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In this paper, we provide a new approach to defining and operationalizing integration as “making place.” We distinguish between making place for – a process of accommodation – and making place with...

Background Adolescents are typically admitted for a short period of time after inpatient surgery, leaving much of their recovery to occur at home. Pain, and thus pain management, is a major component of recovery at home. Research among pediatric outpatient surgical patients has found that pain experienced in the community setting after discharge is often severe and is related to knowledge deficits resulting in inadequate pain management. However, there is little research on community pain management after inpatient surgery. Aim This study aimed to explore the pain experiences of seven adolescents who underwent inpatient surgery. Design This study used Interpretative Phenomenological Analysis as a methodology. Setting This study took place at a pediatric tertiary care hospital in Canada. Participants 7 adolescents participated, all of whom underwent inpatient surgery with admission between 2-14 days in length. Methods Semi-structured interviews were conducted 2 to 6 weeks post-discharge. Results Three themes were identified that described their experiences, including managing severe pain at home with minimal preparation, changes in the parent–child relationship, and difficulties returning to school and regular activities. Conclusions Involving adolescents directly in discharge education, particularly with the use of novel interventions and coaching, may improve outcomes. Key Practice Points Adolescent patients experience significant pain after discharge from hospital after inpatient surgical procedures. Adolescents are in need of adolescent-specific pain management education to increase skill and knowledge and address pain management-related misconceptions. Greater emphasis on involving adolescents in their own pain care and novel intervention could prove useful in improving outcomes.

Background: Short hospital admission periods following pediatric inpatient surgery leave parents responsible for managing their child’s postoperative pain in the community following discharge. Little is known about the experiences of parents caring for their child’s postoperative pain after discharge home following inpatient surgery. Research examining parental postoperative pain management following their child’s day surgery has found that parents are challenged in their pain management knowledge and practices. Aims: This interpretative phenomenological analysis study sought to understand parents’ experiences caring for their child’s postoperative pain at home. Methods: Semistructured telephone interviews were conducted with seven parents between 2 weeks and 6 months after their child’s discharge from hospital. Results: Identified themes were coming home without support, managing significant pain at home, and changes in the parent–child relationship. Conclusions: Parents could potentially benefit from nurses optimizing educational interventions, from receiving ongoing support of transitional pain teams, and from assistance with return to school planning.

Two strains of mice (BALB/c and CB6F1) were vaccinated with a range of Bacille Calmette-Guérin (BCG) Danish doses from 3 × 105to 30 CFU/mouse, followed by aerosol infection withMtb(H37Rv or West-Beijing HN878 strain). The results indicated that both strains of mice when infected with HN878 exhibited significant protection in their lungs with BCG doses at 3 × 105—3000 CFU (BALB/c) and 3 × 105—300 CFU (CB6F1). Whereas, a significant protection was seen in both strains of mice with BCG doses at 3 × 105—300 CFU when infected with H37Rv. A significant increase in the frequencies of BCG-specific IFNγ+IL2+TNFα+CD4 T cells in the BCG doses at 3 × 105—3000 CFU (BALB/c) and 3 × 105—300 CFU (CB6F1) was seen. The IFNγ+IL2+TNFα+CD4 T cells correlated with theMtbburden in the lungs of HN878 infected mice (BALB/c and CB6F1) whereas, IFNγ+TNFα+CD4 T cells correlated with the BALB/c mice infected with H37Rv or HN878. The BCG dose at 3000 CFU (an equivalent single human dose in the mice by body weight) is protective in both strains of mice infected with H37Rv or HN878 and may serve an interesting dose to test new TB vaccine in a preclinical animal model.

Objective To map research based pain management interventions used in the paediatric intensive care unit. Methodology A scoping review of research literature has been conducted. Five databases were searched from their inception to end 2015 (CINAHL, EMBASE, MEDLINE, PsychINFO, and ProQuest Dissertations & Theses Global). Reference lists from the screened full text articles were reviewed. Results 7046 articles were identified, 100 underwent full text screening and 27 were included in the scoping review. Seventeen (63%) were non-experimental, and 10 (37%) were experimental, of which 8 (30%) were randomised controlled trials. The majority of the articles focused on pharmacological interventions (n = 21, 78%), one on physical, and one on psychological interventions. Four studies included more than one category of interventions. The majority of the studies focused on post-operative pain management (n = 18, 67%), three (11%) on analgesia and sedation management and six (22%) on other pain management for different conditions. Discussion Most studies included in this scoping review focused on medications and post-operative pain management and most were non clinical trials. More research, including clinical trials, is warranted to determine the effectiveness of pharmacological and non-pharmacological interventions for pain management in the paediatric intensive care unit.

COVID-19 has proven to be a potent disruptor of postgraduate training, assessment and learning. In so doing, it has equally proved to be a potent catalyst and has driven innovation. Here we discuss the response of the Federation of the three UK Royal Colleges of Physicians to the challenges presented in these areas by the COVID-19 pandemic.

To assess the reach, acceptability, and effect of the BSweet2Babies video showing breast-feeding, skin-to-skin care, and sucrose during blood sampling on intention to recommend the video or advocate for use of the interventions. In July 2014, the video and an electronic survey were produced and posted. After 1 year, the online viewer survey responses and YouTube analytics were analyzed. One year after posting, the BSweet2Babies video had 10 879 views from 125 countries and 187 (1.7%) viewers completed the survey. Most respondents were aware of the analgesic effects of breast-feeding, skin-to-skin care, and sucrose. Nearly all respondents (n = 158, 92%) found the BSweet2Babies video to be a helpful resource and 146 (84%) answered that they would recommend the video to others. After viewing the video, 183 (98%) respondents answered that they would advocate for 1 or more of the interventions. The BSweet2Babies video showing effective pain treatment during blood sampling had a large reach but a very small response rate for the survey. Therefore, analysis of acceptability and effect on intention to recommend the video and advocate for the interventions depicted are limited. Further research is warranted to explore how to best evaluate videos delivered through social media and to determine the effect of the video to promote knowledge translation into clinical practice.

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Background: Posterior interosseous nerve neurectomies (PINN) are an option in the treatment of chronic dorsal wrist pain. However, the literature describing PINN consists primarily of small case series, and the procedure is typically done as an adjunct treatment; therefore, the outcomes of the PINN itself are not well known. We performed a systematic review of the literature to provide characteristics of patients following a PINN. Methods: A systematic review of the literature was performed. Papers published in the PubMed database in English on isolated PINN were included. Articles in which a PINN was performed as an adjunct were excluded. Primary outcomes were return to work, patient satisfaction, pain/function scores, wrist range of motion, complications, and pain recurrence. Weighted averages were used to calculate continuous data, whereas categorical data were noted in percentages. Results: The search yielded 427 articles including 6 studies and 135 patients (136 cases). The average age was 43.6 years (range, 17-75), and most patients were female (54.1%). At an average final follow-up of 51 months, 88.9% of patients were able to return to work. After initial improvement, a recurrence of pain occurred in 25.5% of patients at an average of 12.3 months. Excluding recurrence of pain, the complication rate was 0.9%, including 1 reflex sympathetic dystrophy. Overall, 88.4% of patients experienced a subjective improvement and were satisfied with the procedure. Conclusions: Isolated PINN have shown excellent clinical outcomes, with few patients experiencing recurrent pain at long-term follow-up. PINN can provide relief in patient’s chronic wrist pain.

Objective: To establish if focused rigidity casts (FRCs) reduce forefoot pressures in healthy participants, and to examine the effects of FRCs on contact area, contact pressure, peak pressure and force–time integral on the forefoot and the plantar pressures of the whole foot in participants with differing foot posture. Method: Thirty-one healthy participants were recruited from a convenience sample of university staff and students. This study employed a repeated measures design, where walking in FRCs was compared with a control (canvas shoe). An in-shoe pressure measuring system was used to record changes in plantar pressure and the foot posture index was used to record foot posture. Results: A statistically significant reduction in contact pressure (p ≤ 0.000; n=31) and peak pressures (p ≤ 0.002; n=31) was observed in the forefoot. A statistically significant reduction in contact area and contact pressure over the whole foot and rear foot when participants wore the FRC was also found. The greatest decrease occurred in participants with a supinated foot posture while the least occurred in participants with a pronated foot posture. An increase in peak pressure was found in the mid foot for participants with a normal and supinated foot postures when the FRC was worn. Conclusion: The results suggest that FRCs are an effective way of reducing forefoot pressures when compared with the control shoe. FRC's work by redistributing pressure away from the forefoot to the area of increased rigidity beneath the cast. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.

The objective of this study was to evaluate the long-term benefits of sharp scalpel debridement of painful forefoot plantar callosities in rheumatoid arthritis (RA). The null hypothesis: sharp scalpel debridement would offer no additional long-term advantage in terms of pain and function. Sixty-five people with RA were randomised to receive regular sharp scalpel debridement of painful forefoot plantar callosities in conjunction with a combined therapeutic approach or a combined therapeutic approach alone. The primary outcome measure was change at 18 months in participant-reported forefoot plantar pain measured by a 100-mm visual analogue scale (VAS). Secondary outcome measures were recorded at baseline and study exit and included revised Foot Function Index, Health Assessment Questionnaire, Foot Impact Scale and gait parameters. At 18 months, there were no differences between groups for the primary outcome VAS-measured forefoot plantar pain (left foot (F = 0.23, p = 0.635), right foot (F = 2.14, p = 0.148)). Within-group changes were highly significant (treatment arm, difference = 16.9 (95 % confidence interval (CI) 9.4, 24.4), t = 4.6, p < 0.0001; control arm, difference = 17.5 (95 % CI 9.4, 25.5), t = 4.4, p < 0.0001). There was little change in scores of overall function and foot impact in either group and there were no significant changes in gait parameters noted. The long-term effects of sharp scalpel debridement of painful forefoot plantar callosities in people with RA, when used in conjunction with a combined therapeutic approach, produced no additional benefit over the combined therapeutic approach alone. Trial registration http://www.controlled-trials.com/ISRCTN05190231.

This study examined how individual, relational and environmental factors related to adolescent demand for HIV voluntary counseling and testing (VCT). A cross-sectional survey among randomly selected 16-19-year-olds in Ndola, Zambia, covered individual (e.g., HIV knowledge), environmental (e.g., distance), and relational factors (e.g., discussed VCT with family). Multivariate regression analysis compared 98 respondents who planned to test for HIV within the year with 341 respondents who did not. Discussing HIV testing with family members was strongly associated with planning to test (odds ratio [OR] = 6.1; 95% confidence interval [CI] = 2.24-16.58). VCT discussions with sex partners (OR = 3.64; 95% CI = 1.13-11.71) and with friends (OR = 2.61; 95% CI = 1.34-5.08) were also associated with HIV testing plans. Significant individual factors were having ever had sex (OR = 2.33; 95% CI = 1.41-3.84) and HIV risk perception (OR = 2.71; 95% CI = 1.51-4.88). Relational and individual factors strongly correlated with VCT demand, supporting the need to examine these factors when implementing and evaluating adolescent VCT strategies.

Summary In light of the increasing consumer demand for safe, high-quality food and recent public health concerns about food-borne illness, governments and agricultural industries are under pressure to provide comprehensive food safety policies and programmes consistent with international best practice. Countries that export food commodities derived from livestock must meet both the requirements of the importing country and domestic standards. It is internationally accepted that end-product quality control, and similar methods aimed at ensuring food safety, cannot adequately ensure the safety of the final product. To achieve an acceptable level of food safety, governments and the agricultural industry must work collaboratively to provide quality assurance systems, based on sound risk management principles, throughout the food supply chain. Quality assurance systems on livestock farms, as in other parts of the food supply chain, should address food safety using hazard analysis critical control point principles. These systems should target areas including biosecurity, disease monitoring and reporting, feedstuff safety, the safe use of agricultural and veterinary chemicals, the control of potential food-borne pathogens and traceability. They should also be supported by accredited training programmes, which award certification on completion, and auditing programmes to ensure that both local and internationally recognised guidelines and standards continue to be met. This paper discusses the development of policies for on-farm food safety measures and their practical implementation in the context of quality assurance programmes, using the Australian beef industry as a case study.

For many construction and design firms survival, is arguably predicated on their ability to work together with other organizations. The demands of time and budget placed on these industries by building owners challenge traditional project delivery methods, to which industry is responding. Conversely, many academic institutions continue to neglect the opportunity to collaborate between the design and construction aspects of building by ignoring shared responsibilities. Those that provide opportunities often do so in limited amounts of time or with a limited number of students. This paper presents an undergraduate academic initiative that fostered collaboration between architecture and construction management students, a model which is now proposed to become the basis for a collaborative experience for every construction student in the department. This is significant because pedagogical models for teaching many topics such as conceptual estimating, pre-design services, or sustainability within the two curri...

Adults of monkey and ape species often examine and fondle the penis and scrotum of youngsters. In the past, tribal societies in hot climates routinely wore little clothing so that the genitalia of boys were commonly exposed and unremarked. Diapers were unknown. By contrast, in Western societies genitalia must always be covered, and unethical adults can traumatize boys to the point of their suicide by in secret manipulating these genitalia. The cause of this negative reaction seems to be related to the tension involved in toilet-training toddlers. Parents are usually anxious to hurry the process, in the past to reduce the laundry of cloth diapers and presently to enrol the child in day care programs that refuse to admit children in diapers. Coercive toilet-training may cause irrational fears in boys, some of whom continue to wet their beds as adults. Western insistence that genitalia must be private, never public, may instil in boys that privacy means dirty as well, and too shameful to talk about to their parents or guardians.

The concept of participation in rural development has been evolutionary for the past two decades with those involved, such as development agencies and governments, particularly in rural water supply, re-evaluating their active role. The move towards effective community participation has encouraged a shift from the traditional top-down to a bottom-up approach whereby there is a decentralisation of unevenly distributed resources and power to empower a community and allow mobility of ‘people participation’. The Molinos water project is the first large-scale development project of its kind introduced into the village of Molinos in an under-developed area of Chile, where there has been no tradition of people participation. The project objective was to implement a low technology, low budget water treatment plant to the village of Molinos. Various aspects have hindered the continued development of the project including both technical and financial. In terms of people participation, the initial approach used was the top-down approach. There was a failure to fully integrate the community or inform the community in a formal manner about the project and consult them regarding key project issues. This case study illustrates that the lack of comprehensive consultation and the low level of participation of the community on the participatory scale does not achieve much in terms of people-centred benefits. For governance at the local level to be effective, participation should be inclusive and communicative so as to enhance transparency throughout the project lifetime.

The publication of scientific articles that receive few or no citations raises questions of the appropriate use of resources as well as ethics. In the case of animal research, the ethics issue extends beyond human patients to nonhuman animals, as the research subjects them to pain and, typically, to death. This study is a citation analysis of animal research conducted at Toronto's Hospital for Sick Children (HSC). Of the 594 publications (1990 to 1995) on animal research by affiliates of HSC, 29% received fewer than 10 citations in a 10-year period. We compare the research history of 13 "best" and 13 "worst" HSC scientists. Worst researchers continue to do infrequently cited research. Recommendations indicate how institutions and researchers can become more effective and accountable.

This paper introduces the need for the responsible selection of construction products and then analyses a number of assessment methodologies. Some computer packages and guidebooks that assist in life cycle assessment or aid construction product selection are briefly reviewed. Issues that affect decision-making and complexities in the construction industry are discussed. A tool for assisting responsible construction product selection is then presented that involves carrying out a streamlined life cycle assessment, comparing a novel product to a traditional product. The tool is pragmatic because only three environmental criteria are considered (resource consumption, energy use and human and ecological impacts) and a relative rather then absolute assessment is required. The decision-assisting methodology is demonstrated with a case study. The limitations and benefits of the streamlined LCA are finally presented.

Strategic environmental assessment (SEA) is seen as an important tool for integrating the environment into decision-making, e.g. at plan and programme levels where it is being used with increasing regularity. At the policy and most strategic decision levels, however, it is less clear how SEA can best be used or what methodologies are appropriate in what are inevitably highly politicized contexts. This paper reports on a study carried out for the European Commission to review the mechanisms of integration at strategic decision levels and to examine the role of SEA in helping to achieve better integration. This was undertaken by first reviewing integration and SEA in all EU member states and in a range of other countries and international financing organizations, and then analysing in detail 20 SEA and integration case studies at various strategic decision levels, primarily policy and plan levels. What is clear is that SEA at the most strategic level needs to be flexible in relating to the policy-making process, but can bring significant advantages by providing a more systematic approach to the consideration of environmental issues. Existing institutional mechanisms may already provide elements of SEA that can be harnessed together in a more systematic process. At the most strategic levels qualitative, participation and communication processes become much more important than technical methodologies. SEA should be seen as complementary to the newly emerging tool of sustainability appraisal, although the exact relationship will depend upon the preferred interpretation of sustainable development. Copyright © 2003 John Wiley & Sons, Ltd. and ERP Environment.

This case study describes a highly collaborative project created to develop an online self-assessment tool that offers students the opportunity to plan their preparedness to enter the work place named the Preparation for Placement Assessment Tool. The aim of the project was to develop an artefact that aids all students to think about and prepare for placements, and more broadly to bework-ready. It also aims to help disabled students to identify and manage theirindividual needs. Working in collaboration with students is offered as aneffective strategy for improving project outcomes and managing the tensions foracademics of balancing research, teaching, learning and scholarly activities.This paper discusses the project background, design and delivery, which includesthe engagement of a diverse mix of students, and the practice researchmethodologies used. Discussion focuses on the project's impact, particularly on the students involved. Four key factors: student power, methodology, the use offunding and slow burn are identified as significant for success.

The feasibility of real-time calculation of parameters for an internal combustion engine via reconfigurable hardware implementation is investigated as an alternative to software computation. A detailed in-hardware field programmable gate array (FPGA)-based design is developed and evaluated using input crank angle and in-cylinder pressure data from fully instrumented diesel engines in the QUT Biofuel Engine Research Facility (BERF). Results indicate the feasibility of employing a hardware-based implementation for real-time processing for speeds comparable to the data sampling rate currently used in the facility, with acceptably low level of discrepancies between hardware and software-based calculation of key engine parameters.

Cancer research involves the use of millions of nonhuman animals and billions of dollars in public funds each year, but cures for the disease remain elusive. This article suggests ways to reduce the use of animals and save money by identifying articles that garnered few citations over the 9 years after they were published. I obtained the citations received by 786 articles in 9 general cancer journals published in 1990 and the number of animals used (where possible) in the 220 animal-based research articles. By calculating the ratio of animal number to citation number, I identified the most effective (those with many citations and few animals used) and the least effective (those with many animals and few citations) articles. Using these ratios, I compared the effectiveness of their experiments/articles for the 9 journals, author affiliations and nationalities, and funding sources. This article recommends ways in which experiments with little chance of being influential can be avoided, thus freeing resource...

The renin-angiotensin system is activated in acute severe asthma. The precise mechanism of activation is at present unknown, but may involve, beta2-agonists, catecholamines or proteases released in airway inflammation. This study aims to identify potential factors involved in the activation of the renin-angiotensin system in acute asthma. Forty asthmatics with severe exacerbations of asthma, assessed by measurement of peak expiratory flow rate (mean (SD) 35 (18)% predicted), oxygen saturation (94 (4)%) and pulse rate (108 (16) beats x min(-1)) were recruited. Nineteen (48%) asthmatics had elevated plasma angiotensin II levels (median (interquartile range) 10.9 (4.3-23.5) pg x mL(-1) (normal range 3-12 pg x mL(-1))) and 10 (25%) had elevated plasma renin concentration (22.0 (10.0-50.0) microU x mL(-1) (normal range 9-50 microU x mL(-1))). Plasma renin and angiotensin II correlated strongly, implying renin-dependent angiotensin II formation. No correlation was found between plasma salbutamol, adrenaline, nor-adrenaline, endothelin-1, histamine, eosinophilic cationic protein, serum angio-tensin-converting enzyme (ACE) activity, total immunoglobulin E (IgE), urea and electrolytes, indicators of the severity of the attack, atopic status, blood pressure and renin or angiotensin II levels. We conclude that although a subpopulation of asthmatics appear to have raised renin and angiotensin II during attacks of acute, severe asthma, the mechanism of activation of the renin-angiotensin system remains unclear.

Critical Hemoglobin Desaturation Will Occur before Return to an Unparalyzed State following 1 mg/kg Intravenous Succinylcholine Jonathan Benumof;Rachel Dagg;Reuben Benumof; Anesthesiology

The value of an inflammation-based prognostic score (Glasgow Prognostic score, GPS) was compared with performance status (ECOG-ps) in a longitudinal study of patients (n=101) with inoperable non-small-cell lung cancer (NSCLC). At diagnosis, stratified for treatment, only the GPS (HR 2.32, 95% CI 1.52–3.54, P

Publisher Summary Circulating hormones and vasoactive peptides play a minor role in the physiological regulation of airway tone in normal individuals. Adrenaline is the only hormone known to influence bronchomotor tone, and it is only during strenuous exercise that concentrations are elevated sufficiently to cause bronchodilation. Circulating hormones play a more important role in the regulation of airway tone in diseased states of the airways, such as asthma, and possibly in other disorders, such as cor pulmonale, congestive cardiac failure, respiratory failure, and thyroid diseases. Circulating adrenaline has a role in the maintenance of resting airway tone in asthma, particularly in those patients in whom resting airway caliber is already reduced. The elevated adrenaline and atrial natriuretic peptide concentrations achieved after vigorous exercise may act to counteract exercise-induced asthma. Airway tone and reactivity are influenced by oxygen levels, although the precise effects of oxygen tension on airway function in health and airway disease are not clearly established.

The systemic pressor effects of angiotensin II (ANGII) are well described, whereas relatively little is known regarding its effects on the pulmonary circulation in humans. Doppler echocardiographic measurements were performed in eight normal volunteers after a 30-min control infusion (baseline), after sequential 30 min stepwise infusions of ANGII (2, 4, and 6 ng/kg/min), and again 30 min after stopping ANGII therapy. There were significant dose-related increases in mean pulmonary arterial pressure and total pulmonary vascular resistance, with values returning to baseline after stopping ANGII therapy. However, the increase in vascular resistance was proportionately greater for the pulmonary compared with systemic vascular bed, and the difference was significant at all doses of ANGII. Thus, the pulmonary vasculature exhibited greater sensitivity to the vasoconstrictor effects of ANGII in comparison with the systemic vasculature.

The new Australian two-row malting barley varieties, Franklin and Tallon, which were derived from Triumph, were compared with two existing varieties, Schooner and Weeah. Samples of each variety, gr...

We have measured the far-infrared absorption spectrum of cylopropane (C3H6) at frequencies up to 400 cm−1, at densities up to 5 amagat at 295 K and up to 16 amagat at 360 K, using a combination of Fourier-transform and laser techniques. (An amagat is defined as the density of a gas at N.T.P.). By studying the density-dependence of absorption, we have isolated the collisional component of the spectrum. This arises from pair dipole moments induced by the permanent quadrupole, octopole, and hexadecapole moments of the C3H6 molecule. To the extent that the intermolecular potential is isotropic, the induced spectrum can be expressed as the convolution of symmetric top free rotation spectra with translational spectra representing the relative motion of an interacting molecular pair. The former are calculated using expressions recently derived. For the latter we use information theory to provide a "least-biased" estimate based only on available information concerning the zeroth and second moments of the translational frequency spectrum, which can be calculated without approximation within the framework of equilibrium statistical mechanics. The result of these computations is a simple analytic expression for the absorption coefficient [Formula: see text], which is entirely free of adjustable parameters, and yet yields a good representation of the experimental results over most of the frequency range. Our results lend strong support to the theoretical values of the multipole moments calculated by other workers.

Objective The purpose of this article is to review the available literature on the psychological sequelae of therapeutic abortion, addressing both the issue of the effects of the abortion on the woman involved and the effects on the woman and on the child born when abortion is denied. Method Papers reviewed were initially selected by using a Medline search. This procedure resulted in 225 papers being reviewed, which were further selected by limiting the papers to those reporting original research. Finally, studies were assessed as to whether or not they used control groups or objective, validated symptom measures. Results Adverse sequelae occur in a minority of women, and when such symptoms occur, they usually seem to be the continuation of symptoms that appeared before the abortion and are on the wane immediately after the abortion. Many women denied abortion show ongoing resentment that may last for years, while children born when the abortion is denied have numerous, broadly based difficulties in social, interpersonal, and occupational functions that last at least into early adulthood. Conclusions With increasing pressure on access to abortion services in North America, nonpsychiatrist physicians and mental health professionals need to keep in mind the effects of both performing and denying therapeutic abortion. Increased research into these areas, focusing in particular on why some women are adversely affected by the procedure and clarifying the relationship issues involved, continues to be important.

This study explored how adolescents involve their families, friends and sex partners when making decisions about seeking HIV voluntary counseling and testing (VCT) and disclosing their HIV-status. The study is based on 40 qualitative in-depth interviews with 16 to 19 year olds who knew their HIV status in Ndola, Zambia. The findings show that: a) almost half of the youth turned to family members for advice or approval prior to seeking VCT; b) a disapproving reaction from family members or friends often discouraged youth from attending VCTuntil they found someone supportive; c) informants often attended VCTalone or with a friend, but rarely with a family member; and d) disclosure was common to family and friends, infrequent to sex partners, and not linked to accessing care and support services. Family members need access to information on VCT so they can support young peoples' decisions to test for HIV and to disclose their HIV status. These results reinforce the need to provide confidential VCT services for adolescents and the need to develop and test innovative strategies to reach adolescents, their families and sex partners with VCT information and services.

BioScene (scenarios for reconciling biodiversity conservation with declining agriculture use in mountain areas in Europe) was a three-year project (2002–2005) funded by the European Union’s Fifth Framework Programme, and aimed to investigate the implications of agricultural restructuring and decline for biodiversity conservation in the mountain areas of Europe. The research took a case study approach to the analysis of the biodiversity processes and outcomes of different scenarios of agri-environmental change in six countries (France, Greece, Norway, Slovakia, Switzerland, and the United Kingdom) covering the major biogeographical regions of Europe. The project was coordinated by Imperial College London, and each study area had a multidisciplinary team including ecologists and social and economic experts, which sought a comprehensive understanding of the drivers for change and their implications for sustainability. A key component was the sustainability assessment (SA) of the alternative scenarios. This article discusses the development and application of the SA methodology developed for BioScene. While the methodology was objectives-led, it was also strongly grounded in baseline ecological and socio-economic data. This article also describes the engagement of stakeholder panels in each study area and the use of causal chain analysis for understanding the likely implications for land use and biodiversity of strategic drivers of change under alternative scenarios for agriculture and rural policy and for biodiversity management. Finally, this article draws conclusions for the application of SA more widely, its use with scenarios, and the benefits of stakeholder engagement in the SA process.

The absorption spectrum of gaseous N2O was measured in the spectral region from approximately 15–120 cm−1 at 11 different densities from 3.3 to 64.5 amagat. (An amagat is defined as the density of a gas at N.T.P.) The data were obtained with a Michelson Fourier transform IR spectrometer and a far IR laser using a stainless steel absorption cell 9.26 cm in length. From the density dependence of the absorption, the collision-induced spectrum above approximately 60 cm−1 was clearly separated from the relatively strong allowed transitions peaking at the lower frequency near 22 cm−1. From theoretical expressions for the line shape, derived using information theory, and a reliable value of the quadrupole moment (obtained from the birefringent measurements), we estimate the octopole moment to be 7.6 × 10−34 esu and the hexadecapole moment to be 16.9 × 10−42 esu. Alternatively, if the hexadecapolar contribution is considered to be negligible, then we estimate the octopole moment to be 9 × 10−34 esu. These results are consistent with measurements of the total integrated absorption of the IR band assuming a theoretical expression for the contribution due to the allowed dipole transitions.

Introduction Telomeres are specialized DNA structures found at the end of linear chromosomes, which in humans contains the repetitive DNA sequence, (TTAGGG)n and associated proteins. Telomere length (TL) is important for replicative capacity of cells, and, in somatic cells, telomere length shortens with each cell division. Once a critically short length is reached, cells enter senescence or undergo apoptosis. In the general population, TL varies greatly and declines with age. Chemotherapy can increase the rate of telomere shortening, although these findings have not been consistently demonstrated. There is evidence, mostly in adults, suggesting that patients with shorter TL experience increased toxicity from cancer treatment. Patients with the short telomere syndrome, Dyskeratosis Congenita undergoing hematopoietic stem cell transplantation have increased rates and degree of organ toxicity when given myeloablative conditioning. In the pediatric population there have been no studies assessing the relationship between TL and rates of toxicity after chemotherapy, and few investigating telomere dynamics following chemotherapy. We undertook a retrospective analysis to investigate the relationship between TL and chemotherapy toxicity, and also telomere dynamics in children treated for acute lymphoblastic leukemia (ALL). Methods Patients enrolled on the Australian and New Zealand Children's Hematology and Oncology Group's (ANZCHOG) Study 8 for ALL at the Children's Hospital at Westmead and the Sydney Children's Hospital from October 2002 to November 2011 who had provided consent and who had stored samples suitable for TL analysis were included in the study. Organ toxicity information was collected from the Study 8 database, as well as examination of patient medical records and pathology information systems. Liver and renal toxicities were documented based on abnormalities in transaminases, bilirubin and creatinine respectively. Pulmonary and neurotoxicities were determined through medical record and imaging findings. Standard common terminology criteria for adverse events (CTCAE) criteria were used to systematically grade toxicity. Infectious disease information and intensive care admissions as well as time to complete each cycle of therapy were used as surrogate markers for toxicity and bone marrow recovery. Survival and relapse rates were also analyzed. Relative TL was measured using a quantitative PCR technique on DNA extracted from mononuclear cells taken at Day 79 following commencement of induction and consolidation therapy, and also at the end of treatment, typically 24 months from diagnosis. The relative TL was converted to an age adjusted TL (AATL) by subtracting the expected relative TL (i.e. 50th percentile for age of the patient) from the measured relative TL, so that patients of all ages could be analyzed together. For analysis the cohort was separated into four groups based on AATL quartiles. Results In all, 460 patients with research consent were enrolled on ANZCHOG ALL Study 8 at the 2 hospitals included in this study. Of these 157 patients with AATL measurement and toxicity information were included in our analysis with 149 being standard or medium risk. The median age of diagnosis was 4.79 years (range 1.1 - 17.89) with a median follow up of 53 months (range 9-124 months). The median AATL on Day 79 was 0.035 (range -0.41 to 0.73). The average change in TL from day 79 to end of treatment was -0.126 (range -0.81 to 0.40), which is equivalent to approximately 8-10 years of natural ageing. There was no significant association between survival (Figure 1) or rates of grade 3 or 4 organ toxicity, relapse (Table 2) or bone marrow recovery and AATL. Renal toxicity was significantly increased in the second shortest quartile, however numbers are small (4 patients in second quartile vs 1 in fourth quartile). Conclusion There is an increased rate of telomere attrition during treatment for childhood ALL, however telomere length does not appear to be associated with increased rates of organ toxicity. Support: NHMRC APP1057746 and NHMRC GNT1056667 Disclosures No relevant conflicts of interest to declare.

BACKGROUND: Endothelin-1 (ET-1) is a potent bronchoconstrictor which may have a role in the pathogenesis of asthma. The levels of ET-1 in saliva, induced sputum, and plasma from asthmatic and non-asthmatic subjects were compared. METHODS: Sputum induction was performed on 28 asthmatic subjects and nine normal volunteers. ET-1 levels were measured in plasma, saliva, and sputum samples and reversed phase high performance liquid chromatography (RP-HPLC) was performed on saliva and sputum samples. RESULTS: ET-1 was present in the following order of concentration in both normal and asthmatic subjects: saliva > sputum > plasma (saliva, median 30.1 and 23.9 pg/ ml, respectively; sputum, median 15.5 and 11.2 pg/ml; plasma, median 3.1 and 3.6 pg/ ml). There were no differences between asthmatic and normal subjects in the levels of ET-1 in each fluid. The levels of ET-1 in asthmatic subjects were not influenced by whether or not they were taking inhaled steroids. RP- HPLC of sputum and saliva confirmed the presence of ET-1 in these fluids. CONCLUSIONS: Levels of ET-1 can be measured in saliva and sputum obtained by sputum induction in asthmatic and healthy subjects and, although no difference was found in basal levels of ET-1 in sputum, saliva and plasma between normal subjects and asthmatics without bronchoconstriction, it is apparent that ET-1 is produced or released locally within the respiratory tract in concentrations higher than those in plasma.

The lack of unequivocal immunological correlates of human protection and an absence of a validated animal model for acellular pertussis vaccines, compounded by limited opportunity to undertake efficacy studies in humans and laboratory evaluation side by side, has made it difficult to compare vaccines and formulations. In the present study, the effect on the booster response to pertussis in adolescents primed in infancy with whole cell pertussis vaccine, of three low dose acellular pertussis/diphtheria/tetanus toxoid (TdPa) formulations with or without inactivated poliomyelitis vaccine (IPV) components, was investigated. To assess the relationship between laboratory vaccine evaluation and clinical trial performance, parallel evaluation of the same TdPa vaccines were carried out in a mouse booster model with whole cell pertussis vaccine priming. Prior to boosting, the clinical subjects had low cell mediated immune responses (CMI) responses to pertussis vaccine components. After boosting, all TdPa formulations stimulated CMI responses to the pertussis vaccine components assessed. The booster responses to the pertussis antigens remained skewed towards Th1 type even though acellular pertussis vaccines were used. In general the antibody and CMI responses to pertussis antigens in the mouse model followed the trend seen in the human subjects. Protection against aerosol challenge with virulent Bordetella pertussis was related to the magnitude of the antibody and CMI responses in the mouse model. As in the human subjects, the responses remained skewed towards Th1 type.

This paper provides an overview of the Australian Pesticides and Veterinary Medicines Authority's (APVMA) Adverse Experience Reporting Program for veterinary medicines (AERP Vet). It outlines the history of the AERP Vet and how the program investigates adverse experience reports received from veterinarians, product registrants and members of the public. The benefits to veterinarians of such a program are highlighted and include the ability to trust in the safety, quality and efficacy of the veterinary drugs that they handle and administer daily.

The purpose of this study was to elucidate some of the factors on which accurate shade taking depends. Custom shade tabs (0.5, 1.0 and 1.5 mm porcelain thickness) were fabricated from selected Vita and Shofu porcelains. Four main factors were investigated, namely, the difference between the two types of porcelain used, the effect of light quality, the effect of porcelain thickness and the experience of the observer. The chi-square test for independence at a probability level of P

Improving the mental health of young people is a priority of the NSW Government. A substantial number of adolescents and young adults have significant mental health problems. Up to 24 per cent of adolescents experience depression by the time they are 18 years old, and young people aged 15–24 years are the group most frequently affected by a first episode of psychosis. These mental health disorders have serious consequences for young people and their families.

A prospective cohort study was undertaken to describe the natural history of the cubital fossa peripherally inserted central catheter (PICC), determine which factors influenced the hazard of complication and develop a standard methodology for evaluation of a PICC service. A total of 4349 patient days of PICC observation were analysed using survival analysis techniques. The median time to PICC removal for a complication was 60 days. The most common complications were phlebitis, malposition and tip migration. Complications usually occurred during the first week. There was only one episode of line-related sepsis. Size 3 French gauge catheters had a complication rate of 7.3 per 1000 line days compared to 14.2 for 4 French catheters (hazard rate 1.26 90% CI 1.02 to 1.55). PICCs requiring two or more attempts at insertion were more likely to develop complications than those inserted at the first attempt: 20 per 1000 line days vs 10.5 but the confidence intervals were wide (hazard rate 1.91, 90% CI 0.90 to 4.05). Operator (amongst the four experienced operators who inserted all PICCs), arm of placement, or medial or lateral placement in the cubital fossa did not influence PICC survival.

A 77-year-old retired male physician with a 6-year history of systemic lupus erythematosus (SLE) developed a mechanobullous eruption, the features of which were clinically and immunopathologically consistent with a diagnosis of 'classical' epidermolysis bullosa acquisita (EBA). As EBA shares immunopathological findings with a number of cases reported as the 'bullous eruption of SLE', the clinical findings commonly recognized as 'classical EBA' may, in patients with SLE, represent a specific subset of the bullous eruption of SLE rather than a separate diagnostic entity. There are few reports in the literature describing classical EBA in patients with SLE. Findings in this patient add further support to the suggestion that EBA occurring in association with SLE, represents a subset of the bullous eruption of SLE, the clinical features of which may be modified by genetic susceptibility or disease activity.

These studies examine the effect of acute hypoxia on airway smooth muscle relaxation in response to salbutamol in vitro in human isolated bronchi from non-asthmatics and in vivo in-patients with asthma. Isometric responses were measured from rings of human bronchi pre-constricted with methacholine under oxygen tensions of 95% (hyperoxia), 20% (normoxia) and 4% (hypoxia). Once contractions had plateaued, concentration - response curves were conducted to salbutamol (10(-9)-10(-4)m). Twelve stable asthmatic patients were studied in a randomised double blind fashion. On two study days following baseline measurements, patients were randomised to receive either oxygen (FiO(2)1.0) or a hypoxic gas mixture (FiO(2)0.15) followed by three incremental doses of nebulised salbutamol at 15 min intervals. On two further study days nebulised saline was administered instead of salbutamol. In isolated bronchi, salbutamol-induced relaxations were significantly (P0.001) greater in hyperoxia and normoxia (P0.01) when compared to hypoxia. Among patients with asthma no significant differences were found in the mean maximum % change in forced expiratory volume (FEV(1)) from baseline between the hypoxic and hyperoxic study days on which nebulised salbutamol was administered. We conclude that acute hypoxia attenuates airway smooth muscle relaxation in response to salbutamol in vitro but has no effect on salbutamol-induced bronchodilation in in-patients with asthma.

BACKGROUND We have previously reported the use of a hospital based respiratory nurse service (Acute Respiratory Assessment Service, ARAS) to support home treatment of patients with exacerbations of chronic obstructive pulmonary disease (COPD). A controlled trial was undertaken to compare early discharge with home treatment supported by respiratory nurses with conventional hospital management of patients admitted with exacerbations of COPD. METHODS Patients with COPD admitted as emergencies were identified the next working day. They were eligible for inclusion in the study if the differential diagnosis included an exacerbation of COPD, but were excluded if other medical conditions or acidotic respiratory failure required inpatient investigation or management. Of 360 patients reviewed, 209 were being assessed for other active medical problems and were excluded, 33 potential participants were already involved in research studies and so were ineligible, and 37 did not wish to participate in the study. Eighty one patients were randomised to receive conventional inpatient care (n=40) or to planned early discharge the next working day (n=41). Those discharged early continued treatment at home under the supervision of specialist respiratory nurses. Outcome measures were readmission, additional hospital days, and deaths within 60 days of initial admission. Process measures included number of visits, duration of follow up by the respiratory nurse, and additional treatment provided to support early discharge. RESULTS On an intention to treat basis, a policy of early discharge reduced inpatient stay from a mean of 6.1 (range 1–13) days with conventional management to 3.2 (1–16) days with an early discharge policy. Twelve patients (30% conventional management, 29.3% early discharge) were readmitted in each group giving a mean difference in readmission of 0.7% (95% CI of the difference –19.2 to 20.6). In the conventional management group readmitted patients spent a mean of 8.75 additional days in hospital compared with 7.83 days in the early discharge group, giving a mean difference of 0.92 days (95% CI of the difference –6.5 to 8.3). There were two deaths (5%) in the conventional management group and one (2.4%) in the early discharge group, a mean difference of 2.6% (95% CI of the difference –5.7 to 10.8). CONCLUSIONS Patients with acute exacerbations of COPD uncomplicated by acidotic respiratory failure or other medical problems can be discharged home earlier than is current practice with support by visiting respiratory nurses. No difference was found in the subsequent need for readmission.

The renin-angiotensin system is activated in acute severe asthma. Angiotensin II causes bronchoconstriction in mild asthmatics and potentiates methacholine-evoked bronchoconstriction both in vitro and in vivo.To evaluate the effect of angiotensin II on histamine-induced bronchoconstriction, human bronchial rings (n=6) were obtained from lung tissue at thoracotomy and were prepared in organ baths. Contractions were measured isometrically and cumulative concentration-response curves obtained to angiotensin II alone and to histamine in the presence and absence of threshold concentrations of angiotensin II.Eight asthmatic patients with bronchial hyper-reactivity to histamine were challenged with histamine during intravenous infusion of placebo, angiotensin II 1 ng kg−1 min−1 and angiotensin II 2 ng kg−1 min−1 administered in a randomized, double-blind fashion. FEV1 was measured prior to, during the infusion and during the histamine challenge.Angiotensin II (3 × 10−7 m and 10−6 m) alone evoked small contractions (

BACKGROUND: Recent in vitro and in vivo studies in animals have suggested that ambient oxygen tension may influence airway responsiveness to bronchoconstrictor stimuli. These observations may have relevance to the management of acute exacerbations of asthma. The present studies were designed to examine the influence of inspired oxygen tension (Fio2 1.0, 0.21, 0.15) on methacholine-induced broncho- constriction in patients with asthma. METHODS: In a dual study two groups of asthmatic patients performed methacholine inhalation challenges breathing either air (Fio2 0.21) or a hypoxic gas mixture (Fio2 0.15) in study 1 and air (Fio2 0.21) or hyperoxia (Fio2 1.0) in study 2. The gases were administered through a closed breathing circuit in a randomised double blind fashion. The PC20 values (dose of methacholine causing a 20% fall in forced expiratory volume in one second (FEV1) were calculated after each methacholine challenge by linear interpolation from the logarithmic dose response curve. Plasma catecholamine levels were measured before and after methacholine challenges as well as heart rate, oxygen saturation, and percentage end tidal carbon dioxide levels. RESULTS: The geometric mean PC20 value for methacholine was significantly lower on the hypoxic study day than on the normoxic day in study 1 (mean difference in PC20 values 2.88 mg/ml (95% CI 1.4 to 5.3); p < 0.05), but there was no significant difference in the geometric mean PC20 value for methacholine between the hyperoxic and normoxic study days in study 2 (mean difference in PC20 values 1.45 mg/ ml (95% CI 0.83 to 2.51)). CONCLUSIONS: Acute hypoxia potentiates methacholine induced bronchoconstriction and acute hyperoxia has no effect in mild to moderate patients with stable asthma.