Multiple pharmacological interventions targeting cardiovascular disease risk factors in individuals with type 2 diabetes - systematic review

Background:
The use of pharmacological agents has been shown to slow down the progression of microvascular and macrovascular complications. Most clinical trials address one pharmacological intervention at a time. To date, only a few studies explored multi-factorial pharmacological interventions in T2DM individuals for preventing CVD related complications. Given the current therapeutic inertia in pharmacological management of CVD risk factors, it is important to establish the benefits of a more holistic approach. Therefore, the aim of this review is to assess the efficacy of multiple pharmacological interventions for cardiovascular diseases (CVD) risk factors with or without conventional care in reducing all cause mortality, CVD mortality, stroke and cardiovascular events among adults with type 2 diabetes. Current evidence fails to support the benefit of multiple pharmacological interventions on all cause mortality and death from cardiovascular causes. However, beneficial effects were seen on the reduction of the overall number of cardiovascular events and there were promising trends for secondary outcomes such as stroke, myocardial infarction, revascularisation and amputation.

Second-year pre-service teachers’ responses to proportional reasoning test items

A recent international study of pre-service teachers identified that proportional reasoning was problematic for pre-service teachers. Proportional reasoning is an important topic in the middle years of schooling and therefore it is critical that teachers understand this topic and can rely on their Mathematical Content Knowledge (MCK) when teaching. The focus of this paper is second-year Australian primary pre-service teachers’ MCK of real number items related to ratio, rate, proportion and proportional reasoning. This paper reports on strengths and weakness of pre-service teachers’ MCK when responding to test items; including a method suitable for analysing responses to five items and ranked by three levels of difficulty. The results revealed insights into their correct methods of solutions and common incorrect responses, identifying difficulty, where multiplication and division were required. The method of coding test items by difficulty ranking may assist with developing an appropriate learning trajectory, which will assist pre-service teachers develop their MCK of this and other difficult topics.

Mathematics: Launching Futures Proceedings of the 24th Biennial Conference of The Australian Association of Mathematics Teachers Inc.

‘Mathematics: Launching Futures’ was the theme for the 24th Biennial Conference of The Australian Association of Mathematics Teachers Inc.It was the first national conference on mathematics education since the introduction of the Australian Curriculum and so addresses the support educators will need to implement this curriculum. It also addressed concerns regarding  the low numbers of students studying higher level mathematics at school and university. A major aim of the conference was the sharing of knowledge to encourage  and support teachers at all
stages of their careers. This conference featured a joint day with the 36th Annual Conference of the Mathematics Education Research Group of Australasia (MERGA), aiming to enhance collaboations between researchers and teachers.

Quasi-decentralized functional observers for the LFC of interconnected power systems

This letter presents a novel approach to the load-frequency control (LFC) of interconnected power systems. Based on functional observers theory, quasi-decentralized functional observers (QDFOs) are designed to implement any given global PI state feedback controller. The designed functional observers are decoupled from each other and also of low-order; thus, they are cost effective and easy to implement. Although the proposed approach is applicable to N- area power systems, an example of a two-area interconnected power system with reheat thermal turbines is considered for simplicity.

Negotiating place and space in a school-wide curriculum innovation: a place for the animals

School-wide curriculum innovations are complex fields of practice, held together by a cast of heterogeneous actors who put various and diverse discourses to work in their everyday efforts to shape their work. This paper draws upon ethnographic data collected in a large regional primary school that since the beginning of 2012 has implemented a school-wide science specialism. In this paper, we focus on one feature of the initiative - classroom animals. We explore the discursive construction of ‘classroom animals' in relation to teachers work and student learning, framing our discussion around three dichotomies found in the data that raise questions about: the nature of science education; what it means to be a good teacher in this context; and, what it means to be a good classroom animal. Tensions between canonical, disciplinary approaches to science education and broader, cross-curricular and critical approaches contribute to the broad context of this paper, and implications for embedding science teaching and learning in the everyday work of primary teachers and students are discussed.

Empirical investigation of decision tree ensembles for monitoring cardiac complications of diabetes

Cardiac complications of diabetes require continuous monitoring since they may lead to increased morbidity or sudden death of patients. In order to monitor clinical complications of diabetes using wearable sensors, a small set of features have to be identified and effective algorithms for their processing need to be investigated. This article focuses on detecting and monitoring cardiac autonomic neuropathy (CAN) in diabetes patients. The authors investigate and compare the effectiveness of classifiers based on the following decision trees: ADTree, J48, NBTree, RandomTree, REPTree, and SimpleCart. The authors perform a thorough study comparing these decision trees as well as several decision tree ensembles created by applying the following ensemble methods: AdaBoost, Bagging, Dagging, Decorate, Grading, MultiBoost, Stacking, and two multi-level combinations of AdaBoost and MultiBoost with Bagging for the processing of data from diabetes patients for pervasive health monitoring of CAN. This paper concentrates on the particular task of applying decision tree ensembles for the detection and monitoring of cardiac autonomic neuropathy using these features. Experimental outcomes presented here show that the authors' application of the decision tree ensembles for the detection and monitoring of CAN in diabetes patients achieved better performance parameters compared with the results obtained previously in the literature.

Frequency of CSF oligoclonal banding in multiple sclerosis increases with latitude

With the advent of MRI scanning, the value of lumbar puncture to assess oligoclonal band (OCB) status-for the diagnosis of multiple sclerosis (MS) is increasingly uncertain. One major issue is that the reported frequency of cerebrospinal fluid (CSF)-restricted oligoclonal banding for the diagnosis of MS varies considerably in different studies. In addition, the relationship between OCB positivity and disease outcome remains uncertain, as reported studies are generally too small to assess comparative disability outcomes with sufficient power. In order to further investigate variation of OCB positivity in patients with MS, we utilized MSBase, a longitudinal, Web-based collaborative MS outcomes registry following clinical cohorts in several continents and latitudes. We also assessed whether OCB positivity affects long-term disability outcome. A total of 13,242 patient records were obtained from 37 MS specialist centres in 19 different countries. OCB status was documented in 4481 (34%) patients and 80% of these were OCB positive. The presence of OCB was associated with degree of latitude (p = 0.02). Furthermore, the outcome of patients negative for CSF-specific OCB was significantly better in comparison to the OCB positive patients, as assessed by Expanded Disability Status Scale change (p < 0.001). The results of this study indicate that latitude could explain some of the inconsistencies in OCB status reported in different populations. The study confirms that OCB positivity in MS is associated with a worse long-term prognosis.

Persistence on therapy and propensity matched outcome comparison of two subcutaneous interferon beta 1a dosages for multiple sclerosis

To compare treatment persistence between two dosages of interferon β-1a in a large observational multiple sclerosis registry and assess disease outcomes of first line MS treatment at these dosages using propensity scoring to adjust for baseline imbalance in disease characteristics. Treatment discontinuations were evaluated in all patients within the MSBase registry who commenced interferon β-1a SC thrice weekly (n = 4678). Furthermore, we assessed 2-year clinical outcomes in 1220 patients treated with interferon β-1a in either dosage (22 µg or 44 µg) as their first disease modifying agent, matched on propensity score calculated from pre-treatment demographic and clinical variables. A subgroup analysis was performed on 456 matched patients who also had baseline MRI variables recorded. Overall, 4054 treatment discontinuations were recorded in 3059 patients. The patients receiving the lower interferon dosage were more likely to discontinue treatment than those with the higher dosage (25% vs. 20% annual probability of discontinuation, respectively). This was seen in discontinuations with reasons recorded as “lack of efficacy” (3.3% vs. 1.7%), “scheduled stop” (2.2% vs. 1.3%) or without the reason recorded (16.7% vs. 13.3% annual discontinuation rate, 22 µg vs. 44 µg dosage, respectively). Propensity score was determined by treating centre and disability (score without MRI parameters) or centre, sex and number of contrast-enhancing lesions (score including MRI parameters). No differences in clinical outcomes at two years (relapse rate, time relapse-free and disability) were observed between the matched patients treated with either of the interferon dosages. Treatment discontinuations were more common in interferon β-1a 22 µg SC thrice weekly. However, 2-year clinical outcomes did not differ between patients receiving the different dosages, thus replicating in a registry dataset derived from “real-world” database the results of the pivotal randomised trial. Propensity score matching effectively minimised baseline covariate imbalance between two directly compared sub-populations from a large observational registry.