Building Healthy Communities : GP Network, Medicare Local and Primary Health Care in the Wheatbelt Region of Western Australia

• Government reports consistently recognise the importance of Primary Health Care to an efficient health system. Barriers identified in Australia’s Primary Health Care include workforce pressures, increase rate of chronic disease, and equitable access to Primary Health Care services. • General Practitioners (GPs) are the key to the successful delivery of Primary Health Care especially in rural and remote regions such as the Wheatbelt region in Western Australia (WA). • The Wheatbelt region of WA is vast: some 72,500 residents spread across 150,000km2 in 43 Local Government Authorities catchments. Majority of the Wheatbelt residents live in small towns. There is a higher reported rates of chronic disease, more at risk of chronic diseases and less utilisation of Primary Health Care services in this region. • General practice patients in the Wheatbelt are among those most in need of Primary Health Care services. • Wheatbelt GP Network (the “Network”) was established in 1998. It is a key health service delivery stakeholder in the Wheatbelt. • The Network has responded to the health needs of the community by creating a mobile Allied Health Team that works closely with GPs and is adaptive to ensure priority needs are met. • The Medicare Local model introduced by the Australian Government in 2011 aimed to improve the delivery of Primary Health Care services by improved health planning and coordinating service delivery. • Little if any recognition has been given to the outstanding work that many Divisions of General Practice have done in improving the delivery of Primary Health Care services such as the Network. • The Network has continued to support GPs and general practices and created a complementary system that integrated general practice with the work of an Allied Health Team. Its program mix is extensive. • The Network has consistently delivered on-required contract outputs and has a fifteen (15) years history of operating successfully in a large geographical area comprising in the main smaller communities that cannot support the traditional health services model. • The complexity of supporting International Medical Graduates in the region requires special attention. • The introduction of the Medicare Local in the South West of WA and their intention to take over the delivery of health services, thus effectively shutting the Network will have catastrophic consequences and cannot be supported economically. • The Network proposes to create a new model, built on its past work that increases the delivery of Primary Health Care services through its current Allied Health Team. • The proposal uses the Wheatbelt GP Super Clinic currently under construction in Northam, part of the Network and funded by the Australian Government is a key to the proposed new model. • Wheatbelt GP Super Clinic is different from existing models of GP Super Clinics around Australia which focus predominately on co-location of services. Wheatbelt GP Super Clinic utilises a hub and spoke model of service outreach to small rural towns to ensure equitable Primary Health Care coverage and continuum of care in a financially responsible and viable manner. In particular, the Wheatbelt GP Super Clinic recognises the importance of Allied Health Professionals and will involve them in a collaborative model with rural general practice. • The proposed model advocated by the Network aims to substitute the South West WA Medicare Local direct service delivery proposed for the Wheatbelt. The Network’s proposed model is to expand on the current hub and spoke model of Primary Health Care delivery to otherwise small unviable Wheatbelt towns. A flexible and adaptive skill mix of Allied Health Professionals, Nurse Practitioners and GPs ensure equitable access to service. Expanded scope of practices are utilised to reduce duplication of service and concentration of services in major towns. This involves a partnership approach. • If the proposed model not funded, the Network and the Wheatbelt region will stand to lose 16 Allied Health Professionals and defeats the purpose of Australian Government current funding for the construction of the Wheatbelt GP Super Clinic. • The Network has considered how its model can best be funded. It proposes a re-allocation of funds made available to the South West WA Medicare Local. • This submission argues that the proposal for the South West WA Medicare Local to take over the service delivery of Primary Health Care services in the Wheatbelt makes no economic sense when an existing agency (the Network) has the infrastructure in place, is experienced in working in this geographical area that has special needs and is capable to expand its programs to meet demand.

Designing for participation in local suburban communications

People have difficulty accessing means to easily publicise and discuss their ideas and concerns with their local community. The aim of this research has been to design and evaluate capacity for Internet technologies coupled with public displays to engage a diverse range of community members in the making of a shared local suburban communications network. The research problem relates to the challenges of community building, in particular discovering mechanisms that work to engage a target community and motivate participation. In an effort to understand genuine participation and barriers to use, the study was embedded in a local community and purposely longitudinal. This research contributes knowledge about the limitations of public displays to increase visibility of local communications, the need for long-term and networked visibility of community-building communications, the integral role of community facilitators, and the challenges of sustaining shared communications.

The ECOS Project. An interactive simulation to promote an ECO-friendly universe.

Custom designed for display on the Cube Installation situated in the new Science and Engineering Centre (SEC) at QUT, the ECOS project is a playful interface that uses real-time weather data to simulate how a five-star energy building operates in climates all over the world. In collaboration with the SEC building managers, the ECOS Project incorporates energy consumption and generation data of the building into an interactive simulation, which is both engaging to users and highly informative, and which invites play and reflection on the roles of green buildings. ECOS focuses on the principle that humans can have both a positive and negative impact on ecosystems with both local and global consequence. The ECOS project draws on the practice of Eco-Visualisation, a term used to encapsulate the important merging of environmental data visualization with the philosophy of sustainability. Holmes (2007) uses the term Eco-Visualisation (EV) to refer to data visualisations that ‘display the real time consumption statistics of key environmental resources for the goal of promoting ecological literacy’. EVs are commonly artifacts of interaction design, information design, interface design and industrial design, but are informed by various intellectual disciplines that have shared interests in sustainability. As a result of surveying a number of projects, Pierce, Odom and Blevis (2008) outline strategies for designing and evaluating effective EVs, including ‘connecting behavior to material impacts of consumption, encouraging playful engagement and exploration with energy, raising public awareness and facilitating discussion, and stimulating critical reflection.’ Consequently, Froehlich (2010) and his colleagues also use the term ‘Eco-feedback technology’ to describe the same field. ‘Green IT’ is another variation which Tomlinson (2010) describes as a ‘field at the juncture of two trends… the growing concern over environmental issues’ and ‘the use of digital tools and techniques for manipulating information.’ The ECOS Project team is guided by these principles, but more importantly, propose an example for how these principles may be achieved. The ECOS Project presents a simplified interface to the very complex domain of thermodynamic and climate modeling. From a mathematical perspective, the simulation can be divided into two models, which interact and compete for balance – the comfort of ECOS’ virtual denizens and the ecological and environmental health of the virtual world. The comfort model is based on the study of psychometrics, and specifically those relating to human comfort. This provides baseline micro-climatic values for what constitutes a comfortable working environment within the QUT SEC buildings. The difference between the ambient outside temperature (as determined by polling the Google Weather API for live weather data) and the internal thermostat of the building (as set by the user) allows us to estimate the energy required to either heat or cool the building. Once the energy requirements can be ascertained, this is then balanced with the ability of the building to produce enough power from green energy sources (solar, wind and gas) to cover its energy requirements. Calculating the relative amount of energy produced by wind and solar can be done by, in the case of solar for example, considering the size of panel and the amount of solar radiation it is receiving at any given time, which in turn can be estimated based on the temperature and conditions returned by the live weather API. Some of these variables can be altered by the user, allowing them to attempt to optimize the health of the building. The variables that can be changed are the budget allocated to green energy sources such as the Solar Panels, Wind Generator and the Air conditioning to control the internal building temperature. These variables influence the energy input and output variables, modeled on the real energy usage statistics drawn from the SEC data provided by the building managers.

The ZomPoc Project. A Large Scale Public ARG Event

An experiment in large scale, live, game design and public performance, bringing together participants from across the creative arts to design, deliver and document a project that was both a cooperative learning experience and an experimental public performance. The four month project, funded by the Edge Digital Centre, culminated into a 24 hour ARG event involving over 100 participants in December 2012. Using the premise of a viral outbreak, young enthusiasts auditioned for the roles of Survivor, Zombie, Medic and Military. The main objective was for the Survivors to complete a series of challenges over 24 hours, while the other characters fulfilled their opposing objectives of interference and sabotage supported by both scripted and free-form scenarios staged in constructed scenes throughout the venues. The event was set in the State Library of Queensland and the Edge Digital Centre who granted the project full access, night and day to all areas including public, office and underground areas. These venues were transformed into cinematic settings full of interactive props and various audio-visual effects. The ZomPoc Project was an innovative experiment in writing and directing a large scale, live, public performance, bringing together participants from across the creative industries. In order to design such an event a number of innovative resources were developed exploiting techniques of game design, theatre, film, television and tangible media production. A series of workshops invited local artists, scientists, technicians and engineers to find new ways of collaborating to create networked artifacts, experimental digital works, robotic props, modular set designs, sound effects and unique costuming guided by an innovative multi-platform script developed by Deb Polson. The result of this collaboration was the creation of innovative game and set props, both atmospheric and interactive. Such works animated the space, presented story clues and facilitated interactions between strangers who found themselves sharing a unique experience in unexpected places.

The role of the molecular footprint of EGFR in tailoring treatment decisions in NSCLC

The majority of patients with non-small-cell lung cancer (NSCLC) present with advanced disease, with targeted therapies providing some improvement in clinical outcomes. The epidermal growth factor receptor (EGFR) tyrosine kinase (TK) plays an important role in the pathogenesis of NSCLC. Tyrosine kinase inhibitors (TKIs), which target the EGFR TK domain, have proven to be an effective treatment strategy; however, patient responses to treatment vary considerably. Therefore, the identification of patients most likely to respond to treatment is essential to optimise the benefit of TKIs. Tumour-associated activating mutations in EGFR can identify patients with NSCLC who are likely to have a good response to TKIs. Nonetheless, the majority of patients relapse within a year of starting treatment. Studies of tumours at relapse have demonstrated expression of a T790M mutation in exon 20 of the EGFR TK domain in approximately 50% of cases. Although conferring resistance to reversible TKIs, these patients may remain sensitive to new-generation irreversible/panerb inhibitors. A number of techniques have been employed for genotypic assessment of tumourassociated DNA to identify EGFR mutations, each of which has advantages and disadvantages. This review presents an overview of the current methodologies used to identify such molecular markers. Recent developments in technology may make the monitoring of changes in patients' tumour genotypes easier in clinical practice, which may enable patients' treatment regimens to be tailored during the course of their disease, potentially leading to improved patient outcomes.

A meshfree-based local Galerkin method with condensation of degree of freedom

Condensation technique of degree of freedom is firstly proposed to improve the computational efficiency of meshfree method with Galerkin weak form. In present method, scattered nodes without connectivity are divided into several subsets by cells with arbitrary shape. The local discrete equations are established over each cell by using moving kriging interpolation, in which the nodes that located in the cell are used for approximation. Then, the condensation technique can be introduced into the local discrete equations by transferring equations of inner nodes to equations of boundary nodes based on cell. In the scheme of present method, the calculation of each cell is carried out by meshfree method with Galerkin weak form, and local search is implemented in interpolation. Numerical examples show that the present method has high computational efficiency and convergence, and good accuracy is also obtained.

The inaccuracy of national character stereotypes

Consensual stereotypes of some groups are relatively accurate, whereas others are not. Previous work suggesting that national character stereotypes are inaccurate has been criticized on several grounds. In this article we (a) provide arguments for the validity of assessed national mean trait levels as criteria for evaluating stereotype accuracy and (b) report new data on national character in 26 cultures from descriptions (N= 3323) of the typical male or female adolescent, adult, or old person in each. The average ratings were internally consistent and converged with independent stereotypes of the typical culture member, but were weakly related to objective assessments of personality. We argue that this conclusion is consistent with the broader literature on the inaccuracy of national character stereotypes

New strategy toward dioxin risk reduction for local residents surrounding severe dioxin hotspots in Vietnam

Background A public health intervention program with active involvement of local related stakeholders was piloted in the Bien Hoa dioxin hot spot (2007-2009), and then expanded to the Da Nang dioxin hot spot in Vietnam (2009-2011). It aimed to reduce the risk of dioxin exposure through foods for local residents. This article presents the results of the intervention in Da Nang. Methodology To assess the results of this intervention program, pre-intervention and post-intervention knowledge-attitude-practice (KAP) surveys were implemented in 400 households, randomly selected from four wards surrounding Da Nang Airbase in 2009 and 2011, respectively. Results After the intervention, the knowledge on the existence of dioxin in food, dioxin exposure pathways, potential high risk foods and preventive measures significantly increased (p < 0.05). 98% were willing to follow advice on preventing dioxin exposure. Practices to reduce the risk of dioxin exposure also statistical significantly improved (p<0.05). After intervention, 60.4% of households undertook exposure preventive measures, significantly higher than that of the pre-intervention survey (39.6%; χ2 =40.15 , P<0.001). High risk foods had quite low rates of daily consumption (from 0% to 2.5%) and were significantly reduced (p<0.05). Conclusions This is seen as an effective intervention strategy toward reducing the risk of human exposure to dioxin at dioxin hot spots. While greater efforts are needed for remediating dioxin polluted areas inside airbases, there is also evidence to suggest that, during the past four decades, pollution has been expanding to the surrounding areas. For this reason, this model should be quickly expanded to the remaining dioxin hot spots in Vietnam to further reduce the exposure risk in these areas.

Rebuilding in Ranongga : reflecting on practice based research

Two hundred million people are displaced annually due to natural disasters with a further one billion living in inadequate conditions in urban areas. Architects have a responsibility to respond to this statistic as the effects of natural and social disasters become more visibly catastrophic when paired with population rise. The research discussed in this paper initially questions and considers how digital tools can be employed to enhance rebuilding processes, but still achieve sensitive, culturally appropriate and accepted built solutions. Secondly the paper reflects on the impact ‘real-world’ projects have on architectural education. Research aspirations encouraged an atypical ‘research by design’ methodology involving a focused case study in the recently devastated village Keigold, Ranongga, Solomon Islands. Through this qualitative approach specific place data and the accounts of those affected were documented through naturalistic and archival methods of observation and participation. Findings reveal a number of unanticipated results which would have been otherwise undetected if field research within the design and rebuilding process was not undertaken, reflecting the importance of place specific research in the design process. Ultimately, the study proves that it is critical for issues of disaster to be addressed on a local rather than global scale; decisions cannot be speculative, or solved at a distance, but require intensive collaborative work with communities to achieve optimum solutions. Architectural education and design studios would continue to benefit from focused community engagement and field research within the design process.

Development of a bi-material representative volume element using damaged homogenisation approach

Most civil engineering structures are formed using a number of materials that are bonded to each other with their surface-to-surface interaction playing key role on the overall response of the structure. Unfortunately these interactions are extremely variable; simplified and extremely detailed models trialed to date prove quite complex. Models that assume perfect interaction, on the other hand, predict unsafe behavior. In this paper a damage mechanics based interaction between two materials of different softening properties is developed using homogenisation approach. This paper describes the process of developing a bi-material representative volume element (RVE) using damaged homogenisation approach. The novelty in this paper is the development of non-local transient damage identification algorithm. Numerical examples prove the stability of the approach for a simplified RVE and encourage application to other shapes of RVEs.

Finding Carpentaria

Invited – and inspired – by Rikki Gunn of GhostNets Australia, in September 2008 sixteen Queensland University of Technology (QUT) design and engineering students and four staff set off on a 2488km journey to spend a fortnight in Karumba on the Gulf of Carpentaria. We went to undertake a strategic planning project we called Linking Karumba, to encourage social, economic, environmental and cultural linkages across the town. During this visit, we and our local project partners realised there should be a second half to the project, in the other Carpentaria Shire town of Normanton, which saw another group of us travelling north again in 2010 to undertake Get EnGulfed: Normanton2020, looking back and forwards to propose strategies to strengthen local and regional identities. The responsiveness of our students’ work to the character of Carpentarian culture and environment indicate remarkable levels of immersion, and the community expressed their enjoyment of the process and outcomes. As for us - QUT staff and students - we had a marvellous time doing these projects, and this little book is the story of our finding of the landscapes and communities of Carpentaria “where the outback meets the sea”, and of the project work we did together with locals in the two towns. We go to press as news arrives of the official opening of the Karumba Walking track, linking the two parts of the town. We can’t wait to return and make the walk. Shannon Satherley, 2013

A point prevalence study of cancer nursing practices for managing intravascular devices in an Australian tertiary cancer center

Purpose The use of intravascular devices is associated with a number of potential complications. Despite a number of evidence-based clinical guidelines in this area, there continues to be nursing practice discrepancies. This study aims to examine nursing practice in a cancer care setting to identify nursing practice and areas for improvement respective to best available evidence. Methods A point prevalence survey was undertaken in a tertiary cancer care centre in Queensland, Australia. On a randomly selected day, four nurses assessed intravascular device related nursing practices and collected data using a standardized survey tool. Results 58 inpatients (100%) were assessed. Forty-eight (83%) had a device in situ, comprising 14 Peripheral Intravenous Catheters (29.2%), 14 Peripherally Inserted Central Catheters (29.2%), 14 Hickman catheters (29.2%) and six Port-a-Caths (12.4%). Suboptimal outcomes such as incidences of local site complications, incorrect/inadequate documentation, lack of flushing orders, and unclean/non intact dressings were observed. Conclusions This study has highlighted a number of intravascular device related nursing practice discrepancies compared with current hospital policy. Education and other implementation strategies can be applied to improve nursing practice. Following education strategies, it will be valuable to repeat this survey on a regular basis to provide feedback to nursing staff and implement strategies to improve practice. More research is required to provide evidence to clinical practice with regards to intravascular device related consumables, flushing technique and protocols.

The effect of extent of local resection on patterns of disease progression in malignant pleural mesothelioma

Background We sought to determine whether or not there are differences in disease progression after radical or nonradical (debulking) surgical procedures for malignant pleural mesothelioma. Methods Over a 49-month period, 132 patients with malignant pleural mesothelioma underwent surgery. Fifty-three underwent extrapleural pneumonectomy and 79 underwent nonradical procedures. Time to evidence of clinical disease progression was recorded, as was the site(s) of that disease. Results One-hundred nineteen patients were evaluable, of which 59% (22 radical; 48 nonradical) had disease progression. Overall 30-day mortality was 8.5% (7.5% radical; 9% nonradical). The median time to overall disease progression was considerably longer after extrapleural pneumonectomy than debulking surgery (319 days vs 197 days, p = 0.019), as was the time to local disease progression (631 days vs 218 days, p = 0.0018). There was no preponderance of earlier stage disease in the radical surgery group. There was a trend toward prolonged survival in those undergoing radical surgery, but no significant difference between the groups (497 days vs 324 days, p = 0.079). In those who had extrapleural pneumonectomy, time-to-disease progression significantly decreased with N2 disease compared with N0/1 involvement (197 days vs 358 days, p = 0.02). Conclusions Extrapleural pneumonectomy may be preferable to debulking surgery in malignant pleural mesothelioma to delay disease progression and give greater control of local disease. Involvement of N2 nodes is associated with accelerated disease progression and is therefore a contraindication to extrapleural pneumonectomy. © 2004 by The Society of Thoracic Surgeons.

The Enamovirus P0 protein is a silencing suppressor which inhibits local and systemic RNA silencing through AGO1 degradation

The P0 protein of poleroviruses and P1 protein of sobemoviruses suppress the plant's RNA silencing machinery. Here we identified a silencing suppressor protein (SSP), P0PE, in the Enamovirus Pea enation mosaic virus-1 (PEMV-1) and showed that it and the P0s of poleroviruses Potato leaf roll virus and Cereal yellow dwarf virus have strong local and systemic SSP activity, while the P1 of Sobemovirus Southern bean mosaic virus supresses systemic silencing. The nuclear localized P0PE has no discernable sequence conservation with known SSPs, but proved to be a strong suppressor of local silencing and a moderate suppressor of systemic silencing. Like the P0s from poleroviruses, P0PE destabilizes AGO1 and this action is mediated by an F-box-like domain. Therefore, despite the lack of any sequence similarity, the poleroviral and enamoviral SSPs have a conserved mode of action upon the RNA silencing machinery. © 2012 Elsevier Inc.

Assessing land-use and transport integration via a spatial composite indexing model

Achieving sustainable urban development is identified as one ultimate goal of many contemporary planning endeavours and has become central to formulation of urban planning policies. Within this concept, land-use and transport integration is highlighted as one of the most important and attainable policy objectives. In many cities, integration is embraced as an integral part of local development plans, and a number of key integration principles are identified. However, the lack of available evaluation methods to measure extent of urban sustainability levels prevents successful implementation of these principles. This paper introduces a new indicator-based spatial composite indexing model developed to measure sustainability performance of urban settings by taking into account land-use and transport integration principles. Model indicators are chosen via a thorough selection process in line with key principles of land-use and transport integration. These indicators are grouped into categories and themes according to their topical relevance. These indicators are then aggregated to form a spatial composite index to portray an overview of the sustainability performance of the pilot study area used for model demonstration. The study results revealed that the model is a practical instrument for evaluating success of local integration policies and visualizing sustainability performance of built environments and useful in both identifying problematic areas as well as formulating policy interventions.