A feasibility study of using a high-definition intra-operative exoscope in teaching septorhinoplasty

OBJECTIVE

This pilot study aimed to assess the feasibility of using a high-definition intra-operative exoscope in teaching septorhinoplasty.

METHODS

The exoscope was used in septorhinoplasty cases with different trainers and trainees. A high-definition screen displayed real-time, magnified images. Post-procedure, a questionnaire was completed by trainer and trainees, assessing the feasibility, safety and content validity of the exoscope as a septorhinoplasty training tool.

RESULTS

Trainees and trainers assigned favourable ratings to all aspects of the exoscope as a training tool, particularly with regard to teaching anatomy and improving visualisation.

CONCLUSION

The exoscope is a potentially effective training tool in septorhinoplasty, and is especially useful in improving visualisation, without restricting the operator. Annotatable intra-operative photographs and videos allow trainees to study cases outside of the operating theatre environment. The use of an exoscope for septorhinoplasty in the UK may facilitate increased hands-on involvement earlier in training than is currently typical.

The impact of trauma-informed suicide prevention approaches: A systematic review of evidence across the lifespan

Trauma is associated with an increased likelihood of experiencing suicidality, indicating the need for and potential value of trauma-informed suicide prevention strategies. The aim of this study is to systematically review published literature regarding trauma-informed approaches for suicide prevention, and the impact on suicide outcomes. Systematic searches were conducted in eight databases (Medline, Embase, PsycInfo, Emcare, Nursing, and JBI in the Ovid platform; as well as ProQuest Psychology Database and The Cochrane Library) in March 2022, with no publication date limit. Four studies met the inclusion criteria: two randomized controlled trials and two quasi-experimental studies. Two studies reported reductions in ideation, intent, and behaviour among youth and a cultural minority group. Few studies directly reporting suicide outcomes were identified, all were quantitative, and heterogeneity prevents generalizability across population groups. Currently, there is limited evidence focusing specifically on trauma-informed suicide prevention across the lifespan. Additional research, incorporating lived experience voices, is needed to understand the potential of this approach, as well as how mental health nurses can incorporate these approaches into their practice.

The Effectiveness of the Safety Planning Intervention for Adults Experiencing Suicide-Related Distress: A Systematic Review

The safety planning intervention (SPI) is gaining momentum in suicide prevention practice and research. This systematic review sought to determine the effectiveness of the SPI for adults experiencing suicide-related distress. Systematic searches of international, peer-reviewed literature were conducted in six databases (Cochrane Trials, Embase, Emcare, Medline, PsycINFO and Web of Science), including terms for safety planning, suicide, and suicide-related outcomes. A total of 565 results were included for screening. Result screening (title/abstract and full-text), data extraction and critical appraisal were conducted in duplicate. Twenty-six studies met the inclusion criteria. Studies were primarily quantitative (n = 20), largely with general adult or veteran samples; a small number of studies explored the perspectives of staff and significant others. Half of the studies included the SPI as a standalone intervention, while the other half examined the SPI in combination with other interventions. Most interventions were delivered in-person, with a hard-copy safety plan created, while a smaller number explored internet-based interventions. Primary measures included: suicidality (ideation, behavior, deaths; 10 studies), suicide-related outcomes (depression, hopelessness; 5 studies) and treatment outcomes (hospitalizations, treatment engagement; 7 studies). The evidence supports improvements in each of these domains, with complementary findings from the remaining quantitative and qualitative studies suggesting that the SPI is a feasible and acceptable intervention. While positive, these findings are limited by the heterogeneity of interventions and study designs, making the specific impact of the SPI difficult to both determine and generalize. Conversely, this also points to the flexibility of the SPI.HighlightsThe Safety Planning Intervention (SPI) is a valuable indicated intervention for general adult and veteran populations experiencing suicide-related distress, primarily in face-to-face, clinical settings.Quantitative findings indicate associations between the SPI and improvements in suicidal ideation and behavior, decreases in depression and hopelessness, along with reductions in hospitalizations and improvements in treatment attendance.Qualitative studies suggest the SPI is acceptable and feasible, with areas for development.SPIs have been shown to be adaptable to the clinical area in its modality (digital or paper-based), delivery (face-to-face or online), facilitation (clinician or self-administered) and multiplicity (as stand-alone or combined intervention).

Real world outcomes of minimally invasive epicardial surgical left atrial appendage exclusion in atrial fibrillation patients with high risk of stroke and bleeding

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): AtriCure, Inc

Introduction

The left atrial appendage (LAA) is the site of thrombus formation in patients with atrial fibrillation (AF) and first line therapy for reducing the risk of stroke is oral anticoagulation (OACs). A subset of patients with AF carry a very high risk of stroke and bleeding and are ineligible for OAC and percutaneous LAA occlusion; these patients may be suitable for minimally invasive thoracoscopic epicardial surgical LAA exclusion (LAAE) which can be used with a wide variety of LAA morphologies with a ~98% rate of complete exclusion. While use of LAAE is well studied as a concomitant procedure, there are relatively few data on its use as a stand-alone procedure.

Purpose

To compare real-world outcomes of LAAE versus no-LAAE in AF patients at high risk of stroke and bleeding who are not on OACs.

Methods

We performed an analysis of Medicare beneficiaries with AF who were not on OACs and received LAAE (ICD10-PCS code 02L74CK, Oct 2015 – Dec 31, 2017) in the absence of a concomitant surgical or catheter AF ablation procedure. Patients were propensity-matched (1:4) to otherwise similar patients who did not receive LAAE (control), using age, gender, race, region, AF type, CHA2DS2-VASc, HAS-BLED, and co-morbidities. The primary endpoint was hospital readmission for a thromboembolic event (ischemic stroke, systemic embolism, or transient ischemic attack). Kaplan Meier event rates were calculated and 95% CI were generated via bootstrapping.

Results

A total of 243 patients who underwent LAAE and 1.7M control patients met study criteria. In the matched cohort, the mean age was 75 years, 61% were men, 77% had non-paroxysmal AF, and the mean CHADS2-VASC and HAS-BLED scores were 5.5 and 4.2, respectively. The 1-year rate of thromboembolism in the LAAE and control arms were 7.3% (95% CI 4.3% -10.9%) and 13.6 (95% CI 11.0% -16.4%) (Figure), respectively, with an absolute and relative risk reduction of 6.2% (95% CI 2.0-10.3, p-value=0.001, NNT 17) and 0.54 (95% CI 0.29-0.68, p=0.001).

Conclusion

Among high-risk AF patients who were not on OAC, LAAE was associated with a clinically meaningful and significantly lower risk of TE. Additional studies are needed to confirm these finding.

Image segmentation for neuroscience: lymphatics

A recent discovery in neuroscience prompts the need for innovation in image analysis. Neuroscientists have discovered the existence of meningeal lymphatic vessels in the brain and have shown their importance in preventing cognitive decline in mouse models of Alzheimer’s disease. With age, lymphatic vessels narrow and poorly drain cerebrospinal fluid, leading to plaque accumulation, a marker for Alzheimer’s disease. The detection of vessel boundaries and width are performed by hand in current practice and thereby suffer from high error rates and potential observer bias. The existing vessel segmentation methods are dependent on user-defined initialization, which is time-consuming and difficult to achieve in practice due to high amounts of background clutter and noise. This work proposes a level set segmentation method featuring hierarchical matting, LyMPhi, to predetermine foreground and background regions. The level set force field is modulated by the foreground information computed by matting, while also constraining the segmentation contour to be smooth. Segmentation output from this method has a higher overall Dice coefficient and boundary F1-score compared to that of competing algorithms. The algorithms are tested on real and synthetic data generated by our novel shape deformation based approach. LyMPhi is also shown to be more stable under different initial conditions as compared to existing level set segmentation methods. Finally, statistical analysis on manual segmentation is performed to prove the variation and disagreement between three annotators.

OVPSYCH2: A randomized controlled trial of psychological support versus standard of care following chemotherapy for ovarian cancer

BACKGROUND

Fear of disease progression (FOP) is a rational concern for women with Ovarian Cancer (OC) and depression is also common. To date there have been no randomized trials assessing the impact of psychological intervention on depression and FOP in this patient group.

PATIENTS AND METHODS

Patients with primary or recurrent OC who had recently completed chemotherapy were eligible if they scored between 5 and 19 on the PHQ-9 depression and were randomized 1:1 to Intervention (3 standardized CBT-based sessions in the 6-12 weeks post-chemotherapy) or Control (standard of care). PHQ-9, FOP-Q-SF, EORTC QLQ C30 and OV28 questionnaires were then completed every 3 months for up to 2 years. The primary endpoint was change in PHQ-9 at 3 months. Secondary endpoints were change in other scores at 3 months and all scores at later timepoints.

RESULTS

182 patients registered; 107 were randomized; 54 to Intervention and 53 to Control; mean age 59 years; 75 (70%) had completed chemotherapy for primary and 32 (30%) for relapsed OC and 67 patients completed both baseline and 3-month questionnaires. Improvement in PHQ-9 was observed for patients in both study arms at three months compared to baseline but there was no significant difference in change between Intervention and Control. A significant improvement on FOP-Q-SF scores was seen in the Intervention arm, whereas for those in the Control arm FOP-Q-SF scores deteriorated at 3 months (intervention effect = -4.4 (-7.57, -1.22), p-value = 0.008).

CONCLUSIONS

CBT-based psychological support provided after chemotherapy did not significantly alter the spontaneously improving trajectory of depression scores at three months but caused a significant improvement in FOP. Our findings call for the routine implementation of FOP support for ovarian cancer patients.

Staff Perspectives of Safety Planning as a Suicide Prevention Intervention for People of Refugee and Asylum-Seeker Background

Background: Safety planning involves the co-development of a personalized list of coping strategies to prevent a suicide crisis. Aims: We explored the perspectives of workers regarding safety planning as a suicide prevention strategy for people of refugee background and those seeking asylum in Australia. Method: Participants attended suicide prevention training, specific to refugees and asylum seekers, at which safety planning was a key component. Semistructured, posttraining interviews (n = 12) were analyzed thematically. Results: Four key themes were identified: safety planning as a co-created, personalized activity for the client; therapeutic benefits of developing a safety plan; barriers to engaging in safety planning; strategies to enhance safety planning engagement. Limitations: First-hand refugee and asylum-seeker experiences were not included. Conclusion: As a relatively low-cost, flexible intervention, safety planning may be valuable and effective for these groups.

An Evaluation of Suicide Prevention Education for People Working With Refugees and Asylum Seekers

Abstract.Background: There are concerning rates of suicidality among asylum seekers and refugees in Australia, and tailored suicide prevention initiatives are needed. Aims: We aimed to evaluate the impact of a tailored suicide prevention education program for people working with asylum seekers and refugees. Method: Attendees of the education program completed self-report questionnaires at pretraining, posttraining, and 4–6 months follow-up. Results: Over 400 workers, volunteers, and students across Australia took part in the education program. A series of linear mixed-effects models revealed significant improvements in outcome measures from pretraining (n = 247) to posttraining (n = 231). Improvements were maintained at follow-up (n = 75). Limitations: Limitations of this research were the lack of a control group and a low follow-up response rate. Conclusion: Findings suggest that a 2 days tailored suicide prevention education program contributes to significant improvements in workers’ attitudes toward suicide prevention, and their confidence and competence in assessing and responding to suicidal distress.

The impact of suicide prevention education programmes for nursing students: A systematic review

The purpose of this systematic review was to locate and synthesize peer-reviewed evidence regarding the effectiveness of providing suicide prevention education to nursing students. Systematic searches were conducted in seven databases (EMBASE, EmCare, Joanna Briggs, MEDLINE, PsycINFO, Scopus, and Web of Science). Results were screened in duplicate at two stages: title and abstract, and full text. Critical appraisal and data extraction were also completed in duplicate. Initial database searching yielded 303 results. Following the addition of seven records from relevant reference lists, and the removal of duplicates, a total of 118 results were included for screening. Eight articles were deemed eligible for inclusion in this review; most (n = 5) were quantitative. While all were conducted within university settings, half were stand-alone education sessions, while the remaining were integrated with existing programmes/courses. The types of education programmes varied considerably across studies, with only three being established, evidence-based programmes. The studies explore a range of outcomes, which have been narratively categorized as enhanced skills, abilities, and self-confidence; development of positive attitudes and beliefs; acquisition of knowledge; and programme experience and evaluation. While there is a small body of evidence indicating that suicide prevention education programmes contribute to improvements in skills, abilities, self-confidence, and attitudes among nursing students, the variability in educational interventions and outcomes, coupled with short-term evaluation time frames, makes it difficult to fully understand the impact of this important suicide prevention strategy.

Transforming food retail for better health: The Healthy Stores 2020 trial

Background

How food is promoted in food retail settings impacts population diet. Foods high in sugar, fat and/or salt are promoted by retailers to attract impulse purchases. To combat the high burden of chronic disease and associated conditions confronting society we examined the impact of restricted retail merchandising (promotion and visibility) of discretionary food and beverages on sales and business outcomes.

Methods

We conducted a pragmatic randomised controlled trial in partnership with a retail organisation operating stores in remote communities of Australia (the Arnhem Land Progress Aboriginal Corporation). Twenty consenting stores were allocated to the 12-week intervention (7-point Healthy Stores 2020 strategy) or to usual retail practice. Four intervention stores with retail competition implemented a modified 6-point strategy. Weekly sales data were used to assess intervention impact on free sugars (g) to energy (MJ) (primary outcome) derived from all purchased food and beverages. Impact on gross profit and sales of targeted food and beverages was also assessed. Managers of intervention stores were interviewed to determine their views on customer response and impact on retail practice.

Results

Free sugars were reduced by a relative 2.8% (95% CI -4.8, -0.7). There were significant reductions in free sugars from targeted beverages (-6.4%; -11.1, -1.5) and soft drinks (-12.5%; -18.1, -6.5). Gross profit was not impacted adversely. Managers mostly viewed the strategy favourably and of benefit to the community.

Conclusions

The public health and business relevant gains demonstrated by this novel trial have resulted in ALPA converting their stores to the Healthy Stores 2020 strategy and integrating the strategy in to their nutrition policy. Retail competition impedes complete implementation of the 7-point strategy. Tackling this will require collective agreement by retailers to implement the full strategy and/or government policy power.

Key messages

Restricting merchandising of unhealthy foods can achieve both public health relevant and business relevant gains. Working in partnership with retailers is critical to testing real-world interventions to impact population diet.

Heritable epigenetic diversity for conservation and utilization of epigenetic germplasm resources of clonal East African Highland banana (EAHB) accessions

KEY MESSAGE

Genetically identical East African Highland banana (EAHB) clones are epigenetically diverse with heritable epialleles that can contribute to morphological diversity. Heritable epigenetic variation can contribute to agronomic traits in crops and should be considered in germplasm conservation. Despite the genetic uniformity arising from a genetic bottleneck of one ancestral clone, followed by subsequent vegetative propagation, East African Highland bananas (EAHBs) display significant phenotypic diversity potentially arising from somatic mutations, heritable epialleles and/or genotype-by-environment interactions. Here, we use DNA methylation profiling across EAHB accessions representing most of the primary EAHB genepool to demonstrate that the genetically uniform EAHB genepool harbours significant epigenetic diversity. By analysing 724 polymorphic DNA methylation sites by methylation-sensitive AFLP across 90 EAHB cultivars, we could differentiate the EAHB varieties according to their regions (Kenya and Uganda). In contrast, there was minimal association of DNA methylation variation with the five morphological groups that are used to classify EAHBs. We further analysed DNA methylation patterns in parent-offspring cohort, which were maintained in offspring generated by sexual (seed) and asexual (vegetative) propagation, with higher levels of altered DNA methylation observed in vegetatively generated offspring. Our results indicate that the phenotypic diversity of near-isogenic EAHBs is mirrored by considerable DNA methylation variation, which is transmitted between generations by both vegetative reproduction and seed reproduction. Genetically uniform vegetatively propagated crops such as EAHBs harbour considerable heritable epigenetic variation, where heritable epialleles could arise in offspring and contribute to functional traits. This study provides a basis for developing strategies for conservation of epigenetic resources and for integration of epimarkers into crop breeding programmes.

Development of an evidence-based Evaluation Toolkit for suicide prevention networks in regional Australia

PROBLEM

Suicide is a global public health concern, particularly for those living in rural, regional and remote areas. Despite numerous prevention initiatives, suicide continues to impact individuals, families and communities. Suicide prevention networks are an innovative, community-based approach to addressing suicide within local government areas. Anecdotally, suicide prevention networks make an important contribution to suicide prevention, yet frameworks for evaluating their impact do not exist. The purpose of this project was to develop an Evaluation Toolkit to be used by suicide prevention networks throughout South Australia to monitor their impact.

DESIGN

Participatory action research was used to work with one suicide prevention network in regional South Australia to co-design and produce the Evaluation Toolkit.

SETTING

One regional South Australian town, with an established suicide prevention network.

KEY MEASURES FOR IMPROVEMENT

The development of an Evaluation Toolkit, to allow all South Australian suicide prevention networks to measure their impact in a consistent manner.

STRATEGIES FOR CHANGE

The Evaluation Toolkit has been made freely available in electronic form and as a hard copy booklet for use by all South Australian suicide prevention networks.

EFFECTS OF CHANGE

The purpose of this project was to develop the Evaluation Toolkit. Formal assessment of its usability and effectiveness is yet to be undertaken, but preliminary anecdotal evidence indicates aspects of the Evaluation Toolkit are useful, especially the questionnaire templates that can be adapted and used to evaluate various community events.

LESSONS LEARNT

Participatory action research is a useful method for working with community-based suicide prevention groups.

Report from the 20th annual Western Canadian Gastrointestinal Cancer Consensus Conference; Saskatoon, Saskatchewan; 28-29 September 2018

The 20th annual Western Canadian Gastrointestinal Cancer Consensus Conference was held in Saskatoon, Saskatchewan, 28-29 September 2018. This interactive multidisciplinary conference is attended by health care professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) who are involved in the care of patients with gastrointestinal cancers. In addition, invited speakers from other provinces participate. Surgical, medical, and radiation oncologists, and allied health care professionals participated in presentations and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of colorectal cancers.

Enablers of psychological well-being for refugees and asylum seekers living in transitional countries: A systematic review

The purpose of this systematic review was to locate and synthesise existing peer-reviewed quantitative and qualitative evidence regarding enablers of psychological well-being among refugees and asylum seekers living in transitional countries and for whom migration status is not final. Systematic searches were conducted in nine databases: Academic Search Premier, CINAHL, Embase, Emcare, Medline, Psychology and Behavioral Science, PsycINFO, Scopus, and Web of Science. Search terms were related to refugees and asylum seekers, enablers, and psychological well-being. Studies were limited to those conducted in the last 20 years, with participants who were refugees and asylum seekers with no legal residency status, aged 16 years and above, and living in transit host countries without UNHCR resettlement programmes. This systematic review was conducted between March and June 2018 and followed the PRISMA guidelines. Results were screened by two reviewers at two stages: title and abstracts, and full-text. Critical appraisal and data extraction were also completed by two reviewers. Initial database searching yielded 3,133 results. Following the addition of two records from relevant reference lists and the removal of duplicates, a total of 1,624 results were included for screening. A total of 16 articles were deemed eligible for inclusion in this review, reporting on a collective sample of 1,352 participants. Twelve qualitative and four quantitative studies identified eight enablers of psychological well-being: social support; faith, religion and spirituality; cognitive strategies; education and training opportunities; employment and economic activities; behavioural strategies; political advocacy; and environmental conditions. Despite many challenges associated with forced displacement and the transit period, this review highlights multiple factors that promote well-being and suggest areas for intervention development and resource allocation.

Cancer league actions against sunbed use for skin cancer prevention

The incidence of non-melanoma and melanoma skin cancer has been rising in Europe. Although the World Health Organization's International Agency for Research on Cancer has since 2009 classified sunbeds as a Group 1 carcinogen, sunbed use, especially by those under the age of 18, continues to be a concern. As the only platform for cancer leagues in Europe, the Association of European Cancer Leagues decided to explore interest and actions by its member leagues at the national level against sunbed use, to share experiences and to provide background information on possible future collective actions at the EU level.

Suicide Prevention Training – Improving the Attitudes and Confidence of Rural Australian Health and Human Service Professionals

Abstract. Background: Suicide rates are higher in rural and remote areas of Australia compared with major cities. Aim: To evaluate the impact of a brief, community-based suicide prevention educational intervention on the attitudes and confidence of rural South Australian health and human service professionals. Method: Participants attended a 1-day suicide prevention education program, and completed a survey at four time points: baseline (T1), immediately pretraining (T2), immediately posttraining (T3), and 4-month follow-up (T4). Main outcome measures were self-reported attitudes and confidence when working with people vulnerable to suicide. Results: A total of 248 people attended the training, with 213 participants completing the survey at T1, 236 at T2, 215 at T3, and 172 at T4. There were significant improvements in 11 of the 14 attitude items between T2 and T3 (immediate change), and between T1 and T4 (maintained change). Further, there were significant improvements in all four confidence items between T2 and T3, and T1 and T4. Limitations: Despite the repeated-measures design, findings are limited by the lack of a control group. Conclusion: Findings extend the international evidence by indicating the value of brief suicide prevention education for improving health and human service professionals' attitudes and confidence in rural Australia.

Routine germline BRCA1 and BRCA2 testing in patients with ovarian carcinoma: analysis of the Scottish real-life experience

OBJECTIVE

To determine the rates of germline BRCA1 and BRCA2 mutations in Scottish patients with ovarian cancer, before and after a change in testing policy.

DESIGN

Retrospective cohort study.

SETTING

Four cancer/genetics centres in Scotland.

POPULATION

Patients with ovarian cancer undergoing germline BRCA1 and BRCA2 (gBRCA1/2) sequencing before 2013 (under the 'old criteria', with selection based solely on family history), after 2013 (under the 'new criteria', with sequencing offered to newly presenting patients with non-mucinous ovarian cancer), and in the 'prevalent population' (who presented before 2013, but were not eligible for sequencing under the old criteria but were sequenced under the new criteria).

METHODS

Clinicopathological and sequence data were collected before and for 18 months after this change in selection criteria.

MAIN OUTCOME MEASURES

Frequency of germline BRCA1, BRCA2, RAD51C, and RAD51D mutations.

RESULTS

Of 599 patients sequenced, 205, 236, and 158 were in the 'old criteria', 'new criteria', and 'prevalent' populations, respectively. The frequency of gBRCA1/2 mutations was 30.7, 13.1, and 12.7%, respectively. The annual rate of gBRCA1/2 mutation detection was 4.2 before and 20.7 after the policy change. A total of 48% (15/31) 'new criteria' patients with gBRCA1/2 mutations had a Manchester score of <15 and would not have been offered sequencing based on family history criteria. In addition, 20 patients with gBRCA1/2 were identified in the prevalent population. The prevalence of gBRCA1/2 mutations in patients aged >70 years was 8.2%.

CONCLUSIONS

Sequencing all patients with non-mucinous ovarian cancer gives a much higher annual gBRCA1/2 mutation detection rate, with the frequency of positive tests still exceeding the 10% threshold upon which many family history-based models operate.

TWEETABLE ABSTRACT

BRCA sequencing all non-mucinous cancer patients increases mutation detection five fold.

Perspectives of rural health and human service practitioners following suicide prevention training programme in Australia: A thematic analysis

There are well-established training programmes available to support health and human services professionals working with people vulnerable to suicide. However, little is known about involving people with lived experience in the delivery of suicide prevention training with communities with increased rates of suicide. The aim of this paper was to report on a formative dialogical evaluation that explored the views of health and human services workers with regard to a suicide prevention training programme in regional (including rural and remote areas) South Australia which included meaningful involvement of a person with lived experience in the development and delivery of the training. In 2015, eight suicide prevention training workshops were conducted with health and human services workers. All 248 participants lived and worked in South Australian regional communities. We interviewed a subsample of 24 participants across eight sites. A thematic analysis of the interviews identified five themes: Coproduction is key, It is okay to ask the question, Caring for my community, I can make a difference and Learning for future training. The overall meta-theme was "Involvement of a person with lived experience in suicide prevention training supports regional communities to look out for people at risk of suicide." This paper highlights the need for suicide prevention training and other workforce development programmes to include lived experience participation as a core component in development and delivery.

eHealth readiness of dietitians

BACKGROUND

The present study aimed to determine the eHealth readiness and changes over time of dietitians in Australia.

METHODS

Two cross-sectional analyses of Australian dietitians were conducted in 2013 and 2016, using a survey adapted from one conducted in 2011 by the US Academy of Nutrition and Dietetics. The survey encompassed 30 questions on eHealth readiness across five dimensions: access, standards, attitude, aptitude and advocacy. Descriptive statistics, independent t-tests, chi-squared tests and Z-tests were computed to compare responses from the 2013 and 2016 surveys.

RESULTS

The survey completion rate represented 14.5% (747) of the Dietitians Association of Australia members in 2013 and 8% (417) in 2016. The survey responses in relation to access and standards suggest that dietitians are well positioned for eHealth. For attitude and aptitude, there is a moderate level of preparedness, with minor improvements over time. Although showing significant improvement (P < 0.05), advocacy highlights the area requiring the most development because the majority of dietitians (61%) reported 'no role' in eHealth solutions.

CONCLUSIONS

Dietitians are progressing in relation to access, attitudinal and aptitudinal readiness for eHealth, although they rate poorly with respect to advocacy readiness. It was concluded that dietitians are not yet ready, and also that valuable opportunities to achieve the benefits that eHealth can deliver will be missed, if dietitians do not take the lead in guiding the development, selection and implementation of nutrition-related technologies. Strengthening the dimension of advocacy and ensuring collaboration across the profession, drawing on the varying expertise demonstrated across the practice areas and by the different generations, will be central to improving dietitian eHealth readiness.

More feed efficient sheep produce less methane and carbon dioxide when eating high-quality pellets

The Australian sheep industry aims to increase the efficiency of sheep production by decreasing the amount of feed eaten by sheep. Also, feed intake is related to methane production, and more efficient (low residual feed intake) animals eat less than expected. So we tested the hypothesis that more efficient sheep produce less methane by investigating the genetic correlations between feed intake, residual feed intake, methane, carbon dioxide, and oxygen. Feed intake, methane, oxygen, and carbon dioxide were measured on Merino ewes at postweaning (1,866 at 223 d old), hogget (1,010 sheep at 607 d old), and adult ages (444 sheep at 1,080 d old). Sheep were fed a high-energy grower pellet ad libitum for 35 d. Individual feed intake was measured using automated feeders. Methane was measured using portable accumulation chambers up to 3 times during this feed intake period. Heritabilities and phenotypic and genotypic correlations between traits were estimated using ASReml. Oxygen (range 0.10 to 0.20) and carbon dioxide (range 0.08 to 0.28) were generally more heritable than methane (range 0.11 to 0.14). Selecting to decrease feed intake or residual feed intake will decrease methane (genetic correlation [] range 0.76 to 0.90) and carbon dioxide ( range 0.65 to 0.96). Selecting to decrease intake ( range 0.64 to 0.78) and methane ( range 0.81 to 0.86) in sheep at postweaning age would also decrease intake and methane in hoggets and adults. Furthermore, selecting for lower residual feed intake ( = 0.75) and carbon dioxide ( = 0.90) in hoggets would also decrease these traits in adults. Similarly, selecting for higher oxygen ( = 0.69) in hoggets would also increase this trait in adults. Given these results, the hypothesis that making sheep more feed efficient will decrease their methane production can be accepted. In addition, carbon dioxide is a good indicator trait for feed intake because it has the highest heritability of the gas traits measured; is cheaper, faster, and easier to measure than feed intake and has strong phenotypic and genetic correlations with feed intake. Furthermore, selection for feed intake, feed efficiency, methane, and carbon dioxide can be done early in sheep at postweaning age or hoggets. This early selection reduces the generation interval for breeding, thereby increasing response to selection.

A Data Processing Pipeline for Prediction of Milling Machine Tool Condition from Raw Sensor Data

With recent advances in sensor and computing technology, it is now possible to use real-time machine learning techniques to monitor the state of manufacturing machines. However, making accurate predictions from raw sensor data is still a difficult challenge. In this work, a data processing pipeline is developed to predict the condition of a milling machine tool using raw sensor data. Acceleration and audio time series sensor data is aggregated into blocks that correspond to the individual cutting operations of the Computer Numerical Control (CNC) milling machine. Each block of data is preprocessed using well-known and computationally efficient signal processing techniques. A novel kernel function is proposed to approximate the covariance between preprocessed blocks of time series data. Several Gaussian process regression models are trained to predict tool condition, each with a different covariance kernel function. The model with the novel covariance function outperforms the models that use more common covariance functions. The trained models are expressed using the Predictive Model Markup Language (PMML), where possible, to demonstrate how the predictive model component of the pipeline can be represented in a standardized form. The tool condition model is shown to be accurate, especially when predicting the condition of lightly worn tools.

Nutritional monitoring of patients post-bariatric surgery: implications for smartphone applications

BACKGROUND

Optimal results from bariatric surgery are contingent on patient commitment to dietary and lifestyle changes and follow-up care. The present study aimed to investigate the attitudes and use of mobile health (mHealth) smartphone applications (apps) as a potential tool for maintaining connectivity between dietitians and patients post-bariatric surgery.

METHODS

A cross-sectional online survey was developed and distributed to a purposeful sample of bariatric dietitians and bariatric patients in Australia. The survey questions explored technology penetration (smartphone and app use), communication preferences, nutrition monitoring methods, professional relationship expectations and reasons for loss to follow-up.

RESULTS

Survey completion rate was 85% (n = 50/59) for dietitians and 80% (n = 39/49) for patients. Smartphone ownership was 98% and 95% for dietitians and patients, respectively. Common reasons given for losing patients to follow-up suggest that a traditional in-clinic practice setting could be a barrier for some. Most dietitians (n = 48; 91%) prefer to see patients face-to-face in their clinic, whereas patient preferences extended to e-mail and mobile messaging. Sixty-eight percent of bariatric patients were receptive to two-way communication with dietitians via an app between clinic visits. Both cohorts recognised the potential for emerging technologies to be used in practice, although there was no single routinely recommended mHealth app.

CONCLUSIONS

The present study provides the first insight into the use of mobile devices and apps by post-bariatric patients and the dietitians who support them. A mixture of traditional methods and smartphone technology is desirable to both dietitians and patients. The utility and effectiveness of such technologies should be confirmed in future intervention studies.

Gaussian Process Regression (GPR) Representation in Predictive Model Markup Language (PMML)

This paper describes Gaussian process regression (GPR) models presented in predictive model markup language (PMML). PMML is an extensible-markup-language (XML) -based standard language used to represent data-mining and predictive analytic models, as well as pre- and post-processed data. The previous PMML version, PMML 4.2, did not provide capabilities for representing probabilistic (stochastic) machine-learning algorithms that are widely used for constructing predictive models taking the associated uncertainties into consideration. The newly released PMML version 4.3, which includes the GPR model, provides new features: confidence bounds and distribution for the predictive estimations. Both features are needed to establish the foundation for uncertainty quantification analysis. Among various probabilistic machine-learning algorithms, GPR has been widely used for approximating a target function because of its capability of representing complex input and output relationships without predefining a set of basis functions, and predicting a target output with uncertainty quantification. GPR is being employed to various manufacturing data-analytics applications, which necessitates representing this model in a standardized form for easy and rapid employment. In this paper, we present a GPR model and its representation in PMML. Furthermore, we demonstrate a prototype using a real data set in the manufacturing domain.

The adrenergic-regulated CRTC1 and CRTC2 phosphorylation and cellular distribution is independent of endogenous SIK1 in the male rat pinealocyte

Salt inducible kinase 1 (SIK1) has been reported to repress cAMP-response element binding protein (CREB)-mediated gene transcription by causing the nuclear export of CREB-regulated transcription coactivators (CRTCs) through phosphorylation. Although the repressor role of SIK1 in suppressing the expression of arylalkylamine N-acetyltransferase, the enzyme that controls the daily rhythm in melatonin production in the rat pineal gland, has been established, whether SIK1 regulates the phosphorylation and localization of CRTC1 and CRTC2 in this tissue remains unclear. The present study found that overexpressing SIK1 in NE-stimulated rat pinealocytes could increase the phosphorylation of CRTC1 and CRTC2, reduced selectively the nuclear level of CRTC2 (but not that of CRTC1), and elevated the cytosolic levels of both CRTC1 and CRTC2. In contrast, transient knockdown of endogenous SIK1 had no effect on the phosphorylation or distribution of CRTC1 and CRTC2 in norepinephrine (NE)-stimulated pinealocytes. Our results also showed that adrenergic blockade during NE stimulation led to a rapid rephosphorylation and decline in the nucleus levels of CRTC1 and CRTC2; however SIK1 knockdown had no effect on this rapid rephosphorylation. Moreover, studies with kinase inhibitors revealed that kinase(s) sensitive to KT5823 appeared to be involved in this rapid rephosphorylation. Together, these results indicate that although overexpressing SIK1 can phosphorylate CRTC1 and CRTC2 in the NE-stimulated pinealocyte, the endogenous SIK1, in spite of its induction by NE, does not appear to be the main regulator of the phosphorylation and intracellular localization of these two coactivators.

Physical activity predicts quality of life and happiness in children and adolescents with cerebral palsy

PURPOSE

To examine the associations between physical activity, health-related quality of life and happiness in young people with cerebral palsy.

METHOD

A total of 70 young people with cerebral palsy (45 males, 25 females; mean age 13 years 11 months, SD 2 years 0 month) took part in a cross-sectional, descriptive postal survey assessing physical activity (Physical Activity Questionnaire for Adolescents), functional ability (Gross Motor Function Classification System), quality of life (Pediatric Quality of Life Inventory 4.0) and happiness (single Likert-scale item). Relationships between physical activity, quality of life and happiness were examined using backward stepwise linear regression.

RESULTS

Physical activity significantly predicted physical quality of life (R(2 )= 0.64, β = 6.12, p = 0.02), social quality of life (R(2 )= 0.28, β = 9.27, p < 0.01) and happiness (R(2 )= 0.08, β = 0.9, p = 0.04). Physical activity was not associated with emotional or school quality of life.

CONCLUSIONS

This study found a positive association between physical activity, social and physical quality of life, and happiness in young people with cerebral palsy. Findings underscore the potential benefits of physical activity for the wellbeing of young people with cerebral palsy, in addition to its well-recognised physical and health benefits.

IMPLICATIONS FOR REHABILITATION

Physical activity is a key predictor of quality of life and happiness in young people with cerebral palsy. Physical activity is widely recognised as having physical health benefits for young people with cerebral palsy; however, this study also highlights that it may have important benefits for wellbeing, quality of life and happiness. This emphasises the need for clinical services and intervention studies aimed specifically at increasing physical activity amongst children and adolescents with cerebral palsy.

Use of urinary renal biomarkers to evaluate the nephrotoxic effects of melamine or cyanuric acid in non-pregnant and pregnant rats

Although traditional assessments of renal damage detect loss of kidney function, urinary renal biomarkers are proposed to indicate early changes in renal integrity. The recent adulteration of infant formula and other milk-based foods with melamine revealed a link between melamine ingestion and nephropathy. Thus, the effects of melamine and related analogs (e.g., cyanuric acid) should be assessed in other potentially sensitive groups. We evaluated whether urinary Kim-1, clusterin, and osteopontin could detect the effects of high doses of melamine or cyanuric acid in pregnant and non-pregnant female rats gavaged with 1000 mg/kg bw/day for 10 days. We demonstrate that these biomarkers can differentiate the severity of effects induced by melamine or cyanuric acid. All melamine-treated animals experienced adverse effects; however, pregnant rats were most sensitive as indicated by increased SCr, BUN, and kidney weights, decreased body weight, and presence of renal crystals. These effects coincided with elevated urinary biomarker levels as early as day 2 of exposure. One cyanuric acid-treated rat displayed effects similar to melamine, including increased urinary biomarker levels. This work illustrates that these biomarkers can detect early effects of melamine or cyanuric acid crystal-induced nephropathy and further supports the use of urinary protein immunoassays as a powerful, non-invasive method to assess nephrotoxicity.

A Web-Based, Social Networking Physical Activity Intervention for Insufficiently Active Adults Delivered via Facebook App: Randomized Controlled Trial

Background

Online social networks offer considerable potential for delivery of socially influential health behavior change interventions.

Objective

To determine the efficacy, engagement, and feasibility of an online social networking physical activity intervention with pedometers delivered via Facebook app.

Methods

A total of 110 adults with a mean age of 35.6 years (SD 12.4) were recruited online in teams of 3 to 8 friends. Teams were randomly allocated to receive access to a 50-day online social networking physical activity intervention which included self-monitoring, social elements, and pedometers (“Active Team” Facebook app; n=51 individuals, 12 teams) or a wait-listed control condition (n=59 individuals, 13 teams). Assessments were undertaken online at baseline, 8 weeks, and 20 weeks. The primary outcome measure was self-reported weekly moderate-to-vigorous physical activity (MVPA). Secondary outcomes were weekly walking, vigorous physical activity time, moderate physical activity time, overall quality of life, and mental health quality of life. Analyses were undertaken using random-effects mixed modeling, accounting for potential clustering at the team level. Usage statistics were reported descriptively to determine engagement and feasibility.

Results

At the 8-week follow-up, the intervention participants had significantly increased their total weekly MVPA by 135 minutes relative to the control group (P=.03), due primarily to increases in walking time (155 min/week increase relative to controls, P<.001). However, statistical differences between groups for total weekly MVPA and walking time were lost at the 20-week follow-up. There were no significant changes in vigorous physical activity, nor overall quality of life or mental health quality of life at either time point. High levels of engagement with the intervention, and particularly the self-monitoring features, were observed.

Conclusions

An online, social networking physical activity intervention with pedometers can produce sizable short-term physical activity changes. Future work is needed to determine how to maintain behavior change in the longer term, how to reach at-need populations, and how to disseminate such interventions on a mass scale.

Trial Registration

Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614000488606; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366239 (Archived by WebCite at http://www.webcitation.org/6ZVtu6TMz).

Engaging consumers in the Australian emergency mental health context: a qualitative perspective from clinicians working in the community

Successfully engaging with consumers is seen as an essential component of mental healthcare, yet doing so can be challenging and little is understood about the unique engagement skills and attributes employed by mental health clinicians working in the emergency community context. Consequently, this qualitative study explored the engagement experiences of clinicians to identify the attributes used when engaging with consumers in this unique setting. We conducted two semi-structured focus groups in July and August 2011 with 16 clinicians employed at one metropolitan mental health organisation in South Australia. Using thematic analysis, we identified two key themes pertaining to the skills and attributes used for successful consumer engagement: (i) building trust, through communication style, an honest approach, facilitating choice and locating trust networks; and (ii) portraying genuine care, through showing respect, offering practical assistance and taking the least restrictive pathway. These findings highlight the unique nature of engagement in the emergency community mental health setting, as well as the flexibility and resourcefulness required to facilitate it.

Differences in the distribution of versican, decorin, and biglycan in atherosclerotic human coronary arteries

The distributions of versican, biglycan, and decorin have been examined in segments of normal and atherosclerotic human coronary arteries using antibodies directed against the core proteins of these macromolecules. Versican immunostaining was prominent throughout the extracellular matrix (ECM) in regions of the vessels that contained abundant smooth-muscle cells, such as in diffuse intimal thickenings, fibrous caps, and in zones of loose, myxoid connective tissue. Versican also was present in smooth-muscle-rich thrombi and at borders of the lipid-rich cores of advanced atherosclerotic lesions. Biglycan immunostaining was observed in diffuse intimal thickenings, fibrous caps, and myxoid areas, but, unlike versican, it was abundant in the lipid-rich core of advanced plaques. However, biglycan immunostaining was absent in smooth-muscle cell-enriched thrombi. Decorin immunostaining paralleled biglycan immunostaining except that it was conspicuously absent in the myxoid areas of the plaque and markedly reduced in diffuse intimal thickenings. Both biglycan and decorin immunostaining were consistently associated with some of the microvessels in the thrombi and in advanced atherosclerotic plaques. Taken together, these results indicate that specific proteoglycans distribute to topographically defined regions of normal and atherosclerotic human coronary arteries and that these different distributions may indicate a diversity of functions in normal and pathologic processes of the arterial wall.