A nurse-led model of oncogeriatric assessment

Background There is growing consensus that a multidisciplinary, comprehensive and standardised process for assessing the fitness of older patients for chemotherapy should be undertaken to determine appropriate cancer treatment. Aim This study tested a model of cancer care for the older patient incorporating Comprehensive Geriatric Assessment (CGA), which aimed to ensure that 'fit' individuals amenable to active treatment were accurately identified; 'vulnerable' patients more suitable for modified or supportive regimens were determined; and 'frail 'individuals who would benefit most from palliative regimens were also identified and offered the appropriate level of care. Methods A consecutive-series n=178 sample of patients >65 years was recruited from a major Australian cancer centre. The following instruments were administered by an oncogeriatric nurse prior to treatment: Vulnerable Elders Survey-13; Cumulative Illness Rating Scale (Geriatric); Malnutrition Screening Tool; Mini-mental State Examination; Geriatric Depression Scale; Barthel Index; and Lawton Instrumental Activities of Daily Living Scale. Scores from these instruments were aggregated to predict patient fitness, vulnerability or frailty for chemotherapy. Physicians provided a concurrent (blinded) prediction of patient fitness, vulnerability or frailty based on their clinical assessment. Data were also collected on actual patient outcomes (eg treatment completed as predicted, treatment reduced) during monthly audits of patient trajectories. Data analysis Data analysis is underway. A sample of 178 is adequate to detect, with 90% power, kappa coefficients of agreement between CGA and physician assessments of K>0.90 ("almost perfect agreement"). Primary endpoints comprise a) whether the nurse-led CGA determination of fit, vulnerable or frail agrees with the oncologist's assessments of fit, vulnerable or frail and b) whether the CGA and physician assessments accurately predict actual patient outcomes. Conclusion An oncogeriatric nurse-led model of care is currently being developed from the results. We conclude with a discussion of the pivotal role of nurses in CGA-based models of care.

Synergies and goal conflicts for climate change policy and spatial planning

The purpose of this paper is to identify goal conflicts – both actual and potential – between climate and social policies in government strategies in response to the growing significance of climate change as a socioecological issue (IPCC 2007). Both social and climate policies are political responses to long-term societal trends related to capitalist development, industrialisation, and urbanisation (Koch, 2012). Both modify these processes through regulation, fiscal transfers and other measures, thereby affecting conditions for the other. This means that there are fields of tensions and synergies between social policy and climate change policy. Exploring these tensions and synergies is an increasingly important task for navigating genuinely sustainable development. Gough et al (2008) highlight three potential synergies between social and climate change policies: First, income redistribution – a traditional concern of social policy – can facilitate use of and enhance efficiency of carbon pricing. A second area of synergy is housing, transport, urban policies and community development, which all have potential to crucially contribute towards reducing carbon emissions. Finally, climate change mitigation will require substantial and rapid shifts in producer and consumer behaviour. Land use planning policy is a critical bridge between climate change and social policy that provides a means to explore the tensions and synergies that are evolving within this context. This paper will focus on spatial planning as an opportunity to develop strategies to adapt to climate change, and reviews the challenges of such change. Land use and spatial planning involve the allocation of land and the design and control of spatial patterns. Spatial planning is identified as being one of the most effective means of adapting settlements in response to climate change (Hurlimann and March, 2012). It provides the instrumental framework for adaptation (Meyer, et al., 2010) and operates as both a mechanism to achieve adaptation and a forum to negotiate priorities surrounding adaptation (Davoudi, et al., 2009). The acknowledged role of spatial planning in adaptation however has not translated into comparably significant consideration in planning literature (Davoudi, et al., 2009; Hurlimann and March, 2012). The discourse on adaptation specifically through spatial planning is described as ‘missing’ and ‘subordinate’ in national adaptation plans (Greiving and Fleischhauer, 2012),‘underrepresented’ (Roggema, et al., 2012)and ‘limited and disparate’ in planning literature (Davoudi, et al., 2009). Hurlimann and March (2012) suggest this may be due to limited experiences of adaptation in developed nations while Roggema et al. (2012) and Crane and Landis (2010) suggest it is because climate change is a wicked problem involving an unfamiliar problem, various frames of understanding and uncertain solutions. The potential for goal conflicts within this policy forum seem to outweigh the synergies. Yet, spatial planning will be a critical policy tool in the future to both protect and adapt communities to climate change.

Energy-pollution nexus for urban buildings

Since the first oil crisis in 1974, economic reasons placed energy saving among the top priorities in most industrialised countries. In the decades that followed, another, equally strong driver for energy saving emerged: climate change caused by anthropogenic emissions, a large fraction of which result from energy generation. Intrinsically linked to energy consumption and its related emissions is another problem: indoor air quality. City dwellers in industrialised nations spend over 90% of their time indoors and exposure to indoor pollutants contributes to ~2.6% of global burden of disease and nearly 2 million premature deaths per year1. Changing climate conditions, together with human expectations of comfortable thermal conditions, elevates building energy requirements for heating, cooling, lighting and the use of other electrical equipment. We believe that these changes elicit a need to understand the nexus between energy consumption and its consequent impact on indoor air quality in urban buildings. In our opinion the key questions are how energy consumption is distributed between different building services, and how the resulting pollution affects indoor air quality. The energy-pollution nexus has clearly been identified in qualitative terms; however the quantification of such a nexus to derive emissions or concentrations per unit energy consumption is still weak, inconclusive and requires forward thinking. Of course, various aspects of energy consumption and indoor air quality have been studied in detail separately, but in-depth, integrated studies of the energy-pollution nexus are hard to come by. We argue that such studies could be instrumental in providing sustainable solutions to maintain the trade-off between the energy efficiency of buildings and acceptable levels of air pollution for healthy living.

Prosecution of maritime terrorists : the role of national courts in ensuring accountability

Maritime security has emerged as a critical legal and political issue in the contemporary world. Terrorism in the maritime domain is a major maritime security issue. Ten out of the 44 major terrorist groups of the world, as identified in the US Department of State’s Country Reports on Terrorism, have maritime terrorism capabilities. Prosecution of maritime terrorists is a politically and legally difficult issue, which may create conflicts of jurisdiction. Prosecution of alleged maritime terrorists is carried out by national courts. There is no international judicial institution for the prosecution of maritime terrorists. International law has therefore anticipated a vital role for national courts in this respect. The international legal framework for combating maritime terrorism has been elaborately examined in existing literature therefore this paper will only highlight the issues regarding the prosecution of maritime terrorists. This paper argues that despite having comprehensive intentional legal framework for the prosecution of maritime terrorists there is still some scopes for conflicts of jurisdiction particularly where two or more States are interested to prosecute the same offender. This existing legal problem has been further aggravated in the post September 11 era. Due to the political and security implications, States may show reluctance in ensuring the international law safeguards of alleged perpetrators in the arrest, detention and prosecution process. Nevertheless, international law has established a comprehensive system for the prosecution of maritime terrorists where national courts is the main forum of ensuring the international law safeguards of alleged perpetrators as well as ensuring the effective prosecution of maritime terrorists thereby playing an instrumental role in establishing a rule based system for combating maritime terrorism. Using two case studies, this paper shows that the role of national courts has become more important in the present era because there may be some situations where no State is interested to initiate proceedings in international forums for vindicating rights of an alleged offender even if there is a clear evidence of violation of international human rights law in the arrest, detention and prosecution process. This paper presents that despite some bottlenecks national courts are actively playing this critical role. Overall, this paper highlights the instrumental role of national courts in the international legal order.

Characterising one-to-one conservatoire teaching : Some implications of a quantitative analysis

Despite the significant recent growth in research relating to instrumental, vocal and composition tuition in higher education, little is known about the diversity of approaches that characterise one-to-one teaching in the Conservatoire, and what counts as optimal practice for educating 21st-century musicians. Through analysis of video-recorded one-to-one lessons that draws on a ‘bottom up’ methodology for characterising pedagogical practices (Taylor, 2012; Taylor et al, 2012), this paper provides empirical evidence about the nature of one-to-one pedagogy in one Australian institution. The research aims (1) to enable a better understanding of current one-to-one conservatoire teaching; and (2) to build and improve upon existing teaching practice using authentic insights gained through systematic investigation. The authors hope the research will lead to a better understanding of the diversity and efficacy of the pedagogical practice within the specific context in which the study was conducted, and beyond, to Conservatoire pedagogy generally.

Social support promotes psychological well-being following a natural disaster

Receiving emotional support has consistently been demonstrated as an important factor associated with mental health but sparse research has investigated giving support in addition to receiving it or the types of support that predict well-being. In this paper the relationship between giving and receiving instrumental and emotional social support and psychological well-being during and following a natural disaster is investigated. A survey administered between four and six months after fatal floods was conducted with 200 community members consisting of men (n = 68) and women (n = 132) aged between 17 and 87 years. Social support experiences were assessed using the 2-Way Social Support Scale (2-Way SSS; Shakespeare-Finch & Obst, 2011) and eudemonic well-being was measured using the Psychological Well-Being Scale (PWBS; Ryff & Keyes, 1995). Hierarchical multiple regression analyses were used to examine expected relationships and to explore the differential effects of the four factors of the 2-Way SSS. Results indicated that social support shared significant positive associations with domains of psychological well-being, especially with regards to interpersonal relationships. Receiving and giving emotional support were respectively the strongest unique predictors of psychological well-being. However, receiving instrumental support predicted less autonomy. Results highlight the importance of measuring social support as a multidimensional construct and affirm that disaster response policy and practice should focus on emotional as well as instrumental needs in order to promote individual and community psychosocial health following a flooding crisis.

Consumer acceptance of m-wellbeing services : a social marketing perspective

Purpose This study aims to employ the Model of Goal-Directed Behaviour (MGB) to examine the consumer acceptance of technology-based self-service (TBSS) for a credence service instrumental to a social goal. Credence services are increasingly delivered via self-service technology and in social marketing, the achievement of social goals can be contingent on consumer acceptance of these services. However, little is known about the determinants of acceptance and extant marketing literature fails to account for emotional and goal influences which are likely to be important. Design/methodology/approach The authors interviewed 30 young adults with self-reported stress, anxiety or depression as potential users of a self-help mental health service delivered via mobile phone. The data were analysed deductively and inductively with the assistance of NVivo. Findings The findings generally support using the MGB to enhance understanding of consumers' acceptance of TBSS. The paper also found evidence of the importance of maintenance self-efficacy, the self-evaluation of the ability to continue using the service, and a previously ignored element of consumer level competition that arises between alternatives that achieve the same goal. Originality/value This study is the first to examine factors that influence consumers' acceptance of TBSS for credence services aimed at achieving a social goal. It builds on understanding of consumer decision making in social marketing, particularly the influence of self-efficacy and competition. It also contributes to attitudinal research by providing initial evidence for deepening and broadening the MGB in the context of TBSSs.

Capping them off! Exploring and explaining the patterns in undergraduate capstone subjects in Australian business schools

Universities are increasingly offering capstone subjects as part of curricula to prepare final year undergraduates for employment through consolidating and integrating their knowledge and skills while bridging the gap between academic learning and professional work. This study investigates capstone subjects offered by Australian business schools, drawing on national survey data collected in 2010-2011, complemented by interviews with associate deans teaching and learning instrumental in course and curricula design. Findings indicate the sector-wide use of capstone subjects in business disciplines, diversity in the patterns of offerings, and instances where subjects labelled as capstones do not meet the definition of capstones. We argue that these features are explained by a range of historic and strategic factors, such as the ad hoc development of subjects and a lack of understanding of the features of capstones. The findings of this paper inform the debate on the design, development, value and use of capstone subjects identifying the implications for staff development and knowledge management in higher education.

Person centred nursing care in radiation oncology : a case study

Purpose The aim of this case study is to describe clinical staff perceptions of implementing a person-centred model of nursing in an outpatient radiotherapy treatment department, using a Primary Nursing/Collaborative Practice framework. The questions are: 1) what are the nursing and radiotherapy staff perspectives of the changed model of care, 2) what factors impacted on aspects of the evolving model?, and 3) how was interdisciplinary collaboration influenced by the new model? Methods An instrumental case study addressed the multiple perspectives of several radiotherapy health professionals, within a qualitative approach, to assess the new model of nursing care. Interview data were obtained from thirteen clinical staff over a six month period approximately one year after the model was implemented. Results The new model supports nurses to work more closely with the individual patient, with some perceived positive patient outcomes. Nurses reported increased satisfaction with their work, more autonomy and responsibility, and improved working relationships with medical staff. They also became more aware of the holistic approach to support positive patient outcomes. However, this study acknowledged that education was required for nurses to provide holistic care, especially in the context of complex interdisciplinary relationships. Conclusions A person-centred nursing approach in radiotherapy represents a radical change to the functional approach, providing some benefits for patients. However, the challenges of providing holistic care in the context of complex interdisciplinary relationships are evident, and this study acknowledges the importance of a team approach to addressing changes in practice in the future.

Food in an Australian primary school curriculum : a critical sociological study

Food is a multidimensional construct. It has social, cultural, economic, psychological, emotional, biological, and political dimensions. It is both a material object and a catalyst for a range of social and cultural action. Richly implicated in the social and cultural milieu, food is a central marker of culture and society. Yet little is known about the messages and knowledges in the school curriculum about food. Popular debates around food in schools are largely connected with biomedical issues of obesity, exercise and nutrition. This is a study of the sociological dimensions of food-related messages, practices and knowledge formations in the primary school curriculum. It uses an exploratory, qualitative case study methodology to identify and examine the food activities of a Year 5 class in a Queensland school. Data was gathered over a twoyear period using observation, documentation and interviews methods. Food was found to be an integral part of the primary school's activity. It had economic, symbolic, pedagogic, and instrumental value. Messages about food were found in the official, enacted and hidden curricular which were framed by a food governance framework of legislation, procedures and norms. In the school studied, food knowledge was commodified as a part of a political economy that centred on an 'eat more' message. Certain foods were privileged over others while myths about energy, fruit, fruit juice and sugar shaped student dispositions, values, norms and action. There was little engagement with the cognitive and behavioural dimensions of food and nutrition. The thesis concludes with recommendations for a whole scale reconsideration of food in schools as curricular content and knowledge.

Disengaged and disruptive : behaviour intervention for boys from year four to year seven

Disengaged and disruptive students have been an ongoing concern for teachers for many years. Teaching is complex—complex students with complex lives and complex behaviours. How best to help these students is an ever-present question without a simple answer. Solutions need to be found. Under a positive behaviour support framework when serious, disruptive behaviour requires intervention, an individualised positive behaviour support plan (PBS plan) is developed and implemented. This multicase study (Stake, 2006) investigated how task engagement was changed for boys from year four to year seven who demonstrated serious, disruptive behaviour. The individualised PBS plan was the primary tool of behaviour intervention in each of the five cases. Using the Behaviour Support Plan Quality Evaluation Scoring Guide II (BSP-QE) (Browning- Wright, Saren & Mayer, 2003) the five PBS plans were evaluated prior to implementation and rated highly in terms of technical quality. Positive changes in student task engagement were forthcoming in all five cases. Eleven advisory visiting teachers in behaviour and eleven classroom teachers, five of whom were case-study participants, took part in this study. The classroom teachers were employed in south-east Queensland primary schools located in suburbs of economic disadvantage. All 22 participants expressed very similar perceptions of serious, disruptive behaviour emphasising the collateral impact upon the teaching and learning. Data obtained through direct observations, surveys and semi-structured interviews confirmed previous research to reveal a strong link between integrity of PBS plan implementation and student behaviour change. While classroom teachers, in the main, effectively managed the implementation of the PBS plan, social validity of goals, procedures and effects; in-class technical assistance and performance feedback were identified as three enablers to effective teacher implementation of the PBS plan. While the purpose of each PBS plan was to influence change in student behaviour, this study found that changing teacher behaviour was also instrumental in achieving positive student outcomes. Changing teacher behaviour and building capacity was facilitated by trusting, collaborative partnerships established between the Advisory Visiting Teacher-Behaviour and the classroom teacher responsible for the plan implementation. The Advisory Visiting Teacher-Behaviour provides assistance to teachers dealing with students who demonstrate ongoing, problematic behaviour. The inclusion of a teaching component as part of the implementation stage of the consultation process appeared to have considerable influence upon successful intervention. Results substantiated earlier understandings of the importance of teacher instruction highlighting the value of explicit teaching and performance feedback to the delivery of effective behaviour intervention. Conclusions drawn from this study have had a major impact upon the work of a regional team of Advisory Visiting Teachers-Behaviour. The focus of behaviour intervention has moved from being primarily upon the individual student to include a greater emphasis upon the critical role of the teacher. Procedures and processes are being re-evaluated to align with evidence-based practice and to include a collaborative consultation approach to improve teacher assistance. The framework and content of staff development and training is being created directly from the findings of this study. This practical application of the results has informed better ways of providing behaviour intervention for students demonstrating serious, disruptive behaviour. What this study has clearly shown is that when it comes to behaviour intervention, the important role of the teacher cannot be underestimated.

2 Hour game jam at SLQ Garage Gamer - Live performance with crowd participation

The 2 hour game jam was performed as part of the State Library of Queensland 'Garage Gamer' series of events, summer 2013, at the SLQ exhibition. An aspect of the exhibition was the series of 'Level Up' game nights. We hosted the first of these - under the auspices of brIGDA, Game On. It was a party - but the focal point of the event was a live streamed 2 hour game jam. Game jams have become popular amongst the game development and design community in recent years, particularly with the growth of the Global Game Jam, a yearly event which brings thousands of game makers together across different sites in different countries. Other established jams take place on-line, for example the Ludum Dare challenge which as been running since 2002. Other challenges follow the same model in more intimate circumstances and it is now common to find institutions and groups holding their own small local game making jams. There are variations around the format, some jams are more competitive than others for example, but a common aspect is the creation of an intense creative crucible centred around team work and ‘accelerated game development’. Works (games) produced during these intense events often display more experimental qualities than those undertaken as commercial projects. In part this is because the typical jam is started with a conceptual design brief, perhaps a single word, or in the case of the specific game jam described in this paper, three words. Teams have to envision the challenge key word/s as a game design using whatever skills and technologies they can and produce a finished working game in the time given. Game jams thus provide design researchers with extraordinary fodder and recent years have also seen a number of projects which seek to illuminate the design process as seen in these events. For example, Gaydos, Harris and Martinez discuss the opportunity of the jam to expose students to principles of design process and design spaces (2011). Rouse muses on the game jam ‘as radical practice’ and a ‘corrective to game creation as it is normally practiced’. His observations about his own experience in a jam emphasise the same artistic endeavour forefronted earlier, where the experience is about creation that is divorced from the instrumental motivations of commercial game design (Rouse 2011) and where the focus is on process over product. Other participants remark on the social milieu of the event as a critical factor and the collaborative opportunity as a rich site to engage participants in design processes (Shin et al, 2012). Shin et al are particularly interested in the notion of the site of the process and the ramifications of participants being in the same location. They applaud the more localized event where there is an emphasis on local participation and collaboration. For other commentators, it is specifically the social experience in the place of the jam is the most important aspect (See Keogh 2011), not the material site but rather the physical embodied experience of ‘being there’ and being part of the event. Participants talk about game jams they have attended in a similar manner to those observations made by Dourish where the experience is layered on top of the physical space of the event (Dourish 2006). It is as if the event has taken on qualities of place where we find echoes of Tuan’s description of a particular site having an aura of history that makes it a very different place, redolent and evocative (Tuan 1977). The 2 hour game jam held during the SLQ Garage Gamer program was all about social experience.

Othering the Malay in Malaysia : a planned consequence of politics?

This paper examines the rise in the politicisation of Islam in Malaysia and links it to the othering of the Malaysian Malay. It is my argument that both were “conquering” tools of Malaysia’s “Father of Modernisation”, Mahathir Mohamad, devised to win the support of the Malay Muslim majority in Malaysia. The many awards bestowed on Mahathir obscure the fact that he was instrumental in the systematic erosion of the power and roles of state institutions, especially at the Federal government level. This includes the significant loss of the independence of the Malaysian judiciary. Whilst per capita income in Malaysia may well have increased eight times under his 22-year leadership, this paper asks why is it that the majority of the Malays remain the largest number among the poor and the more disenfranchised of ethnicities in the country? Why have Malay and Muslim women suffered such a rapid decreasing ability to access justice? This paper examines existing research on the social and political changes Malaysia has experienced with Islamisation and under Mahathir’s rule, as well as studies on Malayness, Malay nationalism and Muslim Malay identity formation. The paper elaborates the othering of a majority people, the Malays in Malaysia, and how this othering has brought forth a fast-growing political power in the name of a supremacist Islam, a puritanical Sunni and Malay Islam. Specific events in the rise and rule of Mahathir as Malaysia’s then Prime Minister are reviewed, such as the banning of The Malay Dilemma, and the split in the United Malays National Organisation (UMNO) in 1987. Also examined is the varying emphasis between Muslim and race, and how during Mahathir’s rule, that strong misogynist and patriarchal attitudes took hold in Malay Muslim consciousness, a colonising consciousness that is othering the perceived cultural and genetic “impurities” within the Malay.

Diffusion-sensitive magnetic resonance spectroscopy and imaging in biomedical sciences

We present a mini-review of the development and contemporary applications of diffusion-sensitive nuclear magnetic resonance (NMR) techniques in biomedical sciences. Molecular diffusion is a fundamental physical phenomenon present in all biological systems. Due to the connection between experimentally measured diffusion metrics and the microscopic environment sensed by the diffusing molecules, diffusion measurements can be used for characterisation of molecular size, molecular binding and association, and the morphology of biological tissues. The emergence of magnetic resonance was instrumental to the development of biomedical applications of diffusion. We discuss the fundamental physical principles of diffusion NMR spectroscopy and diffusion MR imaging. The emphasis is placed on conceptual understanding, historical evolution and practical applications rather than complex technical details. Mathematical description of diffusion is presented to the extent that it is required for the basic understanding of the concepts. We present a wide range of spectroscopic and imaging applications of diffusion magnetic resonance, including colloidal drug delivery vehicles; protein association; characterisation of cell morphology; neural fibre tractography; cardiac imaging; and the imaging of load-bearing connective tissues. This paper is intended as an accessible introduction into the exciting and growing field of diffusion magnetic resonance.

Association between maternal depressive symptoms in the early postnatal period and responsiveness in feeding at child age 2 years

Maternal depression is a known risk factor for poor outcomes for children. Pathways to these poor outcomes relate to reduced maternal responsiveness or sensitivity to the child. Impaired responsiveness potentially impacts the feeding relationship and thus may be a risk factor for inappropriate feeding practices. The aim of this study was to examine the longitudinal relationships between self-reported maternal post-natal depressive symptoms at child age 4 months and feeding practices at child age 2 years in a community sample. Participants were Australian first-time mothers allocated to the control group of the NOURISH randomized controlled trial when infants were 4 months old. Complete data from 211 mothers (of 346 allocated) followed up when their children were 2 years of age (51% girls) were available for analysis. The relationship between Edinburgh Postnatal Depression Scale (EPDS) score (child age 4 months) and child feeding practices (child age 2 years) was tested using hierarchical linear regression analysis adjusted for maternal and child characteristics. Higher EPDS score was associated with less responsive feeding practices at child age 2 years: greater pressure [β = 0.18, 95% confidence interval (CI): 0.04–0.32, P = 0.01], restriction (β = 0.14, 95% CI: 0.001–0.28, P = 0.05), instrumental (β = 0.14, 95% CI: 0.005–0.27, P = 0.04) and emotional (β = 0.15, 95% CI: 0.01–0.29, P = 0.03) feeding practices (ΔR2 values: 0.02–0.03, P < 0.05). This study provides evidence for the proposed link between maternal post-natal depressive symptoms and lower responsiveness in child feeding. These findings suggest that the provision of support to mothers experiencing some levels of depressive symptomatology in the early post-natal period may improve responsiveness in the child feeding relationship.