Effect of caffeine on adenosine-induced reversible perfusion defects assessed by automated analysis

Objectives This prospective study investigated the effects of caffeine ingestion on the extent of adenosine-induced perfusion abnormalities during myocardial perfusion imaging (MPI). Methods Thirty patients with inducible perfusion abnormalities on standard (caffeine-abstinent) adenosine MPI underwent repeat testing with supplementary coffee intake. Baseline and test MPIs were assessed for stress percent defect, rest percent defect, and percent defect reversibility. Plasma levels of caffeine and metabolites were assessed on both occasions and correlated with MPI findings. Results Despite significant increases in caffeine [mean difference 3,106 μg/L (95% CI 2,460 to 3,752 μg/L; P < .001)] and metabolite concentrations over a wide range, there was no statistically significant change in stress percent defect and percent defect reversibility between the baseline and test scans. The increase in caffeine concentration between the baseline and the test phases did not affect percent defect reversibility (average change −0.003 for every 100 μg/L increase; 95% CI −0.17 to 0.16; P = .97). Conclusion There was no significant relationship between the extent of adenosine-induced coronary flow heterogeneity and the serum concentration of caffeine or its principal metabolites. Hence, the stringent requirements for prolonged abstinence from caffeine before adenosine MPI—based on limited studies—appear ill-founded.

THE meaning of effectiveness

As the Industry Commission prepares to engage in its examination of the Australian nonprofit sector as defined in its draft terms of reference, it confronts what it should regard as a fundamental dilemma; the meaning of the construct `effectiveness'. I should at this point state clearly that the potential difficulties are not unique to the task of the Commission, but have instead plagued human service evaluation for many a long year. At the level of human service or welfare practice, a favoured method of resolving the conundrum has been to dismiss it as irrelevant to the human services as it pursues its task of working for human betterment however understood. Such a response highlights a fundamental characteristic of the human services generally, not only in the nonprofit arena: their relative freedom from evaluation. While there are many reasons for this, some of which we will canvass later in this paper, one stems from a lack of clarity about the meaning of effectiveness coupled with a lack of consensus about its purpose.

Impact of the introduction of machine gaming in Queensland on minor and major bingo

Material for this paper comes from as report commissioned by the Department of Family Services, Aboriginal and Islander Affairs. The report is the result of a multi strategy research project designed to assess the impact of gaming machines on the fundraising capacity of charitable and community organisations in Queensland. The study was conducted during the 1993 calendar year. The first Queensland gaming machine was commissioned on the 11 February, 1992 at 11.30 am in Brisbane at the Kedron Wavell Services Club. Eighteen more clubs followed that week. Six months later there were gaming machines in 335 clubs, and 250 hotels and taverns, representing a state wide total of 7,974 machines in operation. The 10,000 gaming machine was commissioned on the 18 March, 1993 and the 1,000 operational gaming machine site was opened on 18th February, 1994.

Who claims gifts as a tax deduction? An examination of tax deductible gift statistics

Many donors, particularly those contemplating a substantial donation, consider whether their donation will be deductible from their taxable income. This motivation is not lost on fundraisers who conduct appeals before the end of the taxation year to capitalise on such desires. The motivation is also not lost on Treasury analysts who perceive the tax deduction as “lost” revenue and wonder if the loss is “efficient” in economic terms. Would it be more efficient for the government to give grants to deserving organisations, rather than permitting donor directed gifts? Better still, what about contracts that lock in the use of the money for a government priority? What place does tax deduction play in influencing a donor to give? Does the size of the gift bear any relationship to the size of the tax deduction? Could an increased level of donations take up an increasing shortfall in government welfare and community infrastructure spending? Despite these questions being asked regularly, little has been rigorously established about the effect of taxation deductions on a donor’s gifts.

A randomised controlled trial of an enhanced interdisciplinary community based group program for people with Parkinson’s disease: study rationale and protocol

Parkinson’s disease (PD) is a progressive, chronic neurodegenerative disorder for which there is no known cure. Physical exercise programs may be used to assist with the physical management of PD. Several studies have demonstrated that community based physical therapy programs are effective in reducing physical aspects of disability among people with PD. While multidisciplinary therapy interventions may have the potential to reduce disability and improve the quality of life of people with PD, there is very limited clinical trial evidence to support or refute the use of a community based multidisciplinary or interdisciplinary programs for people with PD. A two group randomized trial is being undertaken within a community rehabilitation service in Brisbane, Australia. Community dwelling adults with a diagnosis of Idiopathic Parkinson’s disease are being recruited. Eligible participants are randomly allocated to a standard exercise rehabilitation group program or an intervention group which incorporates physical, cognitive and speech activities in a multi-tasking framework. Outcomes will be measured at 6-week intervals for a period of six months. Primary outcome measures are the Montreal Cognitive Assessment (MoCA) and the Timed Up and Go (TUG) cognitive test. Secondary outcomes include changes in health related quality of life, communication, social participation, mobility, strength and balance, and carer burden measures. This study will determine the immediate and long-term effectiveness of a unique multifocal, interdisciplinary, dual-tasking approach to the management of PD as compared to an exercise only program. We anticipate that the results of this study will have implications for the development of cost effective evidence based best practice for the treatment of people with PD living in the community.

The interaction between exercise, appetite and food intake : implications for weight control

Exercise could indirectly affect body weight by exerting changes on various components of appetite control, including nutrient and taste preferences, meal size and frequency, and the drive to eat. This review summarizes the evidence on how exercise affects appetite and eating behavior and in particular answers the question, “Does exercise induce an increase in food intake to compensate for the increase in energy expenditure?” Evidence will be presented to demonstrate that there is no automatic increase in food intake in response to acute exercise and that the response to repeated exercise is variable. The review will also identify areas of further study required to explain the variability. One limitation with studies that assess the efficacy of exercise as a method of weight control is that only mean data are presented—the individual variability tends to be overlooked. Recent evidence highlights the importance of characterizing the individual variability by demonstrating exercise-induced changes in appetite. Individuals who experience lower than theoretically predicted reductions in body weight can be characterized by hedonic (eg, pleasure) and homeostatic (eg, hunger) features.

Choosing your niche : the social ecology of the International Baccalaureate Diploma in Australia.

The International Baccalaureate’s branding and reputation targets academic high achievers aiming for university entrance. This is an empirical examination of the growing popularity of this transnational secondary credential amongst local populations in Australia, focusing on its uptake across the community, and the discourses underpinning its spread and popularity. This paper reports on online surveys of 179 parents and 231 students in schools offering the IB as an alternative to Australian state curricula. It sets out to understand the social ecology of who chooses the IB and who it chooses. Statistically significant differences between IB and non-IB choosers were found in terms of family income, parent education, student aspirations, transnational lifestyles, and neoconservative, neoliberal and cosmopolitan beliefs. The analysis demonstrates how the reproduction of advantage is accomplished through choice behaviours in stratified educational markets.

The post-illumination pupil response of melanopsin expressing intrinsically photosensitive retinal ganglion cells in diabetes

Purpose: This study investigates the clinical utility of the melanopsin expressing intrinsically photosensitive retinal ganglion cell (ipRGC) controlled post-illumination pupil response (PIPR) as a novel technique for documenting inner retinal function in patients with Type II diabetes without diabetic retinopathy. Methods: The post-illumination pupil response (PIPR) was measured in seven patients with Type II diabetes, normal retinal nerve fiber thickness and no diabetic retinopathy. A 488 nm and 610 nm, 7.15º diameter stimulus was presented in Maxwellian view to the right eye and the left consensual pupil light reflex was recorded. Results: The group data for the blue PIPR (488 nm) identified a trend of reduced ipRGC function in patients with diabetes with no retinopathy. The transient pupil constriction was lower on average in the diabetic group. The relationship between duration of diabetes and the blue PIPR amplitude was linear, suggesting that ipRGC function decreases with increasing diabetes duration. Conclusion: This is the first report to show that the ipRGC controlled post-illumination pupil response may have clinical applications as a non-invasive technique for determining progression of inner neuroretinal changes in patients with diabetes before they are ophthalmoscopically or anatomically evident. The lower transient pupil constriction amplitude indicates that outer retinal photoreceptor inputs to the pupil light reflex may also be affected in diabetes.

Forging the heteroglossic citizen : articulating local, national, regional and global horizons in the Australian Curriculum

This article offers a discourse analysis comparing selected articles in the national press over the consultative period for Phase 1 subjects in the new Australian Curriculum, with rationales prefacing official Australian Curriculum Assessment and Reporting Authority documents. It traces how various versions of Australia, its ‘nation-ness’ and its future citizens have been taken up in the final product. The analysis uses Lemke's analytic elaboration of Bakhtin's concept of heteroglossia and its derivative, intertextuality. It identifies a range of intertextual thematic formations around ‘nation’, ‘history’, ‘citizen’ and ‘curriculum’ circulating in the public debates, then traces their presence in official curriculum documents. Rather than concluding that these themes are contradictory and incoherent, the conclusion asks how these multiple dialogic facets of Australian nation-ness potentially offer a better response to complex times than any coherent monologic orthodoxy might.

Ruptures in the production of girlhood : teenage flows and multiplicities [Abstract]

This paper examines the paradoxical and ubiquitous nature of Butler’s heterosexual matrix, and opens it up to an alternative Deleuzian analysis. Drawing on stories and art works produced in a collective biography workshop on girls and sexuality this paper extends previous work on the subversion of the heterosexual matrix undertaken by Renold and Ringrose (2008). The paper moves, as they do, from a molar to a molecular analysis, but extends that work by re-thinking the girl/subject in terms of Deleuze and Guattari’s endlessly transforming multiplicities where “the self is only a threshold, a door, a becoming between two multiplicities” (Deleuze and Guattari, 1987: 249)

Complications related to therapeutic anticoagulation in total hip arthroplasty

Bleeding related wound complications cause significant morbidity in lower limb arthroplasty surgery. Patients who require therapeutic anticoagulation in the peri operative period are potentially at higher risk of these complications. This is a retrospective case control study reviewing all primary total hip replacements performed in a single center over a five year period and comparing outcomes of the patients on warfarin with a double-matched control group of patients not on warfarin. The warfarin group had significantly higher risk of deep joint infection (9% vs 2.2%), haematoma/ wound ooze (28% vs 4%) and superficial infection (13.5% vs 2.2%). Managing the total hip arthroplasty patient with therapeutic anticoagulation is a balance between the risk of thromboembolic disease and bleeding related complications. Improved understanding of this risk will better allow the patient to make an informed decision regarding their elective arthroplasty surgery.

Getting beyond 'heroic agency' in conceptualising social workers as policy actors in the Twenty-First Century

The professional project of social work assumes a particular orientation to human agency on the part of social workers. Specifically, the social work educational literature focusing on the nature of the profession suggests that social workers exert considerable control over the means and ends of their practice. In this paper we ask whether this assumption is warranted. While we conceptualise this issue as relevant to the entire spectrum of professional social work practice, here we discuss our claim in relation to social workers adopting policy activist roles. We suggest that the actual engagement of social workers in policy practice and political change in liberal democracies is muted and we canvas a number of reasons that help explain why this is the case. We canvas the impact of naive conceptualisations of what we call the ‘heroic agency’ of social work identity as employed in texts used in pre-service social work education. Specifically we pose the thesis that new social work graduates, when immersed into the organisational rationalities of reconfigured ‘welfare states’, may experience a considerable mismatch between the promise of being a social change agent and their experience as a beginning practitioner, making it difficult for them to confidently articulate their political identity and purpose.