Development, implementation and evaluation of a cancer survivor self-management care plan

Aim There is a growing population of people with cancer who experience physiological and psychological effects that persist long after treatment is complete. Interventions that enhance survivors’ self-management abilities might help offset these effects. The aim of this pilot study was to develop, implement and evaluate interventions tailored to assist patients to manage post-treatment health issues effectively. Method In this pre-post intervention cohort study, participants were recruited on completion of cancer treatment. Participants recruited preimplementation, who received usual care, comprised the control group. Participants recruited later formed the intervention group. In the intervention group, the Cancer Care Coordinator developed an individualised, structured Cancer Survivor Self-management Care Plan. Participants were interviewed on completion of treatment (baseline) and at three months. Assessments concerned health needs (CaSUN), self-efficacy in adjusting and coping with cancer and health-related quality of life (FACIT-B or FACT-C). The impact of the intervention was determined by independent t-tests of change scores. Results The intervention (n = 32) and control groups (n = 35) were comparable on demographic and clinical characteristics. Sample mean age was 54 + 10 years. Cancer diagnoses were breast (82%) and colorectal (18%). Statistically significant differences (p < 0.05) indicated improvement in the intervention group for: (a) functional well-being, from the FACIT, (Control: M = −0.69, SE = 0.91; Intervention: M = 3.04, SE = 1.13); and (b) self-efficacy in maintaining social relationships, (Control: M = −0.333, SE = 0.33; Intervention: M = 0.621, SE = 0.27). No significant differences were found in health needs, other subscales of quality of life, the extent and number of strategies used in coping and adjusting to cancer and in other domains of self-efficacy. Conclusions While the results should be interpreted with caution, due to the non-randomised nature of the study and the small sample size, they indicate the potential benefits of tailored self-management interventions warrant further investigation in this context.

Public policy, disaster risk management and climate change adaptation

Public policymakers are caught in a dilemma : there is a growing list of urgent issues to address, at the same time that public expenditure is being cut. Adding to this dilemma is a system of government designed in the 19th century and competing theories of policymaking dating back to the 1950s. The interlinked problems of disaster risk management and climate change adaptation are cases in point. As the climate changes, there will be more frequent, intense and/or prolonged disasters such as floods and bushfires. Clearly a well integrated whole of government response is needed, but how might this be achieved? Further, how could academic research contribute to resolving this dilemma in a way that would produce something of theoretical interest as well as practical outcomes for policymakers? These are the questions addressed by our research via a comparative analysis of the 2009 Victorian bushfires, the 2011 Perth Hills bushfires, and the 2011 Brisbane floods. Our findings suggest that there is a need to: improve community engagement and communication; refocus attention on resilience; improve interagency communication and collaboration; and, develop institutional arrangements that support continual improvement and policy learning. These findings have implications for all areas of public policy theory and practice.

Rethinking emergency management and climate adaptation policies

Emergency management and climate change adaptation will increasingly challenge all levels of government because of three main factors. First, Australia is extremely vulnerable to the impacts of climate change, particularly through the increasing frequency and/or intensity of disasters such as floods and bushfires. Second, the system of government that divides powers by function and level can often act as a barrier to a well-integrated response. Third, policymaking processes struggle to cope with such complex inter-jurisdictional issues. This paper discusses these factors and explores the nature of the challenge for Australian governments. Investigations into the 2009 Victorian bushfires, the 2011 Perth Hills bushfires, and the 2011 Brisbane floods offer an indication of the challenges ahead and it is argued that there is a need to: improve community engagement and communication; refocus attention on resilience; improve interagency communication and collaboration; and, develop institutional arrangements that support continual improvement and policy learning. These findings offer an opportunity for improving responses as well as a starting point for integrating disaster risk management and climate change adaptation policies. The paper is based on the preliminary findings of an NCCARF funded research project: The Right Tool for the Job – Achieving climate change adaptation outcomes through improved disaster management policies, planning and risk management strategies involving Griffith University and RMIT.

Effect of text type on near work-induced contrast adaptation in myopic and emmetropic young adults

Purpose Contrast adaptation has been speculated to be an error signal for emmetropization. Myopic children exhibit higher contrast adaptation than emmetropic children. This study aimed to determine whether contrast adaptation varies with the type of text viewed by emmetropic and myopic young adults. Methods Baseline contrast sensitivity was determined in 25 emmetropic and 25 spectacle-corrected myopic young adults for 0.5, 1.2, 2.7, 4.4, and 6.2 cycles per degree (cpd) horizontal sine wave gratings. The adults spent periods looking at a 6.2 cpd high-contrast horizontal grating and reading lines of English and Chinese text (these texts comprised 1.2 cpd row and 6 cpd stroke frequencies). The effects of these near tasks on contrast sensitivity were determined, with decreases in sensitivity indicating contrast adaptation. Results Contrast adaptation was affected by the near task (F2,672 = 43.0; P < 0.001). Adaptation was greater for the grating task (0.13 ± 0.17 log unit, averaged across all frequencies) than reading tasks, but there was no significant difference between the two reading tasks (English 0.05 ± 0.13 log unit versus Chinese 0.04 ± 0.13 log unit). The myopic group showed significantly greater adaptation (by 0.04, 0.04, and 0.05 log units for English, Chinese, and grating tasks, respectively) than the emmetropic group (F1,48 = 5.0; P = 0.03). Conclusions In young adults, reading Chinese text induced similar contrast adaptation as reading English text. Myopes exhibited greater contrast adaptation than emmetropes. Contrast adaptation, independent of text type, might be associated with myopia development.

What is plan B? Using Foucault’s archaeology to enhance policy analysis

Many governments in western democracies conduct the work of leading their societies forward through policy generation and implementation. Despite government attempts at extensive negotiation, collaboration and debate, the general populace in these same countries frequently express feelings of disempowerment and undue pressure to be compliant, often leading to disengagement. Here we outline Plan B: a process for examining how policies that emerge from good intentions are frequently interpreted as burdensome or irrelevant by those on whom they have an impact. Using a case study of professional standards for teachers in Australia, we describe how we distilled Foucault’s notions of archaeology into a research approach centring on the creation of ‘polyhedrons of intelligibility’ as an alternative approach by which both policy makers and those affected by their policies may understand how their respective causes are supported and adversely affected.

Discomfort glare in open plan green buildings

This study presents the largest-known, investigation on discomfort glare with 493 surveys collected from five green buildings in Brisbane, Australia. The study was conducted on full-time employees, working under their everyday lighting conditions, all of whom had no affiliation with the research institution. The survey consisted of a specially tailored questionnaire to assess potential factors relating to discomfort glare. Luminance maps extracted from high dynamic range (HDR) images were used to capture the luminous environment of the occupants. Occupants who experienced glare on their monitor and/or electric glare were excluded from analysis leaving 419 available surveys. Occupants were more sensitive to glare than any of the tested indices accounted for. A new index, the UGP was developed to take into account the scope of results in the investigation. The index is based on a linear transformation of the UGR to calculate a probability of disturbed persons. However all glare indices had some correlation to discomfort, and statistically there was no difference between the DGI, UGR and CGI. The UGP broadly reflects the demographics of the working population in Australia and the new index is applicable to open plan green buildings.

Neoliberalism and Spatial Adaptation

Human spatial environments must adapt to climate change. Spatial planning is central to climate change adaptation and potentially well suited to the task, however neoliberal influences and trends threaten this capacity. This paper explores the significance of neoliberal influences on urban planning to climate change adaptation. The potential form of spatial adaptation within the context of a planning environment influenced by neoliberal principles is evaluated. This influence relates to spatial scale, temporal scale, responsibility for action, strategies and mechanisms, accrual of benefits, negotiation of priorities and approach to uncertainty. This paper presents a conceptual framework of the influence of neoliberalism on spatial adaptation. It identifies the potential characteristics, challenges and opportunities of spatial adaptation under a neoliberal frame. The neoliberal frame does not entirely preclude spatial adaptation but significantly influence its form. Neoliberal approaches involve individual action in response to private incentives and near term impacts while collective action, regulatory mechanisms and long term planning is approached cautiously. Challenges concern the degree to which collective action and a long term orientation are necessary, how individual adaptation relates to collective vulnerability and the prioritisation of adaptation by markets. Opportunities might involve the operability of individual and local adaptation, the existence of private incentives to adapt and the potential to align adaptation with entrepreneurial projects.

Doing adaptation differently? Does neoliberalism influence adaptation planning in Queensland?

Australian cities are particularly vulnerable to climate change. Adapting to climate change is a critical task for contemporary spatial planning, one that is widely recognised by the planning profession and beginning to receive substantive attention in planning policy. However adaptation takes place within the context of established spatial governance regimes and planning cultures, and examples of effective adaptation are often grounded in progressive contexts markedly different than Australia. In Australia, planning is subject to strong neoliberal reform agendas (Gleeson & Low, 2000a, 2000b) and national adaptation policies align with neoliberal views (Granberg & Glover, 2011). Planning in Queensland has been subject to deregulation (Buxton et al., 2012) and the continued influence of neoliberalism (Wright & Cleary, 2012). The influence of neoliberalism on climate change adaptation has received little consideration in research and literature. This paper reviews a case study of adaptation planning through the lens of the recent and contemporary influences of neoliberalism. It examines spatial/land-use planning for climate change adaptation in Queensland, identifying the underlying rationales, priorities and strategies. A justification for such an investigation is advanced based on the challenges to planning facilitating adaptation and identified links to neoliberalism. A preliminary analysis of interviews with planners is then used to identify and discuss the ideological influences practitioners perceive in current approaches to adaptation in Queensland and the implications of such.

Adaptation and change in Queensland’s rangelands : cell grazing as an emerging ideology of pastoral-ecology

Does the current global political economic framework, or more specifically, the cost-price squeeze associated with primary production, restrict the choices of Australian cattle graziers in moving to more sustainable practices? It has often been argued by primary producers and academics, alike, that current terms of trade have resulted in reduced profitability at the property level, and as such, have made it difficult for landholders to shift to practices which are environmentally sustainable. Whilst there is mounting evidence that this is case, there is also evidence that some graziers have been able to adapt to the prevailing market conditions through an ideological as well as ‘practice’ shift. Findings from qualitative research in Central Queensland, Australia has highlighted how ‘cell grazing’ departs from the traditional or conventional aspects of grazing which can be described as productivist, to an approach closely approximating Lang and Heasman’s (2004) ‘ecologically integrated paradigm’. It is argued that cell grazing is, at present, a marginal activity that requires an ideological and cultural shift, as well as an investment in new infrastructure, however, current cell grazing activities may also demonstrate that beef grazing has the potential to be both economically and environmentally sustainable.

Towards networked governance : improving interagency communication and collaboration for disaster risk management and climate change adaptation in Australia

Major disasters, such as bushfires or floods, place significant stress on scarce public resources. Climate change is likely to exacerbate this stress. An integrated approach to disaster risk management (DRM) and climate change adaptation (CCA) could reduce the stress by encouraging the more efficient use of pooled resources and expertise. A comparative analysis of three extreme climate-related events that occurred in Australia between 2009 and 2011 indicated that a strategy to improve interagency communication and collaboration would be a key factor in this type of policy/planning integration. These findings are in accord with the concepts of Joined-up Government and Network Governance. Five key reforms are proposed: developing a shared policy vision; adopting multi-level planning; integrating legislation; networking organisations; and establishing cooperative funding. These reforms are examined with reference to the related research literature in order to identify potential problems associated with their implementation. The findings are relevant for public policy generally but are particularly useful for CCA and DRM.

Predicting the likelihood of QA failure using treatment plan accuracy metrics

This study used automated data processing techniques to calculate a set of novel treatment plan accuracy metrics, and investigate their usefulness as predictors of quality assurance (QA) success and failure. 151 beams from 23 prostate and cranial IMRT treatment plans were used in this study. These plans had been evaluated before treatment using measurements with a diode array system. The TADA software suite was adapted to allow automatic batch calculation of several proposed plan accuracy metrics, including mean field area, small-aperture, off-axis and closed-leaf factors. All of these results were compared the gamma pass rates from the QA measurements and correlations were investigated. The mean field area factor provided a threshold field size (5 cm2, equivalent to a 2.2 x 2.2 cm2 square field), below which all beams failed the QA tests. The small aperture score provided a useful predictor of plan failure, when averaged over all beams, despite being weakly correlated with gamma pass rates for individual beams. By contrast, the closed leaf and off-axis factors provided information about the geometric arrangement of the beam segments but were not useful for distinguishing between plans that passed and failed QA. This study has provided some simple tests for plan accuracy, which may help minimise time spent on QA assessments of treatments that are unlikely to pass.

Pockets of Change : Adaptation and Cultural Transition

Pockets of Change collects fourteen essays that address issues of cultural adaptation and transition in the Arts. Based on insights into a range of primary texts and cultural practices—from visual art to film, from literature to theatre—these essays investigate the ways in which traditions, art-forms, cultures and ethics adapt to challenge established boundaries.

Sustainable Urban Water Environment : Climate, Pollution and Adaptation

"This multi-disciplinary book provides practical solutions for safeguarding the sustainability of the urban water environment. Firstly, the importance of the urban water environment is highlighted and the major problems urban water bodies face and strategies to safeguard the water environment are explored. Secondly, the diversity of pollutants entering the water environment through stormwater runoff are discussed and modelling approaches for factoring in climate change and future urban and transport scenarios are proposed. Thirdly, by linking the concepts of sustainable urban ecosystems and sustainable urban and transport development, capabilities of two urban sustainability assessment models are demonstrated."--publisher website

Making YAWL and SmartPM interoperate : managing highly dynamic processes by exploiting automatic adaptation features

In the last years, the trade-o between exibility and sup- port has become a leading issue in work ow technology. In this paper we show how an imperative modeling approach used to de ne stable and well-understood processes can be complemented by a modeling ap- proach that enables automatic process adaptation and exploits planning techniques to deal with environmental changes and exceptions that may occur during process execution. To this end, we designed and imple- mented a Custom Service that allows the Yawl execution environment to delegate the execution of subprocesses and activities to the SmartPM execution environment, which is able to automatically adapt a process to deal with emerging changes and exceptions. We demonstrate the fea- sibility and validity of the approach by showing the design and execution of an emergency management process de ned for train derailments.