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Medication harm affects between 5 and 15% of hospitalised patients, with approximately half of the harm events considered preventable through timely intervention. The Adverse Inpatient Medication Event (AIME) risk prediction model was previously developed to guide a systematic approach to patient prioritisation for targeted clinician review, but frailty was not tested as a candidate predictor variable. To evaluate the predictive performance of an updated AIME model, incorporating a measure of frailty, when applied to a new multisite cohort of hospitalised adult inpatients. A retrospective cohort study was conducted at two tertiary Australian hospitals on patients discharged between 1st January and April 31, 2020. Data were extracted from electronic medical records (EMRs) and clinical coding databases. Medication harm was identified using ICD-10 Y-codes and confirmed by senior pharmacist review of medical records. The Hospital Frailty Risk Score (HFRS) was calculated for each patient. Logistic regression analysis was used to construct a modified AIME model. Candidate variables of the original AIME model, together with new variables including HFRS were tested. Performance of the final model was reported using area under the curve (AUC) and decision curve analysis (DCA). A total of 4089 patient admissions were included, with a mean age ± standard deviation (SD) of 64 years (±19 years), 2050 patients (50%) were males, and mean HFRS was 6.2 (±5.9). 184 patients (4.5%) experienced one or more medication harm events during hospitalisation. The new AIME-Frail risk model incorporated 5 of the original variables: length of stay (LOS), anti-psychotics, antiarrhythmics, immunosuppressants, and INR greater than 3, as well as 5 new variables: HFRS, anticoagulants, antibiotics, insulin, and opioid use. The AUC was 0.79 (95% CI: 0.76–0.83) which was superior to the original model (AUC = 0.70, 95% CI: 0.65–0.74) with a sensitivity of 69%, specificity of 81%, positive predictive value of 0.14 (95% CI: 0.10–0.17) and negative predictive value of 0.98 (95% CI: 0.97–0.99). The DCA identified the model as having potential clinical utility between the probability thresholds of 0.05–0.4. The inclusion of a frailty measure improved the predictive performance of the AIME model. Screening inpatients using the AIME-Frail tool could identify more patients at high-risk of medication harm who warrant timely clinician review. [ABSTRACT FROM AUTHOR]

This study sought to evaluate the adherence to guidelines for the management of mechanical Low Back Pain within a single tertiary metropolitan Emergency Department setting. Our objectives were: 1. To identify the proportion of patients presenting to a single Emergency Department with mechanical Low Back Pain who received management in line with the guidelines; and 2. To understand and describe factors that can influence clinicians' (non-) adherence to the guidelines. A two-stage multi-methods study design was undertaken. Stage 1 involved a retrospective chart audit of patients presenting with a diagnosis of mechanical Low Back Pain to establish documented adherence to clinical guidelines. Stage 2 explored clinicians' perspectives towards factors influencing adherence to the guidelines via a study-specific survey and follow up focus groups. The audit demonstrated low adherence to the following guidelines: (i) appropriate prescription of analgesia, (ii) targeted education and advice, and (iii) attempts to mobilise. Three major themes were identified as factors influencing adherence to the guidelines: (1) clinician driven influences and factors, (2) workflow processes, and (3) patient expectations and behaviours. There was low adherence to some published guidelines and factors influencing adherence to the guidelines were multi-factorial. Understanding the factors that influence care decisions and developing strategies to address these can improve Emergency Department management of mechanical Low Back Pain. [ABSTRACT FROM AUTHOR]

Objective: To develop evidence-informed recommendations to support the delivery of best practice therapeutic exercise for people with knee and/or hip osteoarthritis (OA).Design: A multi-stage, evidence-informed, international multi-disciplinary consensus process that included: 1) a narrative literature review to synthesise existing evidence; 2) generation of evidence-informed proposition statements about delivery of exercise for people with knee and/or hip OA by an international multi-disciplinary expert panel, with statements refined and analysed thematically; 3) an e-Delphi survey with the expert panel to gain consensus on the most important statements; 4) a final round of statement refinement and thematic analysis to group remaining statements into domains.Results: The expert panel included 318 members (academics, health care professionals and exercise providers, patient representatives) from 43 countries. Final recommendations comprised 54 specific proposition statements across 11 broad domains: 1) use an evidence-based approach; 2) consider exercise in the context of living with OA and pain; 3) undertake a comprehensive baseline assessment with follow-up; 4) set goals; 5) consider the type of exercise; 6) consider the dose of exercise; 7) modify and progress exercise; 8) individualise exercise; 9) optimise the delivery of exercise; 10) focus on exercise adherence; and 11) provide education about OA and the role of exercise.Conclusion: The breadth of issues identified as important by the international diverse expert panel highlights that delivering therapeutic exercise for OA is multi-dimensional and complex. [ABSTRACT FROM AUTHOR]

Objective: To explore the nature of postnatal cardiovascular morbidity following pregnancies complicated by preterm pre-eclampsia and investigate associations between pregnancy characteristics and maternal postnatal cardiovascular function.Study Design: This was an observational sub-study of a single-centre feasibility randomised double-blind placebo-controlled trial (https://www.Clinicaltrials: gov; NCT03466333), involving women with preterm pre-eclampsia, delivering before 37 weeks. Eligible women underwent echocardiography, arteriography and blood pressure monitoring within three days of birth, six weeks and six months postpartum. Correlations between pregnancy and cardiovascular characteristics were assessed using Spearman's correlation.Main Outcome Measures: The prevalence of cardiovascular dysfunction and remodelling six months following preterm pre-eclampsia.Results: Forty-four women completed the study. At six months, 27 (61 %) had diastolic dysfunction, 33 (75 %) had raised total vascular resistance (TVR) and 18 (41 %) had left ventricular remodelling. Sixteen (46 %) women had de novo hypertension by six months and only two (5 %) women had a completely normal echocardiogram. Echocardiography did not change significantly from six weeks to six months. Earlier gestation at delivery and lower birthweight centile were associated with worse six-month diastolic dysfunction (E/E': rho = -0.39, p = 0.001 & rho = -0.42, p = 0.005) and TVR (rho = -0.34, p = 0.02 & rho = -0.37, p = 0.01).Conclusions: Preterm pre-eclampsia is associated with persistent cardiovascular morbidity-six months postpartum in the majority of women. These cardiovascular changes have significant implications for long-term cardiovascular health. The graded severity of diastolic dysfunction and TVR with worsening pre-eclampsia phenotype suggests a dose-effect. However, the mechanistic link remains uncertain. [ABSTRACT FROM AUTHOR]

Nature-based solutions (NbS) to climate change, strategies for mitigation and adaptation that rely on natural ecosystem processes to preserve biodiversity and enhance human well-being, hold the potential to contribute to numerous Sustainable Development Goals and uplift Indigenous Peoples and local communities (IPLCs) that pursue place-based livelihoods. The local ecological and societal expertise housed in Indigenous and local knowledge (ILK) could provide substantial benefits to the development, implementation, and evaluation of NbS projects. However, the historical treatment of ILK through misappropriation and biopiracy by the scientific community leave IPLCs politically, socially, culturally, and economically vulnerable to the growing interest in NbS applications to combat climate change. This paper addresses the current state of NbS focused on IPLCs by assessing peer-reviewed literature with criteria developed around the validation, integration, and protection of ILK. The assessment uncovered that most NbS literature does not discuss ILK or the contributions and participation of IPLCs. Such omissions could establish a dangerous precedent of ignoring or misappropriating ILK in NbS projects, possibly ushering in a new era in biopiracy. To facilitate better inclusivity of IPLCs, honor the dual purpose of NbS, and ensure the proper application of ILK in climate response, future NbS projects should detail how ILK is validated, integrated, and protected. • Nature-based solutions hold great potential to help climate mitigation and adaptation. • Indigenous and local knowledge can support nature-based solutions. • Climate projects should validate, integrate, and protect Indigenous knowledge. [ABSTRACT FROM AUTHOR]

Objectives: We sought to determine the effect of impedance cardiography directed medical antihypertensive therapy on fetal growth restriction and perinatal mortality in women with chronic hypertension.Study Design: A retrospective study was conducted on 958 women referred to the Maternal Hypertension Center at Cabell Huntington Hospital between 2005 and 2014 for the indication of chronic hypertension.Main Outcome Measures: Serial assessments of maternal hemodynamics were obtained using non-invasive impedance cardiography. Vasodilators were initiated for increased systemic vascular resistance. Elevated cardiac output was treated with beta blockade.Results: Blood pressure at initial visit was used to stratify patients into five groups. Initial blood pressure of <130 systolic or <80 diastolic had 24 cases of growth restriction (6.8%) and 6 perinatal deaths (1.7%), 130-139 systolic or 80-89 diastolic resulted in 29 cases of growth restriction (9.3%) and 9 perinatal deaths (2.9%), 140-149 systolic or 90-99 diastolic 14 cases of growth restriction (6.5%) and 3 perinatal deaths (1.4%), 150-159 systolic or 100-109 diastolic had 5 cases of growth restriction (8.6%) and 4 perinatal deaths (6.89%), and >160 systolic or >110 diastolic 3 cases of growth restriction (13%) with no perinatal deaths. There were no differences in growth restriction (p = .59) or perinatal death (p = .15) between the groups.Conclusion: The rates of IUGR and perinatal mortality did not increase even with increasing severity of maternal hypertension. This low cost and non-invasive test should be considered for optimizing rates of growth restriction and perinatal mortality in pregnancies complicated by chronic hypertension. [ABSTRACT FROM AUTHOR]

With globalization and technological advances, there has been a sharp increase in the number of people living cross-culturally with mobility. With this, the number of children living mobile cross-national lives, often termed Third Culture Kids (TCKs), is also increasing. TCKs are defined as those who have accompanied their parents for work or study overseas during their significant developmental years, before 18. They are often described as people who build relationships to all of the cultures they have lived in, but not having a full ownership in any. To gain an overall understanding of the current research landscape on this population, a systematic review was conducted on the literature of empirical research on Third Culture Kids (TCKs). The search utilized the EBSCO PsycINFO database and focused on psychosocial issues. An initial yield of 399 articles were further curated based on inclusion and exclusion criteria with consensus by two psychology researchers, resulting in 31 research publications. The content analysis review included comparisons across years, types of publications, authors, research design and analytical methods, sample age and definition, and frequency of the domains and themes. This systematic review compiled descriptive tables of studies and reviewed key findings of the three most-researched domains—emotional, relational, and identity development. The paper also highlighted discussions about the lack of standardization in TCK definition, challenges in TCK research, and suggestions for future directions. [ABSTRACT FROM AUTHOR]

Preeclampsia (PE) is characterized by new onset hypertension in association with elevated soluble fms-like tyrosine kinase-1 (sFlt-1) and preproendothelin-1 (PPET-1) levels. Currently there is no effective treatment for PE except for early delivery of the fetal placental unit, making PE a leading cause for premature births worldwide. Administration of 17-hydroxyprogesterone caproate (17-OHPC) is used for prevention of recurrent preterm birth. This study was designed to test the hypothesis that 17-OHPC improves hypertension and ET-1 in response to elevated sFlt-1 in pregnant rats. sFlt-1 was infused into normal pregnant (NP) Sprague-Dawley rats (3.7 μg·kg-1·day-1 for 6 days, gestation days 13-19) in the presence or absence of 17-OHPC (3.32 mg/kg) administered via intraperitoneal injection on gestational days 15 and 18. Mean arterial blood pressure (MAP), pup and placenta weights, renal cortex PPET-1 mRNA levels and nitrate-nitrite levels were measured on GD 19. Infusion of sFlt-1 into NP rats elevated mean arterial pressure (MAP) compared with control NP rats: 115 ± 1 (n = 13) vs. 99 ± 2 mmHg (n = 12, p < 0.05). 17-OHPC attenuated this hypertension reducing MAP to 102 ± 3 mmHg in sFlt-1 treated pregnant rats (n = 8). Neither pup nor placental weight was affected by sFlt-1 or 17-OHPC. Importantly, renal cortex PPET-1 mRNA levels were elevated 3 fold in NP + sFlt-1 rats compare to NP rats, which decreased with 17-OHPC administration. Plasma nitrate-nitrite levels were 44 ± 9 µM in NP rats (n = 9), 20 ± 3 µM in NP + sFlt-1 (n = 7), which increased to 42 ± 11 µM NP + sFlt-1 + 17OHPC (n = 6). Administration of 17-OHPC improves clinical characteristics of preeclampsia in response to elevated sFlt-1 during pregnancy. [ABSTRACT FROM AUTHOR]

• Analysis revealed six distinct perspectives that drive organizations to participate. • The first perspective, Environmental Mission, explains 48 % of the study variance. • Internal motivations play a stronger role in participation than external pressures. • Knowledge about motivations can aid future watershed partnerships. There has been a rise in environmental collaboratives as a form of watershed governance. These collaboratives depend on a diversity of organizations acting collectively by pooling their resources, yet little information exists as to why organizations decide to become involved in these initiatives. This study attempts to identify why organizations involved in watershed partnerships decide to participate by assessing external and internal motivations. We used Q method to survey 38 representatives from 32 organizations currently participating by investing time or resources in these partnerships in the Intermountain Western United States. Factor analysis revealed six distinct perspectives organizations hold that influence their decision to participate. Our findings differ from the broader environmental management literature in that internal motivations played a much larger role in organizations' motivations for participation. Specific categories of internal motivations that were important included: 1) Environmental Mission, 2) Environmental Leadership, and 3) Wildfire Information. Results suggest that diverse strategies are needed to engage potential partner organizations in watershed collaboratives. [ABSTRACT FROM AUTHOR]

Preeclampsia (PE) is new onset hypertension during pregnancy associated with increased uterine artery resistance (UARI) and an imbalance among CD4 + T lymphocytes and natural killer (NK) cells. We have shown an important role for 17-hydroxyprogesterone caproate (17-OHPC) to improve hypertension and fetal demise in the RUPP rat model of PE. However we have not examined a role for 17-OHPC to improve NK cells and CD4+TH2 cells as possible mechanisms for improved fetal weight and hypertension. Therefore, we hypothesized that 17-OHPC lowers NK cells while improving the T cell ratio in the RUPP rat. RUPP was surgically induced on gestational day 14 in pregnant rats. 17-OHPC (3.32 mg/kg) was administered intraperitoneal on day 15, UARI was measured on day 18. Blood pressure (MAP), blood and tissues were collected on GD 19. MAP in NP rats (n = 9) was 100 ± 2, 104 ± 6 in Sham rats (n = 8), 128 ± 2 in RUPP (n = 11) and 115 ± 3 mmHg in RUPP + 17-OHPC (n = 10), p < 0.05. Pup weight and UARI were improved after 17-OHPC. Total and cytolytic placental NK cells were 38 ± 5, and 12 ± 2% gate in RUPP rats which decreased to 1.6 ± 0.5 and 0.4 ± 0.2% gate in RUPP + 17OHPC rats. CD4+ T cells were 40 ± 3 in RUPP rats, which significantly decreased to 7 ± 1 RUPP + 17-OHPC rats. Circulating and placental TH2 cells were 6.0 ± 1, 0.3 ± 0.1% gate in RUPP rats and 12 ± 1%, 2 ± 0.5% gate in RUPP + 17-OHPC rats, p < 0.05 This study identifies new mechanisms whereby 17-OHPC improves outcomes in response to placental ischemia. [ABSTRACT FROM AUTHOR]

A greater focus on governance is needed to facilitate effective and substantive progress toward sustainability transformations in the aquaculture sector. Concerted governance efforts can help move the sector beyond fragmented technical questions associated with intensification and expansion, social and environmental impacts, and toward system-based approaches that address interconnected sustainability issues. Through a review and expert-elicitation process, we identify five engagement arenas to advance a governance agenda for aquaculture sustainability transformation: (1) setting sustainability transformation goals, (2) cross-sectoral linkages, (3) land–water–sea connectivity, (4) knowledge and innovation, and (5) value chains. We then outline the roles different actors and modes of governance can play in fostering sustainability transformations, and discuss action items for researchers, practitioners, and policymakers to operationalize activities within their engagement arenas. [ABSTRACT FROM AUTHOR]

Background: Medication harm is experienced by up to 30% of hospitalised patients, of which 7% experience severe harm. Pharmacist review can mitigate this harm. However, in increasingly busy hospitals, with high patient throughput, and scarce resources, there is a need to prioritise patients. Current methods are cumbersome, include many risk factors and are not evaluated in the clinical setting.Objectives: To determine key criteria used by hospital pharmacists and investigate perspectives related to patient prioritisation for potential medication harm in the hospital setting.Methods: This study used two methods; focus groups and a cross-sectional survey of Australian hospital pharmacists. Focus groups were used to identify criteria and perspectives related to prioritisation and were analysed thematically. Criteria from focus groups, and a systematic review, were used to design the survey. The survey was distributed via the Society of Hospital Pharmacists of Australia. The top 10 prioritisation criteria, and associated sub-criteria selected by over 50% of respondents were ranked. Combination of criteria used most frequently on a day-to-day basis were identified.Results: Twenty clinical pharmacists participated in four, one-hour, audio recorded focus groups. Using inductive thematic analysis of transcripts three themes were identified; 1) prioritisation criteria, 2) barriers to, and 3) facilitators of patient prioritisation, with five sub-themes and 26 codes. Pharmacists identified a number of barriers such as a lack of relevant handover information. Organisational demands, such as patient discharge and medications supply also influenced priority and could act as barriers to a pharmacist enacting their prioritisation plan. A total of 231 pharmacists completed the survey. High priority criteria included, renal impairment, use of high-risk medications and therapeutic drug monitoring.Conclusion: Pharmacists described prioritisation as a multifactorial process with a focus on high-risk medications and renal impairment. These findings will inform the development of a predictive risk score for patient prioritisation. [ABSTRACT FROM AUTHOR]

• High-fat diet intake resulted in higher digtesta particle size. • Dietary fibre caused higher short-chain fatty acids produced in distal colon. • No significant changes were shown in gut microbiome against different diet treatments. • Limited plasmatic antioxidant capacity enhancement was caused by the black carrots. Altering cellular structure by reducing the particle size and applying heat may enhance the release of polyphenols from the plant cell matrix. The released polyphenols could ameliorate the impacts of a high-fat diet. Using a pig model in a 2 × 2 cross-over trial, we tested the effects of processing on the bioaccessibility of polyphenols in the diet, using low- and high-fat diets supplemented with raw and diced or cooked and pureed black carrots. Raw diced black carrots resulted in higher average particle size in the digesta of all gastrointestinal compartments and higher total and major short chain fatty acids in the descending colon. Supplementing the diet with raw and diced carrots also increased the colonic bacterial counts but with limited effects on gut microbiome diversity. The presence of carrots did not mitigate the negative impacts of decreased plasma antioxidant capacity and high atherogenic index induced by a high-fat diet. [ABSTRACT FROM AUTHOR]

Highlights • Novel exotic tree species bring elevated economic, biosecurity and ecological risks. • Limited exotic introduction is justified to fulfil specific commercial objectives. • There is no justification for novel exotic introduction for conservation objectives. • Exotic introduction requires comprehensive risk assessment across forestry sectors. Abstract Both plantation forests and native woodlands are currently facing challenges in the form of rapid climatic change and unprecedented increases in damage by exotic pests and diseases. To combat these problems it has been proposed that a range of novel exotic tree species (non-native species that have not yet undergone thorough operational testing or previously been grown at a forestry scale) should be grown as part of an adaptive management strategy, and that non-native (including novel) species should be introduced into native woodland. Justifications for this policy are that novel exotic species are required to maintain forest productivity under climate change, to create a more diverse, and by implication more resilient forest, and to substitute for native species threatened by introduced pests and pathogens. Here we examine these arguments in the context of British forestry, where there is a long history of utilising non-native species. On the basis of this documented experience we conclude that in the commercial sector of British forestry, where production is the main objective, there are strong arguments for undertaking a programme of rigorous testing and domestication of a very limited number of the most promising novel exotics which, in addition to good timber and growth, also have attributes that will allow the development of more naturalistic silvicultural systems and a move away from current clear-fell regimes. However this must be undertaken within a comprehensive risk assessment framework, where candidate species are rigorously screened both for any biosecurity threats, and their potential for causing ecological damage if they become invasive outside their initial planting sites. Widespread planting of candidate species should only be recommended after the completion of full species and provenance trials, and when reliable sources of appropriately adapted seed have been established. Conversely where conservation of biodiversity is an objective we find no support for introduction of any non-native species. This is based on the greater ecological and economic risk they pose compared to the use of native species. Use of non-natives is likely to lead to an increase rather than a decrease in pest and disease problems, and to hinder rather than support the retention of threatened native tree species and their associated biodiversity. [ABSTRACT FROM AUTHOR]

To identify and describe the extent, nature, characteristics, and impact of primary care-based models of care (MoCs) for osteoarthritis (OA) that have been developed and/or evaluated. Six electronic databases were searched from 2010 to May 2022. Relevant data were extracted and collated for narrative synthesis. Sixty-three studies pertaining to 37 discrete MoCs from 13 countries were included, of which 23 (62%) could be classified as OA management programmes (OAMPs) comprising a self-management intervention to be delivered as a discrete package. Four models (11%) focussed on enhancing the initial consultation between a patient presenting with OA at the first point of contact into a local health system and the clinician. Emphasis was placed on educational training for general practitioners (GPs) and allied healthcare professionals delivering this initial consultation. The remaining 10 MoCs (27%) detailed integrated care pathways of onward referral to specialist secondary orthopaedic and rheumatology care within local healthcare systems. The majority (35/37; 95%) were developed in high-income countries and 32/37 (87%) targeted hip/and or knee OA. Frequently identified model components included GP-led care, referral to primary care services and multidisciplinary care. The models were predominantly 'one-size fits all' and lacked individualised care approaches. A minority of MoCs, 5/37 (14%) were developed using underlying frameworks, three (8%) of which incorporated behaviour change theories, while 13/37 (35%) incorporated provider training. Thirty-four of the 37 models (92%) were evaluated. Outcome domains most frequently reported included clinical outcomes, followed by system- and provider-level outcomes. While there was evidence of improved quality of OA care associated with the models, effects on clinical outcomes were mixed. There are emerging efforts internationally to develop evidence-based models focused on non-surgical primary care OA management. Notwithstanding variations in healthcare systems and resources, future research should focus on model development alignment with implementation science frameworks and theories, key stakeholder involvement including patient and public representation, provision of training and education for providers, treatment individualisation, integration and coordination of services across the care continuum and incorporation of behaviour change strategies to foster long-term adherence and self-management. [ABSTRACT FROM AUTHOR]

Highlights • This was the first reported mortality due to listeria associated with alemtuzumab therapy in the setting of Multiple Sclerosis. • The rapid and fulminant presentation had symptoms which commonly occur following routine administration of alemtuzumab. • The Acute Phase post administration appears to confer particular vulnerability to this pathogen therefore high vigilance for this complication is mandatory. Abstract We report the case of a patient who died from the rare complication of Listeriosis in the immediate phase following alemtuzumab administration one month after discontinuing dimethyl fumarate (DMF). There is considerable overlap with typical post-infusion symptoms therefore high surveillance and low threshold for empirical or possible prophylactic antibiotic therapy is advocated. [ABSTRACT FROM AUTHOR]

Objectives: Soluble Flt1 (sFlt1) is an anti-angiogenic protein linked to the pathology of preeclampsia (PE). While the placenta serves as the major organ producing sFlt1 during normal pregnancy, peripheral blood mononuclear cells (PBMCs), endothelial cells, and stromal cells also produce sFlt1. The key question is 'what drives the overexpression of sFlt1 observed during PE?' In the present work we show evidence for sFlt1 over-expression in PBMCs due to interaction with placental villi from PE patients.Study Design: sFlt1 production by PBMCs is estimated by using two blood collection methods with different coagulation chemistry. PBMCs were then cultured with homologous villous explants and heterologous villous explants to determine the effects of the interaction between the two tissues.Main Outcome Measures: sFlt1 levels were estimated using real time PCR, ELISA, and gel electrophoresis.Results: Plasma samples obtained using CTAD as anti-coagulant showed 16-23% less sFlt1 compared to plasma collected in EDTA. Preeclamptic PBMCs showed higher basal level of sFlt1 mRNA. In addition, we show evidence of placental interaction as a cause of sFlt1 overexpression in PBMCs using homologous and heterologous co-culture system. However, during co-culture, we observed that while the sFlt1 expression in PE PBMCs is increased, PE villous explants show reduced sFlt1 RNA expression.Conclusion: sFlt1 was produced in significant amounts by preeclamptic PBMCs, and ex vivo studies show that the placenta induces this over-expression. In contrast, exposure to PBMCs appears to decrease sFlt1 production by preeclamptic placenta. [ABSTRACT FROM AUTHOR]

This paper describes my experiences exploring consciousness as an artist-engraver, in particular the sense of reawakening the participatory primal mind, which came about through the act of engraving. This ‘original participation’ is viewed as a fundamental characteristic of our early Acheuelan ancestors and evidence is presented to show that they possessed both a ‘modern’ esthetic sense and also a prayerful, sacramental consciousness. It is suggested that this primal consciousness is a fundamental human quality that became eclipsed in the modern mind by the denial of participation and the Cartesian split between subject and object during the Scientific Revolution. It is upon this denial of participation and the illusion of objectivity that the whole methodology of natural science and the alienated outlook of contemporary culture is based. A re-enchantment of the world can take place through the re-mythologizing of consciousness and the re-apprehension of original participation. [ABSTRACT FROM AUTHOR]

Pecan (Carya illinoinensis) is an important specialty crop in the U.S.A., but yield is limited by several diseases and pests. In mature-tree pecan orchards, large air-blast sprayers are commonly used to apply the pesticides to control these diseases and pests. The spray coverage, deposition and profiles are poorly defined under the range of application scenarios, limiting the recommendations that can be provided to growers to maximize control while minimizing input costs. To explore effects of sprayer setting parameters such as travel speed and spray volume rate on spray coverage on tall targets we set up a system (a simple vertical patternator) using a 19-m-tall pole with cards attached at eight height levels from 5 to 19 m above ground, allowing to determine the vertical distribution pattern of two air-blast sprayers with different air discharge systems. Spray was applied with a standard radial-flow air-blast sprayer during six treatments being combinations of two travel speeds: 2.4 and 3.2 km/h, and three spray volume rates: 470, 940 and 1970 L/ha, as well as with a focused air-flow system (a volute) sprayer during four treatments being combinations of two travel speeds: 2.4 and 3.2 km/h, and two spray volume rates: 470 and 940 L/ha. Results show that using a standard radial air-flow sprayer, application volume affected coverage at heights ≤17 m (higher volumes resulting in more coverage). Higher speed using a standard radial air-flow sprayer resulted in greater spray coverage, but was inconsistent with the focused air-flow system. Using a focused air-flow system more spray coverage occurred at >17 m compared to a standard radial air-flow sprayer. Spray coverage profiles affirmed the rapid decline in coverage with height using a standard radial air-flow sprayer. The results may help guide decisions on volute use, spray volume, and spray partitioning to different parts of the canopy to improve spray profile characteristics for applying more uniform spray coverage to mature pecan tree canopies. • A 19 m vertical patternator was developed to evaluate spray coverage profiles for pecan trees. • Spray coverage profiles produced by standard and volute air-blast sprayers were compared. • Standard air-blast sprayer coverage profiles showed rapid decline with height, while volute air-blast sprayers showed more spray coverage at the top of the patternator. • Higher volumes and speed increased spray coverage. [ABSTRACT FROM AUTHOR]

Extensive outbreaks of the emerald ash borer ( Agrilus planipennis ; EAB), an invasive forest insect, are having serious impacts on the cultural ecosystem services of urban forests in the United States and other countries. Limited experience with how such outbreaks might affect recreational opportunities prompted this investigation of visitors to a state park in St. Paul/Minneapolis, Minnesota, USA, where EAB damage is occurring. A photo-questionnaire solicited visitors’ visual preferences for trail environments in a discrete choice experiment. Systematically manipulated digital images simulated different levels of EAB impact in combination with other physical and social attributes including trail-proximate EAB-related forest management responses, land use context of the viewscape beyond the trail environment, visitor types, and visitor densities. Results indicated that EAB impacts were significant but of lesser importance than surrounding viewscape development and visitor numbers. Specifically, respondents preferred dense trailside shrub vegetation and low trail user numbers and disliked viewscapes showing city buildings and removal of most ash trees. Results suggest that trail planning should not only consider near-view landscape impacts but also the visual quality of more distant viewscapes, and that urban forest managers need to be aware of how forest insect impacts and subsequent management responses affect recreation setting preferences. [ABSTRACT FROM AUTHOR]

Introduction Shoulder pain and dysfunction may occur following neck dissection among people being treated for head and neck cancer. This systematic review aims to examine the prevalence and incidence of shoulder and neck dysfunction after neck dissection and identify risk factors for these post-operative complications. Methods Electronic databases (Pubmed, CINAHL, EMBASE, Cochrane) were searched for articles including adults undergoing neck dissection for head and neck cancer. Studies that reported prevalence, incidence or risk factors for an outcome of the shoulder or neck were eligible and assessed using the Critical Review Form – Quantitative Studies. Results Seventy-five articles were included in the final review. Prevalence rates for shoulder pain were slightly higher after RND (range, 10–100%) compared with MRND (range, 0–100%) and SND (range, 9–25%). The incidence of reduced shoulder active range of motion depended on surgery type (range, 5–20%). The prevalence of reduced neck active range of motion after neck dissection was 1–13%. Type of neck dissection was a risk factor for shoulder pain, reduced function and health-related quality of life. Conclusions The prevalence and incidence of shoulder and neck dysfunction after neck dissection varies by type of surgery performed and measure of dysfunction used. Pre-operative education for patients undergoing neck dissection should acknowledge the potential for post-operative shoulder and neck problems to occur and inform patients that accessory nerve preservation lowers, but does not eliminate, the risk of developing musculoskeletal complications. [ABSTRACT FROM AUTHOR]

IHI, with technical support from CSIRO, designed and constructed the “PICA pilot plant”, for the continued development of an advanced PCC process, which will enable a reduction in the CO 2 capture absorbent regeneration energy by 40% compared to the conventional MEA based process. The project team installed the pilot plant at the AGL Loy Yang power plant in Australia. The pilot plant has been commissioned and tested in a conventional MEA based process configuration and has commenced a 5,000 hour operating campaign using the IHI absorbent and the IHI optimized process configuration, and had achieved 1,800 hours of operationby mid September, 2016. The designed CO2 capture ratio of 90% has been achieved and stable plant operation has been confirmed. Continuous analysis will be kept for confirming the performance and robustness of the system. [ABSTRACT FROM AUTHOR]

In recent years, numerous articles have addressed management strategies aimed at assisting forests to adapt to climate change. However, these seldom take into account the practical and economic implications of implementing these strategies, notably, supply of forest plants and seed. Using semi-structured interviews with practitioners involved in the plant and seed supply chain in Great Britain, we highlight a series of practical and economic bottlenecks commonly encountered in the supply of locally sourced seed and domestically produced planting stock for native woodland and hedging markets. We find that adoption of alternative seed sourcing strategies, designed specifically to account for directional climate warming, is likely to exacerbate existing problems by adding further complexity to decisions nurseries make about tree species and seed origins to produce. The lack of long-term market predictability brought about by the current configuration of forestry grants and regulations and, in particular, the administrative systems for processing grant applications is identified as a major impediment to having a sustainable and competitive supply of home-grown and currently adapted planting stock. Finally, the time and effort it takes to supply healthy plants for native woodland creation projects deserves much wider recognition throughout the industry and will be crucial if planting objectives are to be met sustainably. [ABSTRACT FROM AUTHOR]

The hormone, leptin, plays a key role in the regulation of energy balance and neuroendocrine function, as well as modulating a range of other physiological systems from immunity to cognition. In the adult brain, leptin regulates food intake and energy expenditure primarily via the hypothalamus. In addition to these well-defined actions in adult life, there is increasing evidence for a role of leptin during development. Leptin receptors are widely expressed in the developing brain from an early stage, and leptin is known to have profound effects on the proliferation, maintenance, and differentiation of neuronal and glial cells. During the early postnatal period, in both rats and mice, there is a surge in circulating leptin concentrations. Despite this elevation in leptin, neonates maintain a high level of food intake, and both feeding behavior and metabolic responses to exogenous leptin administration are absent until around the time of weaning. However, it is during this period that direct neurotrophic actions of leptin have been demonstrated, with leptin promoting neurite outgrowth and the establishment of hypothalamic circuitry. Exactly how leptin exerts these effects remains unknown, but changes in the distribution of hypothalamic leptin receptors during this period may, at least in part, underlie these age-specific effects of leptin. [ABSTRACT FROM AUTHOR]

Background: Medication counseling sessions are key times for a pharmacist to speak to patients about their medications and the changes made to their therapies during their hospital stay.Objectives: To explore hospital pharmacists' perceptions of their roles and goals in patient medication counseling, and perceived barriers and facilitators to achieving their goals.Methods: Hospital pharmacist focus groups were held in two tertiary referral hospitals. Eligible pharmacists had provided medication counseling within the previous six months in inpatient and/or outpatient settings. Interested pharmacists attended a focus group designed to elicit their opinions and perceptions of patient medication counseling. Focus groups were audio recorded and transcribed verbatim. Inductive thematic analysis was applied to the data to identify initial patterns (codes) which were then organized into common overarching themes using NVivo(®) software. The codes were reviewed for reliability by pharmacists independent of the focus groups.Results: Six, 1-h focus groups were conducted with a total of 24 pharmacists participating. Saturation of information was determined after four focus groups. Greater than 80% consensus was achieved for reliability of the identified codes. A number of themes emerged from these codes around the goals, roles, and the barriers and facilitators to meeting these goals. Pharmacists' patient-centered goals in medication counseling were to build rapport, to empower patients and to improve patients' experience, health and safety. These goals would be accomplished through specific roles such as being an assessor, educator and problem-solver. Pharmacists frequently cited time pressures caused by systemic (hospital), and pharmacy specific processes as key challenges to achieving their goals. Factors that enabled pharmacists to meet their goals were those related to effective interprofessional collaboration and the quality of professional practice (such as training, expanded roles and advanced planning for discharge).Conclusions: Hospital pharmacists emphasized patient-centered goals in medication counseling and outlined the challenges to meet those goals. The findings from this study will be used to develop strategies for effective communication and inform pharmacy practice changes to improve patient care. [ABSTRACT FROM AUTHOR]

Background: Medication counseling opportunities are key times for pharmacists to speak to patients about their medications and any changes made during their hospital stay. Communication Accommodation Theory (CAT) posits that an individual's goals drive their communication behavior. The way in which pharmacists communicate with patients may be determined by the goals they set for these medication counseling sessions.Objectives: To examine hospital pharmacists' goals in patient medication counseling within the CAT framework.Methods: Hospital pharmacist focus groups were held in two teaching hospitals. Interested pharmacists attended a focus group designed to elicit their goals in patient medication counseling. Focus groups were audio recorded and transcribed verbatim. NVivo(®) software was used to assist in coding and organization. The codes were reviewed for reliability by pharmacists independent of the focus groups. An inductive thematic analysis was applied to the data.Results: Six 1 h focus groups were conducted with a total of 24 pharmacists participating. Saturation of information was achieved after four focus groups. Greater than 80% consensus was achieved for reliability of the identified codes. Patient-centered themes constructed from these codes were to build rapport, to empower patients and to improve patients' experience, health and safety. Exemplars provided by pharmacists for the goals of building rapport and empowering patients were aligned with five CAT communication behaviors (approximation, interpretability, discourse management, emotional expression and interpersonal control).Conclusions: Patient-centered goals described by hospital pharmacists for medication counseling aligned well with CAT behaviors necessary for effective communication. Further research using the CAT framework to examine the effectiveness of hospital pharmacist-patient exchanges that include both participants' perspectives is required to better understand how well pharmacists communicate with patients. [ABSTRACT FROM AUTHOR]

This study evaluates processes of tourism-linked empowerment in four communities outside Cuzco, Peru. Linking Rowlands’ power framework to ethnographic work in the region from June through December of 2013, findings suggest that tourism association members in each community, while experiencing generative empowerment in the form of enhanced agency, collectivity, and self-awareness, have also been the recipients and purveyors of non-generative empowerment in the form of enhanced domination. Potential factors influencing these processes are also identified, pointing to practical ways community-based tourism can better foster generative rather than merely sustainable (i.e., zero-sum) forms of empowerment in the region. [ABSTRACT FROM AUTHOR]

Recent increases in plantation forestry are starting to reverse the global decline in forest cover, in some areas of the world. Britain has practiced afforestation, primarily with non-native conifers, for over a century. It is unclear whether these new plantations have the potential to support native forest species. We quantify afforestation across the North York Moors National Park, UK, deriving a chronology of afforestation from historic maps at six time points from 1854 to 2013. We map the location of current wood ant ( Formica lugubris ) nests and set their distribution in the context of historic forest cover. We use these nest locations and the features of the habitat in which they occur to model the suitability of recently established conifer plantations for wood ants using MaxEnt. We determine whether non-native conifers offer suitable habitat for a forest specialist species, and assess the lag between establishment of conifer plantations and colonisation by wood ants from historic woodland fragments. Forest cover increased by 229% over 160 years and is now dominated by non-native conifer plantations. Our survey data show that current wood ant populations extend hundreds of metres from where forest was in the past, demonstrating geographical population expansions into newly formed forest, comprised of non-native conifer plantations. Both our data and model reveal that the recently planted non-native conifer plantations are a suitable habitat for this forest specialist species. Our model reveals that Formica lugubris has not yet spread through all available suitable habitat due to very poor dispersal ability, displaying a severe lag behind the availability of habitat. Managers should not assume that unoccupied habitat is unsuitable nor should they expect to see immediate colonisation of plantations. Future forest creation should be targeted close to existing forests to facilitate colonisation of forest specialists. [ABSTRACT FROM AUTHOR]

Background Some patients unexpectedly have poor functional improvement after reverse shoulder arthroplasty (RSA) for massive rotator cuff tear without glenohumeral arthritis. Our aim was to identify risk factors for this outcome. We also assessed the value of RSA for cases with poor functional improvement vs. controls. Methods The study was a retrospective case-control analysis for primary RSA performed for massive rotator cuff tear without glenohumeral arthritis with minimum 2-year follow-up. Cases were defined as Simple Shoulder Test (SST) score improvement of ≤1, whereas controls improved SST score ≥2. Risk factors were chosen on the basis of previous association with poor outcomes after shoulder arthroplasty. Latissimus dorsi tendon transfer results were analyzed as a subgroup. Value was defined as improvement in American Shoulder and Elbow Surgeons (ASES) score per $10,000 hospital cost. Results In a multivariate binomial logistic regression analysis, neurologic dysfunction ( P = .006), age <60 years ( P = .02), and high preoperative SST score ( P = .03) were independently associated with poor functional improvement. Latissimus dorsi tendon transfer patients significantly improved in active external rotation (−0.3° to 38.7°; P < .01). The value of RSA (ΔASES/$10,000 cost) for cases was 0.8 compared with 17.5 for controls ( P < .0001). Conclusions Young age, high preoperative function, and neurologic dysfunction were associated with poor functional improvement. Surgeons should consider these associations in counseling and selection of patients. Concurrent latissimus dorsi transfer was successful in restoring active external rotation in a subgroup of patients. The critical economic importance of improved patient selection is emphasized by the very low value of the procedure in the case group. [ABSTRACT FROM AUTHOR]

Background The promising utility of multi-modality evoked potential batteries to objectively measure multi-tract dysfunction has been evaluated by several groups using different methods. Objective To independently evaluate the use of multi-modality evoked potential batteries as surrogate biomarkers for both physical and cognitive status in a cohort of Primary Progressive Multiple Sclerosis patients and identify the most potentially useful scoring method of those described. Methods 28 Patients with Primary Progressive Multiple Sclerosis underwent clinical evaluation with Kurtzke’s Modified EDSS and the Multiple Sclerosis Functional Composite (MSFC). 19 Participants also underwent the Minimal Assessment of Cognitive Function in Multiple Sclerosis. Visual, Brainstem Auditory, Somatosensory and Motor Evoked Potentials were recorded on all. Results were graded by variants of the Global Evoked Potential Score, Multiple Evoked Potential Score and Summation of Z transformed Evoked Potential Latencies for correlation against the clinical scores. Conclusions Multi-modal evoked potential batteries generally show moderate and useful correlation with clinical status as measured by the regulatory standard of EDSS (r= .65 vs. mEPS p <.005) and MSFC (r= .39 vs. mEPS p <.05). The graded qualitative mEPS scoring system displayed the strongest relationship although the influence of scoring system applied appeared reassuringly minimal. Non-association with cognitive impairment is an important limitation however. [ABSTRACT FROM AUTHOR]

Concentrated piperazine is a promising new solvent under consideration for post combustion capture (PCC) of CO 2 . As it is a secondary amine, one of the concerns when applying this solvent to flue gases is the potential formation of nitrosamines. Secondary amines will form stable nitrosamines, which are generally considered to be carcinogens. The Tarong CO 2 capture pilot plant was recently used to evaluate the concentrated piperazine process on a real coal flue gas. During duration operation completed at the plant, solvent samples were regularly collected and analysed for their nitrosamine content. Mononitrosopiperazine (MNPZ) concentration in the solvent was noted to increase with operating time, reaching a steady state level of approximately 7.5 mmol/kg when operating with a regeneration temperature in the stripping column of 125 °C. The concentration of MNPZ in the solvent was noted to decrease sharply to 2.5 mmol/kg when the regeneration temperature was increased to 155 °C. The results provided here suggest that the concentration of MNPZ formed in the solvent can be controlled through the choice of plant operating conditions. [ABSTRACT FROM AUTHOR]

Introduction Potassium (K + ) channels are key regulators of vascular smooth muscle cell (VSMC) excitability. In systemic small arteries, K v 7 channel expression/activity has been noted and a role in vascular tone regulation demonstrated. We aimed to demonstrate functional K v 7 channels in human fetoplacental small arteries. Methods Human placental chorionic plate arteries (CPAs) were obtained at term. CPA responses to K v 7 channel modulators was determined by wire myography. Presence of K v 7 channel mRNA (encoded by KCNQ1-5 ) and protein expression were assessed by RT-PCR and immunohistochemistry/immunofluorescence, respectively. Results K v 7 channel blockade with linopirdine increased CPA basal tone and AVP-induced contraction. Pre-contracted CPAs (AVP; 80 mM K + depolarization solution) exhibited significant relaxation to flupirtine, retigabine, the acrylamide (S)-1, and (S) BMS-204352, differential activators of K v 7.1 – K v 7.5 channels. All CPAs assessed expressed KCNQ 1 and KCNQ 3-5 mRNA; KCNQ 2 was expressed only in a subset of CPAs. K v 7 protein expression was confirmed in intact CPAs and isolated VSMCs. Discussion K v 7 channels are present and active in fetoplacental vessels, contributing to vascular tone regulation in normal pregnancy. Targeting these channels may represent a therapeutic intervention in pregnancies complicated by increased vascular resistance. [ABSTRACT FROM AUTHOR]

Background Despite the success of total shoulder arthroplasty (TSA), concerns remain about the longevity of the implant, in particular, glenoid component survivorship. The purpose of this study was to determine whether preoperative glenoid wear patterns affect clinical outcomes and value in patients undergoing TSA. Methods A comparative cohort study was conducted of 309 patients with a total of 344 TSA procedures, performed for primary glenohumeral osteoarthritis. Computed tomography scans were obtained in all patients, with preoperative glenoid wear pattern characterized as either concentric (n = 196; follow-up time, 49.2 months) or eccentric (n = 148; follow-up time, 52.3 months) according to a modified Levine classification. A clinical, radiographic, and economic assessment was performed between the 2 wear patterns. Results There was no significant difference in American Shoulder and Elbow Surgeons (ASES) score in the concentric group (80.8 ± 20.8) compared with the eccentric group (77.6 ± 21.2) at final follow-up ( P = .159). Range of motion and final visual analog scale for pain score were similar between the 2 groups. Radiographic evidence of gross glenoid loosening was significantly lower in the concentric group [11 of 195 (5.6%)] compared with the eccentric group [18 of 147 (12.2%)] ( P = .030). Revision rates were similar between the concentric group [4 of 195 (2.0%)] and the eccentric group [3 of 147 (2.0%)]. A value assessment also showed no significant difference between the concentric and eccentric groups [concentric 26.1 vs. eccentric 25.5 (ΔASES score/$10,000 hospital cost) ( P = .479)]. Conclusions Similar clinical results and value can be expected with both concentric and eccentric glenoid wear patterns in TSA. Concerns arise, however, as the eccentric group demonstrated a more than 2-fold increased rate of glenoid component loosening compared with the concentric group. [ABSTRACT FROM AUTHOR]

Background Postoperative instability continues to be one of the most common complications limiting outcomes of reverse shoulder arthroplasty (RSA). The optimal management of this complication remains unknown. The purpose of this study was to evaluate the outcomes of patients with postoperative dislocation after RSA managed with closed reduction. Methods All patients who were treated with a closed reduction for dislocation after RSA in the period between May 2002 and September 2011 were identified and retrospectively reviewed. Final outcomes including recurrent instability, need for revision surgery, American Shoulder and Elbow Surgeons outcome score, and range of motion were evaluated. Results A total of 21 patients were identified. Nearly 50% of cases (10 of 21) had previous surgery, with 80% (8 of 10) of these being previous arthroplasty. The average time to first dislocation was 200 days, with 62% (13 of 21) occurring in the first 90 days. At average follow-up of 28 months, 62% of these shoulders remained stable (13 of 21), 29% required revision surgery (6 of 21), and 9% remained unstable (2 of 21). The average American Shoulder and Elbow Surgeons score was 68.0 for patients treated with closed reduction for instability and 62.7 for those treated with revision surgery ( P = .64). Discussion This study shows that an initial dislocation episode after RSA with use of this implant can be successfully managed with closed reduction and temporary immobilization in more than half of cases. Given that outcomes after revision surgery are not different from those after closed treatment, we would continue to recommend an initial attempt at closed reduction in the office setting in all cases of postoperative RSA dislocation. [ABSTRACT FROM AUTHOR]

The aim of this article is to critique the contemporary scientific reduction of mind to brain and to explore the imaginal realm of consciousness. Through the author’s own practice as an engraver, and through the researches and discoveries of free-thinking scientists, philosophers and artists, this realm of the “One Mind” is revealed to be timeless and universal. [ABSTRACT FROM AUTHOR]

To determine the role of environmental and host genetic factors in shaping fungal endophyte communities we used culturing and metabarcoding techniques to quantify fungal taxa within healthy Scots pine (Pinus sylvestris) needles in a 7-y old provenance-progeny trial replicated at three sites. Both methods revealed a community of ascomycete and basidiomycete taxa dominated by the needle pathogen Lophodermium seditiosum. Differences in fungal endophyte taxon composition and diversity indices were highly significant among trial sites. Within two sites, fungal endophyte communities varied significantly among provenances. Furthermore, the communities differed significantly among maternal families within provenances in 11/15 and 7/15 comparisons involving culture and metabarcoding data respectively. We conclude that both environmental and host genetic variation shape the fungal endophyte community of P. sylvestris needles. [ABSTRACT FROM AUTHOR]

Background The use of cortical suspensory fixation in conjunction with an interference screw to treat distal biceps ruptures has yielded favorable results. However, literature examining the incidence of fixation failure in a large consecutive series of patients treated with this technique is lacking. Methods A retrospective review of electronic medical records identified 170 distal biceps ruptures in 168 consecutive patients (164 men and 4 women) treated using a cortical button in conjunction with an interference screw. The study group was an average age of 48 years (range, 20-71 years). Records were reviewed from the time of the initial clinic visit to the most recent follow-up. Early failures were defined as those that occurred within 12 weeks of the index procedure. Failed repair was defined as tendon defect, deformity, or significant weakness in supination. Results The early incidence of failure was 1.2%, with 2 of the fixations meeting the criteria for failure. One patient had significant brachial artery thrombosis. Other complications included posterior interosseous nerve palsy, lateral antebrachial cutaneous nerve-related complication, and numbness about the radial nerve. Conclusion The use of a cortical suspensory fixation device in conjunction with an interference screw is an effective method of repairing a distal biceps rupture, with a low early rate of failure. [ABSTRACT FROM AUTHOR]

Background Reverse shoulder arthroplasty (RSA) has proven to be a useful yet inconsistent tool to manage a variety of pathologic conditions. Factors believed to lead to poor postoperative range of motion (ROM) may be associated with preoperative diagnosis, poor preoperative ROM, and surgical factors such as inability to lengthen the arm. The purpose of this study was to analyze multiple factors that may be predictive of motion after RSA. Our hypothesis is that intraoperative ROM is most predictive of postoperative ROM. Methods Between February 2003 and April 2011, 540 patients (217 men and 323 women) treated with RSA were evaluated with measurements of preoperative, intraoperative, and postoperative ROM at a follow-up, where ROM was found to have plateaued at 1 year as determined by a pilot study. A regression analysis was performed to define independent predictive factors of postoperative active ROM. Results Intraoperative forward flexion was the strongest predictor of final postoperative ROM, followed by gender and preoperative ROM. Age and arm lengthening were not significant independent predictors. Controlling for gender and preoperative ROM, patients with an intraoperative elevation of 90° gained 29° in postoperative forward elevation (P < .001), 120° gained approximately 40° in postoperative forward elevation (P < .001), 150° gained approximately 56° in postoperative forward elevation (P < .001) and 180° gained approximately 62° in postoperative forward flexion (P < .001). Conclusions Intraoperative forward flexion is the strongest predictor of postoperative ROM. Surgeons may use intraoperative motion as a powerful decision-making tool regarding soft tissue tension in RSA. [ABSTRACT FROM AUTHOR]

Abstract: Migration out of hazard-prone areas presents significant opportunities for disaster risk reduction and climate change adaptation. Alongside and intermingled with opportunistic migration there has always been relocation to escape, particularly from calamity, disaster and warfare. As climate change is considered a likely driver of migration, the literature encompasses a debate as to whether or not migration can be considered to be adaptation. This paper investigates the concept of voluntary within-country migration as an adaptation strategy to reduce disaster risk in Australia. We refer to this internal migration as relocation. The paper examines results of research carried out in Australia at the time of recent and extensive disasters, where opportunities were presented to examine household attitudes towards relocation in the face of future disasters of similar extent. Individuals׳ attitudes towards relocation were ascertained within an adaptation and mitigation context, at a time of emerging longer-term climate change government policy that advocates retreat from hazard-prone locations. The paper examines demographic data to reveal who is likely to leave or stay. Policy implications of relocation strategies as climate change adaptation strategy within a developed nation are discussed. This research concludes that relocation is a strategy available to some as part of an extensive range of responses to extreme weather events but undertaking unsupported resettlement is not always an option for reasons of family commitment, livelihood opportunities, financial constraints and emotional ties. Those who remain, and those who leave a hazard-prone location may both demonstrate a capacity for adaptation and resilience. [Copyright &y& Elsevier]

Background: Postoperative scapular fracture is a common complication after reverse shoulder arthroplasty (RSA). The purpose of this study was to determine its effect on RSA patient outcomes. Methods: A retrospective, case-control study of 25 nonoperatively treated postoperative scapular fractures after RSA were analyzed with a minimum 2-year follow-up from surgery and 1-year follow-up from fracture. Eligible patients were matched 1:4 to a control group for age, sex, follow-up time, surgery indication, and primary operation vs revision. Outcome measures, including American Shoulder and Elbow Surgeons (ASES) score and range of motion, were compared between fracture cases and controls. Also analyzed were radiographic features, including fracture location (acromion vs scapular spine) and healing. Results: Incidence of scapular fracture after RSA in this series was 3.1%. Fractures occurred from 1 to 94 months postoperatively. The revision rate was higher in the fracture group (8% vs 2%) but did not reach statistical significance (P = .18). Fracture patients had improved (?ASES, 21) but inferior clinical outcomes, with a postoperative ASES score of 58.0 compared with 74.2 (P ? .001). Change in range of motion also diminished in the fracture group, with a mean gain of 26° forward elevation compared with 76° (P < .001). Fracture location (P = .54) or healing (P = .40) did not affect outcome. Conclusion: Postoperative scapular fractures may occur at any point postoperatively; increasing incidence is likely as longer follow-up becomes available. This complication leads to inferior clinical results compared with controls. However, patients show improvement compared with their preoperative measurements, even at longer-term follow-up. Patients with postoperative scapular fractures may have increased risk of revision. [Copyright &y& Elsevier]

Abstract: Marine protected areas (MPAs) can be viewed as coupled human-natural systems where a significant number of local people depend on ecosystem goods and services. There are times when these uses contribute to ecosystem degradation that may eventually lead to a systems' collapse. In addition to studies of technical means for predicting and controlling the systems, the understanding of human dimensions, institutional and social-interaction issues has been considered important for improving effective governance of these systems. This paper presents a multilevel analytical framework and discusses application of this framework to the context of three MPAs in Vietnam. It discusses the development of the framework based on a new perspective that views institutions as a structure and governance as a process for operating a governing system. As a result, inter-relations and mutual influences of institutions and governance occurred within the MPAs are illustrated as a cause–effect relationship diagram. These are grouped into three components (i) formal institutions; (ii) political behaviour and organizational structure; and (iii) local communities' engagement, social capital and socio-economic conditions. These components interact with each other and influence the interplays of actors, both state and non-state, for MPA governance. Findings from this study suggest that institutions should be adaptive and regularly amended based on their performance in real-world governance processes. This ensures the match between the approved institutions and their practical effects in complex contextual conditions. Meanwhile, there should be accountable and transparent dialogues and mechanisms for all the stakeholders and actors to be actively involved in the development of institutions, and evaluating and monitoring governance processes. Bridging actors or organizations also need to be available as active facilitators of these dialogues and mechanisms. When the institutional and social-interaction issues are solved, governance of coupled human-natural systems, such as MPAs, will be enhanced. [Copyright &y& Elsevier]