Structured Type 1 Diabetes education delivered within routine care: impact on glycemic control and diabetes-specific quality of life

OBJECTIVE:
To determine whether improvements in glycemic control and diabetes-specific quality of life (QoL) scores reported in research studies for the type 1 diabetes structured education program Dose Adjustment For Normal Eating (DAFNE) are also found when the intervention is delivered within routine U.K. health care.

RESEARCH DESIGN AND METHODS:
Before and after evaluation of DAFNE to assess impact on glycemic control and QoL among 262 adults with type 1 diabetes.

RESULTS:
There were significant improvements in HbA_1c from baseline to 6 and 12 months (from 9.1 to 8.6 and 8.8%, respectively) in a subgroup with suboptimal control. QoL was significantly improved by 3 months and maintained at both follow-up points.

CONCLUSIONS:
Longer-term improved glycemic control and QoL is achievable among adults with type 1 diabetes through delivery of structured education in routine care, albeit with smaller effect sizes than reported in trials.

Experimental study of dynamic compressive behaviour of concrete material reinforced with spiral steel fibres

It has been well demonstrated that the impact loading resistance capacity of the concrete material can be effectively increased by adding fibres. Recent studies proved that compared to other conventional steel fibres, using steel fibres with spiral shape further increases the post-failure energy absorption and crack stopping capacities of concrete because of the better bonds in the concrete matrix and larger deformation ability. The present study conducts high rate impact tests using split Hopkinson pressure bar (SHPB) to further investigate the dynamic compressive properties of spiral fibre reinforced concrete (SFRC). SFRC specimens with different volume fractions of fibres ranging from zero to 1.5% are prepared and tested. The influences of different volume fractions of fibres on strength, stress-strain relation and energy absorption of SFRC specimens under quasi-static and dynamic loadings are studied. In SHPB compression tests, the strain rate achieved ranges from 50 1/s to 200 1/s. Highspeed camera is used to capture the failure processes and failure modes of SFRC specimens with different fibre volume fractions during the tests for comparison. Dynamic stress-strain curves under different strain rates are derived. The energy absorption capacities of the tested specimens are obtained and compared. Strain rate effects on the compressive strength are also discussed. The corresponding empirical DIF (dynamic increase factor) relations for SFRC are proposed.

A modelling framework for optimisation of commodity production by minimising the impact of climate change

The agricultural sector is vulnerable to the impact of climate change due to decreasing rainfall, increasing temperature, and the frequency of extreme weather events. A modelling framework was developed and applied to identify issues, problems and opportunities arising in regional agricultural systems as a consequence of climate change. This integrated framework blends together land suitability analysis, uncertainty analysis and an optimisation approach to establish optimal agricultural land-use patterns on a regional scale for current and possible future climate scenarios. The framework can also be used to identify (i) regions under threat of productivity decline, and (ii) alternative crops and their locations that can cope better with changing climate. The methods and contents of the framework are presented by means of a case study developed in the South West Region of Victoria, Australia. The results can be used to assess land suitability in support of optimised crop allocations across a local region, and to underpin the development of a regional adaptation policy framework designed to reduce the vulnerability of the agriculture sector to the impacts of climate change.

Renal access coordinators' impact on hemodialysis patient outcomes and associated service delivery: a systematic review

Background
Renal access coordinators contribute specifically to dialysis access care for people with chronic and end stage renal disease. Since the introduction of renal access coordinators into Australia in the early 2000s, there have been anecdotal examples of associated improvements in patient outcomes and service delivery; however scant published quantitative evidence exists. Thus, the impact of the implementation of renal access coordinators has not undergone a rigorous review to date.

Objective
The objective of this systematic review was to critically appraise and synthesize the best available evidence related to the impact of renal access coordinators on dialysis patient outcomes and associated service delivery.

INCLUSION CRITERIA

Types of participants
This review considered studies that included renal access coordinators (noting variations of the titles) and adult hemodialysis patients (aged 18 years and over).

Types of intervention(s)
This review considered studies that evaluated the effectiveness of the renal access coordinator. This role typically consists of clinical and administration duties such as providing pre dialysis access coordination, access surveillance patient education and nurse education.

Types of studies
The types of studies considered within this review included experimental and epidemiological study designs. Thus randomized controlled trials (RCT), non-randomized controlled trials, and quasi-experimental, before and after studies, prospective and retrospective cohort studies were considered as were case control studies, analytical cross sectional studies and descriptive cross sectional studies.

Types of outcomes
Patient outcomes considered included: days to first vascular access complication (such as stenosis or thrombosis) and/or primary intervention (such as angioplasty or surgical intervention); percentage of central line insertions (negative); rate of arteriovenous fistula (AVF)/arteriovenous graft (AVG)/central venous catheter (CVC) at start of dialysis (incidence); prevalent rate of AVF/AVG/CVC; time to occlusion of AVF and time from referral to surgery. Service outcomes included: knowledge/up skilling of renal nurses; cannulation skills, ultrasound skills, knowledge of anatomy and physiology and other access related knowledge.

Search strategy
The search strategy aimed to locate published and unpublished studies, utilizing a three-step searching approach. Studies published in English from 1990 to October 2013 were considered for inclusion in this review.

Methodological quality
The studies were assessed by two independent reviewers using the appropriate standardized critical appraisal instruments from the Joanna Briggs Institute.

Data collection
Data were extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute, namely JBI Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).

Data synthesis
This review aimed to conduct meta-analyses of the findings: however, because of the limitations of the data found, this was not possible and so the findings are presented in a narrative format.

Results
Five studies were identified for inclusion in the review. No RCTs were found, therefore four of the five studies were pre-post intervention cohort studies and one was a prospective quality assurance report. Data were heterogeneous and thus did not allow for meta-analysis. All studies included multidisciplinary teams with variable emphasis on the renal access coordinator role. The pre post intervention cohort studies measured incident and/or prevalent AVF, AVG and CVC rates in the hemodialysis population and the quality assurance report measured the difference in patency rates between AVF and AVG. All discussed the role of central coordination as a contributor to the success of vascular access care.

Conclusions
This review found insufficient data to make firm conclusions about the impact that renal access coordinators have on patient outcomes. The results of this review suggest an association between renal access coordinators and improved patient outcomes. These improved patient outcomes were apparent in an increase in incident and prevalent AVFs, and a decrease in the incidence and prevalence of CVCs. Both associations are correlated with a reduction in infection rates, length of hospital stay and healthcare costs.

Closing the emergency facility: Moving schools from literacy triage to better literacy outcomes

This article focuses on the tensions between national and international testing, educational policy and professionalism for middle school English teachers. I argue that state and federal government(s) are responding to the impact of Australia's falling results on the international testing in PISA (Programme for International Student Assessment) through the usage of their own testing program, the National Assessment Program for Literacy and Numeracy (NAPLAN). The publication of NAPLAN results on the MySchool website in a searchable and comparable form has been detrimental to many schools and has pushed these schools into "emergency mode", as they struggle to improve their scores. At the same time, the results from recent PISA examinations reveal extensive inequities in educational outcomes across Australia, as well as some consistent general trends in the Australian data. I use the metaphor of the hospital emergency department to explore this situation. Drawing on Sahlberg's (2011) notion of the Global Educational Reform Movement (GERM), I explore this metaphor becoming a pandemic. I draw on Gillborn and Youdell's (2000) usage of educational triage and cast different and multiple educational professionals playing the role of the triage nurse-the alternate federal and state government education ministers responding to international and state test results in triage; and principals of poor performing schools operating their school as though it is an emergency department; poor literacy results triaged Code Red receiving immediate focus and attention, but "treated" in terms of immediate survival and a focus on basic skills. I argue that the international testing provides better markers for how we are doing as a nation, and what might be done to improve our international standing with respect to our literacy scores. I argue that true gains in literacy and the development of more complex literacy skills are not made through triaging literacy through an emergency department, but through a long-term focus on school redesign.

SMEs and the potential for a collaborative path to environmental responsibility

Globally, the potential for small and medium-sized enterprises (SMEs) to collectively impact negatively on the environment is great. Therefore, the adoption, and maintenance, of environmentally responsible practices by this group of firms is especially critical. Studies of environmental practices successfully implemented by small firms have revealed that relationships with other firms, or other organizations, can contribute to greater awareness of the benefits of such activities and, therefore, enhance the possibility of environmental engagement. Collaborative relationships may provide opportunities for SMEs to overcome some of the barriers to implementing environmental initiatives associated with their size, and/or associated characteristics. This paper focuses on attitudes of SME owner-managers to a variety of environmental issues (including regulation and voluntary standards), and to collaborating with other firms (in either a formal or informal sense). The data this paper draws upon are from two waves of an ongoing longitudinal survey of New Zealand SMEs.

Functionalism, co-operation, good faith, and the making of the "daily-preventive justice" in contract law theory and practice. A contribution to a rational understanding of good faith and to its future reseasonable developments. Evaluations from

The thoughts and observations contained in this paper were first presented in a preliminary form at the Staff Seminar that I gave at the University of Cape Town (UCT) - Department of Private Law, on Tuesday May 8 2012. The organizers generously offered me a free choice of subject. Such an offer always poses a problem to imaginative people like myself. I finally chose as my subject the role of good faith in contract law theory and practice and then entitled the Seminar “Good Faith & Contracts - Brothers in Arms”. The aim of the talk was to briefly describe what I see behind the doctrine of good faith (and, more broadly, behind the general course of the parties’ behavior before and after the conclusion of an agreement), to then explain the need of its protection and future reasonable developments by challenging the limitations of both traditional and current legal approaches to contract law theory and practice. By adopting a comparative modus investigandi, it emerged that especially in the area of contract law a new law-finding process is emerging in the European continent and it is leading to re-conceive the meta-national legislative interventions by challenging the limits of Hobbes’s Leviathan. As asserted, we ought to not take this process for granted because although there are many forms of social organization, contract is the most pervasive and the law of contract still is the most important vehicle to support and supplement private arrangements. However, the point of departure for theorizing about private law is based on experience. Consequently, despite the growing emphasis on the convergence of national legal systems in Europe, conducting research on private law theory and practice requires that imagination and creativity be matched with prudence. Proficiency has to be aligned with what we have learned from history.

Nonparametric rank tests for non-stationary panels

We develop a set of nonparametric rank tests for non-stationary panels based on multivariate variance ratios which use untruncated kernels. As such, the tests do not require the choice of tuning parameters associated with bandwidth or lag length and also do not require choices with respect to numbers of common factors. The tests allow for unrestricted cross-sectional dependence and dynamic heterogeneity among the units of the panel, provided simply that a joint functional central limit theorem holds for the panel of differenced series. We provide a discussion of the relationships between our setting and the settings for which first- and second generation panel unit root tests are designed. In Monte Carlo simulations we illustrate the small-sample performance of our tests when they are used as panel unit root tests under the more restrictive DGPs for which panel unit root tests are typically designed, and for more general DGPs we also compare the small-sample performance of our nonparametric tests to parametric rank tests. Finally, we provide an empirical illustration by testing for income convergence among countries.

Pooled unit root tests in panels with a common factor

This paper proposes new pooled panel unit root tests that are appropriate when the data exhibit cross-sectional dependence that is generated by a single common factor. Using sequential limit arguments, we show that the tests have a limiting normal distribution that is free of nuisance parameters and that they are unbiased against heterogenous local alternatives. Our Monte Carlo results indicate that the tests perform well in comparison to other popular tests that also presumes a common factor structure for the cross-sectional dependence.

Holocene record of Tuggerah Lake estuary development on the Australian east coast: sedimentary responses to sea-level fluctuations and climate variability

We investigated the Holocene palaeo-environmental record of the Tuggerah Lake barrier estuary on the south-east coast of Australia to determine the influence of local, regional and global environmental changes on estuary development. Using multi-proxy approaches, we identified significant down-core variation in sediment cores relating to sea-level rise and regional climate change. Following erosion of the antecedent land surface during the post-glacial marine transgression, sediment began to accumulate at the more seaward location at ~8500. years before present, some 1500. years prior to barrier emplacement and ~4000. years earlier than at the landward site. The delay in sediment accumulation at the landward site was a consequence of exposure to wave action prior to barrier emplacement, and due to high river flows of the mid-Holocene post-barrier emplacement. As a consequence of the mid-Holocene reduction in river flows, coupled with a moderate decline in sea-level, the lake experienced major changes in conditions at ~4000. years before present. The entrance channel connecting the lake with the ocean became periodically constricted, producing cyclic alternation between intervals of fluvial- and marine-dominated conditions. Overall, this study provides a detailed, multi-proxy investigation of the physical evolution of Tuggerah Lake with causative environmental processes that have influenced development of the estuary.

Experimental and stochastic approaches to assessing the strain demand of pipelines and flexibility requirements for coatings

A criterion for selecting a coating for an energy pipeline is that the coating should have a suitable flexibility to meet the high strain demand during hydrostatic testing and during field bending. This requires knowledge of the level of strain demand for the pipeline, and also the maximum strain that could be
tolerated by the coating system. Whereas average strains imposed during manufacturing and construction are reasonably well predicted, there is insufficient understanding on the factors leading to localised deformation of the pipe. Significant work has been carried out in the past to develop tests for assessing
the coatings’ ability to handle a certain amount of strain based on bend testing, tensile testing and burst testing. However, there is a concern as to whether these tests properly represent localised micro-strains associated with construction activities including field bending and pressure testing, particularly pressure testing of pipelines designed for operation at 80% of specified minimum yield strength (SMYS). Consequently coatings considered "suitable" for modern pipelines may fail. The first issue discussed in this paper is main factors affecting strain localisation. The non-deterministic distributions of heterogeneities over the pipe provide a ground to consider the mechanisms of localisation as a stochastic process. An approach is proposed to quantify the maximum localised strain demand through cold field bending and hydrostatic experiments. Another issue discussed in this paper is the experimental assessment of coating flexibility under the effects of localised strains. Preliminary mandrel tests have been carried out to assess the uniformity of the imposed strain. Although mandrel testing has been shown to be a useful method for relative comparison of coating flexibility, it has several weaknesses that could significantly affect the reliability and reproducibility of the results.

Derivation of dynamic material properties of steel-fibre-reinforced concrete using kernel regression

The reliable and efficient design of steel-fibre-reinforced concrete (SFRC) structures requires clear knowledge of material properties. Since the locations and orientations of aggregates and fibres in concrete are intrinsically random, testing results from different specimens vary, and it needs hundreds or even thousands of specimens and tests to derive the unbiased statistical distributions of material properties by using traditional statistical techniques. Therefore, few statistical studies on the SFRC material properties can be found in literature. In this study, high-rate impact test results on SFRC using split Hopkinson pressure bar are further analysed. The influences of different strain rates and various volume fractions of fibres on compressive strength of SFRC specimens under dynamic loadings will be quantified, by using kernel regression, a kernel-based nonparametric statistical method. Several kernel estimators and functions will be compared. This technique allows one to derive an unbiased statistical estimation from limited testing data. Therefore it is especially useful when the testing data is limited.

A multiple case history and systematic review of adoption, diffusion, implementation and impact of provincial daily physical activity policies in Canadian schools

BACKGROUND : Few children meet physical activity (PA) recommendations, and are therefore at increased risk for overweight/obesity and adverse health outcomes. To increase children's opportunities for PA, several Canadian provinces have adopted school-based daily PA (DPA) policies. It is not clear why some jurisdictions have adopted DPA policies, and others have not, nor whether these policies have been implemented and have achieved their intended outcomes. The purpose of this study was to understand the processes underlying adoption and diffusion of Canadian DPA policies, and to review evidence regarding their implementation and impact.

METHODS: We adopted a multiple case history methodology in which we traced the chronological trajectory of DPA policies among Canadian provinces by compiling timelines detailing key historical events that preceded policy adoption. Publicly available documents posted on the internet were reviewed to characterize adopter innovativeness, describe the content of their DPA policies, and explore the context surrounding policy adoption. Diffusion of Innovations theory provided a conceptual framework for the analyses. A systematic literature search identified studies that had investigated adoption, diffusion, implementation or impact of Canadian DPA policies.

RESULTS: Five of Canada's 13 provinces and territories (38.5%) have DPA policies. Although the underlying objectives of the policies are similar, there are clear differences among them and in their various policy trajectories. Adoption and diffusion of DPA policies were structured by the characteristics and capacities of adopters, the nature of their policies, and contextual factors. Limited data suggests implementation of DPA policies was moderate but inconsistent and that Canadian DPA policies have had little to no impact on school-aged children's PA levels or BMI.

CONCLUSIONS: This study detailed the history and current status of Canadian DPA policies, highlighting the conditional nature of policy adoption and diffusion, and describing policy and adopter characteristics and political contexts that shaped policy trajectories. An understanding of the conditions associated with successful policy adoption and diffusion can help identify receptive contexts in which to pioneer novel legislative initiatives to increase PA among children. By reviewing evidence regarding policy implementation and impact, this study can also inform amendments to existing, and development of future PA policies.

Developing physical and physiological employment standards: translation of job analysis findings to assessments and performance standards - a systematic review

Physical employment standards (PES) are developed with the aim of ensuring that an employee's physical and physiological capacities are commensurate with the demands of their occupation. While previous commentaries and narrative reviews have provided frameworks for the development of PES, this is the first systematic review of the methods used to translate job analysis findings to PES tests and performance standards for physically demanding occupations. A search of PubMed and Google Scholar was conducted for research articles published in English up to and including March 2015. Two authors independently reviewed and extracted data.

The search yielded 87 potentially eligible papers, including 60 peer reviewed journal articles and 17 technical reports. 57 papers were excluded leading to a final data set of 31 papers, representing 22 studies. Job analysis was most commonly conducted through subjective determination of job tasks followed by objective quantification and validation. Determination of criterion tasks was evenly distributedthrough subjective and objective methods with criterion tasks being defined most commonly as most demanding, critical and/or frequent. Generic predictive and task-related predictive tests were more commonly observed in isolation or in combination when compared to task simulation tests. Performance standards were more commonly criterion-referenced than norm-referenced with a variety of statistical methods utilised. This review provides recommendations for researchers when developing physical employment standards for a variety of occupations.