Evidence-based enteral feeding for preterm or low birth weight infants : systematic review of the use of protein hydrolysate formula

Infants born preterm, especially those born very preterm, are at elevated risk of mortality and morbidity secondary to organ immaturity and exposure to intensive and invasive care practices and procedures. Although care and outcomes for preterm infants have improved substantially over the past forty years, major challenges remain including the need for better strategies to prevent or treat complications such as necrotising enterocolitis and severe infection. These complications are the most common causes of death and disability after the early neonatal period for preterm infants and are associated with life-long health consequences and costs.This thesis first presents an overview of the epidemiology, causes, and risk factors for preterm birth, and a summary of the interventions for improving outcomes for preterm infants. I then describe the current understanding of the pathogenesis of necrotising enterocolitis, its impact on growth and development, and the evidence-base for interventions to prevent this condition. This discussion focusses on nutritional strategies, and particularly on how the timing and type of enteral feeding affects gut physiology and health, feed tolerance, and the risk of necrotising enterocolitis in preterm infants.The main body of the thesis consists of a Cochrane review of a specific enteral feeding option for preterm infants – the use of formula containing hydrolysed protein rather than standard formula. This costly strategy has become widely adopted in high-income countries based on perceptions that protein hydrolysate formulas are tolerated better by the immature gastro-intestinal tract, and are less likely to lead to complications including necrotising enterocolitis. Using Cochrane methods, we conducted the first systematic review of the evidence-base for this intervention. We found ten eligible randomised controlled trials (total participants 600). Meta-analyses did not show any significant differences in feed intolerance or necrotising enterocolitis, calling into question current policies and practice in neonatal units in high-income countries

"So, Tell Me What Users Want, What They Really, Really Want!"

Equating users' true needs and desires with behavioural measures of 'engagement' is problematic. However, good metrics of 'true preferences' are difficult to define, as cognitive biases make people's preferences change with context and exhibit inconsistencies over time. Yet, HCI research often glosses over the philosophical and theoretical depth of what it means to infer what users really want. In this paper, we present an alternative yet very real discussion of this issue, via a fictive dialogue between senior executives in a tech company aimed at helping people live the life they `really' want to live. How will the designers settle on a metric for their product to optimise

退休準備 : 豐儉不由人

退休意味著失去固定工作收入，亦標誌著生活方式的轉變，同時也會衍生出一系列的健康及社交需要。因此，應制訂一個全面的退休計劃，讓退休人士和準退休人士可更好地應對退休帶來的挑戰

Retirement planning : money matters

Retirement denotes a cut off from monetary income generated from employment, a change of lifestyle, and the emergence of specific healthcare and social needs. A comprehensive retirement plan could be a more feasible approach for pre-retirees and retirees to cope with challenges brought by retirement

Developing a 3D animation for deeper molecular understanding of Michaelis-Menten enzyme kinetics

The mathematical models that describe enzyme kinetics are invaluable predictive tools in numerous scientific fields. However, the daunting mathematical language used to describe kinetic behaviour can be confusing for life science students; they often struggle to conceptualize and relate the mathematical representations to the molecular phenomena occurring at both macroscopic and microscopic levels. Students with less developed abstract and mathematical thinking skills may benefit from a visual learning approach. The paucity of visual resources for enzyme kinetics makes this a fertile field for developing novel learning media. We discuss developing a 3D animation aimed at introducing key concepts of Michaelis-Menten enzyme kinetics to undergraduate life science students. This animation uses both realistic and metaphoric depictions of the underlying molecular players, environments, and interactions in enzyme kinetics to contextualize and explain the relationship between the mathematic models and underlying molecular system. In addition, we will present our production pipeline and workflow for creating educational animations as well as didactic strategies that maximize clarity and accessibility in animated media

The epidemiology of glomerular hyperfiltration among men with HIV in the era of highly active antiretroviral therapy

Background Men infected with HIV and receiving highly active antiretroviral therapy are at higher risk of metabolic and cardiovascular abnormalities as well as accelerated renal function decline and chronic kidney disease (CKD). Glomerular hyperfiltration, defined as elevated glomerular filtration rate (GFR) to pathologically high levels, is associated with diabetes and hypertension and is a treatable risk factor for CKD. The epidemiology of hyperfiltration has not been described in an HIV population. The purposes of this dissertation is to a) describe the prevalence of elevated GFR using directly measured iohexol GFR, a gold standard; b) describe the incidence of hyperfiltration using the serum creatinine-based CKD-EPI estimated GFR equation, a clinical standard; and c) investigate the effect of hyperfiltration on accelerated GFR decline in the Multicenter AIDS Cohort Study. Methods Data consisted of a nested cross-sectional study within the MACS comprising 241 HIV-uninfected and 367 HIV-infected men with iohexol GFR, and all MACS data in the era of HAART comprising approximately 1373 HIV-uninfected and 1255 HIV-infected men. Hyperfiltration was classified using adapted definitions, including estimating the 90th percentiles among HIV-uninfected men. Competing risks analyses, with age (after 30 years) as the time scale, were used to assess the effect of HIV-infection on incident hyperfiltration. To determine the effect of hyperfiltration on GFR decline, downward inflection points were identified. Results There was a higher prevalence of elevated GFR among HIV-infected men compared to HIV-uninfected men (25% vs. 17%; adjusted odds ratio: 1.70, 95%CI: 1.11, 2.61) based on directly measured GFR. Using estimated CKD-EPI GFR, HIV infection was associated with increased risk of incident hyperfiltration among non-blacks at younger ages that diminished over time. A higher non-significant risk was observed among blacks. Hyperfiltration was not associated with accelerated 5-year GFR decline. Compared to uninfected men, men treated for HIV-infection had a faster 5-year GFR decline. Conclusions Treated HIV infection was associated with an increased independent risk of prevalent and incident hyperfiltration, and varied by race. HIV infection, but not hyperfiltration, was associated with accelerated short term GFR decline. Therapies for metabolic, cardiovascular and renal abnormalities, including hyperfiltration, remain important considerations for HIV management

Master teachers as teacher leaders: evidence from Malaysia and the Philippines

The career paths of teachers in most countries lead to talented practitioners progressively reducing their classroom work to take on leadership and management responsibilities culminating in headship. Some education systems seek to keep good teachers in classrooms by offering alternative promoted posts, often described as master teachers. This article presents evidence of the role of master teacher in two underpublished Asia-Pacific contexts: Malaysia and the Philippines. Drawing on interviews with master teachers, and their principals and colleagues, the article provides a picture of the activities and role relationships of these senior practitioners. The findings show that the master teacher role largely succeeds in keeping talented and ambitious teachers in the classroom, but there is only limited evidence of a wider impact on colleagues, schools and the education system

Must I retire? : Optional retirement as a solution to ageing workforce

Like many developed societies, Hong Kong is suffering from a rapid ageing population, especially when taking into account the imminent retirement tide of the baby-boomers. According to the Census and Statistics Department, the proportion of the ageing population is projected to rise sharply from 13% in 2011 to 30% in 2041, making Hong Kong a Hyper-aged Society. Since most organisations require their older employees to leave the workforce when these employees are reaching retirement age, the experienced, skillful, and still able-to-work manpower will be completely wasted, which severely lower the city\u27s productivity due to a shrinking labour force. In addition, with the group of ageing workforce gradually leaving the market in the future, the demands on social security and other related expenses are expected to increase

A study of Malaysian accounting education in higher-learning institutions: Is Malaysia preparing undergraduates for a tsunami of fraud?

The current syllabus lack sufficiency of fraud education in areas of auditing, fraud examination and forensic accounting in the current accounting curriculum. This paper seeks to analyze the relationship between final year accouting students’ perceived coverage of fraud education and the overall sufficiency of the three areas in higher-learning institutions. Learning objectives were used to determine the sufficiency of fraud education in current accounting curriculum and a brief comparison between different higher learning institutions in Malaysia, students with and without internship experience, and test of ethical conduct was performed. Findings include insufficient coverage in the areas of fraud examination and forensic accounting but not auditing and that the students’ perceived coverage of fraud education depends on the sufficiency of fraud examination and forensic accounting areas. The paper only tested the perception aspect of students and results may differ depending on student’s aptitude in learning. This study provides valuable input to redesigning the current accounting curriculum to expose students to fraud-based learning environment and also incorporating forensic accounting courses. It seeks to regain society’s confidence in the accounting profession through improved fraud detection. The research will add value to the accounting education offered to undergraduates as very little prior research has been done to provide insights in students’ (end-user) perception of fraud education

2-D wavelet segmentation in 3-D T-ray tomography

Copyright © 2007 IEEEIn this letter, segmentation techniques for terahertz (T-ray) computed tomographic (CT) imaging are investigated. A set of linear image fusion and novel wavelet scale correlation segmentation techniques is adopted to achieve material discrimination within a 3-D object. The methods are applied to a T-ray CT image dataset taken from a plastic vial containing a plastic tube. This setup simulates the imaging of a simple nested organic structure, which provides an indication of the potential for using T-ray CT imaging to achieve T-ray pulsed signal classification of heterogeneous layersXiaoxia Yin, Brian W.-H. Ng, Bradley Ferguson, Samuel P. Mickan and Derek Abbot