Mental health and child refugees.

This paper presents an overview of the importance of mental health services for unaccompanied asylum-seeking children in the United Kingdom. It reviews what mental health support appears to be available in the United Kingdom following an on-line search which took place in Spring 2021 and using information gathered through 22 interviews and focus groups with stakeholders. The latter group are defined as people working with asylum-seeking children. The primary stakeholders were local authority staff, although interviews were also conducted with local government associations (London Councils, the Local Government Association), NHS bodies and the voluntary sector. Often, further relevant stakeholders were identified during interviews. The report details the aims, methodology and context, before the findings are presented which is followed by recommendations for improving mental and social care provision for unaccompanied asylum-seeking children in the United Kingdom.

Mindfulness based cognitive therapy for youth with inflammatory bowel disease and depression - Findings from a pilot randomised controlled trial.

BACKGROUND: Mindfulness-based cognitive therapy (MBCT) is a promising adjunctive treatment for adolescents and young adults (AYAs) with Inflammatory Bowel Disease (IBD) and comorbid depression. OBJECTIVES: This pilot randomised controlled trial (RCT) aimed to evaluate feasibility and efficacy of an adapted MBCT program for AYA, aged 16-29, with IBD. METHODS: Sixty-four AYAs were randomly allocated to MBCT (n = 33) or treatment as usual (TAU) (n = 31). Primary outcome measure was the depression score on Depression, Anxiety and Stress Scale. Secondary outcomes included anxiety, stress, IBD-related quality of life, coping, mindfulness, post-traumatic growth, medication adherence, IBD activity, inflammatory markers, microbiome characteristics and brain functional connectivity. RESULTS: Study recruitment rate was 75%, retention rate 70%, and session attendance 92%. Intention to treat analyses revealed that, compared to TAU group, MBCT group had significantly lower depression (∆ = -6.0; 95%CI = -10.8 to -1.2; P = 0.015) and stress (∆ = -5.1; 95%CI = -10.1 to -0.0; P = 0.049), higher active coping (∆ = 1.0;95%CI = 0.1-1.9; P = 0.022), and total mindfulness scores (∆ = 10.9;95%CI = 1.1-20.8; P = 0.030) at 8 weeks (post-therapy), and improved coping by positive reframing (∆ = 1.1;95%CI = 0.0-2.2; P = 0.043) and planning (∆ = 0.9;95%CI = 0.0-1.9; P = 0.045), mindful awareness (∆ = 5.2.;95%CI = 2.0-8.5; P = 0.002) and total mindfulness scores (∆ = 10.8.;95%CI = 0.4-21.1; P = 0.042) at 20 weeks. On per protocol analysis, MBCT group had significantly lower depression (∆ = -6.3; 95%CI = -11.4 to -1.2; P = 0.015), stress (∆ = -6.0; 95%CI = -11.2 to -0.5; P = 0.032), increased active coping (∆ = 0.9;95%CI = 0-1.7; P = 0.05) at 8 weeks, and mindful awareness (∆ = 5.4; 95%CI = 2.1-8.6; P = 0.001) at 20 weeks. CONCLUSION: In AYAs with IBD, MBCT is feasible and beneficial in improving depression, stress, mindfulness and adaptive coping. It holds promise as an important component of integrated IBD care. Trial registration number ACTRN12617000876392, U1111-1197-7370; Pre-results.

Serological status of cattle to bovine viral diarrhoea virus and bovine herpesvirus 1 at entry to and exit from Australian feedlot backgrounding facilities.

A total of 6195 cattle were enrolled in this observational study. Serum antibody concentrations to bovine herpesvirus 1 (BHV1) and bovine viral diarrhoea virus (BVDV) were measured at entry to and exit from backgrounding facilities to assess their statuses on arrival and the extent of seroconversion to these viruses during backgrounding. The backgrounding facilities were contiguous with five feedlots in: Queensland (two sites), New South Wales, South Australia and Western Australia. Cattle were held in the backgrounding facilities for a minimum of 29 days and a median of 34 days. On backgrounding facility entry, 32.7% of the study population was seronegative to BVDV, but 85.7% was seronegative to BHV1. After commingling in the backgrounding facilities, of the cattle that were seronegative on backgrounding facility entry, 33.9% and 30.3% showed a serological increase to BVDV and BHV1, respectively. At backgrounding facility exit, when cattle were placed in their feedlots, 19.6% and 59.1% were seronegative to BVDV and BHV1, respectively, and 0.26% were persistently infected with BVDV. There was a strong association between seroincrease to BVDV and seroincrease to BHV1 (P = 0.005) at animal level in cohorts known to contain an animal persistently infected with BVDV.

Health and production effects of killed vaccines against Mannheimia haemolytica, bovine viral diarrhoea virus and bovine herpesvirus 1, in locally backgrounded feedlot cattle.

OBJECTIVES: This study evaluates the effects of respiratory vaccines on health and growth rates in cattle placed in local backgrounding facilities then feedlots. METHODS: A total of 7011 cattle entering backgrounding facilities contiguous with six feedlots in Australia were allocated to eight respiratory vaccine categories, including an untreated control category. The vaccines, against Mannheimia haemolytica, bovine viral diarrhoea virus and bovine herpesvirus 1, were administered in various combinations at backgrounding facility entry and subsequent feedlot entry. Cattle were held in the backgrounding facilities for a minimum of 28 days. RESULTS: During their feedlot phase, 3.7% of study animals were detected with bovine respiratory disease (BRD). BRD sub hazard was lowest in cattle vaccinated with Bovilis MH + infectious bovine rhinotracheitis® (sub hazards ratio: 0.47; 95% confidence interval: 0.27-0.83; P = 0.010), and point estimates for other vaccine combinations did not differ (P > 0.10) from controls. Six of the respiratory vaccine combinations decreased growth rate during backgrounding relative to untreated controls (P ≤ 0.003). Overall, the feedlot growth rate was not significantly affected by the vaccine category (overall Wald P = 0.191). CONCLUSIONS: Use of these respiratory vaccines in cattle held for at least 28 days in backgrounding facilities contiguous with their feedlots before feedlot entry reduces growth rate during the backgrounding period and does not result in large beneficial effects on either BRD risk or average daily live weight gain during the feedlot phase.

Frailty and hospital outcomes within a low socioeconomic population.

BACKGROUND: Clinical frailty scales (CFS) predict hospital-related outcomes. Frailty is more common in areas of higher socioeconomic disadvantage, but no studies exclusively report on the impact of CFS on hospital-related outcomes in areas of known socioeconomic disadvantage. AIMS: To evaluate the association of the CFS with hospital-related outcomes. DESIGN: Retrospective observational study in a community hospital within a disadvantaged area in Australia (Social Economic Index for Areas = 0.1%). METHODS: The CFS was used in the emergency department (ED) for people aged ≥ 75 years. Frailty was defined as a score of ≥4. Associations between the CFS and mortality, admission rates, ED presentations and length of stay (LOS) were analysed using regression analyses. RESULTS: Between 11 July 2017 and 31 March 2018, there were 5151 ED presentations involving 3258 patients aged ≥ 75 years. Frail persons were significantly more likely to be older, represent to the ED and have delirium compared with non-frail persons. CFS was independently associated with 28-day mortality, with odds of mortality increasing by 1.5 times per unit increase in CFS (95% CI: 1.3-1.7). Frail persons with CFS 4-6 were more likely to be admitted (OR: 1.2; 95% CI: 1.0-1.5), have higher geometric mean LOS (1.43; 95% CI 1.15-1.77 days) and higher rates of ED presentations (IRR: 1.12; 95% CI 1.04-1.21) compared with non-frail persons. CONCLUSIONS: The CFS predicts community hospital-related outcomes in frail persons within a socioeconomic disadvantage area. Future intervention and allocation of resources could consider focusing on CFS 4-6 as a priority for frail persons within a community hospital setting.

Mycoplasma bovis and bovine respiratory disease: A risk factor study in Australian feeder cattle.

Mycoplasma bovis can be a bacterial inhabitant of the upper respiratory tract of healthy bovines. In body regions other that the upper respiratory tract however, M. bovis is associated with a number of clinical syndromes such as bovine respiratory disease (BRD). This study used two enzyme-linked immunosorbent assays to assess the sero-status of M. bovis-specific antibodies in Australian feeder cattle at the time of feedlot induction and at approximately 42 days on feed (follow-up). The apparent sero-prevalence of M. bovis-specific antibody at induction was estimated to be 3.5% (95% confidence interval [CI] 2.0-5.0%, 47/1354) and 25.3% (95% CI 21.9-28.8%, 343/1354) at follow-up. Exposure to M. bovis between induction and follow-up as demonstrated by an increase in serum antibodies was estimated to be 19.4% (95% CI 16.2-22.6%, 261/1349). Risk factors associated with sero-positivity at feedlot induction included the region where animals were 28 days prior to induction and saleyard exposure at least 27 days prior to induction. Risk factors associated with a sero-increase between induction and follow-up included breed, source region and access to water shared with an adjoining pen of animals. Of these, shared pen water was considered the most important (odds ratio [OR] 3.3, 95% CI 1.5-7.4, p = 0.003). Animals exposed to M. bovis between induction and follow-up were at a substantially increased risk of BRD (OR 2.2, 95% CI 1.4-3.4, p = 0.001). This is the first Australian study that has identified risk factors for M. bovis sero-positivity and sero-increase and shown an association between sero-increase and the risk of BRD in the feeder cattle population. These findings suggest that M. bovis is a significant pathogen in the Australian feeder cattle population. In addition, identification of defined risk factors associated with an increased risk of exposure to M. bovis can assist in the development of targeted control measures to reduce the economic impact of M. bovis associated disease and BRD in feeder cattle.

Population-level effects of risk factors for bovine respiratory disease in Australian feedlot cattle.

Results obtained from a nationwide longitudinal study were extended to estimate the population-level effects of selected risk factors on the incidence of bovine respiratory disease (BRD) during the first 50days at risk in medium-sized to large Australian feedlots. Population attributable fractions (PAF) and population attributable risks (PAR) were used to rank selected risk factors in order of importance from the perspective of the Australian feedlot industry within two mutually exclusive categories: 'intervention' risk factors had practical strategies that feedlot managers could implement to avoid exposure of cattle to adverse levels of the risk factor and a precise estimate of the population-level effect while 'others' did not. An alternative method was also used to quantify the expected effects of simultaneously preventing exposure to multiple management-related factors whilst not changing exposure to factors that were more difficult to modify. The most important 'intervention' risk factors were shared pen water (PAF: 0.70, 95% credible interval: 0.45-0.83), breed (PAF: 0.67, 95% credible interval: 0.54-0.77), the animal's prior lifetime history of mixing with cattle from other herds (PAF: 0.53, 95% credible interval: 0.30-0.69), timing of the animal's move to the vicinity of the feedlot (PAF: 0.45, 95% credible interval: 0.17-0.68), the presence of Bovine viral diarrhoea virus 1 (BVDV-1) in the animal's cohort (PAF: 0.30, 95% credible interval: 0.04-0.50), the number of study animals in the animal's group 13days before induction (PAF: 0.30, 95% credible interval: 0.10-0.44) and induction weight (PAF: 0.16, 95% credible interval: 0.09-0.23). Other important risk factors identified and prioritised for further research were feedlot region, season of induction and cohort formation patterns. An estimated 82% of BRD incidence was attributable to management-related risk factors, whereby the lowest risk category of a composite management-related variable comprised animals in the lowest risk category of at least four of the five component variables (shared pen water, mixing, move timing, BVDV-1 in the cohort and the number of animals in the animal's group-13). This indicated that widespread adoption of appropriate interventions including ensuring pen water is not shared between pens, optimising animal mixing before induction, timing of the animal's move to the vicinity of the feedlot, and group size prior to placing animals in feedlot pens, and avoiding BVDV-1 in cohorts could markedly reduce the incidence of BRD in medium-sized to large Australian feedlots.

Associations between feedlot management practices and bovine respiratory disease in Australian feedlot cattle.

Bovine respiratory disease (BRD) is the major cause of clinical disease and death in feedlot cattle. A prospective longitudinal study was conducted in a population of Australian feedlot cattle to assess associations between factors related to feedlot management and risk of BRD. In total, 35,131 animals in 170 pens (cohorts) inducted into 14 feedlots were included in statistical analyses. Causal diagrams were used to inform model building to allow separate estimation of total and direct effects. Multilevel mixed effects logistic regression models were fitted within the Bayesian framework. The placement of pen water troughs such that they could be accessed by animals in adjoining pens was associated with markedly increased risk of BRD (OR 4.3, 95% credible interval: 1.4-10.3). Adding animals to pens over multiple days was associated with increased risk of BRD across all animals in those pens compared to placing all animals in the pen on a single day (total effect: OR 1.9, 95% credible interval: 1.2-2.8). The much attenuated direct effect indicated that this was primarily mediated via factors on indirect pathways so it may be possible to ameliorate the adverse effects of adding animals to pens over multiple days by altering exposure to these intervening factors (e.g. mixing history). In pens in which animals were added to the pen over multiple days, animals added ≥7 days (OR: 0.7, credible interval: 0.5-0.9) or 1-6 days (OR: 0.8, credible interval: 0.7-1.0) before the last animal was added were at modestly reduced risk of BRD compared to the animals that were added to the pen on the latest day. Further research is required to disentangle effects of cohort formation patterns at animal-level and higher levels on animal-level risk of BRD. Vaccination against Bovine herpesvirus 1 at feedlot entry was investigated but results were inconclusive and further research is required to evaluate vaccine efficacy. We conclude that there are practical interventions available to feedlot managers to reduce the risk of cattle developing BRD at the feedlot. We recommend placement of water troughs in feedlot pens so that they cannot be accessed by animals in adjoining pens. Further research is required to identify practical and cost-effective management strategies that allow longer adaption times for cattle identified prior to induction as being at higher risk of developing BRD.

Associations between prior management of cattle and risk of bovine respiratory disease in feedlot cattle.

Bovine respiratory disease (BRD) is the major cause of clinical disease and death in feedlot populations worldwide. A longitudinal study was conducted to assess associations between risk factors related to on-farm management prior to transport to the feedlot and risk of BRD in a population of feedlot beef cattle sourced from throughout the cattle producing regions of Australia. Exposure variables were derived from questionnaire data provided by farmers supplying cattle (N=10,721) that were a subset of the population included in a nationwide prospective study investigating numerous putative risk factors for BRD. Causal diagrams were used to inform model building to allow estimation of effects of interest. Multilevel mixed effects logistic regression models were fitted within the Bayesian framework. Animals that were yard weaned were at reduced risk (OR: 0.7, 95% credible interval: 0.5-1.0) of BRD at the feedlot compared to animals immediately returned to pasture after weaning. Animals that had previously been fed grain (OR: 0.6, 95% credible interval: 0.3-1.1) were probably at reduced risk of BRD at the feedlot compared to animals not previously fed grain. Animals that received prior vaccinations against Bovine viral diarrhoea virus 1 (OR: 0.8, 95% credible interval: 0.5-1.1) or Mannheimia haemolytica (OR: 0.8, 95% credible interval: 0.6-1.0) were also probably at reduced risk compared to non-vaccinated animals. The results of this study confirm that on-farm management before feedlot entry can alter risk of BRD after beef cattle enter feedlots.

Associations between exposure to viruses and bovine respiratory disease in Australian feedlot cattle.

Bovine respiratory disease (BRD) is the most important cause of clinical disease and death in feedlot cattle. Respiratory viral infections are key components in predisposing cattle to the development of this disease. To quantify the contribution of four viruses commonly associated with BRD, a case-control study was conducted nested within the National Bovine Respiratory Disease Initiative project population in Australian feedlot cattle. Effects of exposure to Bovine viral diarrhoea virus 1 (BVDV-1), Bovine herpesvirus 1 (BoHV-1), Bovine respiratory syncytial virus (BRSV) and Bovine parainfluenza virus 3 (BPIV-3), and to combinations of these viruses, were investigated. Based on weighted seroprevalences at induction (when animals were enrolled and initial samples collected), the percentages of the project population estimated to be seropositive were 24% for BoHV-1, 69% for BVDV-1, 89% for BRSV and 91% for BPIV-3. For each of the four viruses, seropositivity at induction was associated with reduced risk of BRD (OR: 0.6-0.9), and seroincrease from induction to second blood sampling (35-60 days after induction) was associated with increased risk of BRD (OR: 1.3-1.5). Compared to animals that were seropositive for all four viruses at induction, animals were at progressively increased risk with increasing number of viruses for which they were seronegative; those seronegative for all four viruses were at greatest risk (OR: 2.4). Animals that seroincreased for one or more viruses from induction to second blood sampling were at increased risk (OR: 1.4-2.1) of BRD compared to animals that did not seroincrease for any viruses. Collectively these results confirm that prior exposure to these viruses is protective while exposure at or after feedlot entry increases the risk of development of BRD in feedlots. However, the modest increases in risk associated with seroincrease for each virus separately, and the progressive increases in risk with multiple viral exposures highlights the importance of concurrent infections in the aetiology of the BRD complex. These findings indicate that, while efficacious vaccines could aid in the control of BRD, vaccination against one of these viruses would not have large effects on population BRD incidence but vaccination against multiple viruses would be expected to result in greater reductions in incidence. The findings also confirm the multifactorial nature of BRD development, and indicate that multifaceted approaches in addition to efficacious vaccines against viruses will be required for substantial reductions in BRD incidence.

Associations between animal characteristic and environmental risk factors and bovine respiratory disease in Australian feedlot cattle.

A prospective longitudinal study was conducted in a population of Australian feedlot cattle to assess associations between animal characteristic and environmental risk factors and risk of bovine respiratory disease (BRD). Animal characteristics were recorded at induction, when animals were individually identified and enrolled into study cohorts (comprising animals in a feedlot pen). Environmental risk factors included the year and season of induction, source region and feedlot region and summary variables describing weather during the first week of follow-up. In total, 35,131 animals inducted into 170 cohorts within 14 feedlots were included in statistical analyses. Causal diagrams were used to inform model building and multilevel mixed effects logistic regression models were fitted within the Bayesian framework. Breed, induction weight and season of induction were significantly and strongly associated with risk of BRD. Compared to Angus cattle, Herefords were at markedly increased risk (OR: 2.0, 95% credible interval: 1.5-2.6) and tropically adapted breeds and their crosses were at markedly reduced risk (OR: 0.5, 95% credible interval: 0.3-0.7) of developing BRD. Risk of BRD declined with increased induction weight, with cattle in the heaviest weight category (≥480kg) at moderately reduced risk compared to cattle weighing <400kg at induction (OR: 0.6, 95% credible interval: 0.5-0.7). Animals inducted into feedlots during summer (OR: 2.4, 95% credible interval: 1.4-3.8) and autumn (OR: 2.1, 95% credible interval: 1.2-3.2) were at markedly increased risk compared to animals inducted during spring. Knowledge of these risk factors may be useful in predicting BRD risk for incoming groups of cattle in Australian feedlots. This would then provide the opportunity for feedlot managers to tailor management strategies for specific subsets of animals according to predicted BRD risk.

Effects of exposure to Bovine viral diarrhoea virus 1 on risk of bovine respiratory disease in Australian feedlot cattle.

Viruses play a key role in the complex aetiology of bovine respiratory disease (BRD). Bovine viral diarrhoea virus 1 (BVDV-1) is widespread in Australia and has been shown to contribute to BRD occurrence. As part of a prospective longitudinal study on BRD, effects of exposure to BVDV-1 on risk of BRD in Australian feedlot cattle were investigated. A total of 35,160 animals were enrolled at induction (when animals were identified and characteristics recorded), held in feedlot pens with other cattle (cohorts) and monitored for occurrence of BRD over the first 50days following induction. Biological samples collected from all animals were tested to determine which animals were persistently infected (PI) with BVDV-1. Data obtained from the Australian National Livestock Identification System database were used to determine which groups of animals that were together at the farm of origin and at 28days prior to induction (and were enrolled in the study) contained a PI animal and hence to identify animals that had probably been exposed to a PI animal prior to induction. Multi-level Bayesian logistic regression models were fitted to estimate the effects of exposure to BVDV-1 on the risk of occurrence of BRD. Although only a total of 85 study animals (0.24%) were identified as being PI with BVDV-1, BVDV-1 was detected on quantitative polymerase chain reaction in 59% of cohorts. The PI animals were at moderately increased risk of BRD (OR 1.9; 95% credible interval 1.0-3.2). Exposure to BVDV-1 in the cohort was also associated with a moderately increased risk of BRD (OR 1.7; 95% credible interval 1.1-2.5) regardless of whether or not a PI animal was identified within the cohort. Additional analyses indicated that a single quantitative real-time PCR test is useful for distinguishing PI animals from transiently infected animals. The results of the study suggest that removal of PI animals and/or vaccination, both before feedlot entry, would reduce the impact of BVDV-1 on BRD risk in cattle in Australian feedlots. Economic assessment of these strategies under Australian conditions is required.

Risk factors for bovine respiratory disease in Australian feedlot cattle: use of a causal diagram-informed approach to estimate effects of animal mixing and movements before feedlot entry.

A nationwide longitudinal study was conducted to investigate risk factors for bovine respiratory disease (BRD) in cattle in Australian feedlots. After induction (processing), cattle were placed in feedlot pens (cohorts) and monitored for occurrence of BRD over the first 50 days on feed. Data from a national cattle movement database were used to derive variables describing mixing of animals with cattle from other farms, numbers of animals in groups before arrival at the feedlot, exposure of animals to saleyards before arrival at the feedlot, and the timing and duration of the animal's move to the vicinity of the feedlot. Total and direct effects for each risk factor were estimated using a causal diagram-informed process to determine covariates to include in four-level Bayesian logistic regression models. Mixing, group size and timing of the animal's move to the feedlot were important predictors of BRD. Animals not mixed with cattle from other farms prior to 12 days before induction and then exposed to a high level of mixing (≥4 groups of animals mixed) had the highest risk of developing BRD (OR 3.7) compared to animals mixed at least 4 weeks before induction with less than 4 groups forming the cohort. Animals in groups formed at least 13 days before induction comprising 100 or more (OR 0.5) or 50-99 (OR 0.8) were at reduced risk compared to those in groups of less than 50 cattle. Animals moved to the vicinity of the feedlot at least 27 days before induction were at reduced risk (OR 0.4) compared to cattle undergoing short-haul transportation (<6h) to the feedlot within a day of induction, while those experiencing longer transportation durations (6h or more) within a day of induction were at slightly increased risk (OR 1.2). Knowledge of these risk factors could potentially be used to inform management decisions to reduce the risk of BRD in feedlot cattle.

Phase 3 trial of domiciliary humidification to mitigate acute mucosal toxicity during radiation therapy for head-and-neck cancer: first report of Trans Tasman Radiation Oncology Group (TROG) 07.03 RadioHUM study.

PURPOSE: To assess the impact of domicile-based humidification on symptom burden during radiation therapy (RT) for head-and-neck (H&N) cancer. METHODS AND MATERIALS: From June 2007 through June 2011, 210 patients with H&N cancer receiving RT were randomized to either a control arm or to receive humidification using the Fisher & Paykel Healthcare MR880 humidifier. Humidification commenced on day 1 of RT and continued until Common Terminology Criteria for Adverse Events (CTCAE), version 3.0, clinical mucositis (CMuc) grade ≤1 occurred. Forty-three patients (42%) met a defined benchmark for humidification compliance and contributed to per protocol (PP) analysis. Acute toxicities, hospitalizations, and feeding tube events were recorded prospectively. The McMaster University Head and Neck Radiotherapy Questionnaire (HNRQ) was used for patient-reported outcomes. The primary endpoint was area under the curve (AUC) for CMuc grade ≥2. RESULTS: There were no significant differences in AUC for CMuc ≥2 between the 2 arms. Humidification patients had significantly fewer days in hospital (P=.017). In compliant PP patients, the AUC for CTCAE functional mucositis score (FMuc) ≥2 was significantly reduced (P=.009), and the proportion who never required a feeding tube was significantly greater (P=.04). HNRQ PP analysis estimates also in the direction favoring humidification with less symptom severity, although differences at most time points did not reach significance. CONCLUSIONS: TROG 07.03 has provided efficacy signals consistent with a role for humidification in reducing symptom burden from mucositis, but the influence of humidification compliance on the results moderates recommendations regarding its practical utility.

Demographic analysis of oral lichen planus presentations to Auckland Oral Medicine Clinic from 1999 to 2006.

AIM: The objective of this study was to describe the demographic characteristics of a case series of patients with a clinical and histopathological diagnosis of oral lichen planus who presented to the Oral Health Unit (Auckland District Health Board) between the years 1999 and 2006 (an 8-year period). METHOD: The records of patients who had a clinical and histopathological diagnosis of oral lichen planus were audited. Demographic (age, gender, ethnicity), clinical and histopathological data were collated. Patients whose ethnicity was not recorded were noted but not included in this part of the analysis. RESULTS: Between 1999 and 2006, 267 patients (82 males, 185 females; age range 21 to 93 years) had a clinical and histopathological diagnosis of oral lichen planus. Ethnicity data were available for 207 of those, of whom 108 (52.2%) were European; 65 (31.4%) of Indian subcontinent origin (India, Pakistan, Sri Lanka); 20 (9.7%) were Asian; 14 (6.8%) were Pacific Islanders; 50 (24.2%) were 'Other'; and 10 (4.8%) were 'Unknown'. None was Maori. CONCLUSION: The age and gender distribution in this case series were similar to that observed in a comparable UK study. The major findings were in the ethnic distribution of oral lichen planus in the sample, with patients of Indian subcontinent origin being over-represented, and Maori being under-represented.

Retrospective audit of the use of the Marx Protocol for prophylactic hyperbaric oxygen therapy in managing patients requiring dental extractions following radiotherapy to the head and neck.

OBJECTIVE: The study's primary objective was to review (for the years 2003 to 2006) the outcomes of using prophylactic hyperbaric oxygen therapy (HBOT) to prevent osteoradionecrosis (ORN) in a group of patients previously exposed to radiotherapy of the head and neck. A secondary objective was to evaluate any HBOT-associated vision changes. DESIGN: The study was a retrospective audit of the clinical outcomes of HBOT for the prevention of ORN following dental extractions in previously irradiated jaws. METHODS: Information was obtained from dental records held at Green Lane Clinical Centre (Auckland) and Oxygen Therapies Ltd (Quay Park Health, Auckland). Data included patient age, gender, site of tumour, radiation dose, time lapse between radiotherapy and tooth/teeth extracted, extraction procedures and the HBOTprotocol used. Follow-up data were obtained through a telephone interview using a standardised questionnaire. RESULTS: Of the 29 treated patients, 26 (90%) were available for follow-up. Of these, one failed to heal after dental extractions following the use of prophylactic HBOT, and only nine (34%) developed temporary vision changes. CONCLUSION: The outcome of this audit suggests that it is appropriate to use prophylactic HBOT in association with dental extractions in patients who have previously had radiotherapy to the head and neck. Acute vision changes following the 30th HBOT were transient.

Migrating foreign body in the tongue.

We present an unusual case where a foreign body entered and migrated through the tongue. In its path, it created a multitude of different symptoms including ecchymoses, small lumps, submental swelling and neuralgic-type pain. The foreign body had migrated from the left postero-lateral surface of the tongue, anteriorly along the lateral then dorsal surfaces of the tongue, until it self-exfoliated on the right anterior floor of the mouth. A brief literature review is also presented.

Theoretical model for the wetting of a rough surface.

Many applications would benefit from an understanding of the physical mechanism behind fluid movement on rough surfaces, including the movement of water or contaminants within an unsaturated rock fracture. Presented is a theoretical investigation of the effect of surface roughness on fluid spreading. It is known that surface roughness enhances the effects of hydrophobic or hydrophilic behavior, as well as allowing for faster spreading of a hydrophilic fluid. A model is presented based on the classification of the regimes of spreading that occur when fluid encounters a rough surface: microscopic precursor film, mesoscopic invasion of roughness and macroscopic reaction to external forces. A theoretical relationship is developed for the physical mechanisms that drive mesoscopic invasion, which is used to guide a discussion of the implications of the theory on spreading conditions. Development of the analytical equation is based on a balance between capillary forces and frictional resistive forces. Chemical heterogeneity is ignored. The effect of various methods for estimating viscous dissipation is compared to available data from fluid rise on roughness experiments. Methods that account more accurately for roughness shape better explain the data as they account for more surface friction; the best fit was found for a hydraulic diameter approximation. The analytical solution implies the existence of a critical contact angle that is a function of roughness geometry, below which fluid will spread and above which fluid will resist spreading. The resulting equation predicts movement of a liquid invasion front with a square root of time dependence, mathematically resembling a diffusive process.

Concomitant adsorption and desorption of organic vapor in dry and humid air streams using microwave and direct electrothermal swing adsorption.

Industrial gas streams can contain highly variable organic vapor concentrations that need to be processed before they are emitted to the atmosphere. Fluctuations in organic vapor concentrations make it more difficult to operate a biofilter when compared to a constant vapor concentration. Hence, there is a need to stabilize the concentration of rapidly fluctuating gas streams for optimum operation of biofilters. This paper describes new concomitant adsorption desorption (CAD) systems used with variable organic vapor concentration gas streams to provide the same gas stream, but at a user-selected constant vapor concentration that can then be more readily processed by a secondary air pollution control device such as a biofilter. The systems adsorb organic vapor from gas streams and simultaneously heat the adsorbent using microwave or direct electrothermal energy to desorb the organic vapor at a user-selected set-point concentration. Both systems depicted a high degree of concentration stabilization with a mean relative deviation between set-point and stabilized concentration of 0.3-0.4%. The direct electrothermal CAD system was also evaluated to treat a humid gas stream (relative humidity = 85%) that contained a variable organic vapor concentration. The high humidity did not interfere with CAD operation as water vapor did not adsorb but penetrated through the adsorbent These results are important because they demonstrate the ability of CAD to effectively dampen concentration fluctuation in gas streams.

Home-based humidification for mucositis in patients undergoing radical radiotherapy: preliminary report.

INTRODUCTION: Oropharyngeal mucositis is a frequent, severe complication of local irradiation for tumours in the head and neck. We postulated that heated humidification of inspired air via a nasal interface may palliate symptoms of mucositis by reducing the discomfort associated with dry, sticky secretions. We sought to review the effect of home-based humidification on hospital admissions and the patient reported experience of that humidification. METHODS: This study was a retrospective review. A historical (control) group of patients did not receive home humidification at any stage (n = 55) and a study group (n = 53) received home humidification at or after the onset of grade 3 mucositis. A questionnaire was sent to study group patients to obtain information about their experience of using the humidifier at home. RESULTS: There were no demographic differences between the study and control groups, but the study group had significantly more advanced cancer (stage IV; p = .0307) and significantly higher total fractions and days treated (p < .01). Group comparison showed no difference in subsequent overall hospital admissions (p = .9269), but 7 of the 55 control group patients (12.7%) were admitted for supportive care within 2 months of completing radiotherapy, whereas none of the 53 patients who used home humidification were admitted after starting that use (p < .01). Almost all (95%) of the study group patients reported that humidification was of benefit, and 81% stated that it relieved mouth or throat pain. CONCLUSION: Humidification of inspired gas offers a simple, drug-free option for managing a number of the adverse mucosal effects of radiation and chemoradiation in head and neck cancer patients.