Health Assessment and Physical Examination

"This first Australia and New Zealand edition of the comprehensive Estes’ Health Assessment and Physical Examination is designed to teach students to assess a patient’s physical, psychological, cultural and emotional dimensions of health as a foundation of nursing care. The skills of interviewing, inspection, percussion, palpation, auscultation, and documentation are defined to help students to make clinical assessments and promote healthy patient outcomes. A strong emphasis on science encompasses all the technical aspects of anatomy, physiology and assessment, while highlighting clinically relevant information. Emphasis on caring is displayed through themes of assessment of the whole person, which also encourages nurses to think about care for themselves as well as patients."--publisher website

Diet, physical activity and substrate oxidation : implications for appetite control, weight loss and body composition

In many countries, governments and health agencies are strongly promoting physical activity as a means to prevent the accumulation of fatness that leads to weight gain and obesity. However, there is often a resistance to respond to health promotion initiatives. For example, in the UK, the Chief Medical Officer has recently reported that 71% of women and 61% of men fail to carry out even the minimal amount of physical activity recommended in the government’s guidelines. Similarly, the Food safety Agency has promoted reductions in the intake of fat, sugar and salt but with very little impact on the pattern of consumption. Why is it that recommendations to improve health are so difficult to implement, and produce the desired outcome?

An examination of keystroke dynamics for continuous user authentication

Most current computer systems authorise the user at the start of a session and do not detect whether the current user is still the initial authorised user, a substitute user, or an intruder pretending to be a valid user. Therefore, a system that continuously checks the identity of the user throughout the session is necessary without being intrusive to end-user and/or effectively doing this. Such a system is called a continuous authentication system (CAS). Researchers have applied several approaches for CAS and most of these techniques are based on biometrics. These continuous biometric authentication systems (CBAS) are supplied by user traits and characteristics. One of the main types of biometric is keystroke dynamics which has been widely tried and accepted for providing continuous user authentication. Keystroke dynamics is appealing for many reasons. First, it is less obtrusive, since users will be typing on the computer keyboard anyway. Second, it does not require extra hardware. Finally, keystroke dynamics will be available after the authentication step at the start of the computer session. Currently, there is insufficient research in the CBAS with keystroke dynamics field. To date, most of the existing schemes ignore the continuous authentication scenarios which might affect their practicality in different real world applications. Also, the contemporary CBAS with keystroke dynamics approaches use characters sequences as features that are representative of user typing behavior but their selected features criteria do not guarantee features with strong statistical significance which may cause less accurate statistical user-representation. Furthermore, their selected features do not inherently incorporate user typing behavior. Finally, the existing CBAS that are based on keystroke dynamics are typically dependent on pre-defined user-typing models for continuous authentication. This dependency restricts the systems to authenticate only known users whose typing samples are modelled. This research addresses the previous limitations associated with the existing CBAS schemes by developing a generic model to better identify and understand the characteristics and requirements of each type of CBAS and continuous authentication scenario. Also, the research proposes four statistical-based feature selection techniques that have highest statistical significance and encompasses different user typing behaviors which represent user typing patterns effectively. Finally, the research proposes the user-independent threshold approach that is able to authenticate a user accurately without needing any predefined user typing model a-priori. Also, we enhance the technique to detect the impostor or intruder who may take over during the entire computer session.

Negligible heat strain in armored vehicle officers wearing personal body armor

Objectives This study evaluated the heat strain experienced by armored vehicle officers (AVOs) wearing personal body armor (PBA) in a sub-tropical climate. Methods Twelve male AVOs, aged 35-58 years, undertook an eight hour shift while wearing PBA. Heart rate and core temperature were monitored continuously. Urine specific gravity (USG) was measured before and after, and with any urination during the shift. Results Heart rate indicated an intermittent and low-intensity nature of the work. USG revealed six AVOs were dehydrated from pre through post shift, and two others became dehydrated. Core temperature averaged 37.4 ± 0.3°C, with maximum's of 37.7 ± 0.2°C. Conclusions Despite increased age, body mass, and poor hydration practices, and Wet-Bulb Globe Temperatures in excess of 30°C; the intermittent nature and low intensity of the work prevented excessive heat strain from developing.

Effect of body position on measurements of diffusion capacity after exercise

Background--Pulmonary diffusing capacity for carbon monoxide (Dlco), alveolar capillary membrane diffusing capacity (Dm), and pulmonary capillary blood volume (Vc) are all significantly reduced after exercise. Objective--To investigate whether measurement position affects this impaired gas transfer. Methods--Before and one, two, and four hours after incremental cycle ergometer exercise to fatigue, single breath Dlco, Dm, and Vc measurements were obtained in 10 healthy men in a randomly assigned supine and upright seated position. Results--After exercise, Dlco, Dm, and Vc were significantly depressed compared with baseline in both positions. The supine position produced significantly higher values over time for Dlco (5.22 (0.13) v 4.66 (0.15) ml/min/mm Hg/l, p = 0.022) and Dm (6.78 (0.19) v 6.03 (0.19) ml/min/mm Hg/l, p = 0.016), but there was no significant position effect for Vc. There was a similar pattern of change over time for Dlco, Dm, and Vc in the two positions. Conclusions--The change in Dlco after exercise appears to be primarily due to a decrease in Vc. Although the mechanism for the reduction in Vc cannot be determined from these data, passive relocation of blood to the periphery as the result of gravity can be discounted, suggesting that active vasoconstriction of the pulmonary vasculature and/or peripheral vasodilatation is occurring after exercise.

Characteristics of men aged 50 years or older who do not take up skin self-examination following an educational intervention

Men aged 50 years or older are at high risk of melanoma, and both incidence and mortality are increasing in this group1. Skin self-examination (SSE) could be one avenue to improve outcomes from melanoma. Several recent intervention trials successfully increased SSE, but resistance to such interventions is less well studied. This posthoc secondary analysis of interventional study data aimed to identify characteristics of older men who did not take up SSE for the early signs of skin cancer, despite exposure to educational materials during a randomized intervention trial

Can a parent do too much for their child? An examination by parenting professionals of the concept of overparenting

Is there a point where parental effort can be too much? While the link between parenting effort and the wellbeing of children has been firmly established, contemporary discussion has proposed that extreme levels of parental protection of and responsiveness to children could be counterproductive. Research has not yet addressed this phenomenon to ascertain if overparenting is a genuinely different type of parenting approach. The purpose of the present study was to gain insight into the parenting actions considered by parenting professionals (psychologists and school guidance counsellors) to be overparenting. One hundred and twenty-eight professionals responded to an online survey about their observations of overparenting, with eighty-six respondents providing lists of the types of actions they believed were behavioural examples of the term. The survey data revealed that certain types of actions were considered to be indicative of overparenting, and that particular beliefs and outcomes may be involved in this parenting approach. Implications for parenting advice and education programs, and further research are discussed.

Learning processes in creative industries initiatives in developing countries : an examination of policy and practice

What does a dance group in Benin that mixes contemporary and ethnic dancing have in common with Mongolian felt producers that want to enter the design market in Europe? These are both examples of learning processes in Creative Industries initiatives in developing countries. Following the concept of sustainable development, I argue that the challenge for developing countries in contemporary society is to meet the very real need of people for economic development and opportunities for income generation, while at the same time avoiding unintended and unwanted consequences of economic development and globalisation. The concept of the Creative Industries may be a way to promote a development that is sustainable and avoids social exclusion of groups-at-risk. In line with this, I argue that the Creative Industries sector could, in fact, link economic development and the continuation and evolution of local traditions and cultural heritage. A pressing question then is: how can education and learning contribute to creating a context in which talent can flourish? This study aims to provide a comprehensive analysis of the research problem of this thesis: what elements are conducive for individual learning processes in creative development initiatives? In this, I argue that it is crucial to determine what ingredients and characteristics contribute to making these initiatives successful, that is, to meet their specific goals, in a developing context. This is explored through a staged analysis: an overview of quantitative data, an inventory and comparative case studies and, finally, the description and analysis of two in-depth case studies – felt design in Mongolia (Asia) and dance in Benin (Africa), in which I was an observer of the action phase of the local interventions. The analysis culminates in practice-related outcomes related to the operation of creative development initiatives, as well as the contribution to the academic debate on issues like the cultural gap between developed and developing countries, transformative learning and the connection of learning spaces.

Risk factors for malnutrition in community-dwelling people with Parkinson’s disease

In the elderly, the risks for protein-energy malnutrition from older age, dementia, depression and living alone have been well-documented. Other risk factors including anorexia, gastrointestinal dysfunction, loss of olfactory and taste senses and early satiety have also been suggested to contribute to poor nutritional status. In Parkinson’s disease (PD), it has been suggested that the disease symptoms may predispose people with PD to malnutrition. However, the risks for malnutrition in this population are not well-understood. The current study’s aim was to determine malnutrition risk factors in community-dwelling adults with PD. Nutritional status was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA). Data about age, time since diagnosis, medications and living situation were collected. Levodopa equivalent doses (LDED) and LDED per kg body weight (mg/kg) were calculated. Depression and anxiety were measured using the Beck’s Depression Inventory (BDI) and Spielberger Trait Anxiety questionnaire, respectively. Cognitive function was assessed using the Addenbrooke’s Cognitive Examination (ACE-R). Non-motor symptoms were assessed using the Scales for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT) and Modified Constipation Assessment Scale (MCAS). A total of 125 community-dwelling people with PD were included, average age of 70.2±9.3(35-92) years and average time since diagnosis of 7.3±5.9(0–31) years. Average body mass index (BMI) was 26.0±5.5kg/m2. Of these, 15% (n=19) were malnourished (SGA-B). Multivariate logistic regression analysis revealed that older age (OR=1.16, CI=1.02-1.31), more depressive symptoms (OR=1.26, CI=1.07-1.48), lower levels of anxiety (OR=.90, CI=.82-.99), and higher LDED per kg body weight (OR=1.57, CI=1.14-2.15) significantly increased malnutrition risk. Cognitive function, living situation, number of prescription medications, LDED, years since diagnosis and the severity of non-motor symptoms did not significantly influence malnutrition risk. Malnutrition results in poorer health outcomes. Proactively addressing the risk factors can help prevent declines in nutritional status. In the current study, older people with PD with depression and greater amounts of levodopa per body weight were at increased malnutrition risk.

Greener workplace: An examination of Green HR initiatives adoption through the theory of planned behaviour lens

The goal of this article is to propose the model of green human resource initiatives adoption. Based on innovation management and psychology literatures, attitude, pressure and controllability are key drivers for organizational change. Data were collected from 210 organizations in Australia. Results indicated that attitude, pressure and controllability significantly influenced the firms’ adoption of green HR initiatives. Attitude and resource availability especially had greater impacts than pressure. Limitation, implications and future researches are also outlined.

Candidate radial-inflow turbines and high-density working fluids for geothermal power systems

Optimisation of Organic Rankine Cycle (ORCs) for binary-cycle geothermal applications could play a major role in determining the competitiveness of low to moderate temperature geothermal resources. Part of this optimisation process is matching cycles to a given resource such that power output can be maximised. Two major and largely interrelated components of the cycle are the working fluid and the turbine. Both components need careful consideration: the selection of working fluid and appropriate operating conditions as well as optimisation of the turbine design for those conditions will determine the amount of power that can be extracted from a resource. In this paper, we present the rationale for the use of radial-inflow turbines for ORC applications and the preliminary design of several radial-inflow machines based on a number of promising ORC systems that use five different working fluids: R134a, R143a, R236fa, R245fa and n-Pentane. Preliminary meanline analysis lead to the generation of turbine designs for the various cycles with similar efficiencies (77%) but large differences in dimensions (139–289 mm rotor diameter). The highest performing cycle, based on R134a, was found to produce 33% more net power from a 150 °C resource flowing at 10 kg/s than the lowest performing cycle, based on n-Pentane.

Candidate radial-inflow turbines and high-density working fluids for geothermal power systems

Optimisation of Organic Rankine Cycles (ORCs) for binary-cycle geothermal applications could play a major role in the competitiveness of low to moderate temperature geothermal resources. Part of this optimisation process is matching cycles to a given resource such that power output can be maximised. Two major and largely interrelated components of the cycle are the working fluid and the turbine. Both components need careful consideration. Due to the temperature differences in geothermal resources a one-size-fits-all approach to surface power infrastructure is not appropriate. Furthermore, the traditional use of steam as a working fluid does not seem practical due to the low temperatures of many resources. A variety of organic fluids with low boiling points may be utilised as ORC working fluids in binary power cycle loops. Due to differences in thermodynamic properties, certain fluids are able to extract more heat from a given resource than others over certain temperature and pressure ranges. This enables the tailoring of power cycle infrastructure to best match the geothermal resource through careful selection of the working fluid and turbine design optimisation to yield the optimum overall cycle performance. This paper presents the rationale for the use of radial-inflow turbines for ORC applications and the preliminary design of several radial-inflow turbines based on a selection of promising ORC cycles using five different high-density working fluids: R134a, R143a, R236fa, R245fa and n-Pentane at sub- or trans-critical conditions. Numerous studies published compare a variety of working fluids for various ORC configurations. However, there is little information specifically pertaining to the design and implementation of ORCs using realistic radial turbine designs in terms of pressure ratios, inlet pressure, rotor size and rotational speed. Preliminary 1D analysis leads to the generation of turbine designs for the various cycles with similar efficiencies (77%) but large differences in dimensions (139289 mm rotor diameter). The highest performing cycle (R134a) was found to produce 33% more net power from a 150°C resource flowing at 10 kg/s than the lowest performing cycle (n-Pentane).

Framing Movements for Gesture Interface Design

Gesture interfaces are an attractive avenue for human-computer interaction, given the range of expression that people are able to engage when gesturing. Consequently, there is a long running stream of research into gesture as a means of interaction in the field of human-computer interaction. However, most of this research has focussed on the technical challenges of detecting and responding to people’s movements, or on exploring the interaction possibilities opened up by technical developments. There has been relatively little research on how to actually design gesture interfaces, or on the kinds of understandings of gesture that might be most useful to gesture interface designers. Running parallel to research in gesture interfaces, there is a body of research into human gesture, which would seem a useful source to draw knowledge that could inform gesture interface design. However, there is a gap between the ways that ‘gesture’ is conceived of in gesture interface research compared to gesture research. In this dissertation, I explore this gap and reflect on the appropriateness of existing research into human gesturing for the needs of gesture interface design. Through a participatory design process, I designed, prototyped and evaluated a gesture interface for the work of the dental examination. Against this grounding experience, I undertook an analysis of the work of the dental examination with particular focus on the roles that gestures play in the work to compare and discuss existing gesture research. I take the work of the gesture researcher McNeill as a point of focus, because he is widely cited within gesture interface research literature. I show that although McNeill’s research into human gesture can be applied to some important aspects of the gestures of dentistry, there remain range of gestures that McNeill’s work does not deal with directly, yet which play an important role in the work and could usefully be responded to with gesture interface technologies. I discuss some other strands of gesture research, which are less widely cited within gesture interface research, but offer a broader conception of gesture that would be useful for gesture interface design. Ultimately, I argue that the gap in conceptions of gesture between gesture interface research and gesture research is an outcome of the different interests that each community brings to bear on the research. What gesture interface research requires is attention to the problems of designing gesture interfaces for authentic context of use and assessment of existing theory in light of this.

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.