A national roll out of an insufficiently evaluated practice : how evidence based are our end-of-life care policies?

There has been increasing international efforts to ensure that health care policies are evidence based. One area where there is a lack of ‘effectiveness’ evidence is in the use of end-of-life care pathways (EOLCP) (1). Despite the lack of evidence supporting the efficacy of the EOCLP, their use has been endorsed in the recent national palliative care strategy document in the UK (2). In addition, a publication endorsed by the Australian Government (titled: Supporting Australians to live well at the End of Life- National Palliative Care Strategy 2010) (3), recommended a national roll out of EOLCP across all sectors (primary, acute and aged care) in Australia. According to this document, it is a measure of “appropriateness” and “effectiveness” for promoting quality end-of-life care.

Sloshing motion of water in a moonpool

This thesis is concerned with the sloshing motion of water in a moonpool. It is a relatively new problem, that is particularly predominant in moonpools with relatively large dimensions. The problem is further complicated by the additional behaviour of vertical oscillation. It is inevitable that large moonpools will be needed as offshore technology advances, therefore making a problem an important one. The research involves two parts, the theoretical and experimental study. The theoretical study consists of idealising the moonpool to a two dimensional system, represented by two surface piercing parallel barriers at a distance 2a apart. The barriers are forced to undergo roll motion which in turn generates waves. These travelling waves are travelling in opposite directions to each other and have the same amplitude and period, and thus can be expressed in terms of a standing wave. This is mathematically achieved by applying the theory of wavemaking, and therefore the wave amplitude at the side wall can be evaluated at near resonant conditions. The experimental study comprises of comparing the results obtained from the tank and moonpool experiments. The rolling motion creates the sloshing waves in both cases, in addition the vertical oscillation in the moonpool is produced by generating waves at one end of the towing tank. Apart from highlighting influencing parameters, the resonant frequencies obtained from these experiments are then compared with the theoretical values. Experiments in demonstrating the effect of increasing damping with the aid of baffles are also conducted. This is an important aspect which is very necessary if operations in launching and retrieving are to be carried out efficiently and safely.

Modelling travelling waves in spatially constrained environment solutions

In this study, we consider how Fractional Differential Equations (FDEs) can be used to study the travelling wave phenomena in parabolic equations. As our method is conducted under intracellular environments that are highly crowded, it was discovered that there is a simple relationship between the travelling wave speed and obstacle density.

Higher-order spectral analysis of nonlinear ocean surface gravity waves

Higher-order spectral analysis is used to detect the presence of secondary and tertiary forced waves associated with the nonlinearity of energetic swell observed in 8- and 13-m water depths. Higher-order spectral analysis techniques are first described and then applied to the field data, followed by a summary of the results.

Models of collective cell motion for cell populations with different aspect ratio : diffusion, proliferation and travelling waves

Continuum, partial differential equation models are often used to describe the collective motion of cell populations, with various types of motility represented by the choice of diffusion coefficient, and cell proliferation captured by the source terms. Previously, the choice of diffusion coefficient has been largely arbitrary, with the decision to choose a particular linear or nonlinear form generally based on calibration arguments rather than making any physical connection with the underlying individual-level properties of the cell motility mechanism. In this work we provide a new link between individual-level models, which account for important cell properties such as varying cell shape and volume exclusion, and population-level partial differential equation models. We work in an exclusion process framework, considering aligned, elongated cells that may occupy more than one lattice site, in order to represent populations of agents with different sizes. Three different idealizations of the individual-level mechanism are proposed, and these are connected to three different partial differential equations, each with a different diffusion coefficient; one linear, one nonlinear and degenerate and one nonlinear and nondegenerate. We test the ability of these three models to predict the population level response of a cell spreading problem for both proliferative and nonproliferative cases. We also explore the potential of our models to predict long time travelling wave invasion rates and extend our results to two dimensional spreading and invasion. Our results show that each model can accurately predict density data for nonproliferative systems, but that only one does so for proliferative systems. Hence great care must be taken to predict density data for with varying cell shape.

Roll the dice, rational agent : should extra-curial punishment mitigate an offender's sentence?

It was rugby league State of Origin night 2008 and a group of adults had descended upon a house in Eagleby, Brisbane to have some drinks and to celebrate the game. At 11pm that evening, Shane Thomas Davidson entered the bedroom of the homeowner’s 10-year-old son, TC. Davidson approached the bed and began to massage the boy’s penis under his clothing, which caused TC to wake. Davidson stated, ‘Show me how big your willy is and I’ll show you how big mine is’. TC refused the request and after a small period of time, left the bedroom and told his father what had happened...

Cold and heat waves in the United States

Extreme cold and heat waves, characterised by a number of cold or hot days in succession, place a strain on people’s cardiovascular and respiratory systems. The increase in deaths due to these waves may be greater than that predicted by extreme temperatures alone. We examined cold and heat waves in 99 US cities for 14 years (1987–2000) and investigated how the risk of death depended on the temperature threshold used to define a wave, and a wave’s timing, duration and intensity. We defined cold and heat waves using temperatures above and below cold and heat thresholds for two or more days. We tried five cold thresholds using the first to fifth percentiles of temperature, and five heat thresholds using the ninety-fifth to ninety-ninth percentiles. The extra wave effects were estimated using a two-stage model to ensure that their effects were estimated after removing the general effects of temperature. The increases in deaths associated with cold waves were generally small and not statistically significant, and there was even evidence of a decreased risk during the coldest waves. Heat waves generally increased the risk of death, particularly for the hottest heat threshold. Cold waves of a colder intensity or longer duration were not more dangerous. Cold waves earlier in the cool season were more dangerous, as were heat waves earlier in the warm season. In general there was no increased risk of death during cold waves above the known increased risk associated with cold temperatures. Cold or heat waves earlier in the cool or warm season may be more dangerous because of a build up in the susceptible pool or a lack of preparedness for cold or hot temperatures.

Tactically-driven nonmonotone travelling waves

Models of cell invasion incorporating directed cell movement up a gradient of an external substance and carrying capacity-limited proliferation give rise to travelling wave solutions. Travelling wave profiles with various shapes, including smooth monotonically decreasing, shock-fronted monotonically decreasing and shock-fronted nonmonotone shapes, have been reported previously in the literature. The existence of tacticallydriven shock-fronted nonmonotone travelling wave solutions is analysed for the first time. We develop a necessary condition for nonmonotone shock-fronted solutions. This condition shows that some of the previously reported shock-fronted nonmonotone solutions are genuine while others are a consequence of numerical error. Our results demonstrate that, for certain conditions, travelling wave solutions can be either smooth and monotone, smooth and nonmonotone or discontinuous and nonmonotone. These different shapes correspond to different invasion speeds. A necessary and sufficient condition for the travelling wave with minimum wave speed to be nonmonotone is presented. Several common forms of the tactic sensitivity function have the potential to satisfy the newly developed condition for nonmonotone shock-fronted solutions developed in this work.

Travelling waves for a velocity–jump model of cell migration and proliferation

Cell invasion, characterised by moving fronts of cells, is an essential aspect of development, repair and disease. Typically, mathematical models of cell invasion are based on the Fisher–Kolmogorov equation. These traditional parabolic models can not be used to represent experimental measurements of individual cell velocities within the invading population since they imply that information propagates with infinite speed. To overcome this limitation we study combined cell motility and proliferation based on a velocity–jump process where information propagates with finite speed. The model treats the total population of cells as two interacting subpopulations: a subpopulation of left–moving cells, $L(x,t)$, and a subpopulation of right–moving cells, $R(x,t)$. This leads to a system of hyperbolic partial differential equations that includes a turning rate, $\Lambda \ge 0$, describing the rate at which individuals in the population change direction of movement. We present exact travelling wave solutions of the system of partial differential equations for the special case where $\Lambda = 0$ and in the limit that $\Lambda \to \infty$. For intermediate turning rates, $0 < \Lambda < \infty$, we analyse the travelling waves using the phase plane and we demonstrate a transition from smooth monotone travelling waves to smooth nonmonotone travelling waves as $\Lambda$ decreases through a critical value $\Lambda_{crit}$. We conclude by providing a qualitative comparison between the travelling wave solutions of our model and experimental observations of cell invasion. This comparison indicates that the small $\Lambda$ limit produces results that are consistent with experimental observations.

Engineering the surface of a sugarcane roller mill roll for grip and durability

Roller mills are typically used to crush sugarcane to express the juice from which sugar is manufactured. The mill rolls need to provide sufficient grip to ensure minimal sliding of the sugarcane along the roll surface. The rolls are subject to pressures up to 55 MPa from the sugarcane bagasse (as the sugarcane is called after first being crushed between a pair of rolls). The insoluble component of sugarcane includes typically 10% ash that largely originates from soil that is harvested with the cane. The sugarcane juice is acidic with pH typically between 5.0 and 5.5. As a result of ash and juice, the mill rolls are subjected to a range of abrasive and corrosive wear mechanisms. Solutions to provide grip and resist wear involve the selection of an appropriate roll shell material and compatible hard facing to provide the desired grip and wear characteristics. This paper reviews the various solutions that have been adopted for grip and durability for mill rolls and highlights the advantages and disadvantages of each method.

Lattice-free models of cell invasion : discrete simulations and travelling waves

Invasion waves of cells play an important role in development, disease and repair. Standard discrete models of such processes typically involve simulating cell motility, cell proliferation and cell-to-cell crowding effects in a lattice-based framework. The continuum-limit description is often given by a reaction–diffusion equation that is related to the Fisher–Kolmogorov equation. One of the limitations of a standard lattice-based approach is that real cells move and proliferate in continuous space and are not restricted to a predefined lattice structure. We present a lattice-free model of cell motility and proliferation, with cell-to-cell crowding effects, and we use the model to replicate invasion wave-type behaviour. The continuum-limit description of the discrete model is a reaction–diffusion equation with a proliferation term that is different from lattice-based models. Comparing lattice based and lattice-free simulations indicates that both models lead to invasion fronts that are similar at the leading edge, where the cell density is low. Conversely, the two models make different predictions in the high density region of the domain, well behind the leading edge. We analyse the continuum-limit description of the lattice based and lattice-free models to show that both give rise to invasion wave type solutions that move with the same speed but have very different shapes. We explore the significance of these differences by calibrating the parameters in the standard Fisher–Kolmogorov equation using data from the lattice-free model. We conclude that estimating parameters using this kind of standard procedure can produce misleading results.

A Framework for Adaptation of Australian Households to Heat Waves

Climate change is leading to an increased frequency and severity of heat waves. Spells of several consecutive days of unusually high temperatures have led to increased mortality rates for the more vulnerable in the community. The problem is compounded by the escalating energy costs and increasing peak electrical demand as people become more reliant on air conditioning. Domestic air conditioning is the primary determinant of peak power demand which has been a major driver of higher electricity costs. This report presents the findings of multidisciplinary research which develops a national framework to evaluate the potential impacts of heat waves. It presents a technical, social and economic approach to adapt Australian residential buildings to ameliorate the impact of heat waves in the community and reduce the risk of its adverse outcomes. Through the development of a methodology for estimating the impact of global warming on key weather parameters in 2030 and 2050, it is possible to re-evaluate the size and anticipated energy consumption of air conditioners in future years for various climate zones in Australia. Over the coming decades it is likely that mainland Australia will require more cooling than heating. While in some parts the total electricity usage for heating and cooling may remain unchanged, there is an overall significant increase in peak electricity demand, likely to further drive electricity prices. Through monitoring groups of households in South Australia, New South Wales and Queensland, the impact of heat waves on both thermal comfort sensation and energy consumption for air conditioning has been evaluated. The results show that households are likely to be able to tolerate slightly increased temperature levels indoors during periods of high outside temperatures. The research identified that household electricity costs are likely to rise above what is currently projected due to the impact of climate change. Through a number of regulatory changes to both household design and air conditioners, this impact can be minimised. A number of proposed retrofit and design measures are provided, which can readily reduce electricity usage for cooling at minimal cost to the household. Using a number of social research instruments, it is evident that households are willing to change behaviour rather than to spend money. Those on lower income and elderly individuals are the least able to afford the use of air conditioning and should be a priority for interventions and assistance. Increasing community awareness of cost effective strategies to manage comfort and health during heat waves is a high priority recommended action. Overall, the research showed that a combined approach including behaviour change, dwelling modification and improved air conditioner selection can readily adapt Australian households to the impact of heat waves, reducing the risk of heat related deaths and household energy costs.

Waves for change : the role of the South Tarawa-based women's interests program in the decolonisation process of the Gilbert Islands

This thesis has created a space for women in the history of the decolonisation of the Gilbert Islands. It traces the historical development of the national women's interests program in the Republic of Kiribati (formerly of the Gilbert and Ellice Islands Colony (GEIC)) as it was implemented through a network of women's clubs during the 1960s and 1970s. This thesis has provided the first history and interpretation of the Indigenous women's interests movement as it impacted the Gilbert Islands. It offers a narrative of the movement in terms of three overlapping waves of women leaders, based on an analysis of fieldwork, archival research and interviews conducted on South Tarawa, Kiribati.

The impact of heat waves on children's health : a systematic review

Young children are thought to be particularly sensitive to heatwaves, but relatively less research attention has been paid to this field to date. A systematic review was conducted to elucidate the relationship between heat waves and children’s health. Literature published up to August 2012 were identified using the following MeSH terms and keywords: “heatwave”, “heat wave”, “child health”, “morbidity”, “hospital admission”, “emergency department visit”, “family practice”, “primary health care”, “death” and “mortality”. Of the 628 publications identified, 12 met the selection criteria. The existing literature does not consistently suggest that mortality among children increases significantly during heat waves, even though infants were associated with more heat-related deaths. Exposure to heat waves in the perinatal period may pose a threat to children’s health. Pediatric diseases or conditions associated with heat waves include renal disease, respiratory disease, electrolyte imbalance and fever. Future research should focus on how to develop a consistent definition of a heat wave from a children’s health perspective, identifying the best measure of children’s exposure to heat waves, exploring sensitive outcome measures to quantify the impact of heat waves on children, evaluating the possible impacts of heat waves on children’s birth outcomes, and understanding the differences in vulnerability to heat waves among children of different ages and from different income countries. Projection of the children’s disease burden caused by heat waves under climate change scenarios, and development of effective heat wave mitigation and adaptation strategies that incorporate other child protective health measures, are also strongly recommended.