The automation of radiotherapy treatment planning assessment

Aim The assessment of treatment plans is an important component in the education of radiation therapists. The establishment of a grade for a plan is currently based on subjective assessment of a range of criteria. The automation of assessment could provide a number of advantages including faster feedback, reduced chance of human error, and simpler aggregation of past results. Method A collection of treatments planned by a cohort of 27 second year radiation therapy students were selected for quantitative evaluation. Treatment sites included the bladder, cervix, larynx, parotid and prostate, although only the larynx plans had been assessed in detail. The plans were designed with the Pinnacle system and exported using the DICOM framework. Assessment criteria included beam arrangement optimisation, volume contouring, target dose coverage and homogeneity, and organ-at-risk sparing. The in-house Treatment and Dose Assessor (TADA) software1 was evaluated for suitability in assisting with the quantitative assessment of these plans. Dose volume data were exported in per-student and per-structure data tables, along with beam complexity metrics, dose volume histograms, and reports on naming conventions. Results The treatment plans were exported and processed using TADA, with the processing of all 27 plans for each treatment site taking less than two minutes. Naming conventions were successfully checked against a reference protocol. Significant variations between student plans were found. Correlation with assessment feedback was established for the larynx plans. Conclusion The data generated could be used to inform the selection of future assessment criteria, monitor student development, and provide useful feedback to the students. The provision of objective, quantitative evaluations of plan quality would be a valuable addition to not only radiotherapy education programmes but also for staff development and potentially credentialing methods. New functionality within TADA developed for this work could be applied clinically to, for example, evaluate protocol compliance.

Self-management programs in stage 1-4 chronic kidney disease : a literature review.

Background Chronic kidney disease (CKD) is a complex health problem, which requires individuals to invest considerable time and energy in managing their health and adhering to multifaceted treatment regimens. Objectives To review studies delivering self-management interventions to people with CKD (Stages 1–4) and assess whether these interventions improve patient outcomes. Design: Systematic review. Methods Nine electronic databases (MedLine, CINAHL, EMBASE, ProQuest Health & Medical Complete, ProQuest Nursing & Allied Health, The Cochrane Library, The Joanna Briggs Institute EBP Database, Web of Science and PsycINFO) were searched using relevant terms for papers published between January 2003 and February 2013. Results The search strategy identified 2,051 papers, of which 34 were retrieved in full with only 5 studies involving 274 patients meeting the inclusion criteria. Three studies were randomised controlled trials, a variety of methods were used to measure outcomes, and four studies included a nurse on the self-management intervention team. There was little consistency in the delivery, intensity, duration and format of the self-management programmes. There is some evidence that knowledge- and health-related quality of life improved. Generally, small effects were observed for levels of adherence and progression of CKD according to physiologic measures. Conclusion The effectiveness of self-management programmes in CKD (Stages 1–4) cannot be conclusively ascertained, and further research is required. It is desirable that individuals with CKD are supported to effectively self-manage day-to-day aspects of their health.

Application of a theoretical framework to foster a cardiac-diabetes self-management programme

AIM: This paper analyses and illustrates the application of Bandura's self-efficacy construct to an innovative self-management programme for patients with both type 2 diabetes and coronary heart disease. BACKGROUND: Using theory as a framework for any health intervention provides a solid and valid foundation for aspects of planning and delivering such an intervention; however, it is reported that many health behaviour intervention programmes are not based upon theory and are consequently limited in their applicability to different populations. The cardiac-diabetes self-management programme has been specifically developed for patients with dual conditions with the strategies for delivering the programme based upon Bandura's self-efficacy theory. This patient group is at greater risk of negative health outcomes than that with a single chronic condition and therefore requires appropriate intervention programmes with solid theoretical foundations that can address the complexity of care required. SOURCES OF EVIDENCE: The cardiac-diabetes self-management programme has been developed incorporating theory, evidence and practical strategies. DISCUSSION: This paper provides explicit knowledge of the theoretical basis and components of a cardiac-diabetes self-management programme. Such detail enhances the ability to replicate or adopt the intervention in similar or differing populations and/or cultural contexts as it provides in-depth understanding of each element within the intervention. CONCLUSION: Knowledge of the concepts alone is not sufficient to deliver a successful health programme. Supporting patients to master skills of self-care is essential in order for patients to successfully manage two complex, chronic illnesses. IMPLICATIONS FOR NURSING PRACTICE OR HEALTH POLICY: Valuable information has been provided to close the theory-practice gap for more consistent health outcomes, engaging with patients for promoting holistic care within organizational and cultural contexts.

Dimensions of effectiveness and efficiency: A case study on industry–school partnerships

Internationally, the delivery of vocational education and training is being challenged by increasing skills shortages in certain industries and/or rapidly changing skill requirements. To respond to this challenge, rigid and centralised state bureaucracies are increasingly adopting partnerships between schools and industry as a strategy to encourage school-to-work transition programmes to address the local labour market demand. Drawing on experiences in Australia, this paper reports on a case study of government led partnerships between schools and industry. The Queensland Gateway to industry schools initiative currently involves over 120 schools. The study investigated how two commonly used partnership principles were understood by the Gateway to industry partners. Twelve school–industry partnerships from four industry sectors were analysed in terms of the principles of ‘efficiency’ and ‘effectiveness’ derived from the public–private partnership literature. The study found that some evidence of partnership activities associated with efficiency and effectiveness may be assigned to Gateway schools projects. However, little evidence was found that the above underlying principles were addressed systematically. Some of these partnerships were tenuously facilitated by individuals who had limited infrastructure or strategic support. Implications are that industry–school partnership stakeholders would benefit from applying partnership principles regarding implementation and management to ensure the sustainability of partnerships.

Inclusion?

Whilst inclusive education is a relatively recent advance in our thinking about schooling and pedagogy, it is rapidly establishing movement simultaneously reflected in and refracted by education policy, research, and scholarship. This is manifest in the proliferation of policy texts and programmes generated by education jurisdictions globally and locally, and in the burgeoning number of scholarly texts, academic conferences, and research grants dedicated to inclusive education.

Design and test of a custom instrumented leg press for injury and recovery intervention

There is an increasing desire and emphasis to integrate assessment tools into the everyday training environment of athletes. These tools are intended to fine-tune athlete development, enhance performance and aid in the development of individualised programmes for athletes. The areas of workload monitoring, skill development and injury assessment are expected to benefit from such tools. This paper describes the development of an instrumented leg press and its application to testing leg dominance with a cohort of athletes. The developed instrumented leg press is a 45° reclining sled-type leg press with dual force plates, a displacement sensor and a CCD camera. A custom software client was developed using C#. The software client enabled near-real-time display of forces beneath each limb together with displacement of the quad track roller system and video feedback of the exercise. In recording mode, the collection of athlete particulars is prompted at the start of the exercise, and pre-set thresholds are used subsequently to separate the data into epochs from each exercise repetition. The leg press was evaluated in a controlled study of a cohort of physically active adults who performed a series of leg press exercises. The leg press exercises were undertaken at a set cadence with nominal applied loads of 50%, 100% and 150% of body weight without feedback. A significant asymmetry in loading of the limbs was observed in healthy adults during both the eccentric and concentric phases of the leg press exercise (P < .05). Mean forces were significantly higher beneath the non-dominant limb (4–10%) and during the concentric phase of the muscle action (5%). Given that symmetrical loading is often emphasized during strength training and remains a common goal in sports rehabilitation, these findings highlight the clinical potential for this instrumented leg press system to monitor symmetry in lower-limb loading during progressive strength training and sports rehabilitation protocols.

Renewing the Sustainable Energy Curriculum : Curriculum Frameworks and Guidance for Course Delivery

This guide is to support institutions in developing and teaching tertiary level programmes for sustainable energy professionals. Ongoing curriculum renewal is more difficult but vital for multidisciplinary courses preparing graduates to work in a specialised rapidly changing field. After more than 15 years of offering tertiary level “sustainable energy” qualifications in Australian Universities there was a clear need to assess how these courses are taught and develop curriculum frameworks to guide Universities designing/redesigning programs and courses to provide graduates with the relevant skills, knowledge and attributes (capabilities) seen by graduates and employers as required to work in this rapidly changing field. This guide presents the sustainable energy curriculum frameworks developed by the “Renewing the sustainable energy curriculum – providing internationally relevant skills for a carbon constrained economy” project, which was conducted over a two-and-a-quarter year period.

AITSL pilot projects [Queensland University of Technology : The existing school-based practices and processes for the use of NAPLAN data] Final report

This pilot project investigated the existing practices and processes of Proficient, Highly Accomplished and Lead teachers in the interpretation, analysis and implementation of National Assessment Program – Literacy and Numeracy (NAPLAN) data. A qualitative case study approach was the chosen methodology, with nine teachers across a variety of school sectors interviewed. Themes and sub-themes were identified from the participants’ interview responses revealing the ways in which Queensland teachers work with NAPLAN data. The data illuminated that generally individual schools and teachers adopted their own ways of working with data, with approaches ranging from individual/ad hoc, to hierarchical or a whole school approach. Findings also revealed that data are the responsibility of various persons from within the school hierarchy; some working with the data electronically whilst others rely on manual manipulation. Manipulation of data is used for various purposes including tracking performance, value adding and targeting programmes for specific groups of students, for example the gifted and talented. Whilst all participants had knowledge of intervention programmes and how practice could be modified, there were large inconsistencies in knowledge and skills across schools. Some see the use of data as a mechanism for accountability, whilst others mention data with regards to changing the school culture and identifying best practice. Overall, the findings showed inconsistencies in approach to focus area 5.4. Recommendations therefore include a more national approach to the use of educational data.

Meeting the nutrition challenge of stage 3 renal failure : considerations for nursing practice

Self-care management is needed for effective management of chronic kidney disease. The main aim for treatment or management of chronic kidney disease is to delay the worsening of kidney function, and to prevent or to manage the co-morbidities. Selfcare management is not easy, and patients will face many challenges, especially when they cannot get use to the new treatment plan. One of the challenges they face is dietary restriction, which is a very important aspect in any self-care management programme. Chronic kidney disease patients require a low-protein, low-sodium, low-potassium, and low-phosphorus diet. There are several strategies patients can undertake to ensure adherence, such as self-monitoring their dietary habits and type of food consumed using a food diary; involving social support, such as family members and spouse to help them to adhere to their diet restrictions; setting goals and providing positive reinforcement when they achieved the targeted goals; joining self-management programmes to equip themselves with the necessary skills so that they can better adhere to the treatment regimes, including diet restriction; and lastly, having the knowledge about their regime, and using this knowledge to help them understand and improve their adherence.

Australia’s first Allied Health Prescribing Program – exploring participants' understanding and confidence in clinical therapy choices for patient management

BACKGROUND Globally there are emerging trends for non-medical health professionals to expand their scope of practice into prescribing. The NPS Prescribing Competencies Framework and the Health Professionals Prescribing Pathway Program are recent initiatives to assist with implementation of prescribing for allied health professionals (AHPs). For AHPs to become prescribers, training programmes must be designed to extend their knowledge of medicines information and medicine management principles with the aim of optimising medicines related outcomes for patients. AIM To explore the understanding and confidence in clinical therapeutic choices for patient management of those AHPs enrolled in the Allied Health Prescribing Training Program Module One: Introduction to clinical therapeutics for prescribers, delivered by Queensland University of Technology, Brisbane. METHOD A pre-post survey was developed to explore key themes around understanding and confidence in selecting therapeutic choices for patients with varying complexities of conditions. Data were collected from participants in week one and 13 of the module via an online survey using a five-point Likert scale (1 = Strongly Agree (SA) to 5 = Strongly Disagree (SD)). RESULTS In the pre-Module survey the AHPs had a limited degree (D/SD) of understanding and confidence regarding the safe and effective use of medicines and appropriate therapeutic choices for managing patients, particularly with complex patients. This improved significantly in the post Module survey (A/SA).

Better health outcomes for people with physical disabilities in China through audits of mobility related access : a research and implementation need

China has 85 million people with disabilities, 30% of whom have a physical disability(1). Up to 2006, overall disability rates increased by 0.5% per year, more for males and in rural areas, and rates of physical disability increased by 11.2% per year(2). With population ageing the proportion of people with disability will increase even faster. In May 2014 the 67th World Health Assembly adopted a resolution endorsing the WHO Global Disability Action Plan 2014–2021. One of its three objectives is “to remove barriers and improve access to health services and programmes”. Access to transport contributes to positive health outcomes both directly and indirectly (e.g. access to economic opportunities, which is associated with better health)(3). However, once people with physical disabilities leave their dwellings they are confronted with physical barriers to their mobility, ranging from the condition/provision of paths to the cost/availability of transport and access to buildings. In addition, their mobility restrictions increase their vulnerability as road users, exposing them to a higher risk of injury through road crashes. QUT's School of Public Health and Social Work (PHSW) and and Centre for Accident Research and Road Safety-Queensland (CARRS-Q) CARRS-Q have been collaborating on development of a combined disability audit and road safety access tool that can identify transport barriers and safety issues along the routes taken by people with disabilities, to enable prioritisation of actions to address these issues. There are also spin-off benefits for other road users from addressing the rising toll of disability through road crashes in China(4). The tool has undergone initial proof-of-concept testing in India and Viet Nam, and is currently being assessed in Cambodia and Laos. Given the rapid development of China, increases in rates of physical disability and the impacts of an ageing population, it is proposed to establish collaborative research through the Australia-China Centre for Public Health to (1) tailor the combined road safety audit and disability access tool for use in China; (2) evaluate its use on a sample of routes; (3) develop plans for changes to the routes in consultation with local authorities; (4) evaluate the effectiveness of implemented changes in terms of access and health. 1. Zheng, Q, et al, 2014. Health and Quality of Life Outcomes, 12:25. 2. Zheng, X, et al, 2011. Bull World Health Org, 89:788–797. 3. Götschi, T & Kahlmeier, S, 2011. Integrated Transport, Health, and Sustainability Assessment (INTHESA): Final Report. Institute of Social and Preventive Medicine, University of Zurich. 4. Lin, T, et al, 2013. J Public Health, 35:541–547.

A continental-scale tool for acoustic identification of European bats

Summary 1. Acoustic methods are used increasingly to survey and monitor bat populations. However, the use of acoustic methods at continental scales can be hampered by the lack of standardized and objective methods to identify all species recorded. This makes comparable continent-wide monitoring difficult, impeding progress towards developing biodiversity indicators, transboundary conservation programmes and monitoring species distribution changes. 2. Here we developed a continental-scale classifier for acoustic identification of bats, which can be used throughout Europe to ensure objective, consistent and comparable species identifications. We selected 1350 full-spectrum reference calls from a set of 15 858 calls of 34 European species, from EchoBank, a global echolocation call library. We assessed 24 call parameters to evaluate how well they distinguish between species and used the 12 most useful to train a hierarchy of ensembles of artificial neural networks to distinguish the echolocation calls of these bat species. 3. Calls are first classified to one of five call-type groups, with a median accuracy of 97·6%. The median species-level classification accuracy is 83·7%, providing robust classification for most European species, and an estimate of classification error for each species. 4. These classifiers were packaged into an online tool, iBatsID, which is freely available, enabling anyone to classify European calls in an objective and consistent way, allowing standardized acoustic identification across the continent. 5. Synthesis and applications. iBatsID is the first freely available and easily accessible continental- scale bat call classifier, providing the basis for standardized, continental acoustic bat monitoring in Europe. This method can provide key information to managers and conservation planners on distribution changes and changes in bat species activity through time.

The importance of exotic plantation forest for the New Zealand long-tailed bat (Chalinolobus tuberculatus)

Environmental certification schemes have stimulated increasing interest in biodiversity and its management within exotic plantation forests. These schemes expect management to be scientifically-based, even though little is known about how often, or which, native species use exotic plantation forests. Greater knowledge of the ecology of native species within exotic plantation forests is required to advise management and reduce risks to native species, particularly those that are rare, such as the New Zealand long-tailed bat (Chalinolobus tuberculatus). Long-tailed bats use exotic plantation forests throughout New Zealand but need protection from the impacts of forest management, and particularly clear-fell harvest, that is achievable only through a better understanding of their biology. The consequences of the current reduced re-planting, and the conversion of plantation forests into pasture resulting in smaller forested areas, should not be ignored because they may be associated with reductions in long-tailed bat populations. We review the current knowledge of long-tailed bats' use of exotic plantation forests, and report for the first time which exotic plantations long-tailed bats are known to use. We make recommendations for the design of monitoring programmes to detect long-tailed bats within plantation forests, and for research into the effects of forest management, especially logging, and comment on the likely impacts of reductions in forested areas on long-tailed bats.

Long-tailed bats' use of a Pinus radiata stand in Kinleith Forest : Recommendations for monitoring

Targeted monitoring of threatened species within plantations is becoming more important due to forest certification programmes’ requirement to consider protection of threatened species, and to increase knowledge of the distribution of species. To determine patterns of long-tailed bat (Chalinolobus tuberculatus) activity in different habitat structures, with the aim of improving the likelihood of detection by targeting monitoring, we monitored one stand of 26 year-old Pinus radiata over seven months between December 2007 and June 2008 in Kinleith Forest, an exotic plantation forest centred around Tokoroa, South Waikato, New Zealand. Activity was determined by acoustic recording equipment, which is able to detect and record bats’ echolocation calls. We monitored activity from sunset to sunrise along a road through the stand, along stand edges, and in the interior of the stand. Bats were recorded on 80% of the 35 nights monitored. All activity throughout the monitoring period was detected on the edge of the stand or along the road. No bats were detected within the interior of the stand. Bat activity was highest along the road through the stand (40.4% of all passes), followed by an edge with stream running alongside (35.2%), along the road within a skidsite (19.8%), and along an edge without a stream (4.6%). There was a significant positive relationship between bat pass rate (bat passes h-1) and the feeding buzz rate (feeding buzzes h-1) indicating that bat activity was associated with feeding and not just commuting. Bat feeding activity was also highest along the road through the stand (59.2% of feeding buzzes), followed by the road within the skidsite (30.6%), and along the stream-side edge (10.2%). No feeding buzzes were recorded in either the interior or along the edge without the stream. Differences in overall feeding activity were significant only between the road and edge and between edges with and without a stream. Bat activity was detected each month and always by the second night of monitoring, and in this stand was highest during April. We recommend targeted monitoring for long-tailed bats be focused on road-side and stand edge habitat, and along streams, and that monitoring take place for at least three nights to maximise probability of detection.