Long term survival following the detection of circulating tumour cells in head and neck squamous cell carcinoma

Background Techniques for detecting circulating tumor cells in the peripheral blood of patients with head and neck cancers may identify individuals likely to benefit from early systemic treatment. Methods Reconstruction experiments were used to optimise immunomagnetic enrichment and RT-PCR detection of circulating tumor cells using four markers (ELF3, CK19, EGFR and EphB4). This method was then tested in a pilot study using samples from 16 patients with advanced head and neck carcinomas. Results Seven patients were positive for circulating tumour cells both prior to and after surgery, 4 patients were positive prior to but not after surgery, 3 patients were positive after but not prior to surgery and 2 patients were negative. Two patients tested positive for circulating cells but there was no other evidence of tumor spread. Given this patient cohort had mostly advanced disease, as expected the detection of circulating tumour cells was not associated with significant differences in overall or disease free survival. Conclusion For the first time, we show that almost all patients with advanced head and neck cancers have circulating cells at the time of surgery. The clinical application of techniques for detection of spreading disease, such as the immunomagnetic enrichment RT-PCR analysis used in this study, should be explored further.

Archiving nature’s heartbeat using smart phones

The impact of urban development and climate change has created the impetus to monitor changes in the environment, particularly, the behaviour, habitat and movement of fauna species. The aim of this chapter is to present the design and development of a sensor network based on smart phones to automatically collect and analyse acoustic and visual data for environmental monitoring purposes. Due to the communication and sophisticated programming facilities offered by smart phones, software tools can be developed to allow data to be collected, partially processed and sent to a remote server over the network for storage and further processing. This sensor network which employs a client-server architecture has been deployed in three applications: monitoring a rare bird species near Brisbane Airport, study of koalas behaviour at St Bees Island, and detection of fruit flies. The users of this system include scientists (e.g. ecologists, ornithologists, computer scientists) and community groups participating in data collection or reporting on the environment (e.g. students, bird watchers). The chapter focuses on the following aspects of our research: issues involved in using smart phones as sensors; the overall framework for data acquisition, data quality control, data management and analysis; current and future applications of the smart phone-based sensor network, and our future research directions.

Consumer misbehaviour during professional service encounters

To date, consumer behaviour research is still over-focused on the functional rather than the dysfunctional. Both empirical and anecdotal evidence suggest that service organisations are burdened with the concept of consumer sovereignty, while consumers freely flout the ‘rules’ of social exchange and behave in deviant and dysfunctional ways. Further, the current scope of consumer misbehaviour research suggests that the phenomenon has principally been studied in the context of economically-focused exchange. This limits our current understanding of consumer misbehaviour to service encounters that are more transactional than relational in nature. Consequently, this thesis takes a Social Exchange approach to consumer misbehaviour and reports a three-stage multi-method study that examined the nature and antecedents of consumer misbehaviour in professional services. It addresses the following broad research question: What is the nature of consumer misbehaviour during professional service encounters? Study One initially explored the nature of consumer misbehaviour in professional service encounters using critical incident technique (CIT) within 38 semi-structured in-depth interviews. The study was designed to develop a better understanding of what constitutes consumer misbehaviour from a service provider’s perspective. Once the nature of consumer misbehaviour had been qualified, Study Two focused on developing and refining calibrated items that formed Guttman-like scales for two consumer misbehaviour constructs: one for the most theoretically-central type of consumer misbehaviour identified in Study One (i.e. refusal to participate) and one for the most well-theorised and salient type of consumer misbehaviour (i.e. verbal abuse) identified in Study One to afford a comparison. This study used Rasch modelling to investigate whether it was possible to calibrate the escalating severity of a series of decontextualised behavioural descriptors in a valid and reliable manner. Creating scales of calibrated items that capture the variation in severity of different types of consumer misbehaviour identified in Study One allowed for a more valid and reliable investigation of the antecedents of such behaviour. Lastly, Study Three utilised an experimental design to investigate three key antecedents of consumer misbehaviour: (1) the perceived quality of the service encounter [drawn from Fullerton and Punj’s (1993) model of aberrant consumer behaviour], (2) the violation of consumers’ perceptions of justice and equity [drawn from Rousseau’s (1989) Psychological Contract Theory], and (3) consumers’ affective responses to exchange [drawn from Weiss and Cropanzano’s (1996) Affective Events Theory]. Investigating three key antecedents of consumer misbehaviour confirmed the newly-developed understanding of the nature of consumer misbehaviour during professional service encounters. Combined, the results of the three studies suggest that consumer misbehaviour is characteristically different within professional services. The most salient and theoretically-central behaviours can be measured using increasingly severe decontextualised behavioural descriptors. Further, increasingly severe forms of consumer misbehaviour are likely to occur as a response to consumer anger at low levels of interpersonal service quality. These findings have a range of key implications for both marketing theory and practice.

Measurement and correlates of caregiver self-efficacy amongst family caregivers of persons with dementia living in Shanghai, China

Background: Caring for family members with dementia can be a long-term, burdensome task resulting in physical and emotional distress and impairment. Research has demonstrated significantly lower levels of selfefficacy among family caregivers of people with dementia (CGs) than caregivers of relatives with non-dementia diseases. Intervention studies have also suggested that the mental and physical health of dementia CGs could be improved through the enhancement of their self-efficacy. However, studies are limited in terms of the influences of caregiver self-efficacy on caregiver behaviour, subjective burden and health-related quality of life. Of particular note is that there are no studies on the applicability of caregiver self-efficacy in the social context of China. Objective: The purpose of this thesis was to undertake theoretical exploration using Bandura’s (1997) self-efficacy theory to 1) revise the Revised Caregiving Self-Efficacy Scale (C-RCSES) (Steffen, McKibbin, Zeiss, Gallagher-Thompson, & Bandura, 2002), and 2) explore determinants of caregiver self-efficacy and the role of caregiver self-efficacy and other conceptual constructs (including CGs’ socio-demographic characteristics, CRs’ impairment and CGs’ social support) in explaining and predicting caregiver behaviour, subjective burden and health-related quality of life among CGs in China. Methodology: Two studies were undertaken: a qualitative elicitation study with 10 CGs; and a cross-sectional survey with 196 CGs. In the first study, semi-structured interviews were conducted to explore caregiver behaviours and corresponding challenges for their performance. The findings of the study assisted in the development of the initial items and domains of the Chinese version of the Revised Caregiving Self-Efficacy Scale (C-RCSES). Following changes to items in the scale, the second study, a cross-sectional survey with 196 CGs was conducted to evaluate the psychometric properties of C-RCSES and to test a hypothesised self-efficacy model of family caregiving adapted from Bandura’s theory (1997). Results: 35 items were generated from the qualitative data. The content validity of the C-RCSES was assessed and ensured in Study One before being used for the cross-sectional survey. Eight items were removed and five subscales (caregiver self-efficacy for gathering information about treatment, symptoms and health care; obtaining support; responding to problematic behaviours; management of household, personal and medical care; and controlling upsetting thoughts about caregiving) were identified after principal component factor analysis on the cross-sectional survey data. The reliability of the scale is acceptable: the Cronbach’s alpha coefficients for the whole scale and for each subscale were all over .80; and the fourweek test-retest reliabilities for the whole scale and for each subscale ranged from .64 to .85. The concurrent, convergent and divergent validity were also acceptable. CGs reported moderate levels of caregiver self-efficacy. Furthermore, the level of self-efficacy for management of household, personal and medical care was relatively high in comparison to those of the other four domains of caregiver self-efficacy. Caregiver self-efficacy was also significantly influenced by CGs’ socio-demographic characteristics and the caregiving external factors (CR impairment and social support that CGs obtained). The level of caregiver behaviour that CGs reported was higher than that reported in other Chinese research. CGs’ socio-demographics significantly influenced caregiver behaviour, whereas caregiver self-efficacy did not influence caregiver behaviour. Regarding the two external factors, CGs who cared for highly impaired relatives reported high levels of caregiver behaviour, but social support did not influence caregiver behaviour. Regarding caregiver subjective burden and health-related quality of life, CGs reported moderate levels of subjective burden, and their level of healthrelated quality of life was significantly lower than that of the general population in China. The findings also indicated that CGs’ subjective burden and health-related quality of life were influenced by all major factors in the hypothesised model, including CGs’ socio-demographics, CRs’ impairment, social support that CGs obtained, caregiver self-efficacy and caregiver behaviour. Of these factors, caregiver self-efficacy and social support significantly improved their subjective burden and health-related quality of life; whereas caregiver behaviour and CRs’ impairment were detrimental to CGs, such as increasing subjective burden and worsening health-related quality of life. Conclusion: While requiring further exploration, the qualitative study was the first qualitative research conducted in China to provide an in-depth understanding of CGs’ caregiving experience, including their major caregiver behaviours and the corresponding challenges. Meanwhile, although the C-RCSES needs further psychometric testing, it is a useful tool for assessing caregiver self-efficacy in Chinese populations. Results of the qualitative and quantitative study provide useful information for future studies regarding the explanatory power of caregiver self-efficacy to caregiver behaviour, subjective burden and health-related quality of life. Additionally, integrated with Bandura’s theory, the findings from the quantitative study also suggested a further study exploring the role of outcome expectations in caregiver behaviour, subjective burden and healthrelated quality of life.