Associations between behavioral and self-reported impulsivity, brain structure, and genetic influences in middle childhood.

Impulsivity undergoes a normative developmental trajectory from childhood to adulthood and is thought to be driven by maturation of brain structure. However, few large-scale studies have assessed associations between impulsivity, brain structure, and genetic susceptibility in children. In 9112 children ages 9-10 from the ABCD study, we explored relationships among impulsivity (UPPS-P impulsive behavior scale; delay discounting), brain structure (cortical thickness (CT), cortical volume (CV), and cortical area (CA)), and polygenic scores for externalizing behavior (PGSEXT). Both higher UPPS-P total scores and more severe delay-discounting had widespread, low-magnitude associations with smaller CA in frontal and temporal regions. No associations were seen between impulsivity and CV or CT. Additionally, higher PGSEXT was associated with both higher UPPS-P scores and with smaller CA and CV in frontal and temporal regions, but in non-overlapping cortical regions, underscoring the complex interplay between genetics and brain structure in influencing impulsivity. These findings indicate that, within large-scale population data, CA is significantly yet weakly associated with each of these impulsivity measures and with polygenic risk for externalizing behaviors, but in distinct brain regions. Future work should longitudinally assess these associations through adolescence, and examine associated functional outcomes, such as future substance use and psychopathology.

Iatrogenic Vertebral Artery Dissection with Posterior Fossa and Lateral Medullary Stroke After Uncomplicated Cervical Nerve Ablation.

BACKGROUND: A cervical radiofrequency ablation is a procedure that can be performed to treat arthritis-related pain in the neck and upper back. There have been no large studies reporting complications after this procedure. We report a case of a 55-year-old woman with iatrogenic vertebral artery dissection of C3-C4 with segmental occlusion leading to a posterior fossa stroke and lateral medullary stroke after a high-grade cervical nerve ablation. CASE REPORT: A 55-year-old woman presented to the Emergency Department with vomiting, neck pain, temperature changes, dizziness, and dysarthria after undergoing C2-C3, C4-C5 nerve ablation 30 min prior to arrival. The patient was found to have a vertebral artery dissection with posterior fossa and lateral medullary stroke. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Vertebral artery dissection and subsequent stroke should be considered with recent cervical facet joint injections, such as intra-articular facet joint injections, medial branch blocks, or medial branch radiofrequency nerve ablation. The case we report shows devastating outcomes that can result from what many consider a relatively simple procedure.

Medicare formulary restrictions for glucagon-like peptide 1 receptor agonists and sodium glucose cotransporter 2 inhibitors used in type 2 diabetes mellitus: 2019-2023.

BACKGROUND: Glucagon-like peptide 1 receptor agonists (GLP1-RAs) and sodium glucose cotransporter 2 inhibitors (SGLT2is) have proven benefits in patients with type 2 diabetes mellitus related to decreasing cardiovascular events and heart failure hospitalizations as well as preventing the progression of kidney disease. This led the American Diabetes Association (ADA) to update their guidelines in 2022 to recommend GLP1-RAs and SGLT2is as potential first-line options in patients with cardiorenal conditions. Formulary restrictions, such as step therapy and prior authorizations, can limit access to these beneficial medications. OBJECTIVE: To evaluate trends in Medicare formulary restrictions of GLP1-RAs and SGLT2is following the recommendations by the ADA for first-line use. METHODS: We conducted a retrospective cohort study of Quarter 1 Medicare formulary restrictions on GLP1-RAs and SGLT2is from 2019 to 2023. We analyzed changes in formulary restrictions by year, before and after the ADA first-line recommendations, single vs combination products, and products with and without other indications on a medication level (ie, each unique National Drug Code number on each unique formulary) and formulary level (ie, any prior authorization or step therapy requirements yield formulary restriction). RESULTS: We analyzed 12,212 unique Medicare formularies. GLP1-RAs were 12.5% less likely (relative risk [RR] = 0.87; 95% CI = 0.84-0.91; P < 0.001) and 33.2% less likely (RR = 0.67; 95% CI = 0.60-0.74; P < 0.001) to have restrictions after the ADA guideline changes on a medication and formulary level, respectively. SGLT2is were 87.8% less likely (RR = 0.12; 95% CI = 0.11-0.13; P < 0.001) and 53.0% less likely (RR = 0.47; 95% CI = 0.27-0.80; P = 0.005) to have restrictions after the ADA guideline changes on medication and formulary levels, respectively. CONCLUSIONS: Decreasing trends of medications and formularies with restrictions may indicate payers are recognizing GLP1-RAs and SGLT2is as potential first-line agents, aligning with ADA recommendations.

Proximal versus distal adductor canal catheters for total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: Total knee arthroplasty (TKA) is associated with severe postoperative pain. Continuous adductor canal blockade provides analgesia while preserving quadriceps muscle strength. Nevertheless, uncertainty still exists as to the optimal adductor canal catheter placement approach. We sought to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the analgesic effects of proximal vs distal adductor canal catheters in patients undergoing TKA. SOURCE: We systematically searched PubMed, EMBASE, and Cochrane for RCTs comparing distal and proximal adductor canal catheters for TKA regarding critical clinical outcomes in adult patients. Statistical analysis was performed using R version 4.1.2 (R Foundation for Statistical Computing, Vienna, Austria). Heterogeneity was assessed using the Cochran Q test and I2 statistics. Trial sequential analysis (TSA) was performed to evaluate the risk of random errors and the uncertainty of our results. The risk of bias was appraised according to the RoB-2 tool. PRINCIPAL FINDINGS: Six RCTs and 352 patients were included, of whom 151 (42.9%) were male, and 175 (49.7%) were randomized to undergo proximal adductor canal catheter placement. Due to the randomized nature of the studies, baseline characteristics were similar between groups. There were no statistical differences between proximal and distal adductor canal catheters regarding cumulative opioid consumption in the first 24 hr (mean difference [MD], -4.86; 95% confidence interval [CI], -15.19 to 5.47; P = 0.36; four RCTs; 240 patients); pain scores at rest (MD, 0.41; 95% CI, -1.23 to 0.40; P = 0.32; six RCTs; 350 patients); and pain scores with movement for the first 24 hr (MD, -0.25; 95% CI, -0.85 to 0.35; P = 0.42; four RCTs; 246 patients). In the TSA, the required information size was not reached, and the Z-curve did not cross the monitoring boundaries in any of the endpoints. CONCLUSION: These findings suggest that proximal vs distal adductor canal catheter placement in patients undergoing TKA may be equally effective for the outcomes of opioid consumption in the first 24 hr, pain scores at rest, and pain scores with movement in the first 24 hr. Nevertheless, TSA findings suggest insufficient power to definitively conclude no differences between the two techniques. STUDY REGISTRATION: PROSPERO (CRD42022353576); registered 25 August 2022.

RéSUMé: OBJECTIF: L'arthroplastie totale du genou (ATG) est associée à une douleur postopératoire majeure. Le bloc continu du canal adducteur procure une analgésie tout en préservant la force musculaire du quadriceps. Néanmoins, il existe encore des incertitudes quant à l'approche optimale de positionnement du cathéter du canal adducteur. Nous avons cherché à réaliser une revue systématique et une méta-analyse d'études randomisées contrôlées (ERC) comparant les effets analgésiques de cathéters proximaux et distaux du canal adducteur chez la patientèle bénéficiant d'une ATG. SOURCES: Nous avons réalisé des recherches systématiques dans les bases de données PubMed, EMBASE et Cochrane pour en tirer les ERC comparant les cathéters distaux et proximaux du canal adducteur pour l'ATG touchant aux critères d'évaluation cliniques critiques chez les patient·es adultes. L'analyse statistique a été réalisée à l'aide de la version R 4.1.2 (R Foundation for Statistical Computing, Vienne, Autriche). L'hétérogénéité a été évaluée à l'aide du test Q de Cochran et des statistiques I2. Une analyse séquentielle des études a été réalisée pour évaluer le risque d'erreurs aléatoires et l'incertitude de nos résultats. Le risque de biais a été évalué selon l'outil RoB-2. CONSTATATIONS PRINCIPALES: Six ERC et 352 patient·es ont été inclus·es, dont 151 (42,9 %) hommes, et 175 (49,7 %) ont été randomisé·es pour bénéficier d'une pose proximale d'un cathéter du canal adducteur. En raison de la nature randomisée des études, les caractéristiques initiales étaient similaires entre les groupes. Il n'y avait aucune différence statistique entre les cathéters proximaux et distaux du canal adducteur en ce qui concerne la consommation cumulative d'opioïdes au cours des premières 24 heures (différence moyenne [DM], −4,86; intervalle de confiance [IC] à 95 %, −15,19 à 5,47; P = 0,36; quatre ERC; 240 patient·es); les scores de douleur au repos (DM, −0,41; IC 95 %, −1,23 à 0,40; P = 0,32; six ERC ; 350 patient·es); et les scores de douleur en mouvement pendant les premières 24 heures (DM, −0,25; IC 95 %, −0,85 à 0,35; P = 0,42; quatre ERC; 246 patient·es). Dans l'analyse séquentielle des études, la taille d'information requise n'a pas été atteinte et la courbe en Z n'a franchi les limites de surveillance dans aucun des paramètres. CONCLUSION: Ces résultats suggèrent que le positionnement proximal ou distal d'un cathéter du canal adducteur chez les personnes subissant une ATG peut être tout aussi efficace en ce qui touche aux critères de consommation d'opioïdes au cours des premières 24 heures, de scores de douleur au repos et de scores de douleur en mouvement au cours des premières 24 heures. Néanmoins, les résultats de l'analyse séquentielle suggèrent une puissance insuffisante pour conclure de manière définitive à l'absence de différences entre les deux techniques. ENREGISTREMENT DE L'éTUDE: PROSPERO (CRD42022353576); enregistrée le 25 août 2022.

From the Outside in: ASMR Is Characterised by Reduced Interoceptive Accuracy but Higher Sensation Seeking.

Autonomous Sensory Meridian Response (ASMR) is a complex sensory-perceptual phenomenon characterised by relaxing and pleasurable scalp-tingling sensations. The ASMR trait is nonuniversal, thought to have developmental origins, and a prevalence rate of 20%. Previous theory and research suggest that trait ASMR may be underlined by atypical multisensory perception from both interoceptive and exteroceptive modalities. In this study, we examined whether ASMR responders differed from nonresponders in interoceptive accuracy and multisensory processing style. Results showed that ASMR responders had lower interoceptive accuracy but a greater tendency towards sensation seeking, especially for tactile, olfactory, and gustatory modalities. Exploratory mediation analyses suggest that sensation-seeking behaviours in trait ASMR could reflect a compensatory mechanism for either deficits in interoceptive accuracy, a tendency to weight exteroceptive signals more strongly, or both. This study provides the foundations for understanding how interoceptive and exteroceptive mechanisms might explain not only the ASMR trait, but also individual differences in the ability to experience complex positive emotions more generally.

A replication and extension of the augmented competing stimulus assessment.

Augmenting competing stimulus assessments by embedding tactics to increase stimulus engagement and disrupt challenging behavior can improve outcomes of treatments for automatically maintained self-injurious behavior, even for treatment-resistant subtypes. This study replicated and extended research on augmented competing stimulus assessments by reporting outcomes for 16 consecutively encountered cases with automatically maintained self-injurious behavior (19 total applications); six participants had treatment-responsive Subtype 1 and 10 had treatment-resistant Subtypes 2 or 3. Fewer high-competition stimuli were identified for individuals with treatment-resistant subtypes. When response-promotion and disruption tactics were applied and withdrawn, outcomes improved for six of eight applications. At least one high-competition stimulus was still effective when maintenance probes were conducted for a subset of participants. Ultimately, at least one high-competition stimulus was identified for each participant. Although augmenting tactics may not be necessary for all individuals, these findings provide additional support for their efficacy with treatment-resistant self-injurious behavior.

Heterotopic sites of pleomorphic adenoma.

The majority of the tumours occurring in minor salivary glands are malignant with only 18% being benign. Among the benign tumours, pleomorphic adenoma is the most common. Although it presents more commonly in the parotid and submandibular glands, it can occur at any site where salivary glands reside. Only 6.4% of cases of pleomorphic adenoma occur in minor salivary glands, e.g. palate, cheeks, lips, para-pharyngeal space, etc. It occurs in females in the fourth or fifth decade. It presents as an asymptomatic and slow-growing mass. The treatment of choice is wide local excision due to the high rate of recurrence and malignant potential. We present rare case reports of two patients. The first case is of a young 18 years female presenting with recurrent neck (anterior triangle) swelling and the second case is of a 46-year-old female presenting with lower lip swelling. In both cases, it was a slow-growing mass and asymptomatic. Cytological examination of the lesion revealed the diagnosis of pleomorphic adenoma. It was completely excised with no post-operative complication. Pleomorphic adenoma, although a common benign neoplasm of major salivary glands, should always be kept as a possibility at the locations of minor salivary glands. As pleomorphic adenoma can transform into a malignant counterpart, therefore early diagnosis and treatment of the lesion can prevent further complications. The prognosis of pleomorphic adenoma is excellent. However, a close follow-up of the patient is required due to the high rate of recurrence.

Simplified methods for identifying subtypes of automatically maintained self-injury.

Subtypes of automatically maintained self-injurious behavior (SIB) have been defined based on response patterns observed during the functional analysis, which are thought to reflect each subtype's distinct mechanisms. Current practice for identifying subtypes involves using structured criteria to identify whether SIB is automatically maintained, followed by the application of additional criteria to identify the subtype. We describe a series of studies directed at simplifying these methods to facilitate wider application of the subtyping model in research and practice. In Studies 1 and 2, we demonstrate the accuracy of modified criteria using the level of differentiation of SIB across the play and no-interaction conditions at distinguishing between two subtypes (i.e., Subtypes 1 and 2). We then demonstrate visual analysis (without structured criteria) can accurately identify SIB as automatically maintained in Study 3, which can be used in combination with level of differentiation to enable application of the subtyping model in practice.

How the volatile organic compounds emitted by corpse plant change through flowering.

The corpse plant (Amorphophallus titanum) is so named because it produces a pungent, foul odor when flowering. Little is known about how the emitted volatiles change throughout the two-day flowering period. In this study, the comprehensive monitoring of the presence and change in volatile molecules during the female and the male flowering phases of A. titanum was conducted, and the plant temperature was monitored. A total of 422 volatile features were detected over the entire sampling period, of which 118 features were statistically significantly different between the pre-flowering and both flowering phases, and an additional 304 features were found present throughout the flowering period. A total of 45 molecules could be assigned putative names. The volatile profile of A. titanum changes over the two-day flowering period, with the S-containing molecules and aldehydes dominant in the female flowering phase, and the alcohols and hydrocarbons dominant in the male flowering phase. The two-dimensional gas chromatography time-of-flight mass spectrometry (GC × GC-TOFMS) enabled us to identify 32 new molecules produced by A. titanum. Each of these molecules alone, and in combination, likely contribute to the different odors emitted during the flowering phase of A. titanum.

The autopsy practice and pathology in COVID-19.

The universal spread of novel virus named coronavirus disease 2019 (COVID-19) also known as 2019-nCoV, Middle East Respiratory Syndrome and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) declared by the world health organisation (WHO). This virus has dived in to multiorgan, with clinical manifestations of fever, sore throat, dry cough, dyspnoea, chest pain, nausea, vomiting, diarrhoea and muscle pain. As novel coronavirus been categorised as HG3 infection which has highest with inhalation and by skin surface contact. As previous pandemics have occurred like SARS and MERS special attention to autopsy had been given to prevent exposure to the healthcare workers. Similar attention should be given to the autopsy protocols and underlying pathology for COVID-19 infection so as to better understanding of the disease for further control and treatment guidelines. Thus, herein we bring and summarise review of literature for understanding.

Silver nanostructures prepared via novel green approach as an effective platform for biological and environmental applications.

Silver nanoparticles play a significant role in biomedical sciences due to their unique properties allowing for their use as an effective sensing and remediation platform Herein, the green synthesis of silver nanostructures (Ag NSs), prepared via aqueous extract of waste Brassica oleracea leaves in the presence of silver nitrate solution (10-4 M), is reported. The Ag NSs are fully characterized and their efficacy with respect to 4-nitrophenol reduction, glucose sensing, and microbes is determined. Visually, the color of silver nitrate containing solution altered from colorless to yellowish, then reddish grey, confirming the formation of Ag NSs. HRTEM and SEAD studies revealed the Ag NSs to have different morphologies (triangular, rod-shaped, hexagonal, etc., within a size range of 20-40 nm) with face-centered cubic (fcc) crystal structure. The Ag NSs possess high efficacy for nitrophenol reduction (<11 min and degradation efficiency of 98.2%), glucose sensing (LOD: 5.83 µM), and antimicrobial activity (E. coli and B. subtilis with clearance zones of 18.3 and 14 mm, respectively). Thus, the current study alludes towards the development of a cost-effective, sustainable, and efficient three-in-one platform for biomedical and environmental applications.

Interspecific hybridization between sponge gourd (Luffa cylindrica L.) and 'Satputia' (Luffa hermaphrodita Singh & Bhandari) for preintrogression of cluster bearing, high yield and gynoecism.

Interspecific hybridization with 'Satputia' (bisexual and cluster bearing) can be highly useful for the introgression of cluster bearing, high yield and gynoecism in sponge gourd (monoecious and solitary bearing). However, the occurrence of self-pollination in closed flowers and anthesis of two species at different time intervals creates hindrance in interspecific hybridization. The present investigation highlighted that the reciprocal interspecific cross (Satputia × sponge gourd) is more successful for development of F1 hybrid and its further utilization in development of segregating generations. Pre-anthesis emasculation (28 h before anthesis) of Satputia buds in the evening and pollination with sponge gourd (PSG-9) in the morning on the day of anthesis resulted in high fruit set. Interspecific hybrids were monoecious and morphologically intermediate for most of the vegetative, flower and fruit traits. The seed of hybrid vines was vigorous than both the parents with respect to size and weight. Ample pollen production, pollen viability and high fruit set on selfing confirmed the fertility status of vines. Although pollen size was less than both the parents, but the pollen density improved in F1 vines. Fertile hybrids could be easily used to generate F2 and BC1P2 and TCH segregating generations. In F2 generation, gynoecious, adroecious, andromonoecoius, monoecious and cluster bearing vines of variable length and fruit size were observed. In back cross and triple cross generations, most of the vines were monoecious except a few adroecious and gynoecious with improved fruit size, vine growth and bearing capacity. Backcross and triple cross with sponge gourd displayed a shift towards this species.

Cancer related nutritional and inflammatory markers as predictive parameters of immediate postoperative complications and long-term survival after hepatectomies.

BACKGROUND: The overall survival (OS), disease-free survival (DFS) and complications after liver resections is unsatisfactory. Cancer-related malnutrition and inflammation have an effect on survival but not studied/not clear on postoperative complications. METHODS: We retrospectively analyzed prospectively maintained database of 309 patients. The outcome variables included complications in terms of Clavien-Dindo (CD) Score, OS and DFS; We studied effect of preoperative albumin globulin ratio (AGR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and aspartate transaminase to platelet ratio index (APRI) and dynamic change from pre-operative to postoperative value (Delta-AGR, Delta-NLR, Delta-PLR and Delta-APRI) on complications, OS and DFS. RESULTS: Total 98 patients (31.71%) had postoperative complications. Fifty patients had CD 1 & 2 and 35 (11.33%) had CD 3 & 4, and 13 (4.12%) had mortality (CD 5). Low AGR, high NLR, high PLR and high Delta-AGR and high Delta-APRI predicted increased major complications. Preoperative high NLR predicted worse OS and low AGR predicted worse OS and DFS. Delta-APRI showed trends towards worse OS and DFS. CONCLUSION: These serum inflammatory markers can predict immediate postoperative complications. Preoperative AGR and preoperative NLR can predict survival after liver resections. High Delta-AGR, which is a new entity, is predicting more postoperative complications and needs further detailed studies.

Recent advances in point-of-care diagnostics for oral cancer.

Early-stage diagnosis is a crucial step in reducing the mortality rate in oral cancer cases. Point-of-care (POC) devices for oral cancer diagnosis hold great future potential in improving the survival rates as well as the quality of life of oral cancer patients. The conventional oral examination followed by needle biopsy and histopathological analysis have limited diagnostic accuracy. Besides, it involves patient discomfort and is not feasible in resource-limited settings. POC detection of biomarkers and diagnostic adjuncts has emerged as non- or minimally invasive tools for the diagnosis of oral cancer at an early stage. Various biosensors have been developed for the rapid detection of oral cancer biomarkers at the point-of-care. Several optical imaging methods have also been employed as adjuncts to detect alterations in oral tissue indicative of malignancy. This review summarizes the different POC platforms developed for the detection of oral cancer biomarkers, along with various POC imaging and cytological adjuncts that aid in oral cancer diagnosis, especially in low resource settings. Various immunosensors and nucleic acid biosensors developed to detect oral cancer biomarkers are summarized with examples. The different imaging methods used to detect oral tissue malignancy are also discussed herein. Additionally, the currently available commercial devices used as adjuncts in the POC detection of oral cancer are emphasized along with their characteristics. Finally, we discuss the limitations and challenges that persist in translating the developed POC techniques in the clinical settings for oral cancer diagnosis, along with future perspectives.

CaFu MOF as an efficient adsorbent for simultaneous removal of imidacloprid pesticide and cadmium ions from wastewater.

Heavy metal ions and pesticides are the noteworthy toxic substances which must be removed from contaminated water for safeguarding public health. The higher levels of these substances in natural water may adversely affect the human health, climate and the eco-framework. The adsorptive removal of hazardous constituents employing metal organic frameworks has drawn considerable attention of researchers during the last decade. From this point of view, single crystal of calcium fumarate [Ca(C4H4O4)1.5 (H2O)(CH3OH)2] has been developed and analyzed by single crystal X-ray crystallography which confirmed the formation of 3-D metal organic frameworks (MOFs). The synthesized MOFs was employed for simultaneous adsorptive removal of imidacloprid, a high consumption pesticide, and highly toxic Cd (II) from aqua ecosystem. The effect of variation in experimental conditions such as solution pH, adsorbent dosage, contact time, initial concentration and temperature on adsorption was systematically evaluated. Both the imidacloprid and Cd(II) exhibited maximum adsorption at pH 6.5 and 7.8, respectively. The equilibrium empirical data was fitted into Langmuir, Freundlich and Temkin isotherms. The adsorption capacity of CaFu MOFs was observed to be 467.23 and 781.2 mg g-1 for imidacloprid and cadmium ions, respectively. The adsorbed pollutants were desorbed from the adsorbent using dilute HCl, and the material was reused for five adsorption-desorption cycles without any appreciable loss of adsorption capacity. Therefore, the 3-D CaFu MOFs could be utilized as a novel material for adsorptive removal of imidacloprid pesticide as well as Cd (II) from wastewater.

Assessment of shelf-life of Gymnema sylvestre extract through WHO recommended stability study involving chromatographic and biological activity analyses.

Stability study on Gymnema sylvestre extract under WHO recommended accelerated and long-term conditions for 6 and 30 months, respectively was carried out by taking gymnemagenin as a marker and by evaluating antidiabetic activity through different models. Gymnemagenin was not detected in any stability sample indicating that gymnemic acids (GAs) remain stable in the extract under the test conditions. The extract and its GA rich fraction exhibited mild α-glucosidase inhibitory activity (18-27%) that remained same during the study. Neither hypoglycemic nor anti-hyperglycemic effect was induced by the extract in normal rats in oral glucose tolerance test. The extract and GA rich fraction showed significant antidiabetic activity in alloxan-induced diabetic rats that remained same in all stability samples. Based on these findings, a shelf-life of at least 30 months is suggested for G. sylvestre extract under long-term conditions, and gymnemagenin as a marker for shelf-life assessment of products derived from the plant.

A Clinical Demonstration of Correlational and Experimental Analyses of Precursor Behavior.

Individuals with intellectual and developmental disabilities are at an increased risk for engaging in severe problem behavior, which is often preceded by less intense precursor behaviors. These precursor behaviors may be a viable option as target behaviors for functional analyses in situations where evoking severe problem behavior is not ideal. We identified precursor behaviors through a correlational analysis and confirmed their membership in the same response class as more severe problem behavior through an experimental analysis.

Distress and problem assessment among people living with cancer from Culturally and Linguistically Diverse backgrounds.

OBJECTIVE: To examine whether routine assessment of distress, recommended as part of comprehensive cancer care, is utilised equally with culturally and linguistically diverse (CALD) vs non-CALD people living with cancer. METHODS: A medical records review of all patients attending cancer-specific treatment units at a single tertiary hospital in Melbourne, Australia between 2015-2018. Recording of administration of the Distress Thermometer and Problem Checklist (DT and PC) was extracted for all patients. Details regarding how the DT and PC (used together) was administered were extracted for a random sub-sample of 294 CALD patients and 294 matched non-CALD patients. RESULTS: A total of 6977 patients were identified (12.0% CALD). Just over half of the CALD (54.7%) and non-CALD (58.2%) patients had a recorded DT and PC (P > 0.05). For the sub-sample analysis, CALD patients were less likely to complete the form themselves (14.8% vs 75.9% non-CALD) and were more likely to have a family member complete the form (55.1% vs 15.1% non-CALD). CALD patients reported a similar level of distress to non-CALD patients. Distress scores for CALD and non-CALD patients were higher when family members completed the form. Provision of discussion, written information, referral offers and rates of referral acceptance were similar between CALD and non-CALD patients. CONCLUSIONS: Assessment of distress and associated problems, and the process following assessment, were similar for CALD and non-CALD patients. However, differences in how the form was completed highlight the need for further improvements to ensure that CALD patients are actively involved in their care.

CpG-creating mutations are costly in many human viruses.

Mutations can occur throughout the virus genome and may be beneficial, neutral or deleterious. We are interested in mutations that yield a C next to a G, producing CpG sites. CpG sites are rare in eukaryotic and viral genomes. For the eukaryotes, it is thought that CpG sites are rare because they are prone to mutation when methylated. In viruses, we know less about why CpG sites are rare. A previous study in HIV suggested that CpG-creating transition mutations are more costly than similar non-CpG-creating mutations. To determine if this is the case in other viruses, we analyzed the allele frequencies of CpG-creating and non-CpG-creating mutations across various strains, subtypes, and genes of viruses using existing data obtained from Genbank, HIV Databases, and Virus Pathogen Resource. Our results suggest that CpG sites are indeed costly for most viruses. By understanding the cost of CpG sites, we can obtain further insights into the evolution and adaptation of viruses.