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Small town New Zealand has, in recent years, experienced an increasing number1 and diversity of immigrants, with visible yet under-researched impacts for less populated regions that historically have been dominated by Pākehā (New Zealanders of European descent) and Māori populations. Using qualitative interviews with three ethnic sub-groups in the Clutha District and Southland Region—the Filipino, Samoan, and Malay communities—we investigate their experiences of settling in small towns. While there is considerable variation in the experiences and aspirations of these ethnic minorities, for each community we demonstrate how local and regional contextual factors shape life aspirations, support infrastructures and settlement trajectories. Particularly drawing upon informal networks and social capital immigrants mediate the considerable challenges they face. Our study also demonstrates the limitations of current policy support and initiatives. Indeed, while local authorities clearly have a significant role in creating the conditions for enabling immigrant settlement in small centres in Southland-Clutha, now the role of government services and community-based support also needs to be considered. [ABSTRACT FROM AUTHOR]

Care for U.S. children living with serious illness and their families at home is a complex and patchwork system. Improving home-based care for children and families requires a comprehensive, multilevel approach that accounts for and examines relationships across home environments, communities, and social contexts in which children and families live and receive care. We propose a multilevel conceptual framework, guided by Bronfenbrenner's ecological model, that conceptualizes the complex system of home-based care into five levels. Levels 1 and 2 contain patient and family characteristics. Level 3 contains factors that influence family health, well-being, and experience with care in the home. Level 4 includes the community, including community groups, schools, and providers. Level 5 includes the broader regional system of care that impacts the care of children and families across communities. Finally, care coordination and care disparities transcend levels, impacting care at each level. A multilevel ecological framework of home-based care for children with serious illness and families can be used in future multilevel research to describe and test hypotheses about aspects of this system of care, as well as to inform interventions across levels to improve patient and family outcomes. [ABSTRACT FROM AUTHOR]

Background: Pre-transplant evaluation is mandated by Centers for Medicare and Medicaid Services, but there is wide institutional variation in implementation, and the family experience of the process is incompletely understood. Current literature largely focuses on adult transplant recipients. Methods: This qualitative study begins to fill the knowledge gap about family experience of the pre-transplant evaluation for children through interviews with caregivers at a large pediatric transplant center. Results: Prominent themes heard from caregivers include (1) the pre-transplant evaluation is overwhelming and emotional, (2) prior experiences and background knowledge frame the evaluation experience, and (3) frustration with communication among teams is common. Conclusions: These findings are relevant to efforts by transplant centers to optimize information delivery, minimize concrete barriers, and address healthcare systems issues. A higher resolution version of the Graphical abstract is available as Supplementary information [ABSTRACT FROM AUTHOR]

Objective: To assess parental decision-making preferences when caring for a child with serious illness and to evaluate for an association between preferences and parental trust in physicians, and potential modification of this association by parental anxiety or depression. Methods: We analyzed cross-sectional data from 200 parents of 158 children in the United States who had life-threatening illnesses and whose attending physicians thought that the parents would have to make major medical decision in the next 12 to 24 months. Parents completed measures of decision-making preferences, trust in physicians, anxiety, and depression. Results: Higher reported levels of trust were associated with lower preferences for autonomous decision making (Spearman correlation = −0.24; 95% confidence interval [CI] = −0.36 to −0.01; p < 0.008). Among parents with higher levels of trust, increasing anxiety scores were associated with decreasing preference for autonomy, whereas among parents with lower levels of trust, increasing anxiety scores showed an increasing preference for autonomy (regression coefficient = −0.01; 95% CI = −0.02 to −0.001; p ≤ 0.03). Conclusions: Decreasing trust in physicians is associated with a higher preference for autonomous decision making. Parents who have higher levels of anxiety exhibit this association more strongly. Decision support for parents of children with serious illness should use strategies to respect parental decision-making preferences, address potential distrust, and provide mental health support to parents who are anxious or depressed. [ABSTRACT FROM AUTHOR]

Families of children with medical complexity (CMC) face many types of health-related decisions. These decisions vary in magnitude of consequences, degree of risk, time scale, degree of tradeoffs, degree of uncertainty, degree of linkage with other decisions, and reversibility. There are many influences on decision-making, including evidence, hopes, and values. Primary care pediatricians are in a unique position to assist families of CMC with decision-making. Pediatric clinicians have an opportunity to establish a trusting relationship with a family over time and to understand the family's values, beliefs, and preferences during periods of relative health and stability. This allows primary care pediatricians to support families in decision-making by helping to clarify their values and goals and apply those values to the decision at hand. [Pediatr Ann. 2020;49(11):e473-e477.]. [ABSTRACT FROM AUTHOR]

Background: Parenting a child with a serious life-threatening illness (SLTI) may impact parents' mental health. The protective association of social support with anxiety over time following an acute medical event has not been empirically tested in a sample of parents of children with oncologic and nononcologic serious illnesses. Objective: To test the potential association of perceived social support with anxiety in parents of children with SLTIs over time. Design: Prospective cohort study. Setting/Subjects: Two hundred parents of 158 children in the Decision Making in Serious Pediatric Illness study, conducted at the Children's Hospital of Philadelphia. Measurements: Parental anxiety and perceived social support were assessed using the Hospital Anxiety and Depression Scale (HADS) and the Social Provisions Scale (SPS). We performed bivariate linear regressions to test cross-sectional and longitudinal associations between the SPS and anxiety scores at baseline, 12 months, and 24 months. Results: The average SPS total and subscale scores decreased significantly from baseline to 12 months, and increased from 12 to 24 months. The average HADS-Anxiety scores decreased significantly from baseline to 12 months, and remained stable at 24 months. Cross-sectionally, total SPS scores were negatively associated with anxiety scores at each time point. Longitudinally, SPS scores were associated with anxiety scores, although this association weakened in adjusted modeling. Conclusions: Over a two-year period, higher levels of perceived social support were associated with lower levels of anxiety in parents of seriously ill children. Clinicians and researchers should work to optimize social support for families to improve parental mental health outcomes. [ABSTRACT FROM AUTHOR]

Background: Currently the most effective treatment for severe obesity in adolescents is weight-loss surgery coupled with lifestyle behavior change. In preparation for weight-loss surgery, adolescents are required to make changes to eating and activity habits (lifestyle changes) to promote long term success. Social media support groups, which are popular among adolescents, have the potential to augment preoperative lifestyle changes. The purpose of this study was to qualitatively assess the perceived role of social media as a support tool for weight-loss, and to identify motivators and constraints to lifestyle changes and social media use in adolescents preparing for weight-loss surgery.Methods: Thematic analysis of social media comments from 13 (3 male, 10 female) adolescents aged 16 ± 1.3 years with a body mass index (BMI) 45 ± 7.3 kg/m2 enrolled in a weight-management program preparing for bariatric surgery and who participated in a 12-week pilot social media intervention was performed. Participants commented on moderator posts and videos of nutrition, physical activity, and motivation that were shared three to four times per week. Social media comments were coded using NVivo 11.0 to identify recurrent themes and subthemes.Results: 1) Social media provided accountability, emotional support, and shared behavioral strategies. 2) Motivators for lifestyle changes included family support, personal goals, and non-scale victories. 3) Challenges included negative peers, challenges with planning and tracking, and time constraints.Conclusion: Adolescents considering bariatric surgery identified social media as a tool for social support and reinforcement of strategies for successful behavior change. Important motivators and challenges to lifestyle changes were identified. [ABSTRACT FROM AUTHOR]

Background: Despite evidence that referral to pediatric palliative care reduces suffering and improves quality of life for patients and families, many clinicians delay referral until the end of life. The purpose of this article is to provide a conceptual model for why clinical teams delay discussing palliative care with parents. Discussion: Building on a prior model of parent regoaling and relevant research literature, we argue for a conceptual model of the challenges and facilitators a clinical team might face in shifting from a restorative-focused treatment plan to a plan that includes palliative aspects, resulting in a subspecialty palliative care referral. Like patients and families, clinicians and clinical teams may recognize that a seriously ill patient would benefit from palliative care and shift from a restorative mindset to a palliative approach. We call this transition "clinician regoaling". Clinicians may experience inhibitors and facilitators to this transition at both the individual and team level which influence the clinicians' willingness to consult subspecialty palliative care. The 8 inhibitors to team level regoaling include: 1) team challenges due to hierarchy, 2) avoidance of criticizing colleagues, 3) structural communication challenges, 4) group norms in favor of restorative goals, 5) diffusion of responsibility, 6) inhibited expression of sorrow, 7) lack of social support, 8) reinforcement of labeling and conflict. The 6 facilitators of team regoaling include: 1) processes to build a shared mental model, 2) mutual trust to encourage dissent, 3) anticipating conflict and team problem solving, 4) processes for reevaluation of goals, 5) sharing serious news as a team, 6) team flexibility. Conclusions: Recognizing potential team level inhibitors to transitioning to palliative care can help clinicians develop strategies for making the transition more effectively when appropriate. [ABSTRACT FROM AUTHOR]

Background The role of dairy products in obesity treatment for adolescents is unclear. The study purpose was to assess the association between dairy intake and changes in BMI z -score (z BMI) during adolescent obesity treatment. Methods Observational study nested within a randomized control trial. Linear mixed-effects regression models were adjusted for important non-lifestyle factors then further adjusted for dietary and physical activity variables. In total, 91 adolescents were studied. Results Each serving of total dairy (β = −0.0054, P < 0.01), unflavored milk (β = −0.012, P < 0.01), reduced fat (β = −0.0078, P < 0.05), and low fat/fat-free products (β = −0.0149, P < 0.01) was associated with a decrease in zBMI over 12 months. These associations were no longer significant after adjustment for other dietary and physical activity factors. Sugar-sweetened beverage intake was inversely associated with intake of total dairy (β = −0.186, P = 0.001), unflavored milk (β = −0.115, P = 0.003) and low fat/fat-free dairy (β = −0.125, P = 0.001). Conclusions Intakes of total dairy, unflavored milk, reduced fat dairy and low fat/fat-free dairy products are associated with improved obesity treatment outcomes among adolescents. This could be due to co-occurring healthy lifestyle behaviors or to replacement of other food and beverages associated with obesity, such as sugar-sweetened beverages, by dairy products. [ABSTRACT FROM AUTHOR]

Reports the biological effects resulting from exposure to millimeter (mm) waves. Characterization of phospholipids; Estimation of power deposition pattern of liposome suspension in the capillary; Application of liposomes in identifying the possible sites of interaction of mm-wave irradiation.

Purpose: To determine the reliability of a prognostic curve progression model and the role of the quantity and quality of brace wear for adolescent idiopathic scoliosis (AIS) brace treatment.Methods: To develop a curve progression model for full-time AIS brace treatment, 20 AIS subjects (Group 1) prescribed full-time thoracolumbar sacral orthosis (TLSO) were monitored and followed for 2 years beyond maturity. The developed curve progression model was: curve progression (in degrees) = 33 + 0.11 × Peterson risk (%) - 0.07 in-brace correction (%) - 0.45 × quality (%) - 0.48 × quantity (%) + 0.0062 × quantity × quality. To validate the model, 40 new (test) subjects (Group 2) who met the same inclusion criteria and used the same type of monitors, were monitored and followed for 2 years after bracing.Results: For the 40 test subjects (Group 2), the average in-brace correction was 40 ± 22 %. The average quantity and quality of the brace wear were 56 ± 19 and 55 ± 17 %, respectively. Twelve subjects (30 %) progressed of which 10 subjects (25 %) required surgery and 28 subjects (70 %) showed no progression. The accuracy of the model to determine which patients would progress was 88 % (35/40) which was better than the Peterson's risk model (68 %; 26/40) alone. Patients who had the combined quantity times the quality over a threshold 43 % had a success treatment rate of 95 %.Conclusions: This study showed the prognostic model of brace treatment outcome on AIS patients treated with full-time TLSO was reliable. Both the quantity and quality of the brace wear were important factors in achieving successful brace treatment. [ABSTRACT FROM AUTHOR]

Purpose: Children with advanced cancer are often not referred to palliative or hospice care before they die or are only referred close to the child's death. The goals of the current project were to learn about pediatric oncology team members' perspectives on palliative care, to collaborate with team members to modify and tailor three separate interdisciplinary team-based interventions regarding initiating palliative care, and to assess the feasibility of this collaborative approach.Methods: We used a modified version of experience-based codesign (EBCD) involving members of the pediatric palliative care team and three interdisciplinary pediatric oncology teams (Bone Marrow Transplant, Neuro-Oncology, and Solid Tumor) to review and tailor materials for three team-based interventions. Eleven pediatric oncology team members participated in four codesign sessions to discuss their experiences with initiating palliative care and to review the proposed intervention including patient case studies, techniques for managing uncertainty and negative emotions, role ambiguity, system-level barriers, and team communication and collaboration.Results: The codesign process showed that the participants were strong supporters of palliative care, members of different teams had preferences for different materials that would be appropriate for their teams, and that while participants reported frustration with timing of palliative care, they had difficulty suggesting how to change current practices.Conclusions: The current project demonstrated the feasibility of collaborating with pediatric oncology clinicians to develop interventions about introducing palliative care. The procedures and results of this project will be posted online so that other institutions can use them as a model for developing similar interventions appropriate for their needs. [ABSTRACT FROM AUTHOR]

This article analyzes key factors affecting transboundary water cooperation in the Brahmaputra River basin at multiple scales. The analysis of multi-track diplomacy reaffirms the potential of actor-inclusive approaches, arguing for a need to go beyond purely focusing on formal legal norms and consider the possibilities of cultural norms of informal processes of cooperation. Various ‘windows of opportunity’ exist in the current phase of the Brahmaputra basin’s development, leading to exploration of a Zone of Possible Effective Cooperation, arising from the effort to scale up multi-track initiatives as well as broader geo-political-economic changes happening across and beyond the basin. [ABSTRACT FROM AUTHOR]

ABSTRACT: Obese adolescents have increased fracture risk, but effects of alterations in adiposity on bone accrual and strength in obese adolescents are not understood. We evaluated 12‐month changes in trabecular and cortical volumetric bone mineral density (vBMD) and cortical geometry in obese adolescents undergoing a randomized weight management program, and investigated the effect of body composition changes on bone outcomes. Peripheral quantitative computed tomography (pQCT) of the radius and tibia, and whole‐body dual‐energy X‐ray absorptiometry (DXA) scans were obtained at baseline, 6 months, and 12 months in 91 obese adolescents randomized to standard care versus behavioral intervention for weight loss. Longitudinal models assessed effects of body composition changes on bone outcomes, adjusted for age, bone length, and African‐American ancestry, and stratified by sex. Secondary analyses included adjustment for physical activity, maturation, vitamin D, and inflammatory biomarkers. Baseline body mass index (BMI) was similar between intervention groups. Twelve‐month change in BMI in the standard care group was 1.0 kg/m2 versus –0.4 kg/m2 in the behavioral intervention group (p < 0.01). Intervention groups were similar in bone outcomes, so they were combined for subsequent analyses. For the tibia, BMI change was not associated with change in vBMD or structure. Greater baseline lean body mass index (LBMI) associated with higher cortical vBMD in males, trabecular vBMD in females, and polar section modulus (pZ) and periosteal circumference (Peri‐C) in both sexes. In females, change in LBMI positively associated with gains in pZ and Peri‐C. Baseline visceral adipose tissue (VFAT) was inversely associated with pZ in males and cortical vBMD in females. Change in VFAT did not affect bone outcomes. For the radius, BMI and LBMI changes positively associated with pZ in males. Thus, in obese adolescents, weight loss intervention with modest changes in BMI was not detrimental to radius or tibia bone strength, and changes in lean, but not adiposity, measures were beneficial to bone development. © 2017 American Society for Bone and Mineral Research. [ABSTRACT FROM AUTHOR]

Orthodox approaches to managing Himalayan rivers endorse a singular focus on water as a resource to be harnessed for national security and economic progress, as epitomised by the proposed acceleration of large-scale hydropower construction in the Brahmaputra basin. In reality, existing large-scale hydropower development in the region frequently involves corruption, environmental destruction and forced displacement. This paper argues for an alternative approach to understanding the role of water in India's extractive zones within and beyond the boundaries of the nation, utilising the notions of ‘embeddedness’, ‘hydro-informality’ and ‘rescaling politics’. It is argued that reframing the river in this way can open up space for more just and sustainable practices. [ABSTRACT FROM PUBLISHER]

A method is presented to teach enthymemes using truth tables. Students are given an argument with a missing step, some choices for the missing step and are to put these into a truth table. They are then to use the criteria of consistency, validity and charity to choose a step to complete the argument. This technique is intended to teach introductory logic students about enthymemes and to give them more practice with truth tables and symbolization. This method is limited to sentence logic arguments, but can also evaluate enthymemes missing both a premise and conclusion. [ABSTRACT FROM AUTHOR]

In this article, the authors discuss hope, therapeutic honesty and adaptation in the midst of dying and death. Topics include identification of short-comings in the care of dying patients; mishandling of negative ethical and clinical repercussions for the care that patients with serious illness receive; and connection between denial and acceptance of the ultimately personally fatal consequence of patient condition.

The vulnerability of communities in the Himalayas to water stress caused by climate change depends on changes in the availability of water as well as how it is used. There has been little work done to reconcile these drivers of water stress in the Himalayas. This paper evaluates how climate change may affect water availability in two Nepalese mountain communities, Panglin and Tallo Lorpa, and assesses whether these changes drive vulnerability to water stress. First, estimates of hydrological change are made based on climate model output and hydroclimatological theory. Household surveys, focus group discussions and participatory rural appraisal techniques are used to assess vulnerability and adaptive capacity in each community. Finally, the expected effects of climate change on water availability are linked to findings on the communities’ vulnerability to these changes. The results show that both communities are vulnerable to changes in water availability under climate change, but this vulnerability is small in comparison to adaptation opportunities. However, the ability to appropriate benefits from these opportunities is constrained, and it is the extent of this inhibition that determines vulnerability. These findings demonstrate that Malthusian interpretations may be inappropriate in the Himalayas, and highlight the importance of the constraints to climate change adaptation. [ABSTRACT FROM PUBLISHER]

Background: The North American non-surgical standard of care for adolescent idiopathic scoliosis (AIS) includes observation and bracing, but not exercises. Schroth physiotherapeutic scoliosis-specific exercises (PSSE) showed promise in several studies of suboptimal methodology. The Scoliosis Research Society calls for rigorous studies supporting the role of exercises before including it as a treatment recommendation for scoliosis. Objectives: To determine the effect of a six-month Schroth PSSE intervention added to standard of care (Experimental group) on the Cobb angle compared to standard of care alone (Control group) in patients with AIS. Methods: Fifty patients with AIS aged 10–18 years, with curves of 10°-45° and Risser grade 0–5 were recruited from a single pediatric scoliosis clinic and randomized to the Experimental or Control group. Outcomes included the change in the Cobb angles of the Largest Curve and Sum of Curves from baseline to six months. The intervention consisted of a 30–45 minute daily home program and weekly supervised sessions. Intention-to-treat and per protocol linear mixed effects model analyses are reported. Results: In the intention-to-treat analysis, after six months, the Schroth group had significantly smaller Largest Curve than controls (-3.5°, 95% CI -1.1° to -5.9°, p = 0.006). Likewise, the between-group difference in the square root of the Sum of Curves was -0.40°, (95% CI -0.03° to -0.8°, p = 0.046), suggesting that an average patient with 51.2° at baseline, will have a 49.3° Sum of Curves at six months in the Schroth group, and 55.1° in the control group with the difference between groups increasing with severity. Per protocol analyses produced similar, but larger differences: Largest Curve = -4.1° (95% CI -1.7° to -6.5°, p = 0.002) and (95% CI -0.8 to 0.2, p = 0.006). Conclusion: Schroth PSSE added to the standard of care were superior compared to standard of care alone for reducing the curve severity in patients with AIS. Trial Registration: [ABSTRACT FROM AUTHOR]

The development of new biological and chemical instruments for research and diagnostic applications is often slowed by the cost, specialization, and custom nature of these instruments. New instruments are built from components that are drawn from a host of different disciplines and not designed to integrate together, and once built, an instrument typically performs a limited number of tasks and cannot be easily adapted for new applications. Consequently, the process of inventing new instruments is very inefficient, especially for researchers or clinicians in resource-limited settings. To improve this situation, we propose that a family of standardized multidisciplinary components is needed, a set of “building blocks” that perform a wide array of different tasks and are designed to integrate together. Using these components, scientists, engineers, and clinicians would be able to build custom instruments for their own unique needs quickly and easily. In this work we present the foundation of this set of components, a system we call Multifluidic Evolutionary Components (MECs). “Multifluidic” conveys the wide range of fluid volumes MECs operate upon (from nanoliters to milliliters and beyond); “multi” also reflects the multiple disciplines supported by the system (not only fluidics but also electronics, optics, and mechanics). “Evolutionary” refers to the design principles that enable the library of MEC parts to easily grow and adapt to new applications. Each MEC “building block” performs a fundamental function that is commonly found in biological or chemical instruments, functions like valving, pumping, mixing, controlling, and sensing. Each MEC also has a unique symbol linked to a physical definition, which enables instruments to be designed rapidly and efficiently using schematics. As a proof-of-concept, we use MECs to build a variety of instruments, including a fluidic routing and mixing system capable of manipulating fluid volumes over five orders of magnitude, an acid-base titration instrument suitable for use in schools, and a bioreactor suitable for maintaining and analyzing cell cultures in research and diagnostic applications. These are the first of many instruments that can be built by researchers, clinicians, and students using the MEC system. [ABSTRACT FROM AUTHOR]

In this paper, we critically interrogate the benefits of an interdisciplinary and theoretically diverse dialogue between 'local food' and 'alternative food networks' (AFNs) and outline how this dialogue might be enriched by a closer engagement with discourses of food sovereignty and the politics of scale. In arguing for a shift towards a greater emphasis on food sovereignty, we contend that contemporary discourses of food security are inadequate for the ongoing task of ensuring a just and sustainable economy of food. Further, rather than treating the local and the global as ontologically given categories around which to contest the politics of food, it is our contention that recognising the socio-spatial aspects of the politics of scale has the potential to reinvigorate discourses of food security, food sovereignty and AFNs. Understanding scale as both fixed to a degree as well as contingent and dynamic has implications for an understanding of the role of food systems, for how the rescaled state privileges certain food systems and the possibilities for resistance through 'jumping scale' and food utopias. All of these aspects are significant if we are to fully comprehend and contest the challenges of envisioning and enacting real utopias of food sovereignty. [ABSTRACT FROM AUTHOR]

Background: The psychological well-being of siblings of children with life threatening illness remains largely uncharted. Pediatric cancer research suggests that a supportive family environment may protect the psychological well-being of siblings. Objective: We hypothesized that (1) siblings of pediatric palliative care patients would show clinical/behavioral scores that were elevated but that rates of serious psychopathology would be comparable to the general population of children their age; and (2) higher family functioning scores would be associated with lower clinical scores and higher adaptive scores for these siblings. Methods: We conducted an observational study with families in which a patient receiving palliative care had one or more siblings between the ages of 6 and 11. Parents completed the Behavioral Assessment System for Children, Second Edition (BASC-2) to assess the siblings' psychological well-being and the Family Assessment Device (FAD) to assess the family environment. Results: Twenty-four parents reported data for 30 siblings. Only three siblings scored in the clinical range on a BASC-2 composite clinical scale, and 11 siblings scored in the at-risk range on one or more composite scales. Higher FAD scores predicted significantly higher externalization composite clinical scores (7.54, 95% CI: 1.12, 13.97, p < 0.05) and significantly higher behavioral composite scores (7.88, 95% CI: 1.55, 14.21, p < 0.05). Discussion: Siblings of pediatric palliative care patients are not experiencing lower psychological well-being than the general population. The prediction that a positive family environment would be associated with higher levels of psychological health was supported. [ABSTRACT FROM AUTHOR]

Hydropower development clearly has a significant role to play in the closer integration of different parts of the Himalayas and in facilitating downstream benefits throughout South Asia. However, the neo-liberal approach to infrastructure-led growth frequently overlooks the significant social, economic and political issues associated with this model of development in the region. Furthermore, the ongoing securitisation of water constrains the terms of debate under the guise of a unified national interest and enables large-scale dams to be constructed without due process. To desecuritise water in the Himalayas is to open up this dialogue and in so doing create the conditions for just and sustainable development. [ABSTRACT FROM AUTHOR]

The article presents a study which determines the problems and hopes reported by parents and physicians of children receiving palliative care. The researchers detail the study methodology to observe concordance between participants and to calculate the most common problem domains. It suggests that asking parents and physicians to discuss the problems and hopes may help provide a straightforward means to improve the quality of shared and informed decision making for critically ill children.

The period following the election of the National government in 2008 has been controversial for Aotearoa New Zealand's aid programme for a number of reasons. This article examines changes in funding modalities and other aspects of non-governmental organisation (NGO)-government relations as the sites of contested philosophies that surround aid and development discourse. In focusing on the introduction of the Sustainable Development Fund in 2010, the article argues that this shift has generated significant uncertainty among the aid community and may ultimately undermine many of the relationships NGOs previously enjoyed with partners in the Global South. [ABSTRACT FROM AUTHOR]

Purpose: The objectives of this preliminary study were to assess the reliability and accuracy of ultrasound (US) for measuring coronal curvature with and without the aid of a previous radiograph, and to evaluate the ability of US to detect curve progression in adolescent idiopathic scoliosis (AIS) patients. Methods: Four raters measured 20 AIS US images twice at one-week intervals. Intra-rater reliability and correlation with radiograph were investigated with (rater 1) and without (raters 2-4) the aid of a previous radiograph. The center of lamina (COL) method was used to approximate the Cobb angle. Results: Thirty-six curves were identified. All raters showed high intra-rater reliability (ICC[2,1] >0.80). With the aid of a previous radiograph, rater 1 showed higher correlation with radiograph (ICC[2,1] = 0.86), better standard error of measurement (SEM = 2.2°), and improved error index of selecting end-vertebrae (EI = 1.34), but no statistical improvement of intra-rater reliability ( p > 0.05). For rater 2-4, the range of the ICC[2,1] values between US and radiograph measurements, the SEM value, and the range of the EI values were 0.70°-0.72°, 3.3°, and 1.65°-2.36°, respectively. Specificity and sensitivity of US for detecting curve progression were 0.91 and 0.83, respectively. Conclusions: Using a previous radiograph as a measurement aid helped the user to measure coronal curvature from US images, and improved the accuracy of end-vertebrae selection. US showed high sensitivity and specificity for detecting curve progression, indicating that US may be a suitable, radiation-free alternative for monitoring patients with AIS who have mild or moderate curves. [ABSTRACT FROM AUTHOR]

Background General practitioners with specialty interests ( GPwSIs) have been an emerging entity in the last decade or so and aim to improve patient's access to specialist level care in the primary care setting. This is achieved by them providing equivalent quality and outcomes to secondary consultant-led services, while not necessarily providing the same breadth of clinical care as them. In this systematic review, we attempt to address their efficacy for surgical procedures and specialties. Methods PRISMA guidelines were followed and an electronic literature search was performed independently by two authors using predefined search terms across EMBASE, Ovid Med Line, Pub Med, PSYCINFO and the Cochrane Library databases. A total of 817 articles were reviewed after which only six were included for the systematic review. Results Of the six articles selected, three studies analysed efficacy of GPwSIs with regard to surgical excision of skin lesions. One study looked at the economic evaluation of a GPwSI-led dermatology service in primary care and included GPwSIs carrying out skin excisions. The remaining two included studies were from the same institution and evaluated hernia repairs at a single centre general practitioner practice. Conclusion There is generally, a paucity of evidence looking at the efficacy of GPwSIs for surgical procedures. While they seem to provide an acceptable standard of specialist care in the primary care setting, they do not appear to save money. However, they provide an alternative workforce and the improved access to care that results from it may offset their higher costs. [ABSTRACT FROM AUTHOR]