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Physician turnover has long been a problem in community mental health centers. While explanations for the problem have been offered, there have been no systematic studies of factors associated with the high turnover. In this study, the Minnesota Satisfaction Questionnaire and the Organizational Commitment Questionnaire were given to psychiatrists employed by a community mental health center. Subjects were also asked to identify their treatment ideology, and to rate their perception of the ideology of other clinicians and administrators with whom they work. Psychiatrists perceived significant differences in many ideological areas. Analysis demonstrated a correlation between these differences and the commitment of the psychiatrists to the organization. [ABSTRACT FROM AUTHOR]

Land carbon sink is a vital component for the achievement of China's ambitious carbon neutrality goal, but its magnitude is poorly known. Atmospheric observations and inverse models are valuable tools to constrain the China's land carbon sink. Space-based CO 2 measurements from satellites form an emerging data stream for application of such atmospheric inversions. Here, we reviewed the satellite missions that is dedicated to the monitoring of CO 2 , and the recent progresses on the inversion of China's land carbon sink using satellite CO 2 measurements. We summarized the limitations and challenges in current space platforms, retrieval algorithms, and the inverse modeling. It is shown that there are large uncertainties of contemporary satellite-based estimates of China's land carbon sink. We discussed future opportunities of continuous improvements in three aspects to better constrain China's land carbon sink with space-based CO 2 measurements., (© 2022 John Wiley & Sons Ltd.)

Preseason in rugby union is a period of intensive training where players undergo conditioning to prepare for the competitive season. In some cases, this includes modifying body composition through weight gain or fat loss. This study aimed to describe the macronutrient intakes of professional rugby union players during pre-season training. It was hypothesized that players required to gain weight would have a higher energy, carbohydrate and protein intake compared to those needing to lose weight. Twenty-three professional rugby players completed 3 days of dietary assessment and their sum of eight skinfolds were assessed. Players were divided into three groups by the team coaches and medical staff: weight gain, weight maintain and weight loss. Mean energy intakes were 3,875 ± 907 kcal·d -1 (15,965 ± 3,737 kJ·d -1 ) (weight gain 4,532 ± 804 kcal·d -1 ; weight maintain 3,825 ± 803 kcal·d -1 ; weight loss 3,066 ± 407 kcal·d -1 ) and carbohydrate intakes were 3.7 ± 1.2 g·kg -1 ·d -1 (weight gain 4.8 ± 0.9 g.kg -1 ·d -1 ; weight maintain 2.8 ± 0.7 g·kg -1 ·d -1 ; weight loss 2. 6 ± 0.7 g·kg -1 ·d -1 ). The energy and carbohydrate intakes are similar to published intakes among rugby union players. There were significant differences in energy intake and the percent of energy from protein between the weight gain and the weight loss group.

Social media contains a wealth of nutrition information and proposes a cost-effective, highly engaging platform to deliver nutrition information to athletes. This study used an online questionnaire to determine whether New Zealand athletes are using social media as a source of nutrition information and to understand perceptions of social media as a nutrition resource. Quantitative data were analyzed using t tests, chi-squared tests, and logistic regression analysis. Inductive thematic analysis was adopted for the qualitative data. From the 306 athletes who completed the questionnaire, 65% reported social media use for nutrition purposes in the past 12 months. Social media use was predicted by both athlete status and gender. Female athletes were more likely to have used social media for nutrition purposes (odds ratio = 2.7, 95% confidence interval [1.52, 4.62], p = .001) than males. Elite athletes were less likely to have used social media for nutrition (odds ratio = 0.44, 95% confidence interval [0.24, 0.83], p = .011) than recreational athletes. Athletes commonly used social media for practical nutrition purposes, including recipes and information about restaurants/cafes. Perceived advantages of social media as a nutrition resource included ease of access, well-presented information, personal connectedness, and information richness. Athletes' primary concern for obtaining nutrition information from social media was information unreliability.

N-acetylcysteine (NAC) supplementation may enhance performance and reduce soreness from acute, repeated-sprint, high-intensity exercise. Our aim was to investigate whether semi-elite rugby union athletes may benefit. In a randomized block design, 17 semi-elite male rugby players were assigned to receive either 1 g oral NAC ( n = 8) or placebo ( n = 9) for six days. The mean percentage effect of NAC on exercise performance was assessed through completion of a broken bronco exercise test on days 5 and 6 of supplementation. Players self-reported muscle soreness and tolerability to supplements using a modified Muscle Pain and Treatment Satisfaction Questionnaire throughout the supplement duration. NAC produced a likely beneficial performance effect on maximum shuttle sprint time (2.4%; 90% confidence limit ± 4.8%) but was unclear on total time during back-to-back broken bronco tests compared to placebo. NAC had a likely protective effect on subjective muscle soreness during days 1-4 of supplementation (-19% ± 27%) but a very likely harmful effect on days 5 and 6 of supplementation (71% ± 59%). Daily supplementation with 1 g of oral NAC for six days produced no adverse side effects, reduced muscle soreness after one bout of damaging exercise, but increased soreness following the second bout. The performance effects were generally unclear apart from maximal sprint time.

Rugby is a worldwide intermittent team sport. Players tend to be heavier than the majority of similar team sport athletes on whom the dietary guidelines have been developed. Therefore, the aim of the current review was to describe the intakes of rugby union players. Article databases were searched up to February 2017 and were included if they were published in English and reported dietary intakes of male rugby union players. Of the research articles identified, energy intakes were lower than two of three studies that reported intakes and expenditure, which would suggest the players were losing weight that is somewhat supported by the decreases in skinfolds seen during preseason. However, it should also be noted that there are errors in both the measurement of energy intakes and expenditure. Carbohydrate intakes ranged from 2.6 to 6.5 g·kg -1 ·day -1 , which is lower than the current relative to body mass recommendations; however, this would not be classed as a low-carbohydrate diet. The consistently low intakes of carbohydrate suggest that these intake levels maybe sufficient for performance, given the players greater body mass or there are errors in the measurements. However, there is currently no evidence for the carbohydrate needs of rugby union players in terms of performance. The lower intakes than expenditure would suggest the players were losing weight. Previous research shows that rugby union players lose body fat during preseason training.

Background: To determine athletes perceived and measured indices of fluid balance during training and the influence of hydration strategy use on these parameters., Methods: Thirty-three professional rugby union players completed a 120 minute training session in hot conditions (35°C, 40% relative humidity). Pre-training hydration status, sweat loss, fluid intake and changes in body mass (BM) were obtained. The use of hydration assessment techniques and players perceptions of fluid intake and sweat loss were obtained via a questionnaire., Results: The majority of players (78%) used urine colour to determine pre-training hydration status but the use of hydration assessment techniques did not influence pre-training hydration status (1.025 ± 0.005 vs. 1.023 ± 0.013 g . ml -1 , P = .811). Players underestimated sweat loss (73 ± 17%) to a greater extent than fluid intake (37 ± 28%) which resulted in players perceiving they were in positive fluid balance (0.5 ± 0.8% BM) rather than the measured negative fluid balance (-1.0 ± 0.7% BM). Forty-eight percent of players used hydration monitoring strategies during exercise but no player used changes in BM to help guide fluid replacement., Conclusion: Players have difficulty perceiving fluid intake and sweat loss during training. However, the use of hydration monitoring techniques did not affect fluid balance before or during training.

Objective: This study aims to compare survival from breast, colon, lung, ovarian and rectal cancer by geographical remoteness in New South Wales (NSW)., Design: Retrospective population-wide registry study., Setting: NSW, Australia., Participants: A total of 107 060 NSW residents, who were diagnosed with any of the five cancers between 01 January 2000 and 31 December 2008., Main Outcome Measures: Kaplan-Meier survival curves and proportional hazards regression were used to compare survival by geographical remoteness of residence at diagnosis, controlling for gender, age and extent of disease at diagnosis. Remoteness was classified using standard definitions: major city, inner regional (InnReg), outer regional (OutReg) and remote (including very remote)., Results: Significant differences in survival (likelihood of death) were identified in all five cancers: breast (adjusted hazard ratio(HR) = 1.22 (95% confidence interval (CI), 1.001-1.48) in regionalised and HR = 1.30 (1.02-1.64) in metastatic disease for OutReg areas); colon (HR = 1.14 (1.01-1.29) for OutReg areas in metastatic disease); lung (HR range = 1.08-1.35 (1.01-1.48) for most non-metropolitan areas in all stages of disease excepting regionalised); ovarian (HR = 1.32 (1.06-1.65) for OutReg areas in metastatic disease, HR = 1.40 (1.04-1.90) for InnReg areas and HR = 1.68 (1.02-2.77) for OutReg areas in unknown stage of disease) and rectal (HR = 1.37 (1.05-1.78) for OutReg areas in localised and HR = 1.14 (1.002-1.30) for InnReg areas in regionalised disease). Where significant differences were found, major cities tended to show the best survival, whereas OutReg areas tended to show the worst. Although no definitive interpretation could be made regarding remote areas due to small patient numbers, their survival appeared relatively favourable., Conclusions: Reasons that contribute to the differences observed and the disparate results between cancer types need to be further explored in order to facilitate targeted solutions in reducing survival inequality between NSW regions., (© 2015 National Rural Health Alliance Inc.)

Objective: To investigate opportunities to reduce lung cancer mortality after diagnosis of localised non-small cell lung cancer (NSCLC) in New South Wales through surgical resection., Design, Patients and Setting: In this cohort study, resection rates and lung cancer mortality risk were explored using multivariate logistic regression and competing risk regression, respectively. Data for 3040 patients were extracted from the NSW Central Cancer Registry for the diagnostic period 1 January 2003 to 31 December 2007. Subset analyses for patients at low surgical risk indicated resection rates and outcomes under ideal circumstances., Main Outcome Measures: Resection rates and lung cancer mortality., Results: The resection rate in NSW was estimated to be between 38% and 43%, peaking at 59% by local health district (LHD) of residence. Not having a resection was associated with older age, lower socioeconomic status, lack of private health insurance, and residence by LHD. Adjusted 5-year cumulated probabilities of death were 76% in absence of resection, 30% for wedge resection, 18% for segmental resection, 22% for lobectomy and 45% for pneumonectomy. Of 255 "low surgical risk" patients, 71% had a resection. Those not receiving a resection had a higher probability of death (adjusted subhazard ratio, 14.1; 95% CI, 7.2-27.5). If the low overall resection rate of 38%-43% in NSW were increased to 59% (the highest LHD resection rate), the proportion of all patients with localised NSCLC dying of NSCLC in the 5 years from diagnosis would decrease by about 10%, based on differences in probabilities of death by resection estimated in this study., Conclusions: Potential exists to reduce deaths from NSCLC in NSW through increased resection.

Background: Sun safety and vitamin D status are important for prolonged health. They are of particular interest to those working with athletes for whom for whom safe sun practices maybe limited. The aim of this cross-sectional study was to describe the attitudes of elite New Zealand athletes to both vitamin D and sun exposure., Methods: 110 elite New Zealand outdoor athletes volunteered to participate in an interview with a trained interviewer. The interviewer asked the athletes questions on their Vitamin D knowledge, attitudes and practices regarding sun exposure as well as their concerns about skin cancer., Results: Athletes were more concerned about their risk of skin cancer (66%) than their vitamin D status (6%). Although the majority (97%) were aware of Vitamin D and could identify the sun as a source (76%) only 17% could name another source of Vitamin D. Only 10 (9%) reported always applying sunscreen before going out in the sun. No athlete reported reapplying sunscreen every hour and 25 suggesting that they never reapply sunscreen., Conclusions: Athletes are concerned about skin cancer however, their use of sunscreen is not optimal suggesting reapplication of sunscreen could be targeted in order to reduce the risk of sun cancer. Awareness of sources of Vitamin D other than the sun may also need to be improved potentially through educational interventions and possibly in conjunction with sun smart messages.

The purpose of this study was to compare fluid balance between a resistance and an aerobic training sessions, in elite rugby players. It is hypothesized that resistance exercise will result in a higher prevalence of overdrinking, whereas during the aerobic session, underdrinking will be more prevalent. As with previous fluid balance studies, this was an observational study. Twenty-six players completed the resistance training session, and 20 players completed the aerobic training session. All players were members of an elite rugby union squad competing in the southern hemisphere's premier competition. For both sessions, players provided a preexercise urine sample to determine hydration status, pre- and postexercise measures of body mass, and blood sodium concentration were taken, and the weight of drink bottles were recorded to calculate sweat rates and fluid intake rates. Sweat patches were positioned on the shoulder of the players, and these remained in place throughout each training session and were later analyzed for sodium concentration. The percentage of sweat loss replaced was higher in the resistance (196 ± 130%) than the aerobic training session (56 ± 17%; p = 0.002). Despite this, no cases of hyponatremia were detected. The results also indicated that more than 80% of players started training in a hypohydrated state. Fluid intake seems to differ depending on the nature of the exercise session. In this group of athletes, players did not match their fluid intakes with their sweat loss, resulting in overdrinking during resistance training and underdrinking in aerobic training. Therefore, hydration strategies and education need to be tailored to the exercise session. Furthermore, given the large number of players arriving at training hypohydrated, improved hydration strategies away from the training venue are required.

Introduction: Resection remains the standard treatment for curable oesophageal cancer. By linking the NSW Central Cancer Registry (CCR) and the NSW Admitted Patient Data Collection (APDC) databases, mortality, post-resection complication and survival associated with oesophagectomy were investigated., Methods: All patients diagnosed with oesophageal cancer from 2000 to 2005 as recorded in the CCR (n = 2,082) were linked with records in the APDC, giving a total of 17,205 episodes of care. Over 15% (n = 321) of all patients underwent an oesophagectomy., Results and Discussion: The overall 30-day mortality rate following resection was 3.7%, ranging from 2.6% in high volume hospitals to 6.4% in low volume hospitals. Three-year absolute survival for localised-regional disease following oesophagectomy was 64% (95%CI 54-73%) in high-volume hospitals, 58% (95%CI 46-68%) in mid-volume and 45% (95%CI 23-65%) in low-volume hospitals. The post-resection complication rate was 19% (95%CI 13-26%) for high-volume hospital, 24% (95%CI 13-40%) in low-volume and 31% (95%CI 22-41%) in mid-volume hospitals., Conclusion: Oesophagectomy in NSW is performed with satisfactory results. However, there is a suggestion that higher- rather than lower-volume hospitals have better post-resection outcomes.

Following linkage between the NSW Central Cancer Registry (CCR) and the NSW Midwives Data Collection, an investigation of the association between maternal smoking during pregnancy and the risk of childhood cancer in their offspring was undertaken. Children born in NSW between 1994 and 2005, inclusive of 1,045,966 babies, were matched to 948 cancer cases in the CCR. After adjustment for maternal age, gestational age, baby's gender, birth weight, remoteness index, socioeconomic disadvantage and maternal health factors, no association (OR = 0.96, 95% CI 0.81-1.15, p = 0.68) was found with childhood cancer between mothers who smoked (81/100,000) and those who did not smoke during pregnancy (99/100,000). Maternal smoking was, however, significantly associated with retinoblastoma (OR = 2.20, 95% CI 1.19-4.09, p = 0.01). Association between maternal smoking and preterm birth and low birth weight was significant. Maternal smoking during pregnancy is significantly associated with retinoblastoma and adverse birth outcomes. These results should be highlighted to expectant mothers through antitobacco-smoking campaigns.

Objective: To investigate trends in the incidence of adenocarcinoma (AC) of the oesophagus in New South Wales, factors associated with a diagnosis of AC, and factors associated with survival of patients with AC., Design and Setting: We examined all cases of invasive oesophageal cancer recorded in the NSW Central Cancer Registry from 1972 to 2005. The Accessibility/Remoteness Index of Australia was used to assess geographical remoteness and the Index of Relative Socio-Economic Disadvantage to assess socioeconomic status., Main Outcome Measures: Incidence of AC; factors associated with diagnosis of AC and survival of patients with AC., Results: The overall incidence of oesophageal AC in NSW increased in both males and females (annual percentage change, 4.2% [95% CL, 2.7%, 5.8%] in males [1988-2005] and 4.3% [95% CL, 1.8%, 7.0%] in females [1983-2005]). A diagnosis of AC was significantly associated with being male (adjusted odds ratio [AOR], 4.37 [95% CL, 3.84, 4.98]; P < 0.001); a younger age at diagnosis (P trend < 0.001); having distant rather than localised disease spread (AOR, 2.12 [95% CL, 1.82, 2.48]; P < 0.001); higher socioeconomic status (P trend < 0.001); and living in an inner regional area (AOR, 1.26 [95% CL, 1.11, 1.43]; P < 0.001) or outer regional area (AOR, 1.19 [95% CL, 1.00, 1.41]; P = 0.05) compared with a major city. Early diagnosis of AC was associated with substantial improvement in survival outcomes: patients with metastatic disease at diagnosis had a three times greater risk of dying than those with localised AC at diagnosis., Conclusion: The incidence of AC is increasing in NSW. Possible contributing factors include increasing obesity, which is associated with increased incidence of gastro-oesophageal reflux disease. Survival may be improved by diagnosis at an earlier stage and changes in modifiable risk factors (eg, smoking, diet, exercise).

Objective: To describe a data artefact in degree-of-spread at first presentation in the New South Wales Central Cancer Registry (NSW CCR), the only Australian cancer registry that records degree-of-spread data for all solid tumours., Method: Trends in the proportions of cancer cases diagnosed annually over 1972-2004 by degree-of-spread categories of localised, regional, distant and unknown were calculated for each major cancer type., Results: Excepting breast cancer and melanoma, the proportion of localised cancer cases reported from 1993-1998 was approximately 5% lower than expected, and was mirrored by an artefactual increase in unknown degree-of-spread cases., Conclusion: This artefact was caused by the introduction of the Electronic Notification System and cannot easily be remedied retrospectively. However, regional and distant categories of degree-of-spread in the NSW CCR data are reliably recorded for the 1972-2004 period., Implications: It is important that past and present cancer data users are notified and understand the quality issues with NSW CCR degree-of-spread data, and use it as recommended to avoid anomalous results or conclusions.

The African continent has a large and growing role in the global carbon cycle, with potentially important climate change implications. However, the sparse observation network in and around the African continent means that Africa is one of the weakest links in our understanding of the global carbon cycle. Here, we combine data from regional and global inventories as well as forward and inverse model analyses to appraise what is known about Africa's continental-scale carbon dynamics. With low fossil emissions and productivity that largely compensates respiration, land conversion is Africa's primary net carbon release, much of it through burning of forests. Savanna fire emissions, though large, represent a short-term source that is offset by ensuing regrowth. While current data suggest a near zero decadal-scale carbon balance, interannual climate fluctuations (especially drought) induce sizeable variability in net ecosystem productivity and savanna fire emissions such that Africa is a major source of interannual variability in global atmospheric CO2. Considering the continent's sizeable carbon stocks, their seemingly high vulnerability to anticipated climate and land use change, as well as growing populations and industrialization, Africa's carbon emissions and their interannual variability are likely to undergo substantial increases through the 21st century.

Setting and Objective: We assessed the relative effects of age, gender, period of death and birth cohort on asthma mortality rates in Australia from 1907 to 2000., Design: Asthma mortality data obtained from the Australian Institute of Health and Welfare were adjusted for changes to the International Classification of Diseases and examined for changes over time and age, period and cohort effects., Results: Age-adjusted period asthma mortality rates indicated epidemics during the mid 1960s and 1980s, predominantly affecting those aged 5-34 years. The main 1960s epidemic coincided with the introduction of high-dose, non-selective beta-sympathomimetic amines. There was a gradual rise in mortality rates in younger age groups, with rates rising from 0.5/100 000 males and 0.9/100 000 females in the 1940s to a peak of 3/100 000 for both sexes in 1966. Fluctuations in mortality rates were influenced by period of death and birth cohort. There was an increased risk of death from asthma with increasing age., Conclusion: There was no overall trend in asthma mortality rates in any age group. The 1960s epidemic was probably treatment related. Other increases in mortality occurring despite therapeutic advances may reflect increasing prevalence and highlight the need for ongoing surveillance.

Objective: To investigate a multi-state outbreak of Salmonella bredeney., Design: Case interviews followed by an age and neighbourhood matched case control study., Participants: People with laboratory-confirmed S. bredeney and controls matched on age and geographical location in New South Wales, the Australian Capital Territory, Queensland and Victoria., Results: We identified 157 persons with S. bredeney spread throughout the eastern states and the ACT. In the matched analysis, cold meat and chicken demonstrated a significant odds ratio of 4.4 (p = 0.017) and 4.2 (p = 0.02) respectively. Among primary cases, the odds ratio for chicken was 6.0 (p = 0.01) and for ground pepper was 3.75 (p = 0.04)., Conclusions: The most likely source of this outbreak was a product contaminated at the point of manufacture and distributed widely within NSW and the ACT and, to a lesser extent, Queensland (Brisbane) and Melbourne. The most probable food is a meat or chicken product, followed by substantial cross contamination of other meat products at retail outlets, which served to amplify the outbreak.