Diabetes MILES - Australia (Management and Impact for Long-Term Empowerment and Success) : methods and sample characteristics of a national survey of the psychological aspects of living with type 1 or type 2 diabetes in Australian adults

Background Successful management of diabetes requires attention to the behavioural, psychological and social aspects of this progressive condition. The Diabetes MILES (Management and Impact for Long-term Empowerment and Success) Study is an international collaborative. Diabetes MILES-Australia, the first Diabetes MILES initiative to be undertaken, was a national survey of adults living with type 1 or type 2 diabetes in Australia. The aim of this study was to gather data that will provide insights into how Australians manage their diabetes, the support they receive and the impact of diabetes on their lives, as well as to use the data to validate new diabetes outcome measures.

Methods The survey was designed to include a core set of self-report measures, as well as modules specific to diabetes type or management regimens. Other measures or items were included in only half of the surveys. Cognitive debriefing interviews with 20 participants ensured the survey content was relevant and easily understood. In July 2011, the survey was posted to 15,000 adults (aged 18-70 years) with type 1 or type 2 diabetes selected randomly from the National Diabetes Services Scheme (NDSS) database. An online version of the survey was advertised nationally. A total of 3,338 eligible Australians took part; most (70.4%) completed the postal survey. Respondents of both diabetes types and genders, and of all ages, were adequately represented in both the postal and online survey sub-samples. More people with type 2 diabetes than type 1 diabetes took part in Diabetes MILES-Australia (58.8% versus 41.2%). Most respondents spoke English as their main language, were married/in a de facto relationship, had at least a high school education, were occupied in paid work, had an annual household income > $AUS40,000, and lived in metropolitan areas.

Discussion A potential limitation of the study is the under-representation of respondents from culturally and linguistically diverse backgrounds (including Aboriginal and Torres Strait Islander origin). Diabetes MILES-Australia represents a major achievement in the study of diabetes in Australia, where for the first time, the focus is on psychosocial and behavioural aspects of this condition at a national level.

The importance of long-term follow-up in child and adolescent obesity prevention interventions

Pediatric overweight and obesity continues to be a major public health concern. Once established it is diffi cult to treat; therefore well-designed and evaluated prevention interventions are vitally important. There is considerable evidence to suggest that obesity prevention initiatives can change children ’ s behaviours and weight status over the short- or mediumterm; however, there is far less evidence on which to judge the impact over the longer term. In response to the rise in short- and medium-term obesity prevention studies for children and adolescents over recent years, the Prevention Stream of the Australasian Child and Adolescent Obesity Research Network highlight fi ve points as to why the dearth of obesity prevention studies with long-term follow-up should be urgently addressed. Furthermore, recommendations to strengthen the evidence base and outline key implications for research design in this area and the support required for long-term follow-up studies are detailed.

Long-term species, sexual and individual variations in foraging strategies of fur seals revealed by stable isotopes in whiskers

Background: Individual variations in the use of the species niche are an important component of diversity in trophic interactions. A challenge in testing consistency of individual foraging strategy is the repeated collection of information on the same individuals.

Methodology/Principal Findings: The foraging strategies of sympatric fur seals (Arctocephalus gazella and A. tropicalis) were examined using the stable isotope signature of serially sampled whiskers. Most whiskers exhibited synchronous delta C-13 and delta N-15 oscillations that correspond to the seal annual movements over the long term (up to 8 years). delta C-13 and delta N-15 values were spread over large ranges, with differences between species, sexes and individuals. The main segregating mechanism operates at the spatial scale. Most seals favored foraging in subantarctic waters (where the Crozet Islands are located) where they fed on myctophids. However, A. gazella dispersed in the Antarctic Zone and A. tropicalis more in the subtropics. Gender differences in annual time budget shape the seal movements. Males that do not perform any parental care exhibited large isotopic oscillations reflecting broad annual migrations, while isotopic values of females confined to a limited foraging range during lactation exhibited smaller changes. Limited inter-individual isotopic variations occurred in female seals and in male A. tropicalis. In contrast, male A. gazella showed large inter-individual variations, with some males migrating repeatedly to high-Antarctic waters where they fed on krill, thus meaning that individual specialization occurred over years.

Conclusions/Significance: Whisker isotopic signature yields unique long-term information on individual behaviour that integrates the spatial, trophic and temporal dimensions of the ecological niche. The method allows depicting the entire realized niche of the species, including some of its less well-known components such as age-, sex-, individual- and migration-related changes. It highlights intrapopulation heterogeneity in foraging strategies that could have important implications for likely demographic responses to environmental variability.

The long-term performance of cementitious composites reinforced with coir fibre

Effective prediction of the long-term performance of natural fibre-reinforced cementitious materials is vital for their application. In this study, coir fibres of two different average lengths were combined with cementitious materials and chemical agents to form coir fibre-reinforced cementitious composites (CFRCCs). The composites long-term performance was assessed and compared with two different accelerated ageing processes, i.e. a cement-saturated water ageing, and alternate freeze-thaw ageing. The flexural properties were compared with the properties of the reference mortar. Overall, the flexural strength of 400 days naturally aged CFRCC specimens was weaker than that of the reference mortar. The toughness and ductility of the fibre-reinforced specimens, however, improved. The cement-saturated water ageing method gave a precise prediction of the flexural strength development of 400-day-old specimens, and the freeze-thaw ageing method worked very well for the toughness performance estimation of CFRCCs.

Conservation cornerstones : capitalising on the endeavours of long-term monitoring projects

Ecological monitoring is widely used to measure change through time in ecosystems. The current extinction crisis has resulted in a wealth of monitoring programs focussed on tracking the status of threatened species, and the perceived importance of monitoring has seen it become the cornerstone of many biodiversity conservation programs. However, many monitoring programs fail to produce useful outcomes due to inherent flaws. Here we use a monitoring program from south-eastern Australia as a case study to illustrate the potential of such endeavours. The threatened carnivorous marsupial, the brush-tailed phascogale (Phascogale tapoatafa), has been monitored at various locations between 2000 and 2010. We present strong evidence for a decline in relative abundance during this period, and also describe relationships with environmental variables. These results provide insights likely to be valuable in guiding future management of the species. In the absence of the monitoring program, informed management would not be possible. While early detection of population declines is important, knowledge of the processes driving such declines is required for effective intervention. We argue that monitoring programs will be most effective as a tool for enhanced conservation management if they test specific hypotheses relating to changes in population trajectories. Greater emphasis should be placed on rigorous statistical analysis of monitoring datasets in order to capitalise on the resources devoted to monitoring activities. Many datasets are likely to exist for which careful analysis of results would have benefits for determining management directions.

Nurses’ advice regarding sterile or clean urinary drainage bags for individuals with a long-term Indwelling urinary catheter

PURPOSE: The purpose of this study was to identify, compare, and explore advice nurses give to community-dwelling long-term indwelling catheter users on the use of sterile or clean urinary drainage bags, and to obtain information that would inform the design of a larger-scale international survey.


SUBJECTS AND SETTINGS: A survey was targeted to nurse members of the International Continence Society (n = 130). Respondents (n = 28; 21.5%) included nurses from Australia, Canada, Belgium, Switzerland, the United Kingdom, and the United States, who specialized in managing incontinence.


METHODS: The project was conducted as a descriptive, exploratory pilot study. Respondents completed an online anonymous survey that was distributed by the International Continence Society. The survey instrument was designed by the investigators and comprised 14 questions with both fixed and open-ended response options.


RESULTS: Most respondents in this survey advised indwelling catheter users to reuse their catheter bags (n = 15; 68%). Factors that influenced advice included concerns about the cost of catheter bags, an evaluation of the individual's infection risk, local and national policies, evidence-based guidelines, users' living arrangements, and their ability to clean the bags. Advice on decontamination methods varied; however, the most commonly recommended cleaning agent was water and vinegar, followed by a sterilizing or bleach solution or dishwashing detergent.


CONCLUSION: Nurses play a key role in educating and supporting indwelling catheter users. Results of this study highlight variability in the advice nurses give to community-dwelling long-term indwelling catheter users about sterile or clean urinary drainage bags. This variability requires further investigation and affirms the need for a larger-scale study that draws on a broader sample of nurses.

Clinical evaluation of long-term users of two contact lens care preservative systems

Purpose: To clinically evaluate long-term users of two different contact lens care preservative systems and to investigate whether prolonged use is associated with an increase in the prevalence of dry eye.

Methods: Eighty-nine wearers of group IV hydrogel or silicone hydrogel lenses participated in this one-visit, investigator-masked study. Subjects were required to have consistently used a polyhexamethylene biguanide (PHMB) or polyquaternium-1 (PQT) based solution for 2 years. Consistent use was defined as 80% for the past 2 years and 100% for the past year. Clinical assessments included: average and comfortable wear time; overall and end-of-day comfort; signs of dryness, discomfort, burning or stinging, grittiness or scratchiness and visual changes; non-invasive and fluorescein break-up-time; pre-ocular tear film lipids, tear meniscus height, Schirmer and fluorescein clearance tests; limbal and bulbar hyperemia; palpebral roughness; corneal and conjunctival staining; lens front surface wetting; and lens film deposits.

Results: Significantly more grittiness or scratchiness was reported by subjects using a PHMB-containing system (67% vs. 44%; P = 0.02). Palpebral roughness and hyperemia were significantly greater in the PHMB group wearing group IV lenses (P = 0.01 and P = 0.05, respectively). Corneal staining was significantly higher in the PHMB users in all four peripheral sectors (P < 0.01). Nasal and temporal conjunctival staining was also significantly higher for users of PHMB-containing systems (P < 0.05). Front surface lens wettability was significantly better for group IV PQT users compared to PHMB users (P = 0.008), with 84% vs. 72%, respectively, with lenses graded by the investigator as having good or excellent wettability. Significantly higher levels of lens front surface film deposits were noted with PHMB users (P = 0.007), with 58% of group IV lenses treated with PHMB compared with 38% of group IV lenses treated with PQT showing some lens front surface film deposition. No significant differences between the two preservative system groups were noted for the range of dry eye evaluations nor the remaining clinical assessments.

Conclusions: Differences in both ocular and lens characteristic were observed between long-term users of two preservative systems used in many contact lens multi-purpose solutions. The findings from this study did not support the hypothesis that prolonged use of PHMB-containing solutions leads to dry eye. Additional studies including a larger sample size and perhaps longer use of the systems could help to further elucidate differences in clinical performance between systems.

1H-NMR and mass spectrometric characterization of the metabolic response of juvenile Atlantic salmon (Salmo salar) to long-term handling stress

Stressors of various kinds constantly affect fish both in the wild and in culture, examples being acute water temperature and quality changes, predation, handling, and confinement. Known physiological responses of fish to stress such as increases in plasma cortisol and glucose levels, are considered to be adaptive, allowing the animal to cope in the short term. Prolonged exposure to stressors however, has the potential to affect growth, immune function, and survival. Nonetheless, little is known about the mechanisms underlying the long-term stress response. We have investigated the metabolic response of juvenile Atlantic salmon (Salmo salar) to long-term handling stress by analyzing fish plasma via ¹H nuclear magnetic resonance spectroscopy and ultra high performance liquid chromatography–mass spectrometry (UPLC–MS), and comparing results with controls. Analysis of NMR data indicated a difference in the metabolic profiles of control and stressed fish after 1 week of stress with a maximum difference observed after 2 weeks. These differences were associated with stress-induced increases in phosphatidyl choline, lactate, carbohydrates, alanine, valine and trimethylamine-N-oxide, and decreases in low density lipoprotein, very low density lipoprotein, and lipid. UPLC-MS data showed differences at week 2, associated with another set of compounds, tentatively identified on the basis of their mass/charge. Overall the results provided a multi-faceted view of the response of fish to long-term handling stress, indicating that the metabolic disparity between the control and stress groups increased to week 2, but declined by weeks 3 and 4, and revealed several new molecular indicators of long-term stress.

Establishment and development of a seabird colony : long-term trends in phenology, breeding success, recruitment, breeding density and demography

Few studies document long-term colony-level metrics from colony establishment to maturity (equilibrium) and few test predictions of general models of colony development. We describe long-term trends in a colony of Australasian Gannets (Morus serrator) which has been monitored from an early stage in its development. The colony at Pope’s Eye, within Port Phillip Bay, Victoria, Australia was established in 1984 on an artificial structure and the first nest count (25 nests) was conducted in the same year. The colony was then studied for 15 of 19 years between 1988 and 2006–2007. During the study, 2,516 eggs were recorded, resulting in 1,694 chicks hatching (67 % of eggs), of which 1,310 (77 % of those hatched) fledged. At least 184 (14 %) of fledged offspring returned to Pope’s Eye as breeding adults. Since establishment, the number and density of nests increased (number of nests increased 8.8 % annually), with density increasing at varying rates in different areas of the colony. Early recruitment involved birds from a nearby colony, but within 5 years post establishment the first natal recruits were breeding at Pope’s Eye and thereafter natal recruitment was the main source of new breeding adults (totalling 81.4 % of all recruits). Age of recruitment varied throughout the study, though not systematically, and there was no difference between the sexes. The pattern of rapid initial growth is typical of patterns reported for other seabird colonies. However, as the colony (and birds within it) aged, there was no increase in breeding success and egg laying did not become earlier, as was expected from general models of colony development.