Theory-based self-management programs for promoting recovery in community-dwelling stroke survivors : a systematic review

Background Post-stroke recovery is demanding. Increasing studies have examined the effectiveness of self-management programs for stroke survivors. However no systematic review has been conducted to summarize the effectiveness of theory-based stroke self-management programs. Objectives The aim is to present the best available research evidence about effectiveness of theory-based self-management programs on community-dwelling stroke survivors’ recovery. Inclusion criteria Types of participants All community-residing adults aged 18 years or above, and had a clinical diagnosis of stroke. Types of interventions Studies which examined effectiveness of a self-management program underpinned by a theoretical or conceptual framework for community-dwelling stroke survivors. Types of studies Randomized controlled trials. Types of outcomes Primary outcomes included health-related quality of life and self-management behaviors. Secondary outcomes included physical (activities of daily living), psychological (self-efficacy, depressive symptoms), and social outcomes (community reintegration, perceived social support). Search Strategy A three-step approach was adopted to identify all relevant published and unpublished studies in English or Chinese. Methodological quality The methodological quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal checklist for experimental studies. Data Collection A standardized JBI data extraction form was used. There was no disagreement between the two reviewers on the data extraction results. Data Synthesis There were incomplete details about the number of participants and the results in two studies, which makes it impossible to perform meta-analysis. A narrative summary of the effectiveness of stroke self-management programs is presented. Results Three studies were included. The key issues of concern in methodological quality included insufficient information about random assignment, allocation concealment, reliability and validity of the measuring instruments, absence of intention-to-treat analysis, and small sample sizes. The three programs were designed based on the Stanford Chronic Disease Self-management program and were underpinned by the principles of self-efficacy. One study showed improvement in the intervention group in family and social roles three months after program completion, and work productivity at six months as measured by the Stroke Specific Quality of Life Scale (SSQOL). The intervention group also had an increased mean self-efficacy score in communicating with physicians six months after program completion. The mean changes from baseline in these variables were significantly different from the control group. No significant difference was found in time spent in aerobic exercise between the intervention and control groups at three and six months after program completion. Another study, using SSQOL, showed a significant interaction effect by treatment and time on family roles, fine motor tasks, self-care, and work productivity. However there was no significant interaction by treatment and time on self-efficacy. The third study showed improvement in quality of life, community participation, and depressive symptoms among the participants receiving the stroke self-management program, Stanford Chronic Disease Self-management program, or usual care six months after program completion. However, there was no significant difference between the groups. Conclusions There is inconclusive evidence about the effectiveness of theory-based stroke self-management programs on community-dwelling stroke survivors’ recovery. However the preliminary evidence suggests potential benefits in improving stroke survivors’ quality of life and self-efficacy.

A conceptualization of knowledge governance in project-based organizations

This paper conceptualizes and defines knowledge governance (KG) in project-based organizations (PBOs). Two key contributions towards a multi-faceted view of KG and an understanding of KG in PBOs are advanced, as distinguished from knowledge management and organizational learning concepts. The conceptual framework addresses macro- and micro-level elements of KG and their interaction. Our definition of KG in PBOs highlights the contingent nature of KG processes in relation to their organizational context. These contributions provide a novel platform for understanding KG in PBOs.

Co-morbidity of depression and anxiety in common age-related eye diseases : a population-based study of 662 adults

This study examined the prevalence of co-morbid age-related eye disease and symptoms of depression and anxiety in late life, and the relative roles of visual function and disease in explaining symptoms of depression and anxiety. A community-based sample of 662 individuals aged over 70 years was recruited through the electoral roll. Vision was measured using a battery of tests including high and low contrast visual acuity, contrast sensitivity, motion sensitivity, stereoacuity, Useful Field of View, and visual fields. Depression and anxiety symptoms were measured using the Goldberg scales. The prevalence of self-reported eye disease [cataract, glaucoma, or age-related macular degeneration (AMD)] in the sample was 43.4%, with 7.7% reporting more than one form of ocular pathology. Of those with no eye disease, 3.7% had clinically significant depressive symptoms. This rate was 6.7% among cataract patients, 4.3% among those with glaucoma, and 10.5% for AMD. Generalized linear models adjusting for demographics, general health, treatment, and disability examined self-reported eye disease and visual function as correlates of depression and anxiety. Depressive symptoms were associated with cataract only, AMD, comorbid eye diseases and reduced low contrast visual acuity. Anxiety was significantly associated with self-reported cataract, and reduced low contrast visual acuity, motion sensitivity and contrast sensitivity. We found no evidence for elevated rates of depressive or anxiety symptoms associated with self-reported glaucoma. The results support previous findings of high rates of depression and anxiety in cataract and AMD, and in addition show that mood and anxiety are associated with objective measures of visual function independently of self-reported eye disease. The findings have implications for the assessment and treatment of mental health in the context of late-life visual impairment...

An extensible framework for analysing resource behaviour using event logs

Business processes depend on human resources and managers must regularly evaluate the performance of their employees based on a number of measures, some of which are subjective in nature. As modern organisations use information systems to automate their business processes and record information about processes’ executions in event logs, it now becomes possible to get objective information about resource behaviours by analysing data recorded in event logs. We present an extensible framework for extracting knowledge from event logs about the behaviour of a human resource and for analysing the dynamics of this behaviour over time. The framework is fully automated and implements a predefined set of behavioural indicators for human resources. It also provides a means for organisations to define their own behavioural indicators, using the conventional Structured Query Language, and a means to analyse the dynamics of these indicators. The framework's applicability is demonstrated using an event log from a German bank.

Sectional analysis of the pollutant wash-off process based on runoff hydrograph

The validity of using rainfall characteristics as lumped parameters for investigating the pollutant wash-off process such as first flush occurrence is questionable. This research study introduces an innovative concept of using sector parameters to investigate the relationship between the pollutant wash-off process and different sectors of the runoff hydrograph and rainfall hyetograph. The research outcomes indicated that rainfall depth and rainfall intensity are two key rainfall characteristics which influence the wash-off process compared to the antecedent dry period. Additionally, the rainfall pattern also plays a critical role in the wash-off process and is independent of the catchment characteristics. The knowledge created through this research study provides the ability to select appropriate rainfall events for stormwater quality treatment design based on the required treatment outcomes such as the need to target different sectors of the runoff hydrograph or pollutant species. The study outcomes can also contribute to enhancing stormwater quality modelling and prediction in view of the fact that conventional approaches to stormwater quality estimation is primarily based on rainfall intensity rather than considering other rainfall parameters or solely based on stochastic approaches irrespective of the characteristics of the rainfall event.

The environmental enigma : why do producers professing stewardship continue to practice poor natural resource management?

Despite a wide acceptance that primary producers in Australia subscribe to a stewardship ethic, land and water degradation remains an ongoing problem. Recent calculations suggest that the economic cost of Australia's environmental degradation is amounting to more than $A3.5 billion a year with an estimated cost of managing (not overcoming) problems of salinity, acidification, soil erosion totalling $A60 billion over the next decade. This paper argues that stewardship itself is an unsatisfactory concept when looking to landholders to respond to environmental problems, for rarely does the attitude of stewardship translate into behaviours of improving natural resource management practices on private land. Whilst there is some acceptance of the environmental problem among primary producers, a number of external constraints may also impede the uptake of conservation-orientated practices. In light of the prevailing accounts of poor adoption of sustainable practices a number of policy options are reviewed in this paper, including formal regional partnerships, regulatory frameworks and market-based measures. It is concluded that the contentious nature of some of these new opportunities for change will mean that any moves aimed at reversing environmental degradation in Australia will be slow.

Genuine community engagement in remote dryland regions : natural resource management in Lake Eyre Basin

Remote dryland regions are characterised by sparse populations and socially marginalised voices which pose particular challenges to natural resource management. This paper considers the issue of how to achieve community engagement in regions with these characteristics. In doing so, the paper contributes to an expanding international research agenda focusing on the distinct characteristics of arid and semi-arid regions under the heading of 'dryland syndrome'. The paper draws on government liaison officer and local community perspectives of successful engagement in the case-study region of Lake Eyre Basin, Australia. The results demonstrate that widely recognised characteristics of successful engagement are required but insufficient for genuine engagement in remote dryland regions. In addition to building trust through community ownership, being inclusive, effective communication, and adequate resources, genuine community engagement in drylands also requires respecting the extreme conditions and extraordinary variability of these areas. Residents of dryland regions seek genuine engagement yet engage opportunistically when seasons are conducive and when tangible outcomes are visible. © 2011 The Authors. Geographical Research © 2011 Institute of Australian Geographers.

A distributed control based coordination scheme of household PV systems for overvoltage prevention

This paper presents a distributed communication based active power curtailment (APC) control scheme for grid connected photovoltaic (PV) systems to address voltage rise. A simple distribution feeder model is presented and simulated using MATLAB. The resource sharing based control scheme proposed is shown to be effective at reducing voltage rise during times of peak generation and low load. Simulations also show the even distribution of APC using simple communications. Simulations demonstrate the versatility of the proposed control method under major communication failure conditions. Further research may lead to possible applications in coordinated electric vehicle (EV) charging.

The Implications of Activity Based Funding for Emergency Departments : A Comprehensive Literature Review

Executive Summary Emergency Departments (EDs) locally, nationally and internationally are becoming increasingly busy. Within this context, it can be challenging to deliver a health service that is safe, of high quality and cost-effective. Whilst various models are described within the literature that aim to measure ED ‘work’ or ‘activity’, they are often not linked to a measure of costs to provide such activity. It is important for hospital and ED managers to understand and apply this link so that optimal staffing and financial resourcing can be justifiably sought. This research is timely given that Australia has moved towards a national Activity Based Funding (ABF) model for ED activity. ABF is believed to increase transparency of care and fairness (i.e. equal work receives equal pay). ABF involves a person-, performance- or activity-based payment system, and thus a move away from historical “block payment” models that do not incentivise efficiency and quality. The aim of the Statewide Workforce and Activity-Based Funding Modelling Project in Queensland Emergency Departments (SWAMPED) is to identify and describe best practice Emergency Department (ED) workforce models within the current context of ED funding that operates under an ABF model. The study is comprised of five distinct phases. This monograph (Phase 1) comprises a systematic review of the literature that was completed in June 2013. The remaining phases include a detailed survey of Queensland hospital EDs’ resource levels, activity and operational models of care, development of new resource models, development of a user-friendly modelling interface for ED mangers, and production of a final report that identifies policy implications. The anticipated deliverable outcome of this research is the development of an ABF based Emergency Workforce Modelling Tool that will enable ED managers to profile both their workforce and operational models of care. Additionally, the tool will assist with the ability to more accurately inform adequate staffing numbers required in the future, inform planning of expected expenditures and be used for standardisation and benchmarking across similar EDs. Summary of the Findings Within the remit of this review of the literature, the main findings include: 1. EDs are becoming busier and more congested Rising demand, barriers to ED throughput and transitions of care all contribute to ED congestion. In addition requests by organisational managers and the community require continued broadening of the scope of services required of the ED and further increases in demand. As the population live longer with more lifestyle diseases their propensity to require ED care continues to grow. 2. Various models of care within EDs exist Models often vary to account for site specific characteritics to suit staffing profile, ED geographical location (e.g. metropolitan or rural site), and patient demographic profile (e.g. paediatrics, older persons, ethnicity). Existing and new models implemented within EDs often depend on the target outcome requiring change. Generally this is focussed on addressing issues at the input, throughput or output areas of the ED. Even with models targeting similar demographic or illness, the structure and process elements underpinning the model can vary, which can impact on outcomes and variance to the patient and carer experience between and within EDs. Major models of care to manage throughput inefficiencies include: A. Workforce Models of Care focus on the appropriate level of staffing for a given workload to provide prompt, timely and clinically effective patient care within an emergency care setting. The studies reviewed suggest that the early involvement of senior medical decision maker and/or specialised nursing roles such as Emergency Nurse Practitioners and Clinical Initiatives Nurse, primary contact or extended scope Allied Health Practitioners can facilitate patient flow and improve key indicators such as length of stay and reducing the number of those who did not wait to be seen amongst others. B. Operational Models of Care within EDs focus on mechanisms for streaming (e.g. fast-tracking) or otherwise grouping patient care based on acuity and complexity to assist with minimising any throughput inefficiencies. While studies support the positive impact of these models in general, it appears that they are most effective when they are adequately resourced. 3. Various methods of measuring ED activity exist Measuring ED activity requires careful consideration of models of care and staffing profile. Measuring activity requires the ability to account for factors including: patient census, acuity, LOS, intensity of intervention, department skill-mix plus an adjustment for non-patient care time. 4. Gaps in the literature Continued ED growth calls for new and innovative care delivery models that are safe, clinically effective and cost effective. New roles and stand-alone service delivery models are often evaluated in isolation without considering the global and economic impact on staffing profiles. Whilst various models of accounting for and measuring health care activity exist, costing studies and cost effectiveness studies are lacking for EDs making accurate and reliable assessments of care models difficult. There is a necessity to further understand, refine and account for measures of ED complexity that define a workload upon which resources and appropriate staffing determinations can be made into the future. There is also a need for continued monitoring and comprehensive evaluation of newly implemented workforce modelling tools. This research acknowledges those gaps and aims to: • Undertake a comprehensive and integrated whole of department workforce profiling exercise relative to resources in the context of ABF. • Inform workforce requirements based on traditional quantitative markers (e.g. volume and acuity) combined with qualitative elements of ED models of care; • Develop a comprehensive and validated workforce calculation tool that can be used to better inform or at least guide workforce requirements in a more transparent manner.

Making quality teachers : the role of an explicit values-based pedagogy

There is little conjecture that quality teaching is essential to student achievement and well-being. Whilst much has been written about the importance of quality teaching, including the link to pre-service teacher education, to date there has been little investigation into specific pedagogical practices that can enhance quality teaching dimensions within a pre-service teacher education programme. This paper reports on a small-scale qualitative research study, undertaken in an Australian university, which linked the fields of quality teaching, pre-service teacher education and values education. The study followed the journey of five pre-service teacher education students as they undertook their second field experience unit where the focus was centred on the values-based pedagogy of Philosophy in the Classroom. The research findings, collected via interviews, demonstrated that an explicit values-based pedagogy can have a positive impact on the development of quality teaching dimensions. This new knowledge has potential for further research into examining the ways quality teaching dimensions are gained and practised by pre-service teacher education students and these findings and recommendations are discussed in this paper.

Space as a resource in creative design practices

Based on longitudinal ethnographic fieldwork in two industrial design departments and two design companies, we explore the role of spatial arrangements for supporting creative design practices within different design studios. From our results, we show that designers explicitly make use of the physical space for: 1) communicating and inspiring design ideas; 2) exploring design solutions, and; 3) managing design projects. We believe that these design practices could bring insightful implications for developing ubiquitous technologies to support the design profession.

An efficient and effective localization method for networked disjoint top-view cameras

Disjoint top-view networked cameras are among the most commonly utilized networks in many applications. One of the open questions for these cameras' study is the computation of extrinsic parameters (positions and orientations), named extrinsic calibration or localization of cameras. Current approaches either rely on strict assumptions of the object motion for accurate results or fail to provide results of high accuracy without the requirement of the object motion. To address these shortcomings, we present a location-constrained maximum a posteriori (LMAP) approach by applying known locations in the surveillance area, some of which would be passed by the object opportunistically. The LMAP approach formulates the problem as a joint inference of the extrinsic parameters and object trajectory based on the cameras' observations and the known locations. In addition, a new task-oriented evaluation metric, named MABR (the Maximum value of All image points' Back-projected localization errors' L2 norms Relative to the area of field of view), is presented to assess the quality of the calibration results in an indoor object tracking context. Finally, results herein demonstrate the superior performance of the proposed method over the state-of-the-art algorithm based on the presented MABR and classical evaluation metric in simulations and real experiments.

Exploring a biomimicry based approach and key barriers to evolving water infrastructure systems

Access to clean water is essential for human life and a critical issue facing much of modern society, especially as a result of the 21st Century triad of challenges – population growth, resource scarcity and pollution – which contribute to the rising complexity of providing adequate access to this essential resource for large parts of society. As such, there is now an increasing need for innovative solutions to source, treat and distribute water to cities across the globe. This position paper explores biomimicry – emulating natural form, function, process and systems – as an alternative and sustainable design approach to traditional water infrastructure systems. The key barriers to innovations such as biomimicry are summarised, indicating that regulatory and economic grounds are some of the major hindrances to integrating alternative design approaches in the water sector in developed countries. This paper examines some of the benefits of moving past these barriers to develop sustainable, efficient and resilient solutions that provide adequate access to water in the face of contemporary challenges.

Carbon, biodiversity and regional natural resource planning : towards high impact next generation plans

Given the increased importance of adaptation debates in global climate negotiations, pressure to achieve biodiversity, food and water security through managed landscape-scale adaptation will likely increase across the globe over the coming decade. In parallel, emerging market-based, terrestrial greenhouse gas abatement programs present a real opportunity to secure such adaptation to climate change through enhanced landscape resilience. Australia has an opportunity to take advantage of such programs through regional planning aspects of its governance arrangements for NRM. This paper explores necessary reforms to Australia's regional NRM planning systems to ensure that they will be better able to direct the nation's emerging GGA programs to secure enhanced landscape adaptation. © 2013 Planning Institute Australia.

Source code watermarking based on function dependency oriented sequencing

In the current market, extensive software development is taking place and the software industry is thriving. Major software giants have stated source code theft as a major threat to revenues. By inserting an identity-establishing watermark in the source code, a company can prove it's ownership over the source code. In this paper, we propose a watermarking scheme for C/C++ source codes by exploiting the language restrictions. If a function calls another function, the latter needs to be defined in the code before the former, unless one uses function pre-declarations. We embed the watermark in the code by imposing an ordering on the mutually independent functions by introducing bogus dependency. Removal of dependency by the attacker to erase the watermark requires extensive manual intervention thereby making the attack infeasible. The scheme is also secure against subtractive and additive attacks. Using our watermarking scheme, an n-bit watermark can be embedded in a program having n independent functions. The scheme is implemented on several sample codes and performance changes are analyzed.