Validation of a novel scoring system for changes in skeletal manifestations of hypophosphatasia in newborns, infants, and children: The Radiographic Global Impression of Change scale

Hypophosphatasia (HPP) is the heritable metabolic disease characterized by impaired skeletal mineralization due to low activity of the tissue-nonspecific isoenzyme of alkaline phosphatase. Although HPP during growth often manifests with distinctive radiographic skeletal features, no validated method was available to quantify them, including changes over time. We created the Radiographic Global Impression of Change (RGI-C) scale to assess changes in the skeletal burden of pediatric HPP. Site-specific pairs of radiographs of newborns, infants, and children with HPP from three clinical studies of asfotase alfa, an enzyme replacement therapy for HPP, were obtained at baseline and during treatment. Each pair was scored by three pediatric radiologists ( raters ), with nine raters across the three studies. Intrarater and interrater agreement was determined by weighted Kappa coefficients. Interrater reliability was assessed using intraclass correlation coefficients (ICCs) and by two-way random effects analysis of variance (ANOVA) and a mixed-model repeated measures ANOVA. Pearson correlation coefficients evaluated relationships of the RGI-C to the Rickets Severity Scale (RSS), Pediatric Outcomes Data Collection Instrument Global Function Parent Normative Score, Childhood Health Assessment Questionnaire Disability Index, 6-Minute Walk Test percent predicted, and Z-score for height in patients aged 6 to 12 years at baseline. Eighty-nine percent (8/9) of raters showed substantial or almost perfect intrarater agreement of sequential RGI-C scores (weighted Kappa coefficients, 0.72 to 0.93) and moderate or substantial interrater agreement (weighted Kappa coefficients, 0.53 to 0.71) in patients aged 0 to 12 years at baseline. Moderate-to-good interrater reliability was observed (ICC, 0.57 to 0.65). RGI-C scores were significantly (p ≤ 0.0065) correlated with the RSS and with measures of global function, disability, endurance, and growth in the patients aged 6 to 12 years at baseline. Thus, the RGI-C is valid and reliable for detecting clinically important changes in skeletal manifestations of severe HPP in newborns, infants, and children, including during asfotase alfa treatment. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc

Open Enrollment in Advanced Placement Courses: Experiences of Traditional and Non-Traditional Students

Beginning in the late 1990\u27s, amongst concern that traditionally underrepresented groups of students such as minorities and low income students had been denied the opportunity to enroll in AP courses, The College Board (the non profit agency that runs the AP program) began to emphasize its belief that all students should have the right to take AP courses if they desire and that secondary schools should not limit AP enrollment based on prerequisites such as teacher recommendation, GPA, and class rank. As a result of these factors, the AP program began to see dramatic gains in the number of students enrolled in its courses over the past decade. With the rapid growth in the Advanced Placement program, however, have come concerns that the rigor of the program is being diminished, as schools and teachers work to accommodate larger and larger numbers of underprepared students who have enrolled in these courses. The purpose of this study was to use interviews with students and teachers to explore the experiences of students who enroll in AP courses, and it sought to distinguish between the experiences of traditional AP students versus non-traditional students. The study also used student GPAs, class rank, ACT scores and attendance records to build an academic profile of a successful AP student. The goal of the study was to identify the types of skills and dispositions necessary to achieve success in an AP course in order to provide school administrators and counselors helpful information as they engage in course selection with their students. The results of the study showed that there are many similarities between traditional and non-traditional students with regard to their AP experiences but differences do exist, and school personnel would be well-served to learn the motivations and goals of their students as they work to help them achieve academic success. The findings help to show the value that open enrollment has on a school and its students, and to highlight the attitudes, skills, and dispositions that enable such a policy to be successfully implemented

Incorporating carbon into health care: adding carbon emissions to health technology assessments

Summary At the UN Climate Change Conference 26 in Glasgow, 50 countries committed to low-carbon health services, with 14 countries further committing to net-zero carbon health services by 2050. Reaching this target will require decision makers to include carbon emissions when evaluating new and existing health technologies (tests and treatments). There is currently, however, a scarcity of data on the carbon footprint of health-care interventions, nor any means for decision makers to include and consider carbon emission health-care assessments. We therefore investigated how to integrate carbon emissions calculated by environmental life cycle assessment (LCA) into health technology assessments (HTA). HTAs are extensively used in developing clinical and policy guidelines by individual public or private payers, and by government organisations. In the first section we explain the methodological differences between environmentally extended input-output and process-based LCA. The second section outlines ways in which carbon emissions calculated by LCA could be integrated with HTAs, recognising that HTAs are done in several ways by different jurisdictions. International effort and processes will be needed to ensure that robust and comprehensive carbon footprints of commonly used health-care products are freely available. The technical and implementation challenges of incorporating carbon emissions into HTAs are considerable, but not unsurmountable. Our aim is to lay foundations for meeting these challenges

1 Canadian Field Hospital in Haiti: surgical experience in earthquake relief

The Canadian Forces’ (CF) deployable hospital, 1 Canadian Field Hospital, was deployed to Haiti after an earthquake that caused massive devastation. Two surgical teams performed 167 operations over a 39-day period starting 17 days after the index event. Most operations were unrelated to the earthquake. Replacing or supplementing the destroyed local surgical capacity for a brief period after a disaster can be a valuable contribution to relief efforts. For future humanitarian operations/disaster response missions, the CF will study the feasibility of accelerating the deployment of surgical capabilities. On Jan. 12, 2010, a 7.0-magnitude earthquake occurred in Haiti. The intensity of the earthquake and the frailty of the buildings in most of the country combined to cause extensive structural damage and casualties.1,2 An intense multinational relief effort followed. The Canadian Forces (CF) contributed by sending a contingent of more than 2000 personnel.3 This included 1 Canadian Field Hospital (1 CFH), the CF deployable field hospital. While 1 CFH itself provided the core nucleus of staff for the hospital, 21 reserve and regular forces units across Canada also provided personnel. The full contingent of 117 CF members was first assembled in Petawawa, Ont., home of 1 CFH. Ninety-seven were medical or dental personnel, including medics; dental, laboratory, x-ray and operating room (OR) technicians; pharmacists; nurses; physicians; and surgeons. The remaining 20 were from various nonmedical trades, including signallers, truckers, mechanics, logisticians and others. From Petawawa, the unit moved by ground to Canadian Forces Base Trenton and then by air to Port-Au-Prince on the recently acquired CC-177 aircraft. The first elements of 1 CFH arrived in theatre on January 21. It was decided to position 1 CFH in Léogane, a hard-hit town near the epicentre of the earthquake. Over the next few days, the hospital personnel arrived and contributed to establishing the hospital. Security was provided by 3 Battalion Royal 22e Régiment and naval personnel from the HMCS Athabaskan. Once it was fully operational, the hospital had a 100-bed ward, a 4-bed intensive care unit, radiology and dental suites, a primary care section, a laboratory and 2 ORs (Fig. 1). The first OR became functional on January 29. There were 2 surgical teams, each consisting of an anesthesiologist, general surgeon, orthopedic surgeon, OR technician and OR nurses. This paper discusses our surgical experience during this deployment

Improving the surface brightness-color relation for early-type stars using optical interferometry

The aim of this work is to improve the SBC relation for early-type stars in the $-1 \leq V-K \leq 0$ color domain, using optical interferometry. Observations of eight B- and A-type stars were secured with the VEGA/CHARA instrument in the visible. The derived uniform disk angular diameters were converted into limb darkened angular diameters and included in a larger sample of 24 stars, already observed by interferometry, in order to derive a revised empirical relation for O, B, A spectral type stars with a V-K color index ranging from -1 to 0. We also took the opportunity to check the consistency of the SBC relation up to $V-K \simeq 4$ using 100 additional measurements. We determined the uniform disk angular diameter for the eight following stars: $\gamma$ Ori, $\zeta$ Per, $8$ Cyg, $\iota$ Her, $\lambda$ Aql, $\zeta$ Peg, $\gamma$ Lyr, and $\delta$ Cyg with V-K color ranging from -0.70 to 0.02 and typical precision of about $1.5\%$. Using our total sample of 132 stars with $V-K$ colors index ranging from about $-1$ to $4$, we provide a revised SBC relation. For late-type stars ($0 \leq V-K \leq 4$), the results are consistent with previous studies. For early-type stars ($-1 \leq V-K \leq 0$), our new VEGA/CHARA measurements combined with a careful selection of the stars (rejecting stars with environment or stars with a strong variability), allows us to reach an unprecedented precision of about 0.16 magnitude or $\simeq 7\%$ in terms of angular diameter.Comment: 13 pages, 5 figures, accepted for publication in A&

Sheep Updates 2006 -Part 1

This session covers seven papers from different authors: PLENARY 1. Making Dollars from Merinos, David Sackett, Holmes Sackett & Associates Pty Limited, Wagga Wagga, NSW 2. A new variety of sulla (Hedysarun coronarium)for forage production in southern Australia, Kevin Foster, Ron Yates, Phil Nichols, Department of Agriculture and Food, WA and Centre for Legumes in Mediterranean Agriculture, UWA 3. Mating - Short and fast is better, Graeme Martin, John Milton, Faculty of Natural & Agricultural Sciences, The University of Western Australia 4. Breech strike protection in sheep post 2010, Scott Williams, Program Manager Animal Health and Welfare, Australian Wool Innovation Limited 5. How the West can win!, Garry McAlister, Meat & Livestock Australia Limited, New South Wales. 6. The Merino Company (TMC) - Active Marketing and supply chain management, Mark Suttie, General Manager Marketing – The Merino Company (TMC) 7. Driving on-farm productivity: the next 20 years, Peter Fennessy, Jack Cocks, AbacusBio Limited, Dunedin, New Zealan

The environmental footprint of morphine: a life cycle assessment from opium poppy farming to the packaged drug

OBJECTIVE: To examine the environmental life cycle from poppy farming through to production of 100 mg in 100 mL of intravenous morphine (standard infusion bag). DESIGN: \u27Cradle-to-grave\u27 process-based life cycle assessment (observational). SETTINGS: Australian opium poppy farms, and facilities for pelletising, manufacturing morphine, and sterilising and packaging bags of morphine. MAIN OUTCOME MEASURES: The environmental effects (eg, CO2 equivalent (\u27CO2 e\u27) emissions and water use) of producing 100 mg of morphine. All aspects of morphine production from poppy farming, pelletising, bulk morphine manufacture through to final formulation. Industry-sourced and inventory-sourced databases were used for most inputs. RESULTS: Morphine sulfate (100 mg in 100 mL) had a climate change effect of 204 g CO2 e (95% CI 189 to 280 g CO2 e), approximating the CO2 e emissions of driving an average car 1 km. Water use was 7.8 L (95% CI 6.7- to 9.0 L), primarily stemming from farming (6.7 L). All other environmental effects were minor and several orders of magnitude less than CO2 e emissions and water use. Almost 90% of CO2 e emissions occurred during the final stages of 100 mg of morphine manufacture. Morphine\u27s packaging contributed 95 g CO2 e, which accounted for 46% of the total CO2 e (95% CI 82 to 155 g CO2 e). Mixing, filling and sterilisation of 100 mg morphine bags added a further 86 g CO2 e, which accounted for 42% (95% CI 80 to 92 g CO2 e). Poppy farming (6 g CO2 e, 3%), pelletising and manufacturing (18 g CO2 e, 9%) made smaller contributions to CO2 emissions. CONCLUSIONS: The environmental effects of growing opium poppies and manufacturing bulk morphine were small. The final stages of morphine production, particularly sterilisation and packaging, contributed to almost 90% of morphine\u27s carbon footprint. Focused measures to improve the energy efficiency and sources for drug sterilisation and packaging could be explored as these are relevant to all drugs. Comparisons of the environmental effects of the production of other drugs and between oral and intravenous preparations are required

Health, financial and environmental impacts of unnecessary vitamin D testing: a triple bottom line assessment adapted for healthcare

To undertake an assessment of the health, financial and environmental impacts of a well-recognised example of low-value care; inappropriate vitamin D testing. Design Combination of systematic literature search, analysis of routinely collected healthcare data and environmental analysis. Setting Australian healthcare system. Participants Population of Australia. Outcome measures We took a sustainability approach, measuring the health, financial and environmental impacts of a specific healthcare activity. Unnecessary vitamin D testing rates were estimated from best available published literature; by definition, these provide no gain in health outcomes (in contrast to appropriate/necessary tests). Australian population-based test numbers and healthcare costs were obtained from Medicare for vitamin D pathology services. Carbon emissions in kg CO2e were estimated using data from our previous study of the carbon footprint of common pathology tests. We distinguished between tests ordered as the primary test and those ordered as an add-on to other tests, as many may be done in conjunction with other tests. We conducted base case (8% being the primary reason for the blood test) and sensitivity (12% primary test) analyses. Results There were a total of 4 457 657 Medicare-funded vitamin D tests in 2020, on average one test for every six Australians, an 11.8% increase from the mean 2018–2019 total. From our literature review, 76.5% of Australia’s vitamin D tests provide no net health benefit, equating to 3 410 108 unnecessary tests in 2020. Total costs of unnecessary tests to Medicare amounted to >$A87 000 000. The 2020 carbon footprint of unnecessary vitamin D tests was 28 576 kg (base case) and 42 012 kg (sensitivity) CO2e, equivalent to driving ~160 000–230 000 km in a standard passenger car. Conclusions Unnecessary vitamin D testing contributes to avoidable CO2e emissions and healthcare costs. While the footprint of this example is relatively small, the potential to realise environmental cobenefits by reducing low-value care more broadly is significant

An update on the CHARA array

The CHARA Array, operated by Georgia State University, is located at Mount Wilson Observatory just north of Los Angeles in California. The CHARA consortium includes many groups, including LIESA in Paris, Observatoire de la Cote d’Azur, the University of Michigan, Sydney University, the Australian National University, the NASA Exoplanet Science Institute, and most recently the University of Exeter. The CHARA Array is a six-element optical/NIR interferometer, and for the time being at least, has the largest operational baselines in the world. In this paper we will give a brief introduction to the array infrastructure with a focus on our Adaptive Optics program, and then discuss current funding as well as opportunities of funding in the near future