Natural and engineered kallikrein inhibitors: an emerging pharmacopoeia

The kallikreins and kallikrein-related peptidases are serine proteases that control a plethora of developmental and homeostatic phenomena, ranging from semen liquefaction to skin desquamation and blood pressure. The diversity of roles played by kallikreins has stimulated considerable interest in these enzymes from the perspective of diagnostics and drug design. Kallikreins already have well-established credentials as targets for therapeutic intervention and there is increasing appreciation of their potential both as biomarkers and as targets for inhibitor design. Here, we explore the current status of naturally occurring kallikrein protease-inhibitor complexes and illustrate how this knowledge can interface with strategies for rational re-engineering of bioscaffolds and design of small-molecule inhibitors.

Maximum recovery after knee replacement - the MARKER study rationale and protocol

Background There is little scientific evidence to support the usual practice of providing outpatient rehabilitation to patients undergoing total knee replacement surgery (TKR) immediately after discharge from the orthopaedic ward. It is hypothesised that the lack of clinical benefit is due to the low exercise intensity tolerated at this time, with patients still recovering from the effects of major orthopaedic surgery. The aim of the proposed clinical trial is to investigate the clinical and cost effectiveness of a novel rehabilitation strategy, consisting of an initial home exercise programme followed, approximately six weeks later, by higher intensity outpatient exercise classes. Methods/Design In this multicentre randomised controlled trial, 600 patients undergoing primary TKR will be recruited at the orthopaedic pre-admission clinic of 10 large public and private hospitals in Australia. There will be no change to the medical or rehabilitative care usually provided while the participant is admitted to the orthopaedic ward. After TKR, but prior to discharge from the orthopaedic ward, participants will be randomised to either the novel rehabilitation strategy or usual rehabilitative care as provided by the hospital or recommended by the orthopaedic surgeon. Outcomes assessments will be conducted at baseline (pre-admission clinic) and at 6 weeks, 6 months and 12 months following randomisation. The primary outcomes will be self-reported knee pain and physical function. Secondary outcomes include quality of life and objective measures of physical performance. Health economic data (health sector and community service utilisation, loss of productivity) will be recorded prospectively by participants in a patient diary. This patient cohort will also be followed-up annually for five years for knee pain, physical function and the need or actual incidence of further joint replacement surgery. Discussion The results of this pragmatic clinical trial can be directly implemented into clinical practice. If beneficial, the novel rehabilitation strategy of utilising outpatient exercise classes during a later rehabilitation phase would provide a feasible and potentially cost-effective intervention to optimise the physical well-being of the large number of people undergoing TKR.

“What’s going on here?” The pedagogy of a data analysis session

Data analysis sessions are a common feature of discourse analytic communities, often involving participants with varying levels of expertise to those with significant expertise. Learning how to do data analysis and working with transcripts, however, are often new experiences for doctoral candidates within the social sciences. While many guides to doctoral education focus on procedures associated with data analysis (Heath, Hindmarsh, & Luff, 2010; McHoul & Rapley, 2001; Silverman, 2011; Wetherall, Taylor, & Yates, 2001), the in situ practices of doing data analysis are relatively undocumented. This chapter has been collaboratively written by members of a special interest research group, the Transcript Analysis Group (TAG), who meet regularly to examine transcripts representing audio- and video-recorded interactional data. Here, we investigate our own actual interactional practices and participation in this group where each member is both analyst and participant. We particularly focus on the pedagogic practices enacted in the group through investigating how members engage in the scholarly practice of data analysis. A key feature of talk within the data sessions is that members work collaboratively to identify and discuss ‘noticings’ from the audio-recorded and transcribed talk being examined, produce candidate analytic observations based on these discussions, and evaluate these observations. Our investigation of how talk constructs social practices in these sessions shows that participants move fluidly between actions that demonstrate pedagogic practices and expertise. Within any one session, members can display their expertise as analysts and, at the same time, display that they have gained an understanding that they did not have before. We take an ethnomethodological position that asks, ‘what’s going on here?’ in the data analysis session. By observing the in situ practices in fine-grained detail, we show how members participate in the data analysis sessions and make sense of a transcript.

Supportive-expressive group therapy for women with metastatic breast cancer: Improving access for Australian women through use of teleconference

While supportive-expressive group therapy (SEGT) has been found to be effective in significantly reducing distress associated with life-threatening illness, the challenge in Australia is to develop a means of providing supportive interventions to rural women who may be isolated both by the experience of illness and by geographical location. In this study an adaptation of SEGT was provided to women with metastatic breast cancer (n =21), who attended face-to-face or by telephone conference call. Participants showed significant gains on standardised measures of well-being, including a reduction in negative affect and an increase in positive affect, over a 12-month period. A reduction in intrusive and avoidant stress symptoms was also observed over 12 months; however, this difference was not significant. These outcomes suggest that SEGT, delivered in an innovative way within a community setting, may be an effective means of moderating the adverse effects of a diagnosis of metastatic breast cancer while improving access to supportive care for rural women. These results are considered exploratory, as the study did not include a matched control group.