Randomised controlled trial of an automated, interactive telephone intervention (TLC Diabetes) to improve type 2 diabetes management : Baseline findings and six-month outcomes

Background: Effective self-management of diabetes is essential for the reduction of diabetes-related complications, as global rates of diabetes escalate. Methods: Randomised controlled trial. Adults with type 2 diabetes (n = 120), with HbA1c greater than or equal to 7.5 %, were randomly allocated (4 × 4 block randomised block design) to receive an automated, interactive telephone-delivered management intervention or usual routine care. Baseline sociodemographic, behavioural and medical history data were collected by self-administered questionnaires and biological data were obtained during hospital appointments. Health-related quality of life (HRQL) was measured using the SF-36. Results: The mean age of participants was 57.4 (SD 8.3), 63 % of whom were male. There were no differences in demographic, socioeconomic and behavioural variables between the study arms at baseline. Over the six-month period from baseline, participants receiving the Australian TLC (Telephone-Linked Care) Diabetes program showed a 0.8 % decrease in geometric mean HbA1c from 8.7 % to 7.9 %, compared with a 0.2 % HbA1c reduction (8.9 % to 8.7 %) in the usual care arm (p = 0.002). There was also a significant improvement in mental HRQL, with a mean increase of 1.9 in the intervention arm, while the usual care arm decreased by 0.8 (p = 0.007). No significant improvements in physical HRQL were observed. Conclusions: These analyses indicate the efficacy of the Australian TLC Diabetes program with clinically significant post-intervention improvements in both glycaemic control and mental HRQL. These observed improvements, if supported and maintained by an ongoing program such as this, could significantly reduce diabetes-related complications in the longer term. Given the accessibility and feasibility of this kind of program, it has strong potential for providing effective, ongoing support to many individuals with diabetes in the future.

The late discovery of adoptive and donor insemination offspring status : ethical implications for conceptual understandings of the ‘best interests of the child’ principle

Late discovery is a term used to describe the experience of discovering the truth of one’s genetic origins as an adult. Following discovery, late discoverers face a lack of recognition and acknowledgment of their concerns from family, friends, community and institutions. They experience pain, anger, loss, grief and frustration. This presentation shares the findings of the first qualitative study of both late discovery of adoptive and donor insemination offspring (heterosexual couple use only) experiences. It is also the first study of late discovery experiences undertaken from an ethical perspective. While this study recruited new participants, it also included an ethical re-analysis of existing late discovery accounts across both practices. The findings of this study (a) draws links between past adoption and current donor insemination (heterosexual couple only) practices, (b) reveals that late discoverers are demanding acknowledgment and recognition of the particularity of their experiences, and (c) offers insights into conceptual understandings of the ‘best interests of the child’ principle. These insights derive from the lived experiences of those whose biological and social worlds have been sundered and secrecy and denial of difference used to conceal this. It suggests that acknowledging the equal moral status of the child may be useful in strengthening conceptual understandings of the ‘best interests of the child’ principle. This equal moral status involves ensuring that personal autonomy and the ability to exercise free will is protected; that the integrity of the relationships of trust expected and demanded between parent/s and children is defended and supported; and that equal access to normative socio-cultural practices, that is; non-fictionalised birth certificates and open records, is guaranteed.

Linking scientific evidence and decision making : A case study of hand hygiene interventions

We consider how data from scientific research should be used for decision making in health services. Whether a hand hygiene intervention to reduce risk of nosocomial infection should be widely adopted is the case study. Improving hand hygiene has been described as the most important measure to prevent nosocomial infection. 1 Transmission of microorganisms is reduced, and fewer infections arise, which leads to a reduction in mortality2 and cost savings.3 Implementing a hand hygiene program is itself costly, so the extra investment should be tested for cost-effectiveness.4,5 The first part of our commentary is about cost-effectiveness models and how they inform decision making for health services. The second part is about how data on the effectiveness of hand hygiene programs arising from scientific studies are used, and 2 points are made: the threshold for statistical inference of .05 used to judge effectiveness studies is not important for decision making,6,7 and potentially valuable evidence about effectiveness might be excluded by decision makers because it is deemed low quality.8 The ideas put forward will help researchers and health services decision makers to appraise scientific evidence in a more powerful way.

Understanding the impact of legislative changes on child car seating and restraint practices in regional Queensland

Road crashes contribute to a significant amount of child mortality and morbidity in Australia. In fact, passenger injuries contribute to the majority of child crash road trauma. A number of factors contribute to child injury and death in motor vehicles, including inappropriate seating position, inappropriate choice of restraint, and incorrect installation and use of child restraints. Prior to March 2010, child restraint legislation in Queensland only required children twelve months and younger to be seated in a properly adjusted and fastened child restraint. This legislation left older infants and young children potentially suboptimally protected. From March 2010, new legislation specified seating position and type of child restraint required, depending on the age of the child. This research was underpinned by the Health Belief Model (HBM), which explores health related behaviour, behaviour change, environmental factors influencing behaviour change (including legislative changes) and is flexible enough to be used in relation to parents' health practices for their children, rather than parent health directly. This thesis investigates the extent to which the changes to child restraint legislation have led parents in regional areas of Queensland to use appropriate restraint practices for their children and determines the extent to which the constructs of the HBM, parental perceptions, barriers and environmental factors contribute to the appropriateness of child seating and restraint use. Study One included three sets of observations taken in two regional cities of Queensland prior to the legislative amendment, during an educative period of six months, and after the enactment of the legislation. Each child's seating position and restraint type were recorded. Results showed that the proportion of children observed occupying the front seat decreased by 15.6 per cent with the announcement the legislation. There was no decrease in front seat use at the enactment of the legislation. The proportion of children observed using dedicated child restraints increased by 8.8 per cent with the announcement of the legislation when there was one child in the vehicle. Further, there was a 10.1 per cent increase in the proportion of children observed using a seat belt that fit with the announcement when there was one child in the vehicle and with the enactment of the legislation regardless of the number of children in the vehicle (21.8 per cent for one child, 39.7 per cent for two children and 40.2 per cent for three or more children). Study Two comprised initial intercept interviews, later followed up by telephone, with parents with children aged eight years and younger at the announcement and telephone interviews at the enactment of the legislation in one regional city in Queensland. Parents reported their child restraint practices, and opinions, knowledge and understanding of the requirements of the new legislation. Parent responses were analysed in terms of the constructs in the HBM. When asked which seating position their child 'usually' used, parents reported child front seat use was nil (0.0 per cent) and did not change with the enactment of the legislative amendment. However, when parents were asked whether they allowed children to use the front seat at some point within the six months prior to the interview, reported child front seat use was 7 (5.4 per cent) children at T2 and 10 (9.6 per cent) at T3. Reported use of age-appropriate child restraints did not increase with the enactment of the legislation (p = 0.77, ns). Parents reported restraint practices were classed as either appropriate or inappropriate. Parents who reported appropriate restraint practices were those whose children were sitting in optimal restraints and seating positions for their age according to the requirements of the legislation. Parents who reported inappropriate restraint practices were those who had one or more children who were suboptimally restrained or seated for their age according to the requirements of the legislation. Neither parents' perceptions about their susceptibility of being in a crash nor the likelihood of severity of child injury if involved in a crash yielded significant differences in the appropriateness of reported parent restraint practices over time with the enactment of the legislation. A trend in the data suggested parents perceived a benefit to using appropriate restraint practices was to avoid fines and demerit points. Over 75 per cent of parents who agreed that child restraints provide better protection for children than an adult seat belt reported appropriately seating and restraining their children (2 (1) = 8.093, p<.05). The self-efficacy measure regarding parents' confidence in installing a child restraint showed a significant association with appropriate parental restraint practices (2 (1) = 7.036, p<.05). Results suggested that some parents may have misinterpreted the announcement of the legislative amendment as the announcement of the enforcement of the legislation instead. Some parents who correctly reported details of the legislation did not report appropriate child restraint practices. This finding shows that parents' knowledge of the legislative amendment does not necessarily have an impact on their behaviour to appropriately seat and restrain children. The results of these studies have important implications for road safety and the prevention of road-related injury and death to children in Queensland. Firstly, parents reported feeling unsure of how to install restraints, which suggests that there may be children travelling in restraints that have not been installed correctly, putting them at risk. Interventions to alert and encourage parents to seek advice when unsure about the correct installation of child restraints could be considered. Secondly, some parents in this study although they were using the most appropriate restraint for their children, reported using a type that was not the most appropriate restraint for the child's age according to the legislation. This suggests that intervention may be effective in helping parents make a more accurate choice of the most appropriate type of restraint to use with children, especially as the child ages and child restraint requirements change. Further research could be conducted to ascertain the most effective methods of informing and motivating parents to use the most appropriate restraints and seating positions for their children, as these results show a concerning disparity between reported restraint practices and those that were observed.

Re : Why optometry must work from urban and regional Aboriginal health services

We are writing to support the recent Viewpoint written by Anjou, Boudville and Taylor ‘Why optometry must work in Aboriginal Health Services in urban and regional Australia’.[1] We are a group of optometrists who provide optometric services within Aboriginal Health Services in urban and regional settings and we agree that access to optometry in Aboriginal Health Services should be supported and expanded in an effort to ‘close the gap’ for vision.

Thinking as if you are another : drama, persuasive language and pretexts

Using Shaun Tan’s picture book Rules of Summer (2013) as a pretext, this practical session will explore how primary teachers can engage middle and upper primary students in drama-based activities that support student learning and assessment outcomes in both English and The Arts (with a particular emphasis on drama and media arts). The session will explore notions of persuasive text (written and oral), points of view, devised storytelling and embodied learning.

High penetration of rooftop photovoltaic cells in low voltage distribution networks : voltage imbalance and improvement

Installation of domestic rooftop photovoltaic cells (PVs) is increasing due to feed–in tariff and motivation driven by environmental concerns. Even though the increase in the PV installation is gradual, their locations and ratings are often random. Therefore, such single–phase bi–directional power flow caused by the residential customers can have adverse effect on the voltage imbalance of a three–phase distribution network. In this chapter, a voltage imbalance sensitivity analysis and stochastic evaluation are carried out based on the ratings and locations of single–phase grid–connected rooftop PVs in a residential low voltage distribution network. The stochastic evaluation, based on Monte Carlo method, predicts a failure index of non–standard voltage imbalance in the network in presence of PVs. Later, the application of series and parallel custom power devices are investigated to improve voltage imbalance problem in these feeders. In this regard, first, the effectiveness of these two custom power devices is demonstrated vis–à–vis the voltage imbalance reduction in feeders containing rooftop PVs. Their effectiveness is investigated from the installation location and rating points of view. Later, a Monte Carlo based stochastic analysis is utilized to investigate their efficacy for different uncertainties of load and PV rating and location in the network. This is followed by demonstrating the dynamic feasibility and stability issues of applying these devices in the network.

Insider comes out : an artist's inquiry and narrative about the relationship of art and mental health

Background Through an account of prevailing experiences of art and mental illness, this paper aims to raise awareness, open dialogue and create agency about art created by people with experience of mental illness. Methods This paper draws on personal narrative and inquiry by an artist with mental illness and data collected as part of a larger participatory action research project that investigated understandings of identity, art and mental illness. Result An inquiry through art raised awareness and attentiveness to the importance of choice in identity construction and exposed frequent dichotomies in art and mental illness that were negotiated to eschew prescribed social stratification. As an artist, the first author challenged values present in one idea and absent in the other, and the options and concessions available to authorise her own dialogue and agency of being an artist. Conclusion Constructing an identity is an important part of being human, the labels that we choose or are chosen for us attribute to our identity. Reflections and recommendations are offered to consider expanded ways of thinking about art and mental illness and the functions that art play in identity construction.

Histories of user-generated content : between formal and informal media economies

Debates about user-generated content (UGC) often depend on a contrast with its normative opposite, the professionally produced content that is supported and sustained by commercial media businesses or public organisations. UGC is seen to appear within or in opposition to professional media, often as a disruptive, creative, change-making force. Our suggestion is to position UGC not in opposition to professional or "producer media", or in hybridised forms of subjective combination with it (the so-called "pro-sumer" or "pro-am" system), but in relation to different criteria, namely the formal and informal elements in media industries. In this article, we set out a framework for the comparative and historical analysis of UGC systems and their relations with other formal and informal media activity, illustrated with examples ranging from games to talkback radio. We also consider the policy implications that emerge from a historicised reading of UGC as a recurring dynamic within media industries, rather than a manifestation of consumer agency specific to digital cultures.

An experimental analysis of direction judgment in a curved corridor

An experiment was conducted to investigate direction judgment in a curved corridor. Each participant walked through the curved corridor. A direction was presented to participants at the entrance, and they were asked to point this direction at two points within the corridor. The present study proposed two hypotheses : (a) participants underestimate the change of their traveling direction while walking; (b) participants use four-direction reference axes (front, back, left, and right) for direction judgment. Both hypotheses were supported, and it was suggested that participants estimated the change of their traveling direction to be approximately 90% of the actual change.

Verification and Operation of Adaptive Materials in Space

Piezoelectric polymers based on polyvinylidene fluoride (PVDF) are of interest as smart materials for novel space-based telescope applications. Dimensional adjustments of adaptive thin polymer films are achieved via controlled charge deposition. Predicting their long-term performance requires a detailed understanding of the piezoelectric property changes that develop during space environmental exposure. The overall materials performance is governed by a combination of chemical and physical degradation processes occurring in low Earth orbit as established by our past laboratory-based materials performance experiments (see report SAND 2005-6846). Molecular changes are primarily induced via radiative damage, and physical damage from temperature and atomic oxygen exposure is evident as depoling, loss of orientation and surface erosion. The current project extension has allowed us to design and fabricate small experimental units to be exposed to low Earth orbit environments as part of the Materials International Space Station Experiments program. The space exposure of these piezoelectric polymers will verify the observed trends and their degradation pathways, and provide feedback on using piezoelectric polymer films in space. This will be the first time that PVDF-based adaptive polymer films will be operated and exposed to combined atomic oxygen, solar UV and temperature variations in an actual space environment. The experiments are designed to be fully autonomous, involving cyclic application of excitation voltages, sensitive film position sensors and remote data logging. This mission will provide critically needed feedback on the long-term performance and degradation of such materials, and ultimately the feasibility of large adaptive and low weight optical systems utilizing these polymers in space.

Durability of rammed earth walls exposed for 20 years to natural weathering

This paper presents a study on the durability of different types of stabilised and unstabilised rammed earth walls. These rammed earth walls were constructed and exposed for 20 years to natural weathering, in a wet continental climate. None of these walls have shown complete collapse to date. A method to measure the rammed earth walls erosion by stereo-photogrammetry has been developed. The result shows that the mean erosion depth of the studied walls is about 2 mm (0.5% wall thickness) in the case of rammed earth wall stabilised with 5% by dry weight of hydraulic lime and about 6.4 mm (1.6% wall thickness) in the case of unstabilised rammed earth walls. The stabilisation enables to not use any plaster to protect the walls. In the case of the unstabilised rammed earth walls, an extrapolated lifetime longer than 60 years can be assessed. This shows a potential for the use of unstabilised rammed earth in the similar climatic conditions with this study. The method of stereo-photogrammetry used to measure the erosion of rammed earth walls on site may also help to calibrate and develop more pertinent laboratory test to assess the durability of rammed earth wall.

Teollisuuden ja yhteiskunnan palveluksessa : Arkkitehti Bertel Liljequist (1885 - 1954) tuotantolaitosten suunnittelijana maailmansotien välisenä aikana

My thesis concerns the plans drawn up by architect Bertel Liljequist (1885 1954) for an industrial corporation and a city in Finland during the interwar years. These were two quite different clients: the Kymi Company operating in Kuusankoski and the City of Helsinki. My study includes the micro-examination of the wider social issues involved. That the industrial community and factories in Kuusankoski be constructed correctly in a way supporting corporate strategy was of primary importance for the company s operations. Through the planning process for Helsinki s abattoirs, I show how a city dealt with the twin problems of hygiene and increasing demand for food resulting from a growth in population. I clarify how society and its economic, political and class structures affected the practice of architecture and its expression in the built environment. I analyse how the different backgrounds and starting points of the clients affected the construction projects under study and architect Bertel Liljequist s work. In studying Liljequist as an industrial designer, I have considered it vital to ascertain the client s intentions and objectives within the framework of the prevailing social situation. I examine the meanings the client wished the architecture to express and also to communicate to those working in the factory and the area as well as to the workers living on company land. The social outlook of the owners and management of Kymi Company implicitly affected the appearance of the factory. A brick fairface for the factories was a safe and natural material at the beginning of the 1920s when taking into consideration the events of the 1918 Civil War. To have built a White factory in the style of a defence building would have been provocative. Outside the factory gates, however, the company supported White architecture. The company used the factory buildings to manifest its power and the dwellings to bind the workers and make them loyal to the company. Architecture was thus one way in which the company manifested its position as the higher and undisputed authority. The role of the City of Helsinki within the planning process was for its officials to provide expert opinions but also to arrange study trips for the architect and the abattoir s general manager. The city also decided on the standard of the design. The city s responsibility for the health of its inhabitants and the requirements of modern meat production can be seen in the minimal architecture and clear functionality of the plant. The architecture left no doubt about the trustworthiness of the modern city. Translation: Michael Wynne-Ellis

Near infrared spectroscopy as a rapid tool to measure volatile aroma compounds in Riesling wine: Possibilities and limits

Volatile chemical compounds responsible for the aroma of wine are derived from a number of different biochemical and chemical pathways. These chemical compounds are formed during grape berry metabolism, crushing of the berries, fermentation processes (i.e. yeast and malolactic bacteria) and also from the ageing and storage of wine. Not surprisingly, there are a large number of chemical classes of compounds found in wine which are present at varying concentrations (ng L-1 to mg L-1), exhibit differing potencies, and have a broad range of volatilities and boiling points. The aim of this work was to investigate the potential use of near infrared (NIR) spectroscopy combined with chemometrics as a rapid and low-cost technique to measure volatile compounds in Riesling wines. Samples of commercial Riesling wine were analyzed using an NIR instrument and volatile compounds by gas chromatography (GC) coupled with selected ion monitoring mass spectrometry. Correlation between the NIR and GC data were developed using partial least-squares (PLS) regression with full cross validation (leave one out). Coefficients of determination in cross validation (R 2) and the standard error in cross validation (SECV) were 0.74 (SECV: 313.6 μg L−1) for esters, 0.90 (SECV: 20.9 μg L−1) for monoterpenes and 0.80 (SECV: 1658 ?g L-1) for short-chain fatty acids. This study has shown that volatile chemical compounds present in wine can be measured by NIR spectroscopy. Further development with larger data sets will be required to test the predictive ability of the NIR calibration models developed.

Predatory and trophobiont-tending ants respond differently to fig and fig wasp volatiles

The interaction between figs and their pollinating or parasitic fig wasps is mediated largely by chemical communication. These fig wasps are often preyed upon by predatory ants. In this study, we found that predatory ants (Oecophylla smaragdina) patrolling Ficus racemosa trees were attracted to the odour from fig syconia at different developmental phases, as well as to the odours of fig wasps, whereas other predatory ants (Technomyrmex albipes) responded only to odours of syconia from which fig wasps were dispersing and to fig wasp odour. However, trophobiont-tending ants (Myrmicaria brunnea) patrolling the same trees and exposed to the same volatiles were unresponsive to fig or fig wasp odours. The predatory ants demonstrated a concentration-dependent response towards volatiles from figs receptive to pollinators and those from which wasps were dispersing while the trophobiont-tending ants were unresponsive to such odours at all concentrations. Naive predatory ants failed to respond to the volatiles to which the experienced predatory ants responded, indicating that the response to fig-related odours is learned. We suggest that predatory ants could use fig-associated volatiles to enhance their probability of wasp encounter and can eavesdrop on signals meant for pollinators. (C) 2009 The Association for the Study of Animal Behaviour.