Children and consent to medical treatment

This chapter provides a comprehensive and up-to-date treatment of legislative provisions and common law principles regarding children and the law of consent to medical treatment. When can children provide their own consent? Can parents consent on behalf of their children, and if so, under what circumstances and why? Is court authority ever required, and if so, when, and why? What new contexts are providing fresh challenges to legal principles, parents, medical practitioners, and most importantly, children?

Deriving a preference-based utility measure for cancer patients from the European Organisation for the Research and Treatment of Cancer's Quality of Life Questionnaire C30 : a confirmatory versus exploratory approach

Background Multi attribute utility instruments (MAUIs) are preference-based measures that comprise a health state classification system (HSCS) and a scoring algorithm that assigns a utility value to each health state in the HSCS. When developing a MAUI from a health-related quality of life (HRQOL) questionnaire, first a HSCS must be derived. This typically involves selecting a subset of domains and items because HRQOL questionnaires typically have too many items to be amendable to the valuation task required to develop the scoring algorithm for a MAUI. Currently, exploratory factor analysis (EFA) followed by Rasch analysis is recommended for deriving a MAUI from a HRQOL measure. Aim To determine whether confirmatory factor analysis (CFA) is more appropriate and efficient than EFA to derive a HSCS from the European Organisation for the Research and Treatment of Cancer’s core HRQOL questionnaire, Quality of Life Questionnaire (QLQ-C30), given its well-established domain structure. Methods QLQ-C30 (Version 3) data were collected from 356 patients receiving palliative radiotherapy for recurrent/metastatic cancer (various primary sites). The dimensional structure of the QLQ-C30 was tested with EFA and CFA, the latter informed by the established QLQ-C30 structure and views of both patients and clinicians on which are the most relevant items. Dimensions determined by EFA or CFA were then subjected to Rasch analysis. Results CFA results generally supported the proposed QLQ-C30 structure (comparative fit index =0.99, Tucker–Lewis index =0.99, root mean square error of approximation =0.04). EFA revealed fewer factors and some items cross-loaded on multiple factors. Further assessment of dimensionality with Rasch analysis allowed better alignment of the EFA dimensions with those detected by CFA. Conclusion CFA was more appropriate and efficient than EFA in producing clinically interpretable results for the HSCS for a proposed new cancer-specific MAUI. Our findings suggest that CFA should be recommended generally when deriving a preference-based measure from a HRQOL measure that has an established domain structure.

A collaborative rapid persona-building workshop : creating design personas with health researchers

In the HealthMap project for People With HIV, (PWHIV) designers employed a collaborative rapid ‘persona-building' workshop with health researchers to develop patient personas that embodied patient-centred design goals and contextual awareness from a variety of qualitative and quantitative data. On reflection, this collaborative rapid workshop was a process for drawing together the divergent user research insights and expertise of stakeholders into focus for a chronic disease self-management design. This paper discusses, (i) an analysis of the transcript of the workshop and, (ii) interviews with five practising senior designers, in order to reflect on how the persona-building process was enacted and its role in the HealthMap design evolution. The collaborative rapid persona-building methodology supported: embedding user research insights, eliciting domain expertise, introducing design thinking, facilitating stakeholder collaboration and defining early design requirements. The contribution of this paper is to model the process of collaborative rapid persona-building and to introduce the collaborative rapid persona-building framework as a method to generate design priorities from domain expertise and user research data.

Measuring reliability and validity of the ActiGraph GT3X accelerometer for children with cerebral palsy : a feasibility study

PURPOSE The purposes of this study were to: 1) establish inter-instrument reliability between left and right hip accelerometer placement; 2) examine procedural reliability of a walking protocol used to measure physical activity (PA), and; 3) confirm concurrent validity of accelerometers in measuring PA intensity as compared to the gold standard of oxygen consumption measured by indirect calorimetry. METHODS Eight children (mean age: 11.9; SD: 3.2, 75% male) with CP (GMFCS levels I-III) wore ActiGraph GT3X accelerometers on each hip and the Cosmed K4b^{2} portable indirect calorimeter during two measurement sessions in which they performed the six minute walk test (6MWT) at three self-selected speeds (comfortable/slow, brisk, fast). Oxygen consumption (VO2) and accelerometer step and activity count data were recorded. RESULTS Inter-instrument reliability of ActiGraph GT3X accelerometers placed on left and right hips was excellent (ICC=0.96-0.99, CI_{95}: 0.81-0.99). Reproducibility of the protocol was good/excellent (ICC=0.75-0.95, CI_{95}: 0.75-0.98). Concurrent validity of accelerometer count data and VO2 was fair/good (rho=0.67, p< 0.001). The correlation between step count and VO2 was not significant (rho=0.29, p=0.2). CONCLUSION This preliminary research suggests that ActiGraph GT3X accelerometers are reliable and valid devices to monitor PA during walking in children with CP and may be appropriate in rehabilitation research and clinical practice. ActiGraph GTX3 step counts were not valid for this sample and further research is warranted.

Challenging the myths about flexible work in the ADF

In May 2011, the Minister for Defence requested a review into the treatment of women in the ADF following allegations of inappropriate conduct at the Australian Defence Force Academy. The Australian Human Rights Commission (AHRC) initiated the review under the leadership of the Federal Sex Discrimination Commissioner, Elizabeth Broderick, who challenged the ADF to improve its culture and build a more inclusive environment for its members. The need for flexible work arrangements (FWAs) emerged as a central issue in the review, not least as a mechanism for improving the recruitment and retention of women in the ADF. The review, and its subsequent audit report, concluded that flexibility would strengthen the ADF but that there were cultural and structural obstacles. This article addresses the uptake of formal and informal FWAs in the ADF. The study is part of an Australian Research Council funded project, led by Queensland University of Technology, which addresses how the timing, location and tasks of work are negotiated in exchanges between managers and employees.

A time for everything : reviewing an institution’s virtual learning environment

This paper outlines a review carried out at Queensland University of Technology (QUT) in 2013 to identify the extent to which the centrally supported virtual learning environment met current and future learning and teaching needs. A range of consultation and investigation activities occurred from May to November to encourage open stakeholder feedback as well as to allow for reflection on alternative digital technologies, systems and strategies. This resulted in the development of nine recommendations, which, following a planning phase, will commence being implemented from mid-2014.

In the right space : exploring the dynamics between design, environment and pedagogy

The environments that we inhabit shape our everyday lives, influencing our behaviors and responses (Manu, 2013). As we enter an immersive phase of education in which physical and digital environments become inseparable, should we reconsider the role and importance of design on pedagogical practice? This paper explores the reciprocal cause and effect of space, technology and pedagogy in shaping the design of educational experiences within Queensland University of Technology's collaborative learning spaces.

Roundabout design and cycling safety

Roundabouts reduce the frequency and severity of motor vehicle crashes and therefore the number installed has increased dramatically in the last 20 years in many countries. However, the safety impacts of roundabouts for bicycle riders are a source of concern, with many studies reporting lower injury reductions for cyclists than car occupants. This paper summarises the results of a project undertaken to provide guidance on how cyclist safety could be improved at existing roundabouts in Queensland, Australia, where cyclist crashes have been increasing and legislation gives motor vehicles priority over cyclists and pedestrians at roundabouts. The review of international roundabout design guidelines identified two schools of design: tangential roundabouts (common in English-speaking countries, including Australia), which focus on minimising delay to motor vehicles, and radial roundabouts (common in continental Europe), which focus on speed reduction and safety. While it might be expected that radial roundabouts would be safer for cyclists, there have been no studies to confirm this view. Most guidelines expect cyclists to act as vehicle traffic in single-lane, typically low-speed, roundabouts. Some jurisdictions do not permit cyclists to travel on multi-lane roundabouts, and recommend segregated bicycle facilities because of their lowest crash risk for cyclists. Given that most bicycle-vehicle crashes at roundabouts involve an entering vehicle and a circulating cyclist, the greatest challenges appear to be reducing the speed of motor vehicles on the approach/entry to roundabouts and other ways of maximizing the likelihood that cyclists will be seen. Lower entry speeds are likely to underpin the greater safety of compact roundabouts for cyclists and, conversely, the higher than expected crash rates at two-lane roundabouts. European research discourages the use of bike lanes in roundabouts which position cyclists at the edge of the road and contributes to cyclists being less likely to be noticed by drivers.

Visual field coordinates of pupillary circular axis and optical axis

Purpose: We term the visual field position from which the pupil appears most nearly circular as the pupillary circular axis (PCAx). The aim was to determine and compare the horizontal and vertical co-ordinates of the PCAx and optical axis from pupil shape and refraction information for only the horizontal meridian of the visual field. Method: The PCAx was determined from the changes with visual field angle in the ellipticity and orientation of pupil images out to ±90° from fixation along the horizontal meridian for the right eyes of 30 people. This axis was compared with the optical axis determined from the changes in the astigmatic components of the refractions for field angles out to ±35° in the same meridian. Results: The mean estimated horizontal and vertical field coordinates of the PCAx were (‒5.3±1.9°, ‒3.2±1.5°) compared with (‒4.8±5.1°, ‒1.5±3.4°) for the optical axis. The vertical co-ordinates of the two axes were just significantly different (p =0.03) but there was no significant correlation between them. Only the horizontal coordinate of the PCAx was significantly related to the refraction in the group. Conclusion: On average, the PCAx is displaced from the line-of-sight by about the same angle as the optical axis but there is more inter-subject variation in the position of the optical axis. When modelling the optical performance of the eye, it appears reasonable to assume that the pupil is circular when viewed along the line-of-sight.

Isolation of microvascular endothelial cells from cadaveric corneal limbus

Limbal microvascular endothelial cells (L-MVEC) contribute to formation of the corneal-limbal stem cell niche and to neovascularization of diseased and injuries corneas. Nevertheless, despite these important roles in corneal health and disease, few attempts have been made to isolate L-MVEC with the view to studying their biology in vitro. We therefore explored the feasibility of generating primary cultures of L-MVEC from cadaveric human tissue. We commenced our study by evaluating growth conditions (MesenCult-XF system) that have been previously found to be associated with expression of the endothelial cell surface marker thrombomodulin/CD141, in crude cultures established from collagenase-digests of limbal stroma. The potential presence of L-MVEC in these cultures was examined by flow cytometry using a more specific marker for vascular endothelial cells, CD31/PECAM-1. These studies demonstrated that the presence of CD141 in crude cultures established using the MesenCult-XF system is unrelated to L-MVEC. Thus we subsequently explored the use of magnetic assisted cell sorting (MACS) for CD31 as a tool for generating cultures of L-MVEC, in conjunction with more traditional endothelial cell growth conditions. These conditions consisted of gelatin-coated tissue culture plastic and MCDB-131 medium supplemented with fetal bovine serum (10% v/v), D-glucose (10 mg/mL), epidermal growth factor (10 ng/mL), heparin (50 μg/mL), hydrocortisone (1 μg/mL) and basic fibroblast growth factor (10 ng/mL). Our studies revealed that use of endothelial growth conditions are insufficient to generate significant numbers of L-MVEC in primary cultures established from cadaveric corneal stroma. Nevertheless, through use of positive-MACS selection for CD31 we were able to routinely observe L-MVEC in cultures derived from collagenase-digests of limbal stroma. The presence of L-MVEC in these cultures was confirmed by immunostaining for von Willebrand factor (vWF) and by ingestion of acetylated low-density lipoprotein. Moreover, the vWF+ cells formed aligned cell-to-cell ‘trains’ when grown on Geltrex™. The purity of L-MVEC cultures was found to be unrelated to tissue donor age (32 to 80 years) or duration in eye bank corneal preservation medium prior to use (3 to 10 days in Optisol) (using multiple regression test). Optimal purity of L-MVEC cultures was achieved through use of two rounds of positive-MACS selection for CD31 (mean ± s.e.m, 65.0 ± 20.8%; p<0.05). We propose that human L-MVEC cultures generated through these techniques, in conjunction with other cell types, will provide a useful tool for exploring the mechanisms of blood vessel cell growth in vitro.

Constraints and characteristics of flexible work arrangements in small not-for-profit firms

There is a great deal of research that examines flexible working arrangements, but this work tends to be concentrated in large organisations. This research examines the approach taken to flexible working arrangements in five small community based, not for profit organisations. We present three propositions that aim to understand the constraints and the characteristics of flexible work in this rarely studied sector.

Hardware design and implementation of a MAVLink interface for an FPGA-based autonomous UAV flight control system

This paper details the initial design and planning of a Field Programmable Gate Array (FPGA) implemented control system that will enable a path planner to interact with a MAVLink based flight computer. The design is aimed at small Unmanned Aircraft Vehicles (UAV) under autonomous operation which are typically subject to constraints arising from limited on-board processing capabilities, power and size. An FPGA implementation for the de- sign is chosen for its potential to address such limitations through low power and high speed in-hardware computation. The MAVLink protocol offers a low bandwidth interface for the FPGA implemented path planner to communicate with an on-board flight computer. A control system plan is presented that is capable of accepting a string of GPS waypoints generated on-board from a previously developed in- hardware Genetic Algorithm (GA) path planner and feeding them to the open source PX4 autopilot, while simultaneously respond- ing with flight status information.

The Australian practice pharmacist

Background: Evolution in Australian community pharmacy and general practice environments has seen the emergence of a new opportunity for pharmacist practice, distinct from the conventional community and hospital settings, in which the pharmacist is integrated into the general practice setting to provide professional services. Aim: To characterise pharmacists practising in the Australian general practice setting. Method: An electronic questionnaire. Results: Twenty-six practice pharmacists completed the questionnaire. Practice pharmacists were more likely to be female, aged between 30 and 49 years, have postgraduate qualifications and also work in other pharmacy sectors. The general practice settings more frequently had multiple general practitioners and also housed multiple allied health professionals. The most commonly conducted services provided by the practice pharmacists were Home Medicine Reviews, responding to clinical enquiries from general practitioners and responding to enquiries from other health professionals. Most practice pharmacists worked as independent contractors for services provided. The practice pharmacists provided some services in the absence of remuneration. The majority of practice pharmacists agreed or strongly agreed that a set of competencies should be developed and a credentialing process required with experience of the pharmacist being regarded highly. Conclusion: The results of this study have described the variety of professional roles, remuneration and characteristics in a small sample of pharmacists practising in a general practice setting in Australia. For this model of pharmacist practice to expand an appropriate method of remuneration is required.

Macro- and micronutrient disposition in an ex vivo model of extracorporeal membrane oxygenation

Background Extracorporeal membrane oxygenation (ECMO) circuits have been shown to sequester circulating blood compounds such as drugs based on their physicochemical properties. This study aimed to describe the disposition of macro- and micronutrients in simulated ECMO circuits. Methods Following baseline sampling, known quantities of macro- and micronutrients were injected post oxygenator into ex vivo ECMO circuits primed with the fresh human whole blood and maintained under standard physiologic conditions. Serial blood samples were then obtained at 1, 30 and 60 min and at 6, 12 and 24 h after the addition of nutrients, to measure the concentrations of study compounds using validated assays. Results Twenty-one samples were tested for thirty-one nutrient compounds. There were significant reductions (p < 0.05) in circuit concentrations of some amino acids [alanine (10%), arginine (95%), cysteine (14%), glutamine (25%) and isoleucine (7%)], vitamins [A (42%) and E (6%)] and glucose (42%) over 24 h. Significant increases in circuit concentrations (p < 0.05) were observed over time for many amino acids, zinc and vitamin C. There were no significant reductions in total proteins, triglycerides, total cholesterol, selenium, copper, manganese and vitamin D concentrations within the ECMO circuit over a 24-h period. No clear correlation could be established between physicochemical properties and circuit behaviour of tested nutrients. Conclusions Significant alterations in macro- and micronutrient concentrations were observed in this single-dose ex vivo circuit study. Most significantly, there is potential for circuit loss of essential amino acid isoleucine and lipid soluble vitamins (A and E) in the ECMO circuit, and the mechanisms for this need further exploration. While the reductions in glucose concentrations and an increase in other macro- and micronutrient concentrations probably reflect cellular metabolism and breakdown, the decrement in arginine and glutamine concentrations may be attributed to their enzymatic conversion to ornithine and glutamate, respectively. While the results are generally reassuring from a macronutrient perspective, prospective studies in clinical subjects are indicated to further evaluate the influence of ECMO circuit on micronutrient concentrations and clinical outcomes.