Bevacizumab in NF2-related vestibular schwannomas: a nationally coordinated approach to delivery and prospective evaluation

Background: NF2 patients develop multiple nervous system tumors including bilateral vestibular schwannomas (VS). The tumors and their surgical treatment are associated with deafness, neurological disability, and mortality. Medical treatment with bevacizumab has been reported to reduce VS growth and to improve hearing. In addition to evaluating these effects, this study also aimed to determine other important consequences of treatment including patient-reported quality of life and the impact of treatment on surgical VS rates. Methods: Patients treated with bevacizumab underwent serial prospective MRI, audiology, clinical, CTCAE-4.0 adverse events, and NFTI-QOL quality-of-life assessments. Tumor volumetrics were classified according to the REiNs criteria and annual VS surgical rates reviewed. Results: Sixty-one patients (59% male), median age 25 years (range, 10–57), were reviewed. Median follow-up was 23 months (range, 3–53). Partial volumetric tumor response (all tumors) was seen in 39% and 51% had stabilization of previously growing tumors. Age and pretreatment growth rate were predictors of response. Hearing was maintained or improved in 86% of assessable patients. Mean NFTI-QOL scores improved from 12.0 to 10.7 (P < .05). Hypertension was observed in 30% and proteinuria in 16%. Twelve treatment breaks occurred due to adverse events. The rates of VS surgery decreased after the introduction of bevacizumab. Conclusion: Treatment with bevacizumab in this large, UK-wide cohort decreased VS growth rates and improved hearing and quality of life. The potential risk of surgical iatrogenic damage was also reduced due to an associated reduction in VS surgical rates. Ongoing follow-up of this cohort will determine the long-term benefits and risks of bevacizumab treatment.

The coordinated approach to child health in underserved population (CATCH UP) curriculum: A quantitative evaluation of an innovative preschool obesity prevention program

Obesity has been on the rise in the United States over the last 30 years for all populations, including preschoolers. The purpose of the project was to develop an observation tool to measure physical activity levels in preschool children and use the tool in a pilot test of the CATCH UP curriculum at two Head Start Centers in Houston. Pretest and posttest interobserver agreements were all above 0.60 for physical activity level and physical activity type. Preschoolers spent the majority of their time in light physical activity (75.33% pretest, 87.77% posttest), and spent little time in moderate to vigorous physical activity (MVPA) (24.67% pretest, 12.23% posttest). Percent time spent in MVPA decreased significantly pretest to posttest from (F=5.738, p=0.043). While the pilot testing of the CATCH UP curriculum did not show an increase in MVPA, the SOFIT-P tool did show promising results as being a new method for collecting physical activity level data for preschoolers. Once the new tool has undergone more reliability and validity testing, it could allow for a more convenient method of collecting physical activity levels for preschoolers. ^

Training cooperative extension workers; the coordinated approach.

Mode of access: Internet.

Medical-legal partnerships: the role of mental health providers and legal authorities in the development of a coordinated approach to supporting mental health clients' legal needs in regional and rural settings

INTRODUCTION: Medical-legal partnerships (MLP) are a model in which medical and legal practitioners are co-located and work together to support the health and wellbeing of individuals by identifying and resolving legal issues that impact patients' health and wellbeing. The aim of this article is to analyse the benefits of this model, which has proliferated in the USA, and its applicability in the context of rural and remote Australia.

METHODS: This review was undertaken with three research questions in mind: What is an MLP? Is service provision for individuals with mental health concerns being adequately addressed by current service models particularly in the rural context? Are MLPs a service delivery channel that would benefit individuals experiencing mental health issues?

RESULTS: The combined searches from all EBSCO Host databases resulted in 462 citations. This search aggregated academic journals, newspapers, book reviews, magazines and trade publications. After several reviews 38 papers were selected for the final review based on their relevance to this review question: How do MLPs support mental health providers and legal service providers in the development of a coordinated approach to supporting mental health clients' legal needs in regional and rural Australia?

CONCLUSIONS: There is considerable merit in pursuing the development of MLPs in rural and remote Australia particularly as individuals living in rural and remote areas have far fewer opportunities to access support services than those people living in regional and metropolitan locations. MLPS are important channels of service delivery to assist in early invention of legal problems that can exacerbate mental health problems.

Coordinated research skills training at QUT

Universities are wanting to drive research performance to new levels to increase competitiveness and secure additional research funding. Information technology departments, libraries and research offices are being tasked with the triple role of developing infrastructure, introducing new services, and raising researchers’ awareness and skill levels in the uptake of these services and related eResearch concepts in order to achieve institutional goals. The purpose of this poster is to provide an overview of the coordinated approach to the provision of research skills workshops and seminars provided to researchers and higher degree research (HDR) students at QUT. Seminars and workshops are provided by the Library in collaboration with High Performance Computing and Research Support (HPC) and the Research Students Centre. The sessions are findable and bookable via the Library’s KickStart system. A list of session topics is provided. The Research Support services web site brings together information on a range of research support services provided by the Library and HPC. Seminars and workshops are also available via a research training calendar system into which all sessions are populated, regardless of the provider. The Library and HPC are also undertaking a train the trainer program.

General practice coordinated chronic disease management to reduce avoidable hospital admission

Chronic disease accounts for about 80 per cent of the total disease burden in Australia, and its management accounts for 70 per cent of all current health expenditure.1 Effective prevention and management of chronic disease requires a coordinated approach between primary health care, acute care services, and the patients.2 However, what is not clear is whether improvements in primary healthcare management can have a clear benefit in the cost of care of patients with chronic disease. We recently completed a pilot study in rural Western Australia to ascertain the feasibility of a coordinated general practice-based approach to managing chronic respiratory and cardiovascular conditions, and to determine the direct cost savings to the public insurer through reduction in avoidable hospital admission. The aim of this correspondence is to share our preliminary findings and encourage debate on how such a project may be scaled up or adapted to other primary healthcare settings.

Distributed Linear Precoding and User Selection in Coordinated Multicell Systems

In this manuscript we tackle the problem of semidistributed user selection with distributed linear precoding for sum rate maximization in multiuser multicell systems. A set of adjacent base stations (BS) form a cluster in order to perform coordinated transmission to cell-edge users, and coordination is carried out through a central processing unit (CU). However, the message exchange between BSs and the CU is limited to scheduling control signaling and no user data or channel state information (CSI) exchange is allowed. In the considered multicell coordinated approach, each BS has its own set of cell-edge users and transmits only to one intended user while interference to non-intended users at other BSs is suppressed by signal steering (precoding). We use two distributed linear precoding schemes, Distributed Zero Forcing (DZF) and Distributed Virtual Signalto-Interference-plus-Noise Ratio (DVSINR). Considering multiple users per cell and the backhaul limitations, the BSs rely on local CSI to solve the user selection problem. First we investigate how the signal-to-noise-ratio (SNR) regime and the number of antennas at the BSs impact the effective channel gain (the magnitude of the channels after precoding) and its relationship with multiuser diversity. Considering that user selection must be based on the type of implemented precoding, we develop metrics of compatibility (estimations of the effective channel gains) that can be computed from local CSI at each BS and reported to the CU for scheduling decisions. Based on such metrics, we design user selection algorithms that can find a set of users that potentially maximizes the sum rate. Numerical results show the effectiveness of the proposed metrics and algorithms for different configurations of users and antennas at the base stations.

A systematic policy approach to changing the food system and physical activity environments to prevent obesity

As obesity prevention becomes an increasing health priority in many countries, including Australia
and New Zealand, the challenge that governments are now facing is how to adopt a systematic
policy approach to increase healthy eating and regular physical activity. This article sets out a
structure for systematically identifying areas for obesity prevention policy action across the food
system and full range of physical activity environments. Areas amenable to policy intervention can
be systematically identified by considering policy opportunities for each level of governance (local,
state, national, international and organisational) in each sector of the food system (primary
production, food processing, distribution, marketing, retail, catering and food service) and each
sector that influences physical activity environments (infrastructure and planning, education,
employment, transport, sport and recreation). Analysis grids are used to illustrate, in a structured
fashion, the broad array of areas amenable to legal and regulatory intervention across all levels of
governance and all relevant sectors. In the Australian context, potential regulatory policy
intervention areas are widespread throughout the food system, e.g., land-use zoning (primary
production within local government), food safety (food processing within state government), food
labelling (retail within national government). Policy areas for influencing physical activity are
predominantly local and state government responsibilities including, for example, walking and
cycling environments (infrastructure and planning sector) and physical activity education in schools
(education sector). The analysis structure presented in this article provides a tool to systematically
identify policy gaps, barriers and opportunities for obesity prevention, as part of the process of
developing and implementing a comprehensive obesity prevention strategy. It also serves to
highlight the need for a coordinated approach to policy development and implementation across
all levels of government in order to ensure complementary policy action.

Enhancing patient engagement in chronic disease self-management support initiatives in Australia : the need for an integrated approach

♦ Although emphasis on the prevention of chronic disease is important, governments in Australia need to balance this with continued assistance to the 77% of Australians reported to have at least one long-term medical condition.

♦ Self-management support is provided by health care and community services to enhance patients’ ability to care for their chronic conditions in a cooperative framework.

♦ In Australia, there is a range of self-management support initiatives that have targeted patients (most notably, chronic disease self-management education programs) and health professionals (financial incentives, education and training).

♦ To date, there has been little coordination or integration of these self-management initiatives to enhance the patient–health professional clinical encounter.

♦ If self-management support is to work, there is a need to better understand the infrastructure, systems and training that are required to engage the key stakeholders — patients, carers, health professionals, and health care organisations.

♦ A coordinated approach is required in implementing these elements within existing and new health service models to enhance uptake and sustainability.

Evidence-based decision making to strengthen local governance : nutritional health interventions in Bantul and Gunungkidul

Since 2001, district governments have had the main responsibility for providing public health care in Indonesia. One of the main public health challenges facing many district governments is improving nutritional standards, particularly among poorer segments of the population. Developing effective policies and strategies for improving nutrition requires a multi-sectoral approach encompassing agricultural development policy, access to markets, food security (storage) programs, provision of public health facilities, and promotion of public awareness of nutritional health. This implies a strong need for a coordinated approach involving multiple government agencies at the district level. Due to diverse economic, agricultural, and infrastructure conditions across the country, district governments’ ought to be better placed than central government both to identify areas of greatest need for public nutrition interventions, and devise policies that reflect local characteristics. However, in the two districts observed in this study—Bantul and Gunungkidul—it was clear that local government capacity to generate, obtain and integrate evidence about local conditions into the policy-making process was still limited. In both districts, decision-makers tended to rely more on intuition,anecdote, and precedent in formulating policy. The potential for evidence-based decision making was also severely constrained by a lack of coordination and communication between agencies, and current arrangements related to central government fiscal transfers, which compel local governments to allocate funding to centrally determined programs and priorities.

Evidence based decision making to strenghten local governance : nutritional health interventions

Since 2001, district governments have had the main responsibility for providing public health care in Indonesia. One of the main public health challenges facing many district governments is improving nutritional standards, particularly among poorer segments of the population. Developing effective policies and strategies for improving nutrition requires a multi-sectoral approach encompassing agricultural development policy, access to markets, food security (storage) programs, provision of public health facilities, and promotion of public awareness of nutritional health. This implies a strong need for a coordinated approach involving multiple government agencies at the district level. Due to diverse economic, agricultural,and infrastructure conditions across the country, district governments’ ought to be better placed than central government both to identify areas of greatest need for public nutrition interventions, and devise policies that reflect local characteristics. However, in the two districts observed in this study—Bantul and Gunungkidul—it was clear that local government capacity to generate, obtain and integrate evidence about local conditions into the policy-making process was still limited. In both districts, decision-makers tended to rely more on intuition,anecdote, and precedent in formulating policy. The potential for evidence-based decision making was also severely constrained by a lack of coordination and communication between agencies, and current arrangements related to central government fiscal transfers, which compel local governments to allocate funding to centrally determined programs and priorities.

A life jacket with holes- : a case study of 'temporary engagement' : a strategy used by Education Queensland to employ beginning secondary teachers

This research investigated the impact of Education Queensland's employment policy and practices for beginning secondary teachers appointed on temporary engagement. The context was the public secondary school sector within the state of Queensland, Australia. The study was set within a context of the changing nature of work from full-time permanent employment towards casual, fixed-term contracts, temporary and part-time employment, a trend reflected in the employment patterns for teachers within Australia. Two broad categories of literature relating to the research problem of this thesis were reviewed, namely the beginning teacher and permanency or tenure. The focus in the research literature on beginning teachers was the professional experiences of teachers within the classroom and school. There was a paucity of research that considered the working and industrial conditions of temporary employment for beginning teachers or the personal and professional implications of this form of employment. The review of the context and literature was conceptualised as a Beginning Temporary Teacher Theoretical Framework which served to inform the study. Using a qualitative case study methodology, the research techniques employed for the thesis were semi-structured interview and document analysis. A simultaneously conducted research project in which the researcher participated entitled 'Winning the Lottery? Beginning Teachers on Temporary Engagement' foregrounded this thesis in terms of refining the research question, contributing to the literature and in the selection of the participants. For this case study the perspectives of four distinct yet inter-related categories of professionals were sought. These included four beginning secondary teachers, three school administrators, a Senior Personnel Officer with Education Queensland, and a representative from the Queensland Teachers' Union. The research findings indicated that none of the beginning teachers or other professionals viewed starting a career in teaching on temporary engagement as the ideal. The negative features identified were the differential treatment received and the high level of uncertainty associated with temporary employment. Differential treatment tended to indicate 'less' entitlements, in terms of access to induction and professional development, recreational and sick leave, acceptance by and expectations of other colleagues, and avenues of redress in grievance cases. Moreover, interviews indicated a high level of uncertainty in terms of starting within the teaching profession, commencing at a new school, and a regular income. In addition, frequent changes in schools and/or cohorts of students exacerbated levels of uncertainty. The beginning teachers reported significantly decreased motivation, self-esteem and sense of belonging, and increased stress levels. There was an even more marked negative impact on those beginning teachers who had experienced a higher number of temporary engagements and schools in their first year of teaching. Conversely, strong staff support and a reasonable length of time in the one school improved the quality of the beginning teachers' experiences. The overall impact of being on temporary engagement resulted in delayed permanent position appointments, decreased commitment to particular schools and to Education Queensland as the employing authority, and for two of the beginning teachers, it produced a desire to seek alternative employment. The implementation of Education Queensland's policies relating to working conditions and entitlements for these temporary beginning teachers at the school level was revealed to be less than satisfactory. There was a tendency towards 'just-in- time' management of the beginning teacher on temporary engagement. The beginning teachers received 'less-than-messages' about access to and use of departmental documentation, support through induction and professional development, and their transition from temporary to permanent employment. To ensure a more systematic, supportive and inclusive process for managing the temporary beginning teacher, a conceptual framework entitled 'Continuums of Tension' was developed. The four continuums included permanent employment - temporary employment; system perspective - individual perspective; teaching as a profession - teaching as a job; and the permanent beginning teacher - university graduate. The general principles of the human resource policies of Education Queensland were based on a commitment to permanent employment, a system's perspective, viewing teaching as a profession and a homogeneous group of permanent beginning teachers. Contrasting with this, the beginning teacher on temporary engagement tended to operate from the position of temporary employment and a perspective that was individually based. Their priorities therefore included the 'occupational' aspects of being a temporary teacher striving to become permanent. Thus there existed a tension or contradiction between the general principles of human resource policies within Education Queensland and the employment experiences of beginning teachers on temporary engagement. The study proposed three actions for resolution to address the aforementioned tensions. The actions included: (a) the effective provision and targeted communication of information; (b) support, induction and professional development; and (c) a coordinated approach between Education Queensland, Queensland Teachers' Union, the Universities and the beginning teacher. These actions are fm1her refined to include: (a) an induction kit to suppm1 the individual through the pre-employment to permanent employee phases, (b) an extrapolation of the roles and responsibilities of Education Queensland personnel charged with supporting the beginning temporary teacher, and (c) a series of recommendations to effect a coordinated approach amongst the key stakeholders. The theoretical and conceptual frameworks have provided a means of addressing the identified needs of the beginning teacher on temporary engagement. As such, this study has contributed to the research literature on teacher employment and professionalism and aims to provide a beginning temporary teacher with managed professional and occupational support.

Use of ITS to improve level crossings safety : open issues

Level crossing crashes have been shown to result in enormous human and financial cost to society. According to the Australian Transport Safety Bureau (ATSB) [5] a total of 632 Railway Level crossing (RLX) collisions, between trains and road vehicles, occurred in Australia between 2001 and June 2009. The cost of RLX collisions runs into the tens of millions of dollars each year in Australia [6]. In addition, loss of life and injury are commonplace in instances where collisions occur. Based on estimates that 40% of rail related fatalities occur at level crossings [12], it is estimated that 142 deaths between 2001 and June 2009 occurred at RLX. The aim of this paper is to (i) summarise crash patterns in Australia, (ii) review existing international ITS interventions to improve level crossing and (iii) highlights open human factors research related issues. Human factors (e.g., driver error, lapses or violations) have been evidenced as a significant contributing factor in RLX collisions, with drivers of road vehicles particularly responsible for many collisions. Unintentional errors have been found to contribute to 46% of RLX collisions [6] and appear to be far more commonplace than deliberate violations. Humans have been found to be inherently inadequate at using the sensory information available to them to facilitate safe decision-making at RLX and tend to underestimate the speed of approaching large objects due to the non-linear increases in perceived size [6]. Collisions resulting from misjudgements of train approach speed and distance are common [20]. Thus, a fundamental goal for improved RLX safety is the provision of sufficient contextual information to road vehicle drivers to facilitate safe decision-making regarding crossing behaviours.

Everyone's problem but nobody's job : staff perceptions and explanations for poor nutritional intake in older medical patients

Aim: Up to 60% of older medical patients are malnourished with further decline during hospital stay. There is limited evidence for effective nutrition intervention. Staff focus groups were conducted to improve understanding of potential contextual and cultural barriers to feeding older adults in hospital. Methods: Three focus groups involved 22 staff working on the acute medical wards of a large tertiary teaching hospital. Staff disciplines were nursing, dietetics, speech pathology, occupational therapy, physiotherapy, pharmacy. A semistructured topic guide was used by the same facilitator to prompt discussions on hospital nutrition care including barriers. Focus groups were tape-recorded, transcribed and analysed thematically. Results: All staff recognised malnutrition to be an important problem in older patients during hospital stay and identified patient-level barriers to nutrition care such as non-compliance to feeding plans and hospital-level barriers including nursing staff shortages. Differences between disciplines revealed a lack of a coordinated approach, including poor knowledge of nutrition care processes, poor interdisciplinary communication, and a lack of a sense of shared responsibility/coordinated approach to nutrition care. All staff talked about competing activities at meal times and felt disempowered to prioritise nutrition in the acute medical setting. Staff agreed education and ‘extra hands’ would address most barriers but did not consider organisational change. Conclusions: Redesigning the model of care to reprioritise meal-time activities and redefine multidisciplinary roles and responsibilities would support coordinated nutrition care. However, effectiveness may also depend on hospitalwide leadership and support to empower staff and increase accountability within a team-led approach.

A rural health education, training and research network

The purpose of the Rural Health Education, Training and Research Network is to support the education and training of rural health practitioners and research in rural health through the optimum use of appropriate information and communication technologies to link and inform all individuals and organisation involved in the teaching, planning and delivery of health care in rural and remote Queensland. The health care of people in rural areas has the potential to be enhanced, through providing the rural and remote health professionals in Queensland with the same access to educational and training opportunities as their metropolitan colleagues. This consultative, coordinated approach should be cost-effective through both increasing awareness and utilisation of existing and developing networks, and through more efficient and rational use of both the basic and sophisticated technologies which support them. Technological hardware, expertise and infrastructure are already in place in Queensland to support a Rural Health Education, Training and Research Network, but are not being used to their potential, more often due to a lack of awareness of their existence and utility than to their perceived costs. Development of the network has commenced through seeding funds provided by Queensland Health. Future expansion will ensure access by health professionals to existing networks within Queensland. This paper explores the issues and implications of a network for rural health professionals in Queensland and potentially throughout Australia, with a specific focus on the implications for rural and isolated health professional.