Clinical efficacy and safety of zoledronic acid in osteoporosis and Paget's disease

Osteoporosis and Paget’s bone disease are the most common diseases of the bone. In addition to glucocorticoid treatment, there are many other secondary causes of osteoporosis. Bisphosphonates are used to treat these bone conditions. Zoledronic acid is the most potent bisphosphonate at inhibiting bone resorption. In osteoporosis, zoledronic acid increases bone mineral density for at least 1 year following a single intravenous administration. The efficacy and safety of zoledronic acid in the treatment of osteoporosis and Paget’s bone disease are reviewed. This article also covers the studies of the effects of zoledronic acid in the bone loss associated with the secondary osteoporosis.

Clinical efficacy and safety of zoledronic acid in prostate and breast cancer

The anti-estrogen treatment for hormone-sensitive breast cancer and the androgen deprivation therapy for prostate cancer can lead to the development of osteoporosis and bone fractures. Metastases associated with prostate and breast cancer can also occur in bone. Bisphosphonates are used in these types of bone dysfunction. Zoledronic acid is the most potent bisphosphonate. In osteoporosis, zoledronic acid inhibits bone reabsorption and increases bone mineral density for at least a year after intravenous administration. The efficacy and safety of zoledronic acid in osteoporosis secondary to hormone-sensitive cancers (prostate and breast), and in the bone metastases associated with these cancers are reviewed.

Good clinical endpoints with denosumab in osteoporosis and cancer

Background: Bone loss associated with low oestrogen levels in postmenopausal women, and with androgen deprivation therapy in men with hormone-sensitive prostate cancer, result in an increased incidence of fractures. Denosumab has been shown to increase bone mineral density in these two conditions. Objectives/methods: The objective of this evaluation is to review the clinical trials that have studied clinical endpoints in these conditions. Results: FREEDOM (Fracture Reduction Evaluation of Denosumab in Osteoporosis Every 6 Months) was an International Phase III clinical trial that measured the clinical endpoints with denosumab in postmenopausal women with osteoporosis. At 36 months, new vertebral fractures had occurred in 7.2% of subjects in the placebo group and this was lowered to 2.3% of subjects treated with denosumab. HALT (Denosumab Hormone Ablation Bone Loss Trial) studied the clinical endpoints in men with non-metastatic prostate cancer receiving androgen-deprivation therapy. The incidence of vertebral fractures was significantly lower in the denosumab group (1.5%) than in the placebo group (3.9%). The incidence of adverse effects with denosumab in both clinical trials was low. Conclusions: Denosumab reduces the incidence of fractures in postmenopausal women with osteoporosis and in men with non-metastatic prostate cancer receiving androgen-deprivation therapy. Denosumab is well tolerated.

Enabling Open Access to Public Sector Information With Creative Commons Licences : The Australian Experience

This chapter considers how open content licences of copyright-protected materials – specifically, Creative Commons (CC) licences - can be used by governments as a simple and effective mechanism to enable reuse of their PSI, particularly where materials are made available in digital form online or distributed on disk.

Emergency department surge capacity : Recommendations of the Australasian surge strategy working group

Background For more than a decade emergency medicine organizations have produced guidelines, training and leadership for disaster management. However to date, there have been limited guidelines for emergency physicians needing to provide a rapid response to a surge in demand. The aim of this study is to identify strategies which may guide surge management in the Emergency Department. Method A working group of individuals experienced in disaster medicine from the Australasian College for Emergency Medicine Disaster Medicine Subcommittee (the Australasian Surge Strategy Working Group) was established to undertake this work. The Working Group used a modified Delphi technique to examine response actions in surge situations. The Working Group identified underlying assumptions from epidemiological and empirical understanding and then identified remedial strategies from literature and from personal experience and collated these within domains of space, staff, supplies, and system operation. Findings These recommendations detail 22 potential actions available to an emergency physician working in the context of surge. The Working Group also provides detailed guidance on surge recognition, triage, patient flow through the emergency department and clinical goals and practices. Discussion These strategies provide guidance to emergency physicians confronting the challenges of a surge in demand. The paper also identifies areas that merit future research including the measurement of surge capacity, constraints to strategy implementation, validation of surge strategies and measurement of strategy impacts on throughput, cost, and quality of care.

Emotional experience with portable interactive devices

This paper reports on a six month longitudinal study exploring people’s personal and social emotional experience with Portable Interactive Devices (PIDs). The study is concerned with the experience design approach and based on the theoretical framework of Activity Theory. The focus is on emotional experiences and how artefacts mediate and potentially enhance this experience. The outcomes of the study identified interesting aspects of PID interaction. Findings revealed people interact with PIDs emotionally both at a personal and a social level, supporting previous studies. Further, the social level impacts significantly on the emotional experience attained. If negative social experiences exceeded negative personal experiences the emotional experience was constant over six months. If negative personal experiences surpassed negative social experiences the emotional experience was varied over six months. The findings are discussed in regards to their significance to the field of design, their implication for future PID design and future research directions.

Passenger experience in an airport : an activity-centred approach

An airport is one of the largest and most complex systems in modern society. Observational field studies have been conducted to investigate passenger experiences in, and interactions within, an international airport. Based on these studies, this paper discusses how activities mediate people’s experiences in the airport. For example, moving through the security screening process is discussed from both passenger and staff perspectives. The applied coding scheme ensured research rigor. The findings illustrate that passenger activities are complex and shared, and only partially supported by current terminal design. Thus, this research has the potential to impact on airport design to facilitate passenger flow through airport precincts.

Virtual mooting : using technology to enhance the mooting experience

While a range of benefits to students participating in mooting have been identified by the legal education literature, there are impediments to students participating in mooting that have been revealed by recent surveys of law students at QUT. These impediments include time, geographical location and a failure to perceive the benefits of mooting. This paper will explore the benefits of using technology to overcome these impediments, evaluate technological options to facilitate distance mooting, such as the use of Second Life, Elluminate and video conferencing, and will recommend a trial of these options.

Clinical whole-body skin examination reduces the incidence of thick melanomas

Survival from melanoma is strongly related to tumour thickness, thus earlier diagnosis has the potential to reduce mortality from this disease. However, in the absence of conclusive evidence that clinical skin examination reduces mortality, evidence-based assessments do not recommend population screening. We aimed to assess whether clinical whole-body skin examination is associated with a reduced incidence of thick melanoma and also whether screening is associated with an increased incidence of thin lesions (possible overdiagnosis). A population-based case-control study of all Queensland residents aged 20-75 years with a histologically confirmed first primary invasive cutaneous melanoma diagnosed between January 2000 and December 2003. Telephone interviews were completed by 3,762 eligible cases (78.0%) and 3,824 eligible controls (50.4%) Whole-body clinical skin examination in the three years before diagnosis was associated with a 14% lower risk of being diagnosed with a thick melanoma (>0.75mm) (OR= 0.86, 95% CI=0.75, 0.98). Risk decreased for melanomas of increasing thickness: the risk of being diagnosed with a melanoma 0.76-1.49mm was reduced by 7% (OR=0.93, 95% CI 0.79, 1.10), by 17% for melanomas 1.50-2.99mm (OR=0.83, 95% CI=0.65, 1.05) and by 40% for melanomas ≥3mm (OR=0.60, 95% CI=0.43, 0.83). Screening was associated with a 38% higher risk of being diagnosed with a thin invasive melanoma (≤0.75mm) (OR=1.38, 95% CI=1.22, 1.56). This is the strongest evidence to date that whole-body clinical skin examination reduces the incidence of thick melanoma. Because survival from melanoma is strongly related to tumour thickness, these results suggest that screening would reduce melanoma mortality.

A QUT experience in combining sustainability research with educational activities and professional practice

The paper discusses the development and delivery of a university subject on sustainable construction, using related research projects as case studies and learning materials. It exposed students from a variety of disciplines to real life scenarios, to group around project cases, and learn to work with one another in solving sustainable development problems. The problem based learning approach directly responds to the new trends of learning by practising which, in the area of sustainability education, is particularly appropriate because of the need for multidisciplinary approach to complex issues, and the impetus for research and development to provide timely input for education in this growing discipline with a relatively short history. Collaboration of students from cross-disciplines, the engagement of industry and practitioners, the concept of using project cases and student design competition, and the tangible improvement of students’ comprehension of the sustainability phenomenon as a whole, have been the highlights of this Australian experience.

Assessment of architectural work experience by employers and students

A major element in the architectural work experience program at Queensland University of Technology is the assessment reports provided by students and employers. This paper gives an analysis of assessments submitted during the period 2000 to 2007 as viewed from a practice-base perspective. By comparing the 398 student assessments with 403 employer assessments in five specific categories over an eight year period one is able to obtain a clear understanding of the performance of the program and the relevance of its various sections for its participants that is not always obvious in a yearly analysis. In the major work experience areas there is close agreement between the student and employer assessments. However, the analysis did highlight a misunderstanding of the program’s aims by some participants. Overall the students were very positive about the program and appreciated the opportunity to work on real projects and be given a degree of responsibility for these projects. For Work Integrated Learning (WIL) practitioners this study clearly demonstrates the value of obtaining assessments from students and employers in order to establish the acceptance of a WIL program.

Learning wellness : how ageing Australians experience health information literacy

Given identified synergies between information use and health status greater understanding is needed about how people use information to learn about their health. This article presents the findings of preliminary research into health information literacy which sought to explore how this is phenomenon is experienced among ageing Australians. Analysis of data from semi-structured interviews has revealed six different ways ageing Australians experience using information to learn about their health within one aspect of community life. Health information literacy is a new terrain for information literacy research endeavours and one which warrants further attention by the profession to foster and promote within the community.

Intuitive interaction, prior experience and aging : an empirical study

This paper describes an experiment undertaken to investigate intuitive interaction, particularly in older adults. Previous work has shown that intuitive interaction relies on past experience, and has also suggested that older people demonstrate less intuitive uses and slower times when completing set tasks with various devices. Similarly, this experiment showed that past experience with relevant products allowed people to use the interfaces of two different microwaves more quickly, although there were no significant differences between the different microwaves. It also revealed that certain aspects of cognitive decline related to aging, such as central executive function, have more impact on time, correct uses and intuitive uses than chronological age. Implications of these results and further work in this area are discussed.

Reducing the risk of posttraumatic stress disorder in children following natural disasters

A significant number of children suffer long term psychological disturbance following exposure to a natural disaster. Evidence suggests that a dose-response relationship exists, so that children and adolescents who experience the most intense or extensive exposure to the risk factors for PTSD are likely to develop the most serious and persistent symptoms. Risk factors include gender, age, personality, extent of exposure to the natural disaster, amount of damage to property and infrastructure, witnessing injury or death of others or perceiving a threat to their own life. Knowing these factors enables various strategies to be put in place to decrease the risk of psychological disturbance following the aftermath of traumatic events. Re-establishing a sense of safety, security and normality is important in the aftermath of a natural disaster, and promoting social connectedness, positive family functioning, and effective coping mechanisms can make children more resilient in the face of catastrophic events. This paper examines the risk and protective factors associated with the development of post traumatic stress disorder (PTSD), and considers how schools can use this knowledge to contribute to the recovery effort, and reduce the prevalence of PTSD amongst pupils in the wake of a natural disaster.