Feasibility of brief psychological distress screening by a community-based telephone helpline for cancer patients and carers

Background Up to one-third of people affected by cancer experience ongoing psychological distress and would benefit from screening followed by an appropriate level of psychological intervention. This rarely occurs in routine clinical practice due to barriers such as lack of time and experience. This study investigated the feasibility of community-based telephone helpline operators screening callers affected by cancer for their level of distress using a brief screening tool (Distress Thermometer), and triaging to the appropriate level of care using a tiered model. Methods Consecutive cancer patients and carers who contacted the helpline from September-December 2006 (n = 341) were invited to participate. Routine screening and triage was conducted by helpline operators at this time. Additional socio-demographic and psychosocial adjustment data were collected by telephone interview by research staff following the initial call. Results The Distress Thermometer had good overall accuracy in detecting general psychosocial morbidity (Hospital Anxiety and Depression Scale cut-off score ≥ 15) for cancer patients (AUC = 0.73) and carers (AUC = 0.70). We found 73% of participants met the Distress Thermometer cut-off for distress caseness according to the Hospital Anxiety and Depression Scale (a score ≥ 4), and optimal sensitivity (83%, 77%) and specificity (51%, 48%) were obtained with cut-offs of ≥ 4 and ≥ 6 in the patient and carer groups respectively. Distress was significantly associated with the Hospital Anxiety and Depression Scale scores (total, as well as anxiety and depression subscales) and level of care in cancer patients, as well as with the Hospital Anxiety and Depression Scale anxiety subscale for carers. There was a trend for more highly distressed callers to be triaged to more intensive care, with patients with distress scores ≥ 4 more likely to receive extended or specialist care. Conclusions Our data suggest that it was feasible for community-based cancer helpline operators to screen callers for distress using a brief screening tool, the Distress Thermometer, and to triage callers to an appropriate level of care using a tiered model. The Distress Thermometer is a rapid and non-invasive alternative to longer psychometric instruments, and may provide part of the solution in ensuring distressed patients and carers affected by cancer are identified and supported appropriately.

Review of refugee mental health assessment: Best practices and recommendations

This article focuses on mental health assessment of refugees in clinical, educational and administrative-legal settings in order to synthesise research and practice designed to enhance and promote further development of culturally appropriate clinical assessment services during the refugee resettlement process. It specifically surveys research published over the last 25 years into the development, reliability measurement and validity testing of assessment instruments, which have been used with children, adolescents and adults from refugee backgrounds, prior to or following their arrival in a resettlement country, to determine whether the instruments meet established crosscultural standards of conceptual, functional, linguistic, technical and normative equivalence. The findings suggest that, although attempts have been made to develop internally reliable, appropriately normed tests for use with refugees from diverse cultural and linguistic backgrounds, matters of conceptual and linguistic equivalence and test–retest reliability are often overlooked. Implications of these oversights for underreporting refugees' mental health needs are considered. Efforts should also be directed towards development of culturally comparable, valid and reliable measures of refugee children's mental health and of refugee children's and adults' psychoeducational, neuropsychological and applied memory capabilities.

Managing Wetlands Sustainably as Ecosystems: The Contribution of the Law (Part 2)

In this Part 2 attention is turned towards the legal arrangements in nation states for managing wetlands. These national arrangements have effect within the international arrangements already mentioned and any regional arrangements that are relevant. However, each national system is a reflection of its own historical, cultural, political and constitutional background. It is the purpose of this Part 2 to review and assess the national approaches to wetlands management. This involves an analysis of a range of instruments. These are: constitutional rules; strategic rules; regulatory rules; and management rules. Each of these sets of rules performs different functions, assumes different forms and is differentially capable of enforcement.

The Foot Heath Status Questionnaire : correct scale score calculation

This letter is in response to the recently published article “Evaluation of two self-referent foot health instruments” by Robert Trevethan (RT) and is in regard to the scale scores he derived when using the quality of life measure, the Foot Health Status Questionnaire [1]. Unfortunately, the journal reviewers and editor did not identify, or address, a fundamental flaw in the methodology of this paper. Subsequently, the inference drawn from this paper could, in all reasonableness, mislead the reader

Collaborative destination branding : planning for tourism development through design in the Waterfall Way, NSW, Australia

This thesis develops, applies and analyses a collaborative design methodology for branding a tourism destination. The area between the Northern Tablelands and the Mid-North Coast of New South Wales, Australia, was used as a case study for this research. The study applies theoretical concepts of systems thinking and complexity to the real world, and tests the use of design as a social tool to engage multiple stakeholders in planning. In this research I acknowledge that places (and destinations) are socially constructed through people's interactions with their physical and social environments. This study explores a methodology that is explicit about the uncertainties of the destination’s system, and that helps to elicit knowledge and system trends. The collective design process used the creation of brand concepts, elements and strategies as instruments to directly engage stakeholders in the process of reflecting about their places and the issues related to tourism activity in the region. The methods applied included individual conversations and collaborative design sessions to elicit knowledge from local stakeholders. Concept maps were used to register and interpret information released throughout the process. An important aspect of the methodology was to bring together different stakeholder groups and translate the information into a common language that was understandable by all participants. This work helped release significant information as to what kind of tourism activity local stakeholders are prepared to receive and support. It also helped the emergence of a more unified regional identity. The outcomes delivered by the project (brand, communication material and strategies) were of high quality and in line with the desires and expectation of the local hosts. The process also reinforced local sense of pride, belonging and conservation. Furthermore, interaction between participants from different parts of the region triggered some self organising activity around the brand they created together. A major contribution of the present work is the articulation of an inclusive methodology to facilitate the involvement of locals into the decision-making process related to tourism planning. Of particular significance is the focus on the social construction of meaning in and through design, showing that design exercises can have significant social impact – not only on the final product, but also on the realities of the people involved in the creative process.

Archiving nature’s heartbeat using smart phones

The impact of urban development and climate change has created the impetus to monitor changes in the environment, particularly, the behaviour, habitat and movement of fauna species. The aim of this chapter is to present the design and development of a sensor network based on smart phones to automatically collect and analyse acoustic and visual data for environmental monitoring purposes. Due to the communication and sophisticated programming facilities offered by smart phones, software tools can be developed to allow data to be collected, partially processed and sent to a remote server over the network for storage and further processing. This sensor network which employs a client-server architecture has been deployed in three applications: monitoring a rare bird species near Brisbane Airport, study of koalas behaviour at St Bees Island, and detection of fruit flies. The users of this system include scientists (e.g. ecologists, ornithologists, computer scientists) and community groups participating in data collection or reporting on the environment (e.g. students, bird watchers). The chapter focuses on the following aspects of our research: issues involved in using smart phones as sensors; the overall framework for data acquisition, data quality control, data management and analysis; current and future applications of the smart phone-based sensor network, and our future research directions.

Developing a research method to test a new first-order decision making model for the procurement of public sector major infrastructure

Given global demand for new infrastructure, governments face substantial challenges in funding new infrastructure and simultaneously delivering Value for Money (VfM). The paper begins with an update on a key development in a new early/first-order procurement decision making model that deploys production cost/benefit theory and theories concerning transaction costs from the New Institutional Economics, in order to identify a procurement mode that is likely to deliver the best ratio of production costs and transaction costs to production benefits, and therefore deliver superior VfM relative to alternative procurement modes. In doing so, the new procurement model is also able to address the uncertainty concerning the relative merits of Public-Private Partnerships (PPP) and non-PPP procurement approaches. The main aim of the paper is to develop competition as a dependent variable/proxy for VfM and a hypothesis (overarching proposition), as well as developing a research method to test the new procurement model. Competition reflects both production costs and benefits (absolute level of competition) and transaction costs (level of realised competition) and is a key proxy for VfM. Using competition as a proxy for VfM, the overarching proposition is given as: When the actual procurement mode matches the predicted (theoretical) procurement mode (informed by the new procurement model), then actual competition is expected to match potential competition (based on actual capacity). To collect data to test this proposition, the research method that is developed in this paper combines a survey and case study approach. More specifically, data collection instruments for the surveys to collect data on actual procurement, actual competition and potential competition are outlined. Finally, plans for analysing this survey data are briefly mentioned, along with noting the planned use of analytical pattern matching in deploying the new procurement model and in order to develop the predicted (theoretical) procurement mode.

Busway platform bus capacity analysis

Bus Rapid Transit (BRT), because of its operational flexibility and simplicity, is rapidly gaining popularity with urban designers and transit planners. Earlier BRTs were bus shared lane or bus only lane, which share the roadway with general and other forms of traffic. In recent time, more sophisticated designs of BRT have emerged, such as busway, which has separate carriageway for buses and provides very high physical separation of buses from general traffic. Line capacities of a busway are predominately dependent on bus capacity of its stations. Despite new developments in BRT designs, the methodology of capacity analysis is still based on traditional principles of kerbside bus stop on bus only lane operations. Consequently, the tradition methodology lacks accounting for various dimensions of busway station operation, such as passenger crowd, passenger walking and bus lost time along the long busway station platform. This research has developed a purpose made bus capacity analysis methodology for busway station analysis. Extensive observations of kerbside bus stops and busway stations in Brisbane, Australia were made and differences in their operation were studied. A large scale data collection was conducted using the video recording technique at the Mater Hill Busway Station on the South East Busway in Brisbane. This research identified new parameters concerning busway station operation, and through intricate analysis identified the elements and processes which influence the bus dwell time at a busway station platform. A new variable, Bus lost time, was defined and its quantitative descriptions were established. Based on these finding and analysis, a busway station platform bus capacity methodology was developed, comprising of new models for busway station lost time, busway station dwell time, busway station loading area bus capacity, and busway station platform bus capacity. The new methodology not only accounts for passenger boarding and alighting, but also covers platform crowd and bus lost time in station platform bus capacity estimation. The applicability of this methodology was shown through demonstrative examples. Additionally, these examples illustrated the significance of the bus lost time variable in determining station capacities.

Categorisation of activities of daily living of lower limb amputees during short-term use of a portable kinetic recording system : a preliminary study

The purpose of this preliminary study was to determine the relevance of the categorization of the load regime data to assess the functional output and usage of the prosthesis of lower limb amputees. The objectives were a) to introduce a categorization of load regime, b) to present some descriptors of each activity, and c) to report the results for a case. The load applied on the osseointegrated fixation of one transfemoral amputee was recorded using a portable kinetic system for 5 hours. The periods of directional locomotion, localized locomotion, and stationary loading occurred 44%, 34%, and 22% of recording time and each accounted for 51%, 38%, and 12% of the duration of the periods of activity, respectively. The absolute maximum force during directional locomotion, localized locomotion, and stationary loading was 19%, 15%, and 8% of the body weight on the anteroposterior axis, 20%, 19%, and 12% on the mediolateral axis, and 121%, 106%, and 99% on the long axis. A total of 2,783 gait cycles were recorded. Approximately 10% more gait cycles and 50% more of the total impulse than conventional analyses were identified. The proposed categorization and apparatus have the potential to complement conventional instruments, particularly for difficult cases.

Self-management of cancer treatment-related fatigue, nausea, vomiting and oral mucositis in Chinese cancer patients

Background: Treatment-related symptoms continue to place a significant burden on many cancer patients. Many side effects require patients to engage in a range of self-management actions. While some studies have explored self-management of treatment-related side effects in Western settings, very few studies were identified that described the self-management practices of cancer patients in China. Objective: The purposes of this study are to: (1) Investigate Chinese cancer patients. self-management behaviours in dealing with the fatigue, nausea/vomiting and oral mucositis that result from treatment, as well as the perceived effectiveness of these behaviours and related self-efficacy in performing them. (2) Explore factors influencing symptom self-management behaviours using the Cancer Symptom Self-management Framework based on Grey, Knafl and McCorkle.s (2006) self-management framework as a guide. Methods: This study was divided into two phases. Phase One consisted of the translation and modification of two instruments. The adaptation of these instruments to ensure applicability in the Chinese context was achieved through semi-structured interviews with six cancer patients, and content evaluation with eight experienced oncology nurses. A pilot study was conducted with nine cancer patients to trial the questionnaire set in the Chinese context. Based on the results of Phase One, Phase Two involved a cross-sectional survey of Chinese cancer patients undergoing cancer treatment using these instruments. A total of 277 chemotherapy patients with fatigue and/or nausea and vomiting, and 100 radiotherapy patients with oral mucositis were surveyed. Results: Participants in this study reported a variety of self-management behaviours to cope with fatigue, nausea, vomiting and oral mucositis. There are some consistencies as well disparities between strategies that are frequently used and those rated as effective. For fatigue self-management, participants were more likely to use strategies related to rest and sleep, while activity enhancement strategies were rated as achieving higher relief. For nausea and vomiting self-management, dietary modification and taking medication were most frequently used and rated as moderately effective. Psychological strategies were used by more than a third of participants and were rated as mildly effective. Some other infrequently used strategies, such as distraction by keeping busy and acupressure, were rated as moderately effective. For oral mucositis self-management, having soft, bland food and keeping the mouth moisturised were most frequently reported and they were rated as achieving moderate relief. A prescribed mouthwash was used by most but not all participants and brought moderate relief. In general, patients had low-to-moderate self-efficacy in nausea and vomiting self-management behaviours, moderate self-efficacy in fatigue self-management behaviours, and low-to-moderate self-efficacy in oral mucositis self-management behaviours. In terms of the factors influencing symptom self-management, different predictors were identified affecting engagement in fatigue, nausea/vomiting and oral mucositis self-management behaviours. Self-efficacy scores of different behaviours were consistently found to be a positive predictor of the relief level from corresponding behaviours, after controlling for other variables. Perceived social support from health care professionals was identified as an important factor influencing nausea and vomiting self-management behaviours, while neighbourhood support was important for fatigue self-management. In addition, symptom distress was identified as an important factor influencing nausea and vomiting self-management. Conclusion: Similar to reports from overseas, Chinese cancer patients initiate a wide range of self-management behaviours in response to treatment-related side effects. While some behaviours were reported to provide relief, many did not. Given these results, this study has a number of practical implications for health care professionals, particularly in relation to developing tailored self-management programs for fatigue, nausea, vomiting and oral mucositis. Additionally, this study suggests a number of theoretical implications and directions for future research. It is envisaged that these recommendations may pave the way for further studies understanding and promoting cancer symptom self-management in Chinese people affected by cancer.

Speech recognition in adverse environments using lip information

The performance of automatic speech recognition systems deteriorates in the presence of noise. One known solution is to incorporate video information with an existing acoustic speech recognition system. We investigate the performance of the individual acoustic and visual sub-systems and then examine different ways in which the integration of the two systems may be performed. The system is to be implemented in real time on a Texas Instruments' TMS320C80 DSP.

The promise of computational journalism

Computational journalism involves the application of software and technologies to the activities of journalism, and it draws from the fields of computer science, the social sciences, and media and communications. New technologies may enhance the traditional aims of journalism, or may initiate greater interaction between journalists and information and communication technology (ICT) specialists. The enhanced use of computing in news production is related in particular to three factors: larger government data sets becoming more widely available; the increasingly sophisticated and ubiquitous nature of software; and the developing digital economy. Drawing upon international examples, this paper argues that computational journalism techniques may provide new foundations for original investigative journalism and increase the scope for new forms of interaction with readers. Computer journalism provides a major opportunity to enhance the delivery of original investigative journalism, and to attract and retain readers online.

Early years teachers’ epistemic beliefs and beliefs about children’s moral learning

There is strong political and social interest in values education both internationally and across Australia. Investment in young children is recognised as important for the development of moral values for a cohesive society; however, little is known about early years teachers’ beliefs about moral values teaching and learning. The aim of the current study was to investigate the relationships between Australian early years teachers’ epistemic beliefs and their beliefs about children’s moral learning. Three hundred and seventy-nine teachers completed a survey about their personal epistemic beliefs and their beliefs about children’s moral learning. Results indicated that teachers with more sophisticated epistemic beliefs viewed children as capable of taking responsibility for their own moral learning. Conversely, teachers who held more naive or simplistic personal epistemic beliefs agreed that children need to learn morals through learning the rules for behaviour. Results are discussed in terms of the implications for moral pedagogy in the classroom and teacher professional development. It is suggested that in conjunction with explicitly reflecting on epistemic beliefs, professional development may need to assist teachers to ascertain how their beliefs might relate to their moral pedagogies in order to make any adjustments.

A Krylov-based finite state projection algorithm for solving the chemical master equation arising in the discrete modelling of biological systems

Biochemical reactions underlying genetic regulation are often modelled as a continuous-time, discrete-state, Markov process, and the evolution of the associated probability density is described by the so-called chemical master equation (CME). However the CME is typically difficult to solve, since the state-space involved can be very large or even countably infinite. Recently a finite state projection method (FSP) that truncates the state-space was suggested and shown to be effective in an example of a model of the Pap-pili epigenetic switch. However in this example, both the model and the final time at which the solution was computed, were relatively small. Presented here is a Krylov FSP algorithm based on a combination of state-space truncation and inexact matrix-vector product routines. This allows larger-scale models to be studied and solutions for larger final times to be computed in a realistic execution time. Additionally the new method computes the solution at intermediate times at virtually no extra cost, since it is derived from Krylov-type methods for computing matrix exponentials. For the purpose of comparison the new algorithm is applied to the model of the Pap-pili epigenetic switch, where the original FSP was first demonstrated. Also the method is applied to a more sophisticated model of regulated transcription. Numerical results indicate that the new approach is significantly faster and extendable to larger biological models.