A Sustainable Community for Older People : Case Studies of Green Retirement Villages in Australia

In Australia, the proportion of the population aged 65 years and over reached 13.5% in 2010 and is expected to increase steadily to around 20% by the year 2056 [Australia Bureau of Statistics (ABS), 2010], creating what has been regarded as a looming crisis in how to house and care for older people. As a viable accommodation option, the retirement village is widely accepted as a means of promoting and enhancing independence, choice and quality of life for older people. Recent research by Barker (2010) indicates that the current and potential residents of retirement villages are generally very conscious of resource consumption and would like their residences and community to be more sustainable. The aim of this study was to understand the perception of older people toward sustainability ideas and identify the sustainable practices involved in retirement villages to improve the wellbeing of residents. Multiple research methods, including content analysis, questionnaire survey, interviews and case studies were conducted for the research purpose. The results indicate that most retirement village residents understand and recognize the importance of sustainability in their lifestyle. However, their sustainability requirements need to be supported and enhanced by the provision of affordable sustainability features. Additionally, many retirement village developers and operators realize the importance of providing a sustainable retirement community for their residents, and that a sustainable retirement village (that is environmental-friendly, affordable, and improves social engagement) can be achieved through the consideration of project planning, design, construction, and operations throughout the project life cycle. The clear shift from healthcare to lifestyle-focused services in the recent development of retirement villages together with the increasing number of aged people moving into retirement villages (Simpson and Cheney, 2007) has raised awareness of the need for the retirement village industry to provide a sustainable community for older people to improve their life quality after retirement. This is the first critical study of sustainable development in the retirement village industry and its potential in addressing the housing needs of older people, providing a contribution towards improving the life quality of older people and with direct and immediate significance to the community as a whole.

Chemotherapy-induced nausea and vomiting : a review to inform clinical practice

Chemotherapy-induced nausea and vomiting (CINV) is a common sideeffect of cytotoxic treatment and despite the widespread use of anti-emetic medication, it continues to affect a significant proportion of patients with up to 23% and 73% of chemotherapy patients still experiencing vomiting and nausea symptoms, respectively. This is of particular concern in oncology patients as nausea and vomiting may result in malnutrition, decreased quality of life and in extreme cases, treatment stoppage. Therefore, the primary aim of this paper was to inform clinicians on the current literature regarding CINV including its effect on the patient, its pathophysiology, and current treatment options. In addition, this review will also discuss the usage of dietetic interventions as well as less utilised, novel interventions such as oral ginger extracts in the treatment of CINV. In order to address these issues, a systematic literature search was conducted using Pubmed, CINAHL, MEDLINE, Embase, and Health Source (Nursing/Academic Edition). A key finding of this review was that common dietary strategies (e.g. eating slowly, avoiding fatty foods) seem to be solely based on professional opinion as no clinical trials investigating these strategies were identified. In contrast, ginger extracts were found to possess several viable mechanisms that interact with CINV progression including 5-HT3, Substance P and acetylcholine receptor antagonism; anti-inflammatory and antioxidant properties; and gastrointestinal motility and gastric emptying modulation. In conclusion, research investigating dietetic interventions in the management of CINV is sparse and requires further investigation while novel intervention such as ginger, possess multiple mechanisms that may benefit CINV management. This review will discuss the prevalence and significance of CINV, dietetic and novel treatment options, and provide implications for clinical practise and future research.

Traffic safety risks trends and patterns analysis on motorways

Crashes that occur on motorways contribute to a significant proportion (40-50%) of non-recurrent motorway congestion. Hence, reducing the frequency of crashes assist in addressing congestion issues (Meyer, 2008). Analysing traffic conditions and discovering risky traffic trends and patterns are essential basics in crash likelihood estimations studies and still require more attention and investigation. In this paper we will show, through data mining techniques, that there is a relationship between pre-crash traffic flow patterns and crash occurrence on motorways, compare them with normal traffic trends, and that this knowledge has the potentiality to improve the accuracy of existing crash likelihood estimation models, and opens the path for new development approaches. The data for the analysis was extracted from records collected between 2007 and 2009 on the Shibuya and Shinjuku lines of the Tokyo Metropolitan Expressway in Japan. The dataset includes a total of 824 rear-end and sideswipe crashes that have been matched with crashes corresponding traffic flow data using an incident detection algorithm. Traffic trends (traffic speed time series) revealed that crashes can be clustered with regards to the dominant traffic patterns prior to the crash occurrence. K-Means clustering algorithm applied to determine dominant pre-crash traffic patterns. In the first phase of this research, traffic regimes identified by analysing crashes and normal traffic situations using half an hour speed in upstream locations of crashes. Then, the second phase investigated the different combination of speed risk indicators to distinguish crashes from normal traffic situations more precisely. Five major trends have been found in the first phase of this paper for both high risk and normal conditions. The study discovered traffic regimes had differences in the speed trends. Moreover, the second phase explains that spatiotemporal difference of speed is a better risk indicator among different combinations of speed related risk indicators. Based on these findings, crash likelihood estimation models can be fine-tuned to increase accuracy of estimations and minimize false alarms.

Analysis on causes of death of rural residents in Shouguang City [寿光市农村人群慢性病死因分析]

Among people living in rural areas of Shouguang City, Shandong, China, 88% of deaths were caused by chronic non-communicable diseases. Cardiovascular diseases, respiratory diseases and cancers accounted for 97% of all chronic disease causes and 85% of all causes of death. The proportion of chronic causes increased by 27% from 1993 to 2000. However, the mortality of respiratory diseases showed a decreasing trend over time. Abstract in Chinese 篇首： 随着生活水平的提高,慢性非传染性疾病在居民死因谱中所占比重越来越大,为准确反映居民的死因状况,为农村地区慢性病的控制工作提供科学依据,本文对寿光市农村疾病监测点1993～2000年居民的慢性病死因进行了分析.

Comparison of moped, scooter and motorcycle crashes : implications for rider training and education

Scooter and moped sales have increased at a faster rate than motorcycle sales over the last decade in countries such as Australia, Canada and the United States. This may be particularly evident in jurisdictions where moped riding is permitted for car license holders and a motorcycle license is not required, such as in Queensland, Australia. Having historically comprised only a small proportion of powered two-wheelers (PTWs) outside of Europe and Asia, the safety of scooters and mopeds has received relatively little focused research attention. However, the recent trends in sales and crash involvement have stimulated greater interest in these PTW types. The current paper examines differences and similarities between scooters (over 50cc), mopeds (up to 50cc) and motorcycles in crash involvement and crash characteristics through analyses of crash and registration data from Queensland, Australia. The main findings include that moped and scooter riders are similar in terms of usage patterns, but the evidence suggests superior skills, greater experience and safer behaviour among scooter riders than moped riders. The requirement in Queensland for scooter riders but not moped riders to hold a motorcycle license, usually obtained through competency-based training and assessment, may help to explain some of this difference. Findings also suggest that scooter riders are safer than motorcycle riders in some respects, despite both being subject to the same licensing requirements which encourage participation in rider training. Safer attitudes and motivations rather than superior skills and knowledge may therefore underlie the differences between scooter and motorcycle riders. In summary, riders of larger scooters exhibit a combination of skills and behavior suggestive of safer riding than both their moped and motorcycle riding counterparts. It is reasonable to expect that mopeds and scooters will remain popular and that their usage may increase further, along with that of motorcycles. This research therefore has important practical implications regarding pathways to improved PTW safety. Future policy and planning should consider options for encouraging moped riders to acquire better riding skills and greater safety awareness, as apparent among scooter riders, including rider training, education and licensing. As is noted in recent literature and reflected in some contemporary rider training programs, motorcycle safety may be improved by addressing rider attitudes more comprehensively in addition to developing skills and knowledge.

Antibiotics for bronchiectasis exacerbations in children: rationale and study protocol for a randomised placebo-controlled trial

Background Despite bronchiectasis being increasingly recognised as an important cause of chronic respiratory morbidity in both indigenous and non-indigenous settings globally, high quality evidence to inform management is scarce. It is assumed that antibiotics are efficacious for all bronchiectasis exacerbations, but not all practitioners agree. Inadequately treated exacerbations may risk lung function deterioration. Our study tests the hypothesis that both oral azithromycin and amoxicillin-clavulanic acid are superior to placebo at improving resolution rates of respiratory exacerbations by day 14 in children with bronchiectasis unrelated to cystic fibrosis. Methods We are conducting a bronchiectasis exacerbation study (BEST), which is a multicentre, randomised, double-blind, double-dummy, placebo-controlled, parallel group trial, in five centres (Brisbane, Perth, Darwin, Melbourne, Auckland). In the component of BEST presented here, 189 children fulfilling inclusion criteria are randomised (allocation-concealed) to receive amoxicillin-clavulanic acid (22.5 mg/kg twice daily) with placebo-azithromycin; azithromycin (5 mg/kg daily) with placebo-amoxicillin-clavulanic acid; or placebo-azithromycin with placebo-amoxicillin-clavulanic acid for 14 days. Clinical data and a paediatric cough-specific quality of life score are obtained at baseline, at the start and resolution of exacerbations, and at day 14. In most children, blood and deep nasal swabs are also collected at the same time points. The primary outcome is the proportion of children whose exacerbations have resolved at day 14. The main secondary outcome is the paediatric cough-specific quality of life score. Other outcomes are time to next exacerbation; requirement for hospitalisation; duration of exacerbation; and spirometry data. Descriptive viral and bacteriological data from nasal samples and blood markers will also be reported. Discussion Effective, evidence-based management of exacerbations in people with bronchiectasis is clinically important. Yet, there are few randomised controlled trials (RCTs) in the neglected area of non-cystic fibrosis bronchiectasis. Indeed, no published RCTs addressing the treatment of bronchiectasis exacerbations in children exist. Our multicentre, double-blind RCT is designed to determine if azithromycin and amoxicillin-clavulanic acid, compared with placebo, improve symptom resolution on day 14 in children with acute respiratory exacerbations. Our planned assessment of the predictors of antibiotic response, the role of antibiotic-resistant respiratory pathogens, and whether early treatment with antibiotics affects duration and time to the next exacerbation, are also all novel.

Bronchiectasis exacerbation study on azithromycin and amoxycillin-clavulanate for respiratory exacerbations in children (BEST-2) : study protocol for a randomized controlled trial

Background Bronchiectasis unrelated to cystic fibrosis (CF) is being increasingly recognized in children and adults globally, both in resource-poor and in affluent countries. However, high-quality evidence to inform management is scarce. Oral amoxycillin-clavulanate is often the first antibiotic chosen for non-severe respiratory exacerbations, because of the antibiotic-susceptibility patterns detected in the respiratory pathogens commonly associated with bronchiectasis. Azithromycin has a prolonged half-life, and with its unique anti-bacterial, immunomodulatory, and anti-inflammatory properties, presents an attractive alternative. Our proposed study will test the hypothesis that oral azithromycin is non-inferior (within a 20% margin) to amoxycillin-clavulanate at achieving resolution of non-severe respiratory exacerbations by day 21 of treatment in children with non-CF bronchiectasis. Methods This will be a multicenter, randomized, double-blind, double-dummy, placebo-controlled, parallel group trial involving six Australian and New Zealand centers. In total, 170 eligible children will be stratified by site and bronchiectasis etiology, and randomized (allocation concealed) to receive: 1) azithromycin (5 mg/kg daily) with placebo amoxycillin-clavulanate or 2) amoxycillin-clavulanate (22.5 mg/kg twice daily) with placebo azithromycin for 21 days as treatment for non-severe respiratory exacerbations. Clinical data and a parent-proxy cough-specific quality of life (PC-QOL) score will be obtained at baseline, at the start and resolution of exacerbations, and on day 21. In most children, blood and deep-nasal swabs will also be collected at the same time points. The primary outcome is the proportion of children whose exacerbations have resolved at day 21. The main secondary outcome is the PC-QOL score. Other outcomes are: time to next exacerbation; requirement for hospitalization; duration of exacerbation, and spirometry data. Descriptive viral and bacteriological data from nasal samples and blood inflammatory markers will be reported where available. Discussion Currently, there are no published randomized controlled trials (RCT) to underpin effective, evidence-based management of acute respiratory exacerbations in children with non-CF bronchiectasis. To help address this information gap, we are conducting two RCTs. The first (bronchiectasis exacerbation study; BEST-1) evaluates the efficacy of azithromycin and amoxycillin-clavulanate compared with placebo, and the second RCT (BEST-2), described here, is designed to determine if azithromycin is non-inferior to amoxycillin-clavulanate in achieving symptom resolution by day 21 of treatment in children with acute respiratory exacerbations. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR) number ACTRN12612000010897. http://www.anzctr.org.au/trial_view.aspx?id=347879

The development of chronic cough in children following presentation to a tertiary paediatric emergency department with acute respiratory illness : study protocol for a prospective cohort study

Background Acute respiratory illness, a leading cause of cough in children, accounts for a substantial proportion of childhood morbidity and mortality worldwide. In some children acute cough progresses to chronic cough (> 4 weeks duration), impacting on morbidity and decreasing quality of life. Despite the importance of chronic cough as a cause of substantial childhood morbidity and associated economic, family and social costs, data on the prevalence, predictors, aetiology and natural history of the symptom are scarce. This study aims to comprehensively describe the epidemiology, aetiology and outcomes of cough during and after acute respiratory illness in children presenting to a tertiary paediatric emergency department. Methods/design A prospective cohort study of children aged <15 years attending the Royal Children's Hospital Emergency Department, Brisbane, for a respiratory illness that includes parent reported cough (wet or dry) as a symptom. The primary objective is to determine the prevalence and predictors of chronic cough (>= 4 weeks duration) post presentation with acute respiratory illness. Demographic, epidemiological, risk factor, microbiological and clinical data are completed at enrolment. Subjects complete daily cough dairies and weekly follow-up contacts for 28(+/-3) days to ascertain cough persistence. Children who continue to cough for 28 days post enrolment are referred to a paediatric respiratory physician for review. Primary analysis will be the proportion of children with persistent cough at day 28(+/-3). Multivariate analyses will be performed to evaluate variables independently associated with chronic cough at day 28(+/-3). Discussion Our protocol will be the first to comprehensively describe the natural history, epidemiology, aetiology and outcomes of cough during and after acute respiratory illness in children. The results will contribute to studies leading to the development of evidence-based clinical guidelines to improve the early detection and management of chronic cough in children during and after acute respiratory illness.

Visibility-related characteristics of crashes involving bicyclists and motor vehicles – Responses from an online questionnaire study

Bicyclists are among the most vulnerable of road users, with high fatal crash rates. Although visibility aids have been widely advocated to help prevent bicycle-vehicle conflicts, to date no study has investigated, among crash-involved cyclists, the kind of visibility aids they were using at the time of the crash. This study undertook a detailed investigation of visibility factors involved in bicyclist-motor-vehicle crashes. We surveyed 184 bicyclists (predominantly from Australia via internet cycling forums) who had been involved in motor vehicle collisions regarding the perceived cause of the collision, ambient weather and general visibility, as well as the clothing and bicycle lights used by the bicyclist. Over a third of the crashes occurred in low light levels (dawn, dusk or night-time), which is disproportionate given that only a small proportion of bicyclists typically ride at these times. Importantly, 19% of these bicyclists reported not using bicycle lights at the time of the crash, and only 34% were wearing reflective clothing. Only two participants (of 184) nominated bicyclist visibility as the cause of the crash: 61% attributed the crash to driver inattention. These findings demonstrate that crash-involved bicyclists tend to under-rate and under-utilise visibility aids as a means of improving their safety.

Actigraphy assessment of mother's sleep at 6, 12 & 18 weeks postpartum

Introduction: Mothers’ sleep during the postpartum period is commonly characterised by bouts of sleep across the night, resulting in low sleep efficiency and daytime sleepiness. Understanding of the nature of mothers’ sleep disruption needs to incorporate indices of both sleep quantity and sleep quality, but objective assessment of sleep disturbance experienced during the first postpartum months has not been investigated in great detail. This longitudinal study aimed to objectively measure mothers’ sleep during the first 18 weeks postpartum, to ascertain the level of sleep disturbance experienced. Method: Eleven mothers (Mean age = 29.82, SD = 4.45) from Australia wore Actiwatch-2 devices for up to 7 days and nights at 6, 12 and 18 weeks postpartum. For each night of recording, a number of sleep bouts were identified. Total sleep time (TST) was calculated as the total number of minutes across the night within these bouts. Sleep efficiency was calculated as the percentage of minutes across the night classified as being part of a sleep bout, with higher scores indicating higher efficiency. Sleep quality captured the efficiency of sleep within sleep bouts, and was calculated as the percentage of epochs classified as sleep within sleep bouts, with higher scores indicating higher sleep quality. Results: At 6 weeks postpartum, mean total sleep time was 420.22 minutes (SD = 50.61). Total sleep time did not significantly differ across the assessment; however there was a trend towards an increase over time. Sleep efficiency increased across the time periods (F(2,10) = 10.30, p = .001), with a significant increase between week 12 and week 18. At 6 weeks postpartum, mean sleep quality was 93.15% (SD = 2.68) and scores did not significantly change across the assessment periods. While there was no relationship between sleep efficiency and sleep quality during weeks 6 and 12, a significant positive relationship was observed at week 18, r2 = .52, p = .013. Conclusions: Within this sample, a low level of disruption was consistently shown within the mothers’ night time sleep bouts. However, overall sleep efficiency suggested a significant proportion of time spent awake between sleep bouts. While TST remained stable over time, overall sleep efficiency improved, suggesting the mothers’ sleep was becoming more consolidated. A single sleep bout a night was not often experienced.

Better understanding of food material on the basis of water distribution using Thermogravimetric analysis

The prime objective of drying is to enhance shelf life of perishable food materials. As the process is very energy intensive in nature, researchers are trying to minimise energy consumption in the drying process. In order to determine the exact amount of energy needed for drying a food product, understanding the physics of moisture distribution and bond strength of water within the food material is essential. In order understand the critical moisture content, moisture distribution and water bond strength in food material, Thermogravimetric analysis (TGA) can be properly utilised. This work has been conducted to investigate moisture distribution and water bond strength in selected food materials; apple, banana and potato. It was found that moisture distribution and water bond strength influence moisture migration from the food materials. In addition, proportion of different types of water (bound, free, surface water) has been simply identified using TGA. This study provides a better understanding of water contents and its role in drying rate and energy consumption.

Bioequivalence of two tablet formulations of capecitabine and exploration of age, gender, body surface area, and creatinine clearance as factors influencing systemic exposure in cancer patients

Purpose: The objective of the study was to assess the bioequivalence of two tablet formulations of capecitabine and to explore the effect of age, gender, body surface area and creatinine clearance on the systemic exposure to capecitabine and its metabolites. Methods: The study was designed as an open, randomized two-way crossover trial. A single oral dose of 2000 mg capecitabine was administered on two separate days to 25 patients with solid tumors. On one day, the patients received four 500-mg tablets of formulation B (test formulation) and on the other day, four 500-mg tablets of formulation A (reference formulation). The washout period between the two administrations was between 2 and 8 days. After each administration, serial blood and urine samples were collected for up to 12 and 24 h, respectively. Unchanged capecitabine and its metabolites were determined in plasma using LC/MS-MS and in urine by NMRS. Results: Based on the primary pharmacokinetic parameter, AUC(0-∞) of 5'-DFUR, equivalence was concluded for the two formulations, since the 90% confidence interval of the estimate of formulation B relative to formulation A of 97% to 107% was within the acceptance region 80% to 125%. There was no clinically significant difference between the t(max) for the two formulations (median 2.1 versus 2.0 h). The estimate for C(max) was 111% for formulation B compared to formulation A and the 90% confidence interval of 95% to 136% was within the reference region 70% to 143%. Overall, these results suggest no relevant difference between the two formulations regarding the extent to which 5'-DFUR reached the systemic circulation and the rate at which 5'-DFUR appeared in the systemic circulation. The overall urinary excretions were 86.0% and 86.5% of the dose, respectively, and the proportion recovered as each metabolite was similar for the two formulations. The majority of the dose was excreted as FBAL (61.5% and 60.3%), all other chemical species making a minor contribution. Univariate and multivariate regression analysis to explore the influence of age, gender, body surface area and creatinine clearance on the log-transformed pharmacokinetic parameters AUC(0-∞) and C(max) of capecitabine and its metabolites revealed no clinically significant effects. The only statistically significant results were obtained for AUC(0-∞) and C(max) of intact drug and for C(max) of FBAL, which were higher in females than in males. Conclusion: The bioavailability of 5'-DFUR in the systemic circulation was practically identical after administration of the two tablet formulations. Therefore, the two formulations can be regarded as bioequivalent. The variables investigated (age, gender, body surface area, and creatinine clearance) had no clinically significant effect on the pharmacokinetics of capecitabine or its metabolites.

A model for research supervision of international students in engineering and information technology disciplines

A large proportion (over 12 per cent) of international and non-English speaking background (NESB) postgraduate research students enrol in engineering and information technology (IT) programs in Australian universities. They find themselves in an advanced research culture, and are technically and scientifically challenged early in their programs. This is in addition to cultural, social and religious isolation and linguistic barriers they have to contend with. The project team surveyed this cohort at QUT and UWA, on the hypothesis that they face challenges that are more discipline-specific. The results of the survey indicate that existing supervisory frameworks which are limited to linguistic contexts are not fully assisting these students and supervisors to achieve high quality research. The goal of this project is to extend these supervisory frameworks to a holistic model that will address the unique needs and supervisory issues these students face in engineering and IT disciplines. The model will be useable by all other Australian universities.

Beliefs underlying the intention to donate again among first-time blood donors who experience a mild adverse event

Using the belief basis of the theory of planned behavior (TPB), the current study explored the rate of mild reactions reported by donors in relation to their first donation and the intention and beliefs of those donors with regard to returning to donate again. A high proportion of first-time donors indicated that they had experienced a reaction to blood donation. Further, donors who reacted were less likely to intend to return to donate. Regression analyses suggested that targeting different beliefs for those donors who had and had not reacted would yield most benefit in bolstering donors’ intentions to remain donating. The findings provide insight into those messages that could be communicated via the mass media or in targeted communications to retain first-time donors who have experienced a mild vasovagal reaction.

Herceptest: HER2 expression and gene amplification in non-small cell lung cancer

HER2 is an erbB/HER type I tyrosine kinase receptor that is frequently over-expressed in malignant epithelial tumours. Herceptin, a humanised mouse monoclonal antibody to HER2, is proven therapeutically in the management of metastatic breast cancer, significantly prolonging survival when combined with cytotoxic chemotherapeutic agents. Immunohistochemical studies suggest that non-small-cell lung cancer (NSCLC) tumours may over-express HER2. Our aim was to evaluate HER2 gene amplification and semi-quantitative immuno-expression in NSCLC. A total of 344 NSCLC cases were immunostained for HER2 expression in 2 centres using the HercepTest. Fluorescence in situ hybridisation (FISH) analysis for HER2 gene amplification was performed on most positive cases and a subset of negative cases. Fifteen cases (4.3%) demonstrated 2+ or 3+ membranous HER2 immuno-expression. There was no correlation between immuno-expression and tumour histology or grade. Tumours from higher-stage disease were more often HercepTest-positive (p < 0.001). All 4 HercepTest 3 + cases demonstrated gene amplification. One of the 5 2+ cases tested for gene amplification showed areas of borderline amplification and areas of polyploidy. None of the 19 HercepTest-negative cases demonstrated gene amplification or polyploidy (p < 0.001). Gene amplification was demonstrated in all HercepTest 3+ scoring NSCLC cases. Unlike breast cancer, gene amplification and HER2 protein over-expression assessed by the HercepTest appeared to be uncommon in NSCLC. Herceptin may therefore target only a small proportion of NSCLC tumours and be of limited clinical value in this disease, particularly in the adjuvant setting. © 2001 Wiley-Liss, Inc.