Physical activity in the lives of those living with lymphoedema following cancer treatment

Background Despite recent evidence demonstrating that exercise neither increases risk of nor exacerbates lymphoedema, lymphoedema prevention and management advice cautions against ‘repetitive use’ or ‘overuse’ of the affected arm. It is plausible that this advice creates a barrier to participation in exercise and, more generally, physical activity (any daily activity [PA]). This study explored the relationship between lymphoedema and PA among people following cancer treatment. Methods Social constructionist grounded theory guided study design, development of interview questions and the qualitative data analysis approach undertaken. Data were collected via focus groups and telephone interviews. Results Five focus groups (n=16 participants) and 13 telephone interviews were completed. Participants (women n=26, men n=3) were aged 39-80 years and were experiencing mild to severe lymphoedema following treatment for a variety of cancers. Participants varied in how they defined PA. Its perceived importance was mostly associated with the ability to partake in daily activities, with only some participants highlighting its importance for lymphoedema management or more general health benefits. Most participants’ PA decreased after diagnosis, a consequence of confusion around appropriate PA and fear that PA could worsen lymphoedema symptoms. Conclusions Lymphoedema guidelines need to be more clear and specific when discussing the role of PA and exercise in the prevention and management of lymphoedema. It may be more appropriate to discuss ways to optimize safety when engaging in specific tasks rather than to highlight the need for avoidance of participating in certain activities.

Upper-body morbidity after breast cancer : incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care

The purpose of this paper is to review the incidence of upper-body morbidity (arm and breast symptoms, impairments, and lymphedema), methods for diagnosis, and prevention and treatment strategies. It was also the purpose to highlight the evidence base for integration of prospective surveillance for upper-body morbidity within standard clinical care of women with breast cancer. Between 10% and 64% of women report upper-body symptoms between 6 months and 3 years after breast cancer, and approximately 20% develop lymphedema. Symptoms remain common into longer-term survivorship, and although lymphedema may be transient for some, those who present with mild lymphedema are at increased risk of developing moderate to severe lymphedema. The etiology of morbidity seems to be multifactorial, with the most consistent risk factors being those associated with extent of treatment. However, known risk factors cannot reliably distinguish between those who will and will not develop upper-body morbidity. Upper-body morbidity may be treatable with physical therapy. There is also evidence in support of integrating regular surveillance for upper-body morbidity into the routine care provided to women with breast cancer, with early diagnosis potentially contributing to more effective management and prevention of progression of these conditions.

A meta-analysis of genome-wide association studies to identify prostate cancer susceptibility loci associated with aggressive and non-aggressive disease

Genome-wide association studies (GWAS) have identified multiple common genetic variants associated with an increased risk of prostate cancer (PrCa), but these explain less than one-third of the heritability. To identify further susceptibility alleles, we conducted a meta-analysis of four GWAS including 5953 cases of aggressive PrCa and 11 463 controls (men without PrCa). We computed association tests for approximately 2.6 million SNPs and followed up the most significant SNPs by genotyping 49 121 samples in 29 studies through the international PRACTICAL and BPC3 consortia. We not only confirmed the association of a PrCa susceptibility locus, rs11672691 on chromosome 19, but also showed an association with aggressive PrCa [odds ratio = 1.12 (95% confidence interval 1.03-1.21), P = 1.4 × 10(-8)]. This report describes a genetic variant which is associated with aggressive PrCa, which is a type of PrCa associated with a poorer prognosis.

Identification of 23 new prostate cancer susceptibility loci using the iCOGS custom genotyping

Prostate cancer is the most frequently diagnosed cancer in males in developed countries. To identify common prostate cancer susceptibility alleles, we genotyped 211,155 SNPs on a custom Illumina array (iCOGS) in blood DNA from 25,074 prostate cancer cases and 24,272 controls from the international PRACTICAL Consortium. Twenty-three new prostate cancer susceptibility loci were identified at genome-wide significance (P < 5 × 10−8). More than 70 prostate cancer susceptibility loci, explaining ~30% of the familial risk for this disease, have now been identified. On the basis of combined risks conferred by the new and previously known risk loci, the top 1% of the risk distribution has a 4.7-fold higher risk than the average of the population being profiled. These results will facilitate population risk stratification for clinical studies.

Fine-mapping identifies multiple prostate cancer risk loci on 5p15 some associating with TERT expression

Associations between single nucleotide polymorphisms (SNPs) at 5p15 and multiple cancer types have been reported. We have previously shown evidence for a strong association between prostate cancer (PrCa) risk and rs2242652 at 5p15, intronic in the telomerase reverse transcriptase (TERT) gene that encodes TERT. To comprehensively evaluate the association between genetic variation across this region and PrCa, we performed a fine-mapping analysis by genotyping 134 SNPs using a custom Illumina iSelect array or Sequenom MassArray iPlex, followed by imputation of 1094 SNPs in 22 301 PrCa cases and 22 320 controls in The PRACTICAL consortium. Multiple stepwise logistic regression analysis identified four signals in the promoter or intronic regions of TERT that independently associated with PrCa risk. Gene expression analysis of normal prostate tissue showed evidence that SNPs within one of these regions also associated with TERT expression, providing a potential mechanism for predisposition to disease.

Social moralities and discursive constructions of female sex offenders

This article explores legal, scholarly and social responses to women identified as sex offenders. While much has been written on the male paedophile, rapist and sex offender, little research has been done on the role of gender and sexuality in sex offending. This article examines the ways in which the female sex offender is currently theorized and the discourses surrounding policy, legislative and media responses to their crimes. We identify contradictory public discourses where perceptions of female child abusers in particular often succumb to moral panic, in spite of many such offenders being given lenient sentences for their crimes. An examination of the discursive construction of female child abusers suggests that these contradictions are informed by underlying assumptions concerning harm and subjectivity in sex crimes. In exploring these contradictions we illustrate the ways in which such discourses are impacted by social moralities, and how social moralities construct offender and victim subjectivities differently, based on differences in gender, age and sexuality.

Embedding diversity in a university justice curriculum : an exploration of the issues

This paper reports on an action-learning project conducted within the first year criminal justice curriculum in an Australian university. The project was initiated after an audit of first year units and student feedback revealed that there were gaps in the curriculum that possibly were disadvantaging certain groups of students, including mature, international, queer and disabled students, rendering them invisible. Official (university controlled student surveys and other feedback mechanisms) and anecdotal feedback found that at least some students in these groups felt disenfranchised; that is, unable to relate to either the subject mater, other students, or the university setting itself. As a school in which social justice provides the context for learning about criminal justice, first year subject coordinators as a group came to recognise the need for embedding diversity in the curriculum.

Sex trafficking and moral harm : politicised understandings and depictions of the trafficked experience

This paper explores notions of harm in sex work discourse, highlighting the extent to which essentialist ideas of ‘good’ versus ‘bad’ sex have pervaded trafficking policy. In a comparative examination of Australian Parliamentary Inquiries and United States Congressional Hearings leading to the establishment of anti-trafficking policy, we identify the stories that have influenced legislators, and established a narrative of trafficking heavily dependent upon assumptions of the inherent harm of sex work. This narrative constructs a hierarchy of victimisation, which denies alternative discourses of why women migrate for sex work. We argue that it is not sexual commerce that is harmful, but pathological, systemic inequalities and entrenched disadvantage that are harmful. A narrow narrative of trafficking fails to adequately depict this complexity of the trafficked experience.

The effects of cold air (-110°C) and water (8°C) cryotherapy on knee skin temperature

Exposure to cold air, whole body cryotherapy (WBC), is a novel treatment employed by athletes. In WBC individuals dressed in minimal clothing are exposed to a temperature below -100°C for 2-4 min. The use of WBC has been advocated as a treatment for various knee injuries. PURPOSE: To compare the effects of two modalities of cryotherapy, -110°C WBC and 8°C cold water immersion (CWI) on knee skin temperature (Tsk). METHODS: With ethical approval and written informed consent 10 healthy active male participants (26.5±4.9 yr, 183.5±6.0 cm, 90.7±19.9 kg, 26.8±5.0 kg/m2, 23.0±9.3% body fat (measured by DXA), 7.6 ± 2.0 mm patellar skin fold; mean±SD) were exposed to 4 min of CWI and WBC. The treatment order was randomised in a controlled crossover design, with a minimum of 7 days between treatments. During WBC participants stood in a chamber (-60±3°C) for 20 s before entering the main chamber (-110°C±3°C) where they remained for 3 min and 40 s. For CWI participants were seated in a tank filled with cold water (8±0.3°C) and immersed to the level of the sternum for 4 min. Right knee Tsk was assessed via non-contact, infrared thermal imaging. A quadrilateral region of interest was created using inert markers placed 5 cm above and below the most superior and inferior aspect of the patella. Tsk within this quadrilateral was recorded pre, immediately post and every 10 min thereafter for 60 min. Tsk changes were examined using a two-way (treatment x time) repeated measures analyses of variance. In addition, a paired sample t-test was used to compare baseline Tsk before both treatments. RESULTS: Knee Tsk was similar before treatment (WBC: 29.9±0.7°C, CWI: 29.6±0.9°C, p>0.05). There was a significant main effect for treatment (p<0.05) and time (p<0.001). Compared to baseline, Tsk was significantly reduced (p<0.05) immediately post and at 10, 20, 30, 40, 50 and 60 min after both cooling modalities. Knee Tsk was lower (p<0.05) immediately after WBC (19.0±0.9°C) compared to CWI (20.5±0.6°C). However, from 10 to 60 min post, knee Tsk was lower (p<0.05) following the CWI treatment. CONCLUSION: WBC elicited a greater decrease in knee Tsk compared to CWI immediately after treatment. However, both modalities display different recovery patterns and Tsk after CWI was significantly lower than WBC at 10, 20, 30, 40, 50 and 60 min after treatment.

Integrated genomic characterization of endometrial carcinoma

We performed an integrated genomic, transcriptomic and proteomic characterization of 373 endometrial carcinomas using array- and sequencing-based technologies. Uterine serous tumours and ∼25% of high-grade endometrioid tumours had extensive copy number alterations, few DNA methylation changes, low oestrogen receptor/progesterone receptor levels, and frequent TP53 mutations. Most endometrioid tumours had few copy number alterations or TP53 mutations, but frequent mutations in PTEN, CTNNB1, PIK3CA, ARID1A and KRAS and novel mutations in the SWI/SNF chromatin remodelling complex gene ARID5B. A subset of endometrioid tumours that we identified had a markedly increased transversion mutation frequency and newly identified hotspot mutations in POLE. Our results classified endometrial cancers into four categories: POLE ultramutated, microsatellite instability hypermutated, copy-number low, and copy-number high. Uterine serous carcinomas share genomic features with ovarian serous and basal-like breast carcinomas. We demonstrated that the genomic features of endometrial carcinomas permit a reclassification that may affect post-surgical adjuvant treatment for women with aggressive tumours.

The Levels of Job Satisfaction, Stress and Burnout In Australian and New Zealand Haemodialysis Nurses

Background: Job dissatisfaction, stress and burnout is linked to high rates of nurses leaving the profession, poor morale, poor patient outcomes and increased financial expenditure. Haemodialysis nurses find their work satisfying although it can be stressful. Little is known, however, about job satisfaction, stress or burnout levels of haemodialysis nurses in Australia and New Zealand. Aims: To assess the current levels of job satisfaction, stress, burnout and nurses’ perception of the haemodialysis work environment. Methods: An observational study involved a cross-sectional sample of 417 registered or enrolled nurses working in Australian or New Zealand haemodialysis units. Data was collected using an on-line questionnaire containing demographic and work characteristics as well as validated measures of job satisfaction, stress, burnout and the work environment Results: 74% of respondents were aged over 40 and 75% had more than six years of haemodialysis nursing experience. Job satisfaction levels were comparable to studies in other practice areas with higher satisfaction derived from professional status and interactions with colleagues. Despite nurses viewing their work environment favourably, moderate levels of burnout were noted with frequent stressors related to workload and patient death and dying. Interestingly there were no differences found between the type or location of dialysis unit. Conclusion: Despite acceptable levels of job satisfaction and burnout, stress with workloads and facets of patient care were found. Understanding the factors that contribute to job satisfaction, stress and burnout can impact the healthcare system through decreased costs by retaining valued staff and through improved patient care.

Assessing the suitability of existing spatial data for disaster planning and mitigation in Queensland

The Council of Australian Governments (COAG) in 2003 gave in-principle approval to a best-practice report recommending a holistic approach to managing natural disasters in Australia incorporating a move from a traditional response-centric approach to a greater focus on mitigation, recovery and resilience with community well-being at the core. Since that time, there have been a range of complementary developments that have supported the COAG recommended approach. Developments have been administrative, legislative and technological, both, in reaction to the COAG initiative and resulting from regular natural disasters. This paper reviews the characteristics of the spatial data that is becoming increasingly available at Federal, state and regional jurisdictions with respect to their being fit for the purpose for disaster planning and mitigation and strengthening community resilience. In particular, Queensland foundation spatial data, which is increasingly accessible by the public under the provisions of the Right to Information Act 2009, Information Privacy Act 2009, and recent open data reform initiatives are evaluated. The Fitzroy River catchment and floodplain is used as a case study for the review undertaken. The catchment covers an area of 142,545 km2, the largest river catchment flowing to the eastern coast of Australia. The Fitzroy River basin experienced extensive flooding during the 2010–2011 Queensland floods. The basin is an area of important economic, environmental and heritage values and contains significant infrastructure critical for the mining and agricultural sectors, the two most important economic sectors for Queensland State. Consequently, the spatial datasets for this area play a critical role in disaster management and for protecting critical infrastructure essential for economic and community well-being. The foundation spatial datasets are assessed for disaster planning and mitigation purposes using data quality indicators such as resolution, accuracy, integrity, validity and audit trail.

Work environment, job satisfaction, stress and burnout among haemodialysis nurses

Aim To examine the relationships among nurse and work characteristics, job satisfaction, stress, burnout and the work environment of haemodialysis nurses. Background Haemodialysis nursing is characterised by frequent and intense contact with patients in a complex and intense environment. Method Cross-sectional online survey of 417 haemodialysis nurses that included nurse and work characteristics, the Brisbane Practice Environment Measure, Index of Work Satisfaction, Nursing Stress Scale and the Maslach Burnout Inventory. Results Haemodialysis nurses reported an acceptable level of job satisfaction and perceived their work environment positively, although high levels of burnout were found. Nurses who were older and had worked in haemodialysis the longest had higher satisfaction levels, experienced less stress and lower levels of burnout than younger nurses. The in-centre type of haemodialysis unit had greater levels of stress and burnout than home training units. Greater satisfaction with the work environment was strongly correlated with job satisfaction, lower job stress and emotional exhaustion. Conclusion Haemodialysis nurses experienced high levels of burnout even though their work environment was favourable and they had acceptable levels of job satisfaction. Implications for Nursing Management: Targeted strategies are required to retain and avoid burnout in younger and less experienced nurses in this highly specialised field of nursing.

The Politics of Sex Trafficking : a Moral Geography

This book offers a unique insight into the moral politics behind the making of human trafficking policy in Australia and the United States of America. As governments around the world rush to meet their international obligations to combat human trafficking, a heated debate has emerged over the rights, wrongs, and harms of prostitution, and its relationship to sex trafficking. The Politics of Sex Trafficking identifies and challenges intrinsic notions of moral harm that have pervaded trafficking discourse and resulted in a distinctly anti-prostitution agenda in trafficking policy in recent decades. Including rare interviews with key political actors, this book charts the competing perspectives of feminist, faith-based, and sex-worker activists, and their efforts to influence policy-makers. This critical account of the creation of anti-trafficking policy challenges the sex trafficking narrative dominant in US Congressional and Australian Parliamentary hearings, and demonstrates the power of a moral politics in shaping policy. This book will appeal to academics across the fields of criminology, criminal justice, law, human rights and gender studies, as well as policy-makers.

The need for and appropriate application of spatial data for disaster management and strengthening community resilience

It is only in recent years that the critical role that spatial data can play in disaster management and strengthening community resilience has been recognised. The recognition of this importance is singularly evident from the fact that in Australia spatial data is considered as soft infrastructure. In the aftermath of every disaster this importance is being increasingly strengthened with state agencies paying greater attention to ensuring the availability of accurate spatial data based on the lessons learnt. For example, the major flooding in Queensland during the summer of 2011 resulted in a comprehensive review of responsibilities and accountability for the provision of spatial information during such natural disasters. A high level commission of enquiry completed a comprehensive investigation of the 2011 Brisbane flood inundation event and made specific recommendations concerning the collection of and accessibility to spatial information for disaster management and for strengthening community resilience during and after a natural disaster. The lessons learnt and processes implemented were subsequently tested by natural disasters during subsequent years. This paper provides an overview of the practical implementation of the recommendations of the commission of enquiry. It focuses particularly on the measures adopted by the state agencies with the primary role for managing spatial data and the evolution of this role in Queensland State, Australia. The paper concludes with a review of the development of the role and the increasing importance of spatial data as an infrastructure for disaster planning and management which promotes the strengthening of community resilience.