The role and regulation of MAFbx/atrogin-1 and MuRF1 in skeletal muscle atrophy

Skeletal muscle atrophy occurs in many chronic diseases and disuse conditions. Its severity reduces patient recovery, independence and quality of life. The discovery of two muscle-specific E3 ubiquitin ligases, MAFbx/ atrogin-1 and Muscle RING Finger-1 (MuRF1), promoted an expectation of these molecules as targets for therapeutic development. While numerous studies have determined the conditions in which MAFbx/atrogin-1 and MuRF1 mRNA levels are regulated, few studies have investigated their functional role in skeletal muscle. Recently, studies identifying new target substrates for MAFbx/atrogin-1 and
MuRF1, outside of their response to the initiation of muscle atrophy, suggest that there is more to these proteins than
previously appreciated. This review will highlight our present knowledge of MAFbx/atrogin-1 and MuRF1 in skeletal muscle atrophy, the impact of potential therapeutics and their known regulators and substrates. Finally, we will comment on new approaches that may expand our knowledge of these two molecules in their control of skeletal muscle function.

Reconceptualising engagement : a study of Australian academics

The management of human capital is a strategic imperative for knowledge based firms such as universities. Human capital has been described as the investment in people necessary to build the skills and capabilities to operate at their full potential and enable them to act in ways that enhance the competitiveness of organisations. This thesis is set amidst the series of changes made to the Australian Higher Education sector that have had a profound effect on the management of its human capital. The changes have larg ely been driven by government policy in response to globalisation, increased competition and technological advances. As a result the climate of universities has moved to a more cost efficiency-focused managerialism. Various studies have illustrated the significant consequences for the academic workforce and the way in which work has changed in the sector. Academics now face greater accountability for the quality and quantity of their teaching and research at a time when university funding has been constrained. The results have not been all positive for the quality of academics’ working lives and evidence points to heavy workloads and a steadily disengaging workforce. Despite this, many of the sectoral changes rely on an engaged and cooperative workforce to bring about greater productivity and quality of education to attract a larger share of international and domestic students. ... The two aims of this thesis are: to clarify the current definitions of engagement by bringing together the constructs and concepts that contribute to engagement; and to provide insight into the dimensions that shape engagement in Australian business academics ... The thesis also contributes to the dialogue on human capital and in particular, how it can be harnessed in key areas such as the knowledge industries and for targeted purposes such as the management of talent.

Effect of type and severity of intimate partner violence on women's health and service use : findings from a primary care trial of women afraid of their partners

Intimate partner violence (IPV) has major affects on women’s wellbeing. There has been limited investigation of the association between type and severity of IPV and health outcomes. This article describes socio-demographic characteristics, experiences of abuse, health, safety, and use of services in women enrolled in the Women’s Evaluation of Abuse and Violence Care (WEAVE) project. We explored associations between type and severity of abuse and women’s health, quality of life, and help seeking. Women (aged 16–50 years) attending 52 Australian general practices, reporting fear of partners in last 12 months were mailed a survey between June 2008 and May 2010. Response rate was 70.5% (272/386). In the last 12 months, one third (33.0%) experienced Severe Combined Abuse, 26.2% Physical and Emotional Abuse, 26.6% Emotional Abuse and/or Harassment only, 2.7% Physical Abuse only and 12.4% scored negative on the Composite Abuse Scale. A total of 31.6% of participants reported poor or fair health and 67.9% poor social support. In the last year, one third had seen a psychologist (36.6%) or had 5 or more general practitioner visits (34.3%); 14.7% contacted IPV services; and 24.4% had made a safety plan. Compared to other abuse groups, women with Severe Combined Abuse had poor quality of life and mental health, despite using more medications, counseling, and IPV services and were more likely to have days out of role because of emotional issues. In summary, women who were fearful of partners in the last year, have poor mental health and quality of life, attend health care services frequently, and domestic violence services infrequently. Those women experiencing severe combined physical, emotional, and sexual abuse have poorer quality of life and mental health than women experiencing other abuse types. Health practitioners should take a history of type and severity of abuse for women with mental health issues to assist access to appropriate specialist support.

Associations of leisure-time physical activity with quality of life in a large, population-based sample of colorectal cancer survivors

Objective : To examine the associations between physical activity and quality of life for colorectal cancer survivors; and to describe the associations of medical and sociodemographic attributes with overall quality of life, and their moderating effects on the relationships between physical activity and quality of life.

Methods : Telephone interviews were conducted with 1,996 colorectal cancer survivors recruited through the Queensland Cancer Registry. Data were collected on current quality of life; leisure-time physical activity pre- and post-diagnosis; cancer treatment and side-effects; and general sociodemographic attributes. Hierarchical generalized linear models identified variables significantly associated with quality of life.

Results : After controlling for sociodemographic variables, disease-specific variables, treatment side-effects, and pre-diagnosis leisure-time physical activity, there were significant differences in quality of life scores by post-diagnosis physical activity category. Compared to participants who were inactive after their diagnosis, those who were sufficiently active had a 17.0% higher total quality of life score. Physical activity also had a significant independent positive association with the physical well-being, functional well-being, and additional concerns subscales of the FACT-C.

Conclusions : Our findings demonstrate that quite modest changes in leisure-time physical activity are associated with quality of life. Colorectal cancer survivors may benefit from a more active lifestyle.

Diabetes and end-of-life care: ethical issues, practices and challenges

Abstract:
Diabetes is the most significant chronic disease and the global prevalence is increasing. Diabetes is associated with debilitating long term complications and other comorbidities that cause high rates of morbidity and mortality. Keeping blood glucose and other metabolic parameters within an acceptable, personalised range is important to comfort and quality of life but can be challenging, especially during end-of-life care. Guidelines can help clinicians make appropriate care decisions; however, there is little research about what constitutes best practice diabetes care at the end-of-life: existing recommendations and guidelines blend the best available evidence with consensus opinion. In addition, there are important ethical and methodological considerations concerning research involving vulnerable people at the end-of-life. Chapter 3 describes the ethical and methodological issues that needed to be considered when developing guidelines for managing diabetes at the end-of-life and the contribution interviews with dying people and their family carers made to developing a guiding philosophy and to person-centred guidelines.

Design and rationale of a 16-week adjunctive randomized placebo-controlled trial of mitochondrial agents for the treatment of bipolar depression

Objective: Bipolar disorder places a significant burden on individuals, caregivers and family, and the broader community. Current treatments are believed to be more effective against manic symptoms, leaving a shortfall in recovery during the depressive phase of the illness. The current study draws on recent evidence suggesting that, in addition to increased oxidative load, alterations in mitochondrial function occur in bipolar disorder. Methods: This 16-week study aims to explore the potential benefits of N-acetylcysteine (NAC) alone or in combination (CT) with selected nutraceuticals believed to enhance mitochondrial function. The study includes adults diagnosed with bipolar disorder currently experiencing an episode of depression. Participants are asked to take NAC, CT, or placebo in addition to any usual treatments. A post-discontinuation visit is conducted 4 weeks following the treatment phase. Results: The primary outcome of the study will be mean change on the Montgomery-Asberg Depression Rating Scale. Secondary outcomes include functioning, substance use, mania ratings, and quality of life. Blood samples will be collected at baseline and week 16 to explore biochemical alterations following treatment. Conclusion: This study may provide a novel adjunctive treatment for bipolar depression. Analysis of biological samples may assist in understanding the therapeutic benefits and the underlying etiology of bipolar depression. Trial registration: Australian and New Zealand Clinical Trial Registry ACTRN12612000830897.

An analytical model for optimal spectrum leasing under constraints of quality of service in CRNs

Cognitive radio improves spectrum efficiency and mitigates spectrum scarcity by allowing cognitive users to opportunistically access idle chunks of the spectrum owned by licensed users. In long-term spectrum leasing markets, secondary network operators make a decision about how much spectrum is optimal to fulfill their users' data transmission requirements. We study this optimization problem in multiple channel scenarios. Under the constrains of expected user admission rate and quality of service, we model the secondary network into a dynamic data transportation system. In this system, the spectrum accesses of both primary users and secondary users are in accordance with stochastic processes, respectively. The main metrics of quality of service we are concerned with include user admission rate, average transmission delay and stability of the delay. To quantify the relationship between spectrum provisioning and quality of service, we propose an approximate analytical model. We use the model to estimate the lower and upper bounds of the optimal amount of the spectrum. The distance between the bounds is relatively narrow. In addition, we design a simple algorithm to compute the optimum by using the bounds. We conduct numerical simulations on a slotted multiple channel dynamic spectrum access network model. Simulation results demonstrate the preciseness of the proposed model. Our work sheds light on the design of game and auction based dynamic spectrum sharing mechanisms in cognitive radio networks.

Optimizing safety, fidelity and usability of an Intelligent Clinical Support Tool (ICST) for acute hospital care: an Australian case study using a multi-method Delphi Process

This research focuses on a major health priority for Australia by addressing existing gaps in the implementation of nursing informatics solutions in healthcare. It serves to inform the successful deployment of IT solutions designed to support patient-centered, frontline acute healthcare delivery by multidisciplinary care teams. The outcomes can guide future evaluations of the contribution of IT solutions to the efficiency, safety and quality of care delivery in acute hospital settings.

Toward a standard approach to measurement and reporting of perioperative mortality rate as a global indicator for surgery

INTRODUCTION: The proportion of patients who die during or after surgery, otherwise known as the perioperative mortality rate (POMR), is a credible indicator of the safety and quality of operative care. Its accuracy and usefulness as a metric, however, particularly one that enables valid comparisons over time or between jurisdictions, has been limited by lack of a standardized approach to measurement and calculation, poor understanding of when in relation to surgery it is best measured, and whether risk-adjustment is needed. Our aim was to evaluate the value of POMR as a global surgery metric by addressing these issues using 4, large, mixed, surgical datasets that represent high-, middle-, and low-income countries. METHODS: We obtained data from the New Zealand National Minimum Dataset, the Geelong Hospital patient management system in Australia, and purpose-built surgical databases in Pietermaritzburg, South Africa, and Port Moresby, Papua New Guinea. For each site, we calculated the POMR overall as well as for nonemergency and emergency admissions. We assessed the effect of admission episodes and procedures as the denominator and the difference between in-hospital POMR and POMR, including postdischarge deaths up to 30 days. To determine the need for risk-adjustment for age and admission urgency, we used univariate and multivariate logistic regression to assess the effect on relative POMR for each site. RESULTS: A total of 1,362,635 patient admissions involving 1,514,242 procedures were included. More than 60% of admissions in Pietermaritzburg and Port Moresby were emergencies, compared with less than 30% in New Zealand and Geelong. Also, Pietermaritzburg and Port Moresby had much younger patient populations (P < .001). A total of 8,655 deaths were recorded within 30 days, and 8-20% of in-hospital deaths occurred on the same day as the first operation. In-hospital POMR ranged approximately 9-fold, from 0.38 per 100 admissions in New Zealand to 3.44 per 100 admissions in Pietermaritzburg. In New Zealand, in-hospital 30-day POMR underestimated total 30-day POMR by approximately one third. The difference in POMR if procedures were used instead of admission episodes ranged from 7 to 70%, although this difference was less when central line and pacemaker insertions were excluded. Age older than 65 years and emergency admission had large, independent effects on POMR but relatively little effect in multivariate analysis on the relative odds of in-hospital death at each site. CONCLUSION: It is possible to collect POMR in countries at all level of development. Although age and admission urgency are strong, independent associations with POMR, a substantial amount of its variance is site-specific and may reflect the safety of operative and anesthetic facilities and processes. Risk-adjustment is desirable but not essential for monitoring system performance. POMR varies depending on the choice of denominator, and in-hospital deaths appear to underestimate 30-day mortality by up to one third. Standardized approaches to reporting and analysis will strengthen the validity of POMR as the principal indicator of the safety of surgery and anesthesia care.

Optimising safety, fidelity and usability of an Intelligent Clinical Support Tool (ICST) for acute hospital care: an Australian case Study using a multi-method Delphi process

This research focuses on a major health priority for Australia by addressing existing gaps in the implementation of nursing informatics solutions in healthcare. It serves to inform the successful deployment of IT solutions designed to support patient-centered, frontline acute healthcare delivery by multidisciplinary care teams. The outcomes can guide future evaluations of the contribution of IT solutions to the efficiency, safety and quality of care delivery in acute hospital settings.

Use of videos to support teaching and learning of clinical skills in nursing education: A review

Information and communications technology is influencing the delivery of education in tertiary institutions. In particular, the increased use of videos for teaching and learning clinical skills in nursing may be a promising direction to pursue, yet we need to better document the current research in this area of inquiry. The aim of this paper was to explore and document the current areas of research into the use of videos to support teaching and learning of clinical skills in nursing education. The four main areas of current and future research are effectiveness, efficiency, usage, and quality of videos as teaching and learning materials. While there is a clear need for additional research in the area, the use of videos seems to be a promising, relevant, and increasingly used instructional strategy that could enhance the quality of clinical skills education.

Cognitive-behavioural therapy has no effect on disease activity but improves quality of life in subgroups of patients with inflammatory bowel disease: a pilot randomised controlled trial.

BACKGROUND: Studies have demonstrated usefulness of cognitive-behavioural therapy (CBT) in managing distress in inflammatory bowel disease (IBD); however, few have focused on IBD course. The present trial aimed to investigate whether adding CBT to standard treatment prolongs remission in IBD in comparison to standard therapy alone. METHODS: A 2-arm parallel pragmatic randomised controlled trial (+CBT - standard care plus either face-to-face (F2F) or online CBT over 10 weeks versus standard care alone (SC)) was conducted with adult patients in remission. IBD remission at 12 months since baseline was the primary outcome measure while the secondary outcome measures were mental health status and quality of life (QoL). Linear mixed-effect models were used to compare groups on outcome variables while controlling for baseline. RESULTS: Participants were 174 patients with IBD (90 +CBT, 84 SC). There was no difference in remission rates between groups, with similar numbers flaring at 12 months. Groups did not differ in anxiety, depression or coping at 6 or 12 months (p >0.05). When only participants classified as 'in need' (young, high baseline IBD activity, recently diagnosed; poor mental health) were examined in the post-hoc analysis (n = 74, 34 CBT and 40 controls), CBT significantly improved mental QoL (p = .034, d = .56) at 6 months. Online CBT group had a higher score on Precontemplation than the F2F group, which is consistent with less developed coping with IBD in the cCBT group (p = .045). CONCLUSIONS: Future studies should direct psychological interventions to patients 'in need' and attempt to recruit larger samples to compensate for significant attrition when using online CBT. TRIAL REGISTRATION: The protocol was registered on 21/10/2009 with the Australian New Zealand Clinical Trials Registry (ID: ACTRN12609000913279).

Gross margins in Australian mohair enterprises and relationships with farm inputs, productivity and mohair quality

In the absence of financial information on Australian mohair enterprises we aimed to determine the gross margins (per dry sheep equivalent, DSE) and their relationships with farm inputs, productivity and mohair quality in Australian mohair enterprises. Using established Victorian Farm and Sheep Monitor Project protocols we collected data for the financial years 200405, 200506 and 200607 from farmers in south-eastern Australia and made comparisons with data from wool enterprises of similar farm area. Over 3 years the financial returns from mohair exceeded that from wool in terms of $/DSE ($23.0 v. 11.3) and $/ha ($132 v. $116). This result was achieved despite the mohair enterprises grazing their goats far less intensively compared with the grazing intensity of sheep (5.9 v. 10.311.1 DSE/ha) and by using far less phosphate fertiliser than used in the wool enterprises (2.2 v. 4.66.1 kg P/ha). These differences were counterbalanced by higher prices for mohair compared with fine wool ($13.15/kg v. $8.35/kg clean fibre). Gross margin for the mohair enterprise did not increase as stocking rate increased. Income from mohair sales declined as the proportion of does in the flock increased. Increasing the proportion of does in the flock was associated with a decline in the average price of mohair ($16/kg greasy at 42% does to $8/kg greasy at 83% does in the flock). This decline was closely associated with the increasing proportion of the total amount of mohair coarser than 34.0 μm (either fine hair or hair) plus stained mohair. The variation in profitability between farms indicates significant scope for many mohair enterprises to increase profit. A focus on producing finer quality mohair will increase mohair profitability.