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Objective: Lung cancer patients from ethnic minorities have poorer outcomes than their Caucasian counterparts. We compared lung cancer intervals between culturally and linguistically diverse (CALD) and Anglo-Australian patients to identify ethnic disparities. Methods: This was a prospective, observational cohort study comprising a patient survey and reviews of patients' hospital and general practice records. Across three states, 577 (407 Anglo-Australian and 170 CALD) patients were recruited and their hospital records reviewed. The survey was returned by 189 (135 Anglo-Australian and 54 CALD) patients, and a review was completed by general practitioners (GPs) of 99 (76 Anglo-Australian and 23 CALD) patients. Survival and Cox regression analyses were conducted. Results: CALD patients had longer hospital diagnostic interval [median 30 days, 95% confidence interval (CI) 26–34] than Anglo-Australian patients (median 17, 95% CI 14–20), p = 0.005, hazard ratio (HR) = 1.32 (95% CI 1.09–1.60). This difference persisted after relevant factors were taken into consideration, adjusted HR = 1.26 (95% CI 1.03–1.54, p = 0.022). CALD patients also reported longer prehospital intervals; however, these differences were not statistically significant. Conclusion: Target interventions need to be developed to address ethnic disparity in hospital diagnostic interval.

Jane M Young,1–3 Rebecca L Venchiarutti,1,2 Ivana Durcinoska,1,2 Daniel Steffens1,2 1Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, NSW, Australia; 2Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia; 3RPA Institute of Academic Surgery, Sydney Local Health District, Camperdown, NSW, AustraliaCorrespondence: Jane M YoungSurgical Outcomes Research Centre, Royal Prince Alfred Hospital, P.O. Box M157, Missenden Road, Camperdown, NSW 2050, AustraliaEmail Jane.Young@sydney.edu.auBackground: The Cancer Care Coordination Questionnaire for Patients (CCCQ-P) has been designed to measure patients’ experience of this crucial aspect of their cancer care. Migrants are at particular risk of receiving poorly coordinated cancer care due to challenges in communication as well as unfamiliarity with the health system and roles of health professionals. The aim of this study was to cross-culturally adapt and pilot test the CCCQ-P in Chinese and Arabic languages.Methods: This study followed an established five-stage process for cross-cultural adaptation of self-report measures. The CCCQ-P was forward and back-translated into Arabic, Simplified Chinese, and Traditional Chinese languages by two independent translators. An expert committee review panel appraised the translations, resulting in a pre-final version in the target languages. Face validity, content validity, and consistency of the translated CCCQ-P were then assessed in a sample of bilingual former cancer patients and health professionals. In addition, structured interviews were conducted to explore the meaning of each question and responses to participants.Results: Thirteen health professionals (7 Chinese, 6 Arabic) and 19 former cancer patients (11 Chinese, 8 Arabic) participated in the face validation. Across both language groups, participants agreed that the cross-culturally adapted and translated versio

Little has been published on the diagnostic and referral pathway for lung cancer in Australia. This study set out to quantify general practitioner (GP) and lung specialist attendance and diagnostic imaging in the lead-up to a diagnosis of non-small cell lung cancer (NSCLC) and identify common pathways to diagnosis in New South Wales (NSW), Australia. We used linked health data for participants of the 45 and Up Study (a NSW population-based cohort study) diagnosed with NSCLC between 2006 and 2012. Our main outcome measures were GP and specialist attendances, X-rays and computed tomography (CT) scans of the chest and lung cancer-related hospital admissions. Among our study cohort (N = 894), 60% (n = 536) had ≥4 GP attendances in the 3 months prior to diagnosis of NSCLC, 56% (n = 505) had GP-ordered imaging (chest X-ray or CT scan), 39% (N = 349) attended a respiratory physician and 11% (N = 102) attended a cardiothoracic surgeon. The two most common pathways to diagnosis, accounting for one in three people, included GP and lung specialist (respiratory physician or cardiothoracic surgeon) involvement. Overall, 25% of people (n = 223) had an emergency hospital admission. For 14% of people (N = 129), an emergency hospital admission was the only event identified on the pathway to diagnosis. We found little effect of remoteness of residence on access to services. This study identified a substantial proportion of people with NSCLC being diagnosed in an emergency setting. Further research is needed to establish whether there were barriers to the timely diagnosis of these cases.

Objective: People with pancreatic cancer have poor survival and management is challenging. Pancreatic cancer patients’ perceptions of their care coordination and its association with their outcomes have not been studied. Our objective was to determine if perception of care coordination is associated with patient-reported outcomes or survival. Methods: People with pancreatic cancer who were 1-8 months post-diagnosis (52 with completed resection; 58 with no resection) completed a patient-reported questionnaire which assessed their perception of care coordination, quality of life, anxiety and depression using validated instruments. Mean scores for 15 care coordination items were calculated and then ranked from highest mean score (best experience) to lowest (worst experience). Associations between care coordination scores (including communication and navigation domains) and patient-reported outcomes and survival were investigated using general linear regression and Cox regression, respectively. All analyses were stratified by whether or not the tumour had been resected. Results: In both groups the highest-ranked care coordination items were: knowing who was responsible for coordinating care; health professionals being informed about their history; and waiting times. The worst-ranked items related to: how often patients were asked about visits with other health professionals and how well they and their family were coping; knowing symptoms they should monitor; having sufficient emotional help from staff; and access to additional specialist services. For people who had a resection, better communication and navigation scores were significantly associated with higher quality of life and less anxiety and depression. However, these associations were not statistically significant for those with no resection. Perception of cancer care coordination was not associated with survival in either group. Significance: Our results suggest that while many core clinical aspects of care are

This 22-minute videotape describes how school grounds can be transformed into an educational and social development resource that can enrich the lives of students. It discusses design techniques that break up the school grounds into a variety of places and scale them to size to give students options on where to spend their time and what to do. How group projects held in outdoor areas can be used to teach such subjects as geography, conservation, the sciences, and communication are described. Considerations when developing school grounds are examined, including the needs of the school and surrounding community. Organizational tips and the importance of community participation and support when redesigning school grounds are addressed, as is the importance of having professional advice and support. Finally, the following key issues for managing grounds development are highlighted: timing; safety; vandalism; management and maintenance; and commitment. (GR)

This 25-minute videotape briefly describes the current condition of many of England's secondary school grounds and shows what can be done to improve them. Empowering students to help in redesigning the surrounding school grounds into a conservation area is described. Examples are provided showing how grounds influence student social relations; positively impact behavior; provide opportunities for specific nature clubs; and offer opportunities for physical activities, including activities that consider students with physical and educational disabilities. Further, it explains the usefulness of school grounds for delivering the curriculum in environmental education as well as cross-curricular projects. How these projects contribute to creating responsible stewardship of the environment and instill pride in accomplishment concludes the video. (GR)

Frances Early,1 Jane S Young,2 Elizabeth Robinshaw,3 Emma Z Mi,4 Ella Z Mi,4 Jonathan P Fuld1 1Centre for Self Management Support, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; 2Faculty of Health, Social Care and Education, School of Nursing and Midwifery, Anglia Ruskin University, Cambridge, UK; 3Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK; 4School of Clinical Medicine, University of Cambridge, Cambridge, UK Background: COPD has significant psychosocial impact. Self-management support improves quality of life, but programs are not universally available. IT-based self-management interventions can provide home-based support, but have mixed results. We conducted a case series of an off-the-shelf Internet-based health-promotion program, The Preventive Plan (TPP), coupled with nurse-coach support, which aimed to increase patient activation and provide self-management benefits. Materials and methods: A total of 19 COPD patients were recruited, and 14 completed 3-month follow-up in two groups: groups 1 and 2 with more and less advanced COPD, respectively. Change in patient activation was determined with paired t-tests and Wilcoxon signed-rank tests. Benefits and user experience were explored in semistructured interviews, analyzed thematically. Results: Only group 1 improved significantly in activation, from a lower baseline than group 2; group 1 also improved significantly in mastery and anxiety. Both groups felt significantly more informed about COPD and reported physical functioning improvements. Group 1 reported improvements in mood and confidence. Overall, group 2 reported fewer benefits than group 1. Both groups valued nurse-coach support; for group 1, it was more important than TPP in building confidence to self-manage. The design of TPP and lack of motivation to use IT were barriers to use, but disease severity and poor IT skills were not. Discussion: Our findings demonstrate the feasibility of combining nurse-coach

INTRODUCTION: Colorectal cancer (CRC) and its treatments can cause distressing sequelae. We conducted a multicenter randomized controlled trial aiming to improve psychological distress, supportive care needs (SCNs), and quality of life (QOL) of patients with CRC. The intervention, called SurvivorCare (SC), comprised educational materials, needs assessment, survivorship care plan, end-of-treatment session, and three follow-up telephone calls. METHODS: At the end of treatment for stage I-III CRC, eligible patients were randomized 1:1 to usual care (UC) or to UC plus SC. Distress (Brief Symptom Inventory 18), SCNs (Cancer Survivors' Unmet Needs measure), and QOL (European Organization for Research and Treatment of Cancer [EORTC] QOL questionnaires C30 and EORTC CRC module CR29) were assessed at baseline and at 2 and 6 months (follow-up 1 [FU1] and FU2, respectively). The primary hypothesis was that SC would have a beneficial effect on distress at FU1. The secondary hypotheses were that SC would have a beneficial effect on (a) SCN and QOL at FU1 and on (b) distress, SCNs, and QOL at FU2. A total of 15 items assessed experience of care. RESULTS: Of 221 patients randomly assigned, 4 were ineligible for the study and 1 was lost to FU, leaving 110 in the UC group and 106 in the SC group. Patients' characteristics included the following: median age, 64 years; men, 52%; colon cancer, 56%; rectal cancer, 35%; overlapping sites of disease, 10%; stage I disease, 7%; stage II, 22%; stage III, 71%. Baseline distress and QOL scores were similar to population norms. Between-group differences in distress at FU1 (primary outcome) and at FU2, and SCNs and QOL at FU1 and FU2 were small and nonsignificant. Patients in the SC group were more satisfied with survivorship care than those in the UC group (significant differences on 10 of 15 items). CONCLUSION: The addition of SC to UC did not have a beneficial effect on distress, SCNs, or QOL outcomes, but

Background: There are a variety of methods for priority setting in health research but few studies have addressed how to prioritise the gaps that exist between research evidence and clinical practice. This study aimed to build a suite of robust, evidence based techniques and tools for use in implementation science projects. We applied the priority setting methodology in lung cancer care as an example. Methods: We reviewed existing techniques and tools for priority setting in health research and the criteria used to prioritise items. An expert interdisciplinary consensus group comprised of health service, cancer and nursing researchers iteratively reviewed and adapted the techniques and tools. We tested these on evidence-practice gaps identified for lung cancer. The tools were pilot tested and finalised. A brief process evaluation was conducted. Results: We based our priority setting on the Nominal Group Technique (NGT). The adapted tools included a matrix for individuals to privately rate priority gaps; the same matrix was used for group discussion and reaching consensus. An investment exercise was used to validate allocation of priorities across the gaps. We describe the NGT process, criteria and tool adaptations and process evaluation results. Conclusions: The modified NGT process, criteria and tools contribute to building a suite of methods that can be applied in prioritising evidence-practice gaps. These methods could be adapted for other health settings within the broader context of implementation science projects.

BACKGROUND: Comparing outcomes between hospitals requires consideration of patient factors that could account for any observed differences. Adjusting for comorbid conditions is common when studying outcomes following cancer surgery, and a commonly used measure is the Charlson comorbidity index. Other measures of patient health include the ECOG performance status and the ASA physical status score. This study aimed to ascertain how frequently ECOG and ASA scores are recorded in population-based administrative data collections in New South Wales, Australia and to assess the contribution each makes in addition to the Charlson comorbidity index in risk adjustment models for comparative assessment of colorectal cancer surgery outcomes between hospitals. METHODS: We used linked administrative data to identify 6964 patients receiving surgery for colorectal cancer in 2007 and 2008. We summarised the frequency of missing data for Charlson comorbidity index, ECOG and ASA scores, and compared patient characteristics between those with and without these measures. The performance of ASA and ECOG in risk adjustment models that also included Charlson index was assessed for three binary outcomes: 12-month mortality, extended length of stay and 28-day readmission. Patient outcomes were compared between hospital peer groups using multilevel logistic regression analysis.RESULTS: The Charlson comorbidity index could be derived for all patients, ASA score was recorded for 78 % of patients and ECOG performance status recorded for only 24 % of eligible patients. Including ASA or ECOG improved the predictive ability of models, but there was no consistently best combination. The addition of ASA or ECOG did not substantially change parameter estimates for hospital peer group after adjusting for Charlson comorbidity index.CONCLUSIONS: While predictive ability of regression models is maximised by inclusion of one or both of ASA score and ECOG performance status, there is little to be gained by

OBJECTIVES: The Charlson score is a commonly used measure of comorbidity; however, there is little empirical research into the optimal implementation when studying cancer surgery outcomes using administrative data. We compared four alternative Charlson score implementations, including and excluding metastatic cancer and varying the look-back periods. STUDY DESIGN AND SETTING: Nine years of linked administrative data were used to identify patients undergoing surgery for cancer of the colon, rectum, or lung in New South Wales, Australia. Four binary outcomes of 30- and 365-day mortality, length of stay greater than 21 days, and emergency readmission within 28 days were compared between groups of similar hospitals. Hospital risk adjustment models were compared for alternative Charlson score implementations. RESULTS: Excluding metastatic cancer from the Charlson score improved model performance for short-term outcomes, but there was no implementation that was consistently optimal. Incorporating a look-back period reduced the number of patients for analysis but did not improve hospital risk adjustment. CONCLUSION: Charlson scores for hospital risk adjustment of short-term outcomes of cancer surgery should be calculated excluding metastatic cancer as a separate comorbidity. We found no clear best performing implementation and found no benefit in incorporating any look-back period.

Objectives: The International Cancer Benchmarking Partnership (ICBP) is a collaboration between 6 countries and 12 jurisdictions with similar primary care-led health services. This study investigates primary care physician (PCP) behaviour and systems that may contribute to the timeliness of investigating for cancer and subsequently, international survival differences. Design: A validated survey administered to PCPs via the internet set out in two parts: direct questions on primary care structure and practice relating to cancer diagnosis, and clinical vignettes, assessing management of scenarios relating to the diagnosis of lung, colorectal or ovarian cancer. Participants: 2795 PCPs in 11 jurisdictions: New South Wales and Victoria (Australia), British Columbia, Manitoba, Ontario (Canada), England, Northern Ireland, Wales (UK), Denmark, Norway and Sweden. Primary and secondary outcome measures: Analysis compared the cumulative proportion of PCPs in each jurisdiction opting to investigate or refer at each phase for each vignette with 1-year survival, and conditional 5-year survival rates for the relevant cancer and jurisdiction. Logistic regression was used to explore whether PCP characteristics or system differences in each jurisdiction affected the readiness to investigate. Results: 4 of 5 vignettes showed a statistically significant correlation (p<0.05 or better) between readiness to investigate or refer to secondary care at the first phase of each vignette and cancer survival rates for that jurisdiction. No consistent associations were found between readiness to investigate and selected PCP demographics, practice or health system variables. Conclusions: We demonstrate a correlation between the readiness of PCPs to investigate symptoms indicative of cancer and cancer survival rates, one of the first possible explanations for the variation in cancer survival between ICBP countries. No specific health system features consistently explained these findings. Some jur

BACKGROUND: Surgery remains the dominant treatment for large-bowel obstruction, with emerging data on self-expanding metallic stents. OBJECTIVE: The aim of this study was to assess whether stent insertion improves quality of life and survival in comparison with surgical decompression. DESIGN: This study reports on a randomized control trial (registry number ACTRN012606000199516). SETTING: This study was conducted at Royal Prince Alfred Hospital, Sydney, and Western Hospital, Melbourne. PATIENTS AND INTERVENTION: Patients with malignant incurable large-bowel obstruction were randomly assigned to surgical decompression or stent insertion. MAIN OUTCOME MEASURES: The primary end point was differences in EuroQOL EQ-5D quality of life. Secondary end points included overall survival, 30-day mortality, stoma rates, postoperative recovery, complications, and readmissions. RESULTS: Fifty-two patients of 58 needed to reach the calculated sample size were evaluated. Stent insertion was successful in 19 of 26 (73%) patients. The remaining 7 patients required a stoma compared with 24 of 26 (92%) surgery group patients (p < 0.001). There were no stent-related perforations or deaths. The surgery group had significantly reduced quality of life compared with the stent group from baseline to 1 and 2 weeks (p = 0.001 and p = 0.012), and from baseline to 12 months (p = 0.01) in favor of the stent group, whereas both reported reduced quality of life. The stent group had an 8% 30-day mortality compared with 15% for the surgery group (p = 0.668). Median survival was 5.2 and 5.5 months for the groups (p = 0.613). The stent group had significantly reduced procedure time (p = 0.014), postprocedure stay (p = 0.027), days nothing by mouth (p = 0.002), and days before free access to solids (p = 0.022). LIMITATIONS: This study was limited by the lack of an EQ-5D Australian-based population set. CONCLUSIONS: Stent use in patients with incurable large-bowel obstruction has a number of advantages wi

Mikaela L Jorgensen,1 Jane M Young,1,2 Michael J Solomon2,3 1Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; 2Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and University of Sydney, Sydney, NSW, Australia; 3Discipline of Surgery, University of Sydney, Sydney, NSW, Australia Abstract: Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. With population aging and increases in survival, the number of CRC survivors is projected to rise dramatically. The time following initial treatment is often described as a period of transition from intensive hospital-based care back into “regular life.” This review provides an overview of recommended follow-up care for people with CRC who have been treated with curative intent, as well as exploring the current state of the research that underpins these guidelines. For patients, key concerns following treatment include the development of recurrent and new cancers, late and long-term effects of cancer and treatment, and the interplay of these factors with daily function and general health. For physicians, survivorship care plans can be a tool for coordinating the surveillance, intervention, and prevention of these key patient concerns. Though much of the research in cancer survivorship to date has focused on surveillance for recurrent disease, many national guidelines differ in their conclusions about the frequency and timing of follow-up tests. Most CRC guidelines refer only briefly to the management of side effects, despite reports that many patients have a range of ongoing physiological, psychosocial, and functional needs. Guidance for surveillance and intervention is often limited by a small number of heterogeneous trials conducted in this patient group. However, recently released survivorship guidelines emphasize the potential for the effectiveness of second

Background: Survival rates following a diagnosis of cancer vary between countries. The International Cancer Benchmarking Partnership (ICBP), a collaboration between six countries with primary care led health services, was set up in 2009 to investigate the causes of these differences. Module 3 of this collaboration hypothesised that an association exists between the readiness of primary care physicians (PCP) to investigate for cancer - the 'threshold' risk level at which they investigate or refer to a specialist for consideration of possible cancer - and survival for that cancer (lung, colorectal and ovarian). We describe the development of an international survey instrument to test this hypothesis. Methods: The work was led by an academic steering group in England. They agreed that an online survey was the most pragmatic way of identifying differences between the jurisdictions. Research questions were identified through clinical experience and expert knowledge of the relevant literature. A survey comprising a set of direct questions and five clinical scenarios was developed to investigate the hypothesis. The survey content was discussed and refined concurrently and repeatedly with international partners. The survey was validated using an iterative process in England. Following validation the survey was adapted to be relevant to the health systems operating in other jurisdictions and translated into Danish, Norwegian and Swedish, and into Canadian and Australian English. Results: This work has produced a survey with face, content and cross cultural validity that will be circulated in all six countries. It could also form a benchmark for similar surveys in countries with similar health care systems. Conclusions: The vignettes could also be used as educational resources. This study is likely to impact on healthcare policy and practice in participating countries.

Objective To investigate the associations of a range of personal and clinical variables with bladder cancer survival in men and women in NSW to see if we could explain why bladder cancer survival is consistently poorer in women than in men. Patients and Methods All 6880 cases of bladder cancers diagnosed in NSW between 2000 and 2008 were linked to hospital separation data and to deaths. Separate Cox proportional hazards regression models of hazard of bladder cancer death were constructed for those who did or did not undergo cystectomy. Results A total of 16% of patients with bladder cancer underwent cystectomy (16% of men and 15% of women). Women who underwent cystectomy were 26% more likely to die than men (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.00-1.59) after adjustment for age, stage, time from diagnosis to cystectomy, distance from treatment facility and country of birth. None of the above covariates had a material effect on the difference in hazard between women and men; however, when stratified by a history of cystitis, the adjusted hazard was 55% higher in women (HR 1.55, 95% CI 1.15-2.10) than in men with a history of cystitis while, in the absence of this history, there was no difference in the hazard between men and women (HR 0.99, 95% CI 0.57-1.70). This apparent modification of the effect of sex on bladder cancer outcome was not seen in patients treated only by resection: the adjusted HRs in women relative to men were 1.10 (95% CI 0.92-1.31) in those with a history of cystitis and 1.21 (95% CI 0.98-1.50) in those without. A history of haematuria did not modify appreciably the association of sex with bladder cancer outcome. Conclusion Women's poorer survival from bladder cancer compared with that of men remains unexplained; however, the possibility that some factor associated with a history of cystitis may contribute to or explain the poorer outcome in women merits further investigation.

Background: Colorectal cancer (CRC) is the most common cancer affecting both men and women in Australia. The illness and related treatments can cause distressing adverse effects, impact on emotional and psychological well-being, and adversely affect social, occupational and relationship functioning for many years after the end of treatment or, in fact, lifelong. Current models of follow-up fail to address the complex needs arising after treatment completion. Strategies to better prepare and support survivors are urgently required. We previously developed a nurse-led supportive care program (SurvivorCare) and tested it in a pilot study involving 10 CRC survivors. The intervention was found to be highly acceptable, appropriate, relevant and useful.Methods/design: This study is a multisite, randomised controlled trial, designed to assess the impact of the addition of the SurvivorCare intervention to usual post-treatment care, for people with potentially cured CRC. SurvivorCare comprises the provision of survivorship educational materials, a tailored survivorship care plan, an individually tailored nurse-led, face-to-face end of treatment consultation and three subsequent telephone calls. Eligible patients have completed treatment for potentially cured CRC. Other eligibility criteria include stage I to III disease, age greater than 18 years and adequate understanding of English. All consenting patients complete questionnaires at three time points over a six-month period (baseline, two and six months). Measures assess psychological distress, unmet needs and quality of life.Discussion: This supportive care package has the potential to significantly reduce individual suffering, whilst reducing the burden of follow-up on acute cancer services through enhanced engagement with and utilisation of general practitioners and community based services. If the intervention is successful in achieving the expected health benefits, it could be disseminated readily. All training and sup

Mikaela L Jorgensen,1,2 Jane M Young,1,2 Michael J Solomon1,31Surgical Outcomes Research Centre (SOuRCe), Sydney School of Public Health, University of Sydney and Sydney Local Health District, NSW, Australia; 2Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, University of Sydney, NSW, Australia; 3Discipline of Surgery, University of Sydney, NSW, AustraliaPurpose: Older colorectal cancer patients are significantly less likely than younger patients to receive guideline-recommended adjuvant chemotherapy. Previous research has indicated that patient refusal of treatment is a contributing factor. This study aimed to identify potential barriers to adjuvant chemotherapy use in older patients by examining the associations between patient age, factors influencing chemotherapy treatment decisions, and preferences for information and decision-making involvement.Patients and methods: Sixty-eight patients who underwent surgery for colorectal cancer in Sydney, Australia, within the previous 24 months completed a self-administered survey.Results: Fear of dying, health status, age, quality of life, and understanding treatment procedures and effects were significantly more important to older patients (aged ≥65 years) than younger patients in deciding whether to accept chemotherapy (all P < 0.05). Reducing the risk of cancer returning and physician trust were important factors for all patients. Practical barriers such as traveling for treatment and cost were rated lowest. Older patients preferred less information and involvement in treatment decision making than younger patients. However, 60% of the older group wanted detailed information about chemotherapy, and 83% wanted some involvement in decision making. Those preferring less information and involvement still rated many factors as important in their decision making, including understanding treatment procedures and effects.Conclusion: A range of factors appears to influence patients&

of paper that was presented at The 12th National Conference of Emerging Researchers in Ageing.

This thesis examines the employment of particular carceral tactics both inside and outside Israeli prisons in the context of the Zionist colonial occupation of Palestinian territories. Together these tactics are considered to form an overarching strategy to crush Palestinian resistance to the forty-five year-old occupation. Central to this study is application of Michel Foucault’s model of carceral practices which occur within the walls of the modern prison and extend capillary-like into wider Palestinian society, to the extent it resembles a Foucauldian “carceral archipelago” of control. Various components of Foucault’s concepts of power, discipline, punishment and resistance are applied in order to analyse overlapping canons of colonialism and Zionism, and the response of Palestinians to them. Occupied Palestinians are also linked with Giorgio Agamben’s concept of people killed with impunity - homo sacer - whom Agamben refers to as living a “bare life” without human or political rights, at the margins of society or beyond. Colonial-era laws and regulations are found to have dehumanised Palestinians as a mass security threat to Israel. This categorization is in turn used to justify mass incarceration, detention without trial, torture, extra-judicial executions, collective punishments and the commodification of Palestinian prisoners exemplified in lop-sided prisoner exchanges. The thesis finds Zionist carceral practices entrench the occupation and immiserate Palestinian society, disrupting economic, social and political cohesion, and the potential of the Palestinian people. The thesis identifies hunger strikes, the commandeering of Zionist prison space as sites of Palestinian nationalist education and political recruitment, and a refusal to vacate their own land as clear mechanisms of Palestinian resistance. An oppression-resistance cycle is evident, reinforcing the centrality of the prisoner and the prison in Palestinian life. Contemporary behaviour by Israel indic

Hypothesis Patients and their clinicians hold varying preferences for surgical and adjuvant treatment therapies for rectal cancer. Design Preferences were determined using the Prospective Measure of Preference. Setting Royal Prince Alfred and St Vincent's hospitals in Sydney, Australia. Participants Patients with colorectal cancer were interviewed during their postoperative hospital stay, and physicians were asked to complete a mailed survey. Main Outcome Measures The Prospective Measure of Preference method produces 2 outcome measures of preference: willingness to trade and prospective measure of preference time trade-off. Results Patients' strongest preference was to avoid a stoma: more than 60% would give up a mean of 34% of their life expectancy to avoid this surgical option. This was followed by treatment options involving chemoradiotherapy, where more than 50% would give up a mean of almost 25% of their life to avoid treatment. Surgeons held stronger preferences against all adjuvant options compared with oncologists (P ≤ .01). Conclusions Patients had strong preferences against all treatment options, and these preferences frequently differed from those of physicians. These results highlight the importance of determining patients' own preferences in the clinical encounter. Furthermore, the diversity of preferences of clinical subspecialists emphasizes the need for multidisciplinary treatment planning to ensure a balanced approach to treatment decision making for patients with rectal cancer.

In a survey of career awareness among high school seniors in Northern California, almost all students agreed that career is an important consideration for them, and about two-thirds reported that they had decided on an occupational field. However, only about half reported that they were comfortable with their current career decision-making, had a clear idea of their own interests and abilities, or had sufficient knowledge about potential occupations. Minority students tended to express greater needs with regard to career exploration than white students. Compared to other groups, significantly fewer Latino males had made an occupational decision. Part-time work during the students’ senior year did not appear to hinder school grades or school engagement. In fact, working was associated with generally higher levels of career awareness, especially regarding the importance of career planning. However, part-time work was associated with increases in reported stress levels.

The management of industrial reservoirs for hydroelectric energy can cause severe impacts to surrounding communities. This study examines the generation of dust along the northern foreshore zones of Williston Reservoir in northern British Columbia. The dust is generated in the spring when the reservoir levels are low and impacts a relocated First Nations' village (Tsay Keh) at the north end of the reservoir. Data were gathered to provide an overview of the physical conditions that contribute to the dust problem, including a social survey, soil analysis, and vegetation inventory. The study provides a scoping method to assess a large-scale and complex problem with respect to dust management along a large reservoir. Methods for dust control include short- and long-term solutions that integrate the use of native vegetation along the foreshore zones of the reservoir.

Complex surveys are surveys which involve a survey design other than simple random sampling. In practice sample surveys require a complex design due to many factors such as cost, time and the nature of the population. Standard statistical methods such as linear regression, contingency tables and multivariate analyses are based on data which are independently and identically distributed (IID). That is, the data is assumed to have been selected by a simple random sampling design. The assumptions underlying standard statistical methods are generally not met when the data is from a complex design. A measure of the efficiency of a design was found by the ratio of the variance of the actual design over the variance of a simple random sample (of the same sample size). This is known as the design effect (deff). There are two forms of design effects; one proposed by Kish (1965) and another termed the misspecification effect (meff) by Skinner et al. (1989). Throughout the thesis, the design effect referred to is Skinner et al. (1989)'s misspecification effect. Cluster sampling generally yields a deff greater than one and stratified samples yields a deff less than one. Some researchers have adopted a model based approach for parameter estimation rather than the traditional design based approach. The model based approach is one which each possible respondent has a distribution of possible values, often leading to the equivalent of an infinite background population, called the superpopulation. Both approaches are discussed throughout the thesis. Most of the standard computing packages available have been developed for simple random sample data. Specialized packages are needed to analyse complex survey data correctly. PC CARP and SUDAAN are two such packages. Three examples of statistical analyses on complex sample surveys were explored using the specialized statistical packages. The output from these packages were compared to a standard statistical package, The SAS System. It wa

Representing contemporary printmaking, this monograph includes essays on individual artists and organizations from seven different countries. Wroblewska focuses on the institutional and technical support for printmaking in Poland and recent Polish poster art. Sakane examines the 20th century shifts in the world art scene and its effect on graphic design in Japan. Includes an essay on the problems of legally defining original print versus reproduction.

Young discusses Scott's series of narrative paintings from 1983, which express the passion and jealousy of love. Bellerby relates Scott's work since 1978, to the development of figurative painting in the 1980s. Biographical notes. 12 bibl. ref.

Defining these works as figurative sculpture, Young examines the artists' work, their use of materials, and their political and social themes. Includes brief statements by the artists and biographical notes. 10 bibl. ref.

Young discusses the similarities and differences among the works on paper of 35 artists who are usually recongnized for their sculpture. 44 bibl. ref.

Young surveys Hughes' career from 1929 to 1989, noting his affinity for the beauty and natural order of the west coast landscape. Biographical notes. 47 bibl. ref.

Young describes how Bancroft and Douglas assemble three-dimensional photographic installations to undermine the singularity of the spectator's gaze, and thus undermine assumptions about knowledge, authority, history and nature.

Young asserts that the three installation artists, informed by conceptualism and minimalism, use allusion and metaphor to deconstruct behaviour. Biographical notes. 18 bibl. ref.

Young describes the decorative impulse in Michener's ceramic installations of still lifes and gardens. Includes an artist's statement and biographical notes. 24 bibl. ref.

Hemophilia A and B are X-linked deficiencies of coagulation factor VIII and IX respectively. Males are affected, while females are carriers of the disease. Recently, it has become clear that more than a third of hemophilia carriers (HC) are symptomatic. Carriers may experience prolonged bleeding postpartum, following trauma and surgery as well as menorrhagia. This is the first research to incorporate both a bleeding assessment tool, to assist in objectively quantifying severity of bleeding symptoms, as well as a validated quality of life (QoL) questionnaire to facilitate an understanding of the relationship between bleeding symptoms and QoL. The objectives for this study are to validate a self-administered bleeding assessment tool (Self-BAT) as a screening tool to accurately identify HC with low factor levels (FL) and abnormal bleeding symptoms, to measure QoL of HC using the SF-36v2 and describe its relationship to bleeding severity and FL, and to investigate variability in FL. To date, 59 HC have been enrolled. A positive or abnormal Self-BAT bleeding score (≥6) has a sensitivity of 83%, specificity of 42%, a positive predictive value (PPV) of 0.48 and a negative predictive value (NPV) of 0.79 for the identification of HC with low FL. Analysis of QoL data shows an inverse correlation between QoL and BS (r=-0.52, p<0.0001). No significant relationship is observed between QoL and FL. This study found skewed X-inactivation ratio (XIR) to be significantly more prevalent in this population than has been observed in the general population. This suggests that determination of XIR may be useful in predicting risk of deficient FL. This study validates the Self-BAT as an effective tool to identify HC with low FL and/or abnormal bleeding symptoms. For HC, Self-BAT BS is a more accurate measure of bleeding severity and resultant QoL than FL. HC will benefit from treatment strategies aimed at controlling bleeding symptoms which will facilitate improvements in the management of, Thesis (Master, Pathology & Molecular Medicine) -- Queen's University, 2015-11-17 14:21:27.992