Bilateral Industrial Symbiosis. An assessment of its potential in New South Wales to deal sustainably with manufacturing waste

Manufacturing takes place in NSW on sites that are dispersed throughout the state. They may be isolated, remote from one another and hence from likely users of their waste. This scenario is not conducive to industrial symbiosis which is conventionally understood to be a network of organisations in close geographic proximity that share resources, cascade energy and use each other’s waste. Regulations governing the disposal of waste are stringent and associated costs are significant, largely due to the highest landfill levies anywhere in Australia. The state government’s strategy is to increase levies to a level that ‘induces’ generators of waste to find alternatives to landfill. Responding to these challenges will necessitate a fundamental change in the approach to dealing with waste. The way in which manufactures might accomplish the change sustainably and systematically is the underlying issue addressed in this thesis. The concept of physical bilateral symbiosis, specifically an arrangement between a generator of waste and its user, has been developed to suit geographic conditions in NSW. However, an attempt to establish trials of its autogenous form was unsuccessful. Nevertheless, results of the attempt indicated that broader issues should be investigated: managers’ perceptions of waste disposal, their willingness and their capacity to meet the challenges imposed by government; collectively, what I have called a generator’s internal infrastructure. These issues, in turn, led to an investigation of how third parties, that is, the external infrastructure, might be able to facilitate bilateral symbiosis. The principal findings are that while some generators may develop uses for their waste others will simply not be able to do so. There is, in practice, no external infrastructure capable of facilitating systematic, bilateral symbiosis on behalf of a generator. Furthermore, government action, particularly in relation to policy on funding, is neither appropriate nor adequate for sustainable development in relation to waste. The overall conclusion is that much could be done by the private sector to increase the use of waste, if government policy were to support the effort. However, that support is expected to be very difficult to achieve, even in the form of appropriate legislation in NSW, let alone coordinated among the various jurisdictions in Australia. In regard to what actually happens in practice, the current scenario in general is unlikely to change significantly within the foreseeable future

Socio-economic Status Plays Important Roles in Childhood Cancer Treatment Outcome in Indonesia

Background: The influence of parental socio-economic status on childhood cancer treatment outcome in low-income countries has not been sufficiently investigated. Our study examined this influence and explored parental experiences during cancer treatment of their children in an Indonesian academic hospital. Materials and Methods: Medical charts of 145 children diagnosed with cancer between 1999 and 2009 were reviewed retrospectively. From October 2011 until January 2012, 40 caretakers were interviewed using semi-structured questionnaires. Results: Of all patients, 48% abandoned treatment, 34% experienced death, 9% had progressive/relapsed disease, and 9% overall event-free survival. Prosperous patients had better treatment outcome than poor patients (P<0.0001). Odds-ratio for treatment abandonment was 3.3 (95%CI: 1.4-8.1, p=0.006) for poor versus prosperous patients. Parents often believed that their child's health was beyond doctor control and determined by luck, fate or God (55%). Causes of cancer were thought to be destiny (35%) or God's punishment (23%). Alternative treatment could (18%) or might (50%) cure cancer. Most parents (95%) would like more information about cancer and treatment. More contact with doctors was desired (98%). Income decreased during treatment (55%). Parents lost employment (48% fathers, 10% mothers), most of whom stated this loss was caused by their child's cancer (84% fathers, 100% mothers). Loss of income led to financial difficulties (63%) and debts (55%). Conclusions: Treatment abandonment was most important reason for treatment failure. Treatment outcome was determined by parental socio-economic status. Childhood cancer survival could improve if financial constraints and provision of information and guidance are better addressed

The significance of PTEN and AKT aberrations in pediatric T-cell acute lymphoblastic leukemia

Background PI3K/AKT pathway mutations are found in T-cell acute lymphoblastic leukemia, but their overall impact and associations with other genetic aberrations is unknown. PTEN mutations have been proposed as secondary mutations that follow NOTCH1-activating mutations and cause cellular resistance to γ-secretase inhibitors. Design and Methods The impact of PTEN, PI3K and AKT aberrations was studied in a genetically well-characterized pediatric T-cell leukemia patient cohort (n=146) treated on DCOG or COALL protocols. Results PTEN and AKT E17K aberrations were detected in 13% and 2% of patients, respectively. Defective PTEN-splicing was identified in incidental cases. Patients without PTEN protein but lacking exon-, splice-, promoter mutations or promoter hypermethylation were present. PTEN/AKTmutations were especially abundant in TAL- or LMO-rearranged leukemia but nearly absent in TLX3-rearranged patients (P=0.03), the opposite to that observed for NOTCH1- activating mutations. Most PTEN/AKT mutant patients either lacked NOTCH1-activating mutations (P=0.006) or had weak NOTCH1-activating mutations (P=0.011), and consequently expressed low intracellular NOTCH1, cMYC and MUSASHI levels. T-cell leukemia patients without PTEN/AKT and NOTCH1-activating mutations fared well, with a cumulative incidence of relapse of only 8% versus 35% for PTEN/AKT and/or NOTCH1-activated patients (P=0.005). Conclusions PI3K/AKT pathway aberrations are present in 18% of pediatric T-cell acute lymphoblastic leukemia patients. Absence of strong NOTCH1-activating mutations in these cases may explain cellular insensitivity to γ-secretase inhibitors

Aggravated bone density decline following symptomatic osteonecrosis in children with acute lymphoblastic leukemia

Analysis and Stochastic

Effects of Chemotherapy on Neurocognitive Function in Children With Acute Lymphoblastic Leukemia: A Critical Review of the Literature

Chemotherapy-only treatment has increasingly become the standard of treatment for childhood acute lymphoblastic leukemia (ALL). The objective of this review is to assess the present state of knowledge of the neurocognitive effects of central nervous system (CNS)-directed chemotherapy in children with ALL, and to formulate directions for future research. We performed a review of studies published since 1997, that included an ALL group treated with chemotherapy only and a control group. Twenty-one studies met our inclusion criteria. There is evidence of subtle long-term neurocognitive deficits survivors of childhood ALL after treatment with chemotherapy only. These involve mainly processes of attention and of executive functioning, while global intellectual function is relatively preserved. Young age at diagnosis and female sex emerged as risk factors. Pediatr Blood Cancer 2009;52: 447-454. (c) 2008 Wiley-Liss, In

Different Outcome in Older Children With Acute Lymphoblastic Leukemia With Different Treatment Protocols in the Netherlands

Background. From 1991 until 2004 children with acute lymphoblastic leukemia (ALL) in the Netherlands were treated according to protocols ALL-8 and ALL-9 which were based on different principles. An earlier study showed that the outcome of adolescents highly differed on these protocols. Procedure. In this retrospective study, we analyzed whether the outcome of older children 10-15 years of age at diagnosis differed between the Berlin-Frankfurt-Munster (BFM)-based ALL-8 regimen and the ALL-9 regimen. Two hundred fifty-four older children who were treated according to protocol ALL-8 (n = 82) or ALL-9 (n 172) were included in the analysis. Results. A higher 5-year event-free survival (EFS) rate was found for patients treated according to ALL-8 compared to ALL-9 (79 +/- 5% vs. 65 +/- 4%, P = 0.02). Patient characteristics did not differ except for a slightly higher age in ALL-8. Therefore, additional analyses were done including only patients who were 12-15 years of age. In this age group there was also a difference in the 5-year EFS (82 +/- 5% vs. 61 +/- 5%, P = 0.00) as well as in the 5-year overall survival rate; 89 +/- 4% compared to 68 +/- 5%, respectively (P = 0.01). Major difference between protocols was the use of a consolidation and reinduction/intensification course and higher cumulative doses of asparaginase, methotrexate, and anthracyclines in ALL-8. Conclusions. Children 10-15 years of age have been undertreated with the ALL-9 regimen and benefit by intensive treatment components as used in ALL-8. We recommend using BFM-based protocols for these older children with ALL. Pediatr Blood Cancer 2012; 58: 17-22. (C) 2011 Wiley Periodicals, Inc