Resuscitation in major burns: The problem of fluid creep

We have noticed an alarming tendency for burn patients to be over-resuscitated, and we believe that protocols should be reviewed in light of our own and international experience. We recently managed an 8-year-old boy with 52% fullthickness burns, who developed abdominal and limb compartment syndromes during the period of resuscitation. The fluid volumes infused above those calculated were 1.6 and 4.7 litres on days 1 and 2 respectively to maintain haemodynamic stability and urine output above 2 ml/kg/h. Within 48 hours of the injury, he developed poor peripheral perfusion and a distended abdomen; the intravesical pressure was 32 mmHg and the abdominal perfusion pressure 23 mmHg. Abdominal decompression and three limb fasciotomies were performed, but small-bowel and lower limb muscle necrosis had developed. The patient deteriorated rapidly despite inotropic support and died

The intensive care medicine clinical research agenda in paediatrics

BACKGROUND: Intensive Care Medicine set us the task of outlining a global clinical research agenda for paediatric intensive care (PIC). In line with the clinical focus of this journal, we have limited this to research that may directly influence patient care. METHODS: Clinician researchers from PIC research networks of varying degrees of formality from around the world were invited to answer two main questions: (1) What have been the major recent advances in paediatric critical care research? (2) What are the top 10 studies for the next 10 years? RESULTS: (1) Inclusive databases are well established in many countries. These registries allow detailed observational studies and feasibility testing of clinical trial protocols. Recent trials are larger and more valuable, and (2) most common interventions in PIC are not evidenced-based. Clinical studies for the next 10 years should address this deficit, including: ventilation techniques and interfaces; fluid, transfusion and feeding strategies; optimal targets for vital signs; multiple organ failure definitions, mechanisms and treatments; trauma, prevention and treatment; improving safety; comfort of the patient and their family; appropriate care in the face of medical complexity; defining post-PICU outcomes; and improving knowledge generation and adoption, with novel trial design and implementation strategies. The group specifically highlighted the need for research in resource-limited environments wherein mortality remains often tenfold higher than in well-resourced settings. CONCLUSIONS: Paediatric intensive care research has never been healthier, but many gaps in knowledge remain. We need to close these urgently. The impact of new knowledge will be greatest in resource-limited environments

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)

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

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

Catalyst-free hydrophosphinylation of isocyanates and isothiocyanates under low-added-solvent conditions

A catalyst-free, low-solvent method for the hydrophosphinylation of isocyanates and isothiocyanates is reported. A range of phosphorus nucleophiles including secondary phosphine oxides HP(O)R2 (R = Ph, iPr), phosphites HP(O)(OR)2 (R = Me, Et), and methyl phenylphosphinate were tested. The procedure tolerated isocyanates and isothiocyanates featuring a wide range of substituents and, with use of 4 equiv of 2-methyltetrahydrofuran (2-MeTHF), solid substrates can be utilized. Twenty-five compounds were prepared with improved functional group tolerance compared to previous methods allowing access to new compounds (16 are novel). Facile scale up and simple reaction conditions make this a straightforward and practical methodology for obtaining phosphorus analogues of ureas and thioureas, which are challenging to synthesize by other methods

Catalyst-free Hydrophosphinylation of Isocyanates and Isothiocyanates under Low-Added-Solvent Conditions

A catalyst-free, low-solvent method for the hydrophosphinylation of isocyanates and isothiocyanates is reported. A range of phosphorus nucleophiles including secondary phosphine oxides HP(O)R2 (R = Ph, i Pr), phosphites HP(O)(OR)2 (R = Me, Et), and methyl phenylphosphinate are tested. The procedure tolerates isocyanates and isothiocyanates featuring a wide range of substituents and, by using four equivalents of 2-methyltetrahydrofuran (2-MeTHF), solid substrates can be utilized. Twenty-five compounds are prepared, with improved functional group tolerance compared to previous methods and allowing access to new compounds (16 are novel). Facile scale up and simple reaction conditions make this a straightforward and practical methodology for obtaining phosphorus analogues of ureas and thioureas, which are challenging to synthesize by other methods

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

Photophysics of cage/guest assemblies : photoinduced electron transfer between a coordination cage containing osmium(II) luminophores, and electron-deficient bound guests in the central cavity

An octanuclear cubic Os4Zn4 coordination cage, containing Os(II) tris-diimine units at four of the eight vertices which are good photoelectron donors from their 3MLCT excited state, performs photoinduced electron transfer to electron-accepting organic guests which bind in the central cavity in water via the hydrophobic effect: the resulting charge-separated states have lifetimes of ca. 200 ps and have been characterized by transient absorption spectroscopy

Doing research with children and young people who do not use speech for communication

Despite emphasis in policy on participation of disabled children, we still know relatively little about how to obtain the views of disabled children with significant communication impairment and their views are often overlooked in planning and service provision. This article describes how the views of children who do not use speech were accessed in research aiming to identify disabled children and young people's priorities regarding outcomes of social care and support services. The main challenge was to develop a method that was reliable, non-threatening, enjoyable and relevant to individual children, as well as enabling children to think beyond their everyday life and express what they aspire to