Assessment and management of anxiety disorders in children and adolescents

Anxiety disorders in childhood and adolescence are extremely common and are often associated with lifelong psychiatric disturbance. Consistent with DSM-5 and the extant literature, this review concerns the assessment and treatment of specific phobias, separation anxiety disorder, generalised anxiety disorder, social anxiety disorder, panic disorder and agoraphobia. Evidence-based psychological treatments (cognitive behaviour therapy; CBT) for these disorders have been developed and investigated, and in recent years promising low-intensity versions of CBT interventions have been proposed that offer a means to increase access to evidence-based treatments. There is some evidence of effectiveness of pharmacological treatments for anxiety disorders in children and young people, however, routine prescription is not recommended due to concerns about potential harm.

Massage therapy in the management of myogenic TMD: A pilot study

Introduction: The Temporomandibular disorder (TMD) is greatly prevalent in the population and can be associated with bruxism. This disorder produces several signs and symptoms. Among them, pain is one of the most important because it reduces life quality and productivity of people who have such disorder. The aim of this research was to study if massage causes pain relief and/or electromyographic (EMG) changes. Materials and methods: The subjects were chosen by a questionnaire and divided into 2 different groups. Their ages varied from 19 to 22 years. The experimental group consisted of 6 TMD patients, who were submitted to the massage treatment and 4 EMG-sessions (the 1 st EMG-session occurred before the treatment and the others in the 1 st, 15 th and 30 th days after the treatment). The control group consisted of 6 TMD patients, who were submitted to the same 4 EMG-sessions. While EMG activity was recorded, subjects were asked to keep mandibular rest position (MRP) and to perform maximal voluntary clenching (MVC). The treatment consisted of 15 massage-sessions on face and neck and in application of Visual Analogue Scale (VAS) for measuring pain level. The massage sessions had 30 minutes of duration and were performed daily. The EMG data were processed to obtain the Root Mean Square (RMS), which were normalized by MVC. Results: It was demonstrated that (1) RMS-MRP of the right masseter in experimental group at the 1 st EMG-session was higher than at the 2 nd EMG-session and (2) statistically significant reduction was found for VAS values after massage session. Conclusion: Unfortunately the sample is insufficient to draw any conclusions, therefore, more studies regarding the use of massage in the management of myogenic TMD are necessary.

Diagnosis and management of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is probably one of the most prevalent diseases in the world that also compromises the quality of life of the affected significantly. Its incidence in Brazil is 12%, corresponding to 20 million individuals. OBJECTIVE: To update the GERD management and the new trends on diagnosis and treatment, reviewing the international and Brazilian experience on it. METHOD: The literature review was based on papers published on Medline/Pubmed, SciELO, Lilacs, Embase and Cochrane crossing the following headings: gastroesophageal reflux disease, diagnosis, clinical treatment, surgery, fundoplication. RESULTS: Various factors are involved on GERD physiopathology, the most important being the transient lower esophageal sphincter relaxation. Clinical manifestations are heartburn, regurgitation (typical symptoms), cough, chest pain, asthma, hoarseness and throat clearing (atypical symptoms), which may be followed or not by typical symptoms. GERD patients may present complications such as peptic stenosis, hemorrhage, and Barrett's esophagus, which is the most important predisposing factor to adenocarcinoma. The GERD diagnosis must be based on the anamnesis and the symptoms must be evaluated in terms of duration, intensity, frequency, triggering and relief factors, pattern of evolution and impact on the patient's quality of life. The diagnosis requires confirmation with different exams. The goal of the clinical treatment is to relieve the symptoms and surgical treatment is indicated for patients who require continued drug use, with intolerance to prolonged clinical treatment and with GERD complications. CONCLUSION: GERD is a major digestive health problem and affect 12% of Brazilian people. The anamnesis is fundamental for the diagnosis of GERD, with special analysis of the typical and atypical symptoms (duration, intensity, frequency, triggering and relief factors, evolution and impact on the life quality). High digestive endoscopy and esophageal pHmetry are the most sensitive diagnosctic methods. The clinical treatment is useful in controlling the symptoms; however, the great problem is keeping the patients asymptomatic over time. Surgical treatment is indicated for patients who required continued drug use, intolerant to the drugs and with complicated forms of GERD.

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 1: Update 2012 on the acute treatment of schizophrenia and the management of treatment resistance

These updated guidelines are based on a first edition of the World Federation of Societies of Biological Psychiatry Guidelines for Biological Treatment of Schizophrenia published in 2005. For this 2012 revision, all available publications pertaining to the biological treatment of schizophrenia were reviewed systematically to allow for an evidence-based update. These guidelines provide evidence-based practice recommendations that are clinically and scientifically meaningful and these guidelines are intended to be used by all physicians diagnosing and treating people suffering from schizophrenia. Based on the first version of these guidelines, a systematic review of the MEDLINE/PUBMED database and the Cochrane Library, in addition to data extraction from national treatment guidelines, has been performed for this update. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into six levels of evidence (A-F; Bandelow et al. 2008b, World J Biol Psychiatry 9: 242). This first part of the updated guidelines covers the general descriptions of antipsychotics and their side effects, the biological treatment of acute schizophrenia and the management of treatment-resistant schizophrenia.

Consolidation of international guidelines for the management of canine populations in urban areas and proposal of performance indicators

Consolidation of international guidelines for the management of canine populations in urban areas and proposal of performance indicators The objective of this study is to propose a generic program for the management of urban canine populations with suggestion of performance indicators. The following international guidelines on canine population management were revised and consolidated: World Health Organization, World Organisation for Animal Health, World Society for the Protection of Animals, International Companion Animal Management Coalition, and the Food and Agriculture Organization. Management programs should cover: situation diagnosis, including estimates of population size; social participation with involvement of various sectors in the planning and execution of strategies; educational actions to promote humane values, animal welfare, community health, and responsible ownership (through purchase or adoption); environmental and waste management to eliminate sources of food and shelter; registration and identification of animals; animal health care, reproductive control; prevention and control of zoonoses; control of animal commerce; management of animal behavior and adequate solutions for abandoned animals; and laws regulating responsible ownership, prevention of abandonment and zoonoses. To monitor these actions, four groups of indicators are suggested: animal population indicators, human/animal interaction indicators, public service indicators, and zoonosis indicators. The management of stray canine populations requires political, sanitary, ethologic, ecologic, and humanitarian strategies that are socially acceptable and environmentally sustainable. Such measures must also include the control of zoonoses such as rabies and leishmaniasis, considering the concept of "one health," which benefits both the animals and people in the community.

Asset management of wastewater networks

Asset Management (AM) is a set of procedures operable at the strategic-tacticaloperational level, for the management of the physical asset’s performance, associated risks and costs within its whole life-cycle. AM combines the engineering, managerial and informatics points of view. In addition to internal drivers, AM is driven by the demands of customers (social pull) and regulators (environmental mandates and economic considerations). AM can follow either a top-down or a bottom-up approach. Considering rehabilitation planning at the bottom-up level, the main issue would be to rehabilitate the right pipe at the right time with the right technique. Finding the right pipe may be possible and practicable, but determining the timeliness of the rehabilitation and the choice of the techniques adopted to rehabilitate is a bit abstruse. It is a truism that rehabilitating an asset too early is unwise, just as doing it late may have entailed extra expenses en route, in addition to the cost of the exercise of rehabilitation per se. One is confronted with a typical ‘Hamlet-isque dilemma’ – ‘to repair or not to repair’; or put in another way, ‘to replace or not to replace’. The decision in this case is governed by three factors, not necessarily interrelated – quality of customer service, costs and budget in the life cycle of the asset in question. The goal of replacement planning is to find the juncture in the asset’s life cycle where the cost of replacement is balanced by the rising maintenance costs and the declining level of service. System maintenance aims at improving performance and maintaining the asset in good working condition for as long as possible. Effective planning is used to target maintenance activities to meet these goals and minimize costly exigencies. The main objective of this dissertation is to develop a process-model for asset replacement planning. The aim of the model is to determine the optimal pipe replacement year by comparing, temporally, the annual operating and maintenance costs of the existing asset and the annuity of the investment in a new equivalent pipe, at the best market price. It is proposed that risk cost provide an appropriate framework to decide the balance between investment for replacing or operational expenditures for maintaining an asset. The model describes a practical approach to estimate when an asset should be replaced. A comprehensive list of criteria to be considered is outlined, the main criteria being a visà- vis between maintenance and replacement expenditures. The costs to maintain the assets should be described by a cost function related to the asset type, the risks to the safety of people and property owing to declining condition of asset, and the predicted frequency of failures. The cost functions reflect the condition of the existing asset at the time the decision to maintain or replace is taken: age, level of deterioration, risk of failure. The process model is applied in the wastewater network of Oslo, the capital city of Norway, and uses available real-world information to forecast life-cycle costs of maintenance and rehabilitation strategies and support infrastructure management decisions. The case study provides an insight into the various definitions of ‘asset lifetime’ – service life, economic life and physical life. The results recommend that one common value for lifetime should not be applied to the all the pipelines in the stock for investment planning in the long-term period; rather it would be wiser to define different values for different cohorts of pipelines to reduce the uncertainties associated with generalisations for simplification. It is envisaged that more criteria the municipality is able to include, to estimate maintenance costs for the existing assets, the more precise will the estimation of the expected service life be. The ability to include social costs enables to compute the asset life, not only based on its physical characterisation, but also on the sensitivity of network areas to social impact of failures. The type of economic analysis is very sensitive to model parameters that are difficult to determine accurately. The main value of this approach is the effort to demonstrate that it is possible to include, in decision-making, factors as the cost of the risk associated with a decline in level of performance, the level of this deterioration and the asset’s depreciation rate, without looking at age as the sole criterion for making decisions regarding replacements.

Home-based versus clinic-based specimen collection in the management of Chlamydia trachomatis and Neisseria gonorrhoeae infections

BACKGROUND Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most frequent causes of bacterial sexually transmitted infections (STIs). Management strategies that reduce losses in the clinical pathway from infection to cure might improve STI control and reduce complications resulting from lack of, or inadequate, treatment. OBJECTIVES To assess the effectiveness and safety of home-based specimen collection as part of the management strategy for Chlamydia trachomatis and Neisseria gonorrhoeae infections compared with clinic-based specimen collection in sexually-active people. SEARCH METHODS We searched the Cochrane Sexually Transmitted Infections Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS on 27 May 2015, together with the World Health Organization International Clinical Trials Registry (ICTRP) and ClinicalTrials.gov. We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. SELECTION CRITERIA Randomized controlled trials (RCTs) of home-based compared with clinic-based specimen collection in the management of C. trachomatis and N. gonorrhoeae infections. DATA COLLECTION AND ANALYSIS Three review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. We contacted study authors for additional information. We resolved any disagreements through consensus. We used standard methodological procedures recommended by Cochrane. The primary outcome was index case management, defined as the number of participants tested, diagnosed and treated, if test positive. MAIN RESULTS Ten trials involving 10,479 participants were included. There was inconclusive evidence of an effect on the proportion of participants with index case management (defined as individuals tested, diagnosed and treated for CT or NG, or both) in the group with home-based (45/778, 5.8%) compared with clinic-based (51/788, 6.5%) specimen collection (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.60 to 1.29; 3 trials, I² = 0%, 1566 participants, moderate quality). Harms of home-based specimen collection were not evaluated in any trial. All 10 trials compared the proportions of individuals tested. The results for the proportion of participants completing testing had high heterogeneity (I² = 100%) and were not pooled. We could not combine data from individual studies looking at the number of participants tested because the proportions varied widely across the studies, ranging from 30% to 96% in home group and 6% to 97% in clinic group (low-quality evidence). The number of participants with positive test was lower in the home-based specimen collection group (240/2074, 11.6%) compared with the clinic-based group (179/967, 18.5%) (RR 0.72, 95% CI 0.61 to 0.86; 9 trials, I² = 0%, 3041 participants, moderate quality). AUTHORS' CONCLUSIONS Home-based specimen collection could result in similar levels of index case management for CT or NG infection when compared with clinic-based specimen collection. Increases in the proportion of individuals tested as a result of home-based, compared with clinic-based, specimen collection are offset by a lower proportion of positive results. The harms of home-based specimen collection compared with clinic-based specimen collection have not been evaluated. Future RCTs to assess the effectiveness of home-based specimen collection should be designed to measure biological outcomes of STI case management, such as proportion of participants with negative tests for the relevant STI at follow-up.

MOIRA-PLUS use in decision making on the long-term management of contaminated freshwater bodies and catchments

In the mid-long-term after a nuclear accident, the contamination of drinking water sources, fish and other aquatic foodstuffs, irrigation supplies and people?s exposure during recreational activities may create considerable public concern, even though dose assessment may in certain situations indicate lesser importance than for other sources, as clearly experienced in the aftermath of past accidents. In such circumstances there are a number of available countermeasure options, ranging from specific chemical treatment of lakes to bans on fish ingestion or on the use of water for crop irrigation. The potential actions can be broadly grouped into four main categories, chemical, biological, physical and social. In some cases a combination of actions may be the optimal strategy and a decision support system (DSS) like MOIRA-PLUS can be of great help to optimise a decision. A further option is of course not to take any remedial actions, although this may also have significant socio-economic repercussions which should be adequately evaluated. MOIRA-PLUS is designed to allow for a reliable assessment of the long-term evolution of the radiological situation and of feasible alternative rehabilitation strategies, including an objective evaluation of their social, economic and ecological impacts in a rational and comprehensive manner. MOIRA-PLUS also features a decision analysis methodology, making use of multi-attribute analysis, which can take into account the preferences and needs of different types of stakeholders. The main functions and elements of the system are described summarily. Also the conclusions from end-user?s experiences with the system are discussed, including exercises involving the organizations responsible for emergency management and the affected services, as well as different local and regional stakeholders. MOIRAPLUS has proven to be a mature system, user friendly and relatively easy to set up. It can help to better decisionmaking by enabling a realistic evaluation of the complete impacts of possible recovery strategies. Also, the interaction with stakeholders has allowed identifying improvements of the system that have been recently implemented.

Design and technical evaluation of an enhanced location-awareness service enabler for spatial disorientation management of elderly with mild cognitive impairment

The progressive ageing of population has turned the mild cognitive impairment (MCI) into a prevalent disease suffered by elderly. Consequently, the spatial disorientation has become a significant problem for older people and their caregivers. The ambient-assisted living applications are offering location-based services for empowering elderly to go outside and encouraging a greater independence. Therefore, this paper describes the design and technical evaluation of a location-awareness service enabler aimed at supporting and managing probable wandering situations of a person with MCI. Through the presence capabilities of the IP multimedia subsystem (IMS) architecture, the service will alert patient's contacts if a hazardous situation is detected depending on his location. Furthermore, information about the older person's security areas has been included in the user profile managed by IMS. In doing so, the service enabler introduced contribute to “context-awareness” paradigm allowing the adaptation and personalization of services depending on user's context and specific conditions or preferences.

Gestión intelectual de las prácticas comunicativas en arquitectura : S, M, L, XL, el gran evento = The intellectual management of communication practices in architecture : S, M, L, XL, the big event

La tesis doctoral se centra en la posibilidad de entender que la práctica de arquitectura puede encontrar en las prácticas comunicativas un apoyo instrumental, que sobrepasa cualquier simplificación clásica del uso de los medios como una mera aplicación superficial, post-producida o sencillamente promocional. A partir de esta premisa se exponen casos del último cuarto del siglo XX y se detecta que amenazas como el riesgo de la banalización, la posible saturación de la imagen pública o la previsible asociación incorrecta con otros individuos en presentaciones grupales o por temáticas, han podido influir en un crecimiento notable de la adquisición de control, por parte de los arquitectos, en sus oportunidades mediáticas. Esto es, como si la arquitectura hubiera empezado a superar y optimizar algo inevitable, que las fórmulas expositivas y las publicaciones, o más bien del exponer(se) y publicar(se), son herramientas disponibles para activar algún tipo de gestión intelectual de la comunicación e información circulante sobre si misma. Esta práctica de “autoedición” se analiza en un periodo concreto de la trayectoria de OMA -Office for Metropolitan Architecture-, estudio considerado pionero en el uso eficiente, oportunista y personalizado de los medios. Así, la segunda parte de la tesis se ocupa del análisis de su conocida monografía S,M,L,XL (1995), un volumen que contó con gran participación por parte de sus protagonistas durante la edición, y de cuyo proceso de producción apenas se había investigado. Esta publicación señaló un punto de inflexión en su género alterando todo formato y restricciones anteriores, y se ha convertido en un volumen emblemático para la disciplina que ninguna réplica posterior ha podido superar. Aquí se presenta a su vez como el desencadenante de la construcción de un “gran evento” que concluye en la transformación de la identidad de OMA en 10 años, paradójicamente entre el nacimiento de la Fundación Groszstadt y el arranque de la actividad de AMO, dos entidades paralelas clave anexas a OMA. Este planteamiento deviene de cómo la investigación desvela que S,M,L,XL es una pieza más, central pero no independiente, dentro de una suma de acciones e individuos, así como otras publicaciones, exposiciones, eventos y también artículos ensayados y proyectos, en particular Bigness, Generic City, Euralille y los concursos de 1989. Son significativos aspectos como la apertura a una autoría múltiple, encabezada por Rem Koolhaas y el diseñador gráfico Bruce Mau, acompañados en los agradecimientos de la editora Jennifer Sigler y cerca de una centena de nombres, cuyas aportaciones no necesariamente se basan en la construcción de fragmentos del libro. La supresión de ciertos límites permite superar también las tareas inicialmente relevantes en la edición de una publicación. Un objetivo general de la tesis es también la reflexión sobre relaciones anteriormente cuestionadas, como la establecida entre la arquitectura y los mercados o la economía. Tomando como punto de partida la idea de “design intelligence” sugerida por Michael Speaks (2001), se extrae de sus argumentos que lo esencial es el hallazgo de la singularidad o inteligencia propia de cada estudio de arquitectura o diseño. Asimismo se explora si en la construcción de ese tipo de fórmulas magistrales se alojaban también combinaciones de interés y productivas entre asuntos como la eficiencia y la creatividad, o la organización y las ideas. En esta dinámica de relaciones bidireccionales, y en ese presente de exceso de información, se fundamenta la propuesta de una equivalencia más evidenciada entre la “socialización” del trabajo del arquitecto, al compartirlo públicamente e introducir nuevas conversaciones, y la relación inversa a partir del trabajo sobre la “socialización” misma. Como si la consciencia sobre el uso de los medios pudiera ser efectivamente instrumental, y contribuir al desarrollo de la práctica de arquitectura, desde una perspectiva idealmente comprometida e intelectual. ABSTRACT The dissertation argues the possibility to understand that the practice of architecture can find an instrumental support in the practices of communication, overcoming any classical simplification of the use of media, generally reduced to superficial treatments or promotional efforts. Thus some cases of the last decades of the 20th century are presented. Some threats detected, such as the risk of triviality, the saturation of the public image or the foreseeable wrong association among individuals when they are introduced as part of thematic groups, might have encouraged a noticeable increase of command taken by architects when there is chance to intervene in a media environment. In other words, it can be argued that architecture has started to overcome and optimize the inevitable, the fact that exhibition formulas and publications, or simply the practice of (self)exhibition or (self)publication, are tools at our disposal for the activation of any kind of intellectual management of communication and circulating information about itself. This practice of “self-edition” is analyzed in a specific timeframe of OMA’s trajectory, an office that is considered as a ground-breaking actor in the efficient and opportunistic use of media. Then the second part of the thesis dissects their monograph S,M,L,XL (1995), a volume in which its main characters were deeply involved in terms of edition and design, a process barely analyzed up to now. This publication marked a turning point in its own genre, disrupting old formats and traditional restrictions. It became such an emblematic volume for the discipline that none of the following attempts of replica has ever been able to improve this precedent. Here, the book is also presented as the element that triggers the construction of a “big event” that concludes in the transformation of OMA identity in 10 years. Paradoxically, between the birth of the Groszstadt Foundation and the early steps of AMO, both two entities parallel and connected to OMA. This positions emerge from how the research unveils that S,M,L,XL is one more piece, a key one but not an unrelated element, within a sum of actions and individuals, as well as other publications, exhibitions, articles and projects, in particular Bigness, Generic City, Euralille and the competitions of 1989. Among the remarkable innovations of the monograph, there is an outstanding openness to a regime of multiple authorship, headed by Rem Koolhaas and the graphic designer Bruce Mau, who share the acknowledgements page with the editor, Jennifer Sigler, and almost 100 people, not necessarily responsible for specific fragments of the book. In this respect, the dissolution of certain limits made possible that the expected tasks in the edition of a publication could be trespassed. A general goal of the thesis is also to open a debate on typically questioned relations, particularly between architecture and markets or economy. Using the idea of “design intelligence”, outlined by Michael Speaks in 2001, the thesis pulls out its essence, basically the interest in detecting the singularity, or particular intelligence of every office of architecture and design. Then it explores if in the construction of this kind of ingenious formulas one could find interesting and useful combinations among issues like efficiency and creativity, or organization and ideas. This dynamic of bidirectional relations, rescued urgently at this present moment of excess of information, is based on the proposal for a more evident equivalence between the “socialization” of the work in architecture, anytime it is shared in public, and the opposite concept, the work on the proper act of “socialization” itself. As if a new awareness of the capacities of the use of media could turn it into an instrumental force, capable of contributing to the development of the practice of architecture, from an ideally committed and intelectual perspective.

Setting parameters in MRP for the effective management of bought-out inventory in a JIT assembly environment

In recent years, UK industry has seen an explosive growth in the number of `Computer Aided Production Management' (CAPM) system installations. Of the many CAPM systems, materials requirement planning/manufacturing resource planning (MRP/MRPII) is the most widely implemented. Despite the huge investments in MRP systems, over 80 percent are said to have failed within 3 to 5 years of installation. Many people now assume that Just-In-Time (JIT) is the best manufacturing technique. However, those who have implemented JIT have found that it also has many problems. The author argues that the success of a manufacturing company will not be due to a system which complies with a single technique; but due to the integration of many techniques and the ability to make them complement each other in a specific manufacturing environment. This dissertation examines the potential for integrating MRP with JIT and Two-Bin systems to reduce operational costs involved in managing bought-out inventory. Within this framework it shows that controlling MRP is essential to facilitate the integrating process. The behaviour of MRP systems is dependent on the complex interactions between the numerous control parameters used. Methodologies/models are developed to set these parameters. The models are based on the Pareto principle. The idea is to use business targets to set a coherent set of parameters, which not only enables those business targets to be realised, but also facilitates JIT implementation. It illustrates this approach in the context of an actual manufacturing plant - IBM Havant. (IBM Havant is a high volume electronics assembly plant with the majority of the materials bought-out). The parameter setting models are applicable to control bought-out items in a wide range of industries and are not dependent on specific MRP software. The models have produced successful results in several companies and are now being developed as commercial products.

The planning and management of health for development:a model for Zimbabwe

In this thesis, I view the historical background of Zimbabwe to show the patterns of traditional life that existed prior to settlerism. The form, nature, pace and impact of settlerism and colonialism up to the time of independence are also discussed to show how they affected the health of the population and the pace of development of the country. The political, social and economic underdevelopment of the African people that occurred in Zimbabwe prior to independence was a result of deliberate, politically motivated and controlled policy initiatives. These led to inequatable, inadequate, inappropriate and inaccessible health care provision. It is submitted that since it was the politics that determined the pace of underdevelopment, it must be the politics that must be at the forefront of the development strategy adopted. In the face of the amed conflict that existed in Zimbabwe, existing frameworks of analyses are shown to be inadequate for planning purposes because of their inability to provide indications about the stability of future outcomes. The Metagame technique of analysis of options is proposed as a methology that can be applied in such situations. It rejects deterministic predicative models as misleading and advocates an interactive model based on objective and subjective valuation of human behaviour. In conclusion, the search for stable outcomes rather than optimal and best solutions strategies is advocated in decision making in organisations of all sizes.

Servitization of manufacture:exploring the deployment and skills of people critical to the delivery of advanced services

Purpose - This "research note" sets out to fuel the debate around the practices and technologies within operations that are critical to success with servitization. It presents a study of four companies which are delivering advanced services and reports on the organisation and skill-sets of people within these. Design/methodology/approach - This has been case-based research at four manufacturers leading in their delivery of services. Findings - It describes the desirable behaviour of people in the front-line of service delivery, identifies the supporting skill-sets, how these people are organised, and explains why all these factors are so important. Originality/value - This paper contributes to the understanding of the servitization process and, in particular, the implications to broader operations of the firm. © 2013 Emerald Group Publishing Limited. All rights reserved.

Innovative biomarkers for predicting type 2 diabetes mellitus:relevance to dietary management of frailty in older adults

Type 2 diabetes mellitus (T2DM) increases in prevalence in the elderly. There is evidence for significant muscle loss and accelerated cognitive impairment in older adults with T2DM; these comorbidities are critical features of frailty. In the early stages of T2DM, insulin sensitivity can be improved by a “healthy” diet. Management of insulin resistance by diet in people over 65 years of age should be carefully re-evaluated because of the risk for falling due to hypoglycaemia. To date, an optimal dietary programme for older adults with insulin resistance and T2DM has not been described. The use of biomarkers to identify those at risk for T2DM will enable clinicians to offer early dietary advice that will delay onset of disease and of frailty. Here we have used an in silico literature search for putative novel biomarkers of T2DM risk and frailty. We suggest that plasma bilirubin, plasma, urinary DPP4-positive microparticles and plasma pigment epithelium-derived factor merit further investigation as predictive biomarkers for T2DM and frailty risk in older adults. Bilirubin is screened routinely in clinical practice. Measurement of specific microparticle frequency in urine is less invasive than a blood sample so is a good choice for biomonitoring. Future studies should investigate whether early dietary changes, such as increased intake of whey protein and micronutrients that improve muscle function and insulin sensitivity, affect biomarkers and can reduce the longer term complication of frailty in people at risk for T2DM.