Antimony(V) Incorporation into Schwertmannite: Critical Insights on Antimony Retention in Acidic Environments.

This study examines incorporation of Sb(V) into schwertmannite─an Fe(III) oxyhydroxysulfate mineral that can be an important Sb host phase in acidic environments. Schwertmannite was synthesized from solutions containing a range of Sb(V)/Fe(III) ratios, and the resulting solids were investigated using geochemical analysis, powder X-ray diffraction (XRD), dissolution kinetic experiments, and extended X-ray absorption fine structure (EXAFS) spectroscopy. Shell-fitting and wavelet transform analyses of Sb K-edge EXAFS data, together with congruent Sb and Fe release during schwertmannite dissolution, indicate that schwertmannite incorporates Sb(V) via heterovalent substitution for Fe(III).

Antimony and arsenic particle size distribution in a mining contaminated freshwater river: Implications for sediment quality assessment and quantifying dispersion.

Assessments of antimony (Sb) and arsenic (As) contamination in sediments are reported on a wide range of different particle size fractions, including <63 μm, < 180 μm and <2 mm. Guidelines vary between jurisdictions which limits comparative assessment between contamination events and complicates ecotoxicity assessment, and almost no information exists on Sb size distribution in contaminated sediments. This study quantified and compared the size distribution of Sb and As in 11 sediments (and 2 floodplain soils) collected along 320 km of waterway contaminated by historic mining activity.

Is lactate lower in septic patients who are prescribed beta blockers? Retrospective cohort study of an intensive care population.

Objective: Elevated serum lactate has long been considered an important marker of sepsis severity. Increasing evidence supports catecholamine-stimulated aerobic glycolysis being a major contributor to the hyperlactataemia seen in sepsis. Beta-blockade may blunt such catecholamine mediated rise in lactate analogous to the way it can mask tachycardia.

Pulmonary embolism An update.

Background: Pulmonary embolism is a common condition and can be the source of significant morbidity and mortality.

Objective: This article reviews the approach to the diagnostic assessment and management of patients with suspected pulmonary embolism.

Discussion: Various clinical decision rules and algorithms are available to assist in the diagnosis of pulmonary embolism, and the Wells score and Pulmonary Embolism Rule-out Criteria rule are presented in this article.

Ideal Cricoid Pressure Is Biomechanically Impossible During Laryngoscopy.

Objective: This study was a prospective, randomized controlled trial of rapid sequence intubation (RSI) with cricoid pressure (CP) within the emergency department (ED). The primary aim of the study was to examine the link between ideal CP and the incidence of aspiration.

Method: Patients > 18 years of age undergoing RSI in the ED of two hospitals in New South Wales, Australia, were randomly assigned to receive measured CP using weighing scales to target the ideal CP range (3.

Evaluation of amendments to reduce arsenic and antimony leaching from co-contaminated soils.

Co-contamination of soils with arsenic (As) and antimony (Sb) presents unique challenges for risk management. In this study a sequence of leaching experiments evaluated zero valent iron powder, ferrihydrite, ferric chloride, aluminium and manganese oxides, and kaolinite for As and Sb immobilisation in co-contaminated soils. Iron based amendments were most effective for the reduction of As and Sb in leachate in a column leaching study.

On-line application of near-infrared spectroscopy for monitoring water levels in parts per million in a manufacturing-scale distillation process.

An on-line analytical method based on transmission near-infrared spectroscopy (NIRS) for the quantitative determination of water concentrations (in parts per million) was developed and applied to the manufacture of a pharmaceutical intermediate. Calibration models for water analysis, built at the development site and applied at the manufacturing site, were successfully demonstrated during six manufacturing runs at a 250-gallon scale. The water measurements will be used as a forward-processing control point following distillation of a toluene product solution prior to use in a Grignard reaction.

National project seeking to improve pain management in the emergency department setting: findings from the NHMRC-NICS National Pain Management Initiative.

Objectives: The National Pain Management Initiative was established by the National Institute of Clinical Studies to improve analgesic practice across Australian EDs.

Methods: A barrier analysis provided information to better implement changes in analgesic practice. A working party was established and developed a multifaceted intervention strategy and clinical indicators.

When death is imminent - documenting end-of-life decisions.

Background: There has been widespread promotion of advance care planning in recent years, which is consistent with an ageing population and a greater awareness of patient self determination.

Methods: A review of medical records relating to hospital patient deaths and a separate review of emergency department admissions of patients aged 75 years or more in the same hospital.

Results: In the patient deaths sample, 77% of patients (median age 79 years), had their first documented end-of-life discussion 3 days before death.

Pain management in Australian emergency departments: current practice, enablers, barriers and future directions.

Objective: To explore current pain management practice in Australian EDs and identify enablers and barriers for best-practice pain management.

Methods: Five focus groups and two in-depth interviews were held with ED clinical staff (n= 47) from six hospitals in three states. Participants were asked open-ended questions to determine current pain management practices, enablers and barriers to implementing best-practice pain management, and understand change in practice within the ED setting.

Effectiveness of cricoid pressure in preventing gastric aspiration during rapid sequence intubation in the emergency department: study protocol for a randomised controlled trial.

Background: Cricoid pressure is considered to be the gold standard means of preventing aspiration of gastric content during Rapid Sequence Intubation (RSI). Its effectiveness has only been demonstrated in cadaveric studies and case reports. No randomised controlled trials comparing the incidence of gastric aspiration following emergent RSI, with or without cricoid pressure, have been performed.

Impact of pain location, organ system and treating speciality on timely delivery of analgesia in emergency departments.

Objective: This retrospective, observational cohort study investigated whether the clinical features of a patient's pain, including anatomical location, organ system and likely treating speciality, impact on the delivery of analgesia within 30 min in EDs.

Methods: Data were obtained from 24 centres across Australia between April 2008 and March 2009. Principal outcome was delivery of analgesia within 30 min or less.

Factors influencing rural versus metropolitan work choices for emergency physicians.

Objectives: To survey Fellows of the Australasian College for Emergency Medicine (FACEM) on how a range of factors influenced their decision to accept their most recent position. To compare this information between rural and metropolitan FACEM.

Methods: Analytical cross-sectional survey of FACEM.

Automated versus manual audit in the emergency department.

Purpose: The purpose of this paper is to compare data collected by automated form processing with manual data collection for clinical indicators (CIs) in paediatric emergency medicine.

Design/methodology/approach: Paediatric patients presenting with croup, asthma, bronchiolitis, head injury and gastroenteritis in August 2006 were identified by ICD 9 coding and a traditional manual audit was performed by two data collectors. Data were collected on a total of 16 CIs for these five illnesses.

Could we care for Amillia in rural Australia?

Extremely premature and very low birth weight infants have multiple, costly and complex health and developmental issues. After the neonatal period, the best chance for these children to avoid extreme disability and dependence, and thereby reach their potential, is with timely and intensive early intervention by appropriate allied health services, such as speech, occupational and physiotherapy. However, currently in rural Australia, such children are further disadvantaged by their relative lack of access to appropriate types and levels of services, compared with their urban counterparts.

'Evidence-based implementation' of paediatric asthma guidelines in a rural emergency department.

Aim: To determine if an evidence-based implementation (EBI) could lead to improved compliance with guidelines for acute asthma in children aged 1-15 years presenting to a large rural emergency department.

Methods: Pre-intervention, post-intervention and 12-month follow-up audits were performed to determine the impact of an EBI strategy used to increase compliance with current asthma guidelines. The pre-intervention audit was conducted from 1 April to 30 June 2004, and follow-up data were collected from 1 September to 30 November 2004.

Evidence-based implementation of adult asthma guidelines in the emergency department: a controlled trial.

Objective: To determine if an evidence-based implementation (EBI) strategy could lead to the successful implementation of guidelines for the management of adult asthma in a large rural ED.

Methods: This was a pre- and post-intervention trial, comparing data for seven clinical indicators from a study hospital and a control hospital. Retrospective pre-intervention audits were conducted at the study hospital for 3 months (1 April-30 June 2004) and the control hospital for 4 months (1 March-30 June 2004).

Evidence-based implementation of evidence-based guidelines.

Purpose: There is evidence that some strategies for guideline implementation are more successful than others. This paper aims to describe the process of developing an evidence-based guideline implementation strategy for use in rural emergency departments.

Design/methodology/approach: Participation in a nationally funded, research fellowship program involved attendance at workshops run by internationally renowned experts in the field of knowledge translation.

Effect of an on-site emergency physician in a rural emergency department at night.

Introduction: The problem of emergency department (ED) overcrowding is an issue of some concern and staffing profile has been identified as a contributing factor. The aim of this study was to assess the effect of having an emergency physician on-site at night in a rural base hospital ED in terms of the ED length of stay, waiting times, admissions, specialist consultations, the use of diagnostic tests, and ED representations within 7 days.

Methods: A retrospective analysis was performed of the ED database at Tamworth Base Hospital in rural New South Wales, Australia.

History of evidence-based medicine. Oranges, chloride of lime and leeches: barriers to teaching old dogs new tricks.

Knowledge translation is the process of taking evidence from research and applying it in clinical practice. In this article I will cite some pivotal moments in the history of medicine to highlight the difficulties and delays associated with getting evidence into practice. These historical examples have much in common with modern medical trials and quality improvement processes.

Evidence-based medicine: arguments for and against.

In this article I will discuss the various definitions of evidence-based medicine (EBM), and summarize the application, criticisms and limitations of EBM. The spectrum of evidence, from pathophysiological inference to randomized controlled trials, will be presented as a mechanism for filtering bias with more rigorous evidence being required when bias is more likely. Although randomized controlled trials and meta-analyses are at the top of the evidence hierarchy, they are not always necessary, might not be the most appropriate forms of evidence for some clinical questions, and have their own limitation that need to be understood.

Duodenal perforation: an interesting case report.

We describe a young child presenting with vomiting and altered neurological status. An incidental finding of pneumoperitoneum on abdominal X-ray led to laparotomy and the discovery of a duodenal perforation. We describe the difficulties in making the diagnosis of duodenal perforation in children and some of the factors that led to the delay in diagnosis in this case.