Is age a factor in the success or failure of remote monitoring in heart failure? Telemonitoring and structured telephone support in elderly heart failure patients

Background There are few data regarding the effectiveness of remote monitoring for older people with heart failure. We conducted a post-hoc sub-analysis of a previously published large Cochrane systematic review and meta-analysis of relevant randomized controlled trials to determine whether structured telephone support and telemonitoring were effective in this population. Methods A post hoc sub-analysis of a systematic review and meta-analysis that applied the Cochrane methodology was conducted. Meta-analyses of all-cause mortality, all-cause hospitalizations and heart failure-related hospitalizations were performed for studies where the mean or median age of participants was 70 or more years. Results The mean or median age of participants was 70 or more years in eight of the 16 (n=2,659/5,613; 47%) structured telephone support studies and four of the 11 (n=894/2,710; 33%) telemonitoring studies. Structured telephone support (RR 0.80; 95% CI=0.63-1.00) and telemonitoring (RR 0.56; 95% CI=0.41-0.76) interventions reduced mortality. Structured telephone support interventions reduced heart failure-related hospitalizations (RR 0.81; 95% CI=0.67-0.99). Conclusion Despite a systematic bias towards recruitment of individuals younger than the epidemiological average into the randomized controlled trials, older people with heart failure did benefit from structured telephone support and telemonitoring. These post-hoc sub-analysis results were similar to overall effects observed in the main meta-analysis. While further research is required to confirm these observational findings, the evidence at hand indicates that discrimination by age alone may be not be appropriate when inviting participation in a remote monitoring service for heart failure.

Metal ion levels post primary unilateral Exeter total hip arthroplasty

BACKGROUND: Metal ion release is common following total hip arthroplasty, yet postoperative levels have not been defined for most stems currently used in clinical practice. AIM: To assess metal ion release in the serum of patients with well functioning unilateral Exeter V40 primary total hip arthroplasties one year after surgery. METHODS: Whole blood chromium and serum cobalt levels were measured in 20 patients following primary total hip arthroplasty with the Exeter V40 stem and a variety of acetabular components one year after surgery. RESULTS: Whole blood chromium levels were within the normal range (10-100 nmol/L), with a single mild elevation of serum cobalt (normal < 20 nmol/L). CONCLUSION: In well functioning primary unilateral total hip arthroplasty using the Exeter V40 stem with a variety of acetabular components one year post surgery, whole blood chromium levels are normal and serum cobalt elevations are rare and mild.

School physical education in the post-report era : an analysis from public health

The 1996 United States Surgeon General’s report on physical activity and health represents a watershed moment in the modern history of physical activity and public health. Based on a compelling body of scientific evidence from the fields of medicine, epidemiology, physiology, and health psychology, the Surgeon General’s report proclaimed that people of all ages could improve their health and quality of life through lifelong practice of moderate physical activity (United States Department of Health and Human Services [USDHHS], 1996). Physical Activity and Health: A Report of the Surgeon General was an especially important publication for school physical education. Not only did the report acknowledge the importance of regular physical activity during childhood and adolescence, it also identified school physical education as an important vehicle for promoting healthenhancing physical activity in young people. “With evidence that success in this arena is possible, every effort should be made to encourage schools to require daily physical education in each grade and to promote physical activities that can be enjoyed throughout life” (USDHHS, 1996, p. 6). The purpose of this article is to discuss the status of school physical education since the release of the Surgeon General’s report on physical activity and health nearly a decade ago. Specifically, the article will address four questions: 1) What has been the historical role of physical education in physical activity and public health? 2) What impact, if any, has the Surgeon General’s report has had on physical education programs? 3) What impact should physical education have on public health and physical activity? 4) What should teacher education programs in physical education do to prepare physical education teachers, given the current role of physical education?

A Bayesian hurdle model for analysis of an insect resistance monitoring database

Motivated by the analysis of the Australian Grain Insect Resistance Database (AGIRD), we develop a Bayesian hurdle modelling approach to assess trends in strong resistance of stored grain insects to phosphine over time. The binary response variable from AGIRD indicating presence or absence of strong resistance is characterized by a majority of absence observations and the hurdle model is a two step approach that is useful when analyzing such a binary response dataset. The proposed hurdle model utilizes Bayesian classification trees to firstly identify covariates and covariate levels pertaining to possible presence or absence of strong resistance. Secondly, generalized additive models (GAMs) with spike and slab priors for variable selection are fitted to the subset of the dataset identified from the Bayesian classification tree indicating possibility of presence of strong resistance. From the GAM we assess trends, biosecurity issues and site specific variables influencing the presence of strong resistance using a variable selection approach. The proposed Bayesian hurdle model is compared to its frequentist counterpart, and also to a naive Bayesian approach which fits a GAM to the entire dataset. The Bayesian hurdle model has the benefit of providing a set of good trees for use in the first step and appears to provide enough flexibility to represent the influence of variables on strong resistance compared to the frequentist model, but also captures the subtle changes in the trend that are missed by the frequentist and naive Bayesian models.

The impact of flood and post-flood cleaning on airborne microbiological and particle contamination in residential houses

In January 2011, Brisbane, Australia, experienced a major river flooding event. We aimed to investigate its effects on air quality and assess the role of prompt cleaning activities in reducing the airborne exposure risk. A comprehensive, multi-parameter indoor and outdoor measurement campaign was conducted in 41 residential houses, 2 and 6 months after the flood. The median indoor air concentrations of supermicrometer particle number (PN), PM10, fungi and bacteria 2 months after the flood were comparable to those previously measured in Brisbane. These were 2.88 p cm-3, 15 µg m-3, 804 cfu m-3 and 177 cfu m-3 for flood-affected houses (AFH), and 2.74 p cm-3, 15 µg m-3, 547 cfu m-3 and 167 cfu m-3 for non-affected houses (NFH), respectively. The I/O (indoor/outdoor) ratios of these pollutants were 1.08, 1.38, 0.74 and 1.76 for AFH and 1.03, 1.32, 0.83 and 2.17 for NFH, respectively. The average of total elements (together with transition metals) in indoor dust was 2296 ± 1328 µg m-2 for AFH and 1454 ± 678 µg m-2 for NFH, respectively. In general, the differences between AFH and NFH were not statistically significant, implying the absence of a measureable effect on air quality from the flood. We postulate that this was due to the very swift and effective cleaning of the flooded houses by 60,000 volunteers. Among the various cleaning methods, the use of both detergent and bleach was the most efficient at controlling indoor bacteria. All cleaning methods were equally effective for indoor fungi. This study provides quantitative evidence of the significant impact of immediate post-flood cleaning on mitigating the effects of flooding on indoor bioaerosol contamination and other pollutants.

Homelessness and leaving care : the experiences of young adults in Queensland and Victoria, and implications for practice

This research first asks ‘What happens when young people leave state care?’ in respect of Victoria and Queensland and second ‘What are the service support implications of this?’ A number of methods were used to explore these questions including semi-structured interviews with 27 young adults aged 19-23 years who had been homeless or at risk of homelessness, and focus groups with young people and service providers. This study provides support for the proposition that young people should be proactively and voluntarily involved in periodic monitoring of their lived experience post care and linkage of this monitoring to the activation of timely support. The great majority of young people involved in this study thought this was not only desirable but important. Whilst some young people will be in close contact with leaving care services many others will not. New research is recommended to develop a mentoring and support activation process using participatory monitoring and action research methods. This type of approach reflects the importance of utilising processes with young people in care and leaving care which acknowledge their personhood and capacity to contribute voluntarily to the processes which seek to support them.

The impact of diabetic ketoacidosis and age on behavior six months post-diagnosis in children with type 1 diabetes

Objectives: Children with type 1 diabetes mellitus (DM1) may be at increased risk of psychosocial and adjustment difficulties. We examined behavioral outcomes six months post-diagnosis in a group of children with newly diagnosed DM1. Methods: This study formed part of a larger longitudinal project examining pathophysiology and neuropsychological outcomes in diabetic patients with or without diabetic ketoacidosis (DKA). Participants were 61 children (mean age 11.8 years, SD 2.7 years) who presented with a new diagnosis of DM1 at the Royal Children’s Hospital, Melbourne. Twenty-three (11 female) presented in DKA and 38 (14 female) without DKA. Parents completed the behavior assessment system for children, second edition six months post-diagnosis. Results: There was a non-linear relationship between age and behavior. Internalising problems (i.e. anxiety depression, withdrawal) peaked in the transition from childhood to adolescence; children aged 10–13 years had elevated rates relative to the normal population (t = 2.55, P = 0.018). There was a non-significant trend for children under 10 to display internalising problems (P = 0.052), but rates were not elevated in children over 13 (P = 0.538). Externalising problems were not significantly elevated in any age group. Interestingly, children who presented in DKA were at lower risk of internalising problems than children without DKA (t = 3.83, P < 0.001). There was no effect of DKA on externalising behaviors. Conclusions: Children transitioning from childhood to adolescence are at significant risk for developing internalising problems such as anxiety and lowered mood after diagnosis of DM1. Somewhat counter-intuitively, parents of children presenting in DKA reported fewer internalising symptoms than parents of children without DKA. These results highlight the importance of monitoring and supporting psychosocial adjustment in newly diagnosed children even when they seem physically well.

Expression and regulation of vascular endothelial growth factor ligands and receptors during menstruation and post-menstrual repair of human endometrium

Regeneration and growth of the human endometrium after shedding of the functional layer during menstruation depends on an adequate angiogenic response. We analysed the mRNA expression levels of all known vascular endothelial growth factor (VEGF) ligands and receptors in human endometrium collected in the menstrual and proliferative phases of the menstrual cycle. In addition, we evaluated the expression of VEGF-A, VEGF-R2 and NRP-1 at the protein level. Two periods of elevated mRNA expression of ligands and receptors were observed, separated by a distinct drop at cycle days (CDs) 9 and 10. Immunohistochemical staining showed that VEGF and VEGF-R2 were expressed in epithelial, stromal and endothelial cells. NRP-1 was mainly confined to stroma and blood vessels; only in late-proliferative endometrium, epithelial staining was also observed. Except for endothelial VEGF-R2 expression in CDs 6-8, there were no significant differences in the expression of VEGF, VEGF-R2 or NRP-1 in any of the cell compartments. In contrast, VEGF release by cultured human endometrium explants decreased during the proliferative phase. This output was significantly reduced in menstrual and early-proliferative endometrium by estradiol (E2) treatment. Western blot analysis indicated that part of the VEGF-A was trapped in the extracellular matrix (ECM). Changes in VEGF ligands and receptors were associated with elevated expression of the hypoxia markers HIF1 alpha and CA-IX in the menstrual and early proliferative phases. HIF1 alpha was also detected in late-proliferative phase endometrium. Our findings indicate that VEGF-A exerts its actions mostly during the first half of the proliferative phase. Furthermore, VEGF-A production appears to be triggered by hypoxia in the menstrual phase and subsequently suppressed toy estrogen during the late proliferative phase.

Are there generalizable trends in the release of airborne synthetic clay nanoparticles from a jet milling process?

Despite recent efforts to assess the release of nanoparticles to the workplace during different nanotechnology activities, the existence of a generalizable trend in the particle release has yet to be identified. This study aimed to characterize the release of synthetic clay nanoparticles from a laboratory-based jet milling process by quantifying the variations arising from primary particle size and surface treatment of the material used, as well as the feed rate of the machine. A broad range of materials were used in this study, and the emitted particles mass (PM2.5) and number concentrations (PNC) were measured at the release source. Analysis of variance, followed by linear mixed-effects modeling, was applied to quantify the variations in PM2.5 and PNC of the released particles caused by the abovementioned factors. The results confirmed that using materials of different primary size and surface treatment affects the release of the particles from the same process by causing statistically-significant variations in PM2.5 and PNC. The interaction of these two factors should also be taken into account as it resulted in variations in the measured particles release properties. Furthermore, the feed rate of the milling machine was confirmed to be another influencing parameter. Although this research does not identify a specific pattern in the release of synthetic clay nanoparticles from the jet milling process generalizable to other similar settings, it emphasizes that each tested case should be handled individually in terms of exposure considerations.

Home monitoring for infants at risk of the sudden infant death syndrome

This study evaluates the effectiveness and social implications of home monitoring of 31 infants at risk of sudden infant death syndrome (SIDS). Thirteen siblings of children dying of SIDS, nine near miss SIDS infants and nine preterm infants with apnoea persisting beyond 40 weeks post conceptual age were monitored from a mean age of 15 days to a mean of 10 months. Chest movement detection monitors were used in 27 and thoracic impedance monitors in four. Genuine apnoeic episodes were reported by 21 families, and 13 infants required resuscitation. Apnoeic episodes occurred in all nine preterm infants but in only five (38%) of the siblings of SIDS (P<0.05). Troublesome false alarms were a major problem occurring with 61% of the infants and were more common with the preterm infants than the siblings of SIDS. All but two couples stated that the monitor decreased anxiety and improved their quality of life. Most parents accepted that the social restrictions imposed by the monitor were part of the caring process but four couples were highly resentful of the changes imposed on their lifestyle. The monitors used were far from ideal with malfunction occurring in 17, necessitating replacement in six, repair in six and cessation of monitoring in three. The parents became ingenious in modifying the monitors to their own individual requirements Although none of these 31 ‘at risk’ infants died the study sample was far too small to conclude whether home monitoring prevented any cases of SIDS.

Non-specific conducting polymer-based array capable of monitoring odour emissions from a biofiltration system in a piggery building

A commercial non-specific gas sensor array system was evaluated in terms of its capability to monitor the odour abatement performance of a biofiltration system developed for treating emissions from a commercial piggery building. The biofiltration system was a modular system comprising an inlet ducting system, humidifier and closed-bed biofilter. It also included a gravimetric moisture monitoring and water application system for precise control of moisture content of an organic woodchip medium. Principal component analysis (PCA) of the sensor array measurements indicated that the biofilter outlet air was significantly different to both inlet air of the system and post-humidifier air. Data pre-processing techniques including normalising and outlier handling were applied to improve the odour discrimination performance of the non-specific gas sensor array. To develop an odour quantification model using the sensor array responses of the non-specific sensor array, PCA regression, artificial neural network (ANN) and partial least squares (PLS) modelling techniques were applied. The correlation coefficient (r(2)) values of the PCA, ANN, and PLS models were 0.44, 0.62 and 0.79, respectively.

Post capture necrosis of the feet caused by soft-catch traps – incidents, cause and prevention.

When recapturing satellite collared wild dogs that had been trapped one month previous in padded foothold traps, we noticed varying degrees of pitting on the pads of their trapped paw. Veterinary advice, based on images taken of the injuries, suggests that the necrosis was caused by vascular compromise. Five of six dingoes we recaptured had varying degrees of necrosis restricted only to the trapped foot and ranging from single 5 mm holes to 25% sections of the toe pads missing or deformed, including loss of nails. The traps used were rubber-padded, two–coiled, Victor Soft Catch #3 traps. The springs are not standard Victor springs but were Beefer springs; these modifications slightly increase trap speed and the jaw pressure on the trapped foot. Despite this modification the spring pressure is still relatively mild in comparison to conventional long spring or four-coiled wild dog traps. The five wild dogs developing necrosis were trapped in November 2006 at 5-6 months of age. Traps were checked each morning so the dogs were unlikely to have been restrained in the trap for more than 12 hours. All dogs exhibited a small degree of paw damage at capture which presented itself as a swollen paw and compression at the capture point. In contrast, eight wild dogs, 7-8 month-old, were captured two months later in February. Upon their release, on advice from a veterinarian, we massaged the trapped foot to get blood flow back in to the foot and applied a bruise treatment (Heparinoid 8.33 mg/ml) to assist restoring blood flow. These animals were subsequently recaptured several months later and showed no signs of necrosis. While post-capture foot injuries are unlikely to be an issue in conventional control programs where the animal is immediately destroyed, caution needs to be used when releasing accidentally captured domestic dogs or research animals captured in rubber-padded traps. We have demonstrated that 7-8 month old dogs can be trapped and released without any evidence of subsequent necrosis following minimal veterinary treatment. We suspect that the rubber padding on traps may increase the tourniquet effect by wrapping around the paw and recommend the evaluation of offset laminated steel jaw traps as an alternative. Offset laminated steel jaw traps have been shown to be relatively humane producing as few foot injuries as rubber-jawed traps.

Impacts of a fuel oil spill on seagrass meadows in a subtropical port, Gladstone, Australia - The value of long-term marine habitat monitoring in high risk areas.

We used an established seagrass monitoring programme to examine the short and longer-term impacts of an oil spill event on intertidal seagrass meadows. Results for potentially impacted seagrass areas were compared with existing monitoring data and with control seagrass meadows located outside of the oil spill area. Seagrass meadows were not significantly affected by the oil spill. Declines in seagrass biomass and area 1 month post-spill were consistent between control and impact meadows. Eight months post-spill, seagrass density and area increased to be within historical ranges. The declines in seagrass meadows were likely attributable to natural seasonal variation and a combination of climatic and anthropogenic impacts. The lack of impact from the oil spill was due to several mitigating factors rather than a lack of toxic effects to seagrasses. The study demonstrates the value of long-term monitoring of critical habitats in high risk areas to effectively assess impacts.

AE energy release during the fracture of HSC beams

An attempt has been made experimentally to investigate the acoustic emission (AE) energy release in high-strength concrete (HSC) beams subjected to monotonically increasing load. Acoustic emission energy release during the fracture process of the HSC beams is measured. Stress waves released during the fracture process in materials cause acoustic emissions. AE energy released during the fracture of a notched three-point bend plain concrete beam specimens having 28-day compressive strengths of 50.0 MPa, 69.0 MPa and 78.0 MPa and mortar (cement: sand (1: 4) by weight) specimens are studied. Mortar consists of one part cement and four parts sand by weight. The specimens were tested by a material testing system of 1200 kN capacity employing crack mouth opening displacement control at the rate of 0.0004 mm/s. The fracture energy and the AE energy released during the fracture process of all the tested TPB and mortar specimens are compared and discussed. The observations made in the present experimental study have some applications for monitoring the integrity of structures.

Rapid monitoring of nitrogen in mango trees

Nitrogen (N) is an essential nutrient in mango, influencing both productivity and fruit quality. In Australian mango orchards, tree N is traditionally assessed once a year at the dormant pre-flowering stage using laboratory analysis of leaf N. This single assessment is insufficient to determine tree N status at all stages of the annual phenological cycle. Development of a field-based rapid N test would allow more frequent monitoring of tree N status and improved fertiliser management. These experiments examined the accuracy and useability of several devices used in other horticultural crops to rapidly assess mango leaf N in the field; the Konica Minolta 'SPAD-502 chlorophyll meter', Horiba 'Cardy Meter' and the Merck 'RQflex 10.' Regression and correlation analyses were used to determine the relationship between total leaf N and the measurements from the rapid test devices. The relationship between the chlorophyll index measured by the SPAD-502 meter and leaf N was highly significant at late fruit set (R 2=0.72, n=40) and post-harvest (R 2=0.81, n=40) stages and significant at the flowering stage (R 2=0.51, n=40) in the cultivar 'Kensington Pride', indicating the device can be used to rapidly assess mango leaf N in the field. Correlation analysis indicated the relationship between petiole sap measured with the Cardy or Merck devices and leaf N was non-significant.