Self-care support needs and intervention differentiation across the heart failure illness trajectory

University of Technology Sydney. Faculty of Health.Heart failure is a chronic, progressive condition requiring patients and their care partners to engage in self-care behaviours over time. While self-care support interventions are designed to support self-care, ongoing strategic differentiation of the timing and intensity of interventions to changing self-care support needs has been shown to be limited. This thesis aimed to explore the self-care support needs and intervention differentiation across the heart failure illness trajectory. The study utilised a prospective, longitudinal, mixed method study design to collect data from three study populations: patients with a diagnosis of heart failure; their care partners; and heart failure specialists working in a disease management program. Patient and carer data revealed that heart failure self-care occurs within a dyadic context with pre-established relationship patterns. Self-care engagement was influenced by premorbid personality and remained largely unchanged, regardless of structured intervention. To date, many of the approaches to heart failure self-care have been at an individualistic, linear level. This thesis underscores that living with heart failure is a dynamic and evolving process with patient and care partner demonstrating an ongoing need for information as they undergo individual and dyadic processes of transition in response to living with heart failure as a chronic illness

Monitoring the environmental impact of mining in remote locations through remotely sensed data

Mining is an integral part of the development of many countries in the Asia-Pacific region and is associated with adverse environmental and social impacts. The monitoring of mining in remote locations is problematic due to difficulties of access. Satellite remote sensing is able to provide information on landscape transformation in a cost-effective way around large-scale mines. The PT Freeport Indonesia mine in Papua (Indonesia) is the world's largest copper-gold mine and previous studies have documented a range of impacts. A multi-temporal analysis of Landsat 5 imagery of the Freeport area was undertaken for the years between 1988 and 2004. Anthropogenic land cover changes were quantified by screen digitising polygons from three false colour composite images over this period to determine the area of forested land that had been cleared and the area that had been affected by mine-derived sediment transported by the Ajkwa River system. The results show that both settlement and sediment had radically altered land cover and together had led to a sixfold increase in the area of ultra-diverse lowland tropical rainforest cleared in the study area. The study highlights the utility of this method to monitor elements of the impact of large-scale mining and other extensive forms of resource exploitation such as deforestation in developing countries

Use of Organic Fertilizers to Enhance Soil Fertility, Plant Growth, and Yield in a Tropical Environment

Soils rarely have sufficient nutrient for crops to reach their potential yield. Applying organic fertilizers without prior knowledge of their properties may cause yield decline under low application or pollute the environment with excessive application. Understanding the nutrient variability and release pattern of organic fertilizers is crucial to supply plants with sufficient nutrients to achieve optimum productivity, while also rebuilding soil fertility and ensuring protection of environmental and natural resources. This chapter presents the authors’ experiences with different organic amendments under Hawaii\u27s tropical conditions, rather than an intensive literature review. For meat and bone meal by‐products (tankage), batch‐to‐batch variability, nutrient content/release pattern and quality, and plant growth response to the liquid fertilizer produced from tankage were evaluated. For animal livestock, dairy manure (DM) and chicken manure (CM) quality, changes in soil properties, and crop biomass production and root distributions were evaluated. For seaweed, an established bio‐security protocol, nutrient, especially potassium (K) variability, and plant growth and yield response were evaluated in different tropical soils

Development and implementation of Heart Team: a Facebook support group for cardiac patients

Improving adherence to cardiac rehabilitation programs should reduce the risk of repeat cardiac events and improve quality of life. We present the process of developing and piloting a Facebook support group, Heart Team, which other cardiac health professionals could adapt and trial at their hospital, rehabilitation or community service.Cardiovascular Disease Research Network Project Grant by the Australia Heart Foundatio

Mobile technology utilization among patients from diverse cultural and linguistic backgrounds attending cardiac rehabilitation.

Background: Barriers to attending cardiac rehabilitation (CR), including cultural and linguistic differences, may be addressedby recent technological developments. However, the feasibility of using these approaches in culturally and linguistically diversepatients is yet to be determined.Objective: This study aims to assess the use of mobile technologies and features, as well as confidence in utilization acrosspatients speaking different languages at home (ie, English, Mandarin Chinese, and a language other than English and Mandarin[other]) and are both eligible and physically suitable for CR. In addition, the study aims to determine the sociodemographiccorrelates of the mobile technology/feature use, including language spoken at home in the three groups mentioned above.Methods: This is a descriptive, case matched, comparative study. Age and gender-matched patients speaking English, Mandarinand other languages (n=30/group) eligible for CR were surveyed for their mobile technology and mobile feature use.Results: ‘Participants had a mean age of 66.7 years (SD 13, n=90, range 46-95), with 53.3% (48/90) male. The majority (82/90,91.1%) used at least one technology device, with 87.8% (79/90) using mobile devices, the most common being smartphones(57/90, 63.3%), tablets (28/90, 31.1%), and text/voice-only phones (24/90, 26.7%). More English-speaking participants usedcomputers than Mandarin or “other” language speaking participants (P=.003 and .02) and were more confident in doing socompared to Mandarin-speaking participants (P=.003). More Mandarin-speaking participants used smartphones compared with“other” language speaking participants (P=.03). Most commonly used mobile features were voice calls (77/82, 93.9%), textmessage (54/82, 65.9%), the internet (39/82, 47.6%), email (36/82, 43.9%), and videoconferencing (Skype or FaceTime [WeChator QQ] 35/82, 42.7%). Less Mandarin-speaking participants used emails (P=.001) and social media (P=.007) than English-speakingparticipants. Speaking Mandarin was independently associated with using smartphone, emails, and accessing the web-basedmedication information (OR 7.238, 95% CI 1.262-41.522; P=.03, OR 0.089, 95% CI 0.016-0.490; P=.006 and OR 0.191, 95%CI 0.037-0.984; P=.05).Conclusions: This study reveals a high usage of mobile technology among CR patients and provides further insights intodifferences in the technology use across CALD patients in Australia. The findings of this study may inform the design andimplementation of future technology-based CR

Mobile Technology Use Across Age Groups in Patients Eligible for Cardiac Rehabilitation: Survey Study

Background: Emerging evidence indicates mobile technology–based strategies may improve access to secondary prevention and reduce risk factors in cardiac patients. However, little is known about cardiac patients’ use of mobile technology, particularly for health reasons and whether the usage varies across patient demographics.Objective: This study aimed to describe cardiac patients’ use of mobile technology and to determine variations between age groups after adjusting for education, employment, and confidence with using mobile technology.Methods: Cardiac patients eligible for attending cardiac rehabilitation were recruited from 9 hospital and community sites across metropolitan and rural settings in New South Wales, Australia. Participants completed a survey on the use of mobile technology devices, features used, confidence with using mobile technology, willingness and interest in learning, and health-related use.Results: The sample (N=282) had a mean age of 66.5 (standard deviation [SD] 10.6) years, 71.9% (203/282) were male, and 79.0% (223/282) lived in a metropolitan area. The most common diagnoses were percutaneous coronary intervention (33.3%, 94/282) and myocardial infarction (22.7%, 64/282). The majority (91.1%, 257/282) used at least one type of technology device, 70.9% (200/282) used mobile technology (mobile phone/tablet), and 31.9% (90/282) used all types. Technology was used by 54.6% (154/282) for health purposes, most often to access information on health conditions (41.4%, 117/282) and medications (34.8%, 98/282). Age had an important independent association with the use of mobile technology after adjusting for education, employment, and confidence. The youngest group (69 years) age group (odds ratio [OR] 4.45, 95% CI 1.46-13.55), 5 times more likely to use mobile apps (OR 5.00, 95% CI 2.01-12.44), and 3 times more likely to use technology for health-related reasons (OR 3.31, 95% CI 1.34-8.18). Compared with the older group, the middle age group (56-69 years) was more than twice as likely to use any mobile technology (OR 2.42, 95% CI 1.27-4.59) and mobile technology for health-related purposes (OR 1.92, 95% CI 1.04-3.53). Participants who had completed high school were twice as likely to use mobile technology (OR 2.62, 95% CI 1.45-4.70), mobile apps (OR 2.05, 95% CI 1.09-3.84), and mobile technology for health-related reasons (OR 5.09, 95% CI 2.89-8.95) than those who had not completed high school. Associations were also present between participants living in metropolitan areas and mobile technology use (OR 1.07, 95% CI 1.07-4.24) and employment and mobile app use (OR 2.72, 95% CI 1.44-5.140).Conclusions: Mobile technology offers an important opportunity to improve access to secondary prevention for cardiac patients, particularly when modified to suit subgroups. High levels of mobile technology use and health motivation need to be harnessed for secondary prevention

Cardiac Patients’ Experiences and Perceptions of Social Media: Mixed-Methods Study

Background: Traditional in-person cardiac rehabilitation has substantial benefits for cardiac patients, which are offset by poor attendance. The rapid increase in social media use in older adults provides an opportunity to reach patients who are eligible for cardiac rehabilitation but unable to attend traditional face-to-face groups. However, there is a paucity of research on cardiac patients’ experiences and perspectives on using social media to support their health.Objective: The aim of this study was to describe cardiac rehabilitation patients’ experiences in using social media in general and their perspective on using social media, particularly Facebook, to support their cardiac health and secondary prevention efforts.Methods: A mixed-methods study was undertaken among cardiac rehabilitation patients in both urban and rural areas. First, this study included a survey (n=284) on social media use and capability. Second, six focus group interviews were conducted with current Facebook users (n=18) to elucidate Facebook experience and perspectives.Results: Social media use was low (28.0%, 79/282) but more common in participants who were under 70 years of age, employed, and had completed high school. Social media users accessed Web-based information on general health issues (65%, 51/79), medications (56%, 44/79), and heart health (43%, 34/79). Participants were motivated to invest time in using Facebook for “keeping in touch” with family and friends and to be informed by expert cardiac health professionals and fellow cardiac participants if given the opportunity. It appeared that participants who had a higher level of Facebook capability (understanding of features and the consequences of their use and efficiency in use) spent more time on Facebook and reported higher levels of “liking,” commenting, or sharing posts. Furthermore, higher Facebook capability appeared to increase a participants’ willingness to participate in a cardiac Facebook support group. More capable users were more receptive to the use of Facebook for cardiac rehabilitation and more likely to express interest in providing peer support. Recommended features for a cardiac rehabilitation Facebook group included a closed group, expert cardiac professional involvement, provision of cardiac health information, and ensuring trustworthiness of the group.Conclusions: Cardiac health professionals have an opportunity to capitalize on cardiac patients’ motivations and social media, mostly Facebook, as well as the capability for supporting cardiac rehabilitation and secondary prevention. Participants’ favored purposeful time spent on Facebook and their cardiac health provides such a purpose for a Facebook intervention. The study results will inform the development of a Facebook intervention for secondary prevention of cardiovascular disease

The Immune Landscape of Cancer

We performed an extensive immunogenomic anal-ysis of more than 10,000 tumors comprising 33diverse cancer types by utilizing data compiled byTCGA. Across cancer types, we identified six im-mune subtypes\u2014wound healing, IFN-gdominant,inflammatory, lymphocyte depleted, immunologi-cally quiet, and TGF-bdominant\u2014characterized bydifferences in macrophage or lymphocyte signa-tures, Th1:Th2 cell ratio, extent of intratumoral het-erogeneity, aneuploidy, extent of neoantigen load,overall cell proliferation, expression of immunomod-ulatory genes, and prognosis. Specific drivermutations correlated with lower (CTNNB1,NRAS,orIDH1) or higher (BRAF,TP53,orCASP8) leukocytelevels across all cancers. Multiple control modalitiesof the intracellular and extracellular networks (tran-scription, microRNAs, copy number, and epigeneticprocesses) were involved in tumor-immune cell inter-actions, both across and within immune subtypes.Our immunogenomics pipeline to characterize theseheterogeneous tumors and the resulting data areintended to serve as a resource for future targetedstudies to further advance the field