Randomized clinical trial of the timing it right stroke family support program: Research protocol

Background Family caregivers provide invaluable support to stroke survivors during their recovery, rehabilitation, and community re-integration. Unfortunately, it is not standard clinical practice to prepare and support caregivers in this role and, as a result, many experience stress and poor health that can compromise stroke survivor recovery and threaten the sustainability of keeping the stroke survivor at home. We developed the Timing it Right Stroke Family Support Program (TIRSFSP) to guide the timing of delivering specific types of education and support to meet caregivers' evolving needs. The objective of this multi-site randomized controlled trial is to determine if delivering the TIRSFSP across the stroke care continuum improves caregivers' sense of being supported and emotional well-being. Methods/design Our multi-site single-blinded randomized controlled trial will recruit 300 family caregivers of stroke survivors from urban and rural acute care hospitals. After completing a baseline assessment, participants will be randomly allocated to one of three groups: 1) TIRSFSP guided by a stroke support person (health care professional with stroke care experience), delivered in-person during acute care and by telephone for approximately the first six to 12 months post-stroke; 2) caregiver self-directed TIRSFSP with an initial introduction to the program by a stroke support person, or; 3) standard care receiving the educational resource "Let's Talk about Stroke" prepared by the Heart and Stroke Foundation. Participants will complete three follow-up quantitative assessments 3, 6, and 12-months post-stroke. These include assessments of depression, social support, psychological well-being, stroke knowledge, mastery (sense of control over life), caregiving assistance provided, caregiving impact on everyday life, and indicators of stroke severity and disability. Qualitative methods will also be used to obtain information about caregivers' experiences with the education and support received and the impact on caregivers' perception of being supported and emotional well-being. Discussion This research will determine if the TIRSFSP benefits family caregivers by improving their perception of being supported and emotional well-being. If proven effective, it could be recommended as a model of stroke family education and support that meets the Canadian Stroke Best Practice Guideline recommendation for providing timely education and support to families through transitions.

Study protocol of the YOU CALL - WE CALL TRIAL: Impact of a multimodal support intervention after a "mild" stroke

Background More than 60% of new strokes each year are "mild" in severity and this proportion is expected to rise in the years to come. Within our current health care system those with "mild" stroke are typically discharged home within days, without further referral to health or rehabilitation services other than advice to see their family physician. Those with mild stroke often have limited access to support from health professionals with stroke-specific knowledge who would typically provide critical information on topics such as secondary stroke prevention, community reintegration, medication counselling and problem solving with regard to specific concerns that arise. Isolation and lack of knowledge may lead to a worsening of health problems including stroke recurrence and unnecessary and costly health care utilization. The purpose of this study is to assess the effectiveness, for individuals who experience a first "mild" stroke, of a sustainable, low cost, multimodal support intervention (comprising information, education and telephone support) - "WE CALL" compared to a passive intervention (providing the name and phone number of a resource person available if they feel the need to) - "YOU CALL", on two primary outcomes: unplanned-use of health services for negative events and quality of life. Method/Design We will recruit 384 adults who meet inclusion criteria for a first mild stroke across six Canadian sites. Baseline measures will be taken within the first month after stroke onset. Participants will be stratified according to comorbidity level and randomised to one of two groups: YOU CALL or WE CALL. Both interventions will be offered over a six months period. Primary outcomes include unplanned use of heath services for negative event (frequency calendar) and quality of life (EQ-5D and Quality of Life Index). Secondary outcomes include participation level (LIFE-H), depression (Beck Depression Inventory II) and use of health services for health promotion or prevention (frequency calendar). Blind assessors will gather data at mid-intervention, end of intervention and one year follow up. Discussion If effective, this multimodal intervention could be delivered in both urban and rural environments. For example, existing infrastructure such as regional stroke centers and existing secondary stroke prevention clinics, make this intervention, if effective, deliverable and sustainable.

Impact of a stroke unit on length of hospital stay and in-hospital case fatality

Background and Purpose Randomized trials have demonstrated reduced morbidity and mortality with stroke unit care; however, the effect on length of stay, and hence the economic benefit, is less well-defined. In 2001, a multidisciplinary stroke unit was opened at our institution. We observed whether a stroke unit reduces length of stay and in-hospital case fatality when compared to admission to a general neurology/medical ward. Methods A retrospective study of 2 cohorts in the Foothills Medical Center in Calgary was conducted using administrative databases. We compared a cohort of stroke patients managed on general neurology/medical wards before 2001, with a similar cohort of stroke patients managed on a stroke unit after 2003. The length of stay was dichotomized after being centered to 7 days and the Charlson Index was dichotomized for analysis. Multivariable logistic regression was used to compare the length of stay and case fatality in 2 cohorts, adjusted for age, gender, and patient comorbid conditions defined by the Charlson Index. Results Average length of stay for patients on a stroke unit (n=2461) was 15 days vs 19 days for patients managed on general neurology/medical wards (n=1567). The proportion of patients with length of stay >7 days on general neurology/medical wards was 53.8% vs 44.4% on the stroke unit (difference 9.4%; P<0.0001). The adjusted odds of a length of stay >7 days was reduced by 30% (P<0.0001) on a stroke unit compared to general neurology/medical wards. Overall in-hospital case fatality was reduced by 4.5% with stroke unit care. Conclusions We observed a reduced length of stay and reduced in-hospital case-fatality in a stroke unit compared to general neurology/medical wards.

Impact of adolescent peer aggression on later educational and employment outcomes in an Australian cohort

This study used prospective birth cohort data to analyse the relationship between peer aggression at 14 years of age and educational and employment outcomes at 17 years (N = 1091) and 20 years (N = 1003). Participants from the Western Australian Pregnancy Cohort (Raine) study were divided into mutually exclusive categories of peer aggression. Involvement in peer aggression was reported by 40.2% (10.1% victims; 21.4% perpetrators; 8.7% victim–perpetrators) of participants. Participants involved in any form of peer aggression were less likely to complete secondary school. Perpetrators and victim–perpetrators of peer aggression were more likely to be in the ‘No Education, Employment or Training’ group at 20 years of age. This association was explained by non-completion of secondary school. These findings demonstrate a robust association between involvement in peer aggression and non-completion of secondary school, which in turn was associated with an increased risk of poor educational and employment outcomes in early adulthood.

Effect of bond length on the behaviour of CFRP strengthened concrete-filled steel tubes under transverse impact

Concrete-filled steel tubular (CFST) columns have shown great potential as axial load carrying member and used widely in many mission critical infrastructures. However, attention is needed to strengthen these members where transverse impact force is expected to occur due to vehicle collisions. In this work, finite element (FE) model of carbon fibre reinforced polymer (CFRP) strengthened CFST columns are developed and the effect of CFRP bond length is investigated under transverse impact loading. Initially the numerical models have been validated by comparing impact test results from literature. The validated models are then used for detail parametric studies by varying the length of externally bonded CFRP composites. The parameters considered for this research are impact velocity, impact mass, CFRP modulus, adhesive type, and axial static loading. It has been observed that the effect of CFRP strengthening is consistent after an optimum effective bond length of CFRP wrapping. The effect of effective bond length has been studied for above parameters. The results show that, under combined axial static and transverse impact loads CFST columns can successfully prevent global buckling failure by strengthening only 34% of column length. Therefore, estimation of effective bond length is essential to utilise the CFRP composites cost effectively.

Reducing the environmental impact of road construction

The practice of road construction and maintenance is inherently lean and efficient; a result of the economic benefits that are gained by minimizing wasted resources. In this age of conservation and environmental management, the inbuilt sustainability of existing road construction practices is being developed and extended to produce variety of environmentally sustainable options. A new concept of a “sustainable road” has emerged through both academia and industry, and is defined to be a road that is: - constructed to reduce environmental impacts; - designed to optimise the alignment (vertical and horizontal including considerations of ecological constraints and operational use by vehicles); - resilient to future environmental and economic pressures (e.g. climate change and resource scarcity); - adaptable to changing uses including increased travel volumes, greater demand for public and active (cycling and walking) transport, and; - able to harvest the energy to power itself.

How religiosity influences consumption: The impact of consumer religiosity on perceptions of psychological and social risk

For some people, religion is an important influence in decision-making. This thesis investigates the relationship between the religiosity of consumers and their perceived risk in adopting new products. Two studies gathered data from religious consumers living in Saudi Arabia, Australia, Canada, New Zealand, the UK and the USA. The results confirm the significant impact of religion on perceived risk, and suggest why this may lead to delays in adoption. Theoretically, these studies provide a better explanation of how religion influences consumption decisions, and offer brand managers options to improve the adoption of new products in religious markets.

Impact of electric energy storage scheduling on reliability of distribution system

The development of Electric Energy Storage (EES) integrated with Renewable Energy Resources (RER) has increased use of optimum scheduling strategy in distribution systems. Optimum scheduling of EES can reduce cost of purchased energy by retailers while improve the reliability of customers in distribution system. This paper proposes an optimum scheduling strategy for EES and the evaluation of its impact on reliability of distribution system. Case study shows the impact of the proposed strategy on reliability indices of a distribution system.

The impact of project announcements on property values: An empirical analysis

The study examines the property value impacts of an announcement of a project which has potential environmental impacts as distinct from other studies that address costs associated with under-construction and the operating impacts of developments. The hypothesis is that the announcement of a proposed project with potential environmental impact creates uncertainty in the property market of the affected area, and this impact is greater on properties closer to the project than those farther from it. The results of the study confirm the hypothesis and indicate that the marginal willingness to pay for properties within a 5 km distance declined by AU$17,020 per km proximity to the proposed heavy vehicle route, after the proposed route was announced. The results support the need for more holistic measurement of cost–benefit analysis of projects and provide a basis for improved consideration by policy makers of the rights of affected parties.

The impact of the health insurance program on the near-poor in Vietnam

This thesis is a cross-sectional study of a health insurance scheme for a representative sample of the near-poor in Cao Lanh district, Dong Thap province, Vietnam. It examines insurance coverage, health service utilisation, out-of-pocket expenditures and their associated factors. The research findings contribute evidence for policy makers who seek to improve the health insurance scheme for socioeconomically disadvantaged people in Vietnam, which is an important component of national efforts to implement universal health insurance. This community-level research adds to the evidence-base needed to improve the insurance system and thereby influence the quality of health care services.

Keep It Tame: Promoting respect online Safe And Well Online Pilot Study: Evaluating the design, engagement and impact of a social marketing approach aimed at 12 to 18 year olds

This report describes the Year One Pilot Study processes, and articulates findings from the major project components designed to address these challenges noted above (See Figure 1). Specifically, the pilot study tested the campaign research and development process involving participatory design with young people and sector partners, and the efficacy and practicality of conducting a longitudinal, randomised control trial online with minors, including ways oflinking survey data to campaign data. Each sub-study comprehensively considered the ethical requirements of conducting online research with minors in school settings. The theoretical and methodological framework for measuring campaign engagement and efficacy (Sub-studies 3, 4 and 5) drew on the Model of Goal-Directed Behaviour (MGB) (Perugini & Bagozzi 2001) and Nudge Theory (Thaler & Sunstein, 2008).

The effects of NAPLAN: Teacher perceptions of the impact of NAPLAN on pedagogy and curriculum

This paper reports preliminary findings of a survey of in-service teachers in WA and SA conducted in 2012. Participants completed an online survey open to all teachers in WA and SA. The survey ran for three months from April to June 2012. One section of the survey asked teachers to report their perceptions of the impact that NAPLAN has had on the curriculum and pedagogy of their classroom and school. Two principal research questions were addressed in this preliminary analysis. First what are teacher perceptions of the effects on NAPLAN on curriculum and pedagogy? Second, are there any interaction effects between gender, socioeconomics status, location and school system on teachers perceptions? Statistical analyses examined one- and two-way MANOVA to assess main effects and interaction effects on teachers' global perceptions. These were followed by a series of exploratory one- and two-way ANOVA of specific survey items to suggest potential sources for differences among teachers from different socioeconomic regions, states and systems. Teachers report that they are either choosing or being instructed to teach to the test, that this results in less time being spent on other curriculum areas and that these effects contribute in a negative way on the engagement of students. This largely agrees with a body of international research that suggests that high-stakes literacy and numeracy tests often results in unintended consequences such as a narrow curriculum focus (Au, 2007), a return to teacher-centred instruction (Barret, 2009) and a decrease in motivation (Ryan & Wesinstein, 2009). Preliminary results from early survey respondents suggests there is a relationship between participant responses to the effect of NAPLAN on curriculum and pedagogy based on the characteristics of which State the teacher taught in, their perceptions of the socioeconomic status of the school and the school system in which they were employed (State, Catholic, and Independent).

The impact of snares on the continuity of adolescent-onset antisocial behaviour: A test of Moffitt's developmental taxonomy

Moffitt’s dual typology of ‘life-course persistent’ and ‘adolescence limited’ offending has received extensive empirical attention, but the extent to which the antisocial behaviour of adolescence limited offenders is constrained to adolescence is relatively under-examined.Using data from the Australian Mater University Study of Pregnancy and its Outcomes, we explore Moffitt’s concept of snares, or those factors that may lead to an adolescent persisting in antisocial behaviour such as drug addiction, educational failure, and contact with the justice system. The Mater University Study of Pregnancy and its Outcomes is a longitudinal study of mother–child dyads from the pre-natal stage to 21 years of age. Findings show that one-third of individuals identified as having an adolescent onset of antisocial behaviour persisted with this antisocial behaviour as young adults. This continuity can, in part, be explained by snares and the research suggests that reducing exposure to snares may lead to less antisocial behaviour in adulthood.

Computer analysis of impact behavior of concrete filled steel tube columns

This paper presents a numerical study of the response of axially loaded concrete filled steel tube (CFST) columns under lateral impact loading using explicit non-linear finite element techniques. The aims of this paper are to evaluate the vulnerability of existing columns to credible impact events as well as to contribute new information towards the safe design of such vulnerable columns. The model incorporates concrete confinement, strain rate effects of steel and concrete, contact between the steel tube and concrete and dynamic relaxation for pre-loading, which is a relatively recent method for applying a pre-loading in the explicit solver. The finite element model was first verified by comparing results with existing experimental results and then employed to conduct a parametric sensitivity analysis. The effects of various structural and load parameters on the impact response of the CFST column were evaluated to identify the key controlling factors. Overall, the major parameters which influence the impact response of the column are the steel tube thickness to diameter ratio, the slenderness ratio and the impact velocity. The findings of this study will enhance the current state of knowledge in this area and can serve as a benchmark reference for future analysis and design of CFST columns under lateral impact.

The differential impact of monetary policy announcements and explanatory minutes releases on the Australian interest rate futures market

Unlike US and Continental European jurisdictions, Australian monetary policy announcements are not followed promptly by projections materials or comprehensive summaries that explain the decision process. This information is disclosed 2 weeks later when the explanatory minutes of the Reserve Bank board meeting are released. This paper is the first study to exploit the features of the Australian monetary policy environment in order to examine the differential impact of monetary policy announcements and explanatory statements on the Australian interest rate futures market. We find that both monetary policy announcements and explanatory minutes releases have a significant impact on the implied yield and volatility of Australian interest rate futures contracts. When the differential impact of these announcements is examined using the full sample, no statistically significant difference is found. However, when the sample is partitioned based on stable periods and the Global Financial Crisis, a differential impact is evident. Further, contrary to the findings of Kim and Nguyen (2008), Lu et al. (2009), and Smales (2012a), the response along the yield curve, is found to be indifferent between the short and medium terms.