The relationship between children's motor proficiency and health-related fitness

The overall purpose of this study was to examine the relationship between motor proficiency and health-related fitness in children. In addition, the study aimed to determine if particular combinations of motor skills have a stronger relationship with individual health-related fitness measures

Exploring the diagnostic accuracy of the KidFit screening tool for identifying children with health and motor performance-related fitness impairments: A feasibility study

Child obesity is associated with poor health and reduced motor skills. This study aimed to assess the diagnostic accuracy of the KidFit Screening Tool for identifying children with overweight/obesity, reduced motor skills and reduced cardiorespiratory fitness. Fifty-seven children (mean age: 12.57 ± 1.82 years; male/female: 34/23) were analysed. The Speed and Agility Motor Screen (SAMS) and the Modified Shuttle Test-Paeds (MSTP) made up the KidFit Screening Tool. Motor Proficiency (BOT2) (Total and Gross) was also measured. BMI, peak-oxygen-uptake (VO2peak) were measured with a representative sub-sample (n = 25). Strong relationships existed between the independent variables included in the KidFit Screening Tool and; BMI (R2 = 0.779, p < 0.001); Gross Motor Proficiency (R2 = 0.612, p < 0.001) and VO2peak (mL/kg/min) (R2 = 0.754, p < 0.001). The KidFit Screening Tool has a correct classification rate of 0.84 for overweight/obesity, 0.77 for motor proficiency and 0.88 for cardiorespiratory fitness. The sensitivity and specificity of the KidFit Screening Tool for identifying children with overweight/obesity was 100% (SE = 0.00) and 78.95%, respectively (SE = 0.09), motor skills in the lowest quartile was 90% (SE = 0.095) and 74.47% (SE = 0.064), respectively, and poor cardiorespiratory fitness was 100% (SE = 0.00) and 82.35% (SE = 0.093), respectively. The KidFit Screening Tool has a strong relationship with health- and performance-related fitness, is accurate for identifying children with health- and performance-related fitness impairments and may assist in informing referral decisions for detailed clinical investigations

Flow patterns through vascular graft models with and without cuffs

The shape of a bypass graft plays an important role on its efficacy. Here, we investigated flow through two vascular graft designs±with and without cuff at the anastomosis. We conducted Digital Particle Image Velocimetry (DPIV) measurements to obtain the flow field information through these vascular grafts. Two pulsatile flow waveforms corresponding to cardiac cycles during the rest and the excitation states, with 10% and without retrograde flow out the proximal end of the native artery were examined. In the absence of retrograde flow, the straight end-to-side graft showed recirculation and stagnation regions that lasted throughout the full cardiac cycle with the stagnation region more pronounced in the excitation state. The contoured end-to-side graft had stagnation region that lasted only for a portion of the cardiac cycle and was less pronounced. With 10% retrograde flow, extended stagnation regions under both rest and excitation states for both bypass grafts were eliminated. Our results show that bypass graft designers need to consider both the type of flow waveform and presence of retrograde flow when sculpting an optimal bypass graft geometry

CONDOR: Long endurance high altitude vehicle, volume 5

The results of a design study resulting in the proposed CONDOR aircraft are presented. The basic requirements are for the aircraft to maintain continuous altitude at or above 45,000 feet for at least a 3-day mission, be able to comfortably support a two-man crew during this period with their field of vision not obstructed to a significant degree, carry a payload of 200 pounds, and provide a power supply to the payload of 2000 watts. The take-off and landing distances must be below 5000. feet, and time to reach cruise altitude must not exceed 3 hours. The subjects discussed are configuration selection, structural analysis, stability and control, crew and payload accomodations, and economic estimates

Assessing e-commerce adoption by small and medium enterprises in Malaysia, Singapore and Thailand

Many publications to date, have describe the various adoption of e-commerce among firms small and large. However, although the e-commerce adoption growth has been significant, the e-commerce adoption rate among SMEs has mainly been among the industrialized countries. First objective of this research is to assess the usefulness and ease of using e-commerce perceived by SMEs in both service and manufacturing industries whether there are significant differences between Malaysia, Singapore and Thailand respectively. The second objective is to assess the important technical competencies in terms of technical knowledge and skills in e-commerce setup in both service and manufacturing industry across and to identify whether are there significant difference between Malaysia, Singapore and Thailand. The relationship among variables has been studied through correlation test. Three dimensions have been analyzed. Technical knowledge related to e-commerce, perceive ease of use of e-commerce and perceive usefulness of e-commerce. From the statistical data analysis output, it is found that technical knowledge related to e-commerce is not significantly different between the countries in both the manufacturing and the service industry but both the manufacturing and service industry reckons that technical knowledge and skill poses to biggest challenge that effect the uptake of e-commerce similarly across the three countries

Lessons of Defeat and Success: Taiwan’s 2012 Elections in Comparative Perspective

In early 2011, the Kuomintang (KMT, Guomindang) government appeared to be in danger of losing power in the upcoming presidential elections. The DPP had recovered sufficiently from its disastrous electoral performance in 2008 to pose a real challenge to Ma Ying-jeou (Ma Yingjiu) and had matched the KMT’s vote share in mid-term local elections. Ma also faced the challenge of an independent presidential candidate, James Soong (Song Chuyu), who had come a close second in 2000 and now threatened to divide the pro KMT vote. Nevertheless, the KMT was able to win reduced majorities in both the presidential and legislative elections in January 2012. This article seeks to explain how the KMT was able to hold on to power by comparing the campaign with earlier national-level elections. We are interested in identifying the degree to which the Democratic Progressive Party (DPP, Minjindang) learnt from its electoral setbacks in 2008 and whether the KMT employed a similar campaign strategy to the one that had been so effective in returning it to power in 2008. Our analysis relies of an examination of campaign propaganda and campaign strategies as well as participant observation and survey data from 2012 and earlier contests

Investigating the effect of urgency and modality of pedestrian alert warnings on driver acceptance and performance

Active safety systems have the potential to reduce the risk to pedestrians by warning the driver and/or taking evasive action to reduce the effects of or avoid a collision. However, current systems are limited in the range of scenarios they can address using primary control interventions, and this arguably places more emphasis in some situations on warning the driver so that they can take appropriate action in response to pedestrian hazards. In a counterbalanced experimental design, we varied urgency (‘when’) based on the time-to-collision (TTC) at which the warning was presented (with associated false-positive alarms, but no false negatives, or ‘misses’), and modality (‘how’) by presenting warnings using audio-only and audio combined with visual alerts presented on a HUD. Results from 24 experienced drivers, who negotiated an urban scenario during twelve 6.0-minute drives in a medium-fidelity driving simulator, showed that all warnings were generally rated ‘positively’ (using recognised subjective ‘acceptance’ scales), although acceptance was lower when warnings were delivered at the shortest (2.0s) TTC. In addition, drivers indicated higher confidence in combined audio and visual warnings in all situations. Performance (based on safety margins associated with critical events) varied significantly between warning onset times, with drivers first fixating their gaze on the hazard, taking their foot off the accelerator, applying their foot on the brake, and ultimately bringing the car to a stop further from the pedestrian when warnings were presented at the longest (5.0s) TTC. In addition, drivers applied the brake further from the pedestrian when combined audio and HUD warnings were provided (compared to audio-only), but only at 5.0s TTC. Overall, the study indicates a greater margin of safety associated with the provision of earlier warnings, with no apparent detriment to acceptance, despite relatively high false alarm rates at longer TTCs. Also, that drivers feel more confident with a warning system present, especially when it incorporates auditory and visual elements, even though the visual cue does not necessarily improve hazard localisation or driving performance beyond the advantages offered by auditory alerts alone. Findings are discussed in the context of the design, evaluation and acceptance of active safety systems

Eligibility for co-trimoxazole prophylaxis among adult HIV-infected patients in South Africa

Co-trimoxazole (fixed-dose trimethoprim-sulfamethoxazole) is a broad-spectrum antibiotic used to prevent opportunistic infections in patients with HIV infection. Primary prophylaxis with co-trimoxazole has been shown to decrease hospitalisation, morbidity and mortality among people living with HIV, primarily by decreasing rates of malaria, pneumonia, diarrhoea, Pneumocystis pneumonia, toxoplasmosis and severe bacterial infections.[1-4] Co-trimoxazole is inexpensive and widely available. In standard adult treatment guidelines and essential medicine lists in South Africa (SA), the current recommendation is that co-trimoxazole should be provided for HIV-infected patients with a CD4+ count ˂200 cells/μL, HIV/tuberculosis (TB) co-infection and/or advanced HIV disease (World Health Organization (WHO) stage 3 or 4). Because of expanded access and progression towards initiation of antiretroviral treatment (ART), the WHO issued updated guidelines for co-trimoxazole prophylaxis in 2014.[5] These guidelines recommend co-trimoxazole prophylaxis for adults (including pregnant women) with severe or advanced HIV clinical disease (WHO stage 3 or 4) and/or with a CD4+ count ≤350 cells/μL. In settings with a high prevalence of malaria and/or severe bacterial infections, prophylaxis is recommended for all patients regardless of WHO clinical stage or CD4+ cell count. However, the timing of discontinuation of co-trimoxazole prophylaxis may vary and is dependent on the malarial/ bacterial infection burden in different settings.[5] Therefore, the current WHO guidance should be adapted in the context of a country-specific epidemiological profile and priorities. The impact and benefit of co-trimoxazole prophylaxis on morbidity and mortality among HIV-infected patients with a CD4+ count ≤350 cells/μL in regions with high infectious disease burdens (irrespective of CD4+ count) have been shown in a good-quality systematic review and meta-analysis that included both randomised controlled trials (RCTs) and observational cohort studies.[6] This extensive systematic review by Suthar et al.[6] showed that co-trimoxazole prophylaxis reduced the rate of death when initiated at CD4+ counts ≤350 cells/μL with ART in populations in Africa and Asia. Co-trimoxazole prophylaxis in ART-naive patients with CD4+ counts >350 cells/μL reduced the rate of death and malaria, and continuation of prophylaxis after ART-induced recovery with CD4+ counts >350 cells/μL reduced hospital admission, pneumonia, malaria and diarrhoea in African populations (SA, Zimbabwe, Uganda, Malawi, Mozambique and Ethiopia).[6] While this review largely informed the 2014 WHO guideline update, the findings need to be interpreted in the context of studies included and the varied epidemiological profile across middle- and low-income countries. There were only 2 relatively small RCTs with very few events of key endpoints; therefore, the finding of non-significance was likely (e.g. total of ~5 deaths in both arms from both trials).[7,8] One of the 2 studies was unblinded, and the follow-up in the other study was only 4 months. Ongoing co-trimoxazole prophylaxis was better than discontinuation of the drug at CD4+ counts >200 cells/μL for 3 endpoints with an adequate number of events (pneumonia, diarrhoea and malaria). Furthermore, 8 of 9 studies were conducted in countries with a high burden of malaria and bacterial and parasitic diseases, which is generalisable to the SA context.[9] Although seasonal malaria occurs in the north-eastern parts of SA, the incidence of malaria mortality and morbidity has declined remarkably over time (˂10 000 cases annually for the past 10 years).[10] In contrast, in Uganda, >9 million confirmed cases of malaria were reported in the public health sector in 2015.[9] In this review, further stratification of the impact of co-trimoxazole prophylaxis at CD4+ counts ˂200 cells/μL v. 200 - 350 cells/μL was not available. Lower bacterial resistance to co-trimoxazole is possible among populations included in this review, while resistance to co-trimoxazole in SA is common in patients with community-acquired bacterial infections.[11-13] This potential risk of resistance compounded by the lack of long-term toxicity data needs to be weighed against recommending prophylaxis in populations where benefit has not been established. Local observational studies suggest no benefit of co-trimoxazole prophylaxis with a CD4+ count >200 cells/μL or in patients who were not WHO clinical stage 3 or 4.[14,15] In an observational cohort of patients attending the adult HIV clinics at the University of Cape Town, SA, the effect of prophylactic low-dose co-trimoxazole on survival and morbidity was examined over a 5-year follow-up period. Co-trimoxazole reduced the hazards of mortality by ~44% and the incidence of severe HIV-related illnesses by ~48% in patients with evidence of advanced immunosuppression (WHO stage 3 or 4) or laboratory measurement of total lymphocyte count ˂1 250 × 106/L or CD4+ count ˂200 cells/μL. However, no beneficial effect was seen in patients with WHO clinical stage 2 or CD4+ count 200 - 500 cells/μL. A potential limitation of this study was that the sample size of patients with a CD4+ count 200 - 500 cells/μL receiving co-trimoxazole was small and may have been underpowered to observe a significant benefit. In this study, patients on ART were excluded.[14] In another SA cohort study by Hoffmann et al.,[15] examining co-trimoxazole effectiveness in reducing mortality risk during ART among persons with a CD4+ count >200 cells/μL and varying WHO clinical stages, overall co-trimoxazole prophylaxis reduced mortality by 36% across all CD4+ count strata. Analysis stratified by baseline CD4+ count showed a similar reduction in mortality risk among persons with a CD4+ count ˂200 cells/μL, but no statistically significant association was found between co-trimoxazole prophylaxis and survival in the subgroup of persons with a CD4+ count >200 - 350 cells/μL, CD4+ count >350 cells/μL and WHO stage 1 or 2 disease. However, the findings of this study need to be interpreted cautiously for the following reasons: the group with a CD4+ count >350 cells/μL was small (n=917) and might not have had enough events to draw inferences; the study population was a cohort of miners and might not have been potentially representative of the SA population; and, being a non-randomised study, residual confounding might have been a potential limitation. An earlier Cochrane review established the benefit of initiating prophylaxis at a CD4+ count ˂200 cells/μL in those with stage 2, 3 or 4 HIV disease (including TB), and discontinuation once the CD4+ count was >200 cells/μL for >6 months.[16] There was a reduction of ~31% in mortality, 27% in morbid events and 55% in hospitalisation. Significant reductions were also detected for bacterial and parasitic infections and for Pneumocystis jirovecii pneumonia. Considering the above-mentioned evidence gaps and lack of generalisability of studies to SA, the current National Essential Medicines List Committee and Adult Hospital-Level Technical Sub-committee do not support the implementation of the updated guidance by the WHO for co-trimoxazole prophylaxis among adult HIV-infected patients. Efforts should be directed towards exploring several research gaps. The impact of co-trimoxazole prophylaxis on morbidity and mortality at higher CD4+ counts in low-malariaburden areas needs to be investigated further. More data are needed on timing of co-trimoxazole cessation in HIV and TB co-infection in our context