This thesis identifies some problems, the genetic algorithm (GA) is facing in the area of vehicle routing and proposes various methods to address those problems. Those problems arise from the unavailability of suitable chromosomal representation and evaluation schemes of GA for the Vehicle Routing Problem (VRP). The representation and evaluation schemes already in use have problems of high computational cost, illegal chromosomes (chromosomes not representing a legal tour) and wrong fitness assignment (fitness not truly representing chromosome genetic makeup). These problems are addressed by several proposed new schemes, namely the Self Imposed Constraints Evaluation scheme, the Contour and Reverse Contour Evaluation schemes and the Order Skipping Evaluation scheme, which are specifically tailored for various objectives, problems and situations. Apart from this, a methodology, which has previously being used in other meta-heuristics, is incorporated into GA i.e., the independent application of GA on various sub-localities of the problem. We call this GA, a Localized Genetic Algorithm (LGA). LGA is an iterative procedure between optimization and controlled de-optimization. The procedure of controlled de-optimization is also novel. It brings the solution into a new search space while controlling its cost effectively. LGA is introduced with various search techniques, i.e. intensive, extensive and selective, the use of which depends on the problem size and the availability of computational resources. Furthermore, search reduction techniques (Fitness Approximation Methods) are also introduced into the LGA, which has enabled the LGA to be applied to large scale problems. Due to the implementation of those proposals, LGA is the first GA-driven approach to be applied to very large scale CVRP problems of up to 1200 customers, i.e. datasets presented by Feiyue in 2005 and large scale VRPTW problems of up to 1000 customers, datasets presented by Gehring and Homberger in 1999. Lastly, a standard unit for computational comparison, i.e., Bellman's Evaluation Units BEUs, is also introduced to facilitate computational comparisons for future researchers. LGA has shown promising results on CVRP and VRPTW problems. It is flexible and also has the potential to be extended to not only other vehicle routing problems, but also to other ordering problems.

The efficacy of cognitive-behavioural therapy (CBT) in the treatment of child anxiety disorders has been well established in the literature, with on average, just over 50% of children becoming free of their primary anxiety diagnosis immediately following treatment (James et al., 2008). Despite the existence of these efficacious treatments, up to two thirds of children with anxiety do not receive assistance for their difficulties (Essau et al., 2002). The reasons for this are varied, and include lack of available therapists or services, long waiting lists, high therapy costs and stigma associated with therapy. Computer- and internet-based interventions represent a modern alternative for delivering CBT interventions that may be more appealing and accessible to a greater proportion of children with anxiety. Various forms of computer-assisted therapies have been investigated, including palmtop computers, desktop computers, virtual reality and online programs. Although computerised interventions have demonstrated promise in the treatment of adult anxiety, they have only recently received interest in the child literature. Specifically, there are very few controlled trials evaluating the efficacy of computer- and internet-based interventions for childhood psychological disorders, including anxiety disorders. The present research involved the initial development and subsequent testing of an entirely internet-based, CBT intervention for child anxiety disorders. BRAVE-ONLINE was developed as an internet adaptation of The BRAVE Program, a clinic-based program which has demonstrated efficacy in the treatment of childhood anxiety. The online intervention is a therapist-mediated program, in which children and parents receive email and telephone assistance from a therapist throughout treatment. BRAVE-ONLINE is an interactive program consisting of 10 child and 6 parent sessions to be completed by families in their own home. Following the development of BRAVE–ONLINE, the first study of this thesis included a randomised control trial to investigate the efficacy of the internet-based intervention (NET) compared to a waitlist control (WL). Seventy-three children aged between 7 and 12 years, diagnosed with separation anxiety disorder, social phobia, generalised anxiety disorder or specific phobia were randomly allocated to NET and WL conditions. Treatment effects were evaluated at 10-14 weeks post-assessment and 6-month follow-up, using multiple outcome measures including a diagnostic interview, clinician ratings of severity, parent and child questionnaires. Results indicated that at post-assessment, 30% of NET participants in the completer sample (22.5% in the Intent-to-Treat (ITT) sample) no longer met criteria for their primary anxiety diagnosis, compared to 10% of WL participants. Significant gains were also evident for clinician severity ratings, global assessments of functioning, and several questionnaire measures. However, results also indicated that children and parents were slow to progress through therapy, such that a large proportion of families had not completed all treatment sessions at the post-assessment point. For this reason, 6-month follow-up may present a better indication of treatment efficacy. Indeed, at 6-month follow-up, treatment gains were improved upon such that 75% of children in the completer sample (52.5% in the ITT sample) no longer met criteria for their primary anxiety disorder. Reductions in severity ratings, global assessments of functioning and child and parent self-report measures were also improved upon at 6-month follow-up. Further, the online intervention was found to be highly acceptable to families and was associated with only minimal rates of attrition. The second study of this thesis aimed to explore factors associated with treatment outcome for the online intervention. Factors of interest included demographic factors (age, gender, income and educational background), treatment expectancy, initial symptom severity, program compliance and pre-treatment diagnostic comorbidity. Specifically, this study investigated the extent to which each of these factors predicted the improvement made by children on global assessments of functioning (CGAS) at 6-month follow-up. Results indicated that only some of these factors were directly associated with treatment outcome. Although treatment expectancy predicted compliance with the program, it was not associated with treatment outcome. Baseline severity also did not predict treatment outcome. Contrary to expectation, levels of program compliance by children negatively predicted outcome, such that children who were more compliant with the program showed fewer improvements in overall functioning. Parent compliance did not predict treatment outcome. A significant relationship was evident between diagnostic comorbidity (number of pre-treatment anxiety diagnoses) and treatment outcome, such that higher baseline comorbidity predicted poorer functioning on the CGAS at 6-month follow-up. None of the demographic factors were associated with treatment outcome. Overall, the findings of this research suggest that a CBT intervention delivered entirely over the internet was associated with reductions in indicators of anxiety at post-assessment, compared to a WL control, particularly for the completer sample. Further, these reductions were improved upon at 6-month follow-up, with a substantial proportion of children becoming free of their primary anxiety diagnosis. The results also indicated that the online intervention might not be as effective for children suffering from multiple anxiety disorders. The effects of program compliance were somewhat surprising and possible explanations are offered. Although these results are promising, conclusions should be regarded as tentative until further trials are conducted and the online intervention is compared with clinic-based treatments. Limitations of this research and areas for future research are discussed.

This thesis uses the International Classification of Functioning, Disability and Health (ICF) model (World Health Organisation, 2001) to explore the multidimensional presentation of strengths and problems in young people with cystic fibrosis (CF), firstly examining its theoretical “fit” to the health condition, and secondly using it to characterise the performance of those with CF. Few studies in the literature demonstrate such an holistic approach to the physiotherapy assessment and management of this population. It was expected that this description of performance would provide a framework for identifying key areas for physiotherapy exercise intervention. This then formed the basis for further studies to examine the effect of a targeted exercise program (compared to current exercise practice) on inpatient outcomes, as well as on outcomes of outpatient management. The position paper included provides theoretical support for the ICF model as an appropriate tool in the management of young people with CF. Building on this, Study 1 explored the practical utility of the ICF model for describing the presentation of young inpatients and outpatients with CF. Eighty-four participants with CF were recruited as a consecutive series who satisfied selection criteria to provide a cross-sectional view at younger (7-12 years, n=51) and older (13-17 years, n=33) ages. Musculoskeletal, respiratory and physiological measures represented the body structures and functions domain, the six-minute walk test and jump tests were included in the activities domain, and participation was described by the Cystic Fibrosis Questionnaire–Revised Version and Fels Physical Activity Questionnaire. Contextual factors were also considered (age, gender, inpatient/outpatient status). In this exploratory study, performance of this population was compared to normative data where available. Also, correlations between measures within and between ICF domains were examined as suggested by the model itself. Finally, effects of contextual factors on performance were investigated using univariate analysis of variance. This first study and the position paper support the ICF model as an effective tool for describing performance of young people with CF, and for investigating functional relationships within and between domains. Results showed significant differences in this population compared to normative data, and interrelationships were identified within and between ICF domains. Between inpatients and outpatients in the specified age groups, there was a statistically significant difference in means for a number of measures, whereby inpatients displayed consistently poorer mean scores than outpatients, with this effect significantly stronger in the older age group. The application of the ICF model was useful for highlighting areas to target in physiotherapy exercise intervention, and for substantiating selected measures to assess the program’s effectiveness across domains. Study 2 was a randomised controlled trial with blinded assessor, which investigated the effectiveness of a 10-14 day inpatient-based exercise program (the Cystic Fibrosis: Fitness Challenge) (CF:FC) tailored for young people with CF (7-17 years). The CF:FC program (n=15) included exercise strategies based on recommendations from previous work in the field, and from findings from Study 1. This program included a portable exercise package (FitKitTM) designed to be adaptable to limited space environments such as at the hospital bedside, important when inpatients with CF are isolated according to infection control procedures. Participants in the control program (n=16) received the current exercise practice provided for young people with CF at a tertiary hospital, which included mainly aerobic-type activities to affect airway clearance. Performance on study measures (scoped within the framework of the ICF model, presented in Study 1) were compared pre- and post-intervention (admission and completion of the inpatient exercise program) between the groups. This trial showed significant improvements for participants in both groups from admission to discharge for a range of measures, including respiratory function, muscle strength and quality of life measures. Participants in the intervention group showed significantly greater improvements for some measures, for example: ankle dorsiflexor strength, six-minute walk distance and perception of their respiratory status. The continuation of the intervention and control programs into the outpatient setting was the focus of Study 3. The FitKitTM was provided for the intervention group, incorporating strategies to enhance adherence including a physical activity log (PAL) and internet-based follow-up. The control home exercise program consisted of the current practice provided on discharge. Interestingly, the control group improved significantly in hip abductor strength and six-minute walk distance during the outpatient period, whereas the intervention group sustained the improvements gained in the inpatient period but generally showed no further significant improvement. When the change from inpatient admission to outpatient follow-up was considered, it was apparent that greater improvements during the inpatient period provided a ‘buffer’ to accommodate for possible deteriorations in function in the outpatient phase. Issues regarding adherence to exercise programs during the outpatient period are discussed. This thesis confirms the usefulness of the ICF model for describing young people with CF, guiding assessment and review processes to achieve comprehensive management, and strengthening the evidence-base for targeted physiotherapy exercise intervention. A novel, tailored exercise program is introduced which is effective during inpatient periods, and provides a maintenance effect during outpatient periods, but strategies to enhance adherence during outpatient periods require further investigation.

Introduction: Embolic agents are used to block blood flow of hypervascular tumours, ultimately resulting in target tissue necrosis. However, this therapy is limited by the formation of new blood vessels within the tumour, a process known as angiogenesis. Targeting angiogenesis led to the discovery of anti-angiogenic factors, large molecular weight proteins that can block the angiogenic process. The aim of this research is development of poly (vinyl alcohol) (PVA) aqueous solutions that cross-link in situ to form a hydrogel that functions as an embolic agent for delivery of macromolecular drugs. Methods: PVA (14 kDa, 83% hydrolysed), functionalised by 7 acrylamide groups per chain, was used to prepare 10, 15, and 20wt% non-degradable hydrogels, cured by UV or redox initiation. Structural properties were characterised and the release of FITCDextran (20kDa) was quantified. Degradable networks were then prepared by attaching to PVA (83% and 98 % hydrolysed) ester linkages with an acrylate end group. The effect on degradation profiles was assessed by varying parameters such as macromer concentration, cross-linking density, polymer backbone and curing method. To further enhance the technology, radiopaque degradable PVA was synthesised, and degradation profiles were determined. Cell growth inhibition of modified PVA and degradable products were also investigated. Results: Redox initiation resulted in non-degradable PVA networks of well-controlled structural properties. Increasing the solid content from 10 to 20wt% prolonged the release time from few hours to ~ 2 days but had no effect on the percent release, with only a maximum release of 65% achieved. Ester attachment to the PVA allowed flexibility in designing networks of variable swelling behaviors and degradation times allowing ease of tailoring for specific clinical requirements. Synthesis of radiopaque degradable PVA hydrogels was successful without affecting the polymer solubility in water or its ability to polymerize by redox. This suggested that this novel hydrogel is a potential liquid embolic with enhanced X-ray visibility. Degradable products had negligible cytotoxicity. Conclusion: Novel non-degradable and radiopaque degradable PVA hydrogels cured by redox initiation were developed in this research. The developed PVA hydrogels showed characteristics in vitro that are desirable for the in vivo application as release systems for anti-angiogenic factors.

Introduction: Embolic agents are used to block blood flow of hypervascular tumours, ultimately resulting in target tissue necrosis. However, this therapy is limited by the formation of new blood vessels within the tumour, a process known as angiogenesis. Targeting angiogenesis led to the discovery of anti-angiogenic factors, large molecular weight proteins that can block the angiogenic process. The aim of this research is development of poly (vinyl alcohol) (PVA) aqueous solutions that cross-link in situ to form a hydrogel that functions as an embolic agent for delivery of macromolecular drugs. Methods: PVA (14 kDa, 83% hydrolysed), functionalised by 7 acrylamide groups per chain, was used to prepare 10, 15, and 20wt% non-degradable hydrogels, cured by UV or redox initiation. Structural properties were characterised and the release of FITCDextran (20kDa) was quantified. Degradable networks were then prepared by attaching to PVA (83% and 98 % hydrolysed) ester linkages with an acrylate end group. The effect on degradation profiles was assessed by varying parameters such as macromer concentration, cross-linking density, polymer backbone and curing method. To further enhance the technology, radiopaque degradable PVA was synthesised, and degradation profiles were determined. Cell growth inhibition of modified PVA and degradable products were also investigated. Results: Redox initiation resulted in non-degradable PVA networks of well-controlled structural properties. Increasing the solid content from 10 to 20wt% prolonged the release time from few hours to ~ 2 days but had no effect on the percent release, with only a maximum release of 65% achieved. Ester attachment to the PVA allowed flexibility in designing networks of variable swelling behaviors and degradation times allowing ease of tailoring for specific clinical requirements. Synthesis of radiopaque degradable PVA hydrogels was successful without affecting the polymer solubility in water or its ability to polymerize by redox. This suggested that this novel hydrogel is a potential liquid embolic with enhanced X-ray visibility. Degradable products had negligible cytotoxicity. Conclusion: Novel non-degradable and radiopaque degradable PVA hydrogels cured by redox initiation were developed in this research. The developed PVA hydrogels showed characteristics in vitro that are desirable for the in vivo application as release systems for anti-angiogenic factors.

Stress management interventions (SMIs) are increasingly used by organisations across both private and public settings. Such interventions are employed with the expectation that they will be effective in reducing levels of stress in participants and in turn, will provide a return to the organisation by way of increased productivity through performance improvements of those employees whose stress has been reduced. Despite the increasing popularity of SMIs, there exists a lack of evidence on whether they have any effect on the performance of users, and on the relative effectiveness of the components that often make up SMIs. Although the literature addressing SMIs and their effects is increasing, relatively few studies directly compare different techniques, and even fewer employ randomised controlled designs or follow-up measures. The assumed relationship between the reduction of stress and improvement of managerial performance does not appear to have been tested with a randomised controlled trial. The term “stress” as used in this study specifically denotes the concept of “distress” as defined by Selye (1956; 1987). To support this use of the term, the evolution of current terminology in the field of occupational stress is briefly discussed with specific reference to the development and influence in the wider literature of the Yerkes Dodson Law (Yerkes, 1909). The aims of this thesis were to (1) compare the relative effectiveness of two component techniques often used in SMIs (somatic and cognitive techniques) in the reduction of stress, and (2) to examine the effect of the use of these techniques on the performance of managers in their workplace. Study One was a randomised controlled trial assessing the effect of the use of somatic and cognitive stress management interventions on stress and performance in managers. Participants were 112 corporate managers who were randomly assigned to one of two intervention groups (somatic or cognitive technique training) or to a wait list control group. The intervention groups were trained in their respective techniques over a 4 week period in brief (20-30 minute) face-to-face workshop sessions. Participants were provided with recordings of the techniques to assist practice between training sessions. At baseline, stress was assessed using the Occupational Stress Inventory – Revised Edition (OSI-R, Osipow, 1998), and managerial performance was assessed with the Personal Qualities Competency from the Inventory of Management Competencies (IMC, Saville Holdsworth Ltd., 1993). In the case of the IMC, self, colleague, and subordinate assessments were used. On completion of the 4 week intervention, the OSI-R was readministered, and then at week 12 and week 24, follow-up assessments of stress and managerial performance took place. At the week 12 follow-up, MANOVA for the OSI-R showed no significant difference between the somatic and cognitive interventions in their effect on stress, although both interventions did reduce stress relative to the wait list control group, as measured by the OSI-R. A significant intervention effect was also shown (ηp2 = 0.089, p = 0.002) for the combined intervention groups (cognitive and somatic). MANOVA for the Personal Qualities Competency showed a significant intervention effect for the self (ηp2 = 0.077, p = 0.008) and colleague (ηp2 = 0.064, p = 0.013) assessments, and a no significant effect (ηp2 = 0.032, p = 0.063) for the subordinate assessment at the week 12 follow-up point. Unfortunately, withdrawal and attrition reduced the sample size below that required for analysis at the week 24 follow-up point. Study Two was designed as a follow-up qualitative study that aimed to gather information on participants’ perceptions of the effects of the interventions on their stress and performance, and of their reasons for completion or no completion of the SMI. In this study, 14 participants from Study One took part in semi-structured interviews after the final follow-up assessment (week 24) for that study. The interviews were structured to elicit responses concerning participants’ perceptions of the demands of their workplace and their stress, their experience of using the stress management techniques (including perceived benefits or behavioural changes from that use), their reasons for completion or no completion of the intervention, and their own definitions of stress. Several important findings emerged from this study. First, participants described their workplace as characterised by high pressure and demand with rapid change and a perceived lack of personal control. Second, participants who continued to use the techniques they had learned after the formal intervention was completed did so because they perceived personal benefits in terms of their ability to relax and in terms of their perceptions of workload and demand. For those who did not complete the intervention, the predominant reasons reported for no completion were workplace task demands, lack of top management commitment to an intervention of this nature, and lack of personal gain once the techniques had been learned. In relation to defining stress, participants did not have agreement, but rather reported definitions reflecting a multifaceted complex amalgam of physiological, psychological, and emotional aspects. Research such as this is important in terms of its contribution to the general field of occupational stress and its alleviation. It addresses a long-standing need to assess the relative effectiveness of some of the subcomponents commonly employed as part of more complex multifaceted approaches to SMIs, and the effect of the techniques on both stress and performance. This thesis makes several contributions to existing knowledge. First, this thesis clarifies the origin of the Yerkes Dodson Law and its relevance to current stress management thinking. In management texts distress has come to be regarded as too much stress or pressure. This is coupled with the idea that some stress has a positive impact on performance due to an earlier and erroneous interpretation of the Yerkes Dodson Law. Second, Study One provides evidence of the relative effectiveness of two different SMI components in the reduction of individuals’ occupational stress, as well as evidence for the effectiveness of individual focussed SMIs in the reduction of stress in corporate managers. Third, Study One provides evidence for a positive effect on managers’ performance consequent to their use of stress management techniques. This thesis also sheds light on managers’ definitions of stress, and their reasons for completion or no completion of SMIs. In summary, individual focussed (or secondary) SMIs have the potential to reduce stress and to improve performance in corporate managers as perceived by both the individual and others in the workplace.

The increased work of breathing associated with intense cycling has been identified as a factor that may negatively affect cycling performance. The aerodynamic position, abnormal respiratory mechanics either at rest or during exercise, and the development of a tachypnoeic breathing pattern are factors known to increase the work of breathing. Breathing pattern retraining aims to decrease the work of breathing by delaying the onset of dynamic hyperinflation and the recruitment of accessory breathing muscles. To date no studies have investigated the performance, physiological and perceptual consequences of manipulating breathing pattern in trained cyclists. Purpose: The aim of the present study was to investigate the effect of breathing pattern retraining on 20-km time trial performance and respiratory and metabolic measures in competitive cyclists. Method: Twenty-four competitive male cyclists (age 37.7 ± 8.6 years, mean ± SD; peak 4.34 ± 0.47 L·min-1) were match paired on 20-km time trial performance and assigned at random to either an intervention group (breathing pattern retraining; N = 12) or control group (N = 12). 20-km time trial performance, pulmonary function and the physiological and perceptual response during a maximal incremental cycle step test were assessed pre- and post-intervention. The intervention group underwent four weeks of specific breathing pattern retraining using exercises designed to reduce dynamic hyperinflation and optimise respiratory mechanics. The control group attended the laboratory once a week during this period and performed a 10 minute sub-maximal ride wearing a biofeedback breathing harness. The control group was led to believe the purpose for their participation was to investigate the effect that maximal exercise had on breathing pattern, and to test the reliability of the breathing harness. There was no attempt to modify the breathing pattern of the control group. Data were analysed using an MS Excel spreadsheet designed for statistical analysis. The uncertainty in the effect was expressed as 90% confidence limits and a smallest worthwhile effect of 1.0% was assumed. Results: The intervention group showed substantial improvements in 20-km time trial performance (-1.5 ± 1.1%) and incremental power (3.2 ± 3%). Additionally, breathing frequency (-13.2 ± 8.9%; -9.5 ± 8.4%), tidal volume (10.6 ± 8.5%; 9.4 ± 7.6%), inspiratory time (10.1 ± 8%; 9.4 ± 7.7%), breathing RPE (-30 ± 33.9%; -24.7 ± 28.1%) and leg RPE (-27.9 ± 38.5%; -24.7 ± 28.2%) were all positively affected at lactate threshold and lactate turn point. No positive changes were observed in the control group for 20-km time trial performance (0.0 ± 1.0%), incremental power (-1.4 ± 3.5%), breathing frequency (-1.6 ± 8.0%; -2.0 ± 7.9%), tidal volume (0.9 ± 7.2%; 2.9 ± 9.4%), breathing RPE (16.1 ± 50.2%, 24.8 ± 43%) or leg RPE (13.4 ± 39.6%; 19.9 ± 43.2%) . Conclusion: These results provide evidence of the performance enhancing effect of four weeks of breathing pattern retraining in cyclists. Furthermore, they suggest breathing pattern can be retrained to exhibit a controlled pattern, without a tachypnoeic shift, during high intensity cycling. Additionally, these results indicate breathing pattern retraining attenuates the respiratory and peripheral perceived effort during incremental exercise. Key words: Breathing pattern disorders, retraining, blood stealing, cycling, performance, power output, respiratory mechanics, perceived exertion, 20km-TT

This doctoral portfolio presents two separate but related research study reports on ‘self-care practices of adults with poorly controlled diabetes in Malaysia’. It is comprised of five sections. Section one which is the introduction begins with a general discussion on diabetes mellitus (henceforth referred to as diabetes), a common, growing, serious and costly health problem. The importance of self-care in the management of diabetes and its many disabling long-term complications are emphasised. This is followed by a specific discussion of diabetes in Malaysia - its prevalence, the quality of care, cost and the need for research to uncover new information to improve the care provided to Malaysians with diabetes. Section two is the report on the first research study that investigates the four cornerstones of diabetes self-care practices, namely: dietary intakes, medication adherence, physical activity and self-monitoring of blood glucose in Malaysian adults with poorly controlled diabetes. It also explores the factors that influence these self-care practices. Section three is the report on the second research study that assessed the efficacy of an out-patient diabetes educational program based on a self-efficacy theoretical approach to improve firstly, self-care practices and secondly, clinical outcomes of adults with poorly controlled diabetes in Malaysia. It also identified some of the factors that facilitate or impede such a programme in the Malaysian context. Section four integrates the findings of the two related research studies - the first defining the problem and the second providing possible solutions in the Malaysian context. It points out limited diabetes knowledge on self-care can compromise or create problems regarding self-care practices for Malaysians with poor glycaemic control. It also identifies possible areas of research that can uncover new knowledge that may improve the quality of diabetes care and enhance the quality of life of Malaysian with diabetes. Section five includes publication originating from this work. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1374559 / Thesis (D.Nurs.) -- University of Adelaide, School of Population Health and Clinical Practice, 2009

Background: Physiological studies have shown that many preterm infants and infants with chronic lung disease may suffer chronic hypoxaemia, which possibly leads to poor growth and development. Anecdotal reports indicate that there is a drive to increase the oxygen saturation target range to a higher level in these infants due primarily to perceived benefits derived from clinical experience and from uncontrolled observational studies of babies discharged on home oxygen. Objective The BOOST (Benefits Of Oxygen Saturation Targeting) trial is the first randomised trial to assess the long-term benefits and harms of two different oxygen saturation target ranges. Methods: BOOST was a multicentre, double blinded, randomised controlled trial that enrolled 358 infants born at less than 30 weeks� gestation who remained oxygen-dependent at 32 weeks postmenstrual age. They were randomly assigned to target either a functional oxygen saturation range of 91-94% (standard or control group) or 95-98% (higher or treatment group). The primary outcomes were growth and neurodevelopmental measures at 12 months corrected age. Secondary outcomes included length of hospital stay, retinopathy of prematurity, health service utilisation, parental stress, and infant temperament. Results: Prognostic baseline characteristics did not differ between the two groups. Mean birth weight and gestational age of enrolled infants was 917g and 26.5 weeks respectively. The rate of antenatal corticosteroid use was 83%.

Master of Science / Haematopoietic stem cell transplantation (HSCT) is a complicated and high-risk procedure used to cure disease or stop the spread of disease in a range of cancers. HSCT carries a high incidence of mortality and is associated with distressing short and long-term side effects. In addition, patients remain at risk of recurrence or mortality years after transplantation. Therefore, patients undergoing HSCT have been found to experience significant emotional and psychosocial distress because of the trauma associated with treatment. The literature suggests that about 50% of HSCT patients will experience clinical levels of distress. Carers and family members play an important role in caring for these ill patients in the short and long-term. Major role changes and financial stressors are experienced in many families, adding to the burden of care. However, very little is known about the rates of psychopathology in carers of HSCT patients. Due to the arduous nature of HSCT, psycho-educational programmes have been developed by major transplant centres and hospitals in order to provide HSCT patients and their families with information on the treatment process, side effects, risks, and long-term outcomes. Research on patient education in oncology has shown that providing patients and carers with information about their illness and treatment reduces anxiety and distress. To date, there have been no empirical evaluations to support the use of education programmes for HSCT patients. While it could be assumed that information would be helpful in reducing anxiety and depression in HSCT as it is in oncology generally, the information provided to these patients is usually more confronting and therefore, may be less reassuring. Thus, it is not known whether providing patients with education about HSCT reduces patient and carer distress or whether it might actually increase adverse outcomes. The aim of the present study was to evaluate the rates and correlates of distress in carers and patients and examine the effect of a psychoeducation programme for patients undergoing HSCT and their carers on knowledge, distress, information satisfaction, social support and caregiver burden. A randomised control trial was conducted to provide empirical data in relation to the latter aim. The following hypotheses were proposed. Firstly, it was hypothesised that patients and carers who received the education programme would have higher levels of knowledge, not evidenced in a group waiting to receive the programme. Secondly, it was hypothesised that the education program would not lead to increased anxiety and depressive symptoms. Thirdly, patients who know more about their condition would be the least distressed. As predicted, this study found high levels of distress, particularly in carers. Higher patient distress was related to having more concern about one’s illness and experiencing more symptoms. Education was effective in increasing patient and carer knowledge. Importantly there were no adverse effects of knowledge and greater patient knowledge following the education program was associated with less distress, although there was no direct effect of education on distress. Future research should aim to identify what aspects of the education program are helpful to patients. Finally, support interventions such as CBT are needed to help patients and carers, in particular, cope with the high levels of distress inherent in the HSCT experience.