A systematic review and meta-analysis : tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils)

Asthma severity and control can be measured both subjectively and objectively. Traditionally asthma treatments have been individualised using symptoms and spirometry/peak flow. Increasingly treatment tailored in accordance with inflammatory markers (sputum eosinophil counts or fractional exhaled nitric oxide (FeNO) data) is advocated as an alternative strategy. The objective of this review was to evaluate the efficacy of tailoring asthma interventions based on inflammatory markers (sputum analysis and FeNO) in comparison with clinical symptoms (with or without spirometry/peak flow) for asthma-related outcomes in children and adults. Cochrane Airways Group Specialised Register of Trials, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and reference lists of articles were searched. The last searches were in February 2009. All randomised controlled comparisons of adjustment of asthma treatment based on sputum analysis or FeNO compared with traditional methods (primarily clinical symptoms and spirometry/peak flow) were selected. Results of searches were reviewed against predetermined criteria for inclusion. Relevant studies were selected, assessed and data extracted independently by at least two people. The trial authors were contacted for further information. Data were analysed as 'intervention received' and sensitivity analyses performed. Six (2 adults and 4 children/adolescent) studies utilising FeNO and three adult studies utilising sputum eosinophils were included. These studies had a degree of clinical heterogeneity including definition of asthma exacerbations, duration of study and variations in cut-off levels for percentage of sputum eosinophils and FeNO to alter management in each study. Adults who had treatment adjusted according to sputum eosinophils had a reduced number of exacerbations compared with the control group (52 vs. 77 patients with >=1 exacerbation in the study period; p=0.0006). There was no significant difference in exacerbations between groups for FeNO compared with controls. The daily dose of inhaled corticosteroids at the end of the study was decreased in adults whose treatment was based on FeNO in comparison with the control group (mean difference -450.03 mug, 95% CI -676.73 to -223.34; p<0.0001). However, children who had treatment adjusted according to FeNO had an increase in their mean daily dose of inhaled corticosteroids (mean difference 140.18 mug, 95% CI 28.94 to 251.42; p=0.014). It was concluded that tailoring of asthma treatment based on sputum eosinophils is effective in decreasing asthma exacerbations. However, tailoring of asthma treatment based on FeNO levels has not been shown to be effective in improving asthma outcomes in children and adults. At present, there is insufficient justification to advocate the routine use of either sputum analysis (due to technical expertise required) or FeNO in everyday clinical practice.

Quality management in service ecosystems

Service-oriented architectures and Web services mature and have become more widely accepted and used by industry. This growing adoption increased the demands for new ways of using Web service technology. Users start re-combining and mediating other providers’ services in ways that have not been anticipated by their original provider. Within organisations and cross-organisational communities, discoverable services are organised in repositories providing convenient access to adaptable end-to-end business processes. This idea is captured in the term Service Ecosystem. This paper addresses the question of how quality management can be performed in such service ecosystems. Service quality management is a key challenge when services are composed of a dynamic set of heterogeneous sub-services from different service providers. This paper contributes to this important area by developing a reference model of quality management in service ecosystems. We illustrate the application of the reference model in an exploratory case study. With this case study, we show how the reference model helps to derive requirements for the implementation and support of quality management in an exemplary service ecosystem in public administration.

An outcome evaluation of the ‘Skipper’ designated driver program

The general aim of designated driver programs is to reduce the level of drink driving by encouraging potential drink drivers to travel with a driver who has abstained from (or at least limited) consuming alcohol. Designated driver programs appear to be quite widespread around the world, however a limited number have been subject to rigorous evaluation. This paper reports results from an outcome evaluation of a designated driver program called ‘Skipper’, which was trialled in a provincial city in Queensland, Australia. The outcome evaluation included surveys three weeks prior to (baseline), four months following (1st follow-up), and 16 months following (2nd follow-up) the commencement of the trial in both the ‘intervention area’ (baseline, n = 202; 1st follow-up, n = 211; 2nd follow-up, n = 200) and a ‘comparison area’(baseline, n = 203; 1st follow-up, n = 199; 2nd follow-up, n = 201); and a comparison of random breath testing and crash data before and after the trial. The survey results indicate that awareness of the program in the intervention area was quite high four months following its introduction and that this was maintained at 16 months. The results also suggest that the ‘Skipper’ program and the related publicity had positive impacts on behaviour with an increase in the proportion of people participating in designated driver as a passenger. It is less clear, however, whether the ‘Skipper’ program impacted on other behaviours of interest, such as drink driving or involvement in alcohol-related crashes. Suggestions for further research and program improvement are discussed as well as limitations of the research.

Practice & procedure : disclosure obligations - Personal Injuries Proceedings Act 2002 s27

In Huag v Jupiters Limited [2007] QCA 199 the Queensland Court of Appeal allowed an appeal from interlocutory orders made in the trial division of the court and concluded that, although provisions such as s27 of the Personal Injuries Proceedings Act 2002 (Qld) should be given a broad, remedial construction, this did not mean the words of limitation in the section could be ignored.

Vulnerability to loneliness in people with intellectual disability: an explanatory model

Research with typically developing groups has identified loneliness as a significant predictor of a range of physical and mental health problems. This paper reviews research about loneliness in children and adults with intellectual disability. Although a considerable body of evidence has highlighted the difficulties individuals with intellectual disability have with friendships, there is a relative scarcity of research focused explicitly on loneliness. The available evidence suggests that up to half of those with intellectual disability are chronically lonely, compared with around 15-30% of people in the general population. The cognitive, physical and mental health problems already associated with intellectual disability are likely to be compounded by experiences of chronic loneliness. We argue that people with intellectual disability are highly vulnerable to loneliness and present a theoretical model of vulnerability that comprises three reciprocally influencing domains: social attitudes and expectations; opportunities and experiences; and skill deficits associated with intellectual disability. We propose that societal views which have traditionally devalued and stigmatised those with intellectual disability limit their opportunities for experiencing social and emotional connectedness with others. Individual skill deficits in areas such as communication, self-regulation and social understanding, as well as functional difficulties associated with intellectual disability, also potentially influence the opportunities and experiences of people with intellectual disability, both directly and via multiple layers of the social context. In turn, limited opportunities will entrench particular skill deficits and reinforce negative attitudes towards intellectual disability. Future research about loneliness and intellectual disability needs to address the difficulties of measuring emotional isolation in this population, as well as the possibility that people with intellectual disability may understand, experience and interpret loneliness somewhat differently from others. The model proposed in this paper provides a starting point for developing a more sophisticated understanding of the experience of loneliness for individuals with intellectual disability.

Copyright Protection of object-oriented software

language (such as C++ and Java). The model used allows to insert watermarks on three “orthogonal” levels. For the first level, watermarks are injected into objects. The second level watermarking is used to select proper variants of the source code. The third level uses transition function that can be used to generate copies with different functionalities. Generic watermarking schemes were presented and their security discussed.

An e-support firm's response to local e-readiness and the global e-business environment

The purpose of this study is to understand a small e-support firm’s response to the local e-readiness and the global e-business environment in a developing context. E-Support firms provide Web development and consultancy services to user organizations, assisting them in their uptake and maintenance of their Internet applications. Within the e-readiness research area, little is known about e-support firms, particularly in connection with their interaction with their local and the global e-business environment. As yet the emphasis on e-readiness studies has been at the national level. Nevertheless, the e-support sector is very significant in the successful adoption and diffusion of the Internet and related applications in any economy. It is thus important to understand how such firms relate to their e-business environments.That said, this study draws on the interpretive case study of a small e-support firm in Ghana, a developing context, to investigate the firm’s response to the e-readiness level of the local and the global e-business environment. Findings show that the firm could employ resources from the global environment to address most of the infrastructural challenges posed by a relatively poor local e-readiness context. However, its attempt to transfer advanced e-business technologies from the global e-business environment to the local e-business context did not succeed. This chapter offers implications for practice and research concerning the notion of reconciling local and global e-business environments in the small e-support sector.

Young people and citizenship-delayed, diminished and empty?

This paper is presented in workshop format in order to meet the style and themes of the conference, and seeks to explore as fully as possible with participants issues, concerns and proposals around the discourse of young people and citizenship. This paper takes the position that the relationship between young people and citizenship is complex and in places contradictory, and while Ruth Lister (1998), argues for an 'inclusionary potential', a central concern is that the citizenship that young people get is as Hartley Dean (1997), suggests, at best 'ambiguous', and at its worst, 'diminished'. Under not so new Labour, the term has according to Gail Lewis (1998) re-emerged as a 'category of political articulation', imbued with the pronouncements of Charles Murray (1995) on the underclass, and Amitai Etzioni (1996), on the virtues of Communitarianism and the central assertion that in relation to young people and certain communities, 'rights have exceeded responsibilities'. This body of opinion has proved to be seductive to a government dedicated to joined up solutions in the battle against social exclusion and to the reconfiguration of the welfare state to place the onus for welfare and social provision on to individuals and communities. Those who work with young people and young people themselves may wish to be proactive in asserting the kind of citizenship they require, rights-based, expansive and supportive, rather than accept an imposed version devoid of rights but full to the brim of authoritarian measures, vindictive proposals and narrow horizons. This paper will engender debate and reflection and offer a context of the erosion of young people's rights over the last 20 years, Hartley Dean (1996), and will consider the work of T.H. Marshall (1950) in dividing citizenship into three elements: the civil element, the political element, and the social element. The paper will explore in workshop tradition, strategies and proposals for action relevant to practitioners and academics, such as the reduction in the voting age to 16.

Chinese EFL students' response to an assessment policy change

In light of its documented potential for enhancing learning, formative assessment has been adopted across a range of educational contexts to improve the quality of education. The assessment innovation that the Chinese Ministry of Education (CMoE) proposed to College English in 2007 via the College English Curriculum Requirements (CECR) (CMoE, 2007), is an initiative of this kind. Considering the acknowledged influence of assessment on students’ learning, it is instructive to explore the ways in which Chinese university students respond to an assessment policy change of this magnitude, particularly as it positions them as more active learners, having the potential for increased agency and engagement in their English language learning and assessment practices. In order to explore the response of students to this assessment initiative, a case study was conducted in the context of a College English classroom. Data included an interview with a College English teacher and four students from her classes, and classroom observations and a survey of her two classes of 100 students. Analysis of the data reveals that Chinese students’ responses to the assessment policy change are influenced by a variety of sociocultural factors, including their previous English language learning and assessment experience and the extent to which they are willing to play the ‘assessment game’. These findings have implications for policy and practice.

How innovation and R&D happen in the upstream oil & gas industry : insights from a global survey

Few would disagree that the upstream oil & gas industry has become more technology-intensive over the years. But how does innovation happen in the industry? Specifically, what ideas and inputs flow from which parts of the sector׳s value network, and where do these inputs go? And how do firms and organizations from different countries contribute differently to this process? This paper puts forward the results of a survey designed to shed light on these questions. Carried out in collaboration with the Society of Petroleum Engineers (SPE), the survey was sent to 469 executives and senior managers who played a significant role with regard to R&D and/or technology deployment in their respective business units. A total of 199 responses were received from a broad range of organizations and countries around the world. Several interesting themes and trends emerge from the results, including: (1) service companies tend to file considerably more patents per innovation than other types of organization; (2) over 63% of the deployed innovations reported in the survey originated in service companies; (3) neither universities nor government-led research organizations were considered to be valuable sources of new information and knowledge in the industry׳s R&D initiatives, and; (4) despite the increasing degree of globalization in the marketplace, the USA still plays an extremely dominant role in the industry׳s overall R&D and technology deployment activities. By providing a detailed and objective snapshot of how innovation happens in the upstream oil & gas sector, this paper provides a valuable foundation for future investigations and discussions aimed at improving how R&D and technology deployment are managed within the industry. The methodology did result in a coverage bias within the survey, however, and the limitations arising from this are explored.

A prostitute's progress : male prostitution in scientific discourse

This paper examines discourses of male prostitution through an analysis of scientific texts. A contrast is drawn between nineteenth-century understandings of male prostitution and twentieth-century accounts of male prostitution. In contrast to female prostitution, male prostitution was not regarded as a significant social problem throughout the nineteenth century, despite its close association with gender deviation and social disorder. Changing conceptions of sexuality, linked with the emergence of the ‘adolescent’, drew scientific attention to male prostitution during the 1940s and 1950s. Research suggested that male prostitution was a problem associated with the development of sexual identity. Through the application of scientific techniques, which tagged and differentiated male prostitute populations, a language developed about male prostitution that allowed for normative assessments and judgements to be made concerning particular classes of male prostitute. The paper highlights how a broad distinction emerged between public prostitutes, regarded as heterosexual/masculine, and private prostitutes, regarded as homosexual/effeminate. This distinction altered the way in which male prostitution was understood and governed, allowing for male prostitution to be constituted as a public health concern.

Altered Immune Responses and Transplantation

Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 4th Edition is the most comprehensive go-to reference for essential information about all aspects of professional nursing care of patients. Using the nursing process as a framework for practice, the fourth edition has been extensively revised to reflect the rapid changing nature of nursing practice and the increasing focus on key nursing care priorities. Building on the strengths of the third Australian and New Zealand edition and incorporating relevant global nursing research and practice from the prominent US title Medical-Surgical Nursing, 9Th Edition, Lewis’s Medical-Surgical Nursing, 4th Edition is an essential resource for students seeking to understand the role of the professional nurse in the contemporary health environment.