Finding a way through the ethical and legal maze : withdrawing medical treatment and euthanasia

This article examines Finnis' and Keown's claim that the intention/foresight distinction should be used as the basis for the lawfulness of withholding and withdrawing medical treatment, rather than the act/omission distinction which is currently used. I argue that whilst the intention/foresight distinction is sound and can apply to palliative pain relief hastening death, it cannot be applied to withholding and withdrawing medical treatment. Instead, the act/omission distinction remains the better basis for the lawfulness of withholding and withdrawal, and law reform is consequently unnecessary.

Oxycodone or oxycodone plus paracetamol for acute postoperative pain in adults

In this short communication we wanted to find out what is the analgesic effect of single dose oral oxycodone, with or without the addition of paracetamol, for adults with postoperative pain? Oxycodone at doses of 5mg and above is an effective analgesia for patients with moderate to severe postoperative pain. The efficacy of oxycodone is increased with the addition of paracetamol. The use of oxycodone 10mg plus paracetamol 625mg can be considered for use in the pain relief protocol in post-operative settings. Clinicians should consider a range of factors before prescribing or administering oxycodone for acute post-operative pain, including but not limited to, individual patient clinical profile, adverse effects, cost and patient preference.

Prospective, non-randomized phase 2 clinical trial of carboplatin plus paclitaxel with sequential radical pelvic radiotherapy for uterine papillary serous carcinoma

Objective Uterine Papillary Serous Carcinoma (UPSC) is uncommon and accounts for less than 5% of all uterine cancers. Therefore the majority of evidence about the benefits of adjuvant treatment comes from retrospective case series. We conducted a prospective multi-centre non-randomized phase 2 clinical trial using four cycles of adjuvant paclitaxel plus carboplatin chemotherapy followed by pelvic radiotherapy, in order to evaluate the tolerability and safety of this approach. Methods This trial enrolled patients with newly diagnosed, previously untreated patients with stage 1b-4 (FIGO-1988) UPSC with a papillary serous component of at least 30%. Paclitaxel (175 mg/m2) and carboplatin (AUC 6) were administered on day 1 of each 3-week cycle for 4 cycles. Chemotherapy was followed by external beam radiotherapy to the whole pelvis (50.4 Gy over 5.5 weeks). Completion and toxicity of treatment (Common Toxicity Criteria, CTC) and quality of life measures were the primary outcome indicators. Results Twenty-nine of 31 patients completed treatment as planned. Dose reduction was needed in 9 patients (29%), treatment delay in 7 (23%), and treatment cessation in 2 patients (6.5%). Hematologic toxicity, grade 3 or 4 occurred in 19% (6/31) of patients. Patients' self-reported quality of life remained stable throughout treatment. Thirteen of the 29 patients with stages 1–3 disease (44.8%) recurred (average follow up 28.1 months, range 8–60 months). Conclusion This multimodal treatment is feasible, safe and tolerated reasonably well and would be suitable for use in multi-institutional prospective randomized clinical trials incorporating novel therapies in patients with UPSC.

Mechanical properties of cold-formed steels at elevated temperatures

Mechanical properties have an important role in the fire safety design of cold-formed steel structures due to the rapid reduction in mechanical properties such as yield strength and elastic modulus under fire conditions and associated reduction to the load carrying capacities. Hence there is a need to fully understand the deterioration characteristics of yield strength and elastic modulus of cold-formed steels at elevated temperatures. Although past research has produced useful experimental data on the mechanical properties of cold-formed steels at elevated temperatures, such data do not yet cover different cold-formed steel grades and thicknesses. Therefore, an experimental study was undertaken to investigate the elevated temperature mechanical properties of two low and high strength steels with two thicknesses that are commonly used in Australia. Tensile coupon tests were undertaken using a steady state test method for temperatures in the range 20–700 °C. Test results were compared with the currently available reduction factors for yield strength and elastic modulus, and stress–strain curves, based on which further improvements were made. For this purpose, test results of many other cold-formed steels were also used based on other similar studies undertaken at the Queensland University of Technology. Improved equations were developed to predict the yield strength and elastic modulus reduction factors and stress–strain curves of a range of cold-formed steel grades and thicknesses used in Australia. This paper presents the results of this experimental study, comparisons with the results of past research and steel design standards, and the new predictive equations.

Numerical modelling of light gauge cold-formed steel compression members subjected to distortional buckling at elevated temperatures

Fire safety design of building structures has received greater attention in recent times due to continuing loss of properties and lives during fires. However, fire performance of light gauge cold-formed steel structures is not well understood despite its increased usage in buildings. Cold-formed steel compression members are susceptible to various buckling modes such as local and distortional buckling and their ultimate strength behaviour is governed by these buckling modes. Therefore a research project based on experimental and numerical studies was undertaken to investigate the distortional buckling behaviour of light gauge cold-formed steel compression members under simulated fire conditions. Lipped channel sections with and without additional lips were selected with three thicknesses of 0.6, 0.8, and 0.95 mm and both low and high strength steels (G250 and G550 steels). More than 150 compression tests were undertaken first at ambient and elevated temperatures. Finite element models of the tested compression members were then developed by including the degradation of mechanical properties with increasing temperatures. Comparison of finite element analysis and experimental results showed that the developed finite element models were capable of simulating the distortional buckling and strength behaviour at ambient and elevated temperatures up to 800 °C. The validated model was used to determine the effects of mechanical properties, geometric imperfections and residual stresses on the distortional buckling behaviour and strength of cold-formed steel columns. This paper presents the details of the numerical study and the results. It demonstrated the importance of using accurate mechanical properties at elevated temperatures in order to obtain reliable strength characteristics of cold-formed steel columns under fire conditions.

Elevated plasma fibronectin levels associated with venous thromboembolism

Elevated plasma fibronectin levels occur in various clinical states including arterial disease. Increasing evidence suggests that atherothrombosis and venous thromboembolism (VTE) share common risk factors. To assess the hypothesis that high plasma fibronectin levels are associated with VTE, we compared plasma fibronectin levels in the Scripps Venous Thrombosis Registry for 113 VTE cases vs. age and sex matched controls. VTE cases had significantly higher mean fibronectin concentration compared to controls (127% vs. 103%, p<0.0001); the difference was greater for idiopathic VTE cases compared to secondary VTE cases (133% vs. 120%, respectively). Using a cut-off of >90% of the control values, the odds ratio (OR) for association of VTE for fibronectin plasma levels above the 90th percentile were 9.37 (95% CI 2.73-32.2; p<0.001) and this OR remained significant after adjustment for sex, age, body mass index (BMI), factor V Leiden and prothrombin nt20210A (OR 7.60, 95% CI 2.14-27.0; p=0.002). In particular, the OR was statistically significant for idiopathic VTE before and after these statistical adjustments. For the total male cohort, the OR was significant before and after statistical adjustments and was not significant for the total female cohort. In summary, our results suggest that elevated plasma fibronectin levels are associated with VTE especially in males, and extend the potential association between biomarkers and risk factors for arterial atherothrombosis and VTE. © 2008 Schattauer GmbH.

Urban maze : A typological investigation in porous morphology and dynamic pedestrian networks

Mixed use typologies and pedestrian networks are two strategies commonly applied in design of the contemporary city. These approaches, aimed towards the creation of a more sustainalble urban environment, have their roots in the traditional, pre-industrial towns; they characterize urban form, articulating the tension between privaate and public realms through a series of typological variations as well as stimulating commercial activity in the city centre. Arcades, loggias and verandas are just some of the elements which can mediate this tension. Historically they have defined physical and social spaces with particular character; in the contemporary city these features are applied to deform the urban form and create a porous, dynamic morphology. This paper, comparing case studies from Italy, Japan and Australia, investigates how the design of the transition zone can define hybrid pedestrian networks, where a clear distinction between the public and private realms is no longer applicable. Pedestrians use the city in a dynamic way, combining trajectories on the public street with ones on the fringe or inside of the private built environment. In some cases, cities offer different pedestrian network possibilities at different times, as the commercial precints are subject to variations in accessibility across various timeframes. These walkable systems have an impact on the urban form and identity of places, redefining typologies and requiring an in depth analysis through plan, section and elevation diagrams.

Polycaprolactone-based scaffold plus rhBMP-2 in a sheep thoracic spine fusion model

We report the application of a novel scaffold design in a sheep thoracic spine model for spine deformity correction. The combination of the calcium-phosphate coated polycaprolactone scaffolds with recombinant human bone morphogenic protein-2 (rhBMP-2) are intended as a future bone graft substitute in ensuring the stability of bony intervertebral fusion. A solid free-form fabrication process based on melt extrusion has been utilized in the manufacturing of these scaffolds. To date there are no studies examining the use of such biodegradable implants in a sheep thoracic spine model. The success of anterior scoliosis surgery in humans depends on achieving a solid bony fusion between adjacent vertebrae after the intervertebral discs have been surgically cleared and the disc spaces filled with graft material. Due to limited availability of autograft, there is much current interest in the development of synthetic scaffolds in combination with growth factors such as recombinant human bone morphogenetic protein (rhBMP-2) to achieve a solid bony fusion following scoliosis surgery.

Lateral torsional buckling behaviour of cold-formed steel beams at elevated temperatures

Abstract: This paper presents the details of a study into the behaviour and moment capacities of cold-formed steel lipped channel beams (LCB) subject to lateral-torsional buckling at elevated temperatures. It was based on a validated numerical model of a simply supported and laterally unrestrained LCB subjected to a uniform moment. The ultimate moment capacities from this study were compared with the predicted values using ambient and fire design methods. This study showed that the lateral torsional buckling capacity is strongly influenced by the level of non-linearity in the stress-strain curves of steel at elevated temperatures. Hence most of the current design methods based on a single buckling curve were not adequate to determine the moment capacities. This paper proposes a new design method for the cold-formed steel LCBs subject lateral-torsional buckling at elevated temperatures.