Preserving Pure Siamese Crocodile Populations: A Comprehensive Approach Using Multi-Genetic Tools

Hybrids between the critically endangered Siamese crocodile (Crocodylus siamensis) and least-concern saltwater crocodile (C. porosus) in captive populations represent a serious challenge for conservation and reintroduction programs due to the impact of anthropogenic activities. A previous study used microsatellite and mitochondrial DNA data to establish the criteria for identifying species and their hybrids; however, the results may have been influenced by biased allelic frequencies and genetic drift within the examined population. To overcome these limitations and identify the true signals of selection, alternative DNA markers and a diverse set of populations should be employed. Therefore, this study used DArT sequencing to identify genome-wide single nucleotide polymorphisms (SNPs) in both species and confirm the genetic scenario of the parental species and their hybrids. A population of saltwater crocodiles from Australia was used to compare the distribution of species-diagnostic SNPs. Different analytical approaches were compared to diagnose the level of hybridization when an admixture was present, wherein three individuals had potential backcrossing. Approximately 17.00-26.00% of loci were conserved between the Siamese and saltwater crocodile genomes. Species-diagnostic SNP loci for Siamese and saltwater crocodiles were identified as 8051 loci and 1288 loci, respectively. To validate the species-diagnostic SNP loci, a PCR-based approach was used by selecting 20 SNP loci for PCR primer design, among which 3 loci were successfully able to differentiate the actual species and different hybridization levels. Mitochondrial and nuclear genetic information, including microsatellite genotyping and species-diagnostic DNA markers, were combined as a novel method that can compensate for the limitations of each method. This method enables conservation prioritization before release into the wild, thereby ensuring sustainable genetic integrity for long-term species survival through reintroduction and management programs.

Environmental resistance and habitat quality influence dispersal of the saltwater crocodile

Landscape genetics commonly focuses on the effects of environmental resistance on animal dispersal patterns, but there is an emerging focus on testing environmental effects on emigration and settlement choices. In this study, we used landscape genetics approaches to quantify dispersal patterns in the world's largest crocodilian, the saltwater crocodile (Crocodylus porosus), and demonstrated environmental influences on three processes that comprise dispersal: emigration, movement and settlement. We found that both environmental resistance and properties of the source and destination catchments (proportion of breeding habitat) were important factors influencing observed dispersal events. Our habitat quality variables related to hypotheses about resource competition and represented the ratio of breeding habitat (which limits carrying capacity), suggesting that competition for habitat influences emigration and settlement choices, together with the strong effect of environmental resistance to movement (where high-quality habitat was associated with greatest environmental permeability). Approximately 42% of crocodiles were migrants from populations other than their sampling locations and some outstandingly productive populations had a much higher proportion of emigration rather than immigration. The distance most commonly travelled between source and destination was 150-200 km although a few travelled much longer distances, up to 600-700 km. Given the extensive dispersal range, individual catchments or hydrographic regions that combine two or three adjacent catchments are an appropriate scale for population management.

Initial experience of TAS-102 chemotherapy in Australian patients with Chemo-refractory metastatic colorectal cancer

For patients with refractory metastatic colorectal cancer (mCRC) treatment with Trifluridine/Tipiracil, also known as TAS-102, improves overall survival. This study aims to investigate the efficacy and safety of TAS-102 in a real-world population from Victoria, Australia. A retrospective analysis of prospectively collected data from the Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) registry was undertaken. The characteristics and outcomes of patients receiving TAS-102 were assessed and compared to those enrolled in the registration study (RECOURSE). Across 13 sites, 107 patients were treated with TAS-102. The median age was 60 years (range: 31-83), compared to 63 for RECOURSE. Comparing registry TAS-102-treated and RECOURSE patients, 75% vs 100% were ECOG performance status 0-1, 74% vs 79% had initiated treatment more than 18 months from diagnosis of metastatic disease and 36% vs 49% were RAS wild-type. Median time on treatment was 10.4 weeks (range: 1.7-32). Median progression-free survival (PFS) was 3.3 months compared to 2 months in RECOURSE, while median overall survival was the same at 7.1 months. Two patients (2.3%) had febrile neutropenia and there were no treatment-related deaths, where TAS-102 dose at treatment initiation was at clinician discretion.TRACC registry patients treated with TAS-102 were younger than those from the RECOURSE trial, with similar overall survival observed. Less strict application of RECIST criteria and less frequent imaging may have contributed to an apparently longer PFS.

Monotonous driving induces shifts in spatial attention as a function of handedness

Current evidence suggests that the ability to detect and react to information under lowered alertness conditions might be more impaired on the left than the right side of space. This evidence derives mainly from right-handers being assessed in computer and paper-and-pencil spatial attention tasks. However, there are suggestions that left-handers might show impairments on the opposite (right) side compared to right-handers with lowered alertness, and it is unclear whether the impairments observed in the computer tasks have any real-world implications for activities such as driving. The current study investigated the alertness and spatial attention relationship under simulated monotonous driving in left- and right-handers. Twenty left-handed and 22 right-handed participants (15 males, mean age = 23.6 years, SD = 5.0 years) were assessed on a simulated driving task (lasting approximately 60 min) to induce a time-on-task effect. The driving task involved responding to stimuli appearing at six different horizontal locations on the screen, whilst driving in a 50 km/h zone. Decreases in alertness and driving performance were evident with time-on-task in both handedness groups. We found handedness impacts reacting to lateral stimuli differently with time-on-task: right-handers reacted slower to the leftmost stimuli, while left-handers showed the opposite pattern (although not statistically significant) in the second compared to first half of the drive. Our findings support suggestions that handedness modulates the spatial attention and alertness interactions. The interactions were observed in a simulated driving task which calls for further research to understand the safety implications of these interactions for activities such as driving.

Sexual Risk Behaviors Associated with Sexually Transmitted Infections in a US Military Population Living with HIV After the Repeal of "Don't Ask, Don't Tell"

Risk behaviors associated with sexually transmitted infections (STIs) among people living with HIV (PLWH) have not been well characterized in the US military. We identified risk behaviors associated with a new STI in this population after the repeal of "Don't Ask, Don't Tell." US Military HIV Natural History Study participants who completed the risk behavior questionnaire (RBQ) between 2014 and 2017 and had at least 1 year of follow-up were included (n = 1589). Logistic regression identified behaviors associated with incident STI in the year following RBQ completion. Overall, 18.9% acquired an STI and 52.7% reported condom use at last sexual encounter. Compared with those with no new sex partners, participants with between one and four or five or more new partners were 1.71 [1.25-2.35] and 6.12 [3.47-10.79] times more likely to get an STI, respectively. Individuals reporting low or medium/high perceived risk of STI were 1.83 [1.23-2.72] and 2.65 [1.70-4.15] times more likely to acquire a new STI than those reporting no perceived risk, respectively. Participants who preferred not to answer about sexual preference, number of new partners, or perceived STI risk were also more likely to acquire a new STI. Our study illustrates that despite regular access to health care and accurate perceptions of risk, rates of STI among PLWH remain high in the US military setting, as in others. Given the potential individual and public health consequences of STI coinfection after HIV, more work is needed to assess interventions aimed at sexual behavior change for PLWH.

The relationship between alertness and spatial attention under simulated shiftwork

Higher and lower levels of alertness typically lead to a leftward and rightward bias in attention, respectively. This relationship between alertness and spatial attention potentially has major implications for health and safety. The current study examined alertness and spatial attention under simulated shiftworking conditions. Nineteen healthy right-handed participants (M = 24.6 ± 5.3 years, 11 males) completed a seven-day laboratory based simulated shiftwork study. Measures of alertness (Stanford Sleepiness Scale and Psychomotor Vigilance Task) and spatial attention (Landmark Task and Detection Task) were assessed across the protocol. Detection Task performance revealed slower reaction times and higher omissions of peripheral (compared to central) stimuli, with lowered alertness; suggesting narrowed visuospatial attention and a slight left-sided neglect. There were no associations between alertness and spatial bias on the Landmark Task. Our findings provide tentative evidence for a slight neglect of the left side and a narrowing of attention with lowered alertness. The possibility that one’s ability to sufficiently react to information in the periphery and the left-side may be compromised under conditions of lowered alertness highlights the need for future research to better understand the relationship between spatial attention and alertness under shiftworking conditions.

0300 The Circadian Timing of Sleep Affects the Rate of Accumulation of Neurobehavioral Impairment Across Days of Sleep Restriction

Introduction

Chronic restriction of nighttime sleep to less than ~8h/day leads to build-up of neurobehavioral impairment across days. Although it is known that sleep loss effects depend on the circadian timing of sleep, it is not known how the timing of restricted sleep influences the accumulation of neurobehavioral impairment over days. Here we studied the accumulation of impairment across days of restricted sleep placed in the morning or afternoon.

Methods

N=71 healthy young adults (39% female; ages 21-45y, mean±SD: 27.9±6.6y) completed a 14-day laboratory study. After two baseline days with nighttime sleep (8h TIB: 23:30-07:30), subjects were randomized to 10 consecutive days of A) morning sleep at 4h, 6h, or 8h TIB ending at 11:30 each day (n=18, 8, 8, respectively), or B) afternoon sleep at 4h, 6h, or 8h TIB ending at 19:30 each day (n=13, 17, 7, respectively). Subjects were tested on the 10min psychomotor vigilance test (PVT) every ~2 hours during scheduled wakefulness. Daily averages for PVT lapses (RTs>500ms) observed between 2h and 14h after awakening were analyzed with non-linear mixed-effects regression to investigate differences in the neurobehavioral impairment build-up rate between sleep restriction conditions.

Results

Afternoon sleep conditions showed a significant sleep dose-response effect (p<0.001), with the fastest accrual of PVT performance deficits across days in the 4h condition, and slow-to-negligible accumulation (p=0.36) of PVT performance deficits in the 8h condition. However, morning sleep resulted in no significant sleep dose-response effect (p=0.96). All 3 morning sleep doses displayed negligible (p≥0.12) accumulation of impairment across days.

Conclusion

In this sample of young adults, sleep dosages ending in the morning (at 11:30) appear to provide considerable protection against cumulative performance deficits from sleep restricted to 4h-6h/day over 10 days, suggesting that the afternoon circadian promotion of wakefulness can sustain behavioral alertness even over multiple days of repeated sleep restriction.

Support

NIH grants R01-NR04281 and M01-RR00040

Genomic impact of severe population decline in a nomadic songbird

Uncovering the population genetic histories of non-model organisms is increasingly possible through advances in next generation sequencing and DNA sampling of museum specimens. This new information can inform conservation of threatened species, particularly those for which historical and contemporary population data are unavailable or challenging to obtain. The critically endangered, nomadic regent honeyeater Anthochaera phrygia was abundant and widespread throughout south-eastern Australia prior to a rapid population decline and range contraction since the 1970s. A current estimated population of 250-400 individuals is distributed sparsely across 600,000 km2 from northern Victoria to southern Queensland. Using hybridization RAD (hyRAD) techniques, we obtained a SNP dataset from 64 museum specimens (date 1879-1960), 102 'recent' (1989-2012) and 52 'current' (2015-2016) wild birds sampled throughout the historical and contemporary range. We aimed to estimate population genetic structure, genetic diversity and population size of the regent honeyeater prior to its rapid decline. We then assessed the impact of the decline on recent and current population size, structure and genetic diversity. Museum sampling showed population structure in regent honeyeaters was historically low, which remains the case despite a severe fragmentation of the breeding range. Population decline has led to minimal loss of genetic diversity since the 1980's. Capacity to quantify the overall magnitude of both genetic diversity loss and population decline was limited by the poorer quality of genomic data derived from museum specimens. A rapid population decline, coupled with the regent honeyeater's high mobility, means a detectable genomic impact of this decline has not yet manifested. Extinction may occur in this nomadic species before a detectable genomic impact of small population size is realised. We discuss the implications for genetic management of endangered mobile species and enhancing the value of museum specimens in population genomic studies.

Translocation, genetic structure and homing ability confirm geographic barriers disrupt saltwater crocodile movement and dispersal

Translocated saltwater crocodiles (Crocodylus porosus) in the Northern Territory (NT) of Australia often return to their original capture sites, which complicates management interventions aimed at reducing human-crocodile conflict. We examined the spatial events implicated in this homing ability, using ARGOS satellite tracking devices. Five large male C. porosus (3.03 m to 4.02 m TL) were shifted and released 100-320 km from their capture sites, and 3 additional ones (3.67 m to 4.23 m TL) were released at their site of capture as controls. Translocated crocodiles were more mobile than the controls, and moved at sea in the direction of their original capture site. However, they were unable or unwilling to swim around a geographic structure, Cobourg Peninsula, which prevented homing being achieved in all five cases. Two control crocodiles remained near their capture sites, but one, after the first year, made a 900km journey for six months, before returning to its original capture and release site. Genetic analysis of tissue samples from nests across the NT coast demonstrated significant genetic structure across the coast, and confirmed that Cobourg Peninsula contributes to genetic differentiation among populations along the NT coast. These results provide new insights into C. porosus movements, which have management significance for the maintenance of public safety.

Relationship Between Verbal Fluency Performance, Fight Exposure, and Subcortical Region Brain Volumes in Professional Fighters

Purpose

Verbal fluency performance has been shown to be sensitive to preclinical cognitive changes in neurodegenerative diseases and may detect early, trauma-related cognitive and volumetric changes amongst professional fighters. Baseline verbal fluency performance and volumes of relevant subcortical brain structures were expected to decline as number of professional fights (NoPF) increased, while controlling for education.

Methods

Baseline letter and semantic fluency performance, NoPF, and structural brain imaging from 548 active and retired fighters who participated in the Professional Fighters Brain Health Study were considered. ANCOVAs were conducted to assess differences in verbal fluency performance by NOPF, while controlling for years of education. Number of professional fights were stratified into low (0-20 fights), medium (21-40 fights), and high (41 or more fights).

Results

Semantic fluency performance differed across the three levels of NoPF (F(2, 542)=4.56; p<.02). In addition, significant positive correlations between semantic fluency performance and volumes in the following regions were observed: left thalamus, left putamen, left pallidum, bilateral caudates, bilateral amygdalae, bilateral hippocampi, and bilateral accumbens (all p’s<.05). In contrast, letter fluency performance was not significantly associated with NoPF or volumes of relevant subcortical brain structures (all p’s>.05).

Conclusion

Semantic fluency may be low-cost, easy-to-administer harbinger of emerging cognitive dysfunction and lower volumes in related subcortical brain regions. Additional assessment of clinical utility is necessary.

Isolation, marine transgression and translocation of the bare-nosed wombat (Vombatus ursinus)

Island populations can represent genetically distinct and evolutionarily important lineages relative to mainland conspecifics. However, phenotypic divergence of island populations does not necessarily reflect genetic divergence, particularly for lineages inhabiting islands periodically connected during Pleistocene low sea stands. Marine barriers may also not be solely responsible for any divergence that is observed. Here, we investigated genetic divergence among and within the three phenotypically distinct subspecies of bare-nosed wombats (Vombatus ursinus) in south-east Australia that are presently-but were not historically-isolated by marine barriers. Using genome-wide single nucleotide polymorphisms, we identified three genetically distinct groups (mainland Australia, Bass Strait island, and Tasmania) corresponding to the recognized subspecies. However, isolation by distance was observed in the Tasmanian population, indicating additional constraints on gene flow can contribute to divergence in the absence of marine barriers, and may also explain genetic structuring among fragmented mainland populations. We additionally confirm origins and quantify the genetic divergence of an island population 46 years after the introduction of 21 individuals from the Vulnerable Bass Strait subspecies. In the light of our findings, we make recommendations for the maintenance of genetic variation and fitness across the species range.

"I love having a healthy lifestyle" - a qualitative study investigating body mass index trajectories from childhood to mid-adulthood

Background

Children with overweight or obesity are at greatly increased risk of experiencing obesity in adulthood but for reasons generally unknown some attain a healthier adult weight. This qualitative study investigated individual, social and environmental factors that might explain diverging body mass index (BMI) trajectories. This knowledge could underpin interventions to promote healthy weight.

Methods

This 2016 study included participants from three adult follow-ups of children who (when 7–15 years) participated in the 1985 Australian Schools Health and Fitness Survey and provided BMI data at each time point. Trajectory-based group modelling identified five BMI trajectories: stable below average, stable average, increasing from average, increasing from very high and decreasing from very high. Between six and 12 participants (38–46 years) from each BMI trajectory group were interviewed (n = 50; 60% women). Thematic analysis guided by a social-ecological framework explored individual, social and environmental influences on diet and physical activity within the work setting.

Results

A distinct approach to healthy behaviour was principally identified in the stable and decreasing BMI groups – we term this approach “health identity” (exemplified by “I love having a healthy lifestyle”). This concept was predominant in the stable or decreasing BMI groups when participants explained why work colleagues seemingly did not influence their health behaviour. Participants in the stable and decreasing BMI groups also more commonly reported, bringing home-prepared lunches to work, working or being educated in a health-related field, having a physically active job or situating physical activity within and around work – the latter three factors were common among those who appeared to have a more distinct “health identity”. Alcohol, workplace food culture (e.g. morning teas), and work-related stress appeared to influence weight-related behaviours, but generally these factors were similarly discussed across all trajectory groups.

Conclusion

Work-related factors may influence weight or weight-related behaviours, irrespective of BMI trajectory, but the concept of an individual’s “health identity” may help to explain divergent BMI trajectories. “Health identity” and its influence on health behaviour warrants further exploratory work.

Electronic supplementary material

The online version of this article (10.1186/s40608-019-0239-3) contains supplementary material, which is available to authorized users.

Synchronized drowsiness monitoring and simulated driving performance data under 50-hr sleep deprivation: A double-blind placebo-controlled caffeine intervention

This paper presents the 60-s time-resolution segment from our 50-h total sleep deprivation (TSD) dataset (Aidman et al., 2018) [1] that captures minute-by-minute dynamics of driving performance (lane keeping and speed variability) along with objective, oculography-derived drowsiness estimates synchronised to the same 1-min driving epochs. Eleven participants (5 females, aged 18–28) were randomised into caffeine (administered in four 200 mg doses via chewing gum in the early morning hours) or placebo groups. Every three hours they performed a 40 min simulated drive in a medium fidelity driving simulator, while their drowsiness was continuously measured with a spectacle frame-mounted infra-red alertness monitoring system. The dataset covers 15 driving periods of 40 min each, and thus contains over 600 data points of paired data per participant. The 1-min time resolution enables detailed time-series analyses of both time-since-wake and time-on-task performance dynamics and associated drowsiness levels. It also enables direct examination of the relationships between drowsiness and task performance measures. The question of how these relationships might change under various intervention conditions (caffeine in our case) seems worth further investigation.

Managing military training-related environmental disturbance

Military Training Areas (MTAs) cover at least 2 percent of the Earth's terrestrial surface and occur in all major biomes. These areas are potentially important for biodiversity conservation. The greatest challenge in managing MTAs is balancing the disturbance associated with military training and environmental values. These challenges are unique as no other land use is managed for these types of anthropogenic disturbances in a natural setting. We investigated how military training-related disturbance is best managed on MTAs. Specifically, we explored management options to maximise the amount of military training that can be undertaken on a MTA while minimising the amount of environmental disturbance. MTAs comprise of a number of ranges designed to facilitate different types of military training. We simulated military training-related environmental disturbance at different range usage rates under a typical range rotation use strategy, and compared the results to estimated ecosystem recovery rates from training activities. We found that even at relatively low simulated usage rates, random allocation and random spatial use of training ranges within an MTA resulted in environmental degradation under realistic ecological recovery rates. To avoid large scale environmental degradation, we developed a decision-making tool that details the best method for managing training-related disturbance by determining how training activities can be allocated to training ranges.

Prevalence of Traumatic Findings on Routine MRI in a Large Cohort of Professional Fighters

BACKGROUND AND PURPOSE

Previous studies investigating MR imaging abnormalities among fighters have had small sample sizes. This investigation assessed a large number of fighters using the same conventional sequences on the same scanner.

MATERIALS AND METHODS

Conventional 3T MR imaging was used to assess 499 fighters (boxers, mixed martial artists, and martial artists) and 62 controls for nonspecific WM changes, cerebral microhemorrhage, cavum septum pellucidum, and cavum vergae. The lengths of the cavum septum pellucidum and cavum vergae and the ratio of cavum septum pellucidum to the septum pellucidum lengths were assessed.

RESULTS

The prevalence of nonspecific WM changes was similar between groups. Fighters had a prevalence of cerebral microhemorrhage (4.2% versus 0% for controls, P = .152). Fighters had a higher prevalence of cavum septum pellucidum versus controls (53.1% versus 17.7%, P < .001) and cavum vergae versus controls (14.4% versus 0%, P < .001). The lengths of the cavum septum pellucidum plus the cavum vergae (P < .001), cavum septum pellucidum (P = .025), and cavum septum pellucidum to the septum pellucidum length ratio (P = .009) were higher in fighters than in controls. The number of fights slightly correlated with cavum septum pellucidum plus cavum vergae length (R = 0.306, P < .001) and cavum septum pellucidum length (R = 0.278, P < .001). When fighters were subdivided into boxers, mixed martial artists, and martial artists, results were similar to those in the whole-group analysis.

CONCLUSIONS

This study assessed MR imaging findings in a large cohort demonstrating a significantly increased prevalence of cavum septum pellucidum among fighters. Although cerebral microhemorrhages were higher in fighters than in controls, this finding was not statistically significant, possibly partially due to underpowering of the study.

Validation and reproducibility of an Australian caffeine food frequency questionnaire

The aim of this study was to measure validity and reproducibility of a caffeine food frequency questionnaire (C-FFQ) developed for the Australian population. The C-FFQ was designed to assess average daily caffeine consumption using four categories of food and beverages including; energy drinks; soft drinks/soda; coffee and tea and chocolate (food and drink). Participants completed a seven-day food diary immediately followed by the C-FFQ on two consecutive days. The questionnaire was first piloted in 20 adults, and then, a validity/reproducibility study was conducted (n = 90 adults). The C-FFQ showed moderate correlations (r = .60), fair agreement (mean difference 63 mg) and reasonable quintile rankings indicating fair to moderate agreement with the seven-day food diary. To test reproducibility, the C-FFQ was compared to itself and showed strong correlations (r = .90), good quintile rankings and strong kappa values (κ = 0.65), indicating strong reproducibility. The C-FFQ shows adequate validity and reproducibility and will aid researchers in Australia to quantify caffeine consumption.

Tick abundances in South London parks and the potential risk for Lyme borreliosis to the general public

Tick abundances and prevalences of infection with Borrelia burgdorferi sensu lato, the causative agent of Lyme disease, were investigated in four South London parks. A total of 360 transects were sampled using three methods of collection (blanket, leggings and flags) simultaneously. No ticks were found on Wimbledon Common or at Hampton Court, but 1118 Ixodes ricinus (Ixodida: Ixodidae) ticks were collected at Richmond and Bushy Parks. At Richmond Park, lower canopy humidity [odds ratio (OR) 0.94; P = 0.005], increased mat depth (OR 1.15; P < 0.001) and increased soil moisture (OR 1.40; P = 0.001) predicted the presence of I. ricinus, and increased sward height [incidence rate ratio (IRR) 1.01; P = 0.006] and decreased ground temperature (IRR 0.90; P = 0.009) predicted increased abundance. At Bushy Park, thicker mat depth predicted tick presence (OR 1.17; P = 0.006) and increasing temperature correlated with tick absence (OR 0.57; P = 0.023). A total of 279 ticks were screened for the presence of B. burgdorferi using quantitative polymerase chain reaction. Point prevalences of 0% for larvae (n = 78), 2.14% for nymphs (n = 174) and 0% for adult ticks (n = 7) related to an acarological risk of 0.22 infected ticks per 40 m transect in Richmond Park. The abundance of ticks and the acarological risk, particularly at Richmond Park, highlight the need for appropriate communication of the associated risk to the general public frequenting these recreational areas.

A tool to aid talking about dementia and dying--development and evaluation

BACKGROUND

Health professionals often avoid talking about death and dying with patients and relatives, and this avoidance is compounded in cases of dementia by lack of knowledge of trajectory and prognosis. Unfortunately, this impacts on care, with many terminally ill dementia clients receiving inadequate palliation and excessive intervention at end-of-life. This study developed and evaluated a tool to facilitate conversations about death and dying in aged care facilities.

METHODS

This study utilised available best-practice evidence, feedback from aged care facility nursing and care staff and specialist input to develop the 'discussion tool', which was subsequently trialled and qualitatively evaluated, via thematic analysis of data from family interviews and staff diaries. The study was part of a larger mixed method study, not yet reported. The tool provided knowledge and also skills-based 'how to' information and specific examples of 'what to say'.

RESULTS

The tool facilitated a more open dialogue between dementia palliation resource nurses (a role specifically developed during this project) and family members. Both resource nurses and family members gained confidence in discussing the death of their relative with dementia, and in relevant cases discussed specific decisions around future care. Family members and nurses reported satisfaction with these discussions.

CONCLUSION

Providing specific skills-based support, such as the 'discussion tool' can help staff to gain confidence and change practice in situations where unfamiliar and uncomfortable practices might normally be avoided. As our populations age, health professionals will increasingly need to be able to openly discuss care options towards end-of-life.

Pilot phase I/II personalized therapy trial for metastatic colorectal cancer: evaluating the feasibility of protein pathway activation mapping for stratifying patients to therapy with imatinib and panitumumab

This nonrandomized phase I/II trial assessed the efficacy/tolerability of imatinib plus panitumumab in patients affected by metastatic colorectal cancer (mCRC) after stratification to treatment by selection of activated imatinib drug targets using reverse-phase protein array (RPPA). mCRC patients presenting with a biopsiable liver metastasis were enrolled. Allocation to the experimental and control arms was established using functional pathway activation mapping of c-Kit, PDGFR, and c-Abl phosphorylation by RPPA. The experimental arm received run-in escalation therapy with imatinib followed by panitumumab. The control arm received panitumumab alone. Seven patients were enrolled in the study. For three of the seven patients, sequential pre- and post-treatment biopsies were used to evaluate the effect of the therapeutic compounds on the drug targets and substrates. A decrease in the activation level of the drug targets and downstream substrates was observed in two of three patients. Combination therapy increased the activation of the AKT-mTOR pathway and several receptor tyrosine kinases. This study proposes a novel methodology for stratifying patients to personalized treatment based on the activation level of the drug targets. This workflow provides the ability to monitor changes in the signaling pathways after the administration of targeted therapies and to identify compensatory mechanisms.

Interacting factors driving a major loss of large trees with cavities in a forest ecosystem

Large trees with cavities provide critical ecological functions in forests worldwide, including vital nesting and denning resources for many species. However, many ecosystems are experiencing increasingly rapid loss of large trees or a failure to recruit new large trees or both. We quantify this problem in a globally iconic ecosystem in southeastern Australia – forests dominated by the world's tallest angiosperms, Mountain Ash (Eucalyptus regnans). Tree, stand and landscape-level factors influencing the death and collapse of large living cavity trees and the decay and collapse of dead trees with cavities are documented using a suite of long-term datasets gathered between 1983 and 2011. The historical rate of tree mortality on unburned sites between 1997 and 2011 was >14% with a mortality spike in the driest period (2006–2009). Following a major wildfire in 2009, 79% of large living trees with cavities died and 57–100% of large dead trees were destroyed on burned sites. Repeated measurements between 1997 and 2011 revealed no recruitment of any new large trees with cavities on any of our unburned or burned sites. Transition probability matrices of large trees with cavities through increasingly decayed condition states projects a severe shortage of large trees with cavities by 2039 that will continue until at least 2067. This large cavity tree crisis in Mountain Ash forests is a product of: (1) the prolonged time required (>120 years) for initiation of cavities; and (2) repeated past wildfires and widespread logging operations. These latter factors have resulted in all landscapes being dominated by stands ≤72 years and just 1.16% of forest being unburned and unlogged. We discuss how the features that make Mountain Ash forests vulnerable to a decline in large tree abundance are shared with many forest types worldwide.

Effects of moderate sleep deprivation and low-dose alcohol on driving simulator performance and perception in young men

STUDY OBJECTIVE

To determine the combined effects of sleep restriction and low-dose alcohol on driving simulator performance, EEG, and subjective levels of sleepiness and performance in the mid-afternoon.

DESIGN

Repeated measures with 4 experimental conditions. Normal sleep without alcohol, sleep restriction alone (4 hours) and sleep restriction in combination with 2 different low blood alcohol concentrations (0.025 g/dL and 0.035 g/dL).

SETTING

Sleep Laboratory, Adelaide Institute for Sleep Health.

PARTICIPANTS

Twenty-one healthy young men, aged 18-30 years, mean (+/-SD) = 22.5(+/-3.7) years, BMI = 25(+/-6.7) kg/m2; all had normal sleep patterns and were free of sleep disorders.

MEASUREMENTS

Participants completed a 70-minute simulated driving session, commencing at 14:00. Driving parameters included steering deviation, braking reaction time, and number of collisions. Alpha and theta EEG activity and subjective driving performance and sleepiness were also measured throughout the driving task.

RESULTS

All measures were significantly affected by time. Steering deviation increased significantly when sleep restriction was combined with the higher dose alcohol. This combination also resulted in a significant increase in alpha/theta EEG activity throughout the drive, as well as greater subjective sleepiness and negative driving performance ratings compared to control or sleep restriction alone.

DISCUSSION

These data indicate that combining low-dose alcohol with moderate sleep restriction results in significant decrements to subjective alertness and performance as well as to some driving performance and EEG parameters. This highlights the potential risks of driving after consumption of low and legal doses of alcohol when also sleep restricted.

Kinematics of posterior cruciate ligament-retaining and -substituting total knee arthroplasty: a prospective randomised outcome study

We performed a prospective, randomised trial of 44 patients to compare the functional outcomes of a posterior-cruciate-ligament-retaining and posterior-cruciate-ligament-substituting total knee arthroplasty, and to gain a better understanding of the in vivo kinematic behaviour of both devices. At follow-up at five years, no statistically significant differences were found in the clinical outcome measurements for either design. The prevalence of radiolucent lines and the survivorship were the same. In a subgroup of 15 knees, additional image-intensifier analysis in the horizontal and sagittal planes was performed during step-up and lunge activity. Our analysis revealed striking differences. Lunge activity showed a mean posterior displacement of both medial and lateral tibiofemoral contact areas (roll-back) which was greater and more consistent in the cruciate-substituting than in the cruciate-retaining group (medial p < 0.0001, lateral p = 0.011). The amount of posterior displacement could predict the maximum flexion which could be achieved (p = 0.018). Forward displacement of the tibiofemoral contact area in flexion during stair activity was seen more in the cruciate-retaining than in the cruciate-substituting group. This was attributed mainly to insufficiency of the posterior cruciate ligament and partially to that of the anterior cruciate ligament. We concluded that, despite similar clinical outcomes, there are significant kinematic differences between cruciate-retaining and cruciate-substituting arthroplasties.

The influence of tibial slope on maximal flexion after total knee arthroplasty

Many surgeons believe that increasing the tibial slope in total knee arthroplasty (TKA) is beneficial with regard to maximal postoperative flexion. Review of the clinical literature, however, does not confirm this hypothesis, neither does it give an answer to the question of how much flexion gain can be expected per degree extra tibial slope. The purpose of this study was, therefore, to evaluate and quantify the influence of tibial slope on maximal postoperative flexion in contemporary posterior cruciate ligament (PCL)-retaining TKA. Twenty-one cadaver simulations of a standard PCL-retaining TKA were studied while reproducing identical deep flexion femorotibial kinematics as documented by three-dimensional computer-aided videofluoroscopy from patients with well-functioning TKAs of the same design. In each knee the tibial component was consecutively implanted with 0 degrees posterior slope, 4 degrees posterior slope, and 7 degrees posterior slope. Maximal flexion was recorded for each configuration. Average maximal flexion at 0 degrees tibial slope was 104 degrees, and increased significantly to 112 degrees when the same knees were implanted with 4 degrees tibial slope. Increasing the slope further to 7 degrees again significantly improved average maximal flexion to 120 degrees. When postoperative radiographic tibial slope was compared to maximal flexion, an average gain of 1.7 degrees flexion for every degree extra tibial slope was noted. Increasing the tibial slope in PCL-retaining TKA does indeed improve maximal flexion before tibial insert impingement occurs against the femoral bone. The surgeon can expect an average gain of 1.7 degrees flexion for every degree extra tibial slope.

An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients

We report a prospective audit of 100 parturients who experienced accidental dural puncture by a Tuohy needle, while attending a tertiary referral obstetric unit during the period 1993-1999. The post dural puncture headache rate was 81% and the diagnosis of dural puncture was delayed until presentation of the headache in 27% of these cases. The incidence of unrecognised dural puncture was not influenced by the technique used for identification of the epidural space. Intraspinal opioid administration after dural puncture was associated with a significant reduction in the incidence of headache (P < 0.04). There was no association between mode of delivery and post dural puncture headache. Deliberate cannulation of the subarachnoid space with an epidural catheter at the time of dural puncture, for continuous spinal analgesia or anaesthesia, did not affect the incidence of post dural puncture headache but was associated with a significantly reduced rate of epidural blood patch (43% versus 80%, P < 0.01). Of those who developed post dural puncture headache, 48% were classified 'severe' and in 49% the headache presented within 24 h of dural puncture. There was a trend to earlier onset of headache (either immediate or within 24 h) when the epidural identification technique was loss-of-resistance to air rather than saline (54% versus 33%, P = 0.07). Twenty-eight percent of those suffering from post dural puncture headache were treated expectantly and 72% received a therapeutic blood patch. Of seven parturients who received sumatriptan, six found it ineffective and five subsequently received a blood patch.