Longitudinal Assessment of Neuropathy in Diabetes using novel ophthalmic MARKers (LANDMark): Baseline findings

Purpose:Over the past decade, corneal nerve morphology and corneal sensation threshold have been explored as potential surrogate markers for the evaluation of diabetic neuropathy. We present the baseline findings of a Longitudinal Assessment of Neuropathy in Diabetes using novel ophthalmic Markers (LANDMark). Methods:The LANDMark Study is a 5-year, two-site, natural history (observational) study of individuals with Type 1 diabetes stratified into those with (T1W) and without (T1WO) neuropathy according to the Toronto criteria, and control subjects. All study participants undergo detailed annual assessment of neuropathy including corneal nerve parameters measured using corneal confocal microscopy and corneal sensitivity measured using non-contact corneal esthesiometry. Results:396 eligible individuals (208 in Brisbane and 188 in Manchester) were assessed: 76 T1W, 166 T1WO and 154 controls. Corneal sensation threshold (mbars) was significantly higher in T1W (1.0 ± 1.1) than T1WO (0.7 ± 0.7) and controls (0.6 ± 0.4) (P=0.002); post-hoc analysis (PHA) revealed no difference between T1WO and controls (Tukey HSD, P=0.502). Corneal nerve fiber length (mm/mm2) (CNFL) was lower in T1W (13.8 ± 6.4) than T1WO (19.1 ± 5.8) and controls (23.2 ± 6.3) (P<0.001); PHA revealed CNFL to be lower in T1W than T1WO, and lower in both of these groups than controls (P<0.001). Corneal nerve branch density (branches/mm2) (CNBD) was significantly lower in T1W (40 ± 32) than T1WO (62 ± 37) and controls (83 ± 46) (P<0.001); PHA showed CNBD was lower in T1W than T1WO, and lower in both groups than controls (P<0.001). Alcohol and cigarette consumption did not differ between groups, although age, BMI, BP, waist circumference, HbA1c, albumin-creatinine ratio, and cholesterol were slightly greater in T1W than T1WO (p<0.05). Some site differences were observed. Conclusions:The LANDMark baseline findings confirm that corneal sensitivity and corneal nerve morphometry can detect differences in neuropathy status in individuals with Type 1 diabetes and healthy controls. Corneal nerve morphology is significantly abnormal even in diabetic patients ‘without neuropathy’ compared to control participants. Results of the longitudinal trial will assess the capability of these tests for monitoring change in these parameters over time as potential surrogate markers for neuropathy.

Organisational culture, leadership behaviour and job satisfaction among primary health care professionals in Saudi Arabia : a mixed-methods study

The purpose of this study was to improve individual and organisational performance in primary health care (PHC) by identifying the relationship between organisational culture, leadership behaviour and job satisfaction. The study used a sequential explanatory mixed methods design, to investigate the relationships between organisational culture, leadership behaviour, and job satisfaction among 550 PHCC professionals in Saudi Arabia. From surveying the PHC professionals, the results highlighted the importance of human caring qualities, including praise and recognition, consideration, and support, with respect to their perceptions of job satisfaction, leadership behaviour, and organisational culture. As a consequence a management framework was proposed to address these issues.

Corneal confocal microscopy shown an improvement in small-fibre neuropathy in subjects with type 1 diabetes on continuous subcutaneous insulin infusion compared to multiple daily injection

Improved glycemic control is the only treatment that has been shown to be effective for diabetic peripheral neuropathy in patients with type 1 diabetes (1). Continuous subcutaneous insulin infusion (CSII) is superior to multiple daily insulin injection (MDI) for reducing HbA1c and hypoglycemic events (2). Here, we have compared the benefits of CSII compared withMDI for neuropathy over 24months....

Management accounting change in a subsidiary organisation

Parent–subsidiary relationships are commonplace nowadays, yet surprisingly there is a paucity of research analysing their dynamics over time. This paper presents a (longitudinal) case study, illuminating the dynamics implicated when a UK chemicals company imposed its systems and rules on a new subsidiary. Drawing on observations from a longitudinal case study (from 1993 to 2001), the study considers: (1) the extent to which a parent imposes its (management accounting) systems,rules and procedures on a subsidiary; (2) the role which (local) political, cultural and institutional factors in a subsidiary play in shaping the dynamics of such change implementation; (3) how new systems and practices become accepted and take root as values and beliefs and how they supplement earlier norms? The study provides insight for the questions above, and draws on institutional theories and a power mobilisation framework to assist in the interpretation of observations. We find that the operations of the subsidiary company are influenced by inter-related forces, both inside and outside the organisation encompassing issues of power, politics and culture. As such, existing institutions in a subsidiary organisation are influenced, sustained, and changed by the socio-economic context in which the subsidiary is located. Organisational practices designed to secure external legitimacy are not however always symbolic and decoupled from internal operations

The perspectives of older drivers on the impact of feedback on their driving behaviours : a qualitative study

Self-regulation is a coping strategy that allows older drivers to drive safely for longer. Self-regulation depends largely on the ability of drivers to evaluate their own driving. Therefore the success of self-regulation, in terms of driving safety, is influenced by the ability of older drivers to have insight into their declining driving performance. In addition, previous studies suggest that providing feedback to older adults regarding their driving skills may lead them to change their driving behaviour. However, little is currently known about the impact of feedback on older drivers’ self-awareness and their subsequent driving regulatory behaviour. This study explored the process of self-regulation and driving cessation among older drivers using the PAPM as a framework. It also investigated older adults’ perceptions and opinions about receiving feedback in regards to their driving abilities. Qualitative focus groups with 27 participants aged 70 years or more were conducted. Thematic analysis resulted in the development of five main themes; the meaning of driving, changes in driving pattern, feedback, the planning process, and solutions. The analysis also resulted in an initial model of driving self-regulation among older drivers that is informed by the current research and the Precaution Adoption Process Model as the theoretical framework. It identifies a number of social, personal, and environmental factors that can either facilitate or hinder people’s transition between stages of change. The findings from this study suggest that further elaboration of the PAPM is needed to take into account the role of insight and feedback on the process of self-regulation among older drivers.

The applicability of the Precaution Adoption Process Model for understanding self-regulatory driving behaviour among older drivers

1. Introduction The success of self-regulation, in terms of enhancing older drivers’ safety and maintaining their mobility, depends largely upon older drivers’ awareness of the declines in their driving abilities. Therefore, interventions targeted at increasing older drivers’ safety should aim to enhance their awareness of their physical, sensory and cognitive limitations. Moreover, previous research suggests that driving behaviour change may occur through stages and that interventions and feedback may be perceived differently at each stage. 2. Study aims To further understand the process of driving self-regulation among older adults by exploring their perceptions and experiences of self-regulation, using the PAPM as a framework. To investigate the possible impact of feedback on their driving on their decision making process. 3. Methodology Research tool: Qualitative focus groups (n=5 sessions) Recruitment: Posters, media, newspaper advertisement and emails Inclusion criteria: Aged 70 or more, English-speaking, current drivers Participants: Convenience sample of 27 men and women aged 74 to 90 in the Sunshine Coast and Brisbane city, Queensland, Australia. 4. Analysis Thematic analysis was conducted following the process outlined by Braun and Clarke (2006) to identify, analyse and report themes within the data. Four main themes were identified.

Foreign-currency and monetary geopolitics of United States and its effects on the future of the international system

The US dollar is still considered as the main strategic deposit among the currencies of different countries of the world and the policies of the World Bank and the International Financial Organizations have been and will always be influenced by the US economy. Despite the economic crises and commercial balance deficits in the United States, dollar has maintained its high position in and its domination over foreign exchanges and foreign-currency deposits of the countries. The novelty of the present research relies on its consideration of the political properties of the governments and the geopolitical effects of these countries on the position of their monetary and foreign-currency policies and consequently, on the international financial organizations such as the International Monetary Fund and the World Bank, which can determine the future of international economy and the political relations among countries. Our research proves that the political development of the United States and its geopolitical situation have been of the effective factors on dollar growth; and unless the competitors acquire such a relative advantage, they will not be able to seriously challenge the currency of dollar and the monetary policies of the United States, at least in a short time

Geo-economics and considerations on the tourism industry with emphasis on historical cities tourism and ecotourism in Iran

Considering its many potentials in the tourism industry, Iran has constantly been among the leading countries seeking development in this industry. Iran is a country with many attractions in different tourism sections including cultural, urban, and monument tourism, and ancient places as well as ecotourism, and water tourism etc. for tourists. However, Iran has never economically prospered regarding its potentials in this industry as compared to its rivals. Thus, the main objective of this work is to list the main necessities of harnessing economic power and required instruments to fulfill this goal. In addition, the tourism industry is discussed as an important strategy for reaching this power, and the Iranian wildlife is introduced as an intact environment. It is also discussed that what economic benefits are obtained through using this tourism industry. It must be noted that the main emphasis of this work is on urban, monument tourism, ancient places, and ecotourism as a case study in two Iranian provinces. Finally, the required analyses are performed considering the affinity between these two sections and two provinces. Results indicated that while Iran having the highest percent of growth compared to the two other countries active in this area, however this advantage has not significantly affected the GDP in Iran, and Iran has not been able to improve its geo-economic capacity in this area.

Tourism advertisement management and effective tools in tourism industry

The definition of tourism “is the travel for recreational, leisure, family or business purposes, usually of a limited duration. Tourism is commonly associated with trans-national travel, but may also refer to travel to another location within the same country”. Tourism as an industry, in today’s modern language is a means of global communication between nations and travelers of all countries, introducing them to the various cultures and societies abroad, as well there history, ancient, historical sites, and languages. Hence, advertising overall has become a tool of necessity in this ever-growing global industry. Given that, tourism is a part of the infrastructure of any country’s economy the growth and development of tourism is of great importance. Advertising plays a vital and is a crucial tool in developing the countries tourism by attractively presenting the nations points-of-interests, historical and cultural. Advertising has a central role in expanding this industry, generating economic growth in this area, as well as creating direct and indirect employment, but most importantly a creative innovating competition in the national and international travel industry. Importantly, to achieve a successful tourist industry, the Travel Agencies and governmental offices of the Ministry’s of Tourism and Business must work hand-in-hand to attain these goals. This article shows the impact of the various media and advertising methods used in tourism, which assisted in identifying the correct tool for expanding the country’s industry of tourism. The results of this study illustrated that the appropriate tools for promotional strategies to attract domestic and foreign traveler’s, found to be the most effective were, handbook, internet advertising, TV, brochures, newspapers

A subexponential construction of graph coloring for multiparty computation

We show the first deterministic construction of an unconditionally secure multiparty computation (MPC) protocol in the passive adversarial model over black-box non-Abelian groups which is both optimal (secure against an adversary who possesses any t

An introduction to education research methods: Exploring the learning journey of pre-service teachers in a transnational programme

Internationally there is interest in developing the research skills of pre-service teachers as a means of ongoing professional renewal with a distinct need for systematic and longitudinal investigation of student learning. The current study takes a unique perspective by exploring the research learning journey of pre-service teachers participating in a transnational degree programme. Using a case-study design that includes both a self-reported and direct measure of research knowledge, the results indicate a progression in learning, as well as evidence that this research knowledge is continued or maintained when the pre-service teachers return to their home university. The findings of this study have implications for both pre-service teacher research training and transnational programmes.

The role of non-thermal plasma technique in {NOx} treatment: A review

Non-thermal plasma (NTP) has been introduced over the past several years as a promising method for nitrogen oxide (NOx) removal. The intent, when using NTP, is to selectively transfer input electrical energy to the electrons, and to not expend this in heating the entire gas stream, which generates free radicals through collisions, and promotes the desired chemical changes in the exhaust gases. The generated active species react with the pollutant molecules and decompose them. This paper reviews and summarizes relevant literature regarding various aspects of the application of {NTP} technology on {NOx} removal from exhaust gases. A comprehensive description of available scientific literature on {NOx} removal using {NTP} technology is presented, including various types of NTP, e.g. dielectric barrier discharge, corona discharge and electron beam. Furthermore, the combination of {NTP} with catalyst and adsorbent for better {NOx} removal efficiency is presented in detail. The removal of {NOx} from both simulated gases and real diesel engines is also considered in this review paper. As {NTP} is a new technique and is not yet commercialized, there is a need for more studies to be performed in this field.