bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atrial fibrillation: prevalence and management in an acute general medical unit
Authors: Stewart F. M. , Singh Y. , Persson S. , Gamble G. D. , Braatvedt G. D. 
Published: March 2008

Abstract Background: Atrial fibrillation (AF) is a common comorbid condition in patients admitted to hospital. In managing patients with AF, recent research has highlighted the importance of heart rate control, cardioversion, maintenance of sinus rhythm and anticoagulation for the prevention of thromboembolism. Aim: To determine the prevalence of AF in patients admitted acutely to the general medical service at Auckland Hospital and to assess the adequacy of heart rate control, the number cardioverted and the use of warfarin to prevent thromboembolism. Methods: Prospective review of all acute admissions to the general medical service over a 12 week period. Information was collected from hospital notes on the patients' present and past medical conditions, admission and discharge cardiac medication and the use of investigations, particularly thyroid function tests and echocardiography. The heart rate on discharge, number cardioverted either during the admission or after discharge and the number given warfarin and aspirin were recorded. Results: One hundred and forty‐seven patients (aged 38–96, mean age 76 years and 52% male) were admitted in AF 165 times out of the 1637 admissions over the study period (a prevalence of 10.4%, 95% CI 8.6–11.5%). The main causes of admission were heart failure (23%), pneumonia or sepsis (17%), cerebrovascular accident (CVA) or transient ischaemic attack (TIA) (14%) and ischaemic heart disease (11%). Past medical history included hypertension (46%), ischaemic heart disease (39%), congestive heart failure (58%), valvular heart disease (12%), chronic obstructive airways disease (24%), CVA, TIA or thromboembolic event (24%) and diabetes (17%).Thyroid function tests were performed in 50% of patients and echocardiograms in 38%. Heart rate control at discharge could not be assessed, as this was not recorded prior to any patient's discharge. Seventy‐eight per cent of patients were discharged on digoxin but only 29% on drugs that control the heart rate with exercise. Five patients out of 11 considered for cardioversion had a successful cardioversion in hospital and two were later cardioverted as outpatients. Twenty‐eight per cent were discharged on warfarin, 33% on aspirin and one patient on both. Fifty‐two per cent were considered to have contraindications to warfarin therapy. Prescribing rates for warfarin did not vary according to the patients' clinical risk for thromboembolism. Conclusion: AF is a common comorbid condition in the acute general medical ward. Standard investigations were under‐utilised. Attention needs to be paid to the recording and control of heart rate at rest and on exercise. Cardioversion is considered infrequently. This patient group had a high risk for thromboembolism and after excluding the large group in whom warfarin was contraindicated, warfarin was still under‐utilised.
Implementation of nationally developed guidelines in cardiology: a survey of NSW cardiologists and cardiothoracic surgeons
Authors: Shah S. , Ward J. , Tonkin A. , Harris P. 
Published: March 2008

Abstract Background: In July 1996, the National Health and Medical Research Council (NHMRC) published clinical practice guidelines for ‘The Procedural and Surgical Management of Coronary Heart Disease’. Despite increasing interest in dissemination and implementation of guidelines, initial reactions to these specific Guidelines and factors critical to their successful implementation had not been determined until our study. Aims: To determine views of New South Wales (NSW) clinicians towards these NHMRC Guidelines; to identify perceptions about local relevance, usefulness and likely impact and to elicit preferred implementation strategies. Methods: A postal survey in November 1997 of all cardiologists and cardiothoracic surgeons in NSW. Results: One hundred and ten of 174 clinicians returned the questionnaire (63% response rate). Forty‐eight per cent indicated that they were aware of the Guidelines before receiving a copy with the questionnaire while 26% had commented on the draft version of the Guidelines when distributed in November 1995. More than half of respondents ‘agreed’ or ‘strongly agreed’ with six of nine statements about potential strengths of the Guidelines. While at least 25%‘disagreed’ or ‘strongly disagreed’ on 11 out of the 13 statements about potential criticisms of the Guidelines, more than half agreed or ‘strongly’ agreed that the Guidelines did not tell them ‘anything they didn’t already know’. Fifty‐two per cent ‘agreed’ or ‘strongly agreed’ that guidelines will be misinterpreted by lawyers. At least 30% rated nine out of 11 implementation strategies as important. Local audits of care and regular feedback, reports from colleagues at conferences and hospital workshops outranked other implementation strategies in encouraging uptake of the Guidelines. Conclusions: Clinicians in NSW have generally positive views about the Guidelines, however, medicolegal concerns are apparent. To strengthen evidence‐based decisionmaking as exemplified by the Guidelines, audits, presentations by opinion leaders and hospital‐based workshops are recommended.
Survey of blood cultures from five community hospitals in south‐western Sydney, Australia, 1993–1994
Authors: Gosbell I. B. , Newton P. J. , Sullivan E. A. 
Published: March 2008

Abstract Background: Blood culture results have profound implications for patients. Comprehensive overviews of blood cultures have been uncommon, and focused on tertiary referral hospitals. Aim: To present a review of blood culture results from a laboratory servicing community hospitals in Sydney, Australia. Methods: Retrospective chart review of patients with positive blood cultures from 1 June 1993 to 31 May 1994. Results: During the survey period there were 107,382 hospital admissions; 12,109 blood culture sets from 9292 patients were processed. Of these 1197 sets were positive, representing 974 febrile episodes in 923 patients. There were 476 episodes of contamination. Of the episodes of true bacteraemia, Escherichia coli was isolated in 139, Staphylococcus aureus in 91 (22 methicillin‐resistant), other enterobacteriaceae in 60, and Streptococcus pneumoniae in 51. The diagnoses attributable to bacteraemia included intravenous catheter‐related sepsis (122 episodes), urinary tract infection (88), bacteraemia from unknown source (79), intra‐abdominal and biliary sepsis (91), pneumonia (35), and meningitis (21). Sixty‐eight patients died directly due to bacteraemia. Multivariate analysis showed underlying disease (OR 3.97) or shock (OR 28.1) predicted death. Blood cultures confirmed clinical diagnoses in 258 episodes, but made a de novo diagnosis in 205 episodes. Conclusions: This study describes the clinical and laboratory features of bacteraemias occurring in smaller public hospitals, as distinct from tertiary referral centres. It demonstrated that intravenous catheter‐related sepsis was very common in smaller hospitals. The clinical diagnosis was frequently confirmed, and a de novo diagnosis was often established by a positive blood culture. Unfortunately nearly half the positive blood cultures represented contamination.
Hip fracture outcomes: quality of life and functional status in older adults living in the community
Authors: Hall S. E. , Williams J. A. , Senior J. A. , Goldswain P. R. T. , Criddle R. A. 
Published: March 2008

Abstract Background: People who return to living in the community after a hip fracture are considered to have the best outcome. However, their quality of life (QOL) and its relationship with function over the longer term have not been fully assessed. Aims: This case control study of community dwelling subjects six to 12 months post hip fracture aims to investigate their QOL and functional independence. Method: The Short Form‐36 (SF‐36) was utilised to measure QOL. The Modified Barthel Index (MBI), the Frenchay Activities of Daily Living Index (FAI), the Timed `Up & Go' (TUG), and the Berg Balance Scale (Berg) were used to measure functionality. Results: Ninety‐two subjects and 92 controls were recruited. Despite being age and gender matched, the hip fracture subjects scored significantly (p<0.05) worse than the controls in all measures of function. The fracture group was slower on the TUG (19 vs 10.5 seconds), had more difficulties with balance (46 vs 54 out of 56), and was less active and more dependant than the control group (FAI 24 vs 31 out of 42). The SF‐36 has eight domains: physical function, role physical, bodily pain, mental health, role emotional, social function, general health and vitality. The control group had a higher (p<0.05) perception of their QOL in all domains. Conclusion: The effects of impaired balance and mobility along with reduced functional and social independence are reflected in the diminished QOL perceived by the fracture group. This indicates that many do not return to their pre‐fracture lifestyle.
Lp(a) and conventional risk profiles predict the severity of coronary stenosis in high‐risk hospital‐based patients
Authors: Wang X. Li , Cranney G. , Wilcken D. E. L. 
Published: March 2008

Abstract Aims: To explore predictive power of Lp(a), of conventional lipoprotein profiles and their carrier proteins, and of biometric measurements, for the presence and severity of angiographically documented coronary disease in high‐risk patients, and to compare risk profiles in men and women. Methods: We determined coronary artery disease (CAD) risk factors in 1308 Australian Caucasian patients (313 women and 995 men) aged 65 years who consecutively underwent coronary angiography. Results: In univariate analyses of the risk factors, lipid profiles, Lp(a), cigarette smoking, diabetes, hypertension and obesity were all higher in men and women with CAD and changed significantly with the number of significantly diseased vessels (50% luminal obstruction). When stepwise logistic regression analysis was applied, age (OR 1.06, 95% CI: 1.04–1.09), TC/HDL–C (OR 1.29, 95% CI: 1.15–1.45), male gender (OR 2.64, 95% CI: 1.67–4.16), hyperLp(a) (300 mg/L) (OR 2.09, 95% CI: 1.42–3.07), lifetime smoking dose (OR 1.02, 95% CI: 1.01–1.03), diabetes (OR 2.19, 95% CI: 1.14–4.18) and waist/hip ratio (OR 14.53, 95% CI: 1.21–174.90) were predictive of the disease. Both Lp(a) levels and percentage of hyperLp(a) increased linearly with the number of significantly diseased vessels. When the analyses were conducted in men and women separately, hyperLp(a), TC/HDL–C, lifetime smoking dose and age remained as significant predictors in both groups but the waist/hip ratio was only predictive in women. Conclusions: As Lp(a) is an independent predictor of the occurrence and extent of coronary stenosis and relevant to treatment options, we suggest that it should be measured routinely in the coronary risk profile assessment of high–risk patients.
Advance care planning in residential care
Authors: Nair B. , Kerridgey I. , Dobson A. , McPhee J. , Saul P. 
Published: March 2008

Abstract Background: To provide optimal care for our ageing population, some form of advance care planning (ACP) is essential. Overseas data suggest that the process of ACP and the use of advance care directives (ACD) is suboptimal in residential care institutions. By comparison there are few Australian data. Aim: To study the process of ACP and the prevalence of ACD in residential care. Methods: Cross‐sectional study using a questionnaire in the Hunter area, NSW, Australia. Results: Very low levels of formal advance directives were found (available for only 0.2%). Only 1.1% of residents had no‐CPR' orders documented in the medical record, while 5.6% had a formal guardian and 2.8% had an enduring guardian.Informal processes of advance planning were much more prevalent. Sixty‐five per cent had a `person responsible' recorded to make decisions for them while in 13% of cases, there was `staff consensus' as to the optimal care for the patient. However, in 10.6% there was no clear process for medical decision making identified. Conclusions: Advanced directives are infrequently used in residential care. Further qualitative and quantitative studies are warranted to explore current processes of decision making.
HLA‐B27 expression and reactive arthritis susceptibility in two patient cohorts infected with Salmonella Typhimurium
Authors: McColl G. J. , Diviney M. B. , Holdsworth R. F. , McNair P. D. , Carnie J. , Hart W. , McCluskey J. 
Published: March 2008

Abstract Background: Reactive arthritis (ReA) is an inflammatory arthritis triggered by certain gastrointestinal and genitourinary infections. Single source outbreaks of triggering infections provide an opportunity to elucidate host susceptibility factors in this disease. Aim: To determine the role of Major Histocompatibility Complex (MHC) Class I alleles in ReA susceptibility after two large single source outbreaks of Salmonella Typhimurium gastroenteritis. Methods: A questionnaire screening for features of ReA and a request for HLA class I typing were sent to all patients affected by two single source outbreaks of S. Typhimurium gastroenteritis. Individuals with arthritis of recent onset were interviewed, examined and diagnostic criteria for ReA applied. Results: Nineteen cases of reactive arthritis, 11 female, were diagnosed in the 424 respondents with S. Typhimurium gastroenteritis from both outbreaks. Clinical features of the arthritis were similar to those described after other large single source outbreaks of Salmonella infection. HLA‐B27 was expressed by only two of the 19 ReA patients and therefore did not predict susceptibility to this form of arthritis. Caucasians were, however, more likely to develop reactive arthritis than Asians. Conclusions: In this study, susceptibility to ReA was not increased in HLA‐B27 positive individuals or males but was greater in those of Caucasian descent.
The ethics of cloning and creating embryonic stem cells as a source of tissue for transplantation: time to change the law in Australia
Authors: Savulescu J. 
Published: March 2008

AbstractEvery day, people die because there are insufficient tissues available for transplantation. The development of cloning and embryonic stem (ES) cell line technologies offers real hope for developing better sources of tissues for transplantation. Moreover, these new technologies may mean that damaged tissue (for example, after a stroke or heart attack) can be replaced with normal functioning tissue rather than scar tissue. Research into ‘therapeutic cloning’ and the development of ES cell lines is illegal in several States in Australia. It is time to review that legislation in order to allow destructive embryo research. My argument is that at least research should be allowed on spare embryos from assisted reproduction; that it is only one moral view (of several plausible ones) of the status of the embryo which precludes producing embryos for research; that this view is mistaken and so it is morally permissible to produce embryos for research into therapeutic cloning.
Integrating Landsat and Land Systems for Cover Maps in Southern Inland Queensland
Authors: HILL GREG J. E. , KELLY GAIL D. 
Published: March 2008

Digital analysis of Landsat data is applied to up‐dating land cover maps for the Goondiwindi district of southern, inland Queensland.The imagery was paired with climax cover maps obtained from land systems reports with analysis conducted separately for each of three climax cover types (open forest, woodland and open woodland). Computer classification using this approach produced readily interpreted and reliable results.This work demonstrates that Landsat can be used in conjunction with existing, land systems derived maps to produce data that combine the advantages of two approaches to environmental survey, the former being based on current land cover/land use and the latter on the original environment and its land use potential.
Global Climatic Change: the Difficulties of Assessing Impacts
Authors: HENDERSON‐SELLERS A. 
Published: March 2008

The Intergovernmental Panel on Climate Change (IPCC) report, initiated in 1988, is complete, was debated at the Second World Climate Conference in November, 1990 and was subsequentty submitted to the United Nations General Assembly. IPCC: (i) asserted the reality of humanity's disturbance of the natural climate system; (ii) demanded studies to improve our knowledge of processes vulnerable to climatic changes: and (iii) called for policy responses to mitigate and adapt to these changes. Two fundamental issues are: how will global climatic change affect natural resources and human population and how will the impetus towards policy responses, particularly greenhouse gas emission reduction treaties, affect industry, the economy and trade?A necessary first step in the highly desirable and geographical aspiration of striving to link numerical climate modelling to the predictions of socioeconomic systems is increased awareness and improved understanding of current physical and social models. In this paper I review the status of numerical climatic modelling especially as it pertains to scenarios of the effects of human‐enhanced greenhouse warming. These projections are of futures which are themselves the result of socio‐economic predictions. Development of appropriate adaptive strategies depends crucially upon improved simulation of the continental near‐surface climate and on improved spatial resolution of climate models by at least two orders of magnitude. Such increased resolution is likely to demand a thousandfold increase in computing power. The physical results of global climatic change are likely to be less significant than the social and economic effects resulting from international agreements on emission reduction Recent shifts in international research and policy responses place today's studies of global climatic change firmly at the focus of human‐environment interactions and hence at the core of modern geography.
Late Glacial and Holocene Vegetation History at Dublin Bog North‐Central Tasmania
Authors: COLHOUN ERIC A. , GEER GUUS VAN DE , HANNAN DAVID 
Published: March 2008

Percentage and influx pollen analyses of a 9.17 m core from Dublin Bog give a post last glaciation vegetation history (‐13.6 to 0 ka BP) for the upper Mersey Valley.Herbaceous vegetation of Gramineae, Compositae and Chenopodiaceae developed rapidly after deglaciation and lasted until 13.2 ka BP. Around 13 ka BP Eucalyptus woodland and forest developed rapidly on the valley floor. At the same time Pomaderris apetala became an important understorey shrub/tree, and Phyllocladus aspleniifolius rainforest developed in the gullies on the upper slopes of the Mersey Valley and in the valleys to the west The major change in climate from late glacial cold (and probably drier conditions) to warm humid conditions similar to present occurred between 13.2 and 13 ka BP.Wet sclerophyll Eucalyptus forest occupied the valley throughout the post glacial and attained its maximum development between 11.7 and 8.4 ka BP. Rainforest never occupied the valley floor extensively. Phyllocladus aspleniifolius sattained an early maximum about 13 ka BP. The peak of Pomaderris apetala and expansion of Dicksonia antarctica suggests that the climate was warmer and wetter between 10.3 and 8.4 ka BP than at other times. Nothofagus attained its maximum development between about 10.3 and 6 ka BP. Both sclerophyll and rainforest vegetation associations in the upper Mersey Valley appear to have been very stable and similar to their present floristic compositions during the Holocene.Aborigines occupied the valley by 10 ka BP. Fire was always present in this marginal area between the wet climate of western and the dry climate of eastern Tasmania. Fire did not cause replacement of rainforest by wet sclerophyll forest on the valley floor, though it could have prevented rainforest establishment
Portrayal and Analysis of Thermal Climates
Authors: WACE NIGEL 
Published: March 2008

Mean drybulb air temperatures from 50 sites in the SW Pucific—Australasian—Southern Ocean and Antarctic—Indian Ocean coasts, have been plotted as surfaces in diurnal x seasonal thermoisopleth diagrams. following methods developed by Carl Troll. The diagrams are compared qualitarively, and measurements taken from them, quantifying the trend of the isopleths as the thermal components of seasonality (S) and diurnality (D). Continentality is measured as the hypotenuse of a triangle whose other two sides are S and D. The relationship of S and D values to the latitudes of different sites suggests that the method of measuring isopleth trends is valid. The time/temperature data on which thermoisopleth diagrams are based are reassembled as histograms. which are stacked in register to show the degree of overlap in temperature experience between different sites.Uses of thermoisopleth presentations of mean temperature levels include climatic classification. bioclimatology, measurement of energy demands for managing controlled environments, and the display of thermal climates to travellers. Deficiencies of these “black box” descriptive models are also discussed.
Dendrochronological Flood‐frequency Analysis: An Australian Application
Authors: MARTENS DANIEL M. 
Published: March 2008

Dendrochronological studies have received little attention in Australia and it appears that the methodology is not well understood. This paper describes dendrochronological techniques available in riparian environments and applies them to a small reach of the Hawkesbury River.Results of field investigations into the relationships between flooding and associated tree‐ring variability were used to reconstruct partial duration flood‐frequency data. The ring‐width chronologies of 39 trees were transformed into three indices that made interpretation with respect to flooding possible: (1) a width‐index: (2) an annual‐sensitivity (AS) index; and (3) a tilting vector. It was assumed that floods would either suppress growth or alter the annual distribution of new wood about the tree bole.Width‐indicies and tilting vectors provided the most reliable flooding information. Much reduced growth rates at low elevations supported initial hypotheses and led to the establishment of a relationship between growth‐rate and frequency of inundation. The reconstructed flood‐frequency curve closely matched the historical data‐set although underestimation occured at higher levels due to limited sample size. Analyses indicate that dendrochronological investigations of exotic riparian trees provide detailed flooding information, but techniques may also be used to provide minimum dates of fluvial landforms and date recent channel changes.
Tropical mesoscale rainfall patterns: the opening of the monsoon in the Townsville area, December 1988
Authors: LYONS W.F. , BONELL M. 
Published: March 2008

Rainfall during six days of monsoonal activity in the 1988/89 wet season is examined in terms of the influence of synoptic scale winds on mesoscale rainfall activity over the Townsville coastal plain (3450 km2). The resulting rainfall patterns. which were based on observations from a dense mesoscale network of 133 gauge points. are presented as isohyetal maps of twenty‐four hour totals for each day in the study period.The study has shown that the distribution of rainfall is related to the influence of synoptic scale wind vectors, which provide upper level steering of convective activity. In addition. the interaction between local winds and synoptic circulation is deemed important for inducing convergence and precipitation. Rainfall generated is then directed by the prevailing upper synoptic flow. Orographic effects also appear to be significant, in that rainfall distribution tends to favour slopes on the windward side of the synoptic scale winds. The rainfall patterns described are probably typical of many of those that occurred throughout the 1988/89 wet season, due to the likely persistence of these mesoscale precipitation mechanisms. Similar mechanisms are also likely to occur over the study area in other wet seasons and elsewhere in the seasonally wet and dry tropics.