Monitoring the marine environment adjacent to a petroleum refinery on Corio Bay, Victoria, Australia /Peter James Gilbert

The objective of the work reported in this thesis was to design and implement an ecological effects environmental monitoring program which would: 1) Collect baseline biological information on sessile epibiotic fouling communities from an area adjacent to a petroleum refinery located on Corio Bay, Victoria, to allow comparison with results of future monitoring for the assessment of long term temporal water quality trends. 2) Detect and — if possible - estimate the magnitude of any influence on epibiotic fouling communities within the Corio Bay marine ecosystem attributable to operations at the Shell Petroleum Refinery. 3) Investigate the extent of thermal stratification and rate of dispersal of the petroleum refinery main cooling-water outfall plume (discharging up to 350,000 tonnes of warmed seawater per day), and its effect on epibiotic communities within the EPA-defined mixing zone. A major component of the work undertaken was the design and development of artificial-substrate biological sampling stations suitable for use under the conditions prevailing in Corio Bay, and the development of appropriate quantitative underwater photographic sampling techniques to fulfil the experimental criteria outlined above. Experimental and other constraints imposed on the design of the stations precluded the simple suspension of frames from jetties or pylons, a technique widely used in previous work of this type. Artificial substrate panels were deployed along three radial transects centred within and extending beyond the petroleum refinery main cooling-water mixing zone. Identical substrate panels were deployed at a number of control sites located throughout Corio Bay, each chosen for differences in their degree of exposure to such factors as water movement, depth, shipping traffic and/or comparable industrial activity. The rate of colonisation (space utilisation) and the development of epibiotic fouling communities on artificial substrate panels was monitored over two twelve-month sampling periods using quantitative underwater photographic sampling techniques. Sampling was conducted at 4-8 week intervals with the rate of panel colonisation and community structure determined via coverage measurements. Various species of marine algae, polychaete tubeworms, hydroids, barnacles, simple and colonial ascidians, sponges, bivalve molluscs and encrusting bryozoans were all detected growing on panels. Communities which established on panels within the cooling-water mixing-zone and those at control sites were compared using statistical procedures including agglomerative hierarchical cluster analysis. A photographic sample archive has been established to allow comparison with similar future studies.

Accuracy of national mortality codes in identifying adjudicated cardiovascular deaths

Objective: This study investigated the sensitivity and specificity of the national mortality codes in identifying cardiovascular disease (CVD) deaths and documents methods of verification.

Methods: A 12-year retrospective case ascertainment of all ICD-coded CVD deaths was performed for deaths between 1990 and 2002 in the Melbourne Collaborative Cohort Study, comprising 41,528 subjects. Categories of non-CVD codes were also examined. Stratified samples of 750 deaths were adjudicated from a total of 2,230 deaths. Expert panels of cardiologists and neurologists adjudicated deaths.

Results: Of the 750 deaths adjudicated, 582 were verified as CVD [392 coronary heart disease (CHD) and 92 stroke] and 168 non-CVD. Estimated sensitivity and specificity of national mortality codes for identifying specific causes of death were: CHD 74.2% (95% CI: 69.8–78.5%) and 97.6% (96.0–99.2%), respectively; myocardial infarction 59.9% (50.9–69.0%) and 94.2% (92.4–96.0%), respectively; haemorrhagic stroke 58.9% (46.0–71.7%) and 99.8% (99.4–100.0%), respectively and; ischaemic stroke 38.7% (20.5–56.9%) and 99.9% (99.6–100.0%), respectively. Misclassification was most common for deaths with primary ICD codes for endocrine-metabolic and genito-urinary diseases.

Conclusions: National mortality coding under-estimated the true proportion of CHD and stroke deaths in the cohort by 13.6% and 50.8%, respectively.

Cluster randomized controlled trial of a peer support program for people with diabetes: study protocol for the Australasian peers for progress study

Background
Well managed diabetes requires active self-management in order to ensure optimal glycaemic control and appropriate use of available clinical services and other supports. Peer supporters can assist people with their daily diabetes self-management activities, provide emotional and social support, assist and encourage clinical care and be available when needed.
Methods
A national database of Australians diagnosed with type 2 diabetes is being used to invite people in pre-determined locations to participate in community-based peer support groups. Peer supporters are self-identified from these communities. All consenting participants receive diabetes self-management education and education manual prior to randomization by community to a peer support intervention or usual care. This multi-faceted intervention comprises four interconnected components for delivering support to the participants. (1) Trained supporters lead 12 monthly group meetings. Participants are assisted to set goals to improve diabetes self-management, discuss with and encourage each other to strengthen linkages with local clinical services (including allied health services) as well as provide social and emotional support. (2) Support through regular supporter-participant or participant-participant contact, between monthly sessions, is also promoted in order to maintain motivation and encourage self-improvement and confidence in diabetes self-management. (3) Participants receive a workbook containing diabetes information, resources and community support services, key diabetes management behaviors and monthly goal setting activity sheets. (4) Finally, a password protected website contains further resources for the participants. Supporters are mentored and assisted throughout the intervention by other supporters and the research team through attendance at a weekly teleconference. Data, including a self-administered lifestyle survey, anthropometric and biomedical measures are collected on all participants at baseline, 6 and 12 months. The primary outcome is change in cardiovascular disease risk using the UKPDS risk equation. Secondary outcomes include biomedical, quality of life, psychosocial functioning, and other lifestyle measures. An economic evaluation will determine whether the program is cost effective.
Discussion
This manuscript presents the protocol for a cluster randomized controlled trial of group-based peer support for people with type 2 diabetes in a community setting. Results from this trial will contribute evidence about the effectiveness of peer support in achieving effective self-management of diabetes.

Transcendental Priority and Deleuzian Normativity. A reply to James Williams

I am grateful that someone whose work I greatly admire could be the philosopher to so eloquently and succinctly cut to the heart of the problem that I posed in the previous issue of Deleuze Studies. James Williams' critical reply leaves me, prima facie, confronted by a stark alternative: either I have misunderstood Deleuze, or I have illustrated problems and lacunae in Deleuze. I will suggest, however, that this is a false alternative, and that Williams' and my divergent accounts of The Logic of Sense – and even Deleuze's oeuvre as a whole – is better understood as a situation of ‘both/and’ rather than ‘either/or’, and hence that my interpretation of Deleuze isn't wrong, but necessarily iconoclastic.

Utilisation of general practitioner services and achievement of guideline targets by people with diabetes who joined a peer-support program in Victoria, Australia

This paper describes the use of general practitioner (GP) services and achievement of guideline targets by 285 adults with type 2 diabetes in urban and regional areas of Victoria, Australia. Anthropometric and biomedical measures and responses to a self-administered questionnaire were collected. Findings indicate that almost all participants had visited a GP and had had their hypoglycated haemoglobin (HbA1c) measured in the past 6 months; less than one-third had visited a practice nurse. Fifty per cent achieved a HbA1c target of ≤7.0%; 40%, a total cholesterol ≤4.00 mmol/L; 39%, BP Systolic ≤130 mmHg; 51%, BP Diastolic ≤80 mmHg; 15%, body mass index ≤25 kg/m2; and 34% reported a moderately intense level of physical activity, that is, ≥30 min, 5 days a week. However, 39% of individuals achieved at least two targets and 18% achieved at least three of these guideline targets. Regional participants were more likely to report having a management plan and having visited a practice nurse, but they were less likely to have visited other health professionals. Therefore, a more sustained effort that also includes collaborative care approaches is required to improve the management of diabetes in Australia.