The epidemiology of basal cell carcinoma

Basal cell carcinoma (BCC) is a skin cancer of particular importance to the Australian community. Its rate of occurrence is highest in Queensland, where 1% to 2% of people are newly affected annually. This is an order of magnitude higher than corresponding incidence estimates in European and North American populations. Individuals with a sun-sensitive complexion are particularly susceptible because sun exposure is the single most important causative agent, as shown by the anatomic distribution of BCC which is in general consistent with the levels of sun exposure across body sites. A distinguishing feature of BCC is the occurrence of multiple primary tumours within individuals, synchronously or over time, and their diagnosis and treatment costs contribute substantially to the major public health burden caused by BCC. A primary knowledge gap about BCC pathogenesis however was an understanding of the true frequency of multiple BCC occurrences and their body distribution, and why a proportion of people do develop more than one BCC in their life. This research project sought to address this gap under an overarching research aim to better understand the detailed epidemiology of BCC with the ultimate goal of reducing the burden of this skin cancer through prevention. The particular aim was to document prospectively the rate of BCC occurrence and its associations with constitutional and environmental (solar) factors, all the while paying special attention to persons affected by more than one BCC. The study built on previous findings and recent developments in the field but set out to confirm and extend these and propose more adequate theories about the complex epidemiology of this cancer. Addressing these goals required a new approach to researching basal cell carcinoma, due to the need to account for the phenomenon of multiple incident BCCs per person. This was enabled by a 20 year community-based study of skin cancer in Australians that provided the methodological foundation for this thesis. Study participants were originally randomly selected in 1986 from the electoral register of all adult residents of the subtropical township of Nambour in Queensland, Australia. On various occasions during the study, participants were fully examined by dermatologists who documented cumulative photodamage as well as skin cancers. Participants completed standard questionnaires about skin cancer-related factors, and consented to have any diagnosed skin cancers notified to the investigators by regional pathology laboratories in Queensland. These methods allowed 100% ascertainment of histologically confirmed BCCs in this study population. 1339 participants had complete follow-up to the end of 2007. Statistical analyses in this thesis were carried out using SAS and SUDAAN statistical software packages. Modelling methods, including multivariate logistic regressions, allowed for repeated measures in terms of multiple BCCs per person. This innovative approach gave new findings on two levels, presented in five chapters as scientific papers: 1. Incidence of basal cell carcinoma multiplicity and detailed anatomic distribution: longitudinal study of an Australian population The incidence of people affected multiple times by BCC was 705 per 100,000 person years compared to an incidence rate of people singly affected of 935 per 100,000 person years. Among multiply and singly affected persons alike, site-specific BCC incidence rates were far highest on facial subsites, followed by upper limbs, trunk, and then lower limbs 2. Melanocytic nevi and basal cell carcinoma: is there an association? BCC risk was significantly increased in those with forearm nevi (Odds Ratios (OR) 1.43, 95% Confidence Intervals (CI) 1.09-1.89) compared to people without forearm nevi, especially among those who spent their time mainly outdoors (OR 1.6, 95%CI 1.1-2.3) compared to those who spent their time mainly indoors. Nevi on the back were not associated with BCC. 3. Clinical signs of photodamage are associated with basal cell carcinoma multiplicity and site: a 16-year longitudinal study Over a 16-year follow-up period, 58% of people affected by BCC developed more than one BCC. Among these people 60% developed BCCs across different anatomic sites. Participants with high numbers of solar keratoses, compared to people without solar keratoses, were most likely to experience the highest BCC counts overall (OR 3.3, 95%CI 1.4-13.5). Occurrences of BCC on the trunk (OR 3.3, 95%CI 1.4-7.6) and on the limbs (OR 3.7, 95%CI 2.0-7.0) were strongly associated with high numbers of solar keratoses on these sites. 4. Occurrence and determinants of basal cell carcinoma by histological subtype in an Australian community Among 1202 BCCs, 77% had a single growth pattern and 23% were of mixed histological composition. Among all BCCs the nodular followed by the superficial growth patterns were commonest. Risk of nodular and superficial BCCs on the head was raised if 5 or more solar keratoses were present on the face (OR 1.8, 95%CI 1.2-2.7 and OR 4.5, 95%CI 2.1-9.7 respectively) and similarly on the trunk in the presence of multiple solar keratoses on the trunk (OR 4.2, 95%CI 1.5-11.9 and OR 2.2, 95%CI 1.1-4.4 respectively). 5. Basal cell carcinoma and measures of cumulative sun exposure: an Australian longitudinal community-based study Dermal elastosis was more likely to be seen adjacent to head and neck BCCs than trunk BCCs (p=0.01). Severity of dermal elastosis increased on each site with increasing clinical signs of cutaneous sun damage on that site. BCCs that occurred without perilesional elastosis per se, were always found in an anatomic region with signs of photodamage. This thesis thus has identified the magnitude of the burden of multiple BCCs. It does not support the view that people affected by more than one BCC represent a distinct group of people who are prone to BCCs on certain body sites. The results also demonstrate that BCCs regardless of site, histology or order of occurrence are strongly associated with cumulative sun exposure causing photodamage to the skin, and hence challenge the view that BCCs occurring on body sites with typically low opportunities for sun exposure or of the superficial growth pattern are different in their association with the sun from those on typically sun-exposed sites, or nodular BCCs, respectively. Through dissemination in the scientific and medical literature, and to the community at large, these findings can ultimately assist in the primary and secondary prevention of BCC, perhaps especially in high-risk populations.

From "Secondary Punishment" to "Supermax" : the human costs of high-security regimes in Australia

“Supermax” prisons, conceived by the United States in the early 1980s, are typically reserved for convicted political criminals such as terrorists and spies and for other inmates who are considered to pose a serious ongoing threat to the wider community, to the security of correctional institutions, or to the safety of other inmates. Prisoners are usually restricted to their cells for up to twenty-three hours a day and typically have minimal contact with other inmates and correctional staff. Not only does the Federal Bureau of Prisons operate one of these facilities, but almost every state has either a supermax wing or stand-alone supermax prison. The Globalization of Supermax Prisons examines why nine advanced industrialized countries have adopted the supermax prototype, paying particular attention to the economic, social, and political processes that have affected each state. Featuring essays that look at the U.S.-run prisons of Abu Ghraib and Guantanemo, this collection seeks to determine if the American model is the basis for the establishment of these facilities and considers such issues as the support or opposition to the building of a supermax and why opposition efforts failed; the allegation of human rights abuses within these prisons; and the extent to which the decision to build a supermax was influenced by developments in the United States. Additionally, contributors address such domestic matters as the role of crime rates, media sensationalism, and terrorism in each country’s decision to build a supermax prison.

International Handbook of Entrepreneurship and HRM

This invaluable reference tool has been designed in response to the growing recognition that too little is known about the intersection between entrepreneurship and human resource management. Paying particular attention to the ‘people’ side of venture emergence and development, it offers unique insights into the role that human resource management (HRM) plays in small and entrepreneurial firms.

Design, manufacturing and maintenance of sugar mill equipment

The ISSCT Engineering Workshop 2008 in Brazil was well attended with 62 participants including 39 overseas visitors from 15 countries. The workshop addressed the theme Design, manufacturing and maintenance of sugar mill equipment. From the technical sessions, the following conclusions were drawn: • Several speakers articulated a shared vision of the future of the Brazilian sugar industry. This shared vision gives considerable confidence that the vision can become a reality. • There is an increased focus on energy products. As a result, the reduction of factory energy consumption in order to maximise the energy available for products is also a focus. • New equipment and products are being developed with reduced power consumption, lower capital and maintenance costs, and better performance. • Methods presented for reducing maintenance costs included the use of a maintenance management system, condition monitoring and material selection. The workshop was held in conjunction with Piracicaba’s annual SIMTEC exhibition for the sugar and alcohol industries that provides a forum for technical presentations and discussion, and showcases products and services from manufacturers and service providers. In return for holding the workshop in conjunction with SIMTEC, SIMTEC provided sponsorship for the workshop, including paying travel and accommodation costs for two invited speakers, and organisation for the workshop. The ISSCT and SIMTEC technical programs were arranged so that their technical sessions did not clash, and the ISSCT program was extended a day to provide an opportunity for ISSCT participants to attend the SIMTEC exhibition. Informal feedback from workshop participants suggested that the arrangement between ISSCT and SIMTEC worked well. Site visits to two manufacturing facilities and two sugar mills were arranged as part of the workshop.

Is there such a thing as an “irrevocable authority”?

The Queensland Court of Appeal decision of FTV Holdings Cairns Pty Ltd v Smith [2014] QCA 217 analysed many issues concerning the enforceability of an “irrevocable authority” signed by clients directed to their solicitors regarding the payment of money to a third party. The action also drew those solicitors into the litigation as they acted contrary to that “irrevocable authority” by paying the money concerned directly to their clients but upon their clients’ later instructions. The result probably confirmed what many solicitors have believed to be the case for some time but which had never been considered in legal analysis in an appellate court. The facts of the case would be common to many day to day transactions.

The Business of Unfinished Business : Reflections on Co-construction of Meanings in Research Encounters

My concern in this commentary is the discrepancy between cultural psychologists' theoretical claims that meanings are co-constructed by, with and for individuals in ongoing social interaction, and their research practices where researcher's and research participant's meaning-making processes are separated in time into sequential turns. I argue for the need to live up to these theoretical assumptions, by making both the initial research encounter and the researcher's later interpretation process more co-constructive. I suggest making the initial research encounter more co-constructive by paying attention to these moments when the negotiated flow of interaction between researcher and research participant breaks down, for it allows the research participant's meaning-making to be traced and makes the researcher's efforts towards meaning more explicit. I propose to make the later interpretation process more co-constructive by adopting a more open-ended and dialogical way of writing that is specifically addressed to research participants and invites them to actively engage with researcher's meaning-making.

Working as one: A road map to disaster resilience for Australia

Natural disasters cause widespread disruption, costing the Australian economy $6.3 billion per year, and those costs are projected to rise incrementally to $23 billion by 2050. With more frequent natural disasters with greater consequences, Australian communities need the ability to prepare and plan for them, absorb and recover from them, and adapt more successfully to their effects. Enhancing Australian resilience will allow us to better anticipate disasters and assist in planning to reduce losses, rather than just waiting for the next king hit and paying for it afterwards. Given the scale of devastation, governments have been quick to pick up the pieces when major natural disasters hit. But this approach (‘The government will give you taxpayers’ money regardless of what you did to help yourself, and we’ll help you rebuild in the same risky area.’) has created a culture of dependence. This is unsustainable and costly. In 2008, ASPI published Taking a punch: building a more resilient Australia. That report emphasised the importance of strong leadership and coordination in disaster resilience policymaking, as well as the value of volunteers and family and individual preparation, in managing the effects of major disasters. This report offers a roadmap for enhancing Australia’s disaster resilience, building on the 2011 National Strategy for Disaster Resilience. It includes a snapshot of relevant issues and current resilience efforts in Australia, outlining key challenges and opportunities. The report sets out 11 recommendations to help guide Australia towards increasing national resilience, from individuals and local communities through to state and federal agencies.

Submission to Communications Alliance Industry Code: Copyright Notice Scheme

In making this submission, we suggest that Australia learn from the experiences of other jurisdictions, and avoid some of the mistakes that have been made. In particular, this involves: * Ensuring that adequate information is available to evaluate the success of the scheme * Ensuring that notices sent to consumers provide full and accurate information that helps them understand their rights and options * Limiting the potential abuse of the system, and particularly attempts to intimidate consumers into paying unfair penalties through ‘speculative invoicing’ * Avoiding the potential for actual or perceived bias in the scheme’s oversight body

Making things happen: How the environment triggers action

Innovative research conducted by Dr Jan Golembiewski from Medical Architectures Australasia-Pacific, in the area of environmental design for mental healthcare helps us reflect, through experiential storytelling, on the importance of paying attention to positive environmental ‘triggers for action’ when designing physical spaces to help manage particular patients’ conditions. This article is written about the mental health experience specifically, however environmental design is an issue we can all relate to in our everyday lives (at home, at work, social spots or in places such as hospitals or retreats) when we instinctively notice a connection between our mental health and our surroundings or a healthy sense of place.

Michael Kirby's challenge: Intellectual property, HIV/AIDS, and human rights

In July 2014, Melbourne hosted the 20th International AIDS Conference. The event opened, paying tribute to the late Dutch HIV/AIDS researcher Professor Joep Lange, with his image projected onto a screen, with the accompanying quotation: ‘If we can bring a bottle of Coke to every corner of Africa, we should be able to also deliver antiretroviral drugs.’

An elegy for Greg Ham: Copyright law, the Kookaburra case, and remix culture

The ‘Kookaburra’ case was a tragic and controversial copyright dispute, highlighting the need for copyright law reform by the Australian Parliament. In the Kookaburra case, a copyright action was brought by Larrikin Records against Men at Work’s song ‘Down Under’, alleging copyright infringement of the ‘Kookaburra’ song composed by Marion Sinclair. The dispute raised a host of doctrinal matters. There was disquiet over the length of the copyright term. There were fierce contests as to the copyright ownership of the ‘Kookaburra’ song. The litigation raised questions about copyright infringement and substantiality – particularly in relation to musical works. The ‘Kookaburra’ case highlighted frailties in Australia’s regime of copyright exceptions. The litigation should spur the Australian Law Reform Commission to make recommendations for law reform in its inquiry Copyright and the Digital Economy. This article provides a critical evaluation of the options of a defence for transformative use; a defence for fair use; and statutory licensing. The ‘Kookaburra’ case also examines the question of appropriate remedies in respect of copyright infringement. The conclusion considers the implications of the Kookaburra case for other forms of musical works – including digital sampling, mash-ups, and creative remixes. It finishes with an elegy for Greg Ham – paying tribute to the multi-instrumentalist for Men at Work.

Thinking about complexity thinking in physical education

In the past two decades, complexity thinking has emerged as an important theoretical response to the limitations of orthodox ways of understanding educational phenomena. Complexity provides ways of understanding that embrace uncertainty, non-linearity and the inevitable ‘messiness’ that is inherent in educational settings, paying attention to the ways in which the whole is greater than the sum of its parts. This is the first book to focus on complexity thinking in the context of physical education, enabling fresh ways of thinking about research, teaching, curriculum and learning. Written by a team of leading international physical education scholars, the book highlights how the considerable theoretical promise of complexity can be reflected in the actual policies, pedagogies and practices of physical education (PE). It encourages teachers, educators and researchers to embrace notions of learning that are more organic and emergent, to allow the inherent complexity of pedagogical work in PE to be examined more broadly and inclusively. In doing so, Complexity Thinking in Physical Education makes a major contribution to our understanding of pedagogy, curriculum design and development, human movement and educational practice.

‘Just choose the easy option’: Students talk about alcohol use and social influence

Previous research into young people’s drinking behaviour has studied how social practices influence their actions and how they negotiate drinking-related identities. Here, adopting the perspective of discursive psychology we examine how, for young people, social influences are bound up with issues of drinking and of identity. We conducted 19 focus groups with undergraduate students in Australia aged between 18 and 24 years. Thematic analysis of participants’ accounts for why they drink or do not drink was used to identify passages of talk that referred to social influence, paying particular attention to terms such as ‘pressure’ and ‘choice’. These passages were then analysed in fine-grained detail, using discourse analysis, to study how participants accounted for social influence. Participants treated their behaviour as accountable and produced three forms of account that: (1) minimised the choice available to them, (2) explained drinking as culture and (3) described resisting peer pressure. They also negotiated gendered social dynamics related to drinking. These forms of account allowed the participants to avoid individual responsibility for drinking or not drinking. These findings demonstrate that the effects of social influence on young people’s drinking behaviour cannot be assumed, as social influence itself becomes negotiable within local contexts of talk about drinking.

Infrastructure Disputes Shape Future of Streaming Media

In November 2010, tension between Internet infrastructure companies boiled over in a dispute between content distribution network (CDN) Level 3 and Internet service provider (ISP) Comcast. Level 3, a distribution partner of Netflix, accused Comcast of violating the principles of net neutrality when the ISP increased distribution fees for carrying high bandwidth services. Comcast justified its actions by stating that the price increase was standard practice and argued Level 3 was trying to avoid paying its fair share. The dispute exemplifies the growing concern over the rising costs of streaming media services. The companies facing these inflated infrastructure costs are CDNs (Level 3, Equinix, Limelight, Akamai, and Voxel), companies that host streaming media content on server farms and distribute the content to a variety of carriers, and ISPs (Comcast, Time Warner, Cox, and AT&T), the cable and phone companies that provide “last mile” service to paying customers. Both CDNs and ISPs are lobbying government regulators to keep their costs at a minimum. The outcome of these disputes will influence the cost, quality, and legal status of streaming media.

Kissing fish: Rex Hunt, popular culture, sustainability and fishing practices

Natural resource managers and scientists focus on the behaviour of individual recreational fishers to understand environmental problems associated with this leisure activity. They do this in an effort to identify ways to change attitudes in order to facilitate environmentally friendly choices. This applied use of ABC psychology (attitude, behaviour, choice) has not delivered the expected results. This article offers a different approach by investigating an emergent practice in diverse fishing communities, rather than looking to the responsibility of the individual recreational fisher. Using practice theory, I trace the change from take-all to catch-and-release fishing in Australia by analysing the texts of celebrity fisher Rex Hunt, who is an advocate for releasing fish. I combine this with oral history testimony from a sample of recreational fishers from the broader Australian community to show how change happened. The practice of catch-and-release fishing emerged through the combination of sociotechnical and historically specific elements present in popular culture, including the media. Paying attention to the way different elements catalyse provides a rich account of the changing modes of sustainability in recreational fishing communities.