Comparison of heart-rate and blood-pressure increases during isokinetic eccentric versus isometric exercise in older adults

The authors compared heart-rate and blood-pressure responses to typical isometric (ISO) and isokinetic (90 degrees /s) eccentric (ECC) resistance-training protocols in older adults. Twenty healthy older adults (74 +/- 5 years old) performed randomly ordered ISO and isokinetic ECC exercise (3 sets of 10 repetitions) at a target intensity of 100 % of their peak ISO torque value. Heart rate and systolic (SBP) and diastolic (DBP) blood pressures were recorded continuously, and mean arterial pressure (MAP) and rate-pressure product (RPP) were calculated. ECC peak torque (139 +/- 33 N. m) was significantly greater than ISO peak torque (115 +/- 26 N. m; p <.001). All variables increased significantly (p <.001) during both ISO and ECC exercise. Changes in SBP, DBP, MAP, and RPP were significantly greater during ISO exercise than during ECC exercise (p <.001). Clinically, an isokinetic ECC exercise program enables older adults to work at the same torque output with less cardiovascular stress than ISO exercise.     

Sibling violence: Understanding experiences,impacts, and the need for nuanced responses

Sibling violence is an under-researched field, and the impact of adolescent family violence (AFV) in particular on siblings is not yet well understood. The Australian study Investigating Adolescent Family Violence in Victoria elicited responses from siblings who had experienced AFV from their brothers or sisters, as well as reflections from parents and practitioners on the difficulties of addressing AFV directed towards siblings. This article explores characteristics of sibling violence identified in this study, impacts of the violence on siblings, parents, and families, and responses to sibling violence in Victoria, Australia. Siblings described experiencing severe physical, psychological, and emotional violence, and beyond this recounted a range of difficulties such as not being believed by the adults in their lives; the violence being dismissed as normal sibling behavior; an inability to access support services without the help of parents or other adults; sadness and distress at the loss of the sibling relationship; and resentment towards parents for their perceived inaction against the violence. Practitioners highlighted the dearth of services and resources available for siblings affected by AFV, and the inadequacies of current Child Protection responses. This research sheds light on the hidden issue of sibling violence and highlights the need for nuanced responses rather than a one-size-fits-all approach.     

Following the River’s Flow: A Conversation about Single Session Approaches with Aboriginal Families

Alison Elliott and James Dokona were interviewed by Henry von Doussa, and this article is the written version of that interview. In it, Alison and James separately refer to issues such as early skepticism about the applicability of a single session therapy approach with Indigenous families (Alison), a growing experience of its ‘fit,' philosophically and culturally, and the hope that can be engendered in one conversation. They underline the importance of the oral tradition, and other cultural concepts such as Dadirri (deep listening) as well as the trauma-informed principles of choice, collaboration, and empowerment, through using their language, asking permission, working together on solutions, and not coming across as an expert. The article is infused with the practical ideas and the values inherent in the authors’ work, including permission-seeking, reflection, containment, and their use of a whiteboard as a resource to capture multiple perspectives, a genogram (including pets), and to facilitate yarning. The flow of this conversation in itself reflects James’ imagery of the therapeutic conversation being like a river running – you don’t know which way it’s going to go.     

USE OF EXPERT RATINGS AS SAMPLING STRATA FOR A MORE COST-EFFECTIVE PROBABILITY SAMPLE OF A RARE POPULATION

We consider situations in which externally observable characteristics allow experts to quickly categorize individual households as likely or unlikely to contain a member of a rare target population. This classification can form the basis of disproportionate stratified sampling such that households classified as "unlikely" are sampled at a lower rate than those classified as "likely," thereby reducing screening costs. Design weights account for this approach and allow unbiased estimates for the target population.We demonstrate that with sensitivity and specificity of expert classification at least 70%, and ideally at least 80%, our approach can economically increase effective sample size for a rare population. We develop heuristics for implementing this approach and demonstrate that sensitivity drives design effects and screening costs whereas specificity only drives the latter. We demonstrate that the potential gains from this approach increase as the target population becomes rarer. We further show that for most applications, unlikely strata should be sampled at 1/6 to ? the rate of likely strata.This approach was applied to a survey of Cambodian immigrants in which the 82% of households rated "unlikely" were sampled at ? the rate as "likely" households, reducing screening from 9.4 to 4.0 approaches per complete. Sensitivity and specificity were 86% and 91% respectively. Weighted estimation had a design effect of 1.26 so screening costs per effective sample size were reduced 47%. We also note that in this instance, expert classification appeared to be uncorrelated with survey outcomes of interest among eligibles.