A randomised trial of robotic and open prostatectomy in men with localised prostate cancer

Background
Prostate cancer is the most common male cancer in the Western world however there is ongoing debate about the optimal treatment strategy for localised disease. While surgery remains the most commonly received treatment for localised disease in Australia more recently a robotic approach has emerged as an alternative to open and laparoscopic surgery. However, high level data is not yet available to support this as a superior approach or to guide treatment decision making between the alternatives. This paper presents the design of a randomised trial of Robotic and Open Prostatectomy for men newly diagnosed with localised prostate cancer that seeks to answer this question.

Methods
200 men per treatment arm (400 men in total) are being recruited after diagnosis and before treatment through a major public hospital outpatient clinic and randomised to 1) Robotic Prostatectomy or 2) Open Prostatectomy. All robotic prostatectomies are being performed by one surgeon and all open prostatectomies are being performed by one other surgeon. Outcomes are being measured pre-operatively and at 6 weeks and 3, 6, 12 and 24 months post-surgery. Oncological outcomes are being related to positive surgical margins, biochemical recurrence +/ the need for further treatment. Non-oncological outcome measures include: pain, physical and mental functioning, fatigue, summary (preference-based utility scores) and domain-specific QoL (urinary incontinence, bowel function and erectile function), cancer specific distress, psychological distress, decision-related distress and time to return to usual activities. Cost modelling of each approach, as well as full economic appraisal, is also being undertaken.

Discussion
The study will provide recommendations about the relative benefits of Robotic and Open Prostatectomy to support informed patient decision making about treatment for localised prostate cancer; and to assist in treatment services planning for this patient group. Trial Registration ACTRN12611000661976

Understanding in-vivo abrasion fatigue or common suture materials used in arthroscopic and open shoulder surgery

In orthopaedic surgery the reattachment of tendon to bone requires suture materials that have stable and durable properties to allow healing at the tendon-bone interface. Failure rates of this type of surgery can be as high as 25%. While the tissue suture interface is a weak link, proportions of these failures are caused by in-vivo abrasion of the suture with bone and suture anchor materials. Abrasion of the suture material results from the movement of the suture through the eyelet by the surgeon during surgery, or with limb movement after surgery as the suture is not rigidly restrained within the eyelet. During movement the suture is subjected to bending and frictional forces that can lead to fatigue induced failure. This paper investigates the mechanism of bending abrasion fatigue induced failure of number two grade braided sheath only and braided sheath/multifilament core sutures. Sutures were oscillated over a stainless steel wire at low frequency under load in a dry state to simulate the bending and frictional forces between suture and eyelet. Failure mechanism was determined by video microscopy of the suture during abrasion combined with optical microscopy analysis of partially and fully abraded sutures. Braided only structures had high friction loading on the small number of fibres at the abrasion interface. This caused rapid single fibre breakages that accumulate to cause suture failure. The addition of ultra-high molecular weight polyethylene core fibres to a braided suture distributed the applied load across multiple fibres at the abrasion interface. This improved abrasion resistance by 15-20 times that of braided sheath alone.

Dissemination of therapist-assisted internet cognitive behaviour therapy : development and open pilot study of a workshop

There is considerable research suggesting that therapist-assisted Internet cognitive behaviour therapy (ICBT) is efficacious in the treatment of depression and anxiety. Given this research, there is a growing interest in training students in therapist-assisted ICBT in order to assist with the dissemination of this emerging modality into routine clinical practice. In this study, we developed, delivered, and evaluated a therapist-assisted ICBT workshop for clinical psychology graduate students (n = 20). The workshop provided both research evidence and practical information related to the delivery of therapist-assisted ICBT. The workshop also incorporated an experiential component with students working on and discussing responses to client e-mails. Before and after the workshop, we measured knowledge of therapist-assisted ICBT research and professional practice issues, as well as attitudes towards and confidence in delivering therapist-assisted ICBT. Statistically significant changes were observed in all areas. Eighty-five per cent of students are now offering therapist-assisted ICBT under supervision. We conclude by discussing future research directions related to disseminating therapist-assisted ICBT.

Are voluntary wheel running and open-field behavior correlated in mice? Different answers from comparative and artificial selection approaches

Voluntary wheel running and open-field behavior are probably the two most widely used measures of locomotion in laboratory rodents. We tested whether these two behaviors are correlated in mice using two approaches: the phylogenetic comparative method using inbred strains of mice and an ongoing artificial selection experiment on voluntary wheel running. After taking into account the measurement error and phylogenetic relationships among inbred strains, we obtained a significant positive correlation between distance run on wheels and distance moved in the open-field for both sexes. Thigmotaxis was negatively correlated with distance run on wheels in females but not in males. By contrast, mice from four replicate lines bred for high wheel running did not differ in either distance covered or thigmotaxis in the open field as compared with mice from four non-selected control lines. Overall, results obtained in the selection experiment were generally opposite to those observed among inbred strains. Possible reasons for this discrepancy are discussed.

Between Genet’s Bordello and holy communion : Lacan on comedy in seminar V

This article aalytically reconstructs Lacan's scattered remarks on comedy in Seminar V, turning around his reading of Genet's play the Bordello and Aristophanes' ancient comedies.

Disrupting the encoding of misinformation delivered in closed specific and open presumptive questions

To determine whether the encoding of misleading information presented in two different types of leading questions (closed specific and open presumptive questions) could be disrupted, participants took part in a misinformation experiment. They viewed an event before answering questions that had a closed specific structure (e.g. “Did the robber have a shotgun that had a black barrel and a brown stock?”) or an open presumptive structure (e.g. “Tell me about the shotgun”). Half the questions contained misleading information and half did not. For some of the questions, participants completed a concurrent distractor task. Finally, they completed a recognition memory test about the original event. Results showed that the concurrent distractor task during the interview reduced the size of the misinformation effect for the closed specific questions, but had no impact on the misinformation effect for the open presumptive questions. The results suggest that open presumptive questions encourage participants to encode and process the misleading information more deeply than the closed specific questions. The misinformation effect was more difficult to disrupt with a concurrent task during the encoding of the misleading information for open presumptive questions than for closed specific questions. The implications for interviewing are discussed.

Economic efficiency of free and open source software in the public sector: the example of Chile

Includes bibliography

Pension reform in Central and Eastern Europe: necessity, approaches and open questions

Includes bibliography

Big data and open data as sustainability tools: A working paper prepared by the Economic Commission for Latin America and the Caribbean

The two main forces affecting economic development are the ongoing technological revolution and the challenge of sustainability. Technological change is altering patterns of production, consumption and behaviour in societies; at the same time, it is becoming increasingly difficult to ensure the sustainability of these new patterns because of the constraints resulting from the negative externalities generated by economic growth and, in many cases, by technical progress itself. Reorienting innovation towards reducing or, if possible, reversing the effects of these externalities could create the conditions for synergies between the two processes. Views on the subject vary widely: while some maintain that these synergies can easily be created if growth follows an environmentally friendly model, summarized in the concept of green growth, others argue that production and consumption patterns are changing too slowly and that any technological fix will come too late. These considerations apply to hard technologies, essentially those used in production. The present document explores the opportunities being opened up by new ones, basically information and communication technologies, in terms of increasing the effectiveness (outcomes) and efficiency (relative costs) of soft technologies that can improve the way environmental issues are handled in business management and in public policy formulation and implementation.

Role of TRPV1 channels of the dorsal periaqueductal gray in the modulation of nociception and open elevated plus maze-induced antinociception in mice

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Comparison between endoscopic and open surgery in 37 patients with nasopharyngeal angiofibroma

Juvenile nasopharyngeal angiofibroma is a rare benign vascular tumor of the nasopharynx. Although the treatment of choice is surgery, there is no consensus on what is the best approach. Aim: To compare surgical time and intraoperative transfusion requirements in patients undergoing endoscopic surgery versus open / combined and relate the need for transfusion during surgery with the time between embolization and surgery. Material and Methods: Study descriptive, analytical, retrospective study with a quantitative approach developed in the Otorhinolaryngology department of a teaching hospital. Analyzed 37 patients with angiofibroma undergoing surgical treatment. Data obtained from medical records. Analyzed with tests of the Fisher-Freeman-Halton and Games-Howell. Was considered significant if p <0.05. Study design: Historical cohort study with cross-sectional. Results: The endoscopic approach had a shorter operative time (p <0.0001). There is less need for transfusion during surgery when the embolization was performed on the fourth day. Conclusion: This suggests that the period ahead would be ideal to perform the process of embolization and endoscopic surgery by demanding less time would be associated with a lower morbidity. This study, however, failed to show which group of patients according to tumor stage would benefit from specific technical.

Innovation and economic performance of the firms in the service sector: relevant issues and open problems

This thesis is a collection of essays related to the topic of innovation in the service sector. The choice of this structure is functional to the purpose of single out some of the relevant issues and try to tackle them, revising first the state of the literature and then proposing a way forward. Three relevant issues has been therefore selected: (i) the definition of innovation in the service sector and the connected question of measurement of innovation; (ii) the issue of productivity in services; (iii) the classification of innovative firms in the service sector. Facing the first issue, chapter II shows how the initial width of the original Schumpeterian definition of innovation has been narrowed and then passed to the service sector form the manufacturing one in a reduce technological form. Chapter III tackle the issue of productivity in services, discussing the difficulties for measuring productivity in a context where the output is often immaterial. We reconstruct the dispute on the Baumol’s cost disease argument and propose two different ways to go forward in the research on productivity in services: redefining the output along the line of a characteristic approach; and redefining the inputs, particularly analysing which kind of input it’s worth saving. Chapter IV derives an integrated taxonomy of innovative service and manufacturing firms, using data coming from the 2008 CIS survey for Italy. This taxonomy is based on the enlarged definition of “innovative firm” deriving from the Schumpeterian definition of innovation and classify firms using a cluster analysis techniques. The result is the emergence of a four cluster solution, where firms are differentiated by the breadth of the innovation activities in which they are involved. Chapter 5 reports some of the main conclusions of each singular previous chapter and the points worth of further research in the future.