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Human rights issues on fishing vessels are increasingly receiving much-needed global attention. However, most focus is directed towards the fishing crew, often ignoring other important workers on board fishing vessels, namely, observers. Due to their specific role as the "eyes and ears" on the water, observers are not covered by any current binding international regulations concerning working standards on board fishing vessels. This leaves them relatively unprotected, besides flag state control. One way flag states address observer welfare and working conditions is through observer programmes. The aim of this paper is to assess whether observer programmes fulfil their responsibilities to protect the health, safety, and welfare of observers and their living conditions while onboard fishing vessels. This analysis was done by developing a specific observer benchmark tool for reviewing observer programmes. The results of this research found that, on average, assessed observer programmes demonstrate good performance. Based on the results, four recommendations are provided, including the need to conduct independent reviews of observer programmes. Generally, more research is needed to get a better understanding of geographical hot-spots and observer experiences. Fisheries observers are key to ensuring sustainable fisheries management, and it is imperative that their right to a safe work environment is assured. • Fisheries observers are key to ensuring sustainable fisheries management. • Fisheries observers are excluded from international labour conventions. • Observer programmes are key to protecting observers on board fishing vessels. • Observer programmes established a good framework to protect their observers. • But, there are inconsistencies between procedures and reality on the water. [ABSTRACT FROM AUTHOR]

Adults with severe mental illness (SMI) have lower physical activity (PA) than the general population. Supervised exercise interventions provide high support but may not effectively promote motivation, which is important for behaviour change. Motivational strategies such as PA counselling may target motivation more directly; however, the effectiveness in people with SMI is unclear. This was a randomised controlled trial of interventions designed to promote PA in adults with SMI. Participants were randomised to either: (1) supervised exercise (GYM), or (2) motivational counselling and self-monitoring using fitness trackers (MOT). Group sessions were once/week over 8-weeks. The primary outcome was time spent in moderate-to-vigorous PA (MVPA) assessed using GENEActiv accelerometers worn continuously. Change in MVPA was assessed using the cumulative change from baseline, and as a composition of light activity, sedentary behaviour, and sleep. Sixty-four participants were allocated (63% male, 82% overweight/obese, 59% psychotic disorder). Accelerometer-derived MVPA increased for the MOT group between baseline and post-intervention, and the cumulative sum of change in MVPA from baseline in the MOT group was higher than the GYM group. Compositional analyses showed stable weekly activity profiles, with no significant changes attributable to group allocation. The cumulative change in MVPA was higher for MOT than GYM; however, compositional analyses that considers MVPA as a composition of other daily behaviours showed no change in composition over the intervention period. Exercise interventions should incorporate motivational strategies and supervised exercise; future research should investigate behaviour change interventions with longer durations and more frequent sessions. The trial is registered under the Australian and New Zealand Clinical Trial Registry (ACTRN12617001017314). [Display omitted] • Severe mental illness (SMI) is associated with low moderate-to-vigorous physical activity (MVPA). • Motivation (MOT) and exercise (GYM) interventions may impact behaviour change differently. • MOT increased accelerometer-derived MVPA over GYM, but motivation was unchanged. • Compositional analyses indicated no significant differences. • Motivational strategies should be combined with supervised exercise for people with SMI. [ABSTRACT FROM AUTHOR]

The low FODMAP diet (LFD) is effective in managing irritable bowel syndrome (IBS) in the short term. This study assessed the long-term effect of the LFD on symptoms, nutritional composition and socialising. Patients with IBS who received dietetic-led LFD advice were approached at long term follow up (>6 months post LFD advice) from six centres across the United Kingdom. Participants completed questionnaires assessing gastrointestinal symptoms, adherence, nutritional intake, dietary acceptability and food related quality of life (QOL). 205 participants completed the study, with a mean follow up of 44 months (3.7 years). Adequate symptom relief was noted in 60% of individuals at long term follow up, with 76% being on the personalisation phase of the LFD (pLFD). Mean nutritional intake did not differ between individuals on the pLFD versus habitual diet, with no difference in fructan intake (2.9 g/d vs 2.9 g/d, p = 0.96). The majority (80%) of individuals on the pLFD consumed specific 'free-from' products at the long term, with the purchase of gluten or wheat free products being the commonest (68%). The majority of patients follow the pLFD in the long term, with a large proportion purchasing gluten or wheat free products to manage their symptoms. [ABSTRACT FROM AUTHOR]

Background: Currently, no consensus exists for selection criteria of appropriate candidates for outpatient total hip arthroplasty (THA). This study evaluates patient characteristics associated with same-day discharge, examined surgical start time's effect on rates of same-day discharge, and compares readmission and reoperation rates between groups.Methods: All patients who underwent a THA by one surgeon at a single quaternary care hospital between February 2016 and May 2018 were captured. All patients were given the option for same-day discharge. Patient characteristics and perioperative variables were analyzed.Results: A total of 429 patients met inclusion criteria, 153 (36%) were discharged on the day of surgery. In a multivariate analysis, age (P = .000), multiple comorbidities (P = .004), and start time remained statistically significant (P = .000). Patients with start times prior to 9 AM had odds ratio of 11.56 of being discharged same day when compared to those with start times after 12 PM. Patients discharged the day of surgery were less likely to have a 90-day emergency room visit (P = .010), a readmission within 30 days (P = .001) or 90 days (P = .000), or a reoperation (0 vs 14, P = .003).Conclusion: Same-day discharge following THA is safe and feasible. Patient's age and number of comorbidities should be considered when developing selection criteria for same-day discharge programs. Patients selected for same-day discharge should receive earlier operating room start times. [ABSTRACT FROM AUTHOR]

Koala retrovirus (KoRV) infection shows differences in prevalence and load between northern and southern Australian koala populations; however, the effect of this on diseases such as lymphoma and chlamydial disease is unclear. This study compared clinicopathological findings, haematology and splenic lymphoid area of KoRV-positive koalas from northern (Queensland [Qld], n = 67) and southern (South Australia [SA], n = 92) populations in order to provide further insight into KoRV pathogenesis. Blood was collected for routine haematology and for measurement of KoRV proviral load by quantitative polymerase chain reaction (qPCR). Plasma samples were assessed for KoRV viral load by reverse transcriptase qPCR and conjunctival and cloacal swabs were collected for measurement of the load of Chlamydia pecorum (qPCR). During necropsy examination, spleen was collected for lymphoid area analysis. Lymphoma was morphologically similar between the populations and occurred in koalas with the highest KoRV proviral and viral loads. Severe ocular chlamydial disease was observed in both populations, but urinary tract disease was more severe in Qld, despite similar C. pecorum loads. No associations between KoRV and chlamydial disease severity or load were observed, except in SA where viral load correlated positively with chlamydial disease severity. In both populations, proviral and viral loads correlated positively with lymphocyte and metarubricyte counts and correlated negatively with erythrocyte and neutrophil counts. Splenic lymphoid area was correlated positively with viral load. This study has shown further evidence for KoRV-induced oncogenesis and highlighted that lymphocytes and splenic lymphoid tissue may be key sites for KoRV replication. However, KoRV infection appears to be highly complex and continued investigation is required to fully understand its pathogenesis. [ABSTRACT FROM AUTHOR]

Giardia duodenalis is an ubiquitous parasitic pathogen that causes significant morbidity and mortality worldwide. Failures in drug therapy are commonly due to poor patient compliance as a result of the need for repeated administration, off target drug effects and increasing parasite drug resistance. In this study the in vitro efficacy and selectivity of the aminoguanidine compound robenidine and 2 structural analogues against Giardia were determined. After 5 h exposure to each compound the IC 50 was as low as 0.2 μM with corresponding MLCs as low as 2.8 μM. This is in contrast to metronidazole which required 24 h to exhibit inhibitory activity. A modified adherence assay, developed for this study, demonstrated that three of the compounds inhibited in vitro adherence of the parasite. The lead compound exhibited rapid giardicidal activity (<5hr). In addition, microscopy studies demonstrated damage to the plasma membrane of trophozoites. In conclusion, a class of aminoguanidines, represented by robenidine, has shown antigiardial activity warranting further investigation. Image 1 • Robenidine has faster antigiardial activity in vitro compared to metronidazole. • Novel structures developed with improved antigiardial activity compared to robenidine. • Giardia is unable to recover after short exposure times to novel antigiardials • Electron microscopy images show detailed structural damage after robenidine exposure. [ABSTRACT FROM AUTHOR]

Abstract A nine-year-old domestic cat from Melbourne, Australia, presented with a non-ulcerated nodule on its nasal bridge. A fungal infection of the subcutis was diagnosed based on histopathology and culture of a white mould, which was identified as Sporothrix pallida complex by ITS1–5.8S-ITS2 and β-tubulin gene sequencing. The cat was treated by cytoreduction, itraconazole and subsequently posaconazole, which eventually resulted in regression of residual infected tissues and clinical resolution. [ABSTRACT FROM AUTHOR]

The management of technology is increasingly fuelled by societal challenges and user problems. For effective technology development and implementation, it is important that both are relevant not only in the present, but also in the future. Technological development and implementation take time which means that a technology originally meant to address a particular societal challenge, may be no longer relevant at the time it is implemented because the challenge or problem may no longer exist. We call this 'future technology myopia'. This myopia implies that while analysing the possible future development of a technology, sufficient vigilance should be given to the persistence of i). the technical challenge and ii). the development of the societal problem, and of alternative ways to deal with both. In view of the increasing interdependence between technology and society, broadening the technology management and analysis is therefore relevant for the effective development of technology to address future societal and user problems and for developing relevant strategic technology policies. In this paper we develop a Technology Management Ailment Matrix that identifies imbalances that might arise during the technology development process. It enables firms to identify and compare different technology management ailments collectively; it also identifies a further new ailment: future technology myopia. • Future Technology Myopia (FTM) states that in technology development, too little attention is paid to changing social issues • FTM is a valuable addition to existing ailments such as 'not-invented-her' and the 'innovator's dilemma'- One condition for FTM is that technology takes much time to develop • One strategy to deal with FTM is to broadly explore possible technologies that are potentially capable of addressing a societal issue [ABSTRACT FROM AUTHOR]

This paper examines the alienation entailed in contemporary emotional and affective labour and the ways this might be overcome. I identify the shifts in the nature and function of this labour since it first received attention by feminist and other scholars in the 1970s and '80s. And I point towards the emergence of contemporary struggles to limit the emotional intensity of the working day, similar in some ways to those Karl Marx once described around its length . My primary wager is that overcoming the forms of alienation at stake in the putting to work of personality, subjectivity, and self, need not be understood as a largely idealist question of ‘de-alienation’ or ‘de-reification’. Rather, drawing on Benedict de Spinoza's work on the body, mind, and affects, I suggest it is one of organising material encounters between bodies and their joining together through the construction of ‘common notions’, reason, and a more ‘real’ understanding of the social world as well as one’s location within it. I argue that, in approaching such a project, feminist and other methods of ‘consciousness-raising’ may prove of greater use than many traditional approaches to developing and delivering ‘class consciousness’. [ABSTRACT FROM AUTHOR]

Summary Koala retrovirus (KoRV) infection, thought to be associated with lymphoid neoplasia, and Chlamydia pecorum -related ocular and urogenital disease are both highly prevalent in eastern Australian koala ( Phascolarctos cinereus ) populations. However, in South Australian koalas, little is known about KoRV infection and C. pecorum -associated disease. We report the first South Australian case of lymphoma in a KoRV-A-positive female koala also affected by severe reproductive chlamydiosis. The koala was from the Mount Lofty Ranges population and was presented with hindlimb lameness. Clinical examination identified right stifle crepitus, enlarged superficial lymph nodes and paraovarian cysts. Necropsy examination revealed extensive cartilage degeneration and loss over the medial femoral condyle, solid femoral bone marrow, mesenteric and ovarian tumours, paraovarian cysts and purulent metritis. Histopathology confirmed lymphoma in the bone marrow, mesenteric lymph nodes and ovary, with infiltration and parenchymal effacement in the pancreas, adrenal glands and other tissues. Lymphoma, KoRV and chlamydiosis are being investigated further in this population. [ABSTRACT FROM AUTHOR]

Background Aortic disease is a lifelong, progressive illness that may require repeated intervention over time. We reviewed our 25-year experience with open redo thoracoabdominal aortic aneurysm (TAAA) and descending thoracic aortic aneurysm (DTAA) repair. Our objectives were to determine patient outcomes after redo repair of DTAA/TAAA and compare them with nonredo repair. We also attempted to identify the risk factors for poor outcome. Methods We reviewed all open redo TAAA and DTAA repairs between 1991 and 2014. Patient characteristics, preoperative, intraoperative variables, and postoperative outcomes were gathered. Data were analyzed by contingency table and by multiple logistic regression. Results We performed 1,900 open DTAA/TAAA repairs, with 266 (14%) being redos. Redos were associated with younger age (62 ± 16.4 years vs 64.5 ± 13.4 years, p < 0.02). Reasons for redo DTAA/TAAA were extension of the disease (86.8%), intercostal patch expansion (6.8%), visceral patch expansion (10.9%), infection (4.5%), anastomotic pseudoaneurysm (8.3%), and previous endovascular aortic repair complications (6.4%). Extent IV TAAA was predominantly involved in redos (42.8% redo vs 14.6% nonredo, p < 0.0001). The early mortality rate was significantly higher in redo (61 of 266 [23%]). Long-term survival was significantly lower among redo compared with nonredo DTAA/TAAAs. A multivariable analysis using the significant risk factors for early death from the risk factors on univariate analysis found four preoperative variables were significant (age >70 years, glomerular filtration rate <48 mL/min per 1.73m 2 , extent III TAAA, and emergency presentation) for predicting early death. In the presence of all four risk factors in a redo patient, a maximal risk of 82% for early death was predicted. Conclusions The need for a redo operation in DTAA/TAAA repair is common and most often presents as an extension of the disease into an adjacent segment. A hybrid or completely endovascular treatment should be considered in high-risk patients. [ABSTRACT FROM AUTHOR]

In 2021, a voluntary, anonymous online livestock/equine survey (originally distributed in 2015), was readministered using Qualtrics® software and disseminated to Arizona livestock/equine industry stakeholders through email listservs, social media, personal connections, and attendees of cooperative extension events. The goal was to compare the 2021 data from horse owners (118/237 overall responses) to the 2015 responses (280 horse owners/484 total respondents) to review, update and if necessary, change the focus of our educational programming to topics perceived to be of moderate to critical need by 2021 Arizona horse owners. Survey results from both years came from all 15 Arizona counties and grouped by number of horses owned (1–3, 4–6, 7–9, and ≥ 10). The 2 data sets were analyzed independently using Chi-Square contingency tests, with significance declared at (P < 0.05). In both 2015 and 2021, more respondents owning 1–3 horses used their horses for recreation only (P < 0.05), and more respondents owning ≥ 10 horses used them for business (P < 0.05). In 2015, preferences for methods of information delivery were significantly affected by the age of respondent, with ≥ 70 years choosing newsletters/emails and both 50–69 years and ≥ 70 years preferring hands-on field days (P < 0.05). Additionally, more 50–69year-old respondents wanted fact sheets (P < 0.05). In 2021, ≥ 70 year-old respondents were less receptive to virtual seminars (P < 0.05). Survey takers ranked each of 22 topics related to horse feeding, management, training, horse health, business planning, etc. by no, slight, moderate, or critical need. Highest ranking topics in both 2015 and 2021, (with > 60% of ratings ranging from moderate to critical need), included toxic plants, vaccination programs, training and behavior, hoof care, heat stress, utilizing AZ forage, and lameness. In 2015, more respondents owning ≥ 10 horses chose "no need" for horse training/management (P < 0.05) and heat stress (P < 0.05), but in 2021 the "no need" for heat stress education difference was no longer apparent. In 2015, owners with 1–3 horses did not perceive a critical need for heat stress education, but they did in 2021 (P < 0.05). Topics with the highest perceived need were similar in 2021 and 2015, allowing us to continue with our current programming areas and priorities, although we found the age of respondents affected their preferences for methods of information delivery, and we need to continue heat stress education for recreational horse stakeholders owning 1–3 horses. [ABSTRACT FROM AUTHOR]

Abstract Non-functioning pituitary adenomas (NFPA) are classified as benign tumors of slow growth, but 40% of them present local invasion, a characteristic of behavior still unpredictable with the use of current tumor markers. This work aims to evaluate the tissue markers E-cadherin and NCAM, which act on cell adhesion, in tumor tissue samples of NFPA and its relationship with the degree of local invasiveness. Gene expression of E-cadherin (CDH1) and NCAM (NCAM1) was assessed by real-time PCR and tissue expression by immunohistochemistry. Fifty-three patients with macroadenomas were submitted to transsphenoidal surgery, presented grade II invasive adenomas in 16 cases (30.2%), grade III in 7 (13.2%) and grade IV in 30 (56.6%). In the immunohistochemistry, one case was negative for E-cadherin, 7 showed weak immunostaining, 17 moderate and 28 strong, whereas for NCAM, 5 showed negative, 28 weakly, 14 moderate and 6 strong. Regarding gene expression, 43.3% showed expression for CDH1 (mean of 2.12) and 50% for NCAM1 (mean of 1.86). There was no significant correlation between the immunohistochemical expression of the markers, as well as the gene expression, the degree of invasiveness and clinical data. The results suggest that E-cadherin and NCAM markers are not directly related to the invasiveness in NFPA. Highlights • E-cadherin and NCAM in 53 samples of non-functioning pituitary adenomas • Regarding protein expression, 98% showed expression for E-cadherin and 90% for NCAM. • Regarding gene expression, 43% showed expression for CDH1 and 50% for NCAM1. • There was no correlation between markers expression, invasiveness and clinical data. [ABSTRACT FROM AUTHOR]

Various diets are proposed as first-line therapies for non-constipated irritable bowel syndrome (IBS) despite insufficient or low-quality evidence. We performed a randomized trial comparing traditional dietary advice (TDA) against the low FODMAP diet (LFD) and gluten-free diet (GFD). Patients with Rome IV–defined non-constipated IBS were randomized to TDA, LFD, or GFD (the latter allowing for minute gluten cross-contamination). The primary end point was clinical response after 4 weeks of dietary intervention, as defined by ≥50-point reduction in IBS symptom severity score (IBS-SSS). Secondary end points included (1) changes in individual IBS-SSS items within clinical responders, (2) acceptability and food-related quality of life with dietary therapy, (3) changes in nutritional intake, (4) alterations in stool dysbiosis index, and (5) baseline factors associated with clinical response. The primary end point of ≥50-point reduction in IBS-SSS was met by 42% (n = 14/33) undertaking TDA, 55% (n = 18/33) for LFD, and 58% (n = 19/33) for GFD (P =.43). Responders had similar improvements in IBS-SSS items regardless of their allocated diet. Individuals found TDA cheaper (P <.01), less time-consuming to shop (P <.01), and easier to follow when eating out (P =.03) than the GFD and LFD. TDA was also easier to incorporate into daily life than the LFD (P =.02). Overall reductions in micronutrient and macronutrient intake did not significantly differ across the diets. However, the LFD group had the greatest reduction in total FODMAP content (27.7 g/day before intervention to 7.6 g/day at week 4) compared with the GFD (27.4 g/day to 22.4 g/day) and TDA (24.9 g/day to 15.2 g/day) (P <.01). Alterations in stool dysbiosis index were similar across the diets, with 22%–29% showing reduced dysbiosis, 35%–39% no change, and 35%–40% increased dysbiosis (P =.99). Baseline clinical characteristics and stool dysbiosis index did not predict response to dietary therapy. TDA, LFD, and GFD are effective approaches in non-constipated IBS, but TDA is the most patient-friendly in terms of cost and convenience. We recommend TDA as the first-choice dietary therapy in non-constipated IBS, with LFD and GFD reserved according to specific patient preferences and specialist dietetic input. Clinicaltrials.gov: NCT04072991. [Display omitted] [ABSTRACT FROM AUTHOR]

The medial column fusion is performed for a multitude of etiologies, including peritalar subluxation deformity, Charcot arthropathy, trauma, post-traumatic degenerative joint disease, and rheumatoid arthritis. Various surgical techniques have been described for medial column arthrodesis. We describe a new fixation method using an anatomic distal fibular locking plate for medial column arthrodesis. This technique provides a rigid construct in compromised or at risk bone. After a review of the surgical technique, we outline 2 case examples of patients with peritalar subluxation and Charcot arthropathy. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To perform a methodical review of the evidence available for the efficacy of cognitive rehabilitation in individuals with diagnosed medical conditions known to affect cognitive function, and to establish evidence-based recommendations for clinical practice, as appropriate. Data Sources: Ovid Medline and PubMed literature searches were conducted using the terms cognition, cognitive, crossed with the terms rehabilitation, remediation, retraining, training, crossed with 11 medical diagnostic categories. Articles through December 2008 were accessed, with a resulting 2284 abstracts. Study Selection: A total of 211 articles were selected from initial abstract review. These articles were then assessed by committee members, with agreement of at least 2 members, using 9 exclusion and 3 inclusion criteria. A total of 34 remaining articles were submitted to full review. Data Extraction: Articles were reviewed under diagnostic categories using specific criteria recorded on structured data sheets. Classification was performed according to guidelines of the American Academy of Neurology, with agreement between 2 committee members necessary for final decisions. Data Synthesis: Of the 34 studies fully evaluated, 1 was rated as class I, 6 as class II, 2 as class III, and 25 as class IV. Evidence within each diagnostic area was synthesized for the formulation of Practice Standards, Practice Guidelines, and Practice Options, as possible. Conclusions: Two clinical practice recommendations were advanced, 1 each in the diagnostic areas of brain neoplasms and epilepsy/seizure disorders. Discussion included comments on the research status of the effectiveness of cognitive rehabilitation for cognitive deficits related to these medical conditions, as well as suggestions for future directions in research. [Copyright &y& Elsevier]

Abstract: Screening for HIV in the emergency department (ED) is recommended by the Centers for Disease Control and Prevention. The relative importance of efforts to increase consent among those who currently decline screening is not well understood. We compared the risk characteristics reported by patients who decline risk-targeted, opt-in ED screening with those who consent. We secondarily recorded reasons for declining testing and reversal of the decision to decline testing after prevention counseling. Of 199 eligible patients, 106 consented to testing and 93 declined. Of those declining, 60 (64.5%) of 93 completed a risk assessment. There were no differences in HIV risk behaviors between groups. Declining patients reported recent testing in 73.3% of cases. After prevention counseling, 4 (6.7%) of 60 who initially declined asked to be tested. Given similarities between those who decline and those who consent to testing, efforts to increase consent may be beneficial. However, this should be tempered by the finding that many declined because of a recent negative test. Emphasizing risk during prevention counseling is not a promising strategy for improving opt-in consent rates. [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: A random allocation single blind block design pillow field study was undertaken to investigate the behaviour of cervico-thoracic spine pain in relation to pillow use. Participants (N =106) who reported preference for side sleep position with one pillow were recruited via a telephone survey and newspaper advertisement. They recorded sleep quality and pillow comfort ratings, frequency of retiring and waking cervical pain and duration of waking cervical pain while sleeping for a week on their usual pillow, polyester, foam, feather and rubber pillows of regular shape and a foam contour pillow. Analysis was undertaken comparing sleep quality, pillow comfort, waking and temporal cervical pain reports, between the usual pillow and the trial pillows, between pillows of differing content and foam pillows of differing shape. This study provides evidence to support recommendation of rubber pillows in the management of waking cervical pain, and to improve sleep quality and pillow comfort. The rubber pillow performed better than subjects'' own pillow in most instances. Subjects'' own pillow performed similarly to foam and polyester pillows, and there is no evidence that the use of a foam contour pillow has advantages over the regular shaped pillows. Feather pillows should not be recommended. [Copyright &y& Elsevier]

Abstract: The aim of this study was to evaluate the effectiveness of qigong compared with exercise therapy and no treatment. Elderly patients with chronic neck pain (>6 months) were randomly assigned to qigong or exercise therapy (each 24 sessions over a period of 3 months) or to a waiting list control. Patients completed standardized questionnaires at baseline and after 3 and 6 months. The main outcome measure was average neck pain on the visual analogue scale after 3 months. Secondary outcomes were neck pain and disability (NPAD) and quality of life (SF-36). One hundred seventeen patients (age, 76 ± 8 years, 95% women) were included in the intention-to-treat analysis. The average duration of neck pain was 19.0 ± 14.9 years. After 3 months, no significant differences were observed between the qigong group and the waiting list control group (visual analogue scale mean difference, −11 mm [CI, −24.0; 2.1], P = .099) or between the qigong group and the exercise therapy group (−2.5 mm [ − 15.4; 10.3], P = .699). Results for the NPAD were similar (qigong vs waiting list −6.7 (−15.4; 2.1), P = .135; qigong vs exercise therapy 2.3 (−6.2; 10.8); P = .600). We found no significant effect after 3 months of qigong or exercise therapy compared with no treatment. Further studies should include outcomes more suitable to elderly patients, longer treatment, and patients with less chronic pain. Perspective: In a randomized controlled study, we evaluated whether a treatment of 24 qigong sessions over a period of 3 months is (1) superior to no treatment and (2) superior to the same amount of exercise therapy in elderly patients (age, 76 ± 8 years, 95% women) with long-term chronic neck pain (19.0 ± 14.9 years). After 3 and 6 months, we found no significant differences for pain, neck pain, disability, and quality of life among the 3 groups. [Copyright &y& Elsevier]

STUDY OBJECTIVE: The Institute of Medicine, through its landmark report concerning errors in medicine, suggests that standardization of practice through systematic development and implementation of evidence-based clinical pathways is an effective way of reducing errors in emergency systems. The specialty of emergency medicine is well positioned to develop a complete system of innovative quality improvement, incorporating best practice guidelines with performance measures and practitioner feedback mechanisms to reduce errors and therefore improve quality of care. This article reviews the construction, ongoing development, and initial impact of such a system at a large, urban, university teaching hospital and at 2 affiliated community hospitals. METHODS: The Committee for Procedural Quality and Evidence-Based Practice was formed within the Department of Emergency Medicine to establish evidence-based guidelines for nursing and provider care. The committee measures the effect of such guidelines, along with other quality measures, through pre- and postguideline patient care medical record audits. These measures are fed back to the providers in a provider-specific, peer-matched 'scorecard.' RESULTS: The Committee for Procedural Quality and Evidence-Based Practice affects practice and performance within our department. Multiple physician and nursing guidelines have been developed and put into use. Using asthma as an example, time to first nebulizer treatment and time to disposition from the emergency department decreased. Initial therapeutic agent changed and documentation improved. CONCLUSION: A comprehensive, guideline-driven, evidence-based approach to clinical practice is feasible within the structure of a department of emergency medicine. High-level departmental support with dedicated personnel is necessary for the success of such a system. Internet site development (available at http://www.CPQE.com) for product storage has proven valuable. Patient care has been improved in several ways; however, consistent and complete change in provider behavior remains elusive. Physician scorecards may play a role in altering these phenomena. Emergency medicine can play a leadership role in the development of quality improvement, error reduction, and pay-for-performance systems. [ABSTRACT FROM AUTHOR]

Study objective: The Institute of Medicine, through its landmark report concerning errors in medicine, suggests that standardization of practice through systematic development and implementation of evidence-based clinical pathways is an effective way of reducing errors in emergency systems. The specialty of emergency medicine is well positioned to develop a complete system of innovative quality improvement, incorporating best practice guidelines with performance measures and practitioner feedback mechanisms to reduce errors and therefore improve quality of care. This article reviews the construction, ongoing development, and initial impact of such a system at a large, urban, university teaching hospital and at 2 affiliated community hospitals. Methods: The Committee for Procedural Quality and Evidence-Based Practice was formed within the Department of Emergency Medicine to establish evidence-based guidelines for nursing and provider care. The committee measures the effect of such guidelines, along with other quality measures, through pre- and postguideline patient care medical record audits. These measures are fed back to the providers in a provider-specific, peer-matched “scorecard.” Results: The Committee for Procedural Quality and Evidence-Based Practice affects practice and performance within our department. Multiple physician and nursing guidelines have been developed and put into use. Using asthma as an example, time to first nebulizer treatment and time to disposition from the emergency department decreased. Initial therapeutic agent changed and documentation improved. Conclusion: A comprehensive, guideline-driven, evidence-based approach to clinical practice is feasible within the structure of a department of emergency medicine. High-level departmental support with dedicated personnel is necessary for the success of such a system. Internet site development (available at http://www.CPQE.com) for product storage has proven valuable. Patient care has been improved in several ways; however, consistent and complete change in provider behavior remains elusive. Physician scorecards may play a role in altering these phenomena. Emergency medicine can play a leadership role in the development of quality improvement, error reduction, and pay-for-performance systems. [Copyright &y& Elsevier]

Study objective: Despite recommendations, emergency department (ED)-based HIV screening is not widespread, and feasibility studies are generally limited to settings with high HIV prevalence (>1%). This investigation was to evaluate an ongoing, publicly funded, ED-based HIV counseling and testing program in a low-prevalence area. Methods: We reviewed a database of patients treated by an ED-based HIV counseling and testing program at a large, urban, teaching hospital for 1998 to 2002. ED patients at risk for HIV were targeted for standard serologic testing and counseling. Data were collected prospectively using standardized forms as part of clinical operations rather than in the context of rigorous research methodology; patient-oriented outcomes were not assessed. Counselors were trained according to Centers for Disease Control and Prevention guidelines, and health department guidelines for counseling and testing centers were followed. The main outcome measure was the number and proportion of patients newly diagnosed with HIV. Results: Eight thousand five hundred seventy-four patients were approached; 5,504 consented to HIV testing. Mean age was 29 years (SD 9.4 years), 76% were black, and 50% were men. Five thousand three hundred seventy-four (97.6%) patients tested negative and 39 (0.7%) patients tested positive. Seventy-five percent of negative-test patients and 79% of positive-test patients were notified of test results. Information for seropositive patients not notified of results was forwarded to the health department. All notified HIV-positive patients entered treatment. Risk factors included sexually transmitted disease (47%), multiple sexual partners (40%), unprotected sex while using drugs or alcohol (30%), men having sex with men (5%), and intravenous drug use (4%). Conclusion: Identification of HIV-positive patients is possible in low-prevalence ED settings. In this instance, it was possible to perpetuate an ED-based HIV intervention program during an extended time. Although our work expands the profile of ED-based HIV counseling and testing beyond previous reports, the results should not be overgeneralized. [Copyright &y& Elsevier]

One of the key environmental concerns about shrimp farming is the discharge of waters with high levels of nutrients and suspended solids into adjacent waterways. In this paper we synthesize the results of our multidisciplinary research linking ecological processes in intensive shrimp ponds with their downstream impacts in tidal, mangrove-lined creeks. The incorporation of process measurements and bioindicators, in addition to water quality measurements, improved our understanding of the effect of shrimp farm discharges on the ecological health of the receiving water bodies. Changes in water quality parameters were an oversimplification of the ecological effects of water discharges, and use of key measures including primary production rates, phytoplankton responses to nutrients, community shifts in zooplankton and δ15N ratios in marine plants have the potential to provide more integrated and robust measures. Ultimately, reduction in nutrient discharges is most likely to ensure the future sustainability of the industry. [Copyright &y& Elsevier]

Discusses the potential application of concept mapping in women's health education. Creation of curricula that describes a unique aspect of female physiology; Role in bridging the disciplinary divide.

Summary: The aim of this study was to determine whether a 27 gauge needle could be used to obtain adequate cytology with less discomfort to the patient. Two types of needles were compared—23 gauge (blue) needle versus 27 gauge very fine needle. The cytology specimen was assessed for quality in terms of adequacy for diagnosis. Ninety samples were randomised into this study. The quality of samples was similar in both groups; there was no statistical difference in the quality of samples obtained. The 27 gauge needle produced two inadequate samples (4.4%), whereas there were no inadequate samples with the 23 gauge needle. There was no statistical difference in the amount of blood on the slide between the two groups. The pain scores were significantly better with the finer needle (). This study provides evidence that the 27 gauge FNAC is suitable for obtaining cytology in palpable breast lumps. [Copyright &y& Elsevier]

Purpose Preoperative anxiety in children is associated with postoperative distress in recovery. Both are predictors of long-term maladaptive behavior. Remedies have been suggested to modify individual risk factors, but overall strategy is lacking. Design An approach to anxiety reduction coordinated throughout the hospital experience has been developed in our day-stay pediatric surgical unit. Methods There is a preadmission familiarization visit. On admission, time is spent in a playroom with other children. Anxiety is recorded using the modified Yale Preoperative Anxiety Scale. Children are distracted with an activity book during propofol induction. They are allowed to wake naturally, and emergence state is scored. Finding The incidence of emergence distress is low in our study. Of 68 children, only one exhibited emergence delirium and three had inconsolable crying. Conclusions Important elements in reducing emergence distress are preadmission visit, use of a playroom, effective analgesia, anesthetic maintenance without short-acting volatiles, and undisturbed recovery with a parent present for reassurance. [ABSTRACT FROM AUTHOR]

Background & Aims A gluten-containing diet alters bowel barrier function in patients with irritable bowel syndrome with diarrhea (IBS-D), particularly those who are positive for HLA allele DQ2/8. We studied the effects of a gluten-free diet (GFD) in patients with IBS-D who have not previously considered the effects of gluten in their diet and were unaware of their HLA-DQ2/8 genotype. Methods We performed a prospective study of 41 patients with IBS-D (20 HLA-DQ2/8-positive and 21 HLA-DQ2/8-negative) at the Royal Hallamshire Hospital in Sheffield, United Kingdom, from September 2012 through July 2015. All subjects were placed on a 6-week GFD following evaluation by a dietician. Subjects completed validated questionnaires at baseline and Week 6 of the GFD. The primary endpoint was mean change in IBS Symptom Severity Score; a 50-point reduction was considered to indicate a clinical response. Secondary endpoints were changes in hospital anxiety and depression score, fatigue impact score, and Short Form-36 results. Clinical responders who chose to continue a GFD after the study period were evaluated on average 18 months later to assess diet durability, symptom scores, and anthropometric and biochemical status. Results A 6-week GFD reduced IBS Symptom Severity Score by ≥50 points in 29 patients overall (71%). The mean total IBS Symptom Severity Score decreased from 286 before the diet to 131 points after 6 weeks on the diet ( P < .001); the reduction was similar in each HLA-DQ group. However, HLA-DQ2/8-negative subjects had a greater reduction in abdominal distention ( P = .04). Both groups had marked mean improvements in hospital anxiety and depression scores, fatigue impact score, and Short Form-36 results, although HLA-DQ2/8-positive subjects had a greater reduction in depression score and increase in vitality score than HLA-DQ2/8-negative subjects ( P = .02 and P = .03, respectively). Twenty-one of the 29 subjects with a clinical response (72%) planned to continue the GFD long term; 18 months after the study they were still on a GFD, with maintained symptom reductions, and demonstrated similar anthropometric and biochemical features compared with baseline. Conclusions A dietitian-led GFD provided sustained benefit to patients with IBS-D. The symptoms that improved differed in magnitude according to HLA-DQ status. Clinical trials.gov no: NCT02528929 . [ABSTRACT FROM AUTHOR]

Objective: Differences in the prevalence of undiagnosed HIV between different types of emergency departments (EDs) are not well understood. We seek to define missed opportunities for HIV diagnosis within 3 geographically proximate EDs serving different patient populations in a single metropolitan area. Methods: For an urban academic, an urban community, and a suburban community ED located within 10 miles of one another, we reviewed visit records for a cohort of patients who received a new diagnosis of HIV between July 1999 and June 2003. Missed opportunities for earlier HIV diagnosis were defined as ED visits in the year before diagnosis, during which there was no documented ED HIV testing offer or test. Outcomes were the number of missed opportunity visits and the number of patients with a missed opportunity for each ED. We secondarily reviewed medical records for missed opportunity encounters, using an extensive list of indications that might conceivably trigger testing. Results: Among 276 patients with a new HIV diagnosis, 123 (44.5%) visited an ED in the year before diagnosis or received a diagnosis in the ED. The urban academic ED HIV testing program diagnosed 23 (8.3%) cases and offered testing to 24 (8.7%) patients who declined. Missed opportunities occurred during 187 visits made by 76 (27.5%) patients. These included 70 patients with 157 visits at the urban academic ED, 9 patients with 24 visits at the urban community ED, and 4 patients with 6 visits at the suburban community ED. Medical records were available for 172 of the 187 missed opportunity visits. Visits were characterized by the following potential testing indicators: HIV risk factors (58; 34%), related diagnosis indicating risk (7; 4%), AIDS-defining illness (8; 5%), physician suspicion of HIV (29; 17%), and nonspecific signs or symptoms of illness potentially consistent with HIV (126; 73%). Conclusion: Geographically proximate EDs differ in their opportunities for earlier HIV diagnosis, but all 3 sites had missed opportunities. Many ED patients with undiagnosed HIV have potential indications for testing documented even in the absence of a dedicated risk assessment, although most of these are nonspecific signs or symptoms of illness that may not be clinically useful selection criteria. [Copyright &y& Elsevier]

Objective: The lack of well-described population-level outcome measures for emergency department (ED) HIV testing is one barrier to translation of screening into practice. We demonstrate the impact of an ED diagnostic testing and targeted screening program on the proportion of ED patients ever tested for HIV and explore cumulative effects on testing rates over time. Methods: Data were extracted from electronic HIV testing program records and administrative hospital databases for January 2003 to December 2008 to obtain the monthly number of ED visits and HIV tests. We calculated the proportions of (1) patients tested in the program who reported a previous HIV test or had been previously tested in the program, and (2) the cumulative number of unique ED patients who were tested in our program. Results: During the study period, 165,665 unique patients made 491,552 ED visits and the program provided 13,509 tests to 11,503 unique patients. From 2003 to 2008, tested patients who reported a history of an HIV test increased by 0.085% per month (95% confidence interval [CI] 0.037% to 0.133%), from 67.7% to 74.4%; the percentage of tested patients who had previous testing in the program increased by 0.277% per month (95% CI 0.245% to 0.308%), from 3.2% to 21.2%; and the percentage of unique ED patients previously tested in the program increased by 0.100% per month (95% CI 0.096% to 0.105%), reaching a cumulative proportion of 6.9%. Conclusion: Our HIV testing program increased the proportion of ED patients who have been tested for HIV at least once and repeatedly tested a subset of individuals. HIV screening, even during a minority of ED visits, can have important cumulative effects over time. [Copyright &y& Elsevier]

Objective: Controversy surrounds the linkage of prevention counseling with emergency department (ED)–based HIV testing. Further, the effectiveness and feasibility of prevention counseling in the ED setting is unknown. We investigate these issues by conducting a preliminarily exploration of several related aspects of our ED''s HIV prevention counseling and testing program. Methods: Our urban, academic ED provides formal client-centered prevention counseling in conjunction with HIV testing. Five descriptive, exploratory observations were conducted, involving surveys and analysis of electronic medical records and programmatic data focused on (1) patient perception and feasibility of prevention counseling in the ED, (2) patient perceptions of the need to link prevention counseling with testing, and (3) potential effectiveness of providing prevention counseling in conjunction with ED-based HIV testing. Results: Of 110 ED patients surveyed after prevention counseling and testing, 98% believed privacy was adequate, and 97% reported that their questions were answered. Patients stated that counseling would lead to improved health (80%), behavioral changes (72%), follow-up testing (77%), and discussion with partners (74%). However, 89% would accept testing without counseling, 32% were willing to seek counseling elsewhere, and 26% preferred not to receive the counseling. Correct responses to a 16-question knowledge quiz increased by 1.6 after counseling (95% confidence interval 1.3 to 12.0). The program completed counseling for 97% of patients tested; however, 6% of patients had difficulty recalling the encounter and 13% denied received testing. Among patients undergoing repeated testing, there was no consistent change in self-reported risk behaviors. Conclusion: Participants in the ED prevention counseling and testing program considered counseling acceptable and useful, though not required. Given adequate resources, prevention counseling can be provided in the ED, but it is unlikely that all patients benefit. [Copyright &y& Elsevier]

Abstract: Cicerone KD, Azulay J, Trott C. Methodological quality of research on cognitive rehabilitation after traumatic brain injury. Objective: To evaluate the methodological quality of research on cognitive rehabilitation after traumatic brain injury (TBI). Data Sources: Secondary analysis of studies identified in prior systematic reviews of cognitive rehabilitation. Study Selection: Randomized controlled trials (RCTs) and observational studies involving exclusively or primarily participants with TBI. Data Extraction: Criteria for evaluating methodological quality were adapted from prior reviews of rehabilitation research. These criteria were modified to be relevant to cognitive rehabilitation research. Sixteen criteria for evaluating the quality of RCTs were applied: 8 relating to the internal validity of studies, 5 descriptive criteria, and 3 statistical criteria. Twelve of these criteria were used to evaluate non-RCT observational studies. Data Synthesis: Thirty-two RCTs and 21 observational studies were independently reviewed and rated by 2 of the authors. Initial agreement between raters for individual studies ranged from 57% to 100%. Interrater reliabilities based on the kappa statistic indicated moderate to substantial agreement. Conclusions: Several high-quality RCTs support the effectiveness of interventions for attention, communication skills, and executive functioning after TBI. Several high-quality observational studies support the effectiveness of comprehensive-holistic rehabilitation after TBI, including improvements in participation outcomes. The proposed criteria appear useful for evaluating the quality of research on cognitive rehabilitation and improving the design and reporting of future research in this area. [Copyright &y& Elsevier]