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.

Sulfate transporters involved in sulfate secretion in the kidney are localized in the renal proximal tubule II of the elephant fish (Callorhinchus milii)

Most vertebrates, including cartilaginous fishes, maintain their plasma SO4 (2-) concentration ([SO4 (2-)]) within a narrow range of 0.2-1 mM. As seawater has a [SO4 (2-)] about 40 times higher than that of the plasma, SO4 (2-) excretion is the major role of kidneys in marine teleost fishes. It has been suggested that cartilaginous fishes also excrete excess SO4 (2-) via the kidney. However, little is known about the underlying mechanisms for SO4 (2-) transport in cartilaginous fish, largely due to the extraordinarily elaborate four-loop configuration of the nephron, which consists of at least 10 morphologically distinguishable segments. In the present study, we determined cDNA sequences from the kidney of holocephalan elephant fish (Callorhinchus milii) that encoded solute carrier family 26 member 1 (Slc26a1) and member 6 (Slc26a6), which are SO4 (2-) transporters that are expressed in mammalian and teleost kidneys. Elephant fish Slc26a1 (cmSlc26a1) and cmSlc26a6 mRNAs were coexpressed in the proximal II (PII) segment of the nephron, which comprises the second loop in the sinus zone. Functional analyses using Xenopus oocytes and the results of immunohistochemistry revealed that cmSlc26a1 is a basolaterally located electroneutral SO4 (2-) transporter, while cmSlc26a6 is an apically located, electrogenic Cl(-)/SO4 (2-) exchanger. In addition, we found that both cmSlc26a1 and cmSlc26a6 were abundantly expressed in the kidney of embryos; SO4 (2-) was concentrated in a bladder-like structure of elephant fish embryos. Our results demonstrated that the PII segment of the nephron contributes to the secretion of excess SO4 (2-) by the kidney of elephant fish. Possible mechanisms for SO4 (2-) secretion in the PII segment are discussed.

The mediatization of the knowledge based economy : an Australian field based account

This paper presents an empirical account of mediatization from a Bourdieuian perspective, based on the development of a number of new concepts, such as cross-field effects and the rescaling of such effects as linked to processes of globalization. Built on an Australian empirical case relating to educational policy and the knowledge based economy, this paper argues that mediatization can be understood in relation to the cross-field effects of different fields of journalism on subsequent fields, which have their genesis in forms of practice that cross different social fields. Specifically, the case analysis details interactions between the field of print journalism and the field of policy over the course of an Australian science capability review, chaired by the then chief scientist, Dr Robin Batterham, which led to Australia adopting a national version of the knowledge economy. The empirical case also leads us to consider the impact of both global and national fields of journalism on fields of educational policy in relation to mediatization.

The lure of the local: community activism and place in Australia

The intertwined relationship between the built and natural environments characterises and defines coastal towns, especially those with significant heritage values. Our research is located in the context of the “sea change” phenomenon, which is fundamentally changing the coastal towns of Australia. Barbara Norman, a past national president of the Planning Institute of Australia (PIA), summarised the current struggle occurring in many of Australia’s coastal regions when she wrote: “the Australian coastline is littered with exhausted communities battling to save the character and environment of their townships” (Norman, 2008). The Australian National Sea Change Taskforce was established in 2004, as a response to these wider community and professional concerns, and seeks “to ensure that coastal development is managed with a focus on the sustainability of coastal communities and the coastal environment” (Gurran et al., 2006) concluded that more detailed research is needed to develop new responses to coastal development, particularly in terms of promoting community wellbeing, strengthening social cohesion, avoiding socio-economic and socio-spatial polarisation and preserving sense of place.

Validating planning heritage : evidence and reasoning for national heritage recognition of the 'City of Adelaide Plan' and park lands

The Adelaide Park Lands and the ‘City of Adelaide Plan’ (1837), as prepared by Colonel William Light, have long been held up as an international precedent in town planning literature. The celebrated model, embraced by Ebenezer Howard to describe his Garden City theory, has several layers of cultural landscape heritage. The ‘Plan’, in recent years, has been subject to a rigorous investigation of its Indigenous and colonization evolutionary layers to inform moves to list the landscape as possessing national heritage status under relevant Australian heritage regimes, and more recently under the National Heritage List regime, as a pre-emptive strategy towards an eventual World Heritage nomination of the cultural landscape and ‘Plan’.

A preliminary investigation of the utility of the "Behavior support plan quality evaluation guide II" for use in Australia

Background The quality of behaviour support plans (BSPs) can be an important influence on the quality of the support provided to people with disability who show challenging behaviours. The Behavior Support Plan Quality Evaluation Guide II (BSP-QE II) is one tool that may be useful in assessing the quality of behaviour support plans. It has previously been used to assess BSPs to support children in schools in the USA. In this preliminary study, we examined the utility of the BSP-QE II for assessing behaviour support plans designed for adults with an intellectual disability in community support services in Australia.

Method  Experienced practitioners were surveyed concerning the relevance of BSP-QE II components to the evaluation of BSPs in Australia, and an audit was conducted of randomly selected BSPs submitted as a statutory requirement to the Office of the Senior Practitioner.

Results  The BSP-QE II showed evidence of acceptable construct validity and interrater reliability. There was evidence of a need for substantial improvement in the quality of BSPs, consistent with previous findings conducted using other audit tools.

Conclusions The findings support the utility of the BSP-QE II, to inform and evaluate service planning in supporting adults with intellectual disability who show challenging behaviour.

Rationale and design of the national benchmarking and evidence-based national clinical guidelines for chronic heart failure management programs study

OBJECTIVES: The National Benchmarks and Evidence-Based National Clinical Guidelines for Heart Failure Management Programs Study is a national, multicenter study designed to determine the nature, range, and effect of interventions applied by chronic heart failure management programs (CHF-MPs) throughout Australia on patient outcomes. Its primary objective is to use these data to develop national benchmarks and evidence-based clinical guidelines and optimize their cost-effective application by reducing quality and outcome variability. DATA SOURCES/STUDY SETTING: Primary data will be collected from CHF-MP coordinators and CHF patients enrolled in these programs on a national basis. Secondary outcome data will be collected from a national morbidity record and from patients' medical records. STUDY DESIGN: Stage I of the study involves a prospective clinical audit of all CHF-MPs throughout Australia (n = 45) to determine the extent of variability in programs currently. Stage II is a prospective cross-sectional survey design enrolling 1,500 patients (average of 40 patients per program) to firstly determine the typical profile of patients being managed via a CHF-MP in Australia and, secondly, the subsequent morbidity and mortality during the 6-month follow-up. Outcome data will be subject to multivariate analysis to determine the key components of care in this regard. All study data will be then examined in the final stage of the study (III) to develop national benchmarks for the application and auditing of CHF-MPs in Australia. CONCLUSION: Variability in patient outcomes is a product of heterogeneity among CHF-MPs. The development of national benchmarks will minimize such heterogeneity and will provide a greater level of evidence for their cost-effective application.

Increasing national capability for quality higher education the case of the Sultanate of Oman

This paper explores a number of quality enhancement initiatives being implemented in a developing country, the Sultanate of Oman, to increase the national capability for quality higher education. Oman is a young country with a youthful and rapidly growing population. A brief description of the relatively short history of Oman’s national systems for secondary and postsecondary education is provided. This highlights the challenges for quality education resulting from a strategy of importing postsecondary education from a variety of countries, and delivering the programs through a largely privatized sector.

The paper then describes the outcomes of an initial needs analysis that led to the development of a National Quality Plan. Some of the strategies in this plan for improving and increasing capability are considered, most particularly the establishment of a practitioner‐oriented Oman Quality Network, and the design and implementation of a National Quality Training Program. These two strategies attempt to address common obstacles to capability, namely a paradigm that entrenches compliance and helplessness, and only early awareness of effective quality enhancement and quality assurance principles and methods.

Evaluation results are presented that comment on progress thus far, and suggest critical success factors. These include building legitimacy and trust to overcome barriers to sharing information in a competitive privatized environment. They also include the establishment of peer to peer mechanisms that build confidence and create sustainability over time, as imported or external expertise gives way to local capability and expertise.

An impaired mitochondrial electron transport chain increases retention of the hypoxia imaging agent diacetylbis(4-methylthiosemicarbazonato)copper II

Radiolabeled diacetylbis(4-methylthiosemicarbazonato)copper^II [Cu^II(atsm)] is an effective positron-emission tomography imaging agent for myocardial ischemia, hypoxic tumors, and brain disorders with regionalized oxidative stress, such as mitochondrial myopathy, encephalopathy, and lactic acidosis with stroke-like episodes (MELAS) and Parkinson’s disease. An excessively elevated reductive state is common to these conditions and has been proposed as an important mechanism affecting cellular retention of Cu from Cu^II(atsm). However, data from whole-cell models to demonstrate this mechanism have not yet been provided. The present study used a unique cell culture model, mitochondrial xenocybrids, to provide whole-cell mechanistic data on cellular retention of Cu from Cu^II(atsm). Genetic incompatibility between nuclear and mitochondrial encoded subunits of the mitochondrial electron transport chain (ETC) in xenocybrid cells compromises normal function of the ETC. As a consequence of this impairment to the ETC we show xenocybrid cells upregulate glycolytic ATP production and accumulate NADH. Compared to control cells the xenocybrid cells retained more Cu after being treated with Cu^II(atsm). By transfecting the cells with a metal-responsive element reporter construct the increase in Cu retention was shown to involve a Cu^II(atsm)-induced increase in intracellular bioavailable Cu specifically within the xenocybrid cells. Parallel experiments using cells grown under hypoxic conditions confirmed that a compromised ETC and elevated NADH levels contribute to increased cellular retention of Cu from CuII(atsm). Using these cell culture models our data demonstrate that compromised ETC function, due to the absence of O2 as the terminal electron acceptor or dysfunction of individual components of the ETC, is an important determinant in driving the intracellular dissociation of Cu^II(atsm) that increases cellular retention of the Cu.

Modification of the National Inpatient Medication Chart improves venous thromboembolism prophylaxis rates in high-risk medical patients

Background : Venous thromboembolism (VTE) is a significant contributor to morbidity and mortality in Australia. While there is well-established evidence for the use of VTE prophylaxis in hospital inpatients, adherence to such guidelines is poor. Aim : The aim of the present study is to assess the impact of education and system change on improving rates of VTE prophylaxis in hospital inpatients. Methods : We performed four consecutive audits of inpatient medical records of a regional hospital service over 2 years. The audits aimed to test the impact of serial interventions at increasing the appropriate use of VTE prophylaxis (based on risk assessment). The interventions were (i) staff education and (ii) a process change that mandated a prophylaxis decision by modifying the National Inpatient Medication Chart with ‘VTE avoidance’ preprinted in the first medication box. Results : Our results from the baseline study showed that of the 236 medical inpatients reviewed, 80% were at high risk of VTE. Of this high-risk cohort, 34.9% (confidence interval (CI) 28–42%) had appropriate prophylaxis decisions. Post the education intervention, 43.2% (CI 37–49%) of the high-risk cohort received appropriate VTE prophylaxis, an improvement of 8.3% (CI −1% to 18%) from baseline. With the subsequent introduction of a process change, 82.1% (CI 66–92%) of the high-risk cohort received appropriate prophylaxis, an improvement of 47.2% and 38.8% (CI 24–54%) when compared with baseline and education respectively. Retention rates at 11 months postsystem change were 73% (CI 55–86%). Conclusions : This study therefore concluded that while education has an impact on rates of appropriate VTE prophylaxis, it is system change that has the most marked and sustained effect.