In Response: "Oral versus IV treatment for catheter-related bloodstream infections - by Burke A. Cunha"

In his letter Cunha suggests that oral antibiotic therapy is safer and less expensive than intravenous therapy via central venous catheters (CVCs) (1). The implication is that costs will fall and increased health benefits will be enjoyed resulting in a gain in efficiency within the healthcare system. CVCs are often used in critically ill patients to deliver antimicrobial therapy, but expose patients to a risk of catheter-related bloodstream infection (CRBSI). Our current knowledge about the efficiency (i.e. costeffectiveness) of allocating resources toward interventions that prevent CRBSI in patients requiring a CVC has already been reviewed (2). If for some patient groups antimicrobial therapy can be delivered orally, instead of through a CVC, then the costs and benefits of this alternate strategy should be evaluated...

Greenhouse gas emissions from sub-tropical agricultural soils after addition of organic by-products

As the cost of mineral fertilisers increases globally, organic soil amendments (OAs) from agricultural sources are increasingly being used as substitutes for nitrogen. However, the impact of OAs on the production of greenhouse gases (CO2 and N2O) is not well understood. A 60-day laboratory incubation experiment was conducted to investigate the impacts of applying OAs (equivalent to 296 kg N ha−1 on average) on N2O and CO2 emissions and soil properties of clay and sandy loam soils from sugar cane production. The experiment included 6 treatments, one being an un-amended (UN) control with addition of five OAs being raw mill mud (MM), composted mill mud (CM), high N compost (HC), rice husk biochar (RB), and raw mill mud plus rice husk biochar (MB). These OAs were incubated at 60, 75 and 90% water-filled pore space (WFPS) at 25°C with urea (equivalent to 200 kg N ha−1) added to the soils thirty days after the incubation commenced. Results showed WFPS did not influence CO2 emissions over the 60 days but the magnitude of emissions as a proportion of C applied was RB < CM < MB < HC

A biomechanical study of spherical grip

Use of the hand is vital in working life due to the grabbing and pinching it performs. Spherical grip is the most commonly used, due to similarity to the gripping of a computer mouse. Knowledge of its execution and the involved elements is essential. Analysis of this exertion with surface electromyography devices (to register muscular activity) and accelerometer devices (to register movement values ) can provide multiple variables. Six subjects performed ball gripping and registered real-time electromyography (thenar region, hypothenar region, first dorsal interosseous, flexors of the wrist, flexor carpi ulnaris and extensors of the wrist muscles) and accelerometer (thumb, index, middle, ring, pinky and palm) values. The obtained data was resampled “R software” and processed “Matlab Script” based on an automatic numerical sequence recognition program. Electromyography values were normalized on the basis of maximum voluntary contraction, whilst modular values were calculated for the acceleration vector. After processing and analysing the obtained data and signal, it was possible to identify five stages of movement in accordance with the module vector from the palm. The statistical analysis of the variables was descriptive: average and standard deviations. The outcome variables focus on the variations of the modules of the vector (between the maximum and minimum values of each module and phase) and the maximum values of the standardized electromyography of each muscle. Analysis of movement through accelerometer and electromyography variables can give us an insight into the operation of spherical grip. The protocol and treatment data can be used as a system to complement existing assessments in the hand.

Supine to standing Cobb angle change in idiopathic scoliosis : the effect of endplate pre-selection

Background Supine imaging modalities provide valuable 3D information on scoliotic anatomy, but the altered spine geometry between the supine and standing positions affects the Cobb angle measurement. Previous studies report a mean 7°-10° Cobb angle increase from supine to standing, but none have reported the effect of endplate pre-selection or whether other parameters affect this Cobb angle difference. Methods Cobb angles from existing coronal radiographs were compared to those on existing low-dose CT scans taken within three months of the reference radiograph for a group of females with adolescent idiopathic scoliosis. Reformatted coronal CT images were used to measure supine Cobb angles with and without endplate pre-selection (end-plates selected from the radiographs) by two observers on three separate occasions. Inter and intra-observer measurement variability were assessed. Multi-linear regression was used to investigate whether there was a relationship between supine to standing Cobb angle change and eight variables: patient age, mass, standing Cobb angle, Risser sign, ligament laxity, Lenke type, fulcrum flexibility and time delay between radiograph and CT scan. Results Fifty-two patients with right thoracic Lenke Type 1 curves and mean age 14.6 years (SD 1.8) were included. The mean Cobb angle on standing radiographs was 51.9° (SD 6.7). The mean Cobb angle on supine CT images without pre-selection of endplates was 41.1° (SD 6.4). The mean Cobb angle on supine CT images with endplate pre-selection was 40.5° (SD 6.6). Pre-selecting vertebral endplates increased the mean Cobb change by 0.6° (SD 2.3, range −9° to 6°). When free to do so, observers chose different levels for the end vertebrae in 39% of cases. Multi-linear regression revealed a statistically significant relationship between supine to standing Cobb change and fulcrum flexibility (p = 0.001), age (p = 0.027) and standing Cobb angle (p < 0.001). The 95% confidence intervals for intra-observer and inter-observer measurement variability were 3.1° and 3.6°, respectively. Conclusions Pre-selecting vertebral endplates causes minor changes to the mean supine to standing Cobb change. There is a statistically significant relationship between supine to standing Cobb change and fulcrum flexibility such that this difference can be considered a potential alternative measure of spinal flexibility.

The effect of endplate preselection when measuring supine versus standing cobb angle change in idiopathic scoliosis

The primary aim of this study was to determine whether endplate pre-selection makes a difference to the Cobb Angle change between supine and standing which is known to occur in idiopathic scoliosis. A secondary aim of this study was to identify which (if any) patient characteristics were correlated with supine versus standing Cobb change. The study found that pre-selecting vertebral endplates causes only has a minor effect on supine to standing Cobb change in scoliosis. There is a statistically significant relationship between supine to standing Cobb Angle change and fulcrum flexibility. Therefore, supine to standing Cobb Angle change can be considered as a measure of spinal flexibility when both standing and supine images are clinically available.

Indigenous students transitioning to school : responses to pre-foundational mathematics

Australian Indigenous students' mathematics performance continues to be below that of non-Indigenous students. This occurs from the early years of school, due largely to knowledge and social differences on entry to formal schooling. This paper reports on a mathematics research project conducted in one Aboriginal community school in New South Wales, Australia. The project aimed to identify and explain the ways that young Australian Indigenous students (age 2-4 years) learn number language and processes, specifically attribute language, sorting, 1-1 correspondence and, counting. The project adopted a mixed methods approach. That is, the methodology was decolonising (Smith 1999) in that it collaborated with and gave benefit back to the Indigenous community and school being researched. It was qualitative and interpretative (Burns 2000) and incorporated an action-research teaching-experiment approach where and teachers collaborated with the researchers to try new teaching methods. This paper draws on data pertaining to students' response to diagnostic interview questions, the pre- and post-test results of the interview and photographic evidence as observations during mathematics learning time. Participants referred to in this paper include one female principal (N = 1), and the transition class of students' pre- (N = 6) and post-test (N = 3) results of the pre-foundational processes (also referred to as attributes). The results were encouraging with improvements in colour (34%), patterns (33%); capacity (38%). As a result of this project, our epistemology regarding the importance of finding out about students' pre-foundational knowledge and understandings and providing a culturally appropriate learning environment with resources has been built upon.

Growing rod analysis for the fusionless correction of early onset scoliosis (EOS)

Managing spinal deformities in young children is challenging, particularly early onset scoliosis (EOS). Surgical intervention is often required if EOS has been unresponsive to conservative treatment particularly with rapidly progressive curves. An emerging treatment option for EOS is fusionless scoliosis surgery. Similar to bracing, this surgical option potentially harnesses growth, motion and function of the spine along with correcting spinal deformity. Dual growing rods are one such fusionless treatment, which aims to modulate growth of the vertebrae. The aim of this study was to ascertain the extent to which semi-constrained growing rods (Medtronic Sofamor Danek Memphis, TN, USA) with a telescopic sleeve component, reduce rotational constraint on the spine compared with standard rigid rods and hence potentially provide a more physiological mechanical environment for the growing spine. This study found that semi-constrained growing rods would be expected to allow growth via the telescopic rod components while maintaining the axial flexibility of the spine and the improved capacity for final correction.

Longitudinal performance of polycaprolactone-based scaffold plus recombinant human morphogenetic protein-2 (rhBMP-2) in large preclinical animal model : 6- versus 12 months

There is strong current interest in the use of biodegradable scaffolds in combination with bone growth factors as a valuable alternative to the current gold standard autograft in spinal fusion surgery Yong et al. (2013). Here we report on 6- vs 12- month data set evaluating the longitudinal performance of a CaP coated polycaprolactone (PCL) scaffold loaded with recombinant human bone morphogenetic protein-2 (rhBMP-2) as a bone graft substitute within a preclinical ovine thoracic spine. The results of this study demonstrate the efficacy of scaffold-based delivery of rhBMP-2 in promoting higher fusion grades at 6- and 12- months in comparison to the scaffold alone or autograft group within the same time frame. Fusion grades achieved at six months using PCL+rhBMP-2 are not significantly increased at twelve months post surgery.

Seasonal occurrence and distribution of Bryde's whales in the Hauraki Gulf, New Zealand

The Hauraki Gulf is a large, shallow embayment located north of Auckland City (36°51′S, 174°46′E), New Zealand. Bryde's whales (Balaenoptera edeni) are the most frequently observed balaenopterid in these waters. To assess the use of the Hauraki Gulf for this species, we examined the occurrence and distribution in relation to environmental parameters. Data were collected from a platform of opportunity during 674 daily surveys between March 2003 and February 2006. A total of 760 observations of Bryde's whales were recorded throughout the study period during 371 surveys. The number of Bryde's whales sighted/day was highest in winter, coinciding with the coolest median sea-surface temperature (14.6°C). Bryde's whales were recorded throughout the Hauraki Gulf in water depths ranging from 12.1–59.8 m (mean = 42.3, SD = 5.1). Cow–calf pairs were most frequently observed during the austral autumn in water depths of 29.9–53.9 m (mean = 40.8, SD = 5.2). Data from this study suggest Bryde's whales in the Hauraki Gulf exhibit a mix of both “inshore” and “offshore” characteristics from the Bryde's whales examined off the coast of South Africa. Based on complete mitochondrial DNA sequences, Sasaki et al. (2006) recognized two sister species of Bryde's whales: Balaenoptera brydei and B. edeni, with the latter including small-type, more coastal Bryde's whales from Japan, Hong Kong, and Australia. Their samples and samples in previous analyses of small-type whales, all originated from eastern and southeastern Asia. These authors did not include the forms of Bryde's whales that occur in other regions, e.g., in the Pacific off Peru (Valdivia et al. 1981), in the Atlantic off Brazil (Best 1977) and in the western Indian Ocean off South Africa (Best 1977). Recent genetic analysis using mtDNA from the “inshore” and “offshore” forms from South Africa confirms the offshore form is B. brydei, and establishes that the inshore form is more closely related to B. brydei than to B. edeni (Penry 2010). These different forms do vary considerably in their habitat use and ecology (refer to Table 1 for a detailed comparison between the South African inshore and offshore forms, as described by Best (1967, 1977) and the Bryde's whales from New Zealand (Wiseman 2008). Recent genetic analysis on the Bryde's whales in the Hauraki Gulf suggests they are B. brydei (Wiseman 2008). However, pending resolution of the uncertainty within and between species of this genus, we follow the Society of Marine Mammal's committee on taxonomy, who state that B. edeni applies to all Bryde's whales.

Suppressed thermal conductivity of bilayer graphene with vacancy-initiated linkages

Through larger-scale molecular dynamics simulations, we investigated the impacts from vacancy-initiated linkages on the thermal conductivity of bilayer graphene sheets (of size L × W = 24.5 nm × 3.7 nm). Three different interlayer linkages, including divacancy bridging, “spiro” interstitial bridging and Frenkel pair defects, are considered. It is found that the presence of interlayer linkages induces a significant degradation in the thermal conductivity of the bilayer graphene sheet. The degradation is strongly dependent on the interlayer linkage type, concentration and location. More importantly, the linkages that contain vacancies lead to more severe suppression of the thermal conductivity, in agreement with theoretical predictions that vacancies induce strong phonon scattering. Our finding provides useful guidelines for the application of multilayer graphene sheets in practical thermal management.

Retaining a diverse workforce: The impact of gender-focused human resource management

Demography theory suggests that high gender diversity leads to high turnover. As turnover is costly, we tested the following: a main effect prediction derived from demography theory, and a moderating effect prediction derived from the relational framework. Data on 198 publicly listed organizations were collected through a human resources decision maker survey and archival databases. The results indicate that higher gender diversity leads to lower turnover in organizations with many gender-focused policies and practices. Findings suggest that organizations can lower their turnover rates by increasing their gender diversity and by implementing gender-focused policies and practices.

Relationship between Barthel index with physical tests in adults with intellectual disabilities

We usually find low levels of fitness condition affect other aspects of living for people with ID like dependency in carrying out activivities of daily living. Therefore we find high levels of dependency in activities of daily living due to poor fitness condition. The aim of the study is to explore the criterion validity of the Barthel index with a physical fitness test. An observational cross-sectional study was conducted. Data from the Barthel index and a physical fitness test were measured in 122 adults with intellectual disability. The data were analysed to find out the relationship between four categories of the physical fitness test and the Barthel index. It needs to be stressed that the correlations between the Barthel index and leg, abdominal and arm strength can confirm that these physical test are predictive of the Barthel index. The correlations between the balance variables as functional reach and single-leg stance with eyes open shown relationships with Barthel Index. We found important correlations between the physical fitness test and the Barthel index, so we can affirm that some physical fitness features are predictor variables of the Barthel index.

The path towards greening the Malaysian construction industry

Construction industry contributes significantly to environmental degradation, and governments in many countries which are endeavouring to address the situation. Malaysia is no exception. This paper examines the path towards green construction project delivery in Malaysia, focusing on current green policies and initiatives by governments. The historical waves in Malaysian approaches to tackling environmental issues are described, starting from the early 20th century, through the 1990s to the present, and the influence of these approaches on construction practices is analysed. Based on the findings of policy review, essential green construction practices aimed at mitigating the adverse effects of construction activities on the environment in Malaysia were identified. This paper paves the way for future studies in construction and sustainability in Malaysia, especially for the Southeast Asian region where sustainability practices are urgently needed.

Viewing systematic reviews and meta-analysis in social research through different lenses

Systematic reviews and meta-analyses are used to combine results across studies to determine an overall effect. Meta-analysis is especially useful for combining evidence to inform social policy, but meta-analyses of applied social science research may encounter practical issues arising from the nature of the research domain. The current paper identifies potential resolutions to four issues that may be encountered in systematic reviews and meta-analyses in social research. The four issues are: scoping and targeting research questions appropriate for meta-analysis; selecting eligibility criteria where primary studies vary in research design and choice of outcome measures; dealing with inconsistent reporting in primary studies; and identifying sources of heterogeneity with multiple confounded moderators. The paper presents an overview of each issue with a review of potential resolutions, identified from similar issues encountered in meta-analysis in medical and biological sciences. The discussion aims to share and improve methodology in systematic reviews and meta-analysis by promoting cross-disciplinary communication, that is, to encourage 'viewing through different lenses'.