The 10 Australian ecosystems most vulnerable to tipping points

We identify the 10 major terrestrial and marine ecosystems in Australia most vulnerable to tipping points, in which modest environmental changes can cause disproportionately large changes in ecosystem properties. To accomplish this we independently surveyed the coauthors of this paper to produce a list of candidate ecosystems, and then refined this list during a 2-day workshop. The list includes (1) elevationally restricted mountain ecosystems, (2) tropical savannas, (3) coastal floodplains and wetlands, (4) coral reefs, (5) drier rainforests, (6) wetlands and floodplains in the Murray-Darling Basin, (7) the Mediterranean ecosystems of southwestern Australia, (8) offshore islands, (9) temperate eucalypt forests, and (10) salt marshes and mangroves. Some of these ecosystems are vulnerable to widespread phase-changes that could fundamentally alter ecosystem properties such as habitat structure, species composition, fire regimes, or carbon storage. Others appear susceptible to major changes across only part of their geographic range, whereas yet others are susceptible to a large-scale decline of key biotic components, such as small mammals or stream-dwelling amphibians. For each ecosystem we consider the intrinsic features and external drivers that render it susceptible to tipping points, and identify subtypes of the ecosystem that we deem to be especially vulnerable. © 2011 Elsevier Ltd.

A sonographer's guide to the assessment of heart disease

The book is mostly designed for students of echocardiography, teachers of echocardiography and cardiac sonographers working in routine clinical practice, but will also be very useful to echocardiologists and cardiac registrars. The goal of the text is to provide a comprehensive review of transthoracic echocardiography in the assessment of various cardiac pathologies. Refresher notes on cardiac anatomy and the relevant cardiac physiology and pathophysiology are included to expand the cardiac sonographer’s knowledge in this area and further their understanding of various diseases, disease processes and associated findings.

What parents value from formal support services in the context of identified child abuse

Parents whose children are identified as having experienced or being at risk of experiencing significant harm potentially provide an invaluable dimension to our understanding of the circumstances that result in child abuse or neglect and how best to respond to these invariably complex situations. This paper reports findings from a study of the experiences of six parents. In-depth interviews were conducted with four mothers and two fathers who had been referred to an intensive family support services by the Queensland statutory child protection authority. Using a critical ecological perspective, the study focused on identifying and understanding the experiences of the parents in using formal family support services, including aspects of service delivery that were helpful or unhelpful. Parents also commented on their experiences of statutory child protection services. Service components and worker qualities that parents identified as being helpful included being accessible, targeted and integrated and being able to meet a continuum of needs, from a micro to a broader level. Their reports provide invaluable insight into how formal family support services, including child protection services, can better meet the needs of parents in addressing the recurring problem of child maltreatment.

Enhancing social work interprofessional learning through across university and industry collaboration : early steps in the Advanced Health Directives Project

There is ongoing interest in strategies for enhancing the reciprocal benefit derived from social work placements by students, host agencies, and universities. There is also recognition that interprofessional learning is an important aspect of social work education,and that field education placements have a role to play in this learning. This article reports on an innovation in community-engaged learning undertaken between a major public hospital and a university, where a team of social work and law students contributed to a focused inquiry into a socio-legal practice challenge faced by the hospital, namely the use of Advanced Health Directives (AHDs).Various collaborative processes involved in the early phase of the AHD project are reflected on by participants.A preliminary evaluation supports the value of taking a systematic approach to university–industry engagement where interprofessional collaboration occurs vertically and horizontally within and across university and placement hosting agencies.

Letter to Lady Chatterley

A letter written to Lady Chatterley, a fictional character in a novel by D H Lawrence. The topic of the letter is the influence of fictional characters on a reader's sense of self.

Negotiating futility, managing emotions : nursing the transition to palliative care

Nurses play a pivotal role in caring for patients during the transition from life-prolonging care to palliative care. This is an area of nursing prone to emotional difficulty, interpersonal complexity, and interprofessional conflict. It is situated within complex social dynamics, including those related to establishing and accepting futility and reconciling the desire to maintain hope. Here, drawing on interviews with 20 Australian nurses, we unpack their accounts of nursing the transition to palliative care, focusing on the purpose of nursing at the point of transition; accounts of communication and strategies for representing palliative care; emotional engagement and burden; and key interprofessional challenges. We argue that in caring for patients approaching the end of life, nurses occupy precarious interpersonal and interprofessional spaces that involve a negotiated order around sentimental work, providing them with both capital (privileged access) and burden (emotional suffering) within their day-to-day work.

The lipophilic opioids: Fentanyl, alfentanil, sufentanil and remifentanil

discusses fentanyl, alfentanil, sufentanil, and remifentanil which are synthetic opioid analgesics with high affinity for the mu opioid receptor. They have been widely adopted in anaesthetic practice for various surgical procedures (e.g. in cardiac surgery) and for long-term analgesia and sedation. Important pharmacokinetic differences between these analgesics have been described, and this chapter addresses how the pharmacokinetic profile of each analgesic is affected by many factors, including patient age, plasma protein content, acid–base balance status, cardiopulmonary bypass, changes in hepatic blood flow, and the co-administration of other drugs which compete for plasma protein carriers and metabolic pathways, although their profile is not significantly affected by renal insufficiency or compensated hepatic dysfunction, which has major clinical implications.

Guidelines for syringe driver management in palliative care

These guidelines are intended to provide clinicians and palliative care services with guidelines to inform practice, the development of policy and procedures, and associated training and education programs in relation to portable subcutaneous infusion device (syringe driver) management.

Developing guidelines for syringe driver management

The aim of this project was to develop clinical practice guidelines for the use and administration of pharmacological agents for symptom control via syringe drivers within Australia. By developing evidence-based clinical practice guidelines for the use of this common device, this project aimed to improve patient outcomes, reduce practice variation, minimize errors and encourage more efficient use of resources. A literature review identified current literature regarding syringe driver management and an expert panel was assembled to assist in the development of the guidelines. The development of these practice guidelines provides an example of how palliative care practitioners can use a framework of contemporary evidence to enhance clinical practice.

Physical activity and screen-time of childhood hematopoietic stem cell transplant survivors

Aim Reduced bone mineral density, impaired cardiovascular fitness, and increased risk of obesity are well-known late effects of Hematopoietic Stem Cell Transplantation (HSCT) in survivors of childhood cancer. These comorbidities can be mitigated through physical activity and limiting screen-time (ST). This study aims to increase the understanding of physical activity and ST behaviours for children following HSCT. Method Children were recruited from two oncology follow-up clinics and completed a questionnaire on their physical activity levels and screen-time. Children were classified as short (≤2yrs) and long term (>2yrs) survivors. Results Fifty-eight children were eligible, of whom forty children age 6 to 18 years (60% males) participated in the study. Less than half (47.5%) met the daily recommendations for physical activity and one third met the ST recommendations. Late survivors reported higher daily physical activity and less ST than early survivors. Among late survivors, females reported higher daily physical activity and less ST than males. Conclusions Our findings suggest that the majority of children following HSCT were not sufficiently active and had excessive screen-time; however this was comparable to healthy populations. Appropriately designed physical activity and screen-time intervention programs should be explored early following transplant for children undergoing HSCT.

The National Stroke Nursing Council: A nursing call for action

Nursing is fundamental to the care of stroke patients. From the acute setting all the way to rehabilitation and community reintegration, nursing is there. Having well-educated and highly skilled nurses to monitor and care for stroke patients is crucial. Equally important is the collaboration of colleagues at a national level to facilitate and disseminate research and best practice guidelines across Canada. The National Stroke Nursing Council aims to fill this role. Stroke nurses from across Canada were invited to a national forum in 2005, hosted by the Canadian Stroke Network. The focus of this forum was to elucidate issues of concern to nurses across the stroke care continuum in relation to a Canadian Stroke Strategy. Subsequent to this forum, a cadre of nurses, after undergoing a rigorous screening process, were selected to form the inaugural National Stroke Nursing Council (NSNC). With ongoing support from the Canadian Stroke Network, the mandate of the NSNC is to promote leadership, communication, advocacy, education and nursing research in the field of stroke.

Common genetic variants influence human subcortical brain structures

The highly complex structure of the human brain is strongly shaped by genetic influences. Subcortical brain regions form circuits with cortical areas to coordinate movement, learning, memory and motivation, and altered circuits can lead to abnormal behaviour and disease. To investigate how common genetic variants affect the structure of these brain regions, here we conduct genome-wide association studies of the volumes of seven subcortical regions and the intracranial volume derived from magnetic resonance images of 30,717 individuals from 50 cohorts. We identify five novel genetic variants influencing the volumes of the putamen and caudate nucleus. We also find stronger evidence for three loci with previously established influences on hippocampal volume and intracranial volume. These variants show specific volumetric effects on brain structures rather than global effects across structures. The strongest effects were found for the putamen, where a novel intergenic locus with replicable influence on volume (rs945270; P = 1.08×10 -33; 0.52% variance explained) showed evidence of altering the expression of the KTN1 gene in both brain and blood tissue. Variants influencing putamen volume clustered near developmental genes that regulate apoptosis, axon guidance and vesicle transport. Identification of these genetic variants provides insight into the causes of variability in human brain development, and may help to determine mechanisms of neuropsychiatric dysfunction.

Identification of common variants associated with human hippocampal and intracranial volumes

Identifying genetic variants influencing human brain structures may reveal new biological mechanisms underlying cognition and neuropsychiatric illness. The volume of the hippocampus is a biomarker of incipient Alzheimer's disease and is reduced in schizophrenia, major depression and mesial temporal lobe epilepsy. Whereas many brain imaging phenotypes are highly heritable, identifying and replicating genetic influences has been difficult, as small effects and the high costs of magnetic resonance imaging (MRI) have led to underpowered studies. Here we report genome-wide association meta-analyses and replication for mean bilateral hippocampal, total brain and intracranial volumes from a large multinational consortium. The intergenic variant rs7294919 was associated with hippocampal volume (12q24.22; N = 21,151; P = 6.70 × 10 -16) and the expression levels of the positional candidate gene TESC in brain tissue. Additionally, rs10784502, located within HMGA2, was associated with intracranial volume (12q14.3; N = 15,782; P = 1.12 × 10 -12). We also identified a suggestive association with total brain volume at rs10494373 within DDR2 (1q23.3; N = 6,500; P = 5.81 × 10 -7).