The YOU CALL-WE CALL randomized clinical trial: Impact of a multimodal support intervention after a mild stroke

Background Comparison of a multimodal intervention WE CALL (study initiated phone support/information provision) versus a passive intervention YOU CALL (participant can contact a resource person) in individuals with first mild stroke. Methods and Results This study is a single-blinded randomized clinical trial. Primary outcome includes unplanned use of health services (participant diaries) for adverse events and quality of life (Euroquol-5D, Quality of Life Index). Secondary outcomes include planned use of health services (diaries), mood (Beck Depression Inventory II), and participation (Assessment of Life Habits [LIFE-H]). Blind assessments were done at baseline, 6, and 12 months. A mixed model approach for statistical analysis on an intention-to-treat basis was used where the group factor was intervention type and occasion factor time, with a significance level of 0.01. We enrolled 186 patients (WE=92; YOU=94) with a mean age of 62.5±12.5 years, and 42.5% were women. No significant differences were seen between groups at 6 months for any outcomes with both groups improving from baseline on all measures (effect sizes ranged from 0.25 to 0.7). The only significant change for both groups from 6 months to 1 year (n=139) was in the social domains of the LIFE-H (increment in score, 0.4/9±1.3 [95% confidence interval, 0.1–0.7]; effect size, 0.3). Qualitatively, the WE CALL intervention was perceived as reassuring, increased insight, and problem solving while decreasing anxiety. Only 6 of 94 (6.4%) YOU CALL participants availed themselves of the intervention. Conclusions Although the 2 groups improved equally over time, WE CALL intervention was perceived as helpful, whereas YOU CALL intervention was not used.

Study protocol of the YOU CALL - WE CALL TRIAL: Impact of a multimodal support intervention after a "mild" stroke

Background More than 60% of new strokes each year are "mild" in severity and this proportion is expected to rise in the years to come. Within our current health care system those with "mild" stroke are typically discharged home within days, without further referral to health or rehabilitation services other than advice to see their family physician. Those with mild stroke often have limited access to support from health professionals with stroke-specific knowledge who would typically provide critical information on topics such as secondary stroke prevention, community reintegration, medication counselling and problem solving with regard to specific concerns that arise. Isolation and lack of knowledge may lead to a worsening of health problems including stroke recurrence and unnecessary and costly health care utilization. The purpose of this study is to assess the effectiveness, for individuals who experience a first "mild" stroke, of a sustainable, low cost, multimodal support intervention (comprising information, education and telephone support) - "WE CALL" compared to a passive intervention (providing the name and phone number of a resource person available if they feel the need to) - "YOU CALL", on two primary outcomes: unplanned-use of health services for negative events and quality of life. Method/Design We will recruit 384 adults who meet inclusion criteria for a first mild stroke across six Canadian sites. Baseline measures will be taken within the first month after stroke onset. Participants will be stratified according to comorbidity level and randomised to one of two groups: YOU CALL or WE CALL. Both interventions will be offered over a six months period. Primary outcomes include unplanned use of heath services for negative event (frequency calendar) and quality of life (EQ-5D and Quality of Life Index). Secondary outcomes include participation level (LIFE-H), depression (Beck Depression Inventory II) and use of health services for health promotion or prevention (frequency calendar). Blind assessors will gather data at mid-intervention, end of intervention and one year follow up. Discussion If effective, this multimodal intervention could be delivered in both urban and rural environments. For example, existing infrastructure such as regional stroke centers and existing secondary stroke prevention clinics, make this intervention, if effective, deliverable and sustainable.

The future of roads: How road agencies are facing a conflicted future

Although road construction and use provides significant economic and social benefits, its environmental impact is of growing concern. Roads are one of the greatest greenhouse gas contributors, both directly through fossil energy consumed in mining, transporting, earthworks and paving work, and through the emissions from road use by vehicles. Further,according to the Australian Government, when combined with expected population growth and internal migration,expected changes in temperature and rainfall are expected to increase road maintenance costs. This discussion paper will outline opportunities within the Australian context for reducing environmental and carbon pressure from road building, and provide a framework for considering the potential pressures that will affect the resilience of roads to the impacts of climate change and oil vulnerability.

Understanding the performance of green commercial buildings: a Sustainable Built Environment National Research Centre (SBEnrc) briefing report

Efforts to reduce carbon emissions in the buildings sector have been focused on encouraging green design, construction and building operation; however, the business case is not very compelling if considering the energy cost savings alone. In recent years green building has been driven by a sense that it will improve the productivity of occupants,something with much greater economic returns than energy savings. Reducing energy demand in green commercial buildings in a way that encourages greater productivity is not yet well understood as it involves a set of complex and interdependent factors. This project investigates these factors and focuses on the performance of and interaction between: green design elements, internal environmental quality, occupant experience, tenant/leasing agreements, and building regulation and management. This paper suggests six areas of strategic research that are needed to understand how conditions can be created to support productivity in green buildings, and deliver significant energy consumption reductions.

The future of roads: Reducing environmental pressures and the management of carbon

Although road construction and use provides significant economic and social benefits, its environmental impact is of growing concern. Roads are one of the greatest greenhouse gas contributors, both directly through fossil energy consumed in mining, transporting, earthworks and paving work, plus the emissions from road use by vehicles. Further, according to the Australian Government, when combined with forecast population growth, internal migration and changes in temperature and rainfall, these are expected to increase road maintenance costs. This discussion paper outlines opportunities within the Australian context for reducing environmental and carbon pressure from road building, and provides a framework for considering the potential future pressures that will affect the resilience of roads to the impacts of climate change and oil vulnerability. Seven strategic areas are outlined for further investigation, including a guide to carbon management for road agencies covering planning, funding, procurement, delivery and maintenance of roads.

Reducing the environmental impact of road construction

The practice of road construction and maintenance is inherently lean and efficient; a result of the economic benefits that are gained by minimizing wasted resources. In this age of conservation and environmental management, the inbuilt sustainability of existing road construction practices is being developed and extended to produce variety of environmentally sustainable options. A new concept of a “sustainable road” has emerged through both academia and industry, and is defined to be a road that is: - constructed to reduce environmental impacts; - designed to optimise the alignment (vertical and horizontal including considerations of ecological constraints and operational use by vehicles); - resilient to future environmental and economic pressures (e.g. climate change and resource scarcity); - adaptable to changing uses including increased travel volumes, greater demand for public and active (cycling and walking) transport, and; - able to harvest the energy to power itself.

Scenario planning and emerging global trends for the future of roads and automobile transport

Roads and road infrastructure will be faced with multiple challenges over the coming decades – challenges that in many ways bear little resemblance to those previously faced - and as such will require new approaches. The opportunity exists to transform the way road infrastructure is conceived and constructed, as a key part of the process of assisting society to respond to climate change and reduce other environmental pressures. Innovations in road construction, use and management in order to manage these changes can now be seen. Scenario planning is one tool that can take into account emerging challenges, develop or adopt new approaches, and thus help this transformation to occur. The paper explores scenario planning methodologies, global innovations and trends in road construction and maintenance and the findings from stakeholder workshops in Brisbane and Perth. It highlights key opportunities for road agencies to use scenarios to enable planning that, in the face of future uncertainties, facilitates appropriate responses.

How will the future of roads be navigated?

In the coming decades the design, construction and maintenance of roads will face a range of new challenges - that in many ways will bear little resemblance to the challenges previously faced - and as such will require a number of new approaches. Such challenges will result from a growing number of interconnected environmental, social and economic factors, which are set to apply significant pressure on the future of roads. For instance, environmental pressures will include the impacts of climate change on rainfall patterns and temperature profiles; economic pressure will be affected by shifting global economic balances and flows, and will include materials and resources shortages, along with predicted increases in energy and resource prices globally,i and social pressures will include potential shifts to lighter vehicles, reduced use of cars due to higher fuel costs, and political pressure to respond to climate change.

The reach and rationale for community health fairs

Latinos living in the USA account for one third of the uninsured population and face numerous cultural, linguistic, and financial barriers to accessing healthcare services. Community health fairs have developed to address the unmet need for no- and low-cost services that target prevention and education among underserved communities. The current research describes an ongoing effort in a community in Southern California and examines the barriers to health care among participants registering to receive free breast health screenings, one of the major services offered at a 2010 health fair. A total of 186 adult Latina women completed a brief questionnaire assessing their healthcare utilization and self-reported barriers to engaging in preventive and screening services. Approximately two thirds of the participants reported never receiving or having more than 2 years passing since receiving a preventive health check-up. Participants identified cost (64.5 %) and knowledge of locations for services (52.3 %) as the primary barriers to engaging in routine healthcare services. Engaging with health professionals represents a leading way in which adults obtain health information; health fairs offering cancer health screenings represent a culturally appropriate venue for increased cancer health equity. Implications of the current research for future health fairs and their role in community cancer education are discussed.

Key opportunities for the future of roads to contribute to Australia's climate change response

Road agencies face growing pressure to respond to a range of issues associated with climate change and the reliance on fossil fuels. A key part of this response will be to reduce the dependency on fossil fuel based energy (and the associated greenhouse gas emissions) of transport, both vehicles and infrastructure. This paper presents findings of investigations into three key areas of innovative technologies and processes, namely the inclusion of onsite renewable energy generation technologies as part of road and transport infrastructure, the potential for automated motorways to reduce traffic fuel consumption (referred to as 'Smart Roads'), and the reduction of energy demand from route and signal lighting. The paper then concludes with the recommendation for the engineering profession to embrace sustainability performance assessment and rating tools as the basis for enhancing and communicating the contribution to Australia's response to climate change. Such tools provide a rigorous structure that can standardise approaches to key issues across entire sectors and provide clarity on the evidence required to demonstrate leading performance. The paper has been developed with funding and support provided by Australia's Sustainable Built Environment National Research Centre (SBEnrc), working with partners including Main Roads Western Australia, NSW Roads and Maritime Services, Queensland Department of Transport and Main Roads, John Holland Group, the Infrastructure Sustainability Council of Australia, Roads Australia, and the CRC for Low Carbon Living.

Ecologies of housing and underlying assumptions of vulnerability

Purpose This paper is informed by a study that aimed to understand the difficulties in implementing models of housing, and to help address the lack of accessible and affordable private housing for people with disability in Australia. In responding to this aim, the study formulated an ecological map of housing models, which are examined in this paper in terms of their underlying assumptions of vulnerability. Design/methodology/approach The study involved explanation building, using a multiple case study approach, informed theoretically by an ecological framework. It included organisations, families and individuals with disability. Findings For the purpose of this paper, the study revealed a direct relationship between the nature of the housing models proposed, and assumptions of vulnerability. In the context of the study findings, the paper suggests that attempts to address individual housing needs are more likely to achieve a positive outcome when they are person driven, from a premise of ability rather than disability. Overall, it invites a ‘universalistic’ way of conceptualising housing issues for people with disability that has international relevance. Practical implications This paper highlights how assumptions of vulnerability shape environmental responses, such as housing, for people with disability. Originality/value This paper is based on a study that reconciled a person-centred philosophy with an ecological appreciation of the external and internal factors impacting housing choice for people with disability.

Genome-wide meta-analysis identifies 56 bone mineral density loci and reveals 14 loci associated with risk of fracture

Bone mineral density (BMD) is the most widely used predictor of fracture risk. We performed the largest meta-analysis to date on lumbar spine and femoral neck BMD, including 17 genome-wide association studies and 32,961 individuals of European and east Asian ancestry. We tested the top BMD-associated markers for replication in 50,933 independent subjects and for association with risk of low-trauma fracture in 31,016 individuals with a history of fracture (cases) and 102,444 controls. We identified 56 loci (32 new) associated with BMD at genome-wide significance (P < 5 × 10−8). Several of these factors cluster within the RANK-RANKL-OPG, mesenchymal stem cell differentiation, endochondral ossification and Wnt signaling pathways. However, we also discovered loci that were localized to genes not known to have a role in bone biology. Fourteen BMD-associated loci were also associated with fracture risk (P < 5 × 10−4, Bonferroni corrected), of which six reached P < 5 × 10−8, including at 18p11.21 (FAM210A), 7q21.3 (SLC25A13), 11q13.2 (LRP5), 4q22.1 (MEPE), 2p16.2 (SPTBN1) and 10q21.1 (DKK1). These findings shed light on the genetic architecture and pathophysiological mechanisms underlying BMD variation and fracture susceptibility.

Sizable photocurrent and emission from solid state devices based on CdS nanoparticles

CdS nanoparticles exhibit size dependent optical and electrical properties. We report here the photocurrent and I-V characteristic studies of CdS nanoparticle devices. A sizable short circuit photocurrent was observed in the detection range governed by the size of the clusters. We speculate on the mechanisms leading to the photocurrent and emission in these nanometer scale systems.

eResearch Archive: reaching global agricultural communities

Queensland Department of Primary Industries and Fisheries Library achieved a significant breakthrough in the provision of Open Access to Australian publicly funded research with the launch of its eResearch Archive (eRA). With more than one thousand publication records, journal articles, conferences papers and research reports now available to farmers, industry representatives, academics, researchers, students and members of the public throughout the world, the archive is the first web accessible multidisciplinary science institutional repository produced by an Australian government department.

Biodiversity condition assessment for grazing lands

Using the ABCD Framework as a aurrogate for biodiversity condition.