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Objective: To provide a qualitative examination of the service and support needs of children who have had a mild traumatic brain injury (mTBI), and their parents, in order to improve clinical services. Methods: Semi-structured interviews were conducted with 9 children (8-12 years; M = 10.6 years, SD = 0.8) and their parents (n = 9) 29-55 days (M = 34 days; SD = 9.3) after presenting to an Australian Paediatric Emergency Department (PED) for mTBI. Children's post-concussive symptoms (PCS) were additionally measured using the Post-Concussive Symptom Inventory (PCSI). Audio recordings were transcribed, and a thematic analysis was conducted. Results: Post-injury needs were reflected in four main themes: Communication; Family Burden; Continuity of Care; and Social and Community Support. These themes reflected children's and parents' needs for information, emotional/social/community support, and follow-up care. Both the children's and parents' needs, and the extent to which they were met, appeared to be related to the severity and duration of the child's PCS. Conclusions: Dedicated pediatric mTBI follow-up services that build on family's resources and meet their individual needs for information, emotional support, and referral may assist in optimizing post-injury outcomes. [ABSTRACT FROM AUTHOR]

Aims: This article reports on the quantitative findings from a large mixed method study that determined the extent to which the provision of alternatives to an Emergency Department and Index of Relative Social Disadvantage score influenced non-urgent paediatric Emergency Department use., Background: In Australia, there is an increasing use of Emergency Departments for the provision of non-urgent care that may be better serviced in the community. Further, despite the plethora of literature describing the characteristics of non-urgent users of Emergency Departments the link to social and community characteristics remains under explored., Design: This 2010 retrospective analysis of the Hospital Admission Status data from the paediatric Emergency Department provided the information on attendance types and numbers along with postcode details. The postcodes in conjunction with Australia Bureau of Statistics data provided the levels of deprivation from the Index of Relative Social Deprivation scores., Method: A logistic regression analysis determined the levels of influence of deprivation and General Practitioner or Nurse Practitioner provision on the use of Emergency Departments for non-urgent care., Findings: Rates of use for non-urgent care is higher for populations who come from areas of deprivation and have limited primary care services, such as low levels of General Practitioners. Children from areas of high deprivation and limited access to primary care were up to six times more likely to use Emergency Department for non-urgent care., Conclusions: Deprivation impacts on the use of paediatric Emergency Departments for non-urgent care even in countries like Australia where there is government subsidized health care., (© 2015 John Wiley & Sons Ltd.)

Objective: To determine the number of children with minimal and mild traumatic brain injury (TBI) and their demographic factors, causes, associated signs/symptoms and management., Methods: A cross-sectional analysis of consecutive presentations to a tertiary paediatric centre., Results: There were 2043 presentations of minimal and mild TBI over 3 years (minimal TBI = 79.7% [n = 1628]; mild TBI = 20.3% [n = 415]). Mean age was 5.12 years (SD = 5.14) with children ≤3 years comprising 53.2% (n = 1086). There was a bimodal distribution in mild TBI with peaks at 0-2 and 13-15 years. The male-to-female ratio was 1.6:1. Only 34.6% of GCS scores were documented. Falls caused most injury. Overall, 6.3% (n = 129) required hospital admission and 29.1% (n = 594) were reviewed clinically., Conclusion: Minimal and mild TBI is common, representing a significant burden on individuals, families and healthcare providers. High rates of follow-up impact on the healthcare system and warrant further investigation.

Hepatocellular carcinoma (HCC) is rare in young children. We attempted to see if immunohistochemical and mutational-analysis studies could demonstrate that deficiency of the canalicular bile acid transporter bile salt export pump (BSEP) and mutation in ABCB11, encoding BSEP, underlay progressive familial intrahepatic cholestasis (PFIC)--or "neonatal hepatitis" suggesting PFIC--that was associated with HCC in young children. We studied 11 cases of pediatric HCC in the setting of PFIC or "neonatal hepatitis" suggesting PFIC. Archival liver were retrieved and immunostained for BSEP. Mutational analysis of ABCB11 was performed in leukocyte DNA from available patients and parents. Among the 11 nonrelated children studied aged 13-52 months at diagnosis of HCC, 9 (and a full sibling, with neonatal hepatitis suggesting PFIC, of a tenth from whom liver was not available) had immunohistochemical evidence of BSEP deficiency; the eleventh child did not. Mutations in ABCB11 were demonstrated in all patients with BSEP deficiency in whom leukocyte DNA could be studied (n = 7). These mutations were confirmed in the parents (n = 14). With respect to the other 3 children with BSEP deficiency, mutations in ABCB11 were demonstrated in all 5 parents in whom leukocyte DNA could be studied. Thirteen different mutations were found. In conclusion, PFIC associated with BSEP deficiency represents a previously unrecognized risk for HCC in young children. Immunohistochemical evidence of BSEP deficiency correlates well with demonstrable mutation in ABCB11.

The ATPase activity of the plasma membrane Ca2+ pump (PMCA) has been reported to be inhibited by exposure of red blood cell (RBC) PMCA preparations to high glucose concentrations. It has been claimed that this effect could have potential pathophysiological relevance in diabetes. To ascertain whether high glucose levels also affect PMCA transport function in intact RBCs, Ca2+ extrusion by the Ca2+-saturated pump [PMCA maximal velocity (V(max))] was measured in human and rat RBCs exposed to high glucose in vivo or in vitro. Preincubation of normal human RBCs in 30-100 mM glucose for up to 6 h had no effect on PMCA V(max). The mean V(max) of RBCs from 15 diabetic subjects of 12.9 +/- 0.7 mmol. 340 g Hb(-1). h(-1) was not significantly different from that of controls (14.3 +/- 0.5 mmol. 340 g Hb(-1). h(-1)). Similarly, the PMCA V(max) of RBCs from 11 streptozotocin-diabetic rats was not affected by plasma glucose levels more than three times normal for 6-8 wk. Thus exposure to high glucose concentrations does not affect the ability of intact RBCs to extrude Ca2+.

The total Mg2+ content of human red cells ([Mg]T,i) is partitioned between free and bound forms. The main cytoplasmic Mg2+ buffers are ATP and 2,3 bisphosphoglycerate. Haemoglobin binds free ATP and bisphosphoglycerate, preferentially in the deoxygenated state. Thus, the free ionized Mg2+ concentration ([Mg2+]i) oscillates with the oxy-deoxy condition of the cells. The binding reactions are also modulated by the pH changes that accompany the oxygenation-deoxygenation transitions. The complex interactions between Mg2+, its ligands and Hb can be encoded in a set of equilibrium equations representing all the known binding reactions of the system. To develop a comprehensive understanding of the Mg2+ homeostasis of intact red cells it is necessary to correct and refine the equations and parameters of the model by systematic comparisons between model predictions and measured cytoplasmic Mg2+ buffering curves under a variety of experimental conditions. Earlier models largely underestimated total Mg2+ binding in intact cells. We carried out experiments in which [Mg]T,i and [Mg2+]i were controlled over a wide range ([Mg]T,i between 0.1 and 23 mM) by the use of the ionophore A23187, under diverse metabolic conditions, and the results were used to interpret the adjustments required for good model fits. By the inclusion of low-affinity Mg2+ binding to ATP and bisphosphoglycerate, and also binding of Mg2+ to haemoglobin (four ions per tetramer) with an apparent dissociation constant of 45 mM we were able to realistically model, for the first time, all the experimentally observed changes in [Mg2+]i in human red cells under diverse metabolic conditions.

A patient reported symptoms of upper airway obstruction for 4 years. His symptoms worsened with a viral upper respiratory infection and he suffered acute respiratory arrest. He was resuscitated and a large goitre with intrathoracic extension which was compressing the trachea was resected. The mechanisms of upper airway compromise by goitre are discussed. The symptoms of the effect of goitre on the airway are reviewed.

Objective: To determine whether a solution of bupivacaine Marcain [Astra]), adrenaline and cocaine (MAC) is as safe and effective as tetracaine, adrenaline and cocaine (TAC) as topical anaesthesia for wound suturing., Design: Double-blind, randomised, prospective trial., Setting: Emergency departments of two tertiary referral hospitals (one specialising in paediatric care) in Adelaide, South Australia, between February 1992 and April 1994., Participants: 181 patients, aged six or older, with simple dermal lacerations less than 5mm deep, not involving mucous membranes or areas with end-arterial blood supply., Interventions: Patients received a weight-adjusted dose of either MAC or TAC., Outcome Measures: Needle-prick testing of wound for pain before suturing, pain ratings by patients and physicians during suturing, signs and symptoms of cocaine toxicity, wound complications and patient preference for topical anaesthesia., Results: Topical anaesthesia was adequate for suturing in 73% of patients (83% or those with head wounds and 56% of those with extremity wounds). MAC and TAC did not differ significantly in efficacy overall or by wound location. Pain ratings from patients treated with MAC and TAC were comparable, as was patients acceptance of topical anesthesia (77%, MAC; 81%, TAC) and the incidence of adverse effects (4% infection rate overall)., Conclusions: Topical anesthesia is a safe and effective means of anaesthetising selected lacerations for suturing. As we found no significant differences in either the efficacy or safety of the two solutions, we believe that MAC can be substituted for the less readily available TAC whenever expedient.

Using flow cytometry and osmotic lysis measurements, we document here the means and coefficients of variation of the following red cell (RBC) properties: hemoglobin (Hb) content, volume, Hb concentration, and relative lytic tonicity distributions in populations of normal human RBCs, before and after density fractionation. The distributions showed a pattern characterized by much larger coefficients of variation of the Hb content and volume distributions than of the Hb concentration and relative lytic tonicity distributions. From analysis of the factors that determine those RBC properties, the patterns were interpreted as reflecting previously unrecognized statistical proportionalities between cell osmolyte content, Hb content, and membrane area. The possible origin of these statistical links was analyzed by considering alternative models with and without the participation of regulatory processes during cell maturation. A model was shown to be feasible in which mature RBC variability with proportional volume, area, and Hb content arises solely from cell size variability at the last erythroid cell division.

A case of a 28-year-old man surviving traumatic hemipelvectomy is presented. This patient is the first reported survivor in Australia of traumatic hemipelvectomy and one of few survivors reported in the world literature. Accurate and rapid early management including good resuscitation, rapid transport to the operating room and an aggressive team surgical approach all contributed to survival. Acute complications can be kept to a minimum by adhering to the approach of rapid resuscitation and early intervention by a team of surgeons. Associated dislocation of the contralateral hip with sciatic nerve damage and subsequent heterotopic calcification has not been previously reported and presents a significant obstacle to rehabilitation. Early attention to the psychological status of the patient and early involvement of rehabilitation specialists is advocated.

Objective: To provide Australian data from a community setting on the use of the Emergency Department by elderly persons., Design: The paper describes three studies. Study 1 analyses patient admission patterns, and clinical data taken retrospectively from medical records for 1987. Studies 2 and 3 prospectively survey referral, transport, demographic profiles and clinical management practices in two patient samples taken during 1987 and 1988., Setting: The Emergency Department of Sutherland Hospital, Sydney--a community based hospital of 374 beds., Patients: In study 1, we assessed 4609 hospital admissions of patients aged 60 years or more using ICD-9-CM coding. In Studies 2 and 3, samples of 74 patients aged 65 years or more and 100 patients aged 70 years or more who presented to the Emergency Department were assessed consecutively and prospectively., Interventions: No specific interventions outside of usual Emergency Department routines were undertaken except for collection of demographic data., Main Outcome Measures: Demographic characteristics, diagnostic categories, and referral, admissions and hospital separation data., Results: In Study 1, of 4609 patients aged 60 years or more 3182 (69%) entered hospital via the Emergency Department. These 3182 represented 29% of total hospital admissions for that year. In Study 2 the male to female ratio was 32 to 42; the mean age was 78.16 years; 88% were pensioners; 20% had additional private insurance; 76% of women were widowed compared with 32% of men; 84% of the group lived in their own homes but, of these, 51% of women lived alone compared with 7.7% of men. The disease profile was that of acute organic disease in 97% of presentations. Ambulance transport to the Emergency Department was used by 65% of patients and Emergency Department facilities were used mostly during "working hours"; 64% of patients were admitted to hospital. The pre-hospital "activities of daily living" (ADL) functioning was assessed as being independent in 85%. In Study 3, the social and demographic profile was similar to Study 2. Fifty seven of the 100 patients used ambulance transport to the Emergency Department and this was initiated by a general practitioner in 13 instances. The general practitioner was the referring source in 28% of cases. Waiting times in the Emergency Department demonstrated a mean time from arrival to assessment by a medical officer of 30 minutes and a total time spent in the Emergency Department of 3 hours 4 minutes for those discharged home and 4 hours 24 minutes for those admitted., Conclusion: These studies demonstrate that the Emergency Department is a major area for care of the elderly and entry into the hospital system. Referral from a general practitioner and the use of ambulance transport from home to the Emergency Department are frequent pathways of care that may have important cost-benefit implications and deserve further study. The elderly in these studies appear to use the Emergency Department appropriately for acute medical/surgical need. The social profiles suggest that widowed women present a special case in terms of discharge plans for management.

Objective: To assess the effectiveness of the management of acute traumatic illness at an acute-care general hospital., Design: The study was conducted prospectively for the calendar year 1989. The Trauma Score (TS) and the revised Trauma Score (RTS) were calculated on arrival at hospital. These clinical indices were used, with the Injury Severity Score (ISS) and the age, to predict the probability of survival (Ps) and the probability of mortality. The predicted probabilities were compared with the probabilities of survival and mortality derived from a recognised baseline., Setting: The Trauma Service of The Sutherland Hospital Caringbah, including the Emergency and Intensive Care Departments and the Departments of Surgery and Anaesthetics., Patients: 74 patients of all ages who were brought to the Emergency Department because of acute traumatic illness with an ISS greater than 16. Only patients with signs of life on arrival were included in the study group. Data were complete in all 74 patients., Results: There were 60 survivors and 14 deaths compared to figures predicted using data from the baseline group of 52.6 survivors and 21.4 deaths. There were no preventable deaths. There were five survivors whose probability of survival was less than 0.50. Three cases of late diagnosis were noted; the late diagnoses did not significantly affect the outcomes--they occurred because specialist assessment was delayed., Conclusions: It is possible, with few resources, to quantitatively and qualitatively assess the effectiveness of a trauma care service.

A thermodynamically open system, based on an assembly of capillaries with semi-permeable walls was constructed in order to study glycolysis in human erythrocytes in high haematocrit suspensions. A phenomenological expression for the rate of lactate production as a function of glucose concentration was obtained. The rate was measured under steady-state conditions with low substrate concentrations (approx. 50 mumol/l). In a corresponding closed system, this concentration of glucose would be exhausted within a few minutes. A mathematical model of the whole system consisted of five differential equations, and involved parameters relating to flow rates, volumes of reaction chambers, the rates of lactate efflux from erythrocytes and the expression for the rate of lactate production by red cells. The binding of [14C]pyruvate to haemoglobin and the rate of efflux of [14C]lactate from red cells were measured to yield additional information for the model. The concentrations of ATP and 2,3-bisphosphoglycerate were measured during the perfusion experiments, and a detailed analysis of a model of red cell hexokinase was carried out; the former two compounds inhibit hexokinase and alter the apparent Km and Vmax for glucose in vivo. These steady-state parameters were similar to the glucose concentration at the half-maximal rate of lactate production and the maximal rate, respectively. These findings are consistent with the known high control-strength for hexokinase in glycolysis in human red cells. The practical and theoretical validation of this perfusion system indicates that it will be valuable for NMR-based studies of red cell metabolism using a flow-cell in the spectrometer.