Initiative for ASEAN integration: policy brief 4: graduation of all ASEAN member states from less developed country status

ASEAN recognises that concerted efforts are required to narrow development gaps between ASEAN countries to ensure that development and the benefits of economic integration are equitably shared by all member states and their citizens. Narrowing development gaps between member states is a cornerstone of the equitable economic development agenda within ASEAN and forms an important part of the ASEAN Roadmap. This agenda translates primarily to a concern for the relatively low development achievements in the CLMV countries compared to those in the ASEAN-6 group. 

Performing an intervention

What does it mean to intervene, or to perform an intervention? Presumptively conflictual, the term finds meaning in its clinical and behavioural application as an enforced practice of modification: one performs an intervention on an (often) unwilling subject. Cut one way, you could tell a history of sex/ualities education as a history of interventions of this kind: efforts to interrupt and redirect affective investments, sexual practices and undesirable identifications. The sexually active young person, the homosexual, the single mother, people of colour, people with disabilities, indigenous people, promiscuous poor people – these are some of intervention’s favourite things. These are subjects constituted in part through histories of psycho-therapeutic, medical and health educational correction, histories that are still elaborating themselves through a series of familiar contemporary concerns and campaigns.

Lab-on-a-Chip turns soft : computer-aided, software-enabled microfluidics design

The current practice of designing microfluidic Lab-on-a-Chip (LoCs) limits reusing designs and makes sharing tasks among researchers difficult. One way to achieve that objective is to borrow best practices from engineering. Also it takes a lot of skills to design LoCs. Design-by-assembly in which a LoC can be designed by configuring, laying out subsystems can help new researchers to develop custom chips. Flexible, reusable, and rapid-prototyping-feasible LoC designs can be achieved by fabricated modular microfluidic blocks. However, challenging problems still persist, which limit the usefulness of prefabricated blocks. We propose software microfluidic modules (SoftMABs) based design technique to solve issues fabricated modules face. By configuring SoftMABs, integrating them, the new assembly of SoftMABs can form a 3D LoC design ready to be prototyped. The proposed method can make designing a complex LoC less challenging, and collaborating among laboratories easier. We created SoftMABs and designed a custom microfluidic chip by assembling SoftMABs like LEGOs, dragging-and-dropping them. Later we reconfigured them - by replacing a SoftMAB with another module - to make a new LoC. We believe this computeraided method is an interesting and useful LoC design technique.

Response of unacclimatized males to repeated weekly bouts of exercise in the heat

The purpose of the present study was to determine if there is an acclimation effect when unacclimatized males exercise in the heat at weekly intervals. Five subjects performed four exercise bouts, each lasting 1 h at 55% VO2max. The first trial was in moderate conditions (mean(s.d.) temperature (Ta) = 22.0(0.8)degrees C; mean(s.d.) relative humidity (rh) = 67(6)%) and the subsequent three trials were carried out at weekly intervals in the heat (mean(s.d.) Ta = 34.6(0.6)degrees C; mean(s.d.) rh = 60(7)%). There were no significant differences between trials in the heat for heart rate, rectal temperature, skin temperature or VO2 (repeated measures analysis of variance), and total sweat loss (one-way analysis of variance). As changes in these variables are seen with heat acclimation it was concluded that there was no heat acclimation effect and separating exercise bouts by 1 week was a valid method for comparing the effects of different treatments on unacclimatized males during exercise in the heat.

Desire, dryness and decadence: living big in Australia's suburbs

There are (at least!) two remarkable things about Australia: one is that it is the driest inhabited continent on the planet and the second that it has the largest houses in the world. The relationship between these two facts serves as one way of understanding its settlement patterns and the character of its suburbs, foregrounding the desires that underpin their cultural economies.

Buses, cars, bicycles and walkers the influence of the type of human transport on the flight responses of waterbirds

One way to manage disturbance to waterbirds in natural areas where humans require access is to promote the occurrence of stimuli for which birds tolerate closer approaches, and so cause fewer responses. We conducted 730 experimental approaches to 39 species of waterbird, using five stimulus types (single walker, three walkers, bicycle, car and bus) selected to mimic different human management options available for a controlled access, Ramsar-listed wetland. Across species, where differences existed (56% of 25 cases), motor vehicles always evoked shorter flight-initiation distances (FID) than humans on foot. The influence of stimulus type on FID varied across four species for which enough data were available for complete cross-stimulus analysis. All four varied FID in relation to stimuli, differing in 4 to 7 of 10 possible comparisons. Where differences occurred, the effect size was generally modest, suggesting that managing stimulus type (e.g. by requiring people to use vehicles) may have species-specific, modest benefits, at least for the waterbirds we studied. However, different stimulus types have different capacities to reduce the frequency of disturbance (i.e. by carrying more people) and vary in their capacity to travel around important habitat

Developing a multi-scale visualisation framework for use in climate change response

Climate change is predicted to impact countries, regions and localities differently. However, common to the predicted impacts is a global trend toward increased levels of carbon dioxide and rising sea levels. Governments and communities need to take into account the likely impacts of climate on the landscape, both built and natural. There is a growing and significant body of climate change research. Much of this information produced by domain experts for a range of disciplines is complex and difficult for planners, decision makers and communities to act upon. The need to communicate often complex scientific information which can be used to assist in the planning cycle is a key challenge. This paper draws from a range of international examples of the use of visualisation in the context of landscape planning to communicate climate change impact and adaptation options within the context of the planning cycle. Missing from the literature, however, is a multi-scalar approach which allows decision makers, planners and communities to seamlessly explore scenarios at their special level of interest, as well as to collectively understand what is driving these at a larger scale, and what the implications are at ever more local levels. Visualisation tools such as digital globes provide one way to bring together multi-scaled spatial–temporal datasets. We present an initial development with this goal in mind. Future research is required to determine the best tools for communicating particular complex scientific data and also to better understand how visualisation can be used to improve the landscape planning process.

Ustekinumab for the treatment of moderate to severe psoriasis

This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of ustekinumab for the treatment of moderate to severe psoriasis based upon a review of the manufacturer's submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The submission's main evidence came from three randomised controlled trials (RCTs), of reasonable methodological quality and measuring a range of clinically relevant outcomes. Higher proportions of participants treated with ustekinumab (45 mg and 90 mg) than with placebo or etanercept achieved an improvement on the Psoriasis Area and Severity Index (PASI) of at least 75% (PASI 75) after 12 weeks. There were also statistically significant differences in favour of ustekinumab over placebo for PASI 50 and PASI 90 results, and for ustekinumab over etanercept for PASI 90 results. A weight-based subgroup dosing analysis for each trial was presented, but the methodology was poorly described and no statistical analysis to support the chosen weight threshold was presented. The manufacturer carried out a mixed treatment comparison (MTC); however, the appropriateness of some of the methodological aspects of the MTC is uncertain. The incidence of adverse events was similar between groups at 12 weeks and withdrawals due to adverse events were low and less frequent in the ustekinumab than in the placebo or etanercept groups; however, statistical comparisons were not reported. The manufacturer's economic model of treatments for psoriasis compared ustekinumab with other biological therapies. The model used a reasonable approach; however, it is not clear whether the clinical effectiveness estimates from the subgroup analysis, used in the base-case analysis, were methodologically appropriate. The base-case incremental cost-effectiveness ratio for ustekinumab versus supportive care was 29,587 pounds per quality-adjusted life-year (QALY). In one-way sensitivity analysis the model was most sensitive to the number of hospital days associated with supportive care, the cost estimate for intermittent etanercept 25 mg and the utility scores used. In the ERG's scenario analysis the model was most sensitive to the price of ustekinumab 90 mg, the proportion of patients with baseline weight > 100 kg and the relative risk of intermittent versus continuous etanercept 25 mg. In the ERG's probabilistic sensitivity analysis ustekinumab had the highest probability of being cost-effective at conventional NICE thresholds, assuming the same price for the 45-mg and 90-mg doses; however, doubling the price of ustekinumab 90 mg resulted in ustekinumab no longer dominating the comparators. In conclusion, the clinical effectiveness and cost-effectiveness of ustekinumab in relation to other drugs in this class is uncertain. Provisional NICE guidance issued as a result of the STA states that ustekinumab is recommended as a treatment option for adults with plaque psoriasis when a number of criteria are met. Final guidance is anticipated in September 2009.

Entecavir for the treatment of chronic hepatitis B infection

This paper presents a summary of the evidence review group (ERG) report into the clinical and cost-effectiveness of entecavir for the treatment of chronic hepatitis B (CHB) in adults based upon a review of the manufacturer's submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The submission's evidence came from five randomised controlled trials (RCTs), of good methodological quality and measuring a range of clinically relevant outcomes, comparing entecavir with lamivudine. After 1 year of treatment entecavir was statistically superior to lamivudine in terms of the proportion of patients achieving hepatitis B virus (HBV) DNA suppression, alanine aminotransferase (ALT) normalisation and histological improvement, but not in terms of the proportion of patients achieving hepatitis B e antigen (HBeAg) seroconversion. The incidence of adverse or serious adverse events was similar for both treatments. The results of the manufacturer's mixed treatment comparison (MTC) model to compare entecavir with the comparator drugs in nucleoside-naive patients were considered to be uncertain because of concerns over its conduct and reporting. For the economic evaluation the manufacturer constructed two Markov state transition models, one in HBeAg-positive and one in HBeAg-negative patients. The modelling approach was considered reasonable subject to some uncertainties and concerns over some of the structural assumptions. In HBeAg-positive patients the base-case incremental cost-effectiveness ratios (ICER) for entecavir compared with lamivudine and pegylated interferon alpha-2a were 14,329 pounds and 8403 pounds per quality-adjusted life-year (QALY) respectively. Entecavir was dominated by telbivudine. In HBeAg-negative patients the base-case ICERs for entecavir compared with lamivudine, pegylated interferon alpha-2a and telbivudine were 13,208 pounds, 7511 pounds and 6907 pounds per QALY respectively. In HBeAg-positive lamivudine-refractory patients entecavir dominated adefovir added to lamivudine. In one-way deterministic sensitivity analysis on all key input parameters for entecavir compared with lamivudine in nucleoside-naive patients, ICERs generally remained under 30,000 pounds per QALY. In probabilistic sensitivity analysis in nucleoside-naive HBeAg-positive patients the probability of the ICER for entecavir being below 20,000 pounds per QALY was 57%, 82% and 45% compared with lamivudine, pegylated interferon alpha-2a and telbivudine respectively. In nucleoside-naive HBeAg-negative patients the probabilities were 90%, 100% and 96% respectively. The manufacturer's lifetime treatment scenario for HBeAg-negative patients and the ERG's 20-year treatment scenario for HBeAg-positive patients increased the ICERs, particularly in the latter case. Amending the HBeAg-negative model so that patients with compensated cirrhosis would also receive lifetime treatment gave probabilities of entecavir being cost-effective at a willingness to pay of 20,000 pounds and 30,000 pounds of 4% and 40% respectively. The NICE guidance issued in August 2008 as a result of the STA states that entecavir is recommended as an option for the treatment of people with chronic HBeAg-positive or HBeAg-negative hepatitis B in whom antiviral treatment is indicated.

Teacher practice: a spotlight on the use of feedback and conferencing in the first year of schooling

With the prevalence of statements that refer to a need to “bridge”, “narrow” or “close” gaps in achievement it would appear that Government bodies have an appreciation for the fact that students need not be victims of circumstance. In addition to this, research has suggested that certain skills, such as the acquisition of phonemic awareness, need to be acquired in the early years to ensure that children do not fall behind their peers. Use of feedback is one way in which teachers have attempted to positively influence student outcomes. There are authors, however, who have suggested that not all forms of feedback are necessarily effective. In light of these perspectives, this study sought to investigate whether the incorporation of student/teacher conferences into a pre-existing program could be seen to support the development of phonemic awareness skills of students in their first year of schooling.

Effect of nutritional supplements on wound healing in home-nursed elderly: a randomized trial

 Objective: The objective was to determine whether provision of oral nutritional supplements, delivered by community nurses, could improve nutritional status and wound healing in home-nursed elderly. Methods: This was a double-blind, randomized trial in 50 elderly patients referred for wound management. Patients received 237 mL/d of 4 or 8 kJ/mL of an oral nutritional supplement for 4 wk. Nutritional status was measured with the Subjective Global Assessment and the Mini-Mental State Examination questionnaire to determine cognitive function and wound characteristics to assess healing. Differences between variables were examined with the Mann-Whitney or Student's t test for comparing two groups, one-way analysis of variance when there was more than two groups, and chi-square analysis for comparing two categorical variables. Associations between variables were examined with Pearson's correlation and regression analysis. Results: At baseline, 34% subjects were moderately malnourished and 8% were severely malnourished. In both groups, there was significantly greater improvement in Mini-Mental State Examination scores at week 4 (95% confidence interval -2.0 to -0.001, P = 0.04) and a greater decrease in the wound effusion score (95% confidence interval -2.0 to 0.0, P = 0.045). Median length of stay did not differ between groups (P > 0.05). Conclusions: Malnutrition is common in elderly patients who are nursed at home for wound management. Provision of energy- and protein-dense oral supplements by community nurses is effective in improving some indices of wound healing and cognitive function in this group. Although further study is needed to determine the effect on length of stay, the nutritional needs of this vulnerable group should not be overlooked. © 2005 Elsevier Inc. All rights reserved.

Atmospheric quality and distribution of heavy metals in Argentina employing Tillandsia capillaris as a biomonitor.

The atmospheric quality and distribution of heavy metals were evaluated throughout a wide region of Argentina. In addition, the biomonitor performance of Tillandsia capillaris Ruiz & Pav. f. capillaris was studied in relation to the accumulation of heavy metals and to its physiologic response to air pollutants. A sampling area of 50,000 km2 was selected in the central region of the Argentine Republic. This area was subdivided into grids of 25 x 25 km. Pools of T. capillaris, where present, were collected at each intersection point. From each pool three sub-samples were analyzed independently. Furthermore, five replicates were collected at 20% of the points in order to analyze the variability within the site. The content of Co, Cu, Fe, Ni, Mn, Pb and Zn was determined by Atomic Absorption Spectrometry. Chemical-physiological parameters were also determined to detect symptoms of foliar damage. Chlorophylls, phaeophytins, hydroperoxy conjugated dienes, malondialdehyde and sulfur were quantified in T. capillaris. Some of these parameters were used to calculate a foliar damage index. Data sets were evaluated by one-way ANOVA, correlation analysis, principal component analysis and mapping. Geographical distribution patterns were obtained for the different metals reflecting the contribution of natural and anthropogenic emission sources. According to our results it can be inferred that Fe, Mn and Co probably originated in the soil. For Pb, the highest values were found in the mountainous area, which can be attributed to the presence of Pb in the granitic rocks. Ni showed mainly an anthropogenic origin, with higher values found in places next to industrial centers. For Zn the highest values were in areas of agricultural development. The same was observed for Cu, whose presence could be related to the employment of pesticides. The foliar damage index distribution map showed that the central and southeastern zones were the ones where the major damage in the bioindicator was found. The central zone coincides with the city of Córdoba whereas the southeastern area is strictly agricultural, so the high values found there could be related to the use of pesticides.

Housing strategies that improve indigenous health outcomes

Housing is a key social determinant of health. The relationship between housing outcomes and health outcomes is bi-directional: housing affects healthoutcomes, and health affects housing outcomes. There are clear links between the quality and location of housing and health outcomes. The impacts of housing on health vary between geographic and climatic locations and contexts. There is a wide range of housing interventions that positively impact Indigenous health. One way of categorisingthese is: infrastructure improvements; addressing behavioural factors; and adjustments to policy environments.

A tale of two expropriations: Newcrestia and Agrizania

A comparison will be made between the decision of the High Court of Australia in Newcrest Mining (WA) Ltd v The Commonwealth1 (“Newcrest”) and the decisions of the South African Courts in the Agri South Africa line of cases.2 Although the mineral law systems of the two countries differ insofar as historical development and content,3 the simplified facts of the Newcrest and Agri SA decisions and principles of expropriation law are similar enough to draw an interesting comparison between the respective cases. Both cases dealt with the issue of whether the mineral rights/mining rights of private holders were expropriated by legislation which prohibited mining in one way or another. A comparison between the cases shows the approaches towards the issues and what exactly constitutes deprivation and/or acquisition of property for purposes of expropriation and whether deprivation and/or acquisition actually took place.The differences between the mineral law systems of Australia and South Africa (before the enactment of the Mineral and Petroleum Resources Development Act 28 of 2002 (hereafter “MPRDA”)) and the protection afforded against the resumption/expropriation of mineral rights or mining rights will be set as background information for a better understanding of the respective decisions. The facts of the two cases will first be set out and simplified for comparative purposes before the respective decisions are discussed. At the end, a comparison will be made between the decisions and a conclusion reached about the similarity of principles and the correctness of the respective decisions.

Parents' food choice motives and their associations with children's food preferences

Objective The objective was to investigate parents' motives for selecting foods for their children and the associations between these motives and children's food preferences. Design Cross-sectional survey. A modified version of the Food Choice Questionnaire was used to assess parents' food choice motives. Parents also reported children's liking/disliking of 176 food and beverage items on 5-point Likert scales. Patterns of food choice motives were examined with exploratory principal component analysis. Associations between motives and children's food preferences were assessed with linear regression while one-way and two-way ANOVA were used to test for sociodemographic differences. Setting Two Australian cities. Subjects Parents (n 371) of 2-5-year-old children. Results Health, nutrition and taste were key motivators for parents, whereas price, political concerns and advertising were among the motives considered least important. The more parents' food choice for their children was driven by what their children wanted, the less children liked vegetables (β =-0·27, P<0·01), fruit (β=-0·19, P<0·01) and cereals (β=-0·28, P<0·01) and the higher the number of untried foods (r=0·17, P<0·01). The reverse was found for parents' focus on natural/ethical motives (vegetables β=0·17, P<0·01; fruit β=0·17, P<0·01; cereals β=0·14, P=0·01). Health and nutrition motives bordered on statistical significance as predictors of children's fruit and vegetable preferences. Conclusions Although parents appear well intentioned in their motives for selecting children's foods, there are gaps to be addressed in the nature of such motives (e.g. selecting foods in line with the child's desires) or the translation of health motives into healthy food choices.