Bayside Health Service

OBJECTIVES: To investigate (i) the prevalence of environmental safety hazards in the homes of people aged 70 years and over, (ii) their knowledge of causes of injuries to older people and the safety measures they can implement to prevent such injuries and (iii) the relationship between socio-demographic characteristics of this population group and levels of home environmental hazards. METHOD: A cross-sectional survey of 425 people aged 70 years and older living in a defined geographical area of Australia. Participants were recruited through their general practitioners. A structured interview completed with each participant included questions on demographics and home safety issues. A home safety inspection was also undertaken using a predetermined rating format. RESULTS: 80% (n = 342) of homes inspected had at least one hazard and 39% (n = 164) had > 5 hazards. The bathroom was identified as the most hazardous room, with 66% (n = 279) of bathrooms having at least one hazard. Hazards relating to floor surfaces (62% of homes had one 'flooring' hazard) and absence of appropriate grab or handrails (60% of homes had one or more hazards relating to this) were prevalent. Eighty-eight percent (n = 374) of older people were able to identify falls as the most common cause of injury and 87% (n = 368) were able to accurately name at least one safety measure. Although a significant association was found between the older people's self-assessment of their home's safety and the presence of more than 5 hazards, 30% of those rating their homes as very safe (n = 289) had more than 5 hazards. Logistic regression analysis identified one variable--contact with healthcare service providers--as predictive of the hazard level in older people's homes. Older people who were never visited by service providers were twice as likely to have more than 5 hazards as those who were visited weekly or more often (OR 2.12, 95% CI 1.104, 4.088). CONCLUSION: Many older people are living in potentially hazardous environments. As yet, a causal link between the presence of environmental hazards and falls in older people has not been established. More definitive work in this area needs to be carried out.

Abstract A strong correlation was obtained between bruise volume and energy absorbed for both impact and slow compression of Granny Smith apples. Apple tissue was more easily bruised by slow compression than by impact. For the same amount of energy, bruise volumes were approximately 40% higher under slow compression. There was no correlation between the stiffness (force/deflection) of apple flesh and bruise volume. It is unlikely that the theories of failure based on the theory of elasticity will prove useful in predicting the extent of bruising. The application of elastic theory to bruise initiation was not studied in this paper. A simple model was formulated to explain the behaviour of apples under compression. Apple tissue was likened to an orderly arrangement of liquid‐filled, spherical cells bounded by viscoelastic membranes with air‐filled interstitials. It is postulated that on initial compression the cells are deformed into ellipsoids under a stress distribution similar to that found in an elastic sphere. Further compression would then result in cell wall fracture, i.e., cell bursting in regions of high shearing stress. Distortion and bursting of cells explains the energy dissipative mechanism. The work showed that energy absorbed during compression is a good predictor of bruising and is, thus, a useful parameter in evaluating handling and packing systems.

BACKGROUND AND OBJECTIVE: Adherence with preventive asthma medication by young children is an important factor when evaluating a suboptimal response to treatment. However, few data exist regarding the accuracy of subjective measures of adherence and factors associated with adherence in young children. METHODS: Fifty-one asthmatic children aged 18 months to 7 years had their use of preventive asthma medication monitored using an electronic monitoring device (Smartinhaler) for 1 month. At a follow-up visit the child's parent was asked how often medication had been given and they also completed a confidential questionnaire that included questions about medication usage, barriers to optimal adherence and parenting. The treating physician made an estimate of the child's likely use of medication. RESULTS: The median use of medication as determined by the Smartinhaler was 70.5% (range 21.4-100%). The parents' verbal reports (85.1%) and questionnaire responses (84.2%) overestimated medication usage. The physician was not able to determine which parents correctly estimated their child's use of medication (P = 0.28). The child's age, level of parental education and annual family income did not influence adherence. Parents reported simply 'forgetting' or their child's 'reaction to being given medication' as the principal barriers to adherence. There was a significant association between how stressful the parent found parenting and adherence (P = 0.05). CONCLUSION: Adherence with preventive medication, even within the context of a research study, was generally low and highly variable. Subjective measures of adherence were found to overestimate adherence in young asthmatics.

This study investigates the impact of measuring adherence and providing feedback on medication usage by children with unstable asthma. Adherence was measured using an electronic monitoring device. Subjects were randomized to either being told of their adherence during review consultations or for their adherence to remain undisclosed to their parents and treating physician. Subjects were reviewed monthly for 4 months. Twenty-six children aged between 6 and 14 years were recruited. Adherence was significantly higher in the intervention group (79% versus 58%, p <.01). There were significant improvements in clinical measures of disease control compared with baseline in both groups. The change in forced expiratory volume in 1 s (FEV(1)) (% predicted) was greater in those subjects receiving feedback (13.8% versus 9.8%). However, lung function values were lower in the intervention group at baseline and the relative improvement failed to reach statistical significance. Measuring adherence and providing feedback increases the use of preventive medication. A larger study is required to explore implications for disease control.

OBJECTIVE: A retrospective audit of presentations to a tertiary trauma centre reviewing the demographics of electric scooter injuries in the first 2 months of the scooter-share scheme, which was commenced in Brisbane in November 2018. METHODS: Electric scooter-associated presentations to the Royal Brisbane and Women's Hospital Emergency and Trauma Centre from November 2018 to January 2019 were identified. Data collected included patient demographics, type and location of injuries, helmet use, alcohol consumption, length of stay and disposition. Estimates of costs associated with electric scooter presentation were also obtained. RESULTS: Fifty-four electric scooter encounters were included during the 2-month period. Helmets were worn in 46% and was associated with reduced risk of head injury (odds ratio (OR) 0.18, P = 0.029). Alcohol was involved in 27% although this did not impact on admission rates (OR 1.25, P = 0.83) or operative management (OR 2.14, P = 0.42). Contusions/abrasions and fractures/dislocations were the most common types of injury, whereas upper limb and minor head injuries were the most common sites of injury. Most patients were discharged home (87%), with 74% completing their emergency visit in under 4 h. Six patients required operative management and 15 patients needed outpatient follow-up. There were no deaths. Average patient cost per presentation was $542 and ranged from $285 to $1345. CONCLUSIONS: The findings characterised injury patterns and costs associated with electric scooters in our ED. Given the increasing popularity of electric scooters as an alternate form of transportation, our study may help to inform public policy for future injury prevention.

The First Physical Therapy Summit on Global Health was convened at the 2007 World Confederation for Physical Therapy (WCPT) Congress to vision practice in the 21st century and, in turn, entry-level education and research, as informed by epidemiological indicators, and consistent with evidence-based noninvasive interventions, the hallmark of physical therapy. The Summit and its findings were informed by WHO data and validated through national databases of the countries of the five WCPT regions. The health priorities based on mortality were examined in relation to proportions of physical therapists practicing in the areas of regional priorities and of the curricula in entry-level programs. As a validation check and to contextualize the findings, input from members of the 800 Summit participants was integrated and international consultants refined the recommendations. Lifestyle-related conditions (ischemic heart disease, smoking-related conditions, hypertension, stroke, cancer, and diabetes) were leading causes of premature death across regions. Contemporary definitions of physical therapy support that the profession has a leading role in preventing, reversing, as well as managing lifestyle-related conditions. The proportions of practitioners practicing primarily in these priority areas and of the entry-level curricula based on these priorities were low. The proportions of practitioners in priority areas and entry-level curricula devoted to lifestyle-related conditions warrant being better aligned with the prevalence of these conditions across regions in the 21st century. A focus on clinical competencies associated with effective health education and health behavior change formulates the basis for The Second Physical Therapy Summit on Global Health.

Objective: The purpose of the present study was to provide a consumer perspective on recovery from schizophrenia and to identify what consumers considered important in this journey, compare it to the literature and also to provide a consumer definition of recovery. Methods: A four-part qualitative process was developed following consultation with two consumer focus groups. Fifty-seven people who identified themselves as in recovery participated in the study. The interviews were tape-recorded and thematic analysis used to identify the common themes used by the participants. Results: The most frequently reported category related to an active sense of self, with the person's determination to get better, manage their illness and realising their need to help themselves the most common subcategories. Conclusions: The findings of the present study are discussed in relation to the literature on recovery from mental illness and their implications for the provision of services.

Prescribing of potentially inappropriate medications (PIMs) that pose more risk than benefit in older patients is a common occurrence across all healthcare settings. Reducing such prescribing has been challenging despite multiple interventions, including educational campaigns, audits and feedback, geriatrician assessment and formulary restrictions. With the increasing uptake of electronic medical records (EMRs) across hospitals, clinics and residential aged care facilities (RACFs), integrated with computerized physician order entry (CPOE) and e-prescribing, opportunities exist for incorporating clinical decision support systems (CDSS) into EMR at the point of care. This narrative review assessed the process and outcomes of using EMR-enabled CDSS to reduce the prescribing of PIMs. We searched PubMed for relevant articles published up to January 2018 and focused on those that described EMR-enabled CDSS that assisted prescribers to make changes at the time of ordering PIMs in adults. Computerized systems offering only medication reconciliation, dose checks, monitoring for medication errors, or basic formulary information were not included. In addition to outcome measures of medication-related processes and adverse drug events, qualitative data relating to factors that influence effectiveness of EMR-enabled CDSS were also gathered from selected studies. We analysed 20 studies comprising 10 randomized trials and 10 observational studies performed in hospitals ( n = 8), ambulatory care clinics ( n = 9) and RACFs ( n = 3). Studies varied in patient populations (although most involved older patients), type of CDSS, method of linkage with EMR, study designs and outcome measures. However, assuming little publication bias, the totality of evidence favoured EMR-enabled CDSS as being effective in reducing the prescribing of PIMs in hospitals, although results were more mixed for ambulatory care settings and RACFs. While absolute effects in most positive studies were modest, they suggest EMR-enabled CDSS are feasible and acceptable to clinicians, and if certain design features are adhered to, there is potential for even greater impact.

Abstract Rapid development of axillary branches on rooted cuttings from mature field-grown papaya ( Carica papaya L.) trees was promoted by removal of stem apices and application to the cut surface of a mixture containing 225 mg BAP/liter of lanolin. Small axillary buds were removed from these branches and cultured, initially on solid medium, and then in liquid medium on a roller drum at 3 rpm in Drew and Smith (DS) medium containing 1 µ m BAP + 1 µ m NAA. After two or three subcultures on the roller drum with alternate periods on hormone-free basal medium, apically dominant shoots were produced. Growth of axillary buds subsequently occurred on DS medium containing 1 µ m BAP + 0.25 µ m NAA. Cultures also were established from buds of 6-month-old trees, followed by enhanced axillary shoot growth on DS medium containing 2 µ m BAP + 0.5 µ m NAA. Roots initiated on actively growing shoots when incubated at 27°C in a 12-hr photoperiod on a reduced mineral medium containing 10 µ m IBA. Rooted shoots were established in a high-humidity (&gt;90%) cabinet in a glasshouse and planted in the field. Field plants were characterized by a reduced juvenile stage, excessive vegetation at the lower nodes, and production of flowers and fruit close to the ground. Chemical names used: N 6 -benzylaminopurine (BAP); 1 H-naphthaleneacetic acid ( NAA ); 1 H -indole-3-butyric acid (IBA).

Plant tissue culture involves the culture of all types of plant cells, tissues and organs under aseptic conditions. This definition also extends to the culture of excised embryos and to protoplast culture. An overview of tissue culture techniques and their applications in plant propagation and genetic improvement of plants is presented. The areas under review include: (1) embyro culture, (2) meristem culture, (3) micropropagation, (4) somatic embryogenesis, (5) somaclonal variation, (6) in vitro selection, (7) anther culture and (8) protoplast culture. Problems and limitations of each of the techniques are also discussed. Examples are given of work that has been undertaken or that is currently in progress on the application of these techniques to the improvement of Queensland's subtropical horticultural industries. Key examples are: (1) embryo culture to facilitate incorporation of genes conferring disease-resistance from wild Cucurbita species into cultivated varieties, (2) meristem culture for virus elimination in strawberries (Fragaria × ananassa) and sweet potato (Ipomoea batatas), (3) micropropagation for rapid increase in new varieties of ginger (Zingiber officinale) and pineapple (Ananas comosus) to enable more rapid field evaluation and early release, (4) micropropagation of disease-free, genetically uniform planting material of superior female papaya (Carica papaya) selections and banana (Musa spp.) selections and (5) the use of somaclonal variation and gamma-irradiation for the genetic improvement of banana. Finally, future opportunities for the utilisation of tissue culture in plant propagation and improvement in Queensland's horticultural industries are summarised.

Background Fetal akinesia and arthrogryposis are clinically and genetically heterogeneous and have traditionally been refractive to genetic diagnosis. The widespread availability of affordable genome-wide sequencing has facilitated accurate genetic diagnosis and gene discovery in these conditions. Methods We performed next generation sequencing (NGS) in 190 probands with a diagnosis of arthrogryposis multiplex congenita, distal arthrogryposis, fetal akinesia deformation sequence or multiple pterygium syndrome. This sequencing was a combination of bespoke neurogenetic disease gene panels and whole exome sequencing. Only class 4 and 5 variants were reported, except for two cases where the identified variants of unknown significance (VUS) are most likely to be causative for the observed phenotype. Co-segregation studies and confirmation of variants identified by NGS were performed where possible. Functional genomics was performed as required. Results Of the 190 probands, 81 received an accurate genetic diagnosis. All except two of these cases harboured class 4 and/or 5 variants based on the American College of Medical Genetics and Genomics guidelines. We identified phenotypic expansions associated with CACNA1S, CHRNB1, GMPPB and STAC3 . We describe a total of 50 novel variants, including a novel missense variant in the recently identified gene for arthrogryposis with brain malformations —SMPD4 . Conclusions Comprehensive gene panels give a diagnosis for a substantial proportion (42%) of fetal akinesia and arthrogryposis cases, even in an unselected cohort. Recently identified genes account for a relatively large proportion, 32%, of the diagnoses. Diagnostic-research collaboration was critical to the diagnosis and variant interpretation in many cases, facilitated genotype-phenotype expansions and reclassified VUS through functional genomics.

OBJECTIVE: Obesity and adverse metabolic outcomes in patients with severe mental illness are clinically significant but potentially preventable. Importantly, the evidence for switching to antipsychotics to reduce cardiometabolic burden is unclear. METHOD: PubMED, Embase, PsycINFO, and Cochrane were searched from inception to March 8, 2020. Articles reporting weight and metabolic changes after antipsychotic switching vs staying on the previous antipsychotic were meta-analyzed both across and within group. RESULTS: Of 61 identified studies, 59 were meta-analyzed (40% rated high quality). In the switch-vs-stay pairwise meta-analyses, only aripiprazole significantly reduced weight (-5.52 kg, 95% CI -10.63, -0.42, P = .03), while olanzapine significantly increased weight (2.46 kg, 95% CI 0.34, 4.57, P = .02). Switching to aripiprazole also significantly improved fasting glucose (-3.99 mg/dl, 95% CI -7.34, -0.64, P = .02) and triglycerides (-31.03 mg/dl, 95% CI -48.73, -13.34, P = .0001). Dropout and psychosis ratings did not differ between switch and stay groups for aripiprazole and olanzapine. In before-to-after switch meta-analyses, aripiprazole (-1.96 kg, 95% CI -3.07, -0.85, P < .001) and ziprasidone (-2.22 kg, 95% CI -3.84, -0.60, P = .007) were associated with weight loss, whereas olanzapine (2.71 kg, 95% CI 1.87, 3.55, P < .001), and clozapine (2.80 kg, 95% CI 0.26, 5.34, P = .03) were associated with weight gain. No significant weight or other cardiometabolic changes were observed when switching to amisulpride, paliperidone/risperidone, quetiapine, or lurasidone. CONCLUSIONS: Switching antipsychotics to agents with lower weight gain potential, notably to aripiprazole and ziprasidone, can improve weight profile and other cardiometabolic outcomes. When choosing switch agents, both the weight gain potential of the pre- and post-switch antipsychotic must be considered. Antipsychotic switching in psychiatrically stable patients must be weighed against the risk of psychiatric worsening.

Zinc-bromine flow batteries (ZBFBs) are promising candidates for the large-scale stationary energy storage application due to their inherent scalability and flexibility, low cost, green, and environmentally friendly characteristics. ZBFBs have been commercially available for several years in both grid scale and residential energy storage applications. Nevertheless, their continued development still presents challenges associated with electrodes, separators, electrolyte, as well as their operational chemistry. Therefore, rational design of these components in ZBFBs is of utmost importance to further improve the overall device performance. In this review, the focus is on the scientific understanding of the fundamental electrochemistry and functional components of ZBFBs, with an emphasis on the technical challenges of reaction chemistry, development of functional materials, and their application in ZBFBs. Current limitations of ZBFBs with future research directions in the development of high performance ZBFBs are suggested.

ABSTRACT A quick and easy method of measuring the bruise resistance of apples is described. The method is based on the strong linear correlation between energy absorbed and bruise volume from which is calculated a bruise resistance coefficient, with units m l joule −1 . The bruise resistance coefficient can be accurately determined by dropping a sample of 10 apples. For each drop the energy absorbed is calculated from measured drop height, rebound height and apple mass. The bruise volume on each apple is calculated from measured apple diameter, bruise diameter and bruise depth. The bruise resistance coefficient is effective in the evaluation of packaging, handling and distribution systems for apples.

The Kinrara, Toomba, and Undara basaltic lava flows are from 55 to 160 km long and range in age from 13 to 190 ka. The lavas were emplaced down low gradients (0.2° to 0.4°) with volumes ranging up to 30 km 3 . They were not unusually hot at eruption (1130°–1160°) nor unusually fluid. Gentle topography controlled the flows, and shallow drainage lines captured them. Lava tubes operated in places, and some drained to form caves. Injection under surface crust was widespread, producing inflation features ranging from tumuli and low plateaus to extensive ridges. Sustained eruption was essential for the development of the long flows, but each is composite, with pauses between successive pulses that partially covered the earlier, longer flows. The lava structures are mainly pahoehoe but some 'a'a lavas are present. Of the three volcanoes involved, Undara is a simple low‐angle lava cone with a 200‐m‐wide crater, Toomba is a low‐angled cone with several eruption centers, and Kinrara has a deep crater with evidence of strong fountaining. Effusion rates are not known but may have been relatively low, similar to those observed in Hawaiian volcanoes. Lava tubes, most of which remained undrained, are believed to have been of major importance in flow emplacement. Given the evidence of successive flows and the time needed to develop widespread inflation, it is suggested that the two long flows over 100 km involved many decades of eruption.

Asthma is the most common chronic illness of childhood, affecting up to 14% of children. Poor asthma management and non-adherence to treatment regimens are a pervasive problem in this population and are related to exacerbation of symptoms. Effective management of pediatric asthma involves a complex set of interactions between the parent and child, yet there is a paucity of literature examining these interactions. The main purpose of this study was to identify the child behavior and asthma management tasks parents experience difficulty with. It was hypothesized that the more asthma behavior problems reported, the more problems parents experience in asthma management tasks. Participants in this study were 255 parents of 2-to 10-year-old asthmatic children, recruited via an advertisement placed in school newsletters throughout Australia. Results indicated that the most problematic child asthma behaviors were oppositional behavior, hyperactivity, and aggression, and anxiety was also identified by parents as a concern. The main problematic asthma parenting tasks were entrusting the school, entrusting caregivers, identifying unique symptoms, and identifying and avoiding triggers. More problem asthma behaviors were associated with higher levels of parenting difficulty and more general levels of behavior problems. Parents who reported more dysfunctional parenting styles reported more difficulties with their child's asthma behavior. Based on the results it is suggested that an appropriate parenting intervention program would target basic behavioral management skills, in addition to applying these behavior management principles to asthma management.

Background: Gestational diabetes mellitus (GDM) is defined as glucose intolerance first identified during pregnancy. Delays in diagnosis and challenges in management can lead to serious adverse outcomes for the mother and child. As rates of GDM diagnosis increase worldwide, health systems and maternity services have become increasingly strained, especially with new restrictions around in-person care due to the current COVID-19 pandemic. Mobile health (mHealth) has increasingly shown promise for management of chronic disease, driven by smartphone adoption and increased internet connectivity. The aim of this work was to evaluate the adoption and multidisciplinary care coordination of an mHealth platform called M♡THer in a cohort of women with first-time diagnosis of GDM. Methods: The mHealth platform for GDM management was developed incorporating a smartphone application, clinician portal, and secure cloud data storage. Forty participants with a first-time diagnosis of GDM were recruited to use the app during their pregnancy. User attitudes from clinicians and women were captured through post-hoc surveys, and app-usage metrics. Results: Clinicians and women indicated satisfaction and ease of use of the mHealth platform, with some technological challenges around wireless connectivity. Blood glucose reviews and antenatal contact were higher with use of the M♡THer app compared with a matched historical sample. Conclusion: The M♡THer mHealth platform is a new comprehensive tool for health care of women with GDM, and may provide an effective new avenue to enhance multidisciplinary care in the face of COVID-19 disruptions and challenges to traditional care pathways.

The recently described leptodactylid frog Rheobatrachus silus of Queensland, Australia, exhibits a unique form of parental care. The female carries embryos and young in the stomach, propulsively ejecting the juveniles.

OBJECTIVES: In the aftermath of a disaster, the services provided by pharmacists are essential to ensure the continued health and well-being of the local population. To continue pharmacy services, it is critical that pharmacists are prepared for disasters. A systematic literature review was conducted to explore pharmacists' and pharmacy students' preparedness for disasters and the factors that affect preparedness. METHODS: This review was conducted in April 2020 through electronic databases CINAHL, MEDLINE, Embase, PubMed, Scopus and PsycINFO, and two disaster journals. Search terms such as 'pharmacist*', 'disaster*' and 'prepared*' were used. The search yielded an initial 1781 titles. Articles were included if they measured pharmacists or pharmacy students' disaster preparedness. After screening and quality appraisal by two researchers, four articles were included in final analysis and review. Data were extracted using a data collection tool formulated by the researchers. Meta-analysis was not possible; instead, results were compared across key areas including preparedness ratings and factors that influenced preparedness. KEY FINDINGS: Three articles focused on pharmacy students' preparedness for disasters, and one on registered pharmacists' preparedness. Preparedness across both groups was poor to moderate with <18% of registered pharmacists found to be prepared to respond to a disaster. Factors that potentially influenced preparedness included disaster competency, disaster interventions and demographic factors. CONCLUSION: For pharmacists, the lack of research around their preparedness speaks volumes about their current involvement and expectations within disaster management. Without a prepared pharmacy workforce and pharmacy involvement in disaster management, critical skill and service gaps in disasters may negatively impact patients.

Globally, lung cancer is the leading cause of cancer-related death. The majority of non-small cell lung cancer (NSCLC) tumours express epidermal growth factor receptor (EGFR), which allows for precise and targeted therapy in these patients. The dysregulation of EGFR in solid epithelial cancers has two distinct mechanisms: either a kinase-activating mutation in EGFR (EGFR-mutant) and/or an overexpression of wild-type EGFR (wt-EGFR). The underlying mechanism of EGFR dysregulation influences the efficacy of anti-EGFR therapy as well as the nature of resistance patterns and secondary mutations. This review will critically analyse the mechanisms of EGFR expression in NSCLC, its relevance to currently approved targeted treatment options, and the complex nature of secondary mutations and intrinsic and acquired resistance patterns in NSCLC.