A comparison of treatment options for management of end stage kidney disease in elderly patients : a systematic review

Background Chronic kidney disease is a global public health problem of increasing prevalence. There are five stages of kidney disease, with Stage 5 indicating end stage kidney disease (ESKD) requiring dialysis or death will eventually occur. Over the last two decades there have been increasing numbers of people commencing dialysis. A majority of this increase has occurred in the population of people who are 65 years and over. With the older population it is difficult to determine at times whether dialysis will provide any benefit over non-dialysis management. The poor prognosis for the population over 65 years raises issues around management of ESKD in this population. It is therefore important to review any research that has been undertaken in this area which compares outcomes of the older ESKD population who have commenced dialysis with those who have received non-dialysis management. Objective The primary objective was to assess the effect of dialysis compared with non-dialysis management for the population of 65 years and over with ESKD. Inclusion criteria Types of participants This review considered studies that included participants who were 65 years and older. These participants needed to have been diagnosed with ESKD for greater than three months and also be either receiving renal replacement therapy (RRT) (hemodialysis [HD] or peritoneal dialysis [PD]) or non-dialysis management. The settings for the studies included the home, self-care centre, satellite centre, hospital, hospice or nursing home. Types of intervention(s)/phenomena of interest This review considered studies where the intervention was RRT (HD or PD) for the participants with ESKD. There was no restriction on frequency of RRT or length of time the participant received RRT. The comparator was participants who were not undergoing RRT. Types of studies This review considered both experimental and epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case control studies and analytical cross sectional studies. This review also considered descriptive epidemiological study designs including case series, individual case reports and descriptive cross sectional studies for inclusion. This review included any of the following primary and secondary outcome measures: •Primary outcome – survival measures •Secondary outcomes – functional performance score (e.g. Karnofsky Performance score) •Symptoms and severity of end stage kidney disease •Hospital admissions •Health related quality of life (e.g. KDQOL, SF36 and HRQOL) •Comorbidities (e.g. Charlson Comorbidity index).

Submission to the Attorney-General's Department consultation on "Marrakesh Treaty options for implementation" discussion paper

It is extremely important to ensure that people with disabilities can access information and cultural works on an equal basis with others. Access is fundamentally important to enable people with disabilities to fully participate in economic, social, and political life. This is both a pressing moral imperative and a legal requirement in international law. Australia should take clear steps to affirmatively redress the fundamental inequalities of access that people with disabilities face. This requires a fundamental shift in the way that we think about copyright and disability rights: the mechanisms for enabling access should not be a limited exception to normal distribution, but should instead be strong positive rights that are able to be routinely and practically exercised.

An Investigation into the Options for Increasing the Extent of Energy Efficiency Knowledge and Skills in Engineering Education

Society is increasingly calling for professionals across government, industry, business and civil society to be able to problem-solve issues related to climate change and sustainable development as part of their work. In particular there is an emerging realisation of the fundamental need to swiftly reduce the growing demand for energy across society, and to then meet the demand with low emissions options. A key ingredient to addressing such issues is equipping professionals with emerging knowledge and skills to address energy challenges in all aspects of their work. The Council of Australian Governments has recognised this need, signing the National Partnership Agreement on Energy Efficiency in July 2009, which included a commitment to assist business and industry obtain the knowledge, skills and capacity to pursue cost-effective energy efficiency opportunities.2 Engineering will play a critical part among the professions, with Engineers Australia acknowledging that, ‘The need to make changes in the way energy is used and supplied throughout the world represents the greatest challenge to engineers in moving toward sustainability.’

Therapeutic options for metastatic castration resistant prostate cancer : has the situation improved?

Limited treatment options for Castration Resistant Prostate Cancer (CRPC) still remain a major challenge. Despite therapeutic advances, most patients with malignant PCa have a poor prognosis. Since the year 2000, we have rapidly expanded our understanding of the molecular mechanisms underlying CRPC and this has led to an unprecedented number of new drug approvals within a short span of time. Recently, four new agents namely Abiraterone Acetate, Enzalutamide, Cabazitaxel, and Radium-223 have been shown to be effective in the post-chemotherapy setting in CRPC. The continued dependency of CRPC on androgen synthesis has seen the development of a number of new anti-androgen therapies, with abiraterone acetate and Enzalutamide being the most promising discoveries. Immunotherapeutic approaches have also found their niche in PCa with Sipuleucel-T shown to be effective in minimally asymptomatic CRPC. Research focussed on bone-targeting therapies has witnessed the arrival of promising new drugs with Denosumab and Radium-223 displaying improved survival of patients with CRPC. This review briefly discusses the findings and limitations from ongoing and completed clinical trials of novel treatments and regimens. In addition, potential mechanisms of therapy resistance and future challenges are discussed.

Options for rehabilitation in interlock programs

This report examines the effectiveness of national and international programs that treat and rehabilitate drivers with alcohol dependence and the criteria used to approve the removal of interlocks. The project recommends a stepped care model which requires all participants to attend education and screening and then requires participants who fail to change their behaviour to attend increasingly intensive rehabilitation programs. Failure to complete an interlock program could result in participants having their licence revoked. This project was designed to inform action 36(d) of the National Road Safety Strategy 2011-2020: Investigate the option of requiring demonstrated rehabilitation from alcohol dependence before removal of interlock conditions.

Integrated reporting and directors’ concerns about personal liability exposure: Law reform options

Integrated reporting () holds significant promise as a new reporting paradigm that is holistic, strategic, responsive, material, and relevant across multiple time frames. However, its uptake in Australia is being hampered by directors’ concerns about personal liability exposure, particularly for forward-looking statements that subsequently prove to be unfounded. This article seeks to illuminate the bases for these liability concerns by outlining the similarities between and the operating and financial review requirements under the Corporations Act 2001 (Cth), and the relevant grounds for liability for misleading and deceptive disclosures, and breach of directors’ duties. In light of this discussion, this article proposes four possible reform options, ranging from minor adaptations to the Framework to far-reaching reforms of the Corporations Act. As assurance is desirable to ensure that reliance can be placed on integrated reports, the development of a legal safe harbour for auditors of forward-looking information is also canvassed.

Socioeconomic inequalities in diet and bodyweight: Evidence, causes, and intervention options

Diets low in fruits, vegetables, and whole grains, and high in saturated fat, salt, and sugar are the major contributors to the burden of chronic diseases globally. Previous research, and studies in this issue of Public Health Nutrition (PHN), show that unhealthy diets are more commonly observed among socioeconomically disadvantaged groups, and are key contributors to their higher rates of chronic disease. Most research examining socioeconomic inequalities in diet and bodyweight has been descriptive, and has focused on identifying the nature, extent, and direction of the inequalities. These types of studies are clearly necessary and important. We need however to move beyond description of the problem and focus much more on the question of why inequalities in diet and bodyweight exist. Furthering our understanding of this question will provide the necessary evidence-base to develop effective interventions to reduce the inequalities. The challenge of tackling dietary inequalities however doesn’t finish here: a maximally effective approach will also require equity-based policies that address the unequal population-distribution of social and economic resources, which is the fundamental root-cause of dietary and bodyweight inequalities.

Review and future options for computer modelling in the sugar industry

Computer modelling has been used extensively in some processes in the sugar industry to achieve significant gains. This paper reviews the investigations carried out over approximately the last twenty five years, including the successes but also areas where problems and delays have been encountered. In that time the capability of both hardware and software have increased dramatically. For some processes such as cane cleaning, cane billet preparation, and sugar drying, the application of computer modelling towards improved equipment design and operation has been quite limited. A particular problem has been the large number of particles and particle interactions in these…

'As many options as there are, there are just not enough for me': Contraceptive use and barriers to access among Australian women

OBJECTIVE A comprehensive life course perspective of women's experiences in obtaining and using contraception in Australia is lacking. This paper explores free-text comments about contraception provided by women born between 1973 and 1978 who participated in the Australian Longitudinal Study on Women's Health (ALSWH). METHODS The ALSWH is a national population-based cohort study involving over 40,000 women from three age groups, who are surveyed every three years. An initial search identified 1600 comments from 690 women across five surveys from 1996 (when they were aged 18-23 years) to 2009 (31-36 years). The analysis included 305 comments from 289 participants. Factors relating to experiences of barriers to access and optimal contraceptive use were identified and explored using thematic analysis. RESULTS Five themes recurred across the five surveys as women aged: (i) side effects affecting physical and mental health; (ii) lack of information about contraception; (iii) negative experiences with health services; (iv) contraceptive failure; and (v) difficulty with accessing contraception. CONCLUSION Side effects of hormonal contraception and concerns about contraceptive failure influence women's mental and physical health. Many barriers to effective contraception persist throughout women's reproductive lives. Further research is needed into reducing barriers and minimising negative experiences, to ensure optimal contraceptive access for Australian women.

On the efficacy of Fourier series approximations for pricing European options

This paper investigates several competing procedures for computing the prices of vanilla European options, such as puts, calls and binaries, in which the underlying model has a characteristic function that is known in semi-closed form. The algorithms investigated here are the half-range Fourier cosine series, the half-range Fourier sine series and the full-range Fourier series. Their performance is assessed in simulation experiments in which an analytical solution is available and also for a simple affine model of stochastic volatility in which there is no closed-form solution. The results suggest that the half-range sine series approximation is the least effective of the three proposed algorithms. It is rather more difficult to distinguish between the performance of the halfrange cosine series and the full-range Fourier series. However there are two clear differences. First, when the interval over which the density is approximated is relatively large, the full-range Fourier series is at least as good as the half-range Fourier cosine series, and outperforms the latter in pricing out-of-the-money call options, in particular with maturities of three months or less. Second, the computational time required by the half-range Fourier cosine series is uniformly longer than that required by the full-range Fourier series for an interval of fixed length. Taken together,these two conclusions make a case for pricing options using a full-range range Fourier series as opposed to a half-range Fourier cosine series if a large number of options are to be priced in as short a time as possible.

Genetic Options for Drought Management in Groundnut

Groundnut is one of the principal oilseeds in the world. It is cultivated on 24.8 million ha with a total production of 32.8 million t and an average productivity of 1.32 t ha-'. Developing countries account for 96.9% of the world groundnut area and 93.8% of total production. Production is concentrated in Asia (56.8% area and 66.5% production of the world) and Africa (38.0% area and 24.7% production). The groundnut productivity in Africa is only 0.86 t ha-' compared with 1.55 t hx1 of Asia. The world groundnut economy-facts, trends and outlook are desaibed in detail by Freeman et al., 1999. Briefly, in medium-term (i.e. up to 2010), 'groundnut production and consumption is likely to shift increasingly to developing countries; production will grow in all regions but most rapidly in Asia, slowly in sub-Saharan Africa and decline in Latin America; and utilizationwill continue to shift away from groundnut oil toward groundnut meal, specially confectionery products'.

Economic analyses of options for weedy Sporobolus grass management

Weedy Sporobolus grasses have low palatability for livestock, with infestations reducing land condition and pastoral productivity. Control and containment options are available, but the cost of weed control is high relative to the extra return from livestock, thus, limiting private investment. This paper outlines a process for analysing the economic consequences of alternative management options for weedy Sporobolus grasses. This process is applicable to other weeds and other pastoral degradation or development issues. Using a case study property, three scenarios were developed. Each scenario compared two alternative management options and was analysed using discounted cash flow analysis. Two of the scenarios were based on infested properties and one scenario was based on a currently uninfested property but highly likely to become infested without active containment measures preventing weed seed transport and seedling establishment. The analysis highlighted why particular weedy Sporobolus grass management options may not be financially feasible for the landholder with the infestation. However, at the regional scale, the management options may be highly worthwhile due to a reduction in weed seed movement and new weed invasions. Therefore, to encourage investment by landholders in weedy Sporobolus grass management the investment of public money on behalf of landholders with non-infested properties should be considered.

Scenario analysis of alternative vegetation management options on the greenhouse gas budget of two grazing businesses in north-eastern Australia

The emerging carbon economy will have a major impact on grazing businesses because of significant livestock methane and land-use change emissions. Livestock methane emissions alone account for similar to 11% of Australia's reported greenhouse gas emissions. Grazing businesses need to develop an understanding of their greenhouse gas impact and be able to assess the impact of alternative management options. This paper attempts to generate a greenhouse gas budget for two scenarios using a spread sheet model. The first scenario was based on one land-type '20-year-old brigalow regrowth' in the brigalow bioregion of southern-central Queensland. The 50 year analysis demonstrated the substantially different greenhouse gas outcomes and livestock carrying capacity for three alternative regrowth management options: retain regrowth (sequester 71.5 t carbon dioxide equivalents per hectare, CO2-e/ha), clear all regrowth (emit 42.8 t CO2-e/ha) and clear regrowth strips (emit 5.8 t CO2-e/ha). The second scenario was based on a 'remnant eucalypt savanna-woodland' land type in the Einasleigh Uplands bioregion of north Queensland. The four alternative vegetation management options were: retain current woodland structure (emit 7.4 t CO2-e/ha), allow woodland to thicken increasing tree basal area (sequester 20.7 t CO2-e/ha), thin trees less than 10 cm diameter (emit 8.9 t CO2-e/ha), and thin trees <20 cm diameter (emit 12.4 t CO2-e/ha). Significant assumptions were required to complete the budgets due to gaps in current knowledge on the response of woody vegetation, soil carbon and non-CO2 soil emissions to management options and land-type at the property scale. The analyses indicate that there is scope for grazing businesses to choose alternative management options to influence their greenhouse gas budget. However, a key assumption is that accumulation of carbon or avoidance of emissions somewhere on a grazing business (e.g. in woody vegetation or soil) will be recognised as an offset for emissions elsewhere in the business (e.g. livestock methane). This issue will be a challenge for livestock industries and policy makers to work through in the coming years.

Modelling management options for management of feral camels in central Australia

Camels (Camelus dromedarius) were introduced into Australia from the 1840s to the early 1900s for transport and hauling cargo in arid regions. Feral populations remained small until the 1930s when many were released after they were superseded for transport by trucks and rail. Although camels have a relatively slow population growth (<10% per annum), the population has not reached carrying capacity and therefore, requires control to reduce the increasing impacts on central Australia. The model developed for the Northern Territory suggested that currently there are insufficient numbers being removed. The model also investigated which control options would have greatest impacts and found harvesting to be most important. The extent to which commercial harvesting can feasibly reduce camel populations requires further analysis. Due to the wide dispersal of camels in Australia, fertility control, even if technically feasible, will not target adults, the most important age class of the population. Habitat preferences were also investigated in the model but more validation is required as the population is still under range expansion. Immediate action is suggested to alleviate future costs as camel populations and their impacts rise.

Impacts of grazing management options on pasture and animal productivity in a Heteropogon contortus (black speargrass) pasture in central Queensland. 4. Animal production.

Steer liveweight gains were measured in an extensive grazing study conducted in a Heteropogon contortus (black speargrass) pasture in central Queensland between 1988 and 2001. Treatments included a range of stocking rates in native pastures, legume-oversown native pasture and animal diet supplement/spring-burning pastures. Seasonal rainfall throughout this study was below the long-term mean. Mean annual pasture utilisation ranged from 13 to 61%. Annual liveweight gains per head in native pasture were highly variable among years and ranged from a low of 43 kg/steer at 2 ha/steer to a high of 182 kg/steer at 8 ha/steer. Annual liveweight gains were consistently highest at light stocking and decreased with increasing stocking rate. Annual liveweight gain per hectare increased linearly with stocking rate. These stocking rate trends were also evident in legume-oversown pastures although both the intercept and slope of the regressions for legume-oversown pastures were higher than that for native pasture. The highest annual liveweight gain for legume-oversown pasture was 221 kg/steer at 4 ha/steer. After 13 years, annual liveweight gain per unit area occurred at the heaviest stocking rate despite deleterious changes in the pasture. Across all years, the annual liveweight advantage for legume-oversown pastures was 37 kg/steer. Compared with native pasture, changes in annual liveweight gain with burning were variable. It was concluded that cattle productivity is sustainable when stocking rates are maintained at 4 ha/steer or lighter (equivalent to a utilisation rate around 30%). Although steer liveweight gain occurred at all stocking rates and economic returns were highest at heaviest stocking rates, stocking rates heavier than 4 ha/steer are unsustainable because of their long-term impact on pasture productivity.