Randomized clinical trial of the timing it right stroke family support program: Research protocol

Background Family caregivers provide invaluable support to stroke survivors during their recovery, rehabilitation, and community re-integration. Unfortunately, it is not standard clinical practice to prepare and support caregivers in this role and, as a result, many experience stress and poor health that can compromise stroke survivor recovery and threaten the sustainability of keeping the stroke survivor at home. We developed the Timing it Right Stroke Family Support Program (TIRSFSP) to guide the timing of delivering specific types of education and support to meet caregivers' evolving needs. The objective of this multi-site randomized controlled trial is to determine if delivering the TIRSFSP across the stroke care continuum improves caregivers' sense of being supported and emotional well-being. Methods/design Our multi-site single-blinded randomized controlled trial will recruit 300 family caregivers of stroke survivors from urban and rural acute care hospitals. After completing a baseline assessment, participants will be randomly allocated to one of three groups: 1) TIRSFSP guided by a stroke support person (health care professional with stroke care experience), delivered in-person during acute care and by telephone for approximately the first six to 12 months post-stroke; 2) caregiver self-directed TIRSFSP with an initial introduction to the program by a stroke support person, or; 3) standard care receiving the educational resource "Let's Talk about Stroke" prepared by the Heart and Stroke Foundation. Participants will complete three follow-up quantitative assessments 3, 6, and 12-months post-stroke. These include assessments of depression, social support, psychological well-being, stroke knowledge, mastery (sense of control over life), caregiving assistance provided, caregiving impact on everyday life, and indicators of stroke severity and disability. Qualitative methods will also be used to obtain information about caregivers' experiences with the education and support received and the impact on caregivers' perception of being supported and emotional well-being. Discussion This research will determine if the TIRSFSP benefits family caregivers by improving their perception of being supported and emotional well-being. If proven effective, it could be recommended as a model of stroke family education and support that meets the Canadian Stroke Best Practice Guideline recommendation for providing timely education and support to families through transitions.

A feasibility and pilot randomized controlled trial of the "Timing it Right Stroke Family Support Program"

- Objective Examine feasibility of conducting a randomized controlled trial of the Timing it Right Stroke Family Support Program (TIRSFSP) and collect pilot data. - Design Multi-site mixed method randomized controlled trial. - Setting Acute and community care in three Canadian cities. - Subjects Caregivers were family members or friends providing care to individuals who experienced their first stroke. - Intervention The TIRSFSP offered in two formats, self-directed by the caregiver or stroke support person-directed over time, were compared to standard care. - Main Measures Caregivers completed baseline and follow-up measures 1, 3 and 6 months post-stroke including Centre for Epidemiological Studies Depression, Positive Affect, Social Support, and Mastery Scales. We completed in-depth qualitative interviews with caregivers and maintained intervention records describing support provided to each caregiver. - Results Thirty-one caregivers received standard care (n=10), self-directed (n=10), or stroke support person-directed (n=11) interventions. We retained 77% of the sample through 6-months. Key areas of support derived from intervention records (n=11) related to caregiver wellbeing, caregiving strategies, patient wellbeing, community re-integration, and service delivery. Compared to standard care, caregivers receiving the stroke support person-directed intervention reported improvements in perceived support (estimate 3.1, P=.04) and mastery (estimate .35, P=.06). Qualitative caregiver interviews (n=19) reflected the complex interaction between caregiver needs, preferences and available options when reporting on level of satisfaction. - Conclusions Preliminary findings suggest the research design is feasible, caregivers’ needs are complex, and the support intervention may enhance caregivers’ perceived support and mastery. The intervention will be tested further in a large scale trial.

Systematic review: Unmet supportive care needs in people diagnosed with chronic liver disease

Objective People with chronic liver disease, particularly those with decompensated cirrhosis, experience several potentially debilitating complications that can have a significant impact on activities of daily living and quality of life. These impairments combined with the associated complex treatment mean that they are faced with specific and high levels of supportive care needs. We aimed to review reported perspectives, experiences and concerns of people with chronic liver disease worldwide. This information is necessary to guide development of policies around supportive needs screening tools and to enable prioritisation of support services for these patients. Design Systematic searches of PubMed, MEDLINE, CINAHL and PsycINFO from the earliest records until 19 September 2014. Data were extracted using standardised forms. A qualitative, descriptive approach was utilised to analyse and synthesise data. Results The initial search yielded 2598 reports: 26 studies reporting supportive care needs among patients with chronic liver disease were included, but few of them were patient-reported needs, none used a validated liver disease-specific supportive care need assessment instrument, and only three included patients with cirrhosis. Five key domains of supportive care needs were identified: informational or educational (eg, educational material, educational sessions), practical (eg, daily living), physical (eg, controlling pruritus and fatigue), patient care and support (eg, support groups), and psychological (eg, anxiety, sadness). Conclusions While several key domains of supportive care needs were identified, most studies included hepatitis patients. There is a paucity of literature describing the supportive care needs of the chronic liver disease population likely to have the most needs—namely those with cirrhosis. Assessing the supportive care needs of people with chronic liver disease have potential utility in clinical practice for facilitating timely referrals to support services.

Pedagogical practices and support systems of inclusion: Empirical evidence from Chinese societies

China has a massive population of children with disabilities. To address the special needs of these children, special/inclusive education in China has developed dramatically since the early 1980s onwards. This Special Issue puts together seven empirical studies emerging from the Chinese societies. These studies analyse inclusive discourses embedded in the education policy documents; scrutinise professional competence of inclusive education teachers; evaluate inclusive education practices in physical education, mathematics education, and job-related social skills education provided to students with disabilities; debate the required in-class support for inclusive education teachers; and discuss the social attitudes towards people with disabilities. The foci, methods and theories vary across the seven studies, while their aims converge. These studies are seeking best possible approaches and best available resources that facilitate inclusion. Knowledge built and lessons learned from these studies will provide implications for future inclusive education practices in China and beyond.

Support services for higher degree research students: A survey of three Australian universities

A survey was conducted across three Australian universities to identify the types and format of support services available for higher degree research (HDR, or MA and Ph.D.) students. The services were classified with regards to availability, location and accessibility. A comparative tool was developed to help institutions categorise their services in terms of academic, administrative, social and settlement, language and miscellaneous (other) supports. All three universities showed similarities in the type of academic support services offered, while differing in social and settlement and language support services in terms of the location and the level of accessibility of these services. The study also examined the specific support services available for culturally and linguistically diverse (CALD) students. The three universities differed in their emphases in catering to CALD needs, with their allocation of resources reflecting these differences. The organisation of these services within the universities was further assessed to determine possible factors that may influence the effective delivery of these services, by considering HDR and CALD student specific issues. The findings and tools developed by this study may be useful to HDR supervisors and university administrators in identifying key support services to better improve outcomes for the HDR students and universities.

Formative evaluation to benchmark and improve climate-based decision support for graziers in Western Queelsland

Researchers developing climate-based forecasts, workshops, software tools and information to aid grazier decisions undertook an evaluation study to enhance planning and benchmark impact. One hundred graziers in Western Queensland were randomly selected from 7 shires and surveyed by mail and telephone (43 respondents) to explore levels of knowledge and use of climate information, practices and information needs. We found 36% of respondents apply the Southern Oscillation Index to property decisions but 92% were unaware El Niño Southern Oscillation’s predictive signal in the region is greater for pasture growth than rainfall, suggesting they may not recognise the potential of pasture growth forecasts. Almost 75% of graziers consider they are conservative or risk averse in their attitude to managing their enterprise. Mail respondents (n= 20) if given a 68%, on average, probability of exceeding median rainfall forecast may change a decision; almost two-thirds vary stocking rate based on forage available, last year’s pasture growth or the Southern Oscillation Index; the balance maintain a constant stocking rate strategy; 90% have access to a computer; 75% to the internet and 95% have a fax. This paper presents findings of the study and draws comparisons with a similar study of 174 irrigators in the Northern Murray-Darling Basin (Aust. J. Exp. Ag. 44, 247-257). New insights and information gained are helping the team better understand client needs and plan, design and extend tools and information tailored to grazier knowledge, practice, information needs and preferences. Results have also provided a benchmark against which to measure project impact and have influenced the team to make important changes to their project planning, activities and methods for transferring technology tailored to grazier preferences.

Analysing industry needs to fine tune IPM project activities

As a first step to better targeting the activities of a project for improving management of western flower thrips, Frankliniella occidentialis, (WFT) in field grown vegetable crops, we surveyed growers, consultants and other agribusiness personnel in two regions of Queensland. Using face-to-face interviews, we collected data on key pests and measures used to manage them, the importance of WFT and associated viral diseases, sources of pest management information and additional skills and knowledge needed by growers and industry. Responses were similar in the two regions. While capsicum growers in one northern Queensland district had suffered serious losses from WFT damage in 2002, in general the pest was not seen as a major problem. In cucurbit crops, the silverleaf whitefly (Bemisia tabaci biotype B) was considered the most difficult insect pest to manage. Pest control tactics were largely based on pesticides although many respondents mentioned non-chemical methods such as good farm hygiene practices, control of weed hosts and regular crop monitoring, particularly when prompted. Respondents wanted to know more about pest identification, biology and damage, spray application and the best use of insecticides. Natural enemies were mentioned infrequently. Keeping up to date with available pesticide options, availability of new chemicals and options for a district-wide approach to managing pests emerged as key issues. Growers identified agricultural distributors, consultants, Queensland Department of Primary Industries staff, other growers and their own experience as important sources of information. Field days, workshops and seminars did not rank highly. Busy vegetable growers wanted these activities to be short and relevant, and preferred to be contacted by post and facsimile rather than email. In response to these results, we are focusing on three core, interrelated project extension strategies: (i) short workshops, seminars and farm walks to provide opportunities for discussion, training and information sharing with growers and their agribusiness advisors; (ii) communication via newsletters and information leaflets; (iii) support for commercialisation of services.

Developing a best practice pathway to support improvements in Indigenous Australians' mental health and well-being: A qualitative study

Objective: There is a need to adapt pathways to care to promote access to mental health services for Indigenous people in Australia. This study explored Indigenous community and service provider perspectives of well-being and ways to promote access to care for Indigenous people at risk of depressive illness. Design: A participatory action research framework was used to inform the development of an agreed early intervention pathway; thematic analysis Setting: 2 remote communities in the Northern Territory. Participants: Using snowball and purposive sampling, 27 service providers and community members with knowledge of the local context and the diverse needs of those at risk of depression were interviewed. 30% of participants were Indigenous. The proposed pathway to care was adapted in response to participant feedback. Results: The study found that Indigenous mental health and well-being is perceived as multifaceted and strongly linked to cultural identity. It also confirms that there is broad support for promotion of a clear pathway to early intervention. Key identified components of this pathway were the health centre, visiting and community-based services, and local community resources including elders, cultural activities and families. Enablers to early intervention were reported. Significant barriers to the detection and treatment of those at risk of depression were identified, including insufficient resources, negative attitudes and stigma, and limited awareness of support options. Conclusions: Successful early intervention for wellbeing concerns requires improved understanding of Indigenous well-being perspectives and a systematic change in service delivery that promotes integration, flexibility and collaboration between services and the community, and recognises the importance of social determinants in health promotion and the healing process. Such changes require policy support, targeted training and education, and ongoing promotion.

The Eligibility Definition Used in the Social Security Administration’s Disability Programs Needs to be Changed

In its October 2003 report on the definition of disability used by the Social Security Administration’s (SSA’s) disability programs [i.e., Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) for people with disabilities], the Social Security Advisory Board raises the issue of whether this definition is at odds with the concept of disability embodied in the Americans with Disabilities Act (ADA) and, more importantly, with the aspirations of people with disabilities to be full participants in mainstream social activities and lead fulfilling, productive lives. The Board declares that “the Nation must face up to the contradictions created by the existing definition of disability.” I wholeheartedly agree. Further, I have concluded that we have to make fundamental, conceptual changes to both how we define eligibility for economic security benefits, and how we provide those benefits, if we are ever to fulfill the promise of the ADA. To convince you of that proposition, I will begin by relating a number of facts that paint a very bleak picture – a picture of deterioration in the economic security of the population that the disability programs are intended to serve; a picture of programs that purport to provide economic security, but are themselves financially insecure and subject to cycles of expansion and cuts that undermine their purpose; a picture of programs that are facing their biggest expenditure crisis ever; and a picture of an eligibility determination process that is inefficient and inequitable -- one that rations benefits by imposing high application costs on applicants in an arbitrary fashion. I will then argue that the fundamental reason for this bleak picture is the conceptual definition of eligibility that these programs use – one rooted in a disability paradigm that social scientists, people with disabilities, and, to a substantial extent, the public have rejected as being flawed, most emphatically through the passage of the ADA. Current law requires eligibility rules to be based on the premise that disability is medically determinable. That’s wrong because, as the ADA recognizes, a person’s environment matters. I will further argue that programs relying on this eligibility definition must inevitably: reward people if they do not try to help themselves, but not if they do; push the people they serve out of society’s mainstream, fostering a culture of isolation and dependency; relegate many to a lifetime of poverty; and undermine their promise of economic security because of the periodic “reforms” that are necessary to maintain taxpayer support. I conclude by pointing out that to change the conceptual definition for program eligibility, we also must change our whole approach to providing for the economic security of people with disabilities. We need to replace our current “caretaker” approach with one that emphasizes helping people with disabilities help themselves. I will briefly describe features that such a program might require, and point out the most significant challenges we would face in making the transition.

Post-school needs of young people with high-functioning Autism Spectrum Disorder

This study describes the post-school circumstances and service needs of older teenagers and adults with high-functioning Autism Spectrum Disorder, living in Queensland, Australia. The respondents were 95 parents. Results indicated that the majority of the young people lived in the family home and were unemployed. Of those who worked, 56% had unskilled jobs. They were estimated to spend a significant proportion of their time engaged in solitary, technology-based activities, and comparatively little time in employment or socialising. Parents rated employment support as the greatest service priority for their sons and daughters, followed by specialised support to assist with completing post-school education and training, assistance to support the transition from high school to adulthood, and social skills training.

Comparison of decision tree, support vector machines, and Bayesian network approaches for classification of falls in Parkinson’s disease

Being able to accurately predict the risk of falling is crucial in patients with Parkinson’s dis- ease (PD). This is due to the unfavorable effect of falls, which can lower the quality of life as well as directly impact on survival. Three methods considered for predicting falls are decision trees (DT), Bayesian networks (BN), and support vector machines (SVM). Data on a 1-year prospective study conducted at IHBI, Australia, for 51 people with PD are used. Data processing are conducted using rpart and e1071 packages in R for DT and SVM, con- secutively; and Bayes Server 5.5 for the BN. The results show that BN and SVM produce consistently higher accuracy over the 12 months evaluation time points (average sensitivity and specificity > 92%) than DT (average sensitivity 88%, average specificity 72%). DT is prone to imbalanced data so needs to adjust for the misclassification cost. However, DT provides a straightforward, interpretable result and thus is appealing for helping to identify important items related to falls and to generate fallers’ profiles.

More equal than others?: Meeting the professional development needs of rural primary and secondary science teachers

It is often assumed that teachers in rural and remote schools are at a disadvantage when it comes to accessing professional development. But is there sufficient evidence to support this assumption? This paper reports findings from two national surveys comparing the professional development priorities of primary and secondary science teachers from metropolitan, provincial and remote schools. The research found that while teachers' unmet needs for some PD opportunities increased significantly with school remoteness, this was not the case for all opportunities. In teasing out the different PD priorities of primary and secondary science teachers, the paper provides evidence to help education authorities and professional organisations address the specific needs of teachers in different locations.

Juggling priorities: Balancing economic and social drivers to address the LLN needs of students in the VET sector

Economic success, and a commitment to the social benefits of inclusive training opportunities are important goals for public vocational education and training (VET). Currently, in Australia, VET policy is a shared responsibility between the Commonwealth and the States and Territories. Priorities for investment are juggled between: a) improving efficiency and responsiveness; and b) providing societal prosperity. Amid recent VET educational reforms and policy directives the authors of this paper undertook a pilot study examining language, literacy and numeracy support and inclusive teaching and learning practices in a Diploma of Nursing course. The data highlighted implications arising from new market driven education reforms. This article reports on identified factors that influenced inclusive learning opportunities, noticeably associated with two recent policy developments: the release of the FSK Foundation Skills Training Package (IBSA 2014); and the Queensland's Higher Skills Program Policy 2014-15.

MAC design for heterogeneous application support in OFDM based wireless systems

With the increasing adoption of wireless technology, it is reasonable to expect an increase in file demand for supporting both real-time multimedia and high rate reliable data services. Next generation wireless systems employ Orthogonal Frequency Division Multiplexing (OFDM) physical layer owing, to the high data rate transmissions that are possible without increase in bandwidth. Towards improving file performance of these systems, we look at the design of resource allocation algorithms at medium-access layer, and their impact on higher layers. While TCP-based clastic traffic needs reliable transport, UDP-based real-time applications have stringent delay and rate requirements. The MAC algorithms while catering to the heterogeneous service needs of these higher layers, tradeoff between maximizing the system capacity and providing fairness among users. The novelly of this work is the proposal of various channel-aware resource allocation algorithms at the MAC layer. which call result in significant performance gains in an OFDM based wireless system.

Water management capacity building to support rapidly developing mining economies

Many developing countries are experiencing rapid expansion in mining with associated water impacts. In most cases mining expansion is outpacing the building of national capacity to ensure that sustainable water management practices are implemented. Since 2011, Australia's International Mining for Development Centre (IM4DC) has funded capacity building in such countries including a program of water projects. Five projects in particular (principally covering experiences from Peru, Colombia, Ghana, Zambia, Indonesia, Philippines and Mongolia) have provided insight into water capacity building priorities and opportunities. This paper reviews the challenges faced by water stakeholders, and proposes the associated capacity needs. The paper uses the evidence derived from the IM4DC projects to develop a set of specific capacity-building recommendations. Recommendations include: the incorporation of mine water management in engineering and environmental undergraduate courses; secondments of staff to suitable partner organisations; training to allow site staff to effectively monitor water including community impacts; leadership training to support a water stewardship culture; training of officials to support implementation of catchment management approaches; and the empowerment of communities to recognise and negotiate solutions to mine-related risks. New initiatives to fund the transfer of multi-disciplinary knowledge from nations with well-developed water management practices are called for.