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Background Emergency nurses are at higher risk than the average worker of experiencing lumbar pain. This is the first study to undertake real time monitoring to quantify lumbar movements of nurses working in the emergency department (ED). Methods Emergency nurses at a single Australian ED were recruited for a prospective observational case study. Participants worked in four discrete clinical areas of the ED; In-charge, triage, resuscitation, and cubicles. Data collected included participant demographics, lumbar pain pre- and post-shift, and real-time recording of lumbar movements. Results Sixty-two nurses participated. There were statistically significant differences in time spent standing (p = 0.005), sitting (p ≤ 0.001) and in locomotion (moving) (p ≤ 0.001) when compared by clinical role. Triage nurses spent over half their shift sitting, had the most sustained (> 30 s) flexions (60+ degrees) and had a median of 4 periods of uninterrupted sitting (10−30 mins) per shift. Conclusions Differences in movement demands were identified based on various clinical roles in the ED. Triage was associated with greater periods of uninterrupted sitting and with greater degrees of sustained flexion, both of which are predictors for back pain. This study provides foundation evidence that triage may not be the most appropriate location for staff returning from back injury.

Emerging evidence suggest a possible association between immune thrombocytopenia (ITP) and some formulations of COVID-19 vaccine. We conducted a retrospective case series of ITP following vaccination with Vaxzevria ChadOx1-S (AstraZeneca) and mRNA Comirnaty BNT162b2 COVID-19 (Pfizer-BioNTech) vaccines and compare the incidence to expected background rates for Victoria during the first six months of the Australian COVID-19 vaccination roll-out in 2021. Cases were identified by reports to the Victorian state vaccine safety service, SAEFVIC, of individuals aged 18 years or older presenting with thrombocytopenia following COVID-19 vaccination without evidence of thrombosis. Twenty-one confirmed or probable cases of ITP were identified following receipt of AstraZeneca (n = 17) or Pfizer-BioNTech (n = 4) vaccines. This translates to an observed incidence of 8 per million doses for AstraZeneca vaccine, twice the expected background rate of 4.1 per million. The observed rate for Pfizer-BioNTech was consistent with the expected background rate. The median time to onset for the cases post AstraZeneca vaccination was 10 days (range 1–78) and median platelet nadir 5 × 109/L (range 0–67 × 109/L). Hospital presentations or admissions for management of symptoms such as bleeding occurred in 18 (86%) of the cases. The majority of cases (n = 11) required intervention with at least 2 therapy modalities. In conclusion, we observed a substantially higher than expected rate of ITP following AstraZeneca vaccination. ITP is the second haematological adverse event, distinct from that of thrombosis with thrombocytopenia syndrome (TTS), observed following AstraZeneca vaccination.

Objective This study aimed to develop and internally validate risk prediction models for predicting groin wound surgical site infections (SSIs) following arterial intervention and to evaluate the utility of existing risk prediction models for this outcome. Methods Data from the Groin wound Infection after Vascular Exposure (GIVE) multicentre cohort study were used. The GIVE study prospectively enrolled 1 039 consecutive patients undergoing an arterial procedure through 1 339 groin incisions. An overall SSI rate of 8.6% per groin incision, and a deep/organ space SSI rate of 3.8%, were reported. Eight independent predictors of all SSIs, and four independent predictors of deep/organ space SSIs were included in the development and internal validation of two risk prediction models. A systematic search of the literature was conducted to identify relevant risk prediction models for their evaluation. Results The “GIVE SSI risk prediction model” (“GIVE SSI model”) and the “GIVE deep/organ space SSI risk prediction model” (“deep SSI model”) had adequate discrimination (C statistic 0.735 and 0.720, respectively). Three other groin incision SSI risk prediction models were identified; both GIVE risk prediction models significantly outperformed these other risk models in this cohort (C statistic 0.618 – 0.629; p Conclusion Two models were created and internally validated that performed acceptably in predicting “all” and “deep” groin SSIs, outperforming current existing risk prediction models in this cohort. Future studies should aim to externally validate the GIVE models.

Acute disseminated encephalomyelitis (ADEM) is an autoimmune, central nervous system demyelinating disorder that follows antecedent immunologic challenges, such as infection or vaccination. This study aimed to investigate the potential association between routine childhood vaccinations and ADEM. Children under 7 years of age admitted to the two tertiary level pediatric hospitals in Victoria, Australia with ADEM from 2000–2015 had their clinical information linked to vaccination records from the Australian Childhood Immunization Register. Chart review was undertaken utilizing the Brighton Collaboration ADEM criteria. The self-controlled case-series (SCCS) methodology was employed to determine the relative incidences of ADEM post-vaccination in two risk intervals: 5–28 days and 2–42 days. Forty-six cases were eligible for SCCS analysis with a median age of 3.2 years. Of the forty-six cases, three were vaccine proximate cases and received vaccinations 23, 25 and 28 days before ADEM onset. Two vaccine proximate cases received their 4-year-old scheduled vaccinations (MMR and DTPa-IPV) and one vaccine proximate case the 1-year old scheduled vaccinations (MMR and Hib-MenC). The relative incidence of ADEM during the narrow and broad risk intervals were 1.041 (95% CI 0.323–3.356, p = 0.946) and 0.585 (95% CI 0.182–1.886, p = 0.370) respectively. Sensitivity analyses did not yield any substantial deviations. These results do not provide evidence of an association between vaccinations routinely provided to children aged under 7 years in Australia and the incidence of ADEM. However, these results should be interpreted with caution as the number of ADEM cases identified was limited and further research is warranted.

Background There has been increasing concerns regarding the declining number of medical students entering surgical residencies. The aim of this study is to analyze strategies and outcomes to enhance recruitment to the surgical specialties. Methods A systematic literature PRISMA-based search was performed. Study quality and bias were assessed. Meta-analysis was performed using DerSimonian Laird method. Results Of 3288 unique titles identified, 73 studies met inclusion criteria. Median study unique sample size was 84 participants (range 15–910). Subjective interest was reported in 59 studies, while objective match rate was reported by only 21 studies. The cumulative odds of students interested in the studied specialty was 1.98 (95% CI 1.47–2.67, I2 = 0%) and in any surgical specialty was 1.40 (95% 1.01–1.95, I2 = 37%) after an intervention compared to baseline. Conclusion While studies show increased odds of “interested in” a surgical specialty, the results may be subject to high selective and confounding biases.

Neurodevelopmental impairments have been recognised as a major association of paediatric kidney disease and bladder dysfunction, presenting challenges to clinicians and families to provide reasonable adjustments in order to allow access to investigations and treatments. Autism spectrum disorder (ASD) is a common neurodevelopmental disorder characterised by impairments in social interaction/communication and repetitive sensory-motor behaviours. Mental health, learning and physical co-morbidities are common. There is emerging evidence that ASD and kidney disease have some overlaps with genetic copy number variants and environmental factors contributing to shared pathogenesis. Prevalence rates of ASD in kidney disease are currently not known. A high index of suspicion of underlying ASD is required when a young person presents with communication difficulties, anxiety or behaviour that challenges, which should then trigger referral for a neurodevelopmental and behavioural assessment. We discuss practical approaches for providing care, which include understanding methods of communication and sensory, behavioural and environmental adaptations. Supplementary Information The online version contains supplementary material available at 10.1007/s00467-020-04875-y.

To evaluate an implementation intervention to increase the uptake, referred to as reach, of two evidence-based psychotherapies (EBP) for posttraumatic stress disorder (PTSD) in Veterans Health Administration (VHA) PTSD specialty clinics. The implementation intervention was external facilitation guided by a toolkit that bundled strategies associated with high EBP reach in prior research. We used a prospective quasi-experimental design. The facilitator worked with local champions at two low-reach PTSD clinics. Each intervention PTSD clinic was matched to three control clinics. We compared the change in EBP reach from 6-months pre- to post-intervention using Difference-in-Difference (DID) effect estimation. To incorporate possible clustering effects and adjust for imbalanced covariates, we used mixed effects logistic regression to model the probability of EBP receipt. Analyses were conducted separately for PTSD and other mental health clinics. 29,446 veterans diagnosed with PTSD received psychotherapy in the two intervention and six control sites in the two 6-month evaluation periods. The proportion of therapy patients with PTSD receiving an EBP increased by 16.98 percentage points in the intervention PTSD clinics compared with .45 percentage points in the control PTSD clinics (DID = 16.53%; SE = 2.26%). The adjusted odd ratio of a patient receiving an EBP from pre to post intervention was almost three times larger in the intervention than in the control PTSD clinics (RoR 2.90; 95% CI 2.22–3.80). EBP reach was largely unchanged in other (not PTSD specialty) mental health clinics within the same medical centers. Toolkit-guided external facilitation is a promising intervention to improve uptake of EBPs in VHA. Toolkits that pre-specify targets for clinic change based on prior research may enhance the efficiency and effectiveness of external facilitation. Trial registration ISRCTN registry identifier: ISRCTN65119065. Available at https://www.isrctn.com/search?q=ISRCTN65119065 .

Background Long-term opioid therapy for chronic pain arose amid limited availability and awareness of other pain therapies. Although many complementary and integrative health (CIH) and nondrug therapies are effective for chronic pain, little is known about CIH/nondrug therapy use patterns among people prescribed opioid analgesics. Objective The objective of this study was to estimate patterns and predictors of self-reported CIH/nondrug therapy use for chronic pain within a representative national sample of US military veterans prescribed long-term opioids for chronic pain. Research design National two-stage stratified random sample survey combined with electronic medical record data. Data were analyzed using logistic regressions and latent class analysis. Subjects US military veterans in Veterans Affairs (VA) primary care who received ≥6 months of opioid analgesics. Measures Self-reported use of each of 10 CIH/nondrug therapies to treat or cope with chronic pain in the past year: meditation/mindfulness, relaxation, psychotherapy, yoga, t'ai chi, aerobic exercise, stretching/strengthening, acupuncture, chiropractic, massage; Brief Pain Inventory-Interference (BPI-I) scale as a measure of pain-related function. Results In total, 8891 (65%) of 13,660 invitees completed the questionnaire. Eighty percent of veterans reported past-year use of at least 1 nondrug therapy for pain. Younger age and female sex were associated with the use of most nondrug therapies. Higher pain interference was associated with lower use of exercise/movement therapies. Nondrug therapy use patterns reflected functional categories (psychological/behavioral, exercise/movement, manual). Conclusions Use of CIH/nondrug therapies for pain was common among patients receiving long-term opioids. Future analyses will examine nondrug therapy use in relation to pain and quality of life outcomes over time.

Staple line leaks following laparoscopic sleeve gastrectomy (LSG) are associated with significant morbidity and mortality. Endoluminal techniques, including stent placement and endoluminal vacuum therapy (EVAC), have become viable options to treat these patients without the need for additional surgery. The purpose of this study was to define the conditions where certain endoscopic therapies are most likely to succeed compared to surgery. An IRB approved prospectively maintained database was retrospectively reviewed for all patients treated for gastrointestinal leaks from July 2013 to March 2019. All patients who were treated for gastrointestinal leaks following LSG were included. Endpoints include success of leak closure and hospital-related morbidity for the patients treated solely by endoscopic only methods (EP) compared to the additional surgery group (SP). There were 39 patients (33 females; 6 males) with a median age of 45.9 years. The EP group included 23 patients (59%), whereas SP included 16 patients (31%). On average, the SP had longer days from sentinel surgery to our hospital admission (70 vs 41), a higher percentage of previous bariatric surgery prior to sentinel LSG (50% vs 17%), and a higher readmission rates following discharge (50% vs 39%). Total length of stay was also higher in the SP compared to the EP (45.4 vs 11). Using this data, a treatment algorithm was developed to optimally treat future patients who suffer from gastrointestinal leaks following LSG. Endoscopic therapies, such as EVAC, stent placement, internal drainage, and over-the-scope clips, have a higher chance of success if performed earlier to their sentinel surgery and if patients have had no prior bariatric surgeries. Patients who require additional surgery tend to have longer hospital stays and readmission rates. Using the treatment algorithm provided can help determine when endoscopic therapies are likely to succeed.

Head turning while walking may challenge stability by altering visual and vestibular information. Whether there are age-related changes that affect gait stability while head turning during walking remains unknown. The aim of the current study was to compare gait stability between younger and older adults immediately following a head turn while walking. Ten younger [mean (SD)] [23.4 (3.3) years] and ten older [68.8 (6.0) years] healthy adults walked on a treadmill at their preferred gait velocity and performed head turns by responding to a visual cue. The margin of stability (MoS) in the mediolateral (MoSML), anterior (MoSA) and posterior (MoSP) directions, foot placement (mean step length and width) and rotation of the head, trunk and pelvis were calculated for the four steps immediately following a cue to head turn and compared to walking only. Older adults increased their MoSML and younger adults increased their MoSP immediately following a head turn. However, older adults had a significantly greater MoSP than younger adults during this time. Older adults also had greater pelvic rotation velocity and a trend towards smaller head-on-trunk rotation compared to younger adults. Age does not compromise the stability of healthy older compared to younger adults immediately following or when completing a head turn. However, older adults may use a different motor strategy to perform a head turn to limit isolated movement of the head and the effects of a changing sensory frame of reference.

Background There are limited data regarding vitamin and trace element blood concentrations and supplementation needs in children with non-dialysis stages 3–5 of chronic kidney disease (CKD). Methods Retrospective cross-sectional review for nutritional blood concentrations measured over a recent 2-year period. In our CKD clinics, nutritional bloods including copper, zinc, selenium and vitamin A, vitamin E, active vitamin B12 and folate are monitored annually. Vitamin D status is monitored every 6–12 months. Results We reviewed 112 children (70 boys) with median (IQ1, IQ3) age 8.97 (4.24, 13.80) years. Estimated median (IQ1, IQ3) GFR (mL/min/1.73 m2) was 28 (21, 37). Vitamin A, active vitamin B12 and vitamin E concentrations were within normal range in 19%, 23% and 67% respectively, with all others being above normal range. Vitamin D blood concentrations were within desired range for 85% (15% had low levels) and folate blood concentrations were within normal range in 92%, with the remainder above or below target. For trace elements, 60%, 85% and 87% achieved normal ranges for zinc, selenium and copper respectively. Deficiencies were seen for zinc (35%), copper (7%), folate (3%) and selenium (1%), whilst 5%, 6% and 14% had zinc, copper and selenium levels above normal ranges. Conclusions Several vitamin and trace element blood concentrations were outside normal reference ranges. Monitoring vitamin D and zinc blood concentrations is indicated due to the percentages with low levels in this group. Targeted vitamin and trace element supplementation should be considered where indicated rather than commencing multivitamin and/or mineral supplementation.

Objective Chronic pain is frequently comorbid with opioid abuse and severe depression, a combination that greatly compounds suicide risk. In addition to the therapeutic value of buprenorphine in addiction and analgesia, growing evidence suggests potential use as an antidepressant. Data supporting buprenorphine antisuicidal properties are scarce. We aim to contribute to the discussion of buprenorphine antisuicidal potential in patients with significant psychiatric and medical comorbidity. Methods We performed a chart review of suicidal adult depressed patients with comorbid chronic pain and opioid use disorder who received off-label buprenorphine in outpatient and inpatient settings in a university hospital between 2013 and 2016. Results Four of the patients had an early positive response. However, only three continue to adhere to treatment for six months or longer. Conclusions More severe opioid use disorder seems to more negatively influence clinical outcome, independently of cluster b personality traits. Identification of patients who could benefit from buprenorphine will require further studies.

Objectives: A randomised controlled trial was undertaken to compare the efficacy of topical Calendula officinalis (Calendula) versus standard of care (Sorbolene: 10% glycerine in cetomacragol cream) in reducing the prevalence of radiation-induced dermatitis in women undergoing breast cancer radiotherapy. Methods: A total of 271 women were screened and 82 were randomised. The primary outcome was prevalence of acute radiation-induced dermatitis (RTOG grade 2+) assessed at multiple skin sites. A chi-squared test was conducted for the primary outcome with a worst-case scenario imputation. Results: The recruitment target (n = 178) was not achieved. A total of n = 81 participants were analysed (n = 40 Calendula; n = 41 Sorbolene). There was no detectable difference in prevalence of radiation-induced dermatitis grade 2+ between the Calendula (53%) and Sorbolene (62%) groups (primary analysis OR = 0.87, 95% CI: [0.36, 2.09], P = 0.92; covariate adjusted complete case analysis OR 0.40, 95% CI: [0.13, 1.20], P = 0.10). Conclusion: This randomised controlled trial showed no difference between Calendula and standard of care (Sorbolene) for the prevention of radiation-induced dermatitis. However, the study was underpowered (limited recruitment) for the primary comparison. Refereed/Peer-reviewed

Background: Living in deprived areas is associated with poorer outcomes after certain vascular procedures and surgical site infection in other specialties. Our primary objective was to determine whether living in more income-deprived areas was associated with groin wound surgical site infection after arterial intervention. Secondary objectives were to determine whether living in more income-deprived areas was associated with mortality and clinical consequences of surgical site infection. Methods: Postal code data for patients from the United Kingdom who were included in the Groin Wound Infection after Vascular Exposure (GIVE) multicenter cohort study was used to determine income deprivation, based on index of multiple deprivation (IMD) data. Patients were divided into three IMD groups for descriptive analysis. Income deprivation score was integrated into the final multivariable model for predicting surgical site infection. Results: Only patients from England had sufficient postal code data, analysis included 772 groin incisions (624 patients from 22 centers). Surgical site infection occurred in 9.7% incisions (10.3% of patients). Surgical site infection was equivalent between income deprivation tertiles (tertile 1 = 9.5%; tertile 2 = 10.3%; tertile 3 = 8.6%; p = 0.828) as were the clinical consequences of surgical site infection and mortality. Income deprivation was not associated with surgical site infection in multivariable regression analysis (odds ratio [OR], 0.574; 95% confidence interval [CI], 0.038-8.747; p = 0.689). Median age at time of procedure was lower for patients living in more income-deprived areas (tertile 1 = 68 years; tertile 2 = 72 years; tertile 3 = 74 years; p

Infectious bovine keratoconjunctivitis (IBK) is a painful ocular disease in cattle that is characterized by the presence of a corneal ulcer and production losses. A common industry practice is to cover an affected eye with a piece of cloth to reduce exposure to face flies and ultraviolet light with the goal of alleviating pain, accelerating healing, and reducing spread. To study the efficacy of eye patches in the treatment of IBK, a group of 216 clinically normal Angus crossbred steers were followed between April and August 2019 and evaluated weekly for the development of IBK. Eyes of cattle that developed IBK were enrolled with a blocked randomization scheme based on ulcer severity score to receive either an eye patch (treatment group) or no eye patch (control group). All treatment and control group animals received parenteral antimicrobial and nonsteroidal anti-inflammatory treatments and were housed in a pasture separated from the rest of the cohort for a maximum of 28 d or until clinical cure. Corneal ulcer areas were measured, and body weights were recorded twice weekly for steers in the treatment and control groups. Weights of all steers in the cohort were recorded three times during the trial period. The primary outcome, rate of corneal ulcer healing, was higher (P = 0.001) for lesions in eyes receiving an eye patch as determined by a linear mixed model that controlled for ulcer severity score at enrollment and previous IBK in the opposite eye. Median corneal ulcer healing time was 10 (IQR [Interquartile range] 7–17) d for patched eyes vs. 14 (IQR 7–21) d for unpatched eyes. In a Cox proportional hazards model adjusted for severity score at diagnosis, the hazard ratio for ulcer healing was 1.62 (95% CI: 1.02–2.56, P = 0.042) for eyes that received a patch compared to eyes that did not. Among all 216 steers in the cohort, those that were diagnosed with IBK had a numerically higher average daily gain (ADG) (0.45 [±SE 0.01] kg) vs. those that were not (0.42 [±SE 0.12] kg; P = 0.06). In enrolled steers that received a patch, the secondary outcome ADG was 0.47 (±SE 0.02) kg compared to 0.43 (±SE 0.02) kg in controls (P = 0.22). Weight gain may have been confounded by pasture during the treatment period. Results of this trial support the use of this low-cost intervention; further investigation into possible reasons for observed differences in weight gain may be warranted.

There can be significant uncertainty as to the safety of novel or complex aviation systems, such as Remotely Piloted Aircraft Systems (RPAS). Current aviation safety assessment and compliance processes do not adequately account for uncertainty. The aim of this research is to support more objective, transparent, systematic and consistent regulatory outcomes in relation to the safety assessment of such systems. The objective of this work is to provide a systematic means of accounting for the various uncertainties inherent to any System Safety Assessment (SSA) process. The paper first defines the system safety compliance process and its modification to account for uncertainty. The SSA process, its various outputs, and associated uncertainties are defined and then applied to a generic RPAS. A Bayesian Belief Network (BBN) is adopted that facilitates a more comprehensive treatment of the uncertainty in each of the outputs of a typical SSA process. A case study of a generic RPAS is used to illustrate the features of the new approach. The adoption of the Proposed SSA approach would allow for the high uncertainty associated with the safety assessment of novel or complex aviation systems, such as RPAS, to be taken into consideration. Such an approach would enable the risk-based regulation of the sector.

The arid forests of Abu Dhabi are valuable but they require irrigating. Currently groundwater (GW) is the source of this water, but these subterranean reserves are being over-exploited. Law No 5 of 2016 on the regulation of GW has been passed by the Government of Abu Dhabi to reduce GW abstraction. Abu Dhabi has a supply of tertiary-treated sewage effluent (TSE) that could be used as an alternative for irrigation. We set up experiments near Madinat Zayed in the Al Dhafra region of Abu Dhabi on two arid-forest species: Al Ghaf (Prosopis cineraria) and Al Sidr (Ziziphus spina-christi). The trees were planted at 8 m x 8 m spacing. The TSE is significantly ‘sweeter’ than GW, as its electrical conductivity is

Aims Giggle incontinence is a rare condition resulting in excessive urinary incontinence with laughter, where bladder function is otherwise "normal." Urodynamic descriptions of the condition to date are limited. We believe that giggle incontinence has characteristic urodynamic findings. We tested this hypothesis. Methods We retrospectively reviewed the urodynamic investigations of patients with giggle incontinence managed in a tertiary regional bladder unit between February 2014 and November 2019. Results We identified the studies of seven patients, median age 13.5 years (10.4-15.7) of whom 6 were female. All had videourodynamics. Two went on to have further invasive investigation; one had urethral pressure profile and one had ambulatory urodynamics. Detrusor overactivity (DO) was observed in six. DO was asensate in all. In five DO was triggered by laughter and was associated with laughter induced incontinence in four. Six had DO that was not provoked by laugher. In one amplitude of DO was proportional to vigour of laughter. In three patients there was identification of sudden pelvic floor relaxation during laughter resulting in incontinence. Stress urinary incontinence was not observed in any. Conclusions Giggle incontinence is a complex phenomenon. Urodynamic diagnosis is challenging and is dependent on eliciting laughter. We present the first urodynamic demonstration that giggle incontinence is associated with laughter-induced, asensate DO and concurrent, momentary pelvic floor relaxation. We hope this will provide a more consistent basis for defining this condition in the future.

Pharmacogenomics (PGx) is a growing field within precision medicine. Testing can help predict adverse events and sub-therapeutic response risks of certain medications. To date, the US FDA lists over 280 drugs which provide biomarker-based dosing guidance for adults and children. At Arkansas Children’s Hospital (ACH), a clinical PGx laboratory-based test was developed and implemented to provide guidance on 66 pediatric medications for genotype-guided dosing. This PGx test consists of 174 single nucleotide polymorphisms (SNPs) targeting 23 clinically actionable PGx genes or gene variants. Individual genotypes are processed to provide per-gene discrete results in star-allele and phenotype format. These results are then integrated into EPIC- EHR. Genomic indicators built into EPIC-EHR provide the source for clinical decision support (CDS) for clinicians, providing genotype-guided dosing.

The internet has become a leading resource for patients, to research information about their medical conditions. Access to inaccurate information can lead to miscommunication, poor patient satisfaction and effect shared decision-making with the provider. This study seeks to evaluate the quality and readability of patient resources that appear in the top search results for Thoracic Outlet Syndrome (TOS).Searches were performed for "TOS" and "Thoracic Outlet Syndrome" on the search engines Google ©, Yahoo ©, and Bing©, and on the meta-search platforms Yippy© and Dogpile©. Websites were screened for exclusion and evaluated by 2 reviewers for accountability, interactivity, structure/organization, and content. Exclusion criteria included duplications, no original content on TOS, resources not intended for patients, foreign language, and inaccessible websites. Reviewers came to a consensus on scoring discrepancies. Four indices were used to evaluate readability. Statistical analysis was performed using the Rstudio with ANOVA.In total, 44 websites met inclusion criteria. There were 25 hospital/healthcare organization websites (57%), 11 open access (25%), 5 government agency (11%), 2 professional medical society (5%), and 1 industry sponsored (2%). Median scores were 5.00 out of 16.00 for Accountability (interquartile range IQR: 1.50-8.75), 1.50 out of 5.00 for Interactivity (IQR:1.50-1.50), 3.00 out of 4.00 for Structure/Organization (IQR: 2.00-3.13), 10.00 out of 25.00 for Content (IQR: 7.90-12.63) and 20.25 out of 50.00 for Total Score (IQR: 16.73-27.75). Websites performed well-describing TOS with 98% of websites providing a definition, 90% providing an etiology, 93% providing description or images of the anatomy, 98% providing symptoms of neurogenic TOS, 93% providing symptoms of venous TOS, and 93% providing symptoms of arterial TOS. Physical therapy was the most discussed treatment option (91%) followed by decompression surgery (86%), thrombolysis (41%), vascular repair (39%), interscalene injections (18%), and embolectomy (11%). There was no significant difference across website types for any category other than accountability where Open Access scored the highest (Table II). Readability was difficult with median Flesch Reading Ease formula score correlating to a college level (IQR: 10th-12th grade-college), median Flesch-Kincaid Grade Level of 10 (IQR: 9th-12th grade), median Standardized Measure of Gobbledygook (SMOG) grade of 10 (IQR: 9th-11th grade), and median Dale-Chall Readability Formula Score correlating to 11th-12th grade (IQR: 11th to 12th-college grade level). There was no significant difference between website types for readability.The top web results for TOS have varying degrees of quality with a clear gap in certain areas of information. While websites performed well-explaining the disease, they lacked discussion of the full scope of treatment that may be offered. In addition, readability was poor across all website types which will not help patients' understanding of their condition. Providers should take into account the variability in websites when entering into shared decision-making discussions with patients.

Background Despite the risk of negative sequelae from opioid use disorder (OUD) and clinical guidelines for the use of effective medication treatment for OUD (M-OUD), many Veterans Health Administration (VHA) providers and facilities lag in providing M-OUD. An intensive external facilitation intervention may enhance uptake in low-adopting VHA facilities by engaging stakeholders from multiple clinical settings within a facility (e.g., mental health, primary care, pain specialty clinic, substance use disorder clinics). Our study identified pre-intervention determinants of implementation through qualitative interviews, described strategies employed during the first 6 months of intensive external facilitation, and explored patterns of implementation determinants in relation to early outcomes. Methods Guided by the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, we interviewed stakeholders at low-adopting VHA facilities prior to external facilitation, employed a rapid qualitative analytic process, presented findings during facility visits, and collaboratively created facilitation action plans to achieve goals set by the facilities that would increase M-OUD uptake. The primary outcome was the Substance Use Disorder (SUD)-16, which is a VHA facility-level performance metric consisting of the percent of patients receiving M-OUD among those with an OUD diagnosis. We examined the relationship between pre-implementation factors and 6-month SUD-16 outcomes. Results Across eight VHA facilities, we interviewed 68 participants. Implementation determinants included barriers and facilitators across innovation, context, and recipients constructs of i-PARIHS. Each facility selected goals based on the qualitative results. At 6 months, two facilities achieved most goals and two facilities demonstrated progress. The SUD-16 from baseline to 6 months significantly improved in two facilities (8.4% increase (95 % confidence interval [CI] 4.4–12.4) and 9.9% increase (95% CI 3.6–16.2), respectively). Six-month implementation outcomes showed that the extent to which M-OUD aligns with existing clinical practices and values was a primary factor at all facilities, with six of eight facilities perceiving it as both a barrier and facilitator. External health system barriers were most challenging for facilities with the smallest change in SUD-16. Conclusions Early impacts of a multi-faceted implementation approach demonstrated a strong signal for positively impacting M-OUD prescribing in low-adopting VHA facilities. This signal indicates that external facilitation can influence adoption of M-OUD at the facility level in the early implementation phase. These short-term wins experienced by stakeholders may encourage continued adoption and long-term sustainability M-OUD.

Background: Some studies show that wearing compression garments (CGs) improves balance performance. However, the overall evidence supporting their use for balance improvement is inconclusive. Objective: This study aimed to further explore the effect of CGs on balance. Method: Using a cross sectional within subjects repeated measures design fourteen participants (27 ± 3 years) completed three trials for each of four balance tests, under three conditions: compression garment, no garment, and sham. Subjective performance and garment rating scores were also collected following each test condition. A repeated-measures analysis of variance was performed to compare derived variables between conditions for each balance test. Results: No significant differences were found across conditions or tests for either balance performance or subjective measures. Conclusions: This study demonstrated CGs did not influence dynamic or static balance performance in healthy young males. Further, in contrast to other research this study did not demonstrate an effect of compression garments on dynamic or static balance in healthy young males. However, it remains that CGs may provide benefit in other populations including those with balance and movement deficit disorders.

Chapter 9 provides a discussion of the findings relating to the challenges faced by healthcare professionals and parents, the health and social support measures adopted to address the paediatric patients’ healthcare needs, and the outcomes realised as a result of the care provided. The chapter offers a broader view of some of the complex underlying issues that result in health inequity in Australia, as well as key related considerations, with a discussion of: the complexity of the Australian healthcare system; the cost of healthcare; patient advocacy and linking patients to services; the role of healthcare professionals in addressing health inequity; the benefits of addressing health inequity and the cost of inaction; and strategies to reduce health inequity identified in the literature. The chapter concludes with a call to embrace a paradigm shift in our approach to health and healthcare.

Clarification of what constitutes a challenge in this work is provided in Chapter 6, which presents the obstacles that healthcare professionals and families encountered according to healthcare professionals. The chapter presents the wide variety of issues that needed to be faced and overcome so that appropriate treatments, care, and supports could be provided both within the context of the healthcare service where the patient presented but also beyond, both geographically and temporally.

Chapter 8 presents findings on the outcomes realised for these paediatric patients and their families, as a result of the health and social measures adopted. The chapter identifies cases where ongoing health and/or socioeconomic issues would continue to affect these patients’ overall health and wellbeing, cases where the need for ongoing healthcare involvement was cited, cases where health issues were cited as having being resolved or improved, cases where related socio-economic issues were resolved or improved, and cases where an improved family outcome was achieved.

Chapter 4 focuses on the analyses associated with the SDH identified as impacting adversely on the health and wellbeing of the children/young people reported by healthcare professionals to whom these patients had presented for medical attention. It commences with demographic features of the cohort and proceeds to present each of the SHD and sub-themes with summary tables provided throughout to guide the reader.

Chapter 7 presents the strategies adopted by healthcare professionals to address their patients’ health needs, which they recognised were intertwined with broader familial and social issues that they attempted to address. The chapter concludes with an overview of how health inequity might be addressed based on the healthcare professionals’ responses and views, where expressed.

SLC13A5/NaCT is a sodium-coupled citrate transporter expressed in the plasma membrane of the liver, testis, and brain. In these tissues, SLC13A5 has important functions in the synthesis of fatty acids, cholesterol, and neurotransmitters. In recent years, patients homozygous for recessive mutations in SLC13A5, known as SLC13A5 deficiency [early infantile epileptic encephalopathy-25 (EIEE-25)], exhibit severe global developmental delay, early-onset intractable seizures, spasticity, and amelogenesis imperfecta affecting tooth development. Although the pathogenesis of SLC13A5 deficiency remains not clearly understood, cytoplasmic citrate deficits, decreased energy status in neurons, and citrate-zinc chelation are hypothesized to explain the neurological deficits. However, no study has examined the possibility of specific pharmacological drugs and/or lifestyle changes synergizing with heterozygosity of SLC13A5 deficiency to increase the risk of EIEE-25 clinical phenotype. Here, we report on a heterozygous SLC13A5-deficient patient who demonstrated evidence of pharmaco-synergistic heterozygosity upon administration of metformin, valproic acid, and starvation. The report illustrates the importance of careful consideration of the potential adverse effects of specific pharmacological treatments in patients with heterozygosity for disease-causing recessive mutations in SLC13A5.

Infectious keratoconjunctivitis (IKC) is the most frequent ocular disease in livestock worldwide and is primarily caused by Moraxella bovis, M. ovis, and/or M. bovoculi. The economic impact of IKC is mainly due to ocular damage, which leads to weight loss, management difficulties, pain and discomfort, and cost of treatments. In horses, limited information is available on the association of Moraxella spp. with keratoconjunctivitis. The present report describes two cases of equine keratoconjunctivitis caused by members of the genus Moraxella. Both animals presented with lacrimation, conjunctivitis, photophobia, mucoid or purulent secretions, blepharitis, and conjunctival hyperemia. The diagnosis of IKC was based on the epidemiological and clinical findings; the etiological agent was identified through bacteriological (culture and biochemistry assays) and molecular testing (PCR and nucleotide sequencing). Our study reports the isolation of Moraxella bovoculi (SBP 88/19) and a putative new species/mutant of Moraxella (SBP 39/19) recovered from ocular secretions in horses. Thus, we suggest the inclusion of Moraxella spp. infection in the differential diagnosis of conjunctivitis in horses in Southern Brazil.

Background: Surgical site infections (SSIs) of groin wounds are a common and potentially preventable cause of morbidity, mortality and healthcare costs in vascular surgery. Our aim was to define the contemporaneous rate of groin SSIs, determine clinical sequelae, and identify risk factors for SSI. Method: An international multicentre prospective observational cohort study of consecutive patients undergoing groin incision for femoral vessel access in vascular surgery was undertaken over 3 months, follow up was 90 days. The primary outcome was incidence of groin wound SSI. Results: 1337 groin incisions (1039 patients) from 37 centres were included. 115 groin incisions (8.6%) developed SSI, of which 62 (4.6%) were superficial. Patients who developed an SSI had a significantly longer length of hospital stay (6 vs 5 days, p=0.005), a significantly higher rate of post-operative acute kidney injury (19.6% vs 11.7%, p=0.018), with no significant difference in 90-day mortality. Female sex, Body Mass Index≥30kg/m2, ischaemic heart disease, aqueous betadine skin preparation, bypass/patch use (vein, xenograft or prosthetic) and increased operative time were independent predictors of SSI. Conclusion: Groin infections which are clinically apparent to the treating vascular unit are frequent and their development carries significant clinical sequelae. Risk factors include modifiable and non-modifiable variables.

Background SAEFVIC is the Victorian surveillance system for adverse events following immunisation (AEFI). It enhances passive surveillance by also providing clinical support and education to vaccinees and immunisation providers. This report summarises surveillance, clinical and vaccine pharmacovigilance activities of SAEFVIC in 2018. Methods A retrospective observational cohort study of AEFI reports received by SAEFVIC in 2018, compared with previous years since 2008. Data were categorised by vaccinee demographics of age, sex, pregnancy and Indigenous status, vaccines administered and AEFI reactions reported. Age cohorts were defined as infant (0–12 months); young child (1–4 years); school-aged (5–17 years); adult (18–64 years); and older person (65+ years). Proportional reporting ratios were calculated for signal investigation of serious adverse neurological events with all vaccines and with influenza vaccines. Clinical support services and educational activities are described. Results SAEFVIC received 1730 AEFI reports (26.8 per 100,000 population), with 9.3% considered serious. Nineteen percent (n = 329) attended clinical review. Annual AEFI reporting trends increased for infants, children and older persons, but were stable for school-aged and adult cohorts. Females comprised 55% of all reports and over 80% of reports among adults. There were 17 reports of AEFI in pregnant women and 12 (0.7%) in persons identifying as Indigenous Australians. A possible signal regarding serious adverse neurological events (SANE) was detected, but was not supported by signal validation testing. A clinical investigation is ongoing. Two deaths were reported coincident to immunisation with no evidence of causal association. Conclusion SAEFVIC continues to provide robust AEFI surveillance supporting vaccine safety monitoring in Victoria and Australia, with new signal detection and validation methodologies strengthening capabilities.

Introduction Concerns about the adverse effects of smoking cessation on alcohol use and mental health are a barrier to cessation for smokers with serious mental illness (SMI). The purpose of this study is to examine how incident smoking cessation affects binge drinking and symptoms of depression and anxiety among smokers with SMI. Methods The present study is a secondary analysis of the OPTIN trial, which demonstrated the effectiveness of proactive outreach for smoking cessation among Minnesota Health Care Programs enrollees. Participants with ICD-9 codes indicating schizophrenia spectrum disorders, psychotic disorders, bipolar disorders, or severe/recurrent major depressive disorder were categorized as having SMI (n = 939); remaining smokers were categorized as non-SMI (n = 1382). Multivariable regressions modeled the association between incident smoking cessation and binge drinking, PHQ-2 depression scores, and PROMIS anxiety scores in the two groups. Results Quitting smoking was not associated with binge drinking among those with SMI, but was associated with less binge drinking among those without SMI (p = 0.033). Quitting smoking was not associated with PHQ-2 depression scores among those with or without SMI. However, quitting smoking was associated with lower mean PROMIS anxiety scores for those with SMI (p = 0.031), but not those without SMI. Conclusion Quitting smoking was not associated with heightened binge drinking or symptoms of depression and anxiety among smokers with SMI. These findings suggest that quitting smoking is not detrimental for these patients, and provide evidential support for facilitating access to cessation resources for patients with serious mental illness who smoke.

Introduction Female veterans smoke cigarettes at high rates compared with both male veterans and nonveteran women. Proactive outreach to smokers may reduce gender disparities in cessation care. The objectives of this study were to compare baseline experiences with VA smoking cessation care for men and women and to assess for gender differences in response to a proactive outreach intervention. Methods We conducted a post hoc subgroup analysis of a pragmatic, multisite randomized, controlled trial comparing proactive outreach with usual care (UC). Baseline experiences included physician advice to quit, satisfaction with care, and past-year treatment use. At the 1-year follow-up, treatment use, quit attempts, and 6-month prolonged abstinence for women and men randomized to proactive outreach versus UC were compared using logistic regression. Results Baseline and follow-up surveys were returned by 138 women and 2,516 men. At baseline, women were less likely than men to report being very or somewhat satisfied with the process of obtaining smoking cessation medications in the VA (47% of women vs. 62% of men), but no less likely to report having used cessation medications from the VA in the past year (39% of women vs. 34% of men). After the intervention, phone counseling and combined therapy increased among both women and men in proactive outreach as compared with UC. At the 1-year follow-up, men in proactive outreach were significantly more likely to report prolonged abstinence than those in UC (odds ratio, 1.65; 95% CI, 1.28–2.14); results for women were in the same direction but not statistically significant (odds ratio, 1.39; 95% CI, 0.48–3.99). Conclusions Satisfaction with cessation care in VA remains low. Proactive outreach to smokers was associated with an increased use of cessation therapies, and increased odds of achieving prolonged abstinence. A subgroup analysis by gender did not reveal significant differences in the treatment effect.

This study quantified the crop water consumption, crop-specific irrigation requirements, and availability of water resources to catchments under climate change in the Czech Republic (CZ). Within the SoilClim model and BILAN-WATERES hydrological water balance modeling process, we tried to answer the question of whether there are at least theoretical water resources in the individual catchments of the CZ that could cover possible higher demands for irrigation. An ensemble of five global climate models under the moderate representative concentration pathway (RCP4.5) from the EURO-CORDEX initiative was chosen to project the future water use indicators. The irrigation water requirement indicators for the growing season (GS) of vineyards, hop gardens, orchards, vegetables, and fodder crops were calculated in 1143 catchments for two periods, 2031–2050 (Sc1) and 2061–2080 (Sc2), compared to the observed period 1961–2020 (Obs). To project irrigation scenarios in agricultural water management, the following water use indicators were quantified: relative soil moisture at 0–40 cm (AWR1) and 0–100 cm (AWR), crop water balance (Rain-ETa), irrigation water requirement (Irrig), and the ratio of actual and reference evapotranspiration (ETratio). To assess areas with a critically low water supply and quantify the frequency of water deficit during the GS of each crop, we calculated the number of days with extreme values of water use indicators. Quantification of the extreme irrigation characteristics reflected the highest depletion of soil moisture and the highest water demands, i.e., when the assessed indicators reached the 25th percentiles. For highly marketable vegetables, the largest deficit in Rain-ETa during the GS for Sc1 was projected. If current vegetable growing areas and cropping systems remain unchanged, Irrig will increase by 10.2% by the end of the 21st century under RCP4.5. Although current potato planting areas have soils with a high available water capacity, they will become controlled by the water deficit over the next few decades. The accumulated vineyard water required suggests that 15% and 25% of irrigation water will be lost by evaporation from the soil surface during the 2030s and 2080s, respectively. However, changes in future hopyard irrigation extent and amounts may have important implications in largely cropped irrigation hotspots. In the main traditional hop region for the 2030s, we project a 25% depletion of soil moisture and an increase of ETratio

The average gradient heat-pulse method (CHMP-AG) has been used to monitor sap flow in very young (1-year-old) apple trees, from budburst through until leaf fall. Data are presented to illustrate how CHPM-AG can resolve the full range of sap flux densities in these small trees. The methodology has been implemented by making a very simple software change to existing CHPM instrumentation.

Population-based smoking-cessation services tend to preferentially benefit high-SES smokers, potentially exacerbating disparities. Interventions that include proactive outreach, telephone counseling, and free or low-cost cessation medications may be more likely to help low-SES smokers quit. This analysis evaluated the role of SES in smokers' response to a population-based proactive smoking-cessation intervention.This study, conducted in 2016 and 2017, was a secondary analysis of the Veterans Victory Over Tobacco Study, a multicenter pragmatic RCT of a proactive smoking-cessation intervention conducted from 2009 to 2011. Logistic regression modeling was used to test the effect of income or education level on 6-month prolonged abstinence at 1-year follow-up.Of the 5,123 eligible, randomized participants, 2,565 (50%) reported their education level and 2,430 (47%) reported their income level. The interactions between education (p=0.07) or income (p=0.74) X treatment arm were not statistically significant at the 0.05 level. The largest effect sizes for the intervention were found among smokers in the lowest education category (≤11th grade), with a quit rate of 17.3% as compared with 5.7% in usual care (OR=3.5, 95% CI=1.4, 8.6) and in the lowest income range ($10,000), with a quit rate of 18.7% as compared with 9.4% in usual care (OR=2.2, 95% CI=1.2, 4.0).In a large, multicenter smoking-cessation trial, proactive outreach was associated with higher rates of prolonged abstinence among smokers at all SES levels. Proactive outreach interventions that integrate telephone-based care and facilitated cessation medication access have the potential to reduce socioeconomic disparities in quitting.This study is registered at www.clinicaltrials.gov NCT00608426.

BACKGROUND AND OBJECTIVES Physicians and psychiatrists often encounter patients in the emergency department presenting after methamphetamine use. While physical and psychiatric manifestations associated with methamphetamine use are well known, movement disorders are relatively less common. The aim of this case report is to add to existing literature awareness about the possibility of movement disorders occurring after methamphetamine use, discuss the possible mechanism by which such use leads to dyskinesia, and describe possible management strategies. METHODS AND RESULTS In this case report, we describe choreoathetoid movements occurring in a young female after relatively short-term methamphetamine use. DISCUSSION AND CONCLUSIONS Evidence for treatment of methamphetamine induced choreoathetosis is limited. Expectant management of such symptoms is a viable option if there are no additional comorbidities that require therapy. SCIENTIFIC SIGNIFICANCE Clinicians should be alert to the possibility of movement disorders in methamphetamine users and familiar with treatment options. (Am J Addict 2018;XX:1-4).

The need for cognitive closure describes the extent to which a person, faced with a decision, prefers any answer in lieu of continued uncertainty. This construct may be relevant in lung cancer screening, which can both reduce and increase uncertainty. We examined whether individual differences in need for cognitive closure are associated with Veterans’ completion of lung cancer screening using a self-administered survey ( N = 361). We also assessed whether need for cognitive closure moderates an association between screening completion and lung cancer risk perception. Contrary to our main hypothesis, high need for cognitive closure Veterans were not more likely to complete lung cancer screening and need for cognitive closure did not have a moderating role.

Regulations for remotely piloted aircraft systems (RPAS) should have a strong foundation in, and traceability to, the management of the safety risks. This paper describes a new approach for modelling the risks associated with RPAS operations near populous areas to support the development of regulations and safety cases. A review found that existing models do not provide a simple means for incorporating the wide range of technical and operational controls into the risk analysis process. A Barrier Bow Tie Model (BBTM) is proposed as it focuses risk analysis, evaluation, and decision-making activities on the practical devices, people, and processes that can be used to reduce risk. Existing literature and practical controls were reviewed and used to define the components of the model and a case study is used to exemplify its application. More than 50 practical controls were incorporated into the model. The template barriers, controls, and graphical nature of the BBTM facilitated a simple comparison of the two case study RPAS operations and a more structured approach to the setting of airworthiness requirements taking into consideration the wide range of technical and operational factors that can be used to manage risk. The model provides the linkage between a regulation, associated controls, and how the controls contribute to a reduction in risk, which is necessary for the adoption of a risk-based approach to the regulation of RPAS. The BBTM provides a generic framework that can be used to structure the development of safety cases for any RPA operation.

Introduction Individuals with (vs. without) mental illness use tobacco at higher rates and have more difficulty quitting. Treatment models for smokers with mental illness are needed. Methods This secondary analysis of the Victory Over Tobacco study [a pragmatic randomized clinical trial (N = 5123) conducted in 2009–2011 of Proactive Care (proactive outreach plus connection to smoking cessation services) vs. Usual Care] tests the effectiveness of treatment assignment in participants with and without a mental health diagnosis on population-level, 6 month prolonged abstinence at one year follow-up. Results Analyses conducted in 2015–6 found that there was no interaction between treatment group and mental health group on abstinence (F(1,3300 = 1.12, p = 0.29)). Analyses stratified by mental health group showed that those without mental illness, assigned to Proactive Care, had a significantly higher population-level abstinence rate than those assigned to Usual Care (OR = 1.40, 95% CI = 1.17–1.67); in those with mental illness, assignment to Proactive Care produced a non-significant increase in abstinence compared to Usual Care (OR = 1.18, 95% CI = 0.98–1.41). Those with mental illness reported more medical visits, cessation advice and treatment (p 0.05), but lower abstinence self-efficacy (p Conclusions Those with a mental health diagnosis benefitted less from proactive outreach regarding tobacco use. VA primary care patients with mental illness may not need additional outreach because they are connected to cessation resources during medical appointments. This group may also require more intensive cessation interventions targeting self-efficacy to improve cessation rates. Clinicaltrials.gov registration # NCT00608426 .

We describe a case of a 3-year-old boy with Down syndrome who developed a bladder rupture as a consequence of an undiagnosed posterior urethral valve (PUV). He had a history of urinary tract infections and constipation and was acutely admitted in poor condition and underwent laparotomy that revealed peritoneal sepsis secondary to bladder perforation. Bladder was drained using a suprapubic catheter and the condition of the boy gradually improved. Once stable, a cystourethroscopy confirmed the presence of PUV. Video-urodynamic studies performed at the check cystoscopy showed the bladder to be of reduced compliance (end fill pressure at 100 mL fill 30 cmH2O) with raised voiding pressures (76–100 cmH2O) and significant incomplete bladder emptying. Currently, the patient is doing very well, serum creatinine has normalised, he is infection-free and thriving; his bladder is managed with a vesicostomy.

Clear definitions of 'normal' equine gestation length (GL) are elusive, with GL being subject to a considerable number of internal and external variables that have confounded interpretation and estimation of GL for over 50 years. Consequently, the mean GL of 340 days first established by Rossdale in 1967 for Thoroughbred horses in northern Europe continues to be the benchmark value referenced by veterinarians, breeders and researchers worldwide. Application of a 95% confidence limit to reported GL range values indicates a possible connection between geographic location and GL. Improved knowledge of this variable may help in assessing the degree of the neonate's prematurity and dysmaturity at or soon after birth, and identification of conditions such as incomplete ossification of the carpal and tarsal bones. Associated pathologies such as bone malformation and fracture, angular limb deformity and degenerative joint disease can cause chronic unsoundness, rendering horses unsuitable for athletic purpose and shortening ridden careers. This review will examine both the factors contributing to GL variation and the published data to determine whether there is potential to refine our understanding of GL by establishing a more accurate and regionally relevant GL range based on a 95% confidence limit. This may benefit both equine industry economics and equine welfare by improving early identification of skeletally immature neonates, so that appropriate intervention may be considered.

The effect of high school study of mathematics on numeracy performance of sports and exercise science (SES) students is not clear. To investigate this further, we tested the numeracy skills of 401 students enrolled in a Bachelor of Health Sciences degree in SES using a multiple-choice survey consisting of four background questions and 39 numeracy test questions. Background questions (5-point scale) focused on highest level of mathematics studied at high school, self-perception of mathematics proficiency, perceived importance of mathematics to SES and likelihood of seeking help with mathematics. Numeracy questions focused on rational number, ratios and rates, basic algebra and graph interpretation. Numeracy performance was based on answers to these questions (1 mark each) and represented by the total score (maximum = 39). Students from first (n = 212), second (n = 78) and third (n = 111) years of the SES degree completed the test. The distribution of numeracy test scores for the entire cohort was n...