Educational and psychosocial programmes for adolescents with diabetes: approaches, outcomes and cost-effectiveness

Diabetes incurs heavy personal and health system costs. Self-management is required if complications are to be avoided. Adolescents face particular challenges as they learn to take responsibility for their diabetes. A systematic review of educational and psychosocial programmes for adolescents with diabetes was undertaken. This aimed to: identify and categorise the types of programmes that have been evaluated; assess the cost-effectiveness of interventions; identify areas where further research is required. Sixty-two papers were identified and Subjected to a narrative review. Generic programmes focus on knowledge/skills, psychosocial issues, and behaviour/self-management. They result in modest improvements across a range of outcomes but improvements are often not sustained, suggesting a need for continuous support, possibly integrated into normal care. In-hospital education at diagnosis confers few advantages over home treatment. The greatest returns may be obtained by targeting poorly controlled individuals. Few studies addressed resourcing issues and robust cost-effectiveness appraisals are required to identify interventions that generate the greatest returns on expenditure. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

Modern approaches to floristics and their impact on the region of SW Asia

Attitudes to floristics have changed considerably during the past few decades as a result of increasing and often more focused consumer demands, heightened awareness of the threats to biodiversity, information flow and overload, and the application of electronic and web-based techniques to information handling and processing. This paper will examine these concerns in relation to our floristic knowledge and needs in the region of SW Asia. Particular reference will be made to the experience gained from the Euro+Med PlantBase project for the preparation of an electronic plant-information system for Europe and the Mediterranean, with a single core list of accepted plant names and synonyms, based on consensus taxonomy agreed by a specialist network. The many challenges Ð scientific, technical and organisational Ð that it has presented will be discussed as well as the problems of handling nontaxonomic information from fields such as conservation, karyology, biosystematics and mapping. The question of regional cooperation and the sharing of efforts and resources will also be raised and attention drawn to the recent planning workshop held in Rabat (May 2002) for establishing a technical cooperation network for taxonomic capacity building in North Africa as a possible model for the SW Asia region.

The assessment of enriched apoplastic extracts using proteomic approaches

In plant tissues the extracellular environment or apoplast, incorporating the cell wall, is a highly dynamic compartment with a role in many important plant processes including defence, development, signalling and assimilate partitioning. Soluble apoplast proteins from Arabidopsis thaliana, Triticum aestivum and Oryza sativa were separated by two-dimensional electrophoresis. The molecular weights and isoelectric points for the dominant proteins were established prior to excision, sequencing and identification by matrix-assisted laser-desorption ionisation time of flight mass spectrometry (MALDI - TOF MS). From the selected spots, 23 proteins from O. sativa and 25 proteins from A. thaliana were sequenced, of which nine identifications were made in O. sativa (39%) and 14 in A. thaliana (56%). This analysis revealed that: (i) patterns of proteins revealed by two-dimensional electrophoresis were different for each species indicating that speciation could occur at the level of the apoplast, (ii) of the proteins characterised many belonged to diverse families reflecting the multiple functions of the apoplast and (iii), a large number of the apoplast proteins could not be identified indicating that the majority of extracellular proteins are yet to be assigned. The principal proteins identified in the aqueous matrix of the apoplast were involved in defence, i.e. germin-like proteins or glucanases, and cell expansion, i.e. β-D-glucan glucohydrolases. This study has demonstrated that proteomic analysis can be used to resolve the apoplastic protein complement and to identify adaptive changes induced by environmental effectors.

Approaches to the synthesis of 3-fluoroshikimic acids

Exploitation of the dual dehydrating and fluorodeoxygenating properties of the dialkylaminosulfurtrifluorides has allowed access to the C3-fluorinated analogues of (-)-shikimic acid. (C) 2004 Elsevier Ltd. All rights reserved.

Modelling for planning building design - a critique of available approaches

This paper reviews four approaches used to create rational tools to aid the planning and the management of the building design process and then proposes a fifth approach. The new approach that has been developed is based on the mechanical aspects of technology rather than subjective design issues. The knowledge base contains, for each construction technology, a generic model of the detailed design process. Each activity in the process is specified by its input and output information needs. By connecting the input demands of one technology with the output supply from another technology a map or network of design activity is formed. Thus, it is possible to structure a specific model from the generic knowledge base within a KBE system.

Evidence of systematic approaches to innovation in facilities management

Purpose – This paper seeks to examine the nature of “service innovation” in the facilities management (FM) context. It reviews recent thinking on “service innovation” as distinct from “product innovation”. Applying these contemporary perspectives it describes UK case studies of 11 innovations in different FM organisations. These include both in-house client-based innovations and third-party innovations. Design/methodology/approach – The study described in the paper encompasses 11 different innovations that constitute a mix of process, product and practice innovations. All of the innovations stem from UK-based organisations that were subject to in-depth interviews regarding the identification, screening, commitment of resources and implementation of the selected innovations. Findings – The research suggested that service innovation is highly active in the UK FM sector. However, the process of innovation rarely followed a common formalized path. Generally, the innovations were one-shot commitments at the early stage. None of the innovations studied failed to proceed to full adoption stage. This was either due to the reluctance of participating organisations to volunteer “tested but unsuccessful” innovations or the absence of any trial methods that might have exposed an innovations shortcomings. Research limitations/implications – The selection of innovations was restricted to the UK context. Moreover, the choice of innovations was partly determined by the innovating organisation. This selection process appeared to emphasise “one-shot” high profile technological innovations, typically associated with software. This may have been at the expense of less resource intensive, bottom-up innovations. Practical implications – This paper suggests that there is a role for “research and innovation” teams within larger FM organisations, whether they are client-based or third-party. Central to this philosophy is an approach that is open to the possibility of failure. The innovations studied were risk averse with a firm commitment to proceed at the early stage. Originality/value – This paper introduces new thinking on the subject of “service innovation” to the context of FM. It presents research and development as a planned solution to innovation. This approach will enable service organisations to fully test and exploit service innovations.

Dilettantes, discipline and discourse: requirements management for construction

Requirements management (RM), as practised in the aerospace and defence sectors, attracts interest from construction researchers in response to longstanding problems of project definition. Doubts are expressed whether RM offers a new discipline for construction practitioners or whether it repeats previous exhortations to adopt a more disciplined way of working. Whilst systems engineering has an established track record of addressing complex technical problems, its extension to socially complex problems has been challenged. The dominant storyline of RM is one of procedural rationality and RM is commonly presented as a means of controlling dilettante behaviour. Interviews with RM practitioners suggest a considerable gulf between the dominant storyline in the literature and how practitioners operate in practice. The paper challenges construction researchers interested in RM to reflect more upon the theoretical debates that underpin current equivalent practices in construction and the disparity between espoused and enacted practice.

Change in construction: a critical perspective

Change within the construction sector has been a central concern of governments and a select few private-sector clients for a considerable time. The discourse of change emanating from organizations concerned with reform in the construction sector reflects these ongoing concerns for change in the sector. The underlying assumptions of the content of change and appropriate change mechanisms in the UK are critically examined and challenged. In particular, the limitations of measurement and best practice are explored. The allegiance to approaches based on measurement and best practice is acontextual, unreflective and insufficient in providing wholly reliable explanations for the relationship between practice and performance. Claims for the use of measurement and best practice by the reform movement must therefore be understood to have limitations and their use approached with caution. The emphasis on best practice is also understood to direct attention away from understanding the legitimacy of current practice and change within the UK construction sector. An agenda for change in the UK construction sector will need to engage with and be more reflective of current managerial practice and past change initiatives. Contextual approaches such as structuration theory offer a way in which to underpin a research framework that could support the reform movement in setting such an agenda.

On the discourse of construction competitiveness

It is contended that competitiveness is better understood as a discourse rather than as a characteristic that is supposedly possessed. The discourse of competitiveness derives its legitimacy from the enterprise culture that came to dominance during the 1980s. Current popularized theories of competitiveness are constituent parts of this broader discourse, which has had significant material implications for the UK construction sector. The dominant discourse of competitiveness amongst contracting firms is shaped by the need to achieve structural flexibility to cope with fluctuations in demand. Fashionable espoused improvement recipes such as total quality management, business process re-engineering, and lean construction legitimize and reinforce the material manifestations of the enterprise culture. In consequence, the UK industry is characterized by a plethora of hollowed-out firms that have failed to invest in their human capital. While the adopted model may be rational for individual firms, the systemic effect across the sector as a whole equates to a form of anorexia. However, the discourse of competitiveness is by no means monolithic and continues to be contested locally. There have also been numerous counter-discourses that have been mobilized in response to the undesirable externalities of unbridled enterprise. Currently, important counter-discourses promote the ideas of sustainability and corporate social responsibility.