Nursing care for the families of the dying child/infant in paediatric and neonatal ICU: Nurses’ emotional talk and sources of discomfort. A mixed methods study

BACKGROUND: The majority of in-hospital deaths of children occur in paediatric and neonatal intensive care units. For nurses working in these settings, this can be a source of significant anxiety, discomfort and sense of failure.

OBJECTIVES: The objectives of this study were to explore how NICU/PICU nurses care for families before and after death; to explore the nurses' perspectives on their preparedness/ability to provide family care; and to determine the emotional content of language used by nurse participants.

METHODS: Focus group and individual interviews were conducted with 22 registered nurses from neonatal and paediatric intensive care units of two major metropolitan hospitals in Australia. All data were audio recorded and transcribed verbatim. Transcripts were then analysed thematically and using Linguistic Inquiry to examine emotional content.

RESULTS: Four core themes were identified: preparing for death; communication challenges; the nurse-family relationship and resilience of nurses. Findings suggested that continuing to provide aggressive treatment to a dying child/infant whilst simultaneously caring for the family caused discomfort and frustration for nurses. Nurses sometimes delayed death to allow families to prepare, as evidenced in the Linguistic Inquiry analysis, which enabled differentiation between types of emotional talk such as anger talk, anxiety talk and sadness talk. PICU nurses had significantly more anxiety talk (p=0.018) than NICU nurses.

CONCLUSION: This study provided rich insights into the experiences of nurses who are caring for dying children including the nurses' need to balance the often aggressive treatments with preparation of the family for the possibility of their child's death. There is some room for improvement in nurses' provision of anticipatory guidance, which encompasses effective and open communication, focussed on preparing families for the child's death.

Dietary intake and sources of potassium and the relationship to dietary sodium in a sample of Australian pre-school children

The aim of this study was to determine the intake and food sources of potassium and the molar sodium:potassium (Na:K) ratio in a sample of Australian pre-school children. Mothers provided dietary recalls of their 3.5 years old children (previous participants of Melbourne Infant Feeding Activity and Nutrition Trial). The average daily potassium intake, the contribution of food groups to daily potassium intake, the Na:K ratio, and daily serves of fruit, dairy, and vegetables, were assessed via three unscheduled 24 h dietary recalls. The sample included 251 Australian children (125 male), mean age 3.5 (0.19) (SD) years. Mean potassium intake was 1618 (267) mg/day, the Na:K ratio was 1.47 (0.5) and 54% of children did not meet the Australian recommended adequate intake (AI) of 2000 mg/day for potassium. Main food sources of potassium were milk (27%), fruit (19%), and vegetable (14%) products/dishes. Food groups with the highest Na:K ratio were processed meats (7.8), white bread/rolls (6.0), and savoury sauces and condiments (5.4). Children had a mean intake of 1.4 (0.75) serves of fruit, 1.4 (0.72) dairy, and 0.52 (0.32) serves of vegetables per day. The majority of children had potassium intakes below the recommended AI. The Na:K ratio exceeded the recommended level of 1 and the average intake of vegetables was 2 serves/day below the recommended 2.5 serves/day and only 20% of recommended intake. An increase in vegetable consumption in pre-school children is recommended to increase dietary potassium and has the potential to decrease the Na:K ratio which is likely to have long-term health benefits.

Potential new sources of wheat curl mite resistance in wheat to prevent the spread of yield-reducing pathogens

The wheat curl mite (WCM), Aceria tosichella Keifer (Trombidiformes: Eriophyidae), is a major pest in cropping regions of the world and is recognised as the primary vector of several yield-reducing pathogens, primarily affecting wheat. Management of WCM is complicated due to several aspects of the mite's biology and ecology; however, commercially viable mite resistant wheat varieties may offer practical long-term management options. Unfortunately, mite populations have adapted to previously identified sources of resistance, highlighting the need for further sources of resistance and the value of stacking different resistances to give greater degrees and longevity of control. In this study we assessed the susceptibility of 42 wheat-derived genotypes to mite population growth using a new experimental method that overcomes methodological limitations of previous studies. Experimental wheat lines included a variety of wheat genotypes, related Triticeae species, wheat-alien chromosome amphiploids, and chromosome addition or substitution lines. From these we identify new promising sources of WCM resistance associated with Thinopyrum intermedium, Th. ponticum and Hordeum marinum chromosomes. More specifically we identify group 1J and 5J chromosomes of the L3 and L5 wheat-Th. intermedium addition lines as new sources of resistance that could be exploited to transfer resistance onto homoeologous wheat chromosomes. This study offers new methods for reliable in situ estimations of mite abundance on cereal plants, and new sources of WCM resistance that may assist management of WCM and associated viruses in wheat.

Marketing information sources and the performance of Australian businesses

This study investigated the various sources of information used by business organisations and their association with business performance indicators. The results showed that larger Australian companies predominantly used various internal and external secondary data sources of information, followed by formal primary marketing research. The study indicated an association between market share and the use of competitors, advertising agencies, and sales promotion agencies as sources of information, while overall financial performance was associated with the use of competitors and media/trade publications.

MAAGs: the next generation. A study of the development of medical audit advisory groups and the arrangements for supporting clinical audit in primary care

Background: MAAGs have, historically, been disparate organisations with a lack of central direction, albeit with the same goal: to develop and support the performance of audit in primary care. This goal has been (and is being) achieved in a number of ways all over the country. In the last two years, MAAGs have witnessed many changes in primary care and are adapting themselves to suit these new arrangements at a local level.

Aim: To formalise our knowledge of where MAAGs are going, how they are getting there and the support they are receiving.

Method: A postal questionnaire to the 104 MAAGs in England and Wales, addressing 6 main issues of relevance to the development of MAAGs and the support they are receiving.

Results: At least two MAAGs have dissolved, leaving a possible total of 102 still in existence. Of these, 76 (74.5%) responded to the survey. The composition of the MAAG committee has changed dramatically since the inception of MAAGs in 1990, and staffing levels appear to have risen substantially. MAAGs appear to be more adequately funded by their health authorities than has previously been reported and many are actively seeking additional sources of funding. There is still large variation in levels of MAAG funding. Furthermore, funding is unrelated to the number of GPs or practices served. Security for MAAG staff appears to have been addressed in many areas, with 84% of MAAGs having at least one member of staff on a permanent employment contract. Many MAAGs are developing rolling programmes in an attempt to eliminate the short-sighted approach to the development of clinical audit that has existed since MAAGs were first set up.

Conclusion: Many MAAGs (with the obvious exception of those that have been dissolved) appear to be thriving without central direction or initiative. It is now evident that we were a little hasty in our concerns for the future of MAAGs beyond April 1996. It would seem that many organisations have taken the situation which arose two years ago as an opportunity to grow and develop in ways that may not have been possible within the confines of the Health Circular.

Dietary sources and meal distribution of sodium and potassium in a sample of Australian adults

Aim
Reducing dietary sodium and increasing dietary potassium are recommended to reduce blood pressure. This study aimed to determine the main foods sources of sodium and potassium.

Methods
Participants were recruited via advertisements or blood pressure screening sessions. Food sources of sodium and potassium were assessed via 24-hour dietary records in 299 free-living Australian adults (141 male, 158 female; age 54.6(9.5)years; BMI 29.4(3.9)kg/m2).

Results
The mean sodium intake was 118(51)mmol/d (2725(1176)mg/d) and the mean potassium intake was 91(28)mmol/d (3550(1098)mg/d). Breads and cereals provided the majority (38%) of sodium with bread contributing 20%. Vegetable products/dishes contributed most potassium (23%) with potatoes providing 9%. Main meals provided 89% of sodium and 85% of potassium. Lunch and dinner provided similar sodium proportions (34% and 38%, respectively) but more energy was consumed at dinner (26% vs 40%, respectively). Lunch had the highest sodium density of all meals (420 mg/MJ).

Conclusion
A reduction in the salt content of processed foods, particularly bread, is recommended to decrease sodium intake. This reduction in salt content combined with meal specific education focusing on choosing lower sodium foods at lunch in particular, as well as incorporating more fruits and vegetables, could effectively reduce dietary sodium and increase potassium.

Prospect of renewable energy sources and integrating challenges in Victoria, Australia

The Australian Government has targeted 20% of electricity generation from renewable energy sources by 2020. The 20% renewable energy target (RET) for Australia will be around 45000GWH in 2020. Renewable energy of Victoria also includes as part of support to achieve 20% RET in Australia. In Victoria wind and solar resources are abundant as compared to other sources of renewable energy. Solar radiation and wind speed data for Victoria State was collected from NASA surface meteorology and solar energy web site. A feasibility analysis has been carried out to explore the potentialities of wind and solar energy for Victoria State using hybrid optimization model of electric renewable (HOMER) software. This paper also represents the estimation analysis of RET for Victoria and describes the integrating challenges of renewable energy sources to the utility grid.

Sources, perceived usefulness and understanding of information disseminated to families who entered home quarantine during the H1N1 pandemic in Victoria, Australia: a cross-sectional study

Background Voluntary home quarantine of cases and close contacts was the main non-pharmaceutical intervention used to limit transmission of pandemic (H1N1) 2009 influenza (pH1N1) in the initial response to the outbreak of the disease in Australia. The effectiveness of voluntary quarantine logically depends on affected families having a clear understanding of what they are being asked to do. Information may come from many sources, including the media, health officials, family and friends, schools, and health professionals. We report the extent to which families who entered home quarantine received and used information on what they were supposed to do. Specifically, we outline their sources of information; the perceived usefulness of each source; and associations between understanding of recommendations and compliance. Methods Cross-sectional survey administered via the internet and computer assisted telephone interview to families whose school children were recommended to go into home quarantine because they were diagnosed with H1N1 or were a close contact of a case. The sample included 314 of 1157 potentially eligible households (27% response rate) from 33 schools in metropolitan Melbourne. Adjusting for clustering within schools, we describe self-reported 'understanding of what they were meant to do during the quarantine period'; source of information (e.g. health department) and usefulness of information. Using logistic regression we examine whether compliance with quarantine recommendations was associated with understanding and the type of information source used. Results Ninety per cent understood what they were meant to do during the quarantine period with levels of understanding higher in households with cases (98%, 95% CI 93%-99% vs 88%, 95% CI 84%-91%, P = 0.006). Over 87% of parents received information about quarantine from the school, 63% from the health department and 44% from the media. 53% of households were fully compliant and there was increased compliance in households that reported that they understood what they were meant to do (Odds Ratio 2.27, 95% CI 1.35-3.80). Conclusions It is critical that public health officials work closely with other government departments and media to provide clear, consistent and simple information about what to do during quarantine as high levels of understanding will maximise compliance in the quarantined population.

Default probability for the Jordanian companies: A test of cash flow theory

Abstract
This paper aims to investigate the effect of cash flow and free cash flow on corporate failure in the emerging market in particular Jordan using two samples; matched sample and a cross sectional time-series (panel data) sample representative of 167 Jordanian companies in 1989-2003. LOGIT models are used to outline the relationship between firms’ financial health and the probability of default. Our results show that there is firm’s free cash flow increases corporate failure. The result also shows that the firm’s cash flow decreases corporate failure. Firms’ capital structures are fund a mental in predicting default. Capital structure is seen as the main factor affecting the probability of default as it affects a firm’s ability to access external sources of funds. Jordanian firms depend on short-term debt for both short and long term financing.

Dietary sources and sodium intake in a sample of Australian preschool children

OBJECTIVES: To assess dietary sodium intake and the food sources of sodium in a sample of Australian preschool children. DESIGN: Cross-sectional. SETTING: Mothers were followed up when children were approximately 3.5 years of age after participating in a cluster randomised controlled trial: the Melbourne Infant Feeding Activity and Nutrition Trial Program. PARTICIPANTS: 251 Australian children aged 3.5±0.19 (SD) years. PRIMARY AND SECONDARY OUTCOME MEASURES: The average daily sodium intake was determined using three unscheduled 24 h dietary recalls. The contributions of food groups, core, discretionary and processed foods to daily sodium intake were assessed. RESULTS: The average sodium intake was 1508±495 (SD) mg/day, (salt equivalent 3.9±1.3 (SD) g/day) and 87% of children exceeded the Australian Upper Level of Intake (UL) for sodium of 1000 mg/day (salt equivalent 2.6 g/day). Main food sources of sodium were cereal/cereal products (25%), milk products (19%), meat, poultry/game (17%) and cereal-based products (15%). Core foods contributed 65%, and discretionary foods 35% of total daily sodium intake, and within the total diet, minimally processed, processed, processed culinary ingredient and ultraprocessed foods contributed 16%, 35%, 1% and 48% of sodium, respectively. CONCLUSIONS: Within this sample, most children exceeded the recommended UL for sodium. Core and ultraprocessed foods were key sources of sodium which suggests that reductions in the sodium content of these foods are required to reduce sodium intake in young children. These data also provide further support for public health campaigns that seek to reduce consumption of energy-dense, nutrient-poor foods.

Linking nitrogen sources utilised by seagrass in a temperate marine embayment to patterns of seagrass change during drought

Reductions in the extent of seagrass Zostera nigricaulis coverage in Port Phillip Bay (PPB), Australia, between 2000 and 2011 coincided with a prolonged period of drought (1997 to 2009) characterized by decreases in freshwater and nutrient inputs. This led us to hypothesize that patterns of seagrass expansion and decline in PPB may be linked to nutrient availability. Seagrasses in PPB can make use of a range of different nitrogen (N) sources depending on their relative availability. Accordingly, there is a need to identify the origin of the N utilised by seagrasses in order to understand how changes in the availability of nutrients from various sources may influence seagrass growth. This study used stable isotope analysis to estimate the contribution of different sources of N to seagrass growth in different parts of PPB. Source modelling indicated that regional patterns of N source utilisation matched changes in seagrass extent from 2000 to 2011. Regions in which seagrass declined contained a similar array of sources, including significant contributions from the catchment area, whereas regions where seagrass areas remained unchanged were largely dependent on a single N source (either fixation/recycled or sewage-derived). We propose that reductions in N from the catchment during the drought may have contributed to the decline of seagrasses in regions where N from the catchment is an important source. This finding is likely to have implications for the growth, distribution and resilience of Z. nigricaulis seagrass in PPB as well as in other parts of its range in southern Australia.