River and coast: regionality in North Kimberley rock art

The aim of this thesis is to examine regionality in the rock art of the north Kimberley, Western Australia. The region is renowned for its art of polychrome Wandjina figures, totemic ancestors and creators of the land for modern West Kimberley people. Underlying them are smaller, elegantly painted human figures. These are Bradshaw Figures or the Gwion Gwion as they are increasingly being called. The figures are decorated as if for dancing with waist mounted tassels, sashes and elaborately decorated headdresses, and an elaborate stylistic chronology has been prepared for the Kimberley art sequence. What is missing from the literature and what this thesis aims to fulfil, is knowledge of regionality and changes in the distribution of the body of art. Some the earliest art is from what I term the Early Phase and is thought to date to a time of aridity near the height of the ice age in Australia. Successive art periods may have occurred at times of changing climate as sea levels rose at the end of the ice age and the ensuing flooding of the exposed coastal plain. The sea level and the shoreline only stabilised in its present day position, and the present climate and environment settled to its current conditions, around 6500 years ago. I argue that the different styles of art and different locations selected in which to paint are related to the situation in the period of flux, when the inhabitants of the Kimberley were affected by changes, including the changes in their territory due to rising sea levels. Two geographically distinct areas were selected which would have been different at the time of painting of the earlier art, one being a river and the other, the coast, as at the time of painting the elegant figures, with retreating shorelines, it would have been inland. My research shows that the painters of Middle Phase art oscillated between permanent water and more transient sources, an effect influenced by their experience of ancient changes in climate

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients