A multicentre randomized controlled trial of an empowerment-inspired intervention for adolescents starting continuous subcutaneous insulin infusion : a study protocol

Background. Continuous subcutaneous insulin infusion (CSII) treatment among children with type 1 diabetes is increasing in Sweden. However, studies evaluating glycaemic control in children using CSII show inconsistent results. Omitting bolus insulin doses using CSII may cause reduced glycaemic control among adolescents. The distribution of responsibility for diabetes self-management between children and parents is often unclear and needs clarification. There is much published support for continued parental involvement and shared diabetes management during adolescence. Guided Self-Determination (GSD) is an empowerment-based, person-centred, reflection and problem solving method intended to guide the patient to become self-sufficient and develop life skills for managing difficulties in diabetes self-management. This method has been adapted for adolescents and parents as Guided Self-Determination-Young (GSD-Y). This study aims to evaluate the effect of an intervention with GSD-Y in groups of adolescents starting on insulin pumps and their parents on diabetes-related family conflicts, perceived health and quality of life (QoL), and metabolic control. Here, we describe the protocol and plans for study enrolment. Methods. This study is designed as a randomized, controlled, prospective, multicentre study. Eighty patients between 12-18 years of age who are planning to start CSII will be included. All adolescents and their parents will receive standard insulin pump training. The education intervention will be conducted when CSII is to be started and at four appointments in the first 4 months after starting CSII. The primary outcome is haemoglobin A1c levels. Secondary outcomes are perceived health and QoL, frequency of blood glucose self-monitoring and bolus doses, and usage of carbohydrate counting. The following instruments will be used to evaluate perceived health and QoL: Disabkids, 'Check your health', the Diabetes Family Conflict Scale and the Swedish Diabetes Empowerment Scale. Outcomes will be evaluated within and between groups by comparing data at baseline, and at 6 and 12 months after starting treatment. Results and discussion. In this study, we will assess the effect of starting an insulin pump together with the model of Guided Self-Determination to determine whether this approach leads to retention of improved glycaemic control, QoL, responsibility distribution and reduced diabetes-related conflicts in the family. Trial registration: Current controlled trials: ISRCTN22444034

How does data quality in a network affect heuristic solutions?

To have good data quality with high complexity is often seen to be important. Intuition says that the higher accuracy and complexity the data have the better the analytic solutions becomes if it is possible to handle the increasing computing time. However, for most of the practical computational problems, high complexity data means that computational times become too long or that heuristics used to solve the problem have difficulties to reach good solutions. This is even further stressed when the size of the combinatorial problem increases. Consequently, we often need a simplified data to deal with complex combinatorial problems. In this study we stress the question of how the complexity and accuracy in a network affect the quality of the heuristic solutions for different sizes of the combinatorial problem. We evaluate this question by applying the commonly used p-median model, which is used to find optimal locations in a network of p supply points that serve n demand points. To evaluate this, we vary both the accuracy (the number of nodes) of the network and the size of the combinatorial problem (p). The investigation is conducted by the means of a case study in a region in Sweden with an asymmetrically distributed population (15,000 weighted demand points), Dalecarlia. To locate 5 to 50 supply points we use the national transport administrations official road network (NVDB). The road network consists of 1.5 million nodes. To find the optimal location we start with 500 candidate nodes in the network and increase the number of candidate nodes in steps up to 67,000 (which is aggregated from the 1.5 million nodes). To find the optimal solution we use a simulated annealing algorithm with adaptive tuning of the temperature. The results show that there is a limited improvement in the optimal solutions when the accuracy in the road network increase and the combinatorial problem (low p) is simple. When the combinatorial problem is complex (large p) the improvements of increasing the accuracy in the road network are much larger. The results also show that choice of the best accuracy of the network depends on the complexity of the combinatorial (varying p) problem.

De anställdas outnyttjade kreativitet : En fallstudie på Ica DE Borlänge

Syftet med examensarbetet var att med utgångspunkt i ett konkret exempel, beskriva hur företag kan organisera verksamheten för att ta till vara på de anställdas outnyttjade kreativitet. Materialet i examensarbetet kan mycket väl tillämpas och användas i andra organisationer än den studerade organisationen Ica DE Borlänge. Dock bör beaktande tas till den specifika kontexten som föreligger vid implementeringen av materialet. Med stöd av den teoretiska referensramen visar resultaten av analysen ett behov av en ny organisationsstruktur med tydliga roller och nya belöningssystem. Den studerade organisationen är en lärande organisation där ett medarbetarengagemang söker främjas. Genom en ny organisationsstruktur med tydliga roller ökar detta medarbetarengagemanget och fler genomförda förbättringar genomförs snabbare, vilket bidrar till att de anställdas outnyttjade kreativitet tillvaratas på ett framgångsrikt sätt. De nya belöningssystemen flyttar fokus till medarbetarengagemanget och förbättringsarbetet, vilket främjar ett genomsyrande Lean-tänkande i organisationen. Belöningssystemen skapar även jämnare produktionsflöden som höjer arbetssäkerheten, ökar produktionskvalitén, minimerar stress samt skapar goda förutsättningar för att beräkna personalbemanningen. Kvalitativa metoder har använts för datainsamlingen. Dessa utfördes genom en förstudie och en fallstudie. Fallstudien bestod utav bakgrundsintervjuer, en intervjustudie samt en observation. Det empiriska materialet visar att organisationen arbetar med ett omfattande förbättringsarbete i alla organisatoriska nivåer. Både chefer och medarbetare har viljan och ambitionen att få till ett framgångsrikt förbättringsarbete, men trots flera års arbete med Lean efterfrågas ändå mer tid, bättre organisationsstruktur samt en sambandskoordinatör med specialistkompetens som driver förbättringsarbetet framåt. Empirin ger en viss indikation på att förbättringsverksamheten har anpassats och organiserats till den befintliga organisationsstrukturen. Förbättringsarbetet torde bli mer framgångsrikt om verksamheten anpassas och organiseras utefter de anställdas outnyttjade kreativitet istället. I summering av slutsatsen åskådliggörs två centrala variabler som kan bidra till långsiktiga framgångar i arbetet med att tillvarata de anställdas outnyttjade kreativitet. En ny organisationsstruktur med tydliga roller som fokuserar på förbättringsarbetet samt nya belöningssystem för inlämnade förbättringsförslag, skulle vara av stor betydelse för ett långsiktigt medarbetarengagemang i en framgångsrik organisation.

End-to-end QoS framework for heterogeneous wired-cum-wireless networks

With information access becoming more and more ubiquitous, there is a need for providingQoSsupport for communication that spans wired and wireless networks. For the wired side, RSVP/SBM has been widely accepted as a flow reservation scheme in IEEE 802 style LANs. Thus, it would be desirable to investigate the integration of RSVP and a flow reservation scheme in wireless LANs, as an end-to-end solution for QoS guarantee in wired-cum-wireless networks. For this purpose, we propose WRESV, a lightweight RSVPlike flow reservation and admission control scheme for IEEE 802.11 wireless LANs. Using WRESV, wired/wireless integration can be easily implemented by cross-layer interaction at the Access Point. Main components of the integration are RSVP-WRESV parameter mapping and the initiation of new reservation messages, depending on where senders/receivers are located. In addition, to support smooth roaming of mobile users among different basic service sets (BSS), we devise an efficient handoff scheme that considers both the flow rate demand and network resource availability for continuous QoS support. Furthermore, various optimizations for supporting multicast session and QoS re-negotiation are proposed for better performance improvement. Extensive simulation results showthat the proposed scheme is promising in enriching the QoS support of multimedia applications in heterogeneous wired-cum-wireless networks.

Ensuring quality during monitoring of the learning environment of government primary schools achieved through EUI-PDP for teachers and head teachers

A positive change in the learning environment in schools is visible through ongoing professional development of teachers and administrators. Monitoring the professional development program and providing support to teachers and administrators to transfer their learnings into the school environment ensures some measures of quality. Quality issues led to the launching of the Professional Development Program (PDP) for Primary School Teachers (PSTs) of Sindh by the United Educational Initiative (UEI), a consortium of five Governmental and Non-Governmental Organizations, working under the supervision of Education Sector Reform Assistance (ESRA). Implementation of the UEI-PDP in four districts of Sindh, is ensured by a team of professionals in each district. Recognising that capacity building of district education employees would improve the educational system in the country, 130 Master Trainers were selected, on merit, from the District Education Office for the training of 17,000 teachers and 3000 Head teachers/administrators over a period of two years. This paper developed the design of a Monitoring Process for a Professional Development Program for Primary School Teachers and Administrators. Data was collected through Pre/Post observations, Interviews, Questionnaires and Reports. Such tools make it possible for the monitoring teams to observe, to inquire further, and, along with the Managers, Master Trainers and School Support Team, seek to explain the progress of the program and take corrective action where indicated. Both formative evaluations as well as summative  evaluation techniques are utilized for evaluating the program. The monitoring process that assisted in formative evaluations is described. In order to assist in summative evaluation, data collected through the monitoring process was further developed to categorize the schools where teachers and head teachers are trained. It is hoped that the categorization of the schools may lead to further improvements in those schools which fall in the group for need improvement. It may also initiate further research as to reasons behind why some schools are in the good category and why others fall in the average category.

An improvement to matchmaking algorithms for middle agents

A question frequently asked in multi-agent systems (MASs) concerns the efficient search for suitable agents to solve a specific problem. To answer this question, different types of middle agents are usually employed. The performance of middle agents relies heavily on the matchmaking algorithms used. Matchmaking is the process of finding an appropriate provider for a requester through a middle agent. There has been substantial work on matchmaking in different kinds of middle agents. To our knowledge, almost all currently used matchmaking algorithms missed one point when doing matchmaking -- the matchmaking is only based on the advertised capabilities of provider agents. The actual performance of provider agents in accomplishing delegated tasks is not considered at all. This results in the inaccuracy of the matchmaking outcomes as well as the random selection of provider agents with the same advertised capabilities. The quality of service of different service provider agents varies from one agent to another even though they claimed they have the same capabilities. To this end, it is argued that the practical performance of service provider agents has a significant impact on the matchmaking outcomes of middle agents. An improvement to matchmaking algorithms is proposed, which makes the algorithms have the ability to consider the track records of agents in accomplishing delegated tasks. How to represent, accumulate, and use track records as well as how to give initial values for track records in the algorithm are discussed. A prototype is also built to verify the algorithm. Based on the improved algorithm, the matchmaking outcomes are more accurate and reasonable.

Has quality management run its course? Views from the field

The aim of this paper is to assess and reflect on, through the perspectives of Australian Quality practitioners, the current status of quality management; whether there had been any significant and recent shift in their roles and responsibilities; and if there had been any improvement in the extent to which their development and training needs were being fulfilled. This paper sets out to identify the roles, responsibilities, and training and development needs of Australian quality managers and what impact these may be having on the current 'quality agenda' of organisations in Australia. In light of these findings this paper focuses on the HR people aspects of QM implementation (e.g. development of a quality culture; learning, training and development; leadership and management commitment and support) and the significance of these aspects for sustainable QM implementation. Recent literature On QM implementation and the findings of three previously conducted surveys (Waddell 1998; Waddell and Mallen 2001; and Stewart and Waddell 2003) have been integrated with the findings of this research.

Milkfat characteristics and functionality: opportunities for improvement

Manipulation of the composition of milkfat has the potential to improve the nutritional properties and physical functionality of milkfat and its acceptability in the market. The modifications that have been targeted from a nutritional perspective have included:
(a) reducing the ratio of saturated to unsaturated fatty acids;
(b) increasing the level of omega-3 polyunsaturated fatty acids; and
(c) increasing the content of conjugated linoleic acid.
From a physical functionality viewpoint, the outcome targeted has been an improvement in the spreadability of butter by altering milkfat composition to reduce the hardness of milkfat. Both on-farm strategies and the application of appropriate post-farm processing technologies may be used to alter the milkfat composition to enhance its nutritional image and its physical functionality for a range of product applications. However, changes in milkfat composition that are desirable for a specific nutritional purpose or for one type of milk-based product may not meet all the desirable requirements of another milkfat or dairy product. Furthermore, modification of the milkfat composition can also have an influence on the processing characteristics of milk and the quality of finished dairy products. It is essential to substantiate the benefits of specific target nutritional or physical functionality outcomes before the introduction of breeding goals, altered milk production systems or post-farm processing operations to manipulate milkfat composition. This paper reviews the variation in milkfat characteristics and the strategies that have been used to modify milkfat composition to achieve milkfat with altered nutritional and physical functional properties.

Television time and continuous metabolic risk in physically active adults

Purpose: Among Australian adults who met the public health guideline for the minimum health-enhancing levels of physical activity, we examined the dose-response associations of television-viewing time with continuous metabolic risk variables.

Methods: Data were analyzed on 2031 men and 2033 women aged >= 25 yr from the 1999-2000 Australian Diabetes, Obesity and Lifestyle study without clinically diagnosed diabetes or heart disease, who reported at least 2.5 h·wk-1 of moderate- to vigorous-intensity physical activity. Waist circumference, resting blood pressure, and fasting and 2-h plasma glucose, triglycerides, and high-density-lipoprotein cholesterol (HDL-C) were measured. The cross-sectional associations of these metabolic variables with quartiles and hours per day of self-reported television-viewing time were examined separately for men and for women. Analyses were adjusted for age, education, income, smoking, diet quality, alcohol intake, parental history of diabetes, and total physical activity time, as well as menopausal status and current use of postmenopausal hormones for women.

Results: Significant, detrimental dose-response associations of television-viewing time were observed with waist circumference, systolic blood pressure, and 2-h plasma glucose in men and women, and with fasting plasma glucose, triglycerides, and HDL-C in women. The associations were stronger in women than in men, with significant gender interactions observed for triglycerides and HDL-C. Though waist circumference attenuated the associations, they remained statistically significant for 2-h plasma glucose in men and women, and for triglycerides and HDL-C in women.

Conclusions: In a population of healthy Australian adults who met the public health guideline for physical activity, television-viewing time was positively associated with a number of metabolic risk variables. These findings support the case for a concurrent sedentary behavior and health guideline for adults, which is in addition to the public health guideline on physical activity.

Student learning orientations : are there differences between age and gender?

The increasing diversity and mobility of students have challenged universities, world over, to review educational courses and delivery to provide a more satisfying learning environment to students. The continuous improvement of the 'quality' of teaching and learning is one of the key goals of universities endeavouring to fulfil their obligations as learning institutions. Using a revised SPQ2F instrument (Biggs, 2003, Biggs and Leung, 2001), this exploratory study undertakes a comparative analysis of the age and gender differences in the learning orientations of two groups of tertiary students in an Australian University. The results indicate that there are no significant differences in the learning orientations of students but on average they seem to demonstrate deep learning than surface learning although they may differ in terms of the learning contexts.

Academic pedagogies, quality logics and performative universities : evaluating teaching and what students want

Universities have focused on teaching and learning at a time when quality has become the marker of distinction in international higher education markets. Education markets have meant pedagogical relations have become contractualised with a focus on student satisfaction, exemplified in consumer-oriented generic evaluations of teaching. This article argues, by analysing one example, that generic evaluations are more about accountability and marketing than about improvement of teaching and learning. Furthermore, what students want is not the only criterion for judging teaching. Rather, professionals require, as do academics, a capacity for critical judgement about what constitutes valued knowledge in the pedagogical relationship between teacher and student.

Using large group methods to develop effective quality cultures

It has become evident that higher education institutions in the Sultanate of Oman are currently experiencing change, in particular when it involves implementing quality management systems. The underlying principles of quality management are participatory decision making. Our methods for conducting improvements in quality management, strategic planning and other topics model this principle. Large group methods or interventions involve gathering an entire organization to talk about, influence or invent needed changes (Bunker & Alban, 2002). Change is a result of purposeful social construction by organizational members. It involves a goal (approach/plan), implementation (deployment/act/so), evaluation (results/check) and modification (improvement). This paper explores the different large group methods being used in the field today and it proposes that large group methods allow a forum to overcome some of the hurdles and challenges that are being faced in Oman such as; How do you encourage sharing information in a fiercely competitive environment? And how do you establish an informal network of peers? We were witness to some of these challenges being over come when we used large group methods during various strategic planning workshops with members of staff from the different colleges in Oman. Results from the evaluations of the workshops highlighted that participants enjoyed the opportunity to network and share ideas with their peers as well as being involved in group discussions and brainstorming ideas. The paper will also propose that large group methods can be used effectively in Omani culture strengthening goals towards Omanisation.

Water quality, bacterial flora and production in shrimp farms in Sri Lanka

This study investigated the possibilities of improvement in the brackish water shrimp culture industry in Sri Lanka. Feeding rates could be further reduced without negative effect on shrimp growth while improving effluent water quality. Improvements of feed quality and pond management practices were also suggested.

Volunteering and quality of life of the older age population

The contribution of volunteers to society and economy is substantial. The participation in voluntary work is on the increase, particularly by the over 55 age group. Given the aging of the Australian population, this growth has an important social consequence. The aim of this conceptual study is to review the influences of older age Australian volunteering practice, its growth pattern and the types of voluntary work undertaken. The study uses the expectancy theory of motivation to argue that volunteers participate for the perceived benefits they get from their interaction with others, by experiencing self-esteem from being useful, being connected, gaining self-satisfaction, and by focusing on giving. It reviews the issue of quality of life (QOL) in relation to voluntary social engagement and suggests that there is an association between the older age group voluntarism and improvement in their QOL. The role of policy makers in further motivating larger participation by the older age groups and the social benefits emerging from this strategy is briefly reviewed.