Effect of cage colour and light environment on the skin colour of Australian Snapper Pagrus auratus (Bloch & Schneider, 1801)

A two-factor experiment was performed to evaluate the effects of cage colour (black or white 0.5 m³ experiment cages) and light environment (natural sunlight or reduced level of natural sunlight) on the skin colour of darkened Australian snapper. Each treatment was replicated four times and each replicate cage was stocked with five snapper (mean weight=351 g). Snapper exposed to natural sunlight were held in experimental cages located in outdoor tanks. An approximately 70% reduction in natural sunlight (measured as PAR) was established by holding snapper in experimental cages that were housed inside a 'shade-house' enclosure. The skin colour of anaesthetized fish was measured at stocking and after a 2-, 7- and 14-day exposure using a digital chroma-meter (Minolta CR-10) that quantified skin colour according to the L*a*b* colour space. At the conclusion of the experiment, fish were killed in salt water ice slurry and post-mortem skin colour was quantified after 0.75, 6 and 22 h respectively. In addition to these trials, an ad hoc market appraisal of chilled snapper (mean weight=409 g) that had been held in either white or in black cages was conducted at two local fish markets. Irrespective of the sampling time, skin lightness (L*) was significantly affected by cage colour (P<0.05), with fish in white cages having much higher L* values (L*≈64) than fish held in black cages (L*≈49). However, the value of L* was not significantly affected by the light environment or the interaction between cage colour and the light environment. In general, the L* values of anaesthetized snapper were sustained post mortem, but there were linear reductions in the a* (red) and b* (yellow) skin colour values of chilled snapper over time. According to the commercial buyers interviewed, chilled snapper that had been reared for a short period of time in white cages could demand a premium of 10–50% above the prices paid for similar-sized snapper reared in black cages. Our results demonstrate that short-term use of white cages can reduce the dark skin colour of farmed snapper, potentially improving the profitability of snapper farming.

Cage colour and post-harvest K+ concentration affect skin colour of Australian snapper Pagrus auratus (Bloch & Schneider, 1801)

In an attempt to improve post-harvest skin colour in cultured Australian snapper Pagrus auratus, a two-factor experiment was carried out to investigate the effects of a short-term change in cage colour before harvest, followed by immersion in K⁺-enriched solutions of different concentrations. Snapper supplemented with 39 mg unesterified astaxanthin kg⁻¹ for 50 days were transferred to black (for 1 day) or white cages (for 1 or 7 days) before euthanasia by immersing fish in seawater ice slurries supplemented with 0, 150, 300, 450 or 600 mmol L⁻¹ K⁺ for 1 h. Each treatment was replicated with five snapper (mean weight=838 g) held individually within 0.2 m³ cages. L*, a* and b* skin colour values of all fish were measured after removal from K⁺ solutions at 0, 3, 6, 12, 24 and 48 h. After immersion in K⁺ solutions, fish were stored on ice. Both cage colour and K⁺ concentration significantly affected post-harvest skin colour (P<0.05), and there was no interaction between these factors at any of the measurement times (P>0.05). Conditioning dark-coloured snapper in white surroundings for 1 day was sufficient to significantly improve skin lightness (L*) after death. Although there was no difference between skin lightness values for fish held for either 1 or 7 days in white cages at measurement times up to 12 h, fish held in white cages for 7 days had significantly higher L* values (i.e. they were lighter) after 24 and 48 h of storage on ice than those held only in white cages for 1 day. K⁺ treatment also affected (improved) skin lightness post harvest although not until 24 and 48 h after removal of fish from solutions. Before this time, K⁺ treatment had no effect on skin lightness. Snapper killed by seawater ice slurry darkened (lower L*) markedly during the first 3 h of storage in contrast with all K⁺ treatments that prevented darkening. After 24 and 48 h of storage on ice, fish exposed to 450 and 600 mmol L⁻¹ K⁺ were significantly lighter than fish from seawater ice slurries. In addition, skin redness (a*) and yellowness (b*) were strongly dependent on K⁺ concentration. The initial decline in response to K⁺ was overcome by a return of a* and b* values with time, most likely instigated by a redispersal of erythrosomes in skin erythrophores. Fish killed with 0 mmol L⁻¹ K⁺ maintained the highest a* and b* values after death, but were associated with darker (lower L*) skin colouration. It is concluded that a combination of conditioning snapper in white surroundings for 1 day before harvest, followed by immersion in seawater ice slurries supplemented with 300–450 mmol L⁻¹ K⁺ improves skin pigmentation after >24 h of storage on ice.

Clinical effectiveness of barrier preparations in the prevention and treatment of nappy dermatitis in infants and preschool children of nappy age

Nappy dermatitis is a broad term used to describe an acute inflammatory reaction of the skin in the nappy area because of irritation from urine, faeces, moisture or friction. The prevalence is estimated to be between 7% and 35% in infants. Regular application of a barrier preparation at every nappy change may be a valuable component of nappy dermatitis prevention and/or treatment.

Economic evaluation of a skin cancer prevention program in Australia : past achievements and future prospects

Objectives
Australia has the highest incidence of skin cancer in the world. Skin cancer prevention campaigns have been implemented in Australia for over two decades. The most notable is under the brand name, SunSmart. The aim of the current study is to assess the cost-effectiveness of SunSmart in the past and the potential cost-effectiveness of an ongoing national SunSmart program with optimal investment in the future.

Methods
An economic evaluation from a health sector perspective was conducted using the reduction in skin cancer incidence attributable to the SunSmart program modelled as the primary end-point. Historical SunSmart program expenditures were obtained from three representative states in three latitude zones, covering different levels of UVR exposure. Melanoma incidence rates from the three representative state cancer registers were used to model the health outcomes. Program effectiveness was assessed by the comparison between the well-resourced SunSmart state (Victoria) and the under-invested states (New South Wales and Queensland). Non-Melanoma Skin Cancer (NMSC) was modelled based on national survey results. 2003 was chosen as the reference year and future costs/outcomes over a 20 year time horizon were discounted at 3%.
The future level of investment in a national SunSmart was chosen to strengthen current practice by increasing current investment to a realistic and achievable level. This conservative increase in investment (expressed as ‘$ per capita’) reflected the investment level that has been achieved in Victoria over sustained periods. To model the potential cost-effectiveness of an upgraded national SunSmart program, a conservative approach was taken, whereby the same magnitude of effectiveness from 1988 to 2003 was applied to future skin cancer incidence.

Results
SunSmart in Victoria has saved 22,300 life-years, averted 27,900 disability-adjusted life-years(DALYs)(discounted) since its introduction in 1988 and achieved an incremental cost-effectiveness ratio (ICER) of $AUD 680 per life-year saved (LYS) and $AUD 540 per DALY averted. When the cost-offset from the estimated reduction in skin cancer treatment costs were taken into account, SunSmart achieved ‘dominance’. The net cost of SunSmart in the past was an estimated saving of $AUD 93 million. An upgraded national SunSmart for the next 20 years would save 91,000 life-years and avert 122,000 DALYs (discounted), involving an increased investment level from the current $AUD 0.07 per capita to the historical average of $AUD 0.28 per capita. The ICER for the upgraded SunSmart program was estimated at $AUD 940 per LYS and $AUD 700 per DALY averted. When the cost-offset is included, the program achieves dominance with a cost saving of $AUD 115 million – an estimated $AUD 2.32 return for every dollar invested between 2003 and 2022.

Conclusions
This study demonstrates that a sustained modest investment in skin cancer control is likely to be excellent value-for-money. While the available data base is certainly not prefect, key parameters would have to change dramatically for this conclusion to be challenged.

Prevention and treatment of infant and childhood vitamin D deficiency in Australia and New Zealand : a consensus statement

• Vitamin D deficiency has re-emerged as a significant paediatric health issue, with complications including hypocalcaemic seizures, rickets, limb pain and fracture.

• A major risk factor for infants is maternal vitamin D deficiency. For older infants and children, risk factors include dark skin colour, cultural practices, prolonged breastfeeding, restricted sun exposure and certain medical conditions.

• To prevent vitamin D deficiency in infants, pregnant women, especially those who are dark-skinned or veiled, should be screened and treated for vitamin D deficiency, and breastfed infants of dark-skinned or veiled women should be supplemented with vitamin D for the first 12 months of life.

• Regular sunlight exposure can prevent vitamin D deficiency, but the safe exposure time for children is unknown.

• To prevent vitamin D deficiency, at-risk children should receive 400 IU vitamin D daily; if compliance is poor, an annual dose of 150 000 IU may be considered.

• Treatment of vitamin D deficiency involves giving ergocalciferol or cholecalciferol for 3 months (1000 IU/day if < 1 month of age; 3000 IU/ day if 1-12 months of age; 5000 IU/day if > 12 months of age).

• High-dose bolus therapy (300 000-500 000 IU) should be considered for children over 12 months of age if compliance or absorption issues are suspected.

Effect of surface treatment and knit structure on comfort properties of wool fabrics

The comfort properties of the pique and single jersey knitted wool fabrics were investigated using the Wool ComfortMeter (WCM). The fabrics were knitted in three cover factors and treated with either plasma or a silicone softening agent and were compared with untreated fabrics. Plasma treatment did not show significant effects on the comfort value. However, silicone polymer significantly reduced WCM values suggesting that the silicone coating reduced the number of protruding fibres on the fabric surface. Regardless of treatment used, pique fabrics showed a lower WCM value, and therefore were perceived to be more comfortable than the single jersey structure. While the effect of cover factor was not significant, in fitted model to predict the WCM value of fabrics, mass/unit area and fabric thickness were significant predictors along with fabric structure and finishing treatment.

Clinical pharmacology of dipeptidyl peptidase 4 inhibitors indicated for the treatment of type 2 diabetes mellitus

Dipeptidyl peptidase-4 (DPP-4) inhibitors are a class of oral antidiabetic drugs that improve glycaemic control without causing weight gain or increasing hypoglycaemic risk in patients with type 2 diabetes mellitus (T2DM). The eight available DPP-4 inhibitors, including alogliptin, anagliptin, gemigliptin, linagliptin, saxagliptin, sitagliptin, teneligliptin, and vildagliptin, are small molecules used orally with identical mechanism of action and similar safety profiles in patients with T2DM. DPP-4 inhibitors may be used as monotherapy or in double or triple combination with other oral glucose-lowering agents such as metformin, thiazolidinediones, or sulfonylureas. Although DPP-4 inhibitors have the same mode of action, they differ by some important pharmacokinetic and pharmacodynamic properties that may be clinically relevant in some patients. The main differences between the eight gliptins include: potency, target selectivity, oral bioavailability, elimination half-life, binding to plasma proteins, metabolic pathways, formation of active metabolite(s), main excretion routes, dosage adjustment for renal and liver insufficiency, and potential drug-drug interactions. The off-target inhibition of selective DPP-4 inhibitors is responsible for multiorgan toxicities such as immune dysfunction, impaired healing, and skin reactions. As a drug class, the DPP-4 inhibitors have become accepted in clinical practice due to their excellent tolerability profile, with a low risk of hypoglycaemia, a neutral effect on body weight, and once-daily dosing. It is unknown if DPP-4 inhibitors can prevent disease progression. More clinical studies are needed to validate the optimal regimens of DPP-4 inhibitors for the management of T2DM when their potential toxicities are closely monitored.

Niacin skin sensitivity is increased in adolescents at ultra-high risk for psychosis

BACKGROUND: Most studies provide evidence that the skin flush response to nicotinic acid (niacin) stimulation is impaired in schizophrenia. However, only little is known about niacin sensitivity in the ultra-high risk (UHR) phase of psychotic disorders.

METHODS: We compared visual ratings of niacin sensitivity between adolescents at UHR for psychosis according to the one year transition outcome (UHR-T n = 11; UHR-NT n = 55) with healthy controls (HC n = 25) and first episode schizophrenia patients (FEP n = 25) treated with atypical antipsychotics.

RESULTS: Contrary to our hypothesis niacin sensitivity of the entire UHR group was not attenuated, but significantly increased compared to the HC group, whereas no difference could be found between the UHR-T and UHR-NT groups. As expected, niacin sensitivity of FEP was attenuated compared to HC group. In UHR individuals niacin sensitivity was inversely correlated with omega-6 and -9 fatty acids (FA), but positively correlated with phospholipase A2 (inPLA2) activity, a marker of membrane lipid repair/remodelling.

CONCLUSIONS: Increased niacin sensitivity in UHR states likely indicates an impaired balance of eicosanoids and omega-6/-9 FA at a membrane level. Our findings suggest that the emergence of psychosis is associated with an increased mobilisation of eicosanoids prior to the transition to psychosis possibly reflecting a "pro-inflammatory state", whereas thereafter eicosanoid mobilisation seems to be attenuated. Potential treatment implications for the UHR state should be further investigated.

Mycobacterium ulcerans treatment - can antibiotic duration be reduced in selected patients?

Mycobacterium ulcerans (M. ulcerans) is a necrotizing skin infection endemic to the Bellarine Peninsula, Australia. Current treatment recommendations include 8 weeks of combination antibiotics, with adjuvant surgery if necessary. However, antibiotic toxicity often results in early treatment cessation and local experience suggests that shorter antibiotic courses may be effective with concurrent surgery. We report the outcomes of patients in the Barwon Health M. ulcerans cohort who received shorter courses of antibiotic therapy than 8 weeks. A retrospective analysis was performed of all M. ulcerans infections treated at Barwon Health from March 1, 1998 to July 31, 2013. Sixty-two patients, with a median age of 65 years, received < 56 days of antibiotics and 51 (82%) of these patients underwent concurrent surgical excision. Most received a two-drug regimen of rifampicin combined with either ciprofloxacin or clarithromycin for a median 29 days (IQR 21–41days). Cessation rates were 55% for adverse events and 36% based on clinician decision. The overall success rate was 95% (98% with concurrent surgery; 82% with antibiotics alone) with a 50% success rate for those who received < 14 days of antibiotics increasing to 94% if they received 14–27 days and 100% for 28–55 days (p<0.01). A 100% success rate was seen for concurrent surgery and 14–27 days of antibiotics versus 67% for concurrent surgery and < 14 days of antibiotics (p = 0.12). No previously identified risk factors for treatment failure with surgery alone were associated with reduced treatment success rates with < 56 days of antibiotics. In selected patients, antibiotic treatment durations for M. ulcerans shorter than the current WHO recommended 8 weeks duration may be associated with successful outcomes.