Ice and pulsed electromagnetic field to reduce pain and swelling after distal radius fractures

Objective: To examine the relative effectiveness of ice therapy and/or pulsed electromagnetic field in reducing pain and swelling after the immobilization period following a distal radius fracture.Methods: A total of 83 subjects were randomly allocated to receive 30 minutes of either ice plus pulsed electromagnetic field (group A); ice plus sham pulsed electromagnetic field (group B); pulsed electromagnetic field alone (group C), or sham pulsed electromagnetic field treatment for 5 consecutive days (group D). All subjects received a standard home exercise programme. A visual analogue scale was used for recording pain; volumetric displacement for measuring the swelling of the forearm; and a hand-held goniometer for measuring the range of wrist motions before treatment on days 1, 3 and 5.Results: At day 5, a significantly greater cumulative reduction in the visual analogue scores as well as ulnar deviation range of motion was found in group A than the other 3 groups. For volumetric measurement and pronation, participants in group A performed better than subjects in group D but not those in group B.Conclusion: The addition of pulsed electromagnetic field to ice therapy produces better overall treatment outcomes than ice alone, or pulsed electromagnetic field alone in pain reduction and range of joint motion in ulnar deviation and flexion for a distal radius fracture after an immobilization period of 6 weeks.

Social justice in education in 'new times'

This thesis considers social justice in education in ‘new times’. To facilitate the investigation a number of research questions were pursued. These questions were: • What is meant by the label ‘social justice’? • How is social justice to be understood in contemporary terms? • Are there tensions between traditional and contemporary views of social justice? • How effective are policy developments in delivering social justice via education? • What difference do such policies make at the local level? To answer these questions a critical case analysis of a country community and one of its primary schools was carried out. Data were gathered using a variety of methods. As a researcher who was also a teacher in the school I kept a personal professional journal during 1993 and 1994. During this period I was the teacher in the school with responsibility for curriculum development related to issues of social justice. In 1994 I conducted interviews with twenty students, parents and teachers at the school in relation to social justice issues. I also interviewed the CEO of the town’s Council. A number of relevant Federal and State Government and school policy documents were consulted and an archival search of the local newspaper from 1956 to 1994 was undertaken. Statistical information from the Australian Bureau of Statistics as well as from school records was used. A number of local history books were consulted as well as the minutes of relevant school committee meetings. Contemporary social theory, more specifically the work of Anthony Giddens, provided the major methodological tool. Giddens structuration theory was selected as it provided a way of interpreting society from both macro and micro perspectives, it provided a way of studying the interconnectedness of the individual and society. In addition to this, a metaphor was used as a way of developing an understanding of the data. The river was chosen as the metaphor as it has significance to the case study community and it also provides a way of understanding interconnectedness. At an interpretive level, both social theory and moral philosophy were drawn on, including the work of Geoffrey Sharp, Anthony Giddens and Alisdair MacIntyre. A review of selected literature indicated three main areas of concern in relation to this thesis. We live in a time of constant and ongoing change, understanding how this change impacts on the lives of individuals and society is important. Such an understanding relates directly to issues of ontology. In addition it was necessary to consider schools in these ‘new times’. The literature revealed that the changes occurring in the wider society were related to the changes currently being seen in schools. Specifically this related to the increasing emphasis on economics and on individualism, emphases also reflected in the findings of this thesis. Finally the literature related to social justice was discussed, the focus here was on distributive theories of justice and the way these are reflected in programs such as the DSP. The data, as expressed in the metaphor of the flowing river, revealed dominant and marginal currents in social justice in education in ‘new times’. The dominant social group are the intellectually trained and the dominant issues were related to technology, globalisation and economic and bureaucratic rationalism. In the marginal currents we find the under-employed and the unemployed and marginal issues relating to housing, the black economy, poverty and the survival of rural communities. The data also revealed a marginal tributary running into the river. This tributary shows that social cohesion is still a part of life in ‘new times’, albeit a marginalised part. The dominant and marginal currents in social justice in ‘new times’ reveal changes at a deep cultural level. Social justice in ‘new times’ is set within the limits provided by economic rationalism. Such a position is closely linked to the rise of liberal democracy as a political ideology. A rise which has been on a global scale. This valorizes the individual as compared with the group, and the family as compared to the social whole, within the context of expanded economic groupings and markets. Such an ideological position sees the role of the state as providing the ‘legitimising muscle’ to advance the cause of individuals and their families as compared to larger social groupings. These perceptions were applied in Australia, even under a Labor Government. In this sense social justice policies in ‘new times’ are ideological, they act as a political lever to legitimate economic restructuring. They are policies designed to carry disparate groups forward and together on a common wave of economic reform. They are used to ‘sell’ economic reform as being ‘good’ for all of society. Against the backdrop of economic rationalism and liberal democratic ideals there emerges a language geared to the production of an economically viable self, self image, self identity, self esteem and self confidence. As a result, the sense of identity as ‘social’ is lost from view. This thesis argues that what is needed is a new way of looking at social justice in education. A way that reaches beyond the solutions forwarded by the political Left and the Right. It is about the development of an understanding of the way in which an assimilation of the hyper individual and the social group can result in the emergence of the socially responsible individual. This is a cultural shift that sees the individual/society dualism presented in a new way. The categories enter into a new relationship where the balance shifts away from the individual towards society. A shift to a culture where the individual’s rights and responsibilities are respected within a social whole. Such a cultural shift would result in a curriculum which would build social identity, promoted socially responsible independent thought and make space for creativity and the aesthetic. A ‘curriculum for social responsibility’ would be a socially just curriculum.

A calibration protocol for population-specific accelerometer cut-points in children

Purpose

To test a field-based protocol using intermittent activities representative of children's physical activity behaviours, to generate behaviourally valid, population-specific accelerometer cut-points for sedentary behaviour, moderate, and vigorous physical activity.
Methods

Twenty-eight children (46% boys) aged 10–11 years wore a hip-mounted uniaxial GT1M ActiGraph and engaged in 6 activities representative of children's play. A validated direct observation protocol was used as the criterion measure of physical activity. Receiver Operating Characteristics (ROC) curve analyses were conducted with four semi-structured activities to determine the accelerometer cut-points. To examine classification differences, cut-points were cross-validated with free-play and DVD viewing activities.
Results

Cut-points of ≤372, >2160 and >4806 counts•min−1 representing sedentary, moderate and vigorous intensity thresholds, respectively, provided the optimal balance between the related needs for sensitivity (accurately detecting activity) and specificity (limiting misclassification of the activity). Cross-validation data demonstrated that these values yielded the best overall kappa scores (0.97; 0.71; 0.62), and a high classification agreement (98.6%; 89.0%; 87.2%), respectively. Specificity values of 96–97% showed that the developed cut-points accurately detected physical activity, and sensitivity values (89–99%) indicated that minutes of activity were seldom incorrectly classified as inactivity.
Conclusion

The development of an inexpensive and replicable field-based protocol to generate behaviourally valid and population-specific accelerometer cut-points may improve the classification of physical activity levels in children, which could enhance subsequent intervention and observational studies.

Hedgehog partial agonism drives warburg-lie metabolism in muscle and brown fat

Diabetes, obesity, and cancer affect upward of 15% of the world’s population. Interestingly, all three diseases juxtapose dysregulated intracellular signaling with altered metabolic state. Exactly which genetic factors define stable metabolic set points in vivo remains poorly understood. Here, we show that hedgehog signaling rewires cellular metabolism. We identify a cilium-dependent Smo-Ca2+-Ampk axis that triggers rapid Warburg-like metabolic reprogramming within minutes of activation and is required for proper metabolic selectivity and flexibility. We show that Smo modulators can uncouple the Smo-Ampk axis from canonical signaling and identify cyclopamine as one of a new class of “selective partial agonists,” capable of concomitant inhibition of canonical and activation of noncanonical hedgehog signaling. Intriguingly, activation of the Smo-Ampk axis in vivo drives robust insulin-independent glucose uptake in muscle and brown adipose tissue. These data identify multiple noncanonical endpoints that are pivotal for rational design of hedgehog modulators and provide a new therapeutic avenue for obesity and diabetes.

A parent-focused intervention to reduce infant obesity risk behaviors: a randomized trial

OBJECTIVE: To assess the effectiveness of a parent-focused intervention on infants’ obesity-risk behaviors and BMI.
METHODS: This cluster randomized controlled trial recruited 542 parents and their infants (mean age 3.8 months at baseline) from 62 first-time parent groups. Parents were offered six 2-hour dietitian-delivered sessions over 15 months focusing on parental knowledge, skills, and social support around infant feeding, diet, physical activity, and television viewing. Control group parents received 6 newsletters on nonobesity-focused themes; all parents received usual care from child health nurses. The primary outcomes of interest were child diet (3 × 24-hour diet recalls), child physical activity (accelerometry), and child TV viewing (parent report). Secondary outcomes included BMI z-scores (measured). Data were collected when children were 4, 9, and 20 months of age.
RESULTS: Unadjusted analyses showed that, compared with controls, intervention group children consumed fewer grams of noncore drinks (mean difference = –4.45; 95% confidence interval [CI]: –7.92 to –0.99; P = .01) and were less likely to consume any noncore drinks (odds ratio = 0.48; 95% CI: 0.24 to 0.95; P = .034) midintervention (mean age 9 months). At intervention conclusion (mean age 19.8 months), intervention group children consumed fewer grams of sweet snacks (mean difference = –3.69; 95% CI: –6.41 to –0.96; P = .008) and viewed fewer daily minutes of television (mean difference = –15.97: 95% CI: –25.97 to –5.96; P = .002). There was little statistical evidence of differences in fruit, vegetable, savory snack, or water consumption or in BMI z-scores or physical activity.
CONCLUSIONS: This intervention resulted in reductions in sweet snack consumption and television viewing in 20-month-old children.

Measuring walking within and outside the neighborhood in Chinese elders : reliability and validity

Background : Walking is a preferred, prevalent and recommended activity for aging populations and is influenced by the neighborhood built environment. To study this influence it is necessary to differentiate whether walking occurs within or outside of the neighborhood. The Neighborhood Physical Activity Questionnaire (NPAQ) collects information on setting-specific physical activity, including walking, inside and outside one's neighborhood. While the NPAQ has shown to be a reliable measure in adults, its reliability in older adults is unknown. Additionally its validity and the influence of type of neighborhood on reliability and validity have yet to be explored. Methods : The NPAQ walking component was adapted for Chinese speaking elders (NWQ-CS). Ninety-six Chinese elders, stratified by social economic status and neighborhood walkability, wore an accelerometer and completed a log of walks for 7 days. Following the collection of valid data the NWQ-CS was interviewer-administered. Fourteen to 20 days (average of 17 days) later the NWQ-CS was re-administered. Test-retest reliability and validity of the NWQ-CS were assessed. Results : Reliability and validity estimates did not differ with type of neighborhood. NWQ-CS measures of walking showed moderate to excellent reliability. Reliability was generally higher for estimates of weekly frequency than minutes of walking. Total weekly minutes of walking were moderately related to all accelerometry measures. Moderate-to-strong associations were found between the NWQ-CS and log-of-walks variables. The NWQ-CS yielded statistically significantly lower mean values of total walking, weekly minutes of walking for transportation and weekly frequency of walking for transportation outside the neighborhood than the log-of-walks. Conclusions : The NWQ-CS showed measurement invariance across types of neighborhoods. It is a valid measure of walking for recreation and frequency of walking for transport. However, it may systematically underestimate the duration of walking for transport in samples that engage in high levels of this type of walking.

Adolescents’ physical activity : competition between perceived neighborhood sport facilities and home media resources

Objective. To examine the independent, competing, and interactive effects of perceived availability of specific types of media in the home and neighborhood sport facilities on adolescents’ leisure-time physical activity (PA).

Methods. Survey data from 34 369 students in 42 Hong Kong secondary schools were collected (2006–07). Respondents reported moderate-to-vigorous leisure-time PA, presence of sport facilities in the neighborhood and of media equipment in the home. Being sufficiently physically active was defined as engaging in at least 30 minutes of non-school leisure-time PA on a daily basis. Logistic regression and post-estimation linear combinations of regression coefficients were used to examine the independent and competing effects of sport facilities and media equipment on leisure-time PA.

Results. Perceived availability of sport facilities was positively (ORboys = 1.17; ORgirls = 1.26), and that of computer/Internet negatively (ORboys = 0.48; ORgirls = 0.41), associated with being sufficiently active. A significant positive association between video game console and being sufficiently active was found in girls (ORgirls = 1.19) but not in boys. Compared with adolescents without sport facilities and media equipment, those who reported sport facilities only were more likely to be physically active (ORboys = 1.26; ORgirls = 1.34), while those who additionally reported computer/Internet were less likely to be physically active (ORboys = 0.60; ORgirls = 0.54).

Conclusions. Perceived availability of sport facilities in the neighborhood may positively impact on adolescents’ level of physical activity. However, having computer/Internet may cancel out the effects of active opportunities in the neighborhood. This suggests that physical activity programs for adolescents need to consider limiting the access to computer-mediated communication as an important intervention component.

Exercise training during energy restriction in clinically severe obesity

 In women with clinically severe obesity, 250 minutes of moderate to vigorous intensity aerobic and resistance exercise training combined with energy restriction facilitated fat mass loss and protected against lean mass loss. Additionally, exercise training resulted in clinically meaningful improvements in fitness, physical function, and markers of cardiometabolic disease.

Equating accelerometer estimates among youth: The Rosetta Stone 2

Different accelerometer cutpoints used by different researchers often yields vastly different estimates of moderate-to-vigorous intensity physical activity (MVPA). This is recognized as cutpoint non-equivalence (CNE), which reduces the ability to accurately compare youth MVPA across studies. The objective of this research is to develop a cutpoint conversion system that standardizes minutes of MVPA for six different sets of published cutpoints.

Pd embedded in porous carbon (Pd@CMK-3) as an active catalyst for Suzuki reactions: accelerating mass transfer to enhance the reaction rate

Heterogeneous catalysts are promising candidates for use in organic reactions due to their advantages in separation, recovery, and environment compatibility. In this work, an active porous catalyst denoted as Pd embedded in porous carbon (Pd@CMK-3) has been prepared by a strategy involving immersion, ammoniahydrolysis, and heating procedures. Detailed characterization of the catalyst revealed that Pd(0) and Pd(II) species co-exist and were embedded in the matrix of the porous carbon (CMK-3). The as-prepared catalyst has shown high activity toward Suzuki reactions. Importantly, if the reaction mixture was homogenized by two minutes of ultrasonication rather than magnetic stirring before heating, the resistance to mass transfer in the pore channels was significantly reduced. As a result, the reactions proceeded more rapidly and a four-fold increase in the turnover frequency (TOF) could be obtained. When the ultrasonication was employed throughout the entire reaction process, the conversion could also exceed 90% even without the protection of inert gas, and although the reaction temperature was lowered to 30 °C. This work provides a method for fabricating highly active porous carbon encapsulated Pd catalysts for Suzuki reactions and proves that the problem of mass transfer in porous catalysts can be conveniently resolved by ultrasonication without any chemical modification being necessary.[Figure not available: see fulltext.] © 2014 Tsinghua University Press and Springer-Verlag Berlin Heidelberg.

Simulated hyperopic anisometropia and reading, visual information processing, and reading-related eye movement performance in children.

Purpose: This study investigated the impact of simulated hyperopic anisometropia and sustained near work on performance of academic-related measures in children.
Methods: Participants included 16 children (mean age: 11.1 ± 0.8 years) with minimal refractive error. Academic-related outcome measures included a reading test (Neale Analysis of Reading Ability), visual information–processing tests (Coding and Symbol Search subtests from the Wechsler Intelligence Scale for Children), and a reading-related eye movement test (Developmental Eye Movement test). Performance was assessed with and without 0.75 diopters of simulated monocular hyperopic defocus (administered in a randomized order), before and after 20 minutes of sustained near work. Unilateral hyperopic defocus was systematically assigned to either the dominant or nondominant sighting eye to evaluate the impact of ocular dominance on any performance decrements.
Results: Simulated hyperopic anisometropia and sustained near work both independently reduced performance on all of the outcome measures (P < 0.001). A significant interaction was also observed between simulated anisometropia and near work (P < 0.05), with the greatest decrement in performance observed during simulated anisometropia in combination with sustained near work. Laterality of the refractive error simulation (ocular dominance) did not significantly influence the outcome measures (P > 0.05). A reduction of up to 12% in performance was observed across the range of academic-related measures following sustained near work undertaken during the anisometropic simulation.
Conclusions: Simulated hyperopic anisometropia significantly impaired academic-related performance, particularly in combination with sustained near work. The impact of uncorrected habitual anisometropia on academic-related performance in children requires further investigation. © 2014 The Association for Research in Vision and Ophthalmology, Inc.

Web-based alcohol intervention for Māori university students: double-blind, multi-site randomized controlled trial

AIMS: Like many indigenous peoples, New Zealand Māori bear a heavy burden of alcohol-related harm relative to their non-indigenous compatriots, and disparities are greatest among young adults. We tested the effectiveness of web-based alcohol screening and brief intervention (e-SBI) for reducing hazardous drinking among Māori university students. DESIGN: Parallel, double-blind, multi-site, randomized controlled trial. SETTING: Seven of New Zealand's eight universities. PARTICIPANTS: In April 2010, we sent e-mail invitations to all 6697 17-24-year-old Māori students to complete a brief web questionnaire including the Alcohol Use Disorders Identification Test (AUDIT)-C, a screening tool for hazardous and harmful drinking. Those screening positive were computer randomized to: <10 minutes of web-based alcohol assessment and personalized feedback (intervention) or screening alone (control). MEASUREMENTS: We conducted a fully automated 5-month follow-up assessment with observers and participants blinded to study hypotheses, design and intervention delivery. Pre-determined primary outcomes were: (i) frequency of drinking, (ii) amount consumed per typical drinking occasion, (iii) overall volume of alcohol consumed and (iv) academic problems. FINDINGS: Of the participants, 1789 were hazardous or harmful drinkers (AUDIT-C ≥ 4) and were randomized: 850 to control, 939 to intervention. Follow-up assessments were completed by 682 controls (80%) and 733 intervention group members (78%). Relative to controls, participants receiving intervention drank less often [RR = 0.89; 95% confidence interval (CI): 0.82-0.97], less per drinking occasion (RR = 0.92; 95% CI: 0.84-1.00), less overall (RR = 0.78; 95% CI: 0.69-0.89) and had fewer academic problems (RR = 0.81; 95% CI: 0.69-0.95). CONCLUSIONS: Web-based screening and brief intervention reduced hazardous and harmful drinking among non-help-seeking Māori students in a large-scale pragmatic trial. The study has wider implications for behavioural intervention in the important but neglected area of indigenous health.

Web-based alcohol screening and brief intervention for university students: a randomized trial

IMPORTANCE: Unhealthy alcohol use is a leading contributor to the global burden of disease, particularly among young people. Systematic reviews suggest efficacy of web-based alcohol screening and brief intervention and call for effectiveness trials in settings where it could be sustainably delivered. OBJECTIVE: To evaluate a national web-based alcohol screening and brief intervention program. DESIGN, SETTING, AND PARTICIPANTS: A multisite, double-blind, parallel-group, individually randomized trial was conducted at 7 New Zealand universities. In April and May of 2010, invitations containing hyperlinks to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening test were e-mailed to 14,991 students aged 17 to 24 years. INTERVENTIONS: Participants who screened positive (AUDIT-C score ≥4) were randomized to undergo screening alone or to 10 minutes of assessment and feedback (including comparisons with medical guidelines and peer norms) on alcohol expenditure, peak blood alcohol concentration, alcohol dependence, and access to help and information. MAIN OUTCOMES AND MEASURES: A fully automated 5-month follow-up assessment was conducted that measured 6 primary outcomes: consumption per typical occasion, drinking frequency, volume of alcohol consumed, an academic problems score, and whether participants exceeded medical guidelines for acute harm (binge drinking) and chronic harm (heavy drinking). A Bonferroni-corrected significance threshold of .0083 was used to account for the 6 comparisons and a sensitivity analysis was used to assess possible attrition bias. RESULTS: Of 5135 students screened, 3422 scored 4 or greater and were randomized, and 83% were followed up. There was a significant effect on 1 of the 6 prespecified outcomes. Relative to control participants, those who received intervention consumed less alcohol per typical drinking occasion (median 4 drinks [interquartile range {IQR}, 2-8] vs 5 drinks [IQR 2-8]; rate ratio [RR], 0.93 [99.17% CI, 0.86-1.00]; P = .005) but not less often (RR, 0.95 [99.17% CI, 0.88-1.03]; P = .08) or less overall (RR, 0.95 [99.17% CI, 0.81-1.10]; P = .33). Academic problem scores were not lower (RR, 0.91 [99.17% CI, 0.76-1.08]; P = .14) and effects on the risks of binge drinking (odds ratio [OR], 0.84 [99.17% CI, 0.67-1.05]; P = .04) and heavy drinking (OR, 0.77 [99.17% CI, 0.56-1.05]; P = .03) were not significantly significant. In a sensitivity analysis accounting for attrition, the effect on alcohol per typical drinking occasion was no longer statistically significant. CONCLUSIONS AND RELEVANCE: A national web-based alcohol screening and brief intervention program produced no significant reductions in the frequency or overall volume of drinking or academic problems. There remains a possibility of a small reduction in the amount of alcohol consumed per typical drinking occasion. TRIAL REGISTRATION: anzctr.org.au Identifier: ACTRN12610000279022.

Within-and between-day associations between children's sitting and physical activity time

Background: The objective of this study was to examine whether increased levels of sitting time and physical activity in one period (within-day) or on one day (between-day) were predictive of lower levels in these behaviours in the following period or day among children. Methods: Children aged 8-11 years from 8 primary schools located in Melbourne, Australia, wore an activPAL for 7 consecutive days (n = 235; 53 % boys). Sitting, standing and stepping time were derived for each day and for specific periods on weekdays and weekend days. Multilevel analyses were conducted using generalised linear latent and mixed models to estimate associations between temporally adjacent values (i.e. pairs of days; pairs of periods within-days) between the outcome variables. Results: Significant associations were observed between temporally adjacent days and periods of the day. On any given day, an additional 10 min of stepping was associated with fewer minutes of stepping (~9 min; 95 % CI: -11.5 to -6.2 min) and standing (15 min; 95 % CI: -18.8 to -11.1 min) the following day. Greater time spent sitting during one period, regardless of being a weekday or weekend day, was associated with less time sitting and more time standing and stepping in the following period. Conclusions: The direction of the results suggest that children appeared to compensate for increased sitting, standing, and stepping time both within- and between-days. The implications of such associations for the design and delivery of interventions require consideration.

Eat, drink and gamble: marketing messages about 'risky' products in an Australian major sporting series

BACKGROUND: To investigate the alcohol, gambling, and unhealthy food marketing strategies during a nationally televised, free to air, sporting series in Australia. METHODS/APPROACH: Using the Australian National Rugby League 2012 State of Origin three-game series, we conducted a mixed methods content analysis of the frequency, duration, placement and content of advertising strategies, comparing these strategies both within and across the three games. RESULTS: There were a total of 4445 episodes (mean = 1481.67, SD = 336.58), and 233.23 minutes (mean = 77.74, SD = 7.31) of marketing for alcoholic beverages, gambling products and unhealthy foods and non-alcoholic beverages during the 360 minutes of televised coverage of the three State of Origin 2012 games. This included an average per game of 1354 episodes (SD = 368.79) and 66.29 minutes (SD = 7.62) of alcohol marketing; 110.67 episodes (SD = 43.89), and 8.72 minutes (SD = 1.29) of gambling marketing; and 17 episodes (SD = 7.55), and 2.74 minutes (SD = 0.78) of unhealthy food and beverage marketing. Content analysis revealed that there was a considerable embedding of product marketing within the match play, including within match commentary, sporting equipment, and special replays. CONCLUSIONS: Sport is increasingly used as a vehicle for the promotion of range of 'risky consumption' products. This study raises important ethical and health policy questions about the extent and impact of saturation and incidental marketing strategies on health and wellbeing, the transparency of embedded marketing strategies, and how these strategies may influence product consumption.