Fostering resilience-oriented thinking in engineering practice

Round tables discussing the resilience of critical infrastructure systems held in the UK, the USA and New Zealand have provided insight into how organisations are changing the basis of planning and investment decisions to enhance resilience. The events convened stakeholders to explore how resilience is embraced in their sectors and to identify how to advance practice. The overarching premise was to convene a diverse group who would not typically have an opportunity to engage with each other, to share their perspectives on putting resilience thinking into practice. The round tables identified that early-adopting organisations are implementing approaches to decision making that embrace resilience thinking, but such approaches are not yet embedded in common practice across organisations that are responsible for planning and managing critical infrastructure. The findings emphasise that multi-agency coordination and collaboration is required to advance resilience thinking in professional practice and to move beyond traditional risk-based paradigms. Governance and policy interventions will help encourage cross-sector information sharing and enforce responsibility and transparency surrounding exposure to potential shocks and stresses. It is recommended that such interventions could expand on principles and practice in existing emergency-management efforts, on the basis that such efforts are founded on coordinating various groups. </jats:p

Effects of self-management program on healthy lifestyle behaviors among elderly with hypertension

© 2018, Behavioral Science Research Institute. This research aimed to evaluate whether a self-management program promoted healthy lifestyle behaviors (HLBs) and improved health outcomes among Thai elderly with hypertension. Participants were randomly allocated to either an intervention group (n=20), that received an 8-week self-management program that included home visits, or a control group (n = 20). The data were analyzed by a chi-square analysis, a mixed-model repeated measure MANOVA, and MANCOVAs. There were significant differences in the mean scores of healthy lifestyle behaviors at posttest and follow-up between the two groups (p < 0.01). Moreover, the experimental participants showed statistically significant decrease in BMI as compared to the control group participants in posttest and follow-up (p < 0.001). There was a statistically significant reduction in blood pressure in the experimental participants, compared with the control participants at follow-up (p < 0.001). Furthermore, healthy lifestyle behaviors increased significantly in the experimental participants compared with the control participants and baseline (p < 0.001). In addition, BMI and blood pressure decreased in the experimental participants compared with the control participants and baseline (p < 0.001). The self-management program resulted in improved healthy lifestyle behaviors, and health outcomes among the elderly with hypertension, and has implications for health promotion

Prevalence of elevated alanine transaminase in Australia and its relationship to metabolic risk factors: A cross-sectional study of 9,447 people

BACKGROUND AND AIM: Elevated alanine transaminase (ALT) is a strong predictor of metabolic syndrome, but there are few data from the Australian population. We aimed to determine the prevalence of elevated ALT and association with metabolic risk factors. METHODS: In this cross-sectional study including adult participants (N = 9,447) from a nationwide, population-based survey, we assessed the prevalence of elevated ALT [defined as ≥ 40 IU/L (men) and ≥ 30 IU/L (women) as baseline, and ALT as ≥ 30 IU/L (men) and ≥ 19 IU/L (women) as lower threshold], distribution of metabolic risk factors, and independent predictors of elevated ALT in logistic regression models. Analyses were weighted to the population with population weights. RESULTS: Elevated ALT levels were found in 11.2% of the Australian population. People with elevated ALT were younger (43 vs 46 yrs) with more truncal adiposity (100 vs 91 cm), higher pro-atherogenic lipids and glucose and exercised less (120 vs 160 min per week, P < 0.05 for all analyses). Regression analyses indicated that younger age, male sex, diabetes, triglycerides, apolipoprotein B, and waist circumference were independent predictors of elevated ALT. The population attributable fraction of elevated ALT due to truncal obesity was estimated at 47%. CONCLUSION: These data demonstrate a high prevalence of elevated ALT in the general population that is closely associated with metabolic risk factors. Individuals with elevated ALT should be evaluated for co-existent metabolic disorders

Elevated Liver Enzymes and Mortality in Older Individuals: A Prospective Cohort Study

Aim of the study: The aim of the study was to determine the excess risk of all-cause and cardiovascular mortality in older people with elevated liver enzymes [alanine transaminase (ALT) and gamma glutamyltransferase (GGT)]. Methods: We utilized data from a large, prospective, population based study of 2061 people aged 50 to 99 years with linkage to a National Death Registry. Participants were categorized as having elevated liver enzymes using standard thresholds (for males, GGT>51 and ALT>40 IU/L, and GGT>33 and ALT>31 IU/L for females). Adjusted Cox proportional hazards models assessed the association of elevated liver enzymes and mortality with long duration follow-up. Results: Over a median follow-up of 10 years (20,145 person years), 701 people died, including 203 (34%) from cardiovascular disease. Cox regression models adjusted for sex, age, smoking, and alcohol intake indicated that people with elevated liver enzymes had an increased risk of all-cause mortality that was modified by age (test for interaction P=0.01). Age-stratified analyses demonstrated no increased risk at younger ages [age 59 y and below; hazard ratio (HR): 0.46; 95% confidence interval, 0.06-3.49], but increased risk with age; age 60 to 69, HR: 1.05 (0.53-2.07), age 70 to 79 years, HR: 1.54 (0.81 to 2.93), and age 80 years and above, HR: 3.53 (1.55 to 8.04). Similarly, the risk of cardiovascular mortality with elevated liver enzymes was also modified by, and increased with age (test for interaction P=0.02); age 70 to 79, HR: 3.15 (1.37 to 7.23), age 80 years and above, HR: 6.86 (2.44 to 19.30). Conclusions: In community-dwelling elderly persons, an elevation in both ALT and GGT are associated with an excess risk of all-cause and cardiovascular mortality which increases with age

Development of a fixative protocol using formaldehyde and gluteraldehyde for preservation of microbial art on agar plates.

Agar art bridges the gap between science and art, using microbes instead of paint. Afterwards, the art can change in response to microbial fluctuation, meaning preservation of the original art is essential. Here, formaldehyde and glutaraldehyde were investigated as preservatives, involving techniques used in healthcare settings to preserve samples. Formaldehyde was tested at 1.0%, 2.0% and 3.7%, w/v, whereas glutaraldehyde was tested at 1% and 2.5%, w/v. Both compounds and respective concentrations were tested for different time periods. Escherichia coli, Serratia marcescens, Staphlococcus aureus and Micrococcus luteus were used as bacteria for "drawing" the works of art. The effectiveness of fixation was determined using integrated densities and visual assessment. Initially, both compounds showed potential promise, albeit with a loss of bacteria. Ser. marcescens was prone to colour changes and glutaraldehyde caused discolouration of agar and bacteria. These could be caused by a pH decrease in the agar, due to residual free aldehyde groups. Reduction of this was tested using 300 mM sodium metabisulfite to neutralize excess aldehydes. This initially led to reduced bacterial loss and avoided colour changes, however measurements 24 h post-fixation showed colour loss to some bacterial clusters. This study found that, depending on the species, use of at least 2% formaldehyde for a short fixation period (typically 1 min) was the most promising approach for the preservation of art. Given the success of this with different bacteria, it would make a good starting combination for anyone trying to fix agar art; depending on the bacterial species used, methodology refinement may be needed for optimisation. This study shows successful fixation and preservation of different bacterial species on agar for the first time. The impact of this is to preserve agar art while making it safe and non-infective to those in contact with the microbial art

A randomised controlled trial of a code-word enuresis alarm

Objective: To compare a novel code-word alarm with a commercially available wireless alarm for treating enuresis Design: Randomised controlled trial with blinding of study personnel and outcome assessors Setting: A tertiary paediatric centre Patients: Children aged six to eighteen with at least three wet nights per week in the previous 6 months referred by doctors Outcomes: Primary outcome: the proportion who achieved a full response (14 consecutive dry nights) by 16 weeks. Secondary outcomes: change in frequency of wetting, duration of alarm training, percentage of wet nights that the child woke to the alarm, adherence to treatment, adverse events and satisfaction with treatment. Results: Of the 353 participants, 176 were assigned to the code-word alarm and 177 to control. At 16 weeks, 54% (95% CI, 47% to 61%) in the experimental group and 47% (95% CI, 40% to 55%) in the control group had achieved a full response (p=0.22), with 74% and 66% respectively attaining a 50% or more reduction in wetting frequency (p=0.14). The experimental group woke more often than the control group (median percentage of waking 88% versus 77%, p=0.003) and had greater reduction in wet nights (median reduction 10 versus 9 nights per fortnight). Fewer in the experimental group discontinued therapy before achieving a full response (27% versus 37% discontinued, p=0.04). There were no significant differences in relapse rates at 6 months, adverse events or satisfaction between the two alarms. In a post hoc subgroup analysis of children with monosymptomatic enuresis, more in the experimental group achieved a full response (66% versus 52%, p=0.047), with higher median percentage of waking (89% versus 79%, p=0.006) and greater reduction in wet nights (median reduction 12 versus 9 nights per fortnight). Conclusions: Although the code-word alarm increased waking, no difference in full response rates was demonstrated between the two alarms.The study was funded by an NHMRC Project Grant (570761). AT was supported by an NHMRC Program Grant (633003) to the Screening & Test Evaluation Program

Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease a systematic review and meta-analysis

Context: Clinical practice guidelines on the management of mineral and bone disorders due to chronic kidney disease recommend specific treatment target levels for serum phosphorus, parathyroid hormone, and calcium. Objective: To assess the quality of evidence for the association between levels of serum phosphorus, parathyroid hormone, and calcium and risks of death, cardiovascular mortality, and nonfatal cardiovascular events in individuals with chronic kidney disease. Data Sources: The databases of MEDLINE (1948 to December 2010) and EMBASE (1947 to December 2010) were searched without language restriction. Hand searches also were conducted of the reference lists of primary studies, review articles, and clinical guidelines along with full-text review of any citation that appeared relevant. Study Selection: Of 8380 citations identified in the original search, 47 cohort studies (N=327 644 patients) met the inclusion criteria. Data Extraction: The characteristics of study design, participants, exposures, and covariates together with the outcomes of all-cause mortality, cardiovascular mortality, and nonfatal cardiovascular events at different levels of serum phosphorus, parathyroid hormone, and calcium were analyzed within studies. Data were summarized across studies (when possible) using random-effects meta-regression. Data Synthesis: The risk of death increased 18% for every 1-mg/dL increase in serum phosphorus (relative risk [RR], 1.18 [95% confidence interval {CI}, 1.12-1.25]). There was no significant association between all-cause mortality and serum level of parathyroid hormone (RR per 100-pg/mL increase, 1.01 [95% CI, 1.00-1.02]) or serum level of calcium (RR per 1-mg/dL increase, 1.08 [95% CI, 1.00-1.16]). Data for the association between serum level of phosphorus, parathyroid hormone, and calcium and cardiovascular death were each available in only 1 adequately adjusted cohort study. Lack of adjustment for confounding variables was not a major limitation of the available studies. Conclusions: The evidentiary basis for a strong, consistent, and independent association between serum levels of calcium and parathyroid hormone and the risk of death and cardiovascular events in chronic kidney disease is poor. There appears to be an association between higher serum levels of phosphorus and mortality in this population. ©2011 American Medical Association. All rights reserved

Accuracy of the "traffic light" clinical decision rule for serious bacterial infections in young children with fever: A retrospective cohort study

Objectives To determine the accuracy of a clinical decision rule (the traffic light system developed by the National Institute for Health and Clinical Excellence (NICE)) for detecting three common serious bacterial infections (urinary tract infection, pneumonia, and bacteraemia) in young febrile children. Design Retrospective analysis of data from a two year prospective cohort study Setting A paediatric emergency department. Participants 15 781 cases of children under 5 years of age presenting with a febrile illness. Main outcome measures Clinical features were used to categorise each febrile episodes as low, intermediate, or high probability of serious bacterial infection (green, amber, and red zones of the traffic light system); these results were checked (using standard radiological and microbiological tests) for each of the infections of interest and for any serious bacterial infection. Results After combination of the intermediate and high risk categories, the NICE traffic light system had a test sensitivity of 85.8% (95% confidence interval 83.6% to 87.7%) and specificity of 28.5% (27.8% to 29.3%) for the detection of any serious bacterial infection. Of the 1140 cases of serious bacterial infection, 157 (13.8%) were test negative (in the green zone), and, of these, 108 (68.8%) were urinary tract infections. Adding urine analysis (leucocyte esterase or nitrite positive), reported in 3653 (23.1%) episodes, to the traffic light system improved the test performance: sensitivity 92.1% (89.3% to 94.1%), specificity 22.3% (20.9% to 23.8%), and relative positive likelihood ratio 1.10 (1.06 to 1.14). Conclusion The NICE traffic light system failed to identify a substantial proportion of serious bacterial infections, particularly urinary tract infections. The addition of urine analysis significantly improved test sensitivity, making the traffic light system a more useful triage tool for the detection of serious bacterial infections in young febrile children

“Does Short-term variation in fetal heart rate predict fetal acidaemia?” A Systematic review and meta-analysis

Objective: To evaluate the association of short-term variation (STV) of the fetal heart rate in predicting fetal acidaemia at birth. Methods: The search strategy employed searching of electronic databases (MEDLINE, Web of Science, Scopus, and Google Scholar) and reference lists of relevant studies. Data was extracted from studies, adhering strictly to the following criteria: singleton pregnancy at ≥ 24 weeks gestation, computerised CTG (index test) and calculation of STV before delivery. The outcome measure was arterial pH assessed in cord blood obtained at birth. Results: Meta-analysis showed moderate accuracy of STV in predicting fetal acidaemia with a sensitivity of 0.57 (95% CI: 0.45 to 0.68), specificity of 0.81 (95% CI: 0.69 to 0.89), positive likelihood ratio of 3.14 (95% CI: 2.13 to 4.63) and negative likelihood ratio of 0.58, (95% CI: 0.46 to 0.72). However, in intra-uterine growth restricted fetuses, a small improvement in detecting acidaemia was observed; with a sensitivity of 0.63, (95% CI: 0.49 to 0.75) and negative likelihood ratio of 0.50, (95% CI: 0.31 to 0.80). Conclusion: STV appears to be a moderate predictor for fetal acidaemia. However, its usefulness as a stand-alone test in predicting acidaemia in clinical setting remains to be determined