Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study.

BACKGROUND: We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide. METHODS: Prospective cohort study of 2781 adults with definite IE who were admitted to 58 hospitals in 25 countries from June 1, 2000, through September 1, 2005. RESULTS: The median age of the cohort was 57.9 (interquartile range, 43.2-71.8) years, and 72.1% had native valve IE. Most patients (77.0%) presented early in the disease (<30 days) with few of the classic clinical hallmarks of IE. Recent health care exposure was found in one-quarter of patients. Staphylococcus aureus was the most common pathogen (31.2%). The mitral (41.1%) and aortic (37.6%) valves were infected most commonly. The following complications were common: stroke (16.9%), embolization other than stroke (22.6%), heart failure (32.3%), and intracardiac abscess (14.4%). Surgical therapy was common (48.2%), and in-hospital mortality remained high (17.7%). Prosthetic valve involvement (odds ratio, 1.47; 95% confidence interval, 1.13-1.90), increasing age (1.30; 1.17-1.46 per 10-year interval), pulmonary edema (1.79; 1.39-2.30), S aureus infection (1.54; 1.14-2.08), coagulase-negative staphylococcal infection (1.50; 1.07-2.10), mitral valve vegetation (1.34; 1.06-1.68), and paravalvular complications (2.25; 1.64-3.09) were associated with an increased risk of in-hospital death, whereas viridans streptococcal infection (0.52; 0.33-0.81) and surgery (0.61; 0.44-0.83) were associated with a decreased risk. CONCLUSIONS: In the early 21st century, IE is more often an acute disease, characterized by a high rate of S aureus infection. Mortality remains relatively high.

Mental health legislation (civil) in Australia and China: a comparative study

This comparative review of statutory provisions of Australian and Chinese law focuses on accessibility of mental health care, diagnosis, admission and treatment orders for involuntary patients in civil cases as well as discharge procedures. The introduction contextualises the object of the comparative study, including key rights and principles that are used as the basis for analysis. Such factors as different political and legal systems, history, culture, and infrastructure resources of China and Australia form the background for the legal examination. Not surprisingly, these five factors, rather than statutory texts per se, are found to be the most important drivers of each country’s approach to the law of mental health. Two cases, XX v WW [2014] VSC 564 in Australia and Xu Lixin v Xu Canxing, Qingchun Psychiatric Rehabilitation Hospital of Shanghai [2015], known as the Right to Liberty Case, in China illustrate practical differences in legal approach to involuntary treatment. The comparative analysis concludes by identifying the most problematic aspects of the legislation in each country.

Alcohol consumption, obesity, and psychological distress in farming communities — an Australian study

Purpose: Alcohol consumption patterns nationally and internationally have been identified as elevated in rural and remote populations. In the general Australian population, 20.5% of adult males and 16.9% of adult females drink at short-term, high-risk levels. Farmers are more likely to drink excessively than those living in major cities. This study seeks to explore the relationships between farmers’ physical and mental health and their alcohol consumption patterns. Our hypothesis is that farmers consume alcohol at high-risk levels more often than the Australian average and that this consumption is associated with obesity and psychological distress.

Methods: Cross-sectional descriptive data were collected within Australian farming communities from 1,792 consenting adults in 97 locations across Australia. Data on anthropometric measurements, general physical attributes and biochemical assessments were used to explore the interrelationships of self-reported alcohol consumption patterns with obesity, psychological distress, and other physical health parameters.

Findings: There was a higher prevalence of short-term, high-risk alcohol consumption (56.9% in men and 27.5% in women) reported in the study compared with national data. There was also a significant positive association between the prevalence of high-risk alcohol consumption and the prevalence of obesity and abdominal adiposity in psychologically distressed participants.

Conclusions: The prevalence of short-term, high-risk alcohol consumption practices in this cohort of farming men and women is significantly higher than the Australian average. These consumption practices are coupled with a range of other measurable health issues within the farming population, such as obesity, hypertension, psychological distress, and age.

Emergency responses for clinical deterioration within and beyond 24 hours of emergency admission: Patient outcomes and ICU implications

Introduction: The National Emergency Access Target was implemented to ensure 90% of patients leave emergency departments (EDs) within 4h. The impact of time driven performance on the number of physiologically unstable ward-based patients is unknown. An increase in clinical deterioration episodes potentially leading to adverse events will have resource implications for intensive care units (ICUs).
Objectives: To compare the characteristics and outcomes of patients who required an emergency response for clinical deterioration (cardiac arrest team or rapid response system activation) within and beyond 24 h of emergency admission to general medical and surgical units.
Methods: A retrospective exploratory design was used. The study site was a 365 bed urban hospital in Melbourne. Emergency responses for clinical deterioration during 2012 were examined.
Results: Of 819 emergency responses for clinical deterioration, 587 patients were admitted via ED. The median time to first responsewas59h, 28.4% of patients required this <24 h after admission. One in eight patients required ICU admission. Comparison of patients requiring a response within and beyond 24h of admission showed no significant differences in age, gender, waiting times, ED length of stay or in-hospital mortality rates. Patients in whom first emergency response occurred <24h after admission were less likely to be admitted to ICU immediately following the emergency response (7.6% vs 13.9%, p-0.039), less likely to have recurrent emergency responses during their hospitalisation (9.7% vs 34.0%, p<0.001), and had shorter median hospital length of stay (7 vs 11 days, p<0.001).
Conclusions: Considerable ICU resources were utilised given one in eight patients required ICU admission following emergency response, and patients admitted via the ED constituted 55% of all rapid response system activations. Exploring potential antecedents to clinical deterioration in this cohort may assist in establishing risk management strategies to reduce utilisation of ICU resources.

Book review: marketing and public relations for museums, galleries, cultural and heritage attractions

 The article reviews the book "Marketing and Public Relations for Museums, Galleries, Cultural and Heritage Attractions," by Ylva French and Sue Runyard.

Sexual orientation and gender-identity in high functioning individuals with autism spectrum disorder.

When compared to typically-developing individuals, individuals with Autism Spectrum Disorder(ASD) demonstrated significantly higher sexual diversity, with higher rates of non-heterosexuality, and reported more gender non-conforming identities. The ASD group reported poorer mental health than typically-developing individuals and belonging to a sexual or gender-diverse group worsened this effect.

Dividend forecasts and dividend payments of initial public offerings-when zero means zero and no comment most likely also means zero

Managers often try to forecast dividends because as Brown et al. (2002)  suggest, dividends have cash flow implications for investors and are important signalling devices. This study analyses the dividend forecasts in the prospectuses of initial public offerings (IPOs) in Australia over the period 1994 to 1999. While many companies forecast dividends, many make no dividend forecast at all and some forecast no (or zero) dividends for the forthcoming year. This paper seeks to determine if no forecast at all should present a different signal to investors than a zero dividend forecast. It is found that those that do not forecast a dividend, by and large, do not pay a dividend. It is also found that those that forecast a zero dividend, true to their forecast, pay no dividend.

Public land use planning using bioregions and other attributes : determining the study area of the VEAC river red gum forests investigation

In order to plan for the best use of public land at a regional scale the determination of an appropriate regional boundary is important for ecological, resource use and recreational reasons. The study area for the Victorian Environmental Assessment Council's (VEAC) River Red Gum Forests Investigation incorporated bioregional boundaries, modelled pre- I750 vegetation distribution, recent public land use investigations, and the distribution of public land. This paper outlines how ecological attributes and past land use studies were used to inform the boundary for this major study of public land along the Murray River in northern Victoria.

Clinical judgements : research and practice

This paper explores issues that are relevant to the judgements routinely made by clinical psychologists. It first considers the relative merits of clinical and statistical approaches to decision making and notes that although much of the empirical evidence demonstrates the greater accuracy of statistical approaches to making judgements (where appropriate methods exist), they are rarely routinely used. Instead, clinical approaches to making judgements continue to dominate in the majority of clinical settings. Second, common sources of errors in clinical judgement are reviewed, including the misuse of heuristics, clinician biases, the limitations of human information-processing capacities, and the overreliance on clinical interviews. Finally, some of the basic strategies that can be useful to clinicians in improving the accuracy of clinical judgement are described. These include advanced level training programs, using quality instruments and procedures, being wary of overreliance on theories, adhering to the scientist-practitioner approach, and being selective in the distribution of professional efforts and time.

The ill effects of public sector corruption in the water and sanitation sector

In general, given a particular set of institutions, the greater a county's per capita income, the more extensive will be its pro vision of goods and services that require concerted public action. We contend that one of the most important aspects of institutions in this regard is public sector corruption. We test this contention by analyzing 85 countries observed in 1990, 1995, 2000, and 2004--the only years for which data on improved drinking water and adequate sanitation are available. The models point to statistically significant, negative relations between corruption and access to both improved drinking water and adequate sanitation.

External public piano examinations in Malaysia : social and symbolic significance

The thesis investigated the social and symbolic significance of acquiring a 'music education' through the taking of piano tuition and external public music examinations. It aimed to discover why the learning of the piano and the certification of musical attainment are so prevalent and revered among Malaysian music students. Its purpose was to unravel the socio-cultural raison d'etre of this approach to music education through the creation of a metatheoretical schema, which is premised upon the theories of symbolic interactionist, George Herbert Mead, music analyst, Heinrich Schenker and social theorist, George Ritzer. Central to the argument in this instance is the symbolic significance associated with the act of playing the piano. The investigation attempted to determine if this 'act' conveyed a symbolic meaning that is peculiar to a specific cultural vista. It further examined the degree to which this practice represented both a validation and a sense of conformity to social norms in the continuity and stability of an expanding middle class society in Malaysia. The Associated Board of the Royal Schools of Music (ABRSM) is the largest of the five main external public music examination boards that operate in Malaysia. Since 1948, over one million candidates have enrolled for ABRSM examinations in Malaysia and a team of approximately thirty ABRSM examiners visit Malaysia for three months every year. The majority of the candidates are pianists. Given such large numbers of piano candidates, one might expect a healthy development of musical talent in the country with aspiring pianists eager to demonstrate their musical prowess. However, this does not seem to be the case. On the contrary, there appears to be a curious lacuna between the growing number of students who enrol for external public music examinations and the seemingly lack of interest in public music making and the honing of general musicianship skills. The thesis hence examined the symbolic meaning of this socio-musicological phenomena.