The effects of a simplified tai-chi exercise program (STEP) on the physical health of older adults living in long-term care facilities : a single group design with multiple time points

Background
Studies support the positive effects that Tai Chi has on the physical health of older adults. However, many older adults residing in long-term care facilities feel too weak to practice traditional Tai Chi, and a more simplified style is preferred.
Objective
To test the effects of a newly-developed, Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults who resided in long-term care facilities.
Design
A single group design with multiple time points: three pre-tests, one month apart; four post-tests at one month, two months, three months, and six months after intervention started.
Settings
Two 300–400 bed veteran homes in Taiwan.
Participants
The 51 male older adults were recruited through convenience sampling, and 41 of them completed six-month study. Inclusion criteria included: (1) aged 65 and over; (2) no previous training in Tai Chi; (3) cognitively alert and had a score of at least eight on the Short Portable Mental Status Questionnaire; (4) able to walk without assistance; and (5) had a Barthel Index score of 61 or higher. Participants who had dementia, were wheel-chair bound, or had severe or acute cardiovascular, musculoskeletal, or pulmonary illnesses were excluded.
Methods
The STEP was implemented three times a week, 50 min per session for six months. The outcome measures included cardio-respiratory function, blood pressure, balance, hand-grip strength, lower body flexibility, and physical health actualization.
Results
A drop in systolic blood pressure (p=.017) and diastolic blood pressure (p<.001) was detected six months after intervention started. Increase in hand-grip strength from pre to post intervention was found (left hand: p<.001; right hand: p=.035). Participants also had better lower body flexibility after practicing STEP (p=.038).
Conclusions
Findings suggest that the STEP be incorporated as a floor activity in long-term care facilities to promote physical health of older adults.

Assessing Sleep during Pregnancy - a study across two time points examining the pittsburg sleep quality index and associations with depressive symptoms

Background and Purpose: Sleep quality seems to be an antecedent to depressive symptoms during pregnancy. We sought to 1) examine the psychometrics of the Pittsburgh Sleep Quality Index (PSQI) in pregnancy; 2) examine whether sleep quality predicted increases in depressive symptoms; and 3) compare PSQI scores across 3 or 2 levels of depressive symptoms.

Methods: Each of the 252 participants completed the Beck Depression Inventory (short form) and a sleep quality measure at mid and late pregnancy.

Results: PSQI total scores showed good internal consistency and construct validity. An improved model of the internal structure of the PSQI in pregnancy was found with 1 factor labeled Sleep Efficiency, a second labeled Night and Daytime Disturbances, and an Overall Sleep Quality component associated with, but separate from, both of these 2 factors. Although PSQI scores showed moderate stability over time, sleep disturbance scores increased in late pregnancy. Importantly, PSQI prospectively predicted increases in depressive symptoms.

Conclusions: Findings suggest that the PSQI is useful in pregnancy research. Findings also support the idea that sleep problems are prospective risk factors for increases in depressive symptoms during pregnancy. Practitioners are advised to screen for sleep quality during early pregnancy.

Exploratory surgery of the female psyche

The thesis explores the visual narrative concerning a journey of empowerment for women. To enable the journey to advance the inquiry is directed into two areas. The first area is female gender, which is argued to be socially constructed and implicit in the marginalisation of women in western society. The second area is ‘feminine authority’, which is gained by developing an understanding and acceptance of the characteristics which have historically been considered as belonging to the feminine. Granting these characteristics agency would recognise their authority and assist in the elevation of the female to a position of equality in western society. Beginning from a feminist position, the research supported the belief that the female is marginalised in western society. It also confirmed the notion that empowerment and authority can be attained by women if they actively pursue the following; • Explore their own psychology beyond the existing socially constructed gender roles. • Develop an understanding of their feminine self by applying Jung's theories on individuation and archetypes. • Expose the underlying patriarchal influence in western epistemology and science by challenging existing deeply held cultural and scientific beliefs and by actively contributing as feminists to the areas of epistemology and science. Archetypal myths of the ‘feminine’ have developed from an androcentric position. They enforce and perpetuate gender imbalance which contributes to the disenfranchisement of women in western society, ‘Individuation’ is a process in which a person explores aspects of themselves to bring forth parts of their unconscious into their conscious mind in an attempt to gain a deeper understanding of themselves. As a consequence the consciousness develops closer links with archetypal memories which assists the exploration. The ‘true feminine’ is the feminine not restricted or defined by the dominant androcentric view. Knowledge of the feminine empowers women to address the marginalisation of the female in western society and assists in the process of gaining female authority. This enquiry also investigated the four stages of female psychological development with regard to patriarchal influences. Of particular importance is the second stage of psychological development where the female identifies with historically perceived inferior characteristics of the female. This is when she rejects her connections with the primacy of female power and her deep connections with nature which were inherited from archaic times. It is at this stage that she absorbs the myths associated with western patriarchal society which effectively disempower her. Western epistemology, with its emphasis on ‘objective’ investigation and empiricism contributes to the support for and promotion of ‘inferior’ female gender. This type of investigation is brought into question when areas of research into primates and human evolutionary theory is shown to develop from an androcentric view. Western knowledge has associations with power and justice and power is commonly associated with dominance. Regard for ‘truth’ and ‘absolute’ can be viewed as key elements in the support for knowledge and its associations with power. Knowledge has historically maintained suppression of individual experience which promotes a universalised account. This suppression of beliefs other than the dominant authority maintains the existing dominant social structure. Foucault's view of the genderised or inscribed body alerts us to areas where dominance, resistance and power play a part in maximising masculine power and control. Gender becomes an instrument of power within the existing patriarchal structure. Gender, knowledge and power are identified as areas obstructing female empowerment. Part 3 of this exegesis examines the imagery which embodies the visual narrative. Particularly, the harlequin image, its historical background and connections with ancient mythology including reference to Jungian psychology. The harlequin image is developed sequentially in the earlier black and white drawings on paper. These drawings contained a female figure which was often placed in juxtaposition with a Venus or goddess image, reference was also made to ‘eve’ and the ‘siren’. These elements provided the framework which enabled the harlequin image to emerge and evolve. The narrative developed with an understanding of the ‘feminine’ aspects of the psyche which resulted in the harlequin acquiring the elevated authority of a goddess. The Harlequin evolved from my need for symbolic representation of the female psyche. It represents contradiction and dualism. It is a composition of opposites, reflects masculine and feminine traits, the dark and light of the conscious and unconscious mind, it houses both comic and sinister elements, is a trickster and menace. The costume, colours and patterns are expressive elements conducive to fragmentation and layering within the composition of the paintings. Jung examined the harlequin in Picasso's paintings. He concluded that as Picasso drew on his inner experiences the harlequin became important as a symbol; it was a pictorial representation from the unconscious psyche. It travelled freely from the conscious to the unconscious and represented the masculine and feminine, chthonian and apollonian. The final painting in the series, a triptych, completes the narrative and stands alone as a salutatory work. It unites the series by combining existing compositional devices and technique while making reference to imagery from previous works, ‘The Three Graces Victorious’, expresses the authority of the feminine. It completes a victorious stage of a journey where the harlequin is empowered by archaic memories and knowledge of the psyche. The feminine is hailed, elevated and venerated. Other elements which assist in expressing the visual narrative are; colour, technique and influence. Colour is explored and its use as an emotive devise in expressionism. Paul Klee's writing on the use of colour and it's symbolic meaning and Julia Kristeva's investigation on colour from a psychoanalytic and semiotic view are also discussed. To indicate influences and connections within my oeuvre, reference is also made to the following: Jasper Johns' for his use of imagery in his ‘Four Seasons’ series with it's reference to a journey of maturation and Louise Bourgeois' work which deals with issues of gender, memories and past journeys. Although ‘The Three Graces Victorious’; the concluding painting for the investigation is celebratory and represents a finality to the thesis, it points to further areas that impede feminine development and need future examination. Reference is made to a continuation of the exploratory journey by plotting the Harlequin/Goddesses future directions. Although the Harlequin/Goddess is empowered with newly acquired authority, her future journey does not need to be bound by mathematics or limited by rationality. She does not require power to dominate or gender structures to subjugate, but requires limitless boundaries and contexts. The Harlequin/Goddess's future journey is not fixed.

Transitions : experiences of women with type 1 diabetes : Turning points and transitions as experienced by young women with type 1 diabetes in Australia

The relationship among psychosocial stress, coping and metabolic control has a key effect on diabetes clinical outcomes and mental health. Life transitions are peak times of major change within personal and social contexts, which add stress affecting on peoples? problem solving. The thesis describes young women with Type 1 diabetes? perspectives of the problems encountered and how they managed them when they faced turning points and made life transitions. The study identified the women?s health concerns and factors that enhanced or hindered their ability to manage turning points and transitions. A substantive theory that comprised a problem of ?being in the grip of blood glucose levels? (BGLs) and a process termed ?creating stability? to manage life transitions was developed. The state of being in the grip of BGLs was associated with the impact of fluctuating BGLs; responses of other people to the womens? diabetes and the impact of diabetes on other people?s lives. The women managed these problems by engaging in social and psychological strategies helping them to stabilised their lives and feel more in control during life transitions.

Cut-points for waist circumference in Europids and South Asians

There is little strong evidence that currently recommended higher waist circumference cut-points for Europids compared with South Asians are associated with similar risk for type 2 diabetes. This study was designed to provide such evidence. Longitudinal studies over 5 years were conducted among 5,515 Europid and 2,214 ethnically South Asian participants. Age-standardized diabetes incidence at different levels of waist circumference and incidence difference relative to a reference value were calculated. The Youden Index was used to determine waist circumference cut-points. At currently recommended cut-points, estimated annual diabetes incidence for a 50-year-old Europid was <0.6% for both sexes, and for a 50-year-old South Asian, 5.8% for men and 2.1% for women. Annual diabetes incidence of 1% was observed for a 50 year old at a waist circumference 35–40 cm greater in Europid compared to South Asian men and women. Incidence difference between recommended cut-points and a reference value (80 cm in men, 70 cm in women) was 0.3 and 4.4% per year for Europid and South Asian men, and 0.2 and 0.8% per year for Europid and South Asian women, respectively. Waist circumference cut-points chosen using the Youden Index were shown to be dependent on obesity levels in the population. The much higher observed risk of diabetes in South Asians compared to Europids at the respective recommended waist circumference cut-points suggests that differences between them should be greater. Approaches that use the Youden Index to select waist circumference cut-points are inappropriate and should not be used for this purpose.

Using progression points for diagnostic (formative) assessment : chance

Find every Chance-related Progression Point, in Level-order, from Prep to Year 10. Translate each Progression Point into a pencil-and-paper task. This makes a developmentally or progressively graded worksheet-like ''diagnostic profile' for assessing knowledge of and skills with Chance. It is diagnostic because it starts with easy, early questions, and progressively gets harder and harder as the concepts and skills in the Chance curriculum develop. Presenting this diagnostic profile to students at the beginning of a unit of work on Chance gives invaluable formative assessment information to guide your teaching. Using the same profile, or a parrallel version at the end of the unit provides before-and-after summative assessment of the students' learning during the unit.

Turning points and transitions : experiences of young women with Type 1 diabetes

This research explores young women with Type 1 diabetes' perspectives of the problems and how they manage them when facing turning points and making life transitions. The study presents a substantive theory of how the women tried to minimise the grip of blood glucose levels felt during transitions by creating stability in their lives.

Context dependency of comfort and energy performance in mixed mode offices

This article investigates the context dependency of comfort and energy performance in mixed-mode offices in the climate of Athens, Greece. It is based on a parametric study using the simulation software EnergyPlus. Context refers to different building design priorities on the real estate market (prestige, low cost and green), occupant behaviour scenarios (ideal and worst case) and cooling strategies (fixed and adaptive set points). Results are evaluated according to energy consumption and related greenhouse gas emissions, daylight autonomy, view and percentage of working time when heating and cooling are operating. The results indicate that a holistic approach to comfort and energy performance evaluation focused on the specific context of a building and its occupants is necessary to develop appropriate optimization strategies. In early design stages, such specific information is not yet available and ideal/worst-case scenarios can indicate the magnitude of influence of occupants compared to building design.

Sequential fixed-width confidence bands for kernel regression estimation

We consider a random design model based on independent and identically distributed (iid) pairs of observations (Xi, Yi), where the regression function m(x) is given by m(x) = E(Yi|Xi = x) with one independent variable. In a nonparametric setting the aim is to produce a reasonable approximation to the unknown function m(x) when we have no precise information about the form of the true density, f(x) of X. We describe an estimation procedure of non-parametric regression model at a given point by some appropriately constructed fixed-width (2d) confidence interval with the confidence coefficient of at least 1−. Here, d(> 0) and 2 (0, 1) are two preassigned values. Fixed-width confidence intervals are developed using both Nadaraya-Watson and local linear kernel estimators of nonparametric regression with data-driven bandwidths.

The sample size was optimized using the purely and two-stage sequential procedure together with asymptotic properties of the Nadaraya-Watson and local linear estimators. A large scale simulation study was performed to compare their coverage accuracy. The numerical results indicate that the confidence bands based on the local linear estimator have the best performance than those constructed by using Nadaraya-Watson estimator. However both estimators are shown to have asymptotically correct coverage properties.

Sample size determination for kernel regression estimation using sequential fixed-width confidence bands

We consider a random design model based on independent and identically distributed pairs of observations (Xi, Yi), where the regression function m(x) is given by m(x) = E(Yi|Xi = x) with one independent variable. In a nonparametric setting the aim is to produce a reasonable approximation to the unknown function m(x) when we have no precise information about the form of the true density, f(x) of X. We describe an estimation procedure of non-parametric regression model at a given point by some appropriately constructed fixed-width (2d) confidence interval with the confidence coefficient of at least 1−. Here, d(> 0) and 2 (0, 1) are two preassigned values. Fixed-width confidence intervals are developed using both Nadaraya-Watson and local linear kernel estimators of nonparametric regression with data-driven bandwidths. The sample size was optimized using the purely and two-stage sequential procedures together with asymptotic properties of the Nadaraya-Watson and local linear estimators. A large scale simulation study was performed to compare their coverage accuracy. The numerical results indicate that the confi dence bands based on the local linear estimator have the better performance than those constructed by using Nadaraya-Watson estimator. However both estimators are shown to have asymptotically correct coverage properties.

Perspectives on culture : meeting points and divergences

In a post-modern world of diversity, difference and melting social, political, economic and cultural boundaries, there is a fundamental tension between the preservation of cultural identity and the cultural homogenisation that defines a globalised world.

This paper reports on a collaborative, international study between researchers in Thailand, Japan and Australia which examines perceptions of conceptual differences and meeting points in the cultural views of their three communities of teachers. In doing so, it attempts to move beyond post-modernism and the reality of globalism by proposing a new methodology for facilitating intercultural understanding.