Androgen deprivation therapy for prostate cancer : novel mechanisms of testosterone action and the benefits of home-based progressive resistance training

Testosterone is a key anabolic hormone which has a major role in the regulation of muscle mass and function, glucose and fat metabolism, mental well-being and general health. Androgen deprivation therapy (ADT) is a common treatment modality in men with prostate cancer. In reducing testosterone to castrate levels, it offers a unique model to study the physiological effects of testosterone. Testosterone is known to act on multiple pathways which regulates muscle mass, fibre hypertrophy and protein turnover. Protein is hydrolysed into amino acids which are then available for synthesis of new protein, or alternatively can be eliminated as urea by the hepatic urea cycle; a rate limiting step in the irreversible loss of protein nitrogen. Although testosterone deficiency is well-known to be associated with loss of muscle mass and other protein depots, the effect of testosterone on the hepatic urea cycle has not been studied in humans. ADT also leads to a substantial increase in fat mass, worsening glucose tolerance, impairment in muscle function, and deterioration in mental health. In fact, cardiovascular disease accounts for approximately a quarter of deaths amongst men with prostate cancer. Exercise has been used to improve ADT-induced adverse effects, but existing studies focus on reversing established changes with supervised programs which have limitations in terms of access and cost. Home-based progressive resistance training (PRT), if found effective, may provide a viable alternative to supervised training programs. The work described in this thesis aimed to determine a hepatic site of testosterone action via the urea cycle- firstly in a cohort of hypogonadal men, followed by a population of men with prostate cancer starting ADT. A home-based PRT program was 16 also evaluated in this population regarding its efficacy in preventing the adverse effects of ADT when initiated at the start of treatment. In summary, the work described in this thesis demonstrates, for the first time, a hepatic site of testosterone action via the urea cycle in humans. Additionally, it shows the benefits of a home-based PRT program in preventing ADT-induced adverse effects. These findings may contribute to the discovery of a potential, novel treatment method for sarcopenia, and a viable alternative to supervised exercise programs during prostate cancer treatment

Access to Eye Care Before and After Vision Loss: A Qualitative Study Investigating Eye Care Among Persons Who Have Become Blind

Navigating access to eye care requires that patients recognize the need for screening and care, employ limited financial and social resources, manage complex health insurance policies, and access specialty clinical care. We investigated the experience of patients through the progression of vision loss to blindness, utilizing qualitative methods. We conducted structured telephone interviews with 28 persons with blindness throughout Oregon. Utilizing closed and open-ended questions, we explored patient experience on the events preceding avoidable blindness. Coding for emergent themes was conducted independently by two researchers using a constant comparative method. Participants described important barriers to accessing eye care: at the systems level, lack of access to providers and treatment; at the community level, available social support and services; and at the individual level, readiness to act and trust in providers. These findings suggest that important barriers to accessing preventive eye care, early diagnosis and treatment, vocational rehabilitation, and social services often occur at multiple levels. Access to eye care should be prioritized in efforts to reduce preventable visual impairment

Improving Medication Safety in the ICU: The Pharmacist’s Role

Purpose: The clinical impact of a critical care pharmacist in reducing medication errors in the intensive care unit (ICU) setting was evaluated. Methods: The study was divided into two 8-week phases: control phase without a critical care pharmacist and an ICU pharmacist phase with a critical care pharmacist. During both phases, pharmacy staff documented interventions using an electronic documentation system. Interventions that could be classified as medication errors were categorized by type of error and whether they were “averted” (intervention accepted) or “not averted” (intervention not accepted). The type and frequency of medication errors, number of medication errors “averted,” and clinical outcomes associated with the medication errors were compared between the control and ICU pharmacist phases. Results: There was no significant difference between the groups for gender and mean age. Of the 267 interventions included in the ICU pharmacist phase, 256 were classified as medication errors compared with 54 of 58 interventions for the control phase. The average number of medication errors per day was significantly higher during the ICU pharmacist phase (4.27 ± 5.2) compared with the control phase (0.92 ± 1.29, P \u3c 0.0001). The number of medication errors “averted” was higher in the ICU pharmacist phase compared with the control phase (212 vs 50). The “averted” medication errors during the ICU pharmacist phase were related to a higher percentage of improved or resolved clinical outcomes compared with the control phase (66/194 [34%] vs 7/46 [15.2%], P = 0.013). Conclusion: A critical care pharmacist improves medication safety by identifying and preventing medication errors and improving outcomes

The prevalence of psychological consequences of COVID-19: A systematic review and meta-analysis of observational studies

© The Author(s) 2020. A systematic review and a meta-analysis were conducted to examine the overall prevalence of psychological health outcomes during COVID-19. Seven databases were systematically searched to include studies reporting on at least one psychological outcome. The pooled prevalence of primary psychological outcomes was 26% (95%CI: 21–32). Pooled prevalence for symptoms of PTSD was 33% (0–86), anxiety 28% (21–36), stress 27% (14–43), and depression 22% (13–33). The prevalence of psychological outcomes was similar in healthcare workers and in the general population (34% [24–44] and 33% [27–40] respectively). High prevalence figures support the importance of ensuring adequate provision of resources for mental health

Elderly participation and empowerment : experiences of SAGE

The Hong Kong Society for the Age (SAGE) established in 1977 is one of the well-known Non-Government Organizations (NGOs) in responding to the rapid growing elderly population and the welfare needs of the senior in Hong Kong. Its services include Care and Attention Home, Elderly Hostels, Elderly Centres, Day Care Centres, Home Care Service. etc. The mission of SAGE is to ensure the elderly to have dignity and reasonable comfort in their old age. In 2008, SAGE aims to provide distinctive services to the elderly, i.e. elderly participation and empowerment (Homepage of Sage: http://www.sage.org.hk/eng/ideal.htm). This paper focuses how Sage as an elderly organization in Hong Kong empower older persons through active participation. In the past, the term “client” was widely used to describe those who approached SAGE for service or assistance. It was later changed to “Service User” or “Service Recipient”, a more appropriate term to describe the relationship as SAGE moves more towards the philosophy of a customer-oriented approach. However, the usage of this term implied a power relationship between the service providers, meaning those who “give”, and the service recipients, meaning those who “receive”. Therefore, the situation has been changed in order to emphasize “partnership” instead – a term that is devoid of status hierarchy with a fair chance of participation for both parties, which could result in a win-win situation. It is anticipated that there will be an even more progressive approach to include service users as “decision-makers”, so that they can have more say in deciding the type and mode of service provision, as well as in allocating resources. These changes not only denote the significance of enhancing the customers’ dual roles of being “partners” and “decision-makers” in the process of service provision, but also emphasis the importance of encouraging their participation through empowerment. With rapid development in information and technology, distinguish to before, the participations of the Hong Kong elderly are no longer conservative and invisible nowadays, this development promotes and enhances the active role and self-awareness in society among the elderly. Throughout the advocacy, guidance, and support of many community services in SAGE, it helps to echo the active involvement of the elders in the community. This involvement leads the elders becoming more aware of their collective strength and the power of voicing their concerns about social issues that directly or indirectly affect their own life and well-being. From SAGE experience, Elders’ involvement can be seen from the active roles they play in the organization and operation of different committees, including “Service Users’ Councils”, “Canteen Service Management Committees”, elder learning platform, etc., all these participation definitely enhance the well-being of the elders. However, elderly participation is still relatively low as regards to the whole society, and there exists considerable room for improvements at the policy-making and decision level. For example, at present, most elders’ involvements are mainly through invitations. Their opinions are generally sought on specific issues such as elderly education and welfare. From time to time, maybe, elderly representatives from different sectors of the community are invited to participate in focus group discussions initiated by the Elderly Commission of the Hong Kong Special Administrative Region, an official agency that is responsible for advocacy and policy decision-making concerning elderly welfare. Sometimes the elders themselves run some self-organized groups at local level, such as “The Hong Kong Association of Senior Citizens”, which helps play their active roles in sensitizing the Government and the community towards elderly-related issues. With these examples, how could we identify the benefits of the elderly participation? How do the elderly being empowered? A theoretical framework of participation and empowerment with a real experience in SAGE is going to explain in the next part

Use of tablets in higher education: an experience with iPads

En el marco de la tendencia creciente del m-learning, la presente investigación se propuso analizar la disposición hacia el uso de tablets, describir el potencial de estos dispositivos para la realización de actividades académicas y personales, e identificar las condiciones requeridas para la incorporación de dicha herramienta en el aula en un contexto universitario peruano. Dispositivos Apple iPad 2 fueron entregados en calidad de préstamo a un grupo de 18 estudiantes y 3 profesores de las carreras de Educación y Psicología de una universidad privada de Lima para su utilización durante el semestre académico 2012-2. Se empleó el cuestionario del modelo unificado de aceptación y uso de tecnología (UTAUT), cuyos supuestos se cumplieron parcialmente. Se halló una correlación positiva y fuerte entre la intención de uso y la expectativa de desempeño, la actitud hacia el uso de tecnología y la influencia social. Además, concluida la experiencia, se encontró un incremento en el puntaje de las escalas de expectativa de esfuerzo, autoeficacia e intención de uso. De la información recogida mediante las observaciones de clase y los grupos focales, se apreció que los participantes se sintieron satisfechos con la experiencia y tuvieron calificativos positivos hacia ella por los múltiples usos dados a la herramienta en actividades académicas y no académicas. Se evidenció la importancia de planificar la integración del dispositivo a los contenidos curriculares, de modo que se lograse un uso significativo y estratégico. No obstante, al tratarse de una primera aproximación, se identificaron ciertas limitaciones en el uso del iPad y algunas dificultades a lo largo del proyectoIn the context of the growing trend of m-learning, this research aimed to analyze the disposition toward the use of tablets, describe the potential of these devices for conducting academic and personal activities, and identify the conditions required for the incorporation of this tool in the classroom in a Peruvian university context. Apple iPad 2 devices were given on loan to a group of 18 students and 3 teachers from Education and Psychology of a private university in Lima for use during the 2012-2 academic semester. Unified theory of acceptance and use of technology (UTAUT) questionnaire was used, whose assumptions were partly accomplished. It was found a strong positive correlation between usage intention and performance expectancy, attitude toward using technology, and social influence. In addition, once the experience finished, it was found an increase in the score of effort expectancy, self-efficacy and usage intention. From the information gathered through classroom observations and focus groups, it was found that participants were satisfied and had positive opinions about the experience, where the tool and its applications were used in multiple ways in academic and non-academic activities. Also it was shown the importance of planning the integration of the tool according to the curriculum content, so that participants could use the device significantly and strategically. However, being a first approach, some limitations in the use of iPad and some difficulties along the project were identified

Bringing scientific rigor to community-developed programs in Hong Kong

BACKGROUND: This paper describes efforts to generate evidence for community-developed programs to enhance family relationships in the Chinese culture of Hong Kong, within the framework of community-based participatory research (CBPR). METHODS: The CBPR framework was applied to help maximize the development of the intervention and the public health impact of the studies, while enhancing the capabilities of the social service sector partners. RESULTS: Four academic-community research teams explored the process of designing and implementing randomized controlled trials in the community. In addition to the expected cultural barriers between teams of academics and community practitioners, with their different outlooks, concerns and languages, the team navigated issues in utilizing the principles of CBPR unique to this Chinese culture. Eventually the team developed tools for adaptation, such as an emphasis on building the relationship while respecting role delineation and an iterative process of defining the non-negotiable parameters of research design while maintaining scientific rigor. Lessons learned include the risk of underemphasizing the size of the operational and skills shift between usual agency practices and research studies, the importance of minimizing non-negotiable parameters in implementing rigorous research designs in the community, and the need to view community capacity enhancement as a long term process. CONCLUSIONS: The four pilot studies under the FAMILY Project demonstrated that nuanced design adaptations, such as wait list controls and shorter assessments, better served the needs of the community and led to the successful development and vigorous evaluation of a series of preventive, family-oriented interventions in the Chinese culture of Hong Kong

Novel High Capacity Oligomers for Low Cost CO2 Capture

The novel concept of using a molecule possessing both physi-sorbing and chemi-sorbing properties for post-combustion CO2 capture was explored and mixtures of aminosilicones and hydroxyterminated polyethers had the best performance characteristics of materials examined. The optimal solvent composition was a 60/40 blend of GAP-1/TEG and a continuous bench-top absorption/desorption unit was constructed and operated. Plant and process models were developed for this new system based on an existing coal-fired power plant and data from the laboratory experiments were used to calculate an overall COE for a coal-fired power plant fitted with this capture technology. A reduction in energy penalty, from 30% to 18%, versus an optimized 30% MEA capture system was calculated with a concomitant COE decrease from 73% to 41% for the new aminosilicone solvent system

Sign of the times : Framing the grievances of the 2019-2020 Hong Kong protests

The 2019-2020 Hong Kong (HK) protest movement, which was initially triggered by the HK government’s proposed bill, eventually turned into a prolonged civil resistance. Collective action frames (CAFs), which can bring legitimacy to civil disobedience and mobilise collective actions, were manifested through protest signs that “blossomed” throughout HK. The study examined intertextuality in the expression of grievances of the 2019-2020 HK protests in signs. A total of 246 protest signs from the “Lennon Walls” and social media sources from the 2019-2020 HK protests were collected for analysis of CAFs using qualitative content analysis. The analysis shows three primary CAFs: (1) “unified pro�democracy Hongkongers” which emphasises the solidarity and unity among movement actors to maintain collective actions for the protests; (2) “police brutality” which stresses HK police’s abuses of human rights in order to mobilise the readers to respond in ways that are in favour of the protests; and (3) “conscience before politics” which highlights the importance of having a conscience in view of human rights violations. The study showed that the language of the protest signs marks the target audience and further reinforces the solidarity of Hongkongers to resist the undemocratic government and fight for freedom