Aeropalynology of Australian native arboreal species in Brisbane, Australia

The influence of meteorological parameters on airborne pollen of Australian native arboreal species was investigated in the sub-tropical city of Brisbane, Australia over the five-year period, June 1994–May 1999. Australian native arboreal pollen (ANAP), shed by taxa belonging to the families Cupressaceae, Casuarinaceae and Myrtaceae accounts for 18.4% of the total annual pollen count and is distributed in the atmosphere during the entire year with maximum loads restricted to the months May through November. Daily counts within the range 11–100 grains m–3 occurred over short intervals each year and were recorded on 100 days during the five-year sampling period. Total seasonal ANAP concentrations varied each year, with highest annual values measured for the family Cupressaceae, for which greater seasonal frequencies were shown to be related to pre-seasonal precipitation (r 2 = 0.76, p = 0.05). Seasonal start dates were near consistent for the Cupressaceae and Casuarinaceae. Myrtaceae start dates were variable and established to be directly related to lower average pre-seasonal maximum temperature (r 2 = 0.78, p = 0.04). Associations between daily ANAP loads and weather parameters showed that densities of airborne Cupressaceae and Casuarinaceae pollen were negatively correlated with maximum temperature (p < 0.0001), minimum temperature (p < 0.0001) and precipitation (p < 0.05), whereas associations with daily Myrtaceae pollen counts were not statistically significant. This is the first study to be conducted in Australia that has assessed the relationships between weather parameters and the airborne distribution of pollen emitted by Australian native arboreal species. Pollen shed by Australian native Cupressaceae, Casuarinaceae and Myrtaceae species are considered to be important aeroallergens overseas, however their significance as a sensitising source in Australia remains unclear and requires further investigation.

Are diagnosis specific outcome indicators based on administrative data useful in assessing quality of hospital care?

Background: Hospital performance reports based on administrative data should distinguish differences in quality of care between hospitals from case mix related variation and random error effects. A study was undertaken to determine which of 12 diagnosis-outcome indicators measured across all hospitals in one state had significant risk adjusted systematic ( or special cause) variation (SV) suggesting differences in quality of care. For those that did, we determined whether SV persists within hospital peer groups, whether indicator results correlate at the individual hospital level, and how many adverse outcomes would be avoided if all hospitals achieved indicator values equal to the best performing 20% of hospitals. Methods: All patients admitted during a 12 month period to 180 acute care hospitals in Queensland, Australia with heart failure (n = 5745), acute myocardial infarction ( AMI) ( n = 3427), or stroke ( n = 2955) were entered into the study. Outcomes comprised in-hospital deaths, long hospital stays, and 30 day readmissions. Regression models produced standardised, risk adjusted diagnosis specific outcome event ratios for each hospital. Systematic and random variation in ratio distributions for each indicator were then apportioned using hierarchical statistical models. Results: Only five of 12 (42%) diagnosis-outcome indicators showed significant SV across all hospitals ( long stays and same diagnosis readmissions for heart failure; in-hospital deaths and same diagnosis readmissions for AMI; and in-hospital deaths for stroke). Significant SV was only seen for two indicators within hospital peer groups ( same diagnosis readmissions for heart failure in tertiary hospitals and inhospital mortality for AMI in community hospitals). Only two pairs of indicators showed significant correlation. If all hospitals emulated the best performers, at least 20% of AMI and stroke deaths, heart failure long stays, and heart failure and AMI readmissions could be avoided. Conclusions: Diagnosis-outcome indicators based on administrative data require validation as markers of significant risk adjusted SV. Validated indicators allow quantification of realisable outcome benefits if all hospitals achieved best performer levels. The overall level of quality of care within single institutions cannot be inferred from the results of one or a few indicators.

Estimating disease likelihood: a case of rubbery figures

In diagnosis and prognosis, we should avoid intuitive “guesstimates” and seek a validated numerical aid

Factors influencing PRN medication use in nursing homes

Objective: To identify determinants of PRN ( as needed) drug use in nursing homes. Decisions about the use of these medications are made expressly by nursing home staff when general medical practitioners (GPs) prescribe medications for PRN use. Method: Cross-sectional drug use data were collected during a 7-day window from 13 Australian nursing homes. Information was collected on the size, staffing-mix, number of visiting GPs, number of medication rounds, and mortality rates in each nursing home. Resident specific measures collected included age, gender, length of stay, recent hospitalisation and care needs. Main outcome measures: The number of PRN orders prescribed per resident and the number of PRN doses given per week averaged over the number of PRN medications given at all in the seven-day period. Results: Approximately 35% of medications were prescribed for PRN use. Higher PRN use was found for residents with the lower care needs, recent hospitalisation and more frequent doses of regularly scheduled medications. With increasing length of stay, PRN medication orders initially increased then declined but the number of doses given declined from admission. While some resident-specific characteristics did influence PRN drug use, the key determinant for PRN medication orders was the specific nursing home in which a resident lived. Resident age and gender were not determinants of PRN drug use. Conclusion: The determinants of PRN drug use suggest that interventions to optimize PRN medications should target the care of individual residents, prescribing and the nursing home processes and policies that govern PRN drug use.

Central auditory processing and central auditory processing disorder: Fundamental questions and considerations

Despite several decades of research, neither clinicians nor academics can agree on a single definition of central auditory processing (CAP) or central auditory processing disorder (CAPD). This article considers why this is the case, and comments on the resulting implications for CAP assessment and CAPD rehabilitation in the clinic.

Assessment of volume depletion in children with malaria

Background The degree of volume depletion in severe malaria is currently unknown, although knowledge of fluid compartment volumes can guide therapy. To assist management of severely ill children, and to test the hypothesis that volume changes in fluid compartments reflect disease severity, we measured body compartment volumes in Gabonese children with malaria. Methods and Findings Total body water volume (TBW) and extracellular water volume (ECW) were estimated in children with severe or moderate malaria and in convalescence by tracer dilution with heavy water and bromide, respectively. Intracellular water volume (ICW) was derived from these parameters. Bioelectrical impedance analysis estimates of TBW and ECW were calibrated and bioelectrical impedance analysis measurements were taken daily against dilution methods, until discharge. Sixteen children had severe and 19 moderate malaria. Severe childhood malaria was associated with depletion of TBW (mean [SD] of 37 [33] ml/kg, or 6.7% [6.0%]) relative to measurement at discharge. This is defined as mild dehydration in other conditions. ECW measurements were normal on admission in children with severe malaria and did not rise in the first few days of admission. Volumes in different compartments (TBW, ECW, and ICW) were not related to hyperlactataemia or other clinical and laboratory markers of disease severity. Moderate malaria was not associated with a depletion of TBW. Conclusions Significant hypovolaemia does not exacerbate complications of severe or moderate malaria. As rapid rehydration of children with malaria may have risks, we suggest that fluid replacement regimens should aim to correct fluid losses over 12-24 h.

The effects of density on the growth and survival of different families of juvenile Penaeus japonicus Bate

Variations in the growth and survival of six families of juvenile (initial mean weight = 4.16 g) Penaeus japonicus were examined at two densities (48 and 144 individuals m(-2)) in a controlled laboratory experiment. Survival was very high throughout the experiment (95.4%), but differed significantly between densities and rearing tanks. Family, sex and family x density interaction did not significantly affect survival. Mean specific growth rate (SGR) of the shrimp was 18% faster at the low density (1.93 +/- 0.05% day(-1)) than at high density (1.64 +/- 0.03% day(-1)). However, there was a small but significant interaction between family and density indicating that growth of the families was not consistent at both densities. The inconsistent growth of the families across the two densities resulted in a change in the relative performance (ranking) of families at each density. Sex, rearing tank and rearing cage also affected growth of the shrimp. Mean SGR of the females (1.79 +/- 0.03% day(-1)) was 5% faster than males (1.70 +/- 0.03% day(-1)) when averaged across both densities. Shrimp grew significantly faster in rearing tank 3 than rearing tank 1 or 2 at both densities. Results of the present study suggest that family x density interaction could affect the efficiency of selection for growth if shrimp stocks produced from shrimp breeding programs are to be grown across a wide range of densities. Crown Copyright (C) 2004 Published by Elsevier B.V. All rights reserved.

The effects of body position on distortion-product Otoacoustic emission testing

Otoacoustic emissions are frequently acquired from patients in a variety of body positions aside from the standard, seated orientation. Yet little knowledge is available regarding whether these deviations will produce nonpathological changes to the clinical results obtained. The present study aimed to describe the effects of body position on the distortion-product otoacoustic emissions of 60 normal-hearing adults. With particular attention given to common clinical practice, the Otodynamics ILO292, and the measurement parameters of amplitude, signal-to-noise ratio, and noise were utilized. Significant position-related effects and interactions were revealed for all parameters. Specifically, stronger emissions in the mid frequencies and higher noise levels at the extreme low and high frequencies were produced by testing subjects while lying on their side compared with the seated position. Further analysis of body position effects on emissions is warranted, in order to determine the need for clinical application of position-dependent normative data.

Effects of Helicobacter pylori eradication among adults with intellectual disability

Background Compared to the general population, Helicobacter pylori infection is more common among adults with intellectual disability (ID) and is associated with greater levels of disability, maladaptive behaviour, and institutionalization. Little information exists about the effects of eradication therapy in this group, so we aimed to evaluate: (1) success of a standard H. pylori eradication protocol; (2) frequency of side-effects; and (3) impact of eradication on level of functional ability and maladaptive behaviour. Method A cohort of adults with ID underwent assessment of their levels of function and maladaptive behaviour, medical history, physical examination, and H. pylori testing using serology and faecal antigen tests. Some received standard H. pylori eradication therapy. Twelve months later, participants underwent repeat assessment, were grouped by change in H. pylori status and compared. Results Of 168 participants, 117 (70%) were currently infected with H. pylori at baseline, and 96 (82%) of the 117 were given standard H. pylori eradication therapy. The overall eradication rate was 61% but 31% reported side-effects. Institutional status of the participants, their level of behaviour or function, and number of comorbid medical conditions were not associated with failure of eradication. There were no statistically significant differences in level of behaviour or function, ferritin, or weight between the groups in whom H. pylori was eradicated or stayed positive. Conclusion Adults with ID have lower H. pylori eradication and higher side-effect rates than the general population. Levels of maladaptive behaviour and disability did not improve with eradication and thus greater levels of maladaptive behaviour or disability appear to be risk factors for, rather than consequences of, H. pylori infection.