Prevalence and determinants of the health promotion and risk reduction practices of younger female survivors of breast cancer

This thesis describes a discrete component of a larger mixed-method (survey and interview) study that explored the health-promotion and risk-reduction practices of younger premenopausal survivors of ovarian, breast and haematological cancers. This thesis outlines my distinct contribution to the larger study, which was to: (1) Produce a literature review that thoroughly explored all longer-term breast cancer treatment outcomes, and which outlined the health risks to survivors associated with these; (2) Describe and analyse the health-promotion and risk-reduction behaviours of nine younger female survivors of breast cancer as articulated in the qualitative interview dataset; and (3) Test the explanatory power of the Precede-Proceed theoretical framework underpinning the study in relation to the qualitative data from the breast cancer cohort. The thesis reveals that breast cancer survivors experienced many adverse outcomes as a result of treatment. While they generally engaged in healthy lifestyle practices, a lack of knowledge about many recommended health behaviours emerged throughout the interviews. The participants also described significant internal and external pressures to behave in certain ways because of the social norms surrounding the disease. This thesis also reports that the Precede-Proceed model is a generally robust approach to data collection, analysis and interpretation in the context of breast cancer survivorship. It provided plausible explanations for much of the data in this study. However, profound sociological and psychological implications arose during the analysis that were not effectively captured or explained by the theories underpinning the model. A sociological filter—such as Turner’s explanation of the meaning of the body and embodiment in the social sphere (Turner, 2008)—and the psychological concerns teased out in Mishel’s (1990) Uncertainty in Illness Theory, provided a useful dimension to the findings generated through the Precede-Proceed model. The thesis concludes with several recommendations for future research, clinical practice and education in this context.

Autonomous underwater vehicles: development and implementation of time and energy efficient trajectories

Autonomous underwater vehicles (AUVs) are increasingly used, both in military and civilian applications. These vehicles are limited mainly by the intelligence we give them and the life of their batteries. Research is active to extend vehicle autonomy in both aspects. Our intent is to give the vehicle the ability to adapt its behavior under different mission scenarios (emergency maneuvers versus long duration monitoring). This involves a search for optimal trajectories minimizing time, energy or a combination of both. Despite some success stories in AUV control, optimal control is still a very underdeveloped area. Adaptive control research has contributed to cost minimization problems, but vehicle design has been the driving force for advancement in optimal control research. We look to advance the development of optimal control theory by expanding the motions along which AUVs travel. Traditionally, AUVs have taken the role of performing the long data gathering mission in the open ocean with little to no interaction with their surroundings, MacIver et al. (2004). The AUV is used to find the shipwreck, and the remotely operated vehicle (ROV) handles the exploration up close. AUV mission profiles of this sort are best suited through the use of a torpedo shaped AUV, Bertram and Alvarez (2006), since straight lines and minimal (0 deg - 30 deg) angular displacements are all that are necessary to perform the transects and grid lines for these applications. However, the torpedo shape AUV lacks the ability to perform low-speed maneuvers in cluttered environments, such as autonomous exploration close to the seabed and around obstacles, MacIver et al. (2004). Thus, we consider an agile vehicle capable of movement in six degrees of freedom without any preference of direction.

Modelling bus lost time : an additional parameter influencing bus dwell time and station platform capacity at a BRT station platform

The common approach to estimate bus dwell time at a BRT station is to apply the traditional dwell time methodology derived for suburban bus stops. In spite of being sensitive to boarding and alighting passenger numbers and to some extent towards fare collection media, these traditional dwell time models do not account for the platform crowding. Moreover, they fall short in accounting for the effects of passenger/s walking along a relatively longer BRT platform. Using the experience from Brisbane busway (BRT) stations, a new variable, Bus Lost Time (LT), is introduced in traditional dwell time model. The bus lost time variable captures the impact of passenger walking and platform crowding on bus dwell time. These are two characteristics which differentiate a BRT station from a bus stop. This paper reports the development of a methodology to estimate bus lost time experienced by buses at a BRT platform. Results were compared with the Transit Capacity and Quality of Servce Manual (TCQSM) approach of dwell time and station capacity estimation. When the bus lost time was used in dwell time calculations it was found that the BRT station platform capacity reduced by 10.1%.

Fitting airport privatisation to purpose : aligning governance, time and management focus

Where airports were once the sole responsibility of their governments, liberalisation of economies has seen administrative interests in airport spaces divested increasingly towards market led authority. Extant literature suggests that actions in decision spaces can be described under broad idealised forms of governance. However in looking at a sample of 18 different airports it is apparent that these classic models are insufficient to appreciate the contextual complexity of each case. Issues of institutional arrangements, privatisation, and management focus are reviewed against existing governance modes to produce a model for informing privatisation decisions, based on the contextual needs of the individual airport and region. Expanding governance modes to include emergent airport arrangements both contribute to the existing literature, and provides a framework to assist policy makers and those charged with the operation of airports to design effective governance models. In progressing this framework, contributions are made to government decision makers for the development of new, or review of existing strategies for privatisation, while the private sector can identify the intent and expectations of privatisation initiatives to make better informed decisions.

Rural activity spaces and transport disadvantage : qualitative analysis of quantitative models integrating time and space

Current knowledge about the relationship between transport disadvantage and activity space size is limited to urban areas, and as a result, very little is known to date about this link in a rural context. In addition, although research has identified transport disadvantaged groups based on their size of activity spaces, these studies have, however, not empirically explained such differences and the result is often a poor identification of the problems facing disadvantaged groups. Research has shown that transport disadvantage varies over time. The static nature of analysis using the activity space concept in previous research studies has lacked the ability to identify transport disadvantage in time. Activity space is a dynamic concept; and therefore possesses a great potential in capturing temporal variations in behaviour and access opportunities. This research derives measures of the size and fullness of activity spaces for 157 individuals for weekdays, weekends, and for a week using weekly activity-travel diary data from three case study areas located in rural Northern Ireland. Four focus groups were also conducted in order to triangulate the quantitative findings and to explain the differences between different socio-spatial groups. The findings of this research show that despite having a smaller sized activity space, individuals were not disadvantaged because they were able to access their required activities locally. Car-ownership was found to be an important life line in rural areas. Temporal disaggregation of the data reveals that this is true only on weekends due to a lack of public transport services. In addition, despite activity spaces being at a similar size, the fullness of activity spaces of low-income individuals was found to be significantly lower compared to their high-income counterparts. Focus group data shows that financial constraint, poor connections both between public transport services and between transport routes and opportunities forced individuals to participate in activities located along the main transport corridors.

Age and gender comparisons of driving while sleepy : behaviours and risk perceptions

To assist road safety professionals in developing effective strategies to combat the risk associated with driving while fatigued, a survey was administered to 1000 Australian drivers. Participants reported their past behaviours in regards to driving while sleepy and their perceptions of risk associated with driving fatigued as compared to speeding and driving under the influence of alcohol. Although participants appeared to be aware of the substantial risk associated with driving while sleepy, many drivers reported that they frequently drive when sleepy. Age and gender comparisons, revealed that risk taking behaviour in regards to driving while sleepy is occurring across all age groups and in both male and female drivers. Overall young to middle age drivers and male drivers reported the highest frequency of driving while sleepy and reported the lowest perceived personal risk in regards to driving while sleepy.

Convexity, Classification, and Risk Bounds

Many of the classification algorithms developed in the machine learning literature, including the support vector machine and boosting, can be viewed as minimum contrast methods that minimize a convex surrogate of the 0–1 loss function. The convexity makes these algorithms computationally efficient. The use of a surrogate, however, has statistical consequences that must be balanced against the computational virtues of convexity. To study these issues, we provide a general quantitative relationship between the risk as assessed using the 0–1 loss and the risk as assessed using any nonnegative surrogate loss function. We show that this relationship gives nontrivial upper bounds on excess risk under the weakest possible condition on the loss function—that it satisfies a pointwise form of Fisher consistency for classification. The relationship is based on a simple variational transformation of the loss function that is easy to compute in many applications. We also present a refined version of this result in the case of low noise, and show that in this case, strictly convex loss functions lead to faster rates of convergence of the risk than would be implied by standard uniform convergence arguments. Finally, we present applications of our results to the estimation of convergence rates in function classes that are scaled convex hulls of a finite-dimensional base class, with a variety of commonly used loss functions.

Drinking and driving in Vietnam : perceptions and risk

Road traffic injuries are a major global public health problem but continue to receive inadequate attention. Alcohol influences both risk and consequence of road traffic injury but the scale of the problem is not well understood in many countries. In Vietnam, economic development has brought a substantial increase in the number of registered motorcycles as well as alcohol consumption. Traffic injury is among the leading causes of death in Vietnam but there is little local information regarding alcohol related traffic injuries. The primary goal of this study is to explore the drinking and driving patterns of males and their perceptions towards drink-driving and to determine the relationship between alcohol consumption and road traffic injuries. Furthermore, this thesis aims to present the situation analysis for choosing priority actions to reduce drinking and driving in Vietnam. The study is a combination of two cross-sectional surveys and a pilot study. The pilot study, involving 224 traffic injured patients, was conducted to test the tools and the feasibility of approach methods. In the first survey, male patrons (n=464) were randomly selected at seven restaurants. Face-to-face interviews were conducted when patrons just arrived and breath tests were collected when they were about to leave the restaurant. In the second survey, male patients admitted to hospital following a traffic injury (n=480, of which 414 were motorcycle or bicycle riders) were interviewed and their blood alcohol concentration (BAC) measured by breathalyzer. The results show broadly similar patterns of drinking and driving among male patrons and male traffic injured patients with a high frequency of drinking and drink-driving reported among the majority of the two groups. A high proportion of male patrons were leaving restaurants with a BAC over the legal limit. Factors that significantly associate with the number of drinks and BAC were age, hazardous drinking, frequency of drink-driving in the past year, self-estimated number of drinks consumed to drive legally, perceived family’s disapproval of drink-driving, and perceived legal risk and physical risk. The proportion of patrons and patients with BAC above the legal limit of 0.05 were 86.7% and 60.4% respectively, which was much higher than found in previous studies. In addition, both groups had a high prevalence of BAC over 0.15g/100ml (39.7% of patrons and 45.6% patients), a level that can seriously affect driving capacity. Results from the case-crossover analysis for patients indicate a dose-response relationship between alcohol consumption and the risk of traffic injury. The risk of traffic injury increased when alcohol was consumed before driving and there was a more than 13 fold increase when six or more drinks were consumed. Regarding perceptions towards drinking and driving, findings corroborate the low awareness among males in Vietnam, with a majority of respondents holding a low knowledge of safe and legally permissible alcohol use, and a low perceived risk of drinking and driving. The results also indicate a huge gap in prevention skills in terms of planning ahead or using alternative transport to avoid drink-driving and a perception by patrons and patients of a low rate of disapproval of drink-driving from peers and family. Findings in this study have considerable implications for national policy, injury prevention, clinical practice, reporting systems, and for further research. The low rate of compliance with existing laws and a generally low perceived legal risk toward drink-driving in this study call for the strengthening of enforcement along with mass media campaigns and news coverage in order to decrease the widespread perception of impunity and thereby, to reduce the level of drink-driving. In addition, no significant difference was found in this study on risk of traffic injuries between car drivers and motorcycle drivers. The current inconsistency between legal BAC for drivers of motorcycles, compared to cars, thus needs addressing. Furthermore, as drinking was found to be very common, rather than solely targeting drink-driving, it is important to call for a more strategic and comprehensive approach to alcohol policy in Viet Nam. This study also has considerable implications for clinical practice in terms of screening and brief interventions. Our study suggests that the short form of the AUDIT (AUDIT-C) screening tool is appropriate for use in busy emergency departments. The high proportion of traffic injured patients with evidence of alcohol abuse or hazardous drinking suggests that brief interventions by alcohol and drug counselors in emergency departments are a sensible option to addressing this important problem. The significance of this study is in the combination of the systematic collection of breath test and use of case-crossover design to estimate the risk of traffic injuries after alcohol consumption. The results provide convincing evidence to policy makers, health authorities and the media to help raise community awareness and policy advocacy toward the drinkdriving problem in Vietnam. The findings suggest an urgent need for a multi-sectoral approach to curtail drink-driving in Vietnam, especially programs to raise community awareness and effective legal enforcement. Furthermore, serving as a situation analysis, the thesis should inform the formulation of interventions designed to curtail drinking and driving in Vietnam and other developing countries.

Which older women could benefit from interventions to decrease sitting time and increase physical activity?

In addition to the well-known health risks associated with lack of physical activity (PA), evidence is emerging about the health risks of sedentary behaviour (sitting). Research about patterns and correlates of sitting and PA in older women is scarce. METHODS: Self-report data from 6,116 women aged 76-81 years were collected as part of the Australian Longitudinal Study on Woman’s Health. Linear regression models were computed to examine whether demographic, social and health factors were associated with sitting and PA. RESULTS: Women who did no PA sat more than women who did any PA (p<0.001). Seven correlates were associated with sitting and PA (p<0.05). Five of these were associated with more sitting and less PA: three health-related (BMI, chronic conditions, anxiety/depression) and two social correlates (caring duties, volunteering). One demographic (being from another English-speaking country) and one social correlate (more social interaction) were associated with more sitting and more PA. Four correlates, two demographic (living in a city; post-high school education), one social (being single), and one health-related correlate (dizziness/loss of balance) were associated with more sitting only. Two other health-related correlates (stiff/painful joints; feet problems) were associated with less PA only. CONCLUSION: Sedentary behaviour and PA are distinct behaviours in older Australian women. Information about the correlates of both behaviours can be used to identify population groups who might benefit from interventions to reduce sedentary behaviour and/or increase PA.

Creating new narratives through shared time and space : the performer/audience connection in multi-site dance events

Site-specific performance provides choices in audience experience via degrees of scale, proximity, levels of immersion and viewing perspectives. Beyond these choices, multi-site promenade events also form a connected audience/performer relationship in which moving together in time and space can produce a shared narrative and aesthetic sensibility of collective, yet individuated and shifting meanings. This paper interrogates this notion through audience/performer experiences in two separate multi-site, dance-led events. here/there/then/now occurred in four intimate sites within the Brisbane Powerhouse, providing a theatricalised platform for audiences to create linked narratives through open-ended and fragmented intertextuality. Accented Body, based on the concept of “the body as site and in site” and notions of connectivity, provided a more expansive platform for a similar, but heightened, shared engagement. Audiences traversed 6 outdoor and 2 indoor Brisbane sites moving to varying levels of a large complex. Eleven, predominantly interactive, screens provided links to other sites as well as to distributed presences in Seoul and London. The differentiation in scale and travel time between sites deepened the immersive experiences of audiences who reported transformative engagements with both site and architecture, accompanied by a sense of extended and yet quickened time.

Implementable efficient time and energy consumption trajectories design for an autonomous underwater vehicle

In this paper we consider the implementation of time and energy efficient trajectories onto a test-bed autonomous underwater vehicle. The trajectories are losely connected to the results of the application of the maximum principle to the controlled mechanical system. We use a numerical algorithm to compute efficient trajectories designed using geometric control theory to optimize a given cost function. Experimental results are shown for the time minimization problem.

Not-for-profits and risk accountability : insuring the third sector

Not for profit organisations face significant challenges in managing organisational risk. In this regard not-for-profits are not unique but they are distinguishable from their 'for-profit' counterparts in that they are less likely to have the resources to find sufficient risk management strategies and plans, are very vunerable to cyclical changes in the insurance market and are not usually in a position to pass on the costs of increased premiums to third parties such as consumers of their services. This article explores the nature and extent of risks faced by the not-for-profit sector; the appropriateness and scope of risk management to reduce and manage the likelihood and incidence of risk; and the types of insurance and options to cover risks that materialise. It concludes with a recommendation for a potential course of action.