Persons of Interest

A world in upheaval; two lives lived under stress … This story is set in the social and political landscape of pre– and post–World War II. It tells two vastly different tales of Cecily and John's lives in Australia and overseas, as nations clashed, and governments and international organisations tried to remake the world. Cecily Nixon knew that marrying John Burton would be bad for her. But she loved him and, impressed with this handsome, sullen young man and his belief that he could change the world for the better, saw her role in life as to serve the world through John. Cecily’s story is a deeply personal and psychological one of love, duty and betrayal that explores the complexities of relationships. In a world that overwhelmed her, Cecily searched for 'wholeness’ and delved deep into her psyche to find herself and emerge from John’s shadow. John has been known as an influential and controversial young head of Australia’s Department of External Affairs – and as a would-be politician. It is less known that he was also an innovative farmer, bookseller, entrepreneur, arts patron and writer. He received international acclaim for his later work in conflict analysis and resolution. These combined stories of courage and achievement unfold amid political intrigue and psychological trauma. ASIO surveillance, love triangles, loyalty, infidelity and tragedy all play their part in the Burtons’ lives

Educational interventions for the management of cancer-related fatigue in adults

Background: Cancer-related fatigue is reported as the most common and distressing symptom experienced by patients with cancer. It can exacerbate the experience of other symptoms, negatively affect mood, interfere with the ability to carry out everyday activities, and negatively impact on quality of life. Educational interventions may help people to manage this fatigue or to cope with this symptom, and reduce its overall burden. Despite the importance of education for managing cancer-related fatigue there are currently no systematic reviews examining this approach. Objectives: To determine the effectiveness of educational interventions for managing cancer-related fatigue in adults. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), and MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, OTseeker and PEDro up to 1st November 2016. We also searched trials registries. Selection criteria: We included randomised controlled trials (RCTs) of educational interventions focused on cancer-related fatigue where fatigue was a primary outcome. Studies must have aimed to evaluate the effect of educational interventions designed specifically to manage cancer-related fatigue, or to evaluate educational interventions targeting a constellation of physical symptoms or quality of life where fatigue was the primary focus. The studies could have compared educational interventions with no intervention or wait list controls, usual care or attention controls, or an alternative intervention for cancer-related fatigue in adults with any type of cancer. Data collection and analysis: Two review authors independently screened studies for inclusion and extracted data. We resolved differences in opinion by discussion. Trial authors were contacted for additional information. A third independent person checked the data extraction. The main outcome considered in this review was cancer-related fatigue. We assessed the evidence using GRADE and created a 'Summary of Findings' table. Main results: We included 14 RCTs with 2213 participants across different cancer diagnoses. Four studies used only 'information-giving' educational strategies, whereas the remainder used mainly information-giving strategies coupled with some problem-solving, reinforcement, or support techniques. Interventions differed in delivery including: mode of delivery (face to face, web-based, audiotape, telephone); group or individual interventions; number of sessions provided (ranging from 2 to 12 sessions); and timing of intervention in relation to completion of cancer treatment (during or after completion). Most trials compared educational interventions to usual care and meta-analyses compared educational interventions to usual care or attention controls. Methodological issues that increased the risk of bias were evident including lack of blinding of outcome assessors, unclear allocation concealment in over half of the studies, and generally small sample sizes. Using the GRADE approach, we rated the quality of evidence as very low to moderate, downgraded mainly due to high risk of bias, unexplained heterogeneity, and imprecision. There was moderate quality evidence of a small reduction in fatigue intensity from a meta-analyses of eight studies (1524 participants; standardised mean difference (SMD) -0.28, 95% confidence interval (CI) -0.52 to -0.04) comparing educational interventions with usual care or attention control. We found low quality evidence from twelve studies (1711 participants) that educational interventions had a small effect on general/overall fatigue (SMD -0.27, 95% CI -0.51 to -0.04) compared to usual care or attention control. There was low quality evidence from three studies (622 participants) of a moderate size effect of educational interventions for reducing fatigue distress (SMD -0.57, 95% CI -1.09 to -0.05) compared to usual care, and this could be considered clinically significant. Pooled data from four studies (439 participants) found a small reduction in fatigue interference with daily life (SMD -0.35, 95% CI -0.54 to -0.16; moderate quality evidence). No clear effects on fatigue were found related to type of cancer treatment or timing of intervention in relation to completion of cancer treatment, and there were insufficient data available to determine the effect of educational interventions on fatigue by stage of disease, tumour type or group versus individual intervention. Three studies (571 participants) provided low quality evidence for a reduction in anxiety in favour of the intervention group (mean difference (MD) -1.47, 95% CI -2.76 to -0.18) which, for some, would be considered clinically significant. Two additional studies not included in the meta-analysis also reported statistically significant improvements in anxiety in favour of the educational intervention, whereas a third study did not. Compared with usual care or attention control, educational interventions showed no significant reduction in depressive symptoms (four studies, 881 participants, SMD -0.12, 95% CI -0.47 to 0.23; very low quality evidence). Three additional trials not included in the meta-analysis found no between-group differences in the symptoms of depression. No between-group difference was evident in the capacity for activities of daily living or physical function when comparing educational interventions with usual care (4 studies, 773 participants, SMD 0.33, 95% CI -0.10 to 0.75) and the quality of evidence was low. Pooled evidence of low quality from two of three studies examining the effect of educational interventions compared to usual care found an improvement in global quality of life on a 0-100 scale (MD 11.47, 95% CI 1.29 to 21.65), which would be considered clinically significant for some. No adverse events were reported in any of the studies. Authors' conclusions: Educational interventions may have a small effect on reducing fatigue intensity, fatigue's interference with daily life, and general fatigue, and could have a moderate effect on reducing fatigue distress. Educational interventions focused on fatigue may also help reduce anxiety and improve global quality of life, but it is unclear what effect they might have on capacity for activities of daily living or depressive symptoms. Additional studies undertaken in the future are likely to impact on our confidence in the conclusions. The incorporation of education for the management of fatigue as part of routine care appears reasonable. However, given the complex nature of this symptom, educational interventions on their own are unlikely to optimally reduce fatigue or help people manage its impact, and should be considered in conjunction with other interventions. Just how educational interventions are best delivered, and their content and timing to maximise outcomes, are issues that require further research

The relationship between approach to activity engagement, specific aspects of physical function, and pain duration in chronic pain

Objectives:To examine: (1) the relationships between habitual approach to activity engagement and specific aspects of physical functioning in chronic pain; and (2) whether or not these relationships differ according to pain duration.Materials and Methods:Outpatients (N=169) with generalized chronic pain completed a set of written questionnaires. Categories of approach to activity engagement were created using the confronting and avoidance subscales of the Pain and Activity Relations Questionnaire. An interaction term between approach to activity engagement categories and pain duration was entered into analysis with age, sex, pain intensity, the categorical approach to activity engagement variable, and pain duration, in 9 ordinal regression models investigating functioning in a variety of daily activities.Results:The approach to activity engagement category predicted the personal care, lifting, sleeping, social life, and traveling aspects of physical functioning but, interestingly, not the performance skills used during these activities, that is, walking, sitting, and standing. The interaction term was significant in 2 models; however, the effect of pain duration on associations was the inverse of that theorized, with the relationship between variables becoming less pronounced with increasing duration of pain.Discussion:The results of this study do not support the commonly held notion that avoidance and/or overactivity behavior leads to deconditioning and reduced physical capacity over time. Findings do, however, suggest that a relationship exists between avoidance and/or overactivity behavior and reduced participation in activities. Implications for the clinical management of chronic pain and directions for further research are discussed

Associations among gender, coping patterns and functioning for individuals with chronic pain: a systematic review

BACKGROUND: Developing strategies for coping with chronic pain is an integral part of successfully living with this often debilitating health condition. While gender differences in pain coping strategies have long been investigated, the relationship between gender-specific engagement in coping and associated functioning in individuals experiencing chronic pain is yet to be clearly understood

High-Impact Practices and the Adult Online Learner

Institutions of higher education are challenged to get students engaged, especially adult or non-traditional online learners. In this study, the National Survey of Student Engagement (NSSE) 2017 & 2018 data on High-Impact Practices (HIPs) are examined to understand the extent to which adult online learners are engaged in HIPs. This analysis finds that engagement levels for adult learners are lower than those of traditional learners (under the age of 24) for all HIPs surveyed by the NSSE. Moreover, the levels of engagement of the subset of adult learners who took only online courses was even lower than the levels of the broader adult population, and part-time adult online learners had the lowest engagement of all student populations examined. Based on these findings, suggestions for improving the engagement of adult and online learners in HIPs are discussed. Institutions should focus on incorporating opportunities that allow more learners to experience HIPs, as research findings suggest that HIPS increase engagement and could result in significant improvements in student success measures, such as program completion and graduate school attendance (Stoloff, Good, Smith, & Brewster, 2015)

City Heights Community Development Corporation Performance Audit

The City Heights Community Development Corporation (CHCDC) is a 30-year-old nonprofit organization that strives “to enhance the quality of life in City Heights by working with the community to create quality affordable housing, livable neighborhoods, foster economic self- sufficiency, and stimulate investment” (City Heights Community Development Corporation, 2009). The CHCDC is an instrumental organization and an asset to the diverse community of City Heights. The leadership team is enhancing awareness, working through adaptive challenges, building relationships with potential funders and partners, and establishing a healthy organizational culture. Most importantly, the organization is taking the right steps to ensure it stays true to its mission by meeting the needs of the City Height’s community. The consulting team performed a comprehensive audit to ensure the company was in compliance with best organizational practices.https://digital.sandiego.edu/npi-bpl-programdesign/1001/thumbnail.jp