Exercise Induced Systemic Venous Hypertension in the Fontan Circulation

Increasingly end-organ injury is being demonstrated late after institution of the Fontan circulation, particularly liver fibrosis and cirrhosis. The exact mechanisms for these late phenomena remain largely elusive. Hypothesizing that exercise induces precipitous systemic venous hypertension and insufficient cardiac output for the exercise demand, i.e. a possible mechanism for end-organ injury, we sought to demonstrate the dynamic exercise responses in systemic venous (SVP) and concurrent end organ perfusion. Ten stable Fontan patients and 9 control subjects underwent incremental cycle ergometry based cardiopulmonary exercise testing. SVP was monitored in the right upper limb and regional tissue oxygen saturation was monitored in the brain and kidney using Near Infrared Spectroscopy. SVP rose profoundly in concert with workload in the Fontan group, described by the regression equation 15.97+0.073 Watts per mm Hg. In contrast SVP did not change in healthy controls. Regional renal (p<0.01) and cerebral tissue saturations (p<0.001) were significantly lower and fell more rapidly in Fontan patients. We conclude that in a stable group of adult patients with Fontan circulation high intensity exercise was associated with systemic venous hypertension and reduced systemic oxygen delivery. This physiologic substrate has the potential to contribute to endorgan injury

Australia\u27s health 2000 : the seventh biennial report of the Australian Institute of Health and Welfare

Australia\u27s Health 2000 is the seventh biennial health report of the Australian Institute of Health and Welfare. It is the nation\u27s authoritative source of information on patterns of health and illness, determinants of health, the supply and use of health services, and health services costs and performance.This 2000 edition serves as a summary of Australia\u27s health record at the end of the twentieth century. In addition, a special chapter is presented on changes in Australia\u27s disease profile over the last 100 years.Australia\u27s Health 2000 is an essential reference and information source for all Australians with an interest in health

Australia\u27s health 2002 : the eighth biennial report of the Australian Institute of Health and Welfare

Australia\u27s Health 2002 is the eighth biennial health report of the Australian Institute of Health and Welfare. It is the nation\u27s authoritative source of information on patterns of health and illness, determinants of health, the supply and use of health services, and health service costs and performance. Australia\u27s Health 2002 is an essential reference and information resource for all Australians with an interest in health

Australian Bat Lyssavirus in Australia - an inter-sectoral "One Health" Approach to Disease Management

Australian bat lyssavirus causes disease in bats and, on two occasions in the 1990 s, also caused a fatal meningoencephalitis in humans; there have been no reports of disease in other animals resulting from ABLV infection. Data on bat diseases in Australia have been collected under the Bat Surveillance Project Australian Wildlife Health Network since 1996. The data have informed understanding of the potential risks of ABLV to human and animal health and the development of relevant animal and public health policy. In Australia human rabies immunoglobulin (RIG) is used as part of an ABLV post exposure treatment protocol. In recent years there has been increased demand for RIG for post exposure prophylaxis of Australians exposed to potentially rabid animals while overseas. There is now considerable pressure on this increasingly scarce resource. This paper discusses the commitment of Commonwealth and State Government health and wildlife agencies to a ‘partnership’ approach under the One Health’’ concept, relating to the use of scarce therapeutic resources, and national surveillance capabilities for diseases emerging from wildlife, many of which affect trade, human health and biodiversity

A multi-state outbreak of Salmonella Saintpaul in Australia associated with cantaloupe consumption

A multi-state outbreak of Salmonella enterica serovar Saintpaul infection occurred in Australia during October 2006. A case-control study conducted in three affected jurisdictions, New South Wales, Victoria and Australian Capital Territory, included 36 cases with the outbreak-specific strain of S. Saintpaul identified by multiple locus variable-number tandem repeat analysis (MLVA) in a faecal specimen and 106 controls. Consumption of cantaloupe (rockmelon) was strongly associated with illness (adjusted OR 23·9 95%, 95% CI 5·1-112·4). S. Saintpaul, with the outbreak MLVA profile, was detected on the skin of two cantaloupes obtained from an implicated retailer. Trace-back investigations did not identify the specific source of the outbreak strain of S. Saintpaul, but multiple Salmonella spp. were detected in environmental samples from farms and packing plants investigated during the trace-back operation. Cantaloupe production and processing practices pose a potential public health threat requiring regulatory and community educational interventions

Diffusion tractography of the fornix in schizophrenia

Background: White matter fiber tracts, especially those interconnecting the frontal and temporal lobes, are likely implicated in pathophysiology of schizophrenia. Very few studies, however, have focused on the fornix, a compact bundle of white matter fibers, projecting from the hippocampus to the septum, anterior nucleus of the thalamus and the mamillary bodies. Diffusion Tensor Imaging (DTI), and a new post-processing method, fiber tractography, provides a unique opportunity to visualize and to quantify entire trajectories of fiber bundles, such as the fornix, in vivo. We applied these techniques to quantify fornix diffusion anisotropy in schizophrenia. Methods: DTI images were used to evaluate the left and the right fornix in 36 male patients diagnosed with chronic schizophrenia and 35 male healthy individuals, group matched on age, parental socioeconomic status, and handedness. Regions of interest were drawn manually, blind to group membership, to guide tractography, and Fractional Anisotropy (FA), a measure of fiber integrity, was calculated and averaged over the entire tract for each subject. The Doors and People test (DPT) was used to evaluate visual and verbal memory, combined recall and combined recognition. Results: Analysis of variance was performed and findings demonstrated a difference between patients with schizophrenia and controls for fornix FA (P=0.006). Protected post-hoc independent sample t-tests demonstrated a bilateral FA decrease in schizophrenia, compared with control subjects (left side: P=0.048; right side P=0.006). Higher fornix FA was statistically significantly correlated with DPT and measures of combined visual memory (r=.554, p=.026), combined verbal memory (r=.647, p=.007), combined recall (r=.516, p=.041), and combined recognition (r=.710, p=.002) for the control group. No such statistically significant correlations were found in the patient group. Conclusions: Our findings show the utility of applying DTI and tractography to study white matter fiber tracts in vivo in schizophrenia. Specifically, we observed a bilateral disruption in fornix integrity in schizophrenia, thus broadening our understanding of the pathophysiology of this disease

Anterior limb of the internal capsule in schizophrenia: a diffusion tensor tractography study

Thalamo-cortical feedback loops play a key role in the processing and coordination of processing and integration of perceptual inputs and outputs, and disruption in this connection has long been hypothesized to contribute significantly to neuropsychological disturbances in schizophrenia. To test this hypothesis, we applied diffusion tensor tractography on eighteen patients suffering schizophrenia and 20 control subjects. Fractional anisotropy (FA) was evaluated in the bilateral anterior and posterior limbs of the internal capsule, and correlated with clinical and neurocognitive measures. Patients diagnosed with schizophrenia showed significantly reduced FA bilaterally in the anterior but not the posterior limb of the internal capsule, compared with healthy control subjects. Lower FA correlated with lower scores on tests of declarative episodic memory in the patient group only. These findings suggest that disruptions, bilaterally, in thalamo-cortical connections in schizophrenia may contribute to disease-related impairment in the coordination of mnemonic processes of encoding and retrieval that are vital for efficient learning of new information

Cross-Utilization of Workers Whose Capabilities Differ

This paper develops a model for allocating cross-trained workers at the beginning of a shift in a multidepartment service environment. It assumes departments are trying to maximize objective functions that are concave with respect to the number of workers assigned. Worker capabilities are described by parameters that range from zero to one, with fractional values representing workers who are less than fully qualified. The nonlinear programming model presented is a variant of the generalized assignment problem. The model is used in a series of experiments to investigate the value of cross-utilization as a function of factors such as demand variability and levels of cross-training. Results show that the benefits of cross-utilization can be substantial, and in many cases a small degree of cross-training can capture most of the benefits. Beyond a certain amount additional cross-training adds little additional value, and the preferred amount depends heavily on the level of demand variability.manpower scheduling, service operations management, mathematical programming