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The aim of this study was to investigate whether gender was an effect modifier of the relationship between three psychosocial job stressors and sleep quality, in a representative sample of 7280 employed Australians. We conducted linear regressions and effect measure modification analyses. Low job control, high job demands and low job security were associated with poorer sleep quality. There was evidence of effect modification of the relationship between job security and sleep quality by gender on the additive scale, indicating that the combined effect of being male and having low job security is greater than the summed interactive effect.

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OBJECTIVE: For interventions, like the Transition to Independence Process (TIP) Model, to be implemented effectively, efficient and accessible quality assurance tools are needed. The purpose of this article is to describe the process of developing an online staff self-report quality assurance tool for a key process in the TIP Model: the TIP Solution Review (TSR) and to provide data on the acceptability and perceived impact of both the measure and the TSR process. METHOD: We used an iterative approach to pilot test and seek feedback from multidisciplinary teams trained in TIP. Initially, a team of 7 completed the online TSR Quality Assurance Scale, followed by a focus group. The tool was refined and administered to three additional TIP Model trained teams (n = 23 practitioners) in 3 different states. Team supervisors (n = 3) were then interviewed about their perceptions of the TSR process and the new tool. Thematic analyses were conducted on open-ended survey questions and interview and focus group responses. RESULTS: Findings suggest the new tool and TSR processes are acceptable and feasible. Staff feedback provided for further TSR process refinement. Conclusions and Implications for Clinical Practice: The process of developing, refining and evaluating a tool to capture the TSR (an important TIP quality improvement process) led to increased TSR process specification. Findings have implications for systematically guiding how intervention developers structure supervision and preparation of intervention planning and delivery. Future research will more rigorously test the tool to establish its empirical properties and effectiveness in assessing adherence to TSR procedures. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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AIM: To investigate trends in the rate of antenatal detection of cleft lip and palate (CLP) patients referred to the CLP Unit at Princess Margaret Hospital for Children in Perth, Western Australia during the period 2003-2012 and compare data with a previously published report covering the years 1996-2003. METHODS: This is a single-center, retrospective survey of antenatal transabdominal ultrasound screenings of mothers of infants born between July 1, 2003 and June 30, 2012 that were referred to the CLP Unit at Princess Margaret Hospital. RESULTS: Detection rates of oral clefts increased significantly when compared with outcomes reported in the same population between 1996 and 2003 (P < .05). An overall detection rate of 71.7% (165/230) was achieved for clefts involving lip and palate. Detection of isolated cleft palate (1/99) and microform (0/8) remained elusive. Most detections (76.5%) were achieved at 15 to 20 weeks of gestational age, corresponding with routine anatomical screening. A further 16.8% were detected post-20 weeks of gestation. Scans were performed by specialist obstetricians, and sonography clinics reported a detection rate of 84.6% (55/65), whereas nonspecialist clinics reported a detection rate of only 67.1% (110/164). CONCLUSION: The antenatal detection rates of oral clefts involving the lip have improved to the extent that the majority of mothers are now being referred to a cleft unit in Western Australia prior to the births of their children. As a result of this improvement, antenatal counseling is now a common facet of cleft management.

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Transition into adulthood represents a particularly challenging period for youth and young adults with serious mental health conditions and related needs. The Transition to Independence Process (TIP) model is based on a positive development approach and has been demonstrated to be an evidence-supported practice for preparing emerging adults in their movement into employment/career, education, living situation, personal effectiveness/well-being, and community-life functioning--and to be responsive to their families. This article describes the TIP model from a positive youth development framework, its empirical underpinnings, and the fidelity and outcome tracking tools that have been developed for use with transition sites for implementation and sustainability. A research study on the fidelity tools showed their reliability and validity and a second study presents progress and outcome findings for youth and young adults at a new TIP model site. The implications of the TIP model and these findings are discussed.

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Since the mid-1990s, research has established a clear picture of the poor real-life outcomes achieved by transition-age youth and young adults who have been diagnosed with a serious mental health disorder. The purpose of this article is to: (1) introduce the reader to the other eight articles in this special issue on Transition to Adulthood Research; (2) illustrate how each is contributing to the research base available to more fully understand these challenges as well as guide the creation of developmentally appropriate and effective services and supports for youth and young adults and their families; and (3) suggest future directions for continuing to advance this field of research and program implementation to improve outcomes though practice and policy improvements.

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Prior research has indicated that young people with serious mental health conditions show poorer progress and greater challenges in the transition to adulthood, as reflected by lower rates of employment and postsecondary education, higher rates of criminal justice involvement, and greater interference in daily activities from mental health and substance use disorders. Little knowledge exists, however, regarding improvement on these indicators among young people enrolled in community-based transition support programs and individual characteristics that might moderate this improvement. This study describes rates of improvement on indicators of transition progress and challenges among young people enrolled in a multisite demonstration of transition support programs. Young people in the study showed increased rates of progress and decreased rates of challenges over four quarters of enrollment. Moderation of these changes by individual characteristics including demographic, historical, and diagnostic variables suggested ways of improving transition support programs and avenues for future research.

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PURPOSE: The purpose of this study was to characterise the incidence and significance of the meniscal flounce. TYPE OF STUDY: Prospective Cohort Study. METHOD: A prospective study of 1088 consecutive knee arthroscopies. RESULTS: Intact menisci tended to have a flounce of characteristic size and position. The presence of this 'normal' flounce was closely correlated with an intact meniscus (p<0.0001). For the medial meniscus with a small flounce in zone 3 the sensitivity, specificity, and positive predictive value (PPV) for an intact medial meniscus were 68.5%; 92.9%; and 92.1% respectively. Conversely the presence of meniscal pathology correlated closely with either an absent or abnormal flounce (p<0.0001). The absence of a medial flounce had sensitivity, specificity, and PPV for a meniscal tear of 82.8%; 84.9%; and 81.9% respectively. CONCLUSIONS: The findings of this study are useful for arthroscopists especially when there is difficulty visualising all of the posterior half of the meniscus. In this situation the presence of a normal flounce is likely to signify an intact meniscus. However the presence of an abnormal or absent flounce may be the sign of an occult meniscal tear requiring better exposure.

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BACKGROUND: The relationship between socioeconomic position (SEP) and diet has been examined mainly on the basis of food and nutrient intake. As a complement to this work, we focused on the socioeconomic patterning of food purchasing, as many educational dietary messages emphasize behaviours such as food choice when shopping. Also, the type of food people buy influences the quality of their nutrient intake. METHODS: A probability sample of households in Brisbane City, Australia (n = 1003, 66.4% response rate). Data were collected using face-to-face interviews. SEP was measured using education, occupation and household income. Food purchasing was examined on the basis of grocery items (including meat and chicken) and fruit and vegetables. RESULTS: Significant associations were found between each socioeconomic indicator and food purchasing. Persons from socioeconomically disadvantaged backgrounds were less likely to purchase grocery foods that were comparatively high in fibre and low in fat, salt and sugar. The least educated, those employed in blue-collar (manual) occupations and residents of low income households purchased fewer types of fruit and vegetables, and less regularly, than their higher status counterparts. CONCLUSIONS: Health promotion efforts aimed at narrowing socioeconomic differences in food purchasing need to be designed and implemented with an understanding of, and a sensitivity to, the barriers to nutritional improvement that difficult life circumstances can impose.

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We report a prospective trial comparing the effectiveness of a post-operative flexion regime versus a standard extension regime on the early outcome of total knee arthroplasty. A total of 160 knees were allocated to two separate post-operative mobilisation regimes: a static flexion regime or an active extension regime. Patients were implanted with either an IBII or 913 total knee replacement systems. All operations were performed by the same surgeon. Patients were assessed pre-operatively and at 6 weeks, and were well matched with respect to age, sex, diagnosis and pre-op movement. Patients subjected to the flexion regime had a better maximum flexion and range of movement at 6 weeks and were also discharged earlier. These results were statistically significant (P < 0.05). Histograms of results at 6 weeks show that the flexion group had a more predictable outcome with smaller standard deviations (S.D.) than the extension group. Differences were also observed in the percentage of 'sub-optimal' results. No difference was observed in post-operative wound problems. We believe a static flexion regime is as good as reported results with CPM, better than an extension regime and does not result in an increase in wound problems.

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Clinical data has moved to the forefront as a valuable resource to enhance patient care and measure organizational performance. These data, most of which is now captured electronically, must be assessed for value and appropriateness. This article examines a data quality management model and its use in the initiation of computerized patient record (CPR) projects.

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Accurate component placement in knee replacement surgery is important. The precision with which the implants are placed directly affects patient outcome as implant position and alignment influence stability, durability and patellar tracking. The ability to measure the accuracy of implantation of knee replacement components is valuable in assessing not only ones own technique but also in evaluating new instruments or implants and in teaching. The standard AP and lateral radiographs employed by most surgeons give inadequate information to assess alignment of each component accurately. We present a straightforward way of assessing femoral and tibial component alignment by using a series of three radiographs. This technique is reproducible and can be performed using standard equipment in any radiology department. This technique was applied to 160 total knee replacements performed using newly developed instrumentation. It was shown to be simple and the measurements were reproducible, with very little inter observer bias. We believe this technique has a role in audit, teaching, training and assessing new techniques and instruments.

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Carbocylic coformycin (4) is a potent herbicide whose primary mode of action involves inhibition of adenosine 5'-monophosphate deaminase (AMPDA) following phosphorylation of the 5'-hydroxyl group in vivo. The search for more stable and accessible structures led to the synthesis of carbocyclic nebularine (8) and deaminoformycin (10). The latter compound is a good herbicide and its corresponding 5'-monophosphate 14 is a strong inhibitor of plant AMPDA (IC50 100 nM).

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1. To assess neurological, cardiovascular, metabolic and other side-effects of mefloquine given in conventional prophylactic dose to healthy volunteers, a double-blind, randomized, placebo-controlled trial was conducted. In addition, the identity of the active drug was concealed until the end of the trial. 2. A total of 106 healthy adults were recruited, of whom 95 (mean age 24 years; 45% males) completed the full study protocol. 3. Subjects had a baseline assessment, received placebo as first dose, were randomized to mefloquine 250 mg or placebo weekly for 4 weeks starting a week later, and were reassessed after the 2nd and 4th active/placebo doses. Subjects kept a daily symptom diary from 2 weeks before until 2 weeks after the dosing period. 4. Plasma mefloquine assay suggested compliance in all 46 subjects allocated active treatment (week 5 mean +/- s.d.; 2.35 +/- 0.94 mumol l-1. Mefloquine did not alter calcium homoeostasis but produced a mean 0.5 mmol l-1 fall in serum glucose over the study period (P < 0.001) and relative hyperinsulinaemia. Symbol digit modalities, and digit forwards and backwards test scores, were similar in active and placebo groups across the three assessments, as were lying/standing blood pressure and high-tone hearing loss. Electrocardiographic QTc interval prolongation and diarrhoea were mild but transient side-effects of mefloquine (P < 0.01). Neurological symptoms were comparable in the two groups throughout the study. There was no evidence of drug toxicity in 11 subjects who withdrew. 5. Mefloquine prophylaxis does not appear to produce low-grade but debilitating neurological symptoms or to alter the results of sensitive tests of cerebral function. However, there may be situations in which mefloquine might contribute to hypoglycaemia and cardiac dysrhythmias.

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OBJECTIVE: To evaluate the accuracy of ultrasound measurement of nuchal thickness in first trimester fetuses for predicting fetal karyotype. DESIGN: A prospective study of the nuchal thickness of fetuses measured during an ultrasound examination in all women undergoing first trimester chorionic villus sampling (CVS). SETTING: Two major public hospitals and two associated private practices between 7 September 1993 and 6 September 1994. PARTICIPANTS: Pregnant women with various indications for CVS (in 82% because of maternal age). RESULTS: 1306 women underwent CVS, including 11 with twin pregnancies: 1317 fetuses were tested. Karyotype results were obtained for 1312 fetuses: 41 (3.1%) had an abnormal karyotype, and 20 of these (49%) had a nuchal thickness measurement of 3 mm or more, compared with 44 (3.5%) of the 1271 fetuses with a normal karyotype. Of the 21 fetuses shown to have trisomy 21, 12 would have been detected if a nuchal thickness of 3 mm or more had been used as an indicator, giving a sensitivity of 57%. Nuchal thickness measurements of 1 or 2 mm excluded trisomy 21 with a negative predictive value of 99.3%. Fetuses with moderate nuchal thickening, normal karyotype and no other problems noted on the initial ultrasound scan had neonatal outcomes similar to those in the general obstetric population. CONCLUSION: Nuchal thickening in the first trimester (10 weeks on) of pregnancy in a high risk population is a powerful indicator of increased risk of aneuploidy.

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We have determined the fatty acid content and composition of retail samples of meat and assessed them with respect to UK dietary recommendations. Fifty beef sirloin steaks, pork chops and lamb chops were purchased from four supermarkets on separate occasions. The percentage of muscle (boneless basis) in the samples was 84.4 ± 4.3, 69.8 ± 7.7 and 78.9 ± 7.1 for beef, lamb and pork, respectively, with fatty acid contents of 3.84 ± 1.3, 4.73 ± 1.66 and 2.26 ± 0.7 g per 100 g muscle, respectively. Adipose tissue fatty acid contents were 70.0 ± 8.2, 70.6 ± 8.6 and 65.3 ± 9.4 g per 100 g tissue. A range of C20 and C22 polyunsaturated fatty acids (PUFA) was present in the muscle of all three species and pork adipose tissue but their concentrations in lamb and beef adipose tissue were too low to measure. The mean P:S ratios for beef, lamb and pork muscle were (adipose tissue values in parentheses): 0.11 (0.05); 0.15 (0.09) and 0.58 (0.61), and the n-6:n-3 ratios were 2.1 (2.3), 1.3 (1.4) and 7.2 (7.6). We conclude that the muscles of red meat species are a valuable source of PUFA, particularly the C20 and C22 n-3 fatty acids, in the human diet and that, considered as part of a varied diet, the low P:S ratio of the ruminant muscle, the high n-6:n-3 ratio of pork and the total fatty acid contents do not detract significantly from the nutritional value of lean meat.

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We investigated the role of local cutaneous signals and of co-contraction of antagonists in repeated judgements of heaviness of weights lifted by flexor pollicis longus. A reference weight lifted by right thumb flexion was matched to a weight lifted by left thumb flexion. Anaesthesia of the right thumb, or of the superficial radial, dorsal ulnar or mixed radial nerves failed to impair accuracy of weight judgements. However, perceived heaviness significantly increased by 85% and 20% following anaesthesia of the thumb and dorsal radial surface of the hand, respectively, confirming a role for cutaneous inputs from these areas in motor control of the thumb.

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Two cases of amnion rupture are presented in 'low-risk' pregnancies. One case ended in fetal death in utero at 21 weeks. The other resulted in the preterm delivery of an otherwise normal male with mild amniotic band syndrome.

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PIP: The author discusses political developments in the Caucasus region since the collapse of the Soviet Union. The focus is on the events in Georgia that led to the war in South Ossetia (particularly in Abkhazia), and the author suggests that this development is the latest in a 200-year history of demographic manipulation of minority peoples by the region's two major powers, Russia and Georgia. Parallels are drawn between the Georgian war in Abkhazia and Russia's war in Chechenia. The author questions the value of the principle of territorial integrity, and suggests that alternative principles safeguarding the rights of ethnic minorities would be more appropriate in these circumstances.^ieng

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