Long-term azithromycin for Indigenous children with non-cystic-fibrosis bronchiectasis or chronic suppurative lung disease (Bronchiectasis Intervention Study) : a multicentre, double-blind, randomised controlled trial

Background Indigenous children in high-income countries have a heavy burden of bronchiectasis unrelated to cystic fibrosis. We aimed to establish whether long-term azithromycin reduced pulmonary exacerbations in Indigenous children with non-cystic-fibrosis bronchiectasis or chronic suppurative lung disease. Methods Between Nov 12, 2008, and Dec 23, 2010, we enrolled Indigenous Australian, Maori, and Pacific Island children aged 1—8 years with either bronchiectasis or chronic suppurative lung disease into a multicentre, double-blind, randomised, parallel-group, placebo-controlled trial. Eligible children had had at least one pulmonary exacerbation in the previous 12 months. Children were randomised (1:1 ratio, by computer-generated sequence with permuted block design, stratified by study site and exacerbation frequency [1—2 vs ≥3 episodes in the preceding 12 months]) to receive either azithromycin (30 mg/kg) or placebo once a week for up to 24 months. Allocation concealment was achieved by double-sealed, opaque envelopes; participants, caregivers, and study personnel were masked to assignment until after data analysis. The primary outcome was exacerbation (respiratory episodes treated with antibiotics) rate. Analysis of the primary endpoint was by intention to treat. At enrolment and at their final clinic visits, children had deep nasal swabs collected, which we analysed for antibiotic-resistant bacteria. This study is registered with the Australian New Zealand Clinical Trials Registry; ACTRN12610000383066. Findings 45 children were assigned to azithromycin and 44 to placebo. The study was stopped early for feasibility reasons on Dec 31, 2011, thus children received the intervention for 12—24 months. The mean treatment duration was 20·7 months (SD 5·7), with a total of 902 child-months in the azithromycin group and 875 child-months in the placebo group. Compared with the placebo group, children receiving azithromycin had significantly lower exacerbation rates (incidence rate ratio 0·50; 95% CI 0·35—0·71; p<0·0001). However, children in the azithromycin group developed significantly higher carriage of azithromycin-resistant bacteria (19 of 41, 46%) than those receiving placebo (four of 37, 11%; p=0·002). The most common adverse events were non-pulmonary infections (71 of 112 events in the azithromycin group vs 132 of 209 events in the placebo group) and bronchiectasis-related events (episodes or investigations; 22 of 112 events in the azithromycin group vs 48 of 209 events in the placebo group); however, study drugs were well tolerated with no serious adverse events being attributed to the intervention. Interpretation Once-weekly azithromycin for up to 24 months decreased pulmonary exacerbations in Indigenous children with non-cystic-fibrosis bronchiectasis or chronic suppurative lung disease. However, this strategy was also accompanied by increased carriage of azithromycin-resistant bacteria, the clinical consequences of which are uncertain, and will need careful monitoring and further study.

Medieval knights amid the gum-trees : the experience of European heritage tourism in south-east Queensland, Australia

This paper is interested in the way in which the heritage of another place, time, and culture is repurposed for popular consumption in an experience economy, as well as the way in which the visitors experience their own past and the past of others. We trace the processes of engagement, education and nostalgia that occur when the European heritage is presented in a postcolonial context and an Australian environment. The information presented includes the results of qualitative and quantitative research conducted at the Abbey Museum over the December-Jan. period of 2012-13.

Educational programmes for primary prevention of skin cancer (Protocol)

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of education programmes for skin cancer prevention in the general population. Description of the condition Skin cancer is a term that includes both melanoma and keratinocyte cancer. Keratinocyte cancer (also known as nonmelanoma skin cancer) generally refers to basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), although it also includes other rare cutaneous neoplasms (Madan 2010). Skin cancer is the most common cancer in populations of predominantly fair-skinned people (Donaldson 2011; Lomas 2012; Stern 2010), with incidence increasing (Garbe 2009; Leiter 2012). There are variations in annual incidence rates between these populations, with Australia reporting the highest rate of skin cancer in the world (Lomas 2012). In 2012, the estimated age-standardised incidence rate for melanoma was almost 63 per 100,000 people for Australian men, and 40 per 100,000 people for Australian women (AIHW 2012). In Europe, incidence rates range from 10 to 15 per 100,000 people (Garbe 2009; Lasithiotakis 2006), with rates highest amongst men (Stang 2006). In the United States, incidence rates are approximately 18 per 100,000 people (Garbe 2009),with the highest rates reported forwomen (Bradford 2010). Keratinocyte cancer is much more common than melanoma. In 2012, the estimated Australian age-standardised rates for BCCand SCC were 884 and 387 per 100,000 people, respectively (Staples 2006). The cumulative three-year risk of developing a subsequent keratinocyte cancer is 18% for SCC and 44% for BCC (Marcil 2000).

The Australian Nonprofit Sector Legal and Accounting Almanac 2013

INTRODUCTION CASES For a number of years, Professor Myles McGregor-Lowndes, Frances Hannah and Anne Overell have compiled one to two page summaries of cases involving nonprofit organisations and published them on The Australian Centre for Philanthropy and Nonprofit Studies, Developing Your Organisation (DYO) website.1 You can be alerted of new case summaries as they are posted to the DYO website by subscribing to the ACPNS RSS feed or the ACPNS twitter service.2 There were some very significant cases during 2013, such as Commissioner of Taxation v Cancer & Bowel Research Association (see case notes 2.8.2 and 2.8.11), The Hunger Project case which is under appeal, but could change the face of PBI jurisprudence (see case note 2.8.7) while Home Health Pty Ltd retained the PBI status quo but might have been different if appealed (see case note 2.8.8). For sheer interest there is nothing better in my 30 odd years of reading tax and charity judgements than case involving The Study and Prevention of Psychological Diseases Foundation Incorporated (see case note 2.1.1). It even rivals some of the more bizarre cases from the US jurisdiction of which St Joseph Abbey v Castille (case note 2.10.9) is certainly ‘dead centre’. A set of cases which stand out for attention are those involving New Zealand’s Christchurch Cathedral which anyone with responsibility for heritage-listed buildings should study carefully, for implications in relation to their own circumstances. A number of cases summarised in this Almanac are working their way through the appeals process and care should be taken with their application. In addition, some of the cases are from jurisdictions outside Australia, and readers should exercise caution when considering the implications of these cases for Australian law. LEGISLATION The Almanac includes a review of major statutory amendments during 2013, which are relevant to the nonprofit sector in all Australian jurisdictions. Special thanks must go to Nathan MacDonald and the JusticeConnect team for providing legislative updates for Victoria. SPECIAL ISSUES DURING 2013 A number of legal practitioners have contributed articles on significant legal issues facing nonprofit organisations: charitable trusts giving to government entities (Alice Macdougall); workplace bullying (Tim Longwill); and privacy (James Tan and Nina Brewer). WORLD ROUND-UP Major developments from the UK and Ireland (Kerry O’Halloran), Canada (Peter Broder), New Zealand (Michael Gousmett and Susan Barker) and Jamaica (Frances Hannah) are all summarised in a review of a significant part of the common law charity jurisdictions. WHAT DOES 2014 HOLD The final section moves from looking in the rear view mirror to peering out the front windscreen to discern the reform agenda. The view from the windscreen in 2013 was of considerable reform traffic at the Commonwealth level jostling for a place in the parliamentary agenda. This year is quite different with a smaller number of vehicles ahead, but the potential for significant impact.

An evidence-based program to improve analgesic practice and pain outcomes in residential aged care facilities

Pain is common in individuals living in residential aged care facilities (RACFs), and a number of obstacles have been identified as recurring barriers to adequate pain management. To address this, the Australian Pain Society developed 27 recommendations for comprehensive good practice in the identification, assessment, and management of pain. This study reviewed preexisting pain management practice at five Australian RACFs and identified changes needed to implement the recommendations and then implemented an evidence-based program that aimed to facilitate better pain management. The program involved staff training and education and revised in-house pain-management procedures. Reviews occurred before and after the program and included the assessment of 282 residents for analgesic use and pain status. Analgesic use improved after the program (P<.001), with a decrease in residents receiving no analgesics (from 15% to 6%) and an increase in residents receiving around-the-clock plus as-needed analgesics (from 24% to 43%). There were improvements in pain relief for residents with scores indicative of pain, with Abbey pain scale (P=.005), Pain Assessment in Advanced Dementia Scale (P=.001), and Non-communicative Patient's Pain Assessment Instrument scale (P<.001) scores all improving. Although physical function declined as expected, Medical Outcomes Study 36-item Short-Form Survey bodily pain scores also showed improvement (P=.001). Better evidence-based practice and outcomes in RACFs can be achieved with appropriate training and education. Investing resources in the aged care workforce using this program improved analgesic practice and pain relief in participating sites. Further attention to the continued targeted pain management training of aged care staff is likely to improve pain-focused care for residents.

Fresh Cuttings: A Celebration of Fiction and Poetry from UQP's Black Writing Series

As the first anthology of UQP's indigenous-authored books, Fresh Cuttings represents the very best of fiction and poetry publishing from UQP's Black Australian Writing series. An introduction by the editors and a biography of each author is included.

Oral liquid nutritional supplements for people with dementia in residential aged care facilities

AIM: This systematic review investigated the prescription, administration and effectiveness of oral liquid nutritional supplements (OLNS) for people with dementia in residential aged care facilities (RACF). METHODS: A comprehensive search of relevant databases, hand searching and cross-referencing found 15 relevant articles from a total of 2910 possible results. Articles which met the inclusion criteria were critically appraised by two independent reviewers using the relevant Joanna Briggs Institute (JBI) appraisal checklist. Data were extracted using the relevant JBI extraction instruments. No data synthesis was possible due to clinical and methodological heterogeneity. RESULTS: Included studies examined a range of strategies, issues and results related to OLNS for persons with dementia in RACFs; however there appear to be significant gaps in the current body of research, particularly in relation to examinations of effectiveness. CONCLUSIONS: This review was unable to produce a definitive finding regarding effectiveness. OLNS may improve the nutritional state of residents with dementia and help prevent weight loss, and there is some suggestion that it may slow the rate of cognitive decline. However, in order for OLNS to be effective, nursing and care staff need to ensure that sufficient attention is paid to the issues of prescription and administration.

Harmoniaa ja riitasointuja : Yksilön ja yhteisön hyvinvointiin liittyvät ihanteet Syon Abbeyn luostarissa (1415-1539)

Tutkimus käsittelee hyvinvointiin liittyviä ihanteita yksilön ja yhteisön näkökulmasta Syon Abbeyn birgittalaisluostarissa myöhäiskeskiajalla. Vuonna 1415 perustettu Syon Abbey kuului Englannin varakkaimpien luostarien joukkoon. Se noudatti Birgitan (1302/1303–1373) luostarisääntöä (Regula Salvatoris) ja oli säännön mukaisesti kaksoisluostari, jossa eli nunnien lisäksi myös veljiä. Tutkimuksen päälähteinä käytetään Birgitan sääntöä täydentäviä Syon Abbeyn luostaria varten kirjoitettuja sääntölisäyksiä sekä kahta nunnia varten laadittua hengellistä opaskirjaa. Hyvinvointiin liittyvät ihanteet on tässä tutkimuksessa jaoteltu fyysiseen, sosiaaliseen ja henkis-hengelliseen osa-alueeseen. Fyysisen hyvinvoinnin osalta tarkastellaan luostarin omaisuutta ja työnjakoa sekä ravintoon, vaatetukseen ja terveyteen liittyviä kysymyksiä. Varakkaana luostarina Syon Abbey kykeni tarjoamaan asukkailleen tasokkaat elinolosuhteet. Luostaria johti abbedissa, joka jakoi harkintansa mukaan työtehtävät muille luostarin asukkaille. Nunnien vastuu luostarin talouden ja arkielämän järjestämisessä oli suuri. Veljien vastuulla oli sakramenttien toimittaminen, saarnaaminen ja hengellinen ohjaus. Monilla Syon Abbeyn asukkailla oli aristokraattinen syntyperä, ja tottumus korkeaan elintasoon näkyi muun muassa ruokahankinnoissa kalliina mausteina ja muina ylellisyystuotteina, vaikka ihanteena olikin kohtuullisuus. Fyysisiin tarpeisiin liittyviä säädöksiä perusteltiin terveellisyydellä ja tarkoituksenmukaisuudella. Nunnien henkinen työ edellytti, että he olivat hyvin ravittuja ja terveitä. Vaatetuksen tuli olla yhtenäinen, millä osoitettiin toisaalta yhteenkuuluvuutta, toisaalta erottauduttiin muista sääntökunnista ja maallikoista. Sosiaalinen hyvinvointi liittyy yksittäisen nunnan asemaan yhteisössä ja siihen, miten nunnien (sekä nunnien ja veljien) välistä kommunikaatiota säädeltiin. Lähteet osoittavat, että yhteisöelämän sujuvuutta pidettiin Syon Abbeyssä tärkeänä. Pahan puhuminen, toisten loukkaaminen, juoruilu, ylempien uhmaaminen ja puhuminen hiljaisuusaikoina oli kielletty. Toisia piti kohdella kunnioittavasti ja ystävällisesti, mutta kommunikointi olisi pitänyt rajoittaa välttämättömään. Kieltojen ja määräysten runsaslukuisuus nimenomaan kommunikointiin liittyen kertonee siitä, että näitä sääntöjä ei aina noudatettu. Erityisen tiukasti kontrolloitiin nunnien ja veljien keskinäistä yhteydenpitoa. Henkinen ja hengellinen hyvinvointi liittyy luostarin varsinaiseen tehtävään. Syon Abbeyllä oli maine oppineisuuden keskuksena. Kirjallisuuden rooli luostarin elämänihanteiden luojana oli merkittävä ja sen tarkoitus oli auttaa nunnia hoitamaan hyvin tärkeintä tehtäväänsä, yhteisten hetkipalvelusten toimittamista. Veljet ja ulkopuoliset käänsivät Syon Abbeyn nunnille kirjoja englanniksi, joten myös latinaa taitamattomilla oli mahdollisuus hankkia teologista tietämystä ja ymmärtää hetkipalvelusten sisältöä. Suuri kirjasto takasi hyvät lähtökohdat opiskelulle varsinkin, kun huomioidaan, että naisten mahdollisuudet saada opillista sivistystä olivat keskiajalla rajalliset. Yksilön hengellisen elämän tukeminen palveli yhteisöä, koska luostarin hengellinen työ nähtiin konkreettisena taisteluna pahaa vastaan. Vaikka luostari-ihanteet perusteltiin Syon Abbeyssä hengellisesti, myös maallisista tarpeista huolehdittiin, koska ne loppujen lopuksi palvelivat hengellisiä päämääriä.

Aza-induced cardiomyocyte differentiation of P19 EC-cells by epigenetic co-regulation and ERK signaling

Stem cells in cell based therapy for cardiac injury is being potentially considered. However, genetic regulatory networks involved in cardiac differentiation are not clearly understood. Among stem cell differentiation models, mouse P19 embryonic carcinoma (EC) cells, are employed for studying (epi)genetic regulation of cardiomyocyte differentiation. Here, we comprehensively assessed cardiogenic differentiation potential of 5-azacytidine (Aza) on P19 EC-cells, associated gene expression profiles and the changes in DNA methylation, histone acetylation and activated-ERK signaling status during differentiation. Initial exposure of Aza to cultured EC-cells leads to an efficient (55%) differentiation to cardiomyocyte-rich embryoid bodies with a threefold (16.8%) increase in the cTnI(+) cardiomyocytes. Expression levels of cardiac-specific gene markers i.e., Isl-1, BMP-2, GATA-4, and alpha-MHC were up-regulated following Aza induction, accompanied by differential changes in their methylation status particularly that of BMP-2 and alpha-MHC. Additionally, increases in the levels of acetylated-H3 and pERK were observed during Aza-induced cardiac differentiation. These studies demonstrate that Aza is a potent cardiac inducer when treated during the initial phase of differentiation of mouse P19 EC-cells and its effect is brought about epigenetically and co-ordinatedly by hypo-methylation and histone acetylation-mediated hyper-expression of cardiogenesis-associated genes and involving activation of ERK signaling.

Algunas notas sobre el papel de la mujer en Fontevraud y Santa María de Vega

Resumen: El papel relevante desempeñado por la mujer en la abadía real de Fontevraud y en el monasterio de Vega del Cea –priorato de aquellafue ¿síntoma o consecuencia? de un descubrimiento de la mujer en aquel siglo XII, pletórico de novedades, de raptos místicos, de nuevas formas de acercarse a la divinidad y de consecuentes reformas religiosas. En este trabajo esbozo algunas líneas interpretativas acerca de la hegemonía de la mujer sobre el hombre, superioridad que se hizo palpable en los dos cenobios estudiados, ejemplos de mutaciones que fueron interpretadas de forma desigual por los contemporáneos y por aquellos que más tarde abordaron el tema.

Modelos cortesanos y modelos litúrgicos en la corte alfonsí : la performance cantada de las Cantigas de Santa María (CSM)

Integran este número de la revista ponencias presentadas en Studia Hispanica Medievalia VIII: Actas de las IX Jornadas Internacionales de Literatura Española Medieval, 2008, y de Homenaje al Quinto Centenario de Amadis de Gaula.