Kava Anxiety Depression Spectrum Study (KADSS): a mixed methods RCT using an aqueous extract of Piper methysticum

Objectives: To report on the design, significance and potential impacts of the first documented human clinical trial assessing the anxiolytic and thymoleptic efficacy of an aqueous monoextract of Piper methysticum (kava). The significance of the qualitative element of our clinical trial is also explored. The Kava Anxiety Depression Spectrum Study (KADSS) is a 3-week placebocontrolled, double-blind, cross-over trial involving 60 adult participants (18—65) with elevated stable anxiety and varying levels of depressive symptoms. Aims: The aims of KADSS are: (1) to determine whether an aqueous standardised extract of kava is effective for the treatment of anxiety; (2) to assess the effects of kava on differing levels of depression; and (3) to explore participants’ experience of taking kava via qualitative research. The study also provides preliminary assessment of the safety of an aqueous extract of kava in humans. Conclusion: If results reveal that the aqueous kava preparation exerts significant anxiolytic effects and appears safe, potentially beneficial impacts may occur. Data supporting a safe and effective kava extract may encourage a re-introduction of kava to Europe, UK and Canada. This may provide a major socioeconomic benefit to Pacific Island nations, and to sufferers of anxiety disorders.

The Kava Anxiety Depression Spectrum Study (KADSS): A randomized, placebo-controlled, cross-over trial using an aqueous extract of Piper methysticum.

Rationale: Piper methysticum (Kava) has been withdrawn in European, British, and Canadian markets due to concerns over hepatotoxic reactions. The WHO recently recommended research into “aqueous” extracts of Kava. Objective: The objective of this study was to conduct the first documented human clinical trial assessing the anxiolytic and antidepressant efficacy of an aqueous extract of Kava. Design and participants: The Kava Anxiety Depression Spectrum Study was a 3-week placebo-controlled, double-blind crossover trial that recruited 60 adult participants with 1 month or more of elevated generalized anxiety. Five Kava tablets per day were prescribed containing 250 mg of kavalactones/day. Results: The aqueous extract of Kava reduced participants' Hamilton Anxiety Scale score in the first controlled phase by −9.9 (CI = 7.1, 12.7) vs. −0.8 (CI = −2.7, 4.3) for placebo and in the second controlled phase by −10.3 (CI = 5.8, 14.7) vs. +3.3 (CI = −6.8, 0.2). The pooled effect of Kava vs. placebo across phases was highly significant (p < 0.0001), with a substantial effect size (d = 2.24, η² [sub]p[sub] = 0.428). Pooled analyses also revealed highly significant relative reductions in Beck Anxiety Inventory and Montgomery–Asberg Depression Rating Scale scores. The aqueous extract was found to be safe, with no serious adverse effects and no clinical hepatotoxicity. Conclusions: The aqueous Kava preparation produced significant anxiolytic and antidepressant activity and raised no safety concerns at the dose and duration studied. Kava appears equally effective in cases where anxiety is accompanied by depression. This should encourage further study and consideration of globally reintroducing aqueous rootstock extracts of Kava for the management of anxiety.

Review : "Spatial planning and climate change" by Elizabeth Wilson and Jake Piper

This timely and thorough book seeks to provide evidence-based assessments of ways in which spatial planning may develop and deliver new strategies for addressing both the causes and impacts of climate change. The authors state that much of the analysis is informed by experiences and learning from their own involvements with climate change projects. The book aims to be relevant to a wide audience and nominates its intended readership to include planning practitioners, scholars, post-graduate students of built environment courses, politicians and the ‘interested’ public. In this regard, the authors skilfully deliver with a comprehensive and accessible dissemination of the nexus between spatial planning and climate change...

The Piper Fatigue Scale-Revised: Translation and psychometric evaluation in Spanish-speaking breast cancer survivors

Background Cancer-related fatigue (CRF) is the most common and distressing symptom reported by breast cancer survivors. The primary aim of this study was to translate and evaluate psychometrically for the first time a Spanish version of the Piper Fatigue Scale-Revised (S-PFS-R). Methods One hundred and eleven women with stage I–IIIA breast cancer who had completed their primary cancer therapy in the previous 6 months with the exception of hormone therapy completed the S-PFS-R, the Profile of Mood States (POMS) Fatigue (POMS-F) and Vigor subscales (POMS-V), and bilateral force handgrip testing. Data analysis included test–retest reliability, construct validity, criterion-related validity, and exploratory factor analyses. Results Test–retest reliability was satisfactory (r > 0.86), and all subscales showed moderate to high construct validity estimates [corrected item-subscale correlations (Pearson r = ≥ 0.65)]. The exploratory factor analysis revealed four dimensions with 75.5 % of the common variance explained. The S-PFS-R total score positively correlated with the POMS-F subscale (r = 0.50–0.78) and negatively with the POMS-V subscale (r = −0.13 to −0.44) confirming criterion-related validity. Negative correlations among force handgrip testing, subscales, and total scores were weak (r = −0.26 to −0.29). Conclusions The Spanish version of PFS-R shows satisfactory psychometric properties in a sample of breast cancer survivors. This is the first study to translate the PFS-R into Spanish and further testing is warranted.

Developing a supportive culture for teaching and learning : a university, faculty and school perspective

In the early 1990's the University of Salford was typical of most pre-1992 Universities in that whilst students provided much of it's income, little attention was paid to pedagogy. As Warren Piper (1994) observed, University teachers were professional in their subject areas but generally did not seek to acquire a pedagogy of HE. This was the case in Alsford. Courses were efficiently run but only a minority of staff were engaged in actively considering learning and teaching issues. Instead staff time was spent on research and commercial activity.----- In the mid-1990's the teaching environment began to change significantly. As well as Dearing, the advent of QAA and teaching quality reviews, Salford was already experiencing changes in the characteristics of its student body. Wideing access was on our agenda before it was so predominant nationally. With increasing numbers and heterogeneity of students as well as these external factors, new challenges were facing the University and teaching domain.----- This paper describes how a culture which values teaching, learning and pedagogic inquiry is being created in the university. It then focuses on parts of this process specific to the Faculty of Business and Informatics, namely the Faculty's Learning and Teaching Research Network and the establishment of the Centre for Construction Education in the School of Construction and Property Management.----- The Faculty of Business and Informatics' Learning and Teaching Research Network aims to raise the profile, quality and volume of pedagogic research across the five schools in the faculty. The initiative is targeted at all academics regardless of previous research experience. We hope to grow and nurture research potential where it exists and to acknowledge and use the existing expertise of subject-based researchers in collaborative ventures. We work on the principle that people are deliged to share what they know but need appreciation and feedback for doing so. A further ain is to surface and celebrate the significant amount of tacit knowledge in the area of pedagogy evidenced by the strength of student and employer feedback in many areas of the faculty's teaching.----- The Faculty embraces generic and core management expertise but also includes applied management disciplines in information systems and construction and property management where internationally leading research activities and networked centres of excellence have been established. Drawing from this experience, and within the context of the Faculty network, a Centre for Construction Education is being established with key international external partners to develop a sustainable business model of an enterprising pedagogic centre that can undertake useful research to underpin teaching in the Faculty whilst offering sustainable business services to allow it to benefit from pump-priming grant funding.----- Internal and external networking are important elements in our plans and ongoing work. Key to this are our links with the LTSN subject centres (BEST and CEBE) and the LTSN generic centre. The paper discusses networking as a concept and gives examples of practices which have proved useful in this context.----- The academic influences on our approach are also examined. Dixon’s (2000) work examining how a range of companies succeed through internal knowledge sharing has provided a range of transferable practices. We also examine the notion of dialogue in this context, defined by Ballantyne (1999) as ‘The interactive human process of reasoning together which comes into being through interactions based on spontaneity or need and is enabled by trust’ Social constructionist principles of Practical Authorship (Shotter, 1993, Pavlica, Holman and Thorpe, 1998)) have also proved useful in developing our perspective on learning and knowledge creation within our community of practice.

A qualitative study of the experience of oral cancer among Taiwanese men

The incidence and mortality of oral cancer in Taiwanese men have increased over the past decade, primarily associated with a surge in the popularity of betel quid chewing. The aim of this study was to examine the experience of six Taiwanese men with oral cancer, who were aged between 40 and 60 years, using a qualitative approach. The three major themes emerging from the data include: (i) understanding the cancer diagnosis; (ii) the challenges of cancer treatment; and (iii) adapting to difference. Increasing nurses' understanding of the experiential aspects of oral cancer in this population is required if nurses are to develop successful health promotion programmes and nursing interventions to meet these patients' needs.

Kava and St. John's wort : current evidence for use in mood and anxiety disorders

Background: Mood and anxiety disorders pose significant health burdens on the community. Kava and St John’s wort (SJW) are the most commonly used herbal medicines in the treatment of anxiety and depressive disorders, respectively. Objectives: To conduct a comprehensive review of kava and SJW, to review any evidence of efficacy, mode of action, pharmacokinetics, safety and use in Major Depressive Disorder (MDD), Bipolar Disorder (BP), Seasonal Affective Disorder (SAD), Generalized Anxiety Disorder (GAD), Social Phobia (SP), Panic Disorder (PD), Obsessive-Compulsive Disorder (OCD), and Post Traumatic Stress Disorder (PTSD). Methods: A systematic review was conducted using the electronic databases MEDLINE, CINAHL, and The Cochrane Library during late 2008. The search criteria involved mood and anxiety disorder search terms in combination with kava, Piper methysticum, kavalactones, St John’s wort, Hypericum perforatum, hypericin and hyperforin. Additional search criteria for safety, pharmacodynamics , and pharmacokinetics was employed. A subsequent forward search was conducted of the papers using Web of Science cited reference search. Results: Current evidence supports the use of SJW in treating mild-moderate depression, and for kava in treatment of generalized anxiety. In respect to the other disorders, only weak preliminary evidence exists for use of SJW in SAD. Currently there is no published human trial on use of kava in affective disorders, or in OCD, PTSD, PD or SP. These disorders constitute potential applications that warrant exploration. Conclusions: Current evidence for herbal medicines in the treatment of depression and anxiety only supports the use of Hypericum perforatum for depression, and Piper methysticum for generalized anxiety.

Algebraic attacks on clock-controlled stream ciphers

Stream ciphers are encryption algorithms used for ensuring the privacy of digital telecommunications. They have been widely used for encrypting military communications, satellite communications, pay TV encryption and for voice encryption of both fixed lined and wireless networks. The current multi year European project eSTREAM, which aims to select stream ciphers suitable for widespread adoptation, reflects the importance of this area of research. Stream ciphers consist of a keystream generator and an output function. Keystream generators produce a sequence that appears to be random, which is combined with the plaintext message using the output function. Most commonly, the output function is binary addition modulo two. Cryptanalysis of these ciphers focuses largely on analysis of the keystream generators and of relationships between the generator and the keystream it produces. Linear feedback shift registers are widely used components in building keystream generators, as the sequences they produce are well understood. Many types of attack have been proposed for breaking various LFSR based stream ciphers. A recent attack type is known as an algebraic attack. Algebraic attacks transform the problem of recovering the key into a problem of solving multivariate system of equations, which eventually recover the internal state bits or the key bits. This type of attack has been shown to be effective on a number of regularly clocked LFSR based stream ciphers. In this thesis, algebraic attacks are extended to a number of well known stream ciphers where at least one LFSR in the system is irregularly clocked. Applying algebriac attacks to these ciphers has only been discussed previously in the open literature for LILI-128. In this thesis, algebraic attacks are first applied to keystream generators using stop-and go clocking. Four ciphers belonging to this group are investigated: the Beth-Piper stop-and-go generator, the alternating step generator, the Gollmann cascade generator and the eSTREAM candidate: the Pomaranch cipher. It is shown that algebraic attacks are very effective on the first three of these ciphers. Although no effective algebraic attack was found for Pomaranch, the algebraic analysis lead to some interesting findings including weaknesses that may be exploited in future attacks. Algebraic attacks are then applied to keystream generators using (p; q) clocking. Two well known examples of such ciphers, the step1/step2 generator and the self decimated generator are investigated. Algebraic attacks are shown to be very powerful attack in recovering the internal state of these generators. A more complex clocking mechanism than either stop-and-go or the (p; q) clocking keystream generators is known as mutual clock control. In mutual clock control generators, the LFSRs control the clocking of each other. Four well known stream ciphers belonging to this group are investigated with respect to algebraic attacks: the Bilateral-stop-and-go generator, A5/1 stream cipher, Alpha 1 stream cipher, and the more recent eSTREAM proposal, the MICKEY stream ciphers. Some theoretical results with regards to the complexity of algebraic attacks on these ciphers are presented. The algebraic analysis of these ciphers showed that generally, it is hard to generate the system of equations required for an algebraic attack on these ciphers. As the algebraic attack could not be applied directly on these ciphers, a different approach was used, namely guessing some bits of the internal state, in order to reduce the degree of the equations. Finally, an algebraic attack on Alpha 1 that requires only 128 bits of keystream to recover the 128 internal state bits is presented. An essential process associated with stream cipher proposals is key initialization. Many recently proposed stream ciphers use an algorithm to initialize the large internal state with a smaller key and possibly publicly known initialization vectors. The effect of key initialization on the performance of algebraic attacks is also investigated in this thesis. The relationships between the two have not been investigated before in the open literature. The investigation is conducted on Trivium and Grain-128, two eSTREAM ciphers. It is shown that the key initialization process has an effect on the success of algebraic attacks, unlike other conventional attacks. In particular, the key initialization process allows an attacker to firstly generate a small number of equations of low degree and then perform an algebraic attack using multiple keystreams. The effect of the number of iterations performed during key initialization is investigated. It is shown that both the number of iterations and the maximum number of initialization vectors to be used with one key should be carefully chosen. Some experimental results on Trivium and Grain-128 are then presented. Finally, the security with respect to algebraic attacks of the well known LILI family of stream ciphers, including the unbroken LILI-II, is investigated. These are irregularly clock- controlled nonlinear filtered generators. While the structure is defined for the LILI family, a particular paramater choice defines a specific instance. Two well known such instances are LILI-128 and LILI-II. The security of these and other instances is investigated to identify which instances are vulnerable to algebraic attacks. The feasibility of recovering the key bits using algebraic attacks is then investigated for both LILI- 128 and LILI-II. Algebraic attacks which recover the internal state with less effort than exhaustive key search are possible for LILI-128 but not for LILI-II. Given the internal state at some point in time, the feasibility of recovering the key bits is also investigated, showing that the parameters used in the key initialization process, if poorly chosen, can lead to a key recovery using algebraic attacks.

An explorative qualitative analysis of participants' experience of using kava versus placebo in an RCT. (Clinical report)

Many randomised controlled trials (RCT) have been conducted using Piper methysticum (kava), however no qualitative research exploring the experience of taking kava during a clinical trial has previously been reported. ---------- Patients and methods: A qualitative research component (in the form of semi structured and open ended written questions) was incorporated into an RCT to explore the experiences of those participating in a clinical trial of kava. The written questions were provided to participants at weeks 2 and 3 (after randomisation, after each controlled phase). The researcher and participants were blinded as to whether they were taking kava or placebo. Two open ended questions were posed to elucidate their experiences from taking either kava or placebo. Thematic analysis was undertaken and researcher triangulation employed to ensure analytical rigour. Key themes after the kava phases were a reduction in anxiety and stress, and calming or relaxing mental effects. Other themes related to improvement in sleep and in somatic anxiety symptoms. ---------- Results: Kava use did not cause any serious adverse reactions although a few respondents reported nausea or other gastrointestinal side effects. This represents the first documented qualitative investigation of the experience of taking kava during a clinical trial. The primary themes involved anxiolytic and calming effects, with only a minor theme reflecting side effects. Our exploratory qualitative data was consistent with the significant quantitative results revealed in the study and provides additional support to suggest the trial results did not exclude any important positive or negative effects (at least as experienced by the trial participants).

Keeping House : a novel and novel companion

The creative work of this study is a novel-length work of literary fiction called Keeping House (published as Grace's Table, by University of Queensland Press, April 2014). Grace has not had twelve people at her table for a long time. Hers isn't the kind of family who share regular Sunday meals. As Grace prepares the feast, she reflects on her life, her marriage and her friendships. When the three generations of her family come together, simmering tensions from the past threaten to boil over. The one thing that no one can talk about is the one thing that no one can forget. Grace's Table is a moving and often funny novel using food as a language to explore the power of memory and the family rituals that define us. The exegetical component of this study does not adhere to traditional research pedagogies. Instead, it follows the model of what the literature describes as fictocriticism. It is the intention that the exegesis be read as a hybrid genre; one that combines creative practice and theory and blurs the boundaries between philosophy and fiction. In offering itself as an alternative to the exegetical canon it provides a model for the multiplicity of knowledge production suited to the discipline of practice-led research. The exegesis mirrors structural elements of the creative work by inviting twelve guests into the domestic space of the novel to share a meal. The guests, chosen for their diverse thinking, enable examination of the various agents of power involved in the delivery of food. Their ideas cross genders, ages and time periods; their motivations and opinions often collide. Some are more concerned with the spatial politics of where food is consumed, others with its actual preparation and consumption. Each, however, provides a series of creative reflective conversations throughout the meal which help to answer the research question: How can disempowered women take authority within their domestic space? Michel de Certeau must defend his "operational tactics" or "art of the weak" 1 as a means by which women can subvert the colonisation of their domestic space against Michel Foucault's ideas about the functions of a "disciplinary apparatus". 2 Erving Goffman argues that the success of de Certeau's "tactics" depends upon his theories of "performance" and "masquerade" 3; a claim de Certeau refutes. Doreen Massey and the author combine forces in arguing for space, time and politics to be seen as interconnected, non-static and often contested. The author calls for identity, or sense of self, to be considered a further dimension which impacts on the function of spatial models. Yu-Fi Tuan speaks of the intimacy of kitchens; Gaston Bachelard the power of daydreams; and Jean Anthelme Brillat-Savarin gives the reader a taste of the nourishing arts. Roland Barthes forces the author to reconsider her function as a writer and her understanding of the reader's relationship with a text. Fictional characters from two texts have a place at the table – Marian from The Edible Woman by Margaret Atwood 4 and Lilian from Lilian's Story by Kate Grenville. 5 Each explores how they successfully subverted expectations of their gender. The author interprets and applies elements of the conversations to support Grace's tactics in the novel as well as those related to her own creative research practice. Grace serves her guests, reflecting on what is said and how it relates to her story. Over coffee, the two come together to examine what each has learned.

Motor Accident Insurance Act 1994 - reasonable excuse for delay in giving notice under s37

The decisions in Perdis v The Nominal Defendant [2003] QCA 555, Miller v the Nominal Defendant [2003] QCA 558 and Piper v the Nominal Defendant [2003] QCA 557 were handed down contemporaneously by the Queensland Court of Appeal on December 15 2003. They consider important issues as to the construction of key provisions of the Motor Accident Insurance Act 1994 (Qld)

The Role of the Law in Communicating Patient Safety

This chapter considers the role of the law in communicating patient safety. Downie, Lahey, Ford, et al’s (2006) preventing, knowing and responding theoretical framework is adopted to classify the different elements of patient safety law. Rather than setting out all relevant patient safety laws in detail, this chapter highlights key legal strategies which are employed to: prevent the occurrence of patient safety incidents (preventing); support the discovery and open discussion of patient safety incidents when they do occur (knowing),; and guide responses after they occur (responding) (Downie, Lahey, Ford, et al 2006). The law is increasingly being invoked to facilitate open discussion of and communication surrounding patient safety. After highlighting some legal strategies used to communicate patient safety, two practice examples are presented. The practice examples highlight different aspects of patient safety law and are indicative of communication issues commonly faced in practice. The first practice example focuses on the role of the Ccoroner in communicating patient safety. This example highlights the investigative role of the law in relation to patient safety (knowing). It also showcases the preventing responding and preventing elements in respect of the significant number of communication errors that can occur in a multi-disciplinary, networked health system. The main focus of the second practice example is responding example illustrates how the law responds to health service providers’ and professionals’ miscommunication (and subsequent incidents) during treatment, however it also touches upon knowing and preventing.

Exercise and psychosocial interventions in breast cancer survivors: Preliminary results of a randomized controlled trial

Physical and psychological decline is common in the post-treatment breast cancer population, yet the efficacy of concurrent interventions to meet both physical- psychosocial needs in this population has not been extensively examined. PURPOSE: This study explores the effects of a combined exercise and psychosocial intervention model on selected physiological-psychological parameters in post-treated breast cancer. METHODS: Forty-one breast cancer survivors were randomly assigned to one of four groups for an 8-week intervention: exercise only [EX, n=13] (aerobic and resistance training), psychosocial therapy only [PS, n=11] (biofeedback), combined EX and PS [EX+PS, n=11], or to control conditions [CO, n=6]. Mean delta score (post-intervention - baseline) were calculated for each of the following: body weight, % body fat (skin folds), predicted VO2max (Modified Bruce Protocol), overall dynamic muscular endurance [OME] (RMCRI protocol), static balance (Single leg stance test), dynamic balance (360° turn and 4-square step test), fatigue (Revised Piper Scale), and quality of life (FACT-B). A one-way ANOVA was used to analyze the preliminary results of this on-going randomized trial. RESULTS: Overall, there were significant differences in the delta scores for predicted VO2max, OME, and dynamic balance among the 4 groups (p<0.05). The EX+PS group showed a significant improvement in VO2max compared with the PS group (4.2 ± 3.8 vs. -0.9 ± 4.2 mL/kg/min; p<0.05). Both the EX+PS and EX groups showed significant improvements in OME compared with the PS and CO groups (44.5 ± 23.5 and 43.4 ± 22.1 vs. -3.9 ± 15.2 and 2.7 ± 13.7 repetitions; p<0.05). All 3 intervention groups showed significant improvements in dynamic balance compared with the CO group (-0.8 ± 0.6, -0.6 ± 0.8, and -0.6 ±1.0 vs. 0.6 ± 0.6 seconds; p<0.05). Overall, changes in fatigue tended towards significance among the 4 groups (p = 0.08), with decreased fatigue in the intervention groups and increased fatigue in the CO group. CONCLUSIONS: Our preliminary findings suggest that EX and PS seem to produce greater positive changes in the outcome measures than CO. However, at this point no definite conclusions can be made on the additive effects of combining the EX and PS interventions.