The ENHANCES study--Enhancing Head and Neck Cancer patients' Experiences of Survivorship: study protocol for a randomized controlled trial

Background Few cancers pose greater challenges than head and neck (H&N) cancer. Residual effects following treatment include body image changes, pain, fatigue and difficulties with appetite, swallowing and speech. Depression is a common comorbidity. There is limited evidence about ways to assist patients to achieve optimal adjustment after completion of treatment. In this study, we aim to examine the effectiveness and feasibility of a model of survivorship care to improve the quality of life of patients who have completed treatment for H&N cancer. Methods This is a preliminary study in which 120 patients will be recruited. A prospective randomised controlled trial of the H&N Cancer Survivor Self-management Care Plan (HNCP) involving pre- and post-intervention assessments will be used. Consecutive patients who have completed a defined treatment protocol for H&N cancer will be recruited from two large cancer services and randomly allocated to one of three study arms: (1) usual care, (2) information in the form of a written resource or (3) the HNCP delivered by an oncology nurse who has participated in manual-based training and skill development in patient self-management support. The trained nurses will meet patients in a face-to-face interview lasting up to 60 minutes to develop an individualised HNCP, based on principles of chronic disease self-management. Participants will be assessed at baseline, 3 and 6 months. The primary outcome measure is quality of life. The secondary outcome measures include mood, self-efficacy and health-care utilisation. The feasibility of implementing this intervention in routine clinical care will be assessed through semistructured interviews with participating nurses, managers and administrators. Interviews with patients who received the HNCP will explore their perceptions of the HNCP, including factors that assisted them in achieving behavioural change. Discussion In this study, we aim to improve the quality of life of a patient population with unique needs by means of a tailored self-management care plan developed upon completion of treatment. Delivery of the intervention by trained oncology nurses is likely to be acceptable to patients and, if successful, will be a model of care that can be implemented for diverse patient populations.

Correlates of sedentary behaviours in preschool children : a review

Background Sedentary behaviour has been linked with a number of health outcomes. Preschool-aged children spend significant proportions of their day engaged in sedentary behaviours. Research into the correlates of sedentary behaviours in the preschool population is an emerging field, with most research being published since 2002. Reviews on correlates of sedentary behaviours which include preschool children have previously been published; however, none have reported results specific to the preschool population. This paper reviews articles reporting on correlates of sedentary behaviour in preschool children published between 1993 and 2009. Methods A literature search was undertaken to identify articles which examined correlates of sedentary behaviours in preschool children. Articles were retrieved and evaluated in 2008 and 2009. Results Twenty-nine studies were identified which met the inclusion criteria. From those studies, 63 potential correlates were identified. Television viewing was the most commonly examined sedentary behaviour. Findings from the review suggest that child's sex was not associated with television viewing and had an indeterminate association with sedentary behaviour as measured by accelerometry. Age, body mass index, parental education and race had an indeterminate association with television viewing, and outdoor playtime had no association with television viewing. The remaining 57 potential correlates had been investigated too infrequently to be able to draw robust conclusions about associations. Conclusions The correlates of preschool children's sedentary behaviours are multi-dimensional and not well established. Further research is required to provide a more comprehensive understanding of the influences on preschool children's sedentary behaviours to better inform the development of interventions.

Concurrent validity of accelerations measured using a tri-axial inertial measurement unit while walking on firm, compliant and uneven surfaces

Although accelerometers are extensively used for assessing gait, limited research has evaluated the concurrent validity of these devices on less predictable walking surfaces or the comparability of different methods used for gravitational acceleration compensation. This study evaluated the concurrent validity of trunk accelerations derived from a tri-axial inertial measurement unit while walking on firm, compliant and uneven surfaces and contrasted two methods used to remove gravitational accelerations: i) subtraction of the best linear fit from the data (detrending), and; ii) use of orientation information (quaternions) from the inertial measurement unit. Twelve older and twelve younger adults walked at their preferred speed along firm, compliant and uneven walkways. Accelerations were evaluated for the thoracic spine (T12) using a tri-axial inertial measurement unit and an eleven-camera Vicon system. The findings demonstrated excellent agreement between accelerations derived from the inertial measurement unit and motion analysis system, including while walking on uneven surfaces that better approximate a real-world setting (all differences <0.16 m.s−2). Detrending produced slightly better agreement between the inertial measurement unit and Vicon system on firm surfaces (delta range: −0.05 to 0.06 vs. 0.00 to 0.14 m.s−2), whereas the quaternion method performed better when walking on compliant and uneven walkways (delta range: −0.16 to −0.02 vs. −0.07 to 0.07 m.s−2). The technique used to compensate for gravitational accelerations requires consideration in future research, particularly when walking on compliant and uneven surfaces. These findings demonstrate trunk accelerations can be accurately measured using a wireless inertial measurement unit and are appropriate for research that evaluates healthy populations in complex environments.

Is unsupervised exercise following breast cancer safe for all women?

One in eight women living in developed countries will be diagnosed with breast cancer before the age of 85, with the mean age at first diagnosis approximately 60 years. Stage I represents just under 50% of diagnoses, while 45% of cases are diagnosed at later stages (stages II to IV; the remainder being unknown stage). Breast cancer continues to be the most common cause of cancer-related deaths in women , and although survival for women with stage I disease is high (98% 5-year relative survival), survival is significantly lower for those diagnosed with more advanced disease stage (i.e., stages II to IV, 83%; an unknown stage, 50%) .

Calculate excess mortality during heatwaves using Hilbert-Huang transform algorithm

Background Heatwaves could cause the population excess death numbers to be ranged from tens to thousands within a couple of weeks in a local area. An excess mortality due to a special event (e.g., a heatwave or an epidemic outbreak) is estimated by subtracting the mortality figure under ‘normal’ conditions from the historical daily mortality records. The calculation of the excess mortality is a scientific challenge because of the stochastic temporal pattern of the daily mortality data which is characterised by (a) the long-term changing mean levels (i.e., non-stationarity); (b) the non-linear temperature-mortality association. The Hilbert-Huang Transform (HHT) algorithm is a novel method originally developed for analysing the non-linear and non-stationary time series data in the field of signal processing, however, it has not been applied in public health research. This paper aimed to demonstrate the applicability and strength of the HHT algorithm in analysing health data. Methods Special R functions were developed to implement the HHT algorithm to decompose the daily mortality time series into trend and non-trend components in terms of the underlying physical mechanism. The excess mortality is calculated directly from the resulting non-trend component series. Results The Brisbane (Queensland, Australia) and the Chicago (United States) daily mortality time series data were utilized for calculating the excess mortality associated with heatwaves. The HHT algorithm estimated 62 excess deaths related to the February 2004 Brisbane heatwave. To calculate the excess mortality associated with the July 1995 Chicago heatwave, the HHT algorithm needed to handle the mode mixing issue. The HHT algorithm estimated 510 excess deaths for the 1995 Chicago heatwave event. To exemplify potential applications, the HHT decomposition results were used as the input data for a subsequent regression analysis, using the Brisbane data, to investigate the association between excess mortality and different risk factors. Conclusions The HHT algorithm is a novel and powerful analytical tool in time series data analysis. It has a real potential to have a wide range of applications in public health research because of its ability to decompose a nonlinear and non-stationary time series into trend and non-trend components consistently and efficiently.

Heat transfer analysis of viscous incompressible fluid by combined natural convection and radiation in an open cavity

The effect of radiation on natural convection of Newtonian fluid contained in an open cavity is investigated in this study. The governing partial differential equations are solved numerically using the Alternate Direct Implicit method together with the Successive Over Relaxation method. The study is focused on studying the flow pattern and the convective and radiative heat transfer rates are studied for different values of radiation parameters namely, the optical thickness of the fluid, scattering albedo, and the Planck number. It was found that in the optically thin limit, an increase in the optical thickness of the fluid raises the temperature and radiation heat transfer of the fluid. However, a further increase in the optical thickness decreases the radiative heat transfer rate due to increase in the energy level of the fluid, which ultimately reduces the total heat transfer rate within the fluid.

A qualitative investigation of adolescents’ perceived mechanisms of change from a universal school-based depression prevention program

A recent meta-analysis provides evidence supporting the universal application of school-based prevention programs for adolescent depression. The mechanisms underlying such successful interventions, however, are largely unknown. We report on a qualitative analysis of 109 Grade 9 students’ beliefs about what they gained from an evidence-based depression prevention intervention, the Resourceful Adolescent Program (RAP-A). Fifty-four percent of interviewees articulated at least one specific example of program benefit. A thematic analysis of responses revealed two major themes, improved interpersonal relationships and improved self-regulation, both stronger than originally assumed. A more minor theme also emerged—more helpful cognitions. It is postulated that both improved interpersonal relationships and improved self-regulation are likely to enhance one another, and more helpful cognitions may express its contribution through enhanced self-regulation. These findings broaden our understanding of the impact of depression prevention programs, beginning to illuminate how such programs benefit participants.

When supply does not meet demand-ER stress and plant programmed cell death

The endoplasmic reticulum (ER) is the central organelle in the eukaryotic secretory pathway. The ER functions in protein synthesis and maturation and is crucial for proper maintenance of cellular homeostasis and adaptation to adverse environments. Acting as a cellular sentinel, the ER is exquisitely sensitive to changing environments principally via the ER quality control machinery. When perturbed, ER-stress triggers a tightly regulated and highly conserved, signal transduction pathway known as the unfolded protein response (UPR) that prevents the dangerous accumulation of unfolded/misfolded proteins. In situations where excessive UPR activity surpasses threshold levels, cells deteriorate and eventually trigger programmed cell death (PCD) as a way for the organism to cope with dysfunctional or toxic signals. The programmed cell death that results from excessive ER stress in mammalian systems contributes to several important diseases including hypoxia, neurodegeneration, and diabetes. Importantly, hallmark features and markers of cell death that are associated with ER stress in mammals are also found in plants. In particular, there is a common, conserved set of chaperones that modulate ER cell death signaling. Here we review the elements of plant cell death responses to ER stress and note that an increasing number of plant-pathogen interactions are being identified in which the host ER is targeted by plant pathogens to establish compatibility.

STI-GMaS : an open-source environment for simulation of sexually-transmitted infections

Background Sexually-transmitted pathogens often have severe reproductive health implications if treatment is delayed or absent, especially in females. The complex processes of disease progression, namely replication and ascension of the infection through the genital tract, span both extracellular and intracellular physiological scales, and in females can vary over the distinct phases of the menstrual cycle. The complexity of these processes, coupled with the common impossibility of obtaining comprehensive and sequential clinical data from individual human patients, makes mathematical and computational modelling valuable tools in developing our understanding of the infection, with a view to identifying new interventions. While many within-host models of sexually-transmitted infections (STIs) are available in existing literature, these models are difficult to deploy in clinical/experimental settings since simulations often require complex computational approaches. Results We present STI-GMaS (Sexually-Transmitted Infections – Graphical Modelling and Simulation), an environment for simulation of STI models, with a view to stimulating the uptake of these models within the laboratory or clinic. The software currently focuses upon the representative case-study of Chlamydia trachomatis, the most common sexually-transmitted bacterial pathogen of humans. Here, we demonstrate the use of a hybrid PDE–cellular automata model for simulation of a hypothetical Chlamydia vaccination, demonstrating the effect of a vaccine-induced antibody in preventing the infection from ascending to above the cervix. This example illustrates the ease with which existing models can be adapted to describe new studies, and its careful parameterisation within STI-GMaS facilitates future tuning to experimental data as they arise. Conclusions STI-GMaS represents the first software designed explicitly for in-silico simulation of STI models by non-theoreticians, thus presenting a novel route to bridging the gap between computational and clinical/experimental disciplines. With the propensity for model reuse and extension, there is much scope within STI-GMaS to allow clinical and experimental studies to inform model inputs and drive future model development. Many of the modelling paradigms and software design principles deployed to date transfer readily to other STIs, both bacterial and viral; forthcoming releases of STI-GMaS will extend the software to incorporate a more diverse range of infections.

The QUT innovation space : a trans-disciplinary learning environment for entrepreneurship education : final report

In the current climate of global economic volatility, there are increasing calls for training in enterprising skills and entrepreneurship to underpin the systemic innovation required for even medium-term business sustainability. The skills long-recognised as the essential for entrepreneurship now appear on the list of employability skills demanded by industry. The QUT Innovation Space (QIS) was an experiment aimed at delivering entrepreneurship education (EE), as an extra-curricular platform across the university, to the undergraduate students of an Australian higher education institute. It was an ambitious project that built on overseas models of EE studied during an Australian Learning and Teaching Council (ALTC) Teaching Fellowship (Collet, 2011) and implemented those approaches across an institute. Such EE approaches have not been attempted in an Australian university. The project tested resonance not only with the student population, from the perspective of what worked and what didn’t work, but also with every level of university operations. Such information is needed to inform the development of EE in the Australian university landscape. The QIS comprised a physical co-working space, virtual sites (web, Twitter and Facebook) and a network of entrepreneurial mentors, colleagues, and students. All facets of the QIS enabled connection between like-minded individuals that underpins the momentum needed for a project of this nature. The QIS became an innovation community within QUT. This report serves two purposes. First, as an account of the QIS project and its evolution, the report serves to identify the student demand for skills and training as well as barriers and facilitators of the activities that promote EE in an Australian university context. Second, the report serves as a how-to manual, in the tradition of many tomes on EE, outlining the QIS activities that worked as well as those that failed. The activities represent one measure of QIS outcomes and are described herein to facilitate implementation in other institutes. The QIS initially aimed to adopt an incubation model for training in EE. The ‘learning by doing’ model for new venture creation is a highly successful and high profile training approach commonly found in overseas contexts. However, the greatest demand of the QUT student population was not for incubation and progression of a developed entrepreneurial intent, but rather for training that instilled enterprising skills in the individual. These two scenarios require different training approaches (Fayolle and Gailly, 2008). The activities of the QIS evolved to meet that student demand. In addressing enterprising skills, the QIS developed the antecedents of entrepreneurialism (i.e., entrepreneurial attitudes, motivation and behaviours) including high-level skills around risk-taking, effective communication, opportunity recognition and action-orientation. In focusing on the would-be entrepreneur and not on the (initial) idea per se, the QIS also fostered entrepreneurial outcomes that would never have gained entry to the rigid stage-gated incubation model proposed for the original QIS framework. Important lessons learned from the project for development of an innovation community include the need to: 1. Evaluate the context of the type of EE program to be delivered and the student demand for the skills training (as noted above). 2. Create a community that builds on three dimensions: a physical space, a virtual environment and a network of mentors and partners. 3. Supplement the community with external partnerships that aid in delivery of skills training materials. 4. Ensure discovery of the community through the use of external IT services to deliver advertising and networking outlets. 5. Manage unrealistic student expectations of billion dollar products. 6. Continuously renew and rebuild simple activities to maintain student engagement. 7. Accommodate the non-university end-user group within the community. 8. Recognise and address the skills bottlenecks that serve as barriers to concept progression; in this case, externally provided IT and programming skills. 9. Use available on-line and published resources rather than engage in constructing project-specific resources that quickly become obsolete. 10. Avoid perceptions of faculty ownership and operate in an increasingly competitive environment. 11. Recognise that the continuum between creativity/innovation and entrepreneurship is complex, non-linear and requires different training regimes during the different phases of the pipeline. One small entity, such as the QIS, cannot address them all. The QIS successfully designed, implemented and delivered activities that included events, workshops, seminars and services to QUT students in the extra-curricular space. That the QIS project can be considered successful derives directly from the outcomes. First, the QIS project changed the lives of emerging QUT student entrepreneurs. Also, the QIS activities developed enterprising skills in students who did not necessarily have a business proposition, at the time. Second, successful outcomes of the QIS project are evidenced as the embedding of most, perhaps all, of the QIS activities in a new Chancellery-sponsored initiative: the Leadership Development and Innovation Program hosted by QUT Student Support Services. During the course of the QIS project, the Brisbane-based innovation ecosystem underwent substantial change. From a dearth of opportunities for the entrepreneurially inclined, there is now a plethora of entities that cater for a diversity of innovation-related activities. While the QIS evolved with the landscape, the demand endpoint of the QIS activities still highlights a gap in the local and national innovation ecosystems. The freedom to experiment and to fail is not catered for by the many new entities seeking to build viable businesses on the back of the innovation push. The onus of teaching the enterprising skills, which are the employability skills now demanded by industry, remains the domain of the higher education sector.

The feeding practices and structure questionnaire : construction and initial validation in a sample of Australian first-time mothers and their 2-year olds

Background Early feeding practices lay the foundation for children’s eating habits and weight gain. Questionnaires are available to assess parental feeding but overlapping and inconsistent items, subscales and terminology limit conceptual clarity and between study comparisons. Our aim was to consolidate a range of existing items into a parsimonious and conceptually robust questionnaire for assessing feeding practices with very young children (<3 years). Methods Data were from 462 mothers and children (age 21–27 months) from the NOURISH trial. Items from five questionnaires and two study-specific items were submitted to a priori item selection, allocation and verification, before theoretically-derived factors were tested using Confirmatory Factor Analysis. Construct validity of the new factors was examined by correlating these with child eating behaviours and weight. Results Following expert review 10 factors were specified. Of these, 9 factors (40 items) showed acceptable model fit and internal reliability (Cronbach’s α: 0.61-0.89). Four factors reflected non-responsive feeding practices: ‘Distrust in Appetite’, ‘Reward for Behaviour’, ‘Reward for Eating’, and ‘Persuasive Feeding’. Five factors reflected structure of the meal environment and limits: ‘Structured Meal Setting’, ‘Structured Meal Timing’, ‘Family Meal Setting’, ‘Overt Restriction’ and ‘Covert Restriction’. Feeding practices generally showed the expected pattern of associations with child eating behaviours but none with weight. Conclusion The Feeding Practices and Structure Questionnaire (FPSQ) provides a new reliable and valid measure of parental feeding practices, specifically maternal responsiveness to children’s hunger/satiety signals facilitated by routine and structure in feeding. Further validation in more diverse samples is required.

Governance Systems Analysis (GSA) : a framework for reforming governance systems

Most commentators understand that contemporary social, economic and environmental challenges require quality governance from global to local scales. While public scrutiny of governance has increased in recent years, the literature on frameworks and methods for analysis in complex, poly-centric and multi-thematic governance systems remains fragmented; displaying many disciplinary or sectoral biases. This paper establishes a stronger theory-based foundation for the analysis of complex governance systems. It also develops a clear analytical framework applicable across a vast array of differing governance themes, domains and scales (GSA). The key methodological steps and evaluative criteria for the GSA framework are determined and practical guidance for its application in reform is provided.

Study Protocol - Alcohol Management Plans (AMPs) in remote indigenous communities in Queensland: their impacts on injury, violence, health and social indicators and their cost-effectiveness

Background In 2002/03 the Queensland Government responded to high rates of alcohol-related harm in discrete Indigenous communities by implementing alcohol management plans (AMPs), designed to include supply and harm reduction and treatment measures. Tighter alcohol supply and carriage restrictions followed in 2008 following indications of reductions in violence and injury. Despite the plans being in place for over a decade, no comprehensive independent review has assessed to what level the designed aims were achieved and what effect the plans have had on Indigenous community residents and service providers. This study will describe the long-term impacts on important health, economic and social outcomes of Queensland’s AMPs. Methods/Design The project has two main studies, 1) outcome evaluation using de-identified epidemiological data on injury, violence and other health and social indicators for across Queensland, including de-identified databases compiled from relevant routinely-available administrative data sets, and 2) a process evaluation to map the nature, timing and content of intervention components targeting alcohol. Process evaluation will also be used to assess the fidelity with which the designed intervention components have been implemented, their uptake and community responses to them and their perceived impacts on alcohol supply and consumption, injury, violence and community health. Interviews and focus groups with Indigenous residents and service providers will be used. The study will be conducted in all 24 of Queensland’s Indigenous communities affected by alcohol management plans. Discussion This evaluation will report on the impacts of the original aims for AMPs, what impact they have had on Indigenous residents and service providers. A central outcome will be the establishment of relevant databases describing the parameters of the changes seen. This will permit comprehensive and rigorous surveillance systems to be put in place and provided to communities empowering them with the best credible evidence to judge future policy and program requirements for themselves. The project will inform impending alcohol policy and program adjustments in Queensland and other Australian jurisdictions. The project has been approved by the James Cook University Human Research Ethics Committee (approval number H4967 & H5241).

Validation of a framework for measuring hospital disaster resilience using factor analysis

Hospital disaster resilience can be defined as “the ability of hospitals to resist, absorb, and respond to the shock of disasters while maintaining and surging essential health services, and then to recover to its original state or adapt to a new one.” This article aims to provide a framework which can be used to comprehensively measure hospital disaster resilience. An evaluation framework for assessing hospital resilience was initially proposed through a systematic literature review and Modified-Delphi consultation. Eight key domains were identified: hospital safety, command, communication and cooperation system, disaster plan, resource stockpile, staff capability, disaster training and drills, emergency services and surge capability, and recovery and adaptation. The data for this study were collected from 41 tertiary hospitals in Shandong Province in China, using a specially designed questionnaire. Factor analysis was conducted to determine the underpinning structure of the framework. It identified a four-factor structure of hospital resilience, namely, emergency medical response capability (F1), disaster management mechanisms (F2), hospital infrastructural safety (F3), and disaster resources (F4). These factors displayed good internal consistency. The overall level of hospital disaster resilience (F) was calculated using the scoring model: F = 0.615F1 + 0.202F2 + 0.103F3 + 0.080F4. This validated framework provides a new way to operationalise the concept of hospital resilience, and it is also a foundation for the further development of the measurement instrument in future studies.

Disaster resilience in tertiary hospitals : a cross-sectional survey in Shandong Province, China

Background: Hospital disaster resilience can be defined as a hospital’s ability to resist, absorb, and respond to the shock of disasters while maintaining critical functions, and then to recover to its original state or adapt to a new one. This study aims to explore the status of resilience among tertiary hospitals in Shandong Province, China. Methods: A stratified random sample (n = 50) was derived from tertiary A, tertiary B, and tertiary C hospitals in Shandong Province, and was surveyed by questionnaire. Data on hospital characteristics and 8 key domains of hospital resilience were collected and analysed. Variables were binary, and analysed using descriptive statistics such as frequencies. Results: A response rate of 82% (n = 41) was attained. Factor analysis identified four key factors from eight domains which appear to reflect the overall level of disaster resilience. These were hospital safety, disaster management mechanisms, disaster resources and disaster medical care capability. The survey demonstrated that in regard to hospital safety, 93% had syndromic surveillance systems for infectious diseases and 68% had evaluated their safety standards. In regard to disaster management mechanisms, all had general plans, while only 20% had specific plans for individual hazards. 49% had a public communication protocol and 43.9% attended the local coordination meetings. In regard to disaster resources, 75.6% and 87.5% stockpiled emergency drugs and materials respectively, while less than a third (30%) had a signed Memorandum of Understanding with other hospitals to share these resources. Finally in regard to medical care, 66% could dispatch an on-site medical rescue team, but only 5% had a ‘portable hospital’ function and 36.6% and 12% of the hospitals could surge their beds and staff capacity respectively. The average beds surge capacity within 1 day was 13%. Conclusions: This study validated the broad utility of a framework for understanding and measuring the level of hospital resilience. The survey demonstrated considerable variability in disaster resilience arrangements of tertiary hospitals in Shandong province, and the difference between tertiary A hospitals and tertiary B hospitals was also identified in essential areas.