Artisanal and small-scale gold mining and biodiversity: a global literature review

Artisanal and small-scale gold mining (ASGM) is crucial to the livelihoods of close to 20 million people in over 80 countries, including 4-5 million women, mainly in rural areas with limited alternative economic prospects, particularly in developing countries. ASGM is largely informal, which can add to the challenge of addressing negative social and environmental effects including impacts on biodiversity. However, with proper guidance, ASGM can operate in a responsible manner, using cleaner production methods that minimize impacts on human health and the environment. This study presents and analyzes the interactions between ASGM and biodiversity based on new findings from 27 ASGM National Action Plans (NAPs) developed within the framework of Article 7 and Annex C of the Minamata Convention on Mercury, as well as a global literature review of more than 100 publications. In terms of key findings according to the literature reviewed, alongside other human occupation such as agriculture and industrial activities, ASGM also has an impact on the environment and biodiversity. The interrelationship between ASGM and biodiversity, including protected areas, is pervasive at every stage of ASGM operations, from extraction to mine closure, and generates significant impacts on the surrounding ecosystems. These impacts include, in descending order of most reported impacts: deforestation, soil degradation, chemical contamination of aquatic and terrestrial systems, and changes to the turbidity of watercourses. Tropical regions and key species such as amphibians and freshwater fish are among the most affected. Singly or combined, these environmental stressors lead to loss or deterioration of habitat and, by extension, indigenous biodiversity and ecosystem services. In addition, legal, institutional, and regulatory frameworks and related measures, inadequate or non-existent in some cases, may not necessarily support sustainable practices, often resulting in exploited sites abandoned without remediation, reclamation, rehabilitation, or restoration measures. To mitigate such impacts a key recommendation arising from the literature review is to strengthen the integration of the interrelationship between ASGM and biodiversity in the implementation of existing relevant national strategies, including those developed under the NAPs. The global literature review also highlights the importance of a multi-stakeholder, systemic approach combining the use of geospatial analysis, scientific and local knowledge, as well as the adaptation of the relevant frameworks, capacity building, and awareness raising. This approach can inform decision making with a view to developing sustainable initiatives that prevent and reduce the impacts of artisanal and small-scale gold mining on ecosystems, and that preserve biodiversity.

Morphological Complexity in Writing: Implications for Writing Quality and Patterns of Change

PURPOSE

The current study examined (a) the relation between morphologically complex word (MCW) use (words containing at least one derivational morpheme such as prefixes and suffixes) and teachers' ratings of writing quality, (b) average change in MCW use in writing across the school year, and (c) differential change in MCW among students with varying language abilities and linguistic backgrounds including students with developmental language disorders (DLDs) and multilingual learners (MLs).

METHOD

Expository writing samples (writing for the purpose of explaining or educating) were collected in October and May from 824 fifth-grade students, including 109 with DLD and 170 who were MLs receiving English as a second language service. Students' written responses were coded for the use of MCW. Pearson product-moment correlations and two-level hierarchical linear models were employed to investigate the association between MCW usage and writing quality, as well as increases in MCW usage over the course of the academic year, taking into account the nested structure of students within classrooms.

RESULTS

The relation between students' MCW use and teachers' writing quality ratings was moderately strong (r = .47). Student use of MCW in expository writing showed significant change from fall to spring across all students. However, the amount of change in MCW use across the school year was significantly lower for MLs (effect size [ES] = .09) and students identified with DLD (ES = .10).

CONCLUSIONS

The relation between MCW use and teachers' writing quality ratings highlights the utility of MCW as a written language measure for progress monitoring or assessment. The presence of differential change and potential Matthew effects for MLs and students with DLD substantiates the need for further exploration of instructional components that support the increased use of complex vocabulary.

Topsoil porosity prediction across habitats at large scales using environmental variables

Soil porosity and its reciprocal bulk density are important environmental state variables that enable modelers to represent hydraulic function and carbon storage. Biotic effects and their 'dynamic' influence on such state variables remain largely unknown for larger scales and may result in important, yet poorly quantified environmental feedbacks. Existing representation of hydraulic function is often invariant to environmental change and may be poor in some systems, particularly non-arable soils. Here we assess predictors of total porosity across two comprehensive national topsoil (0-15 cm) data sets, covering the full range of soil organic matter (SOM) and habitats (n = 1385 & n = 2570), using generalized additive mixed models and machine learning. Novel aspects of this work include the testing of metrics on aggregate size and livestock density alongside a range of different particle size distribution metrics. We demonstrate that porosity trends in Great Britain are dominated by biotic metrics, soil carbon and land use. Incorporating these variables into porosity prediction improves performance, paving the way for new dynamic calculation of porosity using surrogate measures with remote sensing, which may help improve prediction in data sparse regions of the world. Moreover, dynamic calculation of porosity could support representation of feedbacks in environmental and Earth System Models. Representing the hydrological feedbacks from changes in structural porosity also requires data and models at appropriate spatial scales to capture conditions leading to near-saturated soil conditions. Classification. Environmental Sciences.

Understanding barriers to reducing antimicrobials on Australian dairy farms: A qualitative analysis

INTRODUCTION

Reducing antibiotic use in production animal systems is one strategy which may help to limit the development of antimicrobial resistance. To reduce antimicrobial use in food-producing animals, it is important to first understand how antibiotics are used on farm and what barriers exist to decreasing their use. In dairy production systems, mastitis is one of the most common reasons for administering antimicrobials. Therefore, it is important to understand the motivations and behaviours of dairy farmers in relation to the diagnosis, treatment and prevention of mastitis.

MATERIALS AND METHODS

In this study, we interviewed a sample of dairy farmers and dairy industry professionals from the major dairying regions of eastern Australia regarding their current practices used to diagnose, treat, and control subclinical and clinical mastitis. Inductive thematic analysis was used to code interview transcripts and identify the recurrent themes.

RESULTS

Four overarching themes were identified: (1) the challenges associated with the detection and diagnosis of clinical mastitis, including with laboratory culture, (2) the motivations behind treatment decisions for different cases, (3) decisions around dry cow therapy and the role of herd recording, and (4) concerns regarding the development of antimicrobial resistance.

DISCUSSION

This study identifies several challenges which may limit the ability of Australian dairy farmers to reduce antimicrobial use on farm, such as the need for rapid and reliable diagnostic tests capable of identifying the pathogenic causes of mastitis and the difficulties associated with conducting herd recording for the implementation of selective dry cow therapy. Industry professionals were concerned that farmers were not using individual cow records to aid in treatment decisions, which could result in unnecessary antimicrobial use. The results of this study can act as the basis for future research aimed at assessing these issues across the broader Australian dairy industry.

Teacher Vocabulary Use and Student Language and Literacy Achievement

PURPOSE

We sought to examine second grade teachers' word use throughout the school day to identify the amount and type of teacher vocabulary use across content areas as well as to examine relationships between this teacher talk and student language and literacy achievement.

METHOD

Second grade teachers (n = 64) and a random sample of half of their students (n = 619) participated. Teachers recorded instruction during the school day throughout the year, and students were assessed on vocabulary, grammar, and reading measures in the fall and spring.

RESULTS

Findings reveal second grade students hear thousands of words spoken by the teacher each hour of the school day, including more than a thousand different words per hour on average. The large majority of words were the most common words in the English language. On average, there were few academic or curriculum vocabulary words used, but this varied widely between teachers. The proportion of academic words used by teachers during the school day significantly predicted students' end-of-year vocabulary. Teachers who used more academic words had students with higher vocabulary achievement at the end of the school year. There were no other significant relationships between teachers' language and student achievement.

CONCLUSIONS

This correlational evidence adds to the existing knowledge of the importance of academic language to student school outcomes and provides implications for further research in the area of academic language at the early elementary level.

Examination of an Automated Procedure for Calculating Morphological Complexity

PURPOSE

The aim of this study was to advance the analysis of written language transcripts by validating an automated scoring procedure using an automated open-access tool for calculating morphological complexity (MC) from written transcripts.

METHOD

The MC of words in 146 written responses of students in fifth grade was assessed using two procedures: (a) hand-coding of words containing derivational morphemes by trained scorers and (b) an automated analysis of MC using Morpholex, a newly developed web-based tool. Correlational analysis between the different MC calculations was examined to consider the relation between hand-coded derivational morpheme counts and the automated measures. Additionally, all MC measures were compared to a previously gathered rating of writing quality to consider predictive validity between the automated Morpholex score and teachers' ratings of writing quality.

RESULTS

Automated measures of MC had a strong relation (r = .63) with hand-coding of the number of words with derivational morphemes. Additionally, the number of derivational and inflectional and derivational morphemes accounted for a significant amount of the variation in teachers' overall ratings of writing quality.

CONCLUSION

Automated scoring of MC has potential utility as a valid alternative to hand-coding language samples, which may be valuable for progress monitoring of growth in complexity across repeated samples and measuring components that influence perceived quality of academic writing.

We care but we're not carers: perceptions and experiences of social prescribing in a UK national community organisation

AIMS

(1) To explore how social prescribing referrals impact experiences of existing members of a voluntary and community-based organisation and (2) to describe the processes and relationships associated with joining community and voluntary organisations.

METHODS

Online survey and qualitative interviews with members of Men's Sheds, a global volunteer-led initiative to address loneliness and social isolation in men. 93 self-selecting Shed members (average age 67 years, 93% male) from across England and Scotland took part in the survey about demographics, joining the Shed, and free-text questions about experiences in the Shed. From the survey participants, 21 Shed members were purposively sampled and interviewed to explore the impact of social prescribing and referrals on the Sheds.

RESULTS

Participating in the Men's Shed was often associated with a significant change in personal circumstances, and Sheds provided a unique social support space, particularly valuable for men. Key factors around experiences of social prescribing and referral mechanisms were identified. We developed three themes: the experience of joining a Shed, success factors and risks of social prescribing, and 'we care but we're not carers'.

CONCLUSIONS

The results show that Men's Sheds are a caring organisation, but their members are not trained as professional carers, and men come to the Shed for their own personal reasons. They are concerned about the potential additional responsibilities associated with formal referrals. They encourage the development of relationships and local-level understanding of the essence of Sheds to enable social prescribing. As models of social prescribing grow nationally and internationally, collaboratively working with voluntary and community organisations to develop a mutually beneficial approach is essential for the effectiveness and sustainability of social prescribing in community health.

An examination of 3rd and 5th grade students' use of dialect specific forms during a written editing task

PURPOSE

The goal of the current study was to examine the role of variety and frequency of dialectal features in relation to General American English (GAE) editing ability. This study focused on speakers of dialect-specific forms and their ability to edit to GAE. To gain insight into this relation, the following research questions were posed: (1). How do third and fifth-grade students differ in the variety of features of dialect-specific forms they use, the frequency of their use, and their editing ability to GAE? (2). Is there a significant relation between dialect use and editing ability?

METHODS

Participants included 68 third and fifth-grade students who produced at least one dialect-specific form. We measured students' ability to edit to GAE during a written editing task. Frequency and variety of dialect use were based on an oral language sample where students were asked to share their favorite game or sport.

RESULTS

Fifth-grade students are significantly better at editing written dialect specific forms to reflect GAE writing conventions as compared to third-grade students. However, there was not a significant difference in the dialect specific form usage between the two grades. Finally, there was not a significant relation between dialect specific form use and editing ability.

CONCLUSIONS

These results offer relevant clinical and educational implications for increasing cultural responsivity and promote the use of multiple measures across modalities to gain relevant information when assessing students who use dialect specific forms. Further, the results from this study provide further insights into how written editing ability exhibited through the awareness of GAE conventions improves with age despite the influence of dialect specific forms.

Healthcare Costs Before and After Diagnosis of Cancer of Unknown Primary Versus Ovarian Cancer in Australia

BACKGROUND

Little is known about the healthcare resource usage and costs for patients with cancer of unknown primary (CUP).

OBJECTIVE

The aim of this study was to describe and quantify healthcare resource use and costs in Australia, 6 months prior to and after a diagnosis of CUP, and compare to those of women with ovarian cancer.

METHODS

Individual-level data combining baseline surveys, clinical records and Medicare Benefits Schedule (MBS) claim records were analysed for 149 patients with CUP and 480 patients with ovarian cancer from two prospective cohort studies. MBS data were aggregated for the period 6 months prior to diagnosis date and 6 months after diagnosis. Data included doctor consultations, pathology, diagnostics, therapeutic procedures, imaging, allied health and medicines. Generalised linear models were used to evaluate the cost differences between CUP and ovarian cancer using gamma family and log link functions. Models were adjusted for age, employment, marital status, surgery, chemotherapy and number of comorbidities.

RESULTS

The mean healthcare costs in the 6 months prior to diagnosis of CUP were Australian (AU) $3903 versus AU$1327 for ovarian cancer (adjusted cost ratio 2.94, 95% confidence interval [CI] 2.08-4.15). Mean healthcare costs 6 months post-diagnosis were higher for patients with CUP versus ovarian cancer (AU$20,339 vs AU$13,819, adjusted cost ratio 1.47, 95% CI 1.13-1.92). Higher costs for patients with CUP were driven by imaging (AU$1937 vs AU$1387), procedures (AU$5403 vs AU$2702) and prescribed medicines for all conditions (AU$10,111 vs AU$6717).

CONCLUSIONS

Pre-diagnosis costs for patients with CUP are nearly triple those for ovarian cancer. Six months after diagnosis, healthcare costs for CUP remained higher than for ovarian cancer due to imaging, procedures and medicines.

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Psychometric properties of a self-assessment fear scale in children aged 4 to 12 years. Scary Scale

BACKGROUND

Caregivers encounter difficulties differentiating fear and pain experienced by children and tend to interpret what children may feel, often resulting in inadequate pain management. While many pain self-assessment scales are available, there is no validated self-assessment fear scale for children.

METHODS

The aim of this prospective study was to validate, in children aged 4 to 12 years, the psychometric properties of our scale. In a first part, in a school setting, five exercises were given to 484 children in order to validate the expression of fear, grade the intensity of the faces, the ability to discriminate the faces and the equality of the intervals. The scale's reproducibility was studied by assessing the children's fear in everyday situations at two different time points. In a second part, in a hospital setting, the aim was to test the scale's feasibility. Sixty children admitted to one emergency care department self-assessed their fear with the Scary Scale.

FINDINGS

The expression of fear was validated by 57.64% (p < 0.0001) of the children in comparison with three other emotions (pain, surprise, sadness).The 7-9 year-olds validated the other properties (gradation, discrimination, equality, reproducibility). The 4-6 year-olds failed to validate the gradation exercise, but succeeded with the others. In the hospital, 95% of children self-assessed their fear using the scale.

DISCUSSION

Our self-assessment fear scale was validated in children aged 7-12 years specifically and was readily feasible in the hospital. We recommend its use in that age group in every care situation triggering fear.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT02675504.

Advocacy Engagement and Self-Efficacy of School-Based Speech-Language Pathologists

PURPOSE

The purpose of this study was to investigate advocacy engagement and self-efficacy of school-based speech-language pathologists (SLPs) and their perceptions of key issues in education and challenges to advocacy.

METHOD

A 75-item survey was used to solicit information about advocacy-related experiences of 194 school-based SLPs. The survey included subsections on advocacy engagement, identity, training, and self-efficacy and solicited open-ended responses regarding perceived issues and hindrances.

RESULTS

Results demonstrated low percentages of respondents had received training in advocacy (15%) and participated in an event (14%). A high percentage of respondents (45%) reported feeling ill-equipped to advocate but viewed their role as advocates to be important. Overall, respondents self-rated as moderately efficacious advocates. Age and perceived advocacy importance were significant predictors of self-efficacy. Frequently cited issues in education included lack of resources and support for educators and students, teachers' rights, and mental health. Common challenges to advocacy included time constraints, lack of knowledge and support, and fear of retaliation.

CONCLUSIONS

Based on reported challenges to advocacy, more research is necessary to further investigate the extent these factors influence engagement and self-efficacy. As SLPs in this study viewed their advocacy role to be important but perceived themselves to be unprepared, additional training and professional development opportunities could support the degree to which SLPs engage in advocacy and perceive themselves to be effective advocates.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19111532.

Grammatical Verb Errors: Differences Between English Learners With and Without Diagnosed Language-Based Learning Disabilities

PURPOSE

This study examines the written language samples of fifth grade English learner (EL) students with and without diagnosed language-based learning disabilities (LLDs) in an effort to explore the utility of such supplemental materials for aiding in differential diagnosis of ELs with and without LLDs.

METHOD

This sample of 127 fifth grade students consisted of ELs without identified disabilities (n = 89) and ELs diagnosed with LLDs (n = 38). Written language samples from a classroom-based expository writing task were coded for grammaticality and specific verb type of errors. An analysis of variance (ANOVA) between the groups that differed by language abilities was conducted at two time points to compare the frequency of errors and the average change in grammaticality from the beginning of the school year to the end of the school year.

RESULTS

EL students with and without LLDs performed similarly at the beginning of the school year. ELs without LLDs showed greater average change in accuracy across the school year. Significantly, higher proportions of verb tense and verb omission errors were demonstrated by ELs with LLDs when compared with their EL peers at the end of the school year. Overall grammatical accuracy was also lower for ELs with LLDs.

CONCLUSIONS

Group differences at the end of the school year were confirmed in types and rate of verb errors. Results support the potential clinical utility of monitoring verb errors in writing samples over time as a supplemental tool in diagnostic evaluations and assessments for progress monitoring.

Defining Biochemical Cure After Low Dose Rate Prostate Brachytherapy: External Validation of 4-year Prostate-specific Antigen Nadir as a Predictor of 10- and 15-year Disease-free Survival

AIMS

To externally validate a proposed biochemical definition of cure following low dose rate (LDR) brachytherapy for prostate cancer - 4-year post-implant prostate-specific antigen (PSA) ≤0.2 ng/ml - in a UK population, and report the long-term (10- and 15-year) outcomes for patients stratified by National Comprehensive Cancer Network (NCCN) risk groups, through analysis of a large, prospectively collected, single-centre database.

MATERIALS AND METHODS

All patients treated with LDR brachytherapy for prostate cancer at a single UK centre between 2001 and November 2020 (n = 1142) were eligible; 632 patients met the inclusion criteria for the analysis. The primary end point was disease-free survival (DFS), defined as freedom from clinical, radiological or PSA progression requiring androgen deprivation therapy. Four-year PSA was categorised as ≤0.2, >0.2 to ≤0.5, >0.5 to ≤1.0 and >1.0 ng/ml. Kaplan-Meier analysis to 15 years was undertaken for each group, and sensitivity and specificity of 4-year PSA as a surrogate for long-term cure were calculated. Kaplan-Meier analysis to 15 years was repeated, stratifying patients by NCCN risk groups.

RESULTS

The median cohort age was 63 years; the median follow-up was 9.1 years (range 3.5-18.7). In total, 248 patients were available for analysis at year 10, 46 at year 15. Sixty-four patients (10.1%) relapsed during the study period. The 10-year DFS for 4-year PSA categories ≤0.2, >0.2 to ≤0.5, >0.5 to ≤1.0 and >1.0 ng/ml (95% confidence intervals) were 97.5% (95.4-99.6), 89.0% (82.4-96.1), 81.5% (70.5-94.2) and 41.8% (29.7-58.9), respectively. The 10-year DFS results for NCCN low, favourable-intermediate and unfavourable-intermediate risk disease were 93.1% (89.6-96.7), 92.1% (87.6-96.9) and 75.9% (67.8-84.9), respectively.

CONCLUSIONS

Patients with 4-year PSA ≤0.2 ng/ml may be considered cured, and could be discharged to general practitioner follow-up. LDR brachytherapy is an excellent treatment option for patients with low and favourable-intermediate risk prostate cancer, but those with unfavourable-intermediate risk disease should be considered for treatment intensification strategies.

Language Variation in the Writing of African American Students: Factors Predicting Reading Achievement

Purpose This study aims to examine the predictive relation between measures obtained from African American students' written narrative language samples and reading achievement, as measured by standardized academic assessments. Method Written language samples were elicited from 207 African American students in Grades 1-8. The samples were examined for morphosyntactic variations from standardized written Generalized American English (GAE). These variations were categorized as either (a) specific to African American English (AAE) or (b) neutral across AAE and standardized written GAE (i.e., considered ungrammatical both in AAE and in standardized written GAE). Structural equation modeling was employed to then examine the predictive relation between the density of AAE-specific forms in students' writing and their performance on standardized assessments of literacy and reading vocabulary. This relation was examined while accounting for the density of dialect-neutral morphosyntactic forms, reported family income, age, and written sample length. Results The written samples were highly variable in terms of morphosyntax. Younger students and those from lower income homes tended to use AAE-specific forms at higher rates. However, the density of AAE-specific forms did not significantly predict standardized literacy scores or reading vocabulary after accounting for dialect-neutral variations, income, and sample length. Conclusions These results support the ongoing need to better understand the language, literacy, and overall academic development of students from all backgrounds. It may be essential to focus on dialect-neutral language forms (i.e., morphosyntactic forms that are consistent across both AAE and standardized written GAE) in written samples to maximize assessment validity across students who speak varying dialects of English. Supplemental Material https://doi.org/10.23641/asha.16879558.

Challenges in Service Provision to Children and Families from Linguistically Diverse Backgrounds

The purpose of this study was to examine and describe experiences and perceptions of speech-language pathologists (SLPs) serving children and families from culturally and linguistically diverse populations. Twenty SLPs were interviewed using an online audio platform regarding common practices, resources and supports, challenges, and communication. Participants' responses to the semi-structured questions were transcribed and analyzed to identify themes in experiences. Results suggested six overall themes including: considerations for assessment; cultural impact; linguistic access and barriers; professional preparedness; impact of COVID-19; and helpful tips and resources. The discussion includes recommendations and resources to address obstacles.

State of the Practice of Team Science in Speech-Language Pathology and Audiology

Purpose The purpose of this study was to investigate engagement in collaborative research (team science) and perceptions of related knowledge and skills to inform personnel preparation and workforce development efforts. Method A questionnaire was used to solicit information about the team science-related experiences of 220 doctoral students, faculty, and research scientists in speech-pathology and audiology. Additionally, the questionnaire surveyed participants' perceptions of readiness, benefits, and challenges to team science. Results Results demonstrated low percentages of respondents had received training in collaborative research (17%), and those with training were more likely to engage in cross-disciplinary collaborative research. Group differences were found with female researchers reporting lower psychological safety than male researchers. The most frequently cited advantages of team science included diverse perspectives, collective expertise, innovative ideas, and productivity. Conversely, common challenges included time constraints, finding collaborators, and differing expectations. Implications Because this study yielded group difference in psychological safety between groups that differed in gender and position, results suggest additional efforts may be necessary to ensure that imbalances in the power structure of members are not allowed to dissuade members from actively contributing to team activities. Additional training opportunities in team science could support the degree to which professionals in communication science and disorders engage in collaborative research. Supplemental Material https://doi.org/10.23641/asha.15506034.

683 A Quality Improvement Project (QIP) To Increase Compliance with Peri-Operative Antibiotic Guidelines in Colorectal Surgery (CS)

Introduction

In CS, the correct use of antibiotics is important in order to reduce the risk of surgical site and intra-abdominal infections, whilst balancing risks from overuse of antibiotics. The Commissioning for Quality and Improvement (CQUIN) of 2019/20 identified that antibiotic prophylaxis guideline compliance could be enhanced in CS. This QIP aimed to improve local CS antibiotic prophylaxis and extension guideline compliance.

Method

In December 2019, an educational session was held to highlight the details of the local guideline and prescribing discrepancies. A3 posters of the guideline were created for accessible reference in operating theatres. Perioperative antibiotic prescription data from all colorectal elective cases in January 2020 were extracted and analysed using descriptive methods.

Results

Out of 93 cases in the sample, 70 (75.3%) were compliant with the prophylaxis guideline. However, metronidazole was commonly used in perianal surgery, which is not recommended. 13 cases required extension of the antibiotic course, of which seven were compliant (53.8%). The main issues included: use of agents and course durations which were not indicated; and a lack of antibiotic switch after a pause in therapy.

Conclusions

To further improve compliance with antibiotic guidelines, targeting historic practice, increasing awareness, and making systemic change is required for the next cycle.

Effects of dietary active soybean trypsin inhibitors on pancreatic weights, histology and expression of STAT3 and receptors for androgen and estrogen in different tissues of rats

Our previous study showed that soy milks could contain high levels of active soybean trypsin inhibitors (SBTI) if they were not properly processed. This study investigated the effects of consuming active SBTI on pancreatic weights, histology, trypsinogen production and expression of STAT3, receptors for androgen (AR) and estrogen (ER) in pancreas, liver and uterus of rats. Weanling Sprague-Dawley rats were randomly divided into 3 groups (8 females and 8 males/group) and fed diets containing either 20% casein protein (Casein) or 20% soy protein (SP) in the presence of high (1.42 BAEE unit/µg, SP + SBTI) or low (0.2 BAEE unit/µg, SP-SBTI) levels of active SBTI for 8 weeks. Ingestion of SP + SBTI diet markedly increased pancreatic weights and trypsinogen content (p < 0.01), and caused acinar cell hypertrophy, and reduced pancreatic STAT3, p-STAT3, AR and ERβ content, and increased uterine ERα and ERβ compared to the Casein or SP-SBTI diets (p < 0.05). The two SP-containing diets lowered hepatic STAT3, p-STAT3, and pancreatic ERα, and increased hepatic ERα and ERβ content in the female rats compared to the Casein diet (p < 0.05). This study demonstrated for the first time that consumption of high level of active SBTI not only increased pancreatic weights and acinar cell secretions, but also attenuated the expression of pancreatic STAT3, p-STAT3, AR, and ERβ proteins in both sexes and increased uterine ERα and ERβ content, and that dietary soy protein affected hepatic STAT3, p-STAT3, ERα and ERβ in a gender-dependent manner.

Preschool teachers' language and vocabulary knowledge: Development and predictive associations for a new measure

The present study reports on the development, structure, and associations with practice for a new measure of preschool teachers' knowledge about language and vocabulary development and how to support this development in the classroom. Results from item response theory models with responses from a sample of 248 preschool teachers indicated that four scales measuring pedagogical content knowledge and content knowledge for vocabulary and language, respectively, had adequate psychometric characteristics. Confirmatory factor analyses further supported a four-factor structure, although all scales were correlated. In an overlapping sample of 94 preschool teachers, preliminary investigation of associations between knowledge and teachers' self-reported practices, observed instructional time allocation, and the quality of classroom language environments were mixed. Results indicate promise for the measure yet add to prior research suggesting that connections between knowledge and practice are highly complex and likely interwoven with many other influences on instructional decision-making in early childhood classrooms.

Young children's narrative retell in response to static and animated stories

BACKGROUND

The format of narrative prompts used within language assessment has remained relatively constant; however, the use of animated video prompts deserves exploration given the increase in access to technology.

AIMS

To investigate the effect of story presentation format (static picture book versus animated video) on preschool children's narrative retells. It was hypothesized that children would produce more advanced narrative language elements in response to an animated video than a book.

METHODS & PROCEDURES

A total of 73 children between the ages of 3 and 5 years completed two narrative retells. One of these retells was in response to a 3-min animated video presented on a computer; the other retell was in response to static pictures presented in a book format. Children's stories were then transcribed and coded for linguistic and narrative elements.

OUTCOMES & RESULTS

Paired sample t-tests revealed that children produced significantly longer stories, greater syntactic complexity and lexical variety, and more action verbs when retelling an animated story compared with a book. Furthermore, a post-hoc analysis revealed that examiners provided significantly fewer prompts when eliciting the retell with animation.

CONCLUSIONS & IMPLICATIONS

Typically developing children demonstrated higher quantity and quality of language within a story retell in response to an animated video than after viewing images from the video presented in a static picture book. Although the extent to which these findings may be similar for children with language disorder has yet to be determined, researchers or clinicians should consider the effect of elicitation procedures on children's retells.

Nuclear Receptors: Potential Biomarkers for Assessing Physiological Functions of Soy Proteins and Phytoestrogens

Soy consumption is associated with decreased incidence of chronic diseases, including cardiovascular diseases, atherosclerosis, diabetes, osteoporosis, and certain types of cancers. However, consumption of high amounts of soy isoflavones may adversely influence endocrine functions, such as thyroid function and reproductive performance, because of their structural similarity to endogenous estrogens. Nuclear receptors are a group of transcription factors that play critical roles in the regulation of gene expression and physiological functions through direct interaction with target genes. Modulation of the abundance of these receptors, such as changing their gene expression, alters the sensitivity of the target cells or tissues to the stimulation of ligands, and eventually affects the relevant physiological functions, such as growth, development, osteogenesis, immune response, lipogenesis, reproductive process, and anticarcinogenesis. A number of studies have shown that the bioactive components in soy can modify the expression of these receptors in various tissues and cancer cells, which is believed to be a key intracellular mechanism by which soy components affect physiological functions. This review summarizes the current understanding of the modulation of nuclear receptors by soy proteins and isoflavones, and focuses especially on the receptors for estrogens, progesterone, androgen, vitamin D, retinoic acid, and thyroid hormones as well as the potential impact on physiological functions.

Understanding non-compliance with surgical antibiotic prophylaxis prescribing guidance, in Nigeria

Background

Antimicrobial Resistance is a prominent worldwide threat that is increasing in low-to-middle income countries. Good antibiotic stewardship (AMS) improves compliance with evidence-based antimicrobial prescribing guidelines but just 4% of LMICs have national AMS initiatives in place and only 15% have national policies. As high as 20-50% of surgical antibiotic prophylaxis prescription in Nigeria is thought to be non-compliant. Behaviour change theories can structure our understanding of why poor compliance occurs and can facilitate development of effective interventions to improve it.

Methods

The Theoretical Domains Framework (TDF; Michie et al. 2009) was used to develop an online survey and interview schedule for focus group discussions. Audio recordings were transcribed and analysed by two researchers using thematic analysis, TDF and the COM-B model of behaviour change (Michie et al. 2010).

Results

60 surgeons (59% male; 43% surgical consultant; 5-10 yrs experience) from Lagos University Teaching Hospital, Lagos University College of Medicine and Niger Delta University Teaching Hospital completed the survey. A sub-group of 14 surgeons (79% male; 86% surgical consultant; 10-15 yrs experience) participated in three focus groups. Whilst compliance with guidance was generally considered desirable, surgeons reported translating guidance to Nigerian practice and context was often difficult, time-consuming and restricted by not having access to recommended antibiotics.

Conclusions

Behaviour change theory can be used to further our understanding of key barriers and facilitators to non-compliance with surgical antibiotic prophylaxis prescribing guidance, amongst surgeons in Nigeria. This presentation will conclude with discussion of how findings from this project are being used to develop a cost-effective, scalable, decision-support smartphone app for prescribing behaviour change.

Key messages

Behaviour change theory can be used effectively to further understanding of barriers and facilitators to Nigerian surgeons’ non-compliance with surgical antibiotic prophylaxis prescribing guidance. We must form a comprehensive understanding of factors (social & environmental) driving non-compliant attitudes and behaviours, before creating interventions to change prescribing behaviour.

Guidelines of the French Society of Otorhinolaryngology (SFORL): Nonsteroidal anti-inflammatory drugs (NSAIDs) and pediatric ENT infections. Short version

OBJECTIVES

To present the guidelines of the French Society of Otolaryngology-Head and Neck Surgery concerning the use of non-steroidal anti-inflammatory drugs (NSAIDs) in pediatric ENT infections.

METHODS

Based on a critical analysis of the medical literature up to November 2016, a multidisciplinary workgroup of 11 practitioners wrote clinical practice guidelines. Levels of evidence were classified according to the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) system: GRADE A, B, C or "expert opinion". The first version of the text was reworked by the workgroup following comments by the 22 members of the reading group.

RESULTS

The main recommendations are: NSAIDs are indicated at analgesic doses (e.g. 20-30 mg/kg/day for ibuprofen) in combination with paracetamol (acetaminophen) in uncomplicated pediatric ENT infections (acute otitis media, tonsillitis, upper respiratory infections, and maxillary sinusitis) if: o pain is of medium intensity (visual analogue scale (VAS) score 3-5 or "Evaluation Enfant Douleur" (EVENDOL) child pain score 4-7) and insufficiently relieved by first-line paracetamol (residual VAS≥3 or EVENDOL≥4); o pain is moderate to intense (VAS 5-7 or EVENDOL 7-10). When combined, paracetamol and ibuprofen are ideally taken simultaneously every 6h. It is recommended: (1) o not to prescribe NSAIDs in severe or complicated pediatric ENT infections; (2) o to suspend NSAIDs treatment in case of unusual clinical presentation of the infection (duration or symptoms); (3) o not to prescribe NSAIDs for more than 72h.

Development, analytical validation, and initial clinical evaluation of a radioimmunoassay for the measurement of soluble CD25 concentrations in canine serum

During immune activation, CD25 is expressed by T cells, and its soluble form (sCD25) is released into the extracellular matrix and the bloodstream. In humans, serum sCD25 concentrations are used as a surrogate marker for autoimmune diseases, malignancies, and transplant rejection. However, a canine-specific assay for the measurement of sCD25 in dog serum has not previously been described. Therefore, the aims of this study were to develop and analytically validate a radioimmunoassay to measure sCD25 in canine serum, to establish a reference interval for canine sCD25, and to test the clinical utility of this assay with serum samples for dogs with various diseases. A competitive radioimmunoassay (RIA) was developed and analytically validated. Analytical validation consisted of lower limit of detection (LLOD), dilutional parallelism, spiking recovery, and intra- and inter-assay variability using pooled surplus canine serum samples. A reference interval was established in healthy dogs and serum samples from dogs with various types of neoplasia, IBD, liver disease, suspected pancreatitis, or suspected small intestinal disease and serum samples with an increased C-reactive protein concentration (CRP) were analyzed to test the clinical utility of the assay. LLOD was calculated to be 0.5 ng/mL. The mean (±SD) observed-to-expected ratio (O/E) for serial dilutions was 101.7 ± 14.0%, and the mean (± SD) O/E for spiking recovery was 93.2 ± 4.2%. Coefficients of variation (CVs) for intra-assay variability were ≤12.5% (mean ± SD: 7.5 ± 4.2%), and inter-assay CVs were ≤15.7% (mean ± SD: 11 ± 4.4%). A reference interval (RI) for canine sCD25 of 1.2-4.2 ng/mL was established from a population of 112 clinically healthy dogs. Dogs with neoplasia and dogs with suspected small intestinal disease had decreased concentrations of serum sCD25 when compared to healthy dogs (p < 0.0001, respectively). However, the majority of clinical samples used in this study were within the reference interval. Median concentrations of serum sCD25 were 1.9 ng/mL for healthy dogs. Dogs with cancer, IBD, liver disease, suspected pancreatitis, or suspected small intestinal disease, as well as sera with an increased serum CRP concentration, had median serum sCD25 concentrations of 1.6 ng/mL, 2.1 ng/mL, 2.2 ng/mL, 1.7 ng/mL, 1.5 ng/mL, and 1.8 ng/mL, respectively. Thus, the RIA described here is linear, accurate, precise, and reproducible for measuring sCD25 in canine serum. However, this assay shows little clinical utility of sCD25 as a biomarker for dogs with inflammatory, autoimmune, and/or neoplastic conditions.

Psychometric Evaluation of the Bilingual English-Spanish Assessment Sentence Repetition Task for Clinical Decision Making

Purpose The purpose of this study was (a) to examine the underlying components or factor structure of the Bilingual English-Spanish Assessment (BESA; Peña, Gutiérrez-Clellen, Iglesias, Goldstein, & Bedore, 2014 ) sentence repetition task and (b) to examine the relationship between Spanish-English speaking children's sentence repetition and vocabulary performance. Method Participants were 291 Spanish-English speaking children in kindergarten and 1st grade. Item analyses were used to evaluate the underlying factor structure for each language version of the sentence repetition tasks of the BESA. The tasks were then examined in relation to a measure of English receptive vocabulary. Results Bifactor models, which include a single underlying general factor and multiple specific factors, provided the best overall model fit for both the Spanish and English versions of the task. There was no relation between children's overall Spanish sentence repetition performance and their English vocabulary. However, children's pronoun, noun phrase, and verb phrase item scores in Spanish significantly predicted their English vocabulary scores. For English sentence repetition, both children's overall performance and their specific performance on the noun phrase items were predictors of their English vocabulary scores. Follow-up analyses revealed that, for the purposes of clinical assessment, the BESA sentence repetition tasks can be considered essentially unidimensional, lending support to the current scoring structure of the test. Conclusions Study findings suggest that sentence repetition tasks can provide insight into Spanish-English speaking children's vocabulary skills in addition to their morphosyntactic skills when used on a broad research scale. From a clinical assessment perspective, results indicate that the sentence repetition task has strong internal validity and support to the use of this measure in clinical practice.

Attenuated cortisol reactivity to psychosocial stress is associated with greater visual dependency in postural control

Despite known anatomical links between the hypothalamic-pituitary-adrenal (HPA) axis and the vestibular system, there are no studies on the relationship between postural control and HPA axis function. Visual dependence in postural control, often measured by increased postural sway on exposure to visual motion, is an indication of altered visual-vestibular integration with greater weighting towards visual cues for balance. Visual dependence is more common in older age and a range of vestibular and non-vestibular health conditions. The relationship between visual dependence in postural control was investigated in relation to cortisol reactivity to psychosocial stress (using the Trier Social Stress Test for groups: TSST-G), as an index of HPA axis function, in healthy young females. In those who exhibited a cortisol response (>2 nmol/l), a negative relationship between stress-induced cortisol reactivity and visual dependence in postural control was observed, since those with the largest cortisol response showed less visual motion induced postural sway (measured by force platform). This finding in healthy females indicates that subtle non-clinical differences in vestibular function are associated with dysregulated HPA axis activity as indicated by lower cortisol reactivity to psychosocial stress. It adds to the growing body of evidence linking blunted cortisol reactivity to stress to poor homeostatic regulation and potential negative health and behavioural outcomes.

Item Bias: Predictors of Accuracy on Peabody Picture Vocabulary Test-Fourth Edition Items for Spanish-English-Speaking Children

Purpose This study examines the response patterns of 278 Spanish-English dual language learners (DLLs) on a standardized test of receptive English vocabulary. Method Investigators analyzed responses to 131 items on the Peabody Picture Vocabulary Test-Fourth Edition ( Dunn & Dunn, 2007 ) focusing on differential accuracy on items influenced by (a) cross-linguistic overlap in phonology, (b) part of speech, and (c) word frequency. Results The differential response patterns showed cross-linguistic overlap, part of speech, and word frequency were significant predictors of the likelihood of obtaining a correct response above and beyond the expected difficulty level of the item. Conclusions All 3 factors predicted DLLs' response patterns beyond expected difficulty. Items with the highest likelihood of error included words with few or no shared features between Spanish and English translation equivalents, verbs or modifiers, and words with low frequency of occurrence. Implications Researchers should consider a cross-linguistic overlap in addition to part of speech and word frequency when designing vocabulary assessments for DLLs or utilizing such tests in research and clinical practice. Recognizing potential bias, clinicians should triangulate the appraisal of DLLs' language skills across multiple sources or measures and use caution when interpreting vocabulary assessments.

Predictors of Item Accuracy on the Test de Vocabulario en Imagenes Peabody for Spanish-English Speaking Children in the United States

This study examines the response patterns of 288 Spanish-English dual language learners on a standardized test of receptive Spanish vocabulary. Investigators analyzed responses to 54 items on the Test de Vocabulario en Imagenes (TVIP) (Dunn & Dunn, 2007) focusing on differential accuracy on items influenced by a) cross-linguistic overlap, b) context (home/school), and c) word frequency in Spanish. The response patterns showed cross-linguistic overlap in phonology was a significant predictor of accuracy at the item level. After accounting for item number (expected difficulty level), context of exposure was a significant predictor of the likelihood of obtaining a correct response. Spanish word frequency was not a significant predictor of accuracy. The current findings substantiate the influence of cross-linguistic overlap in phonology and context on Spanish vocabulary recognition by Spanish-English speaking children. Children were more likely to obtain correct responses on lexical items that were associated with the home context. Researchers and practitioners should consider phonological cross-linguistic overlap in addition to context of word exposure and word frequency when designing and utilizing vocabulary assessments for children from linguistic minority backgrounds.

Differential Immune Responses in Epidemic and Endemic Tanzanian Kaposi Sarcoma Patients

Background: Mechanisms underlying Kaposi sarcoma (KS) development are unclear. The high incidence of KS in HIV-1+ individuals implicates immune dysregulation in epidemic KS (EpKS) development. In African endemic KS (EnKS), the immune response is uncharacterized. Aim: The aim was to assess a comparative quantification between newly diagnosed Tanzanian EpKS and EnKS patients, and asymptomatic controls. We also report the first comparison of KSHV NAb prevalence and titer between EpKS and EnKS patients. Methods: To compare innate and adaptive immune responses, we recruited histologically confirmed Tanzanian EpKS and EnKS patients, as well as noncancer controls. After differential detection of KSHV nucleic acids in tissues, neutralizing antibody (NAb), levels of cytokines/chemokines, and T-cell differentiation subsets were quantified. The Mann-Whitney U-test was used to assess median differences between groups. All tests were 2-tailed and P-values < 0.05 were considered significant. Results: A total of 180 patients have been recruited in this study. In addition, a comparable 25 EpKS and 10 EnKS as well as 10 noncancer controls were recruited for this study. KSHV was significantly more frequently detected in EpKS patients than in EnKS. While all EpKS, and some EnKS patients mounted NAb responses, the EpKS patients had higher prevalence and titer of NAb compared with EnKS patients ( P = 0.001). Levels of the cytokines IP-10 and IL-10 were higher in EpKS vs EnKS patients ( P = 0.006 and P = 0.005 respectively), whereas, IL-4 was lower in EpKS vs EnKS patients ( P = 0.004). The levels of all 14 cytokines/chemokines measured were comparable between EnKS patients and HIV− controls ( P < .05 ). The distribution of CD4+ and CD8+ T-cells was similar between EpKS and EnKS such as naive and effector T-cells were depleted while central memory T-cells were elevated in both KS forms. Conclusion: The detection of similar abnormalities in T-cell differentiation subsets in both EpKS and EnKS as compared with controls, suggests that KSHV-induced T-cell dysfunction plays a major role in the disease, and that HIV-1 coinfection is only exacerbating and accelerating KSHV pathogenesis and KS development.

The Effect of e-Book Vocabulary Instruction on Spanish-English Speaking Children

PURPOSE

This study aimed to examine the effect of an intensive vocabulary intervention embedded in e-books on the vocabulary skills of young Spanish-English speaking English learners (ELs) from low-socioeconomic status backgrounds.

METHOD

Children (N = 288) in kindergarten and 1st grade were randomly assigned to treatment and read-only conditions. All children received e-book readings approximately 3 times a week for 10-20 weeks using the same books. Children in the treatment condition received e-books supplemented with vocabulary instruction that included scaffolding through explanations in Spanish, repetition in English, checks for understanding, and highlighted morphology.

RESULTS

There was a main effect of the intervention on expressive labeling (g = 0.38) and vocabulary on the Peabody Picture Vocabulary Test-Fourth Edition (g = 0.14; Dunn & Dunn, 2007), with no significant moderation effect of initial Peabody Picture Vocabulary Test score. There was no significant difference between conditions on children's expressive definitions.

CONCLUSION

Findings substantiate the effectiveness of computer-implemented embedded vocabulary intervention for increasing ELs' vocabulary knowledge.

IMPLICATIONS

Computer-assisted vocabulary instruction with scaffolding through Spanish explanations, repetitions, and highlighted morphology is a promising approach to facilitate word learning for ELs in kindergarten and 1st grade.

Measuring Vitality

Subjective perceptions of mental and physical energy were measured by the use of visual analogue scales (VAS) over the course of a week in a group of normal volunteers. These variables were found to correlate, highly both with one another and with assessments of vigour and fatigue measured with a standard adjectival format. In addition, high correlations were found with a measure of positive affect. These five variables also displayed characteristic patterns of diurnal variation. Physical and mental energy, vigour and positive affect were highest in the morning, falling progressively and significantly over the day. In contrast, fatigue showed the opposite pattern. Extraversion showed positive correlations with physical and mental energy, vigour and positive affect, and negative correlations with fatigue and negative affect, most being significant (P less than 0.05). Conversely, neuroticism showed a negative correlation with the first four energy variables but was positively related to fatigue and negative affect, most correlations again being significant. Physical and mental energy, vigour and positive affect also showed a positive correlation (P less than 0.01) with a measure of happiness. It is concluded that VAS-derived ratings of physical and mental energy are reliable indicators of self-perceived vigour and fatigue. They are easy to record and show sufficient short-term stability to be used in more extensive studies both of well-being and of its physiological correlates.

Say Yes to Life: A Pilot Study

In an attempt to assess whether there are any characteristics which a majority of ordinary people regard as life-affirming or life-denying, a questionnaire was given to a pilot group of 167 respondents, representing three different age and social categories. Five life-affirming and five life-denying characteristics were mentioned by more than 10% of respondents. Of the former, Drive, Sociability, Happiness and Optimism were endorsed by 15–20%. Of the latter, Unsociability and Poor Coping were mentioned by 22%, making them distinctly more frequent than the following categories of Pessimism, Lack of Drive and Unhappiness (11–14%). It is suggested that a number of these subjectively determined characteristics, which the general public perceive as being life-affirming or denying, do indeed influence physical or mental health, illness or illness behaviour. It may therefore be of value to utilize this set of public perceptions in future programmes of health education.

Proposal for a national triage system for the management of ventral hernias

Ventral hernia disease is becoming increasingly prevalent and complex. Subspecialisation for patients with challenging conditions requiring surgery has been shown to improve postoperative outcomes. Worldwide, there is an emergence of specialist hernia centres using new and innovative techniques to repair large and complicated ventral hernias. After a national meeting of hernia experts, we present an algorithm to be used as a national triage system for patients with ventral hernias, with the aim of ensuring that patients are operated on by the most appropriate surgeon. Evidence-based clinical risk factors and ventral hernia parameters are used for risk stratification and patient triage. We hope that this algorithm will guide future ventral hernia management in the UK.