Early diagnosis and treatment of necrotizing fasciitis can improve survival : an observational intensive care unit cohort study

Background
The aim of this study was to describe the clinical characteristics, causative pathogens, clinical management and outcomes of patients presenting to a tertiary adult Australian intensive care unit (ICU) with a diagnosis of necrotizing fasciitis (NF).
Methods
This retrospective observational study was conducted in a 19-bed, level III, adult ICU in a 450-bed tertiary, regional hospital. Clinical databases were accessed for patients diagnosed with NF and admitted to The Geelong Hospital ICU between 1 February 2000 and 1 June 2011. Information on severity of sepsis, surgical procedures and microbiological results were collected.
Results
Twenty patients with NF were identified. The median age was 52.5 years and 38% were female. The overall mortality rate was 8.3%. Common co-morbidities were diabetes (21%) and heart failure (17%), although 50% of patients had no co-morbidities. Group A Streptococcus was the identified pathogen in 11 (46%) patients, and Streptococcus milleri group in 5 (21%) patients. Hyperbaric oxygen therapy was not used in the majority of patients. The initial antibiotics administered were active against subsequently cultured bacteria in 83% of patients. Median time to surgical debridement was 20 h. Diagnosis and management was delayed in the nosocomial group.
Conclusions
This study reports physiological data, aetiology and therapeutic interventions in NF for an adult tertiary hospital. We demonstrate one of the lowest reported mortality rates, with early surgical debridement being achieved in the majority of patients. The main delay was found to be in the diagnosis of NF.

Beginning the search for core principles underpinning literacy development in the early years

Providing opportunities for all people to become literate is now a global imperative (World Bank 2008). There are many and varied reasons underlying this emphasis including global, national, community and personal perspectives (Friere & Macedo 2000) and countries world-wide are investing more money into their early childhood programs and the development of associated policies (Oberhuemer 2005). From a socio-cultural view, literacy development is emergent, ongoing (Cook-Gumperz 2006) and multifaceted (New London Group 1999). Literacy involves far more than reading and writing and encompasses listening, speaking and critical thinking (Department of Education, Science and Training 2005, Luke & Freebody 1997). Literacy is not merely a curricular area, but an important empowering life skill (Harrison 2012, Friere & Macedo 2000). It seems logical then, to search for and identify if there are core principles underpinning early years literacy development.In seeking to identify core principles for emergent literacy development, the study reported here adopted Wiersma & Jurs' (2005) 'Four Step' Historical Research methodological approach involving the identification of a research problem, collection and evaluation of source materials, synthesis of information from the source materials and finally, the analysis, interpretation and the formulation of conclusions. The historical research approach requires creative interpretation (Keastle 1988) and is valued for its effectiveness in sourcing ideas, enlightening current debates, empowering decision-making (Stricker 1992) and influencing policy formation (Wiersma & Jurs 2005).This study involved analysis of Early Years Language and Emergent Literacy Research from the past decade, sourced via education and social sciences databases, as well as information gathered from correspondence with Australian government departments, their websites and policies. The findings from a synthesis of these data sources led to the identification of nine core principles viewed as underpinning children's emergent literacy development. Interested in exploring the relevance and application of these principles to the field of early childhood in Australia, additionally, the researcher has embarked upon a mapping exercise that reveals how the recently introduced Early Years Learning Frameworks align with these principles. Furthermore, in recognition of the importance of the early years as a crucial time in a child's literacy development (Cook-Gumperz 2006, Raban & Nolan 2005, Hall, Larson & Marsh 2003), it is argued that these literacy principles will be valuable to the development of a range of educational tools to be used by Pre-service and practicing Early years educators.

Effects of new and old media on young children’s language acquisition, development, and early literacy : findings from a longitudinal study of Australian children

The current generation of young children has been described as “digital natives”, having been born into a ubiquitous digital media environment. They are envisaged as educationally independent of the guided interaction provided by “digital immigrants”: parents and teachers. This paper uses data from the Longitudinal Study of Australian Children (LSAC) to study children’s (aged 0-8 years) development of vocabulary and traditional literacy; access to digital devices; parental mediation practices; the child’s use of digital devices as recorded in time-diaries and, finally, the association between patterns of media use and family contexts on children’s learning. The analysis shows the importance of the parental context framing media use in acquisition of vocabulary, and suggests that computer (but not games) use is associated with more developed language skills. Independently of these factors raw exposure to television is not harmful to learning.

The impact of smoking in adolescence on early adult anxiety symptoms and the relationship between infant vulnerability factors for anxiety and early adult anxiety symptoms : The TOPP Study

Cigarette smoking is increased in people with trait anxiety and anxiety disorders, however no longitudinal data exist illuminating whether smoking in adolescence can influence the developmental trajectory of anxiety symptoms from early vulnerability in infancy to adult anxiety expression. Using The Tracing Opportunities and Problems in Childhood and Adolescence (TOPP) Study, a community-based cohort of children and adolescents from Norway who were observed from the age of 18months to age 18–19years, we explored the relationship between adolescent smoking, early vulnerability for anxiety in infancy (e.g. shyness, internalizing behaviors, emotional temperaments) and reported early adult anxiety.

Structural equation modeling demonstrated that adolescent active smoking was positively associated with increased early adulthood anxiety (β = 0.17, p<0.05), after controlling for maternal education (proxy for socioeconomic status). Adolescent anxiety did not predict early adult smoking. Adolescent active smoking was a significant effect modifier in the relationship between some infant vulnerability factors and later anxiety; smoking during adolescence moderated the relationship between infant internalizing behaviors (total sample: active smokers: β = 0.85,p<0.01, non-active smokers: ns) and highly emotional temperament (total sample: active smokers: β = 0.55,p<0.01,non-active smokers: ns), but not shyness, and anxiety in early adulthood. The results support a model where smoking acts as an exogenous risk factor in the development of anxiety, and smoking may alter the developmental trajectory of anxiety from infant vulnerability to early adult anxiety symptom expression. Although alternative non-mutually exclusive models may explain these findings, the results suggest that adolescent smoking may be a risk factor for adult anxiety, potentially by influencing anxiety developmental trajectories. Given the known adverse health effects of cigarette smoking and significant health burden imposed by anxiety disorders, this study supports the importance of smoking prevention and cessation programs targeting children and adolescence.

A content analysis of early childhood teachers’ theoretical and practical experiences with infants and toddlers in Australian teacher education programs

 In Australia, the growth in the provision of early childhood services for very young children aged birth to three years has placed increased demands on pre-service teachers as new policy stipulates the need for qualified early childhood teachers. While many teacher education programs offer early childhood courses, they have traditionally had a greater focus on kindergarten and the formal years of schooling. Less is known about the amount of time devoted to developing the specialist educational capacity for teaching and caring for infants and toddlers. This paper explores 55 Australian early childhood teacher undergraduate education programs to provide data regarding what pre-service teachers learn about children from birth to three years of age during their formal program of study. It explores: if pre-service teachers engage in practical experiences with this age range; what content they learn; and how knowledge for this age range is assessed. Utilising information from fully accessible public program websites, data in the form of course details were examined to reveal the extent and nature of courses inclusive of teaching and learning focusing on children aged from birth to three years. Of the 55 programs, 18 programs provided practical experience with infants and toddlers, and to a lesser extent content was evident and assessed. Most of the programs which included a focus on birth to three years of age were delivered by Victorian institutions. Findings are important for the future of early childhood teacher education in Australia and hold key messages for teacher registration bodies.

Evidence from genetic and Lagrangian drifter data for transatlantic transport of small juvenile green turtles

Aim  A key life-history component for many animals is the need for movement between different geographical locations at particular times. Green turtle (Chelonia mydas) hatchlings disperse from their natal location to spend an early pelagic stage in the ocean, followed by a neritic stage where small juveniles settle in coastal areas. In this study, we combined genetic and Lagrangian drifter data to investigate the connectivity between natal and foraging locations. In particular we focus on the evidence for transatlantic transport. Location  Atlantic Ocean.

Methods  We used mitochondrial DNA (mtDNA) sequences (n = 1567) from foraging groups (n = 8) and nesting populations (n = 12) on both sides of the Atlantic. Genetic data were obtained for Cape Verde juvenile turtles, a foraging group not previously sampled for genetic study. Various statistical methods were used to explore spatial genetics and population genetic structure (e.g. exact tests of differentiation, Geneland and analysis of molecular variance). Many-to-many mixed stock analysis estimated the connectivity between nesting and foraging groups.

Results  Our key new finding is robust evidence for connectivity between a nesting population on the South American coast (25% of the Surinam nesting population are estimated to go to Cape Verde) and a foraging group off the coast of West Africa (38% of Cape Verde juveniles are estimated to originate from Surinam), thus extending the results of previous investigations by confirming that there is substantial transatlantic dispersal in both directions. Lagrangian drifter data demonstrated that transport by drift across the Atlantic within a few years is possible.

Main conclusions  Small juvenile green turtles seem capable of dispersing extensively, and can drop out of the pelagic phase on a transatlantic scale (the average distance between natal and foraging locations was 3048 km). Nevertheless, we also find support for the ‘closest-to-home’ hypothesis in that the degree of contribution from a nesting population to a foraging group is correlated with proximity. Larger-sized turtles appear to feed closer to their natal breeding grounds (the average distance was 1133 km), indicating that those that have been initially transported to far-flung foraging grounds may still be able to move nearer to home as they grow larger.

Early years education in the primary years programme (PYP): Implementation strategies and programme outcomes : interim report

This is the October 2013 Interim Report as part of the 'Early Years Education in the Primary Years Programme (PYP): Implementation Strategies and Programme Outcomes' Project submitted to the International Baccalaureate Organisation. This project is investigating implementation strategies and outcomes in Early Years Education in the Primary Years Programme of the IB, through a mixed-methods approach using both quantitative and qualitative data. It is based on intensive case studies of five Early Years Stage programmes within the IB Primary Years Programme, at three sites in Australia and two sites in Singapore.

Age-related differences in inhibitory control in the early school years

The transition to school is associated with a greater requirement to inhibit irrelevant or inappropriate thought and behavior in order to concentrate on effective learning and to interact successfully with peers. Current knowledge of inhibitory control development in the early school years is limited due to a lack of normative data from age-appropriate, sensitive measures. In this study, three pictorial versions of the Stroop task were administered to investigate inhibitory control development in early school-aged children. Age-related trajectories of inhibition and effects of gender were examined in 80 children (42 boys) aged 5 to 8 years. All children were assessed with the Cognitive Assessment System Expressive Attention subtest (Big-Small Stroop), Fruit Stroop, and Boy-Girl Stroop. The Big-Small Stroop revealed substantial age-related improvement in inhibition from 5 to 7 years with a levelling of performance at 8 years of age, while the Fruit Stroop and Boy-Girl Stroop demonstrated clear but nonsignificant age trends. In particular, older children committed fewer errors and corrected their errors more frequently than younger children. Performance on all Stroop tasks correlated significantly, providing evidence that they tap similar cognitive abilities. Some gender differences were found. This study indicates that inhibitory skills develop rapidly in the early school years and suggests that error awareness may be a useful indicator of the development of cognitive inhibition for this age group.

Early childhood predictors of toddlers' physical activity: longitudinal findings from the Melbourne InFANT program

Background: 

A study of children’s musical preference: A data mining approach

Musical preference has long been a research interest in the field of music education, and studies consistently confirm the importance of musical preference in one’s musical learning experiences. However, only a limited number of studies have been focussed on the field of early childhood education (e.g., Hargreaves, North, & Tarrant, 2006; Roulston, 2006). Further, among these limited early childhood studies, few of them discuss children’s musical preference in both the East and the West. There is very limited literature (e.g., Faulkner et al., 2010; Szymanska, 2012) which explores the data by using a data mining approach. This study aims to bridge the research gaps by examining children’s musical preference in Hong Kong and in South Australia by applying a data mining technique – Self Organising Maps (SOM), which is a clustering method that groups similar data objects together. The application of SOM is new in the field of early childhood education and also in the study of children’s musical preference. This paper specifically aims to expand a previous study (Yim & Ebbeck, 2009) by conducting deeper investigations into the existing datasets, for the purpose of uncovering insights that have not been identified through data mining approach.

Maternal and early postnatal nutrition and mental health of offspring by age 5 years: a prospective cohort study clinical guidance

Objective
Diet quality is related to the risk for depression and anxiety in adults and adolescents; however, the possible impact of maternal and early postnatal nutritional exposures on children’s subsequent mental health is unexplored.

Method
The large prospective Norwegian Mother and Child Cohort Study recruited pregnant women between 1999 and 2008. Data were collected from mothers during pregnancy and when children were 6 months and 1.5, 3, and 5 years of age. Latent growth curve models were used to model linear development in children’s internalizing and externalizing problems from 1.5 to 5 years of age as a function of diet quality during pregnancy and at 1.5 and 3 years. Diet quality was evaluated by dietary pattern extraction and characterized as “healthy” or “unhealthy.” The sample comprised 23,020 eligible women and their children. Adjustments were made for variables including sex of the child, maternal depression, maternal and paternal age, maternal educational attainment, household income, maternal smoking before and during pregnancy, mothers’ parental locus of control, and marital status.

Results
Higher intakes of unhealthy foods during pregnancy predicted externalizing problems among children, independently of other potential confounding factors and childhood diet. Children with a high level of unhealthy diet postnatally had higher levels of both internalizing and externalizing problems. Moreover, children with a low level of postnatal healthy diet also had higher levels of both internalizing and externalizing problems.

Conclusion
Among this large cohort of mothers and children, early nutritional exposures were independently related to the risk for behavioral and emotional problems in children.

Early childhood physical activity, sedentary behaviors and psychosocial well-being: a systematic review

Objectives
Little is known about how health behaviors such as physical activity (PA) and sedentary behaviors (SB) may be associated with psychosocial well-being during the crucial early childhood period. The aim of this study was to undertake a systematic review of associations between PA, SB and psychosocial well-being during early childhood.

Methods
In February 2013, MEDLINE, PsycINFO, SPORTDiscus and Embase electronic databases were searched. Inclusion criteria were: 1. peer-reviewed publication since 1980 in English; 2. children aged birth–5 years; 3. PA or SB measured during early childhood; 4. an indicator of child psychosocial well-being; and 5. association between PA/SB and psychosocial well-being reported. Studies could be observational or interventions. Data were extracted by one author and entered into a standardized form in February and March 2013.

Results
19 studies were identified: four examined PA, 13 examined SB and two examined PA and SB. No interventions met the inclusion criteria; all included studies were observational. In total, 21 indicators of psychosocial well-being were examined, 13 only once with the remaining eight reported in more than one study. Some dose–response evidence was identified suggesting that PA is positively, and SB inversely, associated with psychosocial well-being.

Conclusions
Too few studies exist to draw conclusions regarding associations. Future high-quality cohort and intervention studies are warranted particularly investigating dose–response associations.

Organisational and professional commitment of early career accountants: do mentoring and organisational ethical climate matter?

This study assesses the effects of mentoring and organisational ethical climate (OEC) on the organisational and professional commitment (PC) of early career accountants (ECAs) (i.e. accounting graduate recruits with three or less years of working experience). The empirical data are based on a questionnaire survey from 86 ECAs in Australian public accounting firms, and hypothesis testing utilises partial least squares analysis. Our results indicate when a career development style of mentoring is adopted there is greater organisational as well as PC. By contrast, a social support mentoring style has no significant impact on organisational commitment (OC) and a negative effect on PC. Further, our data also reveal OEC to be positively associated with OC, and OC in turn having a positive impact on PC. The results imply that fostering a career-focused mentoring environment and an OEC can increase an ECA's OC and PC. These results have various implications for human resource management at both the accounting firm and professional levels.

The release and induced immune responses of a plant-made and delivered antigen in the mouse gut

This study investigated the site of release of a model vaccine antigen from plant cells and the corresponding induced immune response. Three plant tissues (leaf, fruit and hairy root) and two formulations (aqueous and lipid) were compared in two mouse trials. A developed technique that enabled detection of antigen release by plant cells determined that antigen release occurred at early sites of the gastrointestinal tract when delivered in leaf material and at later sites when delivered in hairy roots. Lipid formulations delayed antigen release from all plant materials tested. While encapsulation in the plant cell provided some protection of the antigen in the gastrointestinal tract and influenced antigen release, formulation medium was also an important consideration with regard to vaccine delivery and immunogenicity. Systemic immune responses induced from the orally delivered vaccine benefited from late release of antigen in the mouse gastrointestinal tract. The influences to the mucosal immune response induced by these vaccines were too complex to be determined by studies performed here with no clear trend regarding plant tissue site of release or formulation medium. Expression and delivery of the model antigen in plant material prepared in an aqueous formulation provided the optimal systemic and mucosal, antigen-specific immune responses.

A day in the life of an early childhood teacher: identifying the confronting issues and challenges that arise

Recent emphasis upon Early Childhood as an educational priority for the Australian Government has resulted in increases in funding, government initiatives, course providers and the introduc- tion of new policies to the sector in order to improve the quality of early childhood education. The study reported here investigated the "reality" of what it means to be an Early Childhood Teacher within this changing context and identified the roles and responsibilities and the associated chal- lenges. A case study involving observation and interviews with five Bachelor qualified Teachers from varied early childhood settings was undertaken in order to gain knowledge about their ex- periences and perspectives on their work. The data were analyzed using a grounded theory ap- proach involving the identification of key themes and issues about the nature of teachers' work. The findings revealed that in their everyday practice teachers played a complex array of roles that required them to contribute far more than just their teaching skills and knowledge. They were expected to concurrently enact the roles of educator, leader, advocate, communicator, counsellor and administrator whilst juggling everyday challenges including a "lack of time", the need for "further support and more resources" and "building successful partnerships with parents".