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BACKGROUND: Each year, approximately one million older adults die in American ICUs or survive with significant functional impairment. Inadequate symptom management, surrogates’ psychological distress and inappropriate healthcare use are major concerns. Pioneering work by Dr. J. Randall Curtis paved the way for integrating palliative care (PC) specialists to address these needs, but convincing proof of efficacy has not yet been demonstrated. DESIGN: We will conduct a multicenter patient-randomized efficacy trial of integrated specialty PC (SPC) versus usual care for 500 high-risk ICU patients over age 60 and their surrogate decision-makers from five hospitals in Pennsylvania. INTERVENTION: The intervention will follow recommended best practices for inpatient PC consultation. Patients will receive care from a multidisciplinary SPC team within 24 hours of enrollment that continues until hospital discharge or death. SPC clinicians will meet with patients, families, and the ICU team every weekday. SPC and ICU clinicians will jointly participate in proactive family meetings according to a predefined schedule. Patients in the control arm will receive routine ICU care. OUTCOMES: Our primary outcome is patient-centeredness of care, measured using the modified Patient Perceived Patient-Centeredness of Care (PPPC) scale. Secondary outcomes include surrogates’ psychological symptom burden and health resource utilization. Other outcomes include patient survival, as well as interprofessional collaboration. We will also conduct prespecified subgroup analyses using variables such as PC needs, measured by the Needs of Social Nature, Existential Concerns, Symptoms, and Therapeutic Interaction (NEST) scale. CONCLUSIONS: This trial will provide robust evidence about the impact of integrating SPC with critical care on patient, family, and health system outcomes.

BackgroundBurn injuries are the fourth most common type of trauma and are associated with substantial morbidity and mortality. The impact of burn injury is clinically significant as burn injuries often give rise to exuberant scarring. Hypertrophic scarring (HTS) is a particular concern as up to 70% of burns patients develop HTS. Laser therapy is used for treating HTS and has shown positive clinical outcomes, although the mechanisms remain unclear limiting approaches to improve its effectiveness. Emerging evidence has shown that fibroblasts and senescent cells are important modifiers of scarring. This study aims to investigate the cellular kinetics in HTS after laser therapy, with a focus on the association of scar reduction with the presence of senescent cells.MethodsWe will conduct a multicentre, intra-patient, single-blinded, randomised controlled longitudinal pilot study with parallel assignments to achieve this objective. 60 participants will be recruited to receive 3 interventional ablative fractional CO2laser treatments over a 12-month period. Each participant will have two scars randomly allocated to receive either laser treatment or standard care. Biopsies will be obtained from laser-treated, scarred- no treatment and non-scarred tissues for immune-histological staining to investigate the longitudinal kinetics of p16INK4A+-senescent cells and fibroblast subpopulations (CD90+/Thy1+and αSMA+). Combined subjective scar assessments including Modified Vancouver Scar Scale, Patient and Observer Scar Assessment Scale and Brisbane Burn Scar Impact Profile; and objective assessment tools including 3D-Vectra-H1 photography, DermaScan®Cortex, Cutometer®and ColoriMeter®DSMIII will be used to evaluate clinical outcomes. These will then be used to investigate the association between senescent cells and scar reduction after laser therapy. This study will also collect blood samples to explore the systemic biomarkers associated with the response to laser therapy.DiscussionThis study will provide an improved understanding of mechanisms potentially mediating scar reduction with laser treatment, which will enable better designs of laser treatment regimens for those living with HTS.Trial registrationClinicalTrials.gov:NCT04736251.

This chapter investigates the long-established ecological cognition framework and updates it to better account for the advances in digital transformation. To do this, two concepts are explored. The first, ‘serendipity engineering for seductive hypermedia', looks at how to design information systems to account for the pleasant occurrences that happen in offline environments studied by those in sales and marketing where beneficial outcomes often occur by chance encounters. The second, ‘user analysis using socialnomics', looks at how a parametric user model based on the ecological framework can be used to understand users of information systems from the point of view of supporting a digital economy of users. A number of additional equations are developed using socialnomics that can be applied to digital transformation based on the parametric user model, including to calculate probability of seduction and probability of serendipity in an information system. The parametric model presented has great applicability for information and communications technology solution providers.

This chapter expends the application of the ecological cognition framework to serendipity engineering, seductive hypermedia, user analysis, and socialnomics. It updates the theory to better account for the advances in computational science computational intelligence. In terms of ‘serendipity engineering for seductive hypermedia', the chapter looks at how to design information systems to account for the pleasant occurrences that happen in offline environments studied by those in sales and marketing where beneficial outcomes often occur by chance encounters. In terms of ‘user analysis using socialnomics', it looks at how a parametric user model based on the ecological framework can be used to understand users of information systems. To do this, a number of socialnomics equations based on the parametric user model are explored, including to calculate probability of seduction and probability of serendipity in an information system. The parametric model presented has great applicability for information and communications technology solution providers.

Background and Aim High rates of inflammatory bowel disease (IBD) have been documented in New Zealand (NZ) children. The objectives of this study were to describe the outcomes and disease course of childhood IBD in the first 3 years following diagnosis. Methods All children diagnosed with IBD in 2015 in NZ were included. Clinical data obtained during routine care for 3 years following diagnosis were analyzed. Growth parameters, disease activity scores, and blood parameters were compared at diagnosis and follow up. Results Three‐year outcome data were available for 48 of 51 children. At follow up, median age was 15.1 years, and 34 had Crohn's disease (CD), 11 had ulcerative colitis (UC), and three had IBD‐unclassified (IBDU). Although disease progression including development of perianal disease occurred in 13 (38%) of 34 children with CD, the majority (n = 30) had inflammatory disease at follow up. Disease extension occurred in 25% (2/8) of children initially diagnosed with UC. Of all IBD patients, the mean body mass index z‐score increased from −0.40 to +0.10 (P = 0.01). Disease activity scores reduced from diagnosis to follow up in both CD (mean pediatric Crohn's disease activity index 35–6, P, This manuscript aimed, for the first time, to assess and describe the outcomes of a cohort of New Zealand children diagnosed with inflammatory bowel disease. Three years after diagnosis, this group of children was predominantly in remission with satisfactory improvements in growth parameters.

ICU readmission is associated with increased mortality, resource utilisation and hospital expenditure. In the general population, respiratory-related event is one of the most common causes of unexpected ICU readmission. Patients with neurological deficits faced an increased risks of ICU readmissions due to impaired mentation, protective reflexes and other factors. A retrospective review revealed that the leading cause of unexpected ICU readmissions in adult neurovascular patients admitted to our hospital was respiratory related. A respiratory therapists-driven assessment-and-treat protocol was developed for proactively assessing and treating adult neurovascular patients. On-duty respiratory therapists assessed all neurovascular patients on admission, assigned a respiratory severity score to each patient and then recommended interventions based on a standardised algorithm.Our quality improvement initiative had no effect on the rate of unexpected ICU readmissions in adult neurovascular patients. When compared with the baseline population, patients enrolled in the intervention group were significantly older ((79, 68–85 years) vs (71, 56–81 years)), but they spent comparable amount of time in the ICU (4.5 vs 4 days, p=0.42). When the respiratory severity score was trended in the intervention group, patients demonstrated significant improvement in their respiratory function, with a greater proportion of patients scoring in the minimal and mild categories and smaller proportion in the moderate category (p

The Classroom 2.0 initiative is one of the most fundamental reforms to the way education is performed across the European Union. Starting its life at the ‘Digital Classroom of Tomorrow' (DCOT) Project in Wales, the initiative has shown that concepts like electronic individual education programmes (eIEPs) and the electronic twinning of schools (eTwinning) can play an important role in enhancing learning outcomes for school age learners. This chapter presents a review of the impact of the original Classroom 2.0 Project – DCOT – and explores some of the technical issues essential to the project's success across Europe and how this has led to Technologies 4.0, which has taken the form of ‘Supporting Information and Education with Multimedia and E-Learning for Networked Societies' (SIEMENS) in Wales.

The COVID-19 crisis has revealed the limitations in the education system that could have been resolved by the Classroom 2.0 programme of blended and networked learning. This chapter presents the Emotivate Project that took place before this crisis and showed how it is possible to deliver cross-community education to provide evidence in support of the big society and free schools agenda. Cross-community education is called School 3.0, and lessons from this chapter could be learned so that it is possible to deliver education in such a way that pandemics do not bring the education system down in the way they have during COVID-19.

BackgroundMechanisms and patterns of injury in children are changing, with violent mechanisms becoming more prevalent over time. Government funding of services for children and young people has reduced nationally over the last decade. We aimed to investigate the trends in admissions of injured children to a Major Trauma Centre (MTC) and examine the relationship between injuries sustained by violent mechanisms and local authority funding of children and youth services within the same catchment area.MethodsA 10-year observational study included all patients agedResults1126 children were included; 71.3% were boys, with median age 11 years (IQR 3–16). There were 154/1126 (14%) children who were victims of violent trauma; they were more likely to be boys than children injured by non-violent mechanisms (84% vs 69%). The proportion of injuries attributed to violence increased over the study period at the same time as reductions in local authority funding of services for the early years, families and youth services. However, there were insufficient data to formally assess the interdependency between these factors.ConclusionsThe proportion of injuries attributed to violence has increased over time, and government spending on specific children and young people’s services has decreased over the same time period. Further work is needed to examine the interdependency between spending and violent injuries in children, and public health interventions to target violence-related injuries should take into account youth service funding.

Summary Background There is ongoing debate on the clinical benefits of antibiotic prophylaxis for reducing pelvic infection after miscarriage surgery. We aimed to study the cost-effectiveness of antibiotic prophylaxis in the surgical management of miscarriage in low-income countries. Methods We did an incremental cost-effectiveness analysis using data from 3412 women recruited to the AIMS trial, a randomised, double-blind, placebo-controlled trial designed to evaluate the effectiveness of antibiotic prophylaxis in the surgical management of miscarriage in Malawi, Pakistan, Tanzania, and Uganda. Economic evaluation was done from a health-care-provider perspective on the basis of the outcome of cost per pelvic infection avoided within 2 weeks of surgery. Pelvic infection was broadly defined by the presence of clinical features or the clinically identified need to administer antibiotics. We used non-parametric bootstrapping and multilevel random effects models to estimate incremental mean costs and outcomes. Decision uncertainty was shown via cost-effectiveness acceptability frontiers. The AIMS trial is registered with the ISRCTN registry, number ISRCTN97143849. Findings Between June 2, 2014, and April 26, 2017, 3412 women were assigned to receive either antibiotic prophylaxis (1705 [50%] of 3412) or placebo (1707 [50%] of 3412) in the AIMS trial. 158 (5%) of 3412 women developed pelvic infection within 2 weeks of surgery, of whom 68 (43%) were in the antibiotic prophylaxis group and 90 (57%) in the placebo group. There is 97–98% probability that antibiotic prophylaxis is a cost-effective intervention at expected thresholds of willingness-to-pay per additional pelvic infection avoided. In terms of post-surgery antibiotics, the antibiotic prophylaxis group was US$0·27 (95% CI −0·49 to −0·05) less expensive per woman than the placebo group. A secondary analysis, a sensitivity analysis, and all subgroup analyses supported these findings. Antibiotic prophylaxis, if implemented routinely before miscarriage surgery, could translate to an annual total cost saving of up to $1·4 million across the four participating countries and up to $8·5 million across the two regions of sub-Saharan Africa and south Asia. Interpretation Antibiotic prophylaxis is more effective and less expensive than no antibiotic prophylaxis. Policy makers in various settings should be confident that antibiotic prophylaxis in miscarriage surgery is cost-effective. Funding UK Medical Research Council, Wellcome Trust, and the UK Department for International Development.

ImportanceSerious traumatic injury is a leading cause of death and disability globally, with most survivors known to develop chronic pain.ObjectiveTo describe early variables associated with poor long-term outcome for posttrauma pain and create a clinical screening tool for this purpose.Design, Setting, and ParticipantsThis was a prospective cohort study at a major trauma center hospital in England. Recruitment commenced in December 2018 and ceased in March 2020. Participants were followed up for 12 months. Patients aged 16 years or older who were hospitalized because of acute musculoskeletal trauma within the preceding 14 days were included. Data were analyzed from March to December 2021.ExposureAcute musculoskeletal trauma requiring admittance to a major trauma center hospital.Main Outcomes and MeasuresA poor outcome was defined as Chronic Pain Grade II or higher and measured at both 6 months (primary time point) and 12 months. A broad range of candidate variables potentially associated with outcomes were used, including surrogates for pain mechanisms, quantitative sensory testing, and psychosocial factors. Univariable models were used to identify the variables most likely to be associated with poor outcome, which were entered into multivariable models. A clinical screening tool (nomogram) was derived from 6-month results.ResultsIn total, 1590 consecutive patients were assessed for eligibility, of whom 772 were deemed eligible and 124 (80 male [64.5%]; mean [SD] age, 48.9 [18.8] years) were recruited. At 6 months, 19 of 82 respondents (23.2%) reported a good outcome, whereas at 12 months 27 of 44 respondents (61.4%) reported a good outcome. At 6 months on univariable analysis, an increase in total posttraumatic stress symptoms (odds ratio [OR], 2.09; 95% CI, 1.33-3.28), pain intensity average (OR, 2.87; 95% CI, 1.37-6.00), number of fractures (OR, 2.79; 95% CI, 1.02-7.64), and pain extent (OR, 4.67; 95% CI, 1.57-13.87) were associated with worse outcomes. A multivariable model including those variables had a sensitivity of 0.93, a specificity of 0.54, and C-index of 0.92.Conclusions and RelevanceA poor long-term pain outcome from musculoskeletal traumatic injuries may be estimated by measures recorded within days of injury. These findings suggest that posttraumatic stress symptoms, pain spatial distribution, perceived average pain intensity, and number of fractures are good candidates for a sensitive multivariable model and derived clinical screening tool.

Background Pre-hospital blood products, including freeze-dried plasma, are increasingly carried on air ambulance helicopters. The purpose of this study was to map the temperatures within a civilian air ambulance and consider the implications for pre-hospital transfusion. Materials and methods We conducted a single-site prospective observational study in the United Kingdom. Tinytag temperature data-loggers (Gemini, UK) were secured on to three locations throughout an air ambulance, and one was placed inside an insulated drug-pouch. Temperatures were monitored at 5-min intervals. Data were downloaded monthly and processed using R and MKT software to collate maximum, minimum, and day/night mean kinetic temperatures (MKTs). Blood was transported in Crēdo ProMed 4 containers (Peli Products, S.L.U) and monitored with QTA data-loggers (Tridentify, Sweden). Results A total of 344,844 temperature recordings were made on 302 days during a 12-month period from January 2019. The external ambient temperatures varied seasonally from -7.1°C to 31.2°C, whereas internal temperatures ranged from -0.3°C to 60.6°C. The warmest area was alongside the left front-crew position (range 1.9-60.6°C, MKT 24.8°C). The lowest daytime MKT (16.9°C) and range (1.7°C-36.4°C) were recorded next to the patient stretcher. Temperatures ranged from 4.2°C to 40.1°C inside the insulated drugs-pouch, exceeding 25°C on 47 days (15%) and falling below 15°C on 192 days (63%) In contrast, thermally packed blood maintained a range of 2-6°C. Conclusion The temperatures within an air ambulance varied throughout the cabin and often exceeded the external ambient temperature. Appropriately selected thermal protection and monitoring is required for the successful delivery of pre-hospital transfusion, even in a temperate climate.

The proliferation of media-rich social networking services has changed the way people use information society and audio-visual media services. Existing theories of cognition in human-computer interaction have limitations in dealing with the unique problems that exist in contemporary virtual environments. The presence of significant numbers of people using these at the same time causes behavioural issues not previously envisaged at the time of multi-user domains (MUDs) or the first massively-multiplayer online role-playing games. To understand such large-scale virtual environments, this chapter makes use of data generated from questionnaires, usability testing, and social and web metrics to assess the relevance of ecological cognition theory for the current age. Through making use of a biometric measure called ‘knol', the chapter suggests a new framework for measuring emotion and cognition in these and future environments.

Project management is systematically conducted in order to achieve a deliverable outcome. In the case of information technology projects, project failure is very common – this is also the case with those IT projects that involve the development of e-learning systems, whether they involve minimal or intensive use of ICTs. The aim of this study, therefore, is to propose an approach to project management that involves the creation of a toolkit so that people without a background in project management, or e-learning, can more successfully run projects within their organisation. The toolkit enhances through approach to knowledge engineering by tailoring project management methodologies to an organisation and its partner organisations.

This chapter proposes automated screening of internet and multimedia communications through a combination of neuroeconomics to measure neuro-response plasticity through forensic phonetics, EEG monitoring, and EigenFaces. These measure neuro-response plasticity through facial differences, including through the eyes, differences in EEG pattern, and prosody in the form of tone of voice. Through describing the ‘Distress in the Mind Test', a computer program is proposed that can be implemented on any device with a camera and microphone and can therefore also be used to diagnose social orientation impariments, such as autism and social phobia. Further development would prevent people with social orientation impairments or whom are otherwise at risk from online harms being exposed to them through automated content filtering.

A chronic and gradual increase in pulse pressure (PP) is associated with cognitive decline and dementia in older individuals, but the mechanisms remain ill-defined. We hypothesized that a chronic elevation of PP would cause brain microvascular endothelial mechanical stress, damage the neurovascular unit, and ultimately induce cognitive impairment in mice, potentially contributing to the progression of vascular dementia and Alzheimer disease. To test our hypothesis, male control wild-type mice and Alzheimer disease model APP/PS1 (amyloid precursor protein/presenilin 1) mice were exposed to a transverse aortic constriction for 6 weeks, creating a PP overload in the right carotid (ipsilateral). We show that the transverse aortic constriction procedure associated with high PP induces a cascade of vascular damages in the ipsilateral parenchymal microcirculation: in wild-type mice, it impairs endothelial dilatory and blood brain barrier functions and causes microbleeds, a reduction in microvascular density, microvascular cell death by apoptosis, leading to severe hypoperfusion and parenchymal cell senescence. These damages were associated with brain inflammation and a significant reduction in learning and spatial memories. In APP/PS1 mice, that endogenously display severe cerebral vascular dysfunctions, microbleeds, parenchymal inflammation and cognitive dysfunction, transverse aortic constriction–induced high PP further aggravates cerebrovascular damage, Aβ (beta-amyloid) accumulation, and prevents learning. Our study, therefore, demonstrates that brain microvessels are vulnerable to a high PP and mechanical stress associated with transverse aortic constriction, promoting severe vascular dysfunction, disruption of the neurovascular unit, and cognitive decline. Hence, chronic elevated amplitude of the PP could contribute to the development and progression of vascular dementia including Alzheimer disease.

Cystic fibrosis (CF) is the most common, life-shortening, genetic illness affecting children in Australia and New Zealand. The genetic abnormality results in abnormal anion transport across the apical membrane of epithelial cells in a number of organs, including the lungs, gastrointestinal tract, liver and genito-urinary tract. Thus, CF is a multi-system disorder that requires a multi-disciplinary approach. Respiratory disease is the predominant cause of both morbidity and mortality in patients with CF. However, there are significant and clinically relevant gastrointestinal, liver, pancreatic and nutritional manifestations that must be detected and managed in a timely and structured manner. The aim of this review is to provide evidence-based information and clinical algorithms to guide the nutritional and gastrointestinal management of patients with CF.

The global incidence of paediatric inflammatory bowel disease (IBD) is increasing. Much of the evidence attesting to this has arisen from North America and Europe. There is a relative paucity of information on the epidemiology of paediatric IBD in the Southern Hemisphere. The present study aimed to document the prospectively collected incidence of paediatric IBD in New Zealand in 2015.All patients younger than 16 years of age and diagnosed with IBD in New Zealand between 1 January 2015 and 31 December 2015 were identified. Demographic and disease phenotypic details were collected and entered into a secure database. Age-specific population data for New Zealand were obtained and national incidence rates for IBD and its subtypes were calculated.The prospectively calculated incidence of paediatric IBD, Crohn disease, ulcerative colitis (UC), and IBD unclassified in New Zealand in 2015 were 5.2 (95% confidence interval 3.9-6.8), 3.5 (2.4-4.8), 1.0 (0.5-1.8), and 0.7 (0.3-1.4) per 100,000 children, respectively.Incidence rates of paediatric IBD in New Zealand are comparable to the highest rates published in the literature from Western Europe and North America. Ongoing prospective ascertainment of the incidence of paediatric IBD is required to better understand the environmental factors, which are accounting for this increase in disease burden.

The beneficial effects of physical exercise on brain health are well documented, yet how exercise modulates cerebrovascular function is not well understood. This study used continuous arterial spin labeling magnetic resonance imaging with a hypercapnic challenge to examine changes in cerebral blood flow and vascular function after voluntary exercise in healthy, adult mice. Thirty exercise mice and twenty-one control mice were imaged prior to the start of the exercise regime (at 12 weeks of age) and after 4 weeks of voluntary exercise. After the second in vivo imaging session, we performed high-resolution ex vivo anatomical brain imaging to correlate the structural brain changes with functional measures of flow and vascular reserve. We found that exercise resulted in increases in the normocapnic and hypercapnic blood flow in the hippocampus. Moreover, the change in normocapnic blood flow between pre-exercise and post-exercise was positively correlated to the hippocampal structure volume following exercise. There was no overall effect of voluntary exercise on blood flow in the motor cortex. Surprisingly, the hypercapnic hippocampal blood flow when measured prior to the start of exercise was predictive of subsequent exercise activity. Moreover, exercise was found to normalize this pre-existing difference in hypercapnic blood flow between mice.

This chapter investigates a method of counting votes called ‘Delegated Transferable Vote' (DTV) as a means to ensure that every vote counts by enabling voters to be able to vote for the candidate they want in the knowledge that their vote will be tactically allocated by the candidate they vote for if they get less than 50% of the vote. The theory is that if a voter trusts someone enough to vote for them then they should trust them to allocate their vote to a candidate with similar policies or political philosophies to them. The chapter finds that in elections where the candidates want to keep out a particular candidate or party, such as because they have a hegemony, then DTV can be effective in changing the outcome. However, in election where tactical voting has already taken place, such as where people vote on issues instead of party lines, then the outcome of counting votes using DTV is on the whole not different from the one presently used in the United Kingdom, which is First-Past-the-Post (FPTP).

Summary: Background: There is ongoing debate on the clinical benefits of antibiotic prophylaxis for reducing pelvic infection after miscarriage surgery. We aimed to study the cost-effectiveness of antibiotic prophylaxis in the surgical management of miscarriage in low-income countries. Methods: We did an incremental cost-effectiveness analysis using data from 3412 women recruited to the AIMS trial, a randomised, double-blind, placebo-controlled trial designed to evaluate the effectiveness of antibiotic prophylaxis in the surgical management of miscarriage in Malawi, Pakistan, Tanzania, and Uganda. Economic evaluation was done from a health-care-provider perspective on the basis of the outcome of cost per pelvic infection avoided within 2 weeks of surgery. Pelvic infection was broadly defined by the presence of clinical features or the clinically identified need to administer antibiotics. We used non-parametric bootstrapping and multilevel random effects models to estimate incremental mean costs and outcomes. Decision uncertainty was shown via cost-effectiveness acceptability frontiers. The AIMS trial is registered with the ISRCTN registry, number ISRCTN97143849. Findings: Between June 2, 2014, and April 26, 2017, 3412 women were assigned to receive either antibiotic prophylaxis (1705 [50%] of 3412) or placebo (1707 [50%] of 3412) in the AIMS trial. 158 (5%) of 3412 women developed pelvic infection within 2 weeks of surgery, of whom 68 (43%) were in the antibiotic prophylaxis group and 90 (57%) in the placebo group. There is 97–98% probability that antibiotic prophylaxis is a cost-effective intervention at expected thresholds of willingness-to-pay per additional pelvic infection avoided. In terms of post-surgery antibiotics, the antibiotic prophylaxis group was US$0·27 (95% CI −0·49 to −0·05) less expensive per woman than the placebo group. A secondary analysis, a sensitivity analysis, and all subgroup analyses supported these findings. Antibiotic prophylaxis, if implemented routinely before miscarriage surgery, could translate to an annual total cost saving of up to $1·4 million across the four participating countries and up to $8·5 million across the two regions of sub-Saharan Africa and south Asia. Interpretation: Antibiotic prophylaxis is more effective and less expensive than no antibiotic prophylaxis. Policy makers in various settings should be confident that antibiotic prophylaxis in miscarriage surgery is cost-effective. Funding: UK Medical Research Council, Wellcome Trust, and the UK Department for International Development.

This paper proposes a new method for distributing votes in democratic elections in such a way that allows for the public to put their trust in independent candidates or those from small political parties. Using the case of a party founded by the authors called The Pluralist Party the paper presents primary data to evaluate the effectiveness of the method – called delegated transferable voting (DTV). Using an auto-ethnographical empirical study in which one of the authors plays a significant role as anthropologist, the paper finds that DTV is more likely to lead to the election of independent candidates over party political ones. Pluralism advocates the election of those who are independent of political party whips in order to best represent the people. The election of independent candidates or small parties is a model of pluralism that can achieve this. The empirical study, through investigating the campaigning methods used by The Pluralist Party, shows that putting effort into an election – whether money, materials or labour and however funded – can improve outcomes for political parties. Making use of official government data in addition to the collected data showed that a higher number of votes for the Pluralist Party was associated with a higher education level, more rooms in a household, a lower number of people not in education, employment or training, and a lower ‘knol,' which is a unit for measuring brain activity.

Research on digital addiction has been increasing significantly since the start of the 2010s. What is not currently available is a measurement scale to assess the extent to which adolescents are at risk of abuse on the Internet that might lead them to develop digital addiction. This chapter sets out to develop a check-list that can be used to risk assess those youths who might be at risk of digital addiction. Through using data from a study into 1,828 young people aged 9-16, the study devised a 6-point check-list based on using a t-test to determine those at high risk and those at low risk. The check-list can be seen as a reliable way for screening those adolescents for whom concerns are raised over their online activities. The chapter concludes that further research will be needed to test the scale with people in older age ranges.

This chapter investigates the views of parents and guardians of Millennials who took part in a clicks-and-mortar adult and community education project based around learning about local heritage and expressing understanding of it through digital and mixed media collages. Issues considered range from the built environment, with the project taking place in various settings, from community centers to church hall, through to online issues, where a dedicated resource separated from the rest of the internet was developed for exploratory learning. Parents and guardians express how they think the needs of Millennials should be taken into account in the provision of education and community activity. The chapter concludes that there are many community resources available for Millennials, but the coordination of their use is the barrier preventing Millennials having the experience of previous generations that had fulfilled teenage years.

The term large-scale virtual environment (LSVE) is not in the common usage. One might find discussion on massively multi-user online role-playing games (MMORPGs) and multi-user virtual environment (MUVEs), but these are sub-types of LSVEs and usually focus on the graphical element, not measuring the capacity of the individual users and the computation of their combined potential, nor the analysis of how they interact with one another to achieve mutual or opposite goals that affect the usage of data and their own nutritional resources. By investigating different user groups, internal and external representations and various thresholds, including the serendipity threshold, this chapter contributes to the understanding of how digital addiction manifests through a brain measurement called knol, which can be used as a floating-point unit.

This chapter looks at the role of the participation continuum in helping to improve relationships that have been damaged as a result of digital addiction. Digital addiction in this context refers to what happens when a person with a compulsion who is not getting that compulsion fulfilled turns to the Internet and other digital technologies in order to fill the void. The chapter is a case study of two people called Person D and Person G in order to make them anonymous. Using medical and other records, it was found that a number of different interventions using the participation continuum could have resulted in changes in the relationship in either holding it together or preventing one party from posting malicious and defamatory comments. The chapter found that a theoretical model, with algorithmic principles applied, called the transitional flow of persuasion model would be able to understand the impacts of digital addiction and provide a means to remedy it.

Network politics is examined in the context of the Arab Spring. Network politics refers to politics and networks. These networks include the Internet, private networks, cellular networks, telephone networks, radio networks, television networks, etc. Network politics includes the applications of networks to enable one or more individuals or organizations to engage in political communication. Furthermore, network politics includes government regulation of networks. Finally, network politics includes the accompanying issues that arise when networks are used for political communication or when there is government regulation of networks. The domain of network politics includes, but is not limited to, e-politics (social networking for driving revolutions and organizing protests, online petitions, political blogs and vlogs, whistleblower websites, online campaigning, e-participation, virtual town halls, e-voting, Internet freedom, access to information, net neutrality, etc.) and applications of other networks in politics (robocalling, text messaging, TV broadcasting, etc.). Network politics has played a crucial role in the Arab Spring.

Sexual harassment has been a problem within organisations for some time. Its manifestation in electronic communication networks can be seen to amount to cyber-bullying or cyber-stalking. Through looking at records relating to an instance of sexual harassment at a higher education institution, including from that member of staff's workplace, and those created by referrals to the police, the court service, and their workplace, this chapter shows how a piece of assistive technology called the ‘Protective Technology for Ensuring Guardianship of Environmental Resources' (PROTEGER) can automatically detect sexual harassment narratives. In this context, ‘environmental resources' should refer to both humans and documents. Human resource managers would be better equipped to deal with disputes between staff if PROTEGER was running on their local area network as it might not be a matter of one member of staff's word against another's.

Network politics is examined in the context of the Arab Spring. Network politics refers to politics and networks. These networks include the Internet, private networks, cellular networks, telephone networks, radio networks, television networks, etc. Network politics includes the applications of networks to enable one or more individuals or organizations to engage in political communication. Furthermore, network politics includes government regulation of networks. Finally, network politics includes the accompanying issues that arise when networks are used for political communication or when there is government regulation of networks. The domain of network politics includes, but is not limited to, e-politics (social networking for driving revolutions and organizing protests, online petitions, political blogs and vlogs, whistleblower websites, online campaigning, e-participation, virtual town halls, e-voting, Internet freedom, access to information, net neutrality, etc.) and applications of other networks in politics (robocalling, text messaging, TV broadcasting, etc.). Network politics has played a crucial role in the Arab Spring.

Digital addiction is a phenomenon where people who might take up addictive substances or other self-medicating activities do so instead with information and communications technology. The environment in which someone finds themselves is known to influence their behaviour. This might be as a result of the environment placing more demands on people with one cognitive set-up compared to those with a different one. One might not normally think of education environments as addictive, but the introduction of technology into them can affect different learners in different ways. Through computing a measure of brain activity called knol (k), this paper seeks to explore how learners with different learning styles react in environments that are differentiated according to the intensity of ICTs used and the physical architecture of the learning environment in which those ICTs are used.

Cystic fibrosis (CF) is the most common, life-shortening, genetic illness affecting children in Australia and New Zealand. The genetic abnormality results in abnormal anion transport across the apical membrane of epithelial cells in a number of organs, including the lungs, gastrointestinal tract, liver and genito-urinary tract. Thus, CF is a multi-system disorder that requires a multi-disciplinary approach. Respiratory disease is the predominant cause of both morbidity and mortality in patients with CF. However, there are significant and clinically relevant gastrointestinal, liver, pancreatic and nutritional manifestations that must be detected and managed in a timely and structured manner. The aim of this review is to provide evidence-based information and clinical algorithms to guide the nutritional and gastrointestinal management of patients with CF.

Background The incidence of pediatric inflammatory bowel disease (IBD) around the world is increasing. However, there is a scarcity of data on the epidemiology of pediatric IBD in the Southern Hemisphere. This study aimed to document the point prevalence of pediatric IBD in New Zealand on June 30, 2015. Methods All patients in New Zealand, under 16 years of age, with a diagnosis of IBD on June 30, 2015 were identified. Demographic and disease phenotypic details were collected and entered into a secure database. Age-specific population data for New Zealand were obtained and national and regional prevalence rates were calculated. Results The point prevalence of pediatric IBD, Crohn's disease, ulcerative colitis, and inflammatory bowel disease unclassified in New Zealand on June 30, 2015 was (95% confidence intervals) 21.7 (18.9-24.8), 16.5 (14.0-19.2), 3.3 (2.2-4.6), and 1.9 (1.2-3.0) per 100,000 children, respectively. There was a striking disparity between the prevalence rates in the North and South Islands. Conclusions The point prevalence of pediatric IBD in New Zealand represents the first-ever national, population-based prevalence rates of pediatric IBD published. Results from the Paediatric IBD in New Zealand (PINZ) study are also the first to show markedly higher prevalence rates of IBD in the southern part of a country compared with its northern counterpart. Ongoing prospective ascertainment of the incidence of pediatric IBD is required.

Background\ud Standardised mortality ratios do not provide accurate measures of preventable mortality. This has generated interest in using case-notes to assess the preventable component of mortality. But different methods of measurement have not been compared. We compared the reliability of two scales for assessing preventability and the correspondence between them.\ud Methods\ud Medical specialists reviewed case-notes of patients who had died in hospital using two instruments: a five-point Likert scale and a continuous (0-100) scale of preventability. To enhance generalisability we used two different hospital datasets with different types of acute medical patients across different epochs and in two jurisdictions (UK and US). We investigated the reliability of measurement and correspondence of preventability estimates across the two scales. Ordinal mixed effects regression methods were used to analyse the Likert scale and to calibrate it against the continuous scale. We report the estimates of the probability a death could have been prevented accounting for reviewer inconsistency.\ud Results \ud Correspondence between the two scales was strong; the Likert categories explained most of the variation (76% UK, 73% US) in the continuous scale. Measurement reliability was low but similar across the two instruments in each dataset (intra-class correlation 0.27 UK, 0.23 US). Adjusting for the inconsistency of reviewer judgements reduced the proportion of cases with high preventability, such that the proportion of all deaths judged probably or definitely preventable on the balance of probability was under 1%.\ud Conclusions \ud The correspondence is high between a Likert and continuous scale, although the low reliability of both would suggest careful measurement design would be needed to use either scale. Few to no cases are above the threshold when using a balance of probability approach to determining a preventable death, and in any case there is little evidence supporting anything more than an ordinal correspondence between these reviewer estimates of probability and the true probability. Thus, it would be more defensible to use them as an ordinal measure of the quality of care received by patients who died in the hospital.\ud

Proximal femoral fractures are a major public health concern with estimated annual direct and social costs amounting to £2 billion and average 30-day mortality risk of 7.5%. In response to the recent debate over out-of-hours hospital provision we investigated the ‘weekend effect’ at a major trauma centre, caring for acute injuries. A single centre, multi-surgeon review of 2060 patients performed. The distribution of patient and treatment variables compared in patients admitted on a weekday or the weekend. Fewer patients met performance indicators during weekend admission, time to surgery (63 vs. 71%) and time to geriatric review (86 vs. 91%). Weekend admission 30-day mortality was marginally lower than weekday (9.7% vs. 10.2%, OR 0.94, 95% CI 0.67 to 1.32, p = 0.7383). Increasing age, female gender, co-morbidities and confusion increased mortality risk. Binary regression analysis including these variables found no significant ‘weekend effect’. Despite the unit observing an increasing workload in the last five years, with meticulous workforce planning, senior doctor provisions and careful use of resources, it is possible to provide a seven-day fracture neck of femur service with no variation in thirty-day mortality by the day of admission.

Retaliatory feedback is a significant problem on the Internet, which is not just confined to online auction websites, but other online environments dependent on reputation systems. Explored in this paper are the acts of an Inter- net troller who spread malicious and false allegations that the series of confer- ences called WORLDCOMP are " fake. " This paper interviews one of the organisers of this conference to ask how they went about dealing with the retaliatory feed- back, and in particular their engagement with law enforcement agencies, such as the FBI, which now forms part of the US Department of Homeland Security. To reform the UK Home Office to learn lessons from this, the paper proposes making greater use of National Crime Agency and Police and Crime Commission- ers to provide a better strategic set-up for law enforcement under the UK Home Office. It also suggest using publicly funded solicitors and community wardens, as opposed to the current set-up of police constables, to deal with community policing. The paper concludes that in order for the promise made by the New Labour Government to be " tough on crime and tough on the causes of crime " to become a reality, encourages peaceful discourses between community members and former offenders is essential.

Internet trolling has become a popularly used term to describe the posting of any content on the Internet which is provocative or offensive. This is different from the original meaning online in the 1990s, which referred to the posting of provocative messages for humourous effect. Those systems operators (sysops) who run online communities are finding they are being targeted because of abuse posted on their platforms. Political discussion groups are some of the most prone to trolling, whether consensual or unwanted. Many such websites ara open for anyone to join, meaning when some members post messages they know are offensive but legal, others might find grossly offensive, meaning these messages could be illegal. This paper develops a questionnaire called the This Is Why We Can't Have Nice Things Scale (TIWWCHNT-20), which aims to help sysops better plan the development of online communities to take account of different users' capacity to be offended, and for users to self-assess whether they will be suited to an online community. The scale is discussed in relation to different Internet posting techniques where different users will act differently.

BackgroundIn children, paracetamol overdose due to deliberate self-poisoning, accidental exposure or medication errors can lead to paediatric acute liver failure and death. In Australia and New Zealand, the nature of ingestion and outcomes of paracetamol-associated paediatric acute liver failure have not been described.ObjectiveTo describe the nature and outcomes of paracetamol-associated paediatric acute liver failure.DesignRetrospective analysis of paracetamol-associated paediatric acute liver failure cases presenting 2002–2012.SettingNew Zealand and Queensland Paediatric Liver Transplant Services.Results14 of 54 cases of paediatric acute liver failure were attributed to paracetamol, the majority were secondary to medication errors. 12 of the 14 children were under the age of 5 years. Seven children received doses in excess of 120 mg/kg/day. Many of the other children received either a double dose, too frequent administration, coadministration of other medicines containing paracetamol or regular paracetamol for up to 24 days. Three children underwent transplant. One of these and one other child died.ConclusionsIn Australia and New Zealand, paracetamol overdose secondary to medication errors is the leading cause of paediatric acute liver failure. A review of regional safety practices surrounding paracetamol use in children is indicated.

A concern shared among nearly all generations of adults is that they must do something to tackle the problems in society caused by young people. They often forget that they were once young, and all too often blame young people for all of problems in their community. This paper challenges this view and shows how the blaming of Internet trolling on today's young people – called digital teens – is probably inaccurate. What might otherwise be called Troublesome Online Youth Groups (TOYGs), this paper looks at data collected from subjects in three UK regions (n=150 to 161), which includes young people who are not in education, employment or training (NEETs). Unlike might be typically thought, the data shows that far from these NEETs being the causes of Internet trolling it is in fact the areas with high levels of productivity, higher education and higher intelligence that report lower perceptions of quality of life that these electronic message faults (EMFts) most occur in.

The advancement of information and communications technology often results in early adoption, followed by concern over a digital divide, followed by mass adoption and then, inevitably, abuse and misuse of that platform. The most recent of these technologies is social networking services. The early adopters used Friendster and MySpace, and the masses now use Facebook and Twitter. The abuse of people on these platforms was called Cyberbullying in the case of the first two in the 2000s, and Internet trolling in the case of the second two in the 2010s. This paper reviews the legislation enacted in the UK parliament between 1981 and 2012 to deal with these offences, called ‘flame trolling’, for those based on transgress humour, or electronic message faults more generally. The paper presents a framework that includes a ‘Trolling Magnitude Scale’ based on established trolling culture, in order to link the legislative offences to the severities of those faults, as well as to the ability of specific Internet users to tolerate them or otherwise. The paper concludes that by using this framework law enforcement agencies such as the police can apply the laws more fairly and proportionally to protect free speech and at the same time be tough on the causes of electronic message faults in the form of Internet abuse and data misuse.

When one thinks of barriers to setting up a news corporation, one might think in terms of the costs of machinery and staffing. This case study of a start-up news corporation called Crocels News shows that the biggest cost can be in resolving legal disputes, most significantly from news articles scrutinising public bodies and their staff. This chapter investigates the difficulties faced by Crocels News in providing news content. By considering the legal correspondence received, the chapter provides insights into some of the problems all news services are likely to experience if they do not have access to the huge legal budgets of the established news corporations. The findings are particularly worrying for emerging forms of news reporting, such as citizen journalism. The chapter therefore proposes changes in statute so that case law that protects free speech is more easily enforced.

Internet trolling describe the posting of any content on the Internet which is provocative or offensive, which is different from the original meaning online in the 1990s, referring to the posting of messages for humourous effect. Those systems operators (sysops) who run online communities are being targeted because of abuse posted on their platforms. Political discussion groups are some of the most prone to trolling, whether consensual or unwanted. Many such websites ara open for anyone to join, meaning when some members post messages they know are offensive but legal, others might find grossly offensive, meaning these messages could be illegal. This paper develops a questionnaire called the This Is Why We Can't Have Nice Things Scale (TIWWCHNT-20), which aims to help sysops better plan the development of online communities to take account of different users' capacity to be offended, and for users to self-assess whether they will be suited to an online community. The scale is discussed in relation to different Internet posting techniques where different users will act differently.

Academia is often plagued with those who define themselves by whether they are “quantitative” or “qualitative.” This chapter contests that when it comes to researching social media the two are inseparable in datafying user generated content. Posts on Twitter for instance have a textual element to the narratives that could be considered qualitative, but also quantitative criteria can be applied. Interviewing approaches can allow for the exploration of discourses to produce new theories, which may then rely of those approaches commonly thought of as quantitative. This chapter tests out a variety of different approaches to show how it is only through using all approaches available can social media be triangulated to produce accurate modelling of user behaviour.

Educator–learner interaction has been a key factor in the advantage traditional learning environments have had over electronic ones. This chapter explores four projects that have challenged this premise. The Young Enterprise Project showed that computers can play an important part of youth entrepreneurship, and subsequently the Emotivate Project showed how they can be an essential part of blending electronic learning with community activism and arts. The Digital Classroom of Tomorrow Project showed that it is possible to use eTwinning of the schools through networked learning. Finally, the Free Digital Project is discussed, which is an initiative that brought all the other projects together to show how through the Cloud young and disabled people can become Internet entrepreneurs.