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‘Every Touch Point Is an Opportunity’: Tobacco Control Experts' Views on How to Implement Smoking Cessation Interventions Within an Australian Lung Cancer Screening Program
No full textBackground: Targeted lung cancer screening (LCS) presents unique opportunities for smoking cessation among high-risk individuals. Implementation requires consideration of context-specific determinants. We sought perspectives from tobacco control/smoking cessation experts on optimally implementing smoking cessation interventions in an Australian LCS program. Methods: Recruitment was via maximum variation and snowball sampling in 2022. Individual/pair interviews explored factors that may influence acceptability and feasibility, potential delivery models, and implementation strategies. We interpreted interview data using codebook thematic analysis, then mapped key topics against the Consolidated Framework for Implementation Research and previous LCS expert-identified determinants. Results: Expert participants' (N = 30) roles included program/policy managers, researchers and clinicians, working in academia, not-for-profits/peak bodies and health departments. They emphasised the benefits of integrating smoking cessation interventions into routine LCS encounters. Key barriers included perceived professional and LCS participant reluctance, stigma, and rural access. Experts discouraged duplicating current cessation resources, and suggested prioritising implementation efforts. Flexible delivery models, addressing needs of priority populations (e.g., rural/remote, culturally and linguistically diverse), were recommended. Experts generally favoured a ‘hybrid’ intervention pathway, combining internal and external cessation services, to maximise feasibility and uptake. Training program staff on cessation intervention delivery and leadership buy-in were emphasised as essential requirements. Discussion: In this Australian tobacco control expert sample, there was near-unanimous support for embedding cessation interventions within routine LCS delivery and capitalising on opportunities to overcome current service delivery barriers. In conjunction with LCS participant perspectives, findings are relevant to planning and implementing cessation interventions in LCS contexts
The Prevalence and Pathways of People with Mental Illness in New South Wales Prisons
No full textThe prevalence of mental illness among prisoners worldwide is high. Although prison has been argued to present an opportunity to provide treatment and rehabilitation to an underserved population, it is evident that this potential remains unrealised. Instead, prison is often associated with poor outcomes in both health and criminal justice domains, particularly for those with a serious mental illness. This research examines the prevalence of mental illness in New South Wales (NSW) prisons and the associated health and justice outcomes in the post-release period, drawing on findings from four studies.
Despite widespread recognition of the high burden of mental illness in correctional settings, few studies have explored changes in prevalence over time within a single jurisdiction. The first study addresses this gap by examining the prevalence rates of mental illness over time using data from three large cross-sectional inmate health surveys conducted in NSW prisons. Trends over time in the prevalence of mental illness, along with associated factors such as substance use and suicidal/self-harm behaviours, are presented and compared with published community prevalence rates. The findings demonstrate a significant increase in the prevalence of self-reported mental illness over a 15 year period (2001 to 2015) in NSW prisons, with a particularly sharp rise observed among women in custody.
Given this rising trend, it is imperative to explore the potential drivers of the persistently high rates of mental illness in the prison population. One contributing factor is the higher and faster rate of return to prison amongst those with a mental illness, which can be posited to result from inadequate continuity of mental health care between prison and the community. This thesis addresses this issue in the subsequent three studies, which explore the provision of mental health services within NSW prisons, the utilisation of public health services following release, and the state of continuity between the two systems.
The second study examines a sample of men and women recruited at time of reception into prison, and tracks their health service utilisation and criminal justice outcomes in the twelve months following release. It reports on outpatient mental health contact, emergency and inpatient health service use as well as reoffending outcomes, and presents comparisons by gender, Aboriginal and Torres Strait Islander background, and presence of serious mental illness. Overall, post-release health service use and reincarceration rates were high, especially among those with a serious mental illness. Rates of emergency service contact was particularly high and found to be associated with increased risk of reoffending.
The third and fourth studies focus in on a specific subgroup of individuals with mental illness who cycle rapidly and repeatedly between prison and the community, a group often overlooked in research and service delivery. The third study examines the characteristics of this ‘revolving door’ group and the level of mental health service provision they receive both in prison and in the early post-release period. While the majority of the sample had some contact with prison mental health services, evidence for discharge planning to facilitate continuity of mental health care was largely absent. This was reflected in low rates of engagement with community mental health services and high rates of reincarceration within three months of release.
The final study examines the twelve-month post-release health and criminal justice outcomes of this same ‘revolving door’ sample. Again, high rates of emergency health service use and reoffending were observed, but no significant association was found between any type of health service use and reoffending outcomes.
Overall, this research provides additional evidence of the growing burden of mental illness in NSW prisons and the disproportionate challenges and negative outcomes experienced by those with mental illness both in prison and following release. The findings highlight the barriers to continuity of mental health care between under-resourced prison mental health and community mental health services, which contribute to a cycle of disadvantage and recidivism which places increasing strain on correctional and public health systems, and emergency health services in particular.
It is proposed that a two-fold approach must be taken to the increasing problem of mental illness in prison. Firstly, preventative strategies such as diversion programs and increased investment in community mental health services and supports must be prioritised to reduce the incarceration rates of individuals with mental illness. Secondly, where incarceration is unavoidable, prison health services must make full use of the valuable opportunity to provide meaningful rehabilitation, treatment and support for community reintegration for those in prison with a mental illness. Reform and coordination across multiple systems is required to improve health outcomes, reduce recidivism and reduce the burden on correctional and health care systems
Spatial Constraints and User Adaptation: A Mixed-Methods Study of High-Density Students Dormitories
No full textThis study employs a mixed-methods approach to investigate the current use and evolving needs of dormitory environments through a cross-analysis of existing research and user experience. A two-phased PRISMA-guided systematic literature review for both global and China-based content was conducted, which was then linked to an examination of eight high-density dormitory spaces in Shanghai. The case studies were analyzed using qualitative content analysis methods, incorporating both spatial analysis and netnography to provide a comprehensive understanding of dormitory use. The cross-analysis highlights a persistent design–use gap: efficiency-driven layouts underdeliver on privacy and comfort, prompting compensatory user modifications. Findings also reveal that most rooms fell below suggested standards; circulation was mainly limited to a single central aisle with no entrance buffer, constraining flexibility and privacy. Students responded to these limitations with small-scale personalization, such as bed curtains, mattress toppers, chair swaps, lighting, and storage hacks, to mitigate acoustic/visual exposure and comfort deficits. With the rising demand for dormitories and based on these insights, we identified three critical dimensions for future dormitory design: privacy, equity, and personalization. These findings underscore that current designs fail to fully satisfy even basic functional requirements, making it essential to develop strategies that respond to evolving needs and integrate considerations of well-being, comfort, and user autonomy
Substance Use and Sex Index version 2 (SUSI-2): Validation of a brief questionnaire for the measurement of behaviours associated with transmission of blood borne viruses and sexually transmitted infections
No full textAims: This study sought to validate a community-acceptable Substance Use & Sex Index (SUSI) for use in substance use intervention research. SUSI aims to measure behaviours associated with the transmission of blood-borne viruses (BBV) and sexually transmitted infections (STI) among people who use substances and incorporate contemporary sexual and drug practices. Design: Validation of a self-administered online behavioural questionnaire. Setting and Participants: An Australian anonymous online questionnaire advertised through health services and social media resulted in 289 respondents with a mean age 35 years (standard deviation [SD] 10.9 years). Measurements: A 26-item scale assessing BBV- and STI-associated behaviours based on previous piloting and expert review was assessed for scale structure using exploratory and confirmatory factor analytic approaches. Item Response Theory (IRT) analyses were applied in decisions to retain and categorise items. Item weightings were defined following expert consensus informed by local BBV, STI and HIV epidemiological profiles. Test–retest reliability was examined on a subsample (n = 98) over three to five days. Criterion validity of the new SUSI-2 scale was examined in comparison to the HIV Risk-taking Behaviour subscale of the Opiate Treatment Index (OTI-HRBS). Findings: Factor analysis identified a two-factor model (“sex”; “drugs with sex”), with moderate magnitude correlation (r = 0.38; 95% confidence interval [CI] 0.19–0.54) between factors and acceptable model fit (p = 0.061). IRT discrimination was statistically significant for all items (p < 0.05). Kappa values for test–retest reliability (n = 98 subsample) ranged from 0.66 to 1.00 with high agreement (all above 87%). Free text responses indicated the questionnaire items were acceptable to respondents, with minimal suggestion for improvements. There was a statistically significant positive correlation between the SUSI-2 and OTI-HRBS sex subscales (weighted r = 0.63, p < 0.001) and between the SUSI-2 sex with drugs and OTI-HRBS drug subscale (weighted r = 0.21, p < 0.01). Four additional items were retained to reflect local other BBV and STI transmission risk. Conclusions: The Substance Use & Sex Index 2 (SUSI-2) appears to be a valid and acceptable two-factor brief scale for the measurement of behaviours associated with blood-borne viruses and sexually transmitted infections for use in substance use interventional research
Investigating the influence of alternating arms for sequential COVID-19 mRNA vaccine doses on systemic and human lymph node immune responses
No full textMechanisms to ensure maximal effective vaccine-induced immune responses are critical for successful public health strategies to outbreaks and pandemics. Efforts to optimise immunisation strategies led to the question of whether alternating arms for a two-dose vaccine regime enhances vaccine efficacy.
To address this, the COVID-19 Vaccination Immune Response (COVAXIR) study enrolled 30 SARS-CoV-2-naïve participants who received the second Pfizer BioNTech (BNT162b2) mRNA vaccine in either the same arm (SA n=20) or opposite arm (OA n=10) to the primary dose. Bilateral fine needle biopsies (FNBs) of axillary lymph nodes (LN) directly probed the B and T cell populations of 18 participants at 5-7 days after the second dose (PV2), focusing on this critical vaccine immune response at the site of its generation. As a correlate of protection, serum neutralising antibodies (NAbs) were assessed at four study timepoints: pre-second dose, 5-7 days, 4 weeks and 4-6 months PV2.
At 5-7 days PV2, SA participants exhibited significantly higher NAbs to the Ancestral, Delta, Omicron-BA.1, -BA.2 and -BA.5 SARS-CoV-2 variants. Immunophenotyping of the FNB samples revealed significantly higher Plasmablasts and T follicular helper (Tfh) cells in the SA draining (d)LNs compared to both OA LNs, and significantly higher proportions of germinal centre (GC) B cells in the SA dLN compared to the OA dLN. Single-cell RNA-sequencing of six LN FNB samples (SA:3, OA:3) at 5-7 days PV2 was used to characterise the B and T cell subsets within the GCs. Differential gene expression analysis between the dLNs indicated activation and maturation of GC B cells, Plasmablasts and Tfh cells in the SA participants. Analysis of the B cell receptors (BCRs) demonstrated more expanded B cell clones that mapped to previously reported SARS- CoV-2-specific BCRs in the SA dLN when compared to the OA dLN, however the OA ndLN contained more expanded B cell clones that mapped to previously reported SARS-CoV-2-specific BCRs than the SA dLN, suggesting a persistent primary dose within that LN. Computational analysis of the T:B cell-cell communication predicted to be occurring within the GCs revealed a more actively engaged immune response within the SA dLN compared to the OA dLN.
Collectively, these findings suggest a more robust early response to the vaccine booster in the SA participants. By analysing early humoral responses and cellular dynamics at the site of immune generation, this thesis provides insight into how simple changes to vaccine administration protocols may enhance the rapid production of protective immunity, offering practical relevance for multi-dose vaccine strategies and future pandemic preparedness, when accelerated protection may be key to success
Empowering Context-Aware Applications with AI-Driven Vision-Based Multimodal Interfaces
No full textContext-awareness play a vital role in the field of Human-Computer Interaction (HCI) by enabling machines to adapt to dynamic environments and respond effectively to user needs, envisioning a future where humans and intelligent systems are closely coupled. Among various modalities in the system information, visual data holds particular importance due to its richness and ability to convey detailed contextual cues, making Vision-based Interfaces (VIs) a cornerstone in the field of advanced intelligent systems. However, the increasing complexity of modern applications, driven by emerging technologies like Artificial Intelligence (AI), necessitates interfaces capable of integrating multiple modalities. Vision-based Multimodal Interfaces (VMIs) address this need by extending the capabilities of VIs, enabling more accurate interpretation of high-level user intentions and complex physical and digital environments. My research focuses on advancing VMIs to develop novel context-aware applications that improve interaction quality and bridge the gap between humans and intelligent systems, fostering seamless, efficient, and accessible integration.
To accomplish this goal, from a data perspective, I initially conducted a comprehensive literature review on VMIs that identified three applications corresponding to the visual dimensions of scale, space, and time, which could be beneficial for context-aware enhancements. My first application involved developing a technique for detecting surface materials and object types using microscopic images, essential for analyzing the physical environment at a microscopic scale. In my second application, I utilized depth images to enhance the accuracy of real-world detection and representation, thus improving the workflow of projection creation. My third application involved designing a framework to detect background video in a Virtual Reality (VR) environment, transforming this information into somatosensory electrical signals to provide tactile feedback and augment user immersion. Drawing from these findings, I propose design considerations that will empower context awareness and benefit practitioners in the field.
My thesis contributions include:
1. An extensive literature review through a data-driven lens, offering new classifications of VMIs for enhancing context awareness.
2. A contact sensing technology utilizing a visual modality (microscope image) and motion modality (IMU data) to detect surface materials and object types.
3. A content-creation tool combining visual modality (depth image) and textual modality (prompt), leveraging a depth camera and contrastive learning to strengthen physical environment perception and understanding of input prompts in stage performance projection scenario.
4. A haptic rendering framework integrating visual modality (video) and auditory modality (audio), converting the background elements of VR video like particle motion and explosion sounds into somatosensory-based haptic feedback, thereby advancing user immersion.
5. A set of system design considerations for VMIs, providing practical insights and actionable suggestions to develop or improve various context-aware applications
Too Much of a Good Thing? The Impact of Organizational Citizenship Behaviors on Emotional Exhaustion and Next-Day Work Engagement
No full textWhile firms encourage their employees to engage in organizational citizenship behavior toward others (OCBI), there can be negative consequences when employees go too far and become exhausted. Little research has looked at how OCBI can lead to emotional exhaustion and how that carries over to next-day work engagement. Using conservation of resources and self-determination theories, a model was tested to examine the double-edged effect of daily OCBI on employees’ end day emotional exhaustion and their next-day work engagement. Using multi-source data collected across five consecutive workdays from 153 employees and 40 managers working in 20 bank branches in Vietnam, results of multilevel structured equation model (MSEM) suggests that daily OCBI has a U-shaped association with daily emotional exhaustion. When OCBI levels are low and moderate, engaging in OCBI helps reduce emotional exhaustion; however, when the level of OCBI exceeds the useful resources achieved, it increases emotional exhaustion. Additionally, while organization identification helps to mitigate, employee autonomy intensifies the negative impact of previous-day emotional exhaustion on next-day work engagement. This study provides managers with strategies to tackle the lagged effect of end-work emotional exhaustion so that they can provide a supportive next-day work environment
A holistic adaptive ageing framework (HAAF) to address complex challenges in ageing
No full textMany of the challenges facing ageing societies involve an interaction of factors from many domains and levels, including person-level age-related changes in function through to the physical environment, economy, urban design and social policies. The pace of change in our societies is accelerated by climate change and the rapid introduction of artificial intelligence and other technologies. When presented with practical challenges or problems to solve that are inherently due to an ageing society, it is not possible for any individual to have the expertise and capacity to address all the dimensions involved. Therefore, developing a multidisciplinary framework that signals the dimensions of influence that need to be considered in adaptive ageing, may assist in optimizing how complex issues in ageing are tackled. This paper proposes a holistic adaptive ageing framework (HAAF) as a starting point for multidisciplinary and multisectoral approaches to develop optimal solutions to complex problems. The five dimensions of the framework include lived experience, person-level adaptation, environmental context, technology and social and economic policy. Future research is needed to operationalize the framework and evaluate its application to complex problems
Far-Field Electromagnetic Side-Channel Analysis in Noisy Environments
No full textSide-Channel Analysis (SCA) exploits unintentional information leakage from electronic
devices, like power consumption or Electromagnetic (EM) emissions. This leakage acts as
a double-edged sword: while it threatens systems by enabling adversaries to recover secret
information, it also offers opportunities to observe anomalies, attribute malicious activity,
and reconstruct incident timelines for deeper system understanding. EM emissions are
one of the most significant and widely studied side-channel types. Electromagnetic Side-
Channel Analysis (EM-SCA) can be classified into near-field, where probes are placed very
close to the device, and far-field, where emissions are captured from distances of centimeters
to meters. Far-field techniques reflect more realistic and scalable adversarial scenarios,
making them an increasingly important research direction. This thesis first examines the
diverse applications of EM-SCA in both benign and adversarial contexts before narrowing
its focus to far-field EM-SCA for extracting cryptographic keys. Current approaches in
this area often rely on high-gain parabolic antennas to acquire high-quality EM signals in
noisy environments. Although effective, such antennas are large and non-portable, limiting
their practicality for realistic attack scenarios. This motivated the present thesis
to develop a robust framework for mitigating environmental noise and signal attenuation,
thereby enabling the effective use of simpler and more compact antennas. In particular, an
advanced signal pre-processing technique is proposed to accurately detect encryption operations
within continuous signals. Furthermore, a Transformer denoising module is developed
to transform noisy signals into cleaner representations, thereby improving the quality
of EM measurements. In addition, a Convolutional Neural Network (CNN) classifier is
employed for cryptographic key extraction, trained with a transfer-learning approach to
improve reliability. The experimental results showed that the proposed framework, when
combined with a simple antenna setup, achieved superior performance compared to the
baseline methods by accurately locating the trace segment corresponding to the encryption
process and improving the attack performance. These findings highlight the growing
threat posed by EM-SCA in real-world environments and emphasise the importance of
incorporating robust countermeasures into cryptographic systems