Differences in identifying healthcare associated infections using clinical vignettes and the influence of respondent characteristics: A cross-sectional survey of Australian infection prevention staff

Background Australia has commenced public reporting and benchmarking of healthcare associated infections (HAIs), despite not having a standardised national HAI surveillance program. Annual hospital Staphylococcus aureus bloodstream (SAB) infection rates are released online, with other HAIs likely to be reported in the future. Although there are known differences between hospitals in Australian HAI surveillance programs, the effect of these differences on reported HAI rates is not known. Objective To measure the agreement in HAI identification, classification, and calculation of HAI rates, and investigate the influence of differences amongst those undertaking surveillance on these outcomes. Methods A cross-sectional online survey exploring HAI surveillance practices was administered to infection prevention nurses who undertake HAI surveillance. Seven clinical vignettes describing HAI scenarios were included to measure agreement in HAI identification, classification, and calculation of HAI rates. Data on characteristics of respondents was also collected. Three of the vignettes were related to surgical site infection and four to bloodstream infection. Agreement levels for each of the vignettes were calculated. Using the Australian SAB definition, and the National Health and Safety Network definitions for other HAIs, we looked for an association between the proportion of correct answers and the respondents’ characteristics. Results Ninety-two infection prevention nurses responded to the vignettes. One vignette demonstrated 100 % agreement from responders, whilst agreement for the other vignettes varied from 53 to 75 %. Working in a hospital with more than 400 beds, working in a team, and State or Territory was associated with a correct response for two of the vignettes. Those trained in surveillance were more commonly associated with a correct response, whilst those working part-time were less likely to respond correctly. Conclusion These findings reveal the need for further HAI surveillance support for those working part-time and in smaller facilities. It also confirms the need to improve uniformity of HAI surveillance across Australian hospitals, and raises questions on the validity of the current comparing of national HAI SAB rates.

Illicit drug use between an annual key holiday and a control period: Wastewater analysis in a semi-rural, an urban and a vacation area

Introduction and Aims: Holiday periods are potentially a time for increased substance use as social events and private parties are more common. Data on community illicit drug consumption during holiday periods are limited. Besides existing methods for determining drug use, such as population surveys, one emerging method is to measure illicit drugs and/or their metabolites in wastewater samples. This study examined the change in consumption of cannabis, methamphetamine, cocaine and 3,4- methylenedioxymethamphetamine in three different types of areas (an inland semi-rural area, a coastal urban area and a vacation island) with respect to holiday times. Design and Methods: Samples were collected at the inlet of the major wastewater treatment plant in each area during a key annual holiday (i.e. the summer holiday including Christmas and New Year) and control period. Illicit drug residues in the daily composited samples were measured by liquid chromatography coupled with tandem mass spectrometry. Results: Drug use varied substantially among the three areas within each monitoring period as well as between the holiday and control period within each area. Use consistently increased and peaked over New Year particularly for cocaine and 3,4-methylenedioxymethamphetamine whereas cannabis and methamphetamine were relatively less subjected to holiday times in all the areas. Discussion and Conclusions: Wastewater sampling and analysis provides higher spatio-temporal resolution than national surveys and supplements drug epidemiology studies originating primary in metropolitan locations. Such data is essential for policy makers to plan potential intervention strategies associated with these illicit substances in regional areas and other settings besides urban areas in the future.

Identification of IL6R and chromosome 11q13.5 as risk loci for asthma

We aimed to identify novel genetic variants affecting asthma risk, since these might provide novel insights into molecular mechanisms underlying the disease. We did a genome-wide association study (GWAS) in 2669 physician-diagnosed asthmatics and 4528 controls from Australia. Seven loci were prioritised for replication after combining our results with those from the GABRIEL consortium (n=26 475), and these were tested in an additional 25 358 independent samples from four in-silico cohorts. Quantitative multi-marker scores of genetic load were constructed on the basis of results from the GABRIEL study and tested for association with asthma in our Australian GWAS dataset. Two loci were confirmed to associate with asthma risk in the replication cohorts and reached genome-wide significance in the combined analysis of all available studies (n=57 800): rs4129267 (OR 1·09, combined p= 2·4×10-8) in the interleukin-6 receptor (IL6R) gene and rs7130588 (OR 1·09, p=1·8×10-8) on chromosome 11q13.5 near the leucine-rich repeat containing 32 gene (LRRC32, also known as GARP). The 11q13.5 locus was significantly associated with atopic status among asthmatics (OR 1·33, p=7×10-4), suggesting that it is a risk factor for allergic but not non-allergic asthma. Multi-marker association results are consistent with a highly polygenic contribution to asthma risk, including loci with weak effects that might be shared with other immune-related diseases, such as NDFIP1, HLA-B, LPP, and BACH2. The IL6R association further supports the hypothesis that cytokine signalling dysregulation affects asthma risk, and raises the possibility that an IL6R antagonist (tocilizumab) may be effective to treat the disease, perhaps in a genotype-dependent manner. Results for the 11q13.5 locus suggest that it directly increases the risk of allergic sensitisation which, in turn, increases the risk of subsequent development of asthma. Larger or more functionally focused studies are needed to characterise the many loci with modest effects that remain to be identified for asthma. National Health and Medical Research Council of Australia. A full list of funding sources is provided in the webappendix. © 2011 Elsevier Ltd.

Perspectives on Australian, Indian and Malaysian approaches to STEM education

STEM education faces an interesting conundrum. Western countries have implemented constructivist inspired student centred practices which are argued to be more engaging and relevant to student learning than the traditional, didactic approaches. However, student interest in pursuing careers in STEM have fallen or stagnated. In contrast, students in many developing countries in which teaching is still somewhat didactic and teacher centred are more disposed to STEM related careers than their western counterparts. Clearly, factors are at work which impact the way students value science and mathematics. This review draws on three components that act as determinants of science education in three different countries – Australia, India and Malaysia. We explore how national priorities and educational philosophy impacts educational practices as well as teacher beliefs and the need for suitable professional development. Socio-economic conditions for science education that are fundamental for developing countries in adopting constructivist educational models are analysed. It is identified that in order to reduce structural dissimilarities among countries that cause fragmentation of scientific knowledge, for Malaysia constructivist science education through English medium without losing the spirit of Malaysian culture and Malay language is essential while India need to adopt constructivist quality indicators in education. While adopting international English education, and reducing dominance of impact evaluation, India and Malaysia need to prevent losing their cultural and social capital vigour. Furthermore the paper argues that Australia might need to question the efficacy of current models that fail to engage students’ long term interest in STEM related careers. Australian and Malaysian science teachers must be capable of changing the personal biographies of learners for developing scientific conceptual information. In addition both Malaysia and Australia need to provide opportunities for access to different curricular programmes of knowledge based constructivist learning for different levels of learner competencies.

Is there a relationship between screening for diabetes related foot complications and limb amputation?

Background From the conservative estimates of registrants with the National Diabetes Supply Scheme, we will be soon passing 1.1 Million Australians affected by all types of diabetes. The diabetes complications of foot ulceration and amputation are costly to all. These costs can be reduced with appropriate prevention strategies, starting with identifying people at risk through primary care diabetic foot screening. Yet levels of diabetic foot screening in Australia are difficult to quantify. This presentation aims to report on foot screening rates as recorded in existing academic literature, national health surveys and national database reports. Methods Literature searches included diabetic foot screening that occurred in the primary care setting for populations over 2000 people from 2002 to 2014. Searches were performed using Medline and CINAHL as well as internet searches of Organisations for Economic Co-operation and Development (OECD) countries health databases. The focus is on type 1 and type 2 diabetes in adults, and not gestational diabetes or children. The two primary outcome measures were foot -screening rates as a percentage of adult diabetic population and major lower limb amputation incidence rates from standardised OECD data. Results The most recent and accurate level for Australian population review was in the AUSDIAB (Australian Diabetes and lifestyle survey) from 2004. This survey reported screening in primary care to be as low as 50%. Countries such as the United Kingdom and United States of America have much higher reported rates of foot screening (67-86%) recorded using national databases and web based initiatives that involve patients and clinicians. By comparison major amputation rates for Australia were similar to the United Kingdom at 6.5 versus 5.1 per 100,000 population, but dis-similar to the United States of America at 17 per 100,000 population. Conclusions Australian rates of diabetic foot screening in primary care centres is ambiguous. There is no direct relationship between foot screening levels in a primary care environment and major lower limb amputation, based on national health survey's and OECD data. Uptake of national registers, incentives and web-based systems improve levels of diabetic foot assessment, which are the first steps to a healthier diabetic population.

Visions of Past Glory: Nationalism and the Construction of Early Finnish History

The study is an examination of how the distant national past has been conceived and constructed for Finland from the mid-sixteenth century to the Second World War. The author argues that the perception and need of a national 'Golden Age' has undergone several phases during this period, yet the perceived Greatness of the Ancient Finns has been of great importance for the growth and development of the fundamental concepts of Finnish nationalism. It is a question reaching deeper than simply discussing the Kalevala or the Karelianism of the 1890s. Despite early occurrences of most of the topics the image-makers could utilize for the construction of an Ancient Greatness, a truly national proto-history only became a necessity after 1809, when a new conceptual 'Finnishness' was both conceived and brought forth in reality. In this process of nation-building, ethnic myths of origin and descent provided the core of the nationalist cause - the defence of a primordial national character - and within a few decades the antiquarian issue became a standard element of the nationalist public enlightenment. The emerging, archaeologically substantiated, nationhood was more than a scholarly construction: it was a 'politically correct' form of ethnic self-imaging, continuously adapting its message to contemporary society and modern progress. Prehistoric and medieval Finnishness became even more relevant for the intellectual defence of the nation during the period of Russian administrative pressure 1890-1905. With independence the origins of Finnishness were militarized even further, although the 'hot' phase of antiquarian nationalism ended, as many considered the Finnish state reestablished after centuries of 'dependency'. Nevertheless, the distant past of tribal Finnishness and the conceived Golden Age of the Kalevala remained obligating. The decline of public archaeology is quite evident after 1918, even though the national message of the antiquarian pursuits remained present in the history culture of the public. The myths, symbols, images, and constructs of ancient Finnishness had already become embedded in society by the turn of the century, like the patalakki cap, which remains a symbol of Finnishness to this day. The method of approach is one of combining a broad spectrum of previously neglected primary sources, all related to history culture and the subtle banalization of the distant past: school books, postcards, illustrations, festive costumes, drama, satirical magazines, novels, jewellery, and calendars. Tracing the origins of the national myths to their original contexts enables a rather thorough deconstruction of the proto-historical imaginary in this Finnish case study. Considering Anthony D. Smith's idea of ancient 'ethnies' being the basis for nationalist causes, the author considers such an approach in the Finnish case totally misplaced.

Luonto, tiede ja teknologia : Kansanvalistuksen Suomi-kuva 1870-1920

Nature, science and technology. The image of Finland through popular enlightenment texts 1870-1920 This doctoral thesis looks at how Finnish popular enlightenment texts published between 1870 and 1920 took part in the process of forming a genuine Finnish national identity. The same process was occurring in other Nordic countries at the time and the process in Finland was in many ways influenced by them, particularly Sweden. In Finland the political realities under Russian rule especially during the Russification years, and the fact that its history was considered to be short compared to other European countries, made this nation-building process unique. The undertaking was led by members of the national elite, influential in the cultural, academic as well as political arenas, who were keen to support the foundation of a modern Finnish identity. The political realities and national philosophy of history necessitated a search for elements of identity in nature and the Finnish landscape, which were considered to have special national importance: Finland was very much determined as a political entity on the basis of its geography and nature. Nature was also used as means of taking a cultural or political view in terms of, for example, geographical facts such as the nation s borders or the country s geographical connections to Western Europe. In the building of a proper national identity the concept of nature was not, however, static, but was more or less affected by political and economic progress in society. This meant that nature, or the image of the national landscape, was no longer seen only as a visual image of the national identity, but also as a source of science, technology and a prosperous future. The role of technology in this process was very much connected to the ability to harness natural resources to serve national interests. The major change in this respect had occurred by the early 20th century, when indisputable scientific progress altered the relationship between nature and technology. Concerning technology, the thesis is mainly interested in the large and at the time modern technological manifestations, such as railways, factories and industrial areas in Finland. Despite the fact that the symbiosis between national nature and international but successfully localized technology was in Finnish popular enlightenment literature depicted mostly as a national success story, concerns began to arise already in last years of the 19th century. It was argued that the emerging technology would eventually destroy Finland s natural environment, and therefore the basis of its national identity. The question was not how to preserve nature through natural science, but more how to conserve such natural resources and images that were considered to be the basis of national identity and thus of the national history. National parks, isolated from technology, and distant enough so as to have no economic value, were considered the solution to the problem. Methodologically the thesis belongs to the genre of science and technology studies, and offers new viewpoints with regard to both the study of Finnish popular enlightenment literature and the national development process as a whole.

Bitou bush and boneseed eradication and containment in Australia

Bitou bush and boneseed (Chrysanthemoides monilifera subsp. rotundata (DC.) T.Norl. and C. monilifera subsp. monilifera (L.) T.Norl., respectively) are highly invasive environmental weeds that pose a serious threat to Australia’s natural ecosystems and biota. Bitou bush threatens coastal plant communities in New South Wales (NSW), eastern Victoria and southeast Queensland (Qld), while boneseed threatens inland and coastal native plant communities across NSW, South Australia (SA), Tasmania, Victoria, and Western Australia (WA). Over 200 plant species and ecological communities in Australia are negatively impacted by these weeds (ARMCANZ et al. 2000, DEC 2006) and over 15% (approx. 120 million ha) of Australia is susceptible to invasion (see maps in Weiss et al 2008). In 2000, the National Bitou Bush and Boneseed Strategic Plan (ARMCANZ et al. 2000) was approved as part of the Commonwealth’s Weeds of National Significance initiative. A key goal of this plan is to prevent the spread of bitou bush and boneseed in Australia. A national program sponsored by the Australian Government and the affected states has resulted in the development of national containment and eradication zones that prevent the spread of bitou bush and boneseed. This paper presents an overview of these bitou bush and boneseed containment and eradication programs.

Indian developments in ultrasonics and acoustic emission methods

Fundamental investigations in ultrasonics in India date back to the early 20th century. But, fundamental and applied research in the field of nondestructive evaluation (NDE) came much later. In the last four decades it has grown steadily in academic institutions, national laboratories and industry. Currently, commensurate with rapid industrial growth and realisation of the benefits of NDE, the activity is becoming much stronger, deeper, broader and very wide spread. Acoustic Emission (AE) is a recent entry into the field of nondestructive evaluation. Pioneering efforts in India in AE were carried out at the Indian Institute of Science in the early 1970s. The nuclear industry was the first to utilise it. Current activity in AE in the country spans materials research, incipient failure detection, integrity evaluation of structures, fracture mechanics studies and rock mechanics. In this paper, we attempt to project the current scenario in ultrasonics and acoustic emission research in India.

A review of current knowledge of the weedy species Themeda quadrivalvis (grader grass)

This review of grader grass (Themeda quadrivalvis) attempts to collate current knowledge and identify knowledge gaps that may require further research. Grader grass is a tropical annual grass native to India that is now spread throughout many of the tropical regions of the world. In Australia, it has spread rapidly since its introduction in the 1930s and is now naturalised in the tropical areas of Queensland, the Northern Territory and Western Australia and extends south along the east coast to northern New South Wales. It is a vigorous grass with limited palatability, that is capable of invading native and improved pastures, cropping land and protected areas such as state and national parks. Grader grass can form dense monocultures that reduce biodiversity, decrease animal productivity and increase the fire hazard in the seasonally dry tropics. Control options are based on herbicides, grazing management and slashing, while overgrazing appears to favour grader grass. The effect of fire on grader grass is inconclusive and needs to be defined. Little is known about the biology and impacts of grader grass in agricultural and protected ecosystems in Australia. In particular, information is needed on soil seed bank longevity, seed production, germination and growth, which would allow the development of management strategies to control this weedy grass.

Porn, censorship, classification and free speech: Global paradoxes in the governance of media content

In this presentation, I reflect upon the global landscape surrounding the governance and classification of media content, at a time of rapid change in media platforms and services for content production and distribution, and contested cultural and social norms. I discuss the tensions and contradictions arising in the relationship between national, regional and global dimensions of media content distribution, as well as the changing relationships between state and non-state actors. These issues will be explored through consideration of issues such as: recent debates over film censorship; the review of the National Classification Scheme conducted by the Australian Law Reform Commission; online controversies such as the future of the Reddit social media site; and videos posted online by the militant group ISIS.

Water use studies and implications for management of subtropical C4 turfgrasses in dryland and irrigated urban open space

A 2000-03 study to improve irrigation efficiency of grassed urban public areas in northern Australia found it would be difficult to grow most species in dry areas without supplementary watering. Sporoboulus virginicus and sand couch, Zoysia macrantha, were relatively drought-tolerant. Managers of sporting fields, parks and gardens could more than halve their current water use by irrigating over a long cycle, irrigating according to seasonal conditions and using grasses with low water use and sound soil management practices that encourage deep rooting. The use of effluent water provides irrigation and fertiliser cost savings and reduced nitrogen and phosphorus discharge to local waterways. Projected savings are $8000/ha/year in water costs for a typical sporting field.

Establishment and management of salt-tolerant amenity grasses to reduce urban salinity effect

This project built upon the successful outcomes of a previous project (TU02005) by adding to the database of salt tolerance among warm season turfgrass cultivars, through further hydroponic screening trials. Hydroponic screening trials focussed on new cultivars or cultivars that were not possible to cover in the time available under TU02005, including: 11 new cultivars of Paspalum vaginatum; 13 cultivars of Cynodon dactylon; six cultivars of Stenotaphrum secundatum; one accession of Cynodon transvaalensis; 12 Cynodon dactylon x transvaalensis hybrids; two cultivars of Sporobolus virginicus; five cultivars of Zoysia japonica; one cultivar of Z. macrantha, one common form of Z. tenuifolia and one Z. japonica x tenuifolia hybrid. The relative salinity tolerance of different turfgrasses is quantified in terms of their growth response to increasing levels of salinity, often defined by the salt level that equates to a 50% reduction in shoot yield, or alternatively the threshold salinity. The most salt tolerant species in these trials were Sporobolus virginicus and Paspalum vaginatum, consistent with the findings from TU02005 (Loch, Poulter et al. 2006). Cynodon dactylon showed the largest range in threshold values with some cultivars highly sensitive to salt, while others were tolerant to levels approaching that of the more halophytic grasses. Coupled with the observational and anecdotal evidence of high drought tolerance, this species and other intermediately tolerant species provide options for site specific situations in which soil salinity is coupled with additional challenges such as shade and high traffic conditions. By recognising the fact that a salt tolerant grass is not the complete solution to salinity problems, this project has been able to further investigate sustainable long-term establishment and management practices that maximise the ability of the selected grass to survive and grow under a particular set of salinity and usage parameters. Salt-tolerant turf grasses with potential for special use situations were trialled under field conditions at three sites within the Gold Coast City Council, while three sites, established under TU02005 within the Redland City Council boundaries were monitored for continued grass survival. Several randomised block experiments within Gold Coast City were established to compare the health and longevity of seashore paspalum (Paspalum vaginatum), Manila grass (Zoysia matrella), as well as the more tolerant cultivars of other species like buffalo grass (Stenotaphrum secundatum) and green couch (Cynodon dactylon). Whilst scientific results were difficult to achieve in the field situation, where conditions cannot be controlled, these trials provided valuable observational evidence of the likely survival of these species. Alternatives to laying full sod such as sprigging were investigated, and were found to be more appropriate for areas of low traffic as the establishment time is greater. Trials under controlled and protected conditions successfully achieved a full cover of Paspalum vaginatum from sprigs in a 10 week time frame. Salt affected sites are often associated with poor soil structure. Part of the research investigated techniques for the alleviation of soil compaction frequently found on saline sites. Various methods of soil de-compaction were investigated on highly compacted heavy clay soil in Redlands City. It was found that the heavy duplex soil of marine clay sediments required the most aggressive of treatments in order to achieve limited short-term effects. Interestingly, a well constructed sports field showed a far greater and longer term response to de-compaction operations, highlighting the importance of appropriate construction in the successful establishment and management of turfgrasses on salt affected sites. Fertiliser trials in this project determined plant demand for nitrogen (N) to species level. This work produced data that can be used as a guide when fertilising, in order to produce optimal growth and quality in the major turf grass species used in public parkland. An experiment commenced during TU02005 and monitored further in this project, investigated six representative warm-season turfgrasses to determine the optimum maintenance requirements for fertiliser N in south-east Queensland. In doing so, we recognised that optimum level is also related to use and intensity of use, with high profile well-used parks requiring higher maintenance N than low profile parks where maintaining botanical composition at a lower level of turf quality might be acceptable. Kikuyu (Pennisetum clandestinum) seemed to require the greatest N input (300-400 kg N/ha/year), followed by the green couch (Cynodon dactylon) cultivars ‘Wintergreen’ and ‘FLoraTeX’ requiring approximately 300 kg N/ha/year for optimal condition and growth. ‘Sir Walter’ (Stenotaphrum secundatum) and ‘Sea Isle 1’ (Paspalum vaginatum) had a moderate requirement of approximately 200 kg/ha/year. ‘Aussiblue’ (Digitaria didactyla)maintained optimal growth and quality at 100-200 kg N/ha/year. A set of guidelines has been prepared to provide various options from the construction and establishment of new grounds, through to the remediation of existing parklands by supporting the growth of endemic grasses. They describe a best management process through which salt affected sites should be assessed, remediated and managed. These guidelines, or Best Management Practices, will be readily available to councils. Previously, some high salinity sites have been turfed several times over a number of years (and Council budgets) for a 100% failure record. By eliminating this budgetary waste through targeted workable solutions, local authorities will be more amenable to investing appropriate amounts into these areas. In some cases, this will lead to cost savings as well as resulting in better quality turf. In all cases, however, improved turf quality will be of benefit to ratepayers, directly through increased local use of open space in parks and sportsfields and indirectly by attracting tourists and other visitors to the region bringing associated economic benefits. At the same time, environmental degradation and erosion of soil in bare areas will be greatly reduced.

Evidence-based perspective on CP rehabilitation : Reviews on physiotherapy, physiotherapy-related motor-based interventions and orthotic devices

This thesis utilises an evidence-based approach to critically evaluate and summarize effectiveness research on physiotherapy, physiotherapy-related motor-based interventions and orthotic devices in children and adolescents with cerebral palsy (CP). It aims to assess the methodological challenges of the systematic reviews and trials, to evaluate the effectiveness of interventions in current use, and to make suggestions for future trials Methods: Systematic reviews were searched from computerized bibliographic databases up to August 2007 for physiotherapy and physiotherapy-related interventions, and up to May 2003 for orthotic devices. Two reviewers independently identified, selected, and assessed the quality of the reviews using the Overview Quality Assessment Questionnaire complemented with decision rules. From a sample of 14 randomized controlled trials (RCT) published between January 1990 and June 2003 we analysed the methods of sampling, recruitment, and comparability of groups; defined the components of a complex intervention; identified outcome measures based on the International Classification of Functioning, Disability and Health (ICF); analysed the clinical interpretation of score changes; and analysed trial reporting using a modified 33-item CONSORT (Consolidated Standards of Reporting Trials) checklist. The effectiveness of physiotherapy and physiotherapy-related interventions in children with diagnosed CP was evaluated in a systematic review of randomised controlled trials that were searched from computerized databases from January 1990 up to February 2007. Two reviewers independently assessed the methodological quality, extracted the data, classified the outcomes using the ICF, and considered the level of evidence according to van Tulder et al. (2003). Results: We identified 21 reviews on physiotherapy and physiotherapy-related interventions and five on orthotic devices. These reviews summarized 23 or 5 randomised controlled trials and 104 or 27 observational studies, respectively. Only six reviews were of high quality. These found some evidence supporting strength training, constraint-induced movement therapy or hippotherapy, and insufficient evidence on comprehensive interventions. Based on the original studies included in the reviews on orthotic devices we found some short-term effects of lower limb casting on passive range of movement, and of ankle-foot orthoses on equinus walk. Long term effects of lower limb orthoses have not been studied. Evidence of upper limb casting or orthoses is conflicting. In the sample of 14 RCTs, most trials used simple randomisation, complemented with matching or stratification, but only three specified the concealed allocation. Numerous studies provided sufficient details on the components of a complex intervention, but the overlap of outcome measures across studies was poor and the clinical interpretation of observed score changes was mostly missing. Almost half (48%) of the applicable CONSORT-based items (range 28 32) were reported adequately. Most reporting inadequacies were in outcome measures, sample size determination, details of the sequence generation, allocation concealment and implementation of the randomization, success of assessor blinding, recruitment and follow-up dates, intention-to-treat analysis, precision of the effect size, co-interventions, and adverse events. The systematic review identified 22 trials on eight intervention categories. Four trials were of high quality. Moderate evidence of effectiveness was established for upper extremity treatments on attained goals, active supination and developmental status, and of constraint-induced therapy on the amount and quality of hand use and new emerging behaviours. Moderate evidence of ineffectiveness was found for strength training's effect on walking speed and stride length. Conflicting evidence was found for strength training's effect on gross motor function. For the other intervention categories the evidence was limited due to the low methodological quality and the statistically insignificant results of the studies. Conclusions: The high-quality reviews provide both supportive and insufficient evidence on some physiotherapy interventions. The poor quality of most reviews calls for caution, although most reviews drew no conclusions on effectiveness due to the poor quality of the primary studies. A considerable number of RCTs of good to fair methodological and reporting quality indicate that informative and well-reported RCTs on complex interventions in children and adolescents with CP are feasible. Nevertheless, methodological improvement is needed in certain areas of the trial design and performance, and the trial authors are encouraged to follow the CONSORT criteria. Based on RCTs we established moderate evidence for some effectiveness of upper extremity training. Due to limitations in methodological quality and variations in population, interventions and outcomes, mostly limited evidence on the effectiveness of most physiotherapy interventions is available to guide clinical practice. Well-designed trials are needed, especially for focused physiotherapy interventions.

Association between endometriosis and the interleukin 1A (IL1A) locus

STUDY QUESTION Are single-nucleotide polymorphisms (SNPs) at the interleukin 1A (IL1A) gene locus associated with endometriosis risk? SUMMARY ANSWER We found evidence for strong association between IL1A SNPs and endometriosis risk. WHAT IS KNOWN ALREADY Genetic factors contribute substantially to the complex aetiology of endometriosis and the disease has an estimated heritability of ∼51%. We, and others, have conducted genome-wide association (GWA) studies for endometriosis, which identified a total of nine independent risk loci. Recently, two small Japanese studies reported eight SNPs (rs6542095, rs11677416, rs3783550, rs3783525, rs3783553, rs2856836, rs1304037 and rs17561) at the IL1A gene locus as suggestively associated with endometriosis risk. There is also evidence of a link between inflammation and endometriosis. STUDY DESIGN, SIZE, DURATION We sought to further investigate the eight IL1A SNPs for association with endometriosis using an independent sample of 3908 endometriosis cases and 8568 controls of European and Japanese ancestry. The study was conducted between October 2013 and July 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS By leveraging GWA data from our previous multi-ethnic GWA meta-analysis for endometriosis, we imputed variants in the IL1A region, using a recent 1000 Genomes reference panel. After combining summary statistics for the eight SNPs from our European and Japanese imputed data with the published results, a fixed-effect meta-analysis was performed. An additional meta-analysis restricted to endometriosis cases with moderate-to-severe (revised American Fertility Society stage 3 or 4) disease versus controls was also performed. MAIN RESULTS AND THE ROLE OF CHANCE All eight IL1A SNPs successfully replicated at P < 0.014 in the European imputed data with concordant direction and similar size to the effects reported in the original Japanese studies. Of these, three SNPs (rs6542095, rs3783550 and rs3783525) also showed association with endometriosis at a nominal P < 0.05 in our independent Japanese sample. Fixed-effect meta-analysis of the eight SNPs for moderate-to-severe endometriosis produced a genome-wide significant association for rs6542095 (odds ratio = 1.21; 95% confidence interval = 1.13–1.29; P = 3.43 × 10−8). LIMITATIONS, REASONS FOR CAUTION The meta-analysis for moderate-to-severe endometriosis included results of moderate-to-severe endometriosis cases from our European data sets and all endometriosis cases from the Japanese data sets, as disease stage information was not available for endometriosis cases in the Japanese data sets. WIDER IMPLICATIONS OF THE FINDINGS SNP rs6542095 is located ∼2.3 kb downstream of the IL1A gene and ∼6.9 kb upstream of cytoskeleton-associated protein 2-like (CKAP2L) gene. The IL1A gene encodes the IL1a protein, a member of the interleukin 1 cytokine family which is involved in various immune responses and inflammatory processes. These results provide important replication in an independent Japanese sample and, for the first time, association of the IL1A locus in endometriosis patients of European ancestry. SNPs within the IL1A locus may regulate other genes, but if IL1A is the target, our results provide supporting evidence for a link between inflammatory responses and the pathogenesis of endometriosis. STUDY FUNDING/COMPETING INTEREST(S) The research was funded by grants from the Australian National Health and Medical Research Council and Wellcome Trust. None of the authors has competing interests for the study.