Baseline comorbidities in a population-bases cohort of rheumatoid arthritis patients receiving biological therapy: data from the Australian Rheumatology Association database

Aims: To describe the baseline characteristics of an Australian population-based cohort of rheumatoid arthritis (RA) patients commencing biological therapy.

Methods: Descriptive analysis from the Australian Rheumatology Association Database (ARAD).

Results: Up to October 2006, there were 681 RA patients taking biologics enrolled in ARAD. Baseline data were available for 624 (72% female, mean (SD) age 57.0 (12.5) years). Of these, 59.5% reported at least one comorbid condition, most commonly hypertension (35.7%) and osteoporosis (30.4%); 61 (9.8%) had a history of malignancy (35 nonmelanoma skin, 5 breast, 4 bowel, 5 cervix, 3 melanoma, 3 prostate and 1 each of lip, lung, myeloma, testis, uterus, vagina). Self-reported infections within the previous 6 months were common (71.5%).

Conclusions: History of comorbidities, including recent infections, is common among Australian RA patients commencing biologics, and 10% have a history of malignancy. This may impact future evaluations of health outcomes among this population, including attribution of adverse events of biologic therapy.

Procedural justice and Australian environment : the case of the Wonthaggi water desalination plant

Drier conditions in Australia have compelled governments to implement various projects to address current or impending water shortages. Such projects have not always been popular with the local community who are directly affected by this infrastructure, with 'procedural justice' emerging as a critical issue. This paper analyses issues of public perceptions of 'procedural justice' in implementing environmental projects in regional areas, in the context of the recently approved desalination plant in the regional Victorian town of Wonthaggi. Drawing on both qualitative and quantitative data from a survey of 316 Wonthaggi residents, we show that one of the major predictors of residents' resistance toward accepting the building of the desalination plant was explained by perceptions of procedural injustice. We further argue that inadequate attention to the particular political history of the region has compounded the sense that the plant implementation has been unfair. Attention to such political histories is vital to avoiding conflict with local stakeholders and to the successful and ethical implementation of development projects in regional areas.

Options for change in the Australian cervical cancer screening program in context of HPV detection and vaccination

Introduction:
Cervical cancer screening has been implemented for over a decade in Australia and has significantly reduced the mortality and morbidity of the disease. The emergence of new technologies for cervical cancer, such as the Human Papillomavirus (HPV) vaccine and DNA testing has encouraged debate regarding the effective use of resources in cervical cancer prevention. The present study evaluates the cost-effectiveness, from a health sector perspective, of various screening strategies in the era of these new technologies.

Methods:
A stochastic epidemiological model using a discrete event and continuous algorithm was developed to describe the natural history of cervical cancer. By allowing one member of the cohort into the model at a time, this micro-simulation model encompasses the characteristics of heterogeneity and can track individual life histories. To evaluate the cost-effectiveness of the HPV vaccine a Markov model was built to simulate the effect on the incidence of HPV and subsequent cervical cancer. A number of proposed screening strategies were evaluated with the stochastic model for the application of HPV DNA testing, with changes in the screening interval and target population. Health outcomes were measured by Disability-Adjusted Life-Years (DALYs), adjusted for application within an evaluation setting (i.e. the mortality component of the DALY was adjusted by a disability weight when early mortality due to cervical cancer is avoided). Costs in complying with the Australian updated guidelines were assessed by pathway analysis to estimate the resources associated with cervical cancer and its pre-cancerous lesion treatment. Sensitivity analyses were performed to investigate the key parameters that influenced the cost-effectiveness results.

Results:
Current practice has already brought huge health gain by preventing more than 4,000 deaths and saving more than 86,000 life-years in a cohort of a million women. Any of the alternative screening strategies alter the total amount of health gain by a small margin compared to current practice. The results of incremental analyses of the alternative screening strategies compared to current practice suggest the adoption of the HPV DNA test as a primary screening tool every 3 years commencing at age 18, or the combined pap smear/HPV test every 3 years commencing at age 25, are more costly than current practice but with reasonable ICERs (AUD$1,810 per DALY and AUD$18,600 per DALY respectively). Delaying commencement of Pap test screening to age 25 is less costly than current practice, but involves considerable health loss. The sensitivity analysis shows, however, that the screening test accuracy has a significant impact on these conclusions. Threshold analysis indicates that a sensitivity ranging from 0.80 to 0.86 for the combined test in women younger than 30 is required to produce an acceptable incremental cost-effectiveness ratio.

Conclusions:
The adoption of HPV and combined test with an extended screening interval is more costly but affordable, resulting in reasonable ICERs. They appear good value for money for the Australian health care system, but need more information on test accuracy to make an informed decision. Potential screening policy change under current Australian HPV Vaccination Program is current work in progress. A Markov model is built to simulate the effect on the incidence of HPV and subsequent cervical cancer. Adoption of HPV DNA test as a primary screening tool in the context of HPV vaccination is under evaluation.

The odd bod, the icon and the modest woman : the differences and similarities amongst three Australian women music teachers, performers and composers

Throughout Australia's history there have been many women who have been active in music education, performance and composition, despite the traditional family commitments which women have negotiated, overcoming prevailing negative attitudes to success outside the home. The period 1900 to 1950 in Australia saw significant changes in the social structure such as universal suffrage, Federation and World War 1. These changes broadened opportunities for some women to negotiate a life-time career in music. The researcher has identified three significant women who were able to forge careers in music during this time in music teaching, composition and performance. The women were Mona McBurney, Ruby Davy and Ruth Flockart. The selected women were all unique; McBurney was an outstanding composer for her time, being the first woman in Australia to compose an opera. Also, she was the first woman in Australia to gain her Bachelor of Music. Despite these successes, she had a reputation for her overwhelming modesty and shyness. Davy was significant because of her diversified ability as a teacher, performer, composer and elocutionist, and because she was the first woman in Australia to gain her Doctorate of Music. Davy has been described by several people as unusual, strange, and an 'odd bod'. Flockart was a music teacher at Methodist Ladies' College Melbourne for almost fifty years, half of those as the Director of Music. She was a significant figure in contemporary music education, particularly as a choral conductor, where she has been described as an 'icon'. This research looks at the differences and similarities amongst these three women in terms of family life, social position, education and support systems, and their ability to negotiate a career in music teaching, performance and composition.

Matilda's last dance: death, gender, sexuality and Australian adolescent literature

This thesis examines representations of death in a selection of contemporary texts for Australian adolescent audiences. It demonstrates that, although death is a complex subject, a characteristically Australian 'way of death' is identifiable in these fictions and it is invariably associated with issues of sexuality, gender and power.

"Old Man" : Australian battalion commanders in the Second World War

Examining the background, training and conduct of Australian Second World War battalion commanders, this thesis rejects the notion of a single Australian command style. Rather, it shows command practice was a product of the interaction between terrain, tactics, technology and training, and that increasing professionalisation was central to battlefield success.

(Queer) Deleuzean readings of desire in Australian young adult fiction

This thesis analyses the representation of adolescent girls' friendships in Australian young adult fiction. Through Deleuzean philosophy, the relationships between girls are read as spaces of empowering and unbounded passions which defy binarised distinctions and categorisations. The analysis of these fictional relationships disentangles desire from psychoanalytic lack and uncovers its productivity.

A life history model for the giant crab Pseudocarcinus gigas

This study examined P. gigas populations from Cape Naturaliste (Western Australia) to Flinders Island (Tasmania), investigated reproduction, developed a unique tag to study their movement and growth, and collected new environmental information that allowed the development of a model of the life history for this iconic endemic Australian species.

Side-by-side memorials and Australian Vietnam War remembrance

This thesis argues that side-by-side memorials, built by Vietnamese and Australian Vietnam veterans, are a unique theme in Australia's memorial landscape wherein Australian soldier statues generally stand alone. It provides understanding of how these memorials emerged, and discusses the significance of this new theme for Australian Vietnam War remembrance.

Evolutionary consequences of life history variation in galaxiid fish

This thesis examined genetic variation among populations of galaxiid fish of different life histories. Evidence of incipient speciation was found among several landlocked populations; however, little genetic differentiation was found among Australian coastal populations. Evidence was found to suggest a marine ancestry for galaxiids and several taxonomic revisions were suggested.

Australian women artists and domesticity in the twentieth century

The professionalism of women artists around the turn of the century coincided with the growing expectation that female members of the family should do the housework formerly done by domestic servants. The Women's Art Register was the research base for the compilation of a twentieth century history of Australian women artists and their attitude towards domesticity and housework. The authors work as located within this artistic tradition is also discussed.