Effects of type 2 diabetes behavioural telehealth interventions on glycaemic control and adherence : a systematic review

We reviewed the effect of behavioural telehealth interventions on glycaemic control and diabetes self-management in patients with type 2 diabetes. The databases CINAHL, Medline and psychINFO were searched in August 2012. Journal articles were selected that had been published in English with a randomized controlled trial design using a usual care comparison group, and in which the primary intervention component was delivered by telehealth. Relevant outcome measures were glycaemic control and one or more of the following diabetes self-care areas: diet, physical activity, blood glucose self-monitoring (BGSM) or medication adherence. Interventions were excluded if they were primarily based on telemonitoring. The search retrieved 1027 articles, from which 49 were selected based on their title and abstract. Fourteen articles (reporting 13 studies) met the eligibility criteria for inclusion. Four studies reported significant improvements in glycaemic control. Five of eight studies on dietary adherence reported significant treatment effects, as did five of eight on physical activity, four of nine on blood glucose self-monitoring, and three of eight on medication adherence. Overall, behavioural telehealth interventions show promise in improving the diabetes self-care and glycaemic control of people with type 2 diabetes.

Adams-Type Methods for the Numerical Solution of Stochastic Ordinary Differential Equations

Stochastic differential equations (SDEs) arise fi om physical systems where the parameters describing the system can only be estimated or are subject to noise. There has been much work done recently on developing numerical methods for solving SDEs. This paper will focus on stability issues and variable stepsize implementation techniques for numerically solving SDEs effectively. (C) 2000 Elsevier Science B.V. All rights reserved.

Cement-in-cement revision for selected Vancouver Type B1 femoral periprosthetic fractures : A biomechanical analysis

The aim of this study was to perform a biomechanical analysis of the cement-in-cement (c-in-c) technique for fixation of selected Vancouver Type B1 femoral periprosthetic fractures and to assess the degree of cement interposition at the fracture site. Six embalmed cadaveric femora were implanted with a cemented femoral stem. Vancouver Type B1 fractures were created by applying a combined axial and rotational load to failure. The femora were repaired using the c-in-c technique and reloaded to failure. The mean primary fracture torque was 117 Nm (SD 16.6, range 89–133). The mean revision fracture torque was 50 Nm (SD 16.6, range 29–74), which is above the torque previously observed for activities of daily living. Cement interposition at the fracture site was found to be minimal.

ACE research vignette 024 : New firm formation and job creation by type of firm an type of region.

This series of research vignettes is aimed at sharing current and interesting research findings from our team of international Entrepreneurship researchers. This vignette, written by Mr. Darren Kavanagh and Professor Per Davidsson, takes a closer look at job creation by new firms.

Does experience with one type of two-wheeler affect behaviours and attitudes to other types?

Failure to give way by motor vehicles is a factor in many collisions with both powered and unpowered two wheelers (TWs). Motor vehicle drivers often report that they did not see the TW, but research has shown that motor vehicle drivers who have experience riding a motorcycle are less likely to fail to detect motorcycles. The research reported here examines whether this phenomenon extends to detection of bicycles and whether car drivers who have experience with one mode of TW show improved detection of the other mode. A driving simulator study was conducted in an Australian urban setting which incorporated some of the most common car-TW crash scenarios. Participants with car-only, car plus motorcycle, car plus bicycle, and car plus bicycle plus motorcycle experience operated a car simulator. Their interactions with both types of TWs were measured in terms of visual detection, lateral distance and speed when approaching and passing. The effects of different levels of colour and lighting of the TWs on driver responses were also examined. The attitudes of participants towards TWs were measured in a questionnaire.

Perceived barriers to healthy lifestyle activities in midlife and older Australian women with type 2 diabetes

Purpose: Type 2 diabetes is a leading cause of morbidity and mortality in midlife and older Australian women with known modifiable risk factors for type 2 diabetes including smoking, nutrition, physical activity and obesity. In Australia little research has been done to investigate the perceived barriers to healthy lifestyle activities in midlife and older women with type 2 diabetes. The primary aim of this study was to explore the level and type of perceived barriers to health promotion activities. The secondary aim was to explore the relationship of perceived barriers to smoking behaviour, fruit and vegetable intake, physical activity, and body mass index. Methods: The study was a cross sectional survey of women, aged over 45 with type 2 diabetes, attending metropolitan community health clinics (N = 41). Data was collected from self-report questionnaire and analysed using descriptive and inferential statistics. Results: Women in the study had average total barriers scores similar to those reported in the literature for women with a range of physical disabilities and illnesses. The leading barriers for this group of women were: lack of interest, concern about safety, too tired, lack of money and feeling what they do does not help. There was no association between total barriers scores and body mass index, physical activity, fruit and vegetable intake or socio-demographic variables. Conclusion: This study contributes to understanding the perceptions of midlife and older women with type 2 diabetes about the level and type of barriers to healthy lifestyle activities that they experience. Evidence from this study can be applied to inform health promotion for lifestyle risk factor reduction in women with type 2 diabetes.

Stress distribution of CFRP strengthened steel hollow sections under tension

Carbon fibre reinforced polymer (CFRP) sheets have many outstanding properties such as high strength, high elastic modulus, light weight and good durability which are made them a suitable alternative for steel in strengthening work. This paper describe the ultimate load carrying capacity of steel hollow sections at effective bond length in terms of its cross sectional area and the stress distribution within bond region for different layers CFRP. It was found that depending on their size and orientation of uni- directional CFRP layers, the ultimate tensile load was different. Along with these tests, non linear finite element analysis was also performed to validate the ultimate load carrying capacity depending on their cross sections. The predicted ultimate loads from FE analysis are found very close to the laboratory test results. The validated model has been used to determine the stress distribution at bond joint for different orientation of CFRP. This research shows the effect of stress distribution and suitable wrapping layer to be used for the strengthening of steel hollow sections in tension.

Bubble extinction in Hele-Shaw flow with surface tension and kinetic undercooling regularisation

We perform an analytic and numerical study of an inviscid contracting bubble in a two-dimensional Hele-Shaw cell, where the effects of both surface tension and kinetic undercooling on the moving bubble boundary are not neglected. In contrast to expanding bubbles, in which both boundary effects regularise the ill-posedness arising from the viscous (Saffman-Taylor) instability, we show that in contracting bubbles the two boundary effects are in competition, with surface tension stabilising the boundary, and kinetic undercooling destabilising it. This competition leads to interesting bifurcation behaviour in the asymptotic shape of the bubble in the limit it approaches extinction. In this limit, the boundary may tend to become either circular, or approach a line or "slit" of zero thickness, depending on the initial condition and the value of a nondimensional surface tension parameter. We show that over a critical range of surface tension values, both these asymptotic shapes are stable. In this regime there exists a third, unstable branch of limiting self-similar bubble shapes, with an asymptotic aspect ratio (dependent on the surface tension) between zero and one. We support our asymptotic analysis with a numerical scheme that utilises the applicability of complex variable theory to Hele-Shaw flow.

‘Working with the team’ : an exploratory study of improved type 2 diabetes management in a new model of integrated primary/secondary care

This study aimed to explore how a new model of integrated primary/secondary care for type 2 diabetes management, the Brisbane South Complex Diabetes Service (BSCDS), related to improved diabetes management in a selected group of patients. We used a qualitative research design to obtain detailed accounts from the BSCDS via semi-structured interviews with 10 patients. The interviews were fully transcribed and systematically coded using a form of thematic analysis. Participants’ responses were grouped in relation to: (1) Patient-centred care; (2) Effective multiprofessional teamwork; and (3) Empowering patients. The key features of this integrated primary/secondary care model were accessibility and its delivery within a positive health care environment, clear and supportive interpersonal communication between patients and health care providers, and patients seeing themselves as being part of the team-based care. The BSCDS delivered patient-centred care and achieved patient engagement in ways that may have contributed to improved type 2 diabetes management in these participants.

An investigation of factors influencing diabetes self-management among adults with type 2 diabetes in Vietnam

Background: In diabetes care, health care professionals need to provide support for their patients. In order to provide good diabetes self-management support for adults with type 2 diabetes in Vietnam, it is important that health care professionals in Vietnam understand the factors influencing diabetes self-management among these people. However, knowledge about factors influencing diabetes self-management among adults with type 2 diabetes in Vietnam is limited. Objectives: This study aimed to investigate factors influencing diabetes self-management among adults with type 2 diabetes in Vietnam. Methodology: A cross-sectional survey with convenience sampling was conducted on 198 adults with type 2 diabetes in VietnamData collection was administeted via interview. Descriptive statistics, simple correlation statistics and structural equation modelling statistics were used for data analysis. Results: Adults with type 2 diabetes in Vietnam had limited diabetes knowledge (Median = 6.0). The majority of the study participants (72.7%) believed that performing diabetes self-management activities was very important or extremely important for controlling their blood glucose levels and for preventing complications from diabetes; about half usually received support from their family and friends’ (48.5%), and around two thirds rarely received support from their health care providers (68.2%). Many of the participants (41.4%) had limited confidence to perform diabetes management activities. The practices of diabetes self-management were limited among the study population (Mean = 96.7, SD = 19.4). Diabetes knowledge (β = 0.17, p < .001), belief in treatment effectiveness (β = 0.13, p < .01), family and friends’ support (β = 0.13, p < .001), health care providers’ support (β = 0.27, p < .001) and diabetes management self-efficacy (β = 0.43, p < .001) directly influenced their diabetes self-management. Diabetes knowledge, and family and friends’ support also indirectly influenced diabetes self-management among these people through their belief in treatment effectiveness and their diabetes management self-efficacy (p < .05). Conclusion: Findings in this study indicated that health care professionals should provide diabetes self-management support for adults with type 2 diabetes in Vietnam in the future. The adapted theory-based model of factors influencing diabetes self-management among adults with type 2 diabetes in Vietnam found in this study could be a useful framework to develop this supporting program.

Write vs. type : tangible and situated media for situated engagement

Digital media is often criticised for being intangible, transient and ephemeral. These characteristics limit the provision of long-lasting social experiences, as it is through the use of all our senses that we attach meaning to space, creating a sense of place. This paper presents a comparative study of the affordances of two design interventions, one tangible paper-based, called Print + Talk = Love (PTL), the other digital screen-based, called Discussions in Space (DIS). The emphasis is on a) how tangible media, such as paper, provides different and meaningful collective experiences, and b) how it can stand on its own as an interactive design intervention and as a comprehensive data-gathering tool in urban public places. By positioning PTL and DIS within the context of urban public places and testing their abilities to engage participants, we examine their particular situated engagement abilities through a mixed method approach. As a result, the digital aspects of DIS, e.g., using Twitter, extend the situated experience beyond the actual location of the intervention. Moreover, informing a hybrid approach, we also found that the physical aspects of PTL and its tangible presence, kept the user experience focused on the actual place and event surrounding the intervention.

Functional analysis of missense variants in the TRESK (KCNK18) K+ channel

A loss of function mutation in the TRESK K2P potassium channel (KCNK18), has recently been linked with typical familial migraine with aura. We now report the functional characterisation of additional TRESK channel missense variants identified in unrelated patients. Several variants either had no apparent functional effect, or they caused a reduction in channel activity. However, the C110R variant was found to cause a complete loss of TRESK function, yet is present in both sporadic migraine and control cohorts, and no variation in KCNK18 copy number was found. Thus despite the previously identified association between loss of TRESK channel activity and migraine in a large multigenerational pedigree, this finding indicates that a single non-functional TRESK variant is not alone sufficient to cause typical migraine and highlights the genetic complexity of this disorder. Migraine is a common, disabling neurological disorder with a genetic, environmental and in some cases hormonal component. It is characterized by attacks of severe, usually unilateral and throbbing headache, can be accompanied by nausea, vomiting and photophobia and is clinically divided into two main subtypes, migraine with aura (MA) when a migraine is accompanied by transient and reversible focal neurological symptoms and migraine without aura (MO)1. The multifactorial and clinical heterogeneity of the disorder have considerably hindered the identification of common migraine susceptibility genes and most of our current understanding comes from the studies of familial hemiplegic migraine (FHM), a rare monogenic autosomal dominant form of MA2. So far, the three susceptibility genes that have been convincingly identified in FHM families all encode ion channels or transporters: CACNA1A encoding the α1 subunit of the Cav2.1 calcium channel3, SCN1A encoding the Nav1.1 sodium channel4 and ATP1A2 encoding the α2 subunit of the Na+/K+ pump5. It is believed that mutations in these genes may lead to increased efflux of glutamate and potassium in the synapse and thereby cause migraine by rendering the brain more susceptible to cortical spreading depression (CSD)6 which is thought to play a role in initiating a migraine attack7,8. However, these genes have not to date been implicated in common forms of migraine9. Nevertheless, current opinion suggests that typical migraine, like FHM, is also disorder of neuronal excitability, ion homeostasis and neurotransmitter release10,11,12. Mutations in the SLC4A4 gene encoding the sodium-bicarbonate cotransporter NBCe1, have recently been implicated in several different forms of migraine13, and a variety of genes involved in glutamate homeostasis (PGCP, MTDH14 and LRP115) and a cation channel (TRPM8)15 have also recently been implicated in migraine via genome-wide association studies. Ion channels are therefore highly likely to play an important role in the pathogenesis of typical migraine. TRESK (KCNK18), is a member of the two-pore domain (K2P) family of potassium channels involved in the control of cellular electrical excitability16. Regulation of TRESK activity by the calcium-dependent phosphatase calcineurin17, as well as its expression in dorsal root ganglia (DRG)18 and trigeminal ganglia (TG)19,20 has led to a proposed role for this channel in a variety of pain pathways. In a recent study, a frameshift mutation (F139Wfsx24) in TRESK was identified in a large multigenerational pedigree where it co-segregated perfectly with typical MA and a significant genome-wide linkage LOD score of 3.0. Furthermore, functional analysis revealed that this mutation caused a complete loss of TRESK function and that the truncated subunit was also capable of down regulating wild-type channel function. This therefore highlighted KCNK18 as potentially important candidate gene and suggested that TRESK dysfunction might play a possible role in the pathogenesis of familial migraine with visual aura20. Additional screening for KCNK18 mutations in unrelated sporadic migraine and control cohorts also identified a number of other missense variants; R10G, A34V, C110R, S231P and A233V20. The A233V variant was found only in the control cohort, whilst A34V was identified in a single Australian migraine proband for which family samples were not available, but it was not detected in controls. By contrast, the R10G, C110R, and S231P variants were found in both migraineurs and controls in both cohorts. In this study, we have investigated the functional effect of these variants to further probe the potential association of TRESK dysfunction with typical migraine.

Variants in the human potassium channel gene (KCNN3) are associated with migraine in a high risk genetic isolate

The calcium-activated potassium ion channel gene (KCNN3) is located in the vicinity of the familial hemiplegic migraine type 2 locus on chromosome 1q21.3. This gene is expressed in the central nervous system and plays a role in neural excitability. Previous association studies have provided some, although not conclusive, evidence for involvement of this gene in migraine susceptibility. To elucidate KCNN3 involvement in migraine, we performed gene-wide SNP genotyping in a high-risk genetic isolate from Norfolk Island, a population descended from a small number of eighteenth century Isle of Man ‘Bounty Mutineer’ and Tahitian founders. Phenotype information was available for 377 individuals who are related through the single, well-defined Norfolk pedigree (96 were affected: 64 MA, 32 MO). A total of 85 SNPs spanning the KCNN3 gene were genotyped in a sub-sample of 285 related individuals (76 affected), all core members of the extensive Norfolk Island ‘Bounty Mutineer’ genealogy. All genotyping was performed using the Illumina BeadArray platform. The analysis was performed using the statistical program SOLAR v4.0.6 assuming an additive model of allelic effect adjusted for the effects of age and sex. Haplotype analysis was undertaken using the program HAPLOVIEW v4.0. A total of four intronic SNPs in the KCNN3 gene displayed significant association (P < 0.05) with migraine. Two SNPs, rs73532286 and rs6426929, separated by approximately 0.1 kb, displayed complete LD (r 2 = 1.00, D′ = 1.00, D′ 95% CI = 0.96–1.00). In all cases, the minor allele led to a decrease in migraine risk (beta coefficient = 0.286–0.315), suggesting that common gene variants confer an increased risk of migraine in the Norfolk pedigree. This effect may be explained by founder effect in this genetic isolate. This study provides evidence for association of variants in the KCNN3 ion channel gene with migraine susceptibility in the Norfolk genetic isolate with the rarer allelic variants conferring a possible protective role. This the first comprehensive analysis of this potential candidate gene in migraine and also the first study that has utilised the unique Norfolk Island large pedigree isolate to implicate a specific migraine gene. Studies of additional variants in KCNN3 in the Norfolk pedigree are now required (e.g. polyglutamine variants) and further analyses in other population data sets are required to clarify the association of the KCNN3 gene and migraine risk in the general outbred population.