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Background: The aim of this study was to describe and compare the demographic characteristics, clinical characteristics and patient and health service outcomes of emergency department (ED) presentations brought in by police with and without an emergency examination authority., Methods: A retrospective cohort study of adult (≥ 18 years old) presentations brought in by police to EDs in Queensland, Australia from 01 January 2018 to 31 December 2020. Routinely collected ED data were used to describe and compare the demographic characteristics, clinical characteristics, and outcomes of people brought in by police with and without an emergency examination authority., Results: A total of 42 502 adult ED presentations were brought in by police over the three-year period, of which 22 981 (44.7%) had an emergency examination authority. Compared with presentations brought in by police without an emergency examination authority, those brought in by police with an emergency examination authority had a higher proportion of presentations for mental health problems, were from major cities, and were allocated more urgent Australasian Triage Scale categories. Presentations brought in by police with an emergency examination authority were less likely to be seen within their Australasian Triage Scale timeframe and experienced a longer length of stay than those brought in by police without an emergency examination authority whether admitted (217 mins vs. 186 mins, p < 0.001) or discharged (212 mins vs. 97 mins, p < 0.001)., Conclusions: The characteristics and outcomes of people brought in by police with emergency examination authorities differed to those brought in by police without emergency examination authorities. Further research is required to enhance understanding of this relatively unexplored group of people and foster interagency collaborations., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Recent technological advancements allowed the development of engaging technological tools. Using ASN funding from the ASN, we developed a 3D Virtual Reality (VR) physiology course entitled DiAL-Neph (Diuretic Action and eLectrolyte transport in the Nephron). We hereby present its evaluation., Methods: The study consisted of 2 parts: evaluation of knowledge gain, and qualitative evaluation of platform reception. Internal medicine PGY1 residents were randomly assigned into 2 groups: a VR group and a conventional group. Knowledge acquisition was assessed with a post-test administered at the end of the course and repeated within 6 to 12 weeks. Independent t-tests were used to compare the number of correct answers between the groups. A survey and focus groups composed of medicine residents evaluated the platform. Sessions were recorded and transcribed verbatim. Data was analyzed through the content analysis approach by two independent reviewers., Results: Of 117 PGY1 resident participants, 64 were randomized to the VR group and 53 were randomized to the traditional group. Initial test results showed higher scores among VR compared to the traditional group (76.5% correct vs. 68.8%). Seventy-eight PGY1s participated in the follow up testing (46 VR group vs. 32 traditional group) and results showed no significant difference in test results. Greater than 90% of the residents rated the platform positively and 77% preferred it as a teaching method., Conclusion: The DiAL-Neph VR platform appeared to improve short-term learning but not long-term retention. Further studies are needed to investigate the impact of such teaching platforms on overall interest in nephrology., (© 2024 International Society of Nephrology. Published by Elsevier Inc.)

Background: Clinical practice provides an opportunity for undergraduate nursing students to develop the professional attitudes, knowledge and skills required for the delivery of safe competent care. Some students, however, are challenged to consolidate learning in clinical practice and are therefore at risk of failing courses or programmes. Supporting these students requires remediation strategies specific to clinical practice. This is challenging, however, as remediation approaches frequently centre on supporting students in theoretical components of courses/programmes, rather than clinical practice., Objectives: A scoping review was conducted to explore and summarise literature in undergraduate nurse education related to remediation support for clinical practice., Methods: The research question was developed using the Population/Concept/Context model. Following the identification of keywords, five databases (CINHAL Plus, MEDLINE, ProQuest, Scopus and Informit) were searched. Abstracts and full-text articles were independently screened by two authors. Data from included studies was extracted and then thematically analysed., Results: Twenty papers met inclusion/exclusion criteria (five literature reviews, one concept analysis, six commentary papers and eight original research studies). Research studies used qualitative, quantitative, or mixed methods research designs. Populations included nurse academics, mentors/preceptors, health professional students (including nursing students) and nursing students exclusively. Three themes were identified: pre-placement remediation strategies; on-placement remediation strategies and post-placement remediation strategies. All authors highlighted the importance of remediation for at-risk students in clinical practice., Conclusions: This review identified several remediation strategies that may support undergraduate nursing students in clinical practice. Few, however, were well-defined or rigorously evaluated, highlighting the need for additional research on nursing student remediation in clinical practice. A partnership-based approach to remediation that engages students, educators, and healthcare providers and is underpinned by clear processes may be of further benefit to nursing students in clinical practice., Competing Interests: Declaration of competing interest The authors wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. This work has been produced as part of a larger project that was awarded internal funding from a Griffith University Teaching and Learning Grant. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship. We confirm that the order of the authors listed in the manuscript has been approved by all of us., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: To explore nurses' and doctors' experiences of providing care to people brought in by police (BIBP) to the emergency department (ED)., Design: A qualitative interpretive study using in-depth individual interviews., Methods: Semi-structured interviews were conducted with nurses and doctors who worked in various EDs in one Australian state and were involved in the care of people BIBP. Interviews were undertaken between May and October 2022 and focused on the structures (i.e., what), processes (i.e., how) and outcomes of care for people BIBP. Data were analysed using deductive and then inductive content analysis., Results: Nine nurses and eight doctors were interviewed. Structures described by participants included human structures (staff) and organizational structures (areas for assessment, involuntary assessment orders, investigations, chemical/physical restraints). For processes, participants described practices including risk/mental health assessments, legal considerations, and increased/decreased levels of care compared to other presentations. Communication processes were largely between police and health care staff. Service outcomes pertained to discharge location (custody, community, hospital admission) and length of stay., Conclusion: The current care delivery for people BIBP to the ED is unique and complex, often occurring in high traffic, resource-intensive areas. There is a need to strengthen structures and processes, to improve service outcomes., Implications for the Profession: Understanding the care requirements for people brought into ED by police enables the delivery of targeted care alongside appropriate resource allocation., Impact: This study provides a comprehensive understanding of the health care requirements for people BIBP to EDs. Interventions delivered in the ED to support health care delivery for people BIBP and foster clinician and police relationships are required to optimize patient and health service outcomes., Reporting Method: This study adheres to the COREQ checklist (Table S1) of the EQUATOR guidelines., Patient or Public Contribution: This study focused on ED staff experiences., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Introduction: People arriving to the emergency department with mental health problems experience varying and sometimes inferior outcomes compared with people without mental health problems, yet little is known about whether or how their arrival mode is associated with these outcomes. This study describes and compares demographics, clinical characteristics, and patient and health service outcomes of adult mental health emergency department patient presentations, based on arrival mode: brought in by ambulance, privately arranged transport, and brought in by police., Methods: Using a retrospective observational study design with state-wide administrative data from Queensland, Australia, mental health presentations from January 1, 2012, to December 31, 2017, were analyzed using descriptive and inferential analyses., Results: Of the 446,815 presentations, 51.8% were brought in by ambulance, 37.2% arrived via privately arranged transport, and 11.0% were brought in by police. Compared with other arrival modes, presentations brought in by ambulance were more likely to be older and female and have more urgent triage categories and a longer length of stay. Presentations arriving by privately arranged transport were more likely than other arrival modes to present during the day, be assigned a less urgent triage category, be seen within their recommended triage time, have a shorter length of stay in the emergency department, have higher rates of discharge, and have waited longer to be seen by a clinician. Presentations brought in by police were more likely than other arrival modes to be younger and male and experience a shorter time to be seen by a clinician., Discussion: Discrepancies between arrival modes indicates a need for further investigation to support inter- and intra-agency mental health care interventions., (Copyright © 2023 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Narrative medicine (NM) is the practice of reflecting on patient stories, which can improve physician empathy and has been linked to higher levels of well-being. We implemented a NM curriculum for a large internal medicine residency program and report the curriculum's positive effects., Competing Interests: Competing InterestsThe authors declare no competing interests., (© The Author(s) under exclusive licence to International Association of Medical Science Educators 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction: This curriculum was designed to improve access to procedures for our internal medicine residents., Methods: We created an interdisciplinary procedure course (IDPC) composed of two simulation sessions and a one-week procedural rotation supervised by multiple specialties including nephrology, cardiology, cardiothoracic anesthesiology, general anesthesiology, and interventional radiology. After the course, residents completed two surveys documenting the number of procedures and their level of confidence on a Likert scale (1 = very unconfident to 5 = very confident) prior to and after completing the curriculum., Results: Sixteen residents participated in the course from September 2021 to June 2022. The collective number of procedures performed by these 16 residents increased from 176 to 343 after a one-week rotation. For arterial lines, the proportion of residents that reported an improvement in confidence scores was 0.44 (95% confidence interval 0.23 to 1, p-value of 0.60). The proportion of residents that had an increase in their confidence performing central lines was 0.63 (95% confidence interval 0.39 to 1, p-value of 0.23). For intubations, the proportion of residents that reported an improvement in confidence was 0.94 (95% confidence interval 0.72 to 1, p-value of 0.0006)., Conclusion: By collaborating with multiple specialties, residents almost doubled the number of procedures performed during training and reported an increased level of confidence in procedural performance for airway intubation. We learned residents want to improve their access to procedures and described a curriculum that was easily implemented., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Montane et al.)

Background: As emergency department (ED) presentations continue to rise, understanding the complexities of vulnerable populations such as people brought in by police (BIBP) is crucial. This review aimed to map and describe the research about people BIBP to the ED., Design and Method: A scoping review, guided by the Joanna Briggs Institute process, was undertaken. The databases CINAHL, Embase and PubMed were searched between November 2017 and July 2022. The Patterns, Advances, Gaps, Evidence for practice, Research recommendations (PAGER) framework was used to guide the analysis., Results: A total of 21 studies were included in the review, originating mainly from westernised countries. Examination of patterns across studies revealed four themes: routinely collected data is used to describe people BIBP to the ED; a focus on mental health care; the relationship between care delivery and outcomes; and the role of police in providing emergency care., Conclusion: There is some understanding of the demographic characteristics, clinical characteristics, and outcomes of people BIBP to the ED. Knowledge gaps surrounding sociodemographic factors, prehospital and ED care delivery for people BIBP require further investigation to optimise outcomes for this vulnerable cohort of presenters., Competing Interests: Conflict of Interest, (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective This study aimed to identify factors associated with an emergency department (ED) length of stay ≥4 hours (h) and hospital admission for people with a mental health problem brought in by police. Methods We undertook a retrospective, observational cohort study of state-wide adult ED mental health presentations brought in by police from 1 January 2012 to 31 December 2017. We used multivariable logistic regression to determine factors associated with an ED length of stay ≥4 h and hospital admission. Results In total, 9325 ED presentations with a mental health problem brought in by police to Queensland EDs were included. Factors most strongly associated with an ED length of stay ≥4 h included an Australasian Triage Score (ATS) of 1, an age of 85 years or older, night shift arrival and subsequent hospital admission. For hospital admission, an ATS of 1, an age of 85 years or older and an ED length of stay ≥4 h were the strongest factors. Conclusion Findings indicate opportunities for targeted mental health models of care to better support people brought in by police to an ED. Such models should involve ED, pre-hospital providers (police and ambulance) and mental health services to support early intervention and potentially reduce the likelihood of a long ED length of stay and subsequent hospital admission.

Objective This study aimed to identify factors associated with an emergency department (ED) length of stay ≥4 hours (h) and hospital admission for people with a mental health problem brought in by police. Methods We undertook a retrospective, observational cohort study of state-wide adult ED mental health presentations brought in by police from 1 January 2012 to 31 December 2017. We used multivariable logistic regression to determine factors associated with an ED length of stay ≥4 h and hospital admission. Results In total, 9325 ED presentations with a mental health problem brought in by police to Queensland EDs were included. Factors most strongly associated with an ED length of stay ≥4 h included an Australasian Triage Score (ATS) of 1, an age of 85 years or older, night shift arrival and subsequent hospital admission. For hospital admission, an ATS of 1, an age of 85 years or older and an ED length of stay ≥4 h were the strongest factors. Conclusion Findings indicate opportunities for targeted mental health models of care to better support people brought in by police to an ED. Such models should involve ED, pre-hospital providers (police and ambulance) and mental health services to support early intervention and potentially reduce the likelihood of a long ED length of stay and subsequent hospital admission.

Background: Some people with mental health problems arrive to the Emergency Department (ED) under involuntary assessment orders (IAOs) and can have complex medical and socioeconomic factors, which may impact on the delivery of care in the ED. Therefore, this scoping review aimed to identify, evaluate and summarise the current literature regarding the demographic characteristics, clinical characteristics and outcomes for people brought to the ED under IAOs., Method: A scoping review was undertaken guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Guidelines and the Arksey and O'Malley framework., Results: In total 21 articles were included in this review. People under IAOs most commonly present to EDs with suicidal ideation/intent, with interagency involvement noted when responding to these people in the pre-hospital setting. Most people arriving to ED under IAOs were reported to experience length of staylonger than four hours., Conclusion: This review highlights the limited information pertaining to people brought to EDs under an IAO. High levels of mental health problems and extended length of stay for people under IAOs suggests the need for interagency collaboration to inform the development and implementation of models of care that incorporates social determinants of health and are tailored to this complex population., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: Understanding how people arrive to the ED assists in planning health services' response to fluctuating ED demand. The present study aimed to describe and compare demographics, clinical characteristics and health service outcomes of adult ED patient presentations based on mode of arrival: brought in by police (BIBP)/brought in by ambulance (BIBA)/privately arranged transport (PAT)., Methods: A retrospective cohort study of ED patient presentations made between 1 January 2018 and 31 December 2020 from all public hospital EDs across Queensland, Australia. Descriptive and inferential analyses were performed to ascertain presentation characteristics and predictors of health service outcomes., Results: From 4 707 959 ED presentations, 0.9% were BIBP, 34.8% were BIBA and 64.0% were PAT. Presentations BIBP were younger and comprised a higher proportion of mental health problems and Emergency Examination Authority orders compared to presentations BIBA or PAT. Compared to presentations BIBP or PAT, presentations BIBA were more likely to be assigned more urgent triage scores, be admitted to hospital, and have a longer ED length of stay (LOS). Compared to other modes of arrival, presentations arriving by PAT were more likely to be discharged and have a shorter ED LOS., Conclusion: Presentations BIBA and BIBP encountered a longer ED LOS and higher admission rates than PAT, suggesting more complex care needs than those from PAT. Clinical care pathways for specific modes of arrival that support pre-hospital providers and patients and are considerate of the throughput and output stages of ED care may be needed., (© 2021 Australasian College for Emergency Medicine.)

Background: People brought in by police (BIBP) to the emergency department (ED) can present with complicated health conditions that may impact care delivery. We sought to identify factors predictive of an ED length of stay (LOS) ≥4 hours and hospital admission for presentations BIBP., Methods: This retrospective cohort study comprised a sample of all adults (aged ≥ 18 years old) BIBP to public hospital EDs across Queensland, Australia between 1 January 2018 and 31 December 2020. Univariate and multivariate logistic regression were used to identify predictors of an ED LOS ≥4 hours and hospital admission for presentations BIBP., Results: Of the 42,502 presentations BIBP, independent predictors of an ED LOS ≥4 hours included higher priority triage categories, hospital transfer/admission, evening/night shift arrival, an Emergency Examination Authority (EEA), (i.e. an involuntary presentation), and a non-descript mental health diagnosis. Independent predictors of hospital admission included higher priority triage categories, increasing age, day/evening shift arrival, a 'mental or behavioural issues' diagnosis, and an ED LOS ≥4 hours., Conclusions: Noted predictors of a LOS ≥4 hours and hospital admission indicate further need to support intra and inter-agency interventions to optimise patient outcomes., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background : Collaborative, Indigenous-led pedagogical and research approaches in nursing education are fundamental to ensuring culturally safe curriculum innovations that address institutional racism. These approaches privilege, or make central, Indigenous worldviews in the ways healthcare practices are valued and assessed. With the aim of informing excellence in cultural safety teaching and learning, and research approaches, this study draws on the experiences and key learnings of non-Indigenous nursing academics in the collaborative implementation of First Peoples Health interprofessional and simulation-based learning (IPSBL) innovations in an Australian Bachelor of Nursing (BN) program. Methods : An Indigenous-led sequential mixed method design was used to investigate non-Indigenous nursing academics' experiences in the design, development and delivery of two IPSBL innovations. A validated survey (the Awareness of Cultural Safety Scale, (ACSS)) was administered to nursing academics before and after the innovations were delivered. Phenomenological interviews were also conducted following the implementation of the innovations. Results : Of the 27 staff involved in the delivery of the innovations, six nursing academics completed both pre-and post-surveys (22%). Nine (33%) participated in phenomenological interviews. There was a non-significant trend towards improved scores on the ACSS following the delivery of the innovations. Nursing academics' perceptions of the innovations' relevance to their practice were enhanced. An increased awareness of culturally safe academic practices was reported among those actively involved in innovations. Impact statement : Indigenous-led approaches in teaching and research promote excellence within mandatory cultural safety education for nurses and midwives. Conclusions : This study confirms the importance of educating the educators about cultural safety in teaching and learning, and research approaches. It also provides important insights into how non-Indigenous nursing academics can work within Indigenous-led pedagogical and research approaches to design culturally safe curriculum innovations.

Background: People detained in short-term custodial settings can require health care that may necessitate transfer to an Emergency Department (ED). What and how health care is delivered to detainees in short-term custodial settings may influence their health outcomes., Objective: The aim of this scoping review was to synthesise and critically appraise the evidence on health care delivered to detainees in short-term custody settings., Design: A scoping review was undertaken. Five online databases (CINAHL, PubMed, Medline, Embase and Criminal Justice Database) were searched from January 2010 to May 2020. Data extracted pertained to the structures, processes and outcomes of health care delivery. The Mixed Methods Assessment Tool was used to quality appraise the studies. Deductive analysis was used to sort the findings into structures, processes and outcomes of health care delivery and then thematic analysis was undertaken to synthesise these findings., Results: In total, 37 studies with varied designs were included in this review; 3 randomised control trials, 4 quantitative comparative studies, 21 quantitative descriptive studies, 8 qualitative studies and 1 mixed methods study. Studies were mainly from westernised countries. The quality of evidence varied across studies. Health care delivery structures had a strong focus on the identification of mental illness, with processes predominantly comprising health assessment screening on arrival to the short-term custodial setting. Outcomes (at the detainee and organisation level) included increased identification of substance misuse issues and improvement of health conditions, alongside inadequate assessment/identification of physical and mental health issues for detainees., Conclusion: Gaps in evidence identified limited international perspectives as most studies originated from the US, a focus on detainee conditions/symptoms and limited long-term research within the area of health care in short-term custodial settings. Literature regarding health care delivery in short-term custodial settings focused predominantly on mental illness identification. Understanding the nature of health care delivery in short-term custodial settings further through research into specific roles such as the custody nurse is required to develop targeted interventions that address the needs of the detainee on a comprehensive level., (Copyright © 2021 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Purpose: The association between patient-reported experience of care and care quality is not well described. The purpose of this study was to assess the relationship between the patient-reported experience and receipt of guideline-concordant colon cancer (CC) treatment., Methods: Medicare beneficiaries with resected stage I-III CC (2003-2013) were identified in the linked SEER Consumer Assessment of Healthcare Providers and Systems data set. Patient-reported scores were compared by receipt of guideline concordant care (GCC) (resection of ≥ 12 lymph nodes [stage I-III] and adjuvant chemotherapy [stage III]). Linear mixed-effects regression was performed to compare adjusted mean patient experience scores by GCC., Results: Of the 1,010 identified patients, 58.4% of stage I (n = 192/329) and 73.4% of stage II (n = 298/406) patients underwent resection of ≥ 12 LN. Among stage III patients, 76.0% (n = 209/275) underwent resection of ≥ 12 lymph node and 52.4% (n = 144/275) received adjuvant chemotherapy. By multivariable analysis, patient-reported scores of healthcare quality, physicians, physician communication, getting needed care, and getting care quickly were similar among patients who received GCC compared with those who did not. However, mean scores of overall healthcare quality (91.3 v 82.4, P = .0004) and getting needed care (92.8 v 86.8, P = .047) were higher among stage III patients who received GCC compared with those who did not., Conclusion: Patient-reported scores of healthcare quality and ability to get needed care are associated with GCC among elderly patients with stage III CC. Further investigation is needed to determine whether patient-reported experience correlates with other clinical measures of quality of CC care.

Aim: The aim of this concept synthesis was to add clarity to the concept of vulnerability with application to the Emergency Department (ED) by critiquing, analysing and amalgamating published concept analyses., Background: The concept of vulnerability has been used widely, however it has various meanings. A clearer understanding of vulnerability and application to the ED may help healthcare professionals provide high quality care responsive to the needs of vulnerable individuals., Method: Nine concept analyses of vulnerability were retrieved using Medline, CINAHL, and PsycINFO databases. After extracting data on each analysis, Walker and Avant's concept synthesis method was used to structure this synthesis, with a thematic synthesis approach used in the analysis., Findings: Four themes associated with vulnerability emerged from the synthesis. The first theme, vulnerability as a journey, reflected elements within an individual's life that perpetuate and exacerbate vulnerability. The second theme, vulnerability as susceptibility and risk, highlighted intrinsic and extrinsic elements that contribute to a state of risk. The third theme, positive and negative repercussions, emphasised lessons that can be learned from experience, with the fourth theme of a shared understanding indicating the importance of understanding the concept of vulnerability for patient care., Conclusion: Findings from this synthesis highlight the multiple elements associated with a vulnerable state, evident in the context of the ED. With multiple ED-specific elements contributing to vulnerability, clarity of the term is important to inform ED-specific interventions designed to meet the needs of vulnerable populations., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Preceptors provide fundamental support for the graduate registered nurse, acting as both teacher and role model with an aim to transition the graduate to becoming an independent practitioner. The purpose of this study was to investigate the expectations of the preceptor role from the preceptor's perspective. An interpretative phenomenological approach was used to explore the experience of being a preceptor with seven nurses working in acute clinical areas. Three themes emerged from the thematic analysis; balancing the preceptor role, exploring past experiences reveals current expectations and developing relationships. Participants had distinctive views on their role during the graduates' transition period, which were influenced by personal experience. Preceptors discussed their role including; education and support and the influence of the connection with the graduate nurse. The participants reflected on their own experiences and how this challenged their role expectations. Graduate characteristics were also highlighted to influence the balance of support. Overall the role of the preceptor was a complex role of balancing support and guidance while aiming to achieve professional development. The development of communication workshops and relationship building programs may be useful in addressing the multiple influencing elements of this relationship., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: Cortisol is a critical stress hormone with circadian rhythms synchronized by light. There are seasonal differences in expression of pro-inflammatory genes and in some diseases moderated by glucocorticoids. As light changes with season and with latitude and longitude, we assessed changes in population cortisol associated with these parameters., Design: Retrospective data audit., Patients: Populations across 4 states of Australia over 3 years., Measurements: Serum cortisol levels, age, gender, time of collection, sunrise time, season and location were determined., Results: In 4 geographically separate populations (n = 84 937), sunrise time and time of sample collection were the most important factors influencing median cortisol. Over 2 hours in the morning cortisol could decrease by up to 76 nmol/L, and for each hour that sunrise time advanced there was up to 6.9% increase in cortisol. A cyclic seasonal pattern of cortisol was confirmed each year in all populations with autumn/winter cortisol highest compared to spring/summer with differences of up to 44 nmol/L. There was less change in cortisol in latitudes closer to the equator but cortisol progressively increased from 25 to 30°S of the equator. In more southerly latitudes, seasonal cortisol variation also increased, and over the entire latitude range, there was up to 50 nmol/L change in cortisol. Longitude variation within a time zone had a minimal effect on median cortisol., Conclusions: Location, time of year and time of day are important influences on population cortisol levels. Elevated autumn/winter morning cortisol levels are likely due to sampling closer to the circadian peak due to later sunrise time. Understanding how the environment can influence cortisol levels may further our knowledge of physiology and disease., (© 2018 John Wiley & Sons Ltd.)

This study was designed to determine the sensitivity and reproducibility of recovering anti-streptolysin O titres (ASOT) from dried blood spot (DBS) samples, a methodologic subcomponent of the penicillin pharmacokinetic studies in children receiving secondary prophylaxis with intramuscular benzathine penicillin for acute rheumatic fever., (Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.)