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Aim: To examine the associations between visceral adipose tissue (VAT) and brain structural measures at midlife and explore how these associations may be affected by age, sex and cardiometabolic factors. Methods: We used abdominal and brain magnetic resonance imaging data from a population‐based cohort of people at midlife in the UK Biobank. Regression modelling was applied to study associations of VAT volume with total brain volume (TBV), grey matter volume (GMV), white matter volume, white matter hyperintensity volume (WMHV) and total hippocampal volume (THV), and whether these associations were altered by age, sex or cardiometabolic factors. Results: Complete data were available for 17 377 participants (mean age 63 years, standard deviation = 12, 53% female). Greater VAT was associated with lower TBV, GMV and THV (P <.001). We found an interaction between VAT and sex on TBV (P <.001), such that the negative association of VAT with TBV was greater in men (β = −2.89, 95% confidence interval [CI] −2.32 to −10.15) than in women (β = −1.32, 95% CI −0.49 to −3.14), with similar findings for GMV. We also found an interaction between VAT and age (but not sex) on WMHV (P <.001). The addition of other cardiometabolic factors or measures of physical activity resulted in little change to the models. Conclusions: VAT volume is associated with poorer brain health in midlife and this relationship is greatest in men and those at younger ages. [ABSTRACT FROM AUTHOR]

Purpose: To appraise the measurement properties of generic patient-reported outcome measures (PROMs) measuring postoperative quality of life in adults undergoing elective abdominal surgery. Methods: We conducted a systematic review of PROMs administered after elective abdominal surgery. We systematically searched Ovid MEDLINE, Embase, the Cumulative Index to Nursing & Allied Health Literature database, and the Cochrane Library from earliest available dates to July 24, 2021, using relevant search terms. Articles were included if they reported assessment of measurement properties of a generic PROM/s measuring postoperative quality of life in adults who had undergone elective abdominal surgery. We used the Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN) Risk of Bias checklist to assess methodological quality. We synthesized the data and used the COSMIN criteria for good measurement properties and the Grading of Recommendations, Assessment, Development and Evaluations criteria to rate the certainty of evidence. Results: Of 12,121 identified articles, nine articles assessing five PROMs (SF-6D, EQ-5D, SF-36, SF-12, PROMIS-10) met inclusion criteria. Measurement properties assessed included internal consistency (n = 2), construct validity (n = 5), and responsiveness (n = 8). Two PROMs had high quality evidence for a single measurement property each. The SF-6D demonstrated high quality evidence for responsiveness and the EQ-5D had high quality evidence for construct validity. Conclusion: There is insufficient evidence to support the choice of a specific generic PROM to evaluate quality of life following elective abdominal surgery. Clinicians and researchers should be aware of the current limitations in knowledge of the measurement properties of available PROMs. [ABSTRACT FROM AUTHOR]

Sharing in embryology and function between the eye and brain has led to interest in whether assessments of the eye reflect brain changes seen in neurodegeneration. We aimed to examine the associations between measures of retinal layer thickness using optical coherence tomography (OCT) and multimodal measures of brain structure and function. Using a convenient sample of twins discordant for type 2 diabetes, we performed cognitive testing, structural brain MRI (tissue volumetry), diffusion tensor imaging (white matter microstructure), and arterial spin labelling (cerebral blood flow). OCT images were recorded and retinal thickness maps generated. We used mixed level modelling to examine the relationship between retinal layer thicknesses and brain measures. We enrolled 35 people (18 pairs, mean age 63.8 years, 63% female). Ganglion cell layer thickness was positively associated with memory, speed, gray matter volume, and altered mean diffusivity. Ganglion cell layer thickness was strongly positively associated with regional cerebral blood flow. We found only a limited number of associations between other retinal layer thickness and measures of brain structure or function. Ganglion cell layer thickness showed consistent associations with a range of brain measures suggesting it may have utility as a marker for future dementia risk. [ABSTRACT FROM AUTHOR]

Sharing in embryology and function between the eye and brain has led to interest in whether assessments of the eye reflect brain changes seen in neurodegeneration. We aimed to examine the associations between measures of retinal layer thickness using optical coherence tomography (OCT) and multimodal measures of brain structure and function. Using a convenient sample of twins discordant for type 2 diabetes, we performed cognitive testing, structural brain MRI (tissue volumetry), diffusion tensor imaging (white matter microstructure), and arterial spin labelling (cerebral blood flow). OCT images were recorded and retinal thickness maps generated. We used mixed level modelling to examine the relationship between retinal layer thicknesses and brain measures. We enrolled 35 people (18 pairs, mean age 63.8 years, 63% female). Ganglion cell layer thickness was positively associated with memory, speed, gray matter volume, and altered mean diffusivity. Ganglion cell layer thickness was strongly positively associated with regional cerebral blood flow. We found only a limited number of associations between other retinal layer thickness and measures of brain structure or function. Ganglion cell layer thickness showed consistent associations with a range of brain measures suggesting it may have utility as a marker for future dementia risk. [ABSTRACT FROM AUTHOR]

The predictive ability and efficiency of inpatient harm screening tools is unclear. We performed a retrospective analysis of approximately 25 000 people admitted to our hospital in 2019. We found that the discriminatory ability of the harm screening tools was at best moderate and could be attributed to one or two questions that overlapped with each other in the harm they predicted. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes (T2D) is associated with an increased risk of cognitive impairment and dementia with poorly understood underlying mechanisms.Objective: We examined the role of blood pressure (BP), aortic stiffness, and hemodynamics in this association.Methods: Cross-sectional sample of late middle-aged twins discordant for T2D from the Australian Twin Registry. Measurements included neuropsychological battery and brain MRI including arterial spin labelling (ASL) to measure cerebral perfusion. Mobil-o-Graph devices were used to non-invasively obtain 24-hour BP, aortic stiffness, and hemodynamic measures. Using mixed modelling, we studied associations of T2D with cognition, MRI measures, BP, aortic stiffness, and hemodynamics.Results: There were 23 twin pairs with mean age 63.7 (SD = 6.1) years. T2D (β=-0.45, p < 0.001) and age (β=-0.05, p = 0.022) were independently associated with poorer attention but not with memory or perceptual speed. T2D was associated with reduced nocturnal central systolic BP dipping (β=-3.79, p = 0.027), but not with BP, aortic stiffness, cerebral perfusion, or other hemodynamic measures. There was a statistically significant interaction between T2D and central systolic BP dipping in predicting attention scores (both p < 0.05 for the interaction term) whereby there was a positive association between BP dipping and attention scores in those with T2D, but not in those without T2D.Conclusion: We found an association between T2D and reduced nocturnal central systolic dipping, but not with any other measures of BP, stiffness or hemodynamic measures. Further study of the role of nocturnal central BP dipping in the association between T2D and cognitive impairment may help identify potential mechanisms. [ABSTRACT FROM AUTHOR]

Background: Hypertension is an established risk factor for dementia. However, it is unclear whether there are differential effects of angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blockers (ARB) on brain health. In human observational studies, the evidence for superiority of either agent remains unclear.Objective: To compare brain atrophy and cognitive decline between people treated with ACEi or ARB.Methods: Participants aged 55-90 years without dementia had brain magnetic resonance imaging and neuropsychological assessments performed at 3 time points. The sample was enriched with people with type 2 diabetes (T2D). Multivariable mixed models were used to examine longitudinal associations of antihypertensive medication class with change in cognition and total brain volume.Results: Of 565 people with longitudinal data, there were 163 on ACEi (mean age 69.9 years, T2D:64% with) and 125 on ARB (mean age 69.6 years, T2D:62%) at baseline. The baseline characteristics of those taking either an ACEi or ARB were similar with regards to age, sex, blood pressure control, and vascular risk factors. The mean duration of follow up was 3.2 years. The baseline association of ACEi and ARB use with total brain volume was similar in both groups. However, those taking an ARB had a slower rate of brain atrophy than those taking an ACEi (p = 0.031). Neither ACEi nor ARB use was associated with baseline cognitive function or cognitive decline.Conclusions: These results support the theory that ARB may be preferable to ACEi to reduce brain atrophy. The mechanisms underlying this differential association warrant further investigation. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is associated with an elevated risk of cognitive impairment and dementia. Cerebrovascular disease and neurodegeneration are two major pathways that may explain the effect of diabetes on the brain and therefore deserve investigation. Neuroimaging provides an effective way to investigate the contribution of these pathways in vivo, guiding further mechanistic research and providing biomarkers for clinical correlation or interventional studies. In this paper, we present a narrative review of the state of play with neuroimaging evidence in studies of people with diabetes mellitus, how these data are useful in understanding mechanistic links between diabetes and brain impairment, and possible ways that the field may develop in the future. [ABSTRACT FROM AUTHOR]

Aim: Type 2 diabetes mellitus (T2D) is associated with gray matter atrophy. Adiposity and physical inactivity are risk factors for T2D and brain atrophy. We studied whether the associations of T2D with total gray matter volume (GMV) and hippocampal volume (HV) are dependent on obesity and physical activity. Materials and Methods: In this cross-sectional study, we measured waist-hip ratio (WHR), body mass index (BMI), mean steps/day and brain volumes in a community dwelling cohort of people with and without T2D. Using multivariable linear regression, we examined whether WHR, BMI and physical activity mediated or modified the association between T2D, GMV and HV. Results: There were 258 participants with (mean age 67±7 years) and 302 without (mean age 72±7 years) T2D. Adjusting for age, sex and intracranial volume, T2D was independently associated with lower total GMV (p = 0.001) and HV (p<0.001), greater WHR (p<0.001) and BMI (p<0.001), and lower mean steps/day (p = 0.002). After adjusting for covariates, the inclusion of BMI and mean steps/day did not significantly affect the T2D-GMV association, but WHR attenuated it by 32% while remaining independently associated with lower GMV (p<0.01). The T2D-HV association was minimally changed by the addition of BMI, steps/day or WHR in the model. No statistical interactions were observed between T2D and measures of obesity and physical activity in explaining brain volumes. Conclusions: Abdominal obesity or its downstream effects may partially mediate the adverse effect of T2D on brain atrophy. This requires confirmation in longitudinal studies. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (T2DM) is associated with brain atrophy, but the mechanisms underlying this link are unknown. Advanced glycation end products (AGEs) accumulate in T2DM, resulting in inflammation, oxidative stress, and protein cross-linking, which are known contributors to neurodegeneration. We aimed to study whether tissue AGE accumulation is associated with T2DM-related brain atrophy. We performed brain magnetic resonance imaging, cognitive tests, and noninvasive skin autofluorescence (SAF; a measure of tissue AGE levels) on people aged >55 years with and without T2DM. Multivariable linear regression was used to study the relationships among T2DM, SAF, and gray matter volume (GMV). There were 486 people included in the study. T2DM was associated with greater SAF. Greater SAF, T2DM, and cognitive impairment were each associated with lower GMV independently of age, sex, and total intracranial volume. SAF partially mediated the association between T2DM and GMV. Longitudinal studies may help confirm whether tissue AGE accumulation is associated with brain atrophy in T2DM. [ABSTRACT FROM AUTHOR]

Mining regions undergo abrupt and extensive land use change, the impacts of which pose management challenges for mining companies and regulatory agencies. In this study we investigated 20 years of land use change in Brazil's Iron Quadrangle (QF) mining region. We classified remote sensing images to produce land use maps and conducted a Land Change analysis to investigate the causes and consequences of observed changes. The QF underwent extensive land use change between 1990 and 2010, including deforestation, plantation expansion, urbanization and mine expansion. Comparing our results with those of surrounding non-mining landscapes illustrated important differences. For example, QF contained additional highly profitable land uses, including mining and plantation forestry, which were driven by globalized markets for mineral resources. This finding suggests processes of land use change within mining regions are distinct from those found elsewhere and, as such, land management policies should reflect this. We also hypothesized four generalizations regarding these processes: 1) the direct footprints of mining expands over time, 2) the offsite footprints of mining are extensive and also often expanding, 3) the direct and indirect land used by mines causes environmental and social impacts, some of which are not captured by current management approaches, and 4) the footprints of mining (and associated impacts) are driven by global factors, many of which are uncontrollable by local land holders and regional land management plans and policies. We describe and discuss these generalizations, drawing on published evidence from other mining regions to illustrate both their generality and implications for land management. [ABSTRACT FROM AUTHOR]

Chris Moran was supported by a NHMRC-ARC (Australian Research Council) Dementia Research Fellowship (application ID 1109482)." now reads: "NHMRC (National Health and Medical Research Council) project grant (application ID 1063608). This project received seed funding from a Pfizer Neuroscience Research Grant (2011) (application ID WS1931543). This project received seed funding from a Pfizer Neuroscience Research Grant (2011) (application ID WS1931543). [Extracted from the article]

Abstract: Introduction: There is a paucity of research into the outcomes and complications of cervical spine immobilisation (hard collar or halothoracic brace) in older people. Aims: To identify morbidity and mortality outcomes using geriatric medicine assessment techniques following cervical immobilisation in older people with isolated cervical spine fractures. Patients and methods: We identified participants using an injury database. We completed a questionnaire measuring pre-admission medical co-morbidities and functional independence. We recorded the surgical plan and all complications. A further questionnaire was completed three months later recording complications and functional independence. Results: Sixteen patients were recruited over a three month period. Eight were immobilised with halothoracic brace, 8 with external hard collar. Three deaths occurred during the study. Lower respiratory tract infection was the most common complication (7/16) followed by delirium (6/16). Most patients were unable to return home following the acute admission, requiring sub-acute care on discharge. The majority of patients were from home prior to a fall, 6/16 were residing there at 3 months. Most participants had an increase in their care needs at 3 months. There was no difference in the type or incidence of complications between the different modes of immobilisation. Conclusions: Geriatric medicine assessment techniques identified the morbidity and functional impairment associated with cervical spine immobilisation. This often results in a prolonged length of stay in supported care. This small pilot study recommends a larger study over a longer period using geriatric medicine assessment techniques to better define the issues. [Copyright &y& Elsevier]

Objective: Type 2 diabetes (T2DM) is associated with brain atrophy and cerebrovascular disease. We aimed to define the regional distribution of brain atrophy in T2DM and to examine whether atrophy or cerebrovascular lesions are feasible links between T2DM and cognitive function.Research Design and Methods: This cross-sectional study used magnetic resonance imaging (MRI) scans and cognitive tests in 350 participants with T2DM and 363 participants without T2DM. With voxel-based morphometry, we studied the regional distribution of atrophy in T2DM. We measured cerebrovascular lesions (infarcts, microbleeds, and white matter hyperintensity [WMH] volume) and atrophy (gray matter, white matter, and hippocampal volumes) while blinded to T2DM status. With use of multivariable regression, we examined for mediation or effect modification of the association between T2DM and cognitive measures by MRI measures.Results: T2DM was associated with more cerebral infarcts and lower total gray, white, and hippocampal volumes (all P < 0.05) but not with microbleeds or WMH. T2DM-related gray matter loss was distributed mainly in medial temporal, anterior cingulate, and medial frontal lobes, and white matter loss was distributed in frontal and temporal regions. T2DM was associated with poorer visuospatial construction, planning, visual memory, and speed (P ≤ 0.05) independent of age, sex, education, and vascular risk factors. The strength of these associations was attenuated by almost one-half when adjusted for hippocampal and total gray volumes but was unchanged by adjustment for cerebrovascular lesions or white matter volume.Conclusions: Cortical atrophy in T2DM resembles patterns seen in preclinical Alzheimer disease. Neurodegeneration rather than cerebrovascular lesions may play a key role in T2DM-related cognitive impairment. [ABSTRACT FROM AUTHOR]

OBJECTIVE--Type 2 diabetes (T2DM) is associated with brain atrophy and cerebrovascular disease. We aimed to define the regional distribution of brain atrophy in T2DM and to examine whether atrophy or cerebrovascular lesions are feasible links between T2DM and cognitive function. RESEARCH DESIGN AND METHODS--This cross-sectional study used magnetic resonance imaging (MRI) scans and cognitive tests in 350 participants with T2DM and 363 participants without T2DM. With voxel-based morphometry, we studied the regional distribution of atrophy in T2DM. We measured cerebrovascular lesions (infarcts, microbleeds, and white matter hyperinten-sity [WMH] volume) and atrophy (gray matter, white matter, and hippocampal volumes) while blinded to T2DM status. With use of multivariable regression, we examined for mediation or effect modification of the association between T2DM and cognitive measures by MRI measures. RESULTS--T2DM was associated with more cerebral infarcts and lower total gray, white, and hippocampal volumes (all P< 0.05) but not with microbleeds or WMH. T2DM-related gray matter loss was distributed mainly in medial temporal, anterior cingulate, and medial frontal lobes, and white matter loss was distributed in frontal and temporal regions. T2DM was associated with poorer visuospatial construction, planning, visual memory, and speed (P≤0.05) independent of age, sex, education, and vascular risk factors. The strength of these associations was attenuated by almost one-half when adjusted for hippocampal and total gray volumes but was unchanged by adjustment for cerebrovascular lesions or white matter volume. CONCLUSIONS--Cortical atrophy in T2DM resembles patterns seen in preclinical Alzheimer disease. Neurodegeneration rather than cerebrovascular lesions may play a key role in T2DM-related cognitive impairment. [ABSTRACT FROM AUTHOR]

The minerals industry is being driven to access multiple water sources and increase water reuse to minimize freshwater withdrawal. Bacteria-laden water, such as treated effluent, has been increasingly used as an alternative to freshwater for mineral processing, in particular flotation, where conditions are favorable for bacterial growth. However, the risk posed by bacteria to flotation efficiency is poorly understood. This could be a barrier to the ongoing use of this water source. This study tested the potential of a previously published risk-based approach as a management tool to both assist mine sites in quantifying the risk from bacteria, and finding system-wide cost-effective solutions for risk mitigation. The result shows that the solution of adjusting the flotation chemical regime could only partly control the risk. The second solution of using tailings as an absorbent was shown to be effective in the laboratory in reducing bacterial concentration and thus removing the threat to flotation recovery. The best solution is likely to combine internal and external approaches, that is, inside and outside processing plants. Findings in this study contribute possible methods applicable to managing the risk from water-borne bacteria to plant operations that choose to use bacteria-containing water, when attempting to minimize freshwater use, and avoiding the undesirable consequences of increasing its use. [ABSTRACT FROM AUTHOR]

This review provides a qualitative and quantitative analysis of cerebral glucose metabolism in ageing. We undertook a systematic literature review followed by pooled effect size and activation likelihood estimates (ALE) meta‐analyses. Studies were retrieved from PubMed following the PRISMA guidelines. After reviewing 635 records, 21 studies with 22 independent samples (n = 911 participants) were included in the pooled effect size analyses. Eight studies with eleven separate samples (n = 713 participants) were included in the ALE analyses. Pooled effect sizes showed significantly lower cerebral metabolic rates of glucose for older versus younger adults for the whole brain, as well as for the frontal, temporal, parietal, and occipital lobes. Among the sub‐cortical structures, the caudate showed a lower metabolic rate among older adults. In sub‐group analyses controlling for changes in brain volume or partial volume effects, the lower glucose metabolism among older adults in the frontal lobe remained significant, whereas confidence intervals crossed zero for the other lobes and structures. The ALE identified nine clusters of lower glucose metabolism among older adults, ranging from 200 to 2640 mm3. The two largest clusters were in the left and right inferior frontal and superior temporal gyri and the insula. Clusters were also found in the inferior temporal junction, the anterior cingulate and caudate. Taken together, the results are consistent with research showing less efficient glucose metabolism in the ageing brain. The findings are discussed in the context of theories of cognitive ageing and are compared to those found in neurodegenerative disease. [ABSTRACT FROM AUTHOR]

The literature on large‐scale resting‐state functional brain networks across the adult lifespan was systematically reviewed. Studies published between 1986 and July 2021 were retrieved from PubMed. After reviewing 2938 records, 144 studies were included. Results on 11 network measures were summarized and assessed for certainty of the evidence using a modified GRADE method. The evidence provides high certainty that older adults display reduced within‐network and increased between‐network functional connectivity. Older adults also show lower segregation, modularity, efficiency and hub function, and decreased lateralization and a posterior to anterior shift at rest. Higher‐order functional networks reliably showed age differences, whereas primary sensory and motor networks showed more variable results. The inflection point for network changes is often the third or fourth decade of life. Age effects were found with moderate certainty for within‐ and between‐network altered patterns and speed of dynamic connectivity. Research on within‐subject bold variability and connectivity using glucose uptake provides low certainty of age differences but warrants further study. Taken together, these age‐related changes may contribute to the cognitive decline often seen in older adults. Although the literature on large‐scale, resting state functional networks in aging has been reviewed previously, we offer the first systematic qualitative and quantitative synthesis of the evidence. The novel synthesis stems from the adoption of PRISMA method and the breadth of network measures reviewed. The review offers a contemporary summary of the strength of the evidence, theoretical implications, and recommendations for further research. [ABSTRACT FROM AUTHOR]

Cerebral small vessel disease is difficult to directly visualize in vivo. Therefore, we rely on radiological phenotypes as surrogate markers of disease. The principal phenotypes of clinical interest are small, deep brain infarcts, cerebral white matter lesions, deep brain haemorrhages, and cerebral microbleeds. The causes or mechanisms underlying these phenotypes are understood in varying degrees of detail. This review aims to summarize recent knowledge regarding these phenotypes and place it in context with classical clinicopathological observations to provide mechanistic, clinical, and therapeutic insights into small vessel disease. [ABSTRACT FROM AUTHOR]

The potential environmental threats posed by freshwater withdrawal and mine water discharge are some of the main drivers for the mining industry to improve water management. The use of multiple sources of water supply and introducing water reuse into the mine site water system have been part of the operating philosophies employed by the mining industry to realize these improvements. However, a barrier to implementation of such good water management practices is concomitant water quality variation and the resulting impacts on the efficiency of mineral separation processes, and an increased environmental consequence of noncompliant discharge events. There is an increasing appreciation that conservative water management practices, production efficiency, and environmental consequences are intimately linked through the site water system. It is therefore essential to consider water management decisions and their impacts as an integrated system as opposed to dealing with each impact separately. This paper proposes an approach that could assist mine sites to manage water quality issues in a systematic manner at the system level. This approach can quantitatively forecast the risk related with water quality and evaluate the effectiveness of management strategies in mitigating the risk by quantifying implications for production and hence economic viability. [ABSTRACT FROM AUTHOR]

Abstract: Concerns about the difficulties in securing water have led the Australian coal mining industry to seek innovative ways to improve its water management and to adopt novel strategies that will lead to less water being used and more water being reused. Simulation tools are essential to assess current water management performance and to predict the efficiency of potential strategies. As water systems on coal mines are complex and consist of various inter-connected elements, a systems approach was selected, which views mine site water management as a system that obtains water from various sources (surface, groundwater), provides sufficient water of suitable quality to the mining tasks (coal beneficiation, dust suppression, underground operations) and maintains environmental performance. In this paper, the model is described and its calibration is illustrated. The results of applying the model for the comparison of the water balances of 7 coal mines in the northern Bowen Basin (Queensland, Australia) are presented. The model is used to assess the impact of applying specific water management strategies. Results show that a simple systems model is an appropriate tool for assessing site performance, for providing guidance to improve performance through strategic planning, and for guiding adoption of site objectives. [Copyright &y& Elsevier]

In many parts of the world, mine production and expansion are increasingly limited by access to water. One solution is to consider a water market that would allow trading of mine site water (worked water) from wetter mines to drier mines. However, there is currently no policy support for such a market and it is likely that without government support via incentives, mines will continue to favour freshwater use because it is relatively inexpensive. Furthermore, mines have a high capacity to pay for the water they use, and freshwater creates few risks for production. The opportunity provided by water savings within a trading scheme could be viewed as a source of money to provide incentives for the transfer of worked water between mines. In this paper, we present a new method to trade water among mines based on a site water balance assessment utilising historical climate data, and apply this method to a demonstration region containing multiple coal mines. On average, 340 ML could be transferred per year to drier mines but there remains 11,440 ML per year of water demand unable to be met by trading. The direct monetary value of the worked water that could be transferred, derived from additional coal mining, would be significant. Irrigation may be an attractive option if available infrastructure can be used to trade the saved fresh water in existing markets, thereby providing indirect monetary value (i.e. external to coal production). Alternative uses of water savings may have considerable additional non-monetary value that directly affects the mining industry’s social license-to-operate and its security of long term water supply. [ABSTRACT FROM AUTHOR]

Unprecedented expansion of coal mining in Australia is occurring within the context of a severe ongoing drought. This has induced more companies to adopt improved water management strategies, such as water reuse. A direct consequence of this is an increase in the salt concentration of the water, which affects in turn the efficiency of the coal preparation processes, the quality of the coal product, and the level of required equipment maintenance. There are three strategies that can be adopted with respect to salt management: accept the elevated salt concentrations and increase spending on equipment maintenance; remove the salt by desalination; and dilute the salt by importing more water. A tool is required to predict the salt concentrations arising from water reuse and to simulate the impact of potential management strategies. This paper presents a systems approach to the modelling of coupled mine site water and salt balances to assist with understanding the implications of implementing desalination or dilution and with assessing the costs and benefits of each option. [ABSTRACT FROM AUTHOR]

Abstract: This article reports on five years of Internet domain name dispute resolution activity within the World Intellectual Property Organisation''s Uniform Dispute Resolution Policy. The analysis incorporates findings from WIPO''s publication of an informal “Overview” if the panellists themselves prepared the scheme. [Copyright &y& Elsevier]

Abstract: The three extant peccary species, the Chacoan (Catagonus wagneri), the White-lipped (Tayassu pecari) and the Collared (Pecari tajacu), are morphologically and chromosomally distinct and confined to the New World. There is ongoing paleontological, cytogenetic, and molecular debate about phylogenetic relationships among them. To contribute to the understanding of Tayassuidae phylogeny, three mitochondrial (control region, cytochrome b, and 12S rRNA) and five nuclear (K-casein, thyrotropin, tyrosinase, and swine short interspersed nuclear elements PRE-1 P27 and P642) peccary DNA fragments were amplified, cloned and sequenced from Chacoan, White-lipped, and Collared peccaries. Phylogenetic analyses were performed using maximum likelihood and neighbor joining methods. K-casein, thyrotropin, and tyrosinase sequences did not resolve the phylogeny, while control region, cytochrome b, 12S rRNA, and PRE-1 P27 and P642 sequences were more informative in deciphering phylogenetic relationships. When pig and warthog were used as an outgroup, Chacoan and White-lipped peccaries clustered distinct from Collared peccaries. Furthermore, control region and cytochrome b sequence variation within Collared peccaries was as extreme as that between White-lipped and Chacoan peccaries, supporting subspecific and possibly even specific variation within the widely distributed Collared peccary. This study supports the existence of two independent genera within the Tayassuidae family consisting of Collared and Chacoan/White-lipped peccaries, in contrast with classical morphological taxonomy which clusters White-lipped and Collared peccaries in the genus Tayassu or which alternatively clusters the Collared peccary in the genus Dicotyles as a related sister clade of the Chacoan peccary (genus Catagonus). [Copyright &y& Elsevier]

A fibre optic sensor capable of the distributed detection of multiple hydrocarbon fuel and solvent spills is described. The sensor incorporates liquid-swelling polymers that convert the swelling into a microbend force on an optical fibre when activated. Sensor interrogation is conducted using a standard optical time domain reflectometry (OTDR) technique. This provides the potential of locating target hydrocarbon fuel and solvent spills at many separate positions along the sensor length. Typical sensor response time after exposure to the fuel is 30 s using the current design. Sensors that are capable of locating 1 m long spill events with a location accuracy of 2.5 m over a range of 2 km are reported. A brief description of the underlying technology and the material evaluation tests are presented followed by initial sensor evaluation results. Laboratory and experimental field trials demonstrating repeatability and the simultaneous location of multiple fuel spills are summarised. Automatic detection of events using a custom-built OTDR instrument is briefly discussed and finally the potential applications for this type of sensor technology are outlined. [Copyright &y& Elsevier]

Background Inpatient delirium is common and associated with poor outcomes. Although most organisations have evidence-based guidelines to improve delirium prevention and management, delirium rates and outcomes have remained relatively unchanged over time. A lack of understanding of healthcare providers' experience of caring for people with delirium and its integration into existing guidance may explain some of the slow progress in improving delirium care. Objective To review and synthesise existing qualitative evidence on healthcare providers' experience of caring for inpatients with delirium within and across disciplines. Methods We systematically searched OVID Medline, CINAHL, Embase, Emcare, PsychINFO, AMED and Web of Science databases for articles published between January 1990 and November 2022. Article inclusion and study quality were assessed by two independent reviewers. Both thematic synthesis and content analysis were then conducted to synthesise findings from included studies. Results Within the 25 included studies, the experience of nurses was the most commonly studied perspective, followed by medical and allied health. Nursing, medical and allied health staff all reported that their experience of caring for people with delirium was challenging, highlighting difficulties in delirium recognition and that they felt unsupported at organisational and local levels. Attitudes towards older people and the importance of delirium influenced identification and prioritisation. Conclusions Healthcare providers often find caring for hospitalised patients with delirium challenging and complex. Although good communication within multidisciplinary teams was deemed helpful, more work is required to understand how to achieve this, recognising the unique perspectives of individual disciplines. [ABSTRACT FROM AUTHOR]

Rising rates of insulin resistance and an ageing population are set to exact an increasing toll on individuals and society. Here we examine the contribution of age and insulin resistance to the association of cerebral blood flow and glucose metabolism; both critical process in the supply of energy for the brain. Thirty-four younger (20–42 years) and 41 older (66–86 years) healthy adults underwent a simultaneous resting state MR/PET scan, including arterial spin labelling. Rates of cerebral blood flow and glucose metabolism were derived using a functional atlas of 100 brain regions. Older adults had lower cerebral blood flow than younger adults in 95 regions, reducing to 36 regions after controlling for cortical atrophy and blood pressure. Lower cerebral blood flow was also associated with worse working memory and slower reaction time in tasks requiring cognitive flexibility and response inhibition. Younger and older insulin sensitive adults showed small, negative correlations between relatively high rates of regional cerebral blood flow and glucose metabolism. This pattern was inverted in insulin resistant older adults, who showed hypoperfusion and hypometabolism across the cortex, and a positive correlation. In insulin resistant younger adults, the association showed inversion to positive correlations, although not to the extent seen in older adults. Our findings suggest that the normal course of ageing and insulin resistance alter the rates of and associations between cerebral blood flow and glucose metabolism. They underscore the criticality of insulin sensitivity to brain health across the adult lifespan. [ABSTRACT FROM AUTHOR]

Low fitness and obesity at midlife are individually associated with later‐life decline in cognition and health. However, the relationship between profiles of midlife fitness and obesity with midlife cognition is unclear and was examined by this study. Participants from the third follow‐up of the Childhood Determinants of Adult Health study (2014–2019; aged 36–49 years) were assessed for obesity (body mass index [BMI]), cardiorespiratory (physical work capacity) and muscular fitness (isometric grip and leg strength), and these factors were entered into a latent profile analysis. Psychomotor‐attention, learning–working memory and global cognition composites were derived from z‐scores of individual CogState battery tests. Linear regression analyses examined associations between profiles of fitness and obesity with cognition, adjusting for age, sex, education, alcohol and smoking. Using data from 617 participants [44.4 ± 2.6 (mean ± SD) years, 52% female], we identified 5 mutually exclusive profiles of obesity and fitness. Relative to those with the lowest fitness and highest BMI (5% of sample), those with a profile of (1) highest muscular fitness and average BMI (9%), (2) average muscular fitness and BMI (61%) and (3) highest cardiorespiratory fitness (CRF) and below average BMI (7%) all exhibited better global cognition [at least 0.44 (0.12, 0.77) SD, 95% CI] and psychomotor‐attention performance [at least 0.59 (0.27, 0.91) SD, 95% CI]. Compared with low fitness and unhealthy BMI levels, possessing average or high muscular and CRF and a healthy BMI in midlife was associated with better cognitive performance. Enhancing fitness and reducing obesity in midlife could contribute to improved cognitive performance in middle age. Highlights: Profiles containing adults with a combination of low levels of cardiorespiratory and muscular fitness and higher levels of obesity were associated with lower psychomotor‐attention and global cognition at midlife.Possessing average or higher levels of fitness, and lower obesity at midlife, was associated with better cognitive performance at midlife compared to those with lower fitness and unhealthy BMIs.Maintaining fitness and reducing obesity at midlife may contribute to greater cognitive performance at midlife and beyond and reduce the risk of cognitive decline. [ABSTRACT FROM AUTHOR]

Background: The international scale and spread of evidence-based perioperative medicine for older people undergoing surgery (POPS) services has not yet been fully realised. Implementation science provides a structured approach to understanding factors that act as barriers and facilitators to the implementation of POPS services. In this study, we aimed to identify factors that influence the implementation of POPS services in the UK. Methods: A qualitative case study at three UK health services was undertaken. The health services differed across contextual factors (population, workforce, size) and stages of POPS service implementation maturity. Semi-structured interviews with purposively sampled clinicians (perioperative medical, nursing, allied health, and pharmacy) and managers (n = 56) were conducted. Data were inductively coded, then thematically analysed using the Consolidated Framework for Implementation Research (CFIR). Results: Fourteen factors across all five CFIR domains were relevant to the implementation of POPS services. Key shared facilitators included stakeholders understanding the rationale of the POPS service, with support from their networks, POPS champions, and POPS clinical leads. We found substantial variation and flexibility in the way that health services responded to these shared facilitators and this was relevant to the implementation of POPS services. Conclusions: Health services planning to implement a POPS service should use health service-specific strategies to respond flexibly to local factors that are acting as barriers or facilitators to implementation. To support implementation of a POPS service, we recommend health services prioritise understanding local networks, identifying POPS champions, and ensuring that stakeholders understand the rationale for the POPS service. Our study also provides a structure for future research to understand the factors associated with 'unsuccessful' implementation of a POPS service, which can inform ongoing efforts to implement evidence-based perioperative models of care for older people. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes (T2D) is associated with an increased risk of dementia and early features may become evident even in mid-life. Characterizing these early features comprehensively requires multiple measurement modalities and careful selection of participants with and without T2D. Objective: We conducted a cross-sectional multimodal imaging study of T2D-discordant twins in late mid-life to provide insights into underlying mechanisms. Methods: Measurements included computerized cognitive battery, brain MRI (including arterial spin labelling, diffusion tensor, resting state functional), fluorodeoxyglucose (FDG)-PET, and retinal optical coherence tomography. Results: There were 23 pairs, mean age 63.7 (±6.1) years. In global analyses, T2D was associated with poorer attention (β= –0.45, p <0.001) and with reduced FDG uptake (β= –5.04, p = 0.02), but not with cortical thickness (p = 0.71), total brain volume (p = 0.51), fractional anisotropy (p = 0.15), mean diffusivity (p = 0.34), or resting state activity (p = 0.4). Higher FDG uptake was associated with better attention (β= 3.19, p = 0.01) but not with other cognitive domains. In regional analyses, T2D was associated with lower accumbens volume (β= –44, p = 0.0004) which was in turn associated with poorer attention. Conclusion: T2D-related brain dysfunction in mid-life manifests as attentional loss accompanied by evidence of subtle neurodegeneration and global reduction in cerebral metabolism, in the absence of overt cerebrovascular disease. [ABSTRACT FROM AUTHOR]

Key Points: Question: Does the addition of resuscitative endovascular balloon occlusion of the aorta (REBOA) to standard care reduce mortality in trauma patients with exsanguinating hemorrhage? Findings: In this bayesian randomized clinical trial that included 89 patients at 90 days, all-cause mortality was 54% in the REBOA and standard care group vs 42% in the standard care alone group (odds ratio, 1.58; posterior probability of increased odds of death with REBOA, 86.9%). Meaning: In trauma patients with exsanguinating hemorrhage, a strategy of REBOA and standard care in the emergency department does not reduce, and may increase mortality compared with standard care alone. Importance: Bleeding is the most common cause of preventable death after trauma. Objective: To determine the effectiveness of resuscitative endovascular balloon occlusion of the aorta (REBOA) when used in the emergency department along with standard care vs standard care alone on mortality in trauma patients with exsanguinating hemorrhage. Design, Setting, and Participants: Pragmatic, bayesian, randomized clinical trial conducted at 16 major trauma centers in the UK. Patients aged 16 years or older with exsanguinating hemorrhage were enrolled between October 2017 and March 2022 and followed up for 90 days. Intervention: Patients were randomly assigned (1:1 allocation) to a strategy that included REBOA and standard care (n = 46) or standard care alone (n = 44). Main Outcomes and Measures: The primary outcome was all-cause mortality at 90 days. Ten secondary outcomes included mortality at 6 months, while in the hospital, and within 24 hours, 6 hours, or 3 hours; the need for definitive hemorrhage control procedures; time to commencement of definitive hemorrhage control procedures; complications; length of stay; blood product use; and cause of death. Results: Of the 90 patients (median age, 41 years [IQR, 31-59 years]; 62 [69%] were male; and the median Injury Severity Score was 41 [IQR, 29-50]) randomized, 89 were included in the primary outcome analysis because 1 patient in the standard care alone group declined to provide consent for continued participation and data collection 4 days after enrollment. At 90 days, 25 of 46 patients (54%) had experienced all-cause mortality in the REBOA and standard care group vs 18 of 43 patients (42%) in the standard care alone group (odds ratio [OR], 1.58 [95% credible interval, 0.72-3.52]; posterior probability of an OR >1 [indicating increased odds of death with REBOA], 86.9%). Among the 10 secondary outcomes, the ORs for mortality and the posterior probabilities of an OR greater than 1 for 6-month, in-hospital, and 24-, 6-, or 3-hour mortality were all increased in the REBOA and standard care group, and the ORs were increased with earlier mortality end points. There were more deaths due to bleeding in the REBOA and standard care group (8 of 25 patients [32%]) than in standard care alone group (3 of 18 patients [17%]), and most occurred within 24 hours. Conclusions and Relevance: In trauma patients with exsanguinating hemorrhage, a strategy of REBOA and standard care in the emergency department does not reduce, and may increase, mortality compared with standard care alone. Trial Registration: isrctn.org Identifier: ISRCTN16184981 This randomized clinical trial compares the effectiveness of resuscitative endovascular balloon occlusion of the aorta and standard care in the emergency department vs standard care alone on mortality in trauma patients with exsanguinating hemorrhage. [ABSTRACT FROM AUTHOR]

Abstract: The supply of minerals and energy is critical to the maintenance and growth of human and environmental wellbeing. However, the necessarily disruptive processes can create collateral negative impacts that result in trade-offs with the benefits of supply. Individual companies that undertake these activities have taken steps to minimise any negative impacts and legacies. Similarly, companies have joined in various associations to coordinate the development of policies and the principles that underpin them. The International Council on Mining and Metals is the most globally-prominent industry association. This special volume will explore the changes in light of Rio20+ against the backdrop of the potential for change as articulated by ICMM and other organisations. Publications and guidelines on many topics have been published, e.g., human rights, mine closure, social development, operating in a carbon constrained world, resource endowment etc. The special volume will analyse the achievements that the mining sector has made, take a critical look at areas where progress has been less than what might have been hoped, identify barriers to progress and highlight opportunities for future progress. Papers are invited on all aspects of operating sustainably and how this relates to sustainable development at regional and national levels. [Copyright &y& Elsevier]

Background: Many hospitals use predictive scores to identify a person's risk of inpatient falls, pressure injury and malnutrition despite evidence of limited predictive accuracy. Aim: To examine whether we could improve predictive accuracy by generating a score combining all components of currently used tools. Methods: We performed a retrospective, cross‐validation study in a single sub‐acute (geriatrics and rehabilitation) hospital, extracting data regarding hospital risk scores, and incidence of falls, pressure injury and malnutrition from January 2014 to June 2016. The sample was randomly halved into training and testing data sets. For each harm outcome, model fit was examined using area under receiver operating characteristic curves (AUC) and proportions of people reclassified based on a combined score were calculated. Secondary analyses explored the predictive performance of individual question‐responses. Results: Data were available for 4487 admissions (median age 83.0 years). A total of 667 (15%) people had at least one fall, 499 (11%) had at least one pressure injury and 20 (0.4%) malnutrition. The currently used tools had, at best, moderate ability to predict risk of harm outcomes (AUC 0.56–0.73). Testing of the combined score models resulted in minimal change in AUC (<5.1%) and did not add value to risk category reclassification. Most of the predictive ability of the currently used tools relied on the performance of two individual question‐responses. Conclusion: Combining scores or reducing to two‐item question‐responses did little to change predictive accuracy. This study highlights the limitations of hospital harm predictive scores and emphasises the importance of rigorous testing of predictive scores. [ABSTRACT FROM AUTHOR]

Background: Efforts to minimize medication risks among older adults include avoidance of potentially inappropriate medications (PIMs). However, most PIMs research has focused on older people in aged or inpatient care, creating an evidence gap for community‐dwelling older adults. To address this gap, we investigated the impact of PIMs use in the ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial cohort. Methods: Analysis included 19,114 community‐dwelling ASPREE participants aged 70+ years (65+ if US minorities) without major cardiovascular disease, cognitive impairment, or significant physical disability. PIMs were defined according to a modified 2019 AGS Beers Criteria. Cox proportional‐hazards regression models were used to estimate the association between baseline PIMs exposure and disability‐free survival, death, incident dementia, disability, and hospitalization, with adjustment for sex, age, country, years of education, frailty, average gait speed, and comorbidities. Results: At baseline, 7396 (39% of the total) participants were prescribed at least one PIM. Compared with those unexposed, participants on a PIM at baseline were at an increased risk of persistent physical disability (adjusted hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.21, 1.80) and hospitalization (adjusted HR 1.26, 95% CI 1.20, 1.32), but had similar rates of disability‐free survival (adjusted HR 1.02; 95% CI 0.93, 1.13) and death (adjusted HR 0.92, 95% CI 0.81, 1.05). These effects did not vary by polypharmacy status in interaction analyses. PIMs exposure was associated with higher risk of disability followed by hospitalization (adjusted HR 1.92, 95% CI 1.25, 2.96) as well as vice versa (adjusted HR 1.54, 95% CI 1.15, 2.05). PPIs, anti‐psychotics and benzodiazepines, were associated with increased risk of disability. Conclusions: PIMs exposure is associated with subsequent increased risk of both incident disability and hospitalization. Increased risk of disability prior to hospitalization suggests that PIMs use may start the disability cascade in healthy older adults. Our findings emphasize the importance of caution when prescribing PIMs to older adults in otherwise good health. [ABSTRACT FROM AUTHOR]

Unlike single-gene mutations leading to Mendelian conditions, common human diseases are likely to be emergent phenomena arising from multilayer, multiscale, and highly inter-connected interactions. Atrial and ventricular septal defects are the most common forms of cardiac congenital anomalies in humans. Atrial septal defects (ASD) show an open communication between the left and right atria postnatally, potentially resulting in serious hemodynamic consequences if untreated. A milder form of atrial septal defect, patent foramen ovale (PFO), exists in about one-quarter of the human population, strongly associated with ischaemic stroke and migraine. The anatomic liabilities and genetic and molecular basis of atrial septal defects remain unclear. Here, we advance our previous analysis of atrial septal variation through quantitative trait locus (QTL) mapping of an advanced intercross line (AIL) established between the inbred QSi5 and 129T2/SvEms mouse strains, that show extremes of septal phenotypes. Analysis resolved 37 unique septal QTL with high overlap between QTL for distinct septal traits and PFO as a binary trait. Whole genome sequencing of parental strains and filtering identified predicted functional variants, including in known human congenital heart disease genes. Transcriptome analysis of developing septa revealed downregulation of networks involving ribosome, nucleosome, mitochondrial, and extracellular matrix biosynthesis in the 129T2/SvEms strain, potentially reflecting an essential role for growth and cellular maturation in septal development. Analysis of variant architecture across different gene features, including enhancers and promoters, provided evidence for the involvement of non- coding as well as protein-coding variants. Our study provides the first high-resolution picture of genetic complexity and network liability underlying common congenital heart disease, with relevance to human ASD and PFO. [ABSTRACT FROM AUTHOR]

The author reflects on the new policy for the publication of obituaries in "Animal Genetics." The author mentions that a proposal was made to the Executive Committee that the Obituary Note section in the journal should be devoted with a limited and normally very small amount of space which will include the name and date of the person's death. The author states that the discussions on the policy development was added with a particular element of poignancy.

Background: To examine the effect of frailty on cognitive decline independent of cerebral small vessel disease (cSVD) and brain atrophy, and whether associations between neuropathology and cognition differed depending on frailty status.Methods: The Tasmanian Study of Cognition and Gait was a population-based longitudinal cohort study with data collected at 3 phases from 2005 to 2012. Participants aged 60-85 were randomly selected from the electoral roll. Various data were used to operationalize a 36-item frailty index (FI) at baseline. Brain MRI was undertaken to obtain baseline measures of neuropathology. A neuropsychological battery was used to assess cognition at each time point. Generalized linear mixed models were used to examine the effect of frailty and MRI measures on cognition over time. The associations between MRI measures and cognition were explored after stratifying the sample by baseline frailty status. All analyses were adjusted for age, sex, and education.Results: A total of 385 participants were included at baseline. The mean age was 72.5 years (standard deviation [SD] 7.0), 44% were female (n = 171). In fully adjusted linear mixed models, frailty (FI × time β -0.001, 95% confidence interval [CI] -0.003, -0.001, p = .03) was associated with decline in global cognition, independent of brain atrophy, and cSVD. The association between cSVD and global cognition was significant only in those with low levels of frailty (p = .03).Conclusion: These findings suggest that frailty is an important factor in early cognitive dysfunction, and measuring frailty may prove useful to help identify future risk of cognitive decline. [ABSTRACT FROM AUTHOR]

Introduction: Exeter Trauma Stems (ETS) femoral hemiarthroplasties are based on Exeter THR stems with a few design changes. Little has been published on ETS survival rates to justify their high cost compared to other cheaper implants. This is the largest prospective study to assess ETS implant failure-free survival rates in fracture neck of femur patients (NOF). This non-developing-centre study examined whether these design differences have altered implant survival (compared with Exeter THR's published survival data).Methods: Data were prospectively collected by independent audit officers. Dislocation, periprosthetic fracture, re-admission with severe hip pain, deep infection and revision surgery were considered events of interest in implant failure-free survival.Results: This study assessed 1,123 ETS stems (36 patients received bilateral ETS) in NOF patients. The mean patient age at the time of operation was 83 years (range; 49 - 102 years). The mean observation period was 2.5 years (range; 0 days - 8 years). Only 29 implants failed. All failure events were reported within the first year. Stem failure-free survival was 97.2% at eight years (CI 95.9% - 98%). Dislocation occurred in 10 patients (1%), periprosthetic femoral fracture in 4 (0.4%), and deep infection in 11 patients (1.2%). Patient survival rates were 75% and 48% at one and five years respectively.Conclusion: ETS has high implant failure-free survival rates when used in hip fractures. ETS design changes have not altered ETS survival when used in hip fractures compared with the published literature of Exeter THR stem when used as a treatment for OA. Exeter Trauma Stems in NOF patients might last these elderly patients their entire short lifetime. [ABSTRACT FROM AUTHOR]

Background: Haemorrhage is the most common cause of preventable death after injury. REBOA is a novel technique whereby a percutaneously inserted balloon is deployed in the aorta, providing a relatively quick means of temporarily controlling haemorrhage and augmenting cerebral and coronary perfusion, until definitive control of haemorrhage can be attained. The aim of the UK-REBOA trial is to establish the clinical and cost-effectiveness of a policy of standard major trauma centre treatment plus REBOA, as compared with standard major trauma centre treatment alone, for the management of uncontrolled torso haemorrhage caused by injury.Methods: Pragmatic, Bayesian, group-sequential, randomised controlled trial, performed in 16 major trauma centres in England. We aim to randomise 120 injured patients with suspected exsanguinating haemorrhage to either standard major trauma centre care plus REBOA or standard major trauma centre care alone. The primary clinical outcome is 90-day mortality. Secondary clinical outcomes include 3-h, 6-h, and 24-h mortality; in-hospital mortality; 6-month mortality; length of stay (in hospital and intensive care unit); 24-h blood product use; need for haemorrhage control procedure (operation or angioembolisation); and time to commencement of haemorrhage control procedure (REBOA, operation, or angioembolisation). The primary economic outcome is lifetime incremental cost per QALY gained, from a health and personal social services perspective.Discussion: This study, which is the first to randomly allocate patients to treatment with REBOA or standard care, will contribute high-level evidence on the clinical and cost-effectiveness of REBOA in the management of trauma patients with exsanguinating haemorrhage and will provide important data on the feasibility of implementation of REBOA into mainstream clinical practice.Trial Registration: ISRCTN16184981. [ABSTRACT FROM AUTHOR]

Background: hip fracture represents a huge medical, social and financial burden on patients, their carers and the health and social care systems. For survivors, return to their own home may be a key outcome. The Nottingham Hip Fracture Score (NHFS) is a validated score, based on admission characteristics, for predicting 30-day and 1-year mortality that may be of benefit in predicting return-to-home, directly from the acute orthopaedic ward.Objective: to assess the utility of the NHFS as a predictor of return-to-home in patients following hip fracture.Methods: the NHFS was calculated for all patients admitted from their own home and the correlation between the NHFS and eventual return-to-home was calculated, as well as the probability of discharge by within 7, 14 and 21 days.Results: a total of 6,123 patients were available for analysis. Of which, 3,699 (60%) were discharged from acute hospital to their own home. Increasing NHFS was negatively correlated with eventual return-to-home (r2 = 0.949) and with the proportion of patients discharged back to their own home at 7, 14 and 21 postoperative days, respectively (r2 = 0.84, 0.94, 0.96, respectively).Conclusions: the NHFS is a reliable tool for predicting return-to-home. It may be useful for discharge planning, and for the design of future research trials. [ABSTRACT FROM AUTHOR]

Background: Approximately 70,000 patients/year undergo surgery for repair of a fractured hip in the United Kingdom. This is associated with 30-day mortality of 9% and survivors have a considerable length of acute hospital stay postoperatively (median 26 days). Use of oesophageal Doppler monitoring to guide intra-operative fluid administration in hip fracture repair has previously been associated with a reduction in hospital stay of 4-5 days. Most hip fracture surgery is now performed under spinal anaesthesia. Oesophageal Doppler monitoring may be unreliable in the presence of spinal anaesthesia and most patients would not tolerate the probes. An alternative method of guiding fluid administration (minimally-invasive arterial pulse contour analysis) has been shown to reduce length of stay in high-risk surgical patients but has never been studied in hip fracture surgery.Methods: Single-centre randomised controlled parallel group trial. Randomisation by website using computer generated concealed tables.Setting: University hospital in UK.Participants: 128 patients with acute primary hip fracture listed for operative repair under spinal anaesthesia and aged > 65 years.Intervention: Stroke volume guided intra-operative fluid management. Continuous measurement of SV recorded by a calibrated cardiac output monitor (LiDCOplus). Maintenance fluid and 250 ml colloid boluses given to achieve sustained 10% increases in stroke volume.Control Group: fluid administration at the responsible (blinded) anaesthetist's discretion. The intervention terminates at the end of the surgical procedure and post-operative fluid management is at the responsible anaesthetist's discretion.Primary Outcome: length of acute hospital stay is determined by a blinded team of clinicians. Secondary outcomes include number of complications and total cost of care. Funding NIHR/RfPB: PB-PG-0407-13073.Trial Registration Number: Trial Registration: Current Controlled Trials ISRCTN88284896. [ABSTRACT FROM AUTHOR]

The expansion and contraction of the coal mining industry in Australia has placed pressure on regional communities and environments and multiplied the extent, magnitude and profile of cumulative impacts. While some mining communities have benefited from the expansion of the coal industry through the creation of jobs and the investment in economies, the compounding impacts of multiple mining operations have stretched environmental, social, human and economic systems and rendered conventional mine-by-mine governance approaches ineffective. In this paper we draw from examples in the Bowen Basin, Hunter Valley and Gunnedah Basin to traverse the range of cumulative impacts resulting from mining activities, and detail working examples of management and assessment practices that aim to enhance positive, and avoid and mitigate negative, cumulative impacts. [ABSTRACT FROM AUTHOR]

Background: Several studies have described equivalent performance on radiostereometric analysis at two years for metal-backed compared with all-polyethylene stemmed tibial implants. The purpose of this study was to determine the ten-year survivorship results of these two designs from a large randomized controlled trial. Methods: Patients who were fifty years old or more, with no history of infection, and were undergoing primary total knee arthroplasty were randomized at the time of surgery to receive either an all-polyethylene or a metal-backed tibial component. Patients were assessed preoperatively and at one, three, five, eight, and ten years postoperatively. All assessments included a clinical history, a physical examination, and a radiographic evaluation. A total of 510 consecutive patients (566 knees) were recruited from August 1993 to January 1997. The mean age of the patients at the time of the index arthroplasty was 69.3 years, and 299 (59%) were women. The primary diagnosis was osteoarthritis for 458 knees (80.9%) and rheumatoid arthritis for 108 knees (19.1%). Results: Two hundred and ninety-three patients returned for the ten-year follow-up evaluation. A total of twenty-eight knees had been revised. Ten-year survivorship, with revision for any reason (or the time at which patients were documented as requiring revision but were unfit for surgery) as the end point, was 94.5% (95% confidence interval, 90.4% to 96.8%) for the all-polyethylene design and 96% (95% confidence interval, 92.6% to 97.8%) for the metal-backed design. Ten-year survivorship, with aseptic failure as the end point, was 97% (95% confidence interval, 93.3% to 98.7%) for the all-polyethylene design and 96.8% (95% confidence interval, 93.6% to 98.4%) for the metal-backed design. On the basis of the numbers available at ten years, there was no significant difference in survivorship between the two designs (p> 0.05). Conclusions: The long-term results demonstrate excellent survivorship, with revision as the end point, for both the metal-backed and the all-polyethylene tibial component designs with no differences noted between the two. [ABSTRACT FROM AUTHOR]

Background and Objectives Volunteer-delivered programs to assist people with dementia and/or delirium in-hospital can provide person-centered one-on-one support in addition to usual care. These programs could mitigate hospital resource demands; however, their effectiveness is unknown. This review evaluated literature of volunteer programs in acute hospital settings for people living with dementia and/or delirium. Research Design and Methods Four databases were searched. Studies that reported patient or program outcomes were included (i.e. delirium incidence, length of stay, number of falls, satisfaction). Risk of bias was completed. Meta-analysis was performed where 2 or more studies measured the same outcome. Narrative synthesis was performed on the qualitative results. Results Eleven studies were included in the review, with varied design, participant groups and outcomes measured. Risk of bias averaged 71%. Volunteer-delivered programs addressed delirium risk factors, for example, hydration/nutrition, mobility, use of sensory aids. Eight patients and 6 program outcomes were captured, but only 3 patient outcomes could be pooled. Meta-analyses demonstrated a reduction in delirium incidence (rate ratio = 0.65; 95% confidence interval [CI] 0.47, 0.90) but no reduction in length of stay (mean difference −1.09; 95% CI −0.58, 2.77) or number of falls (rate ratio = 0.67; 95% CI 0.19, 2.35). Narrative synthesis identified benefits to patients (e.g. less loneliness), volunteers (sense of meaning), and staff (timesaving, safety). Discussion and Implications Volunteer-delivered programs for inpatients with dementia and/or delirium may provide benefits for patients, volunteers, and staff. However, studies conducted with more robust designs are required to determine overall effectiveness on program outcomes. Further high-quality research appropriate for this vulnerable population is required to identify volunteer program effectiveness. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity is a risk factor for type 2 diabetes (T2D) and dementia. However, it is unknown if physical activity (PA) intensity is associated with brain health in people with T2D. Therefore, this study aimed to determine (i) associations between PA intensity and step count with both cognition and brain structure and (ii) if apolipoprotein E-ε4 or insulin therapy modifies any associations.Methods: Participants were people with T2D (n = 220; aged 55-86 years). An accelerometer worn over the right hip was used to obtain step count and moderate-to-vigorous PA (MVPA) averaged over 7 days. Cognition in 7 domains was obtained using a battery of neuropsychological tests. Brain structure was measured by Magnetic Resonance Imaging. Linear regression models were used to examine associations between step count, MVPA and each cognitive and Magnetic Resonance Imaging measure. Apolipoprotein E-ε4 × PA and insulin therapy × PA product terms were added to the models to examine effect modification.Results: The mean age of participants was 67.9 (SD = 6.3). Higher step count was associated with greater hippocampal volume (β = 0.028, 95% CI = 0.005, 0.051). Insulin therapy modified the association between MVPA and attention-processing speed, such that associations were significant in people receiving insulin therapy (p for interaction = .019). There were no other significant associations.Conclusions: Higher step count and greater time spent in MVPA may be associated with better hippocampal volume and attention-processing speed, respectively, in people with T2D. People with greater diabetes severity (receiving insulin therapy) may get more cognitive benefit from MVPA. [ABSTRACT FROM AUTHOR]

Direct and simultaneous observation of root growth and plant water uptake is difficult because soils are opaque. X-ray imaging techniques such as projection radiography or Computer Tomography (CT) offer a partial alternative to such limitations. Nevertheless, there is a trade-off between resolution, large field-of-view and 3-dimensionality: With the current state of the technology, it is possible to have any two. In this study, we used X-ray transmission through thin-slab systems to monitor transient saturation fields that develop around roots as plants grow. Although restricted to 2-dimensions, this approach offers a large field-of-view together with high spatial and dynamic resolutions. To illustrate the potential of this technology, we grew peas in 1 cm thick containers filled with soil and imaged them at regular intervals. The dynamics of both the root growth and the water content field that developed around the roots could be conveniently monitored. Compared to other techniques such as X-ray CT, our system is relatively inexpensive and easy to implement. It can potentially be applied to study many agronomic problems, such as issues related to the impact of soil constraints (physical, chemical or biological) on root development. [ABSTRACT FROM AUTHOR]