Non-pharmacological interventions for breathlessness management in patients with lung cancer : A systematic review

The aim is to review the published scientific literature for studies evaluating nonpharmacological interventions for breathlessness management in patients with lung cancer. The following selection criteria were used to systematically search the literature: studies were to be published research or systematic reviews; they were to be published in English and from 1990 to 2007; the targeted populations were adult patients with dyspnoea/breathlessness associated with lung cancer; and the study reported on the outcomes from use of non-pharmacological strategies for breathlessness. This review retrieved five studies that met all inclusion criteria. All the studies reported the benefits of non-pharmacological interventions in improving breathlessness regardless of differences in clinical contexts, components of programmes and methods for delivery. Analysis of the available evidence suggests that tailored instructions delivered by nurses with sufficient training and supervision may have some benefits over other delivery approaches. Based on the results, non-pharmacological interventions are recommended as effective adjunctive strategies in managing breathlessness for patients with lung cancer. In order to refine such interventions, future research should seek to explore the core components of such approaches that are critical to achieving optimal outcomes, the contexts in which the interventions are most effective, and to evaluate the relative benefits of different methods for delivering such interventions.

Comparing the cost-effectiveness of MRSA control strategies between ICU and non-ICU settings

Introduction / objectives Many strategies are used to control MRSA in hospitals. Only a few have been assessed in clinical trials and it is not obvious how findings should be generalised between settings. Uncertainty remains about which strategies represent the most appropriate use of scarce resources. We assess the cost-effectiveness of alternative MRSA screening and infection control strategies in England and Wales and discuss international relevance. Methods Models of MRSA transmission in ICUs and general medical (GM) wards were developed and used to evaluate different screening methods combined with decolonisation or isolation. Strategies were compared in terms of costs and health benefits (quality adjusted life years, QALYs). Different prevalences, proportions of high risk patients and ward sizes were investigated, and probabilistic sensitivity analyses (PSA) conducted. Results Decolonisation strategies were cost-saving in ICUs at a 5% admission prevalence, with admission and weekly PCR screening the most cost-effective (£3,929/QALY). In ICUs, screening and isolation reduced infection rates by ~10%. With admission prevalence ≤5%, targeting screening and isolation to high risk patients was optimal. In GM wards decolonisation and isolation strategies, though able to reduce MRSA infection rates up to ~50%, were not cost-effective. Conclusion The largest reductions in MRSA infection were achieved by screening and decolonisation strategies, and were cost-effective in ICU settings. In comparison, there is limited potential for screening and control strategies to be cost-effective in GM wards due to lower infection and mortality rates.

Risky strategic behaviour : unintended consequences of good intentions in the homelessness service system

The delivery of human services occurs through a complex and often volatile system characterised by both competing and cooperating efforts. A recent strategic intention of government has been to integrate disparate service providers and programs into a more effective and efficient system using competitive funding regimes. A program of amalgamation has also been forecast and promoted as a further mechanism by which to link up smaller agencies thus creating economy and efficiency in the scale and scope of their service modes. Despite the current reliance on competitive funding models and amalgamation as the preferred ways forward for the sector little is known about their integrative capacity including their ability to predict outcomes and their consequences : the ‘unknown unknowns’. Drawing on an extensive data set of human services integration initiatives in Queensland, Australia, this paper examines the impact of government policy and service models and the risks arising from the tensions between competition and accountability on the one hand and the established good will and trust on the other. It is argued that unresolved, these tensions can lead to a weakening of the social infrastructure and make the system more vulnerable to inherent systemic risks. The paper finds that government’s efforts to externalise risk to the non-government sector leads to fragmentation of the service system and fractured collaborative capability. These unintended outcomes themselves have the unintended consequence of leaving governments disconnected from the service system and unable to provide the leadership role and direction necessary for sustained integration. Moreover, facilitating such a leadership role is undermined by behaviours that are directly contrary to collective integration models.

Natural convection in a triangular enclosure due to non-uniform cooling on top

Natural convection in a triangular enclosure subject to non-uniformly cooling at the inclined surfaces and uniformly heating at the base is investigated numerically. The numerical simulations of the unsteady flows over a range of Rayleigh numbers and aspect ratios are carried out using Finite Volume Method. Since the upper surface is cooled and the bottom surface is heated, the air flow in the enclosure is potentially unstable to Rayleigh Benard instability. It is revealed that the transient flow development in the enclosure can be classified into three distinct stages; an early stage, a transitional stage and a steady stage. It is also found that the flow inside the enclosure strongly depends on the governing parameters, Rayleigh number and aspect ratio. The asymmetric behaviour of the flow about the geometric centre line is discussed in detailed. The heat transfer through the roof and the ceiling as a form of Nusselt number is also reported in this study.

Management characteristics and the decision to internationalize : Exploration of exporters vs. non-exporters within the Chilean wine industry

The objective of this exploratory study was to identify the key factors that enhance and inhibit the export activities of wineries and identify differences between exporters and non-exporters. Based on data collected from Chilean wineries, the findings of this study suggest that the major constraints for non-exporters are the lack of financial resources, limited quantities of stocks for market expansion, management’s lack of knowledge and experience, and the high cost of travelling and participating in trade shows. In addition, the main international markets for Chilean wineries were not psychically close markets as has been found for Australian or other wine industries. For domestic market oriented wineries cellar door sales were an important source of revenue. Finally, the results show that managers have educational levels and international experience exceeding those of other comparable New World wineries.

Information and non-information multitasking interplay

Purpose - During multitasking, humans handle multiple tasks through task switching or engage in multitasking information behaviors. For example, a user switches between seeking new kitchen information and medical information. Recent studies provide insights these complex multitasking human information behaviors (HIB). However, limited studies have examined the interplay between information and non-information tasks. Design/methodology/approach - The goal of the paper was to examine the interplay of information and non-information task behaviors. Findings - This paper explores and speculates on a new direction in HIB research. The nature of HIB as a multitasking activity including the interplay of information and non-information behavior tasks, and the relation between multitasking information behavior to cognitive style and individual differences, is discussed. A model of multitasking between information and non-information behavior tasks is proposed. Practical implications/limitations - Multitasking information behavior models should include the interplay of information and non-information tasks, and individual differences and cognitive styles. Originality/value - The paper is the first information science theoretical examination of the interplay between information and non-information tasks. © Emerald Group Publishing Limited.

Free software as a democratic principle

Software forms an important part of the interface between citizens and their government. An increasing amount of government functions are being performed, controlled, or delivered electronically. This software, like all language, is never value-neutral, but must, to some extent, reflect the values of the coder and proprietor. The move that many governments are making towards e-governance, and the increasing reliance that is being placed upon software in government, necessitates a rethinking of the relationships of power and control that are embodied in software.

The resource boom's underbelly : criminological impacts of mining development

Australia is currently in the midst of a major resources boom. Resultant growing demands for labour in regional and remote areas have accelerated the recruitment of non resident workers, mostly contractors, who work extended block rosters of 12-hour shifts and are accommodated in work camps, often adjacent to established mining towns. Serious social impacts of these practices, including violence and crime, have generally escaped industry, government and academic scrutiny. This paper highlights some of these impacts on affected regional communities and workers and argues that post-industrial mining regimes serve to mask and privatize these harms and risks, shifting them on to workers, families and communities.

The internet and the changing global media environment

This chapter describes current trends in the global media environment, with a focus on their implications for the management of public agendas and political processes. It assesses the extent to which trends such as the growth of the blogosphere, "citizen journalism," and other forms if user-generated content, have complicated and problematized news and agenda management as engaged in by both media and political elites. It argues that, in large part due to the rise of the internet and the proliferation if online producers of information and commentary, alongside 24-hour news channels such as CNN and Al Jazeera, political and social actors today face a much more complex, chaotic communication environment than ever bifore, an environment characterized as one of cultural chaos. Having outlined the roots of this trend in the emergence of an expanded, globalized public sphere, the chapter goes on to ask if elite control over the political agenda has been eroded, and if it has, what the consequences for governmmt and the exercise if power might be. Can authoritarian regimes in China, the Middle East, and elsewhere survive the onset if internet-fueled global journalism, for example? In a political environment where public opinion is driven and buffeted by news coverage if unprecedented speed and volume, can democratic governments retain sufficient control over decision- and policy-making processes to enable competent social administration al'ld political management? Can the citizens of contemporary democracies use the emerging media environment to enhance elite accountability and strengthen the democratic process? The chapter concludes that the changing global media environment has the potmtial to strengthen democratic processes, though there is no sil'lgle template for the impact of the internet and other new media on specific countries.

A randomized trial of a telephone-delivered exercise intervention for non-urban dwelling women newly diagnosed with breast cancer : exercise for health

Physical activity is important following breast cancer. Trials of non-face-to-face interventions are needed to assist in reaching women living outside major metropolitan areas. This study seeks to evaluate the feasibility and effectiveness of a telephone-delivered, mixed aerobic and resistance exercise intervention for non-urban Australian women with breast cancer. A randomized controlled trial comparing an 8-month intervention delivered by exercise physiologists (n = 73) to usual care (n = 70). Sixty-one percent recruitment rate and 96% retention at 12 months; 79% of women in the intervention group received at least 75% of calls; odds (OR, 95% CI) of meeting intervention targets favored the intervention group for resistance training (OR 3.2; 1.2, 8.9) and aerobic (OR 2.1; 0.8, 5.5) activity. Given the limited availability of physical activity programs for non-urban women with breast cancer, results provide strong support for feasibility and modest support for the efficacy of telephone-delivered interventions.

Problematising the processes of participation in networks : working through the rhetoric

Participation in networks, both as a concept and process, is widely supported in environmental education as a democratic and equitable pathway to individual and social change for sustainability. However, the processes of participation in networks are rarely problematized. Rather, it is assumed that we inherently know how to participate in networks. This assumption means that participation is seldom questioned. Underlying support for participation in networks is a belief that it allows individuals to connect in new and meaningful ways, that individuals can engage in making decisions and in bringing about change in arenas that affect them, and that they will be engaging in new, non-hierarchical and equitable relationships. In this paper we problematize participation in networks. As an example we use research into a decentralized network – described as such in its own literature - the Queensland Environmentally Sustainable Schools Initiative Alliance in Australia – to argue that while network participants were engaged and committed to participation in this network, 'old' forms of top-down engagement and relationships needed to be unlearnt. This paper thus proposes that for participation in decentralized networks to be meaningful, new learning about how to participate needs to occur.

Personal Injuries Proceedings Act 2002, s 32 - Duty to Disclose - consequences of non-disclosure - discretion to excuse non-compliance

In Newson v Aust Scan Pty Ltd t/a Ikea Springwood [2010] QSC 223 the Supreme Court examined the discretion under s 32(2) of the Personal Injuries Proceedings Act 2002 (Qld), to permit a document which has not been disclosed as required by the pre-court procedures under the PIPA to be used in a subsequent court proceeding. This appears to be the first time that the nature and parameters of the discretion have been judicially considered.

A study of environmental and management drivers of non-CO2 greenhouse gas emissions in Australian agro-ecosystems

Australian climate, soils and agricultural management practices are significantly different from those of the northern hemisphere nations. Consequently, experimental data on greenhouse gas production from European and North American agricultural soils and its interpretation are unlikely to be directly applicable to Australian systems. A programme of studies of non-CO2 greenhouse gas emissions from agriculture has been established that is designed to reduce uncertainty of non-CO2 greenhouse gas emissions in the Australian National Greenhouse Gas Inventory and provide outputs that will enable better on-farm management practices for reducing non-CO2 greenhouse gas emissions, particularly nitrous oxide. The systems being examined and their locations are irrigated pasture (Kyabram Victoria), irrigated cotton (Narrabri, NSW), irrigated maize (Griffith, NSW), rain-fed wheat (Rutherglen, Victoria) and rain-fed wheat (Cunderdin, WA). The field studies include treatments with and without fertilizer addition, stubble burning versus stubble retention, conventional cultivation versus direct drilling and crop rotation to determine emission factors and treatment possibilities for best management options. The data to date suggest that nitrous oxide emissions from nitrogen fertilizer, applied to irrigated dairy pastures and rain-fed winter wheat, appear much lower than the average of northern hemisphere grain and pasture studies. More variable emissions have been found in studies of irrigated cotton/vetch/wheat rotation and substantially higher emissions from irrigated maize.