Clinical research and leadership training program as a knowledge translation initiative across an Australian health care service

&nbsp;Health professionals need to be integrated more effectively in clinical research initiatives to ensure that research addresses key clinical needs and provides practical, implementable solutions at the coal face of care. Here we describe the informative phase of a broader program to enable and support health professionals at Monash Health who do not have a research background, to engage in and lead research to improve healthcare outcomes. The findings will be used to develop a dedicated clinical research and leadership training program. The training program will support Monash Health staff to up-skill or enhance skills to conduct rigorous research; engage and lead multidisciplinary, collaborative teams; and to use research to guide practice, as well as identify and address gaps in clinical research. &nbsp;</div

Routinely collected infant feeding data:Time for global action

The importance of breastfeeding is clear. However, global action to support breastfeeding is hindered by the lack of reliable standard data, which continues to impede progress. Routinely collected data can monitor the effectiveness of health policy, evaluate interventions, and enhance international research collaboration and comparisons. Use of routine data to support effective public health initiatives such as smoking cessation has been demonstrated. However, the data collected about infant feeding practices worldwide is inconsistent in timing, methods, definitions, detail, storage, and consistency. Improvements to the reach and quality of routinely collected data about infant feeding are needed to strengthen the global evidence and policy base. An international collaborative effort is called for to progress this

Antenatal breast milk expression by women with diabetes for improving infant outcomes (Review)

BackgroundSome women with diabetes in pregnancy are encouraged to express and store colostrum prior to birthing. Following birth, the breastfed infant may be given the stored colostrum to minimise the use of artificial formula or intravenous dextrose administration if correction of hypoglycaemia is required. However, findings from observational studies suggest that antenatal breast milk expression may stimulate labour earlier than expected and increase admissions to special care nurseries for correction of neonatal hypoglycaemia.ObjectivesTo evaluate the benefits and harms of the expression and storage of breast milk during late pregnancy by women with diabetes.Search methodsWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2014).Selection criteriaAll published and unpublished randomised controlled trials comparing antenatal breast milk expressing with not expressing, by pregnant women with diabetes (pre-existing or gestational) and a singleton pregnancy.Data collection and analysisTwo review authors independently evaluated reports identified by the search strategy.Main resultsThere were no published or unpublished randomised controlled trials comparing antenatal expressing with not expressing. One randomised trial is currently underway.Authors' conclusionsThere is no high level systematic evidence to inform the safety and efficacy of the practice of expressing and storing breast milk during pregnancy

Fetal pulse oximetry for fetal assessment in labour (Review)

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Vibroacoustic stimulation for fetal assessment in labour in the presence of a nonreassuring fetal heart rate trace (Review)

Background: Fetal vibroacoustic stimulation (VAS) is a simple, non-invasive technique where a device is placed on the maternal abdomen over the region of the fetal head and sound is emitted at a predetermined level for several seconds. It is hypothesised that the resultant startle reflex in the fetus and subsequent fetal heart rate (FHR) acceleration or transient tachycardia following VAS provide reassurance of fetal well-being. This technique has been proposed as a tool to assess fetal well-being in the presence of a nonreassuring cardiotocographic (CTG) trace during the first and second stages of labour. Objectives: To evaluate the clinical effectiveness and safety of VAS in the assessment of fetal well-being during labour, compared with mock or no stimulation for women with a singleton pregnancy exhibiting a nonreassuring FHR pattern. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 September 2012) and reference lists of all retrieved articles. We sought unpublished trials and abstracts submitted to major international congresses and contacted expert informants. Selection criteria: All published and unpublished randomised trials that compared maternal and fetal/neonatal/infant outcomes when VAS was used to evaluate fetal status in the presence of a nonreassuring CTG trace during labour, compared with mock or no stimulation. Data collection and analysis: Two review authors independently sought to assess for inclusion all the potential studies we identified as a result of the search strategy. We planned to resolve any disagreement through discussion or, if required, to consult a third person. Where there was uncertainty about a particular study, we attempted to contact study authors for additional information. However, these attempts were unsuccessful. Main results: The search strategies yielded six studies for consideration of inclusion. However, none of these studies fulfilled the requirements for inclusion in this review. Authors' conclusions: There are currently no randomised controlled trials that address the safety and efficacy of VAS used to assess fetal well-being in labour in the presence of a nonreassuring CTG trace. Although VAS has been proposed as a simple, non-invasive tool for assessment of fetal well-being, there is insufficient evidence from randomised trials on which to base recommendations for use of VAS in the evaluation of fetal well-being in labour in the presence of a nonreassuring CTG trace

Evidence of Resilience in Reef Islands in Response to Rising Sea Level on Huvadhoo Atoll, Maldives

Reef islands are at the forefront of concern for future accelerating sea-level rise since their low-lying and isolated nature puts them at higher risk of marine inundation compared to continental coastlines. However, the perceived threat of complete submersion as implied by projected future sea-level rise and current island elevations do not consider the morphologically resilient nature of reef island systems. In particular, the role of sediment supply in the resilience of these islands is still relatively poorly studied. This study presents detailed descriptions of the sedimentary characteristics and stratigraphy of two lagoonal platform islands in Huvadhoo Atoll, Maldives, that formed during periods of Holocene sea-level rise. Island subsurface stratigraphy was reconstructed by analysing the skeletal composition and textural properties of 306 sediment samples from 37 cores extracted across the islands. Island sediments were dominated by coral sands with varied proportions of secondary constituents (molluscs, Halimeda, foraminifera, and crustose coralline algae). Downcore variations in composition show that the proportion of coral sands decrease with depth and the proportion of molluscs and Halimeda increase with depth (with the exception of cores that terminated on lagoon infill). The increased proportion of Halimeda and molluscs in these early island deposits may have resulted from the catch-up growth strategy of the reef during the mid-Holocene highstand as both organisms have high turnover rates and directly contribute to sediment production after death. The sedimentological response of increased Halimeda and molluscs highlights the resilient and dynamic nature of reef islands and the ability of reefs to adjust ecologically to changing sea levels

Lagoonal reef island formation in Huvadhoo atoll, Maldives, highlights marked temporal variations in island building across the archipelago

Coral reef islands provide the only pedestals of human habitation in mid-ocean atoll archipelagoes. Understanding the environmental controls on island formation is critical for evaluating the future response of islands to environmental change and sea-level rise. This study examines the evolution of lagoonal reef islands in Huvadhoo atoll, southern Maldives. Using extensive ground penetrating radar (GPR) imaging of island sediment structure, combined with comprehensive analysis of island morphology, sedimentology, and 49 radiometric dates, detailed reconstructions of the evolution of two lagoonal islands is presented. A four-stage model shows a complex history of island formation across various stages of sea-level change during the late-Holocene: 1) lagoon infill occurring from ~3000–2000 years ago during a period of sea-level fall from the mid-Holocene highstand; 2) emergence of the island core through vertical aggradation during the latter stages of sea-level fall between ~2000 and 1500 yBP; 3) rapid lateral expansion of the islands between 1500 and 500 yBP coincident with the availability of sandsize sediments and during a period of sea-level oscillation; and, 4) subsequent minor expansion and modification of island shorelines through alongshore reworking of island sediments over the past 500 years. Results provide evidence of marked differences in the timing and mode of island formation within Huvadhoo atoll. Significantly, the formation of the lagoonal islands post-dates the formation of islands on the atoll rim by 1000–2000 years. Furthermore, the formation of sand islands over infilled shallow lagoons contrasts the formation of most atoll rim islands through the sequential deposition of storm-generated rubble deposited directly across reef surfaces that have reached their vertical growth limit. Results of lagoonal island formation in the southern Maldives provide comparative data for the northern Maldives. While the sequence of island formation follows the faro infill model identified in the northern archipelago, lagoonal islands in the south appear to have formed 2000 years after those in the north. This difference is likely to reflect lagged reef growth response from deeper foundations in the southern archipelago

Genetic and Molecular Functional Characterization of Variants within TNFSF13B, a Positional Candidate Preeclampsia Susceptibility Gene on 13q

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