Variability of cortisol assays can confound the diagnosis of adrenal insufficiency in the critically ill population

Objective: To compare the total plasma cortisol values obtained from three widely used immunoassays and a high pressure liquid chromatography (HPLC) technique on samples obtained from patients with sepsis. Design and setting: Observational interventional in the general intensive care unit of a metropolitan hospital. Patients and participants: Patients admitted to the intensive care unit with a diagnosis of sepsis and fulfilling criteria of systemic inflammatory response syndrome. Interventions: Standard short synacthen test performed with 250 mu g cosyntropin. Measurements and results: Two of the three immunoassays returned results significantly higher than those obtained by HPLC: Immulite by 95% (95%CI 31-188%) and TDx by 79% (21-165%). The limits of agreement for all three immunoassays with HPLC ranged from -62% to 770%. In addition, by classifying the patients into responders and non-responders to ACTH by standard criteria there was concordance in all assays in only 44% of patients. Conclusions: Immunoassay estimation of total plasma cortisol in septic patients shows wide assay related variation that may have significant impact in the diagnosis of relative adrenal insufficiency.

Brisbane Airport: An alluvial landscape veiled by marine sediments

At Brisbane Airport, the construction of a diversion channel for Kedron Brook exposed a former beach, low cliff and sand spit, which, with their associated sediments and acid sulfate soils, demonstrate a postglacial high sea-level 1.3 - 1.4 m above present mean sea-level. The beach appears to date from 4000 to 5000 y BP. It varies in level where it lies above soft ground; these variations, and sag depressions that follow buried streamlines, indicate sediment consolidation since withdrawal of the sea from the former shore. Most of the area consists of former estuarine deposits, mangrove and saline marshes, and stranded tidal flats on which acid sulfate soils are widely developed. The modern landforms mostly reproduce subsurface features, to the extent that the surface relief replicates the landscape transgressed by the sea 7000 years ago. A small rise of sea-level possibly to +0.65 m occurred about 2000-3000 years ago. Foredunes near the present shore that are related to a slightly lower level 1000 - 500 years ago (-0.25 m) are currently subject to wave erosion.

Using distributions as statistical evidence in well-structured and ill-structured problems

Research has suggested that understanding in well-structured settings often does not transfer to the everyday, less-structured problems encountered outside of school. Little is known, beyond anecdotal evidence, about how teachers' consideration of distributions as evidence in well-structured settings compares with their use in ill-structured problem contexts. A qualitative study of preservice secondary teachers examined their use of distributions as evidence in four tasks of varying complexity and ill-structuredness. Results suggest that teachers' incorporation of distributions in well-structured settings does not imply that they will be incorporated in less structured problems (and vice-versa). Implications for research and teaching are discussed.