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.

Exploring retinal and functional markers of diabetic neuropathy

Diabetic peripheral neuropathy (DPN) is one of the most debilitating complications of diabetes. DPN is a major cause of foot ulceration and lower limb amputation. Early diagnosis and management is a key factor in reducing morbidity and mortality. Current techniques for clinical assessment of DPN are relatively insensitive for detecting early disease or involve invasive procedures such as skin biopsies. There is a need for less painful, non-invasive and safe evaluation methods. Eye care professionals already play an important role in the management of diabetic retinopathy; however recent studies have indicated that the eye may also be an important site for the diagnosis and monitoring of neuropathy. Corneal nerve morphology has been shown to be a promising marker of diabetic neuropathy occurring elsewhere in the body, and emerging evidence tentatively suggests that retinal anatomical markers and a range of functional visual indicators could similarly provide useful information regarding neural damage in diabetes – although this line of research is, as yet, less well established. This review outlines the growing body of evidence supporting a potential diagnostic role for retinal structure and visual functional markers in the diagnosis and monitoring of peripheral neuropathy in diabetes.

The design environment

This chapter provides an overview of the Editor, which is the core modeling component of the YAWL system. Specifically, it shows how to specify control-flow, data and resourcing requirements in a YAWL workflow model. Moreover, it describes the error reporting capabilities of the Editor and the features of its interchange format.

Consuming authentic neighborhood : an autoethnography of experiencing a neighborhood's new beginnings and origins within its servicescapes

Purpose - This chapter examines individual and collective quests for authenticity, as experienced through consumption activities within an urban neighbourhood. It investigates the interplay between consumption experiences as authenticating acts and authoritative performances (Arnould and Price 2000), and considers the implications with regard to Zukin’s (2010) theories on urban authenticity, and how it may be experienced as new beginnings and origins. Methodology - The chapter is based on autoethnographic research that explores how interaction and identity definition within servicescapes can work to construct place-based community. Findings - It describes how a servicescape of new beginnings offered opportunities for individual authentication that also enabled personal identification with a specific cultural group. This authentication drew on the cultural capital embedded in such locations, including their association with gentrification. This is contrast with the collective identification offered by a servicescape operating as a place of exposure. This site of origins displayed the social practices of a different demographic, which worked to highlight a relational link between the authentication practices of the broader neighbourhood. These sites also worked cumulatively, to highlight the inauthenticities within my identification practices and offer opportunities for redress. Through this interplay it was possible to establish an authentic sense of neighbourhood that drew on its new beginnings and its origins, and was both individual and collective. Originality - Through the combination of urban and consumption-based perspectives of authenticity, and an autoethnographic methodology, this chapter offers a different insight into the ways identification with, and attachment to, a neighbourhood can develop through consumption experiences.

Citizen journalism and everyday life : a case study of Germany's myHeimat.de

The impact of citizen journalism on the established journalism industry, and its role in the future news media mix, remain key topics in current journalism studies research, not least in the context of the current crisis facing many news organisations around the globe. The centrality of this issue is also reflected in the substantial number of ‘citizen journalism’ monographs and collections published across the last few years (see for example Paterson & Domingo, 2008; Boler, 2008; Allan & Thorsen, 2009; Neuberger, Nuernbergk, & Rischke, 2009; Gordon, 2009; Russell & Echchaibi, 2009; Meikle & Redden, forthcoming). With relatively few notable exceptions, much of the research and wider public discussion surrounding the citizen journalism phenomenon has employed a relatively narrow definition of the term, with many researchers focussing on citizen journalism projects which provide mainly political news and commentary, and on their role in influencing the political process especially in countries like the U.S.

Repeatability of measuring corneal subbasal nerve fiber length in individuals with Type 2 Diabetes

Purpose: To analyze the repeatability of measuring nerve fiber length (NFL) from images of the human corneal subbasal nerve plexus using semiautomated software. Methods: Images were captured from the corneas of 50 subjects with type 2 diabetes mellitus who showed varying severity of neuropathy, using the Heidelberg Retina Tomograph 3 with Rostock Corneal Module. Semiautomated nerve analysis software was independently used by two observers to determine NFL from images of the subbasal nerve plexus. This procedure was undertaken on two occasions, 3 days apart. Results: The intraclass correlation coefficient values were 0.95 (95% confidence intervals: 0.92–0.97) for individual subjects and 0.95 (95% confidence intervals: 0.74–1.00) for observer. Bland-Altman plots of the NFL values indicated a reduced spread of data with lower NFL values. The overall spread of data was less for (a) the observer who was more experienced at analyzing nerve fiber images and (b) the second measurement occasion. Conclusions: Semiautomated measurement of NFL in the subbasal nerve fiber layer is highly repeatable. Repeatability can be enhanced by using more experienced observers. It may be possible to markedly improve repeatability when measuring this anatomic structure using fully automated image analysis software.

Engaging marketing students : student operated businesses in a simulated world

Engaged students are committed and more likely to continue their university studies. Subsequently, they are less resource intensive from a university’s perspective. This article details an experiential second-year marketing course that requires students to develop real products and services to sell on two organized market days. In the course, students participate as both consumers and marketers in a simulated world. The current article explores the effectiveness of this experiential assessment in terms of its ability to engage students. Comparing student engagement to a traditional lecture course and National Survey of Student Engagement benchmarks, the results suggest that the use of a simulated marketplace is capable of engaging students. Specifically, the assessment reported encourages more active learning and collaboration, is more academically challenging, and permits more student–faculty interaction than a traditional lecture-based course. The course structure outlined in this article permits the dynamics of a live marketing environment to be introduced into the classroom. The authors provide practical advice for educators seeking to design and implement engaging pedagogy.

Promoting student learning with online videos : a research agenda

Gen Y students are digital natives (Prensky 2001) who learn in complex and diverse ways, with a variety of learning styles apparent in any given course. This paper proposes a web 2.0 conceptual learning solution–online student videos–to respond to different learning styles that exist in the classroom.

Destination competitiveness through the lens of brand positioning : the case of Australia’s Sunshine Coast

The purpose of the paper is to provide a collaborative practitioner/academic interpretation of a destination’s competitiveness through the lens of brand positioning in the domestic short break drive market. A 173 item questionnaire, which was mailed to a systematic random sample of 3000 households in the target market, attracted a 17% useable response. The paper compares how one destination, the Sunshine Coast, is positioned in its most important market, in relation to the brand identity intended by the destination marketing organisation (DMO). Key constructs were brand salience, brand associations and brand resonance. The Sunshine Coast was found to hold a leadership position in the minds of consumers, and the results indicated a strong level of congruence between actual market perceptions and the brand identity intended by the DMO. There were strong associations between brand salience, brand associations and brand resonance. The findings provided the destination of interest with both a measure of past marketing effectiveness as well as positive indicators of future performance. The paper represents collaboration between a tourism practitioner and a tourism academic, and attempts a contribution to the emerging literature on destination competitiveness through the lens of positioning theory.

Visual field size criteria for mobility rehabilitation referral

Purpose. To investigate evidence-based visual field size criteria for referral of low-vision (LV) patients for mobility rehabilitation. Methods. One hundred and nine participants with LV and 41 age-matched participants with normal sight (NS) were recruited. The LV group was heterogeneous with diverse causes of visual impairment. We measured binocular kinetic visual fields with the Humphrey Field Analyzer and mobility performance on an obstacle-rich, indoor course. Mobility was assessed as percent preferred walking speed (PPWS) and number of obstacle-contact errors. The weighted kappa coefficient of association (κr) was used to discriminate LV participants with both unsafe and inefficient mobility from those with adequate mobility on the basis of their visual field size for the full sample and for subgroups according to type of visual field loss and whether or not the participants had previously received orientation and mobility training. Results. LV participants with both PPWS <38% and errors >6 on our course were classified as having inadequate (inefficient and unsafe) mobility compared with NS participants. Mobility appeared to be first compromised when the visual field was less than about 1.2 steradians (sr; solid angle of a circular visual field of about 70° diameter). Visual fields <0.23 and 0.63 sr (31 to 52° diameter) discriminated patients with at-risk mobility for the full sample and across the two subgroups. A visual field of 0.05 sr (15° diameter) discriminated those with critical mobility. Conclusions. Our study suggests that: practitioners should be alert to potential mobility difficulties when the visual field is less than about 1.2 sr (70° diameter); assessment for mobility rehabilitation may be warranted when the visual field is constricted to about 0.23 to 0.63 sr (31 to 52° diameter) depending on the nature of their visual field loss and previous history (at risk); and mobility rehabilitation should be conducted before the visual field is constricted to 0.05 sr (15° diameter; critical).

The relationship between strategic positioning and perceived value of social networking sites

The use of social networking sites (SNS) by online citizens to share photos, update friends, play games and to connect with the world has exploded, with SNS and blogs now eclipsing email traffic (eMarketer 2009). Just one popular application on one SNS, (Farmville on Facebook) acquired more than 63 million users since its launch in June 2009 (Marketing 2009. The major global social networks are Facebook, Twitter, YouTube and MySpace, with Facebook claiming that it passed 350 million users in November (Marketing 2009). As usage increases and competition intensifies, the major sites must strategically position themselves to develop a competitive advantage in order to maintain or grow their share of the pie. So how do the major SNS position their brands, and do users perceive significant differences among the big players? This presentation answers these questions by reporting the results of an empirical study of SNS usage by Australian adults. Like other brands, aligning brand positioning strategies with user knowledge and perceptions of SNS is an important ingredient to achieving success (Keller 1993). Furthermore we compare the types of value for three different SNS to identify the relationships between the value derived by users and the stated positioning of the site.