Older women`s experiences with sternotomy

While incision and subsequent scarring is a feature of all surgery, in cardiac surgery the sternotomy incision is significant and central to the body, separating the chest in half between the breasts. Increasingly older women count for a larger proportion of patients undergoing cardiac surgery each year in Australia yet there has been limited exploration of their experiences with sternotomy. A phenomenological approach was used to elicit the experiences of older women who had undergone cardiac surgery. In-depth interviews with four older women revealed a range of ways in which these women were affected by their sternotomy and their whole experience of cardiac surgery. Findings from this project provide insight into practical issues affecting these women and may assist nurses in the assessment and planning of care and education for older women having cardiac surgery, particularly in the areas of preparation for cardiac surgery and body image.

Effect of three wound dressings on infection, healing comfort, and cost in patients with sternotomy wounds - a randomized trial

Study objective: To compare three dressing types in terms of their ability to protect against infection and promote healing, patient comfort, and cost-effectiveness.

Design: Prospective, randomized controlled trial.

Setting: Major metropolitan, academically affiliated, tertiary referral center.

Patients: Seven hundred thirty-seven patients were randomized to receive a dry absorbent dressing (n = 243) [Primapore; Smith & Nephew; Sydney, NSW, Australia], a hydrocolloid dressing (n = 267) [Duoderm Thin ConvaTec; Mulgrave, VIC, Australia], or a hydroactive dressing (n = 227) [Opsite; Smith & Nephew] in the operating theater on skin closure.

Results: There was no difference in the rate of wound infection or wound healing between treatment groups. The Primapore dressing was the most comfortable and cost-effective dressing option for the sternotomy wound. Duoderm Thin dressings were associated with increased wound exudate (p < 0.001), poor dressing integrity (p < 0.001), more frequent dressing changes (p < 0.001), more discomfort with removal (p < 0.05), and increased cost (p < 0.001).

Conclusions: In the context of no additional benefit for the prevention of wound infection or the rate of wound healing for any of the three dressing products examined, dry absorbent dressings are the most comfortable and cost-effective products for sternotomy wounds following cardiac surgery.

東澳大利亞悉尼盆地南部二疊紀的地層、沈積環境與盆地演化

The latest Carboniferous to Triassic Sydney-Gunnedah-Bowen Basin System in the eastern Australia is an elongate structural basin that locates between the Lachlan Caledonian Fold Belt in the west and the New England Fold Belt in the east. Extending from the Gunnedah district in the north to the Batemans Bay in the south, the Sydney Basin is a subbasin located in the southern part of the Sydney-Gunnedah-Bowen Basin System. The Permian in Sydney Basin consists of sedimentary sequences of fluvial, delta, littoral and shallow marine environments, as well as volcanic rocks. In the southwest of southern Sydney Basin, the Permian unconformably onlaps the highly deformed and metamorphosed Lachlan Fold Belts. The Permian System from the southern Sydney Basin comprises the Lower Permian Tallaterang Group (consisting of Clyde Coal Measures and Wasp Head Formation), Shoalhaven Group ( consisting of the Lower Permian Yadboro & Tallong Conglomerate, Yarrunga Coal Measures, Pebbly Beach Formation, Snapper Point Formation and the Middle Permian Wandrawandian Siltstone, Nowra Sandstone, Berry Siltstone and Broughton Formation) and the Upper Permian Illwarra Coal Measures. From the latest Carboniferous to the Middle Triassic, the SydneyBowen Basin had experienced different tectonic phases from a back-arc extensional regime to a typical foreland basin: a back-arc extensional phase, a passive thermal sag phase and a flexural loading and increased compressional phase.

Analysis of cardioprotective effects using purified Saliva miltiorrhiza extract on isolated rat hearts

The purpose of the current study is to evaluate the cardioprotective effects of purified Salvia miltiorrhiza extract (PSME) on myocardial ischemia/reperfusion injury in isolated rat hearts. Hearts were excised and perfused at constant flow (7 – 9 ml · min⁻¹) via the aorta. Non-recirculating perfusion with Krebs-Henseleit (KH) solution was maintained at 37°C and continuously gassed with 95% O₂ and 5% CO₂. KH solution with or without PSME (100 mg per liter solution) was used after 30-min zero-flow ischemia for the PSME and control group, respectively. Left ventricular (LV) developed pressure; its derivatives, diastolic pressure, and so on were continuously recorded via a pressure transducer attached to a polyvinylchloride balloon that was placed in the left ventricle through an incision in the left atrium. PSME treated hearts showed significant postischemic contractile function recovery (developed pressure recovered to 44.2 ± 4.9% versus 17.1 ± 5.7%, P<0.05; maximum contraction recovered to 57.2 ± 5.9% versus 15.1 ± 6.3%, P<0.001; maximum relaxation restored to 69.3 ± 7.3% versus 15.4 ± 6.3%, P<0.001 in the PSME and control group, respectively). Significant elevation in end-diastolic pressure, which indicated LV stiffening in PSME hearts might have resulted from the excess high dose of PSME used. Further study will be conducted on the potential therapeutic value with lower dose of PSME on prevention of ischemic heart disease.

Older women and sternotomy

Explores the experiences of older women having a sternotomy incision following cardiac surgery. Older women account for a large proportion of patients undergoing cardiac surgery each year in Australia. The context from which they face cardiac surgery is unlike that of men and of younger women, and there has been limited exploration of their experiences.

Unintentional needlestick injuries in livestock production : a case series and review

Livestock producers and their employees sometimes experience unintentional needlestick injury (NSI) while vaccinating or injecting medications into animals. There is little published regarding the medical complications that can develop from this occupational exposure. The objectives of this study were to (1) perform a retrospective review of animal-related NSIs treated at a tertiary medical center of a rural state; and (2) review the risks of NSI and measures to decrease their occurrence. Medical records of patients with NSI related to animal injection were identified from the University of Iowa Hospitals and Clinics database from 2002 to 2008 and reviewed. Nine patients received medical care for NSI that occurred while vaccinating farm animals. Most common NSI site was the nondominant hand and most occurred while attempting to inject the animal. Soft tissue infection was common and all nine received oral and/or intravenous antibiotics. Two thirds required hospital admission. Three required surgery and one had a bedside incision and drainage procedure. One patient had a serious inflammatory reaction with necrosis in the leg due to the oil adjuvant in the animal vaccine. Another case had a probable mycetoma with osteomyelitis and soft tissue infection due to the bacteria Streptomyces, which is a NSI complication not previously reported. Although medical complications from farm-related NSIs do not appear to be common, this case series illustrates how these injuries can be debilitating, costly, and lead to loss of work time and productivity. Producers and employees who inject livestock need to be aware of the risks and utilize measures to decrease unintentional NSI.

Rehabilitating agricultural streams in Australia with wood : a review

Worldwide, the ecological condition of streams and rivers has been impaired by agricultural practices such as broadscale modification of catchments, high nutrient and sediment inputs, loss of riparian vegetation, and altered hydrology. Typical responses include channel incision, excessive sedimentation, declining water quality, and loss of in-stream habitat complexity and biodiversity. We review these impacts, focusing on the potential benefits and limitations of wood reintroduction as a transitional rehabilitation technique in these agricultural landscapes using Australian examples. In streams, wood plays key roles in shaping velocity and sedimentation profiles, forming pools, and strengthening banks. In the simplified channels typical of many agricultural streams, wood provides habitat for fauna, substrate for biofilms, and refuge from predators and flow extremes, and enhances in-stream diversity of fish and macroinvertebrates.

Most previous restoration studies involving wood reintroduction have been in forested landscapes, but some results might be extrapolated to agricultural streams. In these studies, wood enhanced diversity of fish and macroinvertebrates, increased storage of organic material and sediment, and improved bed and bank stability. Failure to meet restoration objectives appeared most likely where channel incision was severe and in highly degraded environments. Methods for wood reintroduction have logistical advantages over many other restoration techniques, being relatively low cost and low maintenance. Wood reintroduction is a viable transitional restoration technique for agricultural landscapes likely to rapidly improve stream condition if sources of colonists are viable and water quality is suitable.

Holocene record of Tuggerah Lake estuary development on the Australian east coast: sedimentary responses to sea-level fluctuations and climate variability

We investigated the Holocene palaeo-environmental record of the Tuggerah Lake barrier estuary on the south-east coast of Australia to determine the influence of local, regional and global environmental changes on estuary development. Using multi-proxy approaches, we identified significant down-core variation in sediment cores relating to sea-level rise and regional climate change. Following erosion of the antecedent land surface during the post-glacial marine transgression, sediment began to accumulate at the more seaward location at ~8500. years before present, some 1500. years prior to barrier emplacement and ~4000. years earlier than at the landward site. The delay in sediment accumulation at the landward site was a consequence of exposure to wave action prior to barrier emplacement, and due to high river flows of the mid-Holocene post-barrier emplacement. As a consequence of the mid-Holocene reduction in river flows, coupled with a moderate decline in sea-level, the lake experienced major changes in conditions at ~4000. years before present. The entrance channel connecting the lake with the ocean became periodically constricted, producing cyclic alternation between intervals of fluvial- and marine-dominated conditions. Overall, this study provides a detailed, multi-proxy investigation of the physical evolution of Tuggerah Lake with causative environmental processes that have influenced development of the estuary.

Sedimentary factors are key predictors of carbon storage in SE Australian saltmarshes

Although coastal vegetated ecosystems are widely recognised as important sites of long-term carbon (C) storage, substantial spatial variability exists in quantifications of these ‘blue C’ stocks. To better understand the factors behind this variability we investigate the relative importance of geomorphic and vegetation attributes to variability in the belowground C stocks of saltmarshes in New South Wales (NSW), southeast Australia. Based on the analysis of over 140 sediment cores, we report mean C stocks in the surface metre of sediments (mean ± SE = 164.45 ± 8.74 Mg C ha−1) comparable to global datasets. Depth-integrated stocks (0–100 cm) were more than two times higher in fluvial (226.09 ± 12.37 Mg C ha−1) relative to marine (104.54 ± 7.11) geomorphic sites, but did not vary overall between rush and non-rush vegetation structures. More specifically, sediment grain size was a key predictor of C density, which we attribute to the enhanced C preservation capacity of fine sediments and/or the input of stable allochthonous C to predominantly fine-grained, fluvial sites. Although C density decreased significantly with sediment depth in both geomorphic settings, the importance of deep C varied substantially between study sites. Despite modest spatial coverage, NSW saltmarshes currently hold approximately 1.2 million tonnes of C in the surface metre of sediment, although more C may have been returned to the atmosphere through habitat loss over the past approximately 200 years. Our findings highlight the suitability of using sedimentary classification to predict blue C hotspots for targeted conservation and management activities to reverse this trend.

Accounting for uncertainty in volumes of seabed change measured with repeat multibeam sonar surveys

Seafloors of unconsolidated sediment are highly dynamic features; eroding or accumulating under the action of tides, waves and currents. Assessing which areas of the seafloor experienced change and measuring the corresponding volumes involved provide insights into these important active sedimentation processes. Computing the difference between Digital Elevation Models (DEMs) obtained from repeat Multibeam Echosounders (MBES) surveys has become a common technique to identify these areas, but the uncertainty in these datasets considerably affects the estimation of the volumes displaced. The two main techniques used to take into account uncertainty in volume estimations are the limitation of calculations to areas experiencing a change in depth beyond a chosen threshold, and the computation of volumetric confidence intervals. However, these techniques are still in their infancy and, as a result, are often crude, seldom used or poorly understood. In this article, we explored a number of possible methodological advances to address this issue, including: (1) using the uncertainty information provided by the MBES data processing algorithm CUBE, (2) adapting fluvial geomorphology techniques for volume calculations using spatially variable thresholds and (3) volumetric histograms. The nearshore seabed off Warrnambool harbour - located in the highly energetic southwest Victorian coast, Australia - was used as a test site. Four consecutive MBES surveys were carried out over a four-months period. The difference between consecutive DEMs revealed an area near the beach experiencing large sediment transfers - mostly erosion - and an area of reef experiencing increasing deposition from the advance of a nearby sediment sheet. The volumes of sediment displaced in these two areas were calculated using the techniques described above, both traditionally and using the suggested improvements. We compared the results and discussed the applicability of the new methodological improvements. We found that the spatially variable uncertainty derived from the CUBE algorithm provided the best results (i.e. smaller confidence intervals), but that similar results can be obtained using as a fixed uncertainty value derived from a reference area under a number of operational conditions.