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Real-time continuous glucose monitoring (rtCGM) can directly improve patient outcomes, including decreased health care system utilization and associated costs. The purpose of this study was to evaluate the clinical benefits of rtCGM use in a high-risk, under-resourced cohort of adolescents and young adults (AYA) with type 1 diabetes (T1D) who had no prior access to rtCGM. The effects of rtCGM use on hemoglobin A1c (A1c) and the frequency of health care events (i.e., diabetes-related emergency room (ER) visits, hospitalizations, emergency medical services (EMS), and after-hour emergency calls) were evaluated regarding payor costs in 33 AYA with ≥70% rtCGM use. Secondary aims included the evaluation of a phone-based pattern management intervention. The frequency of health care events decreased at 12 and 24 weeks for all participants, and there was no significant difference by treatment group. We estimated that the use of rtCGM in this cohort results in a projected annualized cost-savings of $195,943 to $294,864 or 43–65% per year based on Medicare or list pricing for rtCGM, respectively. Results also revealed improvements in A1c at 12 weeks for all study participants, but this was not maintained at 24 weeks for the phone-based pattern management intervention group. Our findings suggest that rtCGM may be an effective tool for reducing diabetes-related events and underscores the importance of access. Future studies are needed to further examine tailored interventions and support to optimize rtCGM use and glycemic health in high-risk AYA.

Important questions remain about the clinical and research utility of the Highly Sensitive Person (HSP) scale, particularly related to gender. Thus, a cluster analysis was conducted with 414 university undergraduates, using the HSP scale, the 7-item Generalized Anxiety Disorder scale, and the Center for Epidemiologic Studies Depression Scale Revised, resulting in parsimonious four-cluster models: four clusters of women and four clusters of men. Three of the four cluster types were consistent across both men and women: non-distressed medium sensitivity (low anxiety and depression, mid-range HSP), non-distressed low sensitivity (low anxiety and depression, low HSP), and distressed high sensitivity (moderate/high anxiety and depression, high HSP). Differences were found in the fourth type. A cluster of women were non-distressed and highly sensitive (low anxiety and depression, high HSP), while the fourth type of men were distressed medium sensitivity (moderate/high anxiety and depression, mid-range HSP). Scores on the HSP scale total (α = .88) indicated adequate internal consistency and external (divergent) validity, with medium effect sizes related to social desirability bias. Internal structural validity indicated a poor fit of the data to previously proposed one- to three-dimensional models. Counseling practice and research implications are discussed.

Salt crystallization is a major cause of damage in porous building materials. Accelerated salt weathering tests carried out in the laboratory are among the most common methods to assess the durability of material to salt decay. However, existing standards and recommendations for salt weathering tests have limitations in terms of effectiveness and/or reliability. In the framework of the RILEM Technical Committee 271-ASC, a procedure has been developed which proposes a new approach to salt crystallization tests. It starts from the consideration that salt damage can be seen as a process developing in two phases: accumulation of the salt in the material and propagation of the decay. In the first phase, salts are introduced in the material and accumulate close to the evaporation surface, while in the second phase damage propagates because of repeated dissolution and crystallization cycles, induced by re-wetting with liquid water and by relative humidity changes. In this paper, the procedure is described and the results of a first round robin validation of the test, carried out on 7 materials and involving 10 laboratories, are presented. The results show that the procedure is effective to cause decay within the time period of the test (about 3 months) and that the decay increases with subsequent cycles. The decay observed differs in type and severity depending on the salt type and concentration and on the type of substrate. The decay types detected in the laboratories are generally representative of those observed in the field for the selected substrates. The differences in durability between the various substrates, as assessed at the end of the test, are in line with the durability expected based on field observation. The reproducibility of the results in terms of decay type is good; some differences have been observed in terms of material loss. These are more significant in the case of NaCl contaminated specimens. Based on the results, proposals for fine-tuning of the procedure are given., Materials and Structures, 55 (9), ISSN:1359-5997, ISSN:1871-6873

Introduction. Anemia is a common medical disorder seen in consultation by hematologists. This study was performed to determine the incidence of the etiologies causing anemia in patients referred to the hematologists at Tammy Walker Cancer Center (TWCC) in the rural Kansas community of Salina. An additional goal of the study was to compare the frequencies of different etiologies for anemia in this cohort of patients with those previously reported by four academic medical centers. Methods. A retrospective review of the medical records of 152 patients seen at TWCC between August 2015 and May 2019 was performed. The patient’s history and physical exam, complete blood count and various additional hematologic studies ordered at the discretion of the TWCC hematologist were used to determine the etiology of each patient’s anemia. Results. The most common causes of anemia found in the chart review were iron deficiency (48.7%), hematologic malignancy (14.5%), chronic inflammation (13.8%), renal insufficiency (11.2%), and unexplained anemia (9.9%). While the incidences of anemia due to hematologic malignancy, chronic inflammation, and renal insufficiency were similar to that reported previously by four academic medical centers, significantly more iron deficiency and less unexplained anemia were found in the patients referred to TWCC. Conclusions. The causes of anemia in patients seen at TWCC were similar to those reported by academic medical centers; however, the incidences were different. The differences in findings may reflect dissimilarities in the demographics of referral populations, the duration and extent of the evaluation at TWCC, or referral patterns.

This recommendation is devoted to testing the resistance of natural stone and fired-clay brick units against salt crystallization. The procedure was developed by the RILEM TC 271-ASC to evaluate the durability of porous building materials against salt crystallization through a laboratory method that allows for accelerated testing without compromising the reliability of the results. The new procedure is designed to replicate salt damage caused by crystallization near the surface of materials as a result of capillary transport and evaporation. A new approach is proposed that considers the presence of two stages in the salt crystallization test. In the first, the accumulation stage, salts gradually accumulate on or near the surface of the material due to evaporation. In the second, the propagation stage, damage initiates and develops due to changes in moisture content and relative humidity that trigger salt dissolution and crystallization cycles. To achieve this, two types of salt were tested, namely sodium chloride and sodium sulphate, with each salt tested separately. A methodology for assessing the salt-induced damage is proposed, which includes visual and photographical observations and measurement of material loss. The procedure has been preliminarily validated in round robin tests.

The oxidation resistance of novelγ/γ’-strengthened Co-base superalloys is clearly outmatched by their Ni-base counterparts within the high-temperature regime. Therefore, surface modification strategies to foster protective alumina growth seem auspicious. This study elucidates the impact of fluorination and shot-peening on protective alumina formation at 900 °C for a quaternary Co-base model alloy (Co-Al-W-Ta system) which is well known for an exceptionally low inherent oxidation resistance. Time-resolved isothermal gravimetric analysis (TGA) in synthetic air, detailed electron microscopic analysis, and X-ray diffraction (XRD) were used. For polished samples, no pronounced enhancement of oxidation resistance could be obtained by halogenation. However, in case of shot-peened samples (halogen-free), an increased tendency for alumina formation is found compared to polished surfaces. The very early stages of oxidation were identified to be especially crucial with respect to sustainable protective scale growth. Most noteworthy is the observation of a strong synergistic effect derived by a combination of halogenation and shot-peening, leading to significantly increased oxidation resistance.

The COVID-19 pandemic prompted the transition of Australian Self-Management and Recovery Training (SMART) Recovery mutual support groups to virtual delivery. This study examined the self-reported experience of online SMART Recovery groups for people seeking support for methamphetamine use (alone or in combination with other behaviours) compared to those who did not endorse methamphetamine use as a reason for seeking support.An online survey invitation was embedded in the post-group exit page. Items assessed participant demographic characteristics, experience, engagement and perceived contribution of the online group to recovery. Unique responses (n = 1414) were analysed using chi-square.After alcohol, methamphetamine use was the second most common behaviour to prompt online SMART Recovery group attendance (n = 205, 14.5%). People attending for methamphetamine use were more likely to endorse multiple addictive behaviours (n = 137, 66.8% vs. n = 371, 30.7%, p 0.001). Irrespective of whether people attended for methamphetamine use or not, participant ratings of experience, engagement and perceived contribution to recovery were positive and largely comparable. People attending for methamphetamine use were significantly less likely to set a 7-day plan (72.7% vs. 81.9%; χFindings support the acceptability of online SMART Recovery groups for people experiencing addictive behaviours, including methamphetamine use. To maximise the benefits of these groups, further evidence on how best to support people to develop a change plan within a time-limited, online group setting is needed. Online mutual support groups may help to reach and support people who might not otherwise engage in treatment and support, including people who use methamphetamine.

The stratified Chilean Comau Fjord sustains a dense population of the cold-water coral (CWC) Desmophyllum dianthus in aragonite supersaturated shallow and aragonite undersaturated deep water. This provides a rare opportunity to evaluate CWC fitness trade-offs in response to physico-chemical drivers and their variability. Here, we combined year-long reciprocal transplantation experiments along natural oceanographic gradients with an in situ assessment of CWC fitness. Following transplantation, corals acclimated fast to the novel environment with no discernible difference between native and novel (i.e. cross-transplanted) corals, demonstrating high phenotypic plasticity. Surprisingly, corals exposed to lowest aragonite saturation (omega(arag) < 1) and temperature (T < 12.0 degrees C), but stable environmental conditions, at the deep station grew fastest and expressed the fittest phenotype. We found an inverse relationship between CWC fitness and environmental variability and propose to consider the high frequency fluctuations of abiotic and biotic factors to better predict the future of CWCs in a changing ocean. The cold-water coral Desmophyllum dianthus benefits from stable environmental conditions in deep waters of Comau Fjord (Chile) and is able to acclimatise quickly to new environmental conditions after transplantation.

Objectives: Appropriate face covering use at public venues can help mitigate the transmission of SARS-CoV-2 in the absence of widespread vaccination and provide protection when viral variants become more infectious. The objective of this study was to evaluate compliance with a statewide face mask mandate by examining trends in face covering use in publicly accessible spaces in King County, Washington. Methods: From November 27, 2020, through May 11, 2021, we conducted a repeated cross-sectional observational study of face covering use across publicly accessible venues (eg, grocery and convenience stores, airport, transit center, post office). Trained observers recorded perceived sex, estimated age group, and face covering use. We calculated estimates of overall face covering use and prevalence ratios (PRs) with 95% CIs. Results: We observed 9865 people in 53 unique venues during 229 observation intervals during 6 observation periods. Correct face covering use was 87.2% overall and lowest at semi-outdoor venues such as transit hubs (78.1%) and the pick-up curb of Seattle–Tacoma International Airport (69.0%). Correct face covering use was lowest among men (PR = 1.42; 95% CI, 1.27-1.58) and among people aged 2-11 years (PR = 2.74; 95% CI, 2.37-3.17) and 12-17 years (PR = 1.36; 95% CI, 1.07-1.72). Compliance declined among adults aged ≥60 years and among younger age groups before vaccine eligibility. Conclusions: Overall compliance with the statewide face mask mandate in King County was high. Layered mitigation strategies, including but not limited to the use of face coverings, and methods to assess adherence to them are crucial to preventing SARS-CoV-2 transmission.

The COVID-19 pandemic prompted rapid, reflexive transition from face-to-face to online healthcare. For group-based addiction services, evidence for the impact on service delivery and participant experience is limited.A 12-month (plus 2-month follow-up) pragmatic evaluation of the upscaling of online mutual-help groups by SMART Recovery Australia (SRAU) was conducted using The Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Data captured by SRAU between 1st July 2020 and 31st August 2021 included participant questionnaires, Zoom Data Analytics and administrative logs.Reach: The number of online groups increased from just 6 pre-COVID-19 to 132. These groups were delivered on 2786 (M = 232.16, SD = 42.34 per month) occasions, to 41,752 (M = 3479.33, SD = 576.34) attendees.Participants (n = 1052) reported finding the online group meetings highly engaging and a positive, recovery supportive experience. 91 % of people with experience of face-to-face group meetings rated their online experience as equivalent or better. Adoption: Eleven services (including SRAU) and five volunteers delivered group meetings for the entire 12-months.SRAU surpassed their goal of establishing 100 groups. Maintenance: The average number of meetings delivered [t(11.14) = -1.45, p = 0.1737] and attendees [t(1.95) = -3.28, p = 0.1880] per month were maintained across a two-month follow-up period.SRAU scaled-up the delivery of online mutual-help groups in response to the COVID-19 pandemic. Findings support the accessibility, acceptability and sustainability of delivering SMART Recovery mutual-help groups online. Not only are these findings important in light of the global pandemic and public safety, but they demonstrate the potential for reaching and supporting difficult and under-served populations.

Information on smoking and other health factors in head and neck cancer (HNC) patients throughout treatment, follow-up and survivorship is limited. This study explores patterns of multiple health factors during radiotherapy (RT) and naturalistic long-term follow-up in a convenience sample of patients with HNC.Smoking, alcohol use and depression were measured at baseline, 4 and 12 weeks post RT for a sub-group of 99 patients who participated in a randomised controlled trial and completed long-term follow-up. These factors plus healthy eating, physical activity and fatigue are also reported from the long-term follow-up component. Smoking was measured by self-report and biochemically, whilst all other variables were by self-report. Where variables were assessed at multiple time points logistic mixed effects regression models determined within-person changes over time.There were important discrepancies between self-reported (4-7%) and biochemically verified (13-29%) rates of smoking. Rates of smoking and hazardous alcohol intake were significantly increased at follow-up compared to baseline. Depression rates were observed to be higher at end of RT compared to baseline. At long-term follow-up, fatigue was common and co-occurred with suboptimal healthy eating and hazardous alcohol use.Clinically important levels of smoking and alcohol consumption post RT in this sample suggest possible targets for intervention beyond treatment into long-term follow-up of patients.

Mining has been a major contributor to economic development in Australia since British arrival in the late 1700s, with little to no thought regarding the long-term environmental consequences. This study assesses the metal pollution legacy caused by different smelting methods and mining activities during the British colonialism in western Tasmania. This region was the largest copper producer in the Southern Hemisphere during the 20th century. Lake sediments from Basin Lake and Owen Tarn, 12 and 5 km from Queenstown’s mines, respectively, were used to reconstruct historical metal contamination. Temporal changes in metal concentrations (iron, copper, arsenic, selenium and lead) were assessed in relation to the scale of mining activities and the technologies used. Sedimentation rates and metal influxes increased from 1900, reflecting the beginning of copper mining in Mount Lyell. Observed metal concentrations peaked after 1930, coinciding with the introduction of large-scale open-cut operations and an expansion of the mining machinery used. All elements underwent at least minor enrichment (EF 1-3) during the lifespan of the mine, with lead and copper undergoing extremely severe enrichment (EF > 50). Although smelters contributed to metal increases in the lakes, large open-cut large operations in the 1930s contributed most to metal contamination. Local metal deposition from mining-related activities decreased significantly once operations decreased, with selenium and arsenic decreasing nearly to background levels within 50 years. Lead and copper, the elements which underwent major enrichment, have not yet reached background values. The ecological consequences include the current degraded local landscape, poor water quality and disrupted local biota. Knowledge about the environmental impacts of mining in western Tasmania is less known compared to other sites around the world with a similar history. Our results demonstrate the urgent need to develop better policies and remediation programs that can mitigate the consequences of metal pollution from abandoned mines in Australia.

Aims This study compared the bag‐mediated filtration system (BMFS) and standard WHO two‐phase separation methods for poliovirus (PV) environmental surveillance, examined factors impacting PV detection and monitored Sabin‐like (SL) PV type 2 presence with withdrawal of oral polio vaccine type 2 (OPV2) in April 2016. Methods and Results Environmental samples were collected in Nairobi, Kenya (Sept 2015–Feb 2017), concentrated via BMFS and two‐phase separation methods, then assayed using the WHO PV isolation algorithm and intratypic differentiation diagnostic screening kit. SL1, SL2 and SL3 were detected at higher rates in BMFS than two‐phase samples (P 0·05), while SL3 was detected less frequently with higher shipment temperatures (P = 0·027). SL2 was detected more frequently before OPV2 withdrawal in BMFS and two‐phase samples (P

Anhaltende Beschwerden und unspezifische Allgemeinsymptome fordern eine grundliche Anamnese und Diagnostik. Die Autoren berichten uber eine trotz mehrfacher Interventionen persistierende osophagopulmonale Fistel bei einem 73-jahrigen Patienten. Dieser hatte seit 27 Jahren unspezifische Allgemeinsymptome mit Husten und Dyspnoe. Bei nachgewiesener osophagopulmonaler Fistel erfolgten mehrfach frustrane Versuche eines Fistelverschlusses mit Over-the-scope-Clips und Watanabe Spigots (Novatech SA, La Ciotat, Frankreich). Nach Off-Label-Applikation eines AMPLATZER Vascular Plug II (Abbott Laboratories, Abbott Park, Ill, USA) zeigte sich der Patient beschwerdefrei.

Rationale: Nontuberculous mycobacteria (NTM), including Mycobacterium avium complex (MAC), are emerging pathogens that can opportunistically cause debilitating pulmonary disease in susceptible huma...

This research quantitatively investigates the impact of violence on the propagation of images in social media in the context of political protest. Using a computational approach, we measure the relative violence of a large set of images shared on Twitter during the protests against the G20 summit in Frankfurt am Main in 2017. This allows us to investigate if more violent content is shared more times and faster than less violent content on Twitter, and if different online communities can be characterized by the level of violence of the visual content they share. The results show that the level of violence in an image tweet does not correlate with the number of retweets and mentions it receives that the time to retweet is marginally lower for image tweets containing a high level of violence and that the level of violence in image tweets differs between communities.

Eradication of poliovirus (PV) is a global public health priority, and as clinical cases decrease, the role of environmental surveillance becomes more important. Persistence of PV and the environmental factors that influence it (such as temperature and sample type) are an important part of understanding and interpreting positive environmental surveillance samples. The objective of this study was to evaluate the persistence of poliovirus type 2 (PV2) and type 3 (PV3) in wastewater and sediment. Microcosms containing either 1) influent wastewater or 2) influent wastewater with a sediment matrix were seeded with either PV2 or PV3, and stored for up to 126 days at three temperatures (4°C, room temperature [RT], and 30°C). Active PV in the liquid of (1), and the sediment and liquid portions of (2) were sampled and quantified at up to 10 time points via plaque assay and RT-qPCR. A suite of 17 models were tested for best fit to characterize decay of PV2 and PV3 over time and determine the time points at which >90% (T90) and >99% (T99) reduction was reached. Linear models assessed the influence of experimental factors (matrix, temperature, virus type and method of detection) on the predicted T90 and T99 values. Results showed that when T90 was the dependent variable, virus type, matrix, and temperature significantly affected decay, and there was a clear interaction between the sediment matrix and temperature. When T99 was the dependent variable, only temperature and matrix type significantly influenced the decay metric. This study characterizes the persistence of both active and molecular PV2 and PV3 in relevant environmental conditions, and demonstrates that temperature and sediment both play important roles in PV viability. As eradication nears and clinical cases decrease, environmental surveillance and knowledge of PV persistence will play a key role in understanding the silent circulation in endemic countries.

Wastewater surveillance for SARS-CoV-2 may serve as a useful source of data for public health departments as the virus is shed in the stool of infected individuals. However, for wastewater data to be actionable, wastewater must be collected, concentrated, and analyzed in a timely manner. This manuscript presents modifications on a skimmed milk concentration protocol to reduce processing time, increase the number of samples that can be processed at once, and enable use in resource-limited settings. Wastewater seeded with Human coronavirus OC43 (OC43) was concentrated using a skimmed milk flocculation protocol, and then pellets were directly extracted with the QIAamp Viral RNA Mini kit. This protocol has a higher average effective volume assayed (6.35 mL) than skimmed milk concentration methods, with and without Vertrel XF™, which involve resuspension of the pellets in PBS extraction prior to nucleic acid extraction (1.28 mL, 1.44 mL, respectively). OC43 was selected as a recovery control organism because both it and SARS-CoV-2 are enveloped respiratory viruses that primarily infect humans resulting in respiratory symptoms. The OC43 percent recovery for the direct extraction protocol (3.4%) is comparable to that of skimmed milk concentration with and without Vertrel XF™ extraction (4.0%, 2.6%, respectively). When comparing SARS-CoV-2 detection using McNemar's chi-square test, the pellet extraction method is not statistically different from skimmed milk concentration, with and without Vertrel XF™ extraction. This suggests that the method performs equally as well as existing methods. Added benefits include reduced time spent per sample and the ability to process more samples at a single time. Direct extraction of skimmed milk pellets is a viable method for quick turnaround of wastewater data for public health interventions.

Inter-hemispheric asynchrony of climate change through the last deglaciation has been theoretically linked to latitudinal shifts in the southern westerlies via their influence over CO2 out-gassing from the Southern Ocean. Proxy-based reconstructions disagree on the behaviour of the westerlies through this interval. The last deglaciation was interrupted in the Southern Hemisphere by the Antarctic Cold Reversal (ACR; 14.7 to 13.0 ka BP (thousand years Before Present)), a millennial-scale cooling event that coincided with the Bolling–Allerod warm phase in the North Atlantic (BA; 14.7 to 12.7 ka BP). We present terrestrial proxy palaeoclimate data that demonstrate a migration of the westerlies during the last deglaciation. We support the hypothesis that wind-driven out-gassing of old CO2 from the Southern Ocean drove the deglacial rise in atmospheric CO2.

IntroductionTransdiagnostic cognitive–behavioural therapy (CBT) targets common psychological factors that underlie multiple disorders. While transdiagnostic interventions are a promising new approach, limited research has evaluated these treatments within the alcohol and other drug (AOD) sector for young people with comorbid mental health symptoms. This project will examine the feasibility and preliminary efficacy of FullFix—a new risk-targeted transdiagnostic CBT telehealth programme for comorbid AOD and depression/anxiety disorders in young people. Secondary aims are to identify moderators and mediators of treatment outcomes, to determine how and why treatment is effective and who is most likely to benefit.Methods/designParticipants will be 130 young people (aged 16–35) accessing AOD services in Queensland, Australia, with comorbid mental health symptoms. They will be randomised to receive either the FullFix intervention plus standard AOD care or standard AOD care alone. Primary outcomes on AOD use and mental health symptoms will be reassessed at 6 weeks, 3 months, 6 months and 12 months, along with secondary outcomes of emotion regulation, social connectedness, perceived self-efficacy, coping skills and quality of life. The trial commenced on October 2018 and expected completion date is September 2021.Ethics and disseminationEthical approval for this trial was provided by the University of Queensland (#2018001185). The results of the trial will be disseminated through publication in a peer-reviewed scientific journal, scientific presentations at conferences and distributed via a report and presentations to the partner organisation.Trial registration numberACTRN12618001563257.

Understanding of long-term climatic change prior to instrumental records necessitates reconstructions from documentary and palaeoclimate archives. In southern Africa, documentary-derived chronologies of nineteenth century rainfall variability and palaeoclimate records have permitted new insights into rainfall variability over past centuries. Rarely considered, however, is the climatic information within early colonial documentary records that emerge from the late fifteenth century onwards. This paper examines evidence for (multi-)seasonal dry and wet events within these earlier written records (c. 1550–1830 CE) from southeast Africa (Mozambique) and west-central Africa (Angola) in conjunction with palaeoclimate records from multiple proxies. Specifically, it aims to understand whether these sources agree in their signals of rainfall variability over a 280-year period covering the ‘main phase’ Little Ice Age (LIA) in southern Africa. The two source types generally, but do not always, show agreement within the two regions. This appears to reflect both the nature of rainfall variability and the context behind documentary recording. Both source types indicate that southeast and west-central Africa were distinct regions of rainfall variability over seasonal and longer timescales during the LIA, with southeast Africa being generally drier and west-central Africa generally wetter. However, the documentary records reveal considerable variability within these mean state climatic conditions, with multi-year droughts a recurrent feature in both regions. An analysis of long-term rainfall links with the El Niño–Southern Oscillation (ENSO) in southeast Africa suggests a complex and possibly non-stationary relationship. Overall, early colonial records provide valuable information for constraining hydroclimate variability where palaeoclimate records remain sparse.

Purpose Malnutrition in head and neck cancer (HNC) treatment is common and associated with poorer morbidity and mortality outcomes. This trial aimed to improve nutritional status during radiation therapy (RT) using a novel method of training dietitians to deliver psychological techniques to improve nutritional behaviors in patients with HNC. Methods and Materials This trial used a stepped-wedge, randomized controlled design to assess the efficacy of the Eating As Treatment (EAT) program. Based on motivational interviewing and cognitive behavioral therapy, EAT was designed to be delivered by oncology dietitians and integrated into their clinical practice. During control steps, dietitians provided treatment as usual, before being trained in EAT and moving into the intervention phase. The training was principles based and sought to improve behavior-change skills rather than provide specific scripts. Patients recruited to the trial (151 controls, 156 intervention) were assessed at 4 time points (the first and the final weeks of RT, and 4 and 12 weeks afterward). The primary outcome was nutritional status at the end of RT as measured by the Patient-Generated Subjective Global Assessment. Results Patients who received the EAT intervention had significantly better scores on the primary outcome of nutritional status at the critical end-of-treatment time point (β = −1.53 [−2.93 to −.13], P = .03). Intervention patients were also significantly more likely than control patients to be assessed as well-nourished at each time point, lose a smaller percentage of weight, have fewer treatment interruptions, present lower depression scores, and report a higher quality of life. Although results were not statistically significant, patients who received the intervention had fewer and shorter unplanned hospital admissions. Conclusions This trial is the first of its kind to demonstrate the effectiveness of a psychological intervention to improve nutrition in patients with HNC who are receiving RT. The intervention provides a means to ameliorate malnutrition and the important related outcomes and consequently should be incorporated into standard care for patients receiving RT for HNC.

BackgroundBehavioural medicine is characterised by findings for the effectiveness and efficacy of complex behaviour change interventions. Comparatively, scant attention has been paid to key intervention components or mechanisms of action. Evaluating relationships between process variables (fidelity) and intervention effects is central to addressing this imbalance. Accordingly, in the current study, we sought to explore the magnitude and direction of effect between fidelity predictors (dietitian adherence and competence) and intervention effects (patient nutritional status) during the intervention phase of a real-world, stepped-wedge evaluation of ‘EAT: Eating As Treatment’.MethodsThe EAT clinical trial was conducted within five major Australian hospitals located in Queensland, Western Australia, Victoria and South Australia between 2013 and 2016. EAT is a dietitian-delivered health behaviour change intervention designed to reduce malnutrition in head and neck cancer (HNC) patients undergoing radiotherapy. Dietitian adherence and competence ratings were derived from a 20% random sample of audio-recorded dietetic consultations (n=194) conducted after dietitians (n=18) were trained in EAT. Sessions were coded by trained, independent, coders using a study checklist, the Behaviour Change Counselling Index (BECCI) and items from the Cognitive Therapy Scale-Revised (CTS-R). Patient nutritional status was measured using the Patient-Generated Subjective Global Assessment (PGSGA).ResultsDietitian adherence to a written nutrition plan (β=7.62, 95% CI=0.65 to 14.58,p=0.032), dietitian adherence to behaviour change counselling (β=0.69, 95% CI =0.02 to 1.38,p=0.045) and competence in delivering behaviour change counselling (β=3.50, 95% CI =0.47 to 6.53,p=0.024) were significant predictors of patient nutritional status. Dietitian adherence and competence ratings were higher during consultations with intervention patients at greater risk of malnutrition.ConclusionsThis study contributes new insights into the relationship between fidelity and treatment outcome by demonstrating that dietitian adherence and competence is greater when working with more challenging patients. This is likely central to the demonstrated success of the EAT intervention in reducing malnutrition and highlights the importance of ensuring that providers are adequately equipped to flexibly integrate intervention elements according to patient need.Trial registrationThis study is a process analysis of a stepped-wedge randomised controlled trial prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12613000320752; Date of registration 21/03/2013).

Objective: There is a demonstrated link between the mental health and substance use comorbidities experienced by young adults, however the vast majority of psychological interventions are disorder specific. Novel psychological approaches that adequately acknowledge the psychosocial complexity and transdiagnostic needs of vulnerable young people are urgently needed. A modular skills-based program for emotion regulation and impulse control (ERIC) addresses this gap. The current one armed open trial was designed to evaluate the impact that 12 weeks exposure to ERIC alongside usual care had on young people's ability to regulate emotions, as well as examine potential moderating mechanisms.Methods: Seventy nine young people (50.6% male; M = 19.30; SD = 2.94) were enrolled to the 12 week intervention period. Twenty one practitioners from youth and community health services delivered relevant ERIC modules adjunct to usual care. Linear mixed effects regression (with random intercept) was used to examine change over time across the primary outcome of emotion dysregulation and secondary outcomes of depression, anxiety, stress, experiential avoidance and mindfulness. Moderation analyses were conducted to test whether the magnitude of change in emotion dysregulation moderated change over time in secondary outcomes.Results: Analyses revealed significant improvement in the primary outcome of emotion dysregulation with a moderate effect size (Mean Change = −10.24, 95% CI (−14.41, −6.06; Cohen's dav = −0.53), in addition to decreases in the secondary outcomes of depression, anxiety, stress and experiential avoidance. No improvements in mindfulness were reported. Moderation analyses revealed that the residualised change over time in emotion dysregulation moderated the change over time in symptoms of distress, depression, anxiety, stress, experiential avoidance, and mindfulness.Conclusion: Reductions in the severity of emotion dysregulation, depression, anxiety, stress and experiential avoidance are promising, and were evident despite the complexity of the participants and the diversity of the service setting. The improvements found in each outcome were only observed for those young people whose emotion regulation also improved, providing preliminary evidence for the role of emotion regulation as a key treatment target in this population.

Locomotion is a key aspect associated with ecologically relevant tasks for many organisms, therefore, survival often depends on their ability to perform well at these tasks. Despite this significance, we have little idea how different performance tasks are weighted when increased performance in one task comes at the cost of decreased performance in another. Additionally, the ability for natural systems to become optimized to perform a specific task can be limited by structural, historic or functional constraints. Climbing lizards provide a good example of these constraints as climbing ability likely requires the optimization of tasks which may conflict with one another such as increasing speed, avoiding falls and reducing the cost of transport (COT). Understanding how modifications to the lizard bauplan can influence these tasks may allow us to understand the relative weighting of different performance objectives among species. Here, we reconstruct multiple performance landscapes of climbing locomotion using a 10 d.f. robot based upon the lizard bauplan, including an actuated spine, shoulders and feet, the latter which interlock with the surface via claws. This design allows us to independently vary speed, foot angles and range of motion (ROM), while simultaneously collecting data on climbed distance, stability and efficiency. We first demonstrate a trade-off between speed and stability, with high speeds resulting in decreased stability and low speeds an increased COT. By varying foot orientation of fore- and hindfeet independently, we found geckos converge on a narrow optimum of foot angles (fore 20°, hind 100°) for both speed and stability, but avoid a secondary wider optimum (fore −20°, hind −50°) highlighting a possible constraint. Modifying the spine and limb ROM revealed a gradient in performance. Evolutionary modifications in movement among extant species over time appear to follow this gradient towards areas which promote speed and efficiency.

Enteric viruses, such as poliovirus, are a leading cause of gastroenteritis, which causes 2–3 million deaths annually. Environmental surveillance of wastewater supplements clinical surveillance for monitoring enteric virus circulation. However, while many environmental surveillance methods require liquid samples, some at-risk locations utilize pit latrines with waste characterized by high solids content. This study’s objective was to develop and evaluate enteric virus concentration protocols for high solids content samples. Two existing protocols were modified and tested using poliovirus type 1 (PV1) seeded into primary sludge. Method 1 (M1) utilized acid adsorption, followed by 2 or 3 elutions (glycine/sodium chloride and/or threonine/sodium chloride), and skimmed milk flocculation. Method 2 (M2) began with centrifugation. The liquid fraction was filtered through a ViroCap filter and eluted (beef extract/glycine). The solid fraction was eluted (beef extract/disodium hydrogen phosphate/citric acid) and concentrated by skimmed milk flocculation. Recovery was enumerated by plaque assay. M1 yielded higher PV1 recovery than M2, though this result was not statistically significant (26.1% and 15.9%, respectively). M1 was further optimized, resulting in significantly greater PV1 recovery when compared to the original protocol (p&lt, 0.05). This method can be used to improve understanding of enteric virus presence in communities without liquid waste streams.

Background: Routine outcome monitoring (ROM) has been implemented across a range of addiction treatment services, settings and organisations. Mutual support groups are a notable exception. Innovative solutions are needed. SMART Track is a purpose built smartphone app designed to capture ROM data and provide tailored feedback to adults attending Australian SMART Recovery groups for addictive behaviour(s).Objective: Details regarding the formative stage of app development is essential, but often neglected. Improved consideration of the end-user is vital for curtailing app attrition and enhancing engagement. This paper provides a pragmatic example of how principles embedded in published frameworks can be operationalised to address these priorities during the design and development of the SMART Track app.Methods: Three published frameworks for creating digital health technologies (“Person-Based Approach,” “BIT” Model and IDEAS framework) were integrated and applied across two stages of research to inform the development, design and content of SMART Track. These frameworks were chosen to ensure that SMART Track was informed by the needs and preferences of the end-user (“Person-Based”); best practise recommendations for mHealth development (“BIT” Model) and a collaborative, iterative development process between the multi-disciplinary research team, app developers and end-users (IDEAS framework).Results: Stage one of the research process generated in-depth knowledge to inform app development, including a comprehensive set of aims (clinical, research/organisation, and usage); clear articulation of the target behaviour (self-monitoring of recovery related behaviours and experiences); relevant theory (self-determination and social control); appropriate behavioural strategies (e.g., behaviour change taxonomy and process motivators) and key factors that may influence engagement (e.g., transparency, relevance and trust). These findings were synthesised into guiding principles that were applied during stage two in an iterative approach to app design, content and development.Conclusions: This paper contributes new knowledge on important person-centred and theoretical considerations that underpin a novel ROM and feedback app for people with addictive behaviour(s). Although person-centred design and best-practise recommendations were employed, further research is needed to determine whether this leads to improved usage outcomes.Clinical Trial Registration: Pilot Trial: http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336.

The life and death of an organism often depends on its ability to perform well at some ecologically relevant task. Yet despite this significance we have little idea how well species are optimised for competing locomotor tasks. Most scientists generally accept that the ability for natural systems to become optimised for a specific task is limited by structural, historic or functional constraints. Climbing lizards provide a good example of constraint where climbing ability requires the optimization of conflicting tasks such as speed, stability, or efficiency. Here we reconstruct multiple performance landscapes of climbing locomotion using a 10-DOF robot based upon the lizard bauplan, including an actuated spine, shoulders, and feet, the latter which interlock with the surface via claws. This design allows us to independently vary speed, foot angles, and range of motion, while simultaneously collecting data on climbed distance, stability and efficiency. We first demonstrate a trade-off between speed and stability with high speeds resulting in decreased stability and low speeds an increased cost of transport. By varying foot orientation of fore and hindfeet independently, we found geckos converge on a narrow optimum for both speed and stability, but avoid a secondary wider optimum highlighting a possible constraint. Modifying the spine and limb range of movement revealed a gradient in performance. Evolutionary modifications in movement among extant species appear to follow this gradient towards areas which promote speed and efficiency. This approach can give us a better understanding about locomotor optimization, and provide inspiration for industrial and search-and-rescue robots.Significance StatementClimbing requires the optimization of conflicting tasks such as speed, stability, or efficiency, but understanding the relative importance of these competing performance traits is difficult.We used a highly modular bio-inspired climbing robot to reconstruct performance landscapes for climbing lizards. We then compared the performance of extant species onto these and show strong congruence with lizard phenotypes and robotic optima.Using this method we can show why certain phenotypes are not present among extant species, illustrating why these would be potentially mal-adaptive.These principles may be useful to compare with relative rates of evolution along differing evolutionary histories. It also highlights the importance of biological inspiration towards the optimization of industrial climbing robots, which like lizards, must negotiate complex environments.

BACKGROUND Mutual support groups are an important source of long-term help for people impacted by addictive behaviors. Routine outcome monitoring (ROM) and feedback are yet to be implemented in these settings. SMART Recovery mutual support groups focus on self-empowerment and use evidence-based techniques (eg, motivational and behavioral strategies). Trained facilitators lead all SMART Recovery groups, providing an opportunity to implement ROM. OBJECTIVE The aim of this stage 1 pilot study is to explore the feasibility, acceptability, and preliminary outcomes of a novel, purpose-built mobile health ROM and feedback app (SMART Track) in mutual support groups coordinated by SMART Recovery Australia (SRAU) over 8 weeks. METHODS SMART Track was developed during phase 1 of this study using participatory design methods and an iterative development process. During phase 2, 72 SRAU group participants were recruited to a nonrandomized, prospective, single-arm trial of the SMART Track app. Four modes of data collection were used: ROM data directly entered by participants into the app; app data analytics captured by Amplitude Analytics (number of visits, number of unique users, visit duration, time of visit, and user retention); baseline, 2-, and 8-week follow-up assessments conducted through telephone; and qualitative telephone interviews with a convenience sample of study participants (20/72, 28%) and facilitators (n=8). RESULTS Of the 72 study participants, 68 (94%) created a SMART Track account, 64 (88%) used SMART Track at least once, and 42 (58%) used the app for more than 5 weeks. During week 1, 83% (60/72) of participants entered ROM data for one or more outcomes, decreasing to 31% (22/72) by the end of 8 weeks. The two main screens designed to provide personal feedback data (Urges screen and Overall Progress screen) were the most frequently visited sections of the app. Qualitative feedback from participants and facilitators supported the acceptability of SMART Track and the need for improved integration into the SRAU groups. Participants reported significant reductions between the baseline and 8- week scores on the Severity of Dependence Scale (mean difference 1.93, SD 3.02; 95% CI 1.12-2.73) and the Kessler Psychological Distress Scale-10 (mean difference 3.96, SD 8.31; 95% CI 1.75-6.17), but no change on the Substance Use Recovery Evaluator (mean difference 0.11, SD 7.97; 95% CI –2.02 to 2.24) was reported. CONCLUSIONS Findings support the feasibility, acceptability, and utility of SMART Track. Given that sustained engagement with mobile health apps is notoriously difficult to achieve, our findings are promising. SMART Track offers a potential solution for ROM and personal feedback, particularly for people with substance use disorders who attend mutual support groups. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12619000686101; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336 INTERNATIONAL REGISTERED REPORT RR2-10.2196/15113