Bankstown Lidcombe Hospital

Hiatal hernia (HH) is commonly observed in patients with Barrett’s oesophagus (BO), a premalignant condition that may progress to oesophageal adenocarcinoma (OAC). While HH has been implicated in BO pathogenesis, it is not formally recognised as a major risk factor in leading international clinical guidelines. This systematic scoping review aimed to evaluate the role of HH in the development, progression, and treatment outcomes of BO. A systematic scoping review was conducted, searching through databases (PubMed, Medline, Embase, Scopus). A total of sixty-six articles were included with majority comprised of observational studies. HH was strongly associated with BO development, particularly in cases with larger hernia size (> 2–4 cm) and long-segment BO. While inconsistent, there could BO a trend towards dysplastic and malignant progression of BO in HH. HH may impair the efficacy of radiofrequency ablation, with larger hernias requiring more treatment sessions. Current evidence supports HH as a significant risk factor for BO onset. Its role in progression and management warrants further investigation. Surgical repair may be beneficial in selected asymptomatic patients, especially those with hernias ≥ 4 cm and established BO, to restore the gastro-oesophageal anatomy and eliminate reflux-prone micro-environment.

HighlightsPublic health relevance—How does this work relate to a public health issue?Having a caregiver with high vulnerability and complex needs can negatively impact child development, particularly during the early years of life.Public health significance—Why is this work of significance to public health?Home visiting interventions can improve caregiver outcomes and, in turn, the caregiving environment.Improvements in the caregiving environment can positively impact child health and development.Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?While home visiting interventions were found to improve a range of caregiver outcomes no one intervention was suitable to address all the varied needs of caregivers with high vulnerability and complex needs.Given the limited number of studies on each intervention and the inclusion of primarily female caregivers in participant samples, more research with diverse samples, notably male caregivers, is required.Past reviews have found home visiting interventions to be successful at improving caregiver outcomes. Though, no review has looked specifically at the effect of home visiting interventions on caregivers with high vulnerability and complex needs. This review aimed to examine and synthesis the literature on the impact of home visiting programs administered to caregivers with young children, high vulnerability and complex needs by professionals/paraprofessionals. Interdisciplinary databases, reference lists, and the Home Visiting Evidence of Effectiveness database were searched for articles that fit the inclusion criteria. Together searches resulted in a total of 623 articles, 34 of these articles were included in the final review, all from high-income countries. Twenty-five interventions were implemented across the 34 studies. Findings showed that these interventions were effective at improving a range of mental health, parenting, and family violence outcomes in caregivers with high vulnerability and complex needs. However, weighted mean standardized effect sizes ranged from 0.01–0.24 (small effect), with only one (i.e., practical parenting skills) of the five significantly different from 0 (standardized mean difference 0.24; 95% CI: 0.10, 0.38; z = 3.39, p = 0.00) and results favoring the control group. Missing information together with considerable variation in interventions, meant that identifying a clear pattern in treatment components that lead to effective verses non-effective interventions was not possible. Further research is therefore needed to assess the effectiveness of these interventions. Trial registration: The University of York Centre for Reviews and Dissemination (PROSPERO) registration number CRD42023460366.

Effective photovoltaic module recycling is essential for improving the sustainability of solar technologies and securing the silver supply chain. One method of recycling silver from end‐of‐life photovoltaic modules is electrodeposition following nitric acid leaching. This study investigates how nitric acid concentration affects the electrochemistry and recovery of silver in a controlled three‐electrode system. Silver recovery and Faradaic efficiency were found to increase with acid concentration from 0.1 м. Maximum values of 97% silver recovery and 96% Faradaic efficiency at 4.0 м nitric acid were observed using a silver working electrode at constant current deposition of −20 mA/cm 2 . Past this point, both recovery and efficiency were observed to decline sharply due to enhanced silver dissolution kinetics. It was also found at low nitric acid concentrations (<2.0 м) silver oxynitrate formed as a solid deposit at the counter electrode, while at higher concentrations (>2.0 м) silver (II) complexes formed but remained dissolved in the electrolyte. Industrially, a nitric acid concentration in the range of 2.0–4.0 м is recommended to optimize silver recovery and efficiency while minimizing anode fouling in a full cell arrangement.

BackgroundCefazolin elastomeric infusers are commonly used in outpatient settings with peripherally inserted central catheters (PICCs) or mid-line catheters to treat various infections. However, data on the safety of cefazolin elastomeric infusers administered via a peripheral IV catheter (PIVC) are limited.ObjectivesTo assess the safety and complications of outpatient cefazolin elastomeric infusers via PIVC.MethodsA retrospective case series study was conducted, reviewing patients treated with cefazolin elastomeric infuser via PIVC between January 2018 and December 2022 in our institution. The primary outcomes assessed were PIVC-related complications using visual infusion phlebitis (VIP) score, including catheter-related bacteraemia and readmissions within 30 days.ResultsA total of 415 patients aged ≥18 years were treated with cefazolin elastomeric infuser through PIVC during the 5 year study period. On average, each patient required two PIVCs during outpatient treatment, amounting to 870 PIVCs in total. Of these, 85% (n = 352) of patients received cefazolin 6 g daily. The majority were treated for cellulitis (83%) with a median duration of 5 days. No complications (VIP score = 0) were observed in 88.3% (n = 768) of catheters. The incidence of VIP scores of 1, 2 and ≥3 was 8.9% (n = 37), 4.1% (n = 17) and 0% (n = 0), respectively. There were no statistically significant differences in age, sex, comorbidity or diagnosis between participants with a VIP score of 0 and those with a VIP score of ≥1. The incidence of complications including catheter leakage, blockage and dislodgement was low (2.3%, 1.6% and 2%, respectively).ConclusionsOutpatient cefazolin elastomeric infusers administered via PIVC were well tolerated and safe.

Abstract The models used to analyse conspiracy theory have often been individualistic; conspiracy theorists have been seen to embody either faulty epistemology (believing things neither true nor justified) or to suffer from psychopathology. In this article, I will argue that the conception of the (disordered) mind common to both is inadequate to the task, and instead that conspiracy theory is better conceived along lines supplied by what colleagues and I call “distributed intelligence”—the way in which human judgement circulates through various technologically mediated networks, subject to forms of contagion and reinforcement. At stake ultimately is not simply a set of epistemic issues, but a consideration of the ways in which certain forms and distributions of judgement entail ethical and political costs, ones which we need to be mindful of if we are to see conspiracy theory in terms more adequate to the phenomenon itself.

BackgroundThe routine use of sedation and analgesia during post-cardiac arrest care and its association with clinical outcomes remain unclear. This study aimed to describe the use of sedatives and analgesics in post-cardiac arrest care, and evaluate associations with good functional outcome, survival, clinical seizures, and late awakening.MethodsThis was a post hoc analysis of the TTM2-trial, which randomized 1900 out-of-hospital cardiac arrest patients to either normothermia or hypothermia. In both groups, deep sedation (Richmond Agitation and Sedation Scale ≤ -4) was mandatory during the 40-h intervention. Cumulative doses of sedatives and analgesic drugs were recorded within the first 72 h from randomization. Outcomes were functional outcome (modified Rankin Scale) and survival status at 6 months, occurrence of clinical seizures during the intensive care stay, and late awakening (Full outline of unresponsiveness motor score of four 96 h after randomization). Cumulative propofol doses were divided into quartiles (Q1-Q4). Logistic regression models were used to assess associations between sedative doses and functional outcome and survival, clinical seizures, and late awakening, adjusting for the severity of illness and other clinical factors influencing sedation.ResultsA total of 1861 patients were analyzed. In a multivariable logistic regression model, higher propofol doses (Q3, 100.7–153.6 mg/kg) were associated with good functional outcome (OR 1.62, 95%CI 1.12—2.34) and (Q2 and Q3, 43.9–153.6 mg/kg) with survival (OR 1.49, 95%CI 1.05—2.12 and OR 1.84, 95%CI 1.27—2.65, respectively). Receiving fentanyl and remifentanil were associated with good functional outcome (OR 1.69, 95%CI 1.27—2.26 and OR 1.50, 95%CI 1.11—2.02) and survival (OR 1.80, 95%CI 1.35—2.40 and OR 1.56, 95%CI 1.16—2.10). Receiving fentanyl (OR 0.64, 95%CI 0.48—0.86) and higher propofol doses (Q2-4 (43.9–669.4 mg/kg) were associated with the occurrence of clinical seizures. The highest quartile of propofol dose (153.7–669.4 mg/kg, OR 3.19, 95%CI 1.91—5.42) was associated with late awakening.ConclusionsIn this study, higher doses of propofol and the use of remifentanil and fentanyl were associated with good functional outcome and survival, occurrence of clinical seizures, and late awakening.

PurposeSacral neuromodulation (SNM) is an established treatment for faecal incontinence. This study analyses patient experience with SNM beyond quality of life and incontinence scores to better understand patient expectations and improve patient selection.MethodsPatients receiving SNM for faecal incontinence at three Australian sites from 2013 to 2023 were subject to cohort analysis. St. Mark’s Incontinence Score (SMIS) and Rapid Assessment of Faecal Incontinence Score (RAFIS) assessed incontinence and quality of life. Thematic analysis of structured interviews qualitatively assessed patient experience.ResultsSeventy-one patients aged 52–86 years (M = 69) experienced SNM and 56 agreed to interview at median 6-year post-procedure. Forty-five (63%) proceeded to permanent SNM and progression was not influenced by age, sex, culture, insurance status or presence of anal sphincter defect. Thirty-nine (87%) retained their neuromodulator with battery life M = 6.5 years, 95% CI [5.2, 7.8]. Permanent SNM improved incontinence (P < 0.01) and quality of life (P < 0.01). Forty-eight (86%) patients desired 30-min education pre- and post-procedure. Thirty-seven (86%) desired follow-ups at 1 month, 12 months and at battery depletion. Twenty (36%) had initial reservations which resolved in all but one patient. Twenty-one (54%) remained dependent on others for neuromodulator customisation and this dependence increased with age (P = 0.02). Fifty (89%) recommend SNM to others, despite 8 (14%) regretting their personal experience.ConclusionSNM continues to improve faecal incontinence and quality of life. Initial reservations usually resolve and most patients recommend it to others. While adequate patient education and follow-up is not onerous to achieve, most patients remain dependent for neuromodulator customisation.