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OBJECTIVES: To synthesize current evidence on the association between anticipatory anxiety, defined as apprehension-specific negative affect that may be experienced when exposed to potential threat or uncertainty, and cancer screening to better inform strategies to maximize participation rates. METHODS: Searches related to cancer screening and anxiety were conducted in seven electronic databases (APA PsycINFO, Scopus, Web of Science, Embase, Cochrane Library, PubMed, CINAHL), with potentially eligible papers screened in Covidence. Data extraction was conducted independently by multiple authors. Barriers to cancer screening for any type of cancer and relationships tested between anticipatory anxiety and cancer screening and intention were categorized and compared according to the form and target of anxiety and cancer types. RESULTS: A total of 74 articles (nparticipants = 119,990) were included, reporting 103 relationships tested between anticipatory anxiety and cancer screening and 13 instances where anticipatory anxiety was reported as a barrier to screening. Anticipatory anxiety related to a possible cancer diagnosis was often associated with increased screening, while general anxiety showed no consistent relationship. Negative relationships were often found between anxiety about the screening procedure and cancer screening. CONCLUSION: Anticipatory anxiety about a cancer diagnosis may promote screening participation, whereas a fear of the screening procedure could be a barrier. Public health messaging and primary prevention practitioners should acknowledge the appropriate risk of cancer, while engendering screening confidence and highlighting the safety and comfort of screening tests.

Detailed, well-dated palaeoclimate and archaeological records are critical for understanding the impact of environmental change on human evolution. Ga-Mohana Hill, in the southern Kalahari, South Africa, preserves a Pleistocene archaeological sequence. Relict tufas at the site are evidence of past flowing streams, waterfalls, and shallow pools. Here, we use laser ablation screening to target material suitable for uranium-thorium dating. We obtained 33 ages covering the last 110 thousand years (ka) and identify five tufa formation episodes at 114-100 ka, 73-48 ka, 44-32 ka, 15-6 ka, and ~3 ka. Three tufa episodes are coincident with the archaeological units at Ga-Mohana Hill dating to ~105 ka, ~31 ka, and ~15 ka. Based on our data and the coincidence of dated layers from other local records, we argue that in the southern Kalahari, from ~240 ka to ~71 ka wet phases and human occupation are coupled, but by ~20 ka during the Last Glacial Maximum (LGM), they are decoupled.

It is well recognized that social networks can buffer the adverse effects of chronic illness on psychological wellbeing. However, the functional impairments associated with brain tumour often affect social participation, which may reduce people's capacity to draw upon their social capital for support. This qualitative phenomenological study aimed to understand how brain tumour influences people's ability to manage, maintain, and rebuild their social networks. Participants were 20 individuals (65% female) aged 22-69 years with diverse types of primary brain tumour (50% high grade or malignant) who were on average 35 months post-diagnosis. Two semi-structured interviews, conducted three months apart, comprised a Social Identity Mapping exercise and questions exploring changes in social groups since diagnosis. Two overarching and interrelated themes emerged: engaging and connecting and then versus now. An interplay of barriers, facilitators and strategies influenced people's ability to engage and connect with their social groups, which in turn influenced whether they experienced stability; maintenance and expansion; loss and rebuilding; or loss and shrinkage of their social networks over time. These novel findings highlight the need to develop interventions that specifically focus on enhancing individuals' abilities to maintain or rebuild their social networks.

Oxalate-rich mineral accretions, often found in rock shelters around the world, offer important opportunities for radiocarbon dating of associated rock art. Here, sample characterization and chemical pretreatment techniques are used to characterize the accretions, prescreen for evidence of open-system behavior, and address potential contamination. The results provide stratigraphically consistent sequences of radiocarbon dates in millimeter-scale laminated accretions, demonstrating their reliability for dating rock art, particularly symbolic markings commonly engraved into these relatively soft deposits. The age sequences are also consistent with correlations between distinctive patterns in the layer sequences visible in shelters up to 90 km apart in the Kimberley region of northwestern Australia, suggesting their synchronized formation is not entirely shelter specific but broadly controlled by variations in regional environmental conditions. Consequently, these accretions also offer potential as paleoenvironmental archives, with radiocarbon dating of layers in nine accretions indicating four, approximately synchronous growth intervals covering the past 43 ka.

BACKGROUND: Measurement of cashew-specific IgE (sIgE) is often used to confirm sensitization but does not reliably diagnose clinical allergy. Ana o 3 is the dominant cashew allergen detected in 75-100% of patients with cashew allergy but not currently used in clinical practice. OBJECTIVES: To determine if component-resolved diagnostics using specific IgE to the 2 S albumin from cashew, Ana o 3, improves the accuracy of diagnosing cashew allergy, thereby circumventing the need for an oral food challenge (OFC) in some patients. METHODS: A population-based sample of 5276 children was recruited at age 1 year and followed up at age 6 years. Children with positive cashew skin prick test at age 6 underwent an OFC to clarify allergy status. Forty-seven children (mean age 5.02 ± 0.2) (33 cashew-allergic and 14 cashew-tolerant) had cashew sIgE and Ana o 3 sIgE quantified by ImmunoCAP System FEIA. RESULTS: A cutoff of >0.32 kUA/L for Ana o 3 sIgE provided 95% specificity and 90% sensitivity and correctly identified 90% of clinical cashew allergy. At the same specificity, the sensitivity for cashew sIgE (>8.5 kUA/L) was only 26%. Sequential measurement of cashew sIgE followed by Ana o 3 sIgE diagnosed 90% of children with cashew allergy without the need for an OFC. CONCLUSION: Ana o 3 sIgE testing provides higher diagnostic accuracy than cashew sIgE. Sequential measurement of cashew sIgE followed by Ana o 3 removed the need for a food challenge from 66% down to 12.8% (5-fold) of children compared with cashew sIgE testing alone.

From March 2020, clinical psychology postgraduate programmes began rapidly adopting telepsychology within their training clinics to support public health and reduce the spread of COVID-19. However, implementing this rapidly, safely, and effectively posed challenges to programmes, educators, supervisors, and trainees who at the time predominantly utilised in-person psychology and had limited experience with telepsychology. This paper outlines the collaboration of Australian psychology postgraduate programmes; the development of the Australian Telepsychology Collaboration’s role in supporting rapid adoption; empirical evidence for the use of telepsychology in training clinics; and reflects on how clinics overcame initial technological, security, clinical, practical and competency barriers to adoption. Implications and recommendations for clinical psychology postgraduate programmes are discussed, and an emphasis is placed on the unique opportunity that psychology programmes have to contribute meaningfully to clinical and empirical telepsychology knowledge. Key Points What is already known about this topic: Telepsychology has been rapidly adopted and is increasingly used in psychology and psychology training programs since the pandemic. Telepsychology is a way to maintain training standards and learning opportunities for post-graduate psychology trainees during times of increased social and movement restrictions. There is emerging literature to support telepsychology for the types of presentations common to training clinics. What this topic adds: A reflection on the security, technological, and clinical knowledge learned by postgraduate psychology training programs transitioning to telepsychology that has relevance for training providers and clinicians undertaking parallel transitions. Overcoming barriers to large-scale telepsychology implementation. Implications and recommendations for psychology postgraduate programmes.

From March 2020, clinical psychology postgraduate programmes began rapidly adopting telepsychology within their training clinics to support public health and reduce the spread of COVID-19. However, implementing this rapidly, safely, and effectively posed challenges to programmes, educators, supervisors, and trainees who at the time predominantly utilised in-person psychology and had limited experience with telepsychology. This paper outlines the collaboration of Australian psychology postgraduate programmes; the development of the Australian Telepsychology Collaboration’s role in supporting rapid adoption; empirical evidence for the use of telepsychology in training clinics; and reflects on how clinics overcame initial technological, security, clinical, practical and competency barriers to adoption. Implications and recommendations for clinical psychology postgraduate programmes are discussed, and an emphasis is placed on the unique opportunity that psychology programmes have to contribute meaningfully to clinical and empirical telepsychology knowledge. Key Points What is already known about this topic: Telepsychology has been rapidly adopted and is increasingly used in psychology and psychology training programs since the pandemic. Telepsychology is a way to maintain training standards and learning opportunities for post-graduate psychology trainees during times of increased social and movement restrictions. There is emerging literature to support telepsychology for the types of presentations common to training clinics. What this topic adds: A reflection on the security, technological, and clinical knowledge learned by postgraduate psychology training programs transitioning to telepsychology that has relevance for training providers and clinicians undertaking parallel transitions. Overcoming barriers to large-scale telepsychology implementation. Implications and recommendations for psychology postgraduate programmes.

Insects form an important source of food for many people around the world, but little is known of the deep-time history of insect harvesting from the archaeological record. In Australia, early settler writings from the 1830s to mid-1800s reported congregations of Aboriginal groups from multiple clans and language groups taking advantage of the annual migration of Bogong moths (Agrotis infusa) in and near the Australian Alps, the continent's highest mountain range. The moths were targeted as a food item for their large numbers and high fat contents. Within 30 years of initial colonial contact, however, the Bogong moth festivals had ceased until their recent revival. No reliable archaeological evidence of Bogong moth exploitation or processing has ever been discovered, signalling a major gap in the archaeological history of Aboriginal groups. Here we report on microscopic remains of ground and cooked Bogong moths on a recently excavated grindstone from Cloggs Cave, in the southern foothills of the Australian Alps. These findings represent the first conclusive archaeological evidence of insect foods in Australia, and, as far as we know, of their remains on stone artefacts in the world. They provide insights into the antiquity of important Aboriginal dietary practices that have until now remained archaeologically invisible.

The Kimberley region in Western Australia hosts one of the world's most substantial bodies of indigenous rock art thought to extend in a series of stylistic or iconographic phases from the present day back into the Pleistocene. As with other rock art worldwide, the older styles have proven notoriously difficult to date quantitatively, requiring new scientific approaches. Here, we present the radiocarbon ages of 24 mud wasp nests that were either over or under pigment from 21 anthropomorphic motifs of the Gwion style (previously referred to as "Bradshaws") from the middle of the relative stylistic sequence. We demonstrate that while one date suggests a minimum age of c. 17 ka for one motif, most of the dates support a hypothesis that these Gwion paintings were produced in a relatively narrow period around 12,000 years ago.

The goal of this project was to develop a specific tool within the institution’s (Rady Children’s Hospital) electronic medical record (EMR) to facilitate diagnosis of FASD. A secondary goal was to create a tool capable of mining specific data points about the patients of the FASD clinic, including physical exam findings, congenital malformations, and neuropsychological profiles. This will be useful in future research studies conducted with the FASD team. This project was conducted with Dr. Miguel Del Campo, with input from various members of the FASD clinic, and in close collaboration with the Rady IT department.

The goal of this project was to develop a specific tool within the institution’s (Rady Children’s Hospital) electronic medical record (EMR) to facilitate diagnosis of FASD. A secondary goal was to create a tool capable of mining specific data points about the patients of the FASD clinic, including physical exam findings, congenital malformations, and neuropsychological profiles. This will be useful in future research studies conducted with the FASD team. This project was conducted with Dr. Miguel Del Campo, with input from various members of the FASD clinic, and in close collaboration with the Rady IT department.

Tramadol is a complex drug, being metabolized by polymorphic enzymes and administered as a racemate with the (+)- and (−)-enantiomers of the parent compound and metabolites showing different pharmacological effects. The study aimed to simultaneously determine the enantiomer concentrations of tramadol, O-desmethyltramadol, N-desmethyltramadol, and N,O-didesmethyltramadol following a single dose, and elucidate if enantioselective pharmacokinetics is associated with the time following drug intake and if interindividual differences may be genetically explained. Nineteen healthy volunteers were orally administered either 50 or 100 mg tramadol, whereupon blood samples were drawn at 17 occasions. Enantiomer concentrations in whole blood were measured by LC-MS/MS and the CYP2D6, CYP2B6 and CYP3A4 genotype were determined, using the xTAG CYP2D6 Kit, pyrosequencing and real-time PCR, respectively. A positive correlation between the (+)/(−)-enantiomer ratio and time following drug administration was shown for all four enantiomer pairs. The largest increase in enantiomer ratio was observed for N-desmethyltramadol in CYP2D6 extensive and intermediate metabolizers, rising from about two to almost seven during 24 hours following drug intake. CYP2D6 poor metabolizers showed metabolic profiles markedly different from the ones of intermediate and extensive metabolizers, with large area under the concentration curves (AUCs) of the N-desmethyltramadol enantiomers and low corresponding values of the O-desmethyltramadol and N,O-didesmethyltramadol enantiomers, especially of the (+)-enantiomers. Homozygosity of CYP2B6 *5 and *6 indicated a reduced enzyme function, although further studies are required to confirm it. In conclusion, the increase in enantiomer ratios over time might possibly be used to distinguish a recent tramadol intake from a past one. It also implies that, even though (+)-O-desmethyltramadol is regarded the enantiomer most potent in causing adverse effects, one should no

This data article contains mineralogical and chemical data from mineral accretions sampled from rock art shelters in the Kimberley region of north west Australia. The accretions were collected both on and off pigment and engraved rock art of varying styles observed in the Kimberley with an aim of providing a thorough understanding of the formation and preservation of such materials in the context of dating [1]. This contribution includes processed powder X-ray Diffraction data, Scanning Electron Microscopy energy dispersive spectroscopy data, and Laser Ablation ICP-MS trace element mapping data.

© 2016, © The Author(s) 2016. A continuing challenge for the education system is how to evaluate the wider outcomes of schools. Wider measures of success – such as citizenship or lifelong learning – influence each other and emerge over time from complex interactions between students, teachers and leaders, and the wider community. Unless methods are found to evaluate these broader outcomes, which are able to do justice to learning and achievement as emergent properties of the learner’s engagement with his or her world the education system will continue to focus on narrow measures of school effectiveness which do not properly account for complexity. In this article we describe the rationale and methodology underpinning a pilot research project that applied hierarchical process modelling to a group of schools as complex living systems, using software developed by engineers at the University of Bristol, called Perimeta. The aim was to generate a stakeholder owned systems design which was better able to account for the full range of outcomes valued by each school, and for the complex processes which facilitate or inhibit them, thus providing a more nuanced leadership decision-making analytic. The project involved three academies in the UK.

© 2016, © The Author(s) 2016. A continuing challenge for the education system is how to evaluate the wider outcomes of schools. Wider measures of success – such as citizenship or lifelong learning – influence each other and emerge over time from complex interactions between students, teachers and leaders, and the wider community. Unless methods are found to evaluate these broader outcomes, which are able to do justice to learning and achievement as emergent properties of the learner’s engagement with his or her world the education system will continue to focus on narrow measures of school effectiveness which do not properly account for complexity. In this article we describe the rationale and methodology underpinning a pilot research project that applied hierarchical process modelling to a group of schools as complex living systems, using software developed by engineers at the University of Bristol, called Perimeta. The aim was to generate a stakeholder owned systems design which was better able to account for the full range of outcomes valued by each school, and for the complex processes which facilitate or inhibit them, thus providing a more nuanced leadership decision-making analytic. The project involved three academies in the UK.

© 2016, © The Author(s) 2016. A continuing challenge for the education system is how to evaluate the wider outcomes of schools. Wider measures of success – such as citizenship or lifelong learning – influence each other and emerge over time from complex interactions between students, teachers and leaders, and the wider community. Unless methods are found to evaluate these broader outcomes, which are able to do justice to learning and achievement as emergent properties of the learner’s engagement with his or her world the education system will continue to focus on narrow measures of school effectiveness which do not properly account for complexity. In this article we describe the rationale and methodology underpinning a pilot research project that applied hierarchical process modelling to a group of schools as complex living systems, using software developed by engineers at the University of Bristol, called Perimeta. The aim was to generate a stakeholder owned systems design which was better able to account for the full range of outcomes valued by each school, and for the complex processes which facilitate or inhibit them, thus providing a more nuanced leadership decision-making analytic. The project involved three academies in the UK.

Several European countries have timely all-cause mortality monitoring. However, small changes in mortality may not give rise to signals at the national level. Pooling data across countries may overcome this, particularly if changes in mortality occur simultaneously. Additionally, pooling may increase the power of monitoring populations with small numbers of expected deaths, e.g. younger age groups or fertile women. Finally, pooled analyses may reveal patterns of diseases across Europe. We describe a pooled analysis of all-cause mortality across 16 European countries. Two approaches were explored. In the ‘summarized' approach, data across countries were summarized and analysed as one overall country. In the ‘stratified' approach, heterogeneities between countries were taken into account. Pooling using the ‘stratified' approach was the most appropriate as it reflects variations in mortality. Excess mortality was observed in all winter seasons albeit slightly higher in 2008/09 than 2009/10 and 2010/11. In the 2008/09 season, excess mortality was mainly in elderly adults. In 2009/10, when pandemic influenza A(H1N1) dominated, excess mortality was mainly in children. The 2010/11 season reflected a similar pattern, although increased mortality in children came later. These patterns were less clear in analyses based on data from individual countries. We have demonstrated that with stratified pooling we can combine local mortality monitoring systems and enhance monitoring of mortality across Europe

OBJECTIVE: The aim of the study was to determine the association between adjuvant chemotherapy for breast cancer and menopausal symptoms, sexual function, and quality of life. METHODS: Participants attended a menopause clinic with a dedicated service for cancer survivors at a large tertiary women's hospital. Information about breast cancer treatments including adjuvant chemotherapy was collected from medical records. Menopausal symptoms were recorded with the Greene Climacteric Scale and Functional Assessment of Cancer Therapy, Breast Cancer, and Endocrine Symptom Subscales. Sexual symptoms were recorded using Fallowfield's Sexual Activity Questionnaire. Quality of life was measured with Functional Assessment of Cancer Therapy scales. RESULTS: The severity of vasomotor, psychological, or sexual symptoms (apart from pain) did not differ between those who had received adjuvant chemotherapy (n = 339) and other breast cancer survivors (n = 465). After adjustment for current age, time since menopause, and current use of antiestrogen endocrine therapy, the risk of "severe pain" with sexual intercourse was twice as common after chemotherapy (31.6% vs 20.0%, odds ratio [OR] 2.18, 95% CI 1.25-3.79). Those treated with chemotherapy were more likely to report "severe problems" with physical well-being (OR 1.92, 95% CI 1.12-3.28) and lower breast cancer-specific quality of life (OR 1.89 95% CI 1.13-3.18), but did not differ in other quality of life measures. CONCLUSIONS: In this large study of breast cancer patients presenting to a specialty menopause clinic, previous chemotherapy was not associated with current vasomotor or psychological symptoms. Severe pain with intercourse was significantly more common in those treated with adjuvant chemotherapy.

The 2014/15 influenza season in the United Kingdom (UK) was characterised by circulation of predominantly antigenically and genetically drifted influenza A(H3N2) and B viruses. A universal paediatric influenza vaccination programme using a quadrivalent live attenuated influenza vaccine (LAIV) has recently been introduced in the UK. This study aims to measure the end-of-season influenza vaccine effectiveness (VE), including for LAIV, using the test negative case–control design. The overall adjusted VE against all influenza was 34.3% (95% confidence interval (CI) 17.8 to 47.5); for A(H3N2) 29.3% (95% CI: 8.6 to 45.3) and for B 46.3% (95% CI: 13.9 to 66.5). For those aged under 18 years, influenza A(H3N2) LAIV VE was 35% (95% CI: −29.9 to 67.5), whereas for influenza B the LAIV VE was 100% (95% CI:17.0 to 100.0). Although the VE against influenza A(H3N2) infection was low, there was still evidence of significant protection, together with moderate, significant protection against drifted circulating influenza B viruses. LAIV provided non-significant positive protection against influenza A, with significant protection against B. Further work to assess the population impact of the vaccine programme across the UK is underway.

Objective The purpose of this study was to describe patient characteristics and summarize their perceptions of chiropractic in Australia. Methods This study is part of a broader study aiming to extend the knowledge of the role of chiropractic within the current health care environment. A 33-item, paper-based, cross-sectional survey of a sample of patients from 100 systematically sampled chiropractic clinics from all the states and territories of Australia was conducted. The survey focused on patient demographics, socioeconomic status, perceived health status, and perceptions of chiropractic and chiropractic services. Results A total of 486 responses were received (24.3% response rate). Respondents were predominantly female patients (67.1%) of the 45- to 64-year age group. Approximately half of the respondents reported a pretax annual income exceeding $40 000. Most patients sought chiropractic services because of musculoskeletal disorders (68.7%) and for general health (21.2%), and personal beliefs motivated most respondents (70.2%) to visit a chiropractor. Most respondents would seek the chiropractic services again (97.5%) and were satisfied with the service received. Conclusions The results of this study show that the typical chiropractic patient in Australia is a middle-aged woman with a moderate to high income. Although only a small proportion of the Australian population sees a chiropractor, this group seems to be satisfied with the service.

OBJECTIVE: After cancer treatment, troublesome menopausal symptoms are common but poorly understood. Using standardized instruments, we measured differences in symptom nature, severity, impact on quality of life, and sexual function between cancer survivors and noncancer participants. METHODS: The Menopause Symptoms After Cancer Clinic operates within the general menopause service in a large women's hospital, providing menopause advice and management to women with menopausal symptoms and a cancer history. Menopausal symptoms were recorded using the Greene Climacteric Scale, past-week symptoms were recorded using the Functional Assessment of Cancer Therapy breast cancer subscale and endocrine symptom subscale, and sexual symptoms were recorded using Fallowfield's Sexual Activity Questionnaire. RESULTS: Cancer survivors (n = 934) and noncancer participants (n = 155) did not significantly differ by age at menopause (46 y) or age at first clinic visit (51 y). Cancer survivors were more likely than noncancer participants to be severely troubled by vasomotor symptoms (hot flushes and night sweats; odds ratio, 1.71; 95% CI, 1.06-2.74) and reported more frequent (6.0 vs 3.1 in 24 h; P < 0.001) and more severe (P = 0.008) hot flushes. In contrast, cancer survivors were significantly less troubled by psychological and somatic symptoms and reported better quality of life than noncancer participants. Groups did not differ significantly in physical or functional well-being, gynecologic symptom severity, or sexual function. CONCLUSIONS: Cancer survivors are more troubled by vasomotor symptoms than noncancer participants, but noncancer participants report greater psychological symptoms. Sexual function does not differ. An improved understanding of the nature and impact of menopause on cancer survivors can be used to direct management protocols.

Objective The purpose of this study was to describe patient characteristics and summarize their perceptions of chiropractic in Australia. Methods This study is part of a broader study aiming to extend the knowledge of the role of chiropractic within the current health care environment. A 33-item, paper-based, cross-sectional survey of a sample of patients from 100 systematically sampled chiropractic clinics from all the states and territories of Australia was conducted. The survey focused on patient demographics, socioeconomic status, perceived health status, and perceptions of chiropractic and chiropractic services. Results A total of 486 responses were received (24.3% response rate). Respondents were predominantly female patients (67.1%) of the 45- to 64-year age group. Approximately half of the respondents reported a pretax annual income exceeding $40 000. Most patients sought chiropractic services because of musculoskeletal disorders (68.7%) and for general health (21.2%), and personal beliefs motivated most respondents (70.2%) to visit a chiropractor. Most respondents would seek the chiropractic services again (97.5%) and were satisfied with the service received. Conclusions The results of this study show that the typical chiropractic patient in Australia is a middle-aged woman with a moderate to high income. Although only a small proportion of the Australian population sees a chiropractor, this group seems to be satisfied with the service.

Background: An increase in the use of complementary and alternative medicine was identified in several countries including Australia. There is a need to assess the current position of chiropractic within the Australian health system. Objectives: To estimate the lifetime prevalence of the use of chiropractic in Australia; to investigate the perceptions and attitudes of Australian general public about: their health status, the chiropractic profession, chiropractic and health services in general. Methods: A survey was carried out in which a novel 21-item questionnaire was utilised. To obtain a sample whose opinions would be representative of the Australian general population with a 95% level of significance and 4% margin of error, 600 respondents were required. Descriptive statistics, the chi-squared test and logistic regression were used to present and analyse the data. Results: 757 respondents completed the survey. A high prevalence of pain and discomfort relating to the musculoskeletal system were found, particularly in the lower back (71.1 % of the respondents) and neck (55.6%). The first contact with respect to therapy for the greatest proportion of respondents was general medicine (35.5%), followed by chiropractic (16%), physiotherapy (13.8%) and massage (10.2%). Physiotherapy was rated highest in its ability to relieve the symptoms (18%) followed by chiropractic (15.9%), massage (15.5%) and medicine (14%). In our sample 302 (39.9%) participants used chiropractic before and 75.9% of these consumers were satisfied or highly satisfied with the services provided. No significant differences in income, age and gender were found with regards to those individuals who reported a previous use of chiropractic services. The main reasons for not using chiropractic were: that there was no perceived need for a chiropractic intervention, associated cost, lack of information about chiropractic, lack of referral, being attended by another health professional, and concern about th

Background: An increase in the use of complementary and alternative medicine was identified in several countries including Australia. There is a need to assess the current position of chiropractic within the Australian health system. Objectives: To estimate the lifetime prevalence of the use of chiropractic in Australia; to investigate the perceptions and attitudes of Australian general public about: their health status, the chiropractic profession, chiropractic and health services in general. Methods: A survey was carried out in which a novel 21-item questionnaire was utilised. To obtain a sample whose opinions would be representative of the Australian general population with a 95% level of significance and 4% margin of error, 600 respondents were required. Descriptive statistics, the chi-squared test and logistic regression were used to present and analyse the data. Results: 757 respondents completed the survey. A high prevalence of pain and discomfort relating to the musculoskeletal system were found, particularly in the lower back (71.1 % of the respondents) and neck (55.6%). The first contact with respect to therapy for the greatest proportion of respondents was general medicine (35.5%), followed by chiropractic (16%), physiotherapy (13.8%) and massage (10.2%). Physiotherapy was rated highest in its ability to relieve the symptoms (18%) followed by chiropractic (15.9%), massage (15.5%) and medicine (14%). In our sample 302 (39.9%) participants used chiropractic before and 75.9% of these consumers were satisfied or highly satisfied with the services provided. No significant differences in income, age and gender were found with regards to those individuals who reported a previous use of chiropractic services. The main reasons for not using chiropractic were: that there was no perceived need for a chiropractic intervention, associated cost, lack of information about chiropractic, lack of referral, being attended by another health professional, and concern about th

Overexpression of the multi-drug transporter P-glycoprotein, encoded by the ABCB1 gene, is a clinically relevant problem in acute myeloid leukemia (AML). Polymorphisms in ABCB1 might contribute to cancer risk and therapeutic response. We therefore investigated the influence of polymorphisms G1199A, C1236T, G2677T/A and C3435T on cancer susceptibility, in vitro cytotoxicity and overall survival in 100 de novo AML patients with normal karyotype. Patients with 1236C/C or 2677G/G genotypes showed poorer survival than patients with other genotypes (P = 0.03 and P = 0.02, respectively). Both these genotypes were significant factors for survival in multivariate analysis, along with age, NPM1 and FLT3 mutation status. In vitro cytotoxicity studies demonstrated that leukemic cells from 1236T/T and 2677T/T patients were significantly more susceptible to mitoxantrone (P 0.02), and tended to be more susceptible to etoposide and daunorubicin (P = 0.07-0.09), but not to cytarabine. No significant difference in allele frequencies was found between patients and healthy volunteers (n = 400).

Objectives: The aim of this report is to describe the demographic characteristics including the age profile, gender differences, income and perceptions of supply and demand of the chiropractic profession in Australia. This workforce study (WFS) was divided into three components, Australian Chiropractors (Stage 1), their patients (Stage 2), and members of the general public (Stage 3). Methods: A web-based, 64-item, cross-sectional survey questionnaire was issued to registered chiropractors (CAA and non-CAA members) throughout Australia in 2010. At the time of the survey there were 3,892 registered chiropractors. Survey invitations were sent to those who were registered chiropractors, and had provided email addresses (n=1,917). Results: Demographic Characteristics: There is evidence to suggest that the profession may be becoming increasingly female over time. Income exclusively from chiropractic care included 27.9% who reported an annual pre-tax net income of $115,000 or less and 32.3% earned more than $115,000. Of the latter group, 12% indicated that they were earning more than $215,000. Income was not related to the hours worked per week particularly for males. Supply and Demand: When considering their home state and their local region, more chiropractors thought that there was undersupply in their state, but an adequate supply in their local region. A large proportion (40%) of the sample felt that universities in Australia were graduating the correct number of chiropractors per year, and 32% reported that too many were being produced in Australia. Very few reported that the Universities were not graduating enough chiropractors. Conclusion: This paper reflects some of the findings from Stage 1 of the three stage Workforce study, showing a profession heading towards a more even gender balance and characterised by a higher than average annual income. Future research should include the impact on supply and demand of the possibility of an increasingly female profession.

Objectives: The aim of this report is to describe the demographic characteristics including the age profile, gender differences, income and perceptions of supply and demand of the chiropractic profession in Australia. This workforce study (WFS) was divided into three components, Australian Chiropractors (Stage 1), their patients (Stage 2), and members of the general public (Stage 3). Methods: A web-based, 64-item, cross-sectional survey questionnaire was issued to registered chiropractors (CAA and non-CAA members) throughout Australia in 2010. At the time of the survey there were 3,892 registered chiropractors. Survey invitations were sent to those who were registered chiropractors, and had provided email addresses (n=1,917). Results: Demographic Characteristics: There is evidence to suggest that the profession may be becoming increasingly female over time. Income exclusively from chiropractic care included 27.9% who reported an annual pre-tax net income of $115,000 or less and 32.3% earned more than $115,000. Of the latter group, 12% indicated that they were earning more than $215,000. Income was not related to the hours worked per week particularly for males. Supply and Demand: When considering their home state and their local region, more chiropractors thought that there was undersupply in their state, but an adequate supply in their local region. A large proportion (40%) of the sample felt that universities in Australia were graduating the correct number of chiropractors per year, and 32% reported that too many were being produced in Australia. Very few reported that the Universities were not graduating enough chiropractors. Conclusion: This paper reflects some of the findings from Stage 1 of the three stage Workforce study, showing a profession heading towards a more even gender balance and characterised by a higher than average annual income. Future research should include the impact on supply and demand of the possibility of an increasingly female profession.

The primary purpose of this study was to evaluate the effect of CYP2C8*3 and three genetic ABCB1 variants on the elimination of paclitaxel. We studied 93 Caucasian women with ovarian cancer treated with paclitaxel and carboplatin. Using sparse sampling and nonlinear mixed effects modeling, the individual clearance of unbound paclitaxel was estimated from total plasma paclitaxel and Cremophor EL. The geometric mean of clearance was 385 l h(-1) (range 176-726 l h(-1)). Carriers of CYP2C8*3 had 11% lower clearance than non-carriers, P = 0.03. This has not been shown before in similar studies; the explanation is probably the advantage of using both unbound paclitaxel clearance and a population of patients of same gender. No significant association was found for the ABCB1 variants C1236T, G2677T/A and C3435T. Secondarily, other candidate single-nucleotide polymorphisms were explored with possible associations found for CYP2C8*4 (P = 0.04) and ABCC1 g.7356253C > G (P = 0.04).

Despite a number of studies stating that sexual dimorphism is population specific, sexual differences in Southeast Asian populations have received little attention. Previous studies in this region have focused on samples from Thailand or East Asian populations from China and Japan, examining sexual dimorphism predominantly of the postcranial bones, teeth and mandible with comparatively few cranial studies. These earlier studies have used traditional methods to metrically assess differences between the sexes. The aim of this study is to use geometric morphometric methods for the first time to quantify sexual dimorphism of Southeast Asian crania and extend knowledge of cranial sexual dimorphism beyond China, Japan and Thailand. A total of 35 unilateral and midline landmark coordinates were collected from 144 mainland and island Southeast Asian crania (89 male, 55 female). Using the shape analysis software Morphologika, principal components analysis and thin plate splines allowed for the statistical and visual exploration of shape differences. Differences included relative facial breadth, particularly across the zygomatic and postorbital regions and cranial vault breadth. Significant size dimorphism was also apparent. Overall expected accuracies were highest in the discriminant analysis using both shape and centroid size (86.8%).

Despite a number of studies stating that sexual dimorphism is population specific, sexual differences in Southeast Asian populations have received little attention. Previous studies in this region have focused on samples from Thailand or East Asian populations from China and Japan, examining sexual dimorphism predominantly of the postcranial bones, teeth and mandible with comparatively few cranial studies. These earlier studies have used traditional methods to metrically assess differences between the sexes. The aim of this study is to use geometric morphometric methods for the first time to quantify sexual dimorphism of Southeast Asian crania and extend knowledge of cranial sexual dimorphism beyond China, Japan and Thailand. A total of 35 unilateral and midline landmark coordinates were collected from 144 mainland and island Southeast Asian crania (89 male, 55 female). Using the shape analysis software Morphologika, principal components analysis and thin plate splines allowed for the statistical and visual exploration of shape differences. Differences included relative facial breadth, particularly across the zygomatic and postorbital regions and cranial vault breadth. Significant size dimorphism was also apparent. Overall expected accuracies were highest in the discriminant analysis using both shape and centroid size (86.8%).

Contains fulltext : 71467.pdf (publisher's version ) (Open Access), BACKGROUND: The optimum strategy for stopping treatment with drugs that have different half-lives in a combination regimen to minimize the risk of selecting drug-resistant viruses remains unknown. We evaluated drug concentrations in plasma, human immunodeficiency virus (HIV) load, and development of drug resistance after a planned treatment interruption of a nonnucleoside reverse-transcriptase inhibitor (NNRTI)-containing regimen in HIV type 1-infected children. METHODS: Children with viral loads <50 copies/mL and CD4 cell percentages > or =30% (for children aged 2-6 years) or CD4 cell percentages > or =25% and CD4 cell counts > or =500 cells/microL (for children aged 7-15 years) were randomized to either a planned treatment interruption or to continuous therapy. In the planned treatment interruption arm, either (1) treatment with nevirapine or efavirenz was stopped, and treatment with the remaining drugs was continued for 7-14 days, or (2) nevirapine or efavirenz were replaced by a protease inhibitor, and all drugs were stopped after 7-14 days. Sampling for determination of plasma drug concentrations, measurement of viral load, and drug resistance testing was scheduled at day 0, day 7 (drug concentrations only), day 14, and day 28 after interruption of treatment with an NNRTI. RESULTS: Treatment with an NNRTI was interrupted for 35 children (20 were receiving nevirapine, and 15 were receiving efavirenz). Median time from NNRTI cessation to stopping all drugs was 9 days (range, 6-15 days) for nevirapine and 14 days (range, 6-18 days) for efavirenz. At 7 days, 1 (5%) of 19 and 4 (50%) of 8 children had detectable nevirapine and efavirenz concentrations, respectively; efavirenz remained detectable in 3 (25%) of 12 children at 14 days. At 14 days, viral load was > or =50 copies/mL in 6 of 16 children interrupting treatment with nevirapine (range, 52-7000 copies/mL) and in 2 of 12 children interrupting treatment with efavirenz (range, 120-1600 copies/mL). No new NNRTI m

Contains fulltext : 71467.pdf (publisher's version ) (Open Access), BACKGROUND: The optimum strategy for stopping treatment with drugs that have different half-lives in a combination regimen to minimize the risk of selecting drug-resistant viruses remains unknown. We evaluated drug concentrations in plasma, human immunodeficiency virus (HIV) load, and development of drug resistance after a planned treatment interruption of a nonnucleoside reverse-transcriptase inhibitor (NNRTI)-containing regimen in HIV type 1-infected children. METHODS: Children with viral loads <50 copies/mL and CD4 cell percentages > or =30% (for children aged 2-6 years) or CD4 cell percentages > or =25% and CD4 cell counts > or =500 cells/microL (for children aged 7-15 years) were randomized to either a planned treatment interruption or to continuous therapy. In the planned treatment interruption arm, either (1) treatment with nevirapine or efavirenz was stopped, and treatment with the remaining drugs was continued for 7-14 days, or (2) nevirapine or efavirenz were replaced by a protease inhibitor, and all drugs were stopped after 7-14 days. Sampling for determination of plasma drug concentrations, measurement of viral load, and drug resistance testing was scheduled at day 0, day 7 (drug concentrations only), day 14, and day 28 after interruption of treatment with an NNRTI. RESULTS: Treatment with an NNRTI was interrupted for 35 children (20 were receiving nevirapine, and 15 were receiving efavirenz). Median time from NNRTI cessation to stopping all drugs was 9 days (range, 6-15 days) for nevirapine and 14 days (range, 6-18 days) for efavirenz. At 7 days, 1 (5%) of 19 and 4 (50%) of 8 children had detectable nevirapine and efavirenz concentrations, respectively; efavirenz remained detectable in 3 (25%) of 12 children at 14 days. At 14 days, viral load was > or =50 copies/mL in 6 of 16 children interrupting treatment with nevirapine (range, 52-7000 copies/mL) and in 2 of 12 children interrupting treatment with efavirenz (range, 120-1600 copies/mL). No new NNRTI m

Contains fulltext : 71467.pdf (publisher's version ) (Open Access), BACKGROUND: The optimum strategy for stopping treatment with drugs that have different half-lives in a combination regimen to minimize the risk of selecting drug-resistant viruses remains unknown. We evaluated drug concentrations in plasma, human immunodeficiency virus (HIV) load, and development of drug resistance after a planned treatment interruption of a nonnucleoside reverse-transcriptase inhibitor (NNRTI)-containing regimen in HIV type 1-infected children. METHODS: Children with viral loads <50 copies/mL and CD4 cell percentages > or =30% (for children aged 2-6 years) or CD4 cell percentages > or =25% and CD4 cell counts > or =500 cells/microL (for children aged 7-15 years) were randomized to either a planned treatment interruption or to continuous therapy. In the planned treatment interruption arm, either (1) treatment with nevirapine or efavirenz was stopped, and treatment with the remaining drugs was continued for 7-14 days, or (2) nevirapine or efavirenz were replaced by a protease inhibitor, and all drugs were stopped after 7-14 days. Sampling for determination of plasma drug concentrations, measurement of viral load, and drug resistance testing was scheduled at day 0, day 7 (drug concentrations only), day 14, and day 28 after interruption of treatment with an NNRTI. RESULTS: Treatment with an NNRTI was interrupted for 35 children (20 were receiving nevirapine, and 15 were receiving efavirenz). Median time from NNRTI cessation to stopping all drugs was 9 days (range, 6-15 days) for nevirapine and 14 days (range, 6-18 days) for efavirenz. At 7 days, 1 (5%) of 19 and 4 (50%) of 8 children had detectable nevirapine and efavirenz concentrations, respectively; efavirenz remained detectable in 3 (25%) of 12 children at 14 days. At 14 days, viral load was > or =50 copies/mL in 6 of 16 children interrupting treatment with nevirapine (range, 52-7000 copies/mL) and in 2 of 12 children interrupting treatment with efavirenz (range, 120-1600 copies/mL). No new NNRTI m

BACKGROUND: The optimum strategy for stopping treatment with drugs that have different half-lives in a combination regimen to minimize the risk of selecting drug-resistant viruses remains unknown. We evaluated drug concentrations in plasma, human immunodeficiency virus (HIV) load, and development of drug resistance after a planned treatment interruption of a nonnucleoside reverse-transcriptase inhibitor (NNRTI)-containing regimen in HIV type 1-infected children. METHODS: Children with viral loads <50 copies/mL and CD4 cell percentages > or =30% (for children aged 2-6 years) or CD4 cell percentages > or =25% and CD4 cell counts > or =500 cells/microL (for children aged 7-15 years) were randomized to either a planned treatment interruption or to continuous therapy. In the planned treatment interruption arm, either (1) treatment with nevirapine or efavirenz was stopped, and treatment with the remaining drugs was continued for 7-14 days, or (2) nevirapine or efavirenz were replaced by a protease inhibitor, and all drugs were stopped after 7-14 days. Sampling for determination of plasma drug concentrations, measurement of viral load, and drug resistance testing was scheduled at day 0, day 7 (drug concentrations only), day 14, and day 28 after interruption of treatment with an NNRTI. RESULTS: Treatment with an NNRTI was interrupted for 35 children (20 were receiving nevirapine, and 15 were receiving efavirenz). Median time from NNRTI cessation to stopping all drugs was 9 days (range, 6-15 days) for nevirapine and 14 days (range, 6-18 days) for efavirenz. At 7 days, 1 (5%) of 19 and 4 (50%) of 8 children had detectable nevirapine and efavirenz concentrations, respectively; efavirenz remained detectable in 3 (25%) of 12 children at 14 days. At 14 days, viral load was > or =50 copies/mL in 6 of 16 children interrupting treatment with nevirapine (range, 52-7000 copies/mL) and in 2 of 12 children interrupting treatment with efavirenz (range, 120-1600 copies/mL). No new NNRTI m

Contains fulltext : 52486.pdf (publisher's version ) (Closed access), The recommended dose of lamivudine in children is higher when compared with adults: 4 mg/kg vs approximately 2 mg/kg (150 mg) and administered twice a day. Limited data are available to demonstrate that this increased dose results in adequate exposure to lamivudine in children with human immunodeficiency virus (HIV) infection. Data were selected from children who were using lamivudine for at least 2 weeks before a full pharmacokinetic (PK) study was conducted. Lamivudine PK parameters were significantly related to age. The age of 6 years appeared to be a cutoff for a change in PK parameters of lamivudine, with children <6 years of age (n=17) having a median area under the curve 43% lower and a median peak plasma concentration 47% lower (both P<0.001) than older children (n=34). In conclusion, further investigation of the relationship between decreased lamivudine exposure and treatment outcome and long-term resistance development in younger children with HIV infection is warranted.

Contains fulltext : 52486.pdf (publisher's version ) (Closed access), The recommended dose of lamivudine in children is higher when compared with adults: 4 mg/kg vs approximately 2 mg/kg (150 mg) and administered twice a day. Limited data are available to demonstrate that this increased dose results in adequate exposure to lamivudine in children with human immunodeficiency virus (HIV) infection. Data were selected from children who were using lamivudine for at least 2 weeks before a full pharmacokinetic (PK) study was conducted. Lamivudine PK parameters were significantly related to age. The age of 6 years appeared to be a cutoff for a change in PK parameters of lamivudine, with children <6 years of age (n=17) having a median area under the curve 43% lower and a median peak plasma concentration 47% lower (both P<0.001) than older children (n=34). In conclusion, further investigation of the relationship between decreased lamivudine exposure and treatment outcome and long-term resistance development in younger children with HIV infection is warranted.

Contains fulltext : 50519.pdf (publisher's version ) (Closed access), BACKGROUND: Data on adherence to and acceptability of once daily lamivudine and abacavir are few. METHODS: Twenty-four U.K. human immunodeficiency virus type-1 infected children 2-13 years of age participated in the Pediatric European Network for the Treatment of AIDS (PENTA) 13 single arm, open label pharmacokinetic study of twice (every 12 hours) versus once (every 24 hours) daily lamivudine and abacavir. Caregivers were asked to complete an adherence questionnaire at screening, week 0 (switch once daily to twice daily) and weeks 4, 12 and 24. Acceptability was also assessed at screening and week 24. RESULTS: Fifteen children were taking lamivudine and abacavir as part of their regimens, 8 lamivudine only and 1 abacavir only. After switching to lamivudine/abacavir every 24 hours, 7 (29%) received once daily regimens for all drugs. Twenty-three (96%) caregivers thought that switching to once daily lamivudine/abacavir would make things a lot/a little easier for their child: 17 (71%) thought it was actually easier after switching. Six mothers with children taking a mixture of twice/once daily drugs changed their mind, whereas all mothers of children on once daily regimens agreed that it was a lot easier. Nonadherence (missing doses in the last 3 days) was reported for 8 of 118 (7%) completed questionnaires; missed doses were reported for every drug in the regimen with reasons such as "not at home," "forgot" or "routine different from normal." However, viral loads in all these children remained <100 copies/mL. CONCLUSION: Adherence to once daily abacavir/lamivudine was good with no evidence of an association between nonadherence and virologic rebound. Acceptability of once daily drugs was best when the whole regimen was dosed once daily.

Contains fulltext : 49547.pdf (publisher's version ) (Closed access)

The effect of autumn application of urea on the activity and composition of saprotrophic fungi associated with sour cherry (Prunus cerasus) leaf litter infected with the leaf spot pathogen, Blumeriella jaapii, was studied under orchard conditions from the time of leaf fall to the release of ascospores, the following spring. The ability of treatment of infected leaves post leaf fall with urea or with inoculum of selected fungal strains to reduce primary inoculum (ascospores and winter conidia) of B. jaapii in spring was evaluated. Fungal activity was measured enzymatically by quantifying -N-acetylglycosaminidase and fungal composition and frequency were evaluated following isolation at low temperature of mycelia embedded in leaf particles. Activity of the general fungal flora increased in both the urea and water treatments throughout the experimental period and a significantly higher level of activity was detected in urea-treated leaves up to 79 days after treatment. Most of the 2,146 fungal isolates recovered from the leaf litter during November-May could be placed in the following six groups: Phoma macrostoma (52.7%), other Phoma spp. (12.3%), Cladosporium spp. (13.8%), Alternaria and Ulocladium spp. (5.4%), Epicoccum purpurascens (2.9%) and Fusarium spp. (1.6%). These groups were isolated from the leaf litter throughout the experimental period and the effect of urea on fungal composition in the litter was very limited. Of these groups only the frequency of recovery of E. purpurascens was higher from urea- than from water-treated leaves and this significant difference was maintained throughout the 115 days of the experimental period. Phoma macrostoma var. macrostoma, Cladosporium sp., Ulocladium chatarum, Epicoccum purpurascens and Fusarium lateritium var. lateritium were evaluated and compared with urea to reduce primary inoculum of B. jaapii. Urea reduced primary inoculum of B. jaapii in the spring by 77 % and of the fungal strains, especially Cladosporium strai

Contains fulltext : 50519.pdf (publisher's version ) (Closed access), BACKGROUND: Data on adherence to and acceptability of once daily lamivudine and abacavir are few. METHODS: Twenty-four U.K. human immunodeficiency virus type-1 infected children 2-13 years of age participated in the Pediatric European Network for the Treatment of AIDS (PENTA) 13 single arm, open label pharmacokinetic study of twice (every 12 hours) versus once (every 24 hours) daily lamivudine and abacavir. Caregivers were asked to complete an adherence questionnaire at screening, week 0 (switch once daily to twice daily) and weeks 4, 12 and 24. Acceptability was also assessed at screening and week 24. RESULTS: Fifteen children were taking lamivudine and abacavir as part of their regimens, 8 lamivudine only and 1 abacavir only. After switching to lamivudine/abacavir every 24 hours, 7 (29%) received once daily regimens for all drugs. Twenty-three (96%) caregivers thought that switching to once daily lamivudine/abacavir would make things a lot/a little easier for their child: 17 (71%) thought it was actually easier after switching. Six mothers with children taking a mixture of twice/once daily drugs changed their mind, whereas all mothers of children on once daily regimens agreed that it was a lot easier. Nonadherence (missing doses in the last 3 days) was reported for 8 of 118 (7%) completed questionnaires; missed doses were reported for every drug in the regimen with reasons such as "not at home," "forgot" or "routine different from normal." However, viral loads in all these children remained <100 copies/mL. CONCLUSION: Adherence to once daily abacavir/lamivudine was good with no evidence of an association between nonadherence and virologic rebound. Acceptability of once daily drugs was best when the whole regimen was dosed once daily.

Contains fulltext : 49547.pdf (publisher's version ) (Closed access)