[Increased report completeness and satisfaction with structured neurotological reporting in the interdisciplinary assessment of vertigo]. / Erhöhte Befundvollständigkeit und gesteigerte Zuweiserzufriedenheit bei strukturierter neurootologischer Befunderhebung in der interdisziplinären Schwindelabklärung.

BACKGROUND: Results of neurotological function diagnostics in the context of interdisciplinary vertigo assessment are usually formulated as free-text reports (FTR). These are often subject to high variability, which may lead to loss of information. The aim of the present study was to evaluate the completeness of structured reports (SR) and referrer satisfaction in the neurotological assessment of vertigo. MATERIALS AND METHODS: Neurotological function diagnostics performed as referrals (n = 88) were evaluated retrospectively. On the basis of the available raw data, SRs corresponding to FTRs from clinical routine were created by means of a specific SR template for neurotological function diagnostics. FTRs and SRs were evaluated for completeness and referring physician satisfaction (n = 8) using a visual analog scale (VAS) questionnaire. RESULTS: Compared to FTRs, SRs showed significantly increased overall completeness (73.7% vs. 51.7%, p < 0.001), especially in terms of patient history (92.5% vs. 66.7%, p < 0.001), description of previous findings (87.5% vs. 38%, p < 0.001), and neurotological (33.5% vs. 26.7%, p < 0.001) and audiometric function diagnostics (58% vs. 32.3%, p < 0.001). In addition, SR showed significantly increased referring physician satisfaction (VAS 8.8 vs. 4.9, p < 0.001). CONCLUSION: Neurotological SRs enable a significantly increased report completeness with higher referrer satisfaction in the context of interdisciplinary assessment of vertigo. Furthermore, SRs are particularly suitable for scientific data analysis, especially in the context of big data analyses.

Interventions to reduce falls in community-dwelling adults with intellectual disability: a systematic review.

BACKGROUND: People with intellectual disability have a high risk of falls and falls-related injuries. Although people with intellectual disability are at increased risk of falls, there is a need to better understand the efficacy of interventions that can help reduce falls and address risk factors in this population. This systematic review aimed to evaluate the type, nature and effectiveness of interventions undertaken to reduce falls with community-dwelling adults with intellectual disability and the quality of this evidence. METHOD: Four electronic databases were searched: Ovid MEDLINE, PsycINFO, CINAHL Plus and the Cochrane Library. Studies were included if they involved people aged 18 years or over, at least 50% of study participants had intellectual disability, participants were community-dwelling, and the study evaluated any interventions aiming to reduce falls. Study quality was assessed using the National Institutes of Health study quality assessment tools. Reporting of the review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Seven studies were eligible for review, with a total of 286 participants and mean age of 50.4 years. As only one randomised trial was identified, a narrative synthesis of results was undertaken. Five studies evaluated exercise interventions, one evaluated a falls clinic programme, and one evaluated stretch fabric splinting garments. Methodological quality varied (two studies rated as good, four as fair, and one as poor). Exercise interventions varied in terms of exercise type and dosage, frequency and intensity, and most did not align with recommendations for successful falls prevention exercise interventions reported for older people. While the majority of studies reported reduced falls, they differed in methods of reporting falls, and most did not utilise statistical analyses to evaluate outcomes. CONCLUSION: This review identified a small number of falls prevention intervention studies for people with intellectual disability. Although several studies reported improvements in fall outcomes, ability to draw conclusions about intervention effectiveness is limited by small sample sizes and few studies. Further large-scale research is required to implement and evaluate falls prevention interventions specifically for adults with intellectual disability.

Ablating Ion Velocity Distributions in Short-Pulse-Heated Solids via X-Ray Doppler Shifts.

Solids ablate under laser irradiation, but experiments have not previously characterized the initiation of this process at ultrarelativistic laser intensities. We present first measurements of bulk ion velocity distributions as ablation begins, captured as a function of depth via Doppler-shifted x-ray line emission from two viewing angles. Bayesian analysis indicates that bulk ions are either nearly stationary or flowing outward at the plasma sound speed. The measurements quantitatively constrain the laser-plasma ablation mechanism, suggesting that a steplike electrostatic potential structure drives solid disassembly.

Hot Spot Evolution Measured by High-Resolution X-Ray Spectroscopy at the National Ignition Facility.

Evolution of the hot spot plasma conditions was measured using high-resolution x-ray spectroscopy at the National Ignition Facility. The capsules were filled with DD gas with trace levels of Kr and had either a high-density-carbon (HDC) ablator or a tungsten (W)-doped HDC ablator. Time-resolved measurement of the Kr Heß spectra, absolutely calibrated by a simultaneous time-integrated measurement, allows inference of the electron density and temperature through observing Stark broadening and the relative intensities of dielectronic satellites. By matching the calculated hot spot emission using a collisional-radiative code to experimental observations, the hot spot size and areal density are determined. These advanced spectroscopy techniques further reveal the effect of W dopant in the ablator on the hot spot parameters for their improved implosion performance.

Homogeneous, Micron-Scale High-Energy-Density Matter Generated by Relativistic Laser-Solid Interactions.

Short-pulse, laser-solid interactions provide a unique platform for studying complex high-energy-density matter. We present the first demonstration of solid-density, micron-scale keV plasmas uniformly heated by a high-contrast, 400 nm wavelength laser at intensities up to 2×10^{21} W/cm^{2}. High-resolution spectral analysis of x-ray emission reveals uniform heating up to 3.0 keV over 1 µm depths. Particle-in-cell simulations indicate the production of a uniformly heated keV plasma to depths of 2 µm. The significant bulk heating and presence of highly ionized ions deep within the target are attributed to the few MeV hot electrons that become trapped and undergo refluxing within the target sheath fields. These conditions enabled the differentiation of atomic physics models of ionization potential depression in high-energy-density environments.

Solid-Density Ion Temperature from Redshifted and Double-Peaked Stark Line Shapes.

Heß spectral line shapes are important for diagnosing temperature and density in many dense plasmas. This work presents Heß line shapes measured with high spectral resolution from solid-density plasmas with minimized gradients. The line shapes show hallmark features of Stark broadening, including quantifiable redshifts and double-peaked structure with a significant dip between the peaks; these features are compared to models through a Markov chain Monte Carlo framework. Line shape theory using the dipole approximation can fit the width and peak separation of measured line shapes, but it cannot resolve an ambiguity between electron density n_{e} and ion temperature T_{i}, since both parameters influence the strength of quasistatic ion microfields. Here a line shape model employing a full Coulomb interaction for the electron broadening computes self-consistent line widths and redshifts through the monopole term; redshifts have different dependence on plasma parameters and thus resolve the n_{e}-T_{i} ambiguity. The measured line shapes indicate densities that are 80-100% of solid, identifying a regime of highly ionized but well-tamped plasma. This analysis also provides the first strong evidence that dense ions and electrons are not in thermal equilibrium, despite equilibration times much shorter than the duration of x-ray emission; cooler ions may arise from nonclassical thermalization rates or anomalous energy transport. The experimental platform and diagnostic technique constitute a promising new approach for studying ion-electron equilibration in dense plasmas.

Association between computer-aided lung auscultation and treatment failure risk in calves treated for respiratory disease.

The use of computer-aided lung auscultation (CALA, Whisper Veterinary Stethoscope; Merck Animal Health, Madison, New Jersey, USA) is a relatively new approach to assist in confirming the diagnosis of bovine respiratory disease (BRD). For this prospective cohort study at 1 feedlot in the United States, a CALA score was generated for 2726 feeder cattle (calf-fed Holsteins and mixed-breed beef animals) at the time of the first BRD diagnosis and treatment. All cattle were treated according to the same BRD protocol prescribed for that facility and the protocol was not influenced by the CALA score. Data were collected for 120 d after enrollment. In this study, the risk of BRD retreatment and the risk of BRD mortality were each significantly (P < 0.05) associated with the CALA score at the time of first BRD diagnosis and treatment, and those risks increased (numerically and in some cases statistically) as the CALA score increased.

Association entre l'auscultation pulmonaire assistée par ordinateur et le risque d'échec du traitement chez les veaux traités pour une maladie respiratoire. L'utilisation de l'auscultation pulmonaire assistée par ordinateur (CALA, Whisper Veterinary Stethoscope; Merck Animal Health, Madison, New Jersey, USA) est une approche relativement nouvelle pour aider à confirmer le diagnostic de maladie respiratoire bovine (BRD). Pour cette étude de cohorte prospective dans un parc d'engraissement aux États-Unis, un score CALA a été généré pour 2726 bovins d'engraissement (veau Holstein et bovins de race mixte) au moment du premier diagnostic et traitement de la BRD. Tous les bovins ont été traités selon le même protocole BRD prescrit pour ce site et le protocole n'a pas été influencé par le score CALA. Les données ont été collectées pendant 120 jours après l'inscription. Dans cette étude, le risque de retraitement pour BRD et le risque de mortalité associée au BRD étaient chacun significativement (P < 0,05) associés au score CALA au moment du premier diagnostic et traitement BRD, et ces risques augmentaient (numériquement et dans certains cas statistiquement) à mesure que le score CALA augmentait.(Traduit par Dr Serge Messier).

Risk factors for falls in patients with total hip arthroplasty and total knee arthroplasty: a systematic review and meta-analysis.

OBJECTIVE: Falls are common after total hip arthroplasty (THA) and total knee arthroplasty (TKA). While previous studies have investigated various risk factors for falls in patients following THA and TKA, no systematic reviews have summarized these risk factors. Therefore, the current systematic review aimed to summarize evidence regarding risk factors for falls in patients after THA and/or TKA. METHODS: MEDLINE, EMBASE, CINAHL, SPORTDiscus, and Physiotherapy Evidence Database (from inception to June 30, 2018) were searched. The methodological quality and quality of evidence of the included studies were assessed by two independent reviewers. Relevant data regarding participants' characteristics, study design, follow-up time points, and identified risk factors were extracted. Meta-analyses and narrative syntheses were performed. RESULTS: Twelve studies with a total of 1,292,689 participants were included. Twenty-nine identified risk factors for post-THA/TKA falls were classified into either inpatient or post-discharge risk factors. Key risk factors for both post-THA and/or post-TKA inpatient falls that showed moderate level of evidence included: postoperative complications or comorbidities and revision THA/TKA. Likewise, risk factors for post-discharge falls after THA and/or TKA that demonstrated moderate level of evidence included: medications, psychiatric diseases, living alone, prior history of TKA, falls history and female gender. The quality of the included studies varied and sample sizes were not justified. CONCLUSIONS: This review summarized both non-modifiable and modifiable risk factors for post-THA/TKA falls. Our findings highlight the importance of developing strategies to lower the falls risk among patients following THA/TKA.

Inequalities in orthodontic outcomes in England: treatment utilisation, subjective and normative need.

OBJECTIVE: To investigate inequalities in three aspects of access to orthodontic care: uptake of orthodontic treatment, normative need and subjective need in England. METHODS: We used data from two surveys in England: 12 and 15-year-olds from the 2013 Child Dental Health Survey (CDHS 2013) and 12-year-olds from the 2008/2009 NHS Dental Epidemiology Programme for England (NDEP 2008/2009). Summary variables representing orthodontic status were calculated. Two regression-based summary measures of inequalities were used to investigate the relationship between deprivation level and orthodontic outcomes: Slope and Relative indices of Inequality. RESULTS: There were significant absolute and relative inequalities in uptake of orthodontic treatment. The least deprived were 1.9 times more likely to have received orthodontic treatment compared to the most deprived in both surveys. Normative need was not associated with deprivation in either the analyses of CDHS 2013 (SII= 0.03, 95% CI: -0.04, 0.1; RII=1.06, 95% CI: 0.91, 1.24) or the NDEP 2007/2008 (SII= 0.03, 95% CI: -0.02, 0.07; RII=1.06, 95% CI: 0.96, 1.18). There was greater willingness to have teeth straightened in more deprived children from CDHS 2013 (SII=-0.09, 95% CI: -0.16, -0.03; RII=0.85, 95% CI: 0.75, 0.96) but not in NDEP 2007/2008 (SII=0.03, 95% CI: 0, 0.06; RII=1.07, 95% CI: 0.99, 1.15). CONCLUSIONS: Being deprived was associated with lower uptake of orthodontic treatment. Normative need was not related to deprivation. The association between deprivation and subjective need was only partly established, with poorer children showing a greater desire to have their teeth straightened in one survey.

Low rates of dental attendance by the age of one and inequality between local government administrative areas in England.

OBJECTIVE: To describe child dental attendance (DA) by 1 year of age in England and its relationship with area deprivation. BASIC RESEARCH DESIGN: Analysis of National Health Service data for the 12 months to June 2017. Deprivation was measured by Index of Multiple Deprivation Rank of Average Score (2015) for upper-tier and unitary local authorities in England (LAs, n=151). DA rates were calculated for children under 1 year (⟨1yr) and children aged 1 year and under (⟨1yr). A Spearman's test assessed strength of association with deprivation. The Slope Index of Inequality (SII) and Relative Index of Inequality (RII) explored equity. CLINICAL SETTING: Upper-tier and unitary LAs in England. MAIN OUTCOME MEASURE: Attending an NHS primary care dental service. RESULTS: DA rates ranged from 0 to 12.3% (Median:2; IQR:1.4,3.9) in children ⟨1yr and from 3.7 to 37.6% (Median:10; IQR:7.4,17) in children ≤1yr. DA rates decreased as deprivation decreased (Spearman=-0.25, p=0.0019 in children ⟨1yr; Spearman=-0.21, p=0.0104 in children ≤1yr). The SII suggested a 2 percentage point difference in DA rate across the deprivation distribution in children ⟨1yr (SII=-0.02, 95% CI=-0.01,-0.04; p=⟨0.001); and a 5 point difference in children ≤1yr (SII=-0.05, 95% CI=-0.02,-0.09; p=0.003). The DA rate in the most deprived LA was 2.1 higher than the least deprived LA (RII=2.1, 95% CI=1.4,3.2; p=⟨0.001) in children ⟨1yr and 1.5 higher (RII=1.5, 95% CI=1.2,2; p=0.004) in children ≤1yr. CONCLUSIONS: DA rates were low for all LAs and only partially explained by deprivation. More deprived LAs were, unexpectedly, more likely to report higher DA rates.

Development and evaluation of a patient-centred measurement tool for surgeons' non-technical skills.

BACKGROUND: Non-technical skills are essential for safe and effective surgery. Several tools to assess surgeons' non-technical skills from the clinician's perspective have been developed. However, a reliable measurement tool using a patient-centred approach does not currently exist. The aim of this study was to translate the existing Non-Technical Skills for Surgeons (NOTSS) tool into a patient-centred evaluation tool. METHODS: Data were gathered from four cohorts of patients using an iterative four-stage mixed-methods research design. Exploratory and confirmatory factor analyses were performed to establish the psychometric properties of the tool, focusing on validity, reliability, usability and parsimony. RESULTS: Some 534 patients were recruited to the study. A total of 24 patient-centred non-technical skill items were developed in stage 1, and reduced to nine items in stage 2 using exploratory factor analysis. In stage 3, confirmatory factor analysis demonstrated that these nine items each loaded on to one of three factors, with excellent internal consistency: decision-making, leadership, and communication and teamwork. In stage 4, validity testing established that the new tool was independent of physician empathy and predictive of surgical quality. Surgical leadership emerged as the most dominant skill that patients could recognize and evaluate. CONCLUSION: A novel nine-item assessment tool has been developed. The Patients' Evaluation of Non-Technical Skills (PENTS) tool allows valid and reliable measurement of surgeons' non-technical skills from the patient perspective.

Build better bones with exercise (B3E pilot trial): results of a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in older women with vertebral fracture.

We pilot-tested a trial of home exercise on individuals with osteoporosis and spine fracture. Our target enrollment was met, though it took longer than expected. Participants stayed in the study and completed the exercise program with no safety concerns. Future trials should expand the inclusion criteria and consider other changes. PURPOSE: Osteoporotic fragility fractures create a substantial human and economic burden. There have been calls for a large randomized controlled trial examining the effect of exercise on fracture incidence. The B3E pilot trial was designed to evaluate the feasibility of a large trial examining the effects of home exercise on individuals at high risk of fracture. METHODS: Community-dwelling women ≥ 65 years with radiographically confirmed vertebral compression fractures were recruited at seven sites in Canada and Australia. We randomized participants in a 1:1 ratio to a 12-month home exercise program or equal attention control group, both delivered by a physiotherapist (PT). Participants received six PT home visits in addition to monthly phone calls from the PT and a blinded research assistant. The primary feasibility outcomes of the study were recruitment rate (20 per site in 1 year), retention rate (75% completion), and intervention adherence rate (60% of weeks meeting exercise goals). Secondary outcomes included falls, fractures and adverse events. RESULTS: One hundred forty-one participants were recruited; an average of 20 per site, though most sites took longer than anticipated. Retention and adherence met the criteria for success: 92% of participants completed the study; average adherence was 66%. The intervention group did not differ significantly in the number of falls (IRR 0.97, 95% CI 0.58 to 1.63) or fragility fractures (OR 1.11, 95% CI 0.60 to 2.05) compared to the control group. There were 18 serious adverse events in the intervention group and 12 in the control group. CONCLUSION: An RCT of home exercise in women with vertebral fractures is feasible but recruitment was a challenge. Suggestions are made for the conduct of future trials.

One or more bound planets per Milky Way star from microlensing observations.

Most known extrasolar planets (exoplanets) have been discovered using the radial velocity or transit methods. Both are biased towards planets that are relatively close to their parent stars, and studies find that around 17-30% (refs 4, 5) of solar-like stars host a planet. Gravitational microlensing, on the other hand, probes planets that are further away from their stars. Recently, a population of planets that are unbound or very far from their stars was discovered by microlensing. These planets are at least as numerous as the stars in the Milky Way. Here we report a statistical analysis of microlensing data (gathered in 2002-07) that reveals the fraction of bound planets 0.5-10 AU (Sun-Earth distance) from their stars. We find that 17(+6)(-9)% of stars host Jupiter-mass planets (0.3-10 M(J), where M(J) = 318 M(⊕) and M(⊕) is Earth's mass). Cool Neptunes (10-30 M(⊕)) and super-Earths (5-10 M(⊕)) are even more common: their respective abundances per star are 52(+22)(-29)% and 62(+35)(-37)%. We conclude that stars are orbited by planets as a rule, rather than the exception.

Childhood neighborhood context and adult substance use problems: the role of socio-economic status at the age of 30 years.

OBJECTIVES: To examine whether the (a) childhood neighborhood context predicts alcohol use disorder, nicotine dependence, and cannabis use disorder symptoms at the age of 39 years; and (b) socio-economic status during young adulthood mediates these relationships. Gender differences were also examined. STUDY DESIGN: The Seattle Social Development Project is a prospective longitudinal study of 808 individuals followed up from ages 10 to 39 years in Seattle, Washington, United States. The sample was gender balanced (51% were men). METHODS: Alcohol, nicotine, and cannabis use disorder symptoms were assessed using the Diagnostic and Statistical Manual of Mental Disorders IV-based Diagnostic Interview Schedule. Childhood neighborhood data consisted of 10 neighborhood-level variables from the 1990 national census, which were consolidated using principal component analyses. Two components with eigenvalues greater than 1 were extracted-neighborhood disadvantage and neighborhood stability. Educational attainment and employment status represented socio-economic status during young adulthood. Covariates included baseline symptoms of psychopathology, baseline substance use, gender, ethnicity, and childhood socio-economic status at the family level. Negative binomial regression was used as the primary modeling strategy. Six models for each outcome measure were estimated. The first three models examined associations between two neighborhood components and each substance use outcome measure. Next, we tested the second research question by adding unemployment and college graduate indicators at the age of 30 years as potential mediators underlying the link between the childhood neighborhood context and three substance use measures. RESULTS: Study findings revealed that childhood neighborhood stability significantly reduced alcohol and cannabis use disorder symptoms nearly 3 decades later. Path analyses suggested that socio-economic status during the transition to adulthood did not influence these relationships but rather had independent effects on problematic nicotine and cannabis use. Furthermore, the effects of childhood neighborhood factors on problematic nicotine use were stronger for men. CONCLUSIONS: Neighborhood characteristics during childhood may be important factors for alcohol and cannabis use disorder symptoms among adults and nicotine dependence disorder symptoms among men. Prevention efforts that address community stability and disadvantage can and should start in childhood, with a focus on intervention targets that might gain salience later in life to discourage the development and persistence of problematic substance use in adulthood.

A cross-sectional study of confidence in minor surgical skills amongst junior dentists.

INTRODUCTION: To work in the National Health Service (NHS) as a dentist, the practitioner needs to be on the UK dental "performer's list". To apply for access to this list and work as a General Dental Practitioner (GDP), dentists must be qualified from the European Economic Area (EEA) or, those trained in the UK, must undertake Dental Foundation Training (DFT). Dentists interested in further taught learning or pursuing specialist training must continue working as "Dental Core Trainees" (DCTs). Most of these jobs are available in Oral and Maxillofacial Surgery (OMFS) Units and require dentists to undertake unsupervised surgical procedures. It is currently estimated that over 400 "junior dentists" undertake DCT a year. It is the aim of this study to ascertain whether confidence in simple surgical procedures improves when compared to GDPs of similar experience. METHODS: One hundred and two junior dentists, 34 DFTs, 20 DCT1s, 21 DCT2s and 27 second and third year post-DFT GDPs all working across the Midlands, UK, had Likert scale responses about confidence in 14 minor surgical skills assessed. Results were analysed to ascertain whether gender, year group and number of extractions had any effect on confidence. CONCLUSIONS: We conclude that confidence in minor surgical procedures improves significantly when undertaking DCT OMFS posts, with the most significant improvement in confidence occurring within the first 6 months. Dental Core Trainees become significantly more confident in their surgical ability within the first 6 months when compared to GDPs with longer postgraduate experience.

Bone loss with antiepileptic drug therapy: a twin and sibling study.

Changes in areal bone mineral density (aBMD) and other predictors of bone loss were evaluated in 48 same-sex twin/age-matched sibling pairs discordant for antiepileptic drug (AED) use. AED users had reduced BMD at the hip regions. Prolonged AED users had greater aBMD loss, predicting a higher risk of bone fragility. INTRODUCTION: To investigate the longitudinal associations of bone mineral measures with antiepileptic drug (AED) use, including enzyme-inducing (EIAED) and non-enzyme-inducing (NEIAED) types, and other predictors of bone loss in a study of 48 same-sex twin/age-matched sibling pairs (40 female, 8 male) discordant for AED use. METHODS: Using dual-energy X-ray absorptiometry (DXA), areal bone mineral density (aBMD) and content (BMC) at the hip regions, forearm, lumbar spine, and whole body were measured twice, at least 2 years apart. The mean within-pair difference (MWPD), MWPD%, and mean annual rate of aBMD change were adjusted for age, weight, and height. Predictors of bone loss were evaluated. RESULTS: AED users, compared to non-users, at baseline and follow-up, respectively, had reduced aBMD at the total hip (MWPD% 3.8, 4.4%), femoral neck (4.7, 4.5%), and trochanter regions (4.1, 4.6%) (p < 0.05). For the whole cohort, the annual rate of change in all aBMD/BMC (p > 0.05) regions did not differ within pairs. Nevertheless, EIAED users had greater aBMD loss than non-users (n = 20 pairs) at the total hip (1.7 vs. 0.3%, p = 0.013) and whole body regions (0.7% loss vs. 0.1% BMD gain, p = 0.019), which was not found in NEIAED-discordant pairs (n = 16). AED use >20 years predicted higher aBMD loss at the forearm (p = 0.028), whole body (p = 0.010), and whole body BMC (p = 0.031). CONCLUSIONS: AED users had reduced aBMD at the hip regions. Prolonged users and EIAED users had greater aBMD loss, predicting a higher risk of bone fragility. Further prospective studies of AED effects on bone microarchitecture are needed.

Alginate oligosaccharides modify hyphal infiltration of Candida albicans in an in vitro model of invasive human candidosis.

AIMS: A novel alginate oligomer (OligoG CF-5/20) has been shown to potentiate antifungal therapy against a range of fungal pathogens. The current study assessed the effect of this oligomer on in vitro virulence factor expression and epithelial invasion by Candida species. METHODS AND RESULTS: Plate substrate assays and epithelial models were used to assess Candida albicans (CCUG 39343 and ATCC 90028) invasion, in conjunction with confocal laser scanning microscopy and histochemistry. Expression of candidal virulence factors was determined biochemically and by quantitative PCR (qPCR). Changes in surface charge of C. albicans following OligoG treatment were analysed using electrophoretic light scattering. OligoG induced marked alterations in hyphal formation in the substrate assays and reduced invasion in the epithelial model (P < 0·001). Significant dose-dependent inhibition of phospholipase activity in C. albicans was evident following OligoG treatment (P < 0·05). While OligoG binding failed to affect alterations in surface charge (P > 0·05), qPCR demonstrated a reduction in phospholipase B (PLB2) and SAPs (SAP4 and SAP6) expression. CONCLUSION: OligoG CF-5/20 reduced in vitro virulence factor expression and invasion by C. albicans. SIGNIFICANCE AND IMPACT OF THE STUDY: These results, and the previously described potentiation of antifungal activity, define a potential therapeutic opportunity in the treatment of invasive candidal infections.

RESPOND: a programme to prevent secondary falls in older people presenting to the emergency department with a fall: protocol for an economic evaluation.

BACKGROUND: Falls remain common for community-dwelling older people and impose a substantial economic burden to the healthcare system. RESPOND is a novel falls prevention programme that aims to reduce secondary falls and fall injuries among older people who present to a hospital emergency department (ED) with a fall. The present protocol describes a prospective economic evaluation examining the incremental cost-effectiveness of the RESPOND programme, compared with usual care practice, from the Australian health system perspective. METHODS AND DESIGN: This economic evaluation will recruit 528 participants from two major tertiary hospital EDs in Australia and will be undertaken alongside a multisite randomised controlled trial. Outcome and costing data will be collected for all participants over the 12-month trial. It will compare the RESPOND falls prevention programme with usual care practice (current community-based falls prevention practices) to determine its incremental cost-effectiveness according to three intermediate clinical outcomes: (1) falls prevented, (2) fall injuries prevented and (3) injurious falls prevented. In addition, utilities will be derived from a generic quality-of-life measure (EQ-5D-5L) and used to calculate the 'incremental cost per quality-adjusted life years gained'. DISCUSSION: The results of this study will provide healthcare decision makers with evidence to assist with setting spending thresholds for preventive health programmes and inform selection of emergency and community service models of care. TRIAL REGISTRATION NUMBER: The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684); Pre-results.

Hand-arm vibration in orthopaedic surgery: a neglected risk.

Background: Hand-arm vibration syndrome is an occupational disease caused by exposure to hand-arm transmitted vibration. The Health and Safety Executive has set limits for vibration exposure, including an exposure action value (EAV), where steps should be taken to reduce exposure, and an exposure limit value (ELV), beyond which vibrating equipment must not be used for the rest of the working day. Aims: To measure hand-arm transmitted vibration among orthopaedic surgeons, who routinely use hand-operated saws. Methods: We undertook a cadaveric study measuring vibration associated with a tibial cut using battery-operated saws. Three surgeons undertook three tibial cuts each on cadaveric tibiae. Measurements were taken using a frequency-weighted root mean square acceleration, with the vibration total value calculated as the root of the sums squared in each of the three axes. Results: A mean (SD) vibration magnitude of 1 (0.2) m/s2 in the X-axis, 10.3 (1.9) m/s2 in the Y-axis and 4.2 (1.3) m/s2 in the Z-axis was observed. The weighted root mean squared magnitude of vibration was 11.3 (1.7) m/s2. These results suggest an EAV of 23 min and ELV of 1 h 33 min using this equipment. Conclusions: Our results demonstrate that use of a battery-operated sagittal saw can transmit levels of hand-arm vibration approaching the EAV or ELV through prolonged use. Further study is necessary to quantify this risk and establish whether surveillance is necessary for orthopaedic surgeons.

Characterisation of methicillin-resistant Staphylococcus aureus clinical isolates from animals in New Zealand, 2012-2013, and subclinical colonisation in dogs and cats in Auckland.

AIMS: To characterise methicillin-resistant Staphylococcus aureus (MRSA) isolates from infection sites in animals in New Zealand and assess the prevalence of subclinical MRSA colonisation in dogs and cats attending veterinary clinics in Auckland. METHODS: MRSA isolates from clinical specimens obtained by the main New Zealand veterinary diagnostic laboratories between June 2012 and June 2013, were genotypically characterised by DNA microarray hybridisation analysis and spa typing. In addition, nasal or perineal skin swabs collected from a cross-sectional sample of dogs (n=361) and cats (n=225) attending 29 veterinary clinics in Auckland during the same period were analysed for MRSA by culture. RESULTS: Eight MRSA clinical isolates were submitted for characterisation by the participating laboratories. The isolates originated from five dogs, including two isolates from the same dog, one foal, and one isolate had no identification of the source. The strain-types identified were AK3 (ST-5 SCCmecIV t045; n=1), USA500 (ST8 SCCmecIV t064; n=1), WSPP (ST30 SCCmecIV t019; n=1), Rhine Hesse (ST5 SCCmecII t002; n=2), and EMRSA-15 (ST22 SCCmecIV t032; n=3). No MRSA were isolated from 586 cultured swabs. Methicillin-susceptible S. aureus were detected in 9/257 (3.5%) swabs and non-aureus staphylococci in 22/257 (8.5%) swabs. The estimated true MRSA subclinical colonisation prevalence was 0%, with an upper 95% CI boundary of 1.9% for cats and 1.4% for dogs. CONCLUSIONS: The modest number of MRSA isolates submitted for this study by the participating laboratories suggests clinical MRSA infection in animals in New Zealand continues to be sporadic. The wide variety of strain-types found mirrored the evolving strain-type diversity observed in humans. We cannot rule out bias due to the non-random sampling of dogs and cats, but the apparent colonisation prevalence of 0% was consistent with the low prevalence of subclinical colonisation in humans in New Zealand. These similarities indicate the epidemiology of animal and human MRSA infections are linked. CLINICAL RELEVANCE: In the last decade, the prevalence of human MRSA infections in New Zealand has steadily increased. This is the second published study of MRSA in animals in New Zealand. The results indicate clinical MRSA infection in animals remains sporadic, but the diversification of the strain-types may pose new therapeutic challenges to veterinarians, due to their diverse resistome.