1st International Workshop on Secure and Privacy-Aware Information Management in eHealth

Information security and privacy in the healthcare domain is a complex and challenging problem for computer scientists, social scientists, law experts and policy makers. Appropriate healthcare provision requires specialized knowledge, is information intensive and much patient information is of a particularly sensitive nature. Electronic health record systems provide opportunities for information sharing which may enhance healthcare services, for both individuals and populations. However, appropriate information management measures are essential for privacy preservation...

Optimal Irrigation and N-fertilizer Management for Sustainable Winter Wheat Production in Khorezm, Uzbekistan

The efficiency of the nitrogen (N) application rates 0, 120, 180 and 240 kg N ha−1 in combination with low or medium water levels in the cultivation of winter wheat (Triticum aestivum L.) cv. Kupava was studied for the 2005–2006 and 2006–2007 growing seasons in the Khorezm region of Uzbekistan. The results show an impact of the initial soil Nmin (NO3-N + NH4-N) levels measured at wheat seeding on the N fertilizer rates applied. When the Nmin content in the 0–50 cm soil layer was lower than 10 mg kg−1 during wheat seeding in 2005, the N rate of 180 kg ha−1 was found to be the most effective for achieving high grain yields of high quality. With a higher Nmin content of about 30 mg kg−1 as was the case in the 2006 season, 120 kg N ha−1 was determined as being the technical and economical optimum. The temporal course of N2O emissions of winter wheat cultivation for the two water-level studies shows that emissions were strongly influenced by irrigation and N-fertilization. Extremely high emissions were measured immediately after fertilizer application events that were combined with irrigation events. Given the high impact of N-fertilizer and irrigation-water management on N2O emissions, it can be concluded that present N-management practices should be modified to mitigate emissions of N2O and to achieve higher fertilizer use efficiency.

Priority threat management of invasive plant species in the Lake Eyre Basin

This project is led by scientists in conservation decision appraisal and brings together a group of experts working across the Lake Eyre Basin (LEB). The LEB covers a sixth of Australia, with an array of globally significant natural values that are threatened by invasive plants, among other things. Managers at various levels are investing in attempts to control, contain and eradicate these invasive plant species, under severe time and resources limitations. To date there has been no basin-wide assessment of which weed management strategies and locations provide the best investments for maximising outcomes for biodiversity per unit cost. Further, there has been no assessment of the extent of ecosystem intactness that may be lost without effective invasive plant species management strategies. Given that there are insufficient resources to manage all invasive plant species everywhere, this information has the potential to improve current investment decisions. Here, we provide a prioritisation of invasive plant management strategies in the LEB. Prioritisation was based on cost-effectiveness for biodiversity benefits. We identify the key invasive plant species to target to protect ecosystem intactness across the bioregions of the LEB, the level of investment required and the likely reduction in invasive species dominance gained per dollar spent on each strategy. Our focus is on strategies that are technically and socially feasible and reduce the likelihood that high impact invasive plant species will dominate native ecosystems, and therefore change their form and function. The outputs of this work are designed to help guide decision-making and further planning and investment in weed management for the Basin. Experts in weed management, policy-making, community engagement, biodiversity and natural values of the Basin, attended a workshop and agreed upon 12 strategies to manage invasive plants. The strategies focused primarily on 10 weeds which were considered to have a high potential for broad, significant impacts on natural ecosystems in the next 50 years and for which feasible management strategies could be defined. Each strategy consisted of one or more supporting actions, many of which were spatially linked to IBRA (Interim Biogeographical Regionalisation of Australia) bioregions. The first strategy was an over-arching recommendation for improved mapping, information sharing, education and extension efforts in order to facilitate the more specific weed management strategies. The 10 more specific weed management strategies targeted the control and/or eradication of the following high-impact exotic plants: mesquite, parkinsonia, rubber vine, bellyache bush, cacti, mother of millions, chinee apple, athel pine and prickly acacia, as well as a separate strategy for eradicating all invasive plants from one key threatened ecological community, the GAB (Great Artesian Basin dependant) mound springs. Experts estimated the expected biodiversity benefit of each strategy as the reduction in area that an invasive plant species is likely to dominate in over a 50-year period, where dominance was defined as more than 30% coverage at a site. Costs were estimated in present day terms over 50 years largely during follow up discussions post workshop. Cost-effectiveness was then calculated for each strategy in each bioregion by dividing the average expected benefit by the average annual costs. Overall, the total cost of managing 12 invasive plant strategies over the next 50 years was estimated at $1.7 billion. It was estimated that implementation of these strategies would result in a reduction of invasive plant dominance by 17 million ha (a potential 32% reduction), roughly 14% of the LEB. If only targeting Weeds of National Significance (WONS), the total cost was estimated to be $113 million over the next 50 years. Over the next 50 years, $2.3 million was estimated to eradicate all invasive plant species from the Great Artesian Basin Mound Springs threatened ecological community. Prevention and awareness programs were another key strategy targeted across the Basin and estimated at $17.5 million in total over 50 years. The cost of controlling, eradicating and containing buffel grass were the most expensive, over $1.5 billion over 50 years; this strategy was estimated to result in a reduction in buffel grass dominance of a million ha in areas where this species is identified as an environmental problem. Buffel grass has been deliberately planted across the Basin for pasture production and is by far the most widely distributed exotic species. Its management is contentious, having economic value to many graziers while posing serious threats to biodiversity and sites of high cultural and conservation interest. The strategy for containing and locally eradicating buffel grass was a challenge to cost based on expert knowledge, possibly because of the dual nature of this species as a valued pastoral grass and environmental weed. Based on our conversations with experts, it appears that control and eradication programs for this species, in conservation areas, are growing rapidly and that information on the most cost-effective strategies for this species will continue to develop over time. The top five most cost-effective strategies for the entire LEB were for the management of: 1) parkinsonia, 2) chinee apple, 3) mesquite, 4) rubber vine and 5) bellyache bush. Chinee apple and mother of millions are not WONS and have comparatively small populations within the semi-arid bioregions of Queensland. Experts felt that there was an opportunity to eradicate these species before they had the chance to develop into high-impact species within the LEB. Prickly acacia was estimated to have one of the highest benefits, but the costs of this strategy were high, therefore it was ranked 7th overall. The buffel grass strategy was ranked the lowest (10th) in terms of cost effectiveness. The top five most cost-effective strategies within and across the bioregions were the management of: 1) parkinsonia in the Channel Country, 2) parkinsonia in the Desert Uplands, 3) mesquite in the Mitchell Grass Downs, 4) parkinsonia in the Mitchell Grass Downs, and 5) mother of millions in the Desert Uplands. Although actions for several invasive plant species like parkinsonia and prickly acacia were concentrated in the Queensland part of the LEB, the actions involved investing in containment zones to prevent the spread of these species into other states. In the NT and SA bioregions of the LEB, the management of athel pine, parkinsonia and cacti were the main strategies. While outside the scientific research goals of study, this work highlighted a number of important incidental findings that led us to make the following recommendations for future research and implementation of weed management in the Basin: • Ongoing stakeholder engagement, extension and participation is required to ensure this prioritisation effort has a positive impact in affecting on-ground decision making and planning. • Short term funding for weed management was identified as a major reason for failure of current efforts, hence future funding needs to be secure and ongoing. • Improved mapping and information sharing is essential to implement effective weed management. • Due to uncertainties in the outcomes and impacts of management options, strategies should be implemented as part of an adaptive management program. The information provided in this report can be used to guide investment for controlling high-impact invasive plant species for the benefits of biodiversity conservation. We do not present a final prioritisation of invasive plant strategies for the LEB, and we have not addressed the cultural, socio-economic or spatial components necessary for an implementation plan. Cost-effectiveness depends on the objectives used; in our case we used the intactness of ecosystems as a surrogate for expected biodiversity benefits, measured by the extent that each invasive plant species is likely to dominate in a bioregion. When other relevant factors for implementation are considered the priorities may change and some actions may not be appropriate in some locations. We present the costs, ecological benefits and cost-effectiveness of preventing, containing, reducing and eradicating the dominance of high impact invasive plants through realistic management actions over the next 50 years. In doing so, we are able to estimate the size of the weed management problem in the LEB and provide expert-based estimates of the likely outcomes and benefits of implementing weed management strategies. The priorities resulting from this work provide a prospectus for guiding further investment in management and in improving information availability.

Experienced-based management of IMRT quality assurance

This study uses the detailed, bulk analyses of a set of treatment planning and quality assurance data from one radiotherapy centre to provide an illuminating example of the provision evidence-based advice on the management, and potential reduction, of an IMRT quality assurance workload.

Integrated chronic disease management in primary-secondary care : a systematic literature review of the evidence

Introduction: Diabetes has traditionally been managed as a single chronic disease state, but it exists with co-morbidities such as depression and metabolic syndrome. Treatment is multifaceted, requiring both primary and secondary care, however, the delivery of diabetes care is often fragmented. Integrated chronic disease management is a growing model of interest, and is underpinned by the chronic care model (CCM), devised as a guide for primary care management of patients with chronic conditions. The model identifies six key elements for effective care, and has shown promise in improving the management of diabetes. Aim: To find empirical evidence of integrated care interventions targeted at co-morbidities including diabetes, across primary/secondary care. Method: A systematic review of peer reviewed literature from PubMed, CINAHL, Embase, Cochrane Library and Joanna Briggs was performed. Studies were reviewed according to inclusion criteria- studies published in English, between 2004-2014, empirical studies, studies with evidence of primary/secondary implementation, and those dealing with chronic co-morbid disease states. Results: 51 studies met the inclusion criteria. Included studies were mostly from the US (38), with five from Australia, UK (2), Canada (2), Netherlands (1), Norway (1), Ireland (1), and one multi-country study. It was found that all interventions adopted at least one (average 3-4) of the chronic care model, with the majority implementing delivery system redesign activities within the primary care practice/s. We found evidence of interventions which significantly reduced emergency department and hospital admissions, improved processes of care, patient health outcomes such as HbA1c, improved patient satisfaction, and reduced costs. Conclusion/Implications for practice: Diabetes exists as a co-morbid disease, requiring both primary and secondary care. We found that integrated care interventions adopting elements of the chronic care model positively impacted on patient outcomes, service utilisation, as well as costs. This review has highlighted that it may not be necessary to adopt all CCM elements to improve clinical outcomes, patient satisfaction and costs.

Progress and challenges of disaster health management in China : a scoping review

Background Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries. Objective This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity. Design A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims. Results The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue. Conclusions One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level).

Silvicultural management of Hypsipyla species

Existing evidence for successful silvicultural control of Hypsipyla spp. is conflicting and to a large extent anecdotal. Levels of attack have been correlated with factors such as shade, planting density, species mixtures, site characteristics, etc. These factors have often been poorly defined and are usually interdependent. The actual mechanisms that determine whether or not Hypsipyla spp. adversely affects plants we define as host-finding, host suitability, host recovery and natural enemies. These mechanisms can be influenced by the silvicultural techniques applied to a stand. Success of silvicultural techniques can usually be attributed to more than one mechanism and it is difficult to assess which is most the important for minimising the impact of Hypsipyla as these analytical data are lacking. This highlights the need for further research on silvicultural methods for controlling Hypsipyla spp. However, several silvicultural techniques that are briefly described show promise for improving the performance of future plantations. Examples of silvicultural control are reviewed with reference to these mechanisms.

Acceptability-based QoE management for user-centric mobile video delivery : a field study evaluation

Effective Quality of Experience (QoE) management for mobile video delivery – to optimize overall user experience while adapting to heterogeneous use contexts – is still a big challenge to date. This paper proposes a mobile video delivery system to emphasize the use of acceptability as the main indicator of QoE to manage the end-to-end factors in delivering mobile video services. The first contribution is a novel framework for user-centric mobile video system that is based on acceptability-based QoE (A-QoE) prediction models, which were derived from comprehensive subjective studies. The second contribution is results from a field study that evaluates the user experience of the proposed system during realistic usage circumstances, addressing the impacts of perceived video quality, loading speed, interest in content, viewing locations, network bandwidth, display devices, and different video coding approaches, including region-of-interest (ROI) enhancement and center zooming

How can partnerships between the universities and schools exploit new opportunities for pedagogies at the intersection of the arts/design and the sciences?

Driven by information accessibility-on-demand provided by the internet, education modes are changing from a teacher-led approach focused on content delivery and assessible outcomes, to a learner-based approach encouraging self-directed, peer-tutored, and cooperative learning. New pedagogies are required to extend learning beyond the classroom and traditional subject areas such as contemporary arts, in alignment with the cross disciplinary priorities of the Australian Curriculum and values of the International Baccalaureate Organisation. This research explores how partnerships with universities and cultural organisations are implicated in the generation of these new forms of pedagogy and contribute to the field of educational research within the context of Education Queensland’s Framework For Gifted Education. In particular, this paper explores a new pedagogical framework for highly capable year five to nine Queensland state school students at the intersection of arts, design and the sciences, which has arisen from an explicit secondary/ tertiary partnership between the Queensland University of Technology Creative Industries Faculty and Precincts and the Queensland Academies Young Scholars Program. The Young Scholars Program offers experiences in the International Baccalaureate and Australian Curriculum contexts to enhance outcomes via global understanding, unique industry partnerships and 21st century pedagogical innovation based not on 'content' but tacit/experiential learning concepts including immersive, creative, intellectual and social strategies. These strategies for highly capable students are centred around authentic opportunities, primary resources, transdisciplinary learning and relationships with likeminded peers including tertiary arts, design and STEM educators and students, professionals and researchers. The presentation details case studies which are hands-on real time workshops involving inquiry based challenges in the arts, design and sciences, mathematics, history, creative writing and other disciplines, with content drawn from collections from public institutions, academic research and tertiary pedagogy. Both programs implicate student collaboration and creative production as methodology/data capture for ongoing action research, in alignment with the Framework For Gifted Education’s emphasis on evidence-based practices. They also challenge gifted students “to continue their development through curricular activities that require depth of study, complexity of thinking, fast pace of learning, high-level skills development and/or creative and critical thinking (e.g. through independent investigations, tiered tasks, diverse real-world applications, mentors)”(Education Queensland, 2011:3). This presentation highlights the strengths of the ongoing collaboration between QUT Creative industries Faculty and Queensland Academies, which not only provides successful extra curricular activities for gifted students towards a place in the International Baccalaureate Program, but also provides mentoring opportunities for tertiary students in their field of endeavor to assist with their own learning, and unique research opportunities for the Faculty as it focuses on excellence in arts, design and creative education and research. Education Queensland.(2011). Framework For Gifted Education Revised Edition 2011 (accessed Nov 19 2011)

A comparison of treatment options for management of end stage kidney disease in elderly patients : a systematic review

Background Chronic kidney disease is a global public health problem of increasing prevalence. There are five stages of kidney disease, with Stage 5 indicating end stage kidney disease (ESKD) requiring dialysis or death will eventually occur. Over the last two decades there have been increasing numbers of people commencing dialysis. A majority of this increase has occurred in the population of people who are 65 years and over. With the older population it is difficult to determine at times whether dialysis will provide any benefit over non-dialysis management. The poor prognosis for the population over 65 years raises issues around management of ESKD in this population. It is therefore important to review any research that has been undertaken in this area which compares outcomes of the older ESKD population who have commenced dialysis with those who have received non-dialysis management. Objective The primary objective was to assess the effect of dialysis compared with non-dialysis management for the population of 65 years and over with ESKD. Inclusion criteria Types of participants This review considered studies that included participants who were 65 years and older. These participants needed to have been diagnosed with ESKD for greater than three months and also be either receiving renal replacement therapy (RRT) (hemodialysis [HD] or peritoneal dialysis [PD]) or non-dialysis management. The settings for the studies included the home, self-care centre, satellite centre, hospital, hospice or nursing home. Types of intervention(s)/phenomena of interest This review considered studies where the intervention was RRT (HD or PD) for the participants with ESKD. There was no restriction on frequency of RRT or length of time the participant received RRT. The comparator was participants who were not undergoing RRT. Types of studies This review considered both experimental and epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case control studies and analytical cross sectional studies. This review also considered descriptive epidemiological study designs including case series, individual case reports and descriptive cross sectional studies for inclusion. This review included any of the following primary and secondary outcome measures: •Primary outcome – survival measures •Secondary outcomes – functional performance score (e.g. Karnofsky Performance score) •Symptoms and severity of end stage kidney disease •Hospital admissions •Health related quality of life (e.g. KDQOL, SF36 and HRQOL) •Comorbidities (e.g. Charlson Comorbidity index).

Benefits of integrating complementarity into priority threat management

Conservation decision tools based on cost-effectiveness analysis are used to assess threat management strategies for improving species persistence. These approaches rank alternative strategies by their benefit to cost ratio but may fail to identify the optimal sets of strategies to implement under limited budgets because they do not account for redundancies. We devised a multi objective optimization approach in which the complementarity principle is applied to identify the sets of threat management strategies that protect the most species for any budget. We used our approach to prioritize threat management strategies for 53 species of conservation concern in the Pilbara, Australia. We followed a structured elicitation approach to collect information on the benefits and costs of implementing 17 different conservation strategies during a 3-day workshop with 49 stakeholders and experts in the biodiversity, conservation, and management of the Pilbara. We compared the performance of our complementarity priority threat management approach with a current cost-effectiveness ranking approach. A complementary set of 3 strategies: domestic herbivore management, fire management and research, and sanctuaries provided all species with >50% chance of persistence for $4.7 million/year over 20 years. Achieving the same result cost almost twice as much ($9.71 million/year) when strategies were selected by their cost-effectiveness ranks alone. Our results show that complementarity of management benefits has the potential to double the impact of priority threat management approaches.

Use of physical activity self-management strategies by high school students

Teaching adolescents to use self-management strategies (SMS's) may be an effective approach to promoting lifelong physical activity (PA). However, the extent to which adolescents use SMS's and their impact on current PA have not been studied previously. The aims of this study were: 1) describe the prevalence of SMS use in adolescents; and 2) determine relationships between SMS use, PA self-efficacy, and PA participation. 197 students completed questionnaires measuring use of SMS's, self-efficacy, and PA behavior. The most prevalent SMS's (>30%) were thinking about the benefits of PA, making PA more enjoyable, choosing activities that are convenient, setting aside time to do PA, and setting goals to do PA. Less than 10% reported rewarding oneself for PA, writing planned activities in a book or calendar, and keeping charts of PA. SMS use was associated with increased self-efficacy (r = 0.47, P < .001) and higher levels of PA (r = 0.34 P < .001). A one unit difference in SMS scores was associated with a ~ 4-fold increase in the probability of being active (OR = 3.7, 95% CI = 1.8-7.4). Although strongly associated with PA, a relatively small percentage of adolescents routinely use SMS's.

The OnTrack Diabetes web-based program for type 2 diabetes and dysphoria self-management: A randomized controlled trial protocol

Background: The prevalence of type 2 diabetes is rising with the majority of patients practicing inadequate disease self-management. Depression, anxiety, and diabetes-specific distress present motivational challenges to adequate self-care. Health systems globally struggle to deliver routine services that are accessible to the entire population, in particular in rural areas. Web-based diabetes self-management interventions can provide frequent, accessible support regardless of time and location Objective: This paper describes the protocol of an Australian national randomized controlled trial (RCT) of the OnTrack Diabetes program, an automated, interactive, self-guided Web program aimed to improve glycemic control, diabetes self-care, and dysphoria symptoms in type 2 diabetes patients. Methods: A small pilot trial is conducted that primarily tests program functionality, efficacy, and user acceptability and satisfaction. This is followed by the main RCT, which compares 3 treatments: (1) delayed program access: usual diabetes care for 3 months postbaseline followed by access to the full OnTrack Diabetes program; (2) immediate program: full access to the self-guided program from baseline onward; and (3) immediate program plus therapist support via Functional Imagery Training (FIT). Measures are administered at baseline and at 3, 6, and 12 months postbaseline. Primary outcomes are diabetes self-care behaviors (physical activity participation, diet, medication adherence, and blood glucose monitoring), glycated hemoglobin A1c (HbA1c) level, and diabetes-specific distress. Secondary outcomes are depression, anxiety, self-efficacy and adherence, and quality of life. Exposure data in terms of program uptake, use, time on each page, and program completion, as well as implementation feasibility will be conducted. Results: This trial is currently underway with funding support from the Wesley Research Institute in Brisbane, Australia. Conclusions: This is the first known trial of an automated, self-guided, Web-based support program that uses a holistic approach in targeting both type 2 diabetes self-management and dysphoria. Findings will inform the feasibility of implementing such a program on an ongoing basis, including in rural and regional locations.

Australia’s first Allied Health Prescribing Program – exploring participants' understanding and confidence in clinical therapy choices for patient management

BACKGROUND Globally there are emerging trends for non-medical health professionals to expand their scope of practice into prescribing. The NPS Prescribing Competencies Framework and the Health Professionals Prescribing Pathway Program are recent initiatives to assist with implementation of prescribing for allied health professionals (AHPs). For AHPs to become prescribers, training programmes must be designed to extend their knowledge of medicines information and medicine management principles with the aim of optimising medicines related outcomes for patients. AIM To explore the understanding and confidence in clinical therapeutic choices for patient management of those AHPs enrolled in the Allied Health Prescribing Training Program Module One: Introduction to clinical therapeutics for prescribers, delivered by Queensland University of Technology, Brisbane. METHOD A pre-post survey was developed to explore key themes around understanding and confidence in selecting therapeutic choices for patients with varying complexities of conditions. Data were collected from participants in week one and 13 of the module via an online survey using a five-point Likert scale (1 = Strongly Agree (SA) to 5 = Strongly Disagree (SD)). RESULTS In the pre-Module survey the AHPs had a limited degree (D/SD) of understanding and confidence regarding the safe and effective use of medicines and appropriate therapeutic choices for managing patients, particularly with complex patients. This improved significantly in the post Module survey (A/SA).

Sex-specific roost selection by bats in clearfell harvested plantation forest : improved knowledge advises management

To maximize energetic savings, female bats often roost communally whilst pregnant or with non-volant dependents, whereas male bats more often roost alone; however, differences in selection of roosts by sex have not often been investigated. Better understanding of female colony locations could focus management to protect the majority of bats. New Zealand's long-tailed bat (Chalinolobus tuberculatus) roost in exotic plantation forest, where sex-specific roost selection has not been investigated, and therefore such management is not possible. We investigated sex-specific roost selection by long-tailed bats for the first time. Roosts and paired nonroosts were characterized testing predictions that males and females select roosts that differ from non-roosts, and males and females select different roosts. Females and males chose Pinus radiata roosts that differed from non-roost trees. Results suggest each sex chose roosts that maximized energetic savings. Female bats used roosts closer to water sources, that warmed earlier in the day, which allowed maintenance of high temperatures. Males appeared to choose roosts that allowed torpor use for long periods of the day. Males may be less selective with their roost locations than females, as they roosted further from water sources. This could allow persistence of male bats in marginal habitat. As all female long-tailed bats chose roosts within 150 m of waterways, management to protect bats could be focused here. To protect bats least able to escape when roosts are harvested, harvest of forest stands selected by female bats as roost sites should be planned when bats are not heavily pregnant nor have non-volant dependents.