MTHFR C677T and A1298C polymorphism's effect on risk of colorectal cancer in Lynch syndrome.

Lynch syndrome (LS) is characterised by an increased risk of developing colorectal cancer (CRC) and other extracolonic epithelial cancers. It is caused by pathogenic germline variants in DNA mismatch repair (MMR) genes or the EPCAM gene, leading to a less functional DNA MMR system. Individuals diagnosed with LS (LS individuals) have a 10-80% lifetime risk of developing cancer. However, there is considerable variability in the age of cancer onset, which cannot be attributed to the specific MMR gene or variant alone. It is speculated that multiple genetic and environmental factors contribute to this variability, including two single nucleotide polymorphisms (SNPs) in the methylenetetrahydrofolate reductase (MTHFR) gene: C677T (rs1801133) and A1298C (rs1801131). By decreasing MTHFR activity, these SNPs theoretically reduce the silencing of DNA repair genes and increase the availability of nucleotides for DNA synthesis and repair, thereby protecting against early-onset cancer in LS. We investigated the effect of these SNPs on LS disease expression in 2,723 LS individuals from Australia, Poland, Germany, Norway and Spain. The association between age at cancer onset and SNP genotype (risk of cancer) was estimated using Cox regression adjusted for gender, country and affected MMR gene. For A1298C (rs1801131), both the AC and CC genotypes were significantly associated with a reduced risk of developing CRC compared to the AA genotype, but no association was seen for C677T (rs1801133). However, an aggregated effect of protective alleles was seen when combining the alleles from the two SNPs, especially for LS individuals carrying 1 and 2 alleles. For individuals with germline pathogenic variants in MLH1, the CC genotype of A1298C was estimated to reduce the risk of CRC significantly by 39% (HR = 0.61, 95% CI 0.42, 0.89, p = 0.011), while for individuals with pathogenic germline MSH2 variants, the AC genotype (compared to AA) was estimated to reduce the risk of CRC by 26% (HR = 0.66, 95% CI 0.53, 0.83, p = 0.01). In comparison, no association was observed for C677T (rs1801133). In conclusion, our study suggests that combining the MMR gene information with the MTHFR genotype, including the aggregated effect of protective alleles, could be useful in developing an algorithm that estimates the risk of CRC in LS individuals.

The health and wellbeing of Australian social housing tenants compared to people living in other types of housing.

BACKGROUND: Although social housing provides access to safe and affordable housing, recent studies have found that social housing tenants consistently have lower levels of health and well-being compared to other people. Given this, there is a need to examine multimorbidity for social housing tenants. METHODS: Secondary data analysis of the 2017-18 Australian National Health Survey (n = 14,327) compared the health of adults residing in social housing compared to people in other housing types (private rentals, homeowners, and homeowners/mortgagees). RESULTS: Most health factors examined were more prevalent in social housing tenants compared to those living in other housing types. Individual health problems identified as more highly prevalent in social housing tenants compared to all other housing types included mental health issues (43%), arthritis (36%), back problems (32%), hypertension (25%), asthma (22%) and COPD (11%). 24% of social housing tenants reported five or more health factors compared to 3-6% of people in other housing types. CONCLUSIONS: Although these findings are not unexpected, they provide more detailed evidence that social housing providers and policy makers should consider when planning future initiatives.

How Does the Health Literacy of Adults Residing in Social Housing Compare with That of Those Living in Other Housing Tenures in Australia? A Secondary Analysis of the Australian National Health Survey 2017-2018 Dataset.

BACKGROUND: Social housing tenants have poorer health outcomes than homeowners or those renting privately. Health literacy is associated with access to care and health outcomes. This study aimed to examine the health literacy of Australian adults residing in social housing compared with that of people living in other housing types. METHODS: A secondary analysis of the Australian National Health Survey 2017-2018 dataset was undertaken. A total of 5275 respondents were included in the sample and completed the Health Literacy Questionnaire (HLQ). Respondents were categorised according to their housing tenure: 163 (3.1%) respondents were living in social housing, 873 (17%) were living in private rentals, 2085 (40%) were homeowners, and 2154 (41%) were homeowners/mortgages. Mean scores were calculated for each of the nine health literacy domains in the HLQ and compared across housing tenure using linear regression models. RESULTS: Social housing tenants had lower mean domain scores than either homeowners, owner mortgagees, or private renters on six of the nine health literacy domains. This included 'having sufficient information to manage my health', 'social support for health', 'ability to engage with healthcare providers', 'navigating the healthcare system' 'ability to find good health information', and being able to 'understand health information enough to know what to do'. However, the differences in mean scores were small. CONCLUSIONS: Increasing health literacy may be an important part of multicomponent interventions seeking to improve the health and wellbeing of social housing tenants.

The Impact of Podiatric Intervention on the Quality of Life and Pain in Children and Adolescents with Hypermobility.

The purpose of this study was to evaluate the effect of custom-made orthotics on pain, health-related quality of life (HRQoL), function and fatigue in children and adolescents with generalised joint hypermobility (GJH) and lower limb pain. Fifty-three children aged 5-18 years were fitted with custom-made polypropylene orthotics. Visual analogue scale (VAS) assessed lower limb pain severity, Paediatric Quality of Life Inventory assessed HRQoL and fatigue and six-minute walk test (6 MWT) measured functional endurance at baseline, at 1 month and 3 months post-intervention. A mixed model including a random intercept for participant and a fixed effect for time was used to assess differences in outcomes over time. Fifty-two children completed the study (mean age 10.6-years). Children reported significantly reduced pain (mean VAS reduction -27/100, 95%CI: -33, -21), improved HRQoL (mean total improvement 11/100, 95%CI: 7, -15), functional capacity (mean 6MWT improvement 27 m, 95%CI: 18, -36) and fatigue (mean total improvement 13/100, 95%CI: 9, -17) after 1 month of wearing the custom-made orthotics. From 1 month to 3 months there was further statistically but not clinically significant reduction in pain while benefit on other outcomes was maintained. In this study, children with GJH reported reduced lower limb pain, improved HRQoL, functional endurance and fatigue after a month post-fitting of custom-made orthotics which was maintained over a 3 month period. Orthotics were well-tolerated with no serious adverse events reported.

How predictable are mass extinction events?

Many modern extinction drivers are shared with past mass extinction events, such as rapid climate warming, habitat loss, pollution and invasive species. This commonality presents a key question: can the extinction risk of species during past mass extinction events inform our predictions for a modern biodiversity crisis? To investigate if it is possible to establish which species were more likely to go extinct during mass extinctions, we applied a functional trait-based model of extinction risk using a machine learning algorithm to datasets of marine fossils for the end-Permian, end-Triassic and end-Cretaceous mass extinctions. Extinction selectivity was inferred across each individual mass extinction event, before testing whether the selectivity patterns obtained could be used to 'predict' the extinction selectivity exhibited during the other mass extinctions. Our analyses show that, despite some similarities in extinction selectivity patterns between ancient crises, the selectivity of mass extinction events is inconsistent, which leads to a poor predictive performance. This lack of predictability is attributed to evolution in marine ecosystems, particularly during the Mesozoic Marine Revolution, associated with shifts in community structure alongside coincident Earth system changes. Our results suggest that past extinctions are unlikely to be informative for predicting extinction risk during a projected mass extinction.

Creating respectful workplaces for nurses in regional acute care settings: A quasi-experimental design.

AIM: To examine self-reported exposure and experiences of negative workplace behaviour and ways of coping of nursing staff before and after educational workshops. DESIGN: A Quasi-experimental design. METHOD/SETTING/PARTICIPANTS: Data were collected pre- /postworkshops using a structured questionnaire. Nurses (N = 230) from 12 units in four regional acute care hospitals were invited to complete a pre-intervention survey. Educational workshops were then implemented by the organization at two of the hospitals, after which, follow-up surveys were undertaken. RESULTS: There were 74 responses in the pre-intervention and 56 responses in the postintervention time period. There were 111 participants who attended the educational intervention, 20% (n = 22) completed the follow-up survey. Participants were more likely exposed to work-related bullying acts and they used problem-focused coping strategies and sought social support as a way of coping when exposed to the negative behaviours. Overall, there was a decrease in both bullying and incivility experienced by participants; however, our findings were unable to establish that a statistically significant difference was made due to the implementation of the intervention. STUDY REGISTRATION: Australian New Zealand Clinical Trials Registry (Registration No. ACTRN12618002007213; December 14, 2018).

Validation of an Electronic Visual Analog Scale App for Pain Evaluation in Children and Adolescents With Symptomatic Hypermobility: Cross-sectional Study.

BACKGROUND: Rapid advances in mobile apps for clinical data collection for pain evaluation have resulted in more efficient data handling and analysis than traditional paper-based approaches. As paper-based visual analogue scale (p-VAS) scores are commonly used to assess pain levels, new emerging apps need to be validated prior to clinical application with symptomatic children and adolescents. OBJECTIVE: This study aimed to assess the validity and reliability of an electronic visual analogue scale (e-VAS) method via a mobile health (mHealth) App in children and adolescents diagnosed with hypermobility spectrum disorder/hypermobile Ehlers-Danlos syndrome (HSD/HEDS) in comparison with the traditional p-VAS. METHODS: Children diagnosed with HSD/HEDS aged 5-18 years were recruited from a sports medicine center in Sydney (New South Wales, Australia). Consenting participants assigned in random order to the e-VAS and p-VAS platforms were asked to indicate their current lower limb pain level and completed pain assessment e-VAS or p-VAS at one time point. Instrument agreement between the 2 methods was determined from the intraclass correlation coefficient (ICC) and through Bland-Altman analysis. RESULTS: In total, 43 children with HSD/HEDS aged 11 (SD 3.8) years were recruited and completed this study. The difference between the 2 VAS platforms of median values was 0.20. Bland-Altman analysis revealed a difference of 0.19 (SD 0.95) with limits of agreement ranging -1.67 to 2.04. An ICC of 0.87 (95% CI 0.78-0.93) indicated good reliability. CONCLUSIONS: These findings suggest that the e-VAS mHealth App is a validated tool and a feasible method of collecting pain recording scores when compared with the traditional paper format in children and adolescents with HSD/HEDS. The e-VAS App can be reliably used for pediatric pain evaluation, and it could potentially be introduced into daily clinical practice to improve real-time symptom monitoring. Further research is warranted to investigate the usage of the app for remote support in real clinical settings.

Preparation for Cancer Treatment: A Cross-Sectional Study Examining Patient Self-Reported Experiences and Correlates.

Given the significant physical and psychosocial side-effects cancer treatment has on individuals, it is important to ensure patients receive adequate preparation prior to treatment. The purpose of this study was to explore, among Australian oncology patients, (i) the self-reported treatment preparation information they received; and (ii) the patient characteristics associated with the treatment preparation information received. Patients in the early stages of cancer treatment were invited to complete a survey exploring their receipt of information about treatment preparation. Items assessed patients' self-report of whether they had received information about the treatment process. A total of 165 participants completed the survey. Patients most frequently reported receiving information about how they might feel physically (94%) and what side effects to watch for (93%). One in five patients reported not receiving information about how to cope with any stress or worry related to treatment. Females reported receiving significantly fewer items of care compared to males (p = 0.0083). This study suggests that while self-reported preparation for cancer treatment is generally high, components of preparation related to psychosocial concerns could be improved. Survey data could be used as a feedback tool for centres to monitor delivery of care.

Experiences of Patient-Centered Care Among Older Community-Dwelling Australians.

Background: Older adults represent the largest consumers of health care. It is, therefore, important that they receive adequate patient-centered care to empower them to be proactive in managing their health. Aims: This study examined the proportion of older community-dwelling individuals who report receiving patient-centered care during healthcare consultations. Methods: A cross-sectional study was conducted with 117 clients of an Australian aged care provider. Clients completed a survey examining their perceptions of whether they received patient-centered care (11-items) from healthcare professionals. Results: The mean number of patient-centered care items reported was 8.7 (±3.1). Speaking to the patient with respect was the item most often reported to be patient-centered (94%). Asking patients about treatment goals or expectations (62%) and how involved they would like to be in treatment (67%) were the items least reported to be patient-centered. Conclusion: Older adults perceived some important aspects of care were not provided with a patient-centered approach. There is a need to improve healthcare providers' elicitation of older patients' care preferences, enabling patients to determine their level of involvement in their health management.

Effect of customised preformed foot orthoses on gait parameters in children with juvenile idiopathic arthritis: A multicentre randomised clinical trial.

BACKGROUND: Children with juvenile idiopathic arthritis (JIA) can experience significant physical impairment of the lower extremity. Prolonged joint disease and symptoms may cause gait alterations such as reduced walking speed and increased plantar pressures in diseased areas of their feet. There is limited robust clinical trials investigating the effect of non-invasive mechanical therapies such as foot orthoses (FOs) on improving gait parameters in children with JIA. RESEARCH QUESTION: Are customised preformed FOs effective in improving gait parameters in children with JIA? METHODS: A multicentre, parallel design, single-blinded randomised clinical trial was used to assess the gait impacts of customised preformed FOs on children with JIA. Children with a diagnosis of JIA, exhibiting lower limb symptoms and aged 5-18 were eligible. The trial group received a low-density full length, Slimflex Simple device which was customised chair side and the control group received a sham device. Peak pressure and pressure time integrals were used as the main gait outcomes and were measured using portable Tekscan gait analysis technology at baseline, 3 and 6 months. Differences at each follow-up were assessed using the Wilcoxon rank sum test. RESULTS: 66 participants were recruited. Customised preformed FOs were effective in altering plantar pressures in children with JIA versus a control device. Reductions of peak pressures and pressure time integrals in the heel, forefoot and 5th metatarsophalangeal joint were statistically significant in favour of the trial group. This was associated with statistically significant increased midfoot contact with the trial device at baseline, 3 and 6-month data collections. The trial intervention was safe and well accepted by participants, which is reflected in the high retention rate (92%). SIGNIFICANCE: Clinicians may prescribe customised preformed FOs in children with JIA to deflect pressure from painful joints and redistribute from high pressure areas such as the rearfoot and forefoot.

Physical Examination Tool for Swollen and Tender Lower Limb Joints in Juvenile Idiopathic Arthritis: A Pilot Diagnostic Accuracy Study.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children, with lower limb involvement highly prevalent. Recent evidence has highlighted the lack of specific lower limb physical examination (PE) tools for clinicians assisting the paediatric rheumatology team in identifying lower extremity disease in patients with JIA. Early clinical detection may lead to more prompt and targeted interventions to reduce lower limb problems in children with JIA. The aim of this pilot study is to provide preliminary data on the diagnostic accuracy of a lower limb PE tool in JIA. METHODS: Children with JIA requiring magnetic resonance imaging (MRI) on their lower limb joints per their usual care were eligible. Lower limb joint counts were conducted clinically by a podiatrist and paediatric rheumatologist using the proposed twenty joint per side, PE tool. The PE were compared to MRI assessments completed by two independent paediatric radiologists. Data were analysed using agreement (observed, positive and negative) and Cohen's kappa with 95% CIs. RESULTS: Fifteen participants were recruited into the study in which 600 lower limb joints were clinically examined. Statistical analysis showed excellent inter-rater reliability between podiatrist and paediatric rheumatologist for both joint swelling and tenderness. Results of the intra-rater reliability of the podiatrist using the PE tool indicated excellent percentage agreements (98.5-100%) and substantial kappa coefficients (0.93-1). The inter-rater reliability between radiological assessments contrasted the PE results, showing low agreement and poor reliability. Comparisons between PE and MRI resulted in poor kappa coefficients and low agreement percentages. The most agreeable joint between MRI and PE was the ankle joint, while the worst performing joint was the sub-talar joint. CONCLUSION: Results indicate potential clinical reliability; however, the validity and diagnostic accuracy of the proposed PE tool remains unclear due to low kappa coefficients and inconsistent agreements between PE and MRI results. Further research will be required before the tool may be used in a clinical setting.

A pilot randomised controlled trial of abrupt versus gradual smoking cessation in combination with vaporised nicotine products for people receiving alcohol and other drug treatment.

BACKGROUND: Vaporised nicotine products (VNPs) may be a potential quit smoking strategy. Most research has permitted participants to use VNPs ad libitum. This is the first study to examine combining the use of a VNP with a gradual or abrupt cessation guideline. This study aims to test the potential feasibility of a quit smoking strategy (abrupt verses gradual cessation) in combination with vaporised nicotine products among people in AOD treatment. METHODS: We conducted a pilot randomised controlled trial between April 2018 and July 2019. Participants were recruited from AOD programs located within one area health service in Australia. Participants were provided with two VNPs, a 12-week supply of nicotine e-liquid and randomised to either the abrupt (assigned a quit date the day they were provided their VNP) or gradual quit smoking strategy (reduce baseline number of cigarettes per day by 25% over a 4 week period), no further behavioral support was provided. Feasibility was assessed through successful recruitment rates, retention, and adherence to study conditions. Participant perceived helpfulness and satisfaction assessed acceptability. RESULTS: Among 80 interested individuals, 66 were eligible and consented (100% recruitment rate). From the 66 participants that consented and completed the baseline survey, 60 received the intervention assigned at a 1:1 ratio with 30 in the gradual cessation and 30 in the abrupt cessation group. Retention was 86.4% (n = 52) at 12-weeks post-intervention commencement. Ninety-six percent (n = 25) of participants in the gradual and 95.8% (n = 23) of participants in the abrupt group were using the VNPs at 12-weeks (p = 0.66). There was no difference in adherence to the assigned quit plan between gradual cessation 44% (n = 11) and abrupt cessation 71% (n = 17) groups (p = 0.117). Median perceived helpfulness of VNPs was high for both gradual (10/10) and abrupt (9/10) groups (p = 0.813). Similarly, median perceived satisfaction of VNPs was high for both gradual (9 /10) and abrupt (8/10) groups (p = 0.414). CONCLUSIONS: AOD participants found an intervention that involved VNPs to be satisfying and helpful. Future large scale trials are needed to elucidate whether a gradual or abrupt cessation guideline is more beneficial in main a quit attempt with a VNP.

The wellbeing needs of social housing tenants in Australia: an exploratory study.

BACKGROUND: Social housing provides homes for some of the most vulnerable in society. Those in social housing often have complex issues that may require support. Limited research has examined the unmet needs of those living in social housing from the tenant perspective. This exploratory study aimed to embark on filling this gap. METHODS: A cross-sectional study survey of adult social housing tenants in New South Wales, Australia. Consenting tenants completed a survey asking about their support needs across five domains: transport, employment and financial stress; housing and safety; health and health behaviour; access to services; and control over one's life. Negative binomial regression analysis was used to examine associations between the mean number of support needs and characteristics. RESULTS: Of the 104 tenants invited, 101 agreed to participate (97%) of which 100 completed the survey. Paying unexpected bills' (43%), feeling sad or anxious (40%), feelings of anger or frustration (34%), and memory or concentration problems (33%) were the most prevalent reported needs. Other needs included antisocial behaviour from neighbours (31%) and having control in the direction your life is taking (27%). Seventy-five percent of tenants reported at least one need, with an average of seven needs across the sample (median 5.5, range 0-24). Tenants who identified as Aboriginal or Torres Strait Islander had a higher number of needs compared to other tenants (RR 1.87 95% CI 1.08 to 3.35). CONCLUSIONS: More research describing tenant wellbeing needs is required to guide initiatives improving tenant wellbeing. Development of a standardised tool to measure and prioritise tenant wellbeing needs would be beneficial. There is a need for well-controlled research to establish the potential effectiveness and cost effectiveness of initiatives implemented at the policy or housing provider level. Future research must consider the multifaceted needs of this population. Further, Aboriginal and Torres Strait Islander people are generally overrepresented in social housing in Australia, and in this study Aboriginal and Torres Strait Islander tenants reported a higher number of needs compared to non-Aboriginal and Torres Strait Islander tenants. Given this, future research should ensure measurement tools or strategy initiatives are culturally sensitive and appropriate, and are developed in collaboration with Aboriginal and Torres Strait Islander communities.

Assessing the impact of magnetic resonance treatment simulation (MRSIM) on target volume delineation and dose to organs at risk for oropharyngeal radiotherapy.

INTRODUCTION: Assessing the use of a radiation therapy (RT) planning MRI performed in the treatment position (pMRI) on target volume delineation and effect on organ at risk dose for oropharyngeal cancer patients planned with diagnostic MRI (dMRI) and CT scan. METHODS: Diagnostic MRI scans were acquired for 26 patients in a neutral patient position using a 3T scanner (dMRI). Subsequent pMRI scans were acquired on the same scanner with a flat couch top and the patient in their immobilisation mask. Each series was rigidly registered to the patients planning CT scan and volumes were first completed with the CT/dMRI. The pMRI was then made available for volume modification. For the group with revised volumes, two IMRT plans were developed to demonstrate the impact of the modification. Image and registration quality was also evaluated. RESULTS: The pMRI registration led to the modification of target volumes for 19 of 26 participants. The pMRI target volumes were larger in absolute volume resulting in reduced capacity for organ sparing. Predominantly, modifications occurred for the primary gross tumour volume (GTVp) with a mean Dice Similarity Coefficient (DSC) of 0.7 and the resulting high risk planning target volume, a mean DSC of 0.89. Both MRIs scored similarly for image quality, with the pMRI demonstrating improved registration quality and efficiency. CONCLUSIONS: A pMRI provides improvement in registration efficiency, quality and a higher degree of oncologist confidence in target delineation. These results have led to a practice change within our department, where a pMRI is acquired for all eligible oropharyngeal cancer patients.

Effect of preformed foot orthoses in reducing pain in children with juvenile idiopathic arthritis: a multicentre randomized clinical trial.

OBJECTIVES: The aim of this study is to investigate the effect of customized preformed foot orthoses on pain, quality of life, swollen and tender lower joints and foot and ankle disability in children with JIA. METHODS: Parallel group design. Children diagnosed with JIA were recruited from the three children's hospitals in New South Wales, Australia. Participants were randomly assigned to a control group receiving a standard flat innersole (sham) with no corrective modifications. The trial group were prescribed a preformed device that was customized based on biomechanical assessments. Pain was the primary outcome and was followed up to 12 months post intervention. Secondary outcomes include quality of life, foot and ankle disability and swollen and tender joints. A linear mixed model was used to assess the impact of the intervention at each time point. RESULTS: Sixty-six participants were recruited. Child-reported pain was reduced statistically and clinically significant at 4 weeks and 3 months post intervention in favour of the trial group. Statistical significance was not reached at 6 and 12-month follow-ups. Quality of life and foot and ankle disability were not statistically significant at any follow-up; however, tender midfoot and ankle joints were significantly reduced 6 months post intervention. CONCLUSION: Results of this clinical trial indicate customized preformed foot orthoses can be effective in reducing pain and tender joints in children with JIA exhibiting foot and ankle symptoms. Long-term efficacy of foot orthoses remains unclear. Overall, the trial intervention was safe, inexpensive and well tolerated by paediatric patients. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): 12616001082493.

Addressing smoking in sheltered homelessness with intensive smoking treatment (ASSIST project): A pilot feasibility study of varenicline, combination nicotine replacement therapy and motivational interviewing.

BACKGROUND: This pilot study aimed to test the feasibility of providing varenicline in combination with nicotine replacement therapy (NRT) and motivational interviewing (MI) to adult male smokers attending a clinic in a hostel for homeless people. METHODS: A single group pre- and post-treatment (12 weeks following intervention commencement) design with embedded process evaluation (at weekly counselling and fortnightly safety check-ins). Participants were 20 male smokers attending a health clinic within a homelessness service in Sydney, Australia, between December 2019 and March 2020. Participants set a target quit date 7-days post intervention commencement. Adverse events, self-reported abstinence, cigarettes per day, treatment adherence and acceptability of the study interventions were assessed 12 weeks post intervention commencement. Abstinence was biochemically verified. Results are complete cases. RESULTS: Retention was 65% at 12-weeks post-intervention commencement (n = 13). No related adverse events were reported. Three participants (15%) reported continuous abstinence. Two participants self-reported 30-day point prevalence abstinence (10%), confirmed by CO level. Participants who did not quit smoking (n = 10), reported a significant reduction in the number of cigarettes smoked per day (19.4 vs 4.7, p < .01). Cravings, withdrawal symptoms, and psychological distress significantly decreased from baseline to 12-week follow-up (all < 0.01). Adherence to the pharmacological interventions was good, most used combination NRT and varenicline. Adherence to the counselling sessions was low, attending three of 12 sessions. Both NRT and MI were rated as highly acceptable. Some participants expressed concerns about the safety of varenicline. CONCLUSIONS: The intervention was feasible and acceptable and associated with short-term smoking cessation and significant reductions in the number of cigarettes smoked-per-day.

Early evolution of beetles regulated by the end-Permian deforestation.

The end-Permian mass extinction (EPME) led to a severe terrestrial ecosystem collapse. However, the ecological response of insects-the most diverse group of organisms on Earth-to the EPME remains poorly understood. Here, we analyse beetle evolutionary history based on taxonomic diversity, morphological disparity, phylogeny, and ecological shifts from the Early Permian to Middle Triassic, using a comprehensive new dataset. Permian beetles were dominated by xylophagous stem groups with high diversity and disparity, which probably played an underappreciated role in the Permian carbon cycle. Our suite of analyses shows that Permian xylophagous beetles suffered a severe extinction during the EPME largely due to the collapse of forest ecosystems, resulting in an Early Triassic gap of xylophagous beetles. New xylophagous beetles appeared widely in the early Middle Triassic, which is consistent with the restoration of forest ecosystems. Our results highlight the ecological significance of insects in deep-time terrestrial ecosystems.

Giant clam growth in the Gulf of Aqaba is accelerated compared to fossil populations.

The health of reef-building corals has declined due to climate change and pollution. However, less is known about whether giant clams, reef-dwelling bivalves with a photosymbiotic partnership similar to that found in reef-building corals, are also threatened by environmental degradation. To compare giant clam health against a prehistoric baseline, we collected fossil and modern Tridacna shells from the Gulf of Aqaba, Northern Red Sea. After calibrating daily/twice-daily growth lines from the outer shell layer, we determined that modern individuals of all three species (Tridacna maxima, T. squamosa and T. squamosina) grew faster than Holocene and Pleistocene specimens. Modern specimens also show median shell organic δ15N values 4.2‰ lower than fossil specimens, which we propose is most likely due to increased deposition of isotopically light nitrate aerosols in the modern era. Nitrate fertilization accelerates growth in cultured Tridacna, so nitrate aerosol deposition may contribute to faster growth in modern wild populations. Furthermore, colder winter temperatures and past summer monsoons may have depressed fossil giant clam growth. Giant clams can serve as sentinels of reef environmental change, both to determine their individual health and the health of the reefs they inhabit.

Screening for Cognitive Impairment among Community-Dwelling Older Adults: A Comparison of 2 Screening Instruments.

INTRODUCTION: Community aged care services provide support to older adults living in their own homes. Cognitive impairment may increase the complexity of the support required. There is a need to ensure suitable brief screening tools are available to community aged care providers to assess possible cognitive impairment. This study aimed to examine the agreement between 2 validated cognitive impairment screening tools, the Mini-Cog, and Abbreviated Mental Test Score (AMTS), and the perceptions the individuals case manager of Case Manager's. METHODS: A cross-sectional survey study was undertaken with clients of a community aged care provider. Clients were administered both the screening tools via an electronic survey by their Case Manager. RESULTS: In total, 158 (54%) eligible participants consented to participate. There was a 70% agreement between the Mini-Cog and AMTS measures, indicating a moderate agreement which was not statistically different from chance (Kappa 0.08, 95% CI -0.04-0.19). Case Managers identified 37% (n = 48/130) of participants as possibly having cognitive impairment, of which, 15% (n = 20) were also identified via a screening tool. CONCLUSIONS: The findings indicate poor agreement across the 3 measures. To ensure adequate supports are offered to those with cognitive impairment, the use of validated tools that can be administered by non-medical staff in a community setting is a priority. This study highlights a need for further work to determine the most suitable tool for use by community-based aged care services.

Frailty screening among older adults receiving home care packages: a study of feasibility and prevalence.

Home care packages (HCPs) aim to support older people to remain in their homes for as long as possible. Early detection and management of frailty in community-dwelling older people may prevent or delay transfer to residential aged care. This suggests that it is important to establish mechanisms for identifying frailty among older adults. This study examined the feasibility of obtaining self-reported level of frailty from a sample of older adults receiving HCPs from an Australian aged care provider. The prevalence of frailty and sociodemographic and clinical correlates were assessed. Customers aged ≥65 years receiving an HCP from an aged care and disability service provider in New South Wales (n=158; 53.5% consent rate) completed a survey during their scheduled visit. The mean (±s.d.) total score on the Edmonton Frail Scale was 7.3±2.4 (range 1-13). The prevalence of frailty was 45% (5% 'severe frailty', 14% 'moderate frailty', 26% 'mild frailty'). Clients who had fallen in the past year had, on average, a 1.0-point higher frailty score (95% confidence interval 0.16-1.90) than those who had not. Given the high proportion of adults in our sample who were identified as frail, regular standardised assessments of frailty may assist community aged care providers to provide early intervention to reduce the risk of falls within this group of clients.