Paediatric death and dying: Exploring coping strategies of health professionals and perceptions of support provision

Without question a child’s death is a devastating event for parents and their families. Health professionals working with the dying child and family draw upon their expertise and experience to engage with children, parents, and families on this painful journey. A delicate and sensitive area of practice, it has strong and penetrating effects on health professionals. They employ physical, emotional, spiritual and problem solving strategies to continue to perform this role effectively and to protect their continued sense of well-being. Aim To explore health professionals’ perceptions of bereavement support surrounding the loss of a child. Methods The research was underpinned by social constructionism. Semi-structured interviews were held with 10 health professionals including doctors, nurses and social workers who were directly involved in the care of the dying child and family in 7 cases of paediatric death. Health professional narratives were analysed consistent with Charmarz’s (2006) approach. Results For health professionals, constructions around coping emerged as peer support, personal coping strategies, family support, physical impact of support and spiritual beliefs . Analysis of the narratives also revealed health professionals’ perceptions of their support provision. Conclusion Health professionals involved in caring for dying children and their families use a variety of strategies to cope with the emotional and physical toll of providing support. They also engage in self-assessment to evaluate their support provision and this highlights the need for self-evaluation tools in paediatric palliative care.

Using genetic algorithm in profile-based assignment of applications to virtual machines for greener data centers

The increase in data center dependent services has made energy optimization of data centers one of the most exigent challenges in today's Information Age. The necessity of green and energy-efficient measures is very high for reducing carbon footprint and exorbitant energy costs. However, inefficient application management of data centers results in high energy consumption and low resource utilization efficiency. Unfortunately, in most cases, deploying an energy-efficient application management solution inevitably degrades the resource utilization efficiency of the data centers. To address this problem, a Penalty-based Genetic Algorithm (GA) is presented in this paper to solve a defined profile-based application assignment problem whilst maintaining a trade-off between the power consumption performance and resource utilization performance. Case studies show that the penalty-based GA is highly scalable and provides 16% to 32% better solutions than a greedy algorithm.

Laser capture microdissection and multiplex-tandem PCR analysis of proximal tubular epithelial cell signaling in human kidney disease

Interstitial fibrosis, a histological process common to many kidney diseases, is the precursor state to end stage kidney disease, a devastating and costly outcome for the patient and the health system. Fibrosis is historically associated with chronic kidney disease (CKD) but emerging evidence is now linking many forms of acute kidney disease (AKD) with the development of CKD. Indeed, we and others have observed at least some degree of fibrosis in up to 50% of clinically defined cases of AKD. Epithelial cells of the proximal tubule (PTEC) are central in the development of kidney interstitial fibrosis. We combine the novel techniques of laser capture microdissection and multiplex-tandem PCR to identify and quantitate “real time” gene transcription profiles of purified PTEC isolated from human kidney biopsies that describe signaling pathways associated with this pathological fibrotic process. Our results: (i) confirm previous in-vitro and animal model studies; kidney injury molecule-1 is up-regulated in patients with acute tubular injury, inflammation, neutrophil infiltration and a range of chronic disease diagnoses, (ii) provide data to inform treatment; complement component 3 expression correlates with inflammation and acute tubular injury, (iii) identify potential new biomarkers; proline 4-hydroxylase transcription is down-regulated and vimentin is up-regulated across kidney diseases, (iv) describe previously unrecognized feedback mechanisms within PTEC; Smad-3 is down-regulated in many kidney diseases suggesting a possible negative feedback loop for TGF-β in the disease state, whilst tight junction protein-1 is up-regulated in many kidney diseases, suggesting feedback interactions with vimentin expression. These data demonstrate that the combined techniques of laser capture microdissection and multiplex-tandem PCR have the power to study molecular signaling within single cell populations derived from clinically sourced tissue.

Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Methods Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refi nements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries. Findings Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2∙4 billion and 1∙6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537∙6 million in 1990 to 764∙8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114∙87 per 1000 people to 110∙31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013. Interpretation Ageing of the world’s population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to nonfatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries.

The effect of surface tension in porous wave maker problems

Using a mixed-type Fourier transform of a general form in the case of water of infinite depth and the method of eigenfunction expansion in the case of water of finite depth, several boundary-value problems involving the propagation and scattering of time harmonic surface water waves by vertical porous walls have been fully investigated, taking into account the effect of surface tension also. Known results are recovered either directly or as particular cases of the general problems under consideration.

Working group report: Dictionary of Large Hadron Collider signatures

We report on a plan to establish a `Dictionary of LHC Signatures', an initiative that started at the WHEPP-X workshop in Chennai, January 2008. This study aims at the strategy of distinguishing 3 classes of dark matter motivated scenarios such as R-parity conserved supersymmetry, little Higgs models with T-parity conservation and universal extra dimensions with KK-parity for generic cases of their realization in a wide range of the model space. Discriminating signatures are tabulated and will need a further detailed analysis.

Submission to Queensland Law Reform Commission WP 73 Review of Child Protection Mandatory Reporting Laws for the Early Childhood Education and Care Sector

In 2015 the QLRC is conducting an inquiry into whether to extend legislative mandatory reporting duties for physical abuse and sexual abuse to early childhood education and care practitioners. The current legislation does not require these practitioners to report suspected cases of significant harm from physical or sexual absue to child welfare agencies. Based on the literature, and a multidisciplinary analysis, our overall recommendation is that we endorse the extension to selected early childhood education and care practitioners of Queensland’s current mandatory reporting duty in the Child Protection Act 1999 s 13E.

A Pattern Recognition Model of Voice-Based Personal Verification Systems for Forensic Applications

Abstract-The success of automatic speaker recognition in laboratory environments suggests applications in forensic science for establishing the Identity of individuals on the basis of features extracted from speech. A theoretical model for such a verification scheme for continuous normaliy distributed featureIss developed. The three cases of using a) single feature, b)multipliendependent measurements of a single feature, and c)multpleindependent features are explored.The number iofndependent features needed for areliable personal identification is computed based on the theoretcal model and an expklatory study of some speech featues.

The structures of the ammonium halides

A comparison with the alkali halides suggests that all the ammonium halides should occur in the NaCl centre-of-mass structure. Experimentally, at room temperature and atmospheric pressure, only NH4I crystallizes in this structure, while NH4F is found in the ZnO structure, and NH4C1 and NH4Br occur in the CsCl structure. We show that a distributed charge on the NH4+ ion can explain these structures. Taking charges of + 0.2e on each of the five atoms in NH4+, as suggested by other studies, we have recomputed the Madelung energy in the cases of interest. A full ionic theory including electrostatic, van der Waals and repulsive interactions then explains the centre-of-mass structures of all the four ammonium halides. The thermal and pressure transitions are also explained reasonably well. The calculated phase diagram of NH4F compares well with experiment. Barring the poorly understood NH4F(II) phase, which is beyond the scope of this work, the other features are in qualitative agreement. In particular, the theory correctly predicts a pressure transition at room temperature from the ZnO structure directly to the CsCl structure without an intermediate NaCl phase. A feature of our approach is that we do not need to invoke hydrogen bonding in NH4F.

Adducts of Silicon Tetrafluoride with Aminocyclophosphazenes : Synthesis and Characterization

Stable solid adducts of SiF4 with the following aminocyclophosphazenes have been synthesized : N3P3(NHCH2CH2NH)(NMe2)4(,1 ) ; N3P3(NHCH2CH2NH)C14(,2 ) ; N3P3(NMe2)4C12(,3 ) ; N3P3(NHMe),,(4) ; N3P3(NMe2),, (5) ; N,P,(NHMe),, (6) ; N4P4(NMe2),, (7) ; and N,P,(NHBu'),, (8). They have been characterized by elemental analysis, i.r., and n.m.r. ( H, 31 P, and 19F) spectroscopy. The composition of the adducts varies depending on the ring size and also on the nature of the substituents on the phosphorus. The number of SiF4 molecules accommodated by the ligands is larger when the ring size is large, while it is less when the ligands contain chlorine. Except in the cases of ligands (1) and (2), bonding is through the ring nitrogens. With (I), both exocyclic nitrogen and ring nitrogen atoms, and with (2) only exocyclic nitrogen atoms, participate in co-ordination. In these two cases the silicon is six-co-ordinated, while in the other cases it is five-co-ordinated.

Instabilities of a compressible stratified fluid in horizontal sheared motion

The stability characteristics of a Helmholtz velocity profile in a stably stratified, compressible atmosphere in the presence of a lower boundary are studied. A jump in the Brunt–Väisälä frequency is introduced and the level at which this jump occurs is assumed to be different from the shear zone, to simulate sharp temperature discontinuities in the atmosphere. The results are compared with those of Pellacani, Tebaldi, and Tosi and Lindzen and Rosenthal. In the present configuration, new unstable modes with larger growth rates are found. The wavelengths of the most unstable gravity waves for the parameters pertaining to observed cases of clear air turbulence agree quite closely with the experimental values. Physics of Fluids is copyrighted by The American Institute of Physics

Piggery pond sludge as a nitrogen source for crops. 1. Mineral N supply estimated from laboratory incubations and field application of stockpiled and wet sludge

Piggery pond sludge (PPS) was applied, as-collected (Wet PPS) and following stockpiling for 12 months (Stockpiled PPS), to a sandy Sodosol and clay Vertosol at sites on the Darling Downs of Queensland. Laboratory measures of N availability were carried out on unamended and PPS-amended soils to investigate their value in estimating supplementary N needs of crops in Australia's northern grains region. Cumulative net N mineralised from the long-term (30 weeks) leached aerobic incubation was described by a first-order single exponential model. The mineralisation rate constant (0.057/week) was not significantly different between Control and PPS treatments or across soil types, when the amounts of initial mineral N applied in PPS treatments were excluded. Potentially mineralisable N (No) was significantly increased by the application of Wet PPS, and increased with increasing rate of application. Application of Wet PPS significantly increased the total amount of inorganic N leached compared with the Control treatments. Mineral N applied in Wet PPS contributed as much to the total mineral N status of the soil as did that which mineralised over time from organic N. Rates of C02 evolution during 30 weeks of aerobic leached incubation indicated that the Stockpiled PPS was more stabilised (19-28% of applied organic C mineralised) than the WetPPS (35-58% of applied organic C mineralised), due to higher lignin content in the former. Net nitrate-N produced following 12 weeks of aerobic non-leached incubation was highly correlated with net nitrate-N leached during 12 weeks of aerobic incubation (R^2 = 0.96), although it was <60% of the latter in both sandy and clayey soils. Anaerobically mineralisable N determined by waterlogged incubation of laboratory PPS-amended soil samples increased with increasing application rate of Wet PPS. Anaerobically minemlisable N from field-moist soil was well correlated with net N mineralised during 30 weeks of aerobic leached incubation (R^2 =0.90 sandy soil; R^2=0.93 clay soil). In the clay soil, the amount of mineral N produced from all the laboratory incubations was significantly correlated with field-measured nitrate-N in the soil profile (0-1.5 m depth) after 9 months of weed-free fallow following PPS application. In contrast, only anaerobic mineralisable N was significantly correlated with field nitrate-N in the sandy soil. Anaerobic incubation would, therefore, be suitable as a rapid practical test to estimate potentially mineralisable N following applications of different PPS materials in the field.

Improving the outcomes of foot and ankle surgery. Professional impact of the Australasian College of Podiatric Surgeons' audit tool

Background Surgery is an example of expanded practice scope that enhances podiatry and incorporates inter-professional collaboration. By 2050 demand for foot and ankle procedures is predicted to rise nationally by 61.9%. Performance management of this increase motivated the development of an online audit tool. Developed in collaboration with the Australasian College of Podiatric Surgeons (ACPS), the ACPS audit tool provides real-time data capture and reporting. It is the first audit tool designed in Australia to support and improve the outcomes of foot and ankle surgery. Methods Audit activity in general, orthopaedic, plastic and podiatric surgery was examined using a case study design. Audit participation enablers and barriers were explored. Case study results guided a Delphi survey of international experts experienced or associated with foot and ankle surgery. Delphi survey-derived consensus informed modification of a generic data set from the Royal Australasian College of Surgeons (RACS). Based on the Delphi survey findings the ACPS online audit tool was developed and piloted. Reliability and validity of data entry and usability of this new tool was then assessed with an online survey. Results The case study found surgeon attitudes and behaviours positively impacted audit participation, and also indicated that audit data should be: (1) available in real time, (2) identify practice change, (3) applicable for safety and quality management, and; (4) useful for peer review discussion. The Delphi process established consensus on audit variables to be captured, including the modified RACS generic data set. 382 cases of foot and ankle surgery were captured across 3 months using the new tool. Data entry was found to be valid and reliable. Real-time outcome reporting and practice change identification impacted positively on safety and quality management and assisted peer review discussion. An online survey showed high levels of usability. Conclusions Surgeon contribution to audit tool development resulted in 100% audit participation. The data from the ACPS audit tool supported the ACPS submission to the Medical Services Advisory Committee to list podiatric surgery under Medicare, an outcome noted by the Federal Minister of Health.

Development of special fastener elements

A special finite element (FASNEL) is developed for the analysis of a neat or misfit fastener in a two-dimensional metallic/composite (orthotropic) plate subjected to biaxial loading. The misfit fasteners could be of interference or clearance type. These fasteners, which are common in engineering structures, cause stress concentrations and are potential sources of failure. Such cases of stress concentration present considerable numerical problems for analysis with conventional finite elements. In FASNEL the shape functions for displacements are derived from series stress function solutions satisfying the governing difffferential equation of the plate and some of the boundary conditions on the hole boundary. The region of the plate outside FASNEL is filled with CST or quadrilateral elements. When a plate with a fastener is gradually loaded the fastener-plate interface exhibits a state of partial contact/separation above a certain load level. In misfit fastener, the extent of contact/separation changes with applied load, leading to a nonlinear moving boundary problem and this is handled by FASNEL using an inverse formulation. The analysis is developed at present for a filled hole in a finite elastic plate providing two axes of symmetry. Numerical studies are conducted on a smooth rigid fastener in a finite elastic plate subjected to uniaxial loading to demonstrate the capability of FASNEL.

Analysis of laminated shells of revolution with laminated stiffeners using a doubly curved quadrilateral finite element

A finite element analysis of laminated shells of revolution reinforced with laminated stifieners is described here-in. A doubly curved quadrilateral laminated anisotropic shell of revolution finite element of 48 d.o.f. is used in conjunction with two stiffener elements of 16 d.o.f. namely: (i) A laminated anisotropic parallel circle stiffener element (PCSE); (ii) A laminated anisotropic meridional stiffener element (MSE). These stifiener elements are formulated under line member assumptions as degenerate cases of the quadrilateral shell element to achieve compatibility all along the shell-stifiener junction lines. The solutions to the problem of a stiffened cantilever cylindrical shell are used to check the correctness of the present program while it's capability is shown through the prediction of the behavior of an eccentrically stiffened laminated hyperboloidal shell.