The case for routine cervical mediastinoscopy prior to radical surgery for malignant pleural mesothelioma

Objectives: To assess whether cervical mediastinoscopy is necessary before radical resection of malignant pleural mesothelioma (MPM). Methods: Patients who underwent radical excision of MPM in a 48-month period were prospectively followed for evidence of disease recurrence and death. Histological evidence of extra pleural lymph node metastases was correlated with survival. Lymph node size at intraoperative lymphadenectomy was correlated with the presence of metastatic tumour. Results: The 55 patients who underwent radical resection (51 extra pleural pneumonectomies and 4 radical pleurectomies) comprised 50 men and 5 women with a median age of 58 years, range 41-70. Histological examination revealed 50 epithelioid, four biphasic and one sarcomatoid histology. Postoperative IMIG T stage was stage I 4, II 11, III 30 and IV 10. Postoperatively the 17 patients with metastases to the extra pleural lymph nodes had significantly shorter survival (median 4.4 months, 95% CI 3.2-5.4) than those without (median survival 16.3 months, 95% CI 11.6-21.0) P=0.012 Kaplan-Meier analysis. Seventy-seven extra pleural lymph nodes without metastases were measured with a mean long axis diameter of 16.9 mm (range 4-55) ; 22 positive nodes had a mean long axis diameter of 15.2 mm (range 6-30). In 15 of the 17 patients with positive extra pleural nodes, the nodes could have been biopsied at cervical mediastinoscopy. Conclusions: This study confirms that extra pleural nodal metastases are related to poor survival. Pathological nodal involvement cannot be predicted from nodal dimensions. These data suggest that all patients being considered for radical resection of MPM should preferentially undergo preoperative cervical mediastinoscopy irrespective of radiological findings. © 2003 Elsevier B.V. All rights reserved.

Long-term effect of childhood liver transplantation on body cell mass

Malnutrition is common in end-stage liver disease, but a correction after transplantation is expected. Body cell mass (BCM) assessment using total body potassium (TBK) measurements is considered the gold standard for assessing nutritional status. The aim of this study was to examine the BCM and, therefore, nutritional status of long-term survivors after childhood liver transplantation. © 2014 American Association for the Study of Liver Diseases.

Implementation of an integrated, technology-based, discovery mode assessment item involving an incubation period to enhance learning outcomes for engineering maths students

In this paper we discuss our current efforts to develop and implement an exploratory, discovery mode assessment item into the total learning and assessment profile for a target group of about 100 second level engineering mathematics students. The assessment item under development is composed of 2 parts, namely, a set of "pre-lab" homework problems (which focus on relevant prior mathematical knowledge, concepts and skills), and complementary computing laboratory exercises which are undertaken within a fixed (1 hour) time frame. In particular, the computing exercises exploit the algebraic manipulation and visualisation capabilities of the symbolic algebra package MAPLE, with the aim of promoting understanding of certain mathematical concepts and skills via visual and intuitive reasoning, rather than a formal or rigorous approach. The assessment task we are developing is aimed at providing students with a significant learning experience, in addition to providing feedback on their individual knowledge and skills. To this end, a noteworthy feature of the scheme is that marks awarded for the laboratory work are primarily based on the extent to which reflective, critical thinking is demonstrated, rather than the amount of CBE-style tasks completed by the student within the allowed time. With regard to student learning outcomes, a novel and potentially critical feature of our scheme is that the assessment task is designed to be intimately linked to the overall course content, in that it aims to introduce important concepts and skills (via individual student exploration) which will be revisited somewhat later in the pedagogically more restrictive formal lecture component of the course (typically a large group plenary format). Furthermore, the time delay involved, or "incubation period", is also a deliberate design feature: it is intended to allow students the opportunity to undergo potentially important internal re-adjustments in their understanding, before being exposed to lectures on related course content which are invariably delivered in a more condensed, formal and mathematically rigorous manner. In our presentation, we will discuss in more detail our motivation and rationale for trailing such a scheme for the targeted student group. Some of the advantages and disadvantages of our approach (as we perceived them at the initial stages) will also be enumerated. In a companion paper, the theoretical framework for our approach will be more fully elaborated, and measures of student learning outcomes (as obtained from eg. student provided feedback) will be discussed.

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.

Effectiveness of nurse-led preoperative assessment services for elective surgery : a systematic review

Background--The admission and assessment of patients for elective procedures is a task faced by all healthcare organisations that provide elective surgical services. Several different strategies have been used to facilitate the management of these tasks. Nurse-led preadmission clinics or services have been implemented in many health services as one of these management strategies; however their effectiveness has not been established. Objectives--The objective of this review was to examine the available research on the effectiveness of nurse-led elective surgery preoperative assessment clinics or services on patient outcomes.--Results--Of the 19 included articles, there were 10 audits of patient and hospital data, 3 surveys or questionnaires, 3 descriptive studies, 1 action research design, 1 prospective observational study and 1 RCT. Five of ten studies reporting data on cancellations rates found that nurse-led preadmission services reduced the number of day-of-surgery cancellations. Non-attendance for surgery was also reduced, with nine studies reporting decreases in the number of patients failing to attend. Eight studies reporting data on patient or parent satisfaction found high levels of satisfaction with nurse-led preadmission services. Three of four studies investigating the effect of the nurse-led preadmission service on patient anxiety found a reduction in reported anxiety levels. Three studies found that preoperative preparation was enhanced by the use of a nurse-led preadmission service.--Conclusions--While all included studies reported evidence of effectiveness for nurse-led preadmission services on a wide range of outcomes for elective surgery patients, the lack of experimental trials means that the level of evidence is low, and further research is needed.--Implications for practice--Nurse-led preadmission services may be an effective strategy for reducing procedural cancellations, failure to attend for procedures, and patient anxiety, however currently the evidence level is low.

Ovine Enzootic Abortion (OEA): a comparison of antibody responses in vaccinated and naturally-infected swiss sheep over a two year period

Background Prevention and control of ovine enzootic abortion (OEA) can be achieved by application of a live vaccine. In this study, five sheep flocks with different vaccination and infection status were serologically tested using a competitive enzyme-linked immunosorbent assay (cELISA) specific for Chlamydophila (Cp.) abortus over a two-year time period. Results Sheep in Flock A with recent OEA history had high antibody values after vaccination similar to Flock C with natural Cp. abortus infections. In contrast, OEA serology negative sheep (Flock E) showed individual animal-specific immunoreactions after vaccination. Antibody levels of vaccinated ewes in Flock B ranged from negative to positive two and three years after vaccination, respectively. Positive antibody values in the negative control Flock D (without OEA or vaccination) are probably due to asymptomatic intestinal infections with Cp. abortus. Excretion of the attenuated strain of Cp. abortus used in the live vaccine through the eye was not observed in vaccinated animals of Flock E. Conclusion The findings of our study indicate that, using serology, no distinction can be made between vaccinated and naturally infected sheep. As a result, confirmation of a negative OEA status in vaccinated animals by serology cannot be determined.

Caring for women suffering depression in the postnatal period

The research and theoretical perspectives that underpin knowledge of depression in the postnatal period have tended to rely on standardized measures and 'objective' data which combine to disempower women's individual experiences. From a feminist perspective, contradictions exist between women's accounts of the early days and months following childbirth and the diagnosis of postnatal depression made by some health professionals. A framework for nursing care that uses the strengths of feminist and cognitive therapies is suggested. From this feminist-cognitive perspective, mental health nursing care will provide opportunities for women suffering depression to debrief the experience of birth and pregnancy, manage conflicts about identity, gain a sense of survival, and develop a new perspective.

Mothers' sleep and driving in the postpartum period

Introduction: Previous studies investigating mothers’ sleep in the postpartum period commonly demonstrated elevated levels of sleepiness in this population. A Karolinska Sleepiness Scale (KSS) rating of 5 or above is associated with an exponential increase in vehicle crash risk. To date, no studies have investigated the relationship between mothers’ sleep in the postpartum period and their driving behaviour. Methods: Sleep-wake diary data was collected from 14 mother-infant dyads during two 7-day assessment periods when the infants were 6 and 12 weeks old. The mothers’ indicated all driving episodes during these weeks and their respective sleepiness level using the KSS. Semi-structured interviews were conducted with the mothers when their infant was 12 weeks old. Results: The infants slept significantly more than their mothers at 6 weeks and 12 weeks of age. During both time points, mothers and infants had a similar number of night awakenings (waking between 22:00 and 06:00), with some mothers experiencing greater than 19 awakenings over 7 nights. Notably, 36% of the mothers did not experience a continuous sleep period longer than 4.5 hours when their infant was 6 weeks old. A total of 141 driving episodes were reported during the 7 day assessment period when the infants were 6 weeks old. Over 50% of the driving episodes were denoted with a KSS score of 5 or above. Strategies mothers cited they employed during this period included only driving when feeling alert, postponing driving until another person is present, and driving in the morning when less sleepy. Conclusion: Mothers are experiencing disrupted sleep at night and some mothers do not obtain more than 4.5 hours of continuous sleep during the early postpartum weeks. In this sample, some mothers reported self-regulating driving behaviour, however over half of the driving episodes were undertaken with a sleepiness rating linked with elevated crash risk.

Were regulatory changes in reporting "abnormal items" justified? : evidence of intra-period classificatory earnings management practices in Australia

Purpose Managers generally have discretion in determining how components of earnings are presented in financial statements in distinguishing between ‘normal’ earnings and items classified as unusual, special, significant, exceptional or abnormal. Prior research has found that such intra-period classificatory choice is used as a form of earnings management. Prior to 2001, Australian accounting standards mandated that unusually large items of revenue and expense be classified as ‘abnormal items’ for financial reporting, but this classification was removed from accounting standards from 2001. This move by the regulators was partly in response to concerns that the abnormal classification was being used opportunistically to manage reported pre-abnormal earnings. This study extends the earnings management literature by examining the reporting of abnormal items for evidence of intra-period classificatory earnings management in the unique Australian setting. Design/methodology/approach This study investigates associations between reporting of abnormal items and incentives in the form of analyst following and the earnings benchmarks of analysts’ forecasts, earnings levels, and earnings changes, for a sample of Australian top-500 firms for the seven-year period from 1994 to 2000. Findings The findings suggest there are systematic differences between firms reporting abnormal items and those with no abnormal items. Results show evidence that, on average, firms shifted expense items from pre-abnormal earnings to bottom line net income through reclassification as abnormal losses. Originality/value These findings suggest that the standard setters were justified in removing the ‘abnormal’ classification from the accounting standard. However, it cannot be assumed that all firms acted opportunistically in the classification of items as abnormal. With the removal of the standardised classification of items outside normal operations as ‘abnormal’, firms lost the opportunity to use such disclosures as a signalling device, with the consequential effect of limiting the scope of effectively communicating information about the nature of items presented in financial reports.

Persistent digital hyperthermia over a 48 h period does not induce laminitis in horses

Persistent digital hyperthermia, presumably due to vasodilation, occurs during the developmental and acute stages of insulin-induced laminitis. The objectives of this study were to determine if persistent digital hyperthermia is the principal pathogenic mechanism responsible for the development of laminitis. The potent vasodilator, ATP-MgCl 2 was infused continuously into the distal phalanx of the left forefoot of six Standardbred racehorses for 48h via intra-osseous infusion to promote persistent digital hyperthermia. The right forefoot was infused with saline solution and acted as an internal control. Clinical signs of lameness at the walk were not detected at 0h, 24h or 48h post-infusion. Mean±SE hoof wall temperatures of the left forefoot (29.4±0.25°C) were higher (P<0.05) than those on the right (27.5±0.38°C). Serum insulin (15.0±2.89μIU/mL) and blood glucose (5.4±0.22mM) concentrations remained unchanged during the experiment. Histopathological evidence of laminitis was not detected in any horse. The results demonstrated that digital vasodilation up to 30 °C for a period of 48. h does not trigger laminitis in the absence of hyperinsulinaemia. Thus, although digital hyperthermia may play a role in the pathogenesis of laminitis, it is not the sole mechanism involved.

Explaining Gendered Sentencing Patterns for Men and Women in the Late Victorian Period

Contemporary studies of disparities in the sentencing of male and female offenders claim that the differences found are caused by gender-related contextual factors, but not by a gender bias. In contrast, historical studies have suggested that women were disadvantaged by appearing to offend both against the law and the conventions of femininity. This article analyses minor assaults prosecuted in ten English magistrates’ courts between 1880 and 1920. It is based on a data-set that combines court cases and newspaper reports, and allows for the control of gender differences in sentencing outcomes through four contextual factors: severity of the assault, bonds between victim and assailant, culpability, and evidence. The findings reveal a differentiated pattern of sentences that questions the assumption that ‘doubly deviant’ women were more often convicted, and received higher penalties, throughout the Victorian period. The results show that the contextual factors of the offence affected judicial decision-making to the extent that they virtually account for gender differences in conviction rates, but do not, on their own, account for the different penalties handed out to men and women. Women who committed similar assaults to men were likely to receive a lighter punishment. Magistrates clearly targeted ‘male’ contexts of violence, and handed down more convictions and harsher penalties to men involved in these, in contrast to women involved in 'female' contexts. The findings of a strong gender bias in sentencing that disadvantaged lowerclass men indicate that local magistrates directed their efforts of 'civilizing' lower-class communities at 'dangerous masculinities', and deemed assaults committed by women as less important in this task.

Four years on – are the Gazelles still running? A longitudinal study of firm performance after a period of rapid growth

Gazelles, or very rapidly growing firms, are important because they contribute disproportionately to economic growth. There is a concern that some of these firms pursue growth too aggressively resulting in lower subsequent performance. We investigate the relationship between growth and subsequent profitability for gazelle firms, and how this is moderated by firm strategy. Previous empirical research regarding the growth-profitability relationship for firms in general is rather inconclusive, with only one study specifically investigating gazelle firms. Likewise, there are theoretical arguments both for and against growth leading to profitability that equally apply to gazelle firms. Further, while contingency theory might suggest the relationship depends on the firm’s strategy, earlier studies have not investigated this relationship. We address these questions using longitudinal data (seven years) for a sample of 964 Danish Gazelle firms. Our study finds a clear positive relationship between growth and subsequent profitability among gazelle firms. Moreover, this relationship is stronger for firms pursuing a broad market strategy rather than a focus or niche strategy. An important managerial implication is that the growth strategy should be clearly integrated with the general strategic orientation of the firm.