Challenges of recruiting hospice patients with advanced cancer to research : reflections on a delirium screening study

Introduction Delirium research in palliative care, particularly in the dying phase, is possible but is frequently met with ethical and methodological challenges. This paper describes the challenges faced in a previous delirium screening study. Methods Within 72 hours of admission to an acute inpatient specialist palliative care unit one hundred consecutive patients over 18 years of age with advanced cancer were invited to be screened for delirium using validated screening tools. Results Of the 100 consecutive admissions 49 patients were unable to participate including seven who did not meet the inclusion criteria and nine (six families and three patients) who withheld consent. The remaining 33 patients were more unwell and closer to death than those who were recruited. Reasons for non- participation included being too unwell (ten), unresponsive (nine), died (two) or discharged (three) before recruitment and exceeding the 72hour time limit (nine). Conclusion Gate keeping and physical condition of patients were the main obstacles to recruitment and is consistent with barriers faced in previous studies involving palliative care and dying patients. While it is possible and necessary to conduct studies in palliative care, including the terminal phase, as reflective practitioners we must maintain the balance between the demands for evidence-based practice and our compassion and respect for our most vulnerable of patients.

Self-management associated with fatigue in patients with advanced cancer : a prospective longitudinal study

Cancer-related fatigue is one of the most distressing symptoms experienced by patients with advanced cancer. This doctoral study identified that patients with advanced cancer commonly use a number of self-management strategies in response to fatigue, although these strategies had varying levels of effectiveness in reducing the symptom. The study identified that enhancing self-efficacy and managing depressive symptoms are important factors to consider in the design of future interventions to support fatigue self-management.

Extension of constructability to include operation and maintenance for infrastructure projects

This project was a step forward in developing an extension of the concept of constructability to include the post-occupancy stages of operation and maintenance. This was through an in-depth study of Australian health projects and interviews with professionals in the field. The thesis investigated how the operation and maintenance stakeholders can enter the initial planning, design and construction phases resulting in more efficient and effective delivery of infrastructure projects.

Using biomimicry to inform urban infrastructure design that addresses 21st century needs

The design of society’s major infrastructure systems are generally based on anthropogenic learnings and seldom encapsulate learning from nature. This results from a pervading attitude of superiority of human-designed systems, particularly since the Industrial Revolution. Problems created by such behaviours have previously not been thought to present a serious threat to humanity. However, many built environment professionals are now reconsidering the impact of such systems on the environment and their vulnerability to issues such as climate change. This paper presents an approach to delivering sustainable urban infrastructure that addresses 21st Century needs by emulating natural form, function and process - biomimicry – in infrastructure design. The analysis reveals the context for infrastructure change and the need for sustainable solutions, detailing the current inquiry into biomimicry informed design and highlighting potential applications from literature that demonstrate precedence for nature to inspire the design of urban infrastructure, in particular water and energy systems.

Exploring a biomimicry based approach and key barriers to evolving water infrastructure systems

Access to clean water is essential for human life and a critical issue facing much of modern society, especially as a result of the 21st Century triad of challenges – population growth, resource scarcity and pollution – which contribute to the rising complexity of providing adequate access to this essential resource for large parts of society. As such, there is now an increasing need for innovative solutions to source, treat and distribute water to cities across the globe. This position paper explores biomimicry – emulating natural form, function, process and systems – as an alternative and sustainable design approach to traditional water infrastructure systems. The key barriers to innovations such as biomimicry are summarised, indicating that regulatory and economic grounds are some of the major hindrances to integrating alternative design approaches in the water sector in developed countries. This paper examines some of the benefits of moving past these barriers to develop sustainable, efficient and resilient solutions that provide adequate access to water in the face of contemporary challenges.

Managing cost implications for highway infrastructure sustainability

Highway construction works have significant bearings on all aspects of sustainability. With the increasing level of public awareness and government regulatory measures, the construction industry is experiencing a cultural shift to recognise, embrace and pursue sustainability. Stakeholders are now keen to identify sustainable alternatives and the financial implications of including them on a lifecycle basis. They need tools that can aid the evaluation of investment options. To date, however, there have not been many financial assessments on the sustainability aspects of highway projects. This is because the existing life-cycle costing analysis (LCCA) models tend to focus on economic issues alone and are not able to deal with sustainability factors. This paper provides insights into the current practice of life-cycle cost analysis, and the identification and quantification of sustainability-related cost components in highway projects through literature review, questionnaire surveys and semi-structured interviews. The results can serve as a platform for highway project stakeholders to develop practical tools to evaluate highway investment decisions and reach an optimum balance between financial viability and sustainability deliverables.

Navigating the future of roads – considering potential impacts of environmental and social trends on road infrastructure

Providing mobility corridors for communities, enabling freight networks to transport goods and services, and a pathway for emergency services and disaster relief operations, roads are a vital component of our societal system. In the coming decades, a number of modern issues will face road agencies as a result of climate change, resource scarcity and energy related challenges that will have implications for society. To date, these issues have been discussed on a case by case basis, leading to a fragmented approach by state and federal agencies in considering the future of roads – with potentially significant cost and risk implications. Within this context, this paper summarises part of a research project undertaken within the ‘Greening the Built Environment’ program of the Sustainable Built Environment National Research Centre (SBEnrc, Australia), which identified key factors or ‘trends’ affecting the future of roads and key strategies to ensure that road agencies can continue to deliver road infrastructure that meets societal needs in an environmentally appropriate manner. The research was conducted over two years, including a review of academic and state agency literature, four stakeholder workshops in Western Australia and Queensland, and industry consultation. The project was supported financially and through peer review and contribution, by Main Roads Western Australia, QLD Department of Transport and Main Roads, Parsons Brinckerhoff, John Holland Group, and the Australian Green Infrastructure Council (AGIC). The project highlighted several potential trends that are expected to affect road agencies in the future, including predicted resource and materials shortages, increases in energy and natural resources prices, increased costs related to greenhouse gas emissions, changing use and expectations of roads, and changes in the frequency and intensity of weather events. Exploring the implications of these potential futures, the study then developed a number of strategies in order to prepare transport agencies for the associated risks that such trends may present. An unintended outcome of the project was the development of a process for enquiring into future scenarios, which will be explored further in Stage 2 of the project (2013-2014). The study concluded that regardless of the type and scale of response by the agency, strategies must be holistic in approach, and remain dynamic and flexible.

Sustainability in post disaster road infrastructure recovery projects and asset management

Civil infrastructure and especially roads are being impacted with increasing frequency by flood, Tsunami, cyclone related natural and manmade disasters in the world. Responding to such events and in preparing for more regular and intense climate-change induced events in future, the road governing agencies are reviewing how postdisaster road infrastructure recovery projects are best planned and delivered. In particular, there is awareness that rebuilding such infrastructure require sustainable asset management strategies across economic, environmental and social dimensions. A comprehensive asset management framework for pre and post disaster situations can minimize negative impacts on our communities, economy and environment. This research paper is focused on post disaster management in road infrastructures and road infrastructure asset management strategies used by road authorities. Analyzing the implications of disruption to transport network and associated services is an important part of preparing local and regional responses to the impacts of disasters. This research paper will contribute to strategic infrastructure asset planning, management leading to safe, efficient and integrated transport system that supports sustainable economic, social and environmental outcomes. This paper also focuses on proper asset management, governance and engineering principles which should be followed and adopted in post disaster recovery projects to maximize sustainability in environmental, social and economic dimensions.

The identification and rapid extraction of hydrocarbons from Nicotiana glauca : A potential advanced renewable biofuel source

Declining fossil fuels reserves, a need for increased energy security and concerns over carbon emissions from fossil fuel use are the global drivers for alternative, renewable, biosources of fuels and chemicals. In the present study the identification of long chain (C29–C33) saturated hydrocarbons from Nicotiana glauca leaves is reported. The occurrence of these hydrocarbons was detected by gas chromatography–mass spectrometry (GC–MS) and identification confirmed by comparison of physico-chemical properties displayed by the authentic standards available. A simple, robust procedure was developed to enable the generation of an extract containing a high percentage of hydrocarbons (6.3% by weight of dried leaf material) higher than previous reports in other higher plant species consequently, it is concluded that N. glauca could be a crop of greater importance than previously recognised for biofuel production. The plant can be grown on marginal lands, negating the need to compete with food crops or farmland, and the hydrocarbon extract can be produced in a non-invasive manner, leaving remaining biomass intact for bioethanol production and the generation of valuable co-products.

Research Data Management Update on National Programs: New infrastructure and opportunities

Presentation by Dr Joe Young, ITS-HPC and Research Support, Managing your research data seminar, 2012

Bisphenol A degradation enhanced by air bubbles via advanced oxidation using in situ generated ferrous ions from nano zero-valent iron/palygorskite composite materials

Novel nano zero-valent iron/palygorskite composite materials prepared by evaporative and centrifuge methods are tested for the degradation of bisphenol A in an aqueous medium. A systematic study is presented which showed that nano zero-valent iron material has little effect on bisphenol A degradation. When hydrogen peroxide was added to initiate the reaction, some percentage of bisphenol A removal (∼20%) was achieved; however, with the aid of air bubbles, the percentage removal can be significantly increased to ∼99%. Compared with pristine nano zero-valent iron and commercial iron powder, nano zero-valent iron/palygorskite composite materials have much higher reactivity towards bisphenol A and these materials are superior as they have little impact on the solution pH. However, for pristine nano zero-valent iron, it is difficult to maintain the reaction system at a favourable low pH which is a key factor in maintaining high bisphenol A removal. All materials were characterized by X-ray diffraction, scanning electron microscopy, elemental analysis, transmission electron microscopy and X-ray photoelectron spectroscopy. The optimum conditions were obtained based on a series of batch experiments. This study has extended the application of nano zero-valent iron/palygorskite composites as effective materials for the removal of phenolic compounds from the environment.

Sustainability outcomes of infrastructure sustainability rating schemes for road projects

The construction and operation of infrastructure assets can have significant impact on society and the region. Using a sustainability assessment framework can be an effective means to build sustainability aspects into the design, construction and operation of infrastructure assets. The conventional evaluation processes and procedures for infrastructure projects do not necessarily measure the qualitative/quantitative effectiveness of all aspects of sustainability: environment, social wellbeing and economy. As a result, a few infrastructure sustainability rating schemes have been developed with a view to assess the level of sustainability attained in the infrastructure projects. These include: Infrastructure Sustainability (Australia); CEEQUAL (UK); and Envision (USA). In addition, road sector specific sustainability rating schemes such as Greenroads (USA) and Invest (Australia) have also been developed. These schemes address several aspects of sustainability with varying emphasis (weightings) on areas such as: use of resources; emission, pollution and waste; ecology; people and place; management and governance; and innovation. The attainment of sustainability of an infrastructure project depends largely on addressing the whole-of-life environmental issues. This study has analysed the rating schemes’ coverage of different environmental components for the road infrastructure under the five phases of a project: material, construction, use, maintenance and end-of-life. This is based on a comprehensive life cycle assessment (LCA) system boundary. The findings indicate that there is a need for the schemes to consider key (high impact) life cycle environmental components such as traffic congestion during construction, rolling resistance due to surface roughness and structural stiffness of the pavement, albedo, lighting, and end-of-life management (recycling) to deliver sustainable road projects.

Assessment of driving-related performance in chronic whiplash using an advanced driving simulator

Driving is often nominated as problematic by individuals with chronic whiplash associated disorders (WAD), yet driving-related performance has not been evaluated objectively. The purpose of this study was to test driving-related performance in persons with chronic WAD against healthy controls of similar age, gender and driving experience to determine if driving-related performance in the WAD group was sufficiently impaired to recommend fitness to drive assessment. Driving-related performance was assessed using an advanced driving simulator during three driving scenarios; freeway, residential and a central business district (CBD). Total driving duration was approximately 15 min. Five driving tasks which could cause a collision (critical events) were included in the scenarios. In addition, the effect of divided attention (identify red dots projected onto side or rear view mirrors) was assessed three times in each scenario. Driving performance was measured using the simulator performance index (SPI) which is calculated from 12 measures. z-Scores for all SPI measures were calculated for each WAD subject based on mean values of the control subjects. The z-scores were then averaged for the WAD group. A z-score of ≤−2 indicated a driving failing grade in the simulator. The number of collisions over the five critical events was compared between the WAD and control groups as was reaction time and missed response ratio in identifying the red dots. Seventeen WAD and 26 control subjects commenced the driving assessment. Demographic data were comparable between the groups. All subjects completed the freeway scenario but four withdrew during the residential and eight during the CBD scenario because of motion sickness. All scenarios were completed by 14 WAD and 17 control subjects. Mean z-scores for the SPI over the three scenarios was statistically lower in the WAD group (−0.3 ± 0.3; P < 0.05) but the score was not below the cut-off point for safe driving. There were no differences in the reaction time and missed response ratio in divided attention tasks between the groups (All P > 0.05). Assessment of driving in an advanced driving simulator for approximately 15 min revealed that driving-related performance in chronic WAD was not sufficiently impaired to recommend the need for fitness to drive assessment.

Advanced pubertal status at age 11 and lower physical activity in adolescent girls

Objective To examine the relationship between pubertal timing and physical activity. Study design A longitudinal sample of 143 adolescent girls was assessed at ages 11 and 13 years. Girls' pubertal development was assessed at age 11 with blood estradiol levels, Tanner breast staging criteria, and parental report of pubertal development. Girls were classified as early maturers (n = 41) or later maturers (n = 102) on the basis of their scores on the 3 pubertal development measures. Dependent variables measured at age 13 were average minutes/day of moderate to vigorous and vigorous physical activity as measured by the ActiGraph accelerometer. Results Early-maturing girls had significantly lower self-reported physical activity and accumulated fewer minutes of moderate to vigorous and vigorous physical activity and accelerometer counts per day at age 13 than later maturing girls. These effects v.-ere independent of differences in percentage body fat and self-reported physical activity at age 11. Conclusion Girls experiencing early pubertal maturation at age 11 reported lower subsequent physical activity at age 13 than their later maturing peers. Pubertal maturation, in particular early maturation relative to peers, may lead to declines in physical activity among adolescent girls.

The 3rd Knowledge Cities World Summit Proceedings

FROM KCWS 2010 Ch airs and Summit Proceeding Ed ito rs ‘Knowledge’ is a resource, which relies on the past for a better future. In the 21st century, more than ever before, cities around the world depend on the knowledge of their citizens, their institutions and their firms and enterprises. The knowledge image, the human competence and the reputation of their public and private institutions and corporations profiles a city. It attracts investment, qualified labour and professionals, as well as students and researchers. And it creates local life spaces and professional milieus, which offer the quality of life to the citizens that are seeking to cope with the challenges of modern life in a competitive world. Integrating knowledge-based development in urban strategies and policies, beyond the provision of schools and locations for higher education, has become a new ambitious arena of city politics. Coming from theory to practice, and bringing together the manifold knowledge stakeholders in a city and preparing joint visions for the knowledge city is a new challenge for city managers, urban planners and leaders of the civic society . It requires visionary power, creativity, holistic thinking, the willingness to cooperate with all groups of the local civil society, and the capability to moderate communication processes to overcome conflicts and to develop joint action for a sustainable future. This timely Melbourne 2010 – The Third Knowledge City World Summit makes an important reminder that ‘knowledge’ is the key notion in the 21st Century development. Considering this notion, the summit aims to shed light on the multi-faceted dimensions and various scales of building the ‘knowledge city’ and on ‘knowledge-based development’ paradigms. At this summit, the theoretical and practical maturing of knowledge-based development paradigms will be advanced through the interplay between the world’s leading academic’s theories and the practical models and strategies of practitioners’ and policy makers’ drawn from around the world. As chairs of The Melbourne 2010 Summit, we have compiled this summit proceeding in order to disseminate the knowledge generated and shared in Melbourne with the wider research, governance, and practice communities. The papers in the proceedings reflect the broad range of contributions to the summit. They report on recent developments in planning and managing knowledge cities and ICT infrastructure, they assess the role of knowledge institutions in regional innovation systems and of the intellectual capital of cities and regions; they describe the evolution of knowledge-based approaches to urban development in differing cultural environments; they finally bridge the discourse on the knowledge city to other urban development paradigms such as the creative city, the ubiquitous city or the compact city. The diversity of papers presented shows how different scholars from planning cultures around the world interpret the knowledge dimension in urban and regional development. All papers of this proceeding have gone through a double-blind peer review process and been reviewed by our summit editorial review and advisory board members. We cordially thank the members of the Summit Proceeding Editorial Review and Advisory Board for their diligent work in the review of the papers. We hope the papers in this proceeding will inspire and make a significant contribution to the research, governance, and practice circles.