Fetal alcohol spectrum disorder: development of concensus referral criteria for specialist diagnostic assessment in Australia

Background: Fetal alcohol spectrum disorder (FASD) is known to be under-recognised in Australia. The use of standard methods to identify when to refer individuals who may have FASD for specialist assessment could help improve the identification of this disorder. The purpose of this study was to develop referral criteria for use in Australia. Method: An online survey about FASD screening and diagnosis in Australia, which included 23 statements describing criteria for referral for fetal alcohol syndrome (FAS) and FASD based on published recommendations for referral in North America, was sent to 139 health professionals who had expertise or involvement in FASD screening or diagnosis. Survey findings and published criteria for referral were subsequently reviewed by a panel of 14 investigators at a consensus development workshop where criteria for referral were developed.Results: Among the 139 health professionals who were sent the survey, 103 (74%) responded, and 90 (65%) responded to the statements on criteria for referral. Over 80% of respondents agreed that referral for specialist evaluation should occur when there is evidence of significant prenatal alcohol exposure, defined as 7 or more standard drinks per week and at least 3 standard drinks on any one day, and more than 70% agreed with 13 of the16 statements that described criteria for referral other than prenatal alcohol exposure. Workshop participants recommended five independent criteria for referral: confirmed significant prenatal alcohol exposure; microcephaly and confirmed prenatal alcohol exposure; 2 or more significant central nervous system (CNS) abnormalities and confirmed prenatal alcohol exposure; 3 characteristic FAS facial anomalies; and 1 characteristic FAS facial anomaly, growth deficit and 1 or more CNS abnormalities .Conclusion: Referral criteria recommended for use in Australia are similar to those recommended in North America. There is a need to develop resources to raise awareness of these criteria among health professionals and evaluate their feasibility, acceptability and capacity to improve the identification of FASD in Australia

Defining and assessing spiritual health : a comparative study among 13- to 15-year-old pupils attending secular schools, Anglican schools, and private Christian schools in England and Wales

This article argues that the nation's commitment to young people involves proper concern for their physical health, their psychological health, and their spiritual health. In this context the notion of spiritual health is clarified by a critique of John Fisher's model of spiritual health. Fisher developed a relational model of spiritual health, which defines good spiritual health in terms of an individual's relationship to four domains: the personal, the communal, the environmental, and the transcendental. In the present analysis, we make comparisons between pupils educated in three types of schools: publicly funded schools without religious foundation, publicly funded schools with an Anglican foundation, and new independent Christian schools (not publicly funded). Our findings draw attention to significant differences in the levels of spiritual health experienced by pupils within these three types of schools

Promoting students’ interest through culturally sensitive curricula in higher education

Previous studies have emphasized culturally sensitive curricula in the context of enhancing minoritized students’ education. We examined the relationship between second-year higher education students’ perceptions of the cultural sensitivity of their curriculum and both majoritized and minoritized students’ interest in their course. A total of 286 (228 F) students rated the cultural sensitivity of their curriculum on six scales using a revised version of the Culturally Sensitive Curricula Scales (CSCS-R), the perceived quality of their relationships with teachers, and their interest. The CSCS-R widened the construct with two new scales and showed better reliability. Ethnic minority students (n = 99) perceived their curriculum as less culturally sensitive than White students (n = 182), corroborating previous findings. Black students perceived their curriculum as less culturally sensitive than Asian students. There were no significant differences between ethnic minority and White students on interest or perceived quality of relationships with teachers. Five dimensions of cultural sensitivity (Diversity Represented, Positive Depictions, Challenge Power, Inclusive Classroom Interactions, Culturally Sensitive Assessments) and perceived quality of relationships with teachers predicted interest. Ethnicity did not. Ensuring curricula and assessments represent diversity positively, challenge power and are inclusive may support students’ interest while reflecting an increasingly diverse society

A modified Delphi study of screening for fetal alcohol spectrum disorders in Australia

Background: There is little reliable information on the prevalence of fetal alcohol spectrum disorders (FASD) in Australia and no coordinated national approach to facilitate case detection. The aim of this study was to identify health professionals’ perceptions about screening for FASD in Australia. Method: A modified Delphi process was used to assess perceptions of the need for, and the process of, screening for FASD in Australia. We recruited a panel of 130 Australian health professionals with experience or expertise in FASD screening or diagnosis. A systematic review of the literature was used to develop Likert statements on screening coverage, components and assessment methods which were administered using an online survey over two survey rounds. Results: Of the panel members surveyed, 95 (73%) responded to the questions on screening in the first survey round and, of these, 81 (85%) responded to the second round. Following two rounds there was consensus agreement on the need for targeted screening at birth (76%) and in childhood (84%). Participants did not reach consensus agreement on the need for universal screening at birth (55%) or in childhood (40%). Support for targeted screening was linked to perceived constraints on service provision and the need to examine the performance, costs and benefits of screening. For targeted screening of high risk groups, we found highest agreement for siblings of known cases of FASD (96%) and children of mothers attending alcohol treatment services (93%). Participants agreed that screening for FASD primarily requires assessment of prenatal alcohol exposure at birth (86%) and in childhood (88%), and that a checklist is needed to identify the components of screening and criteria for referral at birth (84%) and in childhood (90%). Conclusions: There is an agreed need for targeted but not universal screening for FASD in Australia, and sufficient consensus among health professionals to warrant development and evaluation of standardised methods for targeted screening and referral in the Australian context. Participants emphasised the need for locally-appropriate, evidence-based approaches to facilitate case detection, and the importance of ensuring that screening and referral programs are supported by adequate diagnostic and management capacity

Finding a moral homeground: appropriately critical religious education and transmission of spiritual values

Values-inspired issues remain an important part of the British school curriculum. Avoiding moral relativism while fostering enthusiasm for spiritual values and applying them to non-curricular learning such as school ethos or children's home lives are challenges where spiritual, moral, social and cultural (SMSC) development might benefit from leadership by critical religious education (RE). Whether the school's model of spirituality is that of an individual spiritual tradition (schools of a particular religious character) or universal pluralistic religiosity (schools of plural religious character), the pedagogy of RE thought capable of leading SMSC development would be the dialogical approach with examples of successful implementation described by Gates, Ipgrave and Skeie. Marton's phenomenography, is thought to provide a valuable framework to allow the teacher to be appropriately critical in the transmission of spiritual values in schools of a particular religious character as evidenced by Hella's work in Lutheran schools

Tetramethoxystilbene-loaded liposomes restore reactive-oxygen-species-mediated attenuation of dilator responses in rat aortic vessels Ex vivo

The methylated analogue of the polyphenol resveratrol (RV), 2,3',4,5'-tetramethoxystilbene (TMS) displays potent antioxidant properties and is an effective cytochrome P450 (CYP) 1B1 inhibitor. The bioavailability of TMS is low. Therefore, the use of liposomes for the encapsulation of TMS is a promising delivery modality for enhanced uptake into tissues. We examined the effect of delivery of TMS in liposomes on the restoration of vasodilator responses of isolated aortic vessels after acute tension elevation ex vivo. Aortic vessels from young male Wistar rats were isolated, and endothelial-dependent (acetylcholine, ACh) and -independent (sodium nitroprusside, SNP) responses assessed. Acute tension elevation (1 h) significantly reduced ACh dilator responses, which were restored following incubation with superoxide dismutase or apocynin (an NADPH oxidase inhibitor). Incubation with TMS-loaded liposomes (mean diameter 157 ± 6 nm; PDI 0.097) significantly improved the attenuated dilator responses following tension elevation, which was sustained over a longer period (4 h) when compared to TMS solution. Endothelial denudation or co-incubation with L-NNA (Nω-nitro-l-arginine; nitric oxide synthase inhibitor) resulted in loss of dilator function. Our findings suggest that TMS-loaded liposomes can restore attenuated endothelial-dependent dilator responses induced by an oxidative environment by reducing NADPH-oxidase-derived ROS and potentiating the release of the vasodilator nitric oxide. TMS-loaded liposomes may be a promising therapeutic strategy to restore vasodilator function in vascular disease

Life cycle assessment of the sweetness enhancer thaumatin (E957) produced from Thaumatococcus daniellii fruit foraged from West Africa: The SWEET project

Replacing added sugar with non-nutritive sweeteners and sweetness enhancers is of increasing interest due to the negative health effects of excess sugar consumption. Much has been done to understand health and safety of such sweetening additives, but little on their sustainability. This study, part of the Horizon 2020 SWEET project, presents results from the first life cycle assessment of the sweetness enhancer thaumatin, produced from Thaumatococcus daniellii fruit, from forests in West Africa and extracted in the United Kingdom. Thaumatin is used in formulations to increase perceived sweetness of added sugar, allowing some to be removed. Environmental impact is reported for multiple impact categories from the ReCiPe 2016 (H) method, focusing on global warming potential, land use, water consumption, and freshwater eutrophication. Impacts are expressed in terms of product mass and sweetness equivalence. Global warming potential for production of thaumatin is found to be 719.2 kgCO2-eq/kg. When thaumatin replaces 20% of added sugar, environmental impact for a given sweetness is found to reduce by an average of 19.4% across all impact categories. International transport is a major contributor to global warming potential, as is aril removal from the fruit to freshwater eutrophication and water use, and fruit foraging to land use. However, land use is identified as a key area of future research to improve uncertainty in the data. Results show that thaumatin can be used to reduce the environmental impact of providing sweet taste in food and beverage products

Environmental life cycle assessment of production of the high intensity sweetener steviol glycosides from Stevia rebaudiana leaf grown in Europe: The SWEET project

Purpose There is an increasing interest in the use of non-nutritive sweeteners to replace added sugar in food and beverage products for reasons of improving consumer health. Much work has been done to understand safety of sweeteners, but very little on sustainability. To address that gap, this study presents the results of a life cycle assessment (LCA) of production of rebaudioside A 60%, 95% pure (RA60) steviol glycoside mix from Stevia rebaudiana leaf grown in Europe. Methods An attributional cradle-to-factory-gate life cycle assessment was conducted on growing of stevia leaves and extraction of steviol glycosides in Europe. Primary data were used from a case study supply chain. Results are reported in impact categories from the ReCiPe 2016 (H) method, with focus given to global warming potential, freshwater eutrophication, water consumption, and land use. Impacts are expressed both in terms of production mass and sweetness equivalence, a common metric for understanding high intensity sweetener potency. Sweetness equivalence of RA60 is typically 200 to 300 times that of sugar. Comparison of environmental impact is made to sugar (sucrose) produced from both cane and beets. The research is part of the EU project SWEET (sweeteners and sweetness enhancers: impact on health, obesity, safety, and sustainability). Results and discussion Global warming potential for production of RA60 was found to be 20.25 kgCO2-eq/kgRA60 on a mass basis and 0.081 kgCO2-eq/kgSE on a sweetness equivalence basis. Field production of stevia leaves was found to be the main source of impact for most impact categories, and for all four focus categories. Extraction of the RA60 was the main source of impact for the others. Leaf processing and seedling propagation were minor contributors to life cycle impact. Removal of international transport from the supply chain reduced global warming potential by 18.8%. Compared with sugar on a sweetness equivalence basis, RA60 has approximately 5.7% to 10.2% the impact for global warming potential, 5.6% to 7.2% the impact for land use, and is lower across most other impact categories. Conclusion This is the first LCA of steviol glycoside mix RA60 produced from leaf in Europe. The results indicate that RA60 can be used to reduce environmental impact of providing a sweet taste by replacing sugar across all impact categories. However, it is important to note that specific formulations in which RA60 is used will have a bearing on the final environmental impact of any food or beverage products. For solid foods, this requires further research

Parallel computation of 3-D soil-structure interaction in time domain with a coupled FEM/SBFEM approach

The final publication is available at Springer via http://dx.doi.org/10.1007/s10915-011-9551-xThis paper introduces a parallel algorithm for the scaled boundary finite element method (SBFEM). The application code is designed to run on clusters of computers, and it enables the analysis of large-scale soil-structure-interaction problems, where an unbounded domain has to fulfill the radiation condition for wave propagation to infinity. The main focus of the paper is on the mathematical description and numerical implementation of the SBFEM. In particular, we describe in detail the algorithm to compute the acceleration unit impulse response matrices used in the SBFEM as well as the solvers for the Riccati and Lyapunov equations. Finally, two test cases validate the new code, illustrating the numerical accuracy of the results and the parallel performances. © Springer Science+Business Media, LLC 2011.Jose E. Roman and Enrique S. 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