Intravascular device-related research : future priority areas for cancer nursing

The majority of cancer nurses have to manage intravascular devices (IVDs) on a daily basis, thus placing nurses in the strongest position to generate and use best available evidence to inform this area of practice and to ensure that patients are receiving the best care available. Our literature clearly reflects that cancer nurses are concerned about complications associated with IVDs (eg, extravasation,1 IVD-related bloodstream infection [IVD-BSI],2,3 and thrombosis4). Although enormous attention is given to this area, a number of nursing practices are not sufficiently based on empirical evidence.5,6 Nurses need to set goals and priorities for future research and investments. Priority areas for future research are suggested here for your consideration.

Core competencies required for managing occupational road risks

To provide valuable industry information with human resource applications, this study aimed to identify the minimum level of competency required within organisations to manage occupational road risk. Senior managers from four Australian organisations participated in individual semi-structured interviews. These senior managers were responsible for a combined workforce of approximately 46,000 and a combined fleet of approximately 20,000. The managers assessed a list of 39 safety management tasks that had previously been identified as critical to the management of Occupational Health and Safety (OHS) performance within the construction industry. From this list the managers perceived that organisational personnel required competency in at least 14 of the safety tasks to meet a minimum standard of road risk management. Managers perceived that a full understanding of at least six of these tasks was critical. These six tasks comprised: hazard identification and control; providing OHS information and instruction; incident investigations; inspections of workplace and work tasks; researching and reporting on OHS issues and strategies; and applying legislative OHS requirements. It is hoped that the core competencies identified in this study may assist in the development of an internationally accepted competency framework for managing occupational road risks. This proposed competency framework could have many applications including guiding the design of job descriptions, training curriculums, and employee performance assessments. To build upon this study, the authors recommend future research be conducted to identify the key competencies required to manage occupational road safety across a broad range of organisational contexts.

Improving asset management process modelling and integration

Asset management (AM) processes play an important role in assisting enterprises to manage their assets more efficiently. To visualise and improve AM processes, the processes need to be modelled using certain process modelling methodologies. Understanding the requirements for AM process modelling is essential for selecting or developing effective AM process modelling methodologies. However, little research has been done on analysing the requirements. This paper attempts to fill this gap by investigating the features of AM processes. It is concluded that AM process modelling requires intuitive representation of its processes, ‘fast’ implementation of the process modelling, effective evaluation of the processes and sound system integration.

Occupant comfort, the housing industry and electricity infrastructure : understanding the synergies

Despite increasingly stringent energy performance regulations for new homes, southeast Queensland has a high and growing penetration of, and reliance on, air conditioners to provide thermal comfort to housing inhabitants. This reliance impacts on electricity infrastructure investment which is the key driving force behind rising electricity prices. This paper reports initial findings of a research project that seeks to better understand three key issues: (i) how families manage their thermal comfort in summer and how well their homes limit overheating; (ii) the extent to which the homes have been constructed according to the building approval documentation; and (iii) the impact that these issues have on urban design, especially in relation to electricity infrastructure in urban developments.

Use of a clay modeling task to reduce chocolate craving

Elaborated Intrusion theory (EI theory; Kavanagh, Andrade, & May, 2005) posits two main cognitive components in craving: associative processes that lead to intrusive thoughts about the craved substance or activity, and elaborative processes supporting mental imagery of the substance or activity. We used a novel visuospatial task to test the hypothesis that visual imagery plays a key role in craving. Experiment 1 showed that spending 10 min constructing shapes from modeling clay (plasticine) reduced participants' craving for chocolate compared with spending 10 min 'letting your mind wander'. Increasing the load on verbal working memory using a mental arithmetic task (counting backwards by threes) did not reduce craving further. Experiment 2 compared effects on craving of a simpler verbal task (counting by ones) and clay modeling. Clay modeling reduced overall craving strength and strength of craving imagery, and reduced the frequency of thoughts about chocolate. The results are consistent with EI theory, showing that craving is reduced by loading the visuospatial sketchpad of working memory but not by loading the phonological loop. Clay modeling might be a useful self-help tool to help manage craving for chocolate, snacks and other foods.

Adaptive radiotherapy for virally mediated head and neck cancer : predicting which patients may benefit most

Background: Recent clinical studies have demonstrated an emerging subgroup of head and neck cancers that are virally mediated. This disease appears to be a distinct clinical entity with patients presenting younger and with more advanced nodal disease, having lower tobacco and alcohol exposure and highly radiosensitive tumours. This means they are living longer, often with the debilitating functional side effects of treatment. The primary objective of this study was to determine how virally mediated nasopharyngeal and oropharyngeal cancers respond to radiation therapy treatment. The aim was to determine risk categories and corresponding adaptive treatment management strategies to proactively manage these patients. Method/Results: 121 patients with virally mediated, node positive nasopharyngeal or oropharyngeal cancer who received radiotherapy treatment with curative intent between 2005 and 2010 were studied. Relevant patient demographics including age, gender, diagnosis, TNM stage, pre-treatment nodal size and dose delivered was recorded. Each patient’s treatment plan was reviewed to determine if another computed tomography (re-CT) scan was performed and at what time point (dose/fraction) this occurred. The justification for this re-CT was determined using four categories: tumour and/or nodal regression, weight loss, both or other. Patients who underwent a re-CT were further investigated to determine whether a new plan was calculated. If a re-plan was performed, the dosimetric effect was quantified by comparing dose volume histograms of planning target volumes and critical structures from the actual treatment delivered and the original treatment plan. Preliminary results demonstrated that 25/121 (20.7%) patients required a re-CT and that these re-CTs were performed between fractions 20 to 25 of treatment. The justification for these re-CTs consisted of a combination of tumour and/or nodal regression and weight loss. 16/25 (13.2%) patients had a replan calculated. 9 (7.4%) of these replans were implemented clinically due to the resultant dosimetric effect calculated. The data collected from this assessment was statistically analysed to identify the major determining factors for patients to undergo a re-CT and/or replan. Specific factors identified included nodal size and timing of the required intervention (i.e. how when a plan is to be adapted). This data was used to generate specific risk profiles that will form the basis of a biologically guided adaptive treatment management strategy for virally mediated head and neck cancer. Conclusion: Preliminary data indicates that virally mediated head and neck cancers respond significantly during radiation treatment (tumour and/or nodal regression and weight loss). Implications of this response are the potential underdosing or overdosing of tumour and/or surrounding critical structures. This could lead to sub-optimal patient outcomes and compromised quality of life. Consequently, the development of adaptive treatment strategies that improve organ sparing for this patient group is important to ensure delivery of the prescribed dose to the tumour volume whilst minimizing the dose received to surrounding critical structures. This could reduce side effects and improve overall patient quality of life. The risk profiles and associated adaptive treatment approaches developed in this study will be tested prospectively in the clinical setting in Phase 2 of this investigation.

Changing learning to improve practice : hand hygiene education in Queensland medical schools

The aim of Queensland Health’s ‘Clean hands are life savers’ program is to change the culture and behaviour of healthcare workers related to hand hygiene. Hand hygiene is considered to be the most effective means of preventing pathogen cross-transmission and healthcare-associated infections. Most hospitals throughout Queensland as well as Australia now manage a hand hygiene program to increase the hand hygiene compliance of all healthcare workers. Reports taken from routine hand hygiene observations reveal that doctors are usually less compliant in their hand-washing practices than other healthcare worker groups. The Centre for Healthcare Related Infection Surveillance and Prevention (CHRISP) has attempted to have an impact on this challenging group through their Medical Leadership Initiative. With education as a core component of the program, efforts were made to ensure our future doctors were receiving information that aligned with Queensland Health standards during their formative years at medical school. CHRISP met with university instructors to understand what infection prevention education was currently included in the curriculum and support the introduction of new learning activities that specifically focused on hand hygiene. This prompted change to the existing curriculum and a range of interventions were employed with mixed success. Although met with challenges, methods to integrate more infection prevention teaching were found.

A waste management system for small and medium enterprises engaged in office building retrofit projects

Waste management and minimisation is considered to be an important issue for achieving sustainability in the construction industry. Retrofit projects generate less waste than demolitions and new builds, but they possess unique features and require waste management approaches that are different to traditional new builds. With the increasing demand for more energy efficient and environmentally sustainable office spaces, the office building retrofit market is growing in capital cities around Australia with a high level of refurbishment needed for existing aging properties. Restricted site space and uncertain delivery process in these projects make it a major challenge to manage waste effectively. The labour-intensive nature of retrofit projects creates the need for the involvement of small and medium enterprises (SMEs) as subcontractors in on-site works. SMEs are familiar with on-site waste generation but are not as actively motivated and engaged in waste management activities as the stakeholders in other construction projects in the industry. SMEs’ responsibilities for waste management in office building retrofit projects need to be identified and adapted to the work delivery processes and the waste management system supported by project stakeholders. The existing literature provides an understanding of how to manage construction waste that is already generated and how to increase the waste recovery rate for office building retrofit projects. However, previous research has not developed theories or practical solutions that can guide project stakeholders to understand the specific waste generation process and effectively plan for and manage waste in ongoing project works. No appropriate method has been established for the potential role and capability of SMEs to manage and minimise waste from their subcontracting works. This research probes into the characteristics of office building retrofit project delivery with the aim to develop specific tools to manage waste and incorporate SMEs in this process in an appropriate and effective way. Based on an extensive literature review, the research firstly developed a questionnaire survey to identify the critical factors of on-site waste generation in office building retrofit projects. Semi-structured interviews were then utilised to validate the critical waste factors and establish the interrelationships between the factors. The interviews served another important function of identifying the current problems of waste management in the industry and the performance of SMEs in this area. Interviewees’ opinions on remedies to the problems were also collected. On the foundation of the findings from the questionnaire survey and semi-structured interviews, two waste planning and management strategies were identified for the dismantling phase and fit-out phase of office building retrofit projects, respectively. Two models were then established to organize SMEs’ waste management activities, including a work process-based integrated waste planning model for the dismantling phase and a system dynamics model for the fit-out phase. In order to apply the models in real practice, procedures were developed to guide SMEs’ work flow in on-site waste planning and management. In addition, a collaboration framework was established for SMEs and other project stakeholders for effective waste planning and management. Furthermore, an organisational engagement strategy was developed to improve SME waste management practices. Three case studies were conducted to validate and finalise the research deliverables. This research extends the current literature that mostly covers waste management plans in new build projects, by presenting the knowledge and understanding of addressing waste problems in retrofit projects. It provides practical tools and guidance for industry practitioners to effectively manage the waste generation processes in office building retrofit projects. It can also promote industry-level recognition of the role of SMEs and their performance in on-site waste management.

Reputation modelling in Citizen Science for environmental acoustic data analysis

Citizen Science projects are initiatives in which members of the general public participate in scientific research projects and perform or manage research-related tasks such as data collection and/or data annotation. Citizen Science is technologically possible and scientifically significant. However, although research teams can save time and money by recruiting general citizens to volunteer their time and skills to help data analysis, the reliability of contributed data varies a lot. Data reliability issues are significant to the domain of Citizen Science due to the quantity and diversity of people and devices involved. Participants may submit low quality, misleading, inaccurate, or even malicious data. Therefore, finding a way to improve the data reliability has become an urgent demand. This study aims to investigate techniques to enhance the reliability of data contributed by general citizens in scientific research projects especially for acoustic sensing projects. In particular, we propose to design a reputation framework to enhance data reliability and also investigate some critical elements that should be aware of during developing and designing new reputation systems.

Supply chain benefits expectation management framework

Organizations invest heavily in Supply Chain Management Systems expecting the benefits promised by the software vendors and the implementation partners. However, both academic and industry reports suggest that there is growing dissatisfaction among client organizations due to an increasing gap in benefits purported by the software vendors and benefits realised by the client. In order to better manage expectations of the client organization, this study proposes a Benefit Expectation Management Framework for Supply Chain Management Systems, based on Expectation-Confirmation Theory. This study derives 60 expected benefits of Supply Chain Management Systems through 41 vendor-reported customer stories and academic papers. Through comparing those benefits with the received benefits by a case organization that has implemented SAP Supply Chain Management Systems for seven years, two salient factors – long timetable and multiple stakeholders – have been identified as the controlling factors affecting the confirmation level of Supply Chain Management System expectations and further impacting the satisfaction of a client organization. The case study also highlights the likely causes for realized benefits and enduring issues in relation to the Supply Chain Management Systems.

Smart demand side management of low-voltage distribution networks using multi-objective decision making

A novel intelligent online demand side management system is proposed for peak load management in low-voltage distribution networks. This method uses low-cost controllers with low-bandwidth two-way communication installed in custumers’ premises and at distribution transformers to manage the peak load while maximising customer satisfaction. A multi-objective decision making process is proposed to select the load(s) to be delayed or controlled. The efficacy of the proposed control system is verified by simulation of three different feeder types.

Paramedics' perceptions of their role in palliative care : analysis of focus group transcripts

Paramedics play an important role in out-of-hospital health care. They provide unscheduled care, assisting both patients with minor injuries and those experiencing life-threatening emergencies. Increasingly, paramedics are called on to manage chronic and complex health needs, including symptom relief for patients at the end of life. However, paramedics may not be well prepared to offer palliative care, as practice guidelines and education tend to focus on the management of acute medical emergencies and major trauma. Emergency medical services that employ paramedics rarely have practice guidelines or protocols that deal specifically with palliative care.

Update on complex nonpharmacological interventions for breathlessness

Purpose of review: The study provides a review of current evidence about the role of complex nonpharmacological strategies in managing the multidimensional components of the breathlessness experience for individuals with life-limiting conditions. Recent findings: Evidence continues to demonstrate the significant impact of breathlessness on patients’ quality of life, day-to-day activity, and physical and psychosocial functioning. Recent evidence also confirms that patients draw on a number of self-initiated actions to cope with breathlessness, although many do not use strategies that are supported by a growing body of evidence from randomized controlled trials. Current literature supports the use of multicomponent, nonpharmacological interventions comprising strategies to improve breathing efficiency and reducing psychological distress to manage breathlessness. However trials of these approaches have mostly been conducted among patients with chronic obstructive pulmonary disease (COPD) or lung cancer, and few studies have investigated the benefits of nonpharmacological for patients in later stages of disease. Further investigation of interventions is required across a broader range of chronic life-limiting conditions. Addressing breathlessness and its co-occurring symptoms (symptom clusters) is also an area for future enquiry. Summary: The experience of breathlessness and strategies adopted by patients to manage the experience highlight the importance of multidimensional approaches to improve outcomes for patients with life-limiting conditions. There is good evidence to support the role of multicomponent, nonpharmacological interventions in reducing breathlessness for patients with COPD and lung cancer, although further studies are required to understand the particular clinical contexts in which such interventions are appropriate.

From simulation to emulation : an integrated approach for network security evaluation

We present a virtual test bed for network security evaluation in mid-scale telecommunication networks. Migration from simulation scenarios towards the test bed is supported and enables researchers to evaluate experiments in a more realistic environment. We provide a comprehensive interface to manage, run and evaluate experiments. On basis of a concrete example we show how the proposed test bed can be utilized.

Proteomic and bioinformatics tools to understand virulence mechanisms in Staphylococcus aureus

Staphylococcus aureus, one of the major pathogenic bacteria, is associated with substantial morbidity and mortality. The disease burden of staphylococcal infections is significant, which is primarily attributed to its adaptability and resistance to environmental stresses. S. aureus has the ability to develop multiple resistances to antimicrobial agents. These high resistances make pathogenicity of S. aureus one of the most complex mechanisms to understand and manage. Proteomic and bioinformatics approaches show great potential in exploring microbial adaptation strategies, ability to cause disease by pathogenic bacteria and the development of diagnostic tools. A summary of the latest developments in the application of ‘omics’ technologies to understand resistance mechanisms in S. aureus and their future role in antistaphylococcal vaccine and/or drug discovery is given here.