Interventions to increase physical activity in patients with COPD: A comprehensive review

It is unknown how interventions aimed at increasing physical activity (PA), other than traditional pulmonary rehabilitation, are structured and whether they are effective in increasing PA in chronic obstructive pulmonary disease (COPD). The primary aim of this review was to outline the typical components of PA interventions in patients with COPD. This review followed the PRISMA guidelines. A structured literature search of relevant electronic databases from inception to April 2014 was undertaken to outline typical components and examine outcome variables of PA interventions in patients with COPD. Over 12000 articles were screened and 20 relevant studies involving 31 PA interventions were included. Data extracted included patient demographics, components of the PA intervention, PA outcome measures and effects of the intervention. Quality was assessed using the PEDro and CASP scales. There were 13 randomised controlled trials and three randomised trials (PEDro score 5-7/10) and four cohort studies (CASP score 5/10). Interventions varied in duration, number of participant/researcher contacts and mode of delivery. The most common behaviour change techniques included information on when and where (n = 26/31) and how (n = 22/31) to perform PA behaviour and self-monitoring (n = 18/31). Significant between-group differences post-intervention in favour of the PA intervention, compared to a control group or to other PA interventions, in one or more PA assessments were found in 7/16 studies. All seven studies used walking as the main type of PA/exercise. In conclusion, although the components of PA interventions were variable, there is some evidence that PA interventions have the potential to increase PA in patients with COPD

Is the raised volume rapid thoracic compression technique ready for use in clinical trials in infants with cystic fibrosis?

The European Cystic Fibrosis Society Clinical Trial Network (ECFS-CTN) has established a Standardization Committee to undertake a rigorous evaluation of promising outcome measures with regard to use in multicentre clinical trials in cystic fibrosis (CF). The aim of this article is to present a review of literature on clinimetric properties of the infant raised-volume rapid thoracic compression (RVRTC) technique in the context of CF, to summarise the consensus amongst the group on feasibility and answer key questions regarding the promotion of this technique to surrogate endpoint status.

METHODS: A literature search (from 1985 onwards) identified 20 papers that met inclusion criteria of RVRTC use in infants with CF. Data were extracted and tabulated regarding repeatability, validity, correlation with other outcome measures, responsiveness and reference values. A working group discussed the tables and answered 4 key questions.

RESULTS: Overall, RVRTC in particular forced expiratory volume in 0.5s, showed good clinimetric properties despite presence of individual variability. Few studies showed a relationship between RVRTC and inflammation and infection, and to date, data remains limited regarding the responsiveness of RVRTC after an intervention. Concerns were raised regarding feasibility in multi-centre studies and availability of reference values.

CONCLUSION: The ECFS-CTN Working Group considers that RVRTC cannot be used as a primary outcome in clinical trials in infants with CF before universal standardization of this measurement is achieved and implementation of inter-institutional networking is in place. We advise its use currently in phase I/II trials and as a secondary endpoint in phase III studies. We emphasise the need for (1) more short-term variability and longitudinal 'natural history' studies, and (2) robust reference values for commercially available devices.

Applying the Transtheoretical Model to Physical Activity Behavior in Individuals With Non-Cystic Fibrosis Bronchiectasis

BACKGROUND: The transtheoretical model has been successful in promoting health behavior change in general and clinical populations. However, there is little knowledge about the application of the transtheoretical model to explain physical activity behavior in individuals with non-cystic fibrosis bronchiectasis. The aim was to examine patterns of (1) physical activity and (2) mediators of behavior change (self-efficacy, decisional balance, and processes of change) across stages of change in individuals with non-cystic fibrosis bronchiectasis.

METHODS: Fifty-five subjects with non-cystic fibrosis bronchiectasis (mean age ± SD = 63 ± 10 y) had physical activity assessed over 7 d using an accelerometer. Each component of the transtheoretical model was assessed using validated questionnaires. Subjects were divided into groups depending on stage of change: Group 1 (pre-contemplation and contemplation; n = 10), Group 2 (preparation; n = 20), and Group 3 (action and maintenance; n = 25). Statistical analyses included one-way analysis of variance and Tukey-Kramer post hoc tests.

RESULTS: Physical activity variables were significantly (P < .05) higher in Group 3 (action and maintenance) compared with Group 2 (preparation) and Group 1 (pre-contemplation and contemplation). For self-efficacy, there were no significant differences between groups for mean scores (P = .14). Decisional balance cons (barriers to being physically active) were significantly lower in Group 3 versus Group 2 (P = .032). For processes of change, substituting alternatives (substituting inactive options for active options) was significantly higher in Group 3 versus Group 1 (P = .01), and enlisting social support (seeking out social support to increase and maintain physical activity) was significantly lower in Group 3 versus Group 2 (P = .038).

CONCLUSIONS: The pattern of physical activity across stages of change is consistent with the theoretical predictions of the transtheoretical model. Constructs of the transtheoretical model that appear to be important at different stages of change include decisional balance cons, substituting alternatives, and enlisting social support. This study provides support to explore transtheoretical model-based physical activity interventions in individuals with non-cystic fibrosis bronchiectasis.

Molecular classification of non-invasive breast lesions for personalised therapy and chemoprevention

Breast cancer screening has led to a dramatic increase in the detection of pre-invasive breast lesions. While mastectomy is almost guaranteed to treat the disease, more conservative approaches could be as effective if patients can be stratified based on risk of co-existing or recurrent invasive disease.Here we use a range of biomarkers to interrogate and classify purely non-invasive lesions (PNL) and those with co-existing invasive breast cancer (CEIN). Apart from Ductal Carcinoma In Situ (DCIS), relative homogeneity is observed. DCIS contained a greater spread of molecular subtypes. Interestingly, high expression of p-mTOR was observed in all PNL with lower expression in DCIS and invasive carcinoma while the opposite expression pattern was observed for TOP2A.Comparing PNL with CEIN, we have identified p53 and Ki67 as predictors of CEIN with a combined PPV and NPV of 90.48% and 43.3% respectively. Furthermore, HER2 expression showed the best concordance between DCIS and its invasive counterpart.We propose that these biomarkers can be used to improve the management of patients with pre-invasive breast lesions following further validation and clinical trials. p53 and Ki67 could be used to stratify patients into low and high-risk groups for co-existing disease. Knowledge of expression of more actionable targets such as HER2 or TOP2A can be used to design chemoprevention or neo-adjuvant strategies. Increased knowledge of the molecular profile of pre-invasive lesions can only serve to enhance our understanding of the disease and, in the era of personalised medicine, bring us closer to improving breast cancer care.

Non-invasive ventilation for cystic fibrosis.

Non-invasive ventilation may be a means to temporarily reverse or slow the progression of respiratory failure in cystic fibrosis. To compare the effect of non-invasive ventilation versus no non-invasive ventilation in people with cystic fibrosis. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings. We searched the reference lists of each trial for additional publications possibly containing other trials.Most recent search: 22 February 2013. Randomised controlled trials comparing a form of pressure preset or volume preset non-invasive ventilation to no non-invasive ventilation in people with acute or chronic respiratory failure in cystic fibrosis. Three reviewers independently assessed trials for inclusion criteria and methodological quality, and extracted data. Fifteen trials were identified; seven trials met the inclusion criteria with a total of 106 participants. Six trials evaluated single treatment sessions and one evaluated a six-week intervention.Four trials (79 participants) evaluated non-invasive ventilation for airway clearance compared with an alternative chest physiotherapy method and showed that airway clearance may be easier with non-invasive ventilation and people with cystic fibrosis may prefer it. We were unable to find any evidence that NIV increases sputum expectoration, but it did improve some lung function parameters.Three trials (27 participants) evaluated non-invasive ventilation for overnight ventilatory support, measuring lung function, validated quality of life scores and nocturnal transcutaneous carbon dioxide. Due to the small numbers of participants and statistical issues, there were discrepancies in the results between the RevMan and the original trial analyses. No clear differences were found between non-invasive ventilation compared with oxygen or room air except for exercise performance, which significantly improved with non-invasive ventilation compared to room air over six weeks. Non-invasive ventilation may be a useful adjunct to other airway clearance techniques, particularly in people with cystic fibrosis who have difficulty expectorating sputum. Non-invasive ventilation, used in addition to oxygen, may improve gas exchange during sleep to a greater extent than oxygen therapy alone in moderate to severe disease. These benefits of non-invasive ventilation have largely been demonstrated in single treatment sessions with small numbers of participants. The impact of this therapy on pulmonary exacerbations and disease progression remain unclear. There is a need for long-term randomised controlled trials which are adequately powered to determine the clinical effects of non-invasive ventilation in cystic fibrosis airway clearance and exercise.

Quantification of HER2 heterogeneity in breast cancer-implications for identification of sub-dominant clones for personalised treatment

Breast cancer is a heterogeneous disease, at both an inter- and intra-tumoural level. Appreciating heterogeneity through the application of biomarkers and molecular signatures adds complexity to tumour taxonomy but is key to personalising diagnosis, treatment and prognosis. The extent to which heterogeneity exists, and its interpretation remains a challenge to pathologists. Using HER2 as an exemplar, we have developed a simple reproducible heterogeneity index. Cell-to-cell HER2 heterogeneity was extensive in a proportion of both reported 'amplified' and 'non-amplified' cases. The highest levels of heterogeneity objectively identified occurred in borderline categories and higher ratio non-amplified cases. A case with particularly striking heterogeneity was analysed further with an array of biomarkers in order to assign a molecular diagnosis. Broad biological complexity was evident. In essence, interpretation, depending on the area of tumour sampled, could have been one of three distinct phenotypes, each of which would infer different therapeutic interventions. Therefore, we recommend that heterogeneity is assessed and taken into account when determining treatment options.

Similarity or Variation? Employee Representation and Consultation Approaches Amongst Liberal Market Economy Multinationals

This paper engages with the varieties of capitalism literature to investigate the employee representation and consultation approaches of liberal market economy multinational companies (MNCs), specifically Australian, British and US MNCs operating in Australia. While the literature would suggest commonality amongst these MNCs, the paper considers whether the evidence points to similarity or variation amongst liberal market headquartered MNCs. The findings contribute to filling a recognized empirical gap on MNC employment relations practice in Australia and to a better understanding of within category varieties of capitalism similarity and variation. Drawing on survey data from MNCs operating in Australia, the results demonstrated that UK-owned MNCs were the least likely to report collective structures of employee representation. Moreover, it was found that Australian MNCs were the most likely to engage in collective forms of employee representation and made less use of direct consultative mechanisms relative to their British and US counterparts. In spite of the concerted individualization of the employment relations domain over previous decades, Australian MNCs appear to have upheld more long-standing national institutional arrangements with respect to engaging with employees on a collective basis. This varies from British and US MNC approaches which denotes that our results display within category deviation in the variety of capitalism liberal market economy typology. Just as Hall and Soskice described their seminal work on liberal market economy (LME) and coordinated market economy (CME) categories as a “work-in-progress” (2001: 2), we too suggest that Australia’s evolution in the LME category, and more specifically its industrial relations system development, and the consequences for employment relations practices of its domestic MNCs, may be a work-in-progress.

Delineating human resource management practice in domestic and foreign owned multinational enterprises in Australia

To date there is an absence of any systematic and extensive data on Australian multinational enterprises (MNEs). This research paper fills the information gap and leads to a discussion of the human resource management (HRM) practices of Australian MNEs in the global arena and whether there is a distinctive national identity associated with these practices. We report on the profile of Australian-based multinational enterprises (MNEs). Drawing on a systematic database developed by the authors in 2010–11 we are able to identify the numbers of Australian MNEs and their characteristics and compare them against a representative sample of foreign-owned MNEs operating in Australia.

The Value of Full Scale Prototype Data - Testing Oyster 800 at EMEC, Orkney

This paper demonstrates the unparalleled value of full scale data which has been acquired from ocean trials of Aquamarine Power’s Oyster 800 Wave Energy Converter (WEC) at the European Marine Energy Centre (EMEC), Orkney, Scotland.
High quality prototype and wave data were simultaneously recorded in over 750 distinct sea states (comprising different wave height, wave period and tidal height combinations) and include periods of operation where the hydraulic Power Take-Off (PTO) system was both pressurised (damped operation) and de-pressurised (undamped operation).
A detailed model-prototype correlation procedure is presented where the full scale prototype behaviour is compared to predictions from both experimental and numerical modelling techniques via a high temporal resolution wave-by-wave reconstruction. This unquestionably provides the definitive verification of the capabilities of such research techniques and facilitates a robust and meaningful uncertainty analysis to be performed on their outputs.
The importance of a good data capture methodology, both in terms of handling and accuracy is also presented. The techniques and procedures implemented by Aquamarine Power for real-time data management are discussed, including lessons learned on the instrumentation and infrastructure required to collect high-value data.

Wave Fields around Wave Energy Converter Arrays

Wave energy converters, by their nature, extract large amounts of energy
from incident waves. If the industry is to progress such that wave energy
becomes a significant provider of power in the future, large wave farms will
be required. Presently, consenting for these sites is a long and problematic
process, mainly due to a lack of knowledge of the potential environmental
impacts. Accurate numerical modelling of the effect of wave energy extraction
on the wave field and subsequent evaluation of changes to coastal
processes is therefore required. Modelling the wave field impact is also
necessary to allow optimum wave farm configurations to be determined.
This thesis addresses the need for more accurate representation of wave
energy converters in numerical models so that the effect on the wave field,
and subsequently the coastal processes, may be evaluated. Using a hybrid
of physical and numerical modelling (MIKE21 BW and SW models) the
effect of energy extraction and operation of a WEC array on the local wave
climate has been determined.
The main outcomes of the thesis are: an improved wave basin facility, in
terms of wave climate homogeneity, reducing the standard deviation of wave
amplitude by up to 50%; experimental measurement of the wave field around
WEC arrays, showing that radiated waves account for a significant proportion
of the wave disturbance; a new representation method of WECs for use
with standard numerical modelling tools, validated against experimental
results.
The methodology and procedures developed here allow subsequent evaluation
of changes to coastal processes and sediment transport due to WEC
arrays.

Investigating Tools used to Analyse the Impact of a Wave Farm on the surrounding Wave Field

For wave energy to become commercially viable, it is predicted that wave energy converters (WECs) will need to be installed in large wave farms. This will required an extensive environmental impact study. Assessments of impacts of these sites requires prior numerical modelling however the available tools have not been fully validated.
This project investigates the area surrounding an array of five scaled WEC models using experimental techniques. It then assesses the suitability of numerical tools to be validated with this experimental data. Validated numerical tools could then be used to predict parameters relating to the models such as reflection and transmission coefficients.
The physical aspect of this project was conducted in the Portaferry wave basin owned by Queen’s University Belfast. The device studied was a bottom hinged oscillating wave surge converter (OWSC) which penetrates the surface (similar to the Oyster device). The models were tested at 40th scale.

A Review of Numerical Modelling of Wave Energy Converter Arrays

Large-scale commercial exploitation of wave energy is certain to require the deployment of wave energy converters (WECs) in arrays, creating ‘WEC farms’. An understanding of the hydrodynamic interactions in such arrays is essential for determining optimum layouts of WECs, as well as calculating the area of ocean that the farms will require. It is equally important to consider the potential impact of wave farms on the local and distal wave climates and coastal processes; a poor understanding of the resulting environmental impact may hamper progress, as it would make planning consents more difficult to obtain. It is therefore clear that an understanding the interactions between WECs within a farm is vital for the continued development of the wave energy industry.To support WEC farm design, a range of different numerical models have been developed, with both wave phase-resolving and wave phase-averaging models now available. Phase-resolving methods are primarily based on potential flow models and include semi-analytical techniques, boundary element methods and methods involving the mild-slope equations. Phase-averaging methods are all based around spectral wave models, with supra-grid and sub-grid wave farm models available as alternative implementations.The aims, underlying principles, strengths, weaknesses and obtained results of the main numerical methods currently used for modelling wave energy converter arrays are described in this paper, using a common framework. This allows a qualitative comparative analysis of the different methods to be performed at the end of the paper. This includes consideration of the conditions under which the models may be applied, the output of the models and the relationship between array size and computational effort. Guidance for developers is also presented on the most suitable numerical method to use for given aspects of WEC farm design. For instance, certain models are more suitable for studying near-field effects, whilst others are preferable for investigating far-field effects of the WEC farms. Furthermore, the analysis presented in this paper identifies areas in which the numerical modelling of WEC arrays is relatively weak and thus highlights those in which future developments are required.