Interactions between energy intake and expenditure in the development and treatment of obesity.

Summary There are four interactions to consider between energy intake (EI) and energy expenditure (EE) in the development and treatment of obesity. (1) Does sedentariness alter levels of EI or subsequent EE? and (2) Do high levels of EI alter physical activity or exercise? (3) Do exercise-induced increases in EE drive EI upwards and undermine dietary approaches to weight management and (4) Do low levels of EI elevate or decrease EE? There is little evidence that sedentariness alters levels of EI. This lack of cross-talk between altered EE and EI appears to promote a positive EB. Lifestyle studies also suggest that a sedentary routine actually offers the opportunity for over-consumption. Substantive changes in non exercise activity thermogenesis are feasible, but not clearly demonstrated. Cross talk between elevated EE and EI is initially too weak and takes too long to activate, to seriously threaten dietary approaches to weight management. It appears that substantial fat loss is possible before intake begins to track a sustained elevation of EE. There is more evidence that low levels of EI does lower physical activity levels, in relatively lean men under conditions of acute or prolonged semi-starvation and in dieting obese subjects. During altered EB there are a number of small but significant changes in the components of EE, including (i) sleeping and basal metabolic rate, (ii) energy cost of weight change alters as weight is gained or lost, (iii) exercise efficiency, (iv) energy cost of weight bearing activities, (v) during substantive overfeeding diet composition (fat versus carbohydrate) will influence the energy cost of nutrient storage by ~ 15%. The responses (i-v) above are all “obligatory” responses. Altered EB can also stimulate facultative behavioural responses, as a consequence of cross-talk between EI and EE. Altered EB will lead to changes in the mode duration and intensity of physical activities. Feeding behaviour can also change. The degree of inter-individual variability in these responses will define the scope within which various mechanisms of EB compensation can operate. The relative importance of “obligatory” versus facultative, behavioural responses -as components of EB control- need to be defined.

Low fat loss response after medium-term supervised exercise in obese is associated with exercise-induced increase in food reward

Objective: To examine exercise-induced changes in the reward value of food during medium-term supervised exercise in obese individuals. ---------- Subjects/Methods: The study was a 12-week supervised exercise intervention prescribed to expend 500 kcal/day, 5 d/week. 34 sedentary obese males and females were identified as responders (R) or non-responders (NR) to the intervention according to changes in body composition relative to measured energy expended during exercise. Food reward (ratings of liking and wanting, and relative preference by forced choice pairs) for an array of food images was assessed before and after an acute exercise bout. ---------- Results. 20 responders and 14 non-responders were identified. R lost 5.2 kg±2.4 of total fat mass and NR lost 1.7 kg±1.4. After acute exercise, liking for all foods increased in NR compared to no change in R. Furthermore, NR showed an increase in wanting and relative preference for high-fat sweet foods. These differences were independent of 12-weeks regular exercise and weight loss. ---------- Conclusion. Individuals who showed an immediate post-exercise increase in liking and increased wanting and preference for high-fat sweet foods displayed a smaller reduction in fat mass with exercise. For some individuals, exercise increases the reward value of food and diminishes the impact of exercise on fat loss.

The concentric all-polyethylene Exeter acetabular component in primary total hip replacement

We report the long term outcome of the flangeless, cemented all polyethylene Exeter cup at a mean of 14.6 years (range 10-17) after operation. Of the 263 hips in 243 patients, 122 hips are still in situ, 112 patients (119 hips) have died, eighteen hips were revised, and three patients (four hips) had moved abroad and were lost to follow-up (1.5%). Radiographs demonstrated two sockets had migrated and six more had radiolucent lines in all three zones. The Kaplan Meier survivorship at 15 years with endpoint revision for all causes is 89.9% (95% CI 84.6 to 95.2%) and for aseptic cup loosening or lysis 91.7% (CI 86.6 to 96.8%). In 210 hips with a diagnosis of primary osteoarthritis survivorship for all causes is 93.2% (95% CI 88.1 to 98.3%), and for aseptic cup loosening 95.0% (CI 90.3 to 99.7%). The cemented all polyethylene Exeter cup has an excellent long-term survivorship.

Potential of St John's Wort for the treatment of depression : the economic perspective

The burden of rising health care expenditures has created a demand for information regarding the clinical and economic outcomes associated with complementary and alternative medicines. Meta-analyses of randomized controlled trials have found Hypericum perforatum preparations to be superior to placebo and similarly effective as standard antidepressants in the acute treatment of mild to moderate depression. A clear advantage over antidepressants has been demonstrated in terms of the reduced frequency of adverse effects and lower treatment withdrawal rates, low rates of side effects and good compliance, key variables affecting the cost-effectiveness of a given form of therapy. The most important risk associated with use is potential interactions with other drugs, but this may be mitigated by using extracts with low hyperforin content. As the indirect costs of depression are greater than five times direct treatment costs, given the rising cost of pharmaceutical antidepressants, the comparatively low cost of Hypericum perforatum extract makes it worthy of consideration in the economic evaluation of mild to moderate depression treatments.

Falls in Parkinson's disease : kinematic evidence for impaired head and trunk control

Changes in stride characteristics and gait rhythmicity characterize gait in Parkinson's disease and are widely believed to contribute to falls in this population. However, few studies have examined gait in PD patients who fall. This study reports on the complexities of walking in PD patients who reported falling during a 12-month follow-up. Forty-nine patients clinically diagnosed with idiopathic PD and 34 controls had their gait assessed using three-dimensional motion analysis. Of the PD patients, 32 (65%) reported at least one fall during the follow-up compared with 17 (50%) controls. The results showed that PD patients had increased stride timing variability, reduced arm swing and walked with a more stooped posture than controls. Additionally, PD fallers took shorter strides, walked slower, spent more time in double-support, had poorer gait stability ratios and did not project their center of mass as far forward of their base of support when compared with controls. These stride changes were accompanied by a reduced range of angular motion for the hip and knee joints. Relative to walking velocity, PD fallers had increased mediolateral head motion compared with PD nonfallers and controls. Therefore, head motion could exceed “normal” limits, if patients increased their walking speed to match healthy individuals. This could be a limiting factor for improving gait in PD and emphasizes the importance of clinically assessing gait to facilitate the early identification of PD patients with a higher risk of falling.

Copyright future copyright freedom

If copyright law does not liberate us from restrictions on the dissemination of knowledge, if it does not encourage expressive freedom, what is its purpose? This volume offers the thinking and suggestions of some of the finest minds grappling with the future of copyright regulation. The Copyright Future Copyright Freedom conference held in 2009 at Old Parliament House Canberra brought together Lawrence Lessig, Julie Cohen, Leslie Zines, Adrian Sterling, Sam Ricketson, Graham Greenleaf, Anne Fitzgerald, Susy Frankel, John Gilchrist, Michael Kirby and others to share the rich fruits of their experience and analysis. Zines, Sterling and Gilchrist outline their roles in the genesis and early growth of Australian copyright legislation, enriching the knowledge of anyone asking urgent questions about the future of information regulation.

Defending the sanctity of life principle : a reply to John Keown

This article is a response to Professor Keown’s criticism of my paper “Finding a Way Through the Ethical and Legal Maze: Withdrawal of Medical Treatment and Euthanasia” (2005) 13 (3) Medical Law Review 357. The article takes up and responds to a number of criticisms raised by Keown in an attempt to further the debate concerning the moral and legal status of withdrawing life-sustaining measures, its distinction from euthanasia, and the implications of the lawfulness of withdrawal for the principle of the sanctity of life.

Review of refugee mental health interventions following resettlement : best practices and recommendations

There are increasing numbers of refugees worldwide, with approximately 16 million refugees in 2007 and over 2.5 million refugees resettled in the United States since the start of its humanitarian program. Psychologists and other health professionals who deliver mental health services for individuals from refugee backgrounds need to have confidence that the therapeutic interventions they employ are appropriate and effective for the clients with whom they work. The current review briefly surveys refugee research, examines empirical evaluations of therapeutic interventions in resettlement contexts, and provides recommendations for best practices and future directions in resettlement countries. The resettlement interventions found to be most effective typically target culturally homogeneous client samples and demonstrate moderate to large outcome effects on aspects of traumatic stress and anxiety reduction. Further evaluations of the array of psychotherapeutic, psychosocial, pharmacological, and other therapeutic approaches, including psychoeducational and community-based interventions that facilitate personal and community growth and change, are encouraged. There is a need for increased awareness, training and funding to implement longitudinal interventions that work collaboratively with clients from refugee backgrounds through the stages of resettlement.

School system as axiological medium : the state's primary macro-proposing context and its expanding moral role in Australia

This paper analyses the Australian Values Education Program (VEP) within the framework of late-classical political economy. using analytical methods from systemic functional linguistics and critical discourse analysis, we demonstrate that the VEP is an unwitting restatement of the principles of ideology as developed by the likes of Destutt de Tracy and the Young Hegelians. We conclude that the sudden shock of globalisation and the post-national cultures this has entailed is in many ways similar to the shock of formal nationalism that emerged in the late-Seventeenth and early- Eighteenth centuries. The overall result of the VEP for the Australian school system is a massive procedural burden that is unlikely to produce the results at which the program is aimed.

Directing Democracy : The Case of the John Lewis Partnership

The John Lewis Partnership was founded in 1929 as an “experiment in industrial democracy” (Lewis, 1948). This thesis explores the meaning of democracy in the Partnership and examines the wider implications of the case. It argues that democracy in work should be viewed as something which is intrinsically valuable because of its connection to furthering justice, equality, freedom and the rights and interests of all workers. The thesis makes three main contributions. Firstly, the production of a historically situated exploration of democratic participation in the John Lewis Partnership – the largest co-owned business in the UK. Secondly, an analysis of power relations in the organisation and an examination of the ways in which disciplinary power and regimes of truth both constrain democratic practice and offer the potential for resistance and challenge. Thirdly, the thesis challenges critics of the Partnership who have dismissed it as a form of “pseudo democracy” (Pateman, 1970: 73) and “suffocatingly paternalistic” (Ramsay, 1980: 52). Despite the constant threat of degeneration and dilution of the value framework laid down by the founder, the Partnership’s continued commitment to democratic participation provides an important contribution to our understanding of co-ownership and democratically organised forms of work. The analysis shows that management have attempted to direct and define democracy in a highly constrained way, assigning it an instrumental purpose, and privileging the ‘business case’ for democratic engagement. However, the study emphasises that the meaning of democracy is heavily contested and fraught with contradictions and paradoxes. This creates a space in which understandings of equality, solidarity and democracy are debated by the 69,000 employees who are co-owners of the business.

Library and information science education 2.0 : guiding principles and models of best practice : interview with John Terrell

In 2005, Stephen Abram, vice president of Innovation at SirsiDynix, challenged library and information science (LIS) professionals to start becoming “librarian 2.0.” In the last few years, discussion and debate about the “core competencies” needed by librarian 2.0 have appeared in the “biblioblogosphere” (blogs written by LIS professionals). However, beyond these informal blog discussions few systematic and empirically based studies have taken place. A project funded by the Australian Learning and Teaching Council fills this gap. The project identifies the key skills, knowledge, and attributes required by “librarian 2.0.” Eighty-one members of the Australian LIS profession participated in a series of focus groups. Eight themes emerged as being critical to “librarian 2.0”: technology, communication, teamwork, user focus, business savvy, evidence based practice, learning and education, and personal traits. Guided by these findings interviews with 36 LIS educators explored the current approaches used within contemporary LIS education to prepare graduates to become “librarian 2.0”. This video presents an example of ‘great practice’ in current LIS education as it strives to foster web 2.0 professionals.