Improving the outcomes of foot and ankle surgery. Professional impact of the Australasian College of Podiatric Surgeons' audit tool

Background Surgery is an example of expanded practice scope that enhances podiatry and incorporates inter-professional collaboration. By 2050 demand for foot and ankle procedures is predicted to rise nationally by 61.9%. Performance management of this increase motivated the development of an online audit tool. Developed in collaboration with the Australasian College of Podiatric Surgeons (ACPS), the ACPS audit tool provides real-time data capture and reporting. It is the first audit tool designed in Australia to support and improve the outcomes of foot and ankle surgery. Methods Audit activity in general, orthopaedic, plastic and podiatric surgery was examined using a case study design. Audit participation enablers and barriers were explored. Case study results guided a Delphi survey of international experts experienced or associated with foot and ankle surgery. Delphi survey-derived consensus informed modification of a generic data set from the Royal Australasian College of Surgeons (RACS). Based on the Delphi survey findings the ACPS online audit tool was developed and piloted. Reliability and validity of data entry and usability of this new tool was then assessed with an online survey. Results The case study found surgeon attitudes and behaviours positively impacted audit participation, and also indicated that audit data should be: (1) available in real time, (2) identify practice change, (3) applicable for safety and quality management, and; (4) useful for peer review discussion. The Delphi process established consensus on audit variables to be captured, including the modified RACS generic data set. 382 cases of foot and ankle surgery were captured across 3 months using the new tool. Data entry was found to be valid and reliable. Real-time outcome reporting and practice change identification impacted positively on safety and quality management and assisted peer review discussion. An online survey showed high levels of usability. Conclusions Surgeon contribution to audit tool development resulted in 100% audit participation. The data from the ACPS audit tool supported the ACPS submission to the Medical Services Advisory Committee to list podiatric surgery under Medicare, an outcome noted by the Federal Minister of Health.

Impact of cool roof application on commercial buildings: A contribution to sustainable design in Australia

This study investigated the cool roof technology effects on annual energy saving of a large one-storey commercial building in Queensland, Australia. A computer model of the case study was developed using commercial software by using the appropriate geometrical and thermal building specifications. Field study data were used to validate the model. The model was then used to extend the investigation to other cities in various Australian climate zones. The results of this research show that significant energy savings can be obtained using cool roof technology, particularly in warm, sunny climates, and the thesis can contribute to provide a guideline for application of cool roof technology to single-storey commercial building throughout Australia.

Does a twin pregnancy have a greater impact on physical and emotional well-being than a singleton pregnancy?

A prospective, population-based study was conducted to assess the impact of twin pregnancy on a woman's physical and emotional well-being. It compared women's reports of their general health, experience of a range of specific symptoms, and emotional well-being during pregnancy using the Edinburgh Postnatal Depression Scale. The subjects were 147 women expecting twins and 11,061 women expecting a single child who completed questionnaires at both 20 and 32 weeks’gestation as part of the Avon Longitudinal Study of Pregnancy and Childhood. Results suggested that women expecting twins experienced poorer physical well-being but not poorer emotional well-being than those expecting a single child, even though a significant association between poor health and emotional well-being was found for the population as a whole. It was suggested that the transitory nature of a twin pregnancy, the “special’ status of a twin pregnancy, greater social support, and modified expectations about health may buffer the effects of poor physical health on emotional well-being in a twin pregnancy. The findings should alert those who care for women expecting twins to the greater physical stress these women may feel.

CBCT-guided radiotherapy for locally advanced head and cancer: dosimetric impact of weight loss on VMAT and IMRT plans for selected organs at risk structures (OARs)

Purpose: It is common for head and neck patients to be affected by time trend errors as a result of weight loss during a course of radiation treatment. The objective of this planning study was to investigate the impact of weight loss on Volumetric Modulated Arc Therapy (VMAT) as well as Intensity modulated radiation therapy (IMRT) for locally advanced head and neck cancer using automatic co-registration of the CBCT. Methods and Materials: A retrospective analysis of previously treated IMRT plans for 10 patients with locally advanced head and neck cancer patients was done. A VMAT plan was also produced for all patients. We calculated the dose–volume histograms (DVH) indices for spinal cord planning at risk volumes (PRVs), the brainstem PRVs (SC+0.5cm and BS+0.5cm, respectively) as well as mean dose to the parotid glands. Results: The results show that the mean difference in dose to the SC+0.5cm was 1.03% and 1.27% for the IMRT and VMAT plans, respectively. As for dose to the BS+0.5, the percentage difference was 0.63% for the IMRT plans and 0.61% for the VMAT plans. The analysis of the parotid gland doses shows that the percentage change in mean dose to left parotid was -8.0% whereas that of the right parotid was -6.4% for the IMRT treatment plans. In the VMAT plans, the percentages change for the left and the right parotid glands were -6.6% and -6.7% respectively. Conclusions: This study shows a clinically significant impact of weight loss on DVH indices analysed in head and neck organs at risk. It highlights the importance of adaptive radiotherapy in head and neck patients if organ at risk sparing is to be maintained.

Impact of resistance on the efficacy of binary combinations of spinosad, chlorpyrifos-methyl and s-methoprene against five stored-grain beetles

Laboratory experiments were conducted to determine the efficacy of spinosad (a biopesticide), chlorpyrifos-methyl (an organophosphorus compound (OP)) and s-methoprene (a juvenile hormone analogue) applied alone and in binary combinations against five stored-grain beetles in wheat. There were three strains of Rhyzopertha dominica, and one strain each of Sitophilus oryzae, Tribolium castaneum, Oryzaephilus surinamensis and Cryptolestes ferrugineus. These strains were chosen to represent a range of possible resistant genotypes, exhibiting resistance to organophosphates, pyrethroids or methoprene. Treatments were applied at rates that are registered or likely to be registered in Australia. Adults were exposed to freshly treated wheat for 2 weeks, and the effects of treatments on mortality and reproduction were determined. No single protectant or protectant combination controlled all insect strains, based on the criterion of >99% reduction in the number of live F1 adults relative to the control. The most effective combinations were spinosad at 1 mg kg-1+chlorpyrifos-methyl at 10 mg kg-1 which controlled all strains except for OP-resistant O. surinamensis, and chlorpyrifos-methyl at 10 mg kg-1+s-methoprene at 0.6 mg kg-1 which controlled all strains except for methoprene-resistant R. dominica. The results of this study demonstrate the difficulty in Australia, and potentially other countries which use protectants, of finding protectant treatments to control a broad range of pest species in the face of resistance development.

Modelling the impact of traffic incidents on travel time reliability

Traffic incidents are recognised as one of the key sources of non-recurrent congestion that often leads to reduction in travel time reliability (TTR), a key metric of roadway performance. A method is proposed here to quantify the impacts of traffic incidents on TTR on freeways. The method uses historical data to establish recurrent speed profiles and identifies non-recurrent congestion based on their negative impacts on speeds. The locations and times of incidents are used to identify incidents among non-recurrent congestion events. Buffer time is employed to measure TTR. Extra buffer time is defined as the extra delay caused by traffic incidents. This reliability measure indicates how much extra travel time is required by travellers to arrive at their destination on time with 95% certainty in the case of an incident, over and above the travel time that would have been required under recurrent conditions. An extra buffer time index (EBTI) is defined as the ratio of extra buffer time to recurrent travel time, with zero being the best case (no delay). A Tobit model is used to identify and quantify factors that affect EBTI using a selected freeway segment in the Southeast Queensland, Australia network. Both fixed and random parameter Tobit specifications are tested. The estimation results reveal that models with random parameters offer a superior statistical fit for all types of incidents, suggesting the presence of unobserved heterogeneity across segments. What factors influence EBTI depends on the type of incident. In addition, changes in TTR as a result of traffic incidents are related to the characteristics of the incidents (multiple vehicles involved, incident duration, major incidents, etc.) and traffic characteristics.

Near-global impact of the Madden-Julian Oscillation on rainfall

The accuracy of synoptic-based weather forecasting deteriorates rapidly after five days and is not routinely available beyond 10 days. Conversely, climate forecasts are generally not feasible for periods of less than 3 months, resulting in a weather-climate gap. The tropical atmospheric phenomenon known as the Madden-Julian Oscillation (MJO) has a return interval of 30 to 80 days that might partly fill this gap. Our near-global analysis demonstrates that the MJO is a significant phenomenon that can influence daily rainfall patterns, even at higher latitudes, via teleconnections with broadscale mean sea level pressure (MSLP) patterns. These weather states provide a mechanistic basis for an MJO-based forecasting capacity that bridges the weather-climate divide. Knowledge of these tropical and extra-tropical MJO-associated weather states can significantly improve the tactical management of climate-sensitive systems such as agriculture.

The impact of home loan key facts sheets on borrowers' comparisons of loan costs

This thesis evaluates the effectiveness of the prescribed design and distribution requirements of the Australian Government's home loan key facts sheets (KFS) aimed at helping borrowers compare loan costs. The findings show that despite effectively improving borrower decision-making, few borrowers were aware of their existence and function. It was also demonstrated that KFS have had limited market impact over the four year window since introduction, likely due to the requirement that KFS provision is not required unless formally requested by a borrower. Recommendations include transferring the burden of disclosure to lenders in the first instance to address this information gap.

The impact of inter-fraction set-up errors on the probability of pulmonary and cardiac complication in left-sided breast cancer patients

Purpose This study evaluated the impact of patient set-up errors on the probability of pulmonary and cardiac complications in the irradiation of left-sided breast cancer. Methods and Materials Using the CMS XiO Version 4.6 (CMS Inc., St Louis, MO) radiotherapy planning system's NTCP algorithm and the Lyman -Kutcher-Burman (LKB) model, we calculated the DVH indices for the ipsilateral lung and heart and the resultant normal tissue complication probabilities (NTCP) for radiation-induced pneumonitis and excess cardiac mortality in 12 left-sided breast cancer patients. Results Isocenter shifts in the posterior direction had the greatest effect on the lung V20, heart V25, mean and maximum doses to the lung and the heart. Dose volume histograms (DVH) results show that the ipsilateral lung V20 tolerance was exceeded in 58% of the patients after 1cm posterior shifts. Similarly, the heart V25 tolerance was exceeded after 1cm antero-posterior and left-right isocentric shifts in 70% of the patients. The baseline NTCPs for radiation-induced pneumonitis ranged from 0.73% - 3.4% with a mean value of 1.7%. The maximum reported NTCP for radiation-induced pneumonitis was 5.8% (mean 2.6%) after 1cm posterior isocentric shift. The NTCP for excess cardiac mortality were 0 % in 100% of the patients (n=12) before and after setup error simulations. Conclusions Set-up errors in left sided breast cancer patients have a statistically significant impact on the Lung NTCPs and DVH indices. However, with a central lung distance of 3cm or less (CLD <3cm), and a maximum heart distance of 1.5cm or less (MHD<1.5cm), the treatment plans could tolerate set-up errors of up to 1cm without any change in the NTCP to the heart.

CBCT image guidance in head and neck irradiation: The impact of daily and weekly imaging protocols

Purpose This study evaluated the impact of a daily and weekly image-guided radiotherapy protocols in reducing setup errors and setting of appropriate margins in head and neck cancer patients. Materials and methods Interfraction and systematic shifts for the hypothetical day 1–3 plus weekly imaging were extrapolated from daily imaging data from 31 patients (964 cone beam computed tomography (CBCT) scans). In addition, residual setup errors were calculated by taking the average shifts in each direction for each patient based on the first three shifts and were presumed to represent systematic setup error. The clinical target volume (CTV) to planning target volume (PTV) margins were calculated using van Herk formula and analysed for each protocol. Results The mean interfraction shifts for daily imaging were 0·8, 0·3 and 0·5 mm in the S-I (superior-inferior), L-R (left-right) and A-P (anterior-posterior) direction, respectively. On the other hand the mean shifts for day 1–3 plus weekly imaging were 0·9, 1·8 and 0·5 mm in the S-I, L-R and A-P direction, respectively. The mean day 1–3 residual shifts were 1·5, 2·1 and 0·7 mm in the S-I, L-R and A-P direction, respectively. No significant difference was found in the mean setup error for the daily and hypothetical day 1–3 plus weekly protocol. However, the calculated CTV to PTV margins for the daily interfraction imaging data were 1·6, 3·8 and 1·4 mm in the S-I, L-R and A-P directions, respectively. Hypothetical day 1–3 plus weekly resulted in CTV–PTV margins of 5, 4·2 and 5 mm in the S-I, L-R and A-P direction. Conclusions The results of this study show that a daily CBCT protocol reduces setup errors and allows setup margin reduction in head and neck radiotherapy compared to a weekly imaging protocol.

Online grocery shopping: The impact of shopping frequency on perceived risk

Online grocery shopping has enjoyed strong growth and it is predicted this channel will continue to grow exponentially in the coming years. While online shopping has attracted an abundance of research interest, examinations of online grocery shopping behaviour are only now emerging. Shopping online for groceries differs considerably from general online shopping due to the perishability and variability of the product, and frequency of the shopping activity. Two salient gaps underpin this research into online grocery shopping. This study responds to calls to investigate the online shoppers’ experience in the context of online purchasing frequency. Second, this study examines the mediating effect of perceived risk between trust and online repurchase intention of groceries. An online survey was employed to collect data from shoppers who were recruited from a multi-channel grocery e-retailer’s database. The online survey, comprising 16 reflective validated scale items, was sent to 555 frequent and infrequent online grocery shoppers. Results find that while customer satisfaction predicts trust for both infrequent and frequent online grocery shoppers, perceived risk fully mediates the effect of trust on repurchase intentions for infrequent online grocery shoppers. Furthermore path analysis reveals that the developed behavioural model is variant across both groups of shoppers. Theoretically, we provide a deeper understanding of the online customer experience, while gaining insight into two shopper segments identified as being important to grocery e-retailers. For managers, this study tests an online customer behavioural model with actual purchasing behaviour and identifies the continued presence of perceived risk in grocery e-retailing regardless of purchase frequency or experience.

Rail fatigue and the role of impact forces

Fatigue of the steel in rails continues to be of major concern to heavy haul track owners despite careful selection and maintenance of rails. The persistence of fatigue is due in part to the erroneous assumption that the maximum loads on, and stresses in, the rails are predictable. Recent analysis of extensive wheel impact detector data from a number of heavy haul tracks has shown that the most damaging forces are in fact randomly distributed with time and location and can be much greater than generally expected. Large- scale Monte-Carlo simulations have been used to identify rail stresses caused by actual, measured distributions of wheel-rail forces on heavy haul tracks. The simulations show that fatigue failure of the rail foot can occur in situations which would be overlooked by traditional analyses. The most serious of these situations are those where track is accessed by multiple operators and in situations where there is a mix of heavy haul, general freight and/or passenger traffic. The least serious are those where the track is carrying single-operator-owned heavy haul unit trains. The paper shows how using the nominal maximum axle load of passing traffic, which is the key issue in traditional analyses, is insufficient and must be augmented with consideration of important operational factors. Ignoring such factors can be costly.

Field and laboratory evaluations of fungicides for the control of brown spot (Corynespora cassiicola) and black spot (Asperisporium caricae) of papaya in far north Queensland, Australia

Several chemicals including strobilurins (pyraclostrobin and azoxystrobin), triazoles (difenoconazole and tebuconazole), dithiocarbamates (propineb, metiram, ziram and mancozeb) and the phthalimide chlorothalonil were evaluated in three field experiments in north Queensland, Australia, for the control of brown spot (caused by Corynespora cassiicola) and black spot (caused by Asperisporium caricae) of papaya. Chlorothalonil and pyraclostrobin were shown to be more effective than the industry standard, mancozeb, for the control of brown spot. In the black spot experiments, difenoconazole, pyraclostrobin and chlorothalonil used alone or in spray programs were as effective as, or better than, the industry standards, mancozeb and tebuconazole. Plants treated with pyraclostrobin and difenoconazole had more fruit unaffected by black spot (97% and 99% respectively) than plants treated with tebuconazole (51%), mancozeb (20%) and the untreated controls (1%). Laboratory tests also showed that A. caricae was more sensitive to difenoconazole (EC50 of 2ppm) than tebuconazole (EC50 of 14ppm). In 2007, off-label permits were obtained for chlorothalonil for control of brown spot and difenoconazole and chlorothalonil for the control of black spot of papaya.

Black Sigatoka disease: new technologies to strengthen eradication strategies in Australia

In 2001, an incursion of Mycosphaerella fijiensis, the causal agent of black Sigatoka, was detected in Australia's largest commercial banana growing region, the Tully Banana Production Area in North Queensland. An intensive surveillance and eradication campaign was undertaken which resulted in the reinstatement of the disease-free status for black Sigatoka in 2005. This was the first time black Sigatoka had ever been eradicated from commercial plantations. The success of the eradication campaign was testament to good working relationships between scientists, growers, crop monitors, quarantine regulatory bodies and industry. A key contributing factor to the success was the deployment of a PCR-based molecular diagnostic assay, developed by the Cooperative Research Centre for Tropical Plant Protection (CRCTPP). This assay complemented morphological identification and allowed high throughput diagnosis of samples facilitating rapid decision-making during the eradication campaign. This paper describes the development and successful deployment of molecular diagnostics for black Sigatoka. Shortcomings in the gel-based assay are discussed and the advantages of highly specific real-time PCR assays, capable of differentiating between Mycosphaerella fijiensis, Mycosphaerella musicola and Mycosphaerella eumusae are outlined. Real-time assays may provide a powerful diagnostic tool for applications in surveillance, disease forecasting and resistance testing for Sigatoka leaf spot diseases.

Impact of subsoil constraints on wheat yield and gross margin on fine-textured soils of the southern Victorian Mallee

The APSIM-Wheat module was used to investigate our present capacity to simulate wheat yields in a semi-arid region of eastern Australia (the Victorian Mallee), where hostile subsoils associated with salinity, sodicity, and boron toxicity are known to limit grain yield. In this study we tested whether the effects of subsoil constraints on wheat growth and production could be modelled with APSIM-Wheat by assuming that either: (a) root exploration within a particular soil layer was reduced by the presence of toxic concentrations of salts, or (b) soil water uptake from a particular soil layer was reduced by high concentration of salts through osmotic effects. After evaluating the improved predictive capacity of the model we applied it to study the interactions between subsoil constraints and seasonal conditions, and to estimate the economic effect that subsoil constraints have on wheat farming in the Victorian Mallee under different climatic scenarios. Although the soils had high levels of salinity, sodicity, and boron, the observed variability in root abundance at different soil layers was mainly related to soil salinity. We concluded that: (i) whether the effect of subsoil limitations on growth and yield of wheat in the Victorian Mallee is driven by toxic, osmotic, or both effects acting simultaneously still requires further research, (ii) at present, the performance of APSIM-Wheat in the region can be improved either by assuming increased values of lower limit for soil water extraction, or by modifying the pattern of root exploration in the soil pro. le, both as a function of soil salinity. The effect of subsoil constraints on wheat yield and gross margin can be expected to be higher during drier than wetter seasons. In this region the interaction between climate and soil properties makes rainfall information alone, of little use for risk management and farm planning when not integrated with cropping systems models.