Current aspects and future prospects of total anorectal reconstruction - a critical and comprehensive review of the literature

PURPOSE: Many rectal cancer patients undergo abdominoperineal excision worldwide every year. Various procedures to restore perineal (pseudo-) continence, referred to as total anorectal reconstruction, have been proposed. The best technique, however, has not yet been defined. In this study, the different reconstruction techniques with regard to morbidity, functional outcome and quality of life were analysed. Technical and timing issues (i.e. whether the definitive procedure should be performed synchronously or be delayed), oncological safety, economical aspects as well as possible future improvements are further discussed. METHODS: A MEDLINE and EMBASE search was conducted to identify the pertinent multilingual literature between 1989 and 2013. All publications meeting the defined inclusion/exclusion criteria were eligible for analysis. RESULTS: Dynamic graciloplasty, artificial bowel sphincter, circular smooth muscle cuff or gluteoplasty result in median resting and squeezing neo-anal pressures that equate to the measurements found in incontinent patients. However, quality of life was generally stated to be good by patients who had undergone the procedures, despite imperfect continence, faecal evacuation problems and a considerable associated morbidity. Many patients developed an alternative perception for the urge to defecate that decisively improved functional outcome. Theoretical calculations suggested cost-effectiveness of total anorectal reconstruction compared well to life with a permanent colostomy. CONCLUSIONS: Many patients would be highly motivated to have their abdominal replaced by a functional perineal colostomy. Given the considerable morbidity and questionable functional outcome of current reconstruction technique improvements are required. Tissue engineering might be an option to design an anatomically and physiologically matured, and customised continence organ.

Challenges in improving the safety of learner motorcyclists

Inexperience has been shown to be a major factor in many motorcycle crashes worldwide. Learner motorcyclists are not protected from the risks of the on-road environment to the same extent as learner car drivers. Whilst the learner stage has consistently been shown to be the safest phase for car drivers and the provisional stage to be the most dangerous, data from several Australian states has shown similar numbers of learner and provisionally licensed motorcyclists in crashes. This paper reports a review of learner rider safety research undertaken to inform potential future improvements to the licensing and training system in Queensland, Australia.

Driving for work : a series of organisational audit results

Previous research has indicated that road crashes are the most common form of work related fatalities (Haworth et al., 2000). Historically, industry has often taken a “silver bullet” approach developing and implementing a single countermeasure to address all their work related road safety issues, despite legislative requirements to discharge obligations through minimising risk and enhancing safety. This paper describes the results and implications from a series of work related road safety audits that were undertaken across five organisations to determine deficiencies in each organisation‟s safe driving management and practice. Researchers conducted a series of structured interviews, reviewed documentation relating to work related driving, and analysed vehicle related crash and incident records to determine each organisation‟s current situation in the management of work related road safety and driver behaviour. A number of consistent themes and issues across each organisation were identified relating to managing driver behaviour, organisational policies, incident recording and reporting, communication and education, and formalisation of key work related road safety strategies. Although organisations are required to undertake risk reduction strategies for all work related driving, the results of the research suggest that many organisations fail to systematically manage driver behaviour and mitigate work related road safety risk. Future improvements in work related road safety will require organisations to firstly acknowledge the high risk associated with drivers driving for work and secondly adopt comprehensive risk mitigation strategies in a similar manner to managing other workplace hazards.

Designing a continuum of quality external cause of injury information in Queensland : from ambulance to hospital

This study is the first to employ an epidemiological framework to evaluate the ‘fit-for-purpose’ of ICD-10-AM external cause of injury codes, ambulance and hospital clinical documentation for injury surveillance. Importantly, this thesis develops an evidence-based platform to guide future improvements in routine data collections used to inform the design of effective injury prevention strategies. Quantification of the impact of ambulance clinical records on the overall information quality of Queensland hospital morbidity data collections for injury causal information is a unique and notable contribution of this study.

User-centred study on quality of mobile video services

Mobile video, as an emerging market and a promising research field, has attracted much attention from both industry and researchers. Considering the quality of user-experience as the crux of mobile video services, this chapter aims to provide a guide to user-centered studies of mobile video quality. This will benefit future research in better understanding user needs and experiences, designing effective research, and providing solid solutions to improve the quality of mobile video. This chapter is organized in three main parts: (1) a review of recent user studies from the perspectives of research focuses, user study methods, and data analysis methods; (2) an example of conducting a user study of mobile video research, together with the discussion on a series of relative issues, such as participants, materials and devices, study procedure, and analysis results, and; (3) a conclusion with an open discussion about challenges and opportunities in mobile video related research, and associated potential future improvements.

Teaching and Assessing Reflective Writing in a Large Undergraduate Core Substantive Law Unit

The focus of higher education has shifted towards building students’ skills and self-awareness for future employment, in addition to developing substantive discipline knowledge. This means that there is an increasing need for embedding approaches to teaching and learning which provide a context for skills development and opportunities for students to prepare for the transition from legal education to professional practice. This chapter reports on a large (500-600 students) core undergraduate Equity law unit in an Australian University. ePortfolio has been embedded in Equity as a means of enabling students to document their reflections on their skill development in that unit. Students are taught, practice and are assessed on their teamwork and letter writing skills in the context of writing a letter of advice to a fictional client in response to a real world problem. Following submission of the team letter, students are asked to reflect on their skill development and document their reflections in ePortfolio. A scaffolded approach to teaching reflective writing is adopted using a blended model of delivery which combines face to face lectures and online resources, including an online module, facts sheets designed to guide students through the process of reflection by following the TARL model of reflection, and exemplars of reflective writing. Although students have engaged in the process of reflective writing in Equity for some years, in semester one 2011 assessment criteria were developed and the ePortfolio reflections were summatively assessed for the first time. The model of teaching and assessing reflective practice was evaluated in a range of ways by seeking feedback from students and academic staff responsible for implementing the model and asking them to reflect on their experiences. This chapter describes why skill development and reflective writing were embedded in the undergraduate law unit Equity; identify the teaching and learning approaches which were implemented to teach reflective writing to online and internal Equity students; explain the assessment processes; analyse the empirical evidence from evaluations; document the lessons learnt and discuss planned future improvements to the teaching and assessment strategies.

Interactions between rotation breaks, tillage and N management on sugarcane grown at Bundaberg and Ingham.

The impact of cropping histories (sugarcane, maize and soybean), tillage practices (conventional tillage and direct drill) and fertiliser N in the plant and 1st ratoon (1R) crops of sugarcane were examined in field trials at Bundaberg and Ingham. Average yields at Ingham (Q200) and Bundaberg (Q151) were quite similar in both the plant crop (83 t/ha and 80 t/ha, respectively) and the 1R (89 t/ha v 94 t/ha, respectively), with only minor treatment effects on CCS at each site. Cane yield responses to tillage, break history and N fertiliser varied significantly between sites. There was a 27% yield increase in the plant crop from the soybean fallow at Ingham, with soybeans producing a yield advantage over continuous cane, but there were no clear break effects at Bundaberg - possibly due to a complex of pathogenic nematodes that responded differently to soybeans and maize breaks. There was no carryover benefit of the soybean break into the 1R crop at Ingham, while at Bundaberg the maize break produced a 15% yield advantage over soybeans and continuous cane. The Ingham site recorded positive responses to N fertiliser addition in both the plant (20% yield increase) and 1R (34% yield increase) crops, but there was negligible carryover benefit from plant crop N in the 1R crop, or of a reduced N response after a soybean rotation. By contrast, the Bundaberg site showed no N response in any history in the plant crop, and only a small (5%) yield increase with N applied in the 1R crop. There was again no evidence of a reduced N response in the 1R crop after a soybean fallow. There were no significant effects of tillage on cane yields at either site, although there were some minor interactions between tillage, breaks and N management in the 1R crop at both sites. Crop N contents at Bundaberg were more than 3 times those recorded at Ingham in both the plant and 1R crops, with N concentrations in millable stalk at Ingham suggesting N deficiencies in all treatments. There was negligible additional N recovered in crop biomass from N fertiliser application or soybean residues at the Ingham site. There was additional N recovered in crop biomass in response to N fertiliser and soybean breaks at Bundaberg, but effects were small and fertiliser use efficiencies poor. Loss pathways could not be quantified, but denitrification or losses in runoff were the likely causes at Ingham while leaching predominated at Bundaberg. Results highlight the complexity involved in developing sustainable farming systems for contrasting soil types and climatic conditions. A better understanding of key sugarcane pathogens and their host range, as well as improved capacity to predict in-crop N mineralisation, will be key factors in future improvements to sugarcane farming systems.

AQUAMAN: a web-based decision support system for irrigation scheduling in peanuts

Peanut (Arachis hypogaea L.) is an economically important legume crop in irrigated production areas of northern Australia. Although the potential pod yield of the crop in these areas is about 8 t ha(-1), most growers generally obtain around 5 t ha(-1), partly due to poor irrigation management. Better information and tools that are easy to use, accurate, and cost-effective are therefore needed to help local peanut growers improve irrigation management. This paper introduces a new web-based decision support system called AQUAMAN that was developed to assist Australian peanut growers schedule irrigations. It simulates the timing and depth of future irrigations by combining procedures from the food and agriculture organization (FAO) guidelines for irrigation scheduling (FAO-56) with those of the agricultural production systems simulator (APSIM) modeling framework. Here, we present a description of AQUAMAN and results of a series of activities (i.e., extension activities, case studies, and a survey) that were conducted to assess its level of acceptance among Australian peanut growers, obtain feedback for future improvements, and evaluate its performance. Application of the tool for scheduling irrigations of commercial peanut farms since its release in 2004-2005 has shown good acceptance by local peanuts growers and potential for significantly improving yield. Limited comparison with the farmer practice of matching the pan evaporation demand during rain-free periods in 2006-2007 and 2008-2009 suggested that AQUAMAN enabled irrigation water savings of up to 50% and the realization of enhanced water and irrigation use efficiencies.

Residue specific contributions to stability and activity inferred from saturation mutagenesis and deep sequencing

Multiple methods currently exist for rapid construction and screening of single-site saturation mutagenesis (SSM) libraries in which every codon or nucleotide in a DNA fragment is individually randomized. Nucleotide sequences of each library member before and after screening or selection can be obtained through deep sequencing. The relative enrichment of each mutant at each position provides information on its contribution to protein activity or ligand-binding under the conditions of the screen. Such saturation scans have been applied to diverse proteins to delineate hot-spot residues, stability determinants, and for comprehensive fitness estimates. The data have been used to design proteins with enhanced stability, activity and altered specificity relative to wild-type, to test computational predictions of binding affinity, and for protein model discrimination. Future improvements in deep sequencing read lengths and accuracy should allow comprehensive studies of epistatic effects, of combinational variation at multiple sites, and identification of spatially proximate residues.

Beyond the blur: Construction and characterization of the first autonomous AO system and An AO survey of magnetar proper motions

Adaptive optics (AO) corrects distortions created by atmospheric turbulence and delivers diffraction-limited images on ground-based telescopes. The vastly improved spatial resolution and sensitivity has been utilized for studying everything from the magnetic fields of sunspots upto the internal dynamics of high-redshift galaxies. This thesis about AO science from small and large telescopes is divided into two parts: Robo-AO and magnetar kinematics.

In the first part, I discuss the construction and performance of the world’s first fully autonomous visible light AO system, Robo-AO, at the Palomar 60-inch telescope. Robo-AO operates extremely efficiently with an overhead < 50s, typically observing about 22 targets every hour. We have performed large AO programs observing a total of over 7,500 targets since May 2012. In the visible band, the images have a Strehl ratio of about 10% and achieve a contrast of upto 6 magnitudes at a separation of 1′′. The full-width at half maximum achieved is 110–130 milli-arcsecond. I describe how Robo-AO is used to constrain the evolutionary models of low-mass pre-main-sequence stars by measuring resolved spectral energy distributions of stellar multiples in the visible band, more than doubling the current sample. I conclude this part with a discussion of possible future improvements to the Robo-AO system.

In the second part, I describe a study of magnetar kinematics using high-resolution near-infrared (NIR) AO imaging from the 10-meter Keck II telescope. Measuring the proper motions of five magnetars with a precision of upto 0.7 milli-arcsecond/yr, we have more than tripled the previously known sample of magnetar proper motions and proved that magnetar kinematics are equivalent to those of radio pulsars. We conclusively showed that SGR 1900+14 and SGR 1806-20 were ejected from the stellar clusters with which they were traditionally associated. The inferred kinematic ages of these two magnetars are 6±1.8 kyr and 650±300 yr respectively. These ages are a factor of three to four times greater than their respective characteristic ages. The calculated braking index is close to unity as compared to three for the vacuum dipole model and 2.5-2.8 as measured for young pulsars. I conclude this section by describing a search for NIR counterparts of new magnetars and a future promise of polarimetric investigation of a magnetars’ NIR emission mechanism.

Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa: A Systematic Review

Paper published in PLoS Medicine in 2007.

Evaluating the SEVIRI Fire Thermal Anomaly Detection Algorithm across the Central African Republic Using the MODIS Active Fire Product

Satellite-based remote sensing of active fires is the only practical way to consistently and continuously monitor diurnal fluctuations in biomass burning from regional, to continental, to global scales. Failure to understand, quantify, and communicate the performance of an active fire detection algorithm, however, can lead to improper interpretations of the spatiotemporal distribution of biomass burning, and flawed estimates of fuel consumption and trace gas and aerosol emissions. This work evaluates the performance of the Spinning Enhanced Visible and Infrared Imager (SEVIRI) Fire Thermal Anomaly (FTA) detection algorithm using seven months of active fire pixels detected by the Moderate Resolution Imaging Spectroradiometer (MODIS) across the Central African Republic (CAR). Results indicate that the omission rate of the SEVIRI FTA detection algorithm relative to MODIS varies spatially across the CAR, ranging from 25% in the south to 74% in the east. In the absence of confounding artifacts such as sunglint, uncertainties in the background thermal characterization, and cloud cover, the regional variation in SEVIRI's omission rate can be attributed to a coupling between SEVIRI's low spatial resolution detection bias (i.e., the inability to detect fires below a certain size and intensity) and a strong geographic gradient in active fire characteristics across the CAR. SEVIRI's commission rate relative to MODIS increases from 9% when evaluated near MODIS nadir to 53% near the MODIS scene edges, indicating that SEVIRI errors of commission at the MODIS scene edges may not be false alarms but rather true fires that MODIS failed to detect as a result of larger pixel sizes at extreme MODIS scan angles. Results from this work are expected to facilitate (i) future improvements to the SEVIRI FTA detection algorithm; (ii) the assimilation of the SEVIRI and MODIS active fire products; and (iii) the potential inclusion of SEVIRI into a network of geostationary sensors designed to achieve global diurnal active fire monitoring.

Spectroscopy of the type Ia supernova SN 2002er: Days-11 to+215

We present an extensive set of optical spectroscopy of the nearby type Ia supernova, SN 2002er, with 24 epochs spanning -11 to +34 days. Its spectral evolution is fairly typical of a type Ia supernova although it suffers high extinction. Nevertheless, there are differences in the spectral evolution when compared to coeval spectra of other normal type Ia supernova with comparable decline-rate parameters. Modelling of the photospheric phase spectra using a homogeneous abundance distribution in the atmosphere provides a fair match to the observations, but only by pushing the adopted distance and risetime close to the observational limits. Future improvements here will require models with a more realistic stratified abundance distribution. From simple modelling of a nebular spectrum obtained at +215 d, we infer a Ni-56 mass of 0.69 M-circle dot, consistent with that derived from the light curve.

Multi-standard reconfigurable wireless transmitter architectures

The continuous demand for highly efficient wireless transmitter systems has triggered an increased interest in switching mode techniques to handle the required power amplification. The RF carrier amplitude-burst transmitter, i.e. a wireless transmitter chain where a phase-modulated carrier is modulated in amplitude in an on-off mode, according to some prescribed envelope-to-time conversion, such as pulse-width or sigma-delta modulation, constitutes a promising architecture capable of efficiently transmitting signals of highly demanding complex modulation schemes. However, the tested practical implementations present results that are way behind the theoretically advanced promises (perfect linearity and efficiency). My original contribution to knowledge presented in this thesis is the first thorough study and model of the power efficiency and linearity characteristics that can be actually achieved with this architecture. The analysis starts with a brief revision of the theoretical idealized behavior of these switched-mode amplifier systems, followed by the study of the many sources of impairments that appear when the real system is implemented. In particular, a special attention is paid to the dynamic load modulation caused by the often ignored interaction between the narrowband signal reconstruction filter and the usual single-ended switched-mode power amplifier, which, among many other performance impairments, forces a two transistor implementation. The performance of this architecture is clearly explained based on the presented theory, which is supported by simulations and corresponding measured results of a fully working implementation. The drawn conclusions allow the development of a set of design rules for future improvements, one of which is proposed and verified in this thesis. It suggests a significant modification to this traditional architecture, where now the phase modulated carrier is always on – and thus allowing a single transistor implementation – and the amplitude is impressed into the carrier phase according to a bi-phase code.

O discurso do professor no ensino e aprendizagem das equações literais no 8.º ano, no âmbito da experimentação do novo programa de matemática do ensino básico

Relatório da Prática de Ensino Supervisionada, Mestrado em Ensino da Matemática 3.º Ciclo e Secundário, Universidade de Lisboa, 2010