Integrated chronic disease management in primary-secondary care : a systematic literature review of the evidence

Introduction: Diabetes has traditionally been managed as a single chronic disease state, but it exists with co-morbidities such as depression and metabolic syndrome. Treatment is multifaceted, requiring both primary and secondary care, however, the delivery of diabetes care is often fragmented. Integrated chronic disease management is a growing model of interest, and is underpinned by the chronic care model (CCM), devised as a guide for primary care management of patients with chronic conditions. The model identifies six key elements for effective care, and has shown promise in improving the management of diabetes. Aim: To find empirical evidence of integrated care interventions targeted at co-morbidities including diabetes, across primary/secondary care. Method: A systematic review of peer reviewed literature from PubMed, CINAHL, Embase, Cochrane Library and Joanna Briggs was performed. Studies were reviewed according to inclusion criteria- studies published in English, between 2004-2014, empirical studies, studies with evidence of primary/secondary implementation, and those dealing with chronic co-morbid disease states. Results: 51 studies met the inclusion criteria. Included studies were mostly from the US (38), with five from Australia, UK (2), Canada (2), Netherlands (1), Norway (1), Ireland (1), and one multi-country study. It was found that all interventions adopted at least one (average 3-4) of the chronic care model, with the majority implementing delivery system redesign activities within the primary care practice/s. We found evidence of interventions which significantly reduced emergency department and hospital admissions, improved processes of care, patient health outcomes such as HbA1c, improved patient satisfaction, and reduced costs. Conclusion/Implications for practice: Diabetes exists as a co-morbid disease, requiring both primary and secondary care. We found that integrated care interventions adopting elements of the chronic care model positively impacted on patient outcomes, service utilisation, as well as costs. This review has highlighted that it may not be necessary to adopt all CCM elements to improve clinical outcomes, patient satisfaction and costs.

The role of the Saudi government and the Saudi building code in implementing sustainable housing construction in Saudi Arabia

The housing construction industry in Saudi Arabia has been booming rapidly in the past two decades. This boom has faced multiple downfalls in relation to government regulations and building codes, one of which is the application of sustainable methods to the housing construction. This paper sheds some light on the current role of the Saudi government and the role of the Saudi Building Code (SBC) in the housing construction industry. The methodology utilised in this paper was a Delphi survey that was distributed to twenty-five key stakeholders in the housing construction industry in Saudi Arabia. The results indicate that there is a lack of integration between the Saudi Building Code and the current construction methods used in the current construction industry. Some factors and elements are recommended to be incorporated into the Saudi Building Code and to be adopted as regulations in the Saudi housing construction industry.

A multidisciplinary review of the teaching and assessment of prescribing : how do professions perform?

Aim To investigate the methods employed to teach and assess the principles of effective prescribing across five non-medical professions in a tertiary institution. Methods The National Prescribing Service MedicineWise Prescribing Competencies Framework was employed as the prescribing standard. A curriculum mapping exercise was undertaken to determine whether the prescribing articulated in the competency standards were addressed within the following courses: Master of Nursing Science (Nurse Practitioner), Bachelor of Vision Science, Master of Optometry, Bachelor of Pharmacy, Bachelor of Podiatry, Bachelor of Paramedic Science. The methods employed to teach and assess prescribing principles were documented. For each profession, identified gaps in teaching and/or assessment were noted.

How can partnerships between the universities and schools exploit new opportunities for pedagogies at the intersection of the arts/design and the sciences?

Driven by information accessibility-on-demand provided by the internet, education modes are changing from a teacher-led approach focused on content delivery and assessible outcomes, to a learner-based approach encouraging self-directed, peer-tutored, and cooperative learning. New pedagogies are required to extend learning beyond the classroom and traditional subject areas such as contemporary arts, in alignment with the cross disciplinary priorities of the Australian Curriculum and values of the International Baccalaureate Organisation. This research explores how partnerships with universities and cultural organisations are implicated in the generation of these new forms of pedagogy and contribute to the field of educational research within the context of Education Queensland’s Framework For Gifted Education. In particular, this paper explores a new pedagogical framework for highly capable year five to nine Queensland state school students at the intersection of arts, design and the sciences, which has arisen from an explicit secondary/ tertiary partnership between the Queensland University of Technology Creative Industries Faculty and Precincts and the Queensland Academies Young Scholars Program. The Young Scholars Program offers experiences in the International Baccalaureate and Australian Curriculum contexts to enhance outcomes via global understanding, unique industry partnerships and 21st century pedagogical innovation based not on 'content' but tacit/experiential learning concepts including immersive, creative, intellectual and social strategies. These strategies for highly capable students are centred around authentic opportunities, primary resources, transdisciplinary learning and relationships with likeminded peers including tertiary arts, design and STEM educators and students, professionals and researchers. The presentation details case studies which are hands-on real time workshops involving inquiry based challenges in the arts, design and sciences, mathematics, history, creative writing and other disciplines, with content drawn from collections from public institutions, academic research and tertiary pedagogy. Both programs implicate student collaboration and creative production as methodology/data capture for ongoing action research, in alignment with the Framework For Gifted Education’s emphasis on evidence-based practices. They also challenge gifted students “to continue their development through curricular activities that require depth of study, complexity of thinking, fast pace of learning, high-level skills development and/or creative and critical thinking (e.g. through independent investigations, tiered tasks, diverse real-world applications, mentors)”(Education Queensland, 2011:3). This presentation highlights the strengths of the ongoing collaboration between QUT Creative industries Faculty and Queensland Academies, which not only provides successful extra curricular activities for gifted students towards a place in the International Baccalaureate Program, but also provides mentoring opportunities for tertiary students in their field of endeavor to assist with their own learning, and unique research opportunities for the Faculty as it focuses on excellence in arts, design and creative education and research. Education Queensland.(2011). Framework For Gifted Education Revised Edition 2011 (accessed Nov 19 2011)

Evaluation of the Australian Performing Arts Market 2014-2018 - Year One Report

The Australia Council awarded the tender of APAMs 2014, 2016 and 2018 to the Brisbane Powerhouse. The Australia Council, in awarding the contract for the presentation of APAM by Brisbane Powerhouse, stipulated that a formal evaluation of the three iterations of APAM and activity in the intervening years be undertaken. Queensland University of Technology, Creative Industries Faculty, under the leadership of Associate Professor Sandra Gattenhof, were contracted to undertake the formal evaluation. This is the first year report on the Brisbane iteration of the Market. This report has drawn from data collected across a range of sources, drawing on the scoping study undertaken by Justin Macdonnell addressing the Market from 1994–2010; the tender document submitted by the Brisbane Powerhouse; in-person interviews with APAM staff, APAM Stakeholders, Vox Pops from delegates in response to individual sessions, producer company/artist case studies and, most significantly, responses from a detailed online survey sent to all delegates. The main body of the report is organised around three key research aims, as outlined in the Brisbane Powerhouse Tender document (2011). These have been articulated as: Evaluation of international market development outcomes through showcasing work to targeted international presenters and agents Evaluation of national market development outcomes through showcasing work to national presenters and producers Evaluation of the exchange ideas, dialogue, skill 
development, partnerships, collaborations and co- productions and networks with local and international peers. The culmination of the data analysis has been articulated through five key recommendations, which may assist the APAM delivery team for the next version, in 2016. In summary, the recommendations are described as: 1. Indigenous focus to remain central to the conception and delivery of APAM 2. Re-framing APAM’s function and its delivery 3. Logistics and communications in a multi-venue approach, including communications and housekeeping, volunteers, catering, re-calibrating the employment of Brisbane Powerhouse protocols and processes for APAM 4. Presentation and promotion for presenters 5. Strategic targeting of Asian producers.

Nearness and revealing : The edible veil of the sensible being.

Taking cues from the fragility and grace enfolded within Asian cuisine, this paper explores recent experimentation of an edible rice paper veil. The veil fashions a 'secondary skin', what Jeffery Schnapp the author of 'The Fabric of Modern Times', calls an "object for prosthetic shelf extension...bearing a uniquely intimate and direct relation to the human body" (Schnapp, 1997:197). The process reveals a layered material mutable to moisture and humidity, changing its elastic state in relation to body and surroundings. The moving, breathing, sweating surface of the body further modifies both veil and bodily experience drawing forth deeper emotional responses. The implications here offer a reciprocal affect, a revealing, where new materiality evokes the threshold to a new sensible being, one aware of the depth of material consciousness and inter-corporeal engagement, and which extends the relations between thinking and being of Heidegger and Shklovsky's seminal works.

Measuring reliability and validity of the ActiGraph GT3X accelerometer for children with cerebral palsy : a feasibility study

PURPOSE The purposes of this study were to: 1) establish inter-instrument reliability between left and right hip accelerometer placement; 2) examine procedural reliability of a walking protocol used to measure physical activity (PA), and; 3) confirm concurrent validity of accelerometers in measuring PA intensity as compared to the gold standard of oxygen consumption measured by indirect calorimetry. METHODS Eight children (mean age: 11.9; SD: 3.2, 75% male) with CP (GMFCS levels I-III) wore ActiGraph GT3X accelerometers on each hip and the Cosmed K4b^{2} portable indirect calorimeter during two measurement sessions in which they performed the six minute walk test (6MWT) at three self-selected speeds (comfortable/slow, brisk, fast). Oxygen consumption (VO2) and accelerometer step and activity count data were recorded. RESULTS Inter-instrument reliability of ActiGraph GT3X accelerometers placed on left and right hips was excellent (ICC=0.96-0.99, CI_{95}: 0.81-0.99). Reproducibility of the protocol was good/excellent (ICC=0.75-0.95, CI_{95}: 0.75-0.98). Concurrent validity of accelerometer count data and VO2 was fair/good (rho=0.67, p< 0.001). The correlation between step count and VO2 was not significant (rho=0.29, p=0.2). CONCLUSION This preliminary research suggests that ActiGraph GT3X accelerometers are reliable and valid devices to monitor PA during walking in children with CP and may be appropriate in rehabilitation research and clinical practice. ActiGraph GTX3 step counts were not valid for this sample and further research is warranted.

Reliability in the Parameterization of the Functional Reach Test in Elderly Stroke Patients: A Pilot Study

BACKGROUND: Postural instability is one of the major complications found in stroke survivors. Parameterising the functional reach test (FRT) could be useful in clinical practice and basic research. OBJECTIVES: To analyse the reliability, sensitivity, and specificity in the FRT parameterisation using inertial sensors for recording kinematic variables in patients who have suffered a stroke. DESIGN: Cross-sectional study. While performing FRT, two inertial sensors were placed on the patient's back (lumbar and trunk). PARTICIPANTS: Five subjects over 65 who suffer from a stroke. MEASUREMENTS: FRT measures, lumbosacral/thoracic maximum angular displacement, maximum time of lumbosacral/thoracic angular displacement, time return initial position, and total time. Speed and acceleration of the movements were calculated indirectly. RESULTS: FRT measure is  12.75±2.06 cm. Intrasubject reliability values range from 0.829 (time to return initial position (lumbar sensor)) to 0.891 (lumbosacral maximum angular displacement). Intersubject reliability values range from 0.821 (time to return initial position (lumbar sensor)) to 0.883 (lumbosacral maximum angular displacement). FRT's reliability was 0.987 (0.983-0.992) and 0.983 (0.979-0.989) intersubject and intrasubject, respectively. CONCLUSION: The main conclusion could be that the inertial sensors are a tool with excellent reliability and validity in the parameterization of the FRT in people who have had a stroke.

The political in the age of the digital: propositions for empirical investigation

This article establishes whether there is a case for revising traditional accounts of politics and the public sphere given the ways in which digital technology is now being used in Western and non-Western settings to engage people politically. The article presents a case for framing this inquiry in terms of imaginaries. It then argues for a new political imaginary which helps to specify what is required for deliberative democratic practice in a way that shifts us away from the dominant liberal-utilitarian political imaginary that currently informs the political value systems of most Western nations. Drawing on the work of key political theorists such as Habermas and Dahlgren, five propositions or conditions for deliberative practice are identified that can be used in empirical investigation to help determine the democratic capacity and potential of new political communication and civic spaces being opened by means of digital media.

Introduction to Point and Counterpoint: What does the Review of the Australian Curriculum mean for History?

The April 2015 edition of Curriculum Perspectives has a special focus and casts light on the continuing development of the Australian Curriculum. This paper provides an introduction to a series of papers in the Point and Counterpoint section of this edition on the Review of the Australian Curriculum with reference to History. It makes clear that History is one of the most contested areas of the curriculum and that whilst politicians and policy makers are concerned with the importance of history in relation to national identity and nation building, history serves other purposes. The paper reiterates the need to pay attention to the particularities of discipline–based knowledge for the study of history in schools and the central role of inquiry for student learning in history. In doing so, it establishes the context for the five papers which follow.

Improving wound management for residents in Residential Aged Care Facilities: National dissemination and implementation of the evidence based Champions for Skin Integrity Program

Overview The incidence of skin tears, pressure injuries and chronic wounds increases with age [1-4] and therefore is a serious issue for staff and residents in Residential Aged Care Facilities (RACFs). A pilot project funded in Round 2 of the Encouraging Best Practice in Residential Aged Care (EBPRAC) program by the then Australian Government Department of Health and Ageing found that a substantial proportion of residents in aged care facilities experienced pressure injuries, skin tears or chronic wounds. It also found the implementation of the evidence based Champions for Skin Integrity (CSI) model of wound care was successful in significantly decreasing the prevalence and severity of wounds in residents, improving staff skills and knowledge of evidence based wound management, increasing staff confidence with wound management, increasing implementation of evidence based wound management and prevention strategies, and increasing staff awareness of their roles in evidence based wound care at all levels [5]. Importantly, during the project, the project team developed a resource kit on evidence based wound management. Two critical recommendations resulting from the project were that: - The CSI model or a similar strategic approach should be implemented in RACFs to facilitate the uptake of evidence based wound management and prevention - The resource kit on evidence based wound management should be made available to all Residential Aged Care Facilities and interested parties A proposal to disseminate or rollout the CSI model of wound care to all RACFs across Australia was submitted to the department in 2012. The department approved funding from the Aged Care Services Improvement Healthy Ageing Grant (ACSIHAG) at the same time as the Round 3 of the Encouraging Better Practice in Aged Care (EBPAC) program. The dissemination involved two crucial elements: 1. The updating, refining and distribution of a Champions for Skin Integrity Resource Kit, more commonly known as a CSI Resource Kit and 2. The presentation of intensive one day Promoting Healthy Skin “Train the Trainer” workshops in all capital cities and major regional towns across Australia Due to demand, the department agreed to fund a second round of workshops focussing on regional centres and the completion date was extended to accommodate the workshops. Later, the department also decided to host a departmental website for a number of clinical domains, including wound management, so that staff from the residential aged care sector had easy access to a central repository of helpful clinical resource material that could be used for improving the health and wellbeing of their older adults, consumers and carers. CSI Resource Kit Upgrade and Distribution: At the start of the project, a full evidence review was carried out on the material produced during the EBPRAC-CSI Stage 1 project and the relevant evidence based changes were made to the documentation. At the same time participants in the EBPRAC-CSI Stage 1 project were interviewed for advice on how to improve the resource material. Following this the documentation, included in the kit, was sent to independent experts for peer review. When this process was finalised, a learning designer and QUT’s Visual Communications Services were engaged to completely refine and update the design of the resources, and combined resource kit with the goal of keeping the overall size of the kit suitable for bookshelf mounting and the cost at reasonable levels. Both goals were achieved in that the kit is about the same size as a 25 mm A4 binder and costs between $19.00 and $28.00 per kit depending on the size of the print run. The dissemination of the updated CSI resource kit was an outstanding success. Demand for the kits was so great that a second print run of 2,000 kits was arranged on top of the initial print run of 4,000 kits. All RACFs across Australia were issued with a kit, some 2,740 in total. Since the initial distribution another 1,100 requests for kits has been fulfilled as well as 1,619 kits being distributed to participants at the Promoting Healthy Skin workshops. As the project was winding up a final request email was sent to all workshop participants asking if they required additional kits or resources to distribute the remaining kits and resources. This has resulted in requests for 200 additional kits and resources. Feedback from the residential aged care sector and other clinical providers who have interest in wound care has been very positive regarding the utility of the kit, (see Appendix 4). Promoting Healthy Skin Workshops The workshops also exceeded the project team’s initial objective. Our goal of providing workshop training for staff from one in four facilities and 450 participants was exceeded, with overwhelming demand for workshop places resulting in the need to provide a second round of workshops across Australia. At the completion of the second round, 37 workshops had been given, with 1286 participants, representing 835 facilities. A number of strategies were used to promote the workshops ranging from invitations included in the kit, to postcard mail-outs, broadcast emailing to all facilities and aged care networks and to articles and paid advertising in aged care journals. The most effective method, by far, was directly phoning the facilities. This enabled the caller to contact the relevant staff member and enlist their support for the workshop. As this is a labour intensive exercise, it was only used where numbers needed bolstering, with one venue rising from 3 registrants before the calls to 53 registrants after. The workshops were aimed at staff who had the interest and the capability of implementing evidence-based wound management within their facility or organisation. This targeting was successful in that a large proportion (68%) of participants were Registered Nurses, Nurse Managers, Educators or Consultants. Twenty percent were Endorsed Enrolled Nurses with the remaining 12% being made up of Personal Care Workers or Allied Health Professionals. To facilitate long term sustainability, the workshop employed train-the-trainer strategies. Feedback from the EBPRAC-CSI Stage 1 interviews was used in the development of workshop content. In addition, feedback from the workshop conducted at the end of the EBPRAC-CSI Stage 1 project suggested that change management and leadership training should be included in the workshops. The program was trialled in the first workshop conducted in Brisbane and then rolled out across Australia. Participants were asked to complete pre and post workshop surveys at the beginning and end of the workshop to determine how knowledge and confidence improved over the day. Results from the pre and post surveys showed significant improvements in the level of confidence in attendees’ ability to implement evidence based wound management. The results also indicated a significant increase in the level of confidence in ability to implement change within their facility or organisation. This is an important indication that the inclusion of change management/leadership training with clinical instruction can increase staff capacity and confidence in translating evidence into practice. To encourage the transfer of the evidence based content of the workshop into practice, participants were asked to prepare an Action Plan to be followed by a simple one page progress report three months after the workshop. These reports ranged from simple (e.g. skin moisturising to prevent skin tears), to complex implementation plans for introducing the CSI model across the whole organisation. Outcomes described in the project reports included decreased prevalence of skin tears, pressure injuries and chronic wounds, along with increased staff and resident knowledge and resident comfort. As stated above, some organisations prepared large, complex plans to roll out the CSI model across their organisation. These plans included a review of the organisation’s wound care system, policies and procedures, the creation of new processes, the education of staff and clients, uploading education and resource material onto internal electronic platforms and setting up formal review and evaluation processes. The CSI Resources have been enthusiastically sought and incorporated into multiple health care settings, including aged care, acute care, Medicare Local intranets (e.g. Map of Medicine e-pathways), primary health care, community and home care organisations, education providers and New Zealand aged and community health providers. Recommendations: Recommendations for RACFs, aged care and health service providers and government  Skin integrity and the evidence-practice gap in this area should be recognised as a major health issue for health service providers for older adults, with wounds experienced by up to 50% of residents in aged care settings (Edwards et al. 2010). Implementation of evidence based wound care through the Champions for Skin Integrity model in this and the pilot project has demonstrated the prevalence of wounds, wound healing times and wound infections can be halved.  A national program and Centre for Evidence Based Wound Management should be established to: - expand the reach of the model to other aged care facilities and health service providers for older adults - sustain the uptake of models such as the Champions for Skin Integrity (CSI) model - ensure current resources, expertise and training are available for consumers and health care professionals to promote skin integrity for all older adults  Evidence based resources for the CSI program and similar projects should be reviewed and updated every 3 – 4 years as per NH&MRC recommendations  Leadership and change management training is fundamental to increasing staff capacity, at all levels, to promote within-organisation dissemination of skills and knowledge gained from projects providing evidence based training Recommendations for future national dissemination projects  A formal program of opportunities for small groups of like projects to share information and resources, coordinate activities and synergise education programs interactively would benefit future national dissemination projects - Future workshop programs could explore an incentive program to optimise attendance and reduce ‘no shows’ - Future projects should build in the capacity and funding for increased follow-up with workshop attendees, to explore the reasons behind those who are unable to translate workshop learnings into the workplace and identify factors to address these barriers.

Crystal structure of the magnesium salt of the herbicide 2,4-D: pentaaqua[(2,4-dichlorophenoxy)acetato-kO]magnesium (2,4-dichlorophenoxy)acetate hemihydrate

In the structure of the title magnesium complex with the phenoxy herbicide (2,4-dichlorophenoxy)acetic acid (2,4-D), [Mg(H2O)5(C8H5Cl2O3)]+ C8H5Cl2O3)- . 0.5H2O, the discrete cationic MgO6 complex units comprise a carboxyl O-donor from a monodentate 2,4-D cationic ligand and five water molecules in a slightly distorted octahedral coordination. The 2,4-D anions are linked to the complex units through duplex water O-H...O(carboxyl) hydrogen bonds through the coordinated water molecules. In the crystal inter-unit O-H...O hydrogen-bonding interactions involving coordinated water molecules as well as the hemi-hydrate solvate molecule with carboxyl O-atom acceptors, give a two-dimensional layered structure lying parallel (001), in which pi-pi ligand-cation interactions [minimum ring centroid separation, 3.6405(17)A] and a short O-H...Cl interaction [3.345(2)A] are also found.

A vibrational spectroscopic study of the anhydrous phosphate mineral sidorenkite Na3Mn(PO4)(CO3)

Sidorenkite is a very rare low-temperature hydrothermal mineral, formed very late in the crystallization of hyperagpaitic pegmatites in a differentiated alkalic massif (Mt. Alluaiv, Kola Peninsula, Russia). Sidorenkite Na3Mn(PO4)(CO3) is a phosphate–carbonate of sodium and manganese. Such a formula with two oxyanions lends itself to vibrational spectroscopy. The sharp Raman band at 959 cm−1 and 1012 cm−1 are assigned to the PO43− stretching modes, whilst the Raman bands at 1044 cm−1 and 1074 cm−1 are attributed to the CO32− stretching modes. It is noted that no Raman bands at around 800 cm−1 for sidorenkite were observed. The infrared spectrum of sidorenkite shows a quite intense band at 868 cm−1 with other resolved component bands at 850 and 862 cm−1. These bands are ascribed to the CO32− out-of-plane bend (ν2) bending mode. The series of Raman bands at 622, 635, 645 and 704 cm−1 are assigned to the ν4 phosphate bending modes. The observation of multiple bands supports the concept of a reduction in symmetry of the carbonate anion from D3h or even C2v.

The molecular structure of the borate mineral szaibelyite MgBO2(OH): A vibrational spectroscopic study

We have studied the borate mineral szaibelyite MgBO2(OH) using electron microscopy and vibrational spectroscopy. EDS spectra show a phase composed of Mg with minor amounts of Fe. Both tetrahedral and trigonal boron units are observed. The nominal resolution of the Raman spectrometer is of the order of 2 cm−1 and as such is sufficient enough to identify separate bands for the stretching bands of the two boron isotopes. The Raman band at 1099 cm−1 with a shoulder band at 1093 cm−1 is assigned to BO stretching vibration. Raman bands at 1144, 1157, 1229, 1318 cm−1 are attributed to the BOH in-plane bending modes. Raman bands at 836 and 988 cm−1 are attributed to the antisymmetric stretching modes of tetrahedral boron. The infrared bands at 3559 and 3547 cm−1 are assigned to hydroxyl stretching vibrations. Broad infrared bands at 3269 and 3398 cm−1 are assigned to water stretching vibrations. Infrared bands at 1306, 1352, 1391, 1437 cm−1 are assigned to the antisymmetric stretching vibrations of trigonal boron. Vibrational spectroscopy enables aspects of the molecular structure of the borate mineral szaibelyite to be assessed.