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.

Student perceptions of the quality of property education in Australia : 1994 – 2009

Using the Graduate Careers Australia’s Course Experience Questionnaire (CEQ), the students’ perceptions of the quality of property education in Australia is assessed over 1994-2009. Analyses are presented for the major property universities in Australia regarding good teaching and overall satisfaction, as well as the property discipline benchmarked against the property-related disciplines of accounting, building, business, economics, law and planning. The link between good teaching and overall satisfaction, and the delivery of added value by property programs are also assessed. Changes over this 16-year period are highlighted in terms of student perceptions of the quality of property education in Australia.

Sensitivity of organic matter decomposition to warming varies with its quality

The relationship between organic matter (OM) lability and temperature sensitivity is disputed, with recent observations suggesting that responses of relatively more resistant OM to increased temperature could be greater than, equivalent to, or less than responses of relatively more labile OM. This lack of clear understanding limits the ability to forecast carbon (C) cycle responses to temperature changes. Here, we derive a novel approach (denoted Q(10-q)) that accounts for changes in OM quality during decomposition and use it to analyze data from three independent sources. Results from new laboratory soil incubations (labile Q(10-q)=2.1 +/- 0.2; more resistant Q(10-q)=3.8 +/- 0.3) and reanalysis of data from other soil incubations reported in the literature (labile Q(10-q)=2.3; more resistant Q(10-q)=3.3) demonstrate that temperature sensitivity of soil OM decomposition increases with decreasing soil OM lability. Analysis of data from a cross-site, field litter bag decomposition study (labile Q(10-q)=3.3 +/- 0.2; resistant Q(10-q)=4.9 +/- 0.2) shows that litter OM follows the same pattern, with greater temperature sensitivity for more resistant litter OM. Furthermore, the initial response of cultivated soils, presumably containing less labile soil OM (Q(10-q)=2.4 +/- 0.3) was greater than that for undisturbed grassland soils (Q(10-q)=1.7 +/- 0.1). Soil C losses estimated using this approach will differ from previous estimates as a function of the magnitude of the temperature increase and the proportion of whole soil OM comprised of compounds sensitive to temperature over that temperature range. It is likely that increased temperature has already prompted release of significant amounts of C to the atmosphere as CO2. Our results indicate that future losses of litter and soil C may be even greater than previously supposed.

Analyzing requirements and approaches for sourcing software based services

Increasingly, software is no longer developed as a single system, but rather as a smart combination of so-called software services. Each of these provides an independent, specific and relatively small piece of functionality, which is typically accessible through the Internet from internal or external service providers. To the best of our knowledge, there are no standards or models that describe the sourcing process of these software based services (SBS). We identify the sourcing requirements for SBS and associate the key characteristics of SBS (with the sourcing requirements introduced). Furthermore, we investigate the sourcing of SBS with the related works in the field of classical procurement, business process outsourcing, and information systems sourcing. Based on the analysis, we conclude that the direct adoption of these approaches for SBS is not feasible and new approaches are required for sourcing SBS.

Analyzing requirements and approaches for sourcing software based services

Increasingly, software is no longer developed as a single system, but rather as a smart combination of so-called software services. Each of these provides an independent, specific and relatively small piece of functionality, which is typically accessible through the Internet from internal or external service providers. There are no standards or models that describe the sourcing process of these software based services (SBS). The authors identify the sourcing requirements for SBS and associate the key characteristics of SBS (with the sourcing requirements introduced). Furthermore, this paper investigates the sourcing of SBS with the related works in the field of classical procurement, business process outsourcing, and information systems sourcing. Based on the analysis, the authors conclude that the direct adoption of these approaches for SBS is not feasible and new approaches are required for sourcing SBS.

Upper-body morbidity following breast cancer treatment is common, may persist longer-term and adversely influences quality of life

Background: Impairments in upper-body function (UBF) are common following breast cancer. However, the relationship between arm morbidity and quality of life (QoL) remains unclear. This investigation uses longitudinal data to describe UBF in a population-based sample of women with breast cancer and examines its relationship with QoL. ---------- Methods: Australian women (n = 287) with unilateral breast cancer were assessed at three-monthly intervals, from six- to 18-months post-surgery (PS). Strength, endurance and flexibility were used to assess objective UBF, while the Disability of the Arm, Shoulder and Hand questionnaire and the Functional Assessment of Cancer Therapy- Breast questionnaire were used to assess self-reported UBF and QoL, respectively. ---------- Results: Although mean UBF improved over time, up to 41% of women revealed declines in UBF between sixand 18-months PS. Older age, lower socioeconomic position, treatment on the dominant side, mastectomy, more extensive lymph node removal and having lymphoedema each increased odds of declines in UBF by at least twofold (p < 0.05). Lower baseline and declines in perceived UBF between six- and 18-months PS were each associated with poorer QoL at 18-months PS (p < 0.05). ---------- Conclusions: Significant upper-body morbidity is experienced by many following breast cancer treatment, persisting longer term, and adversely influencing the QoL of breast cancer survivors.

The impact of tax morale and institutional quality on the shadow economy

This paper uses a multivariate analysis to examine how countries‘ tax morale and institutional quality affect the shadow economy. The literature strongly emphasizes the quantitative importance of these factors in understanding the level of and changes in the shadow economy. Newly available data sources offer the unique opportunity to further illuminate a topic that has received increased attention. After controlling for a variety of potential factors, we find strong support that a higher tax morale and a higher institutional quality lead to a smaller shadow economy.

Determination of a set of surrogate parameters to assess urban stormwater quality

This paper presents the outcomes of a research project, which focused on developing a set of surrogate parameters to evaluate urban stormwater quality using simulated rainfall. Use of surrogate parameters has the potential to enhance the rapid generation of urban stormwater quality data based on on-site measurements and thereby reduce resource intensive laboratory analysis. The samples collected from rainfall simulations were tested for a range of physico-chemical parameters which are key indicators of nutrients, solids and organic matter. The analysis revealed that [total dissolved solids (TDS) and dissolved organic carbon (DOC)]; [total solids (TS) and total organic carbon (TOC)]; [turbidity (TTU)]; [electrical conductivity (EC)]; [TTU and EC] as appropriate surrogate parameters for dissolved total nitrogen (DTN), total phosphorus (TP), total suspended solids (TSS), TDS and TS respectively. Relationships obtained for DTN-TDS, DTN-DOC, and TP-TS demonstrated good portability potential. The portability of the relationship developed for TP and TOC was found to be unsatisfactory. The relationship developed for TDS-EC and TS-EC also demonstrated poor portability.

Quality of child abuse information for measurement and surveillance : linking hospital and child welfare data

National estimates of the prevalence of child abuse-related injuries are obtained from a variety of sectors including welfare, justice, and health resulting in inconsistent estimates across sectors. The International Classification of Diseases (ICD) is used as the international standard for categorising health data and aggregating data for statistical purposes, though there has been limited validation of the quality, completeness or concordance of these data with other sectors. This research study examined the quality of documentation and coding of child abuse recorded in hospital records in Queensland and the concordance of these data with child welfare records. A retrospective medical record review was used to examine the clinical documentation of over 1000 hospitalised injured children from 20 hospitals in Queensland. A data linkage methodology was used to link these records with records in the child welfare database. Cases were sampled from three sub-groups according to the presence of target ICD codes: Definite abuse, Possible abuse, unintentional injury. Less than 2% of cases coded as being unintentional were recoded after review as being possible abuse, and only 5% of cases coded as possible abuse cases were reclassified as unintentional, though there was greater variation in the classification of cases as definite abuse compared to possible abuse. Concordance of health data with child welfare data varied across patient subgroups. This study will inform the development of strategies to improve the quality, consistency and concordance of information between health and welfare agencies to ensure adequate system responses to children at risk of abuse.

Quality of child abuse information in emergency department injury surveillance data : linking hospital and child welfare data

Emergency departments (EDs) are often the first point of contact with an abused child. Despite legal mandate, the reporting of definite or suspected abusive injury to child safety authorities by ED clinicians varies due to a number of factors including training, access to child safety professionals, departmental culture and a fear of ‘getting it wrong’. This study examined the quality of documentation and coding of child abuse captured by ED based injury surveillance data and ED medical records in the state of Queensland and the concordance of these data with child welfare records. A retrospective medical record review was used to examine the clinical documentation of almost 1000 injured children included in the Queensland Injury Surveillance Unit database (QISU) from 10 hospitals in urban and rural centres. Independent experts re-coded the records based on their review of the notes. A data linkage methodology was then used to link these records with records in the state government’s child welfare database. Cases were sampled from three sub-groups according to the surveillance intent codes: Maltreatment by parent, Undetermined and Unintentional injury. Only 0.1% of cases coded as unintentional injury were recoded to maltreatment by parent, while 1.2% of cases coded as maltreatment by parent were reclassified as unintentional and 5% of cases where the intent was undetermined by the triage nurse were recoded as maltreatment by parent. Quality of documentation varied across type of hospital (tertiary referral centre, children’s, urban, regional and remote). Concordance of health data with child welfare data varied across patient subgroups. Outcomes from this research will guide initiatives to improve the quality of intentional child injury surveillance systems.

Perceptions of daylight quality delivered by light transport systems

Light Transport Systems (LTS) (e.g lightpipes, fibre optics) can illuminate core areas within buildings with great potential for energy savings. However, they do not provide a clear connection to the outside like windows do, and their effects on people’s physiological and psychological health are not well understood. Furthermore, how people perceive LTS affects users’ acceptance of the device and its performance. The purpose of this research is to understand how occupants perceive and experience spaces illuminated by LTS. Two case studies of commercial buildings with LTS, located in Brisbane, Australia are assessed by qualitative (focus group interviews) and quantitative (measurement of daylight illuminances and luminance) methods. The data from interviews with occupants provide useful insight into the aspects of LTS design that are most relevant to positive perception of the luminous environment. Luminance measurements of the occupied spaces support the perception of the LTS reported by occupants: designs that create high contrast luminous environments are more likely to be perceived negatively.

Scheduling coordination through negotiation between train service providers in an open railway access market

A schedule coordination problem involving two train services provided by different operators is modeled as an optimization of revenue intake. The coordination is achieved through the adjustment of commencement times of the train services by negotiation. The problem is subject to constraints regarding to passenger demands and idle costs of rolling-stocks from both operators. This paper models the operators as software agents having the flexibility to incorporate one of the two (and potentially more) proposed negotiation strategies. Empirical results show that agents employing different combination of strategies have significant impact on the quality of solution and negotiation time.

Modelling issues on the railway resource management process using multi-agent system

Many infrastructure and necessity systems such as electricity and telecommunication in Europe and the Northern America were used to be operated as monopolies, if not state-owned. However, they have now been disintegrated into a group of smaller companies managed by different stakeholders. Railways are no exceptions. Since the early 1980s, there have been reforms in the shape of restructuring of the national railways in different parts of the world. Continuous refinements are still conducted to allow better utilisation of railway resources and quality of service. There has been a growing interest for the industry to understand the impacts of these reforms on the operation efficiency and constraints. A number of post-evaluations have been conducted by analysing the performance of the stakeholders on their profits (Crompton and Jupe 2003), quality of train service (Shaw 2001) and engineering operations (Watson 2001). Results from these studies are valuable for future improvement in the system, followed by a new cycle of post-evaluations. However, direct implementation of these changes is often costly and the consequences take a long period of time (e.g. years) to surface. With the advance of fast computing technologies, computer simulation is a cost-effective means to evaluate a hypothetical change in a system prior to actual implementation. For example, simulation suites have been developed to study a variety of traffic control strategies according to sophisticated models of train dynamics, traction and power systems (Goodman, Siu and Ho 1998, Ho and Yeung 2001). Unfortunately, under the restructured railway environment, it is by no means easy to model the complex behaviour of the stakeholders and the interactions between them. Multi-agent system (MAS) is a recently developed modelling technique which may be useful in assisting the railway industry to conduct simulations on the restructured railway system. In MAS, a real-world entity is modelled as a software agent that is autonomous, reactive to changes, able to initiate proactive actions and social communicative acts. It has been applied in the areas of supply-chain management processes (García-Flores, Wang and Goltz 2000, Jennings et al. 2000a, b) and e-commerce activities (Au, Ngai and Parameswaran 2003, Liu and You 2003), in which the objectives and behaviour of the buyers and sellers are captured by software agents. It is therefore beneficial to investigate the suitability or feasibility of applying agent modelling in railways and the extent to which it might help in developing better resource management strategies. This paper sets out to examine the benefits of using MAS to model the resource management process in railways. Section 2 first describes the business environment after the railway 2 Modelling issues on the railway resource management process using MAS reforms. Then the problems emerge from the restructuring process are identified in section 3. Section 4 describes the realisation of a MAS for railway resource management under the restructured scheme and the feasible studies expected from the model.

Talking the talk and walking the walk : how managers can influence the quality of work-life balance in a construction project

Purpose – The construction industry in Australia is characterised by a long work-hours culture, with conditions that make it difficult for staff to balance their work and non-work lives. The objective of this paper is to measure the success of a work-place intervention designed to improve work-life balance (WLB) in an alliance project in the construction industry, and the role the project manager plays in this success. Design/methodology/approach – The paper focuses on an alliance case study. Interviews were conducted at two points in time, several months apart, after the interventions were implemented. Findings – Results showed that staff on the whole were more satisfied with their work experience after the interventions, and indicated the important role that managers' attitudes and behaviours played. Originality/value – Managerial support for work-life initiatives is a critical element in achieving WLB and satisfaction with working arrangements. The fact that the manager “talked the talk and walked the walk” was a major contributing success factor, which has not previously been demonstrated.

Benchmarking clinical indicators of quality for Australian residential aged care facilities

To undertake exploratory benchmarking of a set of clinical indicators of quality care in residential care in Australia, data were collected from 107 residents within four medium-sized facilities (40–80 beds) in Brisbane, Australia. The proportion of residents in each sample facility with a particular clinical problem was compared with US Minimum Data Set quality indicator thresholds. Results demonstrated variability within and between clinical indicators, suggesting breadth of assessment using various clinical indicators of quality is an important factor when monitoring quality of care. More comprehensive and objective measures of quality of care would be of great assistance in determining and monitoring the effectiveness of residential aged care provision in Australia, particularly as demands for accountability by consumers and their families increase. What is known about the topic? The key to quality improvement is effective quality assessment, and one means of evaluating quality of care is through clinical outcomes. The Minimum Data Set quality indicators have been credited with improving quality in United States nursing homes. What does this paper add? The Clinical Care Indicators Tool was used to collect data on clinical outcomes, enabling comparison of data from a small Australian sample with American quality benchmarks to illustrate the utility of providing guidelines for interpretation. What are the implications for practitioners? Collecting and comparing clinical outcome data would enable practitioners to better understand the quality of care being provided and whether practices required review. The Clinical Care Indicator Tool could provide a comprehensive and systematic means of doing this, thus filling a gap in quality monitoring within Australian residential aged care.