The potential contribution of small firms to innovation in the built environment.

The methods by which small firms overcome the disadvantages of their size to implement innovation on construction projects are examined here through five case studies. It is found that such methods include working with advanced clients, prioritising relationship-building strategies and using patents to protect intellectual property. Key obstacles to innovation implementation by small firms on construction projects are found to be bias in the allocation of government business assistance and regulatory inefficiencies under federal systems of government. The study’s findings derive from a theoretical framework which emphasises firm capabilities and environment, and innovation typologies. Further research is recommended into the impact of government assistance and regulation on small innovative construction firms

Gestures in the virtual environment: the use of deixis in Youtube gaming tutorials

As natural communicators, humans establish meaning by anchoring their language to the space around them. One method that is used to establish communication is through the use of deictic gestures and expressions. Much of the research to date has focused on use of deictic behaviors in face-to-face interactions within the physical world. However, with the advent of new technology and new ways to communicate, researchers have taken interest in the ways humans interact in the virtual environment. This thesis investigates a small portion of virtual communication by examining the use of deictic behaviors in YouTube gaming tutorials. The goal of the creators of these tutorials is to communicate with their audience, in this research I posit that one of the ways they do so is through deictic behaviors that have parallels to those used in the physical world. In order to examine if this is the case, I analyzed video data through the program ELAN and formulated a unique typology of virtual deictic gestures that have roots in previously established gesture theory

Role of advanced neuroimaging, fluid biomarkers and genetic testing in the assessment of sport-related concussion: a systematic review

Objective To conduct a systematic review of published literature on advanced neuroimaging, fluid biomarkers and genetic testing in the assessment of sport-related concussion (SRC). Data sources Computerised searches of Medline, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Scopus and Cochrane Library from 1 January 2000 to 31 December 2016 were done. There were 3222 articles identified. Study selection In addition to medical subject heading terms, a study was included if (1) published in English, (2) represented original research, (3) involved human research, (4) pertained to SRC and (5) involved data from neuroimaging, fluid biomarkers or genetic testing collected within 6 months of injury. Ninety-eight studies qualified for review (76 neuroimaging, 16 biomarkers and 6 genetic testing). Data extraction Separate reviews were conducted for neuroimaging, biomarkers and genetic testing. A standardised data extraction tool was used to document study design, population, tests employed and key findings. Reviewers used a modified quality assessment of studies of diagnostic accuracy studies (QUADAS-2) tool to rate the risk of bias, and a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to rate the overall level of evidence for each search. Data synthesis Results from the three respective reviews are compiled in separate tables and an interpretive summary of the findings is provided. Conclusions Advanced neuroimaging, fluid biomarkers and genetic testing are important research tools, but require further validation to determine their ultimate clinical utility in the evaluation of SRC. Future research efforts should address current gaps that limit clinical translation. Ultimately, research on neurobiological and genetic aspects of SRC is predicted to have major translational significance to evidence-based approaches to clinical management of SRC, much like applied clinical research has had over the past 20 years

Can HbA1c detect undiagnosed diabetes in acute medical hospital admissions?

Objective: to study hyperglycaemia in acute medical admissions to Irish regional hospital.Research design and methods: from 2005 to 2007, 2061 white Caucasians, aged &gt;18 years, were admitted by 1/7 physicians. Those with diabetes symptoms/complications but no previous record of hyperglycaemia (n = 390), underwent OGTT with concurrent HbA1c in representative subgroup (n = 148). Comparable data were obtained for 108 primary care patients at risk of diabetes.Results: diabetes was diagnosed immediately by routine practice in 1% (22/2061) [aged 36 (26–61) years (median IQ range)/55% (12/22) male] with pre-existing diabetes/dysglycaemia present in 19% (390/2061) [69 (58–80) years/60% (235/390) male].Possible diabetes symptoms/complications were identified in 19% [70 (59–79) years/57% (223/390) male] with their HbA1c similar to primary care patients [54 (46–61) years], 5.7 (5.3–6.0)%/39 (34–42) mmol/mol (n = 148) vs 5.7 (5.4–6.1)%/39 (36–43) mmol/mol, p = 0.35, but lower than those diagnosed on admission, 10.2 (7.4–13.3)%/88 (57–122) mmol/mol, p &lt; 0.001. Their fasting plasma glucose (FPG) was similar to primary care patients, 5.2 (4.8–5.7) vs 5.2 (4.8–5.9) mmol/L, p = 0.65, but 2hPG higher, 9.0 (7.3–11.4) vs 5.5 (4.4–7.5), p &lt; 0.001.HbA1c identified diabetes in 10% (15/148) with 14 confirmed on OGTT but overall 32% (48/148) were in diabetic range on OGTT. The specificity of HbA1c in 2061 admissions was similar to primary care, 99% vs 96%, p = 0.20, but sensitivity lower, 38% vs 93%, p &lt; 0.001 (63% on FPG/23% on 2hPG, p = 0.037, in those with possible symptoms/complications).Conclusion: HbA1c can play a diagnostic role in acute medicine as it diagnosed another 2% of admissions with diabetes but the discrepancy in sensitivity shows that it does not reflect transient/acute hyperglycaemia resulting from the acute medical event.</p

The impact of spatial orientation changes on driving behavior in healthy aging

Objectives: Global cognitive changes in older age affect driving behavior and road safety, but how spatial orientation differences affect driving behaviors is unknown on a population level, despite clear implications for driving policy and evaluation during aging. The present study aimed to establish how spatial navigation changes affect driving behavior and road safety within a large cohort of older adults. Methods: Eight hundred and four participants (mean age: 71.05) were recruited for a prospective cohort study. Participants self-reported driving behavior followed by spatial orientation (allocentric and egocentric) testing and a broader online cognitive battery (visuomotor speed, processing speed, executive functioning, spatial working memory, episodic memory, visuospatial functioning). Results: Spatial orientation performance significantly predicted driving difficulty and frequency. Experiencing more driving difficulty was associated with worse allocentric spatial orientation, processing speed, and source memory performance. Similarly, avoiding challenging driving situations was associated with worse spatial orientation and episodic memory. Allocentric spatial orientation was the only cognitive domain consistently affecting driving behavior in under 70 and over 70 age groups, a common age threshold for driving evaluation in older age. Discussion: We established for the first time that worse spatial orientation performance predicted increased driving difficulty and avoidance of challenging situations within an older adult cohort. Deficits in spatial orientation emerge as a robust indicator of driving performance in older age, which should be considered in future aging driving assessments, as it has clear relevance for road safety within the aging population

Comparison of IFCC-calibrated HbA1c from laboratory and point of care testing systems

Objective: WHO, IDF and ADA recommend HbA1c ≥6.5% (48 mmol/mol) for diagnosis of diabetes with pre-diabetes 6.0% (42 mmol/mol) [WHO] or 5.7% (39 mmol/mol) [ADA] to 6.4% (47 mmol/mol). We have compared HbA1c from several methods for research relating glycaemic markers.Research design and methods: HbA1c was measured in EDTA blood from 128 patients with diabetes on IE HPLC analysers (Bio-Rad Variant II NU, Menarini HA8160 and Tosoh G8), point of care systems, POCT, (A1cNow+ disposable cartridges and DCA 2000®+ analyser), affinity chromatography (Primus Ultra2) and the IFCC secondary reference method (Menarini HA8160 calibrated using IFCC SRM protocol).Results: median (IQ range) on IFCC SRM was 7.5% (6.8–8.4) (58(51–68) mmol/mol) HbA1c with minimum 5.3%(34 mmol/mol)/maximum 11.9%(107 mmol/mol). There were positive offsets between IFCC SRM and Bio-Rad Variant II NU, mean difference (1SD), +0.33%(0.17) (+3.6(1.9) mmol/mol), r2 = 0.984, p &lt; 0.001 and Tosoh G8, +0.22%(0.20) (2.4(2.2) mmol/mol), r2 = 0.976, p &lt; 0.001 with a very small negative difference −0.04%(0.11) (−0.4(1.2) mmol/mol), r2 = 0.992, p &lt; 0.001 for Menarini HA8160. POCT methods were less precise with negative offsets for DCA 2000®+ analyser −0.13%(0.28) (−1.4(3.1) mmol/mol), r2 = 0.955, p &lt; 0.001 and A1cNow+ cartridges −0.70%(0.67) (−7.7(7.3) mmol/mol), r2 = 0.699, p &lt; 0.001 (n = 113). Positive biases for Tosoh and Bio-Rad (compared with IFCC SRM) have been eliminated by subsequent revision of calibration.Conclusions: small differences observed between IFCC-calibrated and NGSP certified methods across a wide HbA1c range were confirmed by quality control and external quality assurance. As these offsets affect estimates of diabetes prevalence, the analyser (and calibrator) employed should be considered when evaluating diagnostic data.</p