Lower respiratory tract infections and community acquired pneumonia in adults

Copyright © 2004 Royal Australian College of General Practitioners Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.BACKGROUND: Lower respiratory tract infections--acute bronchitis and community acquired pneumonia (CAP)--are important causes of morbidity in Australia. Acute bronchitis is often treated with antibiotics, although the cause is usually viral. Community acquired pneumonia may be fatal, particularly in the elderly, therefore appropriate assessment and management is essential. OBJECTIVE: This article describes the aetiology, clinical assessment, investigations and management of acute bronchitis and CAP in the community. DISCUSSION: Clinical assessment is important for acute bronchitis and CAP, with investigations such as C reactive protein, serology, and chest X-ray informing diagnosis and management of the latter. Causative organisms are usually not identified, but are presumed to be viral for acute bronchitis, and Streptococcus pneumoniae for CAP; although 'atypicals' are also important. Antibiotics should generally not be prescribed for acute bronchitis, however, there is some evidence they may provide limited benefits in patients who have chest signs, are very unwell, are older, have comorbidities, or smoke. In patients with CAP, treated outside of hospital, the combination of amoxycillin and doxycycline/roxithromycin is the treatment of choice.Nigel Stocks; John Turnidge; Alan Crocket

Towards a Holistic, Total Engineering Cost Model

In this paper, we explore a new approach for a unified and interdisciplinary model for estimating the total engineering effort in developing and delivering a parametric software-intensive complex system. We begin by reviewing some of the limitations of using existing engineering discipline-focused tools for estimating total engineering cost and by articulating the benefits of such a holistic model. Applying a two step method combining heuristic analysis and data validation, we propose three hypotheses to expand the basic cost estimating relationship of COSYSMO, a systems engineering model, to the total engineering scope by including software size drivers. The implementation of the hypotheses and the validation approach are also discussed. We conclude the discussion by outlining the future work required to realize such a model and to apply it to supporting successful system development endeavours

Characterization of the PTW microsilicon detector

According to Technical Report Series No. 483 (TRS 483), a detector that is used for large field dosimetry applications is assumed to be unacceptable for small field dosimetry applications until that detector has been adequately characterized specifically for small field dosimetry applications1. To do this for a silicon diode detector, its dose linearity, dose-per-pulse (DPP) dependence, effective point of measurement (EPOM), small field profiles, and small field output factors need to be measured for a variety of conditions that emulate the conditions in which the detector will actually be used. The PTW microSilicon is a silicon diode detector that has not been adequately characterized in the published literature for small field dosimetry applications

Pharmacokinetic–pharmacodynamic integration and modelling of oxytetracycline for the calf pathogens Mannheimia haemolytica and Pasteurella multocida

A calf tissue cage model was used to study the pharmacokinetics (PK) and pharmacodynamics (PD) of oxytetracycline in serum, inflamed (exudate) and noninflamed (transudate) tissue cage fluids. After intramuscular administration, the PK was characterized by a long mean residence time of 28.3 hr. Based on minimum inhibitory concentrations (MICs) for six isolates each of Mannheimia haemolytica and Pasteurella multocida, measured in serum, integration of in vivo PK and in vitro PD data established area under serum concentration–time curve (AUC0–∞)/MIC ratios of 30.0 and 24.3 hr for M. haemolytica and P. multocida, respectively. Corresponding AUC0–∞/MIC ratios based on MICs in broth were 656 and 745 hr, respectively. PK-PD modelling of in vitro bacterial time–kill curves for oxytetracycline in serum established mean AUC0–24 hr/MIC ratios for 3log10 decrease in bacterial count of 27.5 hr (M. haemolytica) and 60.9 hr (P. multocida). Monte Carlo simulations predicted target attainment rate (TAR) dosages. Based on the potency of oxytetracycline in serum, the predicted 50% TAR single doses required to achieve a bacteriostatic action covering 48-hr periods were 197 mg/kg (M. haemolytica) and 314 mg/kg (P. multocida), respectively, against susceptible populations. Dosages based on the potency of oxytetracycline in broth were 25- and 27-fold lower (7.8 and 11.5 mg/kg) for M. haemolytica and P. multocida, respectively

Arte convenzionale – ovvero – perché non possono esistere artisti realmente anticonformisti

The representation of the artist is generally that of a nonconformist, a lonely Bohemian eager to revolutionise the world from his studio. From this perspective, the traditional interpretation of art history is one of linear progress, spurred on by moments of innovation aiming at new states of conventionalism. This article shows how such a perspective has much to do with the philosophy of modern times, even though it doesn’t provide a satisfactory explanation of the meaning and development of art throughout the centuries, bound as they are instead to the necessity of convention with the values of society (or of its élite) rather than on wild individualism

Doctor of Philosophy

dissertationThis dissertation investigated discrepancies in parent and youth report of youth-witnessed violence (YWV), including the relationship between parent history of victimization and discrepancy, as well as how discrepancies in reports of YWV predict outcomes for youth. The sample included a subset of participants from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN); specifically, 854 children and their primary, female caregivers. Data were collected from parents and children at the age of 4, 8, and 12. Multivariate regression analysis was utilized to examine parent history of victimization as a predictor of discrepant reports of YWV between youth and caregivers. Polynomial regression and response surface analyses were further conducted to understand the relationship between discrepancies in parent and youth reports of YWV as they relate to concurrent and distal internalizing, externalizing, and trauma symptoms, total problems, and youth delinquency. Results indicated that youth reported witnessing significantly more incidents of violence than their parents reported. Additionally, there was support for a significant but small relationship between parents with victimization history and subsequent discrepancies in YWV. Specifically, parents with trauma histories reported greater YWV exposure relative to their children’s reports. With respect to concurrent outcomes associated with discrepancies, results indicated that youth fared the worst (i.e., highest internalizing, externalizing, total problems, and trauma symptoms) when parent and youth agreed and reported high exposure to YWV. When it came to discrepancy, the relationship was significant and negative, indicating that when parents and youth disagreed (i.e., greater discrepancy), parent symptom ratings decreased. When youth reported higher exposure relative to parents, youth reported more posttraumatic stress symptoms. For longitudinal outcomes, these relationships did not hold up and there were no statistically significant relationships between parent-youth discrepancy of YWV at age 8 and parent-reported youth outcomes at age 12. The study provided evidence that parent history of victimization may play a role in discrepancies and warrants further investigation. Additionally, the study suggested that discrepancy matters for understanding youth concurrent functioning and highlights the need to gather multisource data in research and clinical settings

Forgotten Antibiotics: An Inventory in Europe, the United States, Canada, and Australia

In view of the alarming spread of antimicrobial resistance in the absence of new antibiotics, this study aimed at assessing the availability of potentially useful older antibiotics. A survey was performed in 38 countries among experts including hospital pharmacists, microbiologists, and infectious disease specialists in Europe, the United States, Canada, and Australia. An international expert panel selected systemic antibacterial drugs for their potential to treat infections caused by resistant bacteria or their unique value for specific criteria. Twenty-two of the 33 selected antibiotics were available in fewer than 20 of 38 countries. Economic motives were the major cause for discontinuation of marketing of these antibiotics. Fourteen of 33 antibiotics are potentially active against either resistant Gram-positive or Gram-negative bacteria. Urgent measures are then needed to ensure better availability of these antibiotics on a global scal

Conceptualising An Approach To Clinical Reasoning In The Education Profession

An increasing number of teaching qualifications are underpinned by the concept of clinical practice (Alter & Coggshall, 2009; McLean Davies et al., 2013) and draw on clinical education research in the health professions. Teaching as a clinical practice profession is an emergent approach in teacher education. Clinical practice is not a wholesale shift in approach; rather it is a change in perspective that has the capacity to create changes in thinking about learning and teaching. The concept of clinical reasoning presented in this paper is offered as a key element in teacher education that requires greater emphasis. By moving away from apprenticeship and craft frameworks of teaching that were prevalent in teacher education (Hoffman-Kipp, Artiles, & Lopez-Torres, 2003), this approach to clinical reasoning can produce teachers who are better able to articulate their reasoning for pedagogical choices drawing on both school-based and research-based evidence so as to improve their own teaching and improve the teaching of others