A prospective surveillance model for rehabilitation for women with breast cancer

Background: The current model of care for breast cancer is focused on disease treatment followed by ongoing recurrence surveillance. This approach lacks attention to the patients’ physical and functional well-being. Breast cancer treatment sequelae can lead to physical impairments and functional limitations. Common impairments include pain, fatigue, upper extremity dysfunction, lymphedema, weakness, joint arthralgia, neuropathy, weight gain, cardiovascular effects, and osteoporosis. Evidence supports prospective surveillance for early identification and treatment as a means to prevent or mitigate many of these concerns. Purpose: This paper proposes a prospective surveillance model for physical rehabilitation and exercise that can be integrated with disease treatment to create a more comprehensive approach to survivorship health care. The goals of the model are to promote surveillance for common physical impairments and functional limitations associated with breast cancer treatment, to provide education to facilitate early identification of impairments, to introduce rehabilitation and exercise intervention when physical impairments are identified and to promote and support physical activity and exercise behaviors through the trajectory of disease treatment and survivorship. Methods: The model is the result of a multi-disciplinary meeting of research and clinical experts in breast cancer survivorship and representatives of relevant professional and advocacy organizations. Outcomes: The proposed model identifies time points during breast cancer care for assessment of and education about physical impairments. Ultimately, implementation of the model may influence incidence and severity of breast cancer treatment related physical impairments. As such, the model seeks to optimize function during and following treatment and positively influence a growing survivorship community.

Teachers’ and children’s personal epistemologies for moral education : Case studies in early years elementary education

While there is strong interest in teaching values in Australia and internationally there is little focus on young children’s moral values learning in the classroom. Research shows that personal epistemology influences teaching and learning in a range of education contexts, including moral education. This study examines relationships between personal epistemologies (children’s and teachers’), pedagogies, and school contexts for moral learning in two early years classrooms. Interviews with teachers and children and analysis of school policy revealed clear patterns of personal epistemologies and pedagogies within each school. A whole school approach to understanding personal epistemologies and practice for moral values learning is suggested.

Moral and social development: teachers’ knowledge of children’s learning and teaching strategies in the early years

The intention of the analysis in this paper was to determine, from interviews with 11 early years’ teachers, what informed their knowledge of children’s learning and teaching strategies regarding moral development. Overall, the analysis revealed four main categories: definitions of moral behaviour, understanding of children’s learning, pedagogy for moral learning, and the source of knowledge for moral pedagogy. Children’s learning was attributed by five of the teachers to incidental/contextual issues. Nine of the teachers reported using pedagogies that involved discussion of issues, in various contexts, as a way of teaching about social and moral issues. The majority of the teachers (n = 7) described the source of their knowledge of pedagogy as practical/observed as opposed to being theoretically informed. There was no clear relationship between teachers’ definitions, understanding of children’s learning, pedagogy or source of knowledge. These results suggests a strong need for the teaching of moral development to be given more prominence and addressed directly in in-service courses so that teachers are clear about their intentions and the most effective ways of achieving them.

Water-based exercise for patients with chronic arm lymphedema : a randomized controlled pilot trial

Objective: To evaluate the feasibility and effect of a water-based exercise (WBE) program on lymphedema status and shoulder range of motion (ROM) among women with breast cancer related lymphedema. Design: Single-blinded, randomized controlled pilot trial. Twenty-nine eligible breast cancer survivors (median 10 years after surgery) with arm lymphedema (median 21% inter limb difference) were included and randomized into intervention (n= 15) or control (n=14). Twenty-five participants completed the study. The intervention was at least twice weekly WBE for 8 weeks; supervised initially but performed independently during the study period. Outcomes of interest were feasibility as measured by retention and adherence, lymphedema status as measured by optoelectronic perometry, bioimpedance spectroscopy and tissue dielectric constant, and shoulder range of motion (ROM) as measured by goniometer. Results: Four participants were not measured at post-intervention and were not included in the analysis (retention). Four participants in the intervention group did not perform the minimum WBE criteria set (adherence). No effect was found on lymphedema status. Compared to the control group, median ROM change for flexion was 6 (1-10) degrees (p<0.001) and 6 (0-15.5) degrees (p=0,07) for external rotation. Clinically relevant increase in the intervention group was found for 36% in flexion (p≤0.05) and (57%) in external rotation (p≤0.05) compared to controls. Conclusions: This study shows WBE is feasible for breast cancer survivors with arm lymphedema and that shoulder ROM can be improved years after cancer treatment has been completed.

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.

Spaces for Solidarity and Individualism in Educational Contexts

Foreword For children and youth, as citizens in a society, being a part of educational systems means being involved in a community. Through participation in educational systems, there is important learning about the self and others, both for individual development and social solidarity. Individual development and social solidarity are interrelated. These are important values in education at all levels. Individuals are social beings and are necessarily interdependent on others. Nevertheless, individualism and social solidarity are values that sometimes can diverge and come into conflict. These values can be defined and interpreted in various ways. In a time of neo-liberalism, for example, where individual choices and rights are put at the forefront of the societal and educational discourses in many countries it is relevant to raise questions on how issues of solidarity and individualism are interpreted and negotiated in education. What kind of shape and definitions do these concepts take when schools and preschools live under the intense pressures for the accountability of educational outcomes(Biesta, 2009)? Under what conditions can values, such as solidarity and individualism, co-exist and develop in multicultural and globalized societies, without one dominating the other...

Editorial : forecasting urban air quality

Air pollution has significant impacts on both the environment and human health. Therefore, urban areas have received ever growing attention, because they not only have the highest concentrations of air pollutants, but they also have the highest human population. In modern societies, urban air quality (UAQ) is routinely evaluated and local authorities provide regular reports to the public about current UAQ levels. Both local and international authorities also recommended that some air pollutant concentrations remain below a certain level, with the aim of reducing emissions and improving the air quality, both in urban areas and on a more regional scale. In some countries, protocols aimed at reducing emissions have come in force as a result of international agreements.

Epistemic beliefs and beliefs about teaching practices for moral learning in the early years of school : relationships and complexities

While investment in young children is recognised as important for the development of moral values for a cohesive society, little is known about early years teaching practices that promote learning of moral values. This paper reports on observations and interviews with 11 Australian teachers, focusing on their epistemic beliefs and beliefs about teaching practices for moral education with children aged 5 to 8 years. The analysis revealed three main patterns of thinking about moral education: following others, reflecting on points of view, and informing reflection for action. These patterns suggest a relationship between epistemic beliefs and beliefs about teaching practices for moral learning which have implications for teacher professional development concerning experiences in moral education.

International contact lens prescribing in 2011

This is the 11th annual report of contact lens prescribing trends that we have prepared for Contact Lens Spectrum. Each year, we capture current modes of contact lens practice by asking practitioners in each market (optometrists, opticians or ophthalmologists, as appropriate) to provide information about the first 10 lens fits undertaken after receiving our paper or electronic survey form. In 2011, we captured information about 22,362 fits in 29 countries.

Publishing

Publishing is no doubt one of the oldest and most diverse sectors in the creative economy. While publishing originally was associated with print and paper, the term is nowadays also commonly used to represent organizations that control, administer and license intellectual properties in other sectors of the creative economy such as videogames and music. While the title of this chapter is ‘Publishing’, we have no intention of covering all publishing related activities, but will focus on the economic consequences of digitization on two traditional and important print media sectors, namely books and magazines. Within these sectors we will specifically focus on consumer magazines and trade books, in other words books and magazines that are sold via commercial retailers to consumers. It is relevant to study these two publishing industries, since they share a number of very fundamental characteristics and have experienced similar economic consequences caused by the digitization of the creative economy. Both industries have undergone a gradual shift from print to digital and increasingly rely on revenues based on digital content carriers such as e- books, tablet magazine applications, special interest websites, blogs and so on.

Children's perspectives on values and rules in Australian early education

In recent years, issues relating to moral and conventional values have been emphasized in educational policies. This study examines young children’s (100 children aged 4–8 years) own understandings of values and rules for how to treat others and participate in school. Eleven classrooms, within seven different elementary schools in Queensland, were visited. Children were interviewed regarding their views about moral and conventional issues, rules and participation in everyday school life. According to the children, ‘doing the right thing’ in school involved both a concern for others’ wellbeing and for the social order in school, including conventions, rules and behaviour connected with discipline. The children’s responsibility seemed, however, to be to adapt to the (school) system, rather than being an active participant in constructing the system.

Distinguishing attack on SOBER-128 with linear masking

We present a distinguishing attack against SOBER-128 with linear masking. We found a linear approximation which has a bias of 2^− − 8.8 for the non-linear filter. The attack applies the observation made by Ekdahl and Johansson that there is a sequence of clocks for which the linear combination of some states vanishes. This linear dependency allows that the linear masking method can be applied. We also show that the bias of the distinguisher can be improved (or estimated more precisely) by considering quadratic terms of the approximation. The probability bias of the quadratic approximation used in the distinguisher is estimated to be equal to O(2^− − 51.8), so that we claim that SOBER-128 is distinguishable from truly random cipher by observing O(2^103.6) keystream words.

The birthday cake: Social relations and professional practices around mealtimes with toddlers and child care

Events that involve food and eating are important parts of the daily routine in which adults and children participate in child care settings. These events can be viewed as cultural practices because they involve certain everyday ways of acting, thinking or feeling (Grusec JE et al, Child Dev 71(1): 205–211, 2000). The cultural practices around food and eating symbolise and guide the social relations, emotions, social structures and behaviours of the participants. Identities and roles for the participants are created in these practices, marked by ambiguity, movement and fluidity through ongoing processes of negotiation (Punch S et al, Child Geogr 8(3): 227–232, 2010). The formal professional systems that guide these practices in early education and care programs often focus on the nutritional value of the food, while the children and teachers involved in these mealtime events account for the intersubjective experiences. Mealtimes provide opportunities for children and teachers to interact and co-construct meaning around the situations that arise. Of special interest in this research are teachers’ and children’s intentions for communication in the context of events involving food and eating and the kind of learning embedded in the communications that occur. Throughout this chapter, these events are referred to as mealtimes. This study is informed by phenomenological theory which aims to reach understandings about interactions and their meaning from the perspective of the participating individuals.