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Rivers suffer from multiple stressors acting simultaneously on their biota, but the consequences are poorly quantified at the global scale. We evaluated the biological condition of rivers globally, including the largest proportion of countries from the Global South published to date. We gathered macroinvertebrate- and fish-based assessments from 72,275 and 37,676 sites, respectively, from 64 study regions across six continents and 45 nations. Because assessments were based on differing methods, different systems were consolidated into a 3-class system: Good, Impaired, or Severely Impaired, following common guidelines. The proportion of sites in each class by study area was calculated and each region was assigned a Köppen-Geiger climate type, Human Footprint score (addressing landscape alterations), Human Development Index (HDI) score (addressing social welfare), % rivers with good ambient water quality, % protected freshwater key biodiversity areas; and % of forest area net change rate. We found that 50% of macroinvertebrate sites and 42% of fish sites were in Good condition, whereas 21% and 29% were Severely Impaired, respectively. The poorest biological conditions occurred in Arid and Equatorial climates and the best conditions occurred in Snow climates. Severely Impaired conditions were associated (Pearson correlation coefficient) with higher HDI scores, poorer physico-chemical water quality, and lower proportions of protected freshwater areas. Good biological conditions were associated with good water quality and increased forested areas. It is essential to implement statutory bioassessment programs in Asian, African, and South American countries, and continue them in Oceania, Europe, and North America. There is a need to invest in assessments based on fish, as there is less information globally and fish were strong indicators of degradation. Our study highlights a need to increase the extent and number of protected river catchments, preserve and restore natural forested areas in the catchments, treat wastewater discharges, and improve river connectivity.

ARID1A (BAF250a) is a component of the SWI/SNF chromatin modifying complex, plays an important tumour suppressor role, and is considered prognostic in several malignancies. However, in ovarian carcinomas there are contradictory reports on its relationship to outcome, immune response, and correlation with clinicopathological features. We assembled a series of 1,623 endometriosis-associated ovarian carcinomas, including 1,078 endometrioid (ENOC) and 545 clear cell (CCOC) ovarian carcinomas through combining resources of the Ovarian Tumor Tissue Analysis (OTTA) Consortium, the Canadian Ovarian Unified Experimental Resource (COEUR), local, and collaborative networks. Validated immunohistochemical surrogate assays for ARID1A mutations were applied to all samples. We investigated associations between ARID1A loss/mutation, clinical features, outcome, CD8+ tumour-infiltrating lymphocytes (CD8+ TIL), and DNA mismatch repair deficiency (MMRd). ARID1A loss was observed in 42% of CCOC and 25% of ENOC. We found no associations between ARID1A loss and outcomes, stage, age, or CD8+ TIL status in CCOC. Similarly, we found no association with outcome or stage in endometrioid cases. In ENOC, ARID1A loss was more prevalent in younger patients (p=0.012), and associated with MMRd (p

The pressure to the healthcare system for providing ongoing monitoring and treatment for breast cancer survivors is increasing. This study aims to identify the factors that affect the public healthcare costs of stage I-III breast cancer and stage IV cancer in New Zealand.We identified women diagnosed with invasive breast cancer between July 1, 2010 and June 30, 2018 and who received services in a public hospital. Patients were identified from the National Breast Cancer Register and/or New Zealand Cancer Registry and were linked to the national administrative datasets. A two-part model was used to identify the factors that affect the public healthcare costs of stage I-III breast cancer and stage IV cancer.We identified 16,977 stage I-III and 1,093 stage IV breast cancer patients eligible for this study. The costs of stage I-III cancer in the second to fifth year post diagnosis decreased over time, and the costs of stage IV cancer in the first year post diagnosis increased over time. After adjustment for other factors, the costs of stage I-IV cancer decreased with age but increased with cancer stage. HER2+ cancers had the highest costs, followed by triple negative cancers. After adjustment for other factors, Pacific and Asian women had lower costs, and Māori had similar costs compared to others. For stage I-III cancers, women living in nonmajor urban areas had a higher chance of incurring costs in follow-up years, and screen detected patients and patients having any services in a private hospital had a decreased probability of receiving any public healthcare services.Pacific women had higher costs than others, but after adjustment for cancer stage, subtype, and other factors, they had lower costs than others. The early detection and better management of stage I-III breast cancer can lead to better outcome and lower costs in follow-up years.

International trade in vulnerable marine species is regulated once they are listed in CITES Appendices (the Convention on International Trade in Endangered Species of Wild Fauna and Flora). Parties to the Convention submit proposal(s) 150 days prior to the CITES Conference for voting on the inclusion of new species in Appendices I and II, making a case for why CITES listing criteria are met in each case. Before the vote, Parties receive advice from (a) the Food and Agriculture Organization of the United Nations, (b) the International Union for Conservation of Nature—TRAFFIC and (c) the CITES Secretariat, among others. This paper offers an expert review of listing processes, which are the subject of much debate in fishery and environment-protection communities, looking at two specific cases: silky shark (Carcharhinus falciformis, Carcharhinidae) and bigeye thresher shark (Alopias superciliosus, Alopiidae). The reviewers determine that the evidence made available to voting Parties is substantial, but suffers from non-standard presentation across assessments. The best available data are not always presented or described transparently in relation to CITES criteria. An extension of the assessment period, as well as the opportunity to refute evidence, has been suggested as ways to support more informed and effective decision-making by CITES Parties, whose composition of delegations varies greatly in their experience of marine species management and trade. Experts welcomed a greater coherence of advice between fishery and non-fishery sources in the long term, and proposed a range of suggested improvements for the delivery of information and advice to CITES Parties.

Microbial bioelectronic devices integrate naturally occurring or synthetically engineered electroactive microbes with microelectronics. These devices have a broad range of potential applications, but engineering the biotic-abiotic interface for biocompatibility, adhesion, electron transfer, and maximum surface area remains a challenge. Prior approaches to interface modification lack simple processability, the ability to pattern the materials, and/or a significant enhancement in currents. Here, a novel conductive polymer coating that significantly enhances current densities relative to unmodified electrodes in microbial bioelectronics is reported. The coating is based on a blend of poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate) (PEDOT:PSS) crosslinked with poly(2-hydroxyethylacrylate) (PHEA) along with a thin polydopamine (PDA) layer for adhesion to an underlying indium tin oxide (ITO) electrode. When used as an interface layer with the current-producing bacterium Shewanella oneidensis MR-1, this material produces a 178-fold increase in the current density compared to unmodified electrodes, a current gain that is higher than previously reported thin-film 2D coatings and 3D conductive polymer coatings. The chemistry, morphology, and electronic properties of the coatings are characterized and the implementation of these coated electrodes for use in microbial fuel cells, multiplexed bioelectronic devices, and organic electrochemical transistor based microbial sensors are demonstrated. It is envisioned that this simple coating will advance the development of microbial bioelectronic devices.

Purpose To investigate the receipt of postmastectomy radiotherapy (PMRT) in breast cancer patients in New Zealand for whom radiotherapy is strongly recommended in current clinical guidelines. Method This study involved all women who were diagnosed with primary invasive breast cancer in two health regions, had undergone a mastectomy, and met the “strong recommendation” criteria for PMRT based on New Zealand National Guidelines. We performed logistic regression analyses to identify demographic and clinical factors associated with the receipt of PMRT. Results Of the 1455 patients with stage II to III cancers included in this analysis, 1195 (82%) received radiotherapy. The receipt of PMRT decreased with increasing age, and was significantly lower in rural residents, Māori and Pacific women, those with more comorbidity, those who received primary cancer care in a public facility, and those diagnosed with stage III cancer. Although not significant, the receipt was also lower in patients who resided in more deprived neighborhood, and those with comorbidities. The findings restricted to stage III patients (n = 1325), and to those diagnosed since 2010 (n = 422), after the current guidelines were published, which were very similar to the whole cohort. Conclusion Disparities exist in the receipt of PMRT in breast cancer patients in New Zealand, underscoring the need for a greater equity focus in management of breast cancer.

Background The aim of this study was to understand the factors influencing the use of surgical options by New Zealand women with newly diagnosed breast cancer. Methods Using data from the Auckland and Waikato breast cancer registers, we included 11 798 women diagnosed with stage I-III breast cancer from June 2000 to May 2013. The characteristics of women receiving different surgical treatments and having immediate breast reconstruction following mastectomy were examined. A logistic regression was used to estimate the odds ratio of having breast-conserving surgery (BCS) versus mastectomy and immediate post-mastectomy reconstruction. Bilateral breast cancer cases and women with unilateral breast cancer, but who had bilateral surgery, were also identified. Results Fifty-two percent of women received BCS and 44% had mastectomy over the study period. Key influences associated with BCS were age, mode of diagnosis, socio-economic status and public or private treatment. Just under half of the women who underwent bilateral surgery did not have bilateral cancer. Nineteen percent of women undergoing mastectomy underwent immediate reconstruction. Implant use increased slightly over the study period but there was a decrease in the use of autologous flap procedures. Conclusion Surgical management of women with localized breast cancer was generally in line with guidelines, but with potential to further increase the use of breast conservation and immediate reconstruction in suitable cases.

Aim Trastuzumab was first funded in New Zealand for use in HER2+ve stage I–III breast cancer in 2007. This observational study aims to ascertain the patterns of use of trastuzumab in women with invasive HER2+ve breast cancer, and assess the effectiveness of adjuvant trastuzumab in women with stage I–III HER2+ve breast cancer. Methods The Waikato and Auckland Breast Cancer Registries have clinical details of 12 372 women diagnosed with invasive breast cancer between June 2000 and May 2013. The proportion of women with HER2+ve breast cancer treated with trastuzumab was examined by age, ethnicity, stage and year of diagnosis. Differences in outcomes including the development of metastases and death were assessed for women with stage I–III HER2+ve breast cancer treated with both chemotherapy and trastuzumab, compared to women treated with chemotherapy alone. Results Among the 1587 HER2+ve breast cancer patients, 888 (56.0%) women received trastuzumab. The probability of having trastuzumab decreased with higher age and comorbidity score and increased with year of diagnosis, tumor size and cancer stage. Māori and Pacific women were less likely to be treated with trastuzumab. After adjustment for potential confounding factors, the treatment with trastuzumab improved breast cancer-specific mortality (adjusted hazard ratio 0.57, 95% CI: 0.35–0.93). Conclusion Overall, this observational study has shown a substantial improvement in survival for women with HER2+ve stage I–III breast cancer, and much of this improvement can be attributed to the introduction of trastuzumab. Changes in chemotherapy also appear to have led to improved outcomes.

Background Indigenous Māori are known to experience inferior quality cancer care compared with non-Indigenous Europeans in New Zealand. However, limited data are available on ethnic/socio-economic differences in surgical treatment of breast cancer, or reasons for such variations within the local context. We investigated ethnic/socio-economic differences in rates of mastectomy, sentinel node biopsy (SNB), post-mastectomy breast reconstruction and definitive local therapy for breast cancer in New Zealand. Methods A retrospective review of prospective data in the Waikato Breast Cancer Register for women diagnosed during 1999–2012 was performed. Differences in rates of mastectomy (for stage I/II, T1/T2 cancers), SNB (for stage I/II, T1/T2, cN0 cancers), post-mastectomy breast reconstruction (for non-metastatic cancers in women

Background The Quality Audit (BQA) of Breast Surgeons of Australia and New Zealand includes a broad range of data and is the largest New Zealand (NZ) breast cancer (BC) database outside the NZ Cancer Registry. We used BQA data to compare BC survival by ethnicity, deprivation, remoteness, clinical characteristic and case load. Methods BQA and death data were linked using the National Health Index. Disease-specific survival for invasive cases was benchmarked against Australian BQA data and NZ population-based survivals. Validity was explored by comparison with expected survival by risk factor. Results Compared with 93% for Australian audit cases, 5-year survival was 90% for NZ audit cases overall, 87% for Maori, 84% for Pacific and 91% for other. Conclusions BC survival in NZ appears lower than in Australia, with inequities by ethnicity. Differences may be due to access, timeliness and quality of health services, patient risk profiles, BQA coverage and death-record methodology.

Background There is limited evidence to support use of local anaesthetic (LA) wound infiltration in breast surgery. This study seeks to examine whether wound infiltration of bupivacaine (0.25%) decreases post-operative pain and analgesic use, without increasing post-operative complications. Methods A prospective single-blind study was undertaken of 90 patients undergoing breast lump excision, wide local excision and mastectomy with or without axillary surgery. Patients were randomized to receive infiltration with bupivacaine (0.25%) into the surgical wound (Group LA) or no infiltration (Group No LA). Data on post-operative analgesia use was collected. Pain scores were assessed at 1, 24, 48 h and 1 week with a visual analogue scale. Complications associated with wound healing were documented at the first post-operative visit. Results Forty-five patients received infiltration and 34 patients received none. There were no significant differences in baseline characteristics between patient groups or surgical details. Analysis revealed Group LA used significantly less opioids than Group No LA during the first 48 h post-op (3.42 mg versus 7.33 mg; P = 0.02). Overall, Group LA used half the total average opioid equivalent amount (5.04 mg versus 10.08 mg; P = 0.069). There were no significant differences in post-operative pain scores or complications. Overall pain scores were low, suggesting effective analgesic use by nursing staff. Discussion LA infiltration during breast surgery has a marked opioid sparing effect, which has significant patient benefits as well as reducing nursing workload and drug costs.

To determine whether rural practice terms for junior doctors result in increased interest in rural practice and whether these terms improve learning experiences, clinical skills and insight into difficulties of rural practice. Semistructured, self-administered survey with questions on respondent demographics, clinical experience during rural practice terms, post-rural experience and personal opinion. South East Queensland. Thirty junior doctors from three tertiary hospitals were approached. The response rate was 100%. Exploration of junior doctors' rural term experience. Two thirds (67%) of the respondents reported feeling uncomfortable with respect to clinical practice requirements during their rural terms. Half (47%) performed procedures they had only previously performed in simulation environments, and the majority (87%) relied on textbooks or other resources on a daily basis. Two thirds (67%) changed aspects of their usual clinical practice while practising in a rural setting, and 80% reported a change in attitude towards the hardships faced by rural practitioners. The majority of the respondents (87%) enjoyed their rural term, gaining confidence as a result of it, and more than half (53%) reported considering working in rural areas in the future. The results of this survey suggest that junior doctors on rural rotations are required to perform at a clinical level higher than that required of them in metropolitan hospitals. While their clinical experience appears to result in a greater interest in future rural career possibilities for junior doctors, this survey highlights the requirement to improve support for junior doctors undertaking terms in rural areas.

BackgroundThe aim of this study was to establish the preference and reasons for initial axillary surgery performed on women with invasive breast cancer in Australia and New Zealand using data from the Breast Surgeon's Society of Australia and New Zealand Quality Audit (BQA) according to whether sentinel lymph node (SLN) biopsy, axillary lymph node dissection (ALND) or no axillary surgery was used.

Introduction Little published data exists documenting the reasons for and outcomes of colectomies in rural Australia. It remains unclear whether patient characteristics, diagnoses, complications and outcomes differ to metropolitan locations. Methods A retrospective review of prospectively collected data for patients coded with International Classification of Diseases procedure code block 934 and 935 (colectomies) performed at Wimmera Health Care Group: Horsham Campus between July 2004 and July 2011. Records were additionally sought from transfer hospitals. Results Two hundred thirty-eight colectomies were performed over the 7-year period: 164 for a colorectal cancer diagnosis, 74 for a non-colorectal cancer diagnosis. For the colorectal cancer colectomies, 80.5% were elective and 19.5% emergency. There were five (3.0%) intraoperative complications. Postoperatively, there were 16 (9.8%) surgical complications. There was a 3.7% return to theatre rate and a 3.0% unplanned readmission rate. There were no anastomotic leaks. The perioperative mortality rate was 5.5%. For the non-colorectal cancer colectomies, 85.1% were emergency and 14.9% elective. There were five (6.8%) intraoperative complications. Postoperatively, there were 14 (18.9%) surgical complications. There was a 12.2% return to theatre rate, a 5.4% unplanned readmission rate and three anastomotic leaks. The perioperative mortality rate was 10.8%. Conclusions The outcomes and complications for colectomies appear similar to the accepted standard of surgery in other rural and metropolitan centres. Areas have been identified for improved surgical performance at Wimmera Health Care Group: Horsham Campus.

Objective There is paucity of research documenting the management of splenic injury in rural Australia. No data exists for Rural, Remote and Metropolitan Area 4 locations. Design A retrospective review of prospectively collected data. Records were additionally sought from transfer hospitals. A qualitative assessment of splenic trauma management in the Wimmera Region was also performed. Setting Wimmera Health Care Group: Horsham Campus, a Level 3 trauma hospital between January 2000 and July 2011. Participants Patients coded with injury of spleen or excision procedure on spleen. Interventions Nil Main outcome measures surgical vs. non-surgical management Results Nineteen patients were included (mean age 27.8, range 8–54). Only 26% were from Horsham. Most injuries were due to sporting trauma/falls (53%) and motor vehicle accidents (37%). One patient died in theatre from massive trauma. Eleven patients were managed non-operatively. Seven patients had splenec- tomy performed. Four of these had delay in computed tomography scanning, delay to theatre and suffered major postoperative complication. The age (mean 39.9 versus 20.8) and Injury Severity Score (mean 21.9 versus 13.8) of patients requiring splenectomy was higher than those managed non-operatively. Six of the splenic injury admissions (32%) were transferred from surrounding general practitioner-run Rural, Remote and Metropolitan Area 5 hospitals. All of these patients had Victorian State Trauma Service-defined major trauma with an Injury Severity Score >15. There was an approximate 4-hour delay in transfer of these patients, with transfer occurring when clinical deterioration occurred. Conclusions Although splenic injury is uncommon in the Wimmera region, improved trauma triaging is required, with early transfer of unstable patients and high-energy trauma mechanisms. A lower threshold for computed tomography scanning is recommended.

Background Mild disturbances of higher order activities of daily living are present in people diagnosed with mild cognitive impairment (MCI). These deficits may be difficult to detect among those still living independently. Unobtrusive continuous assessment of a complex activity such as home computer use may detect mild functional changes and identify MCI. We sought to determine whether long-term changes in remotely monitored computer use differ in persons with MCI in comparison with cognitively intact volunteers. Methods Participants enrolled in a longitudinal cohort study of unobtrusive in-home technologies to detect cognitive and motor decline in independently living seniors were assessed for computer use (number of days with use, mean daily use, and coefficient of variation of use) measured by remotely monitoring computer session start and end times. Results More than 230,000 computer sessions from 113 computer users (mean age, 85 years; 38 with MCI) were acquired during a mean of 36 months. In mixed-effects models, there was no difference in computer use at baseline between MCI and intact participants controlling for age, sex, education, race, and computer experience. However, over time, between MCI and intact participants, there was a significant decrease in number of days with use ( P = .01), mean daily use (∼1% greater decrease/month; P = .009), and an increase in day-to-day use variability ( P = .002). Conclusions Computer use change can be monitored unobtrusively and indicates individuals with MCI. With 79% of those 55 to 64 years old now online, this may be an ecologically valid and efficient approach to track subtle, clinically meaningful change with aging.

Background and objective: The aim of the present study was to report the features of five patients with concurrent histopathological features of pulmonary alveolar proteinosis (PAP) and hypersensitivity pneumonitis (HP) and their high-resolution CT (HRCT) appearances. Methods: Patients with histopathological features of both HP and PAP on surgical lung biopsy referred for tertiary review were retrospectively identified. The pathology and HRCT images were semi-quantitatively scored to evaluate the relative contribution to HP and PAP. Results: Five patients had histopathological features of HP and PAP but had varied HRCT appearances. All had imaging features of PAP to a varying degree with two patients also showing characteristics of HP but three patients had ill-defined thickened interlobular septa, not typical of either disease. Conclusions: We describe the coexistence of PAP and HP in five patients and discuss possible linkages between these two distinct pathologies.

There are now six classes of oral antidiabetic drugs and a new class of injectable GLP-1 agonists in the drug therapy of type 2 diabetes, with metformin remaining the cornerstone of treatment. Our Drug review considers their mode of action, properties and recommended use, followed by sources of further information and an analysis of prescription data. Copyright © 2010 Wiley Interface Ltd

Vildagliptin, an oral DPP-4 inhibitor, is licensed as an add-on therapy when adequate glycaemic control has not been achieved with metformin, a sulphonylurea or a glitazone. In our New products review Steve Chaplin presents the clinical data relating to its efficacy and adverse effects, and Professor Ian Campbell comments on its place in type 2 diabetes therapy. Copyright © 2008 Wiley Interface Ltd

Over many years the industrial wing of the ALP has had many fights with the political wing on two main issues. The first is the deviation of the political wing from the pledged policy of the party…the second issue is the attempt of the political wing to dictate union policy and interfere in union affairs. this was the main issue on which Lang parted company, first with the trade union movement and then with the ALP.

BACKGROUND. Letrozole is safe and effective in postmenopausal women with estrogen receptor-positive early breast cancer, but long-term aromatase inhibitor use may cause bone loss and increase fracture risk. This study evaluated an immediate or delayed strategy of bone protection therapy with zoledronic acid. METHODS. A total of 1065 patients who were receiving adjuvant letrozole were randomized to immediate-start or delayed-start zoledronic acid (4 mg intravenously biannually for 5 years). The delayed group received zoledronic acid if lumbar spine or total hip T-score decreased below −2.0 or when a nontraumatic fracture occurred. The primary endpoint was change in lumbar spine bone mineral density (BMD) at Month 12. Secondary endpoints included changes in total hip BMD, serum bone turnover markers, and safety at Month 12. RESULTS. Lumbar spine BMD increased from baseline in the immediate arm, while it decreased from baseline in delayed-arm patients. At Month 12, the differences between the groups in lumbar spine and total hip BMD were 5.7% (P < .0001; 95% confidence intervals [CI], 5.2% to 6.1%), and 3.6% (P < .0001; 95% CI, 3.3 to 4.0%), respectively. Both regimens were well tolerated with few serious adverse events. Bone pain was higher in the immediate group, as expected, because some patients experienced acute-phase reactions after zoledronic acid infusion. CONCLUSIONS. At 12 months, immediate zoledronic acid therapy prevented bone loss in postmenopausal women who were receiving adjuvant letrozole. Cancer 2008. © 2008 American Cancer Society.

Two-by-two tables commonly arise in comparative trials and cross-sectional studies. In medical studies, two-by-two tables may have a small sample size due to the rarity of a condition, or to limited resources. Current recommendations on the appropriate statistical test mostly specify the chi-squared test for tables where the minimum expected number is at least 5 (following Fisher and Cochran), and otherwise the Fisher-Irwin test; but there is disagreement on which versions of the chi-squared and Fisher-Irwin tests should be used. A further uncertainty is that, according to Cochran, the number 5 was chosen arbitrarily. Computer-intensive techniques were used in this study to compare seven two-sided tests of two-by-two tables in terms of their Type I errors. The tests were K. Pearson's and Yates's chi-squared tests and the 'N-1' chi-squared test (first proposed by E. Pearson), together with four versions of the Fisher-Irwin test (including two mid-P versions). The optimum test policy was found to be analysis by the 'N-1' chi-squared test when the minimum expected number is at least 1, and otherwise, by the Fisher-Irwin test by Irwin's rule (taking the total probability of tables in either tail that are as likely as, or less likely than the one observed). This policy was found to have increased power compared to Cochran's recommendations.

There are now five classes of oral anti-diabetic drugs available, with metformin remaining the cornerstone of drug therapy in type 2 diabetes. Our Drug review considers their mode of action, properties and recommended use, followed by sources of further information, an analysis of prescrip tion data and the Datafile. Copyright © 2007 Wiley Interface Ltd

Presented here are several convergent synthetic routes to conjugated oligo(phenylene ethynylene)s. Some of these oligomers are free of functional groups, while others possess donor groups, acceptor groups, porphyrin interiors, and other heterocyclic interiors for various potential transmission and digital device applications. The syntheses of oligo(phenylene ethynylene)s with a variety of end groups for attachment to numerous metal probes and surfaces are presented. Some of the functionalized molecular systems showed linear, wire-like, current versus voltage (I(V)) responses, while others exhibited nonlinear I(V) curves for negative differential resistance (NDR) and molecular random access memory effects. Finally, the syntheses of functionalized oligomers are described that can form self-assembled monolayers on metallic electrodes that reduce the Schottky barriers. Information from the Schottky barrier studies can provide useful insight into molecular alligator clip optimizations for molecular electronics.

A widely applicable electroabsorption technique to measure internal electric fields in organic light-emitting diodes is presented. The technique exploits the change in the a.c. electroabsorption response in the presence of a d.c. electric field. The electroabsorption signal is modulated at the fundamental frequency of the a.c. test signal, in addition to the usual modulation at the second harmonic frequency, when a d.c. bias is present. In metal/organic film/metal devices employing different metal contacts there is a built-in electric field in the organic film caused by the difference in work function between the two contacts. The electroabsorption response at the fundamental frequency of the applied a.c. bias is measured as a function of an external d.c. bias. The electroabsorption signal is nulled when the applied d.c. bias cancels the built-in electric field established by the different metals. We apply this technique to measure changes in metal–polymer Schottky barrier heights as a function of the contact metal. In metal/multiple organic films/metal structures the electroabsorption signals from the constituent organic films are identified spectroscopically and measured at both the fundamental and second harmonic frequency of the a.c. test signal. The amplitudes of the electroabsorption responses are then used to determine the a.c. and d.c. electric fields present in the organic layers. We apply this technique to determine the d.c. electric field distribution within a multi-layer organic light-emitting diode. These results highlight the general applicability of electroabsorption methods to probe internal electric fields in organic light-emitting diodes. © 1997 John Wiley & Sons, Ltd.

Background: Increased cognitive andmotor test-to-test variability are associated with Mild Cognitive Impairment (MCI). Home-based, unobtrusive and continuous assessment of walking speed may provide a means of capturing early changes in the real-world trajectory of activity variance characterizing MCI. We examined whether long-term in-home assessment of walking speed and its variability can distinguish MCI from those who are cognitively intact.Methods: Participants enrolled in the Intelligent Systems for Assessing Aging Change (ISSAC) study, a longitudinal study of unobtrusive in-home technologies to detect cognitive and motor decline in independently living seniors, were defined as MCI or normal at baseline using neuropsychological test data and pre-defined algorithms. Walking speed was assessed using passive infra-red sensors fixed in series on the ceiling of the homes of seniors. The weekly median speed and coefficient of variation (CoV) were analyzed using latent trajectory and mixed effects models. Results:Data from 111 ISAAC subjects living alone (35 with MCI) was acquired for a mean of 271.9 6 175.2 days. Mean cohort age was 84.9 6 4.8 yrs. Latent trajectory models identified 3 and 4 distinct trajectories for median speed and CoV, respectively. MCI was not associated with any of the trajectory patterns of weekly median walking speed, but was more likely to be in the group where CoV was high at baseline and remained high over time (OR 1⁄4 7.0; p 1⁄4 0.03), as opposed to be in the group with lower CoVovertime. The mixed effects model controlling for age and gender confirmed these findings showing that MCI was associated with a high CoVof walking speed (p 1⁄4 0.02) that remained high over time (no interaction of time*MCI). Absolute walking speed over time (i.e., weekly median speed) or speed obtained during annual in-person assessments with a stopwatch over the same approximate two year period were not significantly different between the MCI and cognitively intact groups. Conclusions: Unobtrusive home-based assessment of variability in walking speed provides an indicator of individuals with MCI. These and other real-time measures of function may be used to detect transition phases representing presymptomatic or latent disease leading to dementia and to assess treatment outcomes overtime.

Steve Chaplin and Professor Ian Campbell provide an overview of the indications and properties of DPP-4 inhibitors and their current recommended place in treating type 2 diabetes. Copyright © 2011 Wiley Interface Ltd

The outcome of day-care versus inpatient surgery for two equivalent groups of children is examined. Ratings were made of medical outcome, behaviour change in the children at 1 week and 3 mths post-discharge from a pre-admission criterion, convenience and subjective anxiety for parents, and relative costs of the two procedures. Results showed trends in favour of the day-care procedure. Argument is made that day-care should be the preferred option for minor surgery in young children.