A screening test for heroin based on sequential injection analysis with dual-reagent chemiluminescence detection

A sequential injection analysis procedure with dual-reagent chemiluminescence detection was applied to the screening of street drug seizure samples for the presence of heroin. The chemiluminescence reagents (acidic potassium permanganate and tris(2,2′-bipyridine)ruthenium(III)) were aspirated from either side of a sample aliquot that was sufficiently large to prevent interdispersion of the reagent zones, and therefore two different chemical reactions could be performed simultaneously at either end of the sample zone. The presence of heroin in seizure samples was indicated by a strong response with the tris(2,2′-bipyridine)ruthenium(III) reagent and confirmed by a significant increase in the response with the permanganate reagent when the sample was treated with sodium hydroxide to hydrolyse the heroin to morphine. Nicomorphine (a morphine-derived pharmaceutical) was synthesised and tested under the same conditions. The responses with the permanganate reagent were similar to those for heroin, which supports the proposed chemical basis for the test. However, the responses with tris(2,2′-bipyridine)ruthenium(III) were far lower for nicomorphine than heroin (approximately 5-fold for the samples that had not been hydrolysed).

Using a monitored sip test to assess risk of aspiration in perioperative patients.

• PULMONARY ASPIRATION is associated with high morbidity and mortality rates. Older adult patients have been shown to be particularly at risk for aspiration.

• A RANDOMIZED CONTROLLED TRIAL was conducted to investigate the efficacy of a simple, noninvasive screening test—the monitored sip test—in identifying patients at risk for aspiration, including “silent aspirators.”

• BASED ON CLINICAL JUDGMENT using the study's outcome measures, incidence of aspiration-related lung injury was high (ie, 37.5%); however, no identification of patients at risk for aspiration occurred after either the use of the monitored sip test or routine cautious introduction of fluids during the data collection phase of the study.

Exploring general practitioners' experience of informing women about prenetal screening tests for foetal abnomalities : a qualitative focus group study

Background: Recent developments have made screening tests for foetal abnormalities available earlier in pregnancy and women have a range of testing options accessible to them. It is now recommended that all women, regardless of their age, are provided with information on prenatal screening tests. General Practitioners (GPs) are often the first health professionals a woman consults in pregnancy. As such, GPs are well positioned to inform women of the increasing range of prenatal screening tests available. The aim of this study was to explore GPs experience of informing women of prenatal genetic screening tests for foetal abnormality.
Methods: A qualitative study consisting of four focus groups was conducted in metropolitan and rural Victoria, Australia. A discussion guide was used and the audio-taped transcripts were independently coded
by two researchers using thematic analysis. Multiple coders and analysts and informant feedback were employed to reduce the potential for researcher bias and increase the validity of the findings.
Results: Six themes were identified and classified as 'intrinsic' if they occurred within the context of the consultation or 'extrinsic' if they consisted of elements that impacted on the GP beyond the scope of the
consultation. The three intrinsic themes were the way GPs explained the limitations of screening, the extent to which GPs provided information selectively and the time pressures at play. The three extrinsic
factors were GPs' attitudes and values towards screening, the conflict they experienced in offering screening information and the sense of powerlessness within the screening test process and the health
care system generally. Extrinsic themes reveal GPs' attitudes and values to screening and to disability, as well as raising questions about the fundamental premise of testing.
Conclusion: The increasing availability and utilisation of screening tests, in particular first trimester tests,has expanded GPs' role in facilitating women's informed decision-making. Recognition of the importance
of providing this complex information warrants longer consultations to respond to the time pressures that GPs experience. Understanding the intrinsic and extrinsic factors that impact on GPs may serve to shape
educational resources to be more appropriate, relevant and supportive.

Options for change in the Australian cervical cancer screening program in context of HPV detection and vaccination

Introduction:
Cervical cancer screening has been implemented for over a decade in Australia and has significantly reduced the mortality and morbidity of the disease. The emergence of new technologies for cervical cancer, such as the Human Papillomavirus (HPV) vaccine and DNA testing has encouraged debate regarding the effective use of resources in cervical cancer prevention. The present study evaluates the cost-effectiveness, from a health sector perspective, of various screening strategies in the era of these new technologies.

Methods:
A stochastic epidemiological model using a discrete event and continuous algorithm was developed to describe the natural history of cervical cancer. By allowing one member of the cohort into the model at a time, this micro-simulation model encompasses the characteristics of heterogeneity and can track individual life histories. To evaluate the cost-effectiveness of the HPV vaccine a Markov model was built to simulate the effect on the incidence of HPV and subsequent cervical cancer. A number of proposed screening strategies were evaluated with the stochastic model for the application of HPV DNA testing, with changes in the screening interval and target population. Health outcomes were measured by Disability-Adjusted Life-Years (DALYs), adjusted for application within an evaluation setting (i.e. the mortality component of the DALY was adjusted by a disability weight when early mortality due to cervical cancer is avoided). Costs in complying with the Australian updated guidelines were assessed by pathway analysis to estimate the resources associated with cervical cancer and its pre-cancerous lesion treatment. Sensitivity analyses were performed to investigate the key parameters that influenced the cost-effectiveness results.

Results:
Current practice has already brought huge health gain by preventing more than 4,000 deaths and saving more than 86,000 life-years in a cohort of a million women. Any of the alternative screening strategies alter the total amount of health gain by a small margin compared to current practice. The results of incremental analyses of the alternative screening strategies compared to current practice suggest the adoption of the HPV DNA test as a primary screening tool every 3 years commencing at age 18, or the combined pap smear/HPV test every 3 years commencing at age 25, are more costly than current practice but with reasonable ICERs (AUD$1,810 per DALY and AUD$18,600 per DALY respectively). Delaying commencement of Pap test screening to age 25 is less costly than current practice, but involves considerable health loss. The sensitivity analysis shows, however, that the screening test accuracy has a significant impact on these conclusions. Threshold analysis indicates that a sensitivity ranging from 0.80 to 0.86 for the combined test in women younger than 30 is required to produce an acceptable incremental cost-effectiveness ratio.

Conclusions:
The adoption of HPV and combined test with an extended screening interval is more costly but affordable, resulting in reasonable ICERs. They appear good value for money for the Australian health care system, but need more information on test accuracy to make an informed decision. Potential screening policy change under current Australian HPV Vaccination Program is current work in progress. A Markov model is built to simulate the effect on the incidence of HPV and subsequent cervical cancer. Adoption of HPV DNA test as a primary screening tool in the context of HPV vaccination is under evaluation.

Introducing mental health and substance use screening into a community-based health service in Australia : usefulness and implications for service change

Mental health issues such as depression or anxiety and alcohol or other drug (AOD) problems often remain undiagnosed and untreated despite their prevalence in the community. This paper reports on the implementation and evaluation of an AOD and depression/anxiety screening programme within two Community Health Services (CHS) in Australia. Study 1 examined results from 5 weeks of screening (March–April 2008) using the Patient Health Questionnaire (two- and nine-item, Kroenke et al. 2001, 2003), the Conjoint Screen for Alcohol and other Drug Problems (Brown et al. 2001) and the Alcohol, Smoking and Substance Involvement Screening Test (Humeniuk & Ali 2006). Of the 55 clients screened, 33% were at risk of depression or anxiety, 22% reporting moderate-severe depression. Thirteen per cent were at risk of substance use disorders. A substantial proportion of at-risk clients were not currently accessing help for these issues from the CHS and therefore screening can facilitate identification and treatment referral. However, the majority of eligible clients were not screened, limiting screening reach. A second study evaluated the screening implementation from a process perspective via thematic analysis of focus group data from six managers and 14 intake/assessment workers (April 2008). This showed that when screening occurred, it facilitated opportunities for education and intervention with at-risk clients, although cultural mores, privacy concerns and shame/stigma could affect accuracy of screen scores at times. Importantly, the evaluation revealed that most decisions not to screen were made by workers, not by clients. Reasons for non-screening related to worker discomfort in asking sensitive questions and/or managing client distress, and a reluctance to spend long periods of time screening in time-pressured environments. The evaluation suggested that these problems could be resolved by splitting screening responsibilities, enhancing worker training and expanding follow-up screening. Findings will inform any community-based health system considering introducing screening.

Web-based alcohol screening and brief intervention for university students: a randomized trial

IMPORTANCE: Unhealthy alcohol use is a leading contributor to the global burden of disease, particularly among young people. Systematic reviews suggest efficacy of web-based alcohol screening and brief intervention and call for effectiveness trials in settings where it could be sustainably delivered. OBJECTIVE: To evaluate a national web-based alcohol screening and brief intervention program. DESIGN, SETTING, AND PARTICIPANTS: A multisite, double-blind, parallel-group, individually randomized trial was conducted at 7 New Zealand universities. In April and May of 2010, invitations containing hyperlinks to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening test were e-mailed to 14,991 students aged 17 to 24 years. INTERVENTIONS: Participants who screened positive (AUDIT-C score ≥4) were randomized to undergo screening alone or to 10 minutes of assessment and feedback (including comparisons with medical guidelines and peer norms) on alcohol expenditure, peak blood alcohol concentration, alcohol dependence, and access to help and information. MAIN OUTCOMES AND MEASURES: A fully automated 5-month follow-up assessment was conducted that measured 6 primary outcomes: consumption per typical occasion, drinking frequency, volume of alcohol consumed, an academic problems score, and whether participants exceeded medical guidelines for acute harm (binge drinking) and chronic harm (heavy drinking). A Bonferroni-corrected significance threshold of .0083 was used to account for the 6 comparisons and a sensitivity analysis was used to assess possible attrition bias. RESULTS: Of 5135 students screened, 3422 scored 4 or greater and were randomized, and 83% were followed up. There was a significant effect on 1 of the 6 prespecified outcomes. Relative to control participants, those who received intervention consumed less alcohol per typical drinking occasion (median 4 drinks [interquartile range {IQR}, 2-8] vs 5 drinks [IQR 2-8]; rate ratio [RR], 0.93 [99.17% CI, 0.86-1.00]; P = .005) but not less often (RR, 0.95 [99.17% CI, 0.88-1.03]; P = .08) or less overall (RR, 0.95 [99.17% CI, 0.81-1.10]; P = .33). Academic problem scores were not lower (RR, 0.91 [99.17% CI, 0.76-1.08]; P = .14) and effects on the risks of binge drinking (odds ratio [OR], 0.84 [99.17% CI, 0.67-1.05]; P = .04) and heavy drinking (OR, 0.77 [99.17% CI, 0.56-1.05]; P = .03) were not significantly significant. In a sensitivity analysis accounting for attrition, the effect on alcohol per typical drinking occasion was no longer statistically significant. CONCLUSIONS AND RELEVANCE: A national web-based alcohol screening and brief intervention program produced no significant reductions in the frequency or overall volume of drinking or academic problems. There remains a possibility of a small reduction in the amount of alcohol consumed per typical drinking occasion. TRIAL REGISTRATION: anzctr.org.au Identifier: ACTRN12610000279022.

Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players

Background—Palpation is an important clinical test for jumper's knee.

Objectives—To (a) test the reproducibility of palpation tenderness, (b) evaluate the sensitivity and specificity of palpation in subjects with clinical symptoms of jumper's knee, and (c) determine whether tenderness to palpation may serve as a useful screening test for patellar tendinopathy. The yardstick for diagnosis of patellar tendinopathy was ultrasonographic abnormality.

Methods—In 326 junior symptomatic and asymptomatic athletes' tendons, palpation was performed by a single examiner before ultrasonographic examination by a certified ultrasound radiologist. In 58 tendons, palpation was performed twice to test reliability. Tenderness to palpation was scored on a scale from 0 to 3 where 0 represented no pain, and 1, 2, and 3 represented mild, moderate, and severe tenderness respectively.

Results—Patellar tendon palpation was a reliable examination for a single examiner (Pearson r = 0.82). In symptomatic tendons, the positive predictive value of palpation was 68%. As a screening examination in asymptomatic subjects, the positive predictive value of tendon palpation was 36–38%. Moderate and severe palpation tenderness were better predictors of ultrasonographic tendon pathology than absent or mild tenderness (p<0.001). Tender and symptomatic tendons were more likely to have ultrasound abnormality than tenderness alone (p<0.01).

Conclusions—In this age group, palpation is a reliable test but it is not cost effective in detecting patellar tendinopathy in a preparticipation examination. In symptomatic tendons, palpation is a moderately sensitive but not specific test. Mild tenderness in the patellar tendons in asymptomatic jumping athletes should be considered normal.

Evaluation of a community-based mental health drug and alcohol nurse in the care of people living with HIV/AIDS

There is a growing need for advanced practice mental health and drug and alcohol nursing roles in the care of people living with HIV/AIDS; however, limited publications address these domains. This study evaluated a community-based mental health drug and alcohol nurse role caring for people living with HIV/AIDS (Mental Health D&A Nurse) in a large not-for-profit district nursing organization providing care to people living with HIV/AIDS in an Australian city. Outcomes from a client assessment and 6–8-week follow-up by the Mental Health D&A Nurse are presented as captured by the Depression Anxiety Stress Scales (DASS 21), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), Health of the Nation Outcome Scales (HONOS) and WHOQoL BREF. Mean scores and caseness were analysed, and significant differences were found on the 'impairment' and 'social problems' subscales of the HONOS. Results of semi-structured interviews with clients describe effective and supportive mental health care and health-promoting education following visits by the Mental Health D&A Nurse. These positive findings support continuing implementation of the role within this community setting and indicate that even greater benefits will ensue as the role develops further. Findings are of interest to clinicians and policy makers seeking to implement similar roles in community-based HIV/AIDS care.

Instructional strategies integrating cognitive style construct : a meta-knowledge processing model

The overarching goal of this dissertation was to evaluate the contextual components of instructional strategies for the acquisition of complex programming concepts. A meta-knowledge processing model is proposed, on the basis of the research findings, thereby facilitating the selection of media treatment for electronic courseware. When implemented, this model extends the work of Smith (1998), as a front-end methodology, for his glass-box interpreter called Bradman, for teaching novice programmers. Technology now provides the means to produce individualized instructional packages with relative ease. Multimedia and Web courseware development accentuate a highly graphical (or visual) approach to instructional formats. Typically, little consideration is given to the effectiveness of screen-based visual stimuli, and curiously, students are expected to be visually literate, despite the complexity of human-computer interaction. Visual literacy is much harder for some people to acquire than for others! (see Chapter Four: Conditions-of-the-Learner) An innovative research programme was devised to investigate the interactive effect of instructional strategies, enhanced with text-plus-textual metaphors or text-plus-graphical metaphors, and cognitive style, on the acquisition of a special category of abstract (process) programming concept. This type of concept was chosen to focus on the role of analogic knowledge involved in computer programming. The results are discussed within the context of the internal/external exchange process, drawing on Ritchey's (1980) concepts of within-item and between-item encoding elaborations. The methodology developed for the doctoral project integrates earlier research knowledge in a novel, interdisciplinary, conceptual framework, including: from instructional science in the USA, for the concept learning models; British cognitive psychology and human memory research, for defining the cognitive style construct; and Australian educational research, to provide the measurement tools for instructional outcomes. The experimental design consisted of a screening test to determine cognitive style, a pretest to determine prior domain knowledge in abstract programming knowledge elements, the instruction period, and a post-test to measure improved performance. This research design provides a three-level discovery process to articulate: 1) the fusion of strategic knowledge required by the novice learner for dealing with contexts within instructional strategies 2) acquisition of knowledge using measurable instructional outcome and learner characteristics 3) knowledge of the innate environmental factors which influence the instructional outcomes This research has successfully identified the interactive effect of instructional strategy, within an individual's cognitive style construct, in their acquisition of complex programming concepts. However, the significance of the three-level discovery process lies in the scope of the methodology to inform the design of a meta-knowledge processing model for instructional science. Firstly, the British cognitive style testing procedure, is a low cost, user friendly, computer application that effectively measures an individual's position on the two cognitive style continua (Riding & Cheema,1991). Secondly, the QUEST Interactive Test Analysis System (Izard,1995), allows for a probabilistic determination of an individual's knowledge level, relative to other participants, and relative to test-item difficulties. Test-items can be related to skill levels, and consequently, can be used by instructional scientists to measure knowledge acquisition. Finally, an Effect Size Analysis (Cohen,1977) allows for a direct comparison between treatment groups, giving a statistical measurement of how large an effect the independent variables have on the dependent outcomes. Combined with QUEST's hierarchical positioning of participants, this tool can assist in identifying preferred learning conditions for the evaluation of treatment groups. By combining these three assessment analysis tools into instructional research, a computerized learning shell, customised for individuals' cognitive constructs can be created (McKay & Garner,1999). While this approach has widespread application, individual researchers/trainers would nonetheless, need to validate with an extensive pilot study programme (McKay,1999a; McKay,1999b), the interactive effects within their specific learning domain. Furthermore, the instructional material does not need to be limited to a textual/graphical comparison, but could be applied to any two or more instructional treatments of any kind. For instance: a structured versus exploratory strategy. The possibilities and combinations are believed to be endless, provided the focus is maintained on linking of the front-end identification of cognitive style with an improved performance outcome. My in-depth analysis provides a better understanding of the interactive effects of the cognitive style construct and instructional format on the acquisition of abstract concepts, involving spatial relations and logical reasoning. In providing the basis for a meta-knowledge processing model, this research is expected to be of interest to educators, cognitive psychologists, communications engineers and computer scientists specialising in computer-human interactions.

Development of play profiles : influence of disability on children's play

Occupational therapists value play as a significant occupation in a child’s life and use play both as a means and as an end in itself to support development. This thesis explores the nature of play in children with developmental disabilities, seeking to determine whether there are consistent patterns of play specific to different disability categories. An extensive literature review of play and disability was completed, and Cooper’s (2000) model of play is used to organize the literature findings. This study investigated differences in play behaviour in 50 children diagnosed with Autistic Spectrum Disorder, Down syndrome, Developmental Delay and Physical impairments, aged 4 to 6 years 6 months who attended educational facilities in a regional centre in South East Queensland. Quantitative and qualitative play behaviour was assessed using two measures, Revised Knox Preschool Play Scale (Knox, 2008) and the Child Initiated Pretend Play Assessment (Stagnitti, 2007) with the Australian Developmental Screening Test (Burdon, 1993) used to determine developmental age to eliminate this as a potential confounding variable when statistically analyzing the results.
Cognitive, language and fine motor abilities were found to have a statistically significant impact on play ability rather than the different disability groupings. Children with Down syndrome had significantly more imitative play actions than any other disability grouping. Cooper’s (2000) model was found to be a useful tool to analyze differing play characteristics according to different disability groupings. Modifications to Cooper’s original model of play to more accurately depict play characteristics are proposed.

The effects of progressive resistance training combined with a whey-protein drink and vitamin D supplementation on glycaemic control, body composition and cardiometabolic risk factors in older adults with type 2 diabetes: study protocol for a randomized c

While physical activity, energy restriction and weight loss are the cornerstone of type 2 diabetes management, less emphasis is placed on optimizing skeletal muscle mass. As muscle is the largest mass of insulin-sensitive tissue and the predominant reservoir for glucose disposal, there is a need to develop safe and effective evidence-based, lifestyle management strategies that optimize muscle mass as well as improve glycaemic control and cardiometabolic risk factors in people with this disease, particularly older adults who experience accelerated muscle loss.

FRAX (Aus) and falls risk: Association in men and women

Purpose: The WHO fracture risk prediction tool (FRAX®) utilises clinical risk factors to estimate the probability of fracture over a 10-year period. Although falls increase fracture risk, they have not been incorporated into FRAX. It is currently unclear if FRAX captures falls risk and whether addition of falls would improve fracture prediction. We aimed to investigate the association of falls risk and Australian-specific FRAX. Methods: Clinical risk factors were documented for 735 men and 602 women (age 40-90. yr) assessed at follow-up (2006-2010 and 2000-2003, respectively) of the Geelong Osteoporosis Study. FRAX scores with and without BMD were calculated. A falls risk score was determined at the time of BMD assessment and self-reported incident falls were documented from questionnaires returned one year later. Multivariable analyses were performed to determine: (i) cross-sectional association between FRAX scores and falls risk score (Elderly Falls Screening Test, EFST) and (ii) prospective relationship between FRAX and time to a fall. Results: There was an association between FRAX (hip with BMD) and EFST scores (. β=. 0.07, p<. 0.001). After adjustment for sex and age, the relationship became non-significant (. β=. 0.00, p=. 0.79). The risk of incident falls increased with increasing FRAX (hip with BMD) score (unadjusted HR 1.04, 95% CI 1.02, 1.07). After adjustment for age and sex, the relationship became non-significant (1.01, 95% CI 0.97, 1.05). Conclusions: There is a weak positive correlation between FRAX and falls risk score, that is likely explained by the inclusion of age and sex in the FRAX model. These data suggest that FRAX score may not be a robust surrogate for falls risk and that inclusion of falls in fracture risk assessment should be further explored.

Excessive daytime sleepiness and falls among older men and women: cross-sectional examination of a population-based sample

Background: Excessive daytime sleepiness (EDS) has been associated with an increased risk for falls among clinical samples of older adults. However, there is little detailed information among population-representative samples. The current study aimed to assess the relationship between EDS and falls among a cohort of population-based older adults. Methods: This study assessed 367 women aged 60-93years (median 72, interquartile range 65-79) and 451 men aged 60-92years (median 73, interquartile range 66-80) who participated in the Geelong Osteoporosis Study between the years 2001 and 2008. Falls during the prior year were documented via self-report, and for men, falls risk score was obtained using an Elderly Fall Screening Test (EFST). Sleepiness was assessed using the Epworth Sleepiness Scale (ESS), and scores of≥10 indicated EDS. Differences among those with and without EDS in regard to falls were tested using logistic regression models. Results: Among women, 50 (13.6 %) individuals reported EDS. Women with EDS were more likely to report a fall, and were more likely to report the fall occurring outside. EDS was similarly associated with an increased risk of a fall following adjustment for use of a walking aid, cases of nocturia and antidepressant medication use (adjusted OR∈=∈2.54, 95 % CI 1.24-5.21). Multivariate modelling revealed antidepressant use (current) as an effect modifier (p∈<∈.001 for the interaction term). After stratifying the data by antidepressant medication use, the association between EDS and falls was sustained following adjustment for nocturia among antidepressant non-users (adjusted OR∈=∈2.63, 95 % CI 1.31-5.30). Among men, 72 (16.0 %) individuals reported EDS. No differences were detected for men with and without EDS in regard to reported falls, and a trend towards significance was noted between EDS and a high falls risk as assessed by the EFST (p∈=∈0.06), however, age explained this relationship (age adjusted OR∈=∈2.20, 95 % CI 1.03-1.10). Conclusions: For women, EDS is independently associated with at least one fall during the previous year, and this is more likely to occur whilst located outside. Amelioration of EDS may assist in improving functional outcomes among these individuals by reducing the risk for falls.

Application of the Ceditest® FMDV type O and FMDV-NS enzyme-linked immunosorbent assays for detection of antibodies against foot-and-mouth disease virus in selected livestock and wildlife species in Uganda

Diagnosis and control of Foot-and-mouth disease virus (FMDV) requires rapid and sensitive diagnostic tests. Two antibody enzyme-linked immunosorbent assay (ELISA) kits, Ceditest® FMDV-NS for the detection of antibodies against the nonstructural proteins of all FMDV serotypes and Ceditest® FMDV type O for the detection of antibodies against serotype O, were evaluated under African endemic conditions where the presence of multiple serotypes and the use of nonpurified vaccines complicate serological diagnosis. Serum samples from 218 African buffalo, 758 cattle, 304 goats, and 88 sheep were tested using both kits, and selected samples were tested not only in serotype-specific ELISAs for antibodies against primarily FMDV serotype O, but also against other serotypes. The FMDV-NS assay detected far more positive samples (93%) than the FMDV type O assay (30%) in buffalo (P < 0.05), with predominant antibodies against the South African Territories (SAT) serotypes, while the seroprevalence was generally comparable in cattle with antibodies against serotype O elicited by infection and/or vaccination. However, some districts had higher seroprevalence using the FMDV type O assay indicating vaccination without infection, while 1 cattle herd with antibodies against the SAT serotypes had far more positive samples (85%) using the FMDV-NS versus the FMDV type O (10%), consistent with the latter test's lower sensitivity for antibodies against SAT serotypes. Based on the current investigation, the FMDV type O ELISA may be limited by the presence of SAT serotypes. The FMD NS assay worked well as a screening test for antibodies against all FMDV serotypes present in Uganda; however, as long as nonpurified vaccines are applied in the region, this test cannot be used to differentiate between vaccinated and infected animals.