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.

Building a community of learners within the STEM higher education classroom

Building rich and authentic learning experiences in the STEM classroom, is a challenge for many educators within Higher Education. While many Higher Education Institutions have embraced the need to transform current teaching and learning practices and include a range of online tools, this has often been met with some resistance and approaches that do not always recognise the academic who are a critical component to the success of the transformational process. Over the last decade the Internet has evolved from being a tool used by a few dedicated educators to one that is being used by the majority of educators. However, what is important is how this great resource is used in teaching and learning to allow students to build knowledge. The ability for students to construct knowledge and engage in higher order thinking skills is at the heart of educational practices, and building a community of learners has the potential to support these practices, especially within STEM education. This paper explores the relationship between students and an academic teaching in a technology rich STEM learning environment and their adoption of social community and shared tools. In particular the paper reports on the critical components that make a successful community of learners and the educational tools and approaches that were successfully used to enhance the student learning experience in a STEM classroom.

Indie 100 2013

The Independent Music Project is centred around the development and creation of new music, and includes research into copyright, business models of the future, new technologies, and new audiences. The music industry is undergoing the most radical changes it has faced in almost a century. New digital technologies have made the production, distribution, and promotion of recorded music accessible to anyone with a personal computer. People can now make high-quality digital copies of music and distribute them globally within minutes. Even bastions of the established industries, such as EMI and Columbia, are struggling to make sense of the new industry terrain. The whole employment picture has changed just as radically for people who wish to make a living from music. In Australia, many of the avenues that provided employment for musicians have either disappeared or dramatically shrunk. The advertising industry no longer provides the level of employment it used to prior to the Federal deregulation of the industry in 1992. In many places, new legislative pressures on inner-city and suburban venues have diminished the number of performance spaces that musicians can work in. Just as quickly, new sectors have opened to professional musicians: computer games, ringtones, sound-enabled toys and web advertising all present new opportunities to the enterprising musician. The opportunity to distribute music internationally without being signed to a major label is very attractive to many aspiring and established professionals. No doubt the music industry will face many more challenges as technologies continue to change, as global communication gets easier and faster, and as the challenges to copyright proliferate and change. These challenges cannot be successfully met on a single front. They require research and expertise from all sectors being affected, and this is why the independent music project (IMP) exists.

Indie 100 2014

The Independent Music Project is centred around the development and creation of new music, and includes research into copyright, business models of the future, new technologies, and new audiences. The music industry is undergoing the most radical changes it has faced in almost a century. New digital technologies have made the production, distribution, and promotion of recorded music accessible to anyone with a personal computer. People can now make high-quality digital copies of music and distribute them globally within minutes. Even bastions of the established industries, such as EMI and Columbia, are struggling to make sense of the new industry terrain. The whole employment picture has changed just as radically for people who wish to make a living from music. In Australia, many of the avenues that provided employment for musicians have either disappeared or dramatically shrunk. The advertising industry no longer provides the level of employment it used to prior to the Federal deregulation of the industry in 1992. In many places, new legislative pressures on inner-city and suburban venues have diminished the number of performance spaces that musicians can work in. Just as quickly, new sectors have opened to professional musicians: computer games, ringtones, sound-enabled toys and web advertising all present new opportunities to the enterprising musician. The opportunity to distribute music internationally without being signed to a major label is very attractive to many aspiring and established professionals. No doubt the music industry will face many more challenges as technologies continue to change, as global communication gets easier and faster, and as the challenges to copyright proliferate and change. These challenges cannot be successfully met on a single front. They require research and expertise from all sectors being affected, and this is why the independent music project (IMP) exists.

100 Songs Project 2012

The Independent Music Project is centred around the development and creation of new music, and includes research into copyright, business models of the future, new technologies, and new audiences. The music industry is undergoing the most radical changes it has faced in almost a century. New digital technologies have made the production, distribution, and promotion of recorded music accessible to anyone with a personal computer. People can now make high-quality digital copies of music and distribute them globally within minutes. Even bastions of the established industries, such as EMI and Columbia, are struggling to make sense of the new industry terrain. The whole employment picture has changed just as radically for people who wish to make a living from music. In Australia, many of the avenues that provided employment for musicians have either disappeared or dramatically shrunk. The advertising industry no longer provides the level of employment it used to prior to the Federal deregulation of the industry in 1992. In many places, new legislative pressures on inner-city and suburban venues have diminished the number of performance spaces that musicians can work in. Just as quickly, new sectors have opened to professional musicians: computer games, ringtones, sound-enabled toys and web advertising all present new opportunities to the enterprising musician. The opportunity to distribute music internationally without being signed to a major label is very attractive to many aspiring and established professionals. No doubt the music industry will face many more challenges as technologies continue to change, as global communication gets easier and faster, and as the challenges to copyright proliferate and change. These challenges cannot be successfully met on a single front. They require research and expertise from all sectors being affected, and this is why the independent music project (IMP) exists.

100 Songs Project 2011

The Independent Music Project is centred around the development and creation of new music, and includes research into copyright, business models of the future, new technologies, and new audiences. The music industry is undergoing the most radical changes it has faced in almost a century. New digital technologies have made the production, distribution, and promotion of recorded music accessible to anyone with a personal computer. People can now make high-quality digital copies of music and distribute them globally within minutes. Even bastions of the established industries, such as EMI and Columbia, are struggling to make sense of the new industry terrain. The whole employment picture has changed just as radically for people who wish to make a living from music. In Australia, many of the avenues that provided employment for musicians have either disappeared or dramatically shrunk. The advertising industry no longer provides the level of employment it used to prior to the Federal deregulation of the industry in 1992. In many places, new legislative pressures on inner-city and suburban venues have diminished the number of performance spaces that musicians can work in. Just as quickly, new sectors have opened to professional musicians: computer games, ringtones, sound-enabled toys and web advertising all present new opportunities to the enterprising musician. The opportunity to distribute music internationally without being signed to a major label is very attractive to many aspiring and established professionals. No doubt the music industry will face many more challenges as technologies continue to change, as global communication gets easier and faster, and as the challenges to copyright proliferate and change. These challenges cannot be successfully met on a single front. They require research and expertise from all sectors being affected, and this is why the independent music project (IMP) exists.

Editors review of 'Research in early childhood education for sustainability : international perspectives and provocations'

Mounting concerns about climate change and unsustainable development, and their current and future impacts on all of us – but particularly on children - provided the impetus for this book. Then, as researchers in early childhood education (ECE) and/or education for sustainability (EfS), we used these concerns to shape and question our thinking. This first-ever research text in Early Childhood Education for Sustainability (ECEfS) was advanced when the chapter authors, almost all of whom participated in one or both Transnational Dialogues in Research in Early Childhood Education for Sustainability (Stavanger, Norway, 2010, and Brisbane, Australia, 2011) met for the first time - a critical mass of researchers from vastly different parts of the globe - Norway, Sweden, Australia and New Zealand at the inaugural meeting, with participants from Korea, Japan and Singapore attending the second. We came together to debate, discuss and share ideas about research and theory in the emerging field of ECEfS. An agreed-upon outcome of the Dialogues was this text.

Biological monitoring in workers in a nitrobenzene reduction plant : Haemoglobin versus serum albumin adducts

The high priority of monitoring workers exposed to nitrobenzene is a consequence of clear findings of experimental carcinogenicity of nitrobenzene and the associated evaluations by the International Agency for Research on Cancer. Eighty male employees of a nitrobenzene reduction plant, with potential skin contact with nitrobenzene and aniline, participated in a current medical surveillance programme. Blood samples were routinely taken and analysed for aniline, 4-aminodiphenyl (4-ADP) and benzidine adducts of haemoglobin (Hb) and human serum albumin (HSA). Also, levels of methaemoglobin (Met-Hb) and of carbon monoxide haemoglobin (CO-Hb) were monitored. Effects of smoking were straightforward. Using the rank sum test of Wilcoxon, we found that very clear-cut and statistically significant smoking effects (about 3-fold increases) were apparent on CO-Hb (P = 0.00085) and on the Hb adduct of 4-ADP (P = 0.0006). The mean aniline-Hb adduct level in smokers was 1.5 times higher than in non-smokers; the significance (P = 0.05375) was close to the 5% level. The strongest correlation was evident between the Hb and HSA adducts of aniline (rs = 0.846). Less pronounced correlations (but with P values < 0.02) appeared between aniline-Hb and 4-ADP-Hb adducts (rs = 0.388), between 4-ADP and 4-ADP-HSA adducts (rs = 0.373), and between 4-ADP-Hb and aniline-HSA adducts (rs = 0.275). In view of the proposal for additional use of the aniline-HSA adduct for biological monitoring, particularly in cases of acute overexposures or poisonings, the strong correlation of the Hb and HSA conjugates is noteworthy; the ratio aniline-HSA:aniline-Hb was 1:42 for the entire cohort.

Brief interventions to reduce ecstasy use : a multi-site randomized controlled trial

Studies examining the ability of motivational enhancement therapy (MET) to augment education provision among ecstasy users have produced mixed results and none have examined whether treatment fidelity was related to ecstasy use outcomes. The primary objectives of this multi-site, parallel, two-group randomized controlled trial were to determine if a single-session of MET could instill greater commitment to change and reduce ecstasy use and related problems more so than an education-only intervention and whether MET sessions delivered with higher treatment fidelity are associated with better outcomes. The secondary objective was to assess participants’ satisfaction with their assigned interventions. Participants (N = 174; Mage = 23.62) at two Australian universities were allocated randomly to receive a 15-minute educational session on ecstasy use (n = 85) or a 50-minute session of MET that included an educational component (n = 89). Primary outcomes were assessed at baseline, and then at 4-, 16-, and 24-weeks post-baseline, while the secondary outcome measure was assessed 4-weeks post-baseline by researchers blind to treatment allocation. Overall, the treatment fidelity was acceptable to good in the MET condition. There were no statistical differences at follow-up between the groups on the primary outcomes of ecstasy use, ecstasy-related problems, and commitment to change. Both interventions groups reported a 50% reduction in their ecstasy use and a 20% reduction in the severity of their ecstasy-related problems at the 24-week follow up. Commitment to change slightly improved for both groups (9% - 17%). Despite the lack of between-group statistical differences on primary outcomes, participants who received a single session of MET were slightly more satisfied with their intervention than those who received education only. MI fidelity was not associated with ecstasy use outcomes. Given these findings, future research should focus on examining mechanisms of change. Such work may suggest new methods for enhancing outcomes.

What women want : qualitative analysis of consumer evaluations of maternity care in Queensland, Australia

Background Maternity care reform plans have been proposed at state and national levels in Australia, but the extent to which these respond to maternity care consumers’ expressed needs is unclear. This study examines open-text survey comments to identify women’s unmet needs and priorities for maternity care. It is then considered whether these needs and priorities are addressed in current reform plans. Methods Women who had a live single or multiple birth in Queensland, Australia, in 2010 (n 3,635) were invited to complete a retrospective self-report survey. In addition to questions about clinical and interpersonal maternity care experiences from pregnancy to postpartum, women were asked an open-ended question “Is there anything else you’d like to tell us about having your baby?” This paper describes a detailed thematic analysis of open-ended responses from a random selection of 150 women (10% of 1,510 who responded to the question). Results Four broad themes emerged relevant to improving women’s experiences of maternity care: quality of care (interpersonal and technical); access to choices and involvement in decision-making; unmet information needs; and dissatisfaction with the care environment. Some of these topics are reflected in current reform goals, while others provide evidence of the need for further reforms. Conclusions The findings reinforce the importance of some existing maternity reform objectives, and describe how these might best be met. Findings affirm the importance of information provision to enable informed choices; a goal of Queensland and national reform agendas. Improvement opportunities not currently specified in reform agendas were also identified, including the quality of interpersonal relationships between women and staff, particular unmet information needs (e.g., breastfeeding), and concerns regarding the care environment (e.g., crowding and long waiting times).

An accuracy assessment of ASTER stereo images-derived digital elevation model by using rational polynomial coefficient model

The along-track stereo images of Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) sensor with 15 m resolution were used to generate Digital Elevation Model (DEM) on an area with low and near Mean Sea Level (MSL) elevation in Johor, Malaysia. The absolute DEM was generated by using the Rational Polynomial Coefficient (RPC) model which was run on ENVI 4.8 software. In order to generate the absolute DEM, 60 Ground Control Pointes (GCPs) with almost vertical accuracy less than 10 meter extracted from topographic map of the study area. The assessment was carried out on uncorrected and corrected DEM by utilizing dozens of Independent Check Points (ICPs). Consequently, the uncorrected DEM showed the RMSEz of ± 26.43 meter which was decreased to the RMSEz of ± 16.49 meter for the corrected DEM after post-processing. Overall, the corrected DEM of ASTER stereo images met the expectations.

La Niña : we knew it was coming, and it’s not going away

"The major La Niña climate event responsible for record flooding in Queensland  - and the largest ever cyclone to hit Australia in Yasi  —  is not over yet according to a senior climatologist at Britain’s Met office."

2nd ESMO consensus conference on lung cancer : early-stage non-small-cell lung cancer consensus on diagnosis, treatment and follow-up

To complement the existing treatment guidelines for all tumour types, ESMO organises consensus conferences to focus on specific issues in each type of tumour. The 2nd ESMO Consensus Conference on Lung Cancer was held on 11-12 May 2013 in Lugano. A total of 35 experts met to address several questions on non-small-cell lung cancer (NSCLC) in each of four areas: pathology and molecular biomarkers, first-line/second and further lines in advanced disease, earlystage disease and locally advanced disease. For each question, recommendations were made including reference to the grade of recommendation and level of evidence. This consensus paper focuses on early-stage disease. © The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

2nd ESMO Consensus Conference on Lung Cancer : non-small-cell lung cancer first-line/second and further lines in advanced disease

To complement the existing treatment guidelines for all tumour types, ESMO organises consensus conferences to focus on specific issues in each type of tumour. The 2nd ESMO Consensus Conference on Lung Cancer was held on 11-12 May 2013 in Lugano. A total of 35 experts met to address several questions on non-small-cell lung cancer (NSCLC) in each of four areas: pathology and molecular biomarkers, first-line/second and further lines in advanced disease, early stage disease and locally-advanced disease. For each question, recommendations were made including reference to the grade of recommendation and level of evidence. This consensus paper focuses on 1st line / 2nd and further lines of treatment in advanced disease. © The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Second ESMO consensus conference on lung cancer : pathology and molecular biomarkers for non-small-cell lung cancer

To complement the existing treatment guidelines for all tumour types, ESMO organises consensus conferences to focus on specific issues in each type of tumour. The Second ESMO Consensus Conference on Lung Cancer was held on 11-12 May 2013 in Lugano. A total of 35 experts met to address several questions on management of patients with nonsmall- cell lung cancer (NSCLC) in each of four areas: pathology and molecular biomarkers, early stage disease, locally advanced disease and advanced (metastatic) disease. For each question, recommendations were made including reference to the grade of recommendation and level of evidence. This consensus paper focuses on recommendations for pathology and molecular biomarkers in relation to the diagnosis of lung cancer, primarily non-small-cell carcinomas.