Magnetotelluric support for edge-driven convection and shear-driven upwelling in the Newer Volcanics Province

Intraplate volcanic provinces present significant natural hazards to many populated regions globally but their origins are poorly understood. Though hypotheses involving mantle plumes are predominant, the Newer Volcanics Province of southeast Australia-a relatively young (< 4.5 Ma), EW trending collection of over 400 volcanic centres-is increasingly attributed to some combination of edge-driven convection (EDC) and shear-driven upwelling (SDU). In this paper, we provide magnetotelluric (MT) data in support of these geodynamic processes. Three-dimensional inversion of 49 new broadband MT sites, in combination with 143 previously collected broadband, long-period, and geomagnetic depth soundings, reveals an elongate zone of moderately low resistivity (∼ 10-300 Ω m) spanning the Mt Gambier subprovince at a depth of between 20 and 40 km. The newly defined Gambier Conductor is contiguous to, and orientationally aligned with, significant step in the seismically-defined lithosphere-asthenosphere boundary (LAB) presented by earlier studies. Moderately low resistivity is interpreted as fluid-catalysed alteration of iron-bearing crust resulting from percolating magmatic volatiles. We argue that localised low resistivity (< 10 Ω m) at ~ 25 km depth in the mid-lower crust is associated with 1.2-3.6% partial melt. Supporting evidence indicates possible crustal thickening from 5.8 Ma at a rate comparable to estimates of SDU-induced surface eruptions and previous NVP production rate estimates.

Perceptions of friendship, peers and influence on adolescent smoking according to tobacco control context: a systematic review and meta-ethnography of qualitative research

BACKGROUND

A relationship between smoking and interpersonal influences has been well established within the literature. There have been cultural shifts in denormalisation and a reduction in tobacco smoking in many countries. Hence there is a need to understand social influences on adolescents' smoking across smoking normalisation contexts.

METHODS

The search was conducted in July 2019 and updated in March 2022 within 11 databases and secondary sources. Search terms included schools, adolescents, smoking, peers, social norms and qualitative research. Screening was conducted by two researchers independently and in duplicate. Study quality was assessed using the eight-item Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-centre) tool for the appraisal of qualitative studies. Results were synthesised using a meta-narrative lens for meta-ethnography and compared across smoking normalisation contexts.

RESULTS

Forty one studies were included and five themes were developed, mapping onto the socio ecological model. The social processes by which adolescents take up smoking differed according to a mixture of school type, peer group structure and the smoking culture within the school, as well as the wider cultural context. Data available from smoking denormalised contexts, described changes in social interactions around smoking to cope with its stigmatisation. This was manifested through i) direct peer influence, whereby subtle techniques were employed, ii) group belonging whereby smoking was less likely to be seen as a key determinant of group membership and smoking was less commonly reported to be used as a social tool, and iii) popularity and identity construction, whereby smoking was perceived more negatively in a denormalised context, compared with a normalised context.

CONCLUSIONS

This meta-ethnography is the first study to demonstrate, drawing on international data, that peer processes in adolescent smoking may undergo changes as smoking norms within society change. Future research should focus on understanding differences across socioeconomic contexts, to inform the adaptation of interventions.

A-45 Clinical Considerations of Neuropsychologists for Treating Concussions

Purpose: The purpose of this study was to explore sex specific clinical considerations by neuropsychologists’ and general clinical considerations for the treatment of concussion. Methods: Fourteen clinical neuropsychologists who see concussion patients regularly (&gt;1 case per week) were interviewed using a semi-structured guide that included a generic patient vignette. Participants were asked about clinical considerations that they faced while assessing, managing, and treating concussion. Two investigators independently coded the transcriptions and met to compare coding processes, definitions, and categories. A final codebook was developed in an iterative fashion and reapplied to all transcripts. Independent coding and member checks contributed to the trustworthiness of the data. Results: Participants’ clinical experience in treating concussion ranged from 1 to 40 years, and the sample was 64% female (9/14). Four major themes were identified, including patients’ sex considerations, sleep and napping, patient education and reassurance, and mental health considerations. Several participants (4/14; 29%) noted the lack of action-oriented clinical recommendations for previously documented sex differences (i.e., menstruation). There was a lack of uniformity in sleep and napping recommendations across the participants (e.g., permitting napping vs recommended nap-length). Participants noted that a large portion of their clinical time was spent educating and reassuring patients that concussion is treatable. Comorbid mental health considerations such as anxiety were a prevailing clinical concern across participants. Conclusions: The study revealed the need for better action-oriented clinical recommendations in consensus statements that address the four main themes of sex considerations, sleep and napping considerations, patient education and reassurance, and mental health considerations.

A-26 A Principal Component Analysis of Clinical Outcomes Among Adolescent Patients Following Concussion

Objective

Previous research utilizing factor analytic methods, such as principal components analysis (PCA) has focused on concussion factors derived from symptom scales (Piland, 2003; Kontos, 2012) and neurocognitive testing (Schatz, 2013). However, researchers have yet to conduct a PCA that incorporates symptoms, cognitive, ocular, and vestibular outcomes. The purpose was to utilize PCA to examine the factor structure of concussion among adolescents within 31 days of injury.

Method

Participants included 238 adolescents (41.2% female) diagnosed with concussion. Average age was 14.81 ± 1.57 years (10 to 17 years). A PCA was performed on 11 variables, including PCSS (via symptom factors: cognitive/fatigue/migraine, affective, somatic, and sleep), near point of convergence (NPC), ImPACT composites, and VOMS symptoms. Items retained in the factor models on the basis of having a primary factor loading of .6 or above.

Results

A three-component model was supported that accounted for 65.12% of the variance: 1) cognitive, 2) symptoms, and 3) vestibular/ocular. The cognitive component included visual motor speed, reaction time, verbal, and visual memory (37.95%). Symptoms component included affective, cognitive/fatigue/migraine, and sleep (17.42%). Vestibular/ocular component included vestibular and ocular symptoms (9.75%). All items loaded into the PCA, with exception of somatic and NPC average were retained.

Conclusions

The current study supported three factors and extended findings of previous PCAs by including ocular and vestibular components. The current study better reflects contemporary models of concussion involving clinical profiles or subtypes (e.g., Harmon, 2019). Moving forward, researchers should examine factors across subacute and chronic time points to evaluate potential temporal changes in factors.

A-24 Influence of Biopsychosocial Factors on First-Appointment Presentation After Sport Related Concussion (SRC)

Objective

To examine the influence of biopsychosocial factors on clinical outcomes and recovery time following SRC

Method

59 athletes with SRC (51% male) aged 14.42, SD= 1.65 years from two concussion specialty clinics between May 2019 and January 2020. Patients completed the Behavioral Regulation Assessment for Concussion (BRAC) inventory measuring sleep, diet, hydration, physical activity and stress; on a 4-point Likert scale, ImPACT, and PCSS. Analyses included one-way ANOVAs with Tukey’s post-hoc test and chi-square analyses.

Results

Verbal memory scores were higher F(3,55)= 2.85, p&lt;.05 in participants reporting 8-10hrs of sleep “most of the time” (M= 85.12, SD = 10.58) vs. “some of the time “ (M= 75.65, SD= 11.91). Verbal memory differed when engaged in stress regulation F(4,54)= 2.65, p&lt;.05; “MOT” (M=81.38, SD= 10.95); “SOT” (M=82.33, SD= 12.64) and “never” (M= 84.05, SD= 13.07). PCSS sleep factor scores increased when individuals obtained 8-10hrs of sleep “MOT” (M=.30, SD=.423) “SOT” (M= 1.40, SD= 1.54) and “seldom/rarely” (M= 1.95, SD= 1.58). PCSS somatic scores were associated with decreased sleep X2(1, N=57) = 37.68; p= .001, and hydration X2(1, N=57) = 60.70 p&lt; .001. Sleep and recovery time X2(1, N=55) = 120.82 p= .028.

Conclusions

Findings suggest that biopsychosocial factors including sleep, stress, and hydration are associated with symptoms, cognitive function, and recovery time following SRC and should be monitored by clinicians.

Assertive outreach treatment versus care as usual for the treatment of high-need, high-cost alcohol related frequent attenders: study protocol for a randomised controlled trial

BACKGROUND

Alcohol-related hospital admissions have doubled in the last ten years to > 1.2 m per year in England. High-need, high-cost (HNHC) alcohol-related frequent attenders (ARFA) are a relatively small subgroup of patients, having multiple admissions or attendances from alcohol during a short time period. This trial aims to test the effectiveness of an assertive outreach treatment (AOT) approach in improving clinical outcomes for ARFA, and reducing resource use in the acute setting.

METHODS

One hundred and sixty ARFA patients will be recruited and following baseline assessment, randomly assigned to AOT plus care as usual (CAU) or CAU alone in equal numbers. Baseline assessment includes alcohol consumption and related problems, physical and mental health comorbidity and health and social care service use in the previous 6 months using standard validated tools, plus a measure of resource use. Follow-up assessments at 6 and 12 months after randomization includes the same tools as baseline plus standard measure of patient satisfaction. Outcomes for CAU + AOT and CAU at 6 and 12 months will be compared, controlling for pre-specified baseline measures. Primary outcome will be percentage of days abstinent at 12 months. Secondary outcomes include emergency department (ED) attendance, number and length of hospital admissions, alcohol consumption, alcohol-related problems, other health service use, mental and physical comorbidity 6 and 12 months post intervention. Health economic analysis will estimate the economic impact of AOT from health, social care and societal perspectives and explore cost-effectiveness in terms of quality adjusted life years and alcohol consumption at 12-month follow-up.

DISCUSSION

AOT models piloted with alcohol dependent patients have demonstrated significant reductions in alcohol consumption and use of unplanned National Health Service (NHS) care, with increased engagement with alcohol treatment services, compared with patients receiving CAU. While AOT interventions are costlier per case than current standard care in the UK, the rationale for targeting HNHC ARFAs is because of their disproportionate contribution to overall alcohol burden on the NHS. No previous studies have evaluated the clinical and cost-effectiveness of AOT for HNHC ARFAs: this randomized controlled trial (RCT) targeting ARFAs across five South London NHS Trusts is the first.

TRIAL REGISTRATION

International standard randomized controlled trial number (ISRCTN) registry: ISRCTN67000214, retrospectively registered 26/11/2016.

Comparison of Clinical Outcomes Following Patients' First and Second Concussions

Purpose

The objective of this study was to examine differences in self-reported symptoms, neurocognitive performance, and vestibular-ocular insufficiencies between patients’ first and second concussions. A secondary purpose was to explore the role of risk factors on recovery.

Methods

We conducted a retrospective medical chart review of 73 (32-M/41-F) patients aged 15.69 (SD=1.67) years from a concussion specialty clinic with two separate concussions (84.9% of 1st and 79.5% of 2nd sport-related) that occurred between August 2010 and April 2018. Clinical outcomes included the PCSS, ImPACT, and the Vestibular/Ocular Motor Screening (VOMS). A series of paired samples t-tests were used to compare clinical outcomes along with chi-square analyses for risk factor associations.

Results

Verbal memory scores were higher following the second (M=80.67, SD=15.3) (M=76.32, SD=15.65) (t[73]=–2.18, p=.03) concussion. Visual motor processing speed was faster following the second concussion (M=35.04, SD= 7.90) (M=31.35, SD=7.63) (t[73]=–5.72, p<.001). There were no other significant differences observed. Recovery time was similar for the first (61.07, SD=58.41.5) and second (67.91 SD=70.10) respectively, t(70)=–.91, p=.37. There was no relationship between any risk factors, and recovery time for either injury with the exception a significant association between gender and recovery time (>21 days) with the 1st injury for females (χ2, N=73)=10.58, p=.001.

Conclusion

Findings suggest that a second concussion does not result in more pronounced symptoms, worse neurocognitive performance, or increased deficits on vestibular/ocular performance and/or longer recovery time. The only significant risk factor to a recovery over 21 days included gender.

Comment on "Tracking the global footprint of fisheries"

Kroodsma et al (Reports, 23 February 2018, p. 904) mapped the global footprint of fisheries. Their estimates of footprint and resulting contrasts between the scale of fishing and agriculture are an artifact of the spatial scale of analysis. Reanalyses of their global (all vessels) and regional (trawling) data at higher resolution reduced footprint estimates by factors of >10 and >5, respectively.

Flight-Test of a Tactile Situational Awareness System in a Land-based Deck Landing Task

The National Research Council of Canada and Defence Research and Development Canada flight-tested the U.S. Naval Aerospace Medical Research Laboratory's Tactile Situational Awareness System (TSAS) in a dynamic task. The TSAS vest uses small pneumatic actuators or ‘tactors’ to transmit information to the pilot. Eleven pilots used the TSAS to cue horizontal axis performance in a land-based deck landing task flown in the NRC Bell 205 helicopter. Pilots tracked a vertically moving target with and without the TSAS in good and degraded visual conditions. The TSAS effectively cued longitudinal fore/aft drifts and reduced RMS error. It had less effect on lateral positioning error, possibly due to the presence of strong visual cues. Pilot situational awareness during degraded visual environment conditions in high sea states was significantly improved by the TSAS, as measured by the China Lake situational awareness rating scale. No change in workload, as measured by Modified Cooper Harper Workload Scale, was attributable to the TSAS use. The improvements in situational awareness and the reduction in longitudinal error suggest that the TSAS would be beneficial for helicopter ship deck landing.

Evaluating control activity as a measure of workload in flight test

This paper describes an investigation of a workload measurement technique based on pilot control movements. The Dynamic Interface Modeling and Simulation System Product Metric (DIMSS PM) assumes that pilot control activity can be used to evaluate pilot workload. Three qualified test pilots flew the fly-bywire NRC Bell 205 helicopter in a short test program that compared the DIMSS PM with subjective workload ratings and handling qualities ratings. The pilots performed a variation of an ADS-33E bob-up with varying levels of simulated turbulence and modified cyclic control characteristics. Good agreement was found for most in-flight test conditions between DIMSS Workload Metric scores and subjective workload ratings from the Bedford Workload Scale and Cooper-Harper handling qualities ratings. While, the DIMSS Workload Metric did not accurately reflect workload increases due to variations in the cyclic stick characteristics, the metric shows promise as an objective measurement tool of pilot workload in well-defined tests.

Pulmonary Veno-Occlusive Disease

Pulmonary hypertension is a well-known though poorly characterized disease in veterinary medicine. In humans, pulmonary veno-occlusive disease (PVOD) is a rare cause of severe pulmonary hypertension with a mean survival time of 2 years without lung transplantation. Eleven adult dogs (5 males, 6 females; median age 10.5 years, representing various breeds) were examined following the development of severe respiratory signs. Lungs of affected animals were evaluated morphologically and with immunohistochemistry for alpha smooth muscle actin, desmin, CD31, CD3, CD20, and CD204. All dogs had pulmonary lesions consistent with PVOD, consisting of occlusive remodeling of small- to medium-sized pulmonary veins, foci of pulmonary capillary hemangiomatosis (PCH), and accumulation of hemosiderophages; 6 of 11 dogs had substantial pulmonary arterial medial and intimal thickening. Ultrastructural examination and immunohistochemistry showed that smooth muscle cells contributed to the venous occlusion. Increased expression of CD31 was evident in regions of PCH indicating increased numbers of endothelial cells in these foci. Spindle cells strongly expressing alpha smooth muscle actin and desmin co-localized with foci of PCH; similar cells were present but less intensely labeled elsewhere in non-PCH alveoli. B cells and macrophages, detected by immunohistochemistry, were not co-localized with the venous lesions of canine PVOD; small numbers of CD3-positive T cells were occasionally in and around the wall of remodeled veins. These findings indicate a condition in dogs with clinically severe respiratory disease and pathologic features resembling human PVOD, including foci of pulmonary venous remodeling and PCH.

A Survey of GPs Awareness and Use of Risk Assessment Tools and Cardiovascular Disease Prevention Guidelines

Cardiovascular disease (CVD) is the leading cause of death worldwide. This study aimed to benchmark awareness and use of CVD risk assessment (RA) tools and prevention guidelines in Irish general practice. 493 (18%) Irish general practitioners (GPs) were invited to participate in a cross-sectional study in 2011. 213 (43%) GPs responded with most being male (n = 128, 58.2%) and aged ≥ 45 years (n = 124, 56.8%). While 197 (92.5%) GPs were aware of at least one RA tool, only 69 (32.4%) GPs reported frequent use. 187 (87.8%) GPs were aware of one or more CVD prevention guidelines with 115 (54.0%) GPs reporting frequent use of at least one guideline. No age or gender difference observed. Barriers to implementation of CVD prevention guidelines were lack of remuneration, too many CVD guidelines and time constraints. Most Irish GPs were aware of RA tools and CVD prevention guidelines with half reporting frequent use of guidelines.

Trends in percutaneous coronary intervention and angiography in Ireland, 2004-2011: Implications for Ireland and Europe

BACKGROUND/OBJECTIVES

To study temporal trends in crude and age standardised rates of cardiac catheterisation and percutaneous coronary intervention (PCI) in Ireland, 2004-2011.

METHODS

Two data sources were used: a) a survey of publicly and privately funded hospitals with cardiac catheter laboratories to obtain the annual number of procedures performed and b) anonymised data from the Hospital In-Patient Enquiry (HIPE) for angiography and PCI in acute publicly funded hospitals; age standardised rates were calculated to study trends over time.

RESULTS

From 2004 to 2011 the crude rate of angiography and PCI increased by 47.8% and 35.9% respectively, with rates of 6689 and 1825 per million population in 2011. Following age standardisation, however, PCI activity showed a non-significant decrease over time. The PCI to angiography ratio decreased from 30% to 27% and PCI was performed predominantly for stable coronary heart disease (54%) in 2011.

CONCLUSION

Angiography and PCI rates have increased in Ireland but PCI crude and age adjusted rates show divergent trends. While Ireland differs from USA and UK, with a higher proportion of PCI being performed for stable CHD in recent years, little systematic surveillance of cardiological interventions within Europe is available to benchmark improvements in Ireland.

Primary care in nursing homes revisited: survey of the experiences of primary care physicians

The Irish Health Information and Quality Authority (HIQA) published National Quality Standards for Residential Care Settings for Older People in 2009. We reported on experiences of general practitioners (GPs) in Dublin caring for nursing home patients (NHPs) in 2006. We revisit these experiences following publication of HIQA's standards. 400 GPs received an anonymous postal survey. Of 204 respondents, 145 (71%) felt NHPs required more contact time and 124 (61%) reported more complex consultations compared to other patients. Only 131 (64%) felt adequately trained in gerontology. 143 (70%) reported access to specialist advice, but only 6 (3%) reported a change in this following HIOA standards. 65 (32%) had witnessed substandard care in a NH, of which 16 (25%) made no report, similar figures to 2006. There remains similar levels of concern regarding patient complexity, substandard care, access to specialist support and training in the care of NHPs. Many GPs expressed uncertainty regarding their role in implementing HIQA standards.

Acute childhood asthma in Galway city from 1985-2005: relationship to air pollution and climate

We examine the relationship of air pollution and climatic variables to asthma admission rates of children in Galway city over a 21 year period. Paediatric asthma admissions were recorded from 1985-2005, and admission rates per thousand calculated for pre-school (1-4 years), school aged (5-14 years) and all children (1-14 years) on a monthly and annual basis. These data were compared to average monthly and annual climatic variables (rainfall, humidity, sunshine, wind speed and temperature) and black smoke levels for the city. Simple correlation and Poisson Generalized Additive Models (GAM) were used. Admission rates each month are significantly correlated with smoke levels (p = 0.007). Poisson GAM also shows a relationship between admissions and pollution (p = 0.07). Annual smoke levels impact more on admission rates of preschoolers (p = 0.04) than school age children (p = 0.10). These data suggest that air pollution is an important factor in the epidemiology of acute childhood asthma.

Recovery of South Australian rabbit populations from the impact of rabbit haemorrhagic disease

Context Recovery of Australian rabbit populations from the impact of rabbit haemorrhagic disease virus (RHDV) contrasts with more prolonged suppression of wild rabbits in Europe, and has been widely discussed in the scientific community, but not yet documented in formal scientific literature. The underlying causes of recovery remain unclear, but resistance to RHDV infection has been reported in laboratory studies of wild-caught rabbits. Aims We document numerical changes in two South Australian wild rabbit populations that were initially suppressed by RHDV, and examine serological data to evaluate several alternative hypotheses for the cause of recovery. Methods Rabbit numbers were assessed from spotlight transect counts and dung mass transects between 1991 and 2011, and age and RHDV antibody sero-prevalence were estimated from rabbits shot in late summer. Key results Rabbit numbers were heavily suppressed by RHDV between 1995 and 2002, then increased 5- to 10-fold between 2003 and 2010. During the period of increase, annual RHDV infection rates remained stable or increased slightly, average age of rabbits remained stable and annual rainfall was below average. Conclusions Rabbit populations recovered but neither avoidance of RHDV infection, gradual accumulation of long-lived RHD-immune rabbits, nor high pasture productivity were contributing factors. This leaves increased annual survival from RHDV infection as the most likely cause of recovery. Implications Previously documented evidence of resistance to RHDV infection may be of little consequence to post-RHD recovery in rabbit numbers, unless the factors that influence the probability of infection also shape the course of infection and affect survival of infected rabbits.

Use of morphological characteristics to define functional groups of predatory fishes in the Celtic Sea

An ecomorphological method was developed, with a focus on predation functions, to define functional groups in the Celtic Sea fish community. Eleven functional traits, measured for 930 individuals from 33 species, led to 11 functional groups. Membership of functional groups was linked to body size and taxonomy. For seven species, there were ontogenetic changes in group membership. When diet composition, expressed as the proportions of different prey types recorded in stomachs, was compared among functional groups, morphology-based predictions accounted for 28-56% of the interindividual variance in prey type. This was larger than the 12-24% of variance that could be explained solely on the basis of body size.

HeartBeat--improving heart attack care

We aimed to save lives by assuring best practice in ST elevation myocardial infarction (STEMI) through initiating the Institute for Healthcare Improvement (IHI) methodology nationally. Following collection of a minimum dataset, annual change in indicators in the five initiating hospitals for the period Oct 2006 - Sept 2009 was assessed by analysing the percentage of patients receiving the eight components of evidenced based care on admission and discharge and in-hospital mortality rate. For 635 patients, performance on seven of the eight indicators of care exceeded 90% annually. Timely reperfusion therapy (thrombolysis, primary percutaneous coronary intervention (PPCI)) improved non-significantly from 68.2% (107 patients) in year 1 to 77.1% (118 patients) in year 3. In-hospital mortality declined significantly from 12.4% (24 deaths) in year 1 to 5% (9 deaths) in year 3. Evidence based STEMI care is followed to a high degree but timely reperfusion and PPCI provision remain a challenge nationally.

Contribution of fish to the marine inorganic carbon cycle

Oceanic production of calcium carbonate is conventionally attributed to marine plankton (coccolithophores and foraminifera). Here we report that marine fish produce precipitated carbonates within their intestines and excrete these at high rates. When combined with estimates of global fish biomass, this suggests that marine fish contribute 3 to 15% of total oceanic carbonate production. Fish carbonates have a higher magnesium content and solubility than traditional sources, yielding faster dissolution with depth. This may explain up to a quarter of the increase in titratable alkalinity within 1000 meters of the ocean surface, a controversial phenomenon that has puzzled oceanographers for decades. We also predict that fish carbonate production may rise in response to future environmental changes in carbon dioxide, and thus become an increasingly important component of the inorganic carbon cycle.

Nematode community dynamics over an annual production cycle in the central North Sea

Nematode species composition, trophic structure and body size distributions were followed over an annual production cycle in the central North Sea; to test responses to temporally changing food quality and quantity in the sediment. Changes in the phytoplankton concentration in the water column were quantitatively reflected in the concentration of chlorophyll a and breakdown products in the sediment, with higher concentrations in spring and autumn following blooms, and lower concentrations in summer and winter. The taxonomic and trophic structure of nematode communities differed significantly among stations over relatively short distances, potentially masking some of the temporal dynamics. Spatio-temporal differences in nematode species composition were linked to changes in the quality and quantity of organic material reaching the seabed, reflecting a species-specific response to the nutritional quality of sedimenting organic material and the biochemical changes in the sediment associated with its decomposition. The size distributions of selected nematode species indicated that most species bred continuously throughout the sampling period, although one species, the epigrowth feeder Spilophorella paradoxa, had periods of increased growth following the deposition of the spring phytoplankton bloom. There was no consistent temporal relationship between the trophic composition of nematode communities and spring chlorophyll a or carbon sedimentation, most likely a result of the trophic plasticity of most feeding types and the capacity of the community to use both freshly sedimented material as well as the subsequent breakdown products and refractory organic matter. Community metrics implied that there were small responses to the seasonal production cycle, but these belied strong responses of a few species with life histories that allowed them to track the availability of suitable food resources.

Ecology of the Honey possum, Tarsipes rostratus, in Scott National Park, Western Australia

The Honey possum, Tarsipes rostratus, is an obligate nectarivore, known to feed on plant species from only three Families in south-western Western Australia: Myrtaceae, Proteaceae and Epacridaceae. These plants can be adversely affected by fire, decreased rainfall or groundwater levels and the pathogen Phytophthora cinnamomi. We investigated the ecology of T. rostratus in terms of: (i) how the population fluctuated in response to rainfall and fire over a 20-year period and (ii) changes in diet and movements during a period of decreased food availability in late summer. Mean capture rates were significantly positively correlated with mean flowering rates of Banksia ilicifolia over a 20-year period. Winter capture rates were also significantly positively correlated with both annual and winter rainfall two years prior to trapping in recently burnt areas, but not in long unburnt� areas. Capture rates were significantly higher in unburnt Banksia woodland during winter but densities there have declined since 1996, associated with the death of many Banksia ilicifolia trees from persistent Phytophthora infection. Notwithstanding this decline, winter capture rates in the unburnt areas were still approximately double those in the burnt areas 6 years after the last fire. Short-term capture rates were negatively correlated with barometric pressure, showing that movement and foraging is stimulated by the passage of low pressure frontal weather systems. Despite the paucity of known food sources flowering in late summer and autumn, there was no evidence of T. rostratus using plant species from other than the three above-noted Families. Utilisation areas in summer were also no larger than those previously recorded across all seasons in Scott National Park. Some individuals, however, moved extensive distances to locate spatially restricted food sources. The conservatism of their diet and the sensitivity of the population to changes in rainfall and fire history indicate that T. rostratus populations are particularly vulnerable to some of the environmental changes now occurring in south-western Australia.

Structuring diabetes care in general practices: Many improvements, remaining challenges

BACKGROUND

For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way.

AIM

To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care.

METHODS

An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on.

RESULTS

Structured diabetes care in general practice has led to more dedicated clinics improved processes of care and increased access to multidisciplinary expertise. Improvement in blood pressure control, the use of aspirin and the use of lipid lowering agents indicate a significant decrease in absolute risk of vascular events for this population.

CONCLUSIONS

Structured care in general practice improves intermediate outcomes for people with type 2 diabetes. Further improvements need to be made to reach international targets.

Is ultrasound useful for evaluating paediatric inflammatory neck masses?

OBJECTIVE

To determine the accuracy of ultrasound in detecting the presence of pus in a neck mass in children.

DESIGN

Retrospective case sheet review.

SETTING

A district general hospital.

PARTICIPANTS

Children admitted from January 2000 to January 2004 with an acute cervical mass who were investigated by ultrasonography.

MAIN OUTCOME MEASURES

The presence of a clinically relevant abscess that did not respond to clinical management was used to determine the accuracy of the ultrasound result.

RESULTS

The sensitivity of ultrasound in the detection of an abscess was 65% and the specificity 88%. The predictive value of a positive ultrasound result was 81% and the predictive value of a negative test 77%.

CONCLUSIONS

Ultrasound is a useful modality in the evaluation of acute cervical masses but is observer dependent and has a relatively low sensitivity in detecting whether or not pus is present. The clinical indicators for the presence of an abscess are discussed and clinicians should combine clinical findings with the ultrasound findings in order to determine treatment.

Predicting abundance–body size relationships in functional and taxonomic subsets of food webs

Abundance-body size relationships are widely observed macroecological patterns in complete food webs and in taxonomically or functionally defined subsets of those webs. Observed abundance-body size relationships have frequently been compared with predictions based on the energetic equivalence hypothesis and, more recently, with predictions based on energy availability to different body size classes. Here, we consider the ways in which working with taxonomically or functionally defined subsets of food webs affected the relationship between the predicted and observed scaling of biomass and body mass in sediment dwelling benthic invertebrate communities at three sites in the North Sea. At each site, the energy available to body size classes in the "whole" community (community defined as all animals of 0.03125-32.0 g shell-free wet weight) and in three subsets was predicted from estimates of trophic level based on nitrogen stable isotope analysis. The observed and predicted scalings of biomass and body size were not significantly different for the whole community, and reflected an increase in energy availability with body size. However, the results for subsets showed that energy availability could increase or decrease with body size, and that individuals in the subsets were likely to be competing with individuals outside the subsets for energy. We conclude that the study of abundance-body mass relationships in functionally or taxonomically defined subsets of food webs is unlikely to provide an adequate test of the energetic equivalence hypothesis or other relationships between energy availability and scaling. To consistently and reliably interpret the results of these tests, it is necessary to know about energy availability as a function of body size both within and outside the subset considered.

Effects of chemical lipid extraction and arithmetic lipid correction on stable isotope ratios of fish tissues

For accurate interpretation of fish trophodynamics from carbon stable isotope data it is necessary to extract tissue lipids. This is because lipid content varies within and among tissues in both space and time, and because lipids are 13C-depleted relative to proteins. However, lipid extraction may affect delta15N, thus requiring costly and time-consuming separation of delta13C and delta15N analyses. These problems have prompted the development of arithmetic correction techniques for delta13C, but the techniques and their underlying assumptions have not been systematically tested. This study compared the effects of lipid extraction and arithmetic correction techniques on delta13C and delta15N of European sea bass (Dicentrarchus labrax) tissues. Following Folch lipid extraction from muscle and liver, there was a mean increase in delta15N of 0.77 per thousand, but enrichment varied with lipid content such that effects on delta15N were hard to predict. Changes in delta13C and C:N between untreated and lipid-extracted samples reflected the quantity of lipid removed. The arithmetic correction techniques of mass balance and lipid correction were sensitive to the C:N of the lipid-extracted tissue and to the assumed depletion of lipid delta13C relative to protein delta13C. However, the mass balance approach was appropriate for the mathematical correction of bulk tissue data in most circumstances, provided that the C:N of lipid-extracted tissue could be determined for a small proportion of samples. Application of mass balance arithmetic correction can lead to significant time and cost savings in trophodynamic studies, because the majority of delta13C and delta15N analyses would not need to be run separately.

Capacity and equity in cardiac rehabilitation in the eastern region: good and bad news

AIM

To document current baseline eligibility for Phase 3 cardiac rehabilitation (CR) and the capacity to meet this need in hospitals in the Eastern Regional Health Authority.

METHODS

Information on the eligible population and the capacity for CR was collected in all nine hospitals retrospectively (February-March 2001).

RESULTS

Forty-seven per cent of eligible patients were invited to participate with only two-thirds attending. Completion rates were very high (89%) in attenders. Age and health board area were significant independent predictors of being invited to CR. Gender was not independent of age. Fifty-three per cent of the need for this service was met by capacity in the region's nine hospitals in 2000 rising to 59% in 2002.

CONCLUSIONS

Many eligible patients are not invited to CR. Lack of capacity is a problem. Among the invited, non-participation is a factor. Inequity in age and inter-hospital variation in invitation is noted.

Tissue and fixative dependent shifts of delta13C and delta15N in preserved ecological material

Carbon and nitrogen stable isotope analyses are routinely used to investigate aquatic food webs, and have potential application in retrospective investigations using archived materials. However, such analyses assume that storage does not alter isotopic signatures of materials preserved, or that changes in isotopic composition during storage are predictable. Here we examine preservation shifts on cod (Gadus morhua) muscle, roe and liver tissue over 21 months following preservation in 80% ethanol, in 4% formaldehyde, and by freezing. Preservation shifts were not consistent among tissues. High protein tissues exhibited greater delta(15)N shifts than low protein tissues in 4% formaldehyde, while greater delta(13)C shifts occurred in relatively higher fat tissues when preserved in alcohol. Freezing did not change isotopic signatures. Responses of delta(15)N and delta(13)C are explained by differences in the preservative's isotopic signature and the reaction properties and biochemical composition of the tissues preserved. The results clarify some of the processes that lead to isotopic change during preservation.

Health and safety implications of injury in professional rugby league football

BACKGROUND

Professional sport is characterized by high injury rates but is also covered by health and safety legislation.

AIM

To examine the incidence of injury in professional rugby league as defined by the Reporting of Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR 95).

METHODS

All injuries received during playing and training to both first-team and 'academy' (<19 years old) players during two playing seasons at one professional club were recorded. The length of time a player was unable to take part in full training and playing was used as a measure of severity. Injuries were classified into minor injuries (0-3 days), over 3 day injuries or major injuries, in which the final two categories corresponded with RIDDOR 95.

RESULTS

Thirty-two per cent (95% confidence interval=26-39%) of all injuries received satisfied the RIDDOR 95 criteria. The overall injury rate was 8.5 per 1000 h (7.2-9.9) for the first team and 4.1 per 1000 h (3.2-5.4) for the academy team. During match play the first-team injury rate was 157.7 per 1000 h (133.5-185.1) and 67.7 (51-81.1) for the academy team. Training injury rates were lower, at 0.5 per 1000 h (0.2-1.0) and 0.3 per 1000 h (0.1-0.8), respectively.

CONCLUSION

The injury rate for professional rugby league is much higher than reported in other high-risk occupations such as mining and quarrying. The large differences in injury rates between first and academy teams have implications for young players likely to progress to first-team status.

Medium term follow up of endoscopically assisted BPTB ACL reconstruction using a two-incision technique--return to sporting activity

We report our findings of a prospective outcome study of a series of 50 patients with chronic ACL injury undergoing arthroscopically assisted bone-patellar-tendon-bone ACL reconstruction. Patients underwent reconstruction if they had instability precluding participation in sport at the desired level and were reviewed at a mean of 62 months. Clinical examination was carried out pre and post operatively. Assessment was augmented by KT 1000 measurement, Tegner activity score and Lysholm score. Surgery was considered a failure if the Pivot Shift test was 2+(jerk) or symptoms of instability persisted. By these criteria 48 patients were successfully treated. Our results show a good medium term outcome for this reconstructive method. We had a 94% return to sporting activity but at a lower than expected activity level. Clinical examination showed an improvement and we recorded excellent or good results on Lysholm score in all these patients.