A critical look at the role of self-management for people with arthritis and other chronic diseases

Most patients with chronic conditions, such as osteoarthritis, only have contact with healthcare professionals for a few hours over the course of a year. Good self-management programs are, therefore, critical for patients to cope with their conditions on a daily basis. Drs Osborne, Jordan and Rogers discuss the importance of engaging patients, clinicians and policymakers in the development and implementation of self-management programs.

The lifestyle of our kids (LOOK) project : outline of methods

This methods paper outlines the overall design of a community-based multidisciplinary longitudinal study with the intent to stimulate interest and communication from scientists and practitioners studying the role of physical activity in preventive medicine. In adults, lack of regular exercise is a major risk factor in the development of chronic degenerative diseases and is a major contributor to obesity, and now we have evidence that many of our children are not sufficiently active to prevent early symptoms of chronic disease. The lifestyle of our kids (LOOK) study investigates how early physical activity contributes to health and development, utilizing a longitudinal design and a cohort of eight hundred and thirty 7–8-year-old (grade 2) school children followed to age 11–12 years (grade 6), their average family income being very close to that of Australia. We will test two hypotheses, that (a) the quantity and quality of physical activity undertaken by primary school children will influence their psychological and physical health and development; (b) compared with existing practices in primary schools, a physical education program administered by visiting specialists will enhance health and development, and lead to a more positive perception of physical activity. To test the first hypothesis we will monitor all children longitudinally over the 4 years. To test the second we will involve an intervention group of 430 children who receive two 50 min physical education classes every week from visiting specialists and a control group of 400 who continue with their usual primary school physical education with their class-room teachers. At the end of grades 2, 4, and 6 we will measure several areas of health and development including blood risk factors for chronic disease, cardiovascular structure and function, physical fitness, psychological characteristics and perceptions of physical activity, bone structure and strength, motor control, body composition, nutritional intake, influence of teachers and family, and academic performance.

Another look at the culture-quality-performance link

Quality improvement is usually driven by quality, safety and risk agendas leading to a focus on measurements of the outputs of care; outputs such as fewer complaints, fewer accidents and adverse events. An oft-neglected theme is the impact of the quality improvement initiative within the organisation itself. This paper presents the findings of the first stage of an evaluation that has examined the changes which have occurred within organisations since participating in a quality improvement initiative. These findings indicate that engaging with a quality improvement program can change the nature of social interactions within the organisation. In this way, quality improvement programs can impact on organisational culture, particularly in relation to organisational learning. Thus, this paper argues that successful engagement with a quality improvement program can enhance organisational learning, and, in turn, build organisational capacity.

Contrasting longitudinal and cross-sectional relationships between insulin resistance and percentage of body fat, fitness, and physical activity in children—the LOOK study

Background: Knowledge of individual changes in insulin resistance (IR) and longitudinal relationships of IR with lifestyle-associated factors are of important practical significance, but little longitudinal data exist in asymptomatic children. We aimed to determine (a) changes in the homeostatic model of insulin resistance (HOMA-IR) over a 2-yr period and (b) comparisons of longitudinal and cross-sectional relationships between HOMA-IR and lifestyle-related risk factors.

Methods: Our subjects, 241 boys and 257 girls, were assessed at age 8.1 yr (SD 0.35) and again 2 yr later for fasting blood glucose and insulin, dual X-ray absorptiometry-assessed percentage of body fat (%BF), pedometer-assessed physical activity (PA), and cardio-respiratory fitness (CRF) by multistage running test.

Results: HOMA-IR was initially 9% greater in girls than boys and 27% greater 2 yr later. There was no evidence of longitudinal relationships between HOMA-IR and %BF in boys or girls, despite significant cross-sectional relationships (p < 0.001). In boys, there was evidence of a longitudinal relationship between HOMA-IR and both PA (p < 0.001) and CRF (p = 0.05). In girls, we found a cross-sectional relationship between HOMA-IR and CRF (p < 0.001).

Conclusions: HOMA-IR increases between 8 and 10 yr of age and to a greater extent in girls. Longitudinal, unlike cross-sectional, relationships do not support the premise that body fat has any impact on HOMA-IR during this period or that PA or CRF changes affect HOMA-IR in girls. These data draw attention to difficulties in interpreting observational studies in young children.

Look who's morphing

This project's creative component is "Look who's morphing", a fiction collection that explores the theme of personal identity. The exegesis analyses an issue pertaining to the writer's creative process: what degree of directness was employed in the authorial identity in his creative work and how was this level of directness realised?

Development aid : a fresh look

This book addresses a number of gaps in knowledge on aid allocation and effectiveness, and provides many new and important analytical insights into aid. Among the topics covered are the interface between aid allocation and perceptions of aid effectiveness, the inter-recipient concentration of aid from non-govenment organizations, the year-on-year volatility of aid, impacts of aid on public sector fistcal aggregates, and evaluation of the country-level impacts of aid. The book is an essential companion for professionals engaged in aid policy reforms and also for scholars in the areas of development economics, international finance and economics.

A study on look-ahead control and energy management strategies in hybrid electric vehicles

Fuel efficiency in a hybrid electric vehicle requires a fine balance between usage of combustion engine and battery power. Information about the geometry of the road and traffic ahead can have a great impact on optimized control and the power split between the main parts of a hybrid electric vehicle. This paper provides a survey on the existing methods of control and energy management emphasizing on those that consider the look-ahead road situation and trajectory information. Then it presents the future trends in the control and energy management of hybrid electric vehicles.

"Look at him...he's failing" : male executives' experiences of redundancy

Participation and success in paid work is a key element of identity for many men. The increased prevalence of downsizing and the associated discarding of individuals from their workplaces, then, has particular relevance for men. This paper shares qualitative findings from an exploratory phenomenological study investigating the experiences of Australian executives who had been made redundant. Three themes related to male identity are presented here: Failing as the breadwinner; Being less of a person; and, Losing success. The participants in this study shared feelings of anger, sadness, fear and embarrassment as a result of the assault to their identity that accompanied their involuntary redundancies. The impacts of redundancy were not only felt in relation to their job loss, but continued after returning to work. At a time when downsizing continues to feature as a routine part of organisational life—for some, an experience repeated throughout their careers—further exploration of the experience of redundancy and its implications is required.

Improving our superannuation regime : a post-Henry review look at superannuation taxation, raising superannuation balances and longevity insurance

This paper examines what, if any changes should be made regarding certain aspects of the superannuation system. Specifically, it looks at possible changes to the superannuation tax regime, measures intended at increasing superannuation balances, as well as policies aimed at improving the price and availability of retirement income streams. The recommendations of the final report of the Henry Review on these issues are also critically evaluated. The paper finds that a greater targeting of superannuation tax concessions towards middle and lower income earners would make the system more equitable and achieve other desirable goals such as increasing voluntary savings. Furthermore, the available evidence suggests that the current mandatory contributions rate of 9% is adequate, and a higher contributions rate is likely to have more costs than benefits. On the issue of superannuation income streams, the article finds that whilst taxpayers should continue to be allowed to take their superannuation as a lump sum, policies should be implemented to make lifetime annuities more readily available and better value for money. The Henry Review's recommendations on these issues, with some exceptions, are for the most part sound and based on logic.

The accounting professional of the future : never mind the quality check the look!

Using legitimacy theory this paper contrasts the values portrayed by public accounting firms via their recruitment practices and society's expectations of the responsibilities of a professional accountant. Society confers on organisations legitimacy when the value system of the organisation is congruent with the value system of the larger social system (Deegan, 2006). It is argued that there is increasing incongruence between the value system of public accounting firms (that employ accounting graduates) and society's value system that includes an expectation of accountants to act in the public interest. This study draws on evidence from recent corporate collapses, to question whether the attributes/skills displayed by accountants have reduced their capacity to act in the public interest. Interviews with employers show that preferences for employment are given to graduates who 'fit the culture' of the organisation and have the ability to 'market' the firm to clients. Attributes that define the professional accountant appear to be less highly valued. It is concluded that the attributes valued in the workplace today have the potential to increase the risk of 'severing the social contract' between the accounting profession and society.