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Due to increasing water scarcity, it is essential to determine cost-effective and efficient methods of producing potable water, especially ones that utilize non-traditional sources. Although reverse osmosis (RO) shows promise as a key-player in mitigating water scarcity, it is limited by biofouling. It is therefore integral to identify effective antifoulants that also do not damage the membrane, cause resistance, or negatively impact human health and the environment. Potential antifoulants include preservatives used in home and personal care products. It is hypothesized that safer preservatives can be applied to RO systems to remove or prevent biofouling. Three preservatives including methylisothiazolinone (MIT), phenoxyethanol (PE), and sodium benzoate (SB) were tested via antimicrobial susceptibility tests against P. aeruginosa biofilms grown in 96-well plates to investigate both biofilm prevention and biofilm removal. Data were collected in the form of minimum biofilm inhibitory concentration (MBIC) and minimum biofilm eradication concentration (MBEC), respectively. MIT was the most effective of the three preservatives but also poses the highest hazard to human health and the environment. Due to efficacy and safety concerns, MIT, PE, and SB are not the final solution; however, a process was demonstrated for determining the efficacy of novel, safer antifoulants. Ultimately, further investigations into safer antifoulants, paired with a greater understanding of biofilm removal and prevention doses will help make RO a better solution for water scarcity.

Biofouling, or the build-up of microorganisms in a biofilm at the solid-water or water-air interface, is an interdisciplinary problem. Biofouling causes various issues including clogging systems, contaminating devices, and creating infections that are extremely difficult to treat, to name but a few. Therefore, engineers, pharmacologists, microbiologists, wastewater treatment operators, chemists, food preservative formulators, home and personal care product formulators, and toxicologists all play a role in studying and have an interest in solving biofouling. High-throughput studies on biofilm prevention and removal can take the form of biofilm antimicrobial microdilution susceptibility (BAMS) tests. Due to vested interests of many disciplines, the results from these tests should be applicable and useful to each discipline. This critical review analyses the focuses, biological implications, and metrics required by each discipline. The possible detection methods that could satisfy each desired metric are then summarized. The detection methods were analysed in order to recommend two methods of biofilm detection, Crystal Violet stain and the LIVE/DEAD BacLight stain, which correspond with three metrics including total biomass, log reduction, and the MIC, BPC, MBIC, MBC, BBC, and/or MBEC values. Determining these three metrics for each BAMS test will allow this type of research to be widely applicable and useful across many disciplines.

As potable water scarcity increases across the globe; it is imperative to identify energy and cost-effective processes for producing drinking-water from non-traditional sources. One established method is desalination of brackish and seawater via reverse osmosis (RO). However, the buildup of microorganisms at the water-membrane interface, known as biofouling, clogs RO membranes over time, increasing energy requirements and cost. To investigate biofouling mitigation methods, studies tend to focus on single-species biofilms; choice of organism is crucial to producing useful results. To determine a best-practice organism for studying antimicrobial treatment of biofilms, with specific interest in biofouling of RO membranes, we answered the following two questions, each via its own semi-systematic review: 1. Which organisms are commonly used to test antimicrobial efficacy against biofilms on RO membranes? 2. Which organisms are commonly identified via genetic analysis in biofilms on RO membranes? We then critically review the results of two semi-systematic reviews to identify pioneer organisms from the listed species. We focus on pioneer organisms because they initiate biofilm formation, therefore, inhibiting these organisms specifically may limit biofilm formation in the first place. Based on the analysis of the results, we recommend utilizing Pseudomonas aeruginosa for future single-species studies focused on biofilm treatment including, but not limited to, biofouling of RO membranes.

Background: Follow-up practices after diagnosis and treatment of primary cutaneous melanoma vary considerably. We aimed to determine factors associated with recommendations for follow-up setting, frequency, skin surveillance, and concordance with clinical guidelines., Methods: The population-based Melanoma Patterns of Care study documented clinicians' recommendations for follow-up for 2148 patients diagnosed with primary cutaneous melanoma over a 12-month period (2006/2007) in New South Wales, Australia. Multivariate log binomial regression models adjusted for patient and lesion characteristics were used to examine factors associated with follow-up practices., Results: Of 2158 melanomas, Breslow thickness was < 1 mm for 57% and ≥ 1 mm for 30%, while in situ melanomas accounted for 13%. Follow-up was recommended for 2063 patients (96%). On multivariate analysis, factors associated with a recommendation for follow-up at a specialist center were Breslow thickness ≥ 1 mm [prevalence ratio (PR) 1.05, 95% confidence interval (CI) 1.01-1.09] and initial treatment at a specialist center (PR 1.12, 95% CI 1.08-1.16). Longer follow-up intervals of > 3 months were more likely to be recommended for females, less likely for people living in rural compared with urban areas, and less likely for thicker (≥ 1 mm) melanomas compared with in situ melanomas. Skin self-examination was encouraged in 84% of consultations and was less likely to be recommended for patients ≥ 70 years (PR 0.88, 95% CI 0.84-0.93) and for those with thicker (≥ 1 mm) melanomas (PR 0.92, 95% CI 0.86-0.99). Only 1% of patients were referred for psychological care., Conclusions: Follow-up recommendations were generally consistent with Australian national guidelines for management of melanoma, however some variations could be targeted to improve patient outcomes.

Background: Standardization of the clinical management of melanoma through the formulation of national guidelines, based on interpretation of the existing evidence and consensus expert opinion, seeks to improve quality of care; however, adherence to national guidelines has not been well studied., Methods: A population-based, cross-sectional study of the clinical management of all patients with newly notified primary melanomas in the state of New South Wales, Australia, during 2006/2007 was conducted using cancer registry identification and questionnaires completed by treating physicians., Results: Surgical margin guidelines were adhered to in 35% of cases; 45% were over treated and 21% were undertreated. Factors independently associated with non-concordance on multivariate analysis were lower Breslow thickness, lower socio-economic status of the physician's practice location, older physician age, lower physician caseload, and physicians who biopsied the lesion and then referred for definitive management. Complications were not related to over- or under-treatment on multivariate analysis (p = 0.72). Sentinel lymph node biopsy was performed in 17% of patients with invasive melanoma, with the main determinant for selection being a Breslow thickness >0.75 mm., Conclusions: The low level of concordance with national guidelines for surgical management of melanoma resulted in overtreatment of many patients. However, a fifth of patients were undertreated, which is likely to have resulted in increased locoregional recurrence rates. The better concordance achieved by physicians treating >30 melanomas per year suggests that a minimum caseload threshold for physicians treating melanoma patients would be desirable. High guideline concordance will ensure patients receive optimal care and minimize morbidity and health service costs.

Neuronal nitric oxide synthase (nNOS) produces the key signalling mediator nitric oxide, (NO). This gaseous, free radical molecule modulates a vast array of biological processes, from vascular pressure to immune responses and neurological signalling cascades. Overproduction of NO has been implicated in conditions including Alzheimer's disease, Parkinson's disease and schizophrenia. Inhibition of nNOS therefore offers a potential therapeutic approach for treatment of these conditions. This endeavour is made more complex by the fact that there are two other isoforms of nitric oxide synthase (NOS), endothelial NOS (eNOS) and inducible NOS (iNOS). The selectivity of nNOS inhibitors is therefore a key concern for therapeutic development. This review explores recent advances in the field of selective nNOS inhibition. A particular focus is placed on computational approaches towards the rational design of selective nNOS ligands with improved pharmacokinetic properties. These ligands have been targeted at four key binding sites of the nNOS enzyme - the tetrahydrobiopterin, calmodulin, nicotinamide adenine dinucleotide phosphate (NADPH) and arginine binding sites. The binding sites, and the compounds used to inhibit them, will be discussed in turn, along with the computational methods which have been employed in the field of nNOS inhibition.

Background: An appropriately educated and competent workforce is crucial to an effective health care system. The National Health Workforce Taskforce (now Health Workforce Australia) and the Maternity Services Inter-Jurisdictional Committee funded a project to develop Core Competencies and Educational Framework for Primary Maternity Services in Australia. These competencies recognise the interdisciplinary nature of maternity care in Australia where care is provided by general practitioners, obstetricians and midwives as well as other professionals., Participants: Key stakeholders from professional organisations and providers of services related to maternity care and consumers of services., Methods: A national consensus approach was undertaken using consultation processes with a Steering Committee, a wider Reference Group and public consultation., Findings: A national Core Competencies and Educational Framework for Primary Maternity Services in Australia was developed through an iterative process with a range of key stakeholders. There are a number of strategies that may assist in the integration of these into primary maternity service provider professional groups' education and practice., Conclusions: The Core Competencies and Educational Framework are based on an interprofessional approach to learning and primary maternity service practice. They have sought to value professional expertise and stimulate awareness and respect for the roles of all primary maternity service providers. The competencies and framework described in this paper are now a critical component of Australian maternity services as they are included in actions in the newly released National Maternity Services Plan and thus have relevance for all providers of Australian maternity services., (Copyright © 2011 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: Laparoscopic common bile duct exploration has emerged as a preferred option for the management of choledocholithiasis. The present study sought to review the feasibility of this technique in a rural centre., Methods: A comprehensive retrospective review was undertaken of all patients who underwent surgical treatment of biliary calculi in Lismore, NSW (Australia), between January 1996 and December 2002., Results: During the study period, 1567 consecutive patients underwent laparoscopic cholecystectomy, of whom 82 (5.2%) had choledocholithiasis identified at intraoperative cholangiography. A total of 86 laparoscopic common bile duct explorations were undertaken in these patients, 37 (43%) via a transcystic approach, and 49 (57%) via a laparoscopic choledochotomy. All common bile duct calculi were successfully removed in 78 cases, representing an overall duct clearance rate of 90.7%. Complications were noted in seven patients, a morbidity rate of 8.5%. Median operative time for the procedure over the study period was 173 min. Median hospital stay was 6 days for all patients., Conclusions: Laparoscopic common bile duct exploration can be successfully undertaken in a rural setting by general surgeons who have appropriate laparoscopic experience, and should be the procedure of choice for the management of choledocholithiasis in these patients. It should not be restricted to specialized surgical departments in major referral centres.

This study reviews all childhood intussusceptions treated over a 6 year period in a regional centre with six visiting general surgeons and two paediatricians. Clinical presentation, management, complications and outcomes were noted and an attempt was made to follow up all cases. There were 20 patients, with a median age of 6 months (range 10 weeks to 17 months). Only one patient had all four classical features of intussusception (pain, vomiting, 'red currant jelly' stools and abdominal mass). Seven patients were managed successfully by barium enema reduction, but 14 required operation, four following failed radiological reduction. There was one intestinal perforation due to attempted barium enema reduction and one patient required a reoperation for ileal gangrene following operative reduction. There were no deaths and there have been no subsequent recurrent intussusceptions although three cases were lost to follow up. There was a delay in diagnosis in some cases (average duration from onset to diagnosis was 34 h). Although delay was incurred by parents in some cases and in peripheral hospitals in others, there is a need for greater awareness by surgeons of the significance of subtle features such as pallor and lethargy in a child with persistent vomiting. Delay in diagnosis is likely to lead to an increased need for primary surgical intervention. Adverse features (age > 3 months or < 2 years; symptoms > 24 h; small bowel obstruction; dehydration > 5%) were predictive of an increased likelihood of surgical resection, and may help avoid inappropriate attempts at radiological reduction.(ABSTRACT TRUNCATED AT 250 WORDS)