Adverse breast cancer treatment effects: The economic case for making rehabilitative programs standard of care

Purpose: The purpose of this work was to evaluate the patient-borne financial cost of common, adverse breast cancer treatment-associated effects, comparing cost across women with or without these side-effects. Methods: 287 Australian women diagnosed with early-stage breast cancer were prospectively followed starting at six months post-surgery for 12 months, with three-monthly assessment of detailed treatment-related side effects and their direct and indirect patient costs attributable to breast cancer. Bootstrapping statistics were used to analyze cost data and adjusted logistic regression was used to evaluate the association between costs and adverse events from breast cancer. Costs were inflated and converted from 2002 Australian to 2014 US dollars. Results: More than 90% of women experienced at least one adverse effect (i.e. post-surgical issue, reaction to radiotherapy, upper-body symptoms or reduced function, lymphedema, fatigue or weight gain). On average, women paid $5,636 (95%CI: $4,694, $6,577) in total costs. Women with any one of the following symptoms (fatigue, reduced upper-body function, upper-body symptoms) or women who report ≥4 adverse treatment-related effects, have 1.5 to nearly 4 times the odds of having higher healthcare costs than women who do not report these complaints (p<0.05). Conclusions: Women face substantial economic burden due to a range of treatment-related health problems, which may persist beyond the treatment period. Improving breast cancer care by incorporating prospective surveillance of treatment-related side effects, and strategies for prevention and treatment of concerns (e.g., exercise) has real potential for reducing patient-borne costs.

Socially inclusive learning in a community setting

People with mental health problems, learning difficulties and poor literacy and numeracy are at risk of social exclusion including homelessness. They are often disconnected from the Vocational Education and Training (VET) system, with few opportunities for education and employment. Academic research has demonstrated a link between literacy and numeracy and social inclusion, however, the pathways to enact this are not well understood. This report presents insights into how a community based adult literacy program in West End, Brisbane, was first established and has since evolved into a successful model of what we are calling ‘socially inclusive learning’. The research informing the report was conducted as a twelve-month study from April 2013 to April 2014 funded through a partnership involving Anglicare Southern Queensland, A Place to Belong and the School of Public Health and Social Work, Queensland University of Technology. The research was conducted by Greg Marston and Jeffrey Johnson- Abdelmalik. The aim of the study was to clarify the principles, practice and methodology of the Reading and Writing group (hereafter RAW) and identify the characteristics of RAW that support the social inclusion of the individual being provided literacy learning. The questions guiding the research included: • What are the key principles and practices of the RAW model? • How does the acquisition of literacy and numeracy skills contribute to the recovery of people with mental health and other issues? • How can the acquisition of literacy and numeracy skills support people’s social inclusion, including achieving employment and further education outcomes? A related aim of the project was to document how this community based literacy and numeracy program operates so that other organisations with an interest in addressing similar needs can learn from the model, particularly organisations that co-locate support and education and organisations that adopt a recovery approach when working with people with mental health challenges and intellectual and psychiatric disabilities. The report highlights the background to RAW, the learning philosophy of RAW, the profile of the participants in the program and the various roles and responsibilities and structure that supports the work of RAW. The report presents perspectives from the teachers, student participants and tutors on how the group is designed and the principles implemented.

Approaching wicked problems through design thinking

This paper explores possible ways in which design thinking can be used to understand the issues involved in wicked problems. Following brief reviews of both the design thinking and wicked problems literature, we offer a synthesis of these two areas. This paper distinguishes the connections of the various thinking styles inherent in design thinking methodologies and approaches to the phases of wicked problems. We create links between design thinking and cognitive mechanisms such as thinking styles, simple heuristics and schemas that can deepen understanding and effective decision making in the wicked problems in our complex environments.

Statistical methods for electromyography data and associated problems

This thesis proposes three novel models which extend the statistical methodology for motor unit number estimation, a clinical neurology technique. Motor unit number estimation is important in the treatment of degenerative muscular diseases and, potentially, spinal injury. Additionally, a recent and untested statistic to enable statistical model choice is found to be a practical alternative for larger datasets. The existing methods for dose finding in dual-agent clinical trials are found to be suitable only for designs of modest dimensions. The model choice case-study is the first of its kind containing interesting results using so-called unit information prior distributions.

Adaptive finite element analysis of elliptic problems based on bubble-type local mesh generation

A new mesh adaptivity algorithm that combines a posteriori error estimation with bubble-type local mesh generation (BLMG) strategy for elliptic differential equations is proposed. The size function used in the BLMG is defined on each vertex during the adaptive process based on the obtained error estimator. In order to avoid the excessive coarsening and refining in each iterative step, two factor thresholds are introduced in the size function. The advantages of the BLMG-based adaptive finite element method, compared with other known methods, are given as follows: the refining and coarsening are obtained fluently in the same framework; the local a posteriori error estimation is easy to implement through the adjacency list of the BLMG method; at all levels of refinement, the updated triangles remain very well shaped, even if the mesh size at any particular refinement level varies by several orders of magnitude. Several numerical examples with singularities for the elliptic problems, where the explicit error estimators are used, verify the efficiency of the algorithm. The analysis for the parameters introduced in the size function shows that the algorithm has good flexibility.

Translocation of bats as a conservation strategy : previous attempts and potential problems

Translocation is an increasingly popular conservation tool from which a wide range of taxa have benefited. However, to our knowledge, bats have not been translocated successfully. Bats differ behaviourally, morphologically and physiologically from the taxa for which translocation the- ory has been developed, so existing guidelines may not be directly transferable. We review previous translocations of bats and discuss characteristics of bats that may require special consideration dur- ing translocation. Their vagility and homing ability, coloniality, roost requirements, potential ability to transmit diseases, susceptibility to anthropomorphic impacts, and cryptic nature have implications for establishing populations, effects of these populations on the release site, and ability to monitor translocation success following release. We hope that our discussion of potential problems will be able to supplement the existing, more generic guidelines to provide a starting point for the planning of bat translocations.

Estimating the burden of disease attributable to excess body weight in South Africa in 2000

Objective. To estimate the burden of disease attributable to excess body weight using the body mass index (BMI), by age and sex, in South Africa in 2000. Design. World Health Organization comparative risk assessment (CRA) methodology was followed. Re-analysis of the 1998 South Africa Demographic and Health Survey data provided mean BMI estimates by age and sex. Populationattributable fractions were calculated and applied to revised burden of disease estimates. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. Setting. South Africa. Subjects. Adults 30 years of age. Outcome measures. Deaths and disability-adjusted life years (DALYs) from ischaemic heart disease, ischaemic stroke, hypertensive disease, osteoarthritis, type 2 diabetes mellitus, and selected cancers. Results. Overall, 87% of type 2 diabetes, 68% of hypertensive disease, 61% of endometrial cancer, 45% of ischaemic stroke, 38% of ischaemic heart disease, 31% of kidney cancer, 24% of osteoarthritis, 17% of colon cancer, and 13% of postmenopausal breast cancer were attributable to a BMI 21 kg/m2. Excess body weight is estimated to have caused 36 504 deaths (95% uncertainty interval 31 018 - 38 637) or 7% (95% uncertainty interval 6.0 - 7.4%) of all deaths in 2000, and 462 338 DALYs (95% uncertainty interval 396 512 - 478 847) or 2.9% of all DALYs (95% uncertainty interval 2.4 - 3.0%). The burden in females was approximately double that in males. Conclusions. This study shows the importance of recognising excess body weight as a major risk to health, particularly among females, highlighting the need to develop, implement and evaluate comprehensive interventions to achieve lasting change in the determinants and impact of excess body weight.

Public space for street-scape theatrics : guerrilla spatial tactics and methods of urban hacking in Brisbane, Australia

It could be argued that architecture has an inherent social responsibility to enrich the urban and spatial environments for the city’s occupants. However how we define quality, and how ‘places’ can be designed to be fair and equitable, catering for individuals on a humanistic and psychological level, is often not clearly addressed. Lefebvre discusses the idea of the ‘right to the city’; the belief that public space design should facilitate freedom of expression and incite a sense of spatial ownership for its occupants in public/commercial precincts. Lefebvre also points out the importance of sensory experience in the urban environment. “Street-scape theatrics” are performative activities that summarise these two concepts, advocating the ‘right to the city’ by way of art as well as providing sensual engagement for city users. Literature discusses the importance of Street-scape Theatrics however few sources attempt to discuss this topic in terms of how to design these spaces/places to enhance the city on both a sensory and political level. This research, grounded in political theory, investigates the case of street music, in particular busking, in the city of Brisbane, Australia. Street culture is a notion that already exists in Brisbane, but it is heavily controlled especially in central locations. The study discusses how sensory experience of the urban environment in Brisbane can be enriched through the design for busking; multiple case studies, interviews, observations and thematic mappings provide data to gather an understanding of how street performers see and understand the built form. Results are sometime surprisingly incongruous with general assumptions in regards to street artist as well as the established political and ideological framework, supporting the idea that the best and most effective way of urban hacking is working within the system. Ultimately, it was found that the Central Business District in Brisbane, Australia, could adopt certain political and design tactics which attempt to reconcile systematic quality control with freedom of expression into the public/commercial sphere, realism upheld. This can bridge the gap between the micro scale of the body and the macro of the political economy through freedom of expression, thus celebrating the idiosyncratic nature of the city.

Stefan problems for melting nanoscaled particles

Under certain conditions, the mathematical models governing the melting of nano-sized particles predict unphysical results, which suggests these models are incomplete. This thesis studies the addition of different physical effects to these models, using analytic and numerical techniques to obtain realistic and meaningful results. In particular, the mathematical "blow-up" of solutions to ill-posed Stefan problems is examined, and the regularisation of this blow-up via kinetic undercooling. Other effects such as surface tension, density change and size-dependent latent heat of fusion are also analysed.

Participation in Environmental Organizations

For decades, social scientists have searched for factors that shape pro-environmental behaviour. However, only a few studies have investigated the causes and consequences of participation in environmental organizations. This book fills the gap by analysing in detail the determinants of environmental participation and its consequences in different parts of the world. Benno Torgler, María A. García-Valinas and Alison Macintyre seek the answer to several questions regarding who is working towards positive outcomes for our environment, what sort of social and institutional context will assist voluntary participation, what sort of attitudes are related to positive environmental behavior, and which countries are active on the intergovernmental stage. By focusing on voluntary participation in environmental organizations, we are able to determine the level of willingness to work towards a solution for environmental problems. This allows an insight into the motivations and attitudes of individuals and nations and how these factors can affect environmental cooperation. Participation in Environmental Organizations sheds light on who is liable to participate and will help to see whose priorities and values are forwarded through voluntary activities and to what extent voluntary participation can become representative. Thus, the book provides a unique examination of citizens’ willingness to participate in environmental organizations. The book will be of interest to Economics students and researchers alike who seek a deeper understanding of the theory and practice of environmental participation.

Comparisons between youth of a parent with MS and a control group on adjustment, caregiving, attachment and family functioning

Few studies have examined the effects of parental MS on children, and those that have suffered from numerous methodological weaknesses, some of which are addressed in this study. This study investigated the effects of parental MS on children by comparing youth of a parent with MS to youth who have no family member with a serious health condition on adjustment outcomes, caregiving, attachment and family functioning. A questionnaire survey methodology was used. Measures included youth somatisation, health, pro-social behaviour, behavioural-social difficulties, caregiving, attachment and family functioning. A total of 126 youth of a parent with MS were recruited from MS Societies in Australia and, were matched one-to-one with youth who had no family member with a health condition drawn from a large community sample. Comparisons showed that youth of a parent with MS did not differ on any of the outcomes except for peer relationship problems: adolescent youth of a parent with MS reported lower peer relationship problems than control adolescents. Overall, results did not support prior research findings suggesting adverse impacts of parental MS on youth.

Scoping workplace aggression in nursing : findings from an Australian study

Aim This paper reports a study of workplace aggression among nurses in Tasmania, Australia. Background There is international concern about a perceived rise in occupational violence as a major worldwide public health problem, with associated financial costs. There is reason to suspect that aggression towards nurses is increasing. For example, increased illicit drug use puts nurses at the sharp end in managing patients admitted with drug-related problems. Such people are often resistant to healthcare intervention, and often have associated disorders, including mental illness. Despite this increased awareness, comprehensive data on occupational violence in nursing are not available. Method A specially designed questionnaire was sent to all nurses registered with the Nursing Board of Tasmania (n ¼ 6326) in November/December 2002, with 2407 usable questionnaires returned. The response rate was 38%. Findings A majority of respondents (63Æ5%) had experienced some form of aggression (verbal or physical abuse) in the four working weeks immediately prior to the survey. Patients/clients or their visitors were identified as the main perpetrators, followed by medical and nursing colleagues. Abuse influenced nurses’ distress, their desire to stay in nursing, their productivity and the potential to make errors, yet they were reluctant to make their complaints ‘official’. As well as reporting high levels of verbal and physical abuse, nurses were distressed because they could not provide the appropriate care to meet patients’ needs. Few working environments were free of aggression. Conclusion Future research should try to determine the specific factors, including staff characteristics and environment, associated with the high levels of aggression reported in ‘hot spots’ where, on the basis of the present results, many staff experience high levels of verbal and physical abuse. Unless managers take steps to improve the situation, attrition from the profession for this reason will continue.