Exploring the measure of potentially avoidable general practitioner-type presentations to the emergency department in regional Queensland using linked, patient-perspective data

Objective. To explore measures of potentially avoidable general practitioner (PAGP)-type presentations to the emergency department (ED) of a large regional hospital in northern Queensland. Methods. Linkage of an ED administrative dataset to a face-to-face patient survey of local residents (n = 1000); calculation of Australian Institute of Health and Welfare (AIHW) and Australasian College of Emergency Medicine (ACEM) measures of PAGP-type presentations to the ED; and exploration of these measures with patient-perspective linked data. Results. PAGP-type presenters to the ED were younger in age (median age in years: total cohort: 49; AIHW 38, P , 0.001; ACEM 36, P , 0.001); with the odds of having a chronic condition being less likely for AIHW PAGP-type presenters than other ED presenters (OR (95% CI) 0.54 (0.38–0.77): P = 0.001)) after adjustment for age. PAGP-type presenters nominated reasons of convenience rather than urgency as their rationale for attending the ED, irrespective of measure. The number of PAGP-type presentations to the ED identified by the AIHW measure was more than three-fold higher than the ACEM measure (AIHW: n = 227; ACEM: n = 67). Influencing factors include the low proportion of ED attendees who had a medical consultation time of ,1 h at this hospital site (1-month survey period: 17.8%); and differences between the patient self-report and ED administrative record for 'self-referral to the ED' (Self-referred: Survey 71% vs EDIS 93%, P , 0.001). Conclusions. Identification of PAGP-type presentations to the ED could be enhanced with improvements to the quality of administrative processes when recording patient 'self-referral to the ED', along with further consideration of hospital site variation for the length of medical consultation time

Preventable hospitalisations in regional Queensland: potential for primary health?

Objective The aims of this study were to: (1) use local health data to examine potentially preventable hospitalisations (PPHs) as a proportion of total hospital separations and estimated costs to a large regional hospital in northern Queensland, including differences associated with Indigenous status; and (2) identify priority conditions and discuss issues related to strategic local primary health intervention. Methods A cross-sectional analysis was conducted using Queensland Hospital Admitted Patient Data Collection data (July 2012–June 2014) restricted to 51 087 separations generated by 29 485 local residents. PPHs were identified from the International Statistical Classification of Diseases and Related Health Problems 10th Revision Australian Modification (ICD-10-AM) and procedure codes using National Healthcare Agreement definitions. Age-standardised separation rates were calculated using Australian 2001 reference population and associated economic costs were estimated using Australian-refined diagnosis related groups. Results Eleven per cent (n = 5488) of all hospital separations were classified as PPH, and most were for common chronic (n = 2486; 45.3%) and acute (n = 2845; 51.8%) conditions. Because many acute presentations reflect chronic underlying disease, chronic conditions account for up to 76.5% of all PPHs. Age-standardised PPH rates were 3.4-fold higher for Indigenous than non-Indigenous people. Associated 2-year costs were AU$32.7 million, which was 10.7% of estimated total health care expenditure for hospital separations, and were higher for Indigenous (14.9%) than non-Indigenous (9.7%) people. Conclusions High hospitalisation rates and costs for common preventable chronic conditions represent opportunities for primary healthcare interventions. In particular, community-level health services need to be more responsive to the needs of local Indigenous families

Episodic nitrous oxide soil emissions in Brazilian savanna (cerrado) fire-scars

The seasonally burned cerrados of Brazil are the largest savanna-type ecosystem of South America and their contribution to the global atmospheric nitrous oxide (N20) budget is unknown. Four types of fire-scarred cerrado along a vegetation gradient from grassland to forest were investigated during the wet season of 1992/93. The effect of fire and subsequent water additions on epiodic emissions of N2O and the associated profile dynamic of soil/gas phase N2O concentrations were studied for several months. Additionally, the effect on episodic emissions of N2O of nitrate and glucose additions to a cerrado soil after fire and the associated profile dynamic of soil/gas phase N2O mixing ratios were determined. Finally, N2O episodic emissions in cerrado converted to corn, soybean, and pasture fields were investigated during one growing/wet season. Results showed N2O consumption/emission for the four fire-scared savanna ecosystems, for nitrogen and carbon fertilization, and for agriculture/pasture ranging from -0.3 to +0.7, 1.8 to 9.1, and 0.5 to 3.7 g N2O-N ha(exp -1) d(exp -1), respectively. During the wet season the cerrado biome does not appear to be a major source of N2O to the troposphere, even following fire events. However, the results of this study suggest that conversion of the cerrado to high input agriculture, with liming and fertilization, can increase N2O emissions more than ten fold

Acceptability and usability of computerized cognitive assessment among Australian Indigenous residents of the Torres Strait Islands

Objectives: This cross-sectional study aimed to investigate the acceptability and usability of the Cogstate Brief Battery (CBB) in a community-based sample of Australian Indigenous people from the Torres Strait region, based on a user experience framework of human-computer interaction. Methods: Two-hundred community participants completed the four subtests of the CBB on an iPad platform, during a free adult health check on two islands in the region, between October and December 2016. Acceptability was defined as completing the learning trial of a task and usability as continuing a task through to completion, determined by examiner acumen and internal Cogstate completion and integrity criteria. These were combined into a single dichotomous completion measure for logistic regression analyses. Performance-measured as reaction times and accuracy of responses-was analyzed using linear regression analyses. Results: CBB completion ranged from 82.0% to 91.5% across the four tasks and the odds of completing decreased with age. After adjusting for age, iPad/tablet familiarity increased the odds of completion for all tasks while level of education and employment increased the odds for some tasks only. These variables accounted for 18.0%-23.8% of the variance in reaction times on speeded tasks. Age and education had the most effect, although semipartial correlations were modest. Conclusions: When administered in a health-screening context, the acceptability and usability of the CBB were greatest in young- to middle-aged participants with some education and iPad/tablet experience. Older and more vulnerable participants may have benefited from additional time and practice on the CBB prior to administration

First Multicharged Ion Irradiation Results from the CUEBIT Facility at Clemson University

A new electron beam ion trap (EBIT) based ion source and beamline were recently commissioned at Clemson University to produce decelerated beams of multi- to highly-charged ions for surface and materials physics research. This user facility is the first installation of a DREEBIT-designedsuperconducting trap and ion source (EBIS-SC) in the U.S. and includes custom-designed target preparation and irradiation setups. An overview of the source, beamline, and other facilities as well as results from first measurements on irradiated targets are discussed here. Results include extracted charge state distributions and first data on a series of irradiated metal-oxide-semiconductor (MOS) device targets. For the MOS devices, we show that voltage-dependent capacitance can serve as a record of theelectronic component of ion stopping power for an irradiated, encapsulated oxide target

Methane Flux from Drained Northern Peatlands: Effect of a Persistent Water Table Lowering on Flux

Measurements of CH4 flux from drained and undrained sites in three northern Ontario peatlands (a treed fen, a forested bog, and a treed bog) were made from the beginning of May to the end of October 1991. In the drained portions, the water table had been lowered between 0.1 and 0.5 m, compared to the water table of the undrained portion of the peatlands. The mean seasonal CH4 flux from the undrained portions of three peatlands was small, ranging from 0 to 8 mg m-2d-1, but similar to the CH4 flux from other treed and forested northern peatlands. The mean seasonal CH4 flux from the drained portion of the peatlands was either near zero or slightly negative (i.e., uptake): fluxes ranged from 0.1 to -0.4 mg m-2d-1. Profiles of CH4 in the air-filled pores in the unsaturated zone, and the water-filled pores of the saturated zone of the peat at the undrained sites, showed that all the CH4 produced at depth was consumed within 0.2 m of the water table and that atmospheric CH4 was consumed in the upper 0.15 m of the peatland. On the basis of laboratory incubations of peat slurries to determine CH4 production and consumption potentials, the lowering of the water table eliminated the near-surface zone of CH4 production that existed in the undrained peatland. However, drainage did not alter significantly the potential for CH4 oxidation between the water table and peatland surface but increased the thickness of the layer over which CH4 oxidation could take place. These changes occurred with a drop in the mean summer water table of only 0.1 m (from -0.2 to -0.3 m) suggesting that only a small negative change in soil moisture would be required to significantly reduce CH4 flux from northern peatlands

Dementia Risk Models in an Australian First Nations Population: Cross-Sectional Associations and Preparation for Follow-Up

Background: Reducing the burden of dementia in First Nations populations may be addressed through developing population specific methods to quantify future risk of dementia. Objective: To adapt existing dementia risk models to cross-sectional dementia prevalence data from a First Nations population in the Torres Strait region of Australia in preparation for follow-up of participants. To explore the diagnostic utility of these dementia risk models at detecting dementia. Methods: A literature review to identify existing externally validated dementia risk models. Adapting these models to cross-sectional data and assessing their diagnostic utility through area under the receiver operating characteristic curve (AUROC) analyses and calibration using Hosmer-Lemeshow Chi2. Results: Seven risk models could be adapted to the study data. The Aging, Cognition and Dementia (AgeCoDe) study, the Framingham Heart Study (FHS), and the Brief Dementia Screening Indicator (BDSI) had moderate diagnostic utility in identifying dementia (i.e., AUROC >0.70) before and after points for older age were removed. Conclusion: Seven existing dementia risk models could be adapted to this First Nations population, and three had some cross-sectional diagnostic utility. These models were designed to predict dementia incidence, so their applicability to identify prevalent cases would be limited. The risk scores derived in this study may have prognostic utility as participants are followed up over time. In the interim, this study highlights considerations when transporting and developing dementia risk models for First Nations populations

The Doctor and the Law: A Practical Guide for the Canadian Physician, 3rd Edition

Book review of The Doctor and the Law: A Practical Guide for the Canadian Physician, 3rd Edition by H.E. Emson and published by Butterworths (Markham, Ont.), 1995. (282 pp.