Nutritional approach of inpatients with anorexia nervosa

Anorexia nervosa (AN) is the most prevalent of eating disorders in children and adolescents, and its treatment is long and complex, involving a multidisciplinary team. Nutritional rehabilitation and restoration of a healthy body weight is one of the central goals in the initial stages of inpatient treatment. However, current recommendations on initial energy requirements for these patients are inconsistent, with a clear lack of controlled studies, available scientific evidence and global consensus on the most effective and safe refeeding practices in hospitalized adolescents with anorexia nervosa (AN). Conservative refeeding recommendations have been classically established in order to prevent the refeeding syndrome. Nevertheless, various works have recently appeared advocating a higher initial caloric intake, without observing more complications or refeeding syndrome, and allowing a shorter average stay. We present our experience in the treatment of restricting AN with a conservative progressive treatment. We have obtained good results with this approach, which was well tolerated by patients, with no observing complications. As a consequence, the medical team could establish a pact about the therapeutic goals with the patients in an easier way.

Conservative management for female urinary incontinence and pelvic organ prolapse review 2013 : summary of the 5th International Consultation on Incontinence

Aims The objective of the 5th International Consultation on Incontinence (ICI) chapter on Adult Conservative Management was to review and summarize the new evidence on conservative management of urinary incontinence (UI) and pelvic organ prolapse (POP) in order to compile a current reference source for clinicians, health researchers, and service planners. In this paper, we present the review highlights and new evidence on female conservative management. Methods Revision and updates of the 4th ICI Report using systematic review covering years 2008–2012. Results Each section begins with a brief definition and description of the intervention followed by a summary, where possible, of both the state and level of evidence for prevention and treatment, and ends with a “grade of recommendation.” The paper concludes with areas identified as requiring further research. Conclusions For UI, there are no prevention trials on lifestyle interventions. There are, however, few new intervention trials of lifestyle interventions involving weight loss and fluid intake with improved levels of evidence and grade of recommendation. Outside of pre- and post-natal pelvic floor muscle training (PFMT) trials for the prevention of female UI, there is a dearth of PFMT prevention trials for women with UI. PFMT remains the first-line treatment for female UI with high levels of evidence and grades of recommendation. Bladder training levels of evidence and grades of recommendation are maintained. For POP, new evidence supports the effectiveness of physiotherapy in the treatment of POP and there are now improved levels of evidence and grades of recommendation.

Conservative management in very elderly patients with severe aortic stenosis: Time to change?

Despite current recommendations, a high percentage of patients with severe symptomatic aortic stenosis are managed conservatively. The aim of this study was to study symptomatic patients undergoing conservative management from the IDEAS registry, describing their baseline clinical characteristics, mortality, and the causes according to the reason for conservative management. Consecutive patients with severe aortic stenosis diagnosed at 48 centers during January 2014 were included. Baseline clinical characteristics, echocardiographic data, Charlson index, and EuroSCORE-II were registered, including vital status and performance of valve intervention during one-year follow-up. For the purpose of this substudy we assessed symptomatic patients undergoing conservative management, including them in 5 groups according to the reason for performing conservative management [I: comorbidity/frailty (128, 43.8%); II: dementia 18 (6.2%); III: advanced age 34 (11.6%); IV: patients’ refusal 62 (21.2%); and V: other reasons 50 (17.1%)]. We included 292 patients aged 81.5 ± 9 years. Patients from group I had higher Charlson index (4 ± 2.3), higher EuroSCORE-II (7.5 ± 6), and a higher overall (42.2%) and non-cardiac mortality (16.4%) than the other groups. In contrast, patients from group III had fewer comorbidities, lower EuroSCORE-II (4 ± 2.5), and low overall (20.6%) and non-cardiac mortality (5.9%). Patients with severe symptomatic aortic stenosis managed conservatively have different baseline characteristics and clinical course according to the reason for performing conservative management. A prospective assessment of comorbidity and other geriatric syndromes might contribute to improve therapeutic strategy in this clinical setting.

Conservative management for female urinary incontinence and pelvic organ prolapse review 2013 : summary of the 5th International Consultation on Incontinence

Aims The objective of the 5th International Consultation on Incontinence (ICI) chapter on Adult Conservative Management was to review and summarize the new evidence on conservative management of urinary incontinence (UI) and pelvic organ prolapse (POP) in order to compile a current reference source for clinicians, health researchers, and service planners. In this paper, we present the review highlights and new evidence on female conservative management. Methods Revision and updates of the 4th ICI Report using systematic review covering years 2008–2012. Results Each section begins with a brief definition and description of the intervention followed by a summary, where possible, of both the state and level of evidence for prevention and treatment, and ends with a “grade of recommendation.” The paper concludes with areas identified as requiring further research. Conclusions For UI, there are no prevention trials on lifestyle interventions. There are, however, few new intervention trials of lifestyle interventions involving weight loss and fluid intake with improved levels of evidence and grade of recommendation. Outside of pre- and post-natal pelvic floor muscle training (PFMT) trials for the prevention of female UI, there is a dearth of PFMT prevention trials for women with UI. PFMT remains the first-line treatment for female UI with high levels of evidence and grades of recommendation. Bladder training levels of evidence and grades of recommendation are maintained. For POP, new evidence supports the effectiveness of physiotherapy in the treatment of POP and there are now improved levels of evidence and grades of recommendation.

Fabricating reconciliation : Howard's forgettable speech

In this chapter, John Howard’s policy speech to The Sydney Institute, a conservative think tank, on October 11, 2007 as the Australian Prime Minister of the day, is analysed within the frame of discourse analysis to make visible how the speech works in old ways to dress up neoliberal policy as new and reformist. Taking centre stage, Howard pointed to concrete steps undertaken to achieve what he called a “new reconciliation.” This cynical manoeuvre, which put reconciliation back onto the election agenda (after it was earlier derided for its divisive and muddle headed symbolism), constituted a “neoliberal quickstep” (Reiger, 2006) or quickfix of sorts. The speech was also used as a place to reintroduce the Northern Territory Intervention, which at the time was purported to be a response to child abuse and Indigenous community dysfunction.

Of tails and Tempests : Feminine sexuality and Shakespearean children's texts

This paper reads a range of nineteenth-century texts for children that retell either Shakespeare's The Tempest or mermaid narratives, considering the models of feminine subjectivity and sexuality that they construct. It then moves on to two key contemporary texts — Disney's film adaptation of The Little Mermaid (Clements and Musker 1989) and Penni Russon's Undine (2004) — that combine the Shakespearean heroine with the mermaid, and reads them against the nineteenth-century models. Ultimately, the essay determines that, while these texts seem to perform a progressive appropriation of the two traditions, they actually combine the most conservative aspects of both The Tempest and mermaid stories to produce authoritative (and dangerously persuasive) ideals of passive feminine sexuality that confine girls within patriarchally-dictated familial positions. The new figure for adolescent female subjectivity, the mermaid-Miranda, becomes in turn a model of identification and aspiration for the implied juvenile consumer.

Citizen journalism and political participation : the youdecide project and the 2007 Australian Federal Election

The 2007 Australian Federal election not only saw the election of a Labor government after 11 years of John Howard’s conservative Coalition government. It also saw new levels of political engagement through the Internet, including the rise of citizen journalism as an alternative outlet and mode of reporting on the election. This paper reports on the You Decide 2007 project, an initiative undertaken by a QUT-based research team to facilitate online news reporting on the election on a ‘hyper-local’, electorate-based model. We evaluate the You Decide initiative on the basis of: promoting greater citizen participation in Australian politics; new ways of engaging citizens and key stakeholders in policy deliberation; establishing new links between mainstream media and independent online media; and broadening the base of political participation to include a wider range of citizen and groups.

The appeal of the International Baccalaureate in Australia’s educational market: A curriculum of choice for mobile futures

In Australia there is growing interest in a national curriculum to replace the variety of matriculation credentials managed by State Education departments, ostensibly to address increasing population mobility. Meanwhile, the International Baccalaureate (IB) is attracting increasing interest and enrolments in State and private schools in Australia, and has been considered as one possible model for a proposed Australian Certificate of Education. This paper will review the construction of this curriculum in Australian public discourse as an alternative frame for producing citizens, and ask why this design appeals now, to whom, and how the phenomenon of its growing appeal might inform national curricular debates. The IB’s emergence is understood with reference to the larger context of neo-liberal marketization policies, neo-conservative claims on the curriculum and middle class strategy. The paper draws on public domain documents from the IB Organisation and newspaper reportage to demonstrate how the IB is constructed for public consumption in Australia.

The passionate critic

It's hard to be dispassionate about Reyner Banham. For me, and for the plethora of other people with strong opinions about Banham, his writing is compelling, and one’s connection to him as a figure quite personal. For me, frankly, he rocks. As a landscape architect, I gleaned most of my knowledge about Modern architecture from Banham. His Theory and Design in the First Machine Age, along with Rowe and Koetter’s Collage City and Venturi’s Complexity and Contradiction in Architecture were the most influential books in my library, by far. Later, as a budding “real scholar”, I was disappointed to find that, while these authors had serious credibility, the writings themselves were regarded as “polemical” – when in fact what I admired about them most was their ability and willingness to make rough groupings and gross generalizations, and to offer fickle opinions. It spoke to me of a real personal engagement and an active, participatory reading of the architectural culture they discussed. They were at their best in their witty, cutting, but generally pithy, creative prose, such as in Rowe’s extrapolation of the modern citizen as the latest “noble savage”, or Banham railing against conservative social advocates and their response to high density housing: “those who had just re-discovered ‘community’ in the slums would fear megastructure as much as any other kind of large-scale renewal program, and would see to it that the people were never ready.” Any reader of Banham will be able to find a gem that will relate, somehow, personally, to what they are doing right now. For Banham, it was all personal, and the gaps in his scholarship, rather, were the dispassionate places: “Such bias is essential – an unbiased historian is a pointless historian – because history is an essentially critical activity, a constant re-scrutiny and rearrangement of the profession.” Reyner Banham: Historian of the Immediate Future, Nigel Whiteley’s recent “intellectual biography” (the MIT Press, 2002), allowed me to revisit Banham’s passionate mode of criticism and to consider what his legacy might be. The book examines Banham’s body of work, grouped according to his various primary fascinations, as well as his relationship to contemporaneous theoretical movements, such as postmodernism. His mode of practice, as a kind of creative critic, is also considered in some depth. While there are points where the book delves into Banham’s personal life, on the whole Whiteley is very rigorous in considering and theorizing the work itself: more than 750 articles and twelve books. In academic terms, this is good practice. However, considering the entirely personal nature of Banham’s writing itself, this separation seems artificial. Banham, as he himself noted, “didn’t mind a gossip”, and often when reading the book I was curious about what was happening to him at the time. Banham’s was an amazing type of intellectual practice, and one that academics (a term he hated) could do well to learn from. While Whiteley spends a lot of time arguing for his practice to be regarded as such, and makes strong points about both the role of the critic, and the importance of journalism, rather than scholarly publishing, I found myself wondering what his study looked like. What books he had in his library. Did he smoke when he wrote? What sort of teaching load did he have? He is an inspiration to design writers and thinkers, and I, personally, wanted to know how he did it.

The influence of instructions and body-scaling as constraints on decision-making processes in team sports

Team games conceptualized as dynamical systems engender a view of emergent decision-making behaviour under constraints, although specific effects of instructional and body-scaling constraints have yet to be verified empirically. For this purpose, we studied the effects of task and individual constraints on decision-making processes in basketball. Eleven experienced female players performed 350 trials in 1 vs. 1 sub-phases of basketball in which an attacker tried to perturb the stable state of a dyad formed with a defender (i.e. break the symmetry). In Experiment 1, specific instructions (neutral, risk taking or conservative) were manipulated to observe effects on emergent behaviour of the dyadic system. When attacking players were given conservative instructions, time to cross court mid-line and variability of the attacker's trajectory were significantly greater. In Experiment 2, body-scaling of participants was manipulated by creating dyads with different height relations. When attackers were considerably taller than defenders, there were fewer occurrences of symmetry-breaking. When attackers were considerably shorter than defenders, time to cross court mid-line was significantly shorter than when dyads were composed of athletes of similar height or when attackers were considerably taller than defenders. The data exemplify how interacting task and individual constraints can influence emergent decision-making processes in team ball games.

A study of entrepreneurship : Taiwanese digital content companies in China

China’s accession to the World Trade Organisation (WTO) has greatly enhanced global interest in investment in the Chinese media market, where demand for digital content is growing rapidly. The East Asian region is positioned as a growth area in many forms of digital content and digital service industries. China is attempting to catch up and take its place as a production centre to offset challenges from neighbouring countries. Meanwhile, Taiwan is seeking to use China both as an export market and as a production site for its digital content. This research investigates entry strategies of Taiwanese digital content firms into the Chinese market. By examining the strategies of a sample of Taiwan-based companies, this study also explores the evolution of their market strategies. However, the focus is on how distinctive business practices such as guanxi are important to Taiwanese business and to relations with Mainland China. This research examines how entrepreneurs manage the characteristics of digital content products and in turn how digital content entrepreneurs adapt to changing market circumstances. This project selected five Taiwan-based digital content companies that have business operations in China: Wang Film, Artkey, CnYES, Somode and iPartment. The study involved a field trip, undertaken between November 2006 and March 2007 to Shanghai and Taiwan to conduct interviews and to gather documentation and archival reports. Six senior managers and nine experts were interviewed. Data were analysed according to Miller’s firm-level entrepreneurship theory, foreign direct investment theory, Life Cycle Model and guanxi philosophy. Most studies of SMEs have focused on free market (capitalist) environments. In contrast, this thesis examines how Taiwanese digital content firms’ strategies apply in the Chinese market. I identified three main types of business strategy: cost-reduction, innovation and quality-enhancement; and four categories of functional strategies: product, marketing, resource acquisition and organizational restructuring. In this study, I introduce the concept of ‘entrepreneurial guanxi’, special relationships that imply mutual obligation, assurance and understanding to secure and exchange favors in entrepreneurial activities. While guanxi is a feature of many studies of business in Pan-Chinese society, it plays an important mediating role in digital content industries. In this thesis, I integrate the ‘Life Cycle Model’ with the dynamic concept of strategy. I outline the significant differences in the evolution of strategy between two types of digital content companies: off-line firms (Wang Film and Artkey) and web-based firms (CnYES, Somode and iPartment). Off-line digital content firms tended to adopt ‘resource acquisition strategies’ in their initial stages and ‘marketing strategies’ in second and subsequent stages. In contrast, web-based digital content companies mainly adopted product and marketing strategies in the early stages, and would adopt innovative approaches towards product and marketing strategies in the whole process of their business development. Some web-based digital content companies also adopted organizational restructuring strategies in the final stage. Finally, I propose the ‘Taxonomy Matrix of Entrepreneurial Strategies’ to emphasise the two dimensions of this matrix: innovation, and the firm’s resource acquisition for entrepreneurial strategy. This matrix is divided into four cells: Effective, Bounded, Conservative, and Impoverished.

Downtime reduction analysis of the Australia Post flat mail optical character reader

Machine downtime, whether planned or unplanned, is intuitively costly to manufacturing organisations, but is often very difficult to quantify. The available literature showed that costing processes are rarely undertaken within manufacturing organisations. Where cost analyses have been undertaken, they generally have only valued a small proportion of the affected costs, leading to an overly conservative estimate. This thesis aimed to develop a cost of downtime model, with particular emphasis on the application of the model to Australia Post’s Flat Mail Optical Character Reader (FMOCR). The costing analysis determined a cost of downtime of $5,700,000 per annum, or an average cost of $138 per operational hour. The second section of this work focused on the use of the cost of downtime to objectively determine areas of opportunity for cost reduction on the FMOCR. This was the first time within Post that maintenance costs were considered along side of downtime for determining machine performance. Because of this, the results of the analysis revealed areas which have historically not been targeted for cost reduction. Further exploratory work was undertaken on the Flats Lift Module (FLM) and Auto Induction Station (AIS) Deceleration Belts through the comparison of the results against two additional FMOCR analysis programs. This research has demonstrated the development of a methodical and quantifiable cost of downtime for the FMOCR. This has been the first time that Post has endeavoured to examine the cost of downtime. It is also one of the very few methodologies for valuing downtime costs that has been proposed in literature. The work undertaken has also demonstrated how the cost of downtime can be incorporated into machine performance analysis with specific application to identifying high costs modules. The outcome of this report has both been the methodology for costing downtime, as well as a list of areas for cost reduction. In doing so, this thesis has outlined the two key deliverables presented at the outset of the research.

AITPM Email Newsletter Volume 0910, October 2009 : Presidents Message

President’s Message Hello fellow AITPM members, Well I can’t believe it’s already October! My office is already organising its end of year function and looking to plan for 2010. Our whole School is moving to a different building next year, with the lovely L block eventually making way for a new shiny one. Those of you who have entered the Brisbane CBD from the south side, across the Captain Cook Bridge, would know L block as the big 9 storey brick and concrete Lego block ode to 1970’s functional architecture, which greets you on the right hand side. Onto traffic matters: an issue that has been tossing around in my mind of late is that of speed. I know I am growing older and may be prematurely becoming a “grumpy old man”, but everyone around me locally seems to be accelerating off from the stop line much faster than I was taught to for economical driving, both here and in the United States (yes they made my wife and me resit our written and practical driving tests when we lived there). People here in Australia also seem to be driving right on top of the posted speed limit, on whichever part of the Road Hierarchy, whether urban or rural. I was also taught on both sides of the planet that the posted speed limit is a maximum legal speed, not the recommended driving speed. This message did seem to sink in to the American drivers around me when we lived in Oregon - where people did appear to drive more cautiously. Further, posted speed limits in Oregon were, and I presume still are, set more conservative by about 5mph or 10km/h than Australian limits, for any given part of the Road Hierarchy. Another excellent speed limit treatment used in Oregon was in school zones, where reduced speed limits applied “when children are present” rather than during prescribed hours on school days. This would be especially useful here in Australia, where a lot of extra-curricular activities take place around schools outside of the prescribed speed limit hours. Before and after hours school care is on the increase (with parents dropping and collecting children near dawn and dusk in the winter), and many childcentred land uses are located adjacent to schools, such as Scouts/Guides halls, swimming pools and parks. Consequentially, I believe there needs to be some consideration towards more public campaigning about economical driving and the real purpose of the speed limit = or perhaps even a rethink of the speed limit concept, if people really are driving on top of it and it’s not just me becoming grumpier (our industrial psychology friends at the research centres may be able to assist us here). The Queensland organising committee is now in full swing organising the 2010 AITPM National Conference, What’s New?, so please keep a lookout for related content. Best regards to all, Jon Bunker PS A Cartoonists view of traffic engineers I thought you might enjoy this. http://xkcd.com/277/

A 'deleterious' effect? : Australian legal education and the production of the legal identity

A body of critical legal scholarship argues that, by the time they have completed their studies, students who enter legal education holding social ideals and intending to use their legal education to achieve social change, have become cynical about the ability of the law to do so and no longer possess such ideals. This is explained by critical scholars to be the result of a process of ideological indoctrination, aimed at ensuring that graduates uphold the narrow and conservative interests of the legal profession and capitalist society, being exercised by law schools acting as adjuncts of the legal profession, and exercised upon the passive body of the law student. By using Foucault’s work on knowledge, power, and the subject to interrogate the assumptions upon which this narrative is based, this thesis intends to suggest a way of thinking differently to the approach taken by many critical legal scholars. It then uses an analytics of government (based on Foucault’s notion of ‘governmentality’) to consider the construction of the legal identity differently. It examines the ways in which the governance of the legal identity is rationalised, programmed, and implemented, in three Queensland law schools. It also looks at the way that five prescriptive texts to ‘surviving’ law school suggest students establish and practise a relation to themselves in order to construct their own legal identities. Overall, this analysis shows that governance is not simply conducted in the profession’s interests, but occurs due to a complex arrangement of different practices, which can lead to the construction of skilled legal professional identities as well as ethical lawyer-citizens that hold an interest in justice. The implications of such an analytics provide the basis for original ways of understanding legal education, and legal education scholarship.