Demand for hospital emergency departments : a conceptual understanding

BACKGROUND: Emergency departments (EDs) are critical to the management of acute illness and injury, and the provision of health system access. However, EDs have become increasingly congested due to increased demand, increased complexity of care and blocked access to ongoing care (access block). Congestion has clinical and organisational implications. This paper aims to describe the factors that appear to infl uence demand for ED services, and their interrelationships as the basis for further research into the role of private hospital EDs. DATA SOURCES: Multiple databases (PubMed, ProQuest, Academic Search Elite and Science Direct) and relevant journals were searched using terms related to EDs and emergency health needs. Literature pertaining to emergency department utilisation worldwide was identified, and articles selected for further examination on the basis of their relevance and significance to ED demand. RESULTS: Factors influencing ED demand can be categorized into those describing the health needs of the patients, those predisposing a patient to seeking help, and those relating to policy factors such as provision of services and insurance status. This paper describes the factors influencing ED presentations, and proposes a novel conceptual map of their interrelationship. CONCLUSION: This review has explored the factors contributing to the growing demand for ED care, the influence these factors have on ED demand, and their interrelationships depicted in the conceptual model.

A fragment of the LG3 peptide of endorepellin is present in the urine of physically active mining workers : a potential marker of physical activity

Biomarker analysis has been implemented in sports research in an attempt to monitor the effects of exertion and fatigue in athletes. This study proposed that while such biomarkers may be useful for monitoring injury risk in workers, proteomic approaches might also be utilised to identify novel exertion or injury markers. We found that urinary urea and cortisol levels were significantly elevated in mining workers following a 12 hour overnight shift. These levels failed to return to baseline over 24h in the more active maintenance crew compared to truck drivers (operators) suggesting a lack of recovery between shifts. Use of a SELDI-TOF MS approach to detect novel exertion or injury markers revealed a spectral feature which was associated with workers in both work categories who were engaged in higher levels of physical activity. This feature was identified as the LG3 peptide, a C-terminal fragment of the anti-angiogenic / anti-tumourigenic protein endorepellin. This finding suggests that urinary LG3 peptide may be a biomarker of physical activity. It is also possible that the activity mediated release of LG3 / endorepellin into the circulation may represent a biological mechanism for the known inverse association between physical activity and cancer risk / survival.

The Corio Oval tribe: Geelong Football Club in colonial times

Geelong, Victoria’s second city, has an AFL football club whose culture and identity is closely tied to the city itself. An analysis of its playing group for the colonial period demonstrates that this local tribalism began early. As football became professionalised towards the end of the nineteenth century, country Victoria lost power in relative terms to metropolitan Melbourne: for example, Ballarat’s three main clubs lost their senior status. But Geelong, with its one remaining senior club, prospered and was admitted to the VFL ranks in 1897. The Geelong players were the sons and nephews of the Western District squattocracy and so had access to networks of power and influence. Many attended the prestigious Geelong Grammar School and the worthy Geelong College (in surprisingly equal numbers). They pursued careers both on the land and in professional roles, and maintained the social connections they had built through the club and other local institutions. Despite their elite standing, however, they continued to be regarded by the supporter base as an embodiment of the city and a defence against the city’s Melbourne critics that Geelong was a mere ‘sleepy hollow’.

Cryotherapy and joint position sense in healthy participants: a systematic review

Objective: To (1) search the English-language literature for original research addressing the effect of cryotherapy on joint position sense (JPS) and (2) make recommendations regarding how soon healthy athletes can safely return to participation after cryotherapy. Data Sources: We performed an exhaustive search for original research using the AMED, CINAHL, MEDLINE, and SportDiscus databases from 1973 to 2009 to gather information on cryotherapy and JPS. Key words used were cryotherapy and proprioception, cryotherapy and joint position sense, cryotherapy, and proprioception. Study Selection: The inclusion criteria were (1) the literature was written in English, (2) participants were human, (3) an outcome measure included JPS, (4) participants were healthy, and (5) participants were tested immediately after a cryotherapy application to a joint. Data Extraction: The means and SDs of the JPS outcome measures were extracted and used to estimate the effect size (Cohen d) and associated 95% confidence intervals for comparisons of JPS before and after a cryotherapy treatment. The numbers, ages, and sexes of participants in all 7 selected studies were also extracted. Data Synthesis: The JPS was assessed in 3 joints: ankle (n 5 2), knee (n 5 3), and shoulder (n 5 2). The average effect size for the 7 included studies was modest, with effect sizes ranging from 20.08 to 1.17, with a positive number representing an increase in JPS error. The average methodologic score of the included studies was 5.4/10 (range, 5–6) on the Physiotherapy Evidence Database scale. Conclusions: Limited and equivocal evidence is available to address the effect of cryotherapy on proprioception in the form of JPS. Until further evidence is provided, clinicians should be cautious when returning individuals to tasks requiring components of proprioceptive input immediately after a cryotherapy treatment.

Agrobacterium-mediated transformation of indica rice cultivars using binary and superbinary vectors

The Agrobacterium-mediated transformation system was extended to two indica cultivars: a widely cultivated breeding line IR-64 and an elite basmati cultivar Karnal Local. Root tips and shoot tips of seedlings, and scutellar-calli derived from mature seeds showed high-efficiency Agrobacterium tumefaciens infection and stable transformation. In addition to the superbinary vector pTOK233 in Agrobacterium strain LBA4404, almost equally high levels of transformation were achieved with a relatively much smaller (13.1 kb) binary vector (pCAMBIA1301) in a supervirulent host strain AGL1. In both cases, as well as in both cultivars, while 60–90% of the infected explants produced calli resistant to the selectable agent hygromycin, 59–75% of such calli tested positive for GUS. A high level (400 μM) of acetosyringone in the preinduction medium for Agrobacterium and a higher level (500 μM) in the cocultivation medium was necessary for an enhancement in transformation frequency of the binary vector to levels comparable to a superbinary. Hygromycin-resistant calli could be produced from all the explants used. Transformants could be regenerated for both cultivars using the superbinary and binary vector, but only for calli of scutellar origin. In addition to the molecular confirmation of hpt and gus gene transfer and transcription, absence of gene sequences outside the transferred DNA (T-DNA) region confirmed absence of any long T-DNA transfer.

'Rebellion in the backland': discourse, truth and power

This article sets out to interpret the construction of truth discourse in the War of Canudos, through the classic 'Rebellion in the backland' by Euclides da Cunha. To enrich the research, the articles wrote by Cunha, while he was a war correspondent for the Estado de São Paulo newspaper, will be analyzed, too. Along with the text, the expression “truth-effects” designed by French philosopher Michel Foucault is being used. “Effects of truth” is an expression in reference to the idea of discourses being neither true nor false. In Os sertões, the effects of truth emerge from strategic power disputes amongst the Church, landowners, politicians and a seaside ruling elite that ignores the reality of the poor and forsaken hinterlands. Keywords: discourse, power, truth.

Virtually real : Suzanne Collins's the Hunger Games Trilogy

The Hunger Games trilogy by Suzanne Cololins deals with a dystopian future society in which a punitive ruling elite provide 'entertainment' for the masses in the form of mediatised 'games' featuring young people who must fight to kill one another until there is only one winner. The purpose of these games is to remind the populace of the power of the government and its ability to dispose of any who dare defy it. In acknowledging violent 'games' as virtual entertainments which can be used to political effect, Collins suggests that they possess a disturbing capacity to undermine ethical perspective on the human,the humane and the real. Drawing on Baudrillard's ideas about simulation and simulacra as well as Elaine Scarry's and Susan Sontag's concerns for media representations of the body in pain, this paper discusses the ways in which the texts highlight the dangers of virtual modes while also risking perpetuating their entertainment value.

Strategic planning in a non profit organistion : valuing the process

Non-profit organisations by their very nature are staffed by a variety of different people with a range of backgrounds, experiences and reasons for participation. These differences can lead to “distancing” of certain groups and with little time or money for boundary spanning the organisation can find itself in a fractured state that hampers not just its goal realisation, but its goal determination. Strategic planning is often seen as an expensive, time consuming process that many smaller non-profit organisations can little afford to indulge in. In addition, the ruling elite, whether historical or professional may view the process as unnecessary or threatening. However, strategic planning can offer processes and potential outcomes that non profit organisations can not afford to ignore. This paper provides an analysis through one case study involving a non-profit, health related organisation that moved through a process of strategic planning that ultimately encouraged development and group cohesion through goal identification and determination as well as strategy formulation. The results indicate the importance of valuing the strategic planning process itself rather than the form it takes. Challenging the rulership of the historical or professional elite can be difficult in a non-profit organisation, but diversity of involvement rather than uniformity proved to be a successful strategy. Organisational cohesion through consensus building was the ultimate outcome.

Attunement to haptic information helps skilled performers select implements for striking a ball in cricket

This study examined the perceptual attunement of relatively skilled individuals to physical properties of striking implements in the sport of cricket. We also sought to assess whether utilising bats of different physical properties influenced performance of a specific striking action: the front foot straight drive. Eleven, skilled male cricketers (mean age = 16.6 ± 0.3 years) from an elite school cricket development programme consented to participate in the study. Whist blindfolded, participants wielded six bats exhibiting different mass and moment of inertia (MOI) characteristics and were asked to identify their three most preferred bats for hitting a ball to a maximum distance by performing a front foot straight drive (a common shot in cricket). Next, participants actually attempted to hit balls projected from a ball machine using each of the six bat configurations to enable kinematic analysis of front foot straight drive performance with each implement. Results revealed that, on first choice, the two bats with the smallest mass and MOI values (1 and 2) were most preferred by almost two-thirds (63.7%) of the participants. Kinematic analysis of movement patterns revealed that bat velocity, step length and bat-ball contact position measures significantly differed between bats. Data revealed how skilled youth cricketers were attuned to the different bat characteristics and harnessed movement system degeneracy to perform this complex interceptive action.

Antioxidant supplementation reduces skeletal muscle mitochondrial biogenesis

Purpose: Exercise increases the production of reactive oxygen species (ROS) in skeletal muscle, and athletes often consume antioxidant supplements in the belief they will attenuate ROS-related muscle damage and fatigue during exercise. However, exercise-induced ROS may regulate beneficial skeletal muscle adaptations, such as increased mitochondrial biogenesis. We therefore investigated the effects of long-term antioxidant supplementation with vitamin E and alpha-lipoic acid on changes in markers of mitochondrial biogenesis in the skeletal muscle of exercise-trained and sedentary rats. Methods: Male Wistar rats were divided into four groups: 1) sedentary control diet, 2) sedentary antioxidant diet, 3) exercise control diet, and 4) exercise antioxidant diet. Animals ran on a treadmill 4 d.wk(-1) at similar to 70% V (over dot)O(2max) for up to 90 min.d(-1) for 14 wk. Results: Consistent with the augmentation of skeletal muscle mitochondrial biogenesis and antioxidant defenses, after training there were significant increases in peroxisome proliferator-activated receptor F coactivator 1 alpha (PGC-1 alpha) messenger RNA (mRNA) and protein, cytochrome C oxidase subunit IV (COX IV) and cytochrome C protein abundance, citrate synthase activity, Nfe2l2, and SOD2 protein (P < 0.05). Antioxidant supplementation reduced PGC-1 alpha mRNA, PGC-1 alpha and COX IV protein, and citrate synthase enzyme activity (P < 0.05) in both sedentary and exercise-trained rats. Conclusions: Vitamin E and alpha-lipoic acid supplementation suppresses skeletal muscle mitochondrial biogenesis, regardless of training status.

Thermoregulatory responses to ice-slush beverage ingestion and exercise in the heat

We compared the effects of an ice-slush beverage (ISB) and a cool liquid beverage (CLB) on cycling performance, changes in rectal temperature (T (re)) and stress responses in hot, humid conditions. Ten trained male cyclists/triathletes completed two exercise trials (75 min cycling at similar to 60% peak power output + 50 min seated recovery + 75% peak power output x 30 min performance trial) on separate occasions in 34A degrees C, 60% relative humidity. During the recovery phase before the performance trial, the athletes consumed either the ISB (mean +/- A SD -0.8 +/- A 0.1A degrees C) or the CLB (18.4 +/- A 0.5A degrees C). Performance time was not significantly different after consuming the ISB compared with the CLB (29.42 +/- A 2.07 min for ISB vs. 29.98 +/- A 3.07 min for CLB, P = 0.263). T (re) (37.0 +/- A 0.3A degrees C for ISB vs. 37.4 +/- A 0.2A degrees C for CLB, P = 0.001) and physiological strain index (0.2 +/- A 0.6 for ISB vs. 1.1 +/- A 0.9 for CLB, P = 0.009) were lower at the end of recovery and before the performance trial after ingestion of the ISB compared with the CLB. Mean thermal sensation was lower (P < 0.001) during recovery with the ISB compared with the CLB. Changes in plasma volume and the concentrations of blood variables (i.e., glucose, lactate, electrolytes, cortisol and catecholamines) were similar between the two trials. In conclusion, ingestion of ISB did not significantly alter exercise performance even though it significantly reduced pre-exercise T (re) compared with CLB. Irrespective of exercise performance outcomes, ingestion of ISB during recovery from exercise in hot humid environments is a practical and effective method for cooling athletes following exercise in hot environments.

Probiotics, immunity and exercise : a review

Nutritional practices that promote good health and optimal athletic performance are of interest to athletes, coaches, exercise scientists and dietitians. Probiotic supplements modulate the intestinal microbial flora and offer promise as a practical means of enhancing gut and immune function. The intestinal microbial flora consists of diverse bacterial species that inhabit the gastrointestinal tract. These bacteria are integral to the ontogeny and regulation of the immune system, protection of the body from injection, and maintenance of intestinal homeostasis. The interaction of the gut microbial flora with intestinal epithelial cells and immune cells exerts beneficial effects on the upper respiratory tract, skin and uro-genital tract. The capacity for probiotics to modulate perturbations in immune function after exercise highlight their potential for use in individuals exposed to high degrees of physical and environment stress. Future studies are required to address issues of dose-response in various exercise settings, the magnitude of species-specific effects, mechanisms of action and clinical outcomes in terms of health and performance.

Knee flexor strength and bicep femoris electromyographical activity is lower in previously strained hamstrings

The aim of this study was to determine if athletes with a history of hamstring strain injury display lower levels of surface EMG (sEMG) activity and median power frequency in the previously injured hamstring muscle during maximal voluntary contractions. Recreational athletes were recruited, 13 with a history of unilateral hamstring strain injury and 15 without prior injury. All athletes undertook isokinetic dynamometry testing of the knee flexors and sEMG assessment of the biceps femoris long head (BF) and medial hamstrings (MH) during concentric and eccentric contractions at ± 180 and ± 600.s-1. The knee flexors on the previously injured limb were weaker at all contraction speeds compared to the uninjured limb (+1800.s-1 p = 0.0036; +600.s-1 p = 0.0013; -600.s-1 p = 0.0007; -1800.s-1 p = 0.0007) whilst sEMG activity was only lower in the BF during eccentric contractions (-600.s-1 p = 0.0025; -1800.s-1 p = 0.0003). There were no between limb differences in MH sEMG activity or median power frequency from either BF or MH in the injured group. The uninjured group showed no between limb differences in any of the tested variables. Secondary analysis comparing the between limb difference in the injured and the uninjured groups, confirmed that previously injured hamstrings were mostly weaker (+1800.s-1 p = 0.2208; +600.s-1 p = 0.0379; -600.s-1 p = 0.0312; -1800.s-1 p = 0.0110) and that deficits in sEMG were confined to the BF during eccentric contractions (-600.s-1 p = 0.0542; -1800.s-1 p = 0.0473) Previously injured hamstrings were weaker and BF sEMG activity was lower than the contralateral uninjured hamstring. This has implications for hamstring strain injury prevention and rehabilitation which should consider altered neural function following hamstring strain injury.

Rate of torque and electromyographic development during anticipated eccentric contraction is lower in previously strained hamstrings

Background: Hamstring strain injuries are prevalent in sport and re-injury rates have been high for many years. Whilst much focus has centred on the impact of previous hamstring strain injury on maximal eccentric strength, high rates of torque development is also of interest, given the important role of the hamstrings during the terminal swing phase of running. The impact of prior strain injury on myoelectrical activity of the hamstrings during tasks requiring high rates of torque development has received little attention. Purpose: To determine if recreational athletes with a history of unilateral hamstring strain injury, who have returned to training and competition, will exhibit lower levels of myoelectrical activity during eccentric contraction, rate of torque development and impulse 30, 50 and 100ms after the onset of myoelectrical activity or torque development in the previously injured limb compared to the uninjured limb. Study design: Case-control study Methods: Twenty-six recreational athletes were recruited. Of these, 13 athletes had a history of unilateral hamstring strain injury (all confined to biceps femoris long head) and 13 had no history of hamstring strain injury. Following familiarisation, all athletes undertook isokinetic dynamometry testing and surface electromyography assessment of the biceps femoris long head and medial hamstrings during eccentric contractions at -60 and -1800.s-1. Results: In the injured limb of the injured group, compared to the contralateral uninjured limb rate of torque development and impulse was lower during -600.s-1 eccentric contractions at 50 (RTD, injured limb = 312.27 ± 191.78Nm.s-1 vs. uninjured limb = 518.54 ± 172.81Nm.s-1, p=0.008; IMP, injured limb = 0.73 ± 0.30 Nm.s vs. uninjured limb = 0.97 ± 0.23 Nm.s, p=0.005) and 100ms (RTD, injured limb = 280.03 ± 131.42Nm.s-1 vs. uninjured limb = 460.54.54 ± 152.94Nm.s-1,p=0.001; IMP, injured limb = 2.15 ± 0.89 Nm.s vs. uninjured limb = 3.07 ± 0.63 Nm.s, p<0.001) after the onset of contraction. Biceps femoris long head muscle activation was lower at 100ms at both contraction speeds (-600.s-1, normalised iEMG activity (x1000), injured limb = 26.25 ± 10.11 vs. uninjured limb 33.57 ± 8.29, p=0.009; -1800.s-1, normalised iEMG activity (x1000), injured limb = 31.16 ± 10.01 vs. uninjured limb 39.64 ± 8.36, p=0.009). Medial hamstring activation did not differ between limbs in the injured group. Comparisons in the uninjured group showed no significant between limbs difference for any variables. Conclusion: Previously injured hamstrings displayed lower rate of torque development and impulse during slow maximal eccentric contraction compared to the contralateral uninjured limb. Lower myoelectrical activity was confined to the biceps femoris long head. Regardless of whether these deficits are the cause of or the result of injury, these findings could have important implications for hamstring strain injury and re-injury. Particularly, given the importance of high levels of muscle activity to bring about specific muscular adaptations, lower levels of myoelectrical activity may limit the adaptive response to rehabilitation interventions and suggest greater attention be given to neural function of the knee flexors following hamstring strain injury.

The role of neuromuscular inhibition in hamstring strain injury recurrence

Hamstring strain injuries are amongst the most common and problematic injuries in a wide range of sports that involve high speed running. The comparatively high rate of hamstring injury recurrence is arguably the most concerning aspect of these injuries. A number of modifiable and nonmodifiable risk factors are proposed to predispose athletes to hamstring strains. Potentially, the persistence of risk factors and the development of maladaptations following injury may explain injury recurrence. Here, the role of neuromuscular inhibition following injury is discussed as a potential mechanism for several maladaptations associated with hamstring re-injury. These maladaptations include eccentric hamstring weakness, selective hamstring atrophy and shifts in the knee flexor torque-joint angle relationship. Current evidence indicates that athletes return to competition after hamstring injury having developed maladaptations that predispose them to further injury. When rehabilitating athletes to return to competition following hamstring strain injury, the role of neuromuscular inhibition in re-injury should be considered.