Search

Background Primary sclerosing cholangitis (PSC) is a well-described risk factor for the development of cholangiocarcinoma (CCA). Early detection of CCA in these patients is of great importance because it expands options for therapeutic interventions, including liver transplantation. Current diagnostic tests for the evaluation of biliary strictures are limited to biliary brushing (BB) cytology and fluorescence in situ hybridization (FISH). Next-generation sequencing (NGS) has become an important diagnostic tool in oncology and may be a useful tool for diagnosing CCA on BBs. It is not clear how NGS performs when it is added to BB cytology and FISH in patients with PSC. Methods This study reports the authors' experience with NGS performed as a prospective cotest with cytology and FISH on BBs obtained from 60 patients with PSC followed at Massachusetts General Hospital. A duct with malignancy was defined as a high-risk (HR) stricture with either high-grade dysplasia or CCA. Results NGS was better than FISH and cytology in detecting HR strictures, which showed multiple genetic mutations in all cases. NGS provided specific mutational information, and NGS results were reproducible in longitudinal samples. Conclusions Adding NGS to BB cytology and FISH in the evaluation of biliary strictures for patients with PSC may provide additional information that could help to inform clinical management.

Vendor-independent software tools for quantification of small molecules and metabolites are lacking, especially for targeted analysis workflows. Skyline is a freely available, open-source software tool for targeted quantitative mass spectrometry method development and data processing with a ten-year history supporting 6 major instrument vendors. Designed initially for proteomic analysis, we describe the expansion of Skyline to data for small molecule analysis, including selected reaction monitoring (SRM), high-resolution mass spectrometry (HRMS), and calibrated quantification. This fundamental expansion of Skyline from a peptide-sequence centric tool to a molecule-centric tool makes it agnostic to the source of the molecule while retaining Skyline features critical for workflows in both peptide and more general biomolecular research. The data visualization and interrogation features already available in Skyline - such as peak picking, chromatographic alignment, and transition selection - have been adapted to support small molecule data, including metabolomics. Herein, we explain the conceptual workflow for small molecule analysis using Skyline, demonstrate Skyline performance benchmarked against a comparable instrument vendor software tool, and present additional real-world applications. Further, we include step-by-step instructions on using Skyline for small molecule quantitative method development and data analysis on data acquired with a variety of mass spectrometers from multiple instrument vendors.

International audience

IntroductionDirect-to-family clinical trials efficiently provide data while reducing the participation burden for children and their families. Although these trials can offer significant advantages over traditional clinical trials, the process of designing and implementing direct-to-family studies is poorly defined, especially in children with rheumatic disease. This paper provides lessons learnt from the design and implementation of a self-controlled, direct-to-family pilot trial aimed to evaluate the effects of a medication management device on adherence to hydroxychloroquine in paediatric SLE.MethodsSeveral design features accommodate a direct-to-family approach. Participants meeting eligibility criteria from across the USA were identified a priori through a disease registry, and all outcome data are collected remotely. The primary outcome (medication adherence) is evaluated using electronic medication event-monitoring, plasma drug levels, patient questionnaires and pill counts. Secondary and exploratory endpoints include (1) lupus disease activity measured by a remote SLE Disease Activity Index examination and the Systemic Lupus Activity Questionnaire; and (2) hydroxychloroquine pharmacokinetics and pharmacodynamics. Recruitment of the initial target of 20 participants was achieved within 10 days. Due to initial recruitment success, enrolment was increased to 26 participants. Additional participants who were interested were placed on a waiting list in case of dropouts during the study.Discussion and disseminationDirect-to-family trials offer several advantages but present unique challenges. Lessons learnt from the protocol development, design, and implementation of this trial will inform future direct-to-family trials for children and adults with rheumatic diseases. Additionally, the data collected remotely in this trial will provide critical information regarding the accuracy of teleresearch in lupus, the impact of adherence to hydroxychloroquine on disease activity and a pharmacokinetic analysis to inform paediatric-specific dosing of hydroxychloroquine.Trial registration numberClinicalTrials.gov Registry (NCT04358302).

Purpose Maximally decreasing portal pressures with transjugular intrahepatic portosystemic shunt (TIPS) is associated with improved ascites control but also increased encephalopathy incidence. Since splenic venous flow contributes to portal hypertension, we assessed if combining small-diameter TIPS with splenic artery embolization could improve ascites while minimizing encephalopathy. Methods Fifty-five patients underwent TIPS creation for refractory ascites. Subjects underwent creation of 8 mm TIPS followed by proximal splenic artery embolization (group A, n=8), or of 8 mm (group B, n=6) or 10 mm TIPS (group C, n=41) without splenic embolization. Data were retrospectively reviewed. Results In group A, median portosystemic gradient decreased from 19 mmHg to 9 mmHg after TIPS, and 8 mmHg after subsequent splenic artery embolization. In groups B and C, gradient decreased from 15 mmHg to 8 mmHg and 16 mmHg to 6 mmHg. All patients except for one in group A and two in C had greater than 50% reduction in the number of paracenteses in 3 months. Any postprocedural encephalopathy incidence was 62%, 50%, 83% in groups A, B, and C, respectively. Overall, 20% of subjects with 10 mm TIPS required TIPS reduction/closure compared to 7% of subjects with 8 mm TIPS. Conclusion We found that 8 mm diameter TIPS provided similar ascites control compared to 10 mm TIPS regardless of splenic embolization. While more patients with 10 mm TIPS required reduction/closure for severe encephalopathy, the study was underpowered for definitive assessment. Splenic embolization might have the potential to further decrease portosystemic gradient and ascites as an alternative to dilation of TIPS to 10 mm minimizing the risk of encephalopathy, but larger studies are warranted.

Background and aims Coronavirus disease 2019 (COVID-19), the illness caused by the SARS-CoV-2 virus, is rapidly spreading throughout the world. Hospitals and healthcare providers are preparing for the anticipated surge in critically ill patients, but few are wholly equipped to manage this new disease. The goals of this document are to provide data on what is currently known about COVID-19, and how it may impact hepatologists and liver transplant providers and their patients. Our aim is to provide a template for the development of clinical recommendations and policies to mitigate the impact of the COVID-19 pandemic on liver patients and healthcare providers. Approach and results This article discusses what is known about COVID-19 with a focus on its impact on hepatologists, liver transplant providers, patients with liver disease, and liver transplant recipients. We provide clinicians with guidance for how to minimize the impact of the COVID-19 pandemic on their patients' care. Conclusions The situation is evolving rapidly, and these recommendations will need to evolve as well. As we learn more about how the COVID-19 pandemic impacts the care of patients with liver disease, we will update the online document available at https://www.aasld.org/about-aasld/covid-19-and-liver.

Background Coronavirus disease 2019 (COVID-19) is associated with elevated liver biochemistries in approximately half of hospitalized patients, with many possible etiologies. Aim To assess agreement on the etiology of abnormal liver biochemistries and diagnostic recommendations in COVID-19. Methods Twenty hepatology consultations were reviewed by three senior hepatologists who provided a differential diagnosis and diagnostic recommendations. Kappa agreement on the primary etiology was calculated. Results Kappa agreement between hepatologists on the primary etiology of elevated liver biochemistries was 0.10 (p = 0.03). Agreement was greater around drug-induced liver injury 0.51 (p

Myelofibrosis is a hematologic condition that predisposes to the formation of large and small portal venous clots. Portal injury is believed to underlie the mechanism of development of noncirrhotic portal hypertension in this population. We describe a patient with myelofibrosis, proven portal hypertension, and extramedullary hematopoiesis with no imaging or pathologic evidence of microvascular or macrovascular portal clot. We provide a concise review of the literature which highlights that patients with myelofibrosis and related conditions of polycythemia vera and essential thrombocytosis present not infrequently with portal hypertension and variceal bleeding. We propose this population may benefit from primary variceal screening.

Mass spectrometry (MS)-based targeted lipidomics enables the robust quantification of selected lipids under various biological conditions but comprehensive software tools to support such analyses are lacking. Here we present LipidCreator, a software that fully supports targeted lipidomics assay development. LipidCreator offers a comprehensive framework to compute MS/MS fragment masses for over 60 lipid classes. LipidCreator provides all functionalities needed to define fragments, manage stable isotope labeling, optimize collision energy and generate in silico spectral libraries. We validate LipidCreator assays computationally and analytically and prove that it is capable to generate large targeted experiments to analyze blood and to dissect lipid-signaling pathways such as in human platelets., Targeted mass spectrometry enables reproducible and accurate lipid quantification but dedicated software tools to develop targeted lipidomics assays are lacking. Here, the authors develop a targeted lipidomics workbench and lipid knowledgebase for the streamlined generation of targeted assays.

The consumption of vegetables and fruit during adolescence is crucial to ensuring adequate intake of the nutrients required to meet the rapid growth that characterises this developmental period. However, significant reductions in vegetable and fruit intake during adolescence have been observed making the promotion of consumption an important health promotion challenge. To monitor progress in this population segment toward meeting recommended intake levels and identifying at-risk groups, the present study assessed changes in Australian adolescents' vegetable and fruit consumption over time and identified the demographic factors associated with meeting recommendations. As individuals who are aware of their diet deficiencies are likely to be more receptive to healthy eating interventions, the present study also assessed adolescents' perceptions of the adequacy of their vegetable and fruit intake and identified the demographic factors associated with correctly perceiving fruit and vegetable intake to be inadequate. Two cross-sectional samples of Western Australian secondary school students aged 12-17 years were surveyed in 2009-2010 (n = 1501) and 2012-2013 (n = 1406). Only 14% of students at Wave 1 and 13% at Wave 2 met the recommended guidelines for vegetable intake while 68% and 71% met the guidelines for fruit intake. Females had significantly greater odds of failing to meet guidelines for vegetable intake than males. Only 50% of students correctly identified their vegetable and fruit intake to be inadequate. The observed very low levels of compliance with vegetable intake recommendations suggest that addressing deficiencies in vegetable consumption should be a primary focus of future nutrition interventions. Efforts should also be made to increase adolescents' perceptions of the inadequacy of their intake to optimise the effectiveness of schemes designed to improve vegetable and fruit consumption in this population segment.

Informing drinkers of the health risks associated with alcohol consumption via warning statements located on alcohol products can increase their capacity to make healthier choices. This study assessed whether exposing at-risk drinkers to warning statements relating to specific chronic diseases increases the extent to which alcohol is believed to be a risk factor for those diseases and influences consumption intentions. Australians drinking at levels associated with long-term risk of harm (n = 364; 72% male) completed an online survey assessing their drinking habits, beliefs in the link between alcohol and various diseases and drinking intentions. Respondents were then exposed to one of five statements advising of the potential risks associated with alcohol consumption (either cancer, liver damage, diabetes, mental illness or heart disease). Beliefs and drinking intentions were reassessed. Significant increases in the extent to which alcohol was believed to be a risk factor for diabetes, heart disease, mental illness and cancer were found. With the exception of the liver damage and heart disease statements, exposure to each statement was associated with a significant reduction in consumption intentions. Warning statements advising of the specific chronic diseases associated with alcohol consumption can produce favourable changes in drinking intentions among at-risk drinkers.

Nutrition interventions that target both fruits and vegetables are effective in increasing fruit consumption, but have been limited in their ability to improve vegetable intake. To address the low proportion of children meeting vegetable intake guidelines, approaches specifically targeting vegetables are needed. This paper reports on a mixed-method analysis of a 10-week vegetable promotion pilot project that aimed to increase vegetable intake as part of the existing CrunchSip in-class fruit and vegetable break program.The intervention was designed to promote vegetable consumption through the implementation of vegetable-focused resources, including curriculum resources and parent education materials. Teachers completed pre- and end-of-intervention surveys. Process measures related to the use of resources and teachers' perceptions of barriers to implementation. The outcome evaluation included measures of children's vegetable consumption during CrunchSip breaks and teachers' attitudes and confidence relating to educating students about the benefits of consuming vegetables.Twenty-one Western Australian primary schools already participating in the CrunchSip program participated in the pilot intervention and evaluation. Coverage included 35 primary school teachers representing 818 students aged 4-11 years.The proportion of children bringing vegetables for CrunchSip more than doubled over the 10-week intervention (21% vs 46%; p 0.001). Improvements were observed in teachers' perceived knowledge about the nutritional benefits of vegetables (p = 0.001) and confidence to educate students about the benefits of vegetable consumption (p = 0.028).Preferentially promoting vegetable consumption as part of an existing school-based nutrition program may be an effective strategy to increase children's vegetable intake.

Adolescence is a critical time for disengagement from physical activity making young people a priority group for interventions. To determine whether existing initiatives are working in this population segment and help inform future programs, the present study sought to (i) examine prevalences and trends in physical activity and screen-based recreation among Australian adolescents and (ii) identify the barriers to adolescents meeting recommended guidelines. Two cross-sectional representative samples of Western Australian secondary school students aged 12 to 17years were surveyed in 2009-2010 (n=1505) and 2012-2013 (n=1406). Around a quarter (24%) of boys and just 9% of girls reported engaging in the recommended 60min of physical activity per day in 2012-2013. A minority (13% of boys, 17% of girls) adhered to guidelines for time spent engaging in screen-based recreation (≤2h of electronic media use for entertainment). These findings were comparable to 2009-2010 prevalence levels. Multivariable logistic regression analyses conducted on data from the most recent wave found individual-level barriers to be significantly associated with lower odds of meeting physical activity guidelines in both boys (Adj. OR=0.52, 95% CI=0.38, 0.72) and girls (Adj. OR=0.41, 95% CI=0.25, 0.66). The consistently high proportion of adolescents not meeting physical activity recommendations over time suggests that current efforts to increase physical activity may be failing to have an impact on population-level trends in compliance. While initiatives to improve the built environment may reduce barriers at the environmental level, these initiatives risk having little impact on physical activity if individual level barriers remain unaddressed.

Hybrid additive manufacturing enables the creation of materials with functional microstructure and mechanical property patterns. While samples with functional patterns provide unique advantages in the overall performance of the material, they present a challenge for nondestructive evaluation. In particular, the nondestructive mapping of the properties imparted by hybrid AM processes is critical. In this work, hybrid 316 stainless steel samples are created using laser powder bed fusion (LPBF) with varying hybrid architectures and with a variety of hybrid processes. The ultrasonic responses of these samples, in terms of wave speed, attenuation, and backscatter amplitude, are evaluated for each architecture and process combination. These responses are compared with those from conventionally manufactured samples and traditional AM samples. This evaluation provides information on the sensitivity of ultrasonic responses to hybrid architecture and process, highlighting the potential of ultrasonic nondestructive methods for the characterization of hybrid AM components. [This material is based upon work supported by the National Science Foundation Graduate Research Fellowship Program under Grant No. 1610400. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation.]

ObjectiveTo examine demographic and behavioural correlates of high consumption of soft drinks (non-alcoholic sugar-sweetened carbonated drinks excluding energy drinks) among Australian adolescents and to explore the associations between high consumption and soft drink perceptions and accessibility.DesignCross-sectional self-completion survey and height and weight measurements.SettingAustralian secondary schools.SubjectsStudents aged 12–17 years participating in the 2012–13 National Secondary Students’ Diet and Activity (NaSSDA) survey (n 7835).ResultsOverall, 14 % of students reported consuming four or more cups (≥1 litres) of soft drinks each week (‘high soft drink consumers’). Demographic factors associated with high soft drink consumption were being male and having at least $AU 40 in weekly spending money. Behavioural factors associated with high soft drink consumption were low fruit intake, consuming energy drinks on a weekly basis, eating fast foods at least once weekly, eating snack foods ≥14 times/week, watching television for >2 h/d and sleeping for ConclusionsHigh soft drink consumption clusters with other unhealthy lifestyle behaviours among Australian secondary-school students. Interventions focused on reducing the availability of soft drinks (e.g. increased taxes, restricting their sale in schools) as well as improved education on their harms are needed to lower adolescents’ soft drink intake.

ObjectiveThe Crunch&Sip programme is a school-based nutrition initiative designed to increase the fruit, vegetable and water intakes of primary-school children. In recognition of the notable deficits in children’s vegetable consumption, the present study explored the receptivity of school staff to a realignment of the Crunch&Sip programme to feature a primary focus on vegetable consumption. This involved investigating school staff members’ perceptions of relevant barriers, motivators and facilitators.DesignA multi-method approach was adopted that involved four focus groups and a survey (administered in paper and online formats) containing a mixture of open- and closed-ended items.SettingWestern Australia.SubjectsStaff from Western Australian schools participated in the focus groups (n37) and survey (n620).ResultsSchool staff were strongly supportive of modifying the Crunch&Sip programme to focus primarily on children’s vegetable consumption and this was generally considered to be a feasible change to implement. Possible barriers identified included children’s taste preferences and a perceived lack of parental support. Suggested strategies to overcome these barriers were education sessions for parents and children, teachers modelling vegetable consumption for their students and integrating vegetable-related topics into the school curriculum.ConclusionsSchool staff are likely to support the introduction of school-based nutrition programmes that specifically encourage the consumption of vegetables. Potential barriers may be overcome through strategies to engage parents and children.

Primary biliary cholangitis (PBC) is a chronic, progressive autoimmune liver disease that mainly affects middle-aged women. Obeticholic acid (OCA), which was recently approved by the Food and Drug Administration for PBC treatment, has demonstrated positive effects on biochemical markers of liver function. Our objective was to evaluate the long-term clinical impact and cost-effectiveness of OCA as a second-line treatment for PBC in combination with ursodeoxycholic acid (UDCA) in adults with an inadequate response to UDCA. We developed a mathematical model to simulate the lifetime course of PBC patients treated with OCA+UDCA versus UDCA alone. Efficacy data were derived from the phase 3 PBC OCA International Study of Efficacy trial, and the natural history of PBC was informed by published clinical studies. Model outcomes were validated using the PBC Global Study. We found that in comparison with UDCA, OCA+UDCA could decrease the 15-year cumulative incidences of decompensated cirrhosis from 12.2% to 4.5%, hepatocellular carcinoma from 9.1% to 4.0%, liver transplants from 4.5% to 1.2%, and liver-related deaths from 16.2% to 5.7% and increase 15-year transplant-free survival from 61.1% to 72.9%. The lifetime cost of PBC treatment would increase from $63,000 to $902,000 (1,330% increment). The discounted quality-adjusted life years with UDCA and OCA+UDCA were 10.74 and 11.78, respectively, and the corresponding costs were $142,300 and $633,900, resulting in an incremental cost-effectiveness ratio of $473,400/quality-adjusted life year gained. The results were most sensitive to the cost of OCA. Conclusion: OCA is a promising new therapy to substantially improve the long-term outcomes of PBC patients, but at its current annual price of $69,350, it is not cost-effective using a willingness-to-pay threshold of $100,000/quality-adjusted life year; pricing below $18,450/year is needed to make OCA cost-effective. (Hepatology 2017;65:920-928).

Following publication of this article, the authors noticed that incorrect affiliations were assigned to the author M. W. M. Post. This authors affiliations have now been corrected to the following: 8. University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands 9. Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands This has been corrected in both the PDF and HTML versions of the article.

Background Excess weight is a major risk factor for chronic diseases. In Australia, over 60% of adults are overweight or obese. The overconsumption of energy-dense nutrient-poor (EDNP) foods and low physical activity (PA) levels are key factors contributing to population obesity. New cost-effective approaches to improve population diet and PA behaviors are needed. Objective This 1-year randomized controlled trial (6-month intervention and 6-month follow-up) aims to investigate whether a tailored intervention using mobile technology can improve diet and PA behaviors leading to weight loss in adults (aged 18-65 years) who are overweight or obese and recruited through a social marketing campaign (LiveLighter). Methods All eligible participants will provide data on demographics and lifestyle behaviors online at baseline, 6 months, and 12 months. Using two-stage randomization, participants will be allocated into one of three conditions (n=200 per group): tailored feedback delivered via email at seven time points, informed by objective dietary (mobile food record app) and activity (wearable activity monitor) assessment; active control receiving no tailored feedback, but undergoing the same objective assessments as tailored feedback; and online control receiving no tailored feedback or objective assessments. Primary outcome measures at 6 and 12 months are changes in body mass, EDNP food and beverage consumption, and daily moderate-to-vigorous PA (measured via accelerometry). Secondary outcomes include change in fruit and vegetable consumption, daily sedentary behaviors, and cost effectiveness. Results Enrolment commenced in August 2017. Primary outcomes at 12 months will be available for analysis from September 2019. Conclusions Tailored email feedback provided to individuals may deliver a cost-effective strategy to overcome existing barriers to improving diet and PA. If found to be successful and cost effective, upscaling this intervention for inclusion in larger-scale interventions is highly feasible. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12617000554369; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=371325&isReview=true International Registered Report Identifier (IRRID) DERR1-10.2196/12782

Background/aimsThe MELD score was developed to predict survival after transjugular intrahepatic portosystemic shunt (TIPS) placement. Given changes in practice patterns and development of new prognostic tools in cirrhosis, we aimed to evaluate common models to predict mortality after TIPS placement.MethodsAnalysis of consecutive patients who underwent TIPS placement for ascites or bleeding. Performance to predict 90-day mortality was assessed by C statistic for six models (MELD, MELD-Na, CLIF-C ACLF, Child-Pugh, Platelet-Albumin-Bilirubin, and Emory score). Added predictive value to MELD score was assessed for univariate predictors of 90-day mortality. Stratified analysis by TIPS indication, emergent placement status, and TIPS stent type was performed.Results413 patients were analyzed (248 with variceal bleeding, 165 with refractory ascites). 90-day mortality was 27% (113/413). Mean MELD score was 15 ± 7.9. MELD score best predicted mortality for all patients (c = 0.779), for variceal bleeding (c = 0.844), and for emergent TIPS (c = 0.817). CLIF-C ACLF score best predicted mortality for refractory ascites (c = 0.707). Addition of sodium to the MELD score did not improve predictive value across multiple strata. Addition of hemoglobin improved MELD score's predictive value in variceal bleeding. Addition of age improved MELD score's predictive value in refractory ascites.ConclusionsMELD score best predicted 90-day mortality. Addition of sodium to the MELD score did not improve its performance, though mortality prediction was improved using Age-MELD for ascites and Hemoglobin-MELD for bleeding. An individualized risk stratification approach may be best when considering candidates for TIPS placement.

Primary sclerosing cholangitis (PSC) is a cholestatic liver disease with no effective medical therapies. A perturbation of the gut microbiota has been described in association with PSC, and fecal microbiota transplantation (FMT) has been reported to restore the microbiome in other disease states. Accordingly, we aimed at evaluating the safety, change in liver enzymes, microbiota, and metabolomic profiles in patients with PSC after FMT.An open-label pilot study of patients with PSC with concurrent inflammatory bowel disease and alkaline phosphatase (ALP)1.5× the upper limit of normal was conducted. The patients underwent a single FMT by colonoscopy. Liver enzyme profiles and stool microbiome and metabolomic analysis were conducted at baseline and weeks 1, 4, 8, 12, and 24 post-FMT. The primary outcome was safety, and the secondary outcome was a decrease in ALP levels ≥50% from baseline by week 24 post-FMT; stool microbiota (by 16S rRNA gene profiling) and metabonomic dynamics were assessed.Ten patients underwent FMT. Nine patients had ulcerative colitis, and 1 had Crohn's colitis. The mean baseline ALP level was 489 U/L. There were no related adverse events. Overall, 30% (3/10) experienced a ≥50% decrease in ALP levels. The diversity increased in all patients post-FMT, as early as week 1 (P0.01). Importantly, abundance of engrafter operational taxonomic units in patients post-FMT correlated with decreased ALP levels (P = 0.02).To our knowledge, this is the first study to demonstrate that FMT in PSC is safe. In addition, increases in bacterial diversity and engraftment may correlate with an improvement in ALP among patients with PSC.

Equine Gastric Ulcer Syndrome affects roughly 90% of performance horses. The only reliable antemortem diagnostic method is endoscopy, which is an invasive process. The cornerstone of treatment is acid suppression, a cost-prohibitive option that is not viable for long-term use. The objectives of this study were to investigate the efficacy of a polysaccharide (PS) supplement on gastric ulcers in the squamous (SQ) and glandular (GL) regions of the equine stomach and identify associated serum and saliva biomarkers. It was hypothesized that severity of SQ and GL ulcers throughout the supplemental period would decrease and levels of serum and salivary proteins, as well as total antioxidant capacity (TAC), would fluctuate with ulcer scores. To test this hypothesis, 8 mature geldings were randomly assigned to a treatment (TRT) or non-treatment (CTRL) group, then underwent ulcer induction using a modified Murray method: alternating 12- and 24-h feed deprivations for a total of 108hr. Following the induction, TRT horses’ feed was top-dressed with 1oz of PS supplement twice daily. Horses were fed 1.0% BW in Fescue hay (Festuca pratensis) and 0.25% BW in concentrates daily (Nutrena Triumph Fiber Plus, Cargill, Inc., Holmesville, OH) with ad libitum water access, as recommended by the NRC. Horses were housed in 3.05mx3.65m stalls and turned out into 0.809ha pastures (native grasses, fescue, clover, and annual rye; 4 horses per pasture) from 0600hrs-1800hrs and 1800hrs-0600hrs, respectively. The experiment was divided into 3 periods: pre- (Day 0), mid- (Day 28), and post-supplementation (Day 43). Per period, endoscopic images were captured and saliva and blood samples were collected. The effects of date and treatment were analyzed with a factorial ANOVA. All statistical calculations were performed usuing the software JMP. The severity of ulcer scores decreased in all horses over the 6-week time span (P = 0.001), with no difference found between TRT and CTRL horses in the SQ or GL regions. It is possible that the body's innate healing capacity was adequate in this study, which may have masked the treatment effect of the PS supplement. There was a correlation found between salivary TAC (R2 = 0.559; P = 0.005) and serum TAC (R2 = 0.620; P = 0.002) and ulcer score, which may indicate that oxidative stress decreases as ulcers heal. The investigation of PS supplementation as a preventative measure in ulcerative and non-ulcerative horses under stress is warranted. Additionally, the exploration of other salivary and serum biomarkers to further develop a panel for preliminary screening of equine gastric ulcers should be pursued.

Considering welfare-compromising impact of obesity, knowledge on levels of adiposity and their consequences on equine welfare is important. This study aimed to survey judges’ views on the level of adiposity in horses and ponies in conformation, model, or halter competition, and their ability to distinguish different levels of adiposity from pictures. The survey was created using Qualtrics and was deemed exempt by the University's Institutional Review Board. The survey was sent by email to more than 1000 hunter judges using the United States Hunter Jumper Association (USHJA), American Quarter Horse Association, and Equine Canada's database. The survey included 31 questions about judges’ background experience, judging consequences of thin or obese animals, including 13 photographs of horses and ponies to be categorized as thin, average, overweight or obese. There were 211 completed surveys with the majority (77%) being USHJA judges and with 50% of all respondents indicating they had more than 20 years of judging experience. The majority considered themselves either very experienced or moderately experienced at judging both horses (73%) and ponies (67%) in such competitions. The vast majority (95%) stated that either too much or too little fat coverage would compromise the score of a horse or pony in a show competition. Based on a 2-proportion z-test using R software, at 5% significance level, the proportion of judges agreeing to penalize a horse or pony if they were too thin (p1 = 93.83%, n1 = 211) is significantly greater than the proportion of those who would give similar penalty due to a horse or pony being too fat (p2 = 87.98%, n2 = 208) (P = 0.028), CI95% = [0.008, 1]) though the majority agreed to penalize either. When asked if they accepted more fat coverage on a pony than a horse, 19.5% of respondents agreed, and 38% answered “maybe.” Of the 13 photographs presented in the survey, 5 animals were deemed obese, 3 overweight, 3 thin and 2 average by 2 experts. For 3 of the obese horses, the majority of the judges deemed them at least overweight, with a smaller portion correctly identifying them as obese. The majority (89%, 87%, and 77%) also chose “average” for 3 overweight horses. In contrast, 91% of respondents deemed a horse “thin” for one with only a faint outline of ribs visible that was considered average by the experts. These data suggest that judges may be more lenient on overweight horses than lean horses, and are less likely to identify some overweight and obese animals. Finally, 64% of judges indicated they would like educational material and concrete guidelines in the rules regarding appropriate levels of fat coverage.

Metal hybrid additive manufacturing (AM) processes are suitable to create complex structures that advance engineering performance. Hybrid AM can be used to create functionally graded materials for which the variation in microstructure and material properties across the domain is created through a synergized combination of fully-coupled manufacturing processes and/or energy sources. This expansion in the engineering design and manufacturing spaces presents challenges for nondestructive evaluation, including the assessment of the sensitivity of nondestructive measurements to functional gradients. To address this problem, linear ultrasound measurements are used to interrogate 420 stainless steel coupons from three manufacturing methods: wrought, AM, and hybrid AM (directed energy deposition + laser peening). Wave speed, attenuation, and diffuse backscatter results are compared with microhardness measurements along the build/axial direction of the coupons, while microstructure images are used for qualitative verification. The ultrasound measurements compare well with the destructive measurements without any substantial loss in resolution. Furthermore, ultrasonic methods are shown to be effective for identification of the gradient and cyclic nature of the elastic properties and microstructure on the hybrid AM coupon. These results highlight the potential of ultrasound as an efficient and accessible nondestructive characterization method for hybrid AM samples and inform further nondestructive evaluation decisions in AM.

While protective behavioral strategies (PBSs) have the potential to reduce alcohol-related harm, there is a lack of understanding of the factors influencing adults' use of these strategies. The present study assessed the frequency of enactment of a range of PBSs among Australian adults and identified factors associated with their use and the implications for alcohol harm minimization. A sample of 2,168 Australian drinkers (1,095 males and 1,073 females) recruited via a web panel provider completed an online survey that included items relating to quantity and frequency of alcohol consumption, beliefs about the health consequences of alcohol consumption, use of 5 specific PBSs (e.g., counting drinks and eating while drinking), and demographic characteristics. In general, use of these PBSs was negatively associated with overall alcohol consumption. However, usage rates were relatively low, especially among the heaviest drinkers. Refusing unwanted drinks and alternating between alcoholic and nonalcoholic beverages were identified as especially important strategies in the Australian context, accounting for a substantial proportion of the variance in alcohol consumption. Greater efforts to increase awareness and use of PBSs are warranted. In particular, the results suggest that information relating to the importance of refusing unwanted drinks and alternating between alcoholic and nonalcoholic beverages should be actively disseminated to the drinking public. In addition, the reliance on specified numbers of standard drinks in national drinking guidelines suggests encouraging drinkers to count their drinks should be a further focus of interventions given low reported prevalence of this behavior. (PsycINFO Database Record(c) 2016 APA, all rights reserved). Language: en

Background: There is a growing need for home-based palliative care services, especially for seriously ill individuals who want to avoid hospitalizations and remain with their regular outside care providers. Aim: To evaluate the effectiveness of Care Choices, a new in-home palliative care program provided by the Visiting Nurse Services of Northeastern New York and Ellis Medicine’s community hospital serving New York’s Capital District. Methods: This prospective cohort study assessed patient outcomes over the course of 1 year for 123 patients (49 men and 74 women) with serious illnesses who were new enrollees in the program. Quality of life was assessed at baseline and after 1 month on service. Satisfaction with care was measured after 1 and 3 months on service. The number of emergency department visits and inpatient hospitalizations pre- and postenrollment was measured for all enrollees. Results: Patients were highly satisfied (72.7%-100%) with their initial care and reported greater satisfaction ( P < .05) and stable symptom management over time. Fewer emergency department ( P < .001) and inpatient hospital admissions ( P < .001) occurred among enrollees while on the palliative care service. Conclusion: An in-home palliative care program offered jointly through a visiting nurse service and community hospital may be a successful model for providing quality care that satisfies chronically ill patients’ desire to remain at home and avoid hospital admissions.

Background: This study investigated Australian drinkers’ alcohol-related beliefs according to their alcohol risk status. The primary aims were to assess drinkers’ awareness of the association between alcohol consumption and a range of health consequences and their understanding of the degree of risk represented by their own alcohol consumption.Method: An online survey was administered to 2168 drinkers who consume alcohol at least twice per month. Respondents reported their alcohol intake levels and their beliefs relating to the relationship between alcohol and shorter-term (proximal) risks (e.g., drink-driving) and longer-term (distal) risks (e.g., stroke and cancer).Results: Just over half (52%) of those drinking at high or very high risk levels did not perceive their drinking to be harmful. A large majority (85%) of the sample was aware of various short-term risks of excessive alcohol consumption, but only half appeared aware of the association between alcohol consumption and more distal health ...

The Western Australian (WA) ‘LiveLighter’ (LL) mass media campaign ran during June–August and September–October 2012. The principal campaign ad graphically depicts visceral fat of an overweight individual (‘why’ change message), whereas supporting ads demonstrate simple changes to increase activity and eat healthier (‘how’ to change message). Cross-sectional surveys among population samples aged 25–49 were undertaken pre-campaign (N = 2012) and following the two media waves (N = 2005 and N = 2009) in the intervention (WA) and comparison state (Victoria) to estimate the population impact of LL. Campaign awareness was 54% after the first media wave and overweight adults were more likely to recall LL and perceive it as personally relevant. Recall was also higher among parents, but equal between socio-economic groups. The ‘why’ message about health-harms of overweight rated higher than ‘how’ messages about lifestyle change, on perceived message effectiveness which is predictive of health-related intention and behaviour change. State-by-time interactions showed population-level increases in self-referent thoughts about the health-harms of overweight (P < 0.05) and physical activity intentions (P < 0.05). Endorsement of stereotypes of overweight individuals did not increase after LL aired. LL was associated with some population-level improvements in proximal and intermediate markers of campaign impact. However, sustained campaign activity will be needed to impact behaviour.

Improvised explosive device detection (IDD) dogs explore up to 40 km of land daily and therefore have energetic demands that may be above the National Research Council’s requirement for working dogs. This study was designed to quantify metabolic energy intake (MEI) and total energy expenditure (TEE) in a group of IDD dogs. Two groups of dogs that had undergone different training protocols (CP1, n=8 and CP2, n=11) underwent a 5-day deployment simulation that consisted of combined road clearing, orbit and point-to-point activities and lasted approximately 9 h per day. The CP1 dogs were fed according to the IDD Marine Corps Manual, while CP2 dogs were offered additional calories based on pilot study data of energy expenditure. The MEI was calculated based on feed intake rates and chemical composition of the diets. TEE was quantified using the doubly-labelled water technique in 2 of the CP1 dogs and 7 of the CP2 dogs. During the 5-day deployment simulation the MEI ranged from 189-310 kcal/bodyweight (BW)0.75 per day, with the CP2 dogs at the higher end because they were offered more feed. The TEE ranged between 375-507 kcal/BW0.75 per day, above the MEI, suggesting the dogs were in negative energy balance and metabolic reserves within the body were combusted for energy production. These findings reveal that energy requirements of deployed military working dogs are higher than previously published metabolic energy requirements of working dogs.

Issue addressed Evaluation of the behavioural impact of Western Australia's LiveLighter healthy weight and lifestyle campaign focussed on decreasing consumption of sugar‐sweetened beverages (SSBs) using graphic imagery, as well as monitoring unintended consequences. Methods A cohort design with pre‐campaign telephone survey of Western Australian adults aged 25‐49 (Time 1 May/Jun 2013: N = 1504) undertaken and repeated following the campaign (Time 2 Aug/Sep 2013: N = 822). Results Post‐campaign awareness was 67% with respondents in low socio‐economic areas most likely to report viewing the campaign frequently. There was evidence of reduced SSB intake from baseline to follow‐up among frequent (4+/week) SSB consumers (22% cf. 16%; P = 0.003) and some evidence among overweight (BMI 25+) weekly SSB consumers (56% cf. 48%; P = 0.013). There was also some evidence consumption of sweet food decreased (3+/week: 53% cf. 48%; P = 0.035) while fruit, vegetable and fast food consumption remained stable. Knowledge of potential health consequences of SSBs increased (70% cf. 82%; P

Objective Transitioning to interactive e-textbooks has been considered revolutionary for enhancing student learning. However, adopting this technology has been met with hesitation. This study investigates student and faculty attitudes and utilization of mandatory e-textbooks in a dental hygiene program. Methods In 2017, an online questionnaire was distributed to students and a focus group was conducted with faculty to examine their perspectives about using VitalSource™. Using a 5-point Likert scale with five indicating strongly agree, the questionnaire examined convenience; compatibility with learning style; perceived enjoyment; and usefulness. Open-ended questions captured benefits and challenges. The focus group gathered faculty perspectives. Questionnaire data were analysed using descriptive statistics. Data from the open-ended questionnaire questions and focus group transcript followed a narrative analysis process. Results Survey response was 48% (n = 105). Students scored all factors below neutral. Results from four categories showed convenience (M = 2.75, SD = 0.92); compatibility (M = 1.93, SD = 0.83); perceived effectiveness (M = 2.15, SD = 0.90); and perceived usefulness (M = 2.36, SD = 1.04). A high correlation between all factors suggests they were uniformly rated by students. Majority of students (71%) did not use a textbook greater than once a month. Narrative analysis revealed few benefits; challenges included technical glitches, eyestrain, cost and inability to choose books as desired. Faculty's perspectives aligned with the students, but they appreciated portability of texts and quality of clinical images. Conclusions Students strongly disliked the platform and the online medium and do not frequently access e-textbooks but rely on PowerPoint handouts for studying. Faculty felt e-textbooks do not align with positive learning experiences.

OBJECTIVES—: To assess performance of shear wave elastography for evaluation of fibrosis and the histologic stage in patients with autoimmune liver disease (ALD) and to validate previously established advanced fibrosis cutoff values in this cohort. METHODS—: Shear wave elastography was performed on patients with ALD with an Aixplorer ultrasound system (SuperSonic Imagine, Aix-en-Provence, France) using an SC6–1 transducer. The median estimated tissue Young modulus was calculated from sets of 8 to 10 elastograms. A blinded, subspecialty-trained pathologist reviewed biopsy specimens. The METAVIR classification was used to stage liver fibrosis and necroinflammation. Steatosis was graded from 0 to 4+. The Kendall τ-b correlation test was performed to identify the correlation between the estimated tissue Young modulus and fibrosis, steatosis, and the necroinflammatory score. The Spearman correlation test was performed to identify the correlation between the estimated tissue Young modulus and clinical data. The diagnostic performance of shear wave elastography for differentiating METAVIR stage F2 or higher from F0 and F1 fibrosis was evaluated by a receiver operating characteristic (ROC) curve analysis. RESULTS—: Fifty-one patients with ALD were analyzed. The estimated tissue Young modulus was positively correlated with the fibrosis stage and necroinflammation score (r = 0.386; P < .001; r = 0.338; P = .002, respectively) but not steatosis (r = −0.091; P = .527). Serum aspartate aminotransferase, alanine aminotransferase, and total bilirubin values were positively correlated with the estimated tissue Young modulus (r = 0.501; P < .001; r = 0.44; P = .001; r = 0.291; P = .038). The serum albumin value was negatively correlated (r = −0.309; P = .033). The area under the ROC curve was 0.781 (95% confidence interval, 0.641–0.921) for distinguishing F2 or greater fibrosis from F0 and F1 fibrosis. Based on the ROC curve, an optimal cutoff value of 9.15 kPa was identified (sensitivity, 83.3%; specificity, 72.7%). CONCLUSIONS—: Shear wave elastography is a novel noninvasive adjunct to liver biopsy in evaluation and staging of patients with ALD, showing the potential for serial evaluations of disease progression and treatment responses.

ObjectiveFor more than 20 years, the FOODcents adult nutrition education programme has been delivered to Western Australians. The aim of the programme is to provide disadvantaged individuals with the knowledge, skills and motivation to buy healthy foods on a limited budget. The present study evaluated whether the FOODcents curriculum and the way it is delivered are effective in improving participants’ nutrition-related knowledge and behaviours.DesignEvaluation data were collected via in-session pre–post questionnaires and a post-course online questionnaire.SettingWestern Australia.SubjectsData were collected from participants attending just over one-half (54 %) of the FOODcents courses conducted over the two-year evaluation period. In total, 927 course participants provided usable data.ResultsAfter exposure to the course, respondents demonstrated an improved ability to: (i) categorize foods according to the frequency with which they should be consumed and the proportion of the food budget that should be allocated to them; (ii) correctly interpret nutrition labels on food products; and (iii) appreciate the link between diet/obesity and a range of diseases. Improvements in the latter were especially pronounced among participants of low socio-economic status. In terms of behaviour change, significant improvements in fruit and vegetable consumption were reported, along with reductions in the consumption of fast food. Participants of low socio-economic status reported the greatest changes.ConclusionsThe results indicate that the FOODcents nutrition education programme improves participants’ nutrition-related knowledge and behaviours.

ObjectiveTo examine demographic and behavioural correlates of unhealthy snack-food consumption among Australian secondary-school students and the association between their perceptions of availability, convenience and intake with consumption.DesignCross-sectional survey of students’ eating, physical activity and sedentary behaviours using validated instruments administered via an online questionnaire.SettingAustralian secondary schools across all states/territories.SubjectsSecondary-school students aged 12–17 years participating in the 2009–10 National Secondary Students’ Diet and Activity (NaSSDA) survey (n 12 188).ResultsApproximately one in five students (21 %) reported consuming unhealthy snack foods ≥14 times/week (‘frequent snackers’). After adjusting for all covariates, older students and those with a BMI of ≥25 kg/m2 were less likely to be frequent snackers, while students who reported high fast-food and high sugar-sweetened beverage consumption and those who watched television for >2 h/d were more likely to snack frequently. Furthermore, after adjusting for all covariates and demographic factors, students who agreed that snack foods are usually available at home, convenient to buy and that they eat too many snack foods were more likely to be snacking frequently. Conversely, students who agreed that fruit is a convenient snack were less likely to be frequent snackers.ConclusionsFrequent unhealthy snack-food consumption appears to cluster with other poor health behaviours. Perceptions of availability and convenience are factors most readily amenable to change, and findings suggest interventions should focus on decreasing the availability of unhealthy snack foods in the home and promoting healthier options such as fruit as convenient snacks.

Primary biliary cholangitis, previously called primary biliary cirrhosis, is a cholestatic autoimmune liver disease that is marked by the progressive lymphocytic destruction of the smallest intralobular bile ducts.1,2 In the absence of effective therapy, it progresses inexorably to cirrhosis and liver failure. Ursodiol, a hydrophilic bile acid with an excellent safety profile, was approved by the Food and Drug Administration (FDA) in 1988 for the dissolution of gallstones. On the basis of early promising data in the management of primary biliary cholangitis and the unmet clinical need, the FDA granted ursodiol orphan status in 1991 for the management of . . .

Primary sclerosing cholangitis (PSC) is a progressive autoimmune liver disease characterized by bile duct inflammation and fibrosis. Our understanding of PSC is shaped largely from populations in Europe and the US that almost exclusively included white patients of Northern European descent.1–5 In an ongoing NIH-sponsored PSC cohort study of 1,000 patients, only 5% of subjects are non-Caucasian.6 As a result, little is known about PSC in minority populations in the US, particularly patients of black race, and it is unknown if PSC is a rare disease in patients of black race, or reflects selection bias of sampled cohorts.

OBJECTIVES The primary aim of this study was to determine the impact of obesity on national rates of perioperative complications in women undergoing pelvic reconstructive surgery in 2013 in the United States. METHODS Women who underwent pelvic reconstructive surgery were identified in the 2013 National Inpatient Sample using International Classification of Diseases, Ninth Revision procedure codes. Demographic data and comorbidities including obesity (body mass index ≥30 kg/m) were abstracted. Perioperative complications and mortalities that occurred during the same admission were abstracted from the data set using International Classification of Diseases, Ninth Revision diagnosis codes. The complication rates were compared between obese and nonobese subjects. Univariate analysis was performed to determine factors associated with the primary outcome. Significant factors were included in the regression model to determine the adjusted odds ratio for perioperative complications in obese women. RESULTS A total of 16,639 women underwent pelvic reconstructive surgery in the 2013 National Inpatient Sample data set and were included in the analysis. Approximately 10% of the study cohort was obese. The overall perioperative complication rate during the surgical admission was 25%. On multivariate analysis, obesity was found to increase the odds of perioperative complications by approximately 40% after controlling for age, race, income, concomitant hysterectomy, and medical comorbidities (adjusted odds ratio, 1.40; 95% confidence interval, 1.24-1.58; P < 0.0001). CONCLUSIONS Obesity is an independent risk factor for perioperative complications in women who undergo pelvic reconstructive surgery. This information can be used for preoperative counseling and risk stratification.

Testing the effectiveness of warning statements designed to encourage healthy lifestyle behaviours is largely done by showing the messages to study participants in the absence of ‘real world’ social and physical contexts. This approach does not factor in the impact of the medium of the message. A virtual, 360-degree environment (Messaging360) was developed that online participants can explore and be exposed to messages in a variety of different social and physical contexts: through advertising in a newspaper, labels on products and from a small child and a doctor avatar. The platform allows for large numbers of participants to be tested in a way that models real-life contexts for the messages and so may represent a more effective way of assessing their impact in delivering the health information.

Background Using appropriate terminology in nutrition education programs and behaviour change campaigns is important to optimise the effectiveness of these efforts. To inform future communications on the topic of healthy eating, this study explored adults’ perceptions of the meaning of four terms used to describe unhealthy foods: junk food, snack food, party food, and discretionary food. Methods Australian adults were recruited to participate in an online survey that included demographic items and open-ended questions relating to perceptions of the four terms. In total, 409 respondents aged 25–64 years completed the survey. Results ‘Junk food’ was the term most clearly aligned with unhealthiness, and is therefore likely to represent wording that will have salience and relevance to many target audience members. Snack foods were considered to include both healthy and unhealthy food products, and both snack foods and party foods were often described as being consumed in small portions. Despite being used in dietary guidelines, the term ‘discretionary food’ was unfamiliar to many respondents. Conclusions These results demonstrate that different terms for unhealthy foods can have substantially different meanings for audience members. A detailed understanding of these meanings is needed to ensure that nutrition guidance and health promotion campaigns use appropriate terminology.

Seasonal influenza is a serious respiratory illness that causes annual worldwide epidemics resulting in significant morbidity and mortality. Influenza pandemics occur about every 40 yrs, and may carry a greater burden of illness and death than seasonal influenza. Both seasonal influenza and pandemic influenza have profound economic consequences. The combination of current vaccine efficacy and viral antigenic drifts and shifts necessitates annual vaccination. New manufacturing technologies in influenza vaccine development employ cell culture and recombinant techniques. Both allow more rapid vaccine creation and production. In the past 5 years, brisk, highly creative activity in influenza vaccine research and development has begun. New vaccine technologies and vaccination strategies are addressing the need for viable alternatives to egg production methods and improved efficacy. At present, stubborn problems of sub-optimal efficacy and the need for annual immunization persist. There is an obvious need for more efficacious vaccines and improved vaccination strategies to make immunization easier for providers and patients. Mitigating this serious annual health threat remains an important public health priority.

Literature describing dietary intakes of lactating mothers in the United States (US) is limited and none of the existing studies attempts to identify whether dietary shortcomings of lactating mothers are distinct from those of women of childbearing age in the US. The first objective of this observational study was to comprehensively analyze the dietary intakes of lactating mothers in the US to determine whether nutrient intakes from food were sufficient to meet recommendations. The second objective was to compare these intakes to those of women of childbearing age in the US. Weekly 3-day food records were collected from subjects for six weeks in 2012-2013. Subject mean daily intakes of food groups, macronutrients, vitamins, minerals, carotenoids, and specific fats including omega-3 and omega-6 fatty acids were determined and compared to daily recommendations. Intakes were compared to US women using the 2009-2010 National Health and Nutrition Examination Survey. Fruit, vegetable, and dairy intakes of mothers were ≤50% of recommendations, resulting in 12 of 26 analyzed vitamins or minerals including potassium, iodine, chromium, choline, and vitamins A, D, and E having mean daily intakes below the Estimated Average Requirement. Vitamin D intake of subjects was 18% lower than US women, while most other nutrients showed intakes within 10% of each other between populations. Lactating women are not meeting the increased dietary needs associated with breastfeeding, supporting education initiatives and interventions specifically tailored to breastfeeding populations to increase intakes of vitamin D, vitamin E, iodine, biotin, carotenoids, and polyunsaturated fatty acids from food.

To examine soft drink consumption across age, gender, socioeconomic, and body weight status groups within an adolescent and adult population.Cross-sectional telephone survey.Western Australian residents (n = 1,015) aged 16-65 years, selected through random dialing.Frequency and quantity of sugar-sweetened and diet soft drinks consumption, sociodemographic characteristics.The Kruskal-Wallis test of association for non-parametric data was used to explore differences in quantity of soft drinks consumed. Logistic regression models used to explore type of soft drinks consumed by sociodemographic factors and weight status.A greater proportion of females consumed no soft drinks (29.2%) or diet soft drinks only (20.9%), compared with males (21.7% and 14.0%, respectively) (P.05). The youngest (16-24 years) consumers of sugar-sweetened soft drinks consumed twice (median, 3 cups/wk) as much as the eldest (55-65 years) (1.5 cups/wk) (P.05). Respondents classified as overweight or obese were 1.7 times more likely to drink both sugar-sweetened and diet soft drinks compared with other respondents (P = .02).This study identified a high prevalence of soft drink consumption within the population (74.5%). These results identify young people (16-24 years of age), as well as males, as population groups to target through public health interventions to reduce soft drink consumption.

The purpose of this study was to determine if incorporation of a workflow in the electronic health record (EHR) that empowered medical assistants (MA) to become tobacco-cessation promoters, would increase tobacco documentation and referral for cessation counseling. MAs in three primary care centers were trained to ask every patient, at every visit, about tobacco use then document this status in the EHR. Patients ready to quit were electronically referred to the quitline for tobacco cessation counseling. Documentation of tobacco status, ongoing verification of tobacco use, and chief complaint recording was compared before and after the intervention. Logistic regression analysis indicated that after adjusting for differences between care centers, there were increased odds in initial documentation (OR = 1.52; 95% CI = 1.42 - 1.62) and ongoing verification (OR = 2.86; 95% CI = 1.42 - 1.62) in 2010 in comparison with 2009. Recording of tobacco cessation as the chief complaint in current smokers increased 91% (OR = 1.91; 95% CI = 1.56 - 2.34). Documentation and referrals for smoking cessation can be increased in organizations using EHR by empowering MAs to promote tobacco cessation and providing electronic referral options.

Objective To identify the features of a nutrition education programme for disadvantaged adults deemed most attractive and useful by participants. Design A two-year, multi-method, qualitative evaluation of pre and post data collected from programme participants. Data were imported into NVivo10 for coding to facilitate a thematic analysis. Setting Western Australia. Participants Individuals attending the Western Australian FOODcents nutrition education programme that is designed to provide knowledge and skills needed to consume a healthy diet on a budget. Focus groups were conducted several weeks after course completion (five groups, forty-seven participants), observations were conducted during FOODcents sessions (thirty-one observation episodes, 237 participants), and open-ended questions were asked in pre–post hard-copy surveys administered in sessions (n 927) and an online survey administered on average six weeks after course completion (n 114). Results The course attributes that were found to be especially important to participants were: (i) user-friendly, practical information that could be immediately translated to their daily lives; (ii) experiential learning that involved direct contact with food products; and (iii) opportunities for social interaction. These aspects of nutrition education were described as being highly influential in the decision to participate in the course, the application of the information in their subsequent food purchase and preparation activities, and their word-of-mouth communications with others about the course. Conclusions Incorporating aspects of most importance to participants into nutrition education programme delivery and promotion may increase joining rates, enjoyment, satisfaction with course content and, ultimately, the uptake of recommended behaviours.

To investigate alcohol consumption intentions among Australian women of childbearing age by pregnancy status.Three national online surveys were conducted with adult drinkers who consume an alcoholic beverage at least two days per month. Data from female respondents of childbearing age were analyzed according to pregnancy status: pregnant (n = 101), possibly pregnant (n = 178), and not pregnant (n = 1,957).Pregnant drinkers were significantly more likely than possibly pregnant and nonpregnant drinkers of child-bearing age to report that they should and will reduce their alcohol consumption. Results showed that 33% of the pregnant women, 32% of the nonpregnant women, and 39% of the possibly pregnant women reported intending to drink five or more standard drinks on a single occasion in the following two weeks. Older pregnant women exhibited higher rates of heavy drinking intentions and lower intentions to reduce their consumption relative to younger pregnant women.Despite current alcohol consumption guidelines recommending abstinence while pregnant, pregnant respondents exhibited heavy episodic drinking intentions comparable to those of their nonpregnant peers.There is a need to increase public awareness of current alcohol guidelines for pregnant women. Older women of childbearing age and those planning a pregnancy may require particular attention.