Occurrence and elimination of cyanobacterial toxins in two Australian drinking water treatment plants

In Australian freshwaters, Anabaena circinalis, Microcystis spp. and Cylindrospermopsis raciborskii are the dominant toxic cyanobacteria. Many of these Surface waters are used as drinking water resources. Therefore, the National Health and Medical Research Council of Australia set a guideline for MC-LR toxicity equivalents of 1.3 mug/l drinking, water. However, due to lack of adequate data, no guideline values for paralytic shellfish poisons (PSPs) (e.g. saxitoxins) or cylindrospermopsin (CYN) have been set. In this spot check. the concentration of microcystins (MCs), PSPs and CYN were determined by ADDA-ELISA, cPPA, HPLC-DAD and/or HPLC-MS/MS, respectively, in two water treatment plants in Queensland/Australia and compared to phytoplankton data collected by Queensland Health, Brisbane. Depending on the predominant cyanobacterial species in a bloom, concentrations of up to 8.0, 17.0 and 1.3 mug/l were found for MCs, PSPs and CYN, respectively. However, only traces (< 1.0 mug/l) of these toxins were detected in final water (final product of the drinking water treatment plant) and tap water (household sample). Despite the low concentrations of toxins detected in drinking water, a further reduction of cyanobacterial toxins is recommended to guarantee public safety. (C) 2004 Elsevier Ltd. All rights reserved.

Encouraging practitioners to use resources: evaluation of the national implementation of a resource to improve the clinical management of alcohol-related problems in Indigenous primary care settings

This paper reports on the evaluation of the implementation of the National Recommendations for the Clinical Management of Alcohol-Related Problems in Indigenous Primary Care Settings undertaken in 2001 through 74 standardized workshops, which sought to determine: ( 1) whether this approach to implementation influenced the likelihood that the National Recommendations would be used; ( 2) whether it influenced participants' willingness to engage with Indigenous patients regarding alcohol-related issues; and ( 3) whether the implementation as a whole influenced both practice and clinicians' willingness to engage. Evaluation included pre-/post-workshop and follow-up questionnaires and a focus group. The findings presented indicate that distribution of clinical resources alone is not sufficient to ensure use and that, particularly for medical practitioners, appropriate introduction not only increases use but also positively influences willingness to engage with alcohol-related problems as part of primary clinical care. Further, the enthusiasm for guideline production should be tempered by the need to develop effective implementation strategies.

Physical activity patterns of Singaporean adolescents

The purpose of this study was to document the level of physical activity and sedentary behavior in a representative sample of Singaporean adolescents. A random sample of 1,827 secondary school students from six secondary schools (929 boys, 898 girls, mean age 14.9 +/- 1.2 yr) completed the Three-Day Physical Activity Recall (3DPAR) self-report instrument. Approximately 63% of Singaporean high school students met current guidelines requiring 60 min of moderate to vigorous physical activity daily. Just over half (51.6%) met the guideline calling for regular vigorous physical activity. Across all grade levels, boys were consistently more active than girls. More than 70% of Singaporean high school students exceeded the recommended 2 hours per day of electronic media use. Collectively, these findings suggest that a significant proportion of Singaporean adolescents are not sufficiently active and are in need of programs to promote physical activity and decrease sedentary behavior.

Cautionary tales in the interpretation of systematic reviews of therapy trials

This is the second in a series of articles emphasizing the cautions in the interpretation of health-care studies. Systematic reviews are presented as comprehensive, unbiased summaries of evidence and are often referred to by clinicians, guideline developers and health policy-makers. Their strengths and limitations, and how their results can be subject to bias and misinterpretation, are discussed.

Socio-demographic variations in walking for transport and for recreation or exercise among adult Australians

Background: Walking is integral to strategies to promote physical activity. We identified socio-demographic variations in walking for transport, and for recreation or exercise. Methods: Representative population data (n = 3392) from Australia were collected using computer assisted telephone interviewing, to examine adults’ participation in moderate- or brisk-paced walking for transport and walking for recreation or exercise; walking “sufficient” to meet the current public health guideline (> 150 min/wk); and, the contributions of total walking to meeting the guideline for total physical activity. Results: Rates of sufficient walking for transport (10% for men, 9% for women) were lower than those for walking for recreation or exercise (14% for both genders). Few socio-demographic differences emerged. Men over age 60 y were significantly less likely (OR = 0.40) to walk for transport; men age 45 to 59 y were more likely (OR = 1.56) to walk for recreation or exercise. Walking contributed more toward meeting the current public health guideline among women (15% to 21%) than among men (6% to 8%). Conclusions: There is potential for socially equitable increases in participation, through a focus on both walking for transport and on walking for recreation or exercise; attention to gender differences would be helpful.

Assessment of two arsenic-contaminated drinking water mitigation interventions in Bangladesh

Arsenic is a carcinogen. In Bangladesh, there are over 10 million tube-wells of which about 50% have arsenic concentrations exceeding the WHO recommended guideline value of 10 μg/L for drinking water. This study aimed to evaluate the efficacy of two relatively inexpensive mitigation interventions, three-pitcher filters and dug-wells. A randomised controlled field trial was conducted in Natore. Six Hundred and forty participants, 60 clusters of 47 villages were included in the trial. Two hundred and six participants were selected for the control group, 218 participants for the dug-wells, and 216 participants for the three-pitcher filters. The average arsenic in the drinking water was 128 μg/L in the three-pitcher trial. Twelve months post intervention, about 30% of the filtered water samples were >50 μg/L whereas dug-well water was

Implementation of a triple modular redundant FPGA based safety critical system for reliable software execution

This paper describes the implementation of a TMR (Triple Modular Redundant) microprocessor system on a FPGA. The system exhibits true redundancy in that three instances of the same processor system (both software and hardware) are executed in parallel. The described system uses software to control external peripherals and a voter is used to output correct results. An error indication is asserted whenever two of the three outputs match or all three outputs disagree. The software has been implemented to conform to a particular safety critical coding guideline/standard which is popular in industry. The system was verified by injecting various faults into it.

A RESPONSABILIDADE SOCIAL EMPRESARIAL COMO FERRAMENTA ESTRATÉGICA E MOTIVACIONAL NA INDÚSTRIA AUTOMOTIVA BRASILEIRA. ESTUDO COMPARATIVO DE CASO: VOLKSWAGEN DO BRASIL (GRANDE ABC) X FIAT AUTOMÓVEIS (BETIM/MG)

Este trabalho propõe-se a mostrar a Responsabilidade Social como uma vantagem competitiva, bem como uma ferramenta estratégica vital para a sobrevivência das empresas em um cenário de rápidas e constantes mudanças. A ressaltar que, a partir do processo de globalização, com a pseudofusão das culturas, muitas empresas viram-se, de uma hora para outra, inseridas em um ambiente extremamente competitivo e aguerrido, onde velhas práticas tiveram que ser abandonadas, porque o cliente, antes jogado à própria sorte, tornou-se rei . Isto é, soberano nas suas escolhas e a razão de ser de uma empresa. Para abalizar as informações prestadas, far-se-á o estudo comparativo de caso, por meio de uma pesquisa qualitativa descritiva, entre a Volkswagen Brasil empresa de origem alemã, instalada há mais de 50 anos no país e que detinha a liderança absoluta do mercado até o início do século XXI mas que a perdeu para a Fiat Automóveis de origem italiana, instalada há pouco mais de 30 anos, na cidade mineira de Betim e que conseguiu reverter uma imagem negativa perante os consumidores, tendo como uma das suas ações, a Responsabilidade Social como ferramenta estratégica e motivacional do seu público interno, numa clara cultura social . Enquanto que, recentemente, a Volkswagen enfrentou um longo e desgastante processo de negociação sindical em face do processo de demissão de milhares de empregados por carta da sua unidade de São Bernardo do Campo, o que pôs em xeque as suas práticas e a sua efetiva preocupação com o social. A Pesquisa IPEA de Indicadores Sociais, na sua segunda edição, é elemento norteador do trabalho desenvolvido que traz como principais revelações: a Responsabilidade Social no Brasil ainda é incipiente, está em processo de gestação a ISO 26001, a preocupação ambiental alastra-se por todo o planeta e os gestores, antes atentos quase que exclusivamente ao lucro, passam a ser cobrados pelos possíveis impactos socioambientais de suas decisões no presente.(AU)

ESCOLA DE TEMPO INTEGRAL: UMA ESCOLA DIFERENTE OU A ESCOLA QUE FAZ A DIFERENÇA?

Este trabalho tem por objetivo descrever a proposta atual de Escola de Tempo Integral no Estado de São Paulo, investigar e avaliar a implantação de uma escola da rede pública estadual da Baixada Santista na cidade de Bertioga-SP, no ano de 2006. Trata-se de pesquisa descritivo-analítica do processo de implantação e da proposta de Escola de Tempo Integral, considerando alguns programas e projetos implantados em décadas anteriores no Estado de São Paulo e em outros estados brasileiros. Os dados foram coletados por meio de análise de documentos referente à proposta e observações realizadas pela pesquisadora, membro participante no processo de implantação da Escola de Tempo Integral na escola investigada. Os resultados descrevem a legislação norteadora, princípios filosóficos, diretrizes gerais, organização curricular, carga horária, práticas e atividades cotidianas, bem como as possibilidades e limites desse projeto em sua implantação.(AU)

Uso do protocolo no serviço de psicologia e avaliação psicodinâmica em candidatos à cirurgia bariátrica

A clínica da Obesidade Mórbida e a Cirurgia Bariátrica exige estudos e acompanhamentos do paciente. Os benefícios e riscos do emagrecimento por tratamento cirúrgico devem servir como ponto de alerta aos profissionais da saúde. O uso do questionário no serviço de psicologia é norteado pela escuta psicológica. Objetivos: 1) Descrever o perfil sócio-demográfico candidatos à cirurgia bariátrica. 2) Analisar a percepção dos pacientes sobre características de personalidade associadas à obesidade e transtornos alimentares. 3) Descrever os conteúdos psicodinâmicos da narrativa do sujeito e avaliar o sistema tensional inconsciente de dois pacientes por meio do Teste das Relações Objetais de Phillipson (TRO). Método: O delineamento metodológico com análise de dados pelo método epidemiológico e estudo de caso clínico, orientação psicanalítica. Na primeira etapa foram consultados 300 questionários do serviço de psicologia e na segunda dois pacientes com ganho de peso após 24 meses. São pacientes que procuraram tratamento em clínica especializada, em uma metrópole do sudeste brasileiro, sob consentimento pós-informado. Os questionários foram preenchidos por 227 mulheres e 73 homens; com média de idade igual a 36 anos; escolaridade ensino médio e superior, 53%; maioria casados; IMC entre grave e super mórbido (94,3%). Técnicas cirúrgicas indicadas Capella Bypass e Fobi-Capella (67%). Resultados: características psicológicas referidas pelos pacientes, a ansiedade apontou em 93,7% das respostas, seguidas por impulsividade, depressão, tolerância à frustração, baixa auto-estima, resolvedor de problemas dos outros (mais de 50%). No histórico familiar da obesidade está em mais de 70% depressão e uso do álcool em 30%; realização de psicoterapia (30%) e medicamentos para depressão e ansiedade (10%). Na segunda etapa, foi realizado o diagnóstico psicodinâmico, por meio do Teste das Relações Objetais de Phillipson com duas pacientes, cuja análise indicou necessidade de psicoterapia psicanalítica, pois tinham fixações na posição esquizoparanóide e apresentavam dificuldade em lidar com perdas e baixa motivação para mudança e insigth. Conclusões: Com a aplicação do questionário e o registro das observações empíricas, este questionário de entrevista semidirigida preenche condições de melhor acessar e avaliar os conteúdos revelados pelos pacientes. As contradições entre as respostas e o discurso, no contato individual com o psicólogo, apontam a necessidade de investimento no preparo do paciente para a cirurgia e mais acentuadamente o acompanhamento psicológico no primeiro ano do pós-operatório. Há um pensamento mágico a ser trabalhado durante a aplicação do questionário sobre as crenças frente à cirurgia e o emagrecimento e assim convocar o paciente a ocupar o lugar do sujeito implicado em seu processo pré e pós-operatório. O TRO contribuiu na compreensão do diagnóstico psicodinâmico de pacientes com ganho de peso após cirurgia e reforçou a necessidade de maior investimento no pré-operatório.(AU)

The primacy of theory

Purpose – The purpose of this editorial is to provide indicative guidance to prospective EJM contributors of the importance of theoretical development to the success of submissions. Design/methodology/approach – The authors use a combination of conceptual thinking and theoretical literature to present key concepts of theory and its relevance to a manuscript's contribution to knowledge. Findings – The authors propose some guidelines for researchers who wish to publish the results of their work in EJM, and these also have relevance to other top academic journals. Research limitations/implications – The topic of theoretical conceptualisation and development is a complex one. Because of space constraints, the coverage of many issues is necessarily brief in this article. Practical implications – Scholars should find the thoughts contained in this article to be of significant benefit to their publication efforts in EJM and other top journals. Originality/value – While other top marketing journals have in the past provided similar guideline-style pieces, this is one of the few to be written from an inclusive perspective, with the explicit focus on the theoretical development stage.

An applied linguistic analysis of the simplification of narrative texts

Simplification of texts has traditionally been carried out by replacing words and structures with appropriate semantic equivalents in the learner's interlanguage, omitting whichever items prove intractable, and thereby bringing the language of the original within the scope of the learner's transitional linguistic competence. This kind of simplification focuses mainly on the formal features of language. The simplifier can, on the other hand, concentrate on making explicit the propositional content and its presentation in the original in order to bring what is communicated in the original within the scope of the learner's transitional communicative competence. In this case, simplification focuses on the communicative function of the language. Up to now, however, approaches to the problem of simplification have been mainly concerned with the first kind, using the simplifier’s intuition as to what constitutes difficulty for the learner. There appear to be few objective principles underlying this process. The main aim of this study is to investigate the effect of simplification on the communicative aspects of narrative texts, which includes the manner in which narrative units at higher levels of organisation are structured and presented and also the temporal and logical relationships between lower level structures such as sentences/clauses, with the intention of establishing an objective approach to the problem of simplification based on a set of principled procedures which could be used as a guideline in the simplification of material for foreign students at an advanced level.

A tree-based decision model to support prediction of the severity of asthma exacerbations in children

This paper describes the development of a tree-based decision model to predict the severity of pediatric asthma exacerbations in the emergency department (ED) at 2 h following triage. The model was constructed from retrospective patient data abstracted from the ED charts. The original data was preprocessed to eliminate questionable patient records and to normalize values of age-dependent clinical attributes. The model uses attributes routinely collected in the ED and provides predictions even for incomplete observations. Its performance was verified on independent validating data (split-sample validation) where it demonstrated AUC (area under ROC curve) of 0.83, sensitivity of 84%, specificity of 71% and the Brier score of 0.18. The model is intended to supplement an asthma clinical practice guideline, however, it can be also used as a stand-alone decision tool.

Breast clinic and life style study BLLISS

Background: Independent, strong and unequivocal evidence suggests that life style factors such as obesity and lack of physical activity along with certain reproductive choices can increase the risk of breast cancer. There are no studies measuring the effectiveness of guidelines from the Department of Health regarding life style choices made by women presenting to breast clinics. The aim of this audit was to study the prevalence of obesity, physical activity and reproductive factors in women referred to breast clinic. Patients and methods: All patients attending the Breast clinic as new referrals were invited to complete a life style questionnaire. The data was analysed for prevalence of various risk factors for breast cancer. Three hundred and 73 patients completed the questionnaire. Results: Final analyses of 373 patients demonstrated that 42% of women performed no exercise and only 24% of patients met Department of Health guideline of 30 minutes of exercise for 5 days a week. Overall 50% of patients were either obese or overweight and 22% of patients had BMI of > 30 kg/m. The median age of menarche was 13 and 18% of women started their period below the age 12. Twenty one percent of women were nulliparous and 14% had their first live birth after the age of 30. Fourteen percent of patients were on the hormone replacement therapy of which 57% have used hormones for more than 5 years. Twenty two percent of women smoked and 9% of women consumed alcohol 5 days a week of which 13% had more than 4 glasses of alcohol in a day. Conclusion: There is preponderance of high risk life style choices in women attending breast clinic. If these life style options are not modified, there could potentially be a significant rise in the number of breast cancer in West Midlands.

Is twelve years old an acceptable age at which to begin Diabetic Retinopathy Screening?

Introduction: The English National Screening Programme for diabetic retinopathy (ENSPDR) states that “all people with diabetes aged 12 years and over should be offered screening” Purpose: The audit aims to assess whether the current guideline is suitable and whether diabetes duration should be taken into account when deciding at what age to start screening patients. Method: Retrospective analysis of 143 randomly selected patients aged twelve years or younger who have attended diabetic retinopathy (DR) screening in the Birmingham and Black Country Screening Programme. Results: 98% had Type 1 diabetes and mean visual acuity (VA) was 6/5 (6/4-6/36). 73 were under 12 with 7 the youngest age and 70 were aged 12. Both groups had mean diabetes duration of 5 years (1month-11years). For those under 12, 7/73 (9.6%) had background DR, of these mean diabetes duration was 7 years (6-8) and the youngest aged 8. In those aged 12, 5/70 (7.1%) had background DR; of these mean diabetes duration was 8 years (6-11). In total 12 (8.4%) patients aged 12 years or under developed DR. No patients had retinopathy worse than background changes. One patient was referred to ophthalmology for VAs of 6/12, 6/18 and was diagnosed with optic atrophy so returned to annual screening. Conclusion: The results suggest that the current guideline on when to begin screening should be readdressed as more patients under twelve developed DR than those aged 12. Diabetes duration may help when deciding what age to start screening adolescent patients as DR was not seen in those with disease duration.