Straddling the pathway from paediatrician to mainstream health care : transition issues experienced in disability care

Objective: To identify the strengths and limitations of health care and related services provided to young adults with a disability during the period of transition from the care of a paediatrician to the mainstream health system.
Design: A descriptive design was used to address the study objectives.
Setting: Barwon and south-western region of Victoria.
Subjects: Twelve focus group discussions, with young adults with a disability, carers of young adults with a disability and health care service providers. Each focus group involved eight to 10 participants.
Results: The findings revealed a number of problems with the transition period. All participants acknowledged the supportive, coordinating role of the paediatrician. In the absence of this type of role, carers felt they lacked the knowledge and support to manage the adolescent with a disability. Communication problems between all service providers were identified as being problematical. The general lack of continuity of care between providers made it difficult for individuals to negotiate the transition period and increased the burden of care on carers.
Conclusion: There is a need for policy makers to address these transition problems and develop appropriate services that improve the situation for young adults with a disability and their carers.
What is already known: It is well documented that the transition period from paediatrician to adult health care services is problematic for the young adult with a disability and their carer. The difficulties experienced are attributed to poor communication between service providers and a lack of continuity of care.
What does this study add: This study provides insights from a number of different consumer and health care professionals' perspectives. The findings identify service delivery gaps and a need to develop health care services that could assist the young adult with the disability negotiate this transition from the paediatric services to mainstream health care services in rural and regional settings in Victoria.

Analysis of zinc transporter, hZnT4(Slc30A4), gene expression in a mammary gland disorder leading to reduced zinc secretion into milk

Zinc deficiency, causing impaired growth and development, may have a nutritional or genetic basis. We investigated two cases of inherited zinc deficiency found in breast-fed neonates, caused by low levels of zinc in the maternal milk. This condition is different from acrodermatitis enteropathica but has similarities to the "lethal milk" mouse, where low levels of zinc in the milk of lactating dams leads to zinc deficiency in pups. The mouse disorder has been attributed to a defect in the ZnT4 gene. Little is known about the expression of the human orthologue, hZnT4 (Slc30A4). Sequence analysis of cDNA, real-time PCR and Western blot analysis of hZnT4, carried out on control cells and cells from unrelated mothers of two infants with zinc deficiency, showed no differences. The hZnT4 gene was highly expressed in mouthwash buccal cells compared with lymphoblasts and fibroblasts. The hZnT4 protein did not co-localise with intracellular free zinc pools, suggesting that hZnT4 is not involved in transport of zinc into vesicles destined for secretion into milk. This observation, combined with phenotypic differences between the "lethal milk" mouse and the human disorder, suggests that the "lethal milk" mouse is not the corresponding model for the human zinc deficiency condition.

Linking environmental uncertainty to non-financial performance measures and performance : a research note

Several previous research studies have reported mixed results concerning the direct association between non-financial performance measures and  performance. The presence of environmental uncertainty on this relationship has not been established. This paper makes a contribution to this area by proposing that it is in conditions of environmental uncertainty that non-financial measures are most useful in improving organizational performance. It analyses empirical data from a sample of New Zealand manufacturing organizations to test the hypothesis that non-financial measures of performance would lead to improved organizational performance under conditions of increased environmental uncertainty. Multiple regression analysis of the data suggests that performance should be a declining function of the size of the ‘mismatch’ between an organization's environment and use of the different combinations of non-financial performance measures. Further, the paper concludes that prior mixed results may be attributed to the omission of environmental uncertainty.

The influence of twinning on the hot working flow stress and microstructural evolution of magnesium alloy AZ31

The microstructural evolution during compression (at 350°C and a strain rate of 0.01s-1) was examined for magnesium alloy AZ31 received in the "as-cast" condition. It was revealed that at low strains, many twins are produced and dynamically recrystallized (DRX) grains form as a necklace along pre-existing grain boundaries. At higher strains, DRX stagnates, most likely due to the accommodation of deformation in the DRX fraction of the material. It was also observed that twin boundaries act as sites for the nucleation of DRX grains. The analysis was repeated for samples pre-compressed to a strain of 0.15 at room temperature prior to the hot deformation step. The idea of these additional tests was to increase the degree of twinning and therefore the density of sites for the nucleation of DRX. It was found that statically recrystallized (SRX) grains developed at the twins during heating to the test temperature. When these samples were deformed, the peak flow stress was reduced by approximately 20% and the development of DRX was enhanced. This can be attributed to the accelerated nucleation of DRX in the refined SRX structure.

Safety of low-carbohydrate diets

Low-carbohydrate diets have re-emerged into the public spotlight and are enjoying a high degree of popularity as people search for a solution to the population's ever-expanding waistline. The current evidence though indicates that low-carbohydrate diets present no significant advantage over more traditional energy-restricted diets on long-term weight loss and maintenance. Furthermore, a higher rate of adverse side-effects can be attributed to low-carbohydrate dieting approaches. Short-term efficacy of low-carbohydrate diets has been demonstrated for some lipid parameters of cardiovascular risk and measures of glucose control and insulin sensitivity, but no studies have ascertained if these effects represent a change in primary outcome measures. Low-carbohydrate diets are likely effective and not harmful in the short term and may have therapeutic benefits for weight-related chronic diseases although weight loss on such a program should be undertaken under medical supervision. While new commercial incarnations of the low-carbohydrate diet are now addressing overall dietary adequacy by encouraging plenty of high-fibre vegetables, fruit, low-glycaemic-index carbohydrates and healthier fat sources, this is not the message that reaches the entire public nor is it the type of diet adopted by many people outside of the world of a well-designed clinical trial. Health effects of long-term ad hoc restriction of inherently beneficial food groups without a concomitant reduction in body weight remains unanswered.

Using chitosan as a thickener for electrospinning dilute PVA solutions to improve fibre uniformity

Chitosan was added to PVA aqueous solutions as a thickener to improve the electrospinning process. The presence of a small amount of chitosan considerably improved the uniformity of as-spun nanofibres. This improvement is attributed to its significant effect on the solution viscosity and conductivity, with only a slight impact on the surface tension. The concentration of the PVA required to produce bead-free and uniform nanofibres was reduced with the increase in chitosan concentration. The chitosan thickener suppressed the jet break-up and facilitated the jet stretching so that fine and uniform fibres could be electrospun even from a dilute PVA solution.

Microstructural development during hot working of Mg-3AI-1Zn

he microstructural evolution is examined during the hot compression of magnesium alloy AZ31 for both wrought and as-cast initial microstructures. The influences of strain, temperature, and strain rate on the dynamically recrystallized microstructures are assessed. Both the percentage dynamic recrysallization (DRX) and the dynamically recrystallized grain size were found to be sensitive to the initial microstructure and the applied deformation conditions. Lower Z conditions (lower strain rates and higher temperatures) yield larger dynamically recrystallized grain sizes and increased percentages of DRX, as expected. The rate with which the percentage DRX increases for the as-cast material is considerably lower than for the wrought material. Also, in the as-cast samples, the percentage DRX does not continue to increase toward complete DRX with decreasing Z. These observations may be attributed to the deformation becoming localized in the DRX fraction of the material. Also, the dynamically recrystallized grain size is generally larger in as-cast material than in wrought material, which may be attributed to DRX related to twins and the inhomogeneity of deformation. Orientation maps of the as-cast material (from electron backscattering diffraction (EBSD) data) reveal evidence of discontinuous DRX (DDRX) and DRX related to twins as predominant mechanisms, with some manifestation of continuous DRX (CDRX) and particle-stimulated nucleation (PSN).

Online pedagogy and academic work

This paper emerges from a study that foregrounds the complex nature of the consequences of a decision to implement a range of new technologies including a Learning Management System at one university. The paper draws upon data from interviews with academics to provide insights into the experience of being academic in the 21st century during a time when new technologies of teaching, learning and administration impact on the work of professional academics. It focuses on how academics view and understand online teaching environments; how they make professional judgments about their use of online environments in their teaching and how they make professional judgments about pedagogy. In doing this the paper looks at the differing levels of uptake of new technologies by academics, their levels of engagement and disengagement, the complexity of their relationship with these technologies and their impact on the pedagogy of academics in the study as it looks at patterns of usage in terms of age, gender and levels of experience of academics. It demonstrates the importance of pedagogy to academics and the problems that academics face many of which can be attributed to the impact of measures of bureaucratisation and standardisation including the introduction of an LMS that some argue has lead to the homogenisation of the experience of teaching and learning for both academics and students.

Environmental factors affecting transcription of the human L1 retrotransposon. I. Steroid hormone-like agents

The L1 retrotransposon has significantly shaped the structure of the human genome. At least 30% of human genome sequence can be attributed to L1 reverse transcriptase activity. There are 105 copies of the human L1 retrotransposon, L1Hs, most of which are defective, although ~8–9x103 are full length. L1Hs elements transpose through an RNA intermediate and transcription is thought to be the rate limiting step in retrotransposition. Because transcription of retrotransposons in a variety of organisms has been shown to respond to environmental stimuli, we investigated the influence of various agents on transcription from two different L1Hs promoters. The activity of the L1Hs promoters was analyzed by transfecting L1Hs-expressing cell lines with plasmids containing the L1Hs promoters fused to the LacZ reporter gene and monitoring expression with a ß-galactosidase assay. Small increases in ß-galactosidase activity were observed with both L1Hs promoters after treatment with serum, testosterone, dihydrotestosterone and organochloride pesticides, indicating that these agents can influence L1Hs transcription.

Adiponectin in umbillcal cord blood is inversely related to low-density lipoprotein cholesteril but not ethnicity

Context: Adiponectin is a recognized protective risk marker for cardiovascular disease in adults and is associated with an optimal lipid profile. The role of adiponectin at birth is not well understood, and its relationship with the neonatal lipid profile is unknown. Because ethnic disparities in cardiovascular risk have been attributed to low adiponectin and its associated low high-density lipoprotein cholesterol (HDL-C), investigation at birth may help determine the etiology of these risk patterns.

Objective: Our objective was to investigate the relationship between neonatal adiponectin and lipid profile at birth in two ethnic groups in cord blood.

Design, Setting, and Participants: Seventy-four healthy mothers and their newborns of South Asian and White European origin were studied in this cross-sectional study at St. Mary’s Hospital, Manchester, United Kingdom.

Main Outcome Measures: Serum adiponectin, total cholesterol, HDL-C, low-density lipoprotein cholesterol (LDL-C), and triglyceride levels were measured in umbilical venous blood at birth and in maternal blood collected at 28 wk gestation.

Results: Cord adiponectin was significantly inversely associated with cord LDL-C (r = –0.32; P = 0.005) but not HDL-C. In a multiple regression analysis, cord LDL-C remained the most significant association of cord adiponectin (ß = –0.13; P < 0.001). We did not find any significant ethnic differences in cord adiponectin or lipids with the exception of triglycerides, which were significantly lower in South Asian newborns (P < 0.05).

Conclusion: This is the first report of an inverse relationship between cord adiponectin and LDL-C at birth. In contrast to adult studies, we found no significant association between adiponectin and HDL-C in cord blood. Our results and the strong independent association between adiponectin and HDL-C observed in adult studies suggest a role for adiponectin in lipid metabolism. Ethnic differences in adiponectin may arise after birth.

Application of SWAT to model the water balance of the Woady Yaloak River catchment, Australia

The widespread land use changes that are expected to occur across the Corangamite region in southwest Victoria, Australia, have the potential to significantly alter the water balance of catchments. Adoption of the Soil and Water Assessment Tool (SWAT), which is a long-term water balance model, as a tool for predicting land use change impacts on catchment water balance for the Corangamite region is currently being considered. This paper describes the initial application of SWAT to the Woady Yaloak River catchment, located within the Corangamite region, to carry out an evaluation of its abilities for simulating the long-term water balance dynamics of the catchment. The performance of the model for predicting runoff at annual and monthly time scales was found to be very good. The excessive recharge of the shallow aquifer that occurred during winter, despite the subsoil being relatively impermeable, ultimately contributed to overestimation of baseflow and underestimation of interflow. The actual evapotranspiration from hydrologic response units (HRU s) containing eucalyptus trees was significantly less than that from HRUs containing pasture, a problem attributed to the incorrect simulation of Leaf Area Index (LAI) and biomass by the model for mature stands of eucalyptus trees and also to assigning inadequate values for two parameters that directly influence evapotranspiration. SWAT has very good potential for being used as tool to study land use change impacts across the Corangamite region provided that several modifications are made to the model to overcome some of the shortcomings and deficiencies that were identified in this initial application.

EBSD analysis of a Ti-IF steel subjected to hot torsion in the ferritic region

The effect of grain size on the warm deformation behaviour of a titanium stabilized interstitial free steel was investigated using hot torsion. Tests were performed at temperatures between 765 °C and 850 °C at strain rates between 0.003 s−1 and 1 s−1 for samples with grain sizes of 25 μm, 75 μm and 150 μm. The structures were observed using EBSD analysis and are consistent with those expected for materials dominated by dynamic recovery. Some evidence was found for small amounts of thermally induced migration of pre-existing boundary (bulging) and for the generation of new segments of high angle boundaries by continuous dynamic recrystallization. The early onset of a steady-state flow stress in the finer grained samples is attributed to one or a combination of thermally induced boundary migration and enhanced rates of recovery near subgrain (and grain) boundaries.

Investigations of the I Ching : II. Reliability and validity studies

In six studies on the I Ching - an ancient Chinese system of divination - successful predictions of first- and second-hexagrams (i.e., hexagram hitting) based on pre-selections of corresponding descriptor-pairs have ranged from chance, to significantly above chance. No significant effect below chance has ever been found. Hexagram hitting has been predicted by measures such as paranormal belief, time perspective, and meaningfulness. Storm (2008a) found a near-significant aggregate hexagram hit rate of 27%. Though these results are encouraging, there has been no assessment of the reliability and validity of the main test instrument used in the I Ching studies, the Hexagram Descriptor Form (HDF). To test the validity of the HDF, three control methods were tested against the experimental method. Taking first- and second-hexagram hit rates together, three out of 22 tests on the experimental method (14%) were significant or near-significant. Three significant or near-significant outcomes out of 66 control tests (4.5%) were attributed to chance. Inter-rater reliability was tested using two I Ching experts who judged the 64 descriptor-pairs of the HDF for suitability against their corresponding hexagram readings. The correlation between judges' ratings was not significant (the mean rating ranged between 60% and 82%). Using the pooled data of six studies, the HDF was tested for possible selection and outcome biases. A selection bias was found, but no outcome biases were found. The I Ching and the HDF were considered suitable for parapsychological research.

"Tell us something new!" : the response of planning and transport professionals to public health guidance on the built environment and physical activity

A large proportion of non-communicable disease can be attributed to modifiable risk factors such as poor nutrition and physical inactivity. We present data on planning and transport practitioners' perceptions and responses to government public health guidance aimed at modifying environmental factors to promote physical activity. This study was informed by questions on the role of evidence-based guidance, the views of professionals towards the guidance, the links between guidance and existing legislation and policy and the practicality of guidelines. A key informant 'snowball' sampling technique was used to recruit participants from the main professional planning organisations across England. Seventy-six people were interviewed in eight focus groups. We found that evidence-based public health guidance is a new voice in urban and town planning, although much of the advice is already reflected by the 'accepted wisdom' of these professions. Evidence-based health guidance could be a powerful driver affecting planning practice, but other legislated planning guidance may take priority for planning and transport professionals.

Effects of undoped and manganese-doped zinc oxide nanoparticles on the colour fading of dyed polyester fabrics

This paper describes the effects of applying coatings of an acrylic polymer containing nanoparticles of zinc oxide (ZnO) on the fading rate in artificial sunlight of polyester fabrics dyed with disperse dyes containing anthraquinone and benzopyran chromophores. Factors affecting the transparency and UV absorbance of the coatings are discussed. Removing the UV component of sunlight with ZnO nanoparticles markedly decreased the fading rate of the dyes, provided the polymer/ZnO film was not in direct contact with the fabric. When the treatment was applied directly to the fabrics, however, the protection against colour fading was different for the two dyes studied. Whereas the rate of colour fading of a benzopyran dye, of relatively low lightfastness, was decreased by the polymer-ZnO film, the treatment increased the fading rate of the dye of higher lightfastness, based on anthraquinone. This effect has been attributed to the generation of reactive oxygen species (ROS) when ZnO is exposed to UV. The effect of decreasing the photoactivity of ZnO by doping with manganese has been examined. For the benzopyran dye, the UV protection was greatly increased, whereas a much smaller improvement was found for the anthraquinone-based dye.