Oncology service initiatives and research in regional Australia

Objective: This paper reflects on the recent growth of cancer research being conducted through some of Australia’s rural centres. It encompasses work being done across the fields of clinical, translational and health services research. Design: This is a collaborative piece with contributions from rural health researchers, clinical and cancer services staff from several different regions. Conclusion: The past decade has seen an expansion in cancer research in rural and regional Australia driven in part by the recognition that cancer patients in remote areas experience poorer outcomes than their metropolitan counterparts. This work has led to the development of more effective cancer networks and new models of care designed to meet the particular needs of the rural cancer patient. It is hoped that the growth of cancer research in regional centres will, in time, reduce the disparity between rural and urban communities and improve outcomes for cancer patients across both populations.

Sense of modern heritage

As the society matures, there was an increasing pressure to preserve historic buildings. The economic cost in maintaining these important heritage legacies has become the prime consideration of every state. Dedicated intelligent monitoring systems supplementing the traditional building inspections will enable the stakeholder to carry out not only timely reactive response but also plan the maintenance in a more vigilant approach; thus, preventing further degradation which was very costly and difficult to address if neglected. The application of the intelligent structural health monitoring system in this case studies of ‘modern heritage’ buildings is on its infancy but it is an innovative approach in building maintenance. ‘Modern heritage’ buildings were the product of technological change and were made of synthetic materials such as reinforced concrete and steel. Architectural buildings that was very common in Oceania and The Pacific. Engineering problems that arose from this type of building calls for immediate engineering solution since the deterioration rate is exponential. The application of this newly emerging monitoring system will improve the traditional maintenance system on heritage conservation. Savings in time and resources can be achieved if only pathological results were on hand. This case study will validate that approach. This publication will serve as a position paper to the on-going research regarding application of (Structural Health Monitoring) SHM systems to heritage buildings in Brisbane, Australia. It will be investigated with the application of the SHM systems and devices to validate the integrity of the recent structural restoration of the newly re-strengthened heritage building, the Brisbane City Hall.

Establishing and maintaining social connectivity: An understanding of the lived experiences of older adults residing in regional and rural communities

- Objective To better understand how to plan for an ageing demographic that resides in ever-changing community typologies. Design: Semi-structured in-depth interviews. - Setting Community settings in rural and regional towns in Queensland. - Participants Twenty-two people aged over 65 years living in regional and rural Australia. - Interventions Qualitative study of social connectedness. - Main outcome measure(s) Thematic qualitative analysis. - Results Formal and informal social contact, through family, friends and social groups, was found to be important to the everyday lives of the participants. - Conclusions Social connections for older adults are important in maintaining independence and community engagement.

Systems-based approach to investigate unsafe pedestrian behaviour at level crossings

Crashes at level crossings are a major issue worldwide. In Australia, as well as in other countries, the number of crashes with vehicles has declined in the past years, while the number of crashes involving pedestrians seems to have remained unchanged. A systematic review of research related to pedestrian behaviour highlighted a number of important scientific gaps in current knowledge. The complexity of such intersections imposes particular constraints to the understanding of pedestrians’ crossing behaviour. A new systems-based framework, called Pedestrian Unsafe Level Crossing framework (PULC) was developed. The PULC organises contributing factors to crossing behaviour on different system levels as per the hierarchical classification of Jens Rasmussen’s Framework for Risk Management. In addition, the framework adapts James Reason’s classification to distinguish between different types of unsafe behaviour. The framework was developed as a tool for collection of generalizable data that could be used to predict current or future system failures or to identify aspects of the system that require further safety improvement. To give it an initial support, the PULC was applied to the analysis of qualitative data from focus groups discussions. A total number of 12 pedestrians who regularly crossed the same level crossing were asked about their daily experience and their observations of others’ behaviour which allowed the extraction and classification of factors associated with errors and violations. Two case studies using Rasmussen’s AcciMap technique are presented as an example of potential application of the framework. A discussion on the identified multiple risk contributing factors and their interactions is provided, in light of the benefits of applying a systems approach to the understanding of the origins of individual’s behaviour. Potential actions towards safety improvement are discussed.

'There is nothing that identifies me to that place’: Indigenous Women’s Perceptions of Health Spaces and Places

This chapter provides an overview of the gendered realities of Indigenous men’s and Indigenous women’s lives and gendered Indigenous health perspectives. It offers the nurse some examples of the role of the nurse in working within gendered Indigenous health care.

‘Beyond all the trends’: Torres Strait Island foods, past, present and future

While trends are cyclical, Indigenous perspectives offer continuity to life’s pathways. One of the current trends is the increasing culinary interest in Indigenous Australian foods, not just in restaurants, but also in home kitchens. This is a recent trend despite Indigenous foods being nutritious and wholesome, and sustaining Indigenous peoples for thousands of years. Home Economics can support, foster and affirm Indigenous foods both within this current mainstream trend and in the future in life sustaining ways. In order to do so, Home Economics need’s to ensure it is prepared, and skilled, with the appropriate knowledge and regard for Indigenous ingredients, foods and foodways. This paper will focus on Torres Strait Islander foods from the Torres Strait and from mainland Australia. It will showcase Torres Strait foods is the past, present and the future. Some of what is presented here is part of a research case study, which involves a literature review, data collection, and photography. In documenting the history of Torres Strait Island food and foodways, the traditions and customs will be kept alive for future generations, and beyond any trends or fashions.

Negotiating Chineseness through learning Chinese as a Heritage Language in Australia: The role of habitus

While education researchers have drawn on the work of a wide diversity of theorists over the years, much contemporary theory building in these areas has revolved around the work of Pierre Bourdieu. Theory as Method in Research develops the capacity of students, researchers and teachers to successfully put Bourdieu’s ideas to work in their own research and prepare them effectively for conducting Masters and Doctoral scholarships. Structured around four core themes, this book provides a range of research case studies exploring educational identities, educational inequalities, school leadership and management, and research in teacher education. Issues as diverse as Chinese language learning and identity, school leadership in Australia and the school experience of Afro-Trinidadian boys, are covered, intertwined with a set of innovative approaches to theory application in education research. This collection brings together, in one comprehensive volume, a set of education researchers who place Pierre Bourdieu’s key concepts such as habitus, capital and field at the centre of their research methodologies. Full of insight and innovation, the book is an essential read for practitioners, student teachers, researchers and academics who want to harness the potential of Bourdieu’s core concepts in their own work, thereby helping to bridge the gap between theory and method in education research.

Through their eyes: Seeing experiences of Settlement in photographs taken by refugee background youth in Melbourne, Australia

Although “refugees” are frequently represented in visual media, it is predominantly as the central subject matter and rarely are they positioned as the photographers of their own journeys. In this article we present photographic images that have been taken by refugee background youth portraying their experiences of the first years of settlement in Australia. We consider how, in our longitudinal research conducted with 120 refugee background youth, visual materials can provide equally important yet different insights in comparison to written or spoken narratives on the experiences of refugee settlement. Through an examination of over 1,000 photos taken by these youth, we explore the ways in which they portrayed their early experiences of external suburban settlement environments and their depictions of interior spaces and home-making practices. We discuss how these visual insights capture an alternative way of seeing the experiences of becoming at home as the youth become emplaced post-resettlement in Australia. We argue that the photographs taken by these refugee background youth illustrate how visual methods and materials can provide equally important but often overlooked insights into early settlement experiences. Importantly, the photographic images offer a way of portraying the people, places and sentiments that are central to the everyday lives of refugee background youths in ways that oral and written narratives can not.

Genome-wide association study to identify genetic determinants of severe asthma

Background: The genetic basis for developing asthma has been extensively studied. However, association studies to date have mostly focused on mild to moderate disease and genetic risk factors for severe asthma remain unclear. Objective: To identify common genetic variants affecting susceptibility to severe asthma. Methods: A genome-wide association study was undertaken in 933 European ancestry individuals with severe asthma based on Global Initiative for Asthma (GINA) criteria 3 or above and 3346 clean controls. After standard quality control measures, the association of 480 889 genotyped single nucleotide polymorphisms (SNPs) was tested. To improve the resolution of the association signals identified, non-genotyped SNPs were imputed in these regions using a dense reference panel of SNP genotypes from the 1000 Genomes Project. Then replication of SNPs of interest was undertaken in a further 231 cases and 1345 controls and a meta-analysis was performed to combine the results across studies. Results: An association was confirmed in subjects with severe asthma of loci previously identified for association with mild to moderate asthma. The strongest evidence was seen for the ORMDL3/GSDMB locus on chromosome 17q12-21 (rs4794820, p=1.03×10 (-8)following meta-analysis) meeting genome-wide significance. Strong evidence was also found for the IL1RL1/IL18R1 locus on 2q12 (rs9807989, p=5.59×10 (-8) following meta-analysis) just below this threshold. No novel loci for susceptibility to severe asthma met strict criteria for genome-wide significance. Conclusions: The largest genome-wide association study of severe asthma to date was carried out and strong evidence found for the association of two previously identified asthma susceptibility loci in patients with severe disease. A number of novel regions with suggestive evidence were also identified warranting further study.

Chronicling the patient journey: Co-creating value with digital health ecosystems

With the introduction of the PCEHR (Personally Controlled Electronic Health Record), the Australian public is being asked to accept greater responsibility for the management of their health information. However, the implementation of the PCEHR has occasioned poor adoption rates underscored by criticism from stakeholders with concerns about transparency, accountability, privacy, confidentiality, governance, and limited capabilities. This study adopts an ethnographic lens to observe how information is created and used during the patient journey and the social factors impacting on the adoption of the PCEHR at the micro-level in order to develop a conceptual model that will encourage the sharing of patient information within the cycle of care. Objective: This study aims to firstly, establish a basic understanding of healthcare professional attitudes toward a national platform for sharing patient summary information in the form of a PCEHR. Secondly, the studies aims to map the flow of patient related information as it traverses a patient’s personal cycle of care. Thus, an ethnographic approach was used to bring a “real world” lens to information flow in a series of case studies in the Australian healthcare system to discover themes and issues that are important from the patient’s perspective. Design: Qualitative study utilising ethnographic case studies. Setting: Case studies were conducted at primary and allied healthcare professionals located in Brisbane Queensland between October 2013 and July 2014. Results: In the first dimension, it was identified that healthcare professionals’ concerns about trust and medico-legal issues related to patient control and information quality, and the lack of clinical value available with the PCEHR emerged as significant barriers to use. The second dimension of the study which attempted to map patient information flow identified information quality issues, clinical workflow inefficiencies and interoperability misconceptions resulting in duplication of effort, unnecessary manual processes, data quality and integrity issues and an over reliance on the understanding and communication skills of the patient. Conclusion: Opportunities for process efficiencies, improved data quality and increased patient safety emerge with the adoption of an appropriate information sharing platform. More importantly, large scale eHealth initiatives must be aligned with the value proposition of individual stakeholders in order to achieve widespread adoption. Leveraging an Australian national eHealth infrastructure and the PCEHR we offer a practical example of a service driven digital ecosystem suitable for co-creating value in healthcare.

Sri Lankan entrepreneurs in Australia: Chance or choice?

Purpose Ethnic entrepreneurship is, and always has been, a means of survival. However, there is limited literature on ethnic entrepreneurship in Australia and therefore, an understanding of ethnic entrepreneurs’ motivations to become self-employed. The purpose of this paper is to report the influential factors in the decision to engage in self-employment through case studies of members of Melbourne’s Sri Lankan community informed by the mixed embeddedness approach. Design/methodology/approach The mixed embeddedness approach frames the study where the authors examine the motivations for business of five Sri Lankan entrepreneurs. Narratives are used to construct individual case studies, which are then analyzed in terms of the motivations for, resources used and challenges faced on the entrepreneurial journey. Findings For these ethnic entrepreneurs, their entrepreneurial activity results from a dynamic match between local market opportunities and the specific ethnic resources available to them at the time of founding. The self-employment decision was not prompted by a lack of human capital but an inability to use that human capital in alternative means of employment at specific points in time. Moreover the authors highlight the importance of social and cultural capital as resources used to overcome challenges on the entrepreneurial journey. Originality/value In this community, entrepreneurship was not a result of a lack of human capital but how it was utilized in combination with social and cultural capitals in the given opportunity structure. The mixed embeddedness approach enables the uncovering of how ethnic network ties were used in light of the opportunities available to build entrepreneurial activity.

The effect of data sources and quality on the predictive capacity of CLIMEX models: an assessment of Teleonemia scrupulosa and Octotoma scabripennis for the biocontrol of Lantana camara in Australia

Understanding the effects of different types and quality of data on bioclimatic modeling predictions is vital to ascertaining the value of existing models, and to improving future models. Bioclimatic models were constructed using the CLIMEX program, using different data types – seasonal dynamics, geographic (overseas) distribution, and a combination of the two – for two biological control agents for the major weed Lantana camara L. in Australia. The models for one agent, Teleonemia scrupulosa Stål (Hemiptera:Tingidae) were based on a higher quality and quantity of data than the models for the other agent, Octotoma scabripennis Guérin-Méneville (Coleoptera: Chrysomelidae). Predictions of the geographic distribution for Australia showed that T. scrupulosa models exhibited greater accuracy with a progressive improvement from seasonal dynamics data, to the model based on overseas distribution, and finally the model combining the two data types. In contrast, O. scabripennis models were of low accuracy, and showed no clear trends across the various model types. These case studies demonstrate the importance of high quality data for developing models, and of supplementing distributional data with species seasonal dynamics data wherever possible. Seasonal dynamics data allows the modeller to focus on the species response to climatic trends, while distributional data enables easier fitting of stress parameters by restricting the species envelope to the described distribution. It is apparent that CLIMEX models based on low quality seasonal dynamics data, together with a small quantity of distributional data, are of minimal value in predicting the spatial extent of species distribution.

Development and feasibility testing of an education program to improve knowledge and self-care among Aboriginal and Torres Strait Islander patients with heart failure

Background/Aim There is a 70% higher age-adjusted incidence of heart failure (HF) amongst Aboriginal and Torres Strait Islander people, three times more hospitalisations and twice as many deaths than non-Aboriginal people. There is a need to develop holistic yet individualised approaches in accord with the values of Aboriginal community healthcare to support patient education and self-care. The aim of this study was to re-design an existing HF educational resource (Fluid Watchers-Pacific Rim©) to be culturally safe for Aboriginal and Torres Strait Islander peoples, working in collaboration with the local community, and to conduct feasibility testing. Methods This study was conducted in two phases and utilised a mixed methods approach (qualitative and quantitative). Phase 1 of this study used action research methods to develop a culturally safe electronic resource to be provided to Aboriginal HF patients via a tablet computer. A HF expert panel adapted the existing resource to ensure it was evidence-based and contained appropriate language and images that reflects Aboriginal culture. A stakeholder group (which included Aboriginal workers and HF patients, as well as researchers and clinicians) then reviewed the resources and changes were made accordingly. In Phase 2, the new resource was tested on a sample of Aboriginal HF patients to assess feasibility and acceptability. Patient knowledge, satisfaction and self-care behaviours were measured using a before and after design with validated questionnaires. As this was a pilot test to determine feasibility, no statistical comparisons were made. Results - Phase 1: Throughout the process of resource development, two main themes emerged from the stakeholder consultation. These were the importance of identity, meaning that it was important to ensure that the resource accurately reflected the local community, with the appropriate clothing, skin tone and voice. The resource was adapted to reflect this and of the local community voiced the recordings for the resource. The other theme was comprehension; images were important and all text was converted to the first person and used plain language. - Phase 2: Five Aboriginal participants, mean age 61.6 ± 10.0 years, with NYHA Class III and IV heart failure were enrolled. Participants reported a high level of satisfaction with the resource (83.0%). HF knowledge (percentage of correct responses) increased from 48.0 ± 6.7% to 58.0 ± 9.7%, a 20.8% increase and results of the self-care index indicated that the biggest change was in patient confidence for self-care with a 95% increase in confidence score (46.7 ± 16.0 to 91.1 ± 11.5). Changes in management and maintenance scores varied between9275 patients. Conclusion By working in collaboration with HF experts, Aboriginal researchers and patients, a culturally safe HF resource has been developed for Aboriginal and Torres Strait Islander patients. Engaging Aboriginal researchers, capacity-building, and being responsive to local systems and structures enabled this pilot study to be successfully completed with the Aboriginal community and positive participant feedback demonstrated that the methodology used in this study was appropriate and acceptable; participants were able to engage with willingness and confidence.

Losing the rural nursing workforce: Lessons learnt from resigning nurses

Background Australian workforce planning predicts a shortfall of nurses by 2025 with rural areas being most at risk. Rural areas have lower retention rates of nurses than metropolitan areas, with remote communities experiencing an even higher turnover of nursing staff. There have been few studies that examine the impact of nurse resignations on rural nursing workforces. Objective This paper is abstracted from a larger study into the reasons why nurses resign from rural hospitals and explores the resignation period. Design A qualitative study using grounded theory methods. Following in-depth interviewing and transcription, data analysis occurred with the assistance of NVivo software. Setting Rural NSW. Participants Twelve registered nurses who had resigned from rural NSW hospitals and not for reasons of retirement, maternity leave or relocation; two participants were re-interviewed. Results While the overall study identified a grounded theory which explained rural nurses resign from hospitals due to a conflict of values, three additional themes emerged about the resignation practices at rural hospitals. The first theme identified a ‘window period’ which was an opportunity for the nurse to be retained. The second theme identified that nurses who had resigned were not involved in formal exit processes such as exit interviews. The third theme captured the flow-on effect from rural nurse resignations resulting in nurses leaving the profession of nursing. Conclusion To facilitate nurse retention, it is important that rural hospitals manage nurse resignations more effectively. This includes re-examining resignation procedures, how nurses are treated and collecting meaningful data to inform retention strategies.