Validating accelerometry-derived proxies of energy expenditure using the doubly labelled water method in the smallest penguin species

Understanding energy use is central to understanding an animal's physiological and behavioural ecology. However, directly measuring energy expenditure in free-ranging animals is inherently difficult. The doubly labelled water (DLW) method is widely used to investigate energy expenditure in a range of taxa. Although reliable, DLW data collection and analysis is both financially costly and time consuming. Dynamic body acceleration (e.g. VeDBA) calculated from animal-borne accelerometers has been used to determine behavioural patterns, and is increasingly being used as a proxy for energy expenditure. Still its performance as a proxy for energy expenditure in free-ranging animals is not well established and requires validation against established methods. In the present study, the relationship between VeDBA and the at-sea metabolic rate calculated from DLW was investigated in little penguins (Eudyptula minor) using three approaches. Both in a simple correlation and activity-specific approaches were shown to be good predictors of at-sea metabolic rate. The third approach using activity-specific energy expenditure values obtained from literature did not accurately calculate the energy expended by individuals. However, all three approaches were significantly strengthened by the addition of mean horizontal travel speed. These results provide validation for the use of accelerometry as a proxy for energy expenditure and show how energy expenditure may be influenced by both individual behaviour and environmental conditions.

Addressing negative psychosocial factors linked to severe injury in professional rugby players: An introduction to a group psychotherapy approach

Background

Negative psychosocial sequelae of severe rugby injury (SRI) in professional rugby players are well documented. Unaddressed, these issues can leave players vulnerable to persistent common mental disorders (CMD) and negatively affect injury recovery processes.

Objective

To introduce a psychotherapeutic group intervention aimed at addressing negative psychosocial sequelae linked to SRI in professional rugby player cohorts.

Methods

Literature aimed at clarifying the potential efficacy of an integrative group therapy model, the Recovery Mastery Group (RMG), is discussed after which component parts of the intervention are presented.

Case illustration

A case illustration is presented comprising examples of how the RMG framework addressed psychosocial recovery issues in a professional South African rugby team during 2019.

Conclusion

The proposed Recovery Mastery Group (RMG) is presented as a cost- and time- effective psychotherapeutic intervention that integrates well-researched psychotherapeutic techniques. The RMG appears able to address multiple facets of psychosocial injury recovery, while possibly offering protection from the onset of CMD. This introduction to the RMG can be a forerunner of similar research across larger cohorts, in different team sports, to determine wider therapeutic intervention efficacy.

Dive behaviour and foraging effort of female Cape fur seals Arctocephalus pusillus pusillus

While marine top predators can play a critical role in ecosystem structure and dynamics through their effects on prey populations, how the predators function in this role is often not well understood. In the Benguela region of southern Africa, the Cape fur seal (Arctocephalus pusillus pusillus) population constitutes the largest marine top predator biomass, but little is known of its foraging ecology other than its diet and some preliminary dive records. Dive information was obtained from 32 adult females instrumented with dive recorders at the Kleinsee colony (29°34.17' S, 16°59.80' E) in South Africa during 2006-2008. Most dives were in the depth range of epipelagic prey species (less than 50 m deep) and at night, reflecting the reliance of Cape fur seals on small, vertically migrating, schooling prey. However, most females also performed benthic dives, and benthic diving was prevalent in some individuals. Benthic diving was significantly associated with the frequency with which females exceeded their aerobic dive limit. The greater putative costs of benthic diving highlight the potential detrimental effects to Cape fur seals of well-documented changes in the availability of epipelagic prey species in the Benguela.

Cognitive function, quality of life and mental health in survivors of our-of-hospital cardiac arrest: a review

There is growing interest in the long-term outcomes of patients surviving out-of-hospital cardiac arrest (OHCA). This paper aims to summarise the available literature on the long-term cognitive, health-related quality of life (QoL) and mental health outcomes of survivors of OHCA. Between 30% and 50% of survivors of OHCA experience cognitive deficits for up to several years post-discharge. Deficits of attention, declarative memory, executive function, visuospatial abilities and verbal fluency are commonly reported. Survivors of OHCA appear to report high rates of mental illness, with up to 61% experiencing anxiety, 45% experiencing depression and 27% experiencing post-traumatic stress. Fatigue appears to be a commonly reported long-term outcome for survivors of OHCA. Investigations of long-term QoL for these patients have produced mixed findings. Carers of survivors of OHCA report high rates of depression, anxiety and post-traumatic stress, with insufficient social and financial support. The heterogeneous range of instruments used to assess cognitive function and QoL prevent any clear conclusions being drawn from the available literature. The potential biases inherent in this patient population and the interaction between QoL, cognitive performance and mental health warrant further investigation, as does the role of post-discharge support services in improving long-term patient outcomes.

Management of severe hypercapnia post cardiac arrest with extracorporeal carbon dioxide removal

Normocapnia is recommended in intensive care management of patients after out-of-hospital cardiac arrest. While normocapnia is usually achievable, it may be therapeutically challenging, particularly in patients with airflow obstruction. Conventional mechanical ventilation may not be adequate to provide optimal ventilation in such patients. One of the recent advances in critical care management of hypercapnia is the advent of newer, low-flow extracorporeal carbon dioxide clearance devices. These are simpler and less invasive than conventional extracorporeal devices. We report the first case of using a novel, extracorporeal carbon dioxide removal device in Australia on a patient with out-of-hospital cardiac arrest where mechanical ventilation failed to achieve normocapnia.

Carbon dioxide clearance in critical care

Lung protective ventilation limiting tidal volumes and airway pressures were proven to reduce mortality in patients with acute severe respiratory failure. Hypercapnia and hypercapnic acidosis is often noted with lung protective ventilation. While the protective effects of lung protective ventilation are well recognised, the role of hypercapnia and hypercapnic acidosis remains debatable. Some clinicians argue that hypercapnia and hypercapnic acidosis protect the lungs and may be associated with improved outcomes. To the contrary, some clinicians do not tolerate hypercapnic acidosis and use various techniques including extracorporeal carbon dioxide elimination to treat hypercapnia and acidosis. This review aims at defining the effects of hypercapnia and hypercapnic acidosis with a focus on the pros and cons of clearing carbon dioxide and the modalities that may enhance carbon dioxide clearance.

Sedation and Delirium in the Intensive Care Unit: An Australian and New Zealand Perspective

A survey was conducted to determine sedation and delirium practices in Australian and New Zealand intensive care units.

The survey was in two parts, comprising an online survey of reported sedation and delirium management (unit survey) and a collection of de-identified data about each patient in a unit at a given time on a specified day (patient snapshot survey). All intensive care units throughout Australia and New Zealand were invited by email to participate in the survey.

Twenty-three predominantly metropolitan, level III Australian and New Zealand intensive care units treating adult patients participated. Written sedation policies were in place in 48% of units, while an additional 44% of units reported having informal sedation policies. Seventy percent of units routinely used a sedation scale. In contrast, only 9% of units routinely used a delirium scale. Continuous intravenous infusion is the primary means of patient sedation (74% of units). While 30% of units reported routinely interrupting sedation, only 10% of sedated patients in the snapshot survey had had their sedation interrupted in the preceding 12 hours. Oversedation appears to be common (46% of patients with completed sedation scales). Use of neuromuscular blockade is low (10%) compared to other published studies. Midazolam and propofol were the most frequently used sedatives. The proportion of patients developing delirium was 21% of assessable patients. Failed and self-extubation rates were low: 3.2% and 0.5% respectively.

In Australian and New Zealand intensive care units, routine use of sedation scales is common but not universal, while routine delirium assessment is rare. The use of a sedation protocol is valuable and should be encouraged.

Predictors of outcome of ruptured aortic aneurysms in a metropolitan hospital

The mortality in patients presenting with ruptured abdominal aortic aneurysm remains high. In this study we aimed to assess the outcome and factors predicting the mortality in patients admitted to a teaching hospital with the diagnosis of ruptured abdominal aortic aneurysm. During the study period (July 2001 to July 2007) all patients admitted with a diagnosis of a ruptured abdominal aortic aneurysm were included. There was a total of 62 patients with a mean age of 76 years. The hospital mortality was 32.3% (20 patients). Twelve patients (19.4%) were discharged home, 25 patients (40.3%) were discharged to rehabilitation and five patients (8%) were discharged to other hospitals for further care. There was a significant difference between survivors and non-survivors in age, loss of consciousness at presentation and duration of hospital stay. Logistic regression analysis of these variables suggests the presence of chronic obstructive pulmonary disease (P=0.04, odds ratio 6.7, 95% confidence interval 1.1 to 41.3) and age (P=0.02, odds ratio 1.2, 95% confidence intervals 1.0 to 1.3) to be independently associated with mortality. These results compare favourably with published Australian as well as the international data.

The effect of a sedation scale on ventilation hours, sedative, analgesic and inotropic use in an intensive care unit

OBJECTIVE

Sedative drugs are used routinely in critically ill patients to reduce both physical and psychological stresses imposed by the hostile intensive care unit environment. However, drug accumulation, particularly during prolonged administration, often poses difficulties. Sedation scales chart the physiological effect of sedation although many surveys have revealed that few units use them to monitor the effect of sedative agents hence oversedation is common.

METHODS

We evaluated the impact of a modified Sheffield sedation scale on ventilation hours, sedative, analgesic and inotropic use in an intensive care unit. After an education course on the use of the sedation scale, it was utilised from June 2000 to February 2001. After this 9 month period, the pharmacy and health information services retrieved data on ventilation hours and sedative, analgesic and inotropic use from June 2000 to February 2001 and compared it with data retrieved from a similar period prior to sedation scale use from June 1999 to February 2000.

RESULTS

The population studied during both periods were similar in terms of total ventilated patients (141 versus 147), mean age (59.6 versus 61.2) major case mix groupings, discharge destination and hospital mortality (31% versus 31%). After introducing the sedation scale the average patient ventilated hours decreased from 203.7 to 179.5 hours. The intensive care unit's use of midazolam decreased by 38.38%, morphine use decreased by 52.6% and propofol use decreased by 17.3%. Also the adrenaline use decreased by 13.95%, noradrenaline use decreased by 8.25% and dopamine use decreased by 35.7%.

CONCLUSIONS

Our study demonstrates that the use of a sedation scale lead to a decrease in sedative, analgesic and inotrope use with a trend to less ventilated hours in critically ill patients.

Metabolic stridor: a case report

The clinical features of severe hypokalaemia include constipation, ileus, ventricular and atrial tachycardias, weakness, hypotonicity and rarely an ascending motor paralysis with ventilatory failure. We describe a patient who presented with severe diarrhoea, hypokalaemic normal anion gap metabolic acidosis and hypophosphataemia. He developed stridor and respiratory failure following early correction of his hypokalaemia which was successfully managed with endotracheal intubation, mechanical ventilation and further correction of his fluid and electrolyte abnormalities.

Australian bat lyssavirus infection: a second human case, with a long incubation period

In December 1998, a 37-year-old Queensland woman died from a rabies-like illness, 27 months after being bitten by a flying fox (fruit bat). Molecular techniques enabled diagnosis of infection with Australian bat lyssavirus (ABL), the second human case to be recognised and the first to be acquired from a flying fox. It must be assumed that any bat in Australia could transmit ABL; anyone bitten or scratched by a bat should immediately wash the wounds thoroughly with soap and water and promptly seek medical advice.

A review of mycotic nasal granuloma in cattle, with a report on three cases

Three cases of nasal mycotic granuloma containing fungal cells and hyphae in cattle are described. In 2 animals a mucopurulent or purulent nasal discharge was seen clinically, and epistaxis in the third. Histologically, ulceration of the nasal mucosa and a severe granulomatous inflammation of the nasal submucosa with eosinophils as the predominant cell type were evident in the cattle. Non-pigmented fungal cells identified as chlamydospores and short septate hyphae were demonstrated in giant cells and extracellularly within the granulomatous reactions. In one case, the fungal elements were frequently surrounded by homogeneous eosinophilic (Splendore-Hoeppli) material. Dematiaceous fungi, Bipolaris sp. and Drechslera sp., were isolated from 2 cases. Mycology was not performed on the third animal.

Unstable angina pectoris secondary to multiple calcified coronary artery masses. Successful treatment with coronary artery bypass surgery

A 31-year-old doctor's wife suffered from severe unstable angina pectoris (AP) due to two large, heavily calcified masses involving the right coronary artery and the left anterior descending branch of the left coronary artery. The causes of the masses could not be determined with certainty, but in view of the history (which included the ingestion of large quantities of raw boerewors (traditional spiced sausage) and histopathological findings, we believe that they were coronary artery aneurysms which developed secondary to coronary arteritis many years previously. The possibility of echinococcal (hydatid) infection is also discussed. Cardiac surgery entailed total excision of both masses, together with sections of their accompanying coronary arteries which had become fibrotic as a result of the arteritis, and reestablishment of coronary blood flow by the insertion of two saphenous vein coronary artery bypass grafts. Her AP was dramatically relieved and she continues to be asymptomatic without taking anti-anginal drugs.

Syncope in the elderly. Report of 3 cases with sick sinus syndrome

Three cases of arrhythmia-induced syncope in the elderly are reported. The patients all showed some features of the sick sinus syndrome and had aortic ejection murmurs. Ventricular tachycardia occurred in 2 patients. The importance of trying to record an arrhythmia during a syncopal attack is stressed, as are the adverse effects of many drugs commonly prescribed in this age group. The relationship between the arrhythmias found and their association with aortic stenosis are discussed.