Therapeutic approaches to disease modifying therapy for multiple sclerosis in adults: an Australian and New Zealand perspective: part 3 treatment practicalities and recommendations

In this third and final part of our review of multiple sclerosis (MS) treatment we look at the practical day-to-day management issues that are likely to influence individual treatment decisions. Whilst efficacy is clearly of considerable importance, tolerability and the potential for adverse effects often play a significant role in informing individual patient decisions. Here we review the issues surrounding switching between therapies, and the evidence to assist guiding the choice of therapy to change to and when to change. We review the current level of evidence with regards to the management of women in their child-bearing years with regards to recommendations about treatment during pregnancy and whilst breast feeding. We provide a summary of recommended pre- and post-treatment monitoring for the available therapies and review the evidence with regards to the value of testing for antibodies which are known to be neutralising for some therapies. We review the occurrence of adverse events, both the more common and troublesome effects and those that are less common but have potentially much more serious outcomes. Ways of mitigating these risks and managing the more troublesome adverse effects are also reviewed. Finally, we make specific recommendations with regards to the treatment of MS. It is an exciting time in the world of MS neurology and the prospects for further advances in coming years are high.

Mega-events and mega-profits: Unravelling the Vancouver 2010 security–development nexus

Academic and political commentators have commonly sought to understand the Olympics as a cultural dynamic, a "spectacle" that motivates certain actors to project their relative interests in localized spaces and as well on a global scale (Hiller 2006; Boyle and Haggerty 2009b ). Mega-events, as this argument goes, are monumental cultural events (Roche 2000) that rely on the audacity of spectacle to dramatize and condition the cultural, political, legal and economic landscape. Extending these insights into surveillance studies, Boyle and Haggerty (2009b: 259-260) position spectacle and the disciplinary mechanisms of anxieties associated with mega-events to explain the risk management practices of security planners. The dynamic social implications of the spectacle condition dramatic regimes of securitization and surveillance such that sovereign power emanates from the production and consumption of spectacle. In similar fashion Vida Bajc (2007: 1648) writes that security meta-rituals "demonstrate[s] that the process of transformation of [the] public space [of mega-events] from one of routine of daily life into a sterile area [that] has a ritual form [that] .... separates insiders from outsiders and brings about a new socio-political reality." Put another way, the "security-meta ritual" legitimates security and surveillance practices by normalizing the social hierarchies it imposes. Bajc focuses on the over-determination of dividing practices in mega-event security, but the signifying practices associated with capital are absent (perhaps due to her empirical focus on presidential addresses). Klauser (2008: 181) links commercialization and mechanisms of surveillance, but only by foregrounding the significance of "neutralized space" created by granting absolute commercial rights to event sponsors. Neoliberalprivatization and its articulation with security and surveillance, however, cannot be reduced to control over sponsorship rights and consumptive practices in particular urban "zones," nor can it be limited by the methodological temporality of the event itself.

Population-level perspectives on global change : genetic and demographic analyses indicate various scales, timing, and causes of scyphozoan jellyfish blooms

Whether a perceived increase in the abundance of jellyfishes is related to changing marine environments has been considered primarily using large-scale analyses of multi-species assemblages. Yet jellyfish blooms-rapid increases in the biomass of pelagic coelenterate species-are single-species demographic events. Using published and new genetic analyses and population surveys, we investigate whether there may be a critical knowledge gap between the scales of recent analyses and the scales of natural phenomena. We find that scyphomedusae may show population genetic structure over scales of tens to hundreds of kilometers, that environments vary regionally and locally, and that populations of medusae can display uncorrelated dynamics on these scales. These findings suggest genetic differences between populations and/or environmental differences between sites are important determinants of population dynamics in these jellyfishes. Moreover, the local abundance of medusae may be most strongly correlated with preceding rather than current local environmental conditions, indicating there is a cumulative time-course to the formation of 'blooms'. Broad-scale macro-ecological analyses will need to build from coordinated, long-term, fine-grained studies to synthesize, rather than mask, population-level phenomena in larger-scale analyses. © 2014 Springer International Publishing Switzerland.

Predicting the likely response of data-poor ecosystems to climate change using space-for-time substitution across domains

Predicting ecological response to climate change is often limited by a lack of relevant local data from which directly applicable mechanistic models can be developed. This limits predictions to qualitative assessments or simplistic rules of thumb in data-poor regions, making management of the relevant systems difficult. We demonstrate a method for developing quantitative predictions of ecological response in data-poor ecosystems based on a space-for-time substitution, using distant, well-studied systems across an inherent climatic gradient to predict ecological response. Changes in biophysical data across the spatial gradient are used to generate quantitative hypotheses of temporal ecological responses that are then tested in a target region. Transferability of predictions among distant locations, the novel outcome of this method, is demonstrated via simple quantitative relationships that identify direct and indirect impacts of climate change on physical, chemical and ecological variables using commonly available data sources. Based on a limited subset of data, these relationships were demonstrably plausible in similar yet distant (>2000 km) ecosystems. Quantitative forecasts of ecological change based on climate-ecosystem relationships from distant regions provides a basis for research planning and informed management decisions, especially in the many ecosystems for which there are few data. This application of gradient studies across domains - to investigate ecological response to climate change - allows for the quantification of effects on potentially numerous, interacting and complex ecosystem components and how they may vary, especially over long time periods (e.g. decades). These quantitative and integrated long-term predictions will be of significant value to natural resource practitioners attempting to manage data-poor ecosystems to prevent or limit the loss of ecological value. The method is likely to be applicable to many ecosystem types, providing a robust scientific basis for estimating likely impacts of future climate change in ecosystems where no such method currently exists.

Resistance and resilience: Can the abrupt end of extreme drought reverse avifaunal collapse?

Aim: Climate change is expected to increase the frequency and intensity of extreme climatic events, such as severe droughts and intense rainfall periods. We explored how the avifauna of a highly modified region responded to a 13-year drought (the 'Big Dry'), followed by a two-year period of substantially higher than average rainfall (the 'Big Wet'). Location: Temperate woodlands in north central Victoria, Australia. Methods: We used two spatially extensive, long-term survey programmes, each of which was repeated three times: early and late in the Big Dry, and in the Big Wet. We compared species-specific changes in reporting rates between periods in both programmes to explore the resistance (the ability to persist during drought) and resilience (extent of recovery post-drought) of species to climate extremes. Results: There was a substantial decline in the reporting rates of 42-62% (depending on programme) of species between surveys conducted early and late in the Big Dry. In the Big Wet, there was some recovery, with 21-29% of species increasing substantially. However, more than half of species did not recover and 14-27% of species continued to decline in reporting rate compared with early on in the Big Dry. Species' responses were not strongly related to ecological traits. Species resistance to the drought was inversely related to resilience in the Big Wet for 20-35% of the species, while 76-78% of species with low resistance showed an overall decline across the study period. Conclusions: As declines occurred largely irrespective of ecological traits, this suggests a widespread mechanism is responsible. Species that declined the most during the Big Dry did not necessarily show the greatest recoveries. In already much modified regions, climate extremes such as extended drought will induce on-going changes in the biota. © 2014 John Wiley & Sons Ltd.

Platelet supersensitivity to thrombin stimulation in depression: a possible mechanism for the association with cardiovascular mortality.

The mortality risk associated with cardiovascular disease is significantly increased in patients with major depression and panic disorder. The mechanism of this phenomenon is unclear. Thrombin is responsible for platelet aggregation and shape change, and it plays a significant role in the development of thromboembolic events. In this study, we examined the platelet second messenger intracellular calcium response to thrombin stimulation in patients with major depression (n = 13), major depression after response to electroconvulsive therapy (ECT; n = 13), subsyndromal depression (n = 16), schizophrenia (n = 15), and control subjects (n = 65). Patients with major depression had significantly higher intracellular calcium responses to thrombin stimulation than control subjects, patients with subsyndromal depression, and patients with schizophrenia (p < 0.05). Electroconvulsive therapy did not significantly change this supersensitivity. This suggests that the platelet response to activation in patients with major depression is supersensitive. This study suggests a possible mechanism for the increased risk of cardiovascular disease that is seen in these two psychiatric disorders. The lack of difference between the control and subsyndromal depression groups appears to validate current diagnostic thresholds in depression. The failure of nonpharmacologic treatment to alter this marker suggests that it may be a trait marker of depression.

Evaluating coverage changes in national parks using a hybrid change detection algorithm and remote sensing

Remote sensing is a useful tool for detecting change over time.We introduce a hybrid change-detection method for forest and protected-area vegetation and demonstrate its use with two satellite images of Golestan National Park in northern Iran (1998 and 2010). We report on the advantages and disadvantages of the hybrid method relative to the standard change-detection method. In the proposed hybrid algorithm, the change vector analysis technique was used to determine changes in vegetation. Following this, we used postclassification comparison to determine the nature of the changes observed and their accuracy and to evaluate the effects of different parameters on the performance of the proposed method. We determined 85% accuracy for the proposed hybrid change-detection method, thus demonstrating a method for discovering and assessing environmental threats to natural treasures. © 2014 Society of Photo-Optical Instrumentation Engineers.

Amiodarone, anticoagulation, and clinical events in patients with atrial fibrillation: insights from the ARISTOTLE trial

Amiodarone is an effective medication in preventing atrial fibrillation (AF), but it interferes with the metabolism of warfarin.

Changes in quality of life associated with fragility fractures: Australian arm of the International Cost and Utility Related to Osteoporotic Fractures Study (AusICUROS).

We investigated change in health-related quality of life due to fracture in Australian adults aged over 50 years. Fractures reduce quality of life with the loss sustained at least over 12 months. At a population level, the loss was equivalent to 65 days in full health per fracture.

For a better life: the aspirations of Chinese immigrants in parenting

This article discusses the parenting aspirations of Chinese immigrants, looking in detail at a study in New Zealand. My discussion of the topic centers on the aspirations of educated Chinese immigrants for their preschool children, and their ways of parenting. The “Tiger Mother” practice described in Battle Hymn of the Tiger Mother, and other research on immigrant parenting, directed my attention to this subject. It is argued that in times of change from one context to another, parenting style is an attempt by Chinese immigrants to realize their immigration aspirations for a better life for themselves and their children.

Hungry for change: the food banking industry in Australia

Purpose – Over the last 20 years, food banks in Australia have expanded nationwide and are a well-organised “industry” operating as a third tier of the emergency food relief system. The purpose of this paper is to overview the expansion and operation of food banks as an additional self-perpetuating “tier” in the response to hunger.

Design/methodology/approach – This paper draws on secondary data sourced from the internet; as well as information provided by Foodbank Australia and Food Bank South Australia (known as Food Bank SA) to outline the history, development and operation of food banks. Food banking is then critically analysed by examining the nature and framing of the social problems and policies that food banking seeks to address. This critique challenges the dominant intellectual paradigm that focuses on
solving problems; rather it questions how problem representation may imply certain understandings.

Findings – The issue of food banks is framed as one of food re-distribution and feeding hungry people; however, the paper argue that “the problem” underpinning the food bank industry is one of maintaining food system efficiency. Food banks continue as a neo-liberal mechanism to deflect query, debate and structural action on food poverty and hunger. Consequently their existence does little to ameliorate the problem of food poverty.

Practical implications – New approaches and partnerships with stakeholders remain key challenges for food banks to work more effectively to address food poverty.

Social implications – While the food bank industry remains the dominant solution to food poverty in Australia, debate will be deflected from the underlying structural causes of hunger.

Originality/value – This paper contributes to the limited academic literature and minimal critique of the food bank industry in Australia. It proposes that the rapid expansion of food banks is a salient marker of government and policy failure to address food poverty.

Food security: one of a number of ‘securities’ we need for a full life: an Australian perspective

Although agriculture in Australia is very productive, the current food supply systems in Australia fail to deliver healthy diets to all Australians and fail to protect the natural resources on which they depend. The operation of the food systems creates ‘collateral damage’ to the natural environment including biodiversity loss. In coming decades, Australia’s food supply systems will be increasingly challenged by resource price inflation and climate change. Australia exports more than half of its current agricultural production. Government and business are aiming to substantially increase production to bolster exports. This will increase pressure on agricultural resources and exacerbate ‘collateral’ damage to the environment. The Australian public have a deep and ongoing interest in a very wide range of issues associated with the food systems including the environment, health and sustainability. Food is something we require in order to live and a good diet is something we have to have to be healthy. For health over a life-time we need food security. However, we also require a range of other material goods and social arrangements in order to develop and flourish as human beings. And we need these other things to be secure over a life-time. Food is therefore one security among a range of other securities we need in order to flourish. The paper outlines a number of approaches, as examples, that help to identify what these other goods and arrangements might be. The approaches mentioned in this paper include human rights, national securities, human needs, authentic happiness, capabilities, sustainability and environmental ethics. The different approaches provide a way of evaluating the current situation and indicating a direction for change within the food systems that will address the problems. However, changing large systems such as those involved in food supply is difficult because inertias and vested interests make the current food supply systems resilient to change. The paper suggests that one of the first and ongoing tasks is to develop an understanding of the situation from a comprehensive social–ecological systems perspective. The paper also suggests that a practical leverage point for system change is restructuring the flow of information on the health, natural resources and biodiversity loss issues related to the food supply systems.

To collect is to gather your thoughts through things (spellcheck wants to change curating to crating)

"To collect is to gather your thoughts through things (spellcheck wants to change curating to crating)"This paper unpacks the collection as artwork, will briefly look at how artists have put ideas of collecting and curating to the test, and will investigate some of the established ideas around this tradition, rethinking how artworks, which perform as collections, might make trouble for the work of curating and collecting, and making sense of things—as if on a dare

Obesity prevention in early life: an opportunity to better support the role of Maternal and Child Health Nurses in Australia

BACKGROUND: Because parents with young children access primary health care services frequently, a key opportunity arises for Maternal and Child Health (MCH) nurses to actively work with families to support healthy infant feeding practices and lifestyle behaviours. However, little is known regarding the extent to which MCH nurses promote obesity prevention practices and how such practices could be better supported. METHODS: This mixed methods study involved a survey of 56 MCH nurses (response rate 84.8 %), 16 of whom participated in semi-structured qualitative interviews. Both components aimed to examine the extent to which nurses addressed healthy infant feeding practices, healthy eating, active play and limiting sedentary behavior during routine consultations with young children 0-5 years. Key factors influencing such practices and how they could be best supported were also investigated. All data were collected from September to December 2013. Survey data were analysed descriptively and triangulated with qualitative interview findings, the analysis of which was guided by grounded theory principles. RESULTS: Although nurses reported measuring height/length and weight in most consultations, almost one quarter (22.2 %) reported never/rarely using growth charts to identify infants or children at risk of overweight or obesity. This reflected a reluctance to raise the issue of weight with parents and a lack of confidence in how to address it. The majority of nurses reported providing advice on aspects of infant feeding relevant to obesity prevention at most consultations, with around a third (37 %) routinely provided advice on formula preparation. Less than half of nurses routinely promoted active play and only 30 % discussed limiting sedentary behaviour such as TV viewing. Concerns about parental receptiveness and maintaining rapport were key barriers to more effective implementation. CONCLUSION: While MCH nurses are well placed to address obesity prevention in early life, there is currently a missed public health opportunity. Improving nurse skills in behaviour change counseling will be key to increasing their confidence in raising sensitive lifestyle issues with parents to better integrate obesity prevention practices into normal MCH service delivery.

Indigenous knowledge and climate change: settlement patterns of the past to adaption of the future

For centuries the Aboriginal Peoples of Australia have been confronted with major ecological, geological and climate events, and had to adapt home shelters and settlements to seasonal variations. Many of these changes have been captured in the cultural traditions of the indigenous people reflecting a harsh coastal environment. Weather patterns and climate change were gauged by the occurrence of the tidal changes, landscape changes, recurring weather events and the acknowledgement of six seasons. Community settlements got established and relocated to adapt to the patterns of nature. This paper investigates if this ancient knowledge can provide answers for adaptation of coastal settlements to a changing climate. Drawing upon recent published literature on predicted coastal climate change impacts in the different regions of Australia, and the review of indigenous settlement planning according to a six season cycle, the author explores traditional knowledge as input to a potential Design Based Adaptation Model for coastal settlements along the Australian coast.