were designed at their big round kitchen table. “We designed a hanging scale to weigh penguins in Antarctica for a University of California research project,” she recalls while serving cof-fee and homemade cinnamon buns.

After growing up working with his grandfather in the shop, Jarred Mosdal, a mechanical engineer, has taken over the business. “Today our feed systems are being used in China, Holland, Eng-land, Brazil, Australia, Mexico, Canada, and at least 40 different states.

“One of our feed systems saved a big food processor a million dollars

compared to a competing system. A research facility in Iowa figures with our equipment, they can cut costs by 25¢ per hog per year; saving more than enough to support their entire research farm.

“In the beginning we used the Rice Lake 310 indicator that ran on a special bat-tery. Our indicator of choice today is the IQ plus® 390-DC. Customers love it. It runs on standard C batteries. The

stainless steel enclosure can be washed down. It has a big display that is easy to see in a dusty, dark barn. And the three-stage digital filtering feature (RATTLETRAP®) and LiveWeigh® op-tion gives you an accurate weight even if there is vibration or animal motion.”

To see some Mosdal equipment in use, we visited two swine research facili-

ties in Lafayette, Indiana—at Purdue University Department of Animal Sciences, where swine nutrition trials are run, and at the Hickory Ridge Research & Consulting facility, where swine pharmaceutical trials are con-ducted for a private company.

In Search of thePerfect PigWeight counts, but manners matter. OEM Mosdal Scale builds custom equipment to measure perfection.

The Science of SniffAccording to the National Pork Produc-ers Council, currently there are more than 67,000 pork operations, a fraction of the nearly three million hog farms that punctuated the roadsides in the 1950s. However, the majority of these

(53 percent) now produce 5,000 or more pigs per year. Not only are there fewer hog farms, there is far less farmland as communities make their claim for hous-ing and golf courses. Not surprisingly, when the wind blows in the direction of those neighbors, complaints can be

heard all the way to city hall. Lawsuits and government regulations have forced the swine industry to address what is “blowin’ in the wind.”

Continued on page 21

Jarred Mosdal of Mosdal Scale Systems still uses the tools his grandfather built to create custom equipment for modern agricultural operations.

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Our Day at the Zoo · Continued from page 14

The weekly lion weighing has been transformed into a public experience because, unlike the primates, cats don’t seem to mind human observation.

A special apparatus was created for this task that uses Rice Lake’s IQ plus® 355 digital weight indicator and a RoughDeck floor scale. “The lions are trained to get on the scale and perform other behaviors for the keepers as part of the public demonstration,” said BJ Schoeberl. “This is one of the most popular demonstrations at the zoo!” The IQ plus 355 indicator is an ideal choice because its large bright LED display makes it easy for spectators to see the lion’s weight (approximately 430 pounds for the males and 285 pounds for the females). Its digital filtering capability also allows for an accurate weight reading despite move-ment on the scale.

Going GreenAs the Denver Zoo is planning for the future with their exhibit remodel-ing and additions, another important green project is underway as well.

With the increased concerns about global climate change and the role that years of industrial development has played in increasing pollution, the zoo, like most organizations, is searching for environmentally friendly solu-tions. One of the main contributors to increasing pollution is the overwhelm-ing use of plastic. It’s cheap, relatively strong, and moldable to virtually any shape; however, plastic doesn’t bio-degrade. Instead, it disintegrates into increasingly smaller particles. So, where do these plastic particles end up? Often, it’s in the ocean.

Right now, there is an area of the Pacific Ocean between the coast of California and Hawaii that serves as a pooling station for non-biodegradable garbage from both the U.S. and Japan. The North Pacific Gyre collects this trash through a pattern of swirling ocean currents and deposits it in a central location known as “Garbage Island,” which has now blossomed to a size twice that of Texas. Unfortunately, the marine life in this area has a better chance of eating plastic particles than plankton. When that same marine life ends up on our dinner plates, we ingest chemicals thought to cause disease and

sterility—not exactly what we had in mind for a main course.

To stop the damaging effects on the environment and, in turn, our health, the Denver Zoo is doing its part. It has eliminated plastic and Styrofoam® containers in its cafeteria and conces-sion locations throughout the zoo. The garbage receptacles are color-coded by material for recycling purposes. The zoo is also going beyond a typi-cal recycling plan by mixing specific ingredients of human garbage and animal waste to create fuel through a gasification process.

Paul Quick, who is working on the gasification project, explains, “When the color-coded containers are picked up on a Jeep®, they’re weighed and identified so we know how much of each material is being acquired. We use a mix of about 50-50 between animal waste and compostable materi-als. Then we shred and process it and reduce the moisture content to 15 or 20% so everything has a similar density. The downdraft gasification process is a controlled oxygen conver-sion, so instead of burning the waste, it is being forced to chemically break down inside of a chamber.

“When it breaks down, the waste gives off gases such as methane, hydrogen, and carbon monoxide. We then com-bust those gases in a combustion engine and capture the energy in a generator. In this process, a lot of heat is generated; 60 percent results in heat and 30 percent results in electricity, and only 10 percent is lost. Most combustion engines are only 20 to 25 percent efficient.”

For the new 10-acre Asian Tropics area that will feature abundant water exhibits, the waste-powered generator will run water circulation pumps, heat the build-ings, and provide hot pools for the el-ephants. “By controlling which materials enter the gasification process,” Paul said, “we’re able to achieve a more efficient output.” Monitoring the quantity of each ingredient entering the process is all done by weight, and Rice Lake load cells are being used for their durability.

The zoo has developed a customized press to extract moisture from animal waste, leaving a dry and combustible product. The waste is loaded into the press and a lever is pulled downward. As the waste is compacted, the mois-ture is removed. Four RL9000 TWM

Getting a “spot-on” weight reading is essential for determining proper food portions and medication dosage.

In Search of the Perfect Pig · Continued from page 19

Purdue University Department of Animal Sciences’ mission is to educate students and to research efficient and sustainable production of animal prod-ucts that optimizes animal wellbeing and promotes sound environmental practices. Associate professor, Brian Richert, Ph.D., is conducting nutrition trials to develop a diet that will lessen air emissions from large commercial hog-raising facilities. Dr. Richert ex-plains, “In the past, trials were conduct-ed using hogs at several different facili-ties, each being fed an experimental diet and measuring the air emissions at each facility and comparing those results. But that wasn’t very satisfactory because conditions were not identical at each facility. Each had different ventilation systems, different handlers and different methods used by the research teams.

“We built this research facility in 2004. This is called a ‘hotel-style’ facility. It has a large central hallway separat-ing 12 self-contained units housing 60 hogs each. The idea here is to raise hogs under the same roof and conditions, without co-mingling the atmosphere.”

Dr. Richert investigated several feed systems before he settled on the self-propelled Mosdal feed carts equipped with Rice Lake 390-DC indicators. “One of the possible solutions we looked at was using a feed kitchen and conveying the food to the separate rooms, but that would have co-min-gled the environment and also would have cost a great deal of money.

“Another solution was to feed the vari-ous diets from 50-pound bags brought to each unit. We feed 500 tons a year. That method would also be costly. The cost of the feed sacks alone would come

Mosdal teams the Rice Lake 390-DC to their custom equipment. The stainless steel enclosure can be washed down and the big display can be seen in dusty barns.

The twelve sets of hoppers contain custom feed formulas for each of the units, as well as for one control group.

Series stainless steel weigh modules are mounted in this press to give ac-curate data on how much usable waste is being collected.

Repurposing the zoo’s daily waste output into electricity and heat is an ideal example of how we can reduce

our impact on the environment. Using sustainable resources and creating plans that reuse waste may be the key to pre-venting Garbage Island from becoming Garbage Continent. ■Do you want to see the waste press in action? View this article online at www.ricelake.com/healthmag to watch the video.

“The idea is to raise hogs under the same roof and conditions,

without co-mingling the atmosphere.”Dr. Brian Richert, Ph.D., Purdue University

to $10,000 to $12,000 a year. The cost of the manpower and sore backs is also a big item. Kansas State University had a custom Mosdal Multi-Feed System that worked well for their operation, so we gave Jarred a call.” Dr. Richert figures the Mosdal system saves 50¢ per bag or a penny a pound.

Mosdal Scale Systems designed and built a system that includes 12 hoppers, each containing a custom diet and one containing a control diet. The custom hoppers can be loaded on a self-pro-pelled pallet jack equipped with a scale and Rice Lake 390 indicator. The hopper is tared and each group of hogs is fed the proper weight of custom diet. The “wall air” from each unit and manure pit emis-sion is piped to a computer room where it is sampled, analyzed and recorded.

Reductions in odor and gases often come at the expense of weight gain and other desired characteristics. So the research goes on to find cost-effective, growth-enhancing, efficiently digested swine nutrition. Masking agents, bacte-rial preparations, feed additives, chemi-cals, oxidation processes, air scrubbers, biofilters, and new ventilation systems continue to be studied.

We have to ask a silly question, “Why don’t you feed the hogs some Beano®?”

Dr. Richert smiles, “Actually that’s a good question. Of course Beano would not be cost effective. An enzyme would have to work on the undigested compounds

Continued on page 24

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WhAT's neW mediCAL WhAT's neW mediCAL

The Chair Scale is, of course, designed for patients who need to remain seated. This is a premium scale in every feature. The seat is upholstered to protect fragile skin and bones. The swing-up arms and optional fold-up footrest make it very safe and easy to transfer from chair to wheelchair. Movement compensation technology gives an accurate weight regardless of involuntary tremor. ■

The Mechanical Physician Scale is durable, accurate and easy to operate, move, and store. It features a dual die-cast beam for weighing up to 440 lb. Weight can be read from either the front or back. A removable slip-resistant base cover is easy to keep clean. Large rear wheels enhance por-tability. The standard height rod measures 24 to 84 inches. ■

Our Neonatal Scale is truly state-of-the-art. It combines high resolution accuracy to 1 gram and high speed with movement compensation technology, which is a must in any infant scale. ■

The Physician Eye-Level Scale is very popular with clinics, especially when floor space is at a premium. Even though it has a 550-pound capacity, it has a modern minimal-ist design. The scale features BMI, reweigh, and hold mode allowing the operator to lock measurement and transfer unsteady patients before recording weight. ■ The Digital Handrail Scale is ideal for ambulatory

patients who need additional support. The 700-pound capacity suits regular and bariatric patients. The nonskid platform and side rails not only facilitate accurate weigh-ing but give the patient a sense of security which is so important. It features advanced movement compensation technology and has two heavy-duty rear wheels. ■

The Veterinary Platform Scale is easy to use and clean. The stainless steel platform is protected by a removable nonslip durable rubber mat. The 6.5 foot cable allows the operator to position the scale on the floor and the display on a countertop. ■

MoreScale Talkfrom Joe

See video scale demos at www.ricelake.com/meddemos

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In Search of the Perfect Pig · Continued from page 21

of the particular diet being fed. Ways to reduce nutrient excretion creating the odors are needed. One strategy is mini-mizing nutrient excesses by more closely meeting the pig’s actual needs.”

So far, the Purdue University group has been able to reduce emissions by a breathtaking 40 percent. The results of the trials have been made public in re-ports, and the commercial feed industry has been able to apply the findings and reduce air emissions by 20 percent.

The Search for HealingThe brand new Hickory Ridge Research & Consulting Facility, West Lafayette, was our next stop. Here, owners and operators Dr. Karen (DVM) and David Lehe conduct swine trials for pharmaceutical companies. Dr. Lehe is a highly respected veterinarian in the field of swine medicine and is the principle investigator on the research trials run through the barn. David Lehe, Karen’s husband and partner, manages the day-to-day operations of the facility. David is a good hand with data collection and handles the management side of the business with the acumen acquired with his business degree.

Their facility is as clean as a hospital, so we need to “shower in” after

promising we’ve been “out of hogs” for at least three days to meet the stringent biosecurity requirements. The barn is populated with several pens of baby pigs for the pharmaceuti-cal trial they are running during our visit. The current trial is a disease challenge study, and the pigs are divided into three groups: Challenged/Untreated, Challenged/Treated, and Control (Unchallenged/Untreated). They can do a variety of studies in the research barn, including comparison studies of disease treatment and pre-vention, molecular discovery studies, post-approval studies investigating new uses for approved products, as well as growth studies. Dr. Lehe says, “At Hickory Ridge, the service we provide to our customers is generating and collecting data that they will use

“It is absolutely essential that we

have tools like the Mosdal pig scale

to generate accurate and reliable data.”

Dr. Karen Lehe, DVM, Hickory Ridge Research & Consulting

to sell their products. It is absolutely essential that we have tools like the Mosdal pig scale to generate accurate and reliable data.” ■

The “get set” stage—waiting for balances to stabilize—is history. This balance is set to go by a tuning fork when you are ready to go. This new “no waiting” technology is available for the first time in the TA Analytical Balance.To learn more, go to www.ricelake.com/NoWaiting

Owners and operators David and Dr. Karen (DVM) Lehe

230 W. Coleman Street Rice Lake WI 54868

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