Engineering the fitness of older patients for chemotherapy : an exploration of Comprehensive Geriatric Assessment in practice

Clinicians often report that currently available methods to assess older patients, including standard clinical consultations, do not elicit the information necessary to make an appropriate cancer treatment recommendation for older cancer patients. An increasingly popular way of assessing the potential of older patients to cope with chemotherapy is a Comprehensive Geriatric Assessment. What constitutes Comprehensive Geriatric Assessment, however, is open to interpretation and varies from one setting to another. Furthermore, Comprehensive Geriatric Assessment’s usefulness as a predictor of fitness for chemotherapy and as a determinant of actual treatment is not well understood. In this article, we analyse how Comprehensive Geriatric Assessment was developed for use in a large cancer service in an Australian capital city. Drawing upon Actor–Network Theory, our findings reveal how, during its development, Comprehensive Geriatric Assessment was made both a tool and a science. Furthermore, we briefly explore the tensions that we experienced as scholars who analyse medico-scientific practices and as practitioner–designers charged with improving the very tools we critique. Our study contributes towards geriatric oncology by scrutinising the medicalisation of ageing, unravelling the practices of standardisation and illuminating the multiplicity of ‘fitness for chemotherapy’.

Establishment and characterisation of an open mini-thoracotomy surgical approach to an ovine thoracic spine fusion model

Background A large animal model is required for assessment of minimally invasive, tissue engineering based approaches to thoracic spine fusion, with relevance to deformity correction surgery for human adolescent idiopathic scoliosis. Here we develop a novel open mini–thoracotomy approach in an ovine model of thoracic interbody fusion which allows assessment of various fusion constructs, with a focus on novel, tissue engineering based interventions. Methods The open mini-thoracotomy surgical approach was developed through a series of mock surgeries, and then applied in a live sheep study. Customized scaffolds were manufactured to conform with intervertebral disc space clearances required of the study. Twelve male Merino sheep aged 4 to 6 years and weighing 35 – 45 kg underwent the abovementioned procedure and were divided into two groups of six sheep at survival timelines of 6 and 12 months. Each sheep underwent a 3-level discectomy (T6/7, T8/9 and T10/11) with randomly allocated implantation of a different graft substitute at each of the three levels; (i) polycaprolactone (PCL) based scaffold plus 0.54μg rhBMP-2, (ii) PCL-based scaffold alone or (iii) autograft. The sheep were closely monitored post- operatively for signs of pain (i.e. gait abnormalities/ teeth gnawing/ social isolation). Fusion assessments were conducted post-sacrifice using Computed Tomography and hard-tissue histology. All scientific work was undertaken in accordance with the study protocol has been approved by the Institute's committee on animal research. Results. All twelve sheep were successfully operated on and reached the allotted survival timelines, thereby demonstrating the feasibility of the surgical procedure and post-operative care. There were no significant complications and during the post-operative period the animals did not exhibit marked signs of distress according to the described assessment criteria. Computed Tomographic scanning demonstrated higher fusion grades in the rhBMP-2 plus PCL-based scaffold group in comparison to either PCL-based scaffold alone or autograft. These results were supported by histological evaluation of the respective groups. Conclusion. This novel open mini-thoracotomy surgical approach to the ovine thoracic spine represents a safe surgical method which can reproducibly form the platform for research into various spine tissue engineered constructs (TEC) and their fusion promoting properties.

Women's participation in the Australian digital content industry

The research investigated women’s participation in the Australian Digital Content Industry, which encompasses both multimedia and games production. The Digital Content Industry is an area of growing economic and social significance, both in Australia and internationally. Women are under-represented in core Digital Content Industry work but there has been little theoretical or empirical investigation of the underlying issues. This research identified a range of influences on women’s participation and provides a better understanding of this complex social phenomenon by proposing that influences should be understood from the perspective of agent-driven mechanisms. The key contribution is a new theory - the Acts of Agency Theory - which was used to discuss the phenomenon and issues underpinning women’s participation and to recommend strategies that should foster greater participation of women in the Digital Content Industry.

Open up the building : architectural relevance of building-users and their participations

As buildings have become more advanced and complex, our ability to understand how they are operated and managed has diminished. Modern technologies have given us systems to look after us but it appears to have taken away our say in how we like our environment to be managed. The aim of this paper is to discuss our research concerning spaces that are sensitive to changing needs and allow building-users to have a certain level of freedom to understand and control their environment. We discuss why, what we call the Active Layer, is needed in modern buildings; how building inhabitants are to interact with it; and the development of interface prototypes to test consequences of having the Active Layer in our environment.

The beliefs which influence young males to speed and strategies to slow them down : informing the content of anti-speeding messages

Young male drivers are over-represented in road-related fatalities. Speeding represents a pervasive and significant contributor to road trauma. Anti-speeding messages represent a long-standing strategy aimed at discouraging drivers from speeding. These messages, however, have not always achieved their persuasive objectives which may be due, in part, to them not always targeting the most salient beliefs underpinning the speeding behavior of particular driver groups. The current study elicited key beliefs underpinning speeding behavior as well as strategies used to avoid speeding, using a well-validated belief-based model, the Theory of Planned Behavior and in-depth qualitative methods. To obtain the most comprehensive understanding about the salient beliefs and strategies of young male drivers, how such beliefs and strategies compared with those of drivers of varying ages and gender, was also explored. Overall, 75 males and females (aged 17-25 or 30-55 years) participated in group discussions. The findings revealed beliefs that were particularly relevant to young males and that would likely represent key foci for developing message content. For instance, the need to feel in control and the desire to experience positive affect when driving were salient advantages; while infringements were a salient disadvantage and, in particular, the loss of points and the implications associated with potential licence loss as opposed to the monetary (fine) loss (behavioral beliefs). For normative influences, young males appeared to hold notable misperceptions (compared with other drivers, such as young females); for instance, young males believed that females/girlfriends were impressed by their speeding. In the case of control beliefs, the findings revealed low perceptions of control with respect to being able to not speed and a belief that something “extraordinary” would need to happen for a young male driver to lose control of their vehicle while speeding. The practical implications of the findings, in terms of providing suggestions for devising the content of anti-speeding messages, are discussed.

Differences in Epidural and Analgesic Use in Patients with Apparent Stage I Endometrial Cancer treated by open versus laparoscopic surgery: results from the randomised LACE trial

Objectives: We compared post-operative analgesic requirements between women with early stage endometrial cancer treated by total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH). Methods: 760 patients with apparent stage I endometrial cancer were treated in the international, multicentre, prospective randomised trial (LACE) by TAH (n=353) or TLH (n=407) (2005-2010). Epidural, opioid and non-opioid analgesic requirements were collected until ten months after surgery. Results: Baseline demographics and analgesic use were comparable between treatment arms. TAH patients were more likely to receive epidural analgesia than TLH patients (33% vs 0.5%, p<0.001) during the early postoperative phase. Although opioid use was comparable in the TAH vs TLH groups during postoperative 0-2 days (99.7% vs 98.5%, p 0.09), a significantly higher proportion of TAH patients required opioids 3-5 days (70% vs 22%, p<0.0001), 6-14 days (35% vs 15%, p<0.0001), and 15-60 days (15% vs 9%, p 0.02) post-surgery. Mean pain scores were significantly higher in the TAH versus TLH group one (2.48 vs 1.62, p<0.0001) and four weeks (0.89 vs 0.63, p 0.01) following surgery. Conclusion: Treatment of early stage endometrial cancer with TLH is associated with less frequent use of epidural, lower post-operative opioid requirements and better pain scores than TAH.

Open educational resources in China : a governmentality analysis

Using a sociological approach, this study examines China’s reform of open educational resources (OER), which has prompted significant changes to the nation’s higher education sector. Through an analysis of the policy processes that have driven the reform, this study demonstrates that the reform has involved and brought significant changes to its participants as resource administrators, providers, and receivers. By using governmentality as a poststructuralist analytical framework, this study shows the particular ways in which the reform process has been governed and the ways in which the governing practices have changed the conduct of higher education. The study reveals the power relations exercised through the reform and offers a critique of China’s higher education sector.

The Foxtel-BBC deal : implications for Australian television and content

The ABC’s 50-year TV partnership with the BBC is at breaking point after a landmark deal between the British broadcaster and pay TV provider Foxtel was announced in April 2013. Under the new deal Foxtel will host a new BBC channel that will screen first-run, “fast-tracked” British programming, meaning ABC viewers will no longer have free-to-air access to popular shows such as Silent Witness and The Thick of It. The deal between Foxtel and the BBC’s commercial arm, BBC Worldwide, has major implications not only for the two partners, but also for the ABC and potentially for Australian screen content.

Why new media reforms are bad news for Australian content

Two of the government’s six media reform bills passed in the House of Representatives with multi-party support on Tuesday 19 March. While most attention and debate has focused on the regulation of the news media and ownership, the changes approved on 19 March are both significant and far-reaching.

Addressing Public and Private Issues in a Virtual Ethnography Study of an Open Online Community: a Reflective Paper

This paper discusses the ethical consequences of employing virtual ethnography to observe human behaviour in open online communities. In this paper, we discuss the nature of the online community being studied as well as the lessons learned from both literature and also the ethical clearance application process undertaken by the research team. A key finding was that despite the community being open to the public, generally community members expected the research team to employ strategies similar to those required when dealing with a private community.

A retrospective cohort investigation of active range of motion within one week of open reduction and internal fixation of distal radius fractures

Distal radius fractures stabilized by open reduction internal fixation (ORIF) have become increasingly common. There is currently no consensus on the optimal time to commence range of motion (ROM) exercises post-ORIF. A retrospective cohort review was conducted over a five-year period to compare wrist and forearm range of motion outcomes and number of therapy sessions between patients who commenced active ROM exercises within the first seven days and from day eight onward following ORIF of distal radius fractures. One hundred and twenty-one patient cases were identified. Clinical data, active ROM at initial and discharge therapy assessments, fracture type, surgical approaches, and number of therapy sessions attended were recorded. One hundred and seven (88.4%) cases had complete datasets. The early active ROM group (n = 37) commenced ROM a mean (SD) of 4.27 (1.8) days post-ORIF. The comparator group (n = 70) commenced ROM exercises 24.3 (13.6) days post-ORIF. No significant differences were identified between groups in ROM at initial or discharge assessments, or therapy sessions attended. The results from this study indicate that patients who commenced active ROM exercises an average of 24 days after surgery achieved comparable ROM outcomes with similar number of therapy sessions to those who commenced ROM exercises within the first week.

Open Access and Scholarly Books: Workshop Report, 19 June 2013

On 19 June 2013 Knowledge Unlatched and the Berkman Center for Internet and Society at Harvard Law School jointly convened a one-day workshop titled Open Access and Scholarly Books in Cambridge, MA. The workshop brought together a group of 21 invited publishers, librarians, academics and Open Access innovators to discuss the challenge of making scholarly books Open Access. This report captures discussions that took place on the day.

Skins for smokes and the use of cultural content and imagery

[Extract] For just $5.29 Australians can now purchase "Skins" from local, independent grocers to cover their cigarette packet with the Aboriginal or Torres Strait Islander flag. We argue that this use of cultural content and copyright' imagery on cigarette packets negates health promotion efforts, such as Australia's recent introduction of plain packaging laws and the subsequent dismissal of a legal challenge from the tobacco industry.

The microbial content of vacuum cleaner bag dust and emitted bioaerosols : implications for human exposures indoors

Vacuum cleaners can release large concentrations of particles, both in their exhaust air and from resuspension of settled dust. However, the size, variability and microbial diversity of these emissions are unknown, despite evidence to suggest they may contribute to allergic responses and infection transmission indoors. This study aimed to evaluate bioaerosol emission from various vacuum cleaners. We sampled the air in an experimental flow tunnel where vacuum cleaners were run and their airborne emissions sampled with closed-face cassettes. Dust samples were also 35 collected from the dust bag. Total bacteria, total archaea, Penicillium/Aspergillus and total Clostridium cluster 1 were quantified with specific qPCR protocols and emission rates were calculated. Clostridium botulinum, as well as antibiotic resistance genes were detected in each sample using endpoint PCR. Bacterial diversity was also analyzed using denaturing gel electrophoresis (DGGE), image analysis and band sequencing. We demonstrated that emission of bacteria and moulds (Pen/Asp) can reach values as high as 1E05/min and that those emissions are not related to each other. The bag dust bacterial and mould content was also consistently across the vacuums we assessed, reaching up to 1E07 bacteria or moulds equivalent/g. Antibiotic resistance genes were detected in several samples. No archaea or C. botulinum were detected in any air samples. Diversity analyses showed that most bacteria are from human sources, in keeping with other recent results. These results highlight the potential capability of vacuum cleaners to disseminate appreciable quantities of moulds and human-associated bacteria indoors and their role as a source of exposure to bioaerosols.

Stitching at the boundaries : Vietnamese garment industry workers in transnational spaces

This paper explores the interfaces between the transnational politics of labour and the experiences of Vietnamese women garment workers both in Vietnam and as migrants to other countries. As the global industries have come to organise much of the contemporary economic system, so too have they crossed national boundaries in search of cheap labour. At the same time enclaves of migrant disadvantage within the multi-ethnic nation-states of the developed world have also provided workers for the manufacture of clothing. In the case of Australia, these workers are mostly home-based and not in factories. In this paper I explore Vietnamese women's different incorporations into the garment industry in various locations – in Australia, in Vietnam, and in American Samoa. In so doing, I provide an analysis of the links between gender, global power relations and the contradictory space of transnational exchange.