BIOMECHANICAL ADAPTATIONS FOLLOWING A LATERAL ANKLE SPRAIN INJURY: AN EXPLANATION FOR CHRONIC ANKLE INSTABILITY?

The purpose of this study was to determine whether biomechanical adaptations play a clinically significant role in chronic ankle instability following lateral ankle sprain injury. Synchronised 3D motion analysis was conducted on 32 grade 11 lateral ankle sprain patients (grouped by functional stability score into capers and non-copers) during a dynamic cutting maneuvre. Simultaneous EMG and force data were collected and compared for the injured and non-injured limbs. Copers could be distinguished from noncopers by certain EMG and ground reaction force parameters. Other distinctions could also be made between the injured and non-injured limbs. However these variables did not show significant group- by-side interactions to explain the symptoms of unilateral functional instability experienced by the non-coper group

A Model for Family Preservation Case Assessment

The outcomes of family preservation practice have been researched and debated. The effectiveness of family preservation is still inconclusive and many of the findings may only be inferred to specific situations. Few studies have addressed the assessment techniques or outcome factors from a qualitative perspective. This article synthesizes current literature, research and practice, and proposes a practice framework with questioning techniques to assist practitioners in assessing the strengths and characteristics of a family, and making decisions on whether or not familybased services are appropriate for the family. Two actual cases are presented to illustrate how the worker can benefit from having the assessment data derived from this model

Brief lifestyle interventions for prediabetes in primary care: a service evaluation

BackgroundThe increasing number of cases of prediabetes in the UK is concerning, particularly in Wales where there is no standard programme of support. The aim of the current service evaluation was to examine the effectiveness of brief lifestyle interventions on glucose tolerance in people at risk of developing type 2 diabetes.MethodsIn this pragmatic service evaluation clinical data on people deemed at risk of developing type 2 diabetes were evaluated from two GP clusters. Patients (n = 1207) received a single 15 to 30-min, face-to-face, consultation with a health care practitioner. Interventions were assessed by changes in HbA1c and distribution across the HbA1c ranges 12 months following intervention. Statistical significance of reversion to normoglycaemia and development of diabetes were assessed through comparison with expected rates without intervention.ResultsBetween baseline and 12-month follow-up HbA1c fell from 43.85 ± 1.57 mmol/mol (6.16 ± 0.14%) to 41.63 ± 3.84 mmol/mol (5.96 ± 0.35%), a decrease of 2.22 mmol/mol (0.20%) (95% CI 2.01 (0.18%), 2.42 (0.22%); p < 0.0001). The proportion of people with normal glucose tolerance at 12 months (0.50 95%CI 0.47, 0.52) was significantly larger than the lower (0.06 (p < 0.0001) and the upper (0.19 (p < 0.0001)) estimates based on no intervention.ConclusionResults indicate significant improvement in glucose tolerance across GP clusters. The brief intervention has the potential to offer a robust and effective option to support people at risk of developing type 2 diabetes. Further research in the form of a randomised trial is needed to confirm this and identify those likely to benefit most from this intervention

Service Blueprint for Sustainable Business Model Evaluation

The adverse societal impacts caused by sharing mobility - a form of service-based sustainable business model innovations, showed that operation activities and managerial practices impact heavily on the sustainable value of a service offering. To identify how new service development (NSD) activities can better support the proposed service offering for sustainability, evaluating sustainability of service operations is needed. This study draws learnings from service design, product-service system and sustainable innovation research streams, to build sustainability evaluation framework into service blueprint. Six expert-interviews and two mobility case studies were developed, to illustrate service blueprint's capability in mapping sustainability input and benefits created during NSD and service operation activities. Results revealed a) the shift from using sustainable ‘value’ to ‘benefits’ concept in service operation evaluation, b) the public-private collaboration dilemma and c) the agile NSD and sustainable innovation incompatibility. This paper aims to offer a springboard for practitioners and researchers to uncover compelling insights, discuss latest service design developments, and envision future directions for integrating sustainability into service-based business model innovation.<br

Brief Lifestyle Interventions for Prediabetes in Primary Care:A Service Evaluation

BACKGROUND: The increasing number of cases of prediabetes in the UK is concerning, particularly in Wales where there is no standard programme of support. The aim of the current service evaluation was to examine the effectiveness of brief lifestyle interventions on glucose tolerance in people at risk of developing type 2 diabetes. METHODS: In this pragmatic service evaluation clinical data on people deemed at risk of developing type 2 diabetes were evaluated from two GP clusters. Patients (n = 1207) received a single 15 to 30-min, face-to-face, consultation with a health care practitioner. Interventions were assessed by changes in HbA1c and distribution across the HbA1c ranges 12 months following intervention. Statistical significance of reversion to normoglycaemia and development of diabetes were assessed through comparison with expected rates without intervention. RESULTS: Between baseline and 12-month follow-up HbA1c fell from 43.85 ± 1.57 mmol/mol (6.16 ± 0.14%) to 41.63 ± 3.84 mmol/mol (5.96 ± 0.35%), a decrease of 2.22 mmol/mol (0.20%) (95% CI 2.01 (0.18%), 2.42 (0.22%); p < 0.0001). The proportion of people with normal glucose tolerance at 12 months (0.50 95%CI 0.47, 0.52) was significantly larger than the lower (0.06 (p < 0.0001) and the upper (0.19 (p < 0.0001)) estimates based on no intervention. CONCLUSION: Results indicate significant improvement in glucose tolerance across GP clusters. The brief intervention has the potential to offer a robust and effective option to support people at risk of developing type 2 diabetes. Further research in the form of a randomised trial is needed to confirm this and identify those likely to benefit most from this intervention

The lift industry in Hong Kong : regulatory action and capacity building

published_or_final_versionPolitics and Public AdministrationMasterMaster of Public Administratio

Snake prices and crocodile appetites: Aquatic wildlife supply and demand on Tonle Sap Lake, Cambodia

Commercial trade is a major driver of over-exploitation of wild species, but the pattern of demand and how it responds to changes in supply is poorly understood. Here we explore the markets for snakes from Tonle Sap Lake in Cambodia to evaluate future exploitation scenarios, identify entry points for conservation and, more generally, to illustrate the value of multi-scale analysis of markets to traded wildlife conservation. In Cambodia, the largest driver of snake exploitation is the domestic trade in snakes as crocodile food. We estimate that farmed crocodiles consume between 2.7 and 12.2 million snakes per year. The market price for crocodiles has been in decline since 2003, which, combined with rising prices for their food, has led to a reduced frequency of feeding and closure of small farms. The large farms that generate a disproportionate amount of the demand for snakes continue to operate in anticipation of future market opportunities, and preferences for snakes could help maintain demand if market prices for crocodiles rise to pre 2003 levels. In the absence of a sustained demand from crocodile farms, it is also possible that alternative markets will develop, such as one for human snack food. The demand for snakes, however, also depends on the availability of substitute resources, principally fish. The substitutability and low price elasticity of demand offers a relatively sustainable form of consumerism. Given the nature of these market drivers, addressing consumer preferences and limiting the protection of snakes to their breeding season are likely to be the most effective tools for conservation. This study highlights the importance of understanding the structure of markets and the behaviour of consumer demand prior to implementing regulations on wildlife hunting and trade

Effect of structured self‐monitoring of blood glucose, with and without additional TeleCare support, on overall glycaemic control in non‐insulin treated Type 2 diabetes: the SMBG Study, a 12‐month randomized controlled trial

AimTo examine the impact of structured self-monitoring of blood glucose, with or without TeleCare support, on glycaemic control in people with sub-optimally controlled Type 2 diabetes.MethodsWe conducted a 12-month, multicentre, randomized controlled trial in people with established (>1 year) Type 2 diabetes not on insulin therapy, with sub-optimal glycaemic control [HbA1c ≥58 to ≤119 mmol/mol (≥7.5% to ≤13%)]. A total of 446 participants were randomized to a control group (n =151) receiving usual diabetes care, a group using structured self-monitoring of blood glucose alone (n =147) or a group using structured self-monitoring of blood glucose with additional monthly ‘TeleCare’ support (n =148). The primary outcome was HbA1c at 12 months.ResultsA total of 323 participants (72%) completed the study; 116 (77%) in the control group, 99 (67%) in the self-monitoring of blood glucose alone group and 108 (73%) in the self-monitoring of blood glucose plus TeleCare group. Compared to baseline, the mean HbA1c was lower in all groups at 12 months, with reductions of 3.3 mmol/mol (95% CI –5.71 to –0.78) or 0.3% (95% CI –0.52 to –0.07; P=0.01) in the control group, 11.4 mmol/mol (95% CI –14.11 to –8.76) or 1.1% (–1.29 to –0.81; P<0.0001) in the group using self-monitoring of blood glucose alone and 12.8 mmol/mol (95% CI –15.34 to –10.31) or 1.2% (95% CI –1.40 to -0.94; P<0.0001) in the group using self-monitoring of blood glucose plus TeleCare. This represents a reduction in HbA1c of 8.9 mmol/mol (95% CI –11.97 to –5.84) or 0.8% (95% CI –1.10 to -0.54; P≤0.0001) with structured self-monitoring of blood glucose compared to the control group. Participants with lower baseline HbA1c, shorter duration of diabetes and higher educational achievement were more likely to achieve HbA1c ≤53 mmol/mol (7.0%).ConclusionsStructured self-monitoring of blood glucose provides clinical and statistical improvements in glycaemic control in Type 2 diabetes. No additional benefit, over and above the use of structured self-monitoring of blood glucose, was observed in glycaemic control with the addition of once-monthly TeleCare support.(Clinical trial registration no.: ISRCTN21390608

Study protocol for "Moving bright, eating smart"- a phase 2 clinical trial on the acceptability and feasibility of a diet and physical activity intervention to prevent recurrence in colorectal cancer survivors

Background: Colorectal cancer is the second most common cancer and cancer-killer in Hong Kong with an&nbsp;alarming increasing incidence in recent years. The latest World Cancer Research Fund report concluded that foods&nbsp;low in fibre, and high in red and processed meat cause colorectal cancer whereas physical activity protects againstcolon cancer. Yet, the influence of these lifestyle factors on cancer outcome is largely unknown even though&nbsp;cancer survivors are eager for lifestyle modifications. Observational studies suggested that low intake of a&nbsp;Western-pattern diet and high physical activity level reduced colorectal cancer mortality. The Theory of PlannedBehaviour and the Health Action Process Approach have guided the design of intervention models targeting a&nbsp;wide range of health-related behaviours.Methods/design: We aim to demonstrate the feasibility of two behavioural interventions intended to improve&nbsp;colorectal cancer outcome and which are designed to increase physical activity level and reduce consumption of a&nbsp;Western-pattern diet. This three year study will be a multicentre, randomised controlled trial in a 2x2 factorialdesign comparing the &ldquo;Moving Bright, Eating Smart&rdquo; (physical activity and diet) programme against usual care.&nbsp;Subjects will be recruited over a 12-month period, undertake intervention for 12 months and followed up for a&nbsp;further 12 months. Baseline, interim and three post-intervention assessments will be conducted.&nbsp;Two hundred and twenty-two colorectal cancer patients who completed curative treatment without evidence of&nbsp;recurrence will be recruited into the study. Primary outcome measure will be whether physical activity and dietary&nbsp;targets are met at the end of the 12-month intervention. Secondary outcome measures include the magnitude andmechanism of behavioural change, the degree and determinants of compliance, and the additional health benefits&nbsp;and side effects of the intervention.Discussion: The results of this study will establish the feasibility of targeting the two behaviours (diet and physical activity) and demonstrate the magnitude of behaviour change. The information will facilitate the design of a further&nbsp;larger phase III randomised controlled trial with colorectal cancer outcome as the study endpoint to determine&nbsp;whether this intervention model would reduce colorectal cancer recurrence and mortality