Practice patterns of radiation therapy technology in Australia: Results of a national audit

This article presents the results of a single-day census of radiation therapy (RT) treatment and technology use in Australia. The primary aim of the study was to ascertain patterns of RT practice and technology in use across Australia. These data were primarily collated to inform curriculum development of academic programs, thereby ensuring that training is matched to workforce patterns of practice. Methods: The study design was a census method with all 59 RT centres in Australia being invited to provide quantitative summary data relating to patient case mix and technology use on a randomly selected but common date. Anonymous and demographic-free data were analysed using descriptive statistics. Results: Overall data were provided across all six Australian States by 29 centres of a possible 59, yielding a response rate of 49% and representing a total of 2743 patients. Findings from this study indicate the increasing use of emerging intensity-modulated radiotherapy (IMRT), image fusion and image-guided radiation therapy (IGRT) technology in Australian RT planning and delivery phases. IMRT in particular was used for 37% of patients, indicating a high uptake of the technology in Australia when compared to other published data. The results also highlight the resource-intensive nature of benign tumour radiotherapy. Conclusions: In the absence of routine national data collection, the single-day census method offers a relatively convenient means of measuring and tracking RT resource utilisation. Wider use of this tool has the potential to not only track trends in technology implementation but also inform evidence-based guidelines for referral and resource planning.

Prospective external validation of an accelerated (2-h) acute coronary syndrome rule-out process using a contemporary troponin assay

Background: Recently there have been efforts to derive safe, efficient processes to rule out acute coronary syndrome (ACS) in emergency department (ED) chest pain patients. We aimed to prospectively validate an ACS assessment pathway (the 2-Hour Accelerated Diagnostic Protocol to Assess Patients with Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker (ADAPT) pathway) under pragmatic ED working conditions. Methods: This prospective cohort study included patients with atraumatic chest pain in whom ACS was suspected but who did not have clear evidence of ischaemia on ECG. Thrombolysis in myocardial infarction (TIMI) score and troponin (TnI Ultra) were measured at ED presentation, 2 h later and according to current national recommendations. The primary outcome of interest was the occurrence of major adverse cardiac events (MACE) including prevalent myocardial infarction (MI) at 30 days in the group who had a TIMI score of 0 and had presentation and 2-h TnI assays <99th percentile. Results: Eight hundred and forty patients were studied of whom 177 (21%) had a TIMI score of 0. There were no MI, MACE or revascularization in the per protocol and intention-to-treat 2-h troponin groups (0%, 95% confidence interval (CI) 0% to 4.5% and 0%, 95% CI 0% to 3.8%, respectively). The negative predictive value (NPV) was 100% (95% CI 95.5% to 100%) and 100% (95% CI 96.2% to 100%), respectively. Conclusions: A 2-h accelerated rule-out process for ED chest pain patients using electrocardiography, a TIMI score of 0 and a contemporary sensitive troponin assay accurately identifies a group at very low risk of 30-day MI or MACE.

Development and validation of the Emergency Department Assessment of Chest pain Score and 2h accelerated diagnostic protocol

Objective Risk scores and accelerated diagnostic protocols can identify chest pain patients with low risk of major adverse cardiac event who could be discharged early from the ED, saving time and costs. We aimed to derive and validate a chest pain score and accelerated diagnostic protocol (ADP) that could safely increase the proportion of patients suitable for early discharge. Methods Logistic regression identified statistical predictors for major adverse cardiac events in a derivation cohort. Statistical coefficients were converted to whole numbers to create a score. Clinician feedback was used to improve the clinical plausibility and the usability of the final score (Emergency Department Assessment of Chest pain Score [EDACS]). EDACS was combined with electrocardiogram results and troponin results at 0 and 2 h to develop an ADP (EDACS-ADP). The score and EDACS-ADP were validated and tested for reproducibility in separate cohorts of patients. Results In the derivation (n = 1974) and validation (n = 608) cohorts, the EDACS-ADP classified 42.2% (sensitivity 99.0%, specificity 49.9%) and 51.3% (sensitivity 100.0%, specificity 59.0%) as low risk of major adverse cardiac events, respectively. The intra-class correlation coefficient for categorisation of patients as low risk was 0.87. Conclusion The EDACS-ADP identified approximately half of the patients presenting to the ED with possible cardiac chest pain as having low risk of short-term major adverse cardiac events, with high sensitivity. This is a significant improvement on similar, previously reported protocols. The EDACS-ADP is reproducible and has the potential to make considerable cost reductions to health systems.

Surface materials and aspects of care: A study in modes of being in a visual art practice

Through creative practice and written research, this thesis explores the peculiar qualities of surface materials, revealing a broader ethos of practice which I identify as care. I propose that care arises as a mode of being between artist and work, work and beholder, and between the parts of the work. The thesis situates the art practice within an ethical framework, premised on, but extending, Heidegger's ontological equation of care with being. The original contribution is in the claim that the particular qualities of worldly matter generate the terms for care as a particular mode of engagement that is reciprocal and intransitive.

Founder p.Arg 446* mutation in the PDHX gene explains over half of cases with congenital lactic acidosis in Roma children

Investigation of 31 of Roma patients with congenital lactic acidosis (CLA) from Bulgaria identified homozygosity for the R446* mutation in the PDHX gene as the most common cause of the disorder in this ethnic group. It accounted for around 60% of patients in the study and over 25% of all CLA cases referred to the National Genetic Laboratory in Bulgaria. The detection of a homozygous patient from Hungary and carriers among population controls from Romania and Slovakia suggests a wide spread of the mutation in the European Roma population. The clinical phenotype of the twenty R446* homozygotes was relatively homogeneous, with lactic acidosis crisis in the first days or months of life as the most common initial presentation (15/20 patients) and delayed psychomotor development and/or seizures in infancy as the leading manifestations in a smaller group (5/20 patients). The subsequent clinical picture was dominated by impaired physical growth and a very consistent pattern of static cerebral palsy-like encephalopathy with spasticity and severe to profound mental retardation seen in over 80% of cases. Most patients had a positive family history. We propose testing for the R446* mutation in PDHX as a rapid first screening in Roma infants with metabolic acidosis. It will facilitate and accelerate diagnosis in a large proportion of cases, allow early rehabilitation to alleviate the chronic clinical course, and prevent further affected births in high-risk families.

Australian Media Law [5th Edition]

Australian Media Law details and explains the complex case law, legislation and regulations governing media practice in areas as diverse as journalism, advertising, multimedia and broadcasting. It examines the issues affecting traditional forms of media such as television, radio, film and newspapers as well as for recent forms such as the internet, online forums and digital technology, in a clear and accessible format. New additions to the fifth edition include: - the implications of new anti-terrorism legislation for journalists; - developments in privacy law, including Law Reform recommendations for a statutory cause of action to protect personal privacy in Australia and the expanding privacy jurisprudence in the United Kingdom and New Zealand; - liability for defamation of internet search engines and service providers; - the High Court decision in Roadshow v iiNet and the position of internet service providers in relation to copyright infringement via their services; - new suppression order regimes; - statutory reforms providing journalists with a rebuttable presumption of non-disclosure when called upon to reveal their sources in a court of law; - recent developments regarding whether journalists can use electronic devices to collect and disseminate information about court proceedings; - contempt committed by jurors via social media; and an examination of recent decisions on defamation, confidentiality, vilification, copyright and contempt.

The paribhasas arthavadgrahane nanarthakasya, laksanapratipadoktayoh pratipadoktasyaiva grahanam and ekadesavikrtam ananyavat : Studies on some Metarules in Paninian system

In his grammatical treatise, the Astadhyayi, Panini includes sutras that state guiding rules for the right interpretation and application of his other directly grammatical sutras. These sutras are called paribhasas. In addition to these paribhasas, the various commentaries on Panini frequently invoke supplementary paribhasas which are not stated explicitly in his Astadhyayi. These paribhasas have been a subject of study since early times after Panini and have also occupied modern scholars on Panini s grammar. In regard to most of them, it remains unsettled even today whether they are used in the Astadhyayi, where they apply, what is their role, and whether they are necessary in arriving at the desired grammatical form. Some scholars go even further and argue that none of such paribhasas were intended by Panini. This study aims to settle this question by dealing with three such of these paribhasas individually considering all the information available in the commentaries in their regard and examining the cases in which, according to commentaries, the paribhasas apply. I select the paribhasas arthavadgrahane nanarthakasya, laksanapratipadoktayoh pratipadoktasyaiva grahanam and ekadesavikrtam ananyavat, which are all considered nyayasiddha or lokanyayasiddha; they express logical and obvious principles which are found in daily life. On this basis, Paniniyas explain why Panini did not mention them in the Astadhyayi. I discuss each paribhasa separately and all the issues it involves. I present and explain the cases where the specified paribhasas are invoked in the major commentaries, the Mahabhasya, the Kasika and the Siddhantakaumudi and the arguments found in the commentaries concerning these cases. If available, I supply other solutions to the difficulties for which these paribhasas are invoked. The study aims to make the issue of these paribhasas clearer, which will help us to reach a solution to the key question, that is, whether Panini has presupposed them in his Astadhyayi. My study shows that Panini has presupposed the paribhasa ekadesavikrtam ananyavat (or a similar principle). He also may have used the paribhasa arthavadgrahane nanarthakasya (or a similar principle) as this paribhasa does not lead to undesired results. As for the paribhasa laksanapratipadoktayoh pratipadoktasyaiva grahanam (or a similar principle), the original scope of this paribhasa was clearly extended by later Paniniyas. Moreover, their interpretation of this paribhasa conflicts with Panini s procedure. If Panini has used this paribhasa, he has used it in a very limited way.

Children’s perspectives of play and learning for educational practice

Play as a learning practice increasingly is under challenge as a valued component of early childhood education. Views held in parallel include confirmation of the place of play in early childhood education and, at the same time, a denigration of the role of play in favor for more teacher-structured and formal activities. As a consequence, pedagogical approaches towards play, the curriculum activities that constitute play, and the appropriateness of play in educational settings, have come under scrutiny in recent years. In this context, this study investigates children’s perspectives of play and how they understand the role of play and learning in their everyday activities. This article reports on an Australian study where teacher-researchers investigated child-led insights into what counts as play in their everyday classroom activities. Children (aged 3–4 years) described play as an activity that involved their active participation in “doing” something, being with peers, and having agency and ownership of ideas. Children did not always characterize their activities as “play”, and not all activities in the preschool program were described as play. The article highlights that play and learning are complex concepts that may be easily dismissed as separate, when rather they are deeply intertwined. The findings of this study generate opportunities for educators and academics to consider what counts as “play” for children, and to prompt further consideration of the role of play as an antidote to adult centric views of play.

The SAGE Handbook of Early Childhood Research

Recent decades have seen an upsurge of research with and about young children, their families and communities. The Handbook of Early Childhood Research will provide a landmark overview of the field of early childhood research and will set an agenda for early childhood research into the future. It includes 31 chapters provided by internationally recognized experts in early childhood research. The team of international contributors apply their expertise to conceptual and methodological issues in research and to relevant fields of practice and policy. The Handbook recognizes the main contexts of early childhood research: home and family contexts; out-of-home contexts such as services for young children and their families; and broader societal contexts of that evoke risk for young children.

Staphylococcus epidermidis as a cause of bacteremia

Staphylococcus epidermidis is a biofilm-producing commensal organism found ubiquitously on human skin and mucous membranes, as well as on animals and in the environment. Biofilm formation enables this organism to evade the host immune system. Colonization of percutaneous devices or implanted medical devices allows bacteria access to the bloodstream. Isolation of this organism from blood cultures may represent either contamination during the blood collection procedure or true bacteremia. S. epidermidis bloodstream infections may be indolent compared with other bacteria. Isolation of S. epidermidis from a blood culture may present a management quandary for clinicians. Over-treatment may lead to patient harm and increases in healthcare costs. There are numerous reports indicating the difficulty of predicting clinical infection in patients with positive blood cultures with this organism. No reliable phenotypic or genotypic algorithms currently exist to predict the pathogenicity of a S. epidermidis bloodstream infection. This review will discuss the latest advances in identification methods, global population structure, pathogenicity, biofilm formation, antimicrobial resistance and clinical significance of the detection of S. epidermidis in blood cultures. Previous studies that have attempted to discriminate between invasive and contaminating strains of S. epidermidis in blood cultures will be analyzed.

Happily ever after: Romance, gender and the building blocks of domestic violence

My sister describes the state of something being a psychological or personal 'issue' - such as a trauma, compulsion, phobia, or obsession - as having 'brain spaghetti'. For example, apparently she has spaghetti about me pinning her down as a child and tickling her until she screamed for mercy. She knows this because when her spouse tried to do the same, the experience she had as a child came flooding back as a complex tangle of fears, feelings, and mental images. Notwithstanding the trauma inflicted on a sibling in my youth, the spaghetti metaphor is a simple but useful tool for explaining how complex our experiences are, and I bring it up here because I believe a lot of people have spaghetti about love. So much so, that often love becomes distorted, sometimes to the point of making one completely blind to manipulation and abuse. Part of the blame for 'love spaghetti' can be allotted to media depictions of romance and gender, which helps entrench and maintain our deeply held beliefs about what relationships should look like.

Inland Salt

This work, a small single room installation, was my contribution to the 2015 Palimpsest Biennale in Mildura, and was shown at the ADFA building in the town's centre. On an initial research trip in July, 2015, I stopped at a dried out salt lake near Wentworth. Beach-like, the lake left a tidal line along a curving shore. The vegetation looked like ocean flora; there was the glimmering saltiness of everything, and saltbush everywhere. It brought to mind Sturt's hankering for an inland sea, and his wishful voyage along the Murray, that led him out, not in. This work puts these observations together: a drawing, made from the sanded emboss of saltbush leaves, runs, riverlike, across the space. A looped film of clouds reflected in a shallow saltlake, recalls the dream of an inland sea, supported by the sound of ocean.