There is no health without Cultural Safety: why Cultural Safety matters.

Background: Nurses and midwives predominately work in western-centric health care settings, which may not align with Indigenous perspectives of health and wellbeing. Nurses and midwives will also view care through their own cultural lens. Culturally inappropriate health care can reduce access and engagement in services and contribute to reduced health outcomes for Indigenous peoples. Australian codes of conduct for nurses and midwives now advocate for care that is holistic, free of bias and racism, challenges beliefs based on assumption, and is culturally safe for Indigenous peoples. However, there are varying understandings of cultural care, what it looks like, and how to best achieve it.Aim: To highlight the importance of cultural safety in health care and discuss the integration into nursing and midwifery practice.Design: Discussion paper.Discussion: Cultural safety has emerged in Australia as the framework to improve the access and quality of health care for Indigenous people and to improve disparities in health care outcomes. However, the application of these principles for nurses and midwives has not been widely explored. Misconceptions around the concept remain despite the inclusion in national standards and practice frameworks.Conclusion: Evaluation and research that contributes to evidence-based knowledge specifically on the integration of cultural safety in nursing and midwifery practice is required.Impact Statement: This paper provides an overview of the importance of cultural safety in nursing and midwifery practice. Although cultural safety is now embedded in professional codes and standards, there is limited evidence of how this is translated to clinical care. Research and evaluation are needed to evaluate the application of cultural safety principles by nurses and midwives.

Reporting radiographer peer review systems: A cross-sectional survey of London NHS Trusts.

INTRODUCTION: Peer review is frequently incorporated within radiographer reporting services. The aim of this study is to establish peer review systems used for radiograph reports provided by reporting radiographers in London. METHODS: An online cross-sectional survey of NHS diagnostic imaging departments was performed. Reporting radiographer demographics (number, frequency of reporting, scope of practice) and systems used to provide peer review of radiograph reports (review frequency, case selection, volume, outcome measure, practitioner performing the review) were collected. RESULTS: Thirteen eligible responses were received (61.9% response rate). Variability was found between Trusts in the number of reporting radiographers, frequency of reporting sessions and scope of practice. Most Trusts (9 of 13, 69.2%) have active peer review systems for radiographer reporting. All peer review systems use random case selection, most often performed on a monthly basis. Both a fixed number or a percentage of cases reported were used, with true positive, true negative, false positive, false negative the most frequent outcome measure. Of the 12 Trusts that have or are planning a peer system, all currently or plan to use reporting radiographers to conduct the review, with five (41.2%) also using consultant radiologists. CONCLUSION: Peer review of radiographer reporting is common in London NHS Trusts although there is variation in the methods used. IMPLICATIONS FOR PRACTICE: Radiographer reports frequently undergo peer review. Standardisation of reporting radiographer peer review systems should be considered, and a standardised systematic peer review system has been proposed.

Clinical reporting of radiographs by radiographers: Policy and practice guidance for regional imaging networks.

OBJECTIVES: Radiographer reporting is an essential component of imaging across the United Kingdom. Since the previous policy and practice guidance in 2004 the role and contribution of reporting radiographers has changed significantly. The move to imaging networks further reinforces the need for consistency in scope of practice and clinical governance for radiographer reporting. KEY FINDINGS: This guidance provides a consistent, evidence-based template for planning a reporting service, resourcing, clinical governance, preceptorship, volume and frequency of reporting, a peer learning framework and expected standards. CONCLUSION: Developed for North Central and East London, this framework and standards will help reduce unwarranted variation. IMPLICATIONS FOR PRACTICE: Consistency in practice could help maximise the contribution of radiographer reporting.

Temporal trends and sources of variation in carbon flux from coarse woody debris in experimental forest canopy openings.

Pulses of respiration from coarse woody debris (CWD) have been observed immediately following canopy disturbances, but it is unclear how long these pulses are sustained. Several factors are known to influence carbon flux rates from CWD, but few studies have evaluated more than temperature and moisture. We experimentally manipulated forest structure in a second-growth northern hardwood forest and measured CO2 flux periodically for seven growing seasons following gap creation. We present an analysis of which factors, including the composition of the wood-decay fungal community influence CO2 flux. CO2 flux from CWD was strongly and positively related to wood temperature and varied significantly between substrate types (logs vs. stumps). For five growing seasons after treatment, the CO2 flux of stumps reached rates up to seven times higher than that of logs. CO2 flux of logs did not differ significantly between canopy-gap and closed-canopy conditions in the fourth through seventh post-treatment growing seasons. By the seventh season, the seasonal carbon flux of both logs and stumps had decreased significantly from prior years. Linear mixed models indicated the variation in the wood inhabiting fungal community composition explained a significant portion of variability in the CO2 flux along with measures of substrate conditions. CO2 flux rates were inversely related to fungal diversity, with logs hosting more species but emitting less CO2 than stumps. Overall, our results suggest that the current treatment of CWD in dynamic forest carbon models may be oversimplified, thereby hampering our ability to predict realistic carbon fluxes associated with wood decomposition.

Enhanced recovery after surgery program for elective abdominal surgery at three Victorian hospitals.

The aim of this study was to evaluate the anaesthesia care of an enhanced recovery after surgery (ERAS) program for patients having abdominal surgical in Victorian hospitals. The main outcome measure was the number of ERAS items implemented following introduction of the ERAS program. Secondary endpoints included process of care measures, outcomes and hospital stay. We used a before-and-after design; the control group was a prospective cohort (n=154) representing pre-existing practice for elective abdominal surgical patients from July 2009. The introduction of a comprehensive ERAS program took place over two months and included the education of surgeons, anaesthetists, nurses and allied health professionals. A post-implementation cohort (n=169) was enrolled in early 2010. From a total of 14 ERAS-recommended items, there were significantly more implemented in the post-ERAS period, median 8 (interquartile range 7 to 9) vs 9 (8 to 10), P <0.0001. There were, however, persistent low rates of intravenous fluid restriction (25%) and early removal of urinary catheter (31%) in the post-ERAS period. ERAS patients had less pain and faster recovery parameters, and this was associated with a reduced hospital stay, geometric mean (SD) 5.7 (2.5) vs 7.4 (2.1) days, P=0.006. We found that perioperative anaesthesia practices can be readily modified to incorporate an enhanced recovery program in Victorian hospitals.

Hypertrophic feline muscular dystrophy: diagnostic overview and a novel immunohistochemical diagnostic method using formalin-fixed tissue.

This paper describes a case of hypertrophic feline muscular dystrophy (HFMD) in the UK. The cat under investigation died unexpectedly following routine vaccination, and postmortem investigation revealed myopathy, particularly affecting the diaphragm as well as multiple skeletal muscles. The right lung lobes were also partially collapsed and this was considered secondary to the effect of the muscular dystrophy. Pathological and immunohistochemical findings are described, macroscopic and microscopic findings are compared with other recorded cases in the literature and a diagnostic overview of HFMD is given. Possible causes of death are also discussed and a novel immunohistochemical method of demonstrating dystrophin deficiency using formalin-fixed tissue is described.

Immunohistochemical localization of vascular endothelial growth factor (VEGF) and its two receptors (Flt-I and KDR) in the endometrium and placenta of the mare during the oestrous cycle and pregnancy.

Polyclonal antisera for vascular endothelial growth factor (VEGF) and its two main receptor molecules, VEGF-I (Flt) and VEGF-II (KDR), were used in a conventional immunocytochemical staining method to localize these angiogenic ligand molecules in the endometrium and placenta of the mare during the oestrous cycle and pregnancy. The anti-VEGF and anti-Flt sera both labelled the lumenal and glandular epithelia of the endometrium throughout the oestrous cycle and both the invasive trophoblast cells of the endometrial cups and the non-invasive trophoblast of the allantochorion in pregnancy. The anti-KDR serum likewise stained the maternal and foetal epithelial layers during the oestrous cycle and pregnancy and it also labelled fibroblast-like cells in the endometrial and allantoic stromas and the endothelium of foetal and maternal capillaries. The results demonstrated that constant supplies of the principal vasculogenic and angiogenic factor, VEGF, and its two major receptors, Flt and KDR, are available on both the maternal and foetal sides of the placental barrier throughout gestation in the mare. They are presumed to facilitate the continuing development of the extensive foetal and maternal capillary networks that are such prominent features within the microplacentomes of the diffuse, epitheliochorial equine placenta.

A comparison of patient self-administered and investigator-administered measurement of quality of recovery using the QoR-40.

A 40-item questionnaire (the QoR-40) had been previously developed to measure five dimensions of quality of recovery after anaesthesia and surgery. Each of the 40 items is rated on a scale of 1 to 5, with a maximum score of 200. In this study we compared patient self-administered with investigator-administered QoR-40. We studied 62 postoperative patients within 48 hours of their surgery. Agreement between the two methods was analysed using the intraclass correlation coefficient, bias and limits of agreement. There was strong correlation between the investigator-administered and patient self-administered QoR-40 scores, intraclass correlation coefficient 0.86 (95% CI: 0.77 to 0.92), P<0.001. The bias and limits of agreement were 3.1 and -22 to 28, respectively. There were 10 (16%) patient self-administered questionnaires that were not completed at first attempt. The time to complete the questionnaire when investigator-administered was 253 (16) s [mean, (SD)], and on first attempt for patients was 362 (19) s, P<0.001. The QoR-40 is as valid measure of postoperative recovery when administered with the assistance of an investigator as compared with the patient self-administered version. Investigator-administered measurement of the QoR-40 is a more efficient use of resources, as complete and more timely data are collected.

Detection of EHV-1 and EHV-4 in placental sections of naturally occurring EHV-1- and EHV-4-related abortions in the UK: use of the placenta in diagnosis.

REASONS FOR PERFORMING STUDY: EHV-1 and EHV-4 abortion diagnosis is based upon detailed examination of the aborted fetus. However, in some cases, only the placenta is available for examination. Furthermore, the contribution of lesions in the placenta to pathogenesis and diagnosis of EHV-1 and EHV-4 abortion has been neglected. OBJECTIVES: To assess the utility of placental examination in equine herpesvirus-1 (EHV-1) and EHV-4 abortion diagnosis. METHODS: Sections of allantochorion from 49 herpesvirus abortions were analysed by PCR, in situ hybridisation and immunostaining. RESULTS: Virus-specific nested PCR confirmed the presence of viral DNA in 46 cases; 41 cases were EHV-1-positive and 5 EHV-4-positive. Microscopic changes were nonspecific. Examination of the PCR-positive sections of allantochorion revealed EHV-1 DNA by in situ hybridisation (ISH) in 21 cases and EHV-4 in 4 cases. In 2 samples, DNA of both viruses was present on PCR and ISH. Viral antigen was found by immunohistology in 15 cases. Regarding the localisation of virus in the placentae, both viral DNA and antigen of EHV-1 and EHV-4 were found in endothelial cells of chorionic villi and, occasionally, in trophoblast epithelium. In the stromal endothelium, only EHV-1 was found. CONCLUSIONS: The data indicate that examination of placentae is a useful diagnostic aid in EHV-1 and EHV-4 abortion diagnosis. POTENTIAL RELEVANCE: Virological examination of the placenta should become standard practice in equine abortion investigations, particularly in those cases where the fetus is not available for examination.

Leaf area dynamics of a boreal black spruce fire chronosequence.

Specific leaf area (SLA) and leaf area index (LAI) were estimated using site-specific allometric equations for a boreal black spruce (Picea mariana (Mill.) BSP) fire chronosequence in northern Manitoba, Canada. Stands ranged from 3 to 131 years in age and had soils that were categorized as well or poorly drained. The goals of the study were to: (i) measure SLA for the dominant tree and understory species of boreal black spruce-dominated stands, and examine the effect of various biophysical conditions on SLA; and (ii) examine leaf area dynamics of both understory and overstory for well- and poorly drained stands in the chronosequence. Overall, average SLA values for black spruce (n = 215), jack pine (Pinus banksiana Lamb., n = 72) and trembling aspen (Populus tremuloides Michx., n = 27) were 5.82 +/- 1.91, 5.76 +/- 1.91 and 17.42 +/- 2.21 m2 x kg-1, respectively. Foliage age, stand age, vertical position in the canopy and soil drainage had significant effects on SLA. Black spruce dominated overstory LAI in the older stands. Well-drained stands had significantly higher overstory LAI (P < 0.001), but lower understory LAI (P = 0.022), than poorly drained stands. Overstory LAI was negligible in the recent (3-12 years old) burn sites and highest in the 70-year-old burn site (6.8 and 3.0 in the well- and poorly drained stands, respectively), declining significantly (by 30-50%) from this peak in the oldest stands. Understory leaf area represented a significant portion (> 40%) of total leaf area in all stands except the oldest.

Photosynthesis and light-use efficiency by plants in a Canadian boreal forest ecosystem.

Measurements of the photosynthetic response to midsummer irradiance were made for 11 species representing the dominant trees, understory shrubs, herbaceous plants and moss species in an old black spruce (Picea mariana (Mill.) B.S.P.) boreal forest ecosystem. Maximum rates of photosynthesis per unit foliage area at saturating irradiance, A(max), were highest for aspen (Populus tremuloides Michx.), reaching 16 micromol m(-2) s(-1). For tamarack (Larix laricina (Du Roi) K. Kock) and P. mariana, Amax was only 2.6 and 1.8 micromol m(-2) s(-1), respectively. Values of A(max) for understory shrubs and herbaceous plants were clustered between 9 and 11 micromol m(-2) s(-1), whereas A(max) of feather moss (Pleurozium schreberi (Brid.) Mitt.) reached only 1.9 micromol m(-2) s(-1). No corrections were made for differences in shoot structure, but values of photosynthetic light-use efficiency were similar for most species (70-80 mmol CO2 mol(-1)); however, they were much lower for L. laricina and P. mariana (15 mmol CO2 mol(-1)) and much higher for P. schreberi (102 m;mol CO2 mol(-1)). There was a linear relationship between Amax and foliage nitrogen concentration on an area basis for the broad-leaved species in the canopy and understory, but the data for P. mariana, L. laricina and P. schreberi fell well below this line. We conclude that it is not possible to scale photosynthesis from leaves to the canopy in this ecosystem based on a single relationship between photosynthetic rate and foliage nitrogen concentration.

Nitrogen and carbon leaching in agroecosystems and their role in denitrification potential.

The drainage of water and leaching of dissolved constituents represent major components of agroecosystem mass budgets that have been exceedingly difficult to measure. Equilibrium-tension lysimeters (ETLs) were used to monitor drainage, nitrogen (N), and carbon (C) leaching through Plano silt loam (fine-silty, mixed, superactive, mesic Typic Argiudoll) for a 4-yr period in a restored prairie and N-fertilized no-tillage and chisel-plowed maize (Zea mays L.) agroecosystems. Mean drainage recorded during 4 yr for the prairie, no-tillage, and chisel-plowed ecosystems totaled 461, 1,116, and 1,575 mm and represented 16, 33, and 47% of precipitation plus melting of drifted snow received, respectively. Total inorganic N leaching losses during the 4-yr period for the prairie, no-tillage, and chisel-plowed ecosystems were 0.6, 201, and 179 kg N ha(-1), respectively. Inorganic N leaching represented 26 and 24% of applied fertilizer N additions to the no-tillage and chisel-plowed agroecosystems. Total dissolved C leaching losses were 119, 435, and 502 kg C ha(-1) for the prairie, no-tillage, and chisel-plowed ecosystems, respectively. Sufficient dissolved organic carbon (DOC) and nitrate N (NO3- -N) existed in the prairie and agroecosystems to support subsoil denitrification. Potential denitrification, however, was limited by insufficient lengths of saturated soil conditions in all three ecosystems, the supply of DOC in the agroecosystems, and the supply of nitrate N in the prairie. Based on available DOC and nitrate N, the maximum contribution of denitrification below the root zone in the agroecosystems was less than 25% of the total amount of leached nitrate N and the probable contribution of denitrification was much less.

Molecular cytogenetic analysis of a novel high-grade canine T-lymphoblastic lymphoma demonstrating co-expression of CD3 and CD79a cell markers.

We present the molecular cytogenetic analysis of a novel case of canine lymphoma, in a nine-year-old entire male collie cross retriever dog that presented with an enlarged prescapular lymph node. A diagnosis of high-grade lymphoblastic lymphoma was made by histological evaluation of fixed lymph node biopsy sections, whilst immunohistochemical analyses demonstrated co-expression of B- and T-cell antigens (CD79a and CD3) by 95% of lymphomatous cells. Comparative genomic hybridisation (CGH) analysis detected loss of dog chromosomes 11, 30 and 38 and gain of chromosome 36 within the lymphoma biopsy specimen. These findings correlated with direct cytogenetic analysis of tumour metaphases using whole chromosome paint probes representing each of these four chromosomes. This study represents the first report of the combined application of both direct and indirect cytogenetic techniques for the analysis of recurrent chromosome aberrations in canine cancer.

The role of fire in the boreal carbon budget.

To reconcile observations of decomposition rates, carbon inventories, and net primary production (NPP), we estimated long-term averages for C exchange in boreal forests near Thompson, Manitoba. Soil drainage as defined by water table, moss cover, and permafrost dynamics, is the dominant control on direct fire emissions. In upland forests, an average of about 10-30% of annual NPP was likely consumed by fire over the past 6500 years since these landforms and ecosystems were established. This long-term, average fire emission is much larger than has been accounted for in global C cycle models and may forecast an increase in fire activity for this region. While over decadal to century times these boreal forests may be acting as slight net sinks for C from the atmosphere to land, periods of drought and severe fire activity may result in net sources of C from these systems.

Does hypothermia prevent cerebral ischaemia during cardiopulmonary bypass?

It is believed that moderate hypothermia (25-32 degrees C) during cardiopulmonary bypass provides cerebral protection by reducing the cerebral metabolic rate (CMRO2). Nevertheless episodes of ischaemia do occur and thus it has been suggested that cerebral oxygenation should be monitored by jugular venous oximetry. However, this technique is cumbersome and invasive. Near infrared spectroscopy (NIRS) provides a non-invasive assessment of cerebral oxygenation and this was used together with continuousjugular venous oximetry in 21 patients undergoing hypothermic cardiopulmonary bypass. During the hypothermic period, jugular venous oximetry indicated reduced oxygen extraction consistent with a reduction in CMRO2 (increase from 61 +/- 2.5% to 74 +/- 2.5%). In contrast, near infrared spectroscopy demonstrated increased oxygen extraction (HbO2 - 11.5 +/- 1 microM, HHb + 3.2 +/- 0.3 microM) and a fall in the cerebral concentration of oxidized cytochrome oxidase ( - 1.7 +/- 0.3 microM) indicating ischaemia. These results suggest that cerebral ischaemia occurs during hypothermic cardiopulmonary bypass with a spurious rise in jugular venous oxygen saturation, which represents arterio-venous shunting. Thus if hypothermia does facilitate cerebral protection it does not appear to be a direct result of a reduction in CMRO2 and oxygen requirement.

A histological and immunohistochemical study of the humoral immune system of the lungs in young Thoroughbred horses.

Lungs were obtained from 16 Thoroughbred horses, aged 1 day to 2 years, which had died or been humanely killed for reasons unrelated to disease of the lower respiratory tract. The lungs were then subjected to a histological and immunohistochemical examination of the humoral immune system. At birth there was no evidence of organized lymphoid tissue, and lymphocytes and plasma cells were virtually absent in all tissue compartments in the first week of life. However, by 12 weeks, foals exhibited well developed bronchus- and bronchiole-associated lymphoid tissue, but this had regressed progressively at 1 and 2 years of age. Plasma cells were present in large numbers in the walls of bronchi and bronchioles in foals aged 8 to 12 weeks. IgA-producing plasma cells were common in the lower respiratory tract of these young horses, in addition to IgG- and IgM-producing plasma cells.

Aboveground net primary production decline with stand age: potential causes.

Aboveground net primary production (ANPP) commonly reaches a maximum in young forest stands and decreases by 0-76% as stands mature. However, the mechanism(s) responsible for the decline are not well understood. Current hypotheses for declining ANPP with stand age include: (1) an altered balance between photosynthetic and respiring tissues, (2) decreasing soil nutrient availability, and (3) increasing stomatal limitation leading to reduced photosynthetic rates. Recent empirical and modeling studies reveal that mechanisms (2) and (3) are largely responsible for age-related decline in ANPP for forests in cold environments. Increasing respiratory costs appear to be relatively unimportant in explaining declining productivity in ageing stands.

Belowground carbon allocation in unfertilized and fertilized red pine plantations in northern Wisconsin.

We estimated carbon allocation to belowground processes in unfertilized and fertilized red pine (Pinus resinosa Ait.) plantations in northern Wisconsin to determine how soil fertility affects belowground allocation patterns. We used soil CO(2) efflux and litterfall measurements to estimate total belowground carbon allocation (root production and root respiration) by the carbon balance method, established root-free trenched plots to examine treatment effects on microbial respiration, estimated fine root production by sequential coring, and developed allometric equations to estimate coarse root production. Fine root production ranged from 150 to 284 g m(-2) year(-1) and was significantly lower for fertilized plots than for unfertilized plots. Coarse root production ranged from 60 to 90 g m(-2) year(-1) and was significantly lower for fertilized plots than for unfertilized plots. Annual soil CO(2) fluxes ranged from 331 to 541 g C m(-2) year(-1) and were significantly lower for fertilized plots than for unfertilized plots. Annual foliage litterfall ranged from 110 to 187 g C m(-2) year(-1) and was significantly greater for fertilized plots than for unfertilized plots. Total belowground carbon allocation ranged from 188 to 395 g C m(-2) year(-1) and was significantly lower for fertilized than for unfertilized plots. Annual soil CO(2) flux was lower for trenched plots than for untrenched plots but did not differ between fertilized and unfertilized trenched plots. Collectively, these independent estimates suggest that fertilization decreased the relative allocation of carbon belowground.