Persistent organic pollutants and trace elements detected in New Zealand fur seals (long-nosed fur seal; Arctocephalus forsteri) from New South Wales, Australia, between 1998 and 2019.

Environmental pollution is a growing threat to wildlife health and biodiversity. The relationship between marine mammals and pollutants is, however, complex and as new chemicals are introduced to ecosystems alongside concomitant, interacting threats such as climate change and habitat degradation, the cumulative impact of these stressors to wildlife continues to expand. Understanding the health of wildlife populations requires a holistic approach to identify potential threatening processes. In the context of environmental pollution in little studied wildlife species, it is important to catalogue the current exposome to develop effective biomonitoring programs that can support diagnosis of health impacts and management and mitigation of pollution. In New South Wales, Australia, the New Zealand fur seal (Arctocephalus forsteri) is a resident species experiencing population growth following devastating historic hunting practices. This study presents a retrospective investigation into the exposure of New Zealand fur seals to a range of synthetic organic compounds and essential and non-essential trace elements. Liver tissue from 28 seals were broadly analyzed to assess concentrations of organochlorine and organophosphate pesticides, polychlorinated biphenyls, per- and polyfluoroalkyl substances, and essential and non-essential trace elements. In addition to contributing extensive pollution baseline data for the species, the work explores the influence of sex, age, and body condition on accumulation patterns. Further, based on these findings, it is recommended that a minimum of 11 juvenile male New Zealand fur seals are sampled and analyzed annually in order to maintain a holistic biomonitoring approach for this population.

Higher fees and out-of-pocket costs in radiotherapy point to a need for funding reform.

Objective To elucidate the policy implications of recent trends in the funding of radiotherapy services between 2009-10 and 2021-22. Method We use national aggregate claims data to determine time trends in the fees, benefits and out-of-pocket (OOP) costs of radiotherapy and nuclear therapeutic medicine claims funded through the Medicare Benefits Schedule (MBS) program. All dollar figures are expressed in constant 2021 Australian dollars. Results Radiotherapy and nuclear therapeutic medicine MBS claims increased by 78% whereas MBS funding increased by 137% between 2009-10 and 2021-22. The main driver of Medicare funding growth has been the Extended Medicare Safety Net, which has increased by 404%. Over the 13 year observation period, the percentage of bulk-billed claims peaked in 2017-18 at 76.1% but fell to 69.8% in 2021-22. For non-bulk billed services, average OOP costs per claim increased from $20.40 in 2009-10 to $69.78 in 2021-22. Conclusion Despite increased Medicare funding, patients face increasing financial barriers to access radiation oncology services. Policies with regard to funding radiotherapy services should be reviewed to ensure that services are easily accessible and affordable for all those needing treatment and at a reasonable cost to Government.

Body-size dependent foraging strategies in the Christmas Island flying-fox: implications for seed and pollen dispersal within a threatened island ecosystem.

BACKGROUND: Animals are important vectors for the dispersal of a wide variety of plant species, and thus play a key role in maintaining the health and biodiversity of natural ecosystems. On oceanic islands, flying-foxes are often the only seed dispersers or pollinators. However, many flying-fox populations are currently in decline, particularly those of insular species, and this has consequences for the ecological services they provide. Knowledge of the drivers and the scale of flying-fox movements is important in determining the ecological roles that flying-foxes play on islands. This information is also useful for understanding the potential long-term consequences for forest dynamics resulting from population declines or extinction, and so can aid in the development of evidence-based ecological management strategies. To these ends, we examined the foraging movements, floral resource use, and social interactions of the Critically Endangered Christmas Island flying-fox (Pteropus natalis). METHODS: Utilization distributions, using movement-based kernel estimates (MBKE) were generated to determine nightly foraging movements of GPS-tracked P. natalis (n = 24). Generalized linear models (GLMs), linear mixed-effect models (LMMs), and Generalized linear mixed-effects model (GLMMs) were constructed to explain how intrinsic factors (body mass, skeletal size, and sex) affected the extent of foraging movements. In addition, we identified pollen collected from facial and body swabs of P. natalis (n = 216) to determine foraging resource use. Direct observations (n = 272) of foraging P. natalis enabled us to assess the various behaviors used to defend foraging resources. RESULTS: Larger P. natalis individuals spent more time foraging and less time traveling between foraging patches, traveled shorter nightly distances, and had smaller overall foraging ranges than smaller conspecifics. Additionally, larger individuals visited a lower diversity of floral resources. CONCLUSIONS: Our findings suggest that smaller P. natalis individuals are the primary vectors of long-distance dispersal of pollen and digested seeds in this species, providing a vital mechanism for maintaining the flow of plant genetic diversity across Christmas Island. Overall, our study highlights the need for more holistic research approaches that incorporate population demographics when assessing a species' ecological services.

The Emergency Department Longitudinal Integrated Care (ED-LINC) intervention targeting opioid use disorder: A pilot randomized clinical trial.

INTRODUCTION: Opioid use disorder (OUD) and related comorbid conditions are highly prevalent among patients presenting to emergency department (ED) settings. Research has developed few comprehensive disease management strategies for at-risk patients presenting to the ED that both decrease illicit opioid use and improve initiation and retention in medication treatment for OUD (MOUD). METHODS: The research team conducted a pilot pragmatic clinical trial that randomized 40 patients presenting to a single ED to a collaborative care intervention (n = 20) versus usual care control (n = 20) conditions. Interviewers blinded to patient intervention and control group status followed-up with participants at 1, 3, and 6 months after presentation to the ED. The 3-month Emergency Department Longitudinal Integrated Care (ED-LINC) collaborative care intervention for patients at risk for OUD included: 1) a Brief Negotiated Interview at bedside, 2) overdose education and facilitation of MOUD, 3) longitudinal proactive care management, 4) utilization of the statewide health information exchange platform for 24/7 tracking of recurrent ED utilization, and 5) weekly caseload supervision that incorporated measurement-based care treatment assessment with stepped-up care for patients with recalcitrant symptoms. RESULTS: Overall, the ED-LINC intervention was feasibly delivered and acceptable to patients. The pilot study achieved >80% follow-up rates at 1, 3, and 6 months. In adjusted longitudinal mixed model regression analyses, no statistically significant differences existed in days of opioid use over the past 30 days for ED-LINC intervention patients when compared to patients receiving usual care (incidence-rate ratio (IRR) 1.50, 95% CI 0.54-4.16). The unadjusted mean number of days of illicit opioid use decreased at the 1-month and 3-month follow-up time points for both groups. ED-LINC intervention patients had increased rates of MOUD initiation compared to control patients (50% versus 30%); intervention versus control comparisons did not achieve statistical significance, although power to detect significant differences in the pilot was limited. CONCLUSIONS: The ED-LINC intervention for patients with OUD can be feasibly implemented and warrants testing in larger scale, adequately powered randomized pragmatic clinical trial investigations. CLINICALTRIALS: gov NCT03699085.

Assessing the capacity of Ghana to introduce health technology assessment: a systematic review of economic evaluations conducted in Ghana.

OBJECTIVES: Ghana is in the process of formally introducing health technology assessment (HTA) for health decision making. Similar to other low- and middle-income countries, evidence suggests that the lack of data and human capacity is a major barrier to the conduct and use of HTA. This study assessed the current human and data capacity available in Ghana to undertake HTA. METHODS: As economic evaluation (EE) forms an integral part of HTA, a systematic review of EE studies undertaken in Ghana was conducted to identify the quality and number of studies available, methods and source of data used, and local persons involved. The literature search was undertaken in EMBASE (including MEDLINE), PUBMED, and Google Scholar. The quality of studies was evaluated using the Consolidated Health Economics Evaluation Reporting Standards. The number of local Ghanaians who contributed to authorship were used as a proxy for assessing human capacity for HTA. RESULTS: Thirty-one studies were included in the final review. Overall, studies were of good quality. Studies derived their effectiveness, resource utilization and cost data mainly from Ghana. The most common source of cost data was from the National Health Insurance Scheme pricing list for medicines and tariffs. Effectiveness data were mostly derived from either single study or intervention programs. Sixty out of 199 authors were Ghanaians (30 percent); these authors were mostly involved in data collection and study conceptualization. CONCLUSIONS: Human capacity for HTA in Ghana is limited. To introduce HTA successfully in Ghana, policy makers would need to develop more local capacity to undertake Ghanaian-specific HTA.

Does aquatic exercise relieve pain in adults with neurologic or musculoskeletal disease? A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To evaluate the literature on the effectiveness of aquatic exercise in relieving pain in adults with neurologic or musculoskeletal disease. DATA SOURCES: A systematic literature search of 14 databases was examined for research on aquatic exercise over the period January 1980 to June 2006. STUDY SELECTION: Randomized controlled trials (RCTs) that included adults with neurologic or musculoskeletal disease, pain as an outcome measure, and exercise in water were included. DATA EXTRACTION: Information on the participants, interventions, and outcomes was extracted from the included studies. Quality appraisal was assessed using the Scottish Intercollegiate Guidelines Network criteria for RCTs. DATA SYNTHESIS: Nineteen studies met the inclusion criteria; 8 were of moderate to low risk of bias, and 5 of these had data suitable for meta-analyses. This showed that aquatic exercise has a small posttreatment effect in relieving pain compared with no treatment (P=.04; standardized mean difference [SMD], -.17; 95% confidence interval [CI], -.33 to -.01), but it is not possible to draw a firm conclusion because of the lack of consistency of evidence across studies. Comparable pain-relieving effects were found between aquatic and land-based exercise (P=.56; SMD=.11; 95% CI, -.27 to .50). CONCLUSIONS: There is sound evidence that there are no differences in pain-relieving effects between aquatic and land exercise. Compared with no treatment, aquatic exercise has a small pain-relieving effect; however, the small number of good-quality studies and inconsistency of results means that insufficient evidence limits firm conclusions. Future studies should aim for focused research questions on specific aquatic exercise techniques, using robust methodologic designs and detailed reporting of temperature, depth, and care setting.

Horizontal inequities in Australia's mixed public/private health care system.

Recent comparative evidence from OECD countries suggests that Australia's mixed public-private health system does a good job in ensuring high and fairly equal access to doctor, hospital and dental care services. This paper provides some further analysis of the same data from the Australian National Health Survey for 2001 to examine whether the general finding of horizontal equity remains when the full potential of the data is realized. We extend the common core cross-country comparative analysis by expanding the set of indicators used in the procedure of standardizing for health care need differences, by providing a separate analysis for the use for general practitioner and specialist care and by differentiating between admissions as public and private patients. Overall, our analysis confirms that in 2001 Medicare largely did seem to be attaining an equitable distribution of health care access: Australians in need of care did get to see a doctor and to be admitted to a hospital. However, they were not equally likely to see the same doctor and to end up in the same hospital bed. As in other OECD countries, higher income Australians are more likely to consult a specialist, all else equal, while lower income patients are more likely to consult a general practitioner. The unequal distribution of private health insurance coverage by income contributes to the phenomenon that the better-off and the less well-off do not receive the same mix of services. There is a risk that - as in some other OECD countries - the principle of equal access for equal need may be further compromised by the future expansion of the private sector in secondary care services. To the extent that such inequalities in use may translate in inequalities in health outcomes, there may be some reason for concern.

Two physiotherapists, one librarian and a systematic literature review: collaboration in action.

AIM: This paper explores the processes of collaboration between a librarian and two academic physiotherapists working on a systematic review jointly funded by the University of the West of England (UWE), Bristol, and the Royal National Hospital for Rheumatic Diseases (RNHRD), Bath, UK. The aim of this paper is to describe and evaluate some of the processes of collaboration between the three authors in their work in progress on a funded systematic literature review on the topic of hydrotherapy and pain. METHODS: The vehicle for describing and analysing these processes is a joint (National Health Service Trust and University) funded systematic literature review currently in progress on the topic of hydrotherapy and pain. RESULTS: Systematic review methodology is becoming increasingly complex and is rapidly developing its own research base. Librarian input is a key element in a successful systematic review. CONCLUSIONS: Systematic reviews play a critical role in informing healthcare delivery and research in the UK. The individual nature and inherent complexity of each review demands close collaboration between librarians, academics and clinicians. In addition to enhancing the reviews themselves, there are many other personal and institutional benefits of collaborative working. Consideration may need to be given to library staff structures and roles if these benefits are to be maximized and sustained.

Cardiorespiratory responses to aquatic treadmill walking in patients with rheumatoid arthritis.

BACKGROUND AND PURPOSE: Hydrotherapy is popular with patients with rheumatoid arthritis (RA). Its efficacy as an aerobic conditioning aid is equivocal. Patients with RA have reduced muscle strength and may be unable to achieve a walking speed commensurate with an aerobic training effect because the resistance to movement increases with speed in water. The physiological effects of immersion may alter the heart rate-oxygen consumption relationship (HR-VO2) with the effect of rendering land-based exercise prescriptions inaccurate. The primary purpose of the present study was to compare the relationships between heart rate (HR), and ratings of perceived exertion (RPE), with speed during land and water treadmill walking in patients with RA. METHOD: The study design used a two-factor within-subjects model. Fifteen females with RA (47+/-8 SD years) completed three consecutive bouts of walking for five minutes at 2.5, 3.5 and 4.5 km/h(-1) on land and water treadmills. Expired gas, collected via open-circuit spirometry, HR and RPE were measured. RESULTS: HR and RPE increased on land and in water as speed increased. Below 3.5 km/h(-1) VO2 was significantly lower in water than on land (p<0.01). HR was lower (p<0.001), unchanged and higher (p<0.001) at 2.5, 3.5 and 4.5 km/h(-1) in water than on land. RPE was significantly higher in water than on land (p<0.05). VO2 was approximately 60% of the predicted VO2max during the fast walking speed in water. For a given VO2, HR was approximately nine beats/min(-1) and RPE 1-2 points on the 6-20 Borg scale, higher in water than on land. CONCLUSIONS: The study showed that the metabolic demand of walking at 4.5 km/h(-1) was sufficient to stimulate an increase in aerobic capacity. The use of land-based prescriptive norms would underestimate the metabolic cost in water. Therefore, in water HR should be increased by approximately 9 beats/min(-1) to achieve similar energy demands to land treadmill walking.

A prospective randomized trial of enteral glutamine in critical illness.

OBJECTIVE: To assess the influence of enteral glutamine on the incidence of severe sepsis and death in critically ill patients. DESIGN: This two-armed clinical trial was triple blind (patients, attending staff, research nurse). SETTING: The 10 bed general ICU at Royal Perth Hospital, Western Australia. PATIENTS: This trial evaluated 363 patients requiring mechanical ventilation (median APACHE II score=14); of these, 85 had trauma. INTERVENTION: The intervention solution contained 20 g/l glutamine and the control solution was isojoulic and isonitrogenous. MEASUREMENTS AND RESULTS: The groups had similar characteristics at baseline, and they also received equivalent amounts of protein and energy. Patients in the glutamine group received a median of 19 g/glutamine per day and 91% (332 of 363) of the patients were fed via a nasogastric tube (median duration=10 days). The outcomes were similar in the two groups: (a) death within 6 months: glutamine group 15% (27 of 179) vs control group 16% (30 of 184); p=0.75; relative risk, 0.95 (95% confidence interval, 0.71-1.28); and (b) severe sepsis: glutamine group 21% (38 of 179) vs control group 23% (43 of 184); p=0.62; relative risk, 0.94 (95% confidence interval, 0.72-1.22). There was also no discernable difference in the secondary outcomes relating to infections, febrile period, antimicrobial therapy, and consumption of inotropes. CONCLUSION: This clinical trial did not support the use of enteral glutamine supplements in similar cohorts of critically ill patients.