Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE) : a randomised trial

Background: The two-stage Total Laparoscopic Hysterectomy (TLH) versus Total Abdominal Hysterectomy (TAH) for stage I endometrial cancer (LACE) randomised controlled trial was initiated in 2005. The primary objective of stage 1 was to assess whether TLH results in equivalent or improved QoL up to 6 months after surgery compared to TAH. The primary objective of stage 2 was to test the hypothesis that disease-free survival at 4.5 years is equivalent for TLH and TAH. Results addressing the primary objective of stage 1 of the LACE trial are presented here. Methods: The first 361 LACE participants (TAH n= 142, TLH n=190) were enrolled in the QoL substudy at 19 centres across Australia, New Zealand and Hong Kong, and 332 completed the QoL analysis. Randomisation was performed centrally and independently from other study procedures via a computer generated, web-based system (providing concealment of the next assigned treatment) using stratified permuted blocks of 3 and 6, and assigned patients with histologically confirmed stage 1 endometrioid endometrial adenocarcinoma and ECOG performance status <2 to TLH or TAH stratified by histological grade and study centre. No blinding of patients or study personnel was attempted. QoL was measured at baseline, 1 and 4 weeks (early), and 3 and 6 months (late) after surgery using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire. The primary endpoint was the difference between the groups in QoL change from baseline at early and late time points (a 5% difference was considered clinically significant). Analysis was performed according to the intention-to-treat principle using generalized estimating equations on differences from baseline for the early and late QoL recovery. The LACE trial is registered with clinicaltrials.gov (NCT00096408) and the Australian New Zealand Clinical Trials Registry (CTRN12606000261516). Patients for both stages of the trial have now been recruited and are being followed up for disease-specific outcomes. Findings: The proportion of missing values at the 5%, 10% 15% and 20% differences in the FACT-G scale was 6% (12/190) in the TLH and 14% (20/142) in the TAH group. There were 8/332 conversions (2.4%, 7 of which were from TLH to TAH). In the early phase of recovery, patients undergoing TLH reported significantly greater improvement of QoL from baseline compared to TAH in all subscales except the emotional and social well-being subscales. Improvements in QoL up to 6 months post-surgery continued to favour TLH except for the emotional and social well-being of the FACT and the visual analogue scale of the EuroQoL five dimensions (EuroQoL-VAS). Length of operating time was significantly longer in the TLH group (138±43 mins), than in the TAH group at (109±34 mins; p=0.001). While the proportion of intraoperative adverse events was similar between the treatment groups (TAH 8/142, 5.6%; TLH 14/190, 7.4%; p=0.55), postoperatively, twice as many patients in the TAH group experienced adverse events of CTC grade 3+ than in the TLH group (33/142, 23.2% and 22/190, 11.6%, respectively; p=0.004). Postoperative serious adverse events occurred more frequently in patients who had a TAH (27/142, 19.0%) than a TLH (15/190, 7.9%) (p=0.002). Interpretation: QoL improvements from baseline during early and later phases of recovery, and the adverse event profile significantly favour TLH compared to TAH for patients treated for Stage I endometrial cancer.

Impacts of periodic tillage on soil C stocks : a synthesis

Long-term loss of soil C stocks under conventional tillage and accrual of soil C following adoption of no-tillage have been well documented. No-tillage use is spreading, but it is common to occasionally till within a no-till regime or to regularly alternate between till and no-till practices within a rotation of different crops. Short-term studies indicate that substantial amounts of C can be lost from the soil immediately following a tillage event, but there are few field studies that have investigated the impact of infrequent tillage on soil C stocks. How much of the C sequestered under no-tillage is likely to be lost if the soil is tilled? What are the longer-term impacts of continued infrequent no-tillage? If producers are to be compensated for sequestering C in soil following adoption of conservation tillage practices, the impacts of infrequent tillage need to be quantified. A few studies have examined the short-term impacts of tillage on soil C and several have investigated the impacts of adoption of continuous no-tillage. We present: (1) results from a modeling study carried out to address these questions more broadly than the published literature allows, (2) a review of the literature examining the short-term impacts of tillage on soil C, (3) a review of published studies on the physical impacts of tillage and (4) a synthesis of these components to assess how infrequent tillage impacts soil C stocks and how changes in tillage frequency could impact soil C stocks and C sequestration. Results indicate that soil C declines significantly following even one tillage event (1-11 % of soil C lost). Longer-term losses increase as frequency of tillage increases. Model analyses indicate that cultivating and ripping are less disruptive than moldboard plowing, and soil C for those treatments average just 6% less than continuous NT compared to 27% less for CT. Most (80%) of the soil C gains of NT can be realized with NT coupled with biannual cultivating or ripping. (C) 2007 Elsevier B.V. All rights reserved.

Pastureland use in the southeastern US: Implications for carbon sequestration

More than 13 Mha of nonfederal land in the southeastern U.S. are devoted to pastureland. Between 1982 and 1992, pastureland increased by 100,000 ha, with nearly 70% converted from cultivated land. We examined the potential for carbon (C) sequestration with improved pasture management and conversion into pastureland from cultivated land. Improved pasture management techniques, such as intensive grazing, fertilization, introduction of improved grass and legume species, and better irrigation systems can lead to sequestration of atmospheric C in soil. Literature values for the influence of changes in pasture management on soil C were summarized for several potential management changes in the Southeast. Soil C sequestration estimates for the Southeast were based on current pasture management practices and evaluated for a range of different adoption rates of improved practices. Conversion into pasture can also potentially sequester significant amounts of atmospheric C in soils. Land-use data from the National Resources Inventory and literature estimates of soil C changes following conversion to pasture were used to estimate historical (1982 to 1992) soil C sequestration in pastures. Potential future sequestration was estimated based on extrapolation of land-use trends between 1982 and 1992. With continued conversion into pasture and improvement of pasture management, southeastern U.S. pasture soils may be a significant C sink for several years.

The role of the rule of law in virtual communities

There is a severe tendency in cyberlaw theory to delegitimize state intervention in the governance of virtual communities. Much of the existing theory makes one of two fundamental flawed assumptions: that communities will always be best governed without the intervention of the state; or that the territorial state can best encourage the development of communities by creating enforceable property rights and allowing the market to resolve any disputes. These assumptions do not ascribe sufficient weight to the value-laden support that the territorial state always provides to private governance regimes, the inefficiencies that will tend to limit the development utopian communities, and the continued role of the territorial state in limiting autonomy in accordance with communal values. In order to overcome these deterministic assumptions, this article provides a framework based upon the values of the rule of law through which to conceptualise the legitimacy of the private exercise of power in virtual communities. The rule of law provides a constitutional discourse that assists in considering appropriate limits on the exercise of private power. I argue that the private contractual framework that is used to govern relations in virtual communities ought to be informed by the values of the rule of law in order to more appropriately address the governance tensions that permeate these spaces. These values suggest three main limits to the exercise of private power: that governance is limited by community rules and that the scope of autonomy is limited by the substantive values of the territorial state; that private contractual rules should be general, equal, and certain; and that, most importantly, internal norms be predicated upon the consent of participants.

A vision of the past : The Mill Albion

This paper examines The Mill Albion community history project, a diverse, multi-layered public history/art program that captures the social heritage of The Albion Flour Mill, as told through images produced as part of a research consultancy undertaken by QUT for FKP Property Group. The Albion Flour Mill was built in 1930 and continued operations for more than 72 years. After ceasing operation in 2005 the site was left to deteriorate. The FKP Property Group purchased the land to undertake a new urban redevelopment project. This paper reflects on the project and showcases some of the culturally creative ways this community’s history was told, using images.

Incorporating community history into urban redevelopment

A community history project must be relevant to each person within it so that they see themselves as part of the socio-cultural fabric of the area and feel a sense of ownership of their environment. The Mill Albion community history project is a diverse, multi-layered public history/art program that captures the social heritage of The Mill Albion and allows the community to contribute to their ongoing history. The Albion Flour Mill was built in 1930 at a time when Australia was feeling the effects of its worst economic depression and continued operations for more than 72 years. After ceasing operation in 2005 the site was left to deteriorate. The FKP Property Group purchased the land to undertake a new urban redevelopment project, drawing on the design principles of a traditional ‘village’, while valuing the importance of remembering the community that once included the Flour Mill. This paper reflects on the this project and showcases some of the culturally creative ways this community’s history was told, using methods such as digital stories, contemporary and historical photography and oral history.

Determinants of infant and young child feeding practices in Nepal : secondary data analysis of demographic and health survey 2006

Background: Childhood undernutrition and mortality are high in Nepal, and therefore interventions on infant and young child feeding practices deserve high priority. Objective. To estimate infant and young child feeding indicators and the determinants of selected feeding practices. Methods: The sample consisted of 1,906 children aged 0 to 23 months from the Demographic and Health Survey 2006. Selected indicators were examined against a set of variables using univariate and multivariate analyses. Results. Breastfeeding was initiated within the first hour after birth in 35.4% of children, 99.5% were ever breastfed, 98.1% were currently breastfed, and 3.5% were bottle-fed. The rate of exclusive breastfeeding among infants under 6 months of age was 53.1%, and the rate of timely complementary feeding among those 6 to 9 months of age was 74.7%. Mothers who made antenatal clinic visits were at a higher risk for no exclusive breastfeeding than those who made no visits. Mothers who lived in the mountains were more likely to initiate breastfeeding within 1 hour after birth and to introduce complementary feeding at 6 to 9 months of age, but less likely to exclusively breastfeed. Cesarean deliveries were associated with delay in timely initiation of breastfeeding. Higher rates of complementary feeding at 6 to 9 months were also associated with mothers with better education and those above 35 years of age. Risk factors for bottle-feeding included living in urban areas and births attended by trained health personnel. Conclusions: Most breastfeeding indicators in Nepal are below the expected levels to achieve a substantial reduction in child mortality. Breastfeeding promotion strategies should specifically target mothers who have more contact with the health care delivery system, while programs targeting the entire community should be continued.

Effect of surgical approach on bone vascularisation, fracture and soft tissue healing : comparison of less invasive to open approach

Over the past ten years, minimally invasive plate osteosynthesis (MIPO) for the fixation of long bone fractures has become a clinically accepted method with good outcomes, when compared to the conventional open surgical approach (open reduction internal fixation, ORIF). However, while MIPO offers some advantages over ORIF, it also has some significant drawbacks, such as a more demanding surgical technique and increased radiation exposure. No clinical or experimental study to date has shown a difference between the healing outcomes in fractures treated with the two surgical approaches. Therefore, a novel, standardised severe trauma model in sheep has been developed and validated in this project to examine the effect of the two surgical approaches on soft tissue and fracture healing. Twenty four sheep were subjected to severe soft tissue damage and a complex distal femur fracture. The fractures were initially stabilised with an external fixator. After five days of soft tissue recovery, internal fixation with a plate was applied, randomised to either MIPO or ORIF. Within the first fourteen days, the soft tissue damage was monitored locally with a compartment pressure sensor and systemically by blood tests. The fracture progress was assessed fortnightly by x-rays. The sheep were sacrificed in two groups after four and eight weeks, and CT scans and mechanical testing performed. Soft tissue monitoring showed significantly higher postoperative Creatine Kinase and Lactate Dehydrogenase values in the ORIF group compared to MIPO. After four weeks, the torsional stiffness was significantly higher in the MIPO group (p=0.018) compared to the ORIF group. The torsional strength also showed increased values for the MIPO technique (p=0.11). The measured total mineralised callus volumes were slightly higher in the ORIF group. However, a newly developed morphological callus bridging score showed significantly higher values for the MIPO technique (p=0.007), with a high correlation to the mechanical properties (R2=0.79). After eight weeks, the same trends continued, but without statistical significance. In summary, this clinically relevant study, using the newly developed severe trauma model in sheep, clearly demonstrates that the minimally invasive technique minimises additional soft tissue damage and improves fracture healing in the early stage compared to the open surgical approach method.

A 3D visualisation model applied to a thick, multi-layered alluvial groundwater system under stress : Condamine Valley, QLD

The upper Condamine River in southern Queensland has formed extensive alluvial deposits which have been used for irrigation of cotton crops for over 40 years. Due to excessive use and long term drought conditions these groundwater resources are under substantial threat. This condition is now recognised by all stakeholders, and Qld Department of Environment and Resource Management (DERM) are currently undertaking a water planning process for the Central Condamine Alluvium with water users and other stakeholders. DERM aims to effectively demonstrate the character of the groundwater system and its current status, and notably the continued long-term drawdown of the watertable. It was agreed that 3D visualisation was an ideal tool to achieve this. The Groundwater Visualisation System (GVS) developed at QUT was utilised and the visualisation model developed in conjunction with DERM to achieve a planning-management tool for this particular application

Raised Floor System applications for refurbishing office spaces

While raised floors as a building component has been around since the 70's, its application in terms of a holistic system in the fit-out of commercial office buildings has not been fully embraced due to some inherent problems and negative perceptions of the stakeholders involved. Today, the new generation of raised floor systems(RFS) offers a suite of innovative and integrated products and solutions, and as such are not only suitable for the changing office space requirements, but also capable of meeting tbe smart and sustainable challenges, which are becoming the prerequisite in the refurbishment of existing buildings. As there has been a prediction for continued growth in refurbishment projects in major cities around the globe, RFS as an alternative methodology warrants new examination and highlight. This paper introduces research recently completed in Australia that provided a holistic approach to the application of RFS enabled by intelligent building technologies, and examined key issues of project development when refurbishing commercial office buildings. It focuses on the constructability of RFS, and how it will respond to smart feature requirements in buildings while extending service life, meeting new organisational change and workplace health needs for applications in today's office environment. It also introduces key project procurement issues and the integrated decision support when dealing with the refurbishment of office buildings. The paper recommends procurement strategies as well as the justification of adopting the RFS technology in the Australian office building sector. Given the current economic downturn, refitting as opposed to new build .projects will come onto the spotlight. This paper will provide valuable information for building owners and developers alike when contemplating the retrofit of office buildings.

Managing driver fatigue : education or motivation?

Fatigue has been recognised as the primary contributing factor in approximately 15% of all fatal road crashes in Australia. To develop effective countermeasures for managing fatigue, this study investigates why drivers continue to drive when sleepy, and driver perceptions and behaviours in regards to countermeasures. Based on responses from 305 Australian drivers, it was identified that the major reasons why these participants continued to drive when sleepy were: wanting to get to their destination; being close to home; and time factors. Participants’ perceptions and use of 18 fatigue countermeasures were investigated. It was found that participants perceived the safest strategies, including stopping and sleeping, swapping drivers and stopping for a quick nap, to be the most effective countermeasures. However, it appeared that their knowledge of safe countermeasures did not translate into their use of these strategies. For example, although the drivers perceived stopping for a quick nap to be an effective countermeasure, they reported more frequent use of less safe methods such as stopping to eat or drink and winding down the window. This finding suggests that, while practitioners should continue educating drivers, they may need a greater focus on motivating drivers to implement safe fatigue countermeasures.

The role of bricolage and resource constraints in high potential sustainability ventures

Sustainability decisions and their impacts may be among the greatest challenges facing the world in the 21st century (Davos 2000). Apart from adaptation on the part of established organizations these challenges are arguably going to require solutions developed by new actors However, young ventures have only recently begun generating research interest within sustainability literature (Shepherd et al. 2009). In particular, little is known about resource behaviours of these ventures and how they adapt to substantial resource constraints. One promising theory that has been identified as a way that some entrepreneurs manage constraints is bricolage: a construct defined as “making do by applying combinations of the resources at hand to new problems and opportunities” (Baker and Nelson 2005: 333). Bricolage may be critical as the means of continued venture success as these ventures are frequently developed in severe resource constraint, owing to higher levels of technical sophistication (Rothaermel and Deeds 2006). Further, they are often developed by entrepreneurs committed to personal and social goals of resourcefulness, including values that focus on conservation rather than consumption of resources (Shepherd et al. 2009). In this paper, using seven novel cases of high potential sustainability firms from CAUSEE we consider how constraints impact resource behaviours and further illustrate and extend bricolage domains previously developed by Baker and Nelson (2005) with recommendations for theory and practice provided.

A two-compartment mechanochemical model of the roles of transforming growth factor-beta and tissue tension in dermal wound healing

The repair of dermal tissue is a complex process of interconnected phenomena, where cellular, chemical and mechanical aspects all play a role, both in an autocrine and in a paracrine fashion. Recent experimental results have shown that transforming growth factor-beta (TGF-beta) and tissue mechanics play roles in regulating cell proliferation, differentiation and the production of extracellular materials. We have developed a 1D mathematical model that considers the interaction between the cellular, chemical and mechanical phenomena, allowing the combination of TGF-beta and tissue stress to inform the activation of fibroblasts to myofibroblasts. Additionally, our model incorporates the observed feature of residual stress by considering the changing zero-stress state in the formulation for effective strain. Using this model, we predict that the continued presence of TGF-beta in dermal wounds will produce contractures due to the persistence of myofibroblasts; in contrast, early elimination of TGF-beta significantly reduces the myofibroblast numbers resulting in an increase in wound size. Similar results were obtained by varying the rate at which fibroblasts differentiate to myofibroblasts and by changing the myofibroblast apoptotic rate. Taken together, the implication is that elevated levels of myofibroblasts is the key factor behind wounds healing with excessive contraction, suggesting that clinical strategies which aim to reduce the myofibroblast density may reduce the appearance of contractures.

Population-based survival estimates for childhood cancer in Australia during the period 1997–2006

Background: This study provides the latest available relative survival data for Australian childhood cancer patients. Methods: Data from the population-based Australian Paediatric Cancer Registry were used to describe relative survival outcomes using the period method for 11 903 children diagnosed with cancer between 1983 and 2006 and prevalent at any time between 1997 and 2006. Results: The overall relative survival was 90.4% after 1 year, 79.5% after 5 years and 74.7% after 20 years. Where information onstage at diagnosis was available (lymphomas, neuroblastoma, renal tumours and rhabdomyosarcomas), survival was significantly poorer for more-advanced stage. Survival was lower among infants compared with other children for those diagnosed with leukaemia, tumours of the central nervous system and renal tumours but higher for neuroblastoma. Recent improvements in overall childhood cancer survival over time are mainly because of improvements among leukaemia patients. Conclusion: The high and improving survival prognosis for children diagnosed with cancer in Australia is consistent with various international estimates. However, a 5-year survival estimate of 79% still means that many children who are diagnosed with cancer will die within 5 years, whereas others have long-term health morbidities and complications associated with their treatments. It is hoped that continued developments in treatment protocols will result in further improvements in survival.

Carbon capture and storage laws in Australia : project facilitation or a precautionary approach?

Carbon capture and storage (CCS) is considered to be an integral transitionary measure in the mitigation of the global greenhouse gas emissions from our continued use of fossil fuels. Regulatory frameworks have been developed around the world and pilot projects have been commenced. However, CCS processes are largely untested at commercial scales and there are many unknowns associated with the long terms risks from these storage projects. Governments, including Australia, are struggling to develop appropriate, yet commercially viable, regulatory approaches to manage the uncertain long term risks of CCS activities. There have been numerous CCS regimes passed at the Federal, State and Territory levels in Australia. All adopt a different approach to the delicate balance facilitating projects and managing risk. This paper will examine the relatively new onshore and offshore regimes for CCS in Australia and the legal issues arising in relation to the implementation of CCS projects. Comparisons will be made with the EU CCS Directive where appropriate.