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Microalgae are key components of aquatic food chains and are known to be sensitive to a range of contaminants. Much of the available data on metal toxicity to microalgae have been derived from temperate single-species tests with temperate data used to supplement tropical toxicity data sets to derive guideline values. In the present study, we used single-species and multispecies tests to investigate the toxicity of nickel and copper to tropical freshwater and marine microalgae, including the free-swimming stage of Symbiodinium sp., a worldwide coral endosymbiont. Based on the 10% effect concentration (EC10) for growth rate, copper was two to four times more toxic than nickel to all species tested. The temperate strain of Ceratoneis closterium was eight to 10 times more sensitive to nickel than the two tropical strains. Freshwater Monoraphidium arcuatum was less sensitive to copper and nickel in the multispecies tests compared with the single-species tests (EC10 values increasing from 0.45 to 1.4 mu g Cu/L and from 62 to 330 mu g Ni/L). The Symbiodinium sp. was sensitive to copper (EC10 of 3.1 mu g Cu/L) and less sensitive to nickel (EC50 >1600 mu g Ni/L). This is an important contribution of data on the chronic toxicity of nickel to Symbiodinium sp. A key result from the present study was that three microalgal species had EC10 values below the current copper water quality guideline value for 95% species protection in slightly to moderately disturbed systems in Australia and New Zealand, indicating that they may not be adequately protected by the current copper guideline value. By contrast, toxicity of nickel to microalgae is unlikely to occur at exposure concentrations typically found in fresh and marine waters. Environ Toxicol Chem 2023;00:1-13. (c) 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Bioavailability models, for example, multiple linear regressions (MLRs) of water quality parameters, are increasingly being used to develop bioavailability-based water quality criteria for metals. However, models developed for the Northern Hemisphere cannot be adopted for Australia and New Zealand without first validating them against local species and local water chemistry characteristics. We investigated the applicability of zinc chronic bioavailability models to predict toxicity in a range of uncontaminated natural waters in Australia and New Zealand. Water chemistry data were compiled to guide a selection of waters with different zinc toxicity-modifying factors. Predicted toxicities using several bioavailability models were compared with observed chronic toxicities for the green alga Raphidocelis subcapitata and the native cladocerans Ceriodaphnia cf. dubia and Daphnia thomsoni. The most sensitive species to zinc in five New Zealand freshwaters was R. subcapitata (72-h growth rate), with toxicity ameliorated by high dissolved organic carbon (DOC) or low pH, and hardness having a minimal influence. Zinc toxicity to D. thomsoni (reproduction) was ameliorated by both high DOC and hardness in these same waters. No single trophic level-specific effect concentration, 10% (EC10) MLR was the best predictor of chronic toxicity to the cladocerans, and MLRs based on EC10 values both over- and under-predicted zinc toxicity. The EC50 MLRs better predicted toxicities to both the Australian and New Zealand cladocerans to within a factor of 2 of the observed toxicities in most waters. These findings suggest that existing MLRs may be useful for normalizing local ecotoxicity data to derive water quality criteria for Australia and New Zealand. The final choice of models will depend on their predictive ability, level of protection, and ease of use. Environ Toxicol Chem 2023;42:2614-2629. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC o

Environmental context: Having appropriate and robust models used for developing water quality guidelines is critical for sound environmental management. Methods used to validate models have only been demonstrated appropriate for a small portion of data types used in these models. This study has found that models using certain data types would be more appropriately validated using alternative evaluation criteria. This study serves as an important reference for developing and evaluating robust models. Rationale: Bioavailability-based toxicity models for metals often have performance assessed by whether it can predict toxicity data within a factor of 2 of their paired observed toxicity data. This method has only been verified for median effect values (EC50) for acute fish and daphnia data, however toxicity models have been developed for a much broader range of effect levels (i.e. EC10/EC20) and species (e.g. microalga). This study tested whether the factor-of-2 rule is appropriate for a wider range of organisms and effect concentrations than previously studied. Methodology: Toxicity estimate data from repeated tests conducted under the same conditions were collated to assess variation in results and compare this variation to a range of 4 (a factor of 2 above and below the mean) and a range of 9 (a factor of 3 above and below the mean) to assess if a factor-of-3 rule may be more appropriate for some species and effect levels. Results and discussion: Overall, the factor-of-2 rule is broadly applicable for metal toxicity to a range of species for EC50 data. The EC10 datasets highlighted that larger variability exists in low effect levels and supported the use of a factor-of-3 rule, while the either the factor-of-2 or factor-of-3 rule could be applied to microalgae. The level of performance evaluation chosen may depend on the application of the bioavailability model. This study also found that while repeated toxicity test data is routinely generated, it is rarely published

Background: Despite the finding that Parkinson disease (PD) occurs in more than one in every 1000 people older than 60 years, there have been few attempts to quantify how deficits in impairments, activity, participation, and quality of life progress in this debilitating condition. It is unclear which tools are most appropriate for measuring change over time in PD. Methods and design: This protocol describes a prospective analysis of changes in impairments, activity, participation, and quality of life over a 12 month period together with an economic analysis of costs associated with PD. One-hundred participants will be included, provided they have idiopathic PD rated I-IV on the modified Hoehn & Yahr (1967) scale and fulfil the inclusion criteria. The study aims to determine which clinical and economic measures best quantify the natural history and progression of PD in a sample of people receiving services from the Victorian Comprehensive Parkinson's Program, Australia. When the data become available, the results will be expressed as baseline scores and changes over 3 months and 12 months for impairment, activity, participation, and quality of life together with a cost analysis. Discussion(s): This study has the potential to identify baseline characteristics of PD for different Hoehn & Yahr stages, to determine the influence of disease duration on performance, and to calculate the costs associated with idiopathic PD. Valid clinical and economic measures for quantifying the natural history and progression of PD will also be identified. Trial Registration.

Background: Despite the finding that Parkinson disease (PD) occurs in more than one in every 1000 people older than 60 years, there have been few attempts to quantify how deficits in impairments, activity, participation, and quality of life progress in this debilitating condition. It is unclear which tools are most appropriate for measuring change over time in PD. Methods and design: This protocol describes a prospective analysis of changes in impairments, activity, participation, and quality of life over a 12 month period together with an economic analysis of costs associated with PD. One-hundred participants will be included, provided they have idiopathic PD rated I-IV on the modified Hoehn & Yahr (1967) scale and fulfil the inclusion criteria. The study aims to determine which clinical and economic measures best quantify the natural history and progression of PD in a sample of people receiving services from the Victorian Comprehensive Parkinson's Program, Australia. When the data become available, the results will be expressed as baseline scores and changes over 3 months and 12 months for impairment, activity, participation, and quality of life together with a cost analysis. Discussion(s): This study has the potential to identify baseline characteristics of PD for different Hoehn & Yahr stages, to determine the influence of disease duration on performance, and to calculate the costs associated with idiopathic PD. Valid clinical and economic measures for quantifying the natural history and progression of PD will also be identified. Trial Registration.

The majority of psychological studies of conspiracy theories have investigated the personality correlates and psychological processes associated with conspiracy belief. There is now increasing concern about the consequences of conspiracy theories, however, and it is these consequences that we turn to in this chapter. A growing body of research suggests that conspiracy theories may have negative consequences in a variety of settings that are vital to the smooth functioning of a society. Specifically, conspiracy theories appear to reduce engagement with the political process, climate change, childhood vaccination and increase people’s intentions to leave their workplace. Conspiracy theories are also associated with increased prejudice and discrimination toward stigmatized groups. Further, conspiracy theories can lead to feelings of powerlessness, uncertainty, anomie, and mistrust. This chapter will provide an overview of the literature to date, discussing both the behavioral and psychological consequences of conspiracy theories. Based on our review, we will argue that developing tools to alleviate the potentially dangerous consequences of conspiracy theories is timely and important.

To explicate the outcomes of home support interventions for older people with dementia and/or their carers to inform clinical practice, policy and research.

© 2018 Elsevier Ltd Harmful microalgal blooms are a threat to aquatic organisms, ecosystems and human health. Toxic dinoflagellates of the genus Alexandrium are known to produce paralytic shellfish toxins and to release bioactive extracellular compounds (BECs) with potent cytotoxic, hemolytic, ichtyotoxic and allelopathic activity. Negative allelochemical interactions refer to the chemicals that are released by the genus Alexandrium and that induce adverse effects on the physiology of co-occurring protists and predators. Releasing BECs gives the donor a competitive advantage that may help to form dense toxic blooms of phytoplankton. However BECs released by Alexandrium minutum are uncharacterized and it is impossible to quantify them using classical chemical methods. Allelochemical interactions are usually quantified through population growth inhibition or lytic-activity based bioassays using a secondary target organism. However these bioassays require time (for growth or microalgal counts) and/or are based on lethal effects. The use of pulse amplitude modulation (PAM) fluorometry has been widely used to assess the impact of environmental stressors on phytoplankton but rarely for allelochemical interactions. Here we evaluated the use of PAM and propose a rapid chlorophyll fluorescence based bioassay to quantify allelochemical BECs released from Alexandrium minutum. We used the ubiquitous diatom Chaetoceros muelleri as a target species. The bioassay, based on sub-lethal effects, quantifies allelochemical activity from different samples (filtrates, extracts in seawater) within a short period of time (2 h). This rapid bioassay will help investigate the role of allelochemical interactions in Alexandrium bloom establishment. It will also further our understanding of the potential relationship between allelochemical activities and other cytotoxic activities from BECs. While this bioassay was developed for the species A. minutum, it may be applicable to other species produ

To explicate the outcomes of home support interventions for older people with dementia and/or their carers to inform clinical practice, policy and research.

© 2018 Elsevier Ltd Harmful microalgal blooms are a threat to aquatic organisms, ecosystems and human health. Toxic dinoflagellates of the genus Alexandrium are known to produce paralytic shellfish toxins and to release bioactive extracellular compounds (BECs) with potent cytotoxic, hemolytic, ichtyotoxic and allelopathic activity. Negative allelochemical interactions refer to the chemicals that are released by the genus Alexandrium and that induce adverse effects on the physiology of co-occurring protists and predators. Releasing BECs gives the donor a competitive advantage that may help to form dense toxic blooms of phytoplankton. However BECs released by Alexandrium minutum are uncharacterized and it is impossible to quantify them using classical chemical methods. Allelochemical interactions are usually quantified through population growth inhibition or lytic-activity based bioassays using a secondary target organism. However these bioassays require time (for growth or microalgal counts) and/or are based on lethal effects. The use of pulse amplitude modulation (PAM) fluorometry has been widely used to assess the impact of environmental stressors on phytoplankton but rarely for allelochemical interactions. Here we evaluated the use of PAM and propose a rapid chlorophyll fluorescence based bioassay to quantify allelochemical BECs released from Alexandrium minutum. We used the ubiquitous diatom Chaetoceros muelleri as a target species. The bioassay, based on sub-lethal effects, quantifies allelochemical activity from different samples (filtrates, extracts in seawater) within a short period of time (2 h). This rapid bioassay will help investigate the role of allelochemical interactions in Alexandrium bloom establishment. It will also further our understanding of the potential relationship between allelochemical activities and other cytotoxic activities from BECs. While this bioassay was developed for the species A. minutum, it may be applicable to other species produ

Aim. To synthesise evidence to identify the components of effective psychosocial interventions in dementia care to inform clinical practice, policy and research. Background. With population ageing dementia represents a significant care challenge with 60% of people with dementia living at home. Design. Overview of systematic reviews with narrative summary. Data sources. Electronic searches of published systematic reviews in English using Cochrane Database of Systematic Reviews, DARE, EPPI-Centre, between September 2013 and April 2014. Review methods. Systematic reviews were appraised against Cochrane Collaboration levels of effectiveness. Components of psychosocial interventions were identified with their theoretical rationale. Findings were explored with a Patient, Public and Carer Involvement group.

The value of using social media is being increasingly recognised among the academic community. Blogging has been identified by some researchers as a means of reaching a non-academic audience and in order to increase research citations. However, there is little research exploring this method of communication within specific disciplines. This study, therefore, explored UK psychologists’ views and experiences of blogging using an online survey, of both blog writers and non-blog writers. In addition, the study sought to determine whether those who identified as blog writers when they completed the survey, and who consented to a content analysis of their posts, were still posting regularly 12 months later. The majority of the blog writers said that they wrote blogs as a means of expressing themselves and their research. Content analysis reflected the survey findings, with research as the most common category for posts, but we identified that the intended audience for such posts appeared to be other academics. Interestingly, 37% of blog writers had stopped regularly posting at the point where posts were analysed, 12 months after the survey. Moreover, despite positive attitudes and subjective norms about blogging across the sample, we also identified that for respondents who were non-blog writers were reluctant to blog because they worried that their contribution may not be valued, or that they did not have the time. These findings highlight that there is work to do in order to convince psychologists to engage – and to continue doing so - with this medium of communication.

Aim. To synthesise evidence to identify the components of effective psychosocial interventions in dementia care to inform clinical practice, policy and research. Background. With population ageing dementia represents a significant care challenge with 60% of people with dementia living at home. Design. Overview of systematic reviews with narrative summary. Data sources. Electronic searches of published systematic reviews in English using Cochrane Database of Systematic Reviews, DARE, EPPI-Centre, between September 2013 and April 2014. Review methods. Systematic reviews were appraised against Cochrane Collaboration levels of effectiveness. Components of psychosocial interventions were identified with their theoretical rationale. Findings were explored with a Patient, Public and Carer Involvement group.

PURPOSE: A stepped-wedge cluster-randomised controlled trial was conducted to evaluate the feasibility and effectiveness of a brief psychosocial intervention for depressed cancer patients, delivered by trained front-line health professionals in routine clinical care. METHODS: Nine hundred two patients were assessed across four treatment centres which were allocated in random order from control epoch to intervention epoch. Eligible patients had Hospital Anxiety and Depression Scale (HADS) scores of 8 or greater. Of eligible patients, 222 were recruited in control epoch and 247 in intervention epoch. Twenty-seven health professionals (HPs) were trained to deliver the psychosocial intervention consisting of up to four sessions, tailored to patient symptoms and distress. HPs participated in group supervision with a psychiatrist. The primary outcome, analysed by intention to treat, was depression measured with the HADS at 10 weeks after receiving the intervention. RESULTS: At 10-week follow-up, there were no significant differences in HADS score for the 181 patients in control epoch and 177 in intervention epoch (adjusted difference -1.23, 95 % CI -3.81--1.35, p = 0.35). Patients with disease progression who received the intervention experienced significant benefits in unmet practical support needs including care and support, information, and physical and daily living. CONCLUSION: A brief psychosocial intervention delivered by front-line oncology health professionals is feasible to deliver but is insufficient as a stand-alone treatment for depression in cancer patients. Psychosocial interventions should be targeted to populations most likely to experience benefit.

Purpose: A stepped-wedge cluster-randomised controlled trial was conducted to evaluate the feasibility and effectiveness of a brief psychosocial intervention for depressed cancer patients, delivered by trained front-line health professionals in routine clinical care. Method(s): Nine hundred two patients were assessed across four treatment centres which were allocated in random order from control epoch to intervention epoch. Eligible patients had Hospital Anxiety and Depression Scale (HADS) scores of 8 or greater. Of eligible patients, 222 were recruited in control epoch and 247 in intervention epoch. Twenty-seven health professionals (HPs) were trained to deliver the psychosocial intervention consisting of up to four sessions, tailored to patient symptoms and distress. HPs participated in group supervision with a psychiatrist. The primary outcome, analysed by intention to treat, was depression measured with the HADS at 10 weeks after receiving the intervention. Result(s): At 10-week follow-up, there were no significant differences in HADS score for the 181 patients in control epoch and 177 in intervention epoch (adjusted difference -1.23, 95 % CI -3.81--1.35, p = 0.35). Patients with disease progression who received the intervention experienced significant benefits in unmet practical support needs including care and support, information, and physical and daily living. Conclusion(s): A brief psychosocial intervention delivered by front-line oncology health professionals is feasible to deliver but is insufficient as a stand-alone treatment for depression in cancer patients. Psychosocial interventions should be targeted to populations most likely to experience benefit.Copyright © 2016, Springer-Verlag Berlin Heidelberg.

Purpose: A stepped-wedge cluster-randomised controlled trial was conducted to evaluate the feasibility and effectiveness of a brief psychosocial intervention for depressed cancer patients, delivered by trained front-line health professionals in routine clinical care. Method(s): Nine hundred two patients were assessed across four treatment centres which were allocated in random order from control epoch to intervention epoch. Eligible patients had Hospital Anxiety and Depression Scale (HADS) scores of 8 or greater. Of eligible patients, 222 were recruited in control epoch and 247 in intervention epoch. Twenty-seven health professionals (HPs) were trained to deliver the psychosocial intervention consisting of up to four sessions, tailored to patient symptoms and distress. HPs participated in group supervision with a psychiatrist. The primary outcome, analysed by intention to treat, was depression measured with the HADS at 10 weeks after receiving the intervention. Result(s): At 10-week follow-up, there were no significant differences in HADS score for the 181 patients in control epoch and 177 in intervention epoch (adjusted difference -1.23, 95 % CI -3.81--1.35, p = 0.35). Patients with disease progression who received the intervention experienced significant benefits in unmet practical support needs including care and support, information, and physical and daily living. Conclusion(s): A brief psychosocial intervention delivered by front-line oncology health professionals is feasible to deliver but is insufficient as a stand-alone treatment for depression in cancer patients. Psychosocial interventions should be targeted to populations most likely to experience benefit.Copyright © 2016, Springer-Verlag Berlin Heidelberg.

The British Psychological Society’s Public Engagement and Media Award in 2015 went to Mindhacks, a blog led by psychologists Dr Vaughan Bell and Dr Tom Stafford that has featured over 5000 posts across the past decade. Example posts include descriptions of visual illusions, a self-test for synaesthesia, and tips on the best way to win an argument. Accepting the award at the Society’s Annual Conference, the pair urged: ‘Each one of you has probably got those 5000 posts inside you. Make use of the resources on the internet, but put your own thoughts online too.’ We share their passion for ‘blogademia’ (a term coined by Saper, 2006), and here we aim to reflect on its purpose, positives and pitfalls, moving on to some general tips and guidance on blogging specifically for psychologists.

Objective: To investigate the effectiveness of tai-chi in preventing falls among community-dwelling older people. Design: Multisite parallel group individually randomized controlled trial. Setting: Melbourne, Australia. Participants: Preclinically disabled community-dwelling people 70+years (n=503), without major medical conditions or moderate to severe cognitive impairment. Intervention: Sixty-minute modified Sun style tai-chi group-based exercise program twice weekly for 48weeks; control intervention was a seated group-based flexibility exercise program of the same dose. Measurements: All falls, self-reported using a monthly calendar, analyzed at 24weeks and 48weeks. Injurious falls reported in follow-up telephone interviews for each reported fall. Results: The adjusted fall incidence rate ratios at 24 and 48weeks were 1.08 [(95% confidence interval (CI) 0.64-1.81)], and 1.12 (95% CI 0.75-1.67), respectively. A higher proportion of intervention participants ceased attendance in the first 24weeks (difference 17.9%, 95% CI 9.6-25.8), and the second 24weeks (2.7%, 95% CI-5.0 to 10.4). Intervention participants who ceased attendance had lower left quadriceps strength (difference 3.3kg 95% CI 0.15-6.36) and required longer to complete the timed up and go test (difference 1.7seconds 95% CI 0.22-3.17) at baseline. Conclusions: This study does not support modified Sun style tai-chi as a falls prevention measure among relatively well community-dwelling older people with modified mobility and at increased risk of disability. Insufficient intervention intensity, or low exercise class attendance may have contributed to the lack of effect, as may have attrition bias among the intervention group.

Introduction: Sleep disordered breathing (SDB) in adults has been associated with loss of the nocturnal dipping in blood pressure (BP) and heart rate (HR), however, there have been limited studies in children. We measured BP non-invasively and continuously during overnight polysomnography in 105 children aged 7-12 with a range of severities of SDB and 36 non-snoring controls to examine nocturnal dipping proiles. Method(s): Children with SDB were divided into three severity groups according to the obstructive apnea hypopnea index (OAHI). BP and HR data were categorised into Wake (before sleep onset), total overnight Sleep, NREM 1/2, SWS and REM. Nocturnal dipping proiles were calculated both as % of children exhibiting a >= 10% fall in systolic BP (SAP) and HR from Wake to Sleep and according to SAP Sleep / SAP Wake ratio as extreme dippers ratio <= 0.8, dippers < 0.8 ratio <= 0.9, non dippers < 0.9 ratio <=1.0 and reverse dippers ratio > 1.0. Result(s): Over the whole night BP dipped during Sleep, reaching statistical signiicance for SAP in the Control group (p<0.05). We also found that the fall in BP between wake before sleep onset and NREM 1/2, SWS and REM sleep was not different between the groups. In addition, when children were grouped according to their nocturnal dipping proile there were no differences between the proportions of children in each group across severities of SDB or between sleep states. Conclusion(s): All severities of SDB were associated with similar nocturnal dipping patterns of BP and HR, a inding which may suggest that the cardiovascular system of these young children has not been signiicantly affected. However, further studies are required to determine if the elevated BP we have previously reported in this group will have long term effects on the cardiovascular system.

Aim To compare diffusion-weighted imaging (DWI) and non-DWI magnetic resonance imaging (MRI), proton MR spectroscopy (1H-MRS), and clinical biomarkers for prediction of 2 year developmental outcome in term infants with perinatal hypoxic-ischaemic encephalopathy (HIE). Materials and methods Nineteen infants >=36 weeks gestation with HIE were recruited and MRI performed day 3-7 (mean = 5). MRI was scored independently by three radiologists using a standardized scoring system. Lactate-to-N-acetylaspartate ratio (Lac:NAA) in the lentiform nucleus was calculated. Developmental assessment was performed at 2 years using the Bayley Scales of Infant and Toddler Development (BSID-III). Interobserver agreement about abnormality in 10 brain regions was measured. Univariate analysis was performed to determine variables associated with adverse outcome (i.e., death or Bayley score for any domain <70). Results Good interobserver agreement (kappa = 0.61-0.69) on scores for DWI was obtained for the cortex, putamen, and brainstem, but not for any region on non-DWI. A significant association was found between outcome and Lac:NAA (p < 0.003) and DWI scores for lentiform nucleus, thalamus, cortex, posterior limb of the internal capsule (PLIC), and paracentral white matter (p = 0.001-0.013), but for non-DWI score only in the vermis or brainstem. A combination of Lac:NAA >=0.25 or DWI/apparent diffusion coefficient (ADC) signal abnormality in the PLIC had 100% specificity and sensitivity for poor outcome. Conclusion Interobserver agreement for non-DWI performed during the first week is poor. Agreement by three radiologists about the presence of abnormal signal within the PLIC on ADC/DWI images or elevation of Lac:NAA above 0.25 improved sensitivity without reducing the prognostic specificity of MRS in the 19 patients, but this requires validation in a larger group of infants with HIE who have been treated with hypothermia. © 2013 The Royal College of Radiologists. Published by Elsevier Ltd

Introduction: Sleep disordered breathing (SDB) in adults has been associated with loss of the nocturnal dipping in blood pressure (BP) and heart rate (HR), however, there have been limited studies in children. We measured BP non-invasively and continuously during overnight polysomnography in 105 children aged 7-12 with a range of severities of SDB and 36 non-snoring controls to examine nocturnal dipping proiles. Method(s): Children with SDB were divided into three severity groups according to the obstructive apnea hypopnea index (OAHI). BP and HR data were categorised into Wake (before sleep onset), total overnight Sleep, NREM 1/2, SWS and REM. Nocturnal dipping proiles were calculated both as % of children exhibiting a >= 10% fall in systolic BP (SAP) and HR from Wake to Sleep and according to SAP Sleep / SAP Wake ratio as extreme dippers ratio <= 0.8, dippers < 0.8 ratio <= 0.9, non dippers < 0.9 ratio <=1.0 and reverse dippers ratio > 1.0. Result(s): Over the whole night BP dipped during Sleep, reaching statistical signiicance for SAP in the Control group (p<0.05). We also found that the fall in BP between wake before sleep onset and NREM 1/2, SWS and REM sleep was not different between the groups. In addition, when children were grouped according to their nocturnal dipping proile there were no differences between the proportions of children in each group across severities of SDB or between sleep states. Conclusion(s): All severities of SDB were associated with similar nocturnal dipping patterns of BP and HR, a inding which may suggest that the cardiovascular system of these young children has not been signiicantly affected. However, further studies are required to determine if the elevated BP we have previously reported in this group will have long term effects on the cardiovascular system.

Aim To compare diffusion-weighted imaging (DWI) and non-DWI magnetic resonance imaging (MRI), proton MR spectroscopy (1H-MRS), and clinical biomarkers for prediction of 2 year developmental outcome in term infants with perinatal hypoxic-ischaemic encephalopathy (HIE). Materials and methods Nineteen infants >=36 weeks gestation with HIE were recruited and MRI performed day 3-7 (mean = 5). MRI was scored independently by three radiologists using a standardized scoring system. Lactate-to-N-acetylaspartate ratio (Lac:NAA) in the lentiform nucleus was calculated. Developmental assessment was performed at 2 years using the Bayley Scales of Infant and Toddler Development (BSID-III). Interobserver agreement about abnormality in 10 brain regions was measured. Univariate analysis was performed to determine variables associated with adverse outcome (i.e., death or Bayley score for any domain <70). Results Good interobserver agreement (kappa = 0.61-0.69) on scores for DWI was obtained for the cortex, putamen, and brainstem, but not for any region on non-DWI. A significant association was found between outcome and Lac:NAA (p < 0.003) and DWI scores for lentiform nucleus, thalamus, cortex, posterior limb of the internal capsule (PLIC), and paracentral white matter (p = 0.001-0.013), but for non-DWI score only in the vermis or brainstem. A combination of Lac:NAA >=0.25 or DWI/apparent diffusion coefficient (ADC) signal abnormality in the PLIC had 100% specificity and sensitivity for poor outcome. Conclusion Interobserver agreement for non-DWI performed during the first week is poor. Agreement by three radiologists about the presence of abnormal signal within the PLIC on ADC/DWI images or elevation of Lac:NAA above 0.25 improved sensitivity without reducing the prognostic specificity of MRS in the 19 patients, but this requires validation in a larger group of infants with HIE who have been treated with hypothermia. © 2013 The Royal College of Radiologists. Published by Elsevier Ltd

Objective Sleep disordered breathing (SDB) in adults has been associated with a loss of nocturnal dipping in blood pressure (BP) and heart rate, however, there have been limited studies in children. We measured BP non-invasively and continuously overnight in 105 children aged 7-12 with a range of severities of SDB and 36 non-snoring controls to examine nocturnal dipping profiles. Study Design Children with SDB were divided into three severity groups according to their obstructive apnea hypopnea index. Nocturnal dipping profiles across sleep stages were described both as a proportion of children exhibiting a >=10% fall in systolic arterial pressure (SAP) and heart rate (HR) from wake to sleep and according to SAP sleep/SAP wake ratio as extreme dippers (ratio <= 0.8), dippers (ratio < 0.8 and <=0.9), non-dippers (ratio < 0.9 and <=1.0), and reverse dippers (ratio > 1.0). Results The mean fall in BP between wake and NREM 1/2, SWS, and REM sleep was not different between the groups and there were no differences between the dipping profiles of children in each group. Conclusions SDB did not alter nocturnal dipping patterns of BP and HR compared to controls, a finding which may suggest that these young children have not been exposed to the effects of SDB long enough or that SDB severity was not great enough to affect nocturnal dipping profiles. However, further studies are required to determine if the elevated BP previously reported in this group of children will have long-term effects on the cardiovascular system. Pediatr Pulmonol. 2013; 48:1127-1134. © 2013 Wiley Periodicals, Inc. © 2013 Wiley Periodicals, Inc.

Objective Sleep disordered breathing (SDB) in adults has been associated with a loss of nocturnal dipping in blood pressure (BP) and heart rate, however, there have been limited studies in children. We measured BP non-invasively and continuously overnight in 105 children aged 7-12 with a range of severities of SDB and 36 non-snoring controls to examine nocturnal dipping profiles. Study Design Children with SDB were divided into three severity groups according to their obstructive apnea hypopnea index. Nocturnal dipping profiles across sleep stages were described both as a proportion of children exhibiting a >=10% fall in systolic arterial pressure (SAP) and heart rate (HR) from wake to sleep and according to SAP sleep/SAP wake ratio as extreme dippers (ratio <= 0.8), dippers (ratio < 0.8 and <=0.9), non-dippers (ratio < 0.9 and <=1.0), and reverse dippers (ratio > 1.0). Results The mean fall in BP between wake and NREM 1/2, SWS, and REM sleep was not different between the groups and there were no differences between the dipping profiles of children in each group. Conclusions SDB did not alter nocturnal dipping patterns of BP and HR compared to controls, a finding which may suggest that these young children have not been exposed to the effects of SDB long enough or that SDB severity was not great enough to affect nocturnal dipping profiles. However, further studies are required to determine if the elevated BP previously reported in this group of children will have long-term effects on the cardiovascular system. Pediatr Pulmonol. 2013; 48:1127-1134. © 2013 Wiley Periodicals, Inc. © 2013 Wiley Periodicals, Inc.

BACKGROUND: India currently has more than 60 million people with Type 2 Diabetes Mellitus (T2DM) and this is predicted to increase by nearly two-thirds by 2030. While management of those with T2DM is important, preventing or delaying the onset of the disease, especially in those individuals at 'high risk' of developing T2DM, is urgently needed, particularly in resource-constrained settings. This paper describes the protocol for a cluster randomised controlled trial of a peer-led lifestyle intervention program to prevent diabetes in Kerala, India. METHODS/DESIGN: A total of 60 polling booths are randomised to the intervention arm or control arm in rural Kerala, India. Data collection is conducted in two steps. Step 1 (Home screening): Participants aged 30-60 years are administered a screening questionnaire. Those having no history of T2DM and other chronic illnesses with an Indian Diabetes Risk Score value of ≥60 are invited to attend a mobile clinic (Step 2). At the mobile clinic, participants complete questionnaires, undergo physical measurements, and provide blood samples for biochemical analysis. Participants identified with T2DM at Step 2 are excluded from further study participation. Participants in the control arm are provided with a health education booklet containing information on symptoms, complications, and risk factors of T2DM with the recommended levels for primary prevention. Participants in the intervention arm receive: (1) eleven peer-led small group sessions to motivate, guide and support in planning, initiation and maintenance of lifestyle changes; (2) two diabetes prevention education sessions led by experts to raise awareness on T2DM risk factors, prevention and management; (3) a participant handbook containing information primarily on peer support and its role in assisting with lifestyle modification; (4) a participant workbook to guide self-monitoring of lifestyle behaviours, goal setting and goal review; (5) the health education booklet that i

BACKGROUND: India currently has more than 60 million people with Type 2 Diabetes Mellitus (T2DM) and this is predicted to increase by nearly two-thirds by 2030. While management of those with T2DM is important, preventing or delaying the onset of the disease, especially in those individuals at 'high risk' of developing T2DM, is urgently needed, particularly in resource-constrained settings. This paper describes the protocol for a cluster randomised controlled trial of a peer-led lifestyle intervention program to prevent diabetes in Kerala, India. METHODS/DESIGN: A total of 60 polling booths are randomised to the intervention arm or control arm in rural Kerala, India. Data collection is conducted in two steps. Step 1 (Home screening): Participants aged 30-60 years are administered a screening questionnaire. Those having no history of T2DM and other chronic illnesses with an Indian Diabetes Risk Score value of ≥60 are invited to attend a mobile clinic (Step 2). At the mobile clinic, participants complete questionnaires, undergo physical measurements, and provide blood samples for biochemical analysis. Participants identified with T2DM at Step 2 are excluded from further study participation. Participants in the control arm are provided with a health education booklet containing information on symptoms, complications, and risk factors of T2DM with the recommended levels for primary prevention. Participants in the intervention arm receive: (1) eleven peer-led small group sessions to motivate, guide and support in planning, initiation and maintenance of lifestyle changes; (2) two diabetes prevention education sessions led by experts to raise awareness on T2DM risk factors, prevention and management; (3) a participant handbook containing information primarily on peer support and its role in assisting with lifestyle modification; (4) a participant workbook to guide self-monitoring of lifestyle behaviours, goal setting and goal review; (5) the health education booklet that i

BACKGROUND: India currently has more than 60 million people with Type 2 Diabetes Mellitus (T2DM) and this is predicted to increase by nearly two-thirds by 2030. While management of those with T2DM is important, preventing or delaying the onset of the disease, especially in those individuals at 'high risk' of developing T2DM, is urgently needed, particularly in resource-constrained settings. This paper describes the protocol for a cluster randomised controlled trial of a peer-led lifestyle intervention program to prevent diabetes in Kerala, India. METHODS/DESIGN: A total of 60 polling booths are randomised to the intervention arm or control arm in rural Kerala, India. Data collection is conducted in two steps. Step 1 (Home screening): Participants aged 30-60 years are administered a screening questionnaire. Those having no history of T2DM and other chronic illnesses with an Indian Diabetes Risk Score value of ≥60 are invited to attend a mobile clinic (Step 2). At the mobile clinic, participants complete questionnaires, undergo physical measurements, and provide blood samples for biochemical analysis. Participants identified with T2DM at Step 2 are excluded from further study participation. Participants in the control arm are provided with a health education booklet containing information on symptoms, complications, and risk factors of T2DM with the recommended levels for primary prevention. Participants in the intervention arm receive: (1) eleven peer-led small group sessions to motivate, guide and support in planning, initiation and maintenance of lifestyle changes; (2) two diabetes prevention education sessions led by experts to raise awareness on T2DM risk factors, prevention and management; (3) a participant handbook containing information primarily on peer support and its role in assisting with lifestyle modification; (4) a participant workbook to guide self-monitoring of lifestyle behaviours, goal setting and goal review; (5) the health education booklet that i

Different arrival order scenarios of native functional groups to a site may influence both resource use during development and final community structure. Arrival order may then indirectly influence community resistance to invasion. We present a mesocosm experiment of constructed coastal dune communities that monitored biotic and abiotic responses to different arrival orders of native functional groups. Constructed communities were compared with unplanted mesocosms. We then simulated a single invasion event by bitou (Chrysanthemoides monilifera ssp. rotundata), a dominant exotic shrub of coastal communities. We evaluated the hypothesis that plantings with simultaneous representation of grass, herb and shrub functional groups at the beginning of the experiment would more completely sequester resources and limit invasion than staggered plantings. Staggered plantings in turn would offer greater resource use and invasion resistance than unplanted mesocosms. Contrary to our expectations, there were few effects of arrival order on abiotic variables for the duration of the experiment and arrival order was unimportant in final community invasibility. All planted mesocosms supported significantly more invader germinants and significantly less invader abundance than unplanted mesocosms. Native functional group plantings may have a nurse effect during the invader germination and establishment phase and a competitive function during the invader juvenile and adult phase. Arrival order per se did not affect resource use and community invasibility in our mesocosm experiment. While grass, herb and shrub functional group plantings will not prevent invasion success in restored communities, they may limit final invader biomass.

Different arrival order scenarios of native functional groups to a site may influence both resource use during development and final community structure. Arrival order may then indirectly influence community resistance to invasion. We present a mesocosm experiment of constructed coastal dune communities that monitored biotic and abiotic responses to different arrival orders of native functional groups. Constructed communities were compared with unplanted mesocosms. We then simulated a single invasion event by bitou (Chrysanthemoides monilifera ssp. rotundata), a dominant exotic shrub of coastal communities. We evaluated the hypothesis that plantings with simultaneous representation of grass, herb and shrub functional groups at the beginning of the experiment would more completely sequester resources and limit invasion than staggered plantings. Staggered plantings in turn would offer greater resource use and invasion resistance than unplanted mesocosms. Contrary to our expectations, there were few effects of arrival order on abiotic variables for the duration of the experiment and arrival order was unimportant in final community invasibility. All planted mesocosms supported significantly more invader germinants and significantly less invader abundance than unplanted mesocosms. Native functional group plantings may have a nurse effect during the invader germination and establishment phase and a competitive function during the invader juvenile and adult phase. Arrival order per se did not affect resource use and community invasibility in our mesocosm experiment. While grass, herb and shrub functional group plantings will not prevent invasion success in restored communities, they may limit final invader biomass.

Background: Hypertriglyceridaemia is a recognised metabolic abnormality in HIV-infected people, increasing in severity in people treated with highly active antiretroviral therapy (HAART). An alternative treatment for hypertriglyceridaemia in non-HIV-infected populations is omega-3 fatty acid supplementation. This study aimed to compare the effectiveness ofomega-3 fatty acid supplementation and placebo in lowering fasting triglyceride levels in HIV-infected patients on HAART. Method(s): A placebo-controlled, randomised, double-blind trial in participants on stable HAART with fasting triglycerides of >3.5mM to 10.0 mM using 9 g of omega-3 fatty acids versus placebo (olive oil) after a 6-week lead in on dietary therapy. Result(s): Eleven patients were enrolled. The mean triglyceride level for the population decreased from 5.02 mM at baseline to 4.44mM (-11.6%) after dietary intervention and 3.37 mM (-32.9%) after the 8-week treatment period. In the omega-3 fatty acid arm of the study, triglycerides fell from 5.34 mM to 5.02 mM (-6%) after dietary intervention and to 2.30 mM (-56.9%) after the treatment period. In the placebo arm of the study, triglycerides fell from 4.77 mM to 4.05 mM (-15.1%) after dietary intervention and to 4.08 mM (-14.5%) after the treatment period. Using the random effects model, a statistically significant effect on triglycerides of omega-3 fatty acid versus placebo was found (chi2=6.04, P=0.0487). The estimated difference between groups for change in mean triglycerides over 8 weeks was-2.32 mM (95% CI-4.52,-0.12 mM). Conclusion(s): Omega-3 fatty acids are likely to be an effective treatment for hypertriglyceridaemia in HIV-infected males on HAART. © CSIRO 2006.

Objective: The aim was to develop an electronic adverse event (AE) screening tool applicable to acute care hospital episodes for patients admitted with chronic heart failure (CHF) and pneumonia. Design(s): Consensus building using a modified Delphi method and descriptive analysis of hospital discharge data. Participant(s): Consultant physicians in general medicine (n = 38). Intervention(s): In-hospital acquired (C-prefix) diagnoses associated with CHF and pneumonia admissions to 230 hospitals in Victoria, Australia, were extracted from the Victorian Admitted Episodes Data Set between July 2004 and June 2007. A 9-point rating scale was used to prioritize diagnoses acquired during hospitalization (routinely coded as a 'C-prefix' diagnosis to distinguish from diagnoses present on admission) for inclusion within an AE screening tool. Diagnoses rated a group median score between 7 and 9 by the physician panel were included. Main Outcome Measure(s): Selection of C-prefix diagnoses with a group median rating of 7-9 in a screening tool, and the level of physician agreement, as assessed using the Interpercentile Range Adjusted for Symmetry. Result(s): Of 697 initial C-prefix diagnoses, there were high levels of agreement to include 113 (16.2%) in the AE screening tool. Using these selected diagnoses, a potential AE was flagged in 14% of all admissions for the two index conditions. Intra-rater reliability for each clinician ranged from kappa 0.482 to 1.0. Conclusion(s): A high level of physician agreement was obtained in selecting in-hospital diagnoses for inclusion in an AE screening tool based on routinely collected data. These results support further tool validation. © The Author 2012. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Background and Purpose-: Traditional vascular risk factors do not completely explain the asymmetry, racial, and sex differences in carotid artery disease. Carotid anatomy and geometry may play a role in the pathogenesis of internal carotid artery (ICA) stenosis, but their effects are unknown. We hypothesized that carotid artery anatomy and geometry would be independently associated with ICA stenosis. Method-: This is a retrospective study of patients with CT angiography at Monash Medical Centre, 2006 to 2007. Carotid arteries were segmented using semiautomated Methods to estimate measures of carotid anatomy and geometry. Measurements of carotid artery geometry were performed according to the recent article by Thomas and colleagues. ICA stenosis was dichotomized as <30% or >=30% stenosis. Cluster logistic regression was used to examine the associations of anatomy and geometry with stenosis accounting for the paired arteries within subjects, adjusting for age, sex, and vascular risk factors. Results-: Mean age of the sample (n=178) was 68.4 years (SD, 14 years). The following were independently associated with ICA stenosis: ICA radius at the bifurcation (OR, 0.20; 95% CI, 0.14-0.29), ICA angle (OR, 1.05 per degree increment; 95% CI, 1.04-1.07), age (OR, 1.05 per year increment; 95% CI, 1.03-1.07), male sex (OR, 1.72; 95% CI, 1.08-2.8), and ever-smoker (OR, 1.85; 95% CI, 1.15-2.96). Conclusions-: Carotid anatomy and geometry may enhance the risk of stenosis independent of traditional vascular risk factors and may be of help in very early identification of patients at high risk of developing carotid artery atherosclerosis for aggressive intervention. © 2012 American Heart Association, Inc.

Background: The administration of antenatal corticosteroids to women at risk of preterm birth is an important component of care for such women. However, inevitably, attempts to maximise the number of women who receive corticosteroids ahead of preterm birth will also expose women perceived at risk who subsequently deliver at term. These women have not been previously quantified. Aim(s): To describe antenatal corticosteroid prescribing practices at a single institution over a seven-year period. Method(s): Interrogation of an electronic birthing outcome system supplemented by hand-searching of medical records, recording all women birthing before 34 weeks and all women with a hospital admission before 34 weeks but birthing after 34 weeks. The number of women receiving antenatal corticosteroids in each of these groups was recorded, and trends between groups and over time were analysed using logistic regression. Result(s): While the total number of women receiving antenatal corticosteroids in our institution has risen over the last seven years, the proportion of women receiving antenatal corticosteroids who deliver between 24 and 35 weeks has increased inconsistently and modestly (average increase 12% per year (95% CI: 6-19%, P < 0.001). In contrast, the number of women receiving antenatal corticosteroids who subsequently deliver after 34 weeks has increased consistently, with an average increase rate of 21% per year (95% CI: 16-25%, P < 0.001). Conclusion(s): Increasing numbers of women birthing after 34 weeks in our hospital are receiving antenatal corticosteroids before 34 weeks. The long-term implications of this are not currently clear. © 2007 The Authors Journal compilation © 2007 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Background: Asthma, eczema and hay fever are the classical manifestations of atopic disease. Geographic tongue (benign migratory glossitis) has also been reported to be a manifestation. Anecdotally, atopic people frequently report irritation of the tongue by heat and certain foods, which may be more common than realized. Objective(s): To determine whether atopic people have an increased likelihood of a sensitive tongue manifest as inflamed fungiform papillae and a history of irritation by certain foods. Patients/methods: A descriptive classification of inflammation of the fungiform papillae on the tongue was developed using a 9-point analogue scale where 1 was considered normal and 9 was considered to be severely inflamed. An opportunistic sample of participants were classified as atopic or not on the basis of a personal history of asthma, eczema or hay fever. An examination of the tongue was performed using the classification and then a questionnaire was administered on whether they burnt their tongue easily with hot food and whether they were irritated by certain foods. Result(s): There were 200 participants aged 20 years and over of whom 104 (52%) were classified as atopic on the basis of the personal history. There was a significant positive association between increasingly inflamed fungiform papillae and the likelihood of being atopic. There was also a positive association between increasing inflammation of the fungiform papillae and a history of both burning the tongue easily and irritation of the tongue by food. There was an increased likelihood of a history of irritation of the tongue with certain foods amongst atopic participants and they were also more likely to burn their tongue with hot food than those who were nonatopic. Conclusion(s): Atopic people are more likely than the normal community to have inflammation of the fungiform papillae of their tongue which correlates with a history of a sensitive tongue manifest as irritation by heat and certain foods

Objective: To determine the risk and timing of a broad range of infective outcomes and mortality after splenectomy. Design, setting and participants: Analysis of a non-identifiable linked hospital discharge administrative dataset for splenectomy cases between July 1998 and December 2006 in Victoria, Australia. Main Outcome Measure(s): Age, sex, indication for splenectomy, infectious events and death. Patients splenectomised for trauma were compared with patients splenectomised for other indications. Infectious risk was established using Cox proportional hazards models. Result(s): A total of 2574 patients underwent splenectomy (with 8648 personyears follow-up). Paediatric cases were excluded, leaving 2472 adult cases for analysis. The most common reasons for splenectomy were trauma (635 [25.7%]) and therapeutic haematological indications (583 [23.6%]). After splenectomy, 644 adult patients (26.0%) had a severe infection, with a rate of 8.0 per 100 person-years (95% CI, 7.2-8.4). The risk of severe infection was highest among patients aged >= 50 years (1.9 per 100 person-years; 95% CI, 1.6-2.7) and those splenectomised for malignancy (14.2 per 100 person-years; 95% CI, 11.8-17.1). Gram-negative infections represented the most frequent causative organism group, accounting for 698 (51%) of bacterial pathogens. Staphylococcus aureus was the second most common causative organism. Conclusion(s): The incidence of severe infection and all-cause mortality differed according to age and underlying reason for splenectomy, was highest among the elderly and those with malignancy, and was lowest among trauma patients. This highlights the need for targeted prevention programs.

Obstructive sleep apnoea (OSA) in children is commonly considered to occur predominantly in rapid eye movement (REM) sleep, but clinical experience suggests that this is not universally the case. We hypothesized that there would be a subgroup of children with OSA who have non-REM (NREM) predominance of obstructive events and that these children share certain clinical characteristics. Thus, we aimed to compare the obstructive apnoea-hypopnoea index (OAHI) in REM versus NREM sleep and to assess factors influencing the distribution of events by sleep state. Polysomnography (PSG) recordings of 102 children aged 0-18 years with moderate to severe OSA (OAHI >=5 h-1) were reviewed. OAHI was calculated separately for REM and NREM sleep. A REM predominance index (RPI) was determined using log transformation [RPI = log (REM OAHI + 0.5) - log (NREM OAHI + 0.5)] and compared with possible influencing factors using multiple linear regression. Analysis showed that obstructive events were more common in REM sleep (median REM OAHI 21.4 h-1, median NREM OAHI 8.3 h-1, P < 0.001). Mean RPI was significantly greater than zero (P = 0.003). However, a substantial minority of children (30.4%) had a higher NREM than REM OAHI. The factors that were related significantly to NREM predominance were older age (P = 0.02), higher arousal index (P < 0.001) and higher SpO2 nadir (P < 0.001). Our findings demonstrate that while OSA is a REM sleep-related problem in the majority of children, there is a significant subset of children with NREM predominance of obstructive events. This finding highlights the importance of considering sleep state distribution of events in studies of the pathophysiology and outcomes of OSA in childhood. © 2009 European Sleep Research Society.

Background: Urgent and emergency coronary artery bypass grafting may be associated with significant mortality and morbidity. We report our recent experience with this group of patients. Method(s): A retrospective analysis of 441 patients undergoing urgent and emergency surgery over a 3-year period was carried out. Multivariate analysis was used to identify subgroups of patients who were most at risk of death. Result(s): The 30-day mortality was 3.3 and 16.3% in the urgent and emergency groups, respectively. Urgent surgery was associated with significantly shorter duration of ventilation (16 h vs 69 h) and stay at the intensive care unit (31 h vs 102 h). The incidence of pneumonia, pulmonary embolism, renal failure and neurological events were also less in the urgent group. The preoperative use of the intra-aortic balloon pump was low (0.8% in the urgent group and 4.8% in the emergency group). Multivariate analysis showed that patients over 70 years of age (odds ratio 3.2, 95% confidence interval 1.1-9.5) with left main stenosis (odds ratio 4.4, 95% confidence interval 1.5-12.4) complicated by cardiogenic shock (odds ratio 17.8, 95% confidence interval 5.2-61.1) were at highest risk of death. Patients transferred directly to theatre from cardiac catheter laboratory following failed percutaneous interventions were found to be most at risk. Mortality in this group was 29%, with 50% patients being in shock and 36% having left main stenosis. Conclusion(s): Satisfactory results have been obtained in urgent coronary artery bypass grafting, but acute coronary syndromes complicated by cardiogenic shock remain a high-risk group. Further studies are needed to define the optimal operative management in this group of patients. © 2006 Royal Australasian College of Surgeons.

OBJECTIVE: Sleep-disordered breathing (SDB) in adults has been associated with elevated blood pressure (BP); however, the effects of severity of SDB on BP in children are uncertain. We addressed this issue by measuring BP noninvasively and continuously during sleep in children with a range of severities of SDB and in a group of nonsnoring control children. METHOD(S): A total of 105 children referred for assessment of SDB and 36 nonsnoring controls were studied. Routine polysomnography (PSG) was performed with continuous BP monitoring. Children were assigned to groups according to obstructive apnea/hypopnea index (OAHI). BP data were categorized as quiet awake (recorded before sleep onset), non-rapid eye movement sleep 1 and 2 combined, slow-wave sleep, and rapid eye movement sleep. RESULT(S): BP during awake before sleep onset and during overnight sleep was elevated by 10 to 15 mm Hg in the 3 SDB groups compared with the control group; this finding was independent of SDB severity. BP during stable sleep (with respiratory events and movements excluded) was also elevated in the children with OSA compared with the control group. BP was elevated in rapid eye movement sleep compared with the non-rapid eye movement sleep, and heart rate was higher during wake state than in all sleep states. CONCLUSION(S): We recorded BP continuously overnight and found that SDB, regardless of the severity, was associated with increased BP during sleep and wake compared with nonsnoring control children. These findings highlight the importance of considering the cardiovascular effects of SDB of any severity in children, and the need to review current clinical management that focuses primarily on more severe SDB. Copyright © 2011 by the American Academy of Pediatrics.

Background: Hypertriglyceridaemia is a recognised metabolic abnormality in HIV-infected people, increasing in severity in people treated with highly active antiretroviral therapy (HAART). An alternative treatment for hypertriglyceridaemia in non-HIV-infected populations is omega-3 fatty acid supplementation. This study aimed to compare the effectiveness ofomega-3 fatty acid supplementation and placebo in lowering fasting triglyceride levels in HIV-infected patients on HAART. Method(s): A placebo-controlled, randomised, double-blind trial in participants on stable HAART with fasting triglycerides of >3.5mM to 10.0 mM using 9 g of omega-3 fatty acids versus placebo (olive oil) after a 6-week lead in on dietary therapy. Result(s): Eleven patients were enrolled. The mean triglyceride level for the population decreased from 5.02 mM at baseline to 4.44mM (-11.6%) after dietary intervention and 3.37 mM (-32.9%) after the 8-week treatment period. In the omega-3 fatty acid arm of the study, triglycerides fell from 5.34 mM to 5.02 mM (-6%) after dietary intervention and to 2.30 mM (-56.9%) after the treatment period. In the placebo arm of the study, triglycerides fell from 4.77 mM to 4.05 mM (-15.1%) after dietary intervention and to 4.08 mM (-14.5%) after the treatment period. Using the random effects model, a statistically significant effect on triglycerides of omega-3 fatty acid versus placebo was found (chi2=6.04, P=0.0487). The estimated difference between groups for change in mean triglycerides over 8 weeks was-2.32 mM (95% CI-4.52,-0.12 mM). Conclusion(s): Omega-3 fatty acids are likely to be an effective treatment for hypertriglyceridaemia in HIV-infected males on HAART. © CSIRO 2006.

Objective: The aim was to develop an electronic adverse event (AE) screening tool applicable to acute care hospital episodes for patients admitted with chronic heart failure (CHF) and pneumonia. Design(s): Consensus building using a modified Delphi method and descriptive analysis of hospital discharge data. Participant(s): Consultant physicians in general medicine (n = 38). Intervention(s): In-hospital acquired (C-prefix) diagnoses associated with CHF and pneumonia admissions to 230 hospitals in Victoria, Australia, were extracted from the Victorian Admitted Episodes Data Set between July 2004 and June 2007. A 9-point rating scale was used to prioritize diagnoses acquired during hospitalization (routinely coded as a 'C-prefix' diagnosis to distinguish from diagnoses present on admission) for inclusion within an AE screening tool. Diagnoses rated a group median score between 7 and 9 by the physician panel were included. Main Outcome Measure(s): Selection of C-prefix diagnoses with a group median rating of 7-9 in a screening tool, and the level of physician agreement, as assessed using the Interpercentile Range Adjusted for Symmetry. Result(s): Of 697 initial C-prefix diagnoses, there were high levels of agreement to include 113 (16.2%) in the AE screening tool. Using these selected diagnoses, a potential AE was flagged in 14% of all admissions for the two index conditions. Intra-rater reliability for each clinician ranged from kappa 0.482 to 1.0. Conclusion(s): A high level of physician agreement was obtained in selecting in-hospital diagnoses for inclusion in an AE screening tool based on routinely collected data. These results support further tool validation. © The Author 2012. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Background and Purpose-: Traditional vascular risk factors do not completely explain the asymmetry, racial, and sex differences in carotid artery disease. Carotid anatomy and geometry may play a role in the pathogenesis of internal carotid artery (ICA) stenosis, but their effects are unknown. We hypothesized that carotid artery anatomy and geometry would be independently associated with ICA stenosis. Method-: This is a retrospective study of patients with CT angiography at Monash Medical Centre, 2006 to 2007. Carotid arteries were segmented using semiautomated Methods to estimate measures of carotid anatomy and geometry. Measurements of carotid artery geometry were performed according to the recent article by Thomas and colleagues. ICA stenosis was dichotomized as <30% or >=30% stenosis. Cluster logistic regression was used to examine the associations of anatomy and geometry with stenosis accounting for the paired arteries within subjects, adjusting for age, sex, and vascular risk factors. Results-: Mean age of the sample (n=178) was 68.4 years (SD, 14 years). The following were independently associated with ICA stenosis: ICA radius at the bifurcation (OR, 0.20; 95% CI, 0.14-0.29), ICA angle (OR, 1.05 per degree increment; 95% CI, 1.04-1.07), age (OR, 1.05 per year increment; 95% CI, 1.03-1.07), male sex (OR, 1.72; 95% CI, 1.08-2.8), and ever-smoker (OR, 1.85; 95% CI, 1.15-2.96). Conclusions-: Carotid anatomy and geometry may enhance the risk of stenosis independent of traditional vascular risk factors and may be of help in very early identification of patients at high risk of developing carotid artery atherosclerosis for aggressive intervention. © 2012 American Heart Association, Inc.

Background: The administration of antenatal corticosteroids to women at risk of preterm birth is an important component of care for such women. However, inevitably, attempts to maximise the number of women who receive corticosteroids ahead of preterm birth will also expose women perceived at risk who subsequently deliver at term. These women have not been previously quantified. Aim(s): To describe antenatal corticosteroid prescribing practices at a single institution over a seven-year period. Method(s): Interrogation of an electronic birthing outcome system supplemented by hand-searching of medical records, recording all women birthing before 34 weeks and all women with a hospital admission before 34 weeks but birthing after 34 weeks. The number of women receiving antenatal corticosteroids in each of these groups was recorded, and trends between groups and over time were analysed using logistic regression. Result(s): While the total number of women receiving antenatal corticosteroids in our institution has risen over the last seven years, the proportion of women receiving antenatal corticosteroids who deliver between 24 and 35 weeks has increased inconsistently and modestly (average increase 12% per year (95% CI: 6-19%, P < 0.001). In contrast, the number of women receiving antenatal corticosteroids who subsequently deliver after 34 weeks has increased consistently, with an average increase rate of 21% per year (95% CI: 16-25%, P < 0.001). Conclusion(s): Increasing numbers of women birthing after 34 weeks in our hospital are receiving antenatal corticosteroids before 34 weeks. The long-term implications of this are not currently clear. © 2007 The Authors Journal compilation © 2007 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Background: Asthma, eczema and hay fever are the classical manifestations of atopic disease. Geographic tongue (benign migratory glossitis) has also been reported to be a manifestation. Anecdotally, atopic people frequently report irritation of the tongue by heat and certain foods, which may be more common than realized. Objective(s): To determine whether atopic people have an increased likelihood of a sensitive tongue manifest as inflamed fungiform papillae and a history of irritation by certain foods. Patients/methods: A descriptive classification of inflammation of the fungiform papillae on the tongue was developed using a 9-point analogue scale where 1 was considered normal and 9 was considered to be severely inflamed. An opportunistic sample of participants were classified as atopic or not on the basis of a personal history of asthma, eczema or hay fever. An examination of the tongue was performed using the classification and then a questionnaire was administered on whether they burnt their tongue easily with hot food and whether they were irritated by certain foods. Result(s): There were 200 participants aged 20 years and over of whom 104 (52%) were classified as atopic on the basis of the personal history. There was a significant positive association between increasingly inflamed fungiform papillae and the likelihood of being atopic. There was also a positive association between increasing inflammation of the fungiform papillae and a history of both burning the tongue easily and irritation of the tongue by food. There was an increased likelihood of a history of irritation of the tongue with certain foods amongst atopic participants and they were also more likely to burn their tongue with hot food than those who were nonatopic. Conclusion(s): Atopic people are more likely than the normal community to have inflammation of the fungiform papillae of their tongue which correlates with a history of a sensitive tongue manifest as irritation by heat and certain foods

Objective. To determine cancer risk in a cohort of 459 rheumatoid arthritis (RA) patients treated with methotrexate in community practice. Methods. All RA patients who started methotrexate prior to June 1986 and were attending 1 of 6 rheumatologists were studied. Demographic data were matched to the State Cancer Registry to identify all malignancies (except nonmelanoma skin cancer) for 1983-1998, and to the National Death Index to identify all deaths to the end of 1999. Followup started on the date when methotrexate was started and ended either on the last confirmed date on which the patient was seen hy the rheumatologist or at death. Standardized incidence ratios (SIRs) were calculated using state population cancer rates stratified by sex, age (in 5-year groups), and calendar year. Results. There were 4,145 person-years of followup (average 9.3 years). Eighty-seven malignancies were identified (14 before, 64 during, and 9 after the followup period). There was an estimated 50% excess risk of malignancy among methotrexate-exposed RA patients relative to the general population (SIR 1.5, 95% confidence interval [95% CI] 1.2-1.9), with a 3-fold increase in melanoma (SIR 3.0, 95% CI 1.2-6.2), a 5-fold increase in non-Hodgkin's lymphoma (SIR 5.1, 95% CI 2.2-10.0), and an almost 3-fold increase in lung cancer (SIR 2.9, 95% CI 1.6-4.8). Conclusion. Compared with the general population, methotrexate-treated RA patients have an increased incidence of melanoma, non-Hodgkin's lymphoma, and lung cancer. There may be a role for regular skin cancer screening for all RA patients, particularly those receiving immunosuppressive therapy. © 2008, American College of Rheumatology.

Objective: To determine the risk and timing of a broad range of infective outcomes and mortality after splenectomy. Design, setting and participants: Analysis of a non-identifiable linked hospital discharge administrative dataset for splenectomy cases between July 1998 and December 2006 in Victoria, Australia. Main Outcome Measure(s): Age, sex, indication for splenectomy, infectious events and death. Patients splenectomised for trauma were compared with patients splenectomised for other indications. Infectious risk was established using Cox proportional hazards models. Result(s): A total of 2574 patients underwent splenectomy (with 8648 personyears follow-up). Paediatric cases were excluded, leaving 2472 adult cases for analysis. The most common reasons for splenectomy were trauma (635 [25.7%]) and therapeutic haematological indications (583 [23.6%]). After splenectomy, 644 adult patients (26.0%) had a severe infection, with a rate of 8.0 per 100 person-years (95% CI, 7.2-8.4). The risk of severe infection was highest among patients aged >= 50 years (1.9 per 100 person-years; 95% CI, 1.6-2.7) and those splenectomised for malignancy (14.2 per 100 person-years; 95% CI, 11.8-17.1). Gram-negative infections represented the most frequent causative organism group, accounting for 698 (51%) of bacterial pathogens. Staphylococcus aureus was the second most common causative organism. Conclusion(s): The incidence of severe infection and all-cause mortality differed according to age and underlying reason for splenectomy, was highest among the elderly and those with malignancy, and was lowest among trauma patients. This highlights the need for targeted prevention programs.

Obstructive sleep apnoea (OSA) in children is commonly considered to occur predominantly in rapid eye movement (REM) sleep, but clinical experience suggests that this is not universally the case. We hypothesized that there would be a subgroup of children with OSA who have non-REM (NREM) predominance of obstructive events and that these children share certain clinical characteristics. Thus, we aimed to compare the obstructive apnoea-hypopnoea index (OAHI) in REM versus NREM sleep and to assess factors influencing the distribution of events by sleep state. Polysomnography (PSG) recordings of 102 children aged 0-18 years with moderate to severe OSA (OAHI >=5 h-1) were reviewed. OAHI was calculated separately for REM and NREM sleep. A REM predominance index (RPI) was determined using log transformation [RPI = log (REM OAHI + 0.5) - log (NREM OAHI + 0.5)] and compared with possible influencing factors using multiple linear regression. Analysis showed that obstructive events were more common in REM sleep (median REM OAHI 21.4 h-1, median NREM OAHI 8.3 h-1, P < 0.001). Mean RPI was significantly greater than zero (P = 0.003). However, a substantial minority of children (30.4%) had a higher NREM than REM OAHI. The factors that were related significantly to NREM predominance were older age (P = 0.02), higher arousal index (P < 0.001) and higher SpO2 nadir (P < 0.001). Our findings demonstrate that while OSA is a REM sleep-related problem in the majority of children, there is a significant subset of children with NREM predominance of obstructive events. This finding highlights the importance of considering sleep state distribution of events in studies of the pathophysiology and outcomes of OSA in childhood. © 2009 European Sleep Research Society.

Background: Urgent and emergency coronary artery bypass grafting may be associated with significant mortality and morbidity. We report our recent experience with this group of patients. Method(s): A retrospective analysis of 441 patients undergoing urgent and emergency surgery over a 3-year period was carried out. Multivariate analysis was used to identify subgroups of patients who were most at risk of death. Result(s): The 30-day mortality was 3.3 and 16.3% in the urgent and emergency groups, respectively. Urgent surgery was associated with significantly shorter duration of ventilation (16 h vs 69 h) and stay at the intensive care unit (31 h vs 102 h). The incidence of pneumonia, pulmonary embolism, renal failure and neurological events were also less in the urgent group. The preoperative use of the intra-aortic balloon pump was low (0.8% in the urgent group and 4.8% in the emergency group). Multivariate analysis showed that patients over 70 years of age (odds ratio 3.2, 95% confidence interval 1.1-9.5) with left main stenosis (odds ratio 4.4, 95% confidence interval 1.5-12.4) complicated by cardiogenic shock (odds ratio 17.8, 95% confidence interval 5.2-61.1) were at highest risk of death. Patients transferred directly to theatre from cardiac catheter laboratory following failed percutaneous interventions were found to be most at risk. Mortality in this group was 29%, with 50% patients being in shock and 36% having left main stenosis. Conclusion(s): Satisfactory results have been obtained in urgent coronary artery bypass grafting, but acute coronary syndromes complicated by cardiogenic shock remain a high-risk group. Further studies are needed to define the optimal operative management in this group of patients. © 2006 Royal Australasian College of Surgeons.

OBJECTIVE: Sleep-disordered breathing (SDB) in adults has been associated with elevated blood pressure (BP); however, the effects of severity of SDB on BP in children are uncertain. We addressed this issue by measuring BP noninvasively and continuously during sleep in children with a range of severities of SDB and in a group of nonsnoring control children. METHOD(S): A total of 105 children referred for assessment of SDB and 36 nonsnoring controls were studied. Routine polysomnography (PSG) was performed with continuous BP monitoring. Children were assigned to groups according to obstructive apnea/hypopnea index (OAHI). BP data were categorized as quiet awake (recorded before sleep onset), non-rapid eye movement sleep 1 and 2 combined, slow-wave sleep, and rapid eye movement sleep. RESULT(S): BP during awake before sleep onset and during overnight sleep was elevated by 10 to 15 mm Hg in the 3 SDB groups compared with the control group; this finding was independent of SDB severity. BP during stable sleep (with respiratory events and movements excluded) was also elevated in the children with OSA compared with the control group. BP was elevated in rapid eye movement sleep compared with the non-rapid eye movement sleep, and heart rate was higher during wake state than in all sleep states. CONCLUSION(S): We recorded BP continuously overnight and found that SDB, regardless of the severity, was associated with increased BP during sleep and wake compared with nonsnoring control children. These findings highlight the importance of considering the cardiovascular effects of SDB of any severity in children, and the need to review current clinical management that focuses primarily on more severe SDB. Copyright © 2011 by the American Academy of Pediatrics.