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We present a summary of a guideline produced by an international group of experts for managing type 1 diabetes in adults with an emphasis on the special needs of older people with this condition. The rationale for delivering high-quality diabetes care for adults with type 1 diabetes, why it is important to include older people in our considerations, and the key underpinning principles of the guideline are included. The structure of the recommendations given is described and consists of 'general' recommendations followed by 'specific' recommendations according to three categories depending on the characteristics of adults addressed, such as functional level or self-management ability. Recommendations are provided in the areas of: clinical diagnosis, establishing management plans and glucose regulation, diabetes self-management education, nutritional therapy, physical activity, exercise and lifestyle modification, insulin treatments and regimens, use of technology in diabetes management, hypoglycaemia, managing cardiovascular risk, management of microvascular risk, and inpatient management of type 1 diabetes and ketoacidosis.

Specialized computational chemistry packages have permanently reshaped the landscape of chemical and materials science by providing tools to support and guide experimental efforts and for the prediction of atomistic and electronic properties. In this regard, electronic structure packages have played a special role by using first-principle-driven methodologies to model complex chemical and materials processes. Over the past few decades, the rapid development of computing technologies and the tremendous increase in computational power have offered a unique chance to study complex transformations using sophisticated and predictive many-body techniques that describe correlated behavior of electrons in molecular and condensed phase systems at different levels of theory. In enabling these simulations, novel parallel algorithms have been able to take advantage of computational resources to address the polynomial scaling of electronic structure methods. In this paper, we briefly review the NWChem computational chemistry suite, including its history, design principles, parallel tools, current capabilities, outreach, and outlook.

Background: On any given day, up to 35% of consumers, using healthcare services across Australia have diabetes. They will encounter many health professionals with different levels of diabetes knowledge and expertise and they are likely to disengage with health services when health messaging is inconsistent. Ultimately, diabetes care is everybody’s business. Aims: To inform a capability framework for diabetes care. Methods: Consensus building used a two-phased, four-round, Delphi technique via online Qualtrics. Literature and a consultation group informed the Delphi questions. Thematic analysis used approaches by Luborsky (1994) and an Expert Advisory Group(EAG) supported member checking. Results: Eighty diabetes health professionals contributed as either a pre-Delphi consultation, pilot, Delphi expert panel, EAG or focus group member; including, nurses (n=56, 70%) and allied health(n=24, 30%). Identification of nine broad capabilities with relevant competencies. Capabilities for non-diabetes specific roles focused on awareness; diabetes-specific roles were denoted by exemplification or leading. These included: -Displays/Exemplifies clinical assessment capacities -Supports/Leads diabetes self-management education -Builds therapeutic relationships -Communicates with influence (and leadership) -Supports/Leads counselling to achieve the best outcomes -Supports/Exemplifies quality use of medicines -Displays/Exemplifies quality use of diabetes technology -Supports/Leads care coordination -Achieves quality/Lead and cultivates quality. Responses to prompts to define non-medical prescribing high-lighted that 18% of the Delphi panel members did not understand the term ‘non-medical prescribing’ and 86% indicating they managed medicines routinely. Conclusions: All health professionals require diabetes capabilities to support diabetes care. Implementing a framework that promotes consistency in curricula development across the nation has the potential to prepare the healthcare workforce better for diabetes care and develop a more responsive healthcare workforce

AIMS: To identify diabetes specific patient safety domains that need to be addressed to improve home care of older people; to assess research from primary studies to review evidence on patient safety in home care services for older people with diabetes. DESIGN: An integrative review. DATA SOURCES: Domains for patient safety in diabetes home care settings were identified by conducting two searches. We performed searches in: CINAHL, Medline, Embase and Cochrane Library for the years 2000-2017. REVIEW METHODS: The first search identified frameworks or models on patient safety in home care services published up to October 2017. The second search identified primary studies about older people with diabetes in the home care setting published between 2000 - 2017. RESULTS: Data from the 21 articles populated and refined 13 predetermined domains of patient safety in diabetes home care. These were used to explore how the domains interact to either increase or reduce risk. The domains constitute a model of associations between aspects of diabetes home care and adverse events. The results highlight a knowledge gap in safety for older persons with diabetes, influenced by e.g. hypoglycaemia, falls, pain, foot ulcers, cognitive impairment, depression and polypharmacy. Moreover, providers' inadequate diabetes-specific knowledge and assessment skills contribute to the risk of adverse events. CONCLUSION: Older persons with diabetes in home care are at risk of adverse events due to their reduced ability to self-manage their condition, adverse medication effects, the family's ability to take responsibility or home care service's suboptimal approaches to diabetes care.

Background: A 20% increase in adult diabetes is anticipated by 2030 when 58% of the CDE workforce will have reached retirement age. Fundamental to increasing equity in safe diabetes healthcare access across the health spectrum is a competent, flexible and adaptive workforce. Higher demand for healthcare professionals with both diabetes and non-medical prescribing competencies warrants a more efficient means of developing the workforce. Aim: To develop a Capability Framework by accessing the opinion of a diverse range of diabetes expert healthcare professionals and academics, of different disciplines and work settings. Method: The qualitative research used an online Delphi method informed by consultation and focus groups to gain consensus. A Consultation Group was engaged to inform the Delphi survey development phase. A pilot Delphi survey was administered via Qualtrics, an online platform, to six diabetes experts to test Qualtrics features and confirm questions captured the intended information. An expert panel from across Australia commenced the final Delphi survey. Analysed data obtained from the Delphi survey formed a list of competencies under nine capabilities. An Expert Advisory Group was engaged to review the positioning of competencies, wording and omissions. Further, ‘member checking’ will ensure the trustworthiness of results. The Delphi expert panel ranks the importance of the identified competencies for each of the capability areas until consensus achieved. Results: Fifty-seven diabetes experts from nursing, dietetics, podiatry, pharmacy, exercise physiology and academic backgrounds were recruited to the project and administered the Delphi survey. The Delphi method captured demographic data and comprehensive lists of skills, knowledge and attributes required by health professionals working at basic to expert levels in diabetes care. Discussion: Using Delphi as a method enables ease of access and reach to the breadth of diabetes healthcare professionals across the nation. Also, it allows for re-examining the understanding of valuable information.

Disadvantaged communities carry the highest burden of disease with respect to oral and general health. Diabetes is a growing chronic-condition in Australia with those living in regional or lower socio-economic areas at a higher risk of developing diabetes and experiencing the associated complications. Oral and periodontal disease has been linked to diabetes. Within the community dental clinic we aimed to determine the feasibility of screening for diabetes and reduce the burden of both diseases. All patients presenting to the community dental clinic of the Colac Area Health Service were given the opportunity to participate in a Diabetes screening assessment. Adults who consented completed the Australian Type 2 Diabetes Risk Assessment (AUSDRISK) with those at high risk offered an HbA1c blood test. Six hundred and seventy patients were invited to participate. Seventy-five reported confirmed diabetes and 125 were currently being monitored by their general practitioner. Ninety-six of the remaining 470 eligible patients declined to participate (participation rate 80%). The AUSDRISK was completed by 371 patients (n=3 incomplete) and identified 56 (15%) as low risk, 123 (33%) at intermediate risk and 192 (52%) at high risk. Following HbA1c blood testing, 14 patients were in the high risk range (>6.0%). The high risk category according to the AUSDRISK included 31% emergency patients, an average of 25 (IQR 19-29) Decayed Missing or Filled Teeth, 49% with early signs of periodontal disease, 73% aged 55 years or older, 48% male, 36% had a direct relative with diabetes, 18% had hypertension, 29% currently smoked and 75% had waist measurements >90 cm for men and 80cm for women. The study demonstrated that 68% of patients willing to participate in the study presenting to the community dental clinic had either confirmed diabetes, were being tested by their general practitioner or were in a high risk category (AUSDRISK).