Exercise and Sports Science Australia position statement on exercise training and chronic heart failure

Chronic heart failure (CHF) is a complex syndrome characterised by progressive decline in left ventricular function, low exercise tolerance and raised mortality and morbidity. Regular exercise participation has been shown to be a safe and effective treatment modality in the majority of CHF patients, partially reversing some of the maladaptations evident in myocardial and skeletal muscle function, and resulting in improvements in physical fitness and quality of life, and perhaps reduced mortality. The volume and intensity of exercise that is recommended depends on the syndrome severity, however in most patients it should consist of a combination of low-to-moderate intensity aerobic (endurance) exercise on most days of the week and individually prescribed low-to-moderate intensity resistance (strength) training at least twice per week. Additionally, all patients should be closely monitored prior to and during exercise for contraindications by an appropriately trained health professional. The purpose of this statement is to inform and guide exercise practitioners and health professionals in the safe and effective prescription and supervision of exercise for patients with CHF.

Nurses’ perspectives on the care provided to cancer patients

Background: Optimal care for patients with cancer involves the provision of effective physical and psychological care. Nurses are key providers of this care; however, the effectiveness of care is dependent on the nurses’ training, skills, attitudes, and beliefs.
Objective: The study reported in this article explored cancer nurses’ perceptions of their ability to provide psychosocial care to adults with cancer and their subsequent evaluation of the effectiveness of the care provided. This study was the first part of a larger project that evaluated the effectiveness of Proctor’s model of clinical supervision in an acute care oncology environment.
Methods: An exploratory qualitative design was used for this study. One focus group interview was conducted with 10 randomly selected registered nurses working within the oncology units at a major Melbourne tertiary referral hospital. Analytic themes were developed from the coded data using content analysis.
Results: The 4 analytic themes to emerge from the data were frustration, difficult to look after yourself, inadequate communication processes, and anger.
Conclusion: The findings from this study indicate that, although informal mechanisms of support are available for oncology nurses, most of these services are not accessed.
Implications for Practice: Leaders in cancer care hospital settings need to urgently develop and implement a model of support for their oncology nurses who are attempting to provide psychosocial support to oncology patients.

The 6-PACK programme to decrease fall-related injuries in acute hospitals: protocol for a cluster randomised controlled trial

Background and aims In-hospital fall-related injuries are a source of personal harm, preventable hospitalisation costs, and access block through increased length of stay. Despite increased fall prevention awareness and activity over the last decade, rates of reported fall-related fractures in hospitals appear not to have decreased. This cluster randomised controlled trial (RCT) aims to determine the efficacy of the 6-PACK programme for preventing fall-related injuries, and its generalisability to other acute hospitals.

Methods 24 acute medical and surgical wards from six to eight hospitals throughout Australia will be recruited for the study. Wards will be matched by type and fall-related injury rates, then randomly allocated to the 6-PACK intervention (12 wards) or usual care control group (12 wards). The 6-PACK programme includes a nine-item fall risk assessment and six nursing interventions: ‘falls alert’ sign; supervision of patients in the bathroom; ensuring patient’s walking aids are within reach; establishment of a toileting regime; use of a low-low bed; and use of bed/chair alarm. Intervention wards will be supported by a structured implementation strategy. The primary outcomes are fall and fall-related injury rates 12 months following 6-PACK implementation.

Discussion This study will involve approximately 16 000 patients, and as such is planned to be the largest hospital fall prevention RCT to be undertaken and the first to be powered for the important outcome of fall-related injuries. If effective, there is potential to implement the programme widely as part of daily patient care in acute hospital wards where fall-related injuries are a problem.

Institutional pedagogical waypoints : reflections on doctoral journeys between Taiwan and Australia

Spatial, social and academic journeys undertaken between Taiwan and Australia for doctoral education are the focus of reflection here. The discussion centres on the authors’ experiences of, on the one hand, the development of a Faculty of Education’s doctoral pedagogies in the early 2000s to reflect its international PhD candidature profile – especially from Taiwan – and, on the other, of Taiwanese doctoral candidates’ journeys through their PhDs in the Faculty. The authors write from their particular perspectives: Evans as an Australian academic and a manager of doctoral studies, and Liou as a Taiwanese academic pursuing her doctorate in an Australian university. The article considers the Australian and Taiwanese doctoral contexts between which the students transited. The institutional pedagogical strategies, from pre-enrolment to completion, are examined as waypoints on the doctoral journey for both staff and candidates.

Problematic placement : pathways pre-service teachers’ perspectives on their infant/toddler placement

The inclusion of an infant/toddler placement in a ‘pathways’ early childhood teaching degree, where students already have qualifications and experience in working with young children, can be problematic. This pilot study investigated student teachers’ views on their infant/toddler (birth-to-two-years) placement. Sixty-six students completing their early childhood education degree at an Australian university responded to a survey seeking their perspectives on the effectiveness of the placement in developing teacher confidence, knowledge and skills, and the quality of the supervision they received. The participants had entered their degree with a two-year Diploma of Children’s Services. Responses indicated significant dissatisfaction with the quality of supervision, the absence of teacher-mentors, and the lack of opportunities to practise new approaches. Participants commented that they ‘already knew’ how to work with this age group, and that they aspired to work with older children. The results align with other findings on factors associated with positive placements, and raise questions about the effectiveness of the infant/toddler placement in its current form.

Preparing professionals : student teachers and their supervisors at work

The first teaching experiences of student teachers have changed significantly in Australia even during the last fifty years. One constant has been their involvement with a supervisor, usually a practising teacher of experience. The importance attributed to this supervisory relationship has waxed and waned over the years, but it is presently receiving prominence as being the real place of learning for the novice teacher. This paper argues that the apprenticeship model, with its emphasis on performance and product, is most prominent in present supervisory conferences, despite being inappropriate for inducting student teachers into teaching as a profession. The paper suggests that the development of professional teachers calls for supervisory relationships which include discourses of critical reflection, rather than relationships that are dominated by the techniques of teaching. Further, such relationships are seen as professionally empowering for both student teachers and their supervisors.

Two-dimensional string notation for representing video sequences

Most current work on video indexing concentrates on queries which operate over high level semantic information which must be entirely composed and entered manually. We propose an indexing system which is based on spatial information about key objects in a scene. These key objects may be detected automatically, with manual supervision, and tracked through a sequence using one of a number of recently developed techniques. This representation is highly compact and allows rapid resolution of queries specified by iconic example. A number of systems have been produced which use 2D string notations to index digital image libraries. Just as 2D strings provide a compact and tractable indexing notation for digital pictures, a sequence of 2D strings might provide an index for a video or image sequence. To improve further upon this we reduce the representation to the 2D string pair representing the initial frame, and a sequence of edits to these strings. This takes advantage of the continuity between frames to further reduce the size of the notation. By representing video sequences using string edits, a notation has been developed which is compact, and allows querying on the spatial relationships of objects to be performed without rebuilding the majority of the scene. Calculating ranks of objects directly from the edit sequence allows matching with minimal calculation, thus greatly reducing search time. This paper presents the edit sequence notation and algorithms for evaluating queries over image sequences. A number of optimizations which represent a considerably saving in search time is demonstrated in the paper.

Gymnasium-based unsupervised exercise maintains benefits in oxygen uptake kinetics obtained following supervised training in type 2 diabetes

Supervised exercise (SE) in patients with type 2 diabetes improves oxygen uptake kinetics at the onset of exercise. Maintenance of these improvements, however, has not been examined when supervision is removed. We explored if potential improvements in oxygen uptake kinetics following a 12-week SE that combined aerobic and resistance training were maintained after a subsequent 12-week unsupervised exercise (UE). The involvement of cardiac output (CO) in these improvements was also tested. Nineteen volunteers with type 2 diabetes were recruited. Oxygen uptake kinetics and CO (inert gas rebreathing) responses to constant-load cycling at 50% ventilatory threshold (V_T), 80% V_T, and mid-point between V_T and peak workload (50% Δ) were examined at baseline (on 2 occasions) and following each 12-week training period. Participants decided to exercise at a local gymnasium during the UE. Thirteen subjects completed all the interventions. The time constant of phase 2 of oxygen uptake was significantly faster (p < 0.05) post-SE and post-UE compared with baseline at 50% V_T (17.3 ± 10.7 s and 17.5 ± 5.9 s vs. 29.9 ± 10.7 s), 80% V_T (18.9 ± 4.7 and 20.9 ± 8.4 vs. 34.3 ± 12.7s), and 50% Δ (20.4 ± 8.2 s and 20.2 ± 6.0 s vs. 27.6 ± 3.7 s). SE also induced faster heart rate kinetics at all 3 intensities and a larger increase in CO at 30 s in relation to 240 s at 80% V_T; and these responses were maintained post-UE. Unsupervised exercise maintained benefits in oxygen uptake kinetics obtained during a supervised exercise in subjects with diabetes, and these benefits were associated with a faster dynamic response of heart rate after training.

Aspects of parenting and family functioning associated with obesity in adolescent refugees and migrants from African backgrounds living in Australia

Objective: To investigate the relationship between parenting style and family functioning, and BMI, among adolescent migrants and refugees from African countries.

Method: A total of 104 parents and their adolescent offspring completed questionnaires assessing the variables of interest, and anthropometric data were collected from them.

Results: Parents reported higher maternal involvement, lower levels of paternal involvement, higher levels of positive parenting, greater use of ‘other’ (non-corporal) discipline styles, greater satisfaction and better communication than did their offspring. Parents also reported greater family cohesion and flexibility than adolescents, and saw their families as more enmeshed and more rigid. Parenting style and family functioning were not strong predictors of BMI according to either report. For adolescents, inconsistent discipline and lack of parental supervision accounted for significant variance in BMI.

Conclusions: Inconsistent discipline and lack of parental supervision may be related to adolescent BMI. Further studies with larger samples are required to confirm these relationships with the view to informing obesity prevention programs for this target population.

Implications: Prevention or intervention programs aimed at reducing the prevalence of overweight and obesity need to consider parenting style in their design.

Development of an online intervention for bipolar disorder. www.moodswings.net.au

We describe the development process and completed structure, of a self-help online intervention for bipolar disorder, known as MoodSwings (www.moodswings.net.au). The MoodSwings program was adapted as an Internet intervention from an efficacious and validated face-to-face, group-based psychosocial intervention. The adaptation was created by a psychologist, who had previously been involved with the validation of the face-to-face program, in collaboration with website designers. The project was conducted under the supervision of a team of clinician researchers. The website is available at no cost to registered participants. Self-help modules are accessed sequentially. Other features include a mood diary and a moderated discussion board. There has been an average of 1,475,135 hits on the site annually (2008 and 2009), with some 7400 unique visitors each year. A randomised controlled trial based on this program has been completed. Many people with bipolar disorder are accepting of the Internet as a source of treatment and, once engaged, show acceptable retention rates. The Internet appears to be a viable means of delivering psychosocial self-help strategies.

Augmented optometry training simulator with multi-point haptics

Training of optometrists is traditionally achieved under close supervision of peers and superiors. With the rapid advancement in technology, medical procedures are performed more efficiently and effectively, resulting in faster recovery times and less trauma to the patient. However, application of this technology has made it difficult to effectively demonstrate and teach these manual skills as the education is now a combination of not only the medical procedure but also the use of the technology. In this paper we propose to increase the training capabilities of optometry students through haptically-enabled single-point and multi-point training tools as well as augmented reality techniques. Haptics technology allows a human to touch and feel virtual computer models as though they are real. Through physical connection to the operator, haptic devices are considered to be personal robots that are capable of improving the human-computer interaction with a virtual environment. These devices have played an increasing role in developing expertise, reducing instances of medical error and reducing training costs. A haptically-enabled virtual training environment, integrated with an optometry slit lamp instrument can be used to teach cognitive and manual skills while the system tracks the performance of each individual. These interactions would ideally replicate every aspect of the real procedure, consequently preparing the trainee for every possible scenario, without risking the health of a real patient.

Strategies for agent-based negotiation in e-trade

£-negotiation handles negotiation over the Internet without human supervision and has shown effectiveness in concluding verifiable and more favorable agreements in a reasonably short time. In this chapter, the authors discuss the negotiation 5ystem and its components with particular emphasis on negotiation strategies. A negotiation strategy defines strategic tactics, which advise on the proper action to select from a set of possible actions that optimizes negotiation outcomes. A strategy should integrate negotiation goals and reactive attitudes. Usually, a fixed strategy is implemented during the course of negotiation regardless ofsignificant decision-makingfactors including market status, opponent :S profile, or eagerness for a negotiated goods/service. The chapter presents the main negotiation strategies and outlines the different decision-makingfactors that should be considered. A strategy uses a utility function to evaluate the offer of an opponent and advises on the generation of a counter offer or the best interaction. The authors finally discuss different utility functions presented in the literature.

A cognitive behavioural intervention for overweight and obese adolescents illustrated by four case studies

This article reports four case studies illustrating the implementation of the CHOOSE HEALTH Program, a cognitive behavioural lifestyle intervention for overweight and obese adolescents. Participants were an overweight (12 years) and obese (15 years) female, and an overweight (14 years) and obese (12 years) male. The program was delivered by provisional psychologists with program specific training and supervision. All participants demonstrated improvements in body composition, and maintained or improved dietary quality and psychosocial wellbeing. The program had variable effects on physical activity and minimal effect on cardiovascular fitness for three of the four participants. While parents and adolescents required considerable assistance to develop and monitor long term program goals, these goals were a useful clinical tool to support the adolescent and parent to recognise the improvements they had made. Identification and monitoring of specific, measurable, and realistic behaviour change strategies was particularly important in assisting adolescents and their parents to translate session information into improved health behaviours. Results indicate that an adolescent overweight and obesity treatment program that promotes adolescent responsibility and autonomy, and emphasises the importance of parent support and family change is both effective and highly acceptable to both adolescents and parents.