Doctors' knowledge of the law on withholding and withdrawing life-sustaining medical treatment

Objectives To examine the level of knowledge of doctors about the law on withholding and withdrawing life-sustaining treatment from adults who lack decision-making capacity, and factors associated with a higher level of knowledge. Design, setting and participants Postal survey of all specialists in emergency medicine, geriatric medicine, intensive care, medical oncology, palliative medicine, renal medicine and respiratory medicine on the AMPCo Direct database in New South Wales, Victoria and Queensland. Survey initially posted to participants on 18 July 2012 and closed on 31 January 2013. Main outcome measures Medical specialists’ levels of knowledge about the law, based on their responses to two survey questions. Results Overall response rate was 32%. For the seven statements contained in the two questions about the law, the mean knowledge score was 3.26 out of 7. State and specialty were the strongest predictors of legal knowledge. Conclusions Among doctors who practise in the end-of-life field, there are some significant knowledge gaps about the law on withholding and withdrawing life-sustaining treatment from adults who lack decision-making capacity. Significant consequences for both patients and doctors can flow from a failure to comply with the law. Steps should be taken to improve doctors’ legal knowledge in this area and to harmonise the law across Australia.

An analytical framework for quantifying aquifer response time scales associated with transient boundary conditions

A major challenge in studying coupled groundwater and surface-water interactions arises from the considerable difference in the response time scales of groundwater and surface-water systems affected by external forcings. Although coupled models representing the interaction of groundwater and surface-water systems have been studied for over a century, most have focused on groundwater quantity or quality issues rather than response time. In this study, we present an analytical framework, based on the concept of mean action time (MAT), to estimate the time scale required for groundwater systems to respond to changes in surface-water conditions. MAT can be used to estimate the transient response time scale by analyzing the governing mathematical model. This framework does not require any form of transient solution (either numerical or analytical) to the governing equation, yet it provides a closed form mathematical relationship for the response time as a function of the aquifer geometry, boundary conditions, and flow parameters. Our analysis indicates that aquifer systems have three fundamental time scales: (i) a time scale that depends on the intrinsic properties of the aquifer; (ii) a time scale that depends on the intrinsic properties of the boundary condition, and; (iii) a time scale that depends on the properties of the entire system. We discuss two practical scenarios where MAT estimates provide useful insights and we test the MAT predictions using new laboratory-scale experimental data sets.

Talking across the fence : partners for art education

This presentation explores a model for building and sustaining secondary – tertiary partnerships in Arts education. It traces the evolution of partner relationships in a challenging educational landscape, assesses the value of dialogue between educators, design professionals and community stakeholders, and tells the story of a particular secondary – tertiary partnership exploring new pedagogy in Art and Design, between Kelvin Grove State College, the School of Design Creative Industries Faculty of QUT, and the Design Minds program of the State Library of Queensland. Among other benefits, tertiary and industry partners have brought a myriad of diverse voices into the classrooms, enabled the direct interaction of learners with tertiary student mentors, and with art and design practitioners. The working model has also now matured into formal and informal partner agreements that help guarantee its viability into the future. This presentation, which deals with the opening of new terrain between committed partners, is also the story of how design has gradually been integrated in the curriculum, enriching and expanding the repertoire of Art programs, and how one Visual Art Faculty in a large inner city Brisbane School has adopted design thinking and “metadesign” as a model for future innovation. From the process of interaction and dialogue among educators and practitioners over several years has emerged a conviction that both partnering and design pedagogy are key tools in developing forward thinking curriculum for the Arts. In addition, hammering out a model that works for students across different year levels and in diverse settings by putting ideas into practice and micro-managing this process in studios and workshops has challenged teachers to rethink their own Art pedagogy. Finally, in the ecosystem of Schools and in the wider systems that are now driving change in education, survival for the Arts may depend on the networking and affirmation derived from innovating partners. Our story, the story of committed individuals who have sustained a dialogue across boundaries, may provide a valuable model for other arts educators fighting to retain agency in their schools.

Acute interval exercise intensity does not affect appetite and nutrient preferences in overweight and obese males

This study investigated the influence of two different intensities of acute interval exercise on food preferences and appetite sensations in overweight and obese men. Twelve overweight/obese males (age=29.0±4.1 years; BMI =29.1±2.4 kg/m2) completed three exercise sessions: an initial graded exercise test, and two interval cycling sessions: moderate-(MIIT) and high-intensity (HIIT) interval exercise sessions on separate days in a counterbalanced order. The MIIT session involved cycling for 5-minute repetitions of alternate workloads 20% below and 20% above maximal fat oxidation. The HIIT session consisted of cycling for alternate bouts of 15 seconds at 85% VO2max and 15 seconds unloaded recovery. Appetite sensations and food preferences were measured immediately before and after the exercise sessions using the Visual Analogue Scale and the Liking & Wanting experimental procedure. Results indicated that liking significantly increased and wanting significantly decreased in all food categories after both MIIT and HIIT. There were no differences between MIIT and HIIT on the effect on appetite sensations and Liking & Wanting. In conclusion, manipulating the intensity of acute interval exercise did not affect appetite and nutrient preferences.

The impact of a congestion pricing exemption on the demand for new energy efficient vehicles in Stockholm

As governments seek to transition to more efficient vehicle fleets, one strategy has been to incentivize ‘green’ vehicle choice by exempting some of these vehicles from road user charges. As an example, to stimulate sales of Energy-Efficient Vehicles (EEVs) in Sweden, some of these automobiles were exempted from Stockholm’s congestion tax. In this paper the effect this policy had on the demand for new, privately-owned, exempt EEVs is assessed by first estimating a model of vehicle choice and then by applying this model to simulate vehicle alternative market shares under different policy scenarios. The database used to calibrate the model includes owner-specific demographics merged with vehicle registry data for all new private vehicles registered in Stockholm County during 2008. Characteristics of individuals with a higher propensity to purchase an exempt EEV were identified. The most significant factors included intra-cordon residency (positive), distance from home to the CBD (negative), and commuting across the cordon (positive). By calculating vehicle shares from the vehicle choice model and then comparing these estimates to a simulated scenario where the congestion tax exemption was inactive, the exemption was estimated to have substantially increased the share of newly purchased, private, exempt EEVs in Stockholm by 1.8% (+/- 0.3%; 95% C.I.) to a total share of 18.8%. This amounts to an estimated 10.7% increase in private, exempt EEV purchases during 2008 i.e. 519 privately owned, exempt EEVs.

Assessment of the short-term success of a translocation of lesser short-tailed bats Mystacina tuberculata

Translocation is a powerful tool that has been used in the conservation of a wide range of taxa. However, few translocations of bats have been attempted and we know of no successes. The few translocations which have been attempted have either failed due to dispersal from the release site or have not been monitored sufficiently to determine the cause of failure. We assessed the short-term success of a translocation of lesser short-tailed bats Mystacina tuberculata by the New Zealand Department of Conservation, where 3 release methods were used to minimise dispersal or mortality: bats were juveniles, were maintained in captivity at the release site, and were provided with supplementary food and roosts following release. Success was assessed by determining if founders remained at the release site and maintained condition (weight). Recapture showed that at least 9 of the 20 bats remained at the release site 232 d after release. There was weak evidence that bats lost weight, although final weights were comparable to those of bats from a natural population. However, all bats caputred 8 mo after release had damaged, infected ears and some were balding. The problem was treated but recurred, and bats were returned to captivity. Our results are th first to demonstrate that translocated bats can remain at their release site and survive. However, disease may be an issue in future translocations.

A new approach to estimating trends in chlamydia incidence

Objectives Directly measuring disease incidence in a population is difficult and not feasible to do routinely. We describe the development and application of a new method of estimating at a population level the number of incident genital chlamydia infections, and the corresponding incidence rates, by age and sex using routine surveillance data. Methods A Bayesian statistical approach was developed to calibrate the parameters of a decision-pathway tree against national data on numbers of notifications and tests conducted (2001-2013). Independent beta probability density functions were adopted for priors on the time-independent parameters; the shape parameters of these beta distributions were chosen to match prior estimates sourced from peer-reviewed literature or expert opinion. To best facilitate the calibration, multivariate Gaussian priors on (the logistic transforms of) the time-dependent parameters were adopted, using the Matérn covariance function to favour changes over consecutive years and across adjacent age cohorts. The model outcomes were validated by comparing them with other independent empirical epidemiological measures i.e. prevalence and incidence as reported by other studies. Results Model-based estimates suggest that the total number of people acquiring chlamydia per year in Australia has increased by ~120% over 12 years. Nationally, an estimated 356,000 people acquired chlamydia in 2013, which is 4.3 times the number of reported diagnoses. This corresponded to a chlamydia annual incidence estimate of 1.54% in 2013, increased from 0.81% in 2001 (~90% increase). Conclusions We developed a statistical method which uses routine surveillance (notifications and testing) data to produce estimates of the extent and trends in chlamydia incidence.

Mortality attributable to smoking in Vietnamese men in 2008

Objective Smoking prevalence among Vietnamese men is among the highest in the world. Our aim was to provide estimates of tobacco attributable mortality to support tobacco control policies. Method We used the Peto–Lopez method using lung cancer mortality to derive a Smoking Impact Ratio (SIR) as a marker of cumulative exposure to smoking. SIRs were applied to relative risks from the Cancer Prevention Study, Phase II. Prevalence-based and hybrid methods, using the SIR for cancers and chronic obstructive pulmonary disease and smoking prevalence for all other outcomes, were used in sensitivity analyses. Results When lung cancer was used to measure cumulative smoking exposure, 28% (95% uncertainty interval 24–31%) of all adult male deaths (> 35 years) in Vietnam in 2008 were attributable to smoking. Lower estimates resulted from prevalence-based methods [24% (95% uncertainty interval 21–26%)] with the hybrid method yielding intermediate estimates [26% (95% uncertainty interval 23–28%)]. Conclusion Despite uncertainty in these estimates of attributable mortality, tobacco smoking is already a major risk factor for death in Vietnamese men. Given the high current prevalence of smoking, this has important implications not only for preventing the uptake of tobacco but also for immediate action to adopt and enforce stronger tobacco control measures.

Designing with people with disabilities : adapting best practices of DIY and organizational approaches

Individualization of design is often necessary particularly when designing with people with disabilities. Maker communities, with their flexible Do-It-Yourself (DIY) practices, offer potential to support individualized and cost-effective product design. However, efforts to adapt DIY practices in designing with people with disabilities tend to face difficulties with regard to continuous commitment, infrastructure provision and proper guidance. We carried out interviews with diverse stakeholders in the disability services sector and carried out observations of local makerspaces to understand their current practices and potential for future collaborations. We found that makerspace participants face difficulties in terms of infrastructure provision and proper guidance whereas Disability Service Organizations face difficulties in continuous expertise. We suggest that artful infrastructuring to blend the best of both approaches offers potential to create a sustainable community that can design individualized technologies to support people with disabilities.

The relationship between controlling feeding practices and boys’ and girls’ eating in the absence of hunger

Parental controlling feeding practices have been directly associated with maladaptive child eating behaviours, such as Eating in the Absence of Hunger (EAH). The aim of this study was to examine EAH in very young children (3-4 years old) and to investigate the association between maternal controlling feeding practices and energy intake from a standardised selection of snacks consumed ‘in the absence of hunger’. Thirty-seven mother-child dyads enrolled in the NOURISH RCT participated in a modified EAH protocol conducted in the child’s home. All children displayed EAH, despite 80% reporting to be full or very full following completion of lunch 15 minutes earlier. The relationship between maternal and child covariates and controlling feeding practices and EAH were examined using non-parametric tests, and were stratified by child gender. For boys only, pressure to eat was positively associated with EAH. Neither restriction nor monitoring practices were associated with EAH in either boys or girls. Overall, the present findings suggest gender differences in the relationship between maternal feeding practices and children’s eating behaviours emerge early and should be considered in future research and intervention design.

DS-VBF : dual sink vector-based routing protocol for underwater wireless sensor network

Underwater wireless sensor networks (UWSNs) have become the seat of researchers' attention recently due to their proficiency to explore underwater areas and design different applications for marine discovery and oceanic surveillance. One of the main objectives of each deployed underwater network is discovering the optimized path over sensor nodes to transmit the monitored data to onshore station. The process of transmitting data consumes energy of each node, while energy is limited in UWSNs. So energy efficiency is a challenge in underwater wireless sensor network. Dual sinks vector based forwarding (DS-VBF) takes both residual energy and location information into consideration as priority factors to discover an optimized routing path to save energy in underwater networks. The modified routing protocol employs dual sinks on the water surface which improves network lifetime. According to deployment of dual sinks, packet delivery ratio and the average end to end delay are enhanced. Based on our simulation results in comparison with VBF, average end to end delay reduced more than 80%, remaining energy increased 10%, and the increment of packet reception ratio was about 70%.

Combining initial segments of lists

We propose a new way to build a combined list from K base lists, each containing N items. A combined list consists of top segments of various sizes from each base list so that the total size of all top segments equals N. A sequence of item requests is processed and the goal is to minimize the total number of misses. That is, we seek to build a combined list that contains all the frequently requested items. We first consider the special case of disjoint base lists. There, we design an efficient algorithm that computes the best combined list for a given sequence of requests. In addition, we develop a randomized online algorithm whose expected number of misses is close to that of the best combined list chosen in hindsight. We prove lower bounds that show that the expected number of misses of our randomized algorithm is close to the optimum. In the presence of duplicate items, we show that computing the best combined list is NP-hard. We show that our algorithms still apply to a linearized notion of loss in this case. We expect that this new way of aggregating lists will find many ranking applications.