Nano- to macroscale remodeling of functional tissue-engineered bone

A higher degree of mineralization is found within scaffold groups implanted with cells compared to scaffold alone demonstrating greater bone regenerative potential of cell-scaffold constructs Tissue engineered bone analysed using ESEM and SAXS demonstrates bone formation within the scaffold to be preferentially aligned around the scaffold struts. The mineral particles are not shown to orientate around the osteons within the native bone.

Comparison of two methods to assess malnutrition in community-dwelling people with Parkinson's disease

Nutritional status in people with Parkinson’s disease (PD) has previously been assessed in a number of ways including BMI, % weight loss and the Mini-Nutritional Assessment(MNA). The symptoms of the disease and the side effects of medication used to manage them result in a number of nutrition impact symptoms that can negatively influence intake. These include chewing and swallowing difficulties, lack of appetite, nausea, and taste and smell changes, among others. Community-dwelling people with PD, aged >18 years, were recruited (n=97, 61 M, 36 F). The Patient-Generated Subjective Global Assessment(PG-SGA) and (MNA) were used to assess nutritional status. Weight, height, mid-arm circumference(MAC) and calf circumference were measured. Based on SGA, 16(16.5%) were moderately malnourished (SGA B) while none were severely malnourished (SGA C). The MNA identified 2(2.0%) as malnourished and 22(22.7%) as at risk of malnutrition. Mean MNA scores were different between the three groups,F(2,37)=7.30,p<.05 but not different between SGA B (21.0(2.9)) and MNA at risk (21.8(1.4)) participants. MAC and calf circumference were also different between the three groups,F(2,37)=5.51,p<.05 and F(2,37)=15.33,p<.05 but not between the SGA B (26.2(4.2), 33.3(2.8)) and MNA at risk (28.4(5.6), 36.4(4.7)) participants. The MNA results are similar to other PD studies using MNA where prevalence of malnutrition was between 0-2% with 20-33% at risk of malnutrition. In this population, the PG-SGA may be more sensitive to assessing malnutrition where nutrition impact symptoms influence intake. With society’s increasing body size, it might also be more appropriate as it does not rely on MAC and calf circumference measures.

Motorcycle Safety Research Project Interim Report 2 : Review of the Consistent Assessment Process (CAP)

Motorcycle trauma is a serious road safety issue in Queensland and throughout Australia. In 2009, Queensland Transport (later Transport and Main Roads or TMR) appointed CARRS-Q to provide a three-year program of Road Safety Research Services for Motorcycle Rider Safety. Funding for this research originated from the Motor Accident Insurance Commission. This program of research was undertaken to produce knowledge to assist TMR to improve motorcycle safety by further strengthening the licensing and training system to make learner riders safer by developing a pre-learner package (Deliverable 1), and by evaluating the Q-Ride CAP program to ensure that it is maximally effective and contributes to the best possible training for new riders (Deliverable 2), which is the focus of this report. Deliverable 3 of the program identified potential new licensing components that will reduce the incidence of risky riding and improve higher-order cognitive skills in new riders. This report provides a summary of Deliverables 2.1 through to 2.4.

Parents’ experience of time distortion following diagnosis of a serious or lethal fetal anomaly

PURPOSE: To explore the experience of couples who continued pregnancy following a diagnosis of serious or lethal fetal anomaly. STUDY DESIGN: Thirty-one male and female participants were recruited from a high-risk maternal–fetal medicine clinic in Washington State. Data were collected using in-depth interviews during pregnancy and after the birth of their baby. Transcribed interviews were thematically analyzed through the phenomenological lens of Merleau-Ponty. FINDINGS: Participants described how time became reconfigured and reconstituted as they tried to compress a lifetime of love for their future child into a limited period. Participants’ concepts of time became distorted and were related to their perceptual lived experience rather than the schedule-filled,regimented, linear clock time that governed the health professionals. CONCLUSION: Living in distorted time may be a mechanism parents use to cope with overwhelming and disorienting feelings when their unborn baby is diagnosed with a fetal anomaly.

Credentialing the infection control practitioner

The following proposal is submitted by the AICA's credentialling and certification subcommittee for your consideration. It outlines a process and procedure for interim credentialling of infection control practitioners. In submitting this proposal, the subcommittee acknowledges that, while competency-based education is the preferred process for credentialling, there are clinicians who, in the absence of educational opportunities, have developed a specialist level of competency in infection control practice through self education and experience. Committee members also recognise the need for self-regulation of accrediting processes, to maintain standards in practice and support members in their clinical roles. We ask you to review the following proposal and invite your comments and critique, to be received by the last week in January 1998.

Foundations of International Climate Law : Objectives, principles and methods

This chapter explores the objectives, principle and methods of climate law. The United Nations Framework Convention on Climate Change (UNFCCC) lays the foundations of the international regime by setting out its ultimate objectives in Article 2, the key principles in Article 3, and the methods of the regime in Article 4. The ultimate objective of the regime – to avoid dangerous anthropogenic interference – is examined and assessments of the Intergovernmental Panel on Climate Change (IPCC) are considered when seeking to understand the definition of this concept. The international environmental principles of: state sovereignty and responsibility, preventative action, cooperation, sustainable development, precaution, polluter pays and common but differentiated responsibility are then examined and their incorporation within the international climate regime instruments evaluated. This is followed by an examination of the methods used by the mitigation and adaptation regimes in seeking to achieve the objective of the UNFCCC. Methods of the mitigation regime include: domestic implementation of policies, setting of standards and targets and allocation of rights, use of flexibility mechanisms, and reporting. While it is noted that methods of the adaptation regime are still evolving, the latter includes measures such as impact assessments, national adaptation plans and the provision of funding.

The process and patterns of combining the use of traditional Chinese medicine and Western medicine in Taiwanese people with cancer

Objective: The nature of contemporary cancer therapy means that patients are faced with difficult treatment decisions about surgery, chemotherapy and radiotherapy. For some, this process may also involve consideration of therapies that sit outside the biomedical approach to cancer treatment, in our research, traditional Chinese medicine (TCM). Thus, it is important to explore how cancer patients in Taiwan incorporate TCM into their cancer treatment journey. This paper aims to explore of the patterns of combining the use of TCM and Western medicine into cancer treatment journey in Taiwanese people with cancer. Methods: The sampling was purposive and the data collected through in-depth interviews. Data collection occurred over an eleven month. The research was grounded in the premises of symbolic interactionism and adopted the methods of grounded theory. Twenty four participants who were patients receiving cancer treatment were recruited from two health care settings in Taiwan. Results: The study findings suggest that perceptions of health and illness are mediated through ongoing interactions with different forms of therapy. The participants in this study had a clear focus on “process and patterns of using TCM and Western medicine”. Further, ‘different importance in Western medicine and TCM’, ‘taken for granted to use TCM’, ‘each has specialized skills in Western medicine and TCM’ and ‘different symptoms use different approaches (Western medicine or TCM)’ may explicit how the participants in this study see CAM and Western medicine. Conclusions/Implications for practice: The descriptive frame of the study suggests that TCM and Western medicine occupy quite distinct domains in terms of decision making over their use. People used TCM based on interpretations of the present and against a background of an enduring cultural legacy grounded in Chinese philosophical beliefs about health and healthcare. The increasingly popular term of 'integrative medicine' obscures the complex contexts of the patterns of use of both therapeutic modalities. It is this latter point that is worthy of further exploration.

Transmission X-ray microscopy : a new tool in clay mineral floccules characterization

Effective flocculation and dewatering of mineral processing streams containing clays are microstructure dependent in clay-water systems. Initial clay flocculation is crucial in the design and for the development of a new methodology of gas exploitation. Microstructural engineering of clay aggregates using covalent cations and Keggin macromolecules have been monitored using the new state of the art Transmission X-ray Microscope (TXM) with 60 nm tomography resolution installed in a Taiwanese synchrotron. The 3-D reconstructions from TXM images show complex aggregation structures in montmorillonite aqueous suspensions after treatment with Na+, Ca2+ and Al13 Keggin macromolecules. Na-montmorillonite displays elongated, parallel, well-orientated and closed-void cellular networks, 0.5–3 μm in diameter. After treatment by covalent cations, the coagulated structure displays much smaller, randomly orientated and openly connected cells, 300–600 nm in diameter. The average distances measured between montmorillonite sheets was around 450 nm, which is less than half of the cell dimension measured in Na-montmorillonite. The most dramatic structural changes were observed after treatment by Al13 Keggin; aggregates then became arranged in compacted domains of a 300 nm average diameter composed of thick face-to-face oriented sheets, which forms porous aggregates with larger intra-aggregate open and connected voids.

The use of hypnosis in labor and delivery : a preliminary study

Self-hypnosis was taught to 87 obstetric patients (HYP) and was not taught to 56 other patients (CNTRL), all delivered by the same family physician, in order to determine whether the use of self-hypnosis by low-risk obstetric patients leads to fewer technologic interventions during their deliveries or greater satisfaction of parturients with their delivery experience or both. The outcomes of the deliveries of these two groups were compared, and the HYP group was compared to 352 low-risk patients delivered by other family physicians at the same hospital (WCH). Questionnaires were mailed postpartum to 156 patients, all delivered by the same family physician, to determine satisfaction with delivery using the Labor and Delivery Satisfaction Index (LADSI). The hypnosis group showed a significant reduction in the number of epidurals (11.4% less than CNTRL and 17.9% less than WCH, p < 0.05) and the use of intravenous lines (18.5% less for both, p < 0.05). The number of episiotomies was significantly less in the HYP group compared to WCH (15.9%, p < 0.05) and 11.5% less when compared to CNTRL. The tear rate was not statistically different. Combined use of the intervention triad (epidural–forceps–episiotomy) was less for HYP than for CNTRL (15.8% less) and WCH (10.2% less, p < 0.05). More deliveries were done in the labor room with HYP than CNTRL (21%, p < 0.05). The second stage was shortened by 10 min (HYP vs CNTRL). Overall satisfaction of HYP and CNTRL patients was similar and generally favorable.

Vibrational spectroscopic characterization of the phosphate mineral phosphophyllite – Zn2Fe(PO4)2·4H2O, from Hagendorf Süd, Germany and in comparison with other zinc phosphates

This research was undertaken on phosphophyllite sample from the Hagendorf Süd pegmatite, Bavaria, Germany. Chemical analysis was carried out by Scanning Electron Microscope in the EDS mode and indicates a zinc and iron phosphate with partial substitution of manganese, which partially replaced iron. The calculated chemical formula of the studied sample was determined to be: Zn2(Fe0.65, Mn0.35)P1.00(PO4)2- �4(H2O). The intense Raman peak at 995 cm�1 is assigned to the m1 PO3� 4 symmetric stretching mode and the two Raman bands at 1073 and 1135 cm�1 to the m3 PO3� 4 antisymmetric stretching modes. The m4 PO3� 4 bending modes are observed at 505, 571, 592 and 653 cm�1 and the m2 PO3� 4 bending mode at 415 cm�1. The sharp Raman band at 3567 cm�1 attributed to the stretching vibration of OH units brings into question the actual formula of phosphophyllite. Vibrational spectroscopy enables an assessment of the molecular structure of phosphophyllite to be assessed.

Infrared and Raman spectroscopic characterization of the carbonate mineral weloganite – Sr3Na2Zr(CO3)6·3H2O and in comparison with selected carbonates

The mineral weloganite Na2Sr3Zr(CO3)6·3H2O has been studied by using vibrational spectroscopy and a comparison is made with the spectra of weloganite with other carbonate minerals. Weloganite is member of the mckelveyite group that includes donnayite-(Y) and mckelveyite-(Y). The Raman spectrum of weloganite is characterized by an intense band at 1082 cm−1 with shoulder bands at 1061 and 1073 cm−1, attributed to the View the MathML source symmetric stretching vibration. The observation of three symmetric stretching vibrations is very unusual. The position of View the MathML source symmetric stretching vibration varies with mineral composition. The Raman bands at 1350, 1371, 1385, 1417, 1526, 1546, and 1563 cm−1 are assigned to the ν3 (CO3)2− antisymmetric stretching mode. The observation of additional Raman bands for the ν3 modes for weloganite is significant in that it shows distortion of the carbonate anion in the mineral structure. The Raman band observed at 870 cm−1 is assigned to the (CO3)2− ν2 bending mode. Raman bands observed for weloganite at 679, 682, 696, 728, 736, 749, and 762 cm−1 are assigned to the (CO3)2− ν4 bending modes. A comparison of the vibrational spectra is made with that of the rare earth carbonates decrespignyite, bastnasite, hydroxybastnasite, parisite, and northupite.

ActiGraph GT3X determined variations in “free-living” standing, lying, and sitting duration among sedentary adults

Background Overweight and obesity has become a serious public health problem in many parts of the world. Studies suggest that making small changes in daily activity levels such as “breaking-up” sedentary time (i.e., standing) may help mitigate the health risks of sedentary behavior. The aim of the present study was to examine time spent in standing (determined by count threshold), lying, and sitting postures (determined by inclinometer function) via the ActiGraph GT3X among sedentary adults with differing weight status based on body mass index (BMI) categories. Methods Participants included 22 sedentary adults (14 men, 8 women; mean age 26.5 ± 4.1 years). All subjects completed the self-report International Physical Activity Questionnaire to determine time spent sitting over the previous 7 days. Participants were included if they spent seven or more hours sitting per day. Postures were determined with the ActiGraph GT3X inclinometer function. Participants were instructed to wear the accelerometer for 7 consecutive days (24 h a day). BMI was categorized as: 18.5 to <25 kg/m2 as normal, 25 to <30 kg/m2 as overweight, and ≥30 kg/m2 as obese. Results Participants in the normal weight (n = 10) and overweight (n = 6) groups spent significantly more time standing (after adjustment for moderate-to-vigorous intensity physical activity and wear-time) (6.7 h and 7.3 h respectively) and less time sitting (7.1 h and 6.9 h respectively) than those in obese (n = 6) categories (5.5 h and 8.0 h respectively) after adjustment for wear-time (p < 0.001). There were no significant differences in standing and sitting time between normal weight and overweight groups (p = 0.051 and p = 0.670 respectively). Differences were not significant among groups for lying time (p = 0.55). Conclusion This study described postural allocations standing, lying, and sitting among normal weight, overweight, and obese sedentary adults. The results provide additional evidence for the use of increasing standing time in obesity prevention strategies.

Intern underperformance is detected more frequently in emergency medicine rotations

Objective: To determine the frequency and nature of intern underperformance as documented on in-training assessment forms. Methods: A retrospective review of intern assessment forms from a 2 year period (2009–2010) was conducted at a tertiary referral hospital in Brisbane, Queensland. The frequency of interns assessed as ‘requiring substantial assistance’ and/or ‘requires further development’ on mid- or end-of-term assessment forms was determined. Forms were analysed by the clinical rotation, time of year and domain(s) of clinical practice in which underperformance was documented. Results: During 2009 and 2010 the overall documented incidence of intern underperformance was 2.4% (95% CI 1.5–3.9%). Clinical rotation in emergency medicine detected significantly more underperformance compared with other rotations (P < 0.01). Interns predominantly had difficulty with ‘clinical judgment and decision-making skills’, ‘time management skills’ and ‘teamwork and colleagues’ (62.5%, 55% and 32.5% of underperforming assessments, respectively). Time of the year did not affect frequency of underperformance. A proportion of 13.4% (95% CI 9.2–19.0%) of interns working at the institution over the study period received at least one assessment in which underperformance was documented. Seventy-six per cent of those interns who had underperformance identified by mid-term assessment successfully completed the term following remediation. Conclusion: The prevalence of underperformance among interns is low, although higher than previously suggested. Emergency medicine detects relatively more interns in difficulty than other rotations.

Improving psychosocial care: a professional development programme

Despite the numerous reports of difficulties experienced by health care providers in providing psychosocial care to terminally ill patients and their families, few studies have yet been undertaken to examine the effectiveness of different educational approaches to addressing these issues. The aim of this paper is to describe a programme of professional development for palliative care nurses, which is currently being offered to 181 registered nurses in Queensland, Australia. The programme is based on an action learning model and is designed to facilitate processes of reflection and peer consultation. In Part One of this paper, a review of this literature is presented to provide the background and rationale for the programme design. Details of the research programme developed to evaluate the programme will be presented in Part Two of this paper, which is to be published in the next issue of this Journal. Surveys of health professionals suggest that the demands of working with terminally ill patients are associated with a great deal of stress (Beaton and Degner 1990, Seale 1992, Vachon 1995), and emotional burden, as they are confronted with their patients' physical and emotional suffering over extended periods of time (Ullrich and Fitzgerald 1990). Key areas of concern (Lyons 1988, Bramwell 1989, Seale 1992, Copp and Dunn 1993, Wilkinson 1995) include: * Handling questions and conversations with dying patients. * Dealing with ethical and moral issues. * Handling emotions. * Giving hope. * Providing spiritual care and bereavement support. * Confronting team communication problems.