Incidence, risk factors and estimates of a woman's risk of developing secondary lower limb lymphedema and lymphedema-specific supportive care needs in women treated for endometrial cancer

Objectives: Few studies have assessed the risk and impact of lymphedema among women treated for endometrial cancer. We aimed to quantify cumulative incidence of, and risk factors for developing lymphedema following treatment for endometrial cancer and estimate absolute risk for individuals. Further, we report unmet needs for help with lymphedema-specific issues. Methods: Women treated for endometrial cancer (n = 1243) were followed-up 3–5 years after diagnosis; a subset of 643 completed a follow-up survey that asked about lymphedema and lymphedema-related support needs. We identified a diagnosis of secondary lymphedema from medical records or self-report. Multivariable logistic regression was used to evaluate risk factors and estimates. Results: Overall, 13% of women developed lymphedema. Risk varied markedly with the number of lymph nodes removed and, to a lesser extent, receipt of adjuvant radiation or chemotherapy treatment, and use of nonsteroidal anti-inflammatory drugs (pre-diagnosis). The absolute risk of developing lymphedema was > 50% for women with 15 + nodes removed and 2–3 additional risk factors, 30–41% for those with 15 + nodes removed plus 0–1 risk factors or 6–14 nodes removed plus 3 risk factors, but ≤ 8% for women with no nodes removed or 1–5 nodes but no additional risk factors. Over half (55%) of those who developed lymphedema reported unmet need(s), particularly with lymphedema-related costs and pain. Conclusion: Lymphedema is common; experienced by one in eight women following endometrial cancer. Women who have undergone lymphadenectomy have very high risks of lymphedema and should be informed how to self-monitor for symptoms. Affected women need greater levels of support.

Perceived needs for supported self-management of type 2 diabetes : a qualitative investigation of the potential for a web-based intervention

The estimated one million Australians with type 2 diabetes face significant risks of morbidity and premature mortality. Inadequate diabetes self-management is associated with poor glycaemic control, which is further impaired by comorbid dysphoria. Regular access to ongoing self-management and psychological support is limited, especially in rural and regional locations. Web-based interventions can provide complementary support to patients’ usual care. Semi-structured interviews were undertaken with two samples that comprised (a) 13 people with type 2 diabetes and (b) 12 general practitioners (GPs). Interviews explored enablers and barriers to self-care, emotional challenges, needs for support, and potential web-based programme components. Patients were asked about the potential utility of a web-based support programme, and GPs were asked about likely circumstances of patient referral to it. Thematic analysis was used to summarise responses. Most perceived facilitators and barriers to self-management were similar across the groups. Both groups highlighted the centrality of dietary self-management, valued shared decision-making with health professionals, and endorsed the idea of web-based support. Some emotional issues commonly identified by patients varied to those perceived by GPs, resulting in different attributions for impaired self-care. A web-based programme that supported self-management and psychological/emotional needs appears likely to hold promise in yielding high acceptability and perceived utility.

Maternal employment, work experiences, and financial well-being of Australian mothers who care for young children with special health care needs

The employment and work experiences of mothers who care for young children with special health care needs is the focus of this study. It addresses a gap in the research literature, by providing an understanding of how mothers’ caring role may affect employment conditions, family life, and financial well-being. Quantitative data are drawn from Growing Up in Australia: The Longitudinal Study of Australian Children. The current study employs a matched case–control methodology to compare the experiences of a group of 292 mothers whose children (aged 4-5 years) with long-term special health care needs with those mothers whose children were typically developing. There were few differences between the two groups with regard to job characteristics and job quality. There were significant differences between the two groups with regard to work–family balance. Fewer mothers with children with special health care needs reported work having a positive effect on family functioning.

The educational context and services of children with additional needs in their first years of school in Australia

In Australia, children with additional needs are now primarily educated in mainstream regular classes and schools. While discussion has focused on teacher attitudes, teacher preparation and professional development to support the academic progress of children with additional needs, there is limited research examining the educational contexts and services provided to such children in Australian schools. This descriptive paper examines the educational contexts of 563 Australian children with additional needs, in reference to 3600 of their typically developing peers. Data in relation to educational setting, retention, prevalence of additional needs, access to specialist services, learning support, and individual programming are reported.

The silent and apparent neurological injury in transcatheter aortic valve implantation study (SANITY) : concept, design and rationale

Background The incidence of clinically apparent stroke in transcatheter aortic valve implantation (TAVI) exceeds that of any other procedure performed by interventional cardiologists and, in the index admission, occurs more than twice as frequently with TAVI than with surgical aortic valve replacement (SAVR). However, this represents only a small component of the vast burden of neurological injury that occurs during TAVI, with recent evidence suggesting that many strokes are clinically silent or only subtly apparent. Additionally, insult may manifest as slight neurocognitive dysfunction rather than overt neurological deficits. Characterisation of the incidence and underlying aetiology of these neurological events may lead to identification of currently unrecognised neuroprotective strategies. Methods The Silent and Apparent Neurological Injury in TAVI (SANITY) Study is a prospective, multicentre, observational study comparing the incidence of neurological injury after TAVI versus SAVR. It introduces an intensive, standardised, formal neurologic and neurocognitive disease assessment for all aortic valve recipients, regardless of intervention (SAVR, TAVI), valve-type (bioprosthetic, Edwards SAPIEN-XT) or access route (sternotomy, transfemoral, transapical or transaortic). Comprehensive monitoring of neurological insult will also be recorded to more fully define and compare the neurological burden of the procedures and identify targets for harm minimisation strategies. Discussion The SANITY study undertakes the most rigorous assessment of neurological injury reported in the literature to date. It attempts to accurately characterise the insult and sustained injury associated with both TAVI and SAVR in an attempt to advance understanding of this complication and associations thus allowing for improved patient selection and procedural modification.

Investigating tween children's capacity to conceptualise the complex issue of wellbeing

Wellbeing is an area that has gained increased global focus, particularly when considering children’s lives. With the growing focus on children’s wellbeing, it is apparent that this is an important aspect that is being considered in the policy and provision designed for children. The decision-making surrounding wellbeing provision for children typically occurs without the direct input of the children that these services are designed to benefit. With the children’s capacities being variably considered in wider society, opportunities for children to participate in decision-making on matters that affect them are often limited. The absence of children’s perspectives on matters that affect their lives, such as wellbeing, reveal that adults may be missing a key perspective when seeking to understand and cater for children’s wellbeing needs. This article outlines the results of a study that investigated how children aged 8 to 12 years o age (tweens) defined and conceptualised wellbeing. This article proposes that children can be included in the conceptualisation and development of policy and provision designed to benefit them and argues for increased presence of the voice and participation of children in wider societal initiatives.

Supporting the needs of public health decision-makers and review authors in the UK

Introduction Systematic reviews, through the synthesis of multiple primary research studies, can be powerful tools in enabling evidence-informed public health policy debate, development and action. In seeking to optimize the utility of these reviews, it is important to understand the needs of those using them. Previous work has emphasized that researchers should adopt methods that are appropriate to the problems that public health decision-makers are grappling with, as well as to the policy context in which they operate.1,2 Meeting these demands poses significant methodological challenges for review authors and prompts a reconsideration of the resources, training and support structures available to facilitate the efficient and timely production of useful, comprehensive reviews. The Cochrane Public Health Group (CPHG) was formed in 2008 to support reviews of complex, upstream public health topics. The majority of CPHG authors are from the UK, which has historically been at the forefront of efforts to promote the production and use of systematic reviews of research relevant to public health decision-makers. The UK therefore provides a suitably mature national context in which to examine (i) the current and future demands of decision-makers to increase the use, value and impact of evidence syntheses; (ii) the implications this has for the scope and methods of reviews and (iii) the required action to build and support capacity to conduct such reviews.

Further development of discrete computational techniques for calculation of restricted diffusion propagators in porous media

Magnetic resonance is a well-established tool for structural characterisation of porous media. Features of pore-space morphology can be inferred from NMR diffusion-diffraction plots or the time-dependence of the apparent diffusion coefficient. Diffusion NMR signal attenuation can be computed from the restricted diffusion propagator, which describes the distribution of diffusing particles for a given starting position and diffusion time. We present two techniques for efficient evaluation of restricted diffusion propagators for use in NMR porous-media characterisation. The first is the Lattice Path Count (LPC). Its physical essence is that the restricted diffusion propagator connecting points A and B in time t is proportional to the number of distinct length-t paths from A to B. By using a discrete lattice, the number of such paths can be counted exactly. The second technique is the Markov transition matrix (MTM). The matrix represents the probabilities of jumps between every pair of lattice nodes within a single timestep. The propagator for an arbitrary diffusion time can be calculated as the appropriate matrix power. For periodic geometries, the transition matrix needs to be defined only for a single unit cell. This makes MTM ideally suited for periodic systems. Both LPC and MTM are closely related to existing computational techniques: LPC, to combinatorial techniques; and MTM, to the Fokker-Planck master equation. The relationship between LPC, MTM and other computational techniques is briefly discussed in the paper. Both LPC and MTM perform favourably compared to Monte Carlo sampling, yielding highly accurate and almost noiseless restricted diffusion propagators. Initial tests indicate that their computational performance is comparable to that of finite element methods. Both LPC and MTM can be applied to complicated pore-space geometries with no analytic solution. We discuss the new methods in the context of diffusion propagator calculation in porous materials and model biological tissues.

Recreational needs and service performance expectations

The theoretical contribution of this study lies with its focus on subjective experiencing, that is, the emotional convergence between feeling states, and perceptions of servicescapes and holiday activities. An empirical study models the impact of recreational needs on the perceived importance of destination attributes and intentions to participate in activities. A sample of prospective tourists was asked to indicate how important they considered servicescape elements to be in their general holiday planning. They were also asked to report on their emotional state (orientation) as a proxy for their needs for recreation, and to state their intention and likely involvement with holiday activities. Results suggest that those with high recreational needs (self-reflexive and inward-looking) regard elements of tourism servicescapes as significantly more important than those without (who are outward-looking and energetic), as well as show significant variations in their inclinations to be active and explorative at destinations. Rather, those with higher recreational needs as measured by combinations of lack of energy, self-confidence, and physiological well-being look for creature comfort, coziness, and familiarity, in other words, for things they already know and have experienced before. Subjective experiencing and service performance evaluations are thereby suggested to be influenced by emotional states. These states may also impact tourists' recognition of destination uniqueness as a major component of a destination's competitive advantage that cannot easily be copied. As a consequence, it may be worth reconsidering the role of recreation in tourism service design. Turning an inwardlooking focus bent on recreation to an outward-looking one interested in discovery would enable more tourists to more fully experience the destination before they leave.

The challenges of meeting the needs of children with Autism Spectrum Disorders (ASD) during out of hospital interactoins with Paramedics

This poster presents the results of a critical review of the literature on the intersection between paramedic practice with Autism Spectrum Disorder (ASD) and previews the clinical and communication challenges likely to be experienced with these patients. Paramedics in Australia provide 24/7 out-of-hospital care to the community. Although their core business is to provide emergency care, paramedics also provide care for vulnerable people as a consequence of the social, economic or domestic milieu. Little is known about the frequency of use of emergency out-of-hospital services by children with ASD and their families. Similarly, little is known about the attitudes and perceptions of paramedics to children with ASD and their emergency health care. However, individuals with ASD are likely to require paramedic services at some point across the life span and may be more frequent users of health services as a consequence of the challenges they face. The high rate of co-morbidities of people diagnosed with ASD is reported and includes seizure disorders, gastro-intestinal disorders, metabolic disorders, hormonal dysfunction, ear, nose and throat infections, hearing impairment, hypertension, allergies/anaphylaxis, immune disorders, migraine and diabetes, gross/fine motor skill dysfunction, premature birth, birth defects, obesity and mental illness. Individuals with ASD may frequently experience concurrent communication, behaviour and sensory challenges. Consequently, Paramedics can encounter difficulties gathering important patient information which may compromise sensitive care. These interactions occur often in high pressure and emotionally challenging environments, which add to the difficulties in communicating the treatment and transport needs of this population.

Projecting future air pollution-related mortality under a changing climate: Progress, uncertainties and research needs

Background Climate change may affect mortality associated with air pollutants, especially for fine particulate matter (PM2.5) and ozone (O3). Projection studies of such kind involve complicated modelling approaches with uncertainties. Objectives We conducted a systematic review of researches and methods for projecting future PM2.5-/O3-related mortality to identify the uncertainties and optimal approaches for handling uncertainty. Methods A literature search was conducted in October 2013, using the electronic databases: PubMed, Scopus, ScienceDirect, ProQuest, and Web of Science. The search was limited to peer-reviewed journal articles published in English from January 1980 to September 2013. Discussion Fifteen studies fulfilled the inclusion criteria. Most studies reported that an increase of climate change-induced PM2.5 and O3 may result in an increase in mortality. However, little research has been conducted in developing countries with high emissions and dense populations. Additionally, health effects induced by PM2.5 may dominate compared to those caused by O3, but projection studies of PM2.5-related mortality are fewer than those of O3-related mortality. There is a considerable variation in approaches of scenario-based projection researches, which makes it difficult to compare results. Multiple scenarios, models and downscaling methods have been used to reduce uncertainties. However, few studies have discussed what the main source of uncertainties is and which uncertainty could be most effectively reduced. Conclusions Projecting air pollution-related mortality requires a systematic consideration of assumptions and uncertainties, which will significantly aid policymakers in efforts to manage potential impacts of PM2.5 and O3 on mortality in the context of climate change.

Psychometric properties of an Australian supportive care needs assessment tool for Indigenous patients with cancer

BACKGROUND There are significant disparities in cancer outcomes between Indigenous and non-Indigenous Australians. Identifying the unmet supportive care needs of Indigenous Australians with cancer is imperative to improve their cancer care. The purpose of this study was to test the psychometric properties of a supportive care needs assessment tool for Indigenous Australian (SCNAT-IP) cancer patients. METHODS The SCNAT-IP was administered to 248 Indigenous Australians diagnosed with a range of cancer types and stages, and received treatment in one of four Queensland hospitals. All 39 items were assessed for ceiling and floor effects and analysed using exploratory factor analysis (EFA) to determine construct validity. Identified factors were assessed for internal consistency and convergent validity to validated psychosocial tools. RESULTS EFA revealed a four-factor structure (physical and psychological, hospital care, information and communication, and practical and cultural needs) explaining 51% of the variance. Internal consistency of four subscales was good, with Cronbach Alpha reliability coefficients ranging from 0.70-0.89. Convergent validity was supported by significant correlations between the SCNAT-IP with the Distress Thermometer (r=0.60, p<0.001), and The Cancer Worry Chart (r=0.58, p<0.001) and a moderately strong negative correlation with Assessment of Quality of Life questionnaire (r=-0.56, p<0.001). CONCLUSION These data provide initial support for the SCNAT-IP a measure of multiple supportive care needs domains specific to Indigenous Australian cancer patients undergoing treatment.

Discovering future disaster management capability needs using scenario planning

In recent years disaster risk reduction efforts have focused on disturbances ranging from climate variability, seismic hazards, geo-political instability and public and animal health crises. These factors combined with uncertainty derived from inter-dependencies within and across systems of critical infrastructure create significant problems of governance for the private and public sector alike. The potential for rapid spread of impacts, geographically and virtually, can render a comprehensive understanding of disaster response and recovery needs and risk mitigation issues beyond the grasp of competent authority. Because of such cascading effects communities and governments at local and state-levels are unlikely to face single incidents but rather series of systemic impacts: often appearing concurrently. A further point to note is that both natural and technological hazards can act directly on socio-technical systems as well as being propagated by them: as network events. Such events have been categorised as ‘outside of the box,’ ‘too fast,’ and ‘too strange’ (Lagadec, 2004). Emergent complexities in linked systems can make disaster effects difficult to anticipate and recovery efforts difficult to plan for. Beyond the uncertainties of real world disasters, that might be called familiar or even regular, can we safely assume that the generic capability we use now will suit future disaster contexts? This paper presents initial scoping of research funded by the Bushfire and Natural Hazards Cooperative Research Centre seeking to define future capability needs of disaster management organisations. It explores challenges to anticipating the needs of representative agencies and groups active in before, during and after phases of emergency and disaster situations using capability deficit assessments and scenario assessment.

The Complex Politics of Care: Needs and interests, norms and desires

If you want to understand something about a society, and the social contracts that underpin it, then understanding the way it positions women, children, those with corporeal or cognitive differences and other not-quitecitizens is a good place to start. As most now understand, this positioning is not natural; it is part of the high-stakes social, institutional and above all ideological labour of defining the human body, directing human behaviour and determining who will hold agency, authority and power...

Using academagogy to meet the needs of millennial learners: A comparative case study

Higher education institutions across the world are experiencing a new generation of students, known as millennial learners. They are more technologically literate and digitally connected than previous generations of learners. To meet the teaching and learning needs of these learners, we must offer more deliberate and meaningful learning experiences and opportunities, where students can see the connections between new material and their own experiences and real world applications – an academagogic approach. This study compares the implementation of academagogy for two different groups of millennial learners – one a traditional face-to-face undergraduate Engineering unit, and the other a mixed-mode (online and face-to-face) undergraduate Design unit. The units are discussed in terms of their student evaluation results, both qualitative and quantitative, and in terms of their academic outcomes for students. Conclusions are drawn about the applicability of academagogy as a heuristic for improving teaching and learning across disciplines, as well as its strengths and limitations in terms of student results.