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Summary: Ventilator‐associated pneumonia commonly occurs in critically ill patients. Clinical suspicion results in overuse of antibiotics, which in turn promotes antimicrobial resistance. Detection of volatile organic compounds in the exhaled breath of critically ill patients might allow earlier detection of pneumonia and avoid unnecessary antibiotic prescription. We report a proof of concept study for non‐invasive diagnosis of ventilator‐associated pneumonia in intensive care (the BRAVo study). Mechanically ventilated critically ill patients commenced on antibiotics for clinical suspicion of ventilator‐associated pneumonia were recruited within the first 24 h of treatment. Paired exhaled breath and respiratory tract samples were collected. Exhaled breath was captured on sorbent tubes and then analysed using thermal desorption gas chromatography–mass spectrometry to detect volatile organic compounds. Microbiological culture of a pathogenic bacteria in respiratory tract samples provided confirmation of ventilator‐associated pneumonia. Univariable and multivariable analyses of volatile organic compounds were performed to identify potential biomarkers for a 'rule‐out' test. Ninety‐six participants were enrolled in the trial, with exhaled breath available from 92. Of all compounds tested, the four highest performing candidate biomarkers were benzene, cyclohexanone, pentanol and undecanal with area under the receiver operating characteristic curve ranging from 0.67 to 0.77 and negative predictive values from 85% to 88%. Identified volatile organic compounds in the exhaled breath of mechanically ventilated critically ill patients show promise as a useful non‐invasive 'rule‐out' test for ventilator‐associated pneumonia. [ABSTRACT FROM AUTHOR]

Safety in paediatric regional anaesthesia Large prospective databases have shown the ability to safely perform paediatric regional anaesthesia with minimal risk of neurological damage [[17]]. Keywords: education; nerve block; paediatrics; regional anaesthesia EN education nerve block paediatrics regional anaesthesia 3 8 6 12/09/22 20230101 NES 230101 The "Plan A" blocks principle aims to bring regional anaesthesia to a wider audience by making basic skills and patient access more widespread [[1]]. Regional anaesthesia for paediatric surgery offers intra- and postoperative analgesia, rather than the ability to perform awake surgery, as seen in adult practice. Complications in pediatric regional anesthesia: an analysis of more than 100,000 blocks from the Pediatric Regional Anesthesia Network. [Extracted from the article]

Digital health is transforming the delivery of health care around the world to meet the growing challenges presented by ageing populations with multiple chronic conditions. Digital health technologies can support the delivery of personalised nutrition care through the standardised Nutrition Care Process (NCP) by using personal data and technology‐supported delivery modalities. The digital disruption of traditional dietetic services is occurring worldwide, supporting responsive and high‐quality nutrition care. These disruptive technologies include integrated electronic and personal health records, mobile apps, wearables, artificial intelligence and machine learning, conversation agents, chatbots, and social robots. Here, we outline how digital health is disrupting the traditional model of nutrition care delivery and outline the potential for dietitians to not only embrace digital disruption, but also take ownership in shaping it, aiming to enhance patient care. An overview is provided of digital health concepts and disruptive technologies according to the four steps in the NCP: nutrition assessment, diagnosis, intervention, and monitoring and evaluation. It is imperative that dietitians stay abreast of these technological developments and be the leaders of the disruption, not simply subject to it. By doing so, dietitians now, as well as in the future, will maximise their impact and continue to champion evidence‐based nutrition practice. [ABSTRACT FROM AUTHOR]

Objectives: To assess feasibility of a future randomised controlled trial (RCT) of clinical and cost-effectiveness of lifestyle information and commercial weight management groups to support postnatal weight management to 12 months post-birth.Design: Two-arm feasibility trial, with nested mixed-methods process evaluation.Setting: Inner-city unit, south England.Population: Women with body mass indices (BMIs) ≥25 kg/m2 at pregnancy booking or normal BMIs (18.5-24.9 kg/m2 ) identified with excessive gestational weight gain at 36 weeks of gestation.Methods: Randomised to standard care plus commercial weight management sessions commencing 8-16 weeks postnatally or standard care only.Main Outcomes: Feasibility outcomes included assessment of recruitment, retention, acceptability and economic data collation. Primary and secondary end points included difference between groups in weight 12 months postnatally compared with booking (proposed primary outcome for a future trial), diet, physical activity, smoking, alcohol, mental health, infant feeding, NHS resource use.Results: In all, 193 women were randomised: 98 intervention and 95 control; only four women had excessive gestational weight gain. A slightly greater weight change was found among intervention women at 12 months, with greatest benefit. Among women attending ten or more weight management sessions. There was >80% follow up to 12 months, low risk of contamination and no group differences in trial completion.Conclusion: It was feasible to recruit and retain women with BMIs ≥25 kg/m2 to an intervention to support postnatal weight management; identification of excessive gestational weight gain requires consideration. Economic modelling could inform out-of-trial costs and benefits in a future trial. A definitive trial is an important next step.Tweetable Abstract: A feasibility RCT of postnatal weight support showed women with BMIs ≥25 kg/m2 can be recruited and followed to 12 months postnatally. [ABSTRACT FROM AUTHOR]

Northwest Africa (NWA) 10986 is a new mingled lunar meteorite found in 2015 in Western Sahara. This impact melt breccia contains abundant impact melt glass and clasts as large as 0.75 mm. Clasts are predominantly plagioclase and pyroxene‐rich and represent both highland and basalt lithologies. Highland lithologies include troctolites, gabbronorites, anorthositic norites, and troctolitic anorthosites. Basalt lithologies include crystalline clasts with large zoned pyroxenes representing very low titanium to low titanium basalts. In situ geochemical analysis of minerals within clasts indicates that they represent ferroan anorthosite, Mg‐suite, and gabbronorite lithologies as defined by the Apollo sample collection. Clasts representing magnesian anorthosite, or "gap" lithologies, are prevalent in this meteorite. Whole rock and in situ impact glass measurements indicate low incompatible trace element concentrations. Basalt clasts also have low incompatible trace element concentrations and lack evolved KREEP mineralogy although pyroxferroite grains are present. The juxtaposition of evolved, basaltic clasts without KREEP signatures and highland lithologies suggests that these basaltic clasts may represent cryptomare. The lithologies found in NWA 10986 offer a unique and possibly a complete cross section view of the Moon sourced outside of the Procellarum KREEP Terrane. [ABSTRACT FROM AUTHOR]

Background: Tuberous sclerosis complex (TSC) is a complex multisystem genetic disorder. Approximately 84% of people with TSC have epilepsy. However, there is little literature available regarding families' experiences with TSC and seizure management. Therefore, the aim of the current study was to explore families' positive and negative experiences, and attitudes towards TSC, epilepsy and medical management of seizures. Methods: Framework analysis informed an open exploration of families' experiences with TSC, epilepsy and medical management of seizures. Using structured interviews, 11 parents of people with TSC and 2 people with TSC were interviewed, providing the data set for transcription and thematic analysis. Results: 'TSC rules our life' overarched three subordinate themes: 'Our normal', 'Burnout' and 'Seizure management has given us our life back'. Families had to adapt to the normality of needing to constantly supervise their child even as they become an adult. They express a feeling of fear particularly of seizures, and this has impact throughout the family. There are frequent expressions of exhaustion and struggling to fight for access and support. There are some positives and cautious hope with the gaining of control from seizures as being able to predict or plan improves activity and participation. These interviews provided a rich insight into the lives of those with TSC and their families. Conclusion: There are exciting developments with respect to scientific understanding of the pathophysiology of TSC, which opens opportunity for new treatments. Holistic family centred health care and practical support (e.g. opportunities for parental respite) is as important as medical intervention. As TSC is such a complex condition, there is a need for specialist clinics and TSC‐specific research. [ABSTRACT FROM AUTHOR]

Background: Many patients who undergo lower gastrointestinal surgery neither recommence feeding within timeframes outlined by evidence‐based guidelines, nor meet their nutrition requirements in hospital. Given that the success of timely and adequate post‐operative feeding is largely reliant on patient adherence, the present study explored patients' perceptions of recommencing feeding after colorectal surgery to determine areas of improvement to meet their needs and expectations. Methods: This qualitative study involved one‐on‐one, semi‐structured interviews with patients receiving care after colorectal surgery in an Australian tertiary teaching hospital. Purposive sampling was used to ensure maximal variation in age, sex, procedural type and post‐operative nutrition care experience. Interviews were audio recorded, with data transcribed verbatim before being thematically analysed. Emergent themes and subthemes were discussed by all investigators to ensure consensus of interpretation. Results: Sixteen patients were interviewed (female 56%; age 61.5 ± 12.3 years). Three overarching themes emerged from the data: (i) patients make food‐related decisions based on ideologies, experience and trust; (ii) patients appreciate the opportunity to participate in their nutrition care; and (iii) how dietary information is communicated influences patients' perceptions of and behaviours towards nutrition. Conclusions: Enabling patients to select from a wide range of foods from post‐operative day 1 (by prescribing an unrestricted diet in line with evidence‐based practice guidelines) in conjunction with delivering clear, simple and encouraging dietary‐related information may facilitate patient participation in care and increase oral intakes among patients who have undergone colorectal surgery. [ABSTRACT FROM AUTHOR]

Abstract: Background: Individuals with intellectual disability (ID) are at greater risk of exposure to traumatic life events compared with the non‐ID population. Yet no study to date has examined the role of multiple traumatisation and subsequent psychopathology in people with ID. The aim of this study was to explore the association between multiple traumatisation and subsequent mental health. Methods: A preliminary cross‐sectional study involving 33 participants with DSM‐5 post‐traumatic stress disorder completed self‐report questionnaires on exposure to traumatic life events and post‐traumatic stress disorder symptoms, anxiety, depression and general distress. Results: A proportion of 42.4% of the sample reported multiple traumatisation, including exposure to life events in both childhood and adulthood. Those who reported exposure to life events in childhood and adulthood reported significantly higher risk of harm, depression and general psychological distress compared with those who reported exposure to life events only in adulthood. Conclusions: Preliminary results indicate that more severe psychopathology is associated with multiple traumatisation in childhood and adulthood compared with trauma experienced solely in adulthood. [ABSTRACT FROM AUTHOR]

Abstract: Recent research has highlighted how Lake Baikal, Siberia, has responded to the direct and indirect effects of climate change (e.g., ice‐cover duration), nutrient loading, and pollution, manifesting as changes in phytoplankton/zooplankton populations, community structure, and seasonal succession. Here, we combine and compare analyses of chlorophyll a (an estimate of total algal biomass), carotenoid pigments (biomarkers of algal groups), and lake water silicon isotope geochemistry (δ30SiDSi) to differentiate spatial patterns in dissolved silicon (DSi) uptake at Lake Baikal. A total of 15 sites across the three basins (south, central, and north) of Lake Baikal were sampled in August 2013 along a depth gradient of 0–180 m. Strong, significant correlations were found between vertical profiles of photic zone DSi concentrations and δ30SiDSi compositions (r = −0.81, p < 0.001), although these are strongest in the central basin aphotic zone (r = −0.98, p < 0.001). Data refute the hypothesis of DSi uptake by picocyanobacteria. Algal biomass profiles and high surface δ30SiDSi compositions suggest greater productivity in the south basin and more oligotrophic conditions in the north basin. δ30SiDSi signatures are highest at depth (20 m) in central basin sites, indicating greater (10–40%) DSi utilization at deep chlorophyll maxima. DSi limitation occurs in the pelagic central basin, probably reflecting a high diatom biomass bloom event (Aulacoseira baicalensis). Meanwhile in the more hydrologically restricted, shallow Maloe More region (central basin), both high δ30SiDSi compositions and picocyanobacteria (zeaxanthin) concentrations, respectively point to the legacy of an “Aulacoseira bloom year” and continuous nutrient supply in summer months (e.g., localized eutrophication). [ABSTRACT FROM AUTHOR]

Summary: People with hepatitis C virus (HCV) infection other than genotype 1 represent a heterogeneous group. The aim of the phase 2 C‐SCAPE study was to evaluate elbasvir/grazoprevir (EBR/GZR), with or without ribavirin (RBV), in participants with HCV genotype 2, 4, 5 or 6 infection. This was a part randomised, open‐label, parallel‐group study (NCT01932762; PN047‐03) of treatment‐naive, noncirrhotic participants. Participants with HCV genotype 2 infection received GZR 100 mg + RBV ± EBR 50 mg for 12 weeks and those with genotype 4, 5 or 6 infection were randomized to receive EBR/GZR ± RBV for 12 weeks. The primary endpoint was sustained virological response 12 weeks after completion of treatment (SVR12; HCV RNA <25 IU/mL). Among participants with genotype 2 infection, SVR12 was achieved by 80% (24/30) of those receiving EBR/GZR + RBV and 73% (19/26) of those receiving GZR + RBV. SVR rates were high in participants with HCV genotype 4 infection receiving EBR/GZR with and without RBV (100% [10/10] and 90% [9/10]; respectively). In contrast, the addition of RBV to EBR/GZR appeared to increase SVR12 in participants with genotype 5 infection (EBR/GZR, 25%; EBR/GZR + RBV 100% [4/4]). In participants with genotype 6 infection, SVR12 was 75% (3/4) in both those receiving EBR/GZR and those receiving EBR/GZR + RBV. The safety profile was similar across treatment arms, with adverse events tending to occur more frequently among participants receiving RBV. In conclusion, these data support the inclusion of participants with genotype 4 or 6 infection in the EBR/GZR phase 3 studies. EBR/GZR ± RBV was unsatisfactory for participants with genotype 2 or 5 infection. [ABSTRACT FROM AUTHOR]

Abstract: Background: Early oral feeding after surgery is best practice among adult, noncritically ill patients. Evidenced‐based guidelines (EBG) recommend commencing liquid and solid feeding within 24 h of surgery to improve patient (e.g. reduced morbidity) and hospital (e.g. reduced length of stay) outcomes. Whether these EBG are adhered to in usual clinical practice remains unknown. The present study aimed to identify the time to commencement of first oral feed (liquid or solid) and first solid feed among postoperative, noncritically ill, adult patients. Methods: MEDLINE, CINAHL, SCOPUS and Web of Science databases were searched from inception to June 2016 for observational studies reporting liquid and/or solid feeding practices among postoperative patients. Studies reporting a mean/median time to first feed or first solid feed within 24 h of surgery or where ≥75% of patients were feeding by postoperative day one were considered in‐line with EBG. Results: Of 5826 articles retrieved, 29 studies were included. Only 40% and 22% of studies reported time to first feed and time to first solid feed in‐line with EBG, respectively. Clear and free liquids were the first diet types commenced in 86% of studies. When solids were commenced, 44% of studies reported using various therapeutic diet types (e.g. light) prior to the commencement of a regular diet. Patients who underwent gastrointestinal procedures appeared more likely to experience delayed postoperative feeding. Conclusions: Our findings demonstrate a gap between postoperative feeding evidence and its practical application. This information provides a strong rationale for interventions targeting improved nutritional care following surgery. [ABSTRACT FROM AUTHOR]

Abstract: Human axillary (armpit) odors are highly diverse and have potential to reveal a wide range of individual information. This is echoed in gas chromatography findings, which show that axillary odors are comprised of many volatile compounds. Despite this, only a small number of verbal descriptors are used when investigating the perceptual qualities of body odors. We set out to develop a lexicon that would capture these perceptual qualities in more detail, working alongside perfumers and fragrance evaluators in order to benefit from their expertise in olfactory perception and semantic labeling of odors. Four experts developed a list of 15 verbal descriptors based on an exemplar set of male and female axillary samples, and then rated 62 samples (31 men and 31 women) using these. We explored the predictive value of these ratings, finding that subsets of descriptors distinguished male from female samples, appearing to be more reliable than explicit judgments of odor sex. Practical applications: This lexicon was successful in discriminating sex of odor samples and could enable improved understanding of other perceptual qualities of human odor. For example, it could be possible to link specific perceptual qualities to specific cues (e.g., symmetry, masculinity) or to manipulate odors based on perceptual qualities in experimental settings, with direct practical implications for odor researchers. Furthermore, the existence of such a lexicon will allow body odors to be categorized for practical purposes. For example, such categorization will facilitate exploration of how fragrances, ingredients, or accords may interact with and complement different body odor types. [ABSTRACT FROM AUTHOR]

In both humans and nonhuman animals, mating strategies represent a set of evolutionary adaptations aimed at promoting individual fitness by means of reproduction with the best possible partners. Given this critical role, mating strategies influence numerous aspects of human life. In particular, between‐sex divergence in the intensity of intrasexual competition could account for robust cross‐cultural sex differences in psychology and behavior (e.g., personality, psychiatric disorders, social behavior, violence). Several other factors (including individual differences, relationship type and environment) affect—in an evolutionarily consistent manner—variation in mating strategy that individuals pursue (as one example, awareness of one's own attractiveness impinges on mating standards). Here we provide an overview of relevant theoretical frameworks and empirical evidence on variation in mating strategies. Given its multifaceted nature and intense research interest over several decades, this is a challenging task, and we highlight areas where further investigation is warranted in order to achieve a clearer picture and resolve apparent inconsistencies. However, we suggest that addressing outstanding questions using a variety of different methodological approaches, a deeper understanding of the cognitive representations involved in mating strategies is within reach. WIREs Cogn Sci 2018, 9:e1456. doi: 10.1002/wcs.1456 This article is categorized under: Cognitive Biology > Evolutionary Roots of Cognition Neuroscience > Behavior Neuroscience > Cognition [ABSTRACT FROM AUTHOR]

Summary: Background: Antiviral therapy for hepatitis C has the potential to improve liver function in patients with decompensated cirrhosis. Aims: To examine the virological response and effect of viral clearance in patients with decompensated hepatitis C cirrhosis all with MELD scores ≥15 following sofosbuvir/daclatasvir ± ribavirin. Methods: We prospectively collected data on patients who commenced sofosbuvir/daclatasvir for 24‐weeks under the Australian patient supply program (TOSCAR) and analysed outcomes including sustained viral response at 12 weeks (SVR12), death and transplant. Results: 108 patients (M/F, 79/29; median age 56years; Child‐Pugh 10; MELD 16; genotype 1/3, 55/47) received sofosbuvir/daclatasvir and two also received ribavirin. On intention‐to‐treat, the SVR12 rate was 70% (76/108). Seventy‐eight patients completed 24‐weeks therapy. SVR12 was achieved in 56 of these patients on per‐protocol‐analysis (76%). SVR12 was 80% in genotype 1 compared to 69% in genotype 3. Thirty patients failed to complete therapy. In patients achieving SVR12, median MELD and Child‐Pugh fell from 16(IQR15‐17) to 14(12‐17) and 10(9‐11) to 8(7‐9), respectively (P<.001). In those who died, MELD increased from 16 to 23 at death (P=.036). Patients who required transplantation had a significantly higher baseline MELD (20) compared to those patients completing treatment (16) (P=.0010). The odds ratio for transplant in patients with baseline MELD ≥20 was 13.8(95%CI 2.78‐69.04). Conclusions: SVR12 rates with sofosbuvir/daclatasvir in advanced liver disease are lower than in compensated disease. Although treatment improves MELD and Child‐Pugh in most patients, a significant proportion will die or require transplantation. In those with MELD ≥20, it may be better to delay treatment until post‐transplant. [ABSTRACT FROM AUTHOR]

Summary: Background: Non‐alcoholic fatty liver disease (NAFLD) is a significant disease burden in obesity. Liver fibrosis is an important prognostic factor in NAFLD, and detection is vital. The pathophysiological changes of obesity can alter the accuracy of non‐invasive NAFLD tests. We aimed to review current evidence for common non‐invasive tests for NAFLD‐related fibrosis in obesity. Methods: We systematically searched for studies assessing the diagnostic accuracy of 11 biomarker panels and elastography techniques for NAFLD‐related fibrosis in obesity. Meta‐analyses were performed where possible. Results: Thirty‐eight studies were identified assessing the selected tests in obese populations. Simple biomarker panels (e.g. NAFLD fibrosis score) were the most validated. Evidence showed better accuracy of complex biomarker panels (NAFLD fibrosis score: summary receiver operator characteristic [SROC] 0.795–0.813 vs. enhanced liver fibrosis: SROC 0.962); however, these were poorly validated in obesity. Elastography techniques were better studied and had high diagnostic accuracy (transient elastography: SROC 0.859; magnetic resonance elastography: SROC 0.965) but were limited by BMI‐dependent failure. Limited evidence was found to validate the accuracy of any test in exclusively obese populations. Conclusion: In obese subjects, complex biomarker panels and elastography have been reasonable to good accuracy for NAFLD‐related fibrosis; however, these methods have not been well validated. Further study in this high‐risk population is needed. [ABSTRACT FROM AUTHOR]

Background Chronic hepatitis C infection leads to impairment of patient-reported outcomes ( PROs). Treatment with direct-acting antiviral regimens results in short- and long-term improvement of these outcomes. Aim To assess PROs in patients treated with a newly developed direct-acting antiviral, a fixed-dose combination of sofosbuvir/velpatasvir ( SOF/ VEL) with/without voxilaprevir ( VOX). Methods The PRO data were collected from participants of POLARIS-2 and POLARIS-3 clinical trials ( DAA-naïve, all HCV genotypes). Participants self-administered SF-36v2, FACIT-F, CLDQ- HCV and WPAI: SHP instruments at baseline, during treatment, and in follow-up. Results Of 1160 patients, 611 received SOF/ VEL/ VOX and 549 received SOF/ VEL (52.8 ± 11.0 years, 55.9% male, 75.4% treatment-naïve, 33.9% cirrhotic). The sustained viral response at 12 weeks (SVR12) rates were 95%-98%. During treatment, improvements in most PRO scores were significant (all but one P < .01) and ranged from, on average, +2.3 to +15.0 points (on a 0-100 scale) by the end of treatment. These improvements were similar between SOF/ VEL/ VOX and SOF/ VEL arms (all P > .05). After treatment discontinuation, patients treated with both regimens achieved significant and clinically meaningful PRO gains (+2.7 to +16.7 by post-treatment week 12, +3.9 to +20.1 by post-treatment week 24; all but one P < .001). Multivariate analysis showed that depression, anxiety and cirrhosis were the most consistent independent predictors of PRO impairment while no association of PROs with the treatment regimen choice was found (all P > .05). Conclusions The pan-genotypic regimens with SOF/ VEL with or without VOX not only have excellent efficacy and safety, but also significantly positively impact patients' experience both during treatment and after achieving sustained virologic response in DAA-naïve patients with HCV. [ABSTRACT FROM AUTHOR]

The direct-acting antiviral regimen of ombitasvir ( OBV)/paritaprevir ( PTV)/ritonavir (r)±dasabuvir ( DSV)±ribavirin ( RBV) demonstrated high rates of sustained viral response at post-treatment week 12 ( SVR12) in clinical trials for treatment of hepatitis C virus ( HCV) genotypes ( GT) 1 and 4. To confirm the effectiveness of this regimen in the real world, we conducted meta-analyses of published literature on 30 April 2016. Freeman-Tukey transformation determined the SVR rate within GTs 1a, 1b and 4, as well as specific SVR rates by cirrhosis or prior treatment experience status. Rates of virologic relapse, hepatic decompensation, drug discontinuation and serious adverse events were also analysed. In total, 20 cohorts across 12 countries were identified, totalling 5158 patients. The overall SVR12 rates were 96.8% (95% CI 95.8-97.7) for GT1 and 98.9% (95% CI 94.2-100) for GT4. For GT1a patients, the SVR rates were 94% and 97% for those with or without cirrhosis, and 94% overall. For GT1b patients, the SVR rates were 98% and 99% for those with or without cirrhosis, and 98% overall. The virologic relapse rate of GT1 patients was 1.3%, across 3524 patients in nine studies that reported this parameter. The rate of hepatic decompensation was less than 1% across five studies, including 3440 patients, 70% of which had cirrhosis. Conclusions: Real-world SVR12 rates for OBV/ PTV/r± DSV± RBV were consistently high across HCV GT1 and four irrespective of cirrhosis status or prior HCV treatment experience, confirming effectiveness within a diverse patient population across multiple cohorts and countries. [ABSTRACT FROM AUTHOR]

While HBV and HCV are risk factors for HCC, uncertainty exists as to whether these viral infections have prognostic significance in HCC. Thus, we compared the overall survival of patients with HBV, HCV and nonviral HCC, and evaluated whether the presence of HBV and HCV predicts patient outcomes. We conducted a multicentre study of HCC cases diagnosed at six Melbourne tertiary hospitals between Jan 2000-Dec 2014. Patient demographics, liver disease and tumour characteristics and patient outcomes were obtained from hospital databases, computer records and the Victorian Death Registry. Survival outcomes were compared between HBV, HCV and nonviral hepatitis cases and predictors of survival determined using Cox proportional hazards regression. There were 1436 new HCC cases identified including 776 due to viral hepatitis ( HBV 235, HCV 511, HBV- HCV 30) and 660 from nonviral causes. The median survival of HBV, HCV and nonviral HCC patients was 59.1, 28.4 and 20.9 months, respectively ( P<.0001). On multivariate analysis, independent risk factors for survival included HCC aetiology, gender, BCLC stage, serum AFP, total number and size of lesions, and serum creatinine and albumin. After adjusting for these and method of detection, HBV remained an independent predictor of improved overall survival when compared to both nonviral ( HR 0.60%, 95% CI 0.35-0.98; P=.03) and HCV-related HCC ( HR 0.51%, 95% CI 0.30-0.85; P=.01). In this large multicentre study, HBV is independently associated with improved overall survival compared with HCV and nonviral-related HCC. Further studies are needed to determine the underlying factor(s) responsible. [ABSTRACT FROM AUTHOR]

Background Active patient involvement in nutrition care may improve dietary intakes in hospital. Our team is developing an innovative programme allowing patients to self-assess and self-monitor their nutrition at the bedside. The present study aimed to assess usability and patient perceptions of an electronic foodservice system ( EFS) for participating in nutrition care. Methods This qualitative study was conducted in an Australian tertiary hospital. Participants were sampled purposively and included patients who were able to provide informed consent and communicate in English. Patient interviews were conducted at the bedside and consisted of: (i) usability testing of the EFS using 'Think Aloud' technique and (ii) questioning using a semi-structured interview guide to understand perceptions of the EFS. Interview data were analysed using inductive content analysis. Results Thirty-two patients were interviewed. Their perceptions of using the EFS to participate in nutrition care were expressed in five categories: (i) Familiarity with technology can affect confidence and ability but is not essential to use EFS; (ii) User interface design significantly impacts EFS usability; (iii) Identifying benefits to technology increases its acceptance; (iv) Technology enables participation, which occurs to varying extents; and (v) Degree of participation depends on perceived importance of nutrition. Conclusions Patients found the EFS acceptable and acknowledged benefits to its use. Several factors appeared to influence usability, acceptability and willingness to engage with the system, such as user interface design and perceived ease of use, benefits and importance. The present study provides important insights into designing technology-based interventions for engaging inpatients in their nutrition care. [ABSTRACT FROM AUTHOR]

Aims To compare long-term HbA1c changes associated with different insulin pumps during routine care in a large cohort of adults with Type 1 diabetes representative of other clinic populations. Methods Observational, retrospective study of 508 individuals starting pump therapy between 1999 and 2014 (mean age, 40 years; 55% women; diabetes duration, 20 years; 94% Type 1 diabetes; median follow-up, 3.7 years). Mixed linear models compared covariate-adjusted HbA1c changes associated with different pump makes. Results The pumps compared were: 50% Medtronic, 24% Omnipod, 14% Roche and 12% Animas. Overall HbA1c levels improved and improvements were maintained during a follow-up extending to 10 years (HbA1c: pre-continuous subcutaneous insulin infusion (pre- CSII) vs. 12 months post CSII, 71 (61, 82) vs. 66 (56, 74) mmol/mol; 8.7 (7.7, 9.6) vs. 8.2 (7.3, 8.9)%; P < 0.0001). The percentage of individuals with HbA1c ≥ 64 mmol/mol (8.0%) reduced from a pre- CSII level of 68% to 55%. After adjusting for baseline confounders, there were no between-pump differences in HbA1c lowering ( P = 0.44), including a comparison of patch pumps with traditional catheter pumps ( P = 0.63). There were no significant ( P < 0.05) between-pump differences in HbA1c lowering in pre-specified subgroups stratified by pre-pump HbA1c, age or diabetes duration. HbA1c lowering was positively related to baseline HbA1c ( P < 0.001) and diabetes duration ( P = 0.017), and negatively related to the number of years of CSII use ( P = 0.024). Conclusions Under routine care conditions, there were no covariate-adjusted differences in HbA1c lowering when comparing different pump makes, including a comparison of patch pumps vs. traditional catheter pumps. Therefore, the choice of CSII make should not be influenced by the desired degree of HbA1c lowering. [ABSTRACT FROM AUTHOR]

Infant oral mutilation is the practice of removing developing tooth germs, commonly the mandibular canine, in infants up to the age of 1 year. Subsequent complications include missing, impacted or hypoplastic permanent anterior and canine teeth. We report on a case of bilaterally missing lower canines thought to be due to infant oral mutilation. It is important that general dental practitioners are aware of this practice and resulting complications when treating families from sub-Saharan East Africa. [ABSTRACT FROM AUTHOR]

Background The burden of HCV cirrhosis is high and projected to increase significantly over the next decade. While interferon therapy is problematic in HCV cirrhosis, the era of direct-acting anti-viral ( DAA) therapy provides effective treatment for patients with cirrhosis. Aim To systematically review the results of DAA therapy to date in patients with HCV cirrhosis, and highlight the ongoing challenges for DAA therapy in this population. Methods A structured Medline search was conducted to obtain phase II and III HCV trials in patients with cirrhosis. Citations from review articles were cross-referenced and conference abstracts from EASL and AASLD liver meetings for the preceding 3 years were reviewed manually. Keywords used included hepatitis C, cirrhosis and the DAA's: sofosbuvir, ledipasvir, velpatasvir, grazoprevir, elbasvir, daclatasvir, beclabuvir, asunaprevir, simeprevir, paritaprevir, ombitasvir and dasabuvir. Results Successful direct-acting anti-viral treatment is now possible in patients with HCV-related cirrhosis including those with liver decompensation with several regimens now offering sustained virological response ( SVR) of 90-95%. Overall success rates in GT1 cirrhosis are excellent while GT3-infected patients with cirrhosis remain hard to cure. The pangenotypic combination of sofosbuvir and velpatasvir holds promise for GT3 cirrhosis achieving SVR of ~90%. Conclusions Potent DAA therapies provide much needed, safe and highly effective treatment options for persons with HCV cirrhosis including those previously deemed unsuitable for treatment. Combination therapy with two or more classes of drug is essential to achieve high efficacy and minimise viral resistance, with the role of ribavirin still under evaluation. However, several challenges remain including the hard-to-cure groups of GT3 cirrhosis and direct-acting anti-viral failures, and managing drug-drug interactions. [ABSTRACT FROM AUTHOR]

The Atchafalaya River Basin Floodway (ARBF), a regulated river/floodplain distributary of the Mississippi River, experiences an annual flood pulse that strongly influences floodplain physicochemistry. We developed several metrics to investigate the relationship between the timing and magnitude of the flood pulse and floodplain hypoxia, which in most years is a spatially extensive and temporally prolonged problem in the lower ARBF. Principal components analysis of flood metrics from 2001 to 2009 revealed contrasting flood types (early cool and late warm), but component-based general linear models were unable to predict the magnitude of hypoxia in ARBF water management areas (WMAs). Further analyses based on temperature and geographic information system-determined WMA inundation with generalized additive models (GAMs) revealed WMA-specific patterns of hypoxia, but the likelihood of hypoxia consistently increased when temperatures approached 20°C and inundation rose above 20-30%. Validation with held-out data based on logistic regression indicated that the models constructed with the 2001-2009 temperature and inundation data were able to accurately predict the probabilities of hypoxia in two WMAs based on data collected from 2010 to 2013. The GAMs were an effective tool for visualizing and predicting the probability of hypoxia based on two easily generated parameters. Our analyses indicate that modification of the Atchafalaya River flood pulse could reduce the magnitude of hypoxia within the lower ARBF, subject to engineering (control structure operation) and economic (commercial fisheries production) constraints, by minimizing floodplain inundation after water temperatures reach 20°C. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We conducted a randomised exploratory trial in children aged between one and sixteen years old to establish the time to achieve an end-tidal oxygen fraction ≥ 0.9 in three different positions: supine, and 30 and 45° head up. We recruited 120 children analysed in two age groups: 1-8 years and 9-16 years. The median (IQR [range]) time to reach the end point was 80 (59-114 [41-295]) s in the younger group and 150 (107-211 [44-405]) s in the older group, regardless of position (p = 0.0001). The end point was reached in 90% of children in approximately 160 s in the younger, and 271 s in the older, groups, respectively. There was no statistical difference between the three positions within each age group in the time to reach the endpoint (p = 0.59). Only two patients in the older age group could not reach the end point, due to poorly fitting facemasks. We conclude that pre-oxygenation can therefore be achieved effectively in most children, and that tilting children head up by 30 or 45° does not significantly reduce the time taken to achieve an end-tidal oxygen fraction of ≥ 0.9. The recommended period for pre-oxygenation in both groups should remain at 3 min but it should be noted that this may be insufficient for many older patients. [ABSTRACT FROM AUTHOR]

Background There is little up-to-date review evidence on the prevalence of Helicobacter pylori across Europe. Aim To establish regional and national patterns in H. pylori prevalence across Europe. Secondly, to establish trends over time in H. pylori prevalence and gastric cancer incidence and, thirdly, to report on the relationship between H. pylori prevalence and age group across Europe. Methods A review of H. pylori prevalence from unselected surveys of adult or general populations across 35 European countries and four European regions since 1990. Secondly, an analysis of trends over time in H. pylori prevalence and in gastric cancer incidence from cancer registry data. Results Helicobacter pylori prevalence was lower in northern and western Europe than in eastern and southern Europe (P < 0.001). In 11 of 12 European studies that reported on trends, there were sharp reductions in H. pylori prevalence (mean annual reduction = 3.1%). The mean annual reduction in the incidence of gastric cancer across Europe from 1993 to 2007 was 2.1% with little variation regionally across Europe (north 2.2%, west 2.3%, east 1.9% and south 2.0%). Sharp increases in age-related prevalence of H. pylori often levelled off for middle age groups of about 50 years onwards, especially in areas with high prevalence. Conclusions This review shows that H. pylori prevalence is much higher in less affluent regions of Europe and that age-related increases in prevalence are confined to younger age groups in some areas. There were sharp reductions in both H. pylori prevalence and gastric cancer incidence throughout Europe. [ABSTRACT FROM AUTHOR]

Basaltic lava flows and ignimbrite units around Puerto de Santiago, SW Tenerife, were investigated as potential analogues for hydrocarbon-bearing volcanic reservoir rocks. Conventional helium porosity and air permeability measurements together with the results of a micro-focus X-ray computed tomography study were integrated with field observations on flow morphology and the continuity of defined internal lava flow zones. Individual lava flows typically comprise distinct tops, cores and bases, with lava piles showing repeated cycles of these three internal zones. Reservoir quality is best in the flow tops (mean ϕ = 23.14%, k = 5.622mD) where vesicular porosity dominates. Flow cores are relatively tight with primary porosity mainly controlled by cooling joints, fractures and intercrystalline microporosity (mean ϕ = 2.40%, k = 0.001mD). Flow bases show variable reservoir potential due to the presence of breccia and/or vesiculation (mean ϕ = 11.77%, k = 0.001mD). By contrast, ignimbrites show the highest porosities but have low permeabilities (mean ϕ = 35.64%, k = 0.0056mD). In all cases, the primary porosity and permeability may have been modified to create additional secondary porosity and permeability as a result of fracturing and mineral dissolution during burial or weathering, although porosity may also be occluded through the precipitation of secondary minerals or the alteration of primary minerals. The new porosity data presented demonstrates that pyroclastics and basaltic lava flow tops have the best reservoir properties, with the flow tops having sufficient porosity and permeability to transmit fluids and gas. In contrast, flow cores are relatively tight (impermeable), and would act as seals to potential hydrocarbon accumulations when fractures and cooling joints are absent. The reservoir potential can be high where vesicles and fractures are present (i.e. in lava flow tops), although there is uncertainty whether flow tops could be connected to each other vertically to form a potentially exploitable hydrocarbon reservoir. Although in some areas such volcanic rocks can be primary targets for hydrocarbon exploration (e.g. onshore China), in many others they are considered to be a secondary target, adding incremental resources to hydrocarbons produced from more conventional sandstone and carbonate reservoirs. [ABSTRACT FROM AUTHOR]

Subjective attractiveness ratings of facial portraits of women taken at the fertile phase of the menstrual cycle are higher than those of portraits of the same women taken during non-fertile periods. As female faces tilted downward are rated as more attractive and female courtship behaviours change across the menstrual cycle, we investigated whether systematic downward tilt of women's faces during the fertile phase might be responsible for increased attractiveness ratings. In the original study (Proc. R. Soc. Lond. B, 271, 2004, S272), the fertile-phase portrait of each woman was deemed more attractive in 56-62% of cases. When the portraits were reclassified by head pitch, the more downward-tilted portrait was preferred in 64-73% of cases. The fertile-phase portrait was no more likely to be the downward-tilted one, however, suggesting that effects of fertility on attractiveness are not simply due to changes in head position. We also had these portraits rated (N = 130) for physical attractiveness and behavioural allure. Fertile-phase portraits were rated as more physically attractive than non-fertile portraits, while more downward-tilted portraits were rated as more behaviourally alluring than less downward-tilted ones. These data not only confirm reported effects of head tilt and fertility on perceived female attractiveness, but also suggest that these factors influence different components of the attractiveness percept. [ABSTRACT FROM AUTHOR]

Background Malnutrition is common in hospitals and is a risk factor for pressure ulcers. Nutrition care practices relating to the identification and treatment of malnutrition have not been assessed in patients at risk of pressure ulcers. The present study describes nutrition care practices and factors affecting nutritional intakes in this patient group. Methods The study was conducted in four wards at two hospitals in Queensland, Australia. Adult patients at risk of pressure ulcers as a result of restricted mobility were observed for 24 h to determine their daily oral intake and practices such as nutrition screening, documentation and intervention. Independent samples t-tests and chi-squared tests were used to analyse dietary intake and nutrition care-related data. Predictors of receiving a dietitian referral were identified using logistic regression analyses. Results Two hundred and forty-one patients participated in the present study. The observed nutritional screening rate was 59% (142 patients). Weight and height were documented in 71% and 34% of cases. Sixty-nine patients (29%) received a dietitian referral. Predictors of receiving a dietitian referral included lower body mass index and longer length of stay. On average, patients consumed 73% and 72% of the energy and protein provided, respectively. Between 22% and 38% of patients consumed <50% of food provided at main meals. Conclusions Nutrition care practices including malnutrition risk screening and documentation of nutritional parameters appear to be inadequate in patients at risk of pressure ulcers. A significant proportion of these patients eat inadequately at main meals, further increasing their risk of malnutrition and pressure ulcers. [ABSTRACT FROM AUTHOR]

Background The incidence of acute pancreatitis has increased sharply in many European countries and the USA in recent years. Aim To establish trends in incidence and mortality for acute pancreatitis in Wales, UK, and to assess how incidence may be linked to factors including social deprivation, seasonal effects and alcohol consumption. Methods Use of record linked inpatient, mortality and primary care data for 10 589 hospitalised cases of acute pancreatitis between 1999 and 2010. Results The incidence of acute pancreatitis was 30.0 per 100 000 population overall, mortality was 6.4% at 60 days. Incidence increased significantly from 27.6 per 100 000 in 1999 to 36.4 in 2010 (average annual increase = 2.7% per year), there was little trend in mortality (0.2% average annual reduction). The largest increases in incidence were among women aged <35 years (7.9% per year) and men aged 35-44 (5.7%) and 45-54 (5.3%). Incidence was 1.9 times higher among the most deprived quintile of patients compared with the most affluent (3.9 times higher for alcoholic acute pancreatitis and 1.5 for gallstone acute pancreatitis). Acute pancreatitis was increased significantly during the Christmas and New Year weeks by 48% (95% CI = 24-77%) for alcoholic aetiology, but not for gallstone aetiology (9%). Alcoholic admissions were increased with higher consumption of spirits and beer, but not wine. Conclusions The study shows an elevated rate of alcoholic acute pancreatitis during the Christmas and New Year period. Acute pancreatitis continues to rise, most rapidly for young women, while alcoholic acute pancreatitis is linked strongly with social deprivation. [ABSTRACT FROM AUTHOR]

ABSTRACT Human body odour is often associated with negative attributions, hence the term 'malodour'. Another perspective is that odours contain biologically meaningful information involved in communication of social cues, notably in perception of suitable mates. This evolutionarily informed perspective indicates that we retain capacity to infer mate quality through olfaction (e.g. preferring odours of high-quality or genetically compatible individuals). From either perspective, knowing the extent to which body odour is stable over time is important: either in order to fully understand how perfumes might interact with body odour or whether the biological cues gained from odour are reliable. In addition, from the second perspective, odour-based mate preferences should also be relatively stable over time, especially if both traits and preferences are genetically influenced. Here we measured repeatability in young women of body odour preferences for male odours, over a 3-month period. We also compare stability of body odour preferences with that of preferences for faces and fragrances. We find that preferences for all stimuli were highly repeatable over time. Since the odour stimuli used were repeated samples from the same set of men, repeatability of preferences also indicates odour constancy of individuals over time. Our results on both odour constancy and repeatability of preference have implications for the perfume industry and also lend weight to the assumption that body odour constitutes a meaningful cue of quality that can be used in individual assessment during human interactions. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The risk of bleeding in patients with hereditary bleeding disorders ( HBD) undergoing gastro-intestinal ( GI) endoscopic procedures is unknown but guidelines generally recommend correction of factor deficiency. Investigate the safety of oral tranexamic acid ( TA) without prophylactic factor replacement to prevent bleeding complications in patients with HBD undergoing elective GI endoscopic procedures. A prospective single-arm pilot study testing the feasibility of using TA, without prophylactic factor replacement or desmopressin preprocedure, for prevention of bleeding complications following elective standard risk (<1% risk of bleeding) endoscopic procedures in patients with HBD. Baseline factor levels, haemoglobin and iron studies ( IS) were measured preprocedure. Primary outcome of bleeding ( NCI CTCAE v3.0 Bleeding Scale) was undertaken by patient review and repeat Hb, IS on day 21. Twenty-eight patients underwent 32 GI endoscopic procedures from September 2010 until June 2012. The median age was 53 years (range 24-75 years) and disease types included mild haemophilia A/B ( n = 12), severe haemophilia A/B ( n = 9), von Willebrand disease ( n = 5), FXI deficiency ( n = 1) and FVII deficiency ( n = 1). Procedures performed included 11 gastroscopies, 12 colonoscopies, 8 gastroscopies and colonoscopies and 1 flexible sigmoidoscopy. Fourteen standard risk procedures and two high risk procedures were performed. Two patients experienced Grade 1 bleeding and one patient experienced Grade 2 bleeding. This study suggests that TA without prophylactic factor replacement may be a safe approach for mild and moderate HBD patients undergoing standard risk endoscopic procedures, particularly where no biopsy is performed. These findings should be confirmed in a larger study. [ABSTRACT FROM AUTHOR]

Aim To evaluate trends in survival of patients with hepatocellular carcinoma ( HCC) at The Alfred over a 15-year period from 1995-2009 Methods A retrospective cohort study of patients with HCC comparing epidemiology, clinical presentation, treatment parameters and overall survival of those diagnosed between 1995-2001 and 2002-2009. Overall survival of patients with primary liver cancer. Results The study population consisted of 215 patients; 110 diagnosed between 1995-2001 (Cohort A) and 105 between 2002-2009 (Cohort B). Overall survival increased significantly between 1995-2010 ( P = 0.016); median survival was 365 days in Cohort A compared with 665 in Cohort B. The improvement in survival was associated with an increase in the proportion of cases detected at an asymptomatic stage ( P = 0.012), a decline in the severity of liver disease at diagnosis ( P = 0.002) and increased utilisation of loco-regional therapy ( P = 0.001) over the same period. Survival of patients detected through screening was significantly higher than those detected through non-screening methods (1309 vs 233 days, P < 0.001). Conclusions The survival of patients with HCC managed at a tertiary referral centre has improved over the period 1995-2009. This improvement may relate to the increased detection of the disease at an asymptomatic stage (e.g. through screening) as well as increased utilisation of effective loco-regional therapies for HCC. [ABSTRACT FROM AUTHOR]

The 2006 Ground Water Rule allows three indicators for detection of fecal contamination: Escherichia coli, enterococci, and coliphages. Although each indicator has its benefits and limitations, testing for all three ensures the safest potable water supply. Somatic and male-specific coliphages are viral indicators. Current coliphage detection methods approved by the US Environmental Protection Agency (USEPA) require more preparation and expense compared with rapid bacterial indicator tests. This study describes a tier 2 validation of commercially prepared reagents used in a modified USEPA method 1601 format for the qualitative detection of coliphages. Four water laboratories participated in a USEPA alternative test procedure format using method 1601 performance-based measurement system guidelines to test four geographically diverse groundwaters spiked with wastewater. Results indicated that the modifications to method 1601 have value in predicting the presence of coliphages in 8 h with subsequent overnight plaque confirmation; the total assay time of 16 to 24 h was equivalent to the 48 to 72 h of USEPA method 1601. [ABSTRACT FROM AUTHOR]

Structural alterations in brain morphology have been inconsistently reported in children compared to adults with autism spectrum disorder (ASD). We assessed these differences by performing meta-analysis on the data from 19 voxel-based morphometry studies. Common findings across the age groups were grey matter reduction in left putamen and medial prefrontal cortex (mPFC) and grey matter increases in the lateral PFC, while white matter decreases were seen mainly in the children in frontostriatal pathways. In the ASD sample, children/adolescents were more likely than adults to have increased grey matter in bilateral fusiform gyrus, right cingulate and insula. Results show that clear maturational differences exist in social cognition and limbic processing regions only in children/adolescents and not in adults with ASD, and may underlie the emotional regulation that improves with age in this population. Autism Res 2012,5:49-66. © 2011 International Society for Autism Research, Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: In a rural Irish hospital, a simple clinical score (SCS) determined at the time of admission enabled stratification of acute general medical admissions into five categories that were associated incrementally with patients' immediate and 30-day mortality. The aim of this study was to examine the representative performance of this SCS in predicting the outcomes of general medical admissions to an Australian teaching hospital. Methods: A retrospective chart review was undertaken of a representative sample from 480 admissions in 2007 to an urban university teaching hospital in Australia. The SCS was calculated and related to that patient's outcome in terms of mortality, length of stay, nursing home placement on discharge, the occurrence of medical emergency team call and intensive care unit transfer. These data were compared, where possible, with the outcomes reported in the Irish hospital. Results: Four hundred and seventeen complete sets of data allowed calculation of the SCS. There were significant linear correlations of the SCS (divided into quintiles) and patients' in-hospital and 30-day mortality, their length of stay and their discharge to a nursing home. There was no association of the SCS and the patients' readmission rate, intensive care unit transfer rate or likelihood of a medical emergency team call. The significant trends replicated those from the Irish hospital. Conclusion: The SCS can predict significant outcomes for general medical admissions in an Australian hospital despite obvious differences to the hospital of its derivation. A wider study of Australasian hospitals and the performance of the SCS as a predictor of general medical admission outcomes is underway. [ABSTRACT FROM AUTHOR]

Summary. Signalling activated by Toll-like receptors (TLRs) can result in the production of tumour necrosis factor alpha (TNF-α) which is implicated in hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection. No study has examined or compared hepatic expression of TLRs in both HCV and HCV/HIV. Liver and peripheral blood mononuclear cells (PBMCs) were obtained from HCV & HCV/HIV-infected patients and PBMCs from HIV-infected patients. Liver RNA was analysed by microarray and reverse transcription quantitative PCR (RT-qPCR). PBMCs were analysed by flow cytometry. Associations with hepatic histology and infection type were sought. Forty-six HCV, 20 HIV and 27 HCV/HIV-infected patients were recruited. Increasing Metavir inflammatory activity score was associated with increased hepatic TLR mRNA by RT-qPCR: TLR2 ( P ≤ 0.001), TLR4 ( P = 0.008) and TNF-α ( P ≤ 0.001). A high degree of correlation was seen between hepatic mRNA expression of TNF-α vs TLR2 ( r2 = 0.66, P < 0.0001) and TLR4 ( r2 = 0.60, P < 0.0001). No differences in TLR gene or protein expression was observed between HCV, HCV/HIV- or HIV-infected groups. Hepatic TLR2, TLR4 and TNF-α mRNA are associated with hepatic inflammation in both HCV and HCV/HIV infection. High correlation between TNF-α and TLR2/TLR4 suggests a role for the innate immune response in TNF-α production. Activation of the innate immune response appears to be independent of infection type. [ABSTRACT FROM AUTHOR]

Objective To establish whether a spot urinary albumin: creatinine ratio (ACR) measured before 20 weeks of gestation can predict subsequent pre-eclampsia when urinary albumin is measured by high-performance liquid chromatography (HPLC). Design Prospective exploratory study. Setting Antenatal clinic in a tertiary teaching hospital, Victoria, Australia. Population A cohort of 265 women with a singleton pregnancy, normal renal function, and no evident proteinuria, attending antenatal clinics between 12 and 20 weeks of gestation. Methods The ACR was determined from a mid-stream urine (MSU) sample taken between 17 and 20 weeks of gestation. Intact urinary albumin was determined by HPLC; creatinine was measured by modified Jaffe's method. Outcome measures Pre-eclampsia (primary); gestational hypertension, small for gestational age (SGA), gestational diabetes mellitus, gestational age at delivery, and prematurity (secondary). Results The median ACR was 28 mg/mmol (IQR 16-46 mg/ mmol). Women who subsequently developed pre-eclampsia had a significantly higher ACR (median 50 mg/mmol; IQR 33-90 mg/mmol) compared with women suffering from gestational hypertension (median 27 mg/mmol; IQR 8-35 mg/mmol), and compared with unaffected women (median 28 mg/mmol; IQR 16-46 mg/mmol). Mothers of SGA infants also had a significantly higher median ACR. By ROC analysis, the optimum ACR to predict pre-eclampsia was 35.5 mg/mmol: the relative risk of developing pre-eclampsia in women with a urinary ACR ⩾ 35.5 mg/mmol was 7.8 times more than in those with a urinary ACR < 35.5 mg/mmol. Conclusions When urinary albumin is measured by HPLC, spot urinary ACR values are higher in early uncomplicated pregnancy compared with previously reported conventional methods. When measured early in the second trimester, an ACR ⩾ 35.5 mg/mmol predicted pre-eclampsia well before the onset of clinical manifestations. [ABSTRACT FROM AUTHOR]

The term frailty describes an age-related state of vulnerable health. The aetiology of this condition is not well understood. A number of mechanisms may contribute to frailty. Amongst these is the possible influence of age-related perturbations of sex hormones, particularly, the fall in testosterone in ageing men. This declining androgenic function has been thought to contribute to the loss of muscle mass (sarcopaenia) and strength that occurs with ageing and thereby underpin the development of frailty. Testosterone replacement has therefore been suggested as a possible intervention to treat frailty. This review summarizes evidence from observational and interventional studies on the effects of testosterone on frailty and its key components including body composition, muscle strength and physical function. Evidence from these studies is considered against study design, methodological issues and in the context of the current understanding of frailty. The role of androgens in the development of frailty and their utility in treating this condition are evaluated. Future research directions for the use of androgens in the treatment of frailty are suggested. The potential interaction between testosterone and other frailty mechanisms and the possibility that secondary components of the sex hormone system may be appropriate frailty biomarkers are also discussed. [ABSTRACT FROM AUTHOR]

An introduction to articles published within the issue is presented, including an approach to discover single-nucleotide polymorphisms (SNP) for population genetics study of the ringed seal Pusa hispida hispida, the growth and reproduction in genes of Atlantic cod Gadus morhua, and the use of Illumina GAII technology to map black cottonwood Populas trichocarpa transcriptome data to the completed genome.