Asylum seeker’s ‘brain death’ shows failure of care and of democracy

The news that Hamid Kehazaei, a 24-year-old Iranian asylum seeker detained on Manus Island, has been diagnosed as brain dead following his transfer to the Mater Hospital in Brisbane is a tragedy. That it is a tragedy for this young man and his family is unquestionable – but the extent of this tragedy may be much more pervasive than we realise. If the emerging details of his case are correct, Kehazaei developed septicaemia as a complication of cellulitis (skin and soft-tissue infection) arising from a cut in his foot. This, in itself, is disturbing. Severe infection can result in brain death – either from infection of the brain itself (meningitis, encephalitis or brain abscess), or from brain injury due to a lack of oxygen resulting from cardiac arrest (as appears to be the case here), or from reduced blood supply to the brain. Yet it is very uncommon, especially in a young, previously healthy man. Such a case could occur in Australia and has been described in 2012 in young Indigenous adults in Central Australia. Nevertheless, severe sepsis resulting from a foot infection is preventable. And a case like this occurring in an Australian national would raise serious questions about the appropriateness of the antibiotics used and the timeliness of care. Most cases of brain death result from traumatic brain injury, stroke or lack of oxygen to the brain following asphyxia, near-drowning, or prolonged cardiopulmonary resuscitation. What happened to Hamid Kehazaei raises concerns about the adequacy of care provided to him during initial treatment, including wound care and antibiotics, and how soon he was transferred to expert medical care, first to Port Moresby and subsequently to Brisbane. If this young man became ill and had his brain die while seeking asylum in Australia and while in our care, then we must examine the details of his case and ask ourselves not only whether it was preventable but whether our policies and processes actually contributed to his death

Factors associated with first return to work and sick leave durations in workers with common mental disorders

Background: Associations are examined between socio-demographic, medical, work-related and organizational factors and the moment of first return to work (RTW) (within or after 6 weeks of sick leave) and total sick leave duration in sick leave spells due to common mental disorders. Methods: Data are derived from a Dutch database, build to provide reference data for sick leave duration for various medical conditions. The cases in this study were entered in 2004 and 2005 by specially trained occupational health physicians, based on the physician's assessment of medical and other factors. Odds ratios for first RTW and sick leave durations are calculated in logistic regression models. Results: Burnout, depression and anxiety disorder are associated with longer sick leave duration. Similar, but weaker associations were found for female sex, being a teacher, small company size and moderate or high psychosocial hazard. Distress is associated with shorter sick leave duration. Medical factors, psychosocial hazard and company size are also and analogously associated with first RTW. Part-time work is associated with delayed first RTW. The strength of the associations varies for various factors and for different sick leave durations. Conclusion: The medical diagnosis has a strong relation with the moment of first RTW and the duration of sick leave spells in mental disorders, but the influence of demographic and work-related factors should not be neglected

Participant music listening behaviours in interactive multimedia music instruction

While emerging technologies such as interactive multimedia are increasingly being employed in computerised music instruction, understanding of participant music listening behaviours in interactive multimedia music instruction is currently very limited. With the aim of elucidating music listening behaviour, the central concern of this work is to identify and explain participant interactions with the audio components of interactive multimedia music instruction. The investigation employs a novel documentation procedure, which extends the application of digital audio recording technology, to provide a finely calibrated analysis of the audio activity of a sample of 20 undergraduate music education majors during individual sessions with two commercially-available interactive multimedia music instruction programs. Graphically-based Sound Activity Profiles, which the researcher developed specifically for the current investigation, characterise and summarise participant interactions with audio components, while an analysis of questionnaire responses and follow-up interview transcripts provides supplementary information that further explains participants' music listening behaviours. The results of the investigation show that music listening behaviours during the study sessions were highly variable. While extensive participant interaction with music examples occasionally reflected attentive music listening behaviours, many study sessions were characterised by brief, fragmentary music excerpts and lengthy periods of silence. Participants spent as little as five percent of their session time listening to music and as much as 88 percent of the session time in silence. A substantial number of the study cohort frequently interrupted the music examples they had activated. Participants' perceptions of the extent of their interaction with music examples were frequently inaccurate, as subjects often substantially overestimated the amount of session time they had spent listening to music. The study findings suggest that many interactive multimedia music instruction participants would benefit from interventions that elicit more extensive and prolonged interaction with music examples. Accordingly, recommendations include a call for research to develop and test software designs that incorporate automated monitoring of session audio activity so that dynamic on-screen information about music listening behaviour can be provided to interactive multimedia music instruction participants. Such information may encourage participants to modify inappropriate music listening behaviours

Field emission in ordered arrays of ZnO nanowires prepared by nanosphere lithography and extended Fowler-Nordheim analyses

A multistage chemical method based on nanosphere lithography was used to produce hexagonally patterned arrays of ZnO vertical nanowires, with 1 lm interspacing and aspect ratio 20, with a view to study the effects of emitter uniformity on the current emitted upon application of a dc voltage across a 250 lm vacuum gap. A new treatment, based on the use of analytical expressions for the image-potential correction functions, was applied to the linear region below 2000 V of the Fowler-Nordheim (FN) plot and showed the most suitable value of the work function / in the range 3.3–4.5 eV (conduction band emission) with a Schottky lowering parameter y ~ 0.72 and a field enhancement factor c in the 700–1100 range. A modeled c value of 200 was calculated for an emitter shape of a prolate ellipsoid of revolution and also including the effect of nanowire screening, in fair agreement with the experimental value. The Fowler-Nordheim current densities and effective emission areas were derived as 1011 Am2 and 1017 m2, respectively, showing that field emission likely takes place in an area of atomic dimensions at the tip of the emitter. Possible causes for the observed departure from linear FN plot behavior above 2000 V were discussed

Decreased blood–brain barrier P-glycoprotein function in the progression of Parkinson’s disease, PSP and MSA

Decreased blood–brain barrier (BBB) efflux function of the P-glycoprotein (P-gp) transport system could facilitate the accumulation of toxic compounds in the brain, increasing the risk of neurodegenerative pathology such as Parkinson’s disease (PD). This study investigated in vivo BBB P-gp function in patients with parkinsonian neurodegenerative syndromes, using [11C]-verapamil PET in PD, PSP and MSA patients. Regional differences in distribution volume were studied using SPM with higher uptake interpreted as reduced P-gp function. Advanced PD patients and PSP patients had increased [11C]-verapamil uptake in frontal white matter regions compared to controls; while de novo PD patients showed lower uptake in midbrain and frontal regions. PSP and MSA patients had increased uptake in the basal ganglia. Decreased BBB P-gp function seems a late event in neurodegenerative disorders, and could enhance continuous neurodegeneration. Lower [11C]-verapamil uptake in midbrain and frontal regions of de novo PD patients could indicate a regional up-regulation of P-gp function

Preparing children with a mock scanner training protocol results in high quality structural and functional MRI scans

We evaluated the use of a mock scanner training protocol as an alternative for sedation and for preparing young children for (functional) magnetic resonance imaging (MRI). Children with severe mental retardation or developmental disorders were excluded. A group of 90 children (median age 6.5 years, range 3.65–14.5 years) participated in this study. Children were referred to the actual MRI investigation only when they passed the training. We assessed the pass rate of the mock scanner training sessions. In addition, the quality of both structural and functional MRI (fMRI) scans was rated on a semi-quantitative scale. The overall pass rate of the mock scanner training sessions was 85/90. Structural scans of diagnostic quality were obtained in 81/90 children, and fMRI scans with sufficient quality for further analysis were obtained in 30/43 of the children. Even in children under 7 years of age, who are generally sedated, the success rate of structural scans with diagnostic quality was 53/60. FMRI scans with sufficient quality were obtained in 23/36 of the children in this younger age group. The association between age and proportion of children with fMRI scans of sufficient quality was not statistically significant. We conclude that a mock MRI scanner training protocol can be useful to prepare children for a diagnostic MRI scan. It may reduce the need for sedation in young children undergoing MRI. Our protocol is also effective in preparing young children to participate in fMRI investigations