310 resultados para Plantar pressures


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Diversification and expansion of global higher education in the 21st century, has resulted in Learning Landscapes for architectural education that can no longer be sustained by the traditional model. Changes have resulted because of surging student numbers, extensions to traditional curricula, evolving competency standards and accreditation requirements, and modified geographical and pedagogical boundaries. The influx of available new technology has helped to democratise knowledge, transforming when, where and how learning takes place. Pressures on government funded higher education budgets highlight the need for a critical review of the current approach to the design and use of learning environments. Efficient design of physical space contributes significantly to savings in provision, management and use of facilities, while also potentially improving pedagogical quality. The purpose of this research is to identify emerging trends in the design of future Learning Landscapes for architectural education in Australasia; to understand where and how students of architecture are likely to learn, in the future context. It explores the important linkages between space, place, pedagogy, technology and context, using a multi methodological qualitative research approach. An Australasian context study will explore the Learning Landscapes of 23 Schools of Architecture across Australia, New Zealand and Papua New Guinea. The focus of this paper is on the methodology which is being employed to undertake dynamic data collection for the study. The research will be determined through mapping all forms of architectural learning environments, pedagogical approaches and contextual issues, to bridge the gap between academic theory, and architectural design practice. An initial understanding that pedagogy is an intrinsic component imbedded within the design of learning environments, will play an important role. Active learning environments which are exemplified by the architectural design studio, support dynamic project based and collaborative connected learning models. These have recently become a lot more common in disciplines outside of design and the arts. It is anticipated, therefore, that the implications for this research may well have a positive impact far beyond the confines of the architectural studio learning environment.

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In The Fissured Workplace, David Weil dissects the ways in which ostensibly ‘large’ American businesses have come to shed direct employees and instead source their labour needs through a ‘complicated network of smaller business units’. As he notes, this has increased the profitability of these ‘lead’ businesses, at the expense of those who (ultimately) work for them: Wage setting and supervision shift from core businesses to a myriad of organizations, each operating under the rigorous standards of lead businesses but facing fierce competitive pressures. Although lead businesses set demanding goals and standards, and often detailed work practice requirements for subsidiary companies, the actual liability, oversight, and supervision of the workforce become the problem of one or more other organizations. And by replacing a direct employment relationship with a fissured workplace, employment itself becomes more precarious, with risk shifted onto smaller employers and individual workers, who are often cast in the role of independent businesses in their own right.

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Organisations are always focussed on ensuring that their business operations are performed in the most cost-effective manner, and that processes are responsive to ever-changing cost pressures. In many organisations, however, strategic cost-based decisions at the managerial level are not directly or quickly translatable to process-level operational support. A primary reason for this disconnect is the limited system-based support for cost-informed decisions at the process-operational level in real time. In this paper, we describe the different ways in which a workflow management system can support process-related decisions, guided by cost-informed considerations at the operational level, during execution. As a result, cost information is elevated from its non-functional attribute role to a first-class, fully functional process perspective. The paper defines success criteria that a WfMS should meet to provide such support, and discusses a reference implementation within the YAWL workflow environment that demonstrates how the various types of cost-informed decision rules are supported, using an illustrative example.

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-Essential hypertensives display enhanced signal transduction through pertussis toxin-sensitive G proteins. The T allele of a C825T variant in exon 10 of the G protein beta3 subunit gene (GNB3) induces formation of a splice variant (Gbeta3-s) with enhanced activity. The T allele of GNB3 was shown recently to be associated with hypertension in unselected German patients (frequency=0.31 versus 0.25 in control). To confirm and extend this finding in a different setting, we performed an association study in Australian white hypertensives. This involved an extensively examined cohort of 110 hypertensives, each of whom were the offspring of 2 hypertensive parents, and 189 normotensives whose parents were both normotensive beyond age 50 years. Genotyping was performed by polymerase chain reaction and digestion with BseDI, which either cut (C allele) or did not cut (T allele) the 268-bp polymerase chain reaction product. T allele frequency in the hypertensive group was 0.43 compared with 0.25 in the normotensive group (chi2=22; P=0.00002; odds ratio=2.3; 95% CI=1.7 to 3.3). The T allele tracked with higher pretreatment blood pressure: diastolic=105+/-7, 109+/-16, and 128+/-28 mm Hg (mean+/-SD) for CC, CT, and TT, respectively (P=0.001 by 1-way ANOVA). Blood pressures were higher in female hypertensives with a T allele (P=0.006 for systolic and 0.0003 for diastolic by ANOVA) than they were in male hypertensives. In conclusion, the present study of a group with strong family history supports a role for a genetically determined, physiologically active splice variant of the G protein beta3 subunit gene in the causation of essential hypertension.

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NIt is now widely accepted that corporations have a responsibility to benefit society, as well as generate profit. This study used institutional theory to explore how the complex and contested notion of corporate social responsibility is understood and practiced by junior and mid-tier Australian resources companies operating in the world's most impoverished countries. The study found that CSR meaning and practice in this large but little researched group of companies was shaped by complex pressures at the global, industry, organisational and individual levels. Importantly, the study also revealed striking contradictions and ambiguities between participants' CSR aspirations and their actions and accountability.

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The Road Safety Remuneration Act 2012 (Cth) (the Act) explicitly enables the Road Safety Remuneration Tribunal to make orders that can impose binding requirements on all the participants in the road transport supply chain, including consignors and consignees at the apex the chain, for the pay and safety of both employee and independent contractor drivers. The tribunal is also specifically empowered to make enforceable orders to reduce or remove remuneration related incentives and pressures that contribute to unsafe work practices in the road transport industry. Recently the tribunal handed down its first order. The article considers whether, and the degree to which, the tribunal has been willing to exercise its explicit power to impose enforceable obligations on consignors and consignees — such as large supermarket chains — at the apex of road transport supply chains. It examines the substance and extent of the obligations imposed by the tribunal, including whether the tribunal has exercised the full range of powers vested in it by the Act. We contend that the tribunal’s first order primarily imposes obligations on direct work providers and drivers without making large, powerful consignors and consignees substantively responsible for driver pay and safety. We argue that the tribunal’s first order could have more comprehensively fulfilled the objectives of the Act by more directly addressing the root causes of low pay and poor safety in the road transport industry.

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The movement to protect heritage places has grown enormously in Australia over the past decade. The renewed recognition of the significant roles that heritage places play in the urban environment today is encouraging but has a way to go if the demolition of memorable places and irreversible loss of intangible values seen in previous times is to be discontinued. This study investigated the perceptions of the general public and the professional stakeholders in heritage projects and found that they were very similar, particularly in relation to the reasons for heritage retention. The results indicate that, while there is growing interest in sustaining the reflection of the historic urban landscape by retaining cherished icons for the future, there needs to be better ways to overcome the modern development pressures on heritage sites. The paper concludes that, despite the challenges in heritage retention, they are outweighed by the value that accrues from preserving heritage places and the widespread appreciation of that value.

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Purpose – This paper seeks to demonstrate that a truly learner-centred enterprise education programme can be developed within a traditional business school environment. Design/methodology/approach – This paper unites the broad teaching philosophy of Alfred Whitehead with that of Allan Gibbs’s enterprise specific teaching philosophies to consider the fitness of the recently developed hic et nunc enterprise framework. This is largely achieved by testing the framework for constructive alignment. Findings – It is argued that the hic et nunc framework is consistent with the philosophies of both Whitehead and Gibb. Further, the framework illustrates a process through which enterprise education programmes can be developed independently of any pressures to conform to more traditional pedagogy. Practical implications – Through careful consideration of the process of constructive alignment, an analytical approach to developing and/or refining an enterprise education program exists. Importantly, it represents an approach that is explicitly learner-centred, and therefore free from the constraints of the environment within which the programme is delivered. Originality/value – This paper brings to life the wonderful ideas of the great philosopher, Alfred Whitehead, combining them with the contemporary ideas of Allan Gibb. In doing so, the complementary nature of their thoughts helps to illustrate the minimal requirements of a learner-centred approach to enterprise education

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Many existing companies have set up corporate websites in response to competitive pressures and/or the perceived advantages of having a presence in marketspace. However, the effect of this form of communication and/or way of doing business on the corporate brand has yet to be examined in detail. In this article we argue that the translation of corporate brand values from marketplace to marketspace is often problematic, leading to inconsistencies in the way that the brand values are interpreted. Some of issues discussed are: 1) the effect of changed organizational boundaries on the corporate brand, 2) the need to examine whether it is strategically feasible to translate the corporate brand values from marketplace to marketspace, 3) the inherent difficulty in communicating the emotional aspects of the corporate brand in marketspace, and 4) the need to manage the online brand, in terms of its consistency with the offline brand. The conclusion reached is that a necessary part of the process of embracing marketspace as part of a corporate brand strategy is a plan to manage the consistency and continuity of the corporate brand when applied to the Internet. In cases where this is not achievable, a separate corporate brand or a brand extension is a preferable alternative.

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The National Energy Efficient Building Project (NEEBP) Phase One report, published in December 2014, investigated “process issues and systemic failures” in the administration of the energy performance requirements in the National Construction Code. It found that most stakeholders believed that under-compliance with these requirements is widespread across Australia, with similar issues being reported in all states and territories. The report found that many different factors were contributing to this outcome and, as a result, many recommendations were offered that together would be expected to remedy the systemic issues reported. To follow up on this Phase 1 report, three additional projects were commissioned as part of Phase 2 of the overall NEEBP project. This Report deals with the development and piloting of an Electronic Building Passport (EBP) tool – a project undertaken jointly by pitt&sherry and a team at the Queensland University of Technology (QUT) led by Dr Wendy Miller. The other Phase 2 projects cover audits of Class 1 buildings and issues relating to building alterations and additions. The passport concept aims to provide all stakeholders with (controlled) access to the key documentation and information that they need to verify the energy performance of buildings. This trial project deals with residential buildings but in principle could apply to any building type. Nine councils were recruited to help develop and test a pilot electronic building passport tool. The participation of these councils – across all states – enabled an assessment of the extent to which these councils are currently utilising documentation; to track the compliance of residential buildings with the energy performance requirements in the National Construction Code (NCC). Overall we found that none of the participating councils are currently compiling all of the energy performance-related documentation that would demonstrate code compliance. The key reasons for this include: a major lack of clarity on precisely what documentation should be collected; cost and budget pressures; low public/stakeholder demand for the documentation; and a pragmatic judgement that non-compliance with any regulated documentation requirements represents a relatively low risk for them. Some councils reported producing documentation, such as certificates of final completion, only on demand, for example. Only three of the nine council participants reported regularly conducting compliance assessments or audits utilising this documentation and/or inspections. Overall we formed the view that documentation and information tracking processes operating within the building standards and compliance system are not working to assure compliance with the Code’s energy performance requirements. In other words the Code, and its implementation under state and territory regulatory processes, is falling short as a ‘quality assurance’ system for consumers. As a result it is likely that the new housing stock is under-performing relative to policy expectations, consuming unnecessary amounts of energy, imposing unnecessarily high energy bills on occupants, and generating unnecessary greenhouse gas emissions. At the same time, Councils noted that the demand for documentation relating to building energy performance was low. All the participant councils in the EBP pilot agreed that documentation and information processes need to work more effectively if the potential regulatory and market drivers towards energy efficient homes are to be harnessed. These findings are fully consistent with the Phase 1 NEEBP report. It was also agreed that an EBP system could potentially play an important role in improving documentation and information processes. However, only one of the participant councils indicated that they might adopt such a system on a voluntary basis. The majority felt that such a system would only be taken up if it were: - A nationally agreed system, imposed as a mandatory requirement under state or national regulation; - Capable of being used by multiple parties including councils, private certifiers, building regulators, builders and energy assessors in particular; and - Fully integrated into their existing document management systems, or at least seamlessly compatible rather than a separate, unlinked tool. Further, we note that the value of an EBP in capturing statistical information relating to the energy performance of buildings would be much greater if an EBP were adopted on a nationally consistent basis. Councils were clear that a key impediment to the take up of an EBP system is that they are facing very considerable budget and staffing challenges. They report that they are often unable to meet all community demands from the resources available to them. Therefore they are unlikely to provide resources to support the roll out of an EBP system on a voluntary basis. Overall, we conclude from this pilot that the public good would be well served if the Australian, state and territory governments continued to develop and implement an Electronic Building Passport system in a cost-efficient and effective manner. This development should occur with detailed input from building regulators, the Australian Building Codes Board (ABCB), councils and private certifiers in the first instance. This report provides a suite of recommendations (Section 7.2) designed to advance the development and guide the implementation of a national EBP system.

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As a result of competitive pressures, firms are transitioning to international sourcing and initiating complex relationships with suppliers. Despite a lack of inward internationalisation research, there is progressive support for the importance of importing. Heavier focus has been placed on downstream efforts in past years, despite the fact that many factors affecting exporting also influence importing. For small and medium sized enterprises (SME), the psychic distance construct is especially important for internationalisation behaviour but there is little evidence on how perceptual psychic distance, that is the individual’s experiences, influences the buyer-seller relationship. This study draws on internationalisation process theory and commitment-trust theory, in an effort to describe the relationship between objective characteristics (i.e. language, cultural background, education and international experience) and relationship marketing (trust and commitment). The study utilises a holistic, multiple case study design to gain a deeper understanding of the inherent complexities of the relationships in dyads and how objective characteristics, which reduce psychic distance, can facilitate trust and commitment development between importers and exporters.

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Background Although thermal imaging can be a valuable technology in the prevention and management of diabetic foot disease, it is not yet widely used in clinical practice. Technological advancement in infrared imaging increases its application range. The aim was to explore the first steps in the applicability of high-resolution infrared thermal imaging for noninvasive automated detection of signs of diabetic foot disease. Methods The plantar foot surfaces of 15 diabetes patients were imaged with an infrared camera (resolution, 1.2 mm/pixel): 5 patients had no visible signs of foot complications, 5 patients had local complications (e.g., abundant callus or neuropathic ulcer), and 5 patients had difuse complications (e.g., Charcot foot, infected ulcer, or critical ischemia). Foot temperature was calculated as mean temperature across pixels for the whole foot and for specified regions of interest (ROIs). Results No diferences in mean temperature >1.5 °C between the ipsilateral and the contralateral foot were found in patients without complications. In patients with local complications, mean temperatures of the ipsilateral and the contralateral foot were similar, but temperature at the ROI was >2 °C higher compared with the corresponding region in the contralateral foot and to the mean of the whole ipsilateral foot. In patients with difuse complications, mean temperature diferences of >3 °C between ipsilateral and contralateral foot were found. Conclusions With an algorithm based on parameters that can be captured and analyzed with a high-resolution infrared camera and a computer, it is possible to detect signs of diabetic foot disease and to discriminate between no, local, or difuse diabetic foot complications. As such, an intelligent telemedicine monitoring system for noninvasive automated detection of signs of diabetic foot disease is one step closer. Future studies are essential to confirm and extend these promising early findings.

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Background Skin temperature assessment is a promising modality for early detection of diabetic foot problems, but its diagnostic value has not been studied. Our aims were to investigate the diagnostic value of different cutoff skin temperature values for detecting diabetes-related foot complications such as ulceration, infection, and Charcot foot and to determine urgency of treatment in case of diagnosed infection or a red-hot swollen foot. Materials and Methods The plantar foot surfaces of 54 patients with diabetes visiting the outpatient foot clinic were imaged with an infrared camera. Nine patients had complications requiring immediate treatment, 25 patients had complications requiring non-immediate treatment, and 20 patients had no complications requiring treatment. Average pixel temperature was calculated for six predefined spots and for the whole foot. We calculated the area under the receiver operating characteristic curve for different cutoff skin temperature values using clinical assessment as reference and defined the sensitivity and specificity for the most optimal cutoff temperature value. Mean temperature difference between feet was analyzed using the Kruskal–Wallis tests. Results The most optimal cutoff skin temperature value for detection of diabetes-related foot complications was a 2.2°C difference between contralateral spots (sensitivity, 76%; specificity, 40%). The most optimal cutoff skin temperature value for determining urgency of treatment was a 1.35°C difference between the mean temperature of the left and right foot (sensitivity, 89%; specificity, 78%). Conclusions Detection of diabetes-related foot complications based on local skin temperature assessment is hindered by low diagnostic values. Mean temperature difference between two feet may be an adequate marker for determining urgency of treatment.

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Background Prevention of foot ulcers in patients with diabetes is extremely important to help reduce the enormous burden of foot ulceration on both patient and health resources. A comprehensive analysis of reported interventions is not currently available, but is needed to better inform caregivers about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to prevent first and recurrent foot ulcers in persons with diabetes who are at risk for ulceration. Methods The available medical scientific literature in PubMed, EMBASE, CINAHL and the Cochrane database was searched for original research studies on preventative interventions. Both controlled and non-controlled studies were selected. Data from controlled studies were assessed for methodological quality by two independent reviewers. Results From the identified records, a total of 30 controlled studies (of which 19 RCTs) and another 44 non-controlled studies were assessed and described. Few controlled studies, of generally low to moderate quality, were identified on the prevention of a first foot ulcer. For the prevention of recurrent plantar foot ulcers, multiple RCTs with low risk of bias show the benefit for the use of daily foot skin temperature measurements and consequent preventative actions, as well as for therapeutic footwear that demonstrates to relieve plantar pressure and that is worn by the patient. To prevent recurrence, some evidence exists for integrated foot care when it includes a combination of professional foot treatment, therapeutic footwear and patient education; for just a single session of patient education, no evidence exists. Surgical interventions can be effective in selected patients, but the evidence base is small. Conclusion The evidence base to support the use of specific self-management and footwear interventions for the prevention of recurrent plantar foot ulcers is quite strong, but is small for the use of other, sometimes widely applied, interventions and is practically nonexistent for the prevention of a first foot ulcer and non-plantar foot ulcer.

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Background Patients with diabetic foot disease require frequent screening to prevent complications and may be helped through telemedical home monitoring. Within this context, the goal was to determine the validity and reliability of assessing diabetic foot infection using photographic foot imaging and infrared thermography. Subjects and Methods For 38 patients with diabetes who presented with a foot infection or were admitted to the hospital with a foot-related complication, photographs of the plantar foot surface using a photographic imaging device and temperature data from six plantar regions using an infrared thermometer were obtained. A temperature difference between feet of > 2.2 °C defined a ''hotspot.'' Two independent observers assessed each foot for presence of foot infection, both live (using the Perfusion-Extent-Depth- Infection-Sensation classification) and from photographs 2 and 4 weeks later (for presence of erythema and ulcers). Agreement in diagnosis between live assessment and (the combination of ) photographic assessment and temperature recordings was calculated. Results Diagnosis of infection from photographs was specific (> 85%) but not very sensitive (< 60%). Diagnosis based on hotspots present was sensitive (> 90%) but not very specific (<25%). Diagnosis based on the combination of photographic and temperature assessments was both sensitive (> 60%) and specific (> 79%). Intra-observer agreement between photographic assessments was good (Cohen's j = 0.77 and 0.52 for both observers). Conclusions Diagnosis of foot infection in patients with diabetes seems valid and reliable using photographic imaging in combination with infrared thermography. This supports the intended use of these modalities for the home monitoring of high-risk patients with diabetes to facilitate early diagnosis of signs of foot infection.