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Biological neural networks are capable of recruiting different sets of neurons to encode different memories. However, when training artificial neural networks on a set of tasks, typically, no mechanism is employed for selectively producing anything analogous to these neuronal ensembles. Further, artificial neural networks suffer from catastrophic forgetting, where the network's performance rapidly deteriorates as tasks are learned sequentially. By contrast, sequential learning is possible for a range of biological organisms. We introduce Learned Context Dependent Gating (LXDG), a method to flexibly allocate and recall `artificial neuronal ensembles', using a particular network structure and a new set of regularization terms. Activities in the hidden layers of the network are modulated by gates, which are dynamically produced during training. The gates are outputs of networks themselves, trained with a sigmoid output activation. The regularization terms we have introduced correspond to properties exhibited by biological neuronal ensembles. The first term penalizes low gate sparsity, ensuring that only a specified fraction of the network is used. The second term ensures that previously learned gates are recalled when the network is presented with input from previously learned tasks. Finally, there is a regularization term responsible for ensuring that new tasks are encoded in gates that are as orthogonal as possible from previously used ones. We demonstrate the ability of this method to alleviate catastrophic forgetting on continual learning benchmarks. When the new regularization terms are included in the model along with Elastic Weight Consolidation (EWC) it achieves better performance on the benchmark `permuted MNIST' than with EWC alone. The benchmark `rotated MNIST' demonstrates how similar tasks recruit similar neurons to the artificial neuronal ensemble., Comment: 13 pages, 9 figures

The Iowa Perinatal Project is aimed at understanding the nature of maternal psychopathology across the perinatal period.

Obstructive Sleep Apnoea (OSA) and narcolepsy are sleep disorders associated with multiple other symptoms caused by problems with: - breathing at night (OSA), - the inability of the brain to regulate sleep and wake patterns (narcolepsy). People with OSA and narcolepsy experience delayed diagnosis and poor access to hospital care and treatments. Our study uses anonymous information collected from NHS patient records in the United Kingdom by the Clinical Practice Research Datalink (CPRD). CPRD data describing diagnoses and symptoms, including OSA and narcolepsy, are limited to codes that can be linked to a medical dictionary. We aim to confirm that this coded information is sufficient to study OSA and narcolepsy by asking GPs to complete a questionnaire using more detailed information, including hospital letters, that are available to them. We will describe (1) how healthcare services are used by people with these sleep disorders and (2) other medical conditions they experience, both before and after diagnosis. In doing so, we might uncover misdiagnoses, common referral routes, preventable and comorbid conditions, and inequalities in care. We will provide data comparing healthcare costs for people with and without these conditions before and after diagnosis. Findings will be used by people with OSA and narcolepsy, and the organisations and doctors who support them, to influence future pathways that reduce time to diagnosis and improve access to healthcare, thus providing better joined up treatment of sleep disorders and related conditions. The research and Patient Public Involvement work will be expanded in future to study other uncommon or under-recognised conditions.

Additional file 1: Table A1. Initial 42 nutritional risk indicators, ranked and placed in quartiles (Round 1, part 1), displaying per cent agreement of key stakeholders (Round 1, part 2) and the expert panel (Round 2). Table A2. Nutritional Risk Indicators, ranked and placed in quartiles, displaying agreement percent and weighted mean scores of key stakeholders (Round 3). Table A3. Principal Component Analysis of the final 15 nutritional risk indicators. Table A4. Component score coefficient matrix for the four components with the validated importance ranking of nutritional indicator variables. Figure A1. Scree plot of eigenvalues after principal component analysis

Quantifying the resilience in the food system is important for food security issues. In this work, we present a geospatial knowledge graph (GeoKG)-based method for measuring the resilience of a multi-commodity flow network. Specifically, we develop a CFS-GeoKG ontology to describe geospatial semantics of a multi-commodity flow network comprehensively, and design resilience metrics that measure the node-level and network-level dependence of single-sourcing, distant, or non-adjacent suppliers/customers in food supply chains. We conduct a case study of the US state-level agricultural multi-commodity flow network with hierarchical commodity types. The results indicate that, by leveraging GeoKG, our method supports measuring both node-level and network-level resilience across space and over time and also helps discover concentration patterns of agricultural resources in the spatial network at different geographic scales., Comment: 9 pages, 5 figures, GeoKG'22

Additional file 2.

Enhanced carbon sequestration in vegetation and organic-rich substrates and soils, or Nature-based Carbon Sinks (NCS), can play a key role in mitigating climate change. Globally, research on NCS has tended to concentrate on the science of carbon sequestration; processes through which NCS and how trade-offs with potentially competing demands on natural resources might be most effectively governed have received relatively little attention. This systematic review goes some way toward redressing this imbalance by examining published accounts of the governance of NCS. The review focuses on Southeast Asia, a highly dynamic part of the world with great potential for enhanced carbon sequestration in NCS. A total of 94 articles, 10% of those initially selected from relevant journal articles published between January 2015 and December 2020, focusing on the governance of NCS in Southeast Asia, were subjected to detailed content analysis. The period of interest commences with the release and signing of the 2015 Paris Agreement due to the surge in publications on NCS that followed. Results of the analysis reveal weaknesses in climate governance that, along with competing land uses and rising demands for natural resources, present significant risks to current and future carbon sequestration in NCS. Our systematic literature review, suited to assessing where knowledge gaps exist, thus provides the basis for a future research agenda aimed at supporting the development of holistic and adaptive forms of governance of NCS. Important gaps revealed by the review comprise an uneven geographic coverage that renders governance in several countries and types of NCS in Southeast Asia largely invisible, a focus on either the local or the national scale that leaves the supranational scale and linkages between different scales under-explored, and alternatives to established arrangements, notably REDD+ programmes.

Background Child maltreatment is a major public issue in the United States, yet most children affected by abuse or neglect never engage in evidence-based practices (EBP) for child mental health. Children’s Advocacy Centers (CACs’) are uniquely situated to serve as Family Navigators who connect children impacted by maltreatment to appropriate EBPs. In fact, the CAC position of Victim Advocate mirrors the Mental Health Family Navigator national initiative. Methods The feasibility study protocol is to develop, implement, and evaluate web-based and consultative training for Victim Advocates to enhance early engagement in services (E3 training). The interactive web-based training embeds key targets of knowledge and skills related to family engagement, trauma, and EBP services. Participating CACs were randomized to E3 webinar-based training, E3 webinar plus consultation, or delayed training. The project will test the E3 training’s impact on key mechanisms of change (e.g., knowledge, skills) to improve rates of screening, referral, and access to EBP services. The feasibility of implementing the training program and differential impact and costs by level of training will be examined. Discussion The overarching goal of this project is to test the feasibility of training that is readily implemented through CACs and examine the mechanisms for improving early engagement and, ultimately, child, and adolescent mental health outcomes. Results and cost findings will be used to plan a large-scale comprehensive, mixed-methods hybrid type II effectiveness-implementation and cost-effectiveness trial of family navigator E3 training. If outcomes are positive, considerable infrastructure exists to support the scale-up and sustainability of E3 training nationwide, by embedding the training in national CAC training protocols. Trial registration NCT04221633 Date and version identifier March 25, 2021; Vers. 1.0 (original); September 11, 2021; Vers 2.0 (revision); October 29, 2021; Vers. 3.0 (revision)

Additional file 1.

Supplementary data. (DOCX 14 kb)

The five West African states making up the G5 Sahel rely on foreign contributions to support the nascent regional organization. In February 2018, the European Union (EU) and Saudi Arabia were the top contributors to the G5, each pledging 100 million euros. The investment from the EU builds upon previous agreements and missions for regional development and security. The equal contribution from Saudi Arabia is unprecedented. The partnership with the Sahel G5 emerged about the same time as another Saudi Arabian initiative, the Islamic Military Counter-Terrorism Coalition (IMCTC). The IMCTC serves as the construct for the G5 Sahel partnership. Another relevant actor and investor with the IMCTC is the United Arab Emirates, contributing 30 million euros to the G5, and backing Saudi regional plans. The emergence of a new regional power acting in the Sahel motivated a comparison study with the EU. The research question will answer which external partner(s), the European Union, or SA with the UAE, is more influential over the political, economic and security goals and activities of the G5 Sahel. To determine the effect of EU, Saudi and UAE investment in the G5 Sahel this thesis will include a review of the respective partnerships and the comparison of a series of indicators to determine which partner, and to what extent they influence the region.

Additional file 1. Associations between goal energy (and protein) intake and 28-day mortality by multivariable logistic regressions.

Inhibitors of the phosphatidylinositol 3-kinase (PI3K) pathway are at the forefront of the search for novel cancer treatments, as aberrations in the pathway are found in up to 50% of human cancers. Class I PI3K consists of four isoforms, PI3Kα, PI3Kβ, PI3Kγ and PI3Kδ, which phosphorylate phosphatidylinositol 4,5-bisphosphate to form the second messenger, phosphatidylinositol 3,4,5-trisphosphate. This second messenger signals downstream to regulate cell metabolism, growth and proliferation. Oncogenic mutations in PI3Kα occur in approximately 30% of colorectal cancers and 25-40% of breast cancers. The work in this thesis has sought to add to the understanding of isoform selectivity in PI3K inhibitors, which will hopefully contribute to the successful treatment of human cancers. This has been conducted in two parts: (i) the structural investigation of wild-type PI3Kα, examining the differences in regulation compared with the oncogenic mutant, p110αHis1047Arg, and the characterisation of the lipid-binding site; (ii) the design, synthesis and testing of novel PI3K inhibitors designed to explore the determinants of isoform selectivity. Chapters 3 and 4 have described the synthesis and testing of 38 analogues of the pan PI3K inhibitor, ZSTK474. In Chapter 3, an efficient, regioselective synthetic method was developed for the synthesis of 5- and 6-substituted benzimidazole derivatives of ZSTK474. Methoxy substitutions at these positions resulted in a decrease in potency at PI3Kα. A more dramatic impact on PI3Kγ potency was observed, suggesting alternative substitutions at this position may be a suitable method to dial out PI3Kγ inhibition. Two hydroxyphenyl substituents were investigated as alternatives to the 2-difluoromethylbenzimidazole substituent of ZSTK474. The 3-hydroxyphenyl substituted compounds (37-42) had a greater preference for the PI3Kα isoform than the equivalent 2-difluoromethylbenzimidazole compounds (25a-f), despite a decrease in potency. The 3-hydroxyphenyl substituted compounds also showed significantly greater selectivity against PI3Kγ, suggesting it may be a better affinity pocket binding moiety for the development of PI3Kα selective inhibitors. More work is required to optimise the other binding moiety, replacing a morpholine group of ZSTK474, to improve potency and PI3Kα selectivity. In Chapter 4, a series of inhibitors targeting a specific non-conserved residue in PI3Kα, p110αGln859, was designed, synthesised and tested. Compounds showed a general trend of improved selectivity towards PI3Kδ, due to the presence of a similar residue at the analogous position, p110δAsn836. Compound 46 was the most PI3Kδ selective compound, showing a selectivity of 6-35-fold. Compound 50 displayed the greatest selectivity for PI3Kδ against PI3Kβ of 21-fold. Site-directed mutagenesis assay results of compound 50 are consistent with interactions at the residue p110αGln859. The work in thesis has investigated the design of novel PI3Kα inhibitors. The identification of key differences in interaction and regulation between wild-type PI3Kα and the oncogenic mutant, p110αHis1047Arg has the potential to inform the design of novel, oncogenic mutant specific inhibitors. The characterisation of the PI3Kα lipid-binding site can aid in the structure-based drug design of lipid-competitive inhibitors, potentially providing increased selectivity over related protein kinases. We have demonstrated the applicability of targeting specific non-conserved residues in the PI3K binding site for the rational design of isoform selective inhibitors, and the importance of the affinity pocket binding portion of the inhibitor for dialling out PI3Kγ inhibition.

Ethnic identity is a construct that has been studied for decades in the field of psychology. Much of this literature has focused on contextual factors that may contribute to the development of ethnic identity, as well as how ethnic identity impacts mental health. The purpose of this study was to better understand ethnic identity across different racial and ethnic groups, which social factors are related to ethnic identity in adolescents, and the relationship between ethnic identity and adolescent depression. In a sample of 186 adolescents, ethnic identity was higher in Hispanic youth than Black, Non-Hispanic or White, Non-Hispanic youth. Greater parental support and feelings of school connectedness were predictive of concurrent ethnic identity; parental conflict was not significantly associated with ethnic identity. Ethnic identity did not significantly predict concurrent depressive symptoms. This study highlights the importance of positive social relationships in the development of adolescent ethnic identity. Future research should incorporate general measures of well-being to better understand the relationship between ethnic identity and mental health during adolescence.

This dissertation examines the Indonesian state’s capacity to respond to separatist challenges from Aceh in the period from May 1998 to May 2003. It is a political study of centre-periphery relations seen from the perspective of the centre. With its theoretical focus on the capacity of democratising regimes to deal with their national identity problems/ territorial disputes, this study of Indonesia’s efforts to contain the Aceh conflict through its security and autonomy policy approaches will contribute to the comparative study of post authoritarian regimes contending with internal conflicts. The central thesis is that although Indonesian state capacity was reduced by the change of regime in 1998 and the consequences of the 1997 national economic crisis, Jakarta did have a window of opportunity through which to democratically accommodate the Acehnese people after the initiation of democratisation. This opportunity to implement democratic reforms only existed in Aceh for a limited period after regime change. The more time that elapsed after Suharto’s resignation, the more GAM gained political influence and the more the TNI gradually reasserted itself as the defender of national unity under successive weak civilian governments, with the result that depredations against the civilian population increased and the state’s capacity to effectively govern further declined. In treating the methodological approaches of structure and agency as symbiotic and inter-related, the study views Indonesian state capacity both in terms of the political will and interests of those who shaped Aceh policy choices and their material conditions and institutional networks. That is, the structural and functional constraints imposed by the New Order’s authoritarian legacy and the national economic collapse, as well as the general lack of political will in Jakarta to pursue a negotiated settlement in the five years after the initiation of democratisation are seen as the primary reasons for the escalation of conflict in Aceh in the post-Suharto era. In this, a reoccurring theme in the thesis is that despite the adverse material preconditions facing Indonesia’s political leadership at the point of regime change, with enough political will and determination, a peaceful settlement to the Aceh conflict was not only possible, but achievable, as the successful post tsunami peace process with GAM under Susilo Bambang Yudhoyono’s presidency would later show.

Ensembles of distributed, heterogeneous resources, or Computational Grids, have emerged as popular platforms for large-scale scientific applications. This paper presents the Virtual Instrument project which targets those platforms. More specifically, the project seeks to provide an integrated application execution environment that enables end-users to run and interact with running scientific simulations on the Grid. This work is performed in the specific context of a computational biology application: MCell. Even though MCell provides the basis for running simulations, its capabilities are currently limited in terms of scale, ease-of-use, and interactivity. Those limitations preclude usage scenarios that are critical for scientific advances. Our goal is to create a scientific ``Virtual Instrument'' from MCell by allowing its users to transparently access Grid resources while being able to steer running simulations. In this paper, we motivate the need for an MCell Virtual Instrument. We then introduce a scheduling strategy that exploits the structure of MCell simulations and uses task priorities to accommodates computational steering. Finally, we describe our innovations and contributions in terms of Grid software design and development.Pre-2018 CSE ID: CS2002-0707

A survey that can cover the sky in optical bands over wide fields to faint magnitudes with a fast cadence will enable many of the exciting science opportunities of the next decade. The Large Synoptic Survey Telescope (LSST) will have an effective aperture of 6.7 meters and an imaging camera with field of view of 9.6 deg^2, and will be devoted to a ten-year imaging survey over 20,000 deg^2 south of +15 deg. Each pointing will be imaged 2000 times with fifteen second exposures in six broad bands from 0.35 to 1.1 microns, to a total point-source depth of r~27.5. The LSST Science Book describes the basic parameters of the LSST hardware, software, and observing plans. The book discusses educational and outreach opportunities, then goes on to describe a broad range of science that LSST will revolutionize: mapping the inner and outer Solar System, stellar populations in the Milky Way and nearby galaxies, the structure of the Milky Way disk and halo and other objects in the Local Volume, transient and variable objects both at low and high redshift, and the properties of normal and active galaxies at low and high redshift. It then turns to far-field cosmological topics, exploring properties of supernovae to z~1, strong and weak lensing, the large-scale distribution of galaxies and baryon oscillations, and how these different probes may be combined to constrain cosmological models and the physics of dark energy., 596 pages. Also available at full resolution at http://www.lsst.org/lsst/scibook

Objectives: To investigate causes of death of people with cancer alive five years after diagnosis, and to compare mortality rates for this group with those of the general population. Design, setting, participants: Retrospective cohort study; analysis of South Australian Cancer Registry data for all people diagnosed with cancer during 1990–1999 and alive five years after diagnosis, with follow-up to 31 December 2016. Main outcome measures: All-cause and cancer cause-specific mortality, by cancer diagnosis; standardised mortality ratios (study group v SA general population) by sex, age at diagnosis, follow-up period, and index cancer. Results: Of 32 646 people with cancer alive five years after diagnosis, 30 309 were of European background (93%) and 16 400 were males (50%); the mean age at diagnosis was 60.3 years (SD, 15.7 years). The median follow-up time was 17 years (IQR, 11–21 years); 17 268 deaths were recorded (53% of patients; mean age, 80.6 years; SD, 11.4 years): 7845 attributed to cancer (45% of deaths) and 9423 attributed to non-cancer causes (55%). Ischaemic heart disease was the leading cause of death (2393 deaths), followed by prostate cancer (1424), cerebrovascular disease (1175), and breast cancer (1118). The overall standardised mortality ratio (adjusted for age, sex, and year of diagnosis) was 1.24 (95% CI, 1.22–1.25). The cumulative number of cardiovascular deaths exceeded that of cancer cause-specific deaths from 13 years after cancer diagnosis. Conclusions: Mortality among people with cancer who are alive at least five years after diagnosis was higher than for the general population, particularly cardiovascular disease-related mortality. Survivorship care should include early recognition and management of risk factors for cardiovascular disease. Refereed/Peer-reviewed

Whilst there has been a wealth of research on benefits of physical activity (PA) in people with cancer, with three published reviews of reviews, no review of reviews has focused on older adults (65 years or older) who may have unique biological characteristics and barriers. We summarised PA effectiveness from reviews where majority of study participants were 65 years or older. Methods: Six databases were searched for systematic reviews of randomised controlled studies (RCTs)/quasi-RCTs examining any type of PA in reviews where majority of study participants were aged 65 years or older. Two reviewers conducted the search and analysis according to PRISMA and JBI guidelines. Results: Fifteen reviews involving 76 different primary studies (5404 participants) were included. The majority (3827; 71%) had prostate cancer. PA was associated with benefits across multiple physical outcomes (muscle mass, functional performance, strength), improved fatigue and health service outcomes. In contrast to younger adults, there was no improvement in anxiety and mixed findings for quality of life and depression. Conclusion: PA is associated with multiple benefits in older adults with cancer, with some differences compared to younger individuals which may reflect biological or behavioural determinants. Future research should focus on mechanisms underlying PA effectiveness and underrepresented populations Refereed/Peer-reviewed

Objective: Self-harm is an important public health issue in the UK. Young people who frequently self-harm feel misunderstood, and unable to access help. Improving understanding is key to informing the development and delivery of effective treatments and services. Methods: In this qualitative study, we interviewed nine adolescent girls (13–17 years old) with recurrent self-harm, recruited from NHS specialist child and adolescent mental health services. Data were analysed using Interpretative Phenomenological Analysis (IPA). Results: Findings revealed that self-harm is experienced as powerful mental and physical urges, sated only by self-harming, suggesting that self-harm could be considered a compulsive rather than impulsive disorder, representing a new perspective on the behaviour. Five themes emerged: emotion regulation, an addictive urge, self-harm to survive, interpersonal triggers, interpersonal relationships, not mechanical distractors, reduce self-harm. Conclusions: This study provides further evidence that non-suicidal self-injury may be engaged in to reduce suicidal risk. Seeking the company of helpful friends or family members may reduce the urge to self-harm. Repetitive self-harm may be a compulsive behaviour.

Objectives: This exploratory study sought to investigate the effect of cognitive functioning on the consistency of individual responses to a discrete choice experiment (DCE) study conducted exclusively with older people. Methods: A DCE to investigate preferences for multidisciplinary rehabilitation was administered to a consenting sample of older patients (aged 65 years and older) after surgery to repair a fractured hip (N = 84). Conditional logit, mixed logit, heteroscedastic conditional logit, and generalized multinomial logit regression models were used to analyze the DCE data and to explore the relationship between the level of cognitive functioning (specifically the absence or presence of mild cognitive impairment as assessed by the Mini-Mental State Examination) and preference and scale heterogeneity. Results: Both the heteroscedastic conditional logit and generalized multinomial logit models indicated that the presence of mild cognitive impairment did not have a significant effect on the consistency of responses to the DCE. Conclusions: This study provides important preliminary evidence relating to the effect of mild cognitive impairment on DCE responses for older people. It is important that further research be conducted in larger samples and more diverse populations to further substantiate the findings from this exploratory study and to assess the practicality and validity of the DCE approach with populations of older people. Refereed/Peer-reviewed

Objective: To empirically compare the measurement properties of the DEMQOL-U and DEMQOL-Proxy-U instruments to the EQ-5D-5L and its proxy version (CEQ-5D-5L) in a population of frail older people living in residential aged care in the post-hospitalisation period following a hip fracture. Methods: A battery of instruments to measure health-related quality of life (HRQoL), cognition, and clinical indicators of depression, pain and functioning were administered at baseline and repeated at 4 weeks’ follow-up. Descriptive summary statistics were produced and psychometric analyses were conducted to assess the levels of agreement, convergent validity and known group validity between clinical indicators and HRQoL measures. Results: There was a large divergence in mean (SD) utility scores at baseline for the EQ-5D-5L and DEMQOL-U [EQ-5D-5L mean 0.21 (0.19); DEMQOL-U mean 0.79 (0.14)]. At 4 weeks’ follow-up, there was a marked improvement in EQ-5D-5L scores whereas DEMQOL-U scores had deteriorated. [EQ-5D-5L mean 0.45 (0.38); DEMQOL-U mean 0.58 (0.38)]. The EQ-5D and CEQ-5D-5L were more responsive to the physical recovery trajectory experienced by frail older people following surgery to repair a fractured hip, whereas the DEMQOL-U and DEMQOL-Proxy-U appeared more responsive to the changes in delirium and dementia symptoms often experienced by frail older people in this period. Conclusions: This study presents important insights into the HRQoL of a relatively under-researched population of post-hospitalisation frail older people in residential care. Further research should investigate the implications for economic evaluation of self-complete versus proxy assessment of HRQoL and the choice of preference-based instrument for the measurement and valuation of HRQoL in older people exhibiting cognitive decline, dementia and other co-morbidities. Refereed/Peer-reviewed

Publisher's version made available in accordance with the publisher's policy., Objective: To investigate the preferences of frail older people for individualised multidisciplinary rehabilitation to promote recovery from a hip fracture. Design: Discrete Choice Experiment. Setting: Acute and Rehabilitation Hospitals in Adelaide, South Australia. Subjects: Eighty-seven patients with recent hip fracture (16 living in residential care facilities prior to fracture). Methods: Patients providing informed consent (or consenting family carer proxies in cases where patients were unable to provide informed consent (n = 10)) participated in a face to face interview following surgery to repair a fractured hip to assess their preferences for different configurations of rehabilitation programs. Results: Overall, participants expressed a strong preference for improvements in mobility and a willingness to participate in rehabilitation programs involving moderate pain and effort. However, negative preferences were observed for extremely painful interventions involving high levels of effort (2 h per day for 2 months). Subgroup analysis revealed consistently similar preferences according to place of residence (residential care vs community). Conclusions: Improvements in mobility are highly valued by frail older people recovering from hip fracture, including those living in residential care. Further research should be directed towards achieving greater equity in access to rehabilitation services for the wide spectrum of patients attending hospital with hip fractures. Key words: discrete choice experiment; hip fracture; older people; residential care; rehabilitation.

Ageing is associated with weight loss and subsequently poor health outcomes. The present study assessed agreement between two field methods, bioelectrical impedance spectroscopy (BIS) and corrected arm muscle area (CAMA) for assessment of body composition against dual-energy X-ray absorptiometry (DXA), the reference technique. Agreement between two predictive equations estimating skeletal muscle mass (SMM) from BIS against SMM from DXA was also determined. Assessments occurred at baseline < 14 d post-surgery (n 79), and at 6 months (6M; n 75) and 12 months (12M; n 63) in community-living older adults after surgical treatment for hip fracture. The 95 % limits of agreement (LOA) between BIS and DXA, CAMA and DXA and the equations and DXA were assessed using Bland–Altman analyses. Mean bias and LOA for fat-free mass (FFM) between BIS and DXA were: baseline, 0·7 ( − 10·9, 12·4) kg; 6M, − 0·5 ( − 20·7, 19·8) kg; 12M, 0·1 ( − 8·7, 8·9) kg and for SMM between CAMA and DXA were: baseline, 0·3 ( − 11·7, 12·3) kg; 6M, 1·3 ( − 4·5, 7·1) kg; 12M, 0·9 ( − 5·4, 7·2) kg. Equivalent data for predictive equations against DXA were: equation 1: baseline, 15·1 ( − 9·5, 20·6) kg; 6M, 17·1 ( − 12·0, 22·2) kg; 12M, 17·5 ( − 13·0, 22·0) kg; equation 2: baseline, 12·6 ( − 7·3, 19·9) kg; 6M, 14·4 ( − 9·7, 19·1) kg; 12M, 14·8 ( − 10·7, 18·9) kg. Proportional bias (BIS: β = − 0·337, P< 0·001; CAMA: β = − 0·294, P< 0·001) was present at baseline but not at 6M or 12M. Clinicians should be cautious in using these field methods to predict FFM and SMM, particularly in the acute care setting. New predictive equations would be beneficial., This research was supported by the National Health and Medical Research Council (NHMRC), Australia.

It is known that carbon (C) amendments increase microbial activity in anoxic soil microcosm studies, however the effects on abundance of total and denitrifier bacterial communities is uncertain. Quantitative PCR was used to target the 16S rRNA gene for the total bacterial community, the nosZ functional gene to reflect a broad denitrifier community, and functional genes from narrow denitrifier communities represented by Pseudomonas mandelii and related species ( cnorB P ) and Bosea / Bradyrhizobium / Ensifer spp . ( cnorB B ). Repacked soil cores were amended with varying amounts of glucose and red clover plant tissue (0–1000 mg C kg − 1 of soil) and incubated for 96 h. Carbon amendment significantly increased respiration as measured by cumulative CO 2 emissions. Inputs of red clover or glucose at 1000 mg C kg − 1 of soil caused increased abundance in the total bacteria under the conditions used. There was about an approximate 2-fold increase in the abundance of bacteria bearing the nosZ gene, but only in treatments receiving 500 or 1000 mg C kg − 1 of soil of glucose or red clover, respectively. Additions of ≥ 500 mg C kg − 1 soil of red clover and ≥ 250 mg C kg − 1 of glucose increased cnorB P -gene bearing denitrifiers. Changes in abundance of the targeted communities were related to C availability in soil, as indicated by soil respiration, regardless of C source. Applications of C amendments at rates that would occur in agricultural soils not only increase microbial activity, but can also induce changes in abundance of total bacterial and denitrifier communities in studies of anoxic soil microcosms.

Background and aim: Currently the operational model of a Falls Clinic is not clearly defined making it difficult to assess outcomes. Predominantly referrals are for older, frail adults and while there is merit in current interventions prescribed the effect on falls and other outcomes over time are unclear. The aim of this pilot study is to describe 12 month health outcomes of community-dwelling older adults who have attended a multi-disciplinary Falls Clinic. Methods: A sequential sample of 90 community-dwelling older adults (≥65 years) attending a Falls and Injury Risk Assessment Clinic between April and October 2001 was followed-up at 12 months. Outcomes included grip strength, Timed-Up and Go, body weight, number of fallers, and change in accommodation. Data are summarised as mean (SD) and n (%) with change over time tested using paired sample t-tests (continuous data) and chi-square (categorical data). Results: Sixty-five participants were available at 12 months. Mean (SD) age of participants was 80 (6) years and 30 of 65 (46%) were males. At 12 months, 62 (96%) remained in the same accommodation, 37 out of 65 (57%) reported >1 fall in the previous year, compared to 72% (n=47) on average at baseline (p=0.21). Grip strength (p=0.006), TUG (p=0.001) and body weight (p=0.033) all declined between baseline and 12 months. Conclusions: This pilot study found a trend for reduction in falls, but this was accompanied with a significant decline in measures of frailty, including outcomes of nutritional status, strength and mobility. Evaluation of more targeted multi-disciplinary frailty interventions in this at risk group are required. Refereed/Peer-reviewed

Aims and objectives. To determine whether a nurse-completed dialysis nutritional screening tool improves referral rates fornutritional support and compare nutrition sensitive biochemical indices, mortality rates and patient-centred quality of lifeoutcomes between referred and non-referred dialysis patients.Background. People with chronic kidney disease requiring dialysis are nutritionally at risk. Nutrition screening has beenshown to identify dialysis patients who are nutritionally at risk to refer to dietitian expertise.Design. Prospective cluster-randomised control trial.Methods. Monthly nurse-completed nutrition screening was completed for six consecutive months using a validated four-item instrument measuring weight change, serum phosphate, serum potassium and appetite. Participants (n = 81) were hae-modialysis patients from four satellite haemodialysis centres in one Australian metropolitan health service. Primary outcomemeasure was rate of referral to dietetic services for nutrition support for intervention vs. control groups at six months. Sec-ondary outcome measures were blood pressure, biochemical indices and mortality for referred vs. non-referred patients atsix and nine months, and generic and dialysis-specific quality of life for referred vs. non-referred at nine months was exam-ined.Results. There were three times as many dietetic referrals in the intervention group than in the control group (26 3 vs.9 3%). Serum phosphate increased significantly more in the referred patients than the non-referred patients. There were noclinically significant changes between groups in quality of life, blood pressure, mortality rates or other biochemical indicesat either six or nine months.Conclusion. Nurse-completed nutritional screening can lead to appropriate dietetic referrals for nutritional support by nutri-tional expert clinicians.Relevance to clinical practice. This study is the first to demonstrate that monthly systematic nurse-completed nutritionalscreening can facilitate appropriate dietetic referrals that may lead to increased nutritional care for people in satellite dialysiscentres.Key words: chronic kidney disease, community, haemodialysis, nursing, nutrition, renal nursing, screening, screening tools

Background Proximal femoral fractures are amongst the most devastating consequences of osteoporosis and injurious accidental falls with 25–35% of patients dying in the first year post-fracture. Effective rehabilitation strategies are evolving however, despite established associations between nutrition, mobility, strength and strength-related functional outcomes; there has been only one small study with older adults immediately following fragility fracture where a combination of both exercise and nutrition have been provided. The aim of the INTERACTIVE trial is to establish whether a six month, individualised exercise and nutrition program commencing within fourteen days of surgery for proximal femur fracture, results in clinically and statistically significant improvements in physical function, body composition and quality of life at an acceptable level of cost and resource use and without increasing the burden of caregivers. Methods and Design This randomised controlled trial will be performed across two sites, a 500 bed acute hospital in Adelaide, South Australia and a 250 bed acute hospital in Sydney, New South Wales. Four hundred and sixty community-dwelling older adults aged > 70 will be recruited after suffering a proximal femoral fracture and followed into the community over a 12-month period. Participants allocated to the intervention group will receive a six month individualised care plan combining resistance training and nutrition therapy commencing within 14 days post-surgery. Outcomes will be assessed by an individual masked to treatment allocation at six and 12 months. To determine differences between the groups at the primary end-point (six months), ANCOVA or logistic regression will be used with models adjusted according to potential confounders. Discussion The INTERACTIVE trial is among the first to combine nutrition and exercise therapy as an early intervention to address the serious consequence of rapid deconditioning and weight loss and subsequent ability to regain pre-morbid function in older patients post proximal femoral fracture. The results of this trial will guide the development of more effective rehabilitation programs, which may ultimately lead to reduced health care costs, and improvements in mobility, independence and quality of life for proximal femoral fracture sufferers. Trial registration Australian Clinical Trials Registry: ACTRN12607000017426.

9585 Background: Weight gain and inactivity after cancer are associated with poorer cancer outcomes and may predispose to chronic conditions but the prevalence of these among cancer survivors is not well defined. The objectives of this cross-sectional study were to determine whether those with history of cancer have a greater prevalence of chronic conditions and whether their lifestyle behaviours differ from cancer free controls. Methods: Cross-sectional self-reported data were obtained from adult telephone survey respondents between January 2010 and March 2012. Age and gender matched individuals who did not report a cancer diagnosis were randomly selected from the same data source as controls. Data reported included rates of cardiovascular disease, hypertension, hyperlipidaemia, diabetes, and osteoporosis, lifestyle behaviours (diet, physical activity and smoking), obesity, psychological distress and self-reported health. Between-group differences were assessed using McNemar’s test. Results: 2,103 cases and 4,185 controls were included in the analyses. Cancer cases had a higher prevalence than controls for all chronic conditions: cardiovascular disease 22.1% vs 18.4%, p=0.001; hypertension 53.3% vs 50%, p=0.015; hyperlipidaemia 47.8% vs 41.8%, p