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Objective: This study aimed to examine self-reported code-status practice patterns among emergency clinicians from Japan and the U.S., Methods: A cross-sectional questionnaire was distributed to emergency clinicians from one academic medical center and four general hospitals in Japan and two academic medical centers in the U.S. The questionnaire was based on a hypothetical case involving a critically ill patient with end-stage lung cancer. The questionnaire items assessed whether respondent clinicians would be likely to pose questions to patients about their preferences for medical procedures and their values and goals., Results: A total of 176 emergency clinicians from Japan and the U.S participated. After adjusting for participants' backgrounds, emergency clinicians in Japan were less likely to pose procedure-based questions than those in the U.S. Conversely, emergency clinicians in Japan showed a statistically higher likelihood of asking 10 out of 12 value-based questions., Conclusion: Significant differences were found between emergency clinicians in Japan and the U.S. in their reported practices on posing procedure-based and patient value-based questions., Practice Implications: Serious illness communication training based in the U.S. must be adapted to the Japanese context, considering the cultural characteristics and practical responsibilities of Japanese emergency clinicians., Competing Interests: Declaration of Competing Interest All the Authors have no interest to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: Percutaneous transmural arterial bypass (PTAB) using the DETOUR system aims to create a percutaneous, endovascular femoropopliteal bypass for the treatment of long segment, complex superficial femoral and proximal popliteal artery disease. The goal of the DETOUR2 study is to investigate the safety and effectiveness of the therapy in comparison with pre-established performance goals., Methods: The DETOUR2 investigational device exemption study is a prospective, single-arm, multicenter, international trial of symptomatic peripheral arterial disease patients (Rutherford classes 3-5) undergoing the DETOUR procedure for long segment (>20 cm) superficial femoral artery disease. Prespecified end points included primary safety (composite of major adverse events) at 30 days, and effectiveness (primary patency defined as freedom from restenosis or clinically driven target lesion revascularization) at 1 year., Results: We enrolled 202 patients at 32 sites with 200 treated with the DETOUR system. The mean lesion length was 32.7 cm, of which 96% were chronic total occlusions (CTO) and 70% were severely calcified. Technical success was achieved in 100% of treated patients. The primary safety end point was met with a 30-day freedom from major adverse event rate of 93.0%. The 1-year primary effectiveness end point was met with 72.1% primary patency at 12 months. Primary-assisted and secondary patency were 77.7% and 89.0%, respectively, at 12 months. The 12 month deep venous thrombosis incidence was 4.1% with no pulmonary emboli reported. Venous quality-of-life scores showed no significant changes from baseline. There was a Rutherford improvement of at least one class through 12 months in 97.2% of patients. The mean ankle-brachial index also improved from 0.61 to 0.95 during this period. There were marked improvements in quality-of-life and functional status measures., Conclusions: The DETOUR2 study met both the primary safety and effectiveness end points, demonstrating clinical usefulness of this novel therapeutic strategy in long femoropopliteal lesions., Competing Interests: Disclosures S.P.L. is a consultant for BD, Boston Scientific, Contego Medical, Cordis, Endologix, Inspire MD, Medtronic, Rapid Medical, Shockwave, Penumbra, and Vivasure; holds stock options in Inspire MD and Centerline Biomedical; is a Board Member for VIVA physicians; participates in research studies for Abbott, Endologix, Surmodics, W. L. Gore & Associates, Terumo Aortic, NIH, Boston Scientific, Merit, Contego Medical, Inspire MD, Reva Medical, Penumbra, Medalliance, and Nectero. P.S. is a consultant for Boston Scientific, Endologix, Shockwave, and W. L. Gore & Associates; participates in research studies from Boston Scientific, Contego Medical, Endologix, Limflow, MedAlliance, Micromedical Solutions, NINDS, Philips, Reflow Medical, Reva Medical, and Shockwave. J.M. has the following disclosures: 2MG-Stock, Angiodynamics-trainer/consultant, Asahi Consultant, patent license agreement, Avenda Stock, AvingerTrainer/consultant, research, Bectin Dickinson Trainer/consultant, Boston Scientific Research, Cagent Vascular Stock, CardioFlow Research, board member/chief medical officer, equity ownership/stock, Cardiovascular Systems, Inc. J.M. is a trainer/consultant, CorVista Stock, Endologix Research, Euphrates Stock, Glift Stock, Iatri Board member/chief medical officer, stock, Ichor/FluidX Stock, Immertec Stock options, Levee Medical Stock, Marvao Medical Research, Medtronic Trainer/consultant, MicroMedical Solutions Board member/chief medical officer, stock option, Philips Trainer/consultant, Reflow Medical Research, stock options Salus Scientific Stock, Soundbite Stock, Terumo Trainer/consultant, Transit Medical Stock, Vantis Vascular Stock, and Versono Research. E.A. is a consultant for Abbott, Boston Scientific, W. L. Gore & Associates, Medtronic, MedAlliance, and Shockwave Medical., (Copyright © 2024 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Background: A prolonged repetitive transcranial magnetic stimulation (rTMS) treatment course could be beneficial for some patients experiencing major depressive episodes (MDE). We identified trajectories of rTMS response in depressive patients who received an extended rTMS treatment course and sought to determine which trajectories achieved the greatest benefit with a prolonged treatment course., Method: We applied group-based trajectory modeling to a naturalistic dataset of depressive patients receiving a prolonged course of sequential bilateral rTMS (up to 51 treatment sessions) to the dorsolateral prefrontal cortex. Trajectories of the PHQ-9 with extended treatment courses were characterized, and we explored the association between baseline clinical characteristics and group membership using multinomial logistic regression., Results: Among the 324 study participants, four trajectories were identified: "linear response, extended course" (N = 73; 22.5 %); "nonresponse" (N = 23; 7.1 %); "slowed response" (N = 159; 49.1 %); "rapid response, standard treatment length" (N = 69; 21.3 %). Only the "linear response, extended course" group showed considerable clinical improvement after receiving additional rTMS treatments. Greater baseline depressive symptoms were associated with linear response and non-response., Conclusion: Our results confirmed the distinctive response trajectories in depressive patients receiving rTMS and further highlighted that prolonged rTMS treatment courses may be beneficial for a subset of patients with higher initial symptom levels and linear early treatment response., Competing Interests: Declaration of competing interest Xiao Chen has received research support from the National Natural Science Foundation of China, the China Scholarship Council, and the Chinese Academy of Sciences. Daniel M. Blumberger has received research support from CIHR, NIH, Brain Canada, and the Temerty Family through the CAMH Foundation and the Campbell Family Research Institute. He received research and in-kind equipment support for an investigator-initiated study from Brainsway Ltd. He is the site principal investigator for three sponsor-initiated studies for Brainsway Ltd. He also receives in-kind equipment support from Magventure for investigator-initiated research. He received medication supplies for an investigator-initiated trial from Indivior. Jonathan Downar has received research support from NIH, CIHR, Brain Canada, Ontario Brain Institute, the Klarman Family Foundation, the Krembil Foundation, Arrell Family Foundation, and the Buchan Family Foundation, in-kind equipment support for investigator-initiated trials from MagVenture, is an advisor for BrainCheck, Arc Health Partners and Salience Neuro Health, and is a co-founder of Ampa Health. Tyler S. Kaster is supported by the Canadian Institute for Health Research and the AFP Innovation Fund. Study data was provided at no cost by Salience Health. No funding was provided for the analysis, or manuscript creation. Victoria J. Middleton, Naima Monira, Jennifer Bowman, Joseph Kriske, John Kriske, and Nancy Donachie are employees of Salience Health., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: This article aims to report on the sleep health characteristics of a population-level sample of young Australian adults and examine associations with measures of physical and mental health., Methods: A cross-sectional study using data from the Raine Study. Data from participants (n = 1234) born into the study (Generation 2) at the 22-year follow-up were used, including data from a self-report questionnaire and polysomnography., Results: The highest prevalence of suboptimal sleep health was seen on measures of sleep duration (30%), onset latency (18%), satisfaction (25%) and regularity (60%). Dissatisfaction with sleep (physical health: β =0.08; mental health: β =0.34) and impaired daytime alertness (physical health: β =0.09; mental health: β =0.08) were significantly associated with poorer physical and mental health and inadequate polysomnography-measured sleep duration was associated poorer mental health (β =0.07) (all ps<0.05)., Conclusions: Satisfaction with sleep and daytime alertness, both of which are assessed via self-report, are essential aspects of sleep health for young adults., Implications for Public Health: Findings could inform public health interventions, including screening guidelines, to improve the sleep health and, in turn, the physical and mental health of young adults in Australia., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: Alcohol and other drug (AoD) use is a significant factor in the poor health status of people in prison. Our aim is to explore associations of alcohol consumption with tobacco and illicit drug use among Aboriginal and non-Aboriginal people in prison to inform health services, clinical care and support., Methods: We analysed the alcohol, tobacco and illicit drug use data of the 2015 Network Patient Health Survey of adults in custody in New South Wales (n=1,132). A comparative analysis of Aboriginal to non-Aboriginal participants including bi-variant and multivariant analysis was undertaken., Results: Significantly more Aboriginal than non-Aboriginal participants reported alcohol consumption before prison that was consistent with possible dependence. More Aboriginal than non-Aboriginal participants used cannabis on a daily or almost on daily basis before prison. There was significant association between alcohol and cannabis use among Aboriginal participants., Conclusions: There are differences in Aboriginal and non-Aboriginal AoD use patterns, which should be considered when providing treatment and support programs within and post-release from prison., Implications for Public Health: Specific programs are needed to assist Aboriginal people in this population who co-use alcohol and cannabis., Competing Interests: Conflicts of interest None of the authors have a conflict of interest towards publishing this paper., (Crown Copyright © 2023. Published by Elsevier B.V. All rights reserved.)

Finfish aquaculture is a fast-growing primary industry and is increasingly common in coastal ecosystems. Bacterioplankton is ubiquitous in marine environment and respond rapidly to environmental changes. Changes in bacterioplankton community are not well understood in semi-enclosed stratified embayments. This study aims to examine aquaculture effects in the composition and functional profiles of the bacterioplankton community using amplicon sequencing along a distance gradient from two finfish leases in a marine embayment. Results revealed natural stratification in bacterioplankton associated to NOx, conductivity, salinity, temperature and PO 4 . Among the differentially abundant bacteria in leases, we found members associated with nutrient enrichment and aquaculture activities. Abundant predicted functions near leases were assigned to organic matter degradation, fermentation, and antibiotic resistance. This study provides a first effort to describe changes in the bacterioplankton community composition and function due to finfish aquaculture in a semi-enclosed and highly stratified embayment with a significant freshwater input., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Being overweight or obese is a primary modifiable risk factor that exacerbates disease progression and mobility disability in older knee osteoarthritis (OA) patients. Lifestyle interventions combining exercise with dietary weight loss (EX+DWL) yield meaningful improvements in mobility and weight loss that are superior to EX or DWL alone. Unfortunately, community access to practical, sustainable weight management interventions remains limited and places knee OA patients at increased risk of mobility disability. The Collaborative Lifestyle Intervention Program in Knee Osteoarthritis patients (CLIP-OA), was a two-arm, 18 month randomized-controlled, comparative effectiveness trial designed to contrast the effects of an evidence-based, theory-driven EX+DWL intervention, personalized to patient needs and delivered by our community partners, with those of the Arthritis Foundation's Walk With Ease (WWE) standard of care self-management program in the treatment of knee OA patients with overweight or obesity. The primary outcome of the CLIP-OA trial was mobility performance assessed using the 400-m walk test (400MWT). Secondary outcomes included weight loss, pain, select quality of life and social cognitive variables, and cost-effectiveness of intervention delivery. Findings from the CLIP-OA trial will determine the comparative and cost-effectiveness of the EX+DWL and WWE interventions on key clinical outcomes and has the potential to offer a sustainable medium for intervention delivery that can promote widely accessible weight management among knee OA patients with overweight or obesity. Trial Registration: NCT02835326., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: Atherectomy has become commonplace as an adjunct to interventional treatments for peripheral arterial disease, but the procedures have been complicated by risks including distal embolization and arterial perforation. This study aimed to examine the safety and effectiveness of a novel atherectomy system to treat femoropopliteal and below-knee peripheral arterial disease., Methods: The Revolution Peripheral Atherectomy System (Rex Medical LP, Conshohocken, Pa) was studied in 121 patients with 148 femoropopliteal and below-knee lesions, enrolled at 17 United States institutions. Technical success was defined when the post-atherectomy angiographic stenosis was ≤50%, as assessed by an independent core laboratory. Major adverse events were adjudicated by an independent Clinical Events Committee., Results: Among 148 site-identified target lesions in 121 patients, 21.4% were in the superficial femoral artery, 13.7% involved the popliteal artery, and 67.9% were in tibial arteries; 3.1% involved more than one segment. Technical success was 90.2%, with stenoses decreasing from 73% ± 19% at baseline to 42% ± 14% after atherectomy. Adjunctive treatment after atherectomy included angioplasty with uncoated balloons in 91%, drug-coated balloons in 11%, bare stent deployment in 8%, and drug-eluting stent placement in 3%. Procedural success (<30% residual stenosis) was achieved in 93.7% of target lesions. Complications during the procedure included one target vessel perforation and two distal embolizations; each of which were adjudicated by the Clinical Events Committee as unrelated to the device and were not visualized angiographically by the core laboratory. Freedom from major adverse events was 97.3% through 30 days. The Kaplan-Meier estimates of primary, assisted primary, and secondary patency were 81.6%, 87.7%, and 91.6% at 6 months, respectively., Conclusions: The use of the Revolution Peripheral Atherectomy System was associated with few procedural complications and a high rate of success at the index procedure and through 6 months., (Copyright © 2021. Published by Elsevier Inc.)

Context: Health systems have aspired to integrate palliative care (PC) into the emergency department (ED) to improve care quality for over a decade, yet there are very few examples of implemented models in the literature. The coronavirus disease 2019 (COVID-19) pandemic led to an increase in the volume of seriously ill patients in EDs and a consequent rapid increase in PC integration in many EDs., Objectives: To describe the new PC-ED delivery innovations that emerged during the COVID-19 pandemic., Methods: For this qualitative study of PC programs in EDs, semistructured interviews were conducted with ED and PC clinicians between June 30, 2020 and August 18, 2020. Participants were asked about PC-ED integration before, during, and after COVID. We conducted a two-phased rapid analysis using a rapid analysis template and consolidated matrix to identify innovations., Results: Using purposive and snowball sampling, we interviewed 31 participants, representing 52 hospitals. Several new innovations in care delivery were identified. These included elements of fully embedded PC, the use of PC extenders, technology both within the electronic medical record and outside it, and innovations in training emergency clinicians in primary PC skills to support care delivery. Most PC efforts focused on increasing goals-of-care conversations. Institutions that implemented these programs reported that they increased PC utilization in the ED, were well received by clinicians, and changed patient's care trajectories., Conclusion: Several new innovations in PC-ED care delivery emerged during COVID. Many innovations leveraged different types of clinicians to deliver care, an increased physical presence of PC in the ED, and used technology to enhance care delivery. These innovations may serve as a framework for institutions as they plan for evolving needs in the ED during and after COVID. Additional research is needed to evaluate the impact of these programs and understand their applicability beyond the pandemic., (Copyright © 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the prevalence of, and factors associated with, awareness and use of telephone-based behaviour change support services among clients of a community mental health service., Methods: Adult clients (n=375) of one Australian community mental health service completed a telephone interview and self-reported not meeting Australian National Guidelines for smoking, nutrition, alcohol consumption and/or physical activity. Descriptive statistics summarised awareness and use of the New South Wales Quitline ® and Get Healthy Service ® for participants with lifestyle risk factors addressed by each service. Chi-squares and logistic regressions explored associations between client characteristics, and service awareness and use., Results: Awareness (16.1%) and use (1.9%) of the Get Healthy Service was lower than that of Quitline (89.1%; 18.1%). Television was the most common source of awareness (39.7% Get Healthy Service; 74.0% Quitline). In the regression models, persons in a relationship were more likely to have heard of the Get Healthy Service (OR:2.19, CI:1.15-4.18), and persons aged 36-50 were more likely to have used the Quitline (OR:5.22, CI:1.17-23.37)., Conclusions: Opportunities exist for increasing awareness and use of both services, particularly the Get Healthy Service, among clients of community mental health services. Implications for public health: Strategies to optimise reach for this population group are recommended., (© 2020 The Authors.)

Context: Although the importance of palliative care (PC) integration in the emergency department (ED) has long been recognized, few formalized programs have been reported, and none have evaluated the experience of ED clinicians with embedded PC., Objectives: We evaluate the experience of ED clinicians with embedded PC in the ED during the coronavirus disease pandemic., Methods: ED clinicians completed a survey about their perceptions of embedded PC in the ED. We summarized responses to closed-ended items using descriptive statistics and analyzed open-ended items using thematic analysis., Results: There were 134 ED clinicians surveyed. About 101 replied (75% response rate). Of those who had interacted with PC, 100% indicated a benefit of having PC involved. These included freeing up ED clinicians for other tasks (89%), helping them feel more supported (84%), changing the patients care trajectory (67%), and contributing to clinician education (57%) and skills (49%). Among barriers related to engaging PC were difficulty locating them (8%) and lack of time to consult because of ED volume (5%). About 98% of respondents felt that having PC in the ED was either valuable or very valuable. Open-ended responses reflected a positive impact on clinician wellness and improvement in access to high-quality goal-concordant care. Clinicians expressed gratitude for having PC in the ED and noted the importance of having readily available and easily accessible PC in the ED., Conclusion: ED clinicians' perception of embedded PC was overall positive, with an emphasis on the impact related to task management, enrichment of PC skills, providing support for the team, and improved care for ED patients., (Copyright © 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Adenoid cystic carcinoma (ACC) is a salivary gland malignancy with a propensity for perineural spread and diffuse soft tissue infiltration. In the head and neck this unique biological behaviour can result in skull base involvement. A lack of consensus regarding management of ACC involving the skull base in conjunction with the technical and reconstructive challenges of oncological resection in this region has led to variation in practice between institutions., Method: Retrospective multicentre review of patients with advanced ACC infiltrating the skull base, treated surgically by the Queensland Skull Base Unit between 2005 and 2017, with a minimum follow up time of 24  months., Results: 32 patients were treated for ACC with skull base involvement with oncological resection and post-operative radiation in the study period with a median follow up of 82.18  months (33.11-159.53 months). 5 and 10  year locoregional control were both 88.2% (95% CI 67.5-96.1) despite a high rate of microscopically positive margins (81.3%). Metastatic disease rates were high, resulting in low rates of disease free survival (DFS) (53.0% at 5 years (95% CI 33.7-69.0) and 23.0% at 10 years (9.5-39.8)). Overall survival (OS) was high (5 year 91.8% (95% CI 71.1-97.9), 10 year 63.7% (95% 37.5-81.2)), despite the advanced nature of disease., Conclusion: High rates of locoregional control can be achieved in skull base ACC with oncological resection of disease and post-operative radiation. Whilst disease recurrence rates are high, a majority of recurrence is metastatic and does not confer poor intermediate term overall survival., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

Under US Public Health Service guidelines, organ donors with risk factors for human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV) are categorized as increased risk donors (IRD). Previous studies have suggested that IRD organs are utilized at lower rates than organs from standard risk donors (SRD), but these studies were conducted prior to universal donor nucleic acid test screening. We conducted risk-adjusted analyses to determine the effect of IRD designation on organ utilization using 2010-2017 data (21 626 heart, 101 160 kidney, 52 714 liver, and 16 219 lung recipients in the United States) from the Organ Procurement and Transplantation Network. There was no significant difference (P < .05) between risk-adjusted utilization rates for IRD vs SRD organs for adult hearts and livers and pediatric kidneys, livers, and lungs. Significantly lower utilization was found among IRD adult kidneys, lungs, and pediatric hearts. Analysis of the proportion of transplanted organs recovered from IRD by facility suggests that a subset of facilities contribute to the underutilization of adult IRD kidneys. Along with revised criteria and nomenclature to identify donors with HIV, HBV, or HCV risk factors, educational efforts to standardize informed consent discussions might improve organ utilization., (© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.)

We describe a case of an intraductal mucoepidermoid carcinoma arising from a minor salivary gland of the oral cavity. This is a rare presentation, and our literature review identified only a single previously documented case. To the best of our knowledge, this is the first reported case to be verified by immunohistochemistry demonstrating myoepithelial or basal cells around all the neoplastic units., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Hypothermia is a common problem encountered by search and rescue teams. Although mildly hypothermic patients can be rewarmed in the field and can then self-evacuate, the Wilderness Medical Society hypothermia guidelines suggest that a moderately hypothermic patient in the wilderness requires warming in a medical facility. The hypothermia prevention and management kit, developed by the US military, consists of a chemical heat blanket (CHB) and a heat-reflective shell. We present a case in which a hypothermia wrap and the CHB from a hypothermia prevention and management kit were used successfully to rewarm a patient with apparent moderate hypothermia in the field. We are unaware of previous reports of successful field rewarming of a patient with moderate hypothermia. We believe the use of the CHB in conjunction with a hypothermia wrap made field rewarming possible. We recommend that a CHB, along with the components of a hypothermia wrap, be carried by search and rescue teams when a hypothermic patient might be encountered. Although there were no documented core temperatures, we believe this case is consistent with the hypothesis that if a hypothermic patient who is found lying down and shivering is allowed to stand or walk before insulation is applied and before there has been an additional period of 30 min during which the patient continues to shiver, there may be increased afterdrop with deleterious results., (Copyright © 2019. Published by Elsevier Inc.)

Context: Heart failure (HF) is associated with symptom exacerbations and risk of mortality after an emergency department (ED) visit. Although emergency physicians (EPs) treat symptoms of HF, often the opportunity to connect with palliative care is missed. The "surprise question" (SQ) "Would you be surprised if this patient died in the next 12 months?" is a simple tool to identify patients at risk for 12-month mortality., Objectives: The objective of this study was to assess the accuracy of the SQ when used by EPs to assess patients with HF., Methods: We conducted a prospective cohort study in which clinicians applied the SQ to patients presenting to the ED with symptoms of HF. Chart review and review of death records were completed. The primary outcome was accuracy of the surprise question to predict 12-month mortality. A univariate analysis for potential predictors of 12-month mortality was performed., Results: During the study period, 199 patients were identified, and complete data were available for 97% of observations (n = 193). The one-year mortality was 29%. EPs reported that "they would not be surprised" if the patient died within the next 12 months in 53% of cases. 42.7% of these patients died within 12 months compared to 13.3% in the "would be surprised" group. There was a strong association with death in the "not surprised" group (odds ratio 4.85, 95% CI 2.34-9.98, P < 0.0001). The sensitivity, specificity, positive predictive value, and negative predictive value of the SQ were 78.6%, 56.9%, 42.7%, and 86.7%, respectively, with c-statistic = 0.68., Conclusion: The SQ screening tool can assist ED providers in identifying HF patients that would benefit from early palliative care involvement., (Copyright © 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Real-time video communication technology (e.g. Skype) may be an effective mode for delivering smoking cessation treatment to regional and remote residents. This randomised trial examines the effectiveness of real-time video counselling compared to: 1) telephone counselling; and 2) written materials (control) in achieving smoking abstinence in regional and remote residents., Design: A three-arm, parallel group, randomised trial will be conducted with smokers residing in regional and remote areas of New South Wales, Australia. Potential participants will complete an online screening survey and if eligible an online baseline survey. Participants will be randomly allocated into: 1) real-time video counselling; 2) telephone counselling; or 3) written materials (control). In the video counselling intervention an advisor will deliver up to six video sessions (e.g. via Skype) to participants. Those who nominate a quit date within a month during the initial video session will be offered sessions on the quit date, 3-, 7-, 14- and 30-days after the quit date. Those not ready to set a quit date within a month during the initial video session will be offered sessions 2-, 4- and 6-weeks later. Other than delivery mode, the video counselling and telephone counselling will be identical in content and callback schedules. Control group participants will be mailed one-off written materials. Follow-up surveys will occur at 4-months, 7-months and 13-months post-baseline. The primary outcome will be 7-day point prevalence abstinence at 13-months post-baseline., Discussion: Real-time video counselling may be an effective strategy for smoking cessation that could be integrated into quitlines globally., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The paucity of information on the biological risks of photopolymers in additive manufacturing is a major challenge for the uptake of the technology in the construction of medical devices in dentistry. In this paper, the biocompatibility of methacrylates for denture bases, splints, retainers and surgical guides were evaluated using the innovative zebrafish embryo model, which is providing a high potential for toxicity profiling of photopolymers and has high genetic similarity to humans. Toxicological data obtained confirmed gradations of toxicity influenced by ethanol treatment, exposure scenarios and extraction vehicles. In direct exposure tests, juvenile fish exposed to non-treated methacrylates in ultrapure water showed accelerated toxicity endpoints compared to fish in transparent E3 medium. Similarly, toxic extracts induced mostly acute responses (embryonic mortality) in contrast to cumulative chronic (sublethal and teratogenic effects) in direct exposure. Methacrylates composed of >60% Ethoxylated bisphenol A dimethacrylate produced a relatively lower conversion rate in FTIR spectroscopy, but were safe in zebrafish bioassays after ethanol treatment. The study affirms that biocompatibility was influenced primarily by physico-chemical characteristics of the materials, which subsequently influenced their residual monomer content before and after immersion in ethanol. Given the precautionary implications of the study, we propose a 3-tiered approach i.e. using approved materials, apposite manufacturing parameters and post-processing techniques that together guarantee optimal results for medical devices., Statement of Significance: This study is timely and relevant since there is limited published literature that precisely describes the toxicological properties of additively manufactured methacrylates despite their increased popularity for medical devices. While it is generally accepted that the zebrafish excels as a model system for developmental toxicity, a further examination of its utility in this study using different protocols provides basis for its consideration and adoption at a crucial time when there is a lack of consensus regarding the most suited biological assessment methods for medical devices., (Copyright © 2018 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.)

Objective: To examine the effect of universal, school-based, resilience-focused interventions on mental health problems in children and adolescents., Method: Eligible studies were randomized controlled trials (RCTs) of universal, school-based interventions that included strategies to strengthen a minimum of 3 internal resilience protective factors, and included an outcome measure of mental health problems in children and adolescents aged 5 to 18 years. Six databases were searched from 1995 to 2015. Results were pooled in meta-analyses by mental health outcome (anxiety symptoms, depressive symptoms, hyperactivity, conduct problems, internalizing problems, externalizing problems, and general psychological distress), for all trials (5-18 years). Subgroup analyses were conducted by age (child: 5-10 years; adolescent: 11-18 years), length of follow-up (short: post-≤12 months; long: >12 months), and gender (narrative)., Results: A total of 57 included trials were identified from 5,984 records, with 49 contributing to meta-analyses. For all trials, resilience-focused interventions were effective relative to a control in reducing 4 of 7 outcomes: depressive symptoms, internalizing problems, externalizing problems, and general psychological distress. For child trials (meta-analyses for 6 outcomes), interventions were effective for anxiety symptoms and general psychological distress. For adolescent trials (meta-analyses for 5 outcomes), interventions were effective for internalizing problems. For short-term follow-up, interventions were effective for 2 of 7 outcomes: depressive symptoms and anxiety symptoms. For long-term follow-up (meta-analyses for 5 outcomes), interventions were effective for internalizing problems., Conclusion: The findings may suggest most promise for using universal resilience-focused interventions at least for short-term reductions in depressive and anxiety symptoms for children and adolescents, particularly if a cognitive-behavioral therapy-based approach is used. The limited number of trials providing data amenable for meta-analysis for some outcomes and subgroups, the variability of interventions, study quality, and bias mean that it is not possible to draw more specific conclusions. Identifying what intervention qualities (such as number and type of protective factor) achieve the greatest positive effect per mental health problem outcome remains an important area for future research., Systematic Review Protocol and Registration: Systematic Review of Universal Resilience Interventions Targeting Child and Adolescent Mental Health in the School Setting; http://dx.doi.org/10.1186/s13643-015-0172-6; PROSPERO CRD42015025908., (Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Worldwide, 10-20% of adolescents experience mental health problems. Strategies aimed at strengthening resilience protective factors provide a potential approach for reducing mental health problems in adolescents. This study evaluated the effectiveness of a universal, school-based intervention targeting resilience protective factors in reducing mental health problems in adolescents. A cluster randomised controlled trial was conducted in 20 intervention and 12 control secondary schools located in socio-economically disadvantaged areas of NSW, Australia. Data were collected from 3115 students at baseline (Grade 7, 2011), of whom 2149 provided data at follow up (Grade 10, 2014; enrolments in Grades 7 to 10 typically aged 12-16 years; 50% male; 69.0% retention). There were no significant differences between groups at follow-up for three mental health outcomes: total SDQ, internalising problems, and prosocial behaviour. A small statistically significant difference in favour of the control group was found for externalising problems. Findings highlight the continued difficulties in developing effective, school-based prevention programs for mental health problems in adolescents., Trial Registration: ANZCTR (Ref no: ACTRN12611000606987)., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Context: Little is known about how hospice live discharges vary by hospice providers' tax status and chain affiliation., Objectives: To characterize hospices with high rates of problematic patterns of live discharges., Methods: Three hospice-level patterns of live discharges were defined as problematic when the facility rate was at the 90th percentile or higher. A hospice with a high rate of patients discharged, hospitalized, and readmitted to hospice was considered to have a problematic live discharge pattern, which we have referred to as burdensome transition. The two other problematic live discharge patterns examined were live discharge in the first seven days of a hospice stay and live discharge after 180 days in hospice. A multivariate logistic model examined variation in the hospice-level rate of each discharge pattern by the hospice's chain affiliation and profit status. This model also adjusted for facility rates of medical diagnoses, nonwhite patients, average age, and the state in which the hospice program is located., Results: In 2010, 3028 hospice programs had 996,208 discharges, with 18.0% being alive. Each proposed problematic pattern of live discharge varied by chain affiliation. For-profit providers without a chain affiliation had a higher rate of burdensome transitions than did for-profit providers in national chains (18.2% vs. 12.1%, P < 0.001), whereas not-for-profit providers had the lowest rate of burdensome transitions (1.4%). About one in three (33.8%) for-profit providers exhibited one or more of these discharge patterns compared with 9.0% of not-for-profit providers., Conclusion: Problematic patterns of live discharges are higher among for-profit providers, especially those not affiliated with a hospice chain., (Copyright © 2015 American Academy of Hospice and Palliative Medicine. All rights reserved.)

Background: Telephone-based interventions can be effective in increasing child fruit and vegetable intake in the short term (<6 mo). The long-term efficacy of such interventions, however, is unknown., Objectives: The primary aim of this study was to determine whether the short-term (<6 mo) impact of a telephone-based intervention on children's fruit and vegetable intake was sustained over a longer term. A secondary aim of the study was to assess the long-term impact of the intervention on the intake of foods high in fat, salt, or sugar (noncore foods)., Design: The study used a cluster randomized controlled trial design. Parents were recruited from Australian preschools between February and August 2010 and allocated to receive an intervention consisting of print materials and 4 telephone-counseling calls delivered over 1 mo or to a print information-only control group. The primary endpoint for the trial was the 18-mo postbaseline follow-up. Linear regression models were used to assess between-group differences in child consumption of fruit and vegetables and noncore foods by subscales of the Children's Dietary Questionnaire., Results: Fruit and vegetable subscale scores were significantly higher, indicating greater child fruit and vegetable intake, among children in the intervention group at the 12-mo (16.77 compared with 14.89; P < 0.01) but not the 18-mo (15.98 compared with 16.82; P = 0.14) follow-up. There were no significant differences between groups at either of the follow-up periods in the noncore food subscale score., Conclusion: Further research to identify effective maintenance strategies is required to maximize the benefits of telephone-based interventions on child diet.

In contrast to other pneumococcal serotypes, which are thought to be T-independent antigens, type 1 Streptococcus pneumoniae polysaccharide (Sp1) is a zwitterionic polysaccharide (ZPS). It has previously been shown to be processed and presented by antigen-presenting cells utilizing the MHC-II pathway, which leads to Sp1-induced T cell proliferation, a hallmark of thymus-dependent immune responses. We used peripheral blood mononuclear cells obtained from adults enrolled in a randomised clinical trial to investigate memory B cell responses following immunisation with the 23-valent pneumococcal plain polysaccharide vaccine. Administration of this serotype 1 containing vaccine resulted in the depletion of serotype 1 antigen-specific pre-existing memory B cells compared to baseline. This finding indicates that this ZPS is not processed by a classical TD mechanism within the MHC-II pathway., (Copyright © 2012 Elsevier GmbH. All rights reserved.)

Background: Inadequate fruit and vegetable consumption is associated with increased chronic disease risk and represents a considerable global health burden. Despite evidence that dietary habits track from early childhood, there are few published trials of interventions attempting to increase preschoolers' fruit and vegetable consumption., Objective: The Healthy Habits trial aimed to assess the efficacy of a telephone-based intervention for parents to increase the fruit and vegetable consumption in their 3-5-y-old children., Design: A cluster randomized controlled trial was conducted involving 394 parents of children aged 3-5 y recruited through local preschools. Parents allocated to the intervention received printed resources plus four 30-min telephone calls targeting aspects of the home food environment associated with children's fruit and vegetable consumption. Parents allocated to the control group received generic printed nutrition information. Children's fruit and vegetable consumption was assessed by using the Fruit and Vegetable Subscale of the Children's Dietary Questionnaire, which was administered via telephone interview at baseline and 2 and 6 mo later., Results: Analysis of all available data showed that children's fruit and vegetable scores were significantly higher in the intervention group than in the control group at 2 mo (P < 0.001) and at 6 mo (P = 0.021). Sensitivity analysis using baseline observation carried forward showed an intervention effect at 2 mo (P = 0.008) but not at 6 mo (P = 0.069)., Conclusions: Telephone-delivered parent interventions may be an effective way of increasing children's fruit and vegetable consumption in the short term. Further investigation to determine whether the intervention effect is maintained in the longer term is recommended.

Sentinel species are important tools for studies of biodiversity and environmental health. The American mink (Neovison vison) has long been considered a sentinel of environmental contamination, since the species is known to be sensitive to a number of common contaminants, including polychlorinated biphenyls (PCB) and mercury. Mink may not always satisfy an important criterion of sentinels however--that they are continuous residents of the environment being sampled. This is because domestic mink commonly escape from farms, and can be confused with wild mink in areas where mink ranching is prevalent, biasing estimates of environmental contamination taken from free-ranging mink samples. We tested for bias in a sample of free-ranging mink from Ontario, Canada, where both genetic ancestry (domestic, wild, and domestic-wild hybrid) and contaminant burdens (PCBs and mercury) were known. Of 133 mink sampled for both contaminants and genetic ancestry, 9% were determined to be domestic and 10.5% hybrid animals. We found that including domestic and hybrid mink in our analysis resulted in overestimating mean PCB burdens in wild mink by 27%, and underestimating mercury by 13%. We also investigated morphological methods to aid in excluding domestic mink from free-ranging mink samples and found that we had the highest classification success using skull size (condylobasal length), which was 15% and 12% greater in male and female domestic than wild mink, respectively. Given the potential use of mink as sentinels, and also the potential for bias, we recommend that researchers take steps to exclude domestic mink from free-ranging mink samples in studies of environmental health., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objectives: The study evaluated the antibacterial effect of VIOlight (VL) Personal Travel Toothbrush Sanitizer on biofilms after toothbrush exposure to human saliva compared to Listerine Antiseptic (LA), 3% hydrogen peroxide (3%HP) and water., Methods: Twenty toothbrush heads (n=5/Gp) were immersed in saliva and to allow for bacterial growth and biofilm formation for 24h. VL sanitizer and antiseptic(s) were used for 7 min; after treatment, brush heads were rinsed and placed into 10 mL of 2x AOAC Letheen Broth, sonicated and vortexed for 10s. Tenfold serial dilutions were prepared and plated and incubated aerobically and anaerobically. Log(10)CFU/mL data were compared utilizing ANOVA (p<0.05)., Results: Results showed 3%HP with significantly lower counts than LA, VL and control for aerobic and anaerobic bacteria. LA had significantly lower counts than VL and control for both types of bacteria and VIOlight had significantly lower counts than the control for aerobic bacteria. 3%HP and LA were most effective in rapidly killing bacteria when compared to VIOlight., Conclusions: Results showed that 3% hydrogen peroxide was most effective in reducing the numbers of both aerobic and anaerobic bacteria present on the toothbrush heads. Under the same test conditions, Listerine Antiseptic was shown to be secondarily effective for the same bacteria while the VIOlight unit was the least effective when compared to the other treatment groups., (Copyright 2010. Published by Elsevier Ltd.)

Objectives: To investigate the prevalence of recorded smoking status, nicotine dependence assessment, and nicotine dependence treatment provision; and to examine the patient characteristics associated with the recording of smoking status., Method: A retrospective systematic medical record audit was conducted of all psychiatric inpatient discharges over a six-month period (1 September 2005 to 28 February 2006), at a large Australian psychiatric hospital, with approximately 2,000 patient discharges per year. A one-page audit tool identifying patient characteristics and prevalence of recorded nicotine dependence treatment, and requiring ICD-10-AM diagnoses coding was used., Results: From 1,012 identified discharges, 1,000 medical records were available for audit (99%). Documentation of smoking status most frequently occurred on the admission form (28.8%) and diagnoses summary (41.6%). Documentation of nicotine dependence was not found in any record, and recording of any nicotine dependence treatment was negligible (0-0.5%). The rate of recorded smoking status on discharge summaries was 6%. Patients with a diagnosis of alcohol, cannabis, sedative use disorders or asthma were twice as likely to have their smoking status recorded compared to those who did not have these diagnoses., Conclusions: Mental health services, by failing to diagnose and document treatment for nicotine dependence, do not conform to current clinical practice guidelines, despite nicotine dependence being the most commonly diagnosed psychiatric disorder., Implications: Considerable system change and staff support is required to provide an environment where a primary prevention approach such as smoking care can be sustained.

In a recent review paper, Basu et al. [Basu, N., Scheuhammer, A.M., Bursian, S.J., Elliott, J., Rouvinen-Watt, K., Chan, H.M., 2007. Mink as a sentinel species in environmental health. Environ. Res. 103, 130-144] suggested that the American mink (formerly Mustela vison, now Neovison vison) should be used as a sentinel species for studies of the effects of pollution on environmental health. They based this assertion in large part on their conclusion that mink meet a set of criteria required by a sentinel species. In this commentary, we suggest that Basu et al. overlooked an important criterion for sentinel species - that the species must be a continuous resident of the environment under evaluation. Across their native range and beyond, mink are commonly farmed for the fur industry, and a long history of studies has shown that where they are farmed, they escape. For example, in southern Ontario, Canada, 64% of the mink have been genetically identified as domestic in origin, or domestic-wild hybrids. Thus, we argue that mink do not meet the criterion of continuous residence, and cannot be reliably used as sentinel species. There is a strong likelihood of biased inference when mink are used for such purposes.

Mechanism-of-action (MOA) studies of bioactive compounds are fundamental to drug discovery. However, in vitro studies alone may not recapitulate a compound's MOA in whole cells. Here, we apply a chemogenomics approach in Candida albicans to evaluate compounds affecting purine metabolism. They include the IMP dehydrogenase inhibitors mycophenolic acid and mizoribine and the previously reported GMP synthase inhibitors acivicin and 6-diazo-5-oxo-L-norleucine (DON). We report important aspects of their whole-cell activity, including their primary target, off-target activity, and drug metabolism. Further, we describe ECC1385, an inhibitor of GMP synthase, and provide biochemical and genetic evidence supporting its MOA to be distinct from acivicin or DON. Importantly, GMP synthase activity is conditionally essential in C. albicans and Aspergillus fumigatus and is required for virulence of both pathogens, thus constituting an unexpected antifungal target.

A novel analytical approach has been developed and shown to be capable of detecting the isomers of oestradiol in the low ppt (pg mL(-1)) range in bovine serum and urine. Following extractive derivatisation the analytes were detected as their 3-pentafluorobenzoyl 17-trimethylsilyl ether derivatives by gas chromatography-mass spectrometry/mass spectrometry (GC-MS/MS), using electron capture negative ion chemical ionisation. The isomers of oestradiol were quantified in both blank and post-administration urine and serum samples, with a view to setting action/threshold levels for these compounds, to allow discrimination between normal samples and samples from animals treated with growth promoting ear implants. A non-parametric statistical assessment of the data resulted in proposed action levels (with a false positive probability of 1 in 1000) of 1.6 and 2.7 ng mL(-1) for 17alpha-oestradiol, in male and female urine, respectively, and 40 and 44 pg mL(-1) for 17beta-oestradiol, in male and female urine, respectively. An action level of 20 pg mL(-1) was proposed for 17alpha- and 17beta-oestradiol in male serum. In female serum the proposed action levels were 40 and 20 pg mL(-1) for 17alpha- and 17beta-oestradiol, respectively.

Angus crossbred steers were assigned randomly to one of four finishing diets based on corn, Chinook, Logan, or H3 barley. Steers were harvested and after a 72-h chill, carcass quality and yield grade data were collected. Beef ribs were removed from 72 carcasses for further analysis. Ribs were aged in vacuum bag at 2°C for 14 days. After aging three adjacent steaks (3.18cm) were removed to determine color stability, tenderness, proximate analysis and pH. Diets fed to steers had no effect on quality and yield grade or tenderness of beef steaks. Steaks from steers fed Logan barley variety were significantly less red at 10 days of storage (Hunter a*=24.06) than steaks from steers fed the other barley varieties (Chinook a*=26.4; H3 a*=28.05) or corn (a*=26.14). Identification of barley varieties that affect color stability could result in designing diets specifically for improved color and increase the use of barley as a finishing grain.

Variations in Irgarol 1051 concentrations in the UK's largest marina at Brighton were determined regularly over a period of one year. Aqueous concentrations ranged from <1 to 960 ngl(-1) with highest mean concentrations generally associated with berths for larger vessels and with the main channels. Temporally, highest concentrations were recorded in November through to January and were probably associated with maintenance of vessels in an adjacent boatyard. Elevated levels were also encountered at the beginning of the season, coinciding with the introduction of newly antifouled vessels. Increased concentrations also followed dredging, possibly through re-mobilisation of Irgarol 1051. No correlations were found between dissolved Irgarol 1051 concentrations and pH, temperature or salinity. With the exception of sporadically high concentrations recorded for water samples (probably taken in close proximity to recently antifouled vessels), concentrations rarely exceeded the no observed effect concentration for marine periphyton of 63 ngl(-1). Concentrations of Irgarol 1051 in sediments sampled from the marina ranged from <1 to 77 ngg(-1). Apparent distribution coefficients (K(d)) calculated from sedimentary and aqueous samples (collected simultaneously) are generally within the range of K(d)'s reported from laboratory experiments.

The development of the floral organs is specified by the combinations of three classes of gene for organ identity in the 'ABC' model. Recently, molecular genetic studies have shown this model is applicable to grass plants as well as most eudicots. Transcription factor complexes of ABC and homologous proteins form the molecular basis of the ABC model.

The establishment of abaxial-adaxial polarity in lateral organs involves factors intrinsic to the primordia and interactions with the apical meristem from which they are derived. Recent molecular genetic studies have identified some of the genes that promote either adaxial or abaxial cell fates, with many of the genes encoding spatially localized transcription factors.

There have been recent research developments with Antarctic prokaryotes in the areas of isolations of novel bacterial, culture collections, bioactivity screening, taxonomy, production of polyunsaturated fatty acids (PUFAs), cold-adapted enzymes and bioremediation. Research to date confirms the novelty of bacteria isolated from this extreme environment. Opportunities now exist to exploit these and other findings to develop possible new biotechnological products from Antarctic microorganisms.

Carpels are the ovule-bearing structural units in angiosperms. In Arabidopsis, the specification of carpel identity is achieved by at least two separate pathways: a pathway mediated by the C class gene AG and an AG-independent pathway. Both pathways are negatively regulated by A class genes. Two genes, SPT and CRC, can promote differentiation of carpel tissue independently of AG and are thus components of the AG-independent pathway. CRC and SPT appear to act in a redundant manner to promote the differentiation of subsets of carpel tissues. The carpel primordium is subdivided into regional domains, both medial versus lateral and abaxial versus adaxial. Based on morphological and gene expression analyses, it appears likely that these domains define developmental compartments. The medial domain appears fated to differentiate into the marginal tissue types of the carpel (septum with transmitting tract and placenta with ovules), whereas the lateral domain gives rise to the ovary walls. The expression of ETT defines the abaxial domain, and this gene is involved in the abaxial-adaxial and, possibly, the apical-basal patterning of tissues in the carpel. Once regional domains have been established, the differentiation of tissue and cell types occurs. The MADS-box gene FUL and AGLI/5 are involved in the differentiation of specific tissue types in the valves and valve margins. Thus, the genes identified can be arranged in a functional hierarchy: specification of carpel identity, patterning of the carpel primordium and directing the differentiation of the specialized tissues of the carpel.

The use of computer technology is not new in the delivery of health services. Previous studies have assessed the reliability and validity of computerised surveys, relative to pen and paper versions or interviews or the acceptability of computers in a range of treatment settings. Generally, these studies have reported that the reliability, validity and acceptability of computer surveys is at least comparable to more traditional survey methods. This study provides evidence for the appropriateness of using computers in community-based drug and alcohol clinical settings, reporting a high level of computer acceptability among clients. The advantages of utilising computers in clinical settings, for researchers and clinicians, are discussed.

Rhodopsin is essential for normal photoreceptor development in Drosophila (O'Tousa et al., 1989; Leonard et al., 1992; Kumar and Ready, 1995) and in mice (Humphries et al., 1997). Here we report studies in which a rhodopsin transgene is expressed at restricted stages during the development of Drosophila photoreceptors otherwise lacking rhodopsin. Substantial rescue of normal photoreceptor structure and physiology is effected by rhodopsin expression during the time of the normal onset of rhodopsin synthesis. Expression shortly before or after this critical period does not rescue these deficits. There is a critical developmental period in which rhodopsin plays its key role in photoreceptor morphogenesis.