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• Background Anxiety is commonly experienced by people living with mild cognitive impairment (MCI) and dementia. Whilst there is strong evidence for late-life anxiety treatment using Cognitive Behavioural Therapy (CBT) and delivery via telehealth, there is little evidence for the remote delivery of psychological treatment for anxiety in people living with MCI and dementia. This paper reports the protocol for the Tech-CBT study which aims to investigate the efficacy, cost-effectiveness, usability and acceptability of a technology-assisted and remotely delivered CBT intervention to enhance delivery of anxiety treatment for people living with MCI and dementia of any aetiology. • Methods A hybrid II single-blind, parallel-group randomised trial of a Tech-CBT intervention (n = 35) versus usual care (n = 35), with in-built mixed methods process and economic evaluations to inform future scale-up and implementation into clinical practice. The intervention (i) consists of six weekly sessions delivered by postgraduate psychology trainees via telehealth video-conferencing, (ii) incorporates voice assistant app technology for home-based practice, and (iii) utilises a purpose-built digital platform, My Anxiety Care. The primary outcome is change in anxiety as measured by the Rating Anxiety in Dementia scale. Secondary outcomes include change in quality of life and depression, and outcomes for carers. The process evaluation will be guided by evaluation frameworks. Qualitative interviews will be conducted with a purposive sample of participants (n = 10) and carers (n = 10), to evaluate acceptability and feasibility, as well as factors influencing participation and adherence. Interviews will also be conducted with therapists (n = 18) and wider stakeholders (n = 18), to explore contextual factors and barriers/facilitators to future implementation and scalability. A cost-utility analysis will be undertaken to determine the cost-effectiveness of Tech-CBT compared to usual care. • Discussion This is the first trial to evaluate a novel technology-assisted CBT intervention to reduce anxiety in people living with MCI and dementia. Other potential benefits include improved quality of life for people with cognitive impairment and their care partners, improved access to psychological treatment regardless of geographical location, and upskilling of the psychological workforce in anxiety treatment for people living with MCI and dementia. Trial registration: This trial has been prospectively registered with ClinicalTrials.gov: NCT05528302 [September 2, 2022].

Background: Bariatric surgery may increase the risk of micronutrient deficiencies; however, confounders including preoperative deficiency, supplementation and inflammation are rarely considered. Objective: To examine the impact of bariatric surgeries, supplementation and inflammation on micronutrient deficiency. Setting: Two public hospitals, Australia. Methods: Participants were recruited to an observational study monitoring biochemical micronutrient outcomes, supplementation dose, inflammation and glycemic control, pre-operatively and at 1-3, 6 and 12 months after gastric bypass (GB; Roux-en-Y Gastric Bypass and Single Anastomosis Gastric Bypass; N=66) or sleeve gastrectomy (SG; N=144). Participant retention at 12 months was 81%. Results: Pre-operative micronutrient deficiency was common, for vitamin D (29-30%), iron (13-22%) and selenium (39% GB cohort). Supplement intake increased after surgery; however, dose was Conclusion: In the setting of prophylactic post-surgical micronutrient prescription, few nutrients are at risk of de novo deficiency. Although micronutrient supplementation and monitoring remains important, rationalising high frequency biochemical testing protocols in the first year after surgery may be warranted.

Neisseria gonorrhoeae antimicrobial resistance (NG AMR) has become an urgent concern globally. The World Health Organization, the United States of America Centers for Disease Control, and other regulators have called to improve resistance-testing methods to enhance NG AMR surveillance. NG AMR surveillance remains critical in informing treatment; unfortunately, this is often lacking in settings with limited resources, such as Papua New Guinea (PNG). We conducted a systematic review and a prevalence meta-analysis, and provided an overview of NG AMR in PNG. We showed the lack of NG AMR data in the last decade, and emphasized the need for NG AMR surveillance in PNG. Since NG AMR testing by the NG culture method is unreliable in PNG, we suggested using molecular tests to complement and enhance NG AMR surveillance.

Few Australians consume diets consistent with the Australian Dietary Guidelines. A major problem is high intake of discretionary food and drinks (those not needed for health and high in saturated fat, added sugar, salt and/or alcohol). Low socioeconomic groups (SEGs) suffer particularly poor diet-related health. Surprisingly, detailed quantitative dietary data across SEGs was lacking. Analysis of the most recent national nutrition survey data produced habitual intakes of a reference household (two adults and two children) in SEG quintiles of household income. Cost and affordability of habitual and recommended diets for the reference household were determined using methods based on the Healthy Diets Australian Standardised Affordability and Pricing protocol. Low SEGs reported significantly lower intakes of healthy food and drinks yet similarly high intakes of discretionary choices to high SEGs (435 serves/fortnight). Total habitual diets of low SEGs cost significantly less than those of high SEGs (AU$751/fortnight to AU$853/fortnight). Results confirmed low SEGs cannot afford a healthy diet. Lower intakes of healthy choices in low SEGs may help explain their higher rates of diet-related disease compared to higher SEGs. The findings can inform potential policy actions to improve affordability of healthy foods and help drive healthier diets for all Australians.

Intensive poultry production generates over 100,000 t of litter annually in West Virginia and 9 x 10(6) t nationwide. Current available technological alternatives based on thermophilic anaerobic digestion for residuals treatment are diverse. A modification of the typical continuous stirred tank reactor is a promising process being relatively stable and owing to its capability to manage considerable amounts of residuals at low operational cost. A 40-m3 pilot plant digester was used for performance evaluation considering energy input and methane production. Results suggest some changes to the pilot plant configuration are necessary to reduce power consumption although maximizing biodigester performance.

To determine the patterns of management and surveillance imaging amongst medical oncologists in Australia for stage I testicular cancer during 2010.We conducted a survey comprising 14 questions about the management strategy and surveillance imaging for all patients with stage I testicular cancer treated over the previous 12 months.A total of 52 medical oncologists documented the management for an estimated 470 patients. For seminoma, management was in the form of surveillance in 33%, radiotherapy in 5% and adjuvant carboplatin in 62% of patients. For non-seminoma, management was surveillance in 73%, adjuvant chemotherapy in 23% and retroperitoneal lymph node dissection in 4% of patients. The frequency of surveillance imaging was highly variable, and ≥10 computed tomography (CT) scans were used by 38% of clinicians for seminoma and 46% of clinicians for non-seminoma.We found considerable variation in management patterns. The infrequent use of surveillance and frequent use of carboplatin for seminoma differs from international guidelines. Radiation exposure from CT imaging should be reduced through standardized follow-up protocols, and possibly by alternate imaging methods if validated in appropriate studies.

Part 1. Introduction. H. Tuokko, I. McDowell, An Overview of Mild Cognitive Impairment. Part 2. General Population Research on MCI. C. Fabrigoule, P. Barberger-Gateau, J.-F. Dartigues, The PAQUID Study. K. Palmer, L. Backman, B.J. Small, L. Fratiglioni, Cognitive Impairment in Elderly Persons without Dementia: Findings from the Kungsholmen Project. J. Fleming, F.E. Matthews, M. Chatfield, C. Brayne, Population Levels of Mild Cognitive Impairment in England and Wales. A. Collie, P. Maruff, D.G. Darby, C. Masters, J. Currie, The Melbourne Aging Study. Part 3. Specific Samples. R. Wilson, N.T. Aggarwal, D.A. Bennett, Mild Cognitive Impairment in the Religious Orders Study. G. Smith, M. Machulda, K. Kantarci, A Perspective from the Mayo Clinic. M.C. Tierney, Prediction of Probable Alzheimer's Disease: The Sunnybrook Memory Study. H. Wolf, H.-J. Gertz, Studies in the Leipzig Memory Clinic: Contribution to the Concept of Mild Cognitive Impairment. Part 4. Interventions. H. Chertkow, Emerging Pharmacological Therapies for Mild Cognitive Impairment. B. Woods, L. Clare, Cognition-based Therapies and Mild Cognitive Impairment. K. Peters, G. Winocur, Combined Therapies in Mild Cognitive Impairment. Part 5. Summary and Future Directions. H. Tuokko, D.F. Hultsch, The Future of Mild Cognitive Impairment.

To report the toxicity and early efficacy of high-dose rate brachytherapy (HDR) as a boost to external beam radiation (EBRT) in the treatment of localised prostate cancer.Between December 2002 and November 2007, 101 consecutive patients with intermediate or high risk prostate cancer were treated with EBRT plus an HDR boost. The HDR boost was initially delivered in three fractions of 6.5 Gy each via one implant; this was subsequently modified to a two-fraction technique with separate implants 2 weeks apart (8.5 Gy each). Most patients also received at least 3 months of androgen ablation.Our cohort included 65 intermediate risk and 36 high-risk patients. Sixty-seven patients received the three-fraction regime; 34 the two-fraction schedule. Median follow-up was 56 months, at which time 82% of patients were free from failure. The 4-year disease-free survival for intermediate and high-risk groups was 95% and 66%, respectively (overall 85%). Significant acute toxicities included clot retention (eight patients), one traumatic urethral injury, one case of retention requiring suprapubic catheter placement, one case of new onset atrial fibrillation and three cases of pulmonary emboli. At 4 years, the rate of late grade 2 genitourinary toxicity was 8%; two patients experienced grade 3 toxicity. No late grade 3 gastrointestinal toxicity was observed. Potency was preserved in 72% of those patients reporting normal pre-treatment sexual function.Our cohort experienced toxicity similar to previously published HDR boost series with very promising early efficacy results.

Study Type - Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Only 30-35% of patients with positive surgical margins after radical prostatectomy develop recurrent disease. Adjuvant radiotherapy reduces the rate of biochemical relapse or metastasis and improves overall survival after radical prostatectomy. Various pathological factors, such as location and extent of positive margins, have been proposed as possible prognostic factors in men with margin-positive prostate cancer, however, the recent International Society of Urological Pathology consensus meeting in Boston noted that there is limited data on the significance of Gleason grade of the carcinoma at a positive margin. The present study shows that the presence of high grade prostate cancer, i.e. Gleason pattern 4 or 5, at a positive surgical margin is an independent predictor of biochemical recurrence after radical prostatectomy. Moreover, patients with lower grade carcinoma at the margin have a similar prognosis to men with negative margins. Hence, assessment of Gleason grade at the site of positive margin may aid optimal selection of patients for adjuvant radiotherapy.• To establish predictors of biochemical recurrence by analysing the pathological characteristics of positive surgical margins (PSMs), including Gleason grade of the carcinoma at the involved margin.• Clinicopathological and outcome data on 940 patients who underwent radical prostatectomy (RP) between 1997 and 2003 were collected. • Of these, 285 (30.3%) patients with PSMs were identified for pathological review, including assessment of location of margin, linear extent, number of PSMs, plane of margin and Gleason grade (3 vs 4 or 5) at the margin.• At a median follow-up of 82 months, the biochemical recurrence rate of the PSM cohort was 29%. • On univariate analysis, the presence of Gleason grade 4 or 5 at the margin (34.4% of cases) was significantly associated with biochemical recurrence (hazard ratio [HR] 2.80, 95% confidence interval [CI]= 1.82-4.32, P0.001) compared with the presence of Gleason grade 3. • Linear extent of margin involvement was also associated with recurrence (P= 0.009). • Single vs multiple margin involvement, location, and plane of the involved margin were not significant predictors of recurrence. • On multivariate analysis, Gleason grade 4 or 5 at the margin remained an independent predictor of recurrence (HR 2.14, 95% CI = 1.29-4.03, P= 0.003).• The Gleason grade at the site of a PSM identifies patients at increased risk of biochemical recurrence and should aid stratification of patients for adjuvant radiation therapy.

The effect of feed-loading frequency on digester performance was studied on a thermophilic anaerobic digester with a working volume of 27.43 m(3). The digester was fed 0.93 m(3) of chicken-litter slurry/d, containing 50.9 g/L chemical oxygen demand. The treatments were loading frequencies of 1, 2, 6, and 12 times/d. The hourly pH, biogas production, and methane percent of the biogas were less stable at lower feed frequencies. There was no statistical difference among treatments in methanogenic activity. The feed-loading frequency of six times per day treatment provided the greatest biogas production.

To estimate population norms for use in assessment of individuals in relation to their age-matched peers using true longitudinal patterns of decline.Longitudinal study of 10 years of follow-up data from the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS) on the most commonly used cognitive test across clinical and research settings.England and Wales.Thirteen thousand four people were seen in five sites at baseline, with follow up at 2, 5, and 10 years.Mini-Mental State Examination (MMSE) score at three interviews over 10 years. A total of 42,777 MMSE scores were used in the analysis.MMSE norms are presented according to age and split according to sex using longitudinal data. Potential cohort effects and dropout of individuals with low MMSE scores have been accounted for.It is likely that the cognitive MMSE scale will continue to be used in many settings and across the age range. The figures presented here can be used to plot individual performance and chart where there is change in the relative position of one individual compared with others.

Increasing production of agricultural waste impacts health, economic, and environmental welfare. Thermophilic anaerobic digestion is a technology developed to treat these waste streams whereby the organic material is converted to biogas and effluent. The effluent, available in solid and liquid form, holds promise as a fertilizer. Digested (broiler litter) liquid effluent was compared to chemical and certified organic fertilizers with application rates based on soil analyses and crop recommendations. An unfertilized control and an effluent treatment at twice the recommended amount were also included. Beds treated with liquid effluent maintained higher levels of available phosphorus established from treatment in prior years with solid effluent. Beds treated with liquid effluent showed a significant increase in K, Mg, Cu, and Mn. Potato fresh weight and tuber number for 2× effluent beds were significantly better than the other treatments. Average tuber weight was also statistically significant, but organic, 2×, and 1× effluent were best. For tomato, the 2× effluent treatment was statistically better for fruit number, average weight, and total weight. In fact, the total weight per plant for the 2× effluent treatment was more than three times higher than the other fertilizer treatments. The chemical and effluent treatments were statistically better for broccoli than the organic or unfertilized control. Blueberry yields were not significantly different between treatments. As this is a perennial crop, it may be several years before a significant difference is observed. While not a total solution, our research shows the effectiveness of digested poultry litter as part of a nutrient management program, thereby making a safer, less-polluting alternative to raw livestock residuals.

AP is involved in the destruction of harmful H202. In soybean (Glycine max [L] Merr.) root nodules, AP initiates a sequence of coupled redox reactions (ascorbate-GSH pathway) that results in peroxide scavenging (Dalton et al., 1986). The ascorbate-GSH pathway occurs in other plant tissues and has been extensively studied in chloroplasts where photoreducing conditions lead to the production of H202 (Asada, 1992). Two forms of AP are present in plant cells, a chloroplast form and a cytosol form. Both forms of AP are quite distinct from other types of plant peroxidases that occur in the vacuole, cell wall, or cytosol (Asada, 1992). The molecular cloning and sequencing of cytosolic AP cDNA from pea (Mittler and Zilinskas, 1991) and a cDNA from Arabidopsis (Kubo et al., 1992) as well as a characterization of the pea gene (Mittler and Zilinskas, 1992) have been described. We report the isolation of a full-length cDNA clone that encodes an AP subunit (Table I). The isolation strategy was to screen a nodule cDNA expression library with a polyclonal antibody prepared from purified (Dalton et al., 1987) root nodule AP. Putative AP clones were isolated at a frequency of 1 in 800, and 80% of the isolates contained a 1.1-kb insert. Double-stranded dideoxy sequencing of one clone resulted in a 1054-nucleotide sequence with a 3' poly(A) tail and an open reading frame encoding 249 amino acids. Comparison of the N-terminal amino acid sequence obtained by automated Edman sequencing (20 residues) confirmed that the clone was authentic AP. A comparison of deduced protein sequences (249 amino acids) revealed a sequence identity of 90% with that of pea (Mittler and Zilinskas, 1991) and 78% with that of Arabidopsis (Kubo et al., 1992). The high activity of AP (Dalton et al., 1987) in nodules suggests that this pathway may provide an essential protective action in processes related to nitrogen fixation. This analysis was a first step to studies addressing the genetic regulation of the ascorbate-GSH pathway and ultimately the criticalness of this pathway to nitrogen fixation.

Fertilizer costs and increased awareness of non-point source pollution run-off amplify the pressures on farm economics. Intensive farming operations provided the impetus for our study using effluent from anaerobic thermophilically digested poultry litter as a potential fertilizer. Five fertilizer treatments were used: unfertilized control, pelletized municipal sludge, commercial crop specific products, 1x digested solids and 2x digested solids. All four applications of fertilizer were equalized for nitrogen based on commercial product recommendations. Beds treated with 2x solids accumulated higher percentage of organic matter over the 5-year period. A statistically significant increase in phosphorus was found in the solids beds in 2003. Beds with 2x solids showed statistical significance for Mg, Zn and Cu. Fertilizer trials included blueberries, tomatoes, potatoes, and sweet corn. Potato fresh weight was not significantly different in 2002 or 2003, but was in 2001. Tomato fruit number was not significantly different in 2001 or 2003, but was in 2002. Tomato fresh weight for 2x solids was not significantly different from the commercial or pelletized sludge treatments in 2002 and 2003 suggesting that tomato may discriminate between treatments. Commercial and pelletized sludge fertilizers were statistically better for sweet corn fresh ear weight and number of ears in 2002 and 2003. Blueberry yields were not significantly different between treatments for any year. As this is a perennial crop, it may be several years before a significant difference is observed. While not a total solution, our research shows the effectiveness of digested poultry litter as part of a nutrient management program; making livestock residuals a nutrient resource which offers the potential for organic use.

Two neutral polystyrene resins, Amberlite XAD-2 and Porapak Q, have been tested for effectiveness in the quantitative recovery and trace enrichment of cytokinins from aqueous solutions. Both resins retained all of the cytokinin-active bases and ribonucleosides tested. Elution with 70% ethanol permitted quantitative recovery of cytokinins from the resins. Under the test conditions used here, adenine and the major ribonucleosides were either incompletely retained or not retained at all by the two resins. Quantitative recovery of cytokinin activity from hydrolysates of tRNA and from cultures of Agrobacterium tumefaciens was demonstrated using Amberlite XAD-2.

Ribulose-1,5-bisphosphate carboxylase/oxygenase (rubisco) activase activity was obtained from a partially purified extract of Escherichia coli transformed with a 1.6-kilobase spinach (Spinacia oleracea L.) cDNA clone. This activity was ATP-dependent. Catalysis of rubisco activation by spinach and cloned rubisco activase was accompanied by the same extent of carboxyarabinitol bisphosphate-trapped (14)CO(2) as occurred in spontaneous activation, indicating that rubisco carbamylation is one facet of the rubisco activase reaction. The CO(2) concentration required for one-half maximal rubisco activase activity was about 8 micromolar CO(2). These observations are consistent with the postulated role of rubisco activase in regulating rubisco activity in vivo.

A B S T R A C T Porella navicularis, a common leafy liverwort in western North America, was found to possess numerous epiphytic Nostoc colonies. Although the abundance of colonies was variable, the association was found consistently throughout a broad geographic range. Unlike cyanobacteria in other hepatic assocations, the Nostoc occurred as distinct colonies harbored in crevices and curled margins of leaves. Heterocyst frequency was 3-7%. Acetylene reduction activity was present in 85% of samples examined, with an average value of 53.5 nmol C2H4 g dry wt-' hr- ' and a maximum of 316 nmol C2H4 g dry wt- ' hr- '. This suggests that bryophyte nitrogenfixing associations may be more important than previously realized.

Cytokinin oxidase activity from Phaseolus vulgaris cv Great Northern callus cultures exhibited affinity for the lectin concanavalin A. Over 80% of the activity extracted from the callus tissue bound to a concanavalin A-Sepharose 4B column. The bound activity was eluted from the column by the addition of methylmannose to the eluting buffer. On the basis of this result, it appears that most of the cyokinin oxidase activity present in Great Northern callus cultures exists in the form of a glycoprotein. The apparent pI of this enzyme, as estimated by chromatofocusing, is approximately 5.0.