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Echinoderm skeletons are composed of calcium carbonate ossicles that join in a variety of ways to form flexible or, more rarely, fixed joints. Ossicle "fusion" in echinoderms has been widely reported in the literature to form various types of fixed joint, but fusion in the sense of chemical union (ankylosis) of the calcitic ossicles has rarely been demonstrated. The arm skeleton of ophiuroids is primarily composed of a series of vertebral ossicles; each vertebra is a compound ossicle that consists of paired ambulacral ossicles united by a fixed joint, often reported to be fused. Development of vertebral ossicles in the amphiurid brittlestar Ophiophragmus filograneus from the arm tip to the oral frame was examined using scanning electron microscopy to follow ontogeny of the vertebra. As an ambulacral ossicle grew, its stereomal trabeculae interdigitated and interlocked by hooking around those of its paired ambulacral, forming the characteristic sinuous suture line central to ophiuroid vertebrae. This three‐dimensional interlocking of stereom formed the joint between paired ambulacrals. With further growth of the vertebra, limited fusion of trabeculae of the paired ambulacrals added to the structure of the joint, primarily at the articular surfaces between successive vertebrae. The joint found here with interlocked trabeculae between ambulacral ossicles of O. filograneus appears to be the same type described in the literature in some echinoids and other ophiuroids. This unique type of fixed joint is described here and named the "campylogomphosis" (Greek: campylos, bent; gomphos, bolt). This newly recognized joint might have implications in echinoderm phylogeny, comparative biology, medicine, and materials science. [ABSTRACT FROM AUTHOR]

New guidelines on the management of chronic cough have been published in Australia and the United Kingdom. These guidelines reflect the evolving understanding of cough and emphasize the need for a more comprehensive approach to diagnosis and treatment. The traditional model of attributing chronic cough to conditions like asthma and gastroesophageal reflux disease is inadequate, and a new paradigm suggests that chronic cough is a neuroinflammatory or neuropathic disorder. Treatment options include repurposed drugs and novel medications that target peripheral airway receptors. Non-pharmacological approaches, such as behavioral techniques, can also be effective. The guidelines recommend tailoring investigations and treatments based on individual patient characteristics and avoiding unnecessary tests and empirical treatments. The hope is that these new guidelines will lead to improved outcomes for patients with chronic cough. [Extracted from the article]

Upper urinary tract urothelial carcinomas (UTUCs) are uncommon, accounting for only 5%‐10% of urothelial carcinomas. Radical nephroureterectomy with bladder cuff excision is the standard treatment of high‐risk UTUC. Therefore, accurate preoperative diagnosis, including the use of urine cytology, is essential for appropriate patient management. This case study details a patient's pathway from haematuria to nephroureterectomy. [ABSTRACT FROM AUTHOR]

Around a third of fly‐in fly‐out (FIFO) workers in Australia experience relatively high levels of psychological distress. Although a wide range of associated workplace stressors have been proposed in this context, it is unclear to what extent FIFO workers perceive these stressors as having an impact on their mental health. Identifying the issues that workers perceive as having the greatest impact on their mental health can guide the development of interventions in this area. Thus, this cross‐sectional study sampled 742 FIFO workers from a large mine site in Australia to identify which workplace issues were perceived to have the greatest negative impact on their mental health. Of the 32 issues measured, we found that the top ranked issues related to a lack of control at work, lack of sleep, missing home, and poor physical health. These key issues also predicted poorer recent mental health. Based on these findings, several recommendations are put forward for future on‐site wellness promotion programs, including (a) providing workers with more control and autonomy in their work roles, (b) improving sleep hygiene, (c) facilitating regular communication with family and loved ones, and (d) introducing exercise programs and supporting a healthy diet. This type of proactive consultative approach to mental health issues at FIFO sites cannot only mitigate the increased risk of poor mental health but also foster a more cohesive workplace culture. [ABSTRACT FROM AUTHOR]

Pharmacogenonomics (PGx) is the intersection of genomic medicine and pharmacology whereby knowledge of variation in an individual's genome is utilized to inform prescribing practice. In conclusion, PGx represents a novel piece in the jigsaw of factors that should be collectively considered when developing novel drugs and prescribing current drugs to improve the safety and efficacy of pharmacotherapy. For instance, it is possible that some clinical pharmacologists with a particular interest in PGx may become PGx specialists, similar to how some clinical pharmacologists have specialized in hypertension or clinical toxicology. [Extracted from the article]

The field of pharmacogenomics has made great strides in oncology over the last 20 years and indeed a significant number of pre‐emptive genetic tests are now routinely undertaken prior to anticancer drug administration. Many of these gene–drug interactions are the fruits of candidate gene and genome‐wide association studies, which have largely focused on common genetic variants (allele frequency>1%). Examples where there is clinical utility include genotyping or phenotyping for G6PD to prevent rasburicase‐induced RBC haemolysis, and TPMT to prevent thiopurine‐induced bone marrow suppression. Other associations such as CYP2D6 status in determining the efficacy of tamoxifen are more controversial because of contradictory evidence from different sources, which has led to variability in the implementation of testing. As genomic technology becomes ever cheaper and more accessible, we must look to the additional data our genome can provide to explain interindividual variability in anticancer drug response. Clearly genes do not act on their own and it is therefore important to investigate genetic factors in conjunction with clinical factors, interacting concomitant drug therapies and other factors such as the microbiome, which can all affect drug disposition. Taking account of all of these factors, in conjunction with the somatic genome, is more likely to provide better predictive accuracy in determining anticancer drug response, both efficacy and safety. This review summarises the existing knowledge related to the pharmacogenomics of anticancer drugs and discusses areas of opportunity for further advances in personalisation of therapy in order to improve both drug safety and efficacy. [ABSTRACT FROM AUTHOR]

Errors in the physics schemes and parameters of a land surface model can lead to large errors/bias in simulated soil moisture. In addition, large bias in simulated soil moisture may be caused by soil lateral water flow that is not described in a land surface model. In the present study, three model output statistics (MOS) approaches (a linear regression based MOS, a rescaling based MOS and a cumulative distribution function matching based MOS) are proposed to correct these biases and errors at stations that have soil moisture observations. Results show that the biases/errors in simulated soil moisture were significantly corrected by the three MOS approaches. The best performance was obtained for the linear regression MOS model consisting of four separate linear regression MOS models for different seasons throughout the year (MOS-SN). However, for the linear regression MOS and the rescaling MOS, a few months' data may also be used for MOS correction when the same seasonal period is used for both model fitting and prediction. With respect to goodness of fit and performance, the linear regression MOS model is better than the rescaling MOS model, and the MOS-SN is slightly better than the nonlinear cumulative distribution function matching approach. For sites where soil moisture observations are much shorter, or more intermittent, than meteorological observations, the linear regression MOS approaches can be used to reconstruct missing historic soil moisture data. All MOS approaches can also be used to correct the errors/bias in forecast soil moisture from weather or climate models at sites with soil moisture observations. [ABSTRACT FROM AUTHOR]

Slavery was a major institution that shaped the experiences of people of African descent in the black Atlantic world in the 1700s. This article explores the history of Ayuba Sulieman Diallo, a West African Muslim enslaved in Maryland in 1731 and it takes a critical look at his portrait by the English painter, William Hoare in 1733. (Photo: Public Domain) gl From Ayuba Sulieman Diallo to Job ben Solomon Ayuba Sulieman Diallo was born around 1701 in a Fulbe family of Muslim clerical leaders in Bundu (in present-day Senegal). Diallo's Portrait and Experience in England The Royal African Company owned Ayuba Diallo as a slave when he arrived in England. [Extracted from the article]

Background: Bowel resections have high morbidity and mortality rates and are becoming increasingly common in Australia. To reduce the burden on patients and the health system, measures for improving patient outcomes after resection must be investigated. One possible method for improving patient outcomes is prehabilitation with exercise. The aim of this systematic review is to determine the effect that exercise prehabilitation has on the functional status of patients undergoing colorectal resection. Method: Studies examining the effect of exercise prehabilitation on colorectal patients were gathered from online databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and the Australia New Zealand clinical trial registry. The study design, population, intervention and outcomes were extracted from each study. Results: This systematic review included six studies involving a total of 415 patients. Three studies were randomized control trials and three were prospective cohort studies. Those that tested participants post‐operatively found that the intervention group improved their 6‐min walking distance more than the control group. This result was statistically significant in three studies. Similarly, two studies found that self‐reported physical activity was significantly greater in the intervention group than in control groups. The rate of complications and length of hospital stay were not significantly different between intervention and control groups in any study. Conclusion: Prehabilitation significantly improves functional capacity and self‐reported physical activity but its effect on complication rate was not significant in this review. [ABSTRACT FROM AUTHOR]

Aims: The lipid‐lowering drug, atorvastatin (ATV), is 1 of the most commonly prescribed medications worldwide. The aim of this study was to comprehensively investigate and characterise the clinical factors and comedications associated with circulating levels of ATV and its metabolites in secondary prevention clinical practice. Methods: The plasma concentrations of ATV, 2‐hydroxy (2‐OH) ATV, ATV lactone (ATV L) and 2‐OH ATV L were determined in patients 1 month after hospitalisation for a non‐ST elevation acute coronary syndrome. Factors were identified using all subsets multivariable regression and model averaging with the Bayesian information criterion. Exploratory genotype‐stratified analyses were conducted using ABCG2 rs2231142 (Q141K) and CYP2C19 metaboliser status to further investigate novel associations. Results: A total of 571 patients were included; 534 and 37 were taking ATV 80 mg and 40 mg daily, respectively. Clinical factors associated with ATV and/or its metabolite levels included age, sex, body mass index and CYP3A inhibiting comedications. Smoking was newly associated with increased ATV lactonisation and reduced hydroxylation. Proton pump inhibitors (PPIs) and loop diuretics were newly associated with modestly increased levels of ATV (14% and 38%, respectively) and its metabolites. An interaction between PPIs and CYP2C19 metaboliser status on exposure to specific ATV analytes (e.g. interaction P =.0071 for 2‐OH ATV L) was observed. Overall model R2 values were 0.14–0.24.ConclusionMultiple factors were associated with circulating ATV and metabolite levels, including novel associations with smoking and drug–drug(–gene) interactions involving PPIs and loop diuretics. Further investigations are needed to identify additional factors that influence ATV exposure. [ABSTRACT FROM AUTHOR]

Background: Peer review of surgical deaths can identify deficits in individual and systemic delivery of healthcare, ultimately informing quality improvement. Methods: From 2008 to 2016, cases reported to the Australia and New Zealand Audit of Surgical Mortality were analysed. Variables associated with peer‐judged adverse events were sought. Results: Of 21 045 cases evaluated, 24.8% incurred at least one adverse event judgement. The proportion of cases with reported adverse event significantly decreased over time. Following adjustment for demographic and clinical characteristics, significant negative patient‐related associations were advanced age, greater American Society of Anesthesiologists grade, and neurological and malignant comorbidities. Significant associations were also found with systemic or organizational factors, including state/territory, surgical specialty and hospital regionality. Conclusion: Examination of this peer‐reviewed database revealed systemic or organizational predictors of adverse events that may have implications for quality improvement at an institutional or jurisdictional level. The extent to which these associations are due to the peer‐review process itself should be the focus of further research. [ABSTRACT FROM AUTHOR]

Background Research into clinical determinants of severe acute pancreatitis remains important for therapeutic and preventive purposes. To contribute to prognostication, this study aimed to define clinical risk factors for the development of severe acute pancreatitis. Methods Study design was a prospective cohort study, using multiple logistic regression. From March 2004 to July 2007, 153 cases of acute pancreatitis were recruited in a regional Australian hospital. Data were collected regarding demographic and clinical characteristics. The outcome measure was severe acute pancreatitis, as defined by composite consensus criteria. Results After adjustment for potential confounders, there was a significant positive association with waist circumference and a negative association with current smoking status. Conclusion The study confirms other work suggesting central adiposity as a risk factor for severe acute pancreatitis. The finding of a possible protective effect for smoking may be physiologically plausible but merits further confirmatory research. [ABSTRACT FROM AUTHOR]

Aims To determine whether thiazolidinedione use is associated with a risk of bladder cancer. Methods We searched MEDLINE and EMBASE in June 2012 (with Pub Med update to July 2013) and conducted meta-analysis on the overall risks of bladder cancer with pioglitazone or rosiglitazone and the risk with different categories of cumulative dose or duration of drug use. Results We screened 230 citations and included 18 studies, comprising five randomized controlled trials ( RCTs) and 13 observational studies. Meta-analysis showed a significantly higher overall risk of bladder cancer with pioglitazone in RCTs [7878 participants; odds ratio ( OR) 2.51, 95% confidence interval ( CI) 1.09-5.80] and observational studies (>2.6 million patients; OR for 'ever' users vs. non-users 1.21, 95% CI 1.09-1.35). Subgroup analysis of observational studies by cumulative dose showed the risk of bladder cancer to be greatest with >28.0 g of pioglitazone ( OR 1.64, 95% CI 1.28-2.12). A significantly increased risk was found with both 12-24 months ( OR 1.41, 95% CI 1.16-1.71) and >24 months ( OR 1.51, 95% CI 1.26-1.81) cumulative durations of pioglitazone exposure. No significant risk was seen with rosiglitazone in RCTs ( OR 0.84, 95% CI 0.35-2.04) or 'ever' users vs. non-users in observational studies ( OR 1.03, 95% CI 0.94-1.12); the evidence for any relationship between bladder cancer risk and rosiglitazone cumulative duration is limited and inconsistent. Direct comparison of pioglitazone to rosiglitazone 'ever' users yielded an OR of 1.25 (95% CI 0.91-1.72). Conclusions A modest but clinically significant increase in the risk of bladder cancer with pioglitazone was found, which appears to be related to cumulative dose and duration of exposure. We recommend that prescribers limit pioglitazone use to shorter durations. [ABSTRACT FROM AUTHOR]

Introduction: There are very little clinical and pathological data on colorectal cancer among Indigenous people in Australia. Methods: A retrospective study on Indigenous patients treated for colorectal cancer at the Townsville and Cairns Base Hospitals from 1999 to 2004 was carried out in order to better characterise this disease in the Indigenous population. Results: There were 25 patients (12 M, 13 F) with a median age of 57.3 years. The majority (56%) of the tumours were left-sided, being in the sigmoid colon, rectosigmoid junction and rectum. Of the patients, 60% had American Joint Committee on Cancer (AJCC) staging system Stage I and II disease at presentation. There was a relatively high proportion of poorly differentiated adenocarcinomas (40%). Six patients died of the disease. The median follow-up was 20.5 months (range 2−51). Conclusions: Comparisons were made with available data on colorectal cancer in the general Australian population. The limitations and deficiencies of the study, as well as problems of data collection on Indigenous people were discussed. [ABSTRACT FROM AUTHOR]

Aims: To update our previously reported systematic review and meta‐analysis of observational studies on cardiovascular drug exposure and COVID‐19 clinical outcomes by focusing on newly published randomized controlled trials (RCTs). Methods: More than 500 databases were searched between 1 November 2020 and 2 October 2021 to identify RCTs that were published after our baseline review. One reviewer extracted data with other reviewers verifying the extracted data for accuracy and completeness. Results: After screening 22 414 records, we included 24 and 21 RCTs in the qualitative and quantitative syntheses, respectively. The most investigated drug classes were angiotensin‐converting enzyme inhibitors (ACEIs)/angiotensin receptor blocker (ARBs) and anticoagulants, investigated by 10 and 11 studies respectively. In meta‐analyses, ACEI/ARBs did not affect hospitalization length (mean difference −0.42, 95% confidence interval [CI] −1.83; 0.98 d, n = 1183), COVID‐19 severity (risk ratio/RR 0.90, 95% CI 0.71; 1.15, n = 1661) or mortality (risk ratio [RR] 0.92, 95% CI 0.58; 1.47, n = 1646). Therapeutic anticoagulation also had no effect (hospitalization length mean difference −0.29, 95% CI −1.13 to 0.56 d, n = 1449; severity RR 0.86, 95% CI 0.70; 1.04, n = 2696; and, mortality RR 0.93, 95% CI 0.77; 1.13, n = 5689). Other investigated drug classes were antiplatelets (aspirin, 2 trials), antithrombotics (sulodexide, 1 trial), calcium channel blockers (amlodipine, 1 trial) and lipid‐modifying drugs (atorvastatin, 1 trial). Conclusion: Moderate‐ to high‐certainty RCT evidence suggests that cardiovascular drugs such as ACEIs/ARBs are not associated with poor COVID‐19 outcomes, and should therefore not be discontinued. These cardiovascular drugs should also not be initiated to treat or prevent COVID‐19 unless they are needed for an underlying currently approved therapeutic indication. [ABSTRACT FROM AUTHOR]

Argues that the use of Islam as the paradigm for black racial separatism and identity has an impact on nationalist and Islamic movements in the United States. Conviction that Islam was preferable to Christianity; Important analytical pole of black nationalism.

Objective: To understand the experiences of vulnerable clients who used telehealth during the Coronavirus pandemic. Design: The study employed a qualitative enquiry, utilising semi‐structured interviews lasting 30‐60 minutes with a thematic analysis approach to explore factors influencing client experience with telehealth. Setting: A wide range of locations across Tasmania, Australia. Participants: Twelve participants who were considered to be vulnerable on a number of domains, including: health and human wellbeing factors, social risk factors, functional limitations, and individual behavioural factors. Interventions: The provision of telehealth consultations to vulnerable clients. Main outcome measures: Four global themes were discovered: i) Telehealth saves time, money and energy; ii) User friendly technology facilitates care; iii) Rapport and confidentiality helps clients to feel safe; and iv) Fit for purpose telehealth provides a quality service. Results: The discovered themes entailed the major finding that most participants were satisfied with the overall quality of the telehealth service they received and the convenience of this service. Concerns were raised regarding the limitations around social interaction, physical examination, and access to fit‐for‐purpose telehealth devices. Conclusion: This research with vulnerable clients, from Tasmania, supports the evidence that the utilisation of telehealth allows more convenient access to care. To optimise the service, however, concerns regarding the desire for social interaction, appropriate physical examination, and access to fit‐for‐purpose telehealth devices will need to be addressed. [ABSTRACT FROM AUTHOR]

Sea cucumbers (holothuroids) lack the only known echinoderm immune organ, the axial organ. Holothuroids of the families Synaptidae and Chiridotidae have coelomic organs, known as ciliary urns, that gather and excrete waste and, therefore, might function in immunity. Although ciliary urns are widely reported and illustrated in the literature, the process and histology of urn development remain unknown. Development and structure of ciliary urns were examined in Synaptula hydriformis using scanning electron, brightfield, and scanning laser confocal microscopy. Mature urns occurred on all three mesenteries in 10‐tentacled young and later growth stages, and developing urns were found in post‐pentactulae, 10‐tentacled young, and released juveniles. Developing urns were circular clusters of ciliated collar cells protruding from the mesentery. The cells increased in number to form the sessile cushion stage with a shallow lumen. The subsequent spoon‐shaped stage had a stalk and a deepened lumen with an extensive ciliary field where coelomocytes began to accumulate. Mature urns had a thin stalk and cornucopia‐shaped body with an abluminal epithelium of squamous cells and an adluminal epithelium of densely packed ciliated collar cells. Cell boundaries of the rim of mature urns and of the stalk and body of developing urns were outlined on one or both sides by microvilli and an elevated cell membrane. Ciliary urns resembling the cushion‐stage urns of S. hydriformis have been described in the sea star Archaster typicus. If urns in these groups are homologous, it is likely that cushion urns are plesiomorphic and that they are present and have been overlooked in other echinoderms. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Prompt diagnosis of choledocholithiasis is crucial for reducing disease severity, preventing complications and minimizing length of stay. Magnetic resonance cholangiopancreatography (MRCP) is commonly used to evaluate patients with suspected choledocholithiasis but is expensive and may delay definitive intervention. To optimize patient care and resource utilization, we have developed five machine learning models that predict a patients' risk of choledocholithiasis based on clinical presentation and pre‐MRCP investigation results.Inpatients admitted to the Royal Hobart Hospital from 2018 to 2023 with a suspicion of choledocholithiasis were included. Exclusion criteria included prior hepatobiliary surgery, known hepatobiliary disease, or incomplete records. Variables related to clinical presentation, laboratory testing, and sonographic or CT imaging were collected. Four machine learning techniques were employed: logistic regression, XGBoost, random forest, and K‐nearest neighbours. The three best performing models were combined to create an ensemble model. Model performance was compared against the American Society for Gastrointestinal Endoscopy (ASGE) choledocholithiasis risk stratification guidelines.Of the 222 patients included, 113 (50.9%) had choledocholithiasis. The most successful models were the random forest (accuracy: 0.79, AUROC: 0.83) and ensemble (accuracy and AUROC: 0.81). Every model outperformed the ASGE guidelines. Key variables influencing the models' predictions included common bile duct diameter, lipase, imaging evidence of cholelithiasis, and liver function tests.Machine learning models can accurately assess a patient's risk of choledocholithiasis and could assist in identifying patients who could forgo an MRCP and proceed directly to intervention. Ongoing validation on prospective data is necessary to refine their accuracy and clinical utility. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to continually evaluate the association between cardiovascular drug exposure and COVID‐19 clinical outcomes (susceptibility to infection, disease severity, hospitalization, hospitalization length, and all‐cause mortality) in patients at risk of/with confirmed COVID‐19. Methods: Eligible publications were identified from more than 500 databases on 1 November 2020. One reviewer extracted data with 20% of the records independently extracted/evaluated by a second reviewer. Results: Of 52 735 screened records, 429 and 390 studies were included in the qualitative and quantitative syntheses, respectively. The most‐reported drugs were angiotensin‐converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) with ACEI/ARB exposure having borderline association with confirmed COVID‐19 infection (OR 1.14, 95% CI 1.00–1.31). Among COVID‐19 patients, unadjusted estimates showed that ACEI/ARB exposure was associated with hospitalization (OR 1.76, 95% CI 1.34–2.32), disease severity (OR 1.40, 95% CI 1.26–1.55) and all‐cause mortality (OR 1.22, 95% CI 1.12–1.33) but not hospitalization length (mean difference −0.27, 95% CI −1.36–0.82 days). After adjustment, ACEI/ARB exposure was not associated with confirmed COVID‐19 infection (OR 0.92, 95% CI 0.71–1.19), hospitalization (OR 0.93, 95% CI 0.70–1.24), disease severity (OR 1.05, 95% CI 0.81–1.38) or all‐cause mortality (OR 0.84, 95% CI 0.70–1.00). Similarly, subgroup analyses involving only hypertensive patients revealed that ACEI/ARB exposure was not associated with confirmed COVID‐19 infection (OR 0.93, 95% CI 0.79–1.09), hospitalization (OR 0.84, 95% CI 0.58–1.22), hospitalization length (mean difference −0.14, 95% CI −1.65–1.36 days), disease severity (OR 0.92, 95% CI 0.76–1.11) while it decreased the odds of dying (OR 0.76, 95% CI 0.65–0.88). A similar trend was observed for other cardiovascular drugs. However, the validity of these findings is limited by a high level of heterogeneity and serious risk of bias. Conclusion: Cardiovascular drugs are not associated with poor COVID‐19 outcomes in adjusted analyses. Patients should continue taking these drugs as prescribed. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia repair is one of the most common operations performed worldwide with most of the burden of these occurring in low- or middle-income countries (LMICs). There has been much research investigating the most effective method of hernia repair in resource-rich countries, however very little has been done to determine the most cost-beneficial method of hernia repair in LMICs. Methods: A systematic review of the English literature through PubMed and Scopus was conducted according to the PRISMA statement. Results: Twenty-eight studies met the inclusion criteria of which 17 were randomised controlled trials and 11 were systematic reviews. Three areas of investigation were established from the literature search, namely operative method and type of mesh used (where applicable). Open-mesh procedures were shown to be less costly and have shorter operative times than laparoscopic methods. People who underwent laparoscopic hernia repair regularly returned to normal activities earlier than those who had open-mesh procedures. However, there was no other difference in complication rates between these two methods. Recent investigations have revealed that sterilised synthetic mosquito net was similar to hernia-specific meshes whilst significantly reducing cost. Conclusion: We postulate that the most cost-beneficial method of hernia repair for implementation in LMICs is using open-mesh procedures with sterilised mosquito net under local anaesthetic. Further cost–benefit research is required in this area. Low- and middle-income countries (LMICs) bear the majority of the burden of inguinal hernia-related disease. However, little has been done to investigate the most cost-beneficial method of surgical repair for these. We present a systematic review exploring how best to implement inguinal hernia repair in LMICs. [ABSTRACT FROM AUTHOR]

Snow frequently occurs over New Zealand. The seasonal snow accumulation can be about 3 m deep in early spring at some locations. Thus, for numerical weather prediction and climate modelling over New Zealand, a reliable, sophisticated snow model that can properly describe the physical processes associated with snow cover is required. In the past, owing to a lack of snow observations, modelling and verification of snow processes was limited over New Zealand. In the present study, the multilayer snow scheme of the Joint UK Land Environment Simulator (JULES)—the land surface model used in New Zealand regional weather and climate models—was used to simulate the snow water equivalent (SWE) and snow density at two sites in the South Island of New Zealand. The model captured seasonal and interannual variability in snow accumulation and melt. However, large errors in the simulated SWE (up to 300 mm) were found during snowmelt periods and in relatively warm winters when a significant amount of liquid water was present in snow. Sensitivity tests showed that errors in the simulated long wave radiation (a negative bias of about 6 W/m2), snow albedo (0.05–0.10) and air temperature for snow occurrence (Tc, about 0.5 K) were the major factors causing large errors in the simulated SWE. In addition, the simulated snow density was lower than observed. The relatively warm and humid maritime climate of New Zealand appears to make snow simulation in New Zealand more sensitive to long wave radiation, snow albedo and Tc than for continents. [ABSTRACT FROM AUTHOR]

Active revegetation is an essential component of biodiversity conservation for fragmented ecosystems and the species that depend on them. However, key knowledge gaps exist around the most cost-effective revegetation strategies to employ in different contexts. This article reports on a revegetation trial undertaken in the Capertee Valley of New South Wales, Australia, to assist the conservation of the critically endangered bird, the Regent Honeyeater ( Anthochaera phrygia). Seven treatments were compared to assess their cost-effectiveness for enhancing plant survival at a floodplain site with a history of grazing on introduced pastures. While overall survival rates were low, treatments involving tree guards had higher survival rates and were more cost-effective than treatments without guards. Weed growth, animal activity and water stress all appeared to play a role in the low survival rates at this site, with enhanced weed control emerging as a priority for future trials at similar sites. [ABSTRACT FROM AUTHOR]

Flow chemistry and continuous processing techniques are beginning to have a profound impact on the production of functional materials ranging from quantum dots, nanoparticles and metal organic frameworks to polymers and dyes. These techniques provide robust procedures which not only enable accurate control of the product material's properties but they are also ideally suited to conducting experiments on scale. The modular nature of flow and continuous processing equipment rapidly facilitates reaction optimisation and variation in function of the products. [ABSTRACT FROM AUTHOR]

This study presents a method for estimating daily rainfall on a 0.05° latitude/longitude grid covering all of New Zealand for the period 1960-2004 using a second order derivative trivariate thin plate smoothing spline spatial interpolation model. Use of a hand-drawn (and subsequently digitised) mean annual rainfall surface as an independent variable in the interpolation is shown to reduce the interpolation error compared with using an elevation surface. This result is confirmed when long-term average annual rainfall data, derived from the daily interpolations, are validated using long-term river flow data. Copyright © 2006 Royal Meteorological Society [ABSTRACT FROM AUTHOR]

Background: Objective structured clinical examinations (OSCEs) are commonly used to assess the clinical skills of health professional students. Examiner judgement is one acknowledged source of variation in candidate marks. This paper reports an exploration of examiner decision making to better characterise the cognitive processes and workload associated with making judgements of clinical performance in exit‐level OSCEs. Methods: Fifty‐five examiners for exit‐level OSCEs at five Australian medical schools completed a NASA Task Load Index (TLX) measure of cognitive load and participated in focus group interviews immediately after the OSCE session. Discussions focused on how decisions were made for borderline and clear pass candidates. Interviews were transcribed, coded and thematically analysed. NASA TLX results were quantitatively analysed. Results: Examiners self‐reported higher cognitive workload levels when assessing a borderline candidate in comparison with a clear pass candidate. Further analysis revealed five major themes considered by examiners when marking candidate performance in an OSCE: (a) use of marking criteria as a source of reassurance; (b) difficulty adhering to the marking sheet under certain conditions; (c) demeanour of candidates; (d) patient safety, and (e) calibration using a mental construct of the 'mythical [prototypical] intern'. Examiners demonstrated particularly higher mental demand when assessing borderline compared to clear pass candidates. Conclusions: Examiners demonstrate that judging candidate performance is a complex, cognitively difficult task, particularly when performance is of borderline or lower standard. At programme exit level, examiners intuitively want to rate candidates against a construct of a prototypical graduate when marking criteria appear not to describe both what and how a passing candidate should demonstrate when completing clinical tasks. This construct should be shared, agreed upon and aligned with marking criteria to best guide examiner training and calibration. Achieving this integration may improve the accuracy and consistency of examiner judgements and reduce cognitive workload. Ever wonder what's going on in the mind of OSCE examiners? This study explores that 'black box' and highlights why the evaluation of borderline candidates is particularly taxing. [ABSTRACT FROM AUTHOR]

Background: Despite the success of an orthogeriatric model in improving outcomes of older patients, there is a paucity of evidence in general surgical disciplines. The aim of this project was to assess the viability of acute kidney injury (AKI) as an indicator of the care of older patients admitted under general surgery. Methods: A retrospective review of the medical records of patients aged 75 years and older admitted under general surgery between 1 July 2015 and 30 June 2018 at the Royal Hobart Hospital was conducted. Twenty randomly selected cases were reviewed by an expert panel to assess the preventability of AKI. Results: Of 314 patients, the most common diagnosis was small bowel obstruction. Less than half of all patients underwent a procedural intervention. There were 32 (10%) cases of AKI; 13 (4%) had pre‐hospital and 19 (6%) had inpatient. Diabetes and bowel ischaemia were over‐represented in patients with an AKI, otherwise there was no significant difference between the groups. Patients with an AKI were significantly more likely to die, require an unplanned intensive care unit admission and less likely to return to their original residence. Overall, the expert panel agreed that the AKI was foreseeable and mitigable. Conclusion: Our patients presented with diagnoses that often did not require surgical intervention but not infrequently experienced medical complications. These patients may benefit from a shared model of care and AKI could be a useful indicator to measure the efficiency of this service. [ABSTRACT FROM AUTHOR]

The global spread of invasive plant pathogens is increasing, putting natural forests and ecosystem services under threat. Spatial data can quantify range non‐overlap between invasive pathogens and their hosts to identify existing and potentially restorable refugia to enable 'escape' from the pathogen.In 2017, myrtle rust Austropuccinia psidii was detected in New Zealand. New Zealand has 27 native woody and liana species in the plant family susceptible to the disease (Myrtaceae), many of which are ecosystem dominants and economically important. Spatial methods were used to compare the current New Zealand distribution of myrtle rust with the modelled distributions of its potential native hosts. To guide management and set priorities for conservation of at‐risk species, areas of potential refugia where a Myrtaceae species is predicted to occur outside the pathogen range were identified under two myrtle rust distribution scenarios.Myrtle rust will thrive in New Zealand's warmer regions. Many native Myrtaceae are distributed within this area, but several species occur extensively outside the core range of the disease. Species distributed in cooler southern regions will be best placed to persist in refugia.Myrtaceae species with specific habitat requirements and narrow geographical ranges in warmer (northern) areas are likely to require ex situ or active in situ management. Even widely distributed species will benefit from the restoration of suitable habitat that supports multiple species outside the myrtle rust range.Synthesis and applications. Spatial data can be used to identify refugia and restoration opportunities, and thus inform landscape‐level management responses to invasive pathogens. This approach can guide decisions over where to implement in situ (e.g. fungicide spraying) versus ex situ (e.g. seed banking, botanic gardens) management efforts. [ABSTRACT FROM AUTHOR]

Data from 279 dropsonde profiles collected during the Deep Propagating Gravity Wave Experiment (DEEPWAVE) over New Zealand between 4 June and 20 July 2014 were used to verify the relative humidity (RH) fields simulated by regional configurations of the UK Met Office Unified Model (MetUM) in the troposphere. Significant RH biases (predictions up to 28% too high) were found in the middle and upper troposphere during this period. This RH bias was found to be mainly caused by the errors in the simulated-specific humidity. It is demonstrated here that evaporation from the lower boundary (mainly sea surface) is not a factor leading to the moist bias. A similar magnitude of moist bias was also found in the Global UM (the global configuration of the MetUM) and from a preliminary inspection is also very likely to occur in ERA-interim and NCEP-GFS reanalyses. This study suggests that the moist bias is very likely not a regional or a model specific issue. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue including the scientific background of the International Conference on Software and Systems Process, the software analytics, and the impact of software development process on large company.

Since their isolation almost 20 years ago, the callipeltosides have been of long standing interest to the synthetic community owing to their unique structural features and inherent biological activity. Herein we present our full research effort that has led to the synthesis of these molecules. Key aspects of our final strategy include 1) synthesis of the C1-C9 pyran core ( 5) using an AuCl3-catalysed cyclisation; 2) formation of C10-C22 vinyl iodide ( 55) by sequential bidirectional Stille reactions and 3) diastereoselective union of these advanced fragments by means of an alkenylzinc addition (d.r.=91:9 at C9). The common callipeltoside aglycon ( 4) was completed in a further five steps. Following this, all three sugar fragments were appended to provide the entire callipeltoside family. In addition to this, D-configured callipeltose B was synthesised and appended to the callipeltoside aglycon. The 1H NMR spectrum of this molecule was found to be significantly different to the natural isolate, further supporting our assignment of callipeltoside B ( 2). [ABSTRACT FROM AUTHOR]

Review: [68 refs. [ABSTRACT FROM AUTHOR]

RATIONALE A recently developed miniature electrospray ionisation mass spectrometer has been coupled to a preparative flow chemistry system in order to monitor reactive intermediates and competing reaction paths, screen starting materials, and optimise reaction conditions. Although ideally suited to the application, mass spectrometers have rarely been used in this way, as traditional instruments are too bulky to be conveniently coupled to flow chemistry platforms. METHODS A six-port switching valve fitted with a 5 μL loop was used to periodically sample the flow stream leaving the reactor coil. Mass spectra corresponding to the sample loop contents were observed approximately 10 s after activating the valve. High fluidic pressure was maintained throughout to ensure that gaseous products remained in solution. As an illustrative example of how this apparatus can be employed, the generation of benzyne and its subsequent reaction with furan were investigated. Benzyne was prepared via diazotisation of anthranilic acid using tert-butyl nitrite. RESULTS Unexpectedly, the explosive diazotised intermediate was detected by the mass spectrometer at low coil temperatures or short residence times. The optimum reactor temperature and residence time for production of the desired Diels-Alder product are 50 °C and 3-5 min, respectively. There are competing reaction pathways leading to the formation of acridone and several other by-products. CONCLUSIONS On-line mass spectrometry allowed the flow conditions to be quickly tuned for safe operation and optimal generation of the desired product. The validity of this approach was corroborated by off-line liquid chromatography/mass spectrometry (LC/MS) analysis of flow samples. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Pain relief remains a major problem in hernia surgery. SABER-Bupivacaine is an investigational extended-release formulation of bupivacaine in a resorbable matrix, which may provide up to 72 h of local pain relief. Methods: A double-blinded, randomized controlled trial was undertaken to evaluate the safety and efficacy of SABER-Bupivacaine. Consented patients ( n= 124) undergoing open inguinal hernia repair at five sites in Australia and New Zealand were randomized to receive either 2.5 (330 mg) or 5.0 mL (660 mg) of SABER-Bupivacaine or SABER-Placebo administered to the surgical wound at the end of the procedure. Analgesic efficacy and safety was evaluated. Results: SABER-Bupivacaine appeared safe with no difference in the incidence of side effects compared with SABER-Placebo. The 5.0 mL dose of SABER-Bupivacaine reduced the mean area under the curve of pain intensity on movement compared with SABER-Placebo (2.47 versus 3.60; P= 0.0033) and decreased the number of patients requiring supplemental opioids by 26% (although not statistically significant; P= 0.0909). Normal wound healing was reported throughout the trial and at 3- and 6-month follow-up in every treatment group. Conclusion: After open inguinal hernia repair, SABER-Bupivacaine administered at the surgical site was safe and provided pain relief, reduced the need for supplemental (oral and parenteral) analgesia and did not impair wound healing. [ABSTRACT FROM AUTHOR]

Increased access for smokers to pharmacotherapies for smoking cessation suggests that pharmacists have a potential role in influencing how these pharmacotherapies are used in the community. This study aimed to identify the extent and type of advice provided by pharmacists to customers purchasing nicotine replacement therapy (NRT) or bupropion and to identify pharmacists' perceptions about the desirability and feasibility of providing such advice. A sample of 700 pharmacies was selected at random from the NSW Electronic Yellow Pages and a questionnaire was sent by mail, fax or e-mail to the pharmacist in charge. From 665 eligible pharmacies, 375 pharmacists returned completed questionnaires, giving a response rate of 56.4%. Participants reported providing a mean of 5 minutes of advice to both bupropion and NRT purchasers, with 59.5% reporting the provision of behavioural advice to NRT purchasers. Although over 70% of pharmacists perceived the provision of a brochure about NRT or bupropion as desirable and feasible, brochures were provided to less than one-third of NRT purchasers. Pharmacists report providing a sizeable amount of advice to purchasers of NRT and bupropion. Recommendations for enhancing the role of pharmacists in influencing the use of cessation pharmacotherapies are discussed briefly. [Paul CL, Tzelepis F, Walsh RA, Turner R. Pharmacists on the front line in providing support for nicotine replacement therapy and bupropion purchasers. Drug Alcohol Rev 2007;26:429 - 433] [ABSTRACT FROM AUTHOR]

The synthesis of callipeltosides A, B and C has been achieved in a highly convergent manner. Key to this was the synthesis of the common callipeltoside aglycon by means of an ambitious diastereoselective alkenyl metal addition of the entire bottom fragment to the pyran core, followed by Yamaguchi macrolactonisation. Following this, the endgame was in sight, with each callipeltoside picked off in turn by attachment of the appropriate sugar and unequivocal completion of the series. It’s the bullseye! For more information see the Full Paper by S. V. Ley, J. R. Frost, et al. on page 13261 ff. [ABSTRACT FROM AUTHOR]