The long haul: Caring for bone marrow transplant patients in regional Australia

Objective To evaluate the experience of, and services to, patients from rural and regional Australia referred to a large urban tertiary referral hospital for allogeneic haematopoietic cell transplantation (allo‑HCT) and to compare their quality of life with similar populations. Design and setting A cross‑sectional survey of allo‑HCT recipients referred from the Calvary Mater Newcastle to Westmead Hospital, Sydney, NSW. Subjects Thirty‑seven of forty adult survivors of allo‑HCT (92.5%) who underwent transplant between 1999 and 2008 and were at least three months post transplant. Intervention All subjects completed a validated measure of quality‑of‑life (QoL) in bone marrow transplant recipients ( FACT‑BMT Version 4) and the Regional/Rural BMT Needs Assessment Survey. Results Most patients (79%) were between one and five years post transplant. Almost all reported having been sufficiently prepared for transplant and received most information and support from the Nurse Coordinator. Despite the fact that 89% of patients reported significant adverse effects of allo‑HCT, >60% still reported an acceptable quality of life. Importantly, however, about a third of patients experienced financial difficulties associated with transplantation and felt pressure to return to work. Conclusion Patients referred for allo‑HCT should be advised about the arduousness of transplant but also reassured that most survivors will experience acceptable levels of functioning and QoL one to two years after transplant. With sufficient local support and with appropriate nursing care and coordination the experiences of regional/rural patients is comparable with other allo‑HCT patient populations. Further investigation into vocational rehabilitation is warranted due to the significant financial and occupational pressures reported by survivors of allo‑HC

The long haul: Caring for bone marrow transplant patients in regional Australia

Objective To evaluate the experience of, and services to, patients from rural and regional Australia referred to a large urban tertiary referral hospital for allogeneic haematopoietic cell transplantation (allo‑HCT) and to compare their quality of life with similar populations. Design and setting A cross‑sectional survey of allo‑HCT recipients referred from the Calvary Mater Newcastle to Westmead Hospital, Sydney, NSW. Subjects Thirty‑seven of forty adult survivors of allo‑HCT (92.5%) who underwent transplant between 1999 and 2008 and were at least three months post transplant. Intervention All subjects completed a validated measure of quality‑of‑life (QoL) in bone marrow transplant recipients ( FACT‑BMT Version 4) and the Regional/Rural BMT Needs Assessment Survey. Results Most patients (79%) were between one and five years post transplant. Almost all reported having been sufficiently prepared for transplant and received most information and support from the Nurse Coordinator. Despite the fact that 89% of patients reported significant adverse effects of allo‑HCT, >60% still reported an acceptable quality of life. Importantly, however, about a third of patients experienced financial difficulties associated with transplantation and felt pressure to return to work. Conclusion Patients referred for allo‑HCT should be advised about the arduousness of transplant but also reassured that most survivors will experience acceptable levels of functioning and QoL one to two years after transplant. With sufficient local support and with appropriate nursing care and coordination the experiences of regional/rural patients is comparable with other allo‑HCT patient populations. Further investigation into vocational rehabilitation is warranted due to the significant financial and occupational pressures reported by survivors of allo‑HC

Fire

Vegetation plays a crucial role in regulating environmental conditions, including weather and climate. The amount of water and carbon dioxide in the air and the albedo of our planet are all influenced by vegetation, which in turn influences all life on Earth. Soil properties are also strongly influenced by vegetation, through biogeochemical cycles and feedback loops (see Volume 1A—Section 4). Vegetated landscapes on Earth provide habitat and energy for a rich diversity of animal species, including humans. Vegetation is also a major component of the world economy, through the global production of food, fibre, fuel, medicine, and other plantbased resources for human consumptio

Long-term in vitro maintenance of clonal abundance and leukaemia-initiating potential in acute lymphoblastic leukaemia

Lack of suitable in vitro culture conditions for primary acute lymphoblastic leukaemia (ALL) cells severely impairs their experimental accessibility and the testing of new drugs on cell material reflecting clonal heterogeneity in patients. We show that Nestin-positive human mesenchymal stem cells (MSCs) support expansion of a range of biologically and clinically distinct patient-derived ALL samples. Adherent ALL cells showed an increased accumulation in the S phase of the cell cycle and diminished apoptosis when compared with cells in the suspension fraction. Moreover, surface expression of adhesion molecules CD34, CDH2 and CD10 increased several fold. Approximately 20% of the ALL cells were in G0 phase of the cell cycle, suggesting that MSCs may support quiescent ALL cells. Cellular barcoding demonstrated long-term preservation of clonal abundance. Expansion of ALL cells for >3 months compromised neither feeder dependence nor cancer initiating ability as judged by their engraftment potential in immunocompromised mice. Finally, we demonstrate the suitability of this co-culture approach for the investigation of drug combinations with luciferase-expressing primograft ALL cells. Taken together, we have developed a preclinical platform with patient-derived material that will facilitate the development of clinically effective combination therapies for ALL

Biological and geophysical feedbacks with fire in the Earth System

Roughly 3% of the Earth’s land surface burns annually, representing a critical exchange of energy and matter between the land and atmosphere via combustion. Fires range from slow smouldering peat fires, to low-intensity surface fires, to intense crown fires, depending on vegetation structure, fuel moisture, prevailing climate, and weather conditions. While the links between biogeochemistry, climate and fire are widely studied within Earth system science, these relationships are also mediated by fuels – namely plants and their litter – which are the product of evolutionary and ecological processes. Fire is a powerful selective force and, over their evolutionary history, plants across diverse clades have evolved numerous traits that either tolerate or promote fire. Here we outline a conceptual framework of how plant traits determine the flammability of ecosystems and interact with climate and weather to influence fire regimes. We explore how these evolutionary and ecological processes scale to impact biogeochemistry and Earth system processes. Finally, we outline several research challenges that, when resolved, will improve our understanding of the role of plant evolution in mediating the fire feedbacks driving Earth system processes. Understanding current patterns of fire and vegetation, as well as patterns of fire over geological time, requires research that incorporates evolutionary biology, ecology, biogeography, and the biogeosciences

Savanna burning methodology for fire management and emissions reduction: a critical review of influencing factors

Savanna fire is a major source of global greenhouse gas (GHG) emissions. In Australia, savanna fire contributes about 3% of annual GHG emissions reportable to the Kyoto Protocol. In order to reduce GHG emissions from savanna burning, the Australian government has developed and approved a Kyoto compliant savanna controlled burning methodology—the first legal instrument of this kind at a global level—under its Emission Reduction Fund. However, this approved methodology is currently only applicable to nine vegetation fuel types across northern parts of Australia in areas which receive on average over 600 mm rainfall annually, covering only 15.4% of the total land area in Australia.Savanna ecosystems extend across a large proportion of mainland Australia. This paper provides a critical review often key factors that need to be considered in developing a savanna burning methodology applicable to the other parts of Australia. It will also inform discussion in other countries intent on developing similar emissions reduction strategies

Biological and geophysical feedbacks with fire in the Earth system

Roughly 3% of the Earth’s land surface burns annually, representing a critical exchange of energy and matter between the land and atmosphere via combustion. Fires range from slow smouldering peat fires, to low-intensity surface fires, to intense crown fires, depending on vegetation structure, fuel moisture, prevailing climate, and weather conditions. While the links between biogeochemistry, climate and fire are widely studied within Earth system science, these relationships are also mediated by fuels—namely plants and their litter—that are the product of evolutionary and ecological processes. Fire is a powerful selective force and, over their evolutionary history, plants have evolved traits that both tolerate and promote fire numerous times and across diverse clades. Here we outline a conceptual framework of how plant traits determine the flammability of ecosystems and interact with climate and weather to influence fire regimes. We explore how these evolutionary and ecological processes scale to impact biogeochemical and Earth system processes. Finally, we outline several research challenges that, when resolved, will improve our understanding of the role of plant evolution in mediating the fire feedbacks driving Earth system processes. Understanding current patterns of fire and vegetation, as well as patterns of fire over geological time, requires research that incorporates evolutionary biology, ecology, biogeography, and the biogeosciences

How contemporary bioclimatic and human controls change global fire regimes

Anthropogenically driven declines in tropical savannah burnt area have recently received attention due to their effect on trends in global burnt area. Large-scale trends in ecosystems where vegetation has adapted to infrequent fire, especially in cooler and wetter forested areas, are less well understood. Here, small changes in fire regimes can have a substantial impact on local biogeochemistry. To investigate trends in fire across a wide range of ecosystems, we used Bayesian inference to quantify four primary controls on burnt area: fuel continuity, fuel moisture, ignitions and anthropogenic suppression. We found that fuel continuity and moisture are the dominant limiting factors of burnt area globally. Suppression is most important in cropland areas, whereas savannahs and boreal forests are most sensitive to ignitions. We quantify fire regime shifts in areas with more than one, and often counteracting, trends in these controls. Forests are of particular concern, where we show average shifts in controls of 2.3–2.6% of their potential maximum per year, mainly driven by trends in fuel continuity and moisture. This study gives added importance to understanding long-term future changes in the controls on fire and the effect of fire trends on ecosystem function