The impact of an exercise physiologist coordinated resistance exercise program on the physical function of people receiving hemodialysis: a stepped wedge randomised control study

Background:Exercise during hemodialysis treatments improves physical function, markers of cardiovascular disease and quality of life. However, exercise programs are not a part of standard therapy in the vast majority of hemodialysis clinics internationally. Hemodialysis unit-based accredited exercise physiologists may contribute to an increased intradialytic exercise uptake and improved physical function.Methods and design: This is a stepped wedge cluster randomised controlled trial design. A total of 180 participants will be recruited from 15 community satellite hemodialysis clinics in a large metropolitan Australian city. Each clinic will represent a cluster unit. The stepped wedge design will consist of three groups each containing five randomly allocated cluster units, allocated to either 12, 24 or 36 weeks of the intervention. The intervention will consist of an accredited exercise physiologist-coordinated program consisting of six lower body resistance exercises using resistance elastic bands and tubing. The resistance exercises will include leg abduction, plantar flexion, dorsi flexion, straight-leg/bent-knee raise, knee extension and knee flexion. The resistance training will incorporate the principle of progressive overload and completed in a seated position during the first hour of hemodialysis treatment. The primary outcome measure is objective physical function measured by the 30-second sit to stand test. Secondary outcome measures include the 8-foot timed-up-and-go test, the four square step test, quality of life, cost-utility analysis, uptake and involvement in community activity, self-reported falls, fall\u27s confidence, medication use, blood pressure and morbidity (hospital admissions). Discussion: The results of this study are expected to determine the efficacy of an accredited exercise physiologist supervised resistance training on the physical function of people receiving hemodialysis and the cost-utility of exercise physiologists in hemodialysis centres. This may contribute to intradialytic exercise as standard therapy using an exercise physiologist workforce model.</div

Efficacy and cost-effectiveness of an outcall program to reduce carer burden and depression among carers of cancer patients (PROTECT) : rationale and design of a randomized controlled trial

Published: 6 January 2014BACKGROUND: Carers provide extended and often unrecognized support to people with cancer. The aim of this study is to test the hypothesis that excessive carer burden is modifiable through a telephone outcall intervention that includes supportive care, information and referral to appropriate psycho-social services. Secondary aims include estimation of changes in psychological health and quality of life. The study will determine whether the intervention reduces unmet needs among patient dyads. A formal economic program will also be conducted. METHODS/DESIGN: This study is a single-blind, multi-centre, randomized controlled trial to determine the efficacy and cost-efficacy of a telephone outcall program among carers of newly diagnosed cancer patients. A total of 230 carer/patient dyads will be recruited into the study; following written consent, carers will be randomly allocated to either the outcall intervention program (n = 115) or to a minimal outcall / attention control service (n = 115). Carer assessments will occur at baseline, at one and six months post-intervention. The primary outcome is change in carer burden; the secondary outcomes are change in carer depression, quality of life, health literacy and unmet needs. The trial patients will be assessed at baseline and one month post-intervention to determine depression levels and unmet needs. The economic analysis will include perspectives of both the health care sector and broader society and comprise a cost-consequences analysis where all outcomes will be compared to costs. DISCUSSION: This study will contribute to our understanding on the potential impact of a telephone outcall program on carer burden and provide new evidence on an approach for improving the wellbeing of carers.Patricia M Livingston, Richard H Osborne, Mari Botti, Cathy Mihalopoulos, Sean McGuigan, Leila Heckel, Kate Gunn, Jacquie Chirgwin, David M Ashley and Melinda William

Prior crop and residue incorporation time affect the response of paddy rice to fertiliser nitrogen

Crop residues are an important source of nitrogen (N) for rice (Oryza sativa L.). The objective of this research was to determine how the supply of mineral N from different prior crops or fallow might affect the growth and yield of rice. The study also tested whether N use by rice might be improved by timing the application of inorganic fertiliser N to supplement the N mineralised after prior crops. Experiments consisted of fallow, or cereal or legume crops in the dry-season followed by wet-season rice; and fallow, or cereal or legume crops in the wet-season followed by dry-season rice. Urea at one-third of the rate required for optimum rice yield was applied at 3 times during the rice crop: sowing, permanent flood, and/or panicle initiation. The prior fallow and crop treatments significantly influenced the growth and yield of rice crops. After a fallow, the pattern of soil N mineralisation promoted vegetative growth but was limiting during grain-filling. In contrast, after a cereal crop, rice vegetative growth was limited but grain-filling was promoted. Legume prior crops promoted both vegetative and grain growth. The benefits derived from growing the cereal or legume crops before rice, in terms of replacing fertiliser N, were dependent on the time at which fertiliser N was applied to the rice crop. In particular, legume crops frequently nullified the rice growth responses to fertiliser N. The results demonstrated that fallow and prior crops can alter the amount and timing of mineral N supply to a rice crop. Farmers should consider including a legume crop in rotation with rice because legumes supply N, which increases rice yield and reduces the requirement for fertiliser N. Cereal crops also contribute N, although farmers who use a cereal rotation should monitor the soil and crop N status during early rice growth, and supply extra fertiliser N to alleviate N deficiency

Transitions to Working Life: Securing Professional Competence

This chapter examines the transition from education to work as a critical phase of professional career and the development of professional competence Literature on transition to working life has identified several challenges that many graduates meet in the early stages of their career such as: threat of unemployment, inadequate knowledge and skills, decreased self-efficacy and increased stress, instability of professional identity, newcomers’ role and position in a work community, early attrition and changing occupation. The importance of workplace learning in supporting graduates as they transit to the workplace is influential in assisting graduates deal with these challenges. This chapter examines each of these challenges from the professional competence point of view drawing upon examples from several research projects undertaken by the authors to accentuate how these challenges might be addressed. In particular special attention is paid to the role of social partnerships in meeting the challenges.peerReviewe

Cruise ships like buildings:Wayfinding solutions to improve emergency evacuation

This research aims at demonstrating that wayfinding solutions can improve the effectiveness of the evacuation processes in complex architectural spaces such as those of cruise ships. We investigated the behaviours of passengers in maritime disaster to figure out whether people act similarly during buildings egress and ships evacuation. Data were collected through questionnaires administered in 2015 to passengers boarding various cruise ships at the port of Ancona (Italy), and through the analysis of real footage of the evacuation of the Costa Concordia. The open source software Fire Dynamics Simulator with Evacuation (FDS+EVAC), used in building egress analyses, was adapted to include these behavioural and event information such as familiarity with ship layout, ship rotation and lifeboats boarding. Simulation results on the case study confirmed similarities between ships and buildings evacuations, underlining the effectiveness of wayfinding solutions to improve passengers’ evacuation flows and routes selection. This study also demonstrated that computer simulation could benefit the ship design process, the preparation of safety guidelines, and the crewmembers during naval emergency management training