Impact of Traditional and New Media on Smoking Intentions and Behaviors: Secondary Analysis of Tasmania's Tobacco Control Mass Media Campaign Program, 2019-2021.

BACKGROUND: Tasmania, the smallest state by population in Australia, has a comprehensive tobacco control mass media campaign program that includes traditional (eg, television) and "new" channels (eg, social media), run by Quit Tasmania. The campaign targets adult smokers, in particular men aged 18-44 years, and people from low socioeconomic areas. OBJECTIVE: This study assesses the impact of the 2019-2021 campaign program on smokers' awareness of the campaign program, use of Quitline, and smoking-related intentions and behaviors. METHODS: We used a tracking survey (conducted 8 times per year, immediately following a burst of campaign activity) to assess campaign recall and recognition, intentions to quit, and behavioral actions taken in response to the campaigns. The sample size was approximately 125 participants at each survey wave, giving a total sample size of 2000 participants over the 2 years. We merged these data with metrics including television target audience rating points, digital and Facebook (Meta) analytics, and Quitline activity data, and conducted regression and time-series modeling. RESULTS: Over the evaluation period, unprompted recall of any Quit Tasmania campaign was 18%, while prompted recognition of the most recent campaign was 50%. Over half (52%) of those who recognized a Quit Tasmania campaign reported that they had performed or considered a quitting-related behavioral action in response to the campaign. In the regression analyses, we found having different creatives within a single campaign burst was associated with higher campaign recall and recognition and an increase in the strength of behavioral actions taken. Higher target audience rating points were associated with higher campaign recall (but not recognition) and an increase in quit intentions, but not an increase in behavioral actions taken. Higher Facebook advertisement reach was associated with lower recall among survey participants, but recognition was higher when digital channels were used. The time-series analyses showed no systematic trends in Quitline activity over the evaluation period, but Quitline activity was higher when Facebook reach and advertisement spending were higher. CONCLUSIONS: Our evaluation suggests that a variety of creatives should be used simultaneously and supports the continued use of traditional broadcast channels, including television. However, the impact of television on awareness and behavior may be weakening. Future campaign evaluations should closely monitor the effectiveness of television as a result. We are also one of the first studies to explicitly examine the impact of digital and social media, finding some evidence that they influence quitting-related outcomes. While this evidence is promising for campaign implementation, future evaluations should consider adopting rigorous methods to further investigate this relationship.

'Profound personal and professional impacts': A qualitative study of clinician experiences of a mental health disaster response to Australia's black summer bushfires.

OBJECTIVE: To explore the experiences of clinician and management stakeholders involved in a rural/metropolitan collaborative mental health disaster response to the 2019-2020 Black Summer bushfires in the Snowy Valleys region of southern New South Wales (NSW), Australia. SETTING: A mental health and drug health service in the Snowy Valleys region of rural NSW in collaboration with a mental health service from metropolitan Sydney, NSW. PARTICIPANTS: Mental health clinicians and managers from a rural health district (n = 6) and a metropolitan health district (n = 8) involved in a collaborative disaster response to the 2019-2020 Black Summer bushfire disaster in the Snowy Valleys region of southern NSW, Australia. DESIGN: An interpretive qualitative study design using semi-structured individual interviews, with transcripts analysed using Reflexive Thematic Analysis. RESULTS: Thematic findings on participant experiences are presented under three organising constructs of before (stepping up and jumping right in), during (finding a rhythm of working together), and after (profound personal and professional impacts) the mental health disaster response. CONCLUSION: Participant experiences had shared and distinct components before, during and after the mental health disaster response, culminating in profound personal and professional impacts. Findings highlight positive aspects and challenges for clinicians participating in a rural/metropolitan collaborative mental health disaster response. The findings of this study contribute new knowledge about experiences of mental health clinicians participating in a disaster response after bushfires, from dual perspectives of members of a bushfire-affected community and those responding from outside a bushfire-affected community, which may inform ongoing planning of responses to disaster in Australia.

No Strength Differences Despite Greater Posterior Rotator Cuff Intramuscular Fat in Patients With Eccentric Glenohumeral Osteoarthritis.

BACKGROUND: When nonoperative measures do not alleviate the symptoms of glenohumeral osteoarthritis (OA), patients with advanced OA primarily are treated with anatomic total shoulder arthroplasty (TSA). It is unknown why TSAs performed in patients with eccentric (asymmetric glenoid wear) compared with concentric (symmetric glenoid wear) deformities exhibit higher failure rates, despite surgical advances. Persistent disruption of the posterior-to-anterior rotator cuff (RC) force couple resulting from posterior RC intramuscular degeneration in patients with eccentric deformities could impair external rotation strength and may contribute to eventual TSA failure. Pain and intramuscular fat within the RC muscles may impact external rotation strength measures and are important to consider. QUESTIONS/PURPOSES: (1) Is there relative shoulder external rotation weakness in patients with eccentric compared with concentric deformities? (2) Is there higher resting or torque-dependent pain in patients with eccentric compared with concentric deformities? (3) Do patients with eccentric deformities have higher posterior-to-anterior RC intramuscular fat percent ratios than patients with concentric deformities? METHODS: From February 2020 to November 2021, 65% (52 of 80) of patients with OA met study eligibility criteria. Of these, 63% (33 of 52) of patients enrolled and provided informed consent. From a convenience sample of 21 older adults with no history of shoulder pain, 20 met eligibility criteria as control participants. Of the convenience sample, 18 patients enrolled and provided informed consent. In total for this prospective, cross-sectional study, across patients with OA and control participants, 50% (51 of 101) of participants were enrolled and allocated into the eccentric (n = 16), concentric (n = 17), and control groups (n = 18). A 3-degree-of-freedom load cell was used to sensitively quantify strength in all three dimensions surrounding the shoulder. Participants performed maximal isometric contractions in 26 1-, 2-, and 3-degree-of-freedom direction combinations involving adduction/abduction, internal/external rotation, and/or flexion/extension. To test for relative external rotation weakness, we quantified relative strength in opposing directions (three-dimensional [3D] strength balance) along the X (+adduction/-abduction), Y (+internal/-external rotation), and Z (+flexion/-extension) axes and compared across the three groups. Patients with OA rated their shoulder pain (numerical rating 0-10) before testing at rest (resting pain; response to "How bad is your pain today?") and with each maximal contraction (torque-dependent pain; numerical rating 0-10). Resting and torque-dependent pain were compared between patients with eccentric and concentric deformities to determine if pain was higher in the eccentric group. The RC cross-sectional areas and intramuscular fat percentages were quantified on Dixon-sequence MRIs by a single observer who performed manual segmentation using previously validated methods. Ratios of posterior-to-anterior RC fat percent (infraspinatus + teres minor fat percent/subscapularis fat percent) were computed and compared between the OA groups. RESULTS: There was no relative external rotation weakness in patients with eccentric deformities (Y component of 3D strength balance, mean ± SD: -4.7% ± 5.1%) compared with patients with concentric deformities (-0.05% ± 4.5%, mean difference -4.7% [95% CI -7.5% to -1.9%]; p = 0.05). However, there was more variability in 3D strength balance in the eccentric group (95% CI volume, % 3 : 893) compared with the concentric group (95% CI volume, % 3 : 579). In patients with eccentric compared with concentric deformities, there was no difference in median (IQR) resting pain (1.0 [3.0] versus 2.0 [2.3], mean rank difference 4.5 [95% CI -6.6 to 16]; p = 0.61) or torque-dependent pain (0.70 [3.0] versus 0.58 [1.5], mean rank difference 2.6 [95% CI -8.8 to 14]; p = 0.86). In the subset of 18 of 33 patients with OA who underwent MRI, seven patients with eccentric deformities demonstrated a higher posterior-to-anterior RC fat percent ratio than the 11 patients with concentric deformities (1.2 [0.8] versus 0.70 [0.3], mean rank difference 6.4 [95% CI 1.4 to 11.5]; p = 0.01). CONCLUSION: Patients with eccentric deformities demonstrated higher variability in strength compared with patients with concentric deformities. This increased variability suggests patients with potential subtypes of eccentric wear patterns (posterior-superior, posterior-central, and posterior-inferior) may compensate differently for underlying anatomic changes by adopting unique kinematic or muscle activation patterns. CLINICAL RELEVANCE: Our findings highlight the importance of careful clinical evaluation of patients presenting with eccentric deformities because some may exhibit potentially detrimental strength deficits. Recognition of such strength deficits may allow for targeted rehabilitation. Future work should explore the relationship between strength in patients with specific subtypes of eccentric wear patterns and potential forms of kinematic or muscular compensation to determine whether these factors play a role in TSA failures in patients with eccentric deformities.

Community support for policy interventions targeting unhealthy food environments in public institutions.

ISSUE ADDRESSED: Understanding community support for obesity prevention policy is important for developing effective preventive health action. This study assessed support for a range of obesity prevention interventions, including food environment policies designed to improve healthy food and drink availability and promotion within public institutions. METHODS: An online cross-sectional survey was completed by 2006 NSW adults. Questions explored attitudes and beliefs about obesity, the importance of government-led prevention and support for eight obesity prevention interventions. Regression analyses examined associations between intervention support and sociodemographic, attitudinal and behavioural characteristics. RESULTS: Most respondents (80%) believed obesity was a large problem and that poor individual choices (86%) and the widespread availability of unhealthy food and drink (78%) contributed to the issue. There was moderate to high support for most (n = 7) initiatives. Support for food environment policies was highest for schools (76%-82%) and hospitals (67%-79%). Supporters and opponents rationalised opinions based on perceived effectiveness, the government's role and cost benefits. Opponents were a minority, but principles of autonomy were predominant. Attributing obesity to environment-related factors, and personal lower SSB consumption strongly predicted support. CONCLUSION: There is a significant recognition of the obesity issue and strong support for policies designed to improve the availability and promotion of healthy food and drink in public institutions, particularly in schools and hospitals. SO WHAT?: Substantial community support for healthy food environment policies in schools and hospitals warrants continued implementation in NSW. This may foster further acceptance for wider implementation. Our findings could inform the framing of policy advocacy messages.

Knowledge and Attitudes Toward an Artificial Intelligence-Based Fidelity Measurement in Community Cognitive Behavioral Therapy Supervision.

To capitalize on investments in evidence-based practices, technology is needed to scale up fidelity assessment and supervision. Stakeholder feedback may facilitate adoption of such tools. This evaluation gathered stakeholder feedback and preferences to explore whether it would be fundamentally feasible or possible to implement an automated fidelity-scoring supervision tool in community mental health settings. A partially mixed, sequential research method design was used including focus group discussions with community mental health therapists (n = 18) and clinical leadership (n = 12) to explore typical supervision practices, followed by discussion of an automated fidelity feedback tool embedded in a cloud-based supervision platform. Interpretation of qualitative findings was enhanced through quantitative measures of participants' use of technology and perceptions of acceptability, appropriateness, and feasibility of the tool. Initial perceptions of acceptability, appropriateness, and feasibility of automated fidelity tools were positive and increased after introduction of an automated tool. Standard supervision was described as collaboratively guided and focused on clinical content, self-care, and documentation. Participants highlighted the tool's utility for supervision, training, and professional growth, but questioned its ability to evaluate rapport, cultural responsiveness, and non-verbal communication. Concerns were raised about privacy and the impact of low scores on therapist confidence. Desired features included intervention labeling and transparency about how scores related to session content. Opportunities for asynchronous, remote, and targeted supervision were particularly valued. Stakeholder feedback suggests that automated fidelity measurement could augment supervision practices. Future research should examine the relations among use of such supervision tools, clinician skill, and client outcomes.

Towards healthier food choices for hospital staff and visitors: impacts of a healthy food and drink policy implemented at scale in Australia.

OBJECTIVE: To determine the impact of a healthy food and drink policy on hospital staff and visitors' food purchasing behaviours, and their awareness and support for the changes introduced. DESIGN: Two repeated cross-sectional surveys, consisting of intercept interviews and observations of food items purchased, were conducted before (March-July 2018) and after (April-June 2019) the target date for implementation of thirteen food and drink practices (31 December 2018). Food purchases were coded as 'Everyday' (healthy) or 'Occasional' (unhealthy). SETTING: Ten randomly selected New South Wales public hospitals, collection sites including hospital entrances and thirteen hospital cafés/cafeterias. PARTICIPANTS: Surveys were completed by 4808 hospital staff and visitors (response rate 85 %). The majority were female (63 %), spoke English at home (85 %) and just over half had completed tertiary education (55 %). RESULTS: Significant increases from before to after the implementation target date were found for policy awareness (23 to 42 %; P < 0·0001) and support (89 to 92 %; P = 0·01). The proportion of 'Everyday' food purchases increased, but not significantly (56 to 59 %; P = 0·22); with significant heterogeneity between outlets (P = 0·0008). Overall, younger, non-tertiary-educated adults, visitors and those that spoke English at home were significantly less likely to purchase 'Everyday' food items. Support was also significantly lower in males. CONCLUSIONS: The findings provide evidence of strong policy support, an increasing awareness of related changes and a trend towards increased 'Everyday' food purchasing. Given the relatively early phase of policy implementation, and the complexity of individual food purchasing decisions, longer-term follow-up of purchasing behaviour is recommended following ongoing implementation efforts.

Does a community based recovery service reduce inpatient bed days?

OBJECTIVE: Increasing options for the delivery of community-based care may be one way to reduce inpatient bed pressures. This study set out to examine the effect of community-based step up/step down (SUSD) care on hospital usage for service users with multi-service usage. METHODS: A retrospective audit was undertaken of the medical records of all individuals admitted to a SUSD unit over a 2-year period, calculating inpatient bed days for the 12 months prior to, and the 12 months after, the SUSD admission. RESULTS: There was a statistically nonsignificant decrease in bed days in the 12 months following admission. CONCLUSION: It is possible that inpatient bed day reduction may not be an appropriate outcome measure for a service built on principles of personal recovery. How to translate recovery-outcomes to justifiable financial benefits for services requires further consideration and alignment of values with reporting measures.

"Perceived fit," "understanding," and "communication": Key factors underpinning stakeholder and partnership engagement with the Make Healthy Normal campaign.

ISSUE ADDRESSED: Published evaluations of population-level social marketing campaigns predominantly focus on impact and outcome evaluation. Evaluation of complementary locally implemented activities and programs, despite being common and important components of social marketing campaigns are rarely published. This study sought to examine the drivers of engagement of local implementers in the Make Healthy Normal campaign, implemented in New South Wales (NSW), Australia from 2015 to 2018, and to describe their engagement with the campaign as well as the scope and extent of complementary activities. METHODS: We conducted 13 in-depth semi-structured qualitative interviews with health and nonhealth stakeholders from a range of urban, regional and rural settings across NSW. We analysed the interviews thematically, using an inductive and iterative approach. RESULTS: We found stakeholder engagement (ie decision to buy into and commit resources) to the campaign was underpinned by two main drivers: "understanding", or how well they understood the campaign and their role in it, and "perceived fit", or how appropriate it was to their context. A third factor, "communication" functioned to enhance both understanding and perceived fit. CONCLUSION: Our results suggest that stakeholders would engage with the campaign more where they had a sound understanding of the campaign objectives and content, and an appreciation of how the campaign fits their strategic and procedural context. SO WHAT?: Campaign managers should incorporate clear, regular and efficient communication with local implementers and work with these groups early in the campaign development process. Organisers should also support and promote a "community of practice" approach to capitalise on the innovations of those promoting campaign messages at the community level.

Impact and acceptance of a state-wide policy to remove sugar-sweetened beverages in hospitals in New South Wales, Australia.

ISSUE ADDRESSED: Policy and environmental approaches can reduce the accessibility and purchasing of sugar-sweetened beverages (SSBs), potentially reducing overweight and obesity. This study examined the impact of a state-wide policy on removal of SSBs from sale in NSW public hospitals (launched July 2017), and explored consumer awareness and support. METHODS: A convenience sample of 81 food outlets in 26 hospitals were audited for SSB availability before and after the target date for SSB removal (31 December 2017). An interviewer-administered intercept survey in 10 randomly selected hospitals (March-May 2018), assessed staff and visitors' awareness of and support for SSB removal. Descriptive and χ2 analyses assessed differences in: SSB availability; staff and visitor awareness and support. Open-ended survey responses were thematically analysed. RESULTS: The proportion of outlets that removed SSBs increased from 58.0% to 96.3% (P < .001). The majority (79.5%) of the 2394 surveyed supported SSB removal, with nearly half (48.4%) reporting it would improve people's health. A minority (13.4%) did not support SSB removal, more than half (61.4%) of those said individuals should have free choice. More staff than visitors were aware of the change (61.9% vs 31.2%; P < .0001). CONCLUSIONS: Availability of SSBs in NSW hospitals was significantly reduced after implementation of a policy to remove them from sale. There was strong staff and visitor support for the initiative. SO WHAT?: This study provides clear evidence that a policy designed to provide a healthy hospital retail drink environment can be successfully implemented at scale with high levels of support from staff and visitors. SUMMARY: A state-wide policy initiative to remove SSBs from sale in NSW hospital food outlets in 2017 was successfully implemented, with a sample of outlets having nearly 100% compliance. The majority of staff and visitors (80%) supported the removal of SSBs, mostly because they believed it would improve individual and population health.

Results of a mixed methods evaluation of the Make Healthy Normal campaign.

The Make Healthy Normal obesity prevention mass media campaign was implemented in New South Wales, Australia from 2015 to 2018. This study evaluated Phase 2 (2017-18) of that campaign, using three cross-sectional online surveys with men aged 18-54 years (n = 4352) and six focus groups with men aged 35-54 years and parents with children aged 5-12 years (n = 38), reflecting the campaign's target audiences. We used linear and logistic regressions to examine changes over time in key outcomes, consistent with the campaign's theorized hierarchy of effects. Focus group data were analysed thematically and integrated with survey results at the interpretation stage. Survey results showed reasonable prompted recognition, although unprompted recall remained low, and there were no consistent, positive shifts in other outcomes, including behaviour. Focus group results suggested that this was because the campaign's messages, while considered clear and relevant, did not address the constraints participants experienced that made change difficult. Hence, the campaign by itself was unlikely to lead to behaviour change. We need to reconsider the role of campaigns in addressing multi-determined and complex problems. Evaluations should reconsider metrics of success, as they may not immediately result in behaviour change, especially in the absence of complementary policy and environmental strategies.

Epigenetic Silencing of TAP1 in Aldefluor+ Breast Cancer Stem Cells Contributes to Their Enhanced Immune Evasion.

Avoiding detection and destruction by immune cells is key for tumor initiation and progression. The important role of cancer stem cells (CSCs) in tumor initiation has been well established, yet their ability to evade immune detection and targeting is only partly understood. To investigate the ability of breast CSCs to evade immune detection, we identified a highly tumorigenic population in a spontaneous murine mammary tumor based on increased aldehyde dehydrogenase activity. We performed tumor growth studies in immunocompetent and immunocompromised mice. In immunocompetent mice, growth of the spontaneous mammary tumor was restricted; however, the Aldefluor+ population was expanded, suggesting inherent resistance mechanisms. Gene expression analysis of the sorted tumor cells revealed that the Aldefluor+ tumor cells has decreased expression of transporter associated with antigen processing (TAP) genes and co-stimulatory molecule CD80, which would decrease susceptibility to T cells. Similarly, the Aldefluor+ population of patient tumors and 4T1 murine mammary cells had decreased expression of TAP and co-stimulatory molecule genes. In contrast, breast CSCs identified by CD44+ CD24- do not have decreased expression of these genes, but do have increased expression of C-X-C chemokine receptor type 4. Decitabine treatment and bisulfite pyrosequencing suggests that DNA hypermethylation contributes to decreased TAP gene expression in Aldefluor+ CSCs. TAP1 knockdown resulted in increased tumor growth of 4T1 cells in immunocompetent mice. Together, this suggests immune evasion mechanisms in breast CSCs are marker specific and epigenetic silencing of TAP1 in Aldefluor+ breast CSCs contributes to their enhanced survival under immune pressure. Stem Cells 2018;36:641-654.

'A different kind of space': Mixed methods evaluation of facilitated reflective practice groups for nurses in an acute inpatient mental health unit.

Despite recognising the value of reflective practice, there are challenges in implementation of clinical supervision for nurses. This study reports on the implementation of Reflective Practice Groups for nurses in an acute inpatient mental health setting as a means of introducing nurses to reflective practice. A mixed-methods approach explored participant and facilitator experiences through session evaluation questionnaires, facilitator field notes, and interviews with participants. Findings demonstrate challenges in implementing Reflective Practice Groups however the perceived benefits suggest promise in using Reflective Practice Groups to engage busy nurses in facilitated reflection with an aim to transition to reflective clinical supervision.

A review of the impact of physical activity mass media campaigns on low compared to high socioeconomic groups.

Physical inactivity is a major contributor to non-communicable disease and people of low socioeconomic status (SES) are more likely to be insufficiently active. Physical activity mass media campaigns aim to increase physical activity participation, but little is known about their impact on low SES groups. We reviewed the published literature from 1990 to June 2016 to identify reports of physical activity mass media campaigns. We documented evaluation/study design, target population, campaign outcomes assessed, SES measures used and analysed the results of the SES comparisons. A total of 23 papers were reviewed, reporting on 17 physical activity campaigns and 12 campaigns compared SES differences for 85 outcomes: 45 comparisons showed no difference between lowest and highest SES groups, 20 showed a better outcome for the lowest SES group and 20 showed a worse outcome. Some campaigns found inconsistent results, but seven found only equal and/or better results for low SES groups. Post-campaign physical activity behaviour most commonly showed no SES differences, but no other patterns were seen. Our review found that physical activity mass media campaigns have mostly equitable or better impacts for low SES groups, but to reduce inequalities these campaigns need to be maximally effective for low SES populations.

Is this health campaign really social marketing? A checklist to help you decide.

ISSUE ADDRESSED: Social marketing (SM) campaigns can be a powerful disease prevention and health promotion strategy but health-related campaigns may simply focus on the "promotions" communication activities and exclude other key characteristics of the SM approach. This paper describes the application of a checklist for identifying which lifestyle-related chronic disease prevention campaigns reported as SM actually represent key SM principles and practice. METHODS: A checklist of SM criteria was developed, reviewed and refined by SM and mass media campaign experts. Papers identified in searches for "social marketing" and "mass media" for obesity, diet and physical activity campaigns in the health literature were classified using the checklist. RESULTS: Using the checklist, 66.6% of papers identified in the "SM" search and 39% of papers identified from the "mass media" search were classified as SM campaigns. Inter-rater agreement for classification using the abstract only was 92.1%. CONCLUSIONS: Health-related campaigns that self-identify as "social marketing" or "mass media" may not include the key characteristics of a SM approach. Published literature can provide useful guidance for developing and evaluating health-related SM campaigns, but health promotion professionals need to be able to identify what actually comprises SM in practice. SO WHAT?: SM could be a valuable strategy in comprehensive health promotion interventions, but it is often difficult for non-experts to identify published campaigns that represent a true SM approach. This paper describes the application of a checklist to assist policy makers and practitioners in appraising evidence from campaigns reflecting actual SM in practice. The checklist could also guide reporting on SM campaigns.

Hide-and-seek: the interplay between cancer stem cells and the immune system.

The enhanced ability of cancer stem cells (CSCs) to give rise to new tumors suggests that these cells may also have an advantage in evading immune detection and elimination. This tumor-forming ability, combined with the known plasticity of the immune system, which can play both protumorigenic and antitumorigenic roles, has motivated investigations into the interaction between CSCs and the immune system. Herein, we review the interplay between host immunity and CSCs by examining the immune-related mechanisms that favor CSCs and the CSC-mediated expansion of protumorigenic immune cells. Furthermore, we discuss immune cells, such as natural killer cells, that preferentially target CSCs and the strategies used by CSCs to evade immune detection and destruction. An increased understanding of these interactions and the pathways that regulate them may allow us to harness immune system components to create new adjuvant therapies that eradicate CSCs and improve patient survival.

Are vegans the same as vegetarians? The effect of diet on perceptions of masculinity.

Food and food consumption matters in interpersonal interactions. Foods consumed can affect how a person is perceived by others in terms of morality, likeability, and gender. Food consumption can be used as a strategy for gendered presentation, either in terms of what foods are consumed or in the amount of food consumed. Finally, foods themselves are associated with gender. Previous research (Browarnik, 2012; Ruby & Heine, 2011) shows inconsistent patterns in the association between vegetarianism and masculinity. The current research conceptually replicates and extends this research by including the explicit label of vegetarian. The four studies in this article provide increased information about the effects of diet on gendered perceptions. Study 1 shows that vegetarian and omnivorous targets are rated equally in terms of masculinity. Study 2 shows that perceptions of vegetarians and vegans are similar, though comparing this research with past research indicates that perceptions of vegetarians are more variable. Study 3 shows that veganism leads perceptions of decreased masculinity relative to omnivores. Finally, Study 4 tests one possible mechanism for the results of Study 3, that it is the choice to be vegan that impacts perceptions of gender. Implications include increased knowledge about how meatless diets can affect the perceptions of gender in others. Multiple directions for future research are discussed.

Overcoming disparities in organized physical activity: findings from Australian community strategies.

Organized physical activity through sport and recreational activities is beneficial for physical and psychosocial well-being and community connectedness. However, many who could gain significantly from this have lower participation, especially the socioeconomically disadvantaged, Indigenous people, culturally diverse communities and people with a disability. This study examined barriers to participation by these underserved groups and the success of strategies for overcoming these used in 22 community projects over 3 years in the VicHealth Participation in Community Sport and Recreation Program, in Victoria, Australia. Each year, in-depth interviews were undertaken with 50-60 activity providers and 30-40 project partners. Major barriers to participation were cost, lack of transport, cultural differences, the environment of sporting groups and inaccessible facilities for people with disabilities. Projects that overcame these selected one or two priority groups, put significant effort into communication and building partnerships with community organizations, provided training to staff and volunteers and created new or modified forms of activity. Strategies were put in place to reduce cost and provide transport, but these did not appear to be sustainable. Many organizations found engaging the underserved was more difficult than anticipated and require information and support about how to develop acceptable, accessible and flexible opportunities for disadvantaged groups. Cost and lack of transport are persistent barriers to participation that need to be addressed by the sport and recreation sector and policy-makers.

Assessment of painful total shoulder arthroplasty using computed tomography arthrography.

BACKGROUND: This study assessed the accuracy of computed tomography (CT) arthrography when evaluating glenoid component stability in the setting of postarthroplasty shoulder pain. METHODS: We retrospectively reviewed all patients presenting to the clinic during a 5.5-year period to identify those with a painful shoulder arthroplasty more than 1 year after the index procedure. We excluded reverse and hemiarthroplasty procedures, patients with a clearly identifiable cause for pain, such as rotator cuff insufficiency or gross component loosening as seen on plain radiographs, and those with culture-positive aspiration. There were 14 patients with suspected glenoid component loosening but inconclusive plain radiographs. Each of the 14 patients underwent a CT arthrogram that was evaluated by the senior author (J.J.P.W.) for the presence or absence of contrast material underneath the polyethylene component. Operative reports and surgical videos from subsequent arthroscopy were reviewed to assess glenoid component stability as determined by direct arthroscopic visualization. RESULTS: CT arthrography suggested glenoid component loosening in 8 of 14 patients (57.1%), and arthroscopic inspection identified loosening in 10 of 14 patients (71.4%). In 3 of 10 patients (30%), CTA suggested a well-fixed glenoid component, but gross loosening was identified during arthroscopy. In this study, CTA yielded a sensitivity of 70%, a specificity of 75%, a positive predictive value of 87.5%, and a negative predictive value of 50.0%. CONCLUSION: CTA had a low negative predictive value (50%), and therefore, the prediction of component stability based on the absence of contrast between the glenoid component and the bone-cement interface does not always reflect true stability.

Providing newborn resuscitation at the mother's bedside: assessing the safety, usability and acceptability of a mobile trolley.

BACKGROUND: Deferring cord clamping at very preterm births may be beneficial for babies. However, deferring cord clamping should not mean that newborn resuscitation is deferred. Providing initial care at birth at the mother's bedside would allow parents to be present during resuscitation, and would potentially allow initial care to be given with the cord intact. The aim of this study was to evaluate the usability of a new mobile trolley for providing newborn resuscitation by describing the range of resuscitation procedures performed on a group of babies, to assess the acceptability to clinicians compared with standard equipment, based on a questionnaire survey, to assess safety from post resuscitation temperature measurements and serious adverse event reports and to assess whether the trolley allowed resuscitation with the umbilical cord intact by assessing the proportion of babies that could be placed on the trolley to allow resuscitation with the cord intact. METHODS: The trolley was used when the attendance of a clinician trained in newborn life support was required at a birth. Clinicians were asked to complete a questionnaire about their experience of using the trolley. Serious adverse events were reported. RESULTS: 78 babies were managed on the trolley. Median (range) gestation was 34 weeks (24 to 41 weeks). Median (range) birth weight was 2470 grams (520 to 4080 grams). The full range of resuscitation procedures has been successfully provided, although only one baby required emergency umbilical venous catheterisation. 77/78 babies had a post resuscitation temperature above 36°C. There were no adverse events. Most clinicians rated the trolley as 'the same', 'better' or 'much better' than conventional resuscitation equipment. In most situations, the baby could be resuscitated with umbilical cord intact, although on 18 occasions the cord was too short to reach the trolley. CONCLUSIONS: Immediate stabilisation at birth and resuscitation can be performed successfully and safely at the bedside using this trolley. In most cases this could be achieved with an intact umbilical cord.