Princess Alexandra Hospital model of comprehensive geriatric assessment of cancer patients : methodological and logistical aspects

There is increasing momentum in cancer care to implement a two stage assessment process that accurately determines the ability of older patients to cope with, and benefit from, chemotherapy. The two-step approach aims to ensure that patients clearly fit for chemotherapy can be accurately identified and referred for treatment without undergoing a time- and resource-intensive comprehensive geriatric assessment (CGA). Ideally, this process removes the uncertainty of how to classify and then appropriately treat the older cancer patient. After trialling a two-stage screen and CGA process in the Division of Cancer Services at Princess Alexandra Hospital (PAH) in 2011-2012, we implemented a model of oncogeriatric care based on our findings. In this paper, we explore the methodological and practical aspects of implementing the PAH model and outline further work needed to refine the process in our treatment context.

Assessment of socio-environmental drivers of suicide in Australia

This study examined the association between socio-environmental factors and suicide in Australia. The high risk areas were identified using advanced spatial analysis methods. Higher proportion of Indigenous population, unemployment rate and bigger temperature difference appeared to be among the main socio-environmental drivers of suicide across different places. Both temperature difference and unemployment were positively associated with suicide over time in general. Temperature difference seemed to affect suicide more in months when unemployment rates were high compared with the periods when unemployment rates were low. The findings may provide useful information for determining the socio-environmental impact on suicide and designing effective suicide control and prevention programs.

Work-based assessment : qualitative perspectives of novice nutrition and dietetics educators

Background The assessment of competence for health professionals including nutrition and dietetics professionals in work-based settings is challenging. The present study aimed to explore the experiences of educators involved in the assessment of nutrition and dietetics students in the practice setting and to identify barriers and enablers to effective assessment. Methods A qualitative research approach using in-depth interviews was employed with a convenience sample of inexperienced dietitian assessors. Interviews explored assessment practices and challenges. Data were analysed using a thematic approach within a phenomenological framework. Twelve relatively inexperienced practice educators were purposefully sampled to take part in the present study. Results Three themes emerged from these data. (i) Student learning and thus assessment is hindered by a number of barriers, including workload demands and case-mix. Some workplaces are challenged to provide appropriate learning opportunities and environment. Adequate support for placement educators from the university, managers and their peers and planning are enablers to effective assessment. (ii) The role of the assessor and their relationship with students impacts on competence assessment. (iii) There is a lack of clarity in the tasks and responsibilities of competency-based assessment. Conclusions The present study provides perspectives on barriers and enablers to effective assessment. It highlights the importance of reflective practice and feedback in assessment practices that are synonymous with evidence from other disciplines, which can be used to better support a work-based competency assessment of student performance.

Students' cultural capital : a study of assessment for learning as a field of exchange

This study was conducted within the context of a flexible education institution where conventional educational assessment practices and tests fail to recognise and assess the creativity and cultural capital of a cohort of marginalised young people. A new assessment model which included an electronic-portfolio-social-networking system (EPS) was developed and trialled to identify and exhibit evidence of students' learning. The study aimed to discern unique forms of cultural capital (Bourdieu, 1986) possessed by students who attend the Edmund Rice Education Australia Flexible Learning Centre Network (EREAFLCN). The EPS was trialled at the case study schools in an intervention and developed a space where students could make evident culturally specific forms of capital and funds of knowledge (Gonzalez, Moll, & Amanti, 2005). These resources were evaluated, modified and developed through dialogic processes utilising assessment for learning approaches (Qualifications and Curriculum Development Agency, 2009) in online and classroom settings. Students, peers and staff engaged in the recognition, judgement, revision and evaluation of students' cultural capital in a subfield of exchange (Bourdieu, 1990). The study developed the theory of assessment for learning as a field of exchange incorporating an online system as a teaching and assessment model. The term efield has been coined to describe this particular capital exchange model. A quasi-ethnographic approach was used to develop a collective case study (Stake, 1995). This case study involved an in-depth exploration of five students' forms of cultural capital and the ways in which this capital could be assessed and exchanged using the efield model. A comparative analysis of the five cases was conducted to identify the emergent issues of students' recognisable cultural capital resources and the processes of exchange that can be facilitated to acquire legitimate credentials for these students in the Australian field of education. The participants in the study were young people at two EREAFLC schools aged between 12 and 18 years. Data was collected through interviews, observations and examination of documents made available by the EREAFLCN. The data was coded and analysed using a theoretical framework based on Bourdieu's analytical tools and a sociocultural psychology theoretical perspective. Findings suggest that processes based on dialogic relationships can identify and recognise students' forms of cultural capital that are frequently misrecognised in mainstream school environments. The theory of assessment for learning as a field of exchange was developed into praxis and integrated in an intervention. The efield model was found to be an effective sociocultural tool in converting and exchanging students' capital resources for legitimated cultural and symbolic capital in the field of education.

Review : "Quality of life: the assessment, analysis and interpretation of patient-reported outcomes (2nd Ed.)" by Peter M. Fayers & David Machin

An updated version, this excellent text is a timely addition to the library of any nurse researching in oncology or other settings where individuals’ quality of life must be understood. Health-related quality of life should be a central aspect of studies concerned with health and illness. Indeed, considerable evidence has recently emerged in oncology and other research settings that selfreported quality of life is of great prognostic significance and may be the most reliable predictor of subsequent morbidity and mortality. From a nursing perspective, it is also gratifying to note that novel therapy and other oncology studies increasingly recognize the importance of understanding patients’ subjective experiences of an intervention over time and to ascertain whether patients perceive that a new intervention makes a difference to their quality of life and treatment outcomes. Measurements of quality of life are now routine in clinical trials of chemotherapy drugs and are often considered the prime outcome of interest in the cost/benefit analyses of these treatments. The authors have extensive experience in qualityof- life assessment in cancer clinical trials, where most of the pioneering work into quality of life has been conducted. That said, many of the health-related qualityof- life issues discussed are common to many illnesses, and researchers outside of cancer should find the book equally helpful.

Application of texture analysis in tear film surface assessment based on videokeratoscopy

Purpose Videokeratoscopy images can be used for the non-invasive assessment of the tear film. In this work the applicability of an image processing technique, textural-analysis, for the assessment of the tear film in Placido disc images has been investigated. Methods In the presence of tear film thinning/break-up, the reflected pattern from the videokeratoscope is disturbed in the region of tear film disruption. Thus, the Placido pattern carries information about the stability of the underlying tear film. By characterizing the pattern regularity, the tear film quality can be inferred. In this paper, a textural features approach is used to process the Placido images. This method provides a set of texture features from which an estimate of the tear film quality can be obtained. The method is tested for the detection of dry eye in a retrospective dataset from 34 subjects (22-normal and 12-dry eye), with measurements taken under suppressed blinking conditions. Results To assess the capability of each texture-feature to discriminate dry eye from normal subjects, the receiver operating curve (ROC) was calculated and the area under the curve (AUC), specificity and sensitivity extracted. For the different features examined, the AUC value ranged from 0.77 to 0.82, while the sensitivity typically showed values above 0.9 and the specificity showed values around 0.6. Overall, the estimated ROCs indicate that the proposed technique provides good discrimination performance. Conclusions Texture analysis of videokeratoscopy images is applicable to study tear film anomalies in dry eye subjects. The proposed technique appears to have demonstrated its clinical relevance and utility.

Actigraphy assessment of mother's sleep at 6, 12 & 18 weeks postpartum

Introduction: Mothers’ sleep during the postpartum period is commonly characterised by bouts of sleep across the night, resulting in low sleep efficiency and daytime sleepiness. Understanding of the nature of mothers’ sleep disruption needs to incorporate indices of both sleep quantity and sleep quality, but objective assessment of sleep disturbance experienced during the first postpartum months has not been investigated in great detail. This longitudinal study aimed to objectively measure mothers’ sleep during the first 18 weeks postpartum, to ascertain the level of sleep disturbance experienced. Method: Eleven mothers (Mean age = 29.82, SD = 4.45) from Australia wore Actiwatch-2 devices for up to 7 days and nights at 6, 12 and 18 weeks postpartum. For each night of recording, a number of sleep bouts were identified. Total sleep time (TST) was calculated as the total number of minutes across the night within these bouts. Sleep efficiency was calculated as the percentage of minutes across the night classified as being part of a sleep bout, with higher scores indicating higher efficiency. Sleep quality captured the efficiency of sleep within sleep bouts, and was calculated as the percentage of epochs classified as sleep within sleep bouts, with higher scores indicating higher sleep quality. Results: At 6 weeks postpartum, mean total sleep time was 420.22 minutes (SD = 50.61). Total sleep time did not significantly differ across the assessment; however there was a trend towards an increase over time. Sleep efficiency increased across the time periods (F(2,10) = 10.30, p = .001), with a significant increase between week 12 and week 18. At 6 weeks postpartum, mean sleep quality was 93.15% (SD = 2.68) and scores did not significantly change across the assessment periods. While there was no relationship between sleep efficiency and sleep quality during weeks 6 and 12, a significant positive relationship was observed at week 18, r2 = .52, p = .013. Conclusions: Within this sample, a low level of disruption was consistently shown within the mothers’ night time sleep bouts. However, overall sleep efficiency suggested a significant proportion of time spent awake between sleep bouts. While TST remained stable over time, overall sleep efficiency improved, suggesting the mothers’ sleep was becoming more consolidated. A single sleep bout a night was not often experienced.

“Which child left behind” : historical issues regarding equity in science assessment

Assessment of learning plays a dominant role in formal education in the forms of determining features of curriculum that are emphasized, pedagogic methods that teachers use with their students, and parents’ and employers’ understanding of how well students have performed. A common perception is that fair assessment applies the same mode of assessment and content focus for all students—the approach of assessments in international comparative studies of science achievement. This article examines research evidence demonstrating that the act of assessment is not neutral—different forms of assessment advantage or disadvantage groups of students on the basis of family backgrounds, gender, race, or disability. Assessment that implicitly or explicitly captures the social capital of the child serves to consolidate, not address, educational equity. The article provides an overview of ways that science curriculum focus and assessment can introduce bias in the identification of student achievement. It examines the effect of changes to curriculum and assessment approaches in science, and relationships between assessment of science and the cultural context of the student. Recommendations are provided for science–assessment research to address bias for different groups of students.

Dynamic weaving in aspect oriented business process management

Reducing complexity in Information Systems is an important topic in both research and industry. One strategy to deal with complexity is separation of concerns, which results in less complex, easily maintainable and more reusable systems. Separation of concerns can be addressed through the Aspect Oriented paradigm. Although this paradigm has been well researched in programming, it is still at the preliminary stage in the area of Business Process Management. While some efforts have been made to extend business process modelling with aspect oriented capability, it has not yet been investigated how aspect oriented business process models should be executed at runtime. In this paper, we propose a generic solution to support execution of aspect oriented business process models based on the principle behind dynamic weaving of aspects. This solution is formally specified using Coloured Petri Nets. The resulting formal specification serves as the blueprint to the implementation of a service module in the framework of a state-of-the-art Business Process Management System. Using this developed artefact, a case study is performed in which two simplified processes from real business in the domain of banking are modelled and executed in an aspect oriented manner. Through this case study, we also demonstrate that adoption of aspect oriented modularization increases the reusability while reducing the complexity of business process models in practice.

Vibrational spectroscopy of the silicate mineral plumbotsumite Pb5(OH)10Si4O8 : an assessment of the molecular structure

We have used scanning electron microscopy with energy dispersive X-ray analysis to determine the precise formula of plumbotsumite, a rare lead silicate mineral of formula Pb5(OH)10Si4O8. This study forms the first systematic study of plumbotsumite from the Bigadic deposits, Turkey. Vibrational spectroscopy was used to assess the molecular structure of plumbotsumite as the structure is not known. The mineral is characterized by sharp Raman bands at 1047, 1055 and 1060 cm−1 assigned to SiO stretching vibrational modes and sharp Raman bands at 673, 683 and 697 cm−1 assigned to OSiO bending modes. The observation of multiple bands offers support for a layered structure with variable SiO3 structural units. Little information may be obtained from the infrared spectra because of broad spectral profiles. Intense Raman bands at 3510, 3546 and 3620 cm−1 are ascribed to OH stretching modes. Evidence for the presence of water in the plumbotsumite structure was inferred from the infrared spectra.

Assessment of traffic noise level before and after freeway widening using traffic microsimulation and a refined classic noise prediction method

In this paper, a refined classic noise prediction method based on the VISSIM and FHWA noise prediction model is formulated to analyze the sound level contributed by traffic on the Nanjing Lukou airport connecting freeway before and after widening. The aim of this research is to (i) assess the traffic noise impact on the Nanjing University of Aeronautics and Astronautics (NUAA) campus before and after freeway widening, (ii) compare the prediction results with field data to test the accuracy of this method, (iii) analyze the relationship between traffic characteristics and sound level. The results indicate that the mean difference between model predictions and field measurements is acceptable. The traffic composition impact study indicates that buses (including mid-sizedtrucks) and heavy goods vehicles contribute a significant proportion of total noise power despite their low traffic volume. In addition, speed analysis offers an explanation for the minor differences in noise level across time periods. Future work will aim at reducing model error, by focusing on noise barrier analysis using the FEM/BEM method and modifying the vehicle noise emission equation by conducting field experimentation.

Dynamic load-sharing of longitudinal-connected air suspensions of a tri-axle semi-trailer

The effects of suspension parameters and driving conditions on dynamic load-sharing of longitudinal-connected air suspensions of a tri-axle semi-trailer are investigated in this study. A novel nonlinear model of a multi-axle semi-trailer with longitudinal-connected air suspensions is formulated based on fluid mechanics and thermodynamics and validated through test results. The effects of road surface conditions, driving speeds, air line inside diameter and connector inside diameter on dynamic load-sharing capability of the semi-trailer were analyzed in terms of load-sharing criteria. Simulation results indicate that, when larger air lines and connectors are employed, the DLSC (Dynamic Load-Sharing Coefficient) optimization ratio reaches its peak value when the road roughness is medium. The optimization ratio fluctuates in a complex manner as driving speed increases. The results also indicate that if the air line inside diameter is always assumed to be larger than the connector inside diameter, the influence of air line inside diameter on load-sharing is more significant than that of the connector inside diameter. The proposed approach can be used for further study of the influence of additional factors (such as vehicle load, static absolute air pressure and static height of air spring) on load-sharing and the control methods for multi-axle air suspensions with longitudinal air line.

A framework of Dynamic Difficulty Adjustment in competitive multiplayer video games

The balance between player competence and the challenge presented by a task has been acknowledged as a major factor in providing optimal experience in video games. While Dynamic Difficulty Adjustment (DDA) presents methods for adjusting difficulty in real-time during singleplayer games, little research has explored its application in competitive multiplayer games where challenge is dictated by the competence of human opponents. By conducting a formal review of 180 existing competitive multiplayer games, it was found that a large number of modern games are utilizing DDA techniques to balance challenge between human opponents. From this data, we propose a preliminary framework for classifying Multiplayer Dynamic Difficulty Adjustment (mDDA) instances.

Dynamic contrast-enhanced magnetic resonance imaging as a biomarker for the pharmacological response of PTK787/ZK 222584, an inhibitor of the vascular endothelial growth factor receptor tyrosine kinases, in patients with advanced colorectal cancer and liver metastases: Results from two phase I studies

Purpose: PTK787/ZK 222584 (PTK/ZK), an orally active inhibitor of vascular endothelial growth factor (VEGF) receptor tyrosine kinases, inhibits VEGF-mediated angiogenesis. The pharmacodynamic effects of PTK/ZK were evaluated by assessing changes in contrast-enhancement parameters of metastatic liver lesions using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in patients with advanced colorectal cancer treated in two ongoing, dose-escalating phase I studies. Patients and Methods: Twenty-six patients had DCE-MRI performed at baseline, day 2, and at the end of each 28-day cycle. Doses of oral PTK/ZK ranged from 50 to 2000 mg once daily. Tumor permeability and vascularity were assessed by calculating the bidirectional transfer constant (Ki). The percentage of baseline Ki (% of baseline Ki) at each time point was compared with pharmacokinetic and clinical end points. Results: A significant negative correlation exists between the % of baseline Ki and increase in PTK/ZK oral dose and plasma levels (P = .01 for oral dose; P = .0001 for area under the plasma concentration curve at day 2). Patients with a best response of stable disease had a significantly greater reduction in Ki at both day 2 and at the end of cycle 1 compared with progressors (mean difference in % of baseline Ki, 47%, P = .004%; and 51%, P = .006; respectively). The difference in % of baseline Ki remained statistically significant after adjusting for baseline WHO performance status. Conclusion: These findings should help to define a biologically active dose of PTK/ZK. These results suggest that DCE-MRI may be a useful biomarker for defining the pharmacological response and dose of angiogenesis inhibitiors, such as PTK/ZK, for further clinical development. © 2003 by American Society of Clinical Oncology.