Review of the evidence base in relation to early childhood approaches to support children in highly disadvantaged communities for the Children’s Ground Project

The Children’s Ground project aims to develop a place-based approach to support children and their families in highly disadvantaged communities. The project approach is informed by research and evidence, recognising the multiple and multi-level influences on children’s development and the need to support the role of communities in improving outcomes for children. The review of the evidence base, undertaken by the Centre for Community Child Health in collaboration with the Royal Children’s Hospital Education Institute, begins by outlining the changing social and environmental conditions and the influence of these changes on vulnerable children and families. The report then discusses actions undertaken to address these challenges and the reasons why these actions have failed. Next, key factors enabling optimal outcomes for children and contemporary Australian and international evidence-based interventions and approaches that support vulnerable children are examined. The review concludes by summarising the research on the financial and social costs of doing nothing to intervene and improve outcomes for children. In summary, the review endorses the development of a place-based approach with a number of key strategies that simultaneously address families’ immediate needs for support (the foreground factors) and the broader conditions under which families are raising young children (the background factors). The approach needs to promote wrap around, integrated services that are responsive to and driven by the community. Focus must also be given to how services are delivered rather than what is delivered. In order to implement the approach, it is critical that a robust governance structure or entity capable of coordinating and supporting the many stakeholders and services involved is established and a long-term financial and policy commitment is made. Key messages encapsulating broad themes from the literature, supported by concluding statements, have been developed to enable clear communication to a variety of audiences.&nbsp

Effectiveness of a Nurse Residency Program in Preparing New Graduate Registered Nurses for Interprofessional Teamwork in Inpatient Care

Purpose: The purpose of this project was to determine if a residency program for new graduate nurses was effective in improving nurse manager and experienced staff nurse satisfaction on 36 measures of nurse performance competence. Of particular interest was a subset of item ratings representing Interprofessional Collaboration. Project Design: This was a cross-sectional survey design. It compared University Hospitals nurse managers’ and staff nurses’ ratings on the Nursing Practice Readiness Tool to national benchmark data obtained from a study done in 2007 prior to the implementation of residencies. Setting: University Hospitals of Cleveland is a non-profit, multi-specialty, academic medical center integrating clinical care with research and education. Sample: There were approximately 800 to 1000 potential participants, which included nursing leaders and staff nurses from all inpatient units at University Hospitals of Cleveland. For this study, a new graduate was defined as a registered nurse with one year or less of experience. Measures: The Nurse Executive Center’s Nursing Practice Readiness Tool was administered to eligible participants volunteering for the study. Demographic data as well as satisfaction ratings on 36 competencies deemed necessary for practice were obtained. Data Analysis: Demographic data were reported as a range, median, mode, and percentage. Respondents were grouped by years of experience and mangers versus staff nurses. Satisfaction scores in each competency were calculated using percentages and compared to nationwide benchmark data obtained from a large study conducted in 2007 using the same tool. Findings: Managers, experienced nurses, and new graduate nurses varied in their satisfaction ratings on performance competencies by new graduate nurses. The results showed interprofessional communication is a competency in need of improvement.No embarg

Additively manufacturable micro-mechanical logic gates.

Early examples of computers were almost exclusively based on mechanical devices. Although electronic computers became dominant in the past 60 years, recent advancements in three-dimensional micro-additive manufacturing technology provide new fabrication techniques for complex microstructures which have rekindled research interest in mechanical computations. Here we propose a new digital mechanical computation approach based on additively-manufacturable micro-mechanical logic gates. The proposed mechanical logic gates (i.e., NOT, AND, OR, NAND, and NOR gates) utilize multi-stable micro-flexures that buckle to perform Boolean computations based purely on mechanical forces and displacements with no electronic components. A key benefit of the proposed approach is that such systems can be additively fabricated as embedded parts of microarchitected metamaterials that are capable of interacting mechanically with their surrounding environment while processing and storing digital data internally without requiring electric power

Ibuprofen Blunts Ventilatory Acclimatization to Sustained Hypoxia in Humans.

Ventilatory acclimatization to hypoxia is a time-dependent increase in ventilation and the hypoxic ventilatory response (HVR) that involves neural plasticity in both carotid body chemoreceptors and brainstem respiratory centers. The mechanisms of such plasticity are not completely understood but recent animal studies show it can be blocked by administering ibuprofen, a nonsteroidal anti-inflammatory drug, during chronic hypoxia. We tested the hypothesis that ibuprofen would also block the increase in HVR with chronic hypoxia in humans in 15 healthy men and women using a double-blind, placebo controlled, cross-over trial. The isocapnic HVR was measured with standard methods in subjects treated with ibuprofen (400 mg every 8 hrs) or placebo for 48 hours at sea level and 48 hours at high altitude (3,800 m). Subjects returned to sea level for at least 30 days prior to repeating the protocol with the opposite treatment. Ibuprofen significantly decreased the HVR after acclimatization to high altitude compared to placebo but it did not affect ventilation or arterial O2 saturation breathing ambient air at high altitude. Hence, compensatory responses prevent hypoventilation with decreased isocapnic ventilatory O2-sensitivity from ibuprofen at this altitude. The effect of ibuprofen to decrease the HVR in humans provides the first experimental evidence that a signaling mechanism described for ventilatory acclimatization to hypoxia in animal models also occurs in people. This establishes a foundation for the future experiments to test the potential role of different mechanisms for neural plasticity and ventilatory acclimatization in humans with chronic hypoxemia from lung disease

Sampling designs for exploratory multivariate analysis.

This thesis is concerned with problems of variable selection, influence of sample size and related issues in the applications of various techniques of exploratory multivariate analysis (in particular, correspondence analysis, biplots and canonical correspondence analysis) to archaeology and ecology. Data sets (both published and new) are used to illustrate these methods and to highlight the problems that arise - these practical examples are returned to throughout as the various issues are discussed. Much of the motivation for the development of the methodology has been driven by the needs of the archaeologists providing the data, who were consulted extensively during the study. The first (introductory) chapter includes a detailed description of the data sets examined and the archaeological background to their collection. Chapters Two, Three and Four explain in detail the mathematical theory behind the three techniques. Their uses are illustrated on the various examples of interest, raising data-driven questions which become the focus of the later chapters. The main objectives are to investigate the influence of various design quantities on the inferences made from such multivariate techniques. Quantities such as the sample size (e.g. number of artefacts collected), the number of categories of classification (e.g. of sites, wares, contexts) and the number of variables measured compete for fixed resources in archaeological and ecological applications. Methods of variable selection and the assessment of the stability of the results are further issues of interest and are investigated using bootstrapping and procrustes analysis. Jack-knife methods are used to detect influential sites, wares, contexts, species and artefacts. Some existing methods of investigating issues such as those raised above are applied and extended to correspondence analysis in Chapters Five and Six. Adaptions of them are proposed for biplots in Chapters Seven and Eight and for canonical correspondence analysis in Chapter Nine. Chapter Ten concludes the thesis

Convenient Fictions: The Script of Lesbian Desire in the Post-Ellen Era: A New Zealand Perspective

Little has been published about the ascending trajectory of lesbian characters in prime-time television texts. Rarer still are analyses of lesbian fictions on New Zealand television. This study offers a robust and critical interrogation of Sapphic expression found in the New Zealand television landscape. More specifically, this thesis analyses fictional lesbian representation found in New Zealand's prime-time, free-to-air television environment. It argues that television's script of lesbian desire is more about illusion than inclusion, and that lesbian representation is a misnomer, both qualitatively and quantitively. In order to assess the authenticity of television's lesbian fictions, I sampled the opinions of New Zealand's television audience through focus group and survey methodology, and analysed two primary sources of lesbian representation available between 2004-2006. Television and other media provide the social and cultural background - the milieu - against or within which their fictions, dramas and comedies are set. Even when media texts are clearly non- or anti realistic (fantasy films, for instance), they usually attempt to produce their narratives as consistent, familiar and in keeping with the cultural characteristics, values and proclivities of mainstream contemporary society. This is not realism so much as a set of arbitrary conventions that are read as, or stand for, reality and the real. In short, the media is a teller of stories and fairy tales; and since mainstream Western culture has naturalised homonormativity, television's fairy tales are almost exclusively tales of heterosexuality. Television, from this perspective, reinscribes and reinforces what Pierre Bourdieu refers to as the 'masculine order'. Television uses reality to frame messages of compulsory heterosexuality, and it rarely presents homonormative messages. Lesbian representation is, therefore, difficult for a heteronormative medium to render without effort. Homonormativity is, for lesbian audiences, a central part of the cultural background - the components of realism, if you like, within which representations of lesbians would 'play out' their stories in media texts. Television stories which ignore this imperative deny both the audience's ability to interpret for themselves the integrity of the representation, and their ability to acquire new knowledge of lesbians

Lightweight Mechanical Metamaterials with Tunable Negative Thermal Expansion

Ice floating on water is a great manifestation of negative thermal expansion (NTE) in nature. The limited examples of natural materials possessing NTE have stimulated research on engineered structures. Previous studies on NTE structures were mostly focused on theoretical design with limited experimental demonstration in two-dimensional planar geometries. In this work, aided with multimaterial projection microstereolithography, we experimentally fabricate lightweight multimaterial lattices that exhibit significant negative thermal expansion in three directions and over a temperature range of 170 degrees. Such NTE is induced by the structural interaction of material components with distinct thermal expansion coefficients. The NTE can be tuned over a large range by varying the thermal expansion coefficient difference between constituent beams and geometrical arrangements. Our experimental results match qualitatively with a simple scaling law and quantitatively with computational models.United States. Defense Advanced Research Projects Agency. Materials with Controlled Microstructural Architectures ProgramLawrence Livermore National Laboratory (Award DE-AC52-07NA27344 (LLNL-JRNL-697779))SUTD-MIT Postdoctoral Progra

Duration of antibiotic treatment for common infections in English primary care: cross sectional analysis and comparison with guidelines

Objectives: To evaluate antibiotic therapy durations for common infections in English primary care and to compare this with guidelines. Design: Cross-sectional study. Setting: General practices contributing to The Health Improvement Network database, 2013-2015. Participants: 931,015 consultations that resulted in an antibiotic prescription for one of the following indications: acute sinusitis, acute sore throat, acute cough and bronchitis, pneumonia, acute exacerbation of chronic obstructive pulmonary disease (COPD), acute otitis media, acute cystitis, prostatitis, pyelonephritis, cellulitis, impetigo, scarlet fever and gastroenteritis. Main outcome measures: The main outcomes were the percentage of antibiotic prescriptions with a duration exceeding the guideline recommendation and the total number of days beyond the recommended duration for each indication. Results: The most common reasons for the prescriptions were patients consulting with acute bronchitis and cough (386,972), acute sore throat (239,231), acute otitis media (83,054), and acute sinusitis (76,683). Antibiotic treatments for upper respiratory indications and acute bronchitis accounted for more than two thirds of the total prescriptions considered, and ≥80% of these treatment courses exceeded guideline recommendations. Notable exceptions were acute sinusitis, where only 9.6% (95% CI 9.4 to 9.9%) of prescriptions exceeded 7 days and acute sore throat where only 2.1% (95% CI 2.0 to 2.1) exceed 10 days (recent guidance recommends 5 days). More than half of antibiotic prescriptions were longer than guidelines recommend for acute cystitis among females (54.6%, 95% CI 54.1 to 55.0%). The percentage of antibiotic prescriptions exceeding the recommended duration was lower for most non-respiratory infections. For the 931,015 included consultations resulting in antibiotic prescriptions, approximately 1.3 million days were beyond the durations recommended by the guidelines. Conclusion: For most common infections treated in primary care, a substantial proportion of antibiotic prescriptions have durations exceeding those recommended in guidelines. Substantial reductions in antibiotic exposure can be accomplished by aligning antibiotic prescription durations with guidelines