Symptom control and quality of life in lux-lung 3 : a phase III study of afatinib or cisplatin/pemetrexed in patients with advanced lung adenocarcinoma with EGFR mutations

Purpose Patient-reported symptoms and health-related quality of life (QoL) benefits were investigated in a randomized, phase III trial of afatinib or cisplatin/pemetrexed. Patients and Methods Three hundred forty-five patients with advanced epidermal growth factor receptor (EGFR) mutation-positive lung adenocarcinoma were randomly assigned 2:1 to afatinib 40 mg per day or up to six cycles of cisplatin/pemetrexed. Lung cancer symptoms and health-related QoL were assessed every 21 days until progression using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and Lung Cancer-13 questionnaires. Analyses of cough, dyspnea, and pain were preplanned, including percentage of patients who improved on therapy, time to deterioration of symptoms, and change in symptoms over time. Results Questionnaire compliance was high. Compared with chemotherapy, afatinib significantly delayed the time to deterioration for cough (hazard ratio [HR], 0.60; 95% CI, 0.41 to 0.87; P = .007) and dyspnea (HR, 0.68; 95% CI, 0.50 to 0.93; P = .015), but not pain (HR, 0.83; 95% CI, 0.62 to 1.10; P = .19). More patients on afatinib (64%) versus chemotherapy (50%) experienced improvements in dyspnea scores (P lt; .010). Differences in mean scores over time significantly favored afatinib over chemotherapy for cough (P lt; .001) and dyspnea (P = .001). Afatinib showed significantly better mean scores over time in global health status/QoL (P = .015) and physical (P = .001), role (P = .004), and cognitive (P lt; .007) functioning compared with chemotherapy. Fatigue and nausea were worse with chemotherapy, whereas diarrhea, dysphagia, and sore mouth were worse with afatinib (all P = .01). Conclusion In patients with lung adenocarcinoma with EGFR mutations, first-line afatinib was associated with better control of cough and dyspnea compared with chemotherapy, although diarrhea, dysphagia, and sore mouth were worse. Global health status/QoL was also improved over time with afatinib compared with chemotherapy.

Working towards a ‘thirdspace’ in the teaching of writing to middle years students

The teaching of writing, particularly in the middle years of schooling, is impacted on by converging, and at times, contradictory pedagogical spaces. Perceptions about the way in which writing should be taught are clearly affected by standardised testing regimes in Australia. That is, much writing is taught as a genre process, yet results on standardised tests such as National Assessment Program in Literacy and Numeracy (NAPLAN) show that the writing component consistently receives the lowest scores (ACARA, 2013. Research shows that creative and individualised approaches are necessary for quality writing (Grainger, Goouch & Lambirth, 2005). This paper investigates the writing practices of students in years 5 to 7 in two culturally and linguistically diverse schools. It shows that the writing practices of these students are greatly influenced by teachers’ perceptions about what is required by external testing bodies such as the Australian Curriculum, Assessment and Reporting Authority (ACARA). The paper will then highlight how socio-spatial theory (Lefebvre, 1991) can be applied to explain these practices and offers the notion of a more productive ‘thirdspace’ (Soja, 1996) for improvement in the teaching of writing.

Variations in acculturation and Australian physical education teacher education students' receptiveness to an alternative pedagogical approach to games teaching

Background The development of intelligent, thinking performers as a central theme in Physical Education curriculum documents worldwide has highlighted the need for an evolution of teaching styles from the dominant reproductive approach. This has prompted an Australian university to change the content and delivery of a games unit within their Physical Education Teacher Education (PETE) course and adopt a productive student centred approach that is compatible with current curriculum directives. The significance of prospective physical educators’ biographies on their receptiveness to this pedagogical innovation was studied to help recognise and understand potential differences and subsequently guide programme development to help improve the impact of teacher education. Purpose To investigate whether past school and sporting experiences are powerful influences on Australian PETE recruits’ initial perspectives about effective physical education teaching practice and their receptiveness to an alternative pedagogical approach. Participants and Setting 49 first year pre-service PETE students (53% male; 47% female; mean age 18.88 ± 1.57 years) undertaking a compulsory unit on games teaching at an Australian university volunteered to take part in the study and were grouped according to their highest level of representation in games, either school/club (n=13), regional (n=20), or state/national (n=16). Students experienced the constraints-led approach as learners and teachers during an 8-week games unit informed by nonlinear pedagogy and underpinned by motor learning theory. Data collection and Analysis Prior to the commencement of the unit participants completed part A of a two part mixed response questionnaire aimed at gathering data about their physical education and sporting background. The data were summarised using descriptive statistics. Pre and post intervention, participants completed part B responding, via Likert Scale with their opinion of the importance of each sub-component of the traditional reproductive style for an effective games teaching session. This resulted in a traditional reproductive games teaching belief score. For each sub-component, participants were invited to respond in more detail to justify their opinions. A one-way between groups analysis of variance (ANOVA), Tukey’s HSD Post Hoc Test and a two - tailed, paired samples t test were used to analyse the quantitative data. Content analysis was used to analyse the qualitative data. Findings The traditional, reproductive approach was the most frequently reported teaching approach used by the physical education teachers and sports coaches of participants in all groups. Prior to the commencement of the alternate games unit, participants in each representative level group held very strong custodial traditional reproductive games teaching beliefs. After experiencing the alternative games unit there were statistically significant differences in the traditional reproductive games teaching belief mean scores for each group, This combined with participants’ qualitative responses indicated a receptiveness to the alternative pedagogy. Conclusions The results of this present study show that, contrary to previous research undertaken in North America, in Australia, it is possible for PETE educators to change beliefs in order to overcome the constraint of acculturation and provide PETE students with the knowledge, understanding and belief in an alternate approach to teaching games in physical education compatible with curriculum documents.

Exploring retinal markers of diabetic neuropathy

Purpose To investigate the application of retinal nerve fibre layer (RNFL) thickness as a marker for severity of diabetic peripheral neuropathy (DPN) in people with Type 2 diabetes. Methods This was a cross-sectional study whereby 61 participants (mean age 61 [41-75 years], mean duration of diabetes 14 [1-40 years], 70% male) with Type 2 diabetes and DPN underwent optical coherence tomography (OCT) scans. Global and 4 quadrant (TSNI) RNFL thicknesses were measured at 3.45mm around the optic nerve head of one eye. Neuropathy disability score (NDS) was used to assess the severity of DPN on a 0 to 10 scale. Participants were divided into three age-matched groups representing mild (NDS=3-5), moderate (NDS=6-8) and severe (NDS=9-10) neuropathy. Two regression models were fitted for statistical analysis: 1) NDS scores as co-variate for global and quadrant RNFL thicknesses, 2) NDS groups as a factor for global RNFL thickness only. Results Mean (SD) RNFL thickness (µm) was 103(9) for mild neuropathy (n=34), 101(10) for moderate neuropathy (n=16) and 95(13) in the group with severe neuropathy (n=11). Global RNFL thickness and NDS scores were statistically significantly related (b=-1.20, p=0.048). When neuropathy was assessed across groups, a trend of thinner mean RNFL thickness was observed with increasing severity of neuropathy; however, this result was not statistically significant (F=2.86, p=0.065). TSNI quadrant analysis showed that mean RNFL thickness reduction in the inferior quadrant was 2.55 µm per 1 unit increase in NDS score (p=0.005). However, the regression coefficients were not statistically significant for RNFL thickness in the superior (b=-1.0, p=0.271), temporal (b=-0.90, p=0.238) and nasal (b=-0.99, p=0.205) quadrants. Conclusions RNFL thickness was reduced with increasing severity of DPN and the effect was most evident in the inferior quadrant. Measuring RNFL thickness using OCT may prove to be a useful, non-invasive technique for identifying severity of DPN and may also provide additional insight into common mechanisms for peripheral neuropathy and RNFL damage.

Retinal nerve fibre layer thickness is associated with higher risk of foot ulceration in diabetic peripheral neuropathy

Purpose To evaluate the association between retinal nerve fibre layer (RNFL) thickness and diabetic peripheral neuropathy in people with type 2 diabetes, and specifically those at higher risk of foot ulceration. Methods RNFL thicknesses was measured globally and in four quadrants (temporal, superior, nasal and inferior) at 3.45 mm diameter around the optic nerve head using optical coherence tomography (OCT). Severity of neuropathy was assessed using the Neuropathy Disability Score (NDS). Eighty-two participants with type 2 diabetes were stratified according to NDS scores (0-10) as: none, mild, moderate, and severe neuropathy. A control group was additionally included (n=17). Individuals with NDS≥ 6 (moderate and severe neuropathy) have been shown to be at higher risk of foot ulceration. A linear regression model was used to determine the association between RNFL and severity of neuropathy. Age, disease duration and diabetic retinopathy levels were fitted in the models. Independent t-test was employed for comparison between controls and the group without neuropathy, as well as for comparison between groups with higher and lower risk of foot ulceration. Analysis of variance was used to compare across all NDS groups. Results RNFL thickness was significantly associated with NDS in the inferior quadrant (b= -1.46, p=0.03). RNFL thicknesses globally and in superior, temporal and nasal quadrants did not show significant associations with NDS (all p>0.51). These findings were independent of the effect of age, disease duration and retinopathy. RNFL was thinner for the group with NDS ≥ 6 in all quadrants but was significant only inferiorly (p<0.005). RNFL for control participants was not significantly different from the group with diabetes and no neuropathy (superior p=0.07, global and all other quadrants: p>0.23). Mean RNFL thickness was not significantly different between the four NDS groups globally and in all quadrants (p=0.08 for inferior, P>0.14 for all other comparisons). Conclusions Retinal nerve fibre layer thinning is associated with neuropathy in people with type 2 diabetes. This relationship is strongest in the inferior retina and in individuals at higher risk of foot ulceration.

University Students Depression Inventory : measurement model and psychometric properties

Depression is a serious condition that impacts the academic success and emotional well-being of the university students globally. Keeping in view the debilitating nature of this condition, the present study examined the stability of the factor structure and psychometric properties of the University Student Depression Inventory (USDI; Khawaja and Bryden, 2006). There is a need to translate and validate the scale for Persian speaking students, who live in Iran, its neighboring countries and in many other Western countries. The scale was translated into the Persian language and was used as part of a battery consisting of the scales measuring suicide, depression, stress, happiness and academic achievement. The battery was administered to 359 undergraduate students, and an additional 150 students who had been referred to the mental health center of the University of Tehran as clinical sample. Confirmatory factor analysis upheld the original three-factor structure. The results exhibited internal consistency, test-retest reliability, convergent, and divergent validity, and discriminant validity. There were gender differences and male had higher mean scores on Lethargy, Cognitive\emotion, and Academic motivation subscales than female students. Findings supported the Persian version of the USDI for cross-cultural use as a valid and reliable measure in the diagnosis of depression.

Nutrition screening and assessment in Parkinson's disease : a comparison of methods

Background & Aims Nutrition screening and assessment enable early identification of malnourished people and those at risk of malnutrition. Appropriate assessment tools assist with informing and monitoring nutrition interventions. Tool choice needs to be appropriate to the population and setting. Methods Community-dwelling people with Parkinson’s disease (>18 years) were recruited. Body mass index (BMI) was calculated from weight and height. Participants were classified as underweight according to World Health Organisation (WHO) (≤18.5kg/m2) and age specific (<65 years,≤18.5kg/m2; ≥65 years,≤23.5kg/m2) cut-offs. The Mini-Nutritional Assessment (MNA) screening (MNA-SF) and total assessment scores were calculated. The Patient-Generated Subjective Global Assessment (PG-SGA), including the Subjective Global Assessment (SGA), was performed. Sensitivity, specificity, positive predictive value, negative predictive value and weighted kappa statistic of each of the above compared to SGA were determined. Results Median age of the 125 participants was 70.0(35-92) years. Age-specific BMI (Sn 68.4%, Sp 84.0%) performed better than WHO (Sn 15.8%, Sp 99.1%) categories. MNA-SF performed better (Sn 94.7%, Sp 78.3%) than both BMI categorisations for screening purposes. MNA had higher specificity but lower sensitivity than PG-SGA (MNA Sn 84.2%, Sp 87.7%; PG-SGA Sn 100.0%, Sp 69.8%). Conclusions BMI lacks sensitivity to identify malnourished people with Parkinson’s disease and should be used with caution. The MNA-SF may be a better screening tool in people with Parkinson’s disease. The PG-SGA performed well and may assist with informing and monitoring nutrition interventions. Further research should be conducted to validate screening and assessment tools in Parkinson’s disease.  

An exploratory study of staff nurses' knowledge of delirium in the medical ICU: An Asian perspective

Aim The aim of this study was to establish intensive care unit nurses’ knowledge of delirium within an acute tertiary hospital within South East Asia. Background Delirium is a common, life threatening and often preventable cause of morbidity and mortality among older patients. Undetected and untreated delirium is a catalyst to increased mortality, morbidity, functional decline and results in increased requirement for nursing care, healthcare expense and hospital length of stay. However, despite effective assessment tools to identify delirium in the acute setting, there still remains an inability of ICU nurses’ to accurately identify delirium in the critically ill patient especially that of hypoactive delirium. Method A purposive sample of 53 staff nurses from a 13-bedded medical intensive care unit within an acute tertiary teaching hospital in South East Asia were asked to participate. A 40 item 5-point Likert scale questionnaire was employed to determine the participants’ knowledge of the signs and symptoms; the risk factors and negative outcomes of delirium. Results The overall positively answered mean score was 27 (67.3%) out of a possible 40 questions. Mean scores for knowledge of signs and symptoms, risk factors and negative outcomes were 9.52 (63.5%, n = 15), 11.43 (63.5%, n = 17) and 6.0 (75%, n = 8), respectively. Conclusion Whilst the results of this study are similar to others taken from a western perspective, it appeared that the ICU nurses in this study demonstrated limited knowledge of the signs and symptoms, risk factors and negative outcomes of delirium in the critically patient. The implications for practice of this are important given the outcomes of untreated delirium.

Accused cleric link to top music school probe

THE senior Anglican clergyman at the centre of an international child sex scandal was also a governor of a prestigious English music college that is under investigation for the alleged abuse of scores of its students across decades. Robert Waddington, who is alleged to have sexually assaulted students and choirboys in Britain and Australia, was a governor of the scandal-hit Chetham's School of Music for nine years. Waddington recruited students from the school for his choir at Manchester Cathedral, and allegedly abused at least three of the boys until he retired in 1993. The police investigation into the school, which began after the conviction in February of Michael Brewer, a former Chetham's music director, for the sexual abuse of female students, has not previously looked at Waddington. A victim has told The Weekend Australian that he was aware Waddington abused several boys from Chetham's who, like him, had been in the choir. The Cambridge University-educated business analyst, who has offered to give evidence under oath to police and the Church of England's inquiry into Waddington, said the clergyman had kept a collection of pictures in his house of boys he had abused.

Psychological predictors of injury among elite athletes

Objectives: To establish injury rates among a population of elite athletes, to provide normative data for psychological variables hypothesised to be predictive of sport injuries, and to establish relations between measures of mood, perceived life stress, and injury characteristics as a precursor to introducing a psychological intervention to ameliorate the injury problem. Methods: As part of annual screening procedures, athletes at the Queensland Academy of Sport report medical and psychological status. Data from 845 screenings (433 female and 412 male athletes) were reviewed. Population specific tables of normative data were established for the Brunel mood scale and the perceived stress scale. Results: About 67% of athletes were injured each year, and about 18% were injured at the time of screening. Fifty percent of variance in stress scores could be predicted from mood scores, especially for vigour, depression, and tension. Mood and stress scores collectively had significant utility in predicting injury characteristics. Injury status (current, healed, no injury) was correctly classified with 39% accuracy, and back pain with 48% accuracy. Among a subset of 233 uninjured athletes (116 female and 117 male), five mood dimensions (anger, confusion, fatigue, tension, depression) were significantly related to orthopaedic incidents over the preceding 12 months, with each mood dimension explaining 6–7% of the variance. No sex differences in these relations were found. Conclusions: The findings support suggestions that psychological measures have utility in predicting athletic injury, although the relatively modest explained variance highlights the need to also include underlying physiological indicators of allostatic load, such as stress hormones, in predictive models.

Psychological screening and injury among elite athletes

The purpose of the present investigation was to evaluate the effectiveness of the psychological component of the Queensland Academy of Sport (QAS) Health Screening Questionnaire in screening for injury/illness characteristics among elite athletes. In total, 793 scholarship athletes (409 females and 384 males) ranging in age from 11 to 41 years (M = 19, SD = 4.4) across 20 sports at the QAS in Brisbane, Australia, completed the QAS Health Screening Questionnaire. Psychological risk factors examined were life stress and mood, as measured by the Perceived Stress Scale - 10 (PSS-10) and the Brunel Mood Scale (BRUMS) respectively, in addition to disordered eating behaviours and history of diagnosed psychological disorders. Medical risk factors examined included asthma and back pain. Single-factor MANOVAs showed multivaritate effects for injury, second injury, back pain, asthma, anxiety disorder diagnosis, and fasting. Discriminant function analyses demonstrated that life stress and mood scores had significant utility in correctly classifying injury and second injury status, asthma, back pain, anxiety, and eating disorder diagnosis, in addition to the use of fasting and vomiting as weight control methods. The present findings suggest that the psychology component of the QAS Health Screening Questionnaire demonstrates significant utility as a screening tool regarding injury/illness characteristics among elite athletes.

Coping strategies used by ballet dancers : effects of individual differences in competitive trait anxiety

The purpose of the present investigation was to examine relationships between coping strategies and competitive trait anxiety among ballet dancers. Participants were 104 classical ballet dancers from three professional ballet companies, two private dance schools, and two full-time, university dance courses in Australia. Coping strategies were assessed using the Modified COPE scale (MCOPE: Crocker & Graham, 1995), while competitive trait anxiety was assessed using the Sport Anxiety Scale (SAS: Smith, Smoll, & Schutz, 1990). Standard multiple regression analyses showed that trait anxiety scores were significant predictors of seven of the 12 coping strategies, with moderate to large effect sizes. High trait anxious dancers reported more frequent use of all categories of coping strategies. A two-way MANOVA showed no main effects for gender nor status (professional versus students) and no significant interaction effect. The present results emphasize the need for the effectiveness of specific coping strategies to be considered during the process of preparing young classical dancers for a career in professional ballet.

BDNF and TNF-α polymorphisms in memory

Here, we investigate the genetic basis of human memory in healthy individuals and the potential role of two polymorphisms, previously implicated in memory function. We have explored aspects of retrospective and prospective memory including semantic, short term, working and long-term memory in conjunction with brain derived neurotrophic factor (BDNF) and tumor necrosis factor-alpha (TNF-alpha). The memory scores for healthy individuals in the population were obtained for each memory type and the population was genotyped via restriction fragment length polymorphism for the BDNF rs6265 (Val66Met) SNP and via pyrosequencing for the TNF-alpha rs113325588 SNP. Using univariate ANOVA, a significant association of the BDNF polymorphism with visual and spatial memory retention and a significant association of the TNF-alpha polymorphism was observed with spatial memory retention. In addition, a significant interactive effect between BDNF and TNF-alpha polymorphisms was observed in spatial memory retention. In practice visual memory involves spatial information and the two memory systems work together, however our data demonstrate that individuals with the Val/Val BDNF genotype have poorer visual memory but higher spatial memory retention, indicating a level of interaction between TNF-alpha and BDNF in spatial memory retention. This is the first study to use genetic analysis to determine the interaction between BDNF and TNF-alpha in relation to memory in normal adults and provides important information regarding the effect of genetic determinants and gene interactions on human memory.

Combining recommender and reputation systems to produce better online advice

Although recommender systems and reputation systems have quite different theoretical and technical bases, both types of systems have the purpose of providing advice for decision making in e-commerce and online service environments. The similarity in purpose makes it natural to integrate both types of systems in order to produce better online advice, but their difference in theory and implementation makes the integration challenging. In this paper, we propose to use mappings to subjective opinions from values produced by recommender systems as well as from scores produced by reputation systems, and to combine the resulting opinions within the framework of subjective logic.

Less-skilled learners benefit more from metacognitive instruction to develop listening comprehension

A growing interest in using metacognitive instruction to develop listening comprehension has emerged for almost two decades. This paper investigates the impact of metacognitive instruction on less-skilled and more-skilled learners’ listening comprehension. Thirty-two female adult, Iranian, intermediate level English as a Foreign Language (EFL) learners participated in a ‘strategy-based’ instruction, planning, monitoring and evaluation. Each of three metacognitive strategies focused on promoting learners’ comprehension of International English Language Testing System (IELTS) listening texts. A comparison of pre- and post-test scores showed that the less-skilled learners benefited more from metacognitive instruction than more-skilled learners in IELTS listening tests.