Clinical trials in pediatrics

“Children are not little adults.” Almost all aspects of children's health including clinical trials and drug development are poor cousins of adult health. Over the years, pediatricians worldwide caution against blind extrapolation of adult data to children as it may result in considerable harm [1,2]. Also, it is increasingly recognized that the roots of many chronic diseases in adulthood stem from childhood and tackling health issues in children lead to improved health in adults [3,4]. Furthermore, investment in early childhood has long-term benefits in adults not only in health but also in other aspects of life such as education and crime reduction [4,5]. Arguably, health at birth is the single most important predictor of health in adulthood as the inequality of an infant at birth has intergenerational effects [5]. The Carolina Abecedarian Project showed that early childhood programs that are of high quality result in substantial societal benefits (e.g., reduction of crime, increased earnings, better education) [4,5]. A recent publication from this project found that this benefit also translated into improved adult health outcomes [4]. In a randomized trial, Campbell and colleagues described that disadvantaged children who were randomized to the intervention group (early education, health screenings and nutrition program) had significantly lower rates of metabolic syndrome, obesity and hypertension, when aged in their mid-30s, compared with the control group [4]...

Can skin cancer prevention and early detection be improved via mobile phone text messaging? a randomised, attention-control trial.

Objective. To test the impact of a theory-based, SMS (text message)-delivered behavioural intervention (Healthy Text) targeting sun protection or skin self-examination behaviours compared to attention-control. Method. Overall, 546 participants aged 18–42 years were randomised using a computer-generated number list to the skin self-examination (N = 176), sun protection (N = 187), or attention-control (N = 183) text messages group. Each group received 21 text messages about their assigned topic over 12 months (12 weekly messages for three months, then monthly messages for the next nine months). Data was collected via telephone survey at baseline, three-, and 12-months across Queensland from January 2012 to August 2013. Results. One year after baseline, the sun protection (mean change 0.12; P = 0.030) and skin self-examination groups (mean change 0.12; P = 0.035) had significantly greater improvement in their sun protection habits (SPH) index compared to the attention-control group (reference mean change 0.02). The increase in the proportion of participants who reported any skin self-examination from baseline to 12 months was significantly greater in the skin self-examination intervention group (103/163; 63%; P < 0.001) than the sun protection (83/173; 48%), or attention-control (65/165; 36%) groups. There was no significant effect of the intervention for participants who self-reported whole-body skin self-examination, sun tanning behaviour, or sunburn behaviours. Conclusion. The Healthy Text intervention was effective in inducing significant improvements in sun protection and any type of skin self-examination behaviours.

Milbank’s milieu : theorisations of truth, faith and reason

This article seeks to clarify and theorise three fundamental themes in the work of John Milbank: truth, faith and reason. In his work, Milbank often uses these terms in ambiguous ways, so the terminology requires clarity to facilitate further productive discussion. It is found that truth refers to the revelation of the divine relations in the Trinity, and these correspond with human relations when this revelation is apprehended by faith through participation. Faith means trust or persuasion, such that when the divine is graciously revealed, the mind is transformed and persuaded to participate in the divine relations. This faith is reconciled with reason, or logos, the divine word which is Christ and is the ultimate revelation of the Trinity through the Incarnation, which produces a reason that leads to peace based in faith.

Patient group directions : the application and integration of knowledge in advancing nursing practice

Background: The introduction of Patient Group Directions (PGD) has changed significantly the way in which nurses can now administer prescription only medicines as a one-off for patients requiring this level of service. PGD’s are a written authority to administer drugs to patients that are not identified at the time of treatment. Aim: The aim of this project was to develop a PGD for use within an Outreach team to administer colloid boluses to patients presenting with hypovolemia. Method: Using a case exemplar this paper will discuss the development of a PGD using aspects of transitional change theory to highlight the potential barriers that were encountered. Implications for Practice: The implications for this PGD are wide reaching. First it now enables members from the nursing Outreach team to administer colloid fluid boluses to a prescribed patient cohort without the need for prescription. Second, it ensures the deteriorating patient has interventions initiated in a timely and appropriate manner to reduce inadvertent admission to high care areas. Last, it will improve inter-professional team-working and communication so much so that collaborative patient care reduces health costs and identifies earlier those patients requiring substantially greater nursing and medical input. Conclusion: The experience of developing a working PGD for fluid administration has meant that the Outreach team is able to respond to patients in a more effective way. In addition, it is the experience of developing this PGD that has enabled the team to contemplate other PGD’s in the execution of Outreach work.

Onset of transition in mixed convection of a lid-driven trapezoidal enclosure filled with water-Al2O3 nanofluid

A numerical study is carried out to investigate the transition from laminar to chaos in mixed convection heat transfer inside a lid-driven trapezoidal enclosure. In this study, the top wall is considered as isothermal cold surface, which is moving in its own plane at a constant speed, and a constant high temperature is provided at the bottom surface. The enclosure is assumed to be filled with water-Al2O3 nanofluid. The governing Navier–Stokes and thermal energy equations are expressed in non-dimensional forms and are solved using Galerkin finite element method. Attention is paid in the present study on the pure mixed convection regime at Richandson number, Ri = 1. The numerical simulations are carried out over a wide range of Reynolds (0.1 ≤ Re ≤ 103) and Grashof (0.01 ≤ Gr ≤ 106) numbers. Effects of the presence of nanofluid on the characteristics of mixed convection heat transfer are also explored. The average Nusselt numbers of the heated wall are computed to demonstrate the influence of flow parameter variations on heat transfer. The corresponding change of flow and thermal fields is visualized from the streamline and the isotherm contour plots.

Natural convection due to differential heating of inclined walls and heat source placed on bottom wall of an attic shaped space

Numerical investigation of free convection heat transfer in an attic shaped enclosure with differentially heated two inclined walls and filled with air is performed in this study. The left inclined surface is uniformly heated whereas the right inclined surface is uniformly cooled. There is a heat source placed on the right side of the bottom surface. Rest of the bottom surface is kept as adiabatic. Finite volume based commercial software ANSYS 15 (Fluent) is used to solve the governing equations. Dependency of various flow parameters of fluid flow and heat transfer is analyzed including Rayleigh number, Ra ranging from 103 to 106, heater size from 0.2 to 0.6, heater position from 0.3 to 0.7 and aspect ratio from 0.2 to 1.0 with a fixed Prandtl number of 0.72. Outcomes have been reported in terms of temperature and stream function contours and local Nusselt number for various Ra, heater size, heater position, and aspect ratio. Grid sensitivity analysis is performed and numerically obtained results have been compared with those results available in the literature and found good agreement.

Axial capacity of barrette piles embedded in gravel layer

In this paper, the axial performance of two heavily instrumented barrette piles, with and without grouting, socket into gravel layer in Taipei are evaluated based on the results of pile load tests. Both piles are 44 m long with the same dimension of 0.8 by 2.7 m, installed by hydraulic long bucket. One of the piles with toe grouting was socket 6 m into gravel layer and the other pile without toe grouting was socket 3 m into gravel layer. The load versus displacement relationships at pile head, the t-z curves of upper soil layers and of bottom gravel layer, and the tip resistance versus displacement relationships are important concerns and are presented in the paper. The t-z curves interpreted from the measured data along depth are also simulated by the hyperbolic model.

The global burden attributable to low bone mineral density

Introduction The Global Burden of Disease Study 2010 estimated the worldwide health burden of 291 diseases and injuries and 67 risk factors by calculating disability-adjusted life years (DALYs). Osteoporosis was not considered as a disease, and bone mineral density (BMD) was analysed as a risk factor for fractures, which formed part of the health burden due to falls. Objectives To calculate (1) the global distribution of BMD, (2) its population attributable fraction (PAF) for fractures and subsequently for falls, and (3) the number of DALYs due to BMD. Methods A systematic review was performed seeking population-based studies in which BMD was measured by dual-energy X-ray absorptiometry at the femoral neck in people aged 50 years and over. Age- and sex-specific mean ± SD BMD values (g/cm2) were extracted from eligible studies. Comparative risk assessment methodology was used to calculate PAFs of BMD for fractures. The theoretical minimum risk exposure distribution was estimated as the age- and sex-specific 90th centile from the Third National Health and Nutrition Examination Survey (NHANES III). Relative risks of fractures were obtained from a previous meta-analysis. Hospital data were used to calculate the fraction of the health burden of falls that was due to fractures. Results Global deaths and DALYs attributable to low BMD increased from 103 000 and 3 125 000 in 1990 to 188 000 and 5 216 000 in 2010, respectively. The percentage of low BMD in the total global burden almost doubled from 1990 (0.12%) to 2010 (0.21%). Around one-third of falls-related deaths were attributable to low BMD. Conclusions Low BMD is responsible for a growing global health burden, only partially representative of the real burden of osteoporosis.

Sanctuary Place : Sep Yama / Finding Country 5 Ways

Intelligent architecture allows a generosity of reading. It does not expect that we follow the architect’s instructions but that one is allowed to breath their own meaning into it and take away their own memory. Here, on the fringe of a postured architectural mass of national thinking, is an architectural gem. Its purpose, as I see it, is simple: to make a “camp”. In so doing it has accidentally revealed a passion for Country. Not necessarily Country in the way I might define it but Country in at least how I might recognise it; something alive, something powerful to be engaged.

Are Australian homes liveable and adaptable for Muslim families? - Six case studies in Brisbane

This paper investigates how Muslims living in Brisbane live within their current Australian homes and the liveability and adaptability of these homes from the perspective of home dwellers with respect to their Islamic faiths, cultural traditions and lifestyle. A qualitative case study approach was used to gather information about Muslims’ use of domestic spaces through their lived experiences, within an Australian context. Six participants were interviewed, including: a) three Muslim families residing in one suburb of Brisbane, and; b) three international Muslim students living in three different Brisbane suburbs. These cases indicate that apart from minor difficulties, case study participants were able to perform their daily activities within their current homes through various adaptations made to ensure their respective domestic domains provided their families with privacy and a sense of security and safety. Insight gained from these cases suggest the need for more research into the homes of Muslims homes within an Australian context and the development of culturally adaptable housing as a means of meeting the diverse needs of modern Australian multicultural society.

Social audits and global clothing supply chains : some observations

This study provides some preliminary insight in relation to the use of social audits by the global clothing and retail companies that source garment products from developing nations. In the era of globalisation, companies based in developed nations have transferred their production locations to many parts of the developing nations. At the same time, there are widespread global stakeholder concerns about the use of child labour, inadequate health and safety standards and poor working conditions at many of these production locations. Social audits appear to be a tool used by companies to monitor working conditions and to ensure that manufacturing takes place in a humane working environment. The study finds that companies use social auditing in order to maintain their legitimacy within the wider community.

Airborne viable fungi in school environments in different climatic regions – A review

Elevated levels of fungi in indoor environments have been linked with mould/moisture damage in building structures. However, there is a lack of information about “normal” concentrations and flora as well as guidelines of viable fungi in the school environment in different climatic conditions. We have reviewed existing guidelines for indoor fungi and the current knowledge of the concentrations and flora of viable fungi in different climatic areas, the impact of the local factors on concentrations and flora of viable fungi in school environments. Meta-regression was performed to estimate the average behaviour for each analysis of interest, showing wide variation in the mean concentrations in outdoor and indoor school environments (range: 101-103 cfu/m3). These concentrations were significantly higher for both outdoors and indoors in the moderate than in the continental climatic area, showing that the climatic condition was a determinant for the concentrations of airborne viable fungi. The most common fungal species both in the moderate and continental area were Cladosporium spp. and Penicillium spp. The suggested few quantitative guidelines for indoor air viable fungi for school buildings are much lower than for residential areas. This review provides a synthesis, which can be used to guide the interpretation of the fungi measurements results and help to find indications of mould/moisture in school building structures.

Developing creative services industries in Hangzhou, China

Creativity is changing the People’s Republic of China according to Li Wuwei (2011), a leading Chinese economist and policy advisor. The nation is learning to embrace a “third industrial revolution” (Rifkin, 2011) while banking the economic capital of the carbon-dependent manufacturing economy. Urbanisation is also driving change and consumer culture (Gerth, 2010). Most of China’s high-value creative service industries are found in the large urban centres of Beijing, Shanghai, Guangzhou and Shenzhen in the coastal provinces. China’s second-tier cities, including Hangzhou in Zhejiang province, are also seeking to make capital out of culture, albeit with different strategies than the coastal hubs. The Hangzhou metropolitan area is the fourth largest in China, with 8.8 million residents. Zhejiang province was once known as the “land of rice and fish.” However, with the increased emphasis on productivity in China’s economic reforms since 1978, the province became an economic heavyweight, characterised by small and medium-sized enterprises often working together to produce complementary products...