Emotional effort and perceived support in renal nursing: A comparative interview study

Background: Social support is an important moderator of poor well-being outcomes for nurses engaged in emotional labour with patients; however, the most effective support for renal nurses is not well understood compared with other specialties. Objectives: To identify patterns and themes in how renal nurses and two other specialties engage with patients’ emotional expressions, express their own emotion and access and provide support for emotional expenditure. Method: Renal, emergency and palliative care nurses from Perth, Western Australia, were interviewed. Results: Renal nurses engage in significant amounts of emotional labour with patients, and identify co-workers as the most important source of support due to their availability and a sense of shared experience. However, comparative analysis showed that renal nurses do not recognise their emotional expenditure as readily and have less certainty of co-worker support. Conclusions: Because their high levels of emotional engagement with patients are mostly positive, renal nurses are less prepared than other nurses to manage difficult emotional situations. As co-worker support is highly valued, organisations should train renal nurses specifically to support one another.

A review and comparative analysis of international drug driving policies. Report to the New South Wales (NSW) Centre for Road Safety

The New South Wales (NSW) Centre for Road Safety (CRS) called for research services to conduct a review of international policy and practice to address drug-driving. The project sought to provide Transport for NSW (TfNSW) with a comprehensive review of current and emerging international practices in this area1. This report is submitted by the Centre for Accident Research and Road Safety – Queensland (CARRS-Q)...

Dynamic input to determine hip joint moments, power and work on the prosthetic limb of transfemoral amputees: ground reactions vs knee reactions

Study Design: Comparative analysis Background: Calculations of lower limbs kinetics are limited by floor-mounted force-plates. Objectives: Comparison of hip joint moments, power and mechanical work on the prosthetic limb of a transfemoral amputee calculated by inverse dynamics using either the ground reactions (force-plates) or knee reactions (transducer). Methods: Kinematics, ground reactions and knee reactions were collected using a motion analysis system, two force-plates and a multi-axial transducer mounted below the socket, respectively. Results: The inverse dynamics using ground reactions under-estimated the peaks of hip energy generation and absorption occurring at 63 % and 76 % of the gait cycle (GC) by 28 % and 54 %, respectively. This method over-estimated a phase of negative work at the hip (from 37 %GC to 56 %GC) by 24%. It under-estimated the phases of positive (from 57 %GC to 72 %GC) and negative (from 73 %GC to 98 %GC) work at the hip by 11 % and 58%, respectively. Conclusions: A transducer mounted within the prosthesis has the capacity to provide more realistic kinetics of the prosthetic limb because it enables assessment of multiple consecutive steps and a wide range of activities without issues of foot placement on force-plates. CLINICAL RELEVANCE The hip is the only joint that an amputee controls directly to set in motion the prosthesis. Hip joint kinetics are associated with joint degeneration, low back pain, risks of fall, etc. Therefore, realistic assessment of hip kinetics over multiple gait cycles and a wide range of activities is essential.

Performance dispersion for evidence-based classification of stationary throwers

Background There is a need for better understanding of the dispersion of classification-related variable to develop an evidence-based classification of athletes with a disability participating in stationary throwing events. Objectives The purposes of this study are (A) to describe tools designed to comprehend and represent the dispersion of the performance between successive classes, and (B) to present this dispersion for the elite male and female stationary shot-putters who participated in Beijing 2008 Paralympic Games. Study design Retrospective study Methods This study analysed a total of 479 attempts performed by 114 male and female stationary shot-putters in three F30s (F32-F34) and six F50s (F52-F58) classes during the course of eight events during Beijing 2008 Paralympic Games. Results The average differences of best performance were 1.46±0.46 m for males between F54 and F58 classes as well as 1.06±1.18 m for females between F55 and F58 classes. The results demonstrated a linear relationship between best performance and classification while revealing two male Gold Medallists in F33 and F52 classes were outliers. Conclusions This study confirms the benefits of the comparative matrices, performance continuum and dispersion plots to comprehend classification-related variables. The work presented here represents a stepping stone into biomechanical analyses of stationary throwers, particularly on the eve of the London 2012 Paralympic Games where new evidences could be gathered.

Direct measurement as a tool for assessing the accuracy of inverse dynamics

The understanding of the loads generated within the prosthetic leg can aid engineers in the design of components and clinicians in the process of rehabilitation. Traditional methods to assess these loads have relied on inverse dynamics. This indirect method estimates the applied load using video recordings and force-plates located at a distance from the region of interest, such as the base of the residuum. The well-known limitations of this method are related to the accuracy of this recursive model and the experimental conditions required (Frossard et al., 2003). Recent developments in sensors (Frossard et al., 2003) and prosthetic fixation (Brånemark et al., 2000) permit the direct measurement of the loads applied on the residuum of transfemoral amputees. In principle, direct measurement should be an appropriate tool for assessing the accuracy of inverse dynamics. The purpose of this paper is to determine the validity of this assumption. The comparative variable used in this study is the velocity of the relative body center of mass (VCOM(t)). The relativity is used to align the static (w.r.t. position) force plate measurement with the dynamic load cell measurement.

7-point Subjective Global Assessment is more time sensitive than conventional Subjective Global Assessment in detecting nutrition changes

Background: It is important for nutrition intervention in malnourished patients to be guided by accurate evaluation and detection of small changes in the patient’s nutrition status over time. However, the current Subjective Global Assessment (SGA) is not able to detect changes in a short period of time. The aim of the study was to determine whether 7-point SGA is more time sensitive to nutrition changes than the conventional SGA. Methods: In this prospective study, 67 adult inpatients assessed as malnourished using both the 7-point SGA and conventional SGA were recruited. Each patient received nutrition intervention and was followed up post-discharge. Patients were reassessed using both tools at 1, 3 and 5 months from baseline assessment. Results: It took significantly shorter time to see a one-point change using 7-point SGA compared to conventional SGA (median: 1 month vs. 3 months, p = 0.002). The likelihood of at least a one-point change is 6.74 times greater in 7-point SGA compared to conventional SGA after controlling for age, gender and medical specialties (odds ratio = 6.74, 95% CI 2.88-15.80, p<0.001). Fifty-six percent of patients who had no change in SGA score had changes detected using 7-point SGA. The level of agreement was 100% (k = 1, p < 0.001) between 7-point SGA and 3-point SGA and 83% (k=0.726, p<0.001) between two blinded assessors for 7-point SGA. Conclusion: The 7-point SGA is more time sensitive in its response to nutrition changes than conventional SGA. It can be used to guide nutrition intervention for patients.

A comparative study of prognostic model for bearing failure

An effective prognostics program will provide ample lead time for maintenance engineers to schedule a repair and to acquire replacement components before catastrophic failures occur. This paper presents a technique for accurate assessment of the remnant life of machines based on health state probability estimation technique. For comparative study of the proposed model with the proportional hazard model (PHM), experimental bearing failure data from an accelerated bearing test rig were used. The result shows that the proposed prognostic model based on health state probability estimation can provide a more accurate prediction capability than the commonly used PHM in bearing failure case study.

Exercise, Nutrition, and Bone Health

Optimal bone metabolism is the result of hormonal, nutritional, and mechanical harmony, and a deficit in one area is usually impossible to overcome by improvements in others. Exercise during growth influences bone modeling locally at the regions being loaded, whereas calcium is thought to act systemically to influence bone remodeling. Despite acting through different mechanisms, a growing body of research suggests that exercise and calcium may not operate independently. Low dietary calcium intake or reduced bioavailability may minimize the adaptive response to exercise-induced bone loading. Conversely, adequate levels of calcium intake can maximize the positive effect of physical activity on bone health during the growth period of children and adolescents. Research also suggests that adequate levels of calcium intake can maximize bone density at the regions being loaded during exercise. Achieving optimal bone health and minimizing one’s risk of osteoporotic fracture later in life depend on a lifelong approach. This approach relies on the establishment of an optimum level of bone during the growth years, with a subsequent goal to maintain and slow the rate of age-related bone loss thereafter. Exercise, adequate nutrition, and optimal hormone levels are the components that influence the bone outcome. Making healthy nutritional choices, engaging in weight-bearing physical activity, and ensuring optimal hormone levels during growth provides a window of opportunity to build optimal bone mass, to reduce the risk of fracture later in life. Concurrent management of fracture risk with a physical activity prescription, adequate nutrition, and pharmacotherapy for osteoporosis when required offers the best approach to optimal bone health throughout adulthood.

Comparative exploration of narrative processes for better and poorer outcomes for depression

Background Contemporary psychotherapy research demonstrates that whilst most clients respond positively to psychological interventions, a small, but significant proportion of clients fail to experience the expected benefits of therapy. Although methodologies exist that enable the identification of successful and unsuccessful therapy, we have a limited understanding of the processes associated with these outcomes. Aim The current study sought to examine the relationship between therapeutic outcome and therapeutic language. Methodology: The therapeutic outcomes of 42 trainee-therapists who provided psychotherapy to 173 clients were tracked with the OQ-45.2 over a 5 year period with the view of identifying the client/ trainee-therapist dyads with the best and poorest outcomes. The 6 best outcome and 6 poorest outcome client/ trainee-therapist dyads were identified in order to examine the characteristics of therapeutic conversations associated with better and poorer therapy outcomes. Therapeutic conversations were analysed with the Narrative Process Coding System. Findings The best outcome client/ trainee-therapist dyads demonstrated significant increases in reflexive conversation over the course of psychotherapy. Implications Examining the practices of the best and poorest outcome client/ trainee-therapist dyads with objective measures of therapy outcome provides an important first step in understanding how therapeutic language may contribute to the greatest therapeutic improvement or deterioration.

A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010

BACKGROUND Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. METHODS We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. FINDINGS In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% [95% uncertainty interval 6·2-7·7] of global DALYs), tobacco smoking including second-hand smoke (6·3% [5·5-7·0]), and alcohol use (5·5% [5·0-5·9]). In 1990, the leading risks were childhood underweight (7·9% [6·8-9·4]), household air pollution from solid fuels (HAP; 7·0% [5·6-8·3]), and tobacco smoking including second-hand smoke (6·1% [5·4-6·8]). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2-10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0·9% (0·4-1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. INTERPRETATION Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children.

Bone-anchored prosthesis: Update in international developments

This symposium will provide hand-on update on the current development of the load sensors measuring the inner prosthetic loading that can strongly contribute the ever increasing demand for evidence-based clinical practice. Surgical implantations of osseointegrated fixations for bone-anchored prosthesis are developing at an unprecedented pace worldwide (e.g., Australia, UK, Sweden, US). This option is becoming accessible to a wide range of individuals with limb loss. With these new developments come new potential challenges and opportunities for all the stakeholders involved in the prosthetic care of these patients. Clearly, there is a need for those stakeholders, particularly those attending the ISPO, to be informed of the current and upcoming international developments in bone-anchored prostheses. The objectives of this symposium will be: • To present an overview of the current growth of the procedures worldwide (e.g., identification of key players, centers of activities, growth trend) with a strong focus on the introduction of the framework to evaluate the availability of the procedure at national level (e.g., number of patients treated, range of the levels of implantation, number of commercial fixations accessible), • To provide first-hand updates on the latest cutting-edge scientific and clinical developments of fixations and rehabilitations programs (e.g., Innovative design of implant, cost-effectiveness, long-terms rehabilitation outcomes for screw-type fixation, current developments in US, comparative analysis for press-fit type of implant, potential moves toward single-stage surgeries).

Using academagogy to meet the needs of millennial learners: A comparative case study

Higher education institutions across the world are experiencing a new generation of students, known as millennial learners. They are more technologically literate and digitally connected than previous generations of learners. To meet the teaching and learning needs of these learners, we must offer more deliberate and meaningful learning experiences and opportunities, where students can see the connections between new material and their own experiences and real world applications – an academagogic approach. This study compares the implementation of academagogy for two different groups of millennial learners – one a traditional face-to-face undergraduate Engineering unit, and the other a mixed-mode (online and face-to-face) undergraduate Design unit. The units are discussed in terms of their student evaluation results, both qualitative and quantitative, and in terms of their academic outcomes for students. Conclusions are drawn about the applicability of academagogy as a heuristic for improving teaching and learning across disciplines, as well as its strengths and limitations in terms of student results.

Comparative durability study of CFRP strengthened tubular steel members under cold weather

In strengthening systems, the CFRP (Carbon Fibre Reinforced Polymer) materials typically have excellent resistance against environmental conditions; however, the performance of adhesives between CFRP and steel is generally affected by various environmental conditions such as marine environment, cold and hot weather. This paper presents the comparative durability study of CFRP strengthened tubular steel structures by using two different adhesives such as MBrace saturant and Araldite K630 under four-point bending. The program consisted of testing twelve CFRP strengthened specimens having treated with epoxy based adhesion promoter, untreated surface and one unstrengthened specimen and conditioned under cold weather for 3 and 6 months to determine the environmental durability. The beams were then loaded to failure in quasi-static manner under four-point bending. The structural responses of CFRP strengthened tubular steel beams were compared in terms of failure load, stiffness and modes of failure. The research findings show that the cold weather immersion had adversely affected the durability of CFRP strengthened steel members. Design factor is also proposed to address the short-terms durability performance under cold weather.

Antioxidants in Athlete's Basic Nutrition: Considerations towards a Guideline for the Intake of Vitamin C and Vitamin E

Antioxidants in acute physical exercise and exercise training remain a hot topic in sport nutrition, exercise physiology and biology, in general (Jackson, 2008; Margaritis and Rousseau, 2008; Gomez-Cabrera et al., 2012; Nikolaidis et al., 2012). During the past few decades, antioxidants have received attention predominantly as a nutritional strategy for preventing or minimising detrimental effects of reactive oxygen and nitrogen species (RONS), which are generated during and after strenuous exercise (Jackson, 2008, 2009; Powers and Jackson, 2008). Antioxidant supplementation has become a common practice among athletes as a means to (theoretically) reduce oxidative stress, promote recovery and enhance performance (Peternelj and Coombes, 2011). However, until now, requirements of antioxidant micronutrients and antioxidant compounds for athletes training for and competing in different sport events, including marathon running, triathlon races or team sport events involving repeated sprinting, have not been determined sufficiently (Williams et al., 2006; Margaritis and Rousseau, 2008). Crucially, evidence has been emerging that higher dosages of antioxidants may not necessarily be beneficial in this context, but can also elicit detrimental effects by interfering with performance-enhancing (Gomez-Cabrera et al., 2008) and health-promoting training adaptations (Ristow et al., 2009). As originally postulated in a pioneering study on exercise-induced production of RONS by Davies et al. (1982) in the early 1980s, evidence has been increasing in recent years that RONS are not only damaging agents, but also act as signalling molecules for regulating muscle function (Reid, 2001; Jackson, 2008) and for initiating adaptive responses to exercise (Jackson, 2009; Powers et al., 2010). The recognition that antioxidants could, vice versa, interact with the signalling pathways underlying the responses to acute (and repeated) bouts of exercise has contributed important novel aspects to the continued discussion on antioxidant requirements for athletes. In view of the recent advances in this field, it is the aim of this report to examine the current knowledge of antioxidants, in particular of vitamins C and E, in the basic nutrition of athletes. While overviews on related topics including basic mechanisms of exercise-induced oxidative stress, redox biology, antioxidant defence systems and a summary of studies on antioxidant supplementation during exercise training are provided, this does not mean that this report is comprehensive. Several issues of the expanding and multidisciplinary field of antioxidants and exercise are covered elsewhere in this book and/or in the literature. Exemplarily, the reader is referred to reviews on oxidative stress (Konig et al., 2001; Vollaard et al., 2005; Knez et al., 2006; Powers and Jackson, 2008; Nikolaidis et al., 2012), redox-sensitive signalling and muscle function (Reid, 2001; Vollaard et al., 2005; Jackson, 2008; Ji, 2008; Powers and Jackson, 2008; Powers et al., 2010; Radak et al., 2013) and antioxidant supplementation (Williams et al., 2006; Peake et al., 2007; Peternelj and Coombes, 2011) in the context with exercise. Within the scope of the report, we rather aim to address the question regarding requirements of antioxidants, specifically vitamins C and E, during exercise training, draw conclusions and provide practical implications from the recent research.

Wastewater pollution abatement in China: A comparative study of fifteen industrial sectors from 1998 to 2010

This study analyzes the management of wastewater pollutants in a number of Chinese industrial sectors from 1998 to 2010. We use decomposition analysis to calculate changes in wastewater pollutant emissions that result from cleaner production processes, end-of-pipe treatment, structural changes in industry, and changes in the scale of production. We focus on one indicator of water quality and three pollutants: chemical oxygen demand (COD), petroleum, cyanide, and volatile phenols. We find that until 2002, COD emissions were mainly reduced through end-of-pipe treatments. Cleaner production processes didn’t begin contributing to COD emissions reductions until the introduction of a 2003 law that enforced their implementation. Petroleum emissions were primarily lowered through cleaner production mechanisms, which have the added benefit of reducing the input cost of intermediate petroleum. Diverse and effective pollution abatement strategies for cyanide and volatile phenols are emerging among industries in China. It will be important for the government to consider differences between industries should they choose to regulate the emissions of specific chemical substances.