Symptom control and quality of life in lux-lung 3 : a phase III study of afatinib or cisplatin/pemetrexed in patients with advanced lung adenocarcinoma with EGFR mutations

Purpose Patient-reported symptoms and health-related quality of life (QoL) benefits were investigated in a randomized, phase III trial of afatinib or cisplatin/pemetrexed. Patients and Methods Three hundred forty-five patients with advanced epidermal growth factor receptor (EGFR) mutation-positive lung adenocarcinoma were randomly assigned 2:1 to afatinib 40 mg per day or up to six cycles of cisplatin/pemetrexed. Lung cancer symptoms and health-related QoL were assessed every 21 days until progression using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and Lung Cancer-13 questionnaires. Analyses of cough, dyspnea, and pain were preplanned, including percentage of patients who improved on therapy, time to deterioration of symptoms, and change in symptoms over time. Results Questionnaire compliance was high. Compared with chemotherapy, afatinib significantly delayed the time to deterioration for cough (hazard ratio [HR], 0.60; 95% CI, 0.41 to 0.87; P = .007) and dyspnea (HR, 0.68; 95% CI, 0.50 to 0.93; P = .015), but not pain (HR, 0.83; 95% CI, 0.62 to 1.10; P = .19). More patients on afatinib (64%) versus chemotherapy (50%) experienced improvements in dyspnea scores (P lt; .010). Differences in mean scores over time significantly favored afatinib over chemotherapy for cough (P lt; .001) and dyspnea (P = .001). Afatinib showed significantly better mean scores over time in global health status/QoL (P = .015) and physical (P = .001), role (P = .004), and cognitive (P lt; .007) functioning compared with chemotherapy. Fatigue and nausea were worse with chemotherapy, whereas diarrhea, dysphagia, and sore mouth were worse with afatinib (all P = .01). Conclusion In patients with lung adenocarcinoma with EGFR mutations, first-line afatinib was associated with better control of cough and dyspnea compared with chemotherapy, although diarrhea, dysphagia, and sore mouth were worse. Global health status/QoL was also improved over time with afatinib compared with chemotherapy.

Criminal Laws : Materials and Commentary on Criminal Law and Process in NSW [Fifth Edition]

"The success of Criminal Laws lies both in its distinctive features and in its appeal to a range of readerships. As one review put it, it is simultaneously a "textbook, casebook, handbook and reference work". As such it is ideal for criminal law and criminal justice courses as a teaching text, combining as it does primary sources with extensive critical commentary and a contextual perspective. It is likewise indispensable to practitioners for its detailed coverage of substantive law and its extensive references and inter-disciplinary approach make it a first point of call for researchers from all disciplines. This fifth edition strengthens these distinctive features. All chapters have been systematically updated to incorporate the plethora of legislative, case law, statistical and research material which has emerged since the previous edition. The critical, thematic, contextual and interdisciplinary perspectives have been continued."--Publisher's website. Table of Contents: 1. Some themes -- 2. Criminalisation -- 3. The criminal process -- 4. Components of criminal offences -- 5. Homicide: murder and involuntary manslaughter -- 6. Defences -- 7. Assault and sexual assault -- 8. Public order offences -- 9. Drugs offences -- 10. Dishonest acquisition -- 11. Extending criminal liability: complicity, conspiracy and association -- 12. Sentencing and penality.

A bi-lineage conducive scaffold for osteochondral defect regeneration

Because cartilage and bone tissues have different lineage-specific biological properties, it is challenging to fabricate a single type of scaffold that can biologically fulfill the requirements for regeneration of these two lineages simultaneously within osteochondral defects. To overcome this challenge, a lithium-containing mesoporous bioglass (Li-MBG) scaffold is developed. The efficacy and mechanism of Li-MBG for regeneration of osteochondral defects are systematically investigated. Histological and micro-CT results show that Li-MBG scaffolds significantly enhance the regeneration of subchondral bone and hyaline cartilage-like tissues as compared to pure MBG scaffolds, upon implantation in rabbit osteochondral defects for 8 and 16 weeks. Further investigation demonstrates that the released Li+ ions from the Li-MBG scaffolds may play a key role in stimulating the regeneration of osteochondral defects. The corresponding mechanistic pathways involve Li+ ions enhancing the proliferation and osteogenic differentiation of bone mesenchymal stem cells (BMSCs) through activation of the Wnt signalling pathway, as well as Li+ ions protecting chondrocytes and cartilage tissues from the inflammatory osteoarthritis (OA) environment through activation of autophagy. These findings suggest that the incorporation of Li+ ions into bioactive MBG scaffolds is a viable strategy for fabricating bi-lineage conducive scaffolds that enhance regeneration of osteochondral defects.

Sensitive methods for studying the environmental performance of protective coatings

The safe working lifetime of a structure in a corrosive or other harsh environment is frequently not limited by the material itself but rather by the integrity of the coating material. Advanced surface coatings are usually crosslinked organic polymers such as epoxies and polyurethanes which must not shrink, crack or degrade when exposed to environmental extremes. While standard test methods for environmental durability of coatings have been devised, the tests are structured more towards determining the end of life rather than in anticipation of degradation. We have been developing prognostic tools to anticipate coating failure by using a fundamental understanding of their degradation behaviour which, depending on the polymer structure, is mediated through hydrolytic or oxidation processes. Fourier transform infrared spectroscopy (FTIR) is a widely-used laboratory technique for the analysis of polymer degradation and with the development of portable FTIR spectrometers, new opportunities have arisen to measure polymer degradation non-destructively in the field. For IR reflectance sampling, both diffuse (scattered) and specular (direct) reflections can occur. The complexity in these spectra has provided interesting opportunities to study surface chemical and physical changes during paint curing, service abrasion and weathering, but has often required the use of advanced statistical analysis methods such as chemometrics to discern these changes. Results from our studies using this and related techniques and the technical challenges that have arisen will be presented.

Advanced arterial blood gas analysis in septic shock : a Singaporean nursing case review.

Introduction The admission to the Intensive Care Unit with a diagnosis of sepsis and/or septic shock is not uncommon. The aim of this article is to present a nursing case review of a patient admitted to the intensive care unit with a diagnosis of septic shock and the use of bedside acid–base formulae to inform clinical decision making. Method We chose to use a case review. This method is useful in reporting unusual or rare cases and is typically seen more in medicine than in nursing. Discussion The gentleman in question was a self-presentation with a short history of fever and worsening shortness of breath. His condition worsened where he required admission to the intensive care unit. The use of ‘advanced’ acid–base interpretation to guide his nursing care provided a platform from which to advance a deeper understanding of the intricacies the critically ill patient often presents. Conclusion The use of case review is enlightening in understanding the disease process and the decision-making that accompanies this. The lessons learnt are applicable to a wider nursing audience because understanding acid–base physiology is beneficial in supporting and advancing critical care nursing practice.

Challenges of recruiting hospice patients with advanced cancer to research : reflections on a delirium screening study

Introduction Delirium research in palliative care, particularly in the dying phase, is possible but is frequently met with ethical and methodological challenges. This paper describes the challenges faced in a previous delirium screening study. Methods Within 72 hours of admission to an acute inpatient specialist palliative care unit one hundred consecutive patients over 18 years of age with advanced cancer were invited to be screened for delirium using validated screening tools. Results Of the 100 consecutive admissions 49 patients were unable to participate including seven who did not meet the inclusion criteria and nine (six families and three patients) who withheld consent. The remaining 33 patients were more unwell and closer to death than those who were recruited. Reasons for non- participation included being too unwell (ten), unresponsive (nine), died (two) or discharged (three) before recruitment and exceeding the 72hour time limit (nine). Conclusion Gate keeping and physical condition of patients were the main obstacles to recruitment and is consistent with barriers faced in previous studies involving palliative care and dying patients. While it is possible and necessary to conduct studies in palliative care, including the terminal phase, as reflective practitioners we must maintain the balance between the demands for evidence-based practice and our compassion and respect for our most vulnerable of patients.

Self-management associated with fatigue in patients with advanced cancer : a prospective longitudinal study

Cancer-related fatigue is one of the most distressing symptoms experienced by patients with advanced cancer. This doctoral study identified that patients with advanced cancer commonly use a number of self-management strategies in response to fatigue, although these strategies had varying levels of effectiveness in reducing the symptom. The study identified that enhancing self-efficacy and managing depressive symptoms are important factors to consider in the design of future interventions to support fatigue self-management.

The past, present and future of carbon labelling for construction materials – a review

Global climate change is one of the most significant environmental issues that can harm human development. One central issue for the building and construction industry to address global climate change is the development of a credible and meaningful way to measure greenhouse gas (GHG) emissions. While Publicly Available Specification (PAS) 2050, the first international GHG standard, has been proven to be successful in standardizing the quantification process, its contribution to the management of carbon labels for construction materials is limited. With the recent publication of ISO 14067: Greenhouse gases – carbon footprint of products – requirements and guidelines for quantification and communication in May 2013, it is necessary for the building and construction industry to understand the past, present and future of the carbon labelling practices for construction materials. A systematic review shows that international GHG standards have been evolving in terms of providing additional guidance on communication and comparison, as well as less flexibility on the use of carbon labels. At the same time, carbon labelling schemes have been evolving on standardization and benchmarking. In addition, future actions are needed in the aspect of raising consumer awareness, providing benchmarking, ensuring standardization and developing simulation technologies in order for carbon labelling schemes for construction materials to provide credible, accurate and transparent information on GHG emissions.

Teaching fractions to adult learners enrolled in a civil construction course : knowledge, action and materials action in tandem

This paper investigates the teaching and learning of fractions to Indigenous adult learners in a Civil Construction Certificate Course. More specifically it explores why the use of materials is critical to building knowledge and understanding. This focus is important for two reasons. First, it allows for considerations of a trainer’s approach for teaching fractions and, second it provides insights into how adult learners can be supported with representing their practical experiences of fractions to make generalisation thus building on their knowledge and learning experiences. The paper draws on teaching episodes from an Australian Research Council funded Linkage project that investigates how mathematics is taught and learned in Certificate Courses, here, Certificate 11 in Civil Construction. Action research and decolonising methods (Smith, 1999) were used to conduct the research. Video excerpts which feature one trainer and three students are analysed and described. Findings from the data indicate that adult learners need to be supported with materials to assist with building their capacity to know and apply understandings of fractions in a range of contexts, besides construction. Without materials and where fractions are taught via pen and paper tasks, students are less likely to retain and apply fraction ideas to their Certificate Course. Further they are less likely to understand decimals because of limited understanding of fractions.

The identification and rapid extraction of hydrocarbons from Nicotiana glauca : A potential advanced renewable biofuel source

Declining fossil fuels reserves, a need for increased energy security and concerns over carbon emissions from fossil fuel use are the global drivers for alternative, renewable, biosources of fuels and chemicals. In the present study the identification of long chain (C29–C33) saturated hydrocarbons from Nicotiana glauca leaves is reported. The occurrence of these hydrocarbons was detected by gas chromatography–mass spectrometry (GC–MS) and identification confirmed by comparison of physico-chemical properties displayed by the authentic standards available. A simple, robust procedure was developed to enable the generation of an extract containing a high percentage of hydrocarbons (6.3% by weight of dried leaf material) higher than previous reports in other higher plant species consequently, it is concluded that N. glauca could be a crop of greater importance than previously recognised for biofuel production. The plant can be grown on marginal lands, negating the need to compete with food crops or farmland, and the hydrocarbon extract can be produced in a non-invasive manner, leaving remaining biomass intact for bioethanol production and the generation of valuable co-products.

Numerical estimation of 3D mechanical forces exerted by cells on non-linear materials

The exchange of physical forces in both cell-cell and cell-matrix interactions play a significant role in a variety of physiological and pathological processes, such as cell migration, cancer metastasis, inflammation and wound healing. Therefore, great interest exists in accurately quantifying the forces that cells exert on their substrate during migration. Traction Force Microscopy (TFM) is the most widely used method for measuring cell traction forces. Several mathematical techniques have been developed to estimate forces from TFM experiments. However, certain simplifications are commonly assumed, such as linear elasticity of the materials and/or free geometries, which in some cases may lead to inaccurate results. Here, cellular forces are numerically estimated by solving a minimization problem that combines multiple non-linear FEM solutions. Our simulations, free from constraints on the geometrical and the mechanical conditions, show that forces are predicted with higher accuracy than when using the standard approaches.

Halogen bond mediated crystal engineering of metal complexes

This project explored the potential for halogen bonds to predictably organise metal-containing molecular building blocks in crystalline materials. A novel method for the halogen bond mediated crystal engineering of metal complexes was discovered, which led to the preparation of new materials with potential applications in molecular switching devices and advanced memory storage systems.

Built heritage management systems : the framework of a digital tool for the conservation of Brisbane City Hall

Brisbane City Hall (BCH) is arguably one of Brisbane’s most notable and iconic buildings. Serving as the public’s central civic and municipal building since 1930, the importance of this heritage listed building to cultural significance and identity is unquestionable. This attribute is reflected within the local government, with a simplified image of the halls main portico entrance supplying Brisbane City Council with its insignia and trademark signifier. Regardless of these qualities, this building has been neglected in a number of ways, primarily in the physical sense with built materials, but also, and just as importantly, through inaccurate and undocumented works. Numerous restoration and renovation works have been undertaken throughout BCH’s lifetime, however the records of these amendments are far and few between. Between 2010 and 2013, BCH underwent major restoration works, the largest production project undertaken on the building since its initial construction. Just prior to this conservation process, the full extent of the buildings deterioration was identified, much of which there was little to no original documentation of. This has led to a number of issues pertaining to what investigators expected to find within the building, versus what was uncovered (the unexpected), which have resulted directly from this lack of data. This absence of record keeping is the key factor that has contributed to the decay and unknown deficiencies that had amassed within BCH. Accordingly, this raises a debate about the methods of record keeping, and the need for a more advanced process that is able to be integrated within architectural and engineering programs, whilst still maintaining the ability to act as a standalone database. The immediate objective of this research is to investigate the restoration process of BCH, with focus on the auditorium, to evaluate possible strategies to record and manage data connected to building pathology so that a framework can be developed for a digital heritage management system. The framework produced for this digital tool will enable dynamic uses of a centralised database and aims to reduce the significant data loss. Following an in-depth analysis of this framework, it can be concluded that the implementation of the suggested digital tool would directly benefit BCH, and could ultimately be incorporated into a number of heritage related built form.

Assessment of driving-related performance in chronic whiplash using an advanced driving simulator

Driving is often nominated as problematic by individuals with chronic whiplash associated disorders (WAD), yet driving-related performance has not been evaluated objectively. The purpose of this study was to test driving-related performance in persons with chronic WAD against healthy controls of similar age, gender and driving experience to determine if driving-related performance in the WAD group was sufficiently impaired to recommend fitness to drive assessment. Driving-related performance was assessed using an advanced driving simulator during three driving scenarios; freeway, residential and a central business district (CBD). Total driving duration was approximately 15 min. Five driving tasks which could cause a collision (critical events) were included in the scenarios. In addition, the effect of divided attention (identify red dots projected onto side or rear view mirrors) was assessed three times in each scenario. Driving performance was measured using the simulator performance index (SPI) which is calculated from 12 measures. z-Scores for all SPI measures were calculated for each WAD subject based on mean values of the control subjects. The z-scores were then averaged for the WAD group. A z-score of ≤−2 indicated a driving failing grade in the simulator. The number of collisions over the five critical events was compared between the WAD and control groups as was reaction time and missed response ratio in identifying the red dots. Seventeen WAD and 26 control subjects commenced the driving assessment. Demographic data were comparable between the groups. All subjects completed the freeway scenario but four withdrew during the residential and eight during the CBD scenario because of motion sickness. All scenarios were completed by 14 WAD and 17 control subjects. Mean z-scores for the SPI over the three scenarios was statistically lower in the WAD group (−0.3 ± 0.3; P < 0.05) but the score was not below the cut-off point for safe driving. There were no differences in the reaction time and missed response ratio in divided attention tasks between the groups (All P > 0.05). Assessment of driving in an advanced driving simulator for approximately 15 min revealed that driving-related performance in chronic WAD was not sufficiently impaired to recommend the need for fitness to drive assessment.

Impact of the piston secondary motion on its slap force

A theoretical model is developed for the analysis of piston secondary motion. Based on this model, the slap force of a specific L6 diesel engine was compared when considering different boundary conditions, such as lubricating oil on cylinder liner, surface roughness, deformation of cylinder liner and piston skirt. It is concluded that it is necessary to consider the secondary motion of piston in the analysis of the inner excitation for an internal combustion engine. A more comprehensive consideration of the boundary condition (i.e., more close to the actual condition) will lead to a smaller maximum slap force, and among all boundary conditions considered in this paper, the structural deformation of the piston skirt and cylinder liner is the most influential factor. The theoretical model developed and findings obtained in this study will benefit the future analysis and design of advanced internal combustion engine structures.