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ObjectivesWHO Integrated Management of Childhood Illness (IMCI) guidelines changed pneumonia hospitalisation criteria in 2014, which was implemented in Lao People’s Democratic Republic (Lao PDR) in 2015. We determined adherence to: current (2014) IMCI guidelines for children presenting to hospitals with pneumonia, current outpatient management guidelines and identified hospitalisation predictors.DesignProspective observational study (January 2017 to December 2018).SettingOutpatient and emergency departments of four hospitals in Vientiane, Lao PDR.Patients594 children aged 2–59 months diagnosed with pneumonia.Main outcome measuresNumber of children diagnosed, hospitalised, managed, administered preventive measures and followed-up accordant with current guidelines.ResultsNon-severe and severe pneumonia were correctly diagnosed in 97% and 43% of children, respectively. Non-severe pneumonia with lower chest wall indrawing (LCI) was diagnosed as severe in 15%. Hospitalisation rates were: 80% for severe pneumonia, 86% and 3% for non-severe pneumonia with and without LCI, respectively. Outpatient oral antibiotic prescribing was high (99%), but only 30% were prescribed both the recommended antibiotic and duration. Appropriate planned follow-up was 89%. Hospitalisation predictors included age 2–5 months (compared with 24–59 months; OR 3.95, 95% CI 1.90 to 8.24), public transport to hospital (compared with private vehicle; OR 2.60, 95% CI 1.09 to 6.24) and households without piped drinking water (OR 4.67, 95% CI 2.75 to 7.95).ConclusionsHospitalisation practice for childhood pneumonia in Lao PDR remains more closely aligned with the 2005 WHO IMCI guidelines than the currently implemented 2014 iteration. Compliance with current outpatient antibiotic prescribing guidelines was low.

Pneumonia is a major cause of death in children aged under five years. As children with severe pneumonia have the highest risk of morbidity and mortality, previous studies have evaluated the additional benefit of adjunctive treatments such as oseltamivir, oral steroids, macrolides, and vitamin supplementation that can be added to standard antibiotic management to improve clinical outcomes. The study reviewed the evidence for the role of these additional treatments for children with severe pneumonia in low- and middle-income countries (LMICs).Four electronic databases were searched for English-language articles between 2000 to 2020. Systematic reviews (SRs) with meta-analyses, comparative cohort studies, and randomised controlled trials (RCTs) from LMICs that reported clinical outcomes for children with severe pneumonia aged between one month to 9 years who received adjunct treatment in addition to standard care were included. Risk of bias of included SRs was assessed using AMSTAR 2, and of individual studies using the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies.Overall, the search identified 2147 articles, 32 of which were eligible, including 7 SRs and 25 RCTs. These studies evaluated zinc (4 SRs, 17 RCTs), Vitamin D (1 SR, 4 RCTs), Vitamin A (3 SRs, 1 RCT), Vitamin C (1 SR, 2 RCTs) and micronutrients (1 RCT). Most studies reported clinical outcomes of time to improvement, length of stay, and treatment failure (including mortality). No studies of oseltamivir, steroids, or macrolides fulfilling the inclusion criteria were identified. For zinc, pooled analyses from SRs showed no evidence of benefit. Similarly, a Cochrane review and one RCT found that Vitamin A did not improve clinical outcomes. For Vitamin D, an RCT evaluating a single high dose of 100 000 international units (IU) of vitamin D found a reduction in time to improvement, with 38%-40% documented vitamin D deficiency at baseline. However, two other studies of 1000 IU daily did not show any effect, but vitamin D status was not measured. For vitamin C, two studies found a reduction in time to symptom resolution in those with severe disease, with one reporting a shorter length of hospital stay. However, both studies were of weak quality. Most studies excluded malnourished children, and studies which included these children did not report specifically on the effect of micronutrients.This review found that adjunctive zinc and vitamin A, in addition to standard care, does not improve clinical outcomes in children with severe pneumonia in LMICs (strong evidence). However, a reduction in time to symptom resolution was reported with high dose vitamin D supplementation in children with documented vitamin D deficiency (strong evidence from one study) and vitamin C (weak evidence), although further research is needed, especially in underweight children.

Streptococcus pneumoniae is one of the most common bacteria causing pneumonia and the World Health Organization (WHO) recommends first-line treatment of pneumonia with penicillins. Due to increases in the frequency of penicillin resistance, this systematic review aimed to determine the clinical outcomes of children with pneumonia in low- and middle-income countries (LMICs), with penicillin-group resistant pneumococci in respiratory and/or blood cultures specimens.English-language articles from January 2000 to November 2020 were identified by searching four databases. Systematic reviews and epidemiological studies from LMICs that included children aged one month to 9 years and reported outcomes of pneumonia with a penicillin-resistant pneumococcus in respiratory and blood culture specimens with or without comparison groups were included. Risk of bias was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. A narrative synthesis of findings based on the results of included studies was performed.We included 7 articles involving 2864 children. One strong- and four medium-quality studies showed no difference in clinical outcomes (duration of symptoms, length of hospital stay and mortality) between those children with penicillin non-susceptible compared to susceptible pneumococci. Two weak quality studies suggested better outcomes in the penicillin-susceptible group.Current evidence suggests no difference in clinical outcomes of child pneumonia due to a penicillin-resistant S. pneumoniae and as such, there is no evidence to support a change in current WHO antibiotic guidelines.

Systematic and systematic-like reviews are an important aspect of healthcare research, and are increasingly being employed in other disciplines such as marketing and education. They require a high ...

Here we develop a novel method for quantifying sediment components, e.g. biogenic silica, organic or mineral matter, from near infrared (NIR) spectra based on fitting by multiple regression of measured spectra for end-member materials. We show that with suitable end-members our new open-source multiple regression routine gives excellent simultaneous quantification of the major components of a sediment, the concentrations comparing well with independent methods of quantification. Widely used partial least squares regression approaches rely on large environmental training data sets; our method produces comparable results, but with the advantages of negating the need for a training dataset and with greater simplicity and theoretical robustness. We demonstrate that component NIR spectra are additive, a prerequisite for use of multiple regression to un-mix the compound spectra, and show that a number of environmental materials make suitable end-members for this analysis. We show that spectral mixing is not conservative with respect to mass proportion, but rather to the relative chromatic intensity of contributing sediment components. Concentrations can be calculated using the measured spectra by correction using a chromatic intensity factor, the value of which can be measured independently. We have applied our approach to a postglacial sediment sequence from Loch Grannoch (SW Scotland) and reveal a down-core pattern of varying dominance by biogenic silica, organic and mineral content from the late glacial to present. With isolation and measurement of appropriate end-members this multivariate regression approach to interrogating NIR spectra has utility across a wide range of sedimentary environments and potentially for other spectral analytical methods.

Aims/Objectives/BackgroundVenepuncture and PVC insertion are common procedures in Children’s ED and often include blood cultures. Opening a universal dressing pack (udp) including a plastic tray, sterile swabs, gloves and 2 plastic sterile field drapes (sfd) is common practice. Our department was making a huge spend on udp’s. We aimed to determine if this was necessary and if we could reduce our plastic waste.Methods/DesignA sample of 8 doctors across all grades demonstrated their set up for both procedures. We replaced udp in the IV trollies with x2 sfd pack (sfdp). Information was disseminated via weekly staff brief. Trollies are restocked each night using attached flashcards which were updated appropriately. The use and costs of dressing packs in ED was determined for April-June 2019. We planned to compare this for April-June 2020.Results/ConclusionsAll clinicians were opening a dressing pack for procedures but 87.5% only used the sfd and swabs. 100% discarded gloves due to inappropriate size and 100% discarded the tray. All staff adopted the new equipment with no problems identified. 3500 udps were being used in dept in 3 months. Udp v sfdp per item costs 32p v 8p, weight 65 g v 30 g. Due to CoVID-19 pandemic the number of ED attendances significantly reduced therefore costs were based on 2019 usage. In 3 months switching from udp to sfd would save £840 and 122.5 kg of refuse weight. Volumes of stocks were reduced from 0.05 m2 to 0.01 m2 for 50 udp v 50 sfdp which aids storage and restocking of IV trollies releasing staff time.We demonstrated a significant reduction in unnecessary plastic waste while also reducing costs and need for storage and restocking whilst maintaining safe practice. This has been rolled out in the neighbouring Clinical Decision Unit with anticipation of being a permanent change in both areas.

The Murdoch Children’s Research Institute (MCRI) has prepared a COVID-19 in Victorian Schools Report at the request of the Victorian Department of Health and Human Services (DHHS) and Department of Education and Training (DET). The report analysed DHHS and DET data which included reported COVID-19 cases and outbreaks across all early childhood and primary and secondary educational settings in Victoria from 25 January to 31 August.The report also provided detailed plans to prevent possible outbreaks following the staged easing of lockdown restrictions which would follow a traffic light system. These plans have drawn on experiences from international settings, designed to reduce day-to-day disruptions as far as possible, while ensuring that teachers, students and the wider community are kept as safe as possible.

An important component of the academic health librarian role is the establishment of interventions to support the development of student skills in evidence-based practice. It is important for practicing librarians to evaluate their activities to determine effectiveness and to inform decision making and best practice in librarianship. A series of six online modules was developed for a core first-year Bachelor of Nursing unit. Modules were subsequently investigated for impact on student learning of evidence-based practice by determining any correlation between students’ completion of the modules and their academic performance. The level of students’ interest and engagement was also examined through a survey about their experiences of and attitudes toward the modules. A positive correlation was found between module completion and attainment of higher grades by students. Feedback from the survey indicated that students engaged positively with the modules.

Echidnas have evolved separately from other mammalian groups for around 200 million years and incorporate a mixture of reptilian and mammalian features. Because of these attributes, they have historically been considered "primitive" animals. However, they have successfully adapted to a wide variety of ecological niches and their neurophysiology demonstrates a number of unusual and apparently sophisticated characteristics, including a relatively large brain and cerebral cortex and a comparatively massive frontal cortex. Studies of learning in the echidna have thus far been limited to only a handful of experiments which demonstrated relatively basic abilities such as forming a position habit in a T-maze, successive habit-reversal learning, and simple visual and instrumental discrimination. This study aimed to expand on these results and test the "primitive" echidna on what are generally considered more advanced cognitive tasks-same/different and conditional same/different concept learning. The results demonstrated that echidnas are able to discriminate on the basis of a relational same/different concept, using simultaneously presented multi-element stimuli, and transfer that discrimination to novel stimuli. After further training, they were then able to repeat the performance when the correct choice was conditional on the background color of the stimulus panels.

Welcome to the September 2020 issue of the Journal of the Australian Library and Information Association (JALIA). The main contents of the journal this month are select papers from the Fifteenth Au...

Welcome to the June 2019 issue of the Journal of the Australian Library and Information Association (JALIA). The issue contains five peer reviewed research papers, three research in practice papers...