Feasibility of using telecommunications technology in a Cardiac-Diabetes Self-Management Program

Background: Evidence demonstrates self-management programs are an effective approach to assist patients with chronic diseases such as type 2 diabetes or cardiac conditions to modify their lifestyle for better managing their conditions. Using information technology (IT) has great potential to support self-management programs and assist patients to fulfill their goals in managing their conditions more efficiently and effectively. Examples of different types of technology used in self-management programs that have limited research support include: text messages, telephone followup, web-based programs, and other internet-assisted education. But little is known about the applicability and feasiability of different forms of technology for patients with chronic diseases such as those with type 2 diabetes and critical cardiac conditions. Furthermore, although there is some evidence of the benefits of using IT in supporting self-management programs, further research on the use of IT in such programs is recommended. Objective: To develop and pilot test an integrated Cardiac- Diabetes Self-Management Program (CDSMP) incorporating telephone and text-message follow-up. Methods: A pilot study using randomised controlled trial is conducted in the coronary care unit (CCU) in a Brisbane metropolitan hospital in Australia to collect data on patients with type 2 diabetes admitted to CCU. The main outcomes included self-efficacy levels, knowledge, and quality of life. Results: Initial results reveal that patients with diabetes admitted to the CCU in the experimental group did improve their self-efficacy, and knowledge levels. Acknowledgements: This Project is funded by QUT Early Career Researcher Research Grant

Evaluation of strain energy based damage indices for flexural crack detection of RC beams

Vibration Based Damage Identification Techniques which use modal data or their functions, have received significant research interest in recent years due to their ability to detect damage in structures and hence contribute towards the safety of the structures. In this context, Strain Energy Based Damage Indices (SEDIs), based on modal strain energy, have been successful in localising damage in structuers made of homogeneous materials such as steel. However, their application to reinforced concrete (RC) structures needs further investigation due to the significant difference in the prominent damage type, the flexural crack. The work reported in this paper is an integral part of a comprehensive research program to develop and apply effective strain energy based damage indices to assess damage in reinforced concrete flexural members. This research program established (i) a suitable flexural crack simulation technique, (ii) four improved SEDI's and (iii) programmable sequentional steps to minimise effects of noise. This paper evaluates and ranks the four newly developed SEDIs and existing seven SEDIs for their ability to detect and localise flexural cracks in RC beams. Based on the results of the evaluations, it recommends the SEDIs for use with single and multiple vibration modes.

Rates of attendance at a smoking cessation clinic within a cardiac rehabilitation service

Objectives: Smoking cessation has been shown to be an important intervention for preventing cardiovascular events and improving the health of patients with heart disease. However, unaided quit attempts in these patients often leads to high rates of failure and a return to smoking. Outpatient smoking cessation clinics using face-to-face counseling, ongoing behavioral support, advice on smoking pharmacotherapy and objective monitoring, have been found to be one of the most effective interventions for improving quit smoking rates. An outpatient smoking cessation clinic was trialed within a cardiac rehabilitation service in order to explore its effects on smoking rates for patients with or at risk of heart disease. Attendance rates to the clinic were also monitored. Methods: A descriptive exploratory design was used for this newly developed clinic. Patients who currently smoked tobacco and who had a history of either coronary artery disease, heart failure, atrial fibrillation or those seen under a chest pain assessment service were invited to an outpatient ‘Cardiac Patients Smokers Clinic’. Initially patients were offered up to 10 clinic visits over a 3 month period. Follow-up clinic visits were conducted at 3, 6 and 12 months. A portable carbon monoxide meter was used to objectively measure levels of smoking and validate smoking abstinence. Primary outcomes included rates of attendance. Results: Preliminary findings showed 24 per cent of participants (N = 6) completed all their clinic visits and remained smoke free as measured by their ongoing expired carbon monoxide readings. Clinic attendance rates appeared lowest for those with significant mental health issues such as schizophrenia or substance abuse. However, rates of attendance were improved by having an administration officer make reminder telephone calls prior to clinic visits. Conclusions: Early findings indicate the feasibility of providing a specialist smoking cessation clinic within a cardiac rehabilitation service. Further, that reminder telephone calls prior to appointments improved attendance rates in patients with heart disease to this type of clinic. However, future investigations are warranted.

Multidisciplinary team approach for a peer-support based cardiac-diabetes self-management program

Background: Cardiac patients with diabetes are at higher readmission rates (22%) compared to only 6% for those patients without diabetes. Evidence shows benefits of peer support and using information technology to improve chronic illness and achieve better health outcomes. However limited evidence suggests that cardiac or diabetes self-management programs incorporating peer supporters (patients with similar conditions) or telephone and text-messaging, have improved health outcomes and reduce health care utilisations. A multidisciplinary research team approach is crucial to accommodate the complex aspects of delivering intervention programs for these at-risk patients. However, challenges such as the inconsistency in significance of key concepts across research fields, as well as practical and operational issues within different contexts are often experienced. Aims: To develop an effective multidisciplinary team approach to deliver a peer support based cardiac-diabetes self-management program incorporating the preparation of lay personnel to provide telephone and text-messaging follow up support. Methods: The approach was used for a multidisciplinary project using randomised controlled trial. Results: The findings from multidisciplinary team approach reveal the feasibility of a Peer support based cardiac-diabetes self-management program.

Contrast water therapy and exercise induced muscle damage : a systematic review and meta-analysis

The aim of this systematic review was to examine the effect of Contrast Water Therapy (CWT) on recovery following exercise induced muscle damage. Controlled trials were identified from computerized literature searching and citation tracking performed up to February 2013. Eighteen trials met the inclusion criteria; all had a high risk of bias. Pooled data from 13 studies showed that CWT resulted in significantly greater improvements in muscle soreness at the five follow-up time points(<6, 24, 48, 72 and 96 hours) in comparison to passive recovery. Pooled data also showed that CWT significantly reduced muscle strength loss at each follow-up time (<6, 24, 48, 72 and 96 hours) in comparison to passive recovery. Despite comparing CWT to a large number of other recovery interventions, including cold water immersion, warm water immersion, compression, active recovery and stretching, there was little evidence for a superior treatment intervention. The current evidence base shows that CWT is superior to using passive recovery or rest after exercise; the magnitudes of these effects may be most relevant to an elite sporting population. There seems to be little difference in recovery outcome between CWT and other popular recovery interventions.

Assessing the damage caused by deepwater horizon : not just another Exxon Valdez

In light of the high stakes of the deepwater horizon civil trial and the important precedent-setting role that the case will have on the assessment of future marine disasters, the methodologies underpinning the calculations of damage on both sides will be subjected to considerable scrutiny. Despite the importance of the case, however, there seems to be a pronounced lack of convergence about it in the academic literature. Contributions from scientific journals frequently make comparisons to the Ixtoc I oil spill off the coast of Mexico in 1979; the legal literature, by stark contrast, seems to be much more focused on the Exxon Valdez spill that occurred off the shores of Alaska in 1989. This paper accordingly calls for a more thorough consideration of other analogs beyond the Exxon Valdez spill—most notably, the Ixtoc I incident—in arriving at an assessment of the damage caused by the Deepwater Horizon disaster.

Damage assessment in reinforced concrete flexural members using modal strain energy based method

Damage assessment (damage detection, localization and quantification) in structures and appropriate retrofitting will enable the safe and efficient function of the structures. In this context, many Vibration Based Damage Identification Techniques (VBDIT) have emerged with potential for accurate damage assessment. VBDITs have achieved significant research interest in recent years, mainly due to their non-destructive nature and ability to assess inaccessible and invisible damage locations. Damage Index (DI) methods are also vibration based, but they are not based on the structural model. DI methods are fast and inexpensive compared to the model-based methods and have the ability to automate the damage detection process. DI method analyses the change in vibration response of the structure between two states so that the damage can be identified. Extensive research has been carried out to apply the DI method to assess damage in steel structures. Comparatively, there has been very little research interest in the use of DI methods to assess damage in Reinforced Concrete (RC) structures due to the complexity of simulating the predominant damage type, the flexural crack. Flexural cracks in RC beams distribute non- linearly and propagate along all directions. Secondary cracks extend more rapidly along the longitudinal and transverse directions of a RC structure than propagation of existing cracks in the depth direction due to stress distribution caused by the tensile reinforcement. Simplified damage simulation techniques (such as reductions in the modulus or section depth or use of rotational spring elements) that have been extensively used with research on steel structures, cannot be applied to simulate flexural cracks in RC elements. This highlights a big gap in knowledge and as a consequence VBDITs have not been successfully applied to damage assessment in RC structures. This research will address the above gap in knowledge and will develop and apply a modal strain energy based DI method to assess damage in RC flexural members. Firstly, this research evaluated different damage simulation techniques and recommended an appropriate technique to simulate the post cracking behaviour of RC structures. The ABAQUS finite element package was used throughout the study with properly validated material models. The damaged plasticity model was recommended as the method which can correctly simulate the post cracking behaviour of RC structures and was used in the rest of this study. Four different forms of Modal Strain Energy based Damage Indices (MSEDIs) were proposed to improve the damage assessment capability by minimising the numbers and intensities of false alarms. The developed MSEDIs were then used to automate the damage detection process by incorporating programmable algorithms. The developed algorithms have the ability to identify common issues associated with the vibration properties such as mode shifting and phase change. To minimise the effect of noise on the DI calculation process, this research proposed a sequential order of curve fitting technique. Finally, a statistical based damage assessment scheme was proposed to enhance the reliability of the damage assessment results. The proposed techniques were applied to locate damage in RC beams and slabs on girder bridge model to demonstrate their accuracy and efficiency. The outcomes of this research will make a significant contribution to the technical knowledge of VBDIT and will enhance the accuracy of damage assessment in RC structures. The application of the research findings to RC flexural members will enable their safe and efficient performance.