Patient engagement and coaching for health: the PEACH study- a cluster randomised controlled trial using the telephone to coach people with type 2 diabetes to engage with their GPs to improve diabetes care: a study protocol.

Background
The PEACH study is based on an innovative 'telephone coaching' program that has been used effectively in a post cardiac event trial. This intervention will be tested in a General Practice setting in a pragmatic trial using existing Practice Nurses (PN) as coaches for people with type 2 diabetes (T2D). Actual clinical care often fails to achieve standards, that are based on evidence that self-management interventions (educational and psychological) and intensive pharmacotherapy improve diabetes control. Telephone coaching in our study focuses on both. This paper describes our study protocol, which aims to test whether goal focused telephone coaching in T2D can improve diabetes control and reduce the treatment gap between guideline based standards and actual clinical practice.
Methods/design
In a cluster randomised controlled trial, general practices employing Practice Nurses (PNs) are randomly allocated to an intervention or control group. We aim to recruit 546 patients with poorly controlled T2D (HbA1c >7.5%) from 42 General Practices that employ PNs in Melbourne, Australia. PNs from General Practices allocated to the intervention group will be trained in diabetes telephone coaching focusing on biochemical targets addressing both patient self-management and engaging patients to work with their General Practitioners (GPs) to intensify pharmacological treatment according to the study clinical protocol. Patients of intervention group practices will receive 8 telephone coaching sessions and one face-to-face coaching session from existing PNs over 18 months plus usual care and outcomes will be compared to the control group, who will only receive only usual care from their GPs. The primary outcome is HbA1c levels and secondary outcomes include cardiovascular disease risk factors, behavioral risk factors and process of care measures.
Discussion
Understanding how to achieve comprehensive treatment of T2D in a General Practice setting is the focus of the PEACH study. This study explores the potential role for PNs to help reduce the treatment and outcomes gap in people with T2D by using telephone coaching. The intervention, if found to be effective, has potential to be sustained and embedded within real world General Practice.

Plastid division in mallomonas (Synurophyceae, Heterokonta)

Laser scanning confocal microscopy and TEM were used to study the morphology of secondary plastids in algae of the genus Mallomonas (Synurophyceae). At interphase, Mallomonas splendens (G. S. West) Playfair, M. rasilis Dürrschm., M. striata Asmund, and M. adamas K. Harris et W. H. Bradley contained a single H-shaped plastid consisting of two large lobes connected by a narrow isthmus. Labeling of DNA revealed a necklace-like arrangement of plastid nucleoids at the periphery of the M. splendens plastid and a less-patterned array in M. rasilis. The TEM of M. splendens and M. rasilis showed an electron-dense belt surrounding the plastid isthmus in interphase cells; this putative plastid-dividing ring (PD ring) was adpressed to the inner pair of the four plastid membranes, suggesting that it is homologous to the PD ring of green and red plastids. The PD ring did not contain actin (indicated by lack of staining with phalloidin) and displayed filaments or tubules of 5–10 nm in diameter that may be homologous to the tubules described in red algal PD rings. Confocal microscopy of chl autofluorescence from M. splendens showed that the plastid isthmus was severed as mitosis began, giving rise to two single-lobed daughter plastids, which, as mitosis and cell division progressed, separated from one another and then each constricted to form the H-shaped plastids of daughter cells. Similar plastid division cycles were observed in M. rasilis and M. adamas; however, the plastid isthmus of M. striata was retained throughout most of cell division and was eventually severed by the cell cleavage furrow.

Harm reduction and decision making among recreational ecstasy users

Recent research indicates that 3,4-methylene-dioxymethamphetamine (MDMA), also known as ‘ecstasy’, is becoming increasingly popular as an illicit drug among young people. This study investigated risk and harm reduction practices among recreational ecstasy users. A semi-structured interview with 40 participants was designed to investigate how ecstasy users identify and manage the harms associated with their drug use, and the underlying decision-making process. Overall, the participants identified both positive and negative effects. The reported positive effects predominantly centred around enhanced psychological, physiological and social experiences. However, there were a number of factors that contributed to regulating ecstasy use. These included specific in-group and out-group practices executed within the peer group, preventative harm-reducing practices, shared decision making, and shared responsibility for harm prevention. Recommendations for promoting harm reduction strategies and suggestions for future research are discussed.

On the adoption of family-to-business governance mechanisms in Australian family businesses

This study seeks to identify the adoption of certain family-to-business governance mechanisms and whether the presence of these mechanisms assists family businesses with governance matters.

The emotional context of self-management in chronic illness: A qualitative study of the role of health professional support in the self-management of type 2 diabetes

Background: Support for patient self-management is an accepted role for health professionals. Little evidence exists on the appropriate basis for the role of health professionals in achieving optimum self-management outcomes. This study explores the perceptions of people with type 2 diabetes about their self-management strategies and how relationships with health professionals may support this.

Methods: Four focus groups were conducted with people with type 2 diabetes:  two with English speaking and one each with Turkish and Arabic-speaking. Transcripts from the groups were analysed drawing on grounded hermeneutics and interpretive description.

Results: We describe three conceptually linked categories of text from the focus groups based on emotional context of self management, dominant approaches to self management and support from health professionals for self management. All groups described important emotional contexts to living with and self-managing diabetes and these linked closely with how they approached their diabetes management and what they looked for from health professionals. Culture seemed an important influence in shaping these linkages.

Conclusion: Our findings suggest people construct their own individual self-management and self-care program, springing from an important emotional base. This is shaped in part by culture and in turn determines the aims each  person has in pursuing self-management strategies and the role they make available to health professionals to support them. While health professionals'  support for self-care strategies will be more congruent with patients' expectations if they explore each person's social, emotional and cultural circumstances, pursuit of improved health outcomes may involve a careful balance between supporting as well as helping shift the emotional constructs surrounding a patient life with diabetes.

Importance of assessing family dysfunction in conjunction with standardised measures when treating substance abuse

In this thesis, the link between substance abuse and family dysfunction is examined, and an argument is made for the assessment of family dysfunction when treating clients with substance abuse issues. Family dysfunction has been associated with a broad range of problems in children (e.g., low self esteem, increased risk of child abuse) through to adolescence and adulthood (e.g., increased risk of mental disorders such as depressive disorders, substance abuse disorders, and personality disorders) (Kaplan & Sadock, 1998). It is not the purpose of this thesis to suggest that family dysfunction causes substance abuse but rather to highlight that family dysfunction can in some cases place the individual at greater risk of substance abuse. Therefore, in order to understand the reasons why substance abuse developed and how it is maintained in the present requires the assessment of family dysfunction. Further, the importance of assessing the role and impact that family dysfunction may have had on the client, may help to better understand the nature and extent of substance abuse so that relevant and appropriate treatment goals for change may be set, progress monitored, and risk of relapse reduced. Chapter 1 provides a brief introduction to this thesis, and Chapter 2 is a review of the literature on the impact of family dysfunction including poor parental attachment and supervision, neglect, physical and sexual abuse, in adolescence and adulthood. Four case studies are presented to illustrate how family dysfunction and substance abuse may be related, thus highlighting the importance of assessing family dysfunction when treating substance abuse clients. All of the case studies include an individual with a substance abuse disorder (namely heroin) but they are diverse in terms of the types and extent of family dysfunction. The final chapter discusses the case studies in relation to the literature reviewed. Lastly, it gives consideration to the implication of a history of family dysfunction, and how it may impact negatively on treatment and therefore prognosis.

Does Australia's treatment of non-citizens accord with its international human rights obligations? with specific reference to the treatment of on-shore refugees

The son of immigrants, I was motivated to write a paper addressing the issues of alienation and discrimination which confronts non-citizens upon arriving in Australia. Apart from descendants of Australia's indigenous population, the common bond shared by all citizens and permanent residents of Australia is that they are either themselves immigrants or are descended from immigrants. In this paper I will look at whether Australia's law and practice meets its international human rights treaty and convention obligations vis-a-vis non-citizens. To investigate this issue I trace the history of immigration to Australia and look at the political policies which influenced the treatment of non-citizens from 1788 to present times. In 1958 when my parents stepped upon Australian soil as displaced persons, Australia was a very different place from Australia in the 1990s. At that time Australia was still firmly under the influence of the 'White Australia Policy' which openly encouraged discrimination against non-anglo saxons. Since those times Australia has advanced to become one of the most culturally diverse nations in the world where multiculturalism is encouraged and a non-discriminatory immigration program is supported by both Australia's major political parties. However, notwithstanding the great social advances made in Australia in recent decades the traditional legal sources of law, namely, judicial pronouncements, statutes and the Commonwealth Constitution have not kept pace and it is my submission that Australia's body of law inadequately protects the rights of non-citizens when compared to Australia's international human rights convention and treaty obligations. This paper will consider these major sources of law and will investigate how they have been used in the context of the protection of the rights of non-citizens. It will be asserted that the weaknesses exposed in the Australian legal system can be improved by the adoption of a Bill of Rights1 which encompasses Australia's international human rights treaty and convention obligations. It is envisaged that a Bill of Rights would provide a framework applicable at the State, Territory and Federal levels within which issues pertaining to non-citizens could be resolved. The direction of this thesis owes much to the writings, advice and supervision of Dr. Imtiaz Omar who was always available to discuss the progress of this work. Dr. Omar is a passionate advocate of human rights and has been a tremendous inspiration to me throughout my writing. I owe a debt of thanks to the partners of Coulter Burke who with good nature ignored the sprawl of books and papers on the boardroom table, often for days at a time, thus enabling me to return to my writing from time to time as my inspirational juices ebbed and waned. Thanks also go to my typists Julie Pante, Vesna Dudas and Irene Padula who worked after hours and on weekends always without complaint, on the various versions of this thesis. My final acknowledgement goes to my wife Paula who during the years that I was working on this thesis encouraged me during my darker moments and listened to all my frustrations yet never doubted that I would one day complete the task successfully. I wish to thank her wholeheartedly for her motivation and belief in my abilities. The law relied upon in the thesis is as at the 30th June, 1998. Bill or Charter of Rights 'are taken to be enactments which systematically declare certain fundamental rights and freedoms and require that they be respected'. See Evans, G. 'Prospect and Problems for an Australian Bill of Rights' (1970) 3 Australian Year Book of International Law 1 at 16. Some such notable exception is the New Zealand Bill of Rights Act 1990, contained in an ordinary statute.

Neurotoxic, redox-competent Alzheimer's --amyloid is released from lipid membrane by methionine oxidation

The amyloid β peptide is toxic to neurons, and it is believed that this toxicity plays a central role in the progression of Alzheimer's disease. The mechanism of this toxicity is contentious. Here we report that an Aβ peptide with the sulfur atom of Met-35 oxidized to a sulfoxide (Met(O)Aβ) is toxic to neuronal cells, and this toxicity is attenuated by the metal chelator clioquinol and completely rescued by catalase implicating the same toxicity mechanism as reduced Aβ. However, unlike the unoxidized peptide, Met(O)Aβ is unable to penetrate lipid membranes to form ion channel-like structures, and β-sheet formation is inhibited, phenomena that are central to some theories for Aβ toxicity. Our results show that, like the unoxidized peptide, Met(O)Aβ will coordinate Cu₂₊ and reduce the oxidation state of the metal and still produce H2O2. We hypothesize that Met(O)Aβ production contributes to the elevation of soluble Aβ seen in the brain in Alzheimer's disease.

Strategies for bridging sectors and silos : a training model in mental health promotion

Issue addressed: The determinants of individual and community mental health and wellbeing are diverse and many lie outside the sphere of action of the health sector. Developing the confidence and skills of these other sectors to contribute to improved mental health has been identified as a priority at State and national levels that requires the development of specific workforce capacity-building strategies. Methods: VicHealth developed and implemented a two day short course to raise the capacity of organisations from a range of sectors to contribute to the mental health and wellbeing of communities. The model of this short course was constructed to reflect the diverse sectors targeted, which included health, local government, community arts, sport and recreation, justice, and education. Results: Evaluation of the two year pilot program, with more than 1,000 participants, has identified a high degree of satisfaction with the content and delivery model of the course, with clear changes in knowledge, skills and practice having been achieved. Cross-sector understanding and collaborations between participants increased as a result of the course. Conclusions: Continuing demand for the course demonstrates clearly that mental health and well-being is relevant to the core business of a broad range of community and professional organisations. The course has increased the confidence and capacity of these sector representatives to take action on mental health as well as increased cross-sector dialogue and partnerships. The recruitment of trainers from diverse sectors was successful in promoting a key component of the program, which was the message that mental health promotion should be the business of all sectors.

Universiti Sains Malaysia and the engagement with sustainability and civil society within globalization

According to some commentators, the dynamics and forces of globalization have lead to a radical rethink in respect to the role of the university in contemporary society. This rethink has taken several guises. For some it involves the radical privatization of universities. For others it involves the democratization of  universities. Universities exist therefore in a globalized world that is increasingly interconnected and where space and time are increasingly narrowed and  accelerated. Within these broad phenomenons’s neo-liberal globalization entails the increasing need to produce profit and the expansion of the logic of neo-liberal hegemony in education in the guise of reframing education as a service industry. The contradictions that characterize Malaysia s engagement with globalization at a national level manifest in debates over globalization and Higher Education. The most pertinent issue in regards to this relates to the problem of sustainability. In the context of neo-liberal globalization sustainability contradicts the fundamental essence of consumption. The idea of human beings as first and foremost  consumers of things is a normative ideal at odds with the concept of a  sustainable future. At a very basic philosophical level the concept and normative project of neo-liberal capitalism and globalization is tied to a concept of individual possessiveness and consumption that radically challenges cultures that do not share such possessively individualistic precepts. Marketization in Malaysian universities must be tempered by also connecting universities to civil society in such a way that tempers both extremes of the state and market and allows a more sustainable relationship between the social frameworks within which it operates.

Risk and harm reduction among recreational ecstasy users

Ecstasy users' perceptions of risk, harm reduction and decision making practices were examined in 153 adults. Identified were a range of positive and negative effects attributed to using ecstasy. There was only a weak association between risk perception, other risk taking behaviours and high ecstasy use. However, the role of the peer group was found to be an important factor in the reducation of harm, and in particular, the decision making process.