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Translation is one of the most fundamental processes in the biological cell. Because of the central role that translation plays across all domains of life, the enzyme that carries out this process, the ribosome, is required to process information with high accuracy. This accuracy often approaches values near unity experimentally. In this paper, we model the ribosome as an information channel and demonstrate mathematically that this biological machine has information-processing capabilities that have not been recognized previously. In particular, we calculate bounds on the ribosome's theoretical Shannon capacity and numerically approximate this capacity. Finally, by incorporating estimates on the ribosome's operation time, we show that the ribosome operates at speeds safely below its capacity, allowing the ribosome to process information with an arbitrary degree of error. Our results show that the ribosome achieves a high accuracy in line with purely information-theoretic means., Comment: 7 pages, 5 figures

Objectives A growing body of evidence suggests longer time between symptom onset and start of treatment affects breast cancer prognosis. To explore this association, the International Cancer Benchmarking Partnership Module 4 examined differences in breast cancer diagnostic pathways in 10 jurisdictions across Australia, Canada, Denmark, Norway, Sweden and the UK. Setting Primary care in 10 jurisdictions. Participant Data were collated from 3471women aged >40 diagnosed for the first time with breast cancer and surveyed between 2013 and 2015. Data were supplemented by feedback from their primary care physicians (PCPs), cancer treatment specialists and available registry data. Primary and secondary outcome measures Patient, primary care, diagnostic and treatment intervals. Results Overall, 56% of women reported symptoms to primary care, with 66% first noticing lumps or breast changes. PCPs reported 77% presented with symptoms, of whom 81% were urgently referred with suspicion of cancer (ranging from 62% to 92%; Norway and Victoria). Ranges for median patient, primary care and diagnostic intervals (days) for symptomatic patients were 3-29 (Denmark and Sweden), 0-20 (seven jurisdictions and Ontario) and 8-29 (Denmark and Wales). Ranges for median treatment and total intervals (days) for all patients were 15-39 (Norway, Victoria and Manitoba) and 4-78 days (Sweden, Victoria and Ontario). The 10% longest waits ranged between 101 and 209days (Sweden and Ontario). Conclusions Large international differences in breast cancer diagnostic pathways exist, suggesting some jurisdictions develop more effective strategies to optimise pathways and reduce time intervals. Targeted awareness interventions could also facilitate more timely diagnosis of breast cancer.

Key PointsQuestionAmong critically ill patients undergoing tracheal intubation worldwide, how common are major adverse events during the peri-intubation period? FindingsIn this prospective observational study that included 2964 patients from 197 sites across 29 countries from October 2018 to July 2019, at least one major clinical event occurred after intubation in 45.2% of patients, including cardiovascular instability in 42.6%, severe hypoxemia in 9.3%, and cardiac arrest in 3.1%. MeaningAmong an international sample of critically ill patients undergoing tracheal intubation, major cardiopulmonary events occurred frequently.ImportanceTracheal intubation is one of the most commonly performed and high-risk interventions in critically ill patients. Limited information is available on adverse peri-intubation events. ObjectiveTo evaluate the incidence and nature of adverse peri-intubation events and to assess current practice of intubation in critically ill patients. Design, Setting, and ParticipantsThe International Observational Study to Understand the Impact and Best Practices of Airway Management in Critically Ill Patients (INTUBE) study was an international, multicenter, prospective cohort study involving consecutive critically ill patients undergoing tracheal intubation in the intensive care units (ICUs), emergency departments, and wards, from October 1, 2018, to July 31, 2019 (August 28, 2019, was the final follow-up) in a convenience sample of 197 sites from 29 countries across 5 continents. ExposuresTracheal intubation. Main Outcomes and MeasuresThe primary outcome was the incidence of major adverse peri-intubation events defined as at least 1 of the following events occurring within 30 minutes from the start of the intubation procedure: cardiovascular instability (either: systolic pressure <65 mm Hg at least once, <90 mm Hg for >30 minutes, new or increase need of vasopressors or fluid bolus >15 mL/kg), severe hypoxemia (peripheral oxygen saturation

Importance: Tracheal intubation is one of the most commonly performed and high-risk interventions in critically ill patients. Limited information is available on adverse peri-intubation events. Objective: To evaluate the incidence and nature of adverse peri-intubation events and to assess current practice of intubation in critically ill patients. Design, Setting, and Participants: The International Observational Study to Understand the Impact and Best Practices of Airway Management in Critically Ill Patients (INTUBE) study was an international, multicenter, prospective cohort study involving consecutive critically ill patients undergoing tracheal intubation in the intensive care units (ICUs), emergency departments, and wards, from October 1, 2018, to July 31, 2019 (August 28, 2019, was the final follow-up) in a convenience sample of 197 sites from 29 countries across 5 continents. Exposures: Tracheal intubation. Main Outcomes and Measures: The primary outcome was the incidence of major adverse peri-intubation events defined as at least 1 of the following events occurring within 30 minutes from the start of the intubation procedure: cardiovascular instability (either: systolic pressure <65 mm Hg at least once, <90 mm Hg for >30 minutes, new or increase need of vasopressors or fluid bolus >15 mL/kg), severe hypoxemia (peripheral oxygen saturation <80%) or cardiac arrest. The secondary outcomes included intensive care unit mortality. Results: Of 3659 patients screened, 2964 (median age, 63 years; interquartile range [IQR], 49-74 years; 62.6% men) from 197 sites across 5 continents were included. The main reason for intubation was respiratory failure in 52.3% of patients, followed by neurological impairment in 30.5%, and cardiovascular instability in 9.4%. Primary outcome data were available for all patients. Among the study patients, 45.2% experienced at least 1 major adverse peri-intubation event. The predominant event was cardiovascular instability, ob

Background. Little is known about the health-related quality of life (HRQL) of men living with advanced prostate cancer. We report population-wide functional outcomes and HRQL in men with all stages of prostate cancer, and identify implications for healthcare delivery. Methods. Men alive 18-42 months after diagnosis of prostate cancer were identified through cancer registration data. A postal survey was administered which contained validated measures to assess a) functional outcomes (EPIC-26 plus use of interventions for sexual dysfunction) and b) generic HRQL (EQ-5D-5L & self-assessed health). Log-linear and binary logistic regression models were used to compare functional outcomes and HRQL across diagnostic stage and self-reported treatment groups. Findings. 35,823 (60.8%) men responded. Stage was known for 85.8%; 19,599 (63.8%) stage I/II, 7,209 (23.4%) stage III, 3,925 (12.8%) stage IV. Functional outcomes: Poor sexual function was common (81.0%), regardless of stage, and over half of men (55.8%) received no intervention for this. Differences in urinary and bowel morbidity were greater with respect to treatment than stage. In men treated with androgen deprivation therapy (ADT), 30.7% reported moderate/big problems with hot flushes, 29.4% with lack of energy and 22.5% with weight gain. HRQL: Overall self-assessed health was similar in men with stage I-III disease, and whilst reduced in those with stage IV cancer, 23.5% with metastatic disease reported no problems on any EQ-5D dimension. Interpretation. Men diagnosed with advanced disease do not report markedly different HRQL outcomes to those diagnosed with localised disease, although substantial problems with hormonal function and fatigue are reported amongst men treated with ADT. Sexual dysfunction is common and the majority of men are not offered helpful intervention or support. Service improvements around sexual rehabilitation and measures to reduce the impact of ADT are required.

Background. More men are living following a prostate cancer (PCa) diagnosis. They may need support to maximize the quality of their survival. Physical and psychological impacts of PCa are widely documented. Less is known about social impacts. We aimed to identify key factors associated with social distress following PCa. Methods. The Life After Prostate Cancer Diagnosis study is a UK national cross-sectional survey of men 18–42 months post diagnosis of PCa. Men (n = 58 930) were invited to participate by their diagnosing cancer centre including 82% of English NHS Trusts (n = 111) and 100% of all Health Boards in Northern Ireland (n = 5), Scotland (n = 14) and Wales (n = 6). Social distress was measured using the Social Difficulties Inventory (SDI-21), 16 item Social Distress scale with men assigned to ‘socially distressed’/‘not socially distressed’ groups, according to published guidelines. Clinical and sociodemographic variables were collected from self-report and cancer registries. Results. Response rate 60.8% (n = 35 823) of whom 97% (n = 29 351) completed the Social Distress scale (mean age = 71.2; SD = 7.88). The proportion of ‘socially distressed’ men was 9.4%. Multivariable logistic regression analysis revealed unemployment versus employment (odds ratio (OR): 11.58 [95% CI 9.16–14.63]) and ≥3 co-morbidities versus none (OR: 5.37 [95% CI 4.61–6.27]) as key associations. Others were Androgen Deprivation Therapy, External Beam Radiotherapy in combination with another treatment, age, prior mental health problems and living in a socio-economically deprived area. Conclusion. Most men following PCa are socially resilient. A simple checklist could help clinicians identify men at risk of social distress.

OBJECTIVE: International differences in colorectal cancer (CRC) survival and stage at diagnosis have been reported previously. They may be linked to differences in time intervals and routes to diagnosis. The International Cancer Benchmarking Partnership Module 4 (ICBP M4) reports the first international comparison of routes to diagnosis for patients with CRC and the time intervals from symptom onset until the start of treatment. Data came from patients in 10 jurisdictions across six countries (Canada, the UK, Norway, Sweden, Denmark and Australia). DESIGN: Patients with CRC were identified via cancer registries. Data on symptomatic and screened patients were collected; questionnaire data from patients' primary care physicians and specialists, as well as information from treatment records or databases, supplemented patient data from the questionnaires. Routes to diagnosis and the key time intervals were described, as were between-jurisdiction differences in time intervals, using quantile regression. PARTICIPANTS: A total of 14 664 eligible patients with CRC diagnosed between 2013 and 2015 were identified, of which 2866 were included in the analyses. PRIMARY AND SECONDARY OUTCOME MEASURES: Interval lengths in days (primary), reported patient symptoms (secondary). RESULTS: The main route to diagnosis for patients was symptomatic presentation and the most commonly reported symptom was 'bleeding/blood in stool'. The median intervals between jurisdictions ranged from: 21 to 49 days (patient); 0 to 12 days (primary care); 27 to 76 days (diagnostic); and 77 to 168 days (total, from first symptom to treatment start). Including screen-detected cases did not significantly alter the overall results. CONCLUSION: ICBP M4 demonstrates important differences in time intervals between 10 jurisdictions internationally. The differences may justify efforts to reduce intervals in some jurisdictions.

Objectives: To provide data on the prevalence of urinary, bowel and sexual dysfunction in Northern Ireland (NI), to act as a baseline for studies of prostate cancer outcomes and to aid service provision within the general population. Subjects and Methods: A cross-sectional postal survey of 10 000 men aged ≥40 years in NI was conducted and age-matched to the distribution of men living with prostate cancer. The EuroQoL five Dimensions five Levels (EQ-5D-5L) and 26-item Expanded Prostate Cancer Composite (EPIC-26) instruments were used to enable comparisons with prostate cancer outcome studies. Whilst representative of the prostate cancer survivor population, the age-distribution of the sample differs from the general population, thus data were generalised to the NI population by excluding those aged 40–59 years and applying survey weights. Results are presented as proportions reporting problems along with mean composite scores, with differences by respondent characteristics assessed using chi-squared tests, analysis of variance, and multivariable log-linear regression. Results: Amongst men aged ≥60 years, 32.8% reported sexual dysfunction, 9.3% urinary dysfunction, and 6.5% bowel dysfunction. In all, 38.1% reported at least one problem and 2.1% all three. Worse outcome was associated with increasing number of long-term conditions, low physical activity, and higher body mass index (BMI). Urinary incontinence, urinary irritation/obstruction, and sexual dysfunction increased with age; whilst urinary incontinence, bowel, and sexual dysfunction were more common among the unemployed. Conclusion: These data provide an insight into sensitive issues seldom reported by elderly men, which result in poor general health, but could be addressed given adequate service provision. The relationship between these problems, raised BMI and low physical activity offers the prospect of additional health gain by addressing public health issues such as obesity. The results provide essential c

Strategic competition between India and China in the Indian Ocean has the potential to profoundly affect the stability and security of the region. This essay examines Indian and Chinese views on the status and legitimacy of their roles in the Indian Ocean and argues that fundamental differences in perceptions could exacerbate an already highly competitive security dynamic in the maritime domain. New Delhi tends to have a somewhat proprietary attitude toward the region, questioning the legitimacy of any extraregional naval presence, particularly China. But Indian strategists also see China as having strategic vulnerabilities in the Indian Ocean. For its part, Beijing refuses to recognize India’s claims to great-power status or special prerogatives in the Indian Ocean region (IOR). This essay first summarizes China’s growing strategic imperatives in the Indian Ocean. It then considers India’s aspirations to take a leading role in the IOR and Indian perspectives on China’s presence in the region. Next, the essay discusses Chinese perspectives on India and its role in the Indian Ocean and considers the potential consequences for China of the failure to take India’s sensitivities into account. In short, I argue that China’s failure to try to co-opt India as a partner or address some of its concerns is a mistake. Beijing will find it difficult to create a favorable geostrategic environment in the Indian Ocean in opposition to India.

The Indo-Pacific concept is a useful way of understanding changing regional dynamics, David Brewster writes, but it also reflects a key strategic challenge – the relationship between China and India.

We identified 244 relevant articles pertinent to indigenous health (4% of the total) with a steady increase in number since 1995. Most Australian publications in the journal (with a small Indigenous population) have focussed on conditions such as malnutrition, diarrhoeal disease, iron deficiency, rheumatic fever, acute glomerulonephritis and respiratory and ear infections, and in settings where nearly all affected children are Indigenous. In contrast, New Zealand publications (with a large Maori and Pacific Islander population) have addressed important health issues affecting all children but emphasised the over-representation of Maori and Pacific Islanders. Publications in the journal are largely descriptive studies with relatively few systematic reviews and randomised trials. Our review attempts to cover the important Indigenous health issues in our region as represented by articles published in the Journal. The studies do document definite improvements in indigenous child health over the last 50 years.

We are currently seeing a potentially dangerous nuclear proliferation as India, Pakistan, and perhaps China, look to deploy ship-borne nuclear weapons in the Indian Ocean. India-Pakistan nuclear rivalry is the immediate driver for these developments, but the India-China nuclear relationship is also increasingly moving into the Indian Ocean. The deployment of strategic and tactical nuclear weapons in the maritime realm could further destabilise already unstable nuclear relationships, creating a real risk of a sea-based nuclear exchange.

This paper looks at the key strategic issues faced by China in the Indian Ocean within the context of growing Sino-Indian rivalry. It makes two basic arguments: first, that China has considerable strategic disadvantages in the Indian Ocean as compared with India; and second, that India has had more success than China in developing security relationships in the region. These propositions differ from a more common narrative, according to which China is establishing security relationships throughout the region that seriously threaten India. This paper argues that, on the contrary, China faces a strategic dilemma right across the Indian Ocean that it will only be able to partially mitigate in the short to medium term. Perhaps we should be asking how China's strategic vulnerability should be best managed.

Narendra Modi’s visit to Australia in November 2014 an d his fanfare address to the Australian Parliament was accompanied by much discussion of a “natural partnership” between the two countries. The visit was a significant step forward in a relationship that could one day become an important part of Australia ’s overall strategic posture. One of the most substantive achievements of the visit was the conclusion of a Framework for Security Cooperation setting out an Action Plan for a more comprehensive security and defence relationship. The Framework signals an intention on both sides to intensify the Australia-India security engagement and take it into some important new areas.

In coming years, India is likely to become one of Australia’s most important partners in the region. This article explores how the security and defence relationship has developed in recent times. It discusses challenges in the relationship before exploring potential areas for enhanced security and defence cooperation. It argues that if Australia wishes to be successful in its objectives of promoting greater cooperation with India, it will need to move in a consistent and sustained manner with a time horizon considerably longer than it is generally used to. In some cases, Australia may also need to move past any immediate expectations of the reciprocity that would be expected in developing security partnerships with most countries.

This article will look at strategic convergences between India and Australia in Southeast Asia. It will first examine the development of India’s strategic role in Southeast Asia and the trajectory of relations between Australia and India over the last decade or so. It will then consider the convergence of India and Australia’s strategic interests in Southeast Asia and review opportunities for strategic cooperation in the region, including in the political diplomatic area and cooperation in maritime security. Finally it will consider the idea of the “Indo-Pacific” as a single strategic region and the potential significance of this for the roles of Australia and India in Southeast Asia.

Our mental maps of the world, including our perceptions of where regions begin and end, can have profound consequences on strategic behavior. For decades there has been a sharp division between what we understand to be the regions of South Asia and Southeast Asia. The line between them effectively cuts the Bay of Bengal in two. These perceptions have inhibited a proper analysis of the strategic dynamics of the area. This article argues that the Bay of Bengal increasingly matters as a strategic space. Like, the South China Sea, security issues in the Bay of Bengal and its littoral states need to be understood and addressed in a coherent manner.

India and Australia have the potential to become important strategic partners in Asia as part of a coalition that could help manage the changing balance of power in the region. But while India and Australia share many strategic interests, both countries still have a lot to learn about how to get along with each other. Some might even see them as the odd couple of the Indo-Pacific. This paper looks at recent developments in the relationship in the areas of security, politics and economics, and the prospects for a closer partnership under the new Modi government.

India's defence strategy towards Southeast Asia can be understood in terms of two broad sets of strategic objectives which drive India's relationships in the region. The first is a perceived imperative to be the predominant power in the northeast Indian Ocean. The second is India's objective to assume a greater strategic role in Southeast Asia and the Pacific. India's aspirations to increase its defence presence in the region are broadly consistent with the perspectives of many Association of Southeast Asian Nations (ASEAN) states, which mostly see India as a positive factor in the Southeast Asian balance of power. But India is yet to demonstrate itself as a useful and consistent security partner for the region.

As India expands its strategic reach in the Indian Ocean, it will need friends that it can count on. The island state of Mauritius has long been one of India's closest allies in the region. This article discusses India's plans for a military intervention in Mauritius in 1983 to prevent a feared coup that may have threatened India's interests. A naval task force was readied, but the intervention did not proceed because of disagreements in India's leadership. Instead New Delhi facilitated a political solution to the crisis that firmly consolidated its special role. This previously undisclosed episode sheds light on India's thinking about the Indian Ocean, the alignment of India's interests with the United States, and India's military capabilities.

India's defense strategy toward Southeast Asia can be understood in terms of two broad sets of strategic objectives that together drive India's relationships in the region. These include its ambitions to be the predominant power in the northeast Indian Ocean and a broader objective to assume a greater strategic role in Southeast Asia and the Pacific. India's aspirations to increase its defense presence in the region are broadly consistent with the perspectives of many ASEAN states, which mostly see India as a positive factor in the Southeast Asian balance of power. But India is yet to demonstrate itself as a useful and consistent security partner for much of the region. India is hindered by a lack of strategic focus and planning that is consistent with many of its strategic relationships.

OBJECTIVE: Colorectal cancer (CRC) has a substantial heritable component. Common genetic variation has been shown to contribute to CRC risk. A study was conducted in a large multi-population study to assess the feasibility of CRC risk prediction using common genetic variant data combined with other risk factors. A risk prediction model was built and applied to the Scottish population using available data. DESIGN: Nine populations of European descent were studied to develop and validate CRC risk prediction models. Binary logistic regression was used to assess the combined effect of age, gender, family history (FH) and genotypes at 10 susceptibility loci that individually only modestly influence CRC risk. Risk models were generated from case-control data incorporating genotypes alone (n=39 266) and in combination with gender, age and FH (n=11 324). Model discriminatory performance was assessed using 10-fold internal cross-validation and externally using 4187 independent samples. The 10-year absolute risk was estimated by modelling genotype and FH with age- and gender-specific population risks. RESULTS: The median number of risk alleles was greater in cases than controls (10 vs 9, p<2.2×10(-16)), confirmed in external validation sets (Sweden p=1.2×10(-6), Finland p=2×10(-5)). The mean per-allele increase in risk was 9% (OR 1.09; 95% CI 1.05 to 1.13). Discriminative performance was poor across the risk spectrum (area under curve for genotypes alone 0.57; area under curve for genotype/age/gender/FH 0.59). However, modelling genotype data, FH, age and gender with Scottish population data shows the practicalities of identifying a subgroup with >5% predicted 10-year absolute risk. CONCLUSION: Genotype data provide additional information that complements age, gender and FH as risk factors, but individualised genetic risk prediction is not currently feasible. Nonetheless, the modelling exercise suggests public health potential since it is possible to stratify the population i

The expansion of India’s role as a security provider in the Indian Ocean region has aroused much interest in recent years. Many inside and outside India see great potential for India, and particularly the Indian Navy, to play a positive role in enhancing the region’s security in the context of India’s rise as a major power. Over the last several decades, India has developed good security relationships in the Indian Ocean, particularly with island or small littoral states such as Mauritius, Seychelles and Madagascar in the southwest Indian Ocean, Oman and Qatar in the Persian Gulf, the Maldives in the central Indian Ocean and Singapore in the east. India is now seen as a key security provider to, and even a security guarantor of, several of these states. However, the history of India’s strategic role in the Indian Ocean has not been the subject of a great deal of study. This article will examine India’s previously undisclosed interventions in the Seychelles in 1986, which acted as a prelude to other interventions throughout the region, including India’s foray in Sri Lanka in 1987 and the Maldives in 1988.

Since the end of the Cold War, India's strategic horizons have moved beyond its traditional preoccupations in South Asia. India is developing a strategic role in East Asia in particular. At the same time India's strategic thinking has undergone a revolution, as the country that prided itself on non-alignment has moved closer to the West. But India's culture, history and geography still fundamentally shape its worldview. In engaging with East Asia, India is guided by a mosaic of strategic objectives about extending its sphere of influence, developing a multipolar regional system and balancing against China. The interplay of these objectives will frame India's role in East Asia in coming years.

This article examines the evolution of relations between India and Indonesia. It argues that there are grounds to believe that this relationship may develop into a broad-based security partnership over time. Whether this occurs sooner rather than later will depend on the extent to which both countries see an imperative to turn their numerous complementary interests into practical deeds.

Background: There is limited epidemiological research that provides insight into the complex web of causative and moderating factors that links housing conditions to a variety of poor health outcomes. This study explores the relationship between housing conditions (with a primary focus on the functional state of infrastructure) and common childhood illness in remote Australian Aboriginal communities for the purpose of informing development of housing interventions to improve child health.Methods: Hierarchical multi-level analysis of association between carer report of common childhood illnesses and functional and hygienic state of housing infrastructure, socio-economic, psychosocial and health related behavioursusing baseline survey data from a housing intervention study.Results: Multivariate analysis showed a strong independent association between report of respiratory infection and overall functional condition of the house (Odds Ratio (OR) 3.00; 95%CI 1.36-6.63), but no significant association between report of other illnesses and the overall functional condition or the functional condition of infrastructure required for specific healthy living practices. Associations between report of child illness and secondary explanatory variables which showed an OR of 2 or more included: for skin infection - evidence of poor temperature control inthe house (OR 3.25; 95%CI 1.06-9.94), evidence of pests and vermin in the house (OR 2.88; 95%CI 1.25-6.60); for respiratory infection - breastfeeding in infancy (OR 0.27; 95%CI 0.14-0.49); for diarrhoea/vomiting - hygienic state of food preparation and storage areas (OR 2.10; 95%CI 1.10-4.00); for ear infection - child care attendance (OR 2.25; 95%CI 1.26-3.99).Conclusion: These findings add to other evidence that building programs need to be supported by a range of other social and behavioural interventions for potential health gains to be more fully realised.

The Joint Declaration on Security Cooperation between Australia and India, made during Kevin Rudd’s visit to New Delhi in November 2009, is part of a number of security agreements being entered into across the Asia Pacific. For Australia the Declaration is a notable step in the process of developing a closer security relationship with India. However, some grant it wider significance, seeing it as plugging a “missing link” in a web of bilateral security agreements connecting Australia, India, the United States and Japan—the four members of the so-called Quadrilateral security dialogue that was proposed and then quickly abandoned in 2007. With the AustraliaIndia Declaration all four members of the putative “Quad” now have bilateral security arrangements with each other, facilitating the further development of their relationships. Should, as some argue, the Declaration and other bilateral security arrangements be seen as heralding a coalition among AsiaPacific maritime powers implicitly aimed at containing China?

Many Australian observers see Australia and India as ‘natural’ partners whose strategic perspectives are likely to become ever closer in coming years. This article will examine recent developments in the Australia–India security relationship and consider some possible limits to the strategic convergence of Australia and India, particularly in Indian Ocean security. It argues that Australia's challenge in coming years will be not only to address areas of common interest but to also actively engage with India on the interests and expectations of littoral states and extra-regional powers in the security of the Indian Ocean.

India has an expansive maritime strategy. Driven by great power aspirations and by strategic rivalry with China, India is expanding its naval capabilities and security relationships throughout the Indian Ocean region. India has paid significant attention to developing relationships at the key points of entry into the Indian Ocean—the Malacca Strait, the Persian Gulf and southern Africa. The purpose of this article is to examine India’s maritime ambitions and relationships in the Indian Ocean and ask whether this may presage an extended Indian sphere of influence in the region.

The long-standing strategic disconnect between South Asia and the Korean Peninsula is breaking down. Driven by the changing balance of power in Asia, India and South Korea have developed a strong economic partnership, and taken small but significant steps toward a political and security relationship that reflects their numerous shared strategic interests. This article explores the contours of this evolving relationship.

The aim of this study was to present detailed population-based survival estimates for patients with a rectal adenocarcinoma, using cancer register data supplemented with clinical data. Based on cancer register data, differences in rectal cancer survival have been reported between countries in Europe. Variation in the distribution of stage at diagnosis, initial therapy including surgical technique, and comorbidity are possible explanatory factors. Adenocarcinomas in the rectum, diagnosed in 1997 and identified in the national cancer registries in the Nordic countries and Scotland were included. Age standardized 5-year relative survival and multiplicative regression models for the relative excess mortality were calculated. 3888 patients were included in the survival study. Men in Denmark, Finland and Iceland had lower 5-year relative survival and poorer stage distribution compared to Norway, Sweden and Scotland. Danish men had the highest rate of excess deaths in the first six months after diagnosis. Stage adjusted, the elevated relative excess mortality decreased and after six months the excess mortality rates were the same in all countries. The poor 5-year relative survival in Danish men was mainly due to a high excess rate of death during the first six months after diagnosis. The low survival in Finland and Iceland was not in accordance with other periods. For both countries this may be explained by random variation due to small numbers. The study emphasizes the need for high quality and detailed data in order to understand international survival differences, and cautions comparisons between large national samples and those of smaller areas.

Background: Despite Australia's wealth, poor growth is common among Aboriginal children living in remote communities. An important underlying factor for poor growth is the unhygienic state of the living environment in these communities. This study explores the physical and social barriers to achieving safe levels of hygiene for these children.Methods: A mixed qualitative and quantitative approach included a community level crosssectional housing infrastructure survey, focus groups, case studies and key informant interviews in one community.Results: We found that a combination of crowding, non-functioning essential housinginfrastructure and poor standards of personal and domestic hygiene underlie the high burden of infection experienced by children in this remote community.Conclusion: There is a need to address policy and the management of infrastructure, as well as key parenting and childcare practices that allow the high burden of infection among children to persist. The common characteristics of many remote Aboriginal communities in Australia suggest that these findings may be more widely applicable.

In recent years, India and Singapore have developed a strong bilateral security and economic partnership that has assumed a central position in India's strategic engagement in Southeast Asia. Having sought strategic engagement with India for many decades, Singapore has now successfully positioned itself as India's leading political partner and economic gateway to the region. At the same time, India and Singapore have actively pursued close defence ties, including frequent joint training and the assumption of an active maritime security role by India in Southeast Asia. The recent decision by India to allow the Singapore air force and army to operate long term training facilities on Indian territory represents a significant development in Indian strategic practice and may presage a more permanent Indian security presence in East Asia. This article will examine these developments and consider to what extent the emergent security relationship between India and Singapore should be seen as a desire to balance China's growing economic and political dominance of the region and to what extent it reflects a ‘natural’ strategic sphere for India stretching from Aden to Singapore and beyond into East Asia.

For more than 40 years, India and Vietnam have consistently stood together in resisting Chinese domination of Indochina. The relationship represents one of the few longstanding political partnerships between East and South Asia. In recent years, the two have been seeking to recalibrate their relationship in the context not only of China's growing economic and military power but also India's own security ambitions in the region. What are India's aspirations to project naval power into the South China Sea and how is this perceived in the region? This article looks at this longstanding political alliance in light of India's attempts at strategic engagement with Southeast Asia.

Background: Australian Aboriginal children living in remote communities still experience a high burden of common infectious diseases which are generally attributed to poor hygiene and unsanitary living conditions. The objective of this systematic literature review was to examine the epidemiological evidence for a relationship between various hygiene and public health intervention strategies, separately or in combination, and the occurrence of common preventable childhood infectious diseases. The purpose was to determine what intervention/s might most effectively reduce the incidence of skin, diarrhoeal and infectious diseases experienced by children living in remote Indigenous communities.Methods: Studies were identified through systematically searching electronic databases and hand searching. Study types were restricted to those included in Cochrane Collaboration Effective Practice and Organisation of Care Review Group (EPOC) guidelines and reviewers assessed the quality of studies and extracted data using the same guidelines. The types of participants eligible were Indigenous populations and populations of developing countries. The types of intervention eligible for inclusion were restricted to those likely to prevent conditions caused by poor personal hygiene and poor living environments.Results: The evidence showed that there is clear and strong evidence of effect of education and handwashing with soap in preventing diarrhoeal disease among children (consistent effect in four studies). In the largest well-designed study, children living in households that received plain soap and encouragement to wash their hands had a 53% lower incidence of diarrhoea (95% CI, 0.35, 0.59). There is some evidence of an effect of education and other hygiene behaviour change interventions (six studies), as well as the provision of water supply, sanitation and hygiene education (two studies) on reducing rates of diarrhoeal disease. The size of these effects is small and the quality o