Palliative care: promoting general practice participation

Specialist palliative care services and services involved in the pre-palliative phase of a patient’s disease must accept GPs as an integral part of the care tea

Feedback of evidence into practice

Concern about risks associated with medical care has led to increasing interest in quality improvement processes. Most quality initiatives derive from manufacturing, where they have worked well in improving quality by small, steady increments. Adaptations of quality processes to the healthcare environment have included variations emphasising teamwork; large, ambitious increments in targets; and unorthodox approaches. Feedback of clinical information to clinicians is a central process in many quality improvement activities. It is important to choose feedback data that support the objectives for quality improvement - and not just what is expedient. Clinicians need to be better educated about the quality improvement process to maintain the quality of their care

Prevalence and risk factors of sarcopenia among adults living in nursing homes

Objectives: Sarcopenia is a progressive loss of skeletal muscle and muscle function, with significant healthand disability consequences for older adults. We aimed to evaluate the prevalence and risk factors ofsarcopenia among older residential aged care adults using the European Working Group on Sarcopeniain Older People (EWGSOP) criteria.Study design: A cross-sectional study design that assessed older people (n = 102, mean age 84.5 ± 8.2 years)residing in 11 long-term nursing homes in Australia.Main outcome measurements: Sarcopenia was diagnosed from assessments of skeletal mass index bybioelectrical impedance analysis, muscle strength by handheld dynamometer, and physical performanceby the 2.4 m habitual walking speed test. Secondary variables where collected to inform a risk factoranalysis.Results: Forty one (40.2%) participants were diagnosed as sarcopenic, 38 (95%) of whom were categorizedas having severe sarcopenia. Univariate logistic regression found that body mass index (BMI) (Oddsratio (OR) = 0.86; 95% confidence interval (CI) 0.78–0.94), low physical performance (OR = 0.83; 95% CI0.69–1.00), nutritional status (OR = 0.19; 95% CI 0.05–0.68) and sitting time (OR = 1.18; 95% CI 1.00–1.39)were predictive of sarcopenia. With multivariate logistic regression, only low BMI (OR = 0.80; 95% CI0.65–0.97) remained predictive.Conclusions: The prevalence of sarcopenia among older residential aged care adults is very high. Inaddition, low BMI is a predictive of sarcopenia

Spontaneous superrotation and the role of Kelvin waves in an idealized dry GCM

PublishedJournal ArticleThe nondimensional parameter space of an idealized dry primitive equation model is explored to find superrotating climate states. The model has no convective parameterization and is forced using a simple thermal relaxation to a prescribed radiative equilibrium temperature. It is demonstrated that, of four nondimensional parameters that determine the model's state, only the thermal Rossby number has a significant effect on superrotation. The mode that drives the transition to superrotation in an intermediate-thermal-Rossby-number atmosphere is shown to behave like a Kelvin wave in the tropics. © 2014 American Meteorological Society

Effects of the seasonal cycle on superrotation in planetary atmospheres

PublishedJournal ArticleThe dynamics of dry atmospheric general circulation model simulations forced by seasonally varying Newtonian relaxation are explored over a wide range of two control parameters and are compared with the large-scale circulation of Earth, Mars, and Titan in their relevant parameter regimes. Of the parameters that govern the behavior of the system, the thermal Rossby number (Ro) has previously been found to be important in governing the spontaneous transition from an Earth-like climatology of winds to a superrotating one with prograde equatorial winds, in the absence of a seasonal cycle. This case is somewhat unrealistic as it applies only if the planet has zero obliquity or if surface thermal inertia is very large. While Venus has nearly vanishing obliquity, Earth, Mars, and Titan (Saturn) all have obliquities of ̃25° and varying degrees of seasonality due to their differing thermal inertias and orbital periods. Motivated by this, we introduce a time-dependent Newtonian cooling to drive a seasonal cycle using idealized model forcing, and we define a second control parameter that mimics non-dimensional thermal inertia of planetary surfaces. We then perform and analyze simulations across the parameter range bracketed by Earth-like and Titan-like regimes, assess the impact on the spontaneous transition to superrotation, and compare Earth, Mars, and Titan to the model simulations in the relevant parameter regime. We find that a large seasonal cycle (small thermal inertia) prevents model atmospheres with large thermal Rossby numbers from developing superrotation by the influences of (1) cross-equatorial momentum advection by the Hadley circulation and (2) hemispherically asymmetric zonal-mean zonal winds that suppress instabilities leading to equatorial momentum convergence. We also demonstrate that baroclinic instabilities must be sufficiently weak to allow superrotation to develop. In the relevant parameter regimes, our seasonal model simulations compare favorably to large-scale, seasonal phenomena observed on Earth and Mars. In the Titan-like regime the seasonal cycle in our model acts to prevent superrotation from developing, and it is necessary to increase the value of a third parameter - the atmospheric Newtonian cooling time - to achieve a superrotating climatology. © 2014. The American Astronomical Society. All rights reserved

Saline nasal irrigation for acute upper respiratory tract infections (Review)

BACKGROUND: Acute upper respiratory tract infections (URTIs), including the common cold and rhinosinusitis, are common afflictions that cause discomfort and debilitation and contribute significantly to workplace absenteeism. Treatment is generally by antipyretic and decongestant drugs and sometimes antibiotics, even though most infections are viral. Nasal irrigation with saline is often employed as an adjunct treatment for URTI symptoms despite a relative lack of evidence for benefit in this clinical setting. This review is an update of the Cochrane review by Kassel et al, which found that saline was probably effective in reducing the severity of some symptoms associated with acute URTIs

Using illness trajectories to inform person-centred, advance care planning

What you need to know- Most patients with progressive illness follow characteristic trajectories of decline, previously identified as rapid, intermittent, or a gradual decline from a low baseline- Multimorbidity is increasingly common and follows a distinct fourth trajectory- An understanding of the dynamic multidimensional trajectories of patients with progressive illnesses helps clinicians consider individual holistic needs and have meaningful conversations with patients and families about advance care planning- In patients with an acute deterioration in health (such as from an infection), considering the main underlying illness trajectory helps guide shared decision making about realistic current and future treatment and care option

The Transition to Superrotation in Terrestrial Atmospheres

We show that by changing a single non-dimensional number, the thermal Rossby number, global atmospheric simulations with only axisymmetric forcing pass from an Earth-like atmosphere to a superrotating atmosphere that more resembles the atmospheres of Venus or Titan. The transition to superrotation occurs under conditions in which equatorward-propagating Rossby waves generated by baroclinic instability at intermediate and high latitudes are suppressed, which will occur when the deformation radius exceeds the planetary radius. At large thermal Rossby numbers following an initial, nearly axisymmetric phase, a global baroclinic wave of zonal wavenumber one generated by mixed barotropic-baroclinic instability dominates the eddy flux of zonal momentum. The global wave converges eastward zonal momentum to the equator and deposits westward momentum at intermediate latitudes during spinup and before superrotation emerges, and the baroclinic instability ceases once superrotation is established. A global barotropic mode of zonal wavenumber one generated by a mix of high- and low-latitude barotropic instability is responsible for maintaining superrotation in the statistically steady state. At intermediate thermal Rossby numbers, momentum flux by the global baroclinic mode is subdominant relative to smaller baroclinic modes, and thus strong superrotation does not develop.Comment: accepted for publication in JGR-Planet

Hospital service use for young people with chronic health conditions : a population-based matched retrospective cohort study

Aim: This study aims to identify the hospitalised morbidity associated with three common chronic health conditions among young people using a population-based matched cohort. Methods: A population-level matched case-comparison retrospective cohort study of young people aged ≤18 years hospitalised with asthma, type 1 diabetes (T1D) or epilepsy during 2005–2018 in New South Wales, Australia using linked birth, health and mortality records. The comparison cohort was matched on age, sex and residential postcode. Adjusted rate ratios (ARR) were calculated by sex and age group. Results: There were 65 055 young people hospitalised with asthma, 6648 with epilepsy, and 2209 with T1D. Young people with epilepsy (ARR 10.95; 95% confidence interval (CI) 9.98–12.02), T1D (ARR 8.64; 95% CI 7.72–9.67) or asthma (ARR 4.39; 95% CI 4.26–4.53) all had a higher risk of hospitalisation than matched peers. Admission risk was highest for males (ARR 11.00; 95% CI 9.64–12.56) and females with epilepsy (ARR 10.83; 95% CI 9.54–12.29) compared to peers. The highest admission risk by age group was for young people aged 10–14 years (ARR 5.50; 95% CI 4.77–6.34) living with asthma, children aged ≤4 years (ARR 12.68; 95% CI 11.35–14.17) for those living with epilepsy, and children aged 5–9 years (ARR 9.12; 95% CI 7.69–10.81) for those living with T1D compared to peers. Conclusions: The results will guide health service planning and highlight opportunities for better management of chronic health conditions, such as further care integration between acute, primary and community health services for young people