Design of the multicenter Australian study of epidural anesthesia and analgesia in major surgery: The MASTER Trial

The Multicenter Australian Study of Epidural Anesthesia and Analgesia in Major Surgery (The MASTER Trial) was designed to evaluate the possible benefit of epidural block in improving outcome in high-risk patients. The trial began in 1995 and is scheduled to reach the planned sample size of 900 during 2001. This paper describes the trial design and presents data comparing 455 patients randomized in 21 institutions in Australia, Hong Kong, and Malaysia, with 237 patients from the same hospitals who were eligible but not randomized. Nine categories of high-risk patients were defined as entry criteria for the trial. Protocols for ethical review, informed consent, randomization, clinical anesthesia and analgesia, and perioperative management were determined following extensive consultation with anesthesiologists throughout Australia. Clinical and research information was collected in participating hospitals by research staff who may not have been blind to allocation. Decisions about the presence or absence of endpoints were made primarily by a computer algorithm, supplemented by blinded clinical experts. Without unblinding the trial, comparison of eligibility criteria and incidence of endpoints between randomized and nonrandomized patients showed only small differences. We conclude that there is no strong evidence of important demographic or clinical differences between randomized and nonrandomized patients eligible for the MASTER Trial. Thus, the trial results are likely to be broadly generalizable. Control Clin Trials 2000;21:244-256 (C) Elsevier Science Inc. 2000.

The burden of mental disorders: a comparison of methods between the Australian burden of disease studies and the Global Burden of Disease study

The national and Victorian burden of disease studies in Australia set out to examine critically the methods used in the Global Burden of Disease study to estimate the burden of mental disorders. The main differences include the use of a different set of disability weights allowing estimates in greater detail by level of severity, adjustments for comorbidity between mental disorders, a greater number of menta I disorders measured, and model ling of substance use disorders, anxiety disorders and bipolar disorder as chronic conditions. Uniform age-weighting in the Australian studies produces considerably lower estimates of the burden due to mental disorders in comparison with age-weighted disability-adjusted life years. A lack of follow-up data on people with mental disorders who are identified in cross-sectional surveys poses the greatest challenge in determining the burden of mental disorders more accurately.

The Australian Burden of Disease Study: measuring the loss of health from diseases, injuries and risk factors

This is an overview of the first burden of disease and injury studies carried out in Australia. Methods developed for the World Bank and World Health Organization Global Burden of Disease Study were adapted and applied to Australian population health data. Depression was found to be the top-ranking cause of non-fatal disease burden in Australia, causing 8% of the total years lost due to disability in 1996. Mental disorders overall were responsible for nearly 30% of the non-fatal disease burden. The leading causes of total disease burden (disability-adjusted life years [DALYs]) were ischaemic heart disease and stroke, together causing nearly 18% of the total disease burden. Depression was the fourth leading cause of disease burden, accounting for 3.7% of the total burden. Of the 10 major risk factors to which the disease burden can be attributed, tobacco smoking causes an estimated 10% of the total disease burden in Australia, followed by physical inactivity (7%).

Clathrins A-C: Metabolites from a southern Australian marine sponge, Clathria species

A Clathria sp. collected in the Great Australian Bight has yielded the novel metabolites clathrins A (6), B (7), and C (8). Structures were assigned to clathrins A-C on the basis of spectroscopic analysis. Clathrin A (6) represents a plausible biosynthetic intermediate that provides an inferred link between marine sesquiterpene/benzenoids and mixed terpene/shikimate biosynthesis.

Computational chemistry on Fujitsu vector-parallel processors: Development and performance of applications software

In this and a preceding paper, we provide an introduction to the Fujitsu VPP range of vector-parallel supercomputers and to some of the computational chemistry software available for the VPP. Here, we consider the implementation and performance of seven popular chemistry application packages. The codes discussed range from classical molecular dynamics to semiempirical and ab initio quantum chemistry. All have evolved from sequential codes, and have typically been parallelised using a replicated data approach. As such they are well suited to the large-memory/fast-processor architecture of the VPP. For one code, CASTEP, a distributed-memory data-driven parallelisation scheme is presented. (C) 2000 Published by Elsevier Science B.V. All rights reserved.

Associations between rural background and where South Australian general practitioners work

Objective: To determine the association between rural background on practice location of general practitioners (GPs) (rural or urban). Design: Comparison of data from two postal surveys. Subjects: 268 rural and 236 urban GPs practising in South Australia. Main outcome measures: Association between practice location (rural or urban) and demographic characteristics, training, qualifications, and rural background. Results: Rural GPs were younger than urban GPs (mean age 47 versus 50 years, P<0,01) and more likely to be male (81% versus 67%, P=0.001), to be Australian-born (72% Versus 61%, P=0,01), to have a partner (95% versus 85%, P= 0.001), and to have children (94% Versus 85%, P=0.001). Similar proportions of rural and urban GPs were trained in Australia and were Fellows of the Royal Australian College of General Practitioners, but more rural GPs were vocationally registered (94% versus 84%, P=0,001). Rural GPs were more likely to have grown up in the country (37% versus 27%, P= 0,02), to have received primary (33% versus 19%, P=0,001) and secondary (25% versus 13%, P=0,001) education there, and to have a partner who grew up in the country (49% Versus 24%, P=0.001). In multivariate analysis, only primary education in the country (odds ratio [OR], 2.43; 95% CI, 1.09-5.56) and partner of rural background (OR, 3.14; 95% CI, 1.96-5.10) were independently associated with rural practice. Conclusion: Our findings support the policy of promoting entry to medical school of students with a rural background and provide an argument for policies that address the needs of partners and maintain quality primary and secondary education in the country.

Relationships among climate, latitude and migration: Australian butterflies are not temperate-zone birds

We examined the distribution of butterflies over the mostly arid and semi-arid continent of Australia and analyzed the proportion of migrant species and species diversity with respect to an array of climatic and geographic variables. On a continent-wide scale, latitude explained virtually no variance in either proportion of migrants (r(2) = 0.01) or species diversity (r(2) = 0.03) in Australian butterflies. These results are in marked contrast to those for temperate-zone birds from three continents where latitude explained between 82 and 98% of the variance in frequency of migrants and also accounted for much of the variance in bird species diversity. In eastern Australia where rainfall regimes are similar to those in temperate Europe and North and South America, latitude explains 78% of the variance in frequency of butterfly migrants. In both eastern and central Australia, latitude also accounts for relatively high proportions of the variance in species diversity. Rainfall patterns and especially soil moisture are negatively associated with migration frequency in Australian butterfly faunas, both alone and in combination with other climate variables. Where moisture levels are relatively high, as in eastern Australia, measures of temperature are associated with migration frequency, a result consistent with findings for temperate-zone birds, suggesting latitude is a surrogate for temperature. The ultimate causes of migration in temperate-zone birds and Australian butterflies are the uneven temporal, and in Australia also spatial, distribution of resources. Uneven distribution is brought about primarily by temperature in temperate regions and by erratic rainfall over much of arid Australia. As a key determinant of productivity, especially in the tropics and subtropics, aridity is likely to be an important determinant of the global distributions of migrants.

Inability of adult Limnodynastes peronii (Amphibia : Anura) to thermally acclimate locomotor performance

Despite several studies on adult amphibians, only larvae of the striped marsh frog (Limnodynastes peronii) have been reported to possess the ability to compensate for the effects of cool temperature on locomotor performance by thermal acclimation. In this study, we investigated whether this thermal acclimatory ability is shared by adult L. peronii. We exposed adult L. peronii to either 18 or 30 degrees C for 8 weeks and tested their swimming and jumping performance at six temperatures between 8 and 35 degrees C. Acute changes in temperature affected both maximum swimming and jumping performance, however there was no difference between the two treatment groups in locomotor performance between 8 and 30 degrees C. Maximum swimming velocity of both groups increased from 0.62 +/- 0.02 at 8 degrees C to 1.02 +/- 0.03 m s(-1) at 30 degrees C, while maximum jump distance increased from similar to 20 to > 60 cm over the same temperature range. Although adult L. peronii acclimated to 18 degrees C failed to produce a locomotor response at 35 degrees C, this most likely reflected a change in thermal tolerance limits with acclimation rather than modifications in the locomotor system. As all adult amphibians studied to date are incapable of thermally acclimating locomotor performance, including adults of L. peronii, this acclimatory capacity appears to be absent from the adult stage of development. (C) 2000 Elsevier Science Inc. All rights reserved.

Incubation of eggs of the Australian broad-shelled turtle, Chelodina expansa (Testudinata : Chelidae), at different temperatures: effects on pattern of oxygen consumption and hatchling morphology

Incubation temperature influences embryonic development and the morphology of resultant hatchlings in many species of turtle but few studies have addressed its effect on oxygen consumption and total embryonic energy expenditure. Eggs of the Australian broad-shelled river turtle, Chelodina expansa, were incubated at constant temperatures of 24 degrees C and 28 degrees C to determine the effect of temperature on oxygen consumption, embryonic energy expenditure and hatchling morphology. All embryos at both incubation temperatures experienced a period of developmental diapause immediately after oviposition. Once this initial diapause was broken, embryos underwent a further period of developmental arrest when the embryo was still very small and had minimal oxygen consumption (

Effect of combined supplementation with vitamin E and alpha-lipoic acid on myocardial performance during in vivo ischaemia-reperfusion

Reactive oxygen species (ROS) contribute significantly to myocardial ischaemia-reperfusion (I-R) injury. Recently the combination of the antioxidants vitamin E (VE) and alpha-lipoic acid (alpha-LA) has been reported to improve cardiac performance and reduce myocardial lipid peroxidation during in vitro I-R. The purpose of these experiments was to investigate the effects of VE and alpha-LA supplementation on cardiac performance, incidence of dysrhythmias and biochemical alterations during an in vivo myocardial I-R insult. Female Sprague-Dawley rats (4-months old) were assigned to one of the two dietary treatments: (1) control diet (CON) or (2) VE and alpha-LA supplementation (ANTIOXID). The CON diet was prepared to meet AIN-93M standards, which contains 75 IU VE kg(-1) diet. The ANTIOXID diet contained 10 000 IU VE kg(-1) diet and 1.65 g alpha-LA kg(-1) diet. After the 14-week feeding period, significant differences (P < 0.05) existed in mean myocardial VE levels between dietary groups. Animals in each experimental group were subjected to an in vivo I-R protocol which included 25 min of left anterior coronary artery occlusion followed by 10 min of reperfusion. No group differences (P > 0.05) existed in cardiac performance (e.g. peak arterial pressure or ventricular work) or the incidence of ventricular dysrhythmias during the I-R protocol. Following I-R, two markers of lipid peroxidation were lower (P < 0.05) in the ANTIOXID animals compared with CON. These data indicate that dietary supplementation of the antioxidants, VE and alpha-LA do not influence cardiac performance or the incidence of dysrhythmias but do decrease lipid peroxidation during in viva I-R in young adult rats.

Absolute risk of breast cancer for Australian women with a family history

Background: The purpose of the present paper was to estimate the absolute risk of breast cancer over the remainder of a lifetime in Australian women with different categories of family history. Methods: Age-specific breast cancer incidence rates were adjusted for screening effects, and rates in those with no family history were estimated using the attributable fraction (AF). Relative risks from a published meta-analysis were applied to obtain incidence rates for different categories of family history, and age-specific incidence was converted to cumulative risk of breast cancer. The risk estimates were based upon Australian population statistics and published relative risks. Breast cancer incidence was from New South Wales women for 1996. The AF was calculated using prevalence of a family history of breast cancer from data on Queensland women. The cumulative absolute risk of breast cancer was calculated from decade and mid-decade ages to age 79 years, not adjusted for competing causes of death. Results: Lifetime risk is approximately 8.6% (1 in 12) for the general population and 7.8% (1 in 13) for those without a family history. Women with one relative affected have lifetime risks of 1 in 6-8 and those with two relatives affected have lifetime risks of 1 in 4-6. The cumulative residual lifetime risk decreases with advancing age; by age 60 years all groups with only one relative affected have well above a 90% probability of not developing breast cancer to age 79 years. Conclusions: These Australian risk statistics are useful for public information and in the clinical setting. Risks given here apply to women with average breast cancer risk from other risk factors.

Relationships between body mass index and well-being in young Australian women

OBJECTIVE: To explore relationships between body mass index (BMI, kg/m(2)) and indicators of health and well-being in young Australian women. DESIGN: Population based cohort study-baseline cross sectional data. SUBJECTS: 14,779 women aged 18-23 who participated in the baseline survey of the Australian Longitudinal Study on Women's Health in 1996. MEASUREMENTS: Self-reported height, weight, medical conditions, symptoms and SF-36. RESULTS: The majority of women (68%) had a BMI in the range 18.5-

Species of Trifoliovarium Yamaguti, 1940 (Digenea : Lecithasteridae) from Australian waters, with a description of T-draconis n. sp and a cladistic study of the subfamily Trifoliovariinae Yamaguti, 1958

Three species of Trifoliovarium are described from marine fishes from Moreton Bay, Queensland: T. triacanthi (Parukhin, 1964) n. comb. (syns Hysterolecitha triacanthi Parukhin, 1964; T. triacanthi Bilqees, 1973; T. triacanthusi Gupta & Ahmad, 1976) from Tripodichthys angustifrons; T. ovarilobulus (Wang, 1989) n. comb. (syn. Hysterolecithia[sic]ovarilobulus) from Paramonacanthus japonicus and Pelates quadrilineatus; and T. draconis n. sp. from Callionymus sublaevis and C. belcheri. A list of the species of the subfamily Trifoliovariinae is given along with a key. A cladistic study of the subfamily based on 23 characters is presented, the results of which indicate the monophyly of the genus Assitrema and the paraphyly of Trifoliovarium.