Airflow during clinical examinations with and without protective face masks

Close contact between the patient and physician markedly affects local airflow and their spared airspace, and this can be moderated by mask wearing. Understanding this is particularly relevant in the COVID-19 pandemic and for those new to clinical practice, in particular medical students.

Information Gathering in Investigative and Medical Interviewing: Drawing Parallels Across Contexts

Information gleaned from a patients' medical history is a core determinant of a medical diagnosis. Accurate and effective history-taking is, therefore, a foundational skill for medical practitioners and is introduced early in medical training. Recognizing and developing the skills of effective medical interviewing is an ongoing challenge for medical students and experienced clinicians alike. Important parallels exist between the information gathering skills required in medicine and health, and those required in investigative interviewing. Qualitative interviews were conducted with 19 experienced medical professionals from a range of specialty areas. They were asked about the role of the medical interview in their discipline, and about challenges they experience when gathering information from patients. Both theory-driven and grounded-theory approaches were used in combination to identify common themes. The interviews were rich with themes including approaches to introductory phases of the interview, eliciting a narrative account, and several topics that specifically paralleled issues in interviewing of vulnerable witnesses. We explore these themes through a lens of investigative interviewing by applying the knowledge of effective interviewing skills and structures to the data gained from the medical context. In general, themes indicated that there are numerous parallels to information gathering approaches in both contexts. As such, there may be scope for medical education to adopt some of the training techniques employed in the investigative interviewing field. Further, it is hoped that the present findings be used to spark an interdisciplinary conversation about communication from which both sides can learn.

Development of a reference material for analysing naturally occurring radioactive material from the steel industry

Accurate measurement of naturally occurring radionuclides in blast furnace slag, a by-product of the steel industry, is required for compliance with building regulations where it is often used as an ingredient in cement. A matrix reference blast furnace slag material has been developed to support traceability in these measurements. Raw material provided by a commercial producer underwent stability and homogeneity testing, as well as characterisation of matrix constituents, to provide a final candidate reference material. The radionuclide content was then determined during a comparison exercise that included 23 laboratories from 14 countries. Participants determined the activity per unit mass for ²²⁶Ra, ²³²Th and ⁴⁰K using a range of techniques. The consensus values obtained from the power-moderated mean of the reported participant results were used as indicative activity per unit mass values for the three radionuclides: A₀(²²⁶Ra) = 106.3 (34) Bq·kg^-1, A₀(²³²Th) = 130.0 (48) Bq·kg^-1 and A₀(⁴⁰K) = 161 (11) Bq·kg^-1 (where the number in parentheses is the numerical value of the combined standard uncertainty referred to the corresponding last digits of the quoted result). This exercise helps to address the current shortage of NORM industry reference materials, putting in place infrastructure for production of further reference materials.

Listening as a path to psychological discovery: an introduction to the Listening Guide

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Meeting at the Crossroads: Women's Psychology and Girls' Development

For over a century, psychologists have described adolescence as a time of heightened psychological risk for girls. This article explores a relational impasse or crisis of connection that we have observed in girls' lives at adolescence by tracing through time the thoughts and feelings of two 12-year-old girls who were interviewed as part of a 5-year longitudinal study of girls' psychological development. Using a voice-centered relational method, we join the experiences of struggle and resistance at this developmental juncture with the problems that have been seen as central to the psychology of women.

Culturally and linguistically diverse students in health professional programs: an exploration of concerns and needs

INTRODUCTION

Cultural diversity among students in tertiary institutions in Australia and globally has increased rapidly in the last decade, and is continuing to do so.

METHODS

Focus groups were held at the University of Newcastle, NSW to: (1) examine the specific needs of international students in the Master of Pharmacy, Bachelor of Medicine and Bachelor of Nursing programs in relation to language and cultural considerations and (2) to understand the attitudes of domestic students to the cultural issues faced among their peers. The project explored these issues with the intention to inform curricula changes to accommodate the needs of culturally and linguistically diverse students.

RESULTS

The key themes emerging from international students were: difficulties in spoken language, differences in professional roles and expectations, differences in methods of learning, inadequate social interaction outside the classroom and acceptance of differences in cultural and religious practices. The domestic student views reinforced the comments from international students both in regard to social interaction and in regard to participation in class discussions. Although local students were interested in learning from international students about their culture and religious beliefs, there were limited initiatives from both sides.

DISCUSSION

There is a need for tertiary institutions that benefit economically from increasing the numbers of international students to help them to study and live in a new environment. Assistance needs to go beyond learning the English language to helping students understand its use in a professional context (health terminology and slang used by patients), the nuances of the health professional disciplines in a western society, the approach to study and problem-based learning styles and skills to assist with social interaction. The results of the present exploration have led to a series of proposed actions for the University of Newcastle. These recommendations are applicable to any "Western" teaching institution with a large number of international students from developing countries enrolled in their health programs.

Strengthening healthy resistance and courage in children: a gender-based strategy for preventing youth violence

Beginning with the distinction between core consciousness or a core sense of self and a self that is wedded to a story about itself, this paper suggests that we have collectively been wedded to a false story about ourselves, a story that the core self resists. The gender disparity with respect to times in development when children's resilience is at heightened risk highlights the costs of an initiation that occurs for boys in early childhood and for girls at adolescence. Because of this difference in the timing, girls can become informants about a process of psychic splitting and dissociation that impedes the relational capacities of children and opens the way to violence. The articulateness of girls' resistance to losses that are psychologically and socially consequential illuminates a resistance in boys that may otherwise be overlooked. Evidence drawn from studies of girls' development leads to the suggestion that by joining a healthy resistance in children, we can act to prevent youth violence. The paper ends with a case study of a suicidal adolescent girl to illustrate how a relational framework shifts the interpretation of violent behavior and informs a strategy of response.

Gender differences in the age-changing relationship between instrumentality and family contact in emerging adulthood

Data from the Children in the Community Transitions Study were used to examine gender differences in the impact of family contact on the development of finance and romance instrumentality from ages 17 to 27 years. Family contact decreased among both men and women across emerging adulthood, although it decreased more rapidly in men than in women. Both finance and romance instrumentality increased for men and women across emerging adulthood. The growth rate did not differ between men and women in either domain, although men tended to be characterized by higher levels of instrumentality than women. There were noteworthy gender differences in the impact of family contact on the development of instrumentality. At age 17, family contact was negatively associated with instrumentality for both men and women; at age 27, the impact of family contact on instrumentality was less negative for women and was positive for men.

Dose-response relationship between physical loading and mechanical competence of bone

A dose-response relationship between mechanical loading and bone can be inferred by the fact that bone response is proportional to the applied load in cell and organ culture and in animal models where a known load at a given magnitude and frequency is applied. Proportional responses have been observed in second messengers, growth factors, bone matrix, and bone strength. In the human model, however, the determination of a dose-response relationship is hindered by the lack of appropriate technology to directly evaluate the mechanical load and the skeletal competence. In vitro loading of bone does not duplicate the in vivo physiologic conditions, in particular the neuromuscular responses to the loads applied to the skeleton. While animal studies aid in determining the mechanisms of bone response to mechanical loading and dietary interactions, they do not obviate the need for human clinical trials to evaluate the effects of physical activity on both skeletal competence and fall prevention. The literature reviewed shows that physical activity increases the competence of the skeleton to resist fracture by the maintenance and improvement of bone mineral density (BMD) and neuromuscular competency, thus reducing skeletal fragility, pre-disposition to falls, and fall impact.

Muscular strength and bone density with weight training in middle-aged women

Previous research has demonstrated positive correlations between bone mass and both physical activity and muscular strength. There is a paucity of information describing the specific type of exercise which most benefits the human skeleton. The effects of a 1 yr weight training program on 18 middle-aged women participating in an endurance dance program (E + W) compared with 17 other women in the endurance dance program only (E) and with 19 sedentary controls (C) were studied by measuring muscular strength and bone mineral density (BMD). Eighteen women in the E + W group demonstrated increases in all strength measurements, whereas the E and C groups either had smaller increases or had declined. A significant group x test interaction term, indicating that groups responded differently over time, was observed for nondominant isokinetic elbow flexion measured through the range of motion at a constant velocity of 60 degrees.s-1 (P less than 0.05), nondominant isokinetic elbow extension at 180 degrees.s-1 (P less than 0.01), and nondominant isokinetic elbow flexion at 180 degrees.s-1 (P less than 0.05). BMD did not change significantly except that a significant group x test interaction term appeared for the radius ultradistal site (P less than 0.01). BMD of the humerus and femoral Ward's triangle increased nonsignificantly in both E and E + W over the year. This weight training program increased muscular strength but did not increase measured bone mass.

Physical activity effects on bone metabolism

The incidence of osteoporotic fractures rises exponentially with age and is increasing faster than the demographic increase in the aging population. Physical activity has great potential to reduce the risk for osteoporotic fractures. Three independent but interactive factors contribute to the risk of fractures: bone strength, the risk of falling, and the effectiveness of neuromuscular response that protects the skeleton from injury. Exercise can reduce fracture risk not only by preventing bone loss, but by decreasing the risk of falling and the force of impact by improving strength, flexibility, balance, and reaction time. Extreme inactivity causes rapid bone loss of up to 40%, while athletic activity results in bone hypertrophy of up to 40%. Exercise intervention programs have reduced bone loss or increased bone mass in both men and women of various ages and initial bone status. These benefits have been shown for arm bone mineral content, total body calcium, spine, calcium bone index, tibia, and calcaneus. In both middle-aged and elderly women, physical activity intervention reduced bone loss or increased bone mass. The mechanisms for maintenance of skeletal integrity rely on a cellular response to hormonal and mechanical load stimuli. Studies in animal models show that training affects cellular activity. In osteoporotics, cellular erosion is increased and mineral apposition rate (MAR) decreased compared with normal age-matched controls. In contrast to this, sows trained on a treadmill 20 min per day for 20 weeks had greater active periosteal surface, periosteal MAR, and osteonal MAR than untrained sows.

Calcium supplementation and bone loss in middle-aged women

This 4-y study investigated the effects of a calcium carbonate supplement on bone loss in 169 women aged 35-65 y, randomly assigned to placebo and treatment (1500 mg Ca/d) groups in a double-blind design. Bone mineral content (BMC) and width (W) were measured bilaterally on the radius, ulna, and humerus. BMC and BMC/W loss rates were consistently lower in treatment than in control subjects. Loss was significantly reduced in the left and right humerus and the right radius. In premenopausal subjects, only left humerus BMC loss was significantly reduced by Ca supplementation. In postmenopausal treatment subjects, BMC and BMC/W bone loss was reduced in all 12 (bilateral radius, ulna, and humerus) of the bone variables measured, 5 at p less than 0.01 and 2 at p less than 0.05. Ca supplementation counteracted a large portion of the additional bone loss attributable to menopause in this population.

Deterring bone loss by exercise intervention in premenopausal and postmenopausal women

This study investigated the efficacy of 4 years of exercise intervention in deterring bone loss in middle-aged women, and is a correction and extension of previously published data. Sixty-two control subjects (mean age 50.8) and 80 exercise subjects (mean age 50.1) completed a 4-year study. Subjects exercised three times a week, 45 minutes per session. Bilateral radius, ulna, and humerus bone mineral content (BMC) and width (W) were measured on each subject 11 times over the 4-year period. The two groups did not differ initially in age, height, or weight, but the control group had a greater maximum VO2 (ml/kg/min) than the exercise group. Slopes and intercepts of the bone variables vs. time were determined for each subject, and these values were used for between-group comparisons of loss. The control group BMC and BMC/W declined significantly in all three bones in both arms. The exercise group rate of decline was significantly less than that of the control group for 12 of the 18 bone variables. The greatest effect of the exercise intervention was on the ulna and radius. Exercise subjects lost significantly less than control subjects in left and right ulna and radius BMC and BMC/W, and left ulna and radius W. Lesser differences between groups were observed in the humerus. BMC and W loss rates of the left humerus were reduced in the exercise group, with no difference between exercise and control subjects in the other humerus variables. To determine if menopausal status influenced the response to exercise, we analyzed the difference between groups for premenopausal and postmenopausal subjects separately. Regardless of menopausal status, exercise subjects had lower bone loss rates than control subjects. In both premenopausal and postmenopausal subjects, exercise reduced bone loss significantly for 10 of the 18 bone variables. It can be concluded that physical activity significantly reduces bone loss in the arms of middle-aged women.

Establishing support groups

We have set up a working party to look into establishing a support group for long stay clients and relatives/carers who are living in the community and have been through the rehabilitation system.

Effects of intraindividual and interindividual variation in repeated dietary records

In this study 5,115 daily diet records were collected from 151 women on two randomly selected days per sampling month (29 days) over a two-year period. Yearly estimates of the ratios of intraindividual (sigma w2) and interindividual (sigma b2) variance components were calculated for dietary intake of 15 nutrients and for dietary intake + vitamin/mineral supplements. From one year to the next, corresponding ratios of sigma w2/sigma b2 were nearly identical. Intraindividual variation in dietary intake of all 15 nutrients was greater than interindividual variation (sigma w2/sigma b2 greater than 1). Variance component ratios for highly supplemented nutrients such as iron, vitamin C and B vitamins were less than one (sigma w2/sigma b2 less than 1). Using the ratios of sigma w2/sigma b2, it was calculated that between six and 99 repeated records measuring dietary intake and between two and 31 records measuring total intake may be needed per individual to ensure that the estimate of the population correlation (rho DF) between an individual's "usual" dietary intake or total intake of a dietary risk factor and an individual's mean or usual level of a physiologic risk factor was within 10% of the true population correlation coefficient (rho xy). It was also found that twice as many dietary records per individual were required to estimate the population slope (beta xy) within 10%. These results have serious implications for the design and analysis of prospective nutritional studies.

A two-year dietary survey of middle-aged women: repeated dietary records as a measure of usual intake

A two-year survey of the dietary consumption and supplement use patterns of adult women was conducted at the University of Wisconsin-Madison. Participants were asked to record their diet on two randomly selected days per month over a two-year period. Each subject filled out an average of 19 records a year, for an overall 71% return rate. Because of the sampling design, it was possible to estimate each woman's "usual" or average daily dietary and total intake (diet plus supplements) of 15 nutrients. Many women were consuming usual amounts of energy, calcium, iron, magnesium, vitamin B-6, and, especially, zinc and total folate that were 30% to 50% below recommended levels. It was also found that the women generally took vitamin/mineral supplements for nutrients already adequately supplied in the diet. Low nutrient intakes may have been due, in part, to underreporting of food intakes.

Physical Activity Prescription for the Older Adult

In brief: Disuse accounts for about half of the functional decline that occurs between ages 30 and 70, and aging causes the other half. This article describes how to reverse the decline caused by disuse with a physical activity program tailored to the needs of older adults. The authors give safety tips for exercise testing with a bicycle ergometer and treadmill, as well as a step test that can be performed while sitting. They also present simple equations for computing percent of maximum heart rate, maximum met level, calories used during exercise, and duration of exercise at a particular intensity. Specific examples of how to use the equations are included, along with a list of activities and their met levels.

Sex differences and interpersonal relationships: a cross-sectional sample in the U.S. and India

This study introduces a methodology for exploring sex differences and life span patterns in a small sample for the purpose of generating hypotheses concerning the frequency and kinds of relationships people identify as important. Sixty-two participants from the United States and India, ranging in age from nineteen to seventy-five were interviewed as part of a study on ego and moral development. These open-ended, semistructured interviews yielded information on relationships that was subsequently coded for analysis. Sex differences were found in the number of relationships mentioned, with females mentioning a higher number of relationships than males. Life span patterns regarding the number of relationships mentioned were different for men and women between ages nineteen to thirty-one, with women naming more relationships. At age thirty-five there was a convergence in the number of relationships mentioned by both sexes. This age also was the low point in the number of relationships mentioned by both sexes, with later life ages.

New maps of development: new visions of maturity

Two modes of moral reasoning are distinguished in boys' and girls' discussions of moral dilemmas: one oriented to justice and rights, one to care and response. These different modes are associated with different forms of self-definition and reflect different images of relationships. The contrasting images of hierarchy and web derive from childhood experiences of inequality and interdependence which give rise to the ideals of justice and of care. The representation of these two lines of development and their interplay yields a new mapping of human growth.