Acute delirium in the setting of primary hypothyroidism: the role of thyroid hormone replacement therapy.

Psychiatric illness, mostly mania and psychosis, are reported to occur after rapid normalization of thyroid function in patients with primary hypothyroidism. It is generally believed that the gradual restoration of thyroid function may reduce the risk of psychiatric complications. This case report describes the occurrence of acute delirium in a 67-year-old man with primary hypothyroidism shortly after the initiation of thyroid hormone replacement. The use of low-dose thyroxine initially and persistent severe biochemical hypothyroidism on presentation with psychiatric symptoms illustrate that psychiatric illness can still occur despite unaggressive thyroid hormone replacement. A temporal relationship with the initiation of thyroxine and rapid recovery of mental state over 1 to 2 weeks differentiate this condition from hypothyroidism-related psychopathology, which tends to have a more prolonged course.

Recycled glass as a partial replacement for fine aggregate in structural concrete -effects on compressive strength

Waste management is becoming a major issue for communities worldwide. Glass, being nonbiodegradable, is not suitable for addition to landfill, and as such recycling opportunities need to be investigated. Due to the high material consumption of the construction industry, the utilisation of waste glass as a partial replacement for fine aggregate in structural concrete is particularly attractive. This project aimed to determine the level of glass replacement resulting in optimal compressive strength. Three concrete samples were tested at 7 and 28 days, for glass replacement proportions of 15, 20, 25, 30 and 40%. Compressive strength was found to increase up to a level of 30%, at which point the strength developed was 9% and 6% higher than the control after 7 and 28 days respectively. This demonstrates that concrete containing up to 30% fine glass aggregate exhibits higher compressive strength development than traditional concrete.

Functional replacement across species pools of vertebrate scavengers separated at a continental scale maintains an ecosystem function

Summary: The composition of species pools can vary in space and time. While many studies are focused on understanding which factors influence the make-up of species pools, the question to which degree biogeographic variation in species composition propagates to biogeographic variation in ecological function is rarely examined. If different local species assemblages operate in ways that maintain specific ecological processes across continents, they can be regarded as functionally equivalent. Alternatively, variation in species assemblages might result in the loss of ecological function if different species fulfil different functions, and thereby fail to maintain the ecological process. Here, we test whether ecological function is affected by differences in the composition of species pools across a continental scale, comparing a tropical with a temperate pool. The model systems are assemblages of vertebrates foraging on ocean beaches, and the ecological function of interest is the consumption of wave-cast carrion, a pivotal process in sandy shore ecosystems. We placed fish carcasses (n = 179) at the beach-dune interface, monitored by motion-triggered cameras to record scavengers and quantify the detection and removal of carrion. Scavenging function was measured on sandy beaches in two distinct biogeographic regions of Australia: tropical north Queensland and temperate Victoria. The composition of scavenging assemblages on sandy beaches varied significantly across the study domain. Raptors dominated in the tropics, while invasive red foxes were prominent in temperate assemblages. Notwithstanding the significant biogeographic change in species composition, ecological function - as indexed by carcass detection and removal - was maintained, suggesting strong functional replacement at the continental scale. Species pools of vertebrate scavengers that are assembled from taxonomically distinct groups (birds vs. mammals) and located in distinct climatic regions (temperate vs. tropical) can maintain an ecological process via replacement of species with comparable functional traits.

Patient participation in postoperative care activities in patients undergoing total knee replacement surgery: multimedia intervention for managing patient experience (MIME). Study protocol for a cluster randomised crossover trial

BACKGROUND: Patient participation is an important indicator of quality care. Currently, there is little evidence to support the belief that participation in care is possible for patients during the acute postoperative period. Previous work indicates that there is very little opportunity for patients to participate in care in the acute context. Patients require both capability, in terms of having the required knowledge and understanding of how they can be involved in their care, and the opportunity, facilitated by clinicians, to engage in their acute postoperative care. This cluster randomised crossover trial aims to test whether a multimedia intervention improves patient participation in the acute postoperative context, as determined by pain intensity and recovery outcomes.

METHODS/DESIGN: A total of 240 patients admitted for primary total knee replacement surgery will be invited to participate in a cluster randomised, crossover trial and concurrent process evaluation in at least two wards at a major non-profit private hospital in Melbourne, Australia. Patients admitted to the intervention ward will receive the multimedia intervention daily from Day 1 to Day 5 (or day of discharge, if prior). The intervention will be delivered by nurses via an iPad™, comprising information on the goals of care for each day following surgery. Patients admitted to the control ward will receive usual care as determined by care pathways currently in use across the organization. The primary endpoint is the "worst pain experienced in the past 24 h" on Day 3 following TKR surgery. Pain intensity will be measured using the numerical rating scale. Secondary outcomes are interference of pain on activities of daily living, length of stay in hospital, function and pain following TKR surgery, overall satisfaction with hospitalisation, postoperative complications and hospital readmission.

DISCUSSION: The results of this study will contribute to our understanding of the effectiveness of interventions that provide knowledge and opportunity for patient participation during postoperative in-hospital care in actually increasing participation, and the impact of participation on patient outcomes. The results of this study will also provide data about the barriers and enablers to participation in the acute care context.