Geographical Information Systems (GIS) and their role in sustainable planning : a case study from a Local Government Area (LGA) in Australia

A case study is used to demonstrate the application of Geographical Information Systems (GIS) to inform sustainable development. The suitability of the landscape to support tourism accommodation in a Local Government Area (LGA) is modelled by integrating existing datasets, including conservation areas, residential zones, major roads and known locations of tourism operators into a logistic regression framework. By using a data-driven approach an indication of the relative importance of each explanatory variable can be accounted for, therefore informing planners of the importance of different assets. In a region where tourism is reliant upon natural features, this use of information systems in conjunction with quantitative statistical modelling can value-add to existing datasets. The provision of this kind of knowledge is important as it would otherwise not factor into the decision-making process had the datasets been considered independently of each other &ndash; a concept that applies to both the public and private sectors.<br /

Nature and type of patient-reported safety incidents in primary care: Cross-sectional survey of patients from Australia and England

Background Patient engagement in safety has shown positive effects in preventing or reducing adverse events and potential safety risks. Capturing and utilising patient-reported safety incident data can be used for service learning and improvement. Objective The aim of this study was to characterise the nature of patient-reported safety incidents in primary care. Design Secondary analysis of two cross sectional studies. Participants Adult patients from Australian and English primary care settings. Measures Patients’ self-reported experiences of safety incidents were captured using the validated Primary Care Patient Measure of Safety questionnaire. Qualitative responses to survey items were analysed and categorised using the Primary Care Patient Safety Classification System. The frequency and type of safety incidents, contributory factors, and patient and system level outcomes are presented. Results A total of 1329 patients (n=490, England; n=839, Australia) completed the questionnaire. Overall, 5.3% (n=69) of patients reported a safety incident over the preceding 12 months. The most common incident types were administration incidents (n=27, 31%) (mainly delays in accessing a physician) and incidents involving diagnosis and assessment (n=16, 18.4%). Organisation of care accounted for 27.6% (n=29) of the contributory factors identified in the safety incidents. Staff factors (n=13, 12.4%) was the second most commonly reported contributory factor. Where an outcome could be determined, patient inconvenience (n=24, 28.6%) and clinical harm (n=21, 25%) (psychological distress and unpleasant experience) were the most frequent. Conclusions The nature and outcomes of patient-reported incidents differ markedly from those identified in studies of staff-reported incidents. The findings from this study emphasise the importance of capturing patient-reported safety incidents in the primary care setting. The patient perspective can complement existing sources of safety intelligence with the potential for service improvement

Examining adherence to activity monitoring devices to improve physical activity in adults with cardiovascular disease: A systematic review

Background Activity monitoring devices are currently being used to facilitate and monitor physical activity. No prior review has examined adherence to the use of activity monitoring devices amongst adults with cardiovascular disease. Methods Literature from June 2012 to October 2017 was evaluated to examine the extent of adherence to any activity monitoring device used to collect objective physical activity data. Randomized control trials comparing usual care against the use of an activity monitoring device, in a community intervention for adults from any cardiovascular diagnostic group, were included. A systematic search of databases and clinical trials registers was conducted using Joanna Briggs Institute methodology. Results Of 10 eligible studies, two studies reported pedometer use and eight accelerometer use. Six studies addressed the primary outcome. Mean adherence was 59.1% (range 39.6% to 85.7%) at last follow-up. Studies lacked equal representation by gender (28.6% female) and age (range 42 to 82 years). Conclusion This review indicates that current research on activity monitoring devices may be overstated due to the variability in adherence. Results showed that physical activity tracking in women and in young adults have been understudied

Heart failure following blood cancer therapy in pediatric and adult populations

Aim: The link between chemotherapy treatment and cardiotoxicity is well established, particularly for adults with blood cancers. However, it is less clear for children. This analysis aimed to compare the trajectory and mortality of children and adults who received chemotherapy for blood cancers and were subsequently hospitalised for heart failure. Methods: Linked data from the Queensland Cancer Registry, Death Registry and Hospital Administration records for initial chemotherapy and later heart failure were reviewed (1996-2009). Of all identified blood cancer patients (N=23,434); 8,339 received chemotherapy, including 817 children (aged ≤18 years at time of cancer diagnosis) and 7,522 adults. Time-varying Cox proportional hazards regression models were used to compare the characteristics and survival between the two groups. Results: Of those who were subsequently hospitalised for heart failure, 70% of children and 46% of adults had the index admission within 12 months of their cancer diagnosis. Of these, 53% of the pediatric heart failure population and 71% of the adult heart failure population died within the study period. Following adjustment for age, sex and chemotherapy admissions, children with heart failure had an increased mortality risk compared to their non-heart failure counterparts, a difference which was much greater than that between the adult groups. Conclusion: The impact of heart failure on children previously treated for blood cancer is more severe than for adults, with earlier morbidity and greater mortality. Improved strategies are needed for the prevention and management of cardiotoxicity in this population

Evaluation of AUSDRISK as a screening tool for lifestyle modification programs: international implications for policy and cost-effectiveness

OBJECTIVE: To evaluate the current use of Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) as a screening tool to identify individuals at high risk of developing type 2 diabetes for entry into lifestyle modification programs. RESEARCH DESIGN AND METHODS: AUSDRISK scores were calculated from participants aged 40-74 years in the Greater Green Triangle Risk Factor Study, a cross-sectional population survey in 3 regions of Southwest Victoria, Australia, 2004-2006. Biomedical profiles of AUSDRISK risk categories were determined along with estimates of the Victorian population included at various cut-off scores. Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and receiver operating characteristics were calculated for AUSDRISK in determining fasting plasma glucose (FPG) &ge;6.1 mmol/L. RESULTS: Increasing AUSDRISK scores were associated with an increase in weight, body mass index, FPG, and metabolic syndrome. Increasing the minimum cut-off score also increased the proportion of individuals who were obese and centrally obese, had impaired fasting glucose (IFG) and metabolic syndrome. An AUSDRISK score of &ge;12 was estimated to include 39.5% of the Victorian population aged 40-74 (916 000), while a score of &ge;20 would include only 5.2% of the same population (120 000). At AUSDRISK&ge;20, the PPV for detecting FPG&ge;6.1 mmol/L was 28.4%. CONCLUSIONS: AUSDRISK is powered to predict those with IFG and undiagnosed type 2 diabetes, but its effectiveness as the sole determinant for entry into a lifestyle modification program is questionable given the large proportion of the population screened-in using the current minimum cut-off of &ge;12. AUSDRISK should be used in conjunction with oral glucose tolerance testing, fasting glucose, or glycated hemoglobin to identify those individuals at highest risk of progression to type 2 diabetes, who should be the primary targets for lifestyle modification

Hydrologic landscape regionalisation using deductive classification and random forests

Landscape classification and hydrological regionalisation studies are being increasingly used in ecohydrology to aid in the management and research of aquatic resources. We present a methodology for classifying hydrologic landscapes based on spatial environmental variables by employing non-parametric statistics and hybrid image classification. Our approach differed from previous classifications which have required the use of an a priori spatial unit (e.g. a catchment) which necessarily results in the loss of variability that is known to exist within those units. The use of a simple statistical approach to identify an appropriate number of classes eliminated the need for large amounts of post-hoc testing with different number of groups, or the selection and justification of an arbitrary number. Using statistical clustering, we identified 23 distinct groups within our training dataset. The use of a hybrid classification employing random forests extended this statistical clustering to an area of approximately 228,000 km2 of south-eastern Australia without the need to rely on catchments, landscape units or stream sections. This extension resulted in a highly accurate regionalisation at both 30-m and 2.5-km resolution, and a less-accurate 10-km classification that would be more appropriate for use at a continental scale. A smaller case study, of an area covering 27,000 km2, demonstrated that the method preserved the intra- and inter-catchment variability that is known to exist in local hydrology, based on previous research. Preliminary analysis linking the regionalisation to streamflow indices is promising suggesting that the method could be used to predict streamflow behaviour in ungauged catchments. Our work therefore simplifies current classification frameworks that are becoming more popular in ecohydrology, while better retaining small-scale variability in hydrology, thus enabling future attempts to explain and visualise broad-scale hydrologic trends at the scale of catchments and continents

Balancing environmental impacts and benefits of wastewater reuse

Wastewater reuse is being widely promulgated to help address the global freshwater resource crisis. It can assist in reducing extraction of freshwater from the environment, and reuse of wastewater lessens the need for environmental discharge, which is clearly beneficial to receiving waters. But the practice itself also has the potential to be detrimental to natural and human environments: soil structure can become degraded, aquifers may be polluted, and human health may be threatened. The challenge facing natural resource managers is to identify the potential benefits and risks, and to achieve an appropriate balance. This paper describes environmental benefits and threats concomitant with the reuse of wastewater. We frequently draw upon examples from China and Australia-two countries that face particularly daunting water resourcechallenges-but the principles can be.extended far beyond these geographical bounds and are applicable tomany parts of the world.<br /

The Impact of Caregiving on the Association Between Infant Emotional Behavior and Resting State Neural Network Functional Topology

The extent to which neural networks underlying emotional behavior in infancy serve as precursors of later behavioral and emotional problems is unclear. Even less is known about caregiving influences on these early brain-behavior relationships. To study brain-emotional behavior relationships in infants, we examined resting-state functional network metrics and infant emotional behavior in the context of early maternal caregiving. We assessed 46 3-month-old infants and their mothers from a community sample. Infants underwent functional MRI during sleep. Resting-state data were processed using graph theory techniques to examine specific nodal metrics as indicators of network functionality. Infant positive and negative emotional behaviors, and positive, negative and mental-state talk (MST) indices of maternal caregiving were coded independently from filmed interactions. Regression analyses tested associations among nodal metrics and infant emotionality, and the moderating effects of maternal behavior on these relationships. All results were FDR corrected at alpha = 0.05. While relationships between infant emotional behavior or maternal caregiving, and nodal metrics were weak, higher levels of maternal MST strengthened associations between infant positive emotionality and nodal metrics within prefrontal (p &lt; 0.0001), and occipital (p &lt; 0.0001) cortices more generally. Positive and negative aspects of maternal caregiving had little effect. Our findings suggest that maternal MST may play an important role in strengthening links between emotion regulation neural circuitry and early infant positive behavior. They also provide objective neural markers that could inform and monitor caregiving-based interventions designed to improve the health and well-being of vulnerable infants at-risk for behavioral and emotional problems

Heart Failure Following Cancer Therapy in Patients with Hematological Malignancies Aged 18 Years and Under: A Linked Health Data Analysis (1996-2009)

Made available in accordance with Publisher's Open Access policyntroduction: The causal link between chemotherapy treatments and subsequent cardiotoxicity is well established, particularly for children with hematological malignancies. Little information exists on the characteristics and outcomes for patients with heart failure (HF) after chemotherapy. This study aimed to describe the characteristics, survival and mortality of patients who received chemotherapy for hematological cancer (leukemias, lymphomas and related disorders) before 18 years old and subsequently developed HF compared to those who did not. Methods: Linked health data (1996-2009) from the Queensland Cancer Registry, Death Registry and Hospital Administration records for HF and chemotherapy admissions were reviewed. From all breast and hematological cancers patients (n=73,158), 15,987 received chemotherapy, including 819 patients aged ≤18 years at time of cancer diagnosis. Patients were categorized as those with an index HF admission (occurred after cancer diagnosis) and those without an index HF admission (non HF). Results: Of the 819 patients, 3.7% (n=30) had an index HF admission. Median age of HF patients at time of cancer diagnosis was 5 years (IQR 3-12) compared to 7 years (IQR 3-14) in the non HF group (p=0.503). Median follow up from cancer diagnosis was 2.5 years in the HF group compared to 5.42 years in the non HF group (p<0.01). Of those who developed HF, 70% (n=21) had the index admission within 12 months of their cancer diagnosis. Of those with HF, 53.3% (n=16) died (all cause) compared to 14.6% (n=115) with no HF. On adjustment for age, sex and chemotherapy admissions, HF patients had an almost 5 fold increased mortality risk compared to non HF patients (HR 4.91 [95% CI, 2.88-8.36]) Conclusions: This study demonstrated that in children with hematological cancers the onset of HF occurred soon after chemotherapy and mortality risk is almost 5 times that of children who do not develop HF. Innovative strategies are still needed for the prevention and management of cardiotoxicity in this populatio

Challenges of diabetes prevention in the real world : results and lessons from the Melbourne diabetes prevention study

OBJECTIVE: To assess effectiveness and implementability of the public health programme Life! Taking action on diabetes in Australian people at risk of developing type 2 diabetes. RESEARCH DESIGN AND METHODS: Melbourne Diabetes Prevention Study (MDPS) was a unique study assessing effectiveness of Life! that used a randomized controlled trial design. Intervention participants with AUSDRISK score &ge;15 received 1 individual and 5 structured 90 min group sessions. Controls received usual care. Outcome measures were obtained for all participants at baseline and 12 months and, additionally, for intervention participants at 3 months. Per protocol set (PPS) and intention to treat (ITT) analyses were performed. RESULTS: PPS analyses were considered more informative from our study. In PPS analyses, intervention participants significantly improved in weight (-1.13 kg, p=0.016), waist circumference (-1.35 cm, p=0.044), systolic (-5.2 mm Hg, p=0.028) and diastolic blood pressure (-3.2 mm Hg, p=0.030) compared with controls. Based on observed weight change, estimated risk of developing diabetes reduced by 9.6% in the intervention and increased by 3.3% in control participants. Absolute 5-year cardiovascular disease (CVD) risk reduced significantly for intervention participants by 0.97 percentage points from 9.35% (10.4% relative risk reduction). In control participants, the risk increased by 0.11 percentage points (1.3% relative risk increase). The net effect for the change in CVD risk was -1.08 percentage points of absolute risk (p=0.013). CONCLUSIONS: MDPS effectively reduced the risk of diabetes and CVD, but the intervention effect on weight and waist reduction was modest due to the challenges in recruiting high-risk individuals and the abbreviated intervention