Effects of COVID-19 pandemic restrictions on an Australian neonatal and paediatric retrieval service.

AIM: The COVID-19 pandemic and associated travel and social distancing restrictions have reduced paediatric intensive care unit admissions for respiratory illnesses. The effects on retrieval (transport) services remain unquantified. Our study examined the utility of statistical process control in assessing the impact of the COVID-19 pandemic on the number of neonatal and paediatric transfers in an Australian retrieval service. METHODS: Data collected prospectively from the SA Ambulance Service MedSTAR Emergency Retrieval database in South Australia were analysed from January 2015 to June 2021. Statistical process control methodology, a combination of a time series analysis and assessment for common and special cause variation, was used to assess the impact of the COVID-19 pandemic on retrieval workload (primary outcome of interest). RESULTS: A total of 5659 neonatal and paediatric transfers occurred during the study period and were included. A significant decrease in paediatric transfers occurred after the initial lockdown measures in March 2020 were announced in South Australia (special cause variation). However, a similar reduction was not observed for neonatal transfers (common cause variation). CONCLUSION: Our study demonstrates that statistical process control may be effectively used to understand the effects of external events and processes on usual activity patterns in the retrieval setting. We found a reduction in retrieval numbers for paediatric transfers but no effect on neonatal transfer numbers. The decline in paediatric transfers was primarily attributed to reduced respiratory cases.

Early experience in use of videolaryngoscopy by a neonatal pre-hospital and retrieval service.

OBJECTIVE: To describe initial experience with use of the Glidescope Go videolaryngoscope by an Australian neonatal pre-hospital and retrieval service. METHODS: We conducted a 31-month retrospective review of an airway registry for neonates intubated by MedSTAR Kids clinicians. RESULTS: Twenty-two patients were intubated using the Glidescope Go, compared with 50 using direct laryngoscopy. First-pass success was 17/22 (77.3%) with the Glidescope Go and 38/50 (76%) with direct laryngoscopy. Complications occurred in 7/22 (32%) and 8/50 (16%), respectively. CONCLUSIONS: On initial review of this practice change, videolaryngoscopy allows neonatal tracheal intubation with a comparable success rate to direct laryngoscopy in a pre-hospital and retrieval setting.

Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children.

OBJECTIVE: Children frequently present with head injuries to acute care settings. Although international paediatric clinical practice guidelines for head injuries exist, they do not address all considerations related to triage, imaging, observation versus admission, transfer, discharge and follow-up of mild to moderate head injuries relevant to the Australian and New Zealand context. The Paediatric Research in Emergency Departments International Collaborative (PREDICT) set out to develop an evidence-based, locally applicable, practical clinical guideline for the care of children with mild to moderate head injuries presenting to acute care settings. METHODS: A multidisciplinary Guideline Working Group (GWG) developed 33 questions in three key areas - triage, imaging and discharge of children with mild to moderate head injuries presenting to acute care settings. We identified existing high-quality guidelines and from these guidelines recommendations were mapped to clinical questions. Updated literature searches were undertaken, and key new evidence identified. Recommendations were created through either adoption, adaptation or development of de novo recommendations. The guideline was revised after a period of public consultation. RESULTS: The GWG developed 71 recommendations (evidence-informed = 35, consensus-based = 17, practice points = 19), relevant to the Australian and New Zealand setting. The guideline is presented as three documents: (i) a detailed Full Guideline summarising the evidence underlying each recommendation; (ii) a Guideline Summary; and (iii) a clinical Algorithm: Imaging and Observation Decision-making for Children with Head Injuries. CONCLUSIONS: The PREDICT Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children provides high-level evidence and practical guidance for front line clinicians.

Composite Membranes Derived from Cellulose and Lignin Sulfonate for Selective Separations and Antifouling Aspects.

Cellulose-based membrane materials allow for separations in both aqueous solutions and organic solvents. The addition of nanocomposites into cellulose structure is facilitated through steric interaction and strong hydrogen bonding with the hydroxy groups present within cellulose. An ionic liquid, 1-ethyl-3-methylimidazolium acetate, was used as a solvent for microcrystalline cellulose to incorporate graphene oxide quantum dots into cellulose membranes. In this work, other composite materials such as, iron oxide nanoparticles, polyacrylic acid, and lignin sulfonate have all been uniformly incorporated into cellulose membranes utilizing ionic liquid cosolvents. Integration of iron into cellulose membranes resulted in high selectivity (>99%) of neutral red and methylene blue model dyes separation over salts with a high permeability of 17 LMH/bar. With non-aqueous (alcohol) solvent, iron-cellulose composite membranes become less selective and more permeable, suggesting the interaction of iron ions cellulose OH groups plays a major role in pore structure. Polyacrylic acid was integrated into cellulose membranes to add pH responsive behavior and capacity for metal ion capture. Calcium capture of 55 mg Ca2+/g membrane was observed for PAA-cellulose membranes. Lignin sulfonate was also incorporated into cellulose membranes to add strong negative charge and a steric barrier to enhance antifouling behavior. Lignin sulfonate was also functionalized on the commercial DOW NF270 nanofiltration membranes via esterification of hydroxy groups with carboxyl group present on the membrane surface. Antifouling behavior was observed for both lignin-cellulose composite and commercial membranes functionalized with lignin. Up to 90% recovery of water flux after repeated cycles of fouling was observed for both types of lignin functionalized membranes while flux recovery of up to 60% was observed for unmodified membranes.

Rhodopseudomonas palustris-based conversion of organic acids to hydrogen using plasmonic nanoparticles and near-infrared light.

The simultaneous elimination of organic waste and the production of clean fuels will have an immense impact on both the society and the industrial manufacturing sector. The enhanced understanding of the interface between nanoparticles and photo-responsive bacteria will further advance the knowledge of their interactions with biological systems. Although literature shows the production of gases by photobacteria, herein, we demonstrated the integration of photonics, biology, and nanostructured plasmonic materials for hydrogen production with a lower greenhouse CO2 gas content at quantified light energy intensity and wavelength. Phototrophic purple non-sulfur bacteria were able to generate hydrogen as a byproduct of nitrogen fixation using the energy absorbed from visible and near-IR (NIR) light. This type of biological hydrogen production has suffered from low efficiency of converting light energy into hydrogen in part due to light sources that do not exploit the organisms' capacity for NIR absorption. We used NIR light sources and optically resonant gold-silica core-shell nanoparticles to increase the light utilization of the bacteria to convert waste organic acids such as acetic and maleic acids to hydrogen. The batch growth studies for the small cultures (40 mL) of Rhodopseudomonas palustris demonstrated >2.5-fold increase in hydrogen production when grown under an NIR source (167 ± 18 µmol H2) compared to that for a broad-band light source (60 ± 6 µmol H2) at equal light intensity (130 W m-2). The addition of the mPEG-coated optically resonant gold-silica core-shell nanoparticles in the solution further improved the hydrogen production from 167 ± 18 to 398 ± 108 µmol H2 at 130 W m-2. The average hydrogen production rate with the nanoparticles was 127 ± 35 µmol L-1 h-1 at 130 W m-2.

Adrenaline overdose in pediatric anaphylaxis: a case report.

BACKGROUND: Adrenaline is the standard treatment for anaphylaxis but appropriate administration remains challenging, and iatrogenic overdose is easily overlooked. Despite the established importance of pediatric blood pressure measurement, its use remains inconsistent in clinical practice. CASE PRESENTATION: We report a case of adrenaline overdose in a 9-year-old white boy with anaphylaxis, where signs of adrenaline overdose were indistinguishable from progressive shock until blood pressure measurement was taken. CONCLUSIONS: The consequences of under-dosing adrenaline in anaphylaxis are well-recognized, but the converse is less so. Blood pressure measurement should be a routine part of pediatric assessment as it is key to differentiating adrenaline overdose from anaphylactic shock.

A study of multi-media suicide education in Nunavut.

A CD-ROM on suicide prevention was evaluated in an Inuit hamlet to examine if knowledge is acquired after viewing this multi-media format of education. Twenty-four respondents showed knowledge increased after viewing. Forty six percent had never used a computer yet 95% felt the technology could train counselors. Such technology may improve knowledge and skills in this cultural setting and perhaps may be useful in other cross-cultural environments.

Accreditation of veterinary schools in Australia and New Zealand.

Veterinary schools in Australia and New Zealand are assessed for accreditation purposes every six years by the Veterinary Schools Accreditation Advisory Committee (VSAAC), which is a standing committee of the Australasian Veterinary Boards Council (AVBC).1 Prior to undertaking an assessment, VSAAC requests a Self Evaluation Report from the school and subsequently spends a week on site to collect additional information. The committee also takes into consideration other quality assurance procedures within the university and aims for a process that complements other evaluation activities. Internal evaluation procedures within VSAAC are designed to reflect the process and outcomes of each visit and lead to annual revisions of the publication Policies, Procedures and Guidelines publication. The committee has close links with the Royal College of Veterinary Surgeons (RCVS), and there is a routine exchange of observers on all visits in the United Kingdom and Australasia. In recent years VSAAC has become increasingly interested in looking at ways to place greater emphasis on the outcomes of veterinary education and, eventually, to reduce our reliance on input measures. There has been good progress in identifying desirable attributes for veterinary graduates, but further work is needed to establish the reliability of assessment procedures. The Australasian accreditation system is very supportive of recent moves to achieve greater compatibility of veterinary accreditation systems in different parts of the world because we believe it has the potential to assist globalization of animal disease control and veterinary education.

An irritable infant and the runaway redback: an instructive case.

The envenomation syndrome of Redback spider bites, lactrodectism, is distinctive. However diagnosis can be difficult due to an atypical presentation. We describe the case of a 1 year old boy with irritability, diaphoresis and reduced oral intake, in whom a diagnosis was made of redback spider bite. Successful resolution of symptoms was achieved following treatment with antivenom. The symptoms and management of redback spider bites is discussed.

The hidden menace of non-equine horses.

An emergency department audit of horse-related injury presentations alerted researchers to a hitherto uninvestigated source of childhood harm: non-equine horses. A search for the term "horse" in the database of the South Australian Injury Surveillance and Control Unit was performed for presentations of horse-related injuries to a paediatric emergency department of an Australian tertiary teaching hospital over a 5-year period. After all equine-related episodes were extracted, the remaining presentations were herded together and conclusions were jumped to. When legitimate science and research technique failed, poetic licence was prevailed upon.

Paediatric and adolescent horse-related injuries: does the mechanism of injury justify a trauma response?

OBJECTIVE: To identify the frequency, variety and disposition of horse-related injury presentations to the ED and to use this information to evaluate the existing institutional trauma team activation criteria following horse-related injuries. METHODS: A retrospective case analysis was performed of all horse-related injury presentations to the ED of Women's and Children's Hospital, Adelaide, Australia, in the 5 year period between January 1999 and December 2003. RESULTS: A total of 186 children presented with horse-related injuries during the 5 year study period. The median age of injury was 9 years (range 1-17 years), with 81% of presentations female and 60% of patients hospitalized. The mechanism of injury was divided into four groups: 148 falls (79%), 28 kicks (15%), 7 tramples (4%) and 5 bites (3%). There was one death. Seven presentations rated an Injury Severity Score >15, with full trauma team activation occurring for two of these presentations. CONCLUSION: Although horse-related injury presentations are uncommon, severe injuries do occur. Patients presenting with severe horse-related injuries do not always activate a full trauma team response based on current trauma team activation criteria. These severe injury presentations are supported by a limited trauma team response, which activates on the mechanism of injury. The effectiveness of this as a contingency system needs to be evaluated.

Charging processes in low vacuum scanning electron microscopy.

A framework is presented for understanding charging processes in low vacuum scanning electron microscopy. We consider the effects of electric fields generated above and below the specimen surface and their effects on various processes taking place in the system. These processes include the formation of an ionic space charge, field-enhanced electron emission, charge trapping and dissipation, and electron-ion recombination. The physical mechanisms behind each of these processes are discussed, as are the microscope operating conditions under which each process is most effective. Readily observable effects on gas gain curves, secondary electron images, and X-ray spectra are discussed.