The transition to palliative care: A critical exploration in the context of metastatic melanoma

This research explored the transition to palliative care process through critical analysis of the experiences of patients diagnosed with metastatic melanoma, family carers and health professionals. The outcomes depict a complex intersection between acute care services and palliative care where the discipline of palliative care struggled to position itself within a highly specialised health system. The findings indicate uncertainty around scopes of practice with ambiguity and tension around the transition to palliative care. The research thus argues for stronger and more coherent partnerships and a critical and interdisciplinary conversation about the positioning of palliative care in the acute care sector.

A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010

BACKGROUND Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. METHODS We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. FINDINGS In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% [95% uncertainty interval 6·2-7·7] of global DALYs), tobacco smoking including second-hand smoke (6·3% [5·5-7·0]), and alcohol use (5·5% [5·0-5·9]). In 1990, the leading risks were childhood underweight (7·9% [6·8-9·4]), household air pollution from solid fuels (HAP; 7·0% [5·6-8·3]), and tobacco smoking including second-hand smoke (6·1% [5·4-6·8]). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2-10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0·9% (0·4-1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. INTERPRETATION Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children.

LunaRoo: A Proposal for the Google Lunar XPrize Payload Opportunity with the Part Time Scientists team

This proposal describes the innovative and competitive lunar payload solution developed at the Queensland University of Technology (QUT)–the LunaRoo: a hopping robot designed to exploit the Moon's lower gravity to leap up to 20m above the surface. It is compact enough to fit within a 10cm cube, whilst providing unique observation and mission capabilities by creating imagery during the hop. This first section is deliberately kept short and concise for web submission; additional information can be found in the second chapter.

The positioning of palliative care in acute care: A multiperspective qualitative study in the context of metastatic melanoma

Objective: The positioning and meaning of palliative care within the healthcare system lacks clarity which adds a level of complexity to the process of transition to palliative care. This study explores the transition to the palliative care process in the acute care context of metastatic melanoma. Method: A theoretical framework drawing on interpretive and critical traditions informs this research. The pragmatism of symbolic interactionism and the critical theory of Habermas brought a broad orientation to the research. Integration of the theoretical framework and grounded-theory methods facilitated data generation and analysis of 29 interviews with patients, family carers, and healthcare professionals. Results: The key analytical findings depict a scope of palliative care that was uncertain for users of the system and for those working within the system. Becoming “palliative” is not a defined event; nor is there unanimity around referral to a palliative care service. As such, ambiguity and tension contribute to the difficulties involved in negotiating the transition to palliative care. Significance of Results: Our findings point to uncertainty around the scopes of practice in the transition to palliative care. The challenge in the transition process lies in achieving greater coherency of care within an increasingly specialized healthcare system. The findings may not only inform those within a metastatic melanoma context but may contribute more broadly to palliative practices within the acute care setting.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

From vision to actions: Towards adaptive and autonomous humanoid robots

Although robotics research has seen advances over the last decades robots are still not in widespread use outside industrial applications. Yet a range of proposed scenarios have robots working together, helping and coexisting with humans in daily life. In all these a clear need to deal with a more unstructured, changing environment arises. I herein present a system that aims to overcome the limitations of highly complex robotic systems, in terms of autonomy and adaptation. The main focus of research is to investigate the use of visual feedback for improving reaching and grasping capabilities of complex robots. To facilitate this a combined integration of computer vision and machine learning techniques is employed. From a robot vision point of view the combination of domain knowledge from both imaging processing and machine learning techniques, can expand the capabilities of robots. I present a novel framework called Cartesian Genetic Programming for Image Processing (CGP-IP). CGP-IP can be trained to detect objects in the incoming camera streams and successfully demonstrated on many different problem domains. The approach requires only a few training images (it was tested with 5 to 10 images per experiment) is fast, scalable and robust yet requires very small training sets. Additionally, it can generate human readable programs that can be further customized and tuned. While CGP-IP is a supervised-learning technique, I show an integration on the iCub, that allows for the autonomous learning of object detection and identification. Finally this dissertation includes two proof-of-concepts that integrate the motion and action sides. First, reactive reaching and grasping is shown. It allows the robot to avoid obstacles detected in the visual stream, while reaching for the intended target object. Furthermore the integration enables us to use the robot in non-static environments, i.e. the reaching is adapted on-the- fly from the visual feedback received, e.g. when an obstacle is moved into the trajectory. The second integration highlights the capabilities of these frameworks, by improving the visual detection by performing object manipulation actions.

Modernity, postmodernity and identity of jazz in Chile : The cases of the generation of 1990 and Ángel Parra

This research is about jazz in Chile in relation to modernity and identity. Final chapters focus and detach latest jazz musician s generation in 1990 decade and composer guitarist Angel Parra. An historic and sociological approach is developed, which will be useful for modernity and identity analysis, and so on post modernity and globalization. Modernity has been studied in texts of Adorno, Baudrillard, Brünner, García Canclini, Habermas and Jameson. Identity has been studied in texts of Aharonián, Cordúa, Garretón, Gissi, Larraín and others. Chapter 3 is about Latin-American musicology and jazz investigations, in relation to approach developed in chapter 2. Chapters 4 and 5 are about history of jazz in Chile until beginning of XXI century. Chapter 6 focuses in Ángel Parra Orrego. Conclusions of this investigation detach the modernist mechanical that has conducted jazz development in Chile, which in Ángel Parra´s case has been overcame by a post modernist behaviour. This behaviour has solved in a creative way, subjects like modernity and identity in jazz practice in a Latin-American country.

Henipaviruses: Emerging Paramyxoviruses Associated with Fruit Bats

Two related, novel, zoonotic paramyxoviruses have been described recently. Hendra virus was first reported in horses and thence humans in Australia in 1994; Nipah virus was first reported in pigs and thence humans in Malaysia in 1998. Human cases of Nipah virus infection, apparently unassociated with infection in livestock, have been reported in Bangladesh since 2001. Species of fruit bats (genus Pteropus ) have been identified as natural hosts of both agents. Anthropogenic changes (habitat loss, hunting) that have impacted the population dynamics of Pteropus species across much of their range are hypothesised to have facilitated emergence. Current strategies for the management of henipaviruses are directed at minimising contact with the natural hosts, monitoring identified intermediate hosts, improving biosecurity on farms, and better disease recognition and diagnosis. Investigation of the emergence and ecology of henipaviruses warrants a broad, cross-disciplinary ecosystem health approach that recognises the critical linkages between human activity, ecological change, and livestock and human health.

Käsityöläisyyden kuva kultasepän ammatissa : Käsityöläisyys Suomen Kultaseppien Liiton lehdessä 1990-luvun lopussa

The aim of this study is to survey the meaning of craftmanship in goldsmith occupation. The image of craftmanship is built theoretically as well as researcher's own practical experience. The study describes a dialogue between self-employed goldsmith s everyday work and trade union's opinion. Suomen Kultaseppien Liitto (The Goldsmith Assosiation of Finland) was chosen forthe trade union, because it is the biggest, the oldest and the most influential on the occupational area. The research data are volumes 1995 - 1998 of occupational membership journal of Suomen Kultaseppien Liitto. The data analyzed with Adapted Content Analysis and Grounded Theory. The professional occupation of goldsmiths, the role of craftmanship and the future of the occupation are discussed. Additionally, the relationship between the Suomen Kultaseppien Liitto and occupational culture and profession of goldsmiths was studied. Craft and craftmanship is most often discussed in articles related to tradition and education.Craftmanship is understood very idealistically, with little meaning in practical life. St. Eligius and the skill and art of goldsmiths in St Petersburg are raised to symbols of craftmanship. The occupational image is broken and a clear conflict between education and occupation is visible. Education produces artist-craftsmen, while handicraft workers are required in industry, and retailers or specially trained store assistant in business. Computer-aided design and manufacture render handicraft workmanship unnecessary. In a pessimistic view, the future possibilities of the goldsmith occupational profession are dim, because the artist-craftsmen are bound to lose to fast-paced machines. On the other hand, people involved in goldsmith education see the future light, designer-goldsmiths developing the occupational to new dimensions. Suomen Kultaseppien Liitto represents goldsmiths in public. The union, however is governed by non-artisan goldsmiths. The union stresses business attitudes and enterpreneurship, and has succeeded in protecting the privileges of retailers and industry. Goldsmiths profession is seen in the research data as a combination of precious-metal industry, jewellery and watch stores, anda goldsmith shop is considered a specialized giftstore. The goldsmiths occupation is not a profession, and the Suomen Kultaseppien Liitto is not a trade union for artist and craftmen. Accordingly, part of the representative authority of the union could be transferred from the Association to Taidekäsityöläiset Taiko ry, a member of organization of Ornamo. Results of this study show the importance of defining the images of the goldsmith occupational profession and the trade union. The results could be applied to goldsmith education to examine what would be the optimal education and training for present employment opportunities. The important background theories has been the theories of Habermas and Lévi-Strauss.

New genetic loci link adipose and insulin biology to body fat distribution

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10−8). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms.

Genetic studies of body mass index yield new insights for obesity biology

Obesity is heritable and predisposes to many diseases. To understand the genetic basis of obesity better, here we conduct a genome-wide association study and Metabochip meta-analysis of body mass index (BMI), a measure commonly used to define obesity and assess adiposity, in up to 339,224 individuals. This analysis identifies 97 BMI-associated loci (P < 5 × 10−8), 56 of which are novel. Five loci demonstrate clear evidence of several independent association signals, and many loci have significant effects on other metabolic phenotypes. The 97 loci account for ~2.7% of BMI variation, and genome-wide estimates suggest that common variation accounts for >20% of BMI variation. Pathway analyses provide strong support for a role of the central nervous system in obesity susceptibility and implicate new genes and pathways, including those related to synaptic function, glutamate signalling, insulin secretion/action, energy metabolism, lipid biology and adipogenesis.

Meta-analysis identifies 13 new loci associated with waist-hip ratio and reveals sexual dimorphism in the genetic basis of fat distribution

Waist-hip ratio (WHR) is a measure of body fat distribution and a predictor of metabolic consequences independent of overall adiposity. WHR is heritable, but few genetic variants influencing this trait have been identified. We conducted a meta-analysis of 32 genome-wide association studies for WHR adjusted for body mass index (comprising up to 77,167 participants), following up 16 loci in an additional 29 studies (comprising up to 113,636 subjects). We identified 13 new loci in or near RSPO3, VEGFA, TBX15-WARS2, NFE2L3, GRB14, DNM3-PIGC, ITPR2-SSPN, LY86, HOXC13, ADAMTS9, ZNRF3-KREMEN1, NISCH-STAB1 and CPEB4 (P = 1.9 × 10−9 to P = 1.8 × 10−40) and the known signal at LYPLAL1. Seven of these loci exhibited marked sexual dimorphism, all with a stronger effect on WHR in women than men (P for sex difference = 1.9 × 10−3 to P = 1.2 × 10−13). These findings provide evidence for multiple loci that modulate body fat distribution independent of overall adiposity and reveal strong gene-by-sex interactions.

Towards vision-based deep reinforcement learning for robotic motion control

This paper introduces a machine learning based system for controlling a robotic manipulator with visual perception only. The capability to autonomously learn robot controllers solely from raw-pixel images and without any prior knowledge of configuration is shown for the first time. We build upon the success of recent deep reinforcement learning and develop a system for learning target reaching with a three-joint robot manipulator using external visual observation. A Deep Q Network (DQN) was demonstrated to perform target reaching after training in simulation. Transferring the network to real hardware and real observation in a naive approach failed, but experiments show that the network works when replacing camera images with synthetic images.

Extending visual perception with haptic exploration for improved scene understanding

Scene understanding has been investigated from a mainly visual information point of view. Recently depth has been provided an extra wealth of information, allowing more geometric knowledge to fuse into scene understanding. Yet to form a holistic view, especially in robotic applications, one can create even more data by interacting with the world. In fact humans, when growing up, seem to heavily investigate the world around them by haptic exploration. We show an application of haptic exploration on a humanoid robot in cooperation with a learning method for object segmentation. The actions performed consecutively improve the segmentation of objects in the scene.

Characterisation of the impact of open biomass burning on urban air quality in Brisbane, Australia

Open biomass burning from wildfires and the prescribed burning of forests and farmland is a frequent occurrence in South-East Queensland (SEQ), Australia. This work reports on data collected from 10-30 September 2011, which covers the days before (10-14 September), during (15-20 September) and after (21-30 September) a period of biomass burning in SEQ. The aim of this project was to comprehensively quantify the impact of the biomass burning on air quality in Brisbane, the capital city of Queensland. A multi-parameter field measurement campaign was conducted and ambient air quality data from 13 monitoring stations across SEQ were analysed. During the burning period, the average concentrations of all measured pollutants increased (from 20% to 430%) compared to the non-burning period (both before and after burning), except for total xylenes. The average concentration of O3, NO2, SO2, benzene, formaldehyde, PM10, PM2.5 and visibility-reducing particles reached their highest levels for the year, which were up to 10 times higher than annual average levels, while PM10, PM2.5 and SO2 concentrations exceeded the WHO 24-hour guidelines and O3 concentration exceeded the WHO maximum 8-hour average threshold during the burning period. Overall spatial variations showed that all measured pollutants, with the exception of O3, were closer to spatial homogeneity during the burning compared to the non-burning period. In addition to the above, elevated concentrations of three biomass burning organic tracers (levoglucosan, mannosan and galactosan), together with the amount of non-refractory organic particles (PM1) and the average value of f60 (attributed to levoglucosan), reinforce that elevated pollutant concentration levels were due to emissions from open biomass burning events, 70% of which were prescribed burning events. This study, which is the first and most comprehensive of its kind in Australia, provides quantitative evidence of the significant impact of open biomass burning events, especially prescribed burning, on urban air quality. The current results provide a solid platform for more detailed health and modelling investigations in the future.