The OnTrack Diabetes web-based program for type 2 diabetes and dysphoria self-management: A randomized controlled trial protocol

Background: The prevalence of type 2 diabetes is rising with the majority of patients practicing inadequate disease self-management. Depression, anxiety, and diabetes-specific distress present motivational challenges to adequate self-care. Health systems globally struggle to deliver routine services that are accessible to the entire population, in particular in rural areas. Web-based diabetes self-management interventions can provide frequent, accessible support regardless of time and location Objective: This paper describes the protocol of an Australian national randomized controlled trial (RCT) of the OnTrack Diabetes program, an automated, interactive, self-guided Web program aimed to improve glycemic control, diabetes self-care, and dysphoria symptoms in type 2 diabetes patients. Methods: A small pilot trial is conducted that primarily tests program functionality, efficacy, and user acceptability and satisfaction. This is followed by the main RCT, which compares 3 treatments: (1) delayed program access: usual diabetes care for 3 months postbaseline followed by access to the full OnTrack Diabetes program; (2) immediate program: full access to the self-guided program from baseline onward; and (3) immediate program plus therapist support via Functional Imagery Training (FIT). Measures are administered at baseline and at 3, 6, and 12 months postbaseline. Primary outcomes are diabetes self-care behaviors (physical activity participation, diet, medication adherence, and blood glucose monitoring), glycated hemoglobin A1c (HbA1c) level, and diabetes-specific distress. Secondary outcomes are depression, anxiety, self-efficacy and adherence, and quality of life. Exposure data in terms of program uptake, use, time on each page, and program completion, as well as implementation feasibility will be conducted. Results: This trial is currently underway with funding support from the Wesley Research Institute in Brisbane, Australia. Conclusions: This is the first known trial of an automated, self-guided, Web-based support program that uses a holistic approach in targeting both type 2 diabetes self-management and dysphoria. Findings will inform the feasibility of implementing such a program on an ongoing basis, including in rural and regional locations.

Development of the OnTrack Diabetes program

Background: Type 2 diabetes affects an estimated 347 million people worldwide and often leads to serious complications including blindness, kidney disease, and limb amputation. Comorbid dysphoria is common and is an independent risk factor for poor glycaemic control. Professional support for diabetes self-management and dysphoria has limited availability and involves high costs, especially after regular hours, and in rural and remote areas. Web-based cognitive behavior therapy offers highly accessible, acceptable, and cost-effective support for people with diabetes. This paper describes the development of OnTrack Diabetes, a self-guided, Web-based program to promote improved physical and emotional self-management in people with Type 2 diabetes. Objective: The objective of the study is to describe the development of the OnTrack Diabetes program, which is a self-guided, Web-based program aimed to promote euthymia and improved disease self-management in people with Type 2 diabetes. Methods: Semistructured interviews with 12 general practitioners and 13 patients with Type 2 diabetes identified enablers of and barriers to effective diabetes self-management, requirements for additional support, and potential program elements. Existing resources and research data informed the development of content, and consultants from relevant disciplines provided feedback on draft segments and reviewed the program before release. Using a self-guided delivery format contained costs, in addition to adapting program features and modules from an existing OnTrack program. Results: A separate paper describes the protocol for a randomized controlled trial to provide this required evaluation. Conclusions: Development of the OnTrack Diabetes program demonstrates strategies that help ensure that a program is acceptable to users. The next stages involve testing users’ experiences and examining the program’s effectiveness and cost-effectiveness in randomized controlled trials.

Best practice in peer-led curriculum content : informing an interactive program to improve passenger safety among high school seniors

Despite ongoing improvements in behaviour change strategies, licensing models and road law enforcement measures young drivers remain significantly over-represented in fatal and non-fatal road related crashes. This paper focuses on the safety of those approaching driving age and identifies both high priority road safety messages and relevant peer-led strategies to guide the development school programs. It summarises the review in a program logic model built around the messages and identified curriculum elements, as they may be best operationalised within the licensing and school contexts in Victoria. This paper summarises a review of common deliberate risk-taking and non-deliberate unsafe driving behaviours among novice drivers, highlighting risks associated with speeding, driving while fatigued, driving while impaired and carrying passengers. Common beliefs of young people that predict risky driving were reviewed, particularly with consideration of those beliefs that can be operationalised in a behaviour change school program. Key components of adolescent risk behaviour change programs were also reviewed, which identified a number of strategies for incorporation in a school based behaviour change program, including: a well-structured theoretical design and delivery, thoughtfully considered peer-selected processes, adequate training and supervision of peer facilitators, a process for monitoring and sustainability, and interactive delivery and participant discussions. The research base is then summarised in a program logic model with further discussion about the quality of the current state of knowledge of evaluation of behaviour change programs and the need for considerable development in program evaluation.

Defining a ‘democratic elite’ : key media in the battle for social responsibility

This paper offers a definition of elite media arguing their content focus will sufficiently meet social responsibility needs of democracy. Its assumptions come from the Finkelstein and Leveson Inquiries and regulatory British Royal Charter (2013). These provide guidelines on how media outlets meet ‘social responsibility’ standards, e.g. press has a ‘responsibility to be fair and accurate’ (Finkelstein); ethical press will feel a responsibility to ‘hold power to account’ (Leveson); news media ‘will be held strictly accountable’ (RC). The paper invokes the British principle of media opting-in to observe standards, and so serve the democracy. It will give examples from existing media, and consider social responsibility of media more generally. Obvious cases of ‘quality’ media: public broadcasters, e.g. BBC, Al-Jazeera, and ‘quality’ press, e.g. NYT, Süddeutscher Zeitung, but also community broadcasters, specialised magazines, news agencies, distinctive web logs, and others. Where providing commentary, these abjure gratuitous opinion -- meeting a standard of reasoned, informational and fair. Funding is almost a definer, many such services supported by the state, private trusts, public institutions or volunteering by staff. Literature supporting discussion on elite media will include their identity as primarily committed to a public good, e.g. the ‘Public Value Test’, Moe and Donders (2011); with reference also to recent literature on developing public service media. Within its limits the paper will treat social media as participants among all media, including elite, and as a parallel dimension of mass communication founded on inter-activity. Elite media will fulfil the need for social responsibility, firstly by providing one space, a ‘plenary’ for debate. Second is the notion of building public recognition of elite media as trustworthy. Third is the fact that elite media together are a large sector with resources to sustain social cohesion and debate; notwithstanding pressure on funds, and impacts of digital transformation undermining employment in media more than in most industries.

Efficient web browsing with a single-switch

This paper presents a new approach to web browsing in situ- ations where the user can only provide the device with a sin- gle input command device (switch). Switches have been de- veloped for example for people with locked-in syndrome and are used in combination with scanning to navigate virtual keyboards and desktop interfaces. Our proposed approach leverages the hierarchical structure of webpages to operate a multi-level scan of actionable elements of webpages (links or form elements). As there are a few methods already exist- ing to facilitate browsing under these conditions, we present a theoretical usability evaluation of our approach in com- parison to the existing ones, which takes into account the average time taken to reach any part of a web page (such as a link or a form) but also the number of clicks necessary to reach the goal. We argue that these factors contribute together to usability. In addition, we propose that our ap- proach presents additional usability benefits.

Effects of moisture content on resilient properties of recycled concrete aggregates (RCAs)

In pavement design, resilient modulus of a pavement material is one of the key design parameters. Resilient modulus of a granular pavement material can be measured using repeated load Triaxial (RLT) test or estimated using empirical models. For conventional granular pavement materials, a significant amount of resilient modulus data and empirical models to estimate this key design parameter are available. However, RCA is a relatively new granular pavement material and therefore no such data or empirical models are available. In this study, a number of RLT tests were conducted on RCA sample to investigate the effects of moisture content on its resilient modulus (Mr). It was observed that the resilient modulus of RCA increased with a number of loading cycles but decreased as the moisture content was increased. Further, using RLT test results, empirical models to estimate the resilient modulus of RCA were enhanced and validated.

Agency-generated research of consumer-generated content

Social media enable advertising agencies to engage directly with the public by participating in-and observing-real conversations. The current study recruited a Delphi panel to explore how some of the world's leading advertising professionals view the use of social media to test, track, and evaluate advertising campaigns and how they identify related risks and ethical considerations. The findings suggest that agencies primarily use social media as a tool for understanding consumers and igniting insight, not as a means of testing creative ideas. The authors believe this research provides an important benchmark of agency best practice in social-media research and outlines ethical implications.

A data mining based method for discovery of web services and their compositions

Due to the availability of huge number of web services, finding an appropriate Web service according to the requirements of a service consumer is still a challenge. Moreover, sometimes a single web service is unable to fully satisfy the requirements of the service consumer. In such cases, combinations of multiple inter-related web services can be utilised. This paper proposes a method that first utilises a semantic kernel model to find related services and then models these related Web services as nodes of a graph. An all-pair shortest-path algorithm is applied to find the best compositions of Web services that are semantically related to the service consumer requirement. The recommendation of individual and composite Web services composition for a service request is finally made. Empirical evaluation confirms that the proposed method significantly improves the accuracy of service discovery in comparison to traditional keyword-based discovery methods.

Clustering and labeling a web scale document collection using Wikipedia clusters

Clustering is an important technique in organising and categorising web scale documents. The main challenges faced in clustering the billions of documents available on the web are the processing power required and the sheer size of the datasets available. More importantly, it is nigh impossible to generate the labels for a general web document collection containing billions of documents and a vast taxonomy of topics. However, document clusters are most commonly evaluated by comparison to a ground truth set of labels for documents. This paper presents a clustering and labeling solution where the Wikipedia is clustered and hundreds of millions of web documents in ClueWeb12 are mapped on to those clusters. This solution is based on the assumption that the Wikipedia contains such a wide range of diverse topics that it represents a small scale web. We found that it was possible to perform the web scale document clustering and labeling process on one desktop computer under a couple of days for the Wikipedia clustering solution containing about 1000 clusters. It takes longer to execute a solution with finer granularity clusters such as 10,000 or 50,000. These results were evaluated using a set of external data.

Patient perspectives of using a web based intervention program for patients with type 2 diabetes and acute coronary syndrome

Introduction Research highlights patients with dual diagnoses of type 2 diabetes and acute coronary syndrome (ACS) have higher readmission rates and poorer health outcomes than patients with singular chronic conditions. Despite this, there is a lack of education programs targeted for this dual diagnosis population to improve self-management and decrease negative health outcomes. There is evidence to suggest that internet based interventions may improve health outcomes for patients with singular chronic conditions, however there is a need to develop an evidence base for ACS patients with comorbid diabetes. There is a growing awareness of the importance of a participatory model in developing effective online interventions. That is, internet interventions are more effective if end users’ perceptions of the intervention are incorporated in their final development prior to testing in large scale trials. Objectives This study investigated patients’ perspectives of the web-based intervention designed to promote self-management of the dual conditions in order to refine the intervention prior to clinical trial evaluation. Methods An interpretive approach with thematic analysis was used to obtain deeper understanding regarding participants’ experience when using web-application interventions for patients with ACS and type 2 diabetes. Semi-structured interviews were undertaken on a purposive sample of 30 patients meeting strict inclusion and exclusion criteria to obtain their perspectives on the program. Results Preliminary results indicate patients with dual diagnoses express more complex needs than those with a singular condition. Participants express a positive experience with the proposed internet intervention and emerging themes include that the web page is seen as easy to use and comforting as a support, in that patients know they are not alone. Further results will be reported as they become available. Conclusion The results indicate potential for patient acceptability of the newly developed internet intervention for patients with ACS and comorbid diabetes. Incorporation of patient perspectives into the final development of the intervention is likely to maximise successful outcomes of any future trials that utilise this intervention. Future quantitative evaluation of the effectiveness of the intervention is being planned.

Keeping international visitors safe on Australian beaches : informing the content of surf safety messages

In Australia, international tourists/visitors are one of the highest risk groups for drowning at beaches. Swimming in patrolled areas, between the flags, reduces the risk of drowning with most drownings occuring outside these areas. There is a need to understand beliefs which influence the extent to which international tourists/visitors intend to swim between the flags. The theory of planned behaviour (TPB) and, in particular, the indirect beliefs which underpin constructs in the model, represent a means of determining what factors influence this intention. The current study compared international visitors/tourists as having either low or high intentions to swim between the flags on a range of behavioural, normative, and control beliefs. A series of MANOVAs revealed significant differences between the groups in all three of the beliefs. The findings provide insight into potential foci for message content for use in educational campaigns aimed at keeping international visitors safe on Australian beaches.

Spatial mapping of proteoglycan content in articular cartilage using near-infrared (NIR) spectroscopy

Diagnosis of articular cartilage pathology in the early disease stages using current clinical diagnostic imaging modalities is challenging, particularly because there is often no visible change in the tissue surface and matrix content, such as proteoglycans (PG). In this study, we propose the use of near infrared (NIR) spectroscopy to spatially map PG content in articular cartilage. The relationship between NIR spectra and reference data (PG content) obtained from histology of normal and artificially induced PG-depleted cartilage samples was investigated using principal component (PC) and partial least squares (PLS) regression analyses. Significant correlation was obtained between both data (R2 = 91.40%, p<0.0001). The resulting correlation was used to predict PG content from spectra acquired from whole joint sample, this was then employed to spatially map this component of cartilage across the intact sample. We conclude that NIR spectroscopy is a feasible tool for evaluating cartilage contents and mapping their distribution across mammalian joint