The Renal Treatment Satisfaction Questionnaire (RTSQ): a measure of satisfaction with treatment for chronic kidney failure.

BACKGROUND: Quality and effectiveness of care can be enhanced through the use of condition-specific measures of satisfaction with treatment. The aim of the present study was to design and develop a measure of satisfaction with treatment for patients with chronic kidney failure (CKF) for use in routine clinical care and clinical trials. The Renal Treatment Satisfaction Questionnaire (RTSQ) was designed to be suitable for people using any of the various treatment modalities for CKF. Items measure satisfaction with aspects of treatment, including convenience, flexibility, freedom, and satisfaction to continue with present form of treatment.

METHODS: A 12-item RTSQ was investigated at a UK hospital-based renal unit, using data from 140 outpatients undergoing renal replacement therapy (hemodialysis, n = 35; continuous ambulatory peritoneal dialysis, n = 57; transplantation, n = 46).

RESULTS: An 11-item scale was developed from the original 12-item version, with a single factor accounting for 59% of the variance and item loadings greater than 0.58. Scale reliability was excellent (alpha = 0.93) in the full sample and proved robust to analysis in separate treatment subgroups. As expected, RTSQ scores differed significantly ( P < 0.0001) between the transplantation and other treatment groups. Those who had received a transplant expressed greater overall satisfaction, with specific advantages of transplantation shown by all individual items, including convenience, time, lifestyle, freedom, and satisfaction to continue current treatment.

CONCLUSION: The RTSQ provides a brief reliable measure of satisfaction with treatment for patients with CKF that is suitable for use in routine clinical care and clinical trials.

The economic benefits of reducing physical inactivity : an Australian example

Background: Physical inactivity has major impacts on health and productivity. Our aim was to estimate the health and economic benefits of reducing the prevalence of physical inactivity in the 2008 Australian adult population. The economic benefits were estimated as ‘opportunity cost savings’, which represent resources utilized in the treatment of preventable disease that are potentially available for re-direction to another purpose from fewer incident cases of disease occurring in communities.
Methods: Simulation models were developed to show the effect of a 10% feasible, reduction target for physical inactivity from current Australian levels (70%). Lifetime cohort health benefits were estimated as fewer incident cases of inactivity-related diseases; deaths; and Disability Adjusted Life Years (DALYs) by age and sex. Opportunity costs were estimated as health sector cost impacts, as well as paid and unpaid production gains and leisure impacts from fewer disease events associated with reduced physical inactivity. Workforce production gains were estimated by comparing surveyed participation and absenteeism rates of physically active and inactive adults, and valued using the friction cost approach. The impact of an improvement in health status on unpaid household production and leisure time were modeled from time use survey data, as applied to the exposed and non-exposed population subgroups and valued by suitable proxy. Potential costs associated with interventions to increase physical activity were not included. Multivariable uncertainty analyses and univariate sensitivity analyses were undertaken to provide information on the strength of the conclusions.
Results: A 10% reduction in physical inactivity would result in 6,000 fewer incident cases of disease, 2,000 fewer deaths, 25,000 fewer DALYs and provide gains in working days (114,000), days of home-based production (180,000) while conferring a AUD96 million reduction in health sector costs. Lifetime potential opportunity cost savings in workforce production (AUD12 million), home-based production (AUD71 million) and leisure-based production (AUD79 million) was estimated (total AUD162 million 95% uncertainty interval AUD136 million, AUD196 million).
Conclusions: Opportunity cost savings and health benefits conservatively estimated from a reduction in population-level physical inactivity may be substantial. The largest savings will benefit individuals in the form of unpaid production and leisure gains, followed by the health sector, business and government.

The value of oral history in natural resource management : the Balcombe Estuary Reserve, Mount Martha, Victoria

This study investigates the benefits of using oral history as a tool for the sustainable management of estuaries. Twenty-two semi-structured interviews were conducted to generate oral history records for the Balcombe Estuary Reserve, a small estuary in a periurban zone on the Mornington Peninsula, Victoria. These interviews establish a more complete picture of changes in land use and ecological change to the estuary since European settlement of the area, and document community values. The interviews were followed with a survey to further explore management issues in the area. Use of oral history was found to be an effective approach to assist holistic estuarine management, especially when complemented by other sources of information.

Effectiveness of vertebroplasty using individual patient data from two randomised placebo controlled trials : meta-analysis

Objective To determine whether vertebroplasty is more effective than placebo for patients with pain of recent onset (≤6 weeks) or severe pain (score ≥8 on 0-10 numerical rating scale).

Design Meta-analysis of combined individual patient level data.

Setting Two multicentred randomised controlled trials of vertebroplasty; one based in Australia, the other in the United States.

Participants 209 participants (Australian trial n=78, US trial n=131) with at least one radiographically confirmed vertebral compression fracture. 57 (27%) participants had pain of recent onset (vertebroplasty n=25, placebo n=32) and 99 (47%) had severe pain at baseline (vertebroplasty n=50, placebo n=49).

Intervention Percutaneous vertebroplasty versus a placebo procedure.

Main outcome measure Scores for pain (0-10 scale) and function (modified, 23 item Roland-Morris disability questionnaire) at one month.

Results For participants with pain of recent onset, between group differences in mean change scores at one month for pain and disability were 0.1 (95% confidence interval −1.4 to 1.6) and 0.2 (−3.0 to 3.4), respectively. For participants with severe pain at baseline, between group differences for pain and disability scores at one month were 0.3 (−0.8 to 1.5) and 1.4 (−1.2 to 3.9), respectively. At one month those in the vertebroplasty group were more likely to be using opioids.

Conclusions Individual patient data meta-analysis from two blinded trials of vertebroplasty, powered for subgroup analyses, failed to show an advantage of vertebroplasty over placebo for participants with recent onset fracture or severe pain. These results do not support the hypothesis that selected subgroups would benefit from vertebroplasty.

Migrant Houses in the village Zavoj, Republic of Macedonia, 1988-2010

The focus of this data is on the transformation of the village Zavoj in the Republic of Macedonia, due to emigration from the village, recorded through the architectural changes to the houses in the village. The village had become by default a place for the accommodation of elderly people who did not want to join their offspring abroad in the cities of immigration, or in the fringe suburbs of nearby towns.

The data documents the ‘material history’ of the houses, and constitutes a longitudinal research project tracing the transformation of the architectural fabric of the village since 1988. It includes visual documentation such as photographs and drawings, and includes the houses as HOUSE-STATES as follows:

House-Traditional: Vernacular architecture still in use and maintained as a dwelling.
House-Construction: Buildings that are still being constructed, the house as ongoing construction site.
House-Fragment: An eMigrant house-fragment is juxtaposed with the vernacular dwelling. Typical and affordable techniques of single brick cavity and reinforced concrete structure are evident in the new fragment.
House-Closed: Many new houses have only one door and one window, height, size and volume are minimal; and are closed a lot of the time.
House-Ruin: Vernacular traditional dwellings that are deteriorating. Traditional vernacular dwellings are rarely renovated, reconstructed or repaired.

The data is complemented by several field-work methods including participant observation, interviews, documentation of the village as a totality, recording of oral histories and myths, festivities, and archival statistical research about the vicinity.

This dataset comprises photographic documentation, sketch/drawing documentation, digital interview recordings, and interview notes.

Interventions for preventing obesity in children (review)

Background

Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear.
Objectives

This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?"
Search methods

The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant websites. Non-English language papers were included and experts were contacted.
Selection criteria

The review includes data from childhood obesity prevention studies that used a controlled study design (with or without randomisation). Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomised at a cluster level, 6 clusters were required.
Data collection and analysis

Two review authors independently extracted data and assessed the risk of bias of included studies. Data was extracted on intervention implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical activity (PA)-related behaviours or diet-related behaviours. Adverse outcomes were recorded. A meta-analysis was conducted using available BMI or standardised BMI (zBMI) score data with subgroup analysis by age group (0-5, 6-12, 13-18 years, corresponding to stages of developmental and childhood settings).
Main results

This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged 6-12 years. The meta-analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I2=82%). Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of -0.15kg/m2 (95% confidence interval (CI): -0.21 to -0.09). Intervention effects by age subgroups were -0.26kg/m2 (95% CI:-0.53 to 0.00) (0-5 years), -0.15kg/m2 (95% CI -0.23 to -0.08) (6-12 years), and -0.09kg/m2 (95% CI -0.20 to 0.03) (13-18 years). Heterogeneity was apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention. Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased prevalence of underweight or body image sensitivities was found. Interventions did not appear to increase health inequalities although this was examined in fewer studies.
Authors' conclusions

We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, our synthesis indicates the following to be promising policies and strategies:

· school curriculum that includes healthy eating, physical activity and body image

· increased sessions for physical activity and the development of fundamental movement skills throughout the school week

· improvements in nutritional quality of the food supply in schools

· environments and cultural practices that support children eating healthier foods and being active throughout each day

· support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities)

· parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities

However, study and evaluation designs need to be strengthened, and reporting extended to capture process and implementation factors, outcomes in relation to measures of equity, longer term outcomes, potential harms and costs.

Childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded within health, education and care systems and achieve long term sustainable impacts.

Financial systems and mechanisms of growth in different conditions of country risk

This article uses panel data from 1976 to 2003 to investigate the ways in which banking and stock markets influence economic growth in situations of high and low country risk. The mean and Standard Deviation (SD) of country risk are adopted to classify 28 countries into Low Risk Low Volatility (LRLV) and High Risk High Volatility (HRHV) subgroups. Through the technique of error correction-based panel co-integration developed by Westerlund (2007), several results are obtained. First, LRLV countries can expand the capitalization of stock market to enhance long-term economic growth. Second, HRHV countries, on the other hand, use two distinct strategies to promote long-term economic growth. Initially they develop their equity markets, which promote economic growth directly. Strengthened equity markets, in turn, aid in the development of credit markets, which subsequently brings an economic boom. Finally, regardless of selected subgroups, the contribution of stock market capitalization to economic growth appears to be substantially larger than that of bank credit, highlighting the importance of stock markets.

Comparing trends in BMI and waist circumference

The nature of excess body weight may be changing over time to one of greater central adiposity. The aim of this study is to determine whether BMI and waist circumference (WC) are increasing proportionately among population subgroups and the range of bodyweight, and to examine the public health implications of the findings. Our data are from two cross-sectional surveys (the US National Health and Nutrition Examination Studies (NHANES) in 1988–1994 (NHANES III) and 2005–2006), from which we have used samples of 15,349 and 4,176 participants aged ≥20 years. Between 1988–1994 and 2005–2006 BMI increased by an average of 1.8 kg/m2 and WC by 4.7 cm (adjusted for sex, age, race-ethnicity, and education). The increase in WC was more than could be attributed simply to increases in BMI. This independent increase in WC (of on average, 0.9 cm) was consistent across the different BMI categories, sexes, education levels, and race-ethnicity groups. It occurred in younger but not older age groups. Overall in each BMI category, the prevalence of low-risk WC decreased and the prevalence of increased-risk or substantially increased-risk WC increased. These results suggest that the adverse health consequences associated with obesity may be increasingly underestimated by trends in BMI alone. Since WC is closely linked to adverse cardiovascular outcomes, it is important to know the prevailing trends in both of these parameters.

Duration and persistence in multidimensional deprivation : methodology and Australian application

This article extends the recent literature on static multidimensional deprivation to propose dynamic deprivation measures that incorporate both the persistence and duration of deprivation across multiple dimensions. The article then illustrates the usefulness of the extension by applying it to Australian panel data for the recent period, 2001–2008. The empirical application exploits the subgroup decomposability of the deprivation measures to identify the subgroups that are more deprived than others. The proposed measure is also decomposable by dimensions and is used to identify the dimensions where deprivation is more persistent. The comparison between the subgroups shows that the divide between homeowners and non-homeowners is one of the sharpest, with the latter suffering much more deprivation than the former. The results are robust to alternative schemes for weighting and aggregating the dimensions as well as to the choice of model parameters.

Glaucomatous visual field progression with frequency-doubling technology and standard automated perimetry in a longitudinal prospective study

PURPOSE. To compare frequency-doubling technology (FDT) perimetry with standard automated perimetry (SAP) for detecting glaucomatous visual field progression in a longitudinal prospective study.

METHODS. One eye of patients with open-angle glaucoma was tested every 6 months with both FDT and SAP. A minimum of 6 examinations with each perimetric technique was required for inclusion. Visual field progression was determined by two methods: glaucoma change probability (GCP) analysis and linear regression analysis (LRA). For GCP, several criteria for progression were used. The number of locations required to classify progression with FDT compared with SAP, respectively, was 1:2 (least conservative), 1:3, 2:3, 2:4, 2:6, 2:7, 3:6, 3:7, and 3:10 (most conservative). The number of consecutive examinations required to confirm progression was 2-of-3, 2-of-2, and 3-of-3. For LRA, the progression criterion was any significant decline in mean threshold sensitivity over time in each of the following three visual field subdivisions: (1) all test locations, (2) locations in the central 10° and the superior and inferior hemifields, and (3) locations in each quadrant. Using these criteria, the proportion of patients classified as showing progression with each perimetric technique was calculated and, in the case of progression with both, the differences in time to progression were determined.

RESULTS. Sixty-five patients were followed for a median of 3.5 years (median number of examinations, 9). For the least conservative GCP criterion, 32 (49%) patients were found to have progressing visual fields with FDT and 32 (49%) patients with SAP. Only 16 (25%) patients showed progression with both methods, and in most of those patients, FDT identified progression before SAP (median, 12 months earlier). The majority of GCP progression criteria (15/27), classified more patients as showing progression with FDT than with SAP. Contrary to this, more patients showed progression with SAP than FDT, when analysed with LRA; e.g., using quadrant LRA 20 (31%) patients showed progression with FDT, 23 (35%) with SAP, and only 10 (15%) with both.

CONCLUSIONS. FDT perimetry detected glaucomatous visual field progression. However, the proportion of patients who showed progression with both FDT and SAP was small, possibly indicating that the two techniques identify different subgroups of patients. Using GCP, more patients showed progression with FDT than with SAP, yet the opposite occurred using LRA. As there is no independent qualifier of progression, FDT and SAP progression rates vary depending on the method of analysis and the criterion used.

Business process affordances through the lens of activity theory

Business process designers are increasingly being challenged to develop processes that are not only useful in achieving business objectives but also accepted by the process participants and followed in the work place. Those objectives can only be achieved when both the business and the social/cultural aspects of the specific business environment are taken into account. Humans are not unaided individuals separated from a social group and from supporting artefacts but they are complemented by the environment in which they live in. This paper presents a novel framework for the design of business processes based on the application of activity system, providing a comprehensive framework of humans acting in the world, and the theory of affordances, representing action opportunities offered by the environment. The contribution of this paper is two-fold. First, it provides a theoretical contribution to affordance studies by offering a conceptual model that consolidates new developments in the concept, post Gibson. Second, it introduces a new framework (Activity/Affordance Framework - AAF) to aid the design of business processes. Finally, a case study is used to illustrate the utility of the framework in design practice.

Impact of personalized recommendation and social comparison on learning behaviours and outcomes

ELearning suffers from the lack of face-to-face interaction and can deprive learners from the benefits of social interaction and comparison. In this paper we present the results of a study conducted for the impact of social comparison. The study was conducted by collecting students’ engagement with an eLearning tool, the attendance, and grades scored by students at specific milestones and presented these metrics to students as feedback using Kiviat charts. The charts were complemented with appropriate recommendations to allow them to adapt their study strategy and behaviour. The study spanned over 4 semesters (2 with and 2 without the Kiviats) and the results were analysed using paired T tests to test the pre and post results on topics covered by the eLearning tool. Survey questionnaires were also administered at the end for qualitative analysis. The results indicated that the Kiviat feedback with recommendation had positive impact on learning outcomes and attitudes.

The Australian Broadcasting Corporation’s multiplatform projects : industrial logics of children’s content provision in the digital television era

This paper traces the development of children’s multiplatform commissioning at the Australian Broadcasting Corporation (ABC) in the context of the digitalisation of Australian television. Whilst recent scholarship has focussed on ‘post-broadcast’ or ‘second-shift’ industrial practices, designed to engage view(s)ers with proprietary media brands, less attention has been focussed on children’s and young adults’ television in a public service context. Further, although multiplatform projects in the United States and Britain have been the subject of considerable analysis, less work has attempted to contextualise cultural production in smaller media markets. The paper explores two recent multiplatform projects through textual analysis, empirical research (consisting of interviews with key industry personnel) and an investigation of recent policy documents. The authors argue that the ABC’s mixed diet of children’s programming, featuring an educative or social developmental agenda, is complemented by its appeals to audience ‘participation’, with the Corporation maintaining public service values alongside the need to expand audience reach and the legitimacy of its brand. It finds that the ABC’s historical platform infrastructure, across radio, television and online, have allowed it to move beyond a market failure model to exploit multiplatform synergies competitively in the distribution of Australian children’s content to audiences on-demand.

Designing social media into university learning : technology of collaboration or collaboration for technology?

Using the example of an undergraduate unit of study that is taught both on-campus and externally, but uses Internet-based learning in both cases, we explore how social media might be used effectively in higher education. We place into question the assumption that such technologies necessarily engage students in constructivist learning; we argue that the affordances of social media must be complemented by social affordances, designed into the learning experience, which thereby generate the necessary connection between students’ motivations to study and their motivations to exploit social media. We demonstrate, via the example given, how assessment structures and strategies are the most effective focus when attempting to create the pedagogical affordances that might lead to collaborative learning.

The P-Loop domain of yeast Clp1 mediates interactions between CF IA and CPF factors in Pre-mRNA 3′ end formation

 Cleavage factor IA (CF IA), cleavage and polyadenylation factor (CPF), constitute major protein complexes required for pre-mRNA 3' end formation in yeast. The Clp1 protein associates with Pcf11, Rna15 and Rna14 in CF IA but its functional role remained unclear. Clp1 carries an evolutionarily conserved P-loop motif that was previously shown to bind ATP. Interestingly, human and archaean Clp1 homologues, but not the yeast protein, carry 5' RNA kinase activity. We show that depletion of Clp1 in yeast promoted defective 3' end formation and RNA polymerase II termination; however, cells expressing Clp1 with mutant P-loops displayed only minor defects in gene expression. Similarly, purified and reconstituted mutant CF IA factors that interfered with ATP binding complemented CF IA depleted extracts in coupled in vitro transcription/3' end processing reactions. We found that Clp1 was required to assemble recombinant CF IA and that certain P-loop mutants failed to interact with the CF IA subunit Pcf11. In contrast, mutations in Clp1 enhanced binding to the 3' endonuclease Ysh1 that is a component of CPF. Our results support a structural role for the Clp1 P-loop motif. ATP binding by Clp1 likely contributes to CF IA formation and cross-factor interactions during the dynamic process of 3' end formation.