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Abstract: Horsley, BJ, Tofari, PJ, Halson, SL, Kemp, JG, Chalkley, D, Cole, MH, Johnston, RD, and Cormack, SJ. Validity and reliability of thoracic-mounted inertial measurement units to derive gait characteristics during running. J Strength Cond Res 38(2): 274-282, 2024-Inertial measurement units (IMUs) attached to the tibia or lumbar spine can be used to analyze running gait but, with team-sports, are often contained in global navigation satellite system (GNSS) units worn on the thoracic spine. We assessed the validity and reliability of thoracic-mounted IMUs to derive gait characteristics, including peak vertical ground reaction force (vGRF peak ) and vertical stiffness (K vert ). Sixteen recreationally active subjects performed 40 m run throughs at 3-4, 5-6, and 7-8 m·s -1 . Inertial measurement units were attached to the tibia, lumbar, and thoracic spine, whereas 2 GNSS units were also worn on the thoracic spine. Initial contact (IC) from a validated algorithm was evaluated with F1 score and agreement (mean difference ± SD ) of gait data with the tibia and lumbar spine using nonparametric limits of agreement (LoA). Test-retest error {coefficient of variation, CV (95% confidence interval [CI])} established reliability. Thoracic IMUs detected a nearly perfect proportion (F1 ≥ 0.95) of IC events compared with tibia and lumbar sites. Step length had the strongest agreement (0 ± 0.04 m) at 3-4 m·s -1 , whereas contact time improved from 3 to 4 (-0.028 ± 0.018 second) to 7-8 m·s -1 (-0.004 ± 0.013 second). All values for K vert fell within the LoA at 7-8 m·s -1 . Test-retest error was ≤12.8% for all gait characteristics obtained from GNSS units, where K vert was most reliable at 3-4 m·s -1 (6.8% [5.2, 9.6]) and vGRF peak at 7-8 m·s -1 (3.7% [2.5, 5.2]). The thoracic-spine site is suitable to derive gait characteristics, including K vert , from IMUs within GNSS units, eliminating the need for additional sensors to analyze running gait., (Copyright © 2023 National Strength and Conditioning Association.)

Objectives: The COVID-19 Delta variant of concern continues to pose significant challenges to health systems globally, with increased transmissibility and different patient populations affected. In Sydney, a virtual model of care was implemented in response to the COVID-19 pandemic and Special Health Accommodation (SHA) was made available for community patients with COVID-19 who could not isolate at home or needed health support., Methods: This retrospective observational cohort study of all patients with COVID-19 Delta variant in SHA during the initial phases of the Delta variant outbreak in Sydney describes the demographic and clinical characteristics of patients with Delta variant COVID-19 and determines predictors of need for in-patient hospital admission., Results: Data from 794 patients were analysed. One hundred and fifty-seven patients (19.8%) were transferred to ED. Of those, 125 were admitted to an in-patient unit (admission rate from ED 79.6%), and of these 30 (24%) went to ICU and seven were intubated. Two patients died within the follow-up period. Age >40 years, obesity, and presence of fever (temperature >37.5°C), hypoxia (oxygen saturation <95%), tachycardia or gastrointestinal symptoms on initial assessment in SHA were independent predictors of in-patient admission with an AUROC of 0.78 (95% confidence interval 0.73, 0.82)., Conclusions: Initial symptoms and vital signs were just as predictive for short-term deterioration as age and pre-existing comorbidities and should be included in future risk prediction models for COVID-19. Based on this, we derive a proposed risk prediction score that incorporates these predictors with further validation required., (© 2022 Australasian College for Emergency Medicine.)

Abstract: Weakley, J, McCosker, C, Chalkley, D, Johnston, R, Munteanu, G, and Morrison, M. Comparison of sprint timing methods on performance, and displacement and velocity at timing initiation. J Strength Cond Res 37(1): 234-238, 2023-Sprint testing is commonly used to assess speed and acceleration in athletes. However, vastly different outcomes have been reported throughout the literature. These differences are likely due to the sprint timing method rather than differences in athlete ability. Consequently, this study compared different sprint starting methods on sprint time and quantified the velocity and displacement of the athlete at the moment timing is initiated. Starting in a staggered 2-point stance, 12 team sport athletes were required to accelerate 10 meters for 10 repetitions. During each repetition, 5 independent timing methods were triggered. The methods were (a) triggering a Move sensor; (b) starting 50 cm behind the line; (c) triggering a front-foot switch; (d) triggering a rear-foot switch; and (e) starting with the front foot on the line. Timing for each method was initiated at different points during the acceleration phase, and the displacement and velocity of the centroid of the pelvis at the point of timing initiation was assessed under high-speed motion capture. The Move sensor had the smallest displacement and lowest velocity at the point of timing initiation, whereas the front-foot trigger demonstrated the largest displacement and highest velocities. Trivial to very large effect size differences were observed between all methods in displacement and velocity at the point of timing initiation. Furthermore, small to very large differences in time to 5 m were found. These findings emphasize that sprint outcomes should not be compared, unless starting methods are identical. In addition, to detect real change in performance, consistent standardized protocols should be implemented., (Copyright © 2022 National Strength and Conditioning Association.)

Background: People with Parkinson's disease (PD) are at a high risk of falls, with ~ 60% experiencing a fall each year. Greater mediolateral head and pelvis motion during gait are known to increase the risk of falling in PD, however the ability to modify these aspects of gait has not been examined. Thus, this study aimed to examine whether mediolateral trunk, head and pelvis motion during walking could be successfully decreased in people with PD using real-time biofeedback., Methods: Participants were provided with real-time biofeedback regarding their mediolateral trunk lean via a visual projection whilst walking along an 8-m indoor walkway. Using the feedback provided, they were asked to reduce the magnitude of their mediolateral trunk lean. Gait was recorded for four conditions (i) Baseline, (ii) Intervention, (iii) immediately Post-Intervention, and (iv) 1-week Follow-Up. Biomechanical variables associated with falls risk were compared between conditions, including normalised mediolateral motion, gait velocity and stride length., Results: A reduction in mediolateral trunk lean, step length and gait velocity from Baseline to the Intervention and Post-intervention conditions was observed. Contrary to this, increased normalised ML pelvis and trunk motion was observed between the Baseline and Intervention conditions, but returned to Baseline levels in the Post-Intervention condition., Conclusions: Results from the current study suggest that real-time visual biofeedback may be effective at modifying specific gait characteristics that are associated with falls in PD. Further research is required to better understand the influence of this intervention approach on falls incidence. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12620000994987. Registered 10 June 2020 - Retrospectively registered, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380324., (© 2022. The Author(s).)

Background: Metronome cueing has been shown to reduce gait variability and thereby potentially reduce falls risk in individuals with Parkinson's disease. It is unclear however, if metronome cueing has a similar effect in healthy older adults with a history of falls., Aim: To investigate whether a traditional and/or an adaptive metronome, based on an individual's gait pattern, were effective in reducing gait variability in older adults with a history of falls., Methods: Twenty older adults (15 women, 71 ± 4.9 years) with a history of falls were included in this cross-over study. Participants received two types of cueing (adaptive and traditional metronome) 1 week apart. The variability of the participants' stride time, stride length, walking speed and duration of double leg support were recorded during three walking conditions (baseline, during feedback and post-feedback gait). Repeated-measures ANOVA was used to assess the possible effects of the two cueing strategies on gait variables., Results: Compared with the baseline condition, participants had significantly increased stride time variability during feedback (F (2) = 9.83, p < 0.001) and decreased double leg support time variability post-feedback (F (2) 3.69, p = 0.034). Increased stride time variability was observed with the adaptive metronome in comparison to the traditional metronome., Conclusion: Metronome cueing strategies may reduce double leg support variability in older adults with a history of falls but seem to increase stride time variability. Further studies are needed to investigate if metronome cueing is more beneficial for individuals with greater baseline gait variability than those included in the current study., (© 2022. The Author(s).)

Weakley, J, Chalkley, D, Johnston, R, García-Ramos, A, Townshend, A, Dorrell, H, Pearson, M, Morrison, M, and Cole, M. Criterion validity, and interunit and between-day reliability of the FLEX for measuring barbell velocity during commonly used resistance training exercises. J Strength Cond Res 34(6): 1519-1524, 2020-The aim of this study was to assess the criterion validity, interunit reliability (accounting for technological and biological variance), and between-day reliability of a novel optic laser device (FLEX) for quantifying mean concentric velocity. To assess the validity against a three-dimensional motion capture system and interunit reliability with both technological and biological variation, 18 men and women completed repetitions at 20, 40, 60, 80, 90, and 100% of one repetition maximum in the free-weight barbell back squat and bench press. To assess interunit (technological only) reliability, a purpose-built, calibrated rig completed a set protocol with 2 devices. To assess between-day reliability of the technology, the same protocol was repeated 21 days later. Standardized bias, typical error of the estimate (TEE; %), and Pearson's correlation coefficient (r) were used to assess validity, whereas typical error and coefficient of variation (CV%) were calculated for reliability. Overall, TEE (±90 CL) between the FLEX and criterion measure was 0.03 (±0.004) and 0.04 (±0.005) m·s in the back squat and bench press, respectively. For measures of reliability, overall interunit technological variance (CV% [± 90% confidence interval]) was 3.96% (3.83-4.12) but increased to 9.82% (9.31-10.41) and 9.83% (9.17-10.61) in the back squat and bench press, respectively, when biological variance was introduced. Finally, the overall between-day reliability was 3.77% (3.63-3.91). These findings demonstrate that the FLEX provides valid and reliable mean concentric velocity outputs across a range of velocities. Thus, practitioners can confidently implement this device for the monitoring and prescription of resistance training loads.

Visual exploratory action, in which football players turn their head to perceive their environment, improves prospective performance with the ball during match-play. This scanning action, however, is relevant for players throughout the entire match, as the information perceived through visual exploration is needed to guide movement around the pitch during both offensive and defensive play. This study aimed to understand how a player's on-pitch position, playing role and phase of play influenced the visual exploratory head movements of players during 11v11 match-play. Twenty-two competitive-elite youth footballers (M = 16.25 years) played a total of 1,623 minutes (M = 73.8). Inertial measurement units, global positioning system units and notational analysis were used to quantify relevant variables. Analyses revealed that players explored more extensively when they were in possession of the ball, and less extensively during transition phases, as compared to team ball-possession and opposition ball-possession phases of play. Players explored most extensively when in the back third of the pitch, and least when they were in the middle third of the pitch. Playing role, pitch position and phase of play should be considered as constraints on visual exploratory actions when developing training situations aimed at improving the scanning actions of players.

To control movement of any type, the neural system requires perceptual information to distinguish what actions are possible in any given environment. The behavior aimed at collecting this information, termed "exploration", is vital for successful movement control. Currently, the main function of exploration is understood in the context of specifying the requirements of the task at hand. To accommodate for agency and action-selection, we propose that this understanding needs to be supplemented with a function of exploration that logically precedes the specification of action requirements with the purpose of discovery of possibilities for action-action orientation. This study aimed to provide evidence for the delineation of exploration for action orientation and exploration for action specification using the principles from "General Tau Theory." Sixteen male participants volunteered and performed a laboratory-based exploration task. The visual scenes of different task-specific situations were projected on five monitors surrounding the participant. At a predetermined time, the participant received a simulated ball and was asked to respond by indicating where they would next play the ball. Head movements were recorded using inertial sensors as a measure of exploratory activity. It was shown that movement guidance characteristics varied between different head turns as participants moved from exploration for orientation to exploration for action specification. The first head turn in the trial, used for action-orientation, showed later peaks in the velocity profile and harder closure of the movement gap (gap between the start and end of the head-movement) in comparison to the later head turns. However, no differences were found between the first and the final head turn, which we hypothesized are used mainly for action orientation and specification respectively. These results are in support of differences in the function and control of head movement for discovery of opportunities for action (orientation) vs. head movement for specification of task requirements. Both are important for natural movement, yet in experimental settings,orientation is often neglected. Including both orientation and action specification in an experimental design should maximize generalizability of an experiment to natural behavior. Future studies are required to study the neural bases of movement guidance in order to better understand exploration in anticipation of movement., (Copyright © 2019 van Andel, McGuckian, Chalkley, Cole and Pepping.)

Warman, GE, Cole, MH, Johnston, RD, Chalkley, D, and Pepping, GJ. Using microtechnology to quantify torso angle during match-play in field hockey. J Strength Cond Res 33(10): 2648-2654, 2019-Field hockey is played in a dynamic environment placing specific postural demands on athletes. Little research has been devoted to understanding the nature of a player's torso postures in field hockey match-play and its relationship with the perceptuomotor demands of the sport. We used commercially available microtechnology worn by 16 athletes during a 6-match national tournament to quantify torso flexion/extension angles. Orientation was derived using the inertial and magnetic sensors housed within global positioning system devices, assessing torso angle in the sagittal plane from 91 individual match files. The main independent variable was playing position, whereas the dependent variable was torso flexion/extension, presented as a percentage of playing time spent in 15 × 10° torso postural bands ranging from ≥40° extension to ≥90° flexion. It was shown that athletes spent 89.26% of their playing time in various torso postures, ranging from 20 to 90° of flexion. Defenders spent more time than midfielders (p = 0.004, effect size [ES] = 0.43) and strikers (p = 0.004; ES = 0.44) in the posture band of 10-20° torso flexion, whereas midfielders spent more time between 20 and 30° of torso flexion (p = 0.05; ES = 0.32) than strikers. Conversely, strikers spent more time between 30 and 40° of flexion than defenders (p < 0.001; ES = 0.74). These results reflect the sport-specific and role-specific torso angles adopted by field hockey athletes during match-play. Coaching staff can use these data to gain insight into the postural demands of their sport and inform the preparation of athletes for the perception-action demands of competition.

Objective: The present study describes patients with acute behavioural disturbance presenting to the ED, the impact they have on the department and any complications that occur., Methods: We performed a prospective observational study of adult patients (>17 years old) requiring parenteral sedation for acute behavioural disturbance over a 13 month period. Demographic data, mode of arrival, indication, drug type and dosing used for sedation were collected. Departmental data were recorded including the staff type and numbers involved and the condition of the department. The main outcomes were complications from sedative medication and injury sustained to patients or staff., Results: Over the study period 173 patients met inclusion criteria, the majority (n = 104, 60%) were men with a mean age of 38.5 years (standard deviation 14.4); 51% of patients had more than one indication for sedation (n = 89), the commonest being mental health related plus drug intoxication (n = 30, 33.7%). Intoxication was frequently from either alcohol (n = 62, 47%) or methamphetamine (n = 41, 31%). The median number of staff involved was 10 (interquartile range 8-12). Staff members received an injury in 12% (n = 20) of sedations, with only 1% (n = 2) of patients receiving any physical injury; 12% (n = 20) had a minor complication from the sedation medication. No patient had any major complication (apnoea, intubation, arrhythmias or cardiac arrest)., Conclusion: Patients with acute behavioural disturbance often have a history of mental illnesses and are commonly intoxicated. These patients have impacts on healthcare resources and pose risks to staff safety, but significant complications to patients do not occur frequently., (© 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Visual exploratory action - scanning movements expressed through left and right rotation of the head - allows perception of a surrounding environment and supports prospective actions. In the dynamically changing football environment, the extent to which exploratory action benefits a player's subsequent performance with the ball is likely influenced by how and when the exploratory action occurs. Although few studies have examined the relationship between visual exploration and on-pitch football performance, it has been reported that a higher frequency of exploratory head movement up to 10-s before receiving the ball increases the likelihood of successful performance with the ball. This study investigated the relationship between head turn frequency and head turn excursion, and how and when exploratory head movement - within 10-s before ball possession - is related to performance with the ball in 11v11 match-play. Thirty-two semi-elite football players competed in 11v11 match-play. Head turn frequency and head turn excursion before ball possession were quantified with wearable inertial measurement units, and actions with the ball were coded via notational analysis. Odds ratio calculations were conducted to determine the associations between exploration variables and on-ball performance outcomes. A total of 783 actions with the ball were analyzed. Results revealed a strong relationship between head turn frequency and head turn excursion. Further, a higher than average head turn frequency and head turn excursion before receiving the ball resulted in a higher likelihood of turning with the ball, playing a pass in the attacking direction, and playing a pass to an area that is opposite to which it was received from. The strength of these outcomes varied for different time periods before receiving the ball. When players explored their environment with higher than average head turn frequency and excursion, they used more complex action opportunities afforded by the surrounding environment. Considerations for future research and practical implications are discussed.

Objective: To evaluate population trends in presentations for mental health problems presenting to emergency departments (EDs) in New South Wales during 2010-2014, particularly patients presenting with suicidal ideation, self-harm, or intentional poisoning., Design, Setting and Participants: This was a retrospective, descriptive analysis of linked Emergency Department Data Collection registry data for presentations to NSW public hospital EDs over five calendar years, 2010-2014. Patients were included if they had presented to an ED and a mental health-related diagnosis was recorded as the principal diagnosis., Main Outcome Measures: Rates of mental health-related presentations to EDs by age group and calendar year, both overall and for the subgroups of self-harm, suicidal ideation and behaviour, and intentional poisoning presentations., Results: 331 493 mental health-related presentations to 115 NSW EDs during 2010-2014 were analysed. The presentation rate was highest for 15-19-year-old patients (2014: 2167 per 100 000 population), but had grown most rapidly for 10-14-year-old children (13.8% per year). The combined number of presentations for suicidal ideation, self-harm, or intentional poisoning increased in all age groups, other than those aged 0-9 years; the greatest increase was for the 10-19-year-old age group (27% per year)., Conclusions: The rate of mental health presentations to EDs increased significantly in NSW between 2010 and 2014, particularly presentations by adolescents. Urgent action is needed to provide better access to adolescent mental health services in the community and to enhance ED models of mental health care. The underlying drivers of this trend should be investigated to improve mental health care.

Objective: The objective of the present study is to demonstrate a novel method of mapping ED activity to analyse patterns presentations, occupancy and performance trends., Methods: This was a retrospective, descriptive analysis of de-identified and linked ED presentations across NSW, Australia, over five calendar years, 2010-2014. It was undertaken as part of the Demand for Emergency Services Trend in Years 2010-2014 (DESTINY) study. The DESTINY project analysed 10.8 million presentations during 2010-2014. Hourly Emergency Activity Tracking (HEAT) maps were generated to visually represent and analyse the number of emergency arrivals to ED occupancy and proportion of patients leaving the ED within 4 h per hour of day across consecutive months of the year., Results: HEAT maps provided a means of visually representing ED activity to demonstrate hour-to-hour trends in presentations, occupancy and performance between 2010 and 2014. This analysis has shown that the most marked increase in presentations per hour has occurred during the 10.00-14.00 hour period, associated with an improvement in ED performance during the same period., Conclusion: HEAT maps may be used to facilitate further analyses of ED demand, patterns of patient presentations and patient flow and future health system redesign., (© 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Objectives: To describe population based trends and clinical characteristics of injury related presentations to Emergency Departments (EDs)., Design and Setting: A retrospective, descriptive analysis of de-identified linked ED data across New South Wales, Australia over five calendar years, from 2010 to 2014., Participants: Patients were included in this analysis if they presented to an Emergency Department and had an injury related diagnosis. Injury severity was categorised into critical (triage category 1-2 and admitted to ICU or operating theatre, or died in ED), serious (admitted as an in-patient, excluding above critical injuries) and minor injuries (discharged from ED)., Main Outcome Measures: The outcomes of interest were rates of injury related presentations to EDs by age groups and injury severity., Results: A total of 2.09 million injury related ED presentations were analysed. Minor injuries comprised 85.0%, and 14.1% and 1.0% were serious and critical injuries respectively. There was a 15.8% per annum increase in the rate of critical injuries per 1000 population in those 80 years and over, with the most common diagnosis being head injuries. Around 40% of those with critical injuries presented directly to a major trauma centre., Conclusion: Critical injuries in the elderly have risen dramatically in recent years. A minority of critical injuries present directly to major trauma centres. Trauma service provision models need revision to ensure appropriate patient care. Injury surveillance is needed to understand the external causes of injury presenting to hospital., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objectives: The study aimed to analyze ambulance transportations to Emergency Departments (EDs) in New South Wales (NSW) and to identify temporal changes in demographics, acuity, and clinical diagnoses., Methods: This was a retrospective analysis of a population based registry of ED presentations in New South Wales. The NSW Emergency Department data collection (EDCC) collects patient level data on presentations to designated EDs across NSW. Patients that presented to EDs by ambulance between January 2010 and December 2014 were included. Patients dead on arrival, transferred from another hospital, or planned ED presentations were excluded., Results: A total of 10.8 million ED attendances were identified of which 2.6 million (23%) were transported to ED by ambulance. The crude rate of ambulance transportations to EDs across all ages increased by 3.0% per annum over the five years with the highest rate observed in those 85 years and over (620.5 presentations per 1,000 population). There was an increase in the proportion of category 1 and 2 (life-threatening or potentially life-threatening) cases from 18.1% to 24.0%., Conclusion: Demand for ambulance services appears to be driven by older patients presenting with higher acuity problems. Alternative models of acute care for elderly patients need to be planned and implemented to address these changes.

Objectives: Our primary aim was to analyse the quality of letters from general practitioners (GPs) to the ED as defined by two checklists: the authors' own nine-item list and a template published in 2013 by the New South Wales Agency for Clinical Innovation. The secondary aim was to determine if referral quality was influenced by letter format (handwritten or computer-generated) or urgency of the patient's condition (defined by triage category)., Methods: The present study is a retrospective audit of records of patients presenting to Royal Prince Alfred Hospital ED from a GP during February and March 2014., Results: Out of 12 199 ED presentations, 575 (4.7%) were recommended by a GP and 414 (72.0%) had a letter. Greater than 60% completion was achieved in 80.9% of letters compared to our own checklist, and in 6.3% compared to the Agency for Clinical Innovation checklist. Computer-generated letters were more likely to be fully legible and include an accurate medical history and medication list. Handwritten letters were less frequent (11.9%) but of poorer quality and legibility. Overall, less than half of letters contained results, psychosocial history or vaccination history. Referrals for patients assigned an urgent triage category were more likely to contain examination findings, but there was otherwise no difference in quality., Conclusions: Referral quality was influenced by letter format but not by urgency of the patient's condition. Omission of information from referral letters potentially risks patient safety. Handwritten referrals should be abandoned. Comprehensive electronic letter templates and regular updating of medications, comorbidities and allergies are encouraged., (© 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Objective: The objective of this study is to describe the trends and characteristics of short-term and frequent representations to EDs in New South Wales, Australia., Methods: This was a retrospective analysis of a linked population-based registry of ED representations in New South Wales, conducted as part of the Demand for Emergency Services in Years 2010-2014 project. Trend analysis of unplanned representations to ED within 3 days of discharge from ED, readmission to an in-patient unit within 30 days of index in-patient admission from ED and demographic data and trends for frequent and very frequent ED presenters is discussed., Results: A total of 10 798 797 ED presentations were identified from 4 188 283 individual patients. Within 1 year, 48.9% of ED presentations had a previous presentation, and 4.9% had represented within 3 days of a previous presentation. The readmission rate within 30 days was 2.8%, the proportion of frequent (representing 5212 [0.1%] individual patients) and very frequent representations (representing 1186 [0.03%] individual patients) were 1.7% and 1.0%, respectively. The overall rate of representations within 3 days has decreased from 5.1% in 2010 to 4.7% in 2014 (P < 0.001). The rate of readmissions within 30 days has increased from 2.4% in 2010 to 3.1% in 2014 (P < 0.001)., Conclusions: In this population-based study, short-term representations were highest in the infant patient population, in-patient readmission rates were highest in the elderly and very frequent representations to ED were characterised by middle-aged patients with mental health or drug and alcohol related presentations., (© 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Objective: This study aims to describe the general characteristics and data definitions used in a population-based data set of ED presentations in New South Wales (NSW), used to form the basis of future-trend analyses., Methods: Retrospective analysis of the Emergency Department Data Collection registry, which provided clinical and demographic information of ED presentations across all EDs in NSW between 2010 and 2014. Presenting problems and ED diagnoses were classified using broad clinical categories including injury/musculoskeletal, respiratory, cardiovascular, ear nose and throat, and mental health. Presentations were linked by patient to allow for analysis of representations, and population data were obtained from the Australian Bureau of Statistics., Results: There were 11.8 million presentations that were analysed from 150 EDs (80.6% of all EDs). The rate of ED presentations was highest in those aged 85 years and older and appears to increase across all age groups between 2010 and 2014. The most common ED diagnosis categories were injury/musculoskeletal (27.5%) followed by abdominal/gastrointestinal (12.3%), respiratory (9%) and cardiovascular (8%). Both the Systematised Nomenclature of Medicine Clinical Terms (66%) and the International Classification of Diseases (24%) were used to code ED diagnoses., Conclusions: The elderly population had the highest rate of ED attendances. The use of diverse diagnosis classifications and source information systems may present problems with further analysis. Patterns and characteristics of ED presentations in NSW were broadly consistent with those reported in other states in Australia., (© 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Objective: To contrast long-term population-based trends in general practice (GP) presentations and acute inpatient admissions from the emergency department (ED) in the elderly population within the Greater Sydney Area., Methods: This was a retrospective analysis of population-based ED presentation data over 11 years, between January 2001 and December 2011, conducted within the Greater Sydney Area in Australia. De-identified data were obtained from the New South Wales Emergency Department Data Collection database on all patients presenting to 30 public hospital EDs located within the Greater Sydney Area. The outcomes of interest were GP presentations to ED (triage category 4 or 5, self-referred and discharged from ED) and of acute inpatient admissions from ED per 1000 population., Results: Over 11 million presentations were identified. Around 40% of presentations were classified as a GP presentation and 23% were classified as acute inpatient admissions. There was a 2.9% per annum increase in acute inpatient admissions per 1000 population in those ≥80 years of age and no appreciable change in other age groups. Rates of GP presentations were higher in those <65 years of age. GP presentations increased 1.9% per annum in those aged <65 years of age., Conclusions: The increase in ED demand appears to be driven by the elderly presenting with acute problems requiring inpatient admission. There has been a modest increase in the rate of GP presentations to ED., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Introduction: Trauma data collection by UK hospitals is non-mandatory and data regarding trauma mortality are deficient. Our aim was to provide a contemporary description of mortality in a maturing trauma-receiving hospital serving an inner-city population., Methods: A prospectively maintained registry was analysed for demographics; injury mechanism; and time, location and cause of death in trauma patients admitted via the Emergency Department between 2004 and 2008., Results: 4986 trauma team activations yielded 4243 complete cases. The number of patients rose from 784 in 2004-2005 to 1400 in 2007/8. 302 (7%) of these died. All-cause mortality fell from 8.8% to 5.8% (p=0.0075). Blunt trauma (predominantly falls from height and road traffic collisions) accounted for 79% of admissions but 87% of mortality. Penetrating trauma accounted for 21% of admissions and 13% of mortality. Most penetrating injury deaths were from stabbing injury (31/40) as opposed to gunshot wounds (8/40). The biggest cause of death was central nervous system injury (47.7%) followed by haemorrhage (26.2%). Penetrating injury death was associated with marked shock and acidosis compared to blunt mechanisms--mean (SD) admission systolic blood pressure 25.4 (45.7) versus 105.5 (60.5) mm Hg; mean (SD) base excess -21.84 (7.2) versus 9.71 (8.45) mmol, respectively. No classical trimodal distribution of death was observed., Conclusion: Despite current focus on death from knife and gun crime, the vast majority of trauma mortality arises from blunt aetiology. Maturation of our systems of care has been associated with a drop in mortality as institutional trauma volumes increase and clinical infrastructure develops.

Aims: To investigate whether BCG vaccination, in addition to a reduction of active tuberculosis, leads to a reduction of Mycobacterium tuberculosis infection during an outbreak of tuberculosis., Methods: Pupils (n=199) of a Junior School exposed to a pupil with active pulmonary tuberculosis were screened using a gamma interferon release assay for detection of M. tuberculosis infection (ex vivo ELISPOT assay). Relative risk of M. tuberculosis infection and pulmonary tuberculosis associated with BCG vaccination were calculated and adjusted for exposure risk., Results: Twenty-nine percent of children with previous BCG vaccination had a reactive gamma interferon release assay compared with 47% of unvaccinated children (unadjusted RR 0.61, 95%CI 0.39, 0.96). The protective effect of BCG vaccination persisted following adjustment for other risk factors for infection like ethnicity and proximity to the source case reflected in membership of class and activity groups (corrected relative risk 0.26, 95%CI 0.09, 0.69 and risk reduction of 74%, 95%CI 31%, 91%). A higher proportion of unvaccinated children (11%) were diagnosed with active pulmonary tuberculosis compared with 5% of vaccinated children (RR 0.51 95%CI 0.15, 1.70)., Conclusion: BCG vaccination was associated with a reduction of M. tuberculosis infection diagnosed by gamma interferon release assay testing in school children during a point source outbreak.

The author discusses the evolution of federal constraints on medical, behavioral, and social science research. There has been only one court decision related to behavioral research and none in medical research. The burden of consent procedures can be lightened somewhat by careful consideration of the potential risks and nature of the research; questions are presented that can be used to determine whether constraints apply. The author notes that although there are good reasons for regulations in both behavioral and medical research, the appropriateness of current and proposed constraints is still a matter of debate.

The cyanogenic low-temperature basidiomycete (Coprinus psychromorbidus Redhead and Traquair), unlike other cyanide-tolerant fungi, does not detoxify cyanide via formamide hydro-lyase. Instead, tolerance apparently depends on cyanide-insensitive respiration involving activity of the mitochondrial alternative oxidase. Respiration and growth of young mycelium that lacks alternative oxidase activity are blocked both by cyanide and 1 mum antimycin. When activity of the alternative oxidase is elicited in young mycelium by 0.05 mm cyanide, subsequent treatment with antimycin stimulates respiration and fails to halt growth. Older mycelium becomes tolerant coincidentally with the release of cyanide by the mycelium. Tolerant older mycelium in medium containing 0.05 to 1.0 mum antimycin grows at 30 to 45% of the control rate. Cyanide- and antimycin-tolerant growth and respiration are blocked by salicyl hydroxamic acid, an inhibitor of the alternative oxidase, and by rotenone, which inhibits ATP synthesis at site I.