Determinants of rapid weight gain during infancy: Baseline results from the NOURISH randomised controlled trial.

Background: Rapid weight gain in infancy is an important predictor of obesity in later childhood. Our aim was to determine which modifiable variables are associated with rapid weight gain in early life. Methods: Subjects were healthy infants enrolled in NOURISH, a randomised, controlled trial evaluating an intervention to promote positive early feeding practices. This analysis used the birth and baseline data for NOURISH. Birthweight was collected from hospital records and infants were also weighed at baseline assessment when they were aged 4-7 months and before randomisation. Infant feeding practices and demographic variables were collected from the mother using a self administered questionnaire. Rapid weight gain was defined as an increase in weight-for-age Z-score (using WHO standards) above 0.67 SD from birth to baseline assessment, which is interpreted clinically as crossing centile lines on a growth chart. Variables associated with rapid weight gain were evaluated using a multivariable logistic regression model. Results: Complete data were available for 612 infants (88% of the total sample recruited) with a mean (SD) age of 4.3 (1.0) months at baseline assessment. After adjusting for mother's age, smoking in pregnancy, BMI, and education and infant birthweight, age, gender and introduction of solid foods, the only two modifiable factors associated with rapid weight gain to attain statistical significance were formula feeding [OR=1.72 (95%CI 1.01-2.94), P= 0.047] and feeding on schedule [OR=2.29 (95%CI 1.14-4.61), P=0.020]. Male gender and lower birthweight were non-modifiable factors associated with rapid weight gain. Conclusions: This analysis supports the contention that there is an association between formula feeding, feeding to schedule and weight gain in the first months of life. Mechanisms may include the actual content of formula milk (e.g. higher protein intake) or differences in feeding styles, such as feeding to schedule, which increase the risk of overfeeding. Trial Registration: Australian Clinical Trials Registry ACTRN12608000056392

Assessing performance capability in the work place

As universities worldwide begin to appreciate the value of authentic learning experiences, so they struggle with methods of assessing the outcomes from such experiences. This chapter describes the application of an assessment matrix developed by Queensland University of Technology(QUT) in Australia, to the assessment requirements and practices relating to work integrated learning at the University of Surrey in the UK. Despite the very different institutional contexts and independent way in which the assessment regimes have developed, it was found that the values and outcomes being assessed and the methods used to assess them were similar. The most important feature of assessing work integrated learning experiences is fitness for purpose, hence the learning objectives and assessment of outcomes for a WIL experience must be explicitly aligned to this objective.As universities worldwide begin to appreciate the value of authentic learning experiences, so they struggle with methods of assessing the outcomes from such experiences. This chapter describes the application of an assessment matrix developed by Queensland University of Technology (QUT) in Australia, to the assessment requirements and practices relating to work integrated learning at the University of Surrey in the UK. Despite the very different institutional contexts and independent way in which the assessment regimes have developed, it was found that the values and outcomes being assessed and the methods used to assess them were similar. The most important feature of assessing work integrated learning experiences is fitness for purpose, hence the learning objectives and assessment of outcomes for a WIL experience must be explicitly aligned to this objective.

Blood cultures for assessment of postoperative fever in arthroplasty patients

Postoperative fever in arthroplasty patients is common. The value of diagnostic workup of fever in this instance is of questionable utility. Studies have shown that blood cultures in this scenario add little to clinical management, but sample sizes have been small and the use of blood cultures in this setting continues. This study aimed to examine the value of blood cultures in the assessment of postoperative fever in a large arthroplasty population. The medical records of 101 patients who had 141 blood culture sets taken during a 2-year period were retrospectively analyzed. Of the 141 blood culture sets, only 2 returned positive results. These were both thought to be as a result of skin contamination at the time of venipuncture. No infectious sequelae occurred in either patient. We conclude that blood cultures have no role to play in the assessment of the febrile, otherwise asymptomatic arthroplasty patient in the early postoperative period.

Assessment of preterm infants' readiness to commence breastfeeding

Preterm infants commence breastfeeding when health-care professionals deem them to be ready. However, the optimal timing for commencement of breastfeeding is unclear. Currently, there is little guidance for neonatal care providers to decide when to initiate breastfeeding among preterm infants. A mixed-methods study was conducted to develop and test the Preterm Sucking Readiness (PTSR) scale in four phases. The first phase involved a chart audit to explore the use of age as a criterion by investigating when preterm infants meet feeding milestones as well as other factors that may affect an infant’s readiness to engage in nutritive sucking behaviour. The second phase utilised focus groups to explore and define how neonatal care providers decide when to commence breastfeeding. To gain consensus on the criteria mentioned by the focus groups, a Delphi survey was conducted in phase 3, involving neonatal providers across Australia and New Zealand. Phase 4 of the study involved an observational study that was used to test the six-item PTSR. The age at which specific feeding milestones were reached was consistent with what has been previously described in the literature. The chart audit showed that the time taken to the first feeding attempt in the preterm infant population was affected by gestational age at birth, birth weight, and specific interventions. Staff also considered age along with other criteria when deciding when to initiate feeding. Consensus on nine criteria for inclusion into the six-item PTSR was achieved using the Delphi technique. Three items of PTSR showed significant differences between the preterm and fullterm infant groups. Only two items, feeding-readiness behaviour and low pulse oximetry during handling, explained the variance in breastfeeding behaviour. The inter-rater variability ranged between moderate and very good for the PTSR items. The results of this study indicate the importance of assessing behavioural cues as an indication of breastfeeding readiness in the preterm infant population, once an infant is deemed physiologically stable. Age continues to be a factor in some clinicians' decisions to commence breastfeeding. However, age alone cannot be used to decide if an infant is ready to engage in breastfeeding. Further research is needed to confirm these findings.

Converting theory to practice : university-school collaboration on devising strategies for mentoring pedagogical knowledge

There appears no shortage of theorists for preservice teacher education; however many ideas are abandoned without practical applications. Indeed, it can take years for theories to materialise into practice, if they materialise at all. The quality of preservice teacher education is central for enhancing an education system, and mentors’ roles can assist to shape preservice teachers’ development within the school context. Yet mentoring can be haphazard without being underpinned by a theoretical framework. A mentoring model (personal attributes, system requirements, pedagogical knowledge, modelling, and feedback) has emerged from research and the literature to guide mentors’ practices. This qualitative study investigates mentors’ pedagogical knowledge as one factor crucial to the mentoring process. More specifically, this study involves a questionnaire and audio-recorded focus group meetings with experienced mentors (n=14) who deliberated on devising practical applications for mentoring pedagogical knowledge. Findings revealed that these experienced mentors pinpointed practical applications around a mentor’s role for providing pedagogical knowledge to the mentee. These strategies were varied and demonstrated that any one mentoring practice may be approached from a number of different angles. Nevertheless, there were core mentoring practices in pedagogical knowledge such as showing the mentee how to plan for teaching, articulating classroom management approaches, and talking about how to connect learning to assessment. Mentors may require education on current mentoring practices with practical strategies that are linked to theoretical underpinnings.

The Biodex Isokinetic Dynamometer for knee strength assessment in children : advantages and limitations

Objective: To critically appraise the Biodex System 4 isokinetic dynamometer for strength assessment of children. Methods: Appraisal was based on experiences from two independent laboratories involving testing of 213 children. Issues were recorded and the manufacturer was consulted regarding appropriate solutions. Results: The dynamometer had insufficient height adjustment for alignment of the knee for some children, requiring the construction of padding to better fit the child within the dynamometer. Potential for entrapment of the non-testing leg was evident in the passive and eccentric modes and a leg bracket restraint was constructed. Automated gravity correction did not operate when protocols were linked or data was exported to an external device. Conclusions: Limitations were noted, some of which were applicable to knee strength testing in general and others which were specific to use with children. However, most of these obstacles could be overcome, making the Biodex System 4 suitable for assessment of knee strength in children.

Developing the Pattern and Structure Assessment (PASA) interview to inform early mathematics learning

The Pattern and Structure Mathematical Awareness Program(PASMAP) stems from a 2-year longitudinal study on students’ early mathematical development. The paper outlines the interview assessment the Pattern and Structure Assessment(PASA) designed to describe students’ awareness of mathematical pattern and structure across a range of concepts. An overview of students’ performance across items and descriptions of their structural development are described.

The oral health of critically ill children : an observational cohort study

Aims and objectives: This study will describe the oral health status of critically ill children over time spent in the paediatric intensive care unit, examine influences on the development of poor oral health and explore the relationship between dysfunctional oral health and healthcare-associated infections. Background: The treatment modalities used to support children experiencing critical illness and the progression of critical illness may result in dysfunction in the oral cavity. In adults, oral health has been shown to worsen during critical illness as well as influence systemic health. Design: A prospective observational cohort design was used. Method: The study was undertaken at a single tertiary-referral Paediatric Intensive Care Unit. Oral health status was measured using the Oral Assessment Scale and culturing oropharyngeal flora. Information was also collected surrounding the use of supportive therapies, clinical characteristics of the children and the occurrence of healthcare-associated infections. Results: Of the 46 participants, 63% (n = 32) had oral dysfunction and 41% (n = 19) demonstrated pathogenic oropharyngeal colonisation during their critical illness. The potential systemic pathogens isolated from the oropharynx and included Candida sp., Staphylococcus aureus, Haemophilus influenzae, Enterococcus sp. and Pseudomonas aeruginosa. The severity of critical illness had a significant positive relationship (p < 0·05) with pathogenic and absent colonisation of the oropharynx. Sixty-three percent of healthcare-associated infections involved the preceding or simultaneous colonisation of the oropharynx by the causative pathogen. Conclusions: This study suggests paediatric oral health to be frequently dysfunctional and the oropharynx to repeatedly harbour potential systemic pathogens during childhood critical illness. Relevance to clinical practice: Given the frequency of poor oral health during childhood critical illness in this study and the subsequent potential systemic consequences, evidence based oral hygiene practices should be developed and validated to guide clinicians when nursing critically ill children.

Vocational education and training in schools : career advisers' perceptions and practices

This paper explores the currently highly topical issue of Vocational Education and Training in Schools (VETiS). Specifically, it focuses upon career advisers' perceptions of VETiS, their advising practices as pertaining to this program and their views of others' perceptions of VETiS. It draws upon a national research project and data derived from interviews conducted with career advisers during the course of the project. The paper demonstrates that career advisers perceive VETiS in a favorable light on the whole, and they advocate the practice of advising all students to do VETiS if students desire to do so. That said, the paper goes on to highlight tensions apparent in the career advisers' perceptions of, and subsequent advice-giving practices regarding VETiS - particularly in terms of the potential benefits it affords all students. It becomes clear that careers advisers have different agendas for advising different students - academic and non-academic students - to undertake VETiS as a course of study. Finally, the paper demonstrates the ways in which career advisers become complicit in the marginalisation of VETiS programs and the status of VET.

Navigating a complex organizational landscape : leadership challenges and practices

This paper discusses exploratory research to identify the reported leadership challenges faced by leaders in the public sector in Australia and what specific leadership practices they engage in to deal with these challenges. Emerging is a sense that leadership in these complex work environments is not about controlling or mandating action but about engaging in conversation, building relationships and empowering staff to engage in innovative ways to solve complex problems. In addition leaders provide a strong sense of purpose and identity to guide behaviour and decisions to overcome being overwhelmed by the sheer volume of demands in a unpredictable and often unsupportive environment. Questions are raised as to the core competencies leaders need to develop to drive and underpin these leadership practices and the implications this has for the focus on future leadership development programmes. The possible direction of a future research programme will be put forward for further discussion.

Post-operative CT assessment of interbody fusion two years after thoracoscopic scoliosis surgery

The relationship between radiologic union and clinical outcome in thoracoscopic scoliosis surgery is not clear, as apparent non-union of a spinal fusion does not always correspond to a poor clinical result. The aim of this study was to evaluate CT fusion rates 2yrs after thoracoscopic surgery, and to explore the relationship between fusion scores and rod diameter, graft type, fusion level, implant failure, and lateral position in the disc space. This study suggests that moderate fusion scores secure successful clinical outcomes in thoracoscopic scoliosis surgery.

Closing the loop 21st century style : providing feedback on written assessment via MP3 recordings

Feedback on student performance, whether in the classroom or on written assignments, enables them to reflect on their understandings and restructure their thinking in order to develop more powerful ideas and capabilities. Research has identified a number of broad principles of good feedback practice. These include the provision of feedback that facilitates the development of reflection in learning; helps clarify what good performance is in terms of goals, criteria and expected standards; provides opportunities to close the gap between current and desired performance; delivers high quality information to students about their learning; and encourages positive motivational beliefs and self-esteem. However, high staff–student ratios and time pressures often result in a gulf between this ideal and reality. Whilst greater use of criteria referenced assessment has enabled an improvement in the extent of feedback being provided to students, this measure alone does not go far enough to satisfy the requirements of good feedback practice. Technology offers an effective and efficient means by which personalised feedback may be provided to students. This paper presents the findings of a trial of the use of the freely available Audacity program to provide individual feedback via MP3 recordings to final year Media Law students at the Queensland University of Technology on their written assignments. The trial has yielded wide acclaim by students as an effective means of explaining the exact reasons why they received the marks they were awarded, the things they did well and the areas needing improvement. It also showed that good feedback practice can be achieved without the burden of an increase in staff workload.