“Never mind the logic, give me the numbers”: Former Australian health ministers’ perspectives on the social determinants of health

The articulation of strong evidence and moral arguments about the importance of social determinants of health (SDH) and health equity has not led to commensurate action to address them. Policy windows open when, simultaneously, an issue is recognised as a problem, policy formulation and refinement happens and the political will for action is present. We report on qualitative interviews with 20 former Australian Federal, State or Territory health ministers conducted between September 2011 and January 2012 concerning their views about how and why the windows of policy opportunity on the SDH did or did not open during their tenure. Almost all ex-health ministers were aware of the existence of health inequalities and SDH but their complexity meant that this awareness rarely crystalised into a clear problem other than as a focus on high needs groups, especially Aboriginal people. Formulation of policies about SDH was assisted by cross-portfolio structures, policy entrepreneurs, and evidence from reviews and reports. It was hindered by the complexity of SDH policy, the dominance of medical power and paradigms and the weakness of the policy community advocating for SDH. The political stream was enabling when the general ideological climate was supportive of redistributive policies, the health care sector was not perceived to be in crisis, there was support for action from the head of government and cabinet colleagues, and no opposition from powerful lobby groups. There have been instances of Australian health policy which addressed the SDH over the past twenty five years but they are rare and the windows of opportunity that made them possible did not stay open for long

Continuous low-dose antibiotic prophylaxis for adults with repeated urinary tract infections (AnTIC): a randomised, open-label trial

Funder: UK National Institute for Health Research. Open Access funded by Department of Health UK Acknowledgments We thank all the participants for their commitment to the study, Sheila Wallace for updating the systematic review, members of the Trial Steering Committee and members of the Data Monitoring Committee for their valuable guidance. We thank the National Health Service organisations, principal investigators and local research staff who hosted and ran the study at site. We thank the Health Technology Assessment Programme of the UK NIHR for funding the study (no. 11/72/01). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the UK Government Department of Health. A full report of the study30 has been published by the NIHR Library.Peer reviewedPublisher PD

Recruitment, growth and mortality of an Antarctic hexactinellid sponge, Anoxycalyx joubini.

Polar ecosystems are sensitive to climate forcing, and we often lack baselines to evaluate changes. Here we report a nearly 50-year study in which a sudden shift in the population dynamics of an ecologically important, structure-forming hexactinellid sponge, Anoxycalyx joubini was observed. This is the largest Antarctic sponge, with individuals growing over two meters tall. In order to investigate life history characteristics of Antarctic marine invertebrates, artificial substrata were deployed at a number of sites in the southern portion of the Ross Sea between 1967 and 1975. Over a 22-year period, no growth or settlement was recorded for A. joubini on these substrata; however, in 2004 and 2010, A. joubini was observed to have settled and grown to large sizes on some but not all artificial substrata. This single settlement and growth event correlates with a region-wide shift in phytoplankton productivity driven by the calving of a massive iceberg. We also report almost complete mortality of large sponges followed over 40 years. Given our warming global climate, similar system-wide changes are expected in the future

Accurately measuring the abundance of benthic microalgae in spatially variable habitats

Although many studies measure the abundance of benthic microalgae (BMA), at the meters squared scale, comparing these studies is difficult due to the variety of sampling, extraction, and analysis techniques. This difficulty is exacerbated by the fact that BMA abundance has high spatial and temporal variability, at all spatial scales. A suitable standard sampling regimen would reduce variation in estimates due to different sample collection and processing greatly facilitating comparisons between studies. This study examined the effect of varying the volume of extraction solvent, sampling core diameter, and sample replication on BMA biomass estimates. Key findings, applicable to all spatial scales, to accurately determine biomass were the use of a minimum sediment to extraction solvent ratio of 1:2 and use of a sampling core diameter of 19 mm. Across a wide range of sediment types, at the meters squared scale and using spectrophotometric techniques, a minimum replication number of 8 was found to be appropriate. We report the significant effect coring depth and units of expression have on BMA biomass estimates across a range of sediment types, highlighting the potential pitfalls when comparing studies

Ice Cores from the St. Elias Mountains, Yukon, Canada: Their Significance for Climate, Atmospheric Composition and Volcanism in the North Pacific Region

A major achievement in research supported by the Kluane Lake Research Station was the recovery, in 2001 –02, of a suite of cores from the icefields of the central St. Elias Mountains, Yukon, by teams of researchers from Canada, the United States, and Japan. This project led to the development of parallel, long (103 – 104 year) ice-core records of climate and atmospheric change over an altitudinal range of more than 2 km, from the Eclipse Icefield (3017 m) to the ice-covered plateau of Mt. Logan (5340 m). These efforts built on earlier work recovering single ice cores in this region. Comparison of these records has allowed for variations in climate and atmospheric composition to be linked with changes in the vertical structure and dynamics of the North Pacific atmosphere, providing a unique perspective on these changes over the Holocene. Owing to their privileged location, cores from the St. Elias Icefields also contain a remarkably detailed record of aerosols from various sources around or across the North Pacific. In this paper we review major scientific findings from the study of St. Elias Mountain ice cores, focusing on five main themes: (1) The record of stable water isotopes (δ18O, δD), which has unique characteristics that differ from those of Greenland, other Arctic ice cores, and even among sites in the St. Elias; (2) the snow accumulation history; (3) the record of pollen, biomass burning aerosol, and desert dust deposition; (4) the record of long-range air pollutant deposition (sulphate and lead); and (5) the record of paleo-volcanism. Our discussion draws on studies published since 2000, but based on older ice cores from the St. Elias Mountains obtained in 1980 and 1996

Continuous low-dose antibiotic prophylaxis to prevent urinary tract infection in adults who perform clean intermittent self-catheterisation: the AnTIC RCT

Peer reviewedPublisher PD

969-99 Biocompatible Mechanical Left Ventricular Support: Potential Alternative to Transplantation

Use of mechanical circulatory support has been limited by its associated bleeding and thrombotic complications. Blood contact with an artificial surface results in a well-deined pattern of hematologic alterations. The TCI HeartMate® left ventricular assist device (LVAD) is an implantable circulatory support pump currently used as a bridge to transplantation. Its textured blood contacting surfaces result in a formation of an adherent pseudoneointimal lining which eliminates the direct interaction of blood elements with the artificial surface. To determine if this biological lining could mitigate the stereotypical blood-synthetic surface interactions, we studied eight patients who underwent implantation at our institution over a 10 month period from 5/93 to 3/94. Seven of the 8 patients were bridged to transplantation. Three patients were transplanted within 10 days and one month data could not be obtained. Hemodynamic and hemostatic parameters (mean±sd) were studied as follows:Pre-implantPOD 7POD 28Cardiac index (I/min/m2)1.8±0.73.2±0.43.1±0.5Systolic BP (mmHg)759±6.8125.8±9.7130.4±8.1Hemoglobin (mg/dl)7.4±1.88.2±1.69.6±2.0Plasma free hemoglobin (mg/dl)15.4±1.76.4±2.36.8±1.9Prothrombin time (sec)14.2±1.113.4±0.713.3±0.7Partial thromboplastin time (sec)56.7±15.931.8±4.837.6±11.9Platelet count (× 103lcu mm)250±81269±63325±37In vitro platelet reactivity to the agonist ADP remained normal pre and post implantation. Average perioperative blood requirements included PRBC, 3.3±1.3 units; platelets, 2.3±4.5 units; fresh frozen plasma, 2±1.9 units. No blood products were required after postoperative day 2.We conclude that TCI LVAD support improves hemodynamics and can bridge patients in pre-implant cardiogenic shock to transplantation. Furthermore, no red cell destruction or hemostatic and thrombotic complications were observed despite one month of support without anticoagulation therapy. Therefore, as the donor shortage continues, LVADs with biocompatible surfaces may provide an alternative to cardiac transplantation

Long-term effect of azithromycin in bronchiolitis obliterans syndrome

Introduction Azithromycin stabilises and improves lung function forced expiratory volume in one second (FEV1) in lung transplantation patients with bronchiolitis obliterans syndrome (BOS). A post hoc analysis was performed to assess the long-term effect of azithromycin on FEV1, BOS progression and survival. Methods Eligible patients recruited for the initial randomised placebo-controlled trial received open-label azithromycin after 3 months and were followed up until 6 years after inclusion (n=45) to assess FEV1, BOS free progression and overall survival. Results FEV1 in the placebo group improved after open-label azithromycin and was comparable with the treatment group by 6 months. FEV1 decreased after 1 and 5 years and was not different between groups. Patients (n=18) with rapid progression of BOS underwent total lymphoid irradiation ( TLI). Progression-free survival (log-rank test p=0.40) and overall survival (log-rank test p=0.28) were comparable. Survival of patients with early BOS was similar to late-onset BOS (log-rank test p=0.74). Discussion Long-term treatment with azithromycin slows down the progression of BOS, although the effect of TLI may affect the observed attenuation of FEV1 decline. BOS progression and long-term survival were not affected by randomisation to the placebo group, given the early cross-over to azithromycin and possibly due to TLI in case of further progression. Performing randomised placebo-controlled trials in lung transplantation patients with BOS with a blinded trial duration is feasible, effective and safe