There are many examples of development in the Darwin region that have led to enormous populations of a range of mosquito species, severely effecting residents in nearby areas and requiring costly rectification. To aid planners in their design of the proposed Newton development, the Medical Entomology section of the department of Health and Families has made collections of biting midges and mosquitoes form march 1984 to April 1985 in and around the proposed development area between the Elizabeth and Blackmore Rivers, south-west of Palmerston. Additional surveys of biting midge breeding areas were made in late 1987. This report analyses the result and suggest methods of minimising the adverse effects of the biting insect present in the proposed development area, and outlines some construction guidelines to avoid exacerbating the problem.

Congenital adrenal hyperplasia due to 11 beta-hydroxylase deficiency is a rare autosomal recessive genetic disorder. It is caused by reduced or absent activity of 11β-hydroxylase (CYP11B1) enzyme and the resultant defects in adrenal steroidogenesis. The most common clinical features of 11 beta-hydroxylase deficiency are ambiguous genitalia, accelerated skeletal maturation and resultant short stature, peripheral precocious puberty and hyporeninemic hypokalemic hypertension. The biochemical diagnosis is based on raised serum 11-deoxycortisol and 11-deoxycorticosterone levels together with increased adrenal androgens. More than 100 mutations in CYP11B1 gene have been reported to date. The level of in-vivo activity of CYP11B1 relates to the degree of severity of 11 beta-hydroxylase deficiency. Clinical management of 11 beta-hydroxylase deficiency can pose a challenge to maintain adequate glucocorticoid dosing to suppress adrenal androgen excess while avoiding glucocorticoid-induced side effects. The long-term outcomes of clinical and surgical management are not well studied. This review article aims to collate the current available data about 11 beta-hydroxylase deficiency and its management.

3β-hydroxysteroid dehydrogenase type 2 deficiency (3βHSD2D) is a very rare variant of congenital adrenal hyperplasia (CAH) causing less than 0.5% of all CAH. The aim was to review the literature. PubMed was searched for relevant articles. 3βHSD2D is caused by HSD3B2 gene mutations and characterized by impaired steroid synthesis in the gonads and the adrenal glands and subsequent increased dehydroepiandrosterone (DHEA) concentrations. The main hormonal changes observed in patients with 3βHSD2D are elevated ratios of the Δ5-steroids over Δ4-steroids but molecular genetic testing is recommended to confirm the diagnosis. Several deleterious mutations in the HSD3B2 gene have been associated with salt-wasting (SW) crisis in the neonatal period, while missense mutations have been associated with a non-SW phenotype. Boys may have ambiguous genitalia, whereas girls present with mild or no virilization at birth. The existence of non-classic 3βHSD2D is controversial. In an acute SW crisis, the treatment includes prompt rehydration, correction of hypoglycemia, and parenteral hydrocortisone. Similar to other forms of CAH, glucocorticoid and mineralocorticoid replacement is needed for long-term management. In addition, sex hormone replacement therapy may be required if normal progress through puberty is failing. Little is known regarding possible negative long-term consequences of 3βHSD2D and its treatments, e.g., fertility, final height, osteoporosis and fractures, adrenal and testicular tumor risk, and mortality. Knowledge is mainly based on case reports but many long-term outcomes could be presumed to be similar to other types of CAH, mainly 21-hydroxylase deficiency, although in 3βHSD2D it seems to be more difficult to suppress the androgens.

Royal Darwin Hospital has introduced a new system to manage infection control in the perioperative environment.

Writing of a 'Discharge Summary' has been an integral part of discharge from hospital or transfer of care. With the move from paper-based to electronic clinical records, is there an opportunity to eliminate the practice of 'writing' a discharge summary? One potential benefit of electronic clinical records is that they provide a facility to automate the retrieval of key information without having to re-enter, re-orientate or manually re-format the information contained in the dataset. Equally importantly, they exclude the subjective errors of commission and omission and the personal bias of the person writing a discharge summary who most often is a junior doctor, either intern or a resident. In developing the electronic clinical records systems we should endeavour to make the contextual information, the results of procedures and investigations and the plan of management automatically visible and accessible without recourse to `writing' a separate or additional discharge summary.

ISO 15189:2012 provides an update in both management system and technical competence requirements for the pathology services industry. While most of the requirements remain similar, there are new requirements that require further investment of resources to achieve compliance. These include measurement of uncertainty estimation and additional requirements in induction and training. Furthermore, several new requirements, such as contingency planning and evaluation, are likely to require specialised support. The intent of this guide is to assist with the implementation process by highlighting the main differences between ISO 15189:2007 and ISO 15189:2012 through a gap analysis using a total of 22 administrative requirement headings. Resources for implementation preparation are recommended, including relevant guidance documents, practical tools, such as checklists, internal audits and key performance indicators. Additional change management notes are also provided for further implementation guidance. The implementation process is likely to be successful if relevant knowledge is obtained and relevant guidance documents are consulted during the planning phase.

The Operations Manager and the Development Planning and Vector Control Officer of the Medical Entomology Branch (MEB) went to Alice Springs on 4-5 September 2006 to inspect the Alice Springs storm water drains and the Ilparpa swamp. The purpose of the MEB visit was to both make recommendations on storm water drain maintenance and rectification works required in Alice Springs and to inspect the Ilparpa swamp drainage system to reduce mosquito pest and disease potentials for the people of Alice Springs. MEB staff met with local EH staff, Fiona Smith and Philip Ahchee and a representative of the Alice Springs local Town Council (ASTC).

The Mt Todd Gold Mine is located approximately 55 kilometres north of Katherine. Mining occurred in the 1990’s and ceased in the 2000’s (GHD April 2011). Vista Gold Australia Pty Ltd is proposing to re-establish and operate the Mt Todd Gold Mine. Mine sites have the potential to create or exacerbate mosquito breeding. Mine sites also have the potential to introduce new mosquito species into the Northern Territory, such as the dengue mosquito Aedes aegypti from North Queensland, if equipment is sourced from this area. As part of the environmental process, all major developments in the NT are required to consider mosquitoes during the preparation of an Environmental Impact Statement or Public Environmental Report, to ensure new development does not create new mosquito breeding sites, and also to protect the health of workers. Medical Entomology, of the Centre for Disease Control (CDC), Northern Territory Department of Health (DOH) was subsequently commissioned by GHD Pty Ltd to conduct a Biting Insect Assessment of the mine site. The biting insect assessment was to include monthly adult mosquito trapping for 12 months, and a field investigation to identify actual and potential mosquito breeding sites.

The Defence Housing Authority (DHA) in conjunction with GHD Pty Ltd proposes to develop the new residential suburb of Muirhead in Darwin, located north of the existing Northern Suburbs between Buffalo Creek and Lee Point Road. Muirhead is located on Lot 9737 Town of Nightcliff. Lot 9737 was previously used as a defence facility, and around one third of Lot 9737 has been cleared of trees and shrubs. The majority of lots were proposed to be urban residential, with some rural residential lots, and land set aside for commercial and education as well as open space. Based on the proximity of the development to known mosquito and potential biting midge breeding sites, there is likely to be a number of biting insect problems in various sections of the development area.

A lot has been written about leadership types and styles. An attempt has been made to examine types and style of leadership, but also expectations from them. Perhaps an ability to influence others is one of key determinants of leadership.

Western Desert Resources Limited (WDRL) proposes to construct and operate an iron ore mine within the Roper Bar Iron Ore Province, located in the Gulf Region of the Northern Territory, 50 km inland from the Gulf of Carpentaria at its closest point. Mine sites have the potential to create or exacerbate mosquito breeding. Mine sites also have the potential to introduce new mosquito species into the Northern Territory, such as the dengue mosquito Aedes aegypti from North Queensland. As part of the environmental process, all major developments in the NT are required to consider mosquitoes during the preparation of Environmental Impact Statements or Public Environmental Reports, to ensure new development does not create new mosquito breeding sites, and also to protect the health of workers. Medical Entomology, of the Centre for Disease Control (CDC), Northern Territory Department of Health (DOH) was subsequently commissioned by EcOz Environmental Services to conduct a Biting Insect Assessment of the mine site. The biting insect assessment was to include monthly trapping over a 12 month period, and a field investigation to identify actual or potential mosquito breeding sites.

Background: The northern salt marsh mosquito Aedes vlgllax (Skuse) is an established vector for Ross River and Barmah Forest viruses and is also an aggressive biter and an appreciable pest species. Many of Darwin's northern suburbs are adjacent to a coastal wetland, which offers a breeding habitat for Aedes vigilax. Medical Entomology (ME) of the NT Department of Health and Families conducts EVS trap surveillance and Integrated mosquito control measures for Aedes vigilax breeding in the wetlands of Darwin. One EVS trap, located In Karama, consistently reports some of the highest numbers of Aedes vigilax in all the swamp trap locations. We sought to identify the most important meteorological variables associated With peaks of >500 Aedes vigiax /trap/night. Improved prediction of peaks will enable early intervention, media warnings and should reduce public distress. Furthermore, early prediction of peaks will assist planning of future mosquito surveys, control efforts, and hence maximise the efficiency of the unit. Methods: we identified the maximum tide and cumulative rainfall during the 9 - 13 day period prior to each EVS collection date. logistic regression models were applied, to determine explanatory variables fitted to weekly peaks of female Aedes vigilax mosquitoes >500 per trap. This was modelled controlling for calendar month, year, meteorological variables and larval control efforts. Results: calendar months 9-11 had significantly more peaks than January, with a trend for significance (p=0.09) in December. Discussion: to maximise the efficiency of adult salt-marsh mosquito control operations in Darwin, larval control should be implemented with increased emphasis after rain events during the build-up months between September and November each year. This study reiterates the importance of applying statistical methods to service provider programs, and thus enabling insights into solutions without the need for additional field experiments. This method of evaluation may have applications for other mosquito surveillance and control programs in other areas.

The northern salt-marsh mosquito Aedes vigilax (Skuse) is an established vector for Ross River and Barmah Forest viruses and an aggressive biter and an appreciable pest species in the Northern Territory (NT). Many of Darwin’s northern suburbs are adjacent to the coastal wetland of Leanyer swamp, which has an extensive breeding habitat for Ae. vigilax. Medical Entomology (ME) of the NT Department of Health conducts adult mosquito surveillance and larval mosquito control for Ae. vigilax in this wetland. One trap located near the residential suburb of Karama consistently reports some of the highest numbers of Ae.vigilax of the 7 local swamp trap locations. ME wish to clarify why it should indicate the highest numbers and what environmental variable triggers these peaks. The trap site is close to the residential area, and the results are used to trigger public warnings of mosquito pest or potential disease risks. This paper seeks to identify the most important environmental variables associated with peaks of ≥ 500 Ae. vigilax/trap/night, to better indicate the reasons for the peaks and the section of the swamp that is the source of these peaks, to reduce public pest problems and disease risks. The results of the analysis using models indicated that calendar months September - November had significantly more peaks than January and in addition to rain in these months were more associated with high monthly tides coinciding with rain. The Karama trap site is relatively close to the flood plains and wet lands associated with the Holmes Jungle section of the wetland, and the large tidal influenced swamps to the east outside the 5 km control zone. This suggests larval control should be implemented with increased emphasis in rain flooded tidal influenced areas of the Holmes jungle section of Leanyer swamp after high tides with rain events coinciding s during the build-up months between September and November. This study supports applying statistical methods to existing control programs can enable insights into solutions without the need for additional field experiments and may have applications for other mosquito control programs in other areas.