Does the effect of weight lifting on lymphedema following breast cancer differ by diagnostic method: results from a randomized controlled trial

The lymphedema diagnostic method used in descriptive or intervention studies may influence results found. The purposes of this work were to compare baseline lymphedema prevalence in the physical activity and lymphedema (PAL) trial cohort and to subsequently compare the effect of the weight-lifting intervention on lymphedema, according to four standard diagnostic methods. The PAL trial was a randomized controlled intervention study, involving 295 women who had previously been treated for breast cancer, and evaluated the effect of 12 months of weight lifting on lymphedema status. Four diagnostic methods were used to evaluate lymphedema outcomes: (i) interlimb volume difference through water displacement, (ii) interlimb size difference through sum of arm circumferences, (iii) interlimb impedance ratio using bioimpedance spectroscopy, and (iv) a validated self-report survey. Of the 295 women who participated in the PAL trial, between 22 and 52% were considered to have lymphedema at baseline according to the four diagnostic criteria used. No between-group differences were noted in the proportion of women who had a change in interlimb volume, interlimb size, interlimb ratio, or survey score of ≥5, ≥5, ≥10%, and 1 unit, respectively (cumulative incidence ratio at study end for each measure ranged between 0.6 and 0.8, with confidence intervals spanning 1.0). The variation in proportions of women within the PAL trial considered to have lymphoedema at baseline highlights the potential impact of the diagnostic criteria on population surveillance regarding prevalence of this common morbidity of treatment. Importantly though, progressive weight lifting was shown to be safe for women following breast cancer, even for those at risk or with lymphedema, irrespective of the diagnostic criteria used.

A randomised, feasibility trial of a tele-health intervention for Acute Coronary Syndrome patients with depression ('MoodCare')

Background Coronary heart disease (CHD) and depression are leading causes of disease burden globally and the two often co-exist. Depression is common after Myocardial Infarction (MI) and it has been estimated that 15-35% of patients experience depressive symptoms. Co-morbid depression can impair health related quality of life (HRQOL), decrease medication adherence and appropriate utilisation of health services, lead to increased morbidity and suicide risk, and is associated with poorer CHD risk factor profiles and reduced survival. We aim to determine the feasibility of conducting a randomised, multi-centre trial designed to compare a tele-health program (MoodCare) for depression and CHD secondary prevention, with Usual Care (UC). Methods Over 1600 patients admitted after index admission for Acute Coronary Syndrome (ACS) are being screened for depression at six metropolitan hospitals in the Australian states of Victoria and Queensland. Consenting participants are then contacted at two weeks post-discharge for baseline assessment. One hundred eligible participants are to be randomised to an intervention or a usual medical care control group (50 per group). The intervention consists of up to 10 × 30-40 minute structured telephone sessions, delivered by registered psychologists, commencing within two weeks of baseline screening. The intervention focuses on depression management, lifestyle factors (physical activity, healthy eating, smoking cessation, alcohol intake), medication adherence and managing co-morbidities. Data collection occurs at baseline (Time 1), 6 months (post-intervention) (Time 2), 12 months (Time 3) and 24 months follow-up for longer term effects (Time 4). We are comparing depression (Cardiac Depression Scale [CDS]) and HRQOL (Short Form-12 [SF-12]) scores between treatment and UC groups, assessing the feasibility of the program through patient acceptability and exploring long term maintenance effects. A cost-effectiveness analysis of the costs and outcomes for patients in the intervention and control groups is being conducted from the perspective of health care costs to the government. Discussion This manuscript presents the protocol for a randomised, multi-centre trial to evaluate the feasibility of a tele-based depression management and CHD secondary prevention program for ACS patients. The results of this trial will provide valuable new information about potential psychological and wellbeing benefits, cost-effectiveness and acceptability of an innovative tele-based depression management and secondary prevention program for CHD patients experiencing depression.

A double-blind randomised controlled trial of a natural oil-based emulsion containing allantoin versus aqueous cream for managing radiation-induced skin reactions in patients with cancer

Background: Radiation-induced skin reaction (RISR) is one of the most common and distressing side effects of radiotherapy in patients with cancer. It is featured with swelling, redness, itching, pain, breaks in skin, discomfort, and a burning sensation. There is a lack of convincing evidence supporting any single practice in the prevention or management of RISR. Methods/Designs: This double-blinded randomised controlled trial aims to investigate the effects of a natural oil-based emulsion containing allantoin (as known as Moogoo Udder Cream®) versus aqueous cream in reducing RISR, improving pain, itching and quality of life in this patient group. One group will receive Moogoo Udder Cream®. Another group will receive aqueous cream. Outcome measures will be collected using patient self-administered questionnaire, interviewer administered questionnaire and clinician assessment at commencement of radiotherapy, weekly during radiotherapy, and four weeks after the completion of radiotherapy. Discussion: Despite advances of radiologic advances and supportive care, RISR are still not well managed. There is a lack of efficacious interventions in managing RISR. While anecdotal evidence suggests that Moogoo Udder Cream® may be effective in managing RISR, research is needed to substantiate this claim. This paper presents the design of a double blind randomised controlled trial that will evaluate the effects of Moogoo Udder Cream® versus aqueous cream for managing in RISR in patients with cancer. Trial registration: ACTRN 12612000568819

Urban pre-service teachers’ conceptions of teaching in rural communities

Encouraging quality teaching staff to apply for and accept teaching placements in rural and remote locations is an ongoing concern internationally. The value of different support mechanisms provided for pre-service teachers attending a rural and remote practicum[1] are investigated through theories of place and the school-community nexus. Qualitative data regarding the experiences of the pre-service teachers were collected through interviews and case study notes. This project adds to our understanding of practicum in rural areas by employing a conceptual understanding of place to propose how the experiences of a four-week practicum may contribute to urban pre-service teachers’ conceptions of work and life in a rural community

The theory and practice on pre-qualification in bidding procedure

资格预审是招标程序中重要环节.通过对投标人的资质和业绩等审查既能保证不符合 要求的投标人尽可能早地退出无谓竞争的行列,避免了大量人力"物力的损失和浪费, 又能促进建筑市场优胜劣汰,提高企业竞争力.同时鉴于目前资格预审和建筑市场存在 的问题,笔者以为通过强化资格预审可以有效推进建筑市场信用体系建设,促进行业健康发展,并且深入探讨了资格预审体系建立的具体对策和措施.

International pre-service teachers' self-confidence in critical reflective thinking and writing through an intercultural Patches program

This paper describes part of an action research study that was designed to explore the outcomes of an ongoing program in which the participants, a group of domestic and international pre-service teachers and lecturers, worked together in reflective writing workshops. While the primary long-term goal of the program was to develop the intercultural competence and understanding of all of the participants through social activities, the development of social relationships was initiated and supported by involving the participants in weekly writing workshops that focused on shared salient skills of critical reflective thinking and writing. The focus of this paper is upon the outcomes for the international students, a cohort of second year pre-service teachers from Malaysia. Findings indicated that the program was successful in developing the Malaysian pre-service teachers’ self-confidence in perceiving themselves as writers and future teachers of writing, in shifting their focus from writing product to writing process and content, and in increasing the depth of their critical reflective thinking and writing

The effectiveness of a four layer compression bandage system in comparison to Class 3 compression hosiery on healing and quality of life for patients with venous leg ulcers : a randomised controlled trial

There are an increasing number of compression systems available for treatment of venous leg ulcers and limited evidence on the relative effectiveness of these systems. The purpose of this study was to conduct a randomised controlled trial to compare the effectiveness of a 4-layer compression bandage system with Class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers. Data were collected from 103 participants on demographics, health, ulcer status, treatments, pain, depression and quality of life for 24 weeks. After 24 weeks, 86% of the 4-layer bandage group and 77% of the hosiery group were healed (p=0.24). Median time to healing for the bandage group was 10 weeks, in comparison to 14 weeks for the hosiery group (p=0.018). Cox proportional hazards regression found participants in the 4-layer system were 2.1 times (95% CI 1.2–3.5) more likely to heal than those in hosiery, while longer ulcer duration, larger ulcer area and higher depression scores significantly delayed healing. No differences between groups were found in quality of life or pain measures. Findings indicate these systems were equally effective in healing patients by 24 weeks, however a 4-layer system may produce a more rapid response.

Atomistic investigations of single-crystal silicon with pre-existing defects

Molecular dynamics (MD) simulations have been employed to investigate the single-crystal Si properties with different pre-existing cavities under nanoindentation. Cavities with different radii and positions have been considered. It is found that pre-existing cavities in the Si substrate would obviously influence the mechanical properties of Si under nanoindentation. Furthermore, pre-existing cavities would absorb part of the strain energy during loading and then release during unloading. It would decrease plastic deformation to the substrate. Particularly, the larger of the cavity or the nearer of the cavity to the substrate’s top surface, the larger decrease of Young’s modulus and hardness is usually observed. Just as expected, the larger offset of the cavity in the lateral direction, the less influence is usually seen.

Start Smart : QUT’s trial support program for commencing undergraduate students who have not completed year 12 in the past two years

Commencing students in undergraduate degrees who identify as mature age students experience particular issues when faced with enrolment into university as an adult learner (Bird & Morgan, 2003). In line with QUT’s commitment to “supporting all commencing students to adjust successfully to study at QUT by providing a strong transition experience” (QUT, 2008, 6.2.1), the Start Smart trial program was developed and implemented for Semester 1, 2012. The Start Smart trial program consists of an orientation event, wrapped around and supported by existing First Year Experience (FYE) and Retention strategies within QUT, namely the Student Success Program (SSP) and the Peer Programs Strategy (PPS). This report examines the motivations for designing a program as a response to the needs of a cohort that are unique amongst all commencing undergraduate students. Participants will be asked to consider the implications of delivering special and unique orientation events to specific cohorts, and the long term sustainability of such programs within their own university structures.

What pre-service teachers need to know to be effective at values-based education

Evidence is mounting that values education is providing positive outcomes for students, teachers and schools (Benninga, Berkowitz, Kuehn, & Smith, 2006; DEST, 2008; Hattie, 2003; Lovat, Clement, Dally, & Toomey, 2010). Despite this, Australian pre-service teacher education does not appear to be changing in ways necessary to support skilling teachers to teach with a values focus (Lovat, Dally, Clement, and Toomey, 2011). This article presents findings from a case study that explored current teachers’ perceptions of the skills pre-service teachers need to teach values education effectively. Teachers who currently teach with a values focus highlighted that pre-service teacher education degrees need to encourage an ongoing commitment to continual learning, critical reflection and growth in pre-service teachers, along with excellent questioning and listening skills. Further, they argued that pre-service teachers need to be skilled in recognising and responding to student diversity. This article ends by arguing for some changes that need to occur in pre-service teacher education in order for teachers to teach effectively with a values focus, including the need for stronger connections between pre-service and experienced teachers.

A randomised controlled trial of an enhanced interdisciplinary community based group program for people with Parkinson’s disease: study rationale and protocol

Parkinson’s disease (PD) is a progressive, chronic neurodegenerative disorder for which there is no known cure. Physical exercise programs may be used to assist with the physical management of PD. Several studies have demonstrated that community based physical therapy programs are effective in reducing physical aspects of disability among people with PD. While multidisciplinary therapy interventions may have the potential to reduce disability and improve the quality of life of people with PD, there is very limited clinical trial evidence to support or refute the use of a community based multidisciplinary or interdisciplinary programs for people with PD. A two group randomized trial is being undertaken within a community rehabilitation service in Brisbane, Australia. Community dwelling adults with a diagnosis of Idiopathic Parkinson’s disease are being recruited. Eligible participants are randomly allocated to a standard exercise rehabilitation group program or an intervention group which incorporates physical, cognitive and speech activities in a multi-tasking framework. Outcomes will be measured at 6-week intervals for a period of six months. Primary outcome measures are the Montreal Cognitive Assessment (MoCA) and the Timed Up and Go (TUG) cognitive test. Secondary outcomes include changes in health related quality of life, communication, social participation, mobility, strength and balance, and carer burden measures. This study will determine the immediate and long-term effectiveness of a unique multifocal, interdisciplinary, dual-tasking approach to the management of PD as compared to an exercise only program. We anticipate that the results of this study will have implications for the development of cost effective evidence based best practice for the treatment of people with PD living in the community.

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.

Associations between infant temperament and early feeding practices. A cross-sectional study of Australian mother-infant dyads from the NOURISH randomised controlled trial

The purpose of this study was to investigate the association between temperament in Australian infants aged 2–7 months and feeding practices of their first-time mothers (n=698). Associations between feeding practices and beliefs (Infant Feeding Questionnaire) and infant temperament (easy-difficult continuous scale from the Short Temperament Scale for Infants) were tested using linear and binary logistic regression models adjusted for a comprehensive range of covariates. Mothers of infants with a more difficult temperament reported a lower awareness of infant cues, were more likely to use food to calm and reported high concern about overweight and underweight. The covariate maternal depression score largely mirrored these associations. Infant temperament may be an important variable to consider in future research on the prevention of childhood obesity. In practice, mothers of temperamentally difficult infants may need targeted feeding advice to minimise the adoption of undesirable feeding practices.