Referral for investigation: a redundant SNOMED-CT chief presenting complaint.

AIM: The Ministry of Health has mandated that all emergency department (ED) presentations are coded using the Systematised Nomenclature of Medicine - Clinical Terms (SNOMED-CT) from 2021. The current ED reference set contains the non-specific term 'Referral for investigation' in the list of available chief presenting complaints (CPCs). The aim of this study was to determine the rate of use of this term and how often a more specific (and therefore more clinically useful) term was used. METHOD: This was a cross-sectional audit of routinely collected presenting complaint data, supplemented by a retrospective case note review. RESULTS: 'Referral for investigation' was used for 497/9,067 (5.5%, 95%CI 5-6%) presentations, with increased use for urgent cases. An alternative CPC was available in 467/497 (94.0%, 95%CI 92-96%) of cases from the existing reference set. Of 98 different CPCs, the common alternatives were: 'Chest pain' (6.4%), 'Shortness of breath' (4.2%) 'Abdominal pain' (3.6%), 'Altered mental status' (3.4%) and 'Postoperative complication' (3.2%). Six of 13 cardiac arrests and eight of 63 of multiple trauma cases were coded as 'Referral for investigation'. With the addition of two new terms to the New Zealand reference set ('Abnormal blood test' and 'Radiology request'), each of the remaining 30 presentations would have an alternative and more accurate CPC. CONCLUSION: 'Referral for investigation' should be removed from the New Zealand emergency department reference set for chief presenting complaints to improve data quality.

Alterations in the Rumen Liquid-, Particle- and Epithelium-Associated Microbiota of Dairy Cows during the Transition from a Silage- and Concentrate-Based Ration to Pasture in Spring.

In spring dairy cows are often gradually transitioned from a silage- and concentrate-based ration (total mixed ration, TMR) to pasture. Rumen microbiota adaptability is a key feature of ruminant survival strategy. However, only little is known on the temporal and spatial microbial alterations involved. This study aims to investigate how the rumen liquid (LAAB), particle (PAAB), and epithelium (EAAB) associated archaea and bacteria are influenced by this nutritional change. A 10-wk trial was performed, including 10 rumen-fistulated dairy cows, equally divided into a pasture- and a confinement- group (PG and CG). The CG stayed on a TMR-based ration, while the PG was gradually transitioned from TMR to pasture (wk 1: TMR-only, wk 2: 3 h/day on pasture, wk 3 & 4: 12 h/day on pasture, wk 5-10: pasture-only). In wk 1, wk 5, and wk 10 samples of solid and liquid rumen contents, and papillae biopsies were collected. The DNA was isolated, and PCR-SSCP and 16S rRNA gene amplicon sequencing analysis were performed. Cluster analysis revealed a higher similarity between LAAB and PAAB, compared to the EAAB, characterized by higher species diversity. At all three locations the microbiota was significantly influenced by the ration change, opposite the generally acknowledged hypothesis that the EAAB remain more consistent throughout dietary changes. Even though the animals in the PG were already on a full-grazing ration for 4-6 days in wk 5, the microbiota at all three locations was significantly different compared to wk 10, suggesting an adaptation period of several days to weeks. This is in line with observations made on animal level, showing a required time for adaptation of 2-3 weeks for production and metabolic variables. A large part of the rumen prokaryote species remained unaltered upon transition to pasture and exhibited a strong host influence, supporting the hypothesis that the rumen microbiota consists of a core and a variable microbiota. For the effect of the location as well as the ration change either very similar or opposite trends among member species of common taxa were observed, demonstrating that microbes that are phylogenetically close may still exhibit substantially different phenotypes and functions.

Impact of the New Zealand 2011 Rugby World Cup on an urban emergency department.

AIMS: The next Rugby World Cup will take place in England commencing August 2015. This paper describes the preparation and workload relating to the previous Rugby World Cup, held in New Zealand 2011, as it affected the primary receiving hospital for the main venue. This paper describes preparation arrangements and actual workload patterns to assist planners with future similar events. METHODS: Preparations for the tournament were summarised, and data gathered from the Auckland City Hospital database were analysed for total and hourly presentation rates, short-stay observation workload, admission rate, 6-hour target compliance and type of presentation. RESULTS: Overall workload during the tournament increased by 8%, but much larger spikes in attendances per hour and short-stay workload related to the major events were experienced. Alcohol-related presentations were very much more prominent than usual. Pre-arranged additional staffing and flow arrangements allowed the department to maintain 6-hour target compliance. CONCLUSION: Major sporting events, such as the Rugby World Cup, require special arrangements to be put in place for the main local receiving Emergency Department, especially around the major events of a tournament.

Possible impacts of the invasive plant Rubus niveus on the native vegetation of the Scalesia forest in the Galapagos islands.

Originally from Asia, Rubus niveus has become one of the most widespread invasive plant species in the Galapagos Islands. It has invaded open vegetation, shrubland and forest alike. It forms dense thickets up to 4 m high, appearing to displace native vegetation, and threaten the integrity of several native communities. This study used correlation analysis between a R. niveus cover gradient and a number of biotic (vascular plant species richness, cover and vegetation structure) and abiotic (light and soil properties) parameters to help understand possible impacts in one of the last remaining fragments of the Scalesia forest in Santa Cruz Island, Galapagos. Higher cover of R. niveus was associated with significantly lower native species richness and cover, and a different forest structure. Results illustrated that 60% R. niveus cover could be considered a threshold for these impacts. We suggest that a maximum of 40% R. niveus cover could be a suitable management target.

Impacts of climate variability and human colonization on the vegetation of the Galápagos Islands.

A high-resolution (2-9 year sampling interval) fossil pollen record from the Galápagos Islands, which spans the last 2690 years, reveals considerable ecosystem stability. Vegetation changes associated with independently derived histories of El Niño Southern Oscillation variability provided evidence of shifts in the relative abundance of individual species rather than immigration or extinction. Droughts associated with the Medieval Climate Anomaly induced rapid ecological change that was followed by a reversion to the previous state. The paleoecological data suggested nonneutral responses to climatic forcing in this ecosystem prior to the period of human influence. Human impacts on the islands are evident in the record. A marked decline in long-term codominants of the pollen record, Alternanthera and Acalypha, produced a flora without modern analogue before 1930. Intensified animal husbandry after ca. 1930 may have induced the local extinction of Acalypha and Alternanthera. Reductions in populations of grazing animals in the 1970s and 1980s did not result in the return of the native flora, but in invasions by exotic species. After ca. 1970 the trajectory of habitat change accelerated, continuously moving the ecosystem away from the observed range of variability in the previous 2690 years toward a novel ecosystem. The last 40 years of the record also suggest unprecedented transport of lowland pollen to the uplands, consistent with intensified convection and warmer wet seasons.

Nectar traits in Nicotiana section Alatae (Solanaceae) in relation to floral traits, pollinators, and mating system.

Nicotiana section Alatae exhibits great diversity among species in floral morphology, mating system, and predominant pollinators. As a first step towards estimating nectar's role in floral evolution, we studied nectar traits to determine whether they vary in association with predominant pollinators and mating system. Daily phenology determines when nectar becomes available to pollinators and differed between hummingbird- and moth-pollinated species. Nectar volume and concentration varied significantly among most species and pollinator groups, but were inversely correlated, so that total energy was similar among most species. In general, nectar volume was positively correlated with corolla length. The autogamous species, N. plumbaginifolia, had a nectar volume that matched expectations based on corolla length, but with lower concentration and total energy than predicted by corolla length, while nectar volume was lower than predicted by corolla length in the autogamous population of N. longiflora. Sugar and amino acid components (determined through HPLC) were similar among species, although differences did exist. The nectar of most species was sucrose-dominant, but the autogamous N. plumbaginifolia had nectar that contained similar proportions of sucrose, glucose, and fructose. Many nectar traits varied in association with the predominant pollinators and, in some cases, with the mating system.