Communicating with nurses: the experiences of 10 individuals with an acquired severe communication impairment

Successful communication is integral to quality health care and successful nursing practice. Ten people who had been in hospital in the 12 months prior to the study and who had no functional speech at that time were interviewed about their communication experiences with nurses. Overall, these individuals experienced difficulties, some of which appeared to be related to a lack of augmentative and alternative communication (AAC) resources and a lack of knowledge of AAC among nurses. In addition, the participants noted that nurses did not always have the time or the skills to communicate effectively with them. The participants suggested strategies to improve communication interactions between patients with no or limited functional speech and nurses. These strategies include pre-admission briefing and training nurses about effective strategies for communicating with patients who are unable to speak, including the use of augmentative and alternative communication systems.

Nursing the patient with severe communication impairment

Background. Effective communication with patients is critical to effective nursing practice. Surprisingly, there is little information on nurses' experiences in caring for patients who are unable to speak. Purpose and method. This study provides descriptive information from interviews with 20 nurses who cared for patients with severe communication impairment. The interview protocol explored positive and negative experiences of nursing patients with severe communication impairment. Frequency counts and descriptive analyses were conducted to identify the major themes emerging from the interviews. Results. The results suggest that nurse-patient communication is difficult when the patient has severe communication impairment, although some nurses discovered effective strategies to facilitate communication with such patients. Many of the difficulties could be viewed as a breakdown in understanding arising from the lack of a readily interpretable communication system that could be used by nurse and patient. Conclusions. The results suggest a need for training nurses in the use of alternative modes of communication. Nurses also need access to a variety of simple augmentative communication devices for use with patients who are unable to speak. Finally, nurses should collaborate with speech pathologists on the development of preadmission information and bedside training for people who are admitted to hospital with severe communication impairment.

Association of early childhood abdominal circumference and weight gain with blood pressure at 36 months of age: secondary analysis of data from a prospective cohort study

To assess whether changes in measures of fat distribution and body size during early life are associated with blood pressure at 36 months of age.

Coronary heart disease risk in volunteer firefighters in Victoria, Australia

Coronary heart disease (CHD) is a major problem for firefighters, even when considering the healthy worker effect (HWE). Although volunteer firefighters outnumber paid personnel, previous research has focused on paid US firefighters. By contrast, no CHD data for Australian firefighters exist. Risk factor data were collected from 2,943 Australian volunteer firefighters and CHD risk was compared with reference "low-risk" and Australian population data. Predicted CHD risk for male and female firefighter was 19.2% and 5.1%, respectively. Female firefighters high blood pressure and fasting glucose was significantly lower than the general population, whereas all other risk factors was similar to the general population. Firefighters' CHD risk was greater than other volunteer and paid emergency services, but the prevalence for most risk factors was similar to the general population. Therefore, Australian volunteer firefighters may not benefit from the HWE.

Seagrass viviparous propagules as a potential long-distance dispersal mechanism

Resilience of seagrass meadows relies on the ability of seagrass to successfully recolonise denuded areas or disperse to new areas. While seed germination and rhizome extension have been explored as modes of recovery and expansion, the contribution of seagrass viviparous propagules to meadow population dynamics has received little attention. Here, we investigated the potential of seagrass viviparous propagules to act as dispersal vectors. We performed a series of density surveys, and in situ and mesocosm-based experiments in Port Phillip Bay, VIC, Australia, using Zostera nigricaulis, a species known to produce viviparous propagules. Production of viviparous propagules was higher at sites with high wind and current exposure, compared to more sheltered environments. A number of propagules remained buoyant and healthy for more than 85 days, suggesting the capacity for relatively long-distance dispersal. Transplanted propagules were found to have improved survivorship within seagrass habitats compared to bare sediment over the short term (4 weeks); however, all propagules suffered longer-term (<100 days) mortality in field experiments. Conditions outside of meadows, including sediment scouring, reduced the likelihood of successful colonisation in bare sediment. Furthermore, sediment characteristics within meadows, such as a smaller grain size and high organic content, positively influenced propagule establishment. This research provides preliminary evidence that propagules have the potential to act as an important long-distance dispersal vector, a process that has previously gone unrecognised. Even though successful establishment of propagules may be rare, viviparous propagules show great potential for seagrass populations given they are facing global decline. © 2014 Coastal and Estuarine Research Federation.

Denitrification measurements of sediments using cores and chambers

Denitrification is commonly measured using in situ benthic chambers or laboratory incubations of sediment cores. These techniques are similar in principle but differ considerably in cost and practicality. Despite widespread use of both techniques, it is uncertain whether they give comparable results. We compared cores and chambers for measuring fluxes (dissolved oxygen [DO], N 2, NH4+, NO3- and NO 2-) and denitrification efficiency at 2 sites in Port Phillip Bay, Victoria, Australia. Overall, denitrification efficiency was not significantly different between cores and chambers, but fluxes of DO, NO 3- and NO2- differed. Chambers demonstrated higher levels of oxygen consumption and net fluxes of NO 3- and NO2- out of the sediment, suggesting that denitrification and nitrification were closely coupled. In contrast, there was a greater relative importance for uncoupled denitrification in cores as indicated by reduced oxygen consumption and net fluxes of NO 3- into the sediment. We conclude that cores and chambers give different flux results and therefore are not comparable techniques for measuring denitrification. To ascertain the cause of this, we tested the hypothesis that cores failed to adequately incorporate the impacts of macrofauna on fluxes, due to the small size of cores relative to chambers. However, densities of macrofauna were not significantly different in cores and chambers. We then hypothesised that disturbance during core collection, transportation, and handling may account for differences, but cores deployed in situ and in the laboratory gave similar results. We suggest that compression of sediment during insertion of core cylinders into the sediment may account for differences between core and chamber fluxes.

Evolutionary biology of the invasive Northern Pacific seastar, Asterias amurensis

 Mark investigated the genetic basis of environmental adaptation in invasive and native A. amurensis larvae. He showed rapid changes in genetic architecture and gene expression underlie different physiological responses to elevated temperatures in invasive larvae. These findings are the first step in understanding the potential for range expansion within Australia.

The relative importance of spatial proximity, kin selection and potential ‘greenbeard’ signals on provisioning behaviour among helpers in a cooperative bird

© 2015 Springer-Verlag Berlin Heidelberg Many hypotheses have been proposed to account for cooperative behaviour, with those favouring kin selection receiving the greatest support to date. However, the importance of relatedness becomes less clear in complex societies where interactions can involve both kin and non-kin. To help clarify this, we examined the relative effect of indirect versus key direct benefit hypotheses in shaping cooperative decisions. We assessed the relative importance of likely reciprocal aid (as measured by spatial proximity between participants), kin selection (using molecular-based relatedness indices) and putative signals of relatedness (vocal similarity) on helper/helper cooperative provisioning dynamics in bell miners (Manorina melanophrys), a species living in large, complex societies. Using network analysis, we quantified the extent of shared provisioning (helping at the same nests) among individual helpers (excluding breeding pairs) over three seasons and 4290 provisioning visits, and compared these with the location of individuals within a colony and networks built using either genetic molecular relatedness or call similarity indices. Significant levels of clustering were observed in networks; individuals within a cluster were more closely related to each other than other colony members, and cluster membership was stable across years. The probability of a miner helping at another’s nest was not simply a product of spatial proximity and thus the potential for reciprocal aid. Networks constructed using helping data were significantly correlated to those built using molecular data in 5 of 10 comparisons, compared to 8 of 10 comparisons for networks constructed using call similarity. This suggests an important role of kinship in shaping helping dynamics in a complex cooperative society, apparently determined via an acoustic ‘greenbeard’ signal in this system.

Meropenem versus piperacillin-tazobactam for definitive treatment of bloodstream infections due to ceftriaxone non-susceptible Escherichia coli and Klebsiella spp (the MERINO trial): study protocol for a randomised controlled trial

BACKGROUND: Gram-negative bacteria such as Escherichia coli or Klebsiella spp. frequently cause bloodstream infections. There has been a worldwide increase in resistance in these species to antibiotics such as third generation cephalosporins, largely driven by the acquisition of extended-spectrum beta-lactamase or plasmid-mediated AmpC enzymes. Carbapenems have been considered the most effective therapy for serious infections caused by such resistant bacteria; however, increased use creates selection pressure for carbapenem resistance, an emerging threat arising predominantly from the dissemination of genes encoding carbapenemases. Recent retrospective data suggest that beta-lactam/beta-lactamase inhibitor combinations, such as piperacillin-tazobactam, may be non-inferior to carbapenems for the treatment of bloodstream infection caused by extended-spectrum beta-lactamase-producers, if susceptible in vitro. This study aims to test this hypothesis in an effort to define carbapenem-sparing alternatives for these infections.

METHODS/DESIGN: The study will use a multicentre randomised controlled open-label non-inferiority trial design comparing two treatments, meropenem (standard arm) and piperacillin-tazobactam (carbapenem-sparing arm) in adult patients with bacteraemia caused by E. coli or Klebsiella spp. demonstrating non-susceptibility to third generation cephalosporins. Recruitment is planned to occur in sites across three countries (Australia, New Zealand and Singapore). A total sample size of 454 patients will be required to achieve 80% power to determine non-inferiority with a margin of 5%. Once randomised, definitive treatment will be for a minimum of 4 days, but up to 14 days with total duration determined by treating clinicians. Data describing demographic information, antibiotic use, co-morbid conditions, illness severity, source of infection and other risk factors will be collected. Vital signs, white cell count, use of vasopressors and days to bacteraemia clearance will be recorded up to day 7. The primary outcome measure will be mortality at 30 days, with secondary outcomes including days to clinical and microbiological resolution, microbiological failure or relapse, isolation of a multi-resistant organism or Clostridium difficile infection.

Recovery pathways from small-scale disturbance in a temperate Australian seagrass

Recovery from disturbance is a key element of ecosystem persistence, and recovery can be influenced by large-scale regional differences and smaller local-scale variations in environmental conditions. Seagrass beds are an important yet threatened nearshore habitat and recover from disturbance by regrowth, vegetative extension and dispersive propagules. We described recovery pathways from small-scale disturbances in the seagrass Zostera nigricaulis in Port Phillip Bay, a large embayment in southeastern Australia, and tested whether these pathways differed between 5 regions with different hydrodynamic conditions and water quality, and between sites within those regions. Recovery pathways were broadly consistent. When aboveground biomass was removed, recovery, defined as the point at which disturbed areas converged with undisturbed controls, took from 2 to 8 mo, but when we removed above-and below-ground biomass, it took between 2 and 13 mo. There was no evidence of recovery resulting from sexual reproduction at any sites regardless of the presence of seeds in the sediment or flower production. We found no differences in recovery at the regional scale, but we found substantial differences between local sites. At some sites, rapid recovery occurred because seagrasses grew quickly, but at others, apparent recovery occurred because regrowth coincided with overall declines in cover of undisturbed areas. Recovery time was unrelated to seagrass canopy height, biomass, percentage cover, stem density, seed bank density, epiphyte cover or sediment organic matter in seagrass adjacent to disturbance experiments. This study highlights the importance of understanding fine-scale variation in local recovery mechanisms, which may override or obscure any regional signal.

Cardiovascular risk screening of volunteer firefighters

Background: The work demands involved in firefighting place significant stress on the cardiovascular system. This study investigated the application of the AHA/ACSM Health/Fitness Facility Preparticipation Screening Questionnaire in volunteer Country Fire Brigade (CFA) firefighters. Methods: Cardiovascular disease (CVD) risk factors were measured in 3777 CFA firefighters and entered into a modified version of the American Heart Association (AHA)/ACSM Health/Fitness Facility Preparticipation Screening Questionnaire to stratify individuals as low, moderate or high risk. Results: Just over half (50.8%) of female and more than two thirds (68.2%) of male CFA firefighters were classified as moderate risk. The questionnaire further stratified 2.6% of female and 5.2% of male CFA firefighters as high risk while the remaining 46.6% and 26.6% of female and male firefighters, respectively, were classified as low risk. Conclusion: The majority of firefighters screened were at moderate risk and therefore, would be advised by AHA/ACSM guidelines to undertake and pass a detailed medical examination and a medically supervised exercise test prior to initiating vigorous intensity physical activity. However, considering the financial and practical implications (e.g., reduced emergency response capacity) the introduction of mandatory screening may cause, fire agencies should focus screening for high risk personnel only, while promoting agency wide CVD health education.