Effectiveness of IT-based diabetes management interventions: a review of the literature

Background : Information technology (IT) is increasingly being used in general practice to manage health care including type 2 diabetes. However, there is conflicting evidence about whether IT improves diabetes outcomes. This review of the literature about IT-based diabetes management interventions explores whether methodological issues such as sample characteristics, outcome measures, and mechanisms causing change in the outcome measures could explain some of the inconsistent findings evident in IT-based diabetes management studies.

Methods : Databases were searched using terms related to IT and diabetes management. Articles eligible for review evaluated an IT-based diabetes management intervention in general practice and were published between 1999 and 2009 inclusive in English. Studies that did not include outcome measures were excluded.

Results : Four hundred and twenty-five articles were identified, sixteen met the inclusion criteria: eleven GP focussed and five patient focused interventions were evaluated. Nine were RCTs, five non-randomised control trials, and two single-sample before and after designs. Important sample characteristics such as diabetes type, familiarity with IT, and baseline diabetes knowledge were not addressed in any of the studies reviewed. All studies used HbA1c as a primary outcome measure, and nine reported a significant improvement in mean HbA1c over the study period; only two studies reported the HbA1c assay method. Five studies measured diabetes medications and two measured psychological outcomes. Patient lifestyle variables were not included in any of the studies reviewed. IT was the intervention method considered to effect changes in the outcome measures. Only two studies mentioned alternative possible causal mechanisms.

Conclusion : Several limitations could affect the outcomes of IT-based diabetes management interventions to an unknown degree. These limitations make it difficult to attribute changes solely to such interventions.

c-Cbl facilitates endocytosis and lysosomal degradation of cystic fibrosis transmembrane conductance regulator in human airway epithelial cells

Cystic fibrosis transmembrane conductance regulator (CFTR) is a cAMP-activated Cl− channel expressed in the apical membrane of fluid-transporting epithelia. The apical membrane density of CFTR channels is determined, in part, by endocytosis and the postendocytic sorting of CFTR for lysosomal degradation or recycling to the plasma membrane. Although previous studies suggested that ubiquitination plays a role in the postendocytic sorting of CFTR, the specific ubiquitin ligases are unknown. c-Cbl is a multifunctional molecule with ubiquitin ligase activity and a protein adaptor function. c-Cbl co-immunoprecipitated with CFTR in primary differentiated human bronchial epithelial cells and in cultured human airway cells. Small interfering RNA-mediated silencing of c-Cbl increased CFTR expression in the plasma membrane by inhibiting CFTR endocytosis and increased CFTR-mediated Cl− currents. Silencing c-Cbl did not change the expression of the ubiquitinated fraction of plasma membrane CFTR. Moreover, the c-Cbl mutant with impaired ubiquitin ligase activity (FLAG-70Z-Cbl) did not affect the plasma membrane expression or the endocytosis of CFTR. In contrast, the c-Cbl mutant with the truncated C-terminal region (FLAG-Cbl-480), responsible for protein adaptor function, had a dominant interfering effect on the endocytosis and plasma membrane expression of CFTR. Moreover, CFTR and c-Cbl co-localized and co-immunoprecipitated in early endosomes, and silencing c-Cbl reduced the amount of ubiquitinated CFTR in early endosomes. In summary, our data demonstrate that in human airway epithelial cells, c-Cbl regulates CFTR by two mechanisms: first by acting as an adaptor protein and facilitating CFTR endocytosis by a ubiquitin-independent mechanism, and second by ubiquitinating CFTR in early endosomes and thereby facilitating the lysosomal degradation of CFTR.

The CDM-Net project : the development, implementation and evaluation of a broadband-based network for managing chronic disease

Background. In Australia most chronic disease management is funded by Medicare Australia through General Practitioner Management Plans (GPMPs) and Team Care Arrangements (TCAs). Identified barriers may be reduced effectively using a broadband-based network known as the Chronic Disease Management Service (CDMS).

Aims. To measure the uptake and adherence to CDMS, test CDMS, and assess the adherence of health providers and patients to GPMPs and TCAs generated through CDMS.

Methods. A single cohort before and after study.

Results. GPMPs and TCAs increased. There was no change to prescribed medicines or psychological quality of life. Attendance at allied health professionals increased, but decreased at pharmacies. Overall satisfaction with CDMS was high among GPs, allied health professionals, and patients.

Conclusion. This study demonstrates proof of concept, but replication or continuation of the study is desirable to enable the impact of CDMS on diabetes outcomes to be determined.

Colonial girls' literature and the politics of archives in the digital age

In this paper we examine the politics of print and digital archives and their implications for research in the field of historical children's literature. We use the specific example of our comparative, collaborative project 'From Colonial to Modern: Transnational Girlhood in Australian, New Zealand and Canadian Print Cultures, 1840-1940' to contrast the strengths and limitations of print and digital archives of young people's texts from these three nations. In particular, we consider how the failure of some print archives to collect ephemeral or non-canonical colonial texts may be reproduced in current digitising projects. Similarly, we examine how gaps in the newly forged digital "canon" are especially large for colonial children's texts because of the commercial imperatives of many large-scale digitisation projects. While we acknowledge the revolutionary applications of digital repositories for research on historical children's literature, we also argue that these projects may unintentionally marginalise or erase certain kinds of children's texts from scholarly view in the future.

Girls' school stories, 1749-1929

As part of the ongoing project of retrieving women writers from the margins of literary and cultural history, scholars of literature, history, and gender studies are increasingly exploring and interrogating girls’ print culture. School stories, in particular, are generating substantial scholarly interest because of their centrality to the history of girls’ reading, their engagement with cultural ideas about the education and socialization of girls, and their enduring popularity with book collectors. However, while serious scholars have begun to document the vast corpus of English-language girls’ school stories, few scholarly editions or facsimile editions of these novels and short stories are readily available.

‘I am content with Canada’: Canadian girls at the turn of the twentieth century

This essay focuses on British girls' periodicals and novels published around the turn of the twentieth century that generate an imagined picture of Canadian girlhood; I also begin to contrast these representations with those produced and published in Canada.

Constructing girlhood through the periodical press, 1850-1915

Focusing on six popular British girls' periodicals, Kristine Moruzi explores the debate about the shifting nature of Victorian girlhood between 1850 and 1915. During an era of significant political, social, and economic change, girls' periodicals demonstrate the difficulties of fashioning a coherent, consistent model of girlhood. The mixed-genre format of these magazines, Moruzi suggests, allowed inconsistencies and tensions between competing feminine ideals to exist within the same publication. Adopting a case study approach, Moruzi shows that the Monthly Packet, the Girl of the Period Miscellany, the Girl's Own Paper, Atalanta, the Young Woman, and the Girl's Realm each attempted to define and refine a unique type of girl, particularly the religious girl, the 'Girl of the Period,' the healthy girl, the educated girl, the marrying girl, and the modern girl. These periodicals reflected the challenges of embracing the changing conditions of girls' lives while also attempting to maintain traditional feminine ideals of purity and morality. By analyzing the competing discourses within girls' periodicals, Moruzi's book demonstrates how they were able to frame feminine behaviour in ways that both reinforced and redefined the changing role of girls in nineteenth-century society while also allowing girl readers the opportunity to respond to these definitions.

‘The freedom suits me’: encouraging girls to settle in the colonies

This chapter examines the role of the immensely popular Girl's Own Paper to demonstrate how girls were prompted to think of emigration to a British colony.

Use of web-conferencing software to enhance practical learning for distance students in a first-year Engineering course

BACKGROUND : For many years, Deakin University has delivered an accredited undergraduate engineering course by means of distance education. One of the chief challenges is to provide the necessary practical instruction and experience in engineering to these students. In first-year physics and first-year materials science, off-campus students normally attend on-campus lab classes either on a Saturday or as part of a residential school. However, because some students live either interstate or overseas, it is sometimes impossible for small groups of students to attend an on-campus lab class. PURPOSE : This paper investigates whether web-conferencing software can be an effective means for delivering practical classes to small groups of distance students in first-year physics and also first-year materials. METHOD : Over three semesters in 2012, we employed the Elluminate-Live! software platform to broadcast six lab practicals in first-year physics, and one practical in first-year materials engineering. The students submitted practical reports as did all the other students in each unit. The students in each unit fell into three groups: on-campus students, off-campus students who performed their practicals on-campus, and off-campus students who performed their practicals “virtually” via an Elluminate-Live! session. RESULTS : The trials showed that it is possible to broadcast both physics and materials practical classes by means of web-conferencing software. Report marks of the students performing practicals by this method were comparable to those in the other groups. CONCLUSIONS : Our experience with four initial trials in delivering practical classes over the Internet was encouraging, and showed that the concept will work if done in an effective way.