The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes: Development of an evidence-based global consensus

Foot problems complicating diabetes are a source of major patient suffering and societal costs. Investing in evidence-based, internationally appropriate diabetic foot care guidance is likely among the most cost-effective forms of healthcare expenditure, provided it is goal-focused and properly implemented. The International Working Group on the Diabetic Foot (IWGDF) has been publishing and updating international Practical Guidelines since 1999. The 2015 updates are based on systematic reviews of the literature, and recommendations are formulated using the Grading of Recommendations Assessment Development and Evaluation system. As such, we changed the name from 'Practical Guidelines' to 'Guidance'. In this article we describe the development of the 2015 IWGDF Guidance documents on prevention and management of foot problems in diabetes. This Guidance consists of five documents, prepared by five working groups of international experts. These documents provide guidance related to foot complications in persons with diabetes on: prevention; footwear and offloading; peripheral artery disease; infections; and, wound healing interventions. Based on these five documents, the IWGDF Editorial Board produced a summary guidance for daily practice. The resultant of this process, after reviewed by the Editorial Board and by international IWGDF members of all documents, is an evidence-based global consensus on prevention and management of foot problems in diabetes. Plans are already under way to implement this Guidance. We believe that following the recommendations of the 2015 IWGDF Guidance will almost certainly result in improved management of foot problems in persons with diabetes and a subsequent worldwide reduction in the tragedies caused by these foot problems.

Indoor air quality and energy management through real–time sensing in commercial buildings

Rapid growth in the global population requires expansion of building stock, which in turn calls for increased energy demand. This demand varies in time and also between different buildings, yet, conventional methods are only able to provide mean energy levels per zone and are unable to capture this inhomogeneity, which is important to conserve energy. An additional challenge is that some of the attempts to conserve energy, through for example lowering of ventilation rates, have been shown to exacerbate another problem, which is unacceptable indoor air quality (IAQ). The rise of sensing technology over the past decade has shown potential to address both these issues simultaneously by providing high–resolution tempo–spatial data to systematically analyse the energy demand and its consumption as well as the impacts of measures taken to control energy consumption on IAQ. However, challenges remain in the development of affordable services for data analysis, deployment of large–scale real–time sensing network and responding through Building Energy Management Systems. This article presents the fundamental drivers behind the rise of sensing technology for the management of energy and IAQ in urban built environments, highlights major challenges for their large–scale deployment and identifies the research gaps that should be closed by future investigations.

Improved wound management at lower costs: A sensible goal for Australia

Chronic wounds cost the Australian health system at least US$2·85 billion per year. Wound care services in Australia involve a complex mix of treatment options, health care sectors and funding mechanisms. It is clear that implementation of evidence-based wound care coincides with large health improvements and cost savings, yet the majority of Australians with chronic wounds do not receive evidence-based treatment. High initial treatment costs, inadequate reimbursement, poor financial incentives to invest in optimal care and limitations in clinical skills are major barriers to the adoption of evidence-based wound care. Enhanced education and appropriate financial incentives in primary care will improve uptake of evidence-based practice. Secondary-level wound specialty clinics to fill referral gaps in the community, boosted by appropriate credentialing, will improve access to specialist care. In order to secure funding for better services in a competitive environment, evidence of cost-effectiveness is required. Future effort to generate evidence on the cost-effectiveness of wound management interventions should provide evidence that decision makers find easy to interpret. If this happens, and it will require a large effort of health services research, it could be used to inform future policy and decision-making activities, reduce health care costs and improve patient outcomes.

Complexity of collaborative work in residential aged care facilities: An analysis of information exchange for medication management

Information exchange (IE) is a critical component of the complex collaborative medication process in residential aged care facilities (RACFs). Designing information and communication technology (ICT) to support complex processes requires a profound understanding of the IE that underpins their execution. There is little existing research that investigates the complexity of IE in RACFs and its impact on ICT design. The aim of this study was thus to undertake an in-depth exploration of the IE process involved in medication management to identify its implications for the design of ICT. The study was undertaken at a large metropolitan facility in NSW, Australia. A total of three focus groups, eleven interviews and two observation sessions were conducted between July to August 2010. Process modelling was undertaken by translating the qualitative data via in-depth iterative inductive analysis. The findings highlight the complexity and collaborative nature of IE in RACF medication management. These models emphasize the need to: a) deal with temporal complexity; b) rely on an interdependent set of coordinative artefacts; and c) use synchronous communication channels for coordination. Taken together these are crucial aspects of the IE process in RACF medication management that need to be catered for when designing ICT in this critical area. This study provides important new evidence of the advantages of viewing process as a part of a system rather than as segregated tasks as a means of identifying the latent requirements for ICT design and that is able to support complex collaborative processes like medication management in RACFs. © 2012 IEEE.

Supporting knowledge-intensive construction management tasks in BIM

The delivery of products and services for construction-based businesses is increasingly becoming knowledge-driven and information-intensive. The proliferation of building information modelling (BIM) has increased business opportunities as well as introduced new challenges for the architectural, engineering and construction and facilities management (AEC/FM) industry. As such, the effective use, sharing and exchange of building life cycle information and knowledge management in building design, construction, maintenance and operation assumes a position of paramount importance. This paper identifies a subset of construction management (CM) relevant knowledge for different design conditions of building components through a critical, comprehensive review of synthesized literature and other information gathering and knowledge acquisition techniques. It then explores how such domain knowledge can be formalized as ontologies and, subsequently, a query vocabulary in order to equip BIM users with the capacity to query digital models of a building for the retrieval of useful and relevant domain-specific information. The formalized construction knowledge is validated through interviews with domain experts in relation to four case study projects. Additionally, retrospective analyses of several design conditions are used to demonstrate the soundness (realism), completeness, and appeal of the knowledge base and query-based reasoning approach in relation to the state-of-the-art tools, Solibri Model Checker and Navisworks. The knowledge engineering process and the methods applied in this research for information representation and retrieval could provide useful mechanisms to leverage BIM in support of a number of knowledge intensive CM/FM tasks and functions.

Disease control and management

Globally, the main contributors to morbidity and mortality are chronic conditions, including cardiovascular disease and diabetes. Chronic disease is costly and partially avoidable, with around 60% of deaths and nearly 50% of the global disease burden attributable to these conditions. By 2020, chronic illnesses will likely be the leading cause of disability worldwide. Existing healthcare systems that focus on acute episodic health conditions, both national and international, cannot address the worldwide transition to chronic illness; nor are they appropriate for the ongoing care and management of those already dealing with chronic diseases. As such, chronic disease management requires integrated approaches that incorporate interventions targeted at both individuals and populations, and emphasise the shared risk factors of different conditions. International and Australian strategic planning documents articulate similar elements to manage chronic disease, including the need for aligning sectoral policies for health, forming partnerships, and engaging communities in decision-making. Infectious diseases are also a common and significant contributor to ill health throughout the world. In many countries, this impact has been minimised by the combined efforts of preventative health measures and improved treatment methods. However, in low-income countries, infectious diseases remain the dominant cause of death and disability. The World Health Organization (WHO) estimates that infectious diseases (including respiratory infections) still account for around 23% (or around 14 million) of all deaths each year, and result in over 4.6 billion episodes of diarrhoeal disease and 243 million cases of malaria each year (Lozano et al. 2012, WHO 2009). In addition to the high level of mortality, infectious diseases disable many hundreds of millions of people each year, mainly in developing countries, with the global burden of disease from infectious diseases estimated to be around 300 million DALYs (disability-adjusted life years) (WHO 2012). The aim of this chapter is to outline the impact that infectious diseases and chronic diseases have on the health of the community, describe the public health strategies used to reduce the burden of those diseases, and discuss the historic and emerging disease risks to public health. This chapter examines the comprehensive approaches implemented to prevent both chronic and infectious diseases, and to manage and care for communities with these conditions.

Conference Report: International Institute of Fisheries Economics and Trade Conference (IIFET) 2014

The 17th Biennial Conference of the International Institute of Fisheries Economics and Trade (IIFET) was held in Brisbane in July 2014. IIFET is the principal international association for fisheries economics, and the biennial conference is an opportunity for the best fisheries economists in the world to meet and share their ideas. The conference was organised by CSIRO, QUT, UTAS, University of Adelaide and KG Kailis Ltd. This is the first time the conference has been held in Australia. The conferences covered a wide range of topics of relevance to Australia. These included studies of fishery management systems around the world, identified key issues in aquaculture and marine biodiversity conservation, and provided a forum for new modelling and theoretical approaches to analysing fisheries problems to be presented. The theme of the conference was Towards Ecosystem Based Management of Fisheries: What Role can Economics Play? Several sessions were dedicated to modelling socio-ecological systems, and two keynote speakers were invited to present the latest thinking in the area. In this report, the key features of the conference are outlined.

Evaluating the effectiveness of a self-management exercise intervention on wound healing, functional ability and health-related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial

Exercise that targets ankle joint mobility may lead to improvement in calf muscle pump function and subsequent healing. The objectives of this research were to assess the impact of an exercise intervention in addition to routine evidence-based care on the healing rates, functional ability and health-related quality of life for adults with venous leg ulcers (VLUs). This study included 63 patients with VLUs. Patients were randomised to receive either a 12-week exercise intervention with a telephone coaching component or usual care plus telephone calls at the same timepoints. The primary outcome evaluated the effectiveness of the intervention in relation to wound healing. The secondary outcomes evaluated physical activity, functional ability and health-related quality of life measures between groups at the end of the 12 weeks. A per protocol analysis complemented the effectiveness (intention-to-treat) analysis to highlight the importance of adherence to an exercise intervention. Intention-to-treat analyses for the primary outcome showed 77% of those in the intervention group healed by 12 weeks compared to 53% of those in the usual care group. Although this difference was not statistically significant due to a smaller than expected sample size, a 24% difference in healing rates could be considered clinically significant. The per protocol analysis for wound healing, however, showed that those in the intervention group who adhered to the exercise protocol 75% or more of the time were significantly more likely to heal and showed higher rates for wound healing than the control group (P = 0·01), that is, 95% of those who adhered in the intervention group healed in 12 weeks. The secondary outcomes of physical activity, functional ability and health-related quality of life were not significantly altered by the intervention. Among the secondary outcomes (physical activity, functional ability and health-related quality of life), intention-to-treat analyses did not support the effectiveness of the intervention. However, per protocol analyses revealed encouraging results with those participants who adhered more than 75% of the time (n = 19) showing significantly improved Range of Ankle Motion from the self-management exercise programme (P = 0·045). This study has shown that those participants who adhere to the exercise programme as an adjunctive treatment to standard care are more likely to heal and have better functional outcomes than those who do not adhere to the exercises in conjunction with usual care.

Water management capacity building to support rapidly developing mining economies

Many developing countries are experiencing rapid expansion in mining with associated water impacts. In most cases mining expansion is outpacing the building of national capacity to ensure that sustainable water management practices are implemented. Since 2011, Australia's International Mining for Development Centre (IM4DC) has funded capacity building in such countries including a program of water projects. Five projects in particular (principally covering experiences from Peru, Colombia, Ghana, Zambia, Indonesia, Philippines and Mongolia) have provided insight into water capacity building priorities and opportunities. This paper reviews the challenges faced by water stakeholders, and proposes the associated capacity needs. The paper uses the evidence derived from the IM4DC projects to develop a set of specific capacity-building recommendations. Recommendations include: the incorporation of mine water management in engineering and environmental undergraduate courses; secondments of staff to suitable partner organisations; training to allow site staff to effectively monitor water including community impacts; leadership training to support a water stewardship culture; training of officials to support implementation of catchment management approaches; and the empowerment of communities to recognise and negotiate solutions to mine-related risks. New initiatives to fund the transfer of multi-disciplinary knowledge from nations with well-developed water management practices are called for.

HealthMap: A cluster randomised trial of interactive health plans and self-management support to prevent coronary heart disease in people with HIV

Background The leading causes of morbidity and mortality for people in high-income countries living with HIV are now non-AIDS malignancies, cardiovascular disease and other non-communicable diseases associated with ageing. This protocol describes the trial of HealthMap, a model of care for people with HIV (PWHIV) that includes use of an interactive shared health record and self-management support. The aims of the HealthMap trial are to evaluate engagement of PWHIV and healthcare providers with the model, and its effectiveness for reducing coronary heart disease risk, enhancing self-management, and improving mental health and quality of life of PWHIV. Methods/Design The study is a two-arm cluster randomised trial involving HIV clinical sites in several states in Australia. Doctors will be randomised to the HealthMap model (immediate arm) or to proceed with usual care (deferred arm). People with HIV whose doctors are randomised to the immediate arm receive 1) new opportunities to discuss their health status and goals with their HIV doctor using a HealthMap shared health record; 2) access to their own health record from home; 3) access to health coaching delivered by telephone and online; and 4) access to a peer moderated online group chat programme. Data will be collected from participating PWHIV (n = 710) at baseline, 6 months, and 12 months and from participating doctors (n = 60) at baseline and 12 months. The control arm will be offered the HealthMap intervention at the end of the trial. The primary study outcomes, measured at 12 months, are 1) 10-year risk of non-fatal acute myocardial infarction or coronary heart disease death as estimated by a Framingham Heart Study risk equation; and 2) Positive and Active Engagement in Life Scale from the Health Education Impact Questionnaire (heiQ). Discussion The study will determine the viability and utility of a novel technology-supported model of care for maintaining the health and wellbeing of people with HIV. If shown to be effective, the HealthMap model may provide a generalisable, scalable and sustainable system for supporting the care needs of people with HIV, addressing issues of equity of access. Trial registration Universal Trial Number (UTN) U111111506489; ClinicalTrial.gov Id NCT02178930 submitted 29 June 2014

Book review: "Kozak, M., & Kozak, N. (Eds). 2008. Destination Marketing: An International Perspective. Wallingford, Oxon: Routledge"

This edited volume contains 18 chapters by 40 contributors from many parts the world, and is divided into four thematic sections. The focus of Part 1 is Destination image, and contains five chapters. This has arguably been the most popular topic in the destination marketing literature, underpinned by the knowledge that the image an individual holds of a destination is as important as any tangible features. Yin Chew and Siti Johari attempt to model the relationship between destination image and country image using structural equation modelling. While this does address an important gap in the literature, the measures used to operationalise the constructs are not reported and little of the data analysis is discussed to support the finding that country image is a predictor of destination image. Ana Rodriquez, Antonia Correia and Metin Kozak report the findings of an exploratory study about lakedestination image. They used a neural network content analysis of 40 lake descriptions featuring on an online directory for lake enthusiasts to derive a set of cognitive attribute themes. Yang Zhang and Yi-Wei Xiao explore the relations between literary works and tourism through the Asian voice. Whereas most literary tourism studies have been around Western culture, this is a rare perspective from Chinese culture...

Germination biology and occurrence of pol-yembryony in two forms of cats claw creeper vine, Dolichandra unguis-cati (Bignonia-ceae): implications for its invasiveness and management

Cat’s claw creeper, Dolichandra unguis-cati (L.) Lohmann (syn. Macfadyena unguis-cati (L.) Gentry) is a major environmental weed in Australia. Two forms (‘long’ and ‘short’ pod) of the weed occur in Australia. This investigation aimed to evaluate and compare germination behavior and occurrence of polyembryony in the two forms of the weed. Seeds were germinated in growth chambers set to 10/20 °C, 15/25 °C, 20/30 °C, 30/45 °C and 25 °C. Germination and polyembryony were monitored over a period of 12 weeks. For all the treatments in this study, seeds from the short pod form exhibited significantly higher germination rates and higher occurrence of polyembryony than those from the long pod form. Seeds from the long pod form did not germinate at the lowest temperature of 10/20 °C; in contrast, those of the short pod form germinated under this condition, albeit at a lower rate. Results from this study could explain why the short pod form of D. unguis-cati is the more widely distributed form in Australia, while the long pod form is confined to a few localities. The results have implication in predicting future ranges of both forms of the invasive D. unguis-cati, as well as inform management decisions for control of the weed.