Diagnostic and treatment pathways for men with prostate cancer in Queensland : investigating spatial and demographic inequalities

Background: Patterns of diagnosis and management for men diagnosed with prostate cancer in Queensland, Australia, have not yet been systematically documented and so assumptions of equity are untested. This longitudinal study investigates the association between prostate cancer diagnostic and treatment outcomes and key area-level characteristics and individual-level demographic, clinical and psychosocial factors.---------- Methods/Design: A total of 1064 men diagnosed with prostate cancer between February 2005 and July 2007 were recruited through hospital-based urology outpatient clinics and private practices in the centres of Brisbane, Townsville and Mackay (82% of those referred). Additional clinical and diagnostic information for all 6609 men diagnosed with prostate cancer in Queensland during the study period was obtained via the population-based Queensland Cancer Registry. Respondent data are collected using telephone and self-administered questionnaires at pre-treatment and at 2 months, 6 months, 12 months, 24 months, 36 months, 48 months and 60 months post-treatment. Assessments include demographics, medical history, patterns of care, disease and treatment characteristics together with outcomes associated with prostate cancer, as well as information about quality of life and psychological adjustment. Complementary detailed treatment information is abstracted from participants’ medical records held in hospitals and private treatment facilities and collated with health service utilisation data obtained from Medicare Australia. Information about the characteristics of geographical areas is being obtained from data custodians such as the Australian Bureau of Statistics. Geo-coding and spatial technology will be used to calculate road travel distances from patients’ residences to treatment centres. Analyses will be conducted using standard statistical methods along with multilevel regression models including individual and area-level components.---------- Conclusions: Information about the diagnostic and treatment patterns of men diagnosed with prostate cancer is crucial for rational planning and development of health delivery and supportive care services to ensure equitable access to health services, regardless of geographical location and individual characteristics. This study is a secondary outcome of the randomised controlled trial registered with the Australian New Zealand Clinical Trials Registry (ACTRN12607000233426)

Biomass burning influenced particles characteristics in Northern Territory Australia based on airborne measurements

Airborne measurements of particle number concentrations from biomass burning were conducted in the Northern Territory, Australia, during June and September campaigns in 2003, which is the early and the late dry season in that region. The airborne measurements were performed along horizontal flight tracks, at several heights in order to gain insight into the particle concentration levels and their variation with height within the lower boundary layer (LBL), upper boundary layer (UBL), and also in the free troposphere (FT). The measurements found that the concentration of particles during the early dry season was lower than that for the late dry season. For the June campaign, the concentration of particles in LBL, UBL, and FT were (685 ± 245) particles/cm3, (365 ± 183) particles/cm3, and (495 ± 45) particle/cm3 respectively. For the September campaign, the concentration of particles were found to be (1233 ± 274) particles/cm3 in the LBL, (651 ± 68) particles/cm3 in the UBL, and (568 ± 70) particles/cm3 in the FT. The particle size distribution measurements indicate that during the late dry season there was no change in the particle size distribution below (LBL) and above the boundary layer (UBL). This indicates that there was possibly some penetration of biomass burning particles into the upper boundary layer. In the free troposphere the particle concentration and size measured during both campaigns were approximately the same.

Damage localisation in beams and plates using vibration characteristics

Dynamic computer simulation techniques are used to develop and apply a multi-criteria procedure, incorporating changes in natural frequencies, modal flexibility and the modal strain energy, for damage localisation in beams and plates. Numerically simulated modal data obtained through finite element analyses are used to develop algorithms based on changes of modal flexibility and modal strain energy before and after damage and used as the indices for assessment of the state of structural health. The proposed procedure is illustrated through its application to flexural members under different damage scenarios and the results confirm its feasibility for damage assessment.

Sustainable transportation development : a framework to determine transportation disadvantaged

Urban sprawl combined with low density development causes unsustainable development patterns including accessibility and mobility problems, especially for those who do not have the capacity to own a vehicle or access to quality public transport services. Sustainable transportation development is crucial in order to solve transport disadvantage problems in urban settlements. People who are affected by these problems are referred to as ‘transportation disadvantaged’. Transportation disadvantage is a multi-dimensional problem that combines socio-economics, transportation and spatial characteristics or dimensions. However, a substantial number of transportation disadvantage studies so far only focus on the socio-economic and transportation dimensions, while the latter dimension of transportation disadvantage has been neglected. This chapter investigates the spatial dimension of transportation disadvantage by comparing the travel capabilities of residents and their accessibility levels with land use characteristics. The analysis of the study identifies significant land use characteristics with travel inability, and is useful for identifying the transportation disadvantaged population.

User characteristics of transit oriented developments : the case of Kelvin Grove Urban Village

Transit oriented developments are high density mixed use developments located within short and easily walkable distance of a major transit centre. These developments are often hypothesised as a means of enticing a mode shift from the private car to sustainable transport modes such as, walking, cycling and public transport. However, it is important to gather evidence to test this hypothesis by determining the travel characteristics of transit oriented developments users. For this purpose, travel surveys were conducted for an urban transit oriented development currently under development. This chapter presents the findings from the preliminary data analysis of the travel surveys. Kelvin Grove Urban Village, a mixed use development located in Brisbane, Australia, has been selected as the case for the transit oriented developments study. Travel data for all groups of transit oriented development users ranging from students to shoppers, and residents to employees were collected. Different survey instruments were used for different transit oriented development users to optimise their response rates, and the performance of these survey instruments are stated herein. The travel characteristics of transit oriented development users are reported in this chapter by explaining mode share, trip length distribution, and time of day of trip. The results of the travel survey reveal that Kelvin Grove Urban Village users use more sustainable modes of transport as compared to other Brisbane residents.

Self-service technology and the moderating effects of consumer characteristics

The incidence of self-service technology, where the consumer delivers the service themselves using technology, is increasing in the service encounter. One area that is under-explored is the potential impact of self-service technology on consumer satisfaction and affective commitment. Accordingly, this paper presents an empirical study that investigates the relative impact of self-service technology on consumer satisfaction (both overall and transaction-specific) and affective commitment, accounting for the moderating effects of consumer characteristics. The results highlight the importance of personal service for evaluations of satisfaction and commitment, and the importance of social competency as a moderator in this relationship. An understanding of these consumer perceptions will allow organisations to develop strategies to deliver the services expected by their consumers, improving consumer satisfaction and commitment.

The impacts of traffic and rainfall characteristics on heavy metals build-up and wash-off from urban roads

An investigation into the effects of changes in urban traffic characteristics due to rapid urbanisation and the predicted changes in rainfall characteristics due to climate change on the build-up and wash-off of heavy metals was carried out in Gold Coast, Australia. The study sites encompassed three different urban land uses. Nine heavy metals commonly associated with traffic emissions were selected. The results were interpreted using multivariate data analysis and decision making tools, such as principal component analysis (PCA), fuzzy clustering (FC), PROMETHEE and GAIA. Initial analyses established high, low and moderate traffic scenarios as well as low, low to moderate, moderate, high and extreme rainfall scenarios for build-up and wash-off investigations. GAIA analyses established that moderate to high traffic scenarios could affect the build-up while moderate to high rainfall scenarios could affect the wash-off of heavy metals under changed conditions. However, in wash-off, metal concentrations in 1-75µm fraction were found to be independent of the changes to rainfall characteristics. In build-up, high traffic activities in commercial and industrial areas influenced the accumulation of heavy metal concentrations in particulate size range from 75 - >300 µm, whereas metal concentrations in finer size range of <1-75 µm were not affected. As practical implications, solids <1 µm and organic matter from 1 - >300 µm can be targeted for removal of Ni, Cu, Pb, Cd, Cr and Zn from build-up whilst organic matter from <1 - >300 µm can be targeted for removal of Cd, Cr, Pb and Ni from wash-off. Cu and Zn need to be removed as free ions from most fractions in wash-off.

The impact of managers' characteristics on the use of public relations strategy : an exploratory study in Queensland schools

While previous positive and normative studies have focused on the role public relations should play in organisations and the need for management in all organisations to attend to public relations (Cutlip et al., 2006), there has been little discussion in the public relations literature on why or how managers choose to enact public relations strategies for their organisations. If the discipline of public relations is to cement itself as a management function, then researchers must gain a better understanding of managers themselves given that they are the ones who decide if and how public relations strategies should be employed in the organisation. This study has sought to explore evidence of a relationship between management characteristics and their impact on decisions managers make when choosing which public relations strategies to adopt in response to changes in the organisation’s operating environment. This exploratory research study has been conducted within a specific context of schools in Queensland, Australia. Queensland schools have been facing a number of changes within their operating environment due to changes in Federal funding models in Australia’s education system. This study used an exploratory, qualitative approach to understand the management characteristics demonstrated by managers in schools and how these have impacted on the selection of public relations strategies for responding to their changing and increasingly competitive environment. The unit of analysis for this research study was principals in State (government) schools and in non-government schools. Ten principals were interviewed from four different types of schools in Queensland – the more traditional, elite, private schools (GPS Schools); other Independent Schools; Catholic Schools; and State (or public) schools. These interviews were analysed for quantitative comparisons of the managers’ characteristics across the different schools (in terms of the number of principals in each age bracket, those holding postgraduate qualifications, years of experience etc.); and for qualitative data to provide a greater sense of their understanding of public relations. The 10 schools were selected within a geographic area from Brisbane’s inner city to its outer western suburbs to include an element of competition amongst those managers being interviewed. A detailed review of government, school and other public documents was also conducted to gain an insight into the environment in which principals made decisions about public relations strategy to respond to increasing competition. This study found support for the literature on the relationship between management characteristics and strategy. However, there was also variation in findings warranting further investigation of the literature on the relationship between management characteristics and strategy in a school setting. Key relationships found in this study were between: management characteristics themselves; age and the use of public relations strategies; and gender and the use of public relations strategies. There was also evidence of support for the literature linking the impact that the combination of managers’ age, education and experience had on the use of public relations strategies. While this study was exploratory in nature, it did reveal a number of areas that require further investigation to gain a deeper understanding of how and why managers choose public relations strategies as a response to changes in their operating environment. It also provided a different framework to gain a better understanding of managers’ understanding and support of public relations in schools, which, in conjunction with an analysis of their management characteristics, will hopefully allow public relations scholars and practitioners alike gain an understanding of how and why managers use public relations strategies.

Population-based survival estimates for childhood cancer in Australia during the period 1997–2006

Background: This study provides the latest available relative survival data for Australian childhood cancer patients. Methods: Data from the population-based Australian Paediatric Cancer Registry were used to describe relative survival outcomes using the period method for 11 903 children diagnosed with cancer between 1983 and 2006 and prevalent at any time between 1997 and 2006. Results: The overall relative survival was 90.4% after 1 year, 79.5% after 5 years and 74.7% after 20 years. Where information onstage at diagnosis was available (lymphomas, neuroblastoma, renal tumours and rhabdomyosarcomas), survival was significantly poorer for more-advanced stage. Survival was lower among infants compared with other children for those diagnosed with leukaemia, tumours of the central nervous system and renal tumours but higher for neuroblastoma. Recent improvements in overall childhood cancer survival over time are mainly because of improvements among leukaemia patients. Conclusion: The high and improving survival prognosis for children diagnosed with cancer in Australia is consistent with various international estimates. However, a 5-year survival estimate of 79% still means that many children who are diagnosed with cancer will die within 5 years, whereas others have long-term health morbidities and complications associated with their treatments. It is hoped that continued developments in treatment protocols will result in further improvements in survival.

Lifestyle factors associated concurrently and prospectively with co-morbid cardiovascular disease in a population-based cohort of colorectal cancer survivors

Aims To assess self-reported lifetime prevalence of cardiovascular disease (CVD) among colorectal cancer survivors, and examine the cross-sectional and prospective associations of lifestyle factors with co-morbid CVD. Methods Colorectal cancer survivors were recruited (n = 1966). Data were collected at approximately 5, 12, 24 and 36 months post-diagnosis. Cross-sectional findings included six CVD categories (hypercholesterolaemia, hypertension, diabetes, heart failure, kidney disease and ischaemic heart disease (IHD)) at 5 months post-diagnosis. Longitudinal outcomes included the probability of developing (de novo) co-morbid CVD by 36 months post-diagnosis. Lifestyle factors included body mass index, physical activity, television (TV) viewing, alcohol consumption and smoking. Results Co-morbid CVD prevalence at 5 months post-diagnosis was 59%, and 16% of participants with no known CVD at the baseline reported de novo CVD by 36 months. Obesity at the baseline predicted de novo hypertension (odds ratio [OR] = 2.20, 95% confidence intervals [CI] = 1.09, 4.45) and de novo diabetes (OR = 6.55, 95% CI = 2.19, 19.53). Participants watching >4 h of TV/d at the baseline (compared with <2 h/d) were more likely to develop ischaemic heart disease by 36 months (OR = 5.51, 95% CI = 1.86, 16.34). Conclusion Overweight colorectal cancer survivors were more likely to suffer from co-morbid CVD. Interventions focusing on weight management and other modifiable lifestyle factors may reduce functional decline and improve survival.

Driver distractions: Characteristics underlying drivers' risk perceptions

Driver distraction is a research area that continues to receive considerable research interest but the drivers’ perspective is less well documented. The current research focuses on how drivers perceive the risks associated with a range of driver distractions with the aim of identifying features that contribute to their risk perception judgements. Multidimensional scaling analysis was employed to better understand drivers’ risk perceptions for 15 in-vehicle and external distractions. Results identify both salient qualitative characteristics that underpin drivers’ risk perceptions, such as the probability of a crash, as well as identify other features inherent in the distractions that may also contribute to risk perceptions. The implications of the results are discussed for better understanding drivers’ perceptions of distractions and the potential for improving road safety messages related to distracted driving.

Falls in Parkinson's disease : kinematic evidence for impaired head and trunk control

Changes in stride characteristics and gait rhythmicity characterize gait in Parkinson's disease and are widely believed to contribute to falls in this population. However, few studies have examined gait in PD patients who fall. This study reports on the complexities of walking in PD patients who reported falling during a 12-month follow-up. Forty-nine patients clinically diagnosed with idiopathic PD and 34 controls had their gait assessed using three-dimensional motion analysis. Of the PD patients, 32 (65%) reported at least one fall during the follow-up compared with 17 (50%) controls. The results showed that PD patients had increased stride timing variability, reduced arm swing and walked with a more stooped posture than controls. Additionally, PD fallers took shorter strides, walked slower, spent more time in double-support, had poorer gait stability ratios and did not project their center of mass as far forward of their base of support when compared with controls. These stride changes were accompanied by a reduced range of angular motion for the hip and knee joints. Relative to walking velocity, PD fallers had increased mediolateral head motion compared with PD nonfallers and controls. Therefore, head motion could exceed “normal” limits, if patients increased their walking speed to match healthy individuals. This could be a limiting factor for improving gait in PD and emphasizes the importance of clinically assessing gait to facilitate the early identification of PD patients with a higher risk of falling.

The effects of muscle fatigue on knee function during landing

The human knee acts as a sophisticated shock absorber during landing movements. The ability of the knee to perform this function in the real world is remarkable given that the context of the landing movement may vary widely between performances. For this reason, humans must be capable of rapidly adjusting the mechanical properties of the knee under impact load in order to satisfy many competing demands. However, the processes involved in regulating these properties in response to changing constraints remain poorly understood. In particular, the effects of muscle fatigue on knee function during step landing are yet to be fully explored. Fatigue of the knee muscles is significant for 2 reasons. First, it is thought to have detrimental effects on the ability of the knee to act as a shock absorber and is considered a risk factor for knee injury. Second, fatigue of knee muscles provides a unique opportunity to examine the mechanisms by which healthy individuals alter knee function. A review of the literature revealed that the effect of fatigue on knee function during landing has been assessed by comparing pre and postfatigue measurements, with fatigue induced by a voluntary exercise protocol. The information is limited by inconsistent results with key measures, such as knee stiffness, showing varying results following fatigue, including increased stiffness, decreased stiffness or failure to detect any change in some experiments. Further consideration of the literature questions the validity of the models used to induce and measure fatigue, as well as the pre-post study design, which may explain the lack of consensus in the results. These limitations cast doubt on the usefulness of the available information and identify a need to investigate alternative approaches. Based on the results of this review, the aims of this thesis were to: • evaluate the methodological procedures used in validation of a fatigue model • investigate the adaptation and regulation of post-impact knee mechanics during repeated step landings • use this new information to test the effects of fatigue on knee function during a step-landing task. To address the aims of the thesis, 3 related experiments were conducted that collected kinetic, kinematic and electromyographic data from 3 separate samples of healthy male participants. The methodologies involved optoelectronic motion capture (VICON), isokinetic dynamometry (System3 Pro, BIODEX) and wireless surface electromyography (Zerowire, Aurion, Italy). Fatigue indicators and knee function measures used in each experiment were derived from the data. Study 1 compared the validity and reliability of repetitive stepping and isokinetic contractions with respect to fatigue of the quadriceps and hamstrings. Fifteen participants performed 50 repetitions of each exercise twice in randomised order, over 4 sessions. Sessions were separated by a minimum of 1 week’s rest, to ensure full recovery. Validity and reliability depended on a complex interaction between the exercise protocol, the fatigue indicator, the individual and the muscle of interest. Nevertheless, differences between exercise protocols indicated that stepping was less effective in eliciting valid and reliable changes in peak power and spectral compression, compared with isokinetic exercise. A key finding was that fatigue progressed in a biphasic pattern during both exercises. The point separating the 2 phases, known as the transition point, demonstrated superior between-test reliability during the isokinetic protocol, compared with stepping. However, a correction factor should be used to accurately apply this technique to the study of fatigue during landing. Study 2 examined alterations in knee function during repeated landings, with a different sample (N =12) performing 60 consecutive step landing trials. Each landing trial was separated by 1-minute rest periods. The results provided new information in relation to the pre-post study design in the context of detecting adjustments in knee function during landing. First, participants significantly increased or decreased pre-impact muscle activity or post-impact mechanics despite environmental and task constraints remaining unchanged. This is the 1st study to demonstrate this effect in healthy individuals without external feedback on performance. Second, single-subject analysis was more effective in detecting alterations in knee function compared to group-level analysis. Finally, repeated landing trials did not reduce inter-trial variability of knee function in some participants, contrary to assumptions underpinning previous studies. The results of studies 1 and 2 were used to modify the design of Study 3 relative to previous research. These alterations included a modified isokinetic fatigue protocol, multiple pre-fatigue measurements and singlesubject analysis to detect fatigue-related changes in knee function. The study design incorporated new analytical approaches to investigate fatiguerelated alterations in knee function during landing. Participants (N = 16) were measured during multiple pre-fatigue baseline trial blocks prior to the fatigue model. A final block of landing trials was recorded once the participant met the operational fatigue definition that was identified in Study 1. The analysis revealed that the effects of fatigue in this context are heavily dependent on the compensatory response of the individual. A continuum of responses was observed within the sample for each knee function measure. Overall, preimpact preparation and post-impact mechanics of the knee were altered with highly individualised patterns. Moreover, participants used a range of active or passive pre-impact strategies to adapt post-impact mechanics in response to quadriceps fatigue. The unique patterns identified in the data represented an optimisation of knee function based on priorities of the individual. The findings of these studies explain the lack of consensus within the literature regarding the effects of fatigue on knee function during landing. First, functional fatigue protocols lack validity in inducing fatigue-related changes in mechanical output and spectral compression of surface electromyography (sEMG) signals, compared with isokinetic exercise. Second, fatigue-related changes in knee function during landing are confounded by inter-individual variation, which limits the sensitivity of group-level analysis. By addressing these limitations, the 3rd study demonstrated the efficacies of new experimental and analytical approaches to observe fatigue-related alterations in knee function during landing. Consequently, this thesis provides new perspectives into the effects of fatigue in knee function during landing. In conclusion: • The effects of fatigue on knee function during landing depend on the response of the individual, with considerable variation present between study participants, despite similar physical characteristics. • In healthy males, adaptation of pre-impact muscle activity and postimpact knee mechanics is unique to the individual and reflects their own optimisation of demands such as energy expenditure, joint stability, sensory information and loading of knee structures. • The results of these studies should guide future exploration of adaptations in knee function to fatigue. However, research in this area should continue with reduced emphasis on the directional response of the population and a greater focus on individual adaptations of knee function.

Estimation of parameters for macroparasite population evolution using approximate Bayesian computation

We estimate the parameters of a stochastic process model for a macroparasite population within a host using approximate Bayesian computation (ABC). The immunity of the host is an unobserved model variable and only mature macroparasites at sacrifice of the host are counted. With very limited data, process rates are inferred reasonably precisely. Modeling involves a three variable Markov process for which the observed data likelihood is computationally intractable. ABC methods are particularly useful when the likelihood is analytically or computationally intractable. The ABC algorithm we present is based on sequential Monte Carlo, is adaptive in nature, and overcomes some drawbacks of previous approaches to ABC. The algorithm is validated on a test example involving simulated data from an autologistic model before being used to infer parameters of the Markov process model for experimental data. The fitted model explains the observed extra-binomial variation in terms of a zero-one immunity variable, which has a short-lived presence in the host.