Safety, feasibility and effects of an individualised walking intervention for women undergoing chemotherapy for ovarian cancer : a pilot study

Background: Exercise interventions during adjuvant cancer therapy have been shown to increase functional capacity, relieve fatigue and distress and may assist rates of chemotherapy completion. These studies have been limited to breast, gastric and mixed cancer groups and it is not yet known if a similar intervention is even feasible among women with ovarian cancer. We aimed to assess safety, feasibility and potential effect of a walking intervention in women undergoing chemotherapy for ovarian cancer. Methods: Women newly diagnosed with ovarian cancer were recruited to participate in an individualised walking intervention throughout chemotherapy and were assessed pre-and post-intervention. Feasibility measures included session adherence, compliance with exercise physiologist prescribed walking targets and self-reported program acceptability. Changes in objective physical functioning (6 minute walk test), self-reported distress (Hospital Anxiety and Depression Scale), symptoms (Memorial Symptom Assessment Scale - Physical) and quality of life (Functional Assessment of Cancer Therapy - Ovarian) were calculated, and chemotherapy completion and adverse intervention effects recorded. Results: Seventeen women were enrolled (63% recruitment rate). Mean age was 60 years (SD = 8 years), 88% were diagnosed with FIGO stage III or IV disease, 14 women underwent adjuvant and three neo-adjuvant chemotherapy. On average, women adhered to > 80% of their intervention sessions and complied with 76% of their walking targets, with the majority walking four days a week at moderate intensity for 30 minutes per session. Meaningful improvements were found in physical functioning, physical symptoms, physical well-being and ovarian cancerspecific quality of life. Most women (76%) completed ≥85% of their planned chemotherapy dose. There were no withdrawals or serious adverse events and all women reported the program as being helpful. Conclusions: These positive preliminary results suggest that this walking intervention for women receiving chemotherapy for ovarian cancer is safe, feasible and acceptable and could be used in development of future work. Trial registration: ACTRN12609000252213

Exploring the role of gender and risk perceptions in people’s decisions to register as a bone marrow donor

Increasing the number of bone marrow (BM) donors is important to ensure sufficient diversity on BM registries to meet the needs of patients. This study used an experimental approach to test the hypothesis that providing information about the risks of BM donation to allay unsubstantiated fears would reduce male and female participants’ perceptions of risk for donation and joining the Australian BM Donor Registry (ABMDR). Males’ and females’ intentions to register on the ABMDR, their attitudes, norms, and perceived behavioural control (efficacy) in relation to registering were explored also. Participants were allocated randomly to either a risk (exposed to risk information about BM donation) or no risk(not exposed to risk information) condition. In partial support of hypotheses, exposure to risk information did reduce perceived risk for registering on the ABMDR for males only. Participants in the risk condition also demonstrated lower scores on attitude (males only) and intention compared to participants in the no risk condition. These findings highlight the complex role of risk perceptions and gender differences in understanding people’s decisions to join a BM registry.

Application of operations research techniques to improve efficiency in the emergency department

The main aim of this thesis is to analyse and optimise a public hospital Emergency Department. The Emergency Department (ED) is a complex system with limited resources and a high demand for these resources. Adding to the complexity is the stochastic nature of almost every element and characteristic in the ED. The interaction with other functional areas also complicates the system as these areas have a huge impact on the ED and the ED is powerless to change them. Therefore it is imperative that OR be applied to the ED to improve the performance within the constraints of the system. The main characteristics of the system to optimise included tardiness, adherence to waiting time targets, access block and length of stay. A validated and verified simulation model was built to model the real life system. This enabled detailed analysis of resources and flow without disruption to the actual ED. A wide range of different policies for the ED and a variety of resources were able to be investigated. Of particular interest was the number and type of beds in the ED and also the shift times of physicians. One point worth noting was that neither of these resources work in isolation and for optimisation of the system both resources need to be investigated in tandem. The ED was likened to a flow shop scheduling problem with the patients and beds being synonymous with the jobs and machines typically found in manufacturing problems. This enabled an analytic scheduling approach. Constructive heuristics were developed to reactively schedule the system in real time and these were able to improve the performance of the system. Metaheuristics that optimised the system were also developed and analysed. An innovative hybrid Simulated Annealing and Tabu Search algorithm was developed that out-performed both simulated annealing and tabu search algorithms by combining some of their features. The new algorithm achieves a more optimal solution and does so in a shorter time.

Community protest groups' perceptions of environmental risks using social contagion theory

Local communities are vulnerable to the potential environmental risks associated with construction activity. Currently, little is understood about how perceptions of environmental risks are shaped and spread within a community. A better understanding of this process can help bridge the gap between developers and communities and bring about more sustainable development practices. This paper reports a research methodology which uses social contagion theory to investigate this process. The research adopts a single case study approach of a highly controversial housing project in the greater Sydney metropolitan area. The case study is particularly significant as it investigates an extensive and on-going community-based protest campaign (dating back almost 20 years) that has generated the longest standing 24 hour community picket in the New South Wales.

Setting a new agenda: Developing an Aboriginal and Torres Strait Islander women's health strategy

The Australian National Aboriginal and Torres Strait Islander Women’s Health Strategy was developed to reflect the health priorities of Aboriginal and Torres Strait Islander women, as identified by Aboriginal and Torres Strait Islander women themselves. This article describes the process used by the Australian Women’s Health Network to develop the strategy. The women involved in the research used the talking circle method and engaged with Aboriginal and Torres Strait Islander women through a process referred to as ‘talkin’ up’, where women ‘talk back’ to one another about issues that matter to them. In this article, we describe the power of the talkin’ up process, as a way for Aboriginal and Torres Strait Islander women to identify their own issues, discuss them in context and talk in a culturally safe environment. The strategy which emerged from this process is an accurate reflection of the issues that are important to Australian Indigenous women and highlights the improvements needed in Aboriginal and Torres Strait Islander women’s health to strengthen and underpin women’s health, Indigeneity and their sense of well-being as Aboriginal and Torres Strait Islander women.

A longitudinal assessment of chronic wound fluid to detect biochemical indicators of healing

Chronic venous leg ulcers are a detrimental health issue plaguing our society, resulting in long term pain, immobility and decreased quality of life for a large proportion of sufferers. The frequency of these chronic wounds has led current research to focus on the wound environment to provide important information regarding the prolonged, fluctuated or static healing patterns of these wounds. Disruption to the normal wound healing process results in release of multiple factors in the wound environment that could correlate to wound chronicity. These biochemical factors can often be detected through non-invasively sampling chronic wound fluid (CWF) from the site of injury. Of note, whilst there are numerous studies comparing acute and chronic wound fluids, there have not been any reports in the literature employing a longitudinal study in order to track biochemical changes in wound fluid as patients transition from a non-healing to healed state. Initially the objective of this study was to identify biochemical changes in CWF associated with wound healing using a proteomic approach. The proteomic approach incorporated a multi-dimensional liquid chromatography fractionation technique coupled with mass spectrometry (MS) to enable identification of proteins present in lower concentrations in CWF. Not surprisingly, many of the proteins identified in wound fluid were acute phase proteins normally expressed during the inflammatory phase of healing. However, the number of proteins positively identified by MS was quite low. This was attributed to the diverse range in concentration of protein species in CWF making it challenging to detect the diagnostically relevant low molecular weight proteins. In view of this, SELDI-TOF MS was also explored as a means to target low molecular weight proteins in sequential patient CWF samples during the course of healing. Unfortunately, the results generated did not yield any peaks of interest that were altered as wounds transitioned to a healed state. During the course of proteomic assessment of CWF, it became evident that a fraction of non-proteinaceous compounds strongly absorbed at 280 nm. Subsequent analyses confirmed that most of these compounds were in fact part of the purine catabolic pathway, possessing distinctive aromatic rings and which results in high absorbance at 254 nm. The accumulation of these purinogenic compounds in CWF suggests that the wound bed is poorly oxygenated resulting in a switch to anaerobic metabolism and consequently ATP breakdown. In addition, the presence of the terminal purine catabolite, uric acid (UA), indicates that the enzyme xanthine oxidoreductase (XOR) catalyses the reaction of hypoxanthine to xanthine and finally to UA. More importantly, the studies provide evidence for the first time of the exogenous presence of XOR in CWF. XOR is the only enzyme in humans capable of catalysing the production of UA in conjunction with a burst of the highly reactive superoxide radical and other oxidants like H2O2. Excessive release of these free radicals in the wound environment can cause cellular damage disrupting the normal wound healing process. In view of this, a sensitive and specific assay was established for monitoring low concentrations of these catabolites in CWF. This procedure involved combining high performance liquid chromatography (HPLC) with tandem mass spectrometry and multiple reaction monitoring (MRM). This application was selective, using specific MRM transitions and HPLC separations for each analyte, making it ideal for the detection and quantitation of purine catabolites in CWF. The results demonstrated that elevated levels of UA were detected in wound fluid obtained from patients with clinically worse ulcers. This suggests that XOR is active in the wound site generating significant amounts of reactive oxygen species (ROS). In addition, analysis of the amount of purine precursors in wound fluid revealed elevated levels of purine precursors in wound fluid from patients with less severe ulcers. Taken together, the results generated in this thesis suggest that monitoring changes of purine catabolites in CWF is likely to provide valuable information regarding the healing patterns of chronic venous leg ulcers. XOR catalysis of purine precursors not only provides a method for monitoring the onset, prognosis and progress of chronic venous leg ulcers, but also provides a potential therapeutic target by inhibiting XOR, thus blocking UA and ROS production. Targeting a combination of these purinogenic compounds and XOR could lead to the development of novel point of care diagnostic tests. Therefore, further investigation of these processes during wound healing will be worthwhile and may assist in elucidating the pathogenesis of this disease state, which in turn may lead to the development of new diagnostics and therapies that target these processes.

An application of the Health Belief Model to understanding use of child restraint practices

Aims Multi-method study including two parts: Study One: three sets of observations in two regional areas of Queensland Study Two: two sets of parent intercept interviews conducted in Toowoomba, Queensland. The aim of Study Two is to determine parents’ views, opinions and knowledge of child restraint practices and the Queensland legislative amendment.

Commentary : "Our reflections on identity, gender and transforming action"

This paper explores the cultural interplay between Indigenous women from one geographic locality being on and within the locality of the women of another locality – in this case, Whakatāne, Aotearoa. The authors consider identity, gender and place within the processes of transformation and decolonisation. They argue that women need to be involved in ways that restore their power as women and ensure their rightful place. The authors draw on the female ancestor Wairaka and her courage to argue that Indigenous women need to respond, change and adapt to the places in which they live. They argue that decolonisation needs to include action and possibilities for Māori and Indigenous Australian women.

Confirmatory factor analysis of the Behaviour of Young Novice Drivers Scale (BYNDS)

The greatly increased risk of being killed or injured in a car crash for the young novice driver has been recognised in the road safety and injury prevention literature for decades. Risky driving behaviour has consistently been found to contribute to traffic crashes. Researchers have devised a number of instruments to measure this risky driving behaviour. One tool developed specifically to measure the risky behaviour of young novice drivers is the Behaviour of Young Novice Drivers Scale (BYNDS) (Scott-Parker et al., 2010). The BYNDS consists of 44 items comprising five subscales for transient violations, fixed violations, misjudgement, risky driving exposure, and driving in response to their mood. The factor structure of the BYNDS has not been examined since its development in a matched sample of 476 novice drivers aged 17-25 years. Method: The current research attempted to refine the BYNDS and explore its relationship with the self-reported crash and offence involvement and driving intentions of 390 drivers aged 17-25 years (M = 18.23, SD = 1.58) in Queensland, Australia, during their first six months of independent driving with a Provisional (intermediate) driver’s licence. A confirmatory factor analysis was undertaken examining the fit of the originally proposed BYNDS measurement model. Results: The model was not a good fit to the data. A number of iterations removed items with low factor loadings, resulting in a 36-item revised BYNDS which was a good fit to the data. The revised BYNDS was highly internally consistent. Crashes were associated with fixed violations, risky driving exposure, and misjudgement; offences were moderately associated with risky driving exposure and transient violations; and road-rule compliance intentions were highly associated with transient violations. Conclusions: Applications of the BYNDS in other young novice driver populations will further explore the factor structure of both the original and revised BYNDS. The relationships between BYNDS subscales and self-reported risky behaviour and attitudes can also inform countermeasure development, such as targeting young novice driver non-compliance through enforcement and education initiatives.

Young, inexperienced and on the road : do novice drivers comply with road rules?

The graduated driver licensing (GDL) program in Queensland, Australia, was considerably enhanced in July 2007. This paper explores the compliance of young Learner and Provisional (intermediate) drivers with current GDL requirements and general road rules. Unsupervised driving, Learner logbook accuracy, and experiences of punishment avoidance were explored, along with speeding as a Provisional driver. Participants (609 females; M = 17.43 years) self-reported sociodemographic characteristics, driving behaviours and licensing experiences as Learners. A subset of participants (238 females, 105 males) completed another survey six months later exploring their Provisional behaviours and experiences. While the majority of the participants reported compliance with both the GDL requirements and general road rules such as stopping at red lights on their Learner licence; a considerable proportion reported speeding. Furthermore, they reported becoming less compliant during the Provisional phase, particularly with speed limits. Self-reported speeding was predicted by younger age at licensure, being in a relationship, driving unsupervised, submitting inaccurate Learner logbooks, and speeding as a Learner. Enforcement and education countermeasures should focus upon curtailing noncompliance, targeting speeding in particular. Novice drivers should be encouraged to comply with all road rules, including speed limits, and safe driving behaviours should be developed and reinforced during the Learner and early Provisional periods. Novice drivers have been found to model their parents’ driving, and parents are pivotal in regulating novice driving. It is vital young novice drivers and parents alike are encouraged to comply with all road rules, including GDL requirements.

Speeding by young novice drivers : what can personal characteristics and psychosocial theory add to our understanding?

Purpose: Young novice drivers continue to be overrepresented in fatalities and injuries arising from crashes even with the introduction of countermeasures such as graduated driver licensing (GDL). Enhancing countermeasures requires a better understanding of the variables influencing risky driving. One of the most common risky behaviours performed by drivers of all ages is speeding, which is particularly risky for young novice drivers who, due to their driving inexperience, have difficulty in identifying and responding appropriately to road hazards. Psychosocial theory can improve our understanding of contributors to speeding, thereby informing countermeasure development and evaluation. This paper reports an application of Akers’ social learning theory (SLT), augmented by Gerrard and Gibbons’ prototype/willingness model (PWM), in addition to personal characteristics of age, gender, car ownership, and psychological traits/states of anxiety, depression, sensation seeking propensity and reward sensitivity, to examine the influences on self-reported speeding of young novice drivers with a Provisional (intermediate) licence in Queensland, Australia. Method: Young drivers (n = 378) recruited in 2010 for longitudinal research completed two surveys containing the Behaviour of Young Novice Drivers Scale, and reported their attitudes and behaviours as pre-Licence/Learner (Survey 1) and Provisional (Survey 2) drivers and their sociodemographic characteristics. Results: An Akers’ measurement model was created. Hierarchical multiple regressions revealed that (1) personal characteristics (PC) explained 20.3%; (2) the combination of PC and SLT explained 41.1%; and (3) the combination of PC, SLT and PWM explained 53.7% of variance in self-reported speeding. Whilst there appeared to be considerable shared variance, the significant predictors in the final model included gender, car ownership, reward sensitivity, depression, personal attitudes, and Learner speeding. Conclusions: These results highlight the capacity for psychosocial theory to improve our understanding of speeding by young novice drivers, revealing relationships between previous behaviour, attitudes, psychosocial characteristics and speeding. The findings suggest multi-faceted countermeasures should target the risky behaviour of Learners, and Learner supervisors should be encouraged to monitor their Learners’ driving speed. Novice drivers should be discouraged from developing risky attitudes towards speeding.

A further exploration of sensation seeking propensity, reward sensitivity, depression, anxiety, and the risky behaviour of young novice drivers in a structural equation model

Young novice drivers constitute a major public health concern due to the number of crashes in which they are involved, and the resultant injuries and fatalities. Previous research suggests psychological traits (reward sensitivity, sensation seeking propensity), and psychological states (anxiety, depression) influence their risky behaviour. The relationships between gender, anxiety, depression, reward sensitivity, sensation seeking propensity and risky driving are explored. Participants (390 intermediate drivers, 17-25 years) completed two online surveys at a six month interval. Surveys comprised sociodemographics, Brief Sensation Seeking Scale, Kessler’s Psychological Distress Scale, an abridged Sensitivity to Reward Questionnaire, and risky driving behaviour was measured by the Behaviour of Young Novice Drivers Scale. Structural equation modelling revealed anxiety, reward sensitivity and sensation seeking propensity predicted risky driving. Gender was a moderator, with only reward sensitivity predicting risky driving for males. Future interventions which consider the role of rewards, sensation seeking, and mental health may contribute to improved road safety for younger and older road users alike.

“They’re lunatics on the road” : Exploring the normative influences of parents, friends, and police on young novices’ risky driving decisions

Purpose: Young novice drivers experience significantly greater risk of being injured or killed in car crashes than older more experienced drivers. This research utilised a qualitative approach guided by the framework of Akers’ social learning theory. It explored young novice drivers’ perspectives on risky driving including rewards and punishments expected from and administered by parents, friends, and police, imitation of parents’ and friends’ driving, and advantages and disadvantages of risky driving. Methods: Twenty-one young drivers (12 females, 9 males) aged 16–25 years (M = 17.71 years, SD = 2.15) with a Learner (n = 11) or Provisional (n = 10) driver licence participated in individual or small group interviews. Findings and conclusions: Content analysis supported four themes: (1) rewards and (2) punishments for risky driving, and the influence of (3) parents and (4) friends. The young novice drivers differed in their vulnerability to the negative influences of friends and parents, with some novices advising they were able to resist risky normative influences whilst others felt they could not. The authority of the police as enforcers of road rules was either accepted and respected or seen as being used to persecute young novices. These findings suggest that road safety interventions should consider the normative influence of parents and friends on the risky and safe behaviour of young novices. Police were also seen as influential upon behaviour. Future research should explore the complicated relationship between parents, friends, the police, young novices, and their risky driving behaviour.

Do the myths still exist? Revisiting people’s negative beliefs about organ donation upon death

The prevalence of myths preventing people partial to donation in Australia from consenting is unknown. Respondents (N = 468: 381 donors, 26 non-donors, 61 undecided) were surveyed about their (negative) donation beliefs. Approximately 30% of donors were neutral or supported negative beliefs about organ allocation, especially donation to undesirable organ recipients and a black market organ trade. Confusion about brain death, lack of family and religious support, and discomfort with donation were negative beliefs endorsed by some respondents irrespective of donor preference. Proportionally, donors had greater trust in hospitals/doctors than other groups. Some myths still exist but may vary with donation preference.

Predictors of young people’s charitable intentions to donate money : an extended theory of planned behavior perspective

An extended theory of planned behavior (TPB) was used to predict young people’s intentions to donate money to charities in the future. Students (N = 210; 18-24 years) completed a questionnaire assessing their attitude, subjective norm, perceived behavioral control [PBC], moral obligation, past behavior and intentions toward donating money. Regression analyses revealed the extended TPB explained 61% of the variance in intentions to donate money. Attitude, PBC, moral norm, and past behavior predicted intentions, representing future targets for charitable giving interventions.