Development and validation of 3-Minute Nutrition Screening (3-MinNS) tool for acute hospital patients in Singapore

It is important to detect and treat malnutrition in hospital patients so as to improve clinical outcome and reduce hospital stay. The aim of this study was to develop and validate a nutrition screening tool with a simple and quick scoring system for acute hospital patients in Singapore. In this study, 818 newly admitted patients aged above 18 years old were screened using five parameters that contribute to the risk of malnutrition. A dietitian blinded to the nutrition screening score assessed the same patients using the reference standard, Subjective Global Assessment (SGA) within 48 hours. The sensitivity and specificity were established using the Receiver Operator Characteristics (ROC) curve and the best cutoff scores determined. The nutrition parameter with the largest Area Under the ROC Curve (AUC) was chosen as the final screening tool, which was named 3-Minute Nutrition Screening (3-MinNS). The combination of the parameters weight loss, intake and muscle wastage (3-MinNS), gave the largest AUC when compared with SGA. Using 3-MinNS, the best cutoff point to identify malnourished patients is three (sensitivity 86%, specificity 83%). The cutoff score to identify subjects at risk of severe malnutrition is five (sensitivity 93%, specificity 86%). 3-Minute Nutrition Screening is a valid, simple and rapid tool to identify patients at risk of malnutrition in Singapore acute hospital patients. It is able to differentiate patients at risk of moderate malnutrition and severe malnutrition for prioritization and management purposes.

Identifying with an avatar : a multidisciplinary perspective

Avatars perform a complex range of inter-related functions. They not only allow us to express a digital identity, they facilitate the expression of physical motility and, through non-verbal expression, help to mediate social interaction in networked environments. When well designed, they can contribute to a sense of “presence” (a sense of being there) and a sense of “co-presence” (a sense of being there with others) in digital space. Because of this complexity, the study of avatars can be enriched by theoretical insights from a range of disciplines. This paper considers avatars from the perspectives of critical theory, visual communication, and art theory (on portraiture) to help elucidate the role of avatars as an expression of identity. It goes on to argue that identification with an avatar is also produced through their expression of motility and discusses the benefits of film theory for explaining this process. Conceding the limits of this approach, the paper draws on philosophies of body image, Human Computer Interaction (HCI) theory on embodied interaction, and fields as diverse as dance to explain the sense of identification, immersion, presence and co-presence that avatars can produce.

Polybrominated diphenyl ether (PBDE) concentrations decrease with age : analysis of pooled human blood serum in the Australian population

Introduction Polybrominated diphenyl ethers (PBDEs) are considered to be a cost effective and efficient way to reduce the possibility of product ignition and inhibit the spread of fire, thereby limiting harm caused by fires. PBDEs are incorporated into a wide variety of manufactured products and are now considered an ubiquitous contaminant found worldwide in biological and environmental samples . In comparison to “traditional” persistent organic pollutants (POPs), the exposure modes of PBDEs in humans are less well defined, although dietary sources, inhalation (air/particulate matter) and dust ingestion have been reported 2-4. Limited investigations of population specific factors such as age or gender and PBDE concentrations report: no conclusive correlation by age in adults ; higher concentrations in children ; similar concentrations in maternal and cord blood ; and no gender differences . After preliminary findings of higher PBDE concentrations in children than in adults in Australia11 we sought to investigate at what age the PBDE concentrations peaked in an effort to focus exposure studies. This investigation involved the collection of blood samples from young age groups and the development of a simple model to predict PBDE concentrations by age in Australia.

Testing advertising via new media : an exploratory study of advertising practitioner attitudes

New media, as a free and universal communication tool, has had an impact on the power of the general public to comment on a variety of issues. As the public can comment favourably or unfavourably on advertisements, such as on Youtube, the advertising industry must start using weblogs to research reaction to their advertising campaigns. This exploratory study examines the responses of some advertising industry practitioners, both advertisers and agencies, on the impact of new media, specifically weblogs, and the use of new media as a source of research on advertising campaigns.

Serum polybrominated diphenyl ethers (PBDE) in pooled serum are higher in children (2-5 years of age) than in infants and adults

Background: Polybrominated diphenyl ethers (PBDEs) are used as flame retardants in many products and have been detected in human samples worldwide. Limited data show that concentrations are elevated in young children. Objectives: We investigated the association between PBDEs and age with an emphasis on young children from Australia in 2006–2007. Methods: We collected human blood serum samples (n = 2,420), which we stratified by age and sex and pooled for analysis of PBDEs. Results: The sum of BDE-47, -99, -100, and -153 concentrations (Σ4PBDE) increased from 0–0.5 years (mean ± SD, 14 ± 3.4 ng/g lipid) to peak at 2.6–3 years (51 ± 36 ng/g lipid; p < 0.001) and then decreased until 31–45 years (9.9 ± 1.6 ng/g lipid). We observed no further significant decrease among ages 31–45, 45–60 (p = 0.964), or > 60 years (p = 0.894). The mean Σ4PBDE concentration in cord blood (24 ± 14 ng/g lipid) did not differ significantly from that in adult serum at ages 15–30 (p = 0.198) or 31–45 years (p = 0.140). We found no temporal trend when we compared the present results with Australian PBDE data from 2002–2005. PBDE concentrations were higher in males than in females; however, this difference reached statistical significance only for BDE-153 (p = 0.05). Conclusions: The observed peak concentration at 2.6–3 years of age is later than the period when breast-feeding is typically ceased. This suggests that in addition to the exposure via human milk, young children have higher exposure to these chemicals and/or a lower capacity to eliminate them. Key words: Australia, children, cord blood, human blood serum, PBDEs, polybrominated diphenyl ethers. Environ Health Perspect 117:1461–1465 (2009). doi:10.1289/ehp.0900596

Demographic category membership and leadership in small groups : a social identity analysis

Developing the social identity theory of leadership (e.g., [Hogg, M. A. (2001). A social identity theory of leadership. Personality and Social Psychology Review, 5, 184–200]), an experiment (N=257) tested the hypothesis that as group members identify more strongly with their group (salience) their evaluations of leadership effectiveness become more strongly influenced by the extent to which their demographic stereotype-based impressions of their leader match the norm of the group (prototypicality). Participants, with more or less traditional gender attitudes (orientation), were members, under high or low group salience conditions (salience), of non-interactive laboratory groups that had “instrumental” or “expressive” group norms (norm), and a male or female leader (leader gender). As predicted, these four variables interacted significantly to affect perceptions of leadership effectiveness. Reconfiguration of the eight conditions formed by orientation, norm and leader gender produced a single prototypicality variable. Irrespective of participant gender, prototypical leaders were considered more effective in high then low salience groups, and in high salience groups prototypical leaders were more effective than less prototypical leaders. Alternative explanations based on status characteristics and role incongruity theory do not account well for the findings. Implications of these results for the glass ceiling effect and for a wider social identity analysis of the impact of demographic group membership on leadership in small groups are discussed.

A genealogy of the problematic of homelessness and the homeless in Australia

The homeless have been subject to considerable scrutiny, historically and within current social, political and public discourse. The aetiology of homelessness has been the focus of a large body of economic, sociological, historical and political investigation. Importantly, efforts to conceptualise, explain and measure, the phenomenon of homelessness and homeless people has occurred largely within the context of defining “the problem of the homeless” and the generation of solutions to the ‘problem’. There has been little consideration of how and why homelessness has come to be seen, or understood, as a problem, or how this can change across time and/or place. This alternative stream of research has focused on tracing and analysing the relationship between how people experiencing homeless have become a matter of government concern and the manner in which homelessness itself has been problematised. With this in mind this study has analysed the discourses - political, social and economic rationalities and knowledges - which have provided the conditions of possibility for the identification of the homeless and homelessness as a problem needing to be governed and the means for translating these discourses into the applied domain. The aim of this thesis has been to contribute to current knowledge by developing a genealogy of the conditions and rationalities that have underpinned the problematisation of homelessness and the homeless. The outcome of this analysis has been to open up the opportunity to consider alternative governmental possibilities arising from the exposure of the way in which contemporary problematisation and responses have been influenced by the past. An understanding of this process creates an ability to appreciate the intended and unintended consequences for the future direction of public policy and contemporary research.

The effect of amphiphilic siloxane oligomers on fibroblast and keratinocyte proliferation and apoptosis

The formation of hypertrophic scars is a frequent medical outcome of wound repair and often requires further therapy with treatments such as Silicone Gel Sheets (SGS) or apoptosis-inducing agents, including bleomycin. Although widely used, knowledge regarding SGS and their mode of action is limited. Preliminary research has shown that small amounts of amphiphilic silicone present in SGS have the ability to move into skin during treatment. We demonstrate herein that a commercially available analogue of these amphiphilic siloxane species, the rake copolymer GP226, decreases collagen synthesis upon exposure to cultures of fibroblasts derived from hypertrophic scars (HSF). By size exclusion chromatography, GP226 was found to be a mixture of siloxane species, containing five fractions of different molecular weight. By studies of collagen production, cell viability and proliferation, it was revealed that a low molecular weight fraction (fraction IV) was the most active, reducing the number of viable cells present following treatment and thereby reducing collagen production as a result. Upon exposure of fraction IV to human keratinocytes, viability and proliferation was also significantly affected. HSF undergoing apoptosis after application of fraction IV were also detected via real-time microscopy and by using the TUNEL assay. Taken together, these data suggests that these amphiphilic siloxanes could be potential non-invasive substitutes to apoptotic-inducing chemical agents that are currently used as scar treatments.

Axial elongation following prolonged near work in myopes and emmetropes

Background/aims: To investigate the influence of a period of sustained near work upon axial length in groups of emmetropes and myopes. Methods: Forty young adult subjects (20 myopes and 20 emmetropes) were recruited for the study. Myopes were further classified as either early onset (EOM), late onset (LOM), stable (SM) or progressing (PM) subgroups. Axial length was measured with the IOLMaster instrument before, immediately after and then again 10 minutes after a continuous 30 minute near task of 5 D accommodation demand. Measures of distance objective refraction were also collected. Results: Significant changes in axial length were observed immediately following the near task. EOM axial length elongated on average by 0.027 ± 0.021 mm, LOM by 0.014 ± 0.020 mm, EMM by 0.010 ± 0.015 mm, PM by 0.031 ± 0.022 mm, and SM by 0.014 ± 0.018 mm. At the conclusion of the 10 minute regression period, axial length measures were not significantly different from baseline values. Conclusion: Axial elongation was observed following a prolonged near task. Both EOM and PM groups showed increases in axial length that were significantly greater than emmetropes

Axial length charges during accommodation in myopes and emmetropes

Purpose: To investigate the influence of accommodation upon axial length (and a comprehensive range of ocular biometric parameters), in populations of young adult myopic and emmetropic subjects. Methods: Forty young adult subjects had ocular biometry measured utilizing a non-contact optical biometer (Lenstar LS 900) based upon the principle of optical low coherence reflectometry, under three different accommodation demands (0 D, 3 D and 6 D). Subjects were classified as emmetropes (n=19) or myopes (n=21) based upon their spherical equivalent refraction (mean emmetropic refraction -0.05 ± 0.27DS and mean myopic refraction -1.82 ± 0.84 DS). Results: Axial length changed significantly with accommodation, with a mean increase of 11.9 ± 12.3 µm and 24.1 ± 22.7 µm for the 3 D and 6 D accommodation stimuli respectively. A significant axial elongation associated with accommodation was still evident even following correction of the axial length data for potential error due to lens thickness change. The mean ‘corrected’ increase in axial length was 5.2 ± 11.2 µm, and 7.4 ± 18.9 µm for the 3 D and 6 D stimuli respectively. There was no significant difference between the myopic and emmetropic populations in terms of the magnitude of change in axial length with accommodation, regardless of whether the data were corrected or not. A number of other ocular biometric parameters, such as anterior chamber depth, lens thickness and vitreous chamber depth also exhibited significant change with accommodation. The myopic and emmetropic populations also exhibited no significant difference in the magnitude of change in these parameters with accommodation. Conclusions: The eye undergoes a significant axial elongation associated with a brief period of accommodation, and the magnitude of this change in eye length increases for larger accommodation demands, however there is no significant difference in the magnitude of eye elongation in myopic and emmetropic subjects.

Sustained convergence, axial length, and corneal topography

Purpose: To investigate the influence of convergence on axial length and corneal topography in young adult subjects.---------- Methods: Fifteen emmetropic young adult subjects with normal binocular vision had axial length and corneal topography measured immediately before and after a 15-min period of base out (BO) prismatic spectacle lens wear. Two different magnitude prismatic spectacles were worn in turn (8 [DELTA] BO and 16 [DELTA] BO), and for both tasks, distance fixation was maintained for the duration of lens wear. Eight subjects returned on a separate day for further testing and had axial length measured before, during, and immediately after a 15-min convergence task.---------- Results: No significant change was found to occur in axial length either during or after the sustained convergence tasks (p > 0.6). Some small but significant changes in corneal topography were found to occur after sustained convergence. The most significant corneal change was observed after the 16 [DELTA] BO prism wear. The corneal refractive power spherocylinder power vector J0 was found to change by a small (mean change of 0.03 D after the 16 [DELTA] BO task) but statistically significant (p = 0.03) amount as a result of the convergence task (indicative of a reduction in with-the-rule corneal astigmatism after convergence). Corneal axial power was found to exhibit a significant flattening in superior regions. Conclusions: Axial length appears largely unchanged by a period of sustained convergence. However, small but significant changes occur in the topography of the cornea after convergence.

The use of economic evaluation in CAM : an introductory framework

Background For CAM to feature prominently in health care decision-making there is a need to expand the evidence-base and to further incorporate economic evaluation into research priorities. In a world of scarce health care resources and an emphasis on efficiency and clinical efficacy, CAM, as indeed do all other treatments, requires rigorous evaluation to be considered in budget decision-making. Methods Economic evaluation provides the tools to measure the costs and health consequences of CAM interventions and thereby inform decision making. This article offers CAM researchers an introductory framework for understanding, undertaking and disseminating economic evaluation. The types of economic evaluation available for the study of CAM are discussed, and decision modelling is introduced as a method for economic evaluation with much potential for use in CAM. Two types of decision models are introduced, decision trees and Markov models, along with a worked example of how each method is used to examine costs and health consequences. This is followed by a discussion of how this information is used by decision makers. Conclusions Undoubtedly, economic evaluation methods form an important part of health care decision making. Without formal training it can seem a daunting task to consider economic evaluation, however, multidisciplinary teams provide an opportunity for health economists, CAM practitioners and other interested researchers, to work together to further develop the economic evaluation of CAM.

Potential of St John's Wort for the treatment of depression : the economic perspective

The burden of rising health care expenditures has created a demand for information regarding the clinical and economic outcomes associated with complementary and alternative medicines. Meta-analyses of randomized controlled trials have found Hypericum perforatum preparations to be superior to placebo and similarly effective as standard antidepressants in the acute treatment of mild to moderate depression. A clear advantage over antidepressants has been demonstrated in terms of the reduced frequency of adverse effects and lower treatment withdrawal rates, low rates of side effects and good compliance, key variables affecting the cost-effectiveness of a given form of therapy. The most important risk associated with use is potential interactions with other drugs, but this may be mitigated by using extracts with low hyperforin content. As the indirect costs of depression are greater than five times direct treatment costs, given the rising cost of pharmaceutical antidepressants, the comparatively low cost of Hypericum perforatum extract makes it worthy of consideration in the economic evaluation of mild to moderate depression treatments.