915 resultados para Adverse outcomes
Resumo:
Background: Preterm birth is a major cause of neonatal morbidity and mortality, with 75% of preterm births occurring late preterm. Previous studies have investigated the microbial diversity within placentas delivered early preterm but there has been no investigation of the prevalence of bacteria, particularly Ureaplasma spp. in late preterm placentas. Method: Women giving birth late preterm (320 – 366 weeks of gestation) in Cincinnati were recruited for this study. Samples of chorioamnion were collected aseptically at the time of delivery, shipped to QUT and tested for Ureaplasma spp. and other bacteria by culture and/or PCR assays. The presence of bacteria was correlated with adverse pregnancy outcomes, including histological chorioamnionitis (tissue sections read by US pathologists). Results: To date, Ureaplasma spp. have been detected in 15/270 (5.5%) of placentas by culture and 19/270 (7%) by PCR. Ureaplasma presence correlated with histological chorioamnionitis (12/19%; 63%). However, the presence of other bacteria was not associated with chorioamnionitis (5%). Chorioamnionitis was unevenly distributed in ethnic groups, with a higher incidence in African-Americans’ (6/7; 86%), compared to Caucasians’ (6/12; 50%) who were colonised with ureaplasmas. Conclusion: This study is the first to report the prevalence of ureaplasmas in women (7%) who deliver late preterm. Ureaplasma spp. were associated with a higher incidence of chorioamnionitis (63% compared to 15% for non-infected women). This data strongly suggests that ureaplasmas are a cause of late preterm deliveries and African-American women are at greater risk of chorioamnionitis.
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Alcohol and depression comorbidity is high and is associated with poorer outcomes following treatment. The ability to predict likely treatment response would be advantageous for treatment planning. Craving has been widely studied as a potential predictor, but has performed inconsistently. The effect of comorbid depression on craving's predictive performance however, has been largely neglected, despite demonstrated associations between negative affect and craving. The current study examined the performance of craving, measured pretreatment using the Obsessive subscale of the Obsessive Compulsive Drinking Scale, in predicting 18-week and 12-month post-treatment alcohol use outcomes in a sample of depressed drinkers. Data for the current study were collected during a randomized controlled trial (Baker, Kavanagh, Kay-Lambkin, Hunt, Lewin, Carr, & Connolly, 2010) comparing treatments for comorbid alcohol and depression. A subset of 260 participants from that trial with a Timeline Followback measure of alcohol consumption was analyzed. Pre-treatment craving was a significant predictor of average weekly alcohol consumption at 18 weeks and of frequency of alcohol binges at 18 weeks and 12months, but pre-treatment depressive mood was not predictive, and effects of Baseline craving were independent of depressive mood. Results suggest a greater ongoing risk from craving than from depressive mood at Baseline.
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The decision of Eckford v Stanbroke Pastoral Co Pty Ltd [2012] QSC 48 ,although a decision refusing summary judgement raises a very important question of the ability to claim adverse possession of a pastoral lease issued in 1956 under the Land Act 1962 (Queensland).Division 5 of Part 6 of the Land Title Act 1994 (Qld) which guarantees registered freehold title expressly deals with the right of adverse possession however, there is no such provision in the present Land Act 1994 unlike s 170 of the Crown Lands Act 1989(NSW) which expressly precludes claims for adverse possession of specified non freehold land. There is no mention of adverse possession in any version of the Queensland Land Acts and only s 6(4) of the Limitation of Actions Act 1974 makes it clear that “the right, title or interest of the Crown” in or to any land is not affected by any adverse possessor.It is against the background that the Court considered the right of an adverse possessor to a Crown lease.
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In 1993, contrary to the trend towards enterprise bargaining, and despite an employment environment favouring strong managerial prerogative, a small group of employers in the Queensland commercial health and fitness industry sought industrial regulation through an industry-specific award. A range of factors, including increased competition and unscrupulous profiteers damaging the industry’s reputation, triggered the actions as a business strategy. The strategic choices of the employer group, to approach a union to initiate a consent award, are the inverse of behaviours expected under strategic choice theory. This article argues that organizational size, collective employer action, focus on industry rather than organizational outcomes and the traditional industrial relations system providing broader impacts explain their atypical behaviour.
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ICT (Information and Communication Technology) creates numerous opportunities for teachers to re-think their pedagogies. In subjects like mathematics which draws upon abstract concepts, ICT creates such an opportunity. Instead of a mimetic pedagogical approach, suitably designed activities with ICT can enable learners to engage more proactively with their learning. In this quasi-experimental designed study, ICT was used in teaching mathematics to a group of first year high school students (N=25) in Australia. The control group was taught predominantly through traditional pedagogies (N=22). Most of the variables that had previously impacted on the design of such studies were suitably controlled in this yearlong investigation. Quantitative and qualitative results showed that students who were taught by ICT driven pedagogies benefitted from the experience. Pre and post-test means showed that there was a difference between the treatment and control groups. Of greater significance was that the students (in the treatment group) believed that the technology enabled them to engage more with their learning.
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Context: The benefits of high serum levels of 25-hydroxyvitamin D [25(OH)D] are unclear. Trials are needed to establish an appropriate evidence base. Objective: We plan to conduct a large-scale trial of vitamin D supplementation for the reduction of cancer incidence and overall mortality and report here the methods and results of a pilot trial established to inform its design. Design: Pilot D-Health was a randomized trial carried out in a general community setting with 12 months intervention and follow-up. Participants: Participants were 60- to 84-yr-old residents of one of the four eastern Australian states who did not have any vitamin D-related disorders and who were not taking more than 400 IU supplementary vitamin D per day. A total of 644 participants were randomized, and 615 completed the study (two persons withdrew because of nonserious adverse events). Interventions: The interventions were monthly doses of placebo or 30,000 or 60,000 IU vitamin D3. Main Outcomes: The main outcomes were the recruitment rate and changes in serum 25(OH)D. Results: Ten percent of those approached were recruited. At baseline, the mean 25(OH)D was 42 nmol/liter in all three study arms. The mean change in 25(OH)D in the placebo group was 0.12 nmol/liter, compared with changes of 22 and 36 nmol/liter in the 30,000- and 60,000-IU groups, respectively. Conclusions: The D-Health pilot has shown that a large trial is feasible in Australia and that a dose of 2000 IU/d will be needed to ensure that a large proportion of the population reaches the target serum 25(OH)D level. Copyright © 2012 by The Endocrine Society.
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Work integration social enterprises (WISE) seek to create employment and pathways to employment for those highly disadvantaged in the labour market. This chapter examines the effects of WISE on the wellbeing of immigrants and refugees experiencing multiple barriers to economic and social participation. Drawing on an evaluation of a programme that supports seven such enterprises in the Australian state of Victoria, the effects of involvement for individual participants and their communities are examined. The study finds that this social enterprise model affords unique local opportunities for economic and social participation for groups experiencing significant barriers to meaningful employment. These opportunities have a positive impact on individual and community-level wellbeing. However, the financial costs of the model are high relative to other employment programmes, which is consistent with international findings on intermediate labour market programmes. The productivity costs of WISE are also disproportionately high compared to private sector competitors in some industries. This raises considerable dilemmas for social enterprise operators seeking to produce social value and achieve business sustainability while bearing high productivity costs to fulfil their mission. Further, the evaluation illuminates an ongoing need to address the systemic and structural drivers of health and labour market inequalities that characterize socio-economic participation for immigrants and refugees.
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This paper reports on a four year Australian Research Council funded Linkage Project titled Skilling Indigenous Queensland, conducted in regional areas of Queensland, Australia from 2009 to 2013. The project sought to investigate vocational education, training (VET) and teaching, Indigenous learners’ needs, employer cultural and expectations and community culture and expectations to identify best practice in numeracy teaching for Indigenous VET learners. Specifically it focused on ways to enhance the teaching and learning of courses and the associated mathematics in such courses to benefit learners and increase their future opportunities of employment. To date thirty-nine teachers/trainers/teacher aides and two hundred and thirty-one students consented to participate in the project. Nine VET courses were nominated to be the focus on the study. This paper focuses on questionnaire and interview responses from four trainers, two teacher aides and six students. In recent years a considerable amount of funding has been allocated to increasing Indigenous Peoples’ participation in education and employment. This increased funding is predicated on the assumption that it will make a difference and contribute to closing the education gap between Indigenous and non-Indigenous Australians (Council of Australia Governments, 2009). The central tenet is that access to education for Indigenous People will create substantial social and economic benefits for regional and remote Indigenous People. The project’s aim is to address some of the issues associated with the gap. To achieve the aims, the project adopted a mixed methods design aimed at benefitting research participants and included: participatory collaborative action research (Kemmis & McTaggart, 1988) and, community research (Smith, 1999). Participatory collaborative action research refers to a is a “collective, self-reflective enquiry undertaken by participants in social situations in order to improve the rationality and justice of their own social and educational practices” (Kemmis et al., 1988, p. 5). Community research is described as an approach that “conveys a much more intimate, human and self-defined space” (p. 127). Community research relies on and validates the community’s own definitions. As the project is informed by the social at a community level, it is described as “community action research or emancipatory research” (Smith, 1999, p. 127). It seeks to demonstrate benefit to the community, making positive differences in the lives of Indigenous People and communities. The data collection techniques included survey questionnaires, video recording of teaching and learning processes, teacher reflective video analysis of teaching, observations, semi-structured interviews and student numeracy testing. As a result of these processes, the findings indicate that VET course teachers work hard to adopt contextualising strategies to their teaching, however this process is not always straight forward because of the perceptions of how mathematics has been taught and learned historically. Further teachers, trainers and students have high expectations of one another with the view to successful outcomes from the courses.
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Large scale sugarcane bagasse storage in uncovered stockpiles has the potential to result in adverse impacts on the environment and surrounding communities through hazards associated with nuisance dust, groundwater seepage, spontaneous combustion and generation of contaminated leachates. Managing these hazards will assist in improved health and safety outcomes for factory staff and reduced potential environmental impacts on surrounding communities. Removal of the smaller fibres (pith) from bagasse prior to stockpiling reduced the dust number of bagasse by 50% and modelling suggests peak ground level PM10 dust emissions would reduce by 70%. Depithed bagasse has much lower water holding capacity (~43%) than whole bagasse. This experimental and modelling study investigated the physical properties of depithed and whole bagasse. Dust dispersion modelling was undertaken to determine the likely effects associated with storage of whole and depithed sugarcane bagasse.
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The role of individuals in the innovation process is highlighted as system integrator and/or champion in literature, however, little is known about championing role of a project manager. Our contention is that the role of the project manager (PM) is essentially of a champion to enable innovation and achieve desired project performance in construction project environment. Hypothesizing that championing behaviour is determined by a number of individual and situational factors, which in turn effects on level of innovation and project performance, we used correlation and regression analysis to test the hypotheses. A survey was carried out with project managers and project team members in 32 building and civil engineering projects in Singapore to test the hypothesized relationships. The results corroborate the importance of championing behaviour to fostering innovation and achieve better project performance.
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This study investigated the influence of interpersonal coordination tendencies on performance outcomes of 1-vs-1 subphases in youth soccer. Eight male developing soccer players (age: 11.8+0.4 years; training experience: 3.6+1.1 years) performed an in situ simulation of a 1-vs-1 sub-phase of soccer. Data from 82 trials were obtained with motion-analysis techniques, and relative phase used to measure the space-time coordination tendencies of attacker-defender dyads. Approximate entropy (ApEn) was then used to quantify the unpredictability of interpersonal interactions over trials. Results revealed how different modes of interpersonal coordination emerging from attacker-defender dyads influenced the 1-vs-1 performance outcomes. High levels of space-time synchronisation (47%) and unpredictability in interpersonal coordination processes (ApEn: 0.91+0.34) were identified as key features of an attacking player’s success. A lead-lag relation attributed to a defending player (34% around 7308 values) and a more predictable coordination mode (ApEn: 0.65+0.27, P50.001), demonstrated the coordination tendencies underlying the success of defending players in 1-vs-1 sub-phases. These findings revealed how the mutual influence of each player on the behaviour of dyadic systems shaped emergent performance outcomes. More specifically, the findings showed that attacking players should be constrained to exploit the space-time synchrony with defenders in an unpredictable and creative way, while defenders should be encouraged to adopt postures and behaviours that actively constrain the attacker’s actions.
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Oxidative stress caused by generation of free radicals and related reactive oxygen species (ROS) at the sites of deposition has been proposed as a mechanism for many of the adverse health outcomes associated with exposure to particulate matter (PM). Recently, a new profluorescent nitroxide molecular probe (BPEAnit) developed at QUT was applied in an entirely novel, rapid and non-cell based assay for assessing the oxidative potential of particles (i.e. potential of particles to induce oxidative stress). The technique was applied on particles produced by several combustion sources, namely cigarette smoke, diesel exhaust and wood smoke. One of the main findings from the initial studies undertaken at QUT was that the oxidative potential per PM mass significantly varies for different combustion sources as well as the type of fuel used and combustion conditions. However, possibly the most important finding from our studies was that there was a strong correlation between the organic fraction of particles and the oxidative potential measured by the PFN assay, which clearly highlights the importance of organic species in particle-induced toxicity.
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Our previous study reported microorganisms in human follicular fluid. The objective of this study was to test human follicular fluid for the presence of microorganisms and to correlate these findings with the in vitro fertilization (IVF) outcomes. In this study, 263 paired follicular fluids and vaginal swabs were collected from women undergoing IVF cycles, with various causes for infertility, and were cultured to detect microorganisms. The cause of infertility and the IVF outcomes for each woman were correlated with the microorganisms detected within follicular fluid collected at the time of trans-vaginal oocyte retrieval. Microorganisms isolated from follicular fluids were classified as: (1) ‘colonizers’ if microorganisms were detected within the follicular fluid, but not within the vaginal swab (at the time of oocyte retrieval); or (2) ‘contaminants’ if microorganisms detected in the vagina at the time of oocyte retrieval were also detected within the follicular fluid. The presence of Lactobacillus spp. in ovarian follicular fluids was associated with embryo maturation and transfer. This study revealed microorganisms in follicular fluid itself and that the presence of particular microorganisms has an adverse affect on IVF outcomes as seen by an overall decrease in embryo transfer rates and pregnancy rates in both fertile and infertile women, and live birth rates in women with idiopathic infertility. Follicular fluid microorganisms are a potential cause of adverse pregnancy outcomes in IVF in both infertile women and in fertile women with infertile male partners.
Resumo:
Ureaplasma species are the microorganisms most frequently associated with adverse pregnancy outcomes. The multiple banded antigen (MBA), a surface-exposed lipoprotein, is a key virulence factor of ureaplasmas. The MBA demonstrates size variation, which we have shown previously to be correlated with the severity of chorioamnion inflammation. We aimed to investigate U. parvum serovar 3 pathogenesis in vivo, using a sheep model, by investigating: MBA variation after long term (chronic) and short term (acute) durations of in utero ureaplasma infections, and the severity of chorioamnionitis and inflammation in other fetal tissues. Inocula of 2x107 colony-forming-units (CFU) of U. parvum serovar 3 (Up) or media controls (C) were injected intra-amniotically into pregnant ewes at one of three time points: day 55 (69d Up, n=8; C69, n=4); day 117 (7d Up, n=8; C7, n=2); and day 121 (3d Up, n=8; C3, n=2) of gestation (term=145-150d). At day 124, preterm fetuses were delivered surgically. Samples of chorioamnion, fetal lung, and umbilical cord were: (i) snap frozen for subsequent ureaplasma culture, and (ii) fixed, embedded, sectioned and stained by haematoxylin and eosin stain for histological analysis. Selected fetal lung clinical ureaplasma isolates were cloned and filtered to obtain cultures from a single CFU. Passage 1 and clone 2 ureaplasma cultures were tested by western blot to demonstrate MBA variation. In acute durations of ureaplasma infection no MBA variants (3d Up) or very few MBA variants (7d Up) were present when compared to the original inoculum. However, numerous MBA size variants were generated in vivo (alike within contiguous tissues, amniotic fluid and fetal lung, but different variants were present within chorioamnion), during chronic, 69d exposure to ureaplasma infection. For the first time we have shown that the degree of ureaplasma MBA variation in vivo increased with the duration of gestation.
Resumo:
Health outcomes research has developed as a means of evaluating the effectiveness of health care interventions and as an approach to informing resource allocation. The use of a health outcomes approach in health promotion has made increasing demands on evaluation methodologies to demonstrate program effectiveness. However, criticism of the contribution of health promotion to outcomes research has made several assumptions about the use of qualitative methodologies and the content of program objectives largely derived from a biomedical approach. In contrast to the measurement of biomedical interventions in clinical health care, health promotion practice involves social phenomena, wide-reaching cultural, psychological, political and ideological problems and issues. The integration of methodologies of health promotion evaluation will inform further conceptualisation of the health outcomes approach with the differentiation of three types of outcomes: health development outcomes; social health outcomes; and biomedical health outcomes. It is concluded that this differentiation moves away from dualist concepts that advocate the replacement of goals and targets with regional and locally based approaches. Rather, the future direction for health promotion evaluation needs to employ a framework that elaborates multiple methodologies and approaches necessary for establishing what relationships exist between morbidity, mortality, health advancement and equity.