The ENHANCES study--Enhancing Head and Neck Cancer patients' Experiences of Survivorship: study protocol for a randomized controlled trial

Background Few cancers pose greater challenges than head and neck (H&N) cancer. Residual effects following treatment include body image changes, pain, fatigue and difficulties with appetite, swallowing and speech. Depression is a common comorbidity. There is limited evidence about ways to assist patients to achieve optimal adjustment after completion of treatment. In this study, we aim to examine the effectiveness and feasibility of a model of survivorship care to improve the quality of life of patients who have completed treatment for H&N cancer. Methods This is a preliminary study in which 120 patients will be recruited. A prospective randomised controlled trial of the H&N Cancer Survivor Self-management Care Plan (HNCP) involving pre- and post-intervention assessments will be used. Consecutive patients who have completed a defined treatment protocol for H&N cancer will be recruited from two large cancer services and randomly allocated to one of three study arms: (1) usual care, (2) information in the form of a written resource or (3) the HNCP delivered by an oncology nurse who has participated in manual-based training and skill development in patient self-management support. The trained nurses will meet patients in a face-to-face interview lasting up to 60 minutes to develop an individualised HNCP, based on principles of chronic disease self-management. Participants will be assessed at baseline, 3 and 6 months. The primary outcome measure is quality of life. The secondary outcome measures include mood, self-efficacy and health-care utilisation. The feasibility of implementing this intervention in routine clinical care will be assessed through semistructured interviews with participating nurses, managers and administrators. Interviews with patients who received the HNCP will explore their perceptions of the HNCP, including factors that assisted them in achieving behavioural change. Discussion In this study, we aim to improve the quality of life of a patient population with unique needs by means of a tailored self-management care plan developed upon completion of treatment. Delivery of the intervention by trained oncology nurses is likely to be acceptable to patients and, if successful, will be a model of care that can be implemented for diverse patient populations.

Thermal stability and decomposition kinetics of styrene-butadiene rubber nanocomposites filled with different particle sized kaolinites

A series of styrene-butadiene rubber (SBR) nanocomposites filledwith different particle sized kaolinites are prepared via a latex blending method. The thermal stabilities of these clay polymer nanocomposites (CPN) are characterized by a range of techniques including thermogravimetry (TG), digital photos, scanning electron microscopy (SEM) and Raman spectroscopy. These CPN show some remarkable improvement in thermal stability compared to that of the pure SBR. With the increase of kaolinite particle size, the residual char content and the average activation energy of kaolinite SBR nanocomposites all decrease; the pyrolysis residues become porous; the crystal carbon in the pyrolysis residues decrease significantly from 58.23% to 44.41%. The above results prove that the increase of kaolinite particle size is not beneficial in improving the thermal stability of kaolinite SBR nanocomposites.

Inhibition of the JAK2/STAT3 pathway in ovarian cancer results in the loss of cancer stem cell-like characteristics and a reduced tumor burden

Background Current treatment of ovarian cancer patients with chemotherapy leaves behind a residual tumor which results in recurrent ovarian cancer within a short time frame. We have previously demonstrated that a single short-term treatment of ovarian cancer cells with chemotherapy in vitro resulted in a cancer stem cell (CSC)-like enriched residual population which generated significantly greater tumor burden compared to the tumor burden generated by control untreated cells. In this report we looked at the mechanisms of the enrichment of CSC-like residual cells in response to paclitaxel treatment. Methods The mechanism of survival of paclitaxel-treated residual cells at a growth inhibitory concentration of 50% (GI50) was determined on isolated tumor cells from the ascites of recurrent ovarian cancer patients and HEY ovarian cancer cell line by in vitro assays and in a mouse xenograft model. Results Treatment of isolated tumor cells from the ascites of ovarian cancer patients and HEY ovarian cancer cell line with paclitaxel resulted in a CSC-like residual population which coincided with the activation of Janus activated kinase 2 (JAK2) and signal transducer and activation of transcription 3 (STAT3) pathway in paclitaxel surviving cells. Both paclitaxel-induced JAK2/STAT3 activation and CSC-like characteristics were inhibited by a low dose JAK2-specific small molecule inhibitor CYT387 (1 μM) in vitro. Subsequent, in vivo transplantation of paclitaxel and CYT387-treated HEY cells in mice resulted in a significantly reduced tumor burden compared to that seen with paclitaxel only-treated transplanted cells. In vitro analysis of tumor xenografts at protein and mRNA levels demonstrated a loss of CSC-like markers and CA125 expression in paclitaxel and CYT387-treated cell-derived xenografts, compared to paclitaxel only-treated cell-derived xenografts. These results were consistent with significantly reduced activation of JAK2 and STAT3 in paclitaxel and CYT387-treated cell-derived xenografts compared to paclitaxel only-treated cell derived xenografts. Conclusions This proof of principle study demonstrates that inhibition of the JAK2/STAT3 pathway by the addition of CYT387 suppresses the ‘stemness’ profile in chemotherapy-treated residual cells in vitro, which is replicated in vivo, leading to a reduced tumor burden. These findings have important implications for ovarian cancer patients who are treated with taxane and/or platinum-based therapies. Keywords: Ovarian carcinoma, Cancer stem cell, Metastasis, Ascites, Chemoresistance, Recurrence, JAK2/STAT3 pathway

Open-air direct current plasma jet : scaling up, uniformity, and cellular control

Atmospheric-pressure plasma jets are commonly used in many fields from medicine to nanotechnology, yet the issue of scaling the discharges up to larger areas without compromising the plasma uniformity remains a major challenge. In this paper, we demonstrate a homogenous cold air plasmaglow with a large cross-section generated by a direct current power supply. There is no risk of glow-to-arc transitions, and the plasmaglow appears uniform regardless of the gap between the nozzle and the surface being processed. Detailed studies show that both the position of the quartz tube and the gas flow rate can be used to control the plasma properties. Further investigation indicates that the residual charges trapped on the inner surface of the quartz tube may be responsible for the generation of the air plasma plume with a large cross-section. The spatially resolved optical emission spectroscopy reveals that the air plasma plume is uniform as it propagates out of the nozzle. The remarkable improvement of the plasma uniformity is used to improve the bio-compatibility of a glass coverslip over a reasonably large area. This improvement is demonstrated by a much more uniform and effective attachment and proliferation of human embryonic kidney 293 (HEK 293) cells on the plasma-treated surface.

Relating urban airborne particle concentrations to shipping using carbon based elemental emission ratios

This study demonstrates a novel method for testing the hypothesis that variations in primary and secondary particle number concentration (PNC) in urban air are related to residual fuel oil combustion at a coastal port lying 30 km upwind, by examining the correlation between PNC and airborne particle composition signatures chosen for their sensitivity to the elemental contaminants present in residual fuel oil. Residual fuel oil combustion indicators were chosen by comparing the sensitivity of a range of concentration ratios to airborne emissions originating from the port. The most responsive were combinations of vanadium and sulfur concentration ([S], [V]) expressed as ratios with respect to black carbon concentration ([BC]). These correlated significantly with ship activity at the port and with the fraction of time during which the wind blew from the port. The average [V] when the wind was predominantly from the port was 0.52 ng.m-3 (87%) higher than the average for all wind directions and 0.83 ng.m-3 (280%) higher than that for the lowest vanadium yielding wind direction considered to approximate the natural background. Shipping was found to be the main source of V impacting urban air quality in Brisbane. However, contrary to the stated hypothesis, increases in PNC related measures did not correlate with ship emission indicators or ship traffic. Hence at this site ship emissions were not found to be a major contributor to PNC compared to other fossil fuel combustion sources such as road traffic, airport and refinery emissions.

Assessment of the temperature effect on childhood diarrhea using satellite imagery

A quasi-Poisson generalized linear model combined with a distributed lag non-linear model was used to quantify the main effect of temperature on emergency department visits (EDVs) for childhood diarrhea in Brisbane from 2001 to 2010. Residual of the model was checked to examine whether there was an added effect due to heat waves. The change over time in temperature-diarrhea relation was also assessed. Both low and high temperatures had significant impact on childhood diarrhea. Heat waves had an added effect on childhood diarrhea, and this effect increased with intensity and duration of heat waves. There was a decreasing trend in the main effect of heat on childhood diarrhea in Brisbane across the study period. Brisbane children appeared to have gradually adapted to mild heat, but they are still very sensitive to persistent extreme heat. Development of future heat alert systems should take the change in temperature-diarrhea relation over time into account.

A gray-box neural network-based model identification and fault estimation scheme for nonlinear dynamic systems

A novel gray-box neural network model (GBNNM), including multi-layer perception (MLP) neural network (NN) and integrators, is proposed for a model identification and fault estimation (MIFE) scheme. With the GBNNM, both the nonlinearity and dynamics of a class of nonlinear dynamic systems can be approximated. Unlike previous NN-based model identification methods, the GBNNM directly inherits system dynamics and separately models system nonlinearities. This model corresponds well with the object system and is easy to build. The GBNNM is embedded online as a normal model reference to obtain the quantitative residual between the object system output and the GBNNM output. This residual can accurately indicate the fault offset value, so it is suitable for differing fault severities. To further estimate the fault parameters (FPs), an improved extended state observer (ESO) using the same NNs (IESONN) from the GBNNM is proposed to avoid requiring the knowledge of ESO nonlinearity. Then, the proposed MIFE scheme is applied for reaction wheels (RW) in a satellite attitude control system (SACS). The scheme using the GBNNM is compared with other NNs in the same fault scenario, and several partial loss of effect (LOE) faults with different severities are considered to validate the effectiveness of the FP estimation and its superiority.

Experimental investigation of post-fire mechanical properties of cold-formed steels

Cold-formed steel members are widely used in residential, industrial and commercial buildings as primary load-bearing elements. During fire events, they will be exposed to elevated temperatures. If the general appearance of the structure is satisfactory after a fire event then the question that has to be answered is how the load bearing capacity of cold-formed steel members in these buildings has been affected. Hence after such fire events there is a need to evaluate the residual strength of these members. However, the post-fire behaviour of cold-formed steel members has not been investigated in the past. This means conservative decisions are likely to be made in relation to fire exposed cold-formed steel buildings. Therefore an experimental study was undertaken to investigate the post-fire mechanical properties of cold-formed steels. Tensile coupons taken from cold-formed steel sheets of three different steel grades and thicknesses were exposed to different elevated temperatures up to 800 oC, and were then allowed to cool down to ambient temperature before they were tested to failure. Tensile coupon tests were conducted to obtain their post-fire stress-strain curves and associated mechanical properties (yield stress, Young’s modulus, ultimate strength and ductility). It was found that the post-fire mechanical properties of cold-formed steels are reduced below the original ambient temperature mechanical properties if they had been exposed to temperatures exceeding 300 oC. Hence a new set of equations is proposed to predict the post-fire mechanical properties of cold-formed steels. Such post-fire mechanical property assessments allow structural and fire engineers to make an accurate prediction of the safety of fire exposed cold-formed steel buildings. This paper presents the details of this experimental study and the results of post-fire mechanical properties of cold-formed steels. It also includes the results of a post-fire evaluation of cold-formed steel walls.

Sequential monitoring of hospital adverse events when control charts fail : the example of fall injuries in hospitals

Objective To evaluate methods for monitoring monthly aggregated hospital adverse event data that display clustering, non-linear trends and possible autocorrelation. Design Retrospective audit. Setting The Northern Hospital, Melbourne, Australia. Participants 171,059 patients admitted between January 2001 and December 2006. Measurements The analysis is illustrated with 72 months of patient fall injury data using a modified Shewhart U control chart, and charts derived from a quasi-Poisson generalised linear model (GLM) and a generalised additive mixed model (GAMM) that included an approximate upper control limit. Results The data were overdispersed and displayed a downward trend and possible autocorrelation. The downward trend was followed by a predictable period after December 2003. The GLM-estimated incidence rate ratio was 0.98 (95% CI 0.98 to 0.99) per month. The GAMM-fitted count fell from 12.67 (95% CI 10.05 to 15.97) in January 2001 to 5.23 (95% CI 3.82 to 7.15) in December 2006 (p<0.001). The corresponding values for the GLM were 11.9 and 3.94. Residual plots suggested that the GLM underestimated the rate at the beginning and end of the series and overestimated it in the middle. The data suggested a more rapid rate fall before 2004 and a steady state thereafter, a pattern reflected in the GAMM chart. The approximate upper two-sigma equivalent control limit in the GLM and GAMM charts identified 2 months that showed possible special-cause variation. Conclusion Charts based on GAMM analysis are a suitable alternative to Shewhart U control charts with these data.

An investigation of the impact of various geographical scales for the specification of spatial dependence

Ecological studies are based on characteristics of groups of individuals, which are common in various disciplines including epidemiology. It is of great interest for epidemiologists to study the geographical variation of a disease by accounting for the positive spatial dependence between neighbouring areas. However, the choice of scale of the spatial correlation requires much attention. In view of a lack of studies in this area, this study aims to investigate the impact of differing definitions of geographical scales using a multilevel model. We propose a new approach -- the grid-based partitions and compare it with the popular census region approach. Unexplained geographical variation is accounted for via area-specific unstructured random effects and spatially structured random effects specified as an intrinsic conditional autoregressive process. Using grid-based modelling of random effects in contrast to the census region approach, we illustrate conditions where improvements are observed in the estimation of the linear predictor, random effects, parameters, and the identification of the distribution of residual risk and the aggregate risk in a study region. The study has found that grid-based modelling is a valuable approach for spatially sparse data while the SLA-based and grid-based approaches perform equally well for spatially dense data.

Experimental and numerical studies of fire exposed lipped channel columns subject to distortional buckling

Cold-formed steel sections are commonly used in low-rise commercial and residential buildings. During fire events, cold-formed steel structural elements in these buildings are exposed to elevated temperatures. Hence after such events there is a need to determine the residual strength of these structural elements. However, only limited information is available in relation to the residual strength of fire exposed cold-formed steel members. This research is aimed at investigating the residual distortional buckling capacities of fire exposed cold-formed steel lipped channel sections. A series of compression tests of fire exposed, short lipped channel columns made of varying steel grades and thicknesses was undertaken in this research. Test columns were exposed to different elevated temperatures up to 800 oC. They were then allowed to cool down at ambient temperature before they were tested to failure. Suitable finite element models of tested columns were also developed and validated using test results. The residual compression capacities of tested columns were predicted using the ambient temperature cold-formed steel design rules (AS/NZS 4600, AISI S100 and Direct Strength Method). Post-fire mechanical properties obtained from a previous study were used in this study. Comparison of results showed that ambient temperature design rules for compression members can be used to predict the residual compression capacities of fire exposed short or laterally restrained cold-formed steel columns provided the maximum temperature experienced by the columns can be estimated after a fire event. Such residual capacity assessments will allow structural and fire engineers to make an accurate prediction of the safety of buildings after fire events. This paper presents the details of these experimental and numerical studies and the results.

Post-fire mechanical properties of cold-formed steels

Cold-formed steel members have been widely used in residential, industrial and commercial buildings as primary load-bearing and non-load bearing structural elements. These buildings must be properly evaluated after a fire event to assess the nature and extent of structural damage. If the general appearance of the structure is satisfactory after a fire event then the question that has to be answered is how the structural capacity of cold-formed steel members in these buildings has been affected. Elevated temperatures during a fire event affect the structural performance of cold-formed steel members even after cooling down to ambient temperature due to the possible detrimental changes in their mechanical properties. However, the post-fire behaviour of cold-formed steel members has not been investigated in the past and hence there is a need to investigate the post-fire mechanical properties of cold-formed steels. Therefore an experimental study was undertaken at the Queensland University of Technology to understand the residual mechanical properties of cold-formed steels after fire events. Tensile coupon tests were conducted on three different steel grades and thicknesses to obtain their stress-strain curves and relevant mechanical properties after cooling them down from different elevated temperatures. It was found that the post-fire mechanical properties of cold-formed steels are different to the original ambient temperature mechanical properties. Hence a new set of equations is proposed to predict the reduced mechanical properties of cold-formed steels after a fire event.

Buckling tests of fire exposed cold-formed steel columns

Cold-formed steel sections are commonly used in low-rise commercial and residential buildings. During fire events, cold-formed steel structural elements in these buildings will be exposed to elevated temperatures. Hence after such events there is a need to evaluate the residual strength of these structural elements. However, only limited information is available in relation to the residual strength of fire exposed cold-formed steel sections. This means conservative decisions are often made in relation to fire exposed building structures. This research is aimed at investigating the buckling capacities of fire exposed cold-formed lipped channel steel sections. A series of compression tests of fire exposed, short lipped channel columns made of varying steel grades and thicknesses was undertaken in this research. Test columns were first exposed to different elevated temperatures up to 800 oC. They were then allowed to cool down at ambient temperatures before they were tested to failure. Similarly tensile coupon tests were also undertaken after being exposed to various elevated temperatures, from which the residual mechanical properties (yield stress and Young’s modulus) of the steels used in this study were derived. Using these mechanical properties, the residual compression capacities of tested short columns were predicted using the currently used design rules in AS/NZS 4600 and AISI cold-formed steel standards. This comparison showed that ambient temperature design rules for compression members can be used to predict the residual compression capacities of fire exposed short or laterally restrained cold-formed steel columns provided the maximum temperature experienced by the columns can be estimated after a fire event. Such residual capacity assessments will allow structural and fire engineers to make an accurate prediction of the safety of fire exposed buildings. This paper presents the details of this experimental study and the results.

Distortional buckling behaviour of fire exposed cold-formed steel columns

Cold-formed steel sections are commonly used in low-rise commercial and residential buildings. During fire events, cold-formed steel structural elements in these buildings can be exposed to elevated temperatures. Hence after such events there is a need to evaluate their residual strengths. However, only limited information is available in relation to the residual strength of fire exposed cold-formed steel sections. This research is aimed at investigating the distortional buckling capacities of fire exposed cold-formed lipped channel sections. A series of compression tests of fire exposed, short lipped channel columns made of varying steel grades and thicknesses was undertaken in this research. Test columns were first exposed to different elevated temperatures up to 800 oC, and then tested to failure after cooling down. Suitable finite element models were developed with post-fire mechanical properties to simulate the behaviour of tested columns and were validated using test results. The residual compression capacities of short columns were also predicted using the current cold-formed steel standards and compared with test and finite element analysis results. This comparison showed that ambient temperature design rules for columns can be used to predict the residual compression capacities of fire exposed short or laterally restrained cold-formed steel columns provided the maximum temperature experienced by the column can be estimated after a fire event. Such residual capacity assessments will allow engineers to evaluate the safety of fire exposed buildings. This paper presents the details of this experimental study, finite element analyses and the results.

Experimental studies on web crippling behaviour of hollow flange channel beams under two flange load cases

This paper presents the details of an experimental study of a cold-formed steel hollow flange channel beam known as LiteSteel beam (LSB) subject to web crippling under End Two Flange (ETF) and Interior Two Flange (ITF) load cases. The LSB sections with two rectangular hollow flanges are made using a simultaneous cold-forming and electric resistance welding process. Due to the geometry of the LSB, and its unique residual stress characteristics and initial geometric imperfections, much of the existing research for common cold-formed steel sections is not directly applicable to LSB. Experimental and numerical studies have been carried out to evaluate the behaviour and design of LSBs subject to pure bending, predominant shear and combined actions. To date, however, no investigation has been conducted on the web crippling behaviour and strength of LSB sections. Hence an experimental study was conducted to investigate the web crippling behaviour and capacities of LSBs. Twenty-eight web crippling tests were conducted under ETF and ITF load cases, and the ultimate web crippling capacities were compared with the predictions from the design equations in AS/NZS 4600 and AISI S100. This comparison showed that AS/NZS 4600 and AISI S100 web crippling design equations are unconservative for LSB sections under ETF and ITF load cases. Hence new equations were proposed to determine the web crippling capacities of LSBs based on experimental results. Suitable design rules were also developed under the direct strength method (DSM) format.