Popliteomeniscal fascicles tears with lateral meniscus instability: outcomes of arthroscopic surgical technique at mid-term follow-up.

PURPOSE: The popliteomeniscal fascicles (PMFs) are a crucial part of the posterolateral corner of the knee. They provide stability to the lateral meniscus and stabilize the joint during tibial internal rotation. The clinical diagnosis of a torn PMFs is difficult, and magnetic resonance imaging (MRI) may be inconclusive as well. The aim of the present study was to report the outcomes of a continuous series of patients affected by PMF lesions and treated with an arthroscopic repair. METHODS: Seventeen patients (average age of 22 ± 3.6 years) with PMF lesions and lateral meniscus instability were prospectively enrolled. All patients were evaluated with clinical examination, International Knee Documentation Committee (IKDC), Lysholm and Tegner scores and 1.5 T MRI. All patients had the same arthroscopic procedure consisting of meniscal repair with an all-inside meniscal repair system (mean 2.2 ± 0.77 anchors) and followed with the same postoperative protocol. RESULTS: All patients were available at a mean follow-up of 68 ± 24 months (range 49-84 months). Mean IKDC increased from 60.2 ± 13.5 to 83.1 ± 12, mean Lysholm score improved from 56.7 ± 8.2 to 89.8 ± 3.2, and mean Tegner score improved from 2.9 ± 1.3 to 6.5 ± 2. No intraoperative or postoperative complications were reported. MRI evaluation at 6-month follow-up showed successful healing of the menisco-popliteal fascicles in all cases. CONCLUSIONS: The diagnosis and treatment of tears of the PMFs is still debated. Diagnostic confirmation of tearing of the PMFs is usually determined at the time of arthroscopy. Meniscal repair with an all-inside meniscal repair system appears to be an excellent treatment option, since it yields good functional results at mid-term follow-up, no local complications, and complete radiographic healing at 6-month follow-up MRI. Further studies are needed to confirm these promising early results. LEVEL OF EVIDENCE: Case series, 4.

Behcet's Disease (BD) Presenting as a Cerebral Venous Sinus Thrombosis (CVST).

Presentation 20 year old Caucasian male presented to eye casualty 4 weeks post initial diagnosis of bilateral acute anterior uveitis (AAU), with a three-week history of a progressively worsening headache associated with nausea and vomiting. Diagnosis Non-contrast Computed Topography of the head and Magnetic Resonance venogram revealed a cerebral venous sinus thrombosis (CVST). He had a long-standing history of intermittent oral ulceration, and was diagnosed with Neuro Behcet's Disease (NBD). Treatment The patient was commenced on a therapeutic dose of enoxaparin and prednisolone, and was discharged on enoxaparin, warfarin, tapering prednisolone and azathioprine. Discussion/Conclusion NBD is a rare, but serious manifestation of BD. BD is an important differential diagnosis in a young patient presenting with CVST or bilateral AAU.

Factors associated with Tdap vaccination receipt during pregnancy: a cross-sectional study.

OBJECTIVE: Pertussis morbidity and mortality disproportionately affect infants younger than 1 year, who constitute 70% of deaths from pertussis. In 2017, 43% of infants younger than 6 months diagnosed with pertussis were hospitalized. In 2012, the Advisory Committee on Immunization Practices recommended that all pregnant women should receive Tdap (tetanus-diphtheria-acellular pertussis) vaccine between 27- and 36-weeks gestation in an effort to reduce infant pertussis morbidity and mortality. However, Tdap vaccination rates among pregnant women remain far from robust. The aim of this study was to assess factors associated with maternal Tdap uptake to help providers identify best practices that can improve Tdap receipt and identify women at risk for not receiving this important vaccine. STUDY DESIGN: A retrospective cross-sectional study. METHODS: A review of prenatal and delivery records was performed on all maternal-infant dyads with infants older than 36 weeks gestation admitted to the term nursery at Albany Medical Center from January 1, 2016 to April 16, 2016. A chi-squared analysis using STATA®, version 14.1, was performed to determine if any variables were associated with Tdap uptake, with statistical significance defined as P < 0.05. Multivariate analysis was performed to identify the variables which had the greatest effect on Tdap receipt. RESULTS: Tdap vaccine was received by 65.8% of pregnant women (n = 400) in the study; median gestational age of receipt was 30 weeks. Maternal influenza vaccine receipt, infant hepatitis B vaccine receipt, provider recommendation of Tdap vaccination, and on-site availability of Tdap vaccine were all positively associated with maternal Tdap receipt during pregnancy. CONCLUSION: Receipt of Tdap by pregnant women was highest in those who had received a provider recommendation about its benefits and who also received influenza vaccine during pregnancy. Because women who received the influenza vaccine themselves and also consented to have their infants receive the hepatitis B vaccine had significantly higher uptake rates, encouraging vaccines usage and combating vaccine hesitancy in general can improve Tdap uptake rates. A small, but statistically significant association with receipt of assisted reproductive technologies was also seen, meriting future research.

Comparable clinical and functional outcomes after anterior cruciate ligament reconstruction over and under 40 years of age.

PURPOSE: The aim of the present meta-analysis was to update the literature on the outcomes and complications of ACL reconstruction in patients aged 40 years and older. It has been hypothesized that patients older than 40 years of age may have comparable clinical outcomes to those of younger patients. METHODS: A systematic review of articles from 1996 to 2018 was completed using Pubmed, Medline, Cochrane Reviews, and Google Scholar databases using the keyword terms "anterior cruciate ligament reconstruction" and "middle-aged OR elderly OR over 40 OR age factors." Functional and clinical outcomes (International Knee Documentation Committee, Lysholm and Tegner score and KT-1000 arthrometer), complication and graft failure rate were evaluated. RESULTS: Eleven articles met inclusion criteria. In total, 306 middle-aged patients and 566 younger patients were included in this study. The mean age of patients > 40 was 49 ± 7 (range 40-75) years with a mean follow-up of 25 ± 9 months (range 12-68). The mean age of younger patients was 26 ± 2.7 (range 15-39) years with a mean post-operative follow-up of 26.7 ± 11.5 months (range 3-64). The results were slightly higher (but no significantly different) towards the younger group in terms of objective IKDC (P = n.s.), Lysholm (P = n.s.) and Tegner (P = n.s.) scores and knee laxity assessment (P = n.s.). Complication rate (P = n.s.) and graft failure (P = n.s.) were low even in this cohort. CONCLUSIONS: The present meta-analysis shows that patients older than 40 years achieve comparable clinical outcomes to those of younger patients following primary ACL reconstruction. This evidence may push the surgeons toward a more aggressive approach in this specific cohort of patients. LEVEL OF EVIDENCE: III.

The Oldowan industry from Swartkrans cave, South Africa, and its relevance for the African Oldowan.

The oldest recognized artifacts at the Swartkrans cave hominid-bearing site in South Africa have long been known to occur in the Lower Bank of Member 1, now dated with the cosmogenic nuclide burial method to ca. 1.8-2.19 Ma. However, the affinities of this industry have been debated due to small sample size. In this paper we present newly excavated material from the Lower Bank retrieved since 2005 in the Swartkrans Paleoanthropological Research Project. The sample is now large enough to confirm its affinity with the Oldowan industrial complex. The assemblage is highly expedient and core reduction strategies are largely casual. Although freehand flaking is present, the bipolar technique is most significant, even in non-quartz raw materials. The Swartkrans assemblage shows some significant contrasts with the Sterkfontein Oldowan, ca. 2.18 Ma, which can be explained by its closer proximity to raw material sources, its somewhat different geographic context, and its more expedient nature. The Swartkrans Oldowan now provides us with the first good indication of Oldowan variability in southern Africa, where only two sizeable assemblages have thus far been discovered. Comparisons are made with other sites across Africa that help to place this variability within our overall understanding of the Oldowan industrial complex.

Parsing the Behavioral and Brain Mechanisms of Third-Party Punishment.

UNLABELLED: The evolved capacity for third-party punishment is considered crucial to the emergence and maintenance of elaborate human social organization and is central to the modern provision of fairness and justice within society. Although it is well established that the mental state of the offender and the severity of the harm he caused are the two primary predictors of punishment decisions, the precise cognitive and brain mechanisms by which these distinct components are evaluated and integrated into a punishment decision are poorly understood. Using fMRI, here we implement a novel experimental design to functionally dissociate the mechanisms underlying evaluation, integration, and decision that were conflated in previous studies of third-party punishment. Behaviorally, the punishment decision is primarily defined by a superadditive interaction between harm and mental state, with subjects weighing the interaction factor more than the single factors of harm and mental state. On a neural level, evaluation of harms engaged brain areas associated with affective and somatosensory processing, whereas mental state evaluation primarily recruited circuitry involved in mentalization. Harm and mental state evaluations are integrated in medial prefrontal and posterior cingulate structures, with the amygdala acting as a pivotal hub of the interaction between harm and mental state. This integrated information is used by the right dorsolateral prefrontal cortex at the time of the decision to assign an appropriate punishment through a distributed coding system. Together, these findings provide a blueprint of the brain mechanisms by which neutral third parties render punishment decisions. SIGNIFICANCE STATEMENT: Punishment undergirds large-scale cooperation and helps dispense criminal justice. Yet it is currently unknown precisely how people assess the mental states of offenders, evaluate the harms they caused, and integrate those two components into a single punishment decision. Using a new design, we isolated these three processes, identifying the distinct brain systems and activities that enable each. Additional findings suggest that the amygdala plays a crucial role in mediating the interaction of mental state and harm information, whereas the dorsolateral prefrontal cortex plays a crucial, final-stage role, both in integrating mental state and harm information and in selecting a suitable punishment amount. These findings deepen our understanding of how punishment decisions are made, which may someday help to improve them.

A novel broth medium for enhanced growth of Francisella tularensis.

Francisella tularensis is a fastidious organism that requires a lengthy incubation time in liquid growth media for detection. The objective of this study was to develop a medium formulation using readily available supplements that enhanced early growth of F. tularensis. Francisella tularensis live vaccine strain was used to evaluate the growth responses for each of the media formulations tested. Growth in brain heart infusion broth supplemented with 2% Vitox, 10% Fildes and 1% histidine (BVFH) resulted in a significant increase in growth after 8 h incubation compared to other media formulations tested (P < 0·001). Virulent strains of F. tularensis grown in BVFH medium demonstrated similar enhanced early growth. Cell densities of 3·9-5·2 log10 CFU per ml were obtained after 24 h of growth in BVFH from a 1-2 cell ml-1 starting inoculum of the virulent Type A Schu4 strain, indicating the suitability of this medium in rapidly amplifying low starting titres of F. tularensis. Collectively, these results indicate that the novel formulation of the BVFH medium was capable of producing enhanced growth response for F. tularensis. SIGNIFICANCE AND IMPACT OF THE STUDY: The need for rapid cultivation of Francisella tularensis is essential for detection and monitoring during natural outbreak events or intentional bioterrorism attacks. The addition of selected supplements into the base medium BHI (BVFH) developed in this study enhanced growth of F. tularensis Type A1, A2 and B strains compared to BHI alone. Growth of these organisms in BVFH will allow for improved response time should a natural or intentional contamination event occur.

No relationship between critical shoulder angle and glenoid erosion after shoulder hemiarthroplasty: a comparative radiographic study.

INTRODUCTION: Symptomatic glenoid erosion is one of the most common causes of functional impairment after shoulder hemiarthroplasty. A decrease in the critical shoulder angle (CSA) has been associated with the development of shoulder arthritis. The inter-observer reliability of the CSA and the relationship between CSA and symptomatic glenoid erosion after shoulder hemiarthroplasty were investigated. MATERIALS AND METHODS: Twenty-eight patients with symptomatic glenoid erosion after anatomic hemiarthroplasty were compared to a control group of 30 patients with no signs of symptomatic glenoid erosion. The CSA was measured by two blinded shoulder surgeons at a mean follow-up of 105.2 and 54.7 months, respectively. The inter-observer reliability was calculated. RESULTS: The mean CSA in the control group in neutral, internal, and external rotations was 34°, 33°, and 33°, respectively. The corresponding values in the study group were 33°, 33°, and 33° (<0.01). The interclass correlation coefficient between the two examiners was 0.917 (P < 0.01), 0.924 (P < 0.01), and 0.948 (P < 0.01), respectively. The Mann-Whitney test between the control group and the study group were, respectively, 0.907, 0.932, and 0.602. CONCLUSION: There were no significant differences of CSA values between the two groups. Good inter-observer reliability was found for the CSA method.

New early Pleistocene hominin teeth from the Swartkrans Formation, South Africa.

We describe 14 hominin teeth and tooth fragments excavated recently from Swartkrans Cave (South Africa). The fossils derive from Members 1 (Lower Bank) and 3, from the Member 2/3 interface and from two deposits not yet assigned to member (the "Talus Cone Deposit" and the "Underground North Excavation" [UNE]) of the Swartkrans Formation, and include the first hominin fossil from the UNE, the two smallest Paranthropus robustus deciduous maxillary second molars in the entire hominin fossil record, and one of the smallest P. robustus permanent maxillary second molars from Swartkrans. The small permanent molar is accompanied by another tooth from a different individual but from the same stratigraphic level of the Swartkrans Formation; this second tooth is among, if not, the largest P. robustus permanent maxillary first molars known from anywhere-lending credence to assertions that degrees of body size sexual dimorphism previously ascribed to this species may be underestimated. It is more equivocal whether this evidence also supports hypotheses proposing that P. robustus assemblages from Swartkrans (as well as those from other South African cave sites) formed through the taphonomically biasing actions of large carnivores.

Psychological wellness and health-related stigma: a pilot study of an acceptance-focused cognitive behavioural intervention for people with lung cancer.

People with lung cancer experience health-related stigma that is related to poorer psychosocial and quality of life outcomes. The present Phase 1 study applied mixed methods to test the acceptability of an acceptance-focused cognitive behavioural intervention targeting stigma for this patient group. Fourteen lung cancer patients completed a 6-week Psychological Wellness intervention with pre- and post-test outcome measures of psychological and cancer-specific distress, depression, health-related stigma and quality of life. In-depth interviews applying interpretative phenomenological analysis assessed participants' experiences of the intervention. Moderate to large improvements were observed in psychological (ηp (2) = 0.182) and cancer-specific distress (ηp (2) = 0.056); depression (ηp (2) = 0.621); health-related stigma (ηp (2) = 0.139). In contrast, quality of life declined (ηp (2) = 0.023). The therapeutic relationship; self-management of distress; and relationship support were highly valued aspects of the intervention. Barriers to intervention included avoidance and practical issues. The lung cancer patients who completed the Psychological Wellness intervention reported improvements in psychological outcomes and decreases in stigma in the face of declining quality of life with patients reporting personal benefit from their own perspectives. A randomised controlled trial is warranted to establish the effectiveness of this approach.

Colonoscopy after spinal cord injury: a case-control study.

DESIGN: An age- and gender-matched case-control study. OBJECTIVE: To compare colonoscopy after spinal cord injury (SCI) with the general population in terms of indications, bowel preparation, technical success and disease detection. SETTING: Victoria, Australia. METHODS: Consecutive SCI colonoscopies between January 1998 and February 2013 were compared with a randomly selected age- and gender-matched control group. Injury level, indication for procedure and demographics were collected. Outcome measures included quality of bowel preparation, completion rates, procedural duration and benign and malignant disease detection. RESULTS: A total of 440 colonoscopies were assessed, comprising 148 SCI patients and 292 age- and gender-matched controls. Both the groups were of similar age (54.7 years vs 54.5 years, P=0.906) and comprised predominantly males (87.1% vs 86.3%, P=0.919). SCI colonoscopies were more often performed to investigate abnormalities (85.1% vs 58.2%, P<0.001) than for screening or surveillance (18.2% vs 40.8%, P<0.001). Unsatisfactory bowel preparation was recorded more often in the SCI group (36.0% vs 13.0%, P<0.001) and completion rates were lower (75.7% vs 93.1%, P<0.001). Overall disease detection was lower in the SCI group (45.3% vs 59.6%, P<0.006). The polyp detection rate was lower for SCI (11.4% vs 25.3%, P=0.001). The rate of diagnosis of malignancy was equivalent (2.7% vs 3.0%, P=0.904). CONCLUSION: SCI patients have the same risk of malignancy as the general population and are less likely to undergo screening colonoscopy. Colonoscopy is then limited by poor bowel preparation and lower completion rates with a subsequent lower polyp detection rate.

Novel treatment strategies for schizophrenia from improved understanding of genetic risk.

Recent years have seen significant advances in our understanding of the genetic basis of schizophrenia. In particular, genome-wide approaches have suggested the involvement of many common genetic variants of small effect, together with a few rare variants exerting relatively large effects. While unequivocal identification of the relevant genes has, for the most part, remained elusive, the genes revealed as potential candidates can in many cases be clustered into functionally related groups which are potentially open to therapeutic intervention. In this review, we summarise this information, focusing on the accumulating evidence that genetic dysfunction at glutamatergic synapses and post-synaptic signalling complexes contributes to the aetiology of the disease. In particular, there is converging support for involvement of post-synaptic JNK pathways in disease aetiology. An expansion of our neurobiological knowledge of the basis of schizophrenia is urgently needed, yet some promising novel pharmacological targets can already be discerned.

Punishment after Life: How Attitudes about Longer-than-Life Sentences Expose the Rules of Retribution.

Prison sentences that exceed the natural lifespan present a puzzle because they have no more power to deter or incapacitate than a single life sentence. In three survey experiments, we tested the extent to which participants support these longer-than-life sentences under different decision contexts. In Experiment 1, 130 undergraduates made hypothetical prison sentence-length recommendations for a serious criminal offender, warranting two sentences to be served either concurrently or consecutively. Using a nationally representative sample (N = 182) and an undergraduate pilot sample (N = 260), participants in Experiments 2 and 3 voted on a hypothetical ballot measure to either allow or prohibit the use of consecutive life sentences. Results from all experiments revealed that, compared to concurrent life sentences participants supported the use of consecutive life sentences for serious offenders. In addition, they adjusted these posthumous years in response to mitigating factors in a manner that was indistinguishable from ordinary sentences (Experiment 1), and their support for consecutive life sentencing policies persisted, regardless of the default choice and whether the policy was costly to implement (Experiments 2 and 3). These judgment patterns were most consistent with retributive punishment heuristics and have implications for sentencing policy and for theories of punishment behavior.

Celebrities and screening: a measurable impact on high-grade cervical neoplasia diagnosis from the 'Jade Goody effect' in the UK.

BACKGROUND: The celebrity Jade Goody's cervical cancer diagnosis was associated with increased UK cervical screening attendance. We wanted to establish if there was an increase in high-grade (HG) cervical neoplasia diagnoses, and if so, what the characteristics of the women with HG disease were. METHODS: We analysed prospective data on 3233 consecutive colposcopy referrals in North East London, UK, from 01 April 2005 to 30 June 2010. Characteristics and outcomes of pre- and post-Goody cohorts were compared. RESULTS: Goody's diagnosis was associated with an increased incidence of colposcopy referrals in all subsequent annual quarters (incidence rate ratio (IRR) 1.3-1.9, P<0.002-P<0.0005) and increased HG disease diagnoses in the fourth quarter 2008/2009 (IRR 1.3, P=0.05) and first quarter 2009/2010 (IRR 1.3, P=0.07). We observed 1.90-fold (CI: 1.06-3.39), 2.06 (CI: 1.13-3.76) and 2.13-fold (CI: 1.07-4.25) respective increases in the odds of HG disease women being screening-naive in the first and second quarter 2009/2010, and the first quarter 2010/2011 (P<0.04, P<0.02 and P<0.04, respectively). There was a 2.23-fold increase in the odds of screening-naive HG disease women being symptomatic post-Goody's diagnosis (P=0.023). The age distributions of the pre- and post-Goody cohorts did not differ in any study group. CONCLUSION: Continued publicity about celebrities' diagnoses might encourage screening in at-risk populations.

Punishment as a scarce resource: a potential policy intervention for managing incarceration rates.

Scholars have proposed that incarceration rates might be reduced by a requirement that judges justify incarceration decisions with respect to their operational costs (e.g., prison capacity). In an Internet-based vignette experiment (N = 214), we tested this prediction by examining whether criminal punishment judgments (prison vs. probation) among university undergraduates would be influenced by a prompt to provide a justification for one's judgment, and by a brief message describing prison capacity costs. We found that (1) the justification prompt alone was sufficient to reduce incarceration rates, (2) the prison capacity message also independently reduced incarceration rates, and (3) incarceration rates were most strongly reduced (by about 25%) when decision makers were asked to justify their sentences with respect to the expected capacity costs. These effects survived a test of robustness and occurred regardless of whether participants reported that prison costs should influence judgments of incarceration. At the individual crime level, the least serious crimes were most amenable to reconsideration for probation. These findings are important for policymakers attempting to manage high incarceration rates.

The genome sequence of Desulfatibacillum alkenivorans AK-01: a blueprint for anaerobic alkane oxidation.

Desulfatibacillum alkenivorans AK-01 serves as a model organism for anaerobic alkane biodegradation because of its distinctive biochemistry and metabolic versatility. The D. alkenivorans genome provides a blueprint for understanding the genetic systems involved in alkane metabolism including substrate activation, CoA ligation, carbon-skeleton rearrangement and decarboxylation. Genomic analysis suggested a route to regenerate the fumarate needed for alkane activation via methylmalonyl-CoA and predicted the capability for syntrophic alkane metabolism, which was experimentally verified. Pathways involved in the oxidation of alkanes, alcohols, organic acids and n-saturated fatty acids coupled to sulfate reduction and the ability to grow chemolithoautotrophically were predicted. A complement of genes for motility and oxygen detoxification suggests that D. alkenivorans may be physiologically adapted to a wide range of environmental conditions. The D. alkenivorans genome serves as a platform for further study of anaerobic, hydrocarbon-oxidizing microorganisms and their roles in bioremediation, energy recovery and global carbon cycling.

New hominid fossils from Member 1 of the Swartkrans formation, South Africa.

Member 1 of the Swartkrans Formation is comprised of two sedimentary infills, the Lower Bank (LB) and the Hanging Remnant (HR). Together, the LB and HR preserve fossils of early Homo and Paranthropus robustus, Earlier Stone Age lithic artifacts, purported bone digging tools and butchered animal bones. Collectively, this evidence was the first to establish the co-existence of two early Pleistocene hominid species and also led to inferences of plant root harvesting and meat-eating by one or both of those species. P. robustus is the more abundant of the two hominids at Swartrkrans, represented in Member 1 by hundreds of fossils that derive from at least 99 individuals. Thus, Swartkrans Member 1 stands as the world's single largest repository of that extinct species. Here we add to the Member 1 sample of hominid fossils with descriptions of 14 newly discovered specimens.

Motorcycles and breast cancer: the influence of peer support and challenge on distress and posttraumatic growth.

PURPOSE: Peer support programs based on exercise or challenge activities may have potential to improve well-being for women diagnosed with breast cancer. The current study investigated the role of social comparison and social identity based on group membership on posttraumatic growth (PTG) and distress. METHODS: Fifty-one women diagnosed with breast cancer who participated in a 1,000 mi group motorcycle ride completed pre- and post-ride surveys. Participants had a mean age of 49.82 years (SD = 7.04) and their average time since diagnosis was 6.39 years (SD = 3.89). RESULTS: Cancer-related distress significantly decreased after the ride. PTG did not significantly differ after the ride, which may have been a result of a ceiling effect on this measure. Hierarchical regression analyses showed that pre-ride PTG (p < 0.01) and upward social comparison during the ride (p < 0.05) were related to post-ride PTG. Pre-ride distress was the only variable to remain significantly related to post-ride distress (p < 0.01). CONCLUSIONS: The results of the current study highlight the potential for challenge-based activities to provide a positive peer support environment for women diagnosed with breast cancer. Identifying factors that promote personal growth and reduce cancer-related distress allow us to create a model for the delivery of these challenge-based peer support activities.

The 2010 Royal Australasian College of Physicians' policy statement 'Circumcision of infant males' is not evidence based.

Infant male circumcision (MC) is an important issue guided by Royal Australasian College of Physicians (RACP) policy. Here we analytically review the RACP's 2010 policy statement 'Circumcision of infant males'. Comprehensive evaluation in the context of published research was used. We find that the Statement is not a fair and balanced representation of the literature on MC. It ignores, downplays, obfuscates or misrepresents the considerable evidence attesting to the strong protection MC affords against childhood urinary tract infections, sexually transmitted infections (human immunodeficiency virus, human papilloma virus, herpes simplex virus type 2, trichomonas and genital ulcer disease), thrush, inferior penile hygiene, phimosis, balanoposthitis and penile cancer, and in women protection against human papilloma virus, herpes simplex virus type 2, bacterial vaginosis and cervical cancer. The Statement exaggerates the complication rate. Assertions that 'the foreskin has a functional role' and 'is a primary sensory part of the penis' are not supported by research, including randomised controlled trials. Instead of citing these and meta-analyses, the Statement selectively cites poor quality studies. Its claim, without support from a literature-based risk-benefit analysis, that the currently available evidence does 'not warrant routine infant circumcision in Australia and New Zealand' is misleading. The Statement fails to explain that performing MC in the neonatal period using local anaesthesia maximises benefits, safety, convenience and cost savings. Because the RACP's policy statement is not a fair and balanced representation of the current literature, it should not be used to guide policy. In the interests of public health and individual well-being, an extensive, comprehensive, balanced review of the scientific literature and a risk-benefit analysis should be conducted to formulate policy.

Psychological distress and unmet supportive care needs in cancer patients and carers who contact cancer helplines.

Cancer information services are a highly accessible source of support for people affected by cancer. To date the nature and extent of distress experienced by such callers and their unmet support needs have not been well described. A cross-sectional survey of 354 cancer patients and 336 carers who reported elevated distress on contact with a cancer information service assessed socio-demographic variables; anxiety, depression and somatization; unmet supportive care needs; cancer-specific distress; presenting problems; post-traumatic growth. Adjustment to cancer was most commonly reported; followed by anxiety. In all, 53.4% of patients and 45.2% of carers reached caseness in anxiety, depression or somatization. Carers had higher distress ratings and intrusive thinking compared to patients; whereas patients had higher somatization. For patients, most unmet supportive care needs were psychological; for carers unmet needs were related to health care services and information related to the person diagnosed with cancer. Being single, unemployed, in treatment, having higher initial distress scores, higher intrusion and avoidance predicted poorer outcomes. Information service frameworks should include distress screening and clear triage and referral processes for psychological care.