Purpose of Review
The assessment of fracture risk and use of antiosteoporosis medications have increased greatly over the last 20–30 years. However, despite this, osteoporosis care remains suboptimal ...worldwide. Even in patients who have sustained a fragility fracture, fewer than 20% actually receive appropriate antiosteoporosis therapy in the year following the fracture. There is also evidence that treatment rates have declined substantially in the last 5–10 years, in many countries. The goal of this article is to consider the causes for this decline and consider how this situation could be remedied.
Recent Findings
A number of possible reasons, including the lack of prioritisation of osteoporosis therapy in ageing populations with multimorbidity, disproportionate concerns regarding the rare side effects of anti-resorptives and adverse changes in reimbursement in the USA, have been identified as contributing factors in poor osteoporosis care.
Summary
Improved secondary prevention strategies; screening measures (primary prevention) and appropriate, cost-effective guideline and treatment threshold development could support the optimisation of osteoporosis care and prevention of future fractures.
This article explores the ways Ngaanyatjarra students in Australia respond to Montessori pedagogy in a remote Aboriginal early childhood context. The article initially presents key literature ...pertaining to early childhood education, Aboriginal education, and Montessori education in Australia. The qualitative methodology underpinning the research is subsequently outlined. The approach emphasized in this research is that of interpretivism. The data analysis process highlighted three headings: concentration and engagement, student autonomy, and student independence. The findings of this research indicate the potential for Montessori pedagogy as a viable alternative practice of education for remote Aboriginal early childhood contexts, as Montessori pedagogy may align more harmoniously with the cultural dispositions of Ngaanyatjarra students. Finally, recommendations are presented in light of the research.
Many sit‐and‐wait predators use conspicuous displays of color to attract prey. These displays sometimes express discrete polymorphisms; however, the adaptive drivers of such variation are not well ...understood. Here, we explore a previously unknown color polymorphism in the orb‐web spider Gasteracantha fornicata. We discovered that in North Queensland, Australia, female spiders exhibit dorsal bands appearing (to the human observer) either white or yellow and characterized by sigmoidal spectral curves centered on approx. 447 and 496 nm, respectively. Based on sensory drive theory, we hypothesized that morphs may be alternatively favored by the switch in ambient viewing conditions engendered by sunny vs. cloudy skies. We addressed this hypothesis indirectly by studying morph frequencies across a approx. 200 km geographic gradient of solar exposure (a surrogate for cloudiness), and by investigating the phenotypic signature of catch success via a resource stress experiment and in wild spiders. Our data indicate substantial geographic variation in morph frequency, with white morphs dominating at more cloudy northern locations. Rather than a gradual cline, morph frequency inverted mid‐way along this range and was closely fit by a logistic relationship with latitude. Experimentally restricted access to larger prey caused spiders to lose more mass than size and to exhibit less bright dorsal markings. Wild‐sampled spiders from two localities of divergent morph frequency indicated no differences in residual mass, but intriguingly, the white morph was larger and heavier (than the yellow morph) where it was relatively rare. Our data hint at negative frequency dependence, but remain broadly consistent with a sensory drive explanation based on cloudiness, and we suggest these as worthy avenues for closer investigation.
Post-transplantation lymphoproliferative disorder (PTLD) is a major cause of morbidity and mortality after pediatric heart transplantation.
Heart transplant recipients at The Hospital for Sick ...Children, Toronto, from 1990 to May 2008, were reviewed. Competing risk hazard analysis was used to model the natural history of the disease. Patients were matched for gender and duration of follow-up to identify potential covariates associated with increased risk of PTLD.
A total of 173 heart transplant recipients (42% <1 year old) were reviewed. Twenty-three developed PTLD at a median of 4 years post-transplantation. After transplantation, PTLD affected 9%, 15% and 28% at 3, 5 and 10 years, respectively. Freedom from death or PTLD recurrence was 72%, 58% and 50% at 1, 3 and 5 years, respectively, after PTLD diagnosis. Higher maximum Epstein-Barr viral (EBV) load (hazard ratio HR: 2.6, p = 0.004) and longer duration of induction therapy (HR: 1.7, p = 0.02) were associated with increased risks of PTLD. Higher cumulative cyclosporine doses over the first year post-transplantation were associated with increased risks of PTLD (HR: 1.2 per 1 mg/kg/day equivalent, p = 0.03), but higher tacrolimus doses were not (p = 0.38). Patients on cyclosporine at 6 months post-transplantation were at higher risk of PTLD than those on tacrolimus (HR: 5.2, p = 0.003). The use of anti-viral prophylaxis in patients with high EBV load may provide some protection (HR: 7.6 vs 15.4 with no anti-viral, p = 0.02).
PTLD is a major concern in pediatric heart transplant recipients and is associated with high morbidity/mortality. Exposure to EBV and higher intensity of immunosuppression seems to be associated with increased risk.
Rubrics can be used as road maps for librarians, academic disciplinary faculty, and assessment professionals to examine students' work relative to information literacy learning outcomes. There's ...growing evidence that suggests that rubrics are, in fact, effective drivers of the complete information literacy instruction assessment cycle, because they offer a specific and systematic way to examine student learning outcomes and a method to examine tangible evidence of that student learning. However, rubrics do have a significant drawback; they are only as good as the raters using them. To achieve consistent and reliable use of a rubric among numerous raters, and to create the best possible tool with which to examine student work, the rubric and the raters must go through a "norming" process. Here, Holmes and Oakleaf identify official and unofficial rules for norming rubrics successfully.
Palliative care in gynaecological oncology Holmes, Claire; Mitchell, Alison
Obstetrics, gynaecology and reproductive medicine,
October 2017, 2017-10-00, Letnik:
27, Številka:
10
Journal Article
Recenzirano
Women with a gynaecological malignancy often suffer significant symptom burden, both physically and psychologically, throughout the course of their disease. Despite advances in treatment, up to 25% ...of women diagnosed with a gynaecological malignancy will die from recurrent disease. Early palliative care involvement can provide a holistic approach to care with the benefit of improving symptom control and quality of life for both the patient and carer as well as lowering resource utilisation at the end of life. Palliative care can be offered alongside curative or life prolonging treatment as well as at end of life. This article reviews the management of common physical symptoms and complications experienced by patients with advanced gynaecological malignancy.
Palliative care in gynaecological oncology Holmes, Claire; Mitchell, Alison; Downham, Esther
Obstetrics, gynaecology and reproductive medicine,
March 2021, 2021-03-00, Letnik:
31, Številka:
3
Journal Article
Recenzirano
Women with a gynaecological malignancy often suffer significant symptom burden, both physically and psychologically, throughout the course of their disease. Despite advances in treatment, up to 25% ...of women diagnosed with a gynaecological malignancy will die from recurrent disease. Early palliative care involvement provides a holistic approach to care with the benefit of improving symptom control and quality of life for the patient and their carers, as well as lowering resource utilisation at the end of life. Palliative care can be offered alongside curative or life prolonging treatment as well as at end of life. This article reviews the management of common physical symptoms and complications experienced by patients with advanced gynaecological malignancy.
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