Weight and weight change following breast cancer : evidence from a prospective, population-based, breast cancer cohort study

Background: While weight gain following breast cancer is considered common, results supporting these findings are dated. This work describes changes in body weight following breast cancer over 72 months, compares weight with normative data and explores whether weight changes over time are associated with personal, diagnostic, treatment or behavioral characteristics. Methods: A population-based sample of 287 Australian women diagnosed with early-stage invasive breast cancer was assessed prospectively at six, 12, 18 and 72 months post-surgery. Weight was clinically measured and linear mixed models were used to explore associations between weight and participant characteristics (collected via self-administered questionnaire). Those with BMI changes of one or more units were considered to have experienced clinically significant changes in weight. Results: More than half (57%) of participants were overweight or obese at 6 months post-surgery, and by 72 months post-surgery 68% of women were overweight or obese. Among those who gained more weight than age-matched norms, clinically significant weight gain between 6 and 18 months and 6 and 72 months post-surgery was observed in 24% and 39% of participants, respectively (median [range] weight gain: 3.9kg [2.0-11.3kg] and 5.2kg [0.6-28.7], respectively). Clinically-significant weight losses were observed in up to 24% of the sample (median [range] weight loss between 6 and 72 months post-surgery: -6.4kg [-1.9--24.6kg]). More extensive lymph node removal, being treated on the non-dominant side, receiving radiation therapy and lower physical activity levels at 6 months was associated with higher body weights post-breast cancer (group differences >3kg; all p<0.05). Conclusions: While average weight gain among breast cancer survivors in the long-term is small, subgroups of women experience greater gains linked with adverse health and above that experienced by age-matched counterparts. Weight change post-breast cancer is a contemporary public health issue and the integration of healthy weight education and support into standard breast cancer care has potential to significantly improve the length and quality of cancer survivorship.

Making trouble: Ethnographic designs on ruling relations for students and teachers in non-academic pathways

Since 2009, all Australian states require young people to be ‘earning or learning’ until age 17. Secondary schools and vocational colleges now accommodate students for whom the conventional academic pathways of the past were not designed. The paper reflects on a project designed to explore the moral orders in these institutional settings for managing such students in extended compulsory schooling. Originally designed as classroom ethnographies, the project involved observations over three to four weeks and interviews with teachers and students in five sites in towns experiencing high youth unemployment. The project aimed to support teachers to work productively in such classrooms with such students, under the assumption that teachers orchestrate classroom interactions. However, it became clear events in these classrooms were being shaped by relations and parties above and beyond the classroom, as much as by those present. Teachers and students were observed to both comply with, and push against, the layers of policy and institutional processes regulating their behaviours. This paper re-thinks the original project through the gaze and resources of institutional ethnography, to better account for the layers of accountabilities and documentation practices that impacted on both teacher and student behaviours. By tracing the extended webs of ‘ruling relations’, it shows both how teachers and students could make trouble for the institutional moral order, and then be held accountable for this trouble.

An international comparison of the continuing professional development process (CPD) in Australia, New Zealand and the United Kingdom

Background: The Pharmacy Board of Australia stipulated that for renewal of registration, pharmacists must have accrued a minimum of 20 CPD credits over the 2010-11 registration years (1). Mandatory CPD is not new in Pharmacy. The UK and New Zealand have both established systems of CPD in recent years. The purpose of this study is to investigate established CPD processes in the UK and New Zealand with the view to making recommendations for the implementation of the CPD process in Australia. Objectives: To compare the acquisition and guidance on documentation of CPD credit points in Australia, New Zealand and the United Kingdom. Methodology: A comparative online search of the websites of each of the registering authorities was undertaken. Any practice standards or guidelines which relate to registration or continuing professional development were analysed and compared. Results: In New Zealand the Pharmacy Council require Pharmacists to have a minimum of 12 outcome credits over a 3-year period for recertification (2, 3). The outcome credit related to each CPD action and is based on relevance to the pharmacist and their practice. It is graded between one, for CPD which has occasional relevance to practice and three which have considerable relevance to practice. There are examples of completed CPD recording sheets on their website (8). In the UK, The General Pharmaceutical Council require Pharmacists to make a minimum of nine CPD entries per year (4) and detailed guidance on how to record CPD activities is provided (5,7). The Pharmacy Board of Australia divides CPD activities into three groups (6). Of the 20 credits required annually only 10 can be gained from group one activities, which is information accessed without assessment. There is only brief guidance on the recording of CPD. Discussion: The GPhC in the UK provided the most comprehensive guidance on acquisition of CPD credit points and documentation (5,7) The Pharmacy Council of New Zealand made CPD points relevant to practice.(2,8) The Pharmacy Board of Australia provided limited information for pharmacists on CPD activities, which may impede pharmacist participation. Information may assist in increasing pharmacists’ engagement in CPD activities. In conclusion, there is variation between the three countries in the amount and type of information provided about CPD requirements.

Antioxidant responses to an acute ultra-endurance exercise: Impact on DNA stability and indications for an increased need for nutritive antioxidants in the early recovery phase

Antioxidant requirements have neither been defined for endurance nor been defined for ultra-endurance athletes. To verify whether an acute bout of ultra-endurance exercise modifies the need for nutritive antioxidants, we aimed (1) to investigate the changes of endogenous and exogenous antioxidants in response to an Ironman triathlon; (2) to particularise the relevance of antioxidant responses to the indices of oxidatively damaged blood lipids, blood cell compounds and lymphocyte DNA and (3) to examine whether potential time-points of increased susceptibility to oxidative damage are associated with alterations in the antioxidant status. Blood that was collected from forty-two well-trained male athletes 2 d pre-race, immediately post-race, and 1, 5 and 19 d later was sampled. The key findings of the present study are as follows: (1) Immediately post-race, vitamin C, alpha-tocopherol, and levels of the Trolox equivalent antioxidant capacity, the ferric reducing ability of plasma and the oxygen radical absorbance capacity (ORAC) assays increased significantly. Exercise-induced changes in the plasma antioxidant capacity were associated with changes in uric acid, bilirubin and vitamin C. (2) Significant inverse correlations between ORAC levels and indices of oxidatively damaged DNA immediately and 1 d post-race suggest a protective role of the acute antioxidant responses in DNA stability. (3) Significant decreases in carotenoids and gamma-tocopherol 1 d post-race indicate that the antioxidant intake during the first 24 h of recovery following an acute ultra-endurance exercise requires specific attention. Furthermore, the present study illustrates the importance of a diversified and well-balanced diet to maintain a physiological antioxidant status in ultra-endurance athletes in reference to recommendations.

No acute and persistent DNA damage after an Ironman triathlon

During acute and strenuous exercise, the enhanced formation of reactive oxygen species can induce damage to lipids, proteins, and nucleic acids. The aim of this study was to investigate the effect of an Ironman triathlon (3.8 km swim, 180 km cycle, 42 km run), as a prototype of ultra-endurance exercise, on DNA stability. As biomarkers of genomic instability, the number of micronuclei, nucleoplasmic bridges, and nuclear buds were measured within the cytokinesis-block micronucleus cytome assay in once-divided peripheral lymphocytes of 20 male triathletes. Blood samples were taken 2 days before, within 20 min after the race, and 5 and 19 days post-race. Overall, the number of micronuclei decreased (P < 0.05) after the race, remained at a low level until 5 days post-race, and declined further to 19 days post-race (P < 0.01). The frequency of nucleoplasmic bridges and nuclear buds did not change immediately after the triathlon. The number of nucleoplasmic bridge declined from 2 days pre-race to 19 days post-exercise (P < 0.05). The frequency of nuclear buds increased after the triathlon, peaking 5 days post-race (P < 0.01) and decreased to basic levels 19 days after the race (P < 0.01). The results suggest that an Ironman triathlon does not cause long-lasting DNA damage in well-trained athletes.

Intellectual property and emerging technologies: The new biology

This unique and comprehensive collection investigates the challenges posed to intellectual property by recent paradigm shifts in biology. It explores the legal ramifications of emerging technologies, such as genomics, synthetic biology, stem cell research, nanotechnology, and biodiscovery. Extensive contributions examine recent controversial court decisions in patent law – such as Bilski v. Kappos, and the litigation over Myriad’s patents in respect of BRCA1 and BRCA2 – while other papers explore sui generis fields, such as access to genetic resources, plant breeders' rights, and traditional knowledge. The collection considers the potential and the risks of the new biology for global challenges – such as access to health-care, the protection of the environment and biodiversity, climate change, and food security. It also considers Big Science projects – such as biobanks, the 1000 Genomes Project, and the Doomsday Vault. The inter-disciplinary research brings together the work of scholars from Australia, Canada, Europe, the UK and the US and involves not only legal analysis of case law and policy developments, but also historical, comparative, sociological, and ethical methodologies. Intellectual Property and Emerging Technologies will appeal to policy-makers, legal practitioners, business managers, inventors, scientists and researchers.

Stone baby: An exploration of trembling and its potential for visual art

Informed by Kristeva's formulation of affect and Winnicott's Holding Environment, this practice-led visual art project is an exploration into how sensitivity to the physical sensation of trembling can sustain a creative practice. Building upon this is a further enquiry into what the significance of the affective experience of trembling is for an ethics of affect in contemporary art. I have done this through object and video-based installations informed by my own experience of trembling. This has been further informed by the work of artists like Louise Bourgeois, Dennis Del Favero and Willie Doherty. The creative outcomes contribute to the discourse around ethical responses to affect by extending and developing on the works of these artists.

The development and piloting of the ISPCAN child abuse screening tool-parent version (ICAST-P)

Objective Child maltreatment is a problem that has longer recognition in the northern hemisphere and in high-income countries. Recent work has highlighted the nearly universal nature of the problem in other countries but demonstrated the lack of comparability of studies because of the variations in definitions and measures used. The International Society for the Prevention of Child Abuse and Neglect has developed instrumentation that may be used with cross-cultural and cross-national benchmarking by local investigators. Design and sampling The instrument design began with a team of expert in Brisbane in 2004. A large bank of questions were subjected to two rounds of Delphi review to develop the fielded version of the instrument. Convenience samples included approximately 120 parent respondents with children under the age of 18 in each of six countries (697 total). Results This paper presents an instrument that measures parental behaviors directed at children and reports data from pilot work in 6 countries and 7 languages. Patterns of response revealed few missing values and distributions of responses that generally were similar in the six countries. Subscales performed well in terms of internal consistency with Cronbach's alpha in very good range (0.77–0.88) with the exception of the neglect and sex abuse subscales. Results varied by child age and gender in expected directions but with large variations among the samples. About 15% of children were shaken, 24% hit on the buttocks with an object, and 37% were spanked. Reports of choking and smothering were made by 2% of parents. Conclusion These pilot data demonstrate that the instrument is well tolerated and captures variations in, and potentially harmful forms of child discipline. Practice implications The ISPCAN Child Abuse Screening Tool – Parent Version (ICAST-P) has been developed as a survey instrument to be administered to parents for the assessment of child maltreatment in a multi-national and multi-cultural context. It was developed with broad input from international experts and subjected to Dephi review, translation, and pilot testing in six countries. The results of the Delphi study and pilot testing are presented. This study demonstrates that a single instrument can be used in a broad range of cultures and languages with low rates of missing data and moderate to high internal consistency.

Postprocedural effects of gastrointestinal endoscopy performed as a day case procedure in children : implications for patient and family education

A prospective design that included a survey tool, nursing care records, and telephone interview was used to determine postprocedural effects experienced by children and families following gastrointestinal endoscopy performed as a day procedure. One hundred twenty-one children attending a pediatric gastroenterology unit for endoscopy under general anesthesia participated in the study. Physical symptoms, day care/school attendance, behavioral issues, and economic factors in the 72 hours post procedure were identified. Over half the children (n = 69, 57%) experienced pain in the hospital post procedure. Pain was reported by 73 children (60%) at home on the day of the procedure, by 55 children (45%) on Day 1 post procedure, and by 37 children (31%) on Day 2 post procedure. The throat was the most common site of pain. Nausea or vomiting was experienced by 37 children (31%) at some time following their procedure but was not associated with procedure type, age, or fasting time. Over half the children (n = 53, 51%) who usually attended day care or school did not attend the day following their procedure. Twenty-four parents (40%) who would normally have worked on the day after the procedure did not attend employment. These findings have been used to improve the preprocedural information and discharge management of patients treated in a pediatric gastroenterology ambulatory setting. © The Society of Gastroenterology Nurses & Associates 2007. All Rights Reserved.

Health Assessment and Physical Examination, 2nd Edition

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 refined to help students to make clinical judgements 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.

A comparative study of side-band Fresnel holograms recorded with self-imaging and general objects

This paper deals with new results obtained in regard to the reconstruction properties of side-band Fresnel holograms (SBFH) of self-imaging type objects (for example, gratings) as compared with those of general objects. The major finding is that a distribution I2, which appears on the real-image plane along with the conventional real-image I1, remains a 2Z distribution (where 2Z is the axial distance between the object and its self-imaging plane) under a variety of situations, while its nature and focusing properties differ from one situation to another. It is demonstrated that the two distributions I1 and I2 can be used in the development of a novel technique for image subtraction.

The non-literary Latin letters. A study of their syntax and pragmatics

This dissertation studies the language of Latin letters that were written in Egypt and Vindolanda (in northern Britain) during the period 1st century BC 3rd century AD on papyri, ostraca, and wooden tablets. The majority of the texts is, in one way or another, connected with the Roman army. The focus of the study is on syntax and pragmatics. Besides traditional philological methods, modern syntactic theory is used as well, especially in the pragmatic analysis. The study begins with a critical survey of certain concepts that are current in the research on the Latin language, most importantly the concept of vulgar Latin , which, it is argued, seems to be used as an abstract noun for variation and change in Latin . Further, it is necessary to treat even the non-literary material primarily as written texts and not as straightforward reflections of spoken language. An examination of letter phraseology shows that there is considerable variation between the two major geographical areas of provenance. Latin letter writing in Egypt was influenced by Greek. The study highlights the importance of seeing the letters as a text type, with recurring phraseological elements appearing in the body text as well. It is argued that recognising these elements is essential for the correct analysis of the syntax. Three areas of syntax are discussed in detail: sentence connection (mainly parataxis), syntactically incoherent structures and word order (the order of the object and the verb). For certain types of sentence connection we may plausibly posit an origin in spoken Latin, but for many other linguistic phenomena attested in this material the issue of spoken Latin is anything but simple. Concerning the study of historical syntax, the letters offer information about the changing status of the accusative case. Incoherent structures may reflect contaminations in spoken language but usually the reason for them is the inability of the writer to put his thoughts into writing, especially when there is something more complicated to be expressed. Many incoherent expressions reflect the need to start the predication with a thematic constituent. Latin word order is seen as resulting from an interaction of syntactic and pragmatic factors. The preference for an order where the topic is placed sentence-initially can be seen in word order more generally as well. Furthermore, there appears a difference between Egypt and Vindolanda. The letters from Vindolanda show the order O(bject) V(erb) clearly more often than the letters from Egypt. Interestingly, this difference correlates with another, namely the use of the anaphoric pronoun is. This is an interesting observation in view of the fact that both of these are traditional Latin features, as opposed to those that foreshadow the Romance development (VO order and use of the anaphoric ille). However, it is difficult to say whether this is an indication of social or regional variation.

Modernity, postmodernity and identity of jazz in Chile : The cases of the generation of 1990 and Ángel Parra

This research is about jazz in Chile in relation to modernity and identity. Final chapters focus and detach latest jazz musician s generation in 1990 decade and composer guitarist Angel Parra. An historic and sociological approach is developed, which will be useful for modernity and identity analysis, and so on post modernity and globalization. Modernity has been studied in texts of Adorno, Baudrillard, Brünner, García Canclini, Habermas and Jameson. Identity has been studied in texts of Aharonián, Cordúa, Garretón, Gissi, Larraín and others. Chapter 3 is about Latin-American musicology and jazz investigations, in relation to approach developed in chapter 2. Chapters 4 and 5 are about history of jazz in Chile until beginning of XXI century. Chapter 6 focuses in Ángel Parra Orrego. Conclusions of this investigation detach the modernist mechanical that has conducted jazz development in Chile, which in Ángel Parra´s case has been overcame by a post modernist behaviour. This behaviour has solved in a creative way, subjects like modernity and identity in jazz practice in a Latin-American country.

Essential Oil Composition of Diploid and Tetraploid Clones of Ginger (Zingiber officinale Roscoe) Grown in Australia

Ginger oil, obtained by steam distillation of the rhizome of Zingiber officinale Roscoe, is used in the beverage and fragrance industries. Ginger oil displays considerable compositional diversity, but is typically characterized by a high content of sesquiterpene hydrocarbons, including zingiberene, arcurcumene, â-bisabolene, and â-sesquiphellandrene. Australian ginger oil has a reputation for possessing a particular “lemony” aroma, due to its high content of the isomers neral and geranial, often collectively referred to as citral. Fresh rhizomes of 17 clones of Australian ginger, including commercial cultivars and experimental tetraploid clones, were steam distilled 7 weeks post-harvest, and the resulting oils were analyzed by GC-MS. The essential oils of 16 of the 17 clones, including the tetraploid clones and their parent cultivar, were found to be of substantially similar composition. These oils were characterized by very high citral levels (51-71%) and relatively low levels of the sesquiterpene hydrocarbons typical of ginger oil. The citral levels of most of these oils exceeded those previously reported for ginger oils. The neral-to-geranial ratio was shown to be remarkably constant (0.61 ( 0.01) across all 17 clones. One clone, the cultivar “Jamaican”, yielded oil with a substantially different composition, lower citral content and higher levels of sesquiterpene hydrocarbons. Because this cultivar also contains significantly higher concentrations of pungent gingerols, it possesses unique aroma and flavor characteristics, which should be of commercial interest.

Tekstit viraston työssä : Tutkimus etuuspäätösten kielestä ja konteksteista

Texts in the work of a city department: A study of the language and context of benefit decisions This dissertation examines documents granting or denying the access to municipal services. The data consist of decisions on transport services made by the Social Services Department of the City of Helsinki. The circumstances surrounding official texts and their language and production are studied through textual analysis and interviews. The dissertation describes the textual features of the above decisions, and seeks to explain such features. Also explored are the topics and methods of genre studies, especially the relationship between text and context. Although the approach is linguistic, the dissertation also touches on research in social work and administrative decision making, and contributes to more general discussion on the language and duties of public administration. My key premise is that a text is more than a mere psycholinguistic phenomenon. Rather, a text is also a physical object and the result of certain production processes. This dissertation thus not only describes genre-specific features, but also sheds light on the work that generates the texts examined. Textual analysis and analyses of discursive practices are linked through an analysis of intertextuality: written decisions are compared with other application documents, such as expert statements and the applications themselves. The study shows that decisions are texts governed by strict rules and written with modest resources. Textwork is organised as hierarchical mass production. The officials who write decisions rely on standard phrases extracted from a computer system. This allows them to produce texts of uniform quality which have been approved by the department s legal experts. Using a computer system in text production does not, however, serve all the needs of the writers. This leads to many problems in the texts themselves. Intertextual analysis indicates that medical argumentation weighs most heavily in an application process, although a social appraisal should be carried out when deciding on applications for transport services. The texts reflect a hierarchy in which a physician ranks above the applicant, and the department s own expert physician ranks above the applicant s physician. My analysis also highlights good, but less obvious practices. The social workers and secretaries who write decisions must balance conflicting demands. They use delicate linguistic means to adjust the standard phrases to suit individual cases, and employ subtle strategies of politeness. The dissertation suggests that the customer contact staff who write official texts should be allowed to make better use of their professional competence. A more general concern is that legislation and new management strategies require more and more documentation. Yet, textwork is only rarely taken into account in the allocation of resources. Keywords: (Critical) text analysis, genre analysis, administration, social work, administrative language, texts, genres, context, intertextuality, discursive practices