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The single-arm, open-label, multicenter, phase II Apa-RP study evaluates the biochemical recurrence (confirmed prostate-specific antigen [PSA] 0.2 ng/mL)-free rate in patients with high-risk localized prostate cancer (HR-LPC) after radical prostatectomy following adjuvant apalutamide and androgen-deprivation therapy. In this substudy, relugolix, an oral gonadotropin-releasing hormone antagonist, was evaluated in combination with apalutamide.The aim of this study was to evaluate whether the approved standard maintenance dose of relugolix in combination with apalutamide sustains castrate testosterone levels ( 50 ng/dL).Twelve patients with HR-LPC who met all the main study criteria were included in the substudy. Patients received relugolix monotherapy for 2 weeks (loading dose [360 mg] at Day - 14 then 120 mg/day daily until Day - 1), then daily relugolix (120 mg) with apalutamide (240 mg) from Day 1 to Day 28. Endpoints were rate of maintained castration (testosterone 50 ng/dL) through Day 28 (primary) and safety (secondary).All 12 patients received relugolix and apalutamide and achieved castrate testosterone levels after 2-week relugolix monotherapy (median testosterone 348.5 ng/dL and 8.7 ng/dL at Days - 14 and - 1). All 11 patients who had testosterone measured at Day 28 maintained castrate testosterone (median 10.0 ng/dL) without relugolix dose adjustment. Treatment-emergent adverse events (TEAEs) occurred in nine patients during relugolix monotherapy and in eight patients during relugolix + apalutamide coadministration. Hot flush was the most common TEAE reported, in six and four patients, respectively.Relugolix administered at approved standard doses concurrently with apalutamide was effective in maintaining castrate testosterone levels in HR-LPC without new safety signals.NCT04523207, 21 August 2020.The Apa-RP study evaluates the combination of apalutamide with drugs that lower male sex hormones for reducing the risk of prostate cancer recurrence. Patients in this study had their prostate gland surgically removed and were at high risk for disease recurrence. Relugolix, a newly approved oral drug for advanced prostate cancer, lowers blood testosterone (the primary male sex hormone) and, in combination with apalutamide, may reduce the risk of prostate cancer recurrence. The Apa-RP substudy goal was to test whether relugolix lowers blood testosterone and maintains these low levels when administered with apalutamide. Researchers looked at the testosterone levels of 12 patients with early prostate cancer who received standard doses of relugolix alone for 2 weeks followed by apalutamide and relugolix for an additional 28 days. Testosterone was measured before and after 2 weeks of relugolix treatment, and then again 28 days after apalutamide was added. All 12 substudy patients achieved low testosterone levels ( 50 ng/dL) after 2 weeks of relugolix treatment. Testosterone was measured at Day 28 of relugolix + apalutamide treatment in 11 patients, all of whom maintained low testosterone without adjustment of their relugolix dose. Adverse effects were consistent with those previously reported for each drug when administered alone. All 12 patients completed the substudy and moved onto the main study, the longer-term results of which will be reported in the future. In summary, relugolix administered at the same time as apalutamide was effective in maintaining low testosterone levels in patients with prostate cancer, without any new safety concerns.

BACKGROUND: Due to the rising rates of obesity in the United States, healthcare professionals will likely be seeing individuals from this population more frequently in service provision settings. OBJECTIVE: The purpose of this study was to examine the effectiveness of a self-directed online education program entitled BOOTH: Bariatrics, Obesity, and Occupational THerapy; How we can help. The educational program was directed to occupational therapy practitioners and occupational therapy students and designed to increase knowledge of obesity and bariatric care. METHODS: A convergent parallel mixed methods design was used in which the quantitative component was a one-group quasi-experiment with pre- and post-measurement. Surveys with Likert-style rating and open-ended questions were administered prior to the program and following completion. RESULTS: Paired samples t-testing revealed significant differences (p

In the last 15 years, demand has surged among college students for mental health care and many campuses are struggling to keep up with the demand for services. Primary care services represent a pathway where individuals can receive mental health care without accessing specialty mental health services. There is evidence that integrating mental health services into primary care can reduce racial disparities in access to mental health care and provide greater access to mental health care for underserved persons. This paper describes the development and implementation of a fully integrated model of mental health care services into Xavier University's (XU) primary care clinic. In partnership with TriHealth, a local healthcare provider, and following the primary care behavioral care model, XU integrated supervised psychology doctoral students as behavior health consultants into a campus primary care clinic. Administrative, clinical care, and training processes together with preliminary findings and recommendations are shared.

Study ObjectivesWhile caregiver-reported sleep disturbances are common in children and adolescents with autism spectrum disorder ([‘), few studies have measured objective sleep in ASD compared to controls, and their findings are mixed. We investigated (1) differences in sleep architecture, specifically slow-wave sleep (SWS) and rapid eye movement (REM) sleep, between ASD and typically developing controls (TD); and (2) if any observed differences in sleep were associated with core ASD symptoms.MethodsWe used ambulatory polysomnography (PSG) in 53 participants with ASD (ages 4–18) and 66 age-matched TD in their home sleeping environment. The primary outcome measures were SWS and REM sleep. Core behavioral ASD symptoms were assessed using the Autism Diagnostic Interview-Revised (ADI-R). Spectral power bands during sleep, and additional behavioral measures, were examined in exploratory analyses.ResultsCompared to TD, participants with ASD exhibited a higher SWS ratio and lower REM sleep ratio. Within the ASD group, higher SWS was associated with more severe symptoms on the Restricted, Repetitive, and Stereotyped Behaviors subscale of the ADI-R. No association was observed between REM sleep ratio and any ASD symptom.ConclusionsIncreased SWS and reduced REM sleep ratio differentiated ASD from TD. However, only increased SWS was associated with more severe core ASD symptoms. Increased SWS may reflect neuronal immaturity specific to ASD in this age group. These findings may inform the underlying mechanisms of clinical symptoms observed in children and adolescents with ASD.

Introduction High rates of physician burnout are well documented in the USA. Identifying beneficial leadership behaviors as an organizational approach to mitigating burnout can lead to improved wellness in the physicians that they lead; however, few studies have examined which leadership behaviors are beneficial and which may be detrimental. Materials and Methods This survey study of academic medical center physicians and their physician leaders assessed the correlation between burnout and leadership behaviors. Data were analyzed for the strength of correlation between scores for leadership behaviors and self-reported physician burnout with analysis of variance by sex, time from training, specialty, and age. Results Of 1,145 physicians surveyed, 305 returned surveys. Among the respondents, 45% were female, 25% were 56 years or older, and 57% self-identified as practitioners of medicine or medicine subspecialties. Two transformational leadership categories of behaviors (idealized influence behaviors and individualized consideration) and one transactional leadership behavior category (contingent reward) correlated favorably with all domains of burnout (P Conclusions Organizational interventions are needed to improve burnout in physicians. Adopting favorable leadership behaviors while avoiding unfavorable leadership behaviors can improve burnout in those physicians being led. These findings could inform the conceptual basis of future physician leadership training programs as transactional leadership behaviors also have an impact on physician wellness.

Suicide attempt is highly prevalent in treatment-resistant depression (TRD), however, the neurobiological profile of suicidal ideation versus suicide attempt is unclear. Neuroimaging methods including diffusion MRI (dMRI) based free water imaging may identify neural correlates underlying the progression from suicidal ideation to attempts in individuals with TRD. dMRI data were obtained from 64 participants, including 39 patients with TRD (n=21 suicide ideators and n=18 suicide attempters), and 25 age- and sex-matched healthy controls. Depression and suicidal ideation severity were examined using clinician-rated and self-report measures. Whole-brain analysis of neuroimaging data was conducted using tract-based spatial statistics via FMRIB Software Library to identify between-group differences in white matter microstructural integrity in suicide ideators versus attempters, and in patients with TRD versus controls. Free water imaging revealed elevated axial diffusivity (AD) and extracellular free water (FW) in fronto-thalamo-limbic white matter tracts of suicide attempters compared to ideators (thresholded p

A formal screening of self-complementary adeno-associated virus (scAAV) vector serotypes in canine joint tissues has not been performed to date. Selecting appropriate serotypes is crucial for successful treatment due to their varying levels of tissue tropism. The objective of this study is to identify the most optimal scAAV vector serotype that maximizes transduction efficiencies in canine cell monolayer cultures (chondrocytes, synoviocytes, and mesenchymal stem cells) and tissue explant cultures (cartilage and synovium). Transduction efficiencies of scAAV serotypes 1, 2, 2.5, 3, 4, 5, 6, 8, and 9 were evaluated in each culture type in three different vector concentrations by encoding a green fluorescent protein. It was found that scAAV2 and 2.5 showed the overall highest transduction efficiency among serotypes with dose-response. Since possible immune response against conventional AAV2 was previously reported in dogs, the chimeric scAAV2.5 may be more suitable to use. Evaluation of the safety and efficacy of the scAAV2.5 vector with an appropriate therapeutic gene in vivo is indicated.

Background and aims The literature demonstrates that hepatic steatosis reduces the tolerance of immunosuppression in people with inflammatory bowel disease. It also shows that elevated methylmercaptopurine may be responsible for thiopurine-induced hepatitis. This exploratory study investigates the relationship between hepatic steatosis, methylmercaptopurine and alanine transaminase.Methods We performed a retrospective review of patients started on azathioprine treatment at University Hospitals Bristol NHS Foundation Trust between 2014 and 2017. There were 600 patients in total. Ninety-one patients met our inclusion criteria which were at least one ultrasound scan commenting on the appearance of the liver, liver function tests at commencement of azathioprine and liver function tests and a methylmercaptopurine level between 6 and 8 weeks after starting treatment.Results Of 91 patients included in our study, 32 patients (32%) were identified as having radiological hepatic steatosis on ultrasound imaging and 59 patients had no evidence of steatosis. We found a positive association between methylmercaptopurine levels and change in alanine transaminase in patients with hepatic steatosis (P Conclusion We conclude that the higher levels of methylmercaptopurine may be a risk factor for hepatitis in patients with hepatic steatosis but not in those with a normal liver.

While inherited and de novo copy number variants (CNV) have been implicated in the genetic architecture of schizophrenia (SCZ), the contribution of somatic CNVs (sCNVs), present in some but not all cells of the body, remains unknown. Here we explore the role of sCNVs in SCZ by analyzing blood-derived genotype arrays from 12,834 SCZ cases and 11,648 controls. sCNVs were more common in cases (0.91%) than in controls (0.51%, p = 2.68e-4). We observed recurrent somatic deletions of exons 1-5 of the NRXN1 gene in 5 SCZ cases. Allele-specific Hi-C maps revealed ectopic, allele-specific loops forming between a potential novel cryptic promoter and non-coding cis regulatory elements upon deletions in the 5’ region of NRXN1. We also observed recurrent intragenic deletions of ABCB11, a gene associated with anti-psychotic response, in 5 treatment-resistant SCZ cases. Taken together our results indicate an important role of sCNVs to SCZ risk and treatment-responsiveness.

The S209F variant of Abelson Interactor Protein 3 (ABI3) increases risk for Alzheimer’s disease (AD), but little is known about ABI3 function. RNAscope showed Abi3 is expressed in microglial and non-microglial cells, though its increased expression appears to be driven in plaque-associated microglia. Here, we evaluated Abi3-/- mice and document that both Abi3 and its overlapping gene, Gngt2, are disrupted in these mice. Expression of Abi3 and Gngt2 are tightly correlated, and elevated, in rodent models of AD. RNA-seq of the Abi3-Gngt2-/- mice revealed robust induction of an AD-associated neurodegenerative signature, including upregulation of Trem2, Plcg2 and Tyrobp. In APP mice, loss of Abi3-Gngt2 resulted in a gene dose- and age-dependent reduction in Aβ deposition. Additionally, in Abi3-Gngt2-/- mice, expression of a pro-aggregant form of human tau exacerbated tauopathy and astrocytosis. Further, the AD-associated S209F mutation alters the extent of ABI3 phosphorylation. These data provide an important experimental framework for understanding the role of Abi3-Gngt2 function in AD. Our studies also demonstrate that manipulation of glial function could have opposing effects on amyloid and tau pathology, highlighting the unpredictability of targeting such pathways in AD.

PurposeFemale faculty and students could be affected by stressors disproportionately compared to male counterparts, especially those with children or family obligations. A study was undertaken to determine: 1) stress levels of pharmacy faculty and first-year pharmacy students; 2) whether gender affected faculty and/or student stress levels disproportionally; and 3) how child and family care responsibilities influenced stress levels.MethodsAll first-year (P1) students enrolled in a College of Pharmacy were surveyed along with faculty. Stress levels were assessed using the Perceived Stress Scale (PSS10). Additional demographic information, including items related to children and family obligations, was collected.ResultsFaculty reported average perceived stress levels (M=15.50) while first-year students reported high perceived stress levels (M=21.14). Perceived stress levels of female faculty (M=16.43) were higher than those of male faculty (M=12.00). Perceived stress levels of female students (M=22.60) were higher than those of male students (M=16.78). Perceived stress levels of female faculty with younger children (M=18.85) were higher than those of male faculty with younger children (M=9.67). Perceived stress levels of female students with ≥10 hours of family obligations per week (M=22.71) were higher than male pharmacy students with ≥10 hours (M=12.80).ConclusionLower levels of perceived stress for faculty compared to students may be due to the development of coping strategies coinciding with maturity. Results suggest more time spent on family obligations is negatively associated with stress levels for females, but not males. Colleges of pharmacy should invest resources to help reduce stress levels in faculty and student populations, particularly for the female gender.

Virtual reality, augmented reality, and other forms of virtual environments have the potential to dramatically change how individuals work, learn, and interact with each other. A key objective of human factors research and practice is to determine how these environments should be designed to maximize performance efficiency, ensure health and safety, and circumvent potential human virtual environment interaction problems. This session will demonstrate some of the distinct and diverse uses of virtual reality, mixed reality, and virtual environments in an alternative format. The session will begin with each demonstrator providing a brief overview of their virtual environment and describing how it has been used to address a particular problem or research need. Following the description portion of the session, all demonstrations will be set-up around the room, and session attendees will be encouraged to directly interact with the environment and ask demonstrators questions about their research and inquire about the effectiveness of using their virtual environment for research, training, and evaluation purposes. The overall objective of this alternative session is to provoke ideas among the attendees for how virtual reality, mixed reality, and virtual environments can help address their research, training, education or business needs.

Background: Airway clearance techniques (ACTs) are recommended for people with bronchiectasis both in stable state and during an acute exacerbation. Research has previously investigated ACTs for in...

ACPE defines personal and professional development as an expected outcome of the Doctor of Pharmacy degree program, but there is scarce data in the literature discussing methods for systematically addressing these concepts in curricula. This paper describes the development and attributes of a four-year professional development course sequence within a college of pharmacy designed to develop students’ knowledge, skills, abilities, behaviors, and attitudes necessary to demonstrate self-awareness, leadership, innovation and entrepreneurship, and professionalism through their life-long career. Each course has at least one required activity addressing each of the four elements of Standard 4. The continuous professional development framework is used as a backbone to the course sequence structure, utilizing the four elements of CPD—reflect, plan, act, evaluate. Article Type: Note

Background Airway clearance techniques are recommended for individuals with bronchiectasis both in stable state and during an acute exacerbation, however the current use of airway clearance techniques in the management of individuals during an acute exacerbation is unclear. The aims of this study were to establish what current physiotherapy clinical practice comprises for adults and paediatrics during an acute exacerbation of bronchiectasis; identify physiotherapist’s perceptions of the effectiveness of airway clearance techniques and identify what factors influence their treatment decisions in this population. Methods An anonymous online survey was distributed to the members of the Australian Physiotherapy Association and Physiotherapy New Zealand between August 2016 and April 2017. Results The survey was accessed by 130 physiotherapists and 121 of those deemed themselves eligible and consented to participate. Most participants (89%) reported prescribing airway clearance techniques for 81–100% of individuals during an acute exacerbation of bronchiectasis. The most commonly used airway clearance techniques with adults were huffing (92%), exercise (89%) and the active cycle of breathing technique (89%). The techniques perceived most effective for adults were physical exercise (100%), oscillating positive expiratory pressure devices (97%), directed huffing (95%) the active cycle of breathing technique (90%) and positive expiratory pressure (90%). The most commonly used airway clearance techniques for paediatric patients were: newborn-3 years - percussion (85%) and modified postural drainage (85%); 4–10 years - huffing (100%) and exercise (85%); 11–18 years - huffing (92%) and exercise (77%), active cycle of breathing technique (77%) and positive expiratory pressure therapy (77%). The techniques perceived most effective for paediatric patients were directed huffing (100%), percussion (100%) and positive expiratory pressure via a mask or mouthpiece (93%). The most commonly reported factors influencing choice of technique were patient clinical presentation (72%) and the presence/absence of contra-indications (72%). Conclusion This survey demonstrates that airway clearance techniques are routinely used as part of physiotherapy management of individuals experiencing an acute exacerbation of bronchiectasis, and that choice of technique and perceived effectiveness varies depending on the age of the patient.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. \ud \ud \ud METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. \ud \ud \ud FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. \ud \ud \ud INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. \ud \ud \ud FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca.

This paper contributes to the literature on the determinants of environmental standards by studying the role of income inequality and freedom of the press. Given that evidence of the environmental Kuznets curve has only been found for some countries, it is thus crucial to investigate whether other factors besides income per capita levels may be affecting countries' decisions to pass environmentally-friendly legislation. We investigate the effects that inequality and freedom of the press have on environmental stringency for a sample of OECD and BRIICS countries and a global sample of 82 countries using data over the period 1994–2015. We hypothesize that the more unequal a society is, and the greater the oppression of the press is, the less stringent environmental policies are. The results partially confirm our hypothesis. In particular, lack of press freedom is negatively correlated with environmental stringency, whereas inequality shows a non-linear effect only for non-high-income countries.

Hannu Laaksovirta konsortion jäsenenä. The Genomics England Research Consortium, The International ALS/FTD Genomics Consortium (iAFGC), The International FTD Genetics Consortium (IFGC), The International LBD Genomics Consortium (iLBDGC), The NYGC ALS Consortium, The PROSPECT Consortium,17 James B. Rowe,17 Luisa Benussi,18 Giuliano Binetti,18,19 Roberta Ghidoni,18 Edwin Jabbari,20,21 Coralie Viollet,22 Jonathan D. Glass,23 Andrew B. Singleton,24 Vincenzo Silani,25,26 Owen A. Ross,27 Mina Ryten,8,28,29 Ali Torkamani,30 Toshiko Tanaka,31 Luigi Ferrucci,31 Susan M. Resnick,32 We examined the role of repeat expansions in the pathogenesis of frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) by analyzing whole-genome sequence data from 2,442 FTD/ALS patients, 2,599 Lewy body dementia (LBD) patients, and 3,158 neurologically healthy subjects. Pathogenic expansions (range, 40?64 CAG repeats) in the huntingtin (HTT) gene were found in three (0.12%) patients diagnosed with pure FTD/ALS syndromes but were not present in the LBD or healthy cohorts. We replicated our findings in an independent collection of 3,674 FTD/ALS patients. Postmortem evaluations of two patients revealed the classical TDP-43 pathology of FTD/ALS, as well as huntingtin-positive, ubiquitin-positive aggregates in the frontal cortex. The neostriatal atrophy that pathologically defines Huntington?s disease was absent in both cases. Our findings reveal an etiological relationship between HTT repeat expansions and FTD/ALS syndromes and indicate that genetic screening of FTD/ALS patients for HTT repeat expansions should be considered. We examined the role of repeat expansions in the pathogenesis of frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) by analyzing whole-genome sequence data from 2,442 FTD/ALS patients, 2,599 Lewy body dementia (LBD) patients, and 3,158 neurologically healthy subjects. Pathogenic expansions (range, 40?64 CAG repeats) in the huntingtin (HTT) gene were found in three (0.12%) patients diagnosed with pure FTD/ALS syndromes but were not present in the LBD or healthy cohorts. We replicated our findings in an independent collection of 3,674 FTD/ALS patients. Postmortem evaluations of two patients revealed the classical TDP-43 pathology of FTD/ALS, as well as huntingtin-positive, ubiquitin-positive aggregates in the frontal cortex. The neostriatal atrophy that pathologically defines Huntington?s disease was absent in both cases. Our findings reveal an etiological relationship between HTT repeat expansions and FTD/ALS syndromes and indicate that genetic screening of FTD/ALS patients for HTT repeat expansions should be considered.

Background Delirium is an acute change in cognition, common among older hospitalized patients, however, patients of all ages are at risk of delirium during a hospital stay. The International Federation of Delirium Societies promotes, each year, a World Delirium Awareness Day , to raise the awareness of, not just recognizing delirium in the hospital setting, but ensuring interventions are in place to prevent the development of delirium. Hospitalized patients with delirium have increased risk of adverse events such as falls, pressure injury, malnutrition, increased length of stay, increased health care costs, and mortality. This clinical audit aimed to estimate the risk of a subsequent fall, following an acute episode of in-hospital delirium, across a broad cross-sectional of clinical settings.Methods Seventeen adult acute inpatient wards across the South Western Sydney, Local Health District, undertook an audit of the number of admitted patients who had had at least one episode of delirium since being admitted to hospital. Using the hospital-based incident management reporting system, the rates of subsequent falls was compared between delirium and non-delirium patients.Results Fifty of the 473 patients (11.4%) were identified by the nursing staff to have had at least one episode of delirium since admission. The proportion of fallers among the delirium and non-delirium patients were 10% and 2%, respectively (p = 0.004). The rate of falls per 1000 patient days was 6.45 (95% confidence interval (CI) 2.1 to 15.1) among delirium patients, compared to 2.12 (95% CI 1.0 to 4.0) among patients without delirium. The risk of falling among delirium patients was 4.25 higher compared to non-delirium patients (adjusted hazard ratio (HR) = 4.25, 95% CI 1.26 to 14.39).Conclusion This clinical audit has been able to show that an acute episode of delirium increases the risk of an in-hospital fall fourfold. Importantly, these results have highlighted the need for a hospital wide approach, to not just in identifying delirium, but the need to have interventions in place to reduce the risk of delirium. In other words, delirium prevention should be ‘core business’ of all nursing care, across the acute hospital setting.

PURPOSE: To evaluate the use of abiraterone acetate (1000 mg) plus prednisone (5mg) [AA+P] in patients with high-risk non-metastatic castration resistant prostate cancer (nmCRPC). MATERIALS AND METHODS: Patients considered at high risk for progression to metastatic disease (PSA≥10 ng/mL or PSADT≤10 months) received AA+P daily (28-day cycles). The primary endpoint was the proportion of patients achieving PSA50 during cycles 1–6. Secondary endpoints included time to PSA progression, time to radiographic evidence of disease progression, and safety. RESULTS: Of 131 enrolled patients, 44 (34%) remain on treatment, with a median follow-up of 40.0 months. Median age was 72 (48–90) years. Most patients (82.4%) were white; 14.5% were black. Median screening PSA was 11.9 ng/dL and PSADT was 3.4 months. PSA was significantly reduced (p