83 research outputs found
Management of the patient with potential for massive perioperative blood loss
No full textThis narrative vignette explores the perioperative management of a 65-year-old man scheduled for extended hindquarter amputation due to pelvic chondrosarcoma, with anticipated massive blood loss of 5–7 litres. Despite being otherwise fit, his preoperative haemoglobin of 125 g/L and low iron stores pose risks, prompting the clinical question: How should this patient be managed perioperatively to mitigate massive haemorrhage? Preoperative evaluation emphasises thorough assessment, including transfusion history, coagulopathy screening and optimisation of pre-existing anaemia via erythropoietin or intravenous iron, even in urgent oncological cases. Discontinuation of antiplatelets and anticoagulants requires balancing bleeding and thrombotic risks. Informed consent includes discussing morbidity such as organ failure and mortality. Intraoperatively, strategies include large-bore access, invasive monitoring, thromboelastography-guided transfusions, tranexamic acid to reduce fibrinolysis and cell salvage when feasible. A multidisciplinary approach ensures communication between surgical teams, anaesthetic teams, nursing staff and laboratories. Allogeneic transfusions should commence early to maintain stability, with vigilant monitoring for complications such as hypothermia, hyperkalaemia and transfusion reactions. Postoperatively, ongoing surveillance in high-dependency care allows the assessment of further bleeding and appropriate thromboprophylaxis
Applying the principles of conservation through sustainable use to the commercial kangaroo harvest in New South Wales, Australia
No full textAs has been outlined elsewhere in this volume, there is a strong body of international evidence to show that when local people gain value from the sustainable use of wildlife, they have an incentive to maintain that wildlife and the ecosystems that support it (Webb 2002; Hutton & Leader-Williams 2003). This phenomenon, known as conservation through sustainable use or CSU (Webb 2002), has been acknowledged in the Convention on Biological Diversity (CBD) and elucidated through its Addis Ababa Principles and Guidelines for the Sustainable Use of Biodiversity (CBD 2004). If these guidelines are conscientiously applied, they should ensure that use is both sustainable and generates incentives for conservation where the situation is appropriate. These principles will be referred to here as the CSU principles
Revegetation, bioenergy and sustainable use in the New South Wales central west
No full textRevegetation of heavily-cleared forest and woodland ecosystems is a widespread natural resource management (NRM) goal in Australia, including in the region that is the focus of this chapter – the central west of New South Wales. Tree plantings that generate commercial returns for landholders could help to promote greater uptake of revegetation practices. Bioenergy, in the form of electricity generation, industrial heat or transport fuels, has been suggested by a number of authors as an option to drive establishment of such plantations (for example, Howard & Ozlack 2004; Bell 2005; Total Catchment Management Services 2008). The idea of harnessing commercial drivers such as bioenergy production to promote revegetation raises a number of issues around the concepts of ecological restoration and sustainable use. Harvesting biomass from replanted ecosystems can create incentives for both the maintenance of such ecosystems and the establishment of more plantings. However, trade-offs are also likely to be required between ecological and economic objectives. Such trade-offs, as well as undesirable side-effects, have become increasingly topical for bioenergy production. Recent expansion of bioenergy crops, particularly for liquid biofuels, has demonstrated the capacity for bioenergy to act as both a driver of positive change through both revegetation and climate change mitigation (Simpson et al. 2009; URS Australia 2009), and a driver of negative change through deforestation, increased carbon emissions, dispossession and competition with food production (Gallagher 2008). This chapter explores whether the concept of sustainable use may have applicability for revegetation activities that seek to harness the commercial driver of bioenergy to deliver NRM objectives. Two case studies in the central west of New South Wales are explored in order to identify potentially viable revegetation strategies and highlight implications for policymaker
Performance and client service in a competitive and rapidly changing environment : Queensland University of Technology
No full textGenome-wide analyses in a consanguineous family with autosomal recessive spondyloepimetaphyseal dysplasia and abnormal dentition exclude known genes and provide evidence for a further SEMD locus
No full textIdentifying opportunities for cross-property landholder collaboration for conservation and production
No full textCross-property collaborations offer novel solutions for dealing with complex, multi-scalar issues and fortifying long-term landscape-scale conservation and increasing viability of production systems. This type of coordinated action has the potential to manifest a range of innovative, capital building ventures. This paper reports on a NSW Environmental Trust funded project ‘Increasing landholder collaboration for landscape scale conservation’, focused on the NSW Central West and Central Tablelands. To explore opportunities, a participatory rural appraisal (PRA), an interviewing process which utilises local people as researchers and involves a series of workshops, was conducted and 55 landholders were interviewed. Evidence of cross-property collaboration included biodiversity management, vegetation plantings, fire safety and management, pest and weed control (e.g. dog baiting groups), informal sharing/trading of equipment, labour and transport, and informal grazing arrangements. Major barriers to collaboration were lack of time, reluctance to drive collaboration, individualistic mentalities, social dynamics, lack of contact (especially with absentee landholders), lack of perceived benefit from collaborating, and apprehension about personal liability versus group liability. Opportunities for increased collaboration include habitat connectivity, shared costs for pest and weed management, goat and kangaroo harvesting, shared branding and place-marketing, small-scale mobile production, and eco-tourism for recreation, cultural experience and nature-watching. To enable collaboration, realising synergies with neighbours, being able to discuss novel ideas in an online forum, and learning first-hand from other successful collaborators were identified as initiating steps
Mutations in FRMD7, a newly identified member of the FERM family, cause X-linked idiopathic congenital nystagmus.
No full textIdiopathic congenital nystagmus is characterized by involuntary, periodic, predominantly horizontal oscillations of both eyes. We identified 22 mutations in FRMD7 in 26 families with X-linked idiopathic congenital nystagmus. Screening of 42 singleton cases of idiopathic congenital nystagmus (28 male, 14 females) yielded three mutations (7%). We found restricted expression of FRMD7 in human embryonic brain and developing neural retina, suggesting a specific role in the control of eye movement and gaze stability
A systematic review of evidence on malignant spinal metastases : natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression
No full textBackground: Spinal metastases can lead to significant morbidity and reduction in quality of life due to spinal cord compression (SCC). Between 5% and 20% of patients with spinal metastases develop metastatic spinal cord compression during the course of their disease. An early study estimated average survival for patients with SCC to be between 3 and 7 months, with a 36% probability of survival to 12 months. An understanding of the natural history and early diagnosis of spinal metastases and prediction of collapse of the metastatic vertebrae are important.
Objective: To undertake a systematic review to examine the natural history of metastatic spinal lesions and to identify patients at high risk of vertebral fracture and SCC.
Data sources: The search strategy covered the concepts of metastasis, the spine and adults. Searches were undertaken from inception to June 2011 in 13 electronic databases [MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; EMBASE; Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials (CENTRAL); Database of Abstracts of Reviews of Effects (DARE), NHS Economic Evaluation Database (NHS EED), HTA databases (NHS Centre for Reviews and Dissemination); Science Citation Index and Conference Proceedings (Web of Science); UK Clinical Research Network (UKCRN) Portfolio Database; Current Controlled Trials; ClinicalTrials.gov].
Review methods: Titles and abstracts of retrieved studies were assessed by two reviewers independently. Disagreement was resolved by consensus agreement. Full data were extracted independently by one reviewer. All included studies were reviewed by a second researcher with disagreements resolved by discussion. A quality assessment instrument was used to assess bias in six domains: study population, attrition, prognostic factor measurement, outcome measurement, confounding measurement and account, and analysis. Data were tabulated and discussed in a narrative review. Each tumour type was looked at separately.
Results: In all, 2425 potentially relevant articles were identified, of which 31 met the inclusion criteria. No study examined natural history alone. Seventeen studies reported retrospective data, 10 were prospective studies, and three were other study designs. There was one systematic review. There were no randomised controlled trials (RCTs). Approximately 5782 participants were included. Sample sizes ranged from 41 to 859. The age of participants ranged between 7 and 92 years. Types of cancers reported on were lung alone (n= 3), prostate alone (n= 6), breast alone (n= 7), mixed cancers (n= 13) and unclear (n= 1). A total of 93 prognostic factors were identified as potentially significant in predicting risk of SCC or collapse. Overall findings indicated that the more spinal metastases present and the longer a patient was at risk, the greater the reported likelihood of development of SCC and collapse. There was an increased risk of developing SCC if a cancer had already spread to the bones. In the prostate cancer studies, tumour grade, metastatic load and time on hormone therapy were associated with increased risk of SCC. In one study, risk of SCC before death was 24%, and 2.37 times greater with a Gleason score 7 than with a score of < 7 (p= 0.003). Other research found that patients with six or more bone lesions were at greater risk of SCC than those with fewer than six lesions [odds ratio (OR) 2.9, 95% confidence interval (CI) 1.012 to 8.35, p= 0.047]. For breast cancer patients who received a computerised tomography (CT) scan for suspected SCC, multiple logistic regression in one study identified four independent variables predictive of a positive test: bone metastases 2 years (OR 3.0 95% CI 1.2 to 7.6; p= 0.02); metastatic disease at initial diagnosis (OR 3.4, 95% CI 1.0 to 11.4; p= 0.05); objective weakness (OR 3.8, 95% CI 1.5 to 9.5; p= 0.005); and vertebral compression fracture on spine radiograph (OR 2.6, 95% CI 1.0 to 6.5; p= 0.05). A further study on mixed cancers, among patients who received surgery for SCC, reported that vertebral body compression fractures were associated with presurgery chemotherapy (OR 2.283, 95% CI 1.064 to 4.898; p= 0.03), cancer type [primary breast cancer (OR 4.179, 95% CI 1.457 to 11.983; p= 0.008)], thoracic involvement (OR 3.505, 95% CI 1.343 to 9.143; p= 0.01) and anterior cord compression (OR 3.213, 95% CI 1.416 to 7.293; p= 0.005).
Limitations: Many of the included studies provided limited information about patient populations and selection criteria and they varied in methodological quality, rigour and transparency. Several studies identified type of cancer (e.g. breast, lung or prostate cancer) as a significant factor in predicting SCC, but it remains difficult to determine the risk differential partly because of residual bias. Consideration of quantitative results from the studies does not easily allow generation of a coherent numerical summary, studies were heterogeneous especially with regard to population, results were not consistent between studies, and study results almost universally lacked corroboration from other independent studies.
Conclusion: No studies were found which examined natural history. Overall burden of metastatic disease, confirmed metastatic bone involvement and immediate symptomatology suggestive of spinal column involvement are already well known as factors for metastatic SCC, vertebral collapse or progression of vertebral collapse. Although we identified a large number of additional possible prognostic factors, those which currently offer the most potential are unclear. Current clinical consensus favours magnetic resonance imaging and CT imaging modalities for the investigation of SCC and vertebral fracture. Future research should concentrate on: (1) prospective randomised designs to establish clinical and quality-of-life outcomes and cost-effectiveness of identification and treatment of patients at high risk of vertebral collapse and SCC; (2) Service Delivery and Organisation research on magnetic resonance imaging (MRI) scans and scanning (in tandem with research studies on use of MRI to monitor progression) in order to understand best methods for maximising use of MRI scanners; and (3) investigation of prognostic algorithms to calculate probability of a specified event using high-quality prospective studies, involving defined populations, randomly selected and clearly identified samples, and with blinding of investigators
Kangaroos in the rangelands: opportunities for landholder collaboration
No full text
For 3 years, the Future of Australia’s Threatened Ecosystems (FATE) Program has been working towards achieving multiple benefits for rangelands by applying conservation through sustainable use (CSU) approaches to the kangaroo industry. A critical component of this work is landholder involvement in kangaroo management that results in commercial gain. We are developing strategies for landholders to add value to the harvest at the same time as achieving better control over the impact that kangaroos can have on their land.
This paper outlines FATE’s experiences with two related initiatives exploring landholder involvement in kangaroo harvest in the rangelands. First, a trial in the Barrier Ranges of north-western New South Wales demonstrates the potential benefits of collaboration for landholders in reducing their exposure to kangaroo harvest variability and the associated business risks. Second, an analysis of the various enterprise models which landholders could employ to enter the kangaroo industry identifies opportunities for landholders and kangaroo harvesters to collaborate for mutual benefit. Several challenges exist in bringing these potential benefits to fruition.
The paper includes: (1) analysis of harvest data across collaborating properties; (2) progress towards allocation of harvest tags on a group rather than an individual property basis; (3) results of discussions between key stakeholders; and (4) a description of models for landholder involvement and analysis of the extent to which they can achieve multiple benefits.
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A Comparative Study of Medical Curriculum Outcomes: Opinions of the Graduates of a Traditional Curriculum and an Innovative Curriculum
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