Diagnostic and treatment pathways for men with prostate cancer in Queensland : investigating spatial and demographic inequalities

Background: Patterns of diagnosis and management for men diagnosed with prostate cancer in Queensland, Australia, have not yet been systematically documented and so assumptions of equity are untested. This longitudinal study investigates the association between prostate cancer diagnostic and treatment outcomes and key area-level characteristics and individual-level demographic, clinical and psychosocial factors.---------- Methods/Design: A total of 1064 men diagnosed with prostate cancer between February 2005 and July 2007 were recruited through hospital-based urology outpatient clinics and private practices in the centres of Brisbane, Townsville and Mackay (82% of those referred). Additional clinical and diagnostic information for all 6609 men diagnosed with prostate cancer in Queensland during the study period was obtained via the population-based Queensland Cancer Registry. Respondent data are collected using telephone and self-administered questionnaires at pre-treatment and at 2 months, 6 months, 12 months, 24 months, 36 months, 48 months and 60 months post-treatment. Assessments include demographics, medical history, patterns of care, disease and treatment characteristics together with outcomes associated with prostate cancer, as well as information about quality of life and psychological adjustment. Complementary detailed treatment information is abstracted from participants’ medical records held in hospitals and private treatment facilities and collated with health service utilisation data obtained from Medicare Australia. Information about the characteristics of geographical areas is being obtained from data custodians such as the Australian Bureau of Statistics. Geo-coding and spatial technology will be used to calculate road travel distances from patients’ residences to treatment centres. Analyses will be conducted using standard statistical methods along with multilevel regression models including individual and area-level components.---------- Conclusions: Information about the diagnostic and treatment patterns of men diagnosed with prostate cancer is crucial for rational planning and development of health delivery and supportive care services to ensure equitable access to health services, regardless of geographical location and individual characteristics. This study is a secondary outcome of the randomised controlled trial registered with the Australian New Zealand Clinical Trials Registry (ACTRN12607000233426)

Effect of pedestrian movement on MIMO-OFDM channel capacity in an indoor environment

The rapid growth of mobile telephone use, satellite services, and now the wireless Internet and WLANs are generating tremendous changes in telecommunication and networking. As indoor wireless communications become more prevalent, modeling indoor radio wave propagation in populated environments is a topic of significant interest. Wireless MIMO communication exploits phenomena such as multipath propagation to increase data throughput and range, or reduce bit error rates, rather than attempting to eliminate effects of multipath propagation as traditional SISO communication systems seek to do. The MIMO approach can yield significant gains for both link and network capacities, with no additional transmitting power or bandwidth consumption when compared to conventional single-array diversity methods. When MIMO and OFDM systems are combined and deployed in a suitable rich scattering environment such as indoors, a significant capacity gain can be observed due to the assurance of multipath propagation. Channel variations can occur as a result of movement of personnel, industrial machinery, vehicles and other equipment moving within the indoor environment. The time-varying effects on the propagation channel in populated indoor environments depend on the different pedestrian traffic conditions and the particular type of environment considered. A systematic measurement campaign to study pedestrian movement effects in indoor MIMO-OFDM channels has not yet been fully undertaken. Measuring channel variations caused by the relative positioning of pedestrians is essential in the study of indoor MIMO-OFDM broadband wireless networks. Theoretically, due to high multipath scattering, an increase in MIMO-OFDM channel capacity is expected when pedestrians are present. However, measurements indicate that some reductions in channel capacity could be observed as the number of pedestrians approaches 10 due to a reduction in multipath conditions as more human bodies absorb the wireless signals. This dissertation presents a systematic characterization of the effects of pedestrians in indoor MIMO-OFDM channels. Measurement results, using the MIMO-OFDM channel sounder developed at the CSIRO ICT Centre, have been validated by a customized Geometric Optics-based ray tracing simulation. Based on measured and simulated MIMO-OFDM channel capacity and MIMO-OFDM capacity dynamic range, an improved deterministic model for MIMO-OFDM channels in indoor populated environments is presented. The model can be used for the design and analysis of future WLAN to be deployed in indoor environments. The results obtained show that, in both Fixed SNR and Fixed Tx for deterministic condition, the channel capacity dynamic range rose with the number of pedestrians as well as with the number of antenna combinations. In random scenarios with 10 pedestrians, an increment in channel capacity of up to 0.89 bits/sec/Hz in Fixed SNR and up to 1.52 bits/sec/Hz in Fixed Tx has been recorded compared to the one pedestrian scenario. In addition, from the results a maximum increase in average channel capacity of 49% has been measured while 4 antenna elements are used, compared with 2 antenna elements. The highest measured average capacity, 11.75 bits/sec/Hz, corresponds to the 4x4 array with 10 pedestrians moving randomly. Moreover, Additionally, the spread between the highest and lowest value of the the dynamic range is larger for Fixed Tx, predicted 5.5 bits/sec/Hz and measured 1.5 bits/sec/Hz, in comparison with Fixed SNR criteria, predicted 1.5 bits/sec/Hz and measured 0.7 bits/sec/Hz. This has been confirmed by both measurements and simulations ranging from 1 to 5, 7 and 10 pedestrians.

Repeat participation in colorectal cancer screening utilizing fecal occult blood testing : a community-based project in a rural setting

Background and Aim: To investigate participation in a second round of colorectal cancer screening using a fecal occult blood test (FOBT) in an Australian rural community, and to assess the demographic characteristics and individual perspectives associated with repeat screening. ---------- Methods: Potential participants from round 1 (50–74 years of age) were sent an intervention package and asked to return a completed FOBT (n = 3406). Doctors of participants testing positive referred to colonoscopy as appropriate. Following screening, 119 participants completed qualitative telephone interviews. Multivariable logistic regression models evaluated the association between round-2 participation and other variables.---------- Results: Round-2 participation was 34.7%; the strongest predictor was participation in round 1. Repeat participants were more likely to be female; inconsistent screeners were more likely to be younger (aged 50–59 years). The proportion of positive FOBT was 12.7%, that of colonoscopy compliance was 98.6%, and the positive predictive value for cancer or adenoma of advanced pathology was 23.9%. Reasons for participation included testing as a precautionary measure or having family history/friends with colorectal cancer; reasons for non-participation included apathy or doctors’ advice against screening.---------- Conclusion: Participation was relatively low and consistent across rounds. Unless suitable strategies are identified to overcome behavioral trends and/or to screen out ineligible participants, little change in overall participation rates can be expected across rounds.

Stakeholder engagement by governance networks

As the problems involving infrastructure delivery have become more complex and contentious, there has been an acknowledgement that these problems cannot be resolved by any one body working alone. This understanding has driven multi-sectoral collaboration and has led to an expansion of the set of actors, including stakeholders, who are now involved in delivery of infrastructure projects and services. However, more needs to be understood about how to include stakeholders in these processes and ways of developing the requisite combination of stakeholders to achieve effective outcomes. This thesis draws on stakeholder theory and governance network theory to obtain insights into how three multi-level networks within the Roads Alliance in Queensland engage with stakeholders in the delivery of complex and sensitive infrastructure services and projects. New knowledge about stakeholders will be obtained by testing a model of Stakeholder Salience and Engagement which combines and extends the stakeholder identification and salience theory, ladder of stakeholder management and engagement and the model of stakeholder engagement and moral treatment of stakeholders. By applying this model, the broad research question: “Who or what decides how stakeholders are engaged by governance networks delivering public outcomes?” will be addressed. The case studies will test a theoretical model of stakeholder salience and engagement which links strategic decisions about stakeholder salience with the quality and quantity of engagement strategies for engaging different types of stakeholders. A multiple embedded case study design has been selected as the overall approach to explore, describe, explain and evaluate how stakeholder engagement occurs in three governance networks delivering road infrastructure in Queensland. The research design also incorporates a four stage approach to data collection: observations, stakeholder analysis, telephone survey questionnaire and semi-structured interviews. The outcomes of this research will contribute to and extend stakeholder theory by showing how stakeholder salience impacts on decisions about the types of engagement processes implemented. Governance network theory will be extended by showing how governance networks interact with stakeholders through the concepts of stakeholder salience and engagement. From a practical perspective this research will provide governance networks with an indication of how to optimise engagement with different types of stakeholders. 2

Knowledge about health benefits of Vitamin D in Queensland Australia

In Queensland, Australia, the ultraviolet (UV) radiation levels are high (greater than UV Index 3) almost all year round. Although ambient UV is about three times higher in summer compared to winter, Queensland residents receive approximately equal personal doses of UV radiation within these seasons (Neale et al., 2010). Sun protection messages throughout the year are thus essential (Montague et al., 2001), need to reach all segments of the population, and should incorporate guidelines for maintenance of adequate vitamin D levels. Knowledge is an essential requirement to allow people to make health conscious decisions. Unprompted knowledge commonly requires a higher level of awareness or recency of acquisition compared to prompted recall (Waller et al., 2004). This paper thus reports further on the data from a 2008 population-based, cross-sectional telephone survey conducted in Queensland, Australia (2,001 participants; response rate=45%) (Youl et al., 2009). It was the aim of this research to establish the level of, and factors predicting, unprompted and prompted knowledge about health and vitamin D.

Values, controversial issues and interfaith understanding

Values are fundamental to human activity. What makes us distinctive is our ability to understand the challenges we face in life, and to make choices about how to respond. Yet, as the Cheshire Cat from Lewis Carroll’s Alice’s Adventures in Wonderland observed, if we don’t care about how we make such choices, the outcome of our decision-making is diminished. Values education is a broad, complex and controversial area, and, while it has shifted in emphasis and focus, it continues to be an essential part of many education systems. For example, some international education systems are exploring the links between values education and student wellbeing. In Australia, the values basis for ethical behaviour is receiving emphasis as a general capability, or important component of education, that can be developed across the curriculum. Indeed, some syllabus and policy documents require that particular values are emphasised, while numerous schools aim to inculcate and foster a range of personal social, moral and spiritual values in their students, many of which are shared by members of the wider community. However, because values are also contested in the community, values education involves the exploration of controversial issues. Similarly, values education explores the underlying belief systems of different world views and how they influence value commitments, ways of behaving, and interfaith understanding in today’s globalised world. This chapter explores the significance and teaching possibilities of values, controversial issues and interfaith understanding.

Concept building

In this world of continuous change, there’s probably one certainty: more change lies ahead. Our students will encounter challenges and opportunities that we can’t even imagine. How do we prepare our students as future citizens for the challenges of the 21st century? One of the most influential public intellectuals of our time, Howard Gardner, suggests that in the future individuals will depend to a great extent on the capacity to synthesise large amounts of information. ‘They will need to be able to gather together information from disparate sources and put it together in ways that work for themselves and can be communicated to other persons’(Gardner 2008, p. xiii). One of the first steps in ‘putting things together’ so they ‘work’ in the mind is ‘to group objects and events together on the basis of some similarity between them’ (Lee & das Gupta 1995, p. 116). When we do this and give them a collective name, we are conceptualising. Apart from helping to save our sanity by simplifying the vast amounts of data we encounter every day, concepts help us to understand and gain meaning from what we experience. Concepts are essential for synthesising information and they also help us to communicate with others. Put simply, concepts serve as building blocks for knowledge, understanding and communication. This chapter addresses the importance of teaching and learning about concepts and conceptual development in studies of society and environment. It proceeds as follows: first, it considers how individuals use concepts, and, second, it explores the characteristics of concepts; the third section presents a discussion of approaches that might be adopted by teachers intending to help their students build concepts in the classroom.

Multicultural education, global studies and studies of Asia

Like other nations, Australia has experienced significant change in the past few decades as its society has become increasingly diverse. The new cultures and traditions that result from ethnic and religious diversity have both enriched Australian society and presented it with some challenges. Other challenges have resulted from increased globalisation. For example, the economic fallout from the recent global financial crisis indicates that global issues can impact across a range of levels, from multinational corporations and nation-states to local sites and individual livelihoods. Some suggest that Australia fared better than other nations during this economic crisis because of its export trade with China. Although this is disputed by economists, it highlights another facet of change that is impacting on Australian society and this relates to Australia’s growing engagement with the nations of Asia. There is increasing awareness in education systems that if young people are to achieve their potential as future citizens they need to be able to negotiate the cultural, social, political and economic ties that connect them to the global and regional community through work, leisure and citizenship. Multicultural education, global studies and studies of Asia play a particular part in helping young people to: • appreciate cultural diversity within and beyond their own nation • imagine with some accuracy how others view their world • participate in shaping a better future. This chapter explores the origins, distinctions and common features of each approach.

Tsunami alert : the difference a phone makes

As a new communication technology expands in a disadvantaged, rural area of a developing country, this process of change can radically affect the quality and volume of available information. Substantial growth has occurred in the telecommunication sector in Papua New Guinea (PNG) in the last three years. Mobile telephony is rapidly rolling out to rural and remote localities, following decades of inadequate service provision. The paper examines the introduction of mobile telephones into a rural village in PNG, and focuses on an example of changed information access afforded by the mobile telephone, through comparing the village’s experience of two tsunami alerts: one immediately prior to the introduction of mobile phone services in the area, and the other two years after mobile phone reception became available. The research demonstrates a key application of newly introduced information and communication technologies - to benefit disadvantaged, rural communities in emergency situations.

Facilitating needs based cancer care for people with a chronic disease : evaluation of an intervention using a multi-centre interrupted time series design

Background: Palliative care should be provided according to the individual needs of the patient, caregiver and family, so that the type and level of care provided, as well as the setting in which it is delivered, are dependent on the complexity and severity of individual needs, rather than prognosis or diagnosis. This paper presents a study designed to assess the feasibility and efficacy of an intervention to assist in the allocation of palliative care resources according to need, within the context of a population of people with advanced cancer. ---------- Methods/design: People with advanced cancer and their caregivers completed bi-monthly telephone interviews over a period of up to 18 months to assess unmet needs, anxiety and depression, quality of life, satisfaction with care and service utilisation. The intervention, introduced after at least two baseline phone interviews, involved a) training medical, nursing and allied health professionals at each recruitment site on the use of the Palliative Care Needs Assessment Guidelines and the Needs Assessment Tool: Progressive Disease - Cancer (NAT: PD-C); b) health professionals completing the NAT: PD-C with participating patients approximately monthly for the rest of the study period. Changes in outcomes will be compared pre-and post-intervention.---------- Discussion: The study will determine whether the routine, systematic and regular use of the Guidelines and NAT: PD-C in a range of clinical settings is a feasible and effective strategy for facilitating the timely provision of needs based care.

Sell, give away, or donate : an exploratory study of fashion clothing disposal behaviour in two countries

This study investigates the antecedents to clothing disposal methods in two countries: Scotland and Australia. Increasing volumes of textiles are disposed of in landfill sites to the detriment of the environment. Extant research has identified the influences affecting an increased rate of purchasing and the trend to keep clothing for an ever shorter time. As such, it is imperative to examine the factors that affect consumers’ choice of clothing disposal method as limited research has been undertaken in this area of socially responsible consumption. The results of a survey administered to a sample of female consumers in the two countries identify antecedents of three forms of clothing disposal methods: selling through eBay or second-hand shops, giving away to family or friends or donating to charities. Findings show differences between the countries regarding clothing disposal behaviour. Nevertheless, general recycling behaviour was found to be the strongest predictor for donating to charities in both countries.

Fast and accurate phonetic spoken term detection

For the first time in human history, large volumes of spoken audio are being broadcast, made available on the internet, archived, and monitored for surveillance every day. New technologies are urgently required to unlock these vast and powerful stores of information. Spoken Term Detection (STD) systems provide access to speech collections by detecting individual occurrences of specified search terms. The aim of this work is to develop improved STD solutions based on phonetic indexing. In particular, this work aims to develop phonetic STD systems for applications that require open-vocabulary search, fast indexing and search speeds, and accurate term detection. Within this scope, novel contributions are made within two research themes, that is, accommodating phone recognition errors and, secondly, modelling uncertainty with probabilistic scores. A state-of-the-art Dynamic Match Lattice Spotting (DMLS) system is used to address the problem of accommodating phone recognition errors with approximate phone sequence matching. Extensive experimentation on the use of DMLS is carried out and a number of novel enhancements are developed that provide for faster indexing, faster search, and improved accuracy. Firstly, a novel comparison of methods for deriving a phone error cost model is presented to improve STD accuracy, resulting in up to a 33% improvement in the Figure of Merit. A method is also presented for drastically increasing the speed of DMLS search by at least an order of magnitude with no loss in search accuracy. An investigation is then presented of the effects of increasing indexing speed for DMLS, by using simpler modelling during phone decoding, with results highlighting the trade-off between indexing speed, search speed and search accuracy. The Figure of Merit is further improved by up to 25% using a novel proposal to utilise word-level language modelling during DMLS indexing. Analysis shows that this use of language modelling can, however, be unhelpful or even disadvantageous for terms with a very low language model probability. The DMLS approach to STD involves generating an index of phone sequences using phone recognition. An alternative approach to phonetic STD is also investigated that instead indexes probabilistic acoustic scores in the form of a posterior-feature matrix. A state-of-the-art system is described and its use for STD is explored through several experiments on spontaneous conversational telephone speech. A novel technique and framework is proposed for discriminatively training such a system to directly maximise the Figure of Merit. This results in a 13% improvement in the Figure of Merit on held-out data. The framework is also found to be particularly useful for index compression in conjunction with the proposed optimisation technique, providing for a substantial index compression factor in addition to an overall gain in the Figure of Merit. These contributions significantly advance the state-of-the-art in phonetic STD, by improving the utility of such systems in a wide range of applications.

Script proposals: a device for empowering clients in counselling

Much of the research on the delivery of advice by professionals such as physicians, health workers and counsellors, both on the telephone and in face to face interaction more generally, has focused on the theme of client resistance and the consequent need for professionals to adopt particular formats to assist in the uptake of the advice. In this paper we consider one setting, Kid’s Helpline, the national Australian counselling service for children and young people, where there is an institutional mandate not to give explicit advice in accordance with the values of self-direction and empowerment. The paper examines one practice, the use of script proposals by counsellors, which appears to offer a way of providing support which is consistent with these values. Script proposals entail the counsellors packaging their advice as something that the caller might say – at some future time – to a third party such as a friend, teacher, parent, or partner, and involve the counsellor adopting the speaking position of the caller in what appears as a rehearsal of a forthcoming strip of interaction. Although the core feature of a script proposal is the counsellor’s use of direct reported speech they appear to be delivered, not so much as exact words to be followed, but as the type of conversation that the client needs to have with the 3rd party. Script proposals, in short, provide models of what to say as well as alluding to how these could be emulated by the client. In their design script proposals invariably incorporate one or more of the most common rhetorical formats for maximising the persuasive force of an utterance such as a three part list or a contrastive pair. Script proposals, moreover, stand in a complex relation to the prior talk and one of their functions appears to be to summarise, respecify or expand upon the client’s own ideas or suggestions for problem solving that have emerged in these preceding sequences.

Online alcohol interventions : a systematic review

Background: There has been a significant increase in the availability of online programs for alcohol problems. A systematic review of the research evidence underpinning these programs is timely. Objectives: Our objective was to review the efficacy of online interventions for alcohol misuse. Systematic searches of Medline, PsycINFO, Web of Science, and Scopus were conducted for English abstracts (excluding dissertations) published from 1998 onward. Search terms were: (1) Internet, Web*; (2) online, computer*; (3) alcohol*; and (4) E\effect*, trial*, random* (where * denotes a wildcard). Forward and backward searches from identified papers were also conducted. Articles were included if (1) the primary intervention was delivered and accessed via the Internet, (2) the intervention focused on moderating or stopping alcohol consumption, and (3) the study was a randomized controlled trial of an alcohol-related screen, assessment, or intervention. Results: The literature search initially yielded 31 randomized controlled trials (RCTs), 17 of which met inclusion criteria. Of these 17 studies, 12 (70.6%) were conducted with university students, and 11 (64.7%) specifically focused on at-risk, heavy, or binge drinkers. Sample sizes ranged from 40 to 3216 (median 261), with 12 (70.6%) studies predominantly involving brief personalized feedback interventions. Using published data, effect sizes could be extracted from 8 of the 17 studies. In relation to alcohol units per week or month and based on 5 RCTs where a measure of alcohol units per week or month could be extracted, differential effect sizes to post treatment ranged from 0.02 to 0.81 (mean 0.42, median 0.54). Pre-post effect sizes for brief personalized feedback interventions ranged from 0.02 to 0.81, and in 2 multi-session modularized interventions, a pre-post effect size of 0.56 was obtained in both. Pre-post differential effect sizes for peak blood alcohol concentrations (BAC) ranged from 0.22 to 0.88, with a mean effect size of 0.66. Conclusions: The available evidence suggests that users can benefit from online alcohol interventions and that this approach could be particularly useful for groups less likely to access traditional alcohol-related services, such as women, young people, and at-risk users. However, caution should be exercised given the limited number of studies allowing extraction of effect sizes, the heterogeneity of outcome measures and follow-up periods, and the large proportion of student-based studies. More extensive RCTs in community samples are required to better understand the efficacy of specific online alcohol approaches, program dosage, the additive effect of telephone or face-to-face interventions, and effective strategies for their dissemination and marketing.

Low intensity CBT by mail

Introduction: There are many low intensity (LI) cognitive behavoural therapy (CBT) solutions to the problem of limited service access. In this chapter, we aim to discuss a relatively low-technology approach to access using standard postal services-CBT by mail, or M-CBT. Bibliotherapies including M-CBT teach key concepts and self-management techniques, together with screening tools and forms to structure home practice. M-CBT differs from other bibliotherapies by segmenting interventions and mailing them at regular intervals. Most involve participants returning copies of monitoring forms or completed handouts. Therapist feedback is provided, often in personal letters that accompany the printed materials. Participants may also be given access to telephone or email support. ----- ----- M-CBT clearly fulfills criteria for an LI CBT (see Bennett-Levy et al., Chapter 1, for a definition of LI interventions). Once written, they involve little therapist time and rely heavily on self-management. However, content and overall treatment duration need not be compromised. Long-term interventions with multiple components can be delivered via this method, provided their content can be communicated in letters and engagement is maintained.