Reasons for referral to bone densitometry in men and women aged 20-49 years : population-based data

Introduction Osteoporosis poses a significant public health problem for ageing Australians. However, approximately 25 % of Australian adults aged 20–49 years have osteopenia, a precursor condition to osteoporosis. Despite this, little is known about bone density testing in this age group.

Methods Reasons for referral to dual energy X-ray absorptiometry (DXA) were examined in 2,264 patients aged 20–49 years, referred in 2001–2010 to the Geelong Bone Densitometry Service, Geelong Hospital, Victoria. Referral reasons were determined from clinical indication codes derived from patient records. Age, sex and bone mineral density (BMD) T scores were ascertained for each patient.

Results The most common reason for referral for women reflected glucocorticoid use, and for men reflected fracture. Compared to women, men were more likely to have been referred because of minimal trauma fracture or low BMD (41.7 versus 27.1 %, p < 0.001). No further differences were identified between the sexes, with similar numbers of referral observed for secondary osteoporosis, and monitoring of drug therapy. At the spine, and for all indications, men had a significantly greater BMD deficit compared to women (all p ≤ 0.002). After age adjustment, men who were tested due to fracture or glucocorticoid reasons had significantly greater BMD at the total hip (p ≤ 0.03). No further associations were seen after age adjustment between referral reason and BMD.

Conclusions Our study presents the first data examining reasons for referral to DXA among Australians aged 20–49 years. Understanding health service utilisation regarding bone health in young adults is fundamental to understanding future risk, informing effective public health messages and raising awareness of osteoporosis.

Winds of change in Myanmar? Implications for international cooperation In poverty alleviation

We are witnessing the beginnings of what could well be significant change in Myanmar. Elections in November 2010 were quickly followed by the release of opposition leader Aung San Suu Kyi, then by the resignation of Senior-General Than Shwe, dissolution of the State Peace and Development Council (SPDC), the opening of parliament, and the inauguration of Thein Sein as President on 30th March 2011. Thein Sein's inauguration speech called for national reconciliation and an end to corruption, promised a more market-oriented economy, and vowed to create employment opportunities. He also pledged to develop the health and education sectors in cooperation with international organisations, and to alleviate poverty. While some fear this may only be rhetoric, a growing number of indications suggest that major political and economic reform may indeed be getting underway. This paper traces these recent developments and the possibility of significantly improved international development cooperation in Myanmar, particularly as it affects the prospects of poverty alleviation efforts and cooperation with Western INGO and multilateral agencies. It analyses the implications of this reform on international development assistance and cooperation from the perspectives of humanitarian needs, international relations theory, development theory, and political philosophy.

The Army and AirSea Battle

The AirSea Battle concept and the Joint Operational Access Concept provide clear indications of the character and purpose of US force development for at least the next decade or so. The strategic competition that underpins these concepts is real , important and accelerating - and is already impacting on Australia. The details of the AirSea Battle concept itself are not that important – all wars reflect their immediate strategic contexts and no forward- leaning concept is ever likely to pass into detailed war, campaign or operation planning. However, the view presented in the concept on the character of future wars between states is important and raises critical questions that need to be answered if Australian force development can claim to be rational. The ADF has a number of views of what ‘conventional’ warfare might look like, if we accept the view taken by AirSea Battle and the JOAC, most of them are wrong. For the Army the future described by, and partially shaped by US preparations for, AirSea Battle offer important signposts to future needs and to the nature of the future operational environment. These signposts don’t tell us what it will be like – simply what some of the influences driving strategic and operational systems seem likely to be. It remains for Army to decide how it should approach the challenges that these drivers will present.

Cost-effectiveness of fiscal policies to prevent obesity

Cost-effective, sustainable strategies are urgently required to curb the global obesity epidemic. To date, fiscal policies such as taxes and subsidies have been driven largely by imperatives to raise revenue or increase supply, rather than to change population behaviours. This paper reviews the economic evaluation literature around the use of fiscal policies to prevent obesity. The cost-effectiveness literature is limited, and more robust economic evaluation studies are required. However, uncertainty and gaps in the effectiveness evidence base need to be addressed first: more studies are needed that collect ‘real-world’ empirical data, and larger studies with more robust designs and longer follow-up timeframes are required. Reliability of cross-price elasticity data needs to be investigated, and greater consideration given to moderators of intervention effects and the sustainability of outcomes. Economic evaluations should adopt a societal perspective, incorporate a broader spectrum of economic costs and consider other factors likely to affect the implementation of fiscal measures. The paucity of recent cost-effectiveness studies means that definitive conclusions about the value for money of fiscal policies for obesity prevention cannot yet be drawn. However, as in other public health areas such as alcohol and tobacco, early indications are that population-level fiscal policies are likely to be potentially effective and cost-saving.

Ecological determinism in Australia : tracing the legacy of McHarg downunder and its key precedents

Ecological planning, as advocated by Ian McHarg, filtered extensively through North America following the publication of Design with Nature (1965). The integrated design and planning approach was also advanced by numerous graduates of McHarg's studios at the University of Pennsylvania where this approach was extensively trialled and proven. While a clear synthesis and theoretical framework was articulated and reinforced through a plethora of projects, monographs, and articles, the majority of these perspectives were North American, lacked clarity about the translation of the approach into legal strategic and statutory planning instruments, nor shed light upon what transpired in Australia. This paper reviews the development of the Conservation Plan created for the southern Mornington peninsula in Victoria, Australia, as well as its intent, structure and internal workings as a successful model of ecological statutory planning, in the context of the wider WPRPA activities that draws directly from the McHarg theory. Known as the Conservation Plan for the southern Mornington Peninsula in Victoria, a revolutionary planning structure devised in the early 1970s by several Australian proponents. The Conservation Plan continues in operation today curating a high scenic valued landscape protecting it from intrusion from the growing metropolitan city of Melbourne thus fulfilling its objectives of landscape quality conservation whilst still permitting sympathetic building and land use growth. Contextually, the Conservation Plan appears to be only statutory equivalent translation of the approach internationally other than the Pinelands Commission planning processes in New Jersey.

Bridging formal and informal learning : a mobile learning attitude scale for higher education

Problem Statement: Over the past decade there has been an increasing global demand towards the integration of mobile technologies for teaching and learning. There has emerged a need for a survey instrument that can form a solid foundation for objective judgment of leaner perspectives as they begin using mobile applications for learning. The Mobile Learning Scale, a seven-item, Likert-type survey instrument, was developed by the authors in response to this need. Items were drawn from the key points developed for a 2011 paper by the authors on mobile learning prospects for informal learning in higher education [13], with many of these points initially developed during group discussions at the 2011 International Summit on ICT in Education hosted at UNESCO Headquarters, Paris, France. Approach: In order to access the performance of the instrument, data were gathered from 81 undergraduate and graduate university students during August and September of 2011. Follow-up data were also gathered from 19 undergraduates in February, 2012. Results: Initial indications are the instrument has good reliability (Alpha = .80 - .85) as well as acceptable content, construct, and criterion-related validity when used with its intended audience. Conclusions/Recommendations: The authors conclude that the Mobile Learning Scale v1.0 performs well as a unidimensional scale that is capable of assessing pre-post gains resulting from a mobile learning intervention within a university course. The authors propose that this new instrument should be useful for helping guide educators in the process of meaningful integration of Mobile Applications (Apps) into teaching and learning, inside and outside the classroom.

Evanescent

Exhibition of original artworks created in 2013. Evanescent is a new series produced in 2013 which premiered at the Castlemaine State Festival 15-24 March 2013. The series revisits a childhood delight and fascination with the projected image and the natural world. For me then, as it is now, a magnifying glass was a wonder; its simple optics twisted light into abstract comas and sci-fi aberrations; able to compact a whole view into a luminous, paradoxically inverted phantom that could fit literally into the palm of my hand. By curling fingers and thumb around the lens and cupping both hands around the elusive rays, and by peering into the space in which I had trapped them, I fancied that I had entered into the secret workings of the eye. Chrysalis, for example, appears as a scenic projection from a hand-held lens and simultaneously as the litter of the forest floor. It is produced with a makeshift camera-obscura. The nebulous silhouettes of trees, some blurred under the passing clouds of a summer wind resolve here and there into crisp lines curled across the surface of a fallen leaf on which a moth chrysalis adheres. The leaf assumes Brobdingnagian proportions and thickness as the evanescent image shrinks and is foreshortened then dissolves in the enlarged dust and grit. It manifests the unique sight anchored at this fixed point, to reveal what we might see if we were to become vegetable or mineral. Near and far, large and small, superimpose, trigonometrically exact in their adjacency and spatial relations, presenting us with a located point of view.Why? I want to understand more intimately the interior of the natural landscape, rather than any ‘scene’ of human presence, or the context of any cultural landmark. In the steep, bush locations in which I am making these images, my means are necessarily makeshift; my camera and an old manual-aperture lens able to be carried in a backpack with a black T-shirt as a 'dark-tent'. The project is not systematic but intuitive and responsive to prevailing conditions and the effect on the projection caused by sun, shade, weather and situation. I am guided by the response of objects, textures and surfaces to the projected image and how they modulate and map it. This is landscape, but not from a human point of view.

Introducing a mobile learning attitude scale for higher education

The Mobile Learning Scale v1 .0 consists of seven Likert items drawn from the key points developed for a paper on mobile learning prospects for informal learning in higher education (Khaddage & Knezek, 2011 ). Many of these points had been initially developed during the 2011 International Summit on ICT in Education (UNESCO, Paris, 2011 ), where the first author was Rapporteur for the working group Co-Chaired by the second author. In order to assess the performance of the instrument, data were gathered from 81 undergraduate and graduate university students during August and September of 2011. Data were assessed for strength of agreement on individual items and for internal consistency reliability of the seven item-scale. Initial indications are that the instrument has good reliability for university students (Alpha = .85) and can be useful for assessing attitudes toward mobile learning technologies and applications within the intended audience of higher education learners. Potential uses and plans for future research are discussed.

A review of long-distance movements by marine turtles, and the possible role of ocean currents

Sea turtle movements often occur in open-sea unsheltered areas, and are therefore likely to be influenced by major oceanographic processes. Only recently has work started to examine the possible relationships of these movements with dynamic oceanic features, and consequently a clear picture of such interaction is only available in a few cases. Newborn sea turtles are thought to rely on oceanic currents to reach their pelagic nursery habitats. The actual extent and timing of these developmental migrations are known for only a few populations, but these movements probably last several years and range over thousands of km. Large juveniles that have been tracked during their pelagic stage were found to make long-distance movements, sometimes swimming against the prevailing currents. Older juveniles of most species leave the pelagic habitat to recruit to neritic developmental habitats. This is a very poorly documented phase of the sea turtle life-cycle, and the few available indications show that turtles may have to swim actively for enormous distances to counterbalance their previous drift with the current. The course and extent of adult postnesting migrations vary greatly among different turtle species, but two main patterns are evident. Some species, like green, hawksbill and loggerhead turtles, shuttle between the nesting beach and a specific feeding area used for the entire inter-reproductive period. In these cases, individuals swim, rather than drift, to complete their journeys, with possible advection due to currents sometimes helping them to quickly reach their target, but sometimes providing navigational challenges. Other species such as the olive ridley and the leatherback turtle, leave the coastal nesting areas to reach the pelagic environment where they forage, and perform wandering movements. Major oceanographic processes (such as main currents and eddies) have been recently shown to have a remarkable influence on leatherback movements, making it questionable whether these journeys are to be considered migrations or, rather, prolonged stays in vast feeding areas.

Environmental and cultural change on the Mt Eccles lava-flow landscapes of southwest Victoria, Australia

The Gunditjmara people developed a socio-economic system based on the modification of wetland ecosystems associated with the Mt Eccles lava flow primarily for sustainable production and management of the highly nutritious shortfin eel (Anguilla australis). This paper examines the environmental history of these landscapes since their inception about 30 000 years ago, through palaeoecological analysis of sediment cores from associated lakes and swamps, in order to contribute to an understanding of the causes and timing of cultural transformation. Two records cover the whole of the 30 000 year history of the landscape while two others provide evidence of change within the Holocene. A great deal of variation within the landscape is revealed, both temporally and spatially, with opportunities for human exploitation through the whole recorded period. Although most features of the records can be explained by natural landscape development and climate change, some human modification can be suggested from around the Pleistocene—Holocene transition while more obvious indications of management relating to eel aquaculture are evident from about 4000 cal. yr BP that appear to include adaptations to the onset of a drier and more variable climate. The study has implications for the explanation of intensification of settlement in Australia more generally within the mid to late Holocene.

Youth justice: challenges in responding to young people convicted of sexual offences

The clinical and criminological literature on adolescents who have committed sexual offences indicates that a pathologisation of young people and a labelling or overly punitive response is likely to be more harmful than rehabilitative. Accordingly, therapeutic counselling and diversionary schemes are seen as preferable to custodial terms in most instances. For adolescents convicted of sex offences, clinicians identify the benefits of comprehensive therapeutic care which involves family and is sensitive to the young person's context and culture. The benefits of this approach are documented and, although data are limited, indications are that recidivism is reduced where adolescents are provided with specialised counselling to encourage positive and non-abusive behaviours. Yet each jurisdiction experiences difficulties in ensuring the provision of equitable and comprehensive therapeutic services, particularly to regionally or remotely located youth. This paper draws on data from a national study of the services to children and adolescents with sexualised or sexual offending behaviours. With attention to the difficulty in providing services to regionally or remotely located adolescents, this paper identifies challenges around lengthy remand terms, the provision of pre-offence diversionary programs, and the provision of specialised services for young people serving community orders. For example, jurisdictions with the largest geographic service areas face enormous difficulties in providing specialised supervision for community-based orders. At present there are several jurisdictions where regionally and remotely located adolescents may serve the duration of a youth justice order without receiving sepcialised counselling to assist them in modifying their behaviours. The paper identifies the risks where specialised counselling cannot be provided, but also identifies specific initiatives designed to fill these gaps in service provision to youth justice clients. 

Anterior knee symptoms after S-ROM hinge implantation

Purpose: To evaluate the performance of a canal filling hinge device for complex knee arthroplasty. Methods: Thirty-seven (4 primary hinge implantation and 33 revision cases) patients who had undergone arthroplasty with the S-ROM third generation hinge device for a combination of massive bone loss or ligamentous insufficiency were prospectively examined with a minimum of 5-year follow-up. Median age at surgery was 72 years (range: 43 to 87 years). Principal indications included aseptic loosening or massive osteolysis (24 cases), infection (8 cases) and periprosthetic fracture (4 cases). All patients exhibited either grade 2 (N = 12) or grade 3 (N = 25) AORI bone loss or a grade 3 medial ligament deficiency. Results: One patient experienced implant failure (71 months), and one patient suffered late deep infection (36 months). Mean WOMAC score improved from 27 to 62. Four patients required patellar resurfacing for persistent pain. The 5-year survivorship was 86%. Conclusions: While the S-ROM device may offer satisfactory medium term outcome for complex end stage knee disease, we report a high rate of debilitating anterior knee symptoms.

Therapeutic approaches to disease modifying therapy for multiple sclerosis in adults: an Australian and New Zealand perspective: part 1 historical and established therapies

Multiple sclerosis (MS) is a potentially life-changing immune mediated disease of the central nervous system. Until recently, treatment has been largely confined to acute treatment of relapses, symptomatic therapies and rehabilitation. Through persistent efforts of dedicated physicians and scientists around the globe for 160 years, a number of therapies that have an impact on the long term outcome of the disease have emerged over the past 20 years. In this three part series we review the practicalities, benefits and potential hazards of each of the currently available and emerging treatment options for MS. We pay particular attention to ways of abrogating the risks of these therapies and provide advice on the most appropriate indications for using individual therapies. In Part 1 we review the history of the development of MS therapies and its connection with the underlying immunobiology of the disease. The established therapies for MS are reviewed in detail and their current availability and indications in Australia and New Zealand are summarised. We examine the evidence to support their use in the treatment of MS.

The role of lamotrigine in the management of bipolar disorder.

Lamotrigine has emerged with a distinct place in the pharmacological treatment of bipolar disorder, with the potential to treat and prevent bipolar depression, which is the dominant and arguably most disabling and under-treated phase of the illness. This review examines the published clinical trials of lamotrigine in bipolar treatment. While the data supports its tolerability and safety, the strongest evidence for its efficacy lies in the prevention of bipolar depression, with weaker evidence for the treatment of acute bipolar depression, refractory unipolar and bipolar depression, and rapid cycling bipolar disorder. The total number of published well designed trials is small, even the maintenance evidence is derived from two studies. However, this relative inadequacy compares favorably with the alternative treatment options for bipolar depression, which are marked by poor efficacy or risk of polarity switch. The designation of lamotrigine as first-line treatment for bipolar depression prophylaxis should be done in cognizance of this context, and it would seem prudent to await greater evidence of efficacy before designating lamotrigine as first-line treatment for other bipolar indications. Further randomized controlled trials are required to consolidate the available findings and to explore the boundaries of lamotrigine's efficacy, which may encompass the soft spectral disorders.

Pharmacotherapy of bipolar disorder: the role of atypical antipsychotics and experimental strategies.

Bipolar disorder, despite being a common and debilitating illness, has remarkably few pharmacological therapeutic options, the majority of which, with the exception of lithium, have been borrowed from other medical indications. Furthermore the quantity and quality of controlled clinical data are considerably smaller than in conditions of comparable severity and frequency. Not surprisingly, the clinical outcome of bipolar disorder is frequently suboptimal. Fortunately there are a growing number of novel therapeutic options for its treatment such as atypical antipsychotics, calcium channel blockers and omega-3 fatty acids. This paper summarizes some of the data regarding these "experimental" therapeutic options, focusing principally on atypical antipsychotics as these are now widely prescribed in the management of bipolar disorder.