394 resultados para Dimensions changes-kindergarden


Relevância:

20.00% 20.00%

Publicador:

Resumo:

Background People admitted to intensive care units and those with chronic health care problems often require long-term vascular access. Central venous access devices (CVADs) are used for administering intravenous medications and blood sampling. CVADs are covered with a dressing and secured with an adhesive or adhesive tape to protect them from infection and reduce movement. Dressings are changed when they become soiled with blood or start to come away from the skin. Repeated removal and application of dressings can cause damage to the skin. The skin is an important barrier that protects the body against infection. Less frequent dressing changes may reduce skin damage, but it is unclear whether this practice affects the frequency of catheter-related infections. Objectives To assess the effect of the frequency of CVAD dressing changes on the incidence of catheter-related infections and other outcomes including pain and skin damage. Search methods In June 2015 we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We also searched clinical trials registries for registered trials. There were no restrictions with respect to language, date of publication or study setting. Selection criteria All randomised controlled trials (RCTs) evaluating the effect of the frequency of CVAD dressing changes on the incidence of catheter-related infections on all patients in any healthcare setting. Data collection and analysis We used standard Cochrane review methodology. Two review authors independently assessed studies for inclusion, performed risk of bias assessment and data extraction. We undertook meta-analysis where appropriate or otherwise synthesised data descriptively when heterogeneous. Main results We included five RCTs (2277 participants) that compared different frequencies of CVAD dressing changes. The studies were all conducted in Europe and published between 1995 and 2009. Participants were recruited from the intensive care and cancer care departments of one children's and four adult hospitals. The studies used a variety of transparent dressings and compared a longer interval between dressing changes (5 to15 days; intervention) with a shorter interval between changes (2 to 5 days; control). In each study participants were followed up until the CVAD was removed or until discharge from ICU or hospital. - Confirmed catheter-related bloodstream infection (CRBSI) One trial randomised 995 people receiving central venous catheters to a longer or shorter interval between dressing changes and measured CRBSI. It is unclear whether there is a difference in the risk of CRBSI between people having long or short intervals between dressing changes (RR 1.42, 95% confidence interval (CI) 0.40 to 4.98) (low quality evidence). - Suspected catheter-related bloodstream infection Two trials randomised a total of 151 participants to longer or shorter dressing intervals and measured suspected CRBSI. It is unclear whether there is a difference in the risk of suspected CRBSI between people having long or short intervals between dressing changes (RR 0.70, 95% CI 0.23 to 2.10) (low quality evidence). - All cause mortality Three trials randomised a total of 896 participants to longer or shorter dressing intervals and measured all cause mortality. It is unclear whether there is a difference in the risk of death from any cause between people having long or short intervals between dressing changes (RR 1.06, 95% CI 0.90 to 1.25) (low quality evidence). - Catheter-site infection Two trials randomised a total of 371 participants to longer or shorter dressing intervals and measured catheter-site infection. It is unclear whether there is a difference in risk of catheter-site infection between people having long or short intervals between dressing changes (RR 1.07, 95% CI 0.71 to 1.63) (low quality evidence). - Skin damage One small trial (112 children) and three trials (1475 adults) measured skin damage. There was very low quality evidence for the effect of long intervals between dressing changes on skin damage compared with short intervals (children: RR of scoring ≥ 2 on the skin damage scale 0.33, 95% CI 0.16 to 0.68; data for adults not pooled). - Pain Two studies involving 193 participants measured pain. It is unclear if there is a difference between long and short interval dressing changes on pain during dressing removal (RR 0.80, 95% CI 0.46 to 1.38) (low quality evidence). Authors' conclusions The best available evidence is currently inconclusive regarding whether longer intervals between CVAD dressing changes are associated with more or less catheter-related infection, mortality or pain than shorter intervals.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Wastewater analysis was used to examine prevalence and temporal trends in the use of two cathinones, methylone and mephedrone, in an urban population (>200,000 people) in South East Queensland, Australia. Wastewater samples were collected from the inlet of the sewage treatment plant that serviced the catchment from 2011 to 2013. Liquid chromatography coupled with tandem mass spectrometry was used to measure mephedrone and methylone in wastewater sample using direct injection mode. Mephedrone was not detected in any samples while methylone was detected in 45% of the samples. Daily mass loads of methylone were normalized to the population and used to evaluate methylone use in the catchment. Methylone mass loads peaked in 2012 but there was no clear temporal trend over the monitoring period. The prevalence of methylone use in the catchment was associated with the use of MDMA, the more popular analogue of methylone, as indicated by other complementary sources. Methylone use was stable in the study catchment during the monitoring period whereas mephedrone use has been declining after its peak in 2010. More research is needed on the pharmacokinetics of emerging illicit drugs to improve the applicability of wastewater analysis in monitoring their use in the population.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

This paper provides an empirical estimation of energy efficiency and other proximate factors that explain energy intensity in Australia for the period 1978-2009. The analysis is performed by decomposing the changes in energy intensity by means of energy efficiency, fuel mix and structural changes using sectoral and sub-sectoral levels of data. The results show that the driving forces behind the decrease in energy intensity in Australia are efficiency effect and sectoral composition effect, where the former is found to be more prominent than the latter. Moreover, the favourable impact of the composition effect has slowed consistently in recent years. A perfect positive association characterizes the relationship between energy intensity and carbon intensity in Australia. The decomposition results indicate that Australia needs to improve energy efficiency further to reduce energy intensity and carbon emissions. © 2012 Elsevier Ltd.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

This paper examines the asymmetry of changes in CO2 emissions over business cycle recessions and expansions using yearly data from 1949 and monthly data from 1973 for the United States (US). In addition, decomposition analysis is applied to investigate the relative roles of various proximate contributing factors to observed changes in total and per capita CO2 emissions and emissions intensity, over business cycle phases. The results suggest, inter alia, that aggregate emissions and emissions intensity reduce much faster in contractions than they increase in expansions. In addition, unlike the three previous expansions, in the most recent post-GFC US expansion, emissions per capita have continued to decline, and at a rate very similar to the rate of reduction in preceding contractions. This suggests the real possibility that the most recent contraction may have had an ongoing impact on the path of per capita emissions well beyond the immediate impact experienced during the contraction itself.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Over recent decades, efforts have been made to reduce human exposure to atmospheric pollutants including polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs) through emission control and abatement. Along with the potential changes in their concentrations resulting from these efforts, profiles of emission sources may have also changed over such extended timeframes. However relevant data are quite limited in the Southern Hemisphere. We revisited two sampling sites in an Australian city, where the concentration data in 1994/5 for atmospheric PAHs and PCBs were available. Monthly air samples from July 2013 to June 2014 at the two sites were collected and analysed for these compounds, using similar protocols to the original study. A prominent seasonal pattern was observed for PAHs with elevated concentrations in cooler months whereas PCB levels showed little seasonal variation. Compared to two decades ago, atmospheric concentrations of ∑13 PAHs (gaseous + particle-associated) in this city have decreased by approximately one order of magnitude and the apparent halving time ( t 1 / 2 ) was estimated as 6.2 ± 0.56 years. ∑6 iPCBs concentrations (median value; gaseous + particle-associated) have decreased by 80% with an estimated t 1 / 2 of 11 ± 2.9 years. These trends and values are similar to those reported for comparable sites in the Northern Hemisphere. To characterise emission source profiles, samples were also collected from a bushfire event and within a vehicular tunnel. Emissions from bushfires are suggested to be an important contributor to the current atmospheric concentrations of PAHs in this city. This contribution is more important in cooler months, i.e. June, July and August, and its importance may have increased over the last two decades.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

While much has been written about the relationship between personal epistemologies and learning-teaching approaches, outcomes, and intentions, little has focused specifically on these relationships in the context of teacher education. This chapter addresses changes in preservice teachers’ personal epistemologies by overviewing this emerging body of research and arguing for a new approach to conceptualizing and supporting changes in personal epistemologies based on reflexivity. The overview includes definitions of key concepts and research traditions that have been used since the 1970s and a discussion of the emerging role of epistemic justification as a key mechanism of change in the process of belief development.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

PURPOSE To examine longitudinal changes in choroidal thickness and axial length in a population of children with a range of refractive errors. METHODS One hundred and one children (41 myopes and 60 nonmyopes) aged 10 to 15 years participated in this prospective, observational longitudinal study. For each child, 6-month measures of choroidal thickness (using enhanced depth imaging optical coherence tomography) and axial ocular biometry were collected four times over an 18-month period. Linear mixed-models were used to examine the longitudinal changes in choroidal thickness and the relationship between changes in choroidal thickness and axial eye growth over the study period. RESULTS A significant group mean increase in subfoveal choroidal thickness was observed over 18 months (mean increase 13 6 22 lm, P < 0.001). Myopic children exhibited significantly thinner choroids compared with nonmyopic children (P < 0.001), although there was no significant time by refractive group interaction (P ¼ 0.46), indicating similar changes in choroidal thickness over time in myopes and nonmyopes. However, a significant association between the change in choroidal thickness and the change in axial length over time was found (P < 0.001, β = −0.14). Children showing faster axial eye growth exhibited significantly less choroidal thickening over time compared with children showing slower axial eye growth. CONCLUSIONS A significant increase in choroidal thickness occurs over an 18-month period in normal 10- to 15-year-old children. Children undergoing faster axial eye growth exhibited less thickening and, in some cases, a thinning of the choroid. These findings support a potential role for the choroid in the mechanisms regulating eye growth in childhood.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

• Evidence from cross-sectional studies1,2 suggests that choroidal thickness (ChT) varies with age and refractive error in childhood. However, to date there have been no longitudinal studies examining changes in pediatric ChT. • In this prospective study, the longitudinal changes in ChT and its relationship with eye growth were examined in a population of normal children with a range of refractive errors.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

We explore how a standardization effort (i.e., when a firm pursues standards to further innovation) involves different search processes for knowledge and innovation outcomes. Using an inductive case study of Vanke, a leading Chinese property developer, we show how varying degrees of knowledge complexity and codification combine to produce a typology of four types of search process: active, integrative, decentralized and passive, resulting in four types of innovation outcome: modular, radical, incremental and architectural. We argue that when the standardization effort in a firm involves highly codified knowledge, incremental and architectural innovation outcomes are fostered, while modular and radical innovations are hindered. We discuss how standardization efforts can result in a second-order innovation capability, and conclude by calling for comparative research in other settings to understand how standardization efforts can be suited to different types of search process in different industry contexts.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

High Intensity Exercise (HIE) stimulates greater physiological remodeling when compared to workload matched low-moderate intensity exercise. This study utilized an untargeted metabolomics approach to examine the metabolic perturbations that occur following two workload matched supramaximal low volume HIE trials. In a randomized order, 7 untrained males completed two exercise protocols separated by one week; 1) HIE150%: 30 x 20s cycling at 150% VO2peak, 40s passive rest; 2) HIE300%: 30 x 10s cycling at 300% VO2peak, 50 s passive rest. Total exercise duration was 30 minutes for both trials. Blood samples were taken at rest, during and immediately following exercise and at 60 minutes post exercise. Gas chromatography-mass spectrometry (GC-MS) analysis of plasma identified 43 known metabolites of which 3 demonstrated significant fold changes (HIE300% compared to the HIE150% value) during exercise, 14 post exercise and 23 at the end of the recovery period. Significant changes in plasma metabolites relating to lipid metabolism [fatty acids: dodecanoate (p=0.042), hexadecanoate (p=0.001), octadecanoate (p=0.001)], total cholesterol (p=0.001), and glycolysis [lactate (p=0.018)] were observed following exercise and during the recovery period. The HIE300% protocol elicited greater metabolic changes relating to lipid metabolism and glycolysis when compared to HIE150% protocol. These changes were more pronounced throughout the recovery period rather than during the exercise bout itself. Data from the current study demonstrate the use of metabolomics to monitor intensity-dependent changes in multiple metabolic pathways following exercise. The small sample size indicates a need for further studies in a larger sample cohort to validate these findings.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

On 22 October 2012, the Australian Federal Government announced the removal of the $1,000 in-house fringe benefits concession when used as part of a salary packaging arrangement. At the time of the announcement, the Federal Government predicted that the removal of the concession would contribute additional tax revenue of $445 million over the following four years as well as an increase of GST payments to the States and Territories. However, anecdotal evidence at the same time indicated that the Australian employer response was to immediately stop providing employees with such in-house fringe benefits via salary sacrificing arrangements. Data presented in this article, collected from a combination of interviews with tax managers of four Australian entities as well as a review of the published archival data, confirms that the abolition of the $1,000 in-house fringe benefits concession was perceived as a negative change, whereby employees were considered the ‘big losers’ despite assertions by the Federal Government to the contrary. Using a conceptual map of tax rule change developed by Oats and Sadler, this article seeks to understand the reasons for this fringe benefits tax change and taxpayer response. In particular, the economic and political factors, and the responses of the relevant taxpayers (employers) are explored. Drawing on behavioural economic concepts, the actions, attitudes and response of employers to the rule change are also examined. The research findings suggest that the decision by Australian employers to cease providing the in-house fringe benefits as part of a salary-packaging arrangement after the legislative amendment was impacted by more than simple rational behaviour.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Aggregation of the microtubule associated protein tau (MAPT) within neurons of the brain is the leading cause of tauopathies such as Alzheimer's disease. MAPT is a phospho-protein that is selectively phosphorylated by a number of kinases in vivo to perform its biological function. However, it may become pathogenically hyperphosphorylated, causing aggregation into paired helical filaments and neurofibrillary tangles. The phosphorylation induced conformational change on a peptide of MAPT (htau225−250) was investigated by performing molecular dynamics simulations with different phosphorylation patterns of the peptide (pThr231 and/or pSer235) in different simulation conditions to determine the effect of ionic strength and phosphate charge. All phosphorylation patterns were found to disrupt a nascent terminal β-sheet pattern (226VAVVR230 and 244QTAPVP249), replacing it with a range of structures. The double pThr231/pSer235 phosphorylation pattern at experimental ionic strength resulted in the best agreement with NMR structural characterization, with the observation of a transient α-helix (239AKSRLQT245). PPII helical conformations were only found sporadically throughout the simulations. Proteins 2014; 82:1907–1923. © 2014 Wiley Periodicals, Inc.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Objective: To document electroencephalogram (EEG) changes and their correlation with clinical parameters in a newly diagnosed pediatric cohort of type 1 diabetes mellitus (T1DM) patients with and without diabetic ketoacidosis (DKA) and to define their medium term utility and significance. Research design and methods: Prospective longitudinal study of children presenting with T1DM. EEGs were performed within 24 h of diagnosis, day 5, and at 6 months post-diagnosis and reviewed by a neurologist blinded to clinical status. Severity of encephalopathy was graded from 1 to 5 using the Aoki and Lombroso encephalopathy scale. Cognitive abilities were assessed using standardized tests of attention, memory, and intelligence. Results: Eighty eight children were recruited; 34 presented with DKA. Abnormal background slowing was more often observed in the first 24 h in children with DKA (p = 0.01). Encephalopathy scores on day 1 correlated with initial pH, CO2, HCO3, base excess, respiratory rate, heart rate, diastolic blood pressure, and IV fluid intake (all parameters p < 0.05). EEG scores at day 1 did not correlate with contemporaneous mental state or cognition in the medium term. Conclusions: DKA was associated with significant clinical and neurophysiologic signs of brain dysfunction at presentation. While EEG is sensitive to the detection of encephalopathy in newly diagnosed T1DM, it has limited use in identifying children at risk of later cognitive deficits.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Purpose: Knowledge management (KM) is important to the knowledge-intensive construction industry. The diversified and changing nature of works in this field warrants us to stocktake, identify changes and map out KM research framework for future exploration. Design/methodology/approach: The study involves three aspects. First, three stages of KM research in construction were distinguished in terms of the time distribution of 217 target publications. Major topics in the stages were extracted for understanding the changes of research emphasis from evolutionary perspective. Second, the past works were summed up in a three-dimensional research framework in terms of management organization, managerial methodology and approach, and managerial objective. Finally, potential research orientations in the future were predicted to expand the existing research framework. Findings: It was found that (1) KM research has significantly blossomed in the last two decades with a great potential; (2) major topics of KM were changing in terms of technology, technique, organization, attribute of knowledge and research objectives; (3) past KM studies centred around management organization, managerial methodology and approach, and managerial objective thus a three-dimensional research framework was proposed; (4) within the research framework, team-level, project-level and firm-level KM were studied to achieve project, organizational and competitive objectives by integrated methodologies of information technology, social technique and KM process tool; and (5) nine potential research orientations were predicted corresponding to the three dimensions. Finally, an expanded research framework was proposed to encourage and guide future research works in this field. Research limitations/implications: The paper only focused on the construction industry. The findings need further exploration in order to discover any possible missing important research works which were not published in English or not included in the time period. Originality/value: The paper formed a systematic framework of KM research in construction and predicted the potential research orientations. It provides much value for the researchers who want to understand the past and the future of global KM research in the construction industry.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

This issue marks the beginning of a new editorial cycle. In the seventh volume of the journal the editorial team will continue collating novel scientific and social developments in the broader field of ‘knowledge-based development’ to report to our readers. In this perspective, the first issue of the volume focuses on different dimensions of knowledge-based urban development. As Gabe et al. (2012, p.1179) indicate, “[i]t would be an understatement to suggest that knowledge plays a key role in today’s economy; for much of the developed world, it might be more accurate to assert that knowledge is today’s economy”. Thus, knowledge generation has been a priority for global city administrations, and there is a growing consensus amongst scholars, planners, politicians and industrialists in identifying knowledge-based urban development as a panacea to the burgeoning economic problems (Knight, 1995; Kunzmann, 2009; Yigitcanlar, 2010, 2011; Huggins and Strakova, 2012; Lönnqvist et al., 2014). Although, in the era of global knowledge economy, knowledge-based urban development is a critical factor for economic success (Pratt, 2000; Sheppard, 2002), it is not solely an economic policy. For many, knowledge-based urban development is a policy that targets building an urban setting to form perfect climates for business, people, and governance in an environmentally friendly atmosphere (Carrillo, 2006; Ergazakis et al., 2006; Angelidou et al., 2012). Each of these climates correspond to a dimension or domain of knowledge-based urban development – namely, economy, society, space, and governance (Carrillo et al., 2014). Each paper of this issue corresponds to at least one of these domains, or policy areas.