Australia E-mail Research Articles

Howard, J. (2012): Distressed or Deliberately Defiant? Managing Challenging Student Behaviour Due to Trauma and Disorganised Attachment

There is hope that every child born into the world will experience a normal developmental trajectory into adolescence and adulthood. This means that his or her needs for safety and protection are met in order to facilitate healthy identity formation, and that a positive self-concept is cultivated through trusting, nurturing relationships during the formative years. When the healthy developmental trajectory is disrupted, as in the case of childrenwho have experienced physical, emotional or sexual abuse or neglect, the goal of maintaining and sustaining future healthy relationships and emotional resilience is not always achievable. In recent years, there has been increasing literature to help practitioners view diagnosis, intervention, and assessment through a “trauma lens” to cater to the specific and unique needs of this client population. The lens is also responsible for guiding practitioners and researchers towards greater empathy, understanding, and awareness of the complex needs of these individuals. Howard’s book,Distressed or deliberately defiant? Managing challenging student behaviour due to trauma and disorganised attachment, contributes to this body of work. It helps the reader gain a foundational understanding of complex trauma and disorganized attachment, extending the processes of management and care beyond the clinician and into the classroom for school aged children and adolescents. In seven brief chapters, this book delivers an overview of the causes, symptoms, and management of complex trauma and disorganized attachment and how individuals with such histories can be cared for and catered to in the classroom (Grades Prep. to 12). Chapter one discusses current perceptions on managing students with disorganized attachment and complex trauma and how children may present in the classroom, exemplified by three case studies. Howard acknowledges that misconstrued beliefs and attitudes can undermine the care and treatment of children with trauma or disorganized attachment and that the competing needs of the school, the individual, and the caregivers can create challenging dynamics. Chapter two discusses disorganized attachment and complex trauma through the application of attachment theory (Ainsworth and Bowlby 1991; Bowlby 1969), while Chapter 3 enhances these theories from a physiological and neurological perspective underpinned by empirical developments from the field of neuroscience. Chapter 4 provides a classroom perspective of disorganized attachment and complex trauma and revisits the case studies presented earlier. These case studies are used to provide examples of physiological and psychological outcomes when a child’s physical, cognitive, emotional, and social needs are not met. Chapter five provides a set of practical strategies for educators. Howard outlines how educators can best support students who have had experiences of complex trauma, emphasizing the importance of relationships and emotional selfregulation. Approaches such as mentoring, checking in systems, choosing battles, using codes and symbols, scaling, looking for the positive, setting boundaries, rules, and consequences, managing detentions effectively, using rewards, maintaining predictability, fostering peer relations, and being aware of social behaviours are strategies and approaches discussed in the book. Howard emphasizes that the studentteacher relationship as fundamental to a student’s positive orientation towards school and as a foundation that underpins successful behavior management. Although the strategies discussed in the book are well reported by the broader K.<A. Allen (*) Melbourne Graduate School of Education, The University of Melbourne, Melbourne, Victoria, Australia e-mail: Kellya@toorakc.vic.edu.au

DNA sequencing and metabolomics: new approaches to the forensic assessment of herbal therapeutic agents

The role and frequency that herbal therapeutic agents play in unexpected deaths remains unclear. Herbal agents may be directly toxic in their own right, or they may act synergistically with other herbal materials, or with prescribed pharmaceutical agents. Herbal therapies are also known to sometimes contain toxic agents such as herbicides or heavy metals, or to have been adulterated with standard drugs to enhance their efficacy [1]. In the medicolegal arena the consumption of drugs that may be contraindicated in certain conditions may not be apparent at the time of autopsy, such as when steroids or non-steroidal antiinflammatory agents have been unknowingly taken by an individual with active peptic ulcer disease. Substitution of one plant for another, whether because of financial considerations or from a genuine mistake in plant identification, compounds the complexities associated with attempting to determine whether a herbal preparation has contributed to, or caused, illness or death. Thus, when compared to the assessment of prescribed medications in a standard forensic autopsy, the evaluation of the role of herbal preparations in a death is problematic [2, 3]. Death scene examiners may not document herbal preparations, as they may be considered to be ‘‘natural’’ products and therefore not likely to cause any health problems. Even if herbal medications are recorded at a death scene, there is no guarantee that the ingredients and dosages listed on the container (if this information is available) are a true reflection of the composition of the contained preparation. As standard preparations come as powders, pill or liquids, standard taxonomic classification of herbs by morphology is not possible. Finally, due to the complex organic molecules present and the blending of a number of plants, searching for active organic ingredients in forensic toxicology laboratories may resemble the time honored search for the ‘‘needle in haystack’’ [4]. Fortunately technology is now available which may assist in focusing the search for these elusive active organic agents. Two recent papers [5, 6] show how DNA sequencing can be used to identify materials in herbal medicines that would otherwise be potentially difficult to analyze. In particular, Coghlan et al.’s [5] use of next generation DNA sequencing (NGS) demonstrates how sophisticated analyses of samples, including complex mixtures unable to be evaluated effectively by previous techniques, can be rapidly screened. NGS analysis of herbal medications confiscated at a death scene may provide valuable data that can then be compared to either in-house databases or to larger collections such as the NIH genetic sequence database, GenBank (http://www.ncbi.nlm.nih. gov/genbank/). Although a potential difficulty with external databases involves the accuracy with which entries have been checked prior to uploading, they may, along with smaller databases, be extremely useful in matching the pattern of a DNA sequence to that of known plants. Thus, modern DNA sequencing can rapidly provide a genetic audit of large numbers of cases that can be matched against established standards to focus the search for ingredients [5] such as toxic plants and/or potential allergens. R. W. Byard (&) I. Musgrave C. Hoban School of Medical Sciences, Level 3 Medical School North Building, The University of Adelaide, Frome Road, Adelaide, SA 5005, Australia e-mail: roger.byard@sa.gov.au

Symbols, Signals, and the Archaeological Record

Human social life is very different from that of great apes in many important ways. One is scale: humans now mostly live in enormous social worlds, with specialization and a transformed economic base. But even before our social worlds became so large, they depended on technology, technique, and coordinated cooperation. Great apes are extractive foragers; humans are cooperative extractive foragers, employing and relying on physical and informational resources that have been built over generations (Foley and Lahr 2003; Sterelny 2007; Foley and Gamble 2009). Importantly, the internal lives of human groups are very unlike those of apes. Humans are not just members of groups; they are aware of, and identify with, the groups of which they are a part. And these identities encourage and constrain the behaviors and ideologies of individuals. Like football supporters, humans often advertise these memberships in distinctive styles of dress, language, and behavior (Henshilwood and Marean 2003; Henshilwood and d’Errico 2011). In this way humans invest considerable effort in activities that may appear to be neither functional nor pleasant: erecting monuments, mutilating their bodies and those of their children, avoiding available resources, sacrificing resources in elaborately coordinated displays, and investing labor and material to maintain social connections with the dead. Social life within human groups is structured not merely by regular patterns of action and interaction but by explicit, acknowledged, or if implicit at least apparent, norms. Norms are not always respected, but they help make others’ behavior predictable enough for planning, coordination, and investment in the future, and so departures from these expectations are subject to formal and informal sanction and coercion (Ross 2006, 2008). In short, humans live in symbolically marked worlds, operating within limits constructed by normatively structured groups. How and why did this form of social life begin? One idea is that the answer is revealed in changes in the African archaeological record that began about 100 kya (though smeared in space and time); changes that have been labeled the origins of behavioral modernity (McBrearty and Brooks 2000; Henshilwood and Marean 2003). At about this time, archaeologists claim to recognize an increase in artifact diversity, regional differentiation, expansion of the human range, and a diversification of the habitats and resources humans exploited. Moreover, and of especial importance in this context, dedicated ‘‘material symbols’’ become a highly visible part of the archaeological record. Most archaeologists have read this pattern as showing that before about 100 kya there are no unequivocal signs that hominins lived an ideological life, and no evidence their social interactions were mediated by artificial objects that were signs of identity, social role, status, or authority. The claim is that before this time, there were no cave paintings, statues, or figurines; no jewelry; no musical instruments; no utilitarian objects that are incised and decorated; no burials with grave goods; no sites made or modified for ritual activities. Of course, much of the physical record is lost, and many of these products (cave art, for example) would be especially vulnerable, even if K. Sterelny (&) Philosophy and Tempo and Mode, Australian National University, Canberra, Australia e-mail: kim.sterelny@anu.edu.au

Active screening for multiresistant Enterobacteriaceae

Paul R Ingram Department of Microbiology and Infectious Diseases, Royal Perth Hospital School of Pathology and Laboratory Medicine, University of Western Australia Email: paul.ingram@health.wa.gov.au Jon Iredell Centre for Infectious Diseases and Microbiology, Westmead Hospital, NSW 2145, Australia Marie Bashir and Westmead Millennium Institutes, University of Sydney Email: jonathan.iredell@sydney.edu.au

Antibiotics and Staphylococcus aureus—more than meets the MIC

The discovery of penicillin in 1928 and its subsequent introduction into clinical practice in 1941, heralded a new era in the treatment of serious bacterial infections, including those caused by Staphylococcus aureus . This organism causes a wide range of infections in humans, with bloodstream infection and endocarditis being the most serious and potentially devastating. However, despite the discovery of antibiotics, S. aureus continues to cause a significant burden of illness around the world, with a high mortality rate for invasive disease [1]. One of the reasons for this is the ability of the organism to continually evolve and adapt to new environments, including antibiotic exposures, resulting in the ongoing accumulation of antibiotic resistance [2]. Remarkably, penicillin-resistant S. aureus was detected within 1 year of the clinical use of penicillin, and the progressive acquisition of antibiotic resistance in S. aureus since that time, particularly methicillin-resistant S. aureus (MRSA), has severely impacted the available antibiotic armamentarium. As an example of how serious this problem is, over the past 10 years, there have been more deaths from invasive MRSA infection than human immunodeficiency virus infection in the USA [3], yet MRSA comprises less than half of all S. aureus infections. In day-to-day practice, clinicians rely on susceptibility results from the diagnostic microbiology laboratory to guide appropriate antimicrobial therapy for their patients. Most susceptibility tests performed in these laboratories rely on in vitro phenotypic methods, where the test organism is exposed to different concentrations of antibiotic and the impact on growth of the organism is determined. Performance and interpretation guidelines for these assays are provided by regulatory authorities such as the Clinical and Laboratory Standards Institute, and European Committee on Antimicrobial Susceptibility Testing. The minimum inhibitory concentration (MIC) is the lowest concentration of an antimicrobial that will completely inhibit the growth of an organism after a defined period of incubation, usually 18 to 24 h, and is used by diagnostic microbiology laboratories to define antimicrobial susceptibility or resistance. All clinicians are aware, andmedical students are taught, not to use an antibiotic to treat a bacterial infection if the report from the microbiology laboratory indicates it is resistant to that antibiotic. There is, however, a limitation to the current methods for antimicrobial susceptibility testing—they are performed in vitro and therefore do not measure other potentially important factors influencing the in vivo activity of the agent. Aside from antibiotics, other significant contributors to the clearance of bacterial infections are the innate immune system factors including host defense peptides (HDPs) and neutrophils. Host defense peptides have received increasing attention in the scientific literature because of their antimicrobial activity against a wide range of pathogens, including drugresistant bacterial strains [4]. These amphipathic cationic peptides are naturally occurring antimicrobials produced by a variety of cell types such as epithelial cells and phagocytes [5], and while they have direct antimicrobial activity against human pathogens and cancer cells in vitro, they are increasingly recognized as important immunomodulators in vivo [6]. B. P. Howden (*) Austin Centre for Infection Research (ACIR), Infections Diseases Department, and Department of Microbiology, Austin Health, Heidelberg, Melbourne, Australia e-mail: Benjamin.Howden@austin.org.au

Computer system to support medication reviews: a good but not new concept

In their recent article, de Wit and colleagues put forward a solid argument for the use of clinical decision support systems to support medication reviews for the elderly [1]. They point out that medication reviews are routinely performed, and they have positive effects in terms of reducing medication-related problems. They also rightly note that the quality of the findings and recommendations contained within these medication reviews are only going to be as good as the knowledge and skills of the professionals performing them. They then argue that a clinical decision support system using clinical rules that combine the available pharmacy, clinical and laboratory data may be able to improve the delivery of medication reviews. This we also accept. The authors then assert that doing this would be a ‘‘new approach’’, and outline a simple plan for how they intend to develop this innovative system. In their conclusions, they state ‘‘In our opinion the development of a system, which is able to reduce the time-consuming process of a traditional medication review and create high-quality suggestions for therapy optimisation, will be unique.’’ We wish to highlight that this approach is not unique. Over the past 8 years, we have developed and evaluated systems that can provide intelligent clinical decision support for medication reviewers, and have presented the results at a range of conferences and in international publications [2–4]. In these publications we described the rationale for and the implementation of an advanced system that allows expert medication reviewers to seamlessly and naturally build complex rules based on a patient’s biographical details, medications, medical history, and laboratory results, while performing their routine medication review duties. The approach we used for doing this is based on recent advances in the field of knowledge acquisition (a sub-field of artificial intelligence). This approach allows the expert to iteratively build up and refine a large and complex set of rules that are automatically used to identify medication-related problems. If the system ever identifies a problem that the expert disagrees with, or otherwise fails to identify a problem the expert has detected, the expert is asked to indicate what the problem should have been and why. In this way the system learns over time and the recommendations are highly individualised. Importantly, with this approach, very few false positives are identified, as the system’s knowledge is gradually refined such that problems are only identified when it is definitely appropriate to do so in the particular case. Even when best practice suddenly changes, the system is easily updated to reflect the newest information [3]. With relatively little training our system was capable of identifying approximately 90 % of all medication-related problems for a patient. Importantly, the system was capable of identifying problems that the expert had missed or incorrectly classified (errors). On average, we found that the system prevented the expert from making 2.02 errors per patient [2]. Furthermore, our approach was incorporated into a commercially available system to support medication reviewers. This product has since been used by pharmacists to perform more than 50,000 medication reviews. We have also compared the medication-related problems found by this product against original pharmacist’s findings, and even against the findings found by applying the STOPP/ START guidelines [4, 5]. A 12 member expert panel consisting of accredited medication review pharmacists, I. K. Bindoff (&) G. M. Peterson C. Curtain School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia e-mail: Ivan.Bindoff@utas.edu.au

Introduction to the special virtual issue on climate change

This special virtual issue of Plant Ecology draws together 14 papers on climate change published in the journal over the past 5 years. It encompasses a range of ecosystems and species, and issues relating to potential climate change effects on plants and plant communities. The potential impacts of global climate change on the distribution of species, and the distribution, structure and function of communities in the 21st century have been the subject of an everincreasing scientific literature over the past two decades (Parry 2007). Recent global analyses show that anthropogenic climate change is already affecting species and ecosystems and will continue to do so, with changes in the phenology, distribution and abundance of plants and animals reported for marine, freshwater and terrestrial plants and animals. Measured changes are heavily biased in the directions predicted under global warming scenarios and include earlier timing of spring events such as flowering, bud burst and egg laying, and latitudinal and altitudinal shifts in species ranges (Parmesan 2006). The magnitude and rate of on-going climate change, combined with other stressors, may exceed the adaptive capacity of species and resilience of ecosystems. In addition, changing climate combined with current, and future altered, disturbance regimes may lead to exacerbated rates of range contraction and extinction in plant species unable to maintain contact with suitable habitat through dispersal (Westerling et al. 2011; Moritz et al. 2012). Changes to ecosystems may include impoverished species mixes, simplified ecosystem structure and function, and greater vulnerability to invasive species (Malcolm et al. 2006; Midgley and Thuiller 2007; Keeley and Brennan 2012). Three key conclusions from the 2007 International Panel on Climate Change (Parry 2007) highlight the threat that anthropogenic climate change poses for global plant biodiversity: (1) Resilience of many ecosystems is likely to be exceeded by the combination of climate change, associated disturbances (e.g. wildfire) and other global change drivers. (2) Increases in global temperature of more than 1.5–2.5 C and rising atmospheric CO2 concentrations are projected to cause major changes in ecosystem structure, function and species interactions. (3) 2–30 % of plant species globally are at increased risk of extinction. Many studies on the potential impacts of climate change on plant and animal species have used bioclimatic envelope models which predict the future distribution of species using the correlation of their present range to present-day climate parameters, and the future geographic distribution of these climates based on a range of possible climate futures as described in various GCMs (e.g. Thuiller et al. 2005). Pearson and Dawson (2003) have highlighted the shortcomings of this approach as it ignores factors N. J. Enright (&) Murdoch University School of Veterinary and Life Sciences, Murdoch, Australia e-mail: N.Enright@murdoch.edu.au

New Roles of Serotonin and Tachykinins in Intestinal Mucositis?

The paper by Matsumoto et al. [1] published in this issue of Digestive Diseases and Sciences reports an investigation of expression of 5-hydroxytrypamine (5HT) and tachykinins and their cognate receptors in an experimental model of mucositis of the mouse jejunum induced by the chemotherapeutic agent 5-fluorouracil (5-FU). Mucositis is a serious adverse effect of common chemotherapeutic treatments. Damage to mucosa, prominent in the oral cavity (oral mucositis), also occurs in the esophagus, stomach, and small and large intestines (gastrointestinal mucositis). Gastrointestinal symptoms include pain, nausea and vomiting, ulceration, diarrhea, and rectal bleeding. Patients with mucositis often have to temporarily withdraw from chemotherapy, which can contribute to reduced cancer survival [2]. Current guidelines for treatment of gastrointestinal mucositis include use of the oral histamine H2-receptor antagonist ranitidine or a proton pump inhibitor to reduce gastric injury. Loperamide is recommended for control of diarrhea; if loperamide fails, subcutaneous octreotide is also recommended [3]. Mucosal damage was originally believed to result primarily from inhibition of epithelial cell proliferation, which reduces protection and repair of the mucosa. More recent evidence shows that chemotherapeutic agents stimulate nuclear factor-jB production; subsequent production of proinflammatory cytokines significantly induces mucositis [4]. Therapy limiting intestinal mucosal damage is not in common use, primarily because suitable molecular targets have not been identified. The publication by Matsumoto et al. builds on their previous findings that 5HT3 receptor antagonists reduce damage to mucosa, mucosal cytokine production, and enterocyte apoptosis caused by 5-FU in mice [5]. Their latest paper reports that 5HT3 and neurokinin (NK) NK1 receptor expression were upregulated, mostly in lamina propria macrophage-like cells (CD11?) of the jejunum, of mice injected intraperitoneally with 5-FU for 5 days, investigated on the 5th day. The study also reports increased 5HT and tachykinin (substance P) content of small intestine homogenate, although the number of cells expressing these compounds was unchanged. The number of mucosal 5HT3 receptor immunoreactive nerve fibers also increased. An important unanswered question is whether the results are clinically relevant, given that numerous studies have reported that 5HT3 receptors help modulate the immune– inflammatory axis. Rodents have only two genes encoding 5HT3 subunits whereas the human genome contains five 5-HT3 receptor-encoding genes, although the 5HT3C, 5HT3D, and 5HT3E subunits only express functional channels when co-expressed with 5HT3A [6]. It is currently unclear whether any of the 5HT3 receptor subtypes are expressed on human macrophages. 5HT2B and 5HT7 were the only serotonin receptor-encoding genes expressed above background levels in human macrophages produced by treatment of peripheral monocytes with GM-CSF or M-CSF (granulocyte macrophage and macrophage colonystimulating factors) [7]. Kapellar et al. [6] detected immunoreactivity to 5HT3A, 5HT3C, 5HT3D, and 5HT3E in lamina propria immune cells in the human colon, although their identity was not verified. There is, however, good evidence that 5HT3 receptors are expressed on human B. Callaghan J. B. Furness (&) Department of Anatomy and Neuroscience, University of Melbourne, Parkville, VIC, Australia e-mail: j.furness@unimelb.edu.au

Recent Advances in Lipid-Based Formulation Technology

Lipid-based formulations encompass a wide variety of delivery modes and technologies, ranging from immediate release to sustained release formulations, from liquids to semi-solids, from crystalline suspensions to lipid solutions, from systems containing small-molecule active pharmaceutical ingredients (APIs) to those containing more complex peptide-based molecules, and finally from those intended for oral administrations through to topicals and parenterals. The flexibility of lipid formulation technologies provides the potential to modify pharmaceutical properties such as stability and ease of manufacture, and pharmacokinetic properties such as enhanced absorption and bioavailability, sustained exposure and targeted delivery. With the exception of liposomal technologies (that represent a class of delivery system in their own right and have not been considered here), much of the interest in lipid-based formulations has focused on their use to enhance the oral bioavailability of poorly water-soluble drugs. Drugs with low water solubility continue to present a formidable challenge to effective drug development (1) and commonly show poor, variable, and fooddependent absorption and bioavailability after oral administration. Whilst great strides have been made in lead optimization strategies to design-out the physicochemical properties that lead to low water solubility, in many cases, structural changes that increase solubility also result in unacceptable reductions in potency. Indeed, the majority of reports describing changes in the patterns of physicochemical properties for new drug discovery candidates suggest that trends towards low water solubility are increasing rather than decreasing (2,3). Formulation strategies that facilitate the ‘rescue’ of compounds with intrinsically low water solubility, and that provide for robust and reproducible exposure after oral administration, therefore remain an important weapon in the drug development armory. Several strategies that enable effective delivery of poorly water-soluble compounds are apparent (1) and, in general, may be stratified as technologies that modify solute–solute interactions in the solid state, that enhance solute–solvent interactions in solution, that promote dissolution via changes in surface area, or combinations of the three approaches. Formulation technologies to enhance solubility and dissolution rate include salt formulation,modification of crystal form (amorphous, cocrystals, polymorphs), particle size reduction/nanomilling, alteration of solution/solubilisation conditions (cosolvents, surfactants, cyclodextrins etc.), and approaches such as solid dispersions and lipidbased formulations that may, in practice, achieve a number of these goals. For example, many solid dispersion and lipid-based formulations contain drug in a non-crystalline (amorphous/molecularly dispersed) form, circumventing the challenge to solubility provided by the crystal lattice, and also provide for ongoing solubilisation or stabilization of supersaturation via the inclusion of surfactants, lipids and/or polymers. The current theme issue focuses on the potential utility of lipid-based formulations as a means of enhancing the oral bioavailability of poorly water-soluble drugs. In addition, several manuscripts provide insight into the broader application of lipid-based drug delivery technologies, for example, to facilitate parenteral or site-specific delivery of lipophilic compounds. This is not to suggest any inherent superiority of lipid-based formulation technologies over others, and the appropriate choice of an enabling technology is clearly drug specific. However, for poorly water-soluble lipophilic drugs, lipid-based formulations provide a tried and tested delivery solution to overcome poor and variable oral bioavailability and are increasingly being utilized as a vehicle to achieve modulated or targeted delivery. Nonetheless, whilst lipid-based formulations have been used to good effect in a range of oral and parenteral drug products (4), several challenges to their broader utility remain. These C. J. H. Porter (*) :H. D. Williams :N. L. Trevaskis Drug Delivery Disposition and Dynamics Monash Institute of Pharmaceutical Sciences Monash University (Parkville campus) Melbourne, Victoria, Australia e-mail: chris.porter@monash.edu

A road map for a tissue engineering concept for restoring structure and function after limb loss

In the 21st century the focus of tissue engineering/regenerative medicine (TE/RM) strategies did change its aim from repair to regeneration [1–4]. In concert, interdisciplinary teams composed of scientists, engineers and clinicians in the field of TE/RM are now applying the principles of cell transplantation, biomaterial science, and bioengineering to design and fabricate tissue engineered constructs (TEC) that can restore and maintain normal function in diseased and injured tissues [5, 6]. In biology, regeneration is the process of renewal and restoration that makes genomes, cells, tissues, and organs, resilient to natural fluctuations or events that cause trauma and/or injury [7]. The benchmark for tissue engineers working on limb regeneration is the newt. For example, an adult salamander can regenerate a lost arm or leg over and over again; regardless of how many times the part is amputated [8]. Frogs can regenerate a limb during tadpole stages when their limbs are first growing out, but they leave behind this regeneration potential in adulthood [9]. Even mammalian embryos have some ability to replace developing limb buds, but that competence is lost well before birth. Indeed, this trend toward declining regenerative capacity over the course of an organism’s development is mirrored in the evolution of higher animal forms, leaving newts such as a salamander as the only vertebrate still able to regrow tissues/organs throughout its lifetime. The very first responses of tissues at an amputation site are not that different in salamanders and in humans, but eventually human tissues form a scar, whereas the newt’s reactivate a kind of embryonic development plan which allows the cells to access an encoding programme designed to build a new limb. It is hypothesised that understanding firstly how to recognise and subsequently instruct the human wound environment to trigger salamander-like healing patterns combined with advanced surgical treatment concepts, biomaterials, tissue engineering technologies and stem cell expertise could make it possible to regenerate large volume tissue-interfaces (bone, muscle, neurovascular bundle) of a human limb such as an upper arm or lower leg. Many different types of tissue can be found in a human limb: bone, ligaments, tendons, muscle, nerves, skin, and blood vessels. All of these different tissues have to work together immaculately. Growing new arms just isn’t possible yet, though we are making progress toward helping many patients in need of a single new tissue. Currently, we can build tissue engineered constructs (TECs) that replace a few simple functions of very complex organs. For example, engineered skin is available on the market that can adequately perform the job of real skin as a barrier against the environment [9]. We can also make significant amounts of engineered bone [10] and cartilage [11, 12] and several groups around the world have concepts in place for engineering tendons, ligaments, muscles, peripheral nerves and blood vessels, which have been tested in rodents and some in preclinical animal studies [13]. Although it is clear that much remains to be studied and understood in limb regeneration research, we as scientists are heading in the right direction by taking the necessary D. W. Hutmacher (&) Science and Engineering Faculty, Regenerative Medicine Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD 4059, Australia e-mail: dietmar.hutmacher@qut.edu.au

Sergio Caroli and Gyula Záray: Analytical techniques for clinical chemistry: methods and applications

At 800 pages, this is a doorstop of a book, containing contributions by 64 authors from 14 countries. So, first must be a word of congratulation to the editors for managing such a work that addresses their perceived need for an analytical text in clinical chemistry. This review cannot do justice to the 25 chapters, but it will try to give an overview of the book, dip into some of the offerings, and suggest its place in the literature of the field. The back-cover blurb suggests the book deals with the role of analytical chemistry in ‘‘fostering clinical research’’. So, the perspective is clearly on using analytical chemistry as a means to a number of ends. The branch of chemistry dealing with measurements in clinical science has often led to developments in instrumentation and stimulated wider metrological thinking in analytical chemistry. The need for safety of pharmaceuticals, adherence to regulations, production of timely results for clinicians and patients, and the need to measure ever tinier amounts of obscure compounds in more complex systems put a great task on clinical analytical chemists. It is not surprising that the first chapter in the section ‘‘Exploring Fundamentals’’ is titled ‘‘Good Clinical Practice Principles: Legal Background and Applicability’’. Here is detailed the major standards around Good Clinical Practice from ICH, WHO, and a number of EC directives. As a member of the Joint Committee for Guides on Metrology, Working Group 1 (the group responsible for the Guide to the Expression of Uncertainty in Measurement, GUM [1]), I was particularly interested in the chapter on uncertainty. The authors correctly use definitions from the International Vocabulary of Metrology, VIM [2], which puts the chapter on a sound metrological footing, unlike chapter 9.3 (Validation of Analytical Methods) which appears not have heard of VIM. The GUM is also referenced here, and the problem of ‘‘pre-analytical uncertainty’’ is raised. The chapter as a whole reads more of one addressing general quality issues than simply uncertainty, with sections on method validation, proficiency testing, and reference intervals. There is a tendency to make up quantities and symbols. SE here is short for systematic error, which most statisticians would read as ‘‘standard error’’. Two-letter acronyms abound when, in my opinion, the English words could appear certainly in the text. The space saved by ‘‘CM’’ over ‘‘control material’’ does not make up for the interruption to the reader’s flow, and the proper symbol in equations for standard deviation is s not SD. With all the extraneous, but interesting, material in this chapter, I am not sure whether a reader would be able to estimate a measurement uncertainty for a particular clinical measurement result. This chapter is a good example of the difference in outlook of, if I can call them thus, chemical analytical chemistry and clinical analytical chemistry, the former focusing on measurement, and the latter on process and the system as a whole. The last chapter in the Fundamentals section, on metal toxicology, seems out of place and perhaps should have been in the next section on Selected Applications, while chapter 8 on the role of analytical chemistry in the safety of drug therapy could perhaps have come into Fundamentals. The metals chapter could then have been put next to the chapter on molybdenum. In this section, the chapter of drug detection for antidoping controls caught my attention. This chapter is a nice essay on the state of play with reference to the major substances administered illicitly (EPO, steroids, growth hormones, and the plethora of agonists and antagonists). D. B. Hibbert (&) School of Chemistry, University of New South Wales, Sydney, NSW 2052, Australia e-mail: b.hibbert@unsw.edu.au

Special Issue on: Cooperative and Distributed Wireless Communications

Recent advances in radio technology as well as in hardware and software design have resulted in new possibilities for future mobile communication networks. Among those, cooperative communications among the peer nodes of a cellular network could create much anticipated improvement in coverage and capacity of the cellular systems. Such cooperation would generate a distributed network topology where the abundant processing power and storage capacity of the nodes can be shared for carrying out complex tasks. Distributed wireless communications would also enable mobile computing within the mobile cloud. In this context, the 23rd Annual Symposium on Personal Indoor and Mobile Radio Communications (PIMRC 2012) served as a major international telecommunication forum for researchers and technologists to discuss original contributions and results in all fields of personal, indoor and mobile communication systems, including those related to the above topic of cooperative and distributed wireless communications. This special issue is based upon a selection of a very limited number of papers presented at IEEE PIMRC2012. Authors of the top 15 papers from the symposium were invited to submit an extended version of their papers to this special issue. Among those, we are happy to present you with four papers that have been accepted after a rigorous peer review process. The first paper, New Diversity Combining Receivers for Cooperative Multiplexing in Wireless Multiuser Relay Networks, by Chang Kyung Sung, Iain B. Collings, Maged Elkashlan, and Phee Lep Yeoh, proposes two new diversity combining receivers that support cooperative multiplexing in two-hop wireless multiuser relay networks. Cooperative multiplexing has the potential to double the achievable throughput by allowing the base station (BS) and the relay station (RS) to transmit to different users at the same time in the second time slot of the half time division duplexed (TDD) relay transmission. This throughput improvement comes at a cost of performance degradation due to interuser interference between the BS and the RS. To overcome this degradation, two new receivers for the relay-link users are proposed: (1) cooperative multiplexing optimum combining (CMOC) and (2) cooperative multiplexing selection combining (CMSC). Exact closed-form expressions are derived for the moment generation function, probability density function, and the cumulative distribution function of the output SINR, and new analytical expressions for the outage probability, symbol error rate, and achievable throughput are presented. The authors show that the symbol error rate performance and achievable throughput were notably improved relative to the standard single-channel receiver in the high interference regime. The second paper, Improving Cooperative Transmission Feasibility by Network Reconfiguration in Limited Backhaul Networks, by Martin Draxler, Thorsten Biermann, and Holger Karl, develops a mixed integer linear program (MILP) and a BS selection heuristic for Coordinated MultiPoint (CoMP) that takes into account both aspects of the wireless channels and the backhaul network status. This heuristic can also identify which bottlenecks in the A. Jamalipour (&) University of Sydney, Sydney, NSW, Australia e-mail: a.jamalipour@ieee.org

Cell–Cell Signaling: Broadening Our View of the Basic Multicellular Unit

Harold Frost defined the basic multicellular unit (BMU) 50 years ago as the key grouping of cells that achieve structural changes and skeletal renewal by the process of bone remodeling [1]. The BMU includes the bone-resorbing osteoclast, which removes a small quantity of bone, and the bone-forming osteoblast, which replaces the bone removed by osteoclasts. The BMU concept implies the existence of communication pathways between osteoclasts and osteoblasts, between osteoblasts and osteocytes, and among osteoblasts so that bone remodeling can occur in a controlled manner. We now understand that local control of bone remodeling extends beyond the cells of bone proper. Other cell types in the bone marrow influence BMU activity, and these are explored in this issue. Furthermore, we now understand that the influence of the BMU is no longer restricted to bone; factors released from the BMU influence hematopoiesis, kidney function, and glucose metabolism. A full understanding of the interactions within the bone microenvironment will aid with the design of new therapeutic agents for skeletal disorders and should help clinicians using therapies that target osteoclast and osteoblast function. It is for this reason that we have devoted this issue of Calcified Tissue International to expanding our view of the BMU by exploring the full range of paracrine and direct cell-to-cell signals that affect the BMU and its influence on the local environment. We begin with the cells within the bone matrix itself by exploring newly identified roles for the osteocyte and its communication network. Cheung, Kennedy, Majeska, and Schaffler describe this network and the way it senses and responds to changes in the local environment to influence bone structure and systemic phosphate metabolism. Bellido continues the theme, discussing the roles of apoptosis and RANKL/OPG signaling within osteocytes in controlling bone remodeling. Sims and Tonna then address some of the paracrine communication pathways that exist within the osteoblast/osteocyte lineage, including sclerostin, ephrins, and the IL-6 family of cytokines, and their unique roles at different stages of osteogenic differentiation. Two specific cell contact–dependent communication pathways are then detailed. First, Marie, Hay, Modrowski, Revollo, Mbalaviele, and Civitelli review the biologic role of the cadherin family of cell adhesion molecules in controlling osteoblast differentiation and novel approaches for developing new therapies that modify cadherin function. Next, Stains, Watkins, Grimston, Hebert, and Civitelli discuss the role of intercellular communication via gap junctions, focusing on connexin43 and its downstream signals in regulating osteoblast differentiation, function, and survival. Osteoblasts are derived from mesenchymal stem cells, and multiple pathways regulate their lineage commitment. Chen, Lee, and Bae focus on the Notch signaling pathway in osteoblast and chondrocyte development, while Gimble and Nuttall describe the reciprocal relationship between marrow adipocytes and osteoblast generation from their common progenitors and expand this concept to include the effect of adipokines and lipid metabolites on the skeleton. We then move to key interactions on the bone surface that control bone mass. Henriksen, Karsdal, and Martin N. A. Sims (&) Bone Cell Biology and Disease Unit, St. Vincent’s Institute, Melbourne, VIC, Australia e-mail: nsims@svi.edu.au

Measure DRAM with a purpose: diagnose or evaluate

Diastasis of the rectus abdominis muscle (DRAM) affects a significant number of women during the antenatal and postnatal period [1], and has been related to reduced pelvic control [2] and potential pelvic and low back pain. Historically, DRAM measurement has been done using palpation or the ‘finger method’ to discriminate between women with and without DRAM, i.e., diagnose. Also calipers, tape measures, and more recently ultrasound are used to diagnose DRAM or monitor DRAM width [3]. Barbosa et al. [4] recently published a clinically important comparative measurement study in ‘‘Archives of Gynecology and Obstetrics’’. The authors compared measurements on ultrasound images with those from calipers. The two main aims were (1) to evaluate the measurement error between the two methods, and (2) to find the discriminative agreement or diagnostic value of calipers. The second objective is of great clinical importance for daily practice. Based on these outcomes, clinical decisions, management and follow-up might change. However, the authors interpreted the kappa statistic incorrectly, undervaluing the ability of calipers to identify women with DRAM. They state that ‘‘according to the Kappa test, 65 % of the diagnoses given in the clinical examination were confirmed by ultrasonography’’ (Epub p.3). Although the chance-corrected agreement reflected by the kappa coefficient is indeed 0.66 (r = 0.656), the percentage agreement, and hence proportion ‘confirmed by ultrasonography’ is 83 %. Table 1 provides additional diagnostic accuracy results, based on raw data presented by Barbosa et al. [4]. Keeler et al. [3] found in their survey that 96.6 % of women’s health physiotherapists used palpation to assess, and measure DRAM width. In 1987, Bursch [5] concluded that this method is ‘unreliable’, but used inappropriate statistics to evaluate this [6], and might not have sufficiently considered the method used for their purpose of measurement. It is important to think about the specific purpose of measurement before deciding which measurement method to use: do you want to diagnose (presence/ absence) or rank (small/moderate/large)? Do you want to monitor or evaluate DRAM width over time (using difference in cm or mm), or simply report on DRAM width of a patient? We would like to emphasise the importance of the purpose of clinical measurement and the importance of psychometric and diagnostic studies such as those of Barbosa et al. [4]. Currently, insufficient psychometric information is available for widely used measurement methods such as calipers or palpation. Additional psychometric studies are needed. Psychometric requirements differ depending on the measurement purpose. If discrimination between absence and presence of DRAM is the aim, using, for example, palpation or a tape measure, the positive predictive value or sensitivity is of more importance than absolute measures of reliability. However, when evaluating DRAM width as treatment outcome, small measurement error is desired for which ultrasound [7] or calipers [8] might be more suitable. In summary, the choice of the DRAM measurement method that is clinically feasible for a specific clinical A. T. M. van de Water (&) Musculoskeletal Research Centre and Department of Physiotherapy, School of Allied Health, La Trobe University, Bundoora, VIC 3086, Australia e-mail: a.vandewater@latrobe.edu.au

Advances in ambient intelligence technologies

This special issue contains selected papers from the 3rd International Conference on Ambient Systems, Networks and Technologies (ANT 2012), which was held at Niagara Falls, Ontario, Canada, August 27–29, 2012. The conference attracted a large number of scientific papers that contributed to the state-of-the-art in the areas of pervasive and ambient information systems. All the papers selected for this special issue have undergone two rounds of rigorous review process. Based on the reviewers’ feedback, seven papers were selected for publication from eight best papers invited from ANT 2012. The accepted papers cover interesting works on new developments in ambient intelligence such as adaptable intelligence systems, smart environments, body area networks, and network security. The first paper by Zhang, Khedri, and Jaskolka, ‘‘An Aspect-Oriented Language for Feature Modeling’’, proposes a new language called AO-PFA for developing ambient systems. Built on top of Product Family Algebra (PFA) and by using the aspect-oriented technology, AOPFA offers capabilities in dealing with unpredictable changes in ambient applications. The paper by Hoelzl, Kurz, and Ferscha, ‘‘Goal Oriented Recognition of Composed Activities for Reliable and Adaptable Intelligence Systems’’, focuses on activity and context recognition, an important research topic for adaptable ambient intelligence systems. The paper proposes a goal oriented approach to dynamically create and instantiate models to recognize high level composed activities in an opportunistic way. The paper by Li, He, and Arora, ‘‘ThermoNet: FineGrain Assessment of Building Comfort and Efficiency’’, describes ThermoNet, a hybrid wireless sensor network solution for monitoring and optimizing energy consumption of the Heating, Ventilation, and Air Conditioning systems in large buildings. The paper reports some interesting findings based on the data collected from a realworld environment. The paper by Menon, Jayaraman, and Govindaraju, ‘‘Probabilistic Spatio-Temporal Retrieval in Smart Spaces’’, deals with uncertainties of object tracking in smart spaces. The paper proposes a data model that supports computation of probabilities of spatio-temporal queries giving the uncertainty of the location of an occupant. The paper by Knapen et al., ‘‘Exploiting GraphTheoretic Tools for Matching in Carpooling Applications’’, studies carpooling for commuting and proposes a Global CarPooling Matching Service (GCPMS) that provides advice on how to combine commuting trips by carpooling. In order to evaluate the matching performance of the GCPMS, a multi-agent system is also developed and some initial experimental results are reported. The paper by Khan et al. ‘‘A New Patient Monitoring Framework and Energy-Aware Peering Routing Protocol (EPR) for Body Area Network Communication’’, proposes a new architecture of Body Area Networks for indoor hospital environments. The paper presents an EPR for reducing the traffic load and energy consumption while increasing the number of packets successfully delivered to the destinations. The final paper by Beitollahi and Deconinck, ‘‘ConnectionScore: A Statistical Technique to Resist Application-Layer DDoS Attacks’’, describes a Q. Z. Sheng J. Ma School of Computer Science, The University of Adelaide, Adelaide, SA 5005, Australia e-mail: qsheng@cs.adelaide.edu.au

Scientific writing: the process and the pitfalls

The recent release of updated journal impact factors has shown that Forensic Science Medicine and Pathology has risen from its first entry of 0.698 in 2010, to 1.44 in 2011, and now to a respectable 2.438 in 2012. This is a very gratifying trend and is a tribute to the high quality submissions from our authors and the excellent work of our reviewers, editorial staff, and colleagues at Springer publishers. However, impact factors can also decline and so it is essential that the quality and progress of our journal is maintained so that this level of excellence will only further increase in subsequent years. For this reason it is timely to examine aspects of scientific writing and the problems that authors may encounter. Unfortunately research may have diminished significance if the results of studies and observations are not reported to the wider professional community within a reasonable time. Prompt dissemination enables data to be evaluated and further developed. Much of the success of this process depends upon researchers and pathologists being able to write about their work clearly, in a manner that is suitable for publication, and that is accessible to their colleagues. Writing well is not always as easy as it sounds, and although researchers may be highly skilled at generating and collecting data, the ability to put together a wellcrafted paper may be less well developed. A major problem in submissions which either require significant revision or are rejected outright is a lack of critical examination and explanation of results [1]. The most disappointing papers are those where it appears that a considerable amount of work has been expended by researchers who have then failed to formulate credible or logical conclusions. Often there appears to be a lack of understanding of the precise focus of the paper; specifically, the hypothesis being tested, and how the results either support or refute it. A good way of approaching a study is to encapsulate the aim within the title and to keep coming back to this; i.e., to not stray from the essential path of the paper. In-house peer review by colleagues prior to submission may also be helpful to authors, but this must involve a genuine assessment of the paper and not just a cursory overview—something that will take time to do if it is undertaken properly. The discipline imposed by some journals of limiting the word count for Abstracts provides an example of how writing within certain constraints forces an author to focus on the most significant aspects of his or her research. Other journals may have boxes that contain what is known about the topic and what this paper adds to the literature. As another example of this process, Forensic Science Medicine and Pathology encourages this by requiring four to five ‘‘Key Points’’ that clearly and succinctly summarize the major features of each paper. It is, however, disappointing to see how many authors do not provide this information on their first submission. Cultural differences in expression and the use of the vernacular, combined with problems in translation, can often seriously reduce the impact of a paper. For authors whose first language is not that of the journal, the use of language service companies may be one way of getting appropriate editing so that potentially confusing idiosyncratic expressions and grammatical errors will be removed from the text prior to submission. English language services are available for Forensic Medicine Science and R. W. Byard (&) Discipline of Anatomy and Pathology, School of Medical Sciences, The University of Adelaide, Level 3 Medical School North Building, Frome Road, Adelaide, SA 5005, Australia e-mail: roger.byard@sa.gov.au

The Soria Moria approach to pediatric forensic issues

Pediatric forensic pathology has been a controversial and evolving area in recent years [1, 2]. High profile court cases in many countries, including the United Kingdom and Canada, have focused both professional and public attention on deficiencies in diagnoses and approaches to cases, sometimes with resultant highly unfortunate miscarriages of justice [3, 4]. Examples of irresponsible testimony in court by physicians in cases of child maltreatment and neglect, as well as the medicolegal consequences caused by a medical examiner’s inadequate expertise and experience in pediatric pathology, have been described [5, 6]. Attempts to redress this situation have included the involvement of professional organizations and courts in reviewing cases and in establishing protocols and guidelines. A special issue of Forensic Science Medicine and Pathology was published in 2010 in which a number of issues were reviewed and analyzed including terminology and classifications for unexpected deaths in infancy and the place of parents at infant death scenes [7–9]. Additional problems in the field include declining numbers of trainee pathologists who are interested in pediatric forensic issues and adult practitioners who sometimes make the mistake of extrapolating from adult cases back to children. One way of addressing these problems is to hold meetings that specifically focus on pediatric forensic issues. This has not, however, been a common occurrence. An exception to this is the annual meeting convened in Norway by the Department of Forensic Pathology and Clinical Forensic Medicine of the Norwegian Institute of Public Health at the Soria Moria Convention Center, outside the main city of Oslo. The meeting has been held on an annual basis since 1993; it is an international meeting with English as the official language, although often with a Norwegian meeting held on the preceding day. The meeting lasts for two and a half days and covers a wide range of topics focusing particularly on sudden infant death syndrome (SIDS) and on sudden and unexpected infant and childhood death. The meeting is quite small limited to between 40 and 60 participants, who come from a variety of forensic, clinical, and research backgrounds. To give an insight into the types of presentations that occur, the program for this year (2013) will be reviewed. On the first morning, a session was held on the epidemiology of SIDS and sudden death in infants and children. This included overviews of changing patterns in mortality and trends in classifications, the relationship of SIDS rates to immunizations, death scene investigations in Norway, and discussion on parental responses to death scene examinations and bereavement issues. The morning concluded with a session where participants were able to have short presentations of submitted difficult cases that had raised particular diagnostic or legal problems. Topics included concealed births, second impact syndrome, accidents with bicycle helmets, positional asphyxia, and dehydration. The remainder of the day was devoted to R. W. Byard (&) Discipline of Anatomy and Pathology, The University of Adelaide, Level 3 Medical School North Building, Frome Road, Adelaide, SA 5005, Australia e-mail: roger.byard@sa.gov.au

A logistic challenge - use of electromyographic endotracheal tube in an extremely narrowed airway

Acta Anaesthesiologica ScandinavicaVolume 57, Issue 8 p. 1083-1084 LETTER TO THE EDITOR A logistic challenge – use of electromyographic endotracheal tube in an extremely narrowed airway J. JEYADOSS, J. JEYADOSSSearch for more papers by this authorR. LEA, R. LEASearch for more papers by this authorJ. HORWOOD, J. HORWOODSearch for more papers by this author J. JEYADOSS, J. JEYADOSSSearch for more papers by this authorR. LEA, R. LEASearch for more papers by this authorJ. HORWOOD, J. HORWOODSearch for more papers by this author First published: 30 June 2013 https://doi.org/10.1111/aas.12145 Address: Jellsingh Jeyadoss Department of Anaesthesia The Queen Elizabeth Hospital 28 Woodville Road Woodville, SA 5011 Australia e-mail: jellsingh.jeyadoss2@health.sa.gov.au Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume57, Issue8September 2013Pages 1083-1084 RelatedInformation

User-centric ambient information systems and applications

This theme issue looks at new developments in pervasive and ambient systems such as localization, interaction interfaces, context-aware services, smart environments, and personal task scheduling. It is based on selected and rereviewed papers from the 3rd International Conference on Ambient Systems, Networks and Technologies (ANT 2012), which was held at Niagara Falls, Ontario, Canada, August 27–29, 2012. The conference attracted a large number of scientific papers that contributed to the state-ofthe-art in the areas of pervasive and ambient information systems. All the papers selected for this special issue have undergone two rounds of rigorous review process. Based on the reviewers’ feedback, seven papers were selected for publication from ten best papers invited from ANT 2012. The first paper by Adnan, Datta, and MacLean, ‘‘Efficient and Accurate Sensor Network Localization’’, focuses on localization, a key research challenge in wireless sensor networks, and proposes a generic, distributed algorithm that outperforms a typical range-free algorithm Weighted Monte Carlo Localization (WMCL). The paper by Zhou et al. ‘‘Innovative Wearable Interfaces: An Exploratory Analysis of Paper-based Interfaces with Camera-Glasses Device Unit’’ considers ubiquitous interaction approaches and conducts some interesting research by developing a MobilePaperAccess system. This system enables mobile interactions by exploiting a wearable camera-glasses device with a paper-based interface. Context awareness is a critical feature in user-centric ambient environments in the sense that more personalized services can be offered to users. The following three papers focus on context-awareness and offer some recent developments and advancement. The paper by Ouksel and Lundquist, ‘‘A Context-Aware Cross-Layer (CACL) Broadcast Model for Ad Hoc Networks’’, concerns poor performance of 802.11 medium access control (MAC) and proposes a CACL broadcast model, which offers superior single-hop transmission rates than MAC. Some further extension to CACL is also discussed in the paper. The paper by Yuan and Herbert, ‘‘Context-Aware Hybrid Reasoning Framework for Pervasive Healthcare’’, presents a personalized, flexible, and extensible hybrid reasoning framework for developing context-aware healthcare applications to assist activity of daily living of the elderly. The framework particularly supports context-aware sensor data fusion and anomaly detection by exploiting the hierarchical fuzzy rule-based reasoning (FRBR). The paper by Gronli, Ghinea, and Younas, ‘‘Context-Aware and Automatic Configuration of Mobile Devices in Cloud-Enabled Ubiquitous Computing’’, reports a prototype system on crosssource integration of cloud-based, context aware information in ubiquitous computing. The paper by Mathew et al., ‘‘Building Sustainable Parking Lots with the Web of Things (WoT)’’, describes a scalable parking-lot infrastructure based on the emerging WoT. With this infrastructure, it is possible to perform mashups of physical things for creating a smart parking spot (SPS) that can be interacted by drivers from the Web. The initial evaluation reveals some promising results such as 40 % of saving in both time and air pollution. The final Q. Z. Sheng J. Ma School of Computer Science, The University of Adelaide, Adelaide, SA 5005, Australia e-mail: qsheng@cs.adelaide.edu.au

Reflections on TEAP: training for the future of medical physics

2013 marks the tenth anniversary of the ACPSEM’s Training, Education and Assessment Program (TEAP) for radiation oncology medical physics. It also marks the launch of TEAP for diagnostic imaging medical physics, a new program that caters for both nuclear medicine and radiology medical physics trainees. For both these reasons, this seems like a good time to stop and reflect on the importance of training for medical physics in Australia and New Zealand. What has been achieved? What is the purpose of TEAP? And where do we need to go next? I believe that TEAP marks a fundamental shift in our view of what it means to be a medical physics professional. When I first started working in medical physics in the late 1980s, there was very little formal training. Medical physics was mostly learnt on the job. The skills learnt were dictated by the clinical needs of the department, very often by being thrown in at the deep end. Many highly skilled medical physicists learnt their trade in this system, but the level of expertise that developed was variable. Those who wished to do so could seek external recognition through the ACPSEM accreditation examinations for radiation oncology medical physics, nuclear medicine physics and radiology medical physics. But in most cases achieving accreditation through these processes was not required for professional advancement. Now the story is very different. TEAP registrars commit to completing a highly structured training program which aims to develop the knowledge, skills and attitudes to practice as a medical physics professional. Registrars must undertake an extensive period of competency based training in a hospital, which is far broader in scope than the previous accreditation programs. Radiation oncology medical physics registrars must achieve competencies in treatment planning, brachytherapy and ancillary modules that were not part of the previous system. Diagnostic imaging registrars must undertake common modules which address core professional skills, regardless of the discipline in which they intend to specialize. In addition to the competency based training, registrars in both programs must also demonstrate skills in research and communication by completing an accredited postgraduate degree in medical physics, publications and conference presentations. Competency is assessed by clinical supervisors in departments during the training period, and assessed again by the certification panels during final examinations. Completion of TEAP results in the award of ACPSEM Certification as a Medical Physics Specialist, and is recognized by employers and governments as the new standard for professional competence. In the 10 years since the introduction of TEAP for radiation oncology medical physics, the program has become well established. There are approximately 100 registrars A. Perkins (&) ACPSEM, Suite 7.12, 247 Coward Street, Mascot, NSW 2020, Australia e-mail: Anne.Perkins@acpsem.org.au