Lateral bone density variations in the scoliotic spine

Adolescent Idiopathic Scoliosis (AIS) is the most common deformity of the spine, affecting 2-4% of the population. Previous studies have shown that the vertebrae in scoliotic spines undergo abnormal shape changes, however there has been little exploration of how AIS affects bone density distribution within the vertebrae. Existing pre-operative CT scans of 53 female idiopathic scoliosis patients with right-sided main thoracic curves were used to measure the lateral (right to left) bone density profile at mid-height through each vertebral body. This study demonstrated that AIS patients have a marked convex/concave asymmetry in bone density for vertebral levels at or near the apex of the scoliotic curve. To the best of our knowledge, the only previous studies of bone density distribution in AIS are those of Périé et al [1,2], who reported a coronal plane ‘mechanical migration’ of 0.54mm toward the concavity of the scoliotic curve in the lumbar apical vertebrae of 11 scoliosis patients. This is comparable to the value of 0.8mm (4%) in our study, especially since our patients had more severe scoliotic curves. From a bone adaptation perspective, these results suggest that the axial loading on the scoliotic spine is strongly asymmetric.

Creative Industries come to China (MATE)

This paper introduces the special issue “China: Internationalizing the Creative Industries”, describing the Australian Research Council funded “MATE” project which provides the conceptual background for the questions the issue explores. The MATE project began with the expectation that as China evolves from its status as a developing country with an emphasis on primary industries and manufacturing, to a mature, market-driven economy benefiting from high levels of international investment, it will become more actively engaged with the global “knowledge economy” and “information society”. In this context, developments in the “creative industries”, which are playing such an important role in developed economies, might reasonably be expected in China. Although China continues to be characterised by strong central-policy settings, as the domestic consumer market matures there is greater scope for consumer-led creative business development. The “MATE” project aimed to capture some of these changes as they began to gain momentum across a range of services: Media, Advertising, Tourism and Education. This special issue continues this theme with papers that explore the theoretical challenges, economic questions and implications, and practical instantiations of creative industries growth in China. All papers contained in this special issue have been peer-reviewed.

A systematic review of environmental correlates of obesity-related dietary behaviors in youth

There is increasing interest in the role the environment plays in shaping the dietary behavior of youth, particularly in the context of obesity prevention. An overview of environmental factors associated with obesity-related dietary behaviors among youth is needed to inform the development of interventions. A systematic review of observational studies on environmental correlates of energy, fat, fruit/ vegetable, snack/fast food and soft drink intakes in children (4–12 years) and adolescents (13–18 years) was conducted. The results were summarized using the analysis grid for environments linked to obesity. The 58 papers reviewed mostly focused on sociocultural and economical–environmental factors at the household level. The most consistent associations were found between parental intake and children’s fat, fruit/vegetable intakes, parent and sibling intake with adolescent’s energy and fat intakes and parental education with adolescent’s fruit/ vegetable intake. A less consistent but positive association was found for availability and accessibility on children’s fruit/vegetable intake. Environmental factors are predominantly studied at the household level and focus on sociocultural and economic aspects. Most consistent associations were found for parental influences (parental intake and education).More studies examining environmental factors using longitudinal study designs and validated measures are needed for solid evidence to inform interventions.

The experience of waterfalls

Landscape beauty has long been a concern of geographers and other scholars, but relatively little work has been done on the aesthetic analysis of specific landscape features such as mountain peaks and waterfalls. In Australia, as in many other parts of the world, waterfalls are popular scenic attractions, and this paper attempts to explain the widespread appeal of these landforms by examining them in the light of theories of landscape aesthetics, from the Picturesque and Sublime to arousal and prospect-refuge. While no single theory offers a complete explanation of our experience of waterfalls, this paper suggests that by using several theoretical approaches to the subject we are more likely to gain a full understanding of the way we respond to these landscape features.

Waterfalls : resources for tourism

While very few waterfalls may be regarded as tourism destinations, many are attractions. This paper discusses waterfalls within the theoretical frameworks developed by economists and geographers in the field of recreation and tourism. Examples are drawn from various parts of the world, including the United States, Canada, and the United Kingdom, with Jamaica examined as a case study. Here, as in many tourism areas, although visitors usually choose their destinations for reasons other than the appeal of waterfalls, these landscape features play important roles as attractions. Often associated with ecotourism, waterfalls help to diversify the tourism product and spread the benefits as well as some of the associated problems of tourism to less developed areas.

Aging, retirement, and changes in physical activity : prospective cohort findings from the globe study

There is increased recognition that determinants of health should be investigated in a life-course perspective. Retirement is a major transition in the life course and offers opportunities for changes in physical activity that may improve health in the aging population. The authors examined the effect of retirement on changes in physical activity in the GLOBE Study, a prospective cohort study known by the Dutch acronym for "Health and Living Conditions of the Population of Eindhoven and surroundings," 1991–2004. They followed respondents (n = 971) by postal questionnaire who were employed and aged 40–65 years in 1991 for 13 years, after which they were still employed (n = 287) or had retired (n = 684). Physical activity included 1) work-related transportation, 2) sports participation, and 3) nonsports leisure-time physical activity. Multinomial logistic regression analyses indicated that retirement was associated with a significantly higher odds for a decline in physical activity from work-related transportation (odds ratio (OR) = 3.03, 95% confidence interval (CI): 1.97, 4.65), adjusted for sex, age, marital status, chronic diseases, and education, compared with remaining employed. Retirement was not associated with an increase in sports participation (OR = 1.12, 95% CI: 0.71, 1.75) or nonsports leisure-time physical activity (OR = 0.80, 95% CI: 0.54, 1.19). In conclusion, retirement introduces a reduction in physical activity from work-related transportation that is not compensated for by an increase in sports participation or an increase in nonsports leisure-time physical activity.

Positive development

net sustainability. At best they reduce relative resource consumption. They still consume vast quantities of materials, energy, water and ecosystems during construction. Moreover, green buildings replace land and ecosystems with structures that, at the very best, only 'mimic' ecosystems<'). Mimicking nature is little compensation when we have lost a third of species that are integral parts of our life support system. Already, development has exceeded the Earth's ecological carrying capacity, so even 'restorative' design is not enough. Urban areas must be retrofitted to increase net bioregional carrying capacity - just to support existing or reduced population levels in cities. The eco-retrofitting of our built environment is therefore an essential precondition of achieving a sustainable society. But we need to eco-retrofit cities in ways that increase net sustainability, not just relative efficiency.

Amblyopia treatment : an evidence-based approach to maximising treatment outcome

The basis of treatment for amblyopia (poor vision due to abnormal visual experience early in life) for 250 years has been patching of the unaffected eye for extended times to ensure a period of use of the affected eye. Over the last decade randomised controlled treatment trials have provided some evidence on how to tailor amblyopia therapy more precisely to achieve the best visual outcome with the least negative impact on the patient and the family. This review highlights the expansion of knowledge regarding treatment for amblyopia and aims to provide optometrists with a summary of research evidence to enable them to better treat amblyopia. Treatment for amblyopia is effective, as it reduces overall prevalence and severity of visual loss in this population. Correction of refractive error alone significantly improves visual acuity, sometimes to the point where further amblyopia treatment is not required. Atropine penalisation and patch occlusion are effective in treating amblyopia. Lesser amounts of occlusion or penalisation have been found to be just as effective as greater amounts. Recent evidence has highlighted that occlusion or penalisation in amblyopia treatment can create negative changes in behaviour in children and impact on family life. These complications should be considere when prescribing treatment because they can negatively affect compliance. Studies investigating the maximum age at which treatment of amblyopia can still be effective and the importance of near activities during occlusion are ongoing.

Challenging 'best practice' subtropical design

Genuine sustainability would require that urban development provide net positive social and ecological gains to compensate for previous lost natural capital and carrying capacity. Thus far, green buildings do not contribute to net sustainability. While they reduce relative resource consumption, they consume vast quantities of materials, energy and water.i Moreover, they replace land and ecosystems with structures that, at best, ‘mimic’ ecosystems. Elsewhere, the author has proposed a‘sustainability standard’, where development would leave the ecology, as well as society, better off after construction than before.ii To meet this standard, a development would need to add natural and social capital beyond what existed prior to development. Positive DesignTM or Positive DevelopmentTM is that which expands both the ecological base (life support system) and the public estate (equitable access to means of survival). How to achieve this is discussed in Positive Development (Birkeland 2008). This paper examines how net positive gains can be achieved in a ubtropical as well as temperate environment.

Computed tomography evaluation of axial vertebral derotation in endoscopic anterior instrumentation for adolescent idiopathic scoliosis

Thoracoscopic instrumented anterior spinal fusion for adolescent idiopathic scoliosis (AIS) has clinical benefits that include reduced pulmonary morbidity, postoperative pain, and improved cosmesis. However, quantitative data on radiological improvement of vertebral rotation using this method is lacking. This study’s objectives were to measure preoperative and postoperative axial vertebral rotational deformity at the curve apex in endoscopically-treated anterior-instrumented scoliosis patients using CT, and assess the relevance of these findings to clinically measured chest wall rib hump deformity correction. This is the first quantitative CT study to confirm that endoscopic anterior instrumented fusion for AIS substantially improves axial vertebral body rotational deformity at the apex of the curve. The margin of correction of 43% compares favourably with historically published figures of 24% for patients with posterior all-hook-rod constructs. CT measurements correlated significantly to the clinical outcome of rib hump deformity correction.

Through the clock's workings

Through the Clock’s Workings is a world first: a remixed and remixable anthology of literature.----- Prominent Australian authors have written new short stories and released them under a Creative Commons Attribution Non-Commercial ShareAlike licence. What that means is you can remix the stories, but only if you acknowledge the author, the remix is not for commercial use, and your new work is available for others to remix. The authors’ stories were made available on our website and new and emerging writers were invited to create their own remixes to be posted on the website and considered for publication in the print anthology alongside the original stories.----- The result is a world first: a remixed and remixable anthology of literature. Buy your copy now from the Sydney University Press eStore or download the electronic version.----- So how do you use a remixable anthology? Simple.----- Step 1 - Read. Thumb your way through the pages at will. Find the stories you love, the ones you hate, the ones that could be better.----- Step 2 - Re/create. Each story is yours to share and to remix. Use only one paragraph or character or just make subtle changes. Change the genre, alter its formal or stylistic characteristics, or revise its message. Use as little or as much as you like - as long as it works.----- Step 3 - Share. Be part of a growing community of literature remixing. Email your remix to us and start sharing. The entire anthology can be remixed - the original stories, the remixes, and even the fonts.----- Through the Clock’s Workings is Read&Write!

Advanced nursing practice : a global perspective

Aim: To review the titles, roles and scope of practice of Advanced Practice Nurses internationally.----- Background: There is a worldwide shortage of nurses but there is also an increased demand for nurses with enhanced skills who can manage a more diverse, complex and acutely ill patient population than ever before. As a result, a variety of nurses in advanced practice positions has evolved around the world. The differences in nomenclature have led to confusion over the roles, scope of practice and professional boundaries of nurses in an international context.----- Method: CINAHL, Medline, and the Cochrane database of Systematic Reviews were searched from 1987 to 2008. Information was also obtained through government health and professional organisation websites. All information in the literature regarding current and past status, and nomenclature of advanced practice nursing was considered relevant.----- Findings: There are many names for Advanced Practice Nurses, and although many of these roles are similar in their function, they can often have different titles.----- Conclusion: Advanced Practice Nurses are critical for the future, provide cost-effective care and are highly regarded by patients/clients. They will be a constant and permanent feature of future health care provision. However, clarification regarding their classification and regulation is necessary in some countries.

Neonatal palliative care attitude scale : development of an instrument to measure the barriers to and facilitators of palliative care in neonatal nursing

OBJECTIVE The aim of this research project was to obtain an understanding of the barriers to and facilitators of providing palliative care in neonatal nursing. This article reports the first phase of this research: to develop and administer an instrument to measure the attitudes of neonatal nurses to palliative care. METHODS The instrument developed for this research (the Neonatal Palliative Care Attitude Scale) underwent face and content validity testing with an expert panel and was pilot tested to establish temporal stability. It was then administered to a population sample of 1285 neonatal nurses in Australian NICUs, with a response rate of 50% (N 645). Exploratory factor-analysis techniques were conducted to identify scales and subscales of the instrument. RESULTS Data-reduction techniques using principal components analysis were used. Using the criteria of eigenvalues being 1, the items in the Neonatal Palliative Care Attitude Scale extracted 6 factors, which accounted for 48.1% of the variance among the items. By further examining the questions within each factor and the Cronbach’s of items loading on each factor, factors were accepted or rejected. This resulted in acceptance of 3 factors indicating the barriers to and facilitators of palliative care practice. The constructs represented by these factors indicated barriers to and facilitators of palliative care practice relating to (1) the organization in which the nurse practices, (2) the available resources to support a palliative model of care, and (3) the technological imperatives and parental demands. CONCLUSIONS The subscales identified by this analysis identified items that measured both barriers to and facilitators of palliative care practice in neonatal nursing. While establishing preliminary reliability of the instrument by using exploratory factor-analysis techniques, further testing of this instrument with different samples of neonatal nurses is necessary using a confirmatory factor-analysis approach.

Creating a therapeutic environment : a non-randomised controlled trial of a quiet time intervention for patients in acute care

Background: Noise is a significant barrier to sleep for acute care hospital patients, and sleep has been shown to be therapeutic for health, healing and recovery. Scheduled quiet time interventions to promote inpatient rest and sleep have been successfully trialled in critical care but not in acute care settings. Objectives: The study aim was to evaluate as cheduled quiet time intervention in an acute care setting. The study measured the effect of a scheduled quiet time on noise levels, inpatients’ rest and sleep behaviour, and wellbeing. The study also examined the impact of the intervention on patients’, visitors’ and health professionals’ satisfaction, and organisational functioning. Design: The study was a multi-centred non-randomised parallel group trial. Settings: The research was conducted in the acute orthopaedic wards of two major urban public hospitals in Brisbane, Australia. Participants: All patientsadmitted to the two wards in the5-month period of the study were invited to participate, withafinalsample of 299 participants recruited. This sample produced an effect size of 0.89 for an increase in the number of patients asleep during the quiet time. Methods: Demographic data were collected to enable comparison between groups. Data for noise level, sleep status, sleepiness and well being were collected using previously validated instruments: a Castle Model 824 digital sound level indicator; a three point sleep status scale; the Epworth Sleepiness Scale; and the SF12 V2 questionnaire. The staff, patient and visitor surveys on the experimental ward were adapted from published instruments. Results: Significant differences were found between the two groups in mean decibel level and numbers of patients awake and asleep. The difference in mean measured noise levels between the two environments corresponded to a ‘perceived’ difference of 2 to 1. There were significant correlations between average decibel level and number of patients awake and asleep in the experimental group, and between average decibel level and number of patients awake in the control group. Overall, patients, visitors and health professionals were satisfied with the quiet time intervention. Conclusions: The findings show that a quiet time intervention on an acute care hospital ward can affect noise level and patient sleep/wake patterns during the intervention period. The overall strongly positive response from surveys suggests that scheduled quiet time would be a positively perceived intervention with therapeutic benefit.