Search

Prescriptions and use of medications to treat mental health conditions in young autistic populations are inconsistent worldwide. This makes it hard to compare findings from international studies to the Australian autistic population, where there are limited relevant studies. Apart from risperidone, there are no other medications specified for direct use in autistic persons. This study aims to gain initial broad understanding of the use of medications, commonly prescribed for mental health conditions, specifically by autistics under the age of 21 years. We analysed data that were previously collected as part of the Western Australian Autism Biological Registry between 2011 and 2015 which amounted to 239 surveys completed on young persons with diagnosed autism. The questionnaires included information on co-occurring conditions, current or previous use of medications and reasons for use of the medications. Only one-quarter of the participants in this study reported using at least one mental health-related medication in their lifetime. The most reported medications were stimulants, antidepressants and antiepileptics. The reasons for using medication included managing attention deficit hyperactivity disorder, challenging behaviours, seizures, sleep difficulties and symptoms of anxiety and depression. The number of individuals reporting medication use in this study was lower compared to other developed countries. Nevertheless, these medications should be monitored due to limited understanding of their use to manage co-occurring symptoms in young autistic persons. The findings highlight the importance of ongoing research to better understand mental health-related medications and inform best practice.

Aim: To investigate the association between proton pump inhibitors (PPIs) and risk of incident diabetes in a follow-up study and to investigate its potential mechanisms. Methods: A total of 9531 individuals without type 2 diabetes (T2DM) at baseline were included from the Rotterdam Study, a prospective population-based cohort of 14 926 individuals aged 45 years or older. During the study period (1 April 1997 to 1 January 2012) all incident cases of T2DM were enrolled. We used multivariable linear regression analysis to investigate the associations of baseline PPI use and various serum biomarkers (eg, serum magnesium, insulin-like growth factor 1) which might modify the association. Thereafter, we excluded prevalent PPI users and performed a Cox proportional hazard regression analysis to explore the time-varying effect of incident PPI use on T2DM during follow-up. Results: Baseline use of a PPI was associated with increased serum levels of fasting insulin (0.091 pmoL/L, 95% confidence interval [CI] 0.049, 0.133), homeostasis model assessment-insulin resistance (0.100, 95% CI 0.056, 0.145) and C-reactive protein (0.29 mg/L, 95% CI 0.198, 0.384), but decreased levels of magnesium (−0.009 mmol/L, 95% CI −0.014, −0.004) and IGF-1 (−0.805 nmoL/L, 95% CI −1.015, −0.595). After adjustment for risk factors such as physical activity and body mass index/waist-to-hip ratio, current use of PPI was associated with an increased risk of incident T2DM (hazard ratio [HR] 1.69, 95% CI 1.36-2.10). The effect was dose-dependent with the highest risk (HR 1.88, 95% CI 1.29-2.75) in those on more than one defined daily dose. Conclusion: New users of PPIs during follow-up had a significantly higher dose-dependent risk of incident diabetes. We suggest vigilance regarding their potential adverse effect on glucose homeostasis.

Nicotinamide N-methyltransferase (NNMT) methylates nicotinamide (vitamin B3) to generate 1-methylnicotinamide (MNA). NNMT overexpression has been linked to a variety of diseases, most prominently human cancers, indicating its potential as a therapeutic target. The development of small-molecule NNMT inhibitors has gained interest in recent years, with the most potent inhibitors sharing structural features based on elements of the nicotinamide substrate and the S-adenosyl-L-methionine (SAM) cofactor. We here report the development of new bisubstrate inhibitors that include electron-deficient aromatic groups to mimic the nicotinamide moiety. In addition, a trans-alkene linker was found to be optimal for connecting the substrate and cofactor mimics in these inhibitors. The most potent NNMT inhibitor identified exhibits an IC50 value of 3.7 nM, placing it among the most active NNMT inhibitors reported to date. Complementary analytical techniques, modeling studies, and cell-based assays provide insights into the binding mode, affinity, and selectivity of these inhibitors.

Background : Managing minor ailments in community pharmacy is an evolving pharmacy service in developing countries. Defined scopes of practice for pharmacy staff are essential for the safe management of minor ailments. Limited research exists regarding the perceptions of Indonesian pharmacists’ and pharmacy technicians’ scopes of practice in providing minor ailments management services. Objective : To evaluate pharmacists’ and pharmacy technicians’ understanding of their scopes of practice, perc eived competency and factors influencing the delivery of minor ailments services in Indonesian community pharmacies. Methods : Cross - sectional surveys were conducted during January - February 2020 of pharmacists and pharmacy technicians attending seminars co nducted by relevant Indonesian Associations in Central Java, Indonesia. Percentage of common responses (PCR) described similarity of perceived scopes of practice for pharmacists and pharmacy technicians. Univariate and multivariate analyses ide ntified asso ciations of scopes of practice with pharmacy characteristics. Results : A total of 185 pharmacists and 142 pharmacy technicians participated. Pharmacy technicians performed minor ailment consultations, however, if considered beyond their scope of practice, they referred the patient to the pharmacist (T=120/142, 84.5%). Vaginal thrush, bacterial conjunctivitis, gastro - oesophageal reflux disease, and acute pain were minor ailments perceived only within a pharmacist’s scope (PCR above 60%). Of 34 minor ailments , 11 showed PCR values between 40 - 60% overlapping pharmacists and pharmacy technicians perceived scopes of practice (allergy/rash, back pain, cold sores, dermatitis, diarrhoea, eczema, hayfev er, haemorrhoids, rheumatism, sore throat, and superficial wounds ). Back pain, cold sores, dermatitis, and sore throat associated pharmacists’ scope of practice with years of practice experience (p - value<0.05). Pharmacy technicians perceived their scopes of practice

Contains fulltext : 206209.pdf (publisher's version ) (Open Access)

Objective: There is limited and conflicting evidence on the association between proton pump inhibitors (PPIs) and myocardial infarction (MI). This study aims to examine the occurrence of MI associated with PPI use from the Food and Drug Administration (FDA) Adverse Event Reporting System database. Methods: This is a cross-sectional study using data from the FDA dated from December 2013 to April 2018. Standard descriptive statistics were used to describe demographic information. Logistic regression analyses were performed to investigate the association between the independent variables and MI. Findings: Among the 52,443 individuals who were taking a PPI and experienced an adverse event which was registered on the FDA database, 726 (1.38%) experienced MI. Of all the PPIs, esomeprazole had the largest proportion of users experiencing MI (1.81%). Compared to other PPIs, esomeprazole was associated with a significantly higher rate of MI (odds ratio [OR] =1.53, P < 0.001), whereas lansoprazole was associated with a lower rate of MI (OR = 0.74, P = 0.03). Conclusion: Among the PPIs, esomeprazole appeared to have the highest risk of MI. Although the observed associations do not infer causality, this study highlighted a need for further studies to determine if a PPI, especially esomeprazole, can indeed cause MI.

Background: Atypical visual perception in individuals with Autism Spectrum Disorders (ASD) may contribute to superiority in disembedding tasks. Gaze behavior has provided some insights in to mechanisms underlying this purported superiority in children, however evidence is limited and requires additional investigation. Method: The performance and gaze behavior of 27 adolescents with ASD and 27 matched typically developing (TD) peers were examined during the Figure Ground Subtest of the Test of Visual Perception Skills-third edition (TVPS-3). Results: Compared to their TD counterparts, adolescents with ASD were no different in accuracy, however, had a longer response time. Differences in gaze behavior were also observed, characterized by adolescents with ASD spending less time viewing the incorrect and target figures, and spending a greater proportion of time viewing irrelevant areas of the stimuli compared to TD adolescents. Conclusions: Results suggest that while altered visual perception was observed, this did not contribute to superiority in disembedding tasks in adolescents with ASD. Future research is required to elucidate conditions under which altered visual perception may contribute to behavioral superiority.

© 2019 The British Pharmacological Society Aims: To determine statins' impact on skin infection risk in view of conflicting literature: that statins may reduce infection risk, but are also associated with diabetes mellitus, a risk factor for skin and soft tissue infections (SSTIs). Methods: Sequence symmetry analysis was performed on prescription claims (2001–2011) from the Australian Department of Veterans' Affairs to determine the interrelationships between: (i) statins and SSTIs; (ii) statins and diabetes; and (iii) diabetes and SSTIs; as well as whether statins increased the risk of SSTIs, independent of diabetes status. Chi-square tests were performed to detect differences in Index of Relative Socio-economic Advantage and Disadvantage scores of patients within each interrelationship. Prescriptions for statins, antidiabetic medication, and antistaphylococcal antibiotics were evaluated using nonidentifiable client numbers, prescription dates filled, residential electorates, and pharmaceutical codes. Adjusted sequence ratio and confidence interval were calculated at intervals of 91, 182 and 365 days for sequence symmetry analysis studies. Results: Statins were associated with: (i) significant SSTI risk (adjusted sequence ratio > 1; confidence interval >1), (ii) significant diabetes risk, and (iii) diabetic patients had increased risk of SSTIs. Diabetic and nondiabetic statin users had significantly increased risks of SSTIs, while the influence from socioeconomic status was not significant for each of the 3 relationships. Conclusions: Statins are associated with increased risk of SSTIs via direct and indirect mechanisms, probably independent of diabetes or socioeconomic statuses. We believe that clinicians should be aware of the association between statins and SSTIs, and, where appropriate, monitor blood glucose levels of statin users.

Background: Emotional intelligence (EI) skills are essential to therapy students as they participate in full-time clinical placements. No previous research had explored if, and how, clinical placements influenced therapy students’ EI skills. Methods: The study used a longitudinal, sequential explanatory, mixed methods design. Participants were undergraduate occupational therapy, physiotherapy, and speech pathology students (n=296). Business students (n=93) were included as a control group because they undertake no workplace placements. The Emotional Quotient Inventory 2.0 tracked the changes in EI scores measured at three-time points over the final 16 months of their undergraduate university program. Interviews were conducted with 24 students to determine if, and how, clinical placements influenced the changes in EI skills. Results: Before students commence full-time placements, four EI skillsets were significantly lower than the Australian Population Norms. However, after their clinical placements were completed, therapy students’ Total Emotional Intelligence score increased significantly, as well as 10 other skills. The business students showed no significant EI changes. During interviews, the students agreed that 95% of changes in EI skills were directly related to their clinical placements. The key influences on EI during clinical placements were: supervisory style, the student’s interacting with patients, reflecting on and receiving feedback on EI skills from clinical supervisors. Discussion: Our study contributes new knowledge to clinical supervisors, university educators, and employers of new therapy graduates. Clinical supervisors are recommended to role model an array of EI skills to students, allow students to work closely with patients experiencing complex emotional distress, be emotionally in-tune and engaged with students, and to trust the students to work autonomously with patients in emotional turmoil. Supervisors are encouraged to give students and n

© 2019 Royal Pharmaceutical Society Objectives: To assess the knowledge and understanding of autism spectrum disorder (ASD) by community pharmacists, across Western Australia (WA) and evaluate the extent to which they incorporate ASD friendly practices in their pharmacy. Methods: A cross-sectional study involved a postal questionnaire sent to a stratified random sample of 250 community pharmacies across WA. A score of ≥10/13 (≥76.9%) appropriate responses to selected questions was considered an indication of ‘good knowledge’ of ASD. Univariate associations between ‘good knowledge’ and variables in the questionnaire were analysed using chi-square statistics, and multivariate analysis was performed using a logistic regression model. Demographic data relating to the pharmacy were used to determine the likelihood it was ASD friendly. Key findings: Overall, 97/250 (38.8%) questionnaires were returned. There were 34/96 (35.4%) respondents classified as having ‘good knowledge’. Stigma surrounding ASD was the single best indicator of ‘good knowledge’ (P < 0.0001). None of the respondents indicated they catered specifically for ASD, and 38/97 (39.2%) reported that no changes were needed to their pharmacy to improve accessibility. There were a number of demographic features that increased the likelihood that pharmacies had the potential to be ASD friendly. Conclusions: Pharmacists overall had a basic understanding of ASD. Pharmacists who identified that stigma surrounding ASD existed in the community were more likely to achieve ‘good knowledge’. There was a reluctance to improve pharmacy accessibility to patients with ASD. Pharmacists did not appear to incorporate ASD beneficial practices into their pharmacy and pharmacy environment.

Background: Emotional intelligence (EI) is a critical skill for healthcare practitioners. Minimal longitudinal research has tracked the changes in EI of therapy students over their final full-time clinical placements. Methods: The Emotional Quotient Inventory (EQ-i2.0) measured the EI of 283 therapy students and 93 business students (control group who do no clinical placements) at three time points over a 16-month period, the same period that the therapy students participated in clinical placements. Results: Analysis of the therapy students showed significant increases over the 16 months of the study in Total EI score, as well as nine other EI skills. However, large percentages of students reported declining scores in emotional expression, assertiveness, self-expression, and stress tolerance, with some students reporting low EI scores before commencing full-time extended clinical placements. Conclusions: The study contributes to new knowledge about the changing EI skills of therapy students as they complete their full-time, extended placements. Emotional intelligence in student therapists should be actively fostered during coursework, clinical placements and when first entering the workforce. University educators are encouraged to include EI content through the therapy curricula. Employers are encouraged to provide peer coaching, mentoring and workshops focused on EI skills to recent graduates.

The N-methylation of 4-phenylpyridine produces the neurotoxin 1-methyl-4-phenylpyridinium ion (MPP+). We investigated the kinetics of 4-phenylpyridine N-methylation by nicotinamide N-methyltransferase (NNMT) and its effect upon 4-phenylpyridine toxicity in vitro. Human recombinant NNMT possessed 4-phenylpyridine N-methyltransferase activity, with a specific activity of 1.7 ± 0.03 nmol MPP+ produced/h/mg NNMT. Although the Km for 4-phenylpyridine was similar to that reported for nicotinamide, its kcat of 9.3 × 10-5 ± 2 × 10-5 s-1 and specificity constant, kcat/Km, of 0.8 ± 0.8 s-1 M-1 were less than 0.15% of the respective values for nicotinamide, demonstrating that 4-phenylpyridine is a poor substrate for NNMT. At low (<2.5 mM) substrate concentration, 4-phenylpyridine N-methylation was competitively inhibited by dimethylsulphoxide, with a Ki of 34 ± 8 mM. At high (>2.5 mM) substrate concentration, enzyme activity followed substrate inhibition kinetics, with a Ki of 4 ± 1 mM. In silico molecular docking suggested that 4-phenylpyridine binds to the active site of NNMT in two non-redundant poses, one a substrate binding mode and the other an inhibitory mode. Finally, the expression of NNMT in the SH-SY5Y cell-line had no effect cell death, viability, ATP content or mitochondrial membrane potential. These data demonstrate that 4-phenylpyridine N-methylation by NNMT is unlikely to serve as a source of MPP+. The possibility for competitive inhibition by dimethylsulphoxide should be considered in NNMT-based drug discovery studies. The potential for 4-phenylpyridine to bind to the active site in two binding orientations using the same active site residues is a novel mechanism of substrate inhibition.

Aims and objectives To measure the prevalence of symptomatic (S‐IDH) and asymptomatic intradialytic hypotension (A‐IDH) or postdialysis overhydration in a satellite haemodialysis clinic in Western Australia. Background Intradialytic hypotension is one of the most common side effects of haemodialysis caused by ultrafiltration provoking a temporary volume depletion. The prevalence of asymptomatic hypotension during dialysis has been rarely reported, but is considered to have the same negative consequences as symptomatic hypotension on various end organs like the brain and the gastrointestinal tract. Design Observational study on a retrospective 3‐month period of nursing recorded fluid‐related adverse events. Methods Data collection on the occurrence of S‐IDH and A‐IDH during a total of 2,357 haemodialysis treatments in 64 patients. Body weight of patients at the time of cessation of treatment was recorded, and patients, whose weight exceeded their ideal body weight by at least 0.5 kg, were classified as overhydrated. Data analysis was performed using spss version 24 software. Results Symptomatic intradialytic hypotension was the most common adverse event measured in this cohort, and occurred during 221 (9.4%) of all treatments, whereas asymptomatic intradialytic hypotension occurred in 88 (3.7%) of all treatments. The total occurrence of intradialytic hypotension was 13.1%, and symptomatic was observed in 30 patients, implying that nearly every second patient had at least one symptomatic episode within 3 months. Overhydration occurred in a total of 103 (4.4%) of all treatments, and involved 17 patients. Conclusions Symptomatic and asymptomatic intradialytic hypotension were the most commonly observed adverse events in this cohort; overhydration occurrence was considerably less common. Relevance to clinical practice The high occurrence of hypotension‐related events demonstrates that ultrafiltration treatment goals in satellite dialysis clinics are sometimes overestimat

Fundamentals of Business, Second Edition (2018) is an 372-page open education resource intended to serve as a no-cost, faculty customizable primary text for one-semester undergraduate introductory business courses. It covers the following topics in business: Teamwork; economics; ethics; entrepreneurship; business ownership, management, and leadership; organizational structures and operations management; human resources and motivating employees; managing in labor union contexts; marketing and pricing strategy; hospitality and tourism, accounting and finance, and personal finances. The textbook was designed for use in Virginia Tech’s Pamplin College of Business introductory level business course, MGT1104 Foundations of Business and is shared under a http://hdl.handle.net/10919/84848 (PDF, epub, and other versions) D

Copyright 2018 Lavers et al. Background. Surgical site infections (SSIs) are a common complication following breast surgery procedures, despite being considered a clean surgery. The prevalence of SSIs can be minimised with the appropriate use of antibiotic prophylaxis as outlined in the Australian Therapeutic Guidelines (eTG). The aims of this study were to evaluate adherence to the eTG for antibiotic prophylaxis in breast surgery procedures at a Western Australian teaching hospital following an update of the guidelines in 2014 and examine the impact of prophylactic antibiotics on SSI incidence and length of hospital stay. Method. A retrospective cross-sectional study which reviewed medical records from a random sample of 250 patients selected from 973 patients who underwent breast surgical procedures between February 2015 and March 2017. Results. Overall adherence to current eTG occurred in 49.2% (123/250) of operations. Pre-operative and post-operative antibiotics were prescribed in 98.4% (246/250) and 11.2% (28/250) operations respectively. Adherence rates to three specific elements of the eTG (drug prescribed, drug dosage and timing of administration) were 91.6% (229/250), 53.6% (134/250) and 86.4% (216/250) respectively. For the 14.4% (36/250) patients with relevant drug allergies, there was zero adherence to the eTG. Overall recorded SSI prevalence was low at 5.2% (13/250). The mean length of stay in patients (2.3 ± 1.7 days) was not influenced by level of eTG adherence (p = 0.131) or SSIs (p = 0.306). Conclusion.These data demonstrate a significant improvement in overall adherence to the eTG from 13.3% to 49.2% (p = < 0.001). The level of detected SSIs in this study was low. Further improvement is necessary with respect to prescribing appropriate antibiotic dosages and for those with allergies.

ISSUE ADDRESSED: The activities and well-being outcomes from participating at Men's Sheds are the focus of a growing body of research. Although many Men's Sheds have a clear health or social philosophy, this does not always translate into health and social activities. METHOD: This cross-sectional survey explored the health promotion and social inclusion activities of Men's Sheds and features of Sheds that predict greater levels of these activities. All Australian Men's Sheds were invited to participate. Based on survey responses, Sheds were classified as "active" or "not active" in health promotion and social inclusion, which formed the main survey outcomes. Profiles of the responding Sheds were summarised and compared against the main survey outcomes. Multivariate logistic regression analyses explored the profile variables associated with "active" Sheds. RESULTS: Responses from 300 Sheds indicated 37% and 70% of Sheds were "active" in health promotion and social inclusivity respectively. Number of members, members with mental illness or of Indigenous descent, providing meals and targeting war veterans were associated with health promotion. Having five or more members with a disability, members with English as a second language, targeting of war veterans were associated with social inclusiveness. CONCLUSIONS: Men's Sheds may serve as a unique community resource to reduce barriers of access to preventative health care, education and social connectedness, especially for marginalised members and those living in rural communities. SO WHAT?: A proportion of Men's Sheds reflects the health and well-being exemplars mentioned in the National Male Health Policy that can help to counter the social determinants of poor health, particularly for marginalised males.

Mustafa Atee,1 Kreshnik Hoti,1,2 Richard Parsons,1 Jeffery D Hughes1 1School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia; 2Division of Pharmacy, Faculty of Medicine, University of Pristina, Prishtina, Kosovo Objectives: Regardless of its severity, dementia does not negate the experience of pain. Rather, dementia hinders self-reporting mechanisms in affected individuals because they lose the ability to do so. The primary aim of this study was to examine the interrater reliability of the electronic Pain Assessment Tool (ePAT) among raters when assessing pain in residents with moderate-to-severe dementia. Secondly, it sought to examine the relationship between total instrument scores and facial scores, as determined by automated facial expression analysis. Study design: A 2-week observational study. Setting: An accredited, high-care, and dementia-specific residential aged care facility in Perth, Western Australia. Participants: Subjects were 10 residents (age range: 63.1–84.4 years old) predominantly with severe dementia (Dementia Severity Rating Scale score: 46.3±8.4) rated for pain by 11 aged care staff. Raters (female: 82%; mean age: 44.1±12.6 years) consisted of one clinical nurse, four registered nurses, five enrolled nurses, and one care worker. Measurements: ePAT measured pain using automated detection of facial action codes and recordings of pain behaviors. Results: A total of 76 assessments (rest =38 [n=19 pairs], movement =38 [n=19 pairs]) were conducted. At rest, raters’ agreement was excellent on overall total scores (coefficient of concordance =0.92 [95% CI: 0.85–0.96]) and broad category scores (κ=1.0). Agreement was moderate (κ=0.59) on categorical scores upon movement, while it was exact in 68.4% of the cases. Agreement in actual pain category scores gave κw=0.72 (95% CI: 0.58&nda

Nicotinamide N-methyltransferase (NNMT) is an enzyme that catalyses the methylation of nicotinamide to form N'-methylnicotinamide. Both NNMT and its methylated product have recently been linked to a variety of diseases, suggesting a role for the enzyme as a therapeutic target beyond its previously ascribed metabolic function in detoxification. We here describe the systematic development of NNMT inhibitors derived from the structures of the substrates involved in the methylation reaction. By covalently linking fragments of the NNMT substrates a diverse library of bisubstrate-like compounds was prepared. The ability of these compounds to inhibit NNMT was evaluated providing valuable insights into the structural tolerances of the enzyme active site. These studies led to the identification of new NNMT inhibitors that mimic the transition state of the methylation reaction and inhibit the enzyme with activity on par with established methyltransferase inhibitors.

Research has examined the benefits and costs of employing adults with autism spectrum disorder (ASD) from the perspective of the employee, taxpayer and society, but few studies have considered the employer perspective. This study examines the benefits and costs of employing adults with ASD, from the perspective of employers. Fifty-nine employers employing adults with ASD in open employment were asked to complete an online survey comparing employees with and without ASD on the basis of job similarity. The findings suggest that employing an adult with ASD provides benefits to employers and their organisations without incurring additional costs.

Objective: To compare the number, frequency, enjoyment and performance in extracurricular activities of siblings of children with autism spectrum disorders (ASD) to their typically developing (TD) peers, and to identify differences between actual and desired participation. Methods: A case-control study with 30 siblings of children with ASD and 30 siblings of TD children was conducted using the Paediatric Interest Profiles and a questionnaire. Results: Siblings of children with ASD participated in fewer extracurricular activities than those with TD siblings. ASD symptoms were significantly associated with the sibling participating in fewer extracurricular activities. Children with TD siblings had higher enjoyment scores in relaxation activities than children with siblings with ASD. Conclusion: While results were mainly positive, some differences indicated that having a sibling with ASD may impact participation in extracurricular activities. Assessments of participation barriers, as well as support to minimise participation restrictions among siblings of children with ASD are required.

Dyadic coping strategies may play a pivotal role in relationship satisfaction and explain why some couples adapt positively to the challenges associated with raising a child with ASD and others do not. Survey data from 127 caregivers of a child with ASD were used in generalized estimating equation analyses to investigate the factors associated with relationship satisfaction, including socio-demographics, parenting stress and dyadic coping. Results showed that over two-thirds of the sample reported satisfaction, which was associated with low parenting stress, increased use of positive and decreased use of negative dyadic coping strategies. Positive dyadic coping was found to have a greater influence than negative dyadic coping, supporting a strengths-based approach to interventions promoting family resilience.

Cytomegalovirus (CMV) has been linked with vascular pathology and is a common complication of renal transplantation. We addressed whether CMV seropositivity influences vascular pathology several years after transplant. Levels of CMV antibody increased with age, were higher in transplant recipients than healthy controls (P < 0.001), and correlated with vascular endothelial function measured by flow mediated-dilation of the brachial artery (FMD). However, the optimal general linear model predicting FMD included CMV seropositivity as a marginal effect (P = 0.068), with age (P = 0.013), gender (P < 0.0001), and transplantation (P < 0.0001). Other measures of the burden of CMV are being tested as CMV prophylaxis is feasible as an approach to reduce vascular disease.

Background: Pharmacist’s skills are underutilized whilst they are directly involved with antibiotic supply to the community. Addressing this issue could lead to better use of antibiotics and hence decreased resistance. Objective Explore how pharmacists can prescribe oral antibiotics to treat a limited range of infections whilst focusing on their confidence and appropriateness of prescribing. Setting Community pharmacies, Western Australia. Method Data were collected using a self-administered questionnaire also containing case vignettes. These were distributed to a random sample of metropolitan and rural community pharmacies in Western Australia. A Generalised Estimating Equation was used to compare respondents’ level of confidence in treating various infections and to assess appropriateness of prescribing. Main outcome measure Appropriateness and confidence of antibiotic prescribing. Results A response rate of 34.2% (i.e. 425 responses to case vignettes) was achieved from 240 pharmacies. There were high levels of confidence to treat simple infections such as uncomplicated UTIs (n = 73; 89.0%), impetigo (n = 65; 79.3%), mild bacterial skin infections (n = 62; 75.6%) and moderate acne (n = 61; 72.4%). Over 80% of respondents were confident to prescribe amoxicillin (n = 73; 89%), trimethoprim (n = 72; 87.8%), amoxicillin and clavulanic acid (n = 70; 85.4%), flucloxacillin (n = 70; 85.4%) and cephalexin (n = 68; 82.9%). High levels of appropriate antibiotic prescribing were shown for uncomplicated UTI (97.2%), cellulitis (98.2%) and adolescent acne (100.0%). Conclusion This study identified key limited infections and antibiotics for which pharmacists were supportive and confident to prescribe. This role could lead to better use of antibiotics in the community and minimisation of resistance.

Nicotinamide N-methyltransferase (NNMT) is one of the most abundant small molecule methyltransferases in the human body and is primarily responsible for the N-methylation of the nicotinamide (vitamin B3). Employing the cofactor S-adenosyl-l-methionine, NNMT transfers a methyl group to the pyridine nitrogen of nicotinamide to generate N-methylnicotinamide. Interestingly, NNMT is also able to N-methylate a variety of other pyridine-containing small molecules, suggesting a secondary role for the enzyme in the detoxification of xenobiotics. A number of recent studies have also revealed links between NNMT overexpression and a variety of diseases, including multiple cancers, Parkinson's disease, diabetes, and obesity. To facilitate further study of both the substrate scope and potential for inhibitor development, we here describe the development of a new NNMT activity assay. The assay makes use of ultra-high-performance hydrophilic interaction chromatography, allowing for rapid separation of the reaction products, coupled with quadrupole time-of-flight mass spectrometric detection, providing for enhanced sensitivity and enabling high-throughput sample analysis. We successfully demonstrated the general applicability of the method by performing kinetic analyses of NNMT-mediated methylation for a range of pyridine-based substrates. These findings also provide new insight into the diversity of substrate recognition by NNMT in a quantitative manner. In addition, we further established the suitability of the assay for the identification and characterization of small molecule inhibitors of NNMT. To do so, we investigated the inhibition of NNMT by the nonspecific methyltransferase inhibitors sinefungin and S-adenosyl-l-homocysteine, revealing IC50 values in the low micromolar range. The results of these inhibition studies are particularly noteworthy as they will permit future efforts toward the development of new NNMT-specific inhibitors.

An important characteristic of a screening tool is its discriminant ability or the measures accuracy to distinguish between those with and without mental health problems. The current study examined the inter-rater agreement and screening concordance of the parent and teacher versions of SDQ at scale, subscale and item-levels, with the view of identifying the items that have the most informant discrepancies; and determining whether the concordance between parent and teacher reports on some items has the potential to influence decision making. Cross-sectional data from parent and teacher reports of the mental health functioning of a community sample of 299 students with and without disabilities from 75 different primary schools in Perth, Western Australia were analysed. The study found that: a) Intraclass correlations between parent and teacher ratings of childrens mental health using the SDQ at person level was fair on individual child level; b) The SDQ only demonstrated clinical utility when there was agreement between teacher and parent reports using the possible or 90% dichotomisation system; and c) Three individual items had positive likelihood ratio scores indicating clinical utility. Of note was the finding that the negative likelihood ratio or likelihood of disregarding the absence of a condition when both parents and teachers rate the item as absent was not significant. Taken together, these findings suggest that the SDQ is not optimised for use in community samples and that further psychometric evaluation of the SDQ in this context is clearly warranted., Funding Agencies|Centre for Research into Disability and Society and the School of Occupational Therapy and Social Work, Curtin University, Perth, Australia; Healthway Australia

Gaze-based assistive technology (gaze-based AT) has the potential to provide children affected by severe physical impairments with opportunities for communication and activities. This study aimed to examine changes in eye gaze performance over time (time on task and accuracy) in children with severe physical impairments, without speaking ability, using gaze-based AT. A longitudinal study with a before and after design was conducted on 10 children (aged 1-15years) with severe physical impairments, who were beginners to gaze-based AT at baseline. Thereafter, all children used the gaze-based AT in daily activities over the course of the study. Compass computer software was used to measure time on task and accuracy with eye selection of targets on screen, and tests were performed with the children at baseline, after 5months, 9-11months, and after 15-20months. Findings showed that the children improved in time on task after 5months and became more accurate in selecting targets after 15-20months. This study indicates that these children with severe physical impairments, who were unable to speak, could improve in eye gaze performance. However, the children needed time to practice on a long-term basis to acquire skills needed to develop fast and accurate eye gaze performance.

In this paper, an approach to teaching occupational therapy students how to create orthoses, whilst at the same time developing higher-order critical thinking, reflective, and clinical reasoning skills is described. The scaffolded nature of the learning activities, incorporating Kolb's reflective learning cycle, was used to support students' capacity for clinical reasoning and better prepare them for clinical placement. The peer-assessment element was also designed to support the experiential learning by allowing students to test their evaluation of hand orthoses, compare their assessment with an expert's, and identify areas for improvement. Students who demonstrated higher grades for the written reflection assessment showed better agreement with the experts (smaller bias, p<0.01). This study concluded there was a correlation between students' capacity for reflective thinking and the development of clinical reasoning. Furthermore, the reflective writing exercise encouraged students to generalise their skills beyond the classroom. The approach and findings of this study are relevant to a range of allied health professions through providing a process to support the development of higherorder critical thinking, reflection, and reasoning skills. Furthermore, the study provides an evidence base to demonstrate that higher reflective skill capacity and critical thinking are crucial to creating agentic learners.

Gaze-based assistive technology (gaze-based AT) has the potential to provide children affected by severe physical impairments with opportunities for communication and activities. This study aimed to examine changes in eye gaze performance over time (time on task and accuracy) in children with severe physical impairments, without speaking ability, using gaze-based AT. A longitudinal study with a before and after design was conducted on 10 children (aged 1–15 years) with severe physical impairments, who were beginners to gaze-based AT at baseline. Thereafter, all children used the gaze-based AT in daily activities over the course of the study. Compass computer software was used to measure time on task and accuracy with eye selection of targets on screen, and tests were performed with the children at baseline, after 5 months, 9–11 months, and after 15–20 months. Findings showed that the children improved in time on task after 5 months and became more accurate in selecting targets after 15–20 months. This study indicates that these children with severe physical impairments, who were unable to speak, could improve in eye gaze performance. However, the children needed time to practice on a long-term basis to acquire skills needed to develop fast and accurate eye gaze performance.

This study investigated the changes in emotional intelligence (EI) of occupational therapy, physiotherapy, and speech pathology students (therapy students). Clinical placements have multiple benefits including the development of interprofessional skills, enhancing practice skills and interpersonal skills. Higher EI competencies have been shown to have a positive impact on patient outcomes, teamwork skills, dealing with stress, and patient satisfaction. Data for this study were collected at two time points: before third-year therapy students commenced extended clinical placements (T1 with 261 students) and approximately 7 months later after students had completed one or more clinical placements (T2 with 109 students). EI was measured using the Emotional Quotient Inventory 2.0 (EQ-i2.0). Only one EI score, assertiveness, demonstrated a significant decline. No EI score showed a significant increase. A third or more of the students showed increases of five points or more in self-actualisation, emotional expression, independence, reality testing and optimism. However, of concern were the five EI scores where therapy students’ EI scores decreased by more than five points: assertiveness (where 38% of students declined), problem solving (37%), impulse control (35%), self-actualisation (35%), and stress tolerance (33%). With EI scores declining for some students during clinical placements, there are implications for clinical supervisors and interprofessional facilitators as clinical performance may decline concurrently. There is a range of potential reasons that clinical placements could negatively influence the EI competencies of a therapy student, including poor clinical supervision, conflict between a student, and supervisor and failing a clinical placement. The research suggests that interprofessional facilitators and university educators might consider students undertaking EI tests before clinical placements.

Background: A community pharmacy real-time electronic recording program, ProjectSTOP, enables Australian community pharmacists to verify pseudoephedrine requests. In Western Australia the program was available for voluntary use from April 2007 and became mandatory November 2010. This case study explores the effectiveness of the program by reviewing the total requests for pseudoephedrine products, and the proportion of requests which were classified as ‘denied sales’ before and after mandatory implementation. Seasonal and annual trends in these measures are also evaluated. Methods: ProjectSTOP data recordings for Western Australia pharmacies between 1 December 2007 and 28 February 2014 were analysed. Data included a de-identified pharmacy number and date of each pseudoephedrine product request. The total number of requests and sale classification (allowed, denied, safety, or not recorded) were calculated for each month/pharmacy. The potential influence of mandatory reporting using ProjectSTOP was investigated using a Regression Discontinuity Design. Correlations between sales from the same pharmacy were taken into account by classifying the pharmacy number as a random effect. The main effects of year (continuous variable), and season (categorical variable) were also included in the model. Results: There was a small but steady decline in the total requests for pseudoephedrine per month per 100,000 population (per pharmacy) from the time of mandatory reporting. The number of denied sales showed a steady increase up until mandatory reporting, after which it showed a significant decline over time. Total sales were heavily influenced by season, as expected (highest in winter, least in summer). The seasonal pattern was less pronounced for denied sales, which were highest in winter and similar across other seasons. The pattern over time for safety sales was similar to that for denied sales, with a clear change occurring around the time of mandatory reporting. Conclusion: Re

Background: Evidence suggests that adults with intellectual disability (ID) are vulnerable to poor health outcomes. This paper describes the health status and medication use of adults with ID in Western Australia. Method: We conducted a cross-sectional survey by interview of 328 adults with ID (M age = 37 years, range: 18–82) and their families/support persons (79% proxy or joint informants). Results: Although 90% of participants reported long-term health conditions (M = 2.6, range: 0–10), including epilepsy, allergies, eczema, asthma, and mental health problems, three quarters of the participants (77%) described their health as good or very good. Younger participants (18–44 years) reported osteoporosis and stroke, conditions commonly associated with ageing, more often than the general population at those ages. Medication use was high, with 70% taking one or more medications (Mdn = 3 medications, range: 0–21). Conclusions: Many participants reported that health problems affected their daily lives, yet the majority reported good health. Long-term health conditions were common and many people used several types of medications. Participants had poorer health than the Western Australian population overall. Careful monitoring of health conditions and regular review of medications are recommended to improve health outcomes for adults with ID.

It is unknown if, and how, students redefine their sense of school belongingness after negotiating the transition to secondary school. The current study used longitudinal data from 266 students with, and without, disabilities who negotiated the transition from 52 primary schools to 152 secondary schools. The study presents the 13 most significant personal student and contextual factors associated with belongingness in the first year of secondary school. Student perception of school belongingness was found to be stable across the transition. No variability in school belongingness due to gender, disability or household-socio-economic status (SES) was noted. Primary school belongingness accounted for 22% of the variability in secondary school belongingness. Several personal student factors (competence, coping skills) and school factors (low-level classroom task-goal orientation), which influenced belongingness in primary school, continued to influence belongingness in secondary school. In secondary school, effort-goal orientation of the student and perception of their schools tolerance to disability were each associated with perception of school belongingness. Family factors did not influence belongingness in secondary school. Findings of the current study highlight the need for primary schools to foster belongingness among their students at an early age, and transfer students belongingness profiles as part of the handover documentation. Most of the factors that influenced school belongingness before and after the transition to secondary are amenable to change.

School belongingness has gained currency among educators and school health professionals as an important determinant of adolescent health. The current cross-sectional study presents the 15 most significant personal and contextual factors that collectively explain 66.4% (two-thirds) of the variability in 12-year old students perceptions of belongingness in primary school. The study is part of a larger longitudinal study investigating the factors associated with student adjustment in the transition from primary to secondary school. The study found that girls and students with disabilities had higher school belongingness scores than boys, and their typically developing counterparts respectively; and explained 2.5% of the variability in school belongingness. The majority (47.1% out of 66.4%) of the variability in school belongingness was explained by student personal factors, such as social acceptance, physical appearance competence, coping skills, and social affiliation motivation; followed by parental expectations (3% out of 66.4%), and school-based factors (13.9% out of 66.4%) such as, classroom involvement, task-goal structure, autonomy provision, cultural pluralism, and absence of bullying. Each of the identified contributors of primary school belongingness can be shaped through interventions, system changes, or policy reforms., Funding Agencies|Centre for Research into Disability and Society; School of Occupational Therapy and Social Work, Curtin University, Perth, Australia; Healthway Australia

The literature on whether students with disabilities have worse physical and mental health, social adjustment, and participation outcomes when compared to their peers without disabilities is largely inconclusive. While the majority of case control studies showed significantly worse outcomes for students with disabilities; the proportion of variance accounted for is rarely reported. The current study used a population cross-sectional approach to determine the classification ability of commonly used screening and outcome measures in determining the disability status. Furthermore, the study aimed to identify the variables, if any, that best predicted the presence of disability. Results of univariate discriminant function analyses suggest that across the board, the sensitivity of the outcome/screening tools to correctly identify students with a disability was 31.9% higher than the related Positive Predictive Value (PPV). The lower PPV and Positive Likelihood Ratio (LR+) scores suggest that the included measures had limited discriminant ability (17.6% to 40.3%) in accurately identifying students at-risk for further assessment. Results of multivariate analyses suggested that poor health and hyperactivity increased the odds of having a disability about two to three times, while poor close perceived friendship and academic competences predicted disability with roughly the same magnitude. Overall, the findings of the current study highlight the need for researchers and clinicians to familiarize themselves with the psychometric properties of measures, and be cautious in matching the function of the measures with their research and clinical needs., Funding Agencies|Centre for Research into Disability and Society; School of Occupational Therapy and Social Work, Curtin University, Perth, Australia

Pour la première fois, le texte original de ce roman fantastique de Stoker est publié dans son intégralité !Assailli dans une pièce entièrement close par quelque chose ou quelqu’un, un éminent égyptologue est plongé dans un étrange état cataleptique. Puis, peu après, au même endroit, certains objets précieux disparaissent pendant que d’autres reviennent dans de troublantes et inexplicables conditions. Et, tandis que le mystère grandit, d’autres malédictions resurgissent, dont une sous la forme d’une main momifiée. Une main pourvue de sept doigts. Une main où scintillent d’extraordinaires joyaux, semblables à des étoiles… Le Joyau des Sept Étoiles (1903) est présenté ici pour la première fois dans sa version intégrale. En effet, la seule traduction disponible en langue française était amputée d’environ un tiers du texte original, supprimant ainsi l’efficacité des descriptions que Stoker s’était appliqué à donner de cette descente dans les abîmes de l’effroi. Une deuxième fin est également proposée pour la première fois au lecteur français.Il ne s’agit pas ici de vampirisme, mais l’horreur atteint, dans ce superbe roman, des sommets — ou plutôt des gouffres — d’angoisse inattendus.EXTRAITTout cela paraissait si réel que j’avais peine à imaginer que cela se soit produit antérieurement et cependant, chaque épisode survenait, non pas comme une étape nouvelle dans l’enchaînement logique des faits, mais comme une chose à laquelle on s’attend. C’est de cette façon que la mémoire joue ses tours pour le bien ou pour le mal, pour le plaisir ou pour la douleur, pour le bonheur ou pour le malheur. C’est ainsi que la vie est un mélange de douceur et d’amertume et que ce qui a été devient éternel.De nouveau, le léger esquif, cessant de fendre les eaux tranquilles comme lorsque les avirons brillaient et ruisselaient d’eau, quitta le violent soleil de juillet pour glisser dans l’ombre fraîche des grandes branches de saules qui retombaient — j’étais debout dans le bateau qui oscillai

Background: Patients who have been treated for colorectal cancer in Australia can consult their general practitioner (GP) for advice about symptoms or side effects at any time following their treatment. However, there is no evidence that such patients are consistently advised by GPs, and patients experience substantial unmet need for reassurance and advice. Objective: To explore the patient management options selected by GPs to treat a set of patients describing their symptoms following treatment for colorectal cancer. Methods: This was an Internet-based survey. Participants (GPs) viewed 6 video vignettes of actors representing patients who had been treated for colorectal cancer. The actor-patients presented problems that resulted from their treatment. Participants indicated their diagnosis and stated if they would prescribe, refer, or order tests, based on that diagnosis. These responses were then rated against the management decisions for those vignettes as recommended by a team of colorectal cancer experts. Results: In total, 52 GPs consented to take part in the study, and 40 (77%) completed the study. Most GPs made a diagnosis of colorectal cancer treatment side effects/symptoms of recurrence that was consistent with the experts’ opinions. However, correct diagnosis was dependent on the type of case viewed. Compared with radiation proctitis, GPs were more likely to recognize peripheral neuropathy (odds ratio, OR, 4.43, 95% CI 1.41-13.96, P=.011) and erectile dysfunction (OR 9.70, 95% CI 2.48-38.03, P=.001), but less likely to identify chemotherapy-induced fatigue (OR 0.19, 95% CI 0.08-0.44). GPs who had more hours of direct patient care (OR 0.38, 95% CI 0.17-0.84, P=.02), were experienced (OR 9.78, 95% CI 1.18-8.84, P=.02), and consulted more patients per week (OR 2.48, 95% CI 1.16-5.30, P=.02) suggested a management plan that was consistent with the expert opinion. Conclusions: In this pilot study, years of experience and direct patient contact hours had a sign

Introduction: The initial symptoms of Alzheimers disease (AD) include attention deficits, memory loss and deficiencies in topographic and spatial orientation. People with AD may have way-finding difficulties in driving due to the deterioration of their navigation ability. Although the use of the Global Positioning System (GPS) has been proven to be a useful aid for older people in driving, there is no evidence to suggest that the benefit could extend to drivers with AD. Aim: This study aims to investigate the effectiveness of the GPS in assisting drivers with mild AD in finding their destination safely. Method: Twenty-eight drivers with mild to very mild AD, diagnosed by a general practitioner or a psychogeriatrician, completed all clinical and psychometric assessments including the Mini Mental State Examination, Trail Making Test B and Doors and People Test. During the driving assessment, 3 driving trials with different settings (normal, visualonly and audio-only) of the GPS were administered to all participants. The participants were required to follow instructions from the GPS and perform a variety of driving tasks on a driving simulator. The driving performances of participants were assessed by criteria specific to AD drivers. The driving assessment criteria were first combined to form the overall driving performance score: a higher score indicated a better overall driving performance. The other outcome of this study was the success of participants to navigate to a predetermined destination. Results: The driving performance of participants was different among the 3 settings (F = 72.8, p less than 0.001) and the pairwise comparison between the 3 settings was significant (p less than 0.001). The driving performance score was highest in the audio-only setting (mean: 20.0, SD: 2.2), moderate in the normal setting (mean: 16.7, SD: 2.6) and lowest in the visual-only setting (mean: 14.3, SD: 3.3). When compared with the visual-only setting, drivers using the audioonly