Deprivation and its impact on non-urgent Paediatric Emergency Department use: are Nurse Practitioners the answer?

‘This is the peer reviewed version of the following article: Parry Y.K., Ullah S., Raftos J. & Willis E. (2015) Deprivation and its impact on non-urgent Paediatric Emergency Department use: are Nurse Practitioners the answer? Journal of Advanced Nursing 00(0), 000–000. doi: 10.1111/jan.12810, First published online 18 SEP 2015. This item is under embargo according to publisher policy and will be available from 19 SEP 2016Aims: This paper reports on the quantitative findings from a large mixed method study that determined the extent to which the provision of alternatives to an Emergency Department, and Index of Relative Social Disadvantage score influenced non-urgent paediatric Emergency Department use. Background: In Australia there is an increasing use of Emergency Departments for the provision of non-urgent care that may be better serviced in the community. Further, despite the plethora of literature describing the characteristics of non-urgent users of Emergency Departments the link to social and community characteristics remains under explored. Design: This 2010 retrospective analysis of the Hospital Admission Status data from the paediatric Emergency Department provided the information on attendance types and numbers along with postcode details. The postcodes in conjunction with Australia Bureau of Statistics data provided the levels of deprivation from the Index of Relative Social Deprivation scores. Method: A logistic regression analysis determined the levels of influence of deprivation and General Practitioner or Nurse Practitioner provision on the use of ED for non-urgent care. Findings: Rates of use for non-urgent care is higher for populations who come from areas of deprivation and have limited primary care services, such as low levels of General Practitioners. Children from areas of high deprivation and limited access to primary care were up to 6 times more likely to use Emergency Department for non-urgent care. Conclusions: Deprivation impacts on the use of paediatric ED for non-urgent care even in countries like Australia where there is government subsidised health care

Disease prevention strategies for QX disease (Marteilia sydneyi) of Sydney rock oysters (Saccostrea glomerata)

The Sydney rock oyster (Saccostrea glomerata) forms the basis of an important aquaculture industry on the east coast of Australia. During the 1970s, production of S. glomerata began to decline, in part as a result of mortalities arising from Queensland unknown (QX) disease. Histological studies implicated the paramyxean parasite Marteilia sydneyi in the disease outbreaks. Disease zoning was implemented to prevent the spread of M. sydneyi-infected oysters. This control measure hindered rock oyster farming, which historically has relied on transferring wild-caught spat between estuaries for on-growing to market size and has not prevented the subsequent occurrence of QX disease in the Georges and Hawkesbury rivers in central New South Wales. Management of QX disease has been hampered by the complicated life cycle of M. sydneyi, with outbreaks of QX disease likely to be regulated by a combination of the abundance of intermediate host of M. sydneyi, environmental stressors, and the immunocompetence of S. glomerata. The future of the Sydney rock oyster industry relies on understanding these factors and progressing the industry from relying on farming wild-caught seed to the successful commercialization of hatchery-produced QX-resistant S. glomerata

Determination of glucose exchange rates and permeability of erythrocyte membrane in preeclampsia and subsequent oxidative stress-related protein damage using dynamic-19F-NMR

The cause of the pregnancy condition preeclampsia (PE) is thought to be endothelial dysfunction caused by oxidative stress. As abnormal glucose tolerance has also been associated with PE, we use a fluorinated-mimic of this metabolite to establish whether any oxidative damage to lipids and proteins in the erythrocyte membrane has increased cell membrane permeability. Data were acquired using 19F Dynamic-NMR (DNMR) to measure exchange of 3-fluoro-3-deoxyglucose (3-FDG) across the membrane of erythrocytes from 10 pregnant women (5 healthy control women, and 5 from women suffering from PE). Magnetisation transfer was measured using the 1D selective inversion and 2D EXSY pulse sequences, over a range of time delays. Integrated intensities from these experiments were used in matrix diagonalisation to estimate the values of the rate constants of exchange and membrane permeability. No significant differences were observed for the rate of exchange of 3-FDG and membrane permeability between healthy pregnant women and those suffering from PE, leading us to conclude that no oxidative damage had occurred at this carrier-protein site in the membrane

"Nested" cryptic diversity in a widespread marine ecosystem engineer: a challenge for detecting biological invasions

<p>Abstract</p> <p>Background</p> <p>Ecosystem engineers facilitate habitat formation and enhance biodiversity, but when they become invasive, they present a critical threat to native communities because they can drastically alter the receiving habitat. Management of such species thus needs to be a priority, but the poorly resolved taxonomy of many ecosystem engineers represents a major obstacle to correctly identifying them as being either native or introduced. We address this dilemma by studying the sea squirt <it>Pyura stolonifera</it>, an important ecosystem engineer that dominates coastal communities particularly in the southern hemisphere. Using DNA sequence data from four independently evolving loci, we aimed to determine levels of cryptic diversity, the invasive or native status of each regional population, and the most appropriate sampling design for identifying the geographic ranges of each evolutionary unit.</p> <p>Results</p> <p>Extensive sampling in Africa, Australasia and South America revealed the existence of "nested" levels of cryptic diversity, in which at least five distinct species can be further subdivided into smaller-scale genetic lineages. The ranges of several evolutionary units are limited by well-documented biogeographic disjunctions. Evidence for both cryptic native diversity and the existence of invasive populations allows us to considerably refine our view of the native versus introduced status of the evolutionary units within <it>Pyura stolonifera </it>in the different coastal communities they dominate.</p> <p>Conclusions</p> <p>This study illustrates the degree of taxonomic complexity that can exist within widespread species for which there is little taxonomic expertise, and it highlights the challenges involved in distinguishing between indigenous and introduced populations. The fact that multiple genetic lineages can be native to a single geographic region indicates that it is imperative to obtain samples from as many different habitat types and biotic zones as possible when attempting to identify the source region of a putative invader. "Nested" cryptic diversity, and the difficulties in correctly identifying invasive species that arise from it, represent a major challenge for managing biodiversity.</p

Genomic view of the evolution of the complement system

The recent accumulation of genomic information of many representative animals has made it possible to trace the evolution of the complement system based on the presence or absence of each complement gene in the analyzed genomes. Genome information from a few mammals, chicken, clawed frog, a few bony fish, sea squirt, fruit fly, nematoda and sea anemone indicate that bony fish and higher vertebrates share practically the same set of complement genes. This suggests that most of the gene duplications that played an essential role in establishing the mammalian complement system had occurred by the time of the teleost/mammalian divergence around 500 million years ago (MYA). Members of most complement gene families are also present in ascidians, although they do not show a one-to-one correspondence to their counterparts in higher vertebrates, indicating that the gene duplications of each gene family occurred independently in vertebrates and ascidians. The C3 and factor B genes, but probably not the other complement genes, are present in the genome of the cnidaria and some protostomes, indicating that the origin of the central part of the complement system was established more than 1,000 MYA

Bioaccumulation of heavy metals by tunicates

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Minimal and mild paediatric brain injury: a 3-year cohort of consecutive presentations

OBJECTIVE: To determine the number of children with minimal and mild traumatic brain injury (TBI) and their demographic factors, causes, associated signs/symptoms and management. METHODS: A cross-sectional analysis of consecutive presentations to a tertiary paediatric centre. RESULTS: There were 2043 presentations of minimal and mild TBI over 3 years (minimal TBI = 79.7% [n = 1628]; mild TBI = 20.3% [n = 415]). Mean age was 5.12 years (SD = 5.14) with children ≤3 years comprising 53.2% (n = 1086). There was a bimodal distribution in mild TBI with peaks at 0-2 and 13-15 years. The male-to-female ratio was 1.6:1. Only 34.6% of GCS scores were documented. Falls caused most injury. Overall, 6.3% (n = 129) required hospital admission and 29.1% (n = 594) were reviewed clinically. CONCLUSION: Minimal and mild TBI is common, representing a significant burden on individuals, families and healthcare providers. High rates of follow-up impact on the healthcare system and warrant further investigation.Remo Nunzio Russo, James Rice, Phei Ming Chern, Jeremy Rafto