Paediatric nonbronchoscopic bronchoalveolar lavage: Overview and recommendations for clinical practice

NB-BAL is an effective procedure for the diagnosis of pulmonary disease processes in ventilated infants and children. This procedure is, however, not without risks to both patients and staff. Numerous complications of NB-BAL exist, with hypoxia being the most common. As a result, care should be taken in performing NB-BAL on haemodynamically unstable patients; patients with coagulation defects; and patients with cardiac or brain abnormalities. This paper presents an overview of paediatric nonbronchoscopic bronchoalveolar lavage (NB-BAL) including: the rationale for NB-BAL; the complications associated with the procedure; indications and contraindications. It also recommends an evidence-based clinical guideline for performing the procedure in the paediatric intensive care unit. By following the NB-BAL guidelines presented in this paper, one can ensure that an effective specimen is obtained from the lower respiratory tract, whilst minimising the risk to the patient

Lung function in South African children with cystic fibrosis

Objective: To determine the pattern of lung function in stable cystic fibrosis (CF) patients and to investigate the relationship of abnormal lung function to demographic variables, CF genotype and pulmonary colonisation with Pseudomonas aeruginosa (PA)Design: A descriptive study done at the CF clinic at Red Cross War Memorial Children's Hospital in Cape Town.Methods: Data were recorded and pulmonary function testing (PFT) was performed in 42 CF patients.Results: 29 patients (69%) had mild disease,. while 11 (26%) and 2 (5%) had moderate and severe disease respectively. Twenty-four patients (57'%) demonstrated lower airway obstruction (LAO). Patients with moderate or severe disease were significantly older than those with mild disease (13.3 (3.7) years (mean (SD)) compared with 11.1 (3.0) years (t =2.1; P =OM)). PA colonisation status differed significantly with the pattern of lung function (X2 =6.6; P = 0.04) and severity of lung disease (X2=12.6; P =0.002.). Nine (35%) of the 26 patients tested before and after broncbodilator therapy showed a positive response.Conclusion: The majority of patients had mildly impaired or normal lung function, with LAO predominating. A minority of patients were bronchodilator-responsive. PA colonisation may be associated with the development of abnormal lung function and more severe pulmonary disease.

Parental satisfaction with the quality of care in a South African paediatric intensive care unit

Background. The quality of family-centred care in the paediatric intensive care unit (PICU) has been poorly studied in South Africa (SA). Objective. To explore parents’ satisfaction with care in a PICU in SA. Methods. A prospective descriptive survey study was conducted among a convenience sample of 100 parents of children admitted to the PICU for ≥48 hours. Participants completed the EMpowerment of PArents in THe Intensive Care (EMPATHIC-30) questionnaire, which includes 30 closed questions rating satisfaction in different domains and four open-ended questions to qualitatively describe PICU experiences. Results. Of the 100 admissions included in the study, 35% were unplanned and 88% were mechanically ventilated. Parents were very satisfied with the quality of PICU care, with mean scores in all domains reaching ≥5.5 on a 6-point Likert scale. Parents were most satisfied with the professional attitude of PICU staff, whereas the lowest scores were seen in the ‘Information’ and ‘Parental participation’ domains. The internal consistency (Cronbach’s α) associated with the different domains ranged between 0.25 (Parental participation) and 0.59 (Care and cure). The need for communication and support during the admission period, and the importance of environmental factors, proximity to the child, the attitude of medical staff and social support during the PICU stay emerged as common themes from the responses to the open-ended questions. Conclusion. Although parents were generally well satisfied with the quality of care, improving family involvement and providing adequate information in the PICU can contribute to quality family-centred care. Keywords. Family- centered care; patient- centered care; paediatric intensive care unit; quality of car

Medics in southern Queensland: Effects of sowing method, weed control and phosphorus application on plant population and biomass

Declining sown pasture productivity as a result of a tie-up in plant available soil nitrogen is an ongoing constraint to grazing production across the brigalow bioregion of central and southern Queensland. Research suggests that legume establishment offers the most cost effective long-term remediation strategy for improving pasture quality and yield. Within southern Queensland, medics (Medicago spp.) can provide valuable winter contributions to dietary protein and soil nitrogen, however establishment and yields are frequently poor and soil phosphorus often limiting. An experiment was established across two soil types (brigalow clay and poplar box red loam) 70 km north of Goondiwindi, Queensland to investigate the effects of sowing method, weed control and phosphorus fertiliser application on the establishment and yield of a mix of three medic cultivars (Medicago truncatula cv. Jester & cv .Caliph and Medicago orbicularis cv. Bindaroo Gold). On both soil types, plant population and biomass were significantly improved via direct drilling of seed as compared to broadcasting. On the loam, drilling increased average populations by between 519 and 1,900% above those recorded in broadcast treatments and improved biomass by between 144 and 315%. On the clay soil, drilling increased populations by between 339 and 983% above those measured in broadcast treatments. Clay soil drilling showed biomass improvements of between 124 and 1,368%. No significant biomass or legume population treatment effects were observed on the clay soil. No significant treatment effects were observed for yield on the loam soil. This study implies that medic establishment, plant populations and biomass can be greatly improved through the application of seed drilling

Characteristics and outcome of long-stay patients in a paediatric intensive care unit in Cape Town, South Africa

Background. Paediatric intensive care is a costly, specialised and limited resource in low- and middle-income countries. The implications of extended paediatric intensive care unit (PICU) stay in South Africa (SA) are not known.Objectives. To describe the characteristics, outcomes and resource consumption of long-stay patients (LSPs) and to identify predictive factors for long PICU stay.Methods. A retrospective review of routinely collected data on all children admitted to an SA PICU over one calendar year. Long PICU stay was defined statistically as >19 days. Long- and short-stay patient (SSP) groups were compared, and variables significantly associated with long stay on univariate analysis were entered into a stepwise multiple regression model.Results. Over the study period, 1 126 children (median age 8 months, 60.9% male) were admitted to the PICU, occupying 5 936 bed-days; 54  LSPs (4.8%) utilised 1 807 (30.4%) bed-days. Mortality and the standardised mortality ratio (actual/mean predicted mortality) in LSPs and SSPs were 29.6% v. 12% (p=0.002) and 2.4 v. 0.7 (p=0.002), respectively. Median duration of stay for LSPs and SSPs was 29.5 days and 2 days, respectively (p<0.0001). LSPs were younger than SSPs (median 4 months (interquartile range 2 - 17) v. 9 months (2 - 34); p=0.03), and fewer were male (48% v. 61.6%, p=0.049). On multivariate analysis, only female gender was independently associated with long PICU stay.Conclusions. LSPs represent a small proportion of PICU admissions, yet have a higher mortality rate than SSPs and consume disproportionate PICU resources. No predictive model could be established for early recognition of potential LSPs to plan PICU bed allocation effectively

Determining the extent of declining pasture productivity with nitrogen fertiliser

Declining productivity of sown pastures due to a reduction in plant available soil nitrogen has typically reduced grass and beef production by 50% since initial land development within the Brigalow bioregion of southern and central Queensland. As this decline continues, it’s estimated it will cost the northern beef industry more than $17 billion over the next 30 years. To assist landholders determine the extent of declining pasture productivity on their own properties, and assess the magnitude of response if more nitrogen is made available, nitrogen fertiliser was applied to approximately 70 replicated and non-replicated sites across southern and central Queensland between 2012 and 2014. Nitrogen (N) fertiliser as Green Urea NV® (Incitec Fertilisers) was broadcast onto existing grass-pastures in the lead up to a forecast rainfall event in summer. A range of rates were applied, from 25 – 200 kg N/ha, and dry matter yields and protein levels were measured. At all sites the grass pasture responded to the added nitrogen, with the magnitude of response dependant on the amount of nitrogen applied. As the production from sown pastures continues to decline, options that improve nitrogen supply and address this decline will be required to improve beef production across the northern region

Characteristics course and outcomes of children admitted to a paediatric intensive care unit after cardiac arrest

Background. Cardiac arrest is a potentially devastating event, associated with death or severe neurological complications in survivors. There is little evidence on paediatric cardiac arrest prevalence, characteristics and outcomes in South Africa (SA). Objective. To describe the characteristics, course and outcomes of children admitted to an SA paediatric intensive care unit (PICU) following cardiac arrest. Methods. Retrospective descriptive study of routinely collected data (January 2010 - December 2011). Results. Of 2 501 PICU admissions, 110 (4.4%) had preceding cardiac arrest. The median (interquartile range (IQR)) age of children was 7.2 (2.5 - 21.6) months. In-hospital arrests accounted for 80.6% of the events. The most common primary diagnostic categories were respiratory (29.1%), cardiovascular (21.4%) and gastrointestinal (21.4%). Twenty-four patients (23.3%) arrested during endotracheal intubation. Cardiopulmonary resuscitation (CPR) was applied for a median (IQR) of 10 (5 - 20) minutes. Duration of CPR for non-survivors and survivors was 17.5 (10 - 30) v. 10 (5 - 15) minutes (p=0.006). PICU mortality was 38.8%, with half of the deaths occurring within 24 hours of admission. The standardised mortality ratio was 0.7. The median (IQR) length of stay in the PICU and hospital was 3 (1 - 8) and 27 (9 -52) days, respectively. No independent predictors of mortality were identified. Thirty-nine surviving patients (76.5%) had normal neurological function or mild disability at follow-up after hospital discharge. Six (11.8%) survived with severe disability. Conclusion. Mortality was lower than predicted in children admitted to the PICU following cardiac arrest. The majority of survivors had good neurological outcomes

Queensland SharkSmart Drone Trial Final Report

Remotely Piloted Aircraft Systems, commonly called drones, provide a high-definition aerial view of a wide expanse of ocean, allowing the detection of potentially dangerous sharks in real-time, whilst having a negligible impact on the environment and non-target species. In addition, they are capable of spotting a range of marine hazards and can assist in beach rescue operations, thus providing numerous safety benefits for water users. The beaches of South-East Queensland (SEQ) have relatively good water clarity and a high level of visitation, making them an ideal location to test drones for detecting sharks and improving the safety of water users (Cardno, 2019). North Queensland beaches typically have lower water clarity, although it is important to test drones under these conditions to assess whether they can be effective at detecting sharks. The Queensland SharkSmart drone trial commenced on 19 September 2020, as a partnership between the Queensland Government Department of Agriculture and Fisheries (DAF) and Surf Life Saving Queensland (SLSQ). The trial was part of the Queensland Government’s commitment to research and trialling alternatives to traditional shark control measures. Drones were operated at two beaches on the Sunshine Coast (Alexandra Headland and Coolum North), two beaches on the Gold Coast (Southport Main Beach and Burleigh Beach) and one beach on North Stradbroke Island (NSI; Ocean beach) between 19 September 2020 and 4 October 2021. Additionally, to assess the effectiveness of drones at detecting sharks under the different environmental conditions found at North Queensland (NQ) beaches, drones were operated at Palm Cove, Cairns and Alma Bay, Magnetic Island, from 26 June 2021 to 31 October 2021. Drones were operated on weekends, public holidays and school holidays by SLSQ pilots, with two flights per hour from approximately 8am until midday. Flights lasted 15 - 20 minutes and followed a 400 m transect behind the surf break. All footage was collected in 4K and securely archived for later analysis with key operational and environmental data collected for every flight. When a shark was sighted, the drone pilot lowered the aircraft to determine the species and size while estimating distance of the animal from water users. Data analysis quantified the numbers of sharks sighted at each beach and the rate of sightings as a percentage across the whole trial from 19 September 2020 to 31 October 2021. Generalised Linear Mixed Models (GLMMs) were applied to quantify the influence of environmental and operational factors on the sightability (probability of a shark being sighted) of sharks. The movement tracks of sharks were mapped to analyse their behaviour and identify if there was clustering of movements in certain areas. Sighting rates from drones were also compared with shark catch in adjacent nets and drumlines deployed as part of the Queensland Shark Control Program (SCP)

Best Practice in Conceptual Modelling for Environmental Software Development

Conceptual modelling is used in many fields with a varying degree of formality. In environmental applications, conceptual models are used to express relationships, explore and test ideas, check inference and causality, identify knowledge and data gaps, synchronize mental models and build consensus, and to highlight key or dominant processes. Conceptual model representations range from simple box and line interaction diagrams, through interaction representations and causal models, to complicated formal representations of the relationships between actors or entities, or between states and processes. Due to their sometimes apparent simplicity, the development and use of a conceptual model is often an attractive option when tackling an environmental problem where the system is either not well understood, or where the understanding of the system is not shared amongst stakeholders. However, we have experienced many examples where conceptual modelling has failed to live up to the promises of managing complexity and aiding decision making. This paper explores the development and application of conceptual modelling to environmental problems, and identifies a range of best practices for environmental scientists and managers that include considerations of stakeholder participation, model development and representation, integration of different and disparate conceptual models, model maturation, testing, and transition to application within the problem situation

Sustainable sorbitol-derived compounds for gelation of the full range of ethanol–water mixtures

During the development of soft material systems inspired by green chemistry, we show that naturally occurring starting materials can be used to prepare mono- and di-benzylidene sorbitol derivatives. These compounds gelate a range of organic, aqueous (including with mono and divalent metal salt solutions) and ethanolic (ethanol–water) solutions, with the equimolar mixture of two of the gelators gelling all compositions from 100% ethanol to 100% water (something neither of the individual components do). We explored the influence of modifications to the acetal substituents on the formation of the compounds as well as the impact of steric bulk on self-assembly properties of the gelators. The effect of solvent on the self-assembly, morphology, and rheology of the 1,3:2,4-di(4-isopropylbenzylidene)-D-sorbitol (DBS-iPr), 2,4(4-isopropylbenzylidene)-D-sorbitol (MBS-iPr) and the equimolar multicomponent (DBS–MBS-iPr) gels have been investigated. DBS-iPr gelates polar solvents to form smooth flat fibres, whereas in non-polar solvents such as cyclohexane helical fibres grow where the chirality is determined by the stereochemistry of the sugar. Oscillatory rheology revealed that MBS-iPr gels have appreciable strength and elasticity, in comparison to DBS-iPr gels, regardless of the solvent medium employed. Powder X-ray diffraction was used to probe the arrangement of the gelators in the xerogels they form, and two single crystal X-ray structures of related MBS derivatives give the first precise structural information concerning layering and hydrogen bonding in the monobenzylidene compounds. This kind of layering could explain the apparent self-sorting behaviour of the DBS–MBS-iPr multicomponent gels. The combination of sorbitol-derived gelators reported in this work could find potential applications as multicomponent systems, for example, in soft materials for personal care products, polymer nucleation/clarification, and energy technology