7 research outputs found
Fulminant Bacillus cereus food poisoning with fatal multi-organ failure.
No full textThis case represents a rare fulminant course of fried-rice associated food poisoning in an immunocompetent person due to pre-formed exotoxin produced by Bacillus cereus, with severe manifestations of sepsis, including multi-organ (hepatic, renal, cardiac, respiratory and neurological) failure, shock, metabolic acidosis, rhabdomyolysis and coagulopathy. Despite maximal supportive measures (continuous renal replacement therapy, plasmapheresis, N-acetylcysteine infusion and blood products, and broad-spectrum antimicrobials) and input from a multidisciplinary team (consisting of infectious diseases, intensive care, gastroenterology, surgery, toxicology, immunology and haematology), mortality resulted. This case is the first to use whole genome sequencing techniques to confirm the toxigenic potential of B. cereus It has important implications for food preparation and storage, particularly given its occurrence in home isolation during the COVID-19 pandemic
Pneumococcal bacteraemia in adults over a 10‐year period (2011–2020): a clinical and serotype analysis
No full textBackground: Streptococcus pneumoniae (pneumococcus) is a human nasopharyngeal tract coloniser responsible for invasive pneumococcal disease, which is largely vaccine preventable. Vaccination is recommended from birth for all, and through adulthood for those with risk conditions. Aims: To describe the clinical and serotype analysis of pneumococcus bacteraemia over a 10-year period. Methods: A 10-year (February 2011–December 2020) retrospective review was performed on all adult (age ≥18 years) pneumococcus bacteraemia presenting to the four public hospitals in Western Sydney, Australia. Comorbidities and risk factors were recorded. Results: Three hundred unique episodes of S. pneumoniae bloodstream infection (SPBI) were identified during the study period. The median age for SPBI was 63 years with 31.7% aged 70 years or older. A 94.7% had one or more risks factors for SPBI. Pneumonia was reported in 80% of all SPBI, whereas meningitis was reported in 6% and infective endocarditis in <1%. Asplenia was noted in 2.4%. Seven- and 30-day mortality was 6.6% and 11.9%, with a higher 30-day mortality in those aged ≥70 years (24.4%). The serotype distribution showed 7-valent conjugate vaccine covered 11.0% of all isolates, whereas 13-valent conjugate vaccine (13vPCV) and a 23-valent polysaccharide vaccine (23vPPV) covered 41.7% and 69.0% respectively. Immunisation details were available for 110 individuals, of whom, only 7.3% had received pneumococcal vaccination. Conclusions: Most patients with pneumococcal bacteraemia had age- or comorbidity-related risk factors but were not vaccinated. Two-thirds of cases occurred in people aged <70 years. 13vPCV and 23vPPV covered 41.7% and 69.0% of bacteraemic isolates.Full Tex
Perceptions of US and Australian medical students and instructors about clinical professional attire: Lapel study
No full textContext White coats have long been the professional uniform of physicians. However, when physicians opt to remove the white coat, their clothing underneath is brought to the forefront and can influence how they are perceived by their patients. Objective: To explore the perceptions of medical students and their instructors about appropriate clinical professional attire. MethodsAn anonymous, voluntary 55-question survey was electronically distributed to medical students and their instructors at 2 US and 2 Australian medical schools. The survey incorporated 30 images of sample attire, 9 demographic questions, and 16 questions regarding culture and context of clothing and accessories. ResultsIn total, 411 students and 73 instructors participated in this study. The data revealed that white coats and neckties are nearly absent in Australian clinical attire. Overall, students were significantly more supportive of full facial coverage due to religious or cultural values compared with instructors (P<.001), and US medical students were significantly more supportive than Australian students (P<.001). All cohorts preferred dress code policies that directed students to avoid but not prohibit the use of perfume or cologne. Nose rings were controversial with significantly more support for use from medical students than instructors (pooled cohorts, P=.002). Medical students in both the United States and Australia indicated that they were most influenced by observing the attire of physicians at work (155 [38%]), compared with courses in medical ethics (19 [5%]), school policy (16 [4%]), or hospital policy (9 [2%]). ConclusionAlthough regional dress code practices are different in the United States compared with Australia, medical students were overall most influenced by their instructors’ attire in clinical settings.</p
‐10 diagnostic coding
No full textThe cost and comorbidity of obesity in hospitalized inpatients, is less known. A retrospective study of patients presenting to a large district hospital in Western Sydney (April 2016-February 2017) using clinical, pathological as well as diagnostic coding data for obesity as per ICD-10. Of 43 212 consecutive hospital presentations, 390 had an obesity-coded diagnosis (Ob, 0.90%), of which 244 were gender and age matched to a non-obesity coded cohort (NOb). Weight and BMI were higher in the Ob vs NOb group (126 ± 37 vs 82 ± 25 kg; BMI 46 ± 12 vs 29 ± 8 kg/m2 , P < .001) with a medical record documentation rate of 62% for obesity among Ob. The Ob cohort had 2-5 higher rates of cardiopulmonary and metabolic complications (P < .001), greater pharmacologic burden, length of stay (LOS, 225 vs 89 hours, P < .001) and stay in intensive care but no differences in the prevalence of mental disorders. Compared with BMI 35 kg/m2 were 5 more likely to require intensive care (OR 5.08 [1.43-27.3, 95% CI], P = .0047). The initiation of obesity-specific interventions by clinical teams was very low. People with obesity who are admitted to hospital carry significant cost and complications, yet obesity is seldom recognized as a clinical entity or contributor
Multi-Stage 20-m Shuttle Run Fitness Test, Maximal Oxygen Uptake and Velocity at Maximal Oxygen Uptake.
No full textThe multi-stage 20-m shuttle run fitness test (20mMSFT) is a popular field test which is widely used to measure aerobic fitness by predicting maximum oxygen uptake (VO2max) and performance. However, the velocity at which VO2max occurs (vVO2max) is a better indicator of performance than VO2max, and can be used to explain inter-individual differences in performance that VO2max cannot. It has been reported as a better predictor for running performance and it can be used to monitor athletes' training for predicting optimal training intensity. This study investigated the validity and suitability of predicting VO2max and vVO2max of adult subjects on the basis of the performance of the 20mMST. Forty eight (25 male and 23 female) physical education students performed, in random order, a laboratory based continuous horizontal treadmill test to determine VO2max, vVO2max and a 20mMST, with an interval of 3 days between each test. The results revealed significant correlations between the number of shuttles in the 20mMSFT and directly determined VO2max (r = 0.87, p<0.05) and vVO2max (r = 0.93, p<0.05). The equation for prediction of VO2max was y = 0.0276x + 27.504, whereas for vVO2max it was y = 0.0937x + 6.890. It can be concluded that the 20mMSFT can accurately predict VO2max and vVO2max and this field test can provide useful information regarding aerobic fitness of adults. The predicted vVO2max can be used in monitoring athletes, especially in determining optimal training intensity
On the Benthic Invertebrate Megafauna at the Mid-Atlantic Ridge, in the Vicinity of the Charlie-Gibbs Fracture Zone
No full textLittle is known about the fauna that inhabits non-chemosynthetic environments associated with mid-ocean ridges. This thesis investigates a ridge and fracture zone system to assess its influence as a barrier to faunal dispersal, and as a unique bathyal habitat. It also describes the ecology of megabenthic communities inhabiting a ridge. Sites were chosen on the Mid-Atlantic Ridge in the vicinity of the Charlie-Gibbs Fracture Zone, at a target depth of 2,500 m. Four superstations were chosen north and south of the Fracture Zone, on either side of the ridge. Different productivity levels and hydrographic features were characteristic for the northern and southern sites. In order to characterise the benthic megafauna 50 ha were trawled and 32,000 m2 of seafloor were sampled with HD video footage, targeting both flat and 10 ? sloped habitats. Holothurians were the most abundant megafauna. In order to assess their evolutionary relationship 43 holothurian specimens were genetically studied by modelling five of their genes (16S, 18S, 28S, COI, H3) in a phylogenetic analysis. All four sites exhibited noticeably different faunal characteristics. The biomass was highest at the SE, and lowest at the NW site. Body sizes differed between sites for most taxa, that were sufficient in numbers to be compared between sites, most likely as a result of different adaptations to food supply. Differences in species richness were observed between the sampling methods, with the highest richness at the SE site in trawl samples, and highest at the NW and SW sites in the video survey. Species densities were highest at the northern sites with both methods. Differences in diversity were also observed, with trawl samples providing a higher taxonomic resolution than the video survey and showing highest diversity at the SE site and lowest at the NE site. Community composition was significantly different between sites. Variations in the composition of megabenthic assemblages were observed between flat and 10 ? sloped habitats, although the effect of slope appears to be site dependent. The genetic analyses revealed a close relationship between individuals from different families. The extent to which the Ridge acts as a faunal barrier was unclear as the southern sites lacked an obvious difference in community composition. Faunal differences to the north and south of the Fracture Zone, however, suggest that this feature is a barrier to dispersal. The contrasting megafaunal assemblages of the sites probably reflect a combination of environmental drivers including sediment type, phytodetrital quality, hydrography, and habitat complexity
Isolated lumbar extension exercise as an intervention for chronic low back pain
No full textLow back pain (LBP) is highly prevalent, generally categorised as ‘non-specific’ as clear diagnosis for pain is often absent, and further categorised into acute, sub-acute and chronic, with 69-75% of acute cases developing into chronic. This chronic LBP population accounts for the majority of economic costs worldwide associated with LBP. Although LBP is often ‘non-specific’, many physical dysfunctions are associated with it. Thus LBP can be regarded as multifactorial in nature. Dysfunctions include, but are not limited to: deconditioning of the lumbar extensor musculature, limited range of motion (ROM), gait abnormality and disc disorders. The novel approach of this thesis was to consider lumbar extensor deconditioning, LBP and its associated physical dysfunctions within a multifactorial framework, and the potential improvement of associated dysfunctions from intervention using isolated lumbar extension (ILEX) specifically aimed at addressing lumbar extensor deconditioning. Findings from three empirical studies are reported. The first examined limited ROM ILEX exercise compared with full ROM exercise. Results from this study support that limited ROM training is as effective as full ROM training at improving full ROM ILEX strength, pain and disability. The second study examined the effects of ILEX exercise upon lumbar spine kinematic waveform pattern variability during gait. Results from this study demonstrate that ILEX exercise significantly improves sagittal plane variability in chronic LBP participants. The final study examined the effects of ILEX exercise upon disc hydration determined indirectly through measurement of spinal height using seated stadiometry. Results from this study showed improved ILEX strength, pain and disability but did not demonstrate improvement in disc hydration. These results provide evidence for adopting a multifactorial conceptualisation of LBP in the use of ILEX exercise as a treatment. It is concluded that a wide range of improvements including pain, disability and various aspects of function relating to the multifactorial model are possible through use of a single minimal intervention involving ILEX. This conclusion has potential implications for considering direction of treatments from clinicians towards chronic LBP. Such a minimal intervention offering a wide range of benefits may reduce the need for costly and complex multi-disciplinary interventions
