David Staples

Impact of Compliance with a Care Bundle on Acute Kidney Injury Outcomes: A Prospective Observational Study.

Background A recent report has highlighted suboptimal standards of care for acute kidney injury (AKI) patients in England. The objective of this study was to ascertain if improvement in basic standard of care by implementing a care bundle (CB) with interruptive alert improved outcomes in patients with AKI. Methods An AKI CB linked to electronic recognition of AKI, coupled with an interruptive alert, was introduced to improve basic care delivered to patients with AKI. Outcomes were compared in patients who had the CB completed within 24 hours (early CB group) versus those who didn’t have the CB completed or had it completed after 24 hours. Results In the 11-month period, 2297 patients had 2500 AKI episodes, with 1209 and 1291 episodes occurring before and after implementation of the AKI CB with interruptive alert, respectively. The CB was completed within 24 hours in 306 (12.2%) of AKI episodes. In-hospital case-fatality was significantly lower in the early CB group (18% versus 23.1%, p 0.046). Progression to higher AKI stages was lower in the early CB group (3.9% vs. 8.1%, p 0.01). In multivariate analysis, patients in the early CB group had lower odds of death at discharge (0.641; 95% CI 0.46, 0.891), 30 days (0.707; 95% CI 0.527, 0.950), 60 days (0.704; 95% CI 0.526, 0.941) and after a median of 134 days (0.771; 95% CI 0.62, 0.958). Conclusions Compliance with AKI CB was associated with a decrease in case-fatality and reduced progression to higher AKI stage. Further interventions are required to improve utilization of the CB.

Strong depth-related zonation of megabenthos on a rocky continental margin (∼700-4000 m) off southern Tasmania, Australia.

Assemblages of megabenthos are structured in seven depth-related zones between ∼700 and 4000 m on the rocky and topographically complex continental margin south of Tasmania, southeastern Australia. These patterns emerge from analysis of imagery and specimen collections taken from a suite of surveys using photographic and in situ sampling by epibenthic sleds, towed video cameras, an autonomous underwater vehicle and a remotely operated vehicle (ROV). Seamount peaks in shallow zones had relatively low biomass and low diversity assemblages, which may be in part natural and in part due to effects of bottom trawl fishing. Species richness was highest at intermediate depths (1000–1300 m) as a result of an extensive coral reef community based on the bioherm-forming scleractinian Solenosmilia variabilis. However, megabenthos abundance peaked in a deeper, low diversity assemblage at 2000–2500 m. The S. variabilis reef and the deep biomass zone were separated by an extensive dead, sub-fossil S. variabilis reef and a relatively low biomass stratum on volcanic rock roughly coincident with the oxygen minimum layer. Below 2400 m, megabenthos was increasingly sparse, though punctuated by occasional small pockets of relatively high diversity and biomass. Nonetheless, megabenthic organisms were observed in the vast majority of photographs on all seabed habitats and to the maximum depths observed - a sandy plain below 3950 m. Taxonomic studies in progress suggest that the observed depth zonation is based in part on changing species mixes with depth, but also an underlying commonality to much of the seamount and rocky substrate biota across all depths. Although the mechanisms supporting the extraordinarily high biomass in 2000–2500 m depths remains obscure, plausible explanations include equatorwards lateral transport of polar production and/or a response to depth-stratified oxygen availability.

A revision of the callipallenid genus Pseudopallene Wilson, 1878 (Pycnogonida, Callipallenidae)

Analysis of three northern hemisphere Boreal-Arctic species of Pseudopallene has shown that those species are morphologically distinguishable from their congeners in Australian waters. The holotypes of Australian species Pseudopallene laevis, Pseudopallene ambigua and Pseudopallene harrisi are compared with each other and with additional material from southern Australia. Sixteen species of Pseudopallene are assigned to a new genus Meridionale. Meridionale dubia is assigned to species inquirenda. The genus Cordylochele Sars, 1888 is resurrected. A diagnosis of each genus is provided along with additional figures. A brief summary of the systematic position of Pseudopallene up to the present time is provided. Three species are temporarily assigned to species incertae sedis pending further review.

A reassessment of the pycnogonid genus Cheilopallene (Arthropoda, Callipallenidae) with description of a new species from Papua New Guinea

The genus Cheilopallene is reviewed. Three species are assigned to species incertae sedis pending further analysis. Specimens from Lizard Island, Queensland, previously identified as C. nodulosa are reassigned to C. brevichela. Suspected sexual dimorphism represented by the presence of a chelifore scape node in female C. nodulosa is supported by the finding of the same dimorphism in C. brevichela and in a new species from Milne Bay, Papua New Guinea. It is likely that the presence of a chelifore scape node is a diagnostic character of all females in the genus Cheilopallene. An amended diagnosis is provided.