Identification of early-stage colorectal cancer patients at risk of relapse post-resection by immunobead reverse transcription-PCR analysis of peritoneal lavage fluid for malignant cells

Purpose: Colorectal cancer patients diagnosed with stage I or II disease are not routinely offered adjuvant chemotherapy following resection of the primary tumor. However, up to 10% of stage I and 30% of stage II patients relapse within 5 years of surgery from recurrent or metastatic disease. The aim of this study was to determine if tumor-associated markers could detect disseminated malignant cells and so identify a subgroup of patients with early-stage colorectal cancer that were at risk of relapse. Experimental Design: We recruited consecutive patients undergoing curative resection for early-stage colorectal cancer. Immunobead reverse transcription-PCR of five tumor-associated markers (carcinoembryonic antigen, laminin γ2, ephrin B4, matrilysin, and cytokeratin 20) was used to detect the presence of colon tumor cells in peripheral blood and within the peritoneal cavity of colon cancer patients perioperatively. Clinicopathologic variables were tested for their effect on survival outcomes in univariate analyses using the Kaplan-Meier method. A multivariate Cox proportional hazards regression analysis was done to determine whether detection of tumor cells was an independent prognostic marker for disease relapse. Results: Overall, 41 of 125 (32.8%) early-stage patients were positive for disseminated tumor cells. Patients who were marker positive for disseminated cells in post-resection lavage samples showed a significantly poorer prognosis (hazard ratio, 6.2; 95% confidence interval, 1.9-19.6; P = 0.002), and this was independent of other risk factors. Conclusion: The markers used in this study identified a subgroup of early-stage patients at increased risk of relapse post-resection for primary colorectal cancer. This method may be considered as a new diagnostic tool to improve the staging and management of colorectal cancer. © 2006 American Association for Cancer Research.

Adoption of low-cost rail level crossing warning devices : an Australian case study

The objective of this chapter is to provide rail practitioners with a practical approach for determining safety requirements of low-cost level crossing warning devices (LCLCWDs) on an Australian railway by way of a case study. LCLCWDs, in theory, allow railway operators to improve the safety of passively controlled crossing by upgrading a larger number of level crossings with the same budget that would otherwise be used to upgrade these using the conventional active level crossing control technologies, e.g. track circuit initiated flashing light systems. The chapter discusses the experience and obstacles of adopting LCLCWDs in Australia, and demonstrates how the risk-based approach may be used to make the case for LCLCWDs.

Space, place and power : the spatial turn in literacy research

Place matters to literacy because the meanings of our language and actions are always materially and socially placed in the world (Scollon & Scollon, 2003). We cannot interpret signs, whether an icon, symbol, gesture, word, or action, without taking into account their associations with other meanings and objects in places. This chapter maps an emergent strand of literacy research that foregrounds place and space as constitutive, rather than a backdrop for the real action. Space and place are seen as relational and dynamic, not as fixed and unchanging. Space and place are socially produced, and hence, can be contested, re-imagined and re-made. In bringing space and place into the frame of literacy studies we see a subtle shift – a rebalancing of the semiotic with the materiality of lived, embodied, and situated experience. ...

The assessment of mental health in children with intellectual disability

Aim: Individuals with intellectual disability (ID) have higher rates of mental health problems than the general population. Assessment tends to rely heavily on self-report, but persons with ID often have difficulties in identifying and describing their own thoughts and feelings. Measures that are psychometrically sound with typically developing populations may not be as robust in samples with ID. The aim of the current study was to examine a range of self-report measures for assessing the mental health of children with ID, and to consider the appropriateness of minor modifications to those instruments. Method: The participants were 58 children with ID (mean 11.7 years) attending Year 6 in mainstream primary schools. At the first time point they completed four established measures of depression, anxiety and mood. Minor modifications were made to wording and format at re-administration six months later. Results: Internal consistency varied considerably across measures. Modifications resulted in small or no improvements, but the results were relatively consistent over time and across similar measures. Some gender differences were evident. Conclusions: The findings confirm the difficulties that children with ID may have when responding to self-report measures of mental health, and suggest that care should be taken in choice of instruments. While modifications can produce small improvements, it is clear that more robust measures of mental health are needed for persons with ID.

Outcomes following inpatient rehabilitation of lower limb amputees

Introduction: Lower-limb amputations are a serious adverse consequence of lifestyle related chronic conditions and a serious concern among the aging population in Australia. Lower limb amputations have severe personal, social and economic impacts on the individual, healthcare system and broader community. This study aimed to address a critical gap in the research literature by investigating the physical functioning and social characteristics of lower limb amputees at discharge from tertiary hospital inpatient rehabilitation. Method: A cohort study was implemented among patients with lower limb amputations admitted to a Geriatric Assessment and Rehabilitation Unit for rehabilitation at a tertiary hospital. Conventional descriptive statistics were used to examine patient demographic, physical functioning and social living outcomes recorded for patients admitted between 2005 and 2011. Results: A total of 423 admissions occurred during the study period, 313 (74%) were male. This sample included admissions for left (n = 189, 45%), right (n = 220, 52%) and bilateral (n = 14, 3%) lower limb amputations, with 15 (3%) patients dying whilst an inpatient. The mean (standard deviation) age was 65 (13.9) years. Amputations attributed to vascular causes accounted for 333 (78%) admissions; 65 (15%) of these had previously had an amputation. The mean (SD) length of stay in the rehabilitation unit was 56 (42) days. Prior to this admission, 123 (29%) patients were living alone, 289 (68%) were living with another and 3 (0.7%) were living in residential care. Following this amputation related admission, 89 (21%) patients did not return to their prior living situation. Of those admitted, 187 (44%) patients were discharged with a lower limb prosthesis. Conclusion: The clinical group is predominately older adults. The ratio of males to females was approximately 3:1. Over half did not return to walking and many were not able to return to their prior accommodation. However, few patients died during their admission.

The predictors of active ageing of older Australians : the triple a study

The concept of older adults contributing to society in a meaningful way has been termed ‘active ageing’. Active ageing reflects changes in prevailing theories of social and psychological aspects of ageing, with a focus on individuals' strengths as opposed to their deficits or pathology. In order to explore predictors of active ageing, the Australian Active Ageing (Triple A) project group undertook a national postal survey of participants over the age of 50 years recruited randomly through their 2004 membership of a large Australia-wide senior's organisation. The survey comprised 178 items covering paid and voluntary work, learning, social, spiritual, emotional, health and home, life events and demographic items. A 45% response rate (2655 returned surveys) reflected an expected balance of gender, age and geographic representation of participants. The data were analysed using data mining techniques to represent generalizations on individual situations. Data mining identifies the valid, novel, potentially useful and understandable patterns and trends in data. The results based on the clustering mining technique indicate that physical and emotional health combined with the desire to learn were the most significant factors when considering active ageing. The findings suggest that remaining active in later life is not only directly related to the maintenance of emotional and physical health, but may be significantly intertwined with the opportunity to engage in on-going learning activities that are relevant to the individual. The findings of this study suggest that practitioners and policy makers need to incorporate older peoples' learning needs within service and policy framework developments.

Improving the moment capacities of hollow flange cold-formed Litesteel Beams using web stiffeners

The LiteSteel Beam (LSB) is a new hollow flange section developed in Australia with a unique geometry consisting of torsionally rigid rectangular hollow flanges and a relatively slender web. The LSB is subjected to a relatively new Lateral Distortional Buckling (LDB) mode when used as flexural members. Unlike the commonly observed lateral torsional buckling, lateral distortional buckling of LSBs is characterised by cross sectional change due to web distortion. Lateral distortional buckling causes significant moment capacity reduction for LSBs with intermediate spans. Therefore a detailed investigation was undertaken to determine the methods of reducing the effects of lateral distortional buckling in LSB flexural members. For this purpose the use of web stiffeners was investigated using finite element analyses of LSBs with different web stiffener spacing and sizes. It was found that the use of 5 mm steel plate stiffeners welded or screwed to the inner faces of the top and bottom flanges at third span points considerably reduced the lateral distortional buckling effects in LSBs. Suitable design rules were then developed to calculate the enhanced elastic lateral distortional buckling moments and the higher ultimate moment capacities of LSBs with the chosen web stiffener arrangement. This paper presents the details of this investigation and the results.

Older drivers' crashes in Queensland, Australia

Background: The growing proportion of older adults in Australia is predicted to comprise 23% of the population by 2030. Accordingly, an increasing number of older drivers and fatal crashes of these drivers could also be expected. While the cognitive and physiological limitations of ageing and their road safety implications have been widely documented, research has generally considered older drivers as a homogeneous group. Knowledge of age-related crash trends within the older driver group itself is currently limited. Objective: The aim of this research was to identify age-related differences in serious road crashes of older drivers. This was achieved by comparing crash characteristics between older and younger drivers and between sub-groups of older drivers. Particular attention was paid to serious crashes (crashes resulting in hospitalisation and fatalities) as they place the greatest burden on the Australian health system. Method: Using Queensland Crash data, a total of 191,709 crashes of all-aged drivers (17–80+) over a 9-year period were analysed. Crash patterns of drivers’ aged 17–24, 25–39, 40–49, 50–59, 60–69, 70–79 and 80+ were compared in terms of crash severity (e.g., fatal), at fault levels, traffic control measures (e.g., stop signs) and road features (e.g., intersections). Crashes of older driver sub-groups (60–69, 70–79, 80+) were also compared to those of middle-aged drivers (40–49 and 50–59 combined, who were identified as the safest driving cohort) with respect to crash-related traffic control features and other factors (e.g., speed). Confounding factors including speed and crash nature (e.g., sideswipe) were controlled for. Results and discussion: Results indicated that patterns of serious crashes, as a function of crash severity, at-fault levels, road conditions and traffic control measures, differed significantly between age groups. As a group, older drivers (60+) represented the greatest proportion of crashes resulting in fatalities and hospitalisation, as well as those involving uncontrolled intersections and failure to give way. The opposite was found for middle-aged drivers, although they had the highest proportion of alcohol and speed-related crashes when compared to older drivers. Among all older drivers, those aged 60–69 were least likely to be involved in or the cause of crashes, but most likely to crash at interchanges and as a result of driving while fatigued or after consuming alcohol. Drivers aged 70–79 represented a mid-range level of crash involvement and culpability, and were most likely to crash at stop and give way signs. Drivers aged 80 years and beyond were most likely to be seriously injured or killed in, and at-fault for, crashes, and had the greatest number of crashes at both conventional and circular intersections. Overall, our findings highlight the heterogeneity of older drivers’ crash patterns and suggest that age-related differences must be considered in measures designed to improve older driver safety.

The role of human capital in economic growth revisited

Benhabib and Spiegel (1994) examine the role of human capital in the development process empirically using a theory-driven specification rather than the standard production function approach. While they find evidence of a positive impact of human capital on income growth, their result is not robust to the inclusion of inequality as an additional covariate. Using an alternate dataset and different measures of inequality, we find robust support for the hypothesis that human capital matters even when we account for the adverse effect of income inequality on growth.

A critical analysis of crisis escalation models : understanding stages and severity in infrastructure disturbance

A range of authors from the risk management, crisis management, and crisis communications literature have proposed different models as a means of understanding components of crisis. A generic component of these sources has focused on preparedness practices before disturbance events and response practices during events. This paper provides a critical analysis of three key explanatory models of how crises escalate highlighting the strengths and limitations of each approach. The paper introduces an optimised conceptual model utilising components from the previous work under the four phases of pre-event, response, recovery, and post-event. Within these four phases, a ten step process is introduced that can enhance understanding of the progression of distinct stages of disturbance for different types of events. This crisis evolution framework is examined as a means to provide clarity and applicability to a range of infrastructure failure contexts and provide a path for further empirical investigation in this area.

The Chinese state enterprise sector: Labour market reform and the impact on male–female wage structure

The paper examines the wage structure in the Chinese state enterprise sector between 1981 and 1987. This period is of particular interest given the introduction of major labour market reforms in China during the early 1980s. In essence the reforms represented a movement away from administratively determined prices towards a market–oriented system combined with a relatively flexible system of labour allocation. The Juhn, Murphy and Pierce (1991) decomposition is employed to shed light on the role of changing labour market institutions over the period.

Association analysis of a highly polymorphic CAG Repeat in the human potassium channel gene KCNN3 and migraine susceptibility

Background Migraine is a polygenic multifactorial disease, possessing environmental and genetic causative factors with multiple involved genes. Mutations in various ion channel genes are responsible for a number of neurological disorders. KCNN3 is a neuronal small conductance calcium-activated potassium channel gene that contains two polyglutamine tracts, encoded by polymorphic CAG repeats in the gene. This gene plays a critical role in determining the firing pattern of neurons and acts to regulate intracellular calcium channels. Methods The present association study tested whether length variations in the second (more 3') polymorphic CAG repeat in exon 1 of the KCNN3 gene, are involved in susceptibility to migraine with and without aura (MA and MO). In total 423 DNA samples from unrelated individuals, of which 202 consisted of migraine patients and 221 non-migraine controls, were genotyped and analysed using a fluorescence labelled primer set on an ABI310 Genetic Analyzer. Allele frequencies were calculated from observed genotype counts for the KCNN3 polymorphism. Analysis was performed using standard contingency table analysis, incorporating the chi-squared test of independence and CLUMP analysis. Results Overall, there was no convincing evidence that KCNN3 CAG lengths differ between Caucasian migraineurs and controls, with no significant difference in the allelic length distribution of CAG repeats between the population groups (P = 0.090). Also the MA and MO subtypes did not differ significantly between control allelic distributions (P > 0.05). The prevalence of the long CAG repeat (>19 repeats) did not reach statistical significance in migraineurs (P = 0.15), nor was there a significant difference between the MA and MO subgroups observed compared to controls (P = 0.46 and P = 0.09, respectively), or between MA vs MO (P = 0.40). Conclusion This association study provides no evidence that length variations of the second polyglutamine array in the N-terminus of the KCNN3 channel exert an effect in the pathogenesis of migraine.

Variation in leaf morphology of the invasive cat's claw creeper Dolichandra unguis-cati (Bignoniaceae)

The invasive liana cat’s claw creeper Dolichandra unguis-cati (L.) L.G. Lohmann (syn. Macfadyena unguis-cati (L.) A.H. Gentry) exhibits intraspecific variation in leaf morphology, but this is rarely noted in the published literature. The present study documents variation in leaf morphology in two forms of the species that occur in Australia (long pod and short pod). Leaf morphology is compared between the two forms and the position of the shoots (trunk and ground) at the only two sites in which they co-occur. Leaves were categorised on the basis of leaflet number and the presence or absence of tendrils. Simple leaves were produced mainly on shoots growing along the ground and were more abundant in the short-pod form. Long-pod plants were dominated by bifoliate leaves with tendrils. Cat’s claw creeper exhibits considerably wider variation in leaf morphology than recorded previously. Variations in leaf morphology may be linked to differences in the genotype, developmental stage and plastic responses of the plants. Understanding these variations may have implications for taxonomic delimitation and improved management, particularly biological control involving leaf-feeding insects.