Support needs of parents of sick and/or preterm infants admitted to a neonatal unit

Background: The sudden unexpected delivery of a preterm infant is a shock to parents with studies confirming the importance of providing them with nursing support. The purpose of this descriptive study was to identify the type and level of support that nurses provided to the parents of sick and/or preterm infants. It also investigated whether parents were satisfied with the support provided by nursing staff.
Method: A convenience sample of 112 parents in an Australian tertiary neonatal unit were invited to complete the ‘Nurse Parent Support Tool’ (NPST), which is a 21-item questionnaire. The NPST consists of four domains: emotional, informational, appraisal and instrumental support. A second tool was used to assess parents’ satisfaction with the nurse to parent support.
Results: Instrumental support had the highest mean score for both nurse to parent support at 4.51 (out of 5) and 4.36 (out of 5) for satisfaction. The mean score for nursing support was 4.21 followed by parental satisfaction with nurse to parent support which was 4.16. In contrast, emotional support had the lowest mean score for both nurse to parent support at 3.94 and 3.97 for satisfaction. Parents indicated that they needed further support with lactation, breastfeeding and assistance with parenting skills.
Conclusion: Overall, the results from the study indicated that parents’ perception of nursing support was positive and that parents were highly satisfied with the nursing support provided in the neonatal unit. However, some attention needs to be given to providing more support and information on breastfeeding and parenting skills.

Support needs of parents of sick and/or preterm infants admitted to a neonatal unit

The sudden unexpected delivery of a preterm infant elicits many emotional responses from parents, with studies confirming the importance of providing parents with nursing support. The purpose of this study was to measure parents' perception of the type and level of support that nurses provided in an Australian neonatal unit, and to determine the extent to which parents were satisfied with the support currently provided. A convenience sample of 112 parents in an Australian tertiary neonatal unit were invited to complete the nurse parent support tool (NPST), which is a 21-item questionnaire used to measure the level of nursing support. The NPST consists of four domains -emotional, informational, appraisal and instrumental support. A second tool was used to assess parent satisfaction with nurse-to-parent support. A total of 62 parents completed the NPST and satisfaction tool.

Results showed that instrumental support had the highest mean score for both nurse-to-parent support 4.51 (out of 5) and 4.36 for satisfaction. The mean score for nursing support was 4.21 followed by satisfaction with nurse-to-parent support at 4.16. In contrast, emotional support had the lowest mean score for both nurse-to-parent support at 3.94 and 3.97 for satisfaction. Parents indicated that they needed further support with lactation, breastfeeding and assistance with parenting skills. Overall, results indicated that parent perception of nursing support was positive and that parents were highly satisfied with the nursing support provided in the neonatal unit. However, some attention needs to be given to providing more support and information on breastfeeding and parenting skills.

Do mass media campaigns capture and describe the experience of stroke symptoms?

Introduction: In 2006, the National Stroke Foundation of Australia launched the FAST (Face, Arm, Speech)/ Signs of Stroke (SOS) (5 symptom categories) campaigns designed to improve public awareness of stroke symptoms and the sense of urgency to present to hospital. However, there is little published review of how well such campaigns capture and describe the experience of stroke. This study aims to examine the awareness, content and language of the FAST/SOS campaigns by those experiencing stroke symptoms.
Methods: Interviews were conducted with either the stroke patient or a witness (incapacitated patients) whilst an inpatient at Box Hill or Maroondah Hospitals between August 2006 through April 2008. They were asked to describe awareness of campaigns, symptoms experienced (recorded verbatim and coded into campaign symptom categories) and to evaluate the descriptions of “Signs of Stroke” against their own experience (exact, somewhat, or not at all).
Results: Of 239 eligible stroke cases, 167 (70%) were interviewed (100 patients and 67 witnesses). Few (n= 20, 12%) were aware of the FAST campaign and only 16% recalled all three symptoms. Most recalled that it was “something” to do with the face, however facial droop (n=6) was less commonly experienced compared to speech impairments (n=16) and arm drift (n=13). FAST symptoms detected 84% (patients 77% and witnesses 94%) and SOS symptoms 100% of stroke patients. Patients not describing a FAST symptom (n=27) described: arm or hand numbness; hand incoordination; leg impairments; vision disturbances; or collapse. Approximately, half of patients and witnesses thought the SOS descriptions of the most commonly detected symptoms (arm/leg/face weakness or paralysis or numbness and speech impairments) exactly described the experience. Common language used to describe symptoms were: incoordination of hands or limbs; sudden difficulty walking; drooped/dropped face or mouth; slurred or loss of speech; pins and needles or tingling.
Conclusion: Both campaigns identified symptoms most commonly detected in those experiencing and reacting to symptoms. Both campaigns could portray symptoms more realistically using common descriptors without impacting on the simplicity of the messages

Syphilis and AIDS : historical and social comparisons

Drawing on the literatures of history, sociology, epidemiology, and microbiology, this thesis compares syphillis with human immunodeficiency virus, with special reference to the social and historical factors likely to be relevant to the control or eradication of acquired imune dificiency syndrom (AIDS). The sudden appearance of a new disease causing suffering and death in a community, engenders apprehension and fear which is often manifested as hysteria against, and vilification of, those who have the disease. This fear is greatly increased should the disease be sexually-transmitted. Syphilis in a venereal form, occured in Europe toward the end of the 15th Century. Initially it was an acute, fulminating disease which rapidly spread through Europe and Asia. Attempts to control the disease have gone through periods of either partial successes or massive failures and have ended in frustration for the authorities. When the syndrome of acquired immune deficiency (AIDS) was first reported, it was seen in Western countries in homosexual men. However, as non-homosexual community members and children became infected, it became apparent to authorities that a pandemic was accurring. Within a few years, the disease was identified worldwide. Isolation of the virus (HIV-1), and development of test for detection of carriers, plus restoration of clean blood and blood-product supplies, have reassured the community to some extent. The history of syphilis shows that neither the epidemiological medical, nor the economic political approaches to disease control work, although there are positive aspects resulting from both. It is social responses that will offer the most hope in the long term for the control of AIDS and other sexually-transmitted diseases.

Public libraries in Ballarat : 1851-1900

This thesis analyses the development of the Ballarat East Free Library (1859), the Ballarat Mechanics’ Institute Library (1859) and the City of Ballaarat Free Library (1878) within the broader context of public librarianship in Victoria between 1851-1900. Mechanics’ Institute libraries and free libraries represent the major derivatives of a nineteenth-century library model that emphasised the pursuit of lifelong learning, private reading and the enjoyment of genteel recreational facilities. The circumstances that led to the formation of an Institute and a free library in Ballarat in, 1,859 provide a unique opportunity to analyse the public library model for two reasons. These libraries were established in a remarkable goldfield city that enjoyed a number of economic and cultural advantages and secondly, the Ballarat Mechanics’ Institute Library and the Ballarat East Free Library experienced such spectacular growth that by 1880 they were two of the largest public libraries in Australia. However, it is argued that this growth cycle could not be sustained due to a combination of factors including low membership levels, limited funding for recurrent expenditure purposes, and heightened dissatisfaction with the book collections. Libraries began to stagnate in the late-1880s and the magnitude of this collapse in Ballarat, and throughout the colony, was subsequently confirmed with the publication of a national survey of Australian libraries in 1935. The ‘Munn-Pitt’ report found that public libraries had provided a better service in 1880 than at any other time in the next six decades. Four conclusions are drawn in this comparative analysis of the Ballarat Mechanics’ Institute Library, the Ballarat East Free Library, and to a lesser extent, the City of Ballaarat Free Library, between 1851-1900. Firstly, is it shown that the literature places considerable emphasis on the formation of public libraries but is far less critical of the long-term viability of the public library model as it evolved in Ballarat and throughout the colony in the nineteenth century. Secondly, whilst Ballarat and its library committees benefited from the city's prosperity and the entrepreneurial zeal of its pioneers, these same library committees were unable to overcome the structural flaws in the public library model or to dispel the widespread belief that libraries were elitist organisations. As a consequence, membership of the major libraries in Ballarat never exceeded 4% of the total population. Thirdly, it is acknowledged that an absence of records relating to book borrowing habits by individuals limits is a limiting factor, but this problem has been addressed, in part, by undertaking a comparative analysis of collection development policies, invoices, lists of popular authors and books, public comment and the book borrowing patterns of a number of comparable libraries in central Victoria. These resources provide a number of insights into the reading habits of library patrons in Ballarat in the late-nineteenth century. Finally, this thesis focuses on the management policies and practices of each library committee in Ballarat in order to move beyond the traditional explanation for the demise of nineteenth-century libraries and to propose an alternative explanation for the stagnation of public libraries in Ballarat in the mid-1880s. The traditional explanation for the demise of colonial libraries was the sudden reduction in government funding in the 1890s, whereas this thesis argues that a combination of factors, including the unresolved tensions with regard to libraries collection development policies, committee and municipal rivalry, and increasing conservatism, had already damaged the credibility of Ballarat’s libraries by the mid-1880s. It is argued that the intense rivalry between library committees resulted in an unnecessary duplication of services and an inadequate membership base. It is also argued that the increasingly conservative, un-cooperative and uninviting attitudes of these library committees discouraged patronage and as a direct consequence, membership and daily visitor rates of the free and Institute libraries in Ballarat plummeted by 80% between 1880-1900.

Population dynamics of the infaunal bivalve, Soletellina alba

The population dynamics of the infaunal bivalve Soletellina alba was investigated at three sites situated within close proximity to the mouth of the Hopkins River estuary. The initial study design was planned to examine the importance of winter flooding to the persistence of this bivalve mollusc within the Hopkins estuary, since mass mortalities have been observed during previous years coincident with periods of winter flooding. Unfortunately, the climatic conditions experienced during this study were atypical compared to the long-term average, so detailed sampling was limited to two, unanticipated, non-flood years rather than two, highly anticipated, flood years. This hampered my ability to conduct complete tests of the importance of winter flooding. Patterns of river discharge and the frequency and duration of mouth opening and closing differed greatly from that expected. Unexpectedly, periods of mouth closure were not always associated with periods of minimal river discharge; low salinities were another unexpected result during an extended period of mouth closure during 1998. As expected, salinities varied considerably with increasing water depth when the estuary mouth was open. Mouth closure lead to salinities becoming more uniform between water depths but hypoxic and anoxic conditions became evident via stratification in the water column at 1 m below the Australian Height Datum (AHD). Other than trends associated with increased water depth, significant variation was not evident between measurements of salinity taken from three sites within close proximity of the estuary mouth (approximately 500 m), or during changes in tide. The most pertinent anomaly was the absence of winter flooding. The distribution and abundance of juvenile and adult S. alba was variable across all Dates, Sites and Channel elevations (i.e. water depths) sampled during this study. An experimental test comparing the recruitment of juveniles at different channel elevations and in sediments of varying particle size was conducted during an exceptionally successful period of recruitment during 1999. The results of these tests showed that recruitment was greatest at the shallowest channel elevation used, and there was little evidence that sediment particle size influenced recruitment. In contrast to 1999, recruitment during 1997 or 1998 was extremely poor. Growth rates were monitored using tagged individuals held in caged and uncaged plots, which revealed that growth was highly variable among individuals, but not between Sites. These tests also revealed that growth was negligible during the colder, winter months, and that the fastest growing individuals were capable of growing 0.2 mm/day. Mixed results were obtained for tests of potential cage artifacts and the influence of handling. Caging and differing amounts of handling did not appear to influence growth, but there was evidence that cages and handling influenced bivalve condition and number of mortalities. These direct tests appeared to be the most appropriate method for determining growth rates of this species, since attempts to analyse length-frequency data were made difficult by the apparent convergence of cohorts, and shell aging is difficult due to the thin, fragile nature of the shell. As expected, mass mortalities were observed during the flood of 1996, but not during the two non-flood years of 1997 and 1998. There were, however, some considerable declines in abundances at some channel elevations during the two non-flood years. However, these declines were attributable to the complete disappearance of individuals, rather than the sudden presence of numerous, recently dead individuals that typify observed declines during winter flooding. The complete disappearance of individuals suggest that S. alba may be capable of post-settlement emigration, or that they were consumed by an unknown predator. Salinity tolerance tests showed that bivalves exposed to low salinities (≤6 ppt), exhibited poorer condition and took longer to re-burrow into sediments than those exposed to greater salinities (≥14 ppt), while death of bivalves exposed to salinities ≤1 ppt occurred after 8 days of exposure. These tests provide evidence that low salinities are probably the principal cause of mass mortalities during winter flooding, although the interaction between salinity, temperature and turbidity also deserve consideration. The results of this study indicate that certain aspects of winter flooding, especially salinity, are responsible for the mass mortalities of S. alba rather than the result of a short-lived life history. I hypothesise that the survival of very young juveniles (between 0.5 and 1 mm shell length) and rapid growth rates are important features of the life history of S. alba that explain its successful persistence within the Hopkins River estuary. The rapid rates of growth suggest that it may be possible for juveniles that survive winter flooding to grow, reach sexual maturity, and reproduce before the onset of the next flood event. Unfortunately, the increased survivorship of juveniles during periods of winter flooding was not demonstrated by this study because of the absence of winter flooding and also relatively poor recruitment. It is highly likely that this species is capable of completing it entire life cycle within the estuary since the absence of other nearby populations, together with periods of mouth closure, are likely to greatly limit the potential contribution made by larvae entering from the surrounding marine environment. This study has added considerably to our knowledge of how infauna cope with life in the intermittently closing estuaries that typify semi-arid coastlines in the Southern Hemisphere.

Elevated intracardiac angiotensin II leads to cardiac hypertrophy and mechanical dysfunction in normotensive mice

Introduction
Angiotensin II (Ang II) is known to induce cardiac growth and modulate myocardial contractility. It has been reported that elevated levels of endogenous Ang II contribute to the development of cardiac hypertrophy in hypertensives. However, the long-term functional effects of cardiac exposure to Ang II in normotensives is unclear.

A recently developed transgenic mouse (TG1306/1R), in which cardiac-specific overproduction of Ang II produces primary hypertrophy, provides a new experimental model for investigation of this phenotype. The aim of the present study was to use this model to investigate whether there is a functional deficit in primary hypertrophy that may predispose to cardiac failure and sudden death. We hypothesised that primary cardiac hypertrophy is associated with mechanical dysfunction in the basal state.

Methods
Normotensive heterozygous TG1306/1R mice harbouring multiple copies of a cardiac-specific rat angiotensinogen gene were studied at age 30—40 weeks and compared with age-matched wild-type littermates. Left ventricular function was measured ex vivo in bicarbonate buffer-perfused, Langendorffmounted hearts ( at a perfusion pressure of 80 mmHg, 37°C) using a fluid-filled PVC balloon interfaced to a pressure transducer and digital data acquisition system.

Results
There was no difference in the mean (±SEM) intrinsic heart rate of TG1306/1R and wild-type control mice (357.4±11.8 vs. 367.5±20.9 bpm, n=9 & 7). Under standardised end-diastolic pressure conditions, TG1306/1R hearts exhibited a significant reduction in peak developed pressure (132.2±9.4 vs. 161.5±3.1 mmHg, n=9 & 7, p<0.05) and maximum rate of pressure development (3566.7±323.7 vs. 4486.3±109.4 mmHg, n=9 & 7, p<0.05). TG1306/1R mice show a significant correlation between incidence of arrhythmia and increasing heart size (Spearman's correlation coefficient 0.61).

Conclusion
These data demonstrate that chronic in vivo exposure to elevated levels of intra-cardiac Ang II is associated with significant contractile abnormalities evident in the ex vivo intact heart. Our findings suggest that endogenous overproduction of cardiac Ang II, independent of changes in blood pressure, is sufficient to induce ventricular remodelling that culminates in impaired cardiac function which may precede failure.

Familial and genomic analyses of postural changes in systolic and diastolic blood pressure

The physiological adaptation to the erect posture involves integrated neural and cardiovascular responses that might be determined by genetic factors. We examined the familial- and individual-specific components of variance for postural changes in systolic and diastolic blood pressure in 767 volunteer nuclear adult families from the Victorian Family Heart Study. In 274 adult sibling pairs, we made a genome-wide scan using 400 markers for quantitative trait loci linked with the postural changes in systolic and diastolic pressures. Overall, systolic pressure did not change on standing, but there was considerable variation in this phenotype (SD=8.1 mm Hg). Familial analyses revealed that 25% of the variance of change in systolic pressure was attributable to genetic factors. In contrast, diastolic pressure increased by 6.3 mm Hg (SD=7.0 mm Hg) on standing and there was no evidence of contributory genetic factors. Multipoint quantitative genome linkage mapping suggested evidence (Z=3.2) of linkage of the postural change in systolic pressure to chromosome 12 but found no genome-wide evidence of linkage for the change in diastolic pressure. These findings suggest that genetic factors determine whether systolic pressure decreases or increases when one stands, possibly as the result of unidentified alleles on chromosome 12. The genetics of postural changes in systolic blood pressure might reflect the general buffering function of the baroreflex; thereby, the predisposition to sudden decreases or increases in systolic pressure might cause postural hypotension or vessel wall disruption, respectively.

Simulation-based input loading condition optimisation of airport baggage handling systems

Scheduling check-in station operations are a challenging problem within airport systems. Prior to determining check-in resource schedules, an important step is to estimate the Baggage Handling System (BHS) operating capacity under non-stationary conditions. This ensures that check-in stations are not overloaded with bags, which would adversely affect the system and cause cascade stops and blockages. Cascading blockages can potentially lead to a poor level of service and in worst scenario a customer may depart without their bags. This paper presents an empirical study of a multiobjective problem within a BHS system. The goal is to estimate near optimal input operating conditions, such that no blockages occurs at check-in stations, while minimising the baggage travel time and maximising the throughput performance measures. We provide a practical hybrid simulation and binary search technique to determine a near optimal input throughput operating condition. The algorithm generates capacity constraint information that may be used by a scheduler to plan check-in operations based on flight arrival schedules.

Pain relief for the removal of femoral sheath in interventional cardiology adult patients (Review)

Pain relief for removal of femoral sheath after cardiac procedures
Procedures for the non-surgical management of coronary heart disease include balloon angioplasty and intracoronary stenting. At the start of each procedure an introducer sheath is inserted through the skin (percutaneously) into an artery, frequently a femoral artery in the groin. This allows the different catheters used for the procedure to be exchanged easily without causing trauma to the skin. At the end of the procedure the sheath is removed and, if the puncture site isn't "sealed" using a device closure, firm pressure is required over the site for 30 minutes or more to control any bleeding and reduce vascular complications. Removing the sheath and the firm pressure required to control bleeding can cause pain, although this is generally mild. Some centres routinely give pain relief before removal such as intravenous morphine, or an injection of a local anaesthetic in the soft tissue around the sheath (called a subcutaneous injection). Adequate pain control during sheath removal is also associated with a reduced incidence of a vasovagal reaction, a potentially serious complication involving a sudden drop of blood pressure and a slowed heart rate. Four studies were reviewed in total. Three trials involving 498 participants compared subcutaneous lignocaine, a short acting local anaesthetic, with a control group (participants received either no pain relief or an inactive substance known as a placebo). Two trials involving 399 people compared intravenous opioids (fentanyl or morphine) and an anxiolytic (midazolam) with a control group. One trial involving 60 people compared subcutaneous levobupivacaine, a long acting local anaesthetic, with a control group. Intravenous pain regimens and subcutaneous levobupivacaine appear to reduce the pain experienced during femoral sheath removal. However, the size of the reduction was small. A significant reduction in pain was not experienced by participants who received subcutaneous lignocaine or who were in the control group. There was insufficient data to determine a correlation between pain relief administration and either adverse events or complications. Some patients may benefit from routine pain relief using levobupivacaine or intravenous pain regimens. Identifying who may potentially benefit from pain relief requires clinical judgement and consideration of patient preference. The mild level of pain generally experienced during this procedure should not influence the decision as some people can experience moderate levels of pain.

Multi-scale modelling of DP590 steel

Dual Phase (DP) steel one of the Advanced High Strength Steels (AHSS) has a two phase microstructure where soft and hard phase acts together to offer a high strength composite effect. The high strength, however, must be balanced with ductility so that complex parts and designs can be manufactured from AHSS sheets. However, during forming certain grades of DP steel a sudden crack can occur without any intimation of necking. Thus, due to this abnormal forming behaviour, is difficult to accurately predict because most classical modelling approaches are not designed for such micro-structurally heterogeneous materials. These modelling approaches are generally based on an average representation of the material behaviour in a continuum mechanics formulation. This works for materials that are homogenous, or at least could be assumed to be homogenous at scales lower than the naked eye can see. However, for a material like AHSS, the microstructure plays a significant role in dictating the mechanical behaviour at the macro-scale. This paper studies the multi-scale modelling ofDP590 steel. It is found that the sufficient accuracy can be achieved from multi-scale modelling while comparing with the experiments.

Plastic crystal behaviour in tetraethylammonium dicyanamide

The plastic crystal tetraethylammonium dicyanamide ([N_2,2,2,2][dca]) has been investigated with an emphasis on structure and dynamics in the plastic phase. It was found that almost all of the volume expansion occurs at the II → I transition, with no volume expansion at the melt transition (as normally observed for crystals). The conductivity of this material shows a rapid increase at temperatures below the II → I transition, reaching values ~ 10^{− 3} S/cm in Phase I, and 0.1 S/cm in the melt. The NMR measurements show that there is a sudden onset of rotational motions of the cations at the plastic transition; below this temperature the cations appear static. The rotational motion of the cation in Phase I has been discussed in terms of isotropic tumbling.

Are Chinese firms innovative or imitative?

In recent time, many Chinese firms have not only operated quite successfully at their home front, competing with those giant multinational companies inside China, they are also moving offshore. The short internationalisation process of Chinese firms looks both sudden and unexpected, causing many to wonder the success factors for Chinese firms. A dynamic innovation that combines strategic, organisational, cost as well as technological change was believed to have contributed to the fast growing Chinese firms in the global stage. This paper reviews the literature related to these areas of innovation. It also discusses reasons for firms to innovate or imitate, using institutional perspective and resource-based view (RBV). Intertwined with these discuss ion, empirical studies of innovative performance among Chinese firms are also analysed. The results show that in fact most Chinese firms still follow an imitative strategy, but there is a clear evidence of strategic cost innovation widely practiced among Chinese firms.

High strain rate tensile properties of rapidly cured woven carbon fibre composites

Tensile tests at high speeds corresponding to automotive crash events were conducted to understand the dynamic properties of rapidly cured woven carbon fiber composites. The High Strain Rate (HSR) experiments were conducted on a servo-hydraulic machine at constant velocities up to a maximum of 25 m/s (82 ft/s). Results from HSR tests were compared with the static results to determine the rate sensitivity of the composite. A high speed camera was used to capture the failure at HSR. The tensile properties of rapidly cured laminate were compared to oven cured laminate to justify its productivity while maintaining the desired properties. The methodology used to achieve constant velocity during HSR tests is discussed in detail. The specimen geometry was specially designed to suit the test rig and to achieve high speeds during tests. All the specimens failed with linear elasticity until sudden brittle fracture. The Scanning Electron Microscopy (SEM) images of the fracture zone were used to identify the failure modes observed at static and high strain rates.

Fracture of DP590 steel : a multi-scale modeling approach

Advanced high strength steel sheets are one of the higher strength advance material developed by the steel industry for automotive bodies. One of the categories of this advanced high strength steel is Dual Phase (DP) steel. This steel consists of a two phase microstructure where soft and hard phase acts together to offer a high strength composite effect. The combination of high strength and ductility exhibited by these sheets allows the design and manufacture of complex parts. However, during forming certain grades of DP steel sudden cracking can occur without any intimation of necking. This abnormal forming behavior is difficult to accurately predict because most classical modelling approaches are not designed for such micro-structurally heterogeneous materials. These modelling approaches are generally based on an average representation of the material behaviour in a continuum mechanics formulation. This works for materials that are homogenous, or at least could be assumed to be homogenous at scales lower than the naked eye can see. However, for a material like advanced high strength steel, the microstructure plays a significant role in dictating the mechanical behavior at the macro-scale. This paper studies the forming and fracture behavior through multi-scale modeling of DPO590 steel. It is found that the sufficient accuracy can be achieved from multi-scale modeling when comparing with experiments.