Helicobacter pylori-associated hypochlorhydria in children, and development of iron deficiency

Aims Acute Helicobacter pylori infection is associated with transient hypochlorhydria. In H pylori-associated atrophy, hypochlorhydria has a role in iron deficiency (ID) through changes in the physiology of iron-complex absorption. The aims were to evaluate the association between H pylori-associated hypochlorhydria and ID in children. Methods Symptomatic children (n=123) were prospectively enrolled. Blood, gastric juice and gastric biopsies were taken, respectively, for haematological analyses, pH assessment and H pylori determination, and duodenal biopsies for exclusion of coeliac disease. Stool samples were collected for parasitology/microbiology. Thirteen children were excluded following parasitology and duodenal histopathology, and five due to impaired blood analysis. Results Ten children were hypochlorhydric (pH>4) and 33 were H pylori positive. In H pylori-positive children with pH>4 (n=6) serum iron and transferrin saturation levels % were significantly lower (p<0.01) than H pylori-positive children with pH≤4. No differences in ferritin, or total iron binding capacity, were observed. In H pylori-negative children with pH>4, iron and transferrin saturation were not significantly different from children with pH≤4. Conclusions Low serum iron and transferrin in childhood H pylori infection is associated with hypochlorhydria. In uninfected children, hypochlorhydria was not associated with altered serum iron parameters, indicating a combination of H pylori infection and/or inflammation, and hypochlorhydria has a role in the aetiology of ID. Although H pylori-associated hypochlorhydria is transient during acute gastritis, this alters iron homeostasis with clinical impact in developing countries with a high H pylori prevalence.

The relationship of the incidence of medullated fibres to the dimensional properties of mohair over the lifetime of Angora goats

In a range of animals, increasing mean fibre diameter (MFD) of fibre is associated with an increasing incidence of medullated fibres (Med). It would thus be expected that Med in mohair fleeces, from animals in a flock, would be related to the MFD of those fleeces. MFD of mohair is not the only dimensional attribute of fibres. Med in mohair is phenotypically and genetically related to the size of animals. This study examined how Med is related to dimensional properties of mohair over the lifetime of Angora goats and how the relationship varies with other lifetime factors. The relationship found is then examined to determine the extent that the relationship can be explained by variations in animal size of the goats. Measurements were made over 11 shearing periods on a population of Angora goats representing the current range and diversity of genetic origins in Australia, including South African, Texan and interbred admixtures of these and Australian sources. Records of breed, sire, dam, date of birth, dam age, birth weight, birth parity, weaning weight, live weight, fleece growth and fleece attributes were taken for castrated males (wethers). Animals’ fleece-free live weight (FFLwt, kg) were determined for each goat at shearing time by subtracting the greasy fleece weight from the live weight recorded immediately prior to shearing. The average of the FFLwt at the start of the period and the FFLwt at the end of the period was calculated. Two restricted maximum likelihood (REML) models were developed to relate Med to MFD, staple length (SL) and other lifetime factors. One model allowed FFLwt in the model and the other excluded FFLwt. With the exception of the 1.5 years shearing, Med strongly increased with increasing MFD whether or not adjustments were made for FFLwt measurements. In particular Med increased by 2.0% for each 1 μm increase in MFD, with no adjustment for FFLwt measurements, and increased by 1.5% for each 1 μm increase in MFD, with adjustment for FFLwt measurements. Within each shearing interval increasing average FFLwt was associated with increasing incidence of Med in a similar way to that which has been previously reported without including MFD in the model. There was no evidence that SL needed to be included in the models for Med. Mohair grown by the goats of Mixed genetic background grew mohair which had a higher incidence of Med at ages 2 and 2.5 years and the trend was apparent in other shearing periods. We can conclude that there is both a large response of Med to live weight and a large response to MFD, and that these responses are largely functionally separate. While the response to MFD is in accord with earlier work, there is an unrelated and unreported physiological mechanism that favours the production of Med in larger Angora goats. Clearly, larger Angora goats are biologically different compared with smaller animals from the same flock, in ways that are not purely related to the allometrics of size.

Emotional histories and historical emotions: looking at the past in historical novels

For anyone interested in the past and its representation, historical novels are difficult to ignore. Unlike a multitude of other alternative representations of the past that have been brought into historical view, however, historical novels have been largely excluded from scholarly historical analysis. Although historians might find historical novels fascinating, might read them voraciously, might teach courses on or around them, and might even write them while on sabbaticals, this engagement is not reflected in the pages of their work. Taking Kate Grenville's controversial Australian novel The secret river (2005) as a case study, this article considers the emotional ways in which historical novels make sense of their pasts, offering a methodological way forward in the historical analysis of the genre.

Determining criteria to assess patient readiness for discharge from postanaesthetic care: an international Delphi study

Aims and objectives
To obtain expert consensus on essential criteria required to assess patient readiness for discharge from the postanaesthetic care unit.

Background
A patient's condition can deteriorate after surgery, and the immediate postoperative period is recognised internationally as a time of increased risk to patient safety. A recent systematic review identified evidence-based assessment criteria for the safe discharge of patients from the postanaesthetic care unit and identified gaps in the evidence.

Design
Descriptive consensus study using the Delphi method.

Methods
Members of international clinical specialist groups with expertise in anaesthesia or postanaesthetic care participated in three consultation rounds. Online surveys were used to determine expert consensus with regard to aspects of postanaesthetic care and specific criteria for assessing patient readiness for discharge. Three rounds of surveys were conducted from May 2011–September 2012.

Results
Twenty-three experts contributed to the panel. Consensus, that is, at least 75% agreement, was reached in regard to 24 criteria considered essential (e.g. respiratory rate 100%; pain 100%; heart rate 95%; temperature 91%). Consensus was also reached for 15 criteria not considered essential (e.g. appetite 96%; headache 76%). Consensus was not obtained for a further 10 criteria. Participants (95%) agreed that a discharge tool was important to ensure safe patient discharge.

Conclusion
Consensus was achieved by a panel of international experts on the use of a tool to assess patient readiness for discharge from postanaesthesia care unit and specific variables to be included or excluded from the tool. Further work is required to develop a tool and test its reliability and validity.

Relevance to clinical practice
The findings of this study have informed the development of an evidence-based tool to be piloted in a subsequent funded study of nursing assessment of patient readiness for discharge from the postanaesthetic care unit.

Simulation and evaluation of HERIC and H5 transformerless inverter topologies

Most of the inverters have an isolation transformer which prevents or limits fault current between AC and DC circuits under most fault conditions. If the transformer is excluded from the system, it would increase the PV system efficiency and decrease the size of its installations, which will lead to a lower cost for the whole investment. Thus, elimination of the transformer has to be considered carefully because a galvanic connection appears between the PV arrays and the ground in the absence of an isolation transformer. The galvanic connection causes the stray capacitance between the PV arrays structure and the ground to produce a leakage current. In this paper, a review of full bridge topology with bipolar and unipolar scheme and half bridge topology carried out in regard leakage current.in addition, HERIC and H5 topologies are simulated and leakage current in these topologies are evaluated.

A dish-rack full of crockery : social significance and the Sydney Opera House

The sculptural roof forms of the Sydney Opera House regularly attract visual analogies in the public mind. Although they are mostly referred to as a??sailsa?? or a??shellsa?? they have also been described through humorous metaphors like a??a dishrack full of crockerya??. This particular visual pun, is a reference to a linocut by Eric Thake, produced in 1972, the year before the official opening of the Sydney Opera House. This analogy and its continued popularity to date evidences the social and cultural life of this building. Much of the scholarly on the Sydney Opera House investigates the architecture and the circumstances of its realisation, whilst its reception and social significance, has received little systematic attention. Through Thakea??s linocut, the paper discusses the current limitations in evaluating social significance in an Australian heritage context and proposes an alternative perspective to this problem through two scholars who bring a??subjective experiencea?? to bear on the production of meaning. For Gillian Rose, visual artefacts become significant through their embodied experience, whilst Ann Game argues for the inclusion of such usually-excluded subjects like desire, memory, time and the body in the construction of meaning. By bringing these theories to bear on a specific example - Eric Thakea??s visual metaphor for the Sydney Opera House - the paper investigates a new approach to social significance.

Sex as a determinant of relapse incidence and progressive course of multiple sclerosis

The aim of this work was to evaluate sex differences in the incidence of multiple sclerosis relapses; assess the relationship between sex and primary progressive disease course; and compare effects of age and disease duration on relapse incidence. Annualized relapse rates were calculated using the MSBase registry. Patients with incomplete data or <1 year of follow-up were excluded. Patients with primary progressive multiple sclerosis were only included in the sex ratio analysis. Relapse incidences over 40 years of multiple sclerosis or 70 years of age were compared between females and males with Andersen-Gill and Tweedie models. Female-to-male ratios stratified by annual relapse count were evaluated across disease duration and patient age and compared between relapse-onset and primary progressive multiple sclerosis. The study cohort consisted of 11 570 eligible patients with relapse-onset and 881 patients with primary progressive multiple sclerosis. Among the relapse-onset patients (82 552 patient-years), 48 362 relapses were recorded. Relapse frequency was 17.7% higher in females compared with males. Within the initial 5 years, the female-to-male ratio increased from 2.3:1 to 3.3:1 in patients with 0 versus ≥4 relapses per year, respectively. The magnitude of this sex effect increased at longer disease duration and older age (P < 10−12). However, the female-to-male ratio in patients with relapse-onset multiple sclerosis and zero relapses in any given year was double that of the patients with primary progressive multiple sclerosis. Patient age was a more important determinant of decline in relapse incidence than disease duration (P < 10−12). Females are predisposed to higher relapse activity than males. However, this difference does not explain the markedly lower female-to-male sex ratio in primary progressive multiple sclerosis. Decline in relapse activity over time is more closely related to patient age than disease duration.

The foreign presence in the early-industrial Haut-Rhin, 1820–22 : a short history from the ‘pre-history’ of immigration to France

An attempt to limit the rights of domiciled foreigners in the Alsatian department of the Haut-Rhin in 1821 provides an opportunity to examine the impact of immigration on early-industrial society and shifting perceptions of the place of foreigners in French society in a period often omitted from histories of immigration. New conceptions of belonging become evident, which demonstrate a turn away from local and subjective bonds to community, towards bonds regulated nationally through nationality law. Imposed in an emerging urban, industrial context, the limitations of rights—on access to the biens communaux and the droit d’affouage—were traditional restrictions of rural society and modes of distinguishing the included from the excluded and were imposed on long-settled foreigners who failed to become naturalized as French citizens. The article reflects on the question why, if the concerns about immigration and industrialization turned on recently arrived foreign workers, these traditional exclusions were imposed on established resident foreigners.

Weakly monotone averaging functions

Averaging behaviour of aggregation functions depends on the fundamental property of monotonicity with respect to all arguments. Unfortunately this is a limiting property that ensures that many important averaging functions are excluded from the theoretical framework. We propose a definition for weakly monotone averaging functions to encompass the averaging aggregation functions in a framework with many commonly used non-monotonic means. Weakly monotonic averages are robust to outliers and noise, making them extremely important in practical applications. We show that several robust estimators of location are actually weakly monotone and we provide sufficient conditions for weak monotonicity of the Lehmer and Gini means and some mixture functions. In particular we show that mixture functions with Gaussian kernels, which arise frequently in image and signal processing applications, are actually weakly monotonic averages. Our concept of weak monotonicity provides a sound theoretical and practical basis for understanding both monotone and non-monotone averaging functions within the same framework. This allows us to effectively relate these previously disparate areas of research and gain a deeper understanding of averaging aggregation methods. © Springer International Publishing Switzerland 2014.

Effect of changes to the school food environment on eating behaviours and/or body weight in children: a systematic review

Previous school obesity-prevention reviews have included multi-component interventions. Here, we aimed to review the evidence for the effect of isolated food environment interventions on both eating behaviours (including food purchasing) and/or body weight. Five electronic databases were searched (last updated 30 November 2013). Of the 1,002 unique papers identified, 55 reported on school food environment changes, based on a review of titles and abstracts. Thirty-seven further papers were excluded, for not meeting the inclusion criteria. The final selection consisted of 18 papers (14 United States, 4 United Kingdom). Two studies had a body mass index (BMI) outcome, 14 assessed purchasing or eating behaviours and two studies assessed both weight and behaviour. Seventeen of 18 papers reported a positive outcome on either BMI (or change in BMI) or the healthfulness of food sold or consumed. Two studies were rated as strong quality and 11 as weak. Only three studies included a control group. A school environment supportive of healthy eating is essential to combat heavy marketing of unhealthy food. Modification of the school food environment (including high-level policy changes at state or national level) can have a positive impact on eating behaviours. A need exists, however, for further high-quality studies.

Innovating from the inside: teacher influence and the 'promisingness' of digital learning environments

In line with global trends, Australian educational policy emphatically recognises the need for contemporary learners to be digitally literate, with provision of 'one-to-one' devices to individual learners in schools a major implementation strategy. However, without teacher commitment, the benefits of such investment in one-to-one programs are undermined and the devices themselves are under-utilised. Too often, the focus on hardware is not accompanied by insight into the organisational learning and change required in pedagogical practices. In the knowledge that curriculum and pedagogical renewal rests squarely with teachers and leaders rather than with technological hardware and software per se, this article draws on outcomes/findings from a school/university ethnographic collaboration which closely explored the introduction of a school-funded, one-to-one netbook program in a school excluded from a state-wide initiative. It seeks to make visible the often overlooked work of teachers as members of learning organisations through a narrative of change. The narrative focuses on teacher agency and capacity to mobilise a school community to commit to a vision of; no-blame risk taking; collective professional learning; the power of purpose and passion; leadership in the face of government practice which disempowered teachers and disadvantaged students; and the development of an innovation 'from the inside'.

Weakly monotonic averaging functions

Monotonicity with respect to all arguments is fundamental to the definition of aggregation functions. It is also a limiting property that results in many important nonmonotonic averaging functions being excluded from the theoretical framework. This work proposes a definition for weakly monotonic averaging functions, studies some properties of this class of functions, and proves that several families of important nonmonotonic means are actually weakly monotonic averaging functions. Specifically, we provide sufficient conditions for weak monotonicity of the Lehmer mean and generalized mixture operators. We establish weak monotonicity of several robust estimators of location and conditions for weak monotonicity of a large class of penalty-based aggregation functions. These results permit a proof of the weak monotonicity of the class of spatial-tonal filters that include important members such as the bilateral filter and anisotropic diffusion. Our concept of weak monotonicity provides a sound theoretical and practical basis by which (monotonic) aggregation functions and nonmonotonic averaging functions can be related within the same framework, allowing us to bridge the gap between these previously disparate areas of research.

Lifetime and fleece quality traits associated with the occurrence of entangled mohair staples

Staple entanglement in mohair fleeces occurs when adhesions form between longer and faster growing fibres and shorter and slower growing fibres. This results in accentuated crimp of the longer fibres and an "apparently" reduced staple length. The appearance in the fleece of Angora goats of staple entanglements can lead to the downgrading of the mohair to poorer style and shorter length grades, resulting in up to 60% price reductions. This study examined how staple entanglement score (SES) is related to lifetime factors of Angora goats, and how this relationship can be explained by variations in animal size and fleece attributes. SES was scored using a five-point scale: 5, long free fibres easily separated as no adhesions; 4, some adhesions between fibres; 3, some effort to separate fibres as many adhesions; 2, many adhesions, staple fibres entangled, shortening of staple; 1, very entangled and shortened staple. Measurements were made over 9 shearing periods on a population of Angora castrated males (wethers) goats representing the current range and diversity of genetic origins in Australia, including South African, Texan and interbred admixtures of these and Australian sources. Data on genetic origin, sire, dam, date of birth, dam age, birth weight, birth parity, weaning weight, live weight, fleece growth and fleece attributes were recorded. Two restricted maximum likelihood (REML) models were developed to relate SES with age, animal lifetime factors, fleece quality attributes and live weight. One model allowed fleece quality and live weight traits in the model and the other excluded these traits. Staple entanglement was almost eliminated in mohair harvested from goats shorn every 3. months but was common in mohair from goats shorn twice or once per year. SES was less in goats of Texan genetic background, and was generally less in winter grown mohair. SES was higher for mohair with low fibre curvature (FC, 10°/mm) and a high clean washing yield (CWY, 90%) compared with mohair with low FC and lower CWY (80%), and compared with all mohair with high FC (18°/mm). The response of SES to shearing regime, genetic background, shearing season, age of goat and a response to dam age were almost identical whether or not an adjustment was made for CWY and FC. There was a moderate amount of variability due to sires and individuals. We can conclude that a large part of these effects observed, namely breed, dam age, sire, and a component of the FC and CWY effects, are genetic. Mohair producers can manage the genetic effects by careful selection of sires, especially avoiding those with low CWY or high FC, and avoiding sires with higher levels of staple entanglement or that have produced progeny with higher levels of staple entanglement. Also, unidentified environmental effects are affecting staple entanglement, although a lack of a live weight change effect on entanglement indicates that this effect might not be due to nutrition. © 2013 Elsevier B.V.

UnitingWorld : Partnership for effective involvement in mission including development

This chapter argues that, both theologically and practically, development is a form of mission and therefore dividing 'mission' and 'development' is artificial. A theological understanding of mission clearly incorporates upholding rights especially of people most excluded and vulnerable, the core task of development.One church agency involved in both development and supporting partners in communicating the gospel is UnitingWorld – the national agency of the Uniting Church in Australia responsible for international partnerships including development. The Uniting Church was formed in 1977 from the merging of three denominations, all of which had a long history of overseas engagement – for example with Fiji since 1844 and Korea since 1889. Such partnerships have endured and spread to the point where the Uniting Church now has thirty six formal partners, mainly in the Pacific and Asia.Over the past 20 years, a range of social trends, such as decolonisation, climate change, and increased global commitment to justice, as well as changes in missiological thinking, have influenced collaboration with indigenous churches as well as organisations not explicitly Christian.Recolonising approaches by international inter-government bodies and by the Australian government through promoting predominantly western neo-liberal economic values to neighbours, invites the church to collaborate in valuing partner cultures, spiritualities, values and world-views. For UnitingWorld this is most evident in its Pacific engagement, especially with programs arising from the Pacific Conference of Churches.These factors have further relativised the tensions between what was seen as “mission” and what was seen as “development”. Evangelism as communication of good news exhibits a different hue – now coming out of the natural conversations between partners and speaking of God’s life- giving alternatives to destructive social and economic models. Whilst development is inherent in mission, the major challenge faced by UnitingWorld is with Protestant partners strongly influenced by an era of church teaching that emphasised personal commitment tied to distinctive religious expressions.In this chapter we use case studies from the Pacific to show how UnitingWorld is partnering with a range of church and other organisations to support people in exercising their rights and re-engaging Australian church communities in this task.

Determining criteria to assess patient readiness for discharge from postanaesthetic care: An international Delphi study

Aims and objectives: To obtain expert consensus on essential criteria required to assess patient readiness for discharge from the postanaesthetic care unit. Background: A patient's condition can deteriorate after surgery, and the immediate postoperative period is recognised internationally as a time of increased risk to patient safety. A recent systematic review identified evidence-based assessment criteria for the safe discharge of patients from the postanaesthetic care unit and identified gaps in the evidence. Design: Descriptive consensus study using the Delphi method. Methods: Members of international clinical specialist groups with expertise in anaesthesia or postanaesthetic care participated in three consultation rounds. Online surveys were used to determine expert consensus with regard to aspects of postanaesthetic care and specific criteria for assessing patient readiness for discharge. Three rounds of surveys were conducted from May 2011-September 2012. Results: Twenty-three experts contributed to the panel. Consensus, that is, at least 75% agreement, was reached in regard to 24 criteria considered essential (e.g. respiratory rate 100%; pain 100%; heart rate 95%; temperature 91%). Consensus was also reached for 15 criteria not considered essential (e.g. appetite 96%; headache 76%). Consensus was not obtained for a further 10 criteria. Participants (95%) agreed that a discharge tool was important to ensure safe patient discharge. Conclusion: Consensus was achieved by a panel of international experts on the use of a tool to assess patient readiness for discharge from postanaesthesia care unit and specific variables to be included or excluded from the tool. Further work is required to develop a tool and test its reliability and validity. Relevance to clinical practice: The findings of this study have informed the development of an evidence-based tool to be piloted in a subsequent funded study of nursing assessment of patient readiness for discharge from the postanaesthetic care unit.