Exploring Retinal Markers of Diabetic Neuropathy

Purpose : To investigate the application of retinal nerve fibre layer (RNFL) thickness as a marker for severity of diabetic peripheral neuropathy (DPN) in people with Type 2 diabetes. Methods : This was a cross-sectional study whereby 61 participants (mean age 61 [41-75 years], mean duration of diabetes 14 [1-40 years], 70% male) with Type 2 diabetes and DPN underwent optical coherence tomography (OCT) scans. Global and 4 quadrant (TSNI) RNFL thicknesses were measured at 3.45mm around the optic nerve head of one eye. Neuropathy disability score (NDS) was used to assess the severity of DPN on a 0 to 10 scale. Participants were divided into three age-matched groups representing mild (NDS=3-5), moderate (NDS=6-8) and severe (NDS=9-10) neuropathy. Two regression models were fitted for statistical analysis: 1) NDS scores as co-variate for global and quadrant RNFL thicknesses, 2) NDS groups as a factor for global RNFL thickness only. Results : Mean (SD) RNFL thickness (µm) was 103(9) for mild neuropathy (n=34), 101(10) for moderate neuropathy (n=16) and 95(13) in the group with severe neuropathy (n=11). Global RNFL thickness and NDS scores were statistically significantly related (b=-1.20, p=0.048). When neuropathy was assessed across groups, a trend of thinner mean RNFL thickness was observed with increasing severity of neuropathy; however, this result was not statistically significant (F=2.86, p=0.065). TSNI quadrant analysis showed that mean RNFL thickness reduction in the inferior quadrant was 2.55 µm per 1 unit increase in NDS score (p=0.005). However, the regression coefficients were not statistically significant for RNFL thickness in the superior (b=-1.0, p=0.271), temporal (b=-0.90, p=0.238) and nasal (b=-0.99, p=0.205) quadrants. Conclusions : RNFL thickness was reduced with increasing severity of DPN and the effect was most evident in the inferior quadrant. Measuring RNFL thickness using OCT may prove to be a useful, non-invasive technique for identifying severity of DPN and may also provide additional insight into common mechanisms for peripheral neuropathy and RNFL damage.

Transmedia Storytelling: From Interviewing to Multi-Platform

There is nothing new under the sun – so the saying goes, and in a digital age of recording oral histories, this holds true. Despite advances and innovations across the board in information and communication technology in the field of oral history it is essentially only the devices we record on that have changed. However, what has emerged is a plethora of ways that oral history interviews can be used to produce multimedia, or transmedia storytelling outputs- for exhibitions in public institutions, schools and by communities to engage interested groups, and in families and by individuals wanting to play with new ways of telling their family stories and histories. In 2010, QUT’s Creative Industries introduced a postgraduate unit called Transmedia Storytelling: From Interviewing to Multi-Platform, which was the first postgraduate course of its kind in Australia. Based in a Creative Writing discipline, but open to all coursework Masters, PhD, Research Masters and Doctorate of Creative Industries students, this unit introduces students to the theory and practice of semi-structured interviewing techniques, oral history conventions and applications, and the art of storytelling across various platforms.

Using the Event Analysis of Systemic Teamwork (EAST) to explore conflict between different road user groups when making right hand turns at urban intersections

Collisions between different types of road users at intersections form a substantial component of the road toll. This paper presents an analysis of driver, cyclist, motorcyclist and pedestrian behaviour at intersections that involved the application of an integrated suite of ergonomics methods, the Event Analysis of Systemic Teamwork (EAST) framework, to on-road study data. EAST was used to analyse behaviour at three intersections using data derived from an on-road study of driver, cyclist, motorcyclist and pedestrian behaviour. The analysis shows the differences in behaviour and cognition across the different road user groups and pinpoints instances where this may be creating conflicts between different road users. The role of intersection design in creating these differences in behaviour and resulting conflicts is discussed. It is concluded that currently intersections are not designed in a way that supports behaviour across the four forms of road user studied. Interventions designed to improve intersection safety are discussed.

Online Customer Experience : What is the Experience and how is it Difference for Frequent and Infrequent Purchasers, Age Cohorts and Gender Groups?

What do we know? • Customer Experience is increasingly becoming the new standard for differentiation in both offline and online retailing, and offers a sustainable competitive advantage. o The economic value of a company’s offering has been observed to increase when the customer has a fulfilling shopping experience (Pine & Gilmore, 1998) o Crafting engaging and customer experience is a known method of generating loyalty, advocacy and word of mouth (Tynan & McKechnie, 2009). o A good experience can entice consumers to shop for longer and spend more (Kim, 2001). • The customer’s experience is made up of diverse elements occurring before, during and after the purchase itself. (Discussed further on page 5). It is cumulative over time and can be influenced by touch points across multiple channels. What remains unclear? • How do Coles customers respond to the elements of online customer experience? • How does the online customer experience differ for frequent and infrequent purchasers? • Do differences between genders and age cohorts for online customer experience exist?

Weight-related differences in glucose metabolism and free fatty acid production in two South African population groups

OBJECTIVE The effects of free fatty acids (FFA), leptin, tumour necrosis factor (TNF) alpha and body fat distribution on in vivo oxidation of a glucose load were studied in two South African ethnic groups. DESIGN AND MEASUREMENTS Anthropometric and various metabolic indices were measured at fasting and during a 7h oral glucose tolerance test (OGTT). Body composition was measured using bioelectrical impedance analysis and subcutaneous and visceral fat mass was assessed using a five- and two-level CT-scan respectively. Glucose oxidation was evaluated by measuring the ratio of (13)CO(2) to (12)CO(2) in breath following ingestion of 1-(13)C-labelled glucose. SUBJECTS Ten lean black women (LBW), ten obese black women (OBW), nine lean white women (LWW) and nine obese white women (OWW) were investigated after an overnight fast. RESULTS Visceral fat levels were significantly higher (P < 0.01) in obese white than black women, despite similar body mass indexes (BMIs). There were no ethnic differences in glucose oxidation however; in the lean subjects of both ethnic groups the area under the curve (AUC) was higher than in obese subjects (P < 0.05 for both) and was found to correlate negatively with weight (r = -0.69, P < 0.01) after correcting for age. Basal TNF alpha concentrations were similar in all groups. Percentage suppression of FFAs at 30 min of the OCTT was 24 +/- 12% in OWW and - 38 +/- 23% (P < 0.05) in OBW, ie the 30 min FFA level was higher than the fasting level in the latter group. AUC for FFAs during the late postprandial period (120 - 420 min) was significantly higher in OWW than OBW (P < 0.01) and LWW (P < 0.01) and correlated positively with visceral fat mass independent of age (r = 0.78, P < 0.05) in the OWW only. Leptin levels were higher (P < 0.01) both at fasting and during the course of the OCTT in obese women from both ethnic groups compared to the lean women. CONCLUSIONS Glucose oxidation is reduced in obese subjects of both ethnic groups; inter- and intra-ethnic differences were observed in visceral fat mass and FFA production and it is possible that such differences may play a role in the differing prevalences of obesity-related disorders that have been reported in these two populations.

Ethnic differences in lipid metabolism in two groups of obese South African women

There is a higher prevalence of ischemic heart disease (IHD) in South African white than black women. The objective of this study was to determine biochemical explanations for this prevalence. The study group contained 15 obese black women (OBW) and 14 obese white women (OWW), ah premenopausal, who were examined after an overnight fast. Anthropometric measurements and blood concentrations of glucose, non-esterified fatty acids (NEFAs), catecholamines, plasminogen activator inhibitor-1, C-peptide, proinsulin, lipograms, cortisol, growth hormone, and post-heparin Lipoprotein Lipase activity were measured during an oral glucose tolerance test (OGTT), Body composition was measured using bioelectrical impedance analysis, and subcutaneous and visceral fat mass were assessed with CT-scans. Visceral fat area was higher in OWW (139.7 +/- 10.7 cm(2)) than in OBW (72.3 +/- 3.9 cm(2)) (P < 0.01), as were fasting and 3 h triglyceride concentrations (P < 0.05 for all). OWW also had higher NEFA levels than OBW at 3 and 4 h compared, with OBW (P < 0.05 for both). Fasting cortisol (266 +/- 24 vs. 197 +/- 19 nmol/l; P < 0.05) was higher in OWW than in OBW. These data demonstrate that OWW have higher visceral fat mass than OBW, which may lead to a more atherogenic fasting and postprandial Lipid profile. The higher cortisol levels of the OWW may promote visceral fat deposition. - Punyadeera, C., M-T. van der Merwe, N.J. Crowther, M. Toman, C. P. Schlaphoff, and I. P. Gray. Ethnic differences in lipid metabolism in two groups of obese South African women.

OHS liability, corporate officers and corporate groups

This article examines the new model for corporate officer liability under section 144 of the Occupational Health and Safety Act 2004 (Vic), and explores the extent to which this might effectively extend responsibility for OHS offences to members of corporate groups, such as holding companies. In doing so, the authors canvass the failure of corporate law to impose such obligations on corporate officers in general, and on holding companies as shadow officers. It is argued that provisions such as section 144 of the Victorian Act should be included in all OHS legislation.

Teaching spelling in the middle years : reviewing programs for diverse student groups

In what follows, I draw attention to understandings about the teaching of Standard Australian English spelling developed by being immersed in the URL project site for four years though sharing professional dialogue with teachers and educators and entering into informal conversations with some of the students and their parents. My understandings focus on the potential and problematics of oft-used generic spelling programs and approaches for student cohorts marked by social, cultural and linguistic diversity. This article concludes by considering two possible extensions to the word study approach that may have utility for working with middle years students from diverse backgrounds: creating a discursive ‘Third Space’ that overtly recognises students’ language experiences and the technique of colour blocking to create a visual stress.

Delirium in advanced cancer : screening for the incidence on admission to an inpatient hospice unit

Background Delirium is a common underdiagnosed condition in advanced cancer leading to increased distress, morbidity, and mortality. Screening improves detection but there is no consensus as to the best screening tool to use with patients with advanced cancer. Objective To determine the incidence of delirium in patients with advanced cancer within 72 hours of admission to an acute inpatient hospice using clinical judgement and validated screening tools. Method One hundred consecutive patients with advanced cancer were invited to be screened for delirium within 72 hours of admission to an acute inpatient hospice unit. Two validated tools were used, the Delirium Rating Scale-Revised 98 (DRS-R-98) and the Confusion Assessment Method (CAM) shortened diagnostic algorithm. These results were compared with clinical assessment by review of medical charts. Results Of 100 consecutive admissions 51 participated and of these 22 (43.1%) screened positive for delirium with CAM and/or DRS-R-98 compared to 15 (29.4%) by clinical assessment. Eleven (21.6%) were identified as hypoactive delirium and 5 (9.8%) as subsyndromal delirium. Conclusion This study confirms that delirium is a common condition in patients with advanced cancer.While there remains a lack of consensus regarding the choice of delirium screening tool this study supports theCAMas being appropriate. Further research may determine the optimal screening tool for delirium enabling the development of best practice clinical guidelines for routinemedical practice.

Molecular camouflage : making use of protecting groups to control the self-assembly of inorganic janus particles onto metal–chalcogenide nanotubes by Pearson Hardness

Hard and soft: Binding of inorganic Pt@Fe3O4 Janus particles to WS2 nanotubes through their Pt or Fe3O4 domains is governed by the difference in Pearson hardness: the soft Pt block has a higher sulfur affinity than the harder magnetite face; thus the binding proceeds preferentially through the Pt face. This binding preference can be reversed by masking the Pt face with an organic protecting group.

Alarm setting for the critically ill patient : A descriptive pilot survey of nurses’ perceptions of current practice in an Australian Regional Critical Care Unit

Aim: The aim of this survey was to assess registered nurse’s perceptions of alarm setting and management in an Australian Regional Critical Care Unit. Background: The setting and management of alarms within the critical care environment is one of the key responsibilities of the nurse in this area. However, with up to 99% of alarms potentially being false-positives it is easy for the nurse to become desensitised or fatigued by incessant alarms; in some cases up to 400 per patient per day. Inadvertently ignoring, silencing or disabling alarms can have deleterious implications for the patient and nurse. Method: A total population sample of 48 nursing staff from a 13 bedded ICU/HDU/CCU within regional Australia were asked to participate. A 10 item open-ended and multiple choice questionnaire was distributed to determine their perceptions and attitudes of alarm setting and management within this clinical area. Results: Two key themes were identified from the open-ended questions: attitudes towards inappropriate alarm settings and annoyance at delayed responses to alarms. A significant number of respondents (93%) agreed that alarm fatigue can result in alarm desensitisation and the disabling of alarms, whilst 81% suggested the key factors are those associated with false-positive alarms and inappropriately set alarms.

Navigating uncertainty in Australia : fostering informed citizenship through teaching controversial issues with pre-service teachers

Australia is a multicultural immigrant society created by public policy and direct state action over a period of two hundred years. It is now one of the world’s most diverse societies. However, like many nations, Australia faces challenges to managing ‘unauthorized arrivals’ who claim to be refugees. The issue of how to deal with unauthorized arrivals is controversial and highly emotive as it challenges public policy and government capacity to manage the multicultural ‘mix’ of Australia’s population. It also raises questions about border security. Given that it is impossible to discern beforehand who is a ‘proper’ refugee and who is not, claims to refugee status by unauthorised arrivals in Australia need to be tested against international convention criteria devised by the United Nations High Commissioner for Refugees (UNHCR). There are no simple solutions to controversial questions such as how and where should unauthorised arrivals, and the children accompanying them, be housed whilst their claims are investigated? Moreover, as this issue continues to prompt division and heated debate in Australian society, teachers new to the profession are often reluctant to explore it in the classroom. However, there are opportunities in national and state curriculum documents for the values dimensions of curriculum inquiries into controversial issues such as this to be addressed. For example, the most recent national statement on the goals for schooling in Australia, the Melbourne Declaration (MCEETYA, 2008), makes clear that Australian students need to be prepared for the challenges of the 21st century and to develop the capacity for innovation and complex problem-solving. The Melbourne Declaration informs the first national curriculum to be implemented in the Australian states and territories, and all other national and state initiatives. Its focus on developing active and informed citizens who can contribute to a socially cohesive society implies a capacity to deal with a range of issues associated with cultural diversity, This chapter explores the ways in which pre-service and early career teachers in one Australian state reflect upon curriculum opportunities to address controversial issues in the social sciences and history classroom. As part of their pre-service education, all the participants in this study completed a final year social science curriculum method unit that embedded a range of controversial issues, including the placement of children in Australian Immigration Detention Centres (IDCs), for investigation. By drawing from interviews and focus groups conducted with different cohorts of pre-service teachers in their final year of university study and beginning years of teaching, this chapter analyses the range of perceptions about how controversial issues can be examined in the secondary classroom as part of fostering informed citizenship. The discussion and analysis of the qualitative data in this study makes no claims for the representativeness of its findings, rather, a range of beginner teacher insights into a complex and important facet of teaching in a period of change and uncertainty is offered.

Wide area control of SVCs for first swing stabilisation and damping in longitudinal systems

A non-linear Kalman filter based control strategy for SVCs located in major load groups is presented. This focusses on the limitation and damping of inter-area modes. It does this through treating local modes as noise and uses a tunable nonlinear control algorithm to improve both first swing stability and system damping. Simulation on a four machine system shows that the Kalman filer can successfully lock on to a desired inter-area mode and obtain a 31% improvement in critical clearing time as well as improved damping.

Demographics and discharge outcomes of dysvascular and non-vascular lower limb amputees at a subacute rehabilitation unit: A 7-year series

Objective To examine personal and social demographics, and rehabilitation discharge outcomes of dysvascular and non-vascular lower limb amputees. Methods In total, 425 lower limb amputation inpatient rehabilitation admissions (335 individuals) from 2005 to 2011 were examined. Admission and discharge descriptive statistics (frequency, percentages) were calculated and compared by aetiology. Results Participants were male (74%), aged 65 years (s.d. 14), born in Australia (72%), had predominantly dysvascular aetiology (80%) and a median length of stay 48 days (interquartile range (IQR): 25–76). Following amputation, 56% received prostheses for mobility, 21% (n = 89) changed residence and 28% (n = 116) required community services. Dysvascular amputees were older (mean 67 years, s.d. 12 vs 54 years, s.d. 16; P < 0.001) and recorded lower functional independence measure – motor scores at admission (z = 3.61, P < 0.001) and discharge (z = 4.52, P < 0.001). More nonvascular amputees worked before amputation (43% vs 11%; P < 0.001), were prescribed a prosthesis by discharge (73% vs 52%; P < 0.001) and had a shorter length of stay (7 days, 95% confidence interval: –3 to 17), although this was not statistically significant. Conclusions Differences exist in social and demographic outcomes between dysvascular and non-vascular lower limb amputees.