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Allogeneic haematopoietic stem cell transplantation (allo-HSCT) entails long-term morbidities that impair survivors’ quality of life through broad physical and psychosocial sequelae. Current data and survival measurements may be inadequate for contemporary Australian allo-HSCT recipients. This study sought to comprehensively describe survivorship in an up-to-date, local setting through validated measurements and a novel questionnaire designed to complement and address limitations of current instruments. All adults who received an allo-HSCT between 2000 and 2012 in New South Wales were eligible and included, if alive, those literate and consenting to the study, which encompassed seven survey instruments. Four hundred and forty-three survivors participated, which is 76% of contactable (n=583) and 66% of eligible survivors (n= 669). Chronic GVHD (cGVHD) and co-morbidity rates were similar to published data. Noteworthy results include prevalent sexual dysfunction (66% females, 52% males), loss of income (low income increased from 21 to 36%, P

In addition to prescribed conventional medicines, many allogeneic hematopoietic stem cell transplant (HSCT) survivors also use complementary and alternative medical therapies (CAM), however, the frequency and types of CAMs used by allogeneic HSCT survivors remain unclear. Study participants were adults who had undergone an allogeneic HSCT between 1st January 2000 and 31st December 2012. Participants completed a 402-item questionnaire regarding the use of CAM, medical complications, specialist referrals, medications and therapies, infections, vaccinations, cancer screening, lifestyle, and occupational issues and relationship status following stem cell transplantation. A total of 1475 allogeneic HSCT were performed in the study period. Of the 669 recipients known to be alive at study sampling, 583 were contactable and were sent study packs. Of 432 participants who returned the completed survey (66% of total eligible, 76% of those contacted), 239 (54.1%) HSCT survivors used at least one form of CAM. These included dietary modification (13.6%), vitamin therapy (30%), spiritual or mind–body therapy (17.2%), herbal supplements (13.5%), manipulative and body-based therapies (26%), Chinese medicine (3.5%), reiki (3%), and homeopathy (3%). These results definitively demonstrate that a large proportion of HSCT survivors are using one or more form of CAM therapy. Given the potential benefits demonstrated by small studies of specific CAM therapies in this patient group, as well as clearly documented therapies with no benefit or even toxicity, this result shows there is a large unmet need for additional studies to ascertain efficacy and safety of CAM therapies in this growing population. funded by the New South Wales Agency for Clinical Innovation (ACI) Blood and Marrow Transplant Network and supported by the Northern Blood Research Centre

Highlights •We surveyed 441 allogeneic bone marrow transplantation survivors about their long-term care preference •Of the respondents, 44.9% indicated that they would prefer long-term follow-up with their transplantation physician alone •We found that 74% preferred care with the transplantation center and satellite clinics or telemedicine •The survey revealed that 53% indicated a preference for a single site location for long-term follow-up •Income, education status, and sexual morbidity were factors influencing care preference Abstract Four hundred forty-one adult allogeneic blood and marrow transplantation (BMT) survivors participated in a cross-sectional survey to assess long-term follow-up (LTFU) model of care preference. Survey instruments included the Sydney Post BMT Survey, Functional Assessment of Cancer Therapy-BMT, Depression Anxiety Stress Scales 21, the Chronic GVHD Activity Assessment—Patient Self Report (Form B), the Lee Chronic GVHD Symptom Scale and the Post-Traumatic Growth Inventory. We found most BMT survivors (74%) would prefer LTFU with their transplantation physicians alone or in combination with transplantation center–linked services (satellite clinics or telemedicine) Over one-quarter indicated a preference for receiving comprehensive post-transplantation care in a “satellite” clinic staffed by their BMT team situated closer to their place of residence, with higher income, higher educational level, and sexual morbidity being significant social factors influencing this preference. Regular exercise was reported less often in those who preferred telemedicine, which may reflect reduced mobility. The factor most strongly associated with a preference for transplantation center follow-up was the severity of chronic graft-versus-host disease. Full- and part-time work were negatively associated with transplantation center follow-up, possibly implying decreased dependency on the center and some return to normalcy. This study is the first to explore the preferences of BMT survivors for long-term post-transplantation care. These data provides the basis for LTFU model of care development and health service reform consistent with the preferences of BMT survivors. funded by the New South Wales Agency for Clinical Innovation Blood and Marrow Transplant Network and supported by the Northern Blood Research Centre.

Ballonkyphoplastie (BKP) und Vertebroplastie (VP) sind klinisch erfolgreiche Verfahren. Nichtsdestoweniger zeigen Einzelbeobachtungen bei der BKP ein Versagen der Methode, ohne dass bisher die Ursache aufgezeigt wurde. Nach unserer Meinung liegt das Versagen der BKP insbesondere bei schwerer Osteoporose und Osteonekrose am Stressshielding sowie der Zementsteifigkeit. Bei diesen Patientengruppen könnten andere, knochenerhaltende kyphoplastische Verfahren und die Vertebroplastie sowie neuere, an den Osteoporosegrad angepasste Zemente Vorteile bringen. Weiterhin ist es wichtig, dass intraoperativ bei der BKP eine komplette Aufrichtung erzielt werden sollte, da eine Restkyphose den negativen Effekt hinsichtlich der Belastung der angrenzenden Wirbelkörper bei Erzeugung eines mit Zement gefüllten Hohlraums erhöht. Es ist somit zu überdenken, alternative knochenerhaltende kyphoplastische Massnahmen der BKP vorzuziehen, bei älteren Frakturen eher auf eine VP auszuweichen und neue Zemente einzusetzen.

Background Excessive haemorrhage at cesarean section requires donor (allogeneic) blood transfusion. Cell salvage may reduce this requirement. Methods and findings We conducted a pragmatic randomised controlled trial (at 26 obstetric units; participants recruited from 4 June 2013 to 17 April 2016) of routine cell salvage use (intervention) versus current standard of care without routine salvage use (control) in cesarean section among women at risk of haemorrhage. Randomisation was stratified, using random permuted blocks of variable sizes. In an intention-to-treat analysis, we used multivariable models, adjusting for stratification variables and prognostic factors identified a priori, to compare rates of donor blood transfusion (primary outcome) and fetomaternal haemorrhage ≥2 ml in RhD-negative women with RhD-positive babies (a secondary outcome) between groups. Among 3,028 women randomised (2,990 analysed), 95.6% of 1,498 assigned to intervention had cell salvage deployed (50.8% had salvaged blood returned; mean 259.9 ml) versus 3.9% of 1,492 assigned to control. Donor blood transfusion rate was 3.5% in the control group versus 2.5% in the intervention group (adjusted odds ratio [OR] 0.65, 95% confidence interval [CI] 0.42 to 1.01, p = 0.056; adjusted risk difference −1.03, 95% CI −2.13 to 0.06). In a planned subgroup analysis, the transfusion rate was 4.6% in women assigned to control versus 3.0% in the intervention group among emergency cesareans (adjusted OR 0.58, 95% CI 0.34 to 0.99), whereas it was 2.2% versus 1.8% among elective cesareans (adjusted OR 0.83, 95% CI 0.38 to 1.83) (interaction p = 0.46). No case of amniotic fluid embolism was observed. The rate of fetomaternal haemorrhage was higher with the intervention (10.5% in the control group versus 25.6% in the intervention group, adjusted OR 5.63, 95% CI 1.43 to 22.14, p = 0.013). We are unable to comment on long-term antibody sensitisation effects. Conclusions The overall reduction observed in donor blood transfusion associated with the routine use of cell salvage during cesarean section was not statistically significant. Trial registration This trial was prospectively registered on ISRCTN as trial number 66118656 and can be viewed on http://www.isrctn.com/ISRCTN66118656., In a multi-center randomized trial, Khalid Khan and colleagues examine the effect of routine use of cell salvage during cesarean section vs. standard care on the donor blood transfusion rates., Author summary Why was this study done? Given that cesarean section rates are rising worldwide, the need for promoting alternatives to blood transfusion in cesareans, such as harnessing the patient’s own reserves where feasible, is well recognised. While cell salvage in operations outside of obstetrics has been shown to reduce the need for donor blood transfusion, its effectiveness in cesarean section is unclear and is based on only two small controlled trials of cell salvage in cesarean section, with imprecise and inconclusive findings. Current obstetric guidelines on cell salvage have focused attention on the lack of high-quality research, recognising that although there is potentially a place for cell salvage in emergency blood loss during cesarean section, its use remains controversial. What did the researchers do and find? We conducted a multicentre randomised controlled trial, including 3,028 women at risk of haemorrhage during cesarean section, to test the effect of the routine use of cell salvage compared to the current standard of care on the need for donor blood transfusion. While donor blood transfusion rates were lower in the cell salvage group than in the control group (2.5% versus 3.5%, meaning that, on average, 1 in every 100 mothers given cell salvage avoided a donor blood transfusion), the difference between the groups was not statistically significant. Additionally, the study showed that in women with RhD-negative blood type who gave birth to RhD-positive babies, cell salvage was associated with increased maternal exposure to fetal blood. What do these findings mean? These findings indicate that routine cell salvage does not lead to a statistically significant reduction in donor blood transfusion rates in all women at risk of haemorrhage during cesarean section.

Earlier work on identity, self, and consumption identified that desired and undesired selves play a significant role in the important global phenomenon of symbolic consumption, but neglected to investigate and conceptualise the interrelationship between desired and undesired selves and consumption. Phenomenological interviews with Greek women are used to elicit consumption experiences linked to positive and negative aspects of the self. The interrelationships between desired and undesired selves in consumption were characterised by two patterns (first, conflicting, and second, compatible desired and undesired selves) that could be linked to consumers' different strategies. Examining these strategies, we extend previous work on the strategies that consumers use to handle identity issues. Finally, we evaluate this theory building derived from the Greek empirical data within the context of US-generated theory about individuals' ways of dealing with self-coherence issues through symbolic consumption; we identify consumers' sense of baffled self and ambivalence in the emotions surrounding consumption.

Consumption can facilitate, accelerate, ameliorate or impede identities in transition. Earlier studies have largely examined identity transitions within the context of privileged groups of consumers, to the relative neglect of less privileged consumer groups. Stories from fostered children show how they employ symbolic consumption in their strategies to resist and counteract the threats from their earlier identities as ‘fostered children’ to their newly emergent identities as young adults. From their stories we see how they employ contingencies of self-worth in order firstly, to enhance their self-esteem in the key transitions to establishing an adult identity (becoming parents and establishing family life); and secondly to counter feelings of low self-esteem which contribute significantly to consumer marginality, vulnerability and disadvantage.

In response to the call for family research which (a) acknowledges that alternative forms of families exist, moving away from the predominance of nuclear conventions (Commuri and Gentry, 2000), (b) extends the restrictive nature of the participants recruited in family studies (Ekström, Tansuhaj and Foxman, 1987) and (c) focuses on more than one specific aspect of the family unit at a disaggregate level (Bazerman, 2001) this paper attempts to offer a more holistic view and complete account of how power and influence are exerted in family decision-making. We study the family decision making processes in six different families through a series of in-depth interviews, focussing specifically on how the children in each family try to get their voices heard and how they attempt to exert influence within their families. Themes such as gatekeeping, family microenvironments, intragenerational influence and individual/collaborative influence attempts emerge as ways through which individuals seek to restrict the power of others whilst maintaining or enhancing their own power levels in family decision-making.

Colour is one of the most complex and difficult variables which marketers have to contend with when forecasting, planning, presenting and managing ranges of fashion goods. This paper aims to contribute towards a greater understanding of some of the factors that influence decisions about colour forecasting within the textile and clothing industry. A variety of colour forecasting services are available to aid designers and buyers in colour selection. However, the earlier the colours are predicted, the more expensive the service tends to be.In the case of a leading mail order company, how useful are these services? Do they aid colour selection or are they an unnecessary expense? What are the risks of selecting the wrong colour? These questions and many more shall be addressed by looking at how a leading mail order company selects their colour palette for a season.