Mid-gestation intra-amniotic infection with Ureaplasma parvum is resolved within spiny mice (Acomys cahirinus) by term delivery: but caused chronic infection of fetal lungs and placentae

Background: Ureaplasma species in amniotic fluid at the time of second-trimester amniocentesis increases the risk of preterm birth, but most affected pregnancies continue to term (Gerber et al. J Infect Dis 2003). We aimed to model intra-amniotic (IA) ureaplasma infection in spiny mice, a species with a relatively long gestation (39 days) that allows investigation of the disposition and possible clearance of ureaplasmas in the feto-placental compartment. Method: Pregnant spiny mice received IA injections of U. parvum serovar 6 (10µL, 1x104 colony-forming-units in PBS) or 10B media (10µL; control) at 20 days (d) of gestation (term=39d). At 37d fetuses (n=3 ureaplasma, n=4 control) were surgically delivered and tissues were collected for; bacterial culture, ureaplasma mba and urease gene expression by PCR, tissue WBC counts and indirect fluorescent antibody (IFA) staining using anti-ureaplasma serovar 6 (rabbit) antiserum. Maternal and fetal plasma IgG was measured by Western blot. Results: Ureaplasmas were not detected by culture or PCR in fetal or maternal tissues but were visualized by IFA within placental and fetal lung tissues, in association with inflammatory changes and elevated WBC counts (p<0.0001). Anti-ureaplasma IgG was detected in maternal (2/2 tested) and fetal (1/2 tested) plasma but not in controls (0/3). Conclusions: IA injection of ureaplasmas in mid-gestation spiny mice caused persistent fetal lung and placental infection even though ureaplasmas were undetectable using standard culture or PCR techniques. This is consistent with resolution of IA infection, which may occur in human pregnancies that continue to term despite detection of ureaplasmas in mid-gestation.

Applying quality management to project delivery in Hong Kong : A field study of management perceptions

The concept of market-driven rather than product-driven quality management has been given prominence through the report of a recent inquiry into the performance of the Hong Kong construction industry. The report submitted to the Government of Hong Kong in 2001 establishes a new vision of ‘an integrated industry that is capable of continuous improvement towards excellence in the market-driven environment’. Given the current economic downturn, major contractors are facing many challenges to realize this new quality oriented vision. This paper addresses the critical and timely issue of applying quality management to the project delivery process in Hong Kong. The paper attempts to capture and critically examine management perceptions of quality management aspects as applied to a local large-scale road construction project. Based on the analysis of questionnaire feedback and face-to-face interviews, the paper reveals key attributes of a successful application of quality management approaches, and identifies a mechanism for facilitating such implementation.

Stakeholder engagement by governance networks : a study of stakeholder engagement by road delivery network in Queensland

This thesis explores how governance networks prioritise and engage with their stakeholders, by studying three exemplars of “Regional Road Group” governance networks in Queensland, Australia. In the context of managing regionally significant road works programs, stakeholder prioritisation is a complex activity which is unlikely to influence interactions with stakeholders outside of the network. However, stakeholder priority is more likely to influence stakeholder interactions within the networks themselves. Both stakeholder prioritisation and engagement are strongly influenced by the way that the networks are managed, and in particular network operating rules and continuing access to resources.

Delivery of dimethyloxallyl glycine in mesoporous bioactive glass scaffolds to improve angiogenesis and osteogenesis of human bone marrow stromal cells

Development of hypoxia-mimicking bone tissue engineering scaffolds is of great importance in stimulating angiogenesis for bone regeneration. Dimethyloxallyl glycine (DMOG) is a cell-permeable, competitive inhibitor of hypoxia-inducible factor prolyl hydroxylase (HIF-PH), which can stabilize hypoxia-inducible factor 1α (HIF-1α) expression. The aim of this study was to develop hypoxia-mimicking scaffolds by delivering DMOG in mesoporous bioactive glass (MBG) scaffolds and to investigate whether the delivery of DMOG could induce a hypoxic microenvironment for human bone marrow stromal cells (hBMSC). MBG scaffolds with varied mesoporous structures (e.g. surface area and mesopore volume) were prepared by controlling the contents of mesopore-template agent. The composition, large-pore microstructure and mesoporous properties of MBG scaffolds were characterized. The effect of mesoporous properties on the loading and release of DMOG in MBG scaffolds was investigated. The effects of DMOG delivery on the cell morphology, cell viability, HIF-1α stabilization, vascular endothelial growth factor (VEGF) secretion and bone-related gene expression (alkaline phosphatase, ALP; osteocalcin, OCN; and osteopontin, OPN) of hBMSC in MBG scaffolds were systematically investigated. The results showed that the loading and release of DMOG in MBG scaffolds can be efficiently controlled by regulating their mesoporous properties via the addition of different contents of mesopore-template agent. DMOG delivery in MBG scaffolds had no cytotoxic effect on the viability of hBMSC. DMOG delivery significantly induced HIF-1α stabilization, VEGF secretion and bone-related gene expression of hBMSC in MBG scaffolds in which DMOG counteracted the effect of HIF-PH and stabilized HIF-1α expression under normoxic condition. Furthermore, it was found that MBG scaffolds with slow DMOG release significantly enhanced the expression of bone-related genes more than those with instant DMOG release. The results suggest that the controllable delivery of DMOG in MBG scaffolds can mimic a hypoxic microenvironment, which not only improves the angiogenic capacity of hBMSC, but also enhances their osteogenic differentiation.

A public asset management framework for Indonesian local governments

The decentralisation reform in Indonesia has mandated the Central Government to transfer some functions and responsibilities to local governments including the transfer of human resources, assets and budgets. Local governments became giant asset holders almost overnight and most were ill prepared to handle these transformations. Assets were transferred without analysing local government need, ability or capability to manage the assets and no local government was provided with an asset management framework. Therefore, the aim of this research is to develop a Public Asset Management Framework for provincial governments in Indonesia, especially for infrastructure and real property assets. This framework will enable provincial governments to develop integrated asset management procedures throughout asset‘s lifecycle. Achieving the research aim means answering the following three research questions; 1) How do provincial governments in Indonesia currently manage their public assets? 2) What factors influence the provincial governments in managing these public assets? 3) How is a Public Asset Management Framework developed that is specific for the Indonesian provincial governments‘ situation? This research applied case studies approach after a literature review; document retrieval, interviews and observations were collated. Data was collected in June 2009 (preliminary data collection) and January to July 2010 in the major eastern Indonesian provinces. Once the public asset management framework was developed, a focus group was used to verify the framework. Results are threefold and indicate that Indonesian provincial governments need to improve the effectiveness and efficiency of current practice of public asset management in order to improve public service quality. The second result shows that the 5 major concerns that influence the local government public asset management processes are asset identification and inventory systems, public asset holding, asset guidance and legal arrangements, asset management efficiency and effectiveness, and, human resources and their organisational arrangements. The framework was then applied to assets already transferred to local governments and so included a system of asset identification and a needs analysis to classify the importance of these assets to local governments, their functions and responsibilities in delivering public services. Assets that support local government functions and responsibilities will then be managed using suitable asset lifecycle processes. Those categorised as surplus assets should be disposed. Additionally functions and responsibilities that do not need an asset solution should be performed directly by local governments. These processes must be measured using performance measurement indicators. All these stages should be guided and regulated with sufficient laws and regulations. Constant improvements to the quality and quantity of human resources hold an important role in successful public asset management processes. This research focuses on developing countries, and contributes toward the knowledge of a Public Asset Management Framework at local government level, particularly Indonesia. The framework provides local governments a foundation to improve their effectiveness and efficiency in managing public assets, which could lead to improved public service quality. This framework will ensure that the best decisions are made throughout asset decision ownership and provide a better asset life cycle process, leading to selection of the most appropriate asset, improve its acquisition and delivery process, optimise asset performance, and provide an appropriate disposal program.

Verification of patient position and delivery of IMRT by electronic portal imaging

Background and purpose: The purpose of the work presented in this paper was to determine whether patient positioning and delivery errors could be detected using electronic portal images of intensity modulated radiotherapy (IMRT). Patients and methods: We carried out a series of controlled experiments delivering an IMRT beam to a humanoid phantom using both the dynamic and multiple static field method of delivery. The beams were imaged, the images calibrated to remove the IMRT fluence variation and then compared with calibrated images of the reference beams without any delivery or position errors. The first set of experiments involved translating the position of the phantom both laterally and in a superior/inferior direction a distance of 1, 2, 5 and 10 mm. The phantom was also rotated 1 and 28. For the second set of measurements the phantom position was kept fixed and delivery errors were introduced to the beam. The delivery errors took the form of leaf position and segment intensity errors. Results: The method was able to detect shifts in the phantom position of 1 mm, leaf position errors of 2 mm, and dosimetry errors of 10% on a single segment of a 15 segment IMRT step and shoot delivery (significantly less than 1% of the total dose). Conclusions: The results of this work have shown that the method of imaging the IMRT beam and calibrating the images to remove the intensity modulations could be a useful tool in verifying both the patient position and the delivery of the beam.

Verification of patient position and delivery of IMRT by electronic Portal Imaging

We have taken a new method of calibrating portal images of IMRT beams and used this to measure patient set-up accuracy and delivery errors, such as leaf errors and segment intensity errors during treatment. A calibration technique was used to remove the intensity modulations from the images leaving equivalent open field images that show patient anatomy that can be used for verification of the patient position. The images of the treatment beam can also be used to verify the delivery of the beam in terms of multileaf collimator leaf position and dosimetric errors. A series of controlled experiments delivering an IMRT anterior beam to the head and neck of a humanoid phantom were undertaken. A 2mm translation in the position of the phantom could be detected. With intentional introduction of delivery errors into the beam this method allowed us to detect leaf positioning errors of 2mm and variation in monitor units of 1%. The method was then applied to the case of a patient who received IMRT treatment to the larynx and cervical nodes. The anterior IMRT beam was imaged during four fractions and the images calibrated and investigated for the characteristic signs of patient position error and delivery error that were shown in the control experiments. No significant errors were seen. The method of imaging the IMRT beam and calibrating the images to remove the intensity modulations can be a useful tool in verifying both the patient position and the delivery of the beam.

Framework for implementing design build project delivery system in road infrastructure in Indonesia

The thesis provides a framework for potential implementation of the design-build (DB) project delivery system in road infrastructure projects in Indonesia. This framework proposed a structure of the hierarchy of factors promoting the potential implementation of the DB project delivery system and introduced ways to implement the DB project delivery system through level of hierarchical factors. These findings not only give benefit to the academic knowledge but also to the public officials in guiding them with regard to the priority of promoting factors in the process to implement the DB system.

Electrospraying of polymers with therapeutic molecules : state of the art

The encapsulation and release of bioactive molecules from polymeric vehicles represents the holy grail of drug and growth factor delivery therapies, whereby sustained and controlled release is crucial in eliciting a positive therapeutic effect. To this end, electrospraying is rapidly emerging as a popular technology for the production of polymeric particles containing bioactive molecules. Compared with traditional emulsion fabrication techniques, electrospraying has the potential to reduce denaturation of protein drugs and affords tighter regulation over particle size distribution and morphology. In this article, we review the importance of the electrospraying parameters that enable reproducible tailoring of the particles' physical and in vitro drug release characteristics, along with discussion of existing in vivo data. Controlled morphology and monodispersity of particles can be achieved with electrospraying, with high encapsulation efficiencies and without unfavorable denaturation of bioactive molecules throughout the process. Finally, the combination of electrospraying with electrospun scaffolds, with an emphasis on tissue regeneration is reviewed, depicting a technique in its relative infancy but holding great promise for the future of regenerative medicine.

Composites for delivery of therapeutics : combining melt electrospun scaffolds with loaded electrosprayed microparticles

A novel strategy is reported to produce biodegradable microfiber-scaffolds layered with high densities of microparticles encapsulating a model protein. Direct electrospraying on highly porous melt electrospun scaffolds provides a reproducible scaffold coating throughout the entire architecture. The burst release of protein is significantly reduced due to the immobilization of microparticles on the surface of the scaffold and release mechanisms are dependent on protein-polymer interactions. The composite scaffolds have a positive biological effect in contact with precursor osteoblast cells up to 18 days in culture. The scaffold design achieved with the techniques presented here endorses these new composite scaffolds as promising templates for growth factor delivery.

Evaluating patient presentations for care delivered by emergency nurse practitioners : a retrospective analysis of 12 months

Background The delivery of quality patient care in the emergency department (ED) is emerging as one of the most important service indicators to be measured in health services today. The emergency nurse practitioner role was implemented as a service innovation in a Emergency & Trauma Centre (ETC), Melbourne, Australia, in July 2004 .The primary aim of the role was intended to enhance healthcare services, improve the efficiency and timely delivery of high quality care to patients. Aim To conduct a retrospective study of patient presentations at the ETC to obtain a profile of the characteristics of patients managed by emergency nurse practitioners. Specifically the objectives of the study were to: 1) examine the demographics of the patient population 2) evaluate data on emergency department service indicators for this patient cohort Method All patients presenting to the ETC from January 01 2011 to December 31 2011 and managed by emergency nurse practitioners were included in the review. Data collection included baseline demographics, waiting times to be seen, length of stay, emergency department discharge diagnoses and referral patterns. Data were extracted and imported directly from the emergency department Patient Information System (Cerner log), for the specified time frame. Results A total of 5212 patients were reviewed in the study period. The median age of patients was 35 years and 61% of patients were male. The most common discharge diagnosis was open wounds to hand/wrist. Waiting times to be seen by the emergency nurse practitioner were 14 minutes and length of stay for patients with a discharge disposition of home were 122 minutes. Conclusions This study has provided information on patient baseline characteristics and performance on important service indicators for this patient sample that will inform further research to evaluate specific outcomes of the emergency nurse practitioner service.

Social technologies in public libraries : exploring best practice

Purpose This article reports on a research project that explored social media best practice in the public library sector. Design/methodology/approach The primary research approach for the project was case study. Two organisations participated in case studies that involved interviews, document analysis, and social media observation. Findings The two case study organisations use social media effectively to facilitate participatory networks, however, there have been challenges surrounding its implementation in both organisations. Challenges include negotiating requirements of governing bodies and broader organisational environments, and managing staff reluctance around the implementations. As social media use continues to grow and libraries continue to take up new platforms, social media must be considered to be another service point of the virtual branch, and indeed, for the library service as a whole. This acceptance of social media as being core business is critical to the successful implementation of social media based activities. Practical implications The article provides an empirically grounded discussion of best practice and the conditions that support it. The findings are relevant for information organisations across all sectors and could inform the development of policy and practice in other organisations. This paper contributes to the broader dialogue around best practice in participatory service delivery and social media use in library and information organisations.