Efficacy of a children's procedural preparation and distraction device on healing in acute burn wound care procedures : study protocol for a randomized controlled trial

BACKGROUND: The intense pain and anxiety triggered by burns and their associated wound care procedures are well established in the literature. Non-pharmacological intervention is a critical component of total pain management protocols and is used as an adjunct to pharmacological analgesia. An example is virtual reality, which has been used effectively to dampen pain intensity and unpleasantness. Possible links or causal relationships between pain/anxiety/stress and burn wound healing have previously not been investigated. The purpose of this study is to investigate these relationships, specifically by determining if a newly developed multi-modal procedural preparation and distraction device (Ditto) used during acute burn wound care procedures will reduce the pain and anxiety of a child and increase the rate of re-epithelialization. METHODS/DESIGN: Children (4 to 12 years) with acute burn injuries presenting for their first dressing change will be randomly assigned to either the (1) Control group (standard distraction) or (2) Ditto intervention group (receiving Ditto, procedural preparation and Ditto distraction). It is intended that a minimum of 29 participants will be recruited for each treatment group. Repeated measures of pain intensity, anxiety, stress and healing will be taken at every dressing change until complete wound re-epithelialization. Further data collection will aid in determining patient satisfaction and cost effectiveness of the Ditto intervention, as well as its effect on speed of wound re-epithelialization. DISCUSSION: Results of this study will provide data on whether the disease process can be altered by reducing stress, pain and anxiety in the context of acute burn wounds. TRIAL REGISTRATION: ACTRN12611000913976.

Bcl-X(L) translocation in renal tubular epithelial cells in vitro protects distal cells from oxidative stress

BACKGROUND: The molecular pathogenesis of different sensitivities of the renal proximal and distal tubular cell populations to ischemic injury, including ischemia-reperfusion (IR)-induced oxidative stress, is not well-defined. An in vitro model of oxidative stress was used to compare the survival of distal [Madin-Darby canine kidney (MDCK)] and proximal [human kidney-2 (HK-2)] renal tubular epithelial cells, and to analyze for links between induced cell death and expression and localization of selected members of the Bcl-2 gene family (anti-apoptotic Bcl-2 and Bcl-X(L), pro-apoptotic Bax and Bad). METHODS: Cells were treated with 1 mmol/L hydrogen peroxide (H2O2) or were grown in control medium for 24 hours. Cell death (apoptosis) was quantitated using defined morphological criteria. DNA gel electrophoresis was used for biochemical identification. Protein expression levels and cellular localization of the selected Bcl-2 family proteins were analyzed (Western immunoblots, densitometry, immunoelectron microscopy). RESULTS: Apoptosis was minimal in control cultures and was greatest in treated proximal cell cultures (16.93 +/- 4.18% apoptosis) compared with treated distal cell cultures (2.28 +/- 0.85% apoptosis, P < 0.001). Endogenous expression of Bcl-X(L) and Bax, but not Bcl-2 or Bad, was identified in control distal cells. Bcl-X(L) and Bax had nonsignificant increases (P> 0.05) in these cells. Bcl-2, Bax, and Bcl-X(L), but not Bad, were endogenously expressed in control proximal cells. Bcl-X(L) was significantly decreased in treated proximal cultures (P < 0.05), with Bax and Bcl-2 having nonsignificant increases (P> 0.05). Immunoelectron microscopy localization indicated that control and treated but surviving proximal cells had similar cytosolic and membrane localization of the Bcl-2 proteins. In comparison, surviving cells in the treated distal cultures showed translocation of Bcl-X(L) from cytosol to the mitochondria after treatment with H2O2, a result that was confirmed using cell fractionation and analysis of Bcl-X(L) expression levels of the membrane and cytosol proteins. Bax remained distributed evenly throughout the surviving distal cells, without particular attachment to any cellular organelle. CONCLUSION: The results indicate that in this in vitro model, the increased survival of distal compared with proximal tubular cells after oxidative stress is best explained by the decreased expression of anti-apoptotic Bcl-X(L) in proximal cells, as well as translocation of Bcl-X(L) protein to mitochondria within the surviving distal cells.

The IL-6 response to Chlamydia from primary reproductive epithelial cells is highly variable and may be involved in differential susceptibility to the immunopathological consequences of chlamydial infection

Background Chlamydia trachomatis infection results in reproductive damage in some women. The process and factors involved in this immunopathology are not well understood. This study aimed to investigate the role of primary human cellular responses to chlamydial stress response proteases and chlamydial infection to further identify the immune processes involved in serious disease sequelae. Results Laboratory cell cultures and primary human reproductive epithelial cultures produced IL-6 in response to chlamydial stress response proteases (CtHtrA and CtTsp), UV inactivated Chlamydia, and live Chlamydia. The magnitude of the IL-6 response varied considerably (up to 1000 pg ml-1) across different primary human reproductive cultures. Thus different levels of IL-6 production by reproductive epithelia may be a determinant in disease outcome. Interestingly, co-culture models with either THP-1 cells or autologous primary human PBMC generally resulted in increased levels of IL-6, except in the case of live Chlamydia where the level of IL-6 was decreased compared to the epithelial cell culture only, suggesting this pathway may be able to be modulated by live Chlamydia. PBMC responses to the stress response proteases (CtTsp and CtHtrA) did not significantly vary for the different participant cohorts. Therefore, these proteases may possess conserved innate PAMPs. MAP kinases appeared to be involved in this IL-6 induction from human cells. Finally, we also demonstrated that IL-6 was induced by these proteins and Chlamydia from mouse primary reproductive cell cultures (BALB/C mice) and mouse laboratory cell models. Conclusions We have demonstrated that IL-6 may be a key factor for the chlamydial disease outcome in humans, given that primary human reproductive epithelial cell culture showed considerable variation in IL-6 response to Chlamydia or chlamydial proteins, and that the presence of live Chlamydia (but not UV killed) during co-culture resulted in a reduced IL-6 response suggesting this response may be moderated by the presence of the organism.

Major issues in business process management : an expert perspective

Study Approach The results presented in this report are part of a larger global study on the major issues in BPM. Only one part of the larger study is reported here, viz. interviews with BPM experts. Interviews of BPM tool vendors together with focus group studies involving user organizations were conducted in parallel and set the groundwork for the identification of BPM issues on a global scale. Through this multi-method approach, we identify four distinct sets of outcomes. First, as is the focus of this report, we identify the BPM issues as perceived by BPM experts. Second, the research design allows us to gain insight into the opinions of organizations deploying BPM solutions. Third, an understanding of organizations’ misconceptions of BPM technologies, as confronted by BPM tool vendors, is obtained. Last, we seek to gain an understanding of BPM issues on a global scale, together with knowledge of matters of concern. This final outcome is aimed to produce an industry-driven research agenda that will inform practitioners and, in particular, the research community worldwide on issues and challenges that are prevalent or emerging in BPM and related areas...

What are the secrets of successful process modelling? Insights from an Australian case study

L'intérêt suscité par la ré-ingénierie des processus et les technologies de l'information révèle l'émergence du paradigme du management par les processus. Bien que beaucoup d'études aient été publiées sur des outils et techniques alternatives de modélisation de processus, peu d'attention a été portée à l'évaluation post-hoc des activités de modélisation de processus ou à l'établissement de directives sur la façon de conduire efficacement une modélisation de processus. La présente étude a pour objectif de combler ce manque. Nous présentons les résultats d'une étude de cas détaillée, conduite dans une organisation leader australienne dans le but de construire un modèle de réussite de la modélisation des processus.

Expertise in Business Process Management

As organizations attempt to become more business process-oriented, existing role descriptions are revised and entire new business process-related roles emerge. A lot of attention is often being paid to the technological aspect of Business Process Management (BPM), but relatively little work has been done concerning the people factor of BPM and the specification of BPM expertise in particular. This study tries to close this gap by proposing a comprehensive BPM expertise model, which consolidates existing theories and related work. This model describes the key attributes characterizing “BPM expertise” and outlines their structure, dynamics, and interrelationships. Understanding BPM expertise is a predecessor to being able to develop and apply it effectively. This is the cornerstone of human capital and talent management in BPM.

Business process mining success

Process mining has developed into a popular research discipline and nowadays its associated techniques are widely applied in practice. What is currently ill-understood is how the success of a process mining project can be measured and what the antecedent factors of process mining success are. We consider an improved, grounded understanding of these aspects of value to better manage the effectiveness and efficiency of process mining projects in practice. As such, we advance a model, tailored to the characteristics of process mining projects, which identifies and relates success factors and measures. We draw inspiration from the literature from related fields for the construction of a theoretical, a priori model. That model has been validated and re-specified on the basis of a multiple case study, which involved four industrial process mining projects. The unique contribution of this paper is that it presents the first set of success factors and measures on the basis of an analysis of real process mining projects. The presented model can also serve as a basis for further extension and refinement using insights from additional analyses.

Inter-sector senior leader transitions : experience and outcomes

Purpose The purpose of this article is to explore the experience of senior leaders who move into the public sector from other sectors of the economy, a process we refer to as inter-sector senior leader transitions. This is a little researched area of public sector leadership yet has significant implications for fundamental public sector reform. Design/methodology/approach We employed an interview design to elicit senior leaders' stories of their transition into the public sector. Findings The data suggest that successful senior leader transitions are more likely when a set of conditions is met; (1) the leader transitions into CEO role, rather than levels below CEO, (2) Ministers provide inter-sector transition support, (3) senior leaders develop responses to stress, (4) senior leaders reject high formalization, (5) their change processes focus on building capacity, and (6) senior leaders confront dysfunctional organizational relationships directly. Research limitations/implications The research relies on a relatively small sample. However, access to senior managers at this level can be difficult. Nevertheless, those senior managers who participated were very willing to share their stories. Practical implications If public sector organizations are to realize the value of successful leaders from other sectors, they need to invest in structured processes that facilitate the transition. A laissez-faire approach is not viable given the cost of such transitions. Originality/value The paper focuses on a little researched area of leadership experience which has significant implications for the development and change of the public sector.

Laser-radar data fusion with Gaussian Process Implicit Surfaces

This work considers the problem of building high-fidelity 3D representations of the environment from sensor data acquired by mobile robots. Multi-sensor data fusion allows for more complete and accurate representations, and for more reliable perception, especially when different sensing modalities are used. In this paper, we propose a thorough experimental analysis of the performance of 3D surface reconstruction from laser and mm-wave radar data using Gaussian Process Implicit Surfaces (GPIS), in a realistic field robotics scenario. We first analyse the performance of GPIS using raw laser data alone and raw radar data alone, respectively, with different choices of covariance matrices and different resolutions of the input data. We then evaluate and compare the performance of two different GPIS fusion approaches. The first, state-of-the-art approach directly fuses raw data from laser and radar. The alternative approach proposed in this paper first computes an initial estimate of the surface from each single source of data, and then fuses these two estimates. We show that this method outperforms the state of the art, especially in situations where the sensors react differently to the targets they perceive.

Traversability estimation for a planetary rover via experimental kernel learning in a Gaussian process framework

A critical requirement for safe autonomous navigation of a planetary rover is the ability to accurately estimate the traversability of the terrain. This work considers the problem of predicting the attitude and configuration angles of the platform from terrain representations that are often incomplete due to occlusions and sensor limitations. Using Gaussian Processes (GP) and exteroceptive data as training input, we can provide a continuous and complete representation of terrain traversability, with uncertainty in the output estimates. In this paper, we propose a novel method that focuses on exploiting the explicit correlation in vehicle attitude and configuration during operation by learning a kernel function from vehicle experience to perform GP regression. We provide an extensive experimental validation of the proposed method on a planetary rover. We show significant improvement in the accuracy of our estimation compared with results obtained using standard kernels (Squared Exponential and Neural Network), and compared to traversability estimation made over terrain models built using state-of-the-art GP techniques.

Process modelling and simulation of tissue damage during mechanical peeling of pumpkin as a tough skinned vegetable

Food waste is a current challenge that both developing and developed countries face. This project applied a novel combination of available methods in Mechanical, agricultural and food engineering to address these challenges. A systematic approach was devised to investigate possibilities of reducing food waste and increasing the efficiency of industry by applying engineering concepts and theories including experimental, mathematical and computational modelling methods. This study highlights the impact of comprehensive understanding of agricultural and food material response to the mechanical operations and its direct relation to the volume of food wasted globally.

Posttraumatic stress disorder and traumatic stress : from bench to bedside, from war to disaster

War is a tragic event and its mental health consequences can be profound. Recent studies indicate substantial rates of posttraumatic stress disorder and other behavioral alterations because of war exposure. Understanding the psychological, behavioral, and neurobiological mechanism of mental health and behavioral changes related to war exposure is critical to helping those in need of care. Substantial work to encourage bench to bedside to community knowledge and communication is a core component of addressing this world health need.

PTSD and traumatic stress : from gene to community and bench to bedside

Individuals and communities are exposed to traumatic events, those that are accidents or naturally occurring and those that are intentional or human made. Although resilience is the expected response, for some, posttraumatic stress disorder may be the outcome. Brain models of PTSD require understanding the phenomenology of the disorder and the brain “break down” that occurs. Among several models, importantly, is the perspective that PTSD is a “forgetting” disorder. Other elements in the onset and triggers of PTSD can identify further models to examine at the bench. New studies of the 5-HT2A receptor, the glucocorticoid receptor, p11, mitochondrial genes and cannabinoids are bringing new perspectives to understanding brain function in PTSD. Effective treatments indicate areas for bench research on the mechanisms of the disorder.

The Royal Commission into the NSW Police Service : process corruption and the limits of judicial reflexivity

This paper will offer an examination of the Reports of the Royal Commission into the NSW Police Service (Interim Report February 1996; Interim Report: Immediate Measures November 1996; Final Report Vol I: Corruption; Final Report Vol II: Reform; Final Report Vol III: Appendices May 1997) excluding the Report on Paedophilia, August 1997. The examination will be confined essentially to one question: to what extent do the published Reports consider the part played by the judiciary, prosecutors and lawyers, in the construction of a form of criminal justice revealed by the Commission itself, to be disfigured by serious process corruption? The examination will be conducted by way of a chronological trawl through the Reports of the Commission in an attempt to identify all references to the role of the judiciary, prosecutors and lawyers. The adequacy of any such treatment will then be considered. In order to set the scene a brief and generalised overview of the Wood Commission will be offered together with the Commission's definition of process corruption.

Corticosterone accelerates atherosclerosis in the apolipoprotein E-deficient mouse

Chronic stress is an important risk factor for atherosclerosis, which is a chief process in the development of cardiovascular disease. Increased circulating levels of corticosterone have been documented in several animal models of chronic stress. However, it remains to be established whether corticosterone is sufficient to exacerbate atherosclerosis. To test this hypothesis, apolipoprotein E (ApoE)-deficient mice were fed a high-fat diet for 13 weeks with exposure to either corticosterone or vehicle in the drinking water (CORT and Con). Corticosterone treatment significantly increased atherosclerotic plaque area at the aortic root. Such exacerbation of atherosclerosis was accompanied by significantly lower levels of circulating white blood cells and serum interleukin-1β (IL-1β), and significantly elevated serum concentrations of total cholesterol, low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL) and small dense low-density lipoprotein (sd-LDL) in CORT mice when compared to Con mice. These findings demonstrate that corticosterone is sufficient to exacerbate atherosclerosis in vivo despite its anti-inflammatory properties and that this marked pro-atherogenic phenotype is primarily associated with increased dyslipidaemia.