Integrated chronic disease management in primary-secondary care : a systematic literature review of the evidence

Introduction: Diabetes has traditionally been managed as a single chronic disease state, but it exists with co-morbidities such as depression and metabolic syndrome. Treatment is multifaceted, requiring both primary and secondary care, however, the delivery of diabetes care is often fragmented. Integrated chronic disease management is a growing model of interest, and is underpinned by the chronic care model (CCM), devised as a guide for primary care management of patients with chronic conditions. The model identifies six key elements for effective care, and has shown promise in improving the management of diabetes. Aim: To find empirical evidence of integrated care interventions targeted at co-morbidities including diabetes, across primary/secondary care. Method: A systematic review of peer reviewed literature from PubMed, CINAHL, Embase, Cochrane Library and Joanna Briggs was performed. Studies were reviewed according to inclusion criteria- studies published in English, between 2004-2014, empirical studies, studies with evidence of primary/secondary implementation, and those dealing with chronic co-morbid disease states. Results: 51 studies met the inclusion criteria. Included studies were mostly from the US (38), with five from Australia, UK (2), Canada (2), Netherlands (1), Norway (1), Ireland (1), and one multi-country study. It was found that all interventions adopted at least one (average 3-4) of the chronic care model, with the majority implementing delivery system redesign activities within the primary care practice/s. We found evidence of interventions which significantly reduced emergency department and hospital admissions, improved processes of care, patient health outcomes such as HbA1c, improved patient satisfaction, and reduced costs. Conclusion/Implications for practice: Diabetes exists as a co-morbid disease, requiring both primary and secondary care. We found that integrated care interventions adopting elements of the chronic care model positively impacted on patient outcomes, service utilisation, as well as costs. This review has highlighted that it may not be necessary to adopt all CCM elements to improve clinical outcomes, patient satisfaction and costs.

Experimental evidence for competitive N–O and O–C bond homolysis in gasphase alkoxyamines

The extensive use of alkoxyamines in controlled radical polymerisation and polymer stabilisation is based on rapid cycling between the alkoxyamine (R1R2NO–R3) and a stable nitroxyl radical (R1R2NO•) via homolysis of the labile O–C bond. Competing homolysis of the alkoxyamine N–O bond has been predicted to occur for some substituents leading to production of aminyl and alkoxyl radicals. This intrinsic competition between the O–C and N–O bond homolysis processes has to this point been difficult to probe experimentally. Herein we examine the effect of local molecular structure on the competition between N–O and O–C bond cleavage in the gas phase by variable energy tandem mass spectrometry in a triple quadrupole mass spectrometer. A suite of cyclic alkoxyamines with remote carboxylic acid moieties (HOOC–R1R2NO–R3) were synthesised and subjected to negative ion electrospray ionisation to yield [M – H]− anions where the charge is remote from the alkoxyamine moiety. Collision-induced dissociation of these anions yield product ions resulting, almost exclusively, from homolysis of O–C and/or N–O bonds. The relative efficacy of N–O and O–C bond homolysis was examined for alkoxyamines incorporating different R3 substituents by varying the potential difference applied to the collision cell, and comparing dissociation thresholds of each product ion channel. For most R3 substituents, product ions from homolysis of the O–C bond are observed and product ions resulting from cleavage of the N–O bond are minor or absent. A limited number of examples were encountered however, where N–O homolysis is a competitive dissociation pathway because the O–C bond is stabilised by adjacent heteroatom(s) (e.g., R3 = CH2F). The dissociation threshold energies were compared for different alkoxyamine substituents (R3) and the relative ordering of these experimentally determined energies is shown to correlate with the bond dissociation free energies, calculated by ab initio methods. Understanding the structure-dependent relationship between these rival processes will assist in the design and selection of alkoxyamine motifs that selectively promote the desirable O–C homolysis pathway.

AR and gamification concepts to reduce driver boredom and risk taking behaviours

Young males are over-represented in road crashes. Part of the problem is their proneness to boredom, a hardwired personality factor that can lead to risky driving. This paper presents a theoretical understanding of boredom in the driving context and demonstrates convincing arguments to investigate the role of boredom further. Specifically, this paper calls for the design of innovative technologies and applications that make safe driving more pleasurable and stimulating for young males, e.g., by applying gamification techniques. We propose two design concepts through the following questions: A. Can the simulation of risky driving reduce actual risky driving? B. Can the replacement of risky driving stimuli with alternative stimuli reduce risky driving? We argue that considering these questions in the future design of automotive user-interfaces and personal ubiquitous computing devices could effectively reduce risky driving behaviours among young males.

The influence of families on early adolescent school connectedness : evidence that this association varies with adolescent involvement in peer drinking networks

School connectedness is central to the long term well-being of adolescents, and high quality parent-child relationships facilitate school connectedness. This study examined the extent to which family relationship quality is associated with the school connectedness of pre- and early teenagers, and how this association varies with adolescent involvement in peer drinking networks. The sample consisted of 7,372 10-14 year olds recruited from 231 schools in 30 Australian communities. Participants completed the Communities that Care youth survey. A multi-level model of school connectedness was used, with a random term for school-level variation. Key independent variables included family relationship quality, peer drinking networks, and school grade. Control variables included child gender, sensation seeking, depression, child alcohol use, parent education, and language spoken at home. For grade 6 students, the association of family relationship quality and school connectedness was lower when peer drinking networks were present, and this effect was nonsignificant for older (grade 8) students. Post hoc analyses indicated that the effect for family relationship quality on school connectedness was nonsignificant when adolescents in grade 6 reported that the majority of friends consumed alcohol. The results point to the importance of familyschool partnerships in early intervention and prevention.

Untangling the evidence : introducing an empirical model for evidence-based library and information practice

Introduction This research is the first to investigate the experiences of teacher-librarians as evidence-based practice. An empirically derived model is presented in this paper. Method This qualitative study utilised the expanded critical incident approach, and investigated the real-life experiences of fifteen Australian teacher-librarians, through semi-structured interviews and inductive data analysis. Data collection utilised semi-structured interviews, on-site observations, journaling and the rubric for contextual information. These approaches allowed each of the interviewees to tell their own story and provided richness to the data. Analysis The analysis involved two types of data categorisation: binary and thematic. Binary classification was used to identify factual details. Thematic analysis involved categorising the emerging themes. Results An empirically derived model for evidence-based practice was devised and associated critical findings identified. The results demonstrate that evidence-based practice for teacher-librarians is a holistic practice. It is not a linear, step-by-step process. Conclusions This study is significant for teacher-librarians and library and information professionals as it provides new understanding of evidence-based practice.

Public policy on corporate audit committees : case study evidence of current practice

Corporate failures and malpractices have led to an increasing emphasis on the governance role of audit committees. The Smith report Audit Committee Combined Code Guidance and the Higgs Review of the Role and Effectiveness of Non-Executive Directors (now incorporated in a Revised Combined Code) represent further attempts to strengthen corporate accountability in the UK. Although the regulatory focus on audit committees indicates confidence in their role as part of the solution to governance failures, questions remain about their efficacy in practice. Against the background of the publication of the Smith report and the wider reliance on audit committees in several countries to help improve corporate accountability, this paper provides research evidence, drawn from an ACCA-sponsored project, on the processes and effects of the audit committees in three UK companies. This study complements other research on audit committees by adopting a case study approach, in order to reflect the importance of investigating audit committee operations from within the organisation and to develop a closer understanding of audit committee impact than is available from generally observable data. The empirical evidence for the case studies was obtained from semi-structured interviews with personnel involved in the audit committee process, internal documents made available by the companies, and publicly available information, including annual reports.

Exploring the internal dimensions of work stress : evidence from construction cost estimators in China

A recurring feature of modern practice is the stress placed on project professionals, with both debilitating effects on the people concerned and indirectly affecting project success. Cost estimation, for example, is an essential task for successful project management involving a high level of uncertainty. It is not surprising, therefore, that young cost estimators especially can become stressful at work due to a lack of experience and the heavy responsibilities involved. However, the concept of work stress and the associated underlying dimensions has not been clearly defined in extant studies in the construction management field. To redress this situation, an updated psychology perceived stress questionnaire (PSQ) , first developed by Levenstein et al (1993) and revised by Fliege et al (2005), is used to explore the dimensions of work stress with empirical evidence from the construction industry in China. With 145 reliable responses from young (less than 5 years’ experience) Chinese cost estimators, this study explores the internal dimensions of work stress, identifying four dimensions of tension, demands, lack of joy and worries. It is suggested that this four-dimensional structure may also be applicable in a more general context.

Bluebird AR

"What is Bluebird AR? Bluebird AR was the ABC's alternate reality drama set around the leak of Bluebird, a clandestine geoengineering initiative created by eco-billionaire Harrison Wyld. Proposing a fictional scenario set against a backdrop of real world possibilities, Bluebird AR took some of the conventions of the well-established alternate reality game (ARG) genre and pulled them into the relatively new area of online drama, to create a hybrid entertainment form best described as 'participatory drama'. With Bluebird AR's interactive narrative centred on the experimental science of geoengineering, the deliberate manipulation of the Earth's atmosphere to counteract global warming, the events and characters in the Bluebird story were entirely fictional but fused with reality online. Inhabiting a mixture of third party social media spaces and websites created by the ABC, the story incorporated real online articles, scientific journals, media and debate around geoengineering. In an Australian first, ABC Innovation launched Bluebird AR on 27 April 2010, with a 6 week live phase. Audience members were invited to play collectively to help 'unlock the drama' and push forward the emerging narrative, or passively watch the story unfold in real-time across the internet. Bluebird AR subverted ARG conventions with the high quality of its production and assets, and raised the stakes for online drama with its level of audience participation." © 2014 ABC "Introduction One of the most exciting creative challenges of producing Bluebird AR was formulating the broad array of visual styles and treatments required for the project's diverse range of content. Many assets also needed to translate well not only online but across other media, including television and print. With the project's producers keen to create a visually rich narrative with high production values from the outset, inspiration for the production design for various aspects of the Bluebird story began in the earliest pitching phase in September 2008. Particular visual treatments and styles for Bluebird's characters, their web spaces and real world possessions were formulated concurrently with the creation of their profiles. Ideas around how various clues and gameplay spaces might look and feel were also explored at this early stage. Bluebird AR's small but tight creative team produced 7 website designs and brands, motion graphics for title sequences and logo animations, rotoscope animation, 3D compositing and animation, 3D wireframes and schematics, countless Photoshop composites, and a vast array of character assets for the DC (including Kyle's Bluebird Labs security pass and resignation letter, Kruger's American and Russia passports and birth certificate, Harrison's divorce papers, and more)…" © 2014 ABC