Professor Peter Howley

Aim: To determine the glycaemic impact of increasing protein quantities when consumed with consistent amounts of carbohydrate in individuals with Type 1 diabetes on intensive insulin therapy. Methods: Participants with Type 1 diabetes [aged 10¿40 years, HbA = 64 mmol/mol (8%), BMI = 91st percentile] received a 30-g carbohydrate (negligible fat) test drink daily over 5 days in randomized order. Protein (whey isolate 0 g/kg carbohydrate, 0 g/kg lipid) was added in amounts of 0 (control), 12.5, 25, 50 and 75 g. A standardized dose of insulin was given for the carbohydrate. Postprandial glycaemia was assessed by 5 h of continuous glucose monitoring. Results: Data were collected from 27 participants (15 male). A dose¿response relationship was found with increasing amount of protein. A significant negative relationship between protein dose and mean excursion was seen at the 30- and 60-min time points (P = 0.007 and P = 0.002, respectively). No significant relationship was seen at the 90- and 120-min time points. Thereafter, the dose¿response relationship inverted, such that there was a significant positive relationship for each of the 150¿300-min time points (P < 0.004). Mean glycaemic excursions were significantly greater for all protein-added test drinks from 150 to 300 min (P < 0.005) with the 75-g protein load, resulting in a mean excursion that was 5 mmol/l higher when compared with the control test drink (P < 0.001). Conclusions: Increasing protein quantity in a low-fat meal containing consistent amounts of carbohydrate decreases glucose excursions in the early (0¿60-min) postprandial period and then increases in the later postprandial period in a dose-dependent manner. 1c

This study compared pre-service teachers¿ perceptions of their professional competencies at two campuses of a large regional teacher education university, where one campus provided students 22% more hours of professional placement in schools and related educational settings. Students who had experienced more hours in schools and such settings were more positive about their, ability to apply their knowledge of students and how they learn, classroom management, professional knowledge and practice, and community engagement; however, when students felt well supported during professional experience, such differences diminished. Additional hours were not associated with pre-service teachers¿ perceptions of their ability to apply subject content and teaching; plan, assess and report; and effective student communication. Researchers argued that this pointed to the crucial role of good classroom mentors in teacher professional experience but also the value of students¿ tertiary teacher education in preparing them for classroom teaching.

Background: Root cause analysis (RCA) is often adopted to complement epidemiologic investigation for outbreaks and infection-related adverse events in hospitals; however, RCA has been argued to have limited effectiveness in preventing such events. We describe how an innovative systems analysis approach halted repeated scabies outbreaks, and highlight the importance of systems thinking for outbreaks analysis and sustaining effective infection prevention and control. Methods: Following RCA for a third successive outbreak of scabies over a 17-month period in a 60-bed respiratory care ward of a Taiwan hospital, a systems-oriented event analysis (SOEA) model was used to reanalyze the outbreak. Both approaches and the recommendations were compared. Results: No nosocomial scabies have been reported for more than 1975days since implementation of the SOEA. Previous intervals between seeming eradication and repeat outbreaks following RCA were 270days and 180days. Achieving a sustainable positive resolution relied on applying systems thinking and the holistic analysis of the system, not merely looking for root causes of events. Conclusion: To improve the effectiveness of outbreaks analysis and infection control, an emphasis on systems thinking is critical, along with a practical approach to ensure its effective implementation. The SOEA model provides the necessary framework and is a viable complementary approach, or alternative, to RCA.