Informing Intervention Strategies to Reduce Energy Drink Consumption in Young People: Findings From Qualitative Research

OBJECTIVE

To determine young people's knowledge of energy drinks (EDs), factors influencing ED consumption, and intervention strategies to decrease ED consumption in young people.

DESIGN

Eight group interviews with young people (aged 12-25 years).

SETTING

Community groups and secondary schools in Perth, Western Australia.

PARTICIPANTS

Forty-one young people, 41% of whom were male and 73% of whom consumed EDs.

PHENOMENON OF INTEREST

Factors influencing ED consumption and intervention strategies informed by young people to reduce ED consumption.

ANALYSIS

Two researchers conducted a qualitative content analysis on the data using NVivo software.

RESULTS

Facilitators of ED consumption included enhanced energy, pleasant taste, low cost, peer pressure, easy availability, and ED promotions. Barriers included negative health effects, unpleasant taste, high cost, and parents' disapproval. Strategies to reduce ED consumption included ED restrictions, changing ED packaging, increasing ED prices, reducing visibility in retail outlets, and research and education.

CONCLUSION AND IMPLICATIONS

Because many countries allow the sale of EDs to people aged <18 years, identifying ways to minimize potential harm from EDs is critical. This study provided unique insights into intervention strategies suggested by young people to reduce ED consumption. In addition to more research and education, these strategies included policy changes targeting ED sales, packaging, price, and visibility. Future research might examine the feasibility of implementing such interventions.

ProCAID: a phase I clinical trial to combine the AKT inhibitor AZD5363 with docetaxel and prednisolone chemotherapy for metastatic castration resistant prostate cancer

Background Docetaxel and prednisolone chemotherapy (DP) extends survival in metastatic castration resistant prostate cancer (mCRPC). However, emergent clinical resistance is almost inevitable. AKT pathway activation is highly prevalent in mCRPC contributing to disease progression and DP resistance. AZD5363 is a potent oral pan-AKT inhibitor with pre-clinical data indicating activity in mCRPC and synergy with docetaxel. Methods This phase I trial was to determine an AZD5363 recommended phase II dose (RP2D) for combination with DP. Eligibility criteria included chemotherapy naive mCRPC, PSA or radiographic disease progression and ECOG performance status 0 or 1. Treatment comprised DP (75 mg/m2, IV, day 1 and 5 mg BID, PO, day 1-21 respectively for ten cycles) and AZD5363 to disease progression for all patients. We utilised a 3 + 3 dose escalation design to determine a maximum tolerated dose according to defined dose limiting toxicity criteria assessed using CTCAE version 4.03. Planned AZD5363 dose levels were 320 mg (DL1), 400 mg (DL2) and 480 mg (DL3), BID, PO, 4 days on/3 days off, from day 2 of each cycle. Results 10 patients were treated. Dose limiting toxicities affected 2 patients (grade 3 rash ≥5 days; grade 3 diarrhoea) in DL2. The commonest grade 3 or 4, AZD5363 related, symptomatic adverse events were rash and diarrhoea. Hyperglycaemia affected all patients but was self-limiting. PSA reduction to <50% at 12 weeks occurred in 7 patients. Conclusions The RP2D for AZD5363 is 320 mg BID, 4 days on/3 days off, in combination with full dose DP for mCRPC.

The Language of Data Program: Use of Gaming to Promote Critical Appraisal Skills

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.

Integrative Profiling of Bee Communities from Habitats of Tropical Southern Yunnan (China)

Understanding and managing pollination service is hindered by taxonomic impediments and paucity of data, particularly in the tropics. Herein we apply integrative species delineation and taxonomy to test impacts of land use on the diversity of bee communities within Xishuangbanna (Yunnan, south China), a highly biodiverse tropical region which has undergone extensive land conversion to rubber plantation. 128 Operational Taxonomic Units (OTU) were inferred by an iterative and integrative approach. Bee activity differed significantly across land use samples, although community composition corresponded more to level of vegetation density, when accounting for spatial structure. Species diversity was high in young rubber plantations, although composition overlapped with other species-rich habitats (natural forest edge and river banks), and older plantations (>8 years) showed very low diversity under all measures. Community structures were similar between the natural forest interior and edge, although analysis indicated contrasting drivers of diversity, with clustering in the interior and overdispersion in the forest edge. Further, phylogenetic diversity and derived indices were underestimated when reference data were omitted from analysis. The description of bee communities herein permits more informed choices in land management with respect to ensuring continuation of essential services by bees.

First outbreak of colonization by linezolid- and glycopeptide-resistant Enterococcus faecium harbouring the cfr gene in a UK nephrology unit

AIM

To describe an outbreak of colonization by linezolid- and glycopeptide-resistant Enterococcus faecium harbouring the cfr gene in a UK nephrology unit.

METHODS

Isolates of linezolid-resistant E. faecium were typed by pulsed-field gel electrophoresis (PFGE), and examined by polymerase chain reaction (PCR) and sequencing for the transmissible cfr gene that confers resistance to linezolid. Enhanced environmental cleaning, initial and weekly screening of all patients, and monitoring of adherence to standard infection control precautions were implemented.

FINDINGS

Five patients with pre-existing renal disease were found to have rectal colonization with linezolid-resistant E. faecium over a two-week period. The index case was a 57-year-old male from India who had travelled to the UK. One patient also had a linezolid-resistant E. faecium of a different PFGE profile isolated from a heel wound. All isolates were confirmed to harbour the cfr gene by PCR and Sanger sequencing, and all were resistant to glycopeptides (VanA phenotype).

CONCLUSIONS

This article describes the first UK outbreak with a single strain of linezolid- and glycopeptide-resistant E. faecium harbouring the cfr gene, affecting five patients in a nephrology unit. Following the implementation of aggressive infection control measures, no further cases were detected beyond a two-week period.

Craniometaphyseal Dysplasia: A review and novel oral manifestation

Craniometaphyseal Dysplasia (CMD) is a sclerosing osseous dysplasia characterised by hyperostosis of craniofacial and long bones, resulting in distortion and cranial nerve palsies. We present a case report on the management of a 63 year old female with Craniometaphyseal Dysplasia. This report describes an additional clinical manifestation of hypercementosis, which although well recognised in other sclerosing osseous dysplasias, is not reported in the literature for Craniometaphyseal Dysplasia. We discuss established in vivo studies in mice which link the genetic mutations found in Craniometaphyseal Dysplasia to hypercementosis, and how this report describes the same manifestation in humans. This novel finding can aid the clinician in the management of patients with Craniometaphyseal Dysplasia, and complications that can arise in dentoalveolar surgery.

Social capital and pet ownership - A tale of four cities

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Pet ownership is significantly associated with higher levels of social capital.

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Social capital was associated with pet ownership in the U.S. and Australia.

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Results are not confined to dog owners nor dog walkers.

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Pets are an under-recognized conduit for building social capital.

Altering calcium influx for selective destruction of breast tumor

Background

Human triple-negative breast cancer has limited therapeutic choices. Breast tumor cells have depolarized plasma membrane potential. Using this unique electrical property, we aim to develop an effective selective killing of triple-negative breast cancer.

Methods

We used an engineered L-type voltage-gated calcium channel (Cec), activated by membrane depolarization without inactivation, to induce excessive calcium influx in breast tumor cells. Patch clamp and flow cytometry were used in testing the killing selectivity and efficiency of human breast tumor cells in vitro. Bioluminescence and ultrasound imaging were used in studies of human triple-negative breast cancer cell MDA-MB-231 xenograft in mice. Histological staining, immunoblotting and immunohistochemistry were used to investigate mechanism that mediates Cec-induced cell death.

Results

Activating Cec channels expressed in human breast cancer MCF7 cells produced enormous calcium influx at depolarized membrane. Activating the wild-type Cav1.2 channels expressed in MCF7 cells also produced a large calcium influx at depolarized membrane, but this calcium influx was diminished at the sustained membrane depolarization due to channel inactivation. MCF7 cells expressing Cec died when the membrane potential was held at -10 mV for 1 hr, while non-Cec-expressing MCF7 cells were alive. MCF7 cell death was 8-fold higher in Cec-expressing cells than in non-Cec-expressing cells. Direct injection of lentivirus containing Cec into MDA-MB-231 xenograft in mice inhibited tumor growth. Activated caspase-3 protein was detected only in MDA-MB-231 cells expressing Cec, along with a significantly increased expression of activated caspase-3 in xenograft tumor treated with Cec.

Conclusions

We demonstrated a novel strategy to induce constant calcium influx that selectively kills human triple-negative breast tumor cells.

Acute liver failure in Scotland: changes in aetiology and outcomes over time (the Scottish Look-Back Study)

BACKGROUND

Acute liver failure is a rare and devastating clinical condition resulting from sudden loss of hepatic parenchyma and metabolic function. The Scottish Liver Transplant Unit (SLTU) offers specialist management and emergency liver transplantation to patients with acute liver failure from across Scotland.

AIM

To describe temporal changes in number of admissions, aetiology of acute liver failure, severity of disease at presentation and outcomes over a 22-year period.

METHODS

Retrospective analysis of the SLTU database, including all patients admitted with acute liver injury or acute liver failure between November 1992 and March 2014.

RESULTS

There has been no change in the number of patients presenting with acute liver injury or failure secondary to paracetamol overdose, but a reduction in the number of admissions with acute liver injury or failure secondary to non paracetamol causes. Over time, disease severity at presentation has not changed in the paracetamol cohort; those with a non paracetamol aetiology have latterly presented with milder hepatic encephalopathy. Spontaneous survival rates improved significantly over time for those patients with acute liver failure due to paracetamol and non paracetamol aetiologies. The most marked improvement in survival is observed in the sickest patients meeting Kings College Hospital poor prognostic criteria.

CONCLUSIONS

The number of admissions to the SLTU with acute liver failure is decreasing, due to reduced numbers of non paracetamol cases. Outcomes in this condition are improving, due to improvements in intensive care management and use of liver transplantation, and the increase in survival is most marked in patients meeting Kings College Hospital poor prognostic criteria.

ASPEN Safe Practices for Enteral Nutrition Therapy [Formula: see text]

Enteral nutrition (EN) is a valuable clinical intervention for patients of all ages in a variety of care settings. Along with its many outcome benefits come the potential for adverse effects. These safety issues are the result of clinical complications and of process-related errors. The latter can occur at any step from patient assessment, prescribing, and order review, to product selection, labeling, and administration. To maximize the benefits of EN while minimizing adverse events requires that a systematic approach of care be in place. This includes open communication, standardization, and incorporation of best practices into the EN process. This document provides recommendations based on the available evidence and expert consensus for safe practices, across each step of the process, for all those involved in caring for patients receiving EN.

The association between dog walking, physical activity and owner's perceptions of safety: cross-sectional evidence from the US and Australia

BACKGROUND

We examined the relationship between dog walking and physical activity within and between four US cities and Australia and investigated if dog walking is associated with higher perceived safety in US and Australian cities.

METHODS

Dog owners (n = 1113) in the Pet Connections Study completed a cross-sectional survey. Data were collected across four study sites; three in the US (San Diego, Nashville, Portland) and a fourth in Australia (Perth). Physical activity, local walking, dog walking, and individual and community perceptions of safety were analysed for dog walkers and non-dog walkers for each study site. Between-city comparisons were examined for dog walkers.

RESULTS

Across all study sites, dog walkers walked with their dog 5-6 times/week for a total of 93-109 min/week and achieved ≥30mins of physical activity on more days/week and walked in their neighbourhood more often/week, compared with non-dog walkers (all p ≤ 0.01). Compared with Perth, significantly fewer dog walkers walked in their local park in the three US study sites. San Diego dog walkers walked more often in their neighborhood/week compared with Perth dog walkers (all p ≤ 0.05). In Portland, dog walkers perceived significantly more neighborhood problems and in Nashville dog walkers perceived a significantly higher level of neighborhood natural surveillance (i.e., 'eyes on the street'), compared with non-dog walkers (both p ≤ 0.05). Among dog walkers, females were more likely than males to feel safer walking with their dog in their neighborhood (OR = 2.49; 95 % CI = 1.76, 3.53). Compared with dog walkers in Perth, dog walkers from each of the US study sites felt safer in their neighborhood and perceived there was more neighborhood surveillance (all p ≤ 0.001).

CONCLUSION

This multi-site international study provides further support for the potential for dog walking to increase levels of daily physical activity. Walking with a dog may be a mechanism for increasing perceptions of neighborhood safety and getting to know the neighborhood, however significant between-country differences exist. Further international research is required to understand the drivers for these between-country differences. Community based programs and policies aimed at improving safety and social connectedness should consider the wider community benefits of dog walking and include strategies for supporting more dog walking.