Evidence-based practice and rehabilitation: occupational therapy in Australia and New Zealand experiences

Evidence-based practice has become the dominant paradigm in the delivery of rehabilitation programme. However, occupational therapists in Australia and New Zealand have been slow in making the transition to become evidence-based practitioners. Collaboration between the university/ tertiary institute and clinical setting is one way that clinicians can be assisted with incorporating research into their practice. Two case examples are presented outlining how collaborative practice can result in improved out.. comes for all concerned.

Early-Middle Jurassic stratigraphy of the Fortrose-Chaslands region, southernmost South Island, New Zealand

The 40 km of coastline from Fortrose to Chaslands Mistake (southeastern South Island, New Zealand) comprises sediments that are part of the Early-Middle Jurassic of the Murihiku Terrane. The sediments are dominantly fluvial with some marine beds and alluvial fan deposition, and display an evolution of fluvial style which progresses from perennial flow to seasonal flow. The McPhee Cove Conglomerate is a prominent unit to the north. It has been used to separate two formations which would otherwise, on inherent lithological grounds, be difficult to distinguish. This paper discusses several similar conglomerates which occur in the south, but which are separated from the type area of the McPhee Conglomerate by major tectonic disruption. Hence, the existing lithostratigraphic nomenclature to the north, including the McPhee Cove Conglomerate, cannot be simply extended southwards. The Fortrose-Chaslands area appears to consist of two tectonic blocks, the Slope Point Block and the Brothers Block, which are separated from each other and from the adjacent Papatowai Block by major strike faults (or fault zones). A change is proposed to the existing stratigraphy which involves recognising all terrestrial sediments as part of the False Island Formation. Four prominent clast-supported conglomerate horizons are named as members of the False Islet Formation: the White Head Conglomerate, Black Bluff Conglomerate. Hoiho Conglomerate, and Slope Point Conglomerate Members. The latter contains five named conglomerate beds.

Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units

Objective. To determine the population incidence and outcome of severe sepsis occurring in adult patients treated in Australian and New Zealand intensive care units (ICUs), and compare with recent retrospective estimates from the USA and UK. Design. Inception cohort study. Setting. Twenty-three closed multi-disciplinary ICUs of 21 hospitals (16 tertiary and 5 university affiliated) in Australia and New Zealand. Patients. A total of 5878 consecutive ICU admission episodes. Measurements and results. Main outcome measures were population-based incidence of severe sepsis, mortality at ICU discharge, mortality at 28 days after onset of severe sepsis, and mortality at hospital discharge. A total of 691 patients, 11.8 (95% confidence intervals 10.9-12.6) per 100 ICU admissions, were diagnosed with 752 episodes of severe sepsis. Site of infection was pulmonary in 50.3% of episodes and abdominal in 19.3% of episodes. The calculated incidence of severe sepsis in adults treated in Australian and New Zealand ICUs is 0.77 (0.76-0.79) per 1000 of population. 26.5% of patients with severe sepsis died in ICU, 32.4% died within 28 days of the diagnosis of severe sepsis and 37.5% died in hospital. Conclusion. In this prospective study, 11.8 patients per 100 ICU admissions were diagnosed with severe sepsis and the calculated annual incidence of severe sepsis in adult patients treated in Australian and New Zealand ICUs is 0.77 per 1000 of population. This figure for the population incidence falls in the lower range of recent estimates from retrospective studies in the U.S. and the U.K.

Australia and New Zealand applied linguistics (ANZAL): Taking stock

This paper reviews some emerging trends in applied linguistics in both Australia and New Zealand. It sketches the current scene of (selected) postgraduate applied linguistics programs in higher education and considers how various university programs define applied linguistics through the classes (titles) they have postgraduate students complete to be awarded a degree. Evidence of program requirements and topics reveal not only what applied linguistics generally entails, but offers insights into how applied linguistics is defined and practiced. Additionally, some of the salient research topics (titles) being published in the journals from the two countries' applied linguistics associations are sketched.

Speleothem master chronologies: combined Holocene O-18 and C-13 records from the North Island of New Zealand and their palaeoenvironmental interpretation

The stable isotope records of four stalagmites dated by 19 TIMS uranium series ages are combined to produce master chronologies for delta(18)O and delta(13)C The delta(18)O records display good overall coherence, but considerable variation in detail. Variability in the delta(13)C records is greater, but general trends can still be discerned. This implies that too fine an interpretation of the structure of individual isotopic records can be unreliable. Speleothem delta(18)O values are demonstrated to show a positive relationship with temperature by comparing trends with other proxy records, but also to respond negatively to rainfall amount. Speleothem delta(13)C is considered to be most influenced by rainfall. The postglacial thermal optimum occur-red around 10.8 ka BP, which is similar in timing to Antarctica but up to 2000 years earlier than most Northern Hemisphere sites. Increasingly negative delta(18)O values after 7.5 ka BP indicate that temperatures declined to a late mid-Holocene minimum centred around 3 ka BP, but more positive values followed to mark a warm peak about 750 years ago which coincided with the 'Mediaeval Warm Period' of Europe. Low 5110 values at 325 years BP suggest cooling coincident with the 'Little Ice Age'. A marked feature of the delta(13)C record is an asymmetric periodicity averaging c. 2250 years and amplitude of c. 1.9parts per thousand. It is concluded that this is mainly driven by waterbalance variations with negative swings representing particularly wet intervals. The 5110 record shows a higher-frequency cyclicity with a period of c. 500 years and an amplitude of c. 0.25 parts per thousand. This is most likely to be temperature-driven, but some swings may have been amplified by precipitation.

Classification of perinatal deaths: Development of the Australian and New Zealand classifications

Classifications of perinatal deaths have been undertaken for surveillance of causes of death, but also for auditing individual deaths to identify suboptimal care at any level, so that preventive strategies may be implemented. This paper describes the history and development of the paired obstetric and neonatal Perinatal Society of Australia and New Zealand (PSANZ) classifications in the context of other classifications. The PSANZ Perinatal Death Classification is based on obstetric antecedent factors that initiated the sequence of events leading to the death, and was developed largely from the Aberdeen and Whitfield classifications. The PSANZ Neonatal Death Classification is based on fetal and neonatal factors associated with the death. The classifications, accessible on the PSANZ website (http://www.psanz.org), have definitions and guidelines for use, a high level of agreement between classifiers, and are now being used in nearly all Australian states and New Zealand.

Comparison of the R-70 self-heating rate of New Zealand and Australian coals to Suggate rank parameter

Samples from New Zealand and Australia have been tested in an adiabatic oven to assess the effect of rank on the R-70 selfheating rate of coal. A non-linear relationship can be defined for coals from both countries using the revised Suggate rank (S-r) parameter. Subbituminous coals have the highest R-70 self-heating rate values, which are 20 times that of high volatile A bituminous coals on a dry mineral matter free basis (similar to 1 cf. 20 degrees C h(-1)). However, the moderating effects of moisture and mineral matter can reduce this difference to only 2-3 times for coal in-situ. (c) 2005 Elsevier B.V All rights reserved.

Australian and New Zealand practice in intensive care (ANZPIC II): Predictors of physician confidence to diagnose pneumonia and determine illness severity in ventilated patients

The manner in which elements of clinical history, physical examination and investigations influence subjectively assessed illness severity and outcome prediction is poorly understood. This study investigates the relationship between clinician and objectively assessed illness severity and the factors influencing clinician's diagnostic confidence and illness severity rating for ventilated patients with suspected pneumonia in the intensive care unit (ICU). A prospective study of fourteen ICUs included all ventilated admissions with a clinical diagnosis of pneumonia. Data collection included pneumonia type - community-acquired (CAP), hospital-acquired (HAP) and ventilator-associated (VAP), clinician determined illness severity (CDIS), diagnostic methods, clinical diagnostic confidence (CDC), microbiological isolates and antibiotic use. For 476 episodes of pneumonia (48% CAP, 24% HAP, 28% VAP), CDC was greatest for CAP (64% CAP, 50% HAP and 49% VAP, P < 0.01) or when pneumonia was considered life-threatening (84% high CDC, 13% medium CDC and 3% low CDC, P < 0.001). Life-threatening pneumonia was predicted by worsening gas exchange (OR 4.8, CI 95% 2.3-10.2, P < 0.001), clinical signs of consolidation (OR 2.0, CI 95% 1.2-3.2, P < 0.01) and the Sepsis-Related Organ Failure Assessment (SOFA) Score (OR 1.1, CI 95% 1.1-1.2, P < 0.001). Diagnostic confidence increased with CDIS (OR 163, CI 95% 8.4-31.4, P < 0.001), definite pathogen isolation (OR 3.3, CI 95% 2.0-5.6) and clinical signs of consolidation (OR 2.1, CI 95% 1.3-3.3, P = 0.001). Although the CDIS, SOFA Score and the Simplified Acute Physiologic Score (SAPS II) were all associated with mortality, the SAPS II Score was the best predictor of mortality (P = 0.02). Diagnostic confidence for pneumonia is moderate but increases with more classical presentations. A small set of clinical parameters influence subjective assessment. Objective assessment using SAPS II Scoring is a better predictor of mortality.

High resolution provenancing of long travelled dust deposited on the Southern Alps, New Zealand

On 7 February 2000 an atypical orange discolouration of snowfields in the central Southern Alps, New Zealand occurred following the passage of a cold front. Analysis of snow samples identified fine orangey-brown dust mixed with much coarser grey dust. Air parcel forward trajectories from dust sources in southern and central Australia, where dust storms were reported on 4 February 2000, were computed to identify the deposits source. Geochemical analyses of the dust deposit using 26 trace elements, unaffected by regional air pollution and gravitational sorting, indicate that 20% of the dust was sourced from western New South Wales, with 45% from the eastern Eyre Peninsula of South Australia and the remaining 35% was local New Zealand dust. This provenancing approach provides a spatial resolution of long travelled dust sourcing not previously achieved. (c) 2005 Elsevier B.V. All rights reserved.