Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes : dose adjustment for normal eating (DAFNE) randomised controlled trial

Objectives: To evaluate whether a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment can improve both glycaemic control and quality of life in type 1 diabetes.

Design: Randomised design with participants either attending training immediately (immediate DAFNE) or acting as waiting list controls and attending “delayed DAFNE” training 6 months later.
Setting: Secondary care diabetes clinics in three English health districts.

Participants: 169 adults with type 1 diabetes and moderate or poor glycaemic control.

Main outcome measures: Glycated haemoglobin (HbA1c), severe hypoglycaemia, impact of diabetes on quality of life (ADDQoL).

Results: At 6 months, HbA1c was significantly better in immediate DAFNE patients (mean 8.4%) than in delayed DAFNE patients (9.4%) (t=6.1, P<0.0001). The impact of diabetes on dietary freedom was significantly improved in immediate DAFNE patients compared with delayed DAFNE patients (t=−5.4, P<0.0001), as was the impact of diabetes on overall quality of life (t=2.9, P<0.01). General wellbeing and treatment satisfaction were also significantly improved, but severe hypoglycaemia, weight, and lipids remained unchanged. Improvements in “present quality of life” did not reach significance at 6 months but were significant by 1 year.

Conclusion: Skills training promoting dietary freedom improved quality of life and glycaemic control in people with type 1 diabetes without worsening severe hypoglycaemia or cardiovascular risk. This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation.

What has transcranial magnetic stimulation taught us about neural adaptations to strength training? A brief review

The evidence for neural mechanisms underpinning rapid strength increases has been investigated and discussed for over 30 years using indirect methods, such as surface electromyography, with inferences made toward the nervous system. Alternatively, electrical stimulation techniques such as the Hoffman reflex, volitional wave, and maximal wave have provided evidence of central nervous system changes at the spinal level. For 25 years, the technique of transcranial magnetic stimulation (TMS) has allowed for noninvasive supraspinal measurement of the human nervous system in a number of areas such as fatigue, skill acquisition, clinical neurophysiology, and neurology. However, it has only been within the last decade that this technique has been used to assess neural changes after strength training. The aim of this brief review is to provide an overview of TMS, discuss specific strength training studies that have investigated changes, after short-term strength training in healthy populations in upper and lower limbs, and conclude with further research suggestions and the application of this knowledge for the strength and conditioning coach.

Preparing professionals : student teachers and their supervisors at work

The first teaching experiences of student teachers have changed significantly in Australia even during the last fifty years. One constant has been their involvement with a supervisor, usually a practising teacher of experience. The importance attributed to this supervisory relationship has waxed and waned over the years, but it is presently receiving prominence as being the real place of learning for the novice teacher. This paper argues that the apprenticeship model, with its emphasis on performance and product, is most prominent in present supervisory conferences, despite being inappropriate for inducting student teachers into teaching as a profession. The paper suggests that the development of professional teachers calls for supervisory relationships which include discourses of critical reflection, rather than relationships that are dominated by the techniques of teaching. Further, such relationships are seen as professionally empowering for both student teachers and their supervisors.

Sustaining Victorian certificate of applied learning (VCAL) educators

This paper draws on emerging data from in-progress analysis of interviews with 22 teachers/educators who teach the Victorian Certificate of Applied Learning (VCAL) in the settings of schools, Adult Community Education (ACE) and Technical and Further Education (TAFE). The development and implementation of VCAL occurred in 2002 as a response to Victorian government policy initiatives resulting from the Kirby (2000) Report. The VCAL is offered alongside the Victorian Certificate of Education (VCE), in years 11 and 12 of school, as another pathway into employment or further education and training. VCAL is also offered in the settings of TAFE and ACE. The VCAL curriculum uses applied learning as a pedagogical foundation to engage students in relevant, meaningful and authentic learning. In schools VCAL is delivered by qualified and registered teachers. In the TAFE and ACE sectors VCAL is taught by staff who are not necessarily teacher trained. Many pre-service teaching courses (including Certificate IV in Workplace Training and Assessment) do not include applied learning pedagogy in the curriculum. Since VCALʼs implementation there have been calls for greater consultation with, and support given to, VCAL teachers and organisations (Knipe, Ling, Bottrell and Keamy, 2003, p. 6; Harrison, 2006). Additionally VCAL teachers are frequently ill prepared professionally to manage a cohort which includes a high concentration of disengaged young people demonstrating challenging behaviours and attitudes (Pritchard & Anderson, 2006, p.1). Emerging data from the interviews with VCAL educators indicates these issues have not been addressed and many educators and teachers continue to feel unprepared and poorly supported. This is particularly significant in the light of a recent Victorian government announcement that, despite rising VCAL enrolments, VCAL coordination funding to schools is to be cut in 2012. (VALA, 2011, para. 4). To compensate for a lack of structured support and preparation, VCAL educators are frequently sustaining professional practice by their own agency in adapting already held life-skills and knowledge.

Short-term exercise training early in life restores deficits in pancreatic B-cell mass associated with growth restriction in adult male rats

Fetal growth restriction is associated with reduced pancreatic ß-cell mass, contributing to impaired glucose tolerance and diabetes. Exercise training increases ß-cell mass in animals with diabetes and has long-lasting metabolic benefits in rodents and humans. We studied the effect of exercise training on islet and ß-cell morphology and plasma insulin and glucose, following an intraperitoneal glucose tolerance test (IPGTT) in juvenile and adult male Wistar-Kyoto rats born small. Bilateral uterine vessel ligation performed on day 18 of pregnancy resulted in Restricted offspring born small compared with shamoperated Controls and also sham-operated Reduced litter offspring that had their litter size reduced to five pups at birth. Restricted, Control, and Reduced litter offspring remained sedentary or underwent treadmill running from 5 to 9 or 20 to 24 wk of age. Early life exercise increased relative islet surface area and ß-cell mass across all groups at 9 wk, partially restoring the 60–68% deficit (P = 0.05) in Restricted offspring. Remarkably, despite no further exercise training after 9 wk, ß-cell mass was restored in Restricted at 24 wk, while sedentary littermates retained a 45% deficit (P = 0.05) in relative ß-cell mass. Later exercise training also restored Restricted ß-cell mass to Control levels. In conclusion, early life exercise training in rats born small restored ß-cell mass in adulthood and may have beneficial consequences for later metabolic health and disease.

Connecting with the horizon : developing teachers' appreciation of mathematical structure

A professional learning program for teachers of junior secondary mathematics regarding the content and pedagogy of senior secondary mathematics is the context for this study of teachers’ mathematical and pedagogical knowledge. The analysis of teachers’ reflections on their learning explored teachers’ understanding of mathematical connections and their appreciation of mathematical structure. The findings indicate that a professional learning program about senior secondary mathematics can enable practicing teachers to deepen and broaden their knowledge for teaching junior secondary mathematics and develop their practice to support their students’ present and future learning of mathematics. Further research is needed about professional learning approaches and tasks that may enable teachers to imbed and develop awareness of structure in their practice.

Training improves interobserver reliability for the diagnosis of scaphoid fracture displacement

Background The diagnosis of displacement in scaphoid fractures is notorious for poor interobserver reliability.

Questions/purposes We tested whether training can improve interobserver reliability and sensitivity, specificity, and accuracy for the diagnosis of scaphoid fracture displacement on radiographs and CT scans.

Methods Sixty-four orthopaedic surgeons rated a set of radiographs and CT scans of 10 displaced and 10 nondisplaced scaphoid fractures for the presence of displacement, using a web-based rating application. Before rating, observers were randomized to a training group (34 observers) and a nontraining group (30 observers). The training group received an online training module before the rating session, and the nontraining group did not. Interobserver reliability for training and nontraining was assessed by Siegel’s multirater kappa and the Z-test was used to test for significance.

Results There was a small, but significant difference in the interobserver reliability for displacement ratings in favor of the training group compared with the nontraining group. Ratings of radiographs and CT scans combined resulted in moderate agreement for both groups. The average sensitivity, specificity, and accuracy of diagnosing displacement of scaphoid fractures were, respectively, 83%, 85%, and 84% for the nontraining group and 87%, 86%, and 87% for the training group. Assuming a 5% prevalence of fracture displacement, the positive predictive value was 0.23 in the nontraining group and 0.25 in the training group. The negative predictive value was 0.99 in both groups.

Conclusions Our results suggest training can improve interobserver reliability and sensitivity, specificity and accuracy for the diagnosis of scaphoid fracture displacement, but the improvements are slight. These findings are encouraging for future research regarding interobserver variation and how to reduce it further.

I’m not like everybody else - online forums and PLT

This paper reports some of the findings from a study undertaken as part of the research component for a master of professional education and training degree.
The objectives of the study were to investigate students’ perceptions and satisfaction regarding CMC activities, including community of inquiry framework elements and self-system factors, and to frame recommendations that might improve the use of online discussions as a teaching medium in practical legal training.
A literature review identified themes arising from previous studies concerning the use of CMC in adult learning. The elements of the Community of Inquiry framework and Marzano and Kendall’s concept of students’ Self System were used as reference points to frame the study.
An online questionnaire was used to collect data from students who had undertaken online discussion activities as part of their practical legal training in the professional responsibility in New South Wales, Queensland and Victoria. The data included the students’ opinions, attitudes and perceptions regarding the online discussions. The data was analysed using descriptive statistics that tended to indicate the participants were satisfied with online discussions as teaching medium for PLT. Tests for association between certain variables conducted using Barnard’s Exact Test disclosed 30 possible associations.
This paper focuses on part of the findings, namely associations between the participants’ attributes and contexts, student-student interactions, and satisfaction with the learning experience.
Further research specifically concerning the design and delivery of blended programs of practical legal training would be beneficial. Further study involving quantitative and qualitative methods and regarding the use of computer-mediated communications in PLT is recommended.

Is the lecturer in the room? a study of student satisfaction with online discussions in practical legal training

Reports an exploratory practitioner-initiated study that developed and implemented an online questionnaire to collect data from PLT students in three states, regarding their satisfaction with online discussions. Students’ perceptions of ‘community of inquiry framework’ elements, Marzano and Kendall’s ‘self-system’ factors, and other contextual aspects, were investigated and tested for correlations.The study found student satisfaction with the online discussions was most closely associated with ‘teaching presence’. Students’ satisfaction with student-student interactions was closely associated with ‘self-system’ factors.

Learning leadership is in your hands : toward a scholarship of teaching in practical legal training

This article seeks to promote discussion about scholarship of teaching in Australian postgraduate pre-admission practical legal training (PLT). This is germane to perceptions of the quality of accreditation of young Australian lawyers practicing in a globalised profession. The article gives a definition and outlines the prerequisites for scholarship of teaching. The present position of teacher engagement with scholarship of teaching in Australian PLT is considered, together with the historical and organisational epistemological approaches to professional practical training. Problems of validity, measurement, performativity, and engagement in teaching scholarship are discussed. Possible methodological approaches, including Schön’s conception of action research, together with other methodologies, technologies, and practical considerations, are considered. These discussion points are directed toward future exploration of PLT teachers’ engagement with, and leadership in, the scholarship of teaching in PLT.

Where to from here? Career choices of pre-service teachers undertaking a dual early childhood / primary qualification

Recent Australian government initiatives in the early childhood education and care sector are placing demands for an increase in the number of degree qualified early childhood teachers. Many universities are now offering courses with dual qualifications as a way to provide alternate career opportunities for pre-service teachers; however it cannot be assumed that an equal number of graduates will filter into both primary school and early childhood education jobs. This paper presents a study which examined the expected career choices of pre-service teachers from two Victorian universities who were undertaking a dual early childhood / primary qualification. The findings of the study have implications for teacher education curriculum design in relation to the practical components of courses. The authors therefore argue that more attention needs to be focused on the practical components of teacher training courses considering issues of quality and timing.

Training and experience of nurses in responding to alcohol misuse in rural communities

Objective Alcohol misuse by farmers continues to challenge rural nurses. This article reports on the experiences of Australian nurses participating in the Alcohol Intervention Training Program (AITP).

Design and Sample Qualitative interviews of 15 rural and remote nurses.

Measures Semi-structured phone interviews were utilized to assess the response to and implementation of the AITP—an intervention designed to build nurses' knowledge, confidence and skills when responding to alcohol misuse. It comprises practical and theoretical components and was designed for rural and remote settings where nurses encounter alcohol misuse.

Results Nurses found the training provided new—or built on existing—knowledge of alcohol misuse and offered practical hands-on “real life” skills. A range of workplace and personal situations where the content of the training was now being utilized were identified, and future use anticipated. Barriers to using the new knowledge and skills included both rural and generic issues. Constructive feedback to increasingly target the training to rural settings was recommended.

Conclusions The AITP is an effective training program. It can be further tailored to meet common needs of rural and remote nurses working with farmers who misuse alcohol, while recognizing diversity in rural practice.

Evaluation of an alcohol intervention training program for nurses in rural Australia

Aim: This paper reports on the development, implementation and evaluation of the Alcohol Intervention Training Program (AITP) designed to enhance nurses’ capacity to work with farming men and women who misuse alcohol.

Background: In rural and regional areas where alcohol-related behaviours and problems are relatively elevated, nurses may be the key health professionals dealing with individuals who misuse alcohol. However, they are often ill-equipped to do this, have low confidence in their ability to do so, and perceive numerous barriers. Training is required for these nurses.

Methods: We developed the AITP to enhance nurses’ capacity to work with people with alcohol-related problems. The data were collected during 2010. An intervention group of 15 rural nurses completed the AITP. Nurses’ perceived barriers, attitudes, and perceived performance in working with clients with alcohol problems, and the frequency of engaging with this client group were evaluated. Scores on these measures were compared to those of a control group of 17 nurses’ pre-treatment, post-treatment and at 3-month follow-up.

Results: Participation in the AITP resulted in initial improvements in attitudes to working with alcohol problems, but no change in perceived barriers to doing so. The level of engagement with clients having alcohol-related problems increased, as did perceptions of work performance.

Conclusion: The AITP enhances the ability of rural nurses to address the alcohol and associated health issues of clients in rural and regional areas. However, the program needs refinement and further evaluation.

Learning to engage with human rights in heritage

Cultural heritage should not be seen merely as a technical matter or from a narrow visitor management point of view but rather as cultural practice—a form of cultural politics dominated by ruling regimes and social groups in which decisions are made about the future of and access to scarce resources. Several scholars have sought to push this approach further by arguing that heritage studies should take on the protection of human rights as a core consideration in the processes of identifying, inscribing, conserving and interpreting cultural heritage. This paper builds on these previous works to explore what the shift to a rights-based management approach in the World Heritage system might mean for various stakeholders in the heritage protection enterprise as they learn to meet this challenge and to find ways to support people’s right to access, enjoy and maintain cultural heritage. Reaffirming the need to maintain a strong relationship between theory and praxis, the paper draws into the discussion heritage practitioners, decision makers in governments and government agencies, scholars and educators. Of these, the principal emphasis in this paper is on educators who are seen to have a fundamentally important role in developing a critical understanding of the cultural heritage concept, how heritage is created, used and misused and how conservation approaches and programs sit within the broader context of community attitudes and aspirations and governmental responsibilities. A distinction is made between teachers in universities and trainers offering short courses more focused on specific employer needs. The paper focuses on World Heritage but refers to both tangible and intangible aspects. It shows how current moves to establish a rights-based approach to the management of World Heritage sites connects with moves elsewhere in global governance, most notably in the United Nations Permanent Forum on Indigenous Issues and the United Nations Human Rights Commission.