Analysis of Factors Historically Affecting Innovation in Hospital Building Design.

PURPOSE: This article aims to complement the historical literature on the evolution of hospital buildings via a holistic analysis of the contextual factors triggering hospital design innovation over the past 100 years. BACKGROUND: Innovation in hospital building design should be considered as a complex ecosystem with a heterogeneous set of actors. METHODS: A novel hybrid research design to the Mixed Grounded Theory methodology, with Charmaz's constructivist paradigm, was developed to explore, construct, and interpret concepts and the interconnections between them. RESULTS: Six hundred seventeen interconnections between 146 factors, classified across 14 categories, were developed to explain the individual and combined impacts of all components of the design innovation ecosystem. CONCLUSIONS: This study provides hospital building designers, researchers, policy makers, and stakeholders with a systemic understanding of the innovation ecosystem and their potential role in this system. This knowledge suggests the need for interdisciplinary education to address complex and quickly evolving real-world building design problems.

Promoting the health of mothers of young children in Australia: A review of face-to-face and online support.

ISSUE ADDRESSED: Social support is essential during early motherhood. Societal changes have altered the support networks of mothers of young children, placing them at greater risk of social isolation. The aim of this review was to explore the research related to the experience of social support for mothers of young children to understand how to best promote social connections for the current generation of mothers. METHODS: A systematic search of eight electronic databases through EBSCOhost was undertaken to identify Australian research published from 2013 onwards. No study design limits were applied. Research which focussed into understanding the social support of mothers with children 0-5 years and had outcomes related to mothers experiences were included. RESULTS: Fifteen studies were included. Both face-to-face and online support provided benefits to mothers of young children in terms of shared experiences and reciprocity; trust and intimacy; community connectedness and; mental well-being. While online communities offered immediacy of access to social support, contemporary mothers continued to value social support accessed in face-to-face settings. Accessing face-to-face support was a challenge for young mothers and those in new housing areas. CONCLUSIONS: Face-to-face programs continue to promote the health of contemporary mothers; however, online settings provide avenues for alternative or complimentary support. There is a need to further develop support programs for vulnerable and isolated mothers. SO WHAT?: Social support is essential for mothers of young children and opportunities to enhance social connections are important to boosting mental well-being. While face-to-face programs still need to be provided, services should consider including online options to promote the health of contemporary Australian mothers.

"Surface acquaintances": Parents' experiences of social connectedness and social capital in Australian high-rise developments.

Increasing numbers of families in Australian cities are raising their children in private, high-rise, housing. However, with developments often designed for singles and couples without children, there is a need to better understand the lived experiences of families in these settings. This paper draws on photo-narratives from ten parents of pre-school children aged five and under residing in newer, high-rise developments in Melbourne to explore their experiences of social connectedness and capital. Findings showed that parents' social connections were often hindered by physical and social barriers, including the design of developments and space within apartments; the transient nature of other residents; and the need to maintain a level of distance from neighbours given close proximity. However, parents felt social connectedness was enabled through organised groups and activities, and the shared experience of raising a child in the area. Based on parents' experiences, this paper makes suggestions to improve social connectedness, foster social capital and enhance wellbeing among the increasing number of families living in high-rise developments.

EQUIPT: protocol of a comparative effectiveness research study evaluating cross-context transferability of economic evidence on tobacco control.

INTRODUCTION: Tobacco smoking claims 700,000 lives every year in Europe and the cost of tobacco smoking in the EU is estimated between €98 and €130 billion annually; direct medical care costs and indirect costs such as workday losses each represent half of this amount. Policymakers all across Europe are in need of bespoke information on the economic and wider returns of investing in evidence-based tobacco control, including smoking cessation agendas. EQUIPT is designed to test the transferability of one such economic evidence base-the English Tobacco Return on Investment (ROI) tool-to other EU member states. METHODS AND ANALYSIS: EQUIPT is a multicentre, interdisciplinary comparative effectiveness research study in public health. The Tobacco ROI tool already developed in England by the National Institute for Health and Care Excellence (NICE) will be adapted to meet the needs of European decision-makers, following transferability criteria. Stakeholders' needs and intention to use ROI tools in sample countries (Germany, Hungary, Spain and the Netherlands) will be analysed through interviews and surveys and complemented by secondary analysis of the contextual and other factors. Informed by this contextual analysis, the next phase will develop country-specific ROI tools in sample countries using a mix of economic modelling and Visual Basic programming. The results from the country-specific ROI models will then be compared to derive policy proposals that are transferable to other EU states, from which a centralised web tool will be developed. This will then be made available to stakeholders to cater for different decision-making contexts across Europe. ETHICS AND DISSEMINATION: The Brunel University Ethics Committee and relevant authorities in each of the participating countries approved the protocol. EQUIPT has a dedicated work package on dissemination, focusing on stakeholders' communication needs. Results will be disseminated via peer-reviewed publications, e-learning resources and policy briefs.

Parents׳ experiences of raising pre-school aged children in an outer-Melbourne growth corridor.

There is growing concern about the outer-suburbs in Australia as healthy places to raise children. This paper aimed to explore this from the perspectives of parents raising preschool-age children in an outer-Melbourne municipality. Findings showed that parents were positive about the natural environment as well as the provision of recreation areas and generally felt their neighbourhoods were a safe place for raising children. However, car-dependency, housing estate design and limited local job opportunities all appeared to contribute to social isolation amongst families. Using the Environments for Health Framework, this paper makes suggestions to improve liveability for families in this municipality.

Expectations of parents on low incomes and therapists who work with parents on low incomes of the first therapy session.

BACKGROUND/AIM: Family-centred practice involves allowing families' needs to direct therapy. Parents and therapists often come from different socio-economic positions, yet little is known about how this impacts family-centred practice. This study aimed to explore expectations of care among parents on low incomes and among occupational therapists who work with these families. METHOD: Ten parents who were holders of a low-income Health Care Card and had a child on a waiting list for publicly funded occupational therapy services, and nine paediatric occupational therapists were asked about perceptions of therapy using semi-structured, in-depth interviews. Interview transcripts were analysed using a qualitative descriptive approach. RESULTS: While therapists recognised families' expectations that therapy would 'fix' their child, some of the concerns of parents such as how their child's behaviour reflected on their parenting skills went largely unrecognised. In addition, no therapists recognised parents' primary concerns about their child's physical health, their desires for a structured approach to therapy or the somewhat fatalistic approach some parents were taking to therapy. Some therapists recognised the complexities they encountered in engaging with parents from low socio-economic positions and tried to adapt their practice with some taking less of a family-centred approach and focussing on the needs of either the parent or the child while others continued to practice with a focus on the family as a whole. CONCLUSION: These findings have implications for therapists seeking to work within a framework of family-centred practice with clients from low socio-economic positions.

Optimisation of 2-cyano-pyrimidine inhibitors of cathepsin K: improving selectivity over hERG.

Several structure-guided optimisation strategies were explored in order to improve the hERG selectivity profile of cathepsin K inhibitor 1, whilst maintaining its otherwise excellent in vitro and in vivo profile. Ultimately, attenuation of clogP and pK(a) properties proved a successful approach and led to the discovery of a potent analogue 23, which, in addition to the desired selectivity over hERG (>1000-fold), displayed a highly attractive overall profile.

6-Phenyl-1H-imidazo[4,5-c]pyridine-4-carbonitrile as cathepsin S inhibitors.

6-Phenyl-1H-imidazo[4,5-c]pyridine-4-carbonitrile analogues were identified as potent and selective cathepsin S inhibitor against both purified enzyme and in human JY cell based cellular assays. This core has a very stable thio-trapping nitrile war-head in comparison with the well reported pyrimidine-2-carbonitrile cysteine cathepsin inhibitors. Compound 47 is also very potent in in vivo mouse spleenic Lip10 accumulation assays.

Design and optimization of a series of novel 2-cyano-pyrimidines as cathepsin K inhibitors.

Morphing structural features of HTS-derived chemotypes led to the discovery of novel 2-cyano-pyrimidine inhibitors of cathepsin K with good pharmacokinetic profiles, for example, compound 20 showed high catK potency (IC(50)=4nM), >580-fold selectivity over catL and catB, and oral bioavailability in the rat of 52%.

Parental perceptions of residential location: Impacts on children's health.

This study explored families' views and experiences of their residential location in relation to their children's health. Thematic analysis of interviews with mothers revealed that decisions to live in an outer Melbourne municipality were strongly influenced by ideals around children however; all spoke of experiencing difficulties in raising children in terms of accessing services, recreation facilities, transport and work. Analysis of these findings using Bronfenbrenner's Social Ecology Model revealed how factors could interact to affect children's health and wellbeing. The study findings highlight the importance of parental perceptions of residential location in understanding the relationship between children's health and place.

Characterization of recycled mushroom compost leachate by chemical analysis and thermogravimetry-mass spectrometry.

Recycled compost leachate (RCL or euphemistically named "goody water") can be a potent source of foul odor on mushroom substrate production sites and contributes to composting smells. A complex mixture of sulfur compounds, fatty acids, and nitrogen containing compounds is responsible for odor production. Fifty samples, collected from 14 compost production sites in Ireland and the U.K. over a 2 year period, were analyzed for chemical properties and by thermogravimetry-mass spectrometry (TG-MS) for compositional differences. Results indicated that aerated samples had lower values of electrical conductivity, redox potential, and dry matter content than nonaerated samples and that the higher thermal stability of aerated samples measured by TGA could be attributed to greater mineralization of the substrate due to aerobic processes. The lower temperatures noted for peak evolution of methane, water, and carbon dioxide from TG-MS analysis suggested that a more energetic process had occurred in aerated RCL storage facilities, producing greater decomposition of macromolecules that volatilized at lower temperatures. Chemical composition, thermal stability of the freeze-dried leachate, pyrolysis profiles, and relative amounts of pyrolysis products were all markers of as to how effective control measures could influence RCL quality.

Aged gastric mucosa: Mechanisms of vulnerability.

The incidence, frequency of complications and mortality of gastric ulcer disease are increased four-fold in the elderly taking non-steroidal anti-inflammatory drugs (NSAID). There is controversy as to whether this reflects increased usage of NSAID or specific vulnerability associated with age. We have investigated two possible mechanisms for this increase in gastrointestinal effects in the elderly: (i) increased susceptibility to acute gastrotoxicity; and (ii) reduced adaptation to NSAID, in a model of young (2 month), mature (12 month) and aged (24 month) rats. Aspirin damaged 7.7% of the volume of gastric mucosa in the young rat. In mature and aged rats, this increased to 11.3% (P < 0.002 compared to control) and 21.9% (P < 0.005 compared to control), respectively. Thus, aspirin caused a three-fold increase in the severity of acute gastric mucosal injury in aged animals. However, indomethacin, ibuprofen and L745 337 did not produce any significant acute gastric mucosal damage in 2-, 12- or 24-month-old rats. Significant gastric adaptation to diclofenac treatment occurred in both aged and young rats as measured by gastric mucosal damage. The aged gastric mucosa adapted equally as well as the young gastric mucosa to diclofenac. The findings of this study provide only modest support to the hypothesis of increased vulnerability of the stomach in the aged. Aspirin was associated with greater damage in the aged. Adaptation to diclofenac-induced damage was not reduced in the aged and there was not an increased susceptibility to damage by the non-aspirin NSAID tested. The selective cyclo-oxygenase-2 inhibitor, L745 337, was the least toxic agent and may represent a group of NSAID which cause fewer gastrointestinal complications in the elderly.