Development and validation of models predicting treatment patterns in women with urinary urgency and/or urgency incontinence: A Symptoms of Lower Urinary Tract Dysfunction Research Network observational cohort study.

PURPOSE: To develop a tool to predict a woman's treatment pattern for bothersome urinary urgency (UU) and/or UU incontinence over 1 year after presenting for care at urology or urogynecology clinics. METHODS: The Symptoms of Lower Urinary Tract Dysfunction Research Network observational cohort study enrolled adult women with bothersome UU and/or UU incontinence using the lower urinary tract symptoms (LUTS) Tool who were seeking care for LUTS. Treatments for UU and/or urgency incontinence were ordered from least to most invasive. Ordinal logistic and Cox proportional hazard regression models were fit to predict the most invasive level of treatment during follow-up and overactive bladder (OAB) medication discontinuation, respectively. Binary logistic regression was performed to predict sling treatment during the study follow-up. Clinical tools were then created using the models listed above to predict treatment pattern over 12 months. RESULTS: Among 349 women, 281 reported UU incontinence, and 68 reported UU at baseline. The highest level of treatment during the study was as follows: 20% no treatment, 24% behavioral treatments, 23% physical therapy, 26% OAB medication, 1% percutaneous tibial nerve stimulation, 3% onabotulinumtoxin A, and 3% sacral neuromodulation. Slings were placed in 10% (n = 36) of participants before baseline and in 11% (n = 40) during study follow-up. Baseline factors associated with predicting the most invasive level of treatment included baseline level of treatment, hypertension, UU incontinence severity, stress urinary incontinence (SUI) severity, and anticholinergic burden score. Less severe baseline depression and less severe UU incontinence were associated with OAB medication discontinuation. UU and SUI severity were associated with sling placement during the study period. Three tools are available to predict: (1) highest level of treatment; (2) OAB medication discontinuation; and (3) sling placement. CONCLUSIONS: OAB treatment prediction tools developed in this study can help providers individualize treatment plans and identify not only patients at risk for treatment discontinuation but also patients who may not be escalated to potentially beneficial OAB treatments, with the goal to improve clinical outcomes for patients suffering from this chronic and often debilitating condition.

Impact of Sleep Disturbance, Physical Function, Depression and Anxiety on Male Lower Urinary Tract Symptoms: Results from the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN).

PURPOSE: The impact of nonurological factors on male lower urinary tract symptoms (LUTS) remains unclear. We investigated cross-sectional and longitudinal associations among anxiety, depression, physical function, sleep quality and urinary symptom subdomains. MATERIALS AND METHODS: Data from 518 men in the LURN (Symptoms of Lower Urinary Tract Dysfunction Research Network) study were analyzed to identify associations between Patient-Reported Outcomes Measurement Information System® (PROMIS®) depression, anxiety, sleep disturbance and physical function measures and LUTS subdomains, as derived from the American Urological Association Symptom Index and LUTS Tool. Multivariable linear regression was used to assess the relationships between PROMIS measures and LUTS subdomains at baseline and at 3- and 12-month followup. RESULTS: Baseline depression and anxiety were associated with urinary incontinence (p <0.001), voiding symptoms (p <0.001) and quality of life (p=0.002), whereas baseline sleep disturbance was associated with voiding and storage symptoms and quality of life (p <0.001 for all). Urinary symptom severity improved in all subdomains at 3 and 12 months. Similar associations between PROMIS measures and LUTS subdomains were observed at all time points, but baseline depression, anxiety, sleep disturbance and physical function measures were not associated with longitudinal trajectories of LUTS. CONCLUSIONS: Urinary symptom subdomains are independently associated with modifiable clinical variables including sleep quality and depression at all time points, but these variables do not predict the degree of improvement in LUTS following urological evaluation and treatment over the medium term. Bidirectional assessment and randomized experiments may improve our understanding of these relationships.

Can Biological Control Overcome the Threat From Newly Invasive Coconut Rhinoceros Beetle Populations (Coleoptera: Scarabaeidae)? A Review.

The coconut rhinoceros beetle (CRB: Oryctes rhinoceros Linnaeus) is one of the most damaging pests to coconut and oil palms in Asia and the Pacific Islands. Adults bore into the crown and damage developing fronds, which affects tree development and yield. The insect is native to South and Southeast Asia and was inadvertently introduced into the Pacific in 1909. It has since spread to several Pacific island nations and territories, causing significant economic impact on these important coconut and palm-growing regions. In the 1950s and 1960s, an international biological control effort was initiated to search for and release natural enemy species. Release of the Oryctes rhinoceros nudivirus Huger (OrNV) and the species complex of Metarhizium Sorokin (Hypocreales: Clavicipitaceae) was successful in controlling CRB in its invaded range. Recently a new biotype of the beetle, known as CRB-G, has spread into the Pacific Islands causing unprecedented levels of damage due to the failure of previously successful biological control agents (BCAs) to suppress this biotype. The re-emergence of CRB as a serious pest warrants a rigorous re-evaluation of potential BCAs and a new search for effective natural enemies if necessary. In this article, we review literature on CRB to 1) analyze past introductions of BCAs and their effectiveness; 2) identify potentially important natural enemies and their geographical origins; and 3) assess possible approaches for utilization of BCAs against the new wave of CRB invasion. Research gaps and directions deserving future attention are highlighted and a strategy for renovation of biological controls for CRB suggested.

Patient demographic and psychosocial characteristics associated with 30-day recall of self-reported lower urinary tract symptoms.

AIMS: Measurement of self-reported lower urinary tract symptoms (LUTS) typically uses a recall period, for example, "In the past 30 days…." Compared to averaged daily reports, 30-day recall is generally unbiased, but recall bias varies by item. We examined the associations between personal characteristics (eg, age, symptom bother) and 30-day recall of LUTS using items from the Symptoms of Lower Urinary Tract Dysfunction Research Network Comprehensive Assessment of Self-reported Urinary Symptoms questionnaire. METHODS: Participants (127 women and 127 men) were recruited from 6 US tertiary care sites. They completed daily assessments for 30 days and a 30-day recall assessment at the end of the study month. For each of the 18 tested items, representing 10 LUTS, the average of the participant's daily responses was modeled as a function of their 30-day recall, the personal characteristic, and the interaction between the 30-day recall and the characteristic in separate general linear regression models, adjusted for sex. RESULTS: Nine items representing 7 LUTS exhibited under- or overreporting (recall bias) for at least 25% of participants. Bias was associated with personal characteristics for six LUTS. Underreporting of incontinence was associated with older age, lower anxiety, and negative affect; overreporting of other LUTS was associated with, symptom bother, symptom variability, anxiety, and depression. CONCLUSIONS: We identified under- or overreporting that was associated with personal characteristics for six common LUTS. Some cues (eg, less bother and lower anxiety) were related to recall bias in an unexpected direction. Thus, providers should exercise caution when making judgments about the accuracy of a patient's symptom recall based on patient demographic and psychosocial characteristics.

Host Range Expansion of an Endemic Insect Herbivore is Associated With High Nitrogen and Low Fibre Content in Exotic Pasture Plants.

Endemic moth species of the genus Wiseana spp. (Hepialidae) have become serious pests of introduced pasture plants in New Zealand. The original native host plants of these moths have not been confirmed. This study investigated the performance (survival, development time, weight gain) of three Wiseana species on seven putative host plants: five native and two exotic species. The aim was to identify native hosts for the three Wiseana species and to compare their performance on native plants and exotic pasture plants. The chemical composition of the seven putative host plants was investigated to compare native and exotic plant chemistries, and to test for associations between plant characteristics and performance of selected Wiseana species. Carbon, nitrogen, silica and fibre contents were measured for each plant species; primary metabolite composition was determined by gas chromatography-mass spectrometry. For the three moth species, increased survival and weight gain were significantly associated with high nitrogen and low fibre contents in one exotic host plant, white clover (Trifolium repens), although one species, W. umbraculata, did not complete development to adult on any of the plants tested, including clover. Two exotic plants (T. repens, Lolium perenne × Lolium multiflorum), and two native plants (Aciphylla squarrosa and Festuca actae) supported W. copularis development to the adult stage, but only one exotic (T. repens) and one native (F. actae) species supported complete development of W. cervinata. Exotic and native plant species had distinct metabolite profiles, but there was no significant association between metabolite composition and Wiseana performance. We conclude that W. copularis and W. cervinata, but not W. umbraculata, have expanded their host range, because of their ability to use both native and new hosts. No evidence was found for a host shift, i.e., a loss of performance on the ancestral host compared with the new host.

A risk-based detection survey for the predatory mirid Macrolophus pygmaeus in New Zealand.

Macrolophus pygmaeus, a predatory mirid used to manage greenhouse whitefly, was illegally imported into New Zealand, and for a time was reared and sold to commercial tomato growers. We designed and implemented a risk-based detection survey to determine whether M. pygmaeus was still present in New Zealand a decade later. The survey was designed to have an 80% chance of detecting a single low density (0.05 per lineal metre of host plants) population within 1 km of known points of introduction. The survey was implemented between 8 and 15 March 2018. Local habitat constraints meant that the planned sampling had to be modified but this was accounted for in the subsequent analysis. No M. pygmaeus were found in the samples, but 93 specimens from seven other mirid taxa were detected, validating the sample methods. The survey gives 60% confidence that M. pygmaeus was not present at a mean density of 0.05 per lineal metre of habitat. It gives 80% confidence that a population at 0.1 m-1 was not present and 90% confidence that no population exists at >0.18 m-1. Though there are no published data on typical field population densities of M. pygmaeus, for related species the survey would have had high confidence in detecting any medium to high density population present. Therefore, it is likely that M. pygmaeus is no longer present in New Zealand, but if extant within the sampled areas then we have high certainty that it was at low densities compared to other predaceous mirids.

Can 7 or 30-Day Recall Questions Capture Self-Reported Lower Urinary Tract Symptoms Accurately?

PURPOSE: Self-reported measurement tools often provide a recall period, eg "In the past 7 days…" For lower urinary tract symptoms the concordance of end of day (daily) reports with 7 and 30-day recalled reports is unknown to our knowledge. We evaluated how accurately 7 or 30-day recall questions capture lower urinary tract symptoms. MATERIALS AND METHODS: The 261 female and 254 male participants were recruited from a total of 6 United States tertiary care sites. We evaluated 18 items representing 7 symptoms covering storage, voiding and post-micturition symptoms. Item responses on the daily forms were averaged for a 7 or a 30-day period and compared to the corresponding 7 or 30-day recall version of the item. Analyses were item and gender specific. Within person concordance was assessed using the Pearson correlation. Bias (systematic overreporting or underreporting) was calculated as the difference between the recalled item and the averaged daily item score, and reported as a percent of the item scale. RESULTS: All correlations exceeded 0.60. Correlations between averaged daily reports and recalled reports ranged from 0.72 to 0.89 for 7 days and from 0.71 to 0.91 for 30 days among women, and from 0.68 to 0.90 and 0.68 to 0.95, respectively, among men. Most items did not show systematic bias and the median percent bias did not exceed 10% for any item. However, bias exceeding ±10% for some items was observed in a subset of individuals. CONCLUSIONS: Recalled reports during the 7 and 30 days tracked well with averaged daily reports for men and women. Systematic bias was minimal, suggesting that 7 and 30-day recall periods for self-reported lower urinary tract symptoms are reasonable.

Using All Longitudinal Data to Define Time to Specified Percentages of Estimated GFR Decline: A Simulation Study.

RATIONALE & OBJECTIVE: The standard method to calculate time to the event of a specified percentage decline in estimated glomerular filtration rate (eGFR) uses 2 eGFR assessments, 1 at baseline and 1 at the event time. However, event times may be inaccurate due to eGFR variability and restriction of events to study visit times. We propose a novel method for calculating time to a specified percentage decline in eGFR that uses all available longitudinal eGFR assessments. STUDY DESIGN: Simulation study and comparison of methods in 2 observational cohorts. SETTINGS & PARTICIPANTS: Simulation data and study participants in the Nephrotic Syndrome Study Network (NEPTUNE) and Clinical Phenotyping and Resource Biobank Core (C-PROBE). EXPOSURE: Analytical method for calculating time to a specified percentage decline in eGFR: standard 2-point method versus a regression method incorporating all available longitudinally assessed eGFR assessments. OUTCOME: Time to percentage decline in eGFR. ANALYTIC APPROACH: A 2-point method used only the baseline eGFR and first eGFR below the decline threshold. The comparison method used ordinary linear regression incorporating all longitudinal eGFR assessments to define the baseline measure and 40% decline threshold. Time to a 40% decline in eGFR was defined as the time when the regression line crossed the decline threshold. The 2 outcome calculation methods were compared using simulations to assess the accuracy of estimated event times and power to detect event time differences between groups. Comparison of event times calculated using each method was also implemented using data from NEPTUNE and C-PROBE. RESULTS: The regression method incorporating all eGFR assessments was more accurate than the 2-point method in estimating event times in simulation analyses, particularly when eGFR variability was high, there was a greater correlation among successive eGFR values, or there were more missing data. This method was also more powerful in detecting differences between groups. Using NEPTUNE and C-PROBE data, the standard method estimated a more rapid rate of events, some likely representing transient reductions in kidney function, and was less likely to give accurate estimates in the presence of nonlinear eGFR trajectories. LIMITATIONS: Computations required for our proposed method currently limit its use to research rather than clinical applications. CONCLUSIONS: A regression method using all longitudinal eGFR values to estimate time to a percentage decline in eGFR increases accuracy and power over traditional methods, representing a potential improvement in the ability to discover treatment or biomarker effects on kidney disease progression.

Acute Rejection Increases Risk of Graft Failure and Death in Recent Liver Transplant Recipients.

BACKGROUND & AIMS: Acute rejection is detrimental to most transplanted solid organs, but is considered to be less of a consequence for transplanted livers. We evaluated risk factors for and outcomes after biopsy-proven acute rejection (BPAR) based on an analysis of a more recent national sample of recipients of liver transplants from living and deceased donors. METHODS: We analyzed data from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) from 2003 through 2014 as the exploratory cohort and the Scientific Registry of Transplant Recipients (SRTR) from 2005 through 2013 as the validation cohort. We examined factors associated with time to first BPAR using multivariable Cox regression or discrete-survival analysis. Competing risks methods were used to compare causes of death and graft failure between recipients of living and deceased donors. RESULTS: At least 1 BPAR episode occurred in 239 of 890 recipients in A2ALL (26.9%) and 7066 of 45,423 recipients in SRTR (15.6%). In each database, risk of rejection was significantly lower when livers came from biologically related living donors (A2ALL hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.43-0.76; and SRTR HR, 0.78; 95% CI, 0.66-0.91) and higher in liver transplant recipients with primary biliary cirrhosis, of younger age, or with hepatitis C. In each database, BPAR was associated with significantly higher risks of graft failure and death. The risks were highest in the 12 month post-BPAR period in patients whose first episode occurred more than 1 year after liver transplantation: HRs for graft failure were 6.79 in A2ALL (95% CI, 2.64-17.45) and 4.41 in SRTR (95% CI, 3.71-5.23); HRs for death were 8.81 in A2ALL (95% CI, 3.37-23.04) and 3.94 in SRTR (95% CI, 3.22-4.83). In analyses of cause-specific mortality, associations were observed for liver-related (graft failure) causes of death but not for other causes. CONCLUSIONS: Contrary to previous data, acute rejection after liver transplant is associated with significantly increased risk of graft failure, all-cause mortality, and graft failure-related death, regardless of primary liver disease etiology. Living donor liver transplantation from a biologically related donor is associated with decreased risk of rejection.

On the right path? Exploring the experiences and opinions of clinicians involved in developing and implementing HealthPathways Barwon.

The aims of this paper are to present the findings of a process evaluation exploring the experiences and opinions of clinicians who have been involved in the HealthPathways Barwon clinical workgroups and discuss implications for further development of the program, as well as regional health service initiatives more broadly. HealthPathways Barwon is a web-based program comprising locally agreed-upon evidence-based clinical pathways that assist with assessment, management and region-specific referral for various clinical conditions. Clinical workgroup members participated in focus groups. Coding and thematic analysis were performed and findings were compared with similar evaluations of HealthPathways in other jurisdictions. Five broad themes emerged from the focus group, each with several subthemes: (1) purpose of HealthPathways; (2) workgroup process; (3) barriers and facilitators to HealthPathways use; (4) impact of HealthPathways on clinical practice; and (5) measuring performance. Findings of particular interest were that the perceived drivers for implementation of HealthPathways Barwon are broad, HealthPathways Barwon is viewed positively by clinicians, the workgroup process itself has a positive impact on relationships between primary and secondary care clinicians, existing habits of clinicians are a major barrier to adoption of HealthPathways Barwon, the sustainability of HealthPathways Barwon is a concern and it is difficult to measure the outcomes of HealthPathways. Although HealthPathways Barwon is viewed positively by clinicians and is seen to have the potential to address many issues at the primary-secondary care interface, successful implementation and uptake will depend on buy-in from clinicians, as well as continuous evaluation to inform improved development and implementation. More broadly, health service initiatives like HealthPathways Barwon require longer-term certainty of funding and administration to become established and produce meaningful outcomes.

Generic drug prices and policy in Australia: room for improvement? a comparative analysis with England.

OBJECTIVE: To assess the degree to which reimbursement prices in Australia and England differ for a range of generic drugs, and to analyse the supply- and demand-side factors that may contribute to these differences. METHODS: Australian and English reimbursement prices were compared for a range of generic drugs using pricing information obtained from government websites. Next, a literature review was conducted to identify supply- and demand-side factors that could affect generic prices in Australia and England. Various search topics were identified addressing potential supply-side (e.g. market approval, intellectual property protection of patented drugs, generic pricing policy, market size, generic supply chain and discounting practices) and demand-side (consumers, prescribers and pharmacists) factors. Related terms were searched in academic databases, official government websites, national statistical databases and internet search engines. RESULTS: Analysis of drug reimbursement prices for 15 generic molecules (representing 45 different drug presentations) demonstrated that Australian prices were on average over 7-fold higher than in England. Significant supply-side differences included aspects of pricing policy, the relative size of the generics markets and the use of clawback policies. Major differences in demand-side policies related to generic prescribing, pharmacist substitution and consumer incentives. CONCLUSIONS: Despite recent reforms, the Australian Government continues to pay higher prices than its English counterpart for many generic medications. The results suggest that particular policy areas may benefit from review in Australia, including the length of the price-setting process, the frequency of subsequent price adjustments, the extent of price competition between originators and generics, medical professionals' knowledge about generic medicines and incentives for generic prescribing. WHAT IS KNOWN ABOUT THE TOPIC? Prices of generic drugs have been the subject of much scrutiny over recent years. From 2005 to 2010 the Australian Government responded to observations that Pharmaceutical Benefits Scheme prices for many generics were higher than in numerous comparable countries by instituting several reforms aimed at reducing the prices of generics. Despite this, several studies have demonstrated that prices for generic statins (one class of cholesterol-lowering drug) are higher in Australia compared with England and many other developed countries, and prices of numerous other generics remain higher than in the USA and New Zealand. Recently there has been increasing interest in why these differences exist. WHAT DOES THIS PAPER ADD? By including a much larger range of commonly used and costly generic drugs, this paper builds significantly on the limited previous investigations of generic drug prices in Australia and England. Additionally, this is the first comprehensive investigation of multiple supply- and, in particular, demand-side factors that may explain any price differences between these countries. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Practitioners may contribute to the higher prices of generic medications in Australia compared with England through relatively low rates of generic prescribing. There are also significant implications for health policy makers, as this paper demonstrates that if Australia achieved the same prices as England for many generic drugs there could be substantial savings for the Pharmaceutical Benefits Scheme.

Characterization and screening of new Metarhizium isolates to control the coconut rhinoceros beetle in the Pacific islands.

The coconut rhinoceros beetle (CRB; Oryctes rhinoceros) is one of the most destructive insect pests of coconut and oil palms in tropical Asia and the Pacific islands. Members of a new variant, known as CRB-G (clade I), have recently spread into the Pacific islands, causing significant damage. Biopesticides containing Metarhizium spp. are the strongest candidates for inundative biological control against the emerging CRB threat. Selection of the most virulent and robust isolate may determine the impact of this control option on the pest. In this work, CRB specimens with natural fungal infection were collected in Papua New Guinea (PNG) and Solomon Islands (SI). Putative entomopathogenic fungi were isolated and identified. These new isolates and some previously obtained from other Pacific countries were molecularly identified, characterized, and tested for virulence against CRB larval populations in PNG and SI in laboratory bioassays. Of the new isolates collected, four obtained from SI were identified as Metarhizium majus (conidia length ⁓11-15 µm), and four from PNG were identified as Metarhizium pingshaense (conidia length ⁓4-6 µm). The most virulent isolate was M. majus AgR-F717, which caused 100 % mortality in 20-23 days against a CRB variant from the CRB-S grouping (clade II) in laboratory bioassays carried out in PNG. Isolates of M. pingshaense did not show pathogenicity against CRB larvae. M. majus AgR-F717 was also the most virulent in laboratory bioassays using the mixed SI population (from both CRB-S and CRB-G groupings) and was selected for further evaluation using artificial breeding sites. Under field conditions, this isolate demonstrated its ability to infect CRB, dispersal up to 100 m from treated artificial breeding sites, and persistence in soil for at least four months. The new isolate AgR-F717 of M. majus has demonstrated potential as an augmentative biological control agent for CRB in PNG and SI.

Relationships Between Urinary and Nonurinary Symptoms in Treatment-Seeking Women in LURN.

IMPORTANCE: Physical health and psychological health represent modifiable factors in the causal pathway of lower urinary tract symptoms (LUTS). OBJECTIVES: Understand the relationship between physical and psychological factors and LUTS over time. STUDY DESIGN: Adult women enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network observational cohort study completed the LUTS Tool and Pelvic Floor Distress Inventory, including urinary (Urinary Distress Inventory), prolapse (Pelvic Organ Prolapse Distress Inventory), and colorectal anal (Colorectal-Anal Distress Inventory) subscales at baseline, 3 months, and 12 months. Physical functioning, depression, and sleep disturbance were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires; relationships were assessed using multivariable linear mixed models. RESULTS: Of 545 women enrolled, 472 had follow-up. Median age was 57 years; 61% and 78% reported stress urinary incontinence and overactive bladder, respectively; and 81% reported obstructive symptoms. The PROMIS depression scores were positively associated with all urinary outcomes (range, 2.5- to 4.8-unit increase per 10-unit increase in depression score; P < 0.01 for all). Higher sleep disturbance scores were associated with higher urgency, obstruction, LUTS Total Severity, Urinary Distress Inventory, and Pelvic Floor Distress Inventory (1.9- to 3.4-point increase per 10-unit increase, all P < 0.02). Better physical functioning was associated with less severe urinary symptoms except stress urinary incontinence (2.3- to 5.2-point decrease per 10-unit increase, all P < 0.01). All symptoms decreased over time; however, no association was detected between baseline PROMIS scores and trajectories of LUTS over time. CONCLUSIONS: Nonurologic factors demonstrated small to medium cross-sectional associations with urinary symptom domains, but no significant association was detected with changes in LUTS. Further work is needed to determine whether interventions targeting nonurologic factors reduce LUTS in women.

Carbohydrate diet and reproductive performance of a fruit fly parasitoid, Diachasmimorpha tryoni.

Augmentative releases of parasitoid wasps are often used successfully for biological control of fruit flies in programs worldwide. The development of cheaper and more effective augmentative releases of the parasitoid wasp Diachasmimorpha tryoni (Cameron) (Hymenoptera: Braconidae) may allow its use to be expanded to cover Queensland fruit fly, Bactrocera tryoni (Froggatt) (Diptera: Tephritidae), a serious pest of many vegetables and most fruit production in Australia. This demands a fuller understanding of the parasitoid's reproductive biology. In this study, mating status, fecundity, and size of female D. tryoni were determined under laboratory conditions. A range of pre-release diets, 10% concentrations of honey, white sugar, and golden syrup, were also assessed in the laboratory. Mature egg loads and progeny yields of mated and unmated parasitoid females were statistically similar, demonstrating that mating status was not a determinant of parasitoid performance. Female lifespan was not negatively impacted by the act of oviposition, though larger females carried more eggs than smaller individuals, indicating a need to produce large females in mass-rearing facilities to maintain this trait. White sugar gave the highest adult female lifespan, while honey and golden syrup shared similar survivorship curves, all significantly greater compared with water control females. Pre-release feeding of D. tryoni, particularly with white sugar, may enhance the impact of released parasitoids on B. tryoni. These findings are important because honey is currently the standard diet for mass-reared braconids, but white sugar is less than one-third the cost of other foods; however further work is required to assess postrelease performance of the parasitoid.

Mentalizing in first-episode psychosis: Correlates with symptomatology and traits of borderline personality disorder.

AIM: To explore the associations between mentalizing, positive and negative symptoms of psychosis, and traits of borderline personality disorder, in a sample of patients with first-episode psychosis, and in a non-clinical sample. METHODS: A quantitative cross-sectional design was employed. Thirty-two adults with first-episode psychosis and 148 non-clinical participants were assessed using the reflective functioning questionnaire. The questionnaire measures two dimensions of mentalizing, certainty and uncertainty about mental states. Traits of borderline personality disorder and symptoms of psychosis were measured using the self-report version of the Zanarini rating scale, the Community Assessment of Psychotic Experiences, and the Green et al., paranoid thought scale. RESULTS: Patients with first-episode psychosis reported increased mentalizing impairments, characterized as hypomentalizing tendencies, compared to the non-clinical group. Regression analysis showed significant associations between higher scores on the uncertainty about mental states scale and negative symptoms of psychosis in both groups. No associations were found between mentalizing impairments and traits of borderline personality disorder in the clinical sample, although associations were found in the non-clinical sample. CONCLUSIONS: The present findings suggests that impairments in mentalizing may be associated with negative symptoms of psychosis across both clinical and non-clinical samples. Mentalizing impairments was found to be associated with traits of borderline personality disorder, but this finding was only confirmed in the non-clinical sample. Mentalizing should therefore be considered in the early assessment and treatment of patients experiencing difficulties with negative symptoms of psychosis.

Immunosuppression Exposure and Risk of Infection-Related Acute Care Events in Patients With Glomerular Disease: An Observational Cohort Study.

Rationale & Objective: Infections cause morbidity and mortality in patients with glomerular disease. The relative contributions from immunosuppression exposure and glomerular disease activity to infection risk are not well characterized. To address this unmet need, we characterized the relationship between time-varying combinations of immunosuppressant exposure and infection-related acute care events while controlling for disease activity, among individuals with glomerular disease. Study Design: Prospective, multicenter, observational cohort study. Setting & Participants: Adults and children with biopsy-proven minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or immunoglobulin A nephropathy/vasculitis were enrolled at 71 clinical sites in North America and Europe. A total of 2,388 Cure Glomerulonephropathy Network participants (36% aged <18 years) had at least 1 follow-up visit and were included in the analysis. Exposures: Immunosuppression exposure modeled on a weekly basis. Outcome: Infections leading to an emergency department visit or hospitalization. Analytical Approach: Marginal structural models were used to estimate the effect of time-varying immunosuppression exposure on hazard of first infection-related acute care event while accounting for baseline sociodemographic and clinical factors, and time-varying disease activity. Results: A total of 2,388 participants were followed for a median of 3.2 years (interquartile range, 1.6-4.6), and 15% experienced at least 1 infection-related emergency department visit or hospitalization. Compared to no immunosuppression exposure, steroid exposure, steroid with any other immunosuppressant, and nonsteroid immunosuppressant exposure were associated with a 2.65-fold (95% CI, 1.83-3.86), 2.68-fold (95% CI, 1.95-3.68), and 1.7-fold (95% CI, 1.29-2.24) higher risk of first infection, respectively. Limitations: Absence of medication dosing data, lack of a control group, and potential bias in ascertainment of outcome events secondary to the coronavirus 2 pandemic. Conclusions: Corticosteroids with or without concomitant additional immunosuppression significantly increased risk of infection leading to acute care utilization in adults and children with glomerular disease.

Effect of digital psychoeducation and peer support on the mental health of family carers supporting individuals with psychosis in England (COPe-support): a randomised clinical trial.

BACKGROUND: Psychoeducation delivered face-to-face is effective in alleviating mental health morbidities in family carers of individuals with psychosis. However, research in such interventions delivered online is scarce. We evaluated the effectiveness of a digital multicomponent intervention-COPe-support-in improving carers' mental wellbeing and caregiving-related outcomes. METHODS: In this two-arm, individually randomised, superiority trial, people aged 18 years or older who provided at least weekly support in any format for a relative or close friend affected by psychosis across England were randomly assigned (1:1) to either COPe-support or a passive online information resource using an independent online system. Participants were recruited through 30 mental health UK National Health Service trusts. The study team were masked to allocation and assessment of outcomes as all data collection took place online. Participants had access to either condition for 40 weeks and were advised to spend at least half an hour per week over the initial 20 weeks to go through materials at their own pace and to allow time to integrate knowledge and skills learned into practice. It was not feasible to mask participants or the online facilitator to intervention allocation. COPe-support provided psychoeducation on psychosis-related caregiving strategies and forums with professionals and other carers, and the control intervention comprised a passive online information resource. The primary outcome at 20 weeks was mental wellbeing measured by the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS; minimally clinically important difference [MCID] 3). This trial is registered with ISRCTN, 89563420. FINDINGS: Between March 1, 2018, and Feb 14, 2020, 407 participants were randomly assigned, with 204 allocated to COPe-support and 203 allocated to control. The participants (mean age 53·1 years, SD 13·2) were mostly female (330 [81%] of 407 participants) and White (359 [88%] of 407 participants). 346 (85%) of 407 participants provided primary endpoint data, 174 (85%) of 204 participants in the COPe-support group and 172 (85%) of 203 participants in the control group. The mean WEMWBS score at 20 weeks was 44·5 (SD 8·31) for the COPe-support group and 43·3 (9·19) for the control group. We found no evidence of a difference in wellbeing between the two groups (adjusted mean difference 0·37, 95% CI -1·14 to 1·88; p=0·63). In the COPe-support group, 106 (52%) of 204 participants met the complier definition of a minimum of two logins in separate weeks. The complier average causal effect analysis increased the difference in WEMWBS scores (adjusted difference 0·83, 95% CI -1·45 to 3·11; p=0·47), but this was lower than the MCID. There were no adverse events. INTERPRETATION: Our findings did not support the use of COPe-support over a passive online information resource. However, further research to optimise digital interventions adjunctive to face-to-face support for carers remains important. FUNDING: National Institute for Health Research.

Social media and the medical profession.

Use of social media by doctors and medical students is common and growing. Although professional standards and codes of ethics that govern the behaviour of medical practitioners in Australia and New Zealand do not currently encompass social media, these codes need to evolve, because professional standards continue to apply in this setting. Inappropriate use of social media can result in harm to patients and the profession, including breaches of confidentiality, defamation of colleagues or employers, and violation of doctor-patient boundaries. The professional integrity of doctors and medical students can also be damaged through problematic interprofessional online relationships, and unintended exposure of personal information to the public, employers or universities. Doctors need to exercise extreme care in their use of social media to ensure they maintain professional standards.

Potential for a biopesticide bait to control black beetle, Heteronychus arator (Coleoptera: Scarabaeidae).

BACKGROUND: Yersinia entomophaga is an entomopathogenic bacterium that is active against scarab beetles, among other insects. In New Zealand, the African black beetle, Heteronychus arator (Coleoptera: Scarabaeidae), is a major pest of pastures and arable crops but very few control options exist and no insecticides are registered for use in established pastures. RESULTS: In laboratory bioassays, H. arator adults were susceptible to a bait containing Y. entomophaga at low doses. This bait was more effective against H. arator adults during spring than autumn in small-scale field plots (320 mm diameter). A large-scale field trial (40 × 40 m plots) reduced adult numbers substantially: approximately twice as many beetles were captured in pitfall traps from untreated plots compared with plots treated with the Y. entomophaga bait at 70 kg ha-1 . This single bait application in spring also reduced subsequent larval populations in summer. CONCLUSIONS: Heteronychus arator is a difficult pest to manage using chemical insecticides. This biopesticide with Y. entomophaga as the active ingredient offers a new solution for New Zealand pastures, with potential for application to other crops affected by H. arator and for control of other pests. © 2020 Society of Chemical Industry.

Effect of compost and casing treatments of insecticides against the sciarid Bradysia ocellaris (Diptera: Sciaridae) and on the total yield of cultivated mushrooms, Agaricus bisporus.

BACKGROUND: Bradysia ocellaris (Comstock) is one of the major pests of cultivated mushrooms, Agaricus bisporus (Lange) Imbach. The feeding of sciarid fly larvae causes damage to the cultivation substrates, compost and casing. A comparative study of insecticidal treatments incorporated into compost and casing against B. ocellaris was conducted during 2003-2004. Treatments with an organophosphate, diazinon, a pyrazole, fipronil, and an insect growth regulator (IGR), triflumuron, were incorporated into casing. Another IGR, cyromazine, was incorporated into compost. Insecticidal incorporation into compost and casing has been associated with reductions in mushroom yield. Therefore, the effect of these insecticidal treatments on the overall yield was evaluated. RESULTS: A combined treatment, incorporation of cyromazine at 10 mg kg(-1) into compost and of triflumuron at 20 mg kg(-1) into casing, provided 100% control against B. ocellaris. There was no apparent reduction in yield as a result of incorporation of the tested chemicals into either compost or casing. CONCLUSION: The results obtained from this study suggest that incorporation of insecticides into both compost and casing is required to control a moderate to high pressure of insect pests. There were no significant yield reductions as a result of the incorporation of pesticides in the Australian mushroom-growing system.