Effect of ramipril on walking times and quality of life among patients with peripheral artery disease and intermittent claudication : a randomized controlled trial

Importance Approximately one-third of patients with peripheral artery disease experience intermittent claudication, with consequent loss of quality of life. Objective To determine the efficacy of ramipril for improving walking ability, patient-perceived walking performance, and quality of life in patients with claudication. Design, Setting, and Patients Randomized, double-blind, placebo-controlled trial conducted among 212 patients with peripheral artery disease (mean age, 65.5 [SD, 6.2] years), initiated in May 2008 and completed in August 2011 and conducted at 3 hospitals in Australia. Intervention Patients were randomized to receive 10 mg/d of ramipril (n = 106) or matching placebo (n = 106) for 24 weeks. Main Outcome Measures Maximum and pain-free walking times were recorded during a standard treadmill test. The Walking Impairment Questionnaire (WIQ) and Short-Form 36 Health Survey (SF-36) were used to assess walking ability and quality of life, respectively. Results At 6 months, relative to placebo, ramipril was associated with a 75-second (95% CI, 60-89 seconds) increase in mean pain-free walking time (P < .001) and a 255-second (95% CI, 215-295 seconds) increase in maximum walking time (P < .001). Relative to placebo, ramipril improved the WIQ median distance score by 13.8 (Hodges-Lehmann 95% CI, 12.2-15.5), speed score by 13.3 (95% CI, 11.9-15.2), and stair climbing score by 25.2 (95% CI, 25.1-29.4) (P < .001 for all). The overall SF-36 median Physical Component Summary score improved by 8.2 (Hodges-Lehmann 95% CI, 3.6-11.4; P = .02) in the ramipril group relative to placebo. Ramipril did not affect the overall SF-36 median Mental Component Summary score. Conclusions and Relevance Among patients with intermittent claudication, 24-week treatment with ramipril resulted in significant increases in pain-free and maximum treadmill walking times compared with placebo. This was associated with a significant increase in the physical functioning component of the SF-36 score. Trial Registration clinicaltrials.gov Identifier: NCT00681226

Music production in times of monopoly : the example of Sweden

For several decades now, Sweden has been successful in the worldwide popular music arena. This article explores how Sweden, as an integral part of the global music industry, has been able to cope with the changed market conditions brought about by regulatory changes and digital technologies. The article reflects on the virtualization of music distribution, the decline of the long‐play album and the ageing popular music audience.

Journalists in times of change : Evidence from a new survey of Australia’s journalistic workforce

Studies of journalists’ professional views have a long history in many countries around the globe. This has been no less the case in Australia, where a number of surveys of journalists have been conducted, particularly in recent years. Yet, the only study so far able to lay claim to having studied a representative sample with a small error margin remains Henningham’s account of Australian journalists in the early 1990s. Clearly, Australian journalism has experienced a vast array of changes since that time, and it is crucial to provide a more up-to-date image of the profession. This study, based on telephone surveys with 605 Australian journalists, demonstrates some significant changes in the workforce. Journalists are now older, better educated, more experienced and arguably more left-leaning than 20 years ago. For the first time, women are in a majority, but are still disadvantaged. Journalists’ job satisfaction and ethical views are also discussed.

Response to “Comment on ‘Indications of energetic consequences of decoherence at short times for scattering from open quantum systems’” [AIP Advances 1, 049101 (2011)]

The Comment by Mayers and Reiter criticizes our work on two counts. Firstly, it is claimed that the quantum decoherence effects that we report in consequence of our experimental analysis of neutron Compton scattering from H in gaseous H2 are not, as we maintain, outside the framework of conventional neutron scatteringtheory. Secondly, it is claimed that we did not really observe such effects, owing to a faulty analysis of the experimental data, which are claimed to be in agreement with conventional theory. We focus in this response on the critical issue of the reliability of our experimental results and analysis. Using the same standard Vesuvio instrument programs used by Mayers et al., we show that, if the experimental results for H in gaseous H2 are in agreement with conventional theory, then those for D in gaseous D2 obtained in the same way cannot be, and vice-versa. We expose a flaw in the calibration methodology used by Mayers et al. that leads to the present disagreement over the behaviour of H, namely the ad hoc adjustment of the measured H peak positions in TOF during the calibration of Vesuvio so that agreement is obtained with the expectation of conventional theory. We briefly address the question of the necessity to apply the theory of open quantum systems.

Indications of energetic consequences of decoherence at short times for scattering from open quantum systems

Decoherence of quantum entangled particles is observed in most systems, and is usually caused by system-environment interactions. Disentangling two subsystems A and B of a quantum systemAB is tantamount to erasure of quantum phase relations between A and B. It is widely believed that this erasure is an innocuous process, which e.g. does not affect the energies of A and B. Surprisingly, recent theoretical investigations by different groups showed that disentangling two systems, i.e. their decoherence, can cause an increase of their energies. Applying this result to the context of neutronCompton scattering from H2 molecules, we provide for the first time experimental evidence which supports this prediction. The results reveal that the neutron-proton collision leading to the cleavage of the H-H bond in the sub-femtosecond timescale is accompanied by larger energy transfer (by about 3%) than conventional theory predicts. It is proposed to interpreted the results by considering the neutron-proton collisional system as an entangled open quantum system being subject to decoherence owing to the interactions with the “environment” (i.e., two electrons plus second proton of H2).

The impact of nurse practitioner services on cost, quality of care, satisfaction and wait times in the emergency department: A systematic review

Aims To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. Background The delivery of quality care in the emergency department is one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. Data A comprehensive search of four electronic databases from 2006-­‐2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. Methods A three step approach was used. Following a comprehensive search, two reviewers assessed identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data extracted using standardised tools. Results Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-­‐analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding impact on costs. Conclusion Synthesis of the available research attempts to provide an evidence base for emergency nurse practitioner service to guide healthcare leaders, policy makers and clinicians in reforming emergency department service provision. The findings suggest that further quality research is required for comparative measures of clinical and service effectiveness of emergency nurse practitioner service. In the context of increased health service demand and the need to provide timely and effective care to patients, such measures will assist in delivering quality patient care.

The times, wines and tides of Tasmania’s Tamar Valley

A travel article about the Tamar Valley, Tasmania. FROM Launceston to Low Head and the Tamar River’s entry into Bass Strait, big tides bring with them an atmosphere of a beach community, but also of a community a little stranded in time. Half the day the locals live by the sea, and for the other half along wide flats. It’s an old rhythm in a place where much has gone unchanged...

Regulating Workplace Risks: A Comparative Study of Inspection Regimes in Times of Change

Regulating Workplace Risks is a study of regulatory inspection of occupational health and safety (OHS) and its management in five countries – Australia, Canada (Québec), France, Sweden and the UK – during a time of major change. It examines the implications of the shift from specification to process based regulation, in which attention has been increasingly directed to the means of managing OHS more systematically at a time in which a major restructuring of work has occurred in response to the globalised economy. These changes provide both the context and material for a wider discussion of the nature of regulation and regulatory inspection and their role in protecting the health, safety and well-being of workers in advanced market economies.

The effects of metabolic work rate and ambient environment on physiological tolerance times while wearing explosive and chemical personal protective equipment

This study evaluated the physiological tolerance times when wearing explosive and chemical (>35kg) personal protective equipment (PPE) in simulated environmental extremes across a range of differing work intensities. Twelve healthy males undertook nine trials which involved walking on a treadmill at 2.5, 4 and 5.5 km.h-1 in the following environmental conditions, 21, 30 and 37 °C wet bulb globe temperature (WBGT). Participants exercised for 60 min or until volitional fatigue, core temperature reached 39 °C, or heart rate exceeded 90% of maximum. Tolerance time, core temperature, skin temperature, mean body temperature, heart rate and body mass loss were measured. Exercise time was reduced in the higher WBGT environments (WBGT37-1; P<0.001). The majority of trials (85/108; 78.7%) were terminated due to participant’s heart rate exceeding 90% of their maximum. A total of eight trials (7.4%) lasted the full duration. Only nine (8.3%) trials were terminated due to volitional fatigue and six (5.6%) due to core temperatures in excess of 39 °C. These results demonstrate that physiological tolerance times are influenced by the external environment and workload, and that cardiovascular strain is the limiting factor to work tolerance when wearing this heavy multi layered PPE.

Coverage of international and Pacific news in the Fiji Times and The Australian

The debate over the nature and flow of international news has dominated intellectual debate about journalism practice for some time. Developing countries argued there was an imbalance in the nature and amount of international news concerning them. They argued that the Western media rarely reported on developing countries and when they did, reported predominantly negative news about developing countries. The debate led to calls for a New World Information and Communication Order (NWICO). A number of studies examined its arguments, many finding developing countries were indeed disadvantaged by the Western media. This study compared foreign news coverage in The Australian and The Fiji Times, with special attention on news from the Pacific Islands region. It found the coverage of the Pacific Islands was still grossly inadequate in both newspapers. The coverage consisted of only a small number of stories, which were predominantly negative, surprising especially in the case of The Fiji Times.

Citizens and social media in times of natural disaster: Exploring information experience

Introduction. Social media is becoming a vital source of information in disaster or emergency situations. While a growing number of studies have explored the use of social media in natural disasters by emergency staff, military personnel, medial and other professionals, very few studies have investigated the use of social media by members of the public. The purpose of this paper is to explore citizens’ information experiences in social media during times of natural disaster. Method. A qualitative research approach was applied. Data was collected via in-depth interviews. Twenty-five people who used social media during a natural disaster in Australia participated in the study. Analysis. Audio recordings of interviews and interview transcripts provided the empirical material for data analysis. Data was analysed using structural and focussed coding methods. Results. Eight key themes depicting various aspects of participants’ information experience during a natural disaster were uncovered by the study: connected; wellbeing; coping; help; brokerage; journalism; supplementary and characteristics. Conclusion. This study contributes insights into social media’s potential for developing community disaster resilience and promotes discussion about the value of civic participation in social media when such circumstances occur. These findings also contribute to our understanding of information experiences as a new informational research object.

Testing times for the implementation of curriculum change: Analysis and extension of a curriculum change model

School curriculum change processes have traditionally been managed internally. However, in Queensland, Australia, as a response to the current high-stakes accountability regime, more and more principals are outsourcing this work to external change agents (ECAs). In 2009, one of the authors (a university lecturer and ECA) developed a curriculum change model (the Controlled Rapid Approach to Curriculum Change (CRACC)), specifically outlining the involvement of an ECA in the initiation phase of a school’s curriculum change process. The purpose of this paper is to extend the CRACC model by unpacking the implementation phase, drawing on data from a pilot study of a single school. Interview responses revealed that during the implementation phase, teachers wanted to be kept informed of the wider educational context; use data to constantly track students; relate pedagogical practices to testing practices; share information between departments and professional levels; and, own whole school performance. It is suggested that the findings would be transferable to other school settings and internal leadership of curriculum change. The paper also strikes a chord of concern – Do the responses from teachers operating in such an accountability regime live their professional lives within this corporate and globalised ideology whether they want to or not?

The Times They Are A Changin': The Effect of Institutional Change on Cooperative Behaviour at 26,000ft over Sixty Years

In 2006, Sir Edmund Hillary lambasted the modern climbing fraternity for abandoning other climbers to a slow frozen death on Everest, claiming that in his day they would never leave someone to die. This followed the controversial death of David Sharp, passed by an estimated 40 climbers who were more interested in the summit than the life of a fellow human being. But was this stinging criticism true or just the faded recollections of a former climbing giant? This book investigates that claim through a narrative analysis, which combines the empirical analysis of Hawley and Salisbury's Himalayan Expedition Database with the anecdotal evidence provided by a plethora of newspaper articles and books. While there is evidence supporting the claim that commercialization is to blame for the breakdown of pro-social behaviour, the results cannot conclude if it is the commercial climber or the operator driving the problem and that the Sherpa are the saving grace.