Reaching those most in need: a review of diabetes self-management interventions in disadvantaged populations

There has been increased recognition of the importance of developing diabetes self-management education (DSME) interventions that are effective with under-served and minority populations. Despite several recent studies in this area, there is to our knowledge no systematic review or synthesis of what has been learned from this research. An electronic literature search identified five formative evaluations and ten controlled DSME intervention trials focused on under-served (low-income, minority or aged) populations. The RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) evaluation framework was used to evaluate the controlled studies on the dimensions of reach, efficacy, adoption, implementation, and maintenance. Fifty percent of the studies identified reported on the percentage of patients who participated, and the percentages were highly variable. The methodological quality of the articles was generally good and the short-term results were encouraging, especially on behavioral outcomes. Data on adoption (representativeness of settings and clinicians who participate) and implementation were almost never reported. Studies of modalities in addition to group meetings are needed to increase the reach of DSME with under-served populations. The promising formative evaluation work that has been conducted needs to be extended for more systematic study of the process of intervention implementation and adaptation with special populations. Studies that explicitly address the community context and that address multiple issues related to public health impact of DSME interventions are recommended to enhance long-term results. Copyright (C) 2002 John Wiley Sons, Ltd.

Emotions at multiple levels: An integration

Weiss and Isen have provided many supportive comments about the multi-level perspective, but also found limitations. Isen noted the importance of integrating affect, cognition, and motivation. Weiss commented similarly that the model lacked an integrating “thread.” He suggested that, to be truly multilevel, each level should constrain processes at other levels, and also provide guidance for the development of new concepts. Weiss also noted that the focus on biological processes was a strength of the model. I respond by suggesting that these very biological processes may constitute the “missing” thread. To illustrate this, I discuss some of the recent research on emotions in organizational settings, and argue that biology both constrains and guides theory at each level of the model. Based on this proposition, I revisit each of the five levels in the model, to demonstrate how this integration can be accomplished in this fashion. Finally, I address two additional points: aggregation bias, and the possibility of extending the model to include higher levels of industry and region.

Three-dimensional space-borne synthetic aperture radar (SAR) imaging with multiple pass processing

Three-dimensional (3D) synthetic aperture radar (SAR) imaging via multiple-pass processing is an extension of interferometric SAR imaging. It exploits more than two flight passes to achieve a desired resolution in elevation. In this paper, a novel approach is developed to reconstruct a 3D space-borne SAR image with multiple-pass processing. It involves image registration, phase correction and elevational imaging. An image model matching is developed for multiple image registration, an eigenvector method is proposed for the phase correction and the elevational imaging is conducted using a Fourier transform or a super-resolution method for enhancement of elevational resolution. 3D SAR images are obtained by processing simulated data and real data from the first European Remote Sensing satellite (ERS-1) with the proposed approaches.

Efficacy, timing and method of application of fungicides for management of sorghum ergot caused by Claviceps africana

Trials conducted in Queensland, Australia between 1997 and 2002 demonstrated that fungicides belonging to the triazole group were the most effective in minimising the severity of infection of sorghum by Claviceps africana, the causal agent of sorghum ergot. Triadimenol ( as Bayfidan 250EC) at 0.125 kg a. i./ha was the most effective fungicide. A combination of the systemic activated resistance compound acibenzolar-S-methyl ( as Bion 50WG) at 0.05 kg a. i./ha and mancozeb ( as Penncozeb 750DF) at 1.5 kg a. i./ha has the potential to provide protection against the pathogen, should triazole-resistant isolates be detected. Timing and method of fungicide application are important. Our results suggest that the triazole fungicides have no systemic activity in sorghum panicles, necessitating the need for multiple applications from first anthesis to the end of flowering, whereas acibenzolar-S-methyl is most effective when applied 4 days before flowering. The flat fan nozzles tested in the trials provided higher levels of protection against C. africana and greater droplet deposition on panicles than the tested hollow cone nozzles. Application of triadimenol by a fixed wing aircraft was as efficacious as application through a tractor-mounted boom spray.

Professional status, employee attitudes and multiple identifications at work

We conducted two studies exploring the influence of professional status on three targets of organisational identification. In the first study, 180 employees from a large metropolitan hospital completed an organisation-wide survey. As predicted, employees belonging to high-status professional groups reported higher levels of identification with their profession, followed by their work unit and the organisation. In contrast, employees belonging to low-status professional groups reported higher levels of identification with their work unit and the organisation, compared to their profession. Identification with the various targets was also associated with higher levels of job satisfaction and organisational commitment, and lower levels of uncertainty and emotional exhaustion. In the second study, 60 employees from the same hospital took part in semi-structured interviews to further explore issues relating to professional identification. In line with the results of the first study, the professional group was viewed as a central target of identification at work, particularly for those employees belonging to high status professional groups. Professional identification was also identified as a conduit for social meaning and a signifier of intergroup boundaries. Implications for the management of multiple identifications and heterogeneous teams are discussed.

Management effectiveness: Assessing management of protected areas?

To maximise the potential of protected areas, we need to understand the strengths and weaknesses in their management and the threats and stresses that they face. There is increasing pressure on governments and other bodies responsible for protected areas to monitor their effectiveness. The reasons for assessing management effectiveness include the desire by managers to adapt and improve their management strategies, improve planning and priority setting and the increasing demands for reporting and accountability being placed on managers, both nationally and internationally. Despite these differing purposes for assessment, some common themes and information needs can be identified, allowing assessment systems to meet multiple uses. Protected-area management evaluation has a relatively short history. Over the past 20 years a number of systems have been proposed but few have been adopted by management agencies. In response to a recognition of the need for a globally applicable approach to this issue, the IUCN World Commission on Protected Areas developed a framework for assessing management effectiveness of both protected areas and protected area systems. This framework was launched at the World Conservation Congress in Jordan in 2000. The framework provides guidance to managers to develop locally relevant assessment systems while helping to harmonise assessment approaches around the world. The framework is strongly linked to the protected area management process and is adaptable to different types and circumstances of protected areas around the world. Examples from Fraser Island in Australia and the Congo Basin illustrate the use of the framework.

Medication management at home: medication-related risk factors associated with poor health outcomes

Background: some patients may have medication-related risk factors only identified by home visits, but the extent to which those risk factors are associated with poor health outcomes remains unclear. Objective: to determine the association between medication-related risk factors and poor patient health outcomes from observations in the patients' homes. Design: cross-sectional study. Setting: patients' homes. Subjects: 204 general practice patients living in their own homes and at risk of medication-related poor health outcomes. Methods: medications and medication-related risk factors were identified in the patients' homes by community pharmacists and general practitioners (GPs). The medication-related risk factors were examined as determinants of patients' self-reported health related quality of life (SF-36) and their medication use, as well as physicians' impression of patient adverse drug events and health status. Results: key medication-related risk factors associated with poor health outcomes included: Lack of any medication administration routine, therapeutic duplication, hoarding, confusion between generic and trade names, multiple prescribers, discontinued medication repeats retained and multiple storage locations. Older age and female gender were associated with some poorer health outcomes. In addition, expired medication and poor adherence were also associated with poor health outcomes, however, not independently. Conclusion: the findings support the theory that polypharmacy and medication-related risk factors as a result of polypharmacy are correlated to poor health outcomes.

Multiple directorships and corporate performance in Australian listed companies

How many directorships are too many? Globally, normative advice emphasises the importance of limiting the number of directorships any individual should hold due to the workloads they entail. However, there is little empirical evidence to support this view. Rather, there is a strong tradition of supporting multiple directorships as a mechanism for the firm to co-opt external resources. To explore the issue of director workloads and multiple directorships, we first consider the issues related to multiple directorships and outline the conclusions of extant international and Australian studies into multiple directorships. We then detail our objectives in undertaking this research and our approach to data collection. Our findings indicate that the incidence of multiple directorships in Australian listed companies is low. We also find that many of the apparent examples of multiple directorships are due to related entities, which share common directors and, due to the nature of these entities, have much lower workload requirements. Further, there does not appear to be any relationship between holding multiple directorships and firm financial performance. Finally, we discuss the implications for boards and those interested in governance, particularly the need to ensure governance recommendations and guidelines reflect empirical findings. We offer one solution to address the concerns of boards, investors, other stakeholders and the community regarding multiple directorships: board and individual director evaluations.

"We do it, but they don't": Multiple categorizations and work team communication

The present study adopted an intergroup approach to information sharing and ratings of work team communication in a public hospital (N = 142) undergoing large-scale restructuring. Consistent with predictions, ratings of communication followed a double ingroup serving bias: while team members reported sending about the same levels of information to double ingroup members (same work team/same occupational group) as they did to partial ingroup members (same work team/different occupational group), they reported receiving less information from partial ingroup members than from double ingroup members and rated the communication that they received from partial ingroup members as less effective. We discuss the implication of these results for the management of information sharing and organizational communication.

Indexing and integrating multiple features for WWW images

In this paper, we present a novel indexing technique called Multi-scale Similarity Indexing (MSI) to index image's multi-features into a single one-dimensional structure. Both for text and visual feature spaces, the similarity between a point and a local partition's center in individual space is used as the indexing key, where similarity values in different features are distinguished by different scale. Then a single indexing tree can be built on these keys. Based on the property that relevant images have similar similarity values from the center of the same local partition in any feature space, certain number of irrelevant images can be fast pruned based on the triangle inequity on indexing keys. To remove the dimensionality curse existing in high dimensional structure, we propose a new technique called Local Bit Stream (LBS). LBS transforms image's text and visual feature representations into simple, uniform and effective bit stream (BS) representations based on local partition's center. Such BS representations are small in size and fast for comparison since only bit operation are involved. By comparing common bits existing in two BSs, most of irrelevant images can be immediately filtered. To effectively integrate multi-features, we also investigated the following evidence combination techniques-Certainty Factor, Dempster Shafer Theory, Compound Probability, and Linear Combination. Our extensive experiment showed that single one-dimensional index on multi-features improves multi-indices on multi-features greatly. Our LBS method outperforms sequential scan on high dimensional space by an order of magnitude. And Certainty Factor and Dempster Shafer Theory perform best in combining multiple similarities from corresponding multiple features.

Objectives for multiple-species conservation planning

The first step in conservation planning is to identify objectives. Most stated objectives for conservation, such as to maximize biodiversity outcomes, are too vague to be useful within a decision-making framework. One way to clarify the issue is to define objectives in terms of the risk of extinction for multiple species. Although the assessment of extinction risk for single species is common, few researchers have formulated an objective function that combines the extinction risks of multiple species. We sought to translate the broad goal of maximizing the viability of species into explicit objectives for use in a decision-theoretic approach to conservation planning. We formulated several objective functions based on extinction risk across many species and illustrated the differences between these objectives with simple examples. Each objective function was the mathematical representation of an approach to conservation and emphasized different levels of threat Our objectives included minimizing the joint probability of one or more extinctions, minimizing the expected number of extinctions, and minimizing the increase in risk of extinction from the best-case scenario. With objective functions based on joint probabilities of extinction across species, any correlations in extinction probabilities bad to be known or the resultant decisions were potentially misleading. Additive objectives, such as the expected number of extinctions, did not produce the same anomalies. We demonstrated that the choice of objective function is central to the decision-making process because alternative objective functions can lead to a different ranking of management options. Therefore, decision makers need to think carefully in selecting and defining their conservation goals.

Successful management of lymphangiomatosis and chylothorax in a 7-month-old infant

A 7-month old infant presented with an effusion and multiple lesions in his spleen. A diagnosis of lymphangiomatosis was made based on chylous effusion and an MRI demonstrating numerous enhancing lesions within the spleen on T2-weighed images. Conservative measures, including the withdrawal of feeds and octreotide, did not significantly reduce the rate of chyle production and increasing requirement for respiratory support. Resection of the patient's spleen and partial pleurectomy were associated with a dramatic improvement in his condition. At 27 months the patient was well with no evidence of further lymphangiomas or a recurrence of his chylothoraces.