Current negative mood encourages changes in end-of-life treatment decisions and is associated with false memories

To investigate the effects of mood on people’s end-of-life treatment decisions and their false memories of those decisions, participants took part in two sessions. At Time 1, participants were experimentally induced into positive or negative moods. They decided whether they would want to receive or refuse treatments in a range of hypothetical medical scenarios, such as tube feeding while in a coma. Four weeks later, at Time 2, participants were induced into the same or the opposite mood and made these decisions a second time. They also recalled their previous decisions. Participants in negative moods at Time 2 changed more of their current decisions and falsely remembered more of their previous decisions than participants in positive moods. These findings suggest that people’s current moods influence whether they change their treatment decisions; current decisions in turn bias recall of past decisions

Climate change impacts and adaptation in Bangladesh : an agent-based approach

Bangladesh exemplifies the complex challenges facing densely populated coastal regions. The
pressures on the country are immense: around 145 million people live within an area of just 145,000 sq-km at
the confluence of three major river systems: the Ganges, the Brahmaputra and the Meghna. While progress
has been made, poverty remains widespread, with around 39% of children under five malnourished. Most of
its land-mass lies below 10m above sea level with considerable areas at sea level, leading to frequent and
prolonged flooding during the monsoons. Sea level rise is leading to more flooding as storm surges rise off
higher sea levels, pushing further inland. Higher sea levels also result in salt-water intrusion into freshwater
coastal aquifers and estuaries, contaminating drinking water and farmland. Warmer ocean waters are also
expected to lead to an increase in the intensity of tropical storms.
Bangladesh depends on the South Asian summer monsoon for most of its rainfall which is expected to
increase, leading to more flooding. Climate scientists are also concerned about the stability of monsoon and
the potential for it to undergo a nonlinear phase shift to a drier regime. Bangladesh faces an additional
hydrological challenge in that the Ganges and Brahmaputra rivers both rise in the Himalaya-Tibetan Plateau
region, where glaciers are melting rapidly. The Intergovernmental Panel on Climate Change (IPCC)
concluded that rapid melting is expected to increase river flows until around the late-2030s, by which time
the glaciers are expected to have shrunk from their 1995 extent of 500,000 sq-km to an expected 100,000 sqkm.
After the 2030s, river flows could drop dramatically, turning the great glacier-fed rivers of Asia into
seasonal monsoon-fed rivers. The IPCC concluded that as a result, water shortages in Asia could affect more
than a billion people by the 2050s. Over the same period, crop yields are expected to decline by up to 30% in
South Asia due to a combination of drought and crop heat stress. Bangladesh is therefore likely to face
substantial challenges in the coming decades.
In order to adequately understand the complex, dynamic, spatial and nonlinear challenges facing Bangladesh,
an integrated model of the system is required. An agent-based model (ABM) permits the dynamic
interactions of the economic, social, political, geographic, environmental and epidemiological dimensions of
climate change impacts and adaptation policies to be integrated via a modular approach. Integrating these
dimensions, including nonlinear threshold events such as mass migrations, or the outbreak of conflicts or
epidemics, is possible to a far greater degree with an ABM than with most other approaches.
We are developing a prototype ABM, implemented in Netlogo, to examine the dynamic impacts on poverty,
migration, mortality and conflict from climate change in Bangladesh from 2001 to 2100. The model employs
GIS and sub-district level census and economic data and a coarse-graining methodology to allow model
statistics to be generated on a national scale from local dynamic interactions. This approach allows a more
realistic treatment of distributed spatial events and heterogeneity across the country. The aim is not to
generate precise predictions of Bangladesh’s evolution, but to develop a framework that can be used for
integrated scenario exploration. This paper represents an initial report on progress on this project. So far the
prototype model has demonstrated the desirability and feasibility of integrating the different dimensions of
the complex adaptive system and, once completed, is intended to be used as the basis for a more detailed
policy-oriented model.

Clinical characteristics and management of bipolar disorder in women across the life span

Though prevalent in both genders, specific consideration needs to be given when treating a woman suffering from bipolar disorder over her lifetime. Bipolar disorder is a serious and incapacitating illness affecting an estimated 5% of women. The first episode of illness in women is usually a depressive episode. Female gender has been associated with greater axis-one comorbidity, more depressive episodes, rapid cycling and mixed affective states. Special consideration is required for the treatment of bipolar disorder during reproductive events. More studies are required to better understand the course, outcome and gender-specific treatment strategies of this disorder.

The suitability of polycystic ovary syndrome-specific questionnaires for measuring the impact of PCOS on quality of life in clinical trials

Objectives: Generic patient-reported outcome (PRO) measures underestimate the impact of polycystic ovary syndrome (PCOS) on quality of life (QoL). The aim of this review was to identify PCOS-specific QoL measures and establish whether their development history and measurement properties support their use in clinical trials.

Methods: A systematic search was conducted using terms synonymous with “PCOS” and “QoL.” Following identification of measures, further searches were undertaken using the questionnaire name and abbreviation to explore its use, development history, and demonstrated measurement properties.

Results: Of 56 abstracts screened, 21 reported using PRO measures. One PCOS-specific QoL measure was identified: the PolyCystic Ovary Syndrome Questionnaire (PCOSQ). Nine papers show that the PCOSQ’s development history is somewhat incomplete, and that it does not have good content validity. The PCOSQ subscales demonstrate acceptable levels of reliability (0.70–0.97) and partial known-groups validity as well as convergent/divergent validity with other PRO instruments. Responsiveness
to change is variable and minimally important differences have not been established.

Conclusions: The PCOSQ is the only condition-specific measure of the impact of PCOS on QoL. Additional research is required to ensure its comprehensiveness, sensitivity, and to guide interpretation prior to including in clinical trials.

Health beliefs - what role do they play in outcomes research?

Lay beliefs about health and illness are individual and social, influenced by prevailing social and medical ideologies. Health beliefs clearly influence self-care motivation and have an effect on health-promoting behaviour (e.g. attendance at a screening program, food choices, adherence to prescribed medication). Further, the beliefs and attributions that people hold can directly affect physiological systems (e.g. the immune system). Health beliefs have been shown to influence a variety of patient-reported outcomes, including medication adherence, satisfaction and health-related quality of life. It is widely acknowledged that when the patient's beliefs are acknowledged and incorporated, rather than ignored, optimal biomedical patient-reported outcomes are more likely to be achieved. Several psychological models have been developed to predict health behaviours and may be utilised to identify the beliefs that inform such behaviours. These models consider the social milieu, personality, demographic, political and economic predictors of health beliefs. They demonstrate the impact of beliefs such as the causes of illness, effectiveness of healthcare and acceptability of health services, and how manipulating these can result in actual or intended behaviour change. This workshop will introduce health beliefs and discuss the psychological models that underpin the translation of belief into behaviour. The session is interactive, with participants defining health beliefs and their impact on behaviour. Participants will be invited to critique the models and apply their chosen model to a health indication of their choice.

Insectivore life histories: further evidence against an optimum body size for mammals

1. This study tests a model of the relationship of body mass to reproductive power (the rate of conversion of energy from the environment to an organism’s offspring). Specifically tested is the prediction that the regression of life-history variables on body size will change slope and sign about an ‘optimum’ body mass of 100 g.
2. Life-history data from the mammalian order Insectivora have been collated and analysed using a phylogenetic comparative method to test this prediction.
3. The analyses showed little evidence for significant changes in slope or sign around 100 g body mass, or other possible optimal body masses, contradicting the predictions of the model. These findings agree with those of similar analyses on life-history variables of bats.

Incremental institutional change and Australian universities

Much has been written and researched about transformational change and the exogenous events that result in radical institutional transformation. This paper examines institutions as building blocks of social order comprising power and politics and shared understanding to bring about change. Thelen and Mahoney (2010) go beyond a general model of change that describes the collapse of one set of institutional norms to be replaced by another. The model of change proposed takes into account both exogenous as well as endogenous factors as being the source of institutional change. They go on to state that a view of transformation change as being a result of abrupt, wholesale breakdown needs to be rethought to include incremental, endogenous shifts in thinking that can often result in fundamental transformations. This paper gives consideration to these issues to propose the Australian Higher Education sector as a unique sample in which to investigate this type of change.

The effects of major change : a case study of an Australian university

Organisational RestructuringLeading higher education organisational restructuring is not an easy task. It involves various degree of engagement, decision making and strategic alliances to make the change a success. Research has shown that organisational restructuring has impact on individuals of the organization and vice versa. Studies have shown that imposed change may create negative emotions such as fear of losing something important, anger and anxiety. On the contrary, planned change is accompanied by excitement and hope. Thus, the call for best practices in leading successful organizational change is greater than ever. Factors such as the fundamental characters and practices of higher education, as well as the presence of various human factors (academics and administrative) need to be taken into account. This paper presents the preliminary findings of a case study on organisational restructuring at a higher education institution in Australia. The restructuring in focus involves the amalgamation of two university faculties into one. This paper seeks to present the experiences and life accounts of faculty members with regards to leadership during the amalgamation process. Interviews were carried out with both the academic and administrative staff. Analysis of the interviews found a variation of views on leadership at different levels of the organisation, the emergence of leadership in times of crisis, the gap between the academics and administrative as well as the importance of organisational members to make the restructuring a success. The paper ends with useful suggestions for leaders and their role towards leading successful change in today’s complex higher education scenario.

Osteo-cise : Strong bones for life': protocol for a community-based randomised controlled trial of a multi-modal exercise and osteoporosis education program for older adults at risk of falls and fractures

Background : Osteoporosis affects over 220 million people worldwide, and currently there is no 'cure' for the disease. Thus, there is a need to develop evidence-based, safe and acceptable prevention strategies at the population level that target multiple risk factors for fragility fractures to reduce the health and economic burden of the condition.

Methods : The 'Osteo-cise: Strong Bones for Life' study will investigate the effectiveness and feasibility of a multi-component targeted exercise, osteoporosis education/awareness and behavioural change program for improving bone health and muscle function, and reducing falls risk in community-dwelling older adults at an increased risk of fracture. Men and women aged 60 years or above will participate in an 18-month randomised controlled trial comprising a 12-month structured and supervised community-based program and a 6-month 'research to practise' translational phase. Participants will be randomly assigned to either the 'Osteo-cise' intervention or a self-management control group. The intervention will comprise a multi-modal exercise program incorporating high velocity progressive resistance training, moderate impact weight-bearing exercise and high challenging balance exercises performed three times weekly at local community-based fitness centres. A behavioural change program will be used to enhance exercise adoption and adherence to the program. Community-based osteoporosis education seminars will be conducted to improve participant knowledge and understanding of the risk factors and preventative measures for osteoporosis, falls and fractures. The primary outcomes measures, to be collected at baseline, 6, 12, and 18 months, will include DXA-derived hip and spine bone mineral density measurements and functional muscle power (timed stair-climb test). Secondary outcomes measures include: MRI-assessed distal femur and proximal tibia trabecular bone micro-architecture, lower limb and back maximal muscle strength, balance and function (four square step test, functional reach test, timed up-and-go test and 30-second sit-to-stand), falls incidence and health-related quality of life. Cost-effectiveness will also be assessed.

Discussion : The findings from the Osteo-cise: Strong Bones for Life study will provide new information on the efficacy of a targeted multi-modal community-based exercise program incorporating high velocity resistance training, together with an osteoporosis education and behavioural change program for improving multiple risk factors for falls and fracture in older adults at risk of fragility fracture. Trial Registration: Australian New Zealand Clinical Trials Registry reference ACTRN12609000100291

A bi-directional relationship between obesity and health-related quality of life : evidence from the longitudinal AusDiab study

Objective: To assess the prospective relationship between obesity and health-related quality of life, including a novel assessment of the impact of health-related quality of life on weight gain.

Design and setting: Longitudinal, national, population-based Australian Diabetes, Obesity and Lifestyle (AusDiab) study, with surveys conducted in 1999/2000 and 2004/2005.

Participants: A total of 5985 men and women aged 25 years at study entry.

Main outcome measure(s): At both time points, height, weight and waist circumference were measured and self-report data on health-related quality of life from the SF-36 questionnaire were obtained. Cross-sectional and bi-directional, prospective associations between obesity categories and health-related quality of life were assessed.

Results: Higher body mass index (BMI) at baseline was associated with deterioration in health-related quality of life over 5 years for seven of the eight health-related quality of life domains in women (all P0.01, with the exception of mental health, P>0.05), and six out of eight in men (all P<0.05, with the exception of role-emotional, P=0.055, and mental health, P>0.05). Each of the quality-of-life domains related to mental health as well as the mental component summary were inversely associated with BMI change (all P<0.0001 for women and P0.01 for men), with the exception of vitality, which was significant in women only (P=0.008). For the physical domains, change in BMI was inversely associated with baseline general health in women only (P=0.023).

Conclusions: Obesity was associated with a deterioration in health-related quality of life (including both physical and mental health domains) in this cohort of Australian adults followed over 5 years. Health-related quality of life was also a predictor of weight gain over 5 years, indicating a bi-directional association between obesity and health-related quality of life. The identification of those with poor health-related quality of life may be important in assessing the risk of future weight gain, and a focus on health-related quality of life may be beneficial in weight management strategies.

Seabird and marine mammal management options in the face of climate change

Climate change is already impacting Australia’s oceans. Responses by marine life to both climate variability and change have been documented for low trophic levels, however, responses for Australia’s iconic higher trophic level marine taxa are poorly understood, including for many conservation-dependent seabirds and marine mammals. We report initial results from a national study evaluating impacts an adaptation options. Individual time series and combined analyses show consistent responses to historical climate signals, however, improved monitoring protocols are needed to maximize detection of any climate-related demographic signals. Despite difference in sampling , the development of regional multi-species-indices of environmental change provides robust climate indicators over large regions.

ICT to enhance the triangle of life : the soil, the seed, and the life-giver farmer

This paper reports on the outcomes of an ICT enabled social sustainability project “Green Lanka1” trialled in the Wilgamuwa village, which is situated in the Dambulla district of Sri Lanka. The main goals of the project were focused towards the provision of information about market prices, transportation options, agricultural decision support and modern agriculture practices of the farmer communities to improve their livelihood with the effective use of technologies. The project used Web and Mobile (SMS) enabled systems. The Green Lanka project was sponsored by the Information Communication Technology Agency (ICTA) of Sri Lanka under the Institutional Capacity Building Programme (ICBP) grant scheme which was sponsored by the World Bank. Six hundred families in Wilgamuwa village participated in the project activities. The project was designed, executed and studied through an Action Research approach. The lessons learned through the project activities provide an important understanding of the complex interaction between different stakeholders in the process of implementation of ICT enabled solutions within digitally divided societies. The paper analyses the processes used to reduce the resistance to change and improved involvement of farmer communities in ICT enabled projects. It also analyses the interaction between stakeholders involved in design and implementation of the project activities to improve the chances of project success.

The social life of categories : an empirical study of term categorization

Most classification schemes in common use are actually categorization schemes which fall somewhere on a continuum between unstructured, uncontrolled lists of terms and formal classifications. Over time, terms change meaning and acquire new definitions. This paper presents the results of an approach that used the librarianship principle of consensus to form categories of terms and to relate those categories using a domain reference group. Boisot's Social Learning Cycle (SLC) was then used as a model with which to explain category variations. The single study undertaken in this investigation demonstrated the value of the SLC for explaining the variations between reference group members, and showed the potential for explaining category changes over time. This identifies areas in which consensus is breaking down or emerging, allowing for focused maintenance of categorical schemes.