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• What is the primary question addressed by this study? This study examines the feasibility of testing and implementing a perioperative mental health intervention bundle composed of psychological and pharmacological components, for older surgical patients. • What is the main finding of this study? Twenty-three older adults (mean age 68.0 years, 65% women) participated in this study, achieving a study reach of 82% and intervention reach of 83%. Preliminary efficacy analysis indicated improvement in PHQ-ADS scores (F = 12.13, p <0.001). • What is the meaning of the finding? Patients described overwhelmingly positive experiences with both the intervention activities and the interventionist, and reported improvement in managing depression and/or anxiety. The perioperative period is challenging and stressful for older adults. Those with depression and/or anxiety have an increased risk of adverse surgical outcomes. We assessed the feasibility of a perioperative mental health intervention composed of medication optimization and a wellness program following principles of behavioral activation and care coordination for older surgical patients. We included orthopedic, oncologic, and cardiac surgical patients aged 60 and older. Feasibility outcomes included study reach, the number of patients who agreed to participate out of the total eligible; and intervention reach, the number of patients who completed the intervention out of patients who agreed to participate. Intervention efficacy was assessed using the Patient Health Questionnaire for Anxiety and Depression (PHQ-ADS). Implementation potential and experiences were collected using patient surveys and qualitative interviews. Complementary caregiver feedback was also collected. Twenty-three out of 28 eligible older adults participated in this study (mean age 68.0 years, 65% women), achieving study reach of 82% and intervention reach of 83%. In qualitative interviews, patients (n = 15) and caregivers (complementary data, n = 5) described overwhelmingly positive experiences with both the intervention components and the interventionist, and reported improvement in managing depression and/or anxiety. Preliminary efficacy analysis indicated improvement in PHQ-ADS scores (F = 12.13, p <0.001). The study procedures were reported by participants as feasible and the perioperative mental health intervention to reduce anxiety and depression in older surgical patients showed strong implementation potential. Preliminary data suggest its efficacy for improving depression and/or anxiety symptoms. A randomized controlled trial assessing the intervention and implementation effectiveness is currently ongoing. [ABSTRACT FROM AUTHOR]

Disparities in youth COVID-19 vaccine acceptance and uptake have been documented in several countries, yet few studies have explored the attitudes and perceptions underlying vaccine-related decision-making among adolescent populations with unique sociocultural, environmental, and/or structural contexts that may influence vaccine uptake. This study used data from surveys and semistructured interviews collected between January and March 2022 as part of an ongoing community-based research project in two ethnoculturally diverse, lower income neighborhoods of Montreal, Canada. Youth researchers designed and conducted interviews with unvaccinated adolescents, and thematic analysis was employed to explore attitudes and perceptions underlying vaccine-related decisions and opinions about vaccine passports. Survey data were used to describe sociodemographic and psychological determinants of COVID-19 vaccination. Among 315 survey participants aged 14–17 years, most (74%) were fully vaccinated against COVID-19. Prevalence ranged from 57% among Black adolescents to 91% among South and/or Southeast Asian adolescents (34% difference, 95% confidence interval: 20–49). Qualitative and quantitative findings highlighted several misconceptions about the safety, effectiveness, and necessity of COVID-19 vaccines and adolescents' desire for trusted sources of information to address their concerns. Vaccine passports likely increased uptake, yet adolescents were strongly resistant to the policy, and for some, it may have fueled distrust of government and scientific institutions. Strategies that increase the trustworthiness of institutions and foster genuine partnership with underserved youth may improve vaccine confidence and help ensure an effective, proequity recovery from COVID-19. [ABSTRACT FROM AUTHOR]

In a complex healthcare system such as the NHS we are exposed to conflict every day. Conflict can arise from many different sources, and the pressures that our service currently faces will only serve to drive this further. We know that when managed poorly conflict has the potential to negatively affect the care of our patients and we will discuss some of the communication models that are available to help staff manage it when it arises. It is important looking forward that we minimize unnecessary conflict wherever possible, and therefore this article will also explore some of the current initiatives developed to raise awareness of the impact that conflict can have in the workplace, as well as the NHS' approach to conflict resolution training for its staff. [ABSTRACT FROM AUTHOR]

Introduction: Medication for Opioid Use Disorder (MOUD) has been shown to decrease mortality, reduce overdoses, and increase treatment retention for patients with opioid use disorder (OUD) and has become the state-of-the-art treatment strategy in the emergency department (ED). There is little evidence on long-term (6 and 12 month) treatment retention outcomes for patients enrolled in MOUD from the ED.Methods: A prospective observational study used a convenience sample of patients seen at one community hospital ED over 12 months. Patients >18 years with OUD were eligible for MOUD enrollment. After medical screening, patients were evaluated by the addiction care coordinator (ACC) who evaluated and counselled the patient and if eligible, directly connected them with an addiction medicine appointment. Once enrolled, the patient received treatment with buprenorphine in the ED. A chart review was completed for all enrollments during the first year of the program. Treatment retention was determined by review of the prescription drug monitoring program and defined as patients receiving regular suboxone prescriptions at 6 and 12 months after index ED visit date.Results: From June 2018 - May 2019 the ACCs evaluated patients during 691 visits, screening 571 unique patients. Of the 571 unique patients screened, 279 (48.9%) were enrolled into the MOUD program. 210 (75.3%) attended their first addiction medicine appointment, 151 (54.1%) were engaged in treatment at 1 month, 120 (43.0%) at 3 months, 105 (37.6%) at 6 months, and 97 (34.8%) at 12 months post index ED visit. Self-pay insurance status was associated with a significantly decrease in the odds of long-term treatment retention.Conclusion: Our ED-initiated MOUD program, in partnership with local addiction medicine services, produced high rates of long-term treatment retention. [ABSTRACT FROM AUTHOR]

Neutropenia and diarrhoea are common and potentially serious adverse events associated with abemaciclib in advanced breast cancer (ABC), and the risk factors have been minimally explored. The study aimed to develop clinical prediction tools that allow personalized predictions of neutropenia and diarrhoea following abemaciclib initiation. Data was pooled from MONARCH 1, 2 and 3 trials investigating abemaciclib. Cox proportional hazard analysis was used to assess the association between pre-treatment clinicopathological data and grade ≥3 diarrhoea and neutropenia occurring within the first 365 days of abemaciclib use. Older age was associated with increased risk of grade ≥3 diarrhoea [HR [95%CI] for age > 70: 1.72 [1.14–2.58]; P = 0.009]. A clinical prediction tool for abemaciclib induced grade ≥3 neutropenia was optimally defined by race, ECOGPS and white blood cell count. Large discrimination between subgroups was observed; the highest risk subgroup had a 64% probability of grade ≥3 neutropenia within the first 365 days of abemaciclib (150 mg twice daily) + fulvestrant/NSAI, compared to 5% for the lowest risk subgroup. The study identified advanced age as significantly associated with an increased risk of abemaciclib induced grade ≥ 3 diarrhoea. A clinical prediction tool, defined by race, ECOGPS and pre-treatment white blood cell count, was able to discriminate subgroups with significantly different risks of grade ≥3 neutropenia following abemaciclib initiation. The tool may enable improved interpretation of personalized risks and the risk-benefit ratio of abemaciclib. • Neutropenia and diarrhoea are common adverse effects of abemaciclib. • Higher age was associated with abemaciclib induced diarrhoea. • White blood cell count, Race, and performance status were linked with neutropenia. • A prediction tool was developed to provide personalized risks of neutropenia. [ABSTRACT FROM AUTHOR]

• Difficulties of obtaining DNA for human identification in forensic cases. • Effects of incineration on bone and subsequent DNA yield. • The advantages and disadvantages of demineralisation prior to DNA extraction. • Compare various DNA extraction protocols (chelex, phenol/chloroform, solid-phase). • Explore and discuss areas for future research. Identification of incinerated human remains may rely on genetic analysis of burned bone which can prove far more challenging than fresh tissues. Severe thermal insult results in the destruction or denaturation of DNA in soft tissues, however genetic material may be preserved in the skeletal tissues. Considerations for DNA retrieval from these samples include low levels of exogenous DNA, the dense, mineralised nature of bone, and the presence of contamination, and qPCR inhibitors. This review collates current knowledge in three areas relating to optimising DNA recovery from burned bone: 1) impact of burning on bone and subsequent effects on sample collection, 2) difficulties of preparing burned samples for DNA extraction, and 3) protocols for bone decalcification and DNA extraction. Bone decalcification and various DNA extraction protocols have been tested and optimised for ancient bone, suggesting that prolonged EDTA (Ethylenediaminetetraacetic acid) demineralisation followed by solid-phased silica-based extraction techniques provide the greatest DNA yield. However, there is significantly less literature exploring the optimal protocol for incinerated bones. Although burned bone, like ancient and diagenetic bone, can be considered "low-copy", the taphonomic processes occurring are likely different. As techniques developed for ancient samples are tailored to deal with bone that has been altered in a particular way, it is important to understand if burned bone undergoes similar or different changes. Currently the effects of burning on bone and the DNA within it is not fully understood. Future research should focus on increasing our understanding of the effects of heat on bone and on comparing the outcome of various DNA extraction protocols for these tissues. [ABSTRACT FROM AUTHOR]

Non-alcoholic fatty liver disease (NAFLD) is common and related to obesity and insulin resistance. Iron metabolism is impaired in obese individuals and iron deficiency has been associated with physical inactivity. We investigated whether iron bioavailability is reduced in patients with NAFLD and contributes to reduced cardiorespiratory fitness. We collected information on weight-adjusted, submaximal physical work capacity (PWC), ultrasound-determined hepatic steatosis, iron indices, and hematologic and metabolic parameters from 390 female and 458 male participants of the Raine Study—a longitudinal study of disease development in 2868 children in Western Australia. X2 and linear regression analyses were used to compare characteristics of study participants according to NAFLD status at age 17 years. Fourteen percent of the cohort had NAFLD. PWC was significantly reduced in adolescents with NAFLD compared to adolescents without NAFLD (reduction of 0.17 W/kg, P =.0003, adjusted for sex and body mass index [BMI]). Iron bioavailability (assessed by mean corpuscular volume [MCV], mean corpuscular haemoglobin [MCH], transferrin saturation, and serum levels of iron) was inversely correlated with BMI in adolescents with NAFLD (P ≤.01 for all, adjusted for sex) but not in adolescents without NAFLD (P >.30). MCV and MCH correlated with PWC (MCV, P =.002 for female and P =.0003 male participants; MCH, P =.004 for female and P =.01 for male participants), irrespective of NAFLD status. Reduced PWC was associated with lower transferrin saturation in adolescents with NAFLD (reduction of 0.012 W/kg per unit decrease in transferrin saturation, P =.007) but not in adolescents without NAFLD (reduction of 0.001 W/kg, P =.40), adjusted for sex. This association was independent of MCV or MCH. In a well-defined cohort of adolescents, we found NAFLD to be associated with decreased cardiorespiratory fitness, independent of BMI. The relationship between transferrin saturation and PWC in adolescents with NAFLD indicates that functional iron deficiency might contribute to reductions in cardiorespiratory fitness. [ABSTRACT FROM AUTHOR]

Background: There is evidence that heart failure (HF) patients who receive pharmacist care have better clinical outcomes.Methods and Results: English-language peer-reviewed randomized controlled trials comparing the pharmacist-involved multidisciplinary intervention with usual care were included. We searched PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, and the Cochrane Library from inception through March 2017. Cochrane method for risk of bias was used to assess within and between studies. 18 RCTs (n = 4630) were included for systematic review, and 16 (n = 4447) for meta-analysis. Meta-analysis showed a significant reduction in HF hospitalizations {odds ratio (OR) 0.72 [95% confidence interval (CI) 0.55-0.93], P = .01, I2  =  39%} but no effect on HF mortality. Similarly, a significant reduction in all-cause hospitalizations [OR 0.76, 95% CI (0.60-0.96), P = .02, I2  =  52%] but no effect on all-cause mortality was revealed. The overall trend was an improvement in medication adherence. There were significant improvements in HF knowledge (P<.05), but no significant improvements were found on health care costs and self-care.Conclusions: The pharmacist is a vital member of a multidisciplinary team in HF management to improve clinical outcomes. There was a great deal of variability about which specific intervention is most effective in improving clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To describe opioid prescribing practice patterns and trends in emergency department visits (EDs) by provider type: physicians and advanced practice providers (APPs), which include nurse practitioners (NPs) and physician assistants (PAs).Methods: The data source was the ED visit files of the 2005-2015 National Hospital Ambulatory Care Survey. The study sample was opioid prescription-related ED visits. Descriptive and multinomial logistic regression analyses were conducted to assess the proportion of opioid prescription-related visits by provider type over time in total and by patient age group. We then characterized opioid prescribing practices of NPs, PAs, and physicians according to type of opioid and pain-related diagnosis.Results: From 2005 to 2015, there was a 116.7% increase in the proportion of the opioid prescription-related visits seen by NPs and a 61.2% increase seen by both APPs and physicians. In contrast, the proportion of the physician-only visits decreased (-8.3%). When stratified by age group, the growth was particularly notable among the visits with patients aged 65 and older seen by both APPs and physicians (AOR = 2.35, 95% CI = 1.69, 3.25). Proportionally less hydromorphone and morphine was prescribed by APPs than by physicians. Opioids were prescribed more often by APPs in visits involving dental and injury-related pain, whereas physicians prescribed opioids more in abdominal and chest pain-related visits.Conclusions: From 2005 to 2015, APPs, particularly NPs played an increasing role in opioid prescribing in EDs. Opioid prescribing practices of APPs and physicians varied by patient condition as well as by opioid type. [ABSTRACT FROM AUTHOR]

Abstract Background Cancer cells possess a common metabolic phenotype, rewiring their metabolic pathways from mitochondrial oxidative phosphorylation to aerobic glycolysis and anabolic circuits, to support the energetic and biosynthetic requirements of continuous proliferation and migration. While, over the past decade, molecular and cellular studies have clearly highlighted the association of oncogenes and tumor suppressors with cancer-associated glycolysis, more recent attention has focused on the role of microRNAs (miRNAs) in mediating this metabolic shift. Accumulating studies have connected aberrant expression of miRNAs with direct and indirect regulation of aerobic glycolysis and associated pathways. Scope of review This review discusses the underlying mechanisms of metabolic reprogramming in cancer cells and provides arguments that the earlier paradigm of cancer glycolysis needs to be updated to a broader concept, which involves interconnecting biological pathways that include miRNA-mediated regulation of metabolism. For these reasons and in light of recent knowledge, we illustrate the relationships between metabolic pathways in cancer cells. We further summarize our current understanding of the interplay between miRNAs and these metabolic pathways. This review aims to highlight important metabolism-associated molecular components in the hunt for selective preventive and therapeutic treatments. Major conclusions Metabolism in cancer cells is influenced by driver mutations but is also regulated by posttranscriptional gene silencing. Understanding the nuanced regulation of gene expression in these cells and distinguishing rapid cellular responses from chronic adaptive mechanisms provides a basis for rational drug design and novel therapeutic strategies. Highlights • Various oncogenes and tumor suppressors are associated with cancer cell metabolism. • Metabolic reprogramming involves pathways that rely upon microRNA regulation. • MicroRNAs ensure post-transcriptional buffering of adaptive metabolic responses. • Dysregulated microRNAs can impact energy flux in cancer cells. • Cancer metabolism may be disrupted by novel, multi-target, therapeutic interventions. [ABSTRACT FROM AUTHOR]

Vaccines hold promise both for the prevention of infections and as potential immunologic therapy for patients with autoimmune disease (AD). These patients are at high risk for both common and opportunistic infections, but this risk can be significantly reduced and even obviated with the use of recommended available vaccines. Unfortunately, patients with ADs are not routinely offered or provided indicated vaccinations and have higher rates of complications from vaccine-preventable illnesses than patients without ADs. In addition, vaccine therapy is currently under study for the treatment of autoimmune disorders, with early studies demonstrating immunomodulatory effects that may counter undesired immune activation and alleviate disease activity. [ABSTRACT FROM AUTHOR]

Résumé L’intervention comportementale intensive est de plus en plus utilisée dans le cadre de services à large échelle destinés aux jeunes enfants ayant un trouble du spectre de l’autisme. Il s’avère pertinent d’évaluer l’acceptabilité sociale de ce programme. La présente étude propose de mesurer l’acceptabilité sociale de cette intervention lorsqu’elle est offerte en service de garde inclusif, ainsi que deux interventions ciblées qui y sont associées. Pour ce faire, le questionnaire d’évaluation Treatment Evaluation Inventory Short-form (TEI-SF) a été traduit et adapté en français. Les résultats présentent les premières preuves de validité de la version francophone du TEI-SF de même que des scores de validité d’intervention et un point de vue favorable relié à l’intervention comportementale intensive, ouvrant la porte à des recherches ultérieures. Early intensive behavioral intervention is more widely used in large-scale community-based services in Autism Spectrum Disorder. There is an increased need to evaluate the social acceptability of these programs. The present study used a measure of social acceptability as part of a social validation procedure to evaluate a community-based EIBI offered in inclusive childcare, as well as two focused interventions associated with this program. To do so, the Treatment Evaluation Inventory Short-form (TEI-SF) questionnaire was adapted and translated to French. The validation results for the TEI-SF, as well as for the social acceptability of the EIBI programs and procedures, are presented. The results are the first evidence of the validity of the TEI-SF (adapted and translated to French), presenting scores of validity of intervention and a favourable perspective related to the early intensive behavioral intervention and opening the door to further research. [ABSTRACT FROM AUTHOR]

Koalas are iconic Australian tree-dwelling marsupials that are classified as vulnerable because of threatening processes that include urban development, habitat fragmentation and inbreeding. Koalas eat the leaves of specific eucalypt trees but urban planners and landowners often prefer to plant smaller trees that pose less risk from falling limbs. We have conducted a long-term project to develop shorter koala-food trees for planting in parklands, schools, streets and gardens. We identified a little-known and geographically-confined species, Eucalyptus kabiana , that had potential for urban plantings. We assessed the height of E. kabiana trees in cultivation, determined whether their foliage was palatable to koalas, and compared the amenability to vegetative propagation of E. kabiana with that of an extensively-propagated related species, E. tereticornis . Cultivated E. kabiana trees were short, reaching around 3–5 m height after 6 years. Their foliage was highly palatable to koalas, and their cuttings proved to be amenable to propagation. Average rooting percentages for E. kabiana cuttings were 31–46%, similar to values obtained with E. tereticornis cuttings. Over 600 E. kabiana trees have thus far been distributed for planting in wildlife corridors, parklands, schools and gardens. The planting of more koala-food trees will help to alleviate the risks of inbreeding faced by koala populations in fragmented urban landscapes. School plantings also provide opportunities for students to learn about and interact with organisms such as koalas that inhabit the Eucalyptus trees. [ABSTRACT FROM AUTHOR]

Currently, limited information on the microbiome (community of microorganisms) and its role in infertility in the equine uterus is available beyond the detection of specific pathogens in some subfertile mares. Given that less than 1% of environmental bacteria are cultivable on common media (Handelsman, J. 2004, Microbiol Mol Biol Rev 68, 669-685.), it is likely that these cultured species represent a minority of the resident population. The overarching objectives of this project were to i) identify the resident uterine microbiome in estrus ii) assess how this microbiome evolves over time and iii) compare traditional culture-dependent methods of assessing the presence of bacteria in the equine uterus with 16S rRNA sequencing. Uterine cytobrush and swab samples were collected from 157 maiden Thoroughbred mares aged 8 years or younger and 116 Thoroughbred barren mares aged 4 to 15 years at the first reproductive exam of the breeding season. A second sample was collected from mares that were not pregnant at the end of the season (n=23). Furthermore, 20 of the mares were sampled in three consecutive breeding seasons. All cytobrush samples were placed and stored in RNAlater and kept at -20° C until further processing. Uterine swabs were plated on sheep blood and MacConkey plates, incubated at 37° C in aerobic conditions and assessed for bacterial growth at 24, 48 and 72 hours. DNA was extracted from cytobrush samples using routine methods. The genomic DNArecovered was used as a template for PCR amplification of the V3–V4 variable region of the bacterial 16S rRNA gene. Amplicons were sequenced on the Illumina MiSeq platform. DNA sequencing data was then processed to assess the equine microbiome composition. The richness (number of bacterial species) and evenness (distribution of bacterial numbers) of bacterial genetic sequences was compared between maiden, barren and wet mares and correlated with reproductive success. The microbiome was highly dynamic and changed significantly between seasons within mares with a limited "core microbiome" being detected. In some mares, conventional culture techniques failed to identify known equine genital pathogens that were detected using 16S rRNA sequencing. While the richness and evenness of the microbiome was comparable in maiden, dry and wet mares, the overall bacterial abundance was higher in mares that were barren at the beginning of the season and failed to become pregnant during the season, when compared to successfully bred barren mares and all maiden mares. This was the first time the microbiome of the equine uterus was studied over several timepoints/seasons. Future studies could explore a prognostic test that allows prediction of fertility in barren mares. This work was funded by AgriFutures Australia. [ABSTRACT FROM AUTHOR]

Nanoparticles (NPs) have been shown to enhance X-ray radiotherapy and proton therapy of cancer. The effectiveness of radiation damage is enhanced in the presence of high atomic number (high-Z) NPs due to increased production of low energy, higher linear energy transfer (LET) secondary electrons when NPs are selectively internalized by tumour cells. This work quantifies the local dose enhancement produced by the high-Z ceramic oxide NPs Ta 2 O 5 and CeO 2 , in the target tumour, for the first time in proton therapy, by means of Geant4 simulations. The dose enhancement produced by the ceramic oxides is compared against gold NPs. The energy deposition on a nanoscale around a single nanoparticle of 100 nm diameter is investigated using the Geant4-DNA extension to model particle interactions in the water medium. Enhancement of energy deposition in nano-sized shells of water, local to the NP boundary, ranging between 14% and 27% was observed for proton energies of 5 MeV and 50 MeV, depending on the NP material. Enhancement of electron production and energy deposition can be correlated to the direct DNA damage mechanism if the NP is in close proximity to the nucleus. [ABSTRACT FROM AUTHOR]

Microbeam Radiation Therapy (MRT) exploits tumour selectivity and normal tissue sparing with spatially fractionated kilovoltage X-ray microbeams through the dose volume effect. Experimental measurements with Ta 2 O 5 nanoparticles (NPs) in 9L gliosarcoma treated with MRT at the Australian Synchrotron, increased the treatment efficiency. Ta 2 O 5 NPs were observed to form shells around cell nuclei which may be the reason for their efficiency in MRT. In this article, our experimental observation of NP shell formation is the basis of a Geant4 radiation transport study to characterise dose enhancement by Ta 2 O 5 NPs in MRT. Our study showed that NP shells enhance the physical dose depending microbeam energy and their location relative to a single microbeam. For monochromatic microbeam energies below ∼70 keV, NP shells show highly localised dose enhancement due to the short range of associated secondary electrons. Low microbeam energies indicate better targeted treatment by allowing higher microbeam doses to be administered to tumours and better exploit the spatial fractionation related selectivity observed with MRT. For microbeam energies above ∼100 keV, NP shells extend the physical dose enhancement due to longer-range secondary electrons. Again, with NPs selectively internalised, the local effectiveness of MRT is expected to increase in the tumour. Dose enhancement produced by the shell aggregate varied more significantly in the cell population, depending on its location, when compared to a homogeneous NP distribution. These combined simulation and experimental data provide first evidence for optimising MRT through the incorporation of newly observed Ta 2 O 5 NP distributions within 9L cancer cells. [ABSTRACT FROM AUTHOR]

This study provides the first proof of the novel application of bismuth oxide as a radiosensitiser. It was shown that on the highly radioresistant 9L gliosarcoma cell line, bismuth oxide nanoparticles sensitise to both kilovoltage (kVp) or megavoltage (MV) X-rays radiation. 9L cells were exposed to a concentration of 50 μg.mL −1 of nanoparticle before irradiation at 125 kVp and 10 MV. Sensitisation enhancement ratios of 1.48 and 1.25 for 125 kVp and 10 MV were obtained in vitro , respectively. The radiation enhancement of the nanoparticles is postulated to be a combination of the high Z nature of the bismuth ( Z = 83), and the surface chemistry. Monte Carlo simulations were performed to elucidate the physical interactions between the incident radiation and the nanoparticle. The results of this work show that Bi 2 O 3 nanoparticles increase the radiosensitivity of 9L gliosarcoma tumour cells for both kVp and MV energies. Monte Carlo simulations demonstrate the advantage of a platelet morphology. [ABSTRACT FROM AUTHOR]

The application of nanoparticles (NPs) in radiotherapy is an increasingly attractive technique to improve clinical outcomes. The internalisation of NPs within the tumour cells enables an increased radiation dose to critical cellular structures. The purpose of this study is to investigate, by means of Geant4 simulations, the dose enhancement within a cell population irradiated with a 150 kVp photon field in the presence of a varying concentration of tantalum pentoxide (Ta 2 O 5 ) NP aggregates, experimentally observed to form shells within tumour cells. This scenario is compared to the more traditionally simulated homogeneous solution of NP material in water with the same weight fraction of Ta 2 O 5 , as well as to a cell population without NPs present. The production of secondary electrons is enhanced by increased photoelectric effect interactions within the high-Z material and this is examined in terms of their kinetic energy spectra and linear energy transfer (LET) with various NP distributions compared to water. Our results indicate that the shell formation scenario limits the dose enhancement at 150 kVp. The underlying mechanism for this limit is discussed. [ABSTRACT FROM AUTHOR]

This paper undertakes a systematic critical review through a ‘queer lens’ of the emergency management response and recovery plans in New South Wales, Australia, in order to determine how the needs of sexual and gender minorities (LGBTI people) are considered and met. We also document the outsourcing by the NSW government of emergency response and recovery arrangements to third party, faith-based Christian institutions and explore how those institutions have been exempted from anti-discrimination protections under Commonwealth (Australian) and State (NSW) law. This enables us to explore the potential implications for LGBTI people in relation to the concepts of vulnerability and resilience. We find the needs of LGBTI people should in practice be met. However, due to anti-discrimination exemptions permitted by law to faith-based Christian institutions, LGBTI people are not being treated equally. We find a ‘blindness to difference’ in relation to the needs of LGBTI individuals and families. As such, we principally conclude that in NSW, Australia, the needs of LGBTI people in post-disaster response and recovery arrangements are inadequately addressed. We recommend further research at the intersection of religion, sexuality and disaster risk reduction to better understand the experiences and needs of LGBTI people (including those of faith) and how faith-based institutions might support LGBTI inclusive response and recovery. [ABSTRACT FROM AUTHOR]

As the climate changes and extreme weather events become more common, the role of house and contents insurance in managing risks is garnering more attention. There is concern, as insurance is a key safety net in contemporary life, that significant levels of house and contents underinsurance are placing individuals and communities at undue risk. Yet, the phenomenon of underinsurance is under-researched. Informed by a document analysis of findings from a multi-modal project investigating the experiences and perspectives of insured and uninsured households in bushfire-prone Australia, we identify underinsurance as a complex phenomenon that is variably co-constituted at different scales – households, landscapes, and markets. To better understand what principles can be meaningfully applied for addressing underinsurance, we present four pertinent and novel themes – place (contextualising rates of underinsurance), integration (integrating insurance with other disaster management mechanisms), hegemony (dismantling hegemonic risk discourses including reference to 'shared responsibility'), and solidarity (in insurance, and through disaster and climate responses). We conclude that addressing inequality and inequity remains paramount given the multifarious reasons why households may be underinsured. Strategies for addressing disasters and global environmental change should be socially just and inclusive irrespective of whether or not households have insurance. • In a changing climate, significant rates of house and contents underinsurance are receiving increasing attention. • A multi-modal project investigated experiences of insured and uninsured households in bushfire-prone Australia. • Many factors contribute to house and contents underinsurance and these vary with scale – households, landscapes and markets. • Useful principles for addressing underinsurance are place, integration, hegemony, and solidarity. • Addressing inequality and inequity remains paramount irrespective of whether or not households have insurance. [ABSTRACT FROM AUTHOR]

Purspose The prevention of youth violence is a public health priority in many countries. We examined the prevalence of bullying victimization and physical fighting in youths in 79 high- and low-income countries and the relations between structural determinants of adolescent health (country wealth, income inequality, and government spending on education) and international differences in youth violence. Methods Cross-sectional surveys were administered in schools between 2003 and 2011. These surveys provided national prevalence rates of bullying victimization (n = 334,736) and four or more episodes of physical fighting in the past year (n = 342,312) in eligible and consenting 11–16 year olds. Contextual measures included per capita income, income inequality, and government expenditures on education. We used meta-regression to examine relations between country characteristics and youth violence. Results Approximately 30% of adolescents reported bullying victimization and 10.7% of males and 2.7% of females were involved in frequent physical fighting. More youth were exposed to violence in African and Eastern Mediterranean countries than in Europe and Asia. Violence directly related to country wealth; a 1 standard deviation increase in per capita income corresponded to less bullying (−3.9% in males and −4.2% in females) and less fighting (−2.9% in males and −1.0% in females). Income inequality and education spending modified the relation between country wealth and fighting; where inequality was high, country wealth related more closely to fighting if education spending was also high. Conclusions Country wealth is a robust determinant of youth violence. Fighting in affluent but economically unequal countries might be reduced through increased government spending on education. [ABSTRACT FROM AUTHOR]

Conservation actions generally benefit some groups more than others, and this inequity is thought to affect the probability of achieving conservation objectives. This has led to the common assumption that triple bottom line solutions – those that are effective, efficient, and equitable – are best and most likely to achieve each individual objective. Although this may be true, it has been little tested, and importantly lacks a conceptual foundation for understanding, predicting and evaluating how equity affects conservation outcomes. We describe types of equity relevant to conservation and explore how they may affect the probability of successfully achieving conservation outcomes. Depending on the equity type and context, the relationship between equity and conservation success varies. We find that the best conservation outcome is often achieved without perfect equity; highlighting the risk of ignoring the relationship between equity and success. We offer a conceptual foundation for better addressing this important issue in future research and application. [ABSTRACT FROM AUTHOR]

Background: The t(2;5)(p23;q35) chromosomal translocation results in the expression of the fusion protein NPM/ALK that when expressed in T-lymphocytes gives rise to anaplastic large cell lymphomas (ALCL). In search of new therapy options the dichloromethane extract of the ethnomedicinal plant Neurolaena lobata (L.) R.Br. ex Cass was shown to inhibit NPM/ALK expression.Purpose: Therefore, we analysed whether the active principles that were recently isolated and found to inhibit inflammatory responses specifically inhibit growth of NPM/ALK+ ALCL, leukaemia and breast cancer cells, but not of normal cells, and the intravasation through the lymphendothelial barrier.Methods: ALCL, leukaemia and breast cancer cells, and normal peripheral blood mononuclear cells (PBMCs) were treated with isolated sesquiterpene lactones and analysed for cell cycle progression, proliferation, mitochondrial activity, apoptosis, protein and mRNA expression, NF-κB and cytochrome P450 activity, 12(S)-HETE production and lymphendothelial intravasation.Results: In vitro treatment of ALCL by neurolenin B suppressed NPM/ALK, JunB and PDGF-Rβ expression, inhibited the growth of ALCL cells late in M phase, and induced apoptosis via caspase 3 without compromising mitochondrial activity (as a measure of general exogenic toxicity). Moreover, neurolenin B attenuated tumour spheroid intravasation probably through inhibition of NF-κB and CYP1A1.Conclusion: Neurolenin B specifically decreased pro-carcinogenic NPM/ALK expression in ALK+ ALCL cells and, via the inhibition of NF-kB signalling, attenuated tumour intra/extravasation into the lymphatics. Hence, neurolenin B may open new options to treat ALCL and to manage early metastatic processes to which no other therapies exist. [ABSTRACT FROM AUTHOR]

Ideal nanoparticle (NP)-based drug and vaccine delivery vectors should be free of inherent cytotoxic or immunostimulatory properties. Therefore, determining baseline immune responses to nanomaterials is of utmost importance when designing human therapeutics. We characterized the response of human immune cells to hydrogel NPs fabricated using Particle Replication in Non-wetting Templates (PRINT) technology. We found preferential NP uptake by primary CD14 + monocytes, which was significantly reduced upon PEGylation of the NP surface. Multiplex cytokine analysis of NP treated primary human peripheral blood mononuclear cells suggests that PRINT based hydrogel NPs do not evoke significant inflammatory responses nor induce cytotoxicity or complement activation. We furthered these studies using an in vivo humanized mouse model and similarly found preferential NP uptake by human CD14 + monocytes without systemic inflammatory cytokine responses. These studies suggest that PRINT hydrogel particles form a desirable platform for vaccine and drug delivery as they neither induce inflammation nor toxicity. From the Clinical Editor The authors here fabricated hydrogel nanorods using the PRINT (Particle Replication In Nonwetting Templates) fabrication process. They tested the interaction of human immune cells with these particles and found no immunoreactivity. This finding would suggest that monodisperse PRINT particles of identical shape and size could serve a variety of clinical applications. [ABSTRACT FROM AUTHOR]

Purpose Neurolaena lobata is a Caribbean medicinal plant used for the treatment of several conditions including inflammation. Recent data regarding potent anti-inflammatory activity of the plant and isolated sesquiterpene lactones raised our interest in further pharmacological studies. The present work aimed at providing a mechanistic insight into the anti-inflammatory activity of N. lobata and eight isolated sesquiterpene lactones, as well as a structure–activity relationship and in vivo anti-inflammatory data. Methods The effect of the extract and its compounds on the generation of pro-inflammatory proteins was assessed in vitro in endothelial and monocytic cells by enzyme-linked immunosorbent assay. Their potential to modulate the expression of inflammatory genes was further studied at the mRNA level. In vivo anti-inflammatory activity of the chemically characterized extract was evaluated using carrageenan-induced paw edema model in rats. Results The compounds and extract inhibited LPS- and TNF-α-induced upregulation of the pro-inflammatory molecules E-selectin and interleukin-8 in HUVECtert and THP-1 cells. LPS-induced elevation of mRNA encoding for E-selectin and interleukin-8 was also suppressed. Furthermore, the extract inhibited the development of acute inflammation in rats. Conclusions Sesquiterpene lactones from N. lobata interfered with the induction of inflammatory cell adhesion molecules and chemokines in cells stimulated with bacterial products and cytokines. Structure–activity analysis revealed the importance of the double bond at C-4–C-5 and C-2–C-3 and the acetyl group at C-9 for the anti-inflammatory activity. The effect was confirmed in vivo , which raises further interest in the therapeutic potential of the compounds for the treatment of inflammatory diseases. [ABSTRACT FROM AUTHOR]

Next-generation DNA sequencing has accelerated the genetic characterization of many human primary immunodeficiency diseases (PIDs). These discoveries can be lifesaving for the affected patients and also provide a unique opportunity to study the effect of specific genes on human immune function. In the past 18 months, a number of independent groups have begun to define novel PIDs caused by defects in the caspase recruitment domain family, member 11 (CARD11)-B-cell chronic lymphocytic leukemia/lymphoma 10 (BCL10)-mucosa-associated lymphoid tissue lymphoma translocation gene 1 (MALT1 [CBM]) signalosome complex. The CBM complex forms an essential molecular link between the triggering of cell-surface antigen receptors and nuclear factor κB activation. Germline mutations affecting the CBM complex are now recognized as the cause of novel combined immunodeficiency phenotypes, which all share abnormal nuclear factor κB activation and dysregulated B-cell development as defining features. For this "Current perspectives" article, we have engaged experts in both basic biology and clinical immunology to capture the worldwide experience in recognizing and managing patients with PIDs caused by CBM complex mutations. [ABSTRACT FROM AUTHOR]

Abstract: Research on the future of carbon dioxide (CO2) emissions of road freight transport in Finland is reported in this paper. Delphi method is utilized to forecast the changes of GDP and seven indicators which determine the CO2 emissions of road freight. Information about the factors affecting the future of these indicators was also collected and an innovative method for acquiring qualitative data in the first round of Delphi study and quantifying it in the second round is presented. Cluster analysis is used to create six scenarios for 2030. The scenarios are mostly driven by different economic developments, which result in very different demand for transport. Despite of this, all scenarios forecast at least 26% reduction in CO2 emissions from 2010 level, while the maximum reduction in one of the scenarios is 74%. [Copyright &y& Elsevier]

Abstract: Adaptation to climate change is being planned and implemented across the developing world. As billions of development aid dollars are being mobilised around this new theme there are risks that adaptation efforts of the development sector will result in familiar problems. In this paper we draw upon postdevelopment perspectives that critically consider development aid and the role of the development sector to scrutinise emerging approaches to adaptation. We suggest that a postdevelopment approach to adaptation contributes a much-needed analysis of the agendas that are shaping adaptation discourses and helps us to see nascent possibilities for adaptation that are already unfolding in diverse localities. [Copyright &y& Elsevier]

Highlights: [•] A case of probable rheumatoid arthritis is reported. [•] The skeleton dates from the middle-Saxon period, c. AD 650–900. [•] Very few cases of rheumatoid arthritis of this early date are known in Europe. [•] Differential diagnoses include erosive osteoarthritis and spondyloarthropathies. [Copyright &y& Elsevier]

Purpose: To assess molecular and histologic differences between the proximal (intra-articular) and distal (extra-articular) portions of the long head of the biceps (LHB) tendon in 3 different disease states (biceps instability, tendinosis, and degenerative joint disease [DJD]) compared with a healthy tendon (fresh frozen). Methods: We used 32 LHB tendons of patients undergoing tenodesis (mean age, 54.7 ± 10.1 years) and 9 harvested tissue donors. Tendons were divided according to 4 diagnostic groups: (1) biceps instability, (2) tendinosis, (3) DJD, and (4) normal control. After sectioning, tendons were fixed in formalin and stained with H&E and alcian blue for histologic analysis. Measurements of collagen organization by use of polarized light microscopy was then performed, and protein expression for type I and type III collagen, tenascin C, and decorin was determined. Results: There were no statistical differences found for protein expression of type I or type III collagen, tenascin C, or decorin. The proximal and distal regions of the tendons had statistically significant differences in alcian blue staining, with the proximal portion containing a higher amount of proteoglycan (instability, P = .001; tendinosis, P = .005; DJD, P = .008; control, P = .011). When compared with the nonpathologic control tendons, a significant increase in alcian blue staining for the proximal region was seen in all 3 groups. Total polarized light analysis showed that the distal tendon had a significantly higher intensity (organization) compared with the proximal tendon (P < .001); this was also seen in all of the diagnostic groups (instability, P = .010; tendinosis, P = .013; DJD, P = .07; control, P = .028). Conclusions: This study showed a greater degree of degeneration of the proximal (intra-articular) regions of the LHB tendon when compared with the distal regions in all pathologic groups. However, no major differences at the cellular level were found among groups. Clinical Relevance: The pathomechanisms of the various forms of known LHB diagnoses are not yet fully understood and basic science studies may help in understanding their etiology and therefore optimizing treatment options. [Copyright &y& Elsevier]

Summary: Cowden syndrome is a rare, autosomal-dominant, multisystem disorder characterized by hamartomatous tissue overgrowth and an increased risk of breast, thyroid, and endometrial cancers. Most of the cases arise from germline mutations of the phosphatase and tensin homologue tumor suppressor gene. An association with colon cancer remains unproven but has been suggested in previous reports. We present the case of a 42-year-old man with colonic ganglioneuromatous polyps and an adjacent colonic adenoma giving rise to a signet-ring adenocarcinoma with lymph node metastases in the setting of Cowden syndrome. Although gastrointestinal polyps are a common feature of Cowden syndrome, reports of ganglioneuromatous polyps and malignant degeneration are rare. Cutaneous features of Cowden syndrome in our patient include “cobblestone” lesions of the tongue and oral mucosa, facial trichilemmomas, multiple acral keratoses, and a storiform collagenoma. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Cochlear implantation after renal transplantation is uncommon and poses unique challenges that have only recently been described in the medical literature. This work reports our experience with cochlear implantation in patients who have undergone renal transplantation. Study Design: A retrospective review was performed. Setting: This study was performed in a tertiary academic medical center. Patients: Two patients were identified as having undergone cochlear implantation after renal transplantation. Interventions: Uneventful unilateral cochlear implantations were performed. Main Outcome Measures: Postoperative complications to include wound infection or dehiscence were reported as well as audiometric data. Results: Cochlear implantation was completed uneventfully in both patients without postoperative complications. One patient expired two years after the procedure as a result of multiple comorbidities. Both patients achieved successful use of their device. Conclusions: This study adds to the growing evidence that successful cochlear implantation can be achieved in appropriately selected renal transplant patients. Decision making should rely on surgical candidacy as well as assessment of surgical risk in collaboration with the transplant service. [Copyright &y& Elsevier]

Abstract: Since 1966, exogenous progestins have been used in equine practice for pregnancy maintenance, estrous suppression, and control of erratic sexual behavior. This study was designed to investigate the use of a new compounded controlled-release progesterone preparation (BioRelease P4 LA 300) in early and late spring transitional mares. In the first experiment, the pharmacodynamic properties of the preparation were studied in five geldings. In the second experiment, the use of a single intramuscular injection (600 mg) was tested in 68 embryo-recipient mares maintained under natural photoperiod in the Southern Hemisphere. Experiment 1 demonstrated elevated serum concentrations of progesterone (>1 ng/mL) for 7.6 ± 2.2 days. In experiment 2, there was no effect of treatment in mares that were treated on September 18, independent of their follicular status at day of treatment (10 to 15 mm; 20 to 25 mm, respectively). When mares with a follicular size of 20 to 25 mm were treated on October 14, significantly more progestin-treated mares (10/12; 83%) ovulated between 10 and 24 days after treatment than untreated controls (3/12; 25%) (P < .05). Additionally, there was a trend in mares treated on October 14 for a shorter treatment to ovulation interval (mean ± SD, 18.6 ± 8.7 days) compared with untreated controls (mean ± SD, 26.7 ± 14.7 days) (P = .07). Administration of one single injection of long-acting progesterone is a simple and effective method of controlling the first ovulation of the season in late transitional mares. [Copyright &y& Elsevier]

Abstract: Hybridisation through pollen dispersal from exotic plants is increasingly recognised as a threat to the genetic integrity of native plant populations. Its genetic impact can be greater in rare taxa, due to their vulnerability to pollen swamping by more abundant congeners. We assessed the likelihood of pollen dispersal from exotic eucalypt plantations into all of Australia''s rare native eucalypts, and conducted a case study of Eucalyptus perriniana, which is rare in Tasmania. The Australia-wide study involved spatial analyses of the locations for each rare species superimposed on distributions of eucalypt plantations, which were combined with known taxonomically based reproductive barriers. Of the 74 nationally listed rare eucalypt taxa, 22 had locations within 10km of plantations of the same genus, and eight were within 1km. These eight proximal taxa are considered priorities for monitoring. In the most extreme case, 30% of point locations originating from herbarium records and field surveys for Eucalyptus conglomerata were within 1km of exotic plantations. In the case study, E. perriniana revealed considerable reproductive compatibility with adjacent recently established Eucalyptus nitens plantations. However, F1 hybridisation between these species was limited, with 0.2% of the 18,625 seedlings grown from 100 single-tree open-pollinated seedlots being hybrids. For now, the probability of exotic gene flow into E. perriniana appears to be low, however this probability is likely to increase as more E. nitens flowers in the surrounding landscape. These studies suggest that understanding the breeding system and biology of these populations may reveal surprising resistance to such exotic hybridisation as well as identifying high risk situations to focus conservation management. [Copyright &y& Elsevier]

Abstract: The fate of aquaculture wastes from a seacage farm within a pristine mangrove environment was studied. Seasonal and tidal differences were most important in determining water quality within receiving waters and obscured any nutrient enrichment effect by the farm. Farm wastes added significantly to the N budget status of the creek system, but overall water quality conformed to Queensland EPA Water Quality standards. Mangrove trees throughout the creek system contained 15N signatures traceable to aquaculture feeds, but the footprint of the farm itself was best indicated by the ratio of Zn:Li in sediments. The creek became hypoxic (<2mgl−1) during wet season low tides. Consequently, we recommended monitoring of water-column oxygen concentrations to warn of hypoxic conditions threatening to fish health, as well as Zn:Li ratios in sediment accumulation zones to determine the area of influence of the farm. [ABSTRACT FROM AUTHOR]

Abstract: Background: Adverse drug reactions are recognized as a significant public health issue. Pharmacogenetics (PGx) provides a potential means of preventing some adverse drug reactions by predicting the optimal medication dose for an individual; however, PGx is rarely used in clinical practice. Thus far, there have been few studies investigating consumers'' perceptions of the barriers to the implementation of PGx in clinical practice. Objectives: This study explored the views of the general public regarding their current use of medications, and their experiences of side effects and opinions on PGx. Methods: Members of the general public who suffered a chronic medical condition and/or had an immediate family member with a chronic medical condition were recruited to form 5 separate focus groups (n=35). Three separate age ranges were used in the focus groups. A questioning route was developed and used in focus groups to determine participants'' experiences with medication use and opinions on PGx (referred to as “Personalized Medicine”). Focus group discussions were transcribed by 2 separate investigators, and qualitative analysis, based on the framework approach, was applied to the data. Data were independently coded to identify key themes then compared both within and between focus groups. Results: A common theme was a desire to have a holistic approach to disease diagnosis and medication selection. A wide range of views were expressed by the focus group participants. Concerns were raised regarding the current level of side effects experienced with medications. Storage and privacy of genetic information, and the costs involved, were also seen as potential barriers to implementation of PGx. Conclusions: PGx testing was seen as a potential positive contribution, but only if other factors were considered during the prescribing process. As participants desired a high level of information and effective communication from their health-care professionals, PGx education of clinicians and pharmacists will be essential to satisfy consumers'' requirements. [Copyright &y& Elsevier]

Abstract: Surgical interference screws and suture anchors for attaching soft tissue, such as ligaments and tendons, to bone are routinely used in arthroscopic surgery and sports medicine. Interference screw fixation provides a press fit between bone, graft/tendon, and screw and is frequently used to attach replacement ligaments in tunnels drilled for anterior and posterior cruciate ligament reconstruction. Suture anchors are used in surgical procedures wherein it is necessary for a surgeon to attach (tie) tissue to the surface of the bone, for example, during joint reconstruction and ligament repair or replacement. The composition of these implants ranges from metals to polymers and composites. Typically, because of the relatively large amount of torque that must be applied during insertion, these screws are constructed from metal. However, interference screws and suture anchors have also been constructed from bioabsorbable polymers and composites. The ideal material would (1) provide adequate mechanical fixation, (2) completely degrade once no longer needed, and (3) be completely replaced by bone. Because no material has been shown to be superior for all applications, the surgeon must weigh the advantages and disadvantages of each to evaluate the optimum material for a given application and patient. The purpose of this article is to present a comprehensive review of the commercially available interference screws and suture anchors, with an emphasis on implant composition, interaction, and design. This article provides the orthopaedic surgeon with a background on biomaterials, specifically those used in interference screws and suture anchors. Because there is no material that is perfect for all surgical situations, this review can be used to make educated decisions on a case-by-case basis. [Copyright &y& Elsevier]

Abstract: Background: There have been few previous studies on the health needs of police detainees. London’s Metropolitan Police Service (MPS) uses health screening procedures which have not yet been evaluated. The objective of this study is to determine the extent of health problems and ‘mental vulnerability’ in detainees in police custody, and the efficacy of current health screening procedures. Methods: Custody records from five London Boroughs were reviewed. Prevalence data for health problems and mental vulnerability was obtained from the anonymised records of 307 detainees who were referred to the Forensic Medical Examiner (FME). Data were analysed for the identification of physical and psychiatric morbidity. Results: Injuries, epilepsy and asthma were the most common physical health problems noted. Drug and alcohol issues were also frequently encountered along with depression and self-harming behaviour and suicidal ideation. Morbidity was lower than that reported in other, interview based studies. Less than 2% of detainees were thought to require an Appropriate Adult to be present during police interview. Conclusions: A significant amount of health morbidity is present among detainees in police custody. Our findings suggest that current police screening procedures detect only a proportion of this. Further research is warranted to evaluate the effectiveness of health screening in police custody. [Copyright &y& Elsevier]

Summary: Objectives: To investigate the usage patterns of complementary and alternative medicines (CAMs), as well as dietary interventions, by South Australian people with multiple sclerosis (MS). Design: Self-administered postal survey. Setting: Questionnaire mailed to recipients of the South Australian (SA) MS Society newsletter (n =1230). Main outcome measures: Patterns of CAMs use and dietary interventions, reasons for using/not using CAMs in MS, sources of CAMs information and monthly expenditure on CAMs/dietary interventions. Results: A total of 428 surveys were returned (response rate 34.8%) of which 416 met the inclusion criteria for analysis. The majority of SA people with MS who responded reported using CAMs/dietary interventions (64.7%). Respondents with tertiary education and those with mild and moderate disease reported highest CAM use. The most frequently used CAM product categories were vitamins (81.8%), essential fatty acids (80.7%) and minerals (62.5%). Commonly used herbal products included Ginkgo biloba (18.2%) and valerian (16.4%). Popular diets were the low fat (39.8%), low/no sugar (23.8%) and gluten-free (16.4%) diets. The majority of those using CAMs/dietary interventions did so concurrently with conventional treatments (72.1%). Reasons for use included: general health and well-being; to alleviate ‘general’ as well as specific MS symptoms such as muscle weakness, urinary or memory problems and mobility. Conventional health professionals, and friends/family, were the most common sources of information. Monthly expenditure was most commonly AUD$20–49/month. Conclusion: This study reports frequent use of CAM/dietary intervention amongst SA people with MS. The majority of users did so in conjunction with conventional treatments. [Copyright &y& Elsevier]