Objective-To see whether care provided by general practitioners to non-emergency patients in an accident and emergency department differs significantly from care by usual accident and emergency staff in terms ofprocess, outcome, and comparative cost.Design-A randomised controlled trial. Setting-A busy inner city hospital's accident and emergency department which employed three local general practitioners on a sessional basis.Patients-All new attenders categorised by the triage system as "semiurgent" or "delay acceptable." 66% ofall attenders were eligible for inclusion.Main outcome measures-Numbers of patients undergoing investigation, referral, or prescription; types of disposal; consultation satisfaction scores; reattendance to accident and emergency department within 30 days of index visit; health status at one month; comparative cost differences.Results-4684 patients participated. For semiurgent patients, by comparison with usual accident and emergency staff, general practitioners investigated fewer patients (relative difference 20%; 95% confidence interval 16% to 25%), referred to other hospital services less often (39%; 28% to 47%/6), admitted fewer patients (45%; 32% to 56%), and prescribed more often (41%; 30% to 54%/6). A similar trend was found for patients categorised as delay acceptable and (in a separate analysis) by presenting complaint category. 393 (17%) patients who had been seen by general practitioner staff reattended the department within 30 days of the index visit; 418 patients (18%) seen by accident and emergency staff similarly reattended. 435 patients (72% of those eligible) completed the consultation satisfaction questionnaire and 258 (59% of those eligible) provided health status information one month after consultation. There were no differences between patients managed by general practitioners and those managed by usual staff regarding consultation satisfaction questionnaire scores or health status. For all patients seen by general practitioners during the study, estimated marginal and total savings were £Ir1427 and £Ir117 005 respectively.Conclusion-General practitioners working as an integral part of an accident and emergency department manage non-emergency accident and emergency attenders safely and use fewer resources than do usual accident and emergency staff.

We report the unique depiction of brown adipose tissue (BAT) by MRI and computed tomography (CT) in a human three month-old infant. Based on cellular differences between BAT and more lipid-rich white adipose tissue (WAT), chemical-shift MRI and CT were both capable of generating distinct signal contrasts between the two tissues and against surrounding anatomy, utilizing fat-signal fraction metrics in the former and X-ray attenuation values in the latter. While numerous BAT imaging experiments have been performed previously in rodents, the identification of BAT in humans has only recently been described with fusion positron emission and computed tomography in adults. The imaging of BAT in children has not been widely reported and furthermore, MRI of human BAT in general has not been demonstrated. In the present work, large bilateral supraclavicular BAT depots were clearly visualized with MRI and CT. Tissue identity was subsequently confirmed by histology. BAT has important implications in regulating energy metabolism and non-shivering thermogenesis and has the potential to combat the onset of weight gain and the development of obesity. Current findings suggest that BAT is present in significant amounts in children and that MRI and CT can differentiate BAT from WAT based on intrinsic tissue properties.

Objective To characterize the changes in brown adipose tissue (BAT) during puberty in boys and girls. Study design We examined the prevalence and the volume of BAT at different stages of sexual development in pediatric patients who underwent positron emission tomography/computer tomography (PET/CT) studies. Results Of the 73 patients, 43 (59%) had BAT depicted on PET/CT. Visualized BAT was significantly less prevalent in PET/CT studies of pre-pubertal (Tanner stage 1) children than pubertal (Tanner stages 2-5) subjects (15% vs. 75%). Values for the volume of BAT also increased during puberty, but the magnitude of the increase was substantially greater during the final two stages of puberty (Tanner stage 4 or 5) than in earlier stages of sexual development (Tanner stages 1, 2, and 3) (Boys: 499±246 vs. 50±36, p <0.0001, Girls: 286±139 vs. 36±29, p = 0.024). Changes in BAT volume were also significantly greater in boys than in girls (p = 0.004) and were closely related to muscle volume (r’s = 0.52, 0.64 and both p’s<0.01, for boys and girls, respectively). Conclusion The depiction and the volume of brown fat increase during puberty. Metabolic and hormonal events related to the achievement of sexual maturity are likely responsible for the rapid increase in brown fat that occurs during puberty.

These findings imply that the presence of campus smoking policies and claims of "smoke-free" campuses should not be misinterpreted as achievement and without renewed focus and adequate tobacco control infrastructure, it will remain possible for young adults to initiate and maintain tobacco smoking on campus.

Background Strongyloides stercoralis infects human hosts mainly through skin contact with contaminated soil. The result is strongyloidiasis, a parasitic disease, with a unique cycle of auto-infection causing a variety of symptoms and signs, with possible fatality from hyper-infection. Australian Indigenous community members, often living in rural and remote settings, are exposed to and infected with S. stercoralis. The aim of this review is to determine barriers to control of strongyloidiasis. The purpose is to contribute to the development of initiatives for prevention, early detection and effective treatment of strongyloidiasis.Methodology/Principle FindingsSystematic search reviewing research published 2012 and earlier was conducted. Research articles discussing aspects of strongyloidiasis, context of infection and overall health in Indigenous Australians were reviewed. Based on the PRISMA statement, the systematic search of health databases, Academic Search Premier, Informit, Medline, PubMed, AMED, CINAHL, Health Source Nursing and Academic was conducted. Key search terms included strongyloidiasis, Indigenous, Australia, health, and community. 340 articles were retrieved with 16 original research articles published between 1969 and 2006 meeting criteria. Review found barriers to control defined across three key themes, (1) health status, (2) socioeconomic status, and (3) health care literacy and procedures.Conclusions/SignificanceThis study identifies five points of intervention: (1) develop reporting protocols between health care system and communities; (2) test all Indigenous Australian patients, immunocompromised patients and those exposed to areas with S. stercoralis; (3) health professionals require detailed information on strongyloidiasis and potential for exposure to Indigenous Australian people; (4) to establish testing and treatment initiatives within communities; and (5) to measure and report prevalence rates specific to communities and to act with initiatives based on these results. By defining barriers to control of strongyloidiasis in Australian Indigenous people, improved outcomes of prevention, treatment of strongyloidiasis and increased health overall are attainable.

Two material 3D printing is becoming increasingly popular, inexpensive and accessible. In this paper, freely available printable files and dual extrusion fused deposition modelling were combined to create a number of functional anatomical models. To represent muscle and bone FilaFlex flexible filament and polylactic acid (PLA) filament were extruded respectively via a single 0.4 mm nozzle using a Big Builder printer. For each filament, cubes (5 mm ) were printed and analyzed for X, Y, and Z accuracy. The PLA printed cubes resulted in errors averaging just 1.2% across all directions but for FilaFlex printed cubes the errors were statistically significantly greater (average of 3.2%). As an exemplar, a focus was placed on the muscles, bones and cartilage of upper airway and neck. The resulting single prints combined flexible and hard structures. A single print model of the vocal cords was constructed which permitted movement of the arytenoids on the cricoid cartilage and served to illustrate the action of intrinsic laryngeal muscles. As University libraries become increasingly engaged in offering inexpensive 3D printing services it may soon become common place for both student and educator to access websites, download free models or 3D body parts and only pay the costs of print consumables. Novel models can be manufactured as dissectible, functional multi-layered units and offer rich possibilities for sectional and/or reduced anatomy. This approach can liberate the anatomist from constraints of inflexible hard models or plastinated specimens and engage in the design of class specific models of the future. Anat Sci Educ 11: 65-72. © 2017 American Association of Anatomists.

In Canada, cultural safety (CS) is emerging as a theoretical and practice lens to orient health care services to meet the needs of Aboriginal people. Evidence suggests Aboriginal peoples' encounters with health care are commonly negative, and there is concern that these experiences can contribute to further adverse health outcomes. In this article, we report findings based on participatory action research drawing on Indigenous methods. Our project goal was to interrogate practices within one hospital to see whether and how CS for Aboriginal patients could be improved. Interviews with Aboriginal patients who had accessed hospital services were conducted, and responses were collated into narrative summaries. Using interlocking analysis, findings revealed a number of processes operating to produce adverse health outcomes. One significant outcome is the production of structural violence that reproduces experiences of institutional trauma. Positive culturally safe experiences, although less frequently reported, were described as interpersonal interactions with feelings visibility and therefore, treatment as a "human being."

The activation of BAT in pediatric patients undergoing treatment of malignancy is associated with significantly less adipose accumulation. This trial was registered at clinicaltrials.gov as NCT01517581.