Incidence, risk factors and estimates of a woman's risk of developing secondary lower limb lymphedema and lymphedema-specific supportive care needs in women treated for endometrial cancer

Objectives: Few studies have assessed the risk and impact of lymphedema among women treated for endometrial cancer. We aimed to quantify cumulative incidence of, and risk factors for developing lymphedema following treatment for endometrial cancer and estimate absolute risk for individuals. Further, we report unmet needs for help with lymphedema-specific issues. Methods: Women treated for endometrial cancer (n = 1243) were followed-up 3–5 years after diagnosis; a subset of 643 completed a follow-up survey that asked about lymphedema and lymphedema-related support needs. We identified a diagnosis of secondary lymphedema from medical records or self-report. Multivariable logistic regression was used to evaluate risk factors and estimates. Results: Overall, 13% of women developed lymphedema. Risk varied markedly with the number of lymph nodes removed and, to a lesser extent, receipt of adjuvant radiation or chemotherapy treatment, and use of nonsteroidal anti-inflammatory drugs (pre-diagnosis). The absolute risk of developing lymphedema was > 50% for women with 15 + nodes removed and 2–3 additional risk factors, 30–41% for those with 15 + nodes removed plus 0–1 risk factors or 6–14 nodes removed plus 3 risk factors, but ≤ 8% for women with no nodes removed or 1–5 nodes but no additional risk factors. Over half (55%) of those who developed lymphedema reported unmet need(s), particularly with lymphedema-related costs and pain. Conclusion: Lymphedema is common; experienced by one in eight women following endometrial cancer. Women who have undergone lymphadenectomy have very high risks of lymphedema and should be informed how to self-monitor for symptoms. Affected women need greater levels of support.

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.

Reterritorializing multimodal design in the classroom through a socially mediated Indigenous heritage

National or International Significance Flows of cultural heritage in textual practices are vital to sustaining Indigenous communities - a national and international priority (Commonwealth of Australia, 2011). Indigenous heritage, whether passed on by oral tradition or ubiquitous social media, can be seen as a "conversation between the past and the future" (Fairclough, 2012, p. xv). Indigenous heritage involves appropriating memories within a cultural flow to pass on a spiritual legacy. This presentation reports ethnographic research of social media practices in a small independent Aboriginal school in Southeast Queensland, Australia that is resided over by the Yuggera elders and an Aboriginal principal. Quality of Research The purpose was to rupture existing notions of white literacies in schools, and to deterritorialize the uses of digital media by dominant cultures in the public sphere. Examples of learning experiences included the following: i. Integrating Indigenous language and knowledge into media text production; ii. Classroom visits from Indigenous elders; and iii. Publishing oral histories through digital scrapbooking. The program aligned with the Australian National Curriculum English (ACARA, 2014), which mandates the teaching of multimodal text creation. Data sources included a class set of digital scrapbooks collaboratively created in a preparatory-one primary classroom. The digital scrapbooks combined digitally encoded words, images of material artifacts, and digital music files. A key feature of the writing and digital design task was to retell and digitally display and archive a cultural narrative of significance to the Indigenous Australian community and its memories and material traces of the past for the future. Data analysis of the students' digital stories involved the application of key themes of negotiated, material, and digitally mediated forms of heritage practice. It drew on Australian Indigenous research by Keddie et al. (2013) to guard against the homogenizing of culture that can arise from a focus on a static view of culture. The interpretation of findings located Indigenous appropriation of social media within broader racialized politics that enables Indigenous literacy to be understood as a dynamic, negotiated, and transgenerational flows of practice. It demonstrates that Indigenous children's use of media production reflects "shifting and negotiated identities" in response to changing media environments that can function to sustain Indigenous cultural heritages (Appadurai, 1696, p. xv). Impact on practice, policy or theory The findings are important for teachers at a time when Aboriginal and Torres Strait Islander Histories and Cultures is a cross-curricular policy priority in the Australian Curriculum (ACARA, 2014). The findings show how curriculum policies can be applied to classroom practice in ways that are epistemologically consistent with Indigenous ways of knowing and being. Theoretically, it demonstrates how the children's experiences of culture are layered over time, as successive generations inherit, interweave, and hear others' cultural stories or maps. Practically, recommendations are provided for an approach to appropriating social media in schools that explicitly attends to the dynamic nature of Indigenous practices, negotiated through intercultural constructions and flows, and opening space for a critical anti-racist approach to multimodal text production. Timeliness The research is timely in the context of the accessibility and role of digital and multimodal forms of communication, including for Aboriginal and Torres Strait Islander communities.

Enhancing Raman signal sufficiently for practical sensing applications

Techniques are presented for enhancing weak Raman scattering signals for rapid yet accurate substance detection. Novel surfaces that allow signal enhancement quantification are described as are eye-safe methodologies that maximize the stand-off Raman detection range.

Pollen image classification using the classifynder system: Algorithm comparison and a case study on New Zealand honey

We describe an investigation into how Massey University’s Pollen Classifynder can accelerate the understanding of pollen and its role in nature. The Classifynder is an imaging microscopy system that can locate, image and classify slide based pollen samples. Given the laboriousness of purely manual image acquisition and identification it is vital to exploit assistive technologies like the Classifynder to enable acquisition and analysis of pollen samples. It is also vital that we understand the strengths and limitations of automated systems so that they can be used (and improved) to compliment the strengths and weaknesses of human analysts to the greatest extent possible. This article reviews some of our experiences with the Classifynder system and our exploration of alternative classifier models to enhance both accuracy and interpretability. Our experiments in the pollen analysis problem domain have been based on samples from the Australian National University’s pollen reference collection (2,890 grains, 15 species) and images bundled with the Classifynder system (400 grains, 4 species). These samples have been represented using the Classifynder image feature set.We additionally work through a real world case study where we assess the ability of the system to determine the pollen make-up of samples of New Zealand honey. In addition to the Classifynder’s native neural network classifier, we have evaluated linear discriminant, support vector machine, decision tree and random forest classifiers on these data with encouraging results. Our hope is that our findings will help enhance the performance of future releases of the Classifynder and other systems for accelerating the acquisition and analysis of pollen samples.

A comparison of classification algorithms within the Classifynder pollen imaging system

We describe an investigation into how Massey University's Pollen Classifynder can accelerate the understanding of pollen and its role in nature. The Classifynder is an imaging microscopy system that can locate, image and classify slide based pollen samples. Given the laboriousness of purely manual image acquisition and identification it is vital to exploit assistive technologies like the Classifynder to enable acquisition and analysis of pollen samples. It is also vital that we understand the strengths and limitations of automated systems so that they can be used (and improved) to compliment the strengths and weaknesses of human analysts to the greatest extent possible. This article reviews some of our experiences with the Classifynder system and our exploration of alternative classifier models to enhance both accuracy and interpretability. Our experiments in the pollen analysis problem domain have been based on samples from the Australian National University's pollen reference collection (2890 grains, 15 species) and images bundled with the Classifynder system (400 grains, 4 species). These samples have been represented using the Classifynder image feature set. In addition to the Classifynder's native neural network classifier, we have evaluated linear discriminant, support vector machine, decision tree and random forest classifiers on these data with encouraging results. Our hope is that our findings will help enhance the performance of future releases of the Classifynder and other systems for accelerating the acquisition and analysis of pollen samples. © 2013 AIP Publishing LLC.

Drama, storymaking and iPads in the early years

In this chapter we consider how the iPad and selected applications such as Draw and Tell (Duck Duck Moose, 2013), Popplet (Notion Inc., 2013) and Puppet Pals (Polished Play LLC, 2013) can assist children in collaborative storying, retelling and sequencing story moments that can assist young children in their acquisition of oracy and their understanding of the world, both real and imagined, and their personal relationships. The data gathered from the project will also analysed through the lense of “critical and creative thinking” (ACARA, 2013, p.20-21) skills articulated as one of the general capabilities required in all subject areas of the Australian national curriculum, but which has particular application to The Arts subject areas. In this chapter, we consider artefacts created by preschool children using iPads and selected apps and interviews conducted with preschool children and their caregivers during our research project. We then offer examples of practice to assist preschool teachers in supporting children in their storymaking using the iPad and discuss approaches for engagement that twins the live and mediatised representation of a story.

Teaching dispute resolution in the first year for law student well-being

At the QUT Law School, the most recent curriculum review responded to an increasing demand from the profession for law graduates to be equipped with dispute resolution knowledge, skills and attitudes. From 2015, a compulsory dispute resolution subject will be a critical part of an intentionally designed core first year curriculum. It is important for the Law School at QUT that no graduate of the new curriculum will leave our institution without real world dispute resolution knowledge and skills. This initiative is also grounded in evidenced-based research about the benefits for student well-being that derive from the subject content and pedagogy of dispute resolution. This paper explains why teaching dispute resolution in the first year of the law degree is an important strategy for promoting the well-being of law students.

Towards a theoretical framework for online professional discussions

Online interactions are becoming commonplace for a multitude of educational purposes. Each context presents a unique and dynamic mix of variables that combine to shape the practice and the identities of those involved. In this article, sociocultural theories of learning and sociocultural theories of technology are explored as a way to view and to map the complex interactions that can occur. The case of synchronous online moderation meetings are used as an example of the combination of variables that can impact on the development of shared understandings of a practice. Online moderation can involve teachers from geographically diverse areas discussing and negotiating their judgement decisions. These discussions represent an intersection of a national curriculum, standards-referenced assessment, moderation protocols, site-specific practices and understandings, and individual teachers’ knowledges and histories. It is suggested that the proposed theoretical combination addresses some of the limitations of each of the theories when investigating such a dynamic context. As higher education moves into increasing use of online modes of communication and a higher level of accountability the relevance of this discussion to higher education is evident.

Patient engagement: What and who is it good for?

A huge and diverse literature emphasises that patient engagement is a key factor in: effective health service delivery; quality and safety; responsive health services; patient satisfaction; improved health outcomes; and reduced health care costs. Yet there are also cautionary caveats regarding this discourse. Additionally, although contemporary recommendations regarding good practice and National Health Standards point to the importance of patient engagement and health service providers are striving to implement them in practice, on the ground patient engagement is ‘all things to all people’ with widespread confusion about what patient engagement is and how it could be facilitated. In terms of scholarship, there is a dearth of theoretical and critical examination of what patient engagement constitutes, its application and effects. This analysis aims to contribute to scholarly debate and increased understanding of the use of patient engagement in health policy and practice.

Rediscovering law students as citizens: Critical thinking and the public value of legal education

In a series of publications over the last decade, Australian National University Professor Margaret Thornton has documented a disturbing change in the nature of legal education. This body of work culminates in a recently published book based on interviews with 145 legal academics in Australia, the United Kingdom, New Zealand and Canada. In it, Thornton describes a feeling of widespread unease among legal academics that society, government, university administrators and students themselves are moving away from viewing legal education as a public good which benefits both students and society. Instead, legal education is increasingly being viewed as a purely private good, for consumption by the student in the quest for individual career enhancement.

Open access spatial data and collaboration

On 19 June 2015, representatives from over 40 Australian research institutions gathered in Canberra to launch their Open Data Collections. The one day event, hosted by the Australian National Data Service (ANDS), showcased to government and a range of national stakeholders the rich variety of data collections that have been generated through the Major Open Data Collections (MODC) project. Colin Eustace attended the showcase for QUT Library and presented a poster that reflected the work that he and Jodie Vaughan generated through the project. QUT’s Blueprint 4, the University’s five-year institutional strategic plan, outlines the key priorities of developing a commitment to working in partnership with industry, as well as combining disciplinary strengths with interdisciplinary application. The Division of Technology, Information and Learning Support (TILS) has undertaken a number of Australian National Data Service (ANDS) funded projects since 2009 with the aim of developing improved research data management services within the University to support these strategic aims. By leveraging existing tools and systems developed during these projects, the Major Open Data Collection (MODC) project delivered support to multi-disciplinary collaborative research activities through partnership building between QUT researchers and Queensland government agencies, in order to add to and promote the discovery and reuse of a collection of spatially referenced datasets. The MODC project built upon existing Research Data Finder infrastructure (which uses VIVO open source software, developed by Cornell University) to develop a separate collection, Spatial Data Finder (https://researchdatafinder.qut.edu.au/spatial) as the interface to display the spatial data collection. During the course of the project, 62 dataset descriptions were added to Spatial Data Finder, 7 added to Research Data Finder and two added to Software Finder, another separate collection. The project team met with 116 individual researchers and attended 13 school and faculty meetings to promote the MODC project and raise awareness of the Library’s services and resources for research data management.

Using competences and competence tools in workforce development

The NHS Knowledge and Skills Framework (KSF) has been a driving force in the move to competence-based workforce development in the NHS. Skills for Health has developed national workforce competences that aim to improve behavioural performance, and in turn increase productivity. This article describes five projects established to test Skills for Health national workforce competences, electronic tools and products in different settings in the NHS. Competences and competence tools were used to redesign services, develop job roles, identify skills gaps and develop learning programmes. Reported benefits of the projects included increased clarity and a structured, consistent and standardized approach to workforce development. Findings from the evaluation of the tools were positive in terms of their overall usefulness and provision of related training/support. Reported constraints of using the competences and tools included issues relating to their availability, content and organization. It is recognized that a highly skilled and flexible workforce is important to the delivery of high-quality health care. These projects suggest that Skills for Health competences can be used as a 'common currency' in workforce development in the UK health sector. This would support the need to adapt rapidly to changing service needs.

Water transformed: Sustainable water solutions for climate change adaptation

This online textbook provides free access to a comprehensive education and training package that brings together the knowledge of how countries, specifically Australia, can adapt to climate change. This resource has been developed formally as part of the Federal Government’s Department of Climate Change’s Climate Change Adaptation Professional Skills program.

The culture wars of climate change

Of late, there has been a growth in cultural expression about climate change – with the rise of climate fiction (‘cli-fi’); art and photography responding to changes in nature; musical anthems about climate change; plays and dramas about climate change; and environmental documentaries, and climate cinema. Drawing comparisons to past controversies over cultural funding, this paper considers the cultural wars over climate change. This article considers a number of cultural fields. Margaret Atwood made an important creative and critical contribution to the debate over climate change. The work examines Ian McEwan's novel, Solar, a tragi-comedy about authorship, invention, intellectual property, and climate science. After writing a history of Merchants of Doubt, Naomi Oreskes and Erik Conway have experimented with fiction – as well as history. This article focuses upon artistic works about climate change. It analyses James Balog’s work with the Extreme Ice Survey, which involved photography of glaciers under retreat in a warming world. The work was turned into a documentary called Chasing Ice. It also considers the artistic project of 350.org 'to transform the human rights and environmental issues connected to climate change into powerful art that gets people to stop, think and act.' The paper examines musical storytelling in respect of climate change. The paper explores dramatic works about climate change including Steve Waters' The Contingency Plan, Stephen Emmott's Ten Billion, and Andrew Bovell's When the Rain Stops Falling and Hannie Rayson’s Extinction. The paper also examines the role of documentary film-making. It also considers the cinematographic film, Beasts of the Southern Wild. Such a survey will enable a consideration of the larger question of whether creative art about climate change matters; and whether it is deserving of public funding.