Working and learning in vocational education and training in the knowledge era : final report of the professional development for the future project

This Report summarises the outcomes of the phases of the Professional
Development for the Future Project and presents the implications of this research for professional development of staff in Vocational Education and Training (VET), as they become knowledge workers.

These shifts are occurring within the knowledge era. Distinguishing features of this era are summarised into four broad areas:
- the importance and value placed on knowledge in organisations
- the time span of discretion
- the complexity of relationships, and
- the ubiquitous nature of information and communication technology.

It is within this context that work is currently performed, and understanding this context provides the foundation for considering new capabilities required in the knowledge era.
Key capabilities required of knowledge workers to work effectively in the
knowledge era were drawn together from an analysis of the theoretical literature and the results of interviews with knowledge workers. The core capabilities identified include:
- adaptive problem solving – becoming designers as well as problem -
solvers
- rapid knowledge gathering and sharing with others
- discriminating between relevant and irrelevant information, and
- understanding and working effectively with the organisation’s culture.

Knowledge era characteristics and knowledge worker capabilities have been mapped to each other illustrating conceptual linkages between these two areas.

Professional development themes drawn from interviews with knowledge
workers are presented. While global trends in knowledge work have been well documented, the impact of these trends on the capabilities of workers, and the ways in which knowledge workers develop these capabilities is less well understood. Their learning methods challenge our current thinking in relation to the ways in which workers acquire skills and knowledge. Some of the professional development methods include seeking exposure to new ideas from a wide variety of sources, embracing intense learning opportunities, and using relationships to increase knowledge.

‘Thought pieces’ (see p17 ff) commissioned for this Project, as well as
subsequent interviews with the authors, provided further insights into the
professional development of knowledge workers. The implications of these insights are an extension of earlier themes and emphasise:
- the emergent nature of knowledge work
- the importance of relationships that facilitate knowledge sharing
- coherent conversations and dialogue
- collaborative work and generosity.

A key insight is the shift from thinking about knowledge work in terms of
borrowed knowledge to an emphasis on generated knowledge within a context.

Data from focus groups of the Project provide further insights for knowledge worker professional development. These augment the perspectives of the earlier data analysis but also add greater emphasis to:
- the clear and direct relationship between professional development and
work and career aspirations of knowledge workers,
- the relationship of professional development to the organisational
mission, and
- the issues of managing and leading knowledge workers and their
development.

As part of this analysis the defining features of organisational life in VET were reviewed in relation to effective professional development of knowledge workers.

The final section of the Report revisits the core dimensions of the Project.
Concise commentaries on working and learning in the knowledge era,
professional development in the knowledge era, and leadership and
management in the knowledge era are presented.

The Report concludes with a discussion of the enablers of professional
development for knowledge workers in VET. This discussion is introduced by a re-statement of the VET sector’s positioning in the knowledge era and the consequences of this for VET managers an d staff in terms of complexity, uncertainty and diminished prospects for accurate predictiveness. The enablers comprised:
- integration of information technology into socio -technical systems
- greater understanding of the organisation from within
- connecting staff to the organisation’s fundamental identity
- connecting to the work and career trajectories of workers
- establishing work structures which integrate the use of professional
development resources with knowledge work
- providing workers with the autonomy to design their own professional
development activities
- building professional development into the iterative nature of knowledge
work, and
- creating organisational contexts that value intuitive thinking and working.

Professional development needs to be thou ght of in a much broader context in the knowledge era. What each VET staff member knows and shares will become increasingly central to their work, and in that sense all VET workers require capabilities for knowledge work. This report accurately describes t he VET context, the capabilities required, and the organisational enablers that will promote ‘knowing’ and thus embed a new style of professional development within VET.

The effect of active support training on engagement, opportunities for choice, challenging behaviour and support needs

Background: The aim of this study was to evaluate active support (AS) training and to investigate changes to perceived engagement in domestic tasks, opportunities for choice, frequency of challenging behaviour, and level of support needs.

Method: Participants were 12 adults with ID aged 27–57 years (M = 37 years) residing in three group homes, and their support workers. The support workers completed assessments on three occasions (at baseline, post-training, and at follow-up).

Results: Residents' engagement in domestic tasks increased over time, and overall choice increased, although perceived choice in two life domains initially increased, but decreased to baseline levels at follow-up. Residents exhibited an overall decrease in anxiety, self-absorbed behaviour, disruptive behaviour, and problem behaviour in general. There was also an overall decrease in perceived support needs for five activity domains, with no change for one domain.

Conclusions: The results contribute to a growing body of evidence demonstrating favourable outcomes of AS in terms of engagement and challenging behaviour in people with ID. Surprising results are presented for choice and perceived support needs, warranting further investigation.

Drop-out from parenting training programmes : a retrospective study

Objective: Parent training programmes are a well-established treatment approach for children and adolescents with disruptive behaviour disorders. However, dropout from treatment is a common problem that confounds research on the efficacy of this approach, and wastes important mental health resources. This study sought to further our understanding of the reasons why parents drop out of parent training programmes.

Method: Nine parents of children with disruptive behaviour disorders who had dropped out of a parent training programme were interviewed to investigate why they discontinued the programme.

Results: Parents who dropped out of treatment believed that their children were more difficult than other children with the same disorder and may have been better suited to a child-focused intervention. The parents themselves had very stressful lives, with the majority being single mothers with little support. Dropout parents also had difficulty with the group context and putting strategies into place. Practical concerns included parking, timing of session and the length and number of sessions.

Conclusions: The findings are discussed in terms of what modifications can be made to these programmes to increase retention.

Responding to rural skills shortages : innovations using vocational education and training

Aims & Rationale/Objectives
To locate, analyse and make accessible innovative models of health training and service delivery that have been developed in response to a shortage of skills.

Methods
Drawing on a synthesis of Australian and international literature on innovative and effective models for addressing health skill shortages, 50 models were selected for further study. Models were also identified from nominations by key health sector stakeholders. Selected models represent diversity in terms of the nature of skill shortage addressed, barriers overcome in developing the model, health care specialisations, and customer groups.

Principal Findings
Rural and remote areas have become home to a set of innovative service delivery models. Models identified encompass local, regional and state/national responses. Local responses are usually single health service-training provider partnerships. Regional responses, the most numerous, tend to have a specific focus, such as training young people. A small number of holistic state or national responses, eg the skills ecosystem approach, address multiple barriers to health service provision. Typical barriers include unwillingness to risk-take, stakeholder differences, and entrenched workplace cultures. Enhancers include stakeholder commitment, community acceptance, and cultural fit.

Discussion
Of particular interest is increasing numbers of therapy assistants to help address shortages of allied health professionals, and work to formalise their training, and develop standards of practice and policy. Other models likely to help address skill shortage amongst VET health workers focus on recruiting, supporting and training employees from a range of disadvantaged target groups, and on providing career paths with opportunities for staff to expand their skills. Such models are underpinned by nationally recognised qualifications, but each solution is targeted to a particular context in terms of the potential workforce and local need.

Levy grant training scheme evolution : focus on Fiji and Singapore

This thesis examines the evolution of national training policy in Fiji since 1973 with a particular emphasis on the national levy-grant scheme that was introduced in Fiji in that same year. Developments in the Fiji National Training Council (FNTC) levy-grants scheme since its inception, including substantive amendments to the legislation in late 2002, form part of the scholarship. The thesis will provide an analytical narration of the training policy objectives and their transformation over a time span of almost three decades in the context of a small island nation. To inform this study, it was considered essential to compare the Fiji experience of levy grants schemes with other levy grants scheme. The author decided to use as the focal comparative benchmark the case of the Skills Development Fund (SDF) in Singapore. The SDF has been increasingly portrayed, by the World Bank, the International Labour Organisation and other influential agencies, as the best practice case when it comes to managing a training levy grants scheme. The thesis adopted a qualitative approach that utilized elements of case study, historical research, and key person interviews. The challenges of doing 'insider* research were explored because of its pertinence to the study. Because the study also involved the comparison of the policy experiences of two distinct countries, it was imperative to consider the issues and challenges of undertaking comparative research with particular reference to training matters- Given that training is often enmeshed with other human resources management issues, cognisance was taken of some of the broader debates in this regard. Following consideration of the methodological issues, the research paper explores the objectives of national training strategies and, in particular, issues relating to national competitiveness and skills development. The purpose is to situate the issue of training and skills development within the broader discourse of national development. Alternative approaches to the strategic role of training are considered both at the national and organisational level and some of the classic and current debates surrounding human capital investment are visited. The thesis then proceeds to examine the forms of, and rationale for government interventions in the area of training. One of the challenges both in practice and theoretically is to arrive at a consensual definition of training because of the constantly evolving context and boundaries in which training policies are fashioned. This provides the setting to examine the role that governments can and do play in skills development and how levy-grant schemes, in particular, contribute to the process. Three forms of levy grants schemes are identified and examined: levy-generating; levy-exemption; and levy-grant and reimbursement schemes. The levy-grant and reimbursement variant is the basic thrust of this thesis. In this regard, the UK experience with the levy-grant system from 1964 to 1981 is also reviewed. Some of the issues in relation to training levies are scrutinized including the levy as a sheltered source of training finance, levy rates, duration of levy, impact of levy on the quality and quantity of training, benefits to small businesses, links between training and strategic business objectives, repackaging of training to qualify for grants, and the process by which training levy policies are devised. In looking at the policy formulation, it was necessary to unpack the processes involved and explore the role of the state further. In relation to policy development and implementation, the consultation processes, role of bureaucrats, the policy context, and approaches to policy transfer are examined. In looking at the role of the state in policy development, the alternative roles of government are explored and the concepts of the 'developmental state' and the 'corporatist state* evaluated. The notion of the developmental state has particular relevance to this study given the emphasis placed by the Singaporean government on human resource development policies. This sets the scene for a detailed examination of the role of levy-grant training schemes in Fiji and Singapore. The Skills Development Fund in Singapore was developed as an integral component of national economic policy when the Singaporean government decided to break out of the 'low-skills' trap and move the economy towards a higher value adding structure. The levy-grant system was designed to complement the strategy by focusing on upgrading the skills of employees on lower incomes, the assumption being that employees on lower remuneration were more likely to need skills upgrading. The study notes that the early objectives of the SDF were displaced when it was revealed that the bulk of SDF expenditure was directed at higher level supervisory and management training. As a result, the SDF had to refocus its activities on small and medium enterprises and the workers who were likely to miss out on formal training opportunities. The Singaporean context also shows trade unions playing a significant role in worker education and literacy programmes financed under the SDF. To understand this requires some understanding of the historical linkages between the present Singaporean government and trade union leadership. Another aspect of the development of the SDF has been the constant shifting of the institutional responsibility for the scheme. As late as September 2003, the SDF was again moved, this time to the newly created Singapore Workforce Development Agency, with the focus turning to lifelong learning and assisting Singaporeans who are unemployed or made redundant as a result of the economic restructuring. The Fiji experience with the FNTC scheme is different. It evolved in the context of perceived skills shortages but there was a degree of ambiguity over its objectives. There were no specific linkages with economic policy. Relationships with other public training institutions and more recently, private training providers, have been fraught with difficulties. The study examines the origins of the policy, the early difficulties including perceived employer grievances, and the numerous external assessments of the Fiji levy-grant scheme noting that some of them were highly critical. The thesis also examines an attempted reform of the scheme in 1992-93 that proved unsuccessful and the more recent legislative reforms to the scheme in 2002 that have expanded the role of the scheme to encompass, inter alia, national occupational standards and accreditation activities. The thesis concludes by comparing the two schemes noting that the SDF is well entrenched as a policy instrument in Singapore whilst the FNTC is facing a struggle to assert its legitimacy in Fiji.

Investigation into the diffusion of innovation in technical and further education : implementing e-mail through action research

This research project examined the diffusion of change within one Victorian TAFE Institute by engaging action research to facilitate implementation of e-mail technology. The theoretical framework involving the concepts of technology innovation and action research was enhanced with the aid of Rogers's (1983) model of the diffusion of the innovation process. Political and cultural factors made up the initiation phase of innovation, enabling the research to concentrate on the implementation phase of e-mail Roger's (1983) model also provided adopter categories that related to the findings of a Computer Attitude Survey that was conducted at The School of Mines and Industries Ballarat (SMB), now the University of Ballarat—TAFE Division since amalgamation on 1st January 1998. Despite management rhetoric about the need to utilise e-mail, Institute teaching staff lacked individual computers in their work areas and most were waiting to become connected to the Internet as late as 1997. According to the action research reports, many staff were resistant to the new e-mail facilities despite having access to personal computers whose numbers doubled annually. The action research project became focussed when action researchers realised that e-mail workshop training was ineffective and that staff required improved access. Improvement to processes within education through collaborative action research had earlier been achieved (McTaggart 1994), and this project actively engaged practitioners to facilitate decentralised e-mail training in the workplace through the action research spiral of planning, acting, observing and reflecting, before replanning. The action researchers * task was to find ways to improve the diffusion of e-mail throughout the Institute and to develop theoretical constructs. My research task was to determine whether action research could successfully facilitate e-mail throughout the Institute. A rich literature existed about technology use in education, technology teaching, gender issues, less about computerphobia, and none about 'e-mailphobia \ It seemed appropriate to pursue the issue of e-mailphobia since it was marginalised, or ignored in the literature. The major political and cultural influences on the technologising of SMB and e-mail introduction were complex, making it impossible to ascertain the relative degrees of influence held by Federal and State Governments, SMB's leadership or the local community, Nonetheless, with the implementation of e-mail, traditional ways were challenged as SMB's culture changed. E-mail training was identified as a staff professional development activity that had been largely unsuccessful. Action research is critical collaborative inquiry by reflective practitioners who are accountable for making the results of their inquiry public and who are self-evaluating of their practice while engaging participative problem-solving and continuing professional development (Zuber-Skerritt 1992, 1993). Action research was the methodology employed in researching e-mail implementation into SMB because it involved collaborative inquiry with colleagues as reflective practitioners. Thoughtful questions could best be explored using deconstructivist philosophy, in asking about the noise of silence, which issues were not addressed, what were the contradictions and who was being marginalised with e-mail usage within SMB. Reviewing literature on action research was complicated by its broad definition and by the variability of research (King & Lonnquist 1992), and yet action research as a research methodology was well represented in educational research literature, and provided a systematic and recognisable way for practitioners to conduct their research. On the basis of this study, it could be stated that action research facilitated the diffusion of e-mail technology into one TAFE Institute, despite the process being disappointingly slow. While the process in establishing the action research group was problematic, action researchers showed that a window of opportunity existed for decentralised diffusion of e-mail training,in preference to bureaucratically motivated 'workshops. Eight major findings, grouped under two broad headings were identified: the process of diffusion (planning, nature of the process, culture, politics) and outcomes of diffusion (categorising, e-mailphobia, the survey device and technology in education). The findings indicated that staff had little experience with e-mail and appeared not to recognise its benefits. While 54.1% did not agree that electronic means could be the preferred way to receive Institute memost some 13.7% admitted to problems with using the voice answering service on telephones. Some 43.3% thought e-mail would not improve their connectedness (how they related) to the Institute. A small percentage of staff had trouble with telephone voice-mail and a number of these were anxious computer users. Individualised tuition and peer support proved helpful to individual staff whom action researchers believed to be 'at risk', as determined from the results of a Computer Attitude Survey. An instructional strategy that fostered the development of self-regulation and peer support was valuable, but there was no measure of the effects of this action research program, other than in qualitative terms. Nevertheless, action research gave space to reflect on the nature of the underlying processes in adopting e-mail. Challenges faced by TAFE action researchers are integrally affected by the values within TAFE, which change constantly and have recently been extensive enough to be considered as a 'new paradigm'. The influence of competition policy, the training reform agenda and technologisation of training have challenged traditional TAFE values. Action research reported that many staff had little immediate professional reason to use e-mail Theoretical answers were submerged beneath practical professional concerns, which related back to how much time teachers had and whether they could benefit from e-mail. A need for the development of principles for the sound educational uses of e-mail increases with the internationalisation of education and an increasing awareness of cultural differences. The implications for conducting action research in TAFE are addressed under the two broad issues of power and pedagogy. Issues of power included gaining access, management's inability to overcome staff resistance to technology, changing TAFE values and using technology for conducting action research. Pedagogical issues included the recognition of educational above technological issues and training staff in action research. Finally, seventeen steps are suggested to overcome power and pedagogical impediments to the conduct of action research within TAFE. This action research project has provided greater insight into the difficulties of successfully introducing one culture-specific technology into one TAFE Institute. TAFE Institutes need to encourage more action research into their operations, and it is only then that -we can expect to answer the unanswered questions raised in this research project.

Older adults' neuromuscular adaptations to resistence training and effects on challenging gait tasks

Community locomotion is threatened when older individuals are required to negotiate obstacles, which place considerable stress on the musculoskeletal system. The vulnerability of older adults during challenging locomotor tasks is further compromised by age-related strength decline and muscle atrophy. The first study in this investigation determined the relationship between the major muscle groups of the lower body and challenging locomotor tasks commonly found in the community environment of older adults. Twenty-nine females and sixteen males aged between 62 and 88 years old (68.2 ±6.5) were tested for the maximal voluntary contraction (MVC) strength of the knee extensors and 1-RM for the hip extensors, flexors, adductors, abductors, knee extensors and flexors and ankle plantar flexors. Temporal measurements of an obstacle course comprising four gait tasks set at three challenging levels were taken. The relationship between strength and the obstacle course dependent measures was explored using linear regression models. Significant associations (p≤0.05) between all the strength measures and the gait performances were found. The correlation values between strength and obstructed gait (r = 0.356-0.554) and the percentage of the variance explained by strength (R2 = 13%-31%), increased as a function of the challenging levels, especially for the stepping over and on and off conditions. While the difficulty of community older adults to negotiate obstacles cannot be attributed to a single causal pathway, the findings of the first study showed that strength is a critical requirement. That the magnitude of the association increased as a function of the challenging levels, suggests that interventions aimed at improving strength would potentially be effective in helping community older adults to negotiate environmental gait challenges. In view of the findings of the first study, a second investigation determined the effectiveness of a progressive resistance-training program on obstructed gait tasks measured under specific laboratory conditions and on an obstacle course mimicking a number of environmental challenges. The time courses of strength gains and neuromuscular mechanisms underpinning the exercise-induced strength improvements in community-dwelling older adults were also investigated. The obstructed gait conditions included stepping over an obstacle, on and off a raised surface, across an obstacle and foot targeting. Forty-three community-living adults with a mean age of 68 years (control =14 and experimental=29) completed a 24-week progressive resistance training program designed to improve strength and induce hypertrophy in the major muscles of the lower body. Specific laboratory gait kinetics and kinematics and temporal measures taken on the obstacle course were measured. Lean tissue mass and muscle activation of the lower body muscle groups were assessed. The MVC strength of the knee extensors and 1-RM of the hip extension, hip flexion, knee extension, knee flexion and ankle plantar flexion were measured. A 25% increase on the MVC of the knee extensors (p≤0.05) was reported in the training group. Gains ranging between 197% and 285% were recorded for the 1-RM exercises in the trained subjects with significant improvements found throughout the study (p≤0.05). The exercise-induced strength gains were mediated by hypertrophic and neural factors as shown by 8.7% and 27.7% increases (p≤0.05) in lean tissue mass and integrated electromyographic activity, respectively. Strength gains were accompanied by increases in crossing velocity, stride length and reductions in stride duration, stance and swing time for all gait tasks except for the foot targeting condition. Specific kinematic variables associated with safe obstacle traverse such as vertical obstacle heel clearance, limb flexion, horizontal foot placements prior to and at post obstacle crossing and landing velocities resulted in an improved crossing strategy in the experimental subjects. Significant increases in the vertical and anterior-posterior ground reaction forces accompanied the changes in the gait variables. While further long-term prospective studies of falls rates would be needed to confirm the benefits of lower limb enhanced strength, the findings of the present study provide conclusive evidence of significant improvements to gait efficiency associated with a systematic resistance-training program. It appears, however, that enhanced lower body strength has limited effects on gait tasks involving a dynamic balance component. In addition, due to the larger strength-induced increases in voluntary activation of the leg muscle compared to relatively smaller gains in lean tissue mass, neural adaptations appear to play a greater contributing role in explaining strength gains during the current resistance training protocol.

User-centered evaluation of a virtual environment training system : utility of user perception measures

This study assessed the utility of measures of Self-efficacy (SelfEfficacy) and Perceived VE efficacy (PVEefficacy) for quantifying how effective VEs are in procedural task training. SelfEfficacy and PVEefficacy have been identified as affective construct potentially underlying VE efficacy that is not evident from user task performance. The motivation for this study is to establish subjective measures of VE efficacy and investigate the relationship between PVEefficacy, SelfEfficacy and User task performance. Results demonstrated different levels of prior experience in manipulating 3D objects in gaming or computer environment (LOE3D) effects on task performance and user perception of VE efficacy. Regression analysis revealed LOE3D, SelfEfficacy,
PVEefficacy explain significant portions of the variance in VE efficacy. Results of the study provide further evidence that task performance may share relationships with PVEefficacy and SelfEfficacy, and that affective constructs, such as PVEefficacy, and SelfEfficacy may serve as alternative, subjective measures of task performance that account for VE efficacy.

Relationship between inflammatory cytokines and self-report measures of training overload

It has been purported that inflammatory cytokines may be responsible for the aetiology of overtraining. The aim of the present study was to investigate the relationship between self-reported measures of overtraining and inflammatory cytokines. Eight elite male rowers were monitored in their natural training environment for 8 weeks prior to the 2007 Rowing World Championships. During this period of intense endurance training, self-report measures of overtraining and inflammatory cytokines (Interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12p70, and Tumor Necrosis Factor (TNF)-) were assessed fortnightly. Consistent with previous findings, proinflammatory cytokines IL-1β and TNF- were significantly associated (p ≤ 0.05) with measures of depressed mood, sleep disturbances, and stress. Similarly, IL-6 was significantly associated (p ≤ 0.01) with measures of depressed mood, sleep disturbances, and fatigue. These results are consistent with previous hypotheses describing how overtraining may be caused by excessive cytokine release, and lend further support for a cytokine hypothesis of overtraining.

Impact of training on changes in perceived stress and cytokine production

Data on training of competitive athletes and the inflammatory response, and, more specifically, the utility of psychological inventories to monitor this response in regards to overreaching is limited. The aim of the present study was to investigate the association of the Perceived Stress Scale (PSS) and inflammatory markers in elite rowers. Eight rowers (males n = 4; females n = 4) were monitored over an 8-week training period, comprising 12 sessions each week and training an average 3.11 h·d-1. Training volume was periodized weekly while intensity was maintained throughout the study. Perceived stress was measured weekly pretraining, and capillary blood samples (500 μL) were taken post-training. Significant associations between perceived stress and cytokines interleukin-6 (p < .05) and tumor necrosis factor alpha (p < .05) were observed. While further investigation of the role of cytokines in the overtraining process is required, these data provide preliminary support for an association between perceived stress and the inflammatory responses to training.

The Alcohol Intervention Training Program (AITP) : a response to alcohol misuse in the farming community

Background
Farm men and women in Australia have higher levels of problematic alcohol use than their urban counterparts and experience elevated health risks associated with excessive alcohol consumption. The Sustainable Farm Families (SFF) program has worked successfully with farm men and women to address health, well- being and safety and has identified that further research and training is required to understand and address alcohol misuse behaviours. This project will add an innovative component to the program by training health professionals working with farm men and women to discuss and respond to alcohol-related physical and mental health problems.

Methods/Design
A mixed method design with multi-level evaluation will be implemented following the development and delivery of a training program (The Alcohol Intervention Training Program {AITP}) for Sustainable Farm Families health professionals. Pre-, post- and follow-up surveys will be used to assess both the impact of the training on the knowledge, confidence and skills of the health professionals to work with alcohol misuse and associated problems, and the impact of the training on the attitudes, behaviour and mental health of farm men and women who participate in the SFF project. Evaluations will take a range of forms including self-rated outcome measures and interviews.

Discussion
The success of this project will enhance the health and well-being of a critical population, the farm men and women of Australia, by producing an evidence-based strategy to assist them to adopt more positive alcohol-related behaviours that will lead to better physical and mental health.

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.

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.

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.