Resilience in chronic disease : the relationships among risk factors, protective factors, adaptive outcomes, and the level of resilience in adults with diabetes

Background: There are innumerable diabetes studies that have investigated associations between risk factors, protective factors, and health outcomes; however, these individual predictors are part of a complex network of interacting forces. Moreover, there is little awareness about resilience or its importance in chronic disease in adulthood, especially diabetes. Thus, this is the first study to: (1) extensively investigate the relationships among a host of predictors and multiple adaptive outcomes; and (2) conceptualise a resilience model among people with diabetes. Methods: This cross-sectional study was divided into two research studies. Study One was to translate two diabetes-specific instruments (Problem Areas In Diabetes, PAID; Diabetes Coping Measure, DCM) into a Chinese version and to examine their psychometric properties for use in Study Two in a convenience sample of 205 outpatients with type 2 diabetes. In Study Two, an integrated theoretical model is developed and evaluated using the structural equation modelling (SEM) technique. A self-administered questionnaire was completed by 345 people with type 2 diabetes from the endocrine outpatient departments of three hospitals in Taiwan. Results: Confirmatory factor analyses confirmed a one-factor structure of the PAID-C which was similar to the original version of the PAID. Strong content validity of the PAID-C was demonstrated. The PAID-C was associated with HbA1c and diabetes self-care behaviours, confirming satisfactory criterion validity. There was a moderate relationship between the PAID-C and the Perceived Stress Scale, supporting satisfactory convergent validity. The PAID-C also demonstrated satisfactory stability and high internal consistency. A four-factor structure and strong content validity of the DCM-C was confirmed. Criterion validity demonstrated that the DCM-C was significantly associated with HbA1c and diabetes self-care behaviours. There was a statistical correlation between the DCM-C and the Revised Ways of Coping Checklist, suggesting satisfactory convergent validity. Test-retest reliability demonstrated satisfactory stability of the DCM-C. The total scale of the DCM-C showed adequate internal consistency. Age, duration of diabetes, diabetes symptoms, diabetes distress, physical activity, coping strategies, and social support were the most consistent factors associated with adaptive outcomes in adults with diabetes. Resilience was positively associated with coping strategies, social support, health-related quality of life, and diabetes self-care behaviours. Results of the structural equation modelling revealed protective factors had a significant direct effect on adaptive outcomes; however, the construct of risk factors was not significantly related to adaptive outcomes. Moreover, resilience can moderate the relationships among protective factors and adaptive outcomes, but there were no interaction effects of risk factors and resilience on adaptive outcomes. Conclusion: This study contributes to an understanding of how risk factors and protective factors work together to influence adaptive outcomes in blood sugar control, health-related quality of life, and diabetes self-care behaviours. Additionally, resilience is a positive personality characteristic and may be importantly involved in the adjustment process among people living with type 2 diabetes.

Is length of experience an appropriate criterion to identify level of expertise?

Clinical experience plays an important role in the development of expertise, particularly when coupled with reflection on practice. There is debate, however, regarding the amount of clinical experience that is required to become an expert. Various lengths of practice have been suggested as suitable for determining expertise, ranging from five years to 15 years. This study aimed to investigate the association between length of experience and therapists’ level of expertise in the field of cerebral palsy with upper limb hypertonicity using an empirical procedure named Cochrane–Weiss–Shanteau (CWS). The methodology involved re-analysis of quantitative data collected in two previous studies. In Study 1, 18 experienced occupational therapists made hypothetical clinical decisions related to 110 case vignettes, while in Study 2, 29 therapists considered 60 case vignettes drawn randomly from those used in Study 1. A CWS index was calculated for each participant's case decisions. Then, in each study, Spearman's rho was calculated to identify the correlations between the duration of experience and level of expertise. There was no significant association between these two variables in both studies. These analyses corroborated previous findings of no association between length of experience and judgemental performance. Therefore, length of experience may not be an appropriate criterion for determining level of expertise in relation to cerebral palsy practice.

Changes in Level of Virus Accumulation and Incidence of Infection are Critical in the Characterization of Rice Tungro Bacilliform Virus (RTBV) Resistance in Rice

Analysis by enzyme-linked immunosorbent assay showed that Rice tungro bacilliform virus (RTBV) accumulated in a cyclic pattern from early to late stages of infection in tungro-susceptible variety, Taichung Native 1 (TN1), and resistant variety, Balimau Putih, singly infected with RTBV or co-infected with RTBV+Rice tungro spherical virus (RTSV). These changes in virus accumulation resulted in differences in RTBV levels and incidence of infection. The virus levels were expressed relative to those of the susceptible variety and the incidence of infection was assessed at different weeks after inoculation. At a particular time point, RTBV levels in TN1 or Balimau Putih singly infected with RTBV were not significantly different from the virus level in plants co-infected with RTBV+RTSV. The relative RTBV levels in Balimau Putih either singly infected with RTBV or co-infected with RTBV+RTSV were significantly lower than those in TN1. The incidence of RTBV infection varied at different times in Balimau Putih but not in TN1, and to determine the actual infection, the number of plants that became infected at least once anytime during the 4wk observation period was considered. Considering the changes in RTBV accumulation, new parameters for analyzing RTBV resistance were established. Based on these parameters, Balimau Putih was characterized having resistance to virus accumulation although the actual incidence of infection was >75%.

Agree or disagree? Level of alignment between project manager and stakeholders on performance indicators

Studies indicate project success should be viewed from the different perspectives of the individual stakeholders. Project managers are owner’s agents. In order to allow early corrective actions to take place in case a project is diverted from plan, to accurately report perceived success of the stakeholders by project managers is essential, though there has been little systematic research in this area. The aim of this paper is to report the findings of an empirical study that compares the level of alignment between project managers and key stakeholders on a list of project performance indicators. A telephone survey involving 18 complex project managers and various key project stakeholder groups was conducted in this study. Krippendorff’s Kappa alpha reliability test was used to assess the alignment levels between project managers and stakeholders. Despite the overall agreement level between project manager and stakeholders is only medium; results have also identified 12 performance indicators that have significant level of agreement between project managers and stakeholders.

Challenges facing sustainable housing in Saudi Arabia : a current study showing the level of public awareness

Sustainable housing implementation requires strong support from the public, government and the housing industry. Lack of public awareness and understanding of the language and the meaning of sustainable housing may cause lack of public support. Salama stated that "sustainability or sustainable design is simply a rephrasing of some of the forgotten values of traditional architecture and urbanism"(Salama 2007). This exploratory paper examines public awareness of sustainable housing in Saudi Arabia. In developing countries, like Saudi Arabia, which have been experiencing a rapid rate of urbanisation, sustainable concept intervention is essential due to the scarcity of resources (Reffat 2004a). Sustainable building methods include the full use of the site design, passive solar design, natural light and ventilation. This paper reports on an exploratory survey on understanding the potential of the implementation of sustainable housing in Saudi Arabia. The main problem is that more than half of respondents were not aware of sustainable housing. Thus, one of the recommendations from the survey is to educate the public by using local media to inform people of the benefits of sustainable implementation to both new and existing housing stock.

The role of universities in building prosperous knowledge cities : the Malaysian experience

This paper explores the role and importance of universities, particularly in the Malaysian context, for building prosperous knowledge cities of the rising knowledge economy. It aims to shed light on how universities contribute to the knowledge-based development of Malaysian cities by undertaking a case study investigation. In the case of Bandar Seri Iskandar, the paper scrutinises the creation – from scratch – of a knowledge city, including the establishment of new public and private universities and hence providing a unique opportunity to understand how the idea of the knowledge economy has permeated economic development policy within a developing country context. The research findings reveal that in Malaysia, much like many of the developed countries, universities are being positioned to play a major role in supporting knowledge city (trans)formation. While there has been a tangible success on the spatial development based on a rapid land use change towards accommodating knowledge-intensive land use and activities, the research reports that a more concerted and coordinated effort from academia, public and private sectors are needed to further foster the growth and development of economical, environmental, institutional and social aspects of Bandar Seri Iskandar to become a fully functioning prosperous knowledge city.

Contributions of knowledge-based foundations of universities in knowledge city formation : a Malaysian case study

Purpose – In the 21st Century, as knowledge, technology and education are widely accepted to play key roles in the local economic development, the importance of making space and place for knowledge production is, therefore, on the rise resulting many city administrations and urban policy-makers worldwide restructuring their cities to become highly competitive and creative. Consequently, this has led to a new type of city form, knowledge city, and a new approach in their development, knowledge-based urban development. In this context, knowledge-based foundations of universities are regarded as one of the key elements for knowledge-based urban development and knowledge city formation due to their ability to provide a strong platform for knowledge generation, marketing and transfer. This paper aims to investigate the role and importance of universities and their knowledge-based foundations in the context of developing countries, particularly in Malaysia, in building prosperous knowledge cities of the era of the knowledge economy. Design/Methodology/Approach – The main methodological techniques employed in this research includes: a thorough review of the literature on the role of universities in spatial and socio-economic development of cities; a best practice analysis and policy review of urban and regional development policies targeting to use of university clusters in leveraging knowledge-based development, and; a case study in Malaysia with a review of various policy documents and strategic plans of the local universities and local and state authorities, interviews with key actors, and a trend analysis of local socio-economic and spatial changes. Originality/Value – This paper reports the findings of a pioneering research on examining the role and impact of universities and their knowledge-based foundations, in the context of Malaysia, in building knowledge cities of the era of the knowledge economy. By undertaking a case study investigation in Bandar Seri Iskandar, which is a newly emerging Malaysian knowledge city, located in Perak, Malaysia, the paper sheds light on an important issue of the 21st Century of how universities contribute to the knowledge-based development of cities. Practical Implications – Universities with their rich knowledge-based foundations are increasingly being recognised as knowledge hubs, exercising a strong influence in the intellectual vitality of the city where they are embedded. This paper reveals that universities, in joint action with business and society at large, are necessary prerequisites for constructing and maintaining knowledge societies and, therefore, building prosperous knowledge cities. In light of the literature and case findings, the paper sheds light on the contribution of knowledge-based foundations of universities in knowledge city formation and provides generic recommendations for cities and regions seeking knowledge city transformation.

How do level of experience, purpose for riding, and preference for facilities affect location of riding?

Characteristics of the road infrastructure affect both the popularity of bicycling and its safety, but comparisons of the safety performance of infrastructure may be confounded by differences in the profiles of cyclists who use them. Data from a survey of 2,532 adult bicycle riders in Queensland, Australia, demonstrated that many riders rode reluctantly in particular locations and that preference for riding location was influenced by degree of experience and riding purpose. Most riders rode most often and furthest per week on urban roads, but approximately one-third of all riders (and more new riders) rode there reluctantly. Almost two-thirds of riders rode on bicycle paths, most by choice, not reluctantly. New riders rode proportionally more on bicycle paths, but continuing riders rode further in absolute terms. Utilitarian riders were more likely to ride on bicycle paths than social and fitness riders and almost all of this riding was by choice. Fitness riders were more reluctant in their use of bicycle paths, but still most of their use was by choice. One-third of the respondents reported riding on the sidewalk (legal in Queensland), with approximately two-thirds doing so reluctantly. The frequency and distance ridden on the sidewalk was less than for urban roads and bicycle paths. Sidewalks and bicycle paths were important facilities for both inexperienced and experienced riders and for utilitarian riding, especially when urban roads were considered a poor choice for cycling.

Drivers’ inability to assess their level of alertness on monotonous highways

Decline of alertness constitutes a normal physiological phenomenon but could be aggravated when drivers operate in monotonous environments, even in rested individuals. Driving performance is impaired and this increases crash risk due to inattention. This paper aims to show that road characteristics - namely road design (road geometry) and road side variability (signage and buildings) – influence subjective assessment of alertness by drivers. This study used a driving simulator to investigate the drivers’ ability to subjectively detect periods of time when their alertness is importantly reduced by varying road geometry and road environment. Driver’s EEG activity is recorded as a reference to evaluate objectively driver's alertness and is compared to self-reported alertness by participants. Twenty-five participants drove on four different scenarios (varying road design and road environment monotony) for forty minutes. It was observed that participants were significantly more accurate in their assessment before the driving task as compared to after (90% versus 60%). Errors in assessment were largely underestimations of their real alertness rather than over-estimations. The ability to detect low alertness as assessed with an EEG was highly dependent on the road monotony. Scenarios with low roadside variability resulted in high overestimation of the real alertness, which was not observed on monotonous road design. The findings have consequences for road safety and suggest that countermeasures to lapses of alertness cannot rely solely on self-assessment from drivers and road design should reduce environments with low variability.