Weight management and its role in breast cancer rehabilitation

Overweight and obesity are risk factors for post-menopausal breast cancer, and many women diagnosed with breast cancer, irrespective of menopausal status, gain weight after diagnosis. Weight management plays an important role in rehabilitation and recovery since obesity and/or weight gain may lead to poorer breast cancer prognosis, as well as prevalent co-morbid conditions (e.g. cardiovascular disease and diabetes), poorer surgical outcomes (e.g., increased operating and recovery times, higher infection rates, and poorer healing), lymphedema, fatigue, functional decline, and poorer health and overall quality of life. Health care professionals should encourage weight management at all phases of the cancer care continuum as a means to potentially avoid adverse sequelae and late effects, as well as to improve overall health and possibly survival. Comprehensive approaches that involve dietary and behavior modification, and increased aerobic and strength training exercise have shown promise in either preventing weight gain or promoting weight loss, reducing biomarkers associated with inflammation and co-morbidity, and improving lifestyle behaviors, functional status, and quality of life in this high-risk patient population

Relying on Young Ambassadors to bolster COVID-19 study recruitment and participation

In June 2020, young adults comprised 20% of the COVID-19 cases and asymptomatic individuals were seen as “carriers” taking the virus into their homes and social settings. As with many health issues, the minority population was dealing with worse health outcomes. African Americans young adults were not excluded from this circumstance. In Mississippi, the group had some of the highest rates of COVID-19 in the state. Additionally, some young people across Mississippi were expressing that they felt unengaged and left out of the discussions on COVID-19. These concerns prompted the research project, Young Adults Against COVID-19 (YAACOV), a project under the Mississippi Community Engagement Alliance Against COVID-19 Disparities (MS CEAL), funded by the National Institutes of Health. YAACOV was initiated to explore the perceptions, knowledge and coping strategies of 18 – 29-year-old African American young adults in Mississippi. To reach the recruitment goals, the YAACOV study team employed Young Ambassadors to help promote and recruit other young adults to participate in the study. The Young Ambassador initiative is the focus of the current case

Low-income African American Women’s Cultural Models of Work: Implications for Adult Education

This study investigated how African American women from low-income, single-parent female-headed households conceptualize work and transitions to work, and how these conceptualizations relate to the dominant discourse of work underlying policies and practices in adult education. The findings challenge some prevalent assumptions and approaches in work-related education for low-income women

The Politics of Learning at Work: Experiences of African American Women in Entry-Level Jobs

This research was designed to investigate the on-the-job learning of low-income African American women in entry-level jobs, in particular the relationships between the social context of the workplace, the nature of these jobs, and the kind of skills and knowledge the women acquired. We draw implications for adult basic education research and practice, in which the provision of work-related education for low-income women has become increasingly important due to the effects of welfare reform

Adapting and validating diabetes simulation models across settings: Accounting for mortality differences using administrative data

Abstract Aims. To develop age and sex-specific risk equations for predicting mortality following major complications of diabetes, using a large linked administrative dataset from Western Australia (WA) and to incorporate these into an existing diabetes simulation model.. Methods: The study uses linked hospital and mortality records on 13,884 patients following a major diabetes-related complication with a mean (SD) duration of 2.62 (2.25) years. Risk equations for predicting mortality were derived and integrated into the UKPDS Outcomes Model. Estimates of life expectancy and incremental QALYs gained as a result of two theoretical therapies (a reduction of HbA1c of 1%, and reduction of systolic blood pressure of 10mmHg) were determined using the original and adapted models. Results: The two versions of the model generated differences in life expectancy following specific events; however there was little impact of using alternative mortality equations on incremental QALYs gained as a result of reducing HbA1c or systolic blood pressure, or on outcomes of life expectancy for a cohort initially free of complications. Conclusions: Mortality following complications varies across diabetic populations and can impact on estimates of life expectancy, but appears to have less impact on incremental benefits of interventions that are commonly used in pharmoeconomic analyses.National Health and Medical Resaerch Council; Diabetes Australia Research Trus

Pragmatic pugilist: The social and cultural thought of Ishmael Reed.

This thesis examines the social and cultural thought of the acclaimed and controversial African American author Ishmael Reed. It explores the ideas that have informed Reed's essays and novels since the 1960s, placing his works within the American social and cultural contexts to which he responded. Reed often envisions himself as a prize-fighter, taking on the hypocrisy and racism which he detects within mainstream American journalism and in academia. But Reed is a pragmatic prize-fighter in the sense that he consistently varies his punches according to the contexts in which he finds himself, and in reaction to the different antagonists which are the targets of his critiques. By exploring how Reed grounds his work in controversy and paradox my study aims to reveal a complex cross fertilisation and synergy between Reed's novels and essays. To this end I consider the contrast between Reed's emphasis on the vitality of African and American oral and literary traditions, and his simultaneous declaration of war on the persistence of race and black and white stereotyping in the USA. He sets American cultural and political ideals in opposition to Afncan American realities, thus allowing his writings to function as counter-narratives that foreground the racial tensions still inherent in American society. My focus is on some of the central contradictions in Ishmael Reed's writings. This thesis is divided into three main sections which have allowed to me to analyse, within Reed's complex and interpenetrating prose works, some of the main thematic areas of his fiction and some of the key arguments developed in his essays. The first section explores the role of the intellectual and Reed's conception of his own vocation as a writer. The second engages with issues of race, ethnicity and multiculturalism, while the final section explores Reed's interventions in debates around gender. Rather than seeking to establish a single position that can be associated with Reed, I draw attention to the ambivalences and paradoxes within his thought and writings. Reed presents himself as the committed radical engaging enthusiastically with the complex relationships between ethnic groups, whilst simultaneously championing the Black community. Yet this self-image conflicts with the conservative and misogynist strains in his work. This thesis aims to explore, explain and understand such paradoxes and thus to shed a new light on one of the most fascinating writers of the last fifty years

Building a Peer Reviewer Community of Practice

Introduction: Scholarly peer review is the cornerstone for maintaining quality and relevance in the medical literature. Few programs that support peer-reviewer training have been described. Methods: We developed a 2-pronged approach to support peer-reviewer training at our institution. This approach included a formal online course that offered a certificate of completion and an informal group manuscript peer review (GMPR) meeting held monthly. Results: A total of 13 participants completed the online course in the first 2 years (2017-2018). Nineteen enrolled in the third year. The GMPR met regularly over 3 years and reviewed 26 manuscripts. Typical attendance has been 8-10 interprofessional faculty and learners per session. Discussion: The online course has gained increasing enrollment over its first 3 years, extending beyond the institution and even internationally. Over half of learners who have completed the course are now engaged as peer reviewers for our institutional journal. The GMPR meetings have had consistent, interprofessional attendance, providing a spectrum of viewpoints and levels of expertise. Conclusions: We propose that both an online training course and GMPR meetings are viable options to support and build a scholarly peer-reviewer community of practice

Ultra-brief non-expert-delivered defusion and acceptance exercises for food cravings: A partial replication study

Food cravings are a common barrier to losing weight. This paper presents a randomised comparison of non-expert group-delivered ultra-brief defusion and acceptance interventions against a distraction control. Sixty-three participants were asked to carry a bag of chocolates for a week whilst trying to resist the temptation to eat them. A behavioural rebound measure was administered. Each intervention out-performed control in respect of consumption, but not cravings. These techniques may have a place in the clinical management of food cravings. We provide tentative evidence that the mechanism of action is through decreased reactivity to cravings, not through reduced frequency of cravings

Novel lung imaging biomarkers and skin gene expression subsetting in dasatinib treatment of systemic sclerosis-associated interstitial lung disease.

BackgroundThere are no effective treatments or validated clinical response markers in systemic sclerosis (SSc). We assessed imaging biomarkers and performed gene expression profiling in a single-arm open-label clinical trial of tyrosine kinase inhibitor dasatinib in patients with SSc-associated interstitial lung disease (SSc-ILD).MethodsPrimary objectives were safety and pharmacokinetics. Secondary outcomes included clinical assessments, quantitative high-resolution computed tomography (HRCT) of the chest, serum biomarker assays and skin biopsy-based gene expression subset assignments. Clinical response was defined as decrease of >5 or >20% from baseline in the modified Rodnan Skin Score (MRSS). Pulmonary function was assessed at baseline and day 169.ResultsDasatinib was well-tolerated in 31 patients receiving drug for a median of nine months. No significant changes in clinical assessments or serum biomarkers were seen at six months. By quantitative HRCT, 65% of patients showed no progression of lung fibrosis, and 39% showed no progression of total ILD. Among 12 subjects with available baseline and post-treatment skin biopsies, three were improvers and nine were non-improvers. Improvers mapped to the fibroproliferative or normal-like subsets, while seven out of nine non-improvers were in the inflammatory subset (p = 0.0455). Improvers showed stability in forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO), while both measures showed a decline in non-improvers (p = 0.1289 and p = 0.0195, respectively). Inflammatory gene expression subset was associated with higher baseline HRCT score (p = 0.0556). Non-improvers showed significant increase in lung fibrosis (p = 0.0313).ConclusionsIn patients with SSc-ILD dasatinib treatment was associated with acceptable safety profile but no significant clinical efficacy. Patients in the inflammatory gene expression subset showed increase in skin fibrosis, decreasing pulmonary function and worsening lung fibrosis during the study. These findings suggest that target tissue-specific gene expression analyses can help match patients and therapeutic interventions in heterogeneous diseases such as SSc, and quantitative HRCT is useful for assessing clinical outcomes.Trial registrationClinicaltrials.gov NCT00764309

Maternal work hours in early to middle childhood link to later adolescent diet quality

Objective: Previous studies on maternal work hours and child diet quality have reported conflicting findings possibly due to differences in study design, lack of a comprehensive measure of diet quality and differing ages of the children under investigation. The present study aimed to prospectively examine the impact of parental work hours from age 1 year to age 14 years on adolescent diet quality. Design: Multivariate linear regression models were used to examine independent associations between parents’ work hours at each follow-up and across 14 years and adolescent diet quality at age 14 years. A diet quality index was based on the international literature and Australian recommendations, consisting of six food groups and nine nutrients. Setting: Perth, Western Australia. Subjects: Children (n 1629) participating in the Western Australian Pregnancy Cohort (Raine) Study. Results: Compared with children of mothers in full-time employment, children of mothers who were not employed in early childhood up to age 5 years had a higher average diet quality score at age 14 years, independent of maternal and family socio-economic status. Across 14 years the number of years the mother worked full time and increasing average weekly hours were associated with lower diet quality. Father’s work hours had little association with adolescent diet quality. Conclusions: Having a mother stay at home in early to middle childhood is associated with better diet quality in adolescence. Support may be beneficial for families where the mother returns to full-time employment before the child reaches 8 years of age