Lying in all honesty : capturing truth in women’s confessional memoir

This paper explores the slippery nature of illness and diagnosis in Lauren Slater’s memoir, Lying: a Metaphorical Memoir (2000). Speaking from the shadowy intersection of childhood and adolescence, Slater’s narrator, Lauren, uses the metaphor of epilepsy to describe her own predilection for exaggeration. In exploiting the fallibility of the first-person narrator, Slater insists on the legitimacy of metaphor in accounts of childhood illness that are more concerned with narrative truth than historical accuracy. The result of this playfulness and general misrule is that Slater writes herself into a double bind: on one side, she is the child narrator who inadvertently misrepresents events and misdirects readers, and on the other side, she is the untrustworthy author who employs metaphor as a licence to lie.

Leptospirosis and Leptospires - The silent assassins

Leptospirosis is one of the most common yet under reported zoonoses. Leptospires, the etiological agents of leptospirosis are ubiquitous pathogens, with a world-wide distribution, causing a spectrum of disease ranging from a mild influenza-like illness to Weil’s disease, which manifests itself in multi-organ failure. The following chapter reports on the epidemiology and transmission of the disease in humans and animals. The chapter will also delineate the symptoms observed in humans and animals and in concluding outline unresolved and evolving issues for microbiologists, epidemiologists and public health officials.

Rational design of artificial cellular niches for tissue engineering

Tissue Engineering is a promising emerging field that studies the intrinsic regenerative potential of the human body and uses it to restore functionality of damaged organs or tissues unable of self-healing due to illness or ageing. In order to achieve regeneration using Tissue Engineering strategies, it is first necessary to study the properties of the native tissue and determine the cause of tissue failure; second, to identify an optimum population of cells capable of restoring its functionality; and third, to design and manufacture a cellular microenvironment in which those specific cells are directed towards the desired cellular functions. The design of the artificial cellular niche has a tremendous importance, because cells will feel and respond to both its biochemical and biophysical properties very differently. In particular, the artificial niche will act as a physical scaffold for the cells, allowing their three-dimensional spatial organization; also, it will provide mechanical stability to the artificial construct; and finally, it will supply biochemical and mechanical cues to control cellular growth, migration, differentiation and synthesis of natural extracellular matrix. During the last decades, many scientists have made great contributions to the field of Tissue Engineering. Even though this research has frequently been accompanied by vast investments during extended periods of time, yet too often these efforts have not been enough to translate the advances into new clinical therapies. More and more scientists in this field are aware of the need of rational experimental designs before carrying out complex, expensive and time-consuming in vitro and in vivo trials. This review highlights the importance of computer modeling and novel biofabrication techniques as critical key players for a rational design of artificial cellular niches in Tissue Engineering.

Brave New World of Health

"Within contemporary society the meaning of 'health' is surprisingly unstable. Guiding principles that once seemed self-evident have been challenged by new social, scientific and economic forces. This book argues that the foundational terms and concepts, which form the basic building blocks of dialogue about health, are now in flux. While the forces in play differ, and the pace of change is varied, there is now a 'brave new world' of health which characterises policy debate about health (and illness or disability). This permeates even the more narrow technical issues within clinical medicine, the law and medical science. This construction and reconstruction of health has important implications for the development of law and policy. The book draws on international and local experts to explore these issues. It opens with consideration of the economic and social forces of 'globalisation' - the macro level forces which now shape the 'lived realities' of health for the world's people. This is then contextualised through a series of detailed 'case studies' of more localised examples including; pharmaceuticals, preimplantation genetic diagnosis, body modification, abortion, anorexia and post-traumatic stress disorder. The book also interrogates the way modern health research influences public conceptions of health. Across these issues the book canvasses the social forces at work in the construction of health, disability and illness in shaping our understandings of such concepts by the public, by individuals, by the courts, and by international bodies. Brave New World of Health is an important contribution to advancing that understanding."--Publisher's website.

Antibodies mediate formation of neutrophil extracellular traps in the middle ear and facilitate secondary pneumococcal otitis media

Otitis media (OM) (a middle ear infection) is a common childhood illness that can leave some children with permanent hearing loss. OM can arise following infection with a variety of different pathogens, including a coinfection with influenza A virus (IAV) and Streptococcus pneumoniae (the pneumococcus). We and others have demonstrated that coinfection with IAV facilitates the replication of pneumococci in the middle ear. Specifically, we used a mouse model of OM to show that IAV facilitates the outgrowth of S. pneumoniae in the middle ear by inducing middle ear inflammation. Here, we seek to understand how the host inflammatory response facilitates bacterial outgrowth in the middle ear. Using B cell-deficient infant mice, we show that antibodies play a crucial role in facilitating pneumococcal replication. We subsequently show that this is due to antibody-dependent neutrophil extracellular trap (NET) formation in the middle ear, which, instead of clearing the infection, allows the bacteria to replicate. We further demonstrate the importance of these NETs as a potential therapeutic target through the transtympanic administration of a DNase, which effectively reduces the bacterial load in the middle ear. Taken together, these data provide novel insight into how pneumococci are able to replicate in the middle ear cavity and induce disease.

Asthma and protracted bronchitis : who fares better during an acute respiratory infection?

Aim Acute respiratory infections (ARI) are common in children, and symptoms range from days to weeks. The aim of this study was to determine if children with asthma have more severe ARI episodes compared with children with protracted bronchitis and controls. Methods Parents prospectively scored their child's next ARI using the Canadian acute respiratory illness and flu scale (CARIFS) and a validated cough diary (on days 1–7, 10 and 14 of illness). Children were age- and season-matched. Results On days 10 and 14 of illness, children with protracted bronchitis had significantly higher median CARIFS when compared with children with asthma and healthy controls. On day 14, the median CARIFS were: asthma = 4.1 (interquartile range (IQR) 4.0), protracted bronchitis = 19.6 (IQR 25.8) and controls = 4.1 (IQR 5.25). The median cough score was significantly different between groups on days 1, 7, 10 and 14 (P < 0.001). A significantly higher proportion of children with protracted bronchitis (63%) were still coughing at day 14 in comparison with children with asthma (24%) and healthy controls (26%). Conclusion Children with protracted bronchitis had the most severe ARI symptoms and higher percentage of respiratory morbidity at day 14 in comparison with children with asthma and healthy controls.

The impact of viral respiratory infection on the severity and recovery from an asthma exacerbation

Background Viral respiratory illness triggers asthma exacerbations, but the influence of respiratory illness on the acute severity and recovery of childhood asthma is unknown. Our objective was to evaluate the impact of a concurrent acute respiratory illness (based on a clinical definition and PCR detection of a panel of respiratory viruses, Mycoplasma pneumoniae and Chlamydia pneumoniae) on the severity and resolution of symptoms in children with a nonhospitalized exacerbation of asthma. Methods Subjects were children aged 2 to 15 years presenting to an emergency department for an acute asthma exacerbation and not hospitalized. Acute respiratory illness (ARI) was clinically defined. Nasopharyngeal aspirates (NPA) were examined for respiratory viruses, Chlamydia and Mycoplasma using PCR. The primary outcome was quality of life (QOL) on presentation, day 7 and day 14. Secondary outcomes were acute asthma severity score, asthma diary, and cough diary scores on days 5, 7,10, and 14. Results On multivariate regression, presence of ARI was statistically but not clinically significantly associated with QOL score on presentation (B = 0.36, P = 0.025). By day 7 and 14, there was no difference between groups. Asthma diary score was significantly higher in children with ARI (B = 0.41, P = 0.039) on day 5 but not on presentation or subsequent days. Respiratory viruses were detected in 54% of the 78 NPAs obtained. There was no difference in the any of the asthma outcomes of children grouped by positive or negative NPA. Conclusions The presence of a viral respiratory illness has a modest influence on asthma severity, and does not influence recovery from a nonhospitalized asthma exacerbation.

Cough and exhaled nitric oxide levels : what happens with exercise?

Cough associated with exertion is often used as a surrogate marker of asthma. However, to date there are no studies that have objectively measured cough in association with exercise in children. Our primary aim was to examine whether children with a pre-existing cough have an increase in cough frequency during and post-exercise. We hypothesized that children with any coughing illness will have an increase in cough frequency post-exercise regardless of the presence of exercise-induced broncho-constriction (EIB) or atopy. In addition, we hypothesized that Fractional exhaled nitric oxide (FeNO) levels decreases post-exercise regardless of the presence of EIB or atopy. Children with chronic cough and a control group without cough undertook an exercise challenge, FeNO measurements and a skin prick test, and wore a 24-h voice recorder to objectively measure cough frequency. The association between recorded cough frequency, exercise, atopy, and presence of EIB was tested. We also determined if the change in FeNO post exercise related to atopy or EIB. Of the 50 children recruited (35 with cough, 15 control), 7 had EIB. Children with cough had a significant increase in cough counts (median 7.0, inter-quartile ranges, 0.5, 24.5) compared to controls (2.0, IQR 0, 5.0, p = 0.028) post-exercise. Presence of atopy or EIB did not influence cough frequency. FeNO level was significantly lower post-exercise in both groups but the change was not influenced by atopy or EIB. Cough post-exertion is likely a generic response in children with a current cough. FeNO level decreases post-exercise irrespective of the presence of atopy or EIB. A larger study is necessary confirm or refute our findings.

Genetic technologies and the regulation of reproductive decision-making in Australia

This article provides a critical analysis of the current Australian regulatory landscape at the interface between genetics and reproductive decision- making. The authors argue that a comparative analysis with other countries and international law and a contextual examination of the way law regulates concepts such as disease and health, abnormality and normality is necessary before we can develop appropriate policy and legislative responses in this area. Specific genetic testing technologies are considered including prenatal genetic testing, preimplantation genetic diagnosis and inheritable genetic modification. An increasing number of members of the Australian community are using genetic testing technologies when they decide to have a baby. The authors argue that as concepts of disease and health vary among members of the community and the potential to test for traits other than illness increases, a new tension arises between an ethic of individual choice and a role for government in regulating reproductive decision-making.

Young and Well CRC: Engaging young people as research partners

This paper presents the outcomes of an international collaboration between researchers and young people in Australia and the United States, using participatory design to engage young people as research partners in the collaborative development of a conceptual framework for the Online WellBeing Center (OWBC), a repository of evidence-based mental health tools focused on mental health promotion and the prevention of mental illness developed as part of Young and Well Cooperative Research Centre. Eighteen participants (nine in Australia and nine in USA) were involved as key partners through a series of participatory design workshops to develop the framework for the OWBC. Key objectives of the collaboration included an increased understanding of: how to recruit young people to be part of an international project team collaborating remotely; how to use new technologies to manage communication and maintain engagement; how to apply principles of participatory research to create a youth informed research project; how to develop an international stakeholder partnership to ensure relevancy in value systems, cultural orientation and project outcomes. Recommendations included guidelines for how others can establish international collaborations that integrate young people as active project participants.

An integrative framework of supervisor responses to workgroup conflict

It is well-established that prolonged exposure to workplace conflict, as a work stressor, is linked to physical illness and psychological dysfunction in employees (see Spector and Jex, 1998; Romanov, Appelberg, Honkasalo, and Koskenvuo, 1996; Skogstad, Einarsen, Torsheim, Aasland, and Hetland, 2007). In addition to the negative implications for physiological and psychological health, workplace conflict has been shown to influence employee behaviors that have consequences for organizational effectiveness (e.g., turnover and impaired performance; see Bowling and Beehr, 2006; De Dreu and Weingart, 2003). Further, research suggests that managers spend approximately 20 percent of their time managing conflict (Thomas, 1992; Baron, 1989). There also are substantial financial implications associated with workplace conflict. For example, in the United Kingdom, costs at the national level for sickness absence and replacement costs has been estimated to be close to £2 billion per annum (Hoel, Sparks, and Cooper, 2001).

Considering research enquiry into biophilic urbanism and office worker productivity

In cities, people spend a significant portion of their time indoors, much of which is in office buildings. The quality and nature of these spaces have the potential to be a strong determinant of people’s health and wellbeing. There is a body of evidence that suggests experiences of nature increase the rate of attention recovery, reduce stress, depression and anxiety, and increase cognitive abilities. Further, the presence of nature inside buildings (such as pot plants and internal green walls) can improve indoor air quality, potentially reducing illness and increasing cognitive function. Urban design that integrates nature into the built environment to provide these benefits, among others, is called ‘biophilic urbanism’ and is the subject of growing international interest and research. The potential for these benefits to increase worker productivity in office buildings is of particular interest, as this could significantly increase the financial performance of office building-based organisations. However, productivity is a complex concept that is difficult to define, and affected by a multitude of factors, which make it difficult to measure. This inability to quantify productivity increases from investments in nature- experiences in office buildings is currently a significant barrier to such investments. Within this context, this paper considers opportunities for research to explore the relationship between office-based nature experiences and productivity, by reviewing existing research in this field and reflecting on the authors’ own experiences. This review has a particular focus on the importance of quantifying this link in order to encourage private property owners to voluntarily integrate nature into buildings to provide city-wide ecosystem service benefits. The paper begins with a contextual overview of how biophilic urbanism can potentially increase worker productivity. Existing methods of measuring and evaluating the performance of biophilic urbanism within the context of office buildings are then explored, along with a discussion of issues with such methods that are currently limiting investment in biophilic urbanism to increase worker productivity and wellbeing. This includes a summary of a survey within a Perth office building to explore the impact of views of nature through a window. Drawing on these insights, the paper makes recommendations regarding opportunities for focusing future investigations to enhance understanding of how biophilic urbanism can contribute to increased wellbeing and productivity in office buildings. This paper builds on work conducted as part of the Sustainable Built Environment National Research Centre Project 1.5, Harnessing the Potential of Biophilic Urbanism in Australia, which considered the role of nature integrated into the built environment in responding to emerging challenges of climate change, resource shortages and population pressures, while providing a host of co- benefits to a range of stakeholders.

Considering research enquiry into biophilic urbanism and office worker productivity

In cities, people spend a significant portion of their time indoors, much of which is in office buildings. The quality and nature of these spaces have the potential to be a strong determinant of people’s health and wellbeing. There is a body of evidence that suggests experiences of nature increase the rate of attention recovery, reduce stress, depression and anxiety, and increase cognitive abilities. Further, the presence of nature inside buildings (such as pot plants and internal green walls) can improve indoor air quality, potentially reducing illness and increasing cognitive function. Urban design that integrates nature into the built environment to provide these benefits, among others, is called ‘biophilic urbanism’ and is the subject of growing international interest and research. The potential for these benefits to increase worker productivity in office buildings is of particular interest, as this could significantly increase the financial performance of office building-based organisations. However, productivity is a complex concept that is difficult to define, and affected by a multitude of factors, which make it difficult to measure. This inability to quantify productivity increases from investments in nature- experiences in office buildings is currently a significant barrier to such investments. Within this context, this paper considers opportunities for research to explore the relationship between office-based nature experiences and productivity, by reviewing existing research in this field and reflecting on the authors’ own experiences. This review has a particular focus on the importance of quantifying this link in order to encourage private property owners to voluntarily integrate nature into buildings to provide city-wide ecosystem service benefits. The paper begins with a contextual overview of how biophilic urbanism can potentially increase worker productivity. Existing methods of measuring and evaluating the performance of biophilic urbanism within the context of office buildings are then explored, along with a discussion of issues with such methods that are currently limiting investment in biophilic urbanism to increase worker productivity and wellbeing. This includes a summary of a survey within a Perth office building to explore the impact of views of nature through a window. Drawing on these insights, the paper makes recommendations regarding opportunities for focusing future investigations to enhance understanding of how biophilic urbanism can contribute to increased wellbeing and productivity in office buildings. This paper builds on work conducted as part of the Sustainable Built Environment National Research Centre Project 1.5, Harnessing the Potential of Biophilic Urbanism in Australia, which considered the role of nature integrated into the built environment in responding to emerging challenges of climate change, resource shortages and population pressures, while providing a host of co- benefits to a range of stakeholders.

Factors that influence young people's mental health help‐seeking behaviour : a study based on the Health Belief Model

Aim To identify key predictors and moderators of mental health ‘help-seeking behavior’ in adolescents. Background Mental illness is highly prevalent in adolescents and young adults; however, individuals in this demographic group are among the least likely to seek help for such illnesses. Very little quantitative research has examined predictors of help-seeking behaviour in this demographic group. Design A cross-sectional design was used. Methods A group of 180 volunteers between the ages of 17–25 completed a survey designed to measure hypothesized predictors and moderators of help-seeking behaviour. Predictors included a range of health beliefs, personality traits and attitudes. Data were collected in August 2010 and were analysed using two standard and three hierarchical multiple regression analyses. Findings The standard multiple regression analyses revealed that extraversion, perceived benefits of seeking help, perceived barriers to seeking help and social support were direct predictors of help-seeking behaviour. Tests of moderated relationships (using hierarchical multiple regression analyses) indicated that perceived benefits were more important than barriers in predicting help-seeking behaviour. In addition, perceived susceptibility did not predict help-seeking behaviour unless individuals were health conscious to begin with or they believed that they would benefit from help. Conclusion A range of personality traits, attitudes and health beliefs can predict help-seeking behaviour for mental health problems in adolescents. The variable ‘Perceived Benefits’ is of particular importance as it is: (1) a strong and robust predictor of help-seeking behaviour, and; (2) a factor that can theoretically be modified based on health promotion programmes.

Promoting resilience in children with intellectual disability : a randomized controlled trial in Australian schools

Children with intellectual disability are more vulnerable to adverse developmental outcomes because of the lifelong risks associated with cognitive impairment. Difficulties with learning and adaptive behaviour inevitably produce considerable personal, social and economic disadvantage. Of concern is consistent evidence that psychiatric disorders affect a substantial proportion of people with intellectual disability. The estimated prevalence rate of between 35 and 49 % is three times that found in the general population (Wallander, Dekker, & Koot, 2006). Until recently, mental illness has been relatively neglected for people with intellectual disability, especially in relation to prevention or early detection (Kolaitis, 2008) and most research to date has been descriptive rather than focused on intervention (Bouras, 2013). Yet a considerable body of evidence demonstrates that efficacious interventions do exist for preventing psychopathology and enhancing resilience in typically developing children and adolescents (see Mallin, Walker, & Levin, 2013 for a review). In order to prevent the high comorbidity of intellectual disability and psychopathology, there is a compelling need for evidence-based practices that promote the resilience of individuals with intellectual disability (Matson, Terlonge, & Minshawi, 2008). In this chapter, we describe a randomized controlled trial of an intervention that was designed to enhance the resilience of a group of children with mild intellectual disability as they prepared to make the transition to high school. We report results from our evaluation of this intervention, and reflect on the difficulties of providing successful interventions for children whose lives are complicated not only by intellectual disability, but also by a range of contextual disadvantages.