Breakfast by the wooden bridge

In the second of our occasional series on breakfast refuelling points for early morning canoeists, we take a look at Lo Quay; a café on the northern side of Riverton Bridge. This crossing point is the wooden piled structure built in the 1950s to replace an earlier bridge that supported the main route East from Fremantle. When Leach highway’s heavy traffic demanded a larger crossing, and Shelley Bridge was built, Riverton Bridge settled on its timbers and now manages the slower paced traffic of a pleasant riverside suburb.

Rivo bridge

Close to the southern end of Riverton Bridge is a canoe-friendly launching ramp, and access to the stretch of the Canning River between Riverton Bridge and Kent Street weir. An early morning paddle on a lazy summer’s day is a good time to see herons, pelicans, grebe, cormorant and the occasional sea eagle sorting out their breakfast menu. The smaller birds look like they’re hovering centimetres above the water surface in the shimmering heat. Jellies get this far up river, and shoals of fish break the surface to taunt the predatory birdlife perched in branches of drowned trees at the water’s edge. A short paddle upstream through the Canning River Park  takes you past river islands, banks of reeds and one or two shore-bound fishermen. But your human company is almost entirely the handful of kayakers who pass with a brief greeting and get on with their personal journey. Less than 10 in 2.5km today. This is delightful solitude; decompression after the rigours of  a fast -paced week at work. Afterwards come the breakfast.

Floating birds

Lo Quay is a bustling Saturday morning breakfast/brunch hub with a loyal following of local clients. We were introduced to the place when it was still a burger and sandwich bar several years before the dawn of good coffee. After a rebuild it took on a new purpose in life: bringing a bistro menu to this perfect location under the trees on the northern bank. Its appeal spans family groups, couples, weekend cyclists, social canoeists and suburban residents who have to make do with breakfast here if they run out of sourdough bread, eggs and smoked salmon. Service can be a bit slow during the breakfast rush hour.

Heron

Too late for breakfast? The lunch menu is not bad.

 

Zika infection – five facts

ZIKA VIRUS

5 facts

  1. Zika virus is a flavivirus, the same group as dengue virus

  2. Infection is spread by Aedes mosquitoes

  3. Congenital anomalies including microcephaly have been linked with Zika virus infection during pregnancy

  4. Women who might fall pregnant are being asked to postpone travel to active transmission locations

  5. Zika virus is not endemic in Australia

  • Zikavirus é um flavivirus , o mesmo grupo que o vírus da dengue
  • A infecção é transmitida por mosquitos Aedes
  • As anomalias congênitas , incluindo microcefalia têm sido associadas com a infecção Zikavirus durante a gravidez
  • As mulheres que possam engravidar estão sendo convidados a adiar a viagem para locais de transmissão de activos
  • Zikavirus não é endémica na Austrália

For guidance on how to assess the strength of evidence for a causal relationship between an emerging infection and its effects, see Principia Aetiologica.

For updates on Zikavirus infection see:

Breakfast rocket science

The weekend breakfast

OK, so there are a few secret breakfast haunts hidden away in the southern suburbs: essential support stops for urgent calorie replacement after a brief burst of uncharacteristic activity. Perth has grown a good crop of decent breakfast venues in neat beach or riverside locations these last few years. Some of them have come and gone. Others have sprouted wings and flown off elsewhere. This post is not about the high turnover crowd pleasers. The Micrognome, while considering the challenges of a new semester, has discovered a collection of hidden gems. And here’s one for starters: Coco Belle in Mount Pleasant.

CB breakfast

Rocket food: Back a few streets from the Canning River. Unencumbered by  river views, or a super highway for the lycra-clad, Coco Belle has quickly found a place on this social paddler’s Saturday morning breakfast map. The menu options offer an indy twist on the standard menu. No common-or-garden eggs benny here. Three of us went for wildly different options, and were all rewarded with palate pleasing dishes. The field mushrooms with goat’s cheese, rocket and poached egg was masterly. The goats cheese was delicate and ever so slightly sweet. The rocket got a kick from the few chives they stirred through, complemented nicely by a hint of sweet balsamic. No risks from dodgy lettuce there. The poached eggs were at that critical tipping point shortly after arrival at our table.The gnome was outclassed by his partner’s generous bowl of granola with rhubarb and berry compote, and had to face off against a stack of pancakes with a side serve of bacon.

CB plate

Ambience: relaxed Saturday morning haunt with varied seating options from sit up to sit back

Price point: $$

Location: corner Queens Rd and Reynolds

CB map

 

BCID FilmArray better by a country mile

In one of our latest offering, we show how a molecular method can speed up identification of bacteria in septicaemia by over two days. The FilmArray technique allows clinical lab staff to identify the bacteria  in an hour with pre-packaged reagents and a plug-and-play analyser.

This has to be a batter way of meeting the needs of patients in country communities, than shipping them or their specimens to the big city hospital labs.

FilmArray works by targeting a series of bacterial gene targets from species of interest and running an array of triplicate PCR assays for each target. It is an amplification method, unlike MALDI-TOF, which is used in larger clinical labs to speed up bacterial identification from blood cultures. For country labs to benefit from MALDI-TOF, the specimen or bacterial isolate has to be referred to the city lab, which adds a delay to the process. In our series, FilmArray successfully identified the bacteria from country labs containing, and even coped with mixed cultures. In other words, it performed better than MALDI-TOF for the range of bacterial that cause infections in our regional communities. The quicker time to identification should translate into real improvements in choice of antibiotics and subsequent clinical outcomes.

Other options for country settings & elsewhere:

  • FilmArray has been applied to rapid identification of bacteria in other sterile fluid samples.
  • For those who’ve been following our Ebola stories, a FilmArray has been used in the recent EVD epidemic and its performance assessed.
  • Further applications are appearing in the professional literature.

This interesting new technology is better than anything we’ve had for blood culture rapid ID by a country mile, but we need to be careful not to get too far ahead of ourselves. We have yet to demonstrate that the use of FilmArray for blood culture identification in country labs directly impacts clinical outcomes.

Expect more on better methods for country labs from the gnome factory in future.

 

The antibiotic tightrope

You’ve got to take your hat off to those brave souls with ice cool nerves who cross canyons, waterfalls and other natural obstacles on the narrowest of paths possible. There’s something about a tightrope walk that lifts the human spirit and inspires us beyond the sheer insolence of personal risk taking. Determination, concentration, skill or unique challenge all come to mind. But without a doubt, there is a fundamental need for a finely tuned sense of balance.

Tightrope walker

The tightrope walker is a useful picture of what is missing in the growing clamour over what we need to do about antimicrobial resistance (AMR). At one extreme, we have an urgent need to reduce every imaginable measure of antibiotic use in order to slow the emergence of resistance. That is not a matter for debate. We are up the creek with only half a paddle. Unfortunately, the complete removal of all or any currently used antibiotic from clinical use is not an option. They are just too useful to us. How can we justify restricting antibiotic use where they are clinically indicated, let alone potentially life-saving?

There is really no dilemma for the clinician faced with a serious infection: the immediate needs of the patient will win out every time. The long term consequences of escalating AMR are a problem postponed. The expectation that there will be an effective antibiotic for every infection; a pill for every ill, has a pervasive effect on every medical engagement with infection. The most minor infection might just morph into something much more serious. Even when the odds are heavily stacked against that eventuality, it is often easier to weigh in with an antibiotic just in case. After all, we’ve all heard of cases that have gone badly for lack of an early intervention.

This is why the O’Neill report cites better diagnostic tests as the circuit-breaker in the fight against AMR. The report spells out in detail the rationale for early resolution of the physician’s dilemma with better point of care tests. Those tests must address a series of three questions front line clinical staff must answer when handling any infection:

  1. How sick is this patient
  2. Why are they sick
  3. And what do we need to do about it?

Or to put it another way; better tests are needed to take the guesswork out of prescribing antibiotics. Escalating AMR will make that balancing act all the more difficult, lie a tightrope walk on a windy day.

If you would like to help us make AMR history, go to the website and join the campaign.

trw pic