The evidence-based development of an intervention to address the information needs of adults newly diagnosed with primary brain tumours and their carers

Adults diagnosed with primary brain tumours often experience physical, cognitive and neuropsychiatric impairments and decline in quality of life. Although disease and treatment-related information is commonly provided to cancer patients and carers, newly diagnosed brain tumour patients and their carers report unmet information needs. Few interventions have been designed or proven to address these information needs. Accordingly, a three-study research program, that incorporated both qualitative and quantitative research methods, was designed to: 1) identify and select an intervention to improve the provision of information, and meet the needs of patients with a brain tumour; 2) use an evidence-based approach to establish the content, language and format for the intervention; and 3) assess the acceptability of the intervention, and the feasibility of evaluation, with newly diagnosed brain tumour patients. Study 1: Structured concept mapping techniques were undertaken with 30 health professionals, who identified strategies or items for improving care, and rated each of 42 items for importance, feasibility, and the extent to which such care was provided. Participants also provided data to interpret the relationship between items, which were translated into ‘maps’ of relationships between information and other aspects of health care using multidimensional scaling and hierarchical cluster analysis. Results were discussed by participants in small groups and individual interviews to understand the ratings, and facilitators and barriers to implementation. A care coordinator was rated as the most important strategy by health professionals. Two items directly related to information provision were also seen as highly important: "information to enable the patient or carer to ask questions" and "for doctors to encourage patients to ask questions". Qualitative analyses revealed that information provision was individualised, depending on patients’ information needs and preferences, demographic variables and distress, the characteristics of health professionals who provide information, the relationship between the individual patient and health professional, and influenced by the fragmented nature of the health care system. Based on quantitative and qualitative findings, a brain tumour specific question prompt list (QPL) was chosen for development and feasibility testing. A QPL consists of a list of questions that patients and carers may want to ask their doctors. It is designed to encourage the asking of questions in the medical consultation, allowing patients to control the content, and amount of information provided by health professionals. Study 2: The initial structure and content of the brain tumour specific QPL developed was based upon thematic analyses of 1) patient materials for brain tumour patients, 2) QPLs designed for other patient populations, and 3) clinical practice guidelines for the psychosocial care of glioma patients. An iterative process of review and refinement of content was undertaken via telephone interviews with a convenience sample of 18 patients and/or carers. Successive drafts of QPLs were sent to patients and carers and changes made until no new topics or suggestions arose in four successive interviews (saturation). Once QPL content was established, readability analyses and redrafting were conducted to achieve a sixth-grade reading level. The draft QPL was also reviewed by eight health professionals, and shortened and modified based on their feedback. Professional design of the QPL was conducted and sent to patients and carers for further review. The final QPL contained questions in seven colour-coded sections: 1) diagnosis; 2) prognosis; 3) symptoms and problems; 4) treatment; 5) support; 6) after treatment finishes; and 7) the health professional team. Study 3: A feasibility study was conducted to determine the acceptability of the QPL and the appropriateness of methods, to inform a potential future randomised trial to evaluate its effectiveness. A pre-test post-test design was used with a nonrandomised control group. The control group was provided with ‘standard information’, the intervention group with ‘standard information’ plus the QPL. The primary outcome measure was acceptability of the QPL to participants. Twenty patients from four hospitals were recruited a median of 1 month (range 0-46 months) after diagnosis, and 17 completed baseline and follow-up interviews. Six participants would have preferred to receive the information booklet (standard information or QPL) at a different time, most commonly at diagnosis. Seven participants reported on the acceptability of the QPL: all said that the QPL was helpful, and that it contained questions that were useful to them; six said it made it easier to ask questions. Compared with control group participants’ ratings of ‘standard information’, QPL group participants’ views of the QPL were more positive; the QPL had been read more times, was less likely to be reported as ‘overwhelming’ to read, and was more likely to prompt participants to ask questions of their health professionals. The results from the three studies of this research program add to the body of literature on information provision for brain tumour patients. Together, these studies suggest that a QPL may be appropriate for the neuro-oncology setting and acceptable to patients. The QPL aims to assist patients to express their information needs, enabling health professionals to better provide the type and amount of information that patients need to prepare for treatment and the future. This may help health professionals meet the challenge of giving patients sufficient information, without providing ‘too much’ or ‘unnecessary’ information, or taking away hope. Future studies with rigorous designs are now needed to determine the effectiveness of the QPL.

Development and piloting of a brain tumour-specific question prompt list

The objective of this research was to develop a question prompt list aimed at increasing question asking and reducing the unmet information needs of adults with primary brain tumours, and to pilot the question prompt list to determine its suitability for the intended population. Thematic analysis of existing resources was used to create a draft which was refined via interviews with 12 brain tumour patients and six relatives, readability testing and review by health professionals. A non-randomised before–after pilot study with 20 brain tumour patients was used to assess the acceptability and usefulness of the question prompt list, compared with a ‘standard brochure’, and the feasibility of evaluation strategies. The question prompt list developed covered seven main topics (diagnosis, prognosis, symptoms and changes, treatment, support, after treatment finishes and the health professional team). Pilot study participants provided with the question prompt list agreed that it was helpful (7/7), contained questions that were useful to them (7/7) and prompted them to ask their medical oncologist questions (5/7). The question prompt list is acceptable to patients and contains questions relevant to them. Research is now needed to assess its effectiveness in increasing question asking and reducing unmet information needs.

Review : Surfers Paradise foreshore redevelopment masterplan - urban plaza zone

The Centre for Subtropical Design has prepared this submission to assist the Gold Coast City Council to finalise a plan and detailed design guidelines for the Urban Plaza Zone of Surfers Paradise Foreshore Redevelopment Masterplan which will create a public open space ‘alive’ with the quality appropriate to a place which is both a local centre and an international destination. This review has been informed by the two over-arching values identified as characteristics of a subtropical place and people’s connection to it:  A sense of openness and permeability, and  Engagement with the natural environment. The existing qualities of the foreshore area proposed as the Urban Plaza Zone, reflect these subtropical place values, and are integral to the Surfers Paradise identity:  Seamless visual and spatial access to the beach and sea,  Permeable interface between beach and built zones provided by beach planting and shade to sand by Pandanus,  A shade zone mediating beach and linear promenade, road and commercial zones, enabling a variety of social and visual experiences, on soft and hard finishes, and  A lively, constantly moving shared road and pedestrian way catering for events and day to day activities with visual access to beach and shaded areas. The Centre for Subtropical Design commends the Gold Coast City Council on preparing a plan for a public open space that is a contemporary departure from the adhoc basis of development that has occurred, in that it will make this area more accessible. However, the proposed plan seems to be working too hard in terms of ‘program’. While providing an identifiable interruption in the linear extent of the Foreshore, the lack of continuity of design in terms of both hardscaping (such as perpendicular paving elements) and softscaping (such as tree selections) may contribute to a lack of definition for the entire Foreshore as a place that mediates, along its length, between sea and land. Providing a hard edge to a beach character of soft and planted transitional elements needs to balance the proposed visual and physical barrier with the need for perceived and actual easy access. The Surfers Paradise identity needs strengthening through attention to planting for shade, materials, particularly selection of paving colours, and stronger delineation of the linear nature of the Foreshore. The Urban Plaza zone is an appropriate interruption to the continuous planting, however the link from the commercial zone overtakes the public and beach zone. A more seamless transition from shop to sea, better integration of the roadway and pedestrian zone and improved physical transition from concrete to sand is recommended. Built form solutions must be robust and designed with the subtropical design principles and the Surfers Paradise identity as underpinning parameters for a lasting and memorable public open space.

O'Neill Building Nudgee College

This project involved the complete refurbishment and extension of a 1980’s two-storey domestic brick building, previously used as a Boarding House (Class 3), into Middle School facilities (Class 9b) on a heritage listed site at Nudgee College secondary school, Brisbane. The building now accommodates 12 technologically advanced classrooms, computer lab and learning support rooms, tuckshop, art room, mini library/reading/stage area, dedicated work areas for science and large projects with access to water on both floors, staff facilities and an undercover play area suitable for assemblies and presentations. The project was based on a Reggio Emilia approach, in which the organisation of the physical environment is referred to as the child’s third teacher, creating opportunities for complex, varied, sustained and changing relationships between people and ideas. Classrooms open to a communal centre piazza and are integrated with the rest of the school and the school with the surrounding community. In order to achieve this linkage of the building with the overall masterplan of the site, a key strategy of the internal planning was to orientate teaching areas around a well defined active circulation space that breaks out of the building form to legibly define the new access points to the building and connect up to the pathway network of the campus. The width of the building allowed for classrooms and a generous corridor that has become ‘breakout’ teaching areas for art, IT, and small group activities. Large sliding glass walls allow teachers to maintain supervision of students across all areas and allow maximum light penetration through small domestic window openings into the deep and low-height spaces. The building was also designed with an effort to uphold cultural characteristics from the Edmund Rice Education Charter (2004). Coherent planning is accompanied by a quality fit-out, creating a vibrant and memorable environment in which to deliver the upper primary curriculum. Consistent with the Reggio Emilia approach, materials, expressive of the school’s colours, are used in a contemporary, adventurous manner to create panels of colour useful for massing and defining the ‘breakout’ teaching areas and paths of travel, and storage elements are detailed and arranged to draw attention to their aesthetic features. Modifications were difficult due to the random placement of load bearing walls, minimum ceiling heights, the general standard of finishes and new fire and energy requirements, however the reuse of this building was assessed to be up to 30% cheaper than an equivalent new building, The fit out integrates information technology and services at a level not usually found in primary school facilities. This has been achieved within the existing building fabric through thoughtful detailing and co-ordination with allied disciplines.

Airborne particle concentrations at schools measured at different spatial scales

Potential adverse effects on children health may result from school exposure to airborne particles. To address this issue, measurements in terms of particle number concentration, particle size distribution and black carbon (BC) concentrations were performed in three school buildings in Cassino (Italy) and its suburbs, outside and inside of the classrooms during normal occupancy and use. Additional time resolved information was gathered on ventilation condition, classroom activity, and traffic count data around the schools were obtained using a video camera. Across the three investigated school buildings, the outdoor and indoor particle number concentration monitored down to 4 nm and up to 3 m ranged from 2.8×104 part cm-3 to 4.7×104 part cm-3 and from 2.0×104 part cm-3 to 3.5×104 part cm-3, respectively. The total particle concentrations were usually higher outdoors than indoors, because no indoor sources were detected. I/O measured was less than 1 (varying in a relatively narrow range from 0.63 to 0.74), however one school exhibited indoor concentrations higher than outdoor during the morning rush hours. Particle size distribution at the outdoor site showed high particle concentrations in different size ranges, varying during the day; in relation to the starting and finishing of school time two modes were found. BC concentrations were 5 times higher at the urban school compared with the suburban and suburban-to-urban differences were larger than the relative differences of ultrafine particle concentrations.

The effects of humidity on tin whisker growth by immersion tin plating and tin solder dipping surface finishes

The drive to replace lead (Pb) from electronics has led to the replacement of tin (Sn) alloys as the terminal plating for electronic devices. However, the deposition of Sn based alloys as the component surface finish tends to induce Sn whisker that causes unintended electric shorts when the conductive whiskers grow across to the adjacent conductor. Internal stress is considered as the driving force that causes the growth of Sn whiskers. In this study, stress type of elevated temperature/ humidity exposure at 55C/85%RH with the storage for up to 24 months was conducted to define the acceleration factor in samples with deposition of immersion Sn plating and Sn solder dipping. The addition of Nickel (Ni) under-layer was also applied to examine the correlation to field conditions. The results showed that the whisker length increased in high humidity irrespective of the deposition methods. It was also shown that pure Sn solder dipping mitigated the whisker growth but does not completely prevent it when alloying Sn with 0.4%wtCu. Additionally, Ni under-layer was indicated to be more efficient in mitigating the growth of whisker by prolonging the incubation time for whisker formation.

Influence of all-out and fast start of 5-min cycling time trial performance

Purpose: To examine the influence of two different fast-start pacing strategies on performance and oxygen consumption (V˙O2) during cycle ergometer time trials lasting ∼5 min. Methods: Eight trained male cyclists performed four cycle ergometer time trials whereby the total work completed (113 ± 11.5 kJ; mean ± SD) was identical to the better of two 5-min self-paced familiarization trials. During the performance trials, initial power output was manipulated to induce either an all-out or a fast start. Power output during the first 60 s of the fast-start trial was maintained at 471.0 ± 48.0 W, whereas the all-out start approximated a maximal starting effort for the first 15 s (mean power: 753.6 ± 76.5 W) followed by 45 s at a constant power output (376.8 ± 38.5 W). Irrespective of starting strategy, power output was controlled so that participants would complete the first quarter of the trial (28.3 ± 2.9 kJ) in 60 s. Participants performed two trials using each condition, with their fastest time trial compared. Results: Performance time was significantly faster when cyclists adopted the all-out start (4 min 48 s ± 8 s) compared with the fast start (4 min 51 s ± 8 s; P < 0.05). The first-quarter V˙O2 during the all-out start trial (3.4 ± 0.4 L·min-1) was significantly higher than during the fast-start trial (3.1 ± 0.4 L·min-1; P < 0.05). After removal of an outlier, the percentage increase in first-quarter V˙O2 was significantly correlated (r = -0.86, P < 0.05) with the relative difference in finishing time. Conclusions: An all-out start produces superior middle distance cycling performance when compared with a fast start. The improvement in performance may be due to a faster V˙O2 response rather than time saved due to a rapid acceleration.

Games for change and transformative learning : an ethnographic case study

This thesis aims to contribute to a better understanding of how serious games/games for change function as learning frameworks for transformative learning in an educational setting. This study illustrates how the meaning-making processes and learning with and through computer gameplay are highly contingent, and are significantly influenced by the uncertainties of the situational context. The study focuses on SCAPE, a simulation game that addresses urban planning and sustainability. SCAPE is based on the real-world scenario of Kelvin Grove Urban Village, an inner city redevelopment area in Brisbane, Queensland, Australia. The game is embedded within an educational program, and I thus account for the various gameplay experiences of different school classes participating in this program. The networks emerging from the interactions between students/players, educators, facilitators, the technology, the researcher, as well as the setting, result in unanticipated, controversial, and sometimes unintended gameplay experiences and outcomes. To unpack play, transformative learning and games, this study adopts an ecological approach that considers the magic circle of gameplay in its wider context. Using Actor-Network Theory as the ontological lens for inquiry, the methods for investigation include an extensive literature review, ethnographic participant observation of SCAPE, as well as student and teacher questionnaires, finishing with interviews with the designers and facilitators of SCAPE. Altogether, these methods address my research aim to better understand how the heterogeneous actors engage in the relationships in and around gameplay, and illustrate how their conflicting understandings enable, shape or constrain the (transformative) learning experience. To disentangle these complexities, my focus continuously shifts between the following modes of inquiry into the aims „h To describe and analyse the game as a designed artefact. „h To examine the gameplay experiences of players/students and account for how these experiences are constituted in the relationships of the network. „h To trace the meaning-making processes emerging from the various relations of players/students, facilitators, teachers, designers, technology, researcher, and setting, and consider how the boundaries of the respective ecology are configured and negotiated. „h To draw out the implications for the wider research area of game-based learning by using the simulation game SCAPE as an example for introducing gameplay to educational settings. Accounting in detail for five school classes, these accounts represent, each in its own right, distinct and sometimes controversial forms of engagement in gameplay. The practices and negotiations of all the assembled human and non-human actors highlight the contingent nature of gameplay and learning. In their sum, they offer distinct but by no means exhaustive examples of the various relationships that emerge from the different assemblages of human and non-human actors. This thesis, hence, illustrates that game-based learning in an educational setting is accompanied by considerable unpredictability and uncertainty. As ordinary life spills and leaks into gameplay experiences, group dynamics and the negotiations of technology, I argue that overly deterministic assertions of the game¡¦s intention, as well as a too narrowly defined understanding of the transformative learning outcome, can constrain our inquiries and hinder efforts to further elucidate and understand the evolving uncertainties around game-based learning. Instead, this thesis posits that playing and transformative learning are relational effects of the respective ecology, where all actors are networked in their (partial) enrolment in the process of translation. This study thus attempts to foreground the rich opportunities for exploring how game-based learning is assembled as a network of practices.

Review: "Context : A framework for its Influence on Evaluation Practice (New Directions for Evaluation No. 135)" edited by Rog, D. J.; Fitzpatrick, J. L. and Conner, R. F.

This book offers a framework for the influence of context on evaluation practice and is applied to three case studies: environmental context; indigenous context and political context; and finishes with a process for implementation.

Space within the surface : the patterned surfaces of Florence Broadhurst and Jim Thompson

The Woods Bagot 2007 refurbishment of the Qantas and British Airways Bangkok Business lounge in the Survarnabhumi Airport features wall finishes designed by wallpaper designer, Florence Broadhurst (1899-1977) and Thai Silk trader, Jim Thompson (1906-1967). This distinctive selection, which is proclaimed on the airport’s website, of patterned wall surfaces side by side draws attention to their striking similarities and their defining differences . Thompson and Broadhurst would appear to be worlds apart, but here in the airport their work brings them together. Thompson, the son of a wealthy cotton family in America, worked as an architect before joining the army. He moved to Bangkok to start The Thai Silk Company in 1948. Broadhurst was born on a farm in Mt. Perry, Queensland. She began her career as a performance artist, as part of an Australian troupe in Shanghai, moving onto pursue a career in fashion design, catering to the middle and upper classes in London. Upon her return to Australia, Broadhurst started a print design company in 1959. Both Broadhurst and Thompson pursued multiple careers, lived many lives, and died under mysterious circumstances. Broadhurst was murdered in 1977 at her Sydney print warehouse, which remains an unsolved crime. Thompson disappeared in Malaysia in 1967 and his body has never been found. This chapter investigates the parallels between Thompson and Broadhurst and what lead them to design such popular patterns for wall surfaces towards the end of their careers. While neither designer was a household name, their work is familiar to most, seen in the costume and set design of films, on the walls of restaurants and cafes and even in family homes. The reason for the popularity of their patterns has not previously been analysed. However, this chapter suggests that the patterns are intriguing because they contain something of their designers’ identities. It suggests that the coloured surface provides a way of camouflaging and hiding its subjects’ histories, such that Broadhurst and Thompson, consciously or unconsciously, used the patterned surface as a plane in which their past lives could be buried. The revealing nature of the stark white wall, compared with the forgiveness provided by the pattern in which to hide, is elaborated by painter and advocate for polychromatic architecture, Fernand Léger in his essay, “The Wall, The Architect, The Painter (1965).” Léger writes that, “the modern architect has gone too far in his magnificent attempts to cleanse through emptiness,” and that the resultant white walls of modernity create ‘an impalpability of air, of slick, brilliant new surfaces where nothing can be hidden any longer …even shadows don’t dare to enter’. To counter the exposure produced by the white wall, Thompson and Broadhurst designed patterned surfaces that could harbour their personal histories. Broadhurst and Thompson’s works share a number of commonalities in their design production, even though their work in print design commenced a decade apart. Both designers opted to work more with traditional methods of pattern making. Broadhurst used hand-operated screens, and Thompson outsourced work to local weavers and refrained from operating out of a factory. Despite humble beginnings, Broadhurst and Thompson enjoyed international success with their wall patterns being featured in a number of renowned international hotels in Bahrain, Singapore, Sydney, and London in the 1970s and 1980s. Their patterns were also transferred to fabric for soft furnishings and clothing. Thompson’s patterns were used for costumes in films including the King and I and Ben Hur. Broadhurst’s patterns were also widely used by fashion designers and artists, such as Akira Isogowa‘s costume design for Salome, a 1998 production by the Sydney Dance Company. Most recently her print designs have been used by skin illustrator Emma Hack, in a series of works painting female bodies into Broadhurst’s patterns. Hack’s works camouflage the models’ bodies into the patterned surface, assimilating subject and surface, hinting at there being something living within the patterned wall. More than four decades after Broadhurst’s murder and five decades since Thompson’s disappearance, their print designs persist as more than just a legacy. They are applied as surface finishes with the same fervour as when the designs were first released. This chapter argues that the reason for the ongoing celebration of their work is that there is the impalpable presence of the creator in the patterns. It suggests that the patterns blur the boundary between subject and surface.

Well-trained, healthy triathletes experience no adverse health risks regarding oxidative stress and DNA damage by participating in an ultra-endurance event

Also physical exercise in general is accepted to be protective, acute and strenuous exercise has been shown to induce oxidative stress. Enhanced formation of free radicals leads to oxidation of macromolecules and to DNA damage. On the other hand ultra-endurance events which require strenuous exercise are very popular and the number of participants is continuously increasing worldwide. Since only few data exists on Ironman triathletes, who are prototypes of ultra-endurance athletes, this study was aimed at assessing the risk of oxidative stress and DNA damage after finishing a triathlon and to predict a possible health risk. Blood samples of 42 male athletes were taken 2 days before, within 20 min after the race, 1, 5 and 19 days post-race. Oxidative stress marker increased only moderately after the race and returned to baseline after 5 days. Marker of DNA damage measured by the SCGE assay with and without restriction enzymes as well as by the sister chromatid exchange assay did either show no change or deceased within the first day after the race. Due to intake during the race and the release by the cells plasma concentrations of vitamin C and α-tocopherol increased after the event and returned to baseline 1 day after. This study indicates that despite a temporary increase in some oxidative stress markers, there is no persistent oxidative stress and no DNA damage in response to an Ironman triathlon in trained athletes, mainly due to an appropriate antioxidant intake and general protective alterations in the antioxidant defence system.

An elegy for Greg Ham: Copyright law, the Kookaburra case, and remix culture

The ‘Kookaburra’ case was a tragic and controversial copyright dispute, highlighting the need for copyright law reform by the Australian Parliament. In the Kookaburra case, a copyright action was brought by Larrikin Records against Men at Work’s song ‘Down Under’, alleging copyright infringement of the ‘Kookaburra’ song composed by Marion Sinclair. The dispute raised a host of doctrinal matters. There was disquiet over the length of the copyright term. There were fierce contests as to the copyright ownership of the ‘Kookaburra’ song. The litigation raised questions about copyright infringement and substantiality – particularly in relation to musical works. The ‘Kookaburra’ case highlighted frailties in Australia’s regime of copyright exceptions. The litigation should spur the Australian Law Reform Commission to make recommendations for law reform in its inquiry Copyright and the Digital Economy. This article provides a critical evaluation of the options of a defence for transformative use; a defence for fair use; and statutory licensing. The ‘Kookaburra’ case also examines the question of appropriate remedies in respect of copyright infringement. The conclusion considers the implications of the Kookaburra case for other forms of musical works – including digital sampling, mash-ups, and creative remixes. It finishes with an elegy for Greg Ham – paying tribute to the multi-instrumentalist for Men at Work.

The long drive home: Control beliefs and commuting intentions of mine workers

Purpose: It is relatively common for many mine workers in Australia to drive an average of 250 kilometers to and from work following long shifts and shift blocks. Despite the long distances travelled following long shifts of 12- to 14-hours, there is evidence to suggest that these workers are not engaging in a break following their shift prior to driving home. This naturally raises issues of fatigue and sleepiness when driving. There is limited research in respect to commuting behaviours of mine workers and little is known about the factors that influence these workers to leave site immediately following their shift. Using the theory of planned behaviour, this paper examines individual control beliefs that encourage or prevent workers from leaving the site immediately following their shift block. Method: Data was collected using a cross-sectional survey. The survey instrument was developed following a series of in-depth interviews with workers from a Queensland coal mine (n=37). The quantitative written survey sample (n=461) was drawn from the same coal mine and consisted of workers from all levels of the organisation. Results: The results examine workers intentions to leave the work site and drive home immediately following a shift block. The results show differences in control beliefs between workers finishing night shifts compared with those finishing day shifts. Implications: An understanding of these control beliefs may potentially inform more targeted intervention strategies in the attempt to encourage a safer approach to driving home following shift blocks.