Hepatitis C, mental health and equity of access to antiviral therapy : a systematic narrative review

Introduction Access to hepatitis C (hereafter HCV) antiviral therapy has commonly excluded populations with mental health and substance use disorders because they were considered as having contraindications to treatment, particularly due to the neuropsychiatric effects of interferon that can occur in some patients. In this review we examined access to HCV interferon antiviral therapy by populations with mental health and substance use problems to identify the evidence and reasons for exclusion. Methods We searched the following major electronic databases for relevant articles: PsycINFO, Medline, CINAHL, Scopus, Google Scholar. The inclusion criteria comprised studies of adults aged 18 years and older, peer-reviewed articles, date range of (2002--2012) to include articles since the introduction of pegylated interferon with ribarvirin, and English language. The exclusion criteria included articles about HCV populations with medical co-morbidities, such as hepatitis B (hereafter HBV) and human immunodeficiency virus (hereafter HIV), because the clinical treatment, pathways and psychosocial morbidity differ from populations with only HCV. We identified 182 articles, and of these 13 met the eligibility criteria. Using an approach of systematic narrative review we identified major themes in the literature. Results Three main themes were identified including: (1) pre-treatment and preparation for antiviral therapy, (2) adherence and treatment completion, and (3) clinical outcomes. Each of these themes was critically discussed in terms of access by patients with mental health and substance use co-morbidities demonstrating that current research evidence clearly demonstrates that people with HCV, mental health and substance use co-morbidities have similar clinical outcomes to those without these co-morbidities. Conclusions While research evidence is largely supportive of increased access to interferon by people with HCV, mental health and substance use co-morbidities, there is substantial further work required to translate evidence into clinical practice. Further to this, we conclude that a reconsideration of the appropriateness of the tertiary health service model of care for interferon management is required and exploration of the potential for increased HCV care in primary health care settings.

Intrusion detection in distributed systems, an approach based on taint marking

This paper presents a new framework for distributed intrusion detection based on taint marking. Our system tracks information flows between applications of multiple hosts gathered in groups (i.e., sets of hosts sharing the same distributed information flow policy) by attaching taint labels to system objects such as files, sockets, Inter Process Communication (IPC) abstractions, and memory mappings. Labels are carried over the network by tainting network packets. A distributed information flow policy is defined for each group at the host level by labeling information and defining how users and applications can legally access, alter or transfer information towards other trusted or untrusted hosts. As opposed to existing approaches, where information is most often represented by two security levels (low/high, public/private, etc.), our model identifies each piece of information within a distributed system, and defines their legal interaction in a fine-grained manner. Hosts store and exchange security labels in a peer to peer fashion, and there is no central monitor. Our IDS is implemented in the Linux kernel as a Linux Security Module (LSM) and runs standard software on commodity hardware with no required modification. The only trusted code is our modified operating system kernel. We finally present a scenario of intrusion in a web service running on multiple hosts, and show how our distributed IDS is able to report security violations at each host level.

The multi-platform user engagement and data visualisation tool

The ability to identify and assess user engagement with transmedia productions is vital to the success of individual projects and the sustainability of this mode of media production as a whole. It is essential that industry players have access to tools and methodologies that offer the most complete and accurate picture of how audiences/users engage with their productions and which assets generate the most valuable returns of investment. Drawing upon research conducted with Hoodlum Entertainment, a Brisbane-based transmedia producer, this project involved an initial assessment of the way engagement tends to be understood, why standard web analytics tools are ill-suited to measuring it, how a customised tool could offer solutions, and why this question of measuring engagement is so vital to the future of transmedia as a sustainable industry. Working with data provided by Hoodlum Entertainment and Foxtel Marketing, the outcome of the study was a prototype for a custom data visualisation tool that allowed access, manipulation and presentation of user engagement data, both historic and predictive. The prototyped interfaces demonstrate how the visualization tool would collect and organise data specific to multiplatform projects by aggregating data across a number of platform reporting tools. Such a tool is designed to encompass not only platforms developed by the transmedia producer but also sites developed by fans. This visualisation tool accounted for multiplatform experience projects whose top level is comprised of people, platforms and content. People include characters, actors, audience, distributors and creators. Platforms include television, Facebook and other relevant social networks, literature, cinema and other media that might be included in the multiplatform experience. Content refers to discreet media texts employed within the platform, such as tweet, a You Tube video, a Facebook post, an email, a television episode, etc. Core content is produced by the creators’ multiplatform experiences to advance the narrative, while complimentary content generated by audience members offers further contributions to the experience. Equally important is the timing with which the components of the experience are introduced and how they interact with and impact upon each other. Being able to combine, filter and sort these elements in multiple ways we can better understand the value of certain components of a project. It also offers insights into the relationship between the timing of the release of components and user activity associated with them, which further highlights the efficacy (or, indeed, failure) of assets as catalysts for engagement. In collaboration with Hoodlum we have developed a number of design scenarios experimenting with the ways in which data can be visualised and manipulated to tell a more refined story about the value of user engagement with certain project components and activities. This experimentation will serve as the basis for future research.

Software as a service (SaaS) for small and medium enterprises (SMEs) : the role of intermediaries

Software as a Service (SaaS) is anticipated to provide significant benefits to small and medium enterprises (SMEs) due to ease of access to high-end applications, 7*24 availability, utility pricing, etc. However, underlying SaaS is the assumption that SMEs will directly interact with the SaaS vendor and use a self-service model. In practice, we see the rise of SaaS intermediaries who support SMEs with using SaaS. This paper reports on an empirical study of the role of intermediaries in terms of how they support SMEs in sourcing and leveraging SaaS for their business. The knowledge contributions of this paper are: (1) the identification and description of the role of SaaS intermediaries and (2) the specification of different roles of SaaS intermediaries, in particular a more basic role with technology orientation and operational alignment perspective and (3) a more added value role with customer orientation and strategic alignment perspective.

Safety and efficacy of the combination of trastuzumab with docetaxel for HER2-positive women with advanced breast cancer : a review of the existing clinical trials and results of the expanded access programme in the UK

Trastuzumab is a humanised monoclonal antibody against the extracellular domain of HER2 (human epidermal growth factor receptor-2) that is overexpressed in about 25% of human breast cancers. It has shown clinical benefit in HER2-positive breast cancer cases when used alone or in combination with chemotherapy. Trastuzumab increases the response rate to chemotherapy and prolongs survival when used in combination with taxanes. In this article, we review the clinical trials where trastuzumab has been administered together with docetaxel, and we present the results of the trastuzumab expanded access programme (EAP) in the UK. Combination of trastuzumab with docetaxel results in similar response rates and time-to-progression with the trastuzumab/paclitaxel combinations. The toxicity of the combination and the risk of heart failure are low. The clinical data for the docetaxel/trastuzumab combination indicate a favourable profile from both the efficacy and the safety point of view and confirm the feasibility and safety of trastuzumab administration both as monotherapy and in combination with docetaxel. © 2004 Blackwell Publishing Ltd.

Facebook, telecollaboration, and international access to technology in the classroom

This study uses the well-known social networking site, Facebook (FB), for a study of differences in perceptions on the use of technologies in the classroom around the world. This study is part of a larger project exploring telecollaboration and the use of online discussions between graduate students in an online masters program based in Australia and students in the graduate education program at a regional university in Greece. Postings reveal more similarities between the situations and perceptions of the participants from the different countries than differences. Most participants indicated that while they and their students had access in general to computers and the internet, they did not necessarily have this access in the classroom. Even when technologies were available in schools, participants identified a critical need for professional development to increase teachers’ use of ICT. These findings are relevant to educators and policy development in terms of implementation of ICT or social networking in the language classroom.

Modeling users’ web search behavior and their cognitive styles

Previous studies have shown that users’ cognitive styles play an important role during Web searching. However, only limited studies have showed the relationship between cognitive styles and Web search behavior. Most importantly, it is not clear which components of Web search behavior are influenced by cognitive styles. This paper examines the relationships between users’ cognitive styles and their Web searching and develops a model that portrays the relationship. The study uses qualitative and quantitative analyses to inform the study results based on data gathered from 50 participants. A questionnaire was utilised to collect participants’ demographic information, and Riding’s (1991) Cognitive Style Analysis (CSA) test to assess their cognitive styles. Results show that users’ cognitive styles influenced their information searching strategies, query reformulation behaviour, Web navigational styles and information processing approaches. The user model developed in this study depicts the fundamental relationships between users’ Web search behavior and their cognitive styles. Modeling Web search behavior with a greater understanding of user’s cognitive styles can help information science researchers and information systems designers to bridge the semantic gap between the user and the systems. Implications of the research for theory and practice, and future work are discussed.

Foot ulcer simulation training (FUST) : are podiatrists FUST with long-term clinical confidence?

Background Foot ulcers are a leading cause of diabetes-related hospitalisations. Clinical training has been shown to be beneficial in foot ulcer management. Recently, improved self-confidence in podiatrists was reported immediately after foot ulcer simulation training (FUST) pilot programs. This study aimed to investigate the longer-term impacts of the FUST program on podiatrists’ self-confidence over 12 months in a larger sample. Methods Participants were podiatrists attending a two-day FUST course comprising web-based interactive learning, low-fidelity part-tasks and high-fidelity full clinical scenarios. Primary outcome measures included participants’ self-confidence measured pre-, (immediately) post-, 6-month post- and 12-month post-course via a purpose designed 21-item survey using a five-point Likert scale (1=Very limited, 5=Highly confident). Participants’ perceptions of knowledge gained, satisfaction, relevance and fidelity were also investigated. ANOVA and post hoc tests were used to test any differences between groups. Results Thirty-four participants completed FUST. Survey response rates were 100% (pre), 82% (post), 74% (6-month post), and 47% (12-month post). Overall mean scores were 3.13 (pre), 4.49 (post), 4.35 (6-month post) and 4.30 (12-month post) (p < 0.05); post hoc tests indicated no differences between the immediately, 6-month and 12-month post group scores (p > 0.05). Satisfaction, knowledge, relevance and fidelity were all rated highly. Conclusion This study suggests that significant short-term improvements in self-confidence to manage foot ulcers via simulation training are retained over the longer term. It is likely that improved self-confidence leads to improved foot ulcer clinical practice and outcomes; although this requires further research.

Sex and the virtual suburbs : the pornosphere and community standards

This chapter looks at the management and zoning of online sexual culture–the web sites which make up the pornosphere (McNair 2013). It explores the concept of ‘community standards’, which has been a central part of the management of sexually explicit materials in the offline world, and asks what it might mean to talk about ‘community standards’ on the Internet. And finally, it uses the concept of virtual-community standards to revisit the question of managing access to sexually explicit materials on the Internet.

Delirium knowledge and recognition : a randomized controlled trial of a web-based educational intervention for acute care nurses

Delirium is a significant problem for older hospitalized people and is associated with poor outcomes. It is poorly recognized and evidence suggests that a major reason is lack of education. Nurses, who are educated about delirium, can play a significant role in improving delirium recognition. This study evaluated the impact of a delirium specific educational website. A cluster randomized controlled trial, with a pretest/post-test time series design, was conducted to measure delirium knowledge (DK) and delirium recognition (DR) over three time-points. Statistically significant differences were found between the intervention and non-intervention group. The intervention groups' DK scores were higher and the change over time results were statistically significant [T3 and T1 (t=3.78 p=<0.001) and T2 and T1 baseline (t=5.83 p=<0.001)]. Statistically significant improvements were also seen for DR when comparing T2 and T1 results (t=2.56 p=0.011) between both groups but not for changes in DR scores between T3 and T1 (t=1.80 p=0.074). Participants rated the website highly on the visual, functional and content elements. This study supports the concept that web-based delirium learning is an effective and satisfying method of information delivery for registered nurses. Future research is required to investigate clinical outcomes as a result of this web-based education.

Opening digital learning to deeper inquiry

This chapter presents an historical narrative on the recent evolution of information and communications technology (ICT) that has been, and is, utilized for purposes of learning. In other words, it presents an account of the development of e-learning supported through the Web and other similar virtual environments. It does not attempt to present a definitive account; as such an exercise is fraught with assumptions, contextual bias, and probable conjecture. The concern here is more with contextualizing the role of inquiry in learning and the evolving digital tools that enable interfaces that promote and support it. In tracking this evolution, both multi-disciplinary and trans-disciplinary research has been pursued. Key historical developments are identified as well as interpretations of the key drivers of e-learning over time and into what might be better described as digital learning. Innovations in the development of digital tools are described as dynamic and emergent, evolving as a consequence of multiple, sometimes hidden drivers of change. But conflating advancements in learning technologies with e-learning seems to be pervasive. As is the push for the “open” agenda – a growing number of initiatives and movements dominated by themes associated with access, intellectual property, public benefit, sharing and technical interoperability. Openness is also explored in this chapter, however, more in terms of what it means when associated with inquiry. By investigating opportunities for the stimulation and support of questioning online – in particular, why-questioning – this chapter is focused on “opening” content – not just for access but for inquiry and deeper learning.

Facial expression recognition experiments with data from television broadcasts and the world wide web

Facial expression recognition (FER) systems must ultimately work on real data in uncontrolled environments although most research studies have been conducted on lab-based data with posed or evoked facial expressions obtained in pre-set laboratory environments. It is very difficult to obtain data in real-world situations because privacy laws prevent unauthorized capture and use of video from events such as funerals, birthday parties, marriages etc. It is a challenge to acquire such data on a scale large enough for benchmarking algorithms. Although video obtained from TV or movies or postings on the World Wide Web may also contain ‘acted’ emotions and facial expressions, they may be more ‘realistic’ than lab-based data currently used by most researchers. Or is it? One way of testing this is to compare feature distributions and FER performance. This paper describes a database that has been collected from television broadcasts and the World Wide Web containing a range of environmental and facial variations expected in real conditions and uses it to answer this question. A fully automatic system that uses a fusion based approach for FER on such data is introduced for performance evaluation. Performance improvements arising from the fusion of point-based texture and geometry features, and the robustness to image scale variations are experimentally evaluated on this image and video dataset. Differences in FER performance between lab-based and realistic data, between different feature sets, and between different train-test data splits are investigated.

A web-based approach to data imputation

In this paper, we present WebPut, a prototype system that adopts a novel web-based approach to the data imputation problem. Towards this, Webput utilizes the available information in an incomplete database in conjunction with the data consistency principle. Moreover, WebPut extends effective Information Extraction (IE) methods for the purpose of formulating web search queries that are capable of effectively retrieving missing values with high accuracy. WebPut employs a confidence-based scheme that efficiently leverages our suite of data imputation queries to automatically select the most effective imputation query for each missing value. A greedy iterative algorithm is proposed to schedule the imputation order of the different missing values in a database, and in turn the issuing of their corresponding imputation queries, for improving the accuracy and efficiency of WebPut. Moreover, several optimization techniques are also proposed to reduce the cost of estimating the confidence of imputation queries at both the tuple-level and the database-level. Experiments based on several real-world data collections demonstrate not only the effectiveness of WebPut compared to existing approaches, but also the efficiency of our proposed algorithms and optimization techniques.

Access to commercial destinations within the neighbourhood and walking among Australian older adults

BACKGROUND: Physical activity, particularly walking, is greatly beneficial to health; yet a sizeable proportion of older adults are insufficiently active. The importance of built environment attributes for walking is known, but few studies of older adults have examined neighbourhood destinations and none have investigated access to specific, objectively-measured commercial destinations and walking. METHODS: We undertook a secondary analysis of data from the Western Australian state government's health surveillance survey for those aged 65--84 years and living in the Perth metropolitan region from 2003--2009 (n = 2,918). Individual-level road network service areas were generated at 400 m and 800 m distances, and the presence or absence of six commercial destination types within the neighbourhood service areas identified (food retail, general retail, medical care services, financial services, general services, and social infrastructure). Adjusted logistic regression models examined access to and mix of commercial destination types within neighbourhoods for associations with self-reported walking behaviour. RESULTS: On average, the sample was aged 72.9 years (SD = 5.4), and was predominantly female (55.9%) and married (62.0%). Overall, 66.2% reported some weekly walking and 30.8% reported sufficient walking (>=150 min/week). Older adults with access to general services within 400 m (OR = 1.33, 95% CI = 1.07-1.66) and 800 m (OR = 1.20, 95% CI = 1.02-1.42), and social infrastructure within 800 m (OR = 1.19, 95% CI = 1.01-1.40) were more likely to engage in some weekly walking. Access to medical care services within 400 m (OR = 0.77, 95% CI = 0.63-0.93) and 800 m (OR = 0.83, 95% CI = 0.70-0.99) reduced the odds of sufficient walking. Access to food retail, general retail, financial services, and the mix of commercial destination types within the neighbourhood were all unrelated to walking. CONCLUSIONS: The types of neighbourhood commercial destinations that encourage older adults to walk appear to differ slightly from those reported for adult samples. Destinations that facilitate more social interaction, for example eating at a restaurant or church involvement, or provide opportunities for some incidental social contact, for example visiting the pharmacy or hairdresser, were the strongest predictors for walking among seniors in this study. This underscores the importance of planning neighbourhoods with proximate access to social infrastructure, and highlights the need to create residential environments that support activity across the life course.