Negative appraisals of insulin therapy are common among adults with Type 2 diabetes using insulin: results from diabetes MILES - Australia cross-sectional survey

AIM: To identify insulin therapy appraisals among adults with Type 2 diabetes using insulin and how negative appraisals relate to clinical, self-care and psychosocial outcomes. METHODS: Diabetes MILES - Australia 2011 was a national survey of adults with diabetes, focused on behavioural and psychosocial issues. Subgroup analyses were conducted on the responses of 273 adults with Type 2 diabetes using insulin (46% women; mean ± sd age: 59 ± 9 years; diabetes duration: 12 ± 7 years; years using insulin: 4 ± 4). They completed validated measures of insulin therapy appraisals (ITAS), depression (PHQ-9), anxiety (GAD-7), diabetes distress (PAID) and diabetes-specific self-efficacy (DES-SF). RESULTS: Insulin was perceived to be very important, and its benefits (e.g. improves health) were endorsed by most (82%). Fifty-one per cent believed that taking insulin means their diabetes has become worse; 51% that insulin causes weight gain; 39% that they have 'failed to manage' their diabetes. Those with the greatest and least 'ITAS negative' scores did not differ by diabetes duration or years using insulin, or by average number of insulin injections or blood glucose checks per day. Those with more negative insulin appraisals were significantly younger (Mean Diff. = 5 years, P < 0.001), less satisfied with recent blood glucose levels (P < 0.001, d = 0.63), had reduced diabetes-specific self-efficacy (P < 0.001, d = 0.7), and were more likely to report depressive symptoms, anxiety or diabetes distress (all P < 0.001, d = 0.65-1.1). CONCLUSIONS: Negative insulin therapy appraisals are common among adults with Type 2 diabetes using insulin, and are associated with lower general and diabetes-specific emotional well-being, reduced diabetes-specific self-efficacy and satisfaction with blood glucose.

Our Sherlockian eyes: the surveillance of vision

or this inter-disciplinary article, we undertook a pilot case study that eye-tracked the ‘Holmes Saves Mrs. Hudson’ sequence from the episode, A Scandal in Belgravia (Sherlock, BBC, 2012). This small-scale empirical study involved a total of 13 participants (3 males and 10 females, mean age was: 27 years), comprised of a mixture of academics and undergraduate students at La Trobe University in Melbourne, Australia. The article examines its findings through a range of threaded frames – neuroscience, forensics, surveillance, haptics, memory, performance-movement, and relationality – and uniquely draws upon the interests of the authors to set the examination in context. The article is both a reading of Sherlock and a dialogue between its authors. We discover that the codes and conventions of Sherlock have a direct impact on where viewers look but we also discover eyes emerging in the periphery of the frame, and we account for these ways of seeing in different ways.

Swivelling the spotlight: stardom, celebrity and ‘me’

Celebrity studies critiques the ways in which celebrity culture constructs discourses of authenticity and disclosure, offering the cultural and economic circulation of the ‘private’ self. Rarely, however, do we turn the spotlight on ourselves as not only scholars of stardom and celebrity, but also part of the audience. Autoethnography has become increasingly important across different disciplines, although its status within media and cultural studies is less visible and secure, not least because the emphasis on personal attachments to media forms may threaten the discipline’s still contested claim to cultural legitimacy. The study of stars and celebrities has often found itself at the ‘lower’ end of this already debased continuum, perhaps making such tensions particularly acute. Based on three personal narratives of engagements with stars and celebrities, this co-authored article explores the potential relationships between autoethnography and celebrity studies, and considers the personal, intellectual, and political implications of bringing the scholar into the celebrity frame.

Introduction: queering regionality

To 'address' the region of the sexual is not to effortlessly attend to its boundary, but instead to address an epistle that may or may not reach its destination. At what address might the edge of sexuality be situated? And what response might be received from that address? The outstanding quartet of papers in this special issue of Transformations are written to address that limit, in four different constitutive contexts.

Children impacted by parental substance abuse: an evaluation of the supporting kids and their environment program

The deleterious impact of parental substance abuse on child development and family functioning is well established. However, evaluations of interventions designed to ameliorate such impacts are very limited. This paper presents the results of a service evaluation using a pre-post design of the Supporting Kids And Their Environment (SKATE) program; a child-focused group program run by Glastonbury Community Services from 2006 to 2010 in the Geelong region of Victoria, Australia. The intervention was an 8-week psycho-educative model that used family-based techniques. Outcomes are reported for child behavior problems, assessed on the Child Behavior Checklist, and family functioning, assessed on the Family Support Scale. A total of 89 children and families within 13 intervention groups were recruited via adult Drug and Alcohol Services (Mean age = 10.4 years; SD = 2.4). Results suggest reductions in emotional and behavioral problems in children as well as improving family functioning with small to moderate effect sizes after children’s participation in the SKATE program compared to pre-test. These preliminary findings suggest that children whose parents are substance abusing are a high-risk group but they may benefit from targeted intervention programs that are well integrated with the adult drug treatment system. Such interventions warrant further development and evaluation.

Structured type 1 diabetes education delivered in routine care in Australia reduces diabetes-related emergencies and severe diabetes-related distress: the OzDAFNE program

AIMS: To evaluate structured type 1 diabetes education delivered in routine practice throughout Australia.

METHODS: Participants attended a five-day training program in insulin dose adjustment and carbohydrate counting between April 2007 and February 2012. Using an uncontrolled before-and-after study design, we investigated: HbA1c (% and mmol/mol); severe hypoglycaemia; diabetes ketoacidosis (DKA) requiring hospitalisation, and diabetes-related distress (Problem Areas in Diabetes scale; PAID), weight (kg); body mass index. Data were collected pre-training and 6-18 months post-training. Change in outcome scores were examined overall as well as between groups stratified by baseline HbA1c quartiles. Data are mean±SD or % (n).

RESULTS: 506 participants had data eligible for analysis. From baseline to follow-up, significant reductions were observed in the proportion of participants reporting at least one severe hypoglycaemic event (24.7% (n=123) vs 12.1% (n=59), p<0.001); and severe diabetes-related distress (29.3% (n=145) vs 12.6% (n=60), p<0.001). DKA requiring hospitalisation in the past year reduced from 4.1% (n=20) to 1.2% (n=6). For those with above target baseline HbA1c there was a small, statistically significant improvement (n=418, 8.4±1.1% (69±12mmol/mol) to 8.2±1.1% (66±12mmol/mol). HbA1c improvement was clinically significant among those in the highest baseline quartile (n=122, 9.7±1.1% (82±11mmol/mol) to 9.0±1.2% (75±13mmol/mol), p<0.001).

CONCLUSIONS: The proportion of participants reporting severe hypoglycaemia, DKA and severe diabetes-related distress was at least halved, and HbA1c reduced by 0.7% (7mmol/mol) among those with highest baseline levels. Structured type 1 diabetes education delivered in routine practice offers clinically important benefits for those with greatest clinical need.

Preference relation-based markov random fields

A preference relation-based Top-N recommendation approach, PrefMRF, is proposed to capture both the second-order and the higher-order interactions among users and items. Traditionally Top-N recommendation was achieved by predicting the item ratings fi rst, and then inferring the item rankings, based on the assumption of availability of explicit feed-backs such as ratings, and the assumption that optimizing the ratings is equivalent to optimizing the item rankings. Nevertheless, both assumptions are not always true in real world applications. The proposed PrefMRF approach drops these assumptions by explicitly exploiting the preference relations, a more practical user feedback. Comparing to related work, the proposed PrefMRF approach has the unique property of modeling both the second-order and the higher-order interactions among users and items. To the best of our knowledge, this is the first time both types of interactions have been captured in preference relation-based method. Experiment results on public datasets demonstrate that both types of interactions have been properly captured, and signifi cantly improved Top-N recommendation performance has been achieved.

Streaming variational inference for dirichlet process mixtures

Bayesian nonparametric models are theoretically suitable to learn streaming data due to their complexity relaxation to the volume of observed data. However, most of the existing variational inference algorithms are not applicable to streaming applications since they re-quire truncation on variational distributions. In this paper, we present two truncation-free variational algorithms, one for mix-membership inference called TFVB (truncation-free variational Bayes), and the other for hard clustering inference called TFME (truncation-free maximization expectation). With these algorithms, we further developed a streaming learning framework for the popular Dirichlet process mixture (DPM) models. Our ex-periments demonstrate the usefulness of our framework in both synthetic and real-world data.