Tailored interventions based on exhaled nitric oxide versus clinical symptoms for asthma in children and adults

Background The measurement of severity and control of asthma in both children and adults can be based on subjective or objective measures. It has been advocated that fractional exhaled nitric oxide (FeNO) can be used to monitor airway inflammation as it correlates with some markers of asthma. Interventions for asthma therapies have been traditionally based on symptoms and/or spirometry. Objectives To evaluate the efficacy of tailoring asthma interventions based on exhaled nitric oxide in comparison to clinical symptoms (with or without spirometry/peak flow) for asthma related outcomes in children and adults. Search methods We searched the Cochrane Airways Group Specialised Register of Trials, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and reference lists of articles. The last search was completed in February 2009. Selection criteria All randomised controlled comparisons of adjustment of asthma therapy based on exhaled nitric oxide compared to traditional methods (primarily clinical symptoms and spirometry/peak flow). Data collection and analysis Results of searches were reviewed against pre-determined criteria for inclusion. Relevant studies were independently selected in duplicate. Two authors independently assessed trial quality and extracted data. Authors were contacted for further information with response from one. Main results Two studies have been added for this update, which now includes six (2 adults and 4 children/adolescent) studies; these studies differed in a variety of ways including definition of asthma exacerbations, FeNO cut off levels, the way in which FeNO was used to adjust therapy and duration of study. Of 1053 participants randomised, 1010 completed the trials. In the meta-analysis, there was no significant difference between groups for the primary outcome of asthma exacerbations or for other outcomes (clinical symptoms, FeNO level and spirometry). In post-hoc analysis, a significant reduction in mean final daily dose inhaled corticosteroid per adult was found in the group where treatment was based on FeNO in comparison to clinical symptoms, (mean difference -450 mcg; 95% CI -677 to -223 mcg budesonide equivalent/day). However, the total amount of inhaled corticosteroid used in one of the adult studies was 11% greater in the FeNO arm. In contrast, in the paediatric studies, there was a significant increase in inhaled corticosteroid dose in the FeNO strategy arm (mean difference of 140 mcg; 95% CI 29 to 251, mcg budesonide equivalent/day). Authors' conclusions Tailoring the dose of inhaled corticosteroids based on exhaled nitric oxide in comparison to clinical symptoms was carried out in different ways in the six studies and found only modest benefit at best and potentially higher doses of inhaled corticosteroids in children. The role of utilising exhaled nitric oxide to tailor the dose of inhaled corticosteroids cannot be routinely recommended for clinical practice at this stage and remains uncertain.

Non-formal techniques for requirements elicitation, modeling, and early assessment for services

Designing systems for multiple stakeholders requires frequent collaboration with multiple stakeholders from the start. In many cases at least some stakeholders lack a professional habit of formal modeling. We report observations from two case studies of stakeholder-involvement in early design where non-formal techniques supported strong collaboration resulting in deep understanding of requirements and of the feasibility of solutions.

Task modeling for collaborative authoring

Motivation ?Task analysis for designing modern collaborative work needs a more fine grained approach. Especially in a complex task domain, like collaborative scientific authoring, when there is a single overall goal that can only be accomplished only by collaboration between multiple roles, each requiring its own expertise. We analyzed and re-considered roles, activities, and objects for design for complex collaboration contexts. Our main focus is on a generic approach to design for multiple roles and subtasks in a domain with a shared overall goal, which requires a detailed approach. Collaborative authoring is our current example. This research is incremental: an existing task analysis approach (GTA) is reconsidered by applying it to a case of complex collaboration. Our analysis shows that designing for collaboration indeed requires a refined approach to task modeling: GTA, in future, will need to consider tasks at the lowest level that can be delegated or mandates. These tasks need to be analyzed and redesigned in more in detail, along with the relevant task object.

Designing and evaluating an online role play in conflict management

Purpose This paper aims to identify, through a literature review, key issues regarding how online role plays can be designed and to apply them when designing a role play on conflict management. Design/methodology/approach By drawing on the key issues identified in the literature review, a role play on conflict management was designed and evaluated. Data were collected by developing a survey that focused on perceived learning, participation and satisfaction. Findings Overall, a majority of the students felt that they learned and participated in the role play. The most positive finding was that the students were satisfied with their role play experience. Research limitations/implications Researchers are urged to further develop the dimensions and measures of online role play success. The measures that were developed for evaluating perceived learning, participation and satisfaction with role plays can be further developed and tested. It is suggested that the effects on learning need to be further explored. Practical implications It is suggested that teachers take the identified key issues of online role play design into account. An important challenge seems to be to encourage students to reflect and do additional reading and research in relation with online role plays. Originality/value Online collaboration is commonly argued as beneficial from an e-learning perspective. However, a challenge for research and practice is to learn how collaborative e-learning activities may be developed. This paper contributes by focusing on how online role plays can be designed and evaluated.

The impacts of FOREX fluctuations on construction business performance : an organisational capabilities perspective

Construction projects are a high risk business activity. When undertaking projects in an international context, it is further complicated by the risk of fluctuations in the foreign exchange rates (FOREX). Construction business performance is affected by these fluctuations. They affect progress and cause delays, which in turn create problems for subcontractors, namely cost overruns, disputes, arbitration, total abandonment and litigation. FOREX fluctuations also cause the price of raw materials to increase, leading the cost overruns. Managing FOREX risk is critical and past research have focused on the need for adequate insurance, careful planning and management, and foreign exchange futures hedging to overcome issues that have been caused by the FOREX risk. Analysis of FOREX risk in international construction business usually focused only on issues at the project level. There is currently lack of understanding of Organisational Capabilities (OC) to manage the impacts of FOREX risk, which when examined, are seen in isolation. This paper attempts to bridge the gap by discussing the impacts of FOREX fluctuations on the international construction business. The focus is on the OC perspective and the need to develop OC framework to mitigate the risk in sustaining construction business performance.

Using value-based partnerships to support community engaged learning : benefits, challenges, stakeholder perspectives

Increasingly, the not-for-profit sector, as an emerging contributor to the creative economy, is creating a context for engaging creative practitioners in developing solutions to complex problems, triggering a demand for skills and knowledge needed to address this complexity. Across the university and community contexts alternative models of engagement are emerging to support this dynamic. This paper presents a case study of a creative project in which a value-based approach is used to foster a collaborative partnership between community partners and a multidisciplinary team of final year Creative Industries students who in the course of the project developed a range of communication resources, including a social media campaign, an interactive game and a series of short films to support volunteer engagement and leadership initiatives. The paper considers the implications this values approach has for the design of service learning curriculum for multidisciplinary creative teams and the potential it has to support meaningful collaboration between creatives and the not-for-profit sector. It further explores how it impact on student and partner engagement, learning outcomes and the benefits for the partner organisation. The paper concludes that a value-based approach to university-community engagement has the potential to support and enable a greater degree of reciprocity, deeper engagement between stakeholders and greater relevance of the final outcome.

Mediators of physical activity behavior change among women with young children

Background Women with children are less likely to engage in adequate physical activity (PA) than women without children. This study aimed to evaluate the efficacy of two strategies for promoting increased PA among mothers of preschool-aged children, and to explore the mediators of any resulting change in PA behavior. Design Controlled intervention trial incorporating repeated data collection from 554 women, randomized to one of three experimental conditions. Intervention Group 1 served as a control, while women in Groups 2 and 3 were given print information about overcoming PA barriers. Women in Group 3 were also invited to discuss the development of local strategies for the promotion of PA among mothers of young children. The primary strategies included increasing partner support, social advocacy, and capacity building, and were implemented through collaboration among participants, researchers, and community organizations. Main Outcome Measures Adequate physical activity (PA), self-efficacy (SE) and partner support (PS). Results: Following the intervention, women in Group 3 were significantly more likely to meet guidelines for PA than controls (odds ratio [OR]=1.71, confidence interval [CI]=1.05–2.77)] after controlling for age and PA at baseline. After controlling for baseline PA, residualized change in SE (OR=1.86, CI=1.17–2.94) and PS (OR=2.29, CI=1.46–3.58) significantly predicted meeting guidelines. After controlling for residual change in PS and SE, the significant intervention effect was attenuated (Group 3 OR=1.40, CI=0.76–2.36), indicating that partner support and self-efficacy may be mediators of physical activity behavior change. Conclusions The findings indicate that community participation approaches that facilitate increased self-efficacy and partner support can be effective in increasing PA among mothers of young children.

An approach for extending Building Information Models (BIM) to specifications

The Construction industry accounts for a tenth of global GDP. Still, challenges such as slow adoption of new work processes, islands of information, and legal disputes, remain frequent, industry-wide occurrences despite various attempts to address them. In response, IT-based approaches have been adopted to explore collaborative ways of executing construction projects. Building Information Modelling (BIM) is an exemplar of integrative technologies whose 3D-visualisation capabilities have fostered collaboration especially between clients and design teams. Yet, the ways in which specification documents are created and used in capturing clients' expectations based on industry standards have remained largely unchanged since the 18th century. As a result, specification-related errors are still common place in an industry where vast amounts of information are consumed as well as produced in the course project implementation in the built environment. By implication, processes such as cost planning which depend on specification-related information remain largely inaccurate even with the use of BIM-based technologies. This paper briefly distinguishes between non-BIM-based and BIM-based specifications and reports on-going efforts geared towards the latter. We review exemplars aimed at extending Building Information Models to specification information embedded within the objects in a product library and explore a viable way of reasoning about a semi-automated process of specification using our product library.

Crossing Boundaries : Australian student teachers creating ‘The Global Teacher Exhibition’

This DVD describes a curriculum project embedded into the subject The Global Teacher (code: CLB049/LCB327, Faculty of Education, Queensland University of Technology). The Global Teacher is a subject within the undergraduate degree program for pre-service teachers and provides a global perspective on socio-political issues that shape education. The curriculum in The Global Teacher was designed around a collaborative partnership between Queensland University of Technology and State Library Queensland. Through this collaboration, State Library became not only a resource for information, but also helped to develop the pedagogical skills of the pre-service teaachers by guiding them in exhibiting and curating Global Teacher themes for a broader community-based audience. The collaboration became part of the assessment for The Global Teacher, requiring the pre-service teachers to visually translate their understandings of global educational issues into a public exhibition, which was held at State Library Queensland on 1st May, 2013. This DVD is a creative work explaining the stages of this collaborative project. It explores the learning outcomes achieved, using the voices of participants: the pre-service teachers, the QUT teacher educators and staff of State Library Queensland. A detailed description of this project is to be found at: http://libguides.library.qut.edu.au/content.php?pid=595206&sid=4908024&preview=1b455ed4f2c606d19702090f85d1f965

Assessing capacity in the context of testamentary, enduring power of attorney, and advance care directive documents in Australia

Balancing the competing interests of autonomy and protection of individuals is an escalating challenge confronting an ageing Australian population. Legal and medical professionals are increasingly being asked to determine whether individuals are legally capable to make their own testamentary, financial and/or personal/health care decisions. Diseases such as dementia impact upon cognition which necessitates collaboration between the legal and medical professions to satisfactorily assess the effect of such mentally disabling conditions upon legal competency. Terminological and methodological differences exist between the two professions when assessing capacity in this context which subsequently create miscommunication and misunderstanding. Consequently, it is not necessarily a simple solution for a legal professional to seek the opinion of a medical practitioner. Exacerbating the situation is the fact that no consistent and transparent capacity assessment paradigm currently exists in Australia. Assessments are instead being undertaken on an ad hoc basis dependent upon the skill set of the legal and/or medical professionals involved. A qualitative study seeking the views of legal and medical professionals who practise in this area has been conducted. This incorporated a review of the relevant literature and surveys which informed the semi-structured interviews conducted with 10 legal and 20 medical practitioners. Practitioners were asked whether there is a standard approach to assessment and whether national guidelines would assist. The general consensus was that uniform guidelines would be advantageous. The research also canvassed practitioner views as to the state of the relationship between the professions when assessing capacity. Three promising practices have emerged from this research: first, is the need for the development of national guidelines and supporting principles to satisfactorily assess capacity; second, is the possibility of strengthening the relationship between legal and medical professionals to assist in the satisfactory assessment of legal capacity; and third, the need for increased community education.

Social media as online information grounds : a preliminary conceptual framework

Researchers are increasingly grappling with ways of theorizing social media and its use. This review essay proposes that the theory of Information Grounds (IG) may provide a valuable lens for understanding how social media fosters collaboration and social engagement among information professionals. The paper presents literature that helps us understand how social media can be seen as IG, and maps the characteristics of social media to the seven propositions of IG theory. This work is part of a wider study investigating the ways in which Information Technology (IT) professionals experience social media.

The free encyclopaedia that anyone can edit: the shifting values of Wikipedia editors

Wikipedia is often held up as an example of the potential of the internet to foster open, free and non-commercial collaboration. However such discourses often conflate these values without recognising how they play out in reality in a peer-production community. As Wikipedia is evolving, it is an ideal time to examine these discourses and the tensions that exist between its initial ideals and the reality of commercial activity in the encyclopaedia. Through an analysis of three failed proposals to ban paid advocacy editing in the English language Wikipedia, this paper highlights the shift in values from the early editorial community that forked encyclopaedic content over the threat of commercialisation, to one that today values the freedom that allows anyone to edit the encyclopaedia.

Integrated access control for smart buildings using building information models

This thesis investigates the use of building information models for access control and security applications in critical infrastructures and complex building environments. It examines current problems in security management for physical and logical access control and proposes novel solutions that exploit the detailed information available in building information models. The project was carried out as part of the Airports of the Future Project and the research was modelled based on real-world problems identified in collaboration with our industry partners in the project.

Promoting posttraumatic growth in police recruits : preliminary results of a randomised controlled resilience intervention trial

Recent research has demonstrated that the same experiences that may elicit symptoms of post-traumatic stress disorder (PTSD) in emergency service personnel can also provide a catalyst for positive personal changes such as posttraumatic growth (PTG). In this research newly recruited police officers (N = 412) participated in a randomised control trial of a program specifically designed to promote mental health. On entry to the academy, new recruits were randomly allocated, by classrooms, to either a treatment as usual condition (i.e., existing psychoeducation program) or to the intervention group. The Promoting Resilient Officers (PRO) program is a resilience building intervention adapted from an earlier resilience building program in collaboration with the police service. The PRO program also includes additional components on trauma and PTG. The current research included the participants who had experienced trauma prior to or during the research period (N = 246). It was hypothesised that participation in the PRO program would increase levels of PTG and lower levels of PTSD when compared to recruits in the control condition. Using multilevel modelling and post-hoc analyses, results indicated there were significantly higher levels of PTG across multiple dimensions when compared to the control group. There was no effect on PTSD symptoms with both conditions showing a floor effect. The research indicated the potential value of developing interventions that elicit reflections on the potential for positive as well as negative outcomes of experiencing traumatic and other highly challenging events.

Systematic integration of human factors in the specification of requirements for new railway technologies

Engineering design processes are necessary to attain the requisite standards of integrity for high-assurance safety-related systems. Additionally, human factors design initiatives can provide critical insights that parameterise their development. Unfortunately, the popular perception of human factors as a “forced marriage” between engineering and psychology often provokes views where the ‘human factor’ is perceived as a threat to systems design. Some popular performance-based standards for developing safety-related systems advocate identifying and managing human factors throughout the system lifecycle. However, they also have a tendency to fall short in their guidance on the application of human factors methods and tools, let alone how the outputs generated can be integrated in to various stages of the design process. This case study describes a project that converged engineering with human factors to develop a safety argument for new low-cost railway level crossing technology for system-wide implementation in Australia. The paper enjoins the perspectives of a software engineer and cognitive psychologist and their involvement in the project over two years of collaborative work to develop a safety argument for low-cost level crossing technology. Safety and reliability requirements were informed by applying human factors analytical tools that supported the evaluation and quantification of human reliability where users interfaced with the technology. The project team was confronted with significant challenges in cross-disciplinary engagement, particularly with the complexities of dealing with incongruences in disciplinary language. They were also encouraged to think ‘outside the box’ as to how users of a system interpreted system states and ehaviour. Importantly, some of these states, while considered safe within the boundary of the constituent systems that implemented safety-related functions, could actually lead the users to engage in deviant behaviour. Psychology explained how user compliance could be eroded to levels that effectively undermined levels of risk reduction afforded by systems. Linking the engineering and psychology disciplines intuitively, overall safety performance was improved by introducing technical requirements and making design decisions that minimized the system states and behaviours that led to user deviancy. As a commentary on the utility of transdisciplinary collaboration for technical specification, the processes used to bridge the two disciplines are conceptualised in a graphical model.