Examination of the properties of IMRT and VMAT beams and evaluation against pre-treatment quality assurance results

This study aimed to provide a detailed evaluation and comparison of a range of modulated beam evaluation metrics, in terms of their correlation with QA testing results and their variation between treatment sites, for a large number of treatments. Ten metrics including the modulation index (MI), fluence map complexity (FMC), modulation complexity score (MCS), mean aperture displacement (MAD) and small aperture score (SAS) were evaluated for 546 beams from 122 IMRT and VMAT treatment plans targeting the anus, rectum, endometrium, brain, head and neck and prostate. The calculated sets of metrics were evaluated in terms of their relationships to each other and their correlation with the results of electronic portal imaging based quality assurance (QA) evaluations of the treatment beams. Evaluation of the MI, MAD and SAS suggested that beams used in treatments of the anus, rectum, head and neck were more complex than the prostate and brain treatment beams. Seven of the ten beam complexity metrics were found to be strongly correlated with the results from QA testing of the IMRT beams (p < 0.00008). For example, Values of SAS (with MLC apertures narrower than 10 mm defined as “small”) less than 0.2 also identified QA passing IMRT beams with 100% specificity. However, few of the metrics are correlated with the results from QA testing of the VMAT beams, whether they were evaluated as whole 360◦ arcs or as 60◦ sub-arcs. Select evaluation of beam complexity metrics (at least MI, MCS and SAS) is therefore recommended, as an intermediate step in the IMRT QA chain. Such evaluation may also be useful as a means of periodically reviewing VMAT planning or optimiser performance.

Editorials: A different kind of treatment

Health professionals' duty of care includes combating racism in society as well as in health care settings. The Australian Government's proposed changes to the Racial Discrimination Act 1975 and the repeal of section 18C has transfixed national debates on legally defining racial discrimination.1 Under these changes, racial discrimination would no longer include acts that “offend, insult, humiliate or intimidate” a person based on the person's race, colour or national or ethnic origin and instead be limited to acts that “incite hatred” or “cause fear of physical harm”.2 These proposed changes have been framed in the context of enabling “free speech”, yet, evidence presented in this issue of the Journal shows that they have potential to cause harm. In this issue, Kelaher and colleagues highlight the prevalence of racism as experienced by Indigenous Australians and its deleterious effects on mental health.3 Alarmingly, almost every Aboriginal Victorian participating in this study reported an experience of racism in the preceding 12 months, which included jokes, stereotypes, verbal abuse and exclusionary practices. The experiences of racism reported here neither incited hatred nor caused fear of physical harm, yet resulted in harm such as psychological distress, especially when meted out in our health care system. These findings are a stark reminder that racism is indeed an important health issue, and as health professionals, our duty of care extends to contributing to these broader policy discussions...

Sectional analysis of stormwater treatment performance of a constructed wetland

Constructed wetlands are among the most common Water Sensitive Urban Design (WSUD) measures for stormwater treatment. These systems have been extensively studied to understand their performance and influential treatment processes. Unfortunately, most past studies have been undertaken considering a wetland system as a lumped system with a primary focus on the reduction of the event mean concentration (EMC) values of specific pollutant species or total pollutant load removal. This research study adopted an innovative approach by partitioning the inflow runoff hydrograph and then investigating treatment performance in each partition and their relationships with a range of hydraulic factors. The study outcomes confirmed that influenced by rainfall characteristics, the constructed wetland displays different treatment characteristics for the initial and later sectors of the runoff hydrograph. The treatment of small rainfall events (<15 mm) is comparatively better at the beginning of runoff events while the trends in pollutant load reductions for large rainfall events (>15 mm) are generally lower at the beginning and gradually increase towards the end of rainfall events. This highlights the importance of ensuring that the inflow into a constructed wetland has low turbulence in order to achieve consistent treatment performance for both, small and large rainfall events.

Sensorineural hearing loss after treatment for head and neck cancer : a review of the literature

Background Definitive cisplatin-based is increasingly delivered as the treatment of choice for patients with head and neck cancer. Sensorineural hearing loss is a significant long term side effect of cisplatin-based chemoradiation and is associated with potential major quality of life issues for patients. Purpose The purpose of this manuscript was to review the mechanism behind sensorineural hearing loss in patients treated with cisplatin-based chemoradiation, including incidence, the contributions of radiotherapy and cisplatin to sensorineural hearing loss and the impact of the toxicity on patient quality of life. Methods Database searches were conducted through PubMed (National Centre for Biotechnology Information) and OvidSP Medline via the Queensland University of Technology Library website. General article searches were conducted through the online search engine Google Scholar. Articles were excluded if the full-text was unavailable, they were not in English or if they were published prior to 1990. Keywords included hearing loss, ototoxicity, cancer, quality of life, cisplatin and radiotherapy. Results/Discussion The total number of journal articles accessed was 290. Due to exclusion criteria, 129 articles were deemed appropriated for review. Findings indicated that sensorineural hearing loss is a significant, long term complication for patients treated with cisplatin-based chemoradiation. Current literature recognises the ototoxic effects of cisplatin and cranial irradiation as separate entities, however the impact of combined modality therapy on sensorineural hearing loss is seldom reported. Multiple risk factors for hearing loss are described, however there are contradictory opinions on incidence and severity and the exact radiation dose threshold responsible for inducing hearing loss in patients receiving combined modality therapy. Sensorineural hearing loss creates a subset of complexities for patients with head and neck cancer and that these patients face significant quality of life impairment. Conclusion The literature review identified that sensorineural hearing loss is a major quality of life issue for patients treated with cisplatin-based chemoradiation for head and neck cancer. Further investigation evaluating the contribution of cisplatin-based chemoradiation to sensorineural hearing loss and the subsequent effect on patient quality of life is warranted.

Provision of survivorship care for patients with haematological malignancy at completion of treatment: a cancer nursing practice survey study

Purpose Many haematological cancer survivors report long-term physiological and psychosocial effects, which persist far beyond treatment completion. Cancer services have been required to extend care to the post-treatment phase to implement survivorship care strategies into routine practice. As key members of the multidisciplinary team, cancer nurses’ perspectives are essential to inform future developments in survivorship care provision. Methods This is a pilot survey study, involving 119 nurses caring for patients with haematological malignancy in an Australian tertiary cancer care centre. The participants completed an investigator developed survey designed to assess cancer care nurses’ perspectives on their attitudes, confidence levels, and practice in relation to post-treatment survivorship care for patients with a haematological malignancy. Results Overall, the majority of participants agreed that all of the survivorship interventions included in the survey should be within the scope of the nursing role. Nurses reported being least confident in discussing fertility and employment/financial issues with patients and conducting psychosocial distress screening. The interventions performed least often included, discussing fertility, intimacy and sexuality issues and communicating survivorship care with the patient’s primary health care providers. Nurses identified lack of time, limited educational resources, lack of dedicated end-of-treatment consultation and insufficient skills/knowledge as the key barriers to survivorship care provision. Conclusion Cancer centres should implement an appropriate model of survivorship care and provide improved training and educational resources for nurses to enable them to deliver quality survivorship care and meet the needs of haematological cancer survivors.

Perspectives on Australian bankruptcy law through the prism of the World Bank report on the treatment of the insolvency of natural persons

The insolvency of natural persons raises questions not only for a nation’s economy but also for its concern for equity. The World Bank has recently released a Report on the Treatment of the Insolvency of Natural Persons to guide nations in addressing the issues raised by an individual debtor’s insolvency. A brief review of Australia’s personal insolvency laws shows that it addresses many of the issues raised by the Report. However two areas are identified as worthy of further investigation by policy-makers and scholars to better address a concern for equity.

Towards equalisation of the impact of the penal fine : why the wealth of the offender was taken into account

Important changes in the legal regulation of the fine culminated in the implementation of the day‐fine system in many European countries during the twentieth century. These changes resulted from various late nineteenth century rationalities that considered the fine a justifiable punishment. Therefore, they supported extending its application by making it affordable for people on low incomes, which meant imprisonment for fine default could mostly be avoided without undermining the end of punishment. In this paper I investigate the historical development of the penal fine as well as the changing forms of this penalty in Western European criminal systems from the end of the eighteenth century until the late nineteenth century.

Antisocial personality disorder and therapeutic justice court programs

It has become commonplace for courts to supervise an offender as part of the sentencing process. Many of them have Anti Social Personality Disorder (ASPD). The focus of this article is how the work of specialist and/or problem solving courts can be informed by the insights of the psychology profession into the best practice in the treatment and management of people with ASPD. It is a legitimate purpose of legal work to consider and improve the well-being of the participants in the legal process. Programs designed specifically to deal with those with ASPD could be incorporated into existing Drug Courts, or implemented separately by courts to aid with reforming offenders with ASPD and in managing the re-entry of offenders into the community as part of their sentence. For the success of this initiative on the part of the court, ASPD will need to be specifically diagnosed and treated. Close co-operation between courts and psychologists is required to improve the effectiveness of court programs to treat people with ASPD and to evaluate their success.

Understanding victim behaviour through offender behaviour typologies

Criminology has long sought to define and understand criminal motivations. There has, however, been less attention paid to the motivations involved in “everyday” thought and behaviour that may place someone in harm’s way. This doesn’t mean that victims are somehow motivated to become victims, but they may behave in such a way that victimisation happens as a matter of course. In the parlance of victimity, victim behaviour has often been referred to as either “victim facilitated” or “victim precipitated”. However, while some use these terms to explain the role of victim behaviour in relation to harm or loss, they actually do little to further our knowledge about the cognitive and behavioural milieu in which victimisation occurs. For example, a victim of homicide may precipitate the attack by violently confronting a partner (in retaliation for real or imagined wrongs). Another victim may facilitate domestic violence by not leaving their partner for financial reasons (“cannot afford to go out on my own”). Far from blaming the victim, understanding the motivational nature of victim behaviour can be accomplished by juxtaposing motivations for offender behaviour. This presentation applies offender motivations to victim behaviours, and presents anecdotal and research support for this approach.

Emerging water treatment technologies for decentralised systems : an overview of selected systems suited for application in towns and settlements in remote and very remote regions of Australia and vulnerable and lagging rural regions in Sri Lanka

The primary purpose of this paper is to overview a selection of advanced water treatment technology systems that are suited for application in towns and settlements in remote and very remote regions of Australia and vulnerable and lagging rural regions in Sri Lanka. This recognises that sanitation and water treatment are inextricably linked and both are needed to reduce risks to environment and population health from contaminated water sources. For both Australia and Sri Lanka only a small fraction of the settlements in rural and remote regions are connected to water treatment facilities and town water supplies. In Australia’s remote/very remote regions raw water is drawn from underground sources and rainwater capture. Most settlements in rural Sri Lanka rely on rivers, reservoirs, wells, springs or carted water. Furthermore, Sri Lanka has more than 25,000 hand pumped tube wells which saved the communities during recent droughts. Decentralised water supply systems offer the opportunity to provide safe drinking water to these remote/very remote and rural regions where centralised systems are not feasible due to socio-cultural, economic, political, technological reasons. These systems reduce health risks from contaminated water supplies. In remote areas centralized systems fail due to low population density and less affordability. Globally, a new generation of advanced water treatment technologies are positioned to make a major impact on the provision of safe potable water in remote/very remote regions in Australia and rural regions in Sri Lanka. Some of these systems were developed for higher income countries. However, with careful selection and further research they can be tailored to match local socio-economic conditions and technical capacity. As such, they can equally be used to provide decentralised water supply in communities in developed and developing countries such as Australia and Sri Lanka.

Engaging sex: Promoting the statutory interpretation experience in legal education

Given the ever increasing importance of legislation to the resolution of legal disputes, there is a concomitant need for law students to be well trained in the anatomy, identification, interpretation and application of laws made by or under parliament. This article discusses a blended learning project called Indigo’s Folly, implemented at the Queensland University of Technology Law School in 2014. Indigo’s Folly was created to increase law student competency with respect to statutory interpretation. Just as importantly, it was designed to make the teaching of statutory interpretation more interesting – to “bring the sexy” to the student statutory interpretation experience. Quantitative and qualitative empirical data will be presented as evidence to show that statutory interpretation can be taught in a way that law students find engaging.

When sex doesn't sell: Using sexualized images of women reduces support for ethical campaigns

Images of scantily clad women are used by advertisers to make products more attractive to men. This ‘‘sex sells’’ approach is increasingly employed to promote ethical causes, most prominently by the animal-rights organization PETA. Yet sexualized images can dehumanize women, leaving an unresolved paradox – is it effective to advertise an ethical cause using unethical means? In Study 1, a sample of Australian male undergraduates (N = 82) viewed PETA advertisements containing either sexualized or non-sexualized images of women. Intentions to support the ethical organization were reduced for those exposed to the sexualized advertising, and this was explained by their dehumanization of the sexualized women, and not by increased arousal. Study 2 used a mixed-gender community sample from the United States (N = 280), replicating this finding and extending it by showing that behaviors helpful to the ethical cause diminished after viewing the sexualized advertisements, which was again mediated by the dehumanization of the women depicted. Alternative explanations relating to the reduced credibility of the sexualized women and their objectification were not supported. When promoting ethical causes, organizations may benefit from using advertising strategies that do not dehumanize women.

The role of non-thermal plasma technique in {NOx} treatment: A review

Non-thermal plasma (NTP) has been introduced over the past several years as a promising method for nitrogen oxide (NOx) removal. The intent, when using NTP, is to selectively transfer input electrical energy to the electrons, and to not expend this in heating the entire gas stream, which generates free radicals through collisions, and promotes the desired chemical changes in the exhaust gases. The generated active species react with the pollutant molecules and decompose them. This paper reviews and summarizes relevant literature regarding various aspects of the application of {NTP} technology on {NOx} removal from exhaust gases. A comprehensive description of available scientific literature on {NOx} removal using {NTP} technology is presented, including various types of NTP, e.g. dielectric barrier discharge, corona discharge and electron beam. Furthermore, the combination of {NTP} with catalyst and adsorbent for better {NOx} removal efficiency is presented in detail. The removal of {NOx} from both simulated gases and real diesel engines is also considered in this review paper. As {NTP} is a new technique and is not yet commercialized, there is a need for more studies to be performed in this field.

Deliverable 2: Literature review on effectiveness of alcohol treatment and determining rehabilitation. Report to Austroads (SS1755)

Austroads called for responses to a tender to investigate options for rehabilitation in alcohol interlock programs. Following successful application by the Centre for Accident Research and Road Safety – Queensland (CARRS-Q), a program of work was developed. The project has four objectives: 1. Develop a matrix outlining existing policies in national and international jurisdictions with respect to treatment and rehabilitation programs and criteria for eligibility for interlock removal; 2. Critically review the available literature with a focus on evaluation outcomes regarding the effectiveness of treatment and rehabilitation programs; 3. Analyse and assess the strengths and weaknesses of the programs/approaches identified, and; 4. Outline options with an evidence base for consideration by licensing authorities.