Does self monitoring of blood blucose as opposed to urinalysis provide additional benefit in patients newly diagnosed with type 2 diabetes receiving structured education? The DESMOND SMBG randomised controlled trial protocol

Background
The benefit of self-monitoring of blood glucose (SMBG) in people with type 2 diabetes on diet or oral agents other than sulphonylureas remains uncertain. Trials of interventions incorporating education about self-monitoring of blood glucose have reported mixed results. A recent systematic review concluded that SMBG was not cost-effective. However, what was unclear was whether a cheaper method of self-monitoring (such as urine glucose monitoring) could produce comparable benefit and patient acceptability for less cost.

Methods/Design
The DESMOND SMBG trial is comparing two monitoring strategies (blood glucose monitoring and urine testing) over 18 months when incorporated into a comprehensive self-management structured education programme. It is a multi-site cluster randomised controlled trial, conducted across 8 sites (7 primary care trusts) in England, UK involving individuals with newly diagnosed Type 2 diabetes.

The trial has 80% power to demonstrate equivalence in mean HbA1c (the primary end-point) at 18 months of within ± 0.5% assuming 20% drop out and 20% non-consent. Secondary end-points include blood pressure, lipids, body weight and psychosocial measures as well as a qualitative sub-study.

Practices were randomised to one of two arms: participants attend a DESMOND programme incorporating a module on self-monitoring of either urine or blood glucose. The programme is delivered by accredited educators who received specific training about equipoise. Biomedical data are collected and psychosocial scales completed at baseline, and 6, 12, and 18 months post programme. Qualitative research with participants and educators will explore views and experiences of the trial and preferences for methods of monitoring.

Discussion
The DESMOND SMBG trial is designed to provide evidence to inform the debate about the value of self-monitoring of blood glucose in people with newly diagnosed type 2 diabetes. Strengths include a setting in primary care, a cluster design, a health economic analysis, a comparison of different methods of monitoring while controlling for other components of training within the context of a quality assured structured education programme and a qualitative sub-study.

A randomised, feasibility trial of a tele-health intervention for acute coronary syndrome patients with depression (‘MoodCare’): study protocol

Background Coronary heart disease (CHD) and depression are leading causes of disease burden globally and the two often co-exist. Depression is common after Myocardial Infarction (MI) and it has been estimated that 15-35% of patients experience depressive symptoms. Co-morbid depression can impair health related quality of life (HRQOL), decrease medication adherence and appropriate utilisation of health services, lead to increased morbidity and suicide risk, and is associated with poorer CHD risk factor profiles and reduced survival. We aim to determine the feasibility of conducting a randomised, multi-centre trial designed to compare a tele-health program (MoodCare) for depression and CHD secondary prevention, with Usual Care (UC).

Methods Over 1600 patients admitted after index admission for Acute Coronary Syndrome (ACS) are being screened for depression at six metropolitan hospitals in the Australian states of Victoria and Queensland. Consenting participants are then contacted at two weeks post-discharge for baseline assessment. One hundred eligible participants are to be randomised to an intervention or a usual medical care control group (50 per group). The intervention consists of up to 10 × 30-40 minute structured telephone sessions, delivered by registered psychologists, commencing within two weeks of baseline screening. The intervention focuses on depression management, lifestyle factors (physical activity, healthy eating, smoking cessation, alcohol intake), medication adherence and managing co-morbidities. Data collection occurs at baseline (Time 1), 6 months (post-intervention) (Time 2), 12 months (Time 3) and 24 months follow-up for longer term effects (Time 4). We are comparing depression (Cardiac Depression Scale [CDS]) and HRQOL (Short Form-12 [SF-12]) scores between treatment and UC groups, assessing the feasibility of the program through patient acceptability and exploring long term maintenance effects. A cost-effectiveness analysis of the costs and outcomes for patients in the intervention and control groups is being conducted from the perspective of health care costs to the government.

Discussion This manuscript presents the protocol for a randomised, multi-centre trial to evaluate the feasibility of a tele-based depression management and CHD secondary prevention program for ACS patients. The results of this trial will provide valuable new information about potential psychological and wellbeing benefits, cost-effectiveness and acceptability of an innovative tele-based depression management and secondary prevention program for CHD patients experiencing depression.

CodePipe : an opportunistic feeding and routing protocol for reliable multicast with pipelined network coding

Multicast is an important mechanism in modern wireless networks and has attracted significant efforts to improve its performance with different metrics including throughput, delay, energy efficiency, etc. Traditionally, an ideal loss-free channel model is widely used to facilitate routing protocol design. However, the quality of wireless links would be affected or even jeopardized by many factors like collisions, fading or the noise of environment. In this paper, we propose a reliable multicast protocol, called CodePipe, with advanced performance in terms of energy-efficiency, throughput and fairness in lossy wireless networks. Built upon opportunistic routing and random linear network coding, CodePipe not only simplifies transmission coordination between nodes, but also improves the multicast throughput significantly by exploiting both intra-batch and inter-batch coding opportunities. In particular, four key techniques, namely, LP-based opportunistic routing structure, opportunistic feeding, fast batch moving and inter-batch coding, are proposed to offer substantial improvement in throughput, energy-efficiency and fairness. We evaluate CodePipe on ns2 simulator by comparing with other two state-of-art multicast protocols, MORE and Pacifier. Simulation results show that CodePipe significantly outperforms both of them.

A serverless ultra-lightweight secure search protocol for EPC Class-1 Gen-2 UHF RFID tags

Radio Frequency Identification (RFID) is a technology that enables the non-contact, automatic and unique identification of objects using radio waves. Its use for commercial applications has recently become attractive with RFID technology seen as the replacement for the optical barcode system that is currently in widespread use. RFID has many advantages over the traditional barcode and these advantages have the potential to significantly increase the efficiency of decentralised business environments such as logistics and supply chain management. One of the important features of an RFID system is its ability to search for a particular tag among a group of tags. In order to ensure the privacy and security of the tags, the search has to be conducted in a secure fashion. To our knowledge not much work has been done in this secure search area of RFID. The limited work that has been done does not comply with the EPC Class-1 Gen-2 standards since most of them use expensive hash operations or sophisticated encryption schemes that cannot be implemented on low-cost passive tags that are highly resource constrained. Our work aims to fill this gap by proposing a serverless ultra-lightweight secure search protocol that does not use the expensive hash functions or any complex encryption schemes but achieves compliance with EPC Class-1 Gen-2 standards while meeting the required security requirements. Our protocol is based on XOR encryption and random numbers - operations that are easily implemented on low-cost RFID tags. Our protocol also provides additional protection using a blind-factor to prevent tracking attacks. Since our protocol is EPC Class-1 Gen-2 compliant it makes it possible to implement it on low-cost passive RFID tags.

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.

Managing patient deterioration : a protocol for enhancing undergraduate nursing students’ competence through web-based simulation and feedback techniques

Aims: To describe a funded proposal for the development of an on-line evidence based educational program for the management of deteriorating patients.
Background: There are international concerns regarding the management of deteriorating patients with issues around the ‘failure to rescue’. The primary response to these issues has been the development of medical emergency teams with little focus on the education of primary first responders.
Design/Methods: A mixed methods triangulated convergent design. In this four phase proposal we plan to 1. examine nursing student team ability to manage deteriorating patients and based upon these findings 2. develop web based educational material, including interactive scenarios. This educational material will be tested and refined in the third Phase 3, prior to evaluation and dissemination in the final phase.
Conclusion: This project aims to enhance knowledge development for the management of deteriorating patients through rigorous assessment of team performance and to produce a contemporary evidence-based online training program.

Observer-based controller design of time-delay systems with an interval time-varying delay

This paper considers the problem of designing an observer-based output feedback controller to exponentially stabilize a class of linear systems with an interval time-varying delay in the state vector. The delay is assumed to vary within an interval with known lower and upper bounds. The time-varying delay is not required to be differentiable, nor should its lower bound be zero. By constructing a set of Lyapunov–Krasovskii functionals and utilizing the Newton–Leibniz formula, a delay-dependent stabilizability condition which is expressed in terms of Linear Matrix Inequalities (LMIs) is derived to ensure the closed-loop system is exponentially stable with a prescribed α-convergence rate. The design of an observerbased output feedback controller can be carried out in a systematic and computationally efficient manner via the use of an LMI-based algorithm. A numerical example is given to illustrate the design procedure.

Secure mobile RFID ownership transfer protocol to cover all transfer scenarios

Existing business models require RFID tag to transfer its ownership during its life cycle. As a result, a RFID tags might have many owners during its life cycle. However, the transfer of ownership should ensure that previous owners have no information about current owner's data. Physical ownership does not ensure digital ownership transfer given the wireless nature of communication with RFID tags. Most of the proposed protocol in this nature is implacable to address aU existing RFID tag ownership transfer scenarios. Moreover, they have many security concerns and vulnerabilities. In this paper, we have investigated and discussed all existing business cases and their transfer scenarios. To cover all ownership transfer scenarios, we have presented an ownership transfer protocol. The proposed protocol has used modified DiffieHellman algorithm to perform ownership request validation and authentication of involved parties. Performance comparison shows that our protocol is practical to implement passive low-cost RFID tags, securely performs tag ownership transfer and can be used for all existing ownership transfer scenarios.

A secure search protocol based on Quadratic Residues for EPC Class-1 Gen-2 UHF RFID tags

Radio Frequency Identification (RFID) is a technological revolution that is expected to soon replace barcode systems. One of the important features of an RFID system is its ability to search for a particular tag among a group of tags. This task is quite common where RFID systems play a vital role. To our knowledge not much work has been done in this secure search area of RFID. Also, most of the existing work do not comply with the C1G2 standards. Our work aims to fill that gap by proposing a protocol based on Quadratic Residues property that does not use the expensive hash functions or any complex encryption schemes but achieves total compliance with industry standards while meeting the security requirements.

Life and living in advanced age: a cohort study in New Zealand - Te Puāwaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS NZ: Study protocol

The number of people of advanced age (85 years and older) is increasing and health systems may be challenged by increasing health-related needs. Recent overseas evidence suggests relatively high levels of wellbeing in this group, however little is known about people of advanced age, particularly the indigenous Māori, in Aotearoa, New Zealand. This paper outlines the methods of the study Life and Living in Advanced Age: A Cohort Study in New Zealand. The study aimed to establish predictors of successful advanced ageing and understand the relative importance of health, frailty, cultural, social & economic factors to successful ageing for Māori and non-Māori in New Zealand.

Patron offending and intoxication in night time entertainment districts (POINTED) : a study protocol

Risky alcohol consumption is the subject of considerable community concern in Australia and internationally, particularly the risky drinking practices of young people consuming alcohol in the night-time economy. This study will determine some of the factors and correlates associated with alcohol-related risk-taking, offending and harm in and around licensed venues and night-time entertainment precincts across five Australian cities (three metropolitan and two regional). The primary aim of the study is to measure levels of pre-drinking, drinking in venues, intoxication, illicit drug use and potentially harmful drinking practices (such as mixing with energy drinks) of patrons in entertainment areas, and relating this to offending, risky behaviour and harms experienced. The study will also investigate the effects of license type, trading hours, duration of drinking episodes and geographical location on intoxication, offending, risk-taking and experience of harm. Data collection involves patron interviews (incorporating breathalysing and drug testing) with 7500 people attending licensed venues. Intensive venue observations (n=112) will also be undertaken in a range of venues, including pubs, bars and nightclubs. The information gathered through this study will inform prevention and enforcement approaches of policy makers, police and venue staff.