Managing Motherhood: Strategies Used by New Mothers to Maintain Perceptions of Wellness

The first year or so of motherhood can represent a transitional lifestyle change; however, experiences are not well understood from the mother's own perspective. In a series of interviews, nine mothers related their beliefs and ideas about strategies utilized to maintain a perceived sense of wellness. The mothers used three main strategies: (a) obtaining help, (b) having a plan, and (c) taking time-out. Discovery of a successful strategy lead to a mother feeling greater confidence in the efficacy of her selected method, calmer, and in greater control. In order to achieve a true sense of increasing control over her own health, however, it is recommended a mother prioritize strategies to meet her own personal needs in addition to meeting the needs of others.     

The SMART‐COP score performs well for pneumonia risk stratification in Australia’s Tropical Northern Territory: a prospective cohort study

Objective To prospectively compare a modified pneumonia severity scoring system, SMARTACOP, with other severity scores in patients presenting with pneumonia to the emergency department (ED) of a tertiary referral hospital in tropical Australia. Methods We conducted a prospective observational study of adult patients presenting with radiologically confirmed pneumonia over a 12‐month period. The sensitivity of risk stratification scores were assessed against the need for intensive respiratory or vasopressor support (IRVS). Results There were 367 ED attendances for pneumonia of whom 77.1% were admitted to hospital, 10% required intensive respiratory or vasopressor support and 2.8% died. Mean age was 50.0 years, 52% were men and 59% were Indigenous. The sensitivity of a SMART‐COP score ≥3, a SMARTACOP score ≥3 and a pneumonia severity index (PSI) class ≥3 for predicting IRVS was 97%, 97% and 78% respectively. Conclusions We found no significant advantage of the SMARTACOP over the SMART‐COP score for the prediction of intensive respiratory or vasopressor support, but both scores significantly outperformed PSI. The SMART‐COP score should replace the PSI in tropical Australia and should be assessed in other tropical areas for pneumonia risk stratification in emergency departments.     

Biogeography of Burkholderia pseudomallei in the Torres Strait Islands of Northern Australia

It has been hypothesized that biogeographical boundaries are a feature of Burkholderia pseudomallei ecology, and they impact the epidemiology of melioidosis on a global scale. This study examined the relatedness of B. pseudomallei sourced from islands in the Torres Strait of Northern Australia to determine if the geography of isolated island communities is a determinant of the organisms'' dispersal. Environmental sampling on Badu Island in the Near Western Island cluster recovered a single clone. An additional 32 clinical isolates from the region were sourced. Isolates were characterized using multilocus sequence typing and a multiplex PCR targeting the flagellum gene cluster. Gene cluster analysis determined that 69% of the isolates from the region encoded the ancestral Burkholderia thailandensis-like flagellum and chemotaxis gene cluster, a proportion significantly lower than that reported from mainland Australia and consistent with observations of isolates from southern Papua New Guinea. A goodness-of-fit test indicated that there was geographic localization of sequence types throughout the archipelago, with the exception of Thursday Island, the economic and cultural hub of the region. Sequence types common to mainland Australia and Papua New Guinea were identified. These findings demonstrate for the first time an environmental reservoir for B. pseudomallei in the Torres Strait, and multilocus sequence typing suggests that the organism is not randomly distributed throughout this region and that seawater may provide a barrier to dispersal of the organism. Moreover, these findings support an anthropogenic dispersal hypothesis for the spread of B. pseudomallei throughout this region.     

Magnetic Resonance Imaging Biomarkers in Patients with Progressive Ataxia: Current Status and Future Direction

A diagnostic challenge commonly encountered in neurology is that of an adult patient presenting with ataxia. The differential is vast and clinical assessment alone may not be sufficient due to considerable overlap between different causes of ataxia. Magnetic resonance (MR)-based biomarkers such as voxel-based morphometry, MR spectroscopy, diffusion-weighted and diffusion-tensor imaging and functional MR imaging are gaining great attention for their potential as indicators of disease. A number of studies have reported correlation with clinical severity and underlying pathophysiology, and in some cases, MR imaging has been shown to allow differentiation of conditions causing ataxia. However, despite recent advances, their sensitivity and specificity vary. In addition, questions remain over their validity and reproducibility, especially when applied in routine clinical practice. This article extensively reviews the current literature regarding MR-based biomarkers for the patient with predominantly adult-onset ataxia. Imaging features characteristic of a particular ataxia are provided and features differentiating ataxia groups and subgroups are discussed. Finally, discussion will turn to the feasibility of applying these biomarkers in routine clinical practice.