Culture-Independent Prerequisites for Early Arithmetic.

In numerate societies, early arithmetic development is associated with visuospatial working memory, executive functions, nonverbal intelligence, and magnitude-comparison abilities. To what extent do these associations arise from cultural practices or general cognitive prerequisites? Here, we administered tests of these cognitive abilities (Corsi Blocks, Raven's Colored Progressive Matrices, Porteus Maze) to indigenous children in remote northern Australia, whose culture contains few counting words or counting practices, and to nonindigenous children from an Australian city. The indigenous children completed a standard nonverbal addition task; the nonindigenous children completed a comparable single-digit addition task. The correlation matrices among variables in the indigenous and nonindigenous children showed similar patterns of relationships, and parallel regression analyses showed that visuospatial working memory was the main predictor of addition performance in both groups. Our findings support the hypothesis that the same cognitive capacities promote competence for learners in both numerate and nonnumerate societies.

Aortic arch thrombosis mimicking interrupted aortic arch.

We report a case of a 32-week-gestation male who presented initially with symptoms suggestive of an interrupted aortic arch. The absence of a VSD prompted further investigations, including a CT angiogram, which revealed that he had an extensive thrombus in his aorta. He underwent a successful aortic thrombectomy with arch repair on cardiopulmonary bypass support. In view of the extensive thrombus, the patient was referred to the haematology team. There was no family history of prothrombotic tendencies.

Calculating the need for intensive care beds.

AIM: Prompted by high refused admission rates, we sought to model demand for our 20 bed paediatric intensive care unit. METHODS: We analysed activity (admissions) and demand (admissions plus refused admissions). The recommended method for calculating the required number of intensive care beds assumes a Poisson distribution based upon the size of the local catchment population, the incidence of intensive care admission and the average length of stay. We compared it to the Monte Carlo method which would also include supra-regional referrals not otherwise accounted for but which, due to their complexity, tend to have a longer stay than average. For the new method we assigned data from randomly selected emergency admissions to the refused admissions. We then compared occupancy scenarios obtained by random sampling from the data with replacement. RESULTS: There was an increase in demand for intensive care over time. Therefore, in order to provide an up-to-date model, we restricted the final analysis to data from the two most recent years (2327 admissions and 324 refused admissions). The conventional method suggested 27 beds covers 95% of the year. The Monte Carlo method showed 95% compliance with 34 beds, with seasonal variation quantified as 30 beds needed in the summer and 38 in the winter. CONCLUSION: Both approaches suggest that the high refused admission rate is due to insufficient capacity. The Monte Carlo analysis is based upon the total workload (including supra-regional referrals) and predicts a greater bed requirement than the current recommended approach.

Stability and change in markers of core numerical competencies.

Dot enumeration (DE) and number comparison (NC) abilities are considered markers of core number competence. Differences in DE/NC reaction time (RT) signatures are thought to distinguish between typical and atypical number development. Whether a child's DE and NC signatures change or remain stable over time, relative to other developmental signatures, is unknown. To investigate these issues, the DE and NC RT signatures of 159 children were assessed 7 times over 6 years. Cluster analyses identified within-task and across-age subgroups. DE signatures comprised 4 parameters: (a) the RT slope within the subitizing range, (b) the RT slope for the counting range, (c) the subitizing range (indicated by the point of slope discontinuity), and (d) the overall average DE RT response. NC RT signatures comprised 2 parameters (NC intercept and slope) derived from RTs comparing numbers 1 to 9. Analyses yielded 3 distinct DE and NC profiles at each age. Within-age subgroup profiles reflected differences in 3 of the 4 DE parameters and only 1 NC parameter. Systematic changes in parameters were observed across ages for both tasks, and both tasks broadly identified the same subgroups. Sixty-nine percent of children were assigned to the same subgroup across age, even though parameters themselves changed across age. Subgroups did not differ in processing speed or nonverbal reasoning, suggesting that DE and NC do not tap general cognitive abilities but reflect individual differences specific to the domain of numbers. Indeed, both DE and NC subgroup membership at 6 years predicted computation ability at 6 years, 9.5 years, and 10 years.

MRSA screening on a paediatric intensive care unit.

The accuracies of chromogenic agar and the GeneXpert real-time PCR system (Cepheid, Sunnyvale, California, USA) for admission methicillin-resistant Staphylococcus aureus (MRSA) screening of 1336 consecutive paediatric intensive care unit patients (1282 evaluable swab results) were determined using enrichment culture as the reference standard. Twenty (1.6%) swabs were MRSA-positive by enrichment culture (reference test). PCR was more sensitive (0.9, 95% CI 0.68 to 0.99 vs 0.65, 95% CI 0.41 to 0.85) but less specific (0.98, 95% CI 0.98 to 0.99 vs 100%) than chromogenic agar. After introduction of screening no patient developed MRSA infection or acquired MRSA after admission. In the preceding 3 years of screening, 16 patients had MRSA diagnosed after admission, nine presenting with infection. The accuracy of PCR was comparable to previous studies, but the positive predictive value in a low prevalence paediatric population was only 0.49. Screening provided some clinical benefits, to which the early availability of PCR results may have contributed.

Assuring safety without animal testing: Unilever's ongoing research programme to deliver novel ways to assure consumer safety.

Assuring consumer safety without the generation of new animal data is currently a considerable challenge. However, through the application of new technologies and the further development of risk-based approaches for safety assessment, we remain confident it is ultimately achievable. For many complex, multi-organ consumer safety endpoints, the development, evaluation and application of new, non-animal approaches is hampered by a lack of biological understanding of the underlying mechanistic processes involved. The enormity of this scientific challenge should not be underestimated. To tackle this challenge a substantial research programme was initiated by Unilever in 2004 to critically evaluate the feasibility of a new conceptual approach based upon the following key components: 1.Developing new, exposure-driven risk assessment approaches. 2.Developing new biological (in vitro) and computer-based (in silico) predictive models. 3.Evaluating the applicability of new technologies for generating data (e.g. "omics", informatics) and for integrating new types of data (e.g. systems approaches) for risk-based safety assessment. Our research efforts are focussed in the priority areas of skin allergy, cancer and general toxicity (including inhaled toxicity). In all of these areas, a long-term investment is essential to increase the scientific understanding of the underlying biology and molecular mechanisms that we believe will ultimately form a sound basis for novel risk assessment approaches. Our research programme in these priority areas consists of in-house research as well as Unilever-sponsored academic research, involvement in EU-funded projects (e.g. Sens-it-iv, Carcinogenomics), participation in cross-industry collaborative research (e.g. Colipa, EPAA) and ongoing involvement with other scientific initiatives on non-animal approaches to risk assessment (e.g. UK NC3Rs, US "Human Toxicology Project" consortium).

To use intraosseous access or not to use intraosseous access: determinants of trainees' decision in paediatric emergencies.

OBJECTIVES: We aim to determine whether the duration of paediatric training and previous real life intraosseous (IO) insertion experience influence a trainee paediatrician's decision on emergency vascular access choices. METHODS: A survey was conducted using a predesigned proforma to collect data on paediatric trainees' previous paediatric experience including IO training, and their first choice of vascular access in three hypothetical cases modified from real life scenarios. RESULTS: Of the 105 trainees contacted, 98 participated in the survey, all of which were Advanced Paediatric Life Support Course trained, and 65 had previous real life IO needle insertion experience. Experienced trainees (i.e. with more than 6 years paediatric experience) were more likely to have previous real life experience in IO insertion (odds ratio: 5.94, 95% confidence interval: 2.25-15.72). Despite resuscitation councils' clear recommendation to use IO access in the arrested infant, only 51 participants (52%) chose IO as their first vascular access choice in this situation. Previous real life IO insertion experience significantly increased trainees' willingness to use IO as their first emergency vascular access choice (P<0.0001, Fisher's exact test; odds ratio: 10.13, 95% confidence interval: 3.62-28.35). CONCLUSION: Nothing helps more than previous real life IO needle insertion experience to reduce trainee paediatricians' reluctance in using IO access in an emergency, but this experience was only found more frequently among the more experienced trainees. IO access-specific workshops may provide useful supplemental training to traditional resuscitation courses, and may reduce trainees' reluctance in its use.

Quality of cardio-pulmonary resuscitation (CPR) during paediatric resuscitation training: time to stop the blind leading the blind.

AIMS: Recent evidence suggested that the quality of cardio-pulmonary resuscitation (CPR) during adult advanced life support training was suboptimal. This study aimed to assess the CPR quality of a paediatric resuscitation training programme, and to determine whether it was sufficiently addressed by the trainee team leaders during training. METHODS: CPR quality of 20 consecutive resuscitation scenario training sessions was audited prospectively using a pre-designed proforma. A consultant intensivist and a senior nurse who were also Advanced Paediatric Life Support (APLS) instructors assessed the CPR quality which included ventilation frequency, chest compression rate and depth, and any unnecessary interruption in chest compressions. Team leaders' response to CPR quality and elective change of compression rescuer during training were also recorded. RESULTS: Airway patency was not assessed in 13 sessions while ventilation rate was too fast in 18 sessions. Target compression rate was not achieved in only 1 session. The median chest compression rate was 115 beats/min. Chest compressions were too shallow in 10 sessions and were interrupted unnecessarily in 13 sessions. More than 50% of training sessions did not have elective change of the compression rescuer. 19 team leaders failed to address CPR quality during training despite all team leaders being certified APLS providers. CONCLUSIONS: The quality of CPR performance was suboptimal during paediatric resuscitation training and team leaders-in-training had little awareness of this inadequacy. Detailed CPR quality assessment and feedback should be integrated into paediatric resuscitation training to ensure optimal performance in real life resuscitations.

Effective performance of a new post-operative cardiac resuscitation simulation training scheme in the Paediatric Intensive Care Unit.

OBJECTIVE: This feasibility study aimed to describe and evaluate the effectiveness of a novel chest re-opening paediatric resuscitation scenario training scheme. METHODS: A novel scheme offering training on specialist skills required for post-operative cardiac patients such as chest re-opening and cardiac pacing via simulation was described. A prospective audit of the first 23 consecutive training sessions was conducted to assess the scheme's effectiveness. Parameters assessed included timing of chest re-opening or cardiac pacing orders, and any delays in carrying out these orders. RESULTS: The median time required for the medical team leader to order chest re-opening was 4 min. New medical leaders took significantly longer to order chest re-opening than experienced medical team leaders (P = 0.02, Mann-Whitney U test). The performance of the team-in-training deteriorated with the introduction of new members but was correctable with serial training. CONCLUSIONS: Effective simulation training integrating chest re-opening and cardiac pacing into standard paediatric resuscitation guidelines may be achieved without high fidelity simulation equipment.

Non-animal approaches for consumer safety risk assessments: Unilever's scientific research programme.

Non-animal based approaches to risk assessment are now routinely used for assuring consumer safety for some endpoints (such as skin irritation) following considerable investment in developing and applying new methods over the past 20 years. Unilever's research programme into non-animal approaches for safety assessment is currently focused on the application of new technologies to risk assessments in the areas of skin allergy, cancer and general toxicity (including inhalation toxicity). In all of these areas, a long-term investment is essential to increase the scientific understanding of the underlying biological and chemical processes that we believe will ultimately form a sound basis for novel risk assessment approaches. Our research programme in these priority areas consists of in-house research as well as Unilever-sponsored academic research, involvement with EU-funded projects (e.g. Sens-it-iv, carcinoGENOMICS), participation in cross-industry collaborative research (e.g. COLIPA, EPAA) and ongoing involvement with other scientific initiatives on non-animal approaches to risk assessment (e.g. UK NC3Rs, US 'Human Toxicology Project' consortium).

Assuring consumer safety without animal testing: a feasibility case study for skin sensitisation.

Allergic Contact Dermatitis (ACD; chemical-induced skin sensitisation) represents a key consumer safety endpoint for the cosmetics industry. At present, animal tests (predominantly the mouse Local Lymph Node Assay) are used to generate skin sensitisation hazard data for use in consumer safety risk assessments. An animal testing ban on chemicals to be used in cosmetics will come into effect in the European Union (EU) from March 2009. This animal testing ban is also linked to an EU marketing ban on products containing any ingredients that have been subsequently tested in animals, from March 2009 or March 2013, depending on the toxicological endpoint of concern. Consequently, the testing of cosmetic ingredients in animals for their potential to induce skin sensitisation will be subject to an EU marketing ban, from March 2013 onwards. Our conceptual framework and strategy to deliver a non-animal approach to consumer safety risk assessment can be summarised as an evaluation of new technologies (e.g. 'omics', informatics), leading to the development of new non-animal (in silico and in vitro) predictive models for the generation and interpretation of new forms of hazard characterisation data, followed by the development of new risk assessment approaches to integrate these new forms of data and information in the context of human exposure. Following the principles of the conceptual framework, we have been investigating existing and developing new technologies, models and approaches, in order to explore the feasibility of delivering consumer safety risk assessment decisions in the absence of new animal data. We present here our progress in implementing this conceptual framework, with the skin sensitisation endpoint used as a case study.

Numerical thought with and without words: Evidence from indigenous Australian children.

Are thoughts impossible without the words to express them? It has been claimed that this is the case for thoughts about numbers: Children cannot have the concept of exact numbers until they know the words for them, and adults in cultures whose languages lack a counting vocabulary similarly cannot possess these concepts. Here, using classical methods of developmental psychology, we show that children who are monolingual speakers of two Australian languages with very restricted number vocabularies possess the same numerical concepts as a comparable group of English-speaking indigenous Australian children.

Women with learning disabilities and Read coding: lessons from a cohort study.

BACKGROUND: The aim was to examine any differences in the way that Read codes are applied to the records for female patients with learning disabilities across three PCT areas. To ascertain the most commonly used read codes for learning disability. METHODS: This was a retrospective cohort study carried out in Bury, Heywood-and-Middleton and Rochdale PCTs. All women in the eligible age-group (25-64) as of the 1st June, 2005, who were in contact with the Learning Disabilities Teams in the relevant PCT areas were identified from the Teams' lists. The appropriate Read Codes were then used to identify women on GP systems. Patient data is stored on the GP database systems (Vision, EMIS, EMIS PC4 and Torex) and it was possible to search for patients with learning disabilities. RESULTS: The use of Read Codes varies across the three areas. The most commonly used Read codes were E3 (Mental Retardation)--27%, PJ0. (Down's Syndrome)--14% and Eu81z (Learning Disabilities)--8%. In 24% of the records a Read Code had not been documented. CONCLUSION: Read codes application varies between GP surgeries--dependent on PCT policy and the surgery's approach and also as a result of staff time.

Women with learning disabilities and access to cervical screening: retrospective cohort study using case control methods.

BACKGROUND: Several studies in the UK have suggested that women with learning disabilities may be less likely to receive cervical screening tests and a previous local study in had found that GPs considered screening unnecessary for women with learning disabilities. This study set out to ascertain whether women with learning disabilities are more likely to be ceased from a cervical screening programme than women without; and to examine the reasons given for ceasing women with learning disabilities. It was carried out in Bury, Heywood-and-Middleton and Rochdale. METHODS: Carried out using retrospective cohort study methods, women with learning disabilities were identified by Read code; and their cervical screening records were compared with the Call-and-Recall records of women without learning disabilities in order to examine their screening histories. Analysis was carried out using case-control methods - 1:2 (women with learning disabilities: women without learning disabilities), calculating odds ratios. RESULTS: 267 women's records were compared with the records of 534 women without learning disabilities. Women with learning disabilities had an odds ratio (OR) of 0.48 (Confidence Interval (CI) 0.38 - 0.58; X2: 72.227; p.value <.001) of receiving a cervical screening test; an OR of 2.05 (CI 1.88 - 2.22; X2: 24.236; p.value <.001) of being ceased from screening; and an OR of 0.14 (CI 0.001 - 0.28; X2: 286.341; p.value <0.001 of being a non-responder compared to age and practice-matched women without learning disabilities. CONCLUSION: The reasons given for ceasing and/or not screening suggest that merely being coded as having a learning disability is not the sole reason for these actions. There are training needs among smear takers regarding appropriate reasons not to screen and providing screening for women with learning disabilities.